Surgical treatment of acute subdural hygroma in children

During the years 1967–1984, 91 children were operated on because of acute compressive traumatic intracranial hematoma; 16 (17%) had traumatic acute subdural hygromas. These were unilateral in 12 cases and bilateral in 4. The causes of injury were traffic accidents in 11 children, a fall in 1, and acute deceleration injuries in 5. Nine children suffered multiple injuries to the thorax, inferior extremities, and pelvis. Clinical manifestations and evolution of clinical symptoms included changes in conscious level, palsy, high fever, nystagmus, maximum dilation of either pupil and spontaneous, irregular breathing. The diagnosis was made on the basis of the clinical picture and supplementary clinical investigations: CT, EEG, echoencephalography, isotope cisternography, and arteriography. Treatment was by simple trephination of the cranium and evacuation of hygromatous liquid. All children survived the surgical treatment; 1 child died after the operation and 2 developed hydrocephalus.     

Review of 1,000 consecutive cases of severe head injury treated before the advent of CT scanning

Summary This is a review of 1,000 consecutive cases of severe head injury admitted to our Neurosurgical Department between January 1973 and August 1976, before the advent of CT scanning. All patients were comatose following head injury (GCS8) and were treated homogeneously by the same neurosurgical team by a protocol that included immediate resuscitation on arrival, diagnosis of intracranial lesions by angiography, early surgery when needed, mechanical ventilation, steroids, and mannitol. Extracranial lesions, even if preponderant, were treated by various specialists in the Neurosurgical Department, which for all practical purposes operated as an Emergency Department. Admission criteria were very broad with no preadmission selection. The overall mortality for this series was 45%. A little less than half the patients made good recoveries or remained moderately disabled (47%); 6% were severely disabled, and 2% survived in a persistent vegetative state. More than two-thirds of the patients were brought to our Neurosurgical Department after a short stay at a general hospital; 72% were admitted within 6 hours of injury; 71% were traffic accident victims; and 34% had significant associated extracranial injuries. Carotid angiography was performed in 78% of the patients and indicated the presence of an intracranial haematoma requiring surgery in 36% of the whole series. Mortality was significantly higher in operated than in unoperated patients (56% versus 39%); those treated surgically, however, were older, in worse clinical condition, and showed a higher incidence of acute subdural haematomas associated with brain contusion. Carotid angiography proved very effective in revealing the presence of an expansive lesion but failed to reflect the severity of brain damage, since the group with negative angiograms showed a high mortality (52%). Patients with a lucid interval had a higher percentage of surgical lesions than those with immediate coma (58% versus 26%); but fully 42% of them did not require surgery, and 25% had negative angiograms. From the prognostic point of view the clinical data elicited after initial resuscitation were highly predictive of the outcome: some individual neurological signs, such as mydriasis, posturing and eye movements, were not inferior to the GCS score in that respect. Age also proved a strong predictor, since elderly patients are more likely to have severe subdural and parenchymal lesions and their clinical severity is accordingly greater.Our series amounts to a data bank of cases both contemporary to and in good agreement with that collected by Jennett and his associates in their 1977 multinational study; and it affords a useful reference in the assessment of epidemiological variations and alternative management in relation to outcome.     

支气管肺发育不良基因表达调控异常研究进展

支气管肺发育不良(BPD)是早产儿最常见的慢性肺部疾病。BPD由多种因素引起,其本质是在遗传易感性的基础上,各种环境因素引起的肺损伤和发育中的未成熟肺修复之间的不平衡。研究显示BPD致病分子机理多涉及炎症细胞因子、非编码RNA和各种信号通路因子的异常表达调控。这些相关基因的异常表达,不仅影响了胚胎或早期胎儿肺的正常发育,并阻碍了新生肺损伤后肺的修复,或导致肺功能不全。单独或协同影响了BPD的发生发展。同时研究发现环境风险因素如高氧暴露、炎症导致基因表达异常也是BPD发生的原因之一,环境和基因共同作用推动了BPD的发生发展。     

冷诱导RNA结合蛋白在放射性肺损伤模型中的表达变化

目的 探讨冷诱导RNA结合蛋白（CIRBP）在放射性肺损伤模型中的表达变化。方法 将30只雄性C57BL/6小鼠按体重随机分为2组,每组15只,对照组小鼠不做任何处理,模型组小鼠经20 Gy X射线单次胸部照射,构建放射性肺损伤模型,于照射后5周解剖。采用苏木素-伊红（H&E）染色和Masson染色观察肺组织病理改变及胶原的沉积;采用免疫组织化学法检测肺组织炎症因子白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的表达;采用qRT-PCR技术检测肺组织中CIRBP mRNA的表达;采用免疫荧光技术和Western blotting技术检测肺组织中CIRBP蛋白的表达。结果 与对照组相比,模型组肺组织血管扩张充血、炎细胞浸润、部分肺泡间隔增厚,IL-6的表达[（187.22 ±34.77) vs (129.41 ±5.58),t = 3.179,P < 0.05]和TNF-α的表达[（187.02 ±19.16 )vs (137.52 ±23.53),t = 5.069,P < 0.05]均升高,差异具有统计学意义,而且模型组肺组织中CIRBP mRNA的表达明显升高[（1.97 ±0.39) vs (1 ±0.08),t = 3.45,P < 0.05]。除此之外,免疫荧光和Western blot结果显示模型组CIRBP蛋白表达均明显升高[（14.76 ±1.61) vs (9.32 ±1.26),t = 3.751,P < 0.05;(1.49 ±0.14) vs (1.13 ±0.17),t = 2.819,P < 0.05],差异具有统计学意义。结论 CIRBP在放射性肺损伤模型中的表达明显升高,其可能是放射性肺损伤过程中的重要促炎因子。     

放射性皮肤损伤机制的研究进展

皮肤是人体受到电离辐射时最先接触的器官,因其基底细胞层及毛细血管对射线很敏感,所以放射性皮肤损伤十分常见,急性放射性皮肤损伤常与表皮和真皮中的细胞改变和炎症有关,而皮肤的晚期损伤主要与辐射对血管影响有关。放射性皮肤损伤的临床表现为皮肤黏膜出现红斑、干性脱屑、湿性脱屑、溃疡,严重程度与射线种类、剂量等相关。目前,放射性皮肤损伤的潜在发生机制在很大程度上是未知的,辐射损伤后还未建立治疗的金标准,已知的放射性皮肤损伤的发生机制大致可分为3个途径：活性氧大量增加引发的氧化应激损伤、细胞因子被转录激活后引发的炎症、骨髓源性细胞引起的免疫反应。本文综述了放射性皮肤损伤发生机制的3大途径,为进一步研究放射性皮肤损伤的机制以及预防治疗提供参考。     

Associations between interpersonal violence victimisation and concussions among US college students

Interpersonal violence is common on college campuses and is associated with many adverse health outcomes; however, it remains unknown whether experiencing interpersonal violence victimisation is associated with concussions. The aim of this study was to estimate the associations between interpersonal violence, including emotional abuse, physical abuse and sexual assault, and concussions among a large, diverse sample of college students. We analysed cross-sectional data from the 2018–2019 national (US) Healthy Minds Study (N = 1,478). Multiple logistic regression analyses were conducted to estimate the association between interpersonal violence victimisation (any violence victimisation, emotional abuse, physical abuse and sexual assault) and concussion history (any concussion, diagnosed concussion and undiagnosed concussion), while adjusting for potential confounders. Analyses were conducted among the overall sample and separately by male and female participants. Results showed patterns of significant associations between interpersonal violence victimisation and concussions among the overall sample and among male and female participants. Among the overall sample, any interpersonal violence victimisation (adjusted odds ratio [AOR] 1.45, 95% confidence interval [CI] 1.13–1.88), emotional abuse (AOR 1.36, 95% CI 1.06–1.76), physical abuse (AOR 1.61, 95% CI 1.07–2.44) and sexual assault (AOR 2.17, 95% CI 1.44–3.26) were associated with higher odds of any concussion history. Sexual assault victimisation had the strongest association with any concussion history among male (AOR 1.96, 95% CI 1.04–3.71) and female (AOR 2.96, 95% CI 1.62–5.43) participants. These results expand on prior interpersonal violence and concussion research by showing an association with multiple victimisation measures among a large and diverse sample of college students. Medical professionals should screen for concussions among college students who experience emotional abuse, physical abuse and sexual assault to provide appropriate guidance. Information on the symptoms of concussions should be incorporated into campus violence awareness and prevention efforts.     

2015—2020年徐州市铜山区儿童青少年伤害死亡流行特征分析

目的 掌握2015—2020年徐州市铜山区5～18岁儿童青少年伤害死亡流行特征,为政府部门出台相关政策提供科学依据。方法 搜集徐州市铜山区2015—2020年儿童青少年伤害死亡资料进行描述性统计分析,计算伤害的死亡率和构成比,比较采用χ2检验。结果 伤害是铜山区儿童青少年的首位死亡原因,死亡率为8.01/10万,占儿童青少年总死亡的54.05%。随着年龄增加,主要伤害的死亡率从5～9岁年龄组的5.30/10万增加到15～18岁年龄组的12.47/10万(χ2趋势=14.383,P<0.001)。道路交通事故、溺水、意外跌落和自杀的死亡率分别为3.01/10万、2.81/10万、0.67/10万、0.33/10万,居铜山区儿童青少年伤害死亡的前4位。结论 道路交通事故、溺水、意外跌落、自杀是铜山区儿童青少年伤害死亡的主要原因,应采取针对性措施,预防控制儿童青少年伤害的发生。     

葛花、枳椇子及其配伍对小鼠急性酒精性胃黏膜损伤的保护作用及机制

目的 探讨葛花、枳椇子及其配伍对急性酒精性胃黏膜损伤的改善作用,为进一步开展葛花、枳椇子及其配伍防治酒精致多脏器损伤奠定基础。方法 采用多次灌胃给予56%红星二锅头白酒（15 mL·kg^-1）建立小鼠急性酒精性胃黏膜损伤模型,将120只ICR雄性小鼠随机分为空白组、模型组、奥美拉唑组（0.026 g·kg^-1）、葛花-枳椇子（配伍）高、中、低剂量组（29.2、14.6、7.3 g·kg^-1）、葛花组（19.5 g·kg^-1）、枳椇子组（19.5 g·kg^-1）共8个组,每组15只,动物适应性喂养1周后,按10 mL·kg^-1预给相应药物3 d,从第4天开始,给药1 h后按15 mL·kg^-1灌胃二锅头白酒,空白组给予相同体积去离子水,记录小鼠醉酒和醒酒时间,连续给药给酒3 d,末次给药1 h后摘眼球处死;气相色谱仪测定各组小鼠血清中乙醇体积分数,紫外-可见分光光度计检测各组小鼠胃黏膜中乙醇脱氢酶（ADH）活性;苏木素-伊红（HE）染色观察胃黏膜病理变化;酶联免疫吸附测定法（ELISA）检测各组小鼠血清中炎症因子含量;实时荧光定量聚合酶链式反应（Real-time PCR）检测核转录因子-κB（NF-κB）p65和NF-κB抑制蛋白α（IκBα）mRNA表达。结果 与正常组比较,模型组血清中白细胞介素-6（IL-6）、白细胞介素-1β（IL-1β）和肿瘤坏死因子-α（TNF-α）含量升高（P<0.05）,胃黏膜组织NF-κB p65 mRNA表达升高（P<0.01）,IκBα mRNA表达降低（P<0.01）;与模型组比较,奥美拉唑组、配伍高、中剂量组、葛花组醉酒时间延长（P<0.05）,配伍高、中剂量组醒酒时间缩短（P<0.05）,配伍高剂量组血清中乙醇体积分数降低（P<0.05）,奥美拉唑组、配伍高、中剂量组胃黏膜中ADH活性升高（P<0.05）,配伍各剂量组、葛花组肉眼损伤评分降低（P<0.05）,奥美拉唑组、配伍各剂量组、葛花组病理损伤评分降低（P<0.01）,各给药组血清中IL-6表达降低（P<0.05）,奥美拉唑组、配伍各剂量组、枳椇子组血清中IL-1β表达降低（P<0.05）,配伍高、中剂量组血清中TNF-α表达降低（P<0.05）,各给药组胃黏膜组织NF-κB p65 mRNA表达降低（P<0.05）,奥美拉唑组、配伍各剂量组胃黏膜组织IκBα mRNA表达增加（P<0.05）;与高剂量组比较,配伍低剂量组与枳椇子组醉酒时间缩短（P<0.01）,葛花、枳椇子组醒酒时间延长（P<0.01）,配伍中、低剂量组、葛花组、枳椇子组血清中乙醇体积分数升高（P<0.05）,配伍中、低剂量组、枳椇子组肉眼损伤积分增加（P<0.05）,配伍中、低剂量组、葛花组、枳椇子组病理损伤积分增加（P<0.01）,配伍低剂量组、葛花组、枳椇子组血清中IL-1β含量升高（P<0.01）,葛花组与枳椇子组胃黏膜组织IκBα mRNA表达量降低（P<0.05）;与配伍中剂量组比较,枳椇子组醉酒时间缩短（P<0.05）,葛花组醒酒时间延长（P<0.05）,葛花组、枳椇子组病理损伤积分增加（P<0.01）,配伍低剂量组、葛花组、枳椇子组血清中IL-1β含量升高（P<0.05）;与配伍低剂量组比较,枳椇子组病理损伤积分增加（P<0.05）。结论 葛花、枳椇子及其配伍能起到对小鼠急性酒精性胃黏膜损伤的防治作用,可能与抑制胃黏膜NF-κB信号通路的表达有关,且配伍高剂量组药效最佳。     

致肝损伤中药的减毒措施及肝损伤的中药防治作用

中药在疾病预防和治疗的过程中发挥重大作用,但部分中药在临床的长期应用过程中,给人体带来的不良反应也逐渐显现出来,肝损伤属于其中之一。肝损伤也是中药新药研发过程中作为临床安全用药的重要检查项目,已成为众多上市药物退出市场的重要原因。随着对中药临床用药安全性的关注增加,关于中药肝损伤研究日益增多,大多数研究集中于中药或者中药成分的肝脏损伤研究。为了提高中药的安全性,该文总结了部分致肝损伤中药的物质基础和机制及降低中药肝损伤的措施,包括减少给药剂量和疗程,改变给药途径,改变药物剂型,药物配伍和炮制等方法;此外该文还总结了防治各种诱导物诱发肝损伤的单体中药、中药复方和中药成分及防治肝损伤的生物效应和作用机制。结合现代致肝损伤中药的减毒研究,提出明确致肝损伤中药的安全剂量和“毒-效”界限,明确减毒措施的减毒机制及确定致肝损伤中药的毒性物质基础,为致肝损伤中药的临床应用提供安全性保障;结合中药防治肝损伤的研究,提出加强中药防治肝损伤的临床研究的同时,利用现代科学技术“从局部到整体”来阐释中药复方防治肝损伤的科学内涵,进而为临床防治肝损伤提供科学依据。     

Bovine Colostrum: Its Constituents and Uses

Colostrum is the milk produced during the first few days after birth and contains high levels of immunoglobulins, antimicrobial peptides, and growth factors. Colostrum is important for supporting the growth, development, and immunologic defence of neonates. Colostrum is naturally packaged in a combination that helps prevent its destruction and maintain bioactivity until it reaches more distal gut regions and enables synergistic responses between protective and reparative agents present within it. Bovine colostrum been used for hundreds of years as a traditional or complementary therapy for a wide variety of ailments and in veterinary practice. Partly due to concerns about the side effects of standard Western medicines, there is interest in the use of natural-based products of which colostrum is a prime example. Numerous preclinical and clinical studies have demonstrated therapeutic benefits of bovine colostrum for a wide range of indications, including maintenance of wellbeing, treatment of medical conditions and for animal husbandry. Articles within this Special Issue of Nutrients cover the effects and use bovine colostrum and in this introductory article, we describe the main constituents, quality control and an overview of the use of bovine colostrum in health and disease.