Ginsenoside Rg1 ameliorates blood–brain barrier disruption and traumatic brain injury via attenuating macrophages derived exosomes miR-21 release

During the traumatic brain injury (TBI), improved expression of circulatory miR-21 serves as a diagnostic feature. Low levels of exosome-miR-21 in the brain can effectively improve neuroinflammation and blood–brain barrier (BBB) permeability, reduce nerve apoptosis, restore neural function and ameliorate TBI. We evaluated the role of macrophage derived exosomes-miR-21 (M-Exos-miR-21) in disrupting BBB, deteriorating TBI, and Rg1 interventions. IL-1β-induced macrophages (IIM)-Exos-miR-21 can activate NF-κB signaling pathway and induce the expressions of MMP-1, -3 and -9 and downregulate the levels of tight junction proteins (TJPs) deteriorating the BBB. Rg1 reduced miR-21-5p content in IIM-Exos (RIIM-Exos). The interaction of NMIIA–HSP90 controlled the release of Exos-miR-21, this interaction was restricted by Rg1. Rg1 could inhibit the Exos-miR-21 release in peripheral blood flow to brain, enhancing TIMP3 protein expression, MMPs proteolysis, and restricting TJPs degradation thus protected the BBB integrity. Conclusively, Rg1 can improve the cerebrovascular endothelial injury and hold the therapeutic potential against TBI disease.     

Commentaries: the Turn of the Scrooge: One Yank's Perspective on Accent Reduction

This study uses a qualitative approach to examine common techniques used by speech-language pathologists (SLPs) to manage fatigue in communication intervention following traumatic brain injury (TBI). Thirteen SLPs from New Zealand hospital and rehabilitation services completed semi-structured interviews in which they discussed their current management strategies. A number of management-related themes recurred throughout the interviews, highlighting the basis of fatigue-management-focused (FMF) communication intervention. The four fatigue-related themes were: intervention structure, client and family strategies, monitoring by both the client and therapist, and lifestyle and daily activities. From these four themes, a model of current SLP practice was developed for clients with TBI. This model will provide the basis for future studies evaluating the effectiveness of FMF communication intervention.     

32例自体血回输在外伤性脾破裂手术中应用的临床研究

目的研究分析在外伤性脾破裂手术中的自体血回输的适应症、流程、安全性等问题。方法选取2010年1月—2013年1月间入院治疗的单纯外伤性脾破裂患者32例,应用自体血液回收技术回输,注意流程的严密性、科学性,加强护理干预操作。结果 32例患者通过自体血回输,有效扩充了血容量,平安度过危险期,均安全出院。32例患者中自体回输血量28160mL,占总引流血量49060mL的57.40%,其中最小回输550mL,最多1400mL,平均回输880mL。其中7例患者应用异体输血共2870mL,占总输血量的10.21%。3例发热患者2例伤口感染经对症处理后恢复正常,无溶血反应,未见持续出血、输血后并发症、过敏反应、细菌污染等疾病。结论外伤性脾破裂中应用自体血回输,操作简便,安全可靠,患者并发症较少,并且减少了血资源的浪费和异体输血排异反应及传染疾病的发生率。     

Individuals with pain need more sleep in the early stage of mild traumatic brain injury

ObjectiveHypersomnia is frequently reported after mild traumatic brain injury (mTBI), but its cause(s) remain elusive. This study examined sleep/wake activity after mTBI and its association with pain, a comorbidity often associated with insomnia.MethodsActigraphy recording was performed for 7 ± 2 consecutive days in 56 individuals at one month post-mTBI (64% male; 38 ± 12 years), 24 individuals at one year post-mTBI (58% male; 44 ± 11years), and in 20 controls (50% male; 37 ± 12 years). Pain intensity and its effect on quality of life was assessed with a visual analogue scale and the Short Form Health Survey (SF-36) bodily pain subscale.ResultsOverall, few differences in sleep/wake patterns were found between mTBI patients and controls. However, higher percentages of mTBI individuals with moderate-to-severe pain were found to require more than eight hours of sleep per day (37% vs11%; p = 0.04) and to be frequent nappers (defined as those who took three or more naps per week) (42% vs 22%; p = 0.04) compared to those with mild or no pain at one month postinjury. Correcting for age and depression, The SF-36 score was found to be a significant predictor of sleep duration exceeding eight hours per day at one month (odds ratio = 0.95; 95% confidence interval = 0.92–0.99; p = 0.01), but not at one year post-mTBI. Pain and increased sleep need (in terms of hours per day or napping frequency) were found to co-exist in as much as 29% of mTBI patients at one month postinjury.ConclusionPain could be associated with more pronounced sleep need in about one-third of mTBI patients during early recovery. Unalleviated pain, found in more than 60% of mTBI patients, should therefore be looked for in all mTBI patients reporting new onset of sleep disorder, not only in those with insomnia.     

Anaphylactic shock due to traumatic rupture of pulmonary hydatid cyst: Case report

IntroductionHydatid cyst is an infectious disease caused by « ECHINOCOCCUS GRANULOSIS », it can be asymptomatic or manifests depending on size, location, and relation with other organs, or by complication like rupture. This latter might occur spontaneously or post-traumatic, and it might manifest with an anaphylactic shock, a life-threatening situation.ImportanceAnaphylactic shock is a rare cause of traumatic shock state.Case presentationA 30 years old man with no medical history was admitted to the emergency room after a car accident, on his admission, his Glasgow coma scale was 10/15 with a blood pressure of 80/30 mmHg, he was intubated and stabilized hemodynamically. The full-body CT scan showed no abnormalities except on the thoracic level where it showed a well-limited rounded formation with regular contours containing hydro-aeric level related to ruptured hydatid cyst.After ruling out the diagnosis of hemorrhagic, hypovolemic shock, the diagnosis of anaphylactic shock due to a post-traumatic rupture of the hydatid cyst was maintained.ConclusionPost-traumatic rupture of the hydatid cyst is a rare emergency that requires early diagnosis and management. Surgery remains the principal treatment of ruptured hydatid cyst.Anaphylactic shock is a life-threatening situation with various symptoms; epinephrine is the cornerstone for management of this type of shock.