Objective To evaluate the role of damage control surgery (DCS) in the diagnosis and treatment of sharp abdominal injury combined with multiple trauma.Methods Sixty patients with sharp abdominal injury accompanied by multiple trauma treated from January 2005 to August 2014 were reviewed retrospectively.There were 55 males and 5 females,aged at 15-79 years (mean,32.08 years).Thirty patients underwent definite operative treatment (control group),and 30 patients had DCS (DCS group).Between-group differences were examined in pre-and post-operative hemodynamic changes,function recovery,cure rate and complication incidence.Results All patients showed improved hemodynamic parameters after operation.The cure rate was 97％ (29/30) in DCS group versus 50％ (15/30) in control group (P ＜ 0.05).Complications were reported in 17％ (5) of the patients in DCS group versus 40％ (12) of the patients in control group (P ＜ 0.05).Conclusion DCS is associated with decreased rate of complications and increased cure rate in the treatment of sharp abdominal injury combined with multiple trauma.

Objective To investigate the neuroprotective effect of cattle encephalon glycoside and ignotin injection on the rat model of traumatic brain injury (TBI).Methods Three hundred and six SD rats were randomly divided into sham group,TBI group,high dose group,middle dose group and low dose group according to the random number table.Rats received 1.8,0.6 and 0.2 ml/kg of cattle encephalon glycoside and ignotin injection for 28 days in high,middle and low dose groups,respectively.TBI was induced by the modified Feeney' s weight-drop method.Rat mortality,neurological function score and learning and memory ability were recorded.Brain morphological changes were evaluated with 7.0 T small animal nuclear magnetic resonance and HE staining.Evans blue was applied to assess blood brain barrier (BBB) permeability and hydrocephalus was evaluated by the brain water content.Results Mortality in high dose group decreased significantly compared to that in TBI group (22.40％ vs.28.14％,P ＜ 0.05).Defects in neurological function and learning and memory induced by TBI were significantly mitigated in middle and high dose groups (P ＜ 0.05).Pathological damage and contralateral hippocampal atrophy in middle and high dose groups were reduced significantly compared to TBI group (P ＜ 0.05).Hippocampus neuroapoptosis in middle and high dose groups was significantly improved compared to TBI group (P ＜ 0.05).BBB damage was less severe in middle and high dose groups than in TBI group (P ＜ 0.05).The treatment was preventive against secondary hydrocephalus.Conclusion Middle or high dose cattle encephalon glycoside and ignotin injection over a 28-day period has significant neuroprotective effect on the TBI rats.

Objective To investigate the effect of mild hypothermia on expression of autophagyrelated proteins LC3 and Beclin-1 in the hippocampus of rats with traumatic brain injury (TBI).Methods Sixty healthy male adult SD rats were divided into sham group, TBI group, hypothermiatreated group (31-33℃) according to the random number, with 20 rats per group.Rat models of TBI were established using the Marmarou's method.After 4 h of normothermia or hypothermia, the rats were killed 6, 12, 24, and 48 h later.Co-localization of LC3 with neuron specific protein (NeuN) or mammalian target of rapamycinm (mTOR) was determined by double immunofluorescence.Levels of LC3, Beclin-1 and p-mTOR proteins were detected by Western blot analysis.Results LC3 co-localization with NeuN (or mTOR) was observed under confocal laser scanning microscope.In TBI group LC3 and Beclin-1 levels were seen to rise at 6 h, peaked at 24 h and fell slightly at 48 h, but the levels were still higher than these in sham group (P ＜ 0.05).In TBI group p-mTOR level began to decrease at 6 h, reached the lowest point at 12 h, and then ascended at 24 and 48 h, but the level was still lower than that in sham group (P ＜0.05).Mild hypothermia contributed to remarkable decreases in LC3 and Beclin-I expressions, while up-regulating p-mTOR after injury (P ＜ 0.05).Conclusion Mild hypothermia appears to be neuroprotective as it inhibits autophagy in hippocampal neurons after TBI in rats through activation of mTOR signaling pathway.

Objective To investigate the effect of nerve growth factor (NGF) on osteogenesis induced by bone morphogenetic protein-9 (BMP-9) in mouse embryonic fibroblasts (MEFs).Methods MEFs were respectively transfected with adenovirus-mediated NGF (NGF group), BMP-9 (BMP-9 group) and NGF + BMP-9 (combined group) and green fluorescence protein (GFP) (control group).Cytochemical staining was used to test the activity of alkaline phosphatase (ALP) 3 d and 5 d after treatment.Level of osteopontin (OPN) mRNA was detected by RT-PCR 9 d after treatment.Level of OPN protein was assayed by Western blot and immunocytochemistry 9 d after treatment.Mineralization was detected by Alizarin red staining 14 d after treatment.Results ALP activity in MEFs was elevated in BMP-9 group rather than in NGF group, but a significant increase in ALP activity was noted in combined group.In control group, BMP-9 group, NGF group and combined group, level of OPN mRNA was 0.92 ± 0.03, 1.28 ± 0.04, 0.94 ± 0.03 and 1.62 ± 0.04 respectively (F =214.60, P ＜ 0.01);level of OPN protein was 0.60 ± 0.05, 0.84 ± 0.03, 0.53 ± 0.05 and 1.27 ± 0.05 respectively (F =162.5, P ＜ 0.01).In comparison, OPN mRNA and protein were significantly up-regulated in combined group than in BMP-9 group (t =10.569 and 11.778,P ＜ 0.05).In control group, BMP-9 group, NGF group and combined group, relative density of OPN protein was 3.63 ±0.17, 6.27 ±0.30, 3.86 ±0.18 and 10.16 ±0.18respectively (F =602.6, P ＜ 0.01), with a significant higher level in combined group than in BMP-9 group (t =22.280, P ＜ 0.05).Level of mineralization was significantly higher in combined group than in BMP-9 or NGF group.Conclusion NGF can potentiate the osteogenesis induced by BMP-9 in MEFs.

Objective To analyze the effect of mesporous calcium silicate (m-CS)/calcium sulfate cement (CSC),m-CSC for short,in bone defect repair.Methods Setting time and compressive strength of the m-CSC (15 m-CSC as group Ⅰ and 30 m-CSC as group Ⅱ) were tested.CSC was used as the control.Cement samples were immersed in Tris-HCl solution,andin vitro degradation of the m-CSC was measured.Cell morphology and cell proliferation as well as differentiation on the samples were assessed.The cements were implanted into the traumatic femoral defects in rabbits,and the in vivo degradability and osteogenesis of the cements were investigated by histological evaluation after implantation for 4,8 and 12 weeks.Results Addition of m-CS into CSC prolonged the setting time (7.8 min in group Ⅰ and 10.5 min in group Ⅱ),obviously longer than 3.7 min in control group and did not have obvious effect on compressive strength of the cements.Weight loss of m-CSC solution was obviously lower (61.8 wt％ in group Ⅰ and50.3 wt％ in group Ⅱ),compared to70.4 wt％ in control group,pH value in group Ⅱ decreased from 7.40 to 7.26,while decreased from 7.40 to 6.86 in control group,m-CSC could promote cell proliferation and differentiation compared to CSC.At postoperative 12 weeks,histological sections showed massive new bony tissue (55.2％) in group Ⅱ,obviously higher than 25.6％ in control group.Conclusion m-CSC exhibits good biocompatibility,degradability and osteogenesis,and can promote bone regeneration in bone defect repair.

Objective To evaluate the emergency repair method and its effect for treatment of extensive avulsion injury of the lower extremity in the elderly patients.Methods From May 2008 to February 2015,11 patients aged over 60 years sustaining large avulsion injury (across the knee or ankle joint) of the lower limb in traffic crushes were treated by emergency debridement and one-stage repair with the procedures of autologous skin replantation,arteriovenous anastomosis and vacuum sealing drainage (VSD).Two patients sustained injury to both lower limbs,and nine patients sustained a unilateral injury.Effect of wound repair was evaluated with skin flap survival area.Active and passive motility of the knee and ankle were recorded at postoperative 24 h.Results One patient with multiple fracture and extensive muscular inactivity due to severe crush injury to the lower limbs had poor blood supply after the replantation and was amputated at postoperative 24 h.The remaining ten patients with large skin avulsion showed 90％ of the avulsed skin survived after operation.At the follow-up of 3-24 months,the ten patients showed no obvious pigmentation or scar tissue,were satisfied with the function recovery in knee (106°-110° in flexion and 0°-5°in extension) and ankle joint (15°-20°in dorsiflexion and 30°-35° in plantar flexion),and could walk freely,including excellence outcomes in 3 patients and good outcomes in 6 patients.Conclusion The emergency repair methods including autologous skin replantation,arteriovenous anastomosis and VSD combined with one-stage in situ repair can attain satisfactory clinical effect.

Objective To measure the effect of tetrandrineon (Tet) on inflammatory mediators and endogenous neural stem cell proliferation after spinal cord injury (SCI) in rats.Methods A total of 162 Wistar rats were separated into injury group,Tet group and sham operation group according to the random number table,with 54 rats per group.Allen' s method was used for induction of experimental SCI.Animals in Tet group were given Tet (22.5 mg/kg) through the tail vein at 30 min,24 h and 48 h postinjury.The same volume of normal saline was given to other two groups.Spinal cord tissue samples were taken from the rats after injury to measure levels of tumor necrosis factor (TNF)-α,interleukin (IL)-1 β and IL-10,and tissues were examined with HE staining and Nestin immunohistochemistry staining.Results Levels of TNF-α,IL-1 βand IL-10 in injury and Tet groups increased compared to these in sham operation group at 6 h,12 h,1 d,3 d,5 d and 1 week postinjury (P ＜ 0.05).At the same time point,level of IL-10 was higher in Tet group than in injury group,but inversely for TNF-α and IL-1 β (P ＜ 0.05).More Nestin-positive cells were present in injury and Tet groups than in sham operation group at 1 d,3 d,1 week,2 week,3 week and 4 week postinjury (P ＜ 0.05).Additionally,more Nestin-positive cells were found in Tet group than in injury group at 1 d,3 d,1 week,2 week and 3 week postinjury (P ＜ 0.05).Conclusion Tet is effective to relieve inflammatory reaction,increase neural stem cell number and promote neurological recovery after SCI.

Objective To investigate effect of autologous periosteum transplantation in the repair of anterior cruciate ligament (ACL) injury.Methods Transected ACL injury was induced in 24 white rabbits randomly allocated to receive autologous periosteum transplantation with suture fixation (study group,n =12),isolated suture fixation (control group,n =12),and arthrotomy (blank group,n =3).Gross observation of ACL repair was performed and degeneration of knee joint was evaluated using the Markin score.ACL pathology,collagen fiber formation and insertion degenerative changes were histologically investigated using the HE staining,Masson staining and Picric-Sirius red staining.Results Twelve weeks after the operation,gross observation showed ligamentous continuity and minor joint degeneration in study group.Opposite results were seen in control group.Markin joint degeneration score calculated 7.2 ± 1.6 in study group,12.4 ± 1.8 in control group and 0.6 ± 0.4 in blank group,with significant differences between groups (P ＜ 0.05).Using the HE and Masson staining in study group,rich collagen fibers and microvessel as well as cell infiltration were found in wound tissue and the ligaments were covered with synovial membrane.However,wound tissue did not heal in control group,leaving ligament remnants with loosely disorganized fibers and rich microvessel as well as cell infiltration.And only the residual stump was wrapped with synovial membrane.Using the HE and Picric-Sirius red staining,the typical four-layer structure of ACL insertion remained intact in study group,whereas in control group the layer structure of ACL insertion in control group became disorganized and the tidemark of enthesis almost disappeared.Conclusion Autologous periosteum transplantation is effective to improve the injury healing and mitigate the degeneration of joint.

Objective To investigate the effect of damage control laparotomy in multiple trauma care.Methods A retrospective review was made on clinical data of 33 multiple trauma cases who received damage control laparotomy from January 2009 to June 2015.Twenty-four cases were males and 9 females, with the age range of 19-68 years(mean, 41.0 years).The trauma causes included traffic injury in 21 cases, high fall injury in 6 cases, falling object injury in 5 cases, and detonator blast injury in 1 case.Injury severity score (ISS) ranged from 14 to 64 points (mean, 27.0 points).All cases presented abdominal injury.Complicated injuries included brain injury in 10 cases, chest injury in 23 cases, and pelvic limb injury in 21 cases.All cases underwent damage control laparotomy, and then temporary abdominal closure after abdomen surgery.Abdominal closure time, intro-abdominal hypertension (IAH) or abdominal compartment syndrome (ACS), related treatment methods, hospital length of stay, and complications were recorded after operation.Results Twenty-nine cases had primary fascial closure 5-12 d after surgery.Four cases were unable to complete definitive abdominal wall reconstruction within the short term, and underwent skin grafting to form planned ventral hernia.Twelve cases developed IAH or ACS, and were cured using intra-abdominal volume increment assisted by vacuum sealing draining (VSD).Hospital length of stay was 21-70 d (mean, 31.4 d).There were wound infections in 2 cases of open fractures and abdominal incision infections in 4 cases, but all were cured after debridement plus VSD treatment.Abdominal abscess occurred in 1 case, and was cured by abdominal puncture and drainage.All cases were discharged from hospital smoothly.Conclusion Rational application of damage control laparotomy is a safe and effective treatment method for multiple trauma combined with abdominal injury.

Objective To determine the influence of continuous mild sedation versus usual sedation on the sedative effect and inflammatory factor level in ICU patients with multiple trauma.Methods In this prospective, randomized double-blind investigation, 58 multiple trauma patients hospitalized from October 2013 to April 2015 were randomized into continuous mild sedation group (continuous group, n =30) and conventional sedation group (conventional group, n =28) using the sealed envelopes.Between-group differences were made on the duration of mechanical ventilation, length of stay in the ICU, ratio of inception of continuous renal replacement therapy (CRRT), tracheotomy rate, accidental extubation rate, sepsis rate, multiple organ failure (MOF) rate and mortality.Serum inflammatory factor levels of the patients were recorded.Results There were 3 deaths (10％) in continuous group versus 4 deaths (14％) in conventional group (P ＞ 0.05).Patients in continuous group showed significantly less time spent on mechanical ventilation [(4.8 ±2.7) vs.(8.9 ±3.1)d] and in the ICU [(10.7 ± 5.4) vs.(16.9 ± 7.3) d] compared with conventional group (P ＜ 0.01).Between-group differences were insignificant regarding the ratio of CRRT inception, tracheotomy rate, accidental extubation rate, sepsis rate and MOF rate (P ＞ 0.05).Serum levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, Creactive protein (CRP) were lower in continuous group than those in conventional group at 24 h, 48 h and 72 h post-ICU, but significant differences were only observed at 48 h (P ＜ 0.05).At these time periods, serum IL-10 levels in continuous group were significantly higher than those in conventional group (P ＜0.05).In receiver operative characteristic curve (ROC) analysis, the area under the curve for IL-6, IL-10, TNF-α and CRP in continuous group was 0.726, 0.608, 0.729 and 0.757 respectively at 48 h post-ICU, indicating a predictive value of these markers for sepsis.Conclusion Continuous mild sedation results in shortened length of stay in the ICU and decreased inflammatory response in the treatment of patients with multiple trauma.