Protective effects of Derinat, a nucleotide-based drug, on experimental traumatic brain injury, and its cellular mechanisms

Traumatic brain injury is the most common cause of death and disability in young people including sport athletes and soldiers, people under 45 years of age in the industrialized countries, representing a growing health problem in developing countries, as well as in aging communities. Treatment of the latter is a serious challenge for modern medicine. This type of injury leads to many kinds of disorders and, quite often, to disability. These issue require development of new methods for brain trauma treatment. The new approach to brain trauma treatment was studied in murine experiments. In particular, sodium salt of deoxyribonucleic acid (DNA) was used. This preparation is a drug known as a mixture of peptides with immunomodulatory effect which is widely used for different kinds of therapy. Derinat, a sodium salt of DNA, isolated from the caviar of Russian sturgeon, is a proven immunomodulator for treatment of diseases associatd with reactive oxygen species (ROS), including brain ischemia-reperfusion (IR) injury. Here we show that treatment with Derinat exert neuroprotective, anti-oxidative, and anti-inflammatory effects in experimental model of traumatic brain injury (TBI) in rats. Intraperitoneal injection of Derinat several times over 3 days after TBI showed less pronounced damage of the injured brain area. Immunohistochemical study showed that the Derinat-induced morphological changes of microglia in cerebral cortex and hippocampus 7 days after TBI. TBI-induced accumulation of 8-oxoguanine (8-oxoG), the marker of oxidative damage, was significantly attenuated by Derinat administration, both on 7th and 14th day after TBI. To investigate cellular mechanism of anti-inflammatory effects, the primary cultures of murine microglia supplied with ATP (50 M and 1 mM), as a substance released at injured site, were used to mimic the in vitro inflammatory response. Derinate treatment caused an increase of glial levels of mRNAs encoding neurotrophic factor (GDNF) and nerve growth factor (NGF) in the presence of ATP, whereas tissue plasminogen activator (tPA) mRNA was inhibited by ATP with or without Derinat. Interleukin-6 (IL-6) mRNA expression was not affected by ATP but was increased by Derinat. Both mRNA and protein levels of ATP-induced TNFα production were significantly inhibited by Derinat. These results partially contribute to understanding mechanisms of immunomodulatory effects of DNA preparations in traumatic brain injury.

Crosstalk between Microglia and Neurons in Neurotrauma: An Overview of the Underlying Mechanisms

: Microglia are the resident immune cells of the brain and play a crucial role in housekeeping and maintaining homeostasis of the brain microenvironment. Upon injury or disease, microglial cells become activated, at least partly, via signals initiated by injured neurons. Activated microglia, thereby, contribute to both neuroprotection and neuroinflammation. However, sustained microglial activation initiates a chronic neuroinflammatory response which can disturb neuronal health and disrupt communications between neurons and microglia. Thus, microglia-neuron crosstalk is critical in a healthy brain as well as during states of injury or disease. As most studies focus on how neurons and microglia act in isolation during neurotrauma, there is a need to understand the interplay between these cells in brain pathophysiology. This review highlights how neurons and microglia reciprocally communicate under physiological conditions and during brain injury and disease. Furthermore, the modes of microglia-neuron communication are exposed, focusing on cell-contact dependent signaling and communication by the secretion of soluble factors like cytokines and growth factors. In addition, how microglia-neuron interactions could exert either beneficial neurotrophic effects or pathologic proinflammatory responses are discussed. We further explore how aberrations in microglia-neuron crosstalk may be involved in central nervous system (CNS) anomalies, namely: traumatic brain injury (TBI), neurodegeneration, and ischemic stroke. A clear understanding of how the microglia-neuron crosstalk contributes to the pathogenesis of brain pathologies may offer novel therapeutic avenues of brain trauma treatment.

Educational needs of severe trauma treatment simulation based on mixed reality: Applying focus group interviews to military hospital nurses

Purpose: The purpose of this study is to identify the educational needs of a severe trauma treatment simulation program based on mixed reality which combines element of both virtual reality and augmented reality.Methods: Focus group interviews were conducted with ten military hospital nurses on February 4 and 5, 2021. The collected data were analyzed using a qualitative content analysis. As a framework for data analysis, the educational needs were clustered into the following four categories: teaching contents, teaching methods, teaching evaluation, and teaching environment.Results: The educational needs for each category that emerged were as follows: three subcategories including “realistic education reflecting actual clinical practice” and “motivating education” for teaching contents; five subcategories including “team-based education,” “repeated education that acts as embodied learning,” and “stepwise education” for teaching methods; six subcategories including “debriefing through video conferences,” “team evaluation and evaluator in charge of the team,” “combination of knowledge and practice evaluation” for teaching evaluation; six subcategories including “securing safety,” “similar settings to real clinical environments,” “securing of convenience and accessibility for learners,” and “operating as continuing education” for teaching environment.Conclusion: The findings of this study can provide a guide for the development and operation of a severe trauma treatment simulation program based on mixed reality. Moreover, it suggests that research to identify the educational needs of various learners should be conducted.

Features of NATO’s soldiers limbs combat trauma treatment during armed conflicts on the territory of Iraq and Afghanistan (literature review)

The article describes armed conflicts on the territory of Iraq and Afghanistan. Improvement of individual and collective protection equipment has reduced the number of cases of soft tissue wounds in the extremities. The main cause of mortality and wound complications is antibiotic-resistant microflora. Purulent complications lead to chronic treatment of the wound healing process and a long period of specialized treatment and rehabilitation, which entails difficulties in the socialization of wounded servicemen, as well as significant financial costs from the state. When providing medical care to wounded military personnel, it is negative pressure wound therapy. Phage therapy is a promising method for treating infectious complications.

Design and Development of an Interactive Web-Based Simulator for Trauma Training: A Pilot Study

Trauma is the leading cause of death in people under 45 years old and one of the leading causes of death in the world. Therefore, specific trauma training during medical school as well as after it is crucial. Web-based learning is an important tool in education, offering the possibility to create realistic trauma scenarios. A web-based simulator has been developed and a pilot study has been accomplished to trial the simulator. A pelvic trauma scenario was created and 41 simulations were performed, 28 by medical students and 13 by doctors. The data analyzed are the actions taken to treat the trauma patient, the evolution of the vital signs of the patient, the timing spent on deciding which action to take, when each action was performed and the consequence that it had on the patient. Moreover, a post-simulation questionnaire was completed related to the usability of the simulator. The clinical treatment performance of doctors is better than the performance of medical students performing more actions correctly and in the right sequence as per ATLS recommendations. Moreover, significant differences are obtained in the time response provided to the patients which is key in trauma. With respect to the usability of the tool, responses provide a positive usability rating. In conclusion, this pilot study has demonstrated that the web-based training developed can be used to train and evaluate trauma management. Moreover, this research has highlighted a different approach to trauma treatment between medical students and doctors.

The Efficacy of Art Psychotherapy on Reducing Maladaptive Behavior In Children

This study seeks to evaluate the efficacy of Art Psychotherapy as a treatment for children who have been exposed to trauma to decrease symptoms and the negative impacts on their social and psychological development. Thus, this mixed-method research closely documents the effects of an art psychotherapy program in Brazil in the treatment of 3 children, aged 9 years old, who have experienced trauma. Treatment effects were evaluated through a single-subject research design in a multiple baseline across participants design to quantitatively document change. Qualitatively, artwork progress is analyzed as well as parental and therapist’s evaluations. Results show that contingent on art psychotherapy implementation, targeted maladaptive behaviors decreased in frequency as compared to baseline, which was also reflected in their artwork. This study is aligned with previous work in the efficacy of art psychotherapy field and adds quantitative data to supports its use in the treatment of children with PTSD.