Propofol effects in rodent models of traumatic brain injury: a systematic review

Background Traumatic brain injury (TBI) causes high mortality and disability worldwide. Animal models have been developed to explore the complex processes in TBI. Propofol is used to manage head injuries during surgical intervention and mechanical ventilation in patients with TBI. Many studies have investigated the neuroprotective effect of propofol on TBI. However, other studies have shown neurotoxic effects. Objectives To review systematically the literature regarding the neuroprotective and neurotoxic effects of propofol in rodent models of TBI. Methods Data from rodents as models of TBI with propofol as one of the intervention agents, and/or comparing the neuroprotective effects of propofol with the other substances in rodent models of TBI, were obtained from PubMed, EBSCO Host, and ProQuest databases. The PRISMA 2020 statement recommendations were followed and research questions were developed based on PICOS guidelines. Data was extracted from the literature using a standardized Cochrane method. Results We analyzed data from 12 articles on physiological changes of experimental animals before and after trauma, the effects of propofol administration, and the observed neurotoxic effects. The effects of propofol administration were observed in terms of changes in traumatic lesion volume, the release of antioxidants and inflammatory factors, and the neurological function of rodent models of TBI. Conclusion Propofol has neuroprotective and neurotoxic effects via several mechanisms, and various doses have been used in research to determine its effects. The timing of administration, the dose administered, and the duration of administration contribute to determine the effect of propofol in rodent models of TBI. However, the doses that produce neuroprotective and neurotoxic effects are not yet clear and further research is needed to determine them.

Limb Salvage after Lower-Leg Fracture and Popliteal Artery Transection—The Role of Vessel-First Strategy and Bone Fixation Using the Ilizarov External Fixator Device: A Case Report

Open traumatic lesion of the popliteal artery is relatively rare. Ischemia time longer than 6 h and severity of limb ischemia have been shown to be associated with an increased risk of limb loss. Severe local infection is critical in the presence of major soft tissue trauma or open fractures. We report the case of a young female who suffered a traumatic transection of the popliteal artery associated with an open fracture of the distal tibia and fibula managed by direct vessel reconstruction with an end-to-end repair and skeletal stabilization initially with half-pin external fixation, then replaced by an Ilizarov circular frame. The patient had a very satisfactory outcome, but the fracture healed malunited, later corrected by open reduction and internal fixation with lag-screwing and a neutralization plate.

Comparative analysis of the effectiveness of the oral mucosa traumatic lesion treatment in patients with a comorbidity

Relevance. Patients with diabetes are prone to complications which negatively affect their quality of life. In such patients, several comorbidities may develop. One of the complications of diabetes mellitus is an impaired wound healing. Oral wound healing associated with the constant chronic trauma by sharp edges of teeth and prostheses is not an exception. Such wounds are characterized by a long, persistent, sluggish process of restoring the integrity of the oral mucosa epithelium.Materials and methods. In this paper, a comparative analysis of the effectiveness of wound treatment was carried out in 52 patients with diabetes mellitus. All patients were randomized into two equal groups. In the first group of patients, wounds were treated with traditional methods of pharmacotherapy, while in the second group, the oral mucosa was exposed to ozone and ozonated oil was applied. The patients were monitored and followed up for 14 days and as the reparative function was restored. The area and depth of the wound, the nature and amount of exudate, destruction, the edges of the wound and the surrounding connective tissue were taken into account.Results. The positive wound healing process was noted in both groups during the follow-up period. However, the inclusion of the ozone therapy in the treatment protocol favored faster restoration of the epithelium integrity.Conclusion. The present data will help dentists monitor and treat the wound process, which in turn will prevent malignancy as well as improve the prognosis for patients with diabetes.

Current trends in the treatment of acetabular fractures (literature review)

Acetabular fractures are known for their disabling outcomes, so the search for optimal treatment tactics is an actual problem for modern orthopedics and traumatology. Materials and methods. Randomized trials that reflect the results of acetabular fractures treatment depending on the method of treatment were analyzed. The literature was searched in the PubMed Central database. Hip joint is a complex two-component articulated system. Traumatic lesion of all elements of the joint creates the conditions for the development of a wide range of complications and secondary changes that must be taken into account at preoperative treatment. Aceta­bular fracture is an intra-articular injury, where the visualization methods have the prominent significance. Nowadays the treatment can be conservative and surgical. Surgical treatment can be divided into two areas: osteosynthesis and arthroplasty. Anatomical reposition and stable fixation of fragments, in the most of cases, is the key to a satisfactory functional result, but the development of post-traumatic changes in the joint nullifies the results of even perfect osteosynthesis, encourages repeated surgery and, finally, hip replacement. In recent years, primary arthroplasty has been successfully used to treat acetabular fractures, reducing inpatient and rehabilitation period, compared with osteosynthesis, preventing the possible development of secondary degenerative changes in the joint. Conclusions. Acute hip replacement is an effective treatment, however, the technical aspects of reliable fixation of the ace­tabular component of the implant are insufficiently substantiated and highlighted in actual literature and constitute significant research interest.

Profile of Working-Age Patients with Keloid and Hypertrophic Scar at Dr. Soetomo General Hospital Surabaya in 2014-2017

Introduction: Keloid and hypertrophic scar are pathological scars resulting from excessive accumulation of collagen in wound healing process. Data about profiles of keloid and hypertrophic scar are rarely found in Indonesia. Therefore, it is necessary to conduct research related to keloid and hypertrophic scar. This study aimed to provide valuable data for further research.Methods: This was descriptive retrospective study evaluating 105 patients treated for keloid and hypertrophic scar from 2014 to 2017 using medical records of working-age patients.Results: Mostly in patients between 17-25 years old (40%). Comparison between male and female patients were 1.07:1 (keloid) and 1.09:1 (hypertrophic scar). As many as 10.71% of patients of keloid and 17.39% patients of hypertrophic scar were private employees. 23.21% patients with keloid and 23.91% patients of hypertrophic scar were Javanese. 14.29% patients of keloid and 19.57% patients of hypertrophic scar tend to have daily indoor activities. 17.86% patients of keloid and 26.09% patients of hypertrophic scar felt dark-skinned toned. Most keloid scars were caused by traumatic lesions (32.14%), located on the chest (19.54%), and treated by corticosteroid injection. Hypertrophic scar mostly caused by burn injury (54.35%), located on the face (29.55%), and treated by excision surgery.Conclusion: Both keloid and hypertrophic scars were mostly developed in 17-25 years old, male, private employees, Javanese ethnic, dark skin tone patients, with daily indoor activities, caused by traumatic lesion and located on the chest, earlobe, and hand, treated by corticosteroid injection (keloid). Meanwhile, hypertrophic scars are mostly caused by a burn injury on the face and treated by excision surgery.

Preliminary Results of the Research of Anthropological Material from Tomb I of an Aisleless Quarter Church at Eski-Kermen Plateau

In 2018, the joint expedition of the Institute of Archaeology of the Crimea of the Russian Academy of Sciences and the History and Archaeology of the Crimea Research Centre of the V. I. Vernadsky Crimean Federal University continued the long-term systematic excavations of a residential quarter of the mediaeval town located atop of Eski-Kermen plateau. The regular research uncovered new rooms in the previously excavated mediaeval buildings with adjacent areas of the main and streets and a wall of a previously unknown church with tomb I annexed to it. The researchers of Crimean medieval Christian monuments have paid attention to a great variety of burial traditions connected with constructions of burials and the ways of using them. As a rule, the majority of mediaeval burial constructions at Eski-Kermen plateau were continuously used throughout a long period. The given paper examines the material obtained from tomb I annexed to the wall of an aisleless church. In the tomb under study, there are skeletons of some of the buried persons laying in anatomic order. All the bones of the individuals buried in the tomb occurred within this burial construction. The preservation of bone remains can be evaluated as satisfactory. In the course of work, quantitative and sex-age-related characteristics of the buried persons have been determined; the analysis of palaeopathological conditions has been made; a number of non-metric features has been documented. Epigenetic features more often appeared on the cranium bones; it is possibly connected with the preservation of the bones of postcranial skeletons. Among pathological developments, diseases related with teeth-maxillary apparatus are most common. Diseases of locomotor apparatus have been documented on the bones of vertebral column and big joints of long bones of arms and legs of all sexually mature individuals. Some changes typical of the Forestier disease have been recorded at the backbone of one of the buried male individuals. Pathological changes caused by iron-deficient conditions, inflammatory processes, and changes of osseous tissues connected with physical overexertion of osseous apparatus caused by extreme physical burden have been recorded among those who were buried in tomb 1. Only one traumatic lesion has been documented at the new material.

358 The relationship between serum biomarkers of traumatic brain injury (TBI) and magnetic resonance imaging (MRI) in patients discharged from the emergency department (ED) with a normal acute CT

Aims/Objectives/BackgroundCT remains the neuroimaging of choice in patients with TBI, however the relative lack of sensitivity as compared to MRI for certain traumatic lesion types, including diffuse axonal injury (DAI), could lead to missing important intracranial findings.1 Serum biomarkers may allow screening of ED patients, highlighting those who will benefit from MRI and offer a pathway for further imaging in mild TBI patients.Methods/DesignPatients discharged from ED with a panel of 6 biomarkers (GFAP, NFL, NSE, S100B, t-tau and UCH-L1), acute CT < 24 hrs of injury and acute MRI, were extracted from the CENTER-TBI core dataset.2 Mann Whitney U test to compare median biomarker levels in relation to +ve or –ve MRI. Unadjusted Area Under ROC (AUC) calculated for detection of MRI abnormality.Results/Conclusions80 patients met inclusion criteria, 45 (56%) male, median age 36.5 yr [IQR 24.5–51.3], median GCS 15 [IQR 15–15]. 17/80 (21.25%) had MRI abnormalities. 1 intraventricular haemorrhage, 2 traumatic subarachnoid haemorrhages, 3 intraparenchymal haemorrhages and 13 DAI. Of the biomarkers (median): GFAP (0.28 vs 1.88 ng/ml, p = 0.002), NSE (13.08 vs 15.19 ng/ml, p= 0.013), S100B (0.06 vs 0.12 µg/L, p=0.002), t-tau (0.82 vs 1.58 pg/ml, p=0.002), UCH-L1 (22.33 vs 57.68 pg/ml p<0.001) were significantly raised in patients with MRI abnormality. Serum NFL concentration was not significant (5.80 vs 8.18 pg/ml, p=0.096). AUC [95% CI] for detection of MRI abnormality: GFAP (0.75 [0.61–0.89]), NFL (0.63 [0.48–0.79]), NSE (0.70 [0.55–0.85]), S100B (0.75 [0.61–0.90]), tau (0.75 [0.61–0.89]), UCH-L1 (0.82 [0.69–0.95])The results demonstrate potential utility in several acute serum biomarkers for screening of patients with a negative CT. Fair discrimination for detection of MRI pathology in this cohort was demonstrated by GFAP, NSE, S100B, total tau and UCH-L1. Further prospective analysis is required to assess the utility for biomarkers to determine MRI requirement in an ED population.ReferencesMetting Z, Rödiger LA, De Keyser J, et al. Structural and functional neuroimaging in mild-to-moderate head injury. Lancet Neurol 2007;6:699–710. doi:10.1016/S1474-4422(07)70191-6Maas AIR, Menon DK, Steyerberg EW, et al. Collaborative European neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI): A prospective longitudinal observational study. Neurosurgery 2015;76:67–80. doi:10.1227/NEU.0000000000000575