Primary Injury
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Batuk Diyora ◽  
Gagan Dhall ◽  
Mehool Patel ◽  
Mazharkhan Mulla ◽  
Nilesh More ◽  

AbstractTransorbital orbitofrontal penetrating injury by a nonmissile object is uncommon. The presentation of this injury varies. This injury can be easily missed during the initial clinical presentation, because the foreign body is sometimes not visible on local examination, the wound on the orbital skin is small, and very subtle signs are present. The patient can present with delayed complications of the primary injury. Our patient was a 33-year-old male who presented with an orbitofrontal injury with a meat hook. He had minor symptoms at the time of presentation, which were overlooked. Three weeks later, he developed signs and symptoms of raised intracranial pressure (ICP). Brain imaging revealed a peripheral rim of contrast-enhancing mass lesion in the right frontal lobe, extending into the right orbit with perilesional edema suggestive of posttraumatic brain abscess. Via right frontal craniotomy, pus was drained out and abscess wall was excised. The patient made good clinical recovery. A higher index of suspicion and sound knowledge of occult penetrating injury patterns is required in the cases of orbital injuries. Appropriate radiological imaging can lead to an earlier and accurate diagnosis, and can prevent its delayed sequela like brain abscess.

2021 ◽  
Vol 22 (15) ◽  
pp. 7930
Li-Yu Fay ◽  
Yan-Ru Lin ◽  
Dann-Ying Liou ◽  
Chuan-Wen Chiu ◽  
Mei-Yin Yeh ◽  

Background: Spinal cord injury (SCI) causes a primary injury at the lesion site and triggers a secondary injury and prolonged inflammation. There has been no definitive treatment till now. Promoting angiogenesis is one of the most important strategies for functional recovery after SCI. The omentum, abundant in blood and lymph vessels, possesses the potent ability of tissue regeneration. Methods: The present work examines the efficacy of autologous omentum, either as a flap (with vascular connection intact) or graft (severed vascular connection), on spinal nerve regeneration. After contusive SCI in rats, a thin sheath of omentum was grafted to the injured spinal cord. Results: Omental graft improved behavior scores significantly from the 3rd to 6th week after injury (6th week, 5.5 ± 0.5 vs. 8.6 ± 1.3, p < 0.05). Furthermore, the reduction in cavity and the preservation of class III β-tubulin-positive nerve fibers in the injury area was noted. Next, the free omental flap was transposed to a completely transected SCI in rats through a pre-implanted tunnel. The flap remained vascularized and survived well several weeks after the operation. At 16 weeks post-treatment, SCI rats with omentum flap treatment displayed the preservation of significantly more nerve fibers (p < 0.05) and a reduced injured cavity, though locomotor scores were similar. Conclusions: Taken together, the findings of this study indicate that treatment with an omental graft or transposition of an omental flap on an injured spinal cord has a positive effect on nerve protection and tissue preservation in SCI rats. The current data highlight the importance of omentum in clinical applications.

Cells ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 1867
Balázs Sonkodi ◽  
Zsolt Kopa ◽  
Péter Nyirády

Post orgasmic illness syndrome is a rare, mysterious condition with an unknown pathomechanism and uncertain treatment. The symptoms of post orgasmic illness syndrome last about 2–7 days after an ejaculation. The current hypothesis proposes that the primary injury in post orgasmic illness syndrome is an acute compression proprioceptive axonopathy in the muscle spindle, as is suspected in delayed onset muscle soreness. The terminal arbor degeneration-like lesion of delayed onset muscle soreness is theorized to be an acute stress response energy-depleted dysfunctional mitochondria-induced impairment of Piezo2 channels and glutamate vesicular release. The recurring symptoms of post orgasmic illness syndrome after each ejaculation are suggested to be analogous to the repeated bout effect of delayed onset muscle soreness. However, there are differences in the pathomechanism, mostly attributed to the extent of secondary tissue damage and to the extent of spermidine depletion. The spermidine depletion-induced differences are as follows: modulation of the acute stress response, flu-like symptoms, opioid-like withdrawal and enhanced deregulation of the autonomic nervous system. The longitudinal dimension of delayed onset muscle soreness, in the form of post orgasmic illness syndrome and the repeated bout effect, have cognitive and memory consequences, since the primary injury is learning and memory-related.

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0014
Ami Kapadia ◽  
Charles W. Wyatt ◽  
Gerad K. Montgomery ◽  
Philip L. Wilson ◽  
Henry B. Ellis

Background: The forearm is the most common site of fracture, and perhaps re-fracture, in the pediatric population. Although both bone forearm (BBFA) fractures represent approximately 30% of pediatric upper extremity fractures, little is known about BBFA re-fractures, particularly among youth athletes. Purpose: To evaluate characteristics of BBFA re-fracture and recurrent fractures. Methods: An IRB-approved retrospective chart review based on CPT and ICD-9/10 codes of forearm fractures (ages 10-18 years) treated by a single academic pediatric orthopedic group from June 2009 to May 2020 was conducted. All BBFA, radial, or ulnar fractures with ipsilateral same-site, or non-identical ipsilateral or contralateral forearm fracture were included. Demographics, injury characteristics, length of immobilization, timing of return to activity, and radiographic data (angulation, distance between radius fracture and ulna fracture [in mm], position of fracture within bone, and radiographic healing). An analysis was performed to evaluate associations of ipsilateral same-site re-fracture versus ipsilateral or contra-lateral non-identical site fractures. Results: Twenty-nine of 686 BBFA and distal radius fractures were identified to have recurrent fracture (4.23%), with an average age of 11.5 years and male-to-female ratio of 6.25:1. 67% of ipsilateral same-site re-fractures occurred within one year. The most common mechanisms of primary fracture were contact sports (40%) and tumbling (30%), and re-fracture occurred 182 days after original fracture. 52% percent of recurrent fractures were ipsilateral same-site re-fractures, while 48% occurred in a non-identical site, either ipsilaterally or contralaterally. The most common mechanisms of recurrent fracture were contact sports (38%), falls (38%), and tumbling (14%). Ipsilateral same-site re-fractures compared to other recurrent fractures, were significantly associated with a mid-shaft location (p=0.0029), increased radius to ulna fracture distance (21.14 mm versus 11.3 mm, p=0.0277) [Figure 1], and earlier occurrence following index fracture (re-fracture= 397.33 days versus non-identical recurrent fracture= 884.07 days, p=0.0056). Degree of angulation was not significantly associated with re-fracture. Conclusion: Recurrent fracture may occur at different times and locations following primary injury treatment. Ipsilateral same-site re-fractures tend to occur within the first year of treatment following mid-shaft fractures incurred during contact sports and tumbling, with widely spaced radial and ulnar fracture sites. Further research may be warranted to evaluate biologic, bone health, or personality traits that may lead to recurrent and re-fractures in pediatric forearm fractures. [Figure: see text]

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Jialiang Lin ◽  
Zhencheng Xiong ◽  
Jionghui Gu ◽  
Zhuoran Sun ◽  
Jiang Shuai ◽  

Spinal cord injury (SCI) is one of the most incapacitating neurological disorders. It involves complex pathological processes that include a primary injury and a secondary injury phase, or a delayed stage, which follows the primary injury and contributes to the aggravation of the SCI pathology. Oxidative stress, a key pathophysiological event after SCI, contributes to a cascade of inflammation, excitotoxicity, neuronal and glial apoptosis, and other processes during the secondary injury phase. In recent years, increasing evidence has demonstrated that sirtuins are protective toward the pathological process of SCI through a variety of antioxidant mechanisms. Notably, strategies that modulate the expression of sirtuins exert beneficial effects in cellular and animal models of SCI. Given the significance and novelty of sirtuins, we summarize the oxidative stress processes that occur in SCI and discuss the antioxidant effects of sirtuins in SCI. We also highlight the potential of targeting sirtuins for the treatment of SCI.

2021 ◽  
Sadia Imran

BACKGROUND INTRODUCTION Traumatic brain injury (TBI) is common in all hospitals over Pakistan and it is associated with significant morbidity and mortality. It presents with varying levels of severity. Intensive monitoring and early suspicion of complications make it a mandatory sensitive issue. Moderate to severe head injuries require elective and/or emergency mechanical ventilation at an early stage. Hence, choosing an appropriate mode of ventilation and providing optimum ventilation can help prevent secondary brain injury, which result from ischemic and hypoxic changes in the brain due to injury. Mortality and morbidity of head injury coincides directly with the severity of the injury. Moreover, superimposed secondary brain Injury on a primary injury increases the severity of the injury, decreases the time of the therapeutic window and hence increases the morbidity and mortality of the TBI. An appropriate mechanical ventilation therapy at an early stage of a head injury can help preserve the primary injury, decrease the progression to a secondary Injury, prevent a cascade reaction where an Injury imposes further decompression of the brain and hence by decreasing morbidity can help decrease mortality. OBJECTIVE To determine outcomes of head injury patients ventilated with closed loop IntelliVent-ASV mode as compared to conventional SIMV ventilation mode based on maintenance of PEtCO2. METHODS STYDY DESIGN Randomized controlled trial. SETTING POF Hospital, Wah Cantt STUDY PERIOD Six months after approval of synopsis SAMPLING TECHNIQUE Non probability consecutive sampling SAMPLE SIZE A total of 100 patients with head injury fulfilling the inclusion criteria were selected and randomly allocated into two groups containing 50(n) each. RESULTS Data was analysed using SPSS Version 17. EtCO2 was measured continuously via mainstream EtCO2 . The IntelliVent ASV patients were randomally assigned group A while SIMV patients were assigned group B. Mean GCS score among both groups was 6.18+1.27 and 6.22+1.20 .Average EtCO2 reading among both groups was 34.58+2.01 and 35.58+2.12 respectively. Mean no. of manual adjustments among both groups was 7.50+3.40 and 6.25+0.88 respectively. After performing statistical analysis P value was <0.000 which was statistically significant. CONCLUSIONS Closed loop automated mode in head injury patients secure better outcomes than conventional mode in terms of decreased morbidity. Although the study needs more number of patients and time to determine the efficacy of one mode over another. CLINICALTRIAL ISRCTN10127188

2021 ◽  
Vol 12 ◽  
Agustín. J. Montivero ◽  
Marisa. S. Ghersi ◽  
M. Jazmín Silvero C ◽  
Emilce Artur de la Villarmois ◽  
Johanna Catalan-Figueroa ◽  

Traumatic Brain Injury (TBI) remains a leading cause of morbidity and mortality in adults under 40 years old. Once primary injury occurs after TBI, neuroinflammation and oxidative stress (OS) are triggered, contributing to the development of many TBI-induced neurological deficits, and reducing the probability of critical trauma patients´ survival. Regardless the research investment on the development of anti-inflammatory and neuroprotective treatments, most pre-clinical studies have failed to report significant effects, probably because of the limited blood brain barrier permeability of no-steroidal or steroidal anti-inflammatory drugs. Lately, neurotrophic factors, such as the insulin-like growth factor 1 (IGF-1), are considered attractive therapeutic alternatives for diverse neurological pathologies, as they are neuromodulators linked to neuroprotection and anti-inflammatory effects. Considering this background, the aim of the present investigation is to test early IGF-1 gene therapy in both OS markers and cognitive deficits induced by TBI. Male Wistar rats were injected via Cisterna Magna with recombinant adenoviral vectors containing the IGF-1 gene cDNA 15 min post-TBI. Animals were sacrificed after 60 min, 24 h or 7 days to study the advanced oxidation protein products (AOPP) and malondialdehyde (MDA) levels, to recognize the protein oxidation damage and lipid peroxidation respectively, in the TBI neighboring brain areas. Cognitive deficits were assessed by evaluating working memory 7 days after TBI. The results reported significant increases of AOPP and MDA levels at 60 min, 24 h, and 7 days after TBI in the prefrontal cortex, motor cortex and hippocampus. In addition, at day 7, TBI also reduced working memory performance. Interestingly, AOPP, and MDA levels in the studied brain areas were significantly reduced after IGF-1 gene therapy that in turn prevented cognitive deficits, restoring TBI-animals working memory performance to similar values regarding control. In conclusion, early IGF-1 gene therapy could be considered a novel therapeutic approach to targeting neuroinflammation as well as to preventing some behavioral deficits related to TBI.

2021 ◽  
Vol 14 ◽  
Le Zhang ◽  
Hao Feng ◽  
Yanwu Jin ◽  
Yufeng Zhan ◽  
Qi Han ◽  

Neuropathic pain (NP) is caused by primary injury or dysfunction of the peripheral and the central nervous system. Long non-coding RNAs were critical regulators involved in nervous system diseases, however, the precise regulatory mechanism remains unclear. This study aims to uncover the essential role of LINC01119 in NP progression and further clarify the underlying regulatory mechanism at post-transcriptional level. LINC01119 was significantly upregulated in rats of spare nerve injury (SNI) group compared to sham group. Functionally, silencing of LINC01119 significantly alleviated the neuropathic pain-induced hypersensitivity and reduced the increase in IL−6, IL−1β, and TNF−α caused by SNI. Mechanistically, Brain-derived neurotrophic factor (BDNF) was identified as the functional target of LINC01119. Besides, an RNA binding protein, ELAVL1 could directly interact with LINC01119, and this formed LINC01119- ELAVL1 complex binds to BDNF mRNA, strengthening its RNA stability and increasing the expression level of BDNF at both transcript and protein levels. Clinically, serum LINC01119 was verified as a promising diagnostic biomarker for NP patients. LINC01119 induces NP progression via binding with ELAVL1 and increasing BDNF mRNA stability and expression level. Therefore, LINC01119 may serve as a promising diagnostic marker and therapeutic target for NP treatment.

2021 ◽  
pp. 074823372110253
Banibrata Das

Child labor is an infraction of fundamental human rights, and it prevents the children’s physical, psychosocial, and psychological development. In India, children have been working in different unorganized sectors as paid laborers. Children were found performing a fair amount of manual, rigorous tasks in the brickfield industry due to socioeconomic disadvantages. Child brickfield workers suffered from musculoskeletal pain and injuries due to working with a heavy physical workload, which hampers the overall quality of life. A study had been conducted among these child brickfield laborers from India during 2011–2017. The study found laceration (38.7% male and 36.9% female) as the primary injury followed by sprain and strain, scratches, avulsion, and fractures among child brickfield workers. The study shows that child workers are highly prone to injuries, mainly toe (23.9% male and 28.1% female), hands (22.0% male and 23.4% female), wrists, feet, ankles, and fingers. The injury rate among male and female child brickfield laborers was 7.64 and 9.52 per 1000 workers. The primary source of injuries in brickfields was due to falling from height. Several risk factors, including biomechanical, work stress, may play a key role in work-related injuries among child brickfield laborers.

2021 ◽  
Vol 18 (1) ◽  
Zhimin Zou ◽  
Li Li ◽  
Nadine Schäfer ◽  
Qiaobing Huang ◽  
Marc Maegele ◽  

AbstractTraumatic brain injury (TBI) remains one of the leading causes of death and disability worldwide; more than 10 million people are hospitalized for TBI every year around the globe. While the primary injury remains unavoidable and not accessible to treatment, the secondary injury which includes oxidative stress, inflammation, excitotoxicity, but also complicating coagulation abnormalities, is potentially avoidable and profoundly affects the therapeutic process and prognosis of TBI patients. The endothelial glycocalyx, the first line of defense against endothelial injury, plays a vital role in maintaining the delicate balance between blood coagulation and anticoagulation. However, this component is highly vulnerable to damage and also difficult to examine. Recent advances in analytical techniques have enabled biochemical, visual, and computational investigation of this vascular component. In this review, we summarize the current knowledge on (i) structure and function of the endothelial glycocalyx, (ii) its potential role in the development of TBI associated coagulopathy, and (iii) the options available at present for detecting and protecting the endothelial glycocalyx.

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