Behavioral strategies for the reduction of pain and anxiety associated with orthopedic trauma

This study examined the efficacy of behavioral strategies in alleviating pain and anxiety associated with severe orthopedic trauma. Sixty-four patients with multiple fractures were divided into four groups: (1) control, (2) attention only, (3) EMG biofeedback-assisted relaxation, and (4) audiotaped relaxation training. All were measured over at least six sessions, or as long as hospital stay permitted. Significant between group differences were found on the following: systolic blood pressure, pheripheral temperature, subjective units of discomfort, state anxiety, with a trend for use of sleep medications. No differences were found on other vital signs, EMG recordings, or other medications. EMG-biofeedback relaxation and relaxation training were relatively equivalent for all measures, and little or no change was observed for those patients who received attention only or served as controls.     

An enigmatic hypoplastic defect of the deciduous canine

A roughly circular hypoplastic defect restricted to the labial enamel surface of the deciduous canine is described. This pathology is quite common in available samples of Upper Paleolithic and Neolithic children and a cadaver sample of recent Calcuttans, affecting 44% to 70% of individuals. It is rare in a Neanderthal sample and in children from a clinical practice in Vancouver. The lesion occurs twice as commonly in the lower jaw. The defect appears to commence at or after birth owing to localized pressure on thin or nonexistent alveolar bone overlying the bulging crypt of the deciduous canine. Population differences in the incidence of the pathology probably reflect innate and acquired variation in hard and soft tissue thicknesses in this region.     

Wound healing and scarring after cryosurgery

There are many references in the surgical literature to apparent lack of scarring after cryosurgery. This has been investigated experimentally by comparing the effects on the skin of four freeze-thaw schedules commonly used in clinical practice with those of maximal cryosurgical injury. Absence of damage to collagen is described, and it is proposed that this is an important factor in the often cited lack of scarring. Changes in skin thickness over a 6-month period are described, and obvious scarring after severe injury and long-term dermis thinning after less severe injury are reported. Evidence is presented that epidermal cells and fibroblasts differ in their susceptibility to low-temperature damage.     

The influence of different flow velocities on tumor cell survival in micropore filters

Earlier studies have shown a lower degree of lodgement and early survival of tumor cells in muscle than in liver after infusion via the femoral artery and portal vein, respectively. A possible explanation to this difference might be that the tumor cells are mechanically destroyed, and thus die more rapidly in muscle because they enter this capillary network at a much higher flow velocity. In the present study, the effect on early tumor cell (rat fibrosarcoma) survival of a high and a low flow velocity/deformation rate was evaluated in micropore (5 μm) filters, using isotope (Cr⁵¹) technique. These experiments were combined with scanning electron microscopic (SEM) analyses. The filter experiments showed no significant differences in the rate of cell death in the filters between tumor cells subjected to high or low deformation rates, and there were no qualitative differences in tumor cell appearance in the SEM study. It is, therefore, concluded that the difference in tumor cell lodgement and survival between muscle and liver is not primarily caused by differences in the rate of cell deformation upon entry of the organ capillary network.     

Chroman amide and nicotinyl amide derivatives: Inhibition of lipid peroxidation and protection against head trauma

A series of chroman amide and nicotinyl amide derivatives was designed and synthesized for the treatment of traumatic and ischemic CNS injury. Five compounds were significantly more potent inhibitors of lipid peroxidation in vitro than the reference antioxidant, trolox (p < 0.01). Quantitative structure activity studies demonstrated that the inhibitory action was related to the ability to donate electrons, charge on hydroxy group and E_LUMO, to scavenging radicals and to the lipophilicity log P, which determines penetration of membrane lipids. ESR study indicated the ability of 12 to scavenge the hydroxyl radicals. The most promising compound, [(3,4-dihydro-6-hydroxy-2,5,7,8-tetramethyl-2H-1-benzopyran-2yl)carbonyl]-3′-(aminoethyl) indole (12), inhibited ex vivo lipid peroxidation in a head injury model and showed potent in vivo neuroprotective efficacy. Improvement of neurological recovery within 1 h of injury (grip test score) by as much as 200% was observed together with significant anti-anoxia activity. Compound 12 was a potent antagonist of methamphetamine-induced hypermotility resulting from dopamine release in the mouse brain. These results support the importance of cerebroprotective radical-scavenging agents for the treatment of traumatic injury and anoxia as well as provide additional evidence for the role of oxygen radicals and dopamine in brain damage.     

SLEEP-WAKE SCHEDULE DISORDER DISABILITY: A LIFELONG UNTREATABLE PATHOLOGY OF THE CIRCADIAN TIME STRUCTURE

Certain sleep-wake schedule disorders (SWSDs) cannot be successfully managed clinically using conventional methods of sleep therapy. We describe two cases of SWSD, the first following head trauma and the second originating during childhood, that had been misdiagnosed by physicians for many years. After conventional treatment for SWSD with light therapy and melatonin failed to bring about substantial improvement, it was determined that they were suffering from an incurable disability. Hence, we propose new medical terminology for such cases—SWSD disability. SWSD disability is an untreatable pathology of the circadian time structure. Patients suffering from SWSD disability should be encouraged to accept the fact that they suffer from a permanent disability, and that their quality of life can only be improved if they are willing to undergo rehabilitation. It is imperative that physicians recognize the medical condition of SWSD disability in their patients and bring it to the notice of the public institutions responsible for vocational and social rehabilitation. (Chronobiology International, 18(6), 1019–1027, 2001)     

Activation of ER stress signalling increases mortality after a major trauma

The endoplasmic reticulum (ER) adapts to stress by activating a signalling cascade known as the ER stress response. While ER stress signalling is a central component of the cellular defence against environmental insult, persistent activation is thought to contribute to the progression of various metabolic complications via loss of protein function and cell death. Despite its importance however, whether and how ER stress impacts morbidity and mortality in conditions of hypermetabolism remain unclear. In this study, we discovered that chronic ER stress response plays a role in mediating adverse outcomes that occur after major trauma. Using a murine model of thermal injury, we show that induction of ER stress with Tunicamycin not only increased mortality but also resulted in hepatic damage and hepatic steatosis. Importantly, post‐burn treatment with chaperone ER stress inhibitors attenuated hepatic ER stress and improved organ function following injury. Our study identifies ER stress as a potential hub of the signalling network affecting multiple aspects of metabolism after major trauma and as a novel potential molecular target to improve the clinical outcomes of severely burned patients.     

计算机辅助生物医学技术在全面部骨折的应用研究

全面部骨折的治疗一直是颌面外科的难点和挑战,精确的骨折定位是确保术后良好功能及外形的主要因素,但常规的x线检查并不能提供足够的信息,随着计算机辅助生物医学技术的快速发展,尤其是三维CT、快速成型/反求工程及计算机导航技术的迅猛发展,可为全面部骨折的诊断和临床治疗提供精确、立体定位。本文就基于计算机成像为基础的生物医学技术在全面部骨折的发展趋势及应用前景作一综述。     

前臂皮瓣修复外伤性颌面部缺损的护理体会

目的:探讨颌面部外伤后遗留大面积软组织缺损采用血管化游离前臂皮瓣修复的护理方法。方法:采用前臂皮瓣血管吻合修复17例外伤导致的颌面部软组织缺损,围术期采取严格的护理措施,术前的心理护理、术后的严密观察,最大限度防止皮瓣血管危象发生,保证治疗效果。结果:2例出现血管危象,进行抢救,其中1例失败,另1例抢救成功,其余15例顺利成活。结论:术前进行心理护理、术后严密观察、及时抢救是确保手术成功的关键。     

Interpersonal violence in prehistoric San Pedro de Atacama, Chile: behavioral implications of environmental stress

The prehistoric population of San Pedro de Atacama lived through periods marked by prosperity and interregional interaction, as well as times of severe drought, social stress, and widespread poverty. A sample of 682 crania was analyzed for evidence of cranial trauma in order to assess changing patterns of interpersonal violence during the occupation of the oasis. It was hypothesized that the level of traumatic injuries in this population would parallel some of the changes seen in the archaeological record. Low fracture rates would be expected in periods of affluence and environmental stability, while periods characterized by environmental extremes and state collapse would yield elevated rates of aggression. This analysis found that rates of trauma escalated from 5.1% (5/99) in the earliest period, to 10.9% (10/92) in the Middle Horizon (AD 600-950). Although it may reflect problems related to increasing population density in the oasis, this increase is surprising, given that the early period witnessed the shift to permanent settlements, and the middle period was one of prosperity and plentiful resource availability. Trauma rates peaked at 35.6% (16/45) in an early Late Intermediate period (AD 950-1400) cemetery, with other Late Intermediate cemeteries demonstrating similarly high rates of traumatic injury. The elevated trauma rates during this period correlate with major droughts, the concentration of settlements on the oasis' east side, fortified structures, and material poverty, all reflected in the archaeological record. As the Late Intermediate waned and environmental conditions improved, trauma concomitantly decreased (7.0%), and remained low throughout the Inka occupation (AD 1400-1532). This indicates that while the Atacama was not peaceful, violence became commonplace only during periods of great social change and resource stress.