复杂性眼外伤患者玻璃体切割围手术期护理体会

目的:玻璃体切割术是眼科手术中比较复杂精细显手术,主要应用于治疗眼外伤导致的玻璃体出血,玻璃体浑浊,复杂性视网膜脱离以及增殖性玻璃体视网膜病变。本文主要探讨玻璃体切割术治疗复杂性眼外伤患者的围手术期护理的临床效应。方法:总结作者所在科室多年来护理眼外伤患者的临床经验,对2013年3月至2013年7月入院的75例(75只眼)复杂性眼外伤患者进行悉心的术前心理护理,完善的用药指导,充分的术前准备,术后特殊卧位的指导,预防并发症的护理及出院指导。结果:术后视力提高57例(76.0%),视力不变13(17.3%)例,视力下降5例(6.7%),28例眼内异物患者均经手术顺利取出异物。相关手术并发症经医护人员的对症治疗后均得到有效控制。患者术后满意度达98%以上,医生满意度达100%。结论:复杂性眼外伤患者玻璃体切割手术围手术期进行全方位的护理服务,对促进病人康复起到至关重要的作用。     

Bioarchaeological investigation of ancient Maya violence and warfare in inland northwest Yucatan,Mexico

This study investigates evidence of changes and continuities in ancient Maya violence and warfare in inland northwest Yucatan, Mexico from the Middle Preclassic (600–300 BC) to the Postclassic (AD 1050–1542) through bioarchaeological analysis of cranial and projectile trauma. It is hypothesized that the frequency of violence increases before the Classic Maya collapse and remains high during the Postclassic period. It is also hypothesized that the flat, open terrain was conducive to warfare and resulted in higher trauma frequencies than in other parts of the Maya area. Results show that the frequency of cranial trauma decreases before the Classic collapse and increases in the Postclassic, partially matching the expected chronological trends. The frequency of cranial trauma does not differ significantly from other Maya regions but the pattern does: for all periods, males have more healed injuries than females and they are concentrated on the left side of the anterior of the skull. Some injuries appear to be from small points hafted in wooden clubs. In addition, projectile trauma is evident in a scapula with an embedded arrowhead tip, the first such case reported in a Maya skeleton. Overall, these results suggest greater reliance on open combat and less on raids in this region compared with other parts of the Maya area, possibly due to the flat, open terrain, though the identification of perimortem trauma in both women and men indicates surprise raids on settlements were also practiced. Am J Phys Anthropol 154:140–151, 2014. © 2014 Wiley Periodicals, Inc.     

p53基因多态性和脑外伤预后及临床意义

目的：研究颅脑外伤患者中P53等位基因与基因型的频率分布,探讨其与脑损伤预后的关联性,为脑损伤患者预后提供部分参数依据。方法：选择各型颅脑损伤患者141例,正常对照者144人,患者按GCS格拉斯哥评分法进行分类;采用PCR基因型检测法检测P53等位基因,基因计数法计算等位基因频率;统计学分析等位基因和基因型在脑外伤组与正常对照组、预后良好组与预后不良组的频率分布的差异,并综合分析患者年龄、性别、GCS以及P53各等位基因等因素对脑外伤患者预后的影响。结果：在颅脑外伤患者和正常对照者中P53等位基因和基因型的频率分布,差异均无统计学意义（P〉0.05）;等位基因Arg相对于Pro的OR为1.140,基因型Arg/Pro、Arg/Arg相对于Pro/Pro的OR分别为0.890和1.170。在重型脑外伤患者（3≤GCS≤8分）86例中,预后良好31例,预后不良55例,基因型对预后不良的影响：非Pro/Pro相对于Pro/Pro的OR为0.417,非Arg/Pro相对于Arg/Pro的OR为0.419,非Arg/Arg相对于Arg/Arg的OR为3.667。在所有脑外伤患者中,预后良好组和预后不良组的患者年龄、性别差异均无统计学意义（P〉0.05）;GCS、P53等位基因差异具有显著统计学意义（P〈0.01）。结论：在重型颅脑患者中,基因型Arg/Arg有增加预后不良的风险;脑外伤预后与患者的年龄、性别无关联,与GCS、P53基因密切相关。     

NGF 与Neuritin 在脑外伤伴四肢骨折病人血清中的表达及意义

目的:通过检测脑外伤患者、脑外伤合并骨折患者、骨折患者及正常人外周血中NGF,neuritin不同时间段的表达,根据其含量的变化,判断与骨折愈合速度的相关性,寻找骨折愈合的关键因子。方法:收集单纯脑外伤、单纯骨折患者各80例、脑外伤合并骨折患者60例、健康体检人群20例。选取外伤后3天、10天、2周抽取所有实验对象的静脉血,应用ELISA技术测定标本中NGF与Neuritin的含量。结果:损伤后每个时间段里,患者血清中NGF、neuritin含量有不同程度升高,均高于正常对照组,其中又以脑外伤合并骨折组最高。血清NGF在骨折合并脑外伤组伤后第3天含量明显升高,为(0.86±0.21),伤后10天为(1.47±0.29),14天为(2.0 7±0.21),脑外伤合并四肢骨折组neuritin血清含量在伤后第3天略有升高为(83.47±18.85),10天(108.50±31.65),2周(91.86±21.12).脑外伤合并骨折病人血清NGF、neuritin表达明显高于其他对照组,差别均有统计学意义(P<0.05)。结论:脑外伤合并骨折病人血清NGF、neuritin表达明显高于其他对照组,说明与骨折愈合有着密切的相关性,两种因子可能在骨折愈合修复过程中共同起作用,从而,推测可能是脑外伤后骨折愈合加速的重要因素。     

Vitamin E reduces amyloidosis and improves cognitive function in Tg2576 mice following repetitive concussive brain injury

Traumatic brain injury is a well-recognized environmental risk factor for developing Alzheimer's disease. Repetitive concussive brain injury (RCBI) exacerbates brain lipid peroxidation, accelerates amyloid (Abeta) formation and deposition, as well as cognitive impairments in Tg2576 mice. This study evaluated the effects of vitamin E on these four parameters in Tg2576 mice following RCBI. Eleven-month-old mice were randomized to receive either regular chow or chow-supplemented with vitamin E for 4 weeks, and subjected to RCBI (two injuries, 24 h apart) using a modified controlled cortical impact model of closed head injury. The same dietary regimens were maintained up to 8 weeks post-injury, when the animals were killed for biochemical and immunohistochemical analyses after behavioral evaluation. Vitamin E-treated animals showed a significant increase in brain vitamin E levels and a significant decrease in brain lipid peroxidation levels. After RBCI, compared with the group on regular chow, animals receiving vitamin E did not show the increase in Abeta peptides, and had a significant attenuation of learning deficits. This study suggests that the exacerbation of brain oxidative stress following RCBI plays a mechanistic role in accelerating Alphabeta accumulation and behavioral impairments in the Tg2576 mice.     

Mass-spectrometry based oxidative lipidomics and lipid imaging: applications in traumatic brain injury

Lipids, particularly phospholipids, are fundamental to CNS tissue architecture and function. Endogenous polyunsaturated fatty acid chains of phospholipids possess cis-double bonds each separated by one methylene group. These phospholipids are very susceptible to free-radical attack and oxidative modifications. A combination of analytical methods including different versions of chromatography and mass spectrometry allows detailed information to be obtained on the content and distribution of lipids and their oxidation products thus constituting the newly emerging field of oxidative lipidomics. It is becoming evident that specific oxidative modifications of lipids are critical to a number of cellular functions, disease states and responses to oxidative stresses. Oxidative lipidomics is beginning to provide new mechanistic insights into traumatic brain injury which may have significant translational potential for development of therapies in acute CNS insults. In particular, selective oxidation of a mitochondria-specific phospholipid, cardiolipin, has been associated with the initiation and progression of apoptosis in injured neurons thus indicating new drug discovery targets. Furthermore, imaging mass-spectrometry represents an exciting new opportunity for correlating maps of lipid profiles and their oxidation products with structure and neuropathology. This review is focused on these most recent advancements in the field of lipidomics and oxidative lipidomics based on the applications of mass spectrometry and imaging mass spectrometry as they relate to studies of phospholipids in traumatic brain injury.     

A clinico-demographic analysis of maxillofacial trauma in the elderly

doi: 10.1111/j.1741‐2358.2010.00431.x A clinico‐demographic analysis of maxillofacial trauma in the elderly Introduction: The elderly represent an increasing proportion of society. Management of maxillofacial trauma in this population may be complicated by coexisting medical conditions, requiring multi‐disciplinary care. Methods: This retrospective audit assesses the incidence and pattern of maxillofacial trauma in elderly patients (≥60 years) presented to the Merseyside Regional Maxillofacial Unit. Over the time period of 2003, 2004 and 2005, 7905 trauma patients presented to the accident and emergency department, of whom 757 were elderly (10%). Results: Results indicated that the male to female ratio was 1:1.4. The commonest cause of injury was a fall (83%) followed by an assault (6%); the majority of falls occurring in the home. Conclusion: Management of maxillofacial injuries in this population should focus on targeted prevention programmes, which address known risk factors for falling. We believe that this is a public health issue. Members of the maxillofacial team should be aware of common risk factors of falls in elderly. Better collaboration with the Medicine for Elderly team should be considered at an early stage on managing these patients.     

Prevention of trauma to edentulous ridge from opposing natural teeth

doi: 10.1111/j.1741‐2358.2010.00397.x Prevention of trauma to edentulous ridge from opposing natural teeth Objective: To suggest a technique to prevent trauma of the edentulous ridge from opposing natural or restored teeth. Background: The prevalence of the condition where one edentulous arch opposes a natural or restored dentition is quite common. In most of cases, the maxillary arch is completely edentulous and either all teeth or only anterior teeth are present in the mandibular arch. These remaining teeth may continuously cause trauma to the opposing edentulous ridge during the night when a removable prosthesis is kept out of the mouth. Materials and methods: A thermoplastic acrylic resin mouthguard was fabricated on a cast of the remaining teeth dentition. Conclusion: This article presents a simple and inexpensive procedure to prevent self‐induced trauma of the edentulous ridge from opposing natural teeth by using a thermoplastic acrylic resin mouthguard.