The spinal cord has the ability to regenerate but the microenvironment generated after trauma reduces that capacity. An increase in Src family kinase (SFK) activity has been implicated in neuropathological conditions associated with central nervous system trauma. Therefore, we hypothesized that a decrease in SFK activation by a long-term treatment with 4-amino-5-(4-chlorophenyl)-7-(t-butyl)pyrazolo[3,4-d]pyramidine (PP2), a selective SFK inhibitor, after spinal cord contusion with the New York University (NYU) impactor device would generate a permissive environment that improves axonal sprouting and/or behavioral activity. Results demonstrated that long-term blockade of SFK activation with PP2 increases locomotor activity at 7, 14, 21 and 28 days post-injury in the Basso, Beattie, and Bresnahan open ifeld test, round and square beam crossing tests. In addition, an increase in white matter spared tissue and sero-tonin ifber density was observed in animals treated with PP2. However, blockade of SFK activity did not change the astrocytic response or inifltration of cells from the immune system at 28 days post-injury. Moreover, a reduced SFK activity with PP2 diminished Ephexin (a guanine nucle-otide exchange factor) phosphorylation in the acute phase (4 days post-injury) after trauma. Together, these ifndings suggest a potential role of SFK in the regulation of spared tissue and/or axonal outgrowth that may result in functional locomotor recovery during the pathophysiolo-gy generated after spinal cord injury. Our study also points out that ephexin1 phosphorylation (activation) by SFK action may be involved in the repulsive microenvironment generated after spinal cord injury.

There is currently no standard pharmacological treatment for spinal cord injury. Here, we suggest that progesterone, a steroid hormone, may be a promising therapeutical candidate as it is already for traumatic brain injury, where it has reached phase II clinical trials. We rely on previous works showing anti-inflammatory, neuroprotective and promyelinating roles for progesterone after spinal cord injury and in our recent paper, in which we demonstrate that progesterone dimin-ishes lesion, preserves white matter integrity and improves locomotor recovery in a clinically relevant model of spinal cord lesion.

高迁移率族蛋白B1在创伤免疫功能紊乱中的作用及其调节机制

Objective To investigate the potential effect of high mobility group box 1 protein (HMGB1) on host immune response and its molecular regulation mechanism as well as its interventional pathway following major burns/trauma. Methods With both animal experiments and clinical investigation, serial studies were conducted to observe the effects of HMGB1 on changes in immune function of T lymphoeytes, dendritic cells, and macrophages both in vivo and in vitro. Results It was found that thermal injury or trauma induced a delayed and persistent increase in HMGB1 expression as well as its release in various tissues.HMGB1 formation could markedly influence the cell-mediated immunity, including the changes in T lymphocytes, dendritic cells, and macrophages following major trauma or burns. These effects were closely related with dysfunction of various organs in the course of sepsis. Conclusion These data proved that HMGB1 not only acts as a novel "late" inflammatory mediator but is also closely associated with immunosuppression after acute insults. HMGB1 might play an important role in inducing systemic inflammatory response together with host immunological dissonance, resulting in the development of septic complications. Intervention of HMGB1 expression and release presumably provides a potentially effective way to regulate both excessive inflammatory and immune response, thereby as a measure to improve the prognosis of severe sepsis secondary to major trauma.

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas (CCF) and their complications such as pseudoaneurysms. Methods: Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coil embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stent management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% (4/22). A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% (8/22). Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.

Objective To observe the clinical ef ect of the GBR technique in dental implant of traumatic dentition defect. Methods choose 20 patients who are experiencing dental defect and bone defect as a result of oral and maxil ofacial trauma, and implant 45 implants ( Ankylos or other type) by using the GBR technique. 3-6 months later, perform the second surgery and repair the upper structure. Observe the stability of implant, the condition of bone combination, the amount of bone mass around the implant and the change of the shape of soft tissue in the later 6-24 months. Results In the fol owing observing period after repairment, the condition of bone combination is good and the success rate is 100%. Further more, the shape of soft tissue is quite normal and patients are al satisfied with the results. The bone mass in the root area of implants is stable within the 6 months after the surgery and the vertical bone absorption in the neck is less than 1mm one year after the operation. Conclusion The GBR technique wil get a good ef ect of bone incremet and the patients wil suf er less during the surgery. Therefore, it is wel accpeted and can be used to treat a lot of symptoms, which make the GBR technique a bet er supplementary method in dental implant prosthesis of traumatic dentition defect.

?A?41-year-old?woman?with?blunt?abdominal?trau-ma?due?to?a?motor?vehicle?accident?presented?to?our?emergency?department.?The?patient?had?a?history?of?a?giant?hepatic?cavern-ous?hemangioma.?Emergency?exploratory?laparotomy?was?per-formed?for?suspected?intra-abdominal?bleeding?with?abdominal?compartment?syndrome,?and?more?than?4?liters?of?blood?and?blood?clots?were?removed.?An?active?bleeding?laceration?(5?cm)?of?a?hepatic?cavernous?hemangioma?was?detected?in?segment?III?of?the?liver.?The?bleeding?was?controlled?by?sutures,?Teflon?patches?and?tamponade.?The?abdomen?was?closed?temporarily?using?the?vacuum-assisted?method.?Because?of?the?presence?of?persistent? fresh? blood? through? abdominal? drainage? at? a? rate?of? >1? L/h,? splenectomy? was? performed? to? control? the? bleed-ing?again?by?sutures?and?Teflon?patches.?Finally,?the?abdomen?was?closed?using?a?biologic?mesh.?The?patient?was?discharged?home?30?days?after?trauma.?Bleeding?of?trauma-caused?hepatic?hemangioma?is?rare,?but?splenic?injury?due?to?blunt?abdominal?trauma?is?common.?An?in-depth?investigation?is?necessary?to?avoid?second?intervention.

Computer Assisted Rehabilitation Environment (CAREN) is a system that integrates a training platform (motion base), a virtual environment, a sensor system (motion capture) and D-flow software. It is useful for both diagnostic and therapeutic use. The human gait pattern can be impaired due to disease, trauma or natural decline. Gait analysis is a useful tool to identify impaired gait patterns. Traditional gait analysis is a very time consuming process and therefore only used in exceptional cases. With new systems a quick and extensive analysis is possible and provides useful tools for therapeutic purposes. The range of systems will be described in this paper, highlighting both their diagnostic use and the therapeutic possibilities. Because wounded warriors often have an impaired gait due to amputations or other extremity trauma, these systems are very useful for military rehabilitative efforts. Additionally, the virtual reality environment creates a very challenging situation for the patient, enhancing their rehabilitation experience. For that reason several Armed Forces have these systems already in use. The most recent experiences will be discussed; including new developments both in the extension of the range of systems and the improvement and adaptation of the software. A new and promising development, the use of CAREN in a special application for patients with post-traumatic stress disorder (PTSD), will also be reviewed.