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Comparison of chest CT scan findings between COVID-19 and pulmonary contusion in trauma patients based on RSNA criteria:Established novel criteria for trauma victims

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Chinese Journal of Traumatology 2022年第3期25卷 170-176页

作者： Hossein Abdolrahimzadeh Fard Salahaddin Mahmudi-Azer Qusay Abdulzahraa Yaqoob Golnar Sabetian Pooya Iranpour Zahra Shayan Shahram Bolandparvaz Hamid Reza Abbasi Shiva Aminnia Maryam Salimi Mohammad Mehdi Mahmoudi Shahram Paydara Roham Borazjani Ali Taheri Akerdi Masome Zare Leila Shayan Mohammadreza Sasani Trauma Research Center Shahid Rajaee(Emtiaz)Trauma HospitalShiraz University of Medical SciencesShirazIran Department of General Surgery Kufa University of Medical SciencesNajafIraq Department of Intensive Care Medicine Trauma Research CenterShahid Rajaee(Emtiaz)HospitalShiraz University of Medical SciencesShirazIran Department of Radiology Medical Imaging Research Center.School of MedicineShiraz University of Medical SciencesShirazIran Department of Biostatistics Trauma Research CenterSchool of MedicineShiraz University of Medical SciencesShirazIran Student Research Committee Shiraz University of Medical SciencesShirazIran Trauma Intensive Care Unit Trauma Research CenterShahid Rajaee(Emtiaz)Trauma HospitalShiraz University of Medical SciencesShirazIran

Propose:In this study,we re-assessed the criteria defined by the radiological society of North America(RSNA)to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion.Methods:All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion,COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020.Included patients(Group P)were then classified into two groups based on polymerase chain reaction tests(Group Pa for positive patients and Pb for negative ones).Moreover,44 patients from the prepandemic period(Group PP)were enrolled.They were matched to Group P regarding age,sex,and trauma-related scores.Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria.The radiological findings were compared between Group P and Group PP;statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter.Finally,the sensitivity and specificity of each significant findings were calculated.The Chi-square test was used to compare the radiologica丨findings between Group P and Group PP.Results:In the Group PP,73.7%of all ground-glass opacities(GGOs)and 80%of all multiple bilateral GGOs were detected(p<0.001 and p=0.25,respectively).Single bilateral GGOs were only seen among the Group PP.The Chi-square tests showed that the prevalence of diffused GGOs,multiple unilateral GGOs,multiple consolidations,and multiple bilateral consolidations were significantly higher in the Group P(p=0.001,0.01,0.003,and 0.003,respectively).However,GGOs with irregular borders and single consolidations were more significant among the Group PP(p=0.01 and 0.003,respectively).Of note,reticular distortions and subpleural spares were exclusively detected in the Group PP.Conclusion:We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients.The clinical signs and symptoms are not always usefu

关键词： Chest wall CT contusion COVID-19 RSNA criteria Trauma

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Effects of neural stem cell transplantation on the motor function of rats with contusion spinal cord injuries:a meta-analysis

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Neural Regeneration Research 2020年第4期15卷 748-758页

作者： Kai Qian Tuo-Ye Xu Xi Wang Tao Ma Kai-Xin Zhang Kun Yang Teng-Da Qian Jing Shi Li-Xin Li Zheng Wang Department of Neurosurgery the First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu ProvinceChina Department of Intensive Care Unit the First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu ProvinceChina Department of Neurosurgery the Third Affiliated Hospital of Soochow UniversityChangzhouJiangsu ProvinceChina Department of Neurosurgery Huangshan City People’s HospitalHuangshanAnhui ProvinceChina Department of Neurosurgery Nanjing Brain Hospital Affiliated to Nanjing Medical UniversityNanjingJiangsu ProvinceChina Department of Neurosurgery Jintan Hospital Affiliated to Jiangsu UniversityJintanJiangsu ProvinceChina Department of Gerontology The First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu ProvinceChina

Objective:To judge the efficacies of neural stem cell(NSC)transplantation on functional recovery following contusion spinal cord injuries(SCIs).Data sources:Studies in which NSCs were transplanted into a clinically relevant,standardized rat model of contusion SCI were identified by searching the PubMed,Embase and Cochrane databases,and the extracted data were analyzed by Stata 14.0.Data selection:Inclusion criteria were that NSCs were used in in vivo animal studies to treat contusion SCIs and that behavioral assessment of locomotor functional recovery was performed using the Basso,Beattie,and Bresnahan lo-comotor rating scale.Exclusion criteria included a follow-up of less than 4 weeks and the lack of control groups.Outcome measures:The restoration of motor function was assessed by the Basso,Beattie,and Bresnahan locomotor rating scale.Results:We identified 1756 non-duplicated papers by searching the aforementioned electronic databases,and 30 full-text articles met the inclusion criteria.A total of 37 studies reported in the 30 articles were included in the meta-analysis.The meta-analysis results showed that transplanted NSCs could improve the motor function recovery of rats following contusion SCIs,to a moderate extent(pooled standardized mean difference(SMD)=0.73;95%confidence interval(CI):0.47–1.00;Pcontusion induction and the NSC transplantation sh

关键词： Basso,Beattie,and Bresnahan locomotor rating scale cell transplantation meta-analysis motor functional recovery neural regeneration neural stem cell neural stem cell transplantation rat model spinal contusion spinal cord injury

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Pulmonary contusion mimicking COVID-19:A case report

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World Journal of Clinical Cases 2020年第8期8卷 1554-1560页

作者： Li-Ru Chen Zheng-Xin Chen Yang-Chun Liu Lei Peng Ye Zhang Quan Xu Qing Lin Yun-Ming Tao Hao Wu Sui Yin Ye-Ji Hu Department of Thoracic Surgery Jiangxi Provincial People’s Hospital Affiliated to Nanchang UniversityNanchang 330006Jiangxi ProvinceChina Department of Surgery Yongxin County People's HospitalJi’an 343400Jiangxi ProvinceChina

BACKGROUND Coronavirus disease 2019(COVID-19)is a major public health emergency with obvious characteristics of human-to-human transmission,and there are infective asymptomatic carriers.Early identification and proper management of patients with COVID-19 are important.Features in chest computed tomography(CT)can facilitate identifying newly infected individuals.However,CT findings of some lung contusions are similar to those of COVID-19,as shown in the present case.CASE SUMMARY A 46-year-old woman was admitted to hospital for backache and foot pain caused by a fall injury 1 d before hospitalization.She was suspected of having COVID-19,since there was a confirmed COVID-19 case near her residence.But she had no fever,cough,chest tightness,difficult breathing,nausea,vomiting,or diarrhea,etc.On physical examination,the lower posterior chest of both sides showed dullness on percussion and moist rales at the end of inspiration on auscultation.The white blood cell count and lymphocyte count were 10.88×109/L and 1.04×109/L,respectively.CT performed on February 7,2020 revealed that both lungs were scattered with patchy ground-glass opacity.The patient was diagnosed with pulmonary contusion with thoracic spinal fracture(T12),calcaneal fracture,and pelvic fracture.On day 9 after conservative treatment,her condition was alleviated.On review of the chest CT,the previous shadows were significantly reduced.CONCLUSION Differential diagnosis of lung contusion and COVID-19 must be emphasized.Both conditions require effective prompt actions,especially COVID-19.

关键词： COVID-19 Pulmonary contusion Computed tomography Differential diagnosis Case report Ground-glass opacity

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Early neurosurgical intervention of spinal cord contusion： an analysis of 30 cases

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Chinese Medical Journal 2008年第24期121卷 2473-2478页

作者： ZHU Hui FENG Ya-ping Young Wise YOU Si-wei SHEN Xue-feng LIU Yan-sheng JU Gong Clinical Center for Spinal Cord Injury PLA Kunming General Hospital Kunming Yunnan 650032 China W. M. Keck Center for Collaborative Neuroscience Rutgers the State University of New Jersey NJ 08854 USA Department of Anatomy LKS Faculty of Medicine The University of Hong Kong Hong Kong SAR China Institute of Neurosciences Fourth Military Medical University Xi'an Shaanxi 710032 China

Background The incidence of spinal injury with spinal cord contusion is high in developed countries and is now growing in China. Furthermore, spinal cord injury happens mostly in young people who have a long life expectance. A large number of patients thus are wheelchair bound for the rest of their lives. Therefore, spinal cord injury has aroused great concern worldwide. Despite great efforts, recovery from spinal cord injury remains unsatisfactory. Based on the pathology of spinal cord contusion, an idea of early neurosurgical intervention has been formulated in this study. Methods A total of 30 patients with ＂complete＂ spinal cord injury or classified as American Spinal Injury Association （ASIA）-A were studied. Orthopedic treatment of the injured vertebra（e）, internal fixation of the vertebral column, and bilateral laminectomy for epidural decompression were followed directly by neurosurgical management, including separation of the arachnoid adhesion to restore cerebrospinal fluid flow and debridement of the spinal cord necrotic tissue with concomitant intramedullary decompression. Rehabilitation started 17 days after the operation. The final outcome was evaluated after 3 months of rehabilitation. Pearson chi-square analysis was used for statistical analysis. Results All the patients recovered some ability to walk. The least recovered patients were able to walk with a wheeled weight support and help in stabilizing the weight bearing knee joint （12 cases, 40%）. Thirteen patients （43%） were able to walk with a pair of crutches, a stick or without any support. The timing of the operation after injury was important. An optimal operation time window was identified at 4-14 days after injury. Conclusions Early neurosurgical intervention of spinal cord contusion followed by rehabilitation can significantly improve the locomotion of the patients. It is a new idea of a therapeutic approach for spinal cord contusion and has been proven to be very successful.

关键词： spinal cord contusion neurosurgery rehabilitation

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Therapeutic exploitation of the S-nitrosoglutathione/S-nitrosylation mechanism for the treatment of contusion spinal cord injury

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Neural Regeneration Research 2019年第6期14卷 973-974页

作者： Mushfiquddin Khan Inderjit Singh Department of Pediatrics Children's Research InstituteMedical University of South Carolina

contusion spinal cord injury(SCI)is a major medical and socio-economic problem globally.The incidence of SCI is highest among young adults due to motor vehicle accidents,military or sports injuries,and violence(Selvarajah et al.,2014).The elderly and children are also at risk due to falls and accidents.SCI causes neurodegeneration,with profound loss of locomotor and sensory functions(Siddiqui et al.,2015).Pain and depression are also prevalent in a majority of SCI patients.Expenses for severe SCI are high:initial hospitalization,rehabilitation,and most likely the continuing need for a caregiver and medical care.SCI survivors with less severe injuries usually face lower but still hefty medical bills.However,people≥50 years old with severe SCI may face medical expenses of over$1.8 million during their lifetimes.These injuries also affect spouses and family members,emotionally and financially,and most injuries jeopardize employment for those affected.

关键词： contusion spinal major medical sports injuries

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Effects of amyloid precursor protein peptide APP96-110,alone or with human mesenchymal stromal cells,on recovery after spinal cord injury

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Neural Regeneration Research 2022年第6期17卷 1376-1386页

作者： Stuart I.Hodgetts Sarah J.Lovett D.Baron-Heeris A.Fogliani Marian Sturm C.Van den Heuvel Alan R.Harvey School of Human Sciences The University of Western Australia(UWA)PerthWAAustralia Perron Institute for Neurological and Translational Science PerthWAAustralia Cell and Tissue Therapies WA(CTTWA) Royal Perth HospitalPerthWAAustralia Adelaide Medical School Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSAAustralia

Delivery of a peptide(APP96-110),derived from amyloid precursor protein(APP),has been shown to elicit neuroprotective effects following cerebral stroke and traumatic brain injury.In this study,the effect of APP96-110 or a mutant version of this peptide(mAPP96-110)was assessed following moderate(200 kdyn,(2 N))thoracic contusive spinal cord injury(SCI)in adult Nude rats.Animals received a single tail vein injection of APP96-110 or mAPP96-110 at 30 minutes post-SCI and were then assessed for functional improvements over the next 8 weeks.A cohort of animals also received transplants of either viable or non-viable human mesenchymal stromal cells(hMSCs)into the SC lesion site at one week post-injury to assess the effect of combining intravenous APP96-110 delivery with hMSC treatment.Rats were perfused 8 weeks post-SCI and longitudinal sections of spinal cord analyzed for a number of factors including hMSC viability,cyst size,axonal regrowth,glial reactivity and macrophage activation.Analysis of sensorimotor function revealed occasional significant differences between groups using Ladderwalk or Ratwalk tests,however there were no consistent improvements in functional outcome after any of the treatments.mAPP96-110 alone,and APP96-110 in combination with both viable and non-viable hMSCs significantly reduced cyst size compared to SCI alone.Combined treatments with donor hMSCs also significantly increased βIII tubulin^(+),glial fibrillary acidic protein(GFAP^(+))and laminin+expression,and decreased ED1^(+)expression in tissues.This preliminary study demonstrates that intravenous delivery of APP96-110 peptide has selective,modest neuroprotective effects following SCI,which may be enhanced when combined with hMSC transplantation.However,the effects are less pronounced and less consistent compared to the protective morphological and cognitive impact that this same peptide has on neuronal survival and behaviour after stroke and traumatic brain injury.Thus while the efficacy of a particular therapeutic approach in one CNS inju

关键词： amyloid precursor protein cell transplantation combination contusion functional recovery mesenchymal stromal cells neuroprotection regeneration spinal cord injury tissue sparing

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Experimental study of prethrombotic state in early severe myocardial contusion

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Journal of Medical Colleges of PLA(China) 1999年第4期14卷 289-293页

作者：蔡建辉刘维永易定华罗新林

Objective: To explore whether there existed prethrombotic state (PTS) in early severe myocardial contusion and its changes,so as to provide theoretical evidence for early clinical diagnosis and better treatment. Methods: The present study was carried out in the graded myocardial contusion model in rabbits,which had been previously established by the authors. Fourteen New Zealand rabbits were divided into 2 groups at random :Experimental group (severe myocardial contusion, n = 8) and control group (sham-impact, n = 6). The dynamic changes ofhemorrheology,tissue-type plasminogen activator (t-PA) activity,plasminogen activation inhibitor (PAI) activity,and pathologic changes were observed for 240 min after the impact or sham-impact. Results: ①In experimentalgroup,whole blood viscosity at low shear rate (ηb1) and erythrocyte aggregation index (EAI) increased significantly 30 min after contusion compared with those of pre-impact or control rabbits. There was a tendency of ηb1 andEAl descent 120 min after contusion,but they still remained high 240 min after contusion (Pcontusion. The t-PA activity was significantly lower and PAI activity wad significantly higher 120 min aftercontusion than those in pre-impact or in control rabbits. Both t-PA and PAI activity showed more significantchanges 240 min after contusion. Pathologic changes were compatible with the changes of severe myocardial contusion. And the injury of coronary artery endothelial cells was found. ②In the control group,there were no significant changes in the aforementioned parameters. Conclusion: There is a PTS at the early stage of severe myocardialcontusion. PTS may be one of important factors in the development of severe myocardial contusion and its complications.

关键词： myocardial contusion prethrombotic state

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In the presence of danger: the extracellular matrix defensive response to central nervous system injury

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Neural Regeneration Research 2014年第4期9卷 377-384页

作者： Lyn B.Jakeman Kent E.Williams Bryan Brautigam Department of Physiology and Cell Biology Ohio State University Wexner Medical CenterColumbusOHUSA Neuroscience Graduate Studies Program Ohio State University Wexner Medical CenterColumbusOHUSA Biomedical Research Graduate Program Ohio State University Wexner Medical CenterColumbusOHUSA OSU Center for Brain and Spinal Cord Repair Ohio State University Wexner Medical CenterColumbusOHUSA

Glial cells in the central nervous system （CNS） contribute to formation of the extracellular matrix, which provides adhesive sites, signaling molecules, and a diffusion barrier to enhance efficient on and axon potential propagation. In the normal adult CNS, the extracellular matrix （ECM） is relatively stable except in selected regions characterized by dynamic remodeling. However, after trauma such as a spinal cord injury or cortical contusion, the lesion epicenter becomes a focus of acute neuroinflammation. The activation of the surrounding glial cells leads to a dramatic change in the composition of the ECM at the edges of the lesion, creating a perilesion environment dominated by growth inhibitory molecules and restoration of the peripheral/ central nervous system border. An advantage of this response is to limit the invasion of damaging cells and diffusion of toxic molecules into the spared tissue regions, but this occurs at the cost of inhibiting migration of endogenous repair cells and preventing axonal regrowth. The following review was prepared by reading and discussing over 200 research articles in the field published in PubMed and selecting those with significant impact and/or controversial points. This article highlights structural and functional features of the normal adult CNS ECM and then focuses on the reactions of glial cells and changes in the perilesion border that occur following spinal cord or contusive brain injury. Current research strategies directed at modifying the inhibitory perilesion microenvironment without eliminating the protective functions of glial cell activation are discussed.

关键词： nerve regeneration glial scar proteoglycan axon growth spinal cord injury contusion inhibitory inflammation astrocyte macrophage neural regeneration

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Nogo-A expression dynamically varies after spinal cord injury

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Neural Regeneration Research 2015年第2期10卷 225-229页

作者： Jian-wei Wang Jun-feng Yang Yong Ma Zhen Hua Yang Guo Xiao-lin Gu Ya-feng Zhang Wuxi Hospital of Traditional Chinese Medicine Institute of Orthopedics and Traumatology of Nanjing University of Chinese Medicine Nanjing University of Chinese Medicine

The mechanism involved in neural regeneration after spinal cord injury is unclear. The my-elin-derived protein Nogo-A, which is speciifc to the central nervous system, has been identiifed to negatively affect the cytoskeleton and growth program of axotomized neurons. Studies have shown that Nogo-A exerts immediate and chronic inhibitory effects on neurite outgrowth.In vivo, inhibitors of Nogo-A have been shown to lead to a marked enhancement of regenerative axon extension. We established a spinal cord injury model in rats using a free-falling weight drop device to subsequently investigate Nogo-A expression. Nogo-A mRNA and protein expression and immunoreactivity were detected in spinal cord tissue using real-time quantitative PCR, immu-nohistochemistry and western blot analysis. At 24 hours after spinal cord injury, Nogo-A protein and mRNA expression was low in the injured group compared with control and sham-operated groups. The levels then continued to drop further and were at their lowest at 3 days, rapidly rose to a peak after 7 days, and then gradually declined again after 14 days. These changes were observed at both the mRNA and protein level. The transient decrease observed early after injury followed by high levels for a few days indicates Nogo-A expression is time dependent. This may contribute to the lack of regeneration in the central nervous system after spinal cord injury. The dynamic varia-tion of Nogo-A should be taken into account in the treatment of spinal cord injury.

关键词： nerve regeneration spinal cord injury contusion Nogo-A axon growth immunohisto-chemistry fluorescent quantitative PCR neural regeneration

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Neural progenitor cells but not astrocytes respond distally to thoracic spinal cord injury in rat models

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Neural Regeneration Research 2017年第11期12卷 1885-1894页

作者： Tara Nguyen Yilin Mao Theresa Sutherland Catherine Anne Gorrie School of Life Sciences Faculty of ScienceUniversity of Technology SydneyNew South WalesAustralia

Traumatic spinal cord injury （SCI） is a detrimental condition that causes loss of sensory and motor function in an individual. Many complex secondary injury cascades occur after SCI and they offer great potential for therapeutic targeting. In this study, we investigated the response of endogenous neural progenitor cells, astrocytes, and microglia to a localized thoracic SCI throughout the neuroaxis. Twenty-five adult female Sprague-Dawley rats underwent mild-contusion thoracic SCI （n = 9）, sham surgery （n = 8）, or no surgery （n = 8）. Spinal cord and brain tissues were fixed and cut at six regions of the neuroaxis. Immunohistochem- istry showed increased reactivity of neural progenitor cell marker nestin in the central canal at all levels of the spinal cord. Increased reactivity of astrocyte-specific marker glial fibrillary acidic protein was found only at the lesion epicenter. The number of activated microglia was significantly increased at the lesion site, and activated microglia extended to the lumbar enlargement. Phagocytic microglia and macrophages were significantly increased only at the lesion site. There were no changes in nestin, glial fibrillary acidic protein, microglia and macrophage response in the third ventricle of rats subjected to mild-contusion thoracic SCI compared to the sham surgery or no surgery. These findings indicate that neural progenitor cells, astrocytes and microglia respond differently to a localized SCI, presumably due to differences in inflammatory signaling. These different cellular responses may have implications in the way that neural progenitor cells can be manipulated for neuroregeneration after SCI. This needs to be further investigated.

关键词： nerve regeneration contusion spinal cord neuroinflammatory ependymal cell glial fibrillary acidic protein microglia nestin neuroaxis tanycyte third ventricle trauma neural regeneration

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