Clinical Characteristics and Outcomes of Spinal and Orthopedic Trauma in Patients with Rheumatoid Arthritis

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Objective: Geriatric patients are more prone to traumatic injuries, particularly cranial traumas and spinal fractures resulting from falls, due to osteoporosis and sedentary lifestyles. As a primary measure against the Coronavirus-19 (Covid-19) pandemic, Turkey put into effect a lockdown for people aged 65 and above. This study aimed to compare the change in the number of cranial and spinal trauma cases in the age group of 65 and above who were placed under lockdown between 21st March and 3rd June 2020 with the number in the previous year. Materials and Methods: The study included patients aged 65 and above who presented to the emergency departments and neurosurgery clinics of two trauma centers in our city with cranial and spinal traumas between 21st March and 3rd June in 2019 and 2020. The patients were retrospectively categorized in terms of age, gender, type of trauma and treatment. Results: In total, 83 patients presented to the hospital between 21st March and 3rd June 2019 while only 12 patients presented between 21st March and 3rd June 2020 (p<0.001). Of the 83 patients hospitalised in 2019, 43 were male and 40 were female, and of the 12 patients admitted in 2020, 4 were male and 8 were female (p=0.232). In 2019, 37 of the patients presented with isolated cranial trauma, 27 with isolated spinal trauma and 19 with spinal+orthopaedic trauma. In 2020, 3 patients presented with isolated cranial trauma, 6 with isolated spinal trauma and 3 with spinal+orthopaedic trauma (p=0.33). Falls were the most common cause of geriatric injuries in 2019 and during the lockdown period. Conclusion: Our study reported that trauma was most likely to occur outside the home. Therefore, further research should be conducted to identify the causes of trauma outside the home for this age group and measures need to be taken accordingly to the reduce occurrence of such traumas.s.

Methylprednisolone in Spinal Cord Injury: The Possible Mechanism of Action

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may develop after exposure to severe psychological threats. It is characterized by debilitating symptoms such as re-experiencing and negative changes in mood and cognitions which are associated with comorbidity, functional impairment and increased mortality. Although orthopaedic trauma may be classified as a traumatic experience causing PTSD, the prevalence of PTSD in paediatric patients following orthopaedic trauma is currently unknown. This systematic review aimed to obtain insight into the prevalence of PTSD in paediatric patients after orthopaedic trauma (with or without surgical intervention). Seven medical literature databases were searched to identify studies reporting on the occurrence of PTSD in paediatric patients following orthopaedic trauma. Ten studies were included for analysis. Overall, the pooled prevalence of PTSD was 15% (95% confidence interval: -5.1%, 34.2%), with significant heterogeneity between studies regarding patient population (e.g. age, gender and type of orthopaedic injury) as well as tools used to diagnose PTSD - all influencing the occurrence of PTSD. As PTSD appears to be a relatively common psychological comorbidity after orthopaedic paediatric trauma, we emphasize that both clinicians and parents should be aware of PTSD symptoms in children to allow early treatment of PTSD. Approximately one in seven children may develop PTSD following orthopaedic trauma, highlighting the importance of systematic screening and monitoring of PTSD symptoms in paediatric patients recovering from orthopaedic injuries. Level II (systematic review of level-II studies).

Objective To establish a rat model of spinal cord injury (SCI) and evaluate the effect of in vivo treatment of SCI with FGL-NS peptide that could be self-assembled in vivo into functionalized nanofiber scaffold.Methods The rats were anesthetized and treated with laminectomy at the T10 vertebral segment.Then,the SCI models were established by compressing the spinal cord with a 24 g modified aneurysm clip.One day after SCI,the animals were respectively injected with 2.5 μl 580 μmol/L solution of glucose,1％ RADA-16 and 1％ FGL-NS peptide solution into the injured zone.After treatment for 3 days,1 week,3 weeks,5 weeks,7 weeks and 9 weeks,the functional recovery of SCI rats was evaluated by the Basso,Beattie and Bresnahan Locomotor Rating Scale.After treatment for 9 weeks,apoptosis rate and the number of neurons with neurite and astrocyte were detected by Caspase-3,neurofilament-200 (NF-200) and glial fibrillary acidic protein (GFAP) immunohistochemistry.Results The model of SCI in rats was established successfully.The Basso-Beattie-Bresnahan (BBB) scores of SCI rats treated with FGL-NS were higher than those in RADA-16 group after treatment for 5 weeks.The number of Caspase-3 positive cells in injuried zone treated with FGL-NS was (22.45 ± 2.74) per field,which was significantly less than in RADA-16 group [(30.86 ±3.75) per field].Meanwhile,the number of neurons with neurite in FGL-NS group was (35.32 ±3.12) per field,significantly more than that in RADA-16 group [(18.56 ±2.64) per field] and blank group [(14.83 ± 1.43) per field].Furthormore,FGL-NS inhibited the formation of astrogila at the site of injury.The integrated option density (IOD) in injuried zone treated with FGL-NS was 0.50 ± 0.02,significantly less than in control group (1.30 ± 0.09) and blank group (1.60 ± 0.11).Conclusion Functionalized peptide self-assembling nanofiber scaffolds containing FGL motif could be a useful biomaterial in nerve tissue engineering for improving the functional recovery of SCI rats,inhibiting the formation of astrogila,reducing the cell death and increasing the number of neurons in the injured zone. Key words: Spinal cord injury ; Self-assembly; Regeneration ; Tissue engineering; Scaffold

Objective To discuss the expression of Aldose reductase in acute spinal cord injury and the effect of Aldose reductase inhibitor on spinal cell apoptosis.Methods One hundred and fifty SD adult rats were randomly assigned to sham group (n =50),acute spinal cord injury (n =50 ),Aldose reductase inhibitor (Epalrestat Tablets) group (n =50),each group is divided into five sub- groups(6,12,24,48,72 h sub-groups).In the sham group,only laminectomy was applied; In the SCI group and the ARI group,the model were made by Allen' s method.The pathological changes in injured spinal cord were observed with hematoxylin and eosin staining.The aldose reductase was detected by Elisa methods.The TdTmediated dUTP nick end labeling (TUNEL) method was employed to determine neuronal apoptosis.Results After injury 6,12,24,48 and 72 h,the grey and white matter structure of damage area were damaged,with cavity forming and inflammatory cells infiltrating.The degree of ARI group was lighted than SCI group.The content of aldose reductase in the sham operation group after injury 3,12,24,48,72 h were (10.75 ±0.47),(10.61 ±0.44),(10.62±0.55),(10.92±0.49),(10.57±0.52) U/L,the AR contents of SCI group at corresponding time were ( 12.17 ± 0.65 ),( 14.09 ± 0.61 ),( 14.58 ± 0.72 ),( 15.45 ±0.47 ),( 15.33 ± 0.29 ) U/L,and the AR content of the ARI group at corresponding time were ( 10.84 ±0.21),(12.70±0.47),(12.84±0.55),(12.28±0.54),(11.95±0.90) U/L.The AR content of the SCI group at each time point were significantly higher than the shame operation group and ARI group ( P ＜0.05 ).The spinal cord apoptotic cells were rarely seen in the sham operation group at each time point.The apoptotic rates (％) of SCI group after injuried 3,12,24,48,72 h were were 8.45±0.51,27.38 ± 3.19,32.59 ±3.36,39.04 ±4.51,23.48 ±2.40,and the rates of the ARI group at corresponding time were 8.21 ±0.52,18.69 ±1.63,22.64 ±2.18,25.61 ±3.53,16.48 ± 2.23.The neuron apoptosis rates of SCI group at 12,24 、48and 72 h were higher than that of the ARI group (P ＜ 0.05 ).Conclusion After acute spinal cord injury the expression of the AR increased,ARI may reduce the spinal cord neurons cell apoptosis. Key words: Spinal cord injury; Aldose reductase; Cell apoptosis

Introduction: Spinal cord trauma (SCT) is an important cause of morbidity and mortality around the world. It affects different age groups, especially young adults who are victims of high-energy trauma. The most effective way to reduce the incidence of spinal cord trauma and its consequences is through preventive campaigns and control and surveillance measures through public agencies. The objective of this study is to outline the epidemiological profile of patients with spinal cord trauma attended at a tertiary care center in the city of São Paulo. Methods: Retrospective, cross-sectional study performed at a reference center for the care of patients with spinal cord injury in the State of São Paulo. Data were collected from the medical records of patients with spinal cord trauma between 2012 and 2016. Results: Of the 515 patients with spinal trauma, 153 (29.7%) had spinal cord injury of which 131 (85.62%) were male, and 22 (14.37%) were female, in a ratio of approximately 6:1. The mean age was 39.45 years. The main cause of spinal cord trauma observed was the fall from heights, with 72 cases (47.05%), and 52.94% were classified as Frankel A. Conclusions: The results showed that the majority of the patients were young, economically active, with low educational level, exposed to accidents that could be largely avoided. Most of these patients also had severe disabling injuries, which usually bring considerable psychological sequelae and economic consequences to the individual and to society. Level of evidence: IV. Type of study: Case series.

Objective In order to approach the mechanism of the spinal cord injury (SCI) repaired by OECs transplantation,the effects of olfactory ensheathing cells (OECs) transplantation on the expression of the nerve growth factor (NGF) in injured spinal cord was quantitatively studied.Methods The rat models of SCI were made by NTY - Ⅱ impactor ( 10g -25 mm) at T10 level There are 6 rats in the normal group and 48 rats in the injuried group. Then the injuried group was randomly divided into OECs transplantation group and DMEM group.The GFP - OECs were transplanted into the injured region immediately after SCI in the OECs transplantation group.The DMEM group used the DMEM/F12 to take the place of GFP - OECs.Nothing to do with normal control Thcn the locomotor function was appraised by BBB score at 1 day,7 day,14 day and 21 day.The expression of the NGF in the injured region was detected by the methods of immunohistochemistry and RT - PCR.Results The BBB score in OECs transplantation group was higher than the DMEM group and normal group at 1 day,7 day,14 day and 21 day.The expression of the NGF was advanced at 1 day,and highest at 7 day.The expression of the NGF in the OECs group was higher than the normal control group and the DMEM group at 21 day.Conclusions The expression of NGF can be up - regulated by OECs transplantation,which may be one of the mechanisms for OECs repairing injured spinal cord. Key words: Spinal cord injury; Olfactory ensheathing cells; Cell transplantation; Nerve growth factor

We evaluated by immunohistochemistry the presence of beta-amyloid precursor protein (beta APP) and ubiquitin-like material which may accumulate in axons of the human spinal cord subjected to injury. Autopsy material was obtained from nine cases with different types of trauma: breech delivery with neonatal spinal injury, compression of the cord induced by fractures of the vertebral column, haematomas or intradural meningioma. The posttrauma period ranged from 10 days to several years. The spinal cord of six control cases without evidence of injury presented beta APP immunoreactivity in nerve cell bodies and in a few axonal profiles but not in dendrites. Seven of the nine cases with spinal cord trauma showed an accumulation of beta APP-immunoreactive material in axons of the longitudinal tracts at the site of the injury. Five cases presented similar axonal immunoreactivity in the grey matter of the cord. Ubiquitin-like immunoreactivity was present in expanded axons in cases with spinal cord injury. Cases with spinal cord trauma thus present beta APP-immunoreactive axons particularly of the longitudinal tracts in the same way as in trauma to rat spinal cord and in various brain injuries. The aggregation of beta APP-immunoreactive material indicates disturbed axonal transport of beta APP. Accumulation of ubiquitin-like immunoreactive material in expanded axons at the site of trauma may be one prerequisite for degradation of abnormal proteins by the ubiquitin-mediated proteolytic pathway.

Mechanical trauma to the spinal cord causes extensive neuronal death, contributing to the loss of sensory-motor and autonomic functions below the injury location. Apoptosis affects neurons after spinal cord injury (SCI) and is associated with increased caspase activity. Cleavage of X-linked inhibitor of apoptosis protein (XIAP) after SCI may contribute to this rise in caspase activity. Accordingly, we have shown that the elevation of XIAP resulted in increased neuronal survival after SCI and improved functional recovery. Therefore, we hypothesise that neuronal overexpression of XIAP can be neuroprotective after SCI with improved functional recovery. In line with this, studies of a transgenic mice with overexpression of XIAP in neurons revealed that higher levels of XIAP after spinal cord trauma favours neuronal survival, tissue preservation, and motor recovery after the spinal cord trauma. Using human SH-SY5Y cells overexpressing XIAP, we further showed that XIAP reduced caspase activity and apoptotic cell death after pro-apoptotic stimuli. In conclusion, this study shows that the levels of XIAP expression are an important factor for the outcome of spinal cord trauma and identifies XIAP as an important therapeutic target for alleviating the deleterious effects of SCI.

Objective To investigate the effects of A20 suppressing NF - κB expression on spinal cord injury at early stage.Methods Female C57/BL/6J mice was randomly divided into treatment group,control group and sham group.Immediately after compression lesion in mouse spinal cord injury model,A20was applied to the damaged tissue by lipsome. RT - PCR and Western blot were employed to detect the expression of A20a ndWestern blot to detect NF - κB.TUNEL method was used to detecte the aptosis of neurocytes in the injuried spinal area.Behavioural recovery was assessed using Bassl Mouse Scale.Results 1hour after treatment,A20 expression appeared in leisoned tissue and gradually increased,resulted in steady decline of NF - κB activation.The number of TUNEL( + ) cells in injuried region began to decrease 1day after treatment and significantly in 3 weeks.Compared with control group,BMS of treatment group increased 1week after treatment and significantly in 2 and 3 weeks( P ＜ 0.05 ).Conclusions A20 could suppress the NF - κB expression,which would diminish the neural apoptosis and promote funtional recovery after spinal cord injury. Key words: Zinc finger protein A20; Spinal cord injury; NF - κB; Apoptosis

Does seasonal variation in orthopaedic trauma volume correlate with adverse hospital events and burnout?

Spinal cord injury is one of the main causes of neurological disability due to trauma. The most common cause of spinal cord trauma is due to traffic accidents, etc. Spinal cord trauma itself is classified into complete spinal cord trauma and incomplete spinal cord trauma. While the most common symptoms of spinal cord trauma are acute pain in the back of the neck, paraplegia, total motor sensory paralysis, loss of bladder control (urine retention, bladder distention), decreased sweating and vasomotor tone, decreased respiratory function, respiratory failure. Treatment of spinal cord injuries is primarily aimed at improving and maintaining sensory and motor function. Operative therapy is not recommended unless the patient has an indication for surgery. Incomplete spinal cord injuries tend to have a better prognosis than complete spinal cord injuries.

The Role of Therapeutic Hypothermia After Traumatic Spinal Cord Injury—A Systematic Review

Objective To observe the therapeutic effect of spinal cord injury(SCI)by transplantation cryopreserved neural stem ceils(NSCs).Methods 45 Wistar rats were randomly divided into three groups.with 15 rats in each group.Transplantations were carried out two days after SCI,group A:0.9% saline water,group B:NSCs,group C:cryopreserved NSCs.After the transplantation,immunohistochemical and tissue incision were appeared to detect the survival and differentiation of the transplanted ceils in nivo,and the methods of BBB and oblique plate were used to estimate the recovery of function.Results Group B and C all had active NSCs except group A.The injuried spinal cord A[(3.9±0.1)mm2],B[(1.2±0.3)mm2]and C[(1.1±0.3)mm2],there was an variance in the three groups (F=423.949,P＜0.01),BBB test:group A[(2.0±0.5)mark],B[(16.4±0.8)mark]and C [(16.0±1.4)mark],there was an variance in the three groups(F=970.157,P＜0.01),the oblique plate test:group A[(31.3±2.9)degree],B[(46.8±2.1)degree]and C[(46.5.4-2.4)degree],there was an variance in the three groups(F=151.099,P＜0.01),the tests demonstrate there were no variance in group B and C(all P＞0.05),there was no variance in living rate between the cryopreserved NSCs group [(55.9±5.2)%]and no eryopreserved[(65.1±3.4)%,t=3.334,P＞0.05].Conclusions Cryopreserved NSCs keep the ability of reproducdon and differentiation.NSCs is a kind of valuable cell resource for the therapy of SCI. Key words: Cryopreserved; Neural stem cells; Resuscitation; spinal cord injury; Transplantation