Following a traumatic brain injury (TBI), the excessive release of proinflammatory cytokines is major cause of cerebral edema that can cause permanent neuronal loss. This study examined the changes in brain concentrations of proinflammatory cytokines IL-1, IL-6, TNF-α and TGF- after different doses of estrogen or progesterone treatment in brain-injured rats at 6 and 24 h post-injury. Adult female rats were divided into 14 groups, and underwent either bilateral ovariectomy (12 groups) or sham surgery (2 groups). The hormones or vehicle were given intraperitoneally 0.5 h after TBI. Moderate TBI was induced by Marmarou method in TBI or treatment groups and brain levels of proinflammatory cytokines were measured 6 and 24 h post-injury. The results indicated that high dose of estrogen (E2) and low dose of progesterone (P1) increase brain levels of IL-1 6 h post-injury by 52.8% and 79.2%, respectively compared to the vehicle. By the 24th h post-injury brain IL-1 level was reduced 27.5% and 27%, respectively compared to vehicle, when estrogen low dose (E1) and E2 were administered. Progesterone high dose treatment reduced brain level of IL-6 by 45.9% at 6 h post-injury and P1 treatment reduced IL-6 level by 20.5% at 24 h post-injury when compared to the vehicle. The brain TNF-α level was reduced by 72.5% by P2 at 6 h and 48.5% by E2 at 24 h post-injury, when compared to the vehicle. In addition, TGF- level seem to be increased by E1 up to 3.37 times at 24 h post-injury compared to the vehicle. Both doses of hormones showed increased levels of TGF- at 6 h post-injury, when compared to the vehicle. We conclude that progesterone and estrogen may change the levels of proinflammatory cytokines in the acute or delayed phases after TBI and this may be one of the mechanisms by which hormones reduce cerebral edema.

Globally more than a billion people, 15% of the population, lives with disability and most of disabilities are caused by injuries.. The aim of this study was to describe the prevalence of disability and its predictors at 1 and 3 months post-injury in Kashan City during 2014 - 2015..Patients and In this longitudinal follow-up study, 400 injured patients 15 - 65 years referred to Shahid Beheshti hospital in Kashan and hospitalized more than 24 hours were assessed for disability status with the WHODAS II 12-item instrument at 1 and 3-months post-injury. Patients based on their disability scores were divided into 5 groups: none, mild, moderate, severe and very severe. Work status was assessed at the 3-month follow-up with one question “Are you back at work following your injury”. Also, demographic characteristics and information about injury were gathered by a checklist. Data were analyzed using chi-square, Mann-Whitney U, Kruskal Wallis, Pearson correlation coefficient and logistic regression by SPSS software. The significance level was set at P < 0.05.. The mean disability scores at 1 and 3 months post-injury was 30.3 (9.2) and 18.8 (8.3), respectively and there was a statistical significant difference between disability status at 1 and 3 months after trauma (P < 0.0001). The rates of return to work in 262 employed patients at 1 and 3 months after injury were 29% and 55.4%, respectively. The disability score showed a statistically significant correlation with Injury Severity Score (ISS) (P < 0.0001), work return (P = 0.033), intensive care unit transfer (P < 0.0001), trauma type (P = 0.001) and age (P = 0.004). Also, age, ISS, duration of hospital stay and injury to extremities were predictors of disability.. More than half of the patients were disabled after 3 months of trauma. Elderly patients, patient with severe trauma, and long hospitalization and patients with extremity injuries were high risk for disability..

The present study was designed to evaluate the secondary microglial activation processes after spinal cord injury (SCI). A quantitative histological study was performed to determine ED-1 positive cells, glial cell density, and cavitation size in untreated SCI rats at days 1, 2, and 4, and weeks 1, 2, 3, and 4. The results of glial cell quantification along the 4900-µm long injured spinal cord showed a significant increase in glial cell density percentage at day 2 as compared to other days. Whereas the highest increase in ED-1 immunoreactive cells (monocyte/phagocyte marker in rats) was observed at day 2 (23.15%) post-injury. Evaluation of cavity percentage showed a significant difference between weeks 3 and 4 post-injury groups. This study provides a new insight into the multiphase immune response to SCI, including cellular inflammation, macrophages/microglia activation, glial cell density, and cavitation. Better understanding of the inflammatory processes associated with acute SCI would permit the development of better therapeutic strategies.

It is well-known that severe brain injury can make people susceptible to psychological symptoms. However, mild traumatic brain injury (MTBI) is still open for discussion..
This study aimed to compare psychological symptoms of MTBI patients with those without MTBI considering demographic auxiliary variables..
Patients and This prospective cohort study was conducted on 50 MTBI patients and 50 healthy subjects aged 15 - 65 years. Psychological assessment was carried out six months post-injury using a series of self-report measures including the brief symptom inventory (BSI) scale. Other information of the individuals in the two groups was recorded prospectively. Data were analyzed using the chi-square test, t-test, and multiple linear regression tests..
There was a significant difference between the MTBI patients and healthy subjects in all subscales and total score of BSI. Our findings showed that obsession-compulsion and anxiety subscales were significantly more common in the MTBI patients than in the healthy subjects. Also, multivariate regression analysis six months post- injury showed that head trauma and substance abuse can have an effect on psychological symptoms..
Mild traumatic brain injuries despite of the normal CT scan and history of substance abuse are closely related to psychological symptoms. Therefore, it is recommended that patients with brain trauma 6 months post-injury and subjects with a history of substance abuse be evaluated for psychological distress to support better rehabilitation..

Disorder of consciousness is the common problem of severe traumatic brain injury. There is controversy about the effects of sensory stimulation on the level of consciousness in comatose patients. The aim of this study was to compare the effect of early (7th days post injury) and late (15th DPI) onset sensory stimulation on the level of consciousness of the comatose patients. In this experimental and interventional study twenty – one patients with Glasgow Coma Scale (GCS) £ 8 at least be stable for 3 days post injury (DPI), Normal ICP in CT- scan, no sedation, no previous neurological disorder, aged 18-59 suffering from sever traumatic brain injury were selected and divided in to 3 groups. First group (early onset) was received intervention (tactile, acoustic, visual, R.O.M and smell as stimulation) from 7th DPI to 15th DPI. The second (late onset) was received the intervention as same as early group but from 15th DPI to 21th DPI. The last one (control group) had no intervention. Level of consciousness evaluated by GCS and CRS-R in all of them every other day during the first month after injury. Data were analyzed by use of paired T test, Pearsonian correlation and repeated measurement analysis. Repeated measurement analysis showed significant increase of GCS and CRS-R scores over the time (P<0.001). Significant changes were identified in CRS-R score between early and control group by post hoc test (P<0.05). Nevertheless, the increase of GCS score was different between groups, but this increase wasn’t statically significant (P=0/15). One week intervention of sensory stimulation on the 7-15 DPI can accelerate the trend of improvement in these patients. One thing many experts agree on is that starting rehabilitation early is of paramount importance to increase level of consciousness.

P2X4 receptor (P2X4R)، a purinoceptor expressed in activated spinal microglia، plays a key role in the pathogenesis of neuropathic pain. Spinal nerve injury induces up-regulation of P2X4R on activated microglia in the spinal cord، and blockade of this receptor can reduce neuropathic pain. The present study was undertaken to determine whether paroxetine، an inhibitor of P2X4R، could attenuate allodynia and hyperalgesia in chronic constriction injury (CCI) model of neuropathic pain when used preemptively or after the sciatic nerve injury. Male Wistar rats (150-200 g، n = 6) were divided into 3 different groups: 1- CCI vehicle-treated group، 2- Sham group، and 3- CCI paroxetine-treated group. Paroxetine (10 mg/kg، i. p.) was administered 1 h before surgery and continued daily until day 14. In other part of the study، paroxetine (10 mg/kg، i. p.) was administered at day 7 post injury and continued daily until day 14. von Frey filaments for mechanical allodynia and analgesia meter for thermal hyperalgesia were used to assay pain behavior. In a preventive paradigm، paroxetine significantly attenuated both mechanical allodynia and thermal hyperalgesia (P<0. 001). A significant decrease in pain behavior was seen with paroxetine on existing allodynia (P<0. 001) and hyperalgesia (P<0. 01) when initiated at day 7 post injury. It seems that paroxetine can attenuate pain behavior when administered before and also after sciatic nerve injury in CCI model of neuropathic pain.

3D printing is an evolving technology which has a potential application in the treatment pediatric forearm fractures. Verylittle has been published with regard to 3D casting in children. We present two cases in which upper extremity fractures inpediatric patients were treated by wearing a custom made 3D printed cast. At latest follow-up at least one year post-injury,the clinical outcomes were excellent.Orthopaedic surgeons may benefit from familiarizing themselves with the potential of 3D printing technology and utilizingits current applications, as well as devising future applications, in clinical practice.Level of evidence: IV

Damage control surgery (DCS) represents a staged surgical approach to the treatment of critically surgical approach to the treatment of critically injured trauma patients. Originally described in the context of hepatic trauma and post injury induced coagulopathy, the indications for DCS have extended to the management of extra abdominal trauma and non traumatic acute abdominal emergencies. Significant progress in trauma based resuscitation techniques had le to improved outcomes and a reduction in the DCS requirement.

Recent studies revealed the neuroprotective effects of green tea antioxidant on experimental cerebral ischemia but these effects on spinal cord injury (SCI) has not yet been studied. Rats were randomly divided into three groups of 18 rats each as follows: sham group(laminectomy) control group (SCI) and experimental group (EGCG). Spinal cord samples were taken 24 h after injury and studied for determination of lipid peroxidation levels and TUNEL reaction. Behavioral testing was performed weekly upto six weeks post-injury. Then the rats were euthanized for histopathological assessment. The results showed that lipid peroxidation levels were significantly decreased in experimental group. EGCG significantly reduced TUNEL-positive rate. Also EGCG reduced significantly lesion area and improved behavioral function more than the control group. EGCG treatment decreased secondary spinal cord injury.

Frog skin secretions have potentials against a wide spectrum of bacteria. Also, frog skin compositions have healing properties. The aim of this study was to investigate the antibacterial potentials along with healing properties of frog skin Rana ridibunda, a species which thoroughly lives in Iran marshes, as a biological dressing on wounds. In this study, excisional wounds, dressed with frog skin, were compared between experimental and control groups of guinea pigs. In the experimental groups, wounds were dressed with the dermal (FS) and epidermal (RFS) sides of fresh frog R. ridibunda skin, while only usual cotton gauze covered the wounds of the control group. Furthermore, microbial samples were taken on different days (0, 3, 5, and 7 days post injury) to count the number of the colony-forming units. Additionally, the microbial penetration test was performed on frog skin and then the progression of wound closure was evaluated. In the microbial studies, the bacterial load considerably declined in the wounds treated with FS and RFS compared with the control wounds. On day 7 post injury, the numbers of the colony-forming units for the FS, RFS, and control groups were 6.75, 105, and 375, respectively. In the penetration test, fresh frog skin showed to be a bacterial resistant dressing. The results revealed that the rate of wound closure in the experimental groups significantly was accelerated in comparison with that in the control group. Our results demonstrated the antimicrobial properties of frog skin as a wound dressing, which has antimicrobial effects per se. This biological dressing shows promise as an effective biological wound dressing insofar as not only is it capable of resisting microbes and accelerating wound healing but also it is cost-effective and easy to use..