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OBJECTIVE: To study the activation of p38 mitogen-activated protein kinase (MAPK) in the brain of rabbits after craniocerebral gunshot injury in a hot and humid environment (HHE) and explore its possible mechanism. METHODS: Craniocerebral gunshot injury model was established in 30 New Zealand white rabbits, which were subsequently exposed to environment of normal temperature (at 22.0% +/- 0.5 degrees C; with relative humidity of 50%) or HHE at 39.0 +/- 0.5 degrees C; with relative humidity of 80%-85% for 10 min, 30 min, 1 h, 1.5 h, and 2 h groups, respectively, with 5 rabbits in each group. p38 MAPK activity in the brain tissues of the rabbits following the injury and environmental exposure were detected by Western blotting and analyzed semi-quantitatively by Bio-Profil gel image analysis system. RESULTS: p38 MAPK activity in the cortex and hypothalamus was significantly elevated following gunshot injury and HHE exposure, reaching the peak level at 1 h of HHE exposure and then decreased. p38 MAPK activity was significantly higher in the hypothalamus than in the cortex. CONCLUSION: p38 MAPK activity increases in the early stage following craniocerebral gunshot injury and HHE exposure in rabbits, the mechanism of which might involve the secondary brain insult.

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OBJECTIVE: To study the dynamic changes in lipid peroxidation and the activity of antioxidative enzyme in canine limbs with gunshot wound in hot and humid environment. METHODS: Eighteen dogs with gunshot wound were randomly assigned into 3 groups with equal numbers. Dogs observed after injury in normal environment was designated as NE group, those in hot and humid environment as HHE group and those in hot and humid environment with preceding heat acclimatization training as HA group. Contents of superoxide dismutase (SOD) and malonaldehyde (MDA) in both the peripheral blood and muscular tissues from gunshot wound tract were measured at 0, 1, 3, 4, 6, 8, 10, 14, 18 and 24 h respectively after the dogs had been wounded. RESULTS: Positive correlation between SOD and MDA contents was observed in each group. Three hours after injury, MDA level in HHE group began to ascend, reaching the peak level at 6 h that was significantly higher than those in the other 2 groups (P<0.05); SOD level underwent a reverse change, which was significantly lower in HHE group than in the other groups with that in HA group being the highest. Comparable SOD levels in the groups occurred at the time of 14 h, which happened to MDA levels 4 h later. CONCLUSION: Gunshot injuries in the limbs of dogs exposed to hot and humid environment induces increased free oxygen and aggravated the lipid peroxidation, which can be alleviated by heat acclimatization.

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Histochemical quantification of the nonspecific esterase (NSE) in injured skin was performed using histochemical demonstration of the enzyme and a microspectrophotometric scanning technique on specimens taken from 32 Hartley guinea-pigs and 8 cases of human skin wounds. In all antemortem incisions and lacerations, including those made at the agonal stage, NSE activity could be observed in the dermal tissue of the wound edge. The enzyme activity increases with the antemortem duration of the injuries. Both total content and mean concentration of NSE in the wound edge between antemortem and postmortem wound groups differ significantly (less than 0.01). Multiple range test shows that significant differences (P less than 0.05 or P less than 0.01) of total content of NSE in the wound edge also exist in 0-5 min, 15-30 min, 1-h, 2-h and 4-h antemortem incised wound groups and in 0-min, 5-min, 15-30 min, 1-h and 4-h antemortem laceration groups. The positive NSE reactions in 8 cases of human skin wounds were similar. The study indicates that histochemical quantification of NSE in injured skin is very useful in timing wounds and is exactly applicable in medicolegal practice. According to the different influences of inhibitors on enzymes, it was inferred that the enzyme activity in wound edges was due to B-esterase.

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Fifty-eight patients admitted through our emergency room with severe skeletal muscle injury but no obvious cardiac contusions were evaluated for creatine kinase isoenzyme MB (CK-MB). When such patients show an above-normal value for total CK, it is a question of whether or not myocardial injury has been sustained along with skeletal muscle injury when (a) there are no obvious chest contusions or (b) the patient is unconscious and unable to complain of chest pain. Whenever there is doubt concerning the cardiac status of a patient, lactate dehydrogenase (LD) isoenzymes, serial electrocardiograms, and CK isoenzymes are ordered. Our study revealed that serum of 8.6% of the trauma victims had CK-MB values exceeding 5.0 EU/L (reflecting abnormal CK-MB concentrations) as part of their increased total CK. All patients had normal electrocardiographic patterns along with negative results for LD isoenzymes; none had sustained any demonstrable myocardial injury. The CK-MB value must be interpreted together with the total CK value for appropriate diagnosis in patients with skeletal muscle trauma.

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On the basis of experimental study on 17 dogs, this paper reports on the variation of serum creatine kinase (SCK) with time in the early phase of wounding by spherical steel bullets at three different velocities and its relation with the kinetic energy absorbed by the tissue and with the amount of the excised necrotic tissue surrounding the wound tracks. The results showed that the energy absorbed by the tissue and the amount of the excised necrotic tissue surrounding the wound tracks increased with increasing velocity. Within a period of 6 hours after wounding the SCK activity increased correspondingly.

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Electron microscopy and histochemical tests were used to study the effect of cystamine on gunshot wound healing in experiments on 24 rabbits. Cystamine was established to speed up maturation of the granulation tissue, epithelization of the wound surface and to make the period of gunshot wound healing 4-5 days shorter.

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In the present study, 78 patients with a blunt thorax trauma were examined. Fifty-four percent of the patients had been injured in traffic. Creatinine kinase (CK) and its isoenzymes (MM, MB and BB), ASAT, ALAT, ECG and thorax X-ray were taken. In 24% of the patients examined, the activity of serum MB isoenzyme was greater than or equal to 6% of the total activity of CK, and in 40% no MB activity was observed. Pathological ECG changes were detected in 89% in the MB greater than or equal to 6% group and in 32% in the MB = 0% group. ECG changes cannot be regarded as specific indicators of cardiac contusion. Arrhythmias, conduction defects, ST segment and T wave changes, and a pathologically long QTc interval were present significantly more often (P less than 0.01) in the MB greater than or equal to 6% group than in the MB = 0% group. Roentgenologically, pulmonary contusion, cardiac dilatation and venous congestion-pulmonary edema were diagnosed more frequently in the MB greater than or equal to 6% group (P less than 0.01) than in the MB = 0% group. Eleven of the patients died. A forensic autopsy was performed on these patients, and a macroscopic heart injury was detected in five of them. Serum MB activity had been found in all these five.

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The unexpected finding of hyperamylasemia in a patient with isolated head injury prompted a study of amylase levels in patients with various degrees of cranial trauma. None of seven patients with isolated maxillofacial trauma had hyperamylasemia. This group was studied to discount injury to salivary glands as a source of elevated amylase levels. Only one of ten patients with simple cranial injury without computerized tomographic (CT) scan evidence of intracranial bleeding had hyperamylasemia. Six of ten patients with CT scans positive for intracranial bleeding had hyperamylasemia. Isoamylase analysis showed that the source of the hyperamylasemia was varied. These results suggest a central neural control of serum amylase levels. The reliability of the serum amylase level as an indication of pancreatic trauma in a patient with concomitant head injury is questioned.

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Anesthetized pigs were wounded in the thigh with a spherical missile at an impact velocity of 1500 m/sec. Arterial blood samples were taken before injury and at frequent intervals up to 12 hours after injury. Unbound (free) and total kallikrein (kallikrein + prekallikrein) were analyzed with a chromogenic substrate (S-2302, Kabi, Sweden) in which enzyme activity is determined spectrophotometrically by the development of a yellow colour. The results indicate an activation of the kallikrein-kinin system in bullet wounding, the significance of which remains to be determined.

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