Establishment of soft-tissue-injury model of high-voltage electrical burn and observation of its pathological changes

Exploring the underlying mechanism by transcriptome sequencing in rats with high-voltage electrical burns and the role of iron metabolism

BACKGROUND

Clinically, the condition of skeletal muscle injury is the key to the process of high voltage electrical burn (HVEB) wound repair. The aim of this study was to identify the potential mechanisms and intervention targets of skeletal muscle injury after HVEB.

METHODS

A skeletal muscle injury model in SD rats with HVEB was made. Pathological examination and transcriptome sequencing of injured skeletal muscles were performed, and the expression levels of key proteins and genes in related signaling pathways were verified.

RESULTS

Skeletal muscle injury was progressively aggravated within 48 h, then the injury was gradually repaired with scar formation occurring within 1 week. The mechanism of skeletal muscle injury is complex and varied, and ferroptosis is one of the mechanisms. The ferrous iron content in the injured skeletal muscle tissue of model rats increased significantly at 24 h after injury. After 24 h, damage to injured skeletal muscle tissue could be alleviated by increasing iron storage and blocking lysosomal phagocytosis of autophagy.

CONCLUSIONS

Skeletal muscle injury caused by HVEB is characterized by adjacent endangered tissue progression after injury. Ferroptosis is involved in the mechanism of HVEB, and iron metabolism-related proteins may be potential targets for preventing progressive skeletal muscle injury.

An experimental model of peripheral nerve electrical injury in rats

INTRODUCTION

Although several studies have investigated models of nerve electrical injury, only a few have focused on electrical injury to peripheral nerves, which is a common and intractable problem in clinical practice. Here, we describe an experimental rat model of peripheral nerve electrical injury and its assessment.

METHODS

A total of 120 animals were subjected to short-term corrective electrostimulation (50 Hz, 1-s duration) applied at varying voltages (control, 65, 75, 100, 125, and 150 V) to the exposed left sciatic nerve. Behavioural testing, electrophysiological measurements, and histopathological observation of the sciatic nerve were conducted at 1-, 2-, 4-, and 8-w follow-ups.

RESULTS

No functional defects were noted in the groups that received 65-V stimulation at any time point. Sciatic nerve functional defects were found after 2 w in animals that received 75-V stimulation, but function returned to normal after 4 w. In animals that received 100-V and 125-V stimulation, functional defects were observed at 4 w, but had partially recovered by 8 w. Conversely, animals that received 150-V stimulation did not show recovery after 8 w.

CONCLUSION

We presented a model of peripheral nerve electrical injury that avoided the interference of various external factors, such as current instability, compression of the surrounding tissues, and altered blood supply. The model allowed quantitation and ranking of the nerve injury into four degrees. It facilitated effective evaluation of nerve function impairment and repair after injury. It can be used post-surgically to evaluate peripheral nerve impairment and reconstruction and enables translational interpretation of results, which may improve understanding of the mechanisms underlying the progression of peripheral nerve electrical injury.

Advances in forensic diagnosis of electric shock death in the absence of typical electrical marks

Electrical injury is a relatively uncommon but potentially devastating form of multi-system injury with high morbidity and mortality. In common electric injury cases, it is usually difficult to find characteristic changes of electric injury in major organs by using routine histopathological test methods unless there are landmark traces of electric injury, known as electric marks. How to determine electric shock death, especially in the absence of typical electrical marks on the body surface in some cases (which account for about two-thirds of electric injury cases), remains a challenging problem in forensic practice. Our summary shows that many current related studies have focused their efforts to find characteristic histopathological changes in major organs of the body caused by electric injury. Based on the results obtained through comparison of the literature, we find that it may be more urgent and important to find the optimal autopsy or sampling sites in cases with no typical electric marks, knowing that these sites may often reflect the most significant histopathological changes of electric injury, for instance anatomy and sampling of the anterior wrist and the medial malleolus in cases involving the hand-to-foot electric circuit pathway. In this article, we make a summary of advances in identification methods of electric injury, hoping that it could provide some new insights for further research in this field.

Applications of 256-Slice, Spiral Computed Tomography Perfusion Scanning in Limb Salvage After High-Voltage Electrical Injury

OBJECTIVE

This study aimed to investigate the applications of intelligent 256-slice computed tomography (iCT) perfusion imaging in high-voltage electrical injuries (HVEIs).

METHODS

256-slice iCT was used to perform perfusion scanning for 48 patients with HVEI to detect the perfusion parameters.

RESULTS

The blood flow (BF) and peak enhancement intensity (PEI) values of the plane lower than the amputation level of the diseased side (ALD) were smaller than those of the corresponding healthy side (P<0.05); therefore, the differences were statistically significant. The BF value of the plane beyond the ALD was bigger than that of the ALD (t=2.99 and P=0.042); therefore, the difference was statistically significant. The BF, PEI, and blood volume values of the plane below the ALD were smaller than those of the ALD (P<0.05); therefore, the differences were statistically significant.

CONCLUSIONS

The technique of 256-slice iCT perfusion imaging could provide richer and more comprehensive imaging data for the clinical treatment of HVEIs, thus exhibiting its benefit in reducing the disability of patients with HVEIs. (Disaster Med Public Health Preparedness. 2018;12:478-485).

Electric injury-induced Purkinje cell apoptosis in rat cerebellum: Histological and immunohistochemical study

INTRODUCTION

Electrical injury is a prominent problem in low income countries with increased morbidity and mortality rate. Nervous system is one of the most susceptible systems to electrical current because of its low resistance. There were different studies demonstrated electrocution effect on the nervous system, however little was made on the cerebellum.

AIM

This study was conducted to produce an experimental suggestion concerning injury of the nervous system through evaluating Purkinje cell apoptosis and number in rat cerebellum by fatal and non-fatal electric current using histological and immunohistochemical study. Also to support the diagnosis of electrocution as a probable cause of death and delayed neurological damage as well as disability.

MATERIALS & METHODS

Fifty male Wistar rats were divided into five groups (10 rats each); control group: normal rats that were sacrificed without exposure to electric current, groups 1-3 (non-fatal electrocution groups): rats were exposed to alternating electric current (220v, 50Hz) for one minute then were sacrificed immediately, after 2h, and after 4h respectively, and group 4 (fatal electrocution group): rats were sacrificed after being electrified up to death (153±27s). Sections from cerebellum were processed for histological and caspase-3 immunohistochemical study.

RESULTS

Purkinje cells showed marked histopathological changes in the form of shrunken dark stained cells with significant reduction of their number in H &E stained sections when compared to control, widespread argyrophilia, and degenerated organelles along with shrunken irregular nuclei. For caspase-3 staining, there was significantly increased number of caspase-3 positive cells in groups 1-3 (non-fatal electrocution groups) and markedly increased in group 4 (fatal electrocution group) in comparison to control group. These changes were gradually increased with the increased duration after exposure to the electric current.

CONCLUSION

Apoptosis and loss of Purkinje cells were involved in the pathogenesis of immediate and long term effect of electrical injury on Purkinje cells, which will be an aid to the forensic pathologist to determine the cause of death and residual damage as well as disability after electric shock.

The Clinical and Medicolegal Analysis of Electrical Shocked Rats: Based on the Serological and Histological Methods

This research was aimed at discovering the serological and histological changes in cardiac and hepatic tissue after electric shock. The CK-MB, ALT, and AMS indexes were tested with serological methods. Moreover, the Bcl-2, Bax, and Hsp-60 expression levels were carefully measured. An electrical injury model was established by giving rats electric shocks at 110 V with alternating electric current. Blood samples from the rats were analyzed for the biochemical indexes. The degrees of pathological changes in the heart and liver were evaluated using IHC staining for Bcl-2, Bax, and Hsp-60. The levels of CK-MB in the electrical injury group rapidly peaked at 0.5 hours after the electric shock. Additionally, the levels of Bcl-2, Bax, and Hsp-60 in the cardiac and hepatic tissues changed regularly after the electrical injury and exhibited apparent differences from the levels in the control group. CK-MB, ALT, and AMS were altered regularly after electric shock, and these results provide significant information for clinical and medicolegal practice. This research has shed light on the assessment of electrical injury without obvious electrical burns. Furthermore, the findings obtained for Bcl-2/Bax and Hsp-60 can also facilitate pathological diagnosis and the identification of antemortem and postmortem electrical injury.

Electrical Injuries in Animals: Causes, Pathogenesis, and Morphological Findings

Electrical injuries in animals occur most often accidentally. They comprise contact to various forms of currents, including alternating, rotary, or direct currents. Depending on various parameters of the current (including the type of circuit, voltage, current and duration of exposure) and conditions of the animal (such as wet or dry hair coat and pathway of current through the body), lesions may be absent or may include early or localized development of rigor mortis, signs of acute circulatory failure, or severe thermoelectrical burns. Such burns may present as external current marks, singed hair or feathers, metallization of the skin, or occasionally internal electroporation injury resulting in muscle necrosis, hemolysis, vascular damage with thrombosis, injury to brain and spinal cord, or skeletal fractures. Furthermore, lightning strikes occur regularly in grazing animals, which have greater risk of death from step potentials (ground current) in addition to direct strike and contact injury. Such cases may have no lesions, external signs of linear or punctate burns, keraunographic markings, or exit burns on the soles of the hooves or the coronary bands. Besides detailed information about the circumstances at the location where the animal was found, electrical injuries in animals require a thorough morphological workup, including additional investigations in conjunction with certain knowledge about the possible lesion spectrum.

A new in vitro model to study cellular responses after thermomechanical damage in monolayer cultures

Although electrosurgical instruments are widely used in surgery to cut tissue layers or to achieve hemostasis by coagulation (electrocautery), only little information is available concerning the inflammatory or immune response towards the debris generated. Given the elevated local temperatures required for successful electrocautery, the remaining debris is likely to contain a plethora of compounds entirely novel to the intracorporal setting. A very common in vitro method to study cell migration after mechanical damage is the scratch assay, however, there is no established model for thermomechanical damage to characterise cellular reactions. In this study, we established a new in vitro model to investigate exposure to high temperature in a carefully controlled cell culture system. Heatable thermostat-controlled aluminium stamps were developed to induce local damage in primary human umbilical vein endothelial cells (HUVEC). The thermomechanical damage invoked is reproducibly locally confined, therefore allowing studies, under the same experimental conditions, of cells affected to various degrees as well as of unaffected cells. We show that the unaffected cells surrounding the thermomechanical damage zone are able to migrate into the damaged area, resulting in a complete closure of the ‘wound’ within 48 h. Initial studies have shown that there are significant morphological and biological differences in endothelial cells after thermomechanical damage compared to the mechanical damage inflicted by using the unheated stamp as a control. Accordingly, after thermomechanical damage, cell death as well as cell protection programs were activated. Mononuclear cells adhered in the area adjacent to thermomechanical damage, but not to the zone of mechanical damage. Therefore, our model can help to understand the differences in wound healing during the early phase of regeneration after thermomechanical vs. mechanical damage. Furthermore, this model lends itself to study the response of other cells, thus broadening the range of thermal injuries that can be analysed.

Unusual complications during endoscopic retrograde cholangiopancreatography (ERCP): electrical burn in the liver

Endoscopic retrograde cholangiopancreatography (ERCP) is the gold-standard technique for the diagnosis of biliary obstruction. ERCP is also used for therapeutic purposes. During these procedures (diagnostic and therapeutic), complications such as pancreatitis, infection, hemorrhage, perforation and cardiopulmonary problems may arise. Some of these complications occur frequently, while others are extremely rare, as in the case presented here. In this case report, we present a woman who suffered an electrical burn in the liver during therapeutic ERCP. To our knowledge, this is the first case ever reported, which was caused by a monopolar cutter during ERCP and diagnosed by magnetic resonance imaging (MRI).