Traumatic injury components

Several picrotoxane-containing plants are used in traditional medicines. Cor-iaria species play an important role in Chinese traditional medicine, notably against mental diseases. Coriaria nepalensis is used against numbness, toothache, traumatic injury, and conjunctivitis (252). In the traditional medicine of Taiwan, gastrointestinal disturbances, rheumatism, and uterine cancer are treated with extracts of Coriaria intermedia (255). C. sinica is used for treatment of schizophrenia (29), and extracts of the parasitic plant on C. nepalensis, L. parasiticus, were used as shock therapy in schizophrenia (27). Okuda et al. point to corianin (21) as the main active component (27). 

Acute pain is an adaptive physiological response that follows traumatic injuries and surgery. It has two primary components. (1) The sensory discriminative component describes the location and quality of the stimulus. It is characterized by rapid response, short latency to peak response, and short duration of action. Noxious information is conveyed by rapidly conducting A-delta fibers, and monosynaptic transmission to the sensory cortex [10,12]. This component rapidly identifies the site of injury or potential injury, and initiates reflexive/cognitive withdrawal responses. (2) The affective-motivational component underlies suffering and the emotional components of pain and is responsible for learned avoidance and other adaptative and non-adaptative behavioral responses. 

The neuroprotective properties of mild hypothermia have been demonstrated in numerous experimental animal models. Research in this area has been conducted for many years, yet the mechanisms of cerebral protection by mild hypothermia remain unclear and continue to be the subject of intense investigation. The neuroprotective effects of mild hypothermia have been attributed to alterations in metabolic rate (24), neurotransmitter release (25-27), activity of protein kinases (28), resynthesis of cellular repair proteins (29), cerebral blood flow (30), preservation of the blood-brain barrier (BBB) (31), attenuation of inflammatory processes (32,33), and decreases in free radical production (34). Although these may all be components of a complex cascade leading to neurologic injury, it has become increasingly clear that the primary mechanism of action of hypothermia may be different at various temperatures as well as under different ischemic and traumatic conditions. 

Proteases contribute to the inflammatory response to injury, forming a final common pathway that leads to BBB breakdown, hemorrhage, and cell death. After traumatic and ischemic injuries, there is a buildup of lactate, which is increased with hyperglycemia. Acidosis leads to release of acid hydrolases, which are destructive enzymes that attack cellular components, including membranes, resulting in cell necrosis. In situations where the pH remains neutral, increases in intracellular calcium and cytokines cause induction of neutral proteases. The main neutral proteases are the extracellular matrix-degrading MMPs, plasminogen activator/plasmin, and caspases. 

Finally, it is well recognized that certain acute traumatic and chronic pain conditions are associated with a mixture of noiciceptive inflammatory and neuropathic pain. For example, tissue injury and a marked inflammatory response following laparotomy or thoracotomy initiates a somatic nociceptive component responsible for incisional and muscular pain, while peritoneal or pleuritic irritation is responsible for a visceral nociceptive component. Neural injury related to retraction or transection initiates a neuropathic component. Clinical pain complaint, intensity of symptoms, pain characteristics and choice of analgesic are related to the extent of inflammation, visceral versus somatic nociception, and neural tissue injuries. 

The term reiteration is used in two senses as a part of normal development, and as part of the response of the plant to damage or injury. The latter, partial or traumatic reiteration, is a response to damage to a component of the architectural unit (e.g., a secondary or tertiary branch). It is repaired by regrowth of only a single component. 

---