Background:With the development of emergency and intensive medical technologies,the survival rate of traumatic brain injury has greatly increased.More and more patients have been converted from severe coma to alleviat...Background:With the development of emergency and intensive medical technologies,the survival rate of traumatic brain injury has greatly increased.More and more patients have been converted from severe coma to alleviated state of consciousness,which can be subsequently classified within the framework of disorders of consciousness (DOC).We investigated the clinical application and characteristics of imaging indicators of diffusion tensor imaging (DTI) for the DOC patients.Methods:DTI was performed on a total of 75 cases with a clinical diagnosis of DOC from January 2014 to December 2015 in Beijing Tiantan Hospital and PLA Army General Hospital (including 66 cases of unresponsive wakefulness state (UWS) patients and 9 cases of minimally conscious state (MCS) patients).The data for the imaging indicators,such as fractional anisotropy (FA) and mean diffusivity (MD),were separately collected from three relevant regions of interest (ROIs):brainstem,thalamus,and subcortex.The indicators of two groups with different conscious states were statistically analyzed,and correlation analyses were conducted for the mean values of FA and MD in the ROIs evaluated through clinical Coma Recovery Scale-Revised (CRS-R) scores.Results:The FA value of the UWS group was evidentially lower than that of the MCS group (P ＜ 0.05),while the MD value of the UWS group was higher than that of the MCS group (P ＜ 0.05);the difference was statistically significant.The FA and MD values in the ROIs (locations:brainstem,thalamus,and subcortex) correlated with CRS-R scores,particularly in the thalamus.Conclusion:DTI has a certain clinical reference value for DOC imaging grading.The more severe the DOC,the higher the MD value and the lower the FA value.展开更多
Background: Decompressive craniectomy (DC) has been the classical management for malignant middle cerebral artery infarctions (mMCAI) in clinical practice. However, the association between DC and mMCAI remains unclear...Background: Decompressive craniectomy (DC) has been the classical management for malignant middle cerebral artery infarctions (mMCAI) in clinical practice. However, the association between DC and mMCAI remains unclear. This review went to evaluate the efficacy of DC in treating mMCAI patients. Methods: Studies were entirely searched since the foundation dates of multiple databases to June 2016. All major databases were involved, including Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and other sources. the bias risk of studies involved were evaluated. Modified Rankin Scale was defined as Primary outcome, Odds Ratio and 95% confidence intervals was taken as measurements. T2 (tau-squared) test, I2 test, and chi-square tests were used for statistical heterogeneity evaluation for each meta-analysis result, followed by fixed-effect model. Mantel-haenszel method was used in the process of summary estimations. All of the meta-analysis was conducted by Review Manager 5.3.Results & Conclusion: One thousand one hundred forty-five records of data were critically identified and collected through databases and 14 studies were finally involved. Result suggested that DC can ameliorate the suboptimal outcome of mMCAI patients.展开更多
基金Ministry of Science and Technology of China grant (2012CB825505) Natural Science Foundation of China
文摘Background:With the development of emergency and intensive medical technologies,the survival rate of traumatic brain injury has greatly increased.More and more patients have been converted from severe coma to alleviated state of consciousness,which can be subsequently classified within the framework of disorders of consciousness (DOC).We investigated the clinical application and characteristics of imaging indicators of diffusion tensor imaging (DTI) for the DOC patients.Methods:DTI was performed on a total of 75 cases with a clinical diagnosis of DOC from January 2014 to December 2015 in Beijing Tiantan Hospital and PLA Army General Hospital (including 66 cases of unresponsive wakefulness state (UWS) patients and 9 cases of minimally conscious state (MCS) patients).The data for the imaging indicators,such as fractional anisotropy (FA) and mean diffusivity (MD),were separately collected from three relevant regions of interest (ROIs):brainstem,thalamus,and subcortex.The indicators of two groups with different conscious states were statistically analyzed,and correlation analyses were conducted for the mean values of FA and MD in the ROIs evaluated through clinical Coma Recovery Scale-Revised (CRS-R) scores.Results:The FA value of the UWS group was evidentially lower than that of the MCS group (P ＜ 0.05),while the MD value of the UWS group was higher than that of the MCS group (P ＜ 0.05);the difference was statistically significant.The FA and MD values in the ROIs (locations:brainstem,thalamus,and subcortex) correlated with CRS-R scores,particularly in the thalamus.Conclusion:DTI has a certain clinical reference value for DOC imaging grading.The more severe the DOC,the higher the MD value and the lower the FA value.
文摘Background: Decompressive craniectomy (DC) has been the classical management for malignant middle cerebral artery infarctions (mMCAI) in clinical practice. However, the association between DC and mMCAI remains unclear. This review went to evaluate the efficacy of DC in treating mMCAI patients. Methods: Studies were entirely searched since the foundation dates of multiple databases to June 2016. All major databases were involved, including Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and other sources. the bias risk of studies involved were evaluated. Modified Rankin Scale was defined as Primary outcome, Odds Ratio and 95% confidence intervals was taken as measurements. T2 (tau-squared) test, I2 test, and chi-square tests were used for statistical heterogeneity evaluation for each meta-analysis result, followed by fixed-effect model. Mantel-haenszel method was used in the process of summary estimations. All of the meta-analysis was conducted by Review Manager 5.3.Results & Conclusion: One thousand one hundred forty-five records of data were critically identified and collected through databases and 14 studies were finally involved. Result suggested that DC can ameliorate the suboptimal outcome of mMCAI patients.
