Background：A history of 3 or more concussions is frequently associated with numerous short-and long-term neuropathologies.Impairments in postural control are a known acute consequence of concussion;however,limited ev...Background：A history of 3 or more concussions is frequently associated with numerous short-and long-term neuropathologies.Impairments in postural control are a known acute consequence of concussion;however,limited evidence exists on the effects of multiple concussions on gait.The purpose of this study was to assess gait stepping characteristics in collegiate aged student-athletes based on concussion history.Methods：There were 63 participants divided into 3 even groups based on concussion history：≥3 concussions,1–2 concussions,and 0 concussion.All participants completed 10 trials of gait on a 4.9 m instrumented walkway.The dependent variables of interest included both gait stepping characteristics（step velocity,length,and width,double support time,and the percentage of the gait cycle in stance） and coefficien of variability（CoV） measures（step length,time,and width）.The gait stepping characteristics were compared firs with a MANOVA with follow-up 1-way ANOVAs and Tukey post hoc tests as appropriate.The Co V measures were compared with 1-way ANOVAs and Tukey post hoc tests.Results：There were main effects for group for step velocity,length,width,and double support time.Overall,the 0 concussion group displayed typical healthy young gait parameters and performed significant y better than either concussion group.The 0 concussion group had a significant y greater step length Co V,but there were no differences in the step time or width Co V.Conclusion：This findin provides evidence of subtle impairments in postural control during gait among individuals with prior history of concussion which could be an early indicator of future neurological deficiencies The limited difference in the variability measures is consistent with prior static stance studies and could suggest the individuals constrain their motor systems to reduce variability.Taken together,these findi gs suggest a conservative gait strategy which is adopted by individuals with a history of concussions.展开更多
Objective To investigate alterations in the microtubule-associated protein 2 (MAP-2) of neurons in Wistar rats and the effect of nimodipine (Nim), D-2-amino-5-phosphonovaleric acid (D-AP-5) and mild hypothermia on ne...Objective To investigate alterations in the microtubule-associated protein 2 (MAP-2) of neurons in Wistar rats and the effect of nimodipine (Nim), D-2-amino-5-phosphonovaleric acid (D-AP-5) and mild hypothermia on neuronal MAP-2 following fluid percussion injury (FPI).Methods Alterations of MAP-2 in Wistar rat neurons following FPI were measured by a confocal laserscanning microscope using MAP-2 immunofluorescence staining as a MAP-2 indicator.Results MAP-2 immunofluorescence staining was limited to the cell bodies and dendritic compartments of neurons and more intense in dendrites than in cell bodies. The loss of MAP-2 was marked at 3 h posttrauma ( P ＜ 0.01 ), and reached a maximum at 48 h post-trauma. Afterwards, fluorescence recovered partly at 72 h post-trauma. The application of Nim markedly reduced the loss of MAP-2 immunoreectivity within 1 h post-trauma ( P ＜ 0.01 ), and the application of D-AP-5 markedly reduced the loss of MAP-2immunoreactivity within 10 h post-injury ( P ＜ 0.01 ). The application of mild hypothermia decreased the loss of MAP-2 immunoreactivity within 1 h post-injury (P＜ 0.05).Conclusions The partial recovery of fluorescence at 72 h post-trauma indicate that the partial structure of the neuronal microtubules can be repaired by itself. Nim, D-AP-5 and mild hypothermia reduce the degradation of MAP-2 by different mechanisms. The treatment of neuronal cytoskeleton degradation following FPI must employ multiple therapeutic approaches.展开更多
Objective： To study the effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury （STBI） using clinical microdialysis. Methods：Thirty-one patient...Objective： To study the effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury （STBI） using clinical microdialysis. Methods：Thirty-one patients with STBI （ GCS ≤ 8 ） were randomly divided into hypothermic group （Group A ） and control group（ Group B）. Microdialysis catheters were inserted into the cerebral cortex of perilesional and normal brain tissue. All samples were analyzed using CMA mlcrodialysis analyzer. Results. In comparison with the control group, lactate/glucose ratio （ L/G ）, lactate/pyruvate ratio （ L/P ） and glycerol（Gly） in perilensional tissue were significantly decreased; L/P in normal brain tissue was significantly decreased. In control group, L/G, L/P and Gly in perilensional tissue were higher than that in normal brain tissue. In the hypothermic group, L/P in perileusional tissue was higher than that in relative normal brain. Conclusions： Mild hypothermia protects brain tissues by decreasing L/G, L/P and Gly in perilensional tissue and L/P in ＂ normal brain＂ tissues. The energy crisis and membrane phospholipid degradation in perilensional tissue are easier to happen after traumatic brain injury, and mild hypothermia protects brain better in perilensional tissue than in normal brain tissue.展开更多
Objective： To sum up our experience in percutaneous dilatational tracheostomy （PDT） in ICU patient with severe brain injury. Methods： Between November 2011 and April 2014, PDTs were performed on 32 severe brain i...Objective： To sum up our experience in percutaneous dilatational tracheostomy （PDT） in ICU patient with severe brain injury. Methods： Between November 2011 and April 2014, PDTs were performed on 32 severe brain injury patients in ICU by a team of physicians and intensivists. The success rate, efficacy, safety, and complications including stomal infection and bleeding, paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, as well as clinically significant tracheal stenosis were carefully monitored and recorded respectively. Results： The operations took 4-15 minutes （mean 9.1 minutes±4.2 minutes）. Totally 4 cases suffered from complications in the operations： 3 cases of stomal bleeding, and 1 case of intratracheal bloody secretion, but none required intervention. Paratracheal insertion,pneumothorax, pneumomediastinum, tracheal laceration, or clinically significant tracheal stenosis were not found in PDT patients. There was no procedure-related death occurring during or after PDT. Conclusion： Our study demonstrats that PDT is a safe, highly effective, and minimally invasive procedure. The appropriate sedation and airway management perioperatively help to reduce complication rates. PDT should be performed or supervised by a team of physicians with extensive experience in this procedure, and also an intensivist with experience in difficult airway management.展开更多
This article aims to expound the essence of minimally invasive surgery as well as when and how to use it in craniocerebral trauma surgery according to the characteristics of the disease. In neurosurgery, the importanc...This article aims to expound the essence of minimally invasive surgery as well as when and how to use it in craniocerebral trauma surgery according to the characteristics of the disease. In neurosurgery, the importance of tissue protection should be from the inside to the outside, i.e. brain→dura→skull→scalp. In this article, I want to share my opinion and our team＇s experience in terms of selecting surgical approaches and incision, surgical treatment of the skull, dura handling, intracranial operation and placement of drainage based on the above theory. I hope this will be helpful for trauma surgeons.展开更多
Objective:To explore the protective mechanism of acupuncture plus mild hypothermia for cerebral ischemia-reperfusion injury(CIRI)by observing the effects of acupuncture plus mild hypothermia on miRNA-204 and its targe...Objective:To explore the protective mechanism of acupuncture plus mild hypothermia for cerebral ischemia-reperfusion injury(CIRI)by observing the effects of acupuncture plus mild hypothermia on miRNA-204 and its target gene expressions in CIRI rat brain tissues.Methods:Sixty Sprague-Dawley rats were divided into a blank control group,a sham operation group,a model group,an acupuncture group,a mild hypothermia group and an acup un cture plus mild hypothermia group accordi ng to the random nu mbertable method(n=10).Except for the blank c on trol group an dthe sham operati on group,rats in the other 4 groups received CIRI modeling.After the model was successfully established,rats in the blank control group were bred routinely for 72 h without any interventions;rats in the sham operation group and the model group were bred routinely for 72 h,and only received bin ding without other interve ntions after surgery;rats in the acup un cture group were bred routinely for 72 h,and received acupuncture at Dazhui(GV 14),Baihui(GV 20)and Shuigou(GV 26)after binding;rats in the mild hypothermia group were bred routinely for 72 h,and received mild hypothermia intervention for 72 h after binding;rats in the acupuncture plus mild hypothermia group were bred routinely for 72 h,followed by receiving acupuncture as in the acup uncture group and mild hypothermia therapy as in the mild hypothermia group after bin ding.The n eurological impairme nt score,cerebral infarcti on area ratio,the expressions of miRNA-204 and its target genes in eluding Map3k8,Ntrk2 and Ppp3rl in the ischemic hippocampus of each group were observed after 72 h of intervention.Results:Before intervention,compared with the bgnk control group and the sham operation group,the neurological impairment scores and the infarction area ratios of the modelled rats were statistically significa ntly increased(all P<Q.Ql)f indicating that the model was successful.After intervention,compared with the model group,the neurological impairment scores of the three in tervention groups were sign ifica ntly reduced(all P<0.01);compared with the acupuncture group and the mild hypothermia group,the infarction area ratio in the acupuncture plus mild hypothermia group was signtiicantly reduced(both P<0.01);compared with the model group,the three intervention groups showed significant inhibition of miRNA-204 expression in brain tissues(all P<0.05),which was most significant in the acupuncture plus mild hypothermia group(P<0.01);compared with the acupuncture group and the mild hypothermia group,the Map3k8 expression in the acupuncture plus mild hypothermia group was significantly increased(both P<0.01),but there were no sign ificant d iff ere nces in Ntrk2 and Ppp3rl expressions between groups(all P>0.05).Conclusion:Acupuncture,mild hypothermia,and acupuncture plus mild hypothermia reduced the neurological impairment score and the cerebral infarction area in CIRI rats,while acupuncture plus mild hypothermia showed the most significant effect.In regulating miRNA-204 target gene expressions,acupuncture plus mild hypothermia showed the same effect on Ntrk2 and Ppp3rl expressions,while better effect on Map3k8 expression compared with either acupuncture or hypothermia.展开更多
Objective： To investigate the dynamic changes of glycine （Gly） and taurine （Tau） in corpus striatum of rats with ischemia-reperfusion injury （IRI）, and the regulation effect of electroacupuncture on them. Meth...Objective： To investigate the dynamic changes of glycine （Gly） and taurine （Tau） in corpus striatum of rats with ischemia-reperfusion injury （IRI）, and the regulation effect of electroacupuncture on them. Methods： Thirty SD rats were randomly divided into sham surgery group, model group, and treatment group. Rats in the sham surgery group were operated without ischemia. Rats in the model group and treatment group were operated to make model of cerebral IRI. The ischemia status lasts 1.5 h, and reperfusion was performed for 3.75 h. Rats in the treatment group were treated with electroacupuncture at Fengchi （GB 20）. Neurologic deficit score （NDS） was used to evaluate the rats functions. Microdialysis and High Performance Liquid Chromatography technique were used to detect the changes of Gly and Tan in corpus striatum of rats. Results： Contents of Gly and Tan increased at 1.5 h after ischemia. Them decreased to level as same as those rats in the sham surgery group after reperfusion. The content of Gly in the model and treatment group increased again at 2-2.5 h after reperfusion, and then decreased to the same level of the sham surgery group. There was a third increase of Gly content in the treatment group at 2.75 h after reperfusion. Electroacupuncture treatment could delay the decrease of Tan content after reperfusion, and make it increase at 1.5, 2 and 2.75 h after reperfusion. The peak appeared in the last time. NDS in the model and treatment group were more than that in the sham surgery group, and lowered at 5.25 h after surgery. Effects in treatment group was better than that in the model group （P〈0.05）. Conclusion： IRI makes contents of Gly and Tau in corpus striatum increase at a special time. Electroacuptmcture treatment could increase contents of Gly and Tau at a special time after reperfusion, which maybe an important mechanism of protecting effects of electroacupuncture on the brain.展开更多
基金funded,in part,by an NIH/NINDS grant (1R15NS070744-01A1)a Georgia Southern University Faculty Development grant
文摘Background：A history of 3 or more concussions is frequently associated with numerous short-and long-term neuropathologies.Impairments in postural control are a known acute consequence of concussion;however,limited evidence exists on the effects of multiple concussions on gait.The purpose of this study was to assess gait stepping characteristics in collegiate aged student-athletes based on concussion history.Methods：There were 63 participants divided into 3 even groups based on concussion history：≥3 concussions,1–2 concussions,and 0 concussion.All participants completed 10 trials of gait on a 4.9 m instrumented walkway.The dependent variables of interest included both gait stepping characteristics（step velocity,length,and width,double support time,and the percentage of the gait cycle in stance） and coefficien of variability（CoV） measures（step length,time,and width）.The gait stepping characteristics were compared firs with a MANOVA with follow-up 1-way ANOVAs and Tukey post hoc tests as appropriate.The Co V measures were compared with 1-way ANOVAs and Tukey post hoc tests.Results：There were main effects for group for step velocity,length,width,and double support time.Overall,the 0 concussion group displayed typical healthy young gait parameters and performed significant y better than either concussion group.The 0 concussion group had a significant y greater step length Co V,but there were no differences in the step time or width Co V.Conclusion：This findin provides evidence of subtle impairments in postural control during gait among individuals with prior history of concussion which could be an early indicator of future neurological deficiencies The limited difference in the variability measures is consistent with prior static stance studies and could suggest the individuals constrain their motor systems to reduce variability.Taken together,these findi gs suggest a conservative gait strategy which is adopted by individuals with a history of concussions.
基金ThisstudywassupportedbyagrantfromtheFoundationofHeilongjiangDevelopmentinMedicalSciences (No G98C19 13)
文摘Objective To investigate alterations in the microtubule-associated protein 2 (MAP-2) of neurons in Wistar rats and the effect of nimodipine (Nim), D-2-amino-5-phosphonovaleric acid (D-AP-5) and mild hypothermia on neuronal MAP-2 following fluid percussion injury (FPI).Methods Alterations of MAP-2 in Wistar rat neurons following FPI were measured by a confocal laserscanning microscope using MAP-2 immunofluorescence staining as a MAP-2 indicator.Results MAP-2 immunofluorescence staining was limited to the cell bodies and dendritic compartments of neurons and more intense in dendrites than in cell bodies. The loss of MAP-2 was marked at 3 h posttrauma ( P ＜ 0.01 ), and reached a maximum at 48 h post-trauma. Afterwards, fluorescence recovered partly at 72 h post-trauma. The application of Nim markedly reduced the loss of MAP-2 immunoreectivity within 1 h post-trauma ( P ＜ 0.01 ), and the application of D-AP-5 markedly reduced the loss of MAP-2immunoreactivity within 10 h post-injury ( P ＜ 0.01 ). The application of mild hypothermia decreased the loss of MAP-2 immunoreactivity within 1 h post-injury (P＜ 0.05).Conclusions The partial recovery of fluorescence at 72 h post-trauma indicate that the partial structure of the neuronal microtubules can be repaired by itself. Nim, D-AP-5 and mild hypothermia reduce the degradation of MAP-2 by different mechanisms. The treatment of neuronal cytoskeleton degradation following FPI must employ multiple therapeutic approaches.
文摘Objective： To study the effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury （STBI） using clinical microdialysis. Methods：Thirty-one patients with STBI （ GCS ≤ 8 ） were randomly divided into hypothermic group （Group A ） and control group（ Group B）. Microdialysis catheters were inserted into the cerebral cortex of perilesional and normal brain tissue. All samples were analyzed using CMA mlcrodialysis analyzer. Results. In comparison with the control group, lactate/glucose ratio （ L/G ）, lactate/pyruvate ratio （ L/P ） and glycerol（Gly） in perilensional tissue were significantly decreased; L/P in normal brain tissue was significantly decreased. In control group, L/G, L/P and Gly in perilensional tissue were higher than that in normal brain tissue. In the hypothermic group, L/P in perileusional tissue was higher than that in relative normal brain. Conclusions： Mild hypothermia protects brain tissues by decreasing L/G, L/P and Gly in perilensional tissue and L/P in ＂ normal brain＂ tissues. The energy crisis and membrane phospholipid degradation in perilensional tissue are easier to happen after traumatic brain injury, and mild hypothermia protects brain better in perilensional tissue than in normal brain tissue.
文摘Objective： To sum up our experience in percutaneous dilatational tracheostomy （PDT） in ICU patient with severe brain injury. Methods： Between November 2011 and April 2014, PDTs were performed on 32 severe brain injury patients in ICU by a team of physicians and intensivists. The success rate, efficacy, safety, and complications including stomal infection and bleeding, paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, as well as clinically significant tracheal stenosis were carefully monitored and recorded respectively. Results： The operations took 4-15 minutes （mean 9.1 minutes±4.2 minutes）. Totally 4 cases suffered from complications in the operations： 3 cases of stomal bleeding, and 1 case of intratracheal bloody secretion, but none required intervention. Paratracheal insertion,pneumothorax, pneumomediastinum, tracheal laceration, or clinically significant tracheal stenosis were not found in PDT patients. There was no procedure-related death occurring during or after PDT. Conclusion： Our study demonstrats that PDT is a safe, highly effective, and minimally invasive procedure. The appropriate sedation and airway management perioperatively help to reduce complication rates. PDT should be performed or supervised by a team of physicians with extensive experience in this procedure, and also an intensivist with experience in difficult airway management.
基金This work was supported by research grants from the National Natural Science Foundation of China （No. 81171144, No. 81471238）
文摘This article aims to expound the essence of minimally invasive surgery as well as when and how to use it in craniocerebral trauma surgery according to the characteristics of the disease. In neurosurgery, the importance of tissue protection should be from the inside to the outside, i.e. brain→dura→skull→scalp. In this article, I want to share my opinion and our team＇s experience in terms of selecting surgical approaches and incision, surgical treatment of the skull, dura handling, intracranial operation and placement of drainage based on the above theory. I hope this will be helpful for trauma surgeons.
文摘Objective:To explore the protective mechanism of acupuncture plus mild hypothermia for cerebral ischemia-reperfusion injury(CIRI)by observing the effects of acupuncture plus mild hypothermia on miRNA-204 and its target gene expressions in CIRI rat brain tissues.Methods:Sixty Sprague-Dawley rats were divided into a blank control group,a sham operation group,a model group,an acupuncture group,a mild hypothermia group and an acup un cture plus mild hypothermia group accordi ng to the random nu mbertable method(n=10).Except for the blank c on trol group an dthe sham operati on group,rats in the other 4 groups received CIRI modeling.After the model was successfully established,rats in the blank control group were bred routinely for 72 h without any interventions;rats in the sham operation group and the model group were bred routinely for 72 h,and only received bin ding without other interve ntions after surgery;rats in the acup un cture group were bred routinely for 72 h,and received acupuncture at Dazhui(GV 14),Baihui(GV 20)and Shuigou(GV 26)after binding;rats in the mild hypothermia group were bred routinely for 72 h,and received mild hypothermia intervention for 72 h after binding;rats in the acupuncture plus mild hypothermia group were bred routinely for 72 h,followed by receiving acupuncture as in the acup uncture group and mild hypothermia therapy as in the mild hypothermia group after bin ding.The n eurological impairme nt score,cerebral infarcti on area ratio,the expressions of miRNA-204 and its target genes in eluding Map3k8,Ntrk2 and Ppp3rl in the ischemic hippocampus of each group were observed after 72 h of intervention.Results:Before intervention,compared with the bgnk control group and the sham operation group,the neurological impairment scores and the infarction area ratios of the modelled rats were statistically significa ntly increased(all P<Q.Ql)f indicating that the model was successful.After intervention,compared with the model group,the neurological impairment scores of the three in tervention groups were sign ifica ntly reduced(all P<0.01);compared with the acupuncture group and the mild hypothermia group,the infarction area ratio in the acupuncture plus mild hypothermia group was signtiicantly reduced(both P<0.01);compared with the model group,the three intervention groups showed significant inhibition of miRNA-204 expression in brain tissues(all P<0.05),which was most significant in the acupuncture plus mild hypothermia group(P<0.01);compared with the acupuncture group and the mild hypothermia group,the Map3k8 expression in the acupuncture plus mild hypothermia group was significantly increased(both P<0.01),but there were no sign ificant d iff ere nces in Ntrk2 and Ppp3rl expressions between groups(all P>0.05).Conclusion:Acupuncture,mild hypothermia,and acupuncture plus mild hypothermia reduced the neurological impairment score and the cerebral infarction area in CIRI rats,while acupuncture plus mild hypothermia showed the most significant effect.In regulating miRNA-204 target gene expressions,acupuncture plus mild hypothermia showed the same effect on Ntrk2 and Ppp3rl expressions,while better effect on Map3k8 expression compared with either acupuncture or hypothermia.
基金National Basic Research Program of China (973 Program, 2005CB523306)the Scientific and Technologic Fund of Shanghai (014319364)+1 种基金Shanghai Leading Academic Discipline Project (S30304)Shanghai Municipal Education Commission (06CZ044)
文摘Objective： To investigate the dynamic changes of glycine （Gly） and taurine （Tau） in corpus striatum of rats with ischemia-reperfusion injury （IRI）, and the regulation effect of electroacupuncture on them. Methods： Thirty SD rats were randomly divided into sham surgery group, model group, and treatment group. Rats in the sham surgery group were operated without ischemia. Rats in the model group and treatment group were operated to make model of cerebral IRI. The ischemia status lasts 1.5 h, and reperfusion was performed for 3.75 h. Rats in the treatment group were treated with electroacupuncture at Fengchi （GB 20）. Neurologic deficit score （NDS） was used to evaluate the rats functions. Microdialysis and High Performance Liquid Chromatography technique were used to detect the changes of Gly and Tan in corpus striatum of rats. Results： Contents of Gly and Tan increased at 1.5 h after ischemia. Them decreased to level as same as those rats in the sham surgery group after reperfusion. The content of Gly in the model and treatment group increased again at 2-2.5 h after reperfusion, and then decreased to the same level of the sham surgery group. There was a third increase of Gly content in the treatment group at 2.75 h after reperfusion. Electroacupuncture treatment could delay the decrease of Tan content after reperfusion, and make it increase at 1.5, 2 and 2.75 h after reperfusion. The peak appeared in the last time. NDS in the model and treatment group were more than that in the sham surgery group, and lowered at 5.25 h after surgery. Effects in treatment group was better than that in the model group （P〈0.05）. Conclusion： IRI makes contents of Gly and Tau in corpus striatum increase at a special time. Electroacuptmcture treatment could increase contents of Gly and Tau at a special time after reperfusion, which maybe an important mechanism of protecting effects of electroacupuncture on the brain.
