Dear Editor,Coma, the vegetative state （VS）, and the minimally- conscious state （MCS）, often collectively referred to as disorders of consciousness （DOCs）, typically occur after severe traumatic or non-traumatic...Dear Editor,Coma, the vegetative state （VS）, and the minimally- conscious state （MCS）, often collectively referred to as disorders of consciousness （DOCs）, typically occur after severe traumatic or non-traumatic brain injury [1]. The boundary between awareness and unawareness remains elusive, making it difficult to correctly distinguish MCS from VS patients. It is possible to employ noninvasive neuroimaging techniques, such as functional MRI （fMRI） [2] to assess residual cognitive processing as well as consciousness. However, the causal link between neural activity in specific brain areas and specific behavioral tasks is hard to dissect using fMRI [3]. Therefore, detecting residual cognitive function and consciousness in patients surviving severe brain injury remains extremely challenging.展开更多
BACKGROUND Recent innovations in intensive care have improved the prognosis of patients with severe brain injuries and brought more patients with disorders of consciousness(DoC).Data are lacking regarding the long-ter...BACKGROUND Recent innovations in intensive care have improved the prognosis of patients with severe brain injuries and brought more patients with disorders of consciousness(DoC).Data are lacking regarding the long-term outcomes of those patients in China.It is necessary to study the long-term outcomes of patients with prolonged DoC in light of many factors likely to influence crucial decisions about their care and their life.AIM To present the preliminary results of a DoC cohort.METHODS This was a two-center prospective cohort study of inpatients with vegetative state(VS)/unresponsive wakefulness syndrome(UWS).The study outcomes were the recovery from VS/UWS to minimally conscious state(MCS)and the long-term status of patients with prolonged DoC considered in VS/UWS or MCS for up to 6 years.The patients were evaluated using the Glasgow coma scale,coma recovery scale-revised,and Glasgow outcome scale.The endpoint of follow-up was recovery of full consciousness or death.The changes in the primary clinical outcome improvement in clinical diagnosis were evaluated at 12 mo compared with baseline.RESULTS The study population included 93 patients(62 VS/UWS and 31 MCS).The postinjury interval range was 28-634 d.Median follow-up was 20 mo(interquartile range,12-37 mo).At the endpoint,33 transitioned to an emergence from MCS or full consciousness,eight had a locked-in syndrome,and there were 35 patients remaining in a VS/UWS and 11 in an MCS.Seven(including one locked-in syndrome)patients(7.5%)died within 12 mo of injury.Compared with the unresponsive group(n=52)at 12 mo,the responsive group(n=41)had a higher proportion of males(87.8%vs 63.5%,P=0.008),shorter time from injury(median,40.0 d vs 65.5 d,P=0.006),higher frequency of vascular etiology(68.3%vs 38.5%,P=0.007),higher Glasgow coma scale score at admission(median,9 vs 6,P<0.001),higher coma recovery scale-revised score at admission(median,9 vs 2.5,P<0.001),at 1 mo(median,14 vs 5,P<0.001),and at 3 mo(median,20 vs 6,P<0.001),lower frequency of VS/UWS(36.6%vs 90.0%,P<0.001),and more favorable Glasgow outcome scale outcome(P<0.001).CONCLUSION Patients with severe DoC,despite having strong predictors of poor prognosis,might recover consciousness after a prolonged time of rehabilitation.An accurate initial diagnosis of patients with DoC is critical for predicting outcome and a long-term regular follow-up is also important.展开更多
目的:研究应用不同刺激参数经颅直流电刺激治疗颅脑损伤后最小意识障碍患者的临床疗效。方法:将2020—2022年在山东省立第三医院重症康复科住院的慢性意识障碍患者,按照最小意识障碍(MCS)诊断标准纳入患者,按照随机对照数字表法,分为A组...目的:研究应用不同刺激参数经颅直流电刺激治疗颅脑损伤后最小意识障碍患者的临床疗效。方法:将2020—2022年在山东省立第三医院重症康复科住院的慢性意识障碍患者,按照最小意识障碍(MCS)诊断标准纳入患者,按照随机对照数字表法,分为A组(1 m A,20 min,2次·d^(-1))19例,B组(2 m A,20 min,2次·d^(-1))21例,以及C组(假刺激组)20例,共60例患者。3组患者在治疗前以及治疗后第4周以及第8周由固定医师用昏迷恢复修订量表(CRS-R)进行行为学评估以及脑电图检查。结果:3组患者治疗前CRS-R评分以及脑电图评分组间比较差异无统计学意义(P>0.05);治疗后,3组患者CRS-R评分在治疗后每个时间点与上一个时间点的CRS-R评分比较差异具有统计学意义(P<0.05);4周治疗后,B组与A组、C组比较差异有统计学意义(P<0.05),但是A组与C组比较差异无统计学意义(P>0.05);8周治疗后,3组患者CRS-R评分同时间点比较,差异具有统计学意义(P<0.05)。B组每个时间点与组内前一个时间点的脑电图评分差异有统计学意义(P<0.05)。第4周脑电图评分,A组以及C组与治疗前差异无统计学意义(P>0.05),B组与C组比较差异有统计学意义(P<0.05)。第8周各组脑电图评分与治疗前比较差异有统计学意义(P<0.05),各组间比较差异有统计学意义(P<0.05)。结论:经颅直流电刺激可改善最小意识障碍患者的意识状态;2 m A、2次·d^(-1)的刺激参数,治疗最小意识患者的疗效最为明显。展开更多
In the cruise, MR15-04 by R/V MIRAI, the samplings by the neuston net were performed in 23rd November to 14th December 2016 and three species of Halobates (H. germanus, H. micans, H. sp) were used for the temperature ...In the cruise, MR15-04 by R/V MIRAI, the samplings by the neuston net were performed in 23rd November to 14th December 2016 and three species of Halobates (H. germanus, H. micans, H. sp) were used for the temperature tolerance experiments after the collection. The neuston net was towed three times (3 × 15 min) on the starboard side of R/V MIRAI on the water surface with ship speed of 2 knot to water every 3 nights (19:00 - 20:00) at the fixed point in the south-western direction which was located at 50 km from the Sumatra island (4o03'S - 4o05'S, 101o53'E) in the Indonesia. Experiments on cool coma and heat coma were performed on the three species. Seconds for recovery from cool coma and heat coma were also examined on the Halobates in this study. Cool coma temperatures, gap temperature needed (temperature from the adapted temperature) for the cool coma and seconds for the recover from cool coma ranged 13.0oC to 25.0oC, 3.1oC to 16.1oC, 1 second to 4370 seconds, respectively. Heat coma temperature, gap temperature needed for the heat coma, seconds for the recover from heat coma ranged 29.4oC to 43.1oC, 1.9oC to 15.5oC, 2 seconds to 6420 seconds, respectively. The higher temperature of cool coma temperature during the last five days was shown when Madden-Julian Oscillation has passed over the ship, R/V MIRAI than the previous 10 days in the adults of H. germanus collected at the fixed place neat to Sumatra island (One way ANOVA: F-value = 2.314, df = 7, p = 0.028). Adults of un-described species, H. sp collected near to the Sumatra island, showed lower cool coma temperature [Mean ± SD: 15.51 ± 3.76 (9)] than those of H. germanus collected in the same place [16.96 ± 2.57 (191)]. This lower cool coma temperatures shown by this un-described species might be related to that this species should be a “shore” species inhabiting shore water in which many precipitation could cause the decreased surface temperature from 30oC - 31oC into about 25oC. Most of adults which suffered from the cool coma recovered within 20 seconds, whereas adults which suffered heat coma at 38oC and 39oC needed more than 200 seconds for the recovery and many of those which did it at more than 40oC needed more than 1000 second and some ones did not recover at all. All adults who suffered at more than 43oC did not recover at all. There were significant and negative correlation between cool and heat coma temperatures shown by the adults of H. germanus. This correlation might imply a common physiological mechanism for lower and higher temperature tolerances for this species.展开更多
Visual fixation is an item in the visual function subscale of the Coma Recovery Scale-Revised （CRS-R）. Sometimes clinicians using the behavioral scales find it difficult to detect because of the motor impairment in ...Visual fixation is an item in the visual function subscale of the Coma Recovery Scale-Revised （CRS-R）. Sometimes clinicians using the behavioral scales find it difficult to detect because of the motor impairment in patients with disorders of consciousness （DOCs）. Brain- computer interface （BCI） can be used to improve clinical assessment because it directly detects the brain response to an external stimulus in the absence of behavioral expres- sion. In this study, we designed a BCI system to assist the visual fixation assessment of DOC patients. The results from 15 patients indicated that three showed visual fixation in both CRS-R and BCI assessments and one did not show such behavior in the CRS-R assessment but achieved significant online accuracy in the BCI assessment. The results revealed that electroencephalography-based BCI can detect the brain response for visual fixation. Therefore, the proposed BCI may provide a promising method for assisting behavioral assessment using the CRS-R.展开更多
Auditory stimuli are proposed as beneficial neurorehabilitation methods in patients with disorders of consciousness. However, precise and accurate quantitative indices to estimate their potential effect remain scarce....Auditory stimuli are proposed as beneficial neurorehabilitation methods in patients with disorders of consciousness. However, precise and accurate quantitative indices to estimate their potential effect remain scarce. Fourteen patients were recruited from the Neuro-Rehabilitation Unit of Hangzhou Hospital of Zhejiang Armed Police Corps of China. Altogether, there were seven cases of unresponsive wakefulness syndrome（five males and two females, aged 45.7 ± 16.8 years） and seven cases of minimally conscious state（six males and one female, aged 42.3 ± 20.8 years）. Simultaneously, fourteen healthy controls（10 males and 4 females, aged 51.7 ± 9.7 years） also participated in this case-control experiment. Brain response to music, subjects＇ own name, and noise was monitored by quantitative electroencephalography（QEEG） in the resting state and with acoustic stimulation. Predictive QEEG values in various brain regions were investigated. Our results show that cerebral activation was high in subjects stimulated by their own name, especially in the temporal lobe in patients with disorders of consciousness, and the frontal lobe in the control group. Further, during resting and stimulation, QEEG index（δ ＋ θ/α ＋ β ratio） negatively correlated with the Coma Recovery Scale-Revised score in traumatic disorders of consciousness patients. Hence, we speculate that a subject＇s own name might be an effective awakening therapy for patients with disorders of consciousness. Moreover, QEEG index in specific stimulation states may be used as a prognostic indicator for disorders of consciousness patients（sensitivity, 75%; specificity, 50%）.展开更多
基金supported by the Guangdong Provincial Natural Science Foundation(2015A030313609)the Guangzhou Municipal Project for Science and Technology Foundation(201508020253)
文摘Dear Editor,Coma, the vegetative state （VS）, and the minimally- conscious state （MCS）, often collectively referred to as disorders of consciousness （DOCs）, typically occur after severe traumatic or non-traumatic brain injury [1]. The boundary between awareness and unawareness remains elusive, making it difficult to correctly distinguish MCS from VS patients. It is possible to employ noninvasive neuroimaging techniques, such as functional MRI （fMRI） [2] to assess residual cognitive processing as well as consciousness. However, the causal link between neural activity in specific brain areas and specific behavioral tasks is hard to dissect using fMRI [3]. Therefore, detecting residual cognitive function and consciousness in patients surviving severe brain injury remains extremely challenging.
基金Supported by the National Natural Science Foundation of China,No.81371194 and No.81873723.
文摘BACKGROUND Recent innovations in intensive care have improved the prognosis of patients with severe brain injuries and brought more patients with disorders of consciousness(DoC).Data are lacking regarding the long-term outcomes of those patients in China.It is necessary to study the long-term outcomes of patients with prolonged DoC in light of many factors likely to influence crucial decisions about their care and their life.AIM To present the preliminary results of a DoC cohort.METHODS This was a two-center prospective cohort study of inpatients with vegetative state(VS)/unresponsive wakefulness syndrome(UWS).The study outcomes were the recovery from VS/UWS to minimally conscious state(MCS)and the long-term status of patients with prolonged DoC considered in VS/UWS or MCS for up to 6 years.The patients were evaluated using the Glasgow coma scale,coma recovery scale-revised,and Glasgow outcome scale.The endpoint of follow-up was recovery of full consciousness or death.The changes in the primary clinical outcome improvement in clinical diagnosis were evaluated at 12 mo compared with baseline.RESULTS The study population included 93 patients(62 VS/UWS and 31 MCS).The postinjury interval range was 28-634 d.Median follow-up was 20 mo(interquartile range,12-37 mo).At the endpoint,33 transitioned to an emergence from MCS or full consciousness,eight had a locked-in syndrome,and there were 35 patients remaining in a VS/UWS and 11 in an MCS.Seven(including one locked-in syndrome)patients(7.5%)died within 12 mo of injury.Compared with the unresponsive group(n=52)at 12 mo,the responsive group(n=41)had a higher proportion of males(87.8%vs 63.5%,P=0.008),shorter time from injury(median,40.0 d vs 65.5 d,P=0.006),higher frequency of vascular etiology(68.3%vs 38.5%,P=0.007),higher Glasgow coma scale score at admission(median,9 vs 6,P<0.001),higher coma recovery scale-revised score at admission(median,9 vs 2.5,P<0.001),at 1 mo(median,14 vs 5,P<0.001),and at 3 mo(median,20 vs 6,P<0.001),lower frequency of VS/UWS(36.6%vs 90.0%,P<0.001),and more favorable Glasgow outcome scale outcome(P<0.001).CONCLUSION Patients with severe DoC,despite having strong predictors of poor prognosis,might recover consciousness after a prolonged time of rehabilitation.An accurate initial diagnosis of patients with DoC is critical for predicting outcome and a long-term regular follow-up is also important.
文摘目的:研究应用不同刺激参数经颅直流电刺激治疗颅脑损伤后最小意识障碍患者的临床疗效。方法:将2020—2022年在山东省立第三医院重症康复科住院的慢性意识障碍患者,按照最小意识障碍(MCS)诊断标准纳入患者,按照随机对照数字表法,分为A组(1 m A,20 min,2次·d^(-1))19例,B组(2 m A,20 min,2次·d^(-1))21例,以及C组(假刺激组)20例,共60例患者。3组患者在治疗前以及治疗后第4周以及第8周由固定医师用昏迷恢复修订量表(CRS-R)进行行为学评估以及脑电图检查。结果:3组患者治疗前CRS-R评分以及脑电图评分组间比较差异无统计学意义(P>0.05);治疗后,3组患者CRS-R评分在治疗后每个时间点与上一个时间点的CRS-R评分比较差异具有统计学意义(P<0.05);4周治疗后,B组与A组、C组比较差异有统计学意义(P<0.05),但是A组与C组比较差异无统计学意义(P>0.05);8周治疗后,3组患者CRS-R评分同时间点比较,差异具有统计学意义(P<0.05)。B组每个时间点与组内前一个时间点的脑电图评分差异有统计学意义(P<0.05)。第4周脑电图评分,A组以及C组与治疗前差异无统计学意义(P>0.05),B组与C组比较差异有统计学意义(P<0.05)。第8周各组脑电图评分与治疗前比较差异有统计学意义(P<0.05),各组间比较差异有统计学意义(P<0.05)。结论:经颅直流电刺激可改善最小意识障碍患者的意识状态;2 m A、2次·d^(-1)的刺激参数,治疗最小意识患者的疗效最为明显。
文摘In the cruise, MR15-04 by R/V MIRAI, the samplings by the neuston net were performed in 23rd November to 14th December 2016 and three species of Halobates (H. germanus, H. micans, H. sp) were used for the temperature tolerance experiments after the collection. The neuston net was towed three times (3 × 15 min) on the starboard side of R/V MIRAI on the water surface with ship speed of 2 knot to water every 3 nights (19:00 - 20:00) at the fixed point in the south-western direction which was located at 50 km from the Sumatra island (4o03'S - 4o05'S, 101o53'E) in the Indonesia. Experiments on cool coma and heat coma were performed on the three species. Seconds for recovery from cool coma and heat coma were also examined on the Halobates in this study. Cool coma temperatures, gap temperature needed (temperature from the adapted temperature) for the cool coma and seconds for the recover from cool coma ranged 13.0oC to 25.0oC, 3.1oC to 16.1oC, 1 second to 4370 seconds, respectively. Heat coma temperature, gap temperature needed for the heat coma, seconds for the recover from heat coma ranged 29.4oC to 43.1oC, 1.9oC to 15.5oC, 2 seconds to 6420 seconds, respectively. The higher temperature of cool coma temperature during the last five days was shown when Madden-Julian Oscillation has passed over the ship, R/V MIRAI than the previous 10 days in the adults of H. germanus collected at the fixed place neat to Sumatra island (One way ANOVA: F-value = 2.314, df = 7, p = 0.028). Adults of un-described species, H. sp collected near to the Sumatra island, showed lower cool coma temperature [Mean ± SD: 15.51 ± 3.76 (9)] than those of H. germanus collected in the same place [16.96 ± 2.57 (191)]. This lower cool coma temperatures shown by this un-described species might be related to that this species should be a “shore” species inhabiting shore water in which many precipitation could cause the decreased surface temperature from 30oC - 31oC into about 25oC. Most of adults which suffered from the cool coma recovered within 20 seconds, whereas adults which suffered heat coma at 38oC and 39oC needed more than 200 seconds for the recovery and many of those which did it at more than 40oC needed more than 1000 second and some ones did not recover at all. All adults who suffered at more than 43oC did not recover at all. There were significant and negative correlation between cool and heat coma temperatures shown by the adults of H. germanus. This correlation might imply a common physiological mechanism for lower and higher temperature tolerances for this species.
基金supported by the National Key Research and Development Program of China (2017YFB1002505)the National Natural Science Foundation of China (61633010, 91420302, and 61503143)+1 种基金the Natural Science Foundation of Guangdong Province, China (2014A030312005 and 2014A030310244)the Pearl River S&T Nova Program of Guangzhou Municipality, China (201710010038)
文摘Visual fixation is an item in the visual function subscale of the Coma Recovery Scale-Revised （CRS-R）. Sometimes clinicians using the behavioral scales find it difficult to detect because of the motor impairment in patients with disorders of consciousness （DOCs）. Brain- computer interface （BCI） can be used to improve clinical assessment because it directly detects the brain response to an external stimulus in the absence of behavioral expres- sion. In this study, we designed a BCI system to assist the visual fixation assessment of DOC patients. The results from 15 patients indicated that three showed visual fixation in both CRS-R and BCI assessments and one did not show such behavior in the CRS-R assessment but achieved significant online accuracy in the BCI assessment. The results revealed that electroencephalography-based BCI can detect the brain response for visual fixation. Therefore, the proposed BCI may provide a promising method for assisting behavioral assessment using the CRS-R.
基金supported by grants from the General Project Plan of Zhejiang Medical Technology of China,No.2014RCA007the Medical Science and Technology Project Co-founded by Zhejiang Province and the Ministry of Health of China,No.2016152769
文摘Auditory stimuli are proposed as beneficial neurorehabilitation methods in patients with disorders of consciousness. However, precise and accurate quantitative indices to estimate their potential effect remain scarce. Fourteen patients were recruited from the Neuro-Rehabilitation Unit of Hangzhou Hospital of Zhejiang Armed Police Corps of China. Altogether, there were seven cases of unresponsive wakefulness syndrome（five males and two females, aged 45.7 ± 16.8 years） and seven cases of minimally conscious state（six males and one female, aged 42.3 ± 20.8 years）. Simultaneously, fourteen healthy controls（10 males and 4 females, aged 51.7 ± 9.7 years） also participated in this case-control experiment. Brain response to music, subjects＇ own name, and noise was monitored by quantitative electroencephalography（QEEG） in the resting state and with acoustic stimulation. Predictive QEEG values in various brain regions were investigated. Our results show that cerebral activation was high in subjects stimulated by their own name, especially in the temporal lobe in patients with disorders of consciousness, and the frontal lobe in the control group. Further, during resting and stimulation, QEEG index（δ ＋ θ/α ＋ β ratio） negatively correlated with the Coma Recovery Scale-Revised score in traumatic disorders of consciousness patients. Hence, we speculate that a subject＇s own name might be an effective awakening therapy for patients with disorders of consciousness. Moreover, QEEG index in specific stimulation states may be used as a prognostic indicator for disorders of consciousness patients（sensitivity, 75%; specificity, 50%）.
