In this study, rats were put into traumatic brain injury-induced coma and treated with median nerve electrical stimulation. We explored the wake-promoting effect, and possible mechanisms, of median nerve electrical st...In this study, rats were put into traumatic brain injury-induced coma and treated with median nerve electrical stimulation. We explored the wake-promoting effect, and possible mechanisms, of median nerve electrical stimulation. Electrical stimulation upregulated the expression levels of orexin-A and its receptor OX1R in the rat prefrontal cortex. Orexin-A expression gradually in-creased with increasing stimulation, while OX1R expression reached a peak at 12 hours and then decreased. In addition, after the OX1R antagonist, SB334867, was injected into the brain of rats after traumatic brain injury, fewer rats were restored to consciousness, and orexin-A and OXIR expression in the prefrontal cortex was downregulated. Our ifndings indicate that median nerve electrical stimulation induced an up-regulation of orexin-A and OX1R expression in the pre-frontal cortex of traumatic brain injury-induced coma rats, which may be a potential mechanism involved in the wake-promoting effects of median nerve electrical stimulation.展开更多
This study was a retrospective analysis of outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow coma scale. The series enrolled forty-six consecutive cases of acute traumatic epidural ...This study was a retrospective analysis of outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow coma scale. The series enrolled forty-six consecutive cases of acute traumatic epidural hematomas. The mean age of patients was 29.56 years and 63.04% of the patients were between 21 and 30 years of age. Forty-tree out of 46 (93.47%) of the patients were males. Road traffic crash was the main mode of injury. The severity of the traumatic brain injury was classified according to the Glasgow coma scale score at admission. The injury was mild or moderate in 35 (76.08%) cases and severe in 11. Eight patients (17.39%) presented with pupillary abnormalities. The computed tomography scanning of the head has objectivized the epidural hematoma in all patients and has shown a mass effect with midline shift in all but one case (45/46). The most frequent surgical procedure done was craniotomy. Six (13.04%) patients died (GOS 1), but 38 (82.60%) recovered fully (GOS 5) and two (04.34%) were disabled but independent (GOS 4). The Glasgow coma score at admission was very predictive for good or poor outcome, since all patients but one who died and all survivors who were disabled were comatose at admission (GCS ≤ 8).展开更多
Background: Non-traumatic coma is the most common pediatric medical emergency. Its clinical diagnosis is easy. The difficulty lies in finding the etiology. Objective: To determine the prevalence and clinical profiles ...Background: Non-traumatic coma is the most common pediatric medical emergency. Its clinical diagnosis is easy. The difficulty lies in finding the etiology. Objective: To determine the prevalence and clinical profiles of non-traumatic Coma at the Centre Hospitalier Universitaire Pédiatrique de Bangui (CHUPB). Methodology: This was a descriptive and analytical cross-sectional study conducted between January 1 and June 31, 2021, at CHUPB. Children aged 1 month to 15 years, admitted to the emergency room with a Glasgow score less than or equal to 8 without any traumatism were included. The variables studied were sociodemographic, clinical and paraclinical. Data were entered and analyzed using SPSS 20.0 statistical software. The statistical test used was Pearson’s chi<sup>2</sup>, any p-value Results: Of 8551 children hospitalized during the study period, 370 were hospitalized for non-traumatic coma: 4.32%. They were divided into 57.5% (n = 213) boys and 42.44% (n = 157) girls, giving a sex ratio of 1.35. Their mean age was 35.95 ± 27.21 months. Children aged 1 to 24 months represented 54.59% (n = 202) of cases. The mean time to the consultation was 2.91 days ± 1.8. Fever 86.48% (n = 320) and convulsions 80% (n = 296) were the main reasons for consultation. Coma stages II - III and IV represented 52.44% (n = 194), 42.97% (n = 159) and 4.59% (n = 17) respectively. Neuromalaria (29.72%;n = 110), meningitis-meningoencephalitis-encephalitis (30%;n = 111), sepsis (19.72%;n = 73) and acidosis Coma (5.40%;n = 20) were the main etiologies. Conclusion: Non-traumatic coma is common at CHUPB. Infections were the main etiology, particularly cerebral malaria. The reduction of its frequency requires, among others, the strengthening of the national monitoring malaria program. The strengthening of the technical platform for a good etiological diagnosis constitutes the other axis of prevention.展开更多
Purpose:Patients’gender,which can be one of the most important determinants of traumatic brain injury(TBI)outcomes,is also likely to interact with many other outcome variables of TBI.This multicenter descriptive stud...Purpose:Patients’gender,which can be one of the most important determinants of traumatic brain injury(TBI)outcomes,is also likely to interact with many other outcome variables of TBI.This multicenter descriptive study investigated gender differences in epidemiological,clinical,treatment,mortality,and variable characteristics in adult TBI patients.Methods:The selection criteria were defined as patients who had been diagnosed with TBI and were admitted to the hospital between January 1,2016 and December 31,2018.A total of 4468 adult TBI patients were enrolled at eight University Hospitals.Based on the list of enrolled patients,the medical records of the patients were reviewed and they were registered online at each hospital.The registered patients were classified into three groups according to the Glasgow coma scale(GCS)score:mild(13-15),moderate(9-12),and severe(3-8),and the differences between men and women in each group were investigated.The risk factors of moderated and severe TBI compared to mild TBI were also investigated.Results:The study included 3075 men and 1393 women and the proportion of total males was 68.8%.Among all the TBI patients,there were significant differences between men and women in age,past history,and GCS score.While the mild and severe TBI groups showed significant differences in age,past history,and clinical symptoms,the moderate TBI group showed significant differences in age,past history,cause of justice,and diagnosis.Conclusion:To the best of our knowledge,this multicenter study is the first to focus on gender differences of adult patients with TBI in Korea.This study shows significant differences between men and women in many aspects of adult TBI.Therefore,gender differences should be strongly considered in TBI studies.展开更多
Objective:This study aimed to evaluate the prognostic impact of citicoline sodium capsules on patients with traumatic brain injury(TBI)and its safety.Methods:This study is a multicenter,single-arm,prospective,observat...Objective:This study aimed to evaluate the prognostic impact of citicoline sodium capsules on patients with traumatic brain injury(TBI)and its safety.Methods:This study is a multicenter,single-arm,prospective,observational study of brain trauma patients who met the inclusion criteria between March 2023 and June 2024 and who could be treated with citicoline sodium capsules after being evaluated by the investigator.The Glasgow Coma Scale(GCS)and Mini-Mental State Examination(MMSE),the incidence of adverse drug reactions/adverse events during treatment,and the abnormalities of safety tests with clinical evaluation significance were observed at 1 month and 2 months after treatment.Results:A total of 2806 patients,63.1%of whom were male,with an average age of 58.85 years old.The GCS and MMSE scores of the patients at 1 month and 2 months after treatment were significantly improved and were statistically significant,indicating that citicoline sodium had a significant effect on improving the state of consciousness and cognitive function of patients with TBI.Only 8 adverse reactions were reported in the study,all of which were mild gastrointestinal reactions and anaphylaxis,and did not lead to treatment interruption or serious consequences.Conclusion:Citicoline sodium has a significant therapeutic effect on patients with TBI and has good safety.展开更多
Orexins, produced in the lateral hypothalamus, are important neuropeptides that participate in the sleep/wake cycle, and their expres- sion coincides with the projection area of the vagus nerve in the brain. Vagus ner...Orexins, produced in the lateral hypothalamus, are important neuropeptides that participate in the sleep/wake cycle, and their expres- sion coincides with the projection area of the vagus nerve in the brain. Vagus nerve stimulation has been shown to decrease the amounts of daytime sleep and rapid eye movement in epilepsy patients with traumatic brain injury. In the present study, we investigated whether vagus nerve stimulation promotes wakefulness and affects orexin expression. A rat model of traumatic brain injury was established using the free fall drop method. In the stimulated group, rats with traumatic brain injury received vagus nerve stimulation （frequency, 30 Hz, current, 1.0 mA; pulse width, 0.5 ms; total stimulation time, 15 minutes）. In the antagonist group, rats with traumatic brain injury were intracerebroventricularly injected with the orexin receptor type 1 （OXIR） antagonist SB334867 and received vagus nerve stimulation. Changes in consciousness were observed after stimulation in each group. Enzyme-linked immunosorbent assay, western blot assay and immunohistochemistry were used to assess the levels of orexin-A and OX1R expression in the prefrontal cortex. In the stimulated group, consciousness was substantially improved, orexin-A protein expression gradually increased within 24 hours after injury and OX1R expres- sion reached a peak at 12 hours, compared with rats subjected to traumatic brain injury only. In the antagonist group, the wake-promoting effect of vagus nerve stimulation was diminished, and orexin-A and OX1R expression were decreased, compared with that of the stim- ulated group. Taken together, our findings suggest that vagus nerve stimulation promotes the recovery of consciousness in comatose rats after traumatic brain injury. The upregulation of orexin-A and OXIR expression in the prefrontal cortex might be involved in the wake-promoting effects of vagus nerve stimulation.展开更多
The cingulum,connecting the orbitofrontal cortex to the medial temporal lobe,involves in diverse cognition functions including attention,memory,and motivation.To investigate the relationship between the cingulum injur...The cingulum,connecting the orbitofrontal cortex to the medial temporal lobe,involves in diverse cognition functions including attention,memory,and motivation.To investigate the relationship between the cingulum injury and cognitive impairment in patients with chronic mild traumatic brain injury,we evaluated the integrity between the anterior cingulum and the basal forebrain using diffusion tensor tractography in 73 patients with chronic mild traumatic brain injury(39 males,34 females,age 43.29±11.42 years)and 40 healthy controls(22 males,18 females,age 40.11±16.81 years).The patients were divided into three subgroups based on the integrity between the anterior cingulum and the basal forebrain on diffusion tensor tractography:subgroup A(n=19 patients)– both sides of the anterior cingulum were intact;subgroup B(n=36 patients)– either side of the anterior cingulum was intact;and subgroup C(18 patients)– both sides of the anterior cingulum were discontinued.There were significant differences in total Memory Assessment Scale score between subgroups A and B and between subgroups A and C.There were no significant differences in diffusion tensor tractography parameters(fractional anisotropy,apparent diffusion coefficient,and fiber volume)between patients and controls.These findings suggest that the integrity between the anterior cingulum and the basal forebrain,but not diffusion tensor tractography parameter,can be used to predict the cognitive function of patients with chronic mild traumatic brain injury.This study was approved by Yeungnam University Hospital Institutional Review Board(approval No.YUMC-2014-01-425-010)on August 16,2017.展开更多
BACKGROUND:Traumatic brain injuries are common and costly to hospital systems.Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines.This is a review of ...BACKGROUND:Traumatic brain injuries are common and costly to hospital systems.Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines.This is a review of the current literature discussing the evolving practice of traumatic brain injury.DATA SOURCES:A literature search using multiple databases was performed for articles published through September 2012 with concentration on meta-analyses,systematic reviews,and randomized controlled trials.RESULTS:The focus of care should be to minimize secondary brain injury by surgically decompressing certain hematomas,maintain systolic blood pressure above 90 mmHg,oxygen saturations above 93%,euthermia,intracranial pressures below 20 mmHg,and cerebral perfusion pressure between 60-80 mmHg.CONCLUSION:Much is still unknown about the management of traumatic brain injury.The current practice guidelines have not yet been sufficiently validated,however equipoise is a major issue when conducting randomized control trials among patients with traumatic brain injury.展开更多
Traumatic brain injury(TBI)is a brain injury caused by direct external forces,and its prognosis depends on the extent of the damage and the changes in level of consciousness.Timely awakening from a coma is the first t...Traumatic brain injury(TBI)is a brain injury caused by direct external forces,and its prognosis depends on the extent of the damage and the changes in level of consciousness.Timely awakening from a coma is the first thorny problem to be solved in TBI treatment.Therefore,there is a need for the development of safe and effective methods for timely awakening after TBI coma.Dopamine(DA)and its receptors in the nervous system are involved in the regulation of wakefulness.The amount and activity of dopaminergic neurons can affect cellular function and neuroinflammatory response,and are also significant for the awakening process after TBI.The current common awakening therapy for TBI may also be related to the activation of dopaminergic neurons.Acupuncture plays a beneficial role in timely awakening,recovery of conscious level,and functional rehabilitation after TBI.The mechanism may be related to the targeted regulation of DA and its receptors via acupuncture.Among acupuncture first aid therapies,acupuncture at hand 12 Jing-Well points,with its advantages of simple operation and ultra-early intervention,has shown great promise in timely awakening following TBI and triggering a series of subsequent nerve repair effects in the treatment of TBI.We here present a review that provides a new perspective for the timely awakening from TBI-induced coma,with a focus on the role of DA in the regulation of wakefulness and the efficacy and potential mechanism of DA systems in the treatment of TBI by acupuncture.展开更多
Objective To investigate the effects of propofol and sevoflurane on neurological recovery of traumatic brain injury(TBI)patients in the early postoperative stage.Methods We retrospectively analyzed the clinical data o...Objective To investigate the effects of propofol and sevoflurane on neurological recovery of traumatic brain injury(TBI)patients in the early postoperative stage.Methods We retrospectively analyzed the clinical data of TBI patients who underwent craniotomy or decompressive craniectomy.Generalized additive mixed model(GAMM)was used to analyze effects of propofol and sevoflurane on Glasgow Coma Scale(GCS)on postoperative days 1,3,and 7.Multivariate regression analysis was used to analyze effects of the two anesthetics on Glasgow Outcome Scale(GOS)at discharge.Results A total of 340 TBI patients were enrolled in this study.There were 110 TBI patients who underwent craniotomy including 75 in the propofol group and 35 in the sevoflurane group,and 134 patients who underwent decompressive craniectomy including 63 in the propofol group and 71 in the sevoflurane group.It showed no significant difference in GCS at admission between the propofol and the sevoflurane groups among craniotomy patients(β=0.75,95%CI:-0.55 to 2.05,P=0.260).However,elevation in GCS from baseline was 1.73 points(95%CI:-2.81 to-0.66,P=0.002)less in the sevoflurane group than that in the propofol group on postoperative day 1,2.03 points(95%CI:-3.14 to-0.91,P 0.001)less on day 3,and 1.31 points(95%CI:-2.43 to-0.19,P=0.022)less on day 7.The risk of unfavorable GOS(GOS 1,2,and 3)at discharge was higher in the sevoflurane group(OR=4.93,95%CI:1.05 to 23.03,P=0.043).No significant difference was observed among two-group decompressive craniectomy patients in GCS and GOS.Conclusions Compared to propofol,sevoflurane was associated with worse neurological recovery during the hospital stay in TBI patients undergoing craniotomy.This difference was not detected in TBI patients undergoing decompressive craniectomy.展开更多
BACKGROUND Traumatic brain injury(TBI)is the second most common presentation of trauma victims.Among the various non-neurological complications after TBI,acute kidney injury(AKI)is not uncommon.AIM To establish the in...BACKGROUND Traumatic brain injury(TBI)is the second most common presentation of trauma victims.Among the various non-neurological complications after TBI,acute kidney injury(AKI)is not uncommon.AIM To establish the incidence,risk factors,and predictors of AKI in TBI victims.The secondary aim was to study the impact of AKI development on the outcomes of patients with TBI.METHODS This was a single-center retrospective cohort study of TBI victims with a Glasgow coma scale(GCS)≤11 in an apex trauma center in a metropolitan city.RESULTS The incidence of AKI after TBI was 11%.The risk factors for AKI after TBI were old age(P<0.001),comorbidities(P=0.023),shock(P<0.001),blood transfusion(P=0.016),consecutive neurosurgical intervention(P=0.029),high intracranial pressure(ICP)(P<0.001),rhabdomyolysis(P<0.001),and diabetes insipidus(P<0.001).The predictors of AKI after TBI were,on point-biserial correlation:Lower GCS(rpb=-0.27,n=331,P<0.001);and on multivariate logistic regression:(1)Shock(odds ratio[OR]:-11.94,P<0.001);(2)Rhabdomyolysis(OR:-7.33,P=0.001);(3)High ICP(OR:-4.39,P=0.018);(4)High Carlson comorbidity index(OR:-1.97,P=0.001);and(5)High acute physiology and chronic health evaluation-2(APACHE-2)score(OR:-1.13,P<0.001).The phenomenon of post-TBI AKI increased the extent of stay in intensive care unit(P=0.008),demand for ventilators(P=0.0170),ventilator days(P<0.001),incidence of brain death(P<0.001),and mortality(P<0.001).CONCLUSION Every tenth TBI victim suffers from AKI.AKI after TBI can be predicted by the patient's underlying comorbidities,on arrival low GCS,high APACHE-2 score,shock,rhabdomyolysis,and high ICP.The occurrence of AKI in TBI victims adversely affects outcome variables;however,this may be a reflection of the severe nature of TBI in the AKI group.New research is needed to understand the effects of AKI on outcome variables.展开更多
目的研究院前指数法(prehospital index,PHI)和格拉斯哥昏迷评分(Glasgow coma scale,GCS)对评估创伤颅脑损伤(traumatic brain injury,TBI)合并意识障碍(disorders of consciousness,DoC)的价值。方法选取郑州市第三人民医院TBI合并Do...目的研究院前指数法(prehospital index,PHI)和格拉斯哥昏迷评分(Glasgow coma scale,GCS)对评估创伤颅脑损伤(traumatic brain injury,TBI)合并意识障碍(disorders of consciousness,DoC)的价值。方法选取郑州市第三人民医院TBI合并DoC患者82例作为研究对象,纳入病例时间为2022年1月—2024年1月,均采用PHI法和GCS评分评估患者伤情,与创伤严重程度(injury severity score,ISS)评分进行比较,对比分析PHI法联合GCS评分与ISS评分诊断TBI合并DoC的结果,统计PHI法联合GCS评分与ISS评分诊断TBI合并DoC病情的诊断效能,分析预测值,比较PHI法联合GCS评分与ISS评分评估所需时间。结果82例TBI合并DoC患者中,共有42例重症患者和40例非重症患者;PHI法联合GCS评分检测出42例重症患者和40例非重症患者;ISS评分检测出43例重症患者和39例非重症患者;PHI联合GCS与ISS评分诊断TBI合并DoC的病情的灵敏度(95.24%vs 97.62%)、特异度(95.00%vs 95.00%)、准确度(95.12%vs 96.34%)差异无统计学意义(P>0.05);PHI法联合GCS评分诊断TBI合并DoC阳性预测值95.24%(40/42)、阴性预测值95.00%(38/40)与ISS评分检测预测值[95.35%(41/43)、97.44%(38/39)]对比差异无统计学意义(P>0.05);PHI法联合GCS评分评估所需时间与ISS评分对比差异无统计学意义(P>0.05)。结论PHI法和GCS评分用于TBI合并DoC中,能评估患者病情程度,提升诊断灵敏度和准确度,且评估用时较短,能为患者后续治疗提供参考依据。展开更多
目的:探究成人ICU内严重创伤性脑损伤(Severe traumatic brain injury,sTBI)患者实施目标温度管理(Target temperature management,TTM)持续时间的临床效果。方法:选取九江市第一人民医院成人ICU在2023年1月至2025年2月期间收治的sTBI患...目的:探究成人ICU内严重创伤性脑损伤(Severe traumatic brain injury,sTBI)患者实施目标温度管理(Target temperature management,TTM)持续时间的临床效果。方法:选取九江市第一人民医院成人ICU在2023年1月至2025年2月期间收治的sTBI患者64例,以抽样法将其随机分组为4组:常温组(0-TTM)、2 d TTM组(2-TTM)、5 d TTM组(5-TTM)及8 d TTM组(8-TTM),每组16例,并对所有患者进行相同的其他综合治疗,收集患者基础资料,以超声检测四组患者干预前及干预后的视神经鞘直径(Optic nerve sheath diameter,ONSD),使用格拉斯哥昏迷评分法(Glasgow coma scale,GCS)评估4组患者入院时及干预后的神经功能,并详细记录4组患者干预后3 m内并发症发生情况。结果:4组患者在性别、年龄、受伤机制等方面不存在明显差异(P>0.05),干预后,4组患者ONSD均有所下降,且5 d TTM组及8 d TTM组低于2 d TTM组及常温组,2 d TTM组低于常温组(P<0.05);但5 d TTM组及8 d TTM组患者的ONSD并未表现出显著差异(P>0.05)。干预后,4组患者GCS评分均升高,且5 d TTM组及8 d TTM组患者的评分较2 d TTM组及常温组高,2 d TTM组较常温组高(P<0.05);但5 d TTM组及8 d TTM组患者在GCS评分上无明显差异(P>0.05)。4组患者干预后3 m内的存活数及并发症发生情况对比,未见显著差异(P>0.05)。结论:TTM持续2 d以上,可有效缩短sTBI患者的ONSD,促进神经功能的恢复。展开更多
基金funded by grants from the National Natural Science Foundation of China,No.81260295the Natural Science Foundation of Jiangxi Province of China,No.20132BAB205063
文摘In this study, rats were put into traumatic brain injury-induced coma and treated with median nerve electrical stimulation. We explored the wake-promoting effect, and possible mechanisms, of median nerve electrical stimulation. Electrical stimulation upregulated the expression levels of orexin-A and its receptor OX1R in the rat prefrontal cortex. Orexin-A expression gradually in-creased with increasing stimulation, while OX1R expression reached a peak at 12 hours and then decreased. In addition, after the OX1R antagonist, SB334867, was injected into the brain of rats after traumatic brain injury, fewer rats were restored to consciousness, and orexin-A and OXIR expression in the prefrontal cortex was downregulated. Our ifndings indicate that median nerve electrical stimulation induced an up-regulation of orexin-A and OX1R expression in the pre-frontal cortex of traumatic brain injury-induced coma rats, which may be a potential mechanism involved in the wake-promoting effects of median nerve electrical stimulation.
文摘This study was a retrospective analysis of outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow coma scale. The series enrolled forty-six consecutive cases of acute traumatic epidural hematomas. The mean age of patients was 29.56 years and 63.04% of the patients were between 21 and 30 years of age. Forty-tree out of 46 (93.47%) of the patients were males. Road traffic crash was the main mode of injury. The severity of the traumatic brain injury was classified according to the Glasgow coma scale score at admission. The injury was mild or moderate in 35 (76.08%) cases and severe in 11. Eight patients (17.39%) presented with pupillary abnormalities. The computed tomography scanning of the head has objectivized the epidural hematoma in all patients and has shown a mass effect with midline shift in all but one case (45/46). The most frequent surgical procedure done was craniotomy. Six (13.04%) patients died (GOS 1), but 38 (82.60%) recovered fully (GOS 5) and two (04.34%) were disabled but independent (GOS 4). The Glasgow coma score at admission was very predictive for good or poor outcome, since all patients but one who died and all survivors who were disabled were comatose at admission (GCS ≤ 8).
文摘Background: Non-traumatic coma is the most common pediatric medical emergency. Its clinical diagnosis is easy. The difficulty lies in finding the etiology. Objective: To determine the prevalence and clinical profiles of non-traumatic Coma at the Centre Hospitalier Universitaire Pédiatrique de Bangui (CHUPB). Methodology: This was a descriptive and analytical cross-sectional study conducted between January 1 and June 31, 2021, at CHUPB. Children aged 1 month to 15 years, admitted to the emergency room with a Glasgow score less than or equal to 8 without any traumatism were included. The variables studied were sociodemographic, clinical and paraclinical. Data were entered and analyzed using SPSS 20.0 statistical software. The statistical test used was Pearson’s chi<sup>2</sup>, any p-value Results: Of 8551 children hospitalized during the study period, 370 were hospitalized for non-traumatic coma: 4.32%. They were divided into 57.5% (n = 213) boys and 42.44% (n = 157) girls, giving a sex ratio of 1.35. Their mean age was 35.95 ± 27.21 months. Children aged 1 to 24 months represented 54.59% (n = 202) of cases. The mean time to the consultation was 2.91 days ± 1.8. Fever 86.48% (n = 320) and convulsions 80% (n = 296) were the main reasons for consultation. Coma stages II - III and IV represented 52.44% (n = 194), 42.97% (n = 159) and 4.59% (n = 17) respectively. Neuromalaria (29.72%;n = 110), meningitis-meningoencephalitis-encephalitis (30%;n = 111), sepsis (19.72%;n = 73) and acidosis Coma (5.40%;n = 20) were the main etiologies. Conclusion: Non-traumatic coma is common at CHUPB. Infections were the main etiology, particularly cerebral malaria. The reduction of its frequency requires, among others, the strengthening of the national monitoring malaria program. The strengthening of the technical platform for a good etiological diagnosis constitutes the other axis of prevention.
文摘Purpose:Patients’gender,which can be one of the most important determinants of traumatic brain injury(TBI)outcomes,is also likely to interact with many other outcome variables of TBI.This multicenter descriptive study investigated gender differences in epidemiological,clinical,treatment,mortality,and variable characteristics in adult TBI patients.Methods:The selection criteria were defined as patients who had been diagnosed with TBI and were admitted to the hospital between January 1,2016 and December 31,2018.A total of 4468 adult TBI patients were enrolled at eight University Hospitals.Based on the list of enrolled patients,the medical records of the patients were reviewed and they were registered online at each hospital.The registered patients were classified into three groups according to the Glasgow coma scale(GCS)score:mild(13-15),moderate(9-12),and severe(3-8),and the differences between men and women in each group were investigated.The risk factors of moderated and severe TBI compared to mild TBI were also investigated.Results:The study included 3075 men and 1393 women and the proportion of total males was 68.8%.Among all the TBI patients,there were significant differences between men and women in age,past history,and GCS score.While the mild and severe TBI groups showed significant differences in age,past history,and clinical symptoms,the moderate TBI group showed significant differences in age,past history,cause of justice,and diagnosis.Conclusion:To the best of our knowledge,this multicenter study is the first to focus on gender differences of adult patients with TBI in Korea.This study shows significant differences between men and women in many aspects of adult TBI.Therefore,gender differences should be strongly considered in TBI studies.
文摘Objective:This study aimed to evaluate the prognostic impact of citicoline sodium capsules on patients with traumatic brain injury(TBI)and its safety.Methods:This study is a multicenter,single-arm,prospective,observational study of brain trauma patients who met the inclusion criteria between March 2023 and June 2024 and who could be treated with citicoline sodium capsules after being evaluated by the investigator.The Glasgow Coma Scale(GCS)and Mini-Mental State Examination(MMSE),the incidence of adverse drug reactions/adverse events during treatment,and the abnormalities of safety tests with clinical evaluation significance were observed at 1 month and 2 months after treatment.Results:A total of 2806 patients,63.1%of whom were male,with an average age of 58.85 years old.The GCS and MMSE scores of the patients at 1 month and 2 months after treatment were significantly improved and were statistically significant,indicating that citicoline sodium had a significant effect on improving the state of consciousness and cognitive function of patients with TBI.Only 8 adverse reactions were reported in the study,all of which were mild gastrointestinal reactions and anaphylaxis,and did not lead to treatment interruption or serious consequences.Conclusion:Citicoline sodium has a significant therapeutic effect on patients with TBI and has good safety.
基金supported by the Natural Science Foundation of China,No.81260295the Graduate Student Innovation Fund of Jiangxi Province of China,No.YC2015-S090
文摘Orexins, produced in the lateral hypothalamus, are important neuropeptides that participate in the sleep/wake cycle, and their expres- sion coincides with the projection area of the vagus nerve in the brain. Vagus nerve stimulation has been shown to decrease the amounts of daytime sleep and rapid eye movement in epilepsy patients with traumatic brain injury. In the present study, we investigated whether vagus nerve stimulation promotes wakefulness and affects orexin expression. A rat model of traumatic brain injury was established using the free fall drop method. In the stimulated group, rats with traumatic brain injury received vagus nerve stimulation （frequency, 30 Hz, current, 1.0 mA; pulse width, 0.5 ms; total stimulation time, 15 minutes）. In the antagonist group, rats with traumatic brain injury were intracerebroventricularly injected with the orexin receptor type 1 （OXIR） antagonist SB334867 and received vagus nerve stimulation. Changes in consciousness were observed after stimulation in each group. Enzyme-linked immunosorbent assay, western blot assay and immunohistochemistry were used to assess the levels of orexin-A and OX1R expression in the prefrontal cortex. In the stimulated group, consciousness was substantially improved, orexin-A protein expression gradually increased within 24 hours after injury and OX1R expres- sion reached a peak at 12 hours, compared with rats subjected to traumatic brain injury only. In the antagonist group, the wake-promoting effect of vagus nerve stimulation was diminished, and orexin-A and OX1R expression were decreased, compared with that of the stim- ulated group. Taken together, our findings suggest that vagus nerve stimulation promotes the recovery of consciousness in comatose rats after traumatic brain injury. The upregulation of orexin-A and OXIR expression in the prefrontal cortex might be involved in the wake-promoting effects of vagus nerve stimulation.
基金supported by the Medical Research Center Program(2015R1A5A2009124)through the National Research Foundation of Korea(NRF)funded by the Ministry of Science,ICT and Future Planning(to SHJ and SHK)
文摘The cingulum,connecting the orbitofrontal cortex to the medial temporal lobe,involves in diverse cognition functions including attention,memory,and motivation.To investigate the relationship between the cingulum injury and cognitive impairment in patients with chronic mild traumatic brain injury,we evaluated the integrity between the anterior cingulum and the basal forebrain using diffusion tensor tractography in 73 patients with chronic mild traumatic brain injury(39 males,34 females,age 43.29±11.42 years)and 40 healthy controls(22 males,18 females,age 40.11±16.81 years).The patients were divided into three subgroups based on the integrity between the anterior cingulum and the basal forebrain on diffusion tensor tractography:subgroup A(n=19 patients)– both sides of the anterior cingulum were intact;subgroup B(n=36 patients)– either side of the anterior cingulum was intact;and subgroup C(18 patients)– both sides of the anterior cingulum were discontinued.There were significant differences in total Memory Assessment Scale score between subgroups A and B and between subgroups A and C.There were no significant differences in diffusion tensor tractography parameters(fractional anisotropy,apparent diffusion coefficient,and fiber volume)between patients and controls.These findings suggest that the integrity between the anterior cingulum and the basal forebrain,but not diffusion tensor tractography parameter,can be used to predict the cognitive function of patients with chronic mild traumatic brain injury.This study was approved by Yeungnam University Hospital Institutional Review Board(approval No.YUMC-2014-01-425-010)on August 16,2017.
文摘BACKGROUND:Traumatic brain injuries are common and costly to hospital systems.Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines.This is a review of the current literature discussing the evolving practice of traumatic brain injury.DATA SOURCES:A literature search using multiple databases was performed for articles published through September 2012 with concentration on meta-analyses,systematic reviews,and randomized controlled trials.RESULTS:The focus of care should be to minimize secondary brain injury by surgically decompressing certain hematomas,maintain systolic blood pressure above 90 mmHg,oxygen saturations above 93%,euthermia,intracranial pressures below 20 mmHg,and cerebral perfusion pressure between 60-80 mmHg.CONCLUSION:Much is still unknown about the management of traumatic brain injury.The current practice guidelines have not yet been sufficiently validated,however equipoise is a major issue when conducting randomized control trials among patients with traumatic brain injury.
基金supported by the National Natural Science Foundation of China(No.82074534).
文摘Traumatic brain injury(TBI)is a brain injury caused by direct external forces,and its prognosis depends on the extent of the damage and the changes in level of consciousness.Timely awakening from a coma is the first thorny problem to be solved in TBI treatment.Therefore,there is a need for the development of safe and effective methods for timely awakening after TBI coma.Dopamine(DA)and its receptors in the nervous system are involved in the regulation of wakefulness.The amount and activity of dopaminergic neurons can affect cellular function and neuroinflammatory response,and are also significant for the awakening process after TBI.The current common awakening therapy for TBI may also be related to the activation of dopaminergic neurons.Acupuncture plays a beneficial role in timely awakening,recovery of conscious level,and functional rehabilitation after TBI.The mechanism may be related to the targeted regulation of DA and its receptors via acupuncture.Among acupuncture first aid therapies,acupuncture at hand 12 Jing-Well points,with its advantages of simple operation and ultra-early intervention,has shown great promise in timely awakening following TBI and triggering a series of subsequent nerve repair effects in the treatment of TBI.We here present a review that provides a new perspective for the timely awakening from TBI-induced coma,with a focus on the role of DA in the regulation of wakefulness and the efficacy and potential mechanism of DA systems in the treatment of TBI by acupuncture.
基金Beijing Natural Sciences Foundation(7173255)Beijing Municipal Administration of Hospital Incubating Program(PX2019019).
文摘Objective To investigate the effects of propofol and sevoflurane on neurological recovery of traumatic brain injury(TBI)patients in the early postoperative stage.Methods We retrospectively analyzed the clinical data of TBI patients who underwent craniotomy or decompressive craniectomy.Generalized additive mixed model(GAMM)was used to analyze effects of propofol and sevoflurane on Glasgow Coma Scale(GCS)on postoperative days 1,3,and 7.Multivariate regression analysis was used to analyze effects of the two anesthetics on Glasgow Outcome Scale(GOS)at discharge.Results A total of 340 TBI patients were enrolled in this study.There were 110 TBI patients who underwent craniotomy including 75 in the propofol group and 35 in the sevoflurane group,and 134 patients who underwent decompressive craniectomy including 63 in the propofol group and 71 in the sevoflurane group.It showed no significant difference in GCS at admission between the propofol and the sevoflurane groups among craniotomy patients(β=0.75,95%CI:-0.55 to 2.05,P=0.260).However,elevation in GCS from baseline was 1.73 points(95%CI:-2.81 to-0.66,P=0.002)less in the sevoflurane group than that in the propofol group on postoperative day 1,2.03 points(95%CI:-3.14 to-0.91,P 0.001)less on day 3,and 1.31 points(95%CI:-2.43 to-0.19,P=0.022)less on day 7.The risk of unfavorable GOS(GOS 1,2,and 3)at discharge was higher in the sevoflurane group(OR=4.93,95%CI:1.05 to 23.03,P=0.043).No significant difference was observed among two-group decompressive craniectomy patients in GCS and GOS.Conclusions Compared to propofol,sevoflurane was associated with worse neurological recovery during the hospital stay in TBI patients undergoing craniotomy.This difference was not detected in TBI patients undergoing decompressive craniectomy.
文摘BACKGROUND Traumatic brain injury(TBI)is the second most common presentation of trauma victims.Among the various non-neurological complications after TBI,acute kidney injury(AKI)is not uncommon.AIM To establish the incidence,risk factors,and predictors of AKI in TBI victims.The secondary aim was to study the impact of AKI development on the outcomes of patients with TBI.METHODS This was a single-center retrospective cohort study of TBI victims with a Glasgow coma scale(GCS)≤11 in an apex trauma center in a metropolitan city.RESULTS The incidence of AKI after TBI was 11%.The risk factors for AKI after TBI were old age(P<0.001),comorbidities(P=0.023),shock(P<0.001),blood transfusion(P=0.016),consecutive neurosurgical intervention(P=0.029),high intracranial pressure(ICP)(P<0.001),rhabdomyolysis(P<0.001),and diabetes insipidus(P<0.001).The predictors of AKI after TBI were,on point-biserial correlation:Lower GCS(rpb=-0.27,n=331,P<0.001);and on multivariate logistic regression:(1)Shock(odds ratio[OR]:-11.94,P<0.001);(2)Rhabdomyolysis(OR:-7.33,P=0.001);(3)High ICP(OR:-4.39,P=0.018);(4)High Carlson comorbidity index(OR:-1.97,P=0.001);and(5)High acute physiology and chronic health evaluation-2(APACHE-2)score(OR:-1.13,P<0.001).The phenomenon of post-TBI AKI increased the extent of stay in intensive care unit(P=0.008),demand for ventilators(P=0.0170),ventilator days(P<0.001),incidence of brain death(P<0.001),and mortality(P<0.001).CONCLUSION Every tenth TBI victim suffers from AKI.AKI after TBI can be predicted by the patient's underlying comorbidities,on arrival low GCS,high APACHE-2 score,shock,rhabdomyolysis,and high ICP.The occurrence of AKI in TBI victims adversely affects outcome variables;however,this may be a reflection of the severe nature of TBI in the AKI group.New research is needed to understand the effects of AKI on outcome variables.
文摘目的:探究成人ICU内严重创伤性脑损伤(Severe traumatic brain injury,sTBI)患者实施目标温度管理(Target temperature management,TTM)持续时间的临床效果。方法:选取九江市第一人民医院成人ICU在2023年1月至2025年2月期间收治的sTBI患者64例,以抽样法将其随机分组为4组:常温组(0-TTM)、2 d TTM组(2-TTM)、5 d TTM组(5-TTM)及8 d TTM组(8-TTM),每组16例,并对所有患者进行相同的其他综合治疗,收集患者基础资料,以超声检测四组患者干预前及干预后的视神经鞘直径(Optic nerve sheath diameter,ONSD),使用格拉斯哥昏迷评分法(Glasgow coma scale,GCS)评估4组患者入院时及干预后的神经功能,并详细记录4组患者干预后3 m内并发症发生情况。结果:4组患者在性别、年龄、受伤机制等方面不存在明显差异(P>0.05),干预后,4组患者ONSD均有所下降,且5 d TTM组及8 d TTM组低于2 d TTM组及常温组,2 d TTM组低于常温组(P<0.05);但5 d TTM组及8 d TTM组患者的ONSD并未表现出显著差异(P>0.05)。干预后,4组患者GCS评分均升高,且5 d TTM组及8 d TTM组患者的评分较2 d TTM组及常温组高,2 d TTM组较常温组高(P<0.05);但5 d TTM组及8 d TTM组患者在GCS评分上无明显差异(P>0.05)。4组患者干预后3 m内的存活数及并发症发生情况对比,未见显著差异(P>0.05)。结论:TTM持续2 d以上,可有效缩短sTBI患者的ONSD,促进神经功能的恢复。
