The vegetative state is a complex condition with unclear mechanisms and limited diagnostic, prognostic, and therapeutic methods. In this study, we aimed to explore the proteomic profile of tears from patients in a tra...The vegetative state is a complex condition with unclear mechanisms and limited diagnostic, prognostic, and therapeutic methods. In this study, we aimed to explore the proteomic profile of tears from patients in a traumatic vegetative state and identify potential diagnostic markers using tears-a body fluid that can be collected noninvasively. Using iTRAQ quantitative proteomic technology, in the discovery phase, tear samples collected from 16 patients in a traumatic vegetative state and 16 normal individuals were analyzed. Among 1080 identified tear proteins, 57 were upregulated and 15 were downregulated in the patients compared to the controls. Bioinformatics analysis revealed that the differentially-expressed proteins were mainly involved in the wound response and immune response signaling pathways. Furthermore, we verified the levels of 7 differentially-expressed proteins in tears from 50 traumatic vegetative state patients and 50 normal controls （including the samples used in the discovery phase） using ELISA. The results showed that this 7-protein panel had a high discrimination ability for traumatic vegetative state （area under the curve = 0.999）. In sum- mary, the altered tear proteomic profile identified in this study provides a basis for potential tear protein markers for diagnosis and prognosis of the traumatic vegetative state and also provides novel insights into the mechanisms of traumatic vegetative state.展开更多
BACKGROUND Persistent vegetative state(PVS)is a devastating and long-lasting clinical condition with high morbidity and mortality;currently,there are no available effective interventions.CASE SUMMARY We report the cas...BACKGROUND Persistent vegetative state(PVS)is a devastating and long-lasting clinical condition with high morbidity and mortality;currently,there are no available effective interventions.CASE SUMMARY We report the case of an 11-year-old boy with PVS caused by severe intracerebral bleeding in the left hemisphere following anticoagulation treatment.The patient’s PVS severity showed no notable improvement after 2-mo neuroprotective treatment and rehabilitation,including nerve growth factor and baclofen,hyperbaric oxygen,and comprehensive bedside rehabilitation therapies.Daily inhalation treatment(4-6 h)of high-concentration hydrogen(H2)gas(66.6%H2+33.3%O2)was provided.Surprisingly,the patient’s orientation,consciousness,ability to speak,facial expressions,and locomotor function were significantly restored,along with improvements in essential general health status,after H2 gas inhalation treatment,which was consistent with stabilized neuropathology in the left hemisphere and increased Hounsfield unit values of computed tomography in the right hemisphere.The patient finally recovered to a near normal conscious state with a Coma Recovery Scale-Revised Score of 22 from his previous score of 3.CONCLUSION Phase 1 clinical trials are needed to explore the safety and efficacy of H2 gas inhalation in patients with PVS.展开更多
Following severe traumatic brain injury .（sTBI）, patients may remain in a coma, vegetative state （VS）, or minimally conscious state （MCS）, all of which are also clinically termed disorders of consciousness. Pati...Following severe traumatic brain injury .（sTBI）, patients may remain in a coma, vegetative state （VS）, or minimally conscious state （MCS）, all of which are also clinically termed disorders of consciousness. Patients in a coma show complete disability in the arousal system and fail to achieve awareness spontaneously; yet true coma represents a transient state and rarely lasts longer than a month [1]. The VS （also known as unresponsive wakefulness syndrome）, characterized as a state with spontaneous or stimulus-induced eye-opening but the patient appears totally unaware of self and environment, may persist for months or years [2]. In contrast, the MCS is evidenced by preserved and reproducible signs of awareness as well as sleep-wake cycles, suggesting better recovery than coma and VS. Considering that no signs of consciousness are detectable, patients in a VS suffer from a high rate of misdiagnosis [3].展开更多
Objective: persistent vegetative state is a common symptom in patients with cerebral trauma. Effective intervention plays an important role in promoting patients' recovery, and the application effect of stimulant ...Objective: persistent vegetative state is a common symptom in patients with cerebral trauma. Effective intervention plays an important role in promoting patients' recovery, and the application effect of stimulant rehabilitation nursing is analyzed. Methods: Time: 2019.11-2020.11, object: 78 patients with persistent vegetative state after traumatic brain injury. Grouping method: Random method, applying conventional nursing methods to the control group, applying stimulant rehabilitation nursing to the research group, and analyzing the therapeutic effect of the two groups of patients. Results: the effective rate of nursing and the occurrence of complications were compared between the two groups. The indexes of the study group were better than those of the control group (P<0.05). Conclusion: the application of stimulant rehabilitation nursing to patients with persistent vegetative state after brain injury can promote the relief of vegetative state, avoid the occurrence of various complications such as joint spasm, falling pneumonia, pressure sore, urinary system infection, etc., and promote the early recovery of patients.展开更多
Background:It is a challenge to characterize the consciousness level of patients with severe disturbance of consciousness and predict their prognosis effectively for Chinese doctors.We aimed to investigate the psychom...Background:It is a challenge to characterize the consciousness level of patients with severe disturbance of consciousness and predict their prognosis effectively for Chinese doctors.We aimed to investigate the psychometric property and the diagnostic practicality of severe disturbance of consciousness by Chinese Nanjing persistent vegetative state scale(CNPVSS)which was first set up in 1996 and modified in 2001 and 2011.Methods:The concurrent validity,inter-rater consistency and diagnostic accuracy of CNPVSS and Chinese version of coma recovery scale-revised(CRS-R)were investigated by assessment of 380 patients with severe disorders of consciousness.Results:Total scores of the CNPVSS were correlated significantly with that of the CRS-R,indicating acceptable concurrent validity.Sub-scale analysis showed moderate to high inter-rater reliability and test-retest reliability.CNPVSS was superior to CRS-R on the diagnosis sensitivity.The CNPVSS was able to distinguish 65 patients in emergence from minimal consciousness state who were misclassified as in minimal consciousness state(MCS)by the CRS-R,and it could also distinguish two patients in MCS who were misclassified as in vegetative state by the CRS-R.Conclusion:The CNPVSS is an appropriate measurement and is sensitive to distinguish the MCS patients from the VS patients.展开更多
Background Hypoxic-ischemic brain injury （HIBI） after cardiopulmonary resuscitation is one of the most devastating neurological conditions that causing the impaired consciousness. However, there were few studies inv...Background Hypoxic-ischemic brain injury （HIBI） after cardiopulmonary resuscitation is one of the most devastating neurological conditions that causing the impaired consciousness. However, there were few studies investigated the changes of brain metabolism in patients with vegetative state （VS） after post-resuscitated HIBI. This study aimed to analyze the change of overall brain metabolism and elucidated the brain area correlated with the level of consciousness （LOC） in patients with VS after post-resuscitated HIBI. Methods We consecutively enrolled 17 patients with VS after HIBI, who experienced cardiopulmonary resuscitation. Overall brain metabolism was measured by F-18 fluorodeoxyglucose positron emission tomography （F-18 FDG PET） and we compared regional brain metabolic patterns from 17 patients with those from 15 normal controls using voxel-by-voxel based statistical parametric mapping analysis. Additionally, we correlated the LOC measured by the JFK-coma recovery scale-revised of each patient with brain metabolism by covariance analysis. Results Compared with normal controls, the patients with VS after post-resuscitated HIBI revealed significantly decreased brain metabolism in bilateral precuneus, bilateral posterior cingulate gyrus, bilateral middle frontal gyri, bilateral superior parietal gyri, bilateral middle occipital gyri, bilateral precentral gyri （PFEw correctecd 〈0.0001 ）, and increased brain metabolism in bilateral insula, bilateral cerebella, and the brainstem （PFEWcorrectecd 〈0.0001 ）. In covariance analysis, the LOC was significantly correlated with brain metabolism in bilateral fusiform and superior temporal gyri （P uncorrected 〈0.005）. Conclusions Our study demonstrated that the precuneus, the posterior cingulate area and the frontoparietal cortex, which is a component of neural correlate for consciousness, may be relevant structure for impaired consciousness in patient with VS after post-resuscitated HIBI. In post-resuscitated HIBI, measurement of brain metabolism using PET images may be helpful for investigating the brain function that cannot be obtained by morphological imaging and can be used to assess the brain area responsible for consciousness.展开更多
Objective To explore the effects of acupuncture on nutritional status in patients in a persistent vegetative state.Methods A prospective randomized controlled trial was designed.A total of 66 patients in a persistent ...Objective To explore the effects of acupuncture on nutritional status in patients in a persistent vegetative state.Methods A prospective randomized controlled trial was designed.A total of 66 patients in a persistent vegetative state were randomized into a control group and an observation group,with 33 cases in each group.The control group was given conventional treatment plus enteral nutrition support.The observation group was treated with additional Tiao Shen Jian Pi acupuncture therapy(acupuncture for spirit-regulating and spleen-invigorating)based on the same interventions in the control group.Both groups were treated for 8 weeks.The levels of total protein(TP),prealbumin(PA),albumin(Alb),and hemoglobin(Hb)were measured before and after treatment.The upper arm circumference and skinfold thickness of triceps brachii were measured.And the intestinal flora and fecal short-chain fatty acids contents were determined.Results After treatment,the levels of TP,PA,Alb,and Hb in the control group were decreased(P<0.05),while in the observation group,compared with those before treatment,the levels of TP,PA,Alb,and Hb had no statistical differences(P>0.05),and the levels were all higher than those in the control group(P<0.05).The upper arm circumference and skinfold thickness of triceps brachii in both groups decreased(P<0.05),and the values of these two items in the observation group were higher than those in the control group(P<0.05).In the control group,the contents of Bifidobacterium and Lactobacillus in feces decreased(P<0.05),and the content of Enterococcus increased(P<0.05).In the observation group,the contents of Bifidobacterium and Lactobacillus in feces increased(P<0.05),and the content of Enterococcus decreased(P<0.05).The differences between the two groups were statistically significant(P<0.05).In the control group,the total content of fecal short-chain fatty acids and the contents of acetic acid and butyric acid in feces decreased(P<0.05).In the observation group,the total content of fecal short-chain fatty acids and the contents of acetic acid and butyric acid in feces increased(P<0.05)and were all higher than those in the control group(P<0.05).Conclusion Acupuncture can improve nutrition-related blood indicators in patients in a persistent vegetative state and delay the decrease of upper arm circumference and skinfold thickness of triceps brachii,which may be related to the regulation of intestinal flora and fecal short-chain fatty acids contents.展开更多
Background Permanent vegetative state is defined as the impaired level of consciousness longer than 12 months after traumatic causes and 3 months after non-traumatic causes of brain injury. Although many studies asses...Background Permanent vegetative state is defined as the impaired level of consciousness longer than 12 months after traumatic causes and 3 months after non-traumatic causes of brain injury. Although many studies assessed the cerebral metabolism in patients with acute and persistent vegetative state after brain injury, few studies investigated the cerebral metabolism in patients with permanent vegetative state. In this study, we performed the voxel-based analysis of cerebral glucose metabolism and investigated the relationship between regional cerebral glucose metabolism and the severity of impaired consciousness in patients with permanent vegetative state after acquired brain injury.Methods We compared the regional cerebral glucose metabolism as demonstrated by F-18 fluorodeoxyglucose positron emission tomography from 12 patients with permanent vegetative state after acquired brain injury with those from 12 control subjects. Additionally, covariance analysis was performed to identify regions where decreased changes in regional cerebral glucose metabolism significantly correlated with a decrease of level of consciousness measured by JFK-coma recovery scare. Statistical analysis was performed using statistical parametric mapping.Results Compared with controls, patients with permanent vegetative state demonstrated decreased cerebral glucose metabolism in the left precuneus, both posterior cingulate cortices, the left superior parietal lobule （Pcorrected 〈0.001）, and increased cerebral glucose metabolism in the both cerebellum and the right supramarginal cortices （Pcorrected 〈0.001）. In the covariance analysis, a decrease in the level of consciousness was significantly correlated with decreased cerebral glucose metabolism in the both posterior cingulate cortices （Puncorrected 〈0.005）.Conclusion Our findings suggest that the posteromedial parietal cortex, which are part of neural network for consciousness, may be relevant structure for pathophysiological mechanism in patients with permanent vegetative state after acquired brain injury.展开更多
Disorders of consciousness (DOC) are neuropsychiatric disorders with causes that include traumatic brain injury, hypoxia, and stroke. The possibility of spontaneous recovery is low, and treatment remains a difficult p...Disorders of consciousness (DOC) are neuropsychiatric disorders with causes that include traumatic brain injury, hypoxia, and stroke. The possibility of spontaneous recovery is low, and treatment remains a difficult problem in the frontier challenge of neuroscience and medicine. With progress in neurocritical care, the number of patients with DOC is growing. Spinal cord stimulation (SCS) can improve the level of consciousness in patients with DOC. The present article reviews the current research status and development trends of SCS in promoting consciousness recovery in patients with DOC. It also seeks to identify the frontier problems and challenges associated with this neuroregulatory technology. Through a systematic review of the relevant literature, criteria for inclusion and exclusion in SCS therapy were established, suitable patients with DOC were identified, and the effects of different stimulation frequencies on consciousness and motor function were examined. Additionally, the optimal SCS mode was investigated, and evaluation criteria, treatment mechanisms, and factors influencing effectiveness were summarized. The present review aims to guide the clinical application and research development of SCS. Although SCS has demonstrated efficacy in the treatment of DOC, responses to SCS exhibit significant individual variation. Consequently, further studies are necessary to expand the sample size for continued exploration and enhancement.展开更多
In recent decades, event-related potentials have been used for the clinical electrophysiological assessment of patients with disorders of consciousness （DOCs）. In this paper, an oddball paradigm with two types of fr...In recent decades, event-related potentials have been used for the clinical electrophysiological assessment of patients with disorders of consciousness （DOCs）. In this paper, an oddball paradigm with two types of frequencydeviant stimulus （standard stimuli were pure tones of 1000 Hz; small deviant stimuli were pure tones of 1050 Hz; large deviant stimuli were pure tones of 1200 Hz） was applied to elicit mismatch negativity （MMN） in 30 patients with DOCs diagnosed using the JFK Coma Recovery Scale- Revised （CRS-R）. The results showed that the peak amplitudes of MMN elicited by both large and small deviant stimuli were significantly different from baseline. In terms of the spatial properties of MMN, a significant interaction effect between conditions （small and large deviant stimuli） and electrode nodes was centered at the frontocentral area. Furthermore, correlation coefficients were calculated between MMN amplitudes and CRS-R scores for each electrode among all participants to generate topographic maps. Meanwhile, a significant negative correlation between the MMN amplitudes elicited by large deviant stimuli and the CRS-R scores was also found at the frontocentral area. In consequence, our results combine the above spatial properties of MMN in patients with DOCs, and provide a more precise location （frontocentral area） at which to evaluate the correlation between clinical electrophysiological assessment and the level of consciousness.展开更多
Introduction Functional connectivity across large-scale networks is crucial for the regulation of conscious states. Nonetheless, our understanding of potential alterations in the temporal dynamics of dynamic functiona...Introduction Functional connectivity across large-scale networks is crucial for the regulation of conscious states. Nonetheless, our understanding of potential alterations in the temporal dynamics of dynamic functional connectivity (dFC) among patients with disorders of consciousness (DOC) remains limited. The present study aimed to examine different time-scale spatiotemporal dynamics of electroencephalogram oscillation amplitudes recorded in different consciousness states.Methods Resting-state electroencephalograms were collected from a cohort of 90 patients with DOC. The sliding window approach was used to create dFC matrices, which were subsequently subjected to k-means clustering to identify distinct states. Finally, we performed state analysis and developed a decoding model to predict consciousness.ResultsThere was significantly lower dFC within the forebrain network in patients with unresponsive wakefulness syndrome than in those with a minimally conscious state. Moreover, there were significant differences in temporal properties, mean dwell time, and the number of transitions in the high-frequency band at different time scales between the unresponsive wakefulness syndrome and minimally conscious state groups. Using the multi-band and multi-range temporal dynamics of dFC approach, satisfactory classification accuracy (approximately 83.3 %) was achieved.Conclusion Loss of consciousness is accompanied by an imbalance of complex dynamics within the brain. Both transitions between states at short and medium time scales in high-frequency bands and the forebrain are important in consciousness recovery. Together, our findings contribute to a better understanding of brain network alterations in patients with DOC.展开更多
Patients with disorders of consciousness suffer from severe impairments in arousal and awareness alongside anomalous brain connections and aberrant neuronal activities.The thalamus,a crucial hub in the brain connectom...Patients with disorders of consciousness suffer from severe impairments in arousal and awareness alongside anomalous brain connections and aberrant neuronal activities.The thalamus,a crucial hub in the brain connectome,has been empirically inferred to maintain consciousness and wakefulness.Here,we investigated thalamic spiking,brain connectivity,consciousness states,and recovery outcomes following deep brain stimulation in 29 patients.Our study reveals that thalamic neuronal activity serves as a marker of consciousness state.Patients diagnosed with vegetative state/unresponsive wakefulness syndrome exhibited less-active neurons,with longer and more variable burst discharges,than those in a minimally conscious state.Furthermore,neuronal profiles in the intralaminar thalamus,the direct stimulation site,predicted whether electrostimulation here improved recovery.Stronger tonic firing was correlated with enhanced thalamocortical connectivity and better recovery outcomes in patients.These findings suggest that thalamic spiking signatures,including singleneuron burst discharge and tonic firing,selectively indicate the representation and alteration of consciousness.展开更多
Objective:Vagus nerve stimulation(VNS)has recently been used in neurorehabilitation and the recovery of consciousness based on its effects on cortical plasticity.The aim of this study was to examine the therapeutic ef...Objective:Vagus nerve stimulation(VNS)has recently been used in neurorehabilitation and the recovery of consciousness based on its effects on cortical plasticity.The aim of this study was to examine the therapeutic effects of VNS on patients with a minimally conscious state(MCS).Methods:All patients included in the study were assessed more than 5 months after injury and were receiving regular rehabilitation at our hospital from August 2018 to October 2019.Ten patients diagnosed with MCS by Coma Recovery Scale-Revised(CRS-R)test who underwent VNS surgery were enrolled.The scores on CRS-R evaluation at baseline(before VNS implantation)and 1,3,and 6 months after VNS treatment were recorded.The stimulation parameters were chosen according to a previous study.All clinical rehabilitation protocols remained unchanged during the study.Furthermore,safety was assessed by analyzing treatment-emergent adverse events(TEAEs).Results:No significant improvement in the total CRS-R scores at the end of the 1-month follow-up was observed(p>0.05).After 3 months of stimulation,a significant difference(p=0.0078)was observed in the total CRS-R scores compared with the baseline.After 6 months of VNS treatment,CRS-R assessments showed a continuous significant improvement(p=0.0039);one patient emerged from the MCS and recovered functional communication and object use.Interestingly,one item of CRS-R scores on visual domain was sensitive to VNS treatment(p=0.0039).Furthermore,no serious adverse event occurred throughout the study.Conclusion:This exploratory study provides preliminary evidence suggesting that VNS is a safe and effective tool for consciousness recovery in patients with MCS.展开更多
OBJECTIVE: To discuss the clinical criteria for diagnosing diffuse axonal injury (DAI). METHODS: Clinical and computed tomographic features of 117 patients with severe closed head injury were analyzed. The authors pre...OBJECTIVE: To discuss the clinical criteria for diagnosing diffuse axonal injury (DAI). METHODS: Clinical and computed tomographic features of 117 patients with severe closed head injury were analyzed. The authors preliminarily put forward CT diagnostic criteria of DAI, that is, 1) single or multiple small intraparenchymal hemorrhages in the cerebral hemispheres (展开更多
基金supported by the National Natural Science Foundation of China(81671198)the Grant of Shanghai Municipal Education Commission-Gaofeng Clinical Medicine(20152212)the Shanghai Shenkang Clinical Research Plan of the Shanghai Hospital Development Center(16CR3011A)
文摘The vegetative state is a complex condition with unclear mechanisms and limited diagnostic, prognostic, and therapeutic methods. In this study, we aimed to explore the proteomic profile of tears from patients in a traumatic vegetative state and identify potential diagnostic markers using tears-a body fluid that can be collected noninvasively. Using iTRAQ quantitative proteomic technology, in the discovery phase, tear samples collected from 16 patients in a traumatic vegetative state and 16 normal individuals were analyzed. Among 1080 identified tear proteins, 57 were upregulated and 15 were downregulated in the patients compared to the controls. Bioinformatics analysis revealed that the differentially-expressed proteins were mainly involved in the wound response and immune response signaling pathways. Furthermore, we verified the levels of 7 differentially-expressed proteins in tears from 50 traumatic vegetative state patients and 50 normal controls （including the samples used in the discovery phase） using ELISA. The results showed that this 7-protein panel had a high discrimination ability for traumatic vegetative state （area under the curve = 0.999）. In sum- mary, the altered tear proteomic profile identified in this study provides a basis for potential tear protein markers for diagnosis and prognosis of the traumatic vegetative state and also provides novel insights into the mechanisms of traumatic vegetative state.
文摘BACKGROUND Persistent vegetative state(PVS)is a devastating and long-lasting clinical condition with high morbidity and mortality;currently,there are no available effective interventions.CASE SUMMARY We report the case of an 11-year-old boy with PVS caused by severe intracerebral bleeding in the left hemisphere following anticoagulation treatment.The patient’s PVS severity showed no notable improvement after 2-mo neuroprotective treatment and rehabilitation,including nerve growth factor and baclofen,hyperbaric oxygen,and comprehensive bedside rehabilitation therapies.Daily inhalation treatment(4-6 h)of high-concentration hydrogen(H2)gas(66.6%H2+33.3%O2)was provided.Surprisingly,the patient’s orientation,consciousness,ability to speak,facial expressions,and locomotor function were significantly restored,along with improvements in essential general health status,after H2 gas inhalation treatment,which was consistent with stabilized neuropathology in the left hemisphere and increased Hounsfield unit values of computed tomography in the right hemisphere.The patient finally recovered to a near normal conscious state with a Coma Recovery Scale-Revised Score of 22 from his previous score of 3.CONCLUSION Phase 1 clinical trials are needed to explore the safety and efficacy of H2 gas inhalation in patients with PVS.
基金supported by grants from the National Natural Science Foundation of China(81671143)the Science and Technology Plan of Zhejiang Province(2017C03011),China
文摘Following severe traumatic brain injury .（sTBI）, patients may remain in a coma, vegetative state （VS）, or minimally conscious state （MCS）, all of which are also clinically termed disorders of consciousness. Patients in a coma show complete disability in the arousal system and fail to achieve awareness spontaneously; yet true coma represents a transient state and rarely lasts longer than a month [1]. The VS （also known as unresponsive wakefulness syndrome）, characterized as a state with spontaneous or stimulus-induced eye-opening but the patient appears totally unaware of self and environment, may persist for months or years [2]. In contrast, the MCS is evidenced by preserved and reproducible signs of awareness as well as sleep-wake cycles, suggesting better recovery than coma and VS. Considering that no signs of consciousness are detectable, patients in a VS suffer from a high rate of misdiagnosis [3].
文摘Objective: persistent vegetative state is a common symptom in patients with cerebral trauma. Effective intervention plays an important role in promoting patients' recovery, and the application effect of stimulant rehabilitation nursing is analyzed. Methods: Time: 2019.11-2020.11, object: 78 patients with persistent vegetative state after traumatic brain injury. Grouping method: Random method, applying conventional nursing methods to the control group, applying stimulant rehabilitation nursing to the research group, and analyzing the therapeutic effect of the two groups of patients. Results: the effective rate of nursing and the occurrence of complications were compared between the two groups. The indexes of the study group were better than those of the control group (P<0.05). Conclusion: the application of stimulant rehabilitation nursing to patients with persistent vegetative state after brain injury can promote the relief of vegetative state, avoid the occurrence of various complications such as joint spasm, falling pneumonia, pressure sore, urinary system infection, etc., and promote the early recovery of patients.
文摘Background:It is a challenge to characterize the consciousness level of patients with severe disturbance of consciousness and predict their prognosis effectively for Chinese doctors.We aimed to investigate the psychometric property and the diagnostic practicality of severe disturbance of consciousness by Chinese Nanjing persistent vegetative state scale(CNPVSS)which was first set up in 1996 and modified in 2001 and 2011.Methods:The concurrent validity,inter-rater consistency and diagnostic accuracy of CNPVSS and Chinese version of coma recovery scale-revised(CRS-R)were investigated by assessment of 380 patients with severe disorders of consciousness.Results:Total scores of the CNPVSS were correlated significantly with that of the CRS-R,indicating acceptable concurrent validity.Sub-scale analysis showed moderate to high inter-rater reliability and test-retest reliability.CNPVSS was superior to CRS-R on the diagnosis sensitivity.The CNPVSS was able to distinguish 65 patients in emergence from minimal consciousness state who were misclassified as in minimal consciousness state(MCS)by the CRS-R,and it could also distinguish two patients in MCS who were misclassified as in vegetative state by the CRS-R.Conclusion:The CNPVSS is an appropriate measurement and is sensitive to distinguish the MCS patients from the VS patients.
文摘Background Hypoxic-ischemic brain injury （HIBI） after cardiopulmonary resuscitation is one of the most devastating neurological conditions that causing the impaired consciousness. However, there were few studies investigated the changes of brain metabolism in patients with vegetative state （VS） after post-resuscitated HIBI. This study aimed to analyze the change of overall brain metabolism and elucidated the brain area correlated with the level of consciousness （LOC） in patients with VS after post-resuscitated HIBI. Methods We consecutively enrolled 17 patients with VS after HIBI, who experienced cardiopulmonary resuscitation. Overall brain metabolism was measured by F-18 fluorodeoxyglucose positron emission tomography （F-18 FDG PET） and we compared regional brain metabolic patterns from 17 patients with those from 15 normal controls using voxel-by-voxel based statistical parametric mapping analysis. Additionally, we correlated the LOC measured by the JFK-coma recovery scale-revised of each patient with brain metabolism by covariance analysis. Results Compared with normal controls, the patients with VS after post-resuscitated HIBI revealed significantly decreased brain metabolism in bilateral precuneus, bilateral posterior cingulate gyrus, bilateral middle frontal gyri, bilateral superior parietal gyri, bilateral middle occipital gyri, bilateral precentral gyri （PFEw correctecd 〈0.0001 ）, and increased brain metabolism in bilateral insula, bilateral cerebella, and the brainstem （PFEWcorrectecd 〈0.0001 ）. In covariance analysis, the LOC was significantly correlated with brain metabolism in bilateral fusiform and superior temporal gyri （P uncorrected 〈0.005）. Conclusions Our study demonstrated that the precuneus, the posterior cingulate area and the frontoparietal cortex, which is a component of neural correlate for consciousness, may be relevant structure for impaired consciousness in patient with VS after post-resuscitated HIBI. In post-resuscitated HIBI, measurement of brain metabolism using PET images may be helpful for investigating the brain function that cannot be obtained by morphological imaging and can be used to assess the brain area responsible for consciousness.
文摘Objective To explore the effects of acupuncture on nutritional status in patients in a persistent vegetative state.Methods A prospective randomized controlled trial was designed.A total of 66 patients in a persistent vegetative state were randomized into a control group and an observation group,with 33 cases in each group.The control group was given conventional treatment plus enteral nutrition support.The observation group was treated with additional Tiao Shen Jian Pi acupuncture therapy(acupuncture for spirit-regulating and spleen-invigorating)based on the same interventions in the control group.Both groups were treated for 8 weeks.The levels of total protein(TP),prealbumin(PA),albumin(Alb),and hemoglobin(Hb)were measured before and after treatment.The upper arm circumference and skinfold thickness of triceps brachii were measured.And the intestinal flora and fecal short-chain fatty acids contents were determined.Results After treatment,the levels of TP,PA,Alb,and Hb in the control group were decreased(P<0.05),while in the observation group,compared with those before treatment,the levels of TP,PA,Alb,and Hb had no statistical differences(P>0.05),and the levels were all higher than those in the control group(P<0.05).The upper arm circumference and skinfold thickness of triceps brachii in both groups decreased(P<0.05),and the values of these two items in the observation group were higher than those in the control group(P<0.05).In the control group,the contents of Bifidobacterium and Lactobacillus in feces decreased(P<0.05),and the content of Enterococcus increased(P<0.05).In the observation group,the contents of Bifidobacterium and Lactobacillus in feces increased(P<0.05),and the content of Enterococcus decreased(P<0.05).The differences between the two groups were statistically significant(P<0.05).In the control group,the total content of fecal short-chain fatty acids and the contents of acetic acid and butyric acid in feces decreased(P<0.05).In the observation group,the total content of fecal short-chain fatty acids and the contents of acetic acid and butyric acid in feces increased(P<0.05)and were all higher than those in the control group(P<0.05).Conclusion Acupuncture can improve nutrition-related blood indicators in patients in a persistent vegetative state and delay the decrease of upper arm circumference and skinfold thickness of triceps brachii,which may be related to the regulation of intestinal flora and fecal short-chain fatty acids contents.
文摘Background Permanent vegetative state is defined as the impaired level of consciousness longer than 12 months after traumatic causes and 3 months after non-traumatic causes of brain injury. Although many studies assessed the cerebral metabolism in patients with acute and persistent vegetative state after brain injury, few studies investigated the cerebral metabolism in patients with permanent vegetative state. In this study, we performed the voxel-based analysis of cerebral glucose metabolism and investigated the relationship between regional cerebral glucose metabolism and the severity of impaired consciousness in patients with permanent vegetative state after acquired brain injury.Methods We compared the regional cerebral glucose metabolism as demonstrated by F-18 fluorodeoxyglucose positron emission tomography from 12 patients with permanent vegetative state after acquired brain injury with those from 12 control subjects. Additionally, covariance analysis was performed to identify regions where decreased changes in regional cerebral glucose metabolism significantly correlated with a decrease of level of consciousness measured by JFK-coma recovery scare. Statistical analysis was performed using statistical parametric mapping.Results Compared with controls, patients with permanent vegetative state demonstrated decreased cerebral glucose metabolism in the left precuneus, both posterior cingulate cortices, the left superior parietal lobule （Pcorrected 〈0.001）, and increased cerebral glucose metabolism in the both cerebellum and the right supramarginal cortices （Pcorrected 〈0.001）. In the covariance analysis, a decrease in the level of consciousness was significantly correlated with decreased cerebral glucose metabolism in the both posterior cingulate cortices （Puncorrected 〈0.005）.Conclusion Our findings suggest that the posteromedial parietal cortex, which are part of neural network for consciousness, may be relevant structure for pathophysiological mechanism in patients with permanent vegetative state after acquired brain injury.
基金funded by the 2023 Hebei Provincial Key R&D Program Project“Research and Development of Brain Health Assessment and Auxiliary Intervention Technology and Its Application in Beidaihe Health Care Industry”(No.23377709D).
文摘Disorders of consciousness (DOC) are neuropsychiatric disorders with causes that include traumatic brain injury, hypoxia, and stroke. The possibility of spontaneous recovery is low, and treatment remains a difficult problem in the frontier challenge of neuroscience and medicine. With progress in neurocritical care, the number of patients with DOC is growing. Spinal cord stimulation (SCS) can improve the level of consciousness in patients with DOC. The present article reviews the current research status and development trends of SCS in promoting consciousness recovery in patients with DOC. It also seeks to identify the frontier problems and challenges associated with this neuroregulatory technology. Through a systematic review of the relevant literature, criteria for inclusion and exclusion in SCS therapy were established, suitable patients with DOC were identified, and the effects of different stimulation frequencies on consciousness and motor function were examined. Additionally, the optimal SCS mode was investigated, and evaluation criteria, treatment mechanisms, and factors influencing effectiveness were summarized. The present review aims to guide the clinical application and research development of SCS. Although SCS has demonstrated efficacy in the treatment of DOC, responses to SCS exhibit significant individual variation. Consequently, further studies are necessary to expand the sample size for continued exploration and enhancement.
基金supported by the National Natural Science Foundation of China (81471742, 91748105)Fundamental Research Funds for the Central Universities [DUT16JJ(G)03] in Dalian University of Technology, China
文摘In recent decades, event-related potentials have been used for the clinical electrophysiological assessment of patients with disorders of consciousness （DOCs）. In this paper, an oddball paradigm with two types of frequencydeviant stimulus （standard stimuli were pure tones of 1000 Hz; small deviant stimuli were pure tones of 1050 Hz; large deviant stimuli were pure tones of 1200 Hz） was applied to elicit mismatch negativity （MMN） in 30 patients with DOCs diagnosed using the JFK Coma Recovery Scale- Revised （CRS-R）. The results showed that the peak amplitudes of MMN elicited by both large and small deviant stimuli were significantly different from baseline. In terms of the spatial properties of MMN, a significant interaction effect between conditions （small and large deviant stimuli） and electrode nodes was centered at the frontocentral area. Furthermore, correlation coefficients were calculated between MMN amplitudes and CRS-R scores for each electrode among all participants to generate topographic maps. Meanwhile, a significant negative correlation between the MMN amplitudes elicited by large deviant stimuli and the CRS-R scores was also found at the frontocentral area. In consequence, our results combine the above spatial properties of MMN in patients with DOCs, and provide a more precise location （frontocentral area） at which to evaluate the correlation between clinical electrophysiological assessment and the level of consciousness.
基金supported by the National Natural Science Foundation of China(No 82001112 and No 81201980)the Medical science and Technology research project of Henan Province(LHGJ20190409).
文摘Introduction Functional connectivity across large-scale networks is crucial for the regulation of conscious states. Nonetheless, our understanding of potential alterations in the temporal dynamics of dynamic functional connectivity (dFC) among patients with disorders of consciousness (DOC) remains limited. The present study aimed to examine different time-scale spatiotemporal dynamics of electroencephalogram oscillation amplitudes recorded in different consciousness states.Methods Resting-state electroencephalograms were collected from a cohort of 90 patients with DOC. The sliding window approach was used to create dFC matrices, which were subsequently subjected to k-means clustering to identify distinct states. Finally, we performed state analysis and developed a decoding model to predict consciousness.ResultsThere was significantly lower dFC within the forebrain network in patients with unresponsive wakefulness syndrome than in those with a minimally conscious state. Moreover, there were significant differences in temporal properties, mean dwell time, and the number of transitions in the high-frequency band at different time scales between the unresponsive wakefulness syndrome and minimally conscious state groups. Using the multi-band and multi-range temporal dynamics of dFC approach, satisfactory classification accuracy (approximately 83.3 %) was achieved.Conclusion Loss of consciousness is accompanied by an imbalance of complex dynamics within the brain. Both transitions between states at short and medium time scales in high-frequency bands and the forebrain are important in consciousness recovery. Together, our findings contribute to a better understanding of brain network alterations in patients with DOC.
基金supported by funding fromBeijingNatural Science Foundation grant Z210009National Science and Technology Innovation 2030 Major Projects,STI2030-Major Projects grant 2022ZD0204800+4 种基金National Natural Science Foundation of China grants 32070987 and 31722025Chinese Academy of Sciences Key Program of Frontier Sciences grant QYZDB-SSW-SMC019supported by funding from National Key R&D Program of China grant 2022YFB4700100Strategic Priority Research Program of Chinese Academy of Sciences XDB37030303funded as a chairholder from the Canada Excellence Research Chair in Neuroplasticity,as research director at the Belgian National Fund for Scientific Research,by the European Foundation of Biomedical Research,by the Foundation for Research and Rehabilitation of Neurodegenerative Diseases,and by National Natural Science Foundation of China 81920108023.
文摘Patients with disorders of consciousness suffer from severe impairments in arousal and awareness alongside anomalous brain connections and aberrant neuronal activities.The thalamus,a crucial hub in the brain connectome,has been empirically inferred to maintain consciousness and wakefulness.Here,we investigated thalamic spiking,brain connectivity,consciousness states,and recovery outcomes following deep brain stimulation in 29 patients.Our study reveals that thalamic neuronal activity serves as a marker of consciousness state.Patients diagnosed with vegetative state/unresponsive wakefulness syndrome exhibited less-active neurons,with longer and more variable burst discharges,than those in a minimally conscious state.Furthermore,neuronal profiles in the intralaminar thalamus,the direct stimulation site,predicted whether electrostimulation here improved recovery.Stronger tonic firing was correlated with enhanced thalamocortical connectivity and better recovery outcomes in patients.These findings suggest that thalamic spiking signatures,including singleneuron burst discharge and tonic firing,selectively indicate the representation and alteration of consciousness.
文摘Objective:Vagus nerve stimulation(VNS)has recently been used in neurorehabilitation and the recovery of consciousness based on its effects on cortical plasticity.The aim of this study was to examine the therapeutic effects of VNS on patients with a minimally conscious state(MCS).Methods:All patients included in the study were assessed more than 5 months after injury and were receiving regular rehabilitation at our hospital from August 2018 to October 2019.Ten patients diagnosed with MCS by Coma Recovery Scale-Revised(CRS-R)test who underwent VNS surgery were enrolled.The scores on CRS-R evaluation at baseline(before VNS implantation)and 1,3,and 6 months after VNS treatment were recorded.The stimulation parameters were chosen according to a previous study.All clinical rehabilitation protocols remained unchanged during the study.Furthermore,safety was assessed by analyzing treatment-emergent adverse events(TEAEs).Results:No significant improvement in the total CRS-R scores at the end of the 1-month follow-up was observed(p>0.05).After 3 months of stimulation,a significant difference(p=0.0078)was observed in the total CRS-R scores compared with the baseline.After 6 months of VNS treatment,CRS-R assessments showed a continuous significant improvement(p=0.0039);one patient emerged from the MCS and recovered functional communication and object use.Interestingly,one item of CRS-R scores on visual domain was sensitive to VNS treatment(p=0.0039).Furthermore,no serious adverse event occurred throughout the study.Conclusion:This exploratory study provides preliminary evidence suggesting that VNS is a safe and effective tool for consciousness recovery in patients with MCS.
文摘OBJECTIVE: To discuss the clinical criteria for diagnosing diffuse axonal injury (DAI). METHODS: Clinical and computed tomographic features of 117 patients with severe closed head injury were analyzed. The authors preliminarily put forward CT diagnostic criteria of DAI, that is, 1) single or multiple small intraparenchymal hemorrhages in the cerebral hemispheres (
