Aquaporin 4 expression and ultrastructure of the blood-brain barrier following cerebral contusion injury

This study aimed to investigate aquaporin 4 expression and the ultrastructure of the blood-brain barrier at 2-72 hours following cerebral contusion injury, and correlate these changes to the formation of brain edema. Results revealed that at 2 hours after cerebral contusion and laceration injury, aquaporin 4 expression significantly increased, brain water content and blood-brain barrier permeability increased, and the number of pinocytotic vesicles in cerebral microvascular endothelia cells increased. In addition, the mitochondrial accumulation was observed. As contusion and laceration injury became aggravated, aquaporin 4 expression continued to increase, brain water content and blood-brain barrier permeability gradually increased, brain capillary endothelial cells and astrocytes swelled, and capillary basement membrane injury gradually increased. The above changes were most apparent at 12 hours after injury, after which they gradually attenuated. Aquaporin 4 expression positively correlated with brain water content and the blood-brain barrier index. Our experimental findings indicate that increasing aquaporin 4 expression and blood-brain barrier permeability after cerebral contusion and laceration injury in humans is involved in the formation of brain edema.

Management of Traumatic Brain Injuries at the Kara Regional Hospital

Introduction: Traumatic Brain Injury (TBI) is a major public health problem causing significant morbidity and mortality in young adults. This study aimed to describe the epidemiological, diagnostic, therapeutic, and evolutionary aspects of TBI. Materials and Methods: This was a prospective, descriptive study conducted from 1 April 2022 to 31 March 2023 on patients admitted to and treated for cranioencephalic trauma in the General Surgery department of Kara Regional Hospital. Results: Eighty-three (83) patients with cranioencephalic trauma were managed out of 773 patients admitted to the department during the study period. The mean age was 34 ± 14.98 years and the sex ratio was 3.6 in favour of men. Motorbike taxi drivers were the social group most affected (n = 33, 40%). The causes of trauma were dominated by public road accidents (n = 80;96%). TBI was mild (n = 40;48%), moderate (n = 35;42%) and severe (n = 8;10%). Cerebral CT scans were performed in 19 patients (23%). Cerebral contusion (n = 4) was the most frequent cerebral lesion. Six patients (7%) with severe head injuries were transferred to Kara University Hospital. Six deaths (7%) occurred in patients with severe head injuries. The main sequelae were intermittent headaches in all patients reviewed, and memory problems (6%). Conclusion: Traumatic brain injuries are common at Kara Regional Hospital. Severe cranial trauma is less frequent but leads to death because of financial difficulties and limited technical facilities.

Unilateral Bone Window Cerebral Falx Incision of Bilateral Frontal Lobes Cerebral Contusion and Laceration under Neuroendoscopy and Literature Review

Background: Bilateral frontal lobes cerebral contusion and laceration is one unique brain injury in neurosurgery department. It is characteristic of recessive attacking and develops quickly. The unilateral cerebral falx incision is a new minimally invasive surgery that can solve bilateral frontal lobes cerebral contusion and laceration in one surgery. However, it has some limitations in removal of contralateral frontal hematoma and hemostasis due to the limited field of view under the microscope. The unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy can acquire a good illumination and field of view. This is beneficial to complete removal of contralateral hematoma, effective hemostasis and retaining brain tissue functions to the maximum extent. Case Presentation: The patient, a 55-year-old man, was hospitalized for “consciousness disorder by 12 h because of car accident”. Physical Examination: Coma, GCS score of E1V2M5, bilateral pupil diameter of 2 mm, presence of light response, contusion of scalp at the left top, peripheral dysphoria and bilateral Bartter syndrome negative. The patient has a history of non-traumatic cerebral stroke 3 years ago. Head CT: Longitudinal fracture of frontal parietal occipital bone, bilateral frontal lobes contusion and laceration, subarachnoid hemorrhage. Diagnosis: Bilateral frontal lobes contusion and laceration, longitudinal fracture of frontal parietal occipital bone, subarachnoid hemorrhage and hematoma of scalp. In emergency treatment, unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy was performed. The surgery has achieved satisfying effect. Discussion: This case realized the goal of removing contralateral frontal hematoma through unilateral craniotomy under a neuroendoscopy. Due to the clear field of view, it retained extracerebral layer structures of contralateral olfactory nerve protection frontotemporal completely. Moreover, this surgical technique is conducive to intraoperative recognition of pericallosal arteries and lateral fractured blood vessels. It also involves protection, which conforms to the minimally invasive philosophy. The proposed surgical technology can eliminate contralateral frontal hematoma under a good field of view. However, it is suggested not to manage with the further operation on patients who have brain swelling and difficulties in exposure of cerebral falx. These patients need to determine causes of brain swelling and choose bilateral craniectomy if necessary. Conclusions: Unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy is a new application of minimally invasive philosophy in craniocerebral injury operation. It still needs further clinical verifications and experience accumulation.

Numerical study on dynamic mechanism of brain volume and shear deformation under blast loading

Blast-induced traumatic brain injury(b-TBI)is a kind of significant injury to soldiers in the current military conflicts.However,the mechanism of b-TBI has not been well understood,and even there are some contradictory conclusions.It is crucial to reveal the dynamic mechanism of brain volume and shear deformations under blast loading for better understanding of b-TBI.In this paper,the numerical simulation method is adopted to carry out comprehensive and in-depth researches on this issue for the first time.Based on the coupled Eulerian-Lagrangian method,the fluid-structure coupling model of the blast wave and human head is developed to simulate two situations,namely the head subjected to the frontal and lateral impacts.The simulation results are analyzed to obtain the underlying dynamic mechanisms of brain deformation.The brain volume deformation is dominated by the local bending vibration of the skull,and the corresponding frequency for the forehead skull under the frontal impact and the lateral skull faced to the lateral impact is as high as 8 kHz and 5 kHz,respectively.This leads to the high-frequency fluctuation of brain pressure and the large pressure gradient along the skull,totally different from the dynamic response of brain under head collisions.While the brain shear deformation mainly depends on the relative tangential displacement between the skull and brain and the anatomical structure of inner skull,being not related to the brain pressure and its gradient.By further comparing the medical statistics,it is inferred that diffuse axonal injury and brain contusion,the two most common types of b-TBI,are mainly attributed to brain shear deformations.And the von Mises stress can be adopted as the indicator for these two brain injuries.This study can provide theoretical guidance for the diagnosis of b-TBI and the development of protective equipment.

Risk factors for corticosteroid insufficiency during the sub-acute phase of acute traumatic brain injury

Hypothalamic-pituitary-adrenal axis dysfunction may lead to the occurrence of critical illness-related corticosteroid insufficiency.Critical illness-related corticosteroid insufficiency can easily occur after traumatic brain injury,but few studies have examined this occurrence.A multicenter,prospective,cohort study was performed to evaluate the function of the hypothalamic-pituitary-adrenal axis and the incidence of critical illness-related corticosteroid insufficiency during the sub-acute phase of traumatic brain injury.One hundred and forty patients with acute traumatic brain injury were enrolled from the neurosurgical departments of three tertiary-level hospitals in China,and the critical illness-related corticosteroid insufficiency incidence,critical-illness-related corticosteroid insufficiency-related risk factors,complications,and 28-day mortality among these patients was recorded.Critical illness-related corticosteroid insufficiency was diagnosed in patients with plasma total cortisol levels less than 10μg/dL(275.9 nM)on post-injury day 4 or when serum cortisol was insufficiently suppressed(less than 50%)during a dexamethasone suppression test on post-injury day 5.The results demonstrated that critical illness-related corticosteroid insufficiency occurred during the sub-acute phase of traumatic brain injury in 5.6%of patients with mild injury,22.5%of patients with moderate injury,and 52.2%of patients with severe injury.Traumatic brain injury-induced critical illness-related corticosteroid insufficiency was strongly correlated to injury severity during the sub-acute stage of traumatic brain injury.Traumatic brain injury patients with critical illness-related corticosteroid insufficiency frequently presented with hemorrhagic cerebral contusions,diffuse axonal injury,brain herniation,and hypotension.Differences in the incidence of hospital-acquired pneumonia,gastrointestinal bleeding,and 28-day mortality were observed between patients with and without critical illness-related corticosteroid insufficiency during the sub-acute phase of traumatic brain injury.Hypotension,brain-injury severity,and the types of traumatic brain injury were independent risk factors for traumatic brain injury-induced critical illness-related corticosteroid insufficiency.These findings indicate that critical illness-related corticosteroid insufficiency is common during the sub-acute phase of traumatic brain injury and is strongly associated with poor prognosis.The dexamethasone suppression test is a practical assay for the evaluation of hypothalamic-pituitary-adrenal axis function and for the diagnosis of critical illness-related corticosteroid insufficiency in patients with traumatic brain injury,especially those with hypotension,hemorrhagic cerebral contusions,diffuse axonal injury,and brain herniation.Sub-acute infection of acute traumatic brain injury may be an important factor associated with the occurrence and development of critical illness-related corticosteroid insufficiency.This study protocol was approved by the Ethics Committee of General Hospital of Tianjin Medical University,China in December 2011(approval No.201189).

醒脑静对脑挫裂伤患者神经功能及炎性因子水平的影响

目的分析醒脑静对脑挫裂伤(CCL)患者神经功能及炎性因子水平的影响。方法共纳入乐平市人民医院收治的94例CCL患者,选取时间:2022年6月至2024年2月,以随机数表法分为对照组(n=47)和观察组(n=47),对照组接受常规治疗方案,观察组在对照组基础上给予醒脑静治疗,均治疗2周。比较两组疗效及水肿消退时间、住院时间;于治疗前后比较两组神经功能[美国国立卫生院卒中表(NIHSS)]、昏迷程度[格拉斯哥昏迷评分(GCS)]、炎性因子水平[C反应蛋白(CRP)、白细胞计数(WBC)]。结果与对照组比较,观察组总有效率更高,且水肿消退、住院时间均更短,有统计学差异(P<0.05);治疗后,两组NIHSS评分及炎性因子(CRP、WBC)水平均降低,GCS评分提高,且观察组变化更明显,有统计学差异(P<0.05)。结论在常规治疗基础上予以CCL患者醒脑静辅助治疗,可发挥协同作用,提高治疗效果,改善神经功能,降低炎性因子水平,促进恢复。

脑挫裂伤患者预后影响因素的研究进展

脑挫裂伤是由直接暴力所致的一种常见的颅脑损伤类型,大多由交通事故、自然灾害、高空作业等引起,常常造成神经功能恶化、肢体功能障碍、昏迷甚至死亡等不良后果,严重影响患者预后转归。脑挫裂伤患者预后受众多因素影响,包括患者伤者特征与健康相关因素、损伤与伤情相关因素以及伤后救治相关因素等,其中炎症反应、神经元损伤程度、手术时机等备受关注。本文对脑挫裂伤患者预后影响因素进行综述,以期为改进脑挫裂伤患者的临床干预措施、改善患者预后提供参考。

误诊为脑挫裂伤的单纯疱疹病毒性脑炎临床分析

目的探讨误诊为脑挫裂伤的单纯疱疹病毒性脑炎的临床特点、误诊原因及防范措施。方法回顾分析2019年9月至2021年8月2例误诊为脑挫裂伤的单纯疱疹病毒性脑炎患者的临床资料。结果1例青年男性,以头痛伴精神差3 d由外院转入。1例老年女性,有高血压病史,被发现呼之不应2 d,烦躁1 d由外院转入。2例颅脑影像学提示多发性脑挫裂伤,误诊为多发性脑挫裂伤,后经脑脊液病原微生物高通量基因检测确诊为单纯疱疹病毒1型脑炎。误诊时间分别为5 d和9 d。2例经抗病毒、免疫调节治疗后好转出院,随访6个月,格拉斯哥预后量表评分分别为3分和5分。结论单纯疱疹病毒性脑炎的临床表现无特异性,其影像学、脑脊液改变与早期的脑挫裂伤具有相似性,且单纯疱疹病毒性脑炎并发明显的脑出血相对罕见。当病史不详时,容易延误诊治。熟知该病的临床特点,并对此类患者反复追问病史,尽早完善病原学检查,能提高确诊率,减少或避免误诊误治。

面部挫裂伤患者应用改良美容缝合术的效果探讨

目的:探讨改良美容缝合术治疗面部挫裂伤的临床效果。方法:选取2018年11月-2022年9月笔者医院收治的面部挫裂伤患者125例,根据就诊时患者自愿选择治疗方案的不同分为传统清创缝合术组(对照组,63例)和改良美容缝合术组(观察组,62例)。于术后7 d拆线时比较两组近期伤口愈合情况(分为甲级、乙级和丙级)。于术后6个月采用温哥华瘢痕量表(Vancouver scar scale,VSS)评估两组远期瘢痕情况(包含色泽、厚度、血管分布、柔软度4个方面),并统计患者对瘢痕的满意度。结果:术后7 d拆线时,观察组伤口甲级愈合率高于对照组,丙级愈合率低于对照组(P<0.05),两组乙级愈合率比较差异无统计学意义(P>0.05)。术后6个月,观察组色泽、厚度、血管分布、柔软度等VSS评分及VSS总评分均低于对照组(P<0.05),观察组对瘢痕的满意率为91.94%,高于对照组的76.19%(P<0.05)。结论:相比于传统清创缝合术,改良美容缝合术治疗面部挫裂伤,近期伤口愈合较佳,远期瘢痕较轻,患者满意度高。

早期功能训练联合刺激性干预在脑挫裂伤患者护理中的应用

目的:探讨早期功能训练联合刺激性干预在脑挫裂伤患者护理中的应用效果。方法:便利选取2022年1月1日~2024年2月29日收治的98例脑挫裂伤患者作为研究对象,按入院顺序将2022年1月1日~2023年1月31日收治的49例患者作为对照组,将2023年2月1日~2024年2月29日收治的49例患者作为观察组,对照组行常规护理,观察组行早期功能训练联合刺激性干预;比较两组清醒情况、不良事件发生情况,两组干预前、干预15 d后日常生活能力[采用日常生活能力量表(ADL)]、神经功能恢复情况[采用格拉斯哥昏迷量表(GCS)]及肢体运动功能[采用Fugl-Meyer上肢运动功能评估量表(FMA-UE)]。结果:干预15 d后,观察组GCS、ADL及FMA-UE评分均高于对照组(P<0.01);观察组清醒率高于对照组(P<0.01),不良事件发生率低于对照组(P<0.01)。结论:早期功能训练联合刺激性干预应用于脑挫裂伤患者中可促进清醒,提高日常生活能力,促进神经及运动功能恢复,降低相关不良事件发生率。

改良美容缝合术在面部挫裂伤患者中的临床应用

目的探讨面部挫裂伤患者应用改良美容缝合术的临床效果。方法选取2022年9月至2024年2月江门市新会区第二人民医院收治的面部挫裂伤患者共计86例,分成观察组与对照组,每组43例。对照组患者采用传统清创缝合术,观察组患者采用改良美容缝合术,比较两组患者术后伤口愈合情况及瘢痕严重程度。结果观察组伤口愈合优于对照组(P<0.05);术后6个月,观察组患者温哥华瘢痕量表评分较对照组更低,差异有统计学意义(P<0.05)。结论面部挫裂伤患者应用改良美容缝合术治疗,能够促进伤口愈合,降低瘢痕严重程度。

活血化瘀中药对脑挫裂伤的治疗作用及其机制的实验研究

目的 验证活血化瘀中药对脑挫裂伤的治疗作用及其机制。方法 采用家兔自由落体致脑挫裂伤模型 ,观察活血化瘀中药对脑伤灶大小、病理改变 ,微血管构筑及血脑屏障通透性的影响。结果 活血化瘀中药可减小脑伤灶体积 ,防治微血栓形成 ,减轻间质及细胞水肿 ,改善微血管构筑和血脑屏障通透性。结论 活血化瘀中药能促进脑挫裂伤灶吸收 ,减轻脑水肿和神经细胞损害。

额叶挫裂伤致脑中心疝31例临床分析

目的:探讨额叶挫裂伤致脑中心疝的临床与影像学特点,选择有效治疗方法。方法:回顾性分析31例额叶挫裂伤致脑中心疝患者的临床症状、影像学特征、治疗方法,并结合国内外资料探讨额叶挫裂伤致脑中心疝的诊断、治疗。结果:瞳孔缩小时手术16例:死亡和重残4例,轻残和良好12例。瞳孔散大后手术8例,均为死亡和重残。保守治疗7例。均为死亡和重残。结论:额叶挫裂伤,尤其是双侧额叶挫裂伤患者发生的脑疝大部分为脑中心疝,其CT特征性表现为侧脑室、三脑室、鞍上池、环池、四叠体池等受压变形,间脑期是抢救关键时期。

脑挫裂伤水肿转归时间的探讨

目的总结脑挫裂伤后脑水肿发展与消退的时间,为临床治疗提供依据。方法我院4年来收治的脑挫裂伤的患者174例,至少每3d复查一次CT,根据CT影像表现作为观察脑水肿的指标,记录脑水肿随时间演变的过程。结果所有病例脑水肿在3d内达到高峰,但水肿高峰持续时间存在差异,病程中脑水肿的高峰持续时间3～5d7例,6～8d34例,9～11d112例,12d以上21例。脑水肿高峰持续时间与脑水肿严重程度和挫裂伤的严重程度有显著关系。结论大部分脑挫裂伤脑水肿高峰时间比过去我们认识的要长,故使用控制脑水肿药物的时间应适当延长,特别是严重颅脑损伤患者,并应根据不同情况选择脱水剂。

脑挫裂伤的临床分型与治疗探讨

目的探讨脑挫裂伤的临床分型与治疗的关系。方法280例经头颅CT检查的脑挫裂伤病人,根据病人GCS计分、生命体证、瞳孔和意识变化临床上分为四型。Ⅰ、Ⅱ型主要通过保守治疗(手术治疗仅5例),Ⅲ、Ⅳ型主要通过手术治疗。3月后进行疗效评定。结果Ⅰ型脑挫裂伤62例,Ⅱ型脑挫裂伤97例,治愈好转149例(94%),轻残8例,死亡2例。Ⅲ型脑挫裂伤78例,手术治疗61例,治愈好转52例,轻残和重残各6例,死亡14例。Ⅳ型脑挫裂伤43例,残废6例,治愈好转6例,死亡31例。结论脑挫裂伤进行临床分型对其伤情和预后判断具有重要临床价值。

重型颅脑损伤临床救治经验

目的 回顾性研究重型颅脑损伤 (SCCI)患者临床救治经验 ,探讨有效的治疗措施与方法 ,以改善患者的预后。方法 分析 3310例SCCI患者的致伤原因、临床特征、诊断方法、抢救措施、手术方式及预后状况。结果 本组病例致伤原因主要为交通事故伤和高处坠落伤 ,损伤类型最常见为硬膜下血肿 ,其次为硬膜外和多发性血肿。临床表现主要为意识障碍、锥体束征和瞳孔改变。采用手术、药物等综合疗法。本组治愈、好转 2 4 10例 (72 .8% ) ,死亡 6 4 5例 (19.5 % )。结论 早期诊断和及时手术减压、术中妥善脑保护、维持有效的脑灌注压、加强术后的监护和防治并发症 。

根据S—100蛋白阳性胶质细胞的变化判断脑挫伤时间的实验研究

本文米用免疫组织化学ＡＢＣ法，观察了２４只大白鼠脑挫伤不同时间的胶质细胞特异性标志物Ｓ－１００蛋白的变化。结果表明，挫伤２天后Ｓ—１００阳性胶质细胞的胞体开始增大，突起不明显，随着脑挫伤时间的延长，胞体增大，突起明显的Ｓ—１００阳性胶质细胞数量明显增加，到第五天时达高峰，在脑挫伤的周围区均为胞林大、突起明显的Ｓ—１００阳性细胞，此结果表明Ｓ－１００蛋白的变化可用于挫伤后时间的判断。

双额叶重度脑挫裂伤的早期救治体会

目的:探讨双额叶重度脑挫裂伤并发中央型脑疝的早期救治方法。方法:对41例双额叶重度脑挫裂伤的临床资料进行回顾分析。结果:本组41例病人中,31例经手术治疗,存活28例。伤后半年时根据GOS分级标准:恢复良好12例;中残13例;重残2例;植物生存1例;死亡3例。结论:对于双额叶重度脑挫裂伤患者,应予以高度重视,在非手术治疗过程中,应严密观察患者意识、瞳孔及生命体征变化;注意停脱水剂不宜过早、过快;要动态复查头颅CT,正确掌握手术适应证。早期开颅清除坏死脑组织及去骨瓣减压可有效地提高患者的治愈率。

GFAP、MBP在早期脑挫裂伤诊断中的价值

目的探讨血清神经胶质纤维酸性蛋白(GFAP)、髓鞘碱性蛋白(MBP)联合检测在早期脑挫裂伤患者诊断中的价值。方法采用酶联免疫吸附实验(ELISA)法检测血清GFAP、MBP浓度,多组间比较采用单因素方差分析,两两比较采用q检验分析脑挫裂伤患者与健康人群间的差异。结果血清GFAP、MBP浓度,轻、重型颅脑损伤组与健康对照组3组间统计学分析差异有统计学意义(P<0.05);对照组与轻型颅脑损伤组比较差异有统计学意义(P<0.05);轻、重型颅脑损伤组比较差异有统计学意义(P<0.05);对照组与重型颅脑损伤组比较差异有统计学意义(P<0.05)。脑挫裂伤患者早期血清GFAP、MBP浓度明显高于对照组,且损伤越重升高越明显。结论血清GFAP、MBP水平联合检测可以作为早期脑挫裂伤诊断及评估损伤程度的辅助指标。

大鼠脑挫裂伤模型的建立及损伤机制的代谢组学分析

目的采用自由落体打击法造模,对大鼠脑损伤后病理改变进行代谢组学分析,建立可靠的大鼠脑挫裂伤模型,为进一步的研究提供可靠的动物实验平台。方法选用SD实验大鼠,分为假手术组、20 g打击组、30 g打击组、50 g打击组。假手术组不造模,20 g打击组、30 g打击组、50 g打击组分别用20、30、50 g的砝码,采用自由落体打击法建立脑挫裂伤模型。记录打击后大鼠死残情况、神经功能缺损评分,观察脑组织病理切片,检测大鼠血浆氢谱核磁共振波谱,并作统计学分析。结果 50 g打击组大鼠死亡率最高,病理切片观察见神经细胞广泛坏死,细胞结构破坏;代谢组学分析发现血浆中抑制性氨基酸γ-羟基丁酸成倍增加,胆碱含量增加。30 g打击组神经功能缺损评分〈7分,神经细胞大量坏死,N-乙酰天门冬氨酸明显下降,乳酸含量显著升高,动物死亡率和致残率较高。20 g打击组大鼠神经功能缺损起初评分在7-8分之间,脑组织局部见少量血肿灶,神经细胞水肿较明显,N-乙酰天门冬氨酸、肌酸、γ-氨基丁酸等含量下降,谷氨酸、乳酸、胆碱含量升高;但神经功能缺损评分在术后第6、7天恢复至13-14分。结论自由落体打击后致神经元功能受损,抑制性氨基酸增多,神经抑制明显,继发细胞坏死。打击重量越大,原发脑损伤越严重,继发性损伤也越严重。20 g打击可令动物出现部分神经功能受损,兴奋性氨基酸含量升高,抑制性氨基酸含量下降引起继发脑损伤,脑组织缺血缺氧损伤较明显,但神经功能缺损在术后恢复较快,死亡率低。因此,该方法建立的动物模型病理变化显著,修复也快,过程显著并且完整,死亡率低,适合于进一步研究需要,是理想的脑挫裂伤动物模型。