Changes in platelet parameters and secondary brain injury in acute craniocerebral trauma

Changes in platelet parameters are important in secondary brain injury in acute craniocerebral trauma We selected 163 patients with craniocerebral trauma who were admitted within 24 hours with nonoperative therapy. Platelet parameters of 40 healthy subjects served as controls. Platelet number was decreased, while mean platelet volume and platelet distribution width values were increased, at 1 and 3 days after injury. Platelet number was lower and mean platelet volume and platelet distribution width were larger in patients with traumatic cerebral infarction and those in Glasgow Coma Scale score 〈 8 group. Platelet number was negatively correlated to volume of cerebral edema, but positively correlated to Glasgow Outcome Scale score. These data indicate that changes in platelet parameters may be utilized to indicate the state of central nervous system injury and patient prognosis .

Effects of Continuous Nursing Intervention on Postoperative Rehabilitation of Patients with Craniocerebral Trauma

Objective:To study and analyze the clinical effect of continuous nursing in the process of postoperative rehabilitation for patients with craniocerebral trauma.Methods:From August 2018 to July 2021,40 patients who came to our hospital for craniocerebral trauma treatment were randomly selected as clinical experimental research objects,and they were divided into continuous nursing group and routine nursing group.The rehabilitation of patients in the two groups before and after postoperative nursing was observed and counted.Results:Before nursing intervention,there was no significant difference in MMSE score and Fugl-Meyer score between the two groups,p>0.05.After nursing,the scores were scored again at 3 and 6 months after nursing.It was found that the two groups were improved,but the improvement range in the continuous nursing group was significantly higher than that in the routine nursing group,the difference was statistically significant(p<0.05).From the score of quality of life,the scores of physical pain,psychological function,mental health and social function in the continuous nursing group were better than those in the routine nursing group,the difference was statistically significant(p<0.05).Conclusion:Using continuous nursing measures for rehabilitation nursing of patients with craniocerebral trauma after discharge can significantly improve the quality of life of patients,restore the mental state and limb function of patients,and has significant clinical effect.

Craniocerebral trauma

210234 Regulating effects of the ERK1/2 signaling pathway on neurons apoptosis after diffuse brain injury in rats/Zhao Yaning(赵雅宁,Basic Med Dept,North Chin Coal Med Col,Tangshan 063000)…Chin J Neurosurg.-2010,26(1).

Craniocerebral trauma

209379 Calpain expression changes in response to hypothermia after traumatic brain injury/Wan Jieqing(万杰清,Dept Neurosurg,Renji Hosp,School Med,Shanghai Jiaotong Univ,Shanghai 200127)…∥Chin J Traum.-2009,25(6).-507～509Objective To determaine the effect of hypothermia on gene transcription and protein expression of calpain after traumatic brain injury(TBI).Methods Twenty-seven rats were randomly divided into three groups,ie,normal control group,normothermia TBI group and hypothermia TBI group.All rats with TBI suffered from a lateral fluid percussion injury(FPI)at the right parietal lobe.Hypothermia intervention[rectal temperature for(32±0.5)℃]was performed for four hours immediately after TBI in hypothermia TBI group.Fluorescence PCR and Western blot were utilized to semi-quantify gene transcription and protein expression of calpain and immunofluorescence used to observe protein distribution of Calpain.Results Compared with normothermia TBI group and normal control group,hypothermia TBI group showed increased calpain gene transcription at 12 and 24 hours respectively after FPI (P【0.05).However,the increase of calpain protein expression in hypothermia TBI group was inhibited more significantly by hypothermia at 6,12,24 and 72 hours after TBI,compared with normothermia TBI group(P【0.05).Conclusion Neuroprotection of hypothermia after TBI may somewhat be related to the decrease of calpain protein expression after its gene transcription.10 refs,1 fig,2 tabs.

Clinical Observation of Hemodynamic and Cerebral Protective Effects of Different Doses of Dexmedetomidine in Patients with Traumatic Brain Injury

Background: Patients with craniocerebral trauma may suffer ischemic brain injury and neurological dysfunction due to immune inflammation and neuroendocrine reactions. Dexmedetomidine (Dex) is one of the commonly used anesthetic drugs in clinic. Studies have shown Dex has the function of protecting brain nerves and inhibiting inflammation. However, there are few studies on the effects of different doses of dexmedetomidine on patients undergoing surgery. The purpose of this study is to observe the effects of different doses of Dex on hemodynamics and brain protection in patients undergoing brain trauma surgery. Materials and Methods: Eighty patients with craniocerebral trauma surgery were randomly divided into study group (group A, n = 40) and control group (group B, n = 40) by random number table method. Dex pump volume was 0.5 μg/kg/h in group A and 1.0 μg/kg/h in group B. Heart rate (HR) and mean arterial pressure (MAP) were recorded before anesthesia induction (T0), immediately after endotracheal intubation (T1) and at the end of operation (T2). The serum levels of central nervous system specific protein (S-100β) and neuron specific enolase (NSE) were measured and compared between the two groups at T0 and T2. Results: HR and MAP in group A were significantly higher than those in group B at T2, and the difference was statistically significant (P P β and NSE in both groups at T2 were lower than those at T0, and the concentrations of S-100β and NSE in group A were significantly lower than those in group B at T2 (P Conclusions: 0.5 μg/kg dose of Dex is stable in hemodynamics and has a better protective effect on brain function in patients with traumatic brain injury.

Changes of plasma C-reactive protein in patients with craniocerebral injury before and after hyperbaric oxygenation: A randomly controlled study

Changes of plasma C-reactive protein in patients with craniocerebral injury before and after hyperbaric oxygenation： A randomly controlled study BACKGROUND： Plasma inflammatory factor, such as C-reactive protein, whose content is regarded as a sensitively pathological marked protein and quantitative indexes of central nervous system injury, has been paid more and more attention in clinic. OBJECTIVE： To observe the effects and clinical significance of C-reactive protein in patients with craniocerebral injury after hyperbaric oxygenation. DESIGN： Randomized controlled study. SETTING： Departments of Neurosurgery, Laboratory and Hyperbaric Oxygen, the Second Affiliated Hospital, Medical College of Shantou University. PARTICIPANTS： A total of 60 patients with craniocerebral injury were selected from Department of Neurosurgery, the Second Affiliated Hospital, Medical College of Shantou University from October 2006 to April 2007. There were 37 males and 23 females and the mean age was 26 years. All subjects were certainly diagnosed as history of craniocerebral injury. Patients hospitalized at 24 hours after injury, Glasgow Coma Score ranged from 3 to 12 points, and all patients were certainly diagnosed with CT or MR scanning. Patients and their relatives provided confirmed consent. All the subjects were randomly divided into hyperbaric oxygenation group and control group with 30 in each group. METHODS： Patients in the control group were treated with routinely neurosurgical therapy after hospitalization; however, based the same basic treatment in the control group, patients in the hyperbaric oxygenation group received hyperbaric oxygenation by using iced-wheel four-door 2-cabin air-compression chamber （made in Yantai） from 24 hours to 10 days after operation or injury. After entering the cabin, patients who had a clear consciousness breathed the oxygen by using face mask; contrarily, patients directly breathed the oxygen. Therapeutic project： Expression was increased for about 15–20 minutes, maintained for about 70–80 minutes, and decreased for 20 minutes. Otherwise, pressure was maintained from 0.2 to 0.25 MPa. Hyperbaric oxygenation took an hour for once a day and 10 times were regarded as a course. Venous blood was collected before treatment and on the next day of the first course end. Content of C-reactive protein in plasma was measured with immune turbidimetry in hyperbaric oxygenation group; in addition, content of C-reactive protein in plasma was directly measured with the same method at the corresponding time in the control group. If the content was less or equal to 8 mg/L, it was regarded as normal value. Effects of the two groups were evaluated based on Glasgow Coma Score before and after treatment. MAIN OUTCOME MEASURES： Content of plasma C-reactive protein and Glasgow Coma Score in the two groups before and after treatment. RESULTS： All 60 patients were involved in the final analysis. ① Content of plasma C-reactive protein： The two contents were obviously higher than normal value after craniocerebral injury. There was no significant difference in the two groups before treatment （P 〉 0.05）, but both contents were decreased after treatment, and there was significant difference between HBOT group and control group after treatment （t =4.756, P 〈 0.01）. In addition, there was significant difference in hyperbaric oxygen therapy group before and after treatment （t =5.236, P 〈 0.01）. ② Glasgow Coma Score： There was no significant difference in the two groups before treatment （P 〉 0.05）, but scores were increased in both groups after treatment （t =9.92, 2.51, P 〈 0.01, 0.05）; on the other hand, therefore, there was significant difference between the two groupsafter treatment （t =9.21, P 〈 0.01）. CONCLUSION： Hyperbaric oxygenation can remarkably decrease content of plasma C-reactive protein in patients with craniocerebral injury at the phase of stress.

Umbilical cord-derived mesenchymal stem cell transplantation combined with hyperbaric oxygen treatment for repair of traumatic brain injury

Transplantation of umbilical cord-derived mesenchymal stem cells（UC-MSCs） for repair of traumatic brain injury has been used in the clinic. Hyperbaric oxygen（HBO） treatment has long been widely used as an adjunctive therapy for treating traumatic brain injury. UC-MSC transplantation combined with HBO treatment is expected to yield better therapeutic effects on traumatic brain injury. In this study, we established rat models of severe traumatic brain injury by pressurized fluid（2.5–3.0 atm impact force）. The injured rats were then administered UC-MSC transplantation via the tail vein in combination with HBO treatment. Compared with monotherapy, aquaporin 4 expression decreased in the injured rat brain, but growth-associated protein-43 expression, calaxon-like structures, and CM-Dil-positive cell number increased. Following combination therapy, however, rat cognitive and neurological function significantly improved. UC-MSC transplantation combined with HBO therapyfor repair of traumatic brain injury shows better therapeutic effects than monotherapy and significantly promotes recovery of neurological functions.

Successful management of depression skull fracture in a boy with dog bite injury:A case report

Rationale:There are many cases of daily reported dog bite injuries around the world.However,craniofacial fractures owing to dog bites are quite rare.They are frequently seen in the pediatric age group.Here,we report the successful management of a pediatric patient with depression skull fracture due to a dog bite injury.Patient’s concerns:A 3-year-old boy was admitted to the emergency department with a complicated skull fracture due to a dog bite injury.In physical examination,the patient was neurologically intact.He had hemorrhagic scalp wounds.Cerebrospinal fluid was leaking on the right temporal and frontal sides.Diagnosis:Cranial computed tomography revealed pneumocephalus,brain edema,and compound fracture associated with right frontal concussion.Intervention:After decompressive craniectomy,duraplasty was performed by placing a galea graft.Depressed fractures were removed and subdural bleeding control was provided.Outcomes:Perioperative and postoperative periods were uneventful.Lessons:Emergency medicine physicians should control possible underlying fracture lines in pediatric head trauma caused by dog bites.

Cerebrospinal fluid otorrhea caused by porencephalic cyst: A rare case report and literature review

Objective Poreneephalic cyst presenting with otologie involvement is uncommon. Only a few eases have been reported. We report a rare case of cerebrospinal fluid （CSF） otorrhea caused by a massive porencephalic cyst encompassing the left temporal and occipital lobes. The CSF leak was repaired successfully using a transmastoid approach with facia, abdomen fat and fibrin glue to seal the osseous defects in the sinodural angle. A review of the literature concerning porencephalic cyst and CSF otorrhea is also presented.

About an Observation of a Child Penetrating Brain Injury by Knife

Background: Reported cases of knife injuries to the head in children are rare. Here we describe a case of pediatric penetrating brain injury by knife (PPBIK) and review literature. The patient’s parents were informed that non-identifying information from the case would be submitted for publication, and they provided consent. Case Presentation: A 3-year-old boy presented to our emergency department with a knife penetrating the front of his head during play. Neurologic examination was normal. Radiograph in lateral view demonstrated a metallic knife entering frontal bone. Computed tomography (CT) scan showed small hemorrhage around the foreign body recognized, accompanied by small pneumocephalus. The knife was surgically removed and the dura was closed. He was discharged home after the surgery with normal neurological status. Conclusion: Only four cases of PPBIK have been reported in the literature. The adequate management of these types of injuries requires a correct neuroradiological evaluation.

Delayed right-sided diaphragmatic hernia with severe ：raniocerebral trauma

Diaphragmatic hernia （DH） is an uncommon result of trauma, but presents a severe problem in patients With multiple injuries. Right-sided DH is rare, owing to the protection of the liver and strength of the right hemidiaphragm. Here we present a case of delayed right-sided DH with severe craniocerebral trauma.

重型颅脑损伤患者凝血纤溶标志物动态观察(英文)

Objective To investigate the dynamic changes and the clinic significance of coagulation and fibrinolysis markers in patients with severe craniocerebral trauma.Methods Thirty three consecutive patients [Glasgow coma scale (GCS) ≤8 and APACHE Ⅱ≥10] including 10 women and 23 men with age of (46.3±16.3) years old and with severe craniocerebral trauma were enrolled in this study.Endothelin(ET),alpha-granular membrane protein-140(GMP-140) and D-dimer(DD) were measured at 1st day,3rd day and 7th day of admission,head computerized tomography(CT) was performed on each patient.Twenty healthy people with similar age were as control.ET was determined by the reagent kit which from Shanghai Shenjia company and GC-1200 γ radiatory counter.GMP-140 was determined by the reagent kit which from Suzhou university and PEKINEINMER WIZARD-1470 γ radiatory counter.DD was determined by the reagent kit Shanghai sung biological product company limited and measured by latex agglutination.Results ET,GMP-140 and DD levels were significantly increased at the time of admission[(75.24±26.44)pg/ml,(26.43±13.94)ng/ml,(3.20±0.97)μg/ml,respectively],then gradually decreased.ET and DD levels were significantly higher than control group even after 7 days[(44.66±15.25)pg/ml,(1.35±0.55) μg/ml,respectively],but not for GMP-140.All of the coagulation and fibrinolysis abnormalities markers were negatively correlated with GCS,P<0.05.There were 18 survivors including 8 vegetables and 15 dead including 1 case suffered from disseminated intravascular coagulation(DIC) in this investigation.Conclusions Coagulation and fibrinolysis abnormalities markers were occurred at the very early stage in the patients with severe craniocerebral trauma.The levels of ET,GMP-140 and DD levels were negatively correlated with GCS.