Liposomes as versatile agents for the management of traumatic and nontraumatic central nervous system disorders:drug stability,targeting efficiency,and safety

Various nanoparticle-based drug delivery systems for the treatment of neurological disorders have been widely studied.However,their inability to cross the blood–brain barrier hampers the clinical translation of these therapeutic strategies.Liposomes are nanoparticles composed of lipid bilayers,which can effectively encapsulate drugs and improve drug delivery across the blood–brain barrier and into brain tissue through their targeting and permeability.Therefore,they can potentially treat traumatic and nontraumatic central nervous system diseases.In this review,we outlined the common properties and preparation methods of liposomes,including thin-film hydration,reverse-phase evaporation,solvent injection techniques,detergent removal methods,and microfluidics techniques.Afterwards,we comprehensively discussed the current applications of liposomes in central nervous system diseases,such as Alzheimer's disease,Parkinson's disease,Huntington's disease,amyotrophic lateral sclerosis,traumatic brain injury,spinal cord injury,and brain tumors.Most studies related to liposomes are still in the laboratory stage and have not yet entered clinical trials.Additionally,their application as drug delivery systems in clinical practice faces challenges such as drug stability,targeting efficiency,and safety.Therefore,we proposed development strategies related to liposomes to further promote their development in neurological disease research.

Transcranial magnetic stimulation: potential treatment for co-occurring alcohol, traumatic brain injury and posttraumatic stress disorders

Alcohol use disorder （AUD）, mild traumatic brain injury （mTBI）, and posttraumatic stress disorder （PTSD） commonly co-occur （AUD ＋ mTBI ＋ PTSD）. These conditions have overlapping symptoms which are, in part, reflective of overlapping neuropathology. These conditions become problematic because their co-occurrence can exacerbate symptoms. Therefore, treatments must be developed that are inclusive to all three conditions. Repetitive transcranial magnetic stimulation （rTMS） is non-invasive and may be an ideal treatment for co-occurring AUD ＋ mTBI ＋ PTSD. There is accumulating evidence on rTMS as a treatment for people with AUD, mTBI, and PTSD each alone. However, there are no published studies to date on rTMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. This review article advances the knowledge base for rTMS as a treatment for AUD ＋ mTBI ＋ PTSD. This review provides background information about these co-occurring conditions as well as rTMS. The existing literature on rTMS as a treatment for people with AUD, TBI, and PTSD each alone is reviewed. Finally, neurobiological findings in support of a theoretical model are discussed to inform TMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. The peer-reviewed literature was identified by targeted literature searches using PubMed and supplemented by cross-referencing the bibliographies of relevant review articles. The existing evidence on rTMS as a treatment for these conditions in isolation, coupled with the overlapping neuropathology and symptomology of these conditions, suggests that rTMS may be well suited for the treatment of these conditions together.

Human neural stem cell transplants to address multiple pathologies associated with traumatic brain injury

Traumatic brain injury (TBI), an unmet need: TBI is an alteration in brain function caused by an external force with evidence of brain pathology. It could be from a bump, blow, blast or jolt to the head including penetrating the cranium. TBI is a public health concern worldwide due to its economic impact. Most TBIs are survivable, do not need hospitalization but may influence productivity. A smaller percentage of TBI due to falls or penetrating TBI (PTBI) needs hospitalization and accounts for largest fraction of TBI care costs.

Dementia in military and veteran populations:a review of risk factors—traumatic brain injury,post-traumatic stress disorder,deployment,and sleep

The military population face a unique set of risk factors that may increase the risk of being diagnosed with dementia.Traumatic brain injury(TBI)and post-traumatic stress disorder(PTSD)have a higher prevalence in this group in comparison to the civilian population.By delving into the individual relationships between TBI and dementia,and PTSD and dementia,we are able to better explore dementia in the military and veteran populations.While there are some inconsistencies in results,the TBI-dementia association has become more widely accepted.Moderate-tosevere TBI has been found to increase the risk of being diagnosed with Alzheimer’s disease.A correlation between PTSD and dementia has been established,however,whether or not it is a causal relationship remains unclear.Factors such as blast,combat and chemical exposure may occur during a deployment,along with TBI and/or PTSD diagnosis,and can impact the risk of dementia.However,there is a lack of literature exploring the direct effects of deployment on dementia risk.Sleep problems have been observed to occur in those following TBI,PTSD and deployment.Poor sleep has been associated with possible dementia risk.Although limited studies have focused on the link between sleep and dementia in military and veteran populations,sleep is a valuable factor to study due to its association and interconnection with other military/veteran factors.This review aims to inform of various risk factors to the cognitive health of military members and veterans:TBI,PTSD,deployment,and sleep.

Quetiapine augmentation of prolonged exposure therapy in veterans with PTSD and a history of mild traumatic brain injury: design and methodology of a pilot study

Background: Selective serotonergic reuptake inhibitors(SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder(PTSD), but must be given over extended period of time before the onset of action. The use of SSRIs in PTSD patients with mild traumatic brain injury(m TBI) is problematic since SSRIs could exacerbate post-concussion syndrome(PCS) symptoms. VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement and retention. A previous study from this research group suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in trauma-focused psychotherapy.Methods: We report the study protocol of a pilot study funded under the South-Central Mental Illness Research, Education, and Clinical Center pilot study program from the U.S. Department of Veterans Affairs. This randomized, open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs. treatment as usual to promote patient engagement in PTSD patients with a history of m TBI.Discussion: We expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial. Positive efficacy results in a full-scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans.Trial registration: NCT04280965.

Long-Term Survival in Traumatic Brain Injury and Near-Death Experience Increases Suicide Risks: A Personal Experience and Related Literature

Background: Traumatic brain injury (TBI) remains a cause of lifelong disability, death, and suicide worldwide. TBI-induced near-death experience (NDE) could increase suicide risks. Objective: We investigated TBI coupled with NDE and posttraumatic stress disorder (PTSD) as a possible indicator of suicide. Methods: A 17-year-old male who sustained an acute severe TBI in a traffic collision, was comatose 14 days, had an NDE awakening from the coma, and, years after rehabilitation, suffered PTSD, clinical depression, and survived a suicide attempt. This personal experience of a TBI-induced NDE and lingering PTSD was acquired directly from the patient by interview. We discuss his case while considering relevant literature. Results: Longitudinal data from 1961 to 2021 generated from the PubMed interface revealed 4056 TBI patients committed suicide. NDE was only reported in one of those cases and, although not a suicide, in the personal experience. Neuropsychological assessment at long-term follow-ups revealed few TBI patients exhibited normal mental/physical functions compared to the general population. Unfavorable GOS scores were risk predictors for neuropsychological/physical impairments later in life, with outcomes of depression, PTSD, poor QOL, and/or suicide. Conclusions: For TBI-NDE survivors, including those with PTSD, long-term periodic neuropsychological follow-ups and psychosocial support may help decrease suicide risks.

Neuropsychological and Social Outcome of Patients Sustaining Traumatic Brain Injury in Cotonou

This inaugural study in Benin was aimed at assessing neuropsychological and behavioural problems of patients with traumatic brain injury managed at the Hubert Koutoukou Maga Teaching hospital in Cotonou, and the impact on their standard of leaving. This was a prospective and cross-cutting study with a descriptive and analytical aim. It was carried out from 1 July to 30 October 2018. The study population included patients over 15 years of age who had experienced TBI. A purposive sampling of 585 patients with TBI was done, of which 142 patients could not be reached by phone while. The mean age of patients was 37.16 ± 13.9 years, with extremes ranging from 16 to 87 years. The most frequent complaints were behavioural disorder (79.5%), headache (63.8%) and memory loss (50.4%). The average duration of post traumatic amnesia was 9.08 ± 38.56 days. Sixty-three patients (68.5%) had post-traumatic amnesia that lasted less than 30 minutes and 25 patients (19.2%) had post-traumatic amnesia that lasted over a month. Neuropsychological disorders were more frequent in patients with severe TBI. Attention disorders and difficulties in elaborating strategies were noticed without any statistically significant difference in mild, moderate as well as severe TBI. Nineteen patients lost their job, thus raising the unemployment rate in our sample from 6% to 21%. Among the 100 patients (75%) that recovered their job, 14% had medical follow-up and 10% returned to part-time work. Salary remained unchanged for 61.2% of TBI patients.

Correlation of preoperative inflammatory factors and emotional disorders with postoperative delirium in patients with craniocerebral trauma

BACKGROUND Traumatic brain injury(TBI)imposes a substantial societal and familial burden due to its high disability and fatality rates,rendering it a serious public health problem.Some patients with TBI have poor treatment outcomes and are prone to postoperative delirium(POD),which affects their quality of life.Anxiety has been linked to increased POD incidence in some studies,while others have found no correlation.AIM To investigate the correlation of POD risk factors,preoperative inflammatory factors,and mood disorders in patients with TBI.METHODS We retrospectively collected data on the treatment of 80 patients with TBI from November 2021 to September 2023.Patients were grouped as POD and non-POD,according to their POD status,and the general data of the two groups were compared.Inflammatory factor levels were detected preoperatively,and the Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)were used to investigate the risk factors associated with POD in these patients.Logistic regression was used to identify the independent risk factors.RESULTS Twenty-one patients(26.25%)developed POD,including 7,10,and 4 cases of the excitatory,inhibitory,and mixed types,respectively.There were 59 cases(73.75%)in the non-POD group.Compared with the non-POD group,the POD group had a significantly higher proportion of patients with low Glasgow Coma Scale(GCS)scores before admission,unilateral mydriasis,preoperative hemorrhagic shock,intraventricular hemorrhage(IVH),and postoperative hyperglycemic hyperosmolar disease(P<0.05).In the POD group,interleukin-6(IL-6),human tumor necrosis factor-α(TNF-α),myeloperoxidase levels,HAMA,and HAMD scores were higher than those in the non-POD group(all P<0.05).Logistic multivariate analysis showed that GCS score at admission,IVH,IL-6,TNF-α,HAMA,and HAMD were independent risk factors for POD in patients with TBI(P<0.05).CONCLUSION Low GCS score at admission,IVH,elevated IL-6 and TNF-α,other inflammatory indicators,anxiety,and depression,can increase the risk of POD in patients with TBI after surgery.

Effects of therapeutic horseback riding on post-traumatic stress disorder in military veterans

Background:Large numbers of post-deployment U.S.veterans are diagnosed with post-traumatic stress disorder(PTSD)and/or traumatic brain injury(TBI),leading to an urgent need for effective interventions to reduce symptoms and increase veterans’coping.PTSD includes anxiety,flashbacks,and emotional numbing.The symptoms increase health care costs for stress-related illnesses and can make veterans’civilian life difficult.Methods:We used a randomized wait-list controlled design with repeated measures of U.S.military veterans to address our specific aim to test the efficacy of a 6-week therapeutic horseback riding(THR)program for decreasing PTSD symptoms and increasing coping self-efficacy,emotion regulation,social and emotional loneliness.Fiftyseven participants were recruited and 29 enrolled in the randomized trial.They were randomly assigned to either the horse riding group(n=15)or a wait-list control group(n=14).The wait-list control group experienced a 6-week waiting period,while the horse riding group began THR.The wait-list control group began riding after 6 weeks of participating in the control group.Demographic and health history information was obtained from all the participants.PTSD symptoms were measured using the standardized PTSD Checklist-Military Version(PCL-M).The PCL-M as well as other instruments including,The Coping Self Efficacy Scale(CSES),The Difficulties in Emotion Regulation Scale(DERS)and The Social and Emotional Loneliness Scale for Adults-short version(SELSA)were used to access different aspects of individual well-being and the PTSD symptoms.Results:Participants had a statistically significant decrease in PTSD scores after 3 weeks of THR(P≤0.01)as well as a statistically and clinically significant decrease after 6 weeks of THR(P≤0.01).Logistic regression showed that participants had a 66.7%likelihood of having lower PTSD scores at 3 weeks and 87.5%likelihood at 6 weeks.Under the generalized linear model(GLM),our ANOVA findings for the coping self-efficacy,emotion regulation,and social and emotional loneliness did not reach statistical significance.The results for coping self-efficacy and emotion regulation trended in the predicted direction.Results for emotional loneliness were opposite the predicted direction.Logistic regression provided validation that outcome effects were caused by riding longer.Conclusion:The findings suggest that THR may be a clinically effective intervention for alleviating PTSD symptoms in military veterans.

The Effect of the MNRI Method on Neurotransmitter Biomarkers of Individuals with Neurodevelopmental Disorders

Introduction: The MNRI (Masgutova Neurosensorimotor Reflex Integration) method was developed in 1989 in Russia and has spread world-wide to treat individuals with certain types reflex development deficits, behavior disorders, disorders of speech or language development, and learning disabilities. MNRI is based on techniques called “repatterning” or remodulation, meaning re-education, recoding the reflex nerve pathways specific for dynamic and postural reflex schemes. Objectives: Repatterning activates the extra pyramidal nervous system responsible for automatic mechanisms and processes, the extension of links between neurons, the growth of neural nets, myelination, and the creation of new nerve routing. This potential result was tested utilizing urinary measurements of the following neurotransmitters: epinephrine, norepinephrine, dopamine, DOPAC, serotonin, 5-HIAA, glycine, taurine, GABA, glutamate, PEA, and histamine. Methods: Neurological impact of the Masgutova Neurosensorimotor Reflex Method on the magnitude of changes in neurotransmitters was assessed by an external controlled and double-blind method using patients from one of the four diagnosis groups: 1) global developmental disorders;2) cerebral palsy, Traumatic Brain Injury (TBI), Acute Brain Injury (ABI), and seizures;3) ADD/ADHD;and 4) anxiety disorders. Results: The post-MNRI results in participants show a tendency for regulation of the above neurotransmitters resulting in their calming down, decrease of hypervigilance, stress resilience increase, improvements in behavioral and emotional regulation, positive emotions, and cognitive processes control. Conclusion: The application of the Masgutova Neurosensorimotor Reflex Method as a therapy modality offers a novelty paradigm for the treatment using neuro- and immune-modulation technologies presenting a non-pharmaceutical approach, based on use of neurosensorimotor reflex circuit concept.

颅脑损伤相关创伤后应激障碍的影响因素分析

目的探索颅脑损伤(traumatic brain injury,TBI)患者发生创伤后应激障碍(post-traumatic stress disorder,PTSD)的影响因素.方法回顾性分析2020年至2022年期间入住的90例TBI患者的临床资料,根据格拉斯哥预后量表(glasgow outcome ocale,GOS)评分评估临床预后,纳入预后良好患者56例,利用DSM-5的PTSD诊断与统计手册进行PTSD的评估,并收集入院时血液及脑脊液相关数值进行统计分析.结果TBI患者PTSD的患病率为39.3%,与未出现PTSD的患者相比,发生PTSD的患者的血浆白细胞(white blood cell,WBC)、中性粒细胞、中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、C反应蛋白(c-reactive protein,CRP)、脑脊液中体液WBC(WBC-body fluid、WBC-BF)和脑脊液蛋白含量具有明显统计学意义(P<0.05,P<0.01).Logistic回归分析显示中性粒细胞(OR=3.735,95%CI:1.109-12.577,P=0.033)、NLR(OR=3.742,95%CI:1.112-12.591,P=0.033)和脑脊液WBC-BF(OR=1.216,95%CI:1.072-1.378,P=0.002)是PTSD的影响因素.中性粒细胞AUC为0.880(P<0.01)、敏感性63.6%、特异性为97.1%,NLR的AUC值为0.799(P<0.01)、敏感性81.8%、特异性为85.3%,WBC-BF的AUC值为0.889(P<0.01)、敏感性81.8%、特异性为76.5%.结论中性粒细胞、NLR、脑脊液WBC-BF是TBI患者发生PTSD的独立影响因素,具有良好的预测价值,有较高的敏感性与特异性.对它们的监测有利于早期预测并及早干预,降低PTSD的发病率.

真实世界环境下外周血炎性指标对创伤性颅脑损伤后抑郁障碍的预测价值

目的:探讨真实世界环境下外周血炎性指标预测创伤性颅脑损伤(traumatic brain injury,TBI)后抑郁障碍的临床价值。方法:招募TBI患者67例,随访3个月后根据是否有抑郁障碍将患者分为对照组和抑郁组,筛选TBI后抑郁障碍发生的影响因素。结果:颅内感染是影响TBI后抑郁障碍发生的独立影响因素。外周血白细胞计数、中性粒细胞百分比、CRP水平与TBI患者抑郁程度呈正相关。结论:TBI后抑郁障碍发生率较高,外周血白细胞计数、中性粒细胞百分比、CRP水平有望作为早期诊断TBI后抑郁障碍的标志物。

White Matter Changes in Posttraumatic Stress Disorder Following Mild Traumatic Brain Injury： A Prospective Longitudinal Diffusion Tensor Imaging Study

Background： The ability to predict posttraumatic stress disorder （PTSD） is a critical issue in the management of patients with mild traumatic brain injury （mTBI）, as early medical and rehabilitative interventions may reduce the risks of long-term cognitive changes. The aim of the present study was to investigate how diffusion tensor imaging （DTI） metrics changed in the transition from acute to chronic phases in patients with mTBI and whether the alteration relates to the development of PTSD. Methods： Forty-three patients with mTBI and 22 healthy volunteers were investigated. The patients were divided into two groups： successful recovery （SR, n = 22） and poor recovery （PR, n = 21）, based on neurocognitive evaluation at 1 or 6 months after injury. All patients underwent magnetic resonance imaging investigation at acute （within 3 days）, subacute （10-20 days）, and chronic （1-6 months） phases after injury. Group differences of fractional anisotropy （FA） and mean diffusivity （MD） were analyzed using tract-based spatial statistics （TBSS）. The accuracy of DTI metrics for classifying PTSD was estimated using Bayesian discrimination analysis. Results： TBSS showed white matter （WM） abnormalities in various brain regions. In the acute phase, FA values were higher for PR and SR patients than controls （all P 〈 0.05）. In subacute phase, PR patients have higher mean MD than SR and controls （all P 〈 0.05）. In the chronic phase, lower FA and higher MD were observed in PR compared with both SR and control groups （all P 〈 0.05）. PR and SR groups could be discriminated with a sensitivity of 73%, specificity of 78%, and accuracy of 75.56%, in terms of MD value in subacute phase. Conclusions： Patients with mTBI have multiple abnormalities in various WM regions. DTI metrics change over time and provide a potential indicator at subacute stage for PTSD following mTBI.

Glucose metabolism:A link between traumatic brain injury and Alzheimer’s disease

Traumatic brain injury(TBI),a growing public health problem,is a leading cause of death and disability worldwide,although its prevention measures and clinical cares are substantially improved.Increasing evidence shows that TBI may increase the risk of mood disorders and neurodegenerative diseases,including Alzheimer’s disease(AD).However,the complex relationship between TBI and AD remains elusive.Metabolic dysfunction has been the common pathology in both TBI and AD.On the one hand,TBI perturbs the glucose metabolism of the brain,and causes energy crisis and subsequent hyperglycolysis.On the other hand,glucose deprivation promotes amyloidogenesis viaβ-site APP cleaving enzyme-1 dependent mechanism,and triggers tau pathology and synaptic function.Recent findings suggest that TBI might facilitate Alzheimer’s pathogenesis by altering metabolism,which provides clues to metabolic link between TBI and AD.In this review,we will explore how TBI-induced metabolic changes contribute to the development of AD.

Acceptability of an adjunct equine-assisted activities and therapies program for veterans with posttraumatic stress disorder and/or traumatic brain injury

Objective: Equine-assisted activities and therapies(EAATs) have been a growing adjunctive integrative health modality, as they allow participants to practice mindfulness, emotional regulation, and self-mastery or self-esteem building skills. Preliminary evidence suggests that these programs may be helpful in reducing posttraumatic stress disorder(PTSD), anxiety, and depressive symptoms. The current study examines the acceptability of integrating an EAAT program as part of a two-week, intensive clinical program for veterans with PTSD and/or traumatic brain injury(TBI).Methods: A family member or support person could accompany veterans and participate in the program.One hundred and six participants(veteran n = 62, family n = 44) left the urban environment in an intensive outpatient program(IOP) to attend a two-day, weekend EAAT in rural New Hampshire. Satisfaction surveys were conducted on the last day of the program and examined using thematic analysis.Results: The following themes were reported in the surveys: ability of horses to catalyze emotional rehabilitation, effectiveness of immersion in equine-assisted activities, program’s ability to foster interpersonal relationships and necessity of education about PTSD for staff. Participants also reported enjoying the program as highlighted by qualitative feedback, a mean score of 9.76(standard deviation[SD] = 0.61) as reported by veterans and a mean score of 9.91(SD = 0.29) as reported by family members on a 10-point visual analog scale with higher scores indicating a greater overall experience.Conclusion: These data offer preliminary evidence that an adjunct EAAT program is acceptable for veterans with PTSD and/or TBI participating in an IOP.

突触后支架蛋白Preso在颅脑冲击伤诱导创伤后应激障碍中的作用机制

将36只雄性C57小鼠随机分为对照组(Sham组)、3.5 MPa颅脑冲击伤(blast-related traumatic brain injury,bTBI)组、4.5 MPa bTBI组、5.5 MPa bTBI组、4.5 MPa bTBI+生理盐水组(bTBI+SA组)、4.5 MPa bTBI+小分子多肽组(bTBI+TAT-FERM组),每组6只;将12只Preso^(-/-)小鼠随机分为Sham组和4.5 MPa bTBI组,每组6只。对小鼠进行bTBI造模,完成后常规饲养2周,4.5 MPa bTBI+生理盐水组和4.5 MPa bTBI+TAT-FERM组在bTBI造模后每天通过尾静脉给药1次,连续给药5 d。与对照组相比,3.5 MPa bTBI组小鼠焦虑抑郁行为改变不显著;4.5 MPa bTBI和5.5 MPa bTBI组小鼠出现创伤后应激障碍(posttraumatic stress disorder,PTSD)样症状。与对照组相比,4.5 MPa bTBI组Preso/mGluR1复合体形成增加,使用TAT-FERM可阻断Preso与mGluR1的相互作用,可在不改变Preso/mGluR1复合体组成分子蛋白表达的情况下抑制Preso/mGluR1复合体形成,并且改善bTBI所导致的PTSD症状。bTBI促进Preso/mGluR1复合体形成是bTBI诱致PTSD症状的重要分子病理机制,通过阻断Preso与mGluR1相互作用可减轻bTBI对PTSD的影响,进而为治疗bTBI相关的PTSD提供了潜在靶点。

神经肌肉电刺激促进颅脑损伤后吞咽功能恢复

目的探讨神经肌肉电刺激(NMES)对颅脑损伤后吞咽功能障碍的治疗效果。方法2021年6月至2022年5月前瞻性收集60例颅脑损伤后伴发吞咽功能障碍病人,随机分为对照组(n=30)和NMES组(n=30)。对照组进行吞咽训练,包括进食训练、吞咽训练、屏气训练及发音训练等;NMES组在对照组治疗的基础上增加神经肌肉电刺激;疗程均为4周。运用洼田饮水试验(KDWT)分级、电视透视吞咽功能检查结合渗透-误吸量表(PAS)评分评估吞咽功能。结果治疗前,两组KDWT分级和PAS评分均为统计学差异(P>0.05)。治疗后4周,两组KDWT分级明显降低(P<0.05),PAS评分明显增高(P<0.05);而且,NMES组KDWT分级和PAS评分均明显优于对照组(P<0.05)。结论颅脑损伤后伴发吞咽功能障碍,在积极吞咽训练基础上进行NMES治疗显著促进吞咽功能恢复。

Post‑traumatic Stress Disorder:Relationship to Traumatic Brain Injury and Approach to Forensic Psychiatry Evaluation

Posttraumatic stress disorder(PTSD)has an important and complex relationship with traumatic brain injury(TBI).The prevalence of comorbid PTSD and TBI is increasing in both military and civilian populations.Moreover,TBI has emerged as an important risk factor for the development and manifestation of PTSD.Meanwhile,PTSD is also a significant mediator of the negative sequelae of TBI.PTSD and TBI,especially mild TBI(mTBI),have overlapping neural substrates and neuroanatomical functional features.Given that comorbid PTSD and TBI remain a challenge for forensic psychiatry evaluation,we review the relationship between the two disorders and discuss special considerations during evaluation of the condition.

126例儿童颅脑外伤患者致伤因素及临床特点回顾性分析

目的分析需住院或留院观察的颅脑外伤(TBI)患儿的致伤因素及临床特点。方法收集2014年1月1日至2016年8月31日于急诊科就诊且需留院治疗的126例TBI患儿的临床资料,对其致伤因素及部分临床特点做回顾性分析。结果 126例TBI患儿中,男95例,女31例,年龄2.8(0.8,5.5)岁,以<1岁者最多(48/126,38.1%),死亡26例。TBI类型前2位是硬膜外血肿(54.0%)、蛛网膜下腔出血(50.8%),入院24?h内有83例(65.9%)患儿Glasgow昏迷量表评分≤8分。不同年龄组TBI致伤因素、发生场所各不相同。TBI最常见的前2位致伤因素为坠落/摔伤(51.6%)和道路交通伤害(42.9%)。与其他年龄段相比,<1岁患儿最易发生坠落/摔伤(46%,P=0.023)。道路交通伤害所致TBI高发年龄段为3～6岁(35%,P<0.001)。伤害发生场所集中于家中(47.6%)和公路/街道(45.2%);所有家中致伤患儿中,<1岁组所占比例最高(48%,P=0.002),3～6岁患儿主要受伤地点为公路/街道(53%)。造成TBI患儿死亡的首位致伤因素是道路交通伤害(69%);死亡病例中,以<1岁患儿最多(62%)。结论不同年龄组TBI患儿的致伤因素和发生场所不尽相同。1岁以下儿童发生TBI比例高、死亡人数最多,多为家中发生坠落/摔伤所致。3～6岁儿童易因道路交通伤害发生TBI。道路交通伤害最易导致死亡。

去骨瓣减压术后早期颅骨修补术对颅脑创伤患者神经功能和认知功能的影响

目的探讨早期颅骨修补术对颅脑创伤患者去骨瓣减压术后神经功能和认知功能的影响。方法 2016年1月至2019年12月共106例颅脑创伤去骨瓣减压术后行颅骨修补的患者,分为早期颅骨修补组(去骨瓣减压术后1~3个月,48例)和常规颅骨修补组(去骨瓣减压术后3~6个月,58例),分别于颅骨修补术前和术后6个月采用Glasgow预后分级(GOS)评价预后、改良Rankin量表(mRS)评价日常生活活动能力、美国国立卫生研究院卒中量表(NIHSS)评价神经功能、简易智能状态检查量表(MMSE)评价认知功能,同时记录术后6个月环锯综合征发生率。结果术后6个月时,两组患者GOS评分(P=0.000)和MMSE评分(P=0.000)均高于、mRS评分(P=0.000)和NIHSS评分(P=0.000)均低于术前;术后6个月时,早期颅骨修补组患者GOS评分(P=0.041)和MMSE评分(P=0.040)均高于、mRS评分(P=0.021)和NIHSS评分(P=0.043)均低于常规颅骨修补组,且环锯综合征发生率亦低于常规颅骨修补组[18.75%(9/48)对39.66%(23/58);χ~2=5.446,P=0.020]。结论颅脑创伤患者去骨瓣减压术后早期行颅骨修补术可以有效提高日常生活活动能力、神经功能和认知功能,减少环锯综合征的发生,改善预后和远期生活质量。