Study on cumulative effects of biological craniocerebral trauma under repeated blast

Repeated blast impacts on personnel in explosive environments can exacerbate craniocerebral trauma.Most existing studies focus on the injury effects of a single blast,lacking in-depth analysis on the injury effects and cumulative effects of repeated blasts.Therefore,rats were used as the experimental samples to suffer from explosion blasts with different peak air overpressures(167 kPa~482 kPa)and varying number of repeated blasts.The cumulative effect of craniocerebral trauma was most pronounced for moderate repeated blast,showing approximately 95%increase of trauma severity with penta blast,and an approximately 85%increase of trauma severity with penta minor blast.The cumulative effect of craniocerebral trauma from severe,repeated blast has a smaller rate of change compared to the other two conditions.The severity of trauma from penta blast increased by approximately 69%compared to a single blast.Comprehensive physiological,pathological and biochemical analysis show that the degree of neurological trauma caused by repeated blasts is higher than that of single blasts,and the pathological trauma to brain tissue is more extensive and severe.The trauma degree remains unchanged after double blast,increases by one grade after triple or quadruple blast,and increases by two grades after penta blast.

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.

Occlusion of the anterior cerebral artery after head trauma

Intracranial arterial occlusion is rarely encountered in association with head injury.Only six cases of traumatic occlusion of the anterior cerebral artery(ACA) have previously been reported.In this paper,the authors describe a case of a posttraumatic occlusion of ACA.A 35-year-old male presented to the emergency room with severe head injury.Computed tomography(CT) scan displayed diffuse brain swelling with multiple skull fractures.Follow up CT scan showed extensive cerebral infarction in the territory of ACA.The patient underwent CT angiography that demonstrated occlusion of the ACA by a fracture of the anterior fossa.He died after 3 d.ACA traumatic occlusion is a rare condition,with poor prognosis.In this case,fracture was responsible for dissection and direct obstruction of the artery.

Diffuse axonal injury after traumatic cerebral microbleeds: an evaluation of imaging techniques

Previous neuropathological studies regarding traumatic brain injury have primarily focused on changes in large structures, for example, the clinical prognosis after cerebral contusion, intrace- rebral hematoma, and epidural and subdural hematoma. In fact, many smaller injuries can also lead to severe neurological disorders. For example, cerebral microbleeds result in the dysfunc- tion of adjacent neurons and the disassociation between cortex and subcortical structures. These tiny changes cannot be adequately visualized on CT or conventional MRI. In contrast, gradient echo sequence-based susceptibility-weighted imaging is very sensitive to blood metabolites and microbleeds, and can be used to evaluate traumatic cerebral microbleeds with high sensitivity and accuracy. Cerebral microbleed can be considered as an important imaging marker for dif- fuse axonal injury with potential relevance for prognosis. For this reason, based on experimental and clinical studies, this study reviews the role of imaging data showing traumatic cerebral microbleeds in the evaluation of cerebral neuronal injury and neurofunctional loss.

Cerebral Fat Embolism Syndrome from Penetrating Trauma: A Rare Cause-and-Effect

A 42 year-old male sustained an accidental rifle gunshot wound to his left foot, resulting in fracture deformities of the calcaneus, navicular, cuneiform, 1st and 2nd metatarsal bases, and talus. As he was transported to our trauma center, he developed progressive encephalopathy. Urgent external fixator placement under general anesthesia was postponed due to his encephalopathy of unknown etiology. Brain magnetic resonance imaging demonstrated a “starfield” pattern of infarcts, consistent with cerebral fat embolism syndrome. Subsequently, he underwent uneventful general anesthesia. The patient was managed supportively and continued to have persistent neurologic dysfunction two months after injury.

Neuroprotection of hyperbaric oxygen therapy in sub-acute traumatic brain injury:not by immediately improving cerebral oxygen saturation and oxygen partial pressure

Although hyperbaric oxygen （HBO） therapy can promote the recovery of neural function in patients who have suffered traumatic brain injury （TBI）, the underlying mechanism is unclear. We hypothesized that hyperbaric oxygen treatment plays a neuroprotective role in TBI by increasing regional transcranial oxygen saturation （rSO2） and oxygen partial pressure （PaO2）. To test this idea, we compared two groups： a control group with 20 healthy people and a treatment group with 40 TBI patients. The 40 patients were given 100% oxygen of HBO for 90 minutes. Changes in rSO2 were measured. The controls were also examined for rSO2 and PaO2, but received no treatment, rSO2 levels in the patients did not differ significantly after treatment, but levels before and after treatment were significantly lower than those in the control group. PaO2 levels were significantly decreased after the 30-minute HBO treatment. Our findings suggest that there is a disorder of oxygen metabolism in patients with sub-acute TBI. HBO does not immediately affect cerebral oxygen metabolism, and the underlying mechanism still needs to be studied in depth.

Pulsed arterial spin labeling effectively and dynamically observes changes in cerebral blood flow after mild traumatic brain injury

Cerebral blood flow is strongly associated with brain function, and is the main symptom and diagnostic basis for a variety of encephalopathies. However, changes in cerebral blood flow after mild traumatic brain injury remain poorly understood. This study sought to observe changes in cerebral blood flow in different regions after mild traumatic brain injury using pulsed arterial spin labeling. Our results demonstrate maximal cerebral blood flow in gray matter and minimal in the white matter of patients with mild traumatic brain injury. At the acute and subacute stages, cerebral blood flow was reduced in the occipital lobe, parietal lobe, central region, subcutaneous region, and frontal lobe. Cerebral blood flow was restored at the chronic stage. At the acute, subacute, and chronic stages, changes in cerebral blood flow were not apparent in the insula. Cerebral blood flow in the temporal lobe and limbic lobe diminished at the acute and subacute stages, but was restored at the chronic stage. These findings suggest that pulsed arterial spin labeling can precisely measure cerebral blood flow in various brain regions, and may play a reference role in evaluating a patient＇s condition and judging prognosis after traumatic brain injury.

Prospective Evaluation of Post-Traumatic Vasospasm and Post-Injury Functional Outcome Assessment: Is Cerebral Ischemia Going Unrecognized in Patients with Traumatic Brain Injury?

Background: Secondary injury processes such as posttraumatic vasospasm (PTV) play a critical role in the development of cerebral ischemia/infarction after traumatic brain injury (TBI). The objectives of this study were to evaluate the incidence of cerebral vasospasm in patients with moderate to severe TBI and to assess post-injury functional outcome. Study Design: A prospective observational study was conducted in patients with moderate and severe blunt TBI. Transcranial Doppler (TCD) ultrasound was performed within the first 72 hours and then daily for up to 7 days. Patient characteristics and outcome data including functional outcome as assessed by the Extended Glasgow Outcome Scale (GOS-E) were collected and compared between patients with and without PTV. Results: Twenty-three patients met our inclusion criteria. While there was a 47.8% incidence of vasospasm as detected by TCD, there was no significant difference in hospital LOS or mortality between patients with and without PTV. Of the two patients with PTV who died, both had a cerebral infarct or cerebral ischemia. In evaluating overall GOS-E among patients with a cerebral focal injury, patients with PTV had a significantly higher GOS-E score when compared to patients without PTV (8.0 vs. 6.8, p = 0.01). Conclusions: The high incidence of PTV and the role of clinically significant vasospasm after TBI remain unclear. While functional outcome was better in patients with a focal injury and vasospasm, patients who died had cerebral ischemia or infarction. We hypothesize that there is an interaction between impaired cerebral autoregulation, PTV and poor outcomes in patients with TBI.

Cerebral Blood Flow Measurement in the Assessment of Post-Traumatic Cerebral Contusions

Brain trauma (BT) is extremely common in the Western society, and has been identified as the main cause of death and disability in the under-40 age group. Many aspects of the pathophysiological mechanisms involved and the effect of changes in cerebral metabolism are unclear. The aim of this study was to establish the rela- tionship between anatomical changes and deranged cerebral perfusion in patients with cerebral contusions, using Computed Tomography (CT) and Single Proton Emission Computed Tomography (SPECT). Twenty- two (22) patients who had suffered BT were recruited. All patients underwent SPECT and CT head scans on the same day. 18 were men. Patient average age was 45.6. Patients were assessed using the Glasgow scale (average 10.6). Cause of trauma included traffic accidents (9 patients) and falls (13 patients). A 4-slice spiral CT scan was performed. For each contusion, areas of bleeding, edema, and healthy perilesional tissue were distinguished. SPECT was performed with 20 mCi of 99 mTcECD using a dual-head gamma camera (128 × 128 matrix). CT scan revealed a single lesion in 12 patients, and more than one lesion in 10. The biggest le- sions found on CT were located in the frontal region in 13 patients;temporal region in 4;and parietal region in 1;four patients had poorly defined lesions. A total absence of perfusion was visible in 18 patients in the hemorrhagic area and in 14 patients in the edema, In 7 cases SPECT showed hypoperfusion that did not cor- respond to any morphological changes on the CT scan. Quantitative of fused lesions appearing on both CT scan and SPECT revealed severe perfusion defects in the hemorrhagic area (17.8%) and in the edema (29.4%). In our study, regional cerebral blood flow add relevant information on encephalic damage in pa- tients with BT.

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.

Correlation of serum CNP and IGF-Ⅱ contents with brain injury and inflammatory response in patients with craniocerebral trauma

Objective:To study the correlation of serum C-type natriuretic peptide (CNP) and insulin-like growth factor-Ⅱ (IGF-Ⅱ) contents with brain injury and inflammatory response in patients with craniocerebral trauma.Methods: Patients with craniocerebral trauma who were treated in the First Affiliated Hospital of Xi'an Jiaotong University between March 2015 and July 2017 were included in the case group of the study, and the healthy volunteers who received physical examination during the same period were included in the control group. The contents of CNP, IGF-Ⅱ, nerve markers and pro-inflammatory cytokines in serum as well as the expression of inflammatory signaling molecules in peripheral blood were measured.Results: CNP and IGF-Ⅱ contents in serum of case group were significantly lower than those of control group whereas UCH-L1, GFAP, S100B, Tau, MIP-1α, IL-1β, IL-6, IL-8 and TNF-α contents in serum as well as JAK2, STAT3, MEK and ERK1/2 mRNA expression in peripheral blood were significantly higher than those of control group;CNP and IGF-Ⅱ contents in serum of case group were negatively correlated with UCH-L1, GFAP, S100B, Tau, MIP-1α, IL-1β, IL-6, IL-8 and TNF-α contents in serum as well as JAK2, STAT3, MEK and ERK1/2 mRNA expression in peripheral blood.Conclusion: The decrease of serum CNP and IGF-Ⅱ in patients with craniocerebral trauma is closely related to the aggravation of brain injury and the over-activation of inflammatory response.

Relationship of Nogo-A gene expression in serum and cerebrospinal fluid with nerve injury and inflammatory factor levels in patients with craniocerebral trauma

Objective:To study the relationship of Nogo-A gene expression in serum and cerebrospinal fluid with nerve injury and inflammatory factor levels in patients with craniocerebral trauma. Methods:82 patients with craniocerebral trauma who were treated in our hospital between January 2015 and February 2017 were collected as observation group, and 58 normal subjects who received internal hemorrhoids surgery under lumbar anesthesia in our hospital during the same period were collected as control group. Fluorescence quantitative PCR method was used to detect Nogo-A gene expression in serum and cerebrospinal fluid of both groups, and enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of nerve injury indexes and inflammatory factors in two groups. Pearson test was used to assess the relationship of Nogo-A gene expression in serum and cerebrospinal fluid with disease severity in patients with craniocerebral trauma.Results: Nogo-A mRNA expression in the serum and cerebrospinal fluid of observation group were higher than those of the control group;serum IGF-Ⅱ level was lower than that of control group while NSE, MBP and S100B levels were higher than those of control group;serum HSP-70, PCT, IL-1β, IL-6 and CRP levels were higher than those of control group. Pearson test showed that Nogo-A gene expression in serum and cerebrospinal fluid of patients with craniocerebral trauma were directly correlated with the nerve injury degree and inflammatory factor levels.Conclusions: Nogo-A gene is highly expressed in patients with craniocerebral trauma, and its expression is directly correlated with the nerve injury and systemic inflammatory response.

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).

Effects of propofol anesthesia on oxidative stress, neurological function and inflammatory cytokines in patients with craniocerebral trauma

Objective: To investigate the effect of propofol anesthesia on oxidative stress, neurological function and inflammatory cytokines in patients with craniocerebral trauma. Methods: A total of 102 patients with craniocerebral trauma who underwent surgery in our hospital from December 2014 to January 2017 were randomly divided into control group and observation group, each contained 51 cases. The control group was given 1%-2% of sevoflurane and 0.1-0.2 μg/kg/min of remifentanil and 20-30 μg/kg/h of vecuronium for anesthesia maintenance. The observation group was given propofol 4-6 mg/kg/h, remifentanil 0.1-0.2 μg/kg/min and vecuronium 20-30 μg/kg/h for anesthesia maintenance. The levels of oxidative stress, neurological function, and inflammatory factors were assessed in both groups. Results:Compared with before treatment, the levels of SOD and HO-1 in the two groups were significantly increased and the levels of MDA were significantly decreased, the difference was significant, and the levels of SOD and HO-1 in the observation group were significantly higher than control group, the level of MDA was significantly lower than that of the control group, the difference was significant. Compared with before treatment, the levels of NSE, GFAP and Tau level were significantly decreased in the two groups after treatment, and level in observation group was lower than control group, the difference was statistically significant. Compared with before treatment, the levels of IL-6, TNF-α and CRP in the two groups after treatment were significantly lower than those in the control group, the difference was statistically significant. Conclusion: Propofol anesthesia can significantly reduce the oxidative stress injury, inhibit the inflammatory reaction and protect the neurological function of patients. The effect is better than isoflurane anesthesia, and it is worthy of clinical application.

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.

Effect of propofol and isoflurane general anesthesia on nerve injury in patients with craniocerebral trauma after emergency surgery

Objective: To study the effect of propofol and isoflurane general anesthesia on nerve injury in patients with craniocerebral trauma after emergency surgery. Methods: Patients with craniocerebral trauma who accepted emergency surgery in Dangyang People's Hospital between May 2015 and February 2017 were selected and randomly divided into propofol group and isoflurane group who received propofol + fentanyl + vecuronium bromide as well as isoflurane + fentanyl + vecuronium bromide anesthesia respectively. Serum levels of nerve injury markers, excitatory amino acids, inhibitory amino acids and oxidative stress indicators were detected before operation, immediately after operation and 12 h after operation. Results:Immediately after operation and 12 h after operation, serum NSE, GFAP, NGB, Tau, GLU, ASP, 8-iso-PGF2 and MDA levels of both groups of patients were significantly lower than those before operation while GABA, ALA, HO-1, NQO-1 and SOD levels were significantly higher than those before operation, and serum NSE, GFAP, NGB, Tau, GLU, ASP, 8-iso-PGF2 and MDA levels of propofol group immediately after operation and 12 h after operation were significantly lower than those of isoflurane group while GABA, ALA, HO-1, NQO-1 and SOD levels were significantly higher than those of isoflurane group. Conclusion: Propofol for emergency surgery of patients with craniocerebral trauma is more effective than isoflurane in alleviating nerve injury degree, correcting the excitatory and inhibitory amino acid disorder, and inhibiting oxidative stress reaction.

Risk factors of posttraumatic cerebral infarction in patients with severe and extremely severe head injury

Objective To explore pathogenesis and risk factors for posttraumatic cerebral infarction (PTCI) in patients with severe and extremely severe head injuries for the purpose of providing clues for reducing occurrence of PTCI and case-fatality. Methods Gender,age,Glasgow coma scale (GCS) ,the presence or absence of basicranial fracture,cerebral hernia or infection,surgical modality,hypotension,and the use of diuretics

The effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury

Objective To explore effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury. Methods 71 cases were divided into three groups according age: group A( 【 30 years) ,group B ( 30 ～ 50 years) 。

Effects of calcium antagonist nimodipine on patients with severe craniocerebral trauma

The authors report the effects of a calcium antagonist, nimodipine, on severe craniocerebral trauma.A total of 488 cases of severe craniocerebral trauma with Glasgow Coma Scale (GCS) 3～8 score were recruited into the clinical study. The patients were divi