Hydrogen inhalation promotes recovery of a patient in persistent vegetative state from intracerebral hemorrhage:A case report and literature review

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.

Clinical application of Chinese Nanjing persistent vegetative state scale

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.

Effects of acupuncture on nutritional status in patients in a persistent vegetative state:a prospective randomized controlled study

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.

Clinical studies on diffuse axonal injury in patients with severe closed head injury

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 (