Visualizing traumatic brain injury:ocular clues for diagnosis and assessment

Traumatic brain injury (TBI) is defined as damage to the brain resulting from an external sudden physical force or shock to the head.It is considered a silent public health epidemic causing significant death and disability globally.There were 64,000 TBI related deaths reported in the USA in 2020,with about US$76 billion in direct and indirect medical costs annually.

Clinical associations of corneal neuromas with ocular surface diseases

Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from damage to corneal nerves,such as following corneal pathology or corneal or intraocular surge ries.Initially,denervated areas of sensory nerve fibers become invaded by sprouts of intact sensory nerve fibers,and later injured axons regenerate and new sprouts called neuromas develop.In recent years,analysis of corneal nerve abnormalities including corneal neuromas which can be identified using in vivo confocal microscopy,a non-invasive imaging technique with microscopic resolution,has been used to evaluate corneal neuropathy and ocular surface dysfunction.Corneal neuromas have been shown to be associated with clinical symptoms of discomfort and dryness of eyes,and are a promising surrogate biomarker for ocular surface diseases,such as neuropathic corneal pain,dry eye disease,diabetic corneal neuropathy,neurotrophic keratopathy,Sjogren's syndrome,bullous keratopathy,post-refra ctive surgery,and others.In this review,we have summarized the current literature on the association between these ocular surface diseases and the presentation of corneal microneuromas,as well as elaborated on their pathogenesis,visualization via in vivo confocal microscopy,and utility in monitoring treatment efficacy.As current quantitative analysis on neuromas mainly relies on manual annotation and quantification,which is user-dependent and labor-intensive,future direction includes the development of artificial intelligence software to identify and quantify these potential imaging biomarkers in a more automated and sensitive manner,allowing it to be applied in clinical settings more efficiently.Combining imaging and molecular biomarkers may also help elucidate the associations between corneal neuromas and ocular surface diseases.

Intra-and interobserver reliability of ocular surface analyzer LacryDiag

AIM:To invastigate intra-and interobserver reliability of interferometry,tear meniscus height(TMH)measurement and meibography(MBG)of an ocular surface analyzer,LacryDiag(Quantel Medical,France).METHODS:Five consecutive measurements and subsequent analysis of interferometry,TMH,and MBG were recorded by two examiners using the LacryDiag.To assess intra-and interobserver reliability,we used Cohen’s kappa for categorical variables(interferometry),or intraclass correlation coefficient for continuous variables(TMH,MBG).RESULTS:Thirty eyes of 30 examinees were included.For both observers,there was excellent intraobserver reliability for MBG(0.955 and 0.970 for observer 1 and 2,respectively).Intraobserver reliability for observer 1 was substantial for interferometry(0.799),and excellent for TMH(0.863).Reliability for observer 2 was moderate for interferometry(0.535)and fair to good for TMH(0.431).Interobserver reliability was poor for interferometry(0.074)and fair to good for TMH(0.680)and MBG(0.414).CONCLUSION:LacryDiag ocular surface analyzer in our study proves to be a reliable noninvasive tool for the evaluation of TMH and MBG.As for interferometry,poor interobserver reliability,fair to good intraobserver reliability for observer 1,and moderate for observer 2,leave room for improvement.

Microvascular alterations of the ocular surface and retina in connective tissue disease-related interstitial lung disease

AIM:To examine the disparities in macular retinal vascular density between individuals with connective tissue disease-related interstitial lung disease(CTD-ILD)and healthy controls(HCs)by optical coherence tomography angiography(OCTA)and to investigate the changes in microvascular density in abnormal eyes.METHODS:For a retrospective case-control study,a total of 16 patients(32 eyes)diagnosed with CTD-ILD were selected as the ILD group.The 16 healthy volunteers with 32 eyes,matched in terms of age and sex with the patients,were recruited as control group.The macular retina’s superficial retinal layer(SRL)and deep retinal layer(DRL)were examined and scanned using OCTA in each individual eye.The densities of retinal microvascular(MIR),macrovascular(MAR),and total microvascular(TMI)were calculated and compared.Changes in retinal vascular density in the macular region were analyzed using three different segmentation methods:central annuli segmentation method(C1-C6),hemispheric segmentation method[uperior right(SR),superior left(SL),inferior left(IL),and inferior right(IR)],and Early Treatment Diabetic Retinopathy Study(ETDRS)methods[superior(S),inferior(I),left(L),and right(R)].The data were analyzed using Version 9.0 of GraphPad prism and Pearson analysis.RESULTS:The OCTA data demonstrated a statistically significant difference(P<0.05)in macular retinal microvessel density between the two groups.Specifically,in the SRL and DRL analyses,the ILD group exhibited significantly lower surface density of MIR and TMI compared to the HCs group(P<0.05).Furthermore,using the hemispheric segmentation method,the ILD group showed notable reductions in SL,SR,and IL in the superficial retina(P<0.05),as well as marked decreases in SL and IR in the deep retina(P<0.05).Similarly,when employing the ETDRS method,the ILD group displayed substantial drops in superficial retinal S and I(P<0.05),along with notable reductions in deep retinal L,I,and R(P<0.05).In the central annuli segmentation method,the ILD group exhibited a significant decrease in the superficial retinal C2-4 region(P<0.05),whereas the deep retina showed a notable reduction in the C3-5 region(P<0.05).Additionally,there was an observed higher positive likelihood ratio in the superficial SR region and deep MIR.Furthermore,there was a negative correlation between conjunctival vascular density and both deep and superficial retinal TMI(P<0.001).CONCLUSION:Patients with CTD-ILD exhibits a significantly higher conjunctival vascular density compared to the HCs group.Conversely,their fundus retinal microvascular density is significantly lower.Furthermore,CTD-ILD patients display notably lower superficial and deep retinal vascular density in comparison to the HCs group.The inverse correlation between conjunctival vascular density and both superficial and deep retinal TMI suggests that detecting subtle changes in ocular microcirculation could potentially serve as an early diagnostic indicator for connective tissue diseases,thereby enhancing disease management.

Medical and surgical approach to ocular surface reconstruction

Ocular surface disease(OSD)can have a severe impact on patients as it can lead to visual impairment and persistent discomfort.Ocular surface reconstruction(OSR)is an approach to the management of ocular diseases that cause structural damage to the ocular surface.OSR encompasses both medical and surgical treatment options.In this review,we discuss the medical and surgical strategies used in OSR.Medical management often aims to treat tear insufficiency,inflammation,and keratinization.Surgical treatments may be employed for a variety of reasons,including failure of medical management.This may include improving the oculo-palpebral structures in order to improve lid positioning and tear film.Additional therapies focus on improving tear production,such as through salivary gland transplantation.In situations where the ocular surface is so severely damaged that there is loss of limbal stem cells,limbal stem cell transplant(LSCT)may be indicated.Other surgeries such as amniotic membrane transplant(AMT)and conjunctival flaps(CFs)can help promote corneal healing.Finally,in severe situations where the cornea is beyond salvage,corneal transplantation,such as a penetrating keratoplasty(PKP),can be considered.OSR often requires a combination of medical and surgical approaches targeted to each specific patient’s presentation in order to achieve optimal outcomes.

Necroptosis plays a crucial role in the exacerbation of retinal injury after blunt ocular trauma

Retinal injury after blunt ocular trauma may directly affect prognosis and lead to vision loss.To investigate the pathological changes and molecular mechanisms involved in retinal injury after blunt ocular trauma,we established a weight drop injury model of blunt ocular trauma in male Beagle dogs.Hematoxylin-eosin staining,immunofluorescence staining,western blotting,and TUNEL assays were performed to investigate retinal injury within 14 days after blunt ocular trauma.Compared with the control group,the thicknesses of the inner and outer nuclear layers,as well as the number of retinal ganglion cells,gradually decreased within 14 days after injury.The number of bipolar cells in the inner nuclear layer began to decrease 1 day after injury,while the numbers of cholinergic and amacrine cells in the inner nuclear layer did not decrease until 7 days after injury.Moreover,retinal cell necroptosis increased with time after injury;it progressed from the ganglion cell layer to the outer nuclear layer.Visual electrophysiological findings indicated that visual impairment began on the first day after injury and worsened over time.Additionally,blunt ocular trauma induced nerve regeneration and Müller glial hyperplasia;it also resulted in the recruitment of microglia to the retina and polarization of those microglia to the M1 phenotype.These findings suggest that necroptosis plays an important role in exacerbating retinal injury after blunt ocular trauma via gliosis and neuroinflammation.Such a role has important implications for the development of therapeutic strategies.

Analysis of postoperative ocular surface changes and intervention effect after pars plana vitrectomy in meibomian gland dysfunction dry eye patients

AIM:To observe ocular surface changes after phacovitrectomy in patients with mild to moderate meibomian gland dysfunction(MGD)-type dry eye and track clinical treatment response using a Keratograph 5M and a Lipi View interferometer.METHODS:Forty cases were randomized into control group A and treatment group B;the latter received meibomian gland treatment 3d before phacovitrectomy and sodium hyaluronate before and after surgery.The average non-invasive tear film break-up time(NITBUTav),first noninvasive tear film break-up time(NITBUTf),non-invasive measured tear meniscus height(NTMH),meibomian gland loss(MGL),lipid layer thickness(LLT)and partial blink rate(PBR)were measured preoperatively and 1wk,1 and 3mo postoperatively.RESULTS:The NITBUTav values of group A at 1wk(4.38±0.47),1mo(6.76±0.70),and 3mo(7.25±0.68)were significantly lower than those of group B(7.45±0.78,10.46±0.97,and 11.31±0.89;P=0.002,0.004,and 0.001,respectively).The NTMH values of group B at 1wk(0.20±0.01)and 1mo(0.22±0.01)were markedly higher than those of group A(0.15±0.01 and 0.15±0.01;P=0.008 and P<0.001,respectively);however,there was no difference at 3mo.The LLT of group B at 3mo[91.5(76.25-100.00)]significantly exceeded that of group A[65.00(54.50-91.25),P=0.017].No obvious intergroup difference was found in MGL or PBR(P>0.05).CONCLUSION:Mild to moderate MGD dry eye worsens in the short term after phacovitrectomy.Preoperative cleaning,hot compresses,and meibomian gland massage as well as preoperative and postoperative sodium hyaluronate promote the rapid recovery of tear film stability.

Epidemiology and etiology of chemical ocular injury:A brief review

Chemical ocular injury is one of the common ophthalmologic emergencies that can cause vision loss and serious complications.Despite all protective measures,it continues to be a serious public health problem,especially in young male patients.Although it is known that injuries occur most frequently in the workplace and in young male patients,there is a variable frequency and distribution in different regions around the world.In addition,with the coronavirus disease 2019 pandemic,there are changing trends in ocular chemical injuries.This review aims to specify an update on the epidemiological and etiological features of ocular chemical injuries.

Passive activity enhances residual control ability in patients with complete spinal cord injury

Patients with complete spinal cord injury retain the potential for volitional muscle activity in muscles located below the spinal injury level.However,because of prolonged inactivity,initial attempts to activate these muscles may not effectively engage any of the remaining neurons in the descending pathway.A previous study unexpectedly found that a brief clinical round of passive activity significantly increased volitional muscle activation,as measured by surface electromyography.In this study,we further explored the effect of passive activity on surface electromyographic signals during volitional control tasks among individuals with complete spinal cord injury.Eleven patients with chronic complete thoracic spinal cord injury were recruited.Surface electromyography data from eight major leg muscles were acquired and compared before and after the passive activity protocol.The results indicated that the passive activity led to an increased number of activated volitional muscles and an increased frequency of activation.Although the cumulative root mean square of surface electromyography amplitude for volitional control of movement showed a slight increase after passive activity,the difference was not statistically significant.These findings suggest that brief passive activity may enhance the ability to initiate volitional muscle activity during surface electromyography tasks and underscore the potential of passive activity for improving residual motor control among patients with motor complete spinal cord injury.

Recent progress in N6-methyladenosine modification in ocular surface diseases

N6-methyladenosine(m6A)modification is a reversible process promoted by“writers”,inhibited by“erasers”,and processed by“readers”.During the last decade,increasing emphasis has been placed on the underlying roles of m6A modification owing to their great importance in biological significance.The abnormal regulation of m6A modification will lead to aberrant cellular behavior and various diseases.Recently,studies have demonstrated that m6A modification is closely associated with the genesis and progression of ocular surface diseases(OSDs).This review focus on the role of m6A modification and research progress in OSDs including fungal keratitis,herpes simplex keratitis,immunerelated keratoconjunctival diseases,pterygium,ocular chemical burns,and Graves’ophthalmopathy,which may provide new insights into and prospective applications for OSDs.

A narrative review of ocular surface disease considerations in the management of glaucoma

s from those searches were screened for relevance to our review topics.Publications were included if the subjects included glaucoma patients,and if ocular surface outcomes were described.Non-English papers were excluded.Key Content and Findings:Topical glaucoma medications frequently cause adverse effects on the ocular surface,both through direct action of the medications themselves as well as through toxicity from their associated preservatives.Optimization of the ocular surface may improve medication compliance rates.Traditional surgical treatments for glaucoma,such as trabeculectomy,can exacerbate OSD by disrupting the ocular surface but can also reduce the need for chronic medications.Optimization of ocular surface health is imperative in reducing trabeculectomy complication rates,while also potentially reducing the need for trabeculectomy in patients that are able to achieve intraocular pressure control through improved drop tolerability.The introduction of MIGS represents a promising alternative to existing therapies and has been shown to alleviate the overall medication burden.It would be reasonable to assume that decreasing the medication burden could reduce OSD prevalence and severity.However,more research is needed to directly assess the extent of improvement seen after MIGS.Conclusions:A comprehensive understanding of the importance of OSD in medical and surgical management of glaucoma is essential in optimizing patient care and improving outcomes.

The association between demodex infestation and ocular surface manifestations in meibomian gland dysfunction

AIM： To investigate the association between ocular demodex folliculorum infestation and ocular surface manifestations in meibomian gland dysfunction（MGD）.METHODS： Eight-six patients with MGD were enrolled. All enrolled subjects were tested in the following sequence： ocular surface disease index（OSDI）, slit-lamp biomicroscope examination, corneal surface regularity index（SRI） and surface asymmetry index（SAI）, tear fluid collection, fluorescein tear film break-up time（F-BUT）, corneal fluorescein staining（CFS）, Schirmer I test（SIT） and demodex folliculorum counting. Tear matrix metalloproteinase（MMP）-9 activity was assessed using MMP-9 activity assay kit.RESULTS： Among 86 MGD patients, 40 were positive for demodex. The ocular demodex-positive group showed significantly increased scores of OSDI（25.96±13.74 vs 18.07±11.55, P=0.01）, lid margin abnormality（2.38±0.87 vs 1.98±0.91, P=0.04） and CFS（1.28±2.00 vs 0.94±1.36, P=0.01） compared to the ocular demodex-free group. The tear MMP-9 activity was higher in the ocular demodex-positive group（102.9±32.4 ng/mL） than the ocular demodex-free group（46.2±19.2 ng/mL, P=0.03）. There was no significant difference in meibum quality and expressibility, SRI, SAI, F-BUT and SIT between the two groups（P〉0.05 for each）. No significant correlation was noted between the number of demodex and ocular surface parameters in demodexpositive MGD group（P〉0.05 for each）.CONCLUSION： Ocular demodex folliculorum infestation may be associated with ocular discomfort and ocular surface damage in MGD.

Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury

AIM: To elucidate the question of whether the ocular trauma score(OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment(RD) in patients with open globe injury(OGI).METHODS: A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS: Totally 102 patients with traumatic OGI with a minimum of 12 mo follow-up and a median age at of 48.6 y(range: 3-104 y) were identified. Final best corrected visual acuity(BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score Ⅰ(P<0.0001) or Ⅱ(P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >Ⅲ. OGI associated RD was observed in 36/102 patients(35.3%), whereas post traumatic RD(defined as RD following 14 d after OGI) occurred in 37 patients(36.3%). OGI associated RD did not correlate with the OTS and the zone of injury(P=0.193), yet post traumatic RD correlated significantly with zone Ⅲ injuries(P=0.013). CONCLUSION: The study shows a significant association between lower OTS score and zone Ⅲ injury with lower final BCVA and a higher number of surgeries, but only zone Ⅲ could be significantly associated with a higher rate of RD.

Early changes to dry eye and ocular surface after smallincision lenticule extraction for myopia

AIM： To investigate the early changes in dry eye symptoms, tear function and ocular surface following small-incision lenticule extraction（SMILE） for myopia.·METHODS： Ninety-seven consecutive patients（193 eyes）who underwent SMILE for myopia were observed in this longitudinal and retrospective study. Parameters evaluated included： subjective dry eye symptoms（dryness, foreign body sensation and photophobia）, tear film breakup time（TBUT）, Schirmer Ⅰ test without anesthesia（S Ⅰ T）, tear meniscus height（TMH） and corneal fluorescein staining. Each parameter was evaluated before, and subsequently at 1d, 1wk, 1 and3 mo after surgery.·RESULTS： Compared with preoperative data, dryness was noted to be significantly increased at 1wk and 1mo postoperatively（P 〈0.01）. Symptoms of photophobia and foreign body sensation demonstrated significant differences at 1d and 1wk as compared with preoperative scores respectively（P 〈0.01）. These values were decreased at 1 and 3mo post-surgery（P 〉0.05）.Conversely the corneal staining scores were higher than the preoperative data at 1d, 1wk and 1mo（P 〈0.01）, but were close to the preoperative level at 3mo postoperatively. There was a significant decrease in TMH at 1wk and 1mo（P 〈0.01）, but the value was close to the preoperative level at 3mo postoperatively（P =0.16）. The examination outcomes of S Ⅰ T were significantly increased at 1d then reduced at 1wk after surgery（P 〈0.01）. Each value subsequently returned to the baseline value at 1 and 3mo（P 〉0.05）. TBUT was significantly decreased at all postoperative time points（P 〈0.01）.· CONCLUSION： SMILE resulted in mild dry eye symptoms, tear film instability and ocular surface damages; however, these complications can recover in a short period of time.

Ocular injury resulting in eye removal at a large tertiary care center in China

AIM:To investigate the risk factors for eye removal following ocular trauma at a major ophthalmology department in China.METHODS:A retrospective study of patients who underwent eye removal surgery following ocular trauma was completed.Clinical outcomes were consulted in detail through the hospital’s computed medical data system.Patients’information including age,gender,cause of ocular trauma,affected eye,and education level was collected and recorded in a standardized database.Chi-squared test,Student’s t-test,Fisher’s exact test,and bivariate correlation analysis were used for statistical comparisons.RESULTS:The present study included 1675 removal eyes from 1674 patients over the 20-year period.Patients included 80.5%males and 19.5%females,with mean age of 38y.The majority of the patients(70.7%)were blue-collar workers(physical laborers),and 1098 patients(65.6%)did not receive high school education.Work-related injuries were the most common reason for eye removal(n=739,44.1%),of which 441 cases(59.7%)were related to metal/nail wounds.The most frequent injury type in males was work-related injuries(49.7%),whereas the most frequent injury type in females was home-related injuries(25.8%).CONCLUSION:Work-related injuries are a leading cause of severe ocular injury resulting in eye removal.In addition,men and undereducated patients are more likely to undergo eye removal surgery following ocular trauma.This study identified multiple high-risk factors leading to eye removal following ocular trauma,which is of great importance for preventing severe eye injuries.

Sutureless amniotic membrane transplantation following excision of ocular surface neoplasia

【正】Dear Sir,S uccess of surgical management of conjunctival neoplasias primarily depends on the complete excision of the mass and eradication of tumor cells from the ocular surface[1-3].Especially in cases that extensive resections are required,primary closure may not be feasible;so ocular surface reconstruction can be a challenging problem for the surgeons.For conjunctival tissue defects different surgical

Amniotic membrane transplantation with topical interferon alfa-2b after excision of ocular surface squamous neoplasia

To evaluate the outcome of amniotic membrane transplantation（AMT） after tumor excision followed by topical interferon alfa-2 b（IFNα2 b） drops for primary ocular surface squamous neoplasia（OSSN）. Twelve eyes of 12 patients with a mean age of 66±10 y were included. The average followup was 23±10 mo. All 12 patients had limbal involvement. Smooth ocular surface and transparent cornea were achieved in all cases. No sign of inflammation, neovascularization, symblepharon or recurrence was noted at the last follow-up. We conclude that AMT with topical IFNα2 b drops restores a healthy ocular surface in OSSN without recurrence.

Epidemiology of Child’s Ocular Globe Injury: A Retrospective Study at the University Teaching Hospital-Campus of Lomé(Togo)

Aim: To study clinical and epidemiological characteristics of child’s ocular injuries. Patients and Method: Retrospective study on medical records of children suffering from traumatic injuries of the ocular globe presented to the Campus Teaching Hospital (CHU Campus) of Lomé from 3 January 2015 to 30 June 2016 (18 months). Age, sex, nature of the traumatising agent, consultation delay and the width of the injury (zone I, II or III), the classification of ocular trauma, according to “Birmingham Eye Trauma Terminology (BETT) system”, connected lesions have been studied. Results: Twenty children about 46.51% children presented for ocular trauma have been suffering from a globe injury. The average age was 6.68 years with the extremes of 1 year and 12 years;the age bracket of 0 - 5 years was more represented (45%);predominance was more from the female with a sex-ratio = 0.67. Eighty percent of the children were from rural areas while twenty from urban areas. The delay of consultation was less than 24 hours in 40% of cases and 15% consulted between 24 h and 72 h after the trauma. Traumatisms were entirely unilateral and penetrating within a majority of 15 (75%) cases of which a “stick” is the traumatising agent of the most frequent (40%). The seat of the injury was the zone I (85.71%) and zone II (14.29%). Connected lesions were dominated by iris hernia 7 (35%) and traumatic cataract 6 (30%). Conclusion: children’s traumas were high predominantly and they came in majority from rural zones. Prevention through awareness remains the best treatment.

Effects of Near-surface Low Temperature on Freezing Injury of ‘Tunisian Soft-Seed’ Pomegranate

[Objective]The paper was to explore the influence of near-surface low temperature on cultivation of soft-seed pomegranate,and to provide guidance for planting location of soft-seed pomegranate.[Method]Taking 10 soft-seed pomegranate planting plots under different site conditions as the research objects,the near-surface low temperature of 45-50 cm was dynamically monitored from December 1,2018 to February 20,2019,and comparative analysis was made based on the local meteorological data over the same period.[Result]The near-surface low temperature of each temperature monitoring point was lower than the local meteorological data,which were all in the range of low temperature causing freezing in-jury of pomegranate trees,but the degree of freezing injury was different.The variation of near-surface low temperature was positively correlated with the altitude of terrain,but negatively correlated with the difference of topography and landform.When the local topography and landform were similar,the accumulation time of near-surface low temperature was negatively correlated with the altitude of terrain,while the duration of low tem-perature directly affected the degree of freezing injury.[Conclusion]The development of soft-seed pomegranate cultivation in Tunisia along Huang Mangling region in Henan Province refers to the local meteorological data.Meantime,it is also necessary to pay attention to the impact of regional microclimate environment,especially early monitoring of near-surface temperature to select suitable site and natural conditions.

Two-dimensional gel electrophoresis and surface-enhanced laser desorption ionization-time of flight-mass spectrometry for detection of protein expression profiles in the hippocampus following closed brain injury

Gene expression profile changes in brain regions following traumatic brain injury at the gene level cannot sufficiently elucidate gene expression time, expression amount, protein post-translational processing or modification. Therefore, it is necessary to quantitatively analyze the gene expression profile using proteomic techniques. In the present study, we established a rat model of closed brain injury using Marmarou＇s weight-drop device, and investigated hippocampal differential protein expression using two-dimensional gel electrophoresis and surface-enhanced laser desorption ionization-time of flight-mass spectrometry. A total of 364 protein peaks were detected on weak cation exchange-2 protein chips, including 37 differential protein peaks. 345 protein peaks were detected on immobilized metal affinity capture arrays-Cu, including 12 differential protein peaks Further examination of these differential proteins revealed that glucose-regulated protein and proteasome subunit alpha type 3 expression were significantly upregulated post-injury. These results indicate that brain injury can alter protein expression in the hippocampus, and that glucose-regulated protein and proteasome subunit alpha type 3 are closely associated with the occurrence and development of traumatic brain injury.