Glasgow Coma Scale, brain electric activity mapping and Glasgow Outcome Scale after hyperbaric oxygen treatment of severe brain injury

Objective: To study the effect of hyperbaric oxygen (HBO) treatment of severe brain injury. Methods: Fifty-five patients were divided into a treatment group (n=35 receiving HBO therapy) and a control group (n=20 receiving dehydrating, cortical steroid and antibiotic therapy) to observe the alteration of clinic GCS (Glasgow Coma Scale), brain electric activity mapping (BEAM), prognosis and GOS (Glasgow Outcome Scale) before and after hyperbaric oxygen treatment. Results: In the treatment group GCS,BEAM and GOS were improved obviously after 3 courses of treatment, GCS increased from 5.1 to 14.6 (P< 0.01- 0.001),the BEAM abnormal rate reduced from 94.3% to 38% (P< 0.01- 0.001),the GOS good-mild disability rate was 83.7%, and the middle-severe disability rate was 26.3% compared with the control group. There was a statistic significant difference between the two groups (P< 0.01- 0.001). Conclusions: Hyperbaric oxygen treatment could improve obviously GCS, BEAM and GOS of severe brain injury patients, and effectively reduce the mortality and morbidity. It is an effective method to treat severe brain injury.

Outcome assessment of stroke convalescence using multiple scales based on different dimensions

BACKGROUND: Convalescence is an important stage of stroke treatment. A lot of patients have somatic and mental disorders at various degrees. The primary standard can only reflect partial conditions of somatic disorder; in addition, multiple dimensions of patients at the phase of stroke convalescence are further observed by using a lot of standards, such as signs and symptoms of traditional Chinese medicine, daily activity and psychological status. OBJECTIVE: To analyze the outcome assessments of the cases of stroke convalescence measured with different criteria consisting of various dimensions by a cross-sectional investigation of the condition of stroke convalescent patients. DESIGN: Scale evaluation. SETTING: Departments of Clinical Epidemiology Exploratory Development and Neurology, the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine; National Center for Training of Design, Measurement and Evaluation in Clinical Research,Guangzhou University of Traditional Chinese Medicine. PARTICIPANTS: A total of 194 stroke convalescent patients treated in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from July 26, 2000 to February 28, 2001 were taken as subjects of the study. There were 126 males and 68 females aged from 40 to 89 years, and the illness course ranged from 14 to 181 days. All patients met diagnosis-treatment criteria of stroke (the second version)[DTCS(V2.0)] and various kinds of diagnostic points of cerebrovascular diseases; moreover, all patients provided confirmed consents. METHODS: They were assessed by assessment methods including the following assessment instruments: DTCS(V2.0), self-designed scale of traditional Chinese medicine (TCM) symptoms (28 symptoms and physical signs were scored as 0, 1, 2 marks from none to severity), modified Edinburgh-Scandinavia stroke scale (a total of 45 marks, 0 to 15 marks as mild defect, 16 to 30 as moderate defect, 31 to 45 as severe defect), modified Barthel activities of daily life (ADL) index (a total of 100 marks, less than 60 marks as unable self-care), vitality and mental health (subscales derived from Health Survey Questionnaire, SF-36). The collected data from scales and inter-scale correlation were processed by the statistic methods mainly including descriptive analysis, Spearmen correlation analysis, factor analysis, etc. MAIN OUTCOME MEASURES: ① Average scores of scales and criteria; ② correlation between modified Edinburgh-Scandinavia stroke scale and other scales. RESULTS: All of the patients completed the assessment, and analyzed in the final analysis. ① The average scores of the scales and criteria: The average scores of DTCS(V2.0), self-designed scale of TCM symptoms, modified Edinburgh-Scandinavia stroke scale, modified Barthel ADL index, vitality and mental health scales were 6.51±6.29, 13.73±6.97, 7.56±7.35, 63.58±23.68, 52.79±23.32 and 62.83±22.75 respectively. ② Correlation between modified Edinburgh-Scandinavia stroke scale and other scales: The Spearman correlation coefficients (R ’) of modified Edinburgh-Scandinavia stroke scale with diagnosis-treatment criteria of stroke, scales of TCM symptoms, modified Barthel ADL index, vitality scale and mental health scale were 20.885, 0.302, -0.824, -0.294 and -0.258 respectively. CONCLUSION: The modified Edinburgh-Scandinavia stroke scale and DTCS(V2.0) shared the same assessment dimension, so they can be mutually alternated in some clinical practices. Discrepancy in measurements of health status was gained due to the diverse dimensions applied in outcome assessments. It is necessary to build up a multi-dimensional assessment criteria system, such as signs and symptoms, daily activities and psychological status, for assessing the stroke convalescent cases in a more comprehensive scope and reflecting the efficacy of TCM treatment scientifically.

Gait and Glasgow Coma Scale scores can predict functional recovery in patients with traumatic brain injury

Fifty-one patients with mild （n -- 14）, moderate （n = 10） and severe traumatic brain injury （n = 27） received early rehabilitation. Level of consciousness was evaluated using the Glasgow Coma Score Functional level was determined using the Glasgow Outcome Score, whilst mobility was evaluated using the Mobility Scale for Acute Stroke. Activities of daily living were assessed using the Barthel Index. Following Bobath neurodevelopmental therapy, the level of consciousness was significantly improved in patients with moderate and severe traumatic brain injury, but was not greatly influenced in patients with mild traumatic brain injury. Mobility and functional level were significantly improved in patients with mild, moderate and severe traumatic brain injury. Gait recovery was more obvious in patients with mild traumatic brain injury than in patients with moderate and severe traumatic brain injury. Activities of daily living showed an improvement but this was insignificant except for patients with severe traumatic brain injury. Nevertheless, complete recovery was not acquired at discharge. Multiple regression analysis showed that gait and Glasgow Coma Scale scores can be considered predictors of functional outcomes following traumatic brain injury.

Outcomes of early physiotherapy in patients with cerebral aneurysms treated by surgical clipping or endovascular embolization

Early physiotherapy was given to 124 patients with ruptured or unruptured cerebral aneurysms who were treated by surgical clipping or endovascular embolization.Patients were divided into four groups according to their Hunt and Hess grade at admission and aneurysm treatment modality： Group 1,Hunt and Hess grade≤II and surgical clipping;Group 2,Hunt and Hess grade≤II and endovascular embolization;Group 3,Hunt and Hess grade≥III and surgical clipping;Group 4,Hunt and Hess grade≥III and endovascular embolization.Level of consciousness was evaluated using the Glasgow Coma Scale,functional status using the Glasgow Outcome Scale,level of the mobility using the Mobility Scale for acute stroke patients,and independence in activities of daily living using the Barthel Index.After early physiotherapy,the level of consciousness and functional status improved significantly in Groups 1,3,and 4;mobility improved significantly in all groups;and independence in activities of daily living improved significantly in Groups 1 and 3.At discharge, Groups 1 and 2 had better functional status than Groups 3 and 4.Level of consciousness,functional status,mobility and independence in activities of daily living improved after early physiotherapy. These findings suggest that early physiotherapy improved the prognosis of patients with cerebral aneurysms who were treated by surgical clipping or endovascular embolization.Patients with a worse clinical status at presentation had a poorer functional status at discharge.The outcome of physiotherapy was not affected by whether surgical clipping or endovascular embolization was chosen for treatment of the aneurysm.

Changes of Nitric Oxide and Its Relationship with Clinical Features,Intracranial Pressure and Outcome in Acute Head Injury

To investigate the content and dynamics of nitric oxide (NO) in the cerebrospinal fluid (CSF) of patients with acute head injury and to clarify the relationship of NO with clinical features and intracranial pressure (ICP) as well as outcomes, 38 adults with acute head injury were studied. Glasgow Coma Scale (GCS) obtained at admission and Glasgow Outcome Scale (GOS) 3 months after injury was assessed. ICP was surveyed via intraventricular catheter and lumbar puncture and CSF samples were obtained simultaneously. NO was determined with Griess reagents. Results showed that NO peak content in the head injury group was significantly higher than that of the control group. During dynamic research, no peak content of mildly injured cases and severely injured ones appeared in different time windows respectively. The peak value of NO was distinctly higher in the severe group than in the mild group. NO peak value of the raised ICP group was remarkably higher than that of the normal ICP group. The peak value of NO was considerately higher in the poor outcome group than in the good outcome group. When the content of NO was over 6. 5 μmol/L, the rate of poor outcome was increased. There existed a correlation between NO and GCS, ICP and GOS. It is concluded that the content of NO was increased in patients with acute head injury and the changes of NO had different time windows in severely injured patients and mildly injured ones. The more sever the injury, the higher the NO content; and the more serious the secondary brain injury and brain edema, the worse the outcomes. When NO is combined with GCS, GOS and ICP, it increases the accuracy of judgement to the degree of head injury and outcome.

Preliminary Report on Phenom^®Femoral Component in Total Hip Replacement: The Correlation between Outcome Scores in a Cross-Seccional Study

Background: The main purpose of the present study was to assess the short term performance of a cementless femoral stem in total hip replacement. Methods: Cross-sectional observational study of a 48-patient cohort with Phenom? femoral stems implanted between June 1, 2014 and September 1, 2018, to determine clinical performance, stability, and radiographic osseointegration. Patients were followed-up from 13 to 76 months (mean: 44.5 months) and assessed using the Harris Hip Score-HHS, the Hip Disability and Osteoarthritis Outcome Score-HOOS and radiographs. Results: All stems were radiologically stable. Mean Harris Hip Score was 89.8 and the HOOS was 80.4. No statistical differences were observed among patients with different diagnoses. Conclusions: The short-term results revealed satisfactory clinical outcomes and radiological signs of implant stability in all cases. Using two functional scores was useful in detecting biases and a low to moderate agreement was found between the scores.

Effects of Sevoflurane and Propofol on Neurological Recovery of Traumatic Brain Injury Patients in the Early Postoperative Stage: A Retrospective Cohort Study

Objective To investigate the effects of propofol and sevoflurane on neurological recovery of traumatic brain injury(TBI)patients in the early postoperative stage.Methods We retrospectively analyzed the clinical data of TBI patients who underwent craniotomy or decompressive craniectomy.Generalized additive mixed model(GAMM)was used to analyze effects of propofol and sevoflurane on Glasgow Coma Scale(GCS)on postoperative days 1,3,and 7.Multivariate regression analysis was used to analyze effects of the two anesthetics on Glasgow Outcome Scale(GOS)at discharge.Results A total of 340 TBI patients were enrolled in this study.There were 110 TBI patients who underwent craniotomy including 75 in the propofol group and 35 in the sevoflurane group,and 134 patients who underwent decompressive craniectomy including 63 in the propofol group and 71 in the sevoflurane group.It showed no significant difference in GCS at admission between the propofol and the sevoflurane groups among craniotomy patients(β=0.75,95%CI:-0.55 to 2.05,P=0.260).However,elevation in GCS from baseline was 1.73 points(95%CI:-2.81 to-0.66,P=0.002)less in the sevoflurane group than that in the propofol group on postoperative day 1,2.03 points(95%CI:-3.14 to-0.91,P 0.001)less on day 3,and 1.31 points(95%CI:-2.43 to-0.19,P=0.022)less on day 7.The risk of unfavorable GOS(GOS 1,2,and 3)at discharge was higher in the sevoflurane group(OR=4.93,95%CI:1.05 to 23.03,P=0.043).No significant difference was observed among two-group decompressive craniectomy patients in GCS and GOS.Conclusions Compared to propofol,sevoflurane was associated with worse neurological recovery during the hospital stay in TBI patients undergoing craniotomy.This difference was not detected in TBI patients undergoing decompressive craniectomy.

Effect of improving prehospital hypotension and hypoxemia on the prognosis of patients with traumatic brain injury

Objective:to investigate the effect of improving prehospital hypotension and hypoxemia on the prognosis of different subgroups of patients with traumatic brain injury(TBI).Methods:medical staff were trained about the prehospital first aid for 2 months to fully master the methods of improving prehospital hypotension and hypoxemia,then the prognosis of TBI patients pre-and post-training for 12 months was collected and recorded.The prognostic differences of different TBI subgroups were discussed through data analysis.Results:after the training,the proportion of prehospital hypotension and hypoxemia in TBI patients decreased by 77%(8.5%vs.1.9%)and 63%(9.9%vs.3.6%,P<0.05),respectively.However,only the prognosis of moderate and severe TBI patients was improved,the proportion of patients with"good prognosis^increased by 14%(61.4%vs.70.5%,respectively)and 62%(35.6%vs.58%),and no significant effect showed in mild and critical TBI patients.Conclusion:reducing the incidence of prehospital hypoxemia and hypotension can improve the prognosis of moderate and severe TBI patients,while no significant effect on mild and critical TBI patients.

Microscopic Anterior Callosotomy for Management of Intractable Epilepsy (Al-Azhar Experience)

Background: Anterior Corpus Callosotomy is a palliative treatment for drug-resistant generalized or multifocal epilepsy patients where focus excision is not an option for management. Callosotomy prevents propagation of epileptic discharge from one cerebral hemisphere to the other. Objective: To describe Al-Azhar University Hospitals experience and clinical outcome of Anterior Corpus Callosotomy for management of drug-resistant generalized epilepsy patients as an inexpensive palliative method. Patients and Methods: In this study, there are 15 patients admitted to Neurosurgery Department in Al-Azhar University Hospitals with drug-resistant generalized epilepsy. These patients were not candidates for lesionectomy. They were managed by anterior two thirds Corpus Callosotomy between February 2017 and December 2019. They were followed at outpatient clinic for at least 14 months. Clinical outcome regarding seizure control was assessed using Engel classification. Results: All 15 patients in this study underwent anterior two thirds corpus callosotomy and followed for at least 14 months. The post-operative improvement of seizure frequency has been evaluated using Engel outcome scale with 12 patients (80%) of the patients becoming Engel class II and 3 patients (20%) becoming Engel class III. Only 3 patients (20%) had minor transient postoperative complications;one patient (6.67%) had contra-lateral lower limb heaviness Grade 4 which was transient, one patient (6.67%) had contra-lateral lower limb Jacksonian focal fits and one patient (6.67%) had behavioral changes for one month. Conclusion: Corpus callosotomy is a palliative procedure and inexpensive method for management of patients with intractable focal with generalization and generalized drug-resistant epilepsy who are not suitable for resective surgery and with good outcome.

Comparison of the predictive value of the Helsinki,Rotterdam,and Stockholm CT scores in predicting 6-month outcomes in patients with blunt traumatic brain injuries

Purpose:Despite advances in modern medicine,traumatic brain injuries(TBIs)are still a major medical problem.Early diagnosis of TBI is crucial for clinical decision-making and prognosis.This study aims to compare the predictive value of Helsinki,Rotterdam,and Stockholm CT scores in predicting the 6-month outcomes in blunt TBI patients.Methods:This cohort study was conducted on blunt TBI patients of 15 years or older.All of them were admitted to the surgical emergency department of Shahid Beheshti Hospital in Kashan,Iran from 2020 to 2021 and had abnormal trauma-related findings on brain CT images.The patients’demographic data such as age,gender,history of comorbid conditions,mechanism of trauma,Glasgow coma scale,CT images,length of hospital stay,and surgical procedures were recorded.The Helsinki,Rotterdam,and Stockholm CT scores were simultaneously determined according to the existing guidelines.The included patients'6-month outcome was determined using the Glasgow outcome scale extended.M Data were analyzed by SPSS software version 16.0.Sensitivity,specificity,negative/positive predictive value and the area under the receiver operating characteristic curve were calculated for each test.The Kappa agreement coefficient and Kuder Richardson-20 were used to compare the scoring systems.Results:Altogether 171 TBI patients met the inclusion and exclusion criteria,with the mean age of(44.9±20.2)years.Most patients were male(80.7%),had traffic related injuries(83.1%)and mild TBIs(64.3%).Patients with lower Glasgow coma scale had higher Helsinki,Rotterdam,and Stockholm CT scores and lower Glasgow outcome scale extended scores.Among all the scoring systems,the Helsinki and Stockholm scores showed the highest agreement in predicting patients’outcomes(kappa=0.657,p<0.001).The Rotterdam scoring system had the highest sensitivity(90.1%)in predicting death of TBI patients,whereas the Helsinki scoring system had the highest sensitivity(89.8%)in predicting the 6-month outcome in TBI patients.Conclusion:The Rotterdam scoring system was superior in predicting death in TBI patients,whereas the Helsinki scoring system was more sensitive in predicting the 6-month outcome.

Application of revised trauma evaluation program in emergency treatment of multiple injuries

Recently, with the rapid development of highway ,and high-rise buildings, trauma shows a tendency to increase continuously. The proportion of trauma patients with multiple injuries has increased and trauma arising from multiple injuries has become ＂the first public hazard＂.