Study on difference between intravascular cooling system and traditional moderate hypothermia in patients with severe traumatic brain injury

Objective To study difference between intravascular cooling system and traditional moderate hypothermia in patients with severe traumatic brain injury. Methods Eighty sTBI patients were randomly divided into intravascular hypothermic groups (IVT) and traditional moderate hypothermia groups(HT) . Inclusion criteria included a Glasgow Coma Scale(GCS) score ≤8 and time from injury to admission must be within 12 hours.

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) 。

Effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury

To study the effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury (sTBI).Methods All 33 patients with sTBI(GCS≤8) were randomly divided into hypothermic group and control group.Microdialysis catheters were inserted into the cerebral cortex of perilesion,relative normal brain tissue and subcutaneous tissue of abdomen in order to analyze the concentrations of lactate/pyruvate (L/P),lactate/glucose (L/G) and the glycerol(Gly) in extracellular fluid (ECF).Results In comparison with the control group,the concentration of L/G,L/P and Gly in periphery and that of L/P in ECF of the “normal brain tissue” were significantly decreased in the hypothermic group.In control group,concentration of L/G,L/P and Gly in periphery were higher than those in relative normal brain.In the hypothermic group,L/P concentration in periphery was higher than that in relative normal brain.Conclusion Mild hypothermia protects brain by decreasing concentrations of L/G,L/P and Gly in periphery and L/P concentration in “normal brain tissue”.The energy crisis and membrane phospholipid breakage in periphery are easier to happen after TBI,where mild hypothermia exerts significant protgective role.12 refs,3 tabs.

Dynamic changes in peripheral blood-targeted miRNA expression profiles in patients with severe traumatic brain injury at high altitude

Background:The aim of this work is to detect and compare the peripheral blood mi RNA expression profiles in patients with severe traumatic brain injury(s TBI)2,12,24,48,and 72 h after injury at high altitude and to predict the target genes of differential expressed mi RNAs.Methods:Twenty s TBI patients from high-altitude areas were randomly selected according to the inclusion and exclusion criteria and were divided into five groups:the 2-h group,12-h group,24-h group,48-h group,and 72-h group.Peripheral blood mi RNA expression profiles were detected using real-time quantitative PCR(q RT-PCR).Results:The expression levels of mi R-18 a,mi R-203,mi R-146 a,mi R-149,mi R-23 b,and mi R-let-7 b in peripheral blood showed significant differences between the 2-h group and the 12-h group.The expression levels of mi R-203,mi R-146 a,mi R-149,mi R-23 b,and mi R-let-7 f in peripheral blood were up-regulated in the 24-h group.In the 48-h group,the expression levels of mi R-181 d,mi R-29 a,and mi R-18 b were upregulated.In the 72-h group,the expression levels of mi R-203,mi R-146 a,mi R-149,mi R-23 b,and mi R-let-7 f changed.The main target genes of the differentiation expressed mi RNAs were genes that regulate inflammatory responses,apoptosis,and DNA damage/repair.Conclusions:mi RNAs may be involved in the pathogenesis of s TBI by dynamically regulating the target genes that regulate inflammatory responses,apoptosis,and DNA damage/repair pathways.

Relationship of calcitonin gene-related peptide with disease progression and prognosis of patients with severe traumatic brain injury

Calcitonin gene-related peptide（CGRP） has been implicated in multiple functions across many bioprocesses; however, whether CGRP is associated with severe traumatic brain injury（TBI） remains poorly understood. In this study, 96 adult patients with TBI（enrolled from September 2015 to December 2016） were divided into a mild/moderate TBI group（36 males and 25 females, aged 38 ± 13 years） and severe TBI group（22 males and 13 females, aged 38 ± 11 years） according to Glasgow Coma Scale scores. In addition, 25 healthy individuals were selected as controls（15 males and 10 females, aged 39 ± 13 years）. Radioimmunoassay was used to detect serum levels of CGRP and endothelin-1 at admission and at 12, 24, 48, 72 hours, and 7 days after admission. CGRP levels were remarkably lower, but endothelin-1 levels were obviously higher in the severe TBI group compared with mild/moderate TBI and control groups. Levels of CGRP were remarkably lower, but endothelin-1 levels were obviously higher in deceased patients compared with patients who survived. Survival analysis and logistic regression showed that both CGRP and endothelin-1 levels were associated with patient mortality, with each serving as an independent risk factor for 6-month mortality of severe TBI patients. Moreover, TBI patients with lower serum CGRP levels had a higher risk of death. Thus, our retrospective analysis demonstrates the potential utility of CGRP as a new biomarker, monitoring method, and therapeutic target for TBI.

Clinical Effect of Intelligent Emergency Nursing Mode in Patients with Severe Traumatic Brain Injury

Objective: Severe traumatic brain injury (sTBI) is one of the common acute and critical diseases in neurosurgery. So we aim to explore the clinical effectiveness of an intelligent emergency care model in patients with severe traumatic brain injury. Methods: Eighty patients with severe traumatic brain injury (sTBI) who were treated in Zhuji People’s Hospital of Zhejiang Province from January 2019 to December 2021 were selected as the study subjects. The patients were divided into an observation group and a control group with 40 patients in each group according to the random number table method. Patients in the control group received conventional first-aid nursing mode intervention, and the intelligent emergency nursing mode was used for the observation group based on the control group. Comparisons were conducted between the two groups on the time of arrival to the emergency room, the time from the emergency room to the operating room, Glasgow Coma Scale (GCS) score before surgery, GCS score when leaving the Intensive Care Unit (ICU), the average length of ICU stay, the average length of hospital stay, the total hospital costs. Results: The time of arrival to the emergency room, the time from the emergency room to the operating room, the average length of ICU stay, the average length of hospital stay, and the total hospital costs in the observation group were significantly lower than those in the control group, and the differences were statistically significant (All P Conclusion: Intelligent emergency nursing mode can shorten the time of sTBI rescue, the length of ICU stay, and the average length of hospital stay, reduce the total hospitalization cost, improve the prognosis, with good efficacy, reduce the total cost of hospitalization, and improve the prognosis with better efficacy.

Prognostic Factors for Mortality in Severe Traumatic Brain Injury at HGZ 46, Villahermosa, Tabasco, Period from March 1, 2021 to December 31, 2022

Introduction: A traumatic brain injury (TBI) is caused by a forceful bump, blow, or jolt to the head or body, or by an object that pierces the skull and interrupts the normal function of the brain. Severe TBI is estimated at 73 cases per 100,000 people. The mortality of severe TBI can be reduced if a timely diagnosis and treatment of the injuries are made through prognostic factors. Objective: To determine the prognostic factors related to mortality in severe traumatic brain injury at the Hospital General de Zona No. 46. Material and Methods: Retrospective, cross-sectional and descriptive study in beneficiaries admitted to the Hospital General de Zona (HGZ) No. 46 of the Mexican Institute of Social Security (IMSS by its acronym in Spanish), with a diagnosis of severe TBI;the possible prognostic factors related to mortality of severe TBI were obtained from their records. Measures of central tendency and chi square were used for data analysis. Results: The study sample consisted of 60 subjects diagnosed with severe traumatic brain injury, of which 5 (8%) were women and 55 (92%) were men, and all 60 (100%) patients died. The average age of the sample was 26 with a standard deviation of 9 years. The variables that had a p value less than or equal to 0.05 were: Mydriasis, seizures, Hyperglycemia, Normoglycemia, Hypothermia and Hypotension. This means that these variables were associated with mortality. Conclusion: Statistical significance is demonstrated in prognostic factors of mortality in severe traumatic brain injury with p < 0.05 in the case of mydriasis, seizures, hyperglycemia, normoglycemia, hypothermia and hypotension.

Severe bilateral anterior cingulum injury in patients with mild traumatic brain injury

The cingulum,the neural tract connecting the orbitofrontal cortex with the medial temporal lobe,plays an important role in cognition（Bush et al.,2000）.It is also important in memory because it provides cholinergic innervations to the cerebral cortex after obtaining innervation from the medial septal nucleus,the vertical nucleus of the diagonal band, and the nucleus basalis of Meynert via the medial cholinergic pathway （Nieuwenhuys et al., 2008; Naidich and Duvernoy, 2009; Hong and Jang, 2010a）.

Early Enteral Combined with Parenteral Nutrition Treatment for Severe Traumatic Brain Injury:Effects on Immune Function,Nutritional Status and Outcomes

Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN)with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patientswith severe traumatic brain injury (STBI).Methods A prospective randomized control trial was carried out from January 2009 to May 2012 inNeurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow ComaScale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were administratedEN, PN or EN＋PN treatments respectively. The indexes of nutritional status, immune function,complications and clinical outcomes were examined and compared statistically.

Quantitative electroencephalography in predicting on outcome of awakening in long-term unconscious patients after severe traumatic brain injury

Objective To explore quantitative electroencephalography in unconscious patients after severe traumatic brain injury (TBI) to predict awakening. Methods All cases were divided into two groups(the awake group 19 cases and the unfavourable prognosis group 22 cases).Two weeks after admission the original EEGs were preformed in 41 patients suffering from severe TBI with duration of disturbance of

Clinical significance of large decompressive craniectomy to control intractable increased intracranial pressure in patients with traumatic brain injury

Objective To investigate the role of decompressive craniectomy (DC) to decrease intractable intracranial hypertension(ICH) due to diffuse brain swelling and / or cerebral edema after severe traumatic brain injury and the time window of DC to affect on prognosis. Methods The clinical record of 132 patients who underwent DC for posttraumatic intractable ICH in our hospital from July 2003 to

Differences in pathological changes between two rat models of severe traumatic brain injury

The rat high-impact free weight drop model mimics the diffuse axonal injury caused by severe traumatic brain injury in humans,while severe controlled cortical impact can produce a severe traumatic brain injury model using precise strike parameters.In this study,we compare the pathological mechanisms and pathological changes between two rat severe brain injury models to identify the similarities and differences.The severe controlled cortical impact model was produced by an electronic controlled cortical impact device,while the severe free weight drop model was produced by dropping a 500 g free weight from a height of 1.8 m through a plastic tube.Body temperature and mortality were recorded,and neurological deficits were assessed with the modified neurological severity score.Brain edema and bloodbrain barrier damage were evaluated by assessing brain water content and Evans blue extravasation.In addition,a cytokine array kit was used to detect inflammatory cytokines.Neuronal apoptosis in the brain and brainstem was quantified by immunofluorescence staining.Both the severe controlled cortical impact and severe free weight drop models exhibited significant neurological impairments and body temperature fluctuations.More severe motor dysfunction was observed in the severe controlled cortical impact model,while more severe cognitive dysfunction was observed in the severe free weight drop model.Brain edema,inflammatory cytokine changes and cortical neuronal apoptosis were more substantial and blood-brain barrier damage was more focal in the severe controlled cortical impact group compared with the severe free weight drop group.The severe free weight drop model presented with more significant apoptosis in the brainstem and diffused blood-brain barrier damage,with higher mortality and lower repeatability compared with the severe controlled cortical impact group.Severe brainstem damage was not found in the severe controlled cortical impact model.These results indicate that the severe controlled cortical impact model is relatively more stable,more reproducible,and shows obvious cerebral pathological changes at an earlier stage.Therefore,the severe controlled cortical impact model is likely more suitable for studies on severe focal traumatic brain injury,while the severe free weight drop model may be more apt for studies on diffuse axonal injury.All experimental procedures were approved by the Ethics Committee of Animal Experiments of Tianjin Medical University,China(approval No.IRB2012-028-02)in Febru ary 2012.

Recovery of injured cingulum in a patient with traumatic brain injury

The cingulum is the neural fiber bundle that connects the basal forebrain and medial temporal lobe. The cingulum contains the medial cholinergic pathway, which originates from the basalis nucleus of Meynert in the basal forebrain. Therefore, it is important for memory function （Malykhin et al., 2008; Hong and Jang, 2010）. In the past, identification of the cingulum on conventional brain MRI has been impossible because it cannot discern the cingulum from other adjacent structures. Diffusion tensor tractography （DTT）, derived from diffusion tensor imaging （DTI）, allows three-dimensional visualization and estimation of the cingulum （Malykhin et al., 2008）.

Sarcopenia diagnosed using masseter muscle area predictive of early mortality following severe traumatic brain injury

Traumatic brain injury（TBI）represents a global pandemic and is currently a leading cause of injury related death worldwide.Unfortunately,those who survive initial injury often suffer devastating functional,social,and economic consequences.

Epidemiological Analysis of 135 Cases of Severe Traumatic Brain Injury Managed at a Surgical Intensive Care Unit

This study was a retrospective analysis of the epidemiologic profile of severe traumatic brain injuries managed at the surgical intensive care unit of the University Hospital Center of Yaoundé, Cameroon, between January 2011 and December 2015. All the patients admitted at the surgical intensive care unit for a traumatic brain injury with an initial Glasgow coma scale score ≤ 8 were included. One hundred and thirty-five cases were enrolled. One hundred and fourteen were males and 21 were females. Their mean age was 32.75 years. Forty-four patients were aged between 16 to 30 years. Road traffic accidents represented the first mode of injury with 101 cases and most of the patients were pedestrians hit by a car. Pupils and students were the most involved. Twenty-three patients had additional extracranial injury. On admission, 97 (71.85%) patients had GCS 7-8. A brain CT scan was done for 115 patients. Intracranial and intracerebral hemorrhages were the most frequent radiological findings with 57 cases. The overall mortality was 32.59% with 44 deaths. Thirty-two of the deaths occurred in patients with GCS 7 - 8 on admission. Ninety-one (67.40%) patients survived, 74 (54.81%) had persisting disabilities, while only 17 (12.59%) recovered fully. The following factors had an impact on the outcome: GCS at admission, pupillary anomalies, length of hospital stay, endotracheal intubation and surgery. Severe TBI remains a heavy socio-economic burden worldwide. In Cameroon where the health system is poorly organized, the outcome of individuals who sustained a severe TBI was dismal.

Weak phonation due to unknown injury of the corticobulbar tract in a patient with mild traumatic brain injury: a diffusion tensor tractography study

In this study,we report on a patient who showed weak phonation following mild traumatic brain injury（TBI）,which was demonstrated by diffusion tensor tractography（DTT）.

Unusual neural tract between injured fornix and pedunculopontine nucleus in a patient with traumatic brain injury

It has been known that four cholinergic nuclei are located in the septal region and basal forebrain （Ch 1： medial septal nucleus, Ch 2： vertical nucleus of the diagonal band, Ch 3： horizontal limb of the diagonal band and Ch 4： nucleus basalis of Meynert） and two are located in the brainstem （Ch 5： pedunculopontine nucleus and Ch 6： laterodorsal tegmental nucleus） （Selden et al., 1998; Lucas-Meunier et al., 2003; Mesulam, 2004; Nieuwenhuys et al., 2007）. The fornix transfers information on episodic mem- ory between the medial diencephalon and the medial temporal lobe （Afifi and Bergman, 2005; Wolk and Budson, 2010）. The fornix is known to obtain cholinergic innervation from Ch 1 and Ch 2, and to project to the hippocampal formation （Selden et al., 1998; Lucas-Meunier et al., 2003; Mesulam, 2004; Nieu- wenhuys et al., 2007; Dere et al., 2008; Naidich and Duvernoy, 2009; Isaacson and Pribram, 2013）.

Appearance of a neural bypass between injured cingulum and brainstem cholinergic nuclei of a patient with traumatic brain injury on follow-up diffusion tensor tractography images

The human brain is known to contain a maximum of eight cholinergic nuclei： the basal forebrain region： the medial septal nucleus （Ch 1）, the vertical nucleus of the diagonal band （Ch 2）, the horizontal limb of the diago- nal band （Ch 3）, and the nucleus basalis of Meynert （Ch 4）; the brainstem： the pedunculopontine nucleus （Ch 5）, the laterodorsal tegmental nucleus （Ch 6）, and the para- bigeminal nucleus （Ch 8）; and the thalamus： the medial habenular nucleus （Ch 7） （Nieuwenhuys et al., 2008; Naidich and Duvernoy, 2009）. The cingulum is the neu- ral tract extending from the orbitofrontal cortex to the medial temporal lobe （Mufson and Pandya, 1984）. The cingulum plays an important role in memory because it is a passage of the medial cholinergic pathway, which pro- vides cholinergic innervations to the cerebral cortex after originating from Ch 1 and Ch 2 as well as Ch 4 （mainly） （Selden et al., 1998; Nieuwenhuys et al., 2008; Hong and lang, 2010）.

Effects of hyperbaric oxygen treatment on GCS after traumatic brain injury in patients

Objective To evaluate the effects of hyperbaric oxygen therapy (HBOT) on Glasgow Coma Scale (GCC) after traumatic brain injury (TBI) in patients. Methods One hundred and thirty-eight patients with traumatic brain injury were treated by routine therapy combined with HBOT and 29 patients by routine therapy.

Electroencephalogram and evoked potential parameters examined in Chinese mild head injury patients for forensic medicine

Objective To evaluate the usefulness of quantitative electroencephalogram （QEEG）, flash visual evoked potential （F-VEP） and auditory brainstem responses （ABR） as indicators of general neurological status. Methods Comparison was conducted on healthy controls （N=30） and patients with brain concussion （N=60） within 24 h after traumatic brain injury. Follow-up study of patient group was completed with the same standard paradigm 3 months later. All participants were recorded in multi-modality related potential testing in both early and late concussion at the same clinical setting. Glasgow coma scale, CT scanning, and physical examinations of neuro-psychological function, optic and auditory nervous system were performed before electroencephalogram （EEG） and evoked potential （EEG-EP） testing. Any participants showed abnormal changes of clinical examinations were excluded from the study. Average power of frequency spectrum and power ratios were selected for QEEG testing, and latency and amplitude of F-VEP and ABR were recorded. Results Between patients and normal controls, the results indicated： （1） Highly significance （P 〈 0.01） in average power of α1 and power ratios of θ/α1, 0/α2, α1/α2 of EEG recording; （2） N70-P 100 amplitude of F-VEP in significant difference at early brain concussion; and （3） apparent prolongation of Ⅰ～Ⅲ inter-peak latency of ABR appeared in some individuals at early stage after concussion. The follow-up study showed that some patients with concussion were also afflicted with characteristic changes of EEG components for both increments of α1 average power and θ/α2 power ratio after 3 months recording. Conclusion EEG testing has been shown to be more effective and sensitive than evoked potential tests alone on detecting functional state of patients with mild traumatic brain injury （MTBI）. Increments of α1 average power and θ/α2 power ratio are the sensitive EEG parameters to determining early concussion and evaluating outcome of postconcussion symptoms （PCS）. Follow-up study associated with persistent PCS may be consistent with the postulate of substantial biological, rather than psychological origin. The study suggests that combination of EEG and EP parameters can contribute to the evaluation of brain function as a whole for clinical and forensic applications.