Dear Editor,Coma, the vegetative state （VS）, and the minimally- conscious state （MCS）, often collectively referred to as disorders of consciousness （DOCs）, typically occur after severe traumatic or non-traumatic...Dear Editor,Coma, the vegetative state （VS）, and the minimally- conscious state （MCS）, often collectively referred to as disorders of consciousness （DOCs）, typically occur after severe traumatic or non-traumatic brain injury [1]. The boundary between awareness and unawareness remains elusive, making it difficult to correctly distinguish MCS from VS patients. It is possible to employ noninvasive neuroimaging techniques, such as functional MRI （fMRI） [2] to assess residual cognitive processing as well as consciousness. However, the causal link between neural activity in specific brain areas and specific behavioral tasks is hard to dissect using fMRI [3]. Therefore, detecting residual cognitive function and consciousness in patients surviving severe brain injury remains extremely challenging.展开更多
BACKGROUND Recent innovations in intensive care have improved the prognosis of patients with severe brain injuries and brought more patients with disorders of consciousness(DoC).Data are lacking regarding the long-ter...BACKGROUND Recent innovations in intensive care have improved the prognosis of patients with severe brain injuries and brought more patients with disorders of consciousness(DoC).Data are lacking regarding the long-term outcomes of those patients in China.It is necessary to study the long-term outcomes of patients with prolonged DoC in light of many factors likely to influence crucial decisions about their care and their life.AIM To present the preliminary results of a DoC cohort.METHODS This was a two-center prospective cohort study of inpatients with vegetative state(VS)/unresponsive wakefulness syndrome(UWS).The study outcomes were the recovery from VS/UWS to minimally conscious state(MCS)and the long-term status of patients with prolonged DoC considered in VS/UWS or MCS for up to 6 years.The patients were evaluated using the Glasgow coma scale,coma recovery scale-revised,and Glasgow outcome scale.The endpoint of follow-up was recovery of full consciousness or death.The changes in the primary clinical outcome improvement in clinical diagnosis were evaluated at 12 mo compared with baseline.RESULTS The study population included 93 patients(62 VS/UWS and 31 MCS).The postinjury interval range was 28-634 d.Median follow-up was 20 mo(interquartile range,12-37 mo).At the endpoint,33 transitioned to an emergence from MCS or full consciousness,eight had a locked-in syndrome,and there were 35 patients remaining in a VS/UWS and 11 in an MCS.Seven(including one locked-in syndrome)patients(7.5%)died within 12 mo of injury.Compared with the unresponsive group(n=52)at 12 mo,the responsive group(n=41)had a higher proportion of males(87.8%vs 63.5%,P=0.008),shorter time from injury(median,40.0 d vs 65.5 d,P=0.006),higher frequency of vascular etiology(68.3%vs 38.5%,P=0.007),higher Glasgow coma scale score at admission(median,9 vs 6,P<0.001),higher coma recovery scale-revised score at admission(median,9 vs 2.5,P<0.001),at 1 mo(median,14 vs 5,P<0.001),and at 3 mo(median,20 vs 6,P<0.001),lower frequency of VS/UWS(36.6%vs 90.0%,P<0.001),and more favorable Glasgow outcome scale outcome(P<0.001).CONCLUSION Patients with severe DoC,despite having strong predictors of poor prognosis,might recover consciousness after a prolonged time of rehabilitation.An accurate initial diagnosis of patients with DoC is critical for predicting outcome and a long-term regular follow-up is also important.展开更多
In the cruise, MR15-04 by R/V MIRAI, the samplings by the neuston net were performed in 23rd November to 14th December 2016 and three species of Halobates (H. germanus, H. micans, H. sp) were used for the temperature ...In the cruise, MR15-04 by R/V MIRAI, the samplings by the neuston net were performed in 23rd November to 14th December 2016 and three species of Halobates (H. germanus, H. micans, H. sp) were used for the temperature tolerance experiments after the collection. The neuston net was towed three times (3 × 15 min) on the starboard side of R/V MIRAI on the water surface with ship speed of 2 knot to water every 3 nights (19:00 - 20:00) at the fixed point in the south-western direction which was located at 50 km from the Sumatra island (4o03'S - 4o05'S, 101o53'E) in the Indonesia. Experiments on cool coma and heat coma were performed on the three species. Seconds for recovery from cool coma and heat coma were also examined on the Halobates in this study. Cool coma temperatures, gap temperature needed (temperature from the adapted temperature) for the cool coma and seconds for the recover from cool coma ranged 13.0oC to 25.0oC, 3.1oC to 16.1oC, 1 second to 4370 seconds, respectively. Heat coma temperature, gap temperature needed for the heat coma, seconds for the recover from heat coma ranged 29.4oC to 43.1oC, 1.9oC to 15.5oC, 2 seconds to 6420 seconds, respectively. The higher temperature of cool coma temperature during the last five days was shown when Madden-Julian Oscillation has passed over the ship, R/V MIRAI than the previous 10 days in the adults of H. germanus collected at the fixed place neat to Sumatra island (One way ANOVA: F-value = 2.314, df = 7, p = 0.028). Adults of un-described species, H. sp collected near to the Sumatra island, showed lower cool coma temperature [Mean ± SD: 15.51 ± 3.76 (9)] than those of H. germanus collected in the same place [16.96 ± 2.57 (191)]. This lower cool coma temperatures shown by this un-described species might be related to that this species should be a “shore” species inhabiting shore water in which many precipitation could cause the decreased surface temperature from 30oC - 31oC into about 25oC. Most of adults which suffered from the cool coma recovered within 20 seconds, whereas adults which suffered heat coma at 38oC and 39oC needed more than 200 seconds for the recovery and many of those which did it at more than 40oC needed more than 1000 second and some ones did not recover at all. All adults who suffered at more than 43oC did not recover at all. There were significant and negative correlation between cool and heat coma temperatures shown by the adults of H. germanus. This correlation might imply a common physiological mechanism for lower and higher temperature tolerances for this species.展开更多
Auditory stimuli are proposed as beneficial neurorehabilitation methods in patients with disorders of consciousness. However, precise and accurate quantitative indices to estimate their potential effect remain scarce....Auditory stimuli are proposed as beneficial neurorehabilitation methods in patients with disorders of consciousness. However, precise and accurate quantitative indices to estimate their potential effect remain scarce. Fourteen patients were recruited from the Neuro-Rehabilitation Unit of Hangzhou Hospital of Zhejiang Armed Police Corps of China. Altogether, there were seven cases of unresponsive wakefulness syndrome（five males and two females, aged 45.7 ± 16.8 years） and seven cases of minimally conscious state（six males and one female, aged 42.3 ± 20.8 years）. Simultaneously, fourteen healthy controls（10 males and 4 females, aged 51.7 ± 9.7 years） also participated in this case-control experiment. Brain response to music, subjects＇ own name, and noise was monitored by quantitative electroencephalography（QEEG） in the resting state and with acoustic stimulation. Predictive QEEG values in various brain regions were investigated. Our results show that cerebral activation was high in subjects stimulated by their own name, especially in the temporal lobe in patients with disorders of consciousness, and the frontal lobe in the control group. Further, during resting and stimulation, QEEG index（δ ＋ θ/α ＋ β ratio） negatively correlated with the Coma Recovery Scale-Revised score in traumatic disorders of consciousness patients. Hence, we speculate that a subject＇s own name might be an effective awakening therapy for patients with disorders of consciousness. Moreover, QEEG index in specific stimulation states may be used as a prognostic indicator for disorders of consciousness patients（sensitivity, 75%; specificity, 50%）.展开更多
基金supported by the Guangdong Provincial Natural Science Foundation(2015A030313609)the Guangzhou Municipal Project for Science and Technology Foundation(201508020253)
文摘Dear Editor,Coma, the vegetative state （VS）, and the minimally- conscious state （MCS）, often collectively referred to as disorders of consciousness （DOCs）, typically occur after severe traumatic or non-traumatic brain injury [1]. The boundary between awareness and unawareness remains elusive, making it difficult to correctly distinguish MCS from VS patients. It is possible to employ noninvasive neuroimaging techniques, such as functional MRI （fMRI） [2] to assess residual cognitive processing as well as consciousness. However, the causal link between neural activity in specific brain areas and specific behavioral tasks is hard to dissect using fMRI [3]. Therefore, detecting residual cognitive function and consciousness in patients surviving severe brain injury remains extremely challenging.
基金Supported by the National Natural Science Foundation of China,No.81371194 and No.81873723.
文摘BACKGROUND Recent innovations in intensive care have improved the prognosis of patients with severe brain injuries and brought more patients with disorders of consciousness(DoC).Data are lacking regarding the long-term outcomes of those patients in China.It is necessary to study the long-term outcomes of patients with prolonged DoC in light of many factors likely to influence crucial decisions about their care and their life.AIM To present the preliminary results of a DoC cohort.METHODS This was a two-center prospective cohort study of inpatients with vegetative state(VS)/unresponsive wakefulness syndrome(UWS).The study outcomes were the recovery from VS/UWS to minimally conscious state(MCS)and the long-term status of patients with prolonged DoC considered in VS/UWS or MCS for up to 6 years.The patients were evaluated using the Glasgow coma scale,coma recovery scale-revised,and Glasgow outcome scale.The endpoint of follow-up was recovery of full consciousness or death.The changes in the primary clinical outcome improvement in clinical diagnosis were evaluated at 12 mo compared with baseline.RESULTS The study population included 93 patients(62 VS/UWS and 31 MCS).The postinjury interval range was 28-634 d.Median follow-up was 20 mo(interquartile range,12-37 mo).At the endpoint,33 transitioned to an emergence from MCS or full consciousness,eight had a locked-in syndrome,and there were 35 patients remaining in a VS/UWS and 11 in an MCS.Seven(including one locked-in syndrome)patients(7.5%)died within 12 mo of injury.Compared with the unresponsive group(n=52)at 12 mo,the responsive group(n=41)had a higher proportion of males(87.8%vs 63.5%,P=0.008),shorter time from injury(median,40.0 d vs 65.5 d,P=0.006),higher frequency of vascular etiology(68.3%vs 38.5%,P=0.007),higher Glasgow coma scale score at admission(median,9 vs 6,P<0.001),higher coma recovery scale-revised score at admission(median,9 vs 2.5,P<0.001),at 1 mo(median,14 vs 5,P<0.001),and at 3 mo(median,20 vs 6,P<0.001),lower frequency of VS/UWS(36.6%vs 90.0%,P<0.001),and more favorable Glasgow outcome scale outcome(P<0.001).CONCLUSION Patients with severe DoC,despite having strong predictors of poor prognosis,might recover consciousness after a prolonged time of rehabilitation.An accurate initial diagnosis of patients with DoC is critical for predicting outcome and a long-term regular follow-up is also important.
文摘In the cruise, MR15-04 by R/V MIRAI, the samplings by the neuston net were performed in 23rd November to 14th December 2016 and three species of Halobates (H. germanus, H. micans, H. sp) were used for the temperature tolerance experiments after the collection. The neuston net was towed three times (3 × 15 min) on the starboard side of R/V MIRAI on the water surface with ship speed of 2 knot to water every 3 nights (19:00 - 20:00) at the fixed point in the south-western direction which was located at 50 km from the Sumatra island (4o03'S - 4o05'S, 101o53'E) in the Indonesia. Experiments on cool coma and heat coma were performed on the three species. Seconds for recovery from cool coma and heat coma were also examined on the Halobates in this study. Cool coma temperatures, gap temperature needed (temperature from the adapted temperature) for the cool coma and seconds for the recover from cool coma ranged 13.0oC to 25.0oC, 3.1oC to 16.1oC, 1 second to 4370 seconds, respectively. Heat coma temperature, gap temperature needed for the heat coma, seconds for the recover from heat coma ranged 29.4oC to 43.1oC, 1.9oC to 15.5oC, 2 seconds to 6420 seconds, respectively. The higher temperature of cool coma temperature during the last five days was shown when Madden-Julian Oscillation has passed over the ship, R/V MIRAI than the previous 10 days in the adults of H. germanus collected at the fixed place neat to Sumatra island (One way ANOVA: F-value = 2.314, df = 7, p = 0.028). Adults of un-described species, H. sp collected near to the Sumatra island, showed lower cool coma temperature [Mean ± SD: 15.51 ± 3.76 (9)] than those of H. germanus collected in the same place [16.96 ± 2.57 (191)]. This lower cool coma temperatures shown by this un-described species might be related to that this species should be a “shore” species inhabiting shore water in which many precipitation could cause the decreased surface temperature from 30oC - 31oC into about 25oC. Most of adults which suffered from the cool coma recovered within 20 seconds, whereas adults which suffered heat coma at 38oC and 39oC needed more than 200 seconds for the recovery and many of those which did it at more than 40oC needed more than 1000 second and some ones did not recover at all. All adults who suffered at more than 43oC did not recover at all. There were significant and negative correlation between cool and heat coma temperatures shown by the adults of H. germanus. This correlation might imply a common physiological mechanism for lower and higher temperature tolerances for this species.
基金supported by grants from the General Project Plan of Zhejiang Medical Technology of China,No.2014RCA007the Medical Science and Technology Project Co-founded by Zhejiang Province and the Ministry of Health of China,No.2016152769
文摘Auditory stimuli are proposed as beneficial neurorehabilitation methods in patients with disorders of consciousness. However, precise and accurate quantitative indices to estimate their potential effect remain scarce. Fourteen patients were recruited from the Neuro-Rehabilitation Unit of Hangzhou Hospital of Zhejiang Armed Police Corps of China. Altogether, there were seven cases of unresponsive wakefulness syndrome（five males and two females, aged 45.7 ± 16.8 years） and seven cases of minimally conscious state（six males and one female, aged 42.3 ± 20.8 years）. Simultaneously, fourteen healthy controls（10 males and 4 females, aged 51.7 ± 9.7 years） also participated in this case-control experiment. Brain response to music, subjects＇ own name, and noise was monitored by quantitative electroencephalography（QEEG） in the resting state and with acoustic stimulation. Predictive QEEG values in various brain regions were investigated. Our results show that cerebral activation was high in subjects stimulated by their own name, especially in the temporal lobe in patients with disorders of consciousness, and the frontal lobe in the control group. Further, during resting and stimulation, QEEG index（δ ＋ θ/α ＋ β ratio） negatively correlated with the Coma Recovery Scale-Revised score in traumatic disorders of consciousness patients. Hence, we speculate that a subject＇s own name might be an effective awakening therapy for patients with disorders of consciousness. Moreover, QEEG index in specific stimulation states may be used as a prognostic indicator for disorders of consciousness patients（sensitivity, 75%; specificity, 50%）.
