Establishment of a blunt impact-induced brain injury model in rabbits

Objective: To establish an animal model to replicate the blunt impact brain injury in forensic medicine.Methods:Twenty-four New Zealand white rabbits were randomly divided into control group (n=4),mino...     

Effect of mild head injury on intelligence in Zahedan, Iran

Objective： To investigate the effects of mild head injury （HI） on the victims＇ intelligence by measuring their intelligence quotient （IQ）.Methods： This cohort study was performed in Khatamol-Anbia Hospital, Zahedan, Iran and the IQs of 30 mild HI patients were measured right after the injury （IQ0） and six months later （IQ6）. The IQs of 90 close relatives of the patients were also measured at the same period of time as the non-exposure group. The IQs were measured with Wechsler adult intelligence scale-revised （WAIS-R）. The IQ0, IQ6 and their differences （IQ change） were compared in HI patients and their relatives using the Student＇s t test.Results： The mean IQ0 of the HI patients was similar to their relatives. The IQ6 of HI patients appeared to be less than those of their relatives. Moreover, the IQ6 of the HI patients appeared to be less than their initial scores. HI was associated with more decrease in IQ6 compared with IQ0and the female subjects showed more decrease in IQ6 compared with their IQ0.Conclusion： HI seems to be associated with decrease in IQ six months after the injury and it is more evident in female HI patients.     

Severe head injury combined with orthopedic and vascular trauma of the limbs

From 1982 to 1992, 2766 brain injury patients were admitted to the University Hospital San Cecilio of Granada, Spain. In 873 cases head injury was concomitant with other injuries but the association of severe head injury and combined orthopedic and vascular trauma of the limbs was observed only in 23 cases (incidence 2%). Thirteen patients were scheduled for revascularization, and of these secondary amputation was mandatory in two cases to keep rising intracranial pressure under control. Except for epidural hematomas which constitute an absolute neurosurgical emergency, combined orthopedic and vascular trauma of the limbs can be treated before head injury. However, we prefer to work with two operating teams simultaneously. Physical examination and judicious arteriography provide means for prompt diagnosis and treatment of the injured limb. The compartment syndrome should be anticipated and fasciotomy should be used routinely. Vascular repairs normally using reverse autogenous vein are the first priority, but we must always bear in mind the deleterious effects of the revascularization syndrome which expose the brain to a second aggression, and amputation, when necessary, should be undertaken to reduce mortality. Received: 24 July 1997     

Curative effect of wilsonii injecta on severe head injury

OBJECTIVE: To study the curative effect of wilsonii injecta on severe head injury (SHI). METHODS: A total of 120 patients with SHI were divided randomly into 2 groups, the patients treated with conventional methods as Group A (n=60) and the patients treated with wilsonii injecta as Group B (n=60). The changes of neural function indexes were evaluated with Glasgow Coma Scale (GCS) before treatment and with Glasgow Outcome Scale (GOS) after treatment, simultaneously, the parameters of hemorrheological indexes (HI), brain electrical activity map (BEAM) and transcranial Doppler sonography (TCD) were observed before and after treatment. RESULTS: In Group B, the clinical GCS, the HI, the BEAM and the prognosis GOS were improved much more than those in Group A. And the TCD parameters in Group B decreased, which had significant difference compared with that in Group A (P<0.01). CONCLUSIONS: Wilsonii injecta can rapidly improve the injured p ersons' conscious states, the abnormal BEAM and the surviving quality. It suggests that the improvement of the HI is related to the relief of the vasospasm of the arterial blood vessels in the brain, which may be one of the important mechanisms of wilsonii injecta in improving the prognosis.     

Syndrome of inappropriate secretion of antidiuretic hormone after severe head injury

This study is based on 109 patients with severe head injury who had a Glasgow coma score equal to or less than 7 and a Liège coma score equal to or less than 12 in the first 24 hours. The syndrome of inappropriate secretion of antidiuretic hormone seems to us to be a frequent complication of severe craniocerebral trauma. It has been discovered in 33% of our patients. On the other hand, diabetes insipidus was rarely diagnosed (2.8%). We propose, in cranial trauma, to subdivide the syndrome of inappropriate secretion of antidiuretic hormone into two clinical forms: an early syndrome (5%) that becomes apparent towards the second day and is significantly associated with lesions at the base of the skull; and a delayed syndrome that occurs at the end of the first week and is related to different factors inherent in intensive care procedures. Surgical intervention, in the case of acute craniocerebral trauma, does not result in a higher frequency of inappropriate secretion of antidiuretic hormone.     

A rabbit model of graded primary mechanical injury to brainstem

ObjectiveTo introduce a new animal model of graded mechanical primary brainstem injury (BSI).MethodsAltogether 45 rabbits were subjected to BSI by type II biological impact machine designed by the Third Military Medical University. The animals were divided into 4 experimental groups (n=10) and 1 control group (n=5) according to different magnitudes of impact pressure imposed on the occipital nodule: Group 1, 500-520 kPa; Group 2, 520540 kPa; Group 3, 540-560 kPa; Group 4, 560-580 kPa and Group 5, 0 kPa with 20 kPa increase in each grade. The impact depth was a constant 0.5 cm. After injury, the clinical symptoms and signs as well as pathological changes were observed.ResultsRabbits in Group 1 revealed mild physiological reaction of BSI. They had localized cerebral contusion with punctate hemorrhage and subarachnoid hemorrhage (SAH) was limited to the peripheral tissues at the impact area. In Group 2, obvious physiological reaction was observed. Local pathological lesions reached the superficial layer of brainstem tissues; focal hemorrhage and girdle-shaped SAH in basilar pon were observed under microscope. In Group 3, BSI was more severe with a long respiratory depression. Pathological lesions reached the inner portion of brainstem with massive hemorrhage and the whole brainstem was wrapped by subarachnoid hematoma. In Group 4, most rabbits died due to severe BSI. Pathological lesions deepened to the central brainstem with wide pathological change, rapture of the medulla oblongata central canal. Group 5 was the control group, with normal brainstem structure and no lesion observed.ConclusionThis model successfully simulates different levels of brainstem mechanical injury and clearly shows the subsequent pathological changes following injury. It takes two external parameters (impact pressure and depth) and has a similar injury mechanism to clinical accelerating BSI. Moreover it is reproducible and stable, thus being beneficial for exploring pathophysiological mechanism, diagnosis and forensic identification of various degrees of BSI.     

Acute traumatic coagulopathy in the setting of isolated traumatic brain injury: A systematic review and meta-analysis

Background and objectives

Acute traumatic coagulopathy (ATC) has been reported in the setting of isolated traumatic brain injury (iTBI) and associated with high mortality and poor outcomes. The aim of this systematic review was to examine the incidence and outcome of patients with ATC in the setting of iTBI.

Methods

We conducted a search of the MEDLINE database and Cochrane library, focused on subject headings and keywords involving coagulopathy and TBI. Design and results of each study were described. Studies were assessed for heterogeneity and the pooled incidence of ATC in the setting of iTBI determined. Reported outcomes were described.

Results

There were 22 studies selected for analysis. A statistically significant heterogeneity among the studies was observed (p < 0.01). Using the random effects model the pooled proportion of patients with ATC in the setting of iTBI was 35.2% (95% CI: 29.0–41.4). Mortality of patients with ATC and iTBI ranged between 17% and 86%. Higher blood transfusion rates, longer hospital stays, longer ICU stays, decreased ventilator free days, higher rates of single and multiple organ failure and higher incidence of delayed injury and disability at discharge were reported among patients with ATC.

Conclusions

ATC is commonly associated with iTBI and almost uniformly associated with worse outcomes. Any disorder of coagulation above the normal range appears to be associated with worse outcomes and therefore a clinically important target for management. Earlier identification of patients with ATC and iTBI, for recruitment into prospective trials, presents avenues for further research.     

The influence of traumatic subarachnoid hemorrhage on prognosis of head injury

OBJECTIVE: To study the influence of traumatic subarachnoid hemorrhage on secondary intracranial damage in GCS 13-15 head injuries and prognosis. METHODS: One hundred and twenty-eight patients with mild head injury, including 64 with subarachnoid hemorrhage and 64 without subarachnoid hemorrhage, were selected and analyzed according to the changes of their conditions after injury. RESULTS: Intracranial abnormality was found in 14 patients (21.87%) with subarachnoid hemorrhage and only in 4 patients (6.25%) without subarachnoid hemorrhage (P<0.01). In the 14 patients, 4 were given surgical treatment. Mild disability was in 2 patients and 2 completely recovered. The rest were conservatively treated and achieved complete recovery at last. CONCLUSIONS: Traumatic subarachnoid hemorrhage, as a factor of intracranial complications in mild head injury should be given much attention. Early drainage of bloody cerebrospinal fluid by lumbar puncture is an effective method for prevention and treatment of complications in mild head injury.     

Effects of nimodipine on changes of endothelin after head injury in rabbits

ＩＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ ,ＤａｐｉｎｇＨｏｓｐｉｔａｌ ,ＴｈｉｒｄＭｉｌｉｔａｒｙＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ ,Ｃｈｏｎｇｑｉｎｇ 40 0 0 42 ,Ｃｈｉｎａ (ＳｈｅｎＧＪ ,ＺｈｏｕＹＷ ,ＸｕＭＨ ,ＬｉｕＢＳａｎｄＸｕＹＱ)ｔｉｓｒｅｐｏｒｔｅｄｔｈａｔｅｎｄｏｔｈｅｌｉｎｉｓｉｎｖｏｌｖｅｄｉｎｔｈｅｐａｔｈｏｌｏｇｉｃａｌｐｒｏｃｅｓｓｏｆｂｒａｉｎｄａｍａｇｅａｆｔｅｒｈｅａｄｉｎｊｕｒｙ .Ｔｏｓｅａｒｃｈｆｏｒｔｈｅｐｒａｃｔｉｃａｌｅｎｄｏｔｈｅｌｉｎａｎｔａ…     

The management of trauma victims with head injury: a study by the national confidential enquiry into patient outcome and death

Introduction

In 2006 the National Confidential Enquiry into Patient Outcome and Death undertook a large prospective study of trauma care, which revealed several findings pertaining to the management of head injuries in a sample of 493 patients.

Methods

Case note data were collected for all trauma patients admitted to all hospitals accepting emergencies in England, Wales, Northern Ireland and the Channel Islands over a three-month period. Severely injured patients with an injury severity score (ISS) of ≥16 were included in the study. The case notes for these patients were peer reviewed by a multidisciplinary group of clinicians, who rated the overall level of care the patient received.

Results

Of the 795 patients who met the inclusion criteria for the study, 493 were admitted with a head injury. Room for improvement in the level of care was found in a substantial number of patients (265/493). Good practice was found to be highest in high volume centres. The overall head injury management was found to be satisfactory in 84% of cases (319/381).

Conclusions

This study has shown that care for trauma patients with head injury is frequently rated as less than good and suggests potential long-term remedies for the problem, including a reconfiguration of trauma services and better provision of neurocritical care facilities.     

Effect of mild hypothermia on partial pressure of oxygen in brain tissue and brain temperature in patients with severe head injury

OBJECTIVE: To study the changes of partial pressure of oxygen in brain tissue (P(bt)O(2)) and brain temperature (BT) in patient s in acute phase of severe head injury, and to study the effect of mild hypothermia on P(bt)O(2) and BT. METHODS: The P(bt)O(2) and the BT of 18 patients with severe head injury were monitored, and the patients were treated with mild hypothermia within 20 hours after injury. The rectal temperature (RT) of the patients was kept on 31.5-34.9 degrees C for 1-7 days (57.7 hours+/-28.4 hours averagely), simultaneously, the indexes of P(bt)O(2) and BT were monitored for 1-5 days (with an average of 54.8 hours+/-27.0 hours). According to Glasgow Outcome Scale (GOS), the prognosis of the patients was evaluated at 6 months after injury. RESULTS: Within 24 hours after severe head injury, the P(bt)O(2) was significantly lower (9.6 mm Hg+/-6.8 mm Hg, 1 mm Hg=0.133 kPa) than the normal value (16-40 mm Hg). After treatment of mild hypothermia, the mean P(bt)O(2) increased to 28.7 mm Hg+/-8.8 mm Hg during the first 24 hours, and the P(bt)O(2) was still maintained within the range of normal value at 3 days after injury. The BT was higher than the RT in the patients in acute phase of severe head injury, and the difference between the BT and the RT significantly increased after treatment of mild hypothermia. Hyperventilation (the partial pressure of carbon dioxide in artery (P(a)CO(2)) approximately 25 mm Hg) decreased the high intracranial pressure (ICP) and significantly decreased the P(bt)O(2). CONCLUSIONS: This study demonstrates that P(pt)O(2) and BT monitoring is a safe, reliable and sensitive diagnostic method to follow cerebral oxygenation. It might become an important tool in our treatment regime for patients in the acute phase of severe head injury requiring hypothermia and hyperventilation.     

Prospective survey on neurosurgical intensive care for patients with severe head injury

ＴＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ ,ＧｅｎｅｒａｌＨｏｓｐｉｔａｌｏｆＴｉａｎｊｉｎＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ ,Ｔｉａｎｊｉｎ 30 0 0 5 2 ,Ｃｈｉｎａ (ＹａｎｇＸＪ ,ＹａｎｇＳＹ ,ＷａｎｇＭＬａｎｄＧａｏＹＺ)ｈｅｍａｒｋｅｄｉｍｐｒｏｖｅｍｅｎｔｏｆｃｕｒａｔｉｖｅｏｕｔｃｏｍｅｆｏｒｓｅｖｅｒｅｈｅａｄｉｎｊｕｒｙｉｓａｓｃｒｉｂｅｄｔｏｕｎｄｅｒｓｔａｎｄｉｎｇｏｆｉｔｓｐａｔｈｏｐｈｙｓｉｏｌｏｇｙａｎｄａｄｏｐｔｉｎｇａｎｉｎｔｅｎｓｉｖｅａｐｐｒｏａｃｈｆｏｒｐ…     

Therapeutic effect of mild hypothermia on severe traumatic head injury

ldhypothermia (33 35℃ )isbeneficialforbrainprotectionandthusreducesthemortalityofthepatientswithseveretraumaticbraininjury (TBI) ,whichhasbeen provedbyclinicalandexperimentalevidences .1,2 However ,hypothermialeadstosuchcomplicationsasseveresecondaryinfectionsandshockduringrewarming .1InordertofurtherevaluatetheeffectofhypothermiaonsevereTBI ,wetreatedsuch patientswithmildhypothermiaandnormothermia ,respectively ,ananalyzedtheirclinicaleffectsprospectively .METHODSClinicaldataBetween 199…     

谷氨酰胺强化肠内营养对重型颅脑损伤患者营养状况及预后的影响

目的 了解谷氨酰胺(Gln)强化的肠内营养对重型颅脑损伤患者营养状况和预后的影响.方法 采用随机、开放、平行对照法,将33例重型颅脑损伤患者分为Gln强化组18例和对照组15例.2组患者在给予常规外科治疗的基础上,均采用等氮、等热量的肠内营养支持疗法,疗程2周;Gln强化组在肠内营养液中额外添加Gln 0.5 g·kg~(-1)·d~(-1).观察营养支持治疗前及治疗期间2组患者生命体征和不良反应发生情况.于治疗前及治疗7、14 d时,采集患者静脉血及尿液标本,测定血、尿常规及肝肾功能等指标;测量患者体质量、肱三头肌皮皱厚度(TSF)、上臂周径(AC)、上臂肌周径(AMC)及空腹血糖值,并进行格拉斯哥昏迷量表(GCS)评分.统计2组患者住院时间.结果 2组患者行营养支持治疗后,生命体征及血、尿常规和肝.肾功能指标与治疗前比较,无明显改变;少数患者发生恶心、腹泻等轻微不良反应,均自行缓解.2组患者治疗前后体质量、TSF组内比较或组间比较,差异均无统计学意义(P>0.05);Gln强化组治疗14 d时AC及AMC明显高于对照组(P<0.01).治疗7 d时.Gln强化组空腹血糖值明显低于对照组(P<0.05),GCS评分显著高于对照组(P<0.05).对照组患者住院时间为(33±12)d;Gln强化组为(25±9)d,较对照组明显缩短(P<0.05).结论 Gln强化肠内营养在一定程度上可控制重型颅脑损伤患者血糖值,减少瘦组织丢失,改善机体营养状况,缩短住院日,加速患者康复.     

不同程度和时程低温对犬创伤性脑损伤的影响

目的 探讨不同程度和时程低温对犬创伤性脑损伤的影响.方法 健康犬36只,体重13～15 kg,犬龄1年.采用改进的Feeney法制备创伤性脑损伤模型.采用正交设计,根据实验因素[温度(因素A)、控温时程(因素B)]和水平[A1:正常体温(38 ℃),A2:31℃,A3:35 ℃,B1:6 h,B2:12 h]采用L12(3×24)正交表,分为6组(n=6):A1B1组、A1B2组、A2B1组、A2B2组、A3B1组和A3 B2组.各组均于创伤性脑损伤模型制备后20 min时开始维持目标体温.维持目标温度结束时行动脉血气分析.模型制备后24、48、72 h时进行神经功能缺陷评分(NDS),并取静脉血样,测定血清神经特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)和血浆S-100β蛋白的浓度.最后一次采集静脉血样后取脑组织,测定Bcl-2、Bax的表达水平和细胞凋亡情况,计算细胞凋亡率.结果 与A1B1组或A1B2组比较,其余4组模型制备后血清NSE、MBP及血浆S-100β浓度和NDS评分降低,脑组织Bcl-2表达上调,Bax表达下调,细胞凋亡率降低(P＜0.05或0.01);A3B1组、A3B2组、A2B1组和A2B2组血清NSE、MBP及血浆S-100β浓度依次升高,脑组织Bcl-2表达依次下调,细胞凋亡率依次升高(P＜0.01),A2B1组、A3B2组、A2B2组和A2B1组,脑组织Bax表达依次上调(P＜0.01),4组NDS评分差异无统计学意义(P＞0.05).结论 低温减轻犬创伤性脑损伤的效应无程度和时程依赖性.     

Expression of Hsp70 and Caspase-3 in rabbits after severe traumatic brain injury

ObjectiveTo investigate the expression of Caspase-3 and Hsp70 in rabbits after severe traumatic brain injury (TBI) and to explore the feasibility of its application in estimation of injury time in forensic medicine.MethodsA rabbit model of heavy TBI was developed by high velocity impact on the parietal bone with an iron stick. Totally 8 healthy adult New Zealand white rabbits were randomly divided into control group (n=2) and injury group (n=6). Four hours after injury, tissue specimens from the parietal lobe, temporal lobe, occipital lobe, cerebellum and brainstem were harvested to detect the expression of Hsp70 and Caspase-3 by immunohistochemistry. Besides, the gray values of cells positive for Hsp70 and Caspase-3 were analyzed with an image analyzer.ResultsImmunohistochemistry staining demonstrated a low level of Caspase-3 and Hsp70 expression in normal control group. While in injury group, both the Caspase-3 and Hsp70 expression was significantly elevated (P<0.05). Positive cells gathered around the lesion focus. Occipital lobe and cerebellum had fewer positive cells while temporal and brainstem had the fewest.ConclusionThe expression of Caspase-3 and Hsp70 at an early stage following severe TBI is characteristic and can be applied to estimate the time of injury.     

巴马小型猪脑死亡状态下的肺脏形态变化及其机制

目的 探讨脑死亡状态下肺脏形态变化及可能的机制。方法 巴马小型猪10只，随机分为2组，即脑死亡组与对照组。应用改进的缓慢间断颅内加压法建立脑死亡模型，通过呼吸、循环支持维持实验动物脑死亡状态24h，对照组仅行开颅。分别测定脑死亡后第3、6、12、18和24h时血清中肿瘤坏死因子（TNF—α）、白细胞介素1（IL-1β）及IL-6水平；脑死亡后24h时取肺脏组织，HE染色观察肺脏组织变化，电镜观察肺脏超微结构变化，免疫组化染色观察蛋白激酶C（PKC—α）的表达水平，逆转录聚合酶链反应检测PKC—amRNA的表达水平。结果 对照组各检测时点的IL-1β、IL-6、TNF-α水平变化不明显，脑死亡组血清IL-1β、IL-6、TNF—α明显高于对照组（P〈0．05），并随脑死亡时间的延长而逐渐升高（P〈0．05）。肺组织中PKC-α蛋白及其mRNA水平明显高于对照组（P〈0．05）。对照组的肺组织在光镜及电镜下未见明显的损伤性变化，脑死亡组动物的组织结构发生明显改变，光镜下可见肺泡间隔增宽，肺泡腔有渗出液，肺毛细血管充血，肺组织中有淋巴细胞浸润；电镜下，脑死亡组的肺泡细胞胞质水肿，肺泡上皮Ⅱ型细胞线粒体肿胀，线粒体部分膜溶解等改变，微绒毛缺失。结论 脑死亡状态导致肺脏出现损伤性形态学变化，机体炎症介质水平升高；肺脏中PKC—α mRNA转录和蛋白翻译水平明显升高可能是肺脏发生损伤性形态学变化的原因之一。     

S-100B and neuron specific enolase in outcome prediction of severe head injury

Objective: To elucidate the role of S-100B and neuron specific enolase (NSE) in predicting the outcomes of patients with severe head injury. Methods：Forty patients with severe head injury were included in this study. The serum concentrations of S-100B and NSE were measured within 12 hours after head injury to investigate the correlation between serum levels of S-100B and NSE and outcome. Validity of both S-100B and NSE in outcome prediction was assessed with Receiver Operator Characteristic (ROC) curve. Results: The serum concentrations of S-100B and NSE of both groups, with favorable or unfavorable outcomes, were significantly higher than those of the normal group. The serum concentrations within 12 hours after head injury were closely correlated with the prognosis. Furthermore, according to the ROC curves of S-100B and NSE, S-100B was found better in predicting outcomes than NSE. Conclusions： S-100B and NSE may play importantroles in outcome prediction after severe head injury. Moreover, S-100B is clearly superior to NSE in terms of predictive value and appears to be a more promising serum marker in outcome prediction after severe head injury.     

VEGF与颅脑损伤修复机制的研究进展

干细胞对颅脑损伤的治疗是当前研究的热点.但干细胞移植仍然存在排斥、存活率低等很多问题.研究招募自体骨髓间充质干细胞至损伤部位,并诱导定向分化为神经元细胞达到修复损伤的作用,从而成为颅脑损伤治疗方法的又一大热点.血管内皮细胞生长因子及其受体广泛分布于中枢神经系统,血管内皮细胞生长因子可促进脑微循环重塑、诱导骨髓间充质干细胞向血管内皮分化,可抑制神经元死亡和凋亡,并且具有招募、诱导自体神经祖细胞及骨髓间充质干细胞定向分化为神经元的功能.血管内皮细胞生长因子、骨髓间充质干细胞与神经营养因子之间形成网络机制,共同促进颅脑损伤修复.这种自身修复治疗有望成为一种有良好前景的研究方案.