Neuronal and glial apoptosis in human traumatic brain injury

To establish reliable methods to aid the timing of brain damage after traumatic brain injury (TBI), brain tissue from 56 autopsy cases with TBI and known survival times, ranging from a few minutes to 126 days, were tested for apoptotic changes to the neuronal and glial cells. Apoptosis was established using the TdT-mediated dUTP nick end labelling (TUNEL) method of in-situ labelling and immunohistochemical reaction of caspase 3. In addition, cellular reaction and astroglial cell differentiation were investigated using histological and immunohistochemical markers. From a survival time of 120 min up to 12 days, TUNEL-positive apoptotic neuronal cells were frequently detected in the contusion zone. The earliest positive caspase 3 reaction in cortical neurons was evident after a posttraumatic interval of 80 min. Detection of apoptotic glial cells using the TUNEL technique showed that as in the case of neuronal cells, the earliest positive TUNEL reaction was obtained after 110 min. In cases of survival times of 120 min up to 4 days, apoptotic glial cells could frequently be detected. However, the first caspase 3-positive glial cells appeared 5 h after injury. Cerebral apoptosis was significantly associated with TBI cases as compared to control cases (P<0.001). The reference histological findings of neutrophilic granulocytes, CD3-positive T-lymphocytes, CD68-positive activated microglial cells/macrophages and TUNEL-positive neuronal cells increases the degree of certainty in determining the probable age of traumatic brain injury to 87.5%.     

Classification of brain compartments and head injury lesions by neural networks applied to MRI

An automatic, neural network-based approach was applied to segment normal brain compartments and lesions on MR images. Two supervised networks, backpropagation (BPN) and counterpropagation, and two unsupervised networks, Kohonen learning vector quantizer and analog adaptive resonance theory, were trained on registered T2-weighted and proton density images. The classes of interest were background, gray matter, white matter, cerebrospinal fluid, macrocystic encephalomalacia, gliosis, and unknown. A comprehensive feature vector was chosen to discriminate these classes. The BPN combined with feature conditioning, multiple discriminant analysis followed by Hotelling transform, produced the most accurate and consistent classification results. Classifications of normal brain compartments were generally in agreement with expert interpretation of the images. Macrocystic encephalomalacia and gliosis were recognized and, except around the periphery, classified in agreement with the clinician's report used to train the neural network.     

镁在脑损伤脑水肿中的作用

镁（Mg^ )是人体内重要的细胞内阳离子,作为多种酶的辅助因子参与糖、脂肪及蛋白质的代谢,在脑组织中具有代谢和调节功能。游离Mg^ 的异常可导致能量代谢、膜离子通透性、脂质代谢等方面的病理生理变化。大多数脑损伤常伴有Mg^ 的丢失,摄取Mg^ 不足可导致或加重脑 水肿,补充或适当提高体内Mg^ 的含量对脑损伤具有一定的保护作用。     

颅脑创伤后植物状态磁共振影像36例分析

目的研究颅脑创伤后持续植物状态（PVS）的磁共振影像（MRI）特征。方法分析36例颅脑创伤后持续植物状态患者MRI资料，按病灶位置、性质大小进行统计处理。结果所有患者都有脑实质损害，共发现脑软化灶312处．平均每例8．67处，主要分布在大脑皮层、脑室旁白质、基底节、胼胝体、脑干。结论MRI检查对颅脑创伤后持续植物状态的诊治有重要意义。     

头颈部放疗后软组织损伤的CT表现

目的 :本文旨在观察和探讨头颈部肿瘤放疗后软组织损伤的CT表现 ,以提高对头颈部放射性损伤的影像学认识。方法 :对头颈部恶性肿瘤放疗后 70例作CT扫描观察 ,计 13 3次扫描 ,扫描 1次 3 8例 ,2次 15例 ,3次以上 17例。观察时间分为放疗后近期 ( 6个月以内 )、中期 ( 6～ 12个月 )和远期 ( 12个月以上 )。放疗剂量为 40～ 72Gy(单程放疗 )、14 0Gy(二程及二程以上放疗 )。全部病例均有放疗前CT图像对照。结果 :CT所见包括皮下脂肪层变薄 2 6例 ,皮肤增厚15例 ,皮肤凹陷 2 6例 ,肌肉萎缩 19例 ,颈深筋膜增厚 15例 ,皮下纤维性增生 18例 ,涎腺萎缩 19例 ,复发性肿瘤 18例。结论 :CT对头颈部软组织放射性损伤的表现和程度的判断是准确的 ,能为临床治疗提供参考依据     

脑弥漫性轴索损伤的临床表现及CT诊断

目的探讨脑弥漫性轴索损伤(DAI)的临床表现、CT诊断。方法分析32例脑弥漫性轴索损伤的临床资料及cT图像资料。同时对所有病例进行GCS评分。结果DAI的CT征象主要为：a)弥漫性双侧脑白质水肿、脑肿胀、灰白质界限不清；b)脑室、脑池、脑沟及蛛网膜下腔变窄、消失，无中线移位；c)脑弥漫性肿胀，白质内点、片状出血，但未形成血肿，无占位效应；d)脑弥漫性肿胀伴硬脑膜下薄层出血。患者伤后昏迷时间越长，临床表现越重，GCS评分越低，cT显示脑室系统受压程度越重则预后越差。结论DAI根据临床表现及影像学检查可作出临床诊断?但DAI病情与CT表现不一致时需行CT薄层扫描或MRI检查。     

重型颅脑损伤为主的多发伤救治策略

目的探讨重型颅脑损伤为主的多发伤的临床特点及救治策略。方法回顾性分析福建医科大学省立临床医学院2012年6月—2016年6月收治的65例重型颅脑损伤合并多发伤患者的临床资料,男性48例,女性17例;年龄16~65岁,平均38.2岁。其中合并腹部闭合性损伤18例,合并血气胸、创伤性湿肺、多发肋骨骨折及心脏挫伤12例,合并骨盆骨折11例,合并严重口腔颌面部损伤9例,合并四肢骨折15例;GCS≤8分,ISS≥16分。结果 65例患者中,恢复良好30例(46.2%),轻度残疾12例(18.5%),重度残疾8例(12.3%),植物生存状态及自动出院6例(9.2%),9例死亡(13.8%)。结论颅脑损伤合并多发伤伤情重且复杂,病死率及致残率高,采用多发伤一体化救治模式及损害控制外科原则,优先处理重型颅脑损伤,结合重症综合治疗,对提高重型颅脑损伤合并多发伤患者的救治成功率有积极意义。     

大鼠头颅侧向旋转致脑弥漫性轴索损伤的NF68免疫组化形态学观察

目的探讨大鼠头颅侧向旋转后脑弥漫性轴索损伤(DAI)的形态学改变。方法大鼠12只,随机均分为损伤后30min、2h、24h及对照组,制作头颅侧向旋转脑DAI模型。脑矢状切片经用小鼠抗神经纤维丝(NF)蛋白NF68亚单位的血清、免疫组化ABC法与DAB+H2O2显色技术等处理。选延髓部分,薄片间包埋,光镜定位,阳性区超薄切片,电镜观察。结果伤后30min光镜下延髓轴索迂曲肿胀;电镜下髓鞘轻度分离,轴浆NF结构紊乱。伤后2～24h,轴索破坏随时间渐重,光镜下轴索明显肿胀、断裂并形成轴缩球;电镜下髓鞘显著分离,局部断裂,线粒体空泡变并移向周边,部分胞浆溶解。和正常对照比,伤后轴索轴浆NF68染色也明显增强;伴随轴索结构的变化,NF68阳性轴索染色强度和数量逐步递增。结论大鼠头颅侧向旋转后脑神经轴索内NF蛋白的NF68亚单位免疫活性显著增强,引起NF结构紊乱,终致轴索肿胀、断裂并形成轴缩球。     

高压氧治疗颅脑伤时下丘脑生长抑素和精氨酸加压素神经元的变化

目的 观察生长抑素（SS）和精氨酸加压素（AVP）在高压氧（HBO）治疗颅脑伤时的变化及可能的作用机制。方法 建立颅脑伤模型并用HBO进行治疗，采用SS原位杂交和AVP免疫细胞化学双标法进行观察。结果 颅脑伤时下丘脑室周核SS神经元减少，SS－mRNA表达下降。在视上核SS与AVP共存的阳性神经元数目减少，经HBO治疗则明显增多。结论 颅脑伤时及时给予HBO治疗，有利于神经元的恢复，进而促进SS与AVP的镇痛作用。     

电磁辐射致脑损伤与防护若干问题的思考

随着电磁波在通讯、医疗、工业、军事和家庭等各个领域的应用,电磁辐射已广泛存在于人们的日常生活和工作环境之中,其对健康造成的危害越来越引起人们的高度重视。研究发现,一定强度的电磁辐射可引起脑、生殖、心血管、免疫和眼等的损伤,其中对脑的危害备受关注。本文就电磁辐射致脑损伤效应、机制和防护研究现状进行综述,在此基础上,提出电磁辐射生物效应和防护研究的意见和建议。     

A decade of head,neck and facial cricket injury hospitalisations in Victoria,Australia: From 2007/08 to 2016/17

ObjectivesTo present an epidemiological profile of hospital-treated head, neck and facial cricket injuries from 2007/08 to 2016/17 in Victoria, Australia.DesignRetrospective analysis of emergency department and hospital admission data.MethodsAn analysis of Victorian hospital-treated head, neck and facial cricket injuries of all cricket participants over 5 years old between July 2007 and June 2017.ResultsOver the decade, 3907 head, neck, facial (HNF) cricket injuries were treated in Victorian hospitals. The number of HNF cricket injuries substantially increased in the 2014/15 season from 367 to 435 injuries and remained over 400 in the subsequent years. More injuries were reported for male compared to female participants, 3583 compared to 324 injuries. When adjusted for participation in competitive cricket, the injury incidence rate was 1.3 per 1000 participants for males and 0.4 per 1000 participants for females. The 10−14 year age group most frequently required hospital treatment. Open wounds were the most common type of injury (1166, 29.8%) and the main mechanism for HNF cricket injury for this decade was hit/struck/crush (3361, 86.0%).ConclusionsThis study provides a novel and current insight of the incidence and details of HNF injuries among cricket participants in Victoria over a decade. It is evident that males and younger participants, regardless of gender, have a higher risk of sustaining a HNF injury. This study provides a solid evidence base for stakeholders in developing strategies to minimise head, neck and facial injuries to make cricket a safe sport for all.     

尼莫地平防治颅脑伤后急性胃粘膜病变实验研究

目的：观察尼莫地平对大鼠重型颅脑伤后胃粘膜血流量（ＧＭＢＦ）、胃液ｐＨ及胃粘膜损伤指数影响。方法：将４０只ＳＤ大鼠随机分为对照组、创伤组、西米替丁防治组及尼莫地平防治组，致伤后７２ｈ观察各组大鼠ＧＭＢＦ、胃液ｐＨ及胃粘膜损伤指数。结果：与创上组相比，尼莫地平组ＧＭＢＦ及胃液ｐＨ明显升高（Ｐ＜０．０１），胃粘膜损伤指数明显减少（Ｐ＜０．０１）。结论：尼莫地平具有增加颅脑伤后的ＧＭＢＦ、抑制胃酸分泌及减轻颅脑伤后急性胃粘膜损伤作用。     

白藜芦醇对大鼠脑创伤后伤区脑组织神经细胞凋亡的影响

目的探讨白藜芦醇（resveratrol，Res）对大鼠脑创伤后神经细胞凋亡的影响及可能的作用机制。方法采用改良的Feeney自由落体脑损伤模型，对颅脑损伤大鼠用Res（50mg／kg，ip）治疗，应用原位末端标记法（TUNEL）及免疫组织化学方法检测受损脑组织治疗前后TUNEL阳性细胞数、Bcl-2及Bax的表达变化。结果治疗组大鼠脑组织TUNEL及Bax表达阳性细胞数低于创伤组及对照组（P〈0．05），Bcl-2表达伤后持续升高，治疗组高于对照组和创伤组（P〈0．05），创伤组和对照组差异不明显（P〉0．05）。结论白藜芦醇具有抗凋亡作用，可能是通过抑制促凋亡因素，促进抑凋亡因素表达来减少颅脑损伤后神经细胞的凋亡，发挥脑保护作用，其详细机制有待进一步研究。     

安多霖对微波辐射致大鼠脑损伤的预防作用研究

目的 探讨安多霖对微波辐射致大鼠脑损伤的预防作用.方法 140只二级雄性Wiser大鼠随机分为5组:健康对照组、辐射对照组、低浓度(0.75 g·kg～·d-1)预防组、中浓度(1.5 g·kg～·d-1)预防组及高浓度(3 g·kg～·d-1)预防组.预防组每日1次灌胃给予安多霖溶液,连续给药工2周.给药结束后采用30 mW/cm.微波辐射大鼠15 min.于处理后6 h、7 d和14 d,采用Morris水迷宫检测大鼠学习和记忆能力,高效液相色谱检测海马氨基酸类神经递质含量,光镜和电镜观察海马组织学和超微结构变化.结果 微波辐射后7 d内,大鼠学习和记忆能力下降(F=0.000～0.043,P<0.05);微波辐射后6 h,4种氨基酸类神经递质含量均降低,其中谷氨酸、甘氨酸及γ-氨基丁酸降低明显(F=0.000～0.007,P<0.01);微波辐射后6 h、7 d,海马组织水肿,神经元变性;神经元线粒体肿胀、空化,内质网扩张,突触间隙模糊,血管周间隙增宽.低浓度预防组上述变化与辐射对照组相似.中浓度和高浓度预防组微波辐射后7 d内,大鼠学习和记忆能力损伤不明显,两者与辐射对照组相比,差异有统计学意义(F=0.015～0.028,P<0.05);微波辐射后6 h,4种氮基酸类神经递质含量均无明显下降,其中谷氨酸含量接近正常,两者与辐射对照组比,差异有统计学意义(F=0.000-0.042,P<0.05);微波辐射后6 h、7 d,海马组织无明显损伤.结论 30 mW/cm.微波辐射可引起大鼠学习和记忆能力下降、海马氨基酸类神经递质代谢紊乱及海马组织学和超微结构损伤;1.5和3 g·kg-1·d-1安多霖对微波辐射致大鼠脑损伤有预防作用.1.5 g·kg-1·d-1安多霖为预防微波辐射致大鼠脑损伤的有效剂量.

Abstract：

Objective To study the prevention effects of AduoLa Fuzhenglin(ADL)Oll the brain injury induced by microwave radiation in rats.Methods A total of 140 male Wismr rats were divided randomly into 5 groups,including control group,microwave exposed group,low dosage(0.75 g·kg-1·d-1)group.middle dosage(1.5 g·kg-1·d-1)group and high dosage(3 g·kg-1·d-1)group.Rats in three ADL groups were lavaged with ADL per day for 2 weeks before radiation.After administration,rats were exposed to microwave at 30 mW/cm2 for 15 min.The abilities of learning and memory were detected by Morris water maze,and the contents of amino acids neurotransmitter of hippocampus were detected by HPLC, then the histology and uhrastrncture of hippocampus were observed with light and electron microscope at 6 h,7 and 14 d after exposure.Results The abilities of learning and memory were declined(F=0.000-0.043,P<0.05)from 6 h to 7 d after exposure,and the contents of four kinds of amino acid neurotransmitter in hippocampus were decreased,of which GLU,GLY and GABA were decreased significantly(F=0.000-0.007,P<0.01)at 6h after exposure,then tissue edema,neuronal degeneration,neuron mitoehondria swelling and cavitation,endocytoplasmie rotieulum broaden,synaptic cleft blurred,and perivascular space widen were found in the hippocampus at 6 h and 7 d after exposure.The changes in low dosage group were similar to those of the radiation group.However,in middle and high dosage groups,the abilities of learning and memory were normal to some extent with the significant differences compared to the radiation group from 6 h to 7 d after exposure(F=0.015-0.028.P<0.05).The contents of four kinds of amino acid neurotransmitter were not decreased,especially GLU contents close tO normal level.There were significant differences between middle and high dosage groups and radiation group at 6 h after exposure(F=0.000-0.042,P<0.05).Moreover,no obvious injury in the hippocampus was observed in middle and high dosage groups at 6 h and 7 d after exposure.Conclusions Exposure to 30 mW/cm2 microwave radiation could decrease the abilities of learning and memory,induce amino acid neurotransmitter turbulence,and injure the histology and uhrastructure of hippocampus.ADL at the dosages of 1.5 and 3 g·kg-1·d-1 would have preventive effects on the injury induced by microwave exposure.The concentration of 1.5 g·kg-1 ·d-1 of ADL might be the effective dosage to prevent the brain damage after microwave exposure.     

Detection and monitoring of cerebral hemodynamic disturbances with transcranial color-coded duplex sonography in patients after head injury

Reduced cerebral blood flow after severe head injury results in an increased risk of ischemic brain damage. Blood flow should therefore be monitored with a simple, reliable method. Transcranial color-coded Doppler sonography (TCCS) is an accepted tool for the diagnosis of cerebral vasospasm; however, its usefulness in evaluating patients with head injury has not been proven. Cerebral blood-flow velocity in the middle, anterior, and posterior cerebral arteries was measured with a 2.5 MHz probe (Aplio SSA 770A, Toshiba, Japan) in 36 subjects with moderate or severe head injury. Serial measurements of resistance index (RI), peak-systolic, end-diastolic, and mean velocity in the middle cerebral arteries were performed 2–24 h after head trauma and in the subsequent days during hospitalization. Immediately after head trauma, increased RI values, and unusually decreased blood-flow velocity (mainly in MCA) were observed. Microcirculation disturbances were suspected because the end-diastolic velocity had substantially diminished. Changes in blood-flow parameters correlated with the clinical state, and in most cases, a poor prognosis. In some patients, blood-flow velocity increased above the normal reference limit and this implied poor prognosis. Transcranial color-coded Doppler sonography is a reliable, repeatable, and accessible tool that provides information about cerebral blood-flow disturbances and may hold diagnostic and prognostic importance.     

乘用车致行人头部损伤程度调查及分析

目的 缺乏保护的行人在道路交通事故中易受到伤害,行人头部损伤是导致其残疾和死亡的首要原因.方法 设置调查条件,调查2006～2010年间重庆、北京和山西等地行人交通事故.行人按年龄分为儿童(<15岁),青壮年(≥15岁或﹤65岁)和老年行人组(≥65岁),行人损伤按人体损伤鉴定标准分为轻伤、重伤和死亡.用AIS2005...     

白藜芦醇对大鼠脑创伤后伤区脑组织神经细胞凋亡的影响

目的 探讨白藜芦醇(resveratrol,Res)对大鼠脑创伤后神经细胞凋亡的影响及可能的作用机制.方法 采用改良的Feeney自由落体脑损伤模型,对颅脑损伤大鼠用Res(50mg/kg,ip)治疗,应用原位末端标记法(TUNEL)及免疫组织化学方法检测受损脑组织治疗前后TUNEL阳性细胞数、Bcl-2及Bax的表达变化.结果 治疗组大鼠脑组织TUNEL及Bax表达阳性细胞数低于创伤组及对照组(P＜0.05),Bcl-2表达伤后持续升高,治疗组高于对照组和创伤组(P＜0.05),创伤组和对照组差异不明显(P＞0.05).结论 白藜芦醇具有抗凋亡作用,可能是通过抑制促凋亡因素,促进抑凋亡因素表达来减少颅脑损伤后神经细胞的凋亡,发挥脑保护作用,其详细机制有待进一步研究.     

Immunohistochemical investigations on the course of astroglial GFAP expression following human brain injury

The course of GFAP expression by astrocytes has been immunohistochemically investigated during the first 30 weeks after human brain injury. In order to provide reliable data for a forensic wound age estimation, a quantitative morphometric analysis was performed considering the different topographic regions of the cortex as well as of the white matter. Compared to the GFAP immunoreactivity in unaltered control tissue, significantly increased numbers of GFAP positive astroglial cells could be detected adjacent to the cortical contusion from 1 day up to 4 weeks after brain injury. Received: 10 November 1998 / Received in revised form: 26 February 1999     

亚低温治疗重型颅脑损伤的临床应用及脑氧代谢研究

目的　探讨亚低温疗法对重型颅脑损伤患者的脑保护机理及临床疗效。方法　 112例重型颅脑损伤患者 (GCS≤ 8分 )随机分为亚低温治疗组和常温治疗组。亚低温组 6 5例 ,于伤后 4～ 12小时内行亚低温治疗 ,术中将脑温探头置于硬膜下腔 ,将脑温控制在 32～ 35℃。亚低温治疗 4～ 7天 ,同时检测颈动脉和颈静脉血气及电解质变化、颅内压 (ICP)、血糖及生命体征等指标。常温组除未行亚低温治疗外 ,其余治疗及监测方法同亚低温组。两组病人均于伤后 3个月根据GOS预后评分判定疗效。结果　与常温组比较 ,亚低温治疗组病人脑氧耗明显好转 ,伤后早期高颅压 (ICP)、高血糖情况分别显著下降 ,生命体征及电解质等无明显差异 ,无严重并发症 ,死残率明显降低 ,预后显著改善。结论　亚低温具有显著的脑保护作用 ,临床应用于重型颅脑损伤的救治安全有效 ,无严重并发症     

Finite-element models of the human head and their applications in forensic practice

Since the 1960s, predictive human head impact indices have been developed to help the investigation of causation of human head injury. Finite-element models (FEM) can provide interesting tools for the forensic scientists when various human head injury mechanisms need to be evaluated. Human head FEMs are mainly used for car crash evaluations and are not in common use in forensic science. Recent technological progress has resulted in creating more simple tools, which will certainly help to consider the use of FEM in routine forensic practice in the coming years. This paper reviews the main FEMs developed and focuses on the models which can be used as predictive tools. Their possible applications in forensic medicine are discussed.