Effect of Xingnaojing injection on cerebral edema and blood-brain barrier in rats following traumatic brain injury

Objective：To explore the effects of Xingnaojing injection on cerebral edema and blood-brain barrier （BBB） in rats following traumatic brain injury （TBI）.Methods： A total of 108 adult male Sprague-Dawley rats were used as subjects and randomly assigned to three groups：sham-operation,TBI and Xingnaojing injection was set up by the improved device of Feeney＇s weightcontent and BBB permeability expressed as Evans blue content were measured at 1, 3, 5 and 7 days after surgery.Results： In sham-operation group, brain water content and Evans blue content in brain tissue were 78.97%±1.22%and 5.13μg±0.71μg. Following TBI, water content in brain tissue was increased significantly at 1, 3, 5 and 7 days （83.49%±0.54%, 82.74%±0.72%, 80.22%±0.68%, 79.21%±0.60%）, being significantly higher than that in sham operation group （P〈0.05）. Evans blue content was increased in TBI group （16.54 μg±0.60 μg, 14.92μg±0.71μg, 12.44 μg ±0.92μg, 10.14μg±0.52 μg） as compared with sham-operation group（P〈0.05）. After treatment with Xingnaojing injection, brain water content decreased as compared with TBI group （81.91%±1.04%, 80.38%±0.72%, 79.54%±0.58%,78.60%±0.77%, P〈0.05）. Xingnaojing injection also reduced the leakage of BBB as compared with TBI group （15.11 μg± 0.63 μg, 13.62 μg±0.85μg, 10.06 μg±0.67 μg, 9.54 μg±0.41 μg,P〈0.05）.Conclusion： Xingnaojing injection could alleviate cerebral edema following TBI via reducing permeability ofBBB.     

Correlation of cell apoptosis with brain edema and elevated intracranial pressure in traumatic brain injury

Traumaticbraininjury(TBI) isamongthemostseriousinjuries, frequentlycausingdeathorpermanentdisability. ItiscloselyrelatedwiththehottesttopicsabouthowtoreducetheneurologicalimpairmentwhichmayresultfromTBI.Necrosisinthedamagedregionhadbeenconventionallythoughttobetheonlydeathmodeoftheinjuredneuronsuntilrecently. Atpresent, alotofevidencehasindicatedthatapoptosismightbeanothermainmodeofcelldeathafteraheadtrauma.1 Inthisresearch, animalmodelofTBIwasmadewithadultrabbit, apoptoticcellsweredetecte…     

Effects of magnesium sulfate on traumatic brain edema in rats

svarietyofneuroprotectiveagentshavebeensynthesized .However ,besidessomeagentspresentlybeingevaluatedinclinicaltrails ,mostofthesecompoundshavelimitedclinicalusebecauseofneurotoxicityandbehavioralsideeffects .Recently ,severalstudiesdemonstratedthattraumaticinjurytothebraincausesadecreaseinmagnesiumconcentrationcorrelatedwithinjuryseverity .1Sincethen ,moreandmoreattentionhasbeen paidtoMgSO4 foritsneuroprotectiveeffects .Magnesiumsulfatehasbeenwidelyusedinclinicalpracticeforalmost 10 0 years.…     

Effects of ganglioside GM1 on reduction of brain edema and amelioration of cerebral metabolism after traumatic brain injury

Ｉｎｒｅｃｅｎｔｙｅａｒｓ ,ｉｔｉｓｆｏｕｎｄｔｈａｔｅｘｏｇｅｎｏｕｓｇａｎｇｌｉｏｓｉｄｅＧＭ 1ｎｏｔｏｎｌｙ ｐｒｏｍｏｔｅｃｕｌｔｕｒｅｄｎｅｕｒｏｎｓｔｏｇｅｍｍａｔｅａｎｄａｘｏｎｔｏ ｇｒｏｗｉｎｖｉｔｒｏ ,ｂｕｔａｌｓｏｐａｓｓｅｓｔｈｒｏｕｇｈｂｒａｉｎ ｂｌｏｏｄｂａｒｒｉｅｒｔｏｐｒｏｔｅｃｔｃｅｌｌｕｌａｒｍｅｍｂｒａｎｅｆｕｎｃｔｉｏｎｉｎｔｈｅｅａｒｌｙｓｔａｇｅａｎｄｈａｓｓｉｇｎｉｆｉｃａｎｔｅｆｆｅｃｔｓｏｎｒｅｓｔｏｒａｔｉｏｎｏｆｔｈｅｄａｍａｇｅｄｆｕｎｃｔ…     

Relationship between changes of N-methyl-D-aspartate receptor activity and brain edema after brain injury in rats

ＩＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ ,ＺｈｕｊｉａｎｇＨｏｓｐｉｔａｌ ,ＦｉｒｓｔＭｉｌｉｔａｒｙＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ ,Ｇｕａｎｇｚｈｏｕ 5 10 2 82 ,Ｃｈｉｎａ (ＸｕＲＸａｎｄＬｕｏＣＹ)ＳｕｐｐｏｒｔｅｄｂｙＮａｔｕｒａｌＳｃｉｅｎｃｅＦｏｕｎｄａｔｉｏｎｏｆＧｕａｎｇｄｏｎｇＰｒｏｖｉｎｃｅ (ＧＤ990 416 )ａｎｄＮａｔｕｒａｌＳｃｉｅｎｃｅＦｏｕｎｄａｔｉｏｎｏｆＣｈｉｎａ(39770 76 0 )ｔｉｓｅｘｐｅｒｉｍｅｎｔａｌｌｙｆｏｕｎｄｔｈａｔｇｌｕｔａｍａｔｅｍａｙｉｎ…     

Spironolactone in preventing hypokalemia following traumatic brain injury

Objective： Hypokalemia is a frequent complication observed after traumatic brain injury （TBI）.We evaluated the effect of spironolactone on preventing hypokalemia following moderate to severe TBI.Methods： Patients with moderate to severe TBI, whose Glasgow Coma Scale （GCS） scores of 9-12 and ＜9,respectively, were equally randomized into intervention and control groups, matching with severity of trauma and baseline serum level of potassium. For the intervention group, we administrated spironolactone （1 mg/kg per day）on the second day of admission or the first day of gavage tolerance and continued it for seven days. No additional intervention was done for controls. Hypokalemia （mild： 3-3.5 mg/L, moderate： 2.5-3 mg/L, and severe： ＜2.5 mg/L serum K＋） and other electrolyte abnormalities were compared between the two groups at the end of the intervention.Results： Sixty-eight patients （58 males and 10 females）were included with mean age=（33.1±11.8） years, and GCS=7.6±2.8. The two groups were similar in baseline characteristics.Patients who received spironolactone were significantly less likely to experience mild, moderate, or severe hypokalemia （8.8%, 2.9%, and 0） compared with controls （29.4%, 11.7%,and 2.9%, respectively, P＜0.05）. No significant difference was observed between the two groups in the occurrence of other electrolyte abnormalities, hyperglycemia or oliguria.Conclusion： Spironolactone within the first week of head injury could prevent the occurrence of late hypokalemia with no severe side effects.     

Aquaporin-4 and traumatic brain edema

Brain edema leading to an expansion of brain volume has a crucial impact on morbidity and mortality following traumatic brain injury as it increases intracranial pressure, impairs cerebral perfusion and oxygenation, and contributes to additional ischemic injuries. Classically, two major types of traumatic brain edema exist： ＂vasogenic＂ and ＂cytotoxic/cellular＂. However, the cellular and molecular mechanisms contributing to the development/resolution of traumatic brain edema are poorly understood and no effective drugs can be used now. Aquaporin-4 （AQP4） is a water-channel protein expressed strongly in the brain, predominantly in astrocyte foot processes at the borders between the brain parenchyma and major fluid compartments,including cerebrospinal fluid and blood. This distribution suggests that AQP4 controls water fluxes into and out of the brain parenchyma. In cytotoxic edema, AQP4 deletion slows the rate of water entry into brain, whereas in vasogenic edema, AQP4 deletion reduces the rate of water outflow from brain parenchyma. AQP4 has been proposed as a novel drug target in brain edema. These findings suggest that modulation of AQP4 expression or function may be beneficial in traumatic brain edema.     

不同剂量右美托咪定对创伤性脑损伤小鼠急性期脑水肿的影响

目的探讨不同剂量右美托咪定对创伤性脑损伤(traumatic brain injury,TBI)小鼠急性期脑水肿的影响。方法健康成年雄性C57BL/6J小鼠132只,随机分为六组:正常对照组(C组)、假手术组(Sham组)、创伤性脑损伤组(TBI组)、右美托咪定20μg/kg组(D20组)、40μg/kg组(D40组)、60μg/kg组(D60组),每组22只。应用电子控制性脑皮质撞击仪(eCCI)建立TBI小鼠模型,即刻经腹腔注射不同剂量右美托咪定(20、40、60μg/kg),每隔2小时给药1次,共3次。伤后24h分别采用干/湿重法测定脑含水量,HE染色法观察损伤侧皮质细胞形态变化,Western blot法检测损伤侧脑组织中水通道蛋白4(AQP4)和核转录因子κB(NF-κB)的蛋白含量。并于伤后第1、2、3、7天采用改良神经功能缺陷评分(mNSS)评价其神经功能受损程度,伤后第4、5、6、7天应用Morris水迷宫实验观察其行为学改变。结果与Sham组比较,TBI组不同时点mNSS评分明显升高,逃避潜伏期明显延长,脑含水量明显升高,损伤侧皮质损伤严重,AQP4和NF-κB蛋白含量明显升高(P0.01)。与TBI组比较,右美托咪定各剂量组mNSS评分明显降低,逃避潜伏期明显缩短,脑含水量明显降低,损伤侧皮质细胞空泡变性和炎症反应有所改善,AQP4和NF-κB蛋白含量明显降低(P0.05或P0.01);D60组上述指标改变较D20组更为明显(P0.05或P0.01)。结论右美托咪定20~60μg/kg可以减轻TBI后急性脑水肿和认知功能障碍,随着剂量的增高,此作用更为明显,这可能与降低TBI后AQP4和NF-κB表达密切相关。     

Effect of dexamethasone by local treatment on cerebral edema and serum myelin basic protein after brain injury in rabbits

ＳＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ ,ＴｈｅＦｉｒｓｔＡｆｆｉｌｉａｔｅｄＨｏｓｐｉｔａｌ,ＨｅｎａｎＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ ,Ｚｈｅｎｇｚｈｏｕ 45 0 0 5 2 ,Ｃｈｉｎａ (ＹａｎｇＢａｎｄＳｏｎｇＬＪ)ＡｌｂｅｒｔＥｉｎｓｔｅｉｎＣｏｌｌｅｇｅｏｆＭｅｄｉｃｉｎｅｏｆＹｅｓｈｉｖｅＵｎｉｖｅｒｓｉｔｙ ,ＮｅｗＹｏｒｋ ,10 46 1(ＧｕａｎＦＸ)ＴｈｅＰｈｙｓｉｃｓＤｅｐａｒｔｍｅｎｔｏｆＨｅｎａｎＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ ,Ｚｈｅｎｇｚｈｏｕ 45 0 0 5 2 ,Ｃｈｉｎａ (Ｌｉ…     

Role of bromocriptine in multi-spectral manifestations of traumatic brain injury

Purpose: Despite the prevalence and cost of traumatic brain injury related disabilities, there is paucity in the literature on modern approaches to pharmacotherapy. Medications may promote recovery by enhancing some neurological functions without impacting others. Herein we discussed the role ofbromocriptine in neurorehabilitation for patients with traumatic brain injury.Methods: A cohort comprising of 36 selective nonsurgical cases of traumatic brain injury in minimallyconscious state were enrolled in the study. After hemodynamic stability, bromocriptine was given atpaediatric dose of 3.75 mg/d and adult dose of 7.5 mg/d. It was administered through a naso-gastric (NG) feeding tube in the patients with minimally conscious state, then changed to oral route after proper swallowing and good gag reflex were ensured in the patient. The drug was slowly reduced over three weeks after neurological improvement in the patients. Positive result was determined by improvd GCS score of 2 and motor power by at least 1 British Medical Council (BMC) motor score. Improvement of deficits was evaluated in terms of fluency of speech for aphasia, task switching, digit span double tasking and trail-making test for cognition and attention, and functional independence measure score for motor functioning and self-independence.Results: Accelerated arousal was seen in 47.0% of cases (8/17) in 4e40 days. In 41.2% of cases (7/17), Glasgow outcome score (GOS) was improved to 4/5 in 90 days. Improvement in hemiparesis by at least 1 BMC score was seen in 55.6% of cases (5/9) in 40 days. Aphasia was improved in 80% of cases (4/5) in 7-30 days. Moderate improvement in cognitive impairment was seen in 66.7% of cases (2/3) in 14e20 days. Improvement in memory was observed in 50% of cases (1/2) in over 30 days. No cases were withdrawn from the study because of adverse reactions of the drug. There was no mortality in the study group.Conclusion: Bromocriptine improves neurological sequelae of traumatic brain injury as well as theoverall outcome in the patients. If medication is given to promote recovery and treat its associateddisabilities, clinicians should thoroughly outline the goals and closely monitor adverse effects.     

Cushing''s ulcer in traumatic brain injury

Traumatic brain injury （TBI） remains a complicated and urgent disease in our modernized cities. It becomes now a public health disease. We have got more and more patients in Neurosurgery Intensive Care Unit following motor vehicle accidents and others causes. TBI brings multiple disorders, from the primary injury to secondary injury. The body received the disturbances in the brain, in the hypothalamo-pituitary-adrenocortical （HPA） axis, in the gastric mucosa, in the immune and neuroendocrine systems. The mortality of TBI is more than 50000 deaths / year, the third of the mortality of all injuries. Cushing ulcer is one ofthe severe complications of TBI and its mortality rate is more than 50%. Many studies have improved the management of TBI and the associated complications to give patients a better outcome. Furthers studies need to be done based on the similar methodology to clarify the different steps of the HPA axis and the neuroendocrine change associated. The aim of the present review is to assess the clinical and endocrinal features of hypopituitarism and stress ulcer following TBI.     

Outcome of 2 284 cases with acute traumatic brain injury

ＴＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ ,ＲｏｎｇｇａｎｇＨｏｓｐｉｔａｌ ,Ｓｈｅｎｚｈｅｎ5 18116 ,Ｃｈｉｎａ (ＺｈａｎｇＪａｎｄＺｈｏｎｇＴＡ)ＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ ,ＣｈａｎｇｚｈｅｎｇＨｏｓｐｉｔａｌ,ＳｈａｎｇｈａｉＮｅｕｒｏｓｕｒｇｅｒｙＩｎｓｔｉｔｕｔｅ ,Ｓｈａｎｇｈａｉ 2 0 0 0 0 3 ,Ｃｈｉｎａ(ＪｉａｎｇＪＹ ,ＹｕＭＫａｎｄＺｈｕＣ)ｒａｕｍａｔｉｃｂｒａｉｎｉｎｊｕｒｙ (ＴＢＩ) ,ａｃｏｍｍｏｎｃｌｉｎｉｃａｌｐｒｏｂｌｅｍｆｏｒｎｅｕｒｏｓｕｒｇ…     

Effect of dipeptide of glutamine and alanine on severe traumatic brain injury

OBJECTIVE: To determine the effect of dipeptide of glutamine and alanine on patients with severe traumatic brain injury. METHODS: A total of 46 patients (31 males and 15 females, aged 7-68 years, (47+/-9.6) years on average) with severe traumatic brain injury were randomized into two groups: Group G (n=23) and Group C (n=23). The patients in Group G received nutritional remedy with the dipeptide of glutamine and alanine, whereas the patients in Group C received routine nutritional therapy only. GCS changes, the length of stay in the neurosurgical intensive care unit (NICU), the mortality,the count of lymphocytes, related complications including lung infection and hemorrhage of alimentary tracts, etc, were examined and recorded. RESULTS: The fatality rate and the length of stay in NICU in Group G was lower than these in Group C (P larger than 0.05), but no obvious difference was found in GCS changes of the patients between the two groups (P larger than 0.05). The patients with lung infection and alimentary tract hemorrhage in Group G were less than those in Group C (P larger than 0.05). The count of lymphocytes in Group G was more than that in Group C (P larger than 0.05), but no difference was found in other nutritional data. CONCLUSIONS: Dipeptide of glutamine and alanine can increase the resisting stress and anti-infection ability of patients with severe traumatic brain injury, which can also lower the mortality and shorten the NICU stay.     

Effect of intracranial pressure and cerebral perfusion pressure on outcome prediction of severe traumatic brain injury

ｒａｕｍａｔｉｃｂｒａｉｎｉｎｊｕｒｙｉｓｏｎｅｏｆｔｈｅｌｅａｄｉｎｇｃａｕｓｅｓｏｆｄｅａｔｈｉｎｔｈｅｉｎｄｕｓｔｒｉａｌｉｚｅｄｗｏｒｌｄａｎｄｃｏｓｔｓｍｏｒｅｔｈａｎｔｅｎｂｉｌｌｉｏｎＵＳｄｏｌｌａｒｓｉｎｔｈｅＰｅｏｐｌｅ ｓＲｅｐｕｂｌｉｃｏｆＣｈｉｎａｅａｃｈｙｅａｒ .Ｆｕｒｔｈｅｒｍｏｒｅ ,ｔｈｏｕｓａｎｄｓｏｆｓｕｒｖｉｖａｌｓａｒｅｌｉｖｉｎｇｗｉｔｈｌｏｎｇ ｔｅｒｍｄｉｓａｂｉｌｉｔｉｅｓｆｒｏｍｔｒａｕｍａｔｉｃｂｒａｉｎｉｎｊｕｒｙ .Ｔｈｅｉｍｐａｃｔｏｆｓｅｃｏ…     

Influence of apolipoprotein E and its receptors on cerebral amyloid precursor protein metabolism following traumatic brain injury

Traumatic brain injury (TBI) is the leading cause of mortality and disability among young individuals in our society,and globally the incidence of TBI is rising sharply.Mounting evidence has indicated ...     

Standard large trauma craniotomy for severe traumatic brain injury

ThemortalityofsevereTBIisstillhighatpresent.Howtodecreaseitisanimportanttaskthatmanyneurosurgicalresearchersarepayingcloseattentionto .1Acuteintracranialhematomaanddiffusecontusionandlacerationofthebrainwillleadtosuddenstepping upofintracranialpressureandcerebralherniaformationwhichareoneofthemostimportantcausesofdeathinpatientswithsevereTBI.SurgicaldecompressionisacommonmethodtreatingsevereTBI .Accordingtoreports ,SLTCexcelsroutinecraniotomyintreatingsevereTBI ,butdisputesstillexist .2…     

Effect of leptin on bone metabolism in rat model of traumatic brain injury and femoral fracture

Objective: To observe serum and callus leptin expression within the setting of fracture and traumatic brain injury (TBI).Methods: Atotal of 64 male SD rats were randomized equally into 4 groups: nonoperated group, TBI group, fraeture group, and fracture+TBI group. Rats were sacrificed at 2, 4, 8 and 12 weeks after fracture+TBI. Serum leptin was detected using radioimmunoassay, and callus formation was measured radiologically. Callus leptin was analyzed by immunohistochemistry.Results: Serum ieptin levels in the fracture group, TBI group and combined fracture+TBI group were all significantly increased compared with control group at the 2 week time-point (P＜0.05). Serum leptin in the combined fracture +TBI group was significantly higher than that in the fracture and TBI groups at 4 and 8 weeks after injury (P＜0. 05).The percentage of leptin-positive cells in the fracture+TBI callus and callus volume were significantly higher than those in the fracture-only group (P＜0.01).Conclusions: We demonstrated elevated leptin expression within healing bone especially in the first 8 weeks in a rat model of fracture and TBI. A close association exists between leptin levels and the degree of callus formation in fractures.     

颅脑外伤后进展性脑损害的研究进展

颅脑外伤后进展性脑损害,包括脑出血、脑缺血、脑水肿,都是影响颅脑外伤预后的重要因素.本文复习文献,对颅脑外伤后进展性脑损害的发病率、发生机制、早期诊断方法、治疗和预后等相关问题的研究进展进行了综述.     

创伤性脑损伤研究新进展

创伤性脑损伤(TBI)病情进展迅速、预后险恶,给临床救治工作带来极大困难,已成为现代急危重症医学面临的突出难题。除了特殊情况下必要的手术干预外,有关TBI的临床处置措施、无创和有创监测模式等近年来有了新的认识。本文重点阐述了TBI的监测和治疗现状,通过对TBI病理生理机制的深入了解,在发病不同环节采取针对性和精准化策略...