氯胺酮对脑外伤大鼠脑组织水通道蛋白-4表达的影响

目的 观察氯胺酮对脑外伤大鼠脑组织水通道蛋白-4（AQP-4）表达的影响，探讨氯胺酮减轻脑外伤的作用机制。方法 健康雄性Wistar大鼠152只，随机分为对照组和治疗组，每组76只。采用自由落体致脑外伤动物模型，治疗组大鼠伤后1 h腹腔注射氯胺酮120 mg／kg，对照组相同时间给予容量生理盐水。每组分别在伤后6、12、24、48和72h随机处死15只大鼠，每个时点的5只大鼠用于测定脑组织含水量，每个时点的其余10只大鼠经心脏灌注后取脑组织，观察脑组织病理学改变及神经元凋亡情况，测定AQP-4表达。结果 与对照组比较，治疗组大鼠伤后各时间点脑含水量、AQP-4表达及神经元凋亡计数均降低（P〈0．05或0．01），脑组织病理学改变明显减轻。结论 氯胺酮120 mg／kg通过抑制脑外伤大鼠脑组织AQP-4的表达，减少了神经元的凋亡，从而减轻脑损伤。     

Association of HIF- expression and cell apoptosis after traumatic brain injury in the rat

Objective: To explore the expression of hypoxia inducible factor-1α (HIF-1~) and the correlation between HIF-1α and apoptosis after traumatic brain injury.Methods: Using experimental traumatic brain injury in the rats, the expression of HIF-1α was studied by immunohisto-chemistry in cerebral tissue, apoptotic cell death was evaluated with TUNEL (transferase-mediated XdUTP nick end labeling ), and double-labeled immunohistochemistry and TUNEL methods were used to investigate the relationship between HIF-1α and apoptosis.Results: There was remarkable difference in the expression of HIF-1α between the experimental groups and the control groups (P ＜ 0.01), in the experimental groups,the expression of HIF-1α at 48 hours was highest; the evidence of apoptotic cell death after experimental traumatic brain injury was found by TUNEL; the apoptotic percentage increased or decreased according to the changes of the positive expression of HIF-1α (r = 0.99).Conclusions: The results suggest that secondary brain ischemia plays a crucial role in apoptotic cell death after traumatic brain injury; HIF-1α can prompt apoptotic cell death after experimental traumatic brain injury.*e expres     

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.     

Complications induced by decompressive craniectomies after traumatic brain injury

Tｒａｕｍａｔｉｃｂｒａｉｎｉｎｊｕｒｙ (ＴＢＩ)ｕｓｕａｌｌｙｒｅｓｕｌｔｓｉｎｄｅｖａｓｔａｔｉｎｇｐｅｒｓｏｎａｌ,ｓｏｃｉａｌ,ａｎｄｆｉｎａｎｃｉａｌｃｏｎｓｅｑｕｅｎｃｅｓａｎｄａｍａｊｏｒｉｔｙｏｆＹＢＩｖｉｃｔｉｍｓａｒｅｙｏｕｎｇａｎｄｈｅａｌｔｈｙｐｒｅｖｉｏｕｓｌｙ .ＡｌｔｈｏｕｇｈｏｕｒｇｒｏｗｉｎｇｋｎｏｗｌｅｄｇｅｏｆｔｈｅｐａｔｈｏｐｈｙｓｉｏｌｏｇｙｏｆＴＢＩｈａｓｅｎａｂｌｅｄｕｓｔｏｌｏｗｅｒｔｈｅｍｏｒｔａｌｉｔｙ ,ｎｅｕｒｏｓｕｒｇｅｏｎｓａｒｅｓｔｉｌｌｆ…     

Effects of magnesium sulfate on brain mitochondrial respiratory function in rats after experimental traumatic brain injury

Objective:To study the effects of magnesium sulfate on brain mitochondrial respiratory function in rats after experimental traumatic brain injury and the possible mechanism.Methods:The middle degree brain injury in rats was made by BIM-III multi-function impacting machine.The brain mitochondrial respiratory function was measured with oxygen electrode and the ultra-structural changes were observed with transmission electron microscope(TEM).Results:1.The brain mitochondrial respiratory stage III and respiration control rate reduced significantly in the untreated groups within 24 and 72 hours.But treated Group A showed certain degree of recovery of respiratiory function;treated Group B showed further improvement.2. Untreated Group,treated Groups A and B had different degrees of mitochondrial ultra-structural damage respectively, which could be attenuated after the treatment with magnesium sulfate.Conclusions:The mitochondrial respiratory function decreases significantly after traumatic brain injury.But it can be apparently improved after magnesium sulfate management along with the attenuated damage of mitochondria discovered by TEM.The longer course of treatment can obtain a better improvement of mitochondrial respiratory function.     

胰岛素在烫伤大鼠脑组织中的表达

目的观察烫伤大鼠脑组织中胰岛素的表达情况。方法将15只Wistar大鼠背部造成30％TBSAⅢ度烫伤(烫伤组),于伤后4、12、24 h以Zamboni液行左心室灌注,然后取大鼠脑组织,用免疫荧光法检测脑组织中胰岛素的表达。另取10只大鼠作为对照组,除不烫伤外,其余处理同烫伤组。结果对照组大鼠脑组织中胰岛素的表达不明显。烫伤组大鼠伤后4 h脑组织的嗅球、大脑皮质等部位可见胰岛素免疫反应阳性细胞,其细胞胞体较大,呈椭圆形或梭形;胞核大、圆而透亮,突起明显;阳性产物主要分布于细胞的细胞质,少数细胞的突起内也可见明显的胰岛素阳性产物。伤后12、24 h烫伤组大鼠脑组织中未见胰岛素免疫反应阳性细胞。结论大鼠脑组织具有自身合成胰岛素的潜能,但在正常基础状态下合成量极少,而在烫伤的应激状态下合成量增加。     

静脉滴注胰岛素对颅脑手术患者脑内糖代谢和氧供需平衡的影响

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Effect of AVP on brain edema following traumatic brain injury

Objective: To evaluate plasma arginine vasopressin (AVP) level in patients with traumatic brain injury and investigate the role of AVP in the process of brain edema. Methods: A total of 30 patients with traumatic brain injury were involved in our study. They were divided into two groups by Glasgow Coma Scale: severe traumatic brain injury group (STBI, GCS≤8) and moderate traumatic brain injury group ( MTBI, GCS >8). Samples of venous blood were collected in the morning at rest from 15 healthy volunteers (control group) and within 24 h after traumatic brain injury from these patients for AVP determinations by radioimmunoassay. The severity and duration of the brain edema were estimated by head CT scan. Results: plasma AVP levels (ng/L) were (mean±SD): control, 3. 06±1. 49; MTBI, 38. 12±7. 25; and STBI, 66. 61±17. 10. The plasma level of AVP was significantly increased within 24 h after traumatic brain injury and followed by the reduction of GCS, suggesting the deterioration of cerebral injury (P<0. 01). And the AVP level was correlated with the severity (STBI r =0.919, P < 0.01; MTBI r = 0.724, P < 0.01) and the duration of brain edema (STBI r = 0. 790, P < 0. 01; MTBI r = 0. 712, P<0.01). Conclusions: The plasma AVP level is closely associated with the severity of traumatic brain injury. AVP may play an important role in pathogenesis of brain edema after traumatic brain injury.     

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…     

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.     

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.     

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…     

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…     

Effects of magnesium sulfate on traumatic brain edema in rats

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

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.     

地西泮对放射性脑损伤大鼠血脑屏障的影响

目的研究照射前给予地西泮对放射性脑损伤大鼠血脑屏障的影响,探讨其对放射性脑损伤的防护作用机理。方法 240只SD大鼠随机分为4组,每组60只,D-R组:照射前30 min腹腔注射地西泮5 mg／kg;N-R组:照射前未用药;D-SR组:假照射(放置于照射野之外)前30 min腹腔注射地西泮5 mg／kg;N-SR组:假照射前未用药。D-R、N-R组建立清醒状态下大鼠放射性脑损伤模型。分别于照射前即刻、照射后6 h、1 d、1周和1月时记录磁共振成像(MRI)T1加权、T2加权的信号强度及其增强率,测定脑组织中伊文思蓝(EB)含量,免疫组化法分析海马神经元血管内皮生长因子(VEGF)的表达,并观察病理形态学的改变。结果 N-R组照射后T1加权的信号强度降低,T2加权的信号强度和信号强度的增强率升高,D-R组上述MRI的改变均比N-R组降低,D-R组脑组织EB含量在照射后6 h、1周和1月时及照射后6 h VEGF表达较N-R组降低(P<0．05或0．01)。结论在照射前使用地西泮通过降低脑组织VEGF表达,降低了放射性脑损伤大鼠血脑屏障的通透性,对放射性脑损伤有一定的防护作用。     

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…     

戊乙奎醚预先给药对大鼠内毒素性脑损伤时NF-κB和iNOS表达的影响

目的 评价戊乙奎醚预先给药对大鼠内毒素性脑损伤时NF-κB和诱导型一氧化氮合酶(iNOS)表达的影响.方法 雄性SD大鼠105只,体重200～220 g,随机分为5组(n=21),D1组、D2组或D3组分别腹腔注射戊乙奎醚0.05、0.15、0.45 mg/kg,NS组和L组给予等容量生理盐水,10min后L组、D1组、D2组和D3组经左颈内动脉注射脂多糖150 μg,NS组给予等容量生理盐水.分别于注射戊乙奎醚后4、6和12 h处死7只大鼠,取脑组织,测定脑组织含水量、NF-κB和iNOS表达水平,光镜和电镜下观察脑组织病理学结果.结果 与NS组相比,L组、D1组、D2组和D3组脑组织含水量、NF-κB和iNOS表达增加(P<0.05);与L组相比,D1组脑组织含水量、NF-κB和iNOS表达差异无统计学意义(P0.05),D2组和D3组脑组织含水量、NF-κB和iNOS表达降低(P<0.05).D2组和D3组脑组织病理学损伤轻于L组.结论 戊乙奎醚0.15、0.45 mg/kg预先给药减轻大鼠内毒素性脑损伤的机制与抑制脑组织NF-κB和iNOS表达上调有关.