Behavior problems and adaptive functioning in children with mild and severe closed head injury.

Assessed behavior problems and adaptive functioning in children with mild or severe closed head injuries, on average more than 2 years postaccident. To ensure that any problems detected in the present study were not merely preexisting problems, potential subjects were excluded if there was a history of preexisting CNS damage, significant developmental delay, or behavior problems. Children with severe head injuries had an excessive rate of behavior problems and impaired adaptive functioning. Children with mild head injuries also had an excessive rate of behavior problems (comparable to that of children with severe head injuries) but did not have impaired adaptive functioning. Results are discussed in terms of six alternative ways brain injury and behavior problems can be related functionally.     

6岁儿童行人-汽车碰撞中碰撞角度对头部损伤的影响

目的应用符合欧洲新车安全评鉴协会(the European New Car Assessment Programme,Euro NCAP)要求的6岁儿童行人有限元模型,探究不同碰撞角度对儿童头部损伤的影响。方法应用符合Euro NCAP技术公告(TB024)并且具有详细解剖学结构的6岁儿童行人有限元模型,设置4组行人-汽车碰撞仿真试验,探究不同碰撞角度下儿童头部损伤情况。人体头部质心初始位置在车的纵向中心线上,轿车初速度为40 km/h,轿车分别与人体右侧、前侧、左侧、后侧碰撞(即0°、90°、180°、270°)。比较不同碰撞角度下运动学差异和头部碰撞响应,同时分析面骨和颅骨的损伤情况。结果通过分析儿童行人头部接触力、头部质心合加速度、头部质心相对于车的合速度、头部损伤标准(head injury criterion,HIC_(15))、面骨骨折情况以及颅骨应力分布发现,背面、正面碰撞下儿童头部骨折及发生脑组织损伤的风险大于侧面碰撞,其中背面碰撞下儿童行人头部损伤风险最高,侧面碰撞下儿童行人头部损伤风险最低。结论背面碰撞下儿童行人头部损伤风险最大,研究结果对行人-汽车碰撞评估和防护装置研发具有重要的应用价值。     

Pediatric head trauma: parent, parent-child, and family functioning 2 weeks after hospital discharge

OBJECTIVE: To investigate effects of pediatric head trauma on parent mental health, parent-child relationship and family functioning 2 weeks after discharge. METHODS: Ninety-seven mothers and 37 fathers of 106 preschool children hospitalized with head injury completed Mental Health Inventory (MHI), Parenting Stress Index, Family Adaptability and Cohesion Evaluation Scales II (FACES II) and Multidimensional Scale of Perceived Social Support (MSPSS) 2 weeks after discharge, and perceived injury severity, Parental Concerns Scale (PCS), Parental Stressors Scale: Pediatric Intensive Care Unit (PSS: PICU), and MHI 24-48 h after hospital admission. RESULTS: Mental health after discharge was related to social support and baseline mental health. Mothers' parental distress was related to perceived injury severity and social support. Greater family cohesion was related to baseline mental health, social support, and being in a two-parent family for mothers, and to social support for fathers. CONCLUSIONS: Parents' mental health and social support were important for parent mental health and family cohesion after discharge. Perceived injury severity and parent reactions to hospitalization also played a role.     

Intellectual characteristics of diabetic children at diagnosis and one year later

Examined neurocognitive functions in 63 newly diagnosed pediatric patients with insulin-dependent diabetes mellitus (DM) at onset of illness (T0) and 1 year postdiagnosis (T1). Siblings (S) serving as controls were assessed at T0 only. Subjects were given age-appropriate tests of verbal and visuospatial abilities. In addition, DM were interviewed regularly during diabetes clinic to determine current diabetic control and different intervening glycemic-related events. Results revealed no differences between DM and S at T0, nor any specific impairment in DM predating illness. Also, DM did not demonstrate any acquired impairment after 1 year of illness. Children with early onset DM (less than 5 years) scored lower in spatial ability at T0 and T1 than children with later onset DM, who scored lower in verbal ability. Episodes of asymptomatic and mild chronic hypoglycemia correlated positively, not negatively, with improved outcome over time. There were no adverse effects of severe hypoglycemia. Ketonuria and hospitalizations were associated with lower performance IQs 1 year after onset, as was diabetic ketoacidosis at onset. Results are discussed in terms of critical periods of sensitivity of different brain regions to the effects of diabetes and the need for longer follow-up of these children.     

天幕裂孔切开术治疗重型颅脑损伤合并脑疝

目的：探讨天幕裂孔切开术在救治重型颅脑伤合并颞叶钩回疝患者的临床疗效.方法：100例重型颅脑损伤合并脑疝患者随机分为天幕裂孔切开术组（THI组）和普通手术组（NO组）,每组50例,比较手术疗效.结果：THI组死亡6例,死亡率12% 生存的44例预后按GOS分级方法进行测评,1级8例、2级12例、3级9例、4级9例、5级6例.NO组死亡11例,死亡率22% 生存的39例预后按GOS分级方法进行测评,1级4例、2级6例、3级9例、4级11例、5级9例.两组死亡率及GOS分级比较,差异无统计学意义（P＞0.05）.结论：天幕裂孔切开术有利于缓解颞叶钩回疝及所致继发性脑干伤,降低病残率和死亡率.     

Motor and cognitive deficits in apolipoprotein E-deficient mice after closed head injury

Previous studies suggest that traumatic brain injury is associated with increased risk factor for developing Alzheimer's disease. Furthermore, the extent of the risk seems to be most pronounced in Alzheimer's disease patients who carry the ε4 allele of apolipoprotein E, suggesting a connection between susceptibility to head trauma and the apolipoprotein E genotype. Apolipoprotein E-deficient mice provide a useful model for investigating the role of this lipoprotein in neuronal maintenance and repair. In the present study apolipoprotein E-deficient mice and a closed head injury experimental paradigm were used to examine the role of apolipoprotein E in brain susceptibility to head trauma and in neuronal repair. Apolipoprotein E-deficient mice were assessed up to 40 days after closed head injury for neurological and cognitive functions, as well as for histopathological changes in the hippocampus. A neurological severity score used for clinical assessment revealed more severe motor and behavioural deficits in the apolipoprotein E-deficient mice than in the controls, the impairment persisting for at least 40 days after injury. Performance in the Morris water maze, which tests spatial memory, showed a marked learning deficit of the apolipoprotein E-deficient mice when compared with injured controls, which was apparent for at least 40 days. At this time, histopathological examination revealed overt neuronal cell death bilaterally in the hippocampus of the injured apolipoprotein E-deficient mice.

The finding that apolipoprotein E-deficient mice exhibit an impaired ability to recover from closed head injury suggests that apolipoprotein E plays an important role in neuronal repair following injury and highlights the applicability of this mouse model to the study of the cellular and molecular mechanisms involved.     

益生菌联合早期肠内营养在重型颅脑损伤中的应用

肠内营养是治疗重型颅脑损伤的重要组成部分,但颅脑损伤患者易出现胃肠功能障碍,影响营养吸收。目前研究已经证实益生菌对维持胃肠道菌群平衡、维护胃肠道屏障功能完整性等具有重要作用。本文主要从益生菌对重型颅脑损伤患者胃肠功能、免疫功能、炎症反应及相关感染等的影响进行综述。     

Role of a Dentist in Comprehensive Management of a Comatose Patient with Post Traumatic Head Injury and Neuropathological Chewing

Injury of the head and neck region can result in substantial morbidity. Comprehensive management of such patients requires team work of several specialties, including dentists. A young female patient with extensive loss of cranium and associated pathological chewing was referred to the dental department. The lost cranium was replaced by a custom-made, hand-fabricated cranioplast. Trauma due to pathological mastication was reduced by usage of a custom-made mouthguard. Favorable results were seen in the appearance of the patient and after insertion of the mouthguard as evidenced in good healing response. The intricate role of a dental specialist in the team to manage a patient with post traumatic head injury has been highlighted. The take away message is to make the surgical fraternity aware of the scope of dentistry in the comprehensive management of patients requiring special care.     

Neuropsychological Sequelae of Otitis Media in Children and Adolescents with Learning Disabilities

This study focused on the sequelae of otitis media from a neuropsychologicaland information processing perspective. The data from 84 learning-disabledchildren and adolescents, 49 with and 35 without significanthistories of otitis media, were studied. Ages ranged from 5years 10 months to 16years 7 months. The results indicated thatearly onset, chronic otitis media can lead to long-standingserious cognitive deficits. Particular weakness in the otitismedia group was evidenced in sequential information processing;relative strength was found in nonverbal spatial abilities involvingsimultaneous information processing. General and higher levelverbal abilities did not appear to be affected by the otitismedia condition. A link between the conductive hearing losseswhich generally accompany otitis media and auditory-corticaldysfunction is postulated.     

盐酸多奈哌齐对轻、中型脑外伤患者认知障碍的治疗作用

目的 探讨盐酸多奈哌齐对轻、中型脑外伤患者认知障碍及临床预后的影响。方法 78例轻、中型脑外伤并认知障碍患者被随机分成治疗组和对照组，治疗组应用盐酸多奈哌齐10mg／d，对照组应用吡拉西坦8mg，一日3次服用，两组的治疗周期为12周。治疗前及治疗后12周，分别应用简明精神状态检测量表（MMSE）、国人修订成人韦氏智利量表（WAIS-RC）和格拉斯哥预后评分（GOS）评价疗效。结果 两组在治疗后12周，MMSE和WAIS-RC评分均较治疗前提高（P〈0．05）。治疗后12周，治疗组MMSE和WAIS-RC评分较对照组高（P〈0．05），治疗组GOS预后优良率明显优于对照组（P〈0．05）。结论 盐酸多奈哌齐对轻、中型脑外伤后认知障碍有积极治疗作用，并能改善临床预后。     

急性颅脑损伤患者血清SICAM-1和CRP检测的临床意义

目的:探讨了急性颅脑损伤患者血清细胞间粘附分子-1(SICAM-1)和C反应蛋白(CRP)水平及其临床意义。方法:应用ELISA法和免疫法对33例急性颅脑损伤患者进行了血清SICAM-1和CRP水平检测,并与35名正常健康人作比较。结果:急性颅脑损伤患者血清中SICAM-1和CRP水平非常显著地高于正常人组(P<0.01),尤以重型组为甚。结论:测定急性颅脑损伤患者血清中SICAM-1和CRP水平对了解病情,并有助于预后判断。     

Sequelae of Closed Craniocerebral Trauma and the Efficacy of Piracetam in Its Treatment in Adolescents

The efficacy of piracetam in treating the sequelae of moderate and severe closed craniocerebral trauma (CCT) in adolescents was evaluated in studies of 42 patients aged 12–18 years who had suffered CCT 1.5–5 years prior to the study. Adolescents of the experimental group (20 individuals) received piracetam (Nootropil) at doses of 40–50 mg/kg (daily daily 1600–2400 mg) for one month; patients of group 2 (22 individuals) served as controls. Piracetam was found to have positive therapeutic effects on impairments to higher mental (memory, attention, executive) and motor (coordination) functions and on measures of the speeds of cognitive and motor operations. Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 108, No. 3, pp. 43–48, March, 2008.     

Physiological Response Patterns to Cognitive Testing in Adults With Closed Head Injuries

Physiological measures were taken from 7 closed-head-injured patients and 7 control subjects while they took a series of cognitive tests: the finger tapping test from the Halstead Reitan battery, the Digit Symbol test from the WAIS-R, a test of logical memory, and a paced arithmetic test. Physiological reactivity was assessed relative to rest periods, which occurred at the beginning and end of each session. The tests and physiological assessment were administered twice, approximately one month apart. The patient group performed more poorly on the cognitive tests, and showed less physiological reactivity during them than did the control group. This pattern was statistically significant for heart rate, frequency of electrodermal responses, and, during the initial session, respiration rate. The control group also showed greater finger pulse amplitude during the first posttest rest period in the first session, and greater constriction during a logical memory task in the second session. No significant between-groups differences emerged for state or trait anxiety. The patients showed higher frontalis EMG and respiration rate during rest. These results suggest a pattern of poor physiological modulation for task performance in the patients with closed head injuries. The therapeutic implications are discussed.     

Patterns and Correlates of Supervision in Child Pedestrian Injury

Described supervision in 142 child pedestrian injuries (PI),based on presence and proximity of supervisors and/or peers.Children (5–12 years), families, sites and PI events weredescribed via record reviews, interviews, questionnaires, andsite investigation. Supervision of PI victims varied with familysize and cohesion, and with children age, self–help skils,nearness to home, and activity (playing or journey). Peer presencewas associated with more impulsive behavior among supervised(but not among unsupervised) PI victims. Definitions of supervisionparameters offered here can aid research on the complex relationshipbetween supervision and PI risk.     

Astragaloside IV Alleviates Early Brain Injury Following Experimental Subarachnoid Hemorrhage in Rats

Astragaloside IV, one of the main effective components isolated from Astragalus membranaceus, has multiple neuroprotective properties, while the effects of astragaloside IV on the attenuation of subarachnoid hemorrhage (SAH)-induced early brain injury (EBI) and its possible mechanisms are unknown. In the present study, we aimed to determine whether astragaloside IV could inhibit oxidative stress, reduce neuronal apoptosis, and improve neurological deficits after experimental SAH in rats. Rats (n=68) were randomly divided into the following groups: Sham group, SAH group, SAH+vehicle group, and SAH+astragaloside IV group. Astragaloside IV or an equal volume of vehicle was administered at 1 h and 6 h after SAH, all the rats were subsequently sacrificed at 24 h after SAH. Mortality, neurological scores, and brain edema were assessed, biochemical tests and histological studies were also performed at that point. SAH induced an increase in the malondialdehyde (MDA) level, neuronal apoptosis, cleaved caspase 3, brain edema and decreased activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px). Astragaloside IV treatment reversed these changes and improved neurobehavioral outcomes of SAH rats. Our findings suggested that astragaloside IV may alleviate EBI after SAH through antioxidative and anti-apoptotic effects.     

接受体外循环的先心病患儿认知功能的动态研究

目的: 研究0～4岁行体外循环(Cardiopulmonary bypass,CPB)心脏直视手术的先天性心脏病(Congenital heart disease,CHD)患儿,在术前、术后1周、术后1月神经认知功能的情况.方法: 对110例0～4岁CPB下行心脏直视手术的患儿(紫绀型36例,非紫绀型74例),在术前、术后1周、1月用Gesell发展量表进行神经认知功能测评.结果: 患儿术前神经认知功能处于中下水平,紫绀型患儿的应物能、应人能、运动能、语言能得分均低于非紫绀型患儿[(81.5 ±7.0)vs.(87.7 ±7.3)、(80.7 ±6.8)vs(87.7±8.1)、(79.2±6.4)vs.(87.2 ±8.7)、(80.8±6.1)vs(87.4 ±8.6),P＜0.001或0.01];4个方面得分术后1周均低于术前[如应人能:(82.8 ±7.7)vB.(85.4±8.3),P=0.002],术后1月均高于术前[如应人能:(91.3 ±6.2)vs.(85.4±8.3),P=0.001];年龄与应物能、应人能、运动能、语言能均呈负相关(如术后1周年龄与非紫绀型应人能B=-3.7,与紫绀型应人能β=-0.6);非紫绀型组的ICU停留时间与术后1周应人能、运动及术后1月应人能呈负相关(13=-0.6、-0.4、-0.4);非紫绀型组与紫绀型组的最低鼻咽温与术后1周语言能呈正相关(β=1.7、2.7);紫绀型组主动脉阻断时间与术后1周认知能力的4个方面及术后1月应物、应人呈负相关(β=-9.6、-3.9、-3.4、-4.7、-3.9、-7.8).结论: 接受手术时的年龄越大认知功能水平越低;在短期内,ICU停留时间、最低鼻咽温、主动脉阻断时间对患儿的认知功能有影响,且对紫绀型患儿的影响大于非紫绀型患儿.     

Neuroprotective Effects of Hydrogen Sulfide Against Early Brain Injury and Secondary Cognitive Deficits Following Subarachnoid Hemorrhage

Although the neuroprotective effects of hydrogen sulfide (H₂S) have been demonstrated in several studies, whether H₂S protects against early brain injury (EBI) and secondary cognitive dysfunction in subarachnoid hemorrhage (SAH) model remains unknown. This study was undertaken to evaluate the influence of H₂S on both acute brain injury and neurobehavioral changes as well as the underlying mechanisms after SAH. The H₂S donor, NaHS, was administered via an intraperitoneal injection at a dose of 5.6 mg/kg at 2 h, 6 h, 24 h, and 46 h after SAH in rat model. The results showed that NaHS treatment significantly improved brain edema and neurobehavioral function, and attenuated neuronal cell death in the prefrontal cortex, associated with a decrease in Bax/Bcl‐2 ratio and suppression of caspase‐3 activation at 48 h after SAH. NaHS also promoted phospho‐Akt and phospho‐ERK levels. Furthermore, NaHS treatment significantly enhanced the levels of brain‐derived neurotrophic factor (BDNF) and phospho‐CREB. Importantly, NaHS administration improved learning and memory performance in the Morris water maze test at 7 days post‐SAH in rats. These results demonstrated that NaHS, as an exogenous H₂S donor, could significantly alleviate the development of EBI and cognitive dysfunction induced by SAH via Akt/ERK‐related antiapoptosis pathway, and upregulating BDNF‐CREB expression.     

Neuropsychological Deficit and Academic Performance in Children and Adolescents Following Traumatic Brain Injury

Evaluated the utility of neuropsychological testing in predictingacademic outcome in children 1 year following traumatic braininjury (TBI). Fifty-one schoolage children who were admittedto hospital after TBI were assessed with a battery of neuropsychologicalmeasures at 3 months postinjury. Academic achievement was assessedat 3 and 12 months postinjury. The neuropsychological batteryincluded intelligence testing and measures of memory, learning,and speed of information processing. Academic outcome was assessedin terms of post-TBI changes in reading, spelling, and arithmetic;changes in teacher ratings of school performance; and changein school placement. According to logistic regression analysis,change in placement from regular to special education at 1-yearpost-TBI was predicted by injury severity and by neuropsychologicalperformance at 3 months post-TBI. Findings suggest that neuropsychologicaltesting is useful in identifying children with special educationalneeds subsequent to TBI.     

Review: cognitive and psychological outcomes in pediatric heart transplantation

OBJECTIVE: To review empirical literature investigating the cognitive and psychological effects of pediatric heart transplantation. METHODS: Electronic and library searches were used to identify empirical studies examining the cognitive and psychological effects of pediatric heart transplantation. Only studies investigating cognitive or psychological outcomes, either prospectively or cross-sectionally, were reviewed. RESULTS: Preliminary findings suggest that children and adolescents generally functioned within the normal range on most measures of cognitive functioning post-transplant. However, a complicated transplant course caused by infections or rejections may place these recipients at increased risk for cognitive difficulties post-transplant. Studies also suggested that approximately 20%-24% of pediatric heart transplant recipients experienced significant symptoms of psychological distress (e.g., anxiety, depression, behavior problems) during the first year post-transplant. CONCLUSIONS: Research suggests that some recipients are at risk for cognitive and psychological difficulties post-transplant and may require additional academic remediation and/or psychological intervention to address these challenges. Given the limited number of empirical studies available at this time, continued research investigating cognitive and psychological outcomes following pediatric heart transplantation is needed.     

Age and Gender Differences in School-Age Children's Appraisals of Injury Risk

Objective: To examine age and gender differences in children'sperception of injury risk and to evaluate cognitive factorsthat relate to their appraisal of risk. Methods: The participants were 120 children (6 to 10 years ofage), who used a series of photographs, which depicted playactivities that varied from no to high risk, to appraise injuryrisk. Results: Children were able to distinguish varying degrees ofinjury risk. Boys rated risk as lower than girls, and 6-year-oldchildren identified fewer risk factors and did so more slowlythan 10-year-old children. For girls, perceived vulnerabilityto injury was the best predictor of injury risk ratings, whereasfor boys it was judged severity of potential injury. Conclusions: Children's appraisal of risk and age and genderdifferences in related factors highlight important componentsfor injury prevention programs.