Quantitative analysis of GFAP- and S100 protein-immunopositive astrocytes to investigate the severity of traumatic brain injury

Previous studies have shown that diffuse cortical astrocyte damage is seen in acute deaths due to brain injury and mechanical asphyxiation. The present study quantitatively investigated the number of astrocytes that showed GFAP- and S100-protein immunopositivity in the cerebral white matter and hippocampus at the sites distant from primary injury with regard to survival time, complication, and the immediate cause of death of brain injury cases. Autopsy cases of brain injury (8-48 h postmortem) comprising acute/subacute deaths (survival time, <3/6 h-3 days; n=27/42) and delayed deaths (survival time >3 days) with/without complications (n=30/22) were examined. Delayed death cases with complications were subdivided into those in which the immediate cause of death had been determined as cerebral dysfunction (n=22) and those that had been determined as due to fatal complications (n=8). For controls, natural deaths from pneumonias (n=12) and sudden cardiac deaths (n=27) were used. In brain injury cases, the numbers of astrocytes in the cerebral white matter and hippocampal CA4 region were significantly lower for subacute death and delayed death without complications (p<0.05-0.001). Delayed death with fatal complications showed a significant increase in the number of astrocytes (p<0.05). Among delayed death cases, the numbers of astrocytes were higher in the cases with fatal complications than in those without complications and with non-fatal complications, although the latter cases showed large variations in the numbers of these astrocytes. These findings suggest that critical brain injury causes acute death without evident astrocyte pathology and that subacute death is associated with progressive brain damage accompanied by an astrocyte loss. In delayed death cases, the numbers astrocytes might be closely related to the severity of posttraumatic brain injury. GFAP and S100-immunopositivity might be useful for elucidating the cause and process of deaths due to brain injury.     

进行性出血性脑损伤手术时机探讨

目的探讨进行性出血性脑损伤的最佳手术时机,以提高临床治疗成功率,降低致残率及死亡率。方法将148例进行性出血性脑损伤患者根据其手术时机的不同分为观察组(74例)及对照组(74例)。男性79例,女性69例;年龄11~79岁,平均(44.6±8.7)岁。道路交通伤88例,暴力重击伤43例,高处坠落伤17例。观察组患者手术时间至受伤时间24h,对照组手术时间至受伤时间24h,分析两组患者的临床治疗效果及并发症发生情况。结果观察组患者临床治疗有效率为91.9%,明显高于对照组(79.7%),具有统计学意义;观察组并发症发生率为6.8%,明显低于对照组(14.9%),存在统计学差异。结论伤后及时复查颅脑CT,并在24h内实施开颅手术能够有效地提高进行性出血性脑损伤患者的临床治疗有效率,降低并发症的发生率,改善患者预后。     

脑神经胶质瘤术后复发和播散的螺旋CT表现

目的 探讨脑神经胶质瘤术后复发和播散的螺旋CT表现与组织学类型。方法回顾性分析33例脑胶质瘤术后的螺旋CT资料，总结脑胶质瘤复发和播散的类型及复发时间分布特点，并进行统计学分析。结果33例中有20例脑胶质瘤术后复发和播散，其中包括10例胶质母细胞瘤，4例星形细胞瘤，3例髓母细胞瘤，2例少支胶质细胞瘤，1例胶质肉瘤。复发和播散常发生在术后2个月至1a内。结论 脑胶质瘤术后复发通常起源于手术切缘周围2cm范围内生长。播散主要为脑脊液种植播散。螺旋CT扫描是脑胶质瘤术后复发和播散随诊观察的有效手段。     

颅脑损伤患者创伤后凝血病发生的影响因素分析

目的分析颅脑损伤患者创伤后凝血病发生的危险因素。方法选取2014年6月~2015年10月接受治疗的115例颅脑损伤患者为观察对象,根据其是否发生凝血病分为凝血病组和非凝血病组。观察颅脑损伤患者创伤后凝血病的发生率,分析造成创伤后凝血病发生的危险因素。结果 115例颅脑损伤患者中,发生创伤后凝血病26例,凝血病发生率为22.61%;凝血病组患者凝血酶原时间(PT)、活化部分凝血酶原时间(PTT)和血小板计数(PLT)水平低于非凝血病组,D-二聚体(D-DT)水平高于非凝血病组,两组患者的纤维蛋白原(FIB)水平无明显差异(P0.05);损伤严重度评分(ISS)16分、血压≤90mm Hg、体温36.5℃、动脉血pH7.2的颅脑损伤患者创伤后凝血病的发生率较高,差异具有统计学意义,而不同年龄、性别的患者凝血病发生率无明显差异;将单因素分析有意义的ISS评分16分、收缩压≤90mm Hg、体温36.5℃、动脉血pH7.2作为自变量,将是否发生凝血病作为因变量,进行多因素Logistic回归分析,结果ISS评分、输液量和动脉血pH进入回归方程,其OR值分别为4.286、5.128和3.962。结论颅脑损伤患者有发生创伤后凝血病的危险,ISS评分、输液量和动脉血pH是患者发生凝血病的危险因素。     

高压氧治疗联合常规疗法对脑外伤患者认知功能障碍及预后的影响

目的：探讨脑外伤患者在高压氧联合常规方法治疗下对患者的认知功能障碍及预后的影响。方法选取了2013年5月～2015年5月就诊的88例脑外伤患者,通过随机数字表将88例脑外伤患者均分为观察组和对照组各44例。对照组利用常规药物治疗,观察组在对照组治疗基础上利用高压氧治疗。结果两组脑外伤患者治疗后的NCSE、FIM各个项目的评分均显著的升高,与治疗前比较差异显著,具有统计学的意义（ P＜0．05）;观察组的脑外伤患者治疗有效率（97．73％）显著高于对照组（84．09％）,比较后差异显著,具有统计学的意义（P＜0．05）。结论高压氧疗法可以明显提高脑外伤患者的治疗效果,降低了致残率和后遗症,患者的预后得到明显改善,且认知功能也得到了恢复。     

Enzyme alterations in brain tissue during the early postmortal interval with reference to the histomorphology: Review of the literature

Summary The state of research on enzyme alterations in brain tissue during the early postmortal interval is surveyed with special reference to the histomorphology; the questions currently discussed in the literature are given special consideration. The type of alterations appearing during the postmortal interval and their dependency on the length of the interval are described so that practically applicable conclusions may be drawn. The findings on enzyme alterations presented in the literature (enzymes of the oxidative metabolism, transmitter, enzymes) are compiled in tables.It could be shown that important structural alterations ascertainable with light microscopy and quantitative alterations in enzyme activity ascertainable with biochemical methods do not usually occur during a 6- to 8-h postmortal interval. Qualitative investigations (i.e., histoenzymatic studies) with longer postmortal intervals and with positive findings are applicable.     

大鼠侧向液压脑损伤后脑血管内血栓形成的实验研究

目的探讨颅脑创伤后脑血管内微血栓形成现象及其与外伤后脑梗死的关系。方法采用鼠侧向液压冲击脑损伤装置建立急性脑创伤模型,受损伤大鼠分别在伤后12、24、72h和7天处死。对照组动物仅行开颅术,无液压冲击。观察脑内微血栓形成部位及数量,并比较各组间脑内血栓数量的差异。结果冲击伤后大鼠脑血管内有大量微血栓形成,与对照组比较差异显著（P〈0．05）。大鼠脑内伤后12h即有血栓形成,此后逐渐增多,伤后7天逐渐下降。此外,在脑内血栓相对集中区域还发现大量的变性神经元。结论颅脑外伤引起脑内广泛血栓形成,可能是外伤后脑梗死的原因之一。     

Axonal injury in closed head injury by assault: a quantitative study.

Due to the controversy in the literature regarding the time course of axonal balloon formation in human material, we wished to determine if it was possible to diagnose axonal injury before the development of axonal balloonings. The hypothesis was that the presence of axonal swellings or axonal enlargements associated with a glial reaction could be used as a diagnostic aid in human axonal injury before 12 hours. The brains of eight individuals that survived for less than 48 hours following head injury, and also had evidence of axonal injury using the criteria of Vanezis et al. (1987), were systematically studied by looking at axonal swellings, axonal balloonings, reactive astrocytes, maximum diameter of axonal enlargements and density of axonal enlargements. Controls were eight selected cases without neurological disease. The variables studied were assessed in 25 fields from ten different areas of the brain, using silver stains and immunoperoxidase for glial fibrillary acidic protein (GFAP). Logarithms of one plus the count of each variable were taken from the raw data and these were analysed using percentile distribution and the median, the t-test, Mann-Whitney U test and the Wilcoxon signed rank test. We conclude that quantitation of axonal damage allows the detection of mild degrees of axonal injury that could be overlooked on routine examination, and that the criteria of axonal enlargements, rather than axonal balloonings, are indications of axonal damage, cannot be endorsed with the evidence provided.     

高速公路交通伤后创伤后应激障碍分析

目的 研究高速公路交通伤患者创伤后应激障碍（post traumatic stress disorders，PTSD）的发生情况及影响因素。方法 对我院2002年1月-2004年1月收治的高速公路交通伤患者，采用ICD-10诊断标准，制定PTSD危险网素调查表，分析PTSD的发病率，临床表现及危险洲素。结果 高速公路交通伤患者中PTSD发病率为18．8％。主要临床表现有：睡眠障碍、控制不住同想创伤经历、感到与人疏远、与亲人感情变淡等。PTSD的发生与交通伤患者的性格特征、文化程度、家庭成员问的关系及是否遗留躯体残疾有关。结论 高速公路交通伤患者的PTSD发生率较高，针对易感人群应引起足够的重视并进行早期干预，将有利于减少PTSD的发生。     

Strahlenspätveränderungen nach kleinvolumiger radiochirurgischer Bestrahlung des Rattenhirns Messung des lokalen zerebralen Blutflusses und histopathologische Untersuchungen

BACKGROUND: The goal of this study was to investigate late effects following stereotactic single fraction and small volume irradiation on cerebral blood flow and histologic alterations in the rat brain parenchyma. MATERIAL AND METHODS: 66 Copenhagen rats, separated into eleven groups of six animals each received single doses of 20, 30, 40, 50 and 100 Gy using a 15 MV linear accelerator. Six rats served as controls. Two cylindrical collimators of 2 mm and 3 mm aperture were used. The diameters of the spherical 80% isodose were 3.7 and 4.7 mm, respectively (Table 1). Irradiation was applied to a predefined area in the right frontal lobe. 19 months after irradiation local cerebral blood flow (LCBF) was measured by the autoradiographic method in one animal of each dose group between 20 and 50 Gy. 9 and 19 months after irradiation, half of the animals of each group were sacrificed for brain histology. All animals irradiated with 100 Gy were sacrificed 7 months after irradiation. RESULTS: An increase of local cerebral blood flow was measured in brain structures within the 80% isodose in animals irradiated with 50 Gy (Figure 3) compared to the contralateral hemisphere. Measurements close to necrotic areas showed a strong decrease of local cerebral blood flow (Figure 1). A volume increase of the irradiated hemisphere was seen after 19 months (Figure 2). The histologic examination after 19 months showed necrotic areas in the 30-50 Gy groups (Figure 4b) but not in the 20 Gy groups (Figure 4c). The animals who received 100 Gy demonstrated brain necrosis within 9 months after irradiation (Figure 4a). At both points in time the groups irradiated with the 3-mm collimator showed more pronounced histomorphologic and functional changes compared to the groups irradiated with the 2-mm collimator. CONCLUSION: Alterations of the local cerebral blood flow were measured as a late effect after single dose irradiation. The alterations of the local cerebral blood flow could be explained by the histomorphologic changes of the blood vessels. Using a semi-quantitative classification a dose, time and volume dependence for the endpoint radionecrosis was seen.     

重型颅脑损伤去骨瓣减压术预后分析

目的分析重型颅脑损伤患者行去骨瓣减压术预后的相关因素。方法对我院于2009年1月~2013年6月收治的110例行单侧或双侧去骨瓣减压术的重型颅脑损伤患者的临床资料进行回顾性分析,其中男性83例,女性27例;年龄14~82岁,平均47.2岁。重点观察年龄、受伤至开颅手术时间、格拉斯哥昏迷评分(GCS)、瞳孔大小、对光的反射程度以及CT检查等相关因素与预后之间的关系,并将患者6个月以内的扩展的Glasgow预后量表以评分的形式对预后进行评价。结果据单因素法分析结果表明,预后良好组及预后不良组在年龄[(139.08±14.45)岁vs.(53.91±14.65)岁]、受伤至开颅手术时间[(35.64±47.71)h vs.(9.55±12.19)h]、瞳孔大小[(12.85±0.49)mm vs.(3.57±1.01)mm]、GCS评分[6.37±1.56vs.4.55±1.08]及CT值[3.55±0.89 vs.4.48±0.96]方面存在明显差异(P0.05),具统计学意义;据多因素Logistic回归法分析结果表明,年龄、受伤至开颅手术时间、瞳孔大小、GCS评分及CT值与预后之间有密切联系。结论患者年龄、受伤至开颅手术时间、GCS评分、瞳孔大小、对光的反射程度以及CT检查等相关因素与预后之间存在密切联系,可作为对重型颅脑损伤患者预后进行评价的临床指标。     

自制水枕在重型颅脑损伤中的临床应用

目的观察使用自制水枕对重型颅脑损伤患者头部压疮的预防作用。方法将60例符合入选标准的重型颅脑损伤患者随机分为治疗组和对照组,每组均30例,治疗组常规使用自制水枕预防头部压疮,并按相关指标观察。结果两组年龄分布、性别构成比较差异无统计学意义（P〉0.05）;经观察统计治疗组使用自制水枕后,无一例头部压疮发生,对照组发生头部压疮3例,两组头部压疮发生率比较差异有统计学意义。结论使用自制水枕能有效预防重型颅脑损伤患者头部压疮的发生,使用方便,安全有效,值得临床运用和推广。     

MRI appearances of the infrapatellar fat pad in occult traumatic patellar dislocation

AIM: A study was undertaken to determine the status of Hoffa's infrapatellar fat pad in instances of acutely dislocated patellae. MATERIALS AND METHODS: The study consisted of MR examinations performed on 18 consecutive patients with acutely dislocated and relocated patellae with a mean interval between injury and MR examination date of 14.8 days (range 1-60 days). An analysis of the attachments and intrinsic signal characteristics of the fat pad was performed for each individual case. RESULTS: Hoffa's fat pad was abnormal in all cases. Shear injury from the inferior pole of the patella was present in 16 cases. Intrasubstance disruption with fluid filled clefts were noted in 12 cases. In 17 cases diffuse oedema of Hoffa's fat pad had occurred. In nine cases the damaged fat pad mimicked a loose body, while in five cases an intra-articular post-traumatic loose body was identified. CONCLUSION: Post-traumatic change in Hoffa's fat pad is a constant secondary MR feature not previously reported, that can be added to the spectrum of indirect findings in cases of occult patellar dislocation. In addition, the MRI distinction between post-traumatic changes in Hoffa's infrapatellar fat pad from loose osteo-chondral bodies can be difficult, requiring further correlative imaging.     

微创与传统术式治疗SandersⅡ型跟骨关节内骨折的临床研究

目的探讨微创与传统术式治疗SandersⅡ型跟骨关节内骨折的临床效果。方法选择2012年12月~2014年2月期间30例SandersⅡ型跟骨关节内骨折患者为研究对象,将30例患者按照随机数字表法分为研究组和传统组各15例。研究组:给予微创内固定治疗。传统组:给予传统"L"形切口内固定治疗。记录研究组和传统组等待时间、手术时间、术后引流量、早期并发症、晚期并发症,测量术前、术后Bhler角、Gissane角,采用直观模拟量表(VAS)、美国骨科足踝外科协会(AOFAS)后足评分及健康状况调查表(SF-36)对手术效果进行评估。结果研究组和传统组等待时间、手术时间比较差异无统计学意义(P0.05);研究组术后引流量、早期并发症、晚期并发症发生率少于传统组,差异有统计学意义(P0.05);研究组和传统组术后Bhler角和Gissane角均较术前提高,但增加度数比较差异无统计学意义(P0.05);研究组和传统组VAS评分、AOFAS后足评分比较差异无统计学意义(P0.05);研究组SF-36评分高于传统组,差异有统计学意义(P0.05)。结论与传统内固定治疗相比,微创内固定治疗SandersⅡ型跟骨关节内骨折可以获得与传统内固定治疗接近的疗效,且对患者创伤小,近远期并发症发生率较低,有利于患者距下关节功能的恢复,可加速患者的康复。     

CT三维重建在骨盆骨折及盆腔脏器损伤手术治疗方案设计中的价值

目的：探讨螺旋CT三维重建在骨盆骨折及盆腔脏器损伤手术治疗方案设计中的价值。方法分析2007年1月至2013年12月行手术治疗的骨盆骨折及盆腔脏器损伤的患者CT三维重建影像资料,比较术前与术后影像资料及疗效。采用SPSS 17．0统计软件和χ2检验分析轴位CT及三维CT对骨盆骨折诊断的差异。结果149例骨盆骨折患者通过CT三维重建确诊髂骨骨折19例、骶尾骨骨折43例、耻骨上下支骨折30例及髋臼骨折57例;关节脱位21例、耻骨联合分离5例。轴位CT组与三维CT组间比较在髋臼骨折及骶尾骨骨折上,差异有统计学意义（P＜0．05）。髂骨骨折、耻骨上下支骨折、关节脱位及耻骨联合分离无统计学意义。合并盆腔脏器损伤有17例,其中膀胱破裂8例、后尿道损伤5例,盆腔血肿4例。149例患者术后复位效果中解剖复位64例,满意75例,不满意14例。获得随访20 d至83个月。按Matta疗效标准评定,临床标准：优97例,良45例,可7例,优良率95％;X线标准：优95例,良45例,可9例,优良率94％。结论螺旋CT三维成像多平面重建（MPR）、容积重建（VR）及表面遮盖重建（SSD）以最直观、全面的骨盆骨折及盆腔脏器损伤图像肯定并明确螺旋CT对骨盆骨折的分型;对治疗方案、手术入路、内固定物的选择和制定详细的手术计划可提供正确指导,在骨盆骨折及盆腔脏器损伤术前、术后影像检查中有较高的价值。     

MR imaging of brain injury induced by carbon ion radiotherapy for head and neck tumors.

To clarify the characteristics of magnetic resonance (MR) imaging of radiation-induced brain injury following carbon ion radiotherapy and to observe the changes in lesions over time, we evaluated 40 patients with radiation-induced brain injury from carbon ion radiotherapy for head and neck tumors. Their primary lesions received a radiation dose of 48 to 70.4 Gray equivalent (GyE) in 16 to 18 fractions. MR imaging of radiation-induced brain injury was graded as follows: Grade 1: change in focal white matter; focal contrast enhancement and surrounding edema; Grade 2: nonenhanced area or cystic lesion in enhanced lesion; Grade 3: focal necrosis with mass effect; and Grade 4: mass effect requiring surgical intervention. Radiation-induced brain injury appeared as early as 2 months and as late as 57 months after carbon ion therapy (mean interval, 22.2 months). MR findings of initial lesion were Grade 1 in 26 cases (65.0%), Grade 2 in 13 (32.5%), and Grade 3 in 1 (2.5%). Brain injury was always found in the radiation field initially, but cystic lesion and edema later extended outside the field in 10 cases (25.0%). In follow-up MR studies, size of edema or enhanced lesion was reduced in 17 patients (42.5%) without treatment. Two cases with large cystic lesions required surgery. Improvement of radiation-induced brain injury was observed more often than had been previously described. Because edema and cystic lesion can occasionally extend outside the radiation field, such findings do not exclude the possibility of radiation-induced brain injury. Careful observation is recommended because cystic lesions can enlarge enough to require surgical treatment in some cases.     

水通道蛋白-4在人脑挫裂伤早期脑水肿的作用机制探讨

目的探讨人脑挫裂伤后早期AQP4在脑水肿形成中的作用机制,为颅脑损伤后脑水肿的治疗和预后提供客观依据。方法选取经颅脑CT证实为脑挫裂伤且需手术治疗的患者。手术过程中切取脑挫裂伤区组织标本60例为观察组,10例非功能区相对正常脑组织标本为对照组。对照组不做任何处理,观察组按伤后时间分为2h、6h、8h、12h、24h、72h6个亚组,每组10只（n=10）。采用免疫组化和图像分析技术测定各组相应时间点水肿区AQP4的表达水平,同时用干湿重法检测脑水肿含水量。结果与对照组相比较,观察组在伤后2hAQP4表达开始增加（P〈0．05）,6h、8h、12h明显增加（P〈0．01）,24h-72h达到最高（P〈0．01）。AQP4表达与脑含水量的变化规律趋于一致（r=0．912,P〈0．01）。结论脑挫裂伤后AOP4表达明显增强,提示AQP4可能与颅脑损伤的发生、发展过程密切相关,在损伤后脑水肿的形成过程中起重要作用。     

猫闭合性创伤性脑水肿扩散加权成像的实验研究

目的建立猫急性闭合性脑创伤(TBI)模型,并应用扩散加权成像(DWI)探讨伤后脑水肿类型及演变规律。方法共选取22只猫,以最大角加速度(6.43±0.15)×105rad/s2制成TBI模型,其中10只用于常规MRI及DWI扫描,连续观察伤前及伤后3、6、24、48、72 h 6个时相点,另于上述相同6个时相点,分别选取6只猫用于HE及嗜银染色、6只猫用于透射电镜观察。结果常规MRI显示蛛网膜下腔出血1例、硬膜外或硬膜下出血2例、脑挫裂伤2例、脑室内出血1例、同时显示蛛网膜下腔出血和脑挫裂伤2例、同时显示硬膜下出血和脑实质内点状出血2例。10只猫致伤前后各时点ADC值显示细胞毒性及血管源性两种类型脑水肿,其中7只(70%)猫以细胞毒性脑水肿改变为主,24 h达峰值;3只(30%)猫早期以血管源性脑水肿改变为主,6 h达峰值,而后期以细胞毒性脑水肿为主。HE、嗜银染色及透射电镜显示血管通透性增加、细胞肿胀,轴索肿胀、断裂、轴索球形成。结论猫急性闭合性创伤性脑水肿包括细胞毒性及血管源性两类,以细胞毒性水肿为主。扩散加权成像是观测脑水肿的一种可靠方法。     

早期外固定术在重型颅脑创伤合并四肢骨折中的应用

目的 探讨早期(<48 h)骨折外固定术在重型颅脑创伤(GCS≤8)合并四肢骨折患者中的临床应用效果.方法 统计重型颅脑创伤合并四肢骨折年龄、性别、颅脑创伤情况、骨折部位分布及其他全身情况等差异均无统计学意义的患者,根据骨折的早期(＜48 h)治疗方法不同,将重型颅脑创伤患者分为两组.A组:早期骨折外固定组(40例);B组:早期骨牵引、石膏固定等保守治疗组(57例).对比分析两组患者褥疮、肺炎、下肢静脉血栓形成等并发症发生情况,ICU时间、住院时间、骨折愈合时间、病死率等指标.结果 A组在感染率、褥疮、肺炎、下肢静脉血栓发生率方面明显低于B组(P＜0.05).A组的ICU时间、住院时间、骨折愈合时间短于B组(P＜0.05).A组的病死率低于B组,差异有统计学意义(P＜0.05).结论 针对重型颅脑创伤合并四肢骨折的患者,开展早期骨折外固定法与原有早期骨牵引、石膏固定等保守治疗方法相比,减少了并发症,缩短了恢复时间,降低了病死率.     

Running injury and stride time variability over a prolonged run

Locomotor variability is inherent to movement and, in healthy systems, contains a predictable structure. In this study, detrended fluctuation analysis (DFA) was used to quantify the structure of variability in locomotion. Using DFA, long-range correlations (α) are calculated in over ground running and the influence of injury and fatigue on α is examined. An accelerometer was mounted to the tibia of 18 runners (9 with a history of injury) to quantify stride time. Participants ran at their preferred 5k pace±5% on an indoor track to fatigue. The complete time series data were divided into three consecutive intervals (beginning, middle, and end). Mean, standard deviation (SD), coefficient of variation (CV) and α of stride times were calculated for each interval. Averages for all variables were calculated per group for statistical analysis. No significant interval, group or interval×group effects were found for mean, SD or CV of stride time. A significant linear trend in α for interval occurred with a reduction in α over the course of the run (p=0.01) indicating that over the run, stride times of runners became more unpredictable. This was likely due to movement errors associated with fatigue necessitating frequent corrections. The injured group exhibited lower α (M=0.79, CI(95)=0.70, 0.88) than the non-injured group (p=0.01) (M=0.96, CI(95)=0.88, 1.05); a reduction hypothesized to be associated with altered complexity. Overall, these findings suggest injury and fatigue influence neuromuscular output during running.