Feasibility and Preliminary Validation of an Online Version of the Ohio State University Traumatic Brain Injury Identification Method

Objective

To test the feasibility and validity of an online version of an established interview designed to determine a lifetime history of traumatic brain injury (TBI).

定量磁化率图在脑微出血中的研究进展

脑微出血（CMB）常见于脑小血管病和神经退行性疾病。在病理上,CMB区域存在含铁血黄素沉积。定量磁化率图（QSM）可对这类超顺磁性物质精准定量,从而为CMB相关疾病的早期诊断提供有力工具,且在疾病严重程度分级和预后判断方面发挥重要作用。综述QSM用于诊断脑淀粉样血管病（CAA）、阿尔茨海默病（AD）、血管性痴呆（VaD）、多发性硬化（MS）、前哨性头痛（SH）、创伤性脑损伤（TBI）等中枢神经系统疾病CMB的研究现状及其进展。     

Inhibition of miR-429 improves neurological recovery of traumatic brain injury mice and attenuates microglial neuroinflammation

BackgroundNeuroinflammation is a common therapeutic target for traumatic brain injury (TBI) due to its contribution to delayed secondary cell death and has the potential to occur for years after the initial insult. Previous studies demonstrate that miR-429 is up-regulated in the brain lesions of TBI mice, while its role in regulating neuroinflammation and brain injury remains largely unknown.MethodThe expression of miR-429 in LPS-activated microglia and microglia in TBI model was detected by RT-PCR. The effects of miR-429 inhibitors on LPS-activated microglia in vitro as well as neurological recovery and post-traumatic neuroinflammatory response in TBI model mice were detected in vivo.ResultsLPS and TBI significantly induce the up-expression of miR-429, inflammatory cytokines, MAPK-p38 and phosphorylated NF-κB in microglia, which were all inhibited by miR-429 inhibitors. Meanwhile, miR-429 inhibitors also attenuated the neurological impairment in TBI mice. Bioinformatics analysis showed that miR-429 could target and inhibit the expression of dual specificity protein phosphatase 1 (DUSP1), thus inhibiting the expression of MAPK-p38 and phosphorylated NF-κB.ConclusionmiR-429 plays a pro-inflammatory role in activated microglia by targeting DUSP1 signaling pathway. Inhibiting miR-429 can attenuate the inflammatory response of microglia and TBI-mediated brain damage.     

Predicting neurosurgical clearance in the polytrauma patient with concomitant traumatic brain injury

The goal of this study is to develop a model based on previously used prognostic predictors in traumatic brain injury (TBI) patients with polytrauma, which will facilitate the decision-making of whether to clear these patients for non-cranial surgery. Data of eligible patients was obtained from a trauma database at a Level I trauma and academic tertiary referral center in the United States. The number of days seen by the neurosurgical service prior to clearance, injury severity score (ISS), post-trauma day 0 (PTD 0) of Glasgow Coma Score (GCS), intracranial pressure (ICP) score and computed tomography (CT) score, as well as the changes in GCS, ICP score and CT score between PTD 0 and day of clearance were the variables used in developing the model. The Neurosurgical Clearance Model (NCM) was developed using data from 50 patients included in the study. Patients were cleared by neurosurgeons 1.6 days later than it would appear possible based on a retrospective review of the patients’ clinical conditions. A single model equation was developed, the ultimate result of which is a clearance probability value. The best cutoff clearance probability value was found to be 0.584 (or 58.4%) using Receiver Operator Characteristic curve analysis. Our data suggests that neurosurgeons are risk-averse in clearing polytrauma patients for non-cranial surgery. This pilot NCM, if reproduced and validated by other groups and in larger prospective studies, may become a useful tool to assist clinicians in this often-difficult decision-making process.     

心理治疗对创伤骨折患者心理状况的效果研究

目的 探讨心理治疗对创伤骨折患者心理状态的影响,以便为骨折患者心理干预治疗提供科学依据.方法 将符合条件的创伤骨折患者分为干预组和非干预组.非干预组行常规治疗,干预组在常规治疗的基础上进行心理治疗,应用焦虑自评量表(SAS)、抑郁自评量表(SDS)、生活质量评定问卷(SF-36)对两组患者在心理治疗前后进行测查.结果 与常模比较创伤骨折患者的SAS、SDS的总分高于常模(t=4.88,3.57;P＜0.01);心理治疗后,干预组SAS、SDS总分低于非干预组(t＝ 2.54,P＜0.05;t=2.65,P＜0.01);SF-36除生理机能外各因子分高于非干预组(P＜0.05).结论 创伤骨折患者存在明显的焦虑、抑郁情绪,心理治疗可以明显的改善患者的心理健康状况及其生活质量.     

基于多学科协作团队的急救护理路径在创伤性休克患者中的应用

目的:探讨基于多学科协作团队(MDT)的急救护理路径在创伤性休克患者中的应用效果。方法:选取2018年1月—2019年12月连云港市第一人民医院急诊抢救室收治的创伤性休克患者200例为研究对象。其中2018年1—12月收治的112例患者为对照组,给予常规急救护理措施;2019年1—12月收治的108例患者为观察组,实施基于MDT的急救护理路径。比较两组患者院内抢救反应时间、抢救结果和家属满意度差异。结果:观察组患者抢救介入时间为(8.4±5.8)min,急诊停留时间为(15.0±4.3)min,术前准备时间为(10.4±3.2)min,低于对照组的(14.1±6.7)、(19.7±4.1)、(13.6±3.5)min,差异均有统计学意义(P<0.05)。观察组抢救成功率高于对照组(90.7%vs.73.2%)、患者多器官功能障碍综合征发生率低于对照组(7.4%vs.17.0%)、窒息发生率低于对照组(4.6%vs.13.4%),差异均有统计学意义(P<0.05)。观察组患者家属满意度评分高于对照组[(40.8±3.6)vs.(37.4±3.8)分],差异有统计学意义(P<0.05)。结论:基于MDT的急救护理路径可缩短创伤性休克患者的院内抢救反应时间,提高抢救成功率和患者家属满意度,降低并发症发生率。     

Global mean diffusivity: A radiomarker discriminating good outcome long term after traumatic brain injury

BackgroundTraumatic brain injury (TBI) is a chronic pathology responsible for cognitive disorders impacting outcome. Global clinical outcome several years after TBI may be associated with anatomical sequelae. Anatomical lesions are not well described because characterizing diffuse axonal injury and brain atrophy require using specific MRI sequences with quantitative measures. The best radiologic parameter to describe the lesions long term after TBI is not known.ObjectiveWe aimed to first, assess the global volumetric and diffusion parameters related to long-term outcome after TBI and second, define the most discriminating parameter.MethodsIn this observational study, we included 96 patients with severe TBI and 22 healthy volunteers. The mean delay after TBI was 63.2 months [range 31–119]. The Glasgow Outcome Scale Extended (GOS-E) was used to assess the global long-term clinical outcome. All patients underwent multimodal MRI with measures of brain volume, ventricle volume, global fractional anisotropy (FA) and global mean diffusivity (MD).ResultsAll 96 participants had significant impairment in global FA, global MD, brain volume and ventricle volume as compared with the 22 controls (P < 0.01). Only global MD significantly differed between the “good recovery” group (GOS-E score 7-8) and the other two groups: GOS-E scores 3-4 and 5-6. Brain volume significantly differed between the GOS-E 7-8 and 3-4 groups. Global MD was the most discriminating radiological parameter for the “good recovery” group versus other patients, long term after TBI. FA appeared less relevant at this time. Global atrophy was higher in patients than controls but lacked reliability to discriminate groups of patients.ConclusionGlobal mean diffusivity seems a more promising radiomarker than global FA for discriminating good outcome long term after TBI. Further work is needed to understand the evolution of these long-term radiological parameters after TBI.