心理护理干预对脑震荡患者焦虑抑郁综合征的作用

目的：探讨心理护理干预在治疗脑震荡患者焦虑抑郁综合征中的应用及其效果。方法84例患有焦虑抑郁综合征的脑震荡患者随机分为实验组和对照组,各42例。所有患者给予药物对症治疗,同时对照组给予常规护理,实验组在对照组的基础上增加心理护理干预,对比2组患者治疗前后焦虑抑郁情况以及治疗后患者护理满意度。结果治疗总有效率2组比较差异不具有统计学意义（P＞0．05）;实验组患者护理后焦虑自评量表（SAS）和抑郁自评量表（SDS）评分均显著低于对照组（P＜0．01）;实验组患者护理满意程度为92．86％（39/42）,显著高于对照组的61．90％（26/42）,差异具有统计学意义（P＜0．01）。结论对脑震荡并发焦虑抑郁综合征患者实施心理护理干预,能够潜在改善患者的焦虑抑郁情绪,增加使患者的护理满意度,值得临床借鉴。     

不同打击间隔的三重性脑震荡大鼠空间认知行为变化研究

目的 建立不同打击间隔的三重性脑震荡(multiple cerebral concussion,3MCC)大鼠模型,观察3MCC 24 h、48 h和72 h损伤大鼠水迷宫(morris water maze,MWM)学习记忆行为变化,评估与比较其空间认知功能改变,为临床脑震荡(cerebral concussion,cc)患者的诊治和预防提供实验依据.方法 (1)实验分组:选取成年健康SD大鼠40只,雌雄各半,体重260 ～ 280 g.造模后随机分为3MCC 24 h、3MCC 48 h和3MCC 72 h损伤组(每组10只),另设对照组(10只); (2)应用金属单摆闭合性脑损伤打击装置,分别以打击间隔为24h、48 h和72 h,连续打击3次,形成3MCC 24 h组、3MCC 48 h组和3MCC 72 h组损伤实验大鼠.(3)应用Morris水迷宫实验评估各实验组大鼠空间认知功能.结果 (1)在水下平台实验中,对照组大鼠表现为快速下降后趋于平稳;而各损伤组大鼠逃避潜伏期呈不同程度的徐缓下降,逐渐趋于平稳.与对照组比:3MCC 24 h、48 h和72 h组大鼠逃避潜伏期的伤后恢复均明显延迟,3MCC 24 h组和48 h组在伤后第1～14天、3MCC 72 h组除第7天、第10天外的其余12d均具有统计学意义(P＜0.05).与3MCC 24 h组相比:24h组大鼠逃避潜伏期较其它2个3MCC组明显延迟,3MCC 48 h组和3MCC 72 h组在伤后第1～11天均具有统计学意义(P＜0.05).(2)在水上平台实验中,与对照组比,3个3MCC组大鼠找到水上平台的时间均明显延长,具有统计学差异(P＜o.05).(3)在无平台实验中,各损伤组大鼠在第Ⅰ象限(原平台所在象限)停留的时间减少,且由轻到重依次为72 h组、48 h组、24 h组;与正常组相比,各损伤组在第Ⅰ象限(原平台所在象限)停留时间减少,其中3MCC 24 h组、48 h组减少具有统计学意义(P＜0.05).结论 (1)不同打击间隔的多重性脑震荡大鼠的空间认知功能均有不同程度的损害,至伤后第14天仍未恢复正常; (2)在三重性脑震荡中,打击间隔越长,其空间认知功能的损害就越轻.     

A Preliminary Study to Identify Locomotor-Cognitive Dual Tasks That Reveal Persistent Executive Dysfunction After Mild Traumatic Brain Injury

Objective

To identify different combinations of physical (level, obstacle avoidance, stepping down) and cognitive (visual, mental) demands within a locomotor navigational context that best discriminates between persons with mild traumatic brain injury (MTBI) and control subjects for an eventual clinical tool to assess residual executive dysfunction.

Design

Group comparison study.

Setting

Rehabilitation facility.

Participants

Volunteer sample (N=14) of persons with MTBI (n=7) (6 women; age, 20±1.6y) and a comparison group (n=7) of subjects without neurologic problems (6 women; age, 22.4±1.4y).

Interventions

Not applicable.

Main Outcome Measures

Gait speed (m/s) and dual-task cost calculated as the relative change in gait speed from single (no cognitive task) to dual tasks for the same gait condition.

Results

There were significant interactions between groups and cognitive tasks and between groups and cognitive and physical tasks for gait speed. Specifically, the MTBI group walked slower than control subjects in the dual-task conditions when stepping over an obstacle combined with each cognitive task. When gait speed was measured as dual-task costs, group differences were more evident, except for stepping down.

Conclusions

These preliminary results suggest that both absolute gait speed and calculated dual-task costs during the combination of stepping over an obstacle with a simultaneous cognitive task are sensitive to revealing executive dysfunction in persons with MTBI. Gait speed can be easily measured in the clinic to provide important information to make diagnoses and decide about return to play or function. Continued work building on these preliminary results is needed toward the development of a clinical tool.     

猴头部冲击性脑损伤的判别

为在航空弹射救生的头部冲击伤的研究中区别脑功能性与器质性损伤的界限，使用高速动态加载机，对２４只猴头进行了不同冲击载荷的撞击实验，依据有关临床诊断标准判别，冲击后８只猴发生了单纯性脑震荡，６只猴发生了脑实质性损伤，而其中的３只猴又伴有脑震荡症状。结果表明，发生了脑震荡的猴都出现了暂短生理反射减弱或消失，呼吸和心率减慢，脑干神经细胞尼氏体有减少现象脑震荡伴有脑损伤的猴脑脊液中还检出ＣＫ－ＢＢ酶和红细     

Concussion in rats causes an immediate change in occupancy but not affinity of hypothalamic cholinergic receptors

Experimental concussion in rats is associated with subsequent enhanced binding in vitro of certain ligands to hypothalamic tissue but not to other brain regions. Scatchard analysis shows that the number of specific binding sites for [³H]quinuclidinylbenzilate increases within 3 s after concussion with no significant change in binding affinity. The apparent increase in receptors is likely the result of a deficit in binding of endogenous ligand. We propose that concussion produces a pressure wave that deforms cholinergic and possibly other receptors selectively in the hypothalamus, resulting in a transient deficit in transmitter binding and interruption of neuronal circuits concerned with the state of consciousness.     

大鼠脑缺血再灌流损伤在脑震荡脑损伤中作用的研究

本实验采用单摆式打击装置建立大鼠脑震荡模型。病理组织学改变为伤后１５分钟开始出现全脑血管痉挛，３０分钟血管痉挛缓解，进入持续性充血状态，相继出现神经细胞退变和部分轴索肿胀、断裂。测定了脑皮质中ＬＰＯ含量呈明显时序性改变，伤后３０ｍｉｎ开始上升（Ｐ＜０．０５）。６０ｍｉｎ达高峰。证明了脑震荡脑损伤的形成是在暴力直接作用所致损伤的基础上，伴以缺血再灌流损伤。     

Depression of afferent-induced primary afferent depolarization at the lumbar spinal cord following concussive head injury

Afferent-induced primary afferent depolarization (PAD) was depressed for 2-5 min following concussive head injury in the cat, as assessed by dorsal root potentials and augmentation of antidromic dorsal root potentials, both evoked by stimulation of adjacent dorsal roots. These changes in PAD were abolished by spinal cord transection but not affected by midpontine transection. Spontaneous dorsal root potentials, resting amplitudes of antidromic dorsal root potentials and reductions of antidromic dorsal root potentials following tetanic root stimulation were not substantially altered by injury. These findings suggest that concussive head injury depresses spinal interneuronal transmission by neurally mediated processes involving the bulbar brainstem.     

一次与多重性脑震荡鼠惊跳反射弱刺激抑制变化比较

目的 运用惊跳反射弱刺激抑制(PPI)实验方法对一次单纯性脑震荡(PCC)与多重性脑震荡(MCC)大鼠的感觉门控变化进行研究,以探讨认知损伤的积累效应.方法 用金属单摆闭合性脑损伤打击装置复制PCC和MCC大鼠,另设正常对照组,每组动物10只.自损伤前3d至伤后28d,检测大鼠在惊刺激诱发下的惊吓反射波幅P值、三种不同前置弱刺激惊吓反射波幅值PP67,PP69和PP73值及惊跳反射弱刺激抑制值PPI67,PPI69和PP173的变化情况.结果 PCC后24h内P值及上述3个PP值开始降低(P＜0.05),至损伤16d后接近或恢复正常;MCC后24h内P值及上述3个PP值开始显著降低(P＜0.05)、且比PCC组更加明显,至伤后28d仍未恢复;PCC和MCC组的PPI67,PPI69和PPI73值在部分实验测试点明显高于正常.大鼠脑震荡次数越多,惊吓刺激反射P值和PP值损害性减弱越明显,而惊跳反射弱刺激抑制强度PPI值仅表现出一定程度的加强.结论 大鼠脑震荡后,不论PCC还是MCC,其感觉门控作用均出现一定程度的增强,惊吓刺激反射和前置弱刺激惊吓反射的减弱变化则表现出明显的损伤性累加效应.     

Long-term electrophysiological changes in athletes with a history of multiple concussions

Primary objective: This event-related potentials study investigated the long-term effects associated with a history of one or multiple concussions on the N2pc and P3 components using a visual search oddball paradigm.

Methods and procedure: A total of 47 university football players were assigned to three experimental groups based on prior concussion history: Athletes with a history of one concussion (single-concussion group); Athletes with two or more concussions (multi-concussion group); non-concussed athletic controls. The average post-concussion period was 31 months for athletes in the multi-concussion group and 59 months for the single-concussion group.

Results: This study found significantly suppressed P3 amplitude in the multi-concussed athletes group compared to the single-concussion and non-concussed athletes even when using the time since the latest concussion as a covariate.

Conclusion: This finding suggests that the multi-concussed athletes group showed long-lasting P3 amplitude suppression when compared with single-concussion or non-concussed athletes despite equivalent neuropsychological test scores and post-concussion symptoms self-reports. This pattern of results is important because it shows that 'old' concussions do not cause general or ubiquitous electrophysiological suppression. The specificity of the long-term effects of previous concussions to the P3, along with an intact N2pc response, suggests that further work may allow one to pinpoint the cognitive system that is specifically affected by multiple concussions.     

Epidemiology of Injuries in National Collegiate Athletic Association Men's Ice Hockey: 2014–2015 Through 2018–2019

ContextThe National Collegiate Athletic Association has supported men''s ice hockey, a distinct sport that mandates high-velocity gamesmanship, since 1974.BackgroundInjury surveillance systems are designed to identify evolving injury trends and their temporal qualities. Continual monitoring of collegiate men''s ice hockey athletes remains essential.MethodsExposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program from 2014–2015 through 2018–2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios (IRR) were used to examine differential injury rates.ResultsThe overall injury rate was 7.65 per 1000 athlete-exposures. Injuries from competition occurred at a rate nearly 7 times that from practice injuries (IRR = 6.54, 95% CI = 6.08, 7.04). The most common specific injury diagnoses were concussions (9.6%), acromioclavicular sprains (7.3%), and medial collateral ligament tears (3.7%).SummaryInjury rates by event type and season segment were higher than previously reported. Contusions accounted for nearly a quarter of all injuries, and acromioclavicular sprain rates increased notably across the study period.