Interpretation of three important problems in clinical treatment from guidelines for the management of severe traumatic brain injury (fourth edition) issued by the United States in 2016 / 天津医药

Guidelines for the Management of Severe Traumatic Brain Injury (Fourth Edition) have received extensive attention both at home and abroad after releasing by the Brain Trauma Foundation of the United States in 2016. The interval between the published newest version of the Guidelines and the Third Edition has already approached 7 years. In accordance with more rigorous evidence-based medicine standards, the Fourth Edition includes 94 updated research findings as evidence, in combination with the proposition of more accurate treatment recommendations and problem solutions. Combining the domestic situation and problems in the treatment of severe traumatic brain injury at present, three most important clinical issues related to the Fourth Edition of the guidelines are interpreted and analyzed in the present study, including decompressive craniectomy, mild hypothermia therapy and intracranial pressure monitoring, so as to improve the level of treatment of traumatic brain injury in China.

Comparison of T2 FLAIR and GRE-T2* WI in detection of traumatic extra-axial hemorrhage / 实用放射学杂志

Objective To explore the value of fluid-attenuated inversion recovery (FLAIR)sequence and gradient echo T2 ?weighted image (GRE-T2 ? WI)in diagnosis of acute traumatic extra-axial hemorrhage.Methods 50 patients who were diagnosed as acute traumatic extra-axial hemorrhage by plain CT underwent FLAIR and GRE-T2 ? WI in acute stage.The diagnosis consistency (Kappa ),detection rate of subarachnoid hemorrhage(SAH),epidural hemorrhage(EDH)and subdural hemorrhage(SDH)were compared.The detection rates of SAH in 8 locations among FLAIR,GRE-T2 ? WI and combination of two sequences were analyzed by Chi-square test.Results 48 patients were enrolled in the study.The diagnosis consistency of SAH between FLAIR and GRE-T2 ? WI was high (k =1.0).The detection rate of SAH was 100% for both FLAIR and GRE-T2 ? WI.Comparing with GRE-T2 ? WI and combi-nation of two sequences,FLAIR tended to misdiagnose SAH in perimesencephalic cistern (P <0.05).The diagnosis consistency of EDH between FLAIR and GRE-T2 ? WI was high (k =1.0).3 patients with EDH were all detected by FLAIR and GRE-T2 ? WI. The diagnosis consistency of SDH between FLAIR and GRE-T2 ? WI was high (k =0.943).The detection rate of 12 patients with SDH was 100% in FLAIR,and 1 patient with SDH was missed by GRE-T2 ? WI.Conclusion The detection rate of acute traumatic extra-axial hemorrhage is high for both FLAIR and GRE-T2 ? WI.Combination of two sequences can improve the accuracy of acute traumatic extra-axial hemorrhage in clinic.

Current status and development of traumatic brain injury treatments in China / 中华创伤杂志(英文版)

Due to its high incidence, high disability rate, and high mortality rate, traumatic brain injury (TBI) poses a serious threat to human health. This manuscript describes the urgent problems currently existing in China's TBI treatment and proposes a scheme of a nationwide collaboration platform for the treatment of TBI so as to improve the overall level of TBI treatment in China, and reduce disability and mortality rates in TBI patients.

Research progress in traumatic brain penumbra / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>Following traumatic brain injury (TBI), brain tissue that surrounding the regional primary lesion is known as traumatic penumbra; this region may undergo secondary injury and is considered to have the potential to recover. This review aimed to reveal the existence and significance of traumatic penumbra by analyzing all relevant studies concerning basic pathologic changes and brain imaging after TBI.</p><p><b>DATA SOURCES</b>We collected all relevant studies about TBI and traumatic penumbra in Medline (1995 to June 2013) and ISI (1997 to March 2013), evaluated their quality and relevance, then extracted and synthesized the information.</p><p><b>STUDY SELECTION</b>We included all relevant studies concerning TBI and traumatic penumbra (there was no limitation of research design and article language) and excluded the duplicated articles.</p><p><b>RESULTS</b>The crucial pathological changes after TBI include cerebral blood flow change, cerebral edema, blood-brain barrier damage, cell apoptosis and necrosis. Besides, traditional imaging method cannot characterize the consequences of CBF reduction at an early stage and provides limited insights into the underlying pathophysiology. While advanced imaging technique, such as diffusion tensor imaging (DTI) and positron emission tomography (PET), may provide better characterization of such pathophysiology.</p><p><b>CONCLUSIONS</b>The future of traumatic brain lesions depends to a large extent on the evolution of the penumbra. Therefore, understanding the formation and pathophysiologic process of the traumatic penumbra and its imaging research progress is of great significant for early clinical determination and timely brain rescue.</p>

Effect of PARP inhibitor PJ34 on blood-brain barrier permeability and MMP-9 expression following traumatic brain injury in mice / 中华创伤杂志

Objective To investigate the role of poly(ADP-ribose) polymerase (PARP) inhibitor PJ34 in regulating blood-brain barrier (BBB) permeability and matrix metalloproteinases-9 (MMP-9) expression in a mouse model of traumatic brain injury (TBI).Methods A total of 136 adult male BALB/c mice were randomly divided into sham-operated group,injured group and PJ34-treated group according to the random number table.Controlled cortical impact in mice was established.At 6 and 24hours postinjury,neurological deficit was evaluated,including motor,sensory,reflex and beam balance tests ; BBB permeability and brain water content were detected using Evans blue test and gravimetric technique; brain contusion volume was measured using HE staining; levels of MMP-9 in cytosolic fractions were detected using Western blotting.Results At 6 and 24 hours postinjury,neurological severity score in PJ34-treated group (8.00 ± 0.26,7.50 ±0.25) were lower than those in injured group (12.50 ±0.39,11.80 ± 0.32) ; brain contusion volume in PJ34-treated group [(11.25 ± 0.91) mm3,(13.55 ±1.06) mm3] was lower than those in injured group [(25.37 ± 1.75) mm3,(28.24 ± 1.51) mm3] ; BBB permeability in PJ34-treated group [(440.08 ± 3.10) μg/mg,(860.46 ± 3.86) μg/mg] was lower than those in injured group [(936.96 ± 4.71) μg/mg,(1 302.23 ± 5.89) μg/mg] (all P ＜ 0.01).Brain water content lowered significantly in PJ34-treated group than in injured group at 6 hours postinjury [(80.77 ± 0.76) ％ vs (82.55 ± 0.73) ％,P ＜ 0.0l],but between-group difference was not significant at 24 hours postinjury.Lower levels in MMP-9 were also observed in PJ34-treated group compared with injured group at 6 and 24 hours postinjury(P ＜ 0.05 or 0.01).Conclusion PARP inhibitor PJ34 can attenuate MMP-9 up-regulation,inhibit BBB injury and hence protect the brain against TBI in mice.

Bacterial distribution of cerebrospinal fluid cultures and its effect on therapeutic efficacy in patients with severe intracranial infection after open craniotomy / 中华创伤杂志

Objective To investigate the distribution characteristics of pathogens isolated fromcerebrospinal fluid of neurosurgical patients with intracranial infection following open craniotomy and thetherapeutic effect influenced by these pathogens,in order to give a reference to the clinical treatmentmeasures.Methods A retrospective analysis was made on the pathogen distribution and therapeuticeffect of 43 patients with intracranial infection and positive cerebrospinal fluid cultures after open cranioto-my from May 2007 to May 2013.Cerebrospinal fluid was cleared using the intraventricular catheter orlumbar catheter combined with intraventricular (ventricular irrigation) or intraspinal (intrathecalirrigation) injection of antibacterial agents.Results To test bacteria in cerebrospinal fluid pathogencultures,34 cases were infected with single strain (26 Gram-positive bacteria and 8 Gram-negativebacteria) and 9 cases had mixed infection with multiple strains.Fifty-two pathogen strains were isolated,including 32 (62％) Gram-positive bacteria,18 (35％) Gram-negative bacteria,2 (4％) fungi.A totalof 29 cases were cured (67％),7 improved (16％),and 7 ineffective (16％).Conclusions Cere-brospinal fluid pathogen infection is primarily Gram-positive bacterial infection,usually staphylococcusepidermidis and staphylococcus aureus.Gram-negative pathogens are acinetobacter,klebsiella,andpseudomonas aeruginosa.Ventriculoperitoneal shunting surgery and craniocerebral surgery are often asso-ciated with mixed infection of pathogens.Ventricular irrigation allows better results than intrathecal irriga-tion.Indications of intrathecal irrigation treatment used to control intracranial infection after ventriculoper-itoneal shunting surgery and craniocerebral surgery should be strictly performed.

Effect of high intra-abdominal pressure on intracranial pressure of patients with brain injury combined with abdominal trauma / 中华创伤杂志

Objective To investigate the impact of high intra-abdominal pressure on intracranial pressure in patients with traumatic brain injury and discuss the clinical significance of abdominal decom-pression. Methods Intra-abdominal pressure and intracranial pressure of 15 patients with abdominal trauma and brain injury were observed to discuss changes of intracranial pressure after abdominal decom-pression. Results After abdominal decompression, all patients got lower intracranial pressure, with decrease of (15.2±3.6) mm Hg. Conclusion Intra-abdominal pressure does affect intracranial pres-sure for patients with abdominal trauma and brain injury. Abdominal decompression may be effective for high intracranial pressure.

Application of invasive intracranial pressure monitoring in treatment of traumatic brain injury / 中华创伤杂志

Objective To discuss the effect of invasive intracranial pressure (ICP) monitoring in treating traumatic brain injury (TBI).Methods A total of 116 patients with TBI (including 112 with severe TBI,3 with moderate TBI and 1 with slight TBI) were monitored by using invasive ICP monitoring device in Tiantan Hospital from July 2003 to December 2007.All patients underwent ICP monitoring within first 24 hours after admission and treated with corresponding therapy including drug therapy and surgical treatment.Results Of all,74 patients survived but 42 with severe TBI died.Of 75 patients with GCS 3-5,33 died,with morbidity rate of 44%.Of 37 patieats with GCS 6-8,nine died,with morbidity rate of 24%.Four patients with GCS 9-15 survived.Conclusions Continuous ICP monitoring can help timely understanding of ICP changes for early diagnosis and correct treatment of TBI and is useful for judgment of prognosis.Low GCS and high ICP are predictors for bad outcome.