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Objective, accurate and noninvasive assessment of the condition and prognosis of traumatic brain injury (TBI) patients in the early stage is the basis of TBI treatment. Glasgow coma scale (GCS) is the most common clinical method for assessing trauma condition. However, when patients are sedated, intubated or have language or movement disorders, it is often impossible to make an accurate assessment by GCS. In addition, GCS cannot provide direct evidences of pathological damage in brain tissues. The CT scoring system has emerged in recent years and is a non-invasive evaluation system based on CT images. The evaluation process can objectively reflect the severity of brain tissue damage without being interfered by sedation or intubation. The authors review the progress of researches on CT scoring systems to assess the prognosis of patients with craniocerebral injury, so as to provide a reference for clinicians to choose appropriate injury assessment methods and make clinical decisions.
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Objective To analyze the effects of mild traumatic brain injury ( mTBI) on functional brain network parameters and to study the properties of small world of patients. Methods Ten patients with mild traumatic brain injury and 13 healthy controls matched by age and sex were collected from the Ninth People's Hospital Affiliated to Medical College of Shanghai Jiao Tong University. Resting functional magnetic resonance images of all subjects were collected. Functional networks were constructed and brain network properties were analyzed. Results The brain injury group and the healthy control group had small world at-tributes in the selected sparseness range. The global efficiency of patients with mTBI patients was significantly reduced compared to healthy control group (0. 174±0. 141 vs 0. 184±0. 062),t=2. 417,P=0. 025),and the shortest path length was increased compared to healthy control group (0. 797±0. 930 vs 0. 734±0. 488),t=-2. 083,P=0. 048). Conclusion The functional brain network of patients with mTBI patients has small world attributes,and the parameters of functional brain network of patients have changed.
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Objective To explore the effects of cranioplasty onneurological functionin patients based on the cerebral CT perfusion technique. Methods Twenty cases of patients receiving cranioplasty were rerecorded during the study period,and they wererespectively scanned by CT perfusion within 72 hours before and 2 weeks after the cranioplasty. Meanwhile,the neurological function was evaluated by neurological function scale. Results The difference of cerebral blood flow before and after cranioplasty was statistically significant(P<0.05), whereas the difference of cerebral blood volume,transit time to the peak and mean transit time was not statistically significant(P>0.05).Correlation analysis showed that the preoperativedifference ratio of thecerebral blood infusio-nis not correlated with the neurological function score(P > 0.05). The changes of preoperative and postoperative difference rateof the cerebral blood infusionwas correlated with the functional independence measure(P < 0.05), whereas not with mini-mental state examination(P > 0.05). Conclusions The neurological function of the patients after cranioplasty may be improved.This improvement may benefit from the improvement of cerebral blood flow after cranioplasty.
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Objective To introduce the experience of applying horns percutaneous tracheostomy in critically ill neurosurgical patients. Methods The size of operative incision, operation time, amount of blood loss, incision healing time , and incidence of complications were analyzed retrospectively in 95 patients with GWCH and 83 with ST. Results There were smaller size of operation incision [(1.6 ± 0.4) cm vs. (3.8 ± 0.9) cm], shorter operation time [(4.4 ± 2.8) min vs. (20.5 ± 5.2) min], less blood loss [(4.5 ± 0.8) mL vs. (8.5 ± 4.5) mL] and shorter incision healing time [(3 ± 0.5) d vs. (5 ± 1.5) d] in GWCH group than that in ST group and the difference was statistical significant (P 0.05). Conclusions When compared with traditional ST, horns percutaneous tracheostomy is with smaller incisions , shorter operation time , less blood loss , faster healing and lower incision sputum leaking and is worthy of popularization in critically ill neurosurgical patients.
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Objective To determine the intervention of mycophenolate mofetil (MMF) in glial scar formation and learning and memory function in a rat model of diffuse axonal injury (DAI).Methods Ninety-six SD rats were randomly divided into sham group, normal saline (NS) group and mycophenolate mofetil (MMF) group according to the random number table, with 32 rats per group.Immunohistochemistry was used to detect activated microglia cells, activated astrocytes and chondroitin sulphate proteoglycanns (CSPGs) in the hippocampus.Inage-Pro Plus software was used to quantitatively assess the changes of activated microglia cells, activated astrocytes and CSPGs.Morris water maze was applied for testing rat learning and memory function.Integrated absorbance (IA) of major constituents (microglia, astrosyte, chondroitin sulphate proteoglycan) of the glial scar was determined and analyzed for the correlation with the parameters of MWM.Results At 7, 14 and 28 days after injury, MMF group showed decreased IA of activated microglia in the hippocampus compared to sham and NS groups (P ＜ 0.05).At 7-11 days after injury, percent distance and percent time in the target quadrant of Morris water maze did not differ significantly among the three groups and were not related to the IA of glial scar.At 28-32 days after injury, percent distance and percent time in the target quadrant of Morris water maze lowered significantly in MMF group.At 28 days after injury, IA of the glial scar had a positive correlation with mean speed and mean escape latency, but negative correlation with percent distance and time in the target quadrant that measured in Morris water maze at 28-32 days after injury.Conclusion MMF significantly attenuates glial scar formation into the hippocampus and improves learning and memory function in rats during the recovery stage when administered in the early stage after DAI.
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Objective To discuss about the establishment of mental depression model by traumatic brain injury in rats,and to evaluate the validity of this model.Methods The study was carried out in the experiment center of Wuhan University.A total of 48 male adult Wistar rats were randomized ( random number) into four groups ( n =12,each):( 1 ) in sham operation group,six rats were fed normally in one cage; (2) in model group,the model of the left frontal lobe contusion was made up by hitting with free-fall method on the left cortex of the rat,and subsequently the each of model rats were separately fed in a cage and put them in a lonely environment with chronic stress one week after traumatic brain injury in order to induce them into models of mental depression; ( 3 ) in brain trauma group,the trauma model of the left frontal lobe contusion was set up by the same procedure as in model group,and six rats were fed together in one cage; (4) in CUMS group,each rat was fed normally in one cage in a lonely environment after brain trauma made and chronic mild chaotic stress unpredictable to rats was given to induce mental depression.The consumption of sucrose water and the change of animal behavior were observed and the high performance liquid phase electrochemical with fluorescence detector was used to detect the biogenic monoamine neurotransmitter content (dopamine,serotonin and norepinephrine) in the hippocampus,prefrontal cortex,hypothalamus and striatum area in each group.Experimental data were processed with single factor analysis or t test of variance by Statistical Program for Social Sciences Version 13.0 (SPSS13.0) software.P ＜0.05 was considered as statistically significant difference.Results After modeling,the rats of four groups were examined by behavioral tests.It was found that the amount of sugar-water consumption by the rats in the model group and CUMP group decreased,implying the absence of interest in eating and anhedonia of the rats in these groups.In open-field test,the rats in the model group,CUMP group and brain trauma group showed reduction in square crossing and rearing,implying the under-activity and absence of interest in activity.In the water maze test,it was found that the rats in the model group,CUMP group and brain trauma group needed much time to reach the end-point and made many errors,implying the lowering ability to learn and memorize.Levels of dopamine,serotonin and norepinephrine in the hippocampus,prefrontal cortex,hypothalamus and striatum area decreased in these rats with traumatized brain in three groups especially in model group and CUMP group.Conclusions It is a valid method for establishing the mental depression model in rats by traumatic brain injury with separately feeding in the lonely environment and given chronic mild chaotic stress unpredictable to rats on the setting of the left frontal lobe contusion.
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Objective To observe the spatiotemporal characteristics of the micro-structural injury in a rat model of diffuse axonal injury (DAI) and quantitatively assess the axonal injury severity in the vulnerable areas. Methods The 7.0 T MRI was performed in rats in DAI group (n =20) and control group ( n = 15 ) to synthesize the diffusion tensor imaging ( DTI) parameter map and calculate the parameter value of the vulnerable areas. Immunohistochemistry was used to detect β-APP expression in the vulnerable areas and the IPP software to quantitatively assess the axonal injury severity. Results Compared with the control group, FA and AD maps showed local signal defection or reduction in the corpus callosum and their values decreased significantly in the brain stem and corpus callosum in the DAI group (P ＜0.01 ). The integrated optical density (IOD) value of the vulnerable areas in the DAI group was significantly higher than that of the control group ( P ＜ 0. 01 ) , with the highest level in the brain stem (P＜0.05). The normalized FA, AD and ADC in the vulnerable areas were correlated negatively with the IOD (P ＜ 0.05). Conclusion DTI can detect invisible micro-structural injury in the vulnerable areas and quantitatively assess the axonal injury severity in vivo in the early stage.
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Objective To investigate the brain metabolic changes and evaluate their spatial distributions after traumatic axonal injury (TAI)in rats by using proton magnetic resonance spectroscopy(1H-MRS).Methods The TAI model was made by subjecting the head of the rats to the linear and angular accelerations.The multi-voxel MRS was employed to detect the tissue metabolic state at the levels of hippocampus-caudate and pons prior to injury and at 24 hours after injury.The alterations of NAA/Cr,NAA/Cho and Cho/Cr values as well as the spatial distribution of NAA/Cr reduction were accessed. Immunohistochemical staining for β-APP was used to observe the injured axons. Results A siguificantdecrease in NAA/Cr and NAA/Cho(P<0.05)and subtle increase in Cho/Cr(P>0.05)were observed in rats at 24 hours after TAI in comparison to the pre-injury levels.Notable decrease in NAA/Cr value was observed in the areas including the brain stem,hippocampus,internal capsule,corpus callosum and thalamus,where axonal injuries were confirmed by the histological examination. Conclusion Metabolic imbalances Occur in the brains of rats with TAI.with notable changes in the brain stem and the hippocampus.
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Hypertonic saline solutions have received more attention as effective agents for the treatment of brain damage. Studies indicated the beneficial action of hypertonic saline solutions in intracranial pressure, cerebral blood flow and neurologic outcome. This article reviews the available evidence on hypertonic saline solutions as they relate to traumatic brain injury.
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Objective To investigate the early alterations of neurometabolites in the splenium of corpus callosum by proton magnetic resonance spectroscopy (~1H-MRS) in patients with diffuse axonal injury (DAI) at early stage and their prognostic value. Methods Twenty-one patients with DAI underwent 1H-MRS examination in the splenium of corpus callosum 2 to 14 d after injury, the neurometabolite alterations were evaluated and compared with those of 10 healthy subjects (normal controls). Logistic regression analysis was performed to explore the correlation among neurometabolite alterations, clinical indexes and Glasgow outcome scale (GOS) six months after injury. Results There was a significant decrease in NAA/Cr and NAA/Cho and increase in Cho/Cr in the splenium of corpus callosum in patients with DAI as compared with control group (P<0.05), and these trends tended to be more evident with the increase of injury severity. NAA/Cr and NAA/Cho in patients with poor outcomes were lower than those in patients with good outcomes (P<0.05). NAA/Cr, NAA/Cho and Cho/Cr predicted long-term outcome with 89% accuracy, and the combination with GOS provided the predictive accuracy of 94%. Conclusion ~1H-MRS examination in the splenium of corpus callosum at early stage of DAI can depict brain injury severity, and is useful in predicting outcomes.
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Objective To investigate the changes of expression of stromal cell-derived factor 1α (SDF-1α) in retinas after partial optic nerve injury in rats. Methods Models with injury of partial optic nerve were induced in rats. Retinal tissues were collected 1,2,3,5,7,10 and 14 d after injury. Enzyme linked immunosorbent assay and Real-time quantitative PCR were employed to detect the expression of SDF-1α protein and mRNA in retinal tissues respectively in injury group (n=28), sham operated group (n=28) and normal control group (n=12). Results The expression of SDF-1α protein and mRNA in retinas was higher than that in sham operated group and normal control group at different time points after injury (P<0.01), and it reached the peak at the 5th day after injury. The expression of SDF-1α protein and mRNA maintained a high level at the 14th day after injury. Conclusion The expression of SDF-1α protein and mRNA is up-regulated after partial optic nerve injury, and may last for a long time.
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Objective To investigate the effects of human Rrain-derived neurotrophic factor-gamma fetopro-tein (hBDNF-GFP) gene-transfected neural stem cell (NSC) transplantation on BDNF expressions in the retina of rots after optic nerve (ON) crush injury. Method ①Seventy-eight Sprague-Dawley (SD) rats were randomly as-signed into a control group (n = 6) and ON crush group (n = 72). In the ON crush group, the right ON was crushed while the left NO was exposed as sham injury. Rats in the ON crush group were divided into three sub-groups: PBS group (intravitreons injection of 0.01 mol/L phosphate buffered solution); GFP group (intravitreous transplantation of GFP gene-transfected NSCs); and hBDNF-GFP group (intravitreous transplantation of hBDNF-GFP gene-transfected NSCs). Rats were sacrificed 3, 7, 14 and 28 days after transplantation, and BDNF expres-sions in retinal homogenates was detected by using enzyme-linked immunosorbent assay (ELISA). ②The hBDNF-GFP-NSCs were transplanted intravitreous into six rats after ON crush injury. Following this, two rats were sacri-riced 2, 4 and 8 weeks after transplantation. The survival and location of NSCs in host retina were observed by frozen section analysis. ③Adult SD rats were randomly divided into four groups: control group (n = 5); NSC group (NSC transplantation, n = 10); GFP-NSC group (GFP-NSC transplantation, n = 10); and hBDNF-GFP-NSC group (hBDNF-GFP-NSC transplantation, n = 10). Four and eight weeks after transplantation, five rats from every group were sacrificed. Western blot analysis was used to determine retinal BDNF expression. Results ① There was no significant difference in BDNF expression between the control group and sham-injury groups (P >0.05). Three days after NSC transplantation, BDNF expression increased significantly in the three injured sub-groups compared with the sham-injury group, (P < 0.05), whereas no significant inter-group differences in BDNF expressions among three injured sub-groups were observed (P > 0.05). Seven days after transplantation, there was a significant difference in BDNF expression between the GFP-NSC group and the sham-injury groups (P <0.05), whereas there were no significant differences in BDNF expressions among the PBS, hBDNF-GFP-NSC and sham-injury groups (P > 0.05). Fourteen and 28 days after transplantation, BDNF expressions decreased in the PBS group and the GFP-NSC groups, while BDNF expressions in the hBDNF-GFP-NSC group increased significant-ly compared with the other three groups (P < 0.05); ②Frozen section showed that transplanted hBDNF-GFP-NSCs could survive and gradually extended to all layers of the host retina. ③Westem blot revealed there were no differences in BDNF expressions between 4-week and 8-week intervals in the hBDNF-GFP-NSC group. Compared with other three groups, BDNF expressions in the retina increased significantly after hBDNF-GFP-NSC transplanta-tion. Conclusions The hBDNF-GFP gene-trausfected NSCs can survive in the host retina and BDNF expressions are stable at a high level.
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Objective To investigate the therapeutic effects of recombinant human erythropoietin(rhEPO)on brain mitochondrial energy metabolism and mitachondrial respiratory functionin after brain injury in rats.Method A total of 63 Sprague-Dawley rats were divided randomly into three groups:the rhEPO treated group(n =28),the control group(n=28),the shanl group(n=7).The models of contusion of brain caused by freefalling were set up in rhEPO treated group(n=28).The recombinant human erythropoietin was intraperitoneally injected in dose of 10 U/g immediately after brain injury and it was repeated every 10 hours in rhEPO group treated.The same models of contused brain were made without rhEPO treatment as control group(n=28).In control group,the same volume of normal saline was used in replacemem of rhEPO.Aburr hole was made on the skull of the sham group(n=7),but the brain tissue was not wounded.The mitochondria were isolated at 6 h,12 h,24h,48 h after trealment,respectively.The activity of ATPase and SOD,the content MDA and brain mitochondrial respiratory function were measured by biochemical technique.The data were analyzed with the F-test and t-test.Results The activity of ATPase(P＜0.05),SOD(P＜0.01)and brain mitochondrial respiratory function(P ＜0.05)were increased.and the levd of MDA in brain mitochondria was reduced markedly in rats treated with rhEPO.Conclusions Treatment with rhEPO can alleviates the secondary brain injury by affecting mitochondrial function.