Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus disease 2019 (version 2023) / 中华创伤杂志

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Indication and early medicational administration of patients with traumatic brain injury for admission to neurological intensive care unit / 中华创伤杂志

Objective:To analyze the indication and status of early use of analgesic, sedative and antiepileptic drugs of patients with traumatic brain injury (TBI) admitted to the neurological intensive care unit (NICU).Methods:A questionnaire covering hospital basic characteristics, prehospital and emergency care, inpatient treatment, neurocritical care and rehabilitation were used to survey NICU of 37 hospitals in 18 municipalities or provinces from the Chinese registry of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) by Web or Email. The indications for admission to the NICU, categories and frequency of early use of analgesic and sedative drugs, and categories, frequency and indications of early use of antiepileptic drugs were analyzed.Results:Glasgow coma scale (GCS)≤8 points in patients with TBI and post-operation of TBI were the main indications for admission in 30 NICU (81.1%) and 24 NICU (64.9%), respectively. When admitting patients with a GCS of 9-12 points or 13-15 points, most NICU gave more considerations to the combined other risk factors. In terms of the early use of analgesics and sedatives, fentanyl was routinely used for analgesia (i.e., use frequency for 70%-100%) in 13 NICU (35.1%), and midazolam and alpha-2 agonists were routinely used for sedation in 24 NICU (64.9%) and 18 NICU (48.6%), respectively. Regarding the early use of antiepileptic drugs, sodium valproate was routinely used in 35 NICU (94.6%). Moreover, seizures within 2 hours after injury, penetrating TBI and cortical contusion were indications for routine application of antiepileptic drugs in 35 NICU (94.6%), 21 NICU (56.8%) and 20 NICU (54.1%), respectively.Conclusions:Severe TBI and post-operation of TBI are the main indications for admission to the NICU, while the combination of other risk factors will be considered when admitting patients with moderate or mild TBI. For TBI patients admitted to NICU, fentanyl, midazolam and sodium valproate are the most commonly used analgesic, sedative, and antiepileptic drugs in the early stage. Seizures within 2 hours after injury, penetrating TBI and cortical contusion are the main indications for antiepileptic drug use.

Effect of polyetheretherketone cranioplasty following craniectomy for traumatic brain injury / 中华创伤杂志

Objective:To investigate the effect of cranioplasty with polyetheretherketone (PEEK) after craniectomy in patients with traumatic brain injury (TBI).Methods:A retrospective case series study was used to analyze the clinical data of 85 TBI patients undergone craniectomy admitted to Renji Hospital, Shanghai Jiaotong University School of Medicine from February 2017 to April 2021, including 57 males and 28 females, aged 7-70 years [(40.8±15.5)years]. Patients′ Glasgow Coma Scale (GCS) was 6-15 points [15 (13, 15)points]. All patients underwent PEEK cranioplasty as scheduled. The extended Glasgow Outcome Scale (GOSE) was used to evaluate the neurological function before, at 3 and 6 months after operation. After excluding 33 patients with preoperative GOSE score of 8 points, 52 patients with preoperative GOSE score less than 8 points were analyzed on the degree of GOSE improvement. Patients′ satisfaction with PEEK repair was evaluated through telephone interviews at 6 months postoperatively. The incidence of complications were observed during hospitalization and within 6 months postoperatively.Results:All patients were followed up for 6-7 months [6 (6, 7)months]. The GOSE was 6 (5, 8)points before operation, 6 (5, 8)points at 3 months after operation, and 7 (5, 8)points at 6 months after operation. There was no significant difference in GOSE at 3 months after operation and before operation ( P>0.05), but it was significantly increased at 6 months after operation when compared to the preoperative level ( P<0.05). With regards to GOSE, there were 10 patients with mild amelioration but 42 with no amelioration at 3 months after operation, while 4 patients with significant amelioration and 31 with no amelioration were observed at 6 months after operation ( P<0.05). For PEEK repair, Patients′ satisfaction was very high in 43 patients, high in 33, general in 7 and poor in 2. A total of 25 patients had postoperative complications during hospitalization and within 6 months postoperatively, with the incidence of complications of 29%. Specifically, there was 1 patient with wound infection, 1 new epilepsy, 8 epidural hemorrhage, 13 subcutaneous effusion, 1 subcutaneous effusion, severe infection and material exposure, and 1 severe infection, new-onset epilepsy and subcutaneous effusion. Repair materials were removed in 2 patients due to multiple complications; other patients obtained alleviation via treatment, without affect on their daily life. Conclusion:PEEK cranioplasty following craniectomy for TBI patients can improve prognosis, attain high satisfaction and has low incidences of postoperative infection and exposure of repair materials.

Comparison of provider profiles of rescue centers for traumatic brain injury between China and European Union / 中华创伤杂志

Objective To explore the major differences of the provider profiles in terms of structural characteristics, hospital facilities and workflow of traumatic brain injury ( TBI) centers between China and European Union and compare the efficacy. Methods The questionnaires were designed focusing on the provider profiling, and 45 Chinese centers and 71 European centers were recruited into Collaborative European NeuroTrauma Effectiveness Research in TBI ( CENTER-TBI) program. The structural characteristics, hospital facilities and work flow of the two groups were compared. Results The proportion of helicopter platform facilities[31％ (14/45)] : 80％ (57/71)]in China group was lower than that in European Union group (P <0. 01), while the proportion of neurological ICU facilities [98％ (44/45) : 57％ (40/71)] in China group was higher than that in European Union group (P <0. 01). China group has higher ratios in all-day trauma operation room [96％(43/45):75％(53/71)], open ICU [27％(12/45):4％(3/71)], transitional beds[93％(42/45):71％(50/71)] than those in European Union group (P<0.01). European Union group had higher ratios in implementing brain parenchymal intracranial pressure monitoring [31％ (21/67) :7％ (344)] and adopting 20 mmHg as the threshold of intracranial hypertension [86％(57/66):64％(29/45)](P<0.01). The China group adopted more basic life support and followed the US TBI guidelines for clinical management. Conclusions Significant differences are disclosed upon TBI centers between China and EU, mainly demonstrated in neurological ICU facilities, all-day trauma operation room, brain parenchymal intracranial pressure monitoring, and the threshold of intracranial hypertension management. These differences provide a working analysis basis for further comparative studies in the field of TBI and for determining the best clinical practice.

Comprehensive Proteomic Profiling of Patients' Tears Identifies Potential Biomarkers for the Traumatic Vegetative State / 神经科学通报·英文版

The vegetative state is a complex condition with unclear mechanisms and limited diagnostic, prognostic, and therapeutic methods. In this study, we aimed to explore the proteomic profile of tears from patients in a traumatic vegetative state and identify potential diagnostic markers using tears-a body fluid that can be collected non-invasively. Using iTRAQ quantitative proteomic technology, in the discovery phase, tear samples collected from 16 patients in a traumatic vegetative state and 16 normal individuals were analyzed. Among 1080 identified tear proteins, 57 were upregulated and 15 were downregulated in the patients compared to the controls. Bioinformatics analysis revealed that the differentially-expressed proteins were mainly involved in the wound response and immune response signaling pathways. Furthermore, we verified the levels of 7 differentially-expressed proteins in tears from 50 traumatic vegetative state patients and 50 normal controls (including the samples used in the discovery phase) using ELISA. The results showed that this 7-protein panel had a high discrimination ability for traumatic vegetative state (area under the curve = 0.999). In summary, the altered tear proteomic profile identified in this study provides a basis for potential tear protein markers for diagnosis and prognosis of the traumatic vegetative state and also provides novel insights into the mechanisms of traumatic vegetative state.

Application of quantitative EEG in sedation depth monitoring after traumatic brain injure operation / 中华创伤杂志

Objective To observe the dynamic changes of the power parameters of each frequency band of electroencephalography during the postoperative sedation process of traumatic brain injuries (TBI) to evaluate the values of EEG power in assessing sedation depth.Methods A retrospective case series study was conducted on the clinical postoperative data of 42 patients with TBI from February 2017 to January 2018.There were 22 males and 20 females,aged (39.8 ± 5.3)years (range,25-66 years).Before the sedation,the Glasgow Coma Scale (GCS) was (9.2 ± 2.3)points,ranging from 8 to 12 points.Before the administration of dexmedetomidine (Dex) and 10,30,60,90 minutes after the medication,the body temperature,respiration,heart rate,oxygen saturation (SpO2),and mean arterial pressure (MAP) were recorded and evaluated by Ricker sedation agitation score (SAS).At the same time,the EEG power value changes of four frequency bands (α,β,θ,and δ) were recorded constantly.Correlation analysis was performed between the changing power values and corresponding SAS.Results (1) During sedation,the body temperature,respiration,heart rate,SpO2 and MAP did not show significant fluctuation along with the decrease of SAS (P ＞ 0.01).(2) Before and after Dex sedation,the electroencephalography power value of the delta band was negatively correlated with SAS,with the correlation coefficient absolute value between 0.85 and 0.88 (P ＜ 0.01).The highest absolute value of the correlation coefficient was that of the left frontal and of the right frontal region (0.88,P ＜0.01).The absolute value of the correlation coefficient between (θ + δ)/(α + β) and SAS was between 0.75 and 0.85 (P ＜ 0.01).(3) The fast wave power (α and β band) in each brain area before sedation increased to varied degrees after the sedation,but it decreased along with the falling SAS.The absolute value of correlation coefficient between the electroencephalography power value in α and β band ranged from 0.29 to 0.48 (P ＜ 0.01),indicating weak correlation.There was no significant correlation between the EEG values in the θ band and SAS (P ＞ 0.01).Conclusions The electroencephalography power values of the δ band of each brain region are negatively correlated with SAS and can objectively reflect the dynamic changes of the sedation depth.The absolute values of correlation coefficient between bilateral frontal δ band power and SAS can serve as a better guide for clinical sedation.

Amplitude-Integrated Electroencephalography Predicts Outcome in Patients with Coma After Acute Brain Injury / 神经科学通报·英文版

Prognostication of coma patients after brain injury is important, yet challenging. In this study, we evaluated the predictive value of amplitude-integrated electroencephalography (aEEG) for neurological outcomes in coma patients. From January 2013 to January 2016, 128 coma patients after acute brain injury were prospectively enrolled and monitored with aEEG. The 6-month neurological outcome was evaluated using the Cerebral Performance Category Scale. aEEG monitoring commenced at a median of 7.5 days after coma onset. Continuous normal voltage predicted a good 6-month neurological outcome with a sensitivity of 93.6% and specificity of 85.2%. In contrast, continuous extremely low voltage, burst-suppression, or a flat tracing was correlated with poor 6-month neurological outcome with a sensitivity of 76.5% and specificity of 100%. In conclusion, aEEG is a promising predictor of 6-month neurological outcome for coma patients after acute brain injury.

Intracranial pressure monitoring in the management of traumatic brain injury / 天津医药

Intracranial hypertension remains the key biomarker of severe traumatic brain injury for neurosurgery doctors. The monitoring of intracranial pressure (ICP) provides the technical support of precision and effective treatment strategy. In this article, the authors analyze the methodology, timing, function and development trend of ICP monitoring. The developing process of ICP monitoring contains the efforts of exploring a safe and precise technique to reflect the pressure in an injured brain. The modern ICP monitoring technology provides sufficient information flow for the management of craniocerebral trauma. Neurosurgeons could follow the information in the value and trends of ICP monitoring and implement it into decision making throughout the whole process of patient management. With the advanced data collecting and analyzing system the clinician can look into the waveform and parameter generalized by ICP value, and can interpret to the pathophysiological profiling in brain. ICP monitoring could exert efficacy not only in reflecting the mechanism of brain injury but also in the directing the clinical practice.

Correlation of end-tidal carbon dioxide with arterial carbon dioxide among patients in neurosurgical intensive care unit / 中华创伤杂志

Objective To examine the correlation between end-tidal carbon dioxide (PetCO2) and arterial CO2 (PaCO2) among patients admitted in neurosurgical intensive care unit (NICU) and the factors affecting the PaCO2-PetCO2 [P (a-et) CO2].Methods Thirty-two intubated or cut-trachea patients who presented in the NICU were enrolled.Arterial blood gas test was done at seven every morning,and values of PetCO2 were compared with simultaneously recorded PaCO2.The normal gap of P (a-et) CO2 was defined as-5 mmHg to 5 mmHg.Concordance between PaCO2 and PetCO2 was analyzed using the Bland-Altman plot.Parameters between the normal and high P(a-et) CO2 groups were compared to identify the factors affecting the P(a-et) CO2,including Glasgow Coma Scale(GCS),blood pressure (BP),heart rate (HR),respiration rate (RR),body temperature (BT),and pulse oxygen saturation (SpO2).Results Allvalues of PaCO2 and PetCO2 were in accordance with normal distribution (r =0.668,P ＜ 0.01) and concordance between PaCO2 and PetCO2 was 69.8％.Patients who had high P(aet) CO2 showed lower initial GCS,lower instant GCS,BT,as well as pH and higher actual bicarbonate (AB) and PetCO2 than the patients with normal P (a-et) CO2.Correlation between PaCO2 and PetCO2 rapidly declined when positive end expiratory pressure(PEEP) was greater than 5 mmH2O(r =0.229,P ＜ 0.01).Conclusions PetCO2 correlates well with PaCO2 and appears to be a useful monitor of respiratory function of the patients consecutively.Initial GCS,BT,AB and PEEP have an impact on P(a-et) CO2,so those factors should be considered when attempting to monitor the hyperventilation with PetCO2.

Changes of circulating endothelial progenitor cells and their clinical significance in patients with acute cerebral infarction / 中华创伤杂志

Objective To investigate the changes of circulating endothelial progenitor cells (EPCs) in patients with acute cerebral infarction or chronic cerebral ischemia and discuss the related clinical significance.Methods Circulating EPCs were isolated using staining markers of CD34,CD133,and kinase insert domain receptor (KDR).Peripheral venous blood was collected from patients with acute cerebral infarction within 24 hours of onset (infarction group,n =30),with chronic cerebral ischemia (ischemia group,n =20),and without cerebral ischemia (control group,n =10) to quantify circulating level of EPCs using flow cytometry and measure parameters of systolic pressure,glycosylated hemoglobin (HbAlc),total cholesterol (TC),and triglyceride (TG),and low density lipoprotein-cholesterol (LDL-C),and high density lipoprotein-cholesterol (HDL-C).Results CD34-,CD34/CD133-,and CD34/KDR-positive cells counted (14.2 ± 8.1)‰,(7.1 ± 4.1)‰ and (5.0 ± 3.7)‰ in infarction group,(28.5 ± 9.9)‰,(15.2 ± 3.7)‰ and (6.8 ± 2.0)‰ in ischemia group,and (44.8 ± 9.5) ‰,(22.1 ± 6.6) ‰ and (16.7 ± 6.9) ‰ in control group.Taken together,circulating level of EPCs lowered substantially in infarction and ischemia groups compared to control group (P ＜ 0.05) and a far lower level was observed in infarction group (P ＜ 0.05).Circulating level of EPCs in infarction group was in a moderate negative correlation with systolic pressure,TC,TG,and LDL-C (P ＜ 0.05).Conclusions Decreased circulating level of EPCs may be a risk factor to the development of cerebral ischemia in acute cerebral infarction patients.Therefore,level of EPCs is vital for prediction,prevention and treatment of acute cerebral infarction.

Efficacy analysis of endovascular stenting for aortic arch artery stenosis after nasopharyngeal carcinoma radiotherapy / 中国脑血管病杂志

Objective To investigate the efficacy of endovascular stenting for aortic arch artery stenosis after nasopharyngeal carcinoma radiotherapy. Methods The clinical data of 8 patients with symptomatic severe aortic arch artery stenosis after nasopharyngeal carcinoma radiotherapy were analyzed retrospectively. The patients were all received endovascular stenting,and their improvement of cerebral ischemic symptoms was observed. They were followed up by cervical color Doppler ultrasound.Results The whole brain vascular DSA confirmed that there were 24 severe arterial stenoses on the aortic arch arteries of extracranial segments in 8 patients,including 11 in internal carotid artery,2 in common carotid artery,10 in vertebral artery and 1 in subclavian artery. The patients were treated with vascular angioplasty and stenting respectively. All the patients were followed up for 1 year;there were no recurrence of cerebral ischemic symptoms.Cervical color Doppler ultrasound did not reveal any obvious restenosis. Conclusion Endovascular stent angioplasty for the treatment of aortic arch artery stenosis after nasopharyngeal carcinoma radiotherapy is relatively safe and feasible.

Role of invasive intracranial pressure monitoring in treatment of bilateral posttraumatic acute diffuse brain swelling / 中华创伤杂志

Objective To investigate the instructive role and clinical effect of invasive intracranial pressure monitoring in treating bilateral posttraumatic acute diffuse brain swelling(PADBS).Methods A total of 52 consecutive patients with bilateral PADBS managed under invasive intracranial pressure monitoring between October 2009 and December 2010 were enrolled as the study group.Another 53 patients with bilateral PADBS managed with non-intracranial pressure monitoring from February 2007 to September 2009 were set as the control group.The clinical outcomes of the two groups were compared.Results The ratios of good recovery[Glasgow Outcome Scale(GOS)=5 points]and severe disability(GOS=3 points)were 59.6％(31/52)and 11.5％(6/52)respectively in the study group,but 35.9％(19/53)and 28.3％(15/53)respectively in the control group(P＜0.05).The death rates of the study and control groups were 5.8％(3/52)and 9.4％(5/53)respectively(P＞0.05),and the average hospital stay was(34.35±17.50)days and(42.43±22.17)days respectively(P＜0.05).Conclusion Durative monitoring of invasive intracranial pressure in treatment of bilateral PADBS can improve prognosis,shorten hospital stay and therefore is worthy of clinical application.

Research progress on progressive brain injury after traumatic brain injury / 国际外科学杂志

Progressive brain injury after traumatic brain injury,including intracranial hemorrhage,cerebral ischemia and edema,is an important factor affecting the prognosis of patients with traumatic brain injury.On basis of reviewing literatures,the research progress on incidence,mechanism,methods for early diagnosis,treatment and prognosis of progressive brain injury after traumatic brain injury was reviewed.

Clinical efficacy of early right median nerve electrical stimulation for coma patients followingcraniocerebral trauma / 中华创伤杂志

ObjectiveTo evaluate the clinical benefits of early right median nerve electrical stimulation on coma patients following craniocerebral trauma. MethodsCraniocerebral trauma patients with up to two weeks of coma in the years 2005-2011 were involved in the study and were randomly divided into control group (received routine management ) and treatment group (routine management plus right median nerve electrical stimulation).The treatment lasted for a period of more than two weeks.The clinical efficacy of the right median nerve electric stimulation and the conscious status of the patients within six months after craniocerebral trauma were observed.ResultsA total of 456 patients were enrolled in the study,of whom 437 patients completed the treatment course,including 221 patients in the treatment group and 216 in the control group.There was no complication related to electric stimulation during the treatment.Cerebral blood flow (CBF) imaging and brain stem evoked potential (BEP) examination demonstrated significant improvement in the treatment group.A total of 386 patients were followed up for six months postoperatively,which showed that there were 122 patients with regained consciousness,46 in minimally conscious state and 36 in vegetative state in the treatment group (204 patients) and there were 84 patients with regained consciousness,40 in minimally conscious state and 58 in vegetative state in the control group ( 182 patients).The patients in the treatment group showed a higher ratio of regained consciousness and a lower ratio of vegetative state compared with the control group,but the ratio of minimally conscious state showed no statistical difference between two groups. ConclusionsRight median nerve electrical stimulation is a suitable coma awaking means at early stage after craniocerebral trauma.

Risk factors of traumatic arterial and venous cerebral infarction in patients with moderate or severe craniocerebral trauma / 中华创伤杂志

Objective To provide theoretic support for preventing traumatic arterial and venous cerebral infarction after craniocerebral trauma by probing into the related risk factors.Methods The clinical data of 154 pateints with moderate or severe craniocerebral trauma treated by decompressive craniectomy were studied retrospectively.Univariate analysis was carried out on 13 related factors including gender,age,Glasgow Coma Score(GCS)on admission,pupil status,morphological changes of ambient cisterns,brain midline,associated injury,blood pressure,traumatic superficial cerebral veins injury,platelet count,plasma D-dimer value,dosage of dehydrating agent and perioperative fluid balance.Then,the logistic multiple regression analysis was made on significant indexes with SPSS 10.0.Results Univariate analysis showed that seven factors including pupil status,GCS on admission,age,associated injury,perioperative blood pressure,morphological changes of ambient cisterns and brain midline were significantly correlated with traumatic arterial cerebral infarction(P ＜ 0.05)and that three factors including traumatic superficial cerebral veins injury,plasma D-dimer value and associated injury were significantly correlated with traumatic venous cerebral infarction(P ＜ 0.05).Logistic multi-factors regression analysis showed that mydriasis and hypotension might be the independent risk factor of traumatic arterial cerebral infarction and that traumatic superficial cerebral veins injury might be the independent risk factors of traumatic venous cerebral infarction.Conclusion The pupil status,GCS on admission,age,associated injury,perioperative blood pressure,morphological changes of ambient cisterns and brain midline are the risk factors of traumatic arterial cerebral infarction,with mydriasis and hypotension as independent risk factors.Traumatic superficial cerebral veins injury,plasma D-dimer value and associated injury are the risk factors of raumatic venous cerebral infarction,with traumatic superficial cerebral veins injury as independent risk factor.

Diagnosis and neurosurgical remedy of central brain herniation induced by bifrontal contusions / 中华创伤杂志

Objective To investigate the clinical characteristics, operation time and methods for patients with central brain herniation caused by bifrontal contusions. Methods A retrospective study was performed on the medical records of patients with central brain herniation caused by bifrontal contusions admitted from January 2000 to December 2006. There were 45 males and 18 females, at age range of 20-72 years (average 43 years). The majority of the patients were victims of falls and traffic accidents. There were 29 patients treated with immediate operation and 34 with emergency operation. All the operations involved simultaneous bilateral craniectomy for decompression, including 17 patients treated with bilateral decompressive craniectomy and 46 with unilateral decompressive craniectomy. Results The prognosis was favorable in 19 patients with GOS score of 5 or 4 points, severely disabled in seven with GOS score of 3 points, vegetative in four with GOS score of 4 points and the worst in seven with GOS score of 1 point. Of all, 19 patients suffered severe mental disorders especially personality change and disturbance of intelligence. Seven patients were complicated by epilepsy and three by hydrocephalus. Conclusions Based on early clinical manifestations of central brain herniation combined with imaging manifestations, bilateral balance decompression craniectomy can reduce the mortality and morbidity and improve the cure rate of patients with central herniation caused by bifrontal brain contusions.

Abnormal expressions of Nav1.1 and Nav1.2 in hippocampus following traumatic brain injury in rats / 中华创伤杂志

Objective To investigate the mRNA and protein expressions of Nav 1.1 and Nav 1.2 in hippocampus following traumatic brain injury ( TBI) in rats.Methods After the lateral fluid percussion model was established in adult male Sprague Dawley rats,the rats were sacrificed at 2,12,24 and 72 hours after percussion and collected ipsilateral hippocampus for detecting mRNA and protein expressions of Nav 1.1 and Nav 1.2 by means of fluorescent quantitation RT-PCR,Western blot and immunofluo rescence staining.Results The mRNA expressions of Nav 1.1 and Nav 1.2 were significantly down-regulated (P<0.01) in hippocampus and reached the lowest level at 2 hours following TBI.The protein expression of Nav 1.1 was significantly down-regulated (P<0.01) but recovered near to level of control group at 72 hours after TBI.While there was no statistical difference on protein expression of Nav 1.2 in hippocampus after TBI compared with control group (P>0.05).Conclusion TBI induces significant down-regulated mRNA and protein expressions of Nav 1.1 in the hippocampus,which may be one of molecular mechanisms for functional alternation of sodium channels and excitotoxic action following TBI.

Calpain expression changes in response to hypothermia after traumatic brain injury / 中华创伤杂志

Objective To determine the effect of hypothermia on gene transcription and protein expression of calpain after traumatic brain injury (TBI). Methods Twenty-seven rats were randomly divided into three groups, ie, normal control group, normothermia TBI group and hypothermia TBI group. All rats with TBI were suffered from a lateral fluid percussion injury (FPI) at the right parietal lobe. Hy-pothermia intervention [rectal temperature for (32 ± 0.5) ℃] was performed for four hours immediately after TBI in hypothermia TBI group. Fluorescence PCR and Western blot were utilized to semi-quantify gene transcription and protein expression of ealpain and immunofluorescence used to observe protein dis-tribution of Calpain. Results Compared with normothermia TBi group and normal control group, hypo-thermia TBI group showed increased calpain gene transcription at 12 and 24 hours respectively after FPI (P <0.05). However, the increase of ealpain protein expression in hypothermia TBI group was inhibited more significantly by hypothermia at 6,12,24 and 72 hours after TBI, compared with normothermia TBI group (P < 0.05). Conclusion Neuroproteetion of hypothermia after TBI may somewhat be related to the decrease of calpain protein expression after its gene transcription.

Expression changes of microRNA array in mesencephalon of rats with traumatic coma / 中华创伤杂志

Objective To set up a rat model with acute traumatic coma and identify the variation of microRNA in mesencephalon. Methods After rats were injured moderately by central fluid percussion system, tissues of the mesencephalon were removed one hour after injury. RNA of brain tissue of the mesencephalon was isolated for microRNA array by using the exiqon microarray system. The data were analyzed statistically by Genepix Pro 6.0 after hybridization results were scanned and fluorescence intensity standardized. Resets Hybridization results showed 33 microRNAs with up-regulated expressions but 38 microRNAs with down-regulated activity. Conclusion Expression of microRNA array shows marked changes in the tissues of the mesencephalon in rats with traumatic coma, as may be injury mechanism of traumatic coma and also a way of neurobiological protection of coma.

Microarray analysis of altered gene expression profile of hippocampus after traumatic brain injury in rats / 中华创伤杂志

Objective To screen the altered gene expression profile of hippocampus after traumatic brain injury(TBI)in rats. Methods Rats(n=3)in experimental group underwent moderate fluid-percussion(F-P)brain injury and the hippoeampus sample in the injured hemisphere was removed and conserved in liquid nitrogen three hours later.The rats(n=5)of the control group underwent the same procedure except for injury.Mfymetrix rat genome 230 2.0 array was used to detect the gene expression profile of hippocampus in two groups and find the altered gene expression profile. Results A total of 159 genes in the experimental group changed significantly(≥2 folds)compared with the control group,of which 136 genes were up-regulated and 23 genes down-regulated. Conclusions The significant gene expression changes of hippocampus,especially a large mount of up-regulated genes,are detected after moderate TBI in rats,suggesting that the secondary injury following TBI is a procedure involving multiple factors.