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Intracranial infection is a common and serious complication of acute severe traumatic brain injury, with high mortality and disability rates, which significantly affects the prognosis. In recent years, with the widespread use of antibiotics, antibiotic-resistance rates of pathogens have risen year by year, and the choice of sensitive antibiotics is less and less, sometimes even in difficulties of no drugs available. This paper reviewed the treatment process of 1 case with intracranial infection caused by multi drug-resistant Klebsiella pneumonia after severe traumatic brain injury . The aim is to summarize the clinical experience.
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Objective To evaluate the efficacy and safety of using alteplase for intravenous thrombolysis combined with vascular intervention for treatment of patients with acute intracranial large arterial occlusion.Methods Clinical data of 7 patients with acute intracranial large arterial occlusion treated by using alteplase for intravenous thrombolysis combined with intravascular intervention admitted to Department of Neurosurgery in Affiliated Hospital of the Logistics University of Cinese People's Armed Police Force from July 2015 to August 2016 were retrospectively analyzed.All the 7 patients were treated by alteplase dry powder (50 mg or 20 mg each ampule),solvent dose was 0.9 mg/kg,the maximum dose being ＜ 90 mg,firstly 10％ dose was intravenously injected,and the remaining dose was continuously infused into a vein in 60 minutes,during or after intravenous thrombolysis,digital subtraction angiography (DSA) was performed immediately,and according to the results of the angiography,at least one of the 3 kinds of intravascular mechanical intervention therapy,thrombectomy,balloon dilatation or stent placement,were chosen,and 24 hours after surgery,the anti-platelet aggregation drug and calcium channel antagonists were given,The effect of interventional therapy was analyzed,and the clinical outcome of 90-day treatment was evaluated.Results The mean age of the patients was (60.0 ± 12.6) years.Seven patients all successfully completed the treatment,and satisfactory re-canalization was achieved [they all obtained grade 3 or 2b in accord with the gradation of Thrombolysis in Cerebral Ischemia Scale (TICI)] in all the 7 cases (100％),after treatment,the National Institutes of Health Stroke Scale (NIHSS) score was significantly lower than that before treatment (5.86 ±4.10 vs.19.71 ± 5.56,P ＜0.01).Clinical outcome of 90-day follow up was excellent [Modified Rankin Scale (mRS) score 0-2] in 3 cases (42.8％).Conclusion Using alteplase for intravenous thrombolysis combined with endovascular intervention for treatment of patients with acute intracranial large arterial occlusion can achieve good re-canalization rate.
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Objective To investigate the effectiveness and the best assessment time of the short-latency somatosensory evoked potential (SLSEP) and brainstem auditory-evoked potential (BAEP) in the prognosis prediction of patients with severe cerebrovascular disease. Methods A prospective trial was conducted. The patients with severe cerebrovascular disease and Glasgow coma scale (GCS) ≤ 8 and admitted to the neurological intensive care unit (NICU) of Armed Police Logistics College Affiliated Brain Hospital from December 2014 to May 2015 were enrolled. The patients received SLSEP and BAEP nerve electrophysiological examinations within 24 hours and on 3, 7, 15 days after admission respectively and were graded according to Cant method. GCS was evaluated within 24 hours and on 15 days after admission. The prognosis was evaluated by Glasgow outcome scale (GOS) at six months after the onset of the disease. At different time windows after the onset of the disease, the correlations between different predictive indexes (GCS, SLSEP and BAEP) and outcome (GOS) were analyzed using spearman rank correlation; in the mean time, the efficacy for predicting the prognosis by single index or combined indexes was compared by receiver operator characteristic (ROC) curve. Results Seventy-eight patients were enrolled [men 46, women 32, age range (60.79±12.50) years old]. There were 78, 64, 44 and 19 patients observed at 24 hours and on 3, 7, 15 days after admission because the short-term death of some patients. The graded abnormal rate of SLSEP was 75.64%, 82.81%, 79.55% and 73.98% respectively; and the graded abnormal rate of BAEP was 82.05%, 84.38%, 85.94% and 73.68% respectively. ① Correlation analysis: all the predictors were correlated with GOS within 24 hours and on 3, 7, 15 days after admission, and SLSEP and BAEP grading were moderately correlated with GOS (0.4≤|R| < 0.7). ② The accuracy of the predicting prognosis: the area under the curve (AUC) of GCS on 15 days after admission [AUC = 0.772, 95% confidence interval (95%CI) = 0.561-0.984, P = 0.045] was the maximum when predicting survival. AUC of SLSEP (AUC = 0.825, 95%CI = 0.695-0.955, P = 0.000) and BAEP (AUC = 0.786, 95%CI = 0.646-0.927, P = 0.002) were the maximum on 7 days after admission when predicting death. ③ The effectiveness of the prognosis prediction: the sensitivity of SLSEP grading and BAEP grading were 92.6% and 96.3% respectively, while the sensitivity, specificity and accuracy of SLSEP and BAEP combined prediction were 100% on 7 days after admission. The specificity of GCS was 100% on 15 days after admission. Conclusions SLSEP and BAEP have more close correlation with prognosis compared with the GCS; Continuous dynamic combined evaluation of SLSEP and BAEP has important clinical value for patients with severe cerebrovascular disease possess in the prognosis assessment, the accuracy and the effectiveness of SLSEP and BAEP combined prediction were higher on 7 days especially.
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Objective To investigate the value and efficacy of continuous renal replacement therapy(CRRT) for treatment of heat stroke patients complicated by multiple organ dysfunction syndrome(MODS). Methods The clinical data of 19 heat stroke patients complicated by MODS admitted into the hospital in a period from July 15,2010 to August 30,2010 and treated by CRRT were analyzed retrospectively. Continuous venovenous hemofiltation(CVVH) mode was used in all patients and the initial temperature of replacement fluid range was 28℃to 32℃persisting in 2.0 to 2.5 hours and afterward it maintained at 36℃. Prognosis and adverse effect were observed,the patients' body temperature,heart rate(HR),mean arterial pressure(MAP),acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores,oxygenation index(PaO2/FiO2),the levels of serum urea nitrogen(BUN),serum creatinine(SCr), myoglobin(Mb),creatine kinase(CK),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and arterial lactate(Lac)were monitored before and after CRRT treatment. Results Fifteen patients were cured or improved,and 4 died. Compared with those before CRRT treatment,body temperature(℃),HR(bmp),MAP(mm Hg,1 mm Hg=0.133 kPa),APACHEⅡevaluation(score),PaO2/FiO2(mm Hg)were significantly improved(body temperature:36.8±0.2 vs. 41.6±0.3,HR:93.6±10.3 vs. 132.5±11.4,MAP:69.8±9.9 vs. 45.2±7.7,APACHEⅡ:12.3±3.9 vs. 29.6±4.6,PaO2/FiO2:213.6±95.4 vs. 126.5±87.4,all P<0.05);the levels of BUN(mmol/L),SCr(μmol/L), Mb(μg/L),CK(U/L),ALT(U/L),AST(U/L),Lac(mmol/L)were significantly reduced after the treatment(BUN:23.9±5.3 vs. 42.6±5.4,SCr:123±47 vs. 356±51,Mb:201±45 vs. 468±39,CK:217±32 vs. 843±41,ALT:79±36 vs. 894±88,AST:57±28 vs. 867±92,Lac:3.5±2.4 vs. 16.6±3.9,all P<0.05). In the process of the treatment,hemodynamics was stable,and no obvious side effects occurred. Conclusion CRRT treatment can exactly and safely reduce the core body temperature of patients with heat stroke,and it can also effectively eliminate metabolites of BUN,Cr,Mb,etc,ameliorate the inflammatory reaction and supporting the functions of liver,kidneys and other vital organs,thus the treatment is also safe and effective for such patients complicated by MODS.
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Objective To find a proper way for accurate results of blood counts,and provide reference for the user of 3 cluster blood cell analyzer.Methods Based on the results of blood cell analyzer KX21 and International Consensus Review Rules,set up the criteria for blood cell microscopic examination,1700 blood specimen were detected and the results were analyzed according to the criteria..Statistics analysis were made to evaluate the accordance between warnings of analyzer and manual examination,likewise the reliability of the criteria.Results According to the review rules and slide riview positive criteria[1],the true positive ratio,the false positive ratio,the true negative ratio and the false negative ratio were 11.88%(202/1 700),21.88%(372/1 700),64.29% (1 093/1 700) and 1.94% (33/1 700) respectively..No blast cell and immature cell was missed.Conclusion The smear review criteria suggested by the International Consensus Group could facilitate to establish the review criteria for 3 cluster blood cell analyzer..The review rules used on KX21 blood cell analyzer in this study are suitable for our laboratory.
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@#ObjectiveTo investigate the dynamic changes in microvascular ultrastructure in the cortex after the acute cerebral ischemia-reperfusion.Methods40 male rats were randomly divided into two groups（n=20 for sham operation group and cerebral ischemia-reperfusion group）. Cerebral ischemia-reperfusion model was produced using suture middle cerebral artery occlusion. Rats were sacrificed and the brain samples were adopted 1,3,12,72 h after ischemia-reperfusion, methyl methacrylate composite brain microvascular casting. The production of brain microvascular specimens, scanning electron microscopy of normal rat cerebral cortex microvessels and cerebral cortex of acute brain injury morphological changes in microvascular.ResultsCompared with the sham-operated group, cerebral ischemia-reperfusion in the cortex after the signs of vascular damage, then, vascular casting was to "bean" shape or even had a completely broken "tears candles" stump-like vascular casting, finally, to further the formation of a vascular zone cortex. ConclusionThe structural changes of brain microvascular in the cortex after acute cerebral ischemia-reperfusion is an important cause of cerebral microcirculation in rats.
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Objective To judge injury severity of severe traumatic brain injury (sTBI) by using surface enhanced laser desorption-ionization (SELDI) protein chip technique. Methods Serum sam-ples from sTBI patients were used to detect expression of differential proteins by protein chip CM10 and SELDI to analyze the correlation between expression peak intensity and GCS. Results We obtained 101 protein peaks, with statistical difference upon expression of 27 protein peaks, when negative correla-tion was found between two peaks ( m/z 4 972 and m/z 5 322 ) and GCS score and positive correlation be-tween six peaks (m/z 3 941, m/z 4 295, m/z 8 714, m/z 8 792, m/z 14 020 and m/z 28 148) and GCS score. Conclusion SELDI protein chip technique may become a new and objective detection method in judging injury severity of sTBI.
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Objective To study the changes of proteome expression in brain tissues from rats with severe traumatic brain injury(sTBI). Methods Total protein of brain tissues were obtained at days 3,7 and 14 for two-dimensional gel electrophoresis to screen and identify differential protein spots.Results We screened 17 differential protein spots that were involved in cellular metabolism,stress and inflammatory reaction. Conclusion Some differential proteins involved in sTBI can be found by twodimensional gel electrophoresis.