ABSTRACT
The incidence of venous thromboembolism（VTE）in patients with traumatic brain injury（TBI）, especially in patients with severe TBI, is significantly increased due to disturbance of consciousness and limb movement. In the acute phase of VTE, low molecular weight heparin（LMWH）is the most commonly used safe and effective measure to prevent thrombosis. Due to the changes of injury condition of trauma patients, the deviation of clinicians' understanding of VTE and the medication habits of various medical institutions, there are significant differences in the initial time and dose of LMWH prevention. Insufficient or excessive dose of LMWH will lead to thrombus or bleeding complications. In recent years, administration of LMWH with anti-X activity monitoring has been paid more and more attention in patients with TBI, playing an important role in reducing the incidence of thrombosis. The authors review the research progress in the application of LMWH with anti-X activity monitoring in thrombus prevention in patients with TBI from the aspects of mechanism in LMWH use with anti-X activity monitoring, LWMH medication time window and anti-X activity monitoring, LWMH dose adjustment and anti-X activity monitoring, in order to provide references for clinical treatment.
ABSTRACT
To explore diagnostic significance of treadmill exercise test (TET) combined echocardiography (ECG) for coronary heart disease (CHD) and its severity .Methods :Clinical data of 400 patients who were initially diagnosed as CHD were retrospectively analyzed .With coronary angiography as gold standard ,sensitivities and spe‐cificities of single TET ,single ECG and TET + ECG ,and positive detection rate of different number of diseased vessels were analyzed .Results : Compared with single TET and single ECG ,there was significant reduction in sensi‐tivity (80.67%,68. 07% vs.54.20%) and significant rise in specificity (74.07%,64.82% vs.90.74%) in TET +ECG , P＜0. 01 all.Along with number of diseased coronary vessels rose ,positive detection rates of single TET ,sin‐gle ECG and TET + ECG increased .Compared with single TET and single ECG ,there were significant rise ? In positive detection rates of single vessel coronary disease (72. 32%,56. 25% vs.83.93%) ,double vessel coronary disease (85. 92%,71. 83% vs.97. 18%) and multi vessel coronary disease (90. 91%, 87.27% vs.98. 18%) in TET+ ECG , P＜0.05 or ＜0. 01. Conclusion :Diagnostic specificity of TET + ECG is significantly better than those of single TET and single ECG ;when number of diseased coronary vessels gets more ,positive detection rate of TET +ECG is more significant .
ABSTRACT
Objective To observe the expression of aquaporin 4 (AQP-4) in contused brain tissue and its relationship with brain edema following brain trauma.Methods A retrospective case control analysis was made on 42 patients with severe brain trauma admitted from January 2015 to March 2016.There were 23 males and 19 females,aged from 23 to 62 years [(35.5 ± 5.6) years].Glasgow coma score (GCS) was 3-5 points in 7 patients,6-8 points in 23 and 9-10 points in 12.Brain tissue removed from the area 1 cm near the contusion during the cranial surgery were allocated to study group (n =42),while brain tissue removed far from the contusion after internal decompression were used as control (n =8).Ultrastructure of brain tissues was observed under electron microscope.Water content of brain tissue was measured by dry-wet weight method and expression of AQP-4 was measured by immunohistochemical method at postinjury hours ＜ 6,6-12,12-24,24-72,72-96 and ＞ 96.Results Morphology and structure of brain tissue in control group were normal.Whereas in study group,the intracellular and interstitial edema were obvious and morphological structure were damaged.Water content and AQP-4 expression in control group showed no obvious increase after operation(73.55 ±0.10,0.193 ±0.016).Water content in study group increased significantly compared to control group and reached the peak value (81.28 ± 0.56) at postinjury 24-72 hours (P ＜ 0.01).AQP-4 expression in study group increased at postinjury 6 hours (0.242 ±0.023) and reached a peak at postinjury 24-72 hours (0.338 ± 0.013),with significant difference compared to control group (P ＜ 0.05).Correlation analysis showed change of brain water content was positively correlated with expression level of AQP-4 (r =0.931,P ＜ 0.01).Conclusion Expression of AQP-4 in the injured area of brain trauma is significantly increased along with the increase of water content,suggests that the upregulation of AQP-4 plays an important role in traumatic brain edema.
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Objective To evaluate the effect of controlled decompression on complications such as delayed intracranial hematoma,acute encephalocele and cerebral infarction in patients with severe traumatic brain injury.Methods Pubmed,Cochrane Library,Wanfang data,VIP and CNKI wcrc searched for related literaturc about controlled decompression (treatment group) and traditional surgical methods(control group) for severe traumatic brain injury.The data that met the inclusion criteria were extracted,and analyzed statistically using the Review Manager 5.3.Results A total of 12 studies were included in this meta-analysis,with respective 730 patients in control group and 908 patients in treatment group.Controlled decompression versus traditional treatment methods reduced incidence of delayed intracranial hematoma (RR =0.55,95％ CI 0.44-0.70,P ＜ 0.01),acute encephalocele(RR =0.42,95％ CI 0.32-0.53,P ＜ 0.01) and cerebral infarction (RR =0.42,95％ CI 0.32-0.55,P ＜0.01).Conclusion Applied to treat severe traumatic brain injury,controlled decompression exhibit significantly lower rate of delayed intracranial hematoma,acute encephalocele and cerebral infarction than traditional methods.
ABSTRACT
Objective To investigate the roles of sex hormones and T-cell phenotype in traumatic brain injury (TBI). Methods Within 12 hours, 1, 3 and 7 days after TBI, a dynamic observation and a correlative analysis were performed on CD4 + and CD8 + lymphocytes in the serum and on the changes of estradiol, progesterone and testosterone in the cerebrospinal fluid (CSF) and serum in all cases. Results The CD4 + and CD8 + lymphocytes were inhibited and decreased with injury severity. The estradiol and progesterone levels in serum and cerebrospinal fluid (CSF) increased within 12 hours after trauma in all groups. Estradiol increased markedly continuously within 1, 3 and 7 days and progesterone sustained high within seven days in GCS≤8 group, with a significant difference compared with others groups. The testosterone levels in serum and CSF decreased in the death group. There was a positive correlation between the changes of CD4 + lymphocytes and the levels of serum estradiol, progesterone and testosterone in the death group. Conclusions The increases of estradiol (in the early stage) and progesterone (in the late stage) after TBI may exert powerful protective effects on brain tissues. Decreases of sex hormones and T lymphocyte are important factors leading to death of patients.