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Objective To investigate the application value of auditory mismatch negativity (aMMN) in evaluating the brain function of patients with chronic disorders of consciousness (DOC). Methods Thirty-three patients with DOC or escaped minimally conscious state (eMCS), admitted to our hospital from April to June 2018, were selected in this study. Based on the levels of consciousness assessed by Coma Recovery Scale-Revised (CRS-R), they were divided into vegetative state (VS) group, micro-consciousness state (MCS) group and eMCS group; 14 healthy subjects were included as control group. The differences of aMMN amplitude and latency in patients from different groups, patients with different etiologies and different lateral cerebra were compared. Pearson correlation analysis was used to determine the correlation between CRS-R scores and aMMN. Results (1) There was statistically significant difference in aMMN amplitude between patients from any two groups (P<0.05); as compared with that in the control group, the latency of VS group and MCS group was significantly increased (P<0.05). (2) According to the etiology, the aMMN amplitude of brain injury group, cerebral hemorrhage group and hypoxic encephalopathy group was significantly lower than that of control group (P<0.05). (3) There was significant difference in the amplitude of aMMN between lesion side and contralateral side in 11 patients (t=5.798, P=0.000). (4) Statistical results showed that CRS-R scores were positively correlated with aMMN amplitude (R=0.876, P=0.000), but not with the latency (r=0.018, P=0.922). Conclusion The amplitude of aMMN is significantly positively correlated with levels of consciousness in DOC patients, which can be used as an important tool to assess the levels of consciousness and dynamically estimate the outcomes of consciousness in DOC patients.
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Spinal cord stimulation (SCS) is a promising technique for treating disorders of consciousness (DOCs). However, differences in the spatio-temporal responsiveness of the brain under varied SCS parameters remain unclear. In this pilot study, functional near-infrared spectroscopy was used to measure the hemodynamic responses of 10 DOC patients to different SCS frequencies (5 Hz, 10 Hz, 50 Hz, 70 Hz, and 100 Hz). In the prefrontal cortex, a key area in consciousness circuits, we found significantly increased hemodynamic responses at 70 Hz and 100 Hz, and significantly different hemodynamic responses between 50 Hz and 70 Hz/100 Hz. In addition, the functional connectivity between prefrontal and occipital areas was significantly improved with SCS at 70 Hz. These results demonstrated that SCS modulates the hemodynamic responses and long-range connectivity in a frequency-specific manner (with 70 Hz apparently better), perhaps by improving the cerebral blood volume and information transmission through the reticular formation-thalamus-cortex pathway.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Brain , Consciousness , Physiology , Consciousness Disorders , Therapeutics , Hemodynamics , Physiology , Pilot Projects , Spinal Cord , General Surgery , Spinal Cord Stimulation , MethodsABSTRACT
Treatment for disorders of consciousness (DOCs) is still a Gordian knot. Evidence-based guidelines on the treatment of DOC patients are not currently available, while neuromodulation techniques are seen as a potential treatment. Multiple neuromodulation therapies have been applied. This article reviews the most relevant studies in the literature in order to describe a clear picture of the current state of neuromodulation therapies that could be used to treat DOC patients. Both invasive and non-invasive brain stimulation is discussed. Significant behavioral improvements in prolonged DOCs under neuromodulation therapies are rare. The efficacy of various such therapies remains a matter of debate. Further clinical investigations of existing techniques in larger samples properly controlling for spontaneous recovery are needed, and new approaches are awaited.
Subject(s)
Humans , Brain , General Surgery , Consciousness , Physiology , Consciousness Disorders , Therapeutics , Neurotransmitter Agents , Therapeutic Uses , Transcranial Magnetic Stimulation , Methods , Treatment OutcomeABSTRACT
Mismatch negativity is a kind of event-related evoked potential (ERP),which is an automatic response of the brain to relevant events without active participation,especially suitable for uncoordinated patients with disorders of consciousness.In recent years,it has been more and more widely used in the diagnosis and prognosis prediction of disorders of consciousness.This is a review about the latest progress of the clinical application of mismatch negativity in the area of disorders of consciousness.
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Paroxysmal sympathetic hyperactivity (PSH),which recognized in a subgroup of survivors of severe acquired brain injury,is a syndrome of simultaneous,paroxysmal transient increases in sympathetic (elevated heart rate,blood pressure,respiratory rate,temperature,sweating) and motor (posturing) activity.These symptoms are not specific and can occur in sepsis,epilepsy,malignant hyperthermia,hydrocephalus and many other complications,which is related to confused diagnosis and delayed treatment of PSH.In addition,Patients with PSH have prolonged ICU stays and added healthcare costs.This article discusses the pathophysiological mechanism,clinical diagnostic criteria,and current drug treament measures of PSH,so as to guide rapid diagnosis.
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Objective To evaluate the influence of SOCS3 conditional ablation in macrophage polarization and functional recovery after spinal cord injury in mice.Methods The Socs3fVfl Nes cre mice were used to obtain nervous-system-restricted SOCS3 deletion models as experimental group (n=40),and littermate Socs3fl as control group (n=40).Mice (n=35) in each group were underwent T10 spinal cord compressing injury (the left 5 were as sham-operated controls);on the third,7th and 14th d of injury,injured tissues from 15 mice of each group were harvested;immunofluorescence was performed to detect the changes of M2a and M2c phenotypic marker Arginase1 and M1 and M2b phenotypic marker CD86;on the first,third,7th and 14th d of injury,injured tissues from the left 20 mice from each group were harvested;fluorescent quantitative real time-PCR was used to detect the macrophage phenotypic markers (Arginasel,CD206,iNOS and CD32),SOCS3 and STAT3 gene expressions;the above data from the sham-operated controls were used as base data.BMS scale was used to evaluate the motor functions of posterior limbs and bodies on the first,third,7th and 14th d of injury.Results The behavioral assessments of the experimental group were superior on the third,7th and 14th d of injury as compared with those of control group (P＜0.05).Immunofluorescence showed that as compared with the controls,the Socs3fVfl Nes cre mice had a predominance in distribution and population of Arginasel-positive macrophages in spinal cords on the third,7th and 14th d of injury;in contrast,the control group showed superiority of CD86 expression on the 7th and 14th d,with significant differences (P＜0.05).Similarly,fluorescent quantitative real time-PCR analysis demonstrated that gene expression of A rginase I on the 7th d of injury,that of CD206 on the 7th and 14th d of injury,and that of STAT3 on the third,7th,and 14th d of injury were significantly increased,whereas that of CD32 on the 14th d of injury and SOCS3 on the first and third d of injury were significantly reduced in the experimental group,as compared with those in the control group (P＜0.05).Conclusion SOCS3 conditional knockout can promote the formation of M2 macrophage,as well as good functional recovery after spinal cord injury in mice.
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Objective To review systematically the clinical curative effects and time window of hyperbaric oxygen treatment of persistent vegetative state (PVS).Methods All the clinical research articles about hyperbaric oxygen for PVS from January 1990 to December 2013 were retrieved from China national knowledge internet,Wanfang Database and Vip Database (the Chinese key words:vegetative state,the vegetable,or hyperbaric oxygen),and then,a Meta-analysis was conducted.Results Search terms yielded 165 pieces of articles and 19 were included in the final analysis for treatment efficacy;the treatment group included 939 patients and the control group included 659 patients.Totally,17 pieces of articles of time window were included;the patients with onset＜60 d group included 700 patients and the patients with onset＞ 60 d group included 330 patients.The Jadad scores of included articles were not high in general,and the highest scores were two points.Comparable baseline data were demonstrated in all of the articles.Data from articles were pooled and analyzed,and the results showed that the effective rate of treatment group and control group were 67.51％ and 34.45％,with significant difference (Z=12.16,P=0.000,odd ratio=0.25,95％ confidence interval=0.20-0.31).The effective rate of patients with onset＜60 d group and patients with onset≥60 d group was 22.73％ and 63.29％ (Z=9.72,P=0.000,odd ratio=5.21,95％ confidence interval=3.74-7.27) Conclusion Hyperbaric oxygen treatment enjoys better treatment efficacy than conventional treatment;patients with onset＜60 d have better prognosis than patients with onset≥ 60 d.
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Objective To investigate the calcium/calmodulin-dependent serine protein kinase (CASK) expression in the hippocampus of epileptic rat models and its mechanism.Methods Thirty healthy adult male Sprague-Dawley rats were randomly divided into 6 groups (n=5):control group and experimental groups of 1,3,7,14 and 30 d after kindling by lithium chloride-pilocarpine;CASK expressions in the hippocampus tissues were measured by immunohistochemistry,immunoflurescence and Western blotting.Another 21 healthy adult male Sprague-Dawley rats were divided into 3 groups (n=7):transfected group,empty adenoviral group and control group,and after anesthesia with chloral hydrate,the same volume of CASK-RNAi-LV,LV-scrRNAi and normal saline was given,respectively;the behavior changes of rats in the three groups were observed within one h of kindling;the expression of N-methel-D-aspartate receptor subunit 2b (NMDAR2b,the downstream of CASK complex),in the transfected group and control group was further examined by Western blotting.Results CASK expressed only in neurons not gliacyte;and the number of CASK positive cells in experimental groups was larger than that in the control group.CASK expression in the hippocampus reduced to minimum level one d after kindling,and maintained at increased levels until 30 days.Both seizure frequency and seizure grade of the epilepsy in the transfected group were significantly decreased as compared with those in the empty adenoviral group and control group (P＜0.05).NMDAR2b expression in the hippocampus of control group increased at the first 24 h of kindling and maintained for 3 days,and then,it decreased 10 days after kindling;NMDAR2b expression in the hippocampus of transfected group was significantly reduced as compared with that in the control group at all time points of kindling (P＜0.05).Conclusions The CASK expression of epilepsy rat models is increased,which influences the occurrence and development of epilepsy.CASK is linked to epilepsy via its action on synaptic NMDAR2b,which may be the potential target of anti-epileptic drugs.
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Objective To explore dynamic changes of renal cortex blood perfusion in Goto-Kakizaki rats(GK rats) by contrast-enhanced ultrasonography.The clues for early diagnosis and intervention of diabetic renal impairment may be obtained from the study.Methods Male GK rats were taken as experimental groups,and Wistar male rats were used as controls.Contrast-enhanced agent SonoVue was administered via the femoral vein cannulation in a bolus fashion.Image changes of renal cortex were observed in real time, and dynamic image changes within 0 - 5 minute after injection were observed and stored.The renal cortex blood perfusion changes were analyzed using the time-intensity curve (TIC).Results (1) The kidney was quickly enhanced after the injection of contrast agent.The renal artery, cortex, renal vein were displayed in sequence.(2)The shape of renal perfusion TIC in all the objects was a single peak,steep ascending, flat descending curve.The overall shape of TIC in GK rats was wider than controls and they were wider and wider with age increasing of the GK rats.(3) Compare to controls,the time to peak (TTP)and the half time of peak descending (HDT) in GK rats was longer (P ＜0.01), the slope rates of the ascending curve (S1) and the slope rates of the descending curve (S2) decreased and the area under the curve increased in 12-week-old and 20-week-old GK rats (P ＜ 0.05 or P ＜ 0.01).Conclusions The abnormal blood perfusion of renal cortex microcirculation was present in the early stage of diabetic in GK rats.Real-time contrast-enhanced ultrasonography and TIC could display this change effectively.