Neurocritical care management supported by multimodal brain monitoring after acute brain injury / Abordagem de cuidados neurocríticos apoiada por monitorização cerebral multimodal após lesão cerebral aguda

ABSTRACT Objective: To evaluate the association between different intensive care units and levels of brain monitoring with outcomes in acute brain injury. Methods: Patients with traumatic brain injury and subarachnoid hemorrhage admitted to intensive care units were included. Neurocritical care unit management was compared to general intensive care unit management. Patients managed with multimodal brain monitoring and optimal cerebral perfusion pressure were compared with general management patients. A good outcome was defined as a Glasgow outcome scale score of 4 or 5. Results: Among 389 patients, 237 were admitted to the neurocritical care unit, and 152 were admitted to the general intensive care unit. Neurocritical care unit management patients had a lower risk of poor outcome (OR = 0.228). A subgroup of 69 patients with multimodal brain monitoring (G1) was compared with the remaining patients (G2). In the G1 and G2 groups, 59% versus 23% of patients, respectively, had a good outcome at intensive care unit discharge; 64% versus 31% had a good outcome at 28 days; 76% versus 50% had a good outcome at 3 months (p < 0.001); and 77% versus 58% had a good outcome at 6 months (p = 0.005). When outcomes were adjusted by SAPS II severity score, using good outcome as the dependent variable, the results were as follows: for G1 compared to G2, the OR was 4.607 at intensive care unit discharge (p < 0.001), 4.22 at 28 days (p = 0.001), 3.250 at 3 months (p = 0.001) and 2.529 at 6 months (p = 0.006). Patients with optimal cerebral perfusion pressure management (n = 127) had a better outcome at all points of evaluation. Mortality for those patients was significantly lower at 28 days (p = 0.001), 3 months (p < 0.001) and 6 months (p = 0.001). Conclusion: Multimodal brain monitoring with autoregulation and neurocritical care unit management were associated with better outcomes and should be considered after severe acute brain injury.

RESUMO Objetivo: Avaliar a associação entre diferentes tipos de unidades de cuidados intensivos e os níveis de monitorização cerebral com desfechos na lesão cerebral aguda. Métodos: Foram incluídos doentes com traumatismo craniencefálico e hemorragia subaracnoide internados em unidades de cuidados intensivos. A abordagem na unidade de cuidados neurocríticos foi comparada à abordagem na unidade de cuidados intensivos polivalente geral. Os doentes com monitorização cerebral multimodal e pressão de perfusão cerebral ótima foram comparados aos que passaram por tratamento geral. Um bom desfecho foi definido como pontuação de 4 ou 5 na Glasgow outcome scale. Resultados: Dos 389 doentes, 237 foram admitidos na unidade de cuidados neurocríticos e 152 na unidade de cuidados intensivos geral. Doentes com abordagem em unidades de cuidados neurocríticos apresentaram menor risco de um mau desfecho (Odds ratio = 0,228). Um subgrupo de 69 doentes com monitorização cerebral multimodal (G1) foi comparado aos demais doentes (G2). Em G1 e G2, respectivamente, 59% e 23% dos doentes apresentaram bom desfecho na alta da unidade de cuidados intensivos; 64% e 31% apresentaram bom desfecho aos 28 dias; 76% e 50% apresentaram bom desfecho aos 3 meses (p < 0,001); e 77% e 58% apresentaram bom desfecho aos 6 meses (p = 0,005). Quando os desfechos foram ajustados para o escore de gravidade do SAPS II, usando o bom desfecho como variável dependente, os resultados foram os seguintes: para o G1, em comparação ao G2, a odds ratio foi de 4,607 na alta da unidade de cuidados intensivos (p < 0,001), 4,22 aos 28 dias (p = 0,001), 3,250 aos 3 meses (p = 0,001) e 2,529 aos 6 meses (p = 0,006). Os doentes com abordagem da pressão de perfusão cerebral ótima (n = 127) apresentaram melhor desfecho em todos os momentos de avaliação. A mortalidade desses doentes foi significativamente menor aos 28 dias (p = 0,001), aos 3 meses (p < 0,001) e aos 6 meses (p = 0,001). Conclusão: A monitorização cerebral multimodal com autorregulação e abordagem na unidade de cuidados neurocríticos foi associado a melhores desfechos e deve ser levado em consideração após lesão cerebral aguda grave.

The predictive value of dynamic changes of coagulation function for the occurrence and progression of isolated distal deep vein thrombosis of lower limbs in patients with acute brain injury / 中华危重病急救医学

Objective:To analyze risk factors for the occurrence and progression of isolated distal deep vein thrombosis (IDDVT) of lower limbs, and to explore the predictive value of dynamic changes of coagulation index D-dimer on the occurrence and progression of IDDVT in acute brain injury (ABI) patients during perioperative period.Methods:A retrospective case-control study was conducted. Perioperative ABI patients admitted to department of neurocritical care unit (NCCU) of the First Affiliated Hospital of University of Science and Technology of China from September 2019 to May 2020 were enrolled. Patients' baseline characteristics, disease characteristics, treatment approaches, outcomes and coagulation function index at 1, 2-4, 5-7 and > 7 days post operation were analyzed between patients with IDDVT and patients with progressive IDDVT. Risk factors for IDDVT occurrence and progression were identified by multivariate Logistic regression. Receiver operating characteristic curve (ROC curve) were drawn to assess the predictive value of coagulation indexes for IDDVT occurrence and progression.Results:A total of 164 ABI patients were enrolled. Most of the patients were elderly [age was 60 (51, 69) years], male [99 cases (60.4%)], and severe cases [Glasgow coma score (GCS) at admission was 6 (5, 8)]. The rates of IDDVT occurrence and progression were 61.6% (101 cases) and 16.8% (17 cases), respectively, the rate of proximal deep venous thrombosis (DVT) was 12.8% (21 cases). Compared with the IDDVT group (101 patients), patients without IDDVT group were younger (years: 55±13 vs. 62±13), length of intensive care unit (ICU) stay were shorter (days: 12±6 vs. 15±7), body mass index (BMI) and GCS at admission were higher [59 patients, BMI (kg/m 2): 23±5 vs. 19±8, GCS scores: 7±2 vs. 6±2], the differences were statistically significant (all P < 0.05). Compared with patients with IDDVT progression group, male patients were fewer [61.9% (52/84) vs. 88.2% (15/17)], the proportion of transfusion of red blood cell and anticoagulant therapy were lower [8.3% (7/84) vs. 29.4% (5/17) and 47.6% (40/84) vs. 94.1% (16/17)], the proportion of cerebral herniation was higher [42.9% (38/84) vs. 11.8% (2/17)] in patients without IDDVT progressive group. All of the differences were statistically significant (all P < 0.05). D-dimer were increased in two groups of whether IDDVT occurrence or not over time. D-dimer peaked on 5-7 days after surgery in IDDVT occurrence group, and then decreased. D-dimer peaked at > 7 days after surgery in patients without IDDVT. With time, D-dimer were increased in groups of whether IDDVT progression or not, both peaked at 5-7 days postoperation, and then decreased. Compared with non-IDDVTgroup, D-dimer was significantly increased in IDDVT group from 2-4 days after surgery [mg/L: 4.1 (2.3, 8.0) vs. 2.4 (1.7, 3.4), P < 0.05], and lasted until 5-7 days [mg/L: 5.5 (3.3, 11.4) vs. 3.9 (2.6, 5.8), P < 0.05]. Compared with IDDVT group, D-dimer was significantly increased in IDDVT progressive group from 2-4 days [mg/L: 11.2 (4.7, 20.0) vs. 3.7 (2.1, 6.8), P < 0.05], and lasted until 7 days [mg/L: 11.0 (3.0, 18.9) vs. 4.1 (2.6, 6.5), P < 0.05]. Multivariate Logistic regression analysis showed that age > 60 years [odds ratio ( OR) = 3.43, 95% confidence interval (95% CI) was 1.69-6.96, P = 0.001], GCS score at admission > 8 ( OR = 0.35, 95% CI was 0.17-0.76, P = 0.008), length of ICU stay > 13 days ( OR = 2.25, 95% CI was 1.08-4.70, P = 0.031) were risk factors for IDDVT. Gender ( OR = 0.19, 95% CI was 0.02-0.71, P = 0.019), transfusion of red blood cell ( OR = 6.50, 95% CI was 1.33-31.94, P = 0.021), cerebral herniation ( OR = 0.18, 95% CI was 0.37-0.90, P = 0.036) were risk factors for IDDVT profression. ROC curve analysis showed that age and D-dimer at 5-7 days were predicators of IDDVT [the area under curve ROC (AUC) were 0.68 and 0.72, 95% CI were 0.60-0.75 and 0.64-0.80, both P value were 0.000 1]. When the cut-off value of age was 60 years old and the D-dimer was 5.4 mg/L, the sensitivity were 60.6% and 54.4%, specificity were 71.2% and 80.9%, respectively, positive predictive value were 78.7%, 84.5%, negative predictive value were 51.2%, 48.1%, respectively. The elevation of D-dimer to 3.9 times at days 5-7 compared with day 1 of NCCU stay was a predicator of IDDVT progression (AUC = 0.81, 95% CI was 0.71-0.88, P = 0.000 1). The sensitivity, specificity, positive predictive value and negative predictive value were 76.5%, 74.6%, 41.9% and 93.0%, respectively. Conclusions:IDDVT occurrence and progressiveare common in severe ABI patients during perioperative period. The dynamic change of D-dimer, especially at days 5-7, is a valuable predictor of IDDVT progressionin ABI patients, which is helpful for guiding implementation of deep vein ultrasound of lower limb.

The study on the feasibility of using bispectral index value to assess the degree of acute brain injury / 中国神经精神疾病杂志

Objective To explore the feasibility of using bispectral index (BIS)value to assess the degree of acute brain injury (ABI) and study the correlation between Glasgow Coma Scale (GCS)scores and BIS values in ABI patients. Method A prospective and double-blinded study was conducted to assess GCS scores and BIS values in 330 patients with ABI from January 2013 till July 2017. Mean BIS values (BISMEAN) in mild, moderate and severe group of ABI were calculated. Linear regression between BIS values and GCS scores was constructed. Receiver operating characteristic(ROC) curves to predict non-mild ABI (GCS score less than 13) and severe ABI (GCS score less than 9) were plotted respectively. Results BISMEAN were significantly different among mild, moderate and severe ABI group (75.46±12.94、64.30±12.56、50.37±16.90 respectively, P＜0.01). There were a significant positive correlations between GCS scores and BIS values (R2=0.446, F=264.374, P＜0.01). Regression equation was BIS=2.96 GCS+33.77. ROC curve to predict non-mild ABI demonstrated that area under the curve (AUC)was equal to 0.835 and the optimal cut-off point (BIS value) corresponding with the maximum of sensitivity+specificity was 72.7(sensitivity=0.689, specificity=0.840); ROC curve to predict severe ABI demonstrated that AUC was equal to 0.846 and the optimal cut-off point (BIS value) corresponding with the maximum of sensitivity + specificity was 65.8 (sensitivity=0.721, specificity=0.861). Conclusion BIS values significantly correlate with GCS scores in ABI patients, indicating the feasiblity of using BIS value to assess the degree of ABI. Furthermore, continuous and real-time BIS monitoring can assess degree of ABI better than BIS value.

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.

Correlation study between entropy index and Glasgow coma scale score in patients with acute brain injury / 中华危重病急救医学

Objective To investigate the correlation between the entropy index and Glasgow coma scale (GCS) score in patients with acute brain injury (ABI), and to explore the feasibility of using entropy index to assess the extent of brain damage. Methods A prospective study was conducted. 101 patients with ABI admitted to intensive care unit (ICU) of the First People's Hospital of Changshou from May 2015 to May 2017 were enrolled. The values of reaction entropy (RE) and state entropy (SE) within 24 hours after ICU admission were collected, and the GCS score was recorded. A linear regression analysis of RE and SE values and GCS scores was conducted. Receiver operating characteristic (ROC) curve was plotted, and the value of entropy index in evaluating the severity of ABI was analyzed. Results 101 patients with ABI were finally enrolled in the analysis, with mild in 22 patients (GCS score 13-15), moderate in 35 patients (GCS score 9-12), and severe in 44 patients (GCS score 3-8). With the increase severity of brain damage, the values of RE and SE, and GCS score were gradually decreased (RE values in patients with mild, moderate and severe brain injury were 89.77±5.28, 75.37±4.86 and 50.61±9.89, SE values were 79.91±6.11, 65.20±5.44 and 40.68±9.41, and GCS scores were 14.00±0.82, 10.43±1.15 and 5.32±1.75). There was no significant difference in entropy index or GCS score among patients with different degrees of brain injury (all P < 0.01). Correlation analysis showed that the RE value was positively correlated with the GCS score (r2= 0.974, P = 0.000), SE and GCS scores also showed linear positive correlation (r2= 0.962, P = 0.000). ROC curve analysis showed that the area under ROC curve (AUC) of RE for diagnosis of ABI in patients with severe brain injury was 0.914, when the optimal cut-off value was 53.5, the Youden index was maximum (0.753), the sensitivity was 91.2%, and the specificity was 84.1%. The AUC of SE was 0.916, when the optimal cut-off value was 41.5, the Youden index was maximum (0.730), the sensitivity was 91.2%, and the specificity was 81.8%. The AUC of RE for diagnosis of mild brain injury was 0.884, when the optimal cut-off value was 69.5, the Youden index was maximum (0.651), the sensitivity was 72.7%, and the specificity was 92.4%. The AUC of SE was 0.897, when the optimal cut-off value was 58.5, the Youden index was maximum (0.676), the sensitivity was 72.7%, and the specificity was 94.9%. Conclusions The entropy index RE and SE values of ABI patients were gradually decreased with the severity of brain damage, which was positively correlated with GCS score. As an objective, continuous and real-time method, entropy index could be used as a new tool for the evaluation and monitoring of ABI.

A Prospective Study to Evaluate Efficacy & Safety of HBOT in Acute Traumatic Brain Injury.

Background: The purpose of this study was to test the effectiveness and safety of Hyperbaric Oxygen HBOT group (HBOT) in improving brain function in Traumatic brain injury patients suffering acute neurocognitive impairments. Aims: To study efficacy & safety of hyperbaric oxygen HBOT group on mortality and morbidity in acute traumatic brain injury with respect to degree of recovery, speed of recovery, length of stay in the hospital. Methods: In this prospective study we present 100 cases of head injuries. Patients were included in the study according to inclusion criteria. Fifty of them assigned to the control group and 50 to the HBO treatment group. Allocation is done by chit method in control and HBOT group. Glasgow coma score was obtained pre HBOT and post HBOT. The outcome was assessed by two blinded independent examiners. Results: All patients were assessed for improvement in GCS score. The average improvement in GCS score was 5.29% and 3.87% in HBOT and control group respectively. Similarly the average hospital stay was 12.26% days in the HBOT and 27% in the control group. Conclusion: Hence we would like to conclude that, HBOT is safe and effective for acute brain injury.

Influence of Ulinastatin Combined with Thymosinα1 on Immune Function of Patients with Acute Brain In-jury / 中国药师

Objective:To explore the influence of ulinastatin combined with thymosinα1 on the immune function of patients with a-cute brain injury. Methods:Sixty-eight cases of patients with acute brain injury were divided into the control group and the observation group randomly with thirty-four ones in each. The control group was given the routine treatment, and the observation group was given ulinastatin combined with thymosinα1 additionally. After the 1-day, 3-day, 7-day and 14-day treatment, transforming growth factor-β1 (TGF-β1), interleukin-6(IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) and the other serum inflammatory cyto-kine levels, and CD4 +, CD8 +, CD4 + /CD8 +, HLA-DR and cellular immune index levels were detected in the two groups. The prog-nosis effects were evaluated by the prognostic classification of brain injury, and the adverse reactions were analyzed in the two groups as well. Results:After the 1-day treatment, there were no significant differences in the serum inflammatory cytokines and immune param-eters between the groups (P>0. 05). After the 3-day, 7-day and 14-day treatment, serum TGF-β1, IL-6, IL-10 and TNF- α levels were higher than those on the first day after the treatment, and TGF-β1 showed an increasing trend with time extension, while IL-6, IL-10, TNF-α and CD4 + and CD4 + /CD8 +rose first and then decreased. After the 3-day, 7-day and 14-day treatment, serum IL-10 and CD4 +levels in the observation group were significantly higher than those in the control group, and IL-6 and TNF-αlevels were signifi-cantly lower than those in the control group (P<0. 05). After the 3-day and 14-day treatment, CD4 + and CD8 + levels in the observa-tion were significantly higher than those in the control group, and after the 7-day and 14-day treatment, HLA-DR levels were signifi-cantly higher than those in the control group (P<0. 05). The prognosis effect of the observation group was better than that of the con-trol group with statistically significant difference (P<0. 05). Conclusion:Ulinastatin combined with thymosin α1 is used to treat the patients with acute brain injury with better cellular immune function improvement and prognosis effect, which is worthy of clinical popu-larization and application.

Bundles of Treatment Protocol for Acute Brain Injury Complicated by Acute Lung Injury or Acute Respiratory Distress Syndrome / 中国医科大学学报

Objective To evaluate the efficacy and safety of the bundles of treatment protocol for patients with acute brain injury (ABI) complicated by acute lung injury (ALl)/acute respiratory distress syndrome (ARDS).Methods A total of 83 patients with acute brain injury complicated by ALI/ARDS were randomly divided into experimental group (n =41) and control group (n =42).The control group was treated with the routine bundle protocol while the experimental group was treated with an intensive bundle protocolin addition to the routine bundle protocol.The data was collected,and the effectiveness and safety of the two bundles of treatment protocol were evaluated.Results The results of heart rate (HR),SpO2,and PO2/FiO2 in the two groups showed significant differences before and after treatment.The improvement of PO2/FiO2 in the experimental group occurred earlier and was more significant compared tothe control group,24 hours after treatment.The mechanical ventilation time,ICU stay time,and total hospitalization time for the experimental group were significantly different (P ＜ 0.05) from the control group.The 28-day mortality and morbidity of ventilator-associated pneumonia showed no significant difference (P ＞ 0.05) between the two groups.Conclusion The treatment of acute brain injury complicated by ALI/ARDS by the two bundles of treatment protocol is effective.Compared to the conventional treatment bundles,the intensive treatment bundles can significantly improve oxygenation,and shorten the mechanical ventilation time required,as well as ICU and total hospital stay.

A clinical research on acupuncture for treatment of infantile acute brain injury / 中国中西医结合急救杂志

ObjectiveTo observe the clinical efficacy of acupuncture for treatment of children with acute brain injury.Methods A prospective study was conducted. Sixty-one children with brain injury admitted to Guiyang Maternal and Child Health Hospital from January 2014 to April 2016were enrolled, and they were randomly divided into acupuncture group (31 cases), and conventional treatment control group (30 cases). All cases with operation indications received craniotomy and tracheal intubation, and after operation symptomatic treatment, ventilator assistance, etc. were given to the patients; in acupuncture group,acupuncture was applied after vital signs were stable, the main acupoints being neiguan, renzhong, sanyinjiao, siguan, yongquan, baihui, shixuan, etc. once needle retention time at points 30 minutes, 5 times a week, 10 times for a therapeutic course, the therapeutic course being 2 weeks. The therapeutic effects were evaluated according to the modified Glasgow coma scale (GCS) and the CT image scoring method. Results After treatment, the coma (GCS) and brain injury (CT score) situations in the acupuncture group were more significantly improved than those in control group (P 0.05). The time of treatment in acupuncture group were significantly shorten compared with that of the control group (weeks: 2.7±0.7 vs. 3.7±0.4,P < 0.01). The total effective rate of acupuncture group was significantly higher than that of control group [90.3% (28/31) vs. 70.0% (21/30),P < 0.05].Conclusion Acupuncture has a significant effect for treatment of children with acute brain injury.

Effects of nerve growth factor on serum S100 and IL-6 in acute brain injury / 中国生化药物杂志

Objective To investigate the effect of nerve growth factor on the levels of serum S100 protein and interleukin-6 (IL-6) in patients with acute brain injury.Methods 70 cases with acute craniocerebral injury from March 2013 to May 2015 in department of cerebral surgery of Tianjin port hospital were selected and divided into two groups according to random number method.The control group (35 cases) received conventional symptomatic treatment, the study group (35 cases) received conventional treatment on the basis of mouse nerve growth factor for injection, with a consecutive treatment of two weeks.On admission, one and two weeks after admission, the Glasgow coma scale ( GCS) score was recorded, serum S100 beta protein and IL-6 levels were measured by enzyme-linked immunosorbent assay ( ELISA ) and the clinical curative effect of cerebral edema eliminate was compared.Results After two weeks’ treatment, the total efficacy in control group was lower than that in study group (77.14% vs.94.29%) ( P<0.05).The GCS score of two weeks after admission in study group was lower than that in control group, serum levels of neuron-specific enolase (NSE), myelin basic protein ( MBP) , S100βprotein and IL-6 of one and two weeks after admission in study group were lower than those in control group ( P<0.05).Conclusion The nerve growth factor could decrease the levels of serum S100βand IL-6 and alleviate inflammation in patients with acute craniocerebral injury and the effect is obvious.

Metabolic changes detected by1H NMR spectroscopy in the hippocampus of acute brain injury rats / 国际药学研究杂志

Objective To reveal the alterations of metabolic profiles by detecting changes in hippocampus1H NMR spectrin acute brain injury (ABI) rats. Methods The model of ABI was achieved by trauma, and 2 hours after modeling, the hippocampus samples were collected for NMR analysis. Results Compared to age-matched control rats, the ABI rats exhibited markedly different metabolic profiles, which showed significant changes in glutamate (P<0.01), taurine(5<0.05), myo-inositol (P< 0.05), and glutamine (P<0.05). Conclusion The metabonomics results suggest that amino acid metabolism is disordered when ABI occurs. This study provides clues for further understanding to cure ABI.

Shenqi Fuzheng Injection (SFI) inhibits irradiation-induced brain injury / 中华放射医学与防护杂志

Objective To explore the effect of SFI in radiation-induced mice brain injury after 20 Gy cranial radiation.Methods The mice were divided into three groups:(1) control group,(2) RT-only group:the whole brain was irradiated with a dose of 20 Gy,(3) RT and SFI group:SFI at 20 ml/kg/d from 4 weeks after 20 Gy cranial radiation theraty(CRT).Results Morris water maze test showed that the latency of the irradiated group was longer than control group and SFI improved the cognitive function of mice (t =6.34,6.70,P ＜0.05).The expression of TNF-α reached to the highest level at 3 h after irradiation,and then it decreased but got the second higher level again at 4 weeks after irradiation.The expression of IL-1 β reached to the highest level at 72 h after irradiation and decreased until 4 weeks after irradiation.SFI decreased both expressions of TNF-α (t =11.34,9.70,6.07,P ＜ 0.05) and IL-1 β (t =12.27,5.70,7.52,P ＜ 0.05).Immune florescence staining showed that SFI reduced the number of activated microglia (t =12.35,8.64,7.82,P ＜ 0.05)and inhibited the translocation of p65 of microglia after irradiation.Conclusions Findings suggest that SFI may decrease microglial activation and suppress the expression of TNF-α and IL-1β by inhibiting the translocation of NF-κB p65 and then attenuate irradiation-induced brain injury.

The Dynamic change and clinical significance of C-reactive protein and platelet in patients with acute brain injury / 国际检验医学杂志

Objective To investigate C‐reactive protein in patients with acute brain injury (CRP) ,platelet (PLT) dynamic chan‐ges and clinical significance .Methods A hospital in 2014-2015 120 cases of acute brain injury ,depending on whether surgery di‐vided into :64 cases of surgical group ,56 cases of non‐surgical group .According to Glasgow Outcome Scale (Glasgow Outcome Score ,GOS) divided into 61 cases of poor prognosis group (GOS 1 -3 scores) ,59 patients with good prognosis (GOS 4 -5 scores) .Another choice the same period 50 cases of healthy control group .After the patients were injured 1 d ,3 d ,7 d dynamic tes‐ting CRP ,PLT levels .Results The surgical group and the non‐surgical group patients after injury 1 d serum CRP levels were sig‐nificantly increased ,decreased gradually after all ,the two groups showed a downward trend ,but the surgery group were decreased slowly ,always maintain a high level ,still significantly at 14 d the control group (P<0 .05) .Patients with non‐surgical group de‐creased significantly ,significantly higher than the decline in the extent of the surgery group (P<0 .05) .Surgical and non‐surgical group patients after injury when PLT 1 d showed no increased after 3d began to rise ,increased significantly when 7 d ,PLT levels were elevated degree of surgical group was significantly higher than the non‐surgical group (P<0 .05) .Good prognosis group and a poor prognosis group ,serum CRP on admission were increased ,and reached a peak after 1 d ,after declining in both groups ,with good prognosis group decreased significantly ,while the poor prognosis group ,no significant decline in CRP levels ,continued high levels of state for a long time When postoperative 7d still significantly higher than the normal level (P<0 .05) .At each time point the poor prognosis group ,serum CRP levels were significantly higher than the good prognosis group (P< 0 .05) .When the good prognosis group and a poor prognosis group was mean change 1d PLT little water ,began to increase after the 3 d were poor progno‐sis group of patients was significantly higher than 7 d PLT good prognosis group (P<0 .05) .Conclusion Patients with acute brain injury CRP ,PLT dynamic changes are certain rules ,is to determine the acute phase of the disease of brain injury and prognosis of change .

Metabolic changes detected by 1H NMR spectroscopy in the hippocampus of acute brain injury rats / 国际药学研究杂志

Objective To reveal the alterations of metabolic profiles by detecting changes in hippocampus 1H NMR spectra in acute brain injury (ABI) rats. Methods The model of ABI was achieved by trauma, and 2 hours after modeling, the hippocampus samples were collected for NMR analysis. Results Compared to age-matched control rats, the ABI rats exhibited markedly different metabolic profiles, which showed significant changes in glutamate(P<0.01), taurine(P<0.05), myo-inositol(P<0.05), and glutamine(P<0.05). Conclusion The metabonomics results suggest that amino acid metabolism is disordered when ABI occurs. This study provides clues for further understanding to cure ABI.

Expression of serum IL-6,TNF-α,ICAM-1,pNF-H and NSE in patients with acute brain injury / 中国基层医药

Objective To explore the expression and significance of ser(u)m IL-6,TNF-α,ICAM-1,pNF-H and NSE in patients with acute brain injury.Methods 100 patients with acute brain injury were selected and divided into different groups(mild injury,moderate injury,severe injury).The serum levels of IL-6,TNF-α,ICAM-1,pNF-H and NSE were detected.30 healthy persons were selected as healthy control group.Results The serum IL-6,TNF-α,ICAM-1,pNF-H and NSE levels in the patients were higher than those in the healthy control groups(all P＜0.05).The serum levels of them were increased steply with the order of severity(all P＜0.05).IL-6,TNF-α,ICAM-1 were positive correlated with pNF-H and NSE(all P＜0.05).Conclusion The serum levels of IL-6,TNF-α,ICAM-1,pNF-H and NSE were correlated with degree of injury severity.The measurement of them may contribute to predict the severity of brain injury.

Correlation Between Chemokine Production and Injury Type in Acute Brain Injury Patients

PURPOSE: Cytokines and chemokines are essential in neuronal development and play important roles in both acute and chronic inflammatory reactions in the central nerve system and peripheral tissues. Thus, they may perform key functions in the pathophysiology of acute ischemic and hemorrhagic brain injury. The aim of this study was to evaluate the production of chemokines following acute brain injury (ABI) in humans. The correlations between the three main types of ABI(traumatic, ischemic and spontaneous hemorrhagic brain injury) and the plasma levels of three chemokines-CXCL8 (IL-8), CCL4 (MIP-1beta) and CCL5 (MIP-1beta)-were analyzed. METHODS: Enrolled in this study were 25 patients with isolated severe head trauma, 31 patients with spontaneous intracranial hemorrhage (SIH), and 34 patients with cerebral infarction. The AIS(abbreviated injury scale) was used to identify the isolated severe head trauma patients. The severities of several types of injury were assessed by ISS (injury severity score) in trauma, GCS (Glasgow coma scale) in SIH, and NIHSS(national institute of health stroke scale) in cerebral infarction. Blood samples from 9 healthy blood donors were analyzed as controls. Protein concentrations of CXCL8, CCL4, and CCL5 were measured by ELISA(enzyme-linked immunosorbent assay), and mRMA levels of XCL1(lymphotactin, Ltn), CCL5, CXCL10 (IP-10), CCL4, CCL3(MIP-alpha), CCL2 (MCP-1), CXCL8, and CCL1 (I-309) were evaluated using the RPA(multi-probe RNase protection assay) system in plasma and in peripheral blood mononuclear cells (PBMCs) from patients' venous blood obtained with 24 hours after injury. RESULTS: The expression patterns of XCL1, CCL5, CXCL8, CCL4, and CCL5 mRNA were similar in the three groups of ABI, without differences related to patterns of ABI or trauma severity. Concentrations of the three proteins CXCL8, CCL4, and CCL5 in plasma from all three ABI groups were higher than in the control group. The level of CXCL8 was significantly elevated in the TBI(traumatic brain injury) group (3.57+/-5.93 pg/ml, p<0.05), and this high level of IL-8 was significantly correlated with increased injury severity (high ISS and low GCS score) (p<0.05). The concentration of CCL4 was highest (29.82+/-17.94 pg/ml) in the ischemic brain injury group and was significantly higher than in the SIH group (p<0.05). The protein level of CCL4 was also elevated significantly with high ISS (p<0.05). The level of CCL5 was highest (7692+/-3603 pg/ml) in the SIH group and was significantly higher than in the TBI group (p<0.05). CONCLUSION: ABI resulted in a modest activation of CXCL8, CCL4 and CCL5, and the statistically significant correlations were found between the plasma levels of these chemokines and ABI. In addition, significant correlations were found between the plasma protein levels of CXCL8 and CCL4 and trauma severity in TBI group. Therefore, the continuous monitoring of various chemokine concentrations may provide a useful adjunct to assigning grouping and to gauging severity or prognosis in ABI.

Systemic inflammatory response syndrome following acute brain injury / 医学研究生学报

Acute brain injury is usually complicated by systemic inflammatory response syndrome (SIRS) which is initiated by cytokines and inflammatory mediators and induces a series of adverse physiological changes, culminating in the development of multiple organ failure. SIRS plays a pivotal role on the function of brain and extra cerebral organs, exacerbates the brain edema, and increases the septic rate. The diagnostic criteria and pathological courses of SIRS, and its relationship with acute brain injury and sepsis are briefly reviewed.

Effects of Acute Brain Injury on the Contents of Neurotensin in Brain Areas, Pituitary Gland and Plasma in Rats / 第二军医大学学报

The changes of immunoreactive neurotensin (ir-NT) contents in the brain areas, pituitary gland and plasma in the trautized rats were observed by radioimmunoassay. The results showed the significant changes of the ir-NT contents in the hypothalamus, pituitary gland, plasma, injured tissue, hippocampus, central gray and spinal cord in the posttraumatic rats at different intervals. A predominant characterization of the change of ir-NT levels in the brain areas, pituitary gland and plasma, was the dramatical decrease at various times except for the hypothalamus, central gray, and hippocampus with biphasic alterations. The ir-NT contents in the frontal cortex, pons and medulla also displayed changes to different extent under the acute craniocerebral trauma condition These results suggest that NT may play a role in the pathophysiology of traumatic injury.