The Mechanism of Brain Injury Induced by Rotational Motion / 医用生物力学

Traumatic brain injury ( TBI ) has caused serious economic and social burdens, but due to its heterogeneity, there is no effective treatment. In TBI with different severity, diffuse axonal injury (DAI) incidenceis high. The investigation on DAI will contribute to the diagnosis and treatment of TBI. In this study, the classification of TBI and the research status of DAI were summarized. The method to judge the severity of TBI and DAI, and animal experimental models and related injury criteria and thresholds were reviewed. The result show that DAI is mainly generated by rotational acceleration and it is related to angular acceleration, angular velocity and duration. Several TBI animal models can induce the pathology of DAI, and inertial rotation models which can produce only rotational acceleration have been developed. However, these models are instantaneous rotation models, and the rotation duration is uncontrollable, thus a longer duration is impossible, and DAI severity under long rotational motion cannot be studied. The study proposes that a new rotation animal model which can control rotation duration should be developed. The development of the animal model and investigation on pathomechanism of the model will contribute to the prevention and treatment of DAI.

Proteína precursora del beta-amiloide (ß-App) y daño axonal difuso tras un traumatismo craneoencefálico: un punto de vista forense / Beta-amiloid precursos protein (ß-App) and diffuse axonal damage after head injuries: a forensic point of view

Resumen La proteína precursora del β- Amiloide (β-APP) es una glicoproteína de membrana y un componente habitual de las neuronas. Tiene funciones en el crecimiento y la adhesión celular tras un traumatismo. Es transportada mediante transporte rápido axonal anterógrado y se acumula dentro de las neuronas cuando se daña citoesqueleto. Este proceso es activo, es decir consume energía. El β-APP no es específico de los traumatismos. Se acumula en cualquier circunstancia en la que se dañen los axones, tal como la hipoxia, alteraciones metabólicas, y cualquier otra causa de edema cerebral y aumento de la presión intracraneal que puedan conducir a un daño axonal difuso (DAI) En el presente estudio estudiamos la expresión de esta proteína en casos de traumatismo cráneo-encefálico con diferente evolución cronológica El daño del citoesqueleto producido por la proteólisis, junto con la alteración de las quinasas y las fosfatasas, aumentan la permeabilidad de la membrana, lo que provoca la entrada de calcio en la célula que, a su vez, activa la calmodulina que hace que los neurofilamentos se compacten, los microtúbulos desaparezcan y se rompa la espectrina. Esta disrupción del citoesqueleto tiene como consecuencia que las sustancias que se transportan a su través, se acumulen, sobre todo en las zonas afectadas por el DAI. Al final de todo este proceso, los axones se rompen, lo que se conoce como axotomía secundaria. El estudio de la acumulación del β-APP es útil para valorar la extensión del DAI y para determinar el tiempo de supervivencia tras el traumatismo o cualquier otro daño cerebral.

Abstract β-Amyloid Precursor Protein (β-APP) is a membrane glycoprotein and a common component of neurons. It is involved in adhesion and cell growth processes after traumatic events. It is carried by anterograde fast axonal transport, and it accumulates inside neurons when the cytoskeleton is damaged. This is a vital biochemical process that consumes energy. β-APP is not specific of traumatic events. It accumulates in any case of axonal damage, whatever its cause may be, like hypoxia, metabolic disorders, and any other circumstances that lead to brain swelling and intracranial pressure rising and in consequence to Diffuse Axonal Injury (DAI). In this study we review the expression of this protein in cases of traumatic brain injury with different chronological evolution. The damage of cytoskeleton due to proteolysis in addition to the disturbance of kinases and phosphatases increase the permeability of the membrane. Calcium gets into the cell and activates calmodulin, thus neurofilaments compact, microtubules disappear and spectrin breaks. This disruption of the cytoskeleton has as consequence that the transported substances accumulate in the most affected areas by DAI. At the end of this process axon breaks, which is known as secondary axotomy. The study of the accumulation of β-APP is useful to assess the extent of DAI and to determine the time elapsed after trauma or another insult to CNS.

Hiperactividad simpática paroxística: una entidad subdiagnosticada: caso clínico / Paroxysmal sympathetic hyperactivity: report of one case

Paroxysmal sympathetic hyperactivity may appear after brain injury. Its clinical manifestations are sporadic and self-limited crisis of arterial hypertension, hyperthermia, tachycardia, hyperhidrosis, muscle tension, sialorrhea and mydriasis. These subside with the administration of morphine and beta-blockers. It may be caused by a dysautonomia leading to increased levels of catecholamines due to the lack of brain regulation. We report a 19 years-old man with a history of illicit drug and alcohol consumption, with a secondary axonal injury due to a cranioencephalic trauma. During hospitalization, he had recurrent, self-limited episodes of dysautonomia. An infectious cause was discarded. When morphine was administrated suspecting the presence of pain, the crisis subsided, which helped to establish the diagnosis of paroxysmal sympathetic hyperactivity.

Effect of 8-hydroxy-2-(Di-n-propylamino)tetralin on hypoxia inducible factor 1 alpha expression following diffuse axonal injury in rats / 中国组织工程研究

BACKGROUND: 8-Hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) can decrease brain temperature, which is the potential mechanism of its neuroprotection. OBJECTIVE; To investigate the effect of 8-OH-DPAT on hypoxia inducible factor 1 a in the brain tissue of rats with diffuse axonal injury, and to explore the underlying mechanism of 8-OH-DPAT exerting neuroprotection in rats of diffuse axonal injury. METHODS; The study was approved by the Laboratory Animal Ethical Committee of General Hospital of Northern Theater Command. Wistar rats were randomly assigned into four groups: Model group (n=35), constant temperature group (n=35), 8-OH-DPAT group (n-35) and normal group (n=7). Excepting the normal group, rat models of diffuse axonal injury were established according to Marmarou method. Rat models in the constant temperature and 8-OH-DPAT were intraperitoneally injected with 8-OH-DPAT, but those in the model and normal groups were intraperitoneally injected with physiological saline. The body temperature of rats in the constant temperature group was maintained at (37.0±0.5)°C using the blanket. The body temperature of rats was measured every 1 hour. Then, brain injury and hypoxia inducible factor 1a expression level were observed at 6, 12, 24, 72, and 168 hours after diffuse axonal injury in rats. RESULTS AND CONCLUSION: (1) Compared with the constant temperature and model groups, brain temperature was significantly lower in the 8-OH-DPAT group at 1 hour following modeling (P < 0.05), became lowest at 2 hours (P < 0.05), and then gradually increased. (2) Hematoxylin-eosin staining results revealed that brain injury was more serious in the model group, followed by constant temperature group, and lightest in the 8-OH-DPAT group. (3) Results of immunohistochemistry and ELISA showed that the expression level of hypoxia inducible factor 1a in the serum and brain tissue was lowest in the normal group. In the 8-OH-DPAT group, the expression level of hypoxia inducible factor 1a was increased at 6 hours after diffuse axonal injury, and peaked at 24 hours. Compared with the model group, the expression level of hypoxia inducible factor 1a in serum and brain tissue in the constant temperature and 8-OH-DPAT groups was significantly decreased (P < 0.05 or P < 0.01), especially the 8-OH-DPAT group (P < 0.01). (4) These results imply that 8-OH-DPAT decreases hypoxia inducible factor 1a expression in brain tissue of diffuse axonal injury rats by reducing brain temperature, alleviates the degree of nerve injury, and exerts a neuroprotective effect.

Emerging trends of traumatic brain injury in Western Uttar Pradesh, India: diagnosis and rehabilitation

Background: To study the various advance technology for the diagnosis of Traumatic Brain Injury (TBI) and find out Emerging trends occur in TBI (Traumatic Brain Injury) patients.Methods: The present study was conducted with 500 patients, age between 02 year to 70 years mean age (36 Years) presenting to emergency department of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, with a history of acute head trauma from January 2016 to December 2018. All patients were examined using 64 slices MDCT and 1.5T MRI Scanner also.Results: Traumatic brain injury caused by various reasons like 62.1% road traffic accidents (RTA) and 25.1% fall from height (FFH) being and 11.83% Assault/hit by hard object and 0.88% are gunshot injury. Loss of consciousness was the most common complaint of the 59.1% TBI patients followed by 17.75% Vomiting and headache, 11.83% facial injury and 11.24% scalp injury. All TBI patients were diagnosed by MDCT 64 Slices Somatom Sensation Scanner who was observed 41.42% skull fractures, 29.28% extra dural hematoma, 27.21% sub dural hematoma, 23.96% sub archnoid haemorrhage, 13% intra cerebral hematoma, 30.17% brain contusions and 24.26% diffuse cerebral edema.Conclusions: Road traffic accidents remain the leading cause of trauma in our country. MRI and MDCT are well recognized method to know the extent and various types of hemorrhages and skull fractures in TBI patients. The present study data is indicated 62.1% majority of TBI patients are suffered by Road traffic accidents mainly young males with alcoholism.

Dizziness after Traumatic Brain Injury: Neurological Aspects / 대한평형의학회지

Vertigo, dizziness, and disequilibrium are common symptoms following concussion or traumatic brain injury. Dizziness and vertigo may be the result of trauma to the peripheral vestibular system or the central nervous system, or, in some cases, may be due to anxiety, depression, or posttraumatic stress disorder; these mechanisms are not mutually exclusive. While most peripheral vestibular disorders can be identified by testing and examination, those without inner ear causes that have persisting complaints of dizziness and motion sickness are more difficult to understand and to manage. Some of these patients exhibit features compatible with vestibular migraine and may be treated successfully with migraine preventative medications. This paper reviews the neurological causes of persisting dizziness, the possible mechanisms, and the pathophysiology, as a framework for patient management and for future research.

Glial response following diffuse axonal injury / 解剖学报

Objective To explore the glial response and the relationship with secondary axonal degeneration in rats after diffuse axonal injury (DAI). Methods Adult male Sprague-Dawley rats were randomly assigned to control or DAI groups sacrificed at 1, 2, 3, 5 and 7 days with 10 rats in each group. DAI model was made referring to modified Marmarou method and glial fibrillary acidic protein (G F A P), ionized calcium binding adaptor molecule-1 (Ibal), recombinant oligodendrocyte lineage transcription factor 2 (Olig2), CC-1, NG2 immunohistochemistry, TUNEL staining and transmission electron microscopy were performed in brain stem. Results The number of Ibal labeled positive cells was significantly increased at day 3 and day 7 after injury. Moreover, different hypertrophic morphology was identified after injury. There was no effect of DAI on GFAP expression in brain stem. Numbers of mature oligodendrocyte marker CC-1 immunoreactivity cells within brain stem were significantly decreased at each of the time points after injury. The number of TUNEL positive cells in brain stem was significantly increased with injured time. Olig2 expression was significantly increased throughout the first week and reached peak at day 3 after injury in brain stem. The number of NG2 labeled positive cells was significantly increased at day 3 and day 7 after DAI. Ultrastructural evidence showed myelin release then further developed as widespread delamination and collapse, and leading to degeneration of axonal partner. Conclusion Mature oligodendrocytes are vulnerable in DAI and myelin loss may contribute to axonal degeneration. OPCs proliferate with activation of microglia. This insight of glial response will further explain the pathophysiological mechanism of secondary axonal damage in DAI.

Current contribution of diffusion tensor imaging in the evaluation of diffuse axonal injury / Contribuição atual da imagem por tensor de difusão na avaliação da lesão axonal difusa

ABSTRACT Traumatic brain injury (TBI) is the number one cause of death and morbidity among young adults. Moreover, survivors are frequently left with functional disabilities during the most productive years of their lives. One main aspect of TBI pathology is diffuse axonal injury, which is increasingly recognized due to its presence in 40% to 50% of all cases that require hospital admission. Diffuse axonal injury is defined as widespread axonal damage and is characterized by complete axotomy and secondary reactions due to overall axonopathy. These changes can be seen in neuroimaging studies as hemorrhagic focal areas and diffuse edema. However, the diffuse axonal injury findings are frequently under-recognized in conventional neuroimaging studies. In such scenarios, diffuse tensor imaging (DTI) plays an important role because it provides further information on white matter integrity that is not obtained with standard magnetic resonance imaging sequences. Extensive reviews concerning the physics of DTI and its use in the context of TBI patients have been published, but these issues are still hazy for many allied-health professionals. Herein, we aim to review the current contribution of diverse state-of-the-art DTI analytical methods to the understanding of diffuse axonal injury pathophysiology and prognosis, to serve as a quick reference for those interested in planning new studies and who are involved in the care of TBI victims. For this purpose, a comprehensive search in Pubmed was performed using the following keywords: "traumatic brain injury", "diffuse axonal injury", and "diffusion tensor imaging".

RESUMO O traumatismo cranioencefálico (TCE) é a principal causa de morbimortalidade entre adultos jovens. Aqueles que sobrevivem são frequentemente deixados com sequelas funcionais nos anos mais produtivos de suas vidas. O principal aspecto fisiopatológico do TCE é a lesão axonial difusa (LAD), cada vez mais destacada pois está presente em 40 a 50% dos casos que necessitam de internação hospitalar. LAD é definida como a injúria axonial extensa caracterizada pela axoniotomia completa assim como pelas reações secundárias a axoniopatia, que são demonstradas por métodos de neuroimagem como áreas de edema e micro-hemorragia. Entretanto, os achados da LAD são frequentemente subestimados em estudos de neuroimagem convencional. É neste contexto que imagens por tensor de difusão (DTI) ganharam ênfase, já que permitem obter informações sobre a integridade da substância branca que não eram obtidas por sequências convencionais de ressonância magnética (RM). Existem artigos extensos sobre os fundamentos físicos e as aplicações de DTI em pacientes vítimas de TCE, no entanto, estes assuntos permanecem ainda nebulosos a alguns profissionais da área de saúde. Deste modo, propomos uma revisão didática sobre a contribuição do estado da arte de diferentes métodos analíticos de DTI no entendimento do processo da fisiopatologia e prognóstico da LAD, servindo assim como uma ferramenta acessível para aqueles interessados em planejamento de novos estudos e aqueles envolvidos no tratamento de vítimas de TCE. Uma pesquisa abrangente foi realizada no Pubmed com as seguintes palavras-chave: "traumatismo cranioencefálico", "lesão axonial difusa", "imagem por tensor de difusão".

Research progress in diffuse axonal injury and its association with Apolipoprotein E polymorphism / 中华创伤杂志

Diffuse axonal injury (DAI) is a common primary brain injury.The main mechanism of DAI is the relative displacement of brain tissue junction caused by shearing force during cranial rotation.The pathological changes are the deformation and rupture of white matter nerve fiber bundles.The mechanism of injury and recovery is still unclear,and unified diagnostic criteria are also lacking.Apolipoprotein E (APOE) gene polymorphisms are associated with nervous system development,injury,and repair process.The APOE gene contains six genotypes by the combination among three genes and synthesizes three proteins including apoE2,apoE3 and apoE4.The abnormal spatial structure of apoE4 decreases its ability of transporting lipids,resulting in reduced repair ability after nerve injury.The molecular mechanism of ApoE in the development of axonal injury is complicated.apoE protein can bind to receptor proteins such as low density lipoprotein receptor related protein 1 (LRP1) and heparan sulfate proteoglycan (HSPG) to mediate axonal repair,and it can also damage nerves by influencing calcium influx and producing toxic fragments through hydrolysis.Correcting the abnormal structure of apoE4 is helpful to nerve repair,and apoE analogues also have certain neuroprotective effects.This article reviews the injury characteristics,pathological characteristics,APOE gene polymorphisms,and the role of apoE synthesis in DAI,to provide new insights for elucidation of mechanism of DAI and related clinical application.

Role of susceptibility-weighted imaging and diffusion tensor imaging sequence of MRI in diagnosis and prognosis evaluation of diffuse axonal injury / 中华创伤杂志

Objective To evaluate the clinical application of SWI and DTI of MRI in the diagnosis and prognosis of diffuse axonal injury (DAI).Methods A retrospective case series study was conducted on the clinical data of 16 patients with DAI admitted from January 2015 to December 2017.There were nine males and seven females,aged (56.3 ± 4.1) years.According to Glasgow Coma Scale (GCS),there were seven patients with 3-8 points,eight with 9-12 points,and one with 13 points.All patients received head CT examination on admission and then received head MRI examination within one week to record the number of lesions on T1WI,T2WI,DWI,and SWI in CT and MRI examination.On the DTI sequence,five regions including the subcortical white matter,the corpus callosum,the thalamus,the cerebellum,and the brain stem were selected for measurement of the apparent diffusion coefficient (ADC) and partial fraction of anisotropy (FA) values.The Glasgow outcome scale (GOS) was evaluated 6 months after injury.The linear correlation between ADC,FA values,GCS,and GOS on admission and after 6 months were analyzed.Results The statistical analysis of CT,T1WI,T2WI,DWI and SWI in 16 patients showed that the detection rates of DAI lesions were 25.6％ (43/168),30.4％ (51/168),44.0％ (74/168),51.8％ (87/168),and 100％,respectively (P ＜0.01).The ADC values of the subcortical white matter,the corpus callosum,the thalamus,the cerebellum,and the brain stem were 0.830 ± 0.148,0.536 ± 0.169,0.838 ± 0.596,0.708 ± 0.157,and 0.713 ± 0.135,respectively,and FA values were 0.487 ± 0.103,0.142 ± 0.040,0.293 ± 0.089,0.212 ± 0.045,and 0.366 ± 0.797,respectively.The GCS on admission was (8.9 ± 3.3)points,and GOS was (4.2 ± 1.0)points six months after injury.The correlation analysis showed that the ADC value and FA value of subcortical white matter and cerebellum were not related to GCS and GOS (P ＞ 0.05).The correlation strength of ADC values in each region with the GCS score in descending order was the thalamus,the corpus callosum,and the brain stem (P ＜ 0.05 or 0.01);for ADC with the GOS score,it was the corpus callosum,the thalamus and the brain stem (P ＜0.05 or 0.01);for FA with GCS and GOS scores,it was thalamus,corpus callosum,and brainstem (P ＜ 0.05 or 0.01).Conclusion The SWI has better sensitivity to detect DAI lesions than CT and conventional MRI sequences.DTI can accurately,objectively and visually detect the integrity of cerebral white matter fibers.Both SWI and DTI can help make early diagnosis and evaluate the prognosis of DAI patients accurately.

Application of diffusion tensor imaging in prognosis evaluation in patients with moderate and severe diffuse axonal injury / 中华创伤杂志

Objective To investigate the application of diffusion tensor imaging (DTI) in evaluating prognosis of patients with moderate and severe diffuse axonal injury (DAI).Methods A prospective cohort study was made on 35 patients with moderate and severe DAI,who were enrolled from June 2013 to December 2015 as study group.There were 21 males and 14 females,with age of (55.1 ± 11.6) years.The Glasgow coma scale (GCS) was (8.2 ± 2.9)points on admission.Moderate DAI was seen in 20 patients and severe DAI in 15 patients.Other 15 healthy volunteers were selected as control group.Fractional anisotropy (FA) was measured by DTI in three areas of interests as follows:the corpus callosum,thalamus,and brainstem areas.Glasgow outcome scale (GOS) was adopted to assess the prognosis of DAI patients at 6 months after the injury.The FA values of the three areas between study group and control group as well as FA values of patients when they were admitted to hospital and 6 months after injury were measured.In this way,the relationship between the FA values of different areas of interests in DAI patients on admission and the prognosis 6 months after injury was analyzed.Results The FA values of the corpus callosum,thalamus and brainstem area in study group were all lower than those in control group (P ＜ 0.05).Further,FA values of the corpus callosum,thalamus,brainstem area in severe DAI patients were lower than those of moderate DAI patients (P ＜ 0.05).FA values of the corpus callosum,thalamus,brain stem areas in DAI patients at 6 months after injury were lower than those of corresponding areas when DAI patients were admitted to hospital (P ＜ 0.05).FA values of the corpus callosum,thalamus and brain stem on admission were significantly positively correlated with GOS at 6 months after injury (P ＜ O.05).Conclusions Lower FA values of the corpus callosum,thalamus and brainstem area in patients with moderate and severe DAI are associated with more severe injury and worse prognosis.DTI scans can be used as a valuable tool to evaluate the prognosis of DAI patients.

Correlation between CD8 + T cells' balance and prognosis for patients with diffuse axonal injury / 中国医师杂志

Objective To study the correlation between CD8 + T cells' balance and prognosis for patients with diffuse axonal injury(DAI).Methods To collect the 41 patients with DAI as observation group,with 33 cases light craniocerebral injury (LCI) patients and 35 healthy volunteers as control group.We detect the peripheral blood CD8 + CD28 + T cells and CD8 + CD28-T cell percentage,and calculate the ratio of both.The subjects working curve method (ROC) of.the above CD8 + T cells and its ratio were used to predict the prognosis of patients with DAI efficiency evaluation.Results (1) Compared with control group,CD8 + CD28 + T cells in patients with DAI and LCI increased significantly,and DAI was significantly higher than that of LCI group (P ＜ 0.05).Compared with control group,CD8 + CD28-T cells in patients with DAI were decreased,but no statistical difference was found between LCI and the control group,but DAI group was significantly lower than the LCI group (P ＜ 0.05).(2) CD8 + CD28-T cells and CD8 + CD28 +/CD8 + CD28-ratio were correlated with DAI diagnosis (P =0.003,0.000).When the percentage of CD8 + CD28-T cells =2.95％,the sensitivity of the diagnosis of DAI was 87.49％,86.21％;When the ratio of CD8 + CD28 +/CD8 + CD28-=7.39,the sensitivity was 92.63％,90.71％.(3) a total of 7 cases of patients died within 1 week after injury,CD8 + CD28 + T cells and CD8 + CD28 +/CD8 + CD28-ratio were significantly negative correlated with survival time (r =-0.739,-0.834,P =0.021,0.002),and CD8 + CD28-T cells were significantly positive correlated with survival time (r =0.782,P =0.006).Conclu sions Decreasing CD8 + CD28-T cells and higher CD8 + CD28 +/CD8 + CD28-ratio in patients with DAI immunological characteristics,especially the ratio (balance) is closely corrected with the diagnosis and prognosis of DAI.

Clinical observation and effects by the methods of Xingshen-Kaiqiao to treat diffuse axonal injury combined with western medicine normal treatment / 国际中医中药杂志

Objective In order to observe the clinical curative effect of magnesium sulfate combined with Xingshen-Kaiqiao acupuncture for the diffuse axonal injury (DAI). Methods A total of 60 patients with DAI were divided into the Xingshen-Kaiqiao group and control group according to the random number table method (30 in each). The control group was given traditional Chinese medicine wash-out on the basis of conventional therapy, saline 100 ml+25% magnesium sulfate 8 ml and slow intravenous infusion, then 5% glucose 500 ml+25% magnesium sulfate 8 ml and slow intravenous drip; during the duration of the drug, the concentration of blood magnesium was strictly monitored and the dosage was adjusted as appropriate. And the Xingshen-Kaiqiao group was given acupuncture of Xingshen-Kaiqiao on the basic treatment of the control group. All treatments lasted 4 weeks. After treatment, the expression levels of IL-1β and TNF-α, GSC score, recovery of consciousness and GOS were evaluated and compared before and after treatment. Results After treatment, the IL-1β (62.38 ± 16.92 pg/ml vs. 88.37 ± 14.71 pg/ml, t=8.554), the TNF-α (3.59 ± 1.05 pg/ml vs. 4.06 ± 1.62 pg/ml, t=5.081) of Xingshen-Kaiqiao group were significantly lower than those of the control group (P＜0.05). The GSC scores after 1st week (8.26 ± 0.76 vs. 6.83 ± 0.82, t=-5.036), 2nd week (10.61 ± 0.82 vs. 8.91 ± 0.35, t=-4.387), 3rd week (12.52 ± 1.07 vs. 10.95 ± 0.67, t=-5.212), 4th week (13.26 ± 1.08 vs. 11.58 ± 1.86, t=-5.031) of Xingshen-Kaiqiao group were significantly higher than those of the control group ( P＜0.05). After treatment, the Xingshen-Kaiqiao group awakening rate was 70.0% (21/30) and the control group was 43.3% (13/30), and the difference in awakening rate was statistically significant (χ2=4.344, P=0.037). The awakening time (7.6 ± 3.1 d vs. 11.5 ± 4.9 d, t=6.586) of Xingshen-Kaiqiao group was significantly lower than the control group (P＜0.05); the percentage of GOS was significantly higher than the control group (Z=-2.093, P=0.036). Conclusions Magnesium sulfate combined with acupuncture of Xingshen-Kaiqiao can reduce the awakening time, the death rate and showe more satisfactory clinical efficacy for the patients with DAI.

Longitudinal MRS study of the corpus callosum in patients with diffuse axonal inj ury / 实用放射学杂志

Objective To investigate metabolic levels of the splenium and genu of corpus callosum(CC)in subacute diffuse axonal injury (DAI)patients,and their longitudinal change in a short time.Methods 12 patients with subacute DAI and 12 gender and age matched healthy controls were enrolled successively in this study.All subjects were scanned with single volume magnetic resonance spectrum(MRS)in two regions of interest(the splenium and genu of CC),and they were reexamined with MRS a month later(31.5 d±6.2 d, 28-43 d).Some metabolite concentrations were calculated quantitatively by using LC-model software and the differences were analyzed.Results The concentrations of NAA in the splenium and genu of CC in subacute DAI patients were decreased significantly compared with those of controls (the genu:t=4.474,P=0.001;the splenium:t=4.231,P=0.001),meanwhile the Cho concentrations were increased significantly (the genu:t=2.509,P=0.031;the splenium:t=2.195,P=0.018).The concentrations of NAA and Cho in the splenium and genu of CC in patients with the follow-up were slightly elevated when compared with those of subacute DAI patients,but the difference had no statistical significance.The concentrations of Cr in the splenium and genu of CC in all subjects had no statistic difference.Conclusion The single volume MRS is sensitive to reflect the metabolic levels of CC in subacute DAI patients.The metabolic levels of CC has no significant change in the short term (about 1 month).

Traumatic Brain Injury Caused by Motor Vehicle Collision and Alcoholism in Piauí

Objectives To determine the relationship between alcohol consumption and the incidence of traumatic brain injury (TBI) with diffuse axonal injury (DAI), determining these indices, checking acquired comorbidities and characterizing the patients by gender, age and race/color, as well as describing the characteristics of the motor vehicle collision (vehicle, period of the day, day of the week and site) in people admitted to an emergency hospital in the city of Teresina, in the state of Piauí, Brazil. Methods We have analyzed the data contained in the medical records of patients admitted with a history of motor vehicle collision and severe TBI in intensive care units, based on the forms provided by the Mobile Emergency Care Service (SAMU, in the Portuguese acronym) in the period between February 28 and November 28, 2013. Results In the period covered by the present study, 200 individuals were analyzed, and 54 (27%) had consumed alcohol; of these 11 had DAI. Of the total sample, 17% (34) presented DAI, however, with unknown data regarding the consumption of alcoholic beverages. Conclusion Considering the data, we observed that the profile of the head trauma patients are brown men, mostly (53.5%) aged between 15 and 30 years. The collisions occurred mostly on weekends and at night (55%), and 89.5% of the crashes involved motorcycles.

Screening of Differential Expression Proteins in Rat Brain Tissues after DAI by iTRAQ-LC-MS/MS / 法医学杂志

Objective To screen for the differential expression proteins in brain tissues of SD rat after diffuse axonal injury (DAI) by isobaric tag for relative and absolute quantification-liquid chromatographmass spectrometer/mass spectrometer (iTRAQ-LC-MS/MS),and to explore potential biomarkers available for the diagnosis of DAI.Methods Animal models of DAI were established with the Marmarou method as reference,and the subjects were divided into blank control group (n=4),sham strike group (n=4) and fatal strike group (n=4),respectively.The proteins in rat brain tissues were detected by iTRAQ-LC-MS/MS,and bioinformatics analysis and verification were performed on the results and screened for the differential expression proteins.Results A total of 2 016 proteins were identified and quantified.The bioinformatics analysis revealed that the proteins had wide distribution and function,and participated in different biological processes.There were 16 proteins showed differential expression in fatal strike group,including one up-regulated expression protein and 15 down-regulated expression proteins.The results of iTRAQLC-MS/MS were confirmed by Western blotting method.Conclusion Multiple differential expression proteins in rat brain tissues after DAI can be screened by iTRAQ-LC-MS/MS.This not only indicates a research direction for exploring the pathogenesis of DAI,but also provides potential biomarkers available for the diagnosis of DAI.

Application of Susceptibility Weighted Imaging in the Identification of Hemorrhagic Diffuse Axonal Injury / 法医学杂志

Objective To explore the application value of susceptibility weighted imaging (SWI) in the forensic identification of hemorrhagic diffuse axonal injury (DAI).Methods The forensic identification materials of 20 DAI cases were analyzed retrospectively.The sequence image materials of T1WI,T2WI,diffusion weighted imaging (DWI),fluid attenuated inversion recovery (FLAIR) and susceptibility weighted imaging (SWI) were analyzed statistically.Results DAI related hemorrhage focus commonly located in the superficial area of brain.The detection rate of hemorrhage focus by SWI was the highest,which showing significant difference (P＜0.05) compared with other sequence images.Conclusion The SWI plays an important role in the forensic identification of DAI.

Comparative study on values of CT and MRI for diagnosis of diffuse axonal injury / 医疗卫生装备

Objective To explore the application values of CT and MRI in the diagnosis of diffuse axonal injury.Methods Totally 52 cases of diffuse axonal injury patients from November 2012 to December 2014 were retrospectively analyzed,who underwent examinations by CT and MRI,then the abilities to find the lesions and the sensitivities of CT and MRI were compared.Results The diagnosis sensitivity of CT (48.08％) was significantly lower than that of MRI (73.08％) (P＜0.05).There were 56 lesions of 25 abnormal cases detected by CT,and there were 99 lesions in the T1WI sequence,137 lesions in T2WI sequence,171 lesions in the FLAIR sequence of 38 abnormal cases detected by MRI.The numbers of lesions found by MRI were significantly higher than those by CT (P＜0.05).The radiographic signs showed as diffuse brain swelling,subarachnoid and ventricular hemorrhage,epidural hematoma and parenchymal hemorrhage or edema.Conclusion CT and MRI contribute to the diagnosis and treatment of diffuse axonal injury.MRI gains advantages over CT in the sensitivity of diagnosing diffuse axonal injury,and thus is worthy promoting clinically.

A quantitative study on evaluation of child diffuse axonal injury severity by using MR diffusion tensor imaging / 重庆医学

Objective To compare the value of fractional anisotropy(FA)of MR diffusion tensor imaging(DTI) and Glasgow coma scale(GCS) at admission for judging the injury severity and prognosis of diffuse axonal injury (DAI). Methods Thirty-four patients with DAI adopted the GCS score to evaluate the conscious disturbance levels at admission and conducted the DTI examination within 2 weeks. Twenty-three individuals undergoing healthy physical examination conducted the DTI examination. The FA values of visuality lesion area in various sites,healthy side symmetric site and cerebral midline site were measured. The reduction degree of mean FA value at midline site and visuality lesions were measured. The correlation between GCS score,mean FA value reduction degree in visuality lesions and mean FA value at cerebral midline site with consciousness disorder time and recovery degree in half a year after injury was analyzed. Results The reduction degree of mean FA value at cerebral midline site was significantly correlated with consciousness disorder time and recovery degree in half a year after injury(r= 0. 519,P=0. 002; r= 0. 669, P=0. 000) ;the mean FA value reduction degree in visuality lesions and GCS score had low or weak correlation with consciousness dis order time and recovery degree in half a year after injury(r=0. 285,P=0. 103;r=0. 487,P=0. 003;r= -0. 241,P=0. 169;r=-0. 229,P=0. 192). The correlation between mean FA reduction degree in cerebral midline site and mean FA value reduction degree in visuality lesions with the recovery degree in a half years after injury was higher than that in GCS score. Conclusion DTI is a sensitive sequence for diagnosing DAI and has much more value for judging the injury degree and prognosis than the GCS score generally adopted by clinic.