Progress in application of adult endogenous neurogenesis in brain injury repair / 生理学报

Persistent neurogenesis exists in the subventricular zone (SVZ) of the ventricles and the subgranular zone (SGZ) of the dentate gyrus of the hippocampus in the adult mammalian brain. Adult endogenous neurogenesis not only plays an important role in the normal brain function, but also has important significance in the repair and treatment of brain injury or brain diseases. This article reviews the process of adult endogenous neurogenesis and its application in the repair of traumatic brain injury (TBI) or ischemic stroke, and discusses the strategies of activating adult endogenous neurogenesis to repair brain injury and its practical significance in promoting functional recovery after brain injury.

Muertes por Hemoaspiración en Costa Rica en el año 2015 / Deaths from Hemoaspiration in Costa Rica in 2015

Resumen:La aspiración de sangre en las vías respiratorias es un resultado frecuente de las autopsias en casos de trauma, este hallazgo se relaciona a fracturas de la base del cráneo con laceraciones de la naso y orofaringe.La hemorragia pulmonar aguda antes de la muerte puede aparecer como sangrado dentro del árbol bronquial y ocasionalmente proximal a la tráquea, debido a causas traumáticas o no traumáticas.En este estudio se reportan casos de hemoaspiración ocurridos en víctimas fallecidas, siendo un hallazgo forense frecuente, se contabilizaron 3148 víctimas fallecidas en el año 2015, se tomaron los casos que tenían evidencia en la autopsia de sangre en los pulmones y/o en las vías aéreas. Se obtuvo un total de 37 víctimas con dicho diagnóstico forense, con predominio en hombres entre los 21 y 30 años de edad y seguido por hombres entre los 31 y 40 años de edad. Se documentó una mayorincidencia en los meses de abril y diciembre los cuales coinciden con los meses festivos en Costa Rica y la causa de muerte predominante fue accidental, seguido por homicidio y suicidio.

Abstract:Airway blood aspiration is a frequent result in trauma patient autopsies; it's generally associated with skull base fractures with naso and oropharynx.Acute pulmonary hemorrhage prior to death can appear as bleeding in lower airways in traumatic and non-traumatic cases.Occasionally it can also appear in upper respiratory airways as well.In this study we evaluate blood aspiration in dead victims. A total of 3148 victims deceased in 2015, 37 had pulmonary or lower airway hemorrhage as a forensic diagnose, a higher incidence in males was found with ages between 21 and 30 years, followed by males between 31 and 40 years old. The peak incidence was in the months of April and December, which are months with a high amount of holidays in Costa Rica, the predominant cause of death was accidental, followed by homicide and suicide.

Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection

A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE) recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months) that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.

The Utility of Measuring the Difference between the Two Optic Nerve Sheath Diameters Using Ultrasonography in Predicting Operation Indication in Patients with Traumatic Brain Hemorrhage

PURPOSE: An increase in optic nerve sheath diameter (ONSD) has been associated with elevated intracranial pressure due to brain lesions, such as hemorrhage, infarction, and tumor. The aim of this study was to evaluate whether the difference of both ONSDs can predict surgical treatment in patients with traumatic brain hemorrhage. METHODS: A prospective analysis of the data acquired between September 2016 and November 2016 was performed. We included 155 patients with traumatic brain hemorrhage undergoing computed tomography in the emergency room. We performed an ultrasonography to measure ONSDs for all included patients. The primary outcome of this study was operation indication in patients with traumatic brain hemorrhage. RESULTS: The average age was 63.4±17.0 years (male 60.3±17.3, female 69.8±14.4). There were 61 (39.35%) patients with an indication for operation and 94 (60.65%) patients with an indication for no operation. Indications for operation showed a strong association with the difference of both ONSDs in patients with subdural hemorrhage (p<0.001), no association between them in patients with epidural and intracerebral hemorrhage. In patients with subdural hemorrhage, the area under the curve was 0.988 (0.653-0.998), and the cut-off value for the difference of ONSDs with respect to determining the indications for operation was 0.295 mm f maximizing the sum of the sensitivity (96.9%) and specificity (90.7%) using the receiver operating curve. CONCLUSION: A difference of both ONSDs above 0.295 mm was useful in predicting the indications for operation in patients with traumatic subdural hemorrhage, but not in patients with epidural and intracerebral hemorrhage.

The Relationship of the Facial Injury Location and the Traumatic Brain Hemorrhage

PURPOSE: Several studies have reported that facial fractures were associated with traumatic brain injuries or cervical injuries. The purpose of this study was to analyze the relationship between the location of facial injury and traumatic brain hemorrhage in order to support future decisions for image evaluation in facial injury patients. METHODS: In this retrospective cohort study, we evaluated facial injury patients without external head trauma who visited the emergency department at our hospital between January 1, 2014 and October 31, 2014. We divided the cohort into 2 groups: Facial injury patients with associated traumatic brain hemorrhage and those without traumatic brain hemorrhage. We compared the factors related to traumatic brain hemorrhage, such as facial injury locations, mechanism of accident, types of wounds, altered mentality, headache, and loss of consciousness between the two groups. RESULTS: In 873 patients, 73 (8.36%) presented traumatic brain hemorrhage and the other 800 had no traumatic brain hemorrhage on a brain computed tomography (CT) scan. The rate of headache, loss of consciousness, altered mentality, traffic accident, fall down, fracture, temporal injury, frontal injury, multiple facial area injury, and upper facial area (frontal and upper orbital area) injury were higher in the traumatic brain hemorrhage group than in the non-traumatic brain hemorrhage group (p<0.05). The risk factors of traumatic brain hemorrhage were headache, loss of consciousness, altered mentality, facial bone fracture, and temporal area injury of the face. CONCLUSION: If a facial injury patient has any of the following factors temporal area injury, facial bone fracture, altered mentality, headache, and loss of consciousness, we have to evaluate the brain CT scan even if the patient had no external head injury.

Predictors of outcome in patients with spontaneous intracereberal hemorrhage admitted to Liaquat University Hospital

To study the frequency of mortality and evaluate the influence of various prognostic factors such as Glasgow Coma Scale [GCS] Score, volume of hematoma and age on the outcome of the patient admitted with intracereberal hemorrhage. This descriptive case series study was conducted at Liaquat University of Medical aHealth Sciences hospital from July 2006 to March 2008. It included 399 consecutive patients with a diagnosis of SICH wthin 24 hours of their first stroke onset. Patients excluded from study were with hemorrhage secondary to brain tumors, to trauma, to hemorrhagic transformation of cerebral infarct and with previous history of hemorrhagic stroke. The patients' data was collected in a well designed Proforma. The volume of hematoma was calculated according to ABC/2 formula. Quantitative variables were described as mean with +/- SD. While qualitative variables were described as frequency and percentages. Age, GCS score and volume of hematoma compared to the outcome of the patients by receiver operating characteristics [ROC]. The level of Significance was <0.05. This study included 399 patients of which 261 [65.4%] were male and 138 [34.6%] were female. The number of patients <65 years were 222 [55.6] whereas 177 [44.4%] patients were >65 years old. The number of patients who died during hospitalization were 122 [30.6%] and 277 [69.4%] patients remained alive. AUR comparing the volume of hematoma is 0.707 [p=0.001], GCS on admission 0.815 [p=0.001] and age had 0.552 [p=095]. This study showed elderly patients with decreased level of consciousness and hemorrhage > 60 ml have the worst outcome

Céfalo-hematoma subperiosteal gigante ossificado na infância / Ossified giant subperiosteal cephalhematoma in childhood

Hematoma subperiosteal ou céfalo-hematoma, apesar de condição conhecida em neonatos, é rara em adultos e mesmo em crianças maiores, o que levanta a suspeita de uma diferente patogênese entre as duas situações. A cronificação e a ossificação do céfalo-hematoma são condições extremamente infrequentes, com escasso material bibliográfico, e sua presença no adulto é fato inusitado na literatura. Reportamos o caso de um hematoma subperiosteal crônico de grandes proporções, ossificado, com um ano de evolução, tratado cirurgicamente, em um menino de 12 anos de idade com síndrome epiléptica e déficit cognitivo prévios. A revisão e a discussão de sua patogênese e seu tratamento foram realizadas para exposição da condição.

Subperiosteal hematoma or cephalhematoma is a well known condition on newborns, but rare in adults and older children, what may lead to a different pathogenic origin. Chronic or ossificated cephalhematoma are infrequent, with few reports in medical literature. There are no cases reported in adults. It is presented a case of a 12 year-old boy, with previous epileptic syndrome and cognitive deficit, who was admitted because of a large chronic ossified subperiosteal hematoma. It was removed surgically. Revision and discussion of its pathogenesis were prepared for the case presentation.

The acute inflammatory response in trauma / hemorrhage and traumatic brain injury: current state and emerging prospects

Traumatic injury/hemorrhagic shock (T/HS) elicits an acute inflammatory response that may result in death. Inflammation describes a coordinated series of molecular; cellular; tissue; organ; and systemic responses that drive the pathology of various diseases including T/HS and traumatic brain injury (TBI). Inflammation is a finely tuned; dynamic; highly-regulated process that is not inherently detrimental; but rather required for immune surveillance; optimal post-injury tissue repair; and regeneration. The inflammatory response is driven by cytokines and chemokines and is partially propagated by damaged tissue-derived products (Damage-associated Molecular Patterns; DAMP's). DAMPs perpetuate inflammation through the release of pro-inflammatory cytokines; but may also inhibit anti-inflammatory cytokines. Various animal models of T/HS in mice; rats; pigs; dogs; and non-human primates have been utilized in an attempt to move from bench to bedside. Novel approaches; including those from the field of systems biology; may yield therapeutic breakthroughs in T/HS and TBI in the near future. Key words: Trauma; Hemorrhagic Shock; Taumatic Brain Injury; Inflammation; Systems Biology

Traumatic subarachnoid haemorrhage: part 1: mechanical relations and derived factors incorporated in the mechanism of arterial wall disruption

This work presented a simple treatment of the problem of arterialwall mechanics, when becomes stressed beyond its maximal distensibilityutilizing the available criteria of fluid mechanics and arterial wallmechanics. The inferred equations derived in this study revealed the need for a further application to establish such a mechanical relationship and explained the mechanism of arterial wall disruption