Application of horns percutaneous tracheostomy in critically ill neurosurgical patients / 实用医学杂志

Objective To introduce the experience of applying horns percutaneous tracheostomy in critically ill neurosurgical patients. Methods The size of operative incision, operation time, amount of blood loss, incision healing time , and incidence of complications were analyzed retrospectively in 95 patients with GWCH and 83 with ST. Results There were smaller size of operation incision [(1.6 ± 0.4) cm vs. (3.8 ± 0.9) cm], shorter operation time [(4.4 ± 2.8) min vs. (20.5 ± 5.2) min], less blood loss [(4.5 ± 0.8) mL vs. (8.5 ± 4.5) mL] and shorter incision healing time [(3 ± 0.5) d vs. (5 ± 1.5) d] in GWCH group than that in ST group and the difference was statistical significant (P 0.05). Conclusions When compared with traditional ST, horns percutaneous tracheostomy is with smaller incisions , shorter operation time , less blood loss , faster healing and lower incision sputum leaking and is worthy of popularization in critically ill neurosurgical patients.

Establishment and evaluation of model of depression after traumatic brain injury / 中华急诊医学杂志

Objective To discuss about the establishment of mental depression model by traumatic brain injury in rats,and to evaluate the validity of this model.Methods The study was carried out in the experiment center of Wuhan University.A total of 48 male adult Wistar rats were randomized ( random number) into four groups ( n =12,each):( 1 ) in sham operation group,six rats were fed normally in one cage; (2) in model group,the model of the left frontal lobe contusion was made up by hitting with free-fall method on the left cortex of the rat,and subsequently the each of model rats were separately fed in a cage and put them in a lonely environment with chronic stress one week after traumatic brain injury in order to induce them into models of mental depression; ( 3 ) in brain trauma group,the trauma model of the left frontal lobe contusion was set up by the same procedure as in model group,and six rats were fed together in one cage; (4) in CUMS group,each rat was fed normally in one cage in a lonely environment after brain trauma made and chronic mild chaotic stress unpredictable to rats was given to induce mental depression.The consumption of sucrose water and the change of animal behavior were observed and the high performance liquid phase electrochemical with fluorescence detector was used to detect the biogenic monoamine neurotransmitter content (dopamine,serotonin and norepinephrine) in the hippocampus,prefrontal cortex,hypothalamus and striatum area in each group.Experimental data were processed with single factor analysis or t test of variance by Statistical Program for Social Sciences Version 13.0 (SPSS13.0) software.P ＜0.05 was considered as statistically significant difference.Results After modeling,the rats of four groups were examined by behavioral tests.It was found that the amount of sugar-water consumption by the rats in the model group and CUMP group decreased,implying the absence of interest in eating and anhedonia of the rats in these groups.In open-field test,the rats in the model group,CUMP group and brain trauma group showed reduction in square crossing and rearing,implying the under-activity and absence of interest in activity.In the water maze test,it was found that the rats in the model group,CUMP group and brain trauma group needed much time to reach the end-point and made many errors,implying the lowering ability to learn and memorize.Levels of dopamine,serotonin and norepinephrine in the hippocampus,prefrontal cortex,hypothalamus and striatum area decreased in these rats with traumatized brain in three groups especially in model group and CUMP group.Conclusions It is a valid method for establishing the mental depression model in rats by traumatic brain injury with separately feeding in the lonely environment and given chronic mild chaotic stress unpredictable to rats on the setting of the left frontal lobe contusion.

Study of diffuse axonal injury at early stage using proton magnetic resonance spectroscopy / 上海交通大学学报（医学版）

Objective To investigate the early alterations of neurometabolites in the splenium of corpus callosum by proton magnetic resonance spectroscopy (~1H-MRS) in patients with diffuse axonal injury (DAI) at early stage and their prognostic value. Methods Twenty-one patients with DAI underwent 1H-MRS examination in the splenium of corpus callosum 2 to 14 d after injury, the neurometabolite alterations were evaluated and compared with those of 10 healthy subjects (normal controls). Logistic regression analysis was performed to explore the correlation among neurometabolite alterations, clinical indexes and Glasgow outcome scale (GOS) six months after injury. Results There was a significant decrease in NAA/Cr and NAA/Cho and increase in Cho/Cr in the splenium of corpus callosum in patients with DAI as compared with control group (P<0.05), and these trends tended to be more evident with the increase of injury severity. NAA/Cr and NAA/Cho in patients with poor outcomes were lower than those in patients with good outcomes (P<0.05). NAA/Cr, NAA/Cho and Cho/Cr predicted long-term outcome with 89% accuracy, and the combination with GOS provided the predictive accuracy of 94%. Conclusion ~1H-MRS examination in the splenium of corpus callosum at early stage of DAI can depict brain injury severity, and is useful in predicting outcomes.

Expression change of stromal cell-derived factor 1α in retinas after partial optic nerve injury / 上海交通大学学报（医学版）

Objective To investigate the changes of expression of stromal cell-derived factor 1α (SDF-1α) in retinas after partial optic nerve injury in rats. Methods Models with injury of partial optic nerve were induced in rats. Retinal tissues were collected 1,2,3,5,7,10 and 14 d after injury. Enzyme linked immunosorbent assay and Real-time quantitative PCR were employed to detect the expression of SDF-1α protein and mRNA in retinal tissues respectively in injury group (n=28), sham operated group (n=28) and normal control group (n=12). Results The expression of SDF-1α protein and mRNA in retinas was higher than that in sham operated group and normal control group at different time points after injury (P<0.01), and it reached the peak at the 5th day after injury. The expression of SDF-1α protein and mRNA maintained a high level at the 14th day after injury. Conclusion The expression of SDF-1α protein and mRNA is up-regulated after partial optic nerve injury, and may last for a long time.

The effect of recombinant human erythropoietin on the function of brain mitochondria after brain injury / 中华急诊医学杂志

Objective To investigate the therapeutic effects of recombinant human erythropoietin(rhEPO)on brain mitochondrial energy metabolism and mitachondrial respiratory functionin after brain injury in rats.Method A total of 63 Sprague-Dawley rats were divided randomly into three groups:the rhEPO treated group(n =28),the control group(n=28),the shanl group(n=7).The models of contusion of brain caused by freefalling were set up in rhEPO treated group(n=28).The recombinant human erythropoietin was intraperitoneally injected in dose of 10 U/g immediately after brain injury and it was repeated every 10 hours in rhEPO group treated.The same models of contused brain were made without rhEPO treatment as control group(n=28).In control group,the same volume of normal saline was used in replacemem of rhEPO.Aburr hole was made on the skull of the sham group(n=7),but the brain tissue was not wounded.The mitochondria were isolated at 6 h,12 h,24h,48 h after trealment,respectively.The activity of ATPase and SOD,the content MDA and brain mitochondrial respiratory function were measured by biochemical technique.The data were analyzed with the F-test and t-test.Results The activity of ATPase(P＜0.05),SOD(P＜0.01)and brain mitochondrial respiratory function(P ＜0.05)were increased.and the levd of MDA in brain mitochondria was reduced markedly in rats treated with rhEPO.Conclusions Treatment with rhEPO can alleviates the secondary brain injury by affecting mitochondrial function.

The effect of hyperxia liquid on posttraumatic vasospasm in patients with traumatic brain injury using transcranial Doppler / 中华物理医学与康复杂志

Objective To study the role of transcranial Doppler (TCD) in early diagnosis of posttraumatic vasospasm in traumatic brain injury patients and in treatment effect monitoring of hyperxia liquid for this condition. Methods Seventy-four patients with posttraumatic vasospasm were divided into two groups. The control group (n=42) received the general treatment, while the treatment group (n=32) received the treatment of hyperxia liquid in addition to the general treatment. Their cerebral blood flow velocities of bilateral MCA and extra-cranial portion of ICA were monitored regularly by TCD, starting from the first day after head injury until 14th day. The changes of physiological and neurofunctional parameters in both groups were compared, including cerebral vasospasm(CVS),arterial blood oxygen pressure (PaO 2),arterial blood oxygen saturation (SaO 2), the Glasgow coma scale (GCS)and the ultimate effects of treatment as indicated by Glasgow outcome scale(GOS). Results Cerebral vasospasm occurred in 1 to 3 days and peaked to the 3 to 7 days after injury, then markedly relieved at 14 days after injury. After infusion of hyperxia liquid, the PaO 2 and SaO 2 in the treatment group were significantly higher than those of the control group. The degree of vasospasm was significantly higher in the control group than that in the treatment group. GCS and GOS of the treatment group were significantly higher than those of the control group. Poor outcome was common in patients with severe cerebral vasospasm. Conclusion Early posttraumatic vasospasm can be detected by TCD. High-oxygen liquid is effective for treating posttraumatic vasospasm.