Marcadores Neurales como Indicadores de Funciones Predictivas en Pacientes con Traumatismo Cerebral Moderado a Severo / Neural Markers as Indicators of Predictive Functions in Patients with Moderate to Severe Brain Trauma

Introducción. El traumatismo encéfalo craneano moderado a severo (TEC-MS) es una condición compleja que cambia la estructura y función del cerebro, afectando a personas de distintas edades. Los problemas cognitivos y motores son la mayor causa de discapacidad en individuos con TEC-MS crónico. Sin embargo, muchas de estas dificultades no son visibles de inmediato clasificándose como una "Epidemia silenciosa". Las principales alteraciones reportadas por los pacientes tienen relación con problemas de la memoria, atención y lentitud psicomotora, los cuales tienen un impacto en su independencia y funcionalidad. Objetivo. Este estudio tiene por objetivo discutir y revisar la evidencia disponible acerca de la capacidad de los pacientes crónicos con TEC-MS para generar predicciones en diferentes niveles de procesamiento cerebral. Métodos. Para esto, utilizamos desde las neurociencias el modelo teórico del código predictivo para explicar las respuestas neurofisiológicas adquiridas bajo un paradigma de predicción auditiva. Esta información es complementada con el reporte de datos preliminares de sujetos con TEC-MS y sujetos control, con el fin de ilustrar los aspectos teóricos discutidos. Conclusiones. Esto podría contribuir a una mejor comprensión de los mecanismos neurales detrás de los déficits cognitivos en esta población, aportando una perspectiva que nos oriente al desarrollo de nuestras estrategias terapéuticas.

Background. Moderate to severe traumatic brain injury (TBI-MS) is a complex condition that changes the structure and function of the brain, affecting people of different ages. Cognitive and motor problems are the major cause of disability in individuals with chronic ECT-MS. However, many of these difficulties are not immediately visible, classifying them as a "Silent Epidemic." The main alterations reported by patients are related to problems with memory, attention and psychomotor slowness, which have an impact on their independence and functionality. Objetive. This study aims to discuss and review the available evidence about the ability of chronic ECT-MS patients to generate predictions at different levels of brain processing. Methods. For this, we use the theoretical model of the predictive code from neuroscience to explain the neurophysiological responses acquired under an auditory prediction paradigm. This information is complemented with the report of preliminary data from subjects with ECT-MS and control subjects, in order to illustrate the theoretical aspects discussed. Conclusions. This could contribute to a better understanding of the neural mechanisms behind cognitive deficits in this population, providing a perspective that guides us in the development of our therapeutic strategies.

Risk factors analysis and risk prediction model construction and validation of cognitive dysfunction after brain trauma / 中华行为医学与脑科学杂志

Objective:To analyze the independent risk factors for the occurrence of post-traumatic cognitive dysfunction, construct a prediction model for the risk factors of post-traumatic cognitive dysfunction, and verify the effectiveness of the risk prediction model, so as to provide a clinical tool for early prediction of the risk of post-traumatic cognitive impairment.Methods:Part I: patients with brain trauma (training set with 556 subjects) who were hospitalized in 21 tertiary and secondary hospitals from Tangshan, Cangzhou and Chengde cities of Hebei province were retrospectively collected from February to May 2021 for Montreal cognitive assessment, and 33 influencing factors (general data, symptoms and signs, laboratory and imaging parameters) were obtained obtained through literature research.The patients were divided into case group and control group according to whether they had cognitive impairment or not, and univariate and multivariate analysis were used to screen independent risk factors.Part Ⅱ: a binary Logistic regression equation was used to construct a cognitive impairment prediction model, the visualization model of line graph is presented.Part Ⅲ: brain trauma patients (260 subjects of the validation set) hospitalized in the aforementioned 21 hospitals from August to October 2021 were collected as a prospective validation population for the prediction model of cognitive impairment, and the grouping basis of case group and control group was the same as before.And the risk factors between the two groups were compared.The receiver operating characteristic curve(ROC), calibration curve and clinical applicability of the model were drawn to evaluate the effectiveness of the model for internal and external verification of the model.Results:Binary Logistic regression analysis showed that the risk factors for post-traumatic cognitive dysfunction were basal ganglia injury, severe injury, amnesia experience after injury, frequent headache after injury, upper limb dysfunction after injury, age ≥ 60 years, and education level of elementary school or below.Visual nomograms showed that the experience of amnesia after injury, frequent headache after injury, upper limb dysfunction, and degree of injury among the symptom factors were the factors that contributed greatly to the risk of traumatic brain injury cognitive impairment in this model.Predictive model discrimination using area under curve(AUC) values of the area under the ROC curve showed that internal validation and external validation were 0.868 and 0.885 for R language analysis and 0.868 and 0.901 for SPSS analysis, respectively.The curve after model calibration almost coincided with the reference line, Hosmer-Lemeshow test P>0.05.The two decision curve analysis (DCA) curves drawn by the clinical applicability of the model were higher than the two extreme curves, predicting that traumatic brain injury patients with cognitive impairment could benefit from the predictive model, and there was a net benefit rate in the range of Pt about 0.1-0.8, when Pt reached about 0.1 until the approximate 1.0 composite evaluation model. Conclusion:Risk factors such as experience of amnesia after injury, frequent headache after injury, upper limb dysfunction, and degree of injury are predicting factors contributed to the risk of cognitive impairment in traumatic brain injury, and their prediction models have good predictive effect, high predictive accuracy and good clinical applicability, which can be applied in clinical diagnosis.

Procedimiento anestésico - quirúrgico en un lactante con higrohematoma subdural / Anesthetic - surgical procedure in an infant with subdural hygrohematoma

Se describe el caso clínico de un lactante de 47 días de nacido, quien fue atendido en el Cuerpo de Guardia de Pediatría del Hospital Provincial General Docente Antonio Luaces Iraola de Ciego de Ávila, por presentar aumento de la circunferencia cefálica, irritabilidad y agitación. Los exámenes realizados mostraron signos de hipertensión endocraneana descompensada, secundaria a colección del espacio subdural izquierdo. Se eliminó el higroma subdural y la recuperación fue favorable en las primeras 36 horas; luego comenzó a convulsionar y apareció nuevamente el deterioro neurológico, por lo cual se decidió reintervenir. Se realizó inducción anestésica con tiopental sódico fentanilo y rocuronio. El paciente evolucionó sin complicaciones.

The case report of a 47 days infant is described. He was assisted in the children emergency room of Antonio Luaces Iraola Teaching General Provincial Hospital in Ciego de Ávila, due to an increase of the cephalic circumference, irritability and agitation. The exams showed signs of upset endocranial hypertension, secondary to collection of the left subdural space. The subdural hygroma was eliminated and the recovery was favorable in the first 36 hours; then a covulsion began and the neurological deterioration appeared again, reason why it was decided to operate once more. Anesthetic induction was carried out with fentanyl sodium thiopental and rocuronium. The patient had a favorable clinical course without complications.

Trauma craneoencefálico penetrante / Penetrating traumatic brain injury

El trauma craneoencefálico tiene relevancia a nivel global, con incidencia mundial estimada de 200 casos por 100 000 personas, generando una carga importante también para el sistema de salud de Latinoamérica. El objetivo del presente documento es describir la experiencia exitosa en un Centro de Trauma en la atención de un paciente con trauma craneoencefálico penetrante con objeto a "baja velocidad", un destornillador, realizándose además una sucinta revisión acerca de la literatura relacionada actual.

Trauma brain injury has relevance at the global level, with worldwide estimated incidence of 200 cases per 100 000 people, also generating a significant burden to the health system in Latin America. The aim of this document is to describe the successful experience in a Trauma Center in the management of a patient with penetrating brain trauma injury secondary to a "low speed" object, a screwdriver, in addition a concise review about the current related literature is performed.

Brain Concussion: New Classifications and Current Physiopathological Knowledge of the Disease

The present review paper aims to update the definition and classification of cerebral concussion, highlighting its pathophysiological mechanisms. The high prevalence of cerebral concussion in emergency rooms around the world makes it necessary to know its proper management to avoid its late sequelae, which traditionally compromise cognitive aspects of behavior. New evidence on potential neuroprotective treatments is being investigated.

Estrategias para el empleo optimizado de la neuroimagenología en pacientes con traumatismo encéfalo craneano: puesta al día / Strategies for the optimized use of neuroimaging in patients with head trauma cranial: update

INTRODUCTION: Introduction of current neuroimaging technologies has been essential for the agile and effective diagnosis of cranial brain injuries. However, for various reasons there is a tendency to indiscriminate use. A review of the topic was made aimed at providing an update on the recommended strategies for the optimized use of these technologies. Material and method: A review of the topic of the last five years was made, using the Medline / Pubmed and SciELO platforms of complete articles, in English and Spanish. We also included relevant articles, published in previous years, located in previous bibliographic reviews carried out by the authors. CONCLUSIONS: Routine study with CT scan in all patients with head trauma is not cost effective, should be used in patients with Glasgow less than 15 points or in those with Glasgow of 15 points and risk factors of intracranial injury. Its use as a form of neuromonitoring is similarly useful, but on a selective basis. Magnetic Resonance Imaging is especially useful in the mediate or late periods of cranial trauma, in patients with clinical tomographic incongruences, very useful to establish prognosis in diffuse traumas and intracranial complications. Neurosonology is a useful tool for therapeutic decision.

The effects of hyperbaric oxygen on the hemodynamics and intracranial pressure of patients with severe brain injury: A systematic review of randomized and controlled trials / 中华物理医学与康复杂志

Objective@#To systematically evaluate the effects of hyperbaric oxygen on the hemodynamics and intracranial pressure of patients with severe craniocerebral injury (STBI).@*Methods@#Reports of randomized and controlled trials applying hyperbaric oxygen in the treatment of STBI were retrieved from the Pubmed, Cochrane Library, Embase, CBM, CNKI, VIP and Wan Fang databases. Each report found was evaluated by two researchers independently applying pre-defined inclusion and exclusion criteria. The data were extracted and combined and a meta-analysis was performed.@*Results@#Eight trials involving 725 patients were included in the meta-analysis. They combined to demonstrate that intracranial pressure, oxygen uptake and scores on the Glasgow coma scale improved significantly more in the hyperbaric oxygen group than in the control group after between 3 and 10 days of treatment.@*Conclusion@#Hyperbaric oxygen therapy is effective in treating severe craniocerebral injury and it is worthy of clinical application.

Effects of autologous blood transfusion on coagulation function,inflammatory factors and immune function in patients with traumatic brain injury / 国际检验医学杂志

Objective To explore the effects of autologous blood transfusion on coagulation function,in-flammatory factors and immune function in patients with traumatic brain injury.Methods 85 patients taken autologous blood transfusion were selected as the observation group,30 cases with allogeneic blood transfusion were taken as control group.The blood transfusion volume,perioperative hematocrit,prothrombin time and postoperative complications were observed and compared between the two groups.Results In the observation group,the total amount of autologous blood transfusion in the observation group was 36 338mL,averaged (427.5 ± 28.3)mL,the total amount of allogeneic blood transfusion was 8 747 mL,averaged (102.9 ± 12.7) mL,and the autologous blood accounted for 80.6% of the total transfusion.61 patients only transfused autolo-gous blood,accounting for 71.8%.In the control group,the total allogeneic blood transfusion volume was 15 918 mL,averaged (530.6 ± 22.8)mL,the consumption of banked blood in the observation group was signifi-cantly less than that in the control group (P< 0.05).The levels of platelet (PLT) and plasma fibrinogen (FIB)in the control group increased significantly at 3 d after operation compared with those before operation (P<0.05);while activated partial thromboplastin time (APTT) began to decrease significantly at 3 d after operation (P<0.05);the prothrombin time (PT) and thrombin time (TT)decreased significantly at 7 d after operation(P<0.05),and the level of PLT and FIB in the observation group began to increase significantly at 1 d after operation (P<0.05).PT,APTT and TT were significantly reduced 1 d after operation.Compared with the control group,the level of PLT and FIB in each phase of the observation group was significantly high-er than that of the control group (P<0.05),and the PT,APTT and TT were significantly lower than those in the control group (P<0.05).After operation,the level of pro-inflammatory factors in the observation group was significantly lower than that of the control group.The level of anti inflammatory factors and immune function were significantly higher than that of the control group (P<0.05),and the incidence of complications in the observation group was 2.4%(2/85),which was significantly lower than 16.7%(5/30)of the control group,and the difference was statistically significant (P<0.05).Conclusion Autologous blood transfusion has the advantages of rapidness,timeliness and safety in the operation for patients with brain trauma.It is helpful to save blood,reduce the effect of trauma and blood transfusion on blood coagulation function and im-mune function,and reduce the risk of blood transfusion complications and postoperative infection,which is worth of clinical application.

Comparación de los procesos de la cognición social entre adultos con trauma craneoencefálico leve moderado y severo / Comparison of the of social cognition process among in adults with mild, moderate and severe traumatic brain injure

Resumen El objetivo de esta investigación consistió en comparar los procesos de la cognición social en adultos con trauma craneoencefálico (TCE) leve, moderado y severo. Es un estudio de tipo descriptivo, comparativo, transversal, a partir de la valoración de tres procesos de la cognición social: teoria de la mente, reconocimiento emocional y juicio moral de 126 adultos con TCE con edades entre los 18 y 52 años, medidos a través de tres instrumentos: Test Faux Pas, Test de las miradas y dilemas morales. Se encontraron diferencias significativas en el Faux Pas (Historia de Andres p=.016) y en el test de las miradas (Miradas p = .046). Se concluye que las personas con TCE evaluadas presentan alteración en la teoría de la mente y un desempeño promedio en el reconocimiento emocional y en los dilemas morales.

Abstract The aim of this research was to compare the processes of social cognition in adults with mild, moderate and severe Traumatic Brain Injury (TBI). It was a descriptive, comparative, cross - sectional study, based on the evaluation of three processes of social cognition: Theory of mind, Emotional recognition and Moral judgment of 126 adults with TBI, with ages between 18-52 years evaluated in three cities of Colombia measured through three instruments: Faux Pas Test, Reading the Mind in the Eyes Test and moral dilemmas. Significant differences were found in the Faux Pas and in the eye test. It is concluded that people with TBI evaluated have an alteration in the theory of the mind and an average performance in emotional recognition and moral dilemmas.

Trastornos del sueño en niños y adolescentes con enfermedades neurológicas / Sleep disorders in children and adolescents with neurological diseases

Resumen Los trastornos del ciclo circadiano vigilia-sueño son primarios y secundarios. Los primarios o intrínsecos son menos frecuentes (31%) que los secundarios o extrínsecos pero más rápido diagnosticados y tratados (69%). Los primarios se deben a alteraciones intrínsecas anatómico y/o funcionales del ciclo circadiano sueño-vigilia. Su tratamiento está bien definido en caso de que exista. Los trastornos del sueño secundarios son alteraciones extrínsecas del sueño de origen adquirido cuyo diagnóstico de certeza es más clínico que polisomnográfico y su tratamiento dirigido a la condición asociada así como a la manifestación anormal onírica. Aunque las secundarias son más comunes que las primarias (69% contra 31%) se diagnostican y tratan menos que las primarias. Cuando no se diagnostican y tratan correctamente inducen problemas significativos emocionales, conductuales y cognoscitivos en niños y adolescentes comparados con aquellos sin tales sin trastornos del sueño. El propósito de esta revisión es que los pediatras generales, pediatras neurólogos y paidopsiquiatras tengan en mente la alta incidencia de los trastornos secundarios del sueño en niños con enfermedades neurológicas y que pregunten a los padres y pacientes sobre la calidad del sueño de sus hijos y realicen un diagnóstico y tratamiento precoz para evitar consecuencias en algunos casos fatales.

Abstract The disorders of the circadian cycle sleep-wake are primary and secondary. The primary or intrinsic are less frequent (31%) than the secondary or extrinsic but early diagnosed and treated (69%). The primary intrinsic alterations are due to anatomical and/or functional process circadian rhythm sleep-wake cycle. Its treatment is well defined in case it exists. The secondary sleep alterations are extrinsic and their diagnosis is more clinical than polysomnographic and its treatment directed to the associated condition as well as the manifestation abnormal sleep. Although the secondary are more common than the primary (69% vs. 31%) they are diagnosed and treated less than the primaries. When not properly diagnosed and treated induce significant problems with emotional, behavioral and cognitive changes in children and adolescents compared with those without sleep disorders. The purpose of this review is that the general pediatricians, pediatric neurologists and pediatric psychiatric bear in mind the high incidence of side effects of sleep disorders in children with neurological diseases and to ask parents and patients about the quality of sleep of their children and adolescents and make a diagnosis and early treatment to avoid fatal consequences in some cases.

Analysis of the role and mechanism of A2AR activation in tau hyperphosphorylation after brain injury / 中国生化药物杂志

Objective To study the role and mechanism of A2AR activation in tau hyperphosphorylation after brain injury.Methods SD rats were cultured with no specific pathogen level.SH-SY5Y was cultured.The rats were treated with CGS21680 solution and DMSO and SH-SY5Y respectively.The CGS21680 solution and sb216763, H-89, or Only add ZM241385, the control group plus DMSO, compared with each group tau hyperphosphorylation.Results The phosphorylation level of tau protein in SH-SY5Y cells was significantly higher than that in the control group (P<0.05).The phosphorylation level of tau protein in the primary hippocampal neurons of rats was significantly higher than that of the control group (P<0.05).The levels of tau protein phosphorylation in group 2 and group 3 were significantly higher than those in control group (P<0.05).The expression of tau in group 4 and group 5 was statistically significant (P<0.05)There was no significant difference in phosphorylation level between the two groups.Conclusion A2AR activation can activate kinase A and GSK-3β after brain injury, leading to tau hyperphosphorylation.

The expression of the tryptase in the plasma of the brain traumatic patients / 中国基层医药

Objective To detect the expression of the tryptase in the plasma,and study the meaning in brain traumatic patients.Methods There were two groups:the brain traumatic group(40 patients)and the control group (20 health people).The content of plasma tryptase was determined by fluorescence enzyme immunoassay..Results The level of plasma tryptase had no statistical significance in control group(2.97 ±1.05)μg/L compared with the brain traumatic group(3.03 ±1.39)μg/L,however there had statistical significance comparing with sever brain traumatic patients(3.84 ±0.52μg/L)(t =3.32,P <0.05).4 cases of death in patients with severe head injury group content of tryptase (5.85 ±1.05)μg/L,which was significantly higher than the group of 16 cases of injury in severe head injury after 2 months still alive with the content of serum tryptase (2.49 ±0.52)μg/L,the difference was statistically significant (t =8.13,P <0.01).Conclusion The plasma tryptase level in sever brain traumatic patients increased significantly,and might be of importance for treatment strategies and prognosis.

Influence of intraoperative use of saline and balanced salt solution on nerve function recovery in patients with brain trauma / 局解手术学杂志

Objective To study the influence of intraoperative use of saline and balanced salt solution on postoperative nerve function recovery in patients with brain trauma.Methods Totally 120 patients were randomly divided into the saline group and the balanced salt solu-tion group,and the postoperative nerve function recovery of the two groups were observed.Results The level of pH and HCO3 -24 hours af-ter operation in the saline group were lower than those in the balanced salt solution group (P <0.05),while the level of Cl - in the saline group was higer than that in the balanced salt solution group (P <0.05).The intracranial pressure and preoperative Glasgow coma score (GCS)of the two groups had no statistical significance (P =0.94).And the Glasgow coma score at 336 hours and 672 hours after opreation of the two groups were of statistical significance (P =0.00,P =0.03).The mortality of the saline group and the balanced solution group 28days after surgery were 15% and 10% respectively,and there was no significant difference between the two groups (P =0.58).Conclusion Saline resuscitation during surgery would lead to hyperchloremic acidosis as well as worse nerve function.However,the perfusion of balanced salt solution during the operation is more favorable to the recovery of neurological function.

Trauma craneoencefálico severo: atención prehospitalaria, manejo quirúrgico y monitoreo multomodal / Severe cranioencephalic trauma: prehospital care, surgical management and multimodal monitoring

El trauma craneoencefálico severo representa por lo menos la mitad de las muertes relacionadas con trauma, la patofisiología celular y clínica esta extensamente estudiada y documentada, las opciones de monitorización y tratamiento constituyen los paradigmas actualmente para la el progreso en la sobrevida disminuyendo la probabilidad de secuelas, junto con los principios de manejo general que incluyen entre otros el control de la temperatura, tensión arterial, sedación, ventilación, nutrición hacen posible la calidad en la atención de nuestros pacientes.

Severe brain trauma accounts for at least half of the deaths related to trauma, cellular pathophysiology and clinic it is extensively studied and documented , the monitoring and treatment options are currently paradigms for progress in decreasing the likelihood of survival sequels along with general management principles which include among others the temperature control, blood pressure, sedation, ventilation, nutrition enables quality care for our patients.

Clinical characteristics and risk factors of prognosis in children with brain trauma in PICU / 中国小儿急救医学

Objective To analyze the clinical characteristics and risk factors of prognosis in children with brain trauma.Methods We retrospectively analyzed the clinical data of 125 cases diagnosed as brain trauma in PICU of Shengjing Hospital affiliated to China Medical University from January 2009 to December 2014.The risk factors influencing prognosis were analyzed by using single factor analysis and multiple factors Logistic regression methods.The risk factors included Glasgow coma score (GCS) on admission,blood glucose,lactic acid,prothrombin time,international normalized ratio (INR),serum sodium,serum potassiumin,pulse within 24 hours after admission,gender,age,time for therapy,shock,respiratory failure,cerebral hermia and surgery.Results Eighty-four cases survived and 41 cases died.The fatality rate was 32.8％.T test and chi-square test of risk factors showed that GCS score,blood glucose,blood lactic acid,INR,respiratory failure,shock had a significant influence on the prognosis of brain trauma in children (P ＜ 0.05).Multviariable Logistic regression analysis showed that GCS score,blood glucose,blood lactic acid,respiratory failure were independent risk factors affecting the prognosis of brain trauma (OR =7.434,0.473,0.615,0.000,P ＜ 0.05).Conclusion Pediatric brain trauma has a rapid progress and poor prognosis with high mortality and disability rate.GCS score,blood sugar,blood lactic acid,respiratory failure are independent risk factors for prognosis of brain trauma in children.

Protective effect of ganlioside GM1 on rats with acute brain trauma and its relevant mechanism / 中国生化药物杂志

Objective To explore the protective effect of monosialoganglioside (GM1) on rats with acute brain trauma and its relevant mechanism.Methods Localized brain contusion model in rats were constructed by Feeney's method.65 SD rats were randomly divided into three groups: sham-operation group (n=5), brain injury group (n=30) and GM1 group (n=30).The rats were killed at 3, 7, 14, 28, 56, 168 h after administration, 5 rats in each group (1 rats in sham-operation group).Bax and Bcl-2 protein expression and PARP were decected by immunohistochemical method.The neuronal apotosis was detected by TUNEL.Results There were significant differences in expression of Bax and Bcl-2 protein between brain injury group and sham-operation group at each time point (P<0.05).There were significant differences in expression of Bax and Bcl-2 protein between GM1 group and brain injury group at each time point ( P <0.05 ) , while there were no significant differences in expression of Bax and Bcl-2 protein after 14 h between GM1 group and sham-operation group.After administration, the Bax/Bcl-2 values decreased and was obvious at 14 h.Degradation of PARP and rate of neuronal apotosis in brain injury group at each time point were significantly higher than those in sham-operation group (P<0.05).Degradation of PARP in GM1 group at 28 h, 56 h, 168 h were significant lower than those in brain injury group (P<0.05), and rate of neuronal apotosis was lower at each time point than those in brain injury group (P<0.05).Conclusion GM1 could reduce value of Bax/Bcl-2, degradation of PARP and apoptosis in rats with traumatic injury brain.

Clinical analysis of 36 cases with whirlpool acute epidural hematoma / 中国基层医药

Objective To analyze the clinical features and prognosis of patients with acute epidural hematoma in the whirlpool sign.Methods 36 cases of CT scan showed a whirlpool sign of acute subdural hematoma patients were selected as the observation group.During the same time period,50 acute epidural hematoma patients without the whirlpool sign were selected as the control group.All patients received operation treatment.The Glasgow coma score (GCS),amount of hemorrhage and prognosis were compared between the two groups.Results The preoperative GCS score of the observation group was significantly lower than that of the control group (P ＜ 0.05).In the operation,the blood loss of the observation group was significantly increased compared with the control group (t =3.232,3.164,P ＜ 0.05).Control group CT evaluation of preoperative and intraoperative measurement had no significant difference(P ＞0.05).In the observation group,11 patients died,the mortality rate was 30.5％ (11/36).In the control group,6 patients died,the mortality rate was 12.0％ (6/50),the difference between the two groups was statistically significant (x2 =4.134,P ＜ 0.05).The patients were followed up for 6 months,the excellent and good rate of ADL score in observation group was 64.0％,which was significantly lower than 84.1％ in the control group (x2 =3.989,P ＜ 0.05).Conclusion Acute epidural hematoma patients with thewhirlpool signshowed progressive disease,high mortality,poor prognosis,and active countermeasures should be taken.

Analysis of the Cost-effectiveness of 2 Kinds Regimens in the Treatment of Brain Trauma and Cerebral Hem-orrhage Complicated with Upper Gastrointestinal Hemorrhage / 中国药房

OBJECTIVE:To observe the efficacy and economy of omeprazole and esomeprazole in the treatment of brain trauma and cerebral hemorrhage complicated with upper gastrointestinal hemorrhage. METHODS:The data of 110 patients with trauma cere-bral hemorrhage complicated with upper gastrointestinal hemorrhage were retrospectively analyzed and divided into omeprazole group (56 cases)and esomeprazole group(54 cases). All patients were given conventional treatment. On this basis,omeprazole group was treated with Omeprazole for injection 40 mg by intravenous infusion;esomeprazole group was treated with Esomeprazole injection 40 mg by intravenous infusion,twice a day. The treatment course for 2 groups was 5 d. The efficacy and economy of patients were com-pared. RESULTS:The total effective rates in esomeprazole group were significantly higher than omeprazole group higher,the cost-ef-fectiveness in esomeprazde group(1 397.71)were significantly lower than omeprazole group(1 512.09)(P<0.05),andΔC/ΔE=91.52. CONCLUSIONS:Esomeprazole has good efficacy,safety and economy in the treatment of brain trauma cerebral hemorrhage compli-cated with upper gastrointestinal hemorrhage.

Síndrome postconmocional y su valoración médico legal / Postconcussion syndrome and medicolegal assessment

El síndrome postconmocional consiste en una triada de síntomas físicos, cognitivos y psicológicos que ocurren después de un trauma craneoencefálico y que pueden causar una incapacidad ocupacional o social significativa. Tal síndrome es un trastorno muy presente y relevante en la actividad forense, que suele acompañar a los traumatismos craneoncefálicos, principalmente a los de leve intensidad, los cuales ocasionan un grave problema de salud por ser causa tanto de mortalidad como de repercusiones por discapacidad especialmente en gente joven. Pese a las investigaciones realizadas, aún no existe una definición conceptual clara y no se cuenta con criterios válidos universalmente aceptados, por lo que se pretende realizar una revisión del tema y brindar recomendaciones al momento de realizar la valoración médico legal de tal síndrome.

The postconcussion syndrome is a triad of physical, cognitive and psychological symptoms that occur after a head trauma and can cause significant social or occupational disability. Such syndrome is a very present and relevant in forensic activity disorder that often accompanies trauma craneoncefálicos, mainly mild, which cause a serious health problem cause of both mortality and disability impact especially young people. Despite investigations, there is still no clear conceptual definition and there is no universally accepted criteria valid, so it aims to review the issue and make recommendations at the time of the forensic assessment of such syndrome.

Avaliação do trauma da face sob as perspectivas do Código Penal e das inovações trazidas com a Lei Maria da Penha / Evaluation of facial trauma from the perspective of the Penal Code and the innovations resulting from the Maria da Penha Act: a case report

Objetivo: Analisar os traumas da face sob a ótica do Código Penal Brasileiro caracterizando as qualificadoras da lesão corporal em decorrência de violência doméstica, artigo 129 do Código Penal, e de suas alterações com a Lei Maria da Penha. Metodologia: Um caso de violência contra a mulher foi relatado e, partindo deste caso, foi realizada uma discussão com base na legislação brasileira vigente, referente ao tema. Conclusão: Conclui-se que mesmo com todas essas mudanças na legislação, o Brasil avançou muito pouco. A violência domestica contra a mulher ainda tem muito a ser vencida, até mesmo por estar ligada a um fator cultural muito forte e difícil de desprender na sociedade... (AU)

Obective: To analyze facial traumas from the perspective of the Brazilian Penal Code, characterizing the bodily injury caused by domestic violence, Article 129 of the Penal Code, and its changes resulting from the Maria da Penha Act. Methodology: A case of violence against a woman was reported, which served as the starting point for a discussion on the current Brazilian legislation on the issue. Conclusion: It was concluded that despite all the changes in the legislation, Brazil has made very little progress in this area. Much remains to be done in the fight against domestic violence targeting women, particularly since the latter involves a strong cultural factor that is difficult to eliminate from Brazilian society... (AU)