Brain injuries

摘要： Cerebral ischemia is a serious disease that triggers sequential pathological mechanisms, leading to significant morbidity and mortality. Although most studies to date have typically focused on the lysosome, a single organelle, current evidence supports that the function of lysosomes cannot be separated from that of the endolysosomal system as a whole. The associated membrane fusion functions of this system play a crucial role in the biodegradation of cerebral ischemia-related products. Here, we review the regulation of and the changes that occur in the endolysosomal system after cerebral ischemia, focusing on the latest research progress on membrane fusion function. Numerous proteins, including N-ethylmaleimide-sensitive factor and lysosomal potassium channel transmembrane protein 175, regulate the function of this system. However, these proteins are abnormally expressed after cerebral ischemic injury, which disrupts the normal fusion function of membranes within the endolysosomal system and that between autophagosomes and lysosomes. This results in impaired “maturation” of the endolysosomal system and the collapse of energy metabolism balance and protein homeostasis maintained by the autophagy-lysosomal pathway. Autophagy is the final step in the endolysosomal pathway and contributes to maintaining the dynamic balance of the system. The process of autophagosome-lysosome fusion is a necessary part of autophagy and plays a crucial role in maintaining energy homeostasis and clearing aging proteins. We believe that, in cerebral ischemic injury, the endolysosomal system should be considered as a whole rather than focusing on the lysosome. Understanding how this dynamic system is regulated will provide new ideas for the treatment of cerebral ischemia.

摘要： Traumatic brain injury(TBI)is a serious condition in which trauma to the head causes damage to the brain,leading to a disruption in brain function.This is a significant health issue worldwide,with around 69 million people suffering from TBI each year.Immediately following the trauma,damage occurs in the acute phase of injury that leads to the primary outcomes of the TBI.In the hours-to-days that follow,secondary damage can also occur,leading to chronic outcomes.TBIs can range in severity from mild to severe,and can be complicated by the fact that some individuals sustain multiple TBIs,a risk factor for worse long-term outcomes.Although our knowledge about the pathophysiology of TBI has increased in recent years,unfortunately this has not been translated into effective clinical therapies.The U.S.Food and Drug Administration has yet to approve any drugs for the treatment of TBI;current clinical treatment guidelines merely offer supportive care.Outcomes between individuals greatly vary,which makes the treatment for TBI so challenging.A blow of similar force can have only mild,primary outcomes in one individual and yet cause severe,chronic outcomes in another.One of the reasons that have been proposed for this differential response to TBI is the underlying genetic differences across the population.Due to this,many researchers have begun to investigate the possibility of using precision medicine techniques to address TBI treatment.In this review,we will discuss the research detailing the identification of genetic risk factors for worse outcomes after TBI,and the work investigating personalized treatments for these higher-risk individuals.We highlight the need for further research into the identification of higher-risk individuals and the development of personalized therapies for TBI.

摘要： BACKGROUND Postoperative delirium is common in patients who undergo neurosurgery for craniocerebral injury.However,there is no specific medical test to predict postoperative delirium to date.AIM To explore risk factors for postoperative delirium in patients with craniocerebral injury in the neurosurgery intensive care unit(ICU).METHODS A retrospective analysis was performed in 120 patients with craniocerebral injury admitted to Hainan People’s Hospital/Hainan Hospital Affiliated to Hainan Medical University,The First Affiliated Hospital of Hainan Medical University,and The Second Affiliated Hospital of Hainan Medical University between January 2018 and January 2020.The patients were categorized into groups based on whether delirium occurred.Of them,25 patients with delirium were included in the delirium group,and 95 patients without delirium were included in the observation group.Logistic regression analysis was used to explore the association between sex,age,educational level,Glasgow coma scale(GCS),complications(with or without concussion,cerebral contusion,hypoxemia and ventricular compression)and site of injury and delirium.RESULTS The GCS score above 8 and concomitant disease of cerebral concussion,cerebral contusion,hypoxemia and ventricular compression,and damage to the frontal lobe were associated with delirium in patients admitted to neurosurgical intensive care unit(ICU)(all P<0.05).However,age,sex,administration more than three medicines,and educational level were not significantly associated with the onset of delirium in patients with craniocerebral injury in the neurosurgical ICU(P<0.05).Multivariate logistic regression analysis showed that GCS score above 8,cerebral concussion,cerebral contusion,hypoxemia,ventricle compression,and frontal lobe disorders were independent risk factors for delirium in patients with craniocerebral injury in the neurosurgical ICU(P<0.05).CONCLUSION GCS score,concussive concussion,cerebral contusion,hypoxemia,ventricle compression,and damage to frontal lobe are risk factors of postoperative delirium.

摘要： Introduction: Mild traumatic brain injury (mTBI) is a common injury, with nearly 3 - 4 million cases annually in the United States alone. Neuroimaging in patients with mTBI provides little benefit, and is usually not indicated as the diagnosis is primarily clinical. It is theorized that microvascular trauma to the brain may be present in mTBI, that may not be captured by routine MRI and CT scans. Electromagnetic (EM) waves may provide a more sensitive medical imaging modality to provide objective data in the diagnosis of mTBI. Methods: COMSOL simulation software was utilized to mimic the anatomy of the human skull including skin, cranium, cerebrospinal fluid (CSF), gray-matter tissue of the brain, and microvasculature within the neural tissue. The effects of penetrating EM waves were simulated using the finite element analysis software and results were generated to identify feasibility and efficacy. Frequency ranges from 7 GHz to 15 GHz were considered, with 0.6 and 1 W power applied. Results: Variations between the differing frequency levels generated different energy levels within the neural tissue—particularly when comparing normal microvasculature versus hemorrhage from microvasculature. This difference within the neural tissue was subsequently identified, via simulation, serving as a potential imaging modality for future work. Conclusion: The use of electromagnetic imaging of the brain after concussive events may play a role in future mTBI diagnosis. Utilizing the proper depth frequency and wavelength, neural tissue and microvascular trauma may be identified utilizing finite element analysis.

摘要： BACKGROUND Recent innovations in intensive care have improved the prognosis of patients with severe brain injuries and brought more patients with disorders of consciousness(DoC).Data are lacking regarding the long-term outcomes of those patients in China.It is necessary to study the long-term outcomes of patients with prolonged DoC in light of many factors likely to influence crucial decisions about their care and their life.AIM To present the preliminary results of a DoC cohort.METHODS This was a two-center prospective cohort study of inpatients with vegetative state(VS)/unresponsive wakefulness syndrome(UWS).The study outcomes were the recovery from VS/UWS to minimally conscious state(MCS)and the long-term status of patients with prolonged DoC considered in VS/UWS or MCS for up to 6 years.The patients were evaluated using the Glasgow coma scale,coma recovery scale-revised,and Glasgow outcome scale.The endpoint of follow-up was recovery of full consciousness or death.The changes in the primary clinical outcome improvement in clinical diagnosis were evaluated at 12 mo compared with baseline.RESULTS The study population included 93 patients(62 VS/UWS and 31 MCS).The postinjury interval range was 28-634 d.Median follow-up was 20 mo(interquartile range,12-37 mo).At the endpoint,33 transitioned to an emergence from MCS or full consciousness,eight had a locked-in syndrome,and there were 35 patients remaining in a VS/UWS and 11 in an MCS.Seven(including one locked-in syndrome)patients(7.5%)died within 12 mo of injury.Compared with the unresponsive group(n=52)at 12 mo,the responsive group(n=41)had a higher proportion of males(87.8%vs 63.5%,P=0.008),shorter time from injury(median,40.0 d vs 65.5 d,P=0.006),higher frequency of vascular etiology(68.3%vs 38.5%,P=0.007),higher Glasgow coma scale score at admission(median,9 vs 6,P<0.001),higher coma recovery scale-revised score at admission(median,9 vs 2.5,P<0.001),at 1 mo(median,14 vs 5,P<0.001),and at 3 mo(median,20 vs 6,P<0.001),lower frequency of VS/UWS(36.6%vs 90.0%,P<0.001),and more favorable Glasgow outcome scale outcome(P<0.001).CONCLUSION Patients with severe DoC,despite having strong predictors of poor prognosis,might recover consciousness after a prolonged time of rehabilitation.An accurate initial diagnosis of patients with DoC is critical for predicting outcome and a long-term regular follow-up is also important.

摘要： Poor recovery of neuronal functions is one of the most common healthcare challenges for patients with different types of brain injuries and/or neurodegenerative diseases.Therapeutic interventions face two major challenges:(1)How to generate neurons de novo to replenish the neuronal loss caused by injuries or neurodegeneration(restorative neurogenesis)and(2)How to prevent or limit the secondary tissue damage caused by long-term accumulation of glial cells,including microglia,at injury site(glial scar).In contrast to mammals,zebrafish have extensive regenerative capacity in numerous vital organs,including the brain,thus making them a valuable model to improve the existing therapeutic approaches for human brain repair.In response to injuries to the central nervous system(CNS),zebrafish have developed specific mechanisms to promote the recovery of the lost tissue architecture and functionality of the damaged CNS.These mechanisms include the activation of a restorative neurogenic program in a specific set of glial cells(ependymoglia)and the resolution of both the glial scar and inflammation,thus enabling proper neuronal specification and survival.In this review,we discuss the cellular and molecular mechanisms underlying the regenerative ability in the adult zebrafish brain and conclude with the potential applicability of these mechanisms in repair of the mammalian CNS.

摘要： AIM To quantify and characterize children and adolescent eye injuries treated in trauma department.METHODS A retrospective analysis was conducted of children and adolescent patients(0-19 years of age) with eye injuries using the British Columbia Trauma Registry(BCTR) data. BCTR data was obtained from January 1,2000 to December 31,2008. The BCTR provides the most detailed information on severe injuries throughout the province of BC. There are 12 trauma-receiving facilities in BC from which BCTR collects data.RESULTS A total of 162 patients with eye injuries were registered in BCTR during the data collection period. The highest number of injuries occurred in the 15-19 age group,followed by 10-14 and 5-9 age groups. Seventy-one point six percent of all patients were male. The mean age for all patients was 12.9(SD = 5.8) years. Vehicular crash was by far the most common mechanism of injury among all patients(42.0%) followed by blunt injury(14.2%) and cuts(12.3%). The child and adolescent eyeinjury data set we used for our study indicated that there were in total,50 patients that were tested for alcohol and drug use. The majority of them were 15-19 years of age(n = 38). Among the tested eye injury patients in the 15-19 age group,47%(18/38) tested positive for alcohol. There were approximately 30 cases of physical fighting(assault) and fighting-related injury among adolescents. Some injuries were caused by use of fire arms and knife during the assaults. Out of all patients,62(38%) were seen by an Ophthalmologist on admission,whereas 100(62%) patients were not seen by an eye specialist on admission. The most common injury diagnosis among the patients not consulted by ophthalmologist was conjunctiva injury(53%),whereas almost 9 out of 10 patients with ophthalmological consultation had laceration of cornea injury diagnoses. Using Glasgow Coma Scale(GCS)-based classification of brain injury severity,3.7% of all patients were classified with severe brain injury(GCS ≤ 8),while more than 64% had diagnosed with a mild brain injury(GCS ≥ 13).CONCLUSION This study suggests that most child and adolescent eye injuries in BC occur at street/highway locations followed by incidents at home. Vehicular crash was by far the most common mechanism of injury among all patients(42%). Sixty-four point two percent of child and adolescent eye injury patients also had mild brain injuries. Further,the child and adolescent eye injury data set we used for our study indicated that there were in total,50 patients tested for alcohol and drug use. There is an urgent need for a child and adolescent eye injury prevention plan in our province.

摘要： Major pulmonary disorders may occur after brain injuries as ventilator-associated pneumonia,acute respiratory distress syndrome or neurogenic pulmonary edema.They are key points for the management of brain-injured patients because respiratory failure and mechanical ventilation seem to be a risk factor for increased mortality,poor neurological outcome and longer intensive care unit or hospital length of stay.Brain and lung strongly interact via complex pathways from the brain to the lung but also from the lung to the brain.Several hypotheses have been proposed with a particular interest for the recently described“double hit”model.Ventilator setting in brain-injured patients with lung injuries has been poorly studied and intensivists are often fearful to use some parts of protective ventilation in patients with brain injury.This review aims to describe the epidemiology and pathophysiology of lung injuries in brain-injured patients,but also the impact of different modalities of mechanical ventilation on the brain in the context of acute brain injury.

摘要： Background: Patients with acquired brain injury often experience impaired working memory (WM), a condition that can make everyday life activities and work difficult. Objectives: This study investigates the effects of computerized WM training on WM skills, cognitive tests, activity performance and estimated health and whether the effects of computerized WM training can be attributed to sex or time since injury. Methods: Forty-eight patients with acquired brain injury underwent computerized WM training. Patients were tested by a neuropsychologist and interviewed by an occupational therapist just prior and 20 weeks after completion of training. Results: Patients who participated in computerized WM training significantly improved their WM skills shown in WM index, their neuropsychological test scores, and their self-estimated health scores. They also significantly improved their performance of individually defined WM-related everyday activities and their satisfaction with the performance of these activities. There was a significant difference in terms of WM index, WM-related daily activity performance, and satisfaction with respect to time since injury. Conclusion: Computerized WM training can improve cognitive and everyday performance for patients with acquired brain injury. Patients can improve their cognitive functions a long time after suffering a brain injury or disease. This effect is greater if WM training is used early in the rehabilitation.

摘要： AIM:To investigate the outcomes of trauma patients with traumatic brain injury(TBI)on Dabigatran Etexilate(DE).METHODS:Following IRB approval,all patients taking DE who were admitted to our level 1 trauma service were enrolled in the study.Injury complexity,length of stay(LOS),intensive care length of stay,operative intervention,therapeutic interventions and outcomes were analyzed retrospectively.RESULTS:Twenty-eight of 4310 admissions were taking DE.Eleven patients were excluded on concurrent antiplatelet therapy.Average age was 77.14 years(64-94 years),and average LOS was 4.7 d(1-35 d).Thirty-two percent were admitted with intracranial hemorrhage.Eighteen percent received factorⅦ,and 22%received dialysis in attempts to correct coagulopathy.Mortality was 21%.CONCLUSION:The low incidence,absence of reversal agents,and lack of practice guidelines makes managing patients with TBI taking DE frustrating and provider specific.Local practice guidelines may be helpful in managing such patients.