Outcome predictors for severely brain-injured patients directly admitted or transferred from emergency departments to a trauma center / 世界急诊医学杂志（英文）

@#Dear editor, After sustaining severe traumatic brain injury (TBI), patients frequently require invasive mechanical ventilation (MV). However, up to 26% of patients require tracheostomy due to failure to wean from the ventilator.[1] The decision of when to perform tracheostomy is important as it balances the risk between avoiding prolonged MV and avoiding risk of tracheostomy. Early predictors for tracheostomy, i.e., clinical factors when patients first present to an Emergency Department after trauma or when patient first arrive at a regional trauma center, can help clinicians’ medical decision-making process.

Expression of Monocyte Chemoattractant Protein-1 and Vascular Endothelial Growth Factor mRNA in Rats with Acute Methanol Poisoning / 昆明医科大学学报

Objective This study was aimed to investigate the expression of monocyte chemoattractant protein-1 (MCP-1) and vascular endothelial growth factor (VEGF) mRNA in rats with acute methanol poisoning. Methods Animal models of acute methanol poisoning in rats were duplicated using a plexiglas chamber exposed to a mixture of N2O/O2. Right atrium venous blood of rats were taken at each time point (2 h, 12 h, 24 h,3 d,1 w), and gas chromatography was used to determine the methanol concentration of the rat blood (n=5) . Then got brain tissue to extract total RNA and reverse transcription (n=3) . SYBRGreen real-time PCR was used to monitor the expression of MCP-1 and VEGF mRNA. Results (1) Results of methanol concentration determination:The blood methanol concentration of the low-dose group was significantly increased in comparison with that of the saline control group at 2 h and 12 h time points ( < 0.05) . In the high-dose group, the blood methanol concentration was increased significantly compared with the low-dose group as well as the saline group at 2 h, 12 h and 24 h time points ( < 0.05); (2) The expression of MCP-1 mRNA: The expression level of MCP-1 were significantly enhanced along with the time lapse after acute poisoning,and became most severely at 24 h. The expression levels of MCP-1 have significant differences in groups,of which high-dose group was higher than low-dose group at 2 h, 3 d and 1 w ( <0.05);(3) The expression of VEGF mRNA:The expression level of VEGF was significantly enhanced along with the time lapse after acute poisoning,and became most severely at 24 h. The expression levels of MCP-1 have significant differences in groups,of which high-dose group was higher than low-dose group at 2 h and 12 h ( <0.05) . Conclusion The expression levels of MCP-1 and VEGF mRNA were significantly enhanced, and the degree of poisoning was apparently related with the dose administered. MCP-1 and VEGF might play the important roles in the pathogenesis and progression of brain injured.

The Effect of Cognitive-behavioral Characteristics on Depression of Caregivers in Brain-injured Patients

OBJECTIVE: To evaluate the relationship between depression and cognitive-behavioral characteristics of caregivers using social problem solving inventory (SPSI), social support or conflict scale (SSS or SCS) and somatic symptoms (SS). METHOD: Fifty five couples of brain-injured patients and caregivers participated in this study. We conducted a questionnaire survey of caregivers with Beck depression index (BDI), SPSI, SSS, SCS and SS for cognitive-behavioral characteristics. And also we studied demographic factors of patients and caregivers, clinical features of brain-injured patients, care- giving duration and time per day through interview and review of medical records. The statistical analyses were performed by independent t-test, one-way ANOVA, Pearson correlation test and linear regression analysis-stepwise method. RESULTS: BDI of the caregivers showed a negative correlation with SPSI, SSS, patients' MMSE and caregivers' education level, also a positive correlation with SCS, SS and patients' GDS (p<0.05). And married caregivers showed more depressive mood (p<0.05). Of these factors, the most influencing factors on BDI were GDS and SCS through linear regression analysis (p<0.01). CONCLUSION: MMSE, GDS and education level as cognitive- mental factors rather than physical and economic strain had a statistical correlation with depression of caregivers. Especially, SPSI, SSS and SCS as cognitive-behavioral characteristics should be considered on evaluation of depression of caregivers and will be helpful for successful rehabilitation for patients and caregivers.

Driving State of the Brain Injured after Driver Training Program at the National Rehabilitation Center

OBJECTIVE: To investigate the actual driving state of the brain injured who had received driver training program. METHOD: We conducted a follow up survey with 64 brain injured who had received driver training program at the National Rehabilitation Center. 29 subjects were first attempting to obtain a license (First obtaining group) while 35 subjects were trying to re-obtain a license after being handicapped (Re-obtaining group). The contents of the survey were compared between first obtaining group and re-obtaining group, and between hemiplegic side. RESULTS: 41 subjects obtained license in regard to the total 64 subjects in which 39% of theses were actually driving. Licensed rate was 55% for first obtaining group and 71% for re-obtaining group. Driving rate was 56% for first obtaining group and 28% for re-obtaining group. Comparing to hemiplegic side, left hemiplegics (54%) showed a tendency to have higher rate of accident than right hemiplegics (0%) without statistical significance. CONCLUSION: Licensed rate of the brain injured was 64%, and driving rate and accident rate were 39% and 38%, respectively. Left hemiplegics, especially, had a higher rate of accident than right hemiplegics.

Effect of Methylphenidate on Cognitive Function of Brain Injured Patient: Report of 5 cases

Outcome following brain injury is influenced by several factors, including on early medical and rehabilitative intervention, an integrated interdisciplinary team approach to treatment, and the patient's motivation and ablility to cooperate in rehabilitation efforts. Methylphenidate(MP) is a central stimulant that blocks the reuptake of serotonin and norepinephrine, and also it has a dopaminergic activity by releasing the dopamine from dopamine stored vesicles. Dopamine plays an important role in cognitive and affective brain functions. Methylphenidate has been used in an attention deficit disorder with hyperactivity in the pediatric clinic and for various types of depression and narcolepsy. Clinical research has not irreputably proved or disproved the effectiveness of MP for the improvement of cognitive function in brain injured patients. This report presents five cases who were treated by MP for the improvement of cognitive function in brain injured patients. Among five cases, 3 cases suffered from hemorrhagic strokes and 2 cases from tranmatic brain injuries. Three cases were in drowsy stateand 2 cases were semicomatous. After MP(10 mg) was ingested per oral route before breakfast, we evaluated patients' cognitive function by the Functional Independence Measure(FIM), Rappaport Disability Rating Scale(DRS), Mimi-mental State Examination(MMSE), Galveston Orientation and Amnesia Test(GOAT) and the clinical state as well as side effects. Based on the results from the study we suggest cautionally that MP would be useful for the treatment of brain injured pateints who had decreased cognitive function to induce an early participation of rehabilitation programs. Further prospective study is required with a large control group and affected group, to confirm our preliminary results.