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Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.
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The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.
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Objective To understand the clinical characteristics of traumatic brain injury (TBI) patients and provide fundamental data for reducing the incidence of TBI and improving its treatment efficacy.Methods Medical histories of TBI inpatients from January 2011 to December 2016 were collected from the TBI database of Neurosurgical Department at Tianjin Medical University General Hospital.Information including gender,age,causes of TBI,injury severity,sources of the inpatients,interval from injury to treatment,diagnosis,and treatment were analyzed retrospectively.Results A total of 2 368 TBI patients were enrolled,aged mainly 30-60 years.There were more male patients (n =1 741) than female patients (n =627) (2.78 ∶ 1),while the gender ratio was reversed among patients above 60 years old (2.09 ∶ 1) (P ＜ 0.05).Traffic accident (60.14％) remained the major cause of TBI,while the proportion of electric motorcycle accident was 17.35％,followed by fall from height (13.64％).The proportion of mild TBI patients from suburb counties was lower than that of patients from the six urban areas (P ＜ 0.05),while the proportion of heavy TBI patients from other provinces was higher than those of both urban and suburb counties (P ＜ 0.05).The average interval from injury to specialist treatment was 7.53 hours.Patients who received treatment within 3 hours had better improvement than those who were treated 3 hours after TBI (P ＜ 0.05).The main injuries were skull fracture (33.07％) and brain contusion (30.32％).A total of 783 patients (33.07％) underwent surgery,among which 693 patients received the most common procedure of craniotomy hematoma evacuation (including decompressive craniectomy).The improvement rate of patients with intracranial pressure monitoring was higher than those without intracranial pressure monitoring (P ＜ 0.05).The improvement rate of the surgery group was significantly higher than that of the non surgery group (P ＜0.05).Conclusions The ratio of elderly female TBI patients is on the rise;TBI presents an increase in traffic accidents;mild TBI patients choose to receive treatment in close hospitals while those with severe TBI choose comprehensive hospitals;and the interval from injury to treatment is long.The following strategies including improving the traffic facilities,strengthening the education of traffic safety on elderly females and pedestrians,and optimizing the TBI medical treatment process would reduce the incidence of TBI and improve the efficiency of treatment.
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Traumatic brain injury is always associated with hemorrhage and coagulopathy, leading the occurrence of anemia, platelet function inactivation, platelet and coagulation factor consumptive reduction. Theoretically, transfusion therapy should be given to supplement the missing component in an appropriate range. However, whether the transfusion therapy can improve the prognosis of patients with traumatic brain injury, and the indications of transfusion, have been the focus of academic debate for a long time. This article reviews the latest progress of transfusion therapy in traumatic brain injury, and provides reference for better guidance of transfusion in clinical treatment.
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Fingolimod (FTY720) as a new immunosuppressive agent,is the prodrug of an sphingosine-1-phosphate receptor agonist.It is a potent immunosuppressant which has been approved by the US Food and Drug Administration to treat relapsing-remitting multiple sclerosis,and shows its unique and novel mechanism of action.Unlike the traditional immunosuppressive agents,fingolimod exerts immunosuppressive and immunoregulatory functions mainly through interaction with shhingosine-l-phosphate receptors on the cell surface without affecting activation and proliferation of lymphocytes.In addition,FTY720 has been shown to inhibit a variety of cancer related signal transduction pathways.It also presented significant anticancer effects in the in vivo and in vitro experiments.And in the treatment of glioblastoma multiforme (GBM) experiment,FTY720 displayed excellent activity as well had a synergistic effect in addition to temozolomid,the current standard chemotherapeutic agent to treat malignant gliomas.This article reviewed the advances in study on the anti-GBM effect and mechanism of FTY720.
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Exosomes are homogeneous membrance-derived microvesicles shed by cells,their sizes ranged from 40 to 100 nm.As for microparticles,they are small heterogeneous vesicles at diameters of 100 to 1000 nm shed by cells.Both of them exist in a wide range of body fluids,including peripheral blood,urine,saliva,ascites,amniotic fluid and cerebrospinal fluid,with various kinds of biomolecules like proteins and RNAs.Exosomes and microparticles play important roles in cell-to-cell information transmissions and substance exchanges,contributing to both physiological and pathological processes.Exosomes,functioning as the carders of material transportation,serve as targeted therapy in disease treatments.Microparticle,a new type biomarker,plays an important role in diagnosing the early-stage of diseases and predicting the prognoses.The central nervous system diseases are lacked of early-stage diagnoses and effective treatments because of the complexity and unpredictability.This review is to focus on the specific comparisons between exosomes and microparticles as well as their central nervous system functions and mechanisms,and also to explore the new treatments of the central nervous system diseases.
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Objective To explore the implementation styles on the therapeutic effects on the neurosurgical intensive care unit (NICU) patients. Methods Patients were enrolled during February 3, 2015 to February 3, 2016. The key point time was August 3, 2015 when the treatment in our NICU was fully implemented by NICU professional doctors. Based on this time point, all the enrolled patients were divided into non-NICU professional doctor implementing (NNPDI) group and NICU professional doctor implementing (NPDI) group. Thus non-NICU professional doctors and professional doctors were the leaders of diagnosis and treatment in tow groups. The length of hospital stay, complications, prognosis and other therapeutic outcomes were compared between two groups. Results The length of hospital stay was longer in NPDI group than that in NNPDI group (P0.05). The proportion of referral to other wards and fatality rate were both lower in NPDI group than those in NNPDI group (P0.05). Conclusion The NICU professional doctor implementing may be contribute to, at least in part, the improving of prognosis of NICU patients without obvious advantages in most complications. The level of professional management remains to be improved.
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Objective To investigate the protective effect of hypoxia-inducible factor-1α(HIF-1 α) on the neurovascular unit in rats with traumatic brain injury (TBI).Methods The fluid percussion model was applied to induce TBI in rats.A total of 600 rats were divided into sham operation group,TBI group,TBI + HIF-1 α silence group and TBI + control virus group according to the random number table,with 150 rats in each.Virus-mediated HIF-1 α silence gene and control virus were delivered 24 h before the fluid percussion injury.After 3,7 and 14 d,brain injury area and morphological changes in injured region were detected by HE staining,expressions of vascular endothelial cell markers (vWF) and HIF-1 α were detected by Western blot method,and expressions of vascular endothelial growth factor (VEGF),matrix metalloproteinase-9 (MMP-9),tumor necrosis factor-α (TNF-α),interleukin 6 (IL-6) and nuclear factor-κB (NF-κB) in peripheral blood and brain tissue were detected by ELISA method.Rat neural function was dynamically assessed using the modified neurological severity score (mNSS).Results (1) Brain injury area and edema area in TBI + HIF-1 α silence group were higher than those in TBI group at all time points (P ＜ 0.05).(2) Compared with sham operation group and TBI + control virus group,expression of HIF-1α in TBI group gradually increased and remained high at 7 and 14 d postinjury (P ＜ 0.05).Compared with TBI group,expression of vWF in TBI + HIF-1αsilence group decreased at all time points (P ＜ 0.05) and inhibited angiogenesis.(3) TBI + HIF-lα silence group versus TBI group showed remarkably decreased VEGF at all time points,increased expressions of TNF-α,IL-6 and NF-κB at all time point,and increased expression of MMP-9 at 7 and 14 d postinjury (all P ＜0.05).(4) TBI + HIF-1α silence group versus TBI group showed significant difference in mNSS at 7 and 14 d postinjury (all P ＜ 0.05).Conclusions After TBI,high expression of HIF-1αcan facilitate vascular formation and inhibit inflammatory reaction related factor expression,inducing the mitigation of brain edema and brain injury.Therefore,promoting HIF-1α expression may become a new means to improvement of neurovascular function after TBI.
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Objective To observe if endothelial progenitor cells (EPCs) and bone marrow mesenchymal stem cells (BMSCs) could home to the injured region and study the effect of BMSCs-derived EPCs on traumatic brain injury (TBI) in rats.Methods BMSCs were isolated from 3-month-old SD male rats weighing 150 g,and induced to EPCs.EPCs were identified by surface markers CD133,CD34 and FLK-1.A total of 120 female adult SD rats were divided into 3 groups (n =40 each) according to the random probability table method:EPCs group,BMSCs group and 3T3 cells group.The model of moderate to severe TBI was induced by the fluid percussion device.All the cells (i.e.EPCs,BMSCs and 3T3 cells) were injected with BrdU before transplantation to the tail vein of rats.On days 2,7,14 and 28 after transplantation,rat neurological function was evaluated using the modified neurological severity score (mNSS),and injured brain tissue was harvested to detect CD34 and brain-derived neurotrophic factor (BDNF) positive cell density using the immunohistochemistry method.Sry-positive cells were evaluated using the fluorescence in situ hybridization (FISH).Results The positive rate of CD133,CD34 and Flk-1 was 52％,33％ and 38％,indicating BMSCs differentiation towards an EPCs phenotype.On days 7,14 and 28 after transplantation,the mNSS in EPCs group [(10.2 ± 1.5),(8.7 ± 1.0) and (4.9 ± 1.0) points] and in BMSCs group [(10.8 ± 1.7),(10.1 ± 1.7),and (7.2 ± 1.3) points] were lower than that in 3T3 cells group [(12.4 ± 1.5),(1 1.7 ± 1.8),(10.3 ± 1.5) points] (P ＜ 0.05).On 14 and 28 days after transplantation,BrdU-positive CD34 and BDNF in EPCs group were significantly more than those in BMSCs group (P ＜ 0.05).Instead,there were no positive cells in 3T3 cells group.The method of Sry probe to trace the transplanted cells could detect more positive cells compared to the BrdU labeling method.Conclusion Both BMSCs and EPCs can home to the injured region,but EPCs have much better therapeutic effect.
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Objective To study the effect of simvastatin (SIM) on the expression of neuron specific enoalse (NSE) in rat brain and serum after traumatic brain injury (TBI), and therapeutic effects of SIM on TBI thereof. Methods A total of 90 Sprague-Dwalye (SD) rats aged 8 weeks were randomly divided into sham TBI group, control group and treatment group (n=30). The TBI model was established in control group and treatment group by using Feeney method. Rats in treatment group were fed SIM 10 mg/kg in the evening pre-injury and in every evening post-injury while those in control group were fed the same dose of starch at the same time. Blood samples (3 mL) were collected from carotid atrery in three groups, then rats were sacrificed and brains were collected at different time points (3 h, 12 h, 24 h, 3 d, 7 d and 14 d post-injury). The serum ex-pressions of NSE were detected by ELISA method. The NSE expressions in hippocampal area CA3 were detected with immu-nohistochemistry. Results (1) In control group, the serum NSE level was significantly increased at 3 h after injury, reached the peak at 3 d, and was still higher than that of sham injury group at 14 d. In treatment group, the serum NSE level was in-creased 3 h after injury, reached the peak at 24 h, decreased after 3 d, and was near the sham injury group at 14 d after inju-ry, but was significantly lower than that of control group. (2) Immunohistochemical detection showed that the NSE optical density values in hippocampal area CA3 area were decreased at 3 h after injury in control group. The optical density values reached the lowest level between 3 d to 7 d and were still significantly lower than those of sham injury group at 14 d. In treat-ment group the optical density value was decreased at 3 h after injury, reached the lowest level between 12 h to 24 h and re-bounded significantly at 7 d, then at 14 d up to the level of sham injury group. Conclusion SIM can promote the decrease of serum NSE level in TBI rats and increase the NSE expression of hippocampal neurons of injured side, showing protective effects on neuronal damage after traumatic brain injury.
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Objective To explore the changing rule and clinical significance of the abnormal cortical secretion resulted from traumatic brain injury (TBI). Methods The serums from 55 TBI patients and 13 normal persons were collected to measure the level of secreting total cortisol (Cor) , adrenocorticotropin (ACTH) and corticosteroid-binding-globulin (CBG) by using radioimmunoactive assay and chemiluminescent immunometric assay. In the meantime, the free cortisol (FC) and free cortisol index (CI) were calculated by using Coolen formula. Results CBG maintained stable, while Cor and other hormones were increased significantly with the severity of TBI. Surgical operation could release the stress partially without disturbing the secretion of hormone. The more quickly the serum hormone decreased, the better prognosis the patients would have. The lower level of Cot could result in poorer prognosis. Conclusions TBI can result in a higher level of Cor as well as other hormones in the serum. The prognosis is poor in patients with a persistent high or low level of Cor. It should be cautious to supply large volume of cortisol at the early phase of TBI.
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<p><b>OBJECTIVE</b>To study the gene expression profiles of oligodendrogliomas with gene cDNA array.</p><p><b>METHODS</b>(32)P tagged cDNA probes converted from the total RNA, which had been extracted from 2 fresh samples of oligodendroglioma and 1 of normal brain tissue, were hybridized with the Atlas array. After washing the membranes, the autoradiography was performed and the autoradiograms were analyzed through the special software.</p><p><b>RESULTS</b>As compared to the normal brain tissue, there were 63 co-upregulated genes and 4 co-downregulated genes in these 2 tumor samples. However, a significant quantitative difference existed between them. The expression trend of some genes differed from the known information.</p><p><b>CONCLUSION</b>cDNA array is effective for studying the gene expression profiles of oligodendrogliomas and provides new information for the further research on their molecular mechanisms.</p>
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Humanos , Neoplasias Encefálicas , Genética , Patologia , Expressão Gênica , Perfilação da Expressão Gênica , Oligodendroglioma , Genética , Patologia , Análise de Sequência com Séries de Oligonucleotídeos , Métodos , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Objective: To compare the inhibitory effect of carmustine(BCNU) and bleomycin on craniopharyngiomas in vitro. Methods: Cells were successfully cultured in vitro from the fresh specimens, then the culture medium with bleomycin or BCNU at different concentration was added. The tumor inhibitory curve-line was drawn based on the cell number at different time points. After cultured for 144 h, ATP-luminescence assay was applied to test the antitumor effect. Results: The cell number decreased rapidly when the medium was added. The decreasing speed was faster in BCNU medium than that in bleomycin medium at the same concentration. The bleomycin medium showed no significant inhibitory effect except for the one at 1.00 g/L. However, regardless of the concentration, BCNU medium inhibited the cells effectively. Conclusion: BCNU has stronger inhibitory effect on craniopharyngiomas cells than bleomycin, it can be used to treat this tumor