Role of pre-suture craniotomy combined with controlled decompression under intracranial pressure monitoring in surgery for posttraumatic acute diffuse brain swelling / 中华神经医学杂志

Objective:To investigate the application value of pre-suture craniotomy combined with intracranial pressure monitoring in surgery for posttraumatic acute diffuse brain swelling (PADBS).Methods:One hundred and fifty-seven patients with PADBS admitted to our hospital from February 2015 to December 2019 were chosen in our study; 68 patients (control group), admitted to our hospital from February 2015 to June 2017, underwent controlled decompression under intracranial pressure monitoring; and 89 patients (treatment group), admitted to our hospital from June 2017 to December 2019, were performed pre-suture craniotomy combined with controlled decompression under intracranial pressure monitoring. The craniotomy time, brain tissue exposure time, cranial closure time, incidence of acute encephalocele, and Glasgow outcome scale (GOS) scores at 6 months after injury were retrospectively analyzed and compared between the two groups.Results:As compared with those in the control group, the patients in the treatment group had significantly longer intraoperative craniotomy time ([19.2±1.6] min vs. [15.4±1.4] min), significantly shorter exposure time of brain tissues ([18.5±2.4] min vs. [26.3±2.2] min), significantly shorter time of cranial closure ([11.2±1.5] min vs. [18.3±2.1] min), and statistically lower incidence of acute encephalocele (22.5% vs. 38.2%), P<0.05). The good prognosis rate of the treatment group (70.8%) was significantly higher than that of the control group (50.0%), and the mortality rate (6.7%) was statistically lower than that of the control group (17.6%, P<0.05). Conclusion:Pre-suture craniotomy combined with controlled decompression under intracranial pressure monitoring can shorten the time of cranial closure and brain tissue exposure, reduce the incidence of acute encephalocele, and ultimately improve the prognosis of patients with posttraumatic acute diffuse brain swelling.

Controlled decompression under intracranial pressure monitoring in craniotomy of patients with severe cerebral hemorrhage / 中华神经医学杂志

Objective To explore the value of controlled decompression under intracranial pressure monitoring in craniotomy of patients with severe cerebral hemorrhage.Methods One hundred and six patients with severe cerebral hemorrhage,admitted to our hospital from January 2015 to July 2018,were prospectively enrolled.These patients were divided into control group (n=5 l) and treatment group (n=55) according to their families' wishes.The patients in the control group were treated with traditional craniotomy and hematoma removal;the patients in the treatment group were treated with controlled decompression combined with craniotomy and hematoma clearance under intracranial pressure monitoring,and intracranial pressure monitoring and management were carried out after operation.The rate of bone flap acceptance during operation,incidences of complications such as re-bleeding,scalp exudation,intracranial infection and cerebral infarction after operation,rate of re-operation and Glasgow outcome scale scores 6 months after injury were compared and analyzed between the two groups.Results Five patients had midway withdrawal (2 from the control group and 3 from the treatment group),and 101 patients (49 from the control group and 52 from the treatment group) were included in the statistical analysis.The rate of bone flap acceptance in the treatment group (69.2％) was significantly higher than that in the control group (24.5％,P＜0.05).The incidences of complications such as bleeding,scalp exudation,intracranial infection and cerebral infarction (11.5％,7.7％,3.8％,and 13.5％) were significantly lower than those in the control group (30.6％,22.4％,16.3％,and 34.7％,P＜0.05).The re-operation rate (3.8％) was significantly lower than that in the control group (16.3％,P＜0.05).Good recovery rate in the treatment group (76.9％) was significantly higher than that in the control group (55.1％,P＜0.05).The mortality rate (7.7％) was significantly lower than that of the control group (22.4％,P＜0.05).Conclusion For patients with severe cerebral hemorrhage,controlled decompression under intracranial pressure monitoring combined with craniotomy and hematoma removal can significantly improve the rate of bone flap acceptance,reduce the rate of second-stage cranioplasty,reduce the incidence of complications and re-operation rate,and more effectively improve the quality of life and prognosis of patients.

Pulse index continuous cardiac output combined with intracranial pressure monitoring in patients with severe craniocerebral injury / 中华神经医学杂志

Objective To explore the value of pulse index continuous cardiac output (PICCO) combined with intracranial pressure monitoring in patients with severe craniocerebral injury.Methods One hundred and thirty-eight patients with severe craniocerebral injury accepted controlling decompression surgical treatment in our hospital from February 2015 to February 2019 were prospectively chosen.According to patients' families will,postoperative application of PICCO combined with intracranial pressure monitoring for fluid management was performed in 72 patients (treatment group) and application of central venous pressure combined with intracranial pressure monitoring for fluid management was performed in 66 patients (control group).All patients were adjusted according to the monitoring results.The intracranial pressure and cerebral perfusion pressure one week after surgery,incidences of new traumatic cerebral infarction,neurogenic pulmonary edema,pulmonary infection,scalp exudation,and intracranial infection,average hospitalization days,total hospitalization costs,intensity of antimicrobial use,and Glasgow coma scale scores two weeks after operation were compared and analyzed between the two groups.Glasgow outcome scale was used to evaluate the prognoses of the patients 6 months after injury.Results There were 7 patients (3 from the control group and 4 from the treatment group) dropped out of the study due to various reasons and 131 patients (63 from the control group and 68 from the treatment group) included in the final statistical analysis;there was no significant difference in drop-out rate of the two groups (P＞0.05).The intracranial pressure in the treatment group ([14.28±2.98] mmHg) was significantly lower than that in the control group ([18.99±2.78] mmHg) and cerebral perfision pressure ([66.72±2.25] mmHg) was significantly higher than that in the control group ([52.96±3.12] mmHg) one week after operation (P＜0.05).During hospitalization,the incidences of new traumatic cerebral infarction,neurogenic pulmonary edema,pulmonary infection,scalp exudation and intracranial infection in the treatment group (8.8％,13.2％,11.8％,7.4％,and 2.9％) were significantly lower than those in the control group (22.2％,27.0％,25.4％,19.0％,and 12.7％,P＜0.05).The average hospitalization days,total hospitalization expenses and intensity of antimicrobial use in the treatment group were significantly shorter/lower than those in the control group (P＜0.05).Glasgow coma scale scores (11.88±1.78) and good recovery rate (76.5％) in the treatment group were significantly higher than those in the control group (8.06±1.12,54.0％) two weeks after operation (P＜0.05).Good recovery rate (76.5％) in the treatment group was significantly higher than that in the control group (54.0％,P＜0.05).The mortality rate (5.9％) was significantly lower than that in the control group (17.5％,P＜0.05).Conclusion PICCO combined with intracranial pressure monitoring can effectively improve intracranial pressure,optimize cerebral perfusion,reduce complications such as traumatic cerebral infarction,neurogenic pulmonary edema,pulmonary infection and intracranial infection in patients with severe craniocerebral injury,thereby improving prognosis and reducing mortality;besides that,it can reduce patients' exposure to anti-brain infection,and the breadth and intensity of bacterial drugs can reduce the length of hospitalization and total cost of hospitalization,thereby reducing the burden of family and society.

Role of pulse index continuous cardiac output monitoring in treatment of patients with traumatic acute diffuse brain swelling / 中华神经医学杂志

Objective To explore the role of continuous pulse output (PICCO) monitoring in treatment of patients with traumatic acute diffuse brain swelling (PADBS). Methods Eighty-six PADBS patients, admitted to our hospital from January 2014 to October 2017, were routinely given brain invasive intracranial pressure (ICP) monitoring after admission. At the same time, the patients were given bone flap decompression and hematoma clearance according to the condition of the diseases. After surgery, according to the wishes of family members, patients were divided into two groups (n=43):patients from treatment group accepted PICCO monitoring on the basis of ICP monitoring, and the treatment plan was adjusted according to the monitoring results; and the treatment plan in patients from control group was adjusted according to traditional central venous pressure (CVP) monitoring results on basis of ICP monitoring. Results One week after operation, the ICP in the treatment group was (14.36±2.82) mmHg when the cerebral perfusion pressure (CPP) was controlled between 50 and 70 mmHg, which was significantly different from the ICP in the control group (18.58±2.25) mmHg (P<0.05). Two weeks after treatment, Glasgow Coma Scale (GCS) scores of the treatment group (10.87±1.72) were significantly higher than those of the control group (8.18±1.16, P<0.05). The incidences of posttraumatic cerebral infarction (PTCI) and neurogenic pulmonary edema (NPE) in the treatment group (11.6％, 18.6％) were significantly lower than those of the control group (25.6％, 34.9％, P<0.05); the recovery rate (76.7％) in the treatment group was significantly higher than that in the control group (60.5％, P<0.05); the mortality rate (9.3％) was significantly lower than that in the control group (18.6％, P<0.05). Conclusion On the basis of intraventricular ICP monitoring, combined PICCO monitoring can effectively control ICP, improve cerebral perfusion, reduce the incidence of PTCI and NPE, improve the prognosis, and reduce the mortality in PADBS patients.

miR-16 inhibits glioma cell invasion through regulating NF-κB1/MMP-9 signaling pathway / 中华神经医学杂志

Objective To explore the microRNA-16 (miR-16) and nuclear-transcription factor-κB1 (NF-κB1) expressions in human brain gliomas and their correlations with cell invasion and growth of malignant gliomas SHG44,U87 and U373.Methods (1) Twenty-nine cases of human glioma tissue samples and 6 normal brain tissues,collected in our hospital from January 2000 to January 2011,were chosen in our study; quantitative real-time polymerase chain reaction (qRT-PCR) was used to determine the expressions ofmiR-16 and NF-κB1 in these tissues.(2) In vitro cultured U87,U373 and SHG44 cells were divided into blank-control group,nonsense sequence transfected group and miR-16 mimics transfected group; 48 h after the transfection,qRT-PCR was used to detect the expressions of miR-16 and NF-κB1; tmnswell assay was used to observe the cell invasion capability; 72 h after the transfection,Western blotting was employed to detect the protein expressions of NF-κB1,matrix metallopeptidase 9 (MMP-9) and MMP-2.(3) Luciferase reporter assay was used to detect the target regulating role of miR-16 in NF-κB1 gene.(4) U87 cells were used as negative control group,and U87 cells carried stably expressed miR-16 gene were implanted into intracranial and subcutaneous nude mice (U87-miR-16 group); immunofluorescence was used to detect the MMP-9 expression,and immunohistochemical staining was used to detect the protein expressions of Ki-67,NF-κ B1 and MMP-9; subcutaneous tumor volume was measured and the growth curve was drawn.Results (1) The qPCR results showed that the expression of miR-16 in human brain glioma tissues was significantly lower than that in normal brain tissues; and gradually decreased miR-16 expressions were noted in gliomas of graded Ⅰ,Ⅱ,Ⅲ and Ⅳ (P＜0.05); NF-κB1 expression in human brain glioma tissues was significantly higher than that in normal brain tissues; and gradually increased NF-κB1 expressions were noted in gliomas of graded Ⅰ,Ⅱ,Ⅲ and Ⅳ (P＜0.05).(2) As compared with those in the blank-control group and nonsense sequence transfected group,miR-16 mimics transfected group had significantly increased miR-16 expression,decreased NF-κB1 mRNA expression,decreased invasiveness,and decreased protein expressions of NF-κB1 and MMP-9 (P＜0.05).(3) Luciferase reporter assay showed that the fluorescence normalized ratio in the pMIR-NF-κB1 group was signfcaintly higher than that in the pMIR-NF-κB1+pre-miR-16 group (P＜0.05).(4) As compared with the negative control group,the U87-miR-16 group on the 24-42 d of implantation had significantly smaller volume of tumors (P＜0.05),and lower MMP9 expression,and NF-κB1,MMP-9 and Ki-67 expressions (the proliferation index of Ki-67:13.91％ and 32.98％).Conclusion MiR-16 inhibits glioma cell invasion and growth through down-mgulating NF-κB1 and MMP-9 expressions.

Role of invasive intracranial pressure monitoring in treatment of bilateral posttraumatic acute diffuse brain swelling / 中华创伤杂志

Objective To investigate the instructive role and clinical effect of invasive intracranial pressure monitoring in treating bilateral posttraumatic acute diffuse brain swelling(PADBS).Methods A total of 52 consecutive patients with bilateral PADBS managed under invasive intracranial pressure monitoring between October 2009 and December 2010 were enrolled as the study group.Another 53 patients with bilateral PADBS managed with non-intracranial pressure monitoring from February 2007 to September 2009 were set as the control group.The clinical outcomes of the two groups were compared.Results The ratios of good recovery[Glasgow Outcome Scale(GOS)=5 points]and severe disability(GOS=3 points)were 59.6％(31/52)and 11.5％(6/52)respectively in the study group,but 35.9％(19/53)and 28.3％(15/53)respectively in the control group(P＜0.05).The death rates of the study and control groups were 5.8％(3/52)and 9.4％(5/53)respectively(P＞0.05),and the average hospital stay was(34.35±17.50)days and(42.43±22.17)days respectively(P＜0.05).Conclusion Durative monitoring of invasive intracranial pressure in treatment of bilateral PADBS can improve prognosis,shorten hospital stay and therefore is worthy of clinical application.

Risk factors of traumatic arterial and venous cerebral infarction in patients with moderate or severe craniocerebral trauma / 中华创伤杂志

Objective To provide theoretic support for preventing traumatic arterial and venous cerebral infarction after craniocerebral trauma by probing into the related risk factors.Methods The clinical data of 154 pateints with moderate or severe craniocerebral trauma treated by decompressive craniectomy were studied retrospectively.Univariate analysis was carried out on 13 related factors including gender,age,Glasgow Coma Score(GCS)on admission,pupil status,morphological changes of ambient cisterns,brain midline,associated injury,blood pressure,traumatic superficial cerebral veins injury,platelet count,plasma D-dimer value,dosage of dehydrating agent and perioperative fluid balance.Then,the logistic multiple regression analysis was made on significant indexes with SPSS 10.0.Results Univariate analysis showed that seven factors including pupil status,GCS on admission,age,associated injury,perioperative blood pressure,morphological changes of ambient cisterns and brain midline were significantly correlated with traumatic arterial cerebral infarction(P ＜ 0.05)and that three factors including traumatic superficial cerebral veins injury,plasma D-dimer value and associated injury were significantly correlated with traumatic venous cerebral infarction(P ＜ 0.05).Logistic multi-factors regression analysis showed that mydriasis and hypotension might be the independent risk factor of traumatic arterial cerebral infarction and that traumatic superficial cerebral veins injury might be the independent risk factors of traumatic venous cerebral infarction.Conclusion The pupil status,GCS on admission,age,associated injury,perioperative blood pressure,morphological changes of ambient cisterns and brain midline are the risk factors of traumatic arterial cerebral infarction,with mydriasis and hypotension as independent risk factors.Traumatic superficial cerebral veins injury,plasma D-dimer value and associated injury are the risk factors of raumatic venous cerebral infarction,with traumatic superficial cerebral veins injury as independent risk factor.

Analysis of the influencing factors of pragressive hemorrhagic injury after traumatic brain Injury / 中国综合临床

Objective To investigate the influencing factors of progressive hemorrhagic injury (PHI) after traumatic brain injury. Methods The medical records of 127 patients with traumatic brain injury (n=49 in PHI group and n=78 in non-PHI group) were reviewed. The relationship between PHI and influencing factors including sex, age, Glasgow coma scale, time from injury to first CT, traumatic subaraehnoid hemorrhage (tSAH), prothrombin time(PT),activated partial thromboplastin time(APTT) was analyzed. Results The time for first CT was(1.39± 1.27) h in PHI group and (2.91±1.85) h in non-PHI group (t=2.14, P<0.05). 35 cases of PHI group developed tSAH and 37 of non-PHI group developed tSAH (χ2=7.06, P<0.05). Multifactor Logistic regression analysis showed that the time for first brain CT after injury and the patients accompanied with tSAH were associated with PHI after traumatic brain injury (OR=0.558,95 % CI 0.329-0.946, OR=13.000,95 % CI 1.187-142.354, P<0.05 for each). Conclusions Time from injury to first CT and tSAH can be prognostic factors for PHI.