[Design and application of a drainage tube dredging umbrella and anti-retrograde infection kit].

The consensus has been reached on the benefits of surgical drainage. However, catheter-related blockage and retrograde infection remain bottleneck problems in the treatment process. To this end, with Huashan Hospital, Fudan University, as the main inventors, a drainage tube dredging umbrella and anti-retrograde infection kit have been designed and applied for the national utility model patent (patent number: ZL 2023 2 1300036.2). The main body of the kit consists of a catheter dredging umbrella, drainage tube, and drainage bag. Several isolation layers are installed in the drainage bag to form a maze structure and a reflux valve is added, thereby increasing the distance and resistance of liquid reflux, greatly reducing the possibility of liquid reflux entering the drainage tube, so as to reduce the risk of retrograde infection through physical means. When the drainage tube is blocked, the drainage tube and joint tube of the drainage bag can be separated, the unblocking umbrella can be inserted into the blockage through the guide wire, the cannula can be inserted along the guide wire, the guide wire is pulled to release the dredging umbrella in the contraction state, and the dredging umbrella can be pulled back in the expansion state until the blockage is removed from the drainage tube. The operating procedure is standardized and simple. While preventing retrograde infection (anti-retrograde infection kit), the catheter dredging umbrella could effectively address the issue of catheter blockage. It has certain clinical promotion and application value.

Oral administration of lysozyme protects against injury of ileum via modulating gut microbiota dysbiosis after severe traumatic brain injury.

Objective: The current study sought to clarify the role of lysozyme-regulated gut microbiota and explored the potential therapeutic effects of lysozyme on ileum injury induced by severe traumatic brain injury (sTBI) and bacterial pneumonia in vivo and in vitro experiments. Methods: Male 6-8-week-old specific pathogen-free (SPF) C57BL/6 mice were randomly divided into Normal group (N), Sham group (S), sTBI group (T), sTBI + or Lysozyme-treated group (L), Normal + Lysozyme group (NL) and Sham group + Lysozyme group (SL). At the day 7 after establishment of the model, mice were anesthetized and the samples were collected. The microbiota in lungs and fresh contents of the ileocecum were analyzed. Lungs and distal ileum were used to detect the degree of injury. The number of Paneth cells and the expression level of lysozyme were assessed. The bacterial translocation was determined. Intestinal organoids culture and co-coculture system was used to test whether lysozyme remodels the intestinal barrier through the gut microbiota. Results: After oral administration of lysozyme, the intestinal microbiota is rebalanced, the composition of lung microbiota is restored, and translocation of intestinal bacteria is mitigated. Lysozyme administration reinstates lysozyme expression in Paneth cells, thereby reducing intestinal permeability, pathological score, apoptosis rate, and inflammation levels. The gut microbiota, including Oscillospira, Ruminococcus, Alistipes, Butyricicoccus, and Lactobacillus, play a crucial role in regulating and improving intestinal barrier damage and modulating Paneth cells in lysozyme-treated mice. A co-culture system comprising intestinal organoids and brain-derived proteins (BP), which demonstrated that the BP effectively downregulated the expression of lysozyme in intestinal organoids. However, supplementation of lysozyme to this co-culture system failed to restore its expression in intestinal organoids. Conclusion: The present study unveiled a virtuous cycle whereby oral administration of lysozyme restores Paneth cell's function, mitigates intestinal injury and bacterial translocation through the remodeling of gut microbiota.

Predicting the progression of chronic subdural hematoma based on skull density.

Objective: The objective of this study was to investigate potential correlations between skull density and the progression of chronic subdural hematoma (CSDH). Methods: Patients with unilateral CSDH were retrospectively enrolled between January 2018 and December 2022. Demographic and clinical characteristics, as well as hematoma and skull density (Hounsfield unit, Hu), were collected and analyzed. Results: The study enrolled 830 patients with unilateral CSDH until the resolution of the CDSH or progressed with surgical treatment. Of the total, 488 patients (58.80%) necessitated surgical treatment. The study identified a significant correlation between the progression of CSDH and three variables: minimum skull density (MiSD), maximum skull density (MaSD), and skull density difference (SDD) (p < 0.001). Additionally, in the multivariable regression analysis, MiSD, MaSD, and SDD were independent predictors of CSDH progression. The MiSD + SDD model exhibited an accuracy of 0.88, as determined by the area under the receiver operating characteristic curve, with a sensitivity of 0.77 and specificity of 0.88. The model's accuracy was validated through additional analysis. Conclusion: The findings suggest a significant correlation between skull density and the CSDH progression.

Recovering fetal signals transabdominally through interferometric near-infrared spectroscopy (iNIRS).

Noninvasive transabdominal fetal pulse oximetry can provide clinicians critical assessment of fetal health and potentially contribute to improved management of childbirth. Conventional pulse oximetry through continuous wave (CW) light has challenges measuring the signals from deep tissue and separating the weak fetal signal from the strong maternal signal. Here, we propose a new approach for transabdominal fetal pulse oximetry through interferometric near-infrared spectroscopy (iNIRS). This approach provides pathlengths of photons traversing the tissue, which facilitates the extraction of fetal signals by rejecting the very strong maternal signal from superficial layers. We use a multimode fiber combined with a mode-field converter at the detection arm to boost the signal of iNIRS. Together, we can detect signals from deep tissue (>∼1.6 cm in sheep abdomen and in human forearm) at merely 1.1 cm distance from the source. Using a pregnant sheep model, we experimentally measured and extracted the fetal heartbeat signals originating from deep tissue. This validated a key step towards transabdominal fetal pulse oximetry through iNIRS and set a foundation for further development of this method to measure the fetal oxygen saturation.

Prevalence and Clinical Characteristics of Bacterial Pneumonia in Neurosurgical Emergency Center Patients: A Retrospective Study Spanning 13 Years at a Tertiary Center.

Patients with brain injuries are at a heightened susceptibility to bacterial pneumonia, and the timely initiation of empiric antibiotic treatment has been shown to substantially reduce mortality rates. Nevertheless, there is a need for knowledge regarding the resistance and prevalence of pulmonary bacterial infections in this patient population. To address this gap, a retrospective study was conducted at a neurosurgical emergency center, focusing on patients with brain injuries. Among the entire patient population, a total of 739 individuals (18.23%) were identified as having bacterial pneumonia, consisting of 1489 strains of Gram-negative bacteria and 205 strains of Gram-positive bacteria. The resistance of Klebsiella pneumoniae to imipenem exhibited a significant increase, rising from 21.74% in 2009 to 96.67% in 2018, and subsequently reaching 48.47% in 2021. Acinetobacter baumannii displayed resistance rates exceeding 80.0% against multiple antibiotics. The resistance profile of Pseudomonas aeruginosa was relatively low. The proportion of Staphylococcus aureus reached its peak at 18.70% in 2016, but experienced a decline to 7.83% in 2021. The abundance of Gram-negative bacteria exceeded that of Gram-positive bacteria by a factor of 5.96. Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus are prominent pathogens characterized by limited antibiotic choices and scarce treatment alternatives for the isolated strains.

Early Intraventricular Antibiotic Therapy Improved In-Hospital-Mortality in Neurocritical Patients with Multidrug-Resistant Bacterial Nosocomial Meningitis and Ventriculitis.

BACKGROUND: Hospital-acquired multidrug-resistant (MDR) bacterial meningitis and/or ventriculitis (MEN) is a severe condition associated with high mortality. The risk factors related to in-hospital mortality of patients with MDR bacterial MEN are unknown. We aimed to examine factors related to in-hospital mortality and evaluate their prognostic value in patients with MDR bacterial MEN treated in the neurointensive care unit. METHODS: This was a single-center retrospective cohort study of critically ill neurosurgical patients with MDR bacterial MEN admitted to our hospital between January 2003 and March 2021. Data on demographics, admission variables, treatment, time to start of intraventricular (IVT) therapy, and in-hospital mortality were analyzed. Both univariate and multivariable analyses were performed to identify determinants of in-hospital mortality. RESULTS: All 142 included patients received systemic antibiotic therapy, and 102 of them received concomitant IVT treatment. The median time to start of IVT treatment was 2 days (interquartile range 1-5 days). The time to start of IVT treatment had an effect on in-hospital mortality (hazard ratio 1.17; 95% confidence interval 1.02-1.34; adjusted p = 0.030). The cutoff time to initiate IVT treatment was identified at 3 days: patients treated within 3 days had a higher cerebrospinal fluid (CSF) sterilization rate (81.5%) and a shorter median time to CSF sterilization (7 days) compared with patients who received delayed IVT treatment (> 3 days) (48.6% and 11.5 days, respectively) and those who received intravenous antibiotics alone (42.5% and 10 days, respectively). CONCLUSIONS: Early IVT antibiotics were associated with superior outcomes in terms of the in-hospital mortality rate, time to CSF sterilization, and CSF sterilization rate compared with delayed IVT antibiotics and intravenous antibiotics alone.

Intensity-dependent gamma electrical stimulation regulates microglial activation, reduces beta-amyloid load, and facilitates memory in a mouse model of Alzheimer's disease.

BACKGROUND: Gamma sensory stimulation may reduce AD-specific pathology. Yet, the efficacy of alternating electrical current stimulation in animal models of AD is unknown, and prior research has not addressed intensity-dependent effects. METHODS: The intensity-dependent effect of gamma electrical stimulation (GES) with a sinusoidal alternating current at 40 Hz on Aß clearance and microglia modulation were assessed in 5xFAD mouse hippocampus and cortex, as well as the behavioral performance of the animals with the Morris Water Maze. RESULTS: One hour of epidural GES delivered over a month significantly (1) reduced Aß load in the AD brain, (2) increased microglia cell counts, decreased cell body size, increased length of cellular processes of the Iba1 + cells, and (3) improved behavioral performance (learning & memory). All these effects were most pronounced when a higher stimulation current was applied. CONCLUSION: The efficacy of GES on the reduction of AD pathology and the intensity-dependent feature provide guidance for the development of this promising therapeutic approach.

Overexpression of GPX4 attenuates cognitive dysfunction through inhibiting hippocampus ferroptosis and neuroinflammation after traumatic brain injury.

Ferroptosis is a newly discovered form of regulated cell death that is triggered primarily by lipid peroxidation. A growing body of evidence has implicated ferroptosis in the pathophysiology of traumatic brain injury (TBI). However, none of these studies focused its role on TBI-induced hippocampal injury. Here, we demonstrated that the distinct ferroptotic signature was detected in the injured hippocampus at the early stage of TBI. Besides, a prominent pro-ferroptosis environment was detected in the ipsilateral hippocampus after TBI, including elevated levels of arachidonic acid (AA), ACLS4, and ALXO15, and deficiency of GPX4. Subsequently, we used AAV-mediated Gpx4 overexpression to counteract ferroptosis in the hippocampus, and found that TBI-induced cognitive deficits were significantly alleviated after Gpx4 overexpression. Biochemical results also confirmed that TBI-induced hippocampal ferroptosis and synaptic damage were partially reversed by Gpx4 overexpression. In addition, Gpx4 overexpression inhibited TBI-induced neuroinflammation and peripheral macrophage infiltration. Interestingly, the results of transwell migration assay showed that ferroptotic neurons increased CCL2 expression and promoted iBMDM cell migration. However, this effect was inhibited by CCL2 antagonist, RS102895. These data suggested that inhibition of ferroptosis may be as a potential strategy to ameliorate TBI-induced cognitive deficits through blockade of hippocampal ferroptosis and neuroinflammation.

Deep remediation of As(III) in water by La-Ce bimetal oxide modified carbon framework.

Arsenic contamination of groundwater harms the health of millions of people, especially As(III), which is extremely toxic and difficult to remediate. Herein, we fabricated a reliable La-Ce binary oxide-anchored carbon framework foam (La-Ce/CFF) adsorbent for As(III) deep removal. Its open 3D macroporous structure ensures fast adsorption kinetic. The incorporation of an appropriate amount of La could enhance the affinity of La-Ce/CFF for As(III). The adsorption capacity of La-Ce10/CFF reached 40.01 mg/g. It could purify the As(III) concentrations to drinking standard level (< 10 µg/L) over the pH ranges 3-10. It also possessed excellent anti-interference ability to the interfering ions. In addition, it worked reliably in the simulated As(III)-contaminated groundwater and river water. La-Ce10/CFF could easily apply in fixed-bed, and La-Ce10/CFF (1 g) packed column could purify 4580 BV (36.0 L) of As(III)-contaminated groundwater. When further considering the excellent reusability of La-Ce10/CFF, it is a promising and reliable adsorbent for As(III) deep remediation.

Valproic acid induced aplastic crisis and Stevens-Johnson syndrome in a single pediatric patient.

Valproic acid (VPA) is a commonly used antiepileptic drug (AED). Aplastic crisis is defined as acute arrest of hematopoiesis. Stevens-Johnson syndrome (SJS) is a fatal cutaneous adverse drug reaction. We herein report a rare case of aplastic crisis and SJS in a single pediatric patient that were probably caused by VPA. A 2-year-old girl was involved in a car accident. She was diagnosed with skull fractures, cerebral contusions, pulmonary contusions, and fractures of the left iliac bone by computed tomography. VPA was administered as prophylaxis for post-traumatic epilepsy. From day 13, she developed repeated high fevers, and multiple antibiotics were ineffective; she was then transferred to our pediatric intensive care unit. After transfer, she developed liver function impairment, decreased peripheral blood cell counts, and skin damage. After withdrawal of the VPA and administration of prednisone, intravenous immunoglobulin, local skin care, and nutritional support, her body temperature normalized and her hematopoietic function and skin lesions successively resolved. She was transferred out of the pediatric intensive care unit on day 56 and discharged on day 70. At the 6-month follow-up, a blood examination was normal, and repeat computed tomography revealed multiple softening foci of the bilateral brain and less subdural effusion than before. To our knowledge, no report to date has described aplastic crisis and SJS in a single patient. The purpose of this paper is to increase clinicians' knowledge in the treatment of adverse drug reactions (ADRs) and emphasize the importance of standardized application and strict monitoring of VPA in patients with post-traumatic brain trauma.

Translocation and Dissemination of Gut Bacteria after Severe Traumatic Brain Injury.

Enterobacteriaceae are often found in the lungs of patients with severe Traumatic Brain Injury (sTBI). However, it is unknown whether these bacteria come from the gut microbiota. To investigate this hypothesis, the mice model of sTBI was used in this study. After sTBI, Chao1 and Simpson index peaking at 7 d in the lungs (p < 0.05). The relative abundance of Acinetobacter in the lungs increased to 16.26% at 7 d after sTBI. The chao1 index of gut microbiota increased after sTBI and peaked at 7 d (p < 0.05). Three hours after sTBI, the conditional pathogens such as Lachnoclostridium, Acinetobacter, Bacteroides and Streptococcus grew significantly. At 7 d and 14 d, the histology scores in the sTBI group were significantly higher than the control group (p < 0.05). The myeloperoxidase (MPO) activity increased at all-time points after sTBI and peaked at 7 d (p < 0.05). The LBP and sCD14 peaking 7 d after sTBI (p < 0.05). The Zonulin increased significantly at 3 d after sTBI and maintained the high level (p < 0.05). SourceTracker identified that the lung tissue microbiota reflects 49.69% gut source at 7 d after sTBI. In the small intestine, sTBI induced gastrointestinal dysfunction with increased apoptosis and decreasing antimicrobial peptides. There was a negative correlation between gut conditional pathogens and the expression level of antimicrobial peptides in Paneth cells. Our data indicate that gut bacteria translocated to the lungs after sTBI, and Paneth cells may regulate gut microbiota stability and translocation.

Learned lensless 3D camera.

Single-shot three-dimensional (3D) imaging with compact device footprint, high imaging quality, and fast processing speed is challenging in computational imaging. Mask-based lensless imagers, which replace the bulky optics with customized thin optical masks, are portable and lightweight, and can recover 3D object from a snap-shot image. Existing lensless imaging typically requires extensive calibration of its point spread function and heavy computational resources to reconstruct the object. Here we overcome these challenges and demonstrate a compact and learnable lensless 3D camera for real-time photorealistic imaging. We custom designed and fabricated the optical phase mask with an optimized spatial frequency support and axial resolving ability. We developed a simple and robust physics-aware deep learning model with adversarial learning module for real-time depth-resolved photorealistic reconstructions. Our lensless imager does not require calibrating the point spread function and has the capability to resolve depth and "see-through" opaque obstacles to image features being blocked, enabling broad applications in computational imaging.

Special Section Guest Editorial: Computational Approaches for Neuroimaging.

This guest editorial provides an introduction to the Special Section on Computational Approaches for Neuroimaging.

Ferroptosis in brain microvascular endothelial cells mediates blood-brain barrier disruption after traumatic brain injury.

Ferroptosis is a newly recognized form of regulated cell death. Recently, growing evidence has shown that ferroptosis is involved in the pathogenesis of traumatic brain injury (TBI). However, less attention has been paid to its role in brain microvascular endothelial cells (BMVECs) and blood-brain barrier (BBB) damage, the central pathological process in secondary brain injury of TBI. Here, we established a mechanical stretch injury bEnd.3 model and a Controlled Cortical Impact (CCI) mouse model to explore the ferroptosis-related markers in brain endothelial cells after TBI in vitro and in vivo. From the results of RNA-seq analysis, RT-qPCR and immunostaining, glutathione peroxidase 4 (GPX4) downregulation, Cyclooxygenase-2 (COX-2) upregulation, and iron accumulation were observed in brain endothelial cells after TBI both in vitro and in vivo. Furthermore, we utilized Ferrostatin-1 (Fer-1), a specific inhibitor of ferroptosis, to investigate the protective effects of ferroptosis inhibition on BBB disruption and neurological deficits. From the results of immunostaining, transmission electron microscopy (TEM), and western blotting, we demonstrated that Fer-1 significantly reduced BMVECs death, BBB permeability, and tight junction loss at 3 days after TBI. The neurological tests including grid walking, rotarod test, and wire-hanging test showed that Fer-1 administration exerted neuroprotective effects in the early stage of TBI. Our findings provided evidences for inhibition of BMVECs ferroptosis as a promising therapeutic target against TBI-induced BBB disruption.

Boosting Electrocatalytic Oxygen Evolution: Superhydrophilic/Superaerophobic Hierarchical Nanoneedle/Microflower Arrays of CexCo3-xO4 with Oxygen Vacancies.

The oxygen evolution reaction has become the bottleneck of electrochemical water splitting for its sluggish kinetics. Developing high-efficiency and low-cost non-noble-metal oxide electrocatalysts is crucial but challenging for industrial application. Herein, superhydrophilic/superaerophobic hierarchical nanoneedle/microflower arrays of Ce-substituted Co3O4 (CexCo3-xO4) in situ grown on the nickel foam are successfully constructed. The hierarchical architecture and superhydrophilic/superaerophobic interface can be facilely regulated by controlling the introduction of Ce into Co3O4. The unique feature of hierarchical architecture and superhydrophilic/superaerophobic interface is in favor of electrolyte penetration and bubbles release. In addition, the presence of oxygen vacancy and Ce endows the catalyst with enhanced intrinsic activity. Benefiting from these advantages, the optimized Ce0.12Co2.88O4 catalyst shows a superior electrocatalytic performance for the oxygen evolution reaction (OER) with an overpotential of 282 mV at 20 mA cm-2, and a Tafel slope of 81.4 mV dec-1. The turnover frequency of 0.0279 s-1 for Ce0.12Co2.88O4 is 9.3 times larger than that for Co3O4 at an overpotential of 350 mV. Moreover, the optimized Ce0.12Co2.88O4 catalyst shows a robust long-term stability in alkaline media.

GEOMScope: Large Field-of-view 3D Lensless Microscopy with Low Computational Complexity.

Imaging systems with miniaturized device footprint, real-time processing speed and high resolution three-dimensional (3D) visualization are critical to broad biomedical applications such as endoscopy. Most of existing imaging systems rely on bulky lenses and mechanically refocusing to perform 3D imaging. Here, we demonstrate GEOMScope, a lensless single-shot 3D microscope that forms image through a single layer of thin microlens array and reconstructs objects through an innovative algorithm combining geometrical-optics-based pixel back projection and background suppressions. We verify the effectiveness of GEOMScope on resolution target, fluorescent particles and volumetric objects. Comparing to other widefield lensless imaging devices, we significantly reduce the required computational resource and increase the reconstruction speed by orders of magnitude. This enables us to image and recover large volume 3D object in high resolution with near real-time processing speed. Such a low computational complexity is attributed to the joint design of imaging optics and reconstruction algorithms, and a joint application of geometrical optics and machine learning in the 3D reconstruction. More broadly, the excellent performance of GEOMScope in imaging resolution, volume, and reconstruction speed implicates that geometrical optics could greatly benefit and play an important role in computational imaging.

Deep Compressed Imaging via Optimized-Pattern Scanning.

The need for high-speed imaging in applications such as biomedicine, surveillance and consumer electronics has called for new developments of imaging systems. While the industrial effort continuously pushes the advance of silicon focal plane array image sensors, imaging through a single-pixel detector has gained significant interests thanks to the development of computational algorithms. Here, we present a new imaging modality, Deep Compressed Imaging via Optimized-Pattern Scanning (DeCIOPS), which can significantly increase the acquisition speed for a single-detector-based imaging system. We project and scan an illumination pattern across the object and collect the sampling signal with a single-pixel detector. We develop an innovative end-to-end optimized auto-encoder, using a deep neural network and compressed sensing algorithm, to optimize the illumination pattern, which allows us to reconstruct faithfully the image from a small number of samples, and with a high frame rate. Compared with the conventional switching-mask based single-pixel camera and point scanning imaging systems, our method achieves a much higher imaging speed, while retaining a similar imaging quality. We experimentally validated this imaging modality in the settings of both continuous-wave (CW) illumination and pulsed light illumination and showed high-quality image reconstructions with a high compressed sampling rate. This new compressed sensing modality could be widely applied in different imaging systems, enabling new applications which require high imaging speed.

Highly efficient As(III) removal in water using millimeter-sized porous granular MgO-biochar with high adsorption capacity.

Biochar adsorbents for removing As(III) suffer from the problems of low adsorption capacity and ineffective removal. Herein, a granular MgO-embedded biochar (g-MgO-Bc) adsorbent is fabricated in the form of millimeter-sized particles through a simple gelation-calcination method using chitosan as biochar sources. High-density MgO nanoparticles are evenly dispersed throughout the biochar matrix and can be fully exposed to As(III) through the rich pores in g-MgO-Bc. These features endow the adsorbent with a high adsorption capacity of 249.1 mg/g for As(III). The g-MgO-Bc can efficiently remove As(III) over a wide pH of 3-10. The coexisting carbonate, nitrate, sulfate, silicate, and humic acid exert a negligible influence on As(III) removal. 300 µg/L of As(III) can be purified to far below 10 µg/L using only 0.3 g/L g-MgO-Bc. The spent g-MgO-Bc could be well regenerated by simple calcination. In fixed-bed column experiments, the effective treatment volume of As(III)-spiked groundwater achieves 1500 BV (30 L) (3 g of adsorbent, solution flow rate of 2.0 mL/min, C0 = 50 µg/L). The Mg(OH)2 generated in situ in g-MgO-Bc is responsible for the adsorption of As(III) through the inner-sphere complex mechanism. The work would extend the potential applicability of biochar adsorbent for As(III) removal to a great extent.

Contribution of factor VII polymorphisms to coagulopathy in patients with isolated traumatic brain injury.

BACKGROUND: Coagulopathy is a severe complication of traumatic brain injury (TBI) and can cause secondary injuries and death. Decrease of FVII activity contributes to the coagulopathy and progressive hemorrhagic injury (PHI) in patients with isolated TBI. Some polymorphic loci of coagulation factor VII (FVII) are shown to be essential for FVII activity. However, the relationship between FVII gene polymorphisms and coagulopathy in patients with isolated TBI is still unknown. Therefore, the present study aimed to investigate the relationship between FVII gene polymorphisms and plasma FVIIa levels, and assess whether FVII polymorphisms were associated with TBI-related coagulopathy, PHI, and 6 months GOS in patients with isolated TBI. METHODS: One-hundred-forty-nine patients with isolated TBI (from East of China) admitted to Huashan Hospital's Neurological Trauma Center from March 2012 to March 2016 were enrolled in this study. The Polymorphism-Polymerase Chain Reaction (PCR) method was used to analyze the five FVII polymorphism loci (-323P0/P10, R353Q, -401G/T, -402G/A, and -670A/C) of these patients. Patients' blood was collected to test the activated partial thromboplastin time, international normalized ratio, platelet, and FVIIa concentrations. Other clinical characteristics were also recorded. RESULTS: The minor alleles of three genotypes of -323 P0/P10, R353Q, and -401G/T each independently associated with 23.3%, 28.6%, and 27.6% lower FVIIa levels, respectively. These polymorphisms explained 21% of the total variance of FVIIa levels (adjusted R2:0.206). The genotype of -323P0/P10 was an independent risk factor for coagulopathy (OR = 2.77, p = 0.043) and PHI (OR = 3.47, p = 0.03) after adjustment for confounding factors in the logistic regression model. Polymorphisms of FVII were not independently associated with 6 months Glasgow Outcome Scale (GOS) of isolated TBI patients. CONCLUSION: -323P0/P10, R353Q, and -401 G/T genotypes were associated with FVIIa levels. -323P0/P10 genotype was independently associated with traumatic coagulopathy and PHI in isolated TBI patients.