Stem cell-based therapies have been proposed as a potential treatment for neural regeneration following closed head injury.We previously reported that induced neural stem cells exert beneficial effects on neural regen...Stem cell-based therapies have been proposed as a potential treatment for neural regeneration following closed head injury.We previously reported that induced neural stem cells exert beneficial effects on neural regeneration via cell replacement.However,the neural regeneration efficiency of induced neural stem cells remains limited.In this study,we explored differentially expressed genes and long non-coding RNAs to clarify the mechanism underlying the neurogenesis of induced neural stem cells.We found that H19 was the most downregulated neurogenesis-associated lnc RNA in induced neural stem cells compared with induced pluripotent stem cells.Additionally,we demonstrated that H19 levels in induced neural stem cells were markedly lower than those in induced pluripotent stem cells and were substantially higher than those in induced neural stem cell-derived neurons.We predicted the target genes of H19 and discovered that H19 directly interacts with mi R-325-3p,which directly interacts with Ctbp2 in induced pluripotent stem cells and induced neural stem cells.Silencing H19 or Ctbp2 impaired induced neural stem cell proliferation,and mi R-325-3p suppression restored the effect of H19 inhibition but not the effect of Ctbp2 inhibition.Furthermore,H19 silencing substantially promoted the neural differentiation of induced neural stem cells and did not induce apoptosis of induced neural stem cells.Notably,silencing H19 in induced neural stem cell grafts markedly accelerated the neurological recovery of closed head injury mice.Our results reveal that H19 regulates the neurogenesis of induced neural stem cells.H19 inhibition may promote the neural differentiation of induced neural stem cells,which is closely associated with neurological recovery following closed head injury.展开更多
Objective To explore pathogenesis and risk factors for posttraumatic cerebral infarction (PTCI) in patients with severe and extremely severe head injuries for the purpose of providing clues for reducing occurrence of ...Objective To explore pathogenesis and risk factors for posttraumatic cerebral infarction (PTCI) in patients with severe and extremely severe head injuries for the purpose of providing clues for reducing occurrence of PTCI and case-fatality. Methods Gender,age,Glasgow coma scale (GCS) ,the presence or absence of basicranial fracture,cerebral hernia or infection,surgical modality,hypotension,and the use of diuretics展开更多
To investigate the content and dynamics of nitric oxide (NO) in the cerebrospinal fluid (CSF) of patients with acute head injury and to clarify the relationship of NO with clinical features and intracranial pressure (...To investigate the content and dynamics of nitric oxide (NO) in the cerebrospinal fluid (CSF) of patients with acute head injury and to clarify the relationship of NO with clinical features and intracranial pressure (ICP) as well as outcomes, 38 adults with acute head injury were studied. Glasgow Coma Scale (GCS) obtained at admission and Glasgow Outcome Scale (GOS) 3 months after injury was assessed. ICP was surveyed via intraventricular catheter and lumbar puncture and CSF samples were obtained simultaneously. NO was determined with Griess reagents. Results showed that NO peak content in the head injury group was significantly higher than that of the control group. During dynamic research, no peak content of mildly injured cases and severely injured ones appeared in different time windows respectively. The peak value of NO was distinctly higher in the severe group than in the mild group. NO peak value of the raised ICP group was remarkably higher than that of the normal ICP group. The peak value of NO was considerately higher in the poor outcome group than in the good outcome group. When the content of NO was over 6. 5 μmol/L, the rate of poor outcome was increased. There existed a correlation between NO and GCS, ICP and GOS. It is concluded that the content of NO was increased in patients with acute head injury and the changes of NO had different time windows in severely injured patients and mildly injured ones. The more sever the injury, the higher the NO content; and the more serious the secondary brain injury and brain edema, the worse the outcomes. When NO is combined with GCS, GOS and ICP, it increases the accuracy of judgement to the degree of head injury and outcome.展开更多
BACKGROUND: There have been few reports on the clinical significance of the fibrinogen degradation product(FDP) level in trauma patients with and without head injury. We retrospectively analyzed trauma patients with o...BACKGROUND: There have been few reports on the clinical significance of the fibrinogen degradation product(FDP) level in trauma patients with and without head injury. We retrospectively analyzed trauma patients with or without head injury to investigate the clinical signifi cance of the FDP level.METHODS: From April 2013 to June 2015, a medical chart review was retrospectively performed for all patients with trauma. The exclusion criteria included patients who did not receive a transfusion. The patients were divided into two groups: a FDP>100 group, which included patients who had an FDP level on arrival over 100 ng/m L, and a FDP≤100 group.RESULTS: The ratio of open fractures and the prothrombin ratio in the FDP>100 group were significantly smaller than those observed in the FDP≤100 group. The average age, ratio of blunt injury, Injury Severity Score(ISS), volume of transfusion and mortality ratio in the FDP>100 group were signifi cantly greater than those in the FDP≤100 group. There was a weakly positive correlation between the FDP level and ISS(R=0.35, P=0.002), but it was not associated with the transfusion volume. The results of an analysis excluding patients with head injury showed a similar tendency.CONCLUSION: The FDP levels may be a useful biochemical parameter for the initial evaluation of the severity of trauma and mortality even in blunt traumatized patients without head injury or with stable vital signs.展开更多
It has been shown that annually around 1250 children younger than 15 years old die in traffic accident.The number of children who also injured as a consequence of car accidents is noticeably higher.According to the EC...It has been shown that annually around 1250 children younger than 15 years old die in traffic accident.The number of children who also injured as a consequence of car accidents is noticeably higher.According to the ECE-R44 regulation the safety of children in the cars,the use of a child safety seat(CSS)is highly recommended.Using a CSS would dramatically diminish the injuries of traffic accidents.However,the posture,especially the angle,of a child when seating on a seat may also affect the amount of injury occurs during the accident.It has been revealed that during the accident only few children remained seated in the standard position,and most of them whether slouched or slanted and turned their head to the side-support of the CSS.Extreme positions,such as leaning forward,escaping from the harness or holding feet were also observed.This study aimed to perform a finite element(FE)study to figure out what angle of seating would result in the least amount of injury to the child head in a typical car crash under the speed of 47 km/h.To do that,a 1.5 years old child dummy(a dummy representing the anthropometry of a 1.5 years old child)has been accommodated on a seat under the angles of 15°,30°,and 45°.The results revealed.The resulted displacements in the head after the accident were also calculated at X,Y,and Z directions.The results in this regard indicated a higher displacement at X direction whereas the lowest one was seen at Y direction.The results have implications not only for understanding the amount of injury to the child head after the accident under different seating angles,but also for giving an insight to the CSS industries and families to choose the right seating posture for the child in the car to reduce the severity of injury.展开更多
The correlation of secondary brain injury with thromboxane A<sub>2</sub>（TXA<sub>2</sub>） and prostacy-clin （PGI<sub>2</sub>） levels following head injury was studied in rats an...The correlation of secondary brain injury with thromboxane A<sub>2</sub>（TXA<sub>2</sub>） and prostacy-clin （PGI<sub>2</sub>） levels following head injury was studied in rats and patients.Thromboxane B<sub>2</sub>（TXB<sub>2</sub>） and 6-keto-PGF<sub>1α</sub> in rat brain homogenate and TXB<sub>2</sub> in cerebral spinal fluid （CSF） ofpatients with severe head injury were determined by RIA.The effects of ligustrazini hydrochlo-rioi were also tested.The results showed that the concentration of TXB<sub>2</sub> and 6-keto-PGF<sub>1α</sub> inrat brain was progressively increased within 3h after injury （P【0.01）,and the ratio betweenTXB<sub>2</sub> and 6-keto-PGF<sub>1α</sub>（T/K value） increased during the early stage after injury,along withthe tissue damage aggravation.After the use of ligustrazini hydrochlorioi,TXB<sub>2</sub> content inbrain decreased sharply accompanied with a drop in T/K value.Moreover,TXB<sub>2</sub> content inCSF increased within 7 d after injury （P【0.01）,and it reached its peak value on the 3rd day.This could indicate that the metabolic imbalance between TXA<sub>2</sub> and PGI<sub>2</sub> might be one of theimportant factors in the development of secondary brain injury,and ligustrazini hydrochlorioiproved to have a protective effect on the brain tissue by normalizing the metabolism of TXA<sub>2</sub>and PGI<sub>2</sub>.In addition,the metabolic disorders of TXA<sub>2</sub> in the brain tissue of head injured pa-tients have much to do with the outcome of the patients.展开更多
Background: In view of the growing population and increased vehicle use, traumatic brain injury is becoming the most common and devastating problem especially in young healthy people. It has occupied second place next...Background: In view of the growing population and increased vehicle use, traumatic brain injury is becoming the most common and devastating problem especially in young healthy people. It has occupied second place next to cancer as leading cause of death. In this new era of radiology, computed tomography has become the primary modality of choice in the initial assessment of head injury patients as it is widely available, faster and highly accurate in detecting skull fractures and acute intracranial hemorrhage. Aim: It is to demonstrate the importance of ct scanning in the initial treatment planning, follow up and long term management of patients with acute head injury of varying severity. Patients: A retrospective study has been carried out of 100 cases of acute head trauma with positive CT scanning referred to Narayana medical college and hospital, Nellore, India between 30th April 2012 to 1st May 2013 [1 year retrospective study]. Results: The post traumatic intracranial consequences have been collected, reviewed and analyzed, where in 82% of cases males were involved , and most of the injured people belong to the first three decades of life, the main cause being road traffic accident which is growing in incidence in this 21st century. Most of the cases which were studied showed skull fractures, which indicates that there has been significant trauma and in a single case more than one pathology related to cranium has been seen. The most common post traumatic consequences found in the study of adults are contusions, brain edema and intracerebral hematomas, while other sequelae such as subarachnoid hematomas, subdural hematomas and extradural hematomas are encountered less. Diffuse and focal cerebral edema was being the most common pathology following trauma in children. Conclusion: CT scanning is the primary modality of choice in the diagnostic work up of patients with acute head trauma for identifying the various intracranial consequences following head injury especially within 48 hours which helps in the initial assessment, treatment planning, follow up and long term management of patients.展开更多
Objective: To evaluate the effects of thyorotropin-releasing hormone (TRH ) on severe head injury.Methods: Eighty--seven severely head injured patients with a Glasgow Coma Scale (GCS ) score of & or less wererando...Objective: To evaluate the effects of thyorotropin-releasing hormone (TRH ) on severe head injury.Methods: Eighty--seven severely head injured patients with a Glasgow Coma Scale (GCS ) score of & or less wererandomized into TRH--treated and saline control groups. In TRH treated group. the treatment was started with abolus injection of 0. 2 mg/kg followed by continuous infusion for 2 hours at 0. 2 mg/kg/h. Such treatment wasgiven once a day for 4 times. The patients in control group were given the equivalent normal saline with the samemethod. Results: TRH, administered intravenously after head injury. promoted the recovery of consciousness andGCS score, alleviated the traumatic brain edema, controlled and lowered the intracranial pressure. decreased thelevel of lipid superoxides, decreased the mortality rate. and improved the life quality of the survivals. Nocomplications or adverse and toxic effects were noted during the course of TRH treatment. Conclusion: TRH hasbeneficial effects on patients with severe head injury.展开更多
目的：探讨添加益生菌的早期肠内营养对重型颅脑损伤患者临床结局的影响.方法：电子检索PubMed、Cochrane CentralRegister of Controlled Trials（CENTRAL）、中国知网（China National Knowledge Infrastructure,CNKI）、万方及中国...目的：探讨添加益生菌的早期肠内营养对重型颅脑损伤患者临床结局的影响.方法：电子检索PubMed、Cochrane CentralRegister of Controlled Trials（CENTRAL）、中国知网（China National Knowledge Infrastructure,CNKI）、万方及中国生物医学文献数据库（Chinese Biomedical Literature Database,CBM）中有关添加益生菌的早期肠内营养对重型颅脑损伤患者临床结局影响的随机对照研究（Randomizedcontrolledtrials,RCTs）,并手工检索合格研究及主题相关综述的参考文献.2位研究者独立筛查文献、提取资料、评价合格研究的偏倚风险后,采用STATA12.0软件行Meta分析.伦理与发布：本研究所有分析均基于已发表研究中所报告数据,因此不需要签署伦理许可和患者知情同意书.本系统评价全文完成后,将发表于同行评审的期刊杂志.展开更多
Objectives: Concomitant injuries play an important role when it comes to clinical management of traumatic brain injury (TBI). We examined the incidence of concomitant injuries and their relevance with respect to hospi...Objectives: Concomitant injuries play an important role when it comes to clinical management of traumatic brain injury (TBI). We examined the incidence of concomitant injuries and their relevance with respect to hospitalization. Methods: Children aged between 0 - 18 years hospitalized for treatment of TBI (ICD 10;S06.0 - 9) during 2010-2011 were included. The data relating to concomitant injuries and the course of treatment were evaluated. Statistical analysis included multivariate regressions at a level of significance of p ≤ 0.05. Results: 794 children were treated for head injury in our hospital. Head injury with other associated injuries had been sustained by 158 (19.9%) children. The face and the extremities were the areas of the body most often affected (p = 0.001). Boys represent the majority within the cohort of multiple injured children (p = 0.0001). The older the child, the higher the percentage of children with concomitant injuries (r = 0.27;p = 0.034). There was a significant correlation between the severity of the head injury and the occurrence of concomitant injuries (r = 0.19;p = 0.046). Children with concomitant injuries were found to suffer significantly more falls (N = 82;51.9%) than road traffic accidents (N = 68;43%) (p = 0.0001). A comparison of different variables revealed that age (7 to 10 years), severity of head injury (mild TBI), and trauma mechanism (fall) were most influential (KB = ?1.55;p = 0.023) for concomitant injuries. Children with concomitant injuries have a significant longer stay in hospital than those without: mean stay 2.5 to 4.5 days (p = 0.0001). Conclusion: Concomitant injuries are hints for more severe head injuries and children should be examined with special care.展开更多
Pediatric head injury is one of the major health problems. That can be easily evaluated by computed tomographic scanning. This study describes the various findings of pediatric head trauma seen on CT scan, the timely ...Pediatric head injury is one of the major health problems. That can be easily evaluated by computed tomographic scanning. This study describes the various findings of pediatric head trauma seen on CT scan, the timely diagnosis of which plays a vital role in prognosis, especially in semiurban and remote location where the decision for tertiary referral is important. Timely intervention in traumatic brain injury cases reduces morbidity and mortality. Cerebral edema, which is the most common intracranial lesion, can be promptly managed by medicosurgical support with ICP monitoring, thereby improving the overall prognosis. Other lesions commonly seen are subdural hematomas and skull fractures. Limitations of radiographs, ultrasound and MRI in these acute cases, highlight the benefit of CT scans.展开更多
AIM:To eluciate the role of neuron specific enolase(NSE) in predicting prognosis after severe head injury.METHODS:30 patients with severe head injury were involved into this study,ranging from 26 to 64 years old.Conce...AIM:To eluciate the role of neuron specific enolase(NSE) in predicting prognosis after severe head injury.METHODS:30 patients with severe head injury were involved into this study,ranging from 26 to 64 years old.Concentration of NSE in serum was measured in all cases within 12 hours after head injury.And prognosis of all patients were evaluated by GOS.RESULTS:The concentration of NSE in serum of both groups,with good or poor outcome,were higher than normal group.The concentrations within 12 hours after head injuries had a cose relationship with the prognosis.As a serum marker to assess the prognosis,NSE had high positive prediction ratio.CONCLUSION:The finding suggested that NSE may be a promising predictor for assessing the prognosis after severe head injury.展开更多
Objective:To investigate the effect of hyperbaric oxygen (HBO) on serum inflammatory factors, oxidative stress status, endothelial cell function and intracranial pressure in patients with severe craniocerebral injury ...Objective:To investigate the effect of hyperbaric oxygen (HBO) on serum inflammatory factors, oxidative stress status, endothelial cell function and intracranial pressure in patients with severe craniocerebral injury (STBI), and to provide scientific basis for clinical treatment of patients with severe craniocerebral injury.Methods: 110 cases of STBI were selected and divided into control group and treatment group according to the random data table, 55 cases in each group. The control group received conventional combined therapy, the observation group were given HBO treatment on the base of the control group, the inflammatory factors [C reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10)] and oxidative stress [malondialdehyde (MDA) and superoxide dismutase-1 (SOD-1)], endothelin (ET) and intracranial pressure (ICP) level changes of the two groups were observed and compared before and after treatment for 10 d in patients. Results: The levels of CRP, TNF-α, IL-6, MDA, ET and ICP in the treatment group and the control group were significantly lower than those in the same group before treatment, the difference was statistically significant (P<0.05), the CRP, TNF-α, IL-6, MDA, ET and ICP levels of the observation group after treatment were significantly lower than the control group after treatment (P<0.05);After treatment, IL-10 and SOD-1 levels of the two groups of patients were significantly increased than the same group before treatment (P<0.05), and both levels in the observation group after treatment was significantly higher than the control group after treatment (P<0.05).Conclusions: HBO treatment of severe brain injury patients with significant effect, can effectively reduce oxidative stress damage and inflammation, improve patients' endothelial cell function, reduce intracranial pressure, and has a certain clinical value.展开更多
Traumatic brain injury(TBI) is a leading cause of death and disability in individuals worldwide.Producing a clinically relevant TBI model in small-sized animals remains fairly challenging.For good screening of potenti...Traumatic brain injury(TBI) is a leading cause of death and disability in individuals worldwide.Producing a clinically relevant TBI model in small-sized animals remains fairly challenging.For good screening of potential therapeutics,which are effective in the treatment of TBI,animal models of TBI should be established and standardized.In this study,we established mouse models of closed head injury using the Shohami weight-drop method with some modifications concerning cognitive deficiency assessment and provided a detailed description of the severe TBI animal model.We found that 250 g falling weight from 2 cm height produced severe closed head injury in C57BL/6 male mice.Cognitive disorders in mice with severe closed head injury could be detected using passive avoidance test on day 7 after injury.Findings from this study indicate that weight-drop injury animal models are suitable for further screening of brain neuroprotectants and potentially are similar to those seen in human TBI.展开更多
Objective To evaluate the usefulness of quantitative electroencephalogram (QEEG),flash visual evoked potential (F-VEP) and auditory brainstem responses (ABR) as indicators of general neurological status. Methods Com-p...Objective To evaluate the usefulness of quantitative electroencephalogram (QEEG),flash visual evoked potential (F-VEP) and auditory brainstem responses (ABR) as indicators of general neurological status. Methods Com-parison was conducted on healthy controls (N=30) and patients with brain concussion (N=60) within 24 h after traumatic brain injury. Follow-up study of patient group was completed with the same standard paradigm 3 months later. All participants were recorded in multi-modality related potential testing in both early and late concussion at the same clinical setting. Glasgow coma scale,CT scanning,and physical examinations of neuro-psychological function,optic and auditory nervous system were performed before electroencephalogram (EEG) and evoked potential (EEG–EP) testing. Any partici-pants showed abnormal changes of clinical examinations were excluded from the study. Average power of frequency spectrum and power ratios were selected for QEEG testing,and latency and amplitude of F-VEP and ABR were recorded. Results Between patients and normal controls,the results indicated: (1) Highly significance (P < 0.01) in average power of α1 and power ratios of θ/α1,θ/α2,α1/α2 of EEG recording; (2) N70-P100 amplitude of F-VEP in significant difference at early brain concussion; and (3) apparent prolongation of I^III inter-peak latency of ABR appeared in some individuals at early stage after concussion. The follow-up study showed that some patients with concussion were also afflicted with characteristic changes of EEG components for both increments of α1 average power and θ/α2 power ratio after 3 months recording. Conclusion EEG testing has been shown to be more effective and sensitive than evoked potential tests alone on detecting functional state of patients with mild traumatic brain injury (MTBI). Increments of α1 average power and θ/ α2 power ratio are the sensitive EEG parameters to determining early concussion and evaluating outcome of post-concussion symptoms (PCS). Follow-up study associated with persistent PCS may be consistent with the postulate of substantial biological,rather than psychological origin. The study suggests that combination of EEG and EP parameters can contribute to the evaluation of brain function as a whole for clinical and forensic applications.展开更多
It is widely assumed that fetal ischemic brain injury during labor derives almost exclusively from severe, systemic hypoxemia with marked neonatal depression and acidemia. Severe asphyxia, however, is one of several c...It is widely assumed that fetal ischemic brain injury during labor derives almost exclusively from severe, systemic hypoxemia with marked neonatal depression and acidemia. Severe asphyxia, however, is one of several causes of perinatal neurological injury and may not be the most common;most neonates diagnosed with hypoxic-ischemic encephalopathy do not have evidence of severe asphyxia. Sepsis, direct brain trauma, and drug or toxin exposure account for some cases, while mechanical forces of labor and delivery that increase fetal intracranial pressure sufficiently to impair brain perfusion may also contribute. Because of bony compliance and mobile suture lines, the fetal skull changes shape and redistributes cerebrospinal fluid during labor according to constraints imposed by contractions, and bony and soft tissue elements of the birth canal as the head descends. These accommodations, including the increase in intracranial pressure, are adaptive and necessary for efficient descent of the head while safeguarding cerebral blood flow. Autonomic reflexes mediated through central receptors normally provide ample protection of the brain from the considerable pressure exerted on the skull. On occasion, those forces, which are transmitted intracranially, may overcome the various adaptive anatomical, cardiovascular, metabolic, and neurological mechanisms that maintain cerebral perfusion and oxygen availability, resulting in ischemic brain injury. Accepting the notion of a potentially adverse impact of fetal head compression suggests that avoidance of excessive uterine activity and of relentless pushing without steady progress in descent may offer protection for the fetal brain during parturition. Excessive head compression should be considered in the differential diagnosis of ischemic encephalopathy.展开更多
Objectives: The primary objective was to characterize the range of Knowledge, Attitude, and Practice (KAP) of Helmet use in children amongst parents to prevent head injuries and death. Methods: This is a cross-section...Objectives: The primary objective was to characterize the range of Knowledge, Attitude, and Practice (KAP) of Helmet use in children amongst parents to prevent head injuries and death. Methods: This is a cross-sectional study, done by online survey using a snowball sampling technique, the number of included responses were 386 parents (Male and female) living in Riyadh Aged 21 - 60 years old or above. Results: The study showed that there is a difference in Parents’ belief in the importance of helmet use while riding a Bicycle vs Motorcycle/Quad bike and that was affected by parents’ education level, almost all the people who answered the survey (76.7%) agree that it is important for their children to wear a helmet when riding both a Bicycle and a Motorcycle or Quadbike with a cumulative percentage of (93.8%). And almost all agreed on multiple approaches to help increase helmet use be it by forcing rental shops to give out helmets, forcing sellers to recommend the use of helmets, increasing awareness campaigns, and imposing fines for not wearing helmets. Conclusions: This study is the first to explore Family helmet use while riding Bicycles and Motorcycles/Quad bikes. Although Parent’s belief in the importance of helmet use for their children was high, it is clear that the level of practice is low. With that the risk of head injuries might be high, our findings suggest that safety interventions for increasing pediatric helmet use are needed to increase helmet use and reduce the risk of head injury and hospitalization.展开更多
A major challenge for the efficient treatment of traumatic brain injury is the need for therapeutic molecules to cross the blood-brain barrier to enter and accumulate in brain tissue.To overcome this problem,researche...A major challenge for the efficient treatment of traumatic brain injury is the need for therapeutic molecules to cross the blood-brain barrier to enter and accumulate in brain tissue.To overcome this problem,researchers have begun to focus on nanocarriers and other brain-targeting drug delivery systems.In this review,we summarize the epidemiology,basic pathophysiology,current clinical treatment,the establishment of models,and the evaluation indicators that are commonly used for traumatic brain injury.We also report the current status of traumatic brain injury when treated with nanocarriers such as liposomes and vesicles.Nanocarriers can overcome a variety of key biological barriers,improve drug bioavailability,increase intracellular penetration and retention time,achieve drug enrichment,control drug release,and achieve brain-targeting drug delivery.However,the application of nanocarriers remains in the basic research stage and has yet to be fully translated to the clinic.展开更多
Studies from nearly 3 decades ago suggested that,in the central nervous system(CNS),myelination of axons by oligodendrocytes not only helps improve axonal conductivity but also stabilizes circuitry(Colello and Schwab,...Studies from nearly 3 decades ago suggested that,in the central nervous system(CNS),myelination of axons by oligodendrocytes not only helps improve axonal conductivity but also stabilizes circuitry(Colello and Schwab,1994).Over the years,myelin sheaths produced by oligodendrocytes have been found to contain multiple molecules that are inhibitory to axonal growth(e.g.,MAG,NogoA,OMgp,Semaphorins)(Yiu and He,2006;Silver et al.,2014).After white matter injury in the adult CNS,myelin debris from damaged axons and dead oligodendrocytes accumulates in the forming glial scar and exposes these myelin-associated axon growth-inhibitory molecules to the injured axonal stumps,thereby contributing to the inhibition of axonal regrowth.During development,CNS axons reach their postsynaptic targets and stop growing before oligodendrocytes appear and myelinate them(Foran and Peterson,1992;Dangata et al.,1996).Therefore,myelin-associated axon growth-inhibitory molecules interacting with already grown axons during myelination were thought to block axons from promiscuous sprouting and miswiring,thereby stabilizing neural circuitry in the CNS(Colello and Schwab,1994).展开更多
基金supported by the National Natural Science Foundation of China,Nos.82271397(to MG),82001293(to MG),82171355(to RX),81971295(to RX)and 81671189(to RX)。
文摘Stem cell-based therapies have been proposed as a potential treatment for neural regeneration following closed head injury.We previously reported that induced neural stem cells exert beneficial effects on neural regeneration via cell replacement.However,the neural regeneration efficiency of induced neural stem cells remains limited.In this study,we explored differentially expressed genes and long non-coding RNAs to clarify the mechanism underlying the neurogenesis of induced neural stem cells.We found that H19 was the most downregulated neurogenesis-associated lnc RNA in induced neural stem cells compared with induced pluripotent stem cells.Additionally,we demonstrated that H19 levels in induced neural stem cells were markedly lower than those in induced pluripotent stem cells and were substantially higher than those in induced neural stem cell-derived neurons.We predicted the target genes of H19 and discovered that H19 directly interacts with mi R-325-3p,which directly interacts with Ctbp2 in induced pluripotent stem cells and induced neural stem cells.Silencing H19 or Ctbp2 impaired induced neural stem cell proliferation,and mi R-325-3p suppression restored the effect of H19 inhibition but not the effect of Ctbp2 inhibition.Furthermore,H19 silencing substantially promoted the neural differentiation of induced neural stem cells and did not induce apoptosis of induced neural stem cells.Notably,silencing H19 in induced neural stem cell grafts markedly accelerated the neurological recovery of closed head injury mice.Our results reveal that H19 regulates the neurogenesis of induced neural stem cells.H19 inhibition may promote the neural differentiation of induced neural stem cells,which is closely associated with neurological recovery following closed head injury.
文摘Objective To explore pathogenesis and risk factors for posttraumatic cerebral infarction (PTCI) in patients with severe and extremely severe head injuries for the purpose of providing clues for reducing occurrence of PTCI and case-fatality. Methods Gender,age,Glasgow coma scale (GCS) ,the presence or absence of basicranial fracture,cerebral hernia or infection,surgical modality,hypotension,and the use of diuretics
文摘To investigate the content and dynamics of nitric oxide (NO) in the cerebrospinal fluid (CSF) of patients with acute head injury and to clarify the relationship of NO with clinical features and intracranial pressure (ICP) as well as outcomes, 38 adults with acute head injury were studied. Glasgow Coma Scale (GCS) obtained at admission and Glasgow Outcome Scale (GOS) 3 months after injury was assessed. ICP was surveyed via intraventricular catheter and lumbar puncture and CSF samples were obtained simultaneously. NO was determined with Griess reagents. Results showed that NO peak content in the head injury group was significantly higher than that of the control group. During dynamic research, no peak content of mildly injured cases and severely injured ones appeared in different time windows respectively. The peak value of NO was distinctly higher in the severe group than in the mild group. NO peak value of the raised ICP group was remarkably higher than that of the normal ICP group. The peak value of NO was considerately higher in the poor outcome group than in the good outcome group. When the content of NO was over 6. 5 μmol/L, the rate of poor outcome was increased. There existed a correlation between NO and GCS, ICP and GOS. It is concluded that the content of NO was increased in patients with acute head injury and the changes of NO had different time windows in severely injured patients and mildly injured ones. The more sever the injury, the higher the NO content; and the more serious the secondary brain injury and brain edema, the worse the outcomes. When NO is combined with GCS, GOS and ICP, it increases the accuracy of judgement to the degree of head injury and outcome.
文摘BACKGROUND: There have been few reports on the clinical significance of the fibrinogen degradation product(FDP) level in trauma patients with and without head injury. We retrospectively analyzed trauma patients with or without head injury to investigate the clinical signifi cance of the FDP level.METHODS: From April 2013 to June 2015, a medical chart review was retrospectively performed for all patients with trauma. The exclusion criteria included patients who did not receive a transfusion. The patients were divided into two groups: a FDP>100 group, which included patients who had an FDP level on arrival over 100 ng/m L, and a FDP≤100 group.RESULTS: The ratio of open fractures and the prothrombin ratio in the FDP>100 group were significantly smaller than those observed in the FDP≤100 group. The average age, ratio of blunt injury, Injury Severity Score(ISS), volume of transfusion and mortality ratio in the FDP>100 group were signifi cantly greater than those in the FDP≤100 group. There was a weakly positive correlation between the FDP level and ISS(R=0.35, P=0.002), but it was not associated with the transfusion volume. The results of an analysis excluding patients with head injury showed a similar tendency.CONCLUSION: The FDP levels may be a useful biochemical parameter for the initial evaluation of the severity of trauma and mortality even in blunt traumatized patients without head injury or with stable vital signs.
文摘It has been shown that annually around 1250 children younger than 15 years old die in traffic accident.The number of children who also injured as a consequence of car accidents is noticeably higher.According to the ECE-R44 regulation the safety of children in the cars,the use of a child safety seat(CSS)is highly recommended.Using a CSS would dramatically diminish the injuries of traffic accidents.However,the posture,especially the angle,of a child when seating on a seat may also affect the amount of injury occurs during the accident.It has been revealed that during the accident only few children remained seated in the standard position,and most of them whether slouched or slanted and turned their head to the side-support of the CSS.Extreme positions,such as leaning forward,escaping from the harness or holding feet were also observed.This study aimed to perform a finite element(FE)study to figure out what angle of seating would result in the least amount of injury to the child head in a typical car crash under the speed of 47 km/h.To do that,a 1.5 years old child dummy(a dummy representing the anthropometry of a 1.5 years old child)has been accommodated on a seat under the angles of 15°,30°,and 45°.The results revealed.The resulted displacements in the head after the accident were also calculated at X,Y,and Z directions.The results in this regard indicated a higher displacement at X direction whereas the lowest one was seen at Y direction.The results have implications not only for understanding the amount of injury to the child head after the accident under different seating angles,but also for giving an insight to the CSS industries and families to choose the right seating posture for the child in the car to reduce the severity of injury.
文摘The correlation of secondary brain injury with thromboxane A<sub>2</sub>（TXA<sub>2</sub>） and prostacy-clin （PGI<sub>2</sub>） levels following head injury was studied in rats and patients.Thromboxane B<sub>2</sub>（TXB<sub>2</sub>） and 6-keto-PGF<sub>1α</sub> in rat brain homogenate and TXB<sub>2</sub> in cerebral spinal fluid （CSF） ofpatients with severe head injury were determined by RIA.The effects of ligustrazini hydrochlo-rioi were also tested.The results showed that the concentration of TXB<sub>2</sub> and 6-keto-PGF<sub>1α</sub> inrat brain was progressively increased within 3h after injury （P【0.01）,and the ratio betweenTXB<sub>2</sub> and 6-keto-PGF<sub>1α</sub>（T/K value） increased during the early stage after injury,along withthe tissue damage aggravation.After the use of ligustrazini hydrochlorioi,TXB<sub>2</sub> content inbrain decreased sharply accompanied with a drop in T/K value.Moreover,TXB<sub>2</sub> content inCSF increased within 7 d after injury （P【0.01）,and it reached its peak value on the 3rd day.This could indicate that the metabolic imbalance between TXA<sub>2</sub> and PGI<sub>2</sub> might be one of theimportant factors in the development of secondary brain injury,and ligustrazini hydrochlorioiproved to have a protective effect on the brain tissue by normalizing the metabolism of TXA<sub>2</sub>and PGI<sub>2</sub>.In addition,the metabolic disorders of TXA<sub>2</sub> in the brain tissue of head injured pa-tients have much to do with the outcome of the patients.
文摘Background: In view of the growing population and increased vehicle use, traumatic brain injury is becoming the most common and devastating problem especially in young healthy people. It has occupied second place next to cancer as leading cause of death. In this new era of radiology, computed tomography has become the primary modality of choice in the initial assessment of head injury patients as it is widely available, faster and highly accurate in detecting skull fractures and acute intracranial hemorrhage. Aim: It is to demonstrate the importance of ct scanning in the initial treatment planning, follow up and long term management of patients with acute head injury of varying severity. Patients: A retrospective study has been carried out of 100 cases of acute head trauma with positive CT scanning referred to Narayana medical college and hospital, Nellore, India between 30th April 2012 to 1st May 2013 [1 year retrospective study]. Results: The post traumatic intracranial consequences have been collected, reviewed and analyzed, where in 82% of cases males were involved , and most of the injured people belong to the first three decades of life, the main cause being road traffic accident which is growing in incidence in this 21st century. Most of the cases which were studied showed skull fractures, which indicates that there has been significant trauma and in a single case more than one pathology related to cranium has been seen. The most common post traumatic consequences found in the study of adults are contusions, brain edema and intracerebral hematomas, while other sequelae such as subarachnoid hematomas, subdural hematomas and extradural hematomas are encountered less. Diffuse and focal cerebral edema was being the most common pathology following trauma in children. Conclusion: CT scanning is the primary modality of choice in the diagnostic work up of patients with acute head trauma for identifying the various intracranial consequences following head injury especially within 48 hours which helps in the initial assessment, treatment planning, follow up and long term management of patients.
文摘Objective: To evaluate the effects of thyorotropin-releasing hormone (TRH ) on severe head injury.Methods: Eighty--seven severely head injured patients with a Glasgow Coma Scale (GCS ) score of & or less wererandomized into TRH--treated and saline control groups. In TRH treated group. the treatment was started with abolus injection of 0. 2 mg/kg followed by continuous infusion for 2 hours at 0. 2 mg/kg/h. Such treatment wasgiven once a day for 4 times. The patients in control group were given the equivalent normal saline with the samemethod. Results: TRH, administered intravenously after head injury. promoted the recovery of consciousness andGCS score, alleviated the traumatic brain edema, controlled and lowered the intracranial pressure. decreased thelevel of lipid superoxides, decreased the mortality rate. and improved the life quality of the survivals. Nocomplications or adverse and toxic effects were noted during the course of TRH treatment. Conclusion: TRH hasbeneficial effects on patients with severe head injury.
文摘目的：探讨添加益生菌的早期肠内营养对重型颅脑损伤患者临床结局的影响.方法：电子检索PubMed、Cochrane CentralRegister of Controlled Trials（CENTRAL）、中国知网（China National Knowledge Infrastructure,CNKI）、万方及中国生物医学文献数据库（Chinese Biomedical Literature Database,CBM）中有关添加益生菌的早期肠内营养对重型颅脑损伤患者临床结局影响的随机对照研究（Randomizedcontrolledtrials,RCTs）,并手工检索合格研究及主题相关综述的参考文献.2位研究者独立筛查文献、提取资料、评价合格研究的偏倚风险后,采用STATA12.0软件行Meta分析.伦理与发布：本研究所有分析均基于已发表研究中所报告数据,因此不需要签署伦理许可和患者知情同意书.本系统评价全文完成后,将发表于同行评审的期刊杂志.
文摘Objectives: Concomitant injuries play an important role when it comes to clinical management of traumatic brain injury (TBI). We examined the incidence of concomitant injuries and their relevance with respect to hospitalization. Methods: Children aged between 0 - 18 years hospitalized for treatment of TBI (ICD 10;S06.0 - 9) during 2010-2011 were included. The data relating to concomitant injuries and the course of treatment were evaluated. Statistical analysis included multivariate regressions at a level of significance of p ≤ 0.05. Results: 794 children were treated for head injury in our hospital. Head injury with other associated injuries had been sustained by 158 (19.9%) children. The face and the extremities were the areas of the body most often affected (p = 0.001). Boys represent the majority within the cohort of multiple injured children (p = 0.0001). The older the child, the higher the percentage of children with concomitant injuries (r = 0.27;p = 0.034). There was a significant correlation between the severity of the head injury and the occurrence of concomitant injuries (r = 0.19;p = 0.046). Children with concomitant injuries were found to suffer significantly more falls (N = 82;51.9%) than road traffic accidents (N = 68;43%) (p = 0.0001). A comparison of different variables revealed that age (7 to 10 years), severity of head injury (mild TBI), and trauma mechanism (fall) were most influential (KB = ?1.55;p = 0.023) for concomitant injuries. Children with concomitant injuries have a significant longer stay in hospital than those without: mean stay 2.5 to 4.5 days (p = 0.0001). Conclusion: Concomitant injuries are hints for more severe head injuries and children should be examined with special care.
文摘Pediatric head injury is one of the major health problems. That can be easily evaluated by computed tomographic scanning. This study describes the various findings of pediatric head trauma seen on CT scan, the timely diagnosis of which plays a vital role in prognosis, especially in semiurban and remote location where the decision for tertiary referral is important. Timely intervention in traumatic brain injury cases reduces morbidity and mortality. Cerebral edema, which is the most common intracranial lesion, can be promptly managed by medicosurgical support with ICP monitoring, thereby improving the overall prognosis. Other lesions commonly seen are subdural hematomas and skull fractures. Limitations of radiographs, ultrasound and MRI in these acute cases, highlight the benefit of CT scans.
文摘AIM:To eluciate the role of neuron specific enolase(NSE) in predicting prognosis after severe head injury.METHODS:30 patients with severe head injury were involved into this study,ranging from 26 to 64 years old.Concentration of NSE in serum was measured in all cases within 12 hours after head injury.And prognosis of all patients were evaluated by GOS.RESULTS:The concentration of NSE in serum of both groups,with good or poor outcome,were higher than normal group.The concentrations within 12 hours after head injuries had a cose relationship with the prognosis.As a serum marker to assess the prognosis,NSE had high positive prediction ratio.CONCLUSION:The finding suggested that NSE may be a promising predictor for assessing the prognosis after severe head injury.
文摘Objective:To investigate the effect of hyperbaric oxygen (HBO) on serum inflammatory factors, oxidative stress status, endothelial cell function and intracranial pressure in patients with severe craniocerebral injury (STBI), and to provide scientific basis for clinical treatment of patients with severe craniocerebral injury.Methods: 110 cases of STBI were selected and divided into control group and treatment group according to the random data table, 55 cases in each group. The control group received conventional combined therapy, the observation group were given HBO treatment on the base of the control group, the inflammatory factors [C reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10)] and oxidative stress [malondialdehyde (MDA) and superoxide dismutase-1 (SOD-1)], endothelin (ET) and intracranial pressure (ICP) level changes of the two groups were observed and compared before and after treatment for 10 d in patients. Results: The levels of CRP, TNF-α, IL-6, MDA, ET and ICP in the treatment group and the control group were significantly lower than those in the same group before treatment, the difference was statistically significant (P<0.05), the CRP, TNF-α, IL-6, MDA, ET and ICP levels of the observation group after treatment were significantly lower than the control group after treatment (P<0.05);After treatment, IL-10 and SOD-1 levels of the two groups of patients were significantly increased than the same group before treatment (P<0.05), and both levels in the observation group after treatment was significantly higher than the control group after treatment (P<0.05).Conclusions: HBO treatment of severe brain injury patients with significant effect, can effectively reduce oxidative stress damage and inflammation, improve patients' endothelial cell function, reduce intracranial pressure, and has a certain clinical value.
基金supported by a grant from the Ministry of Higher Education of Malaysia,No.RAGS/2013/UPNM/SKK/01/2
文摘Traumatic brain injury(TBI) is a leading cause of death and disability in individuals worldwide.Producing a clinically relevant TBI model in small-sized animals remains fairly challenging.For good screening of potential therapeutics,which are effective in the treatment of TBI,animal models of TBI should be established and standardized.In this study,we established mouse models of closed head injury using the Shohami weight-drop method with some modifications concerning cognitive deficiency assessment and provided a detailed description of the severe TBI animal model.We found that 250 g falling weight from 2 cm height produced severe closed head injury in C57BL/6 male mice.Cognitive disorders in mice with severe closed head injury could be detected using passive avoidance test on day 7 after injury.Findings from this study indicate that weight-drop injury animal models are suitable for further screening of brain neuroprotectants and potentially are similar to those seen in human TBI.
基金This work was supported in part by grants from National Natural Science Foundation of China （No. 30571909） China Postdoctoral Science Foundation （No. 32134006） Foundation of Soozhow University （No. Q4134405）.
文摘Objective To evaluate the usefulness of quantitative electroencephalogram (QEEG),flash visual evoked potential (F-VEP) and auditory brainstem responses (ABR) as indicators of general neurological status. Methods Com-parison was conducted on healthy controls (N=30) and patients with brain concussion (N=60) within 24 h after traumatic brain injury. Follow-up study of patient group was completed with the same standard paradigm 3 months later. All participants were recorded in multi-modality related potential testing in both early and late concussion at the same clinical setting. Glasgow coma scale,CT scanning,and physical examinations of neuro-psychological function,optic and auditory nervous system were performed before electroencephalogram (EEG) and evoked potential (EEG–EP) testing. Any partici-pants showed abnormal changes of clinical examinations were excluded from the study. Average power of frequency spectrum and power ratios were selected for QEEG testing,and latency and amplitude of F-VEP and ABR were recorded. Results Between patients and normal controls,the results indicated: (1) Highly significance (P < 0.01) in average power of α1 and power ratios of θ/α1,θ/α2,α1/α2 of EEG recording; (2) N70-P100 amplitude of F-VEP in significant difference at early brain concussion; and (3) apparent prolongation of I^III inter-peak latency of ABR appeared in some individuals at early stage after concussion. The follow-up study showed that some patients with concussion were also afflicted with characteristic changes of EEG components for both increments of α1 average power and θ/α2 power ratio after 3 months recording. Conclusion EEG testing has been shown to be more effective and sensitive than evoked potential tests alone on detecting functional state of patients with mild traumatic brain injury (MTBI). Increments of α1 average power and θ/ α2 power ratio are the sensitive EEG parameters to determining early concussion and evaluating outcome of post-concussion symptoms (PCS). Follow-up study associated with persistent PCS may be consistent with the postulate of substantial biological,rather than psychological origin. The study suggests that combination of EEG and EP parameters can contribute to the evaluation of brain function as a whole for clinical and forensic applications.
文摘It is widely assumed that fetal ischemic brain injury during labor derives almost exclusively from severe, systemic hypoxemia with marked neonatal depression and acidemia. Severe asphyxia, however, is one of several causes of perinatal neurological injury and may not be the most common;most neonates diagnosed with hypoxic-ischemic encephalopathy do not have evidence of severe asphyxia. Sepsis, direct brain trauma, and drug or toxin exposure account for some cases, while mechanical forces of labor and delivery that increase fetal intracranial pressure sufficiently to impair brain perfusion may also contribute. Because of bony compliance and mobile suture lines, the fetal skull changes shape and redistributes cerebrospinal fluid during labor according to constraints imposed by contractions, and bony and soft tissue elements of the birth canal as the head descends. These accommodations, including the increase in intracranial pressure, are adaptive and necessary for efficient descent of the head while safeguarding cerebral blood flow. Autonomic reflexes mediated through central receptors normally provide ample protection of the brain from the considerable pressure exerted on the skull. On occasion, those forces, which are transmitted intracranially, may overcome the various adaptive anatomical, cardiovascular, metabolic, and neurological mechanisms that maintain cerebral perfusion and oxygen availability, resulting in ischemic brain injury. Accepting the notion of a potentially adverse impact of fetal head compression suggests that avoidance of excessive uterine activity and of relentless pushing without steady progress in descent may offer protection for the fetal brain during parturition. Excessive head compression should be considered in the differential diagnosis of ischemic encephalopathy.
文摘Objectives: The primary objective was to characterize the range of Knowledge, Attitude, and Practice (KAP) of Helmet use in children amongst parents to prevent head injuries and death. Methods: This is a cross-sectional study, done by online survey using a snowball sampling technique, the number of included responses were 386 parents (Male and female) living in Riyadh Aged 21 - 60 years old or above. Results: The study showed that there is a difference in Parents’ belief in the importance of helmet use while riding a Bicycle vs Motorcycle/Quad bike and that was affected by parents’ education level, almost all the people who answered the survey (76.7%) agree that it is important for their children to wear a helmet when riding both a Bicycle and a Motorcycle or Quadbike with a cumulative percentage of (93.8%). And almost all agreed on multiple approaches to help increase helmet use be it by forcing rental shops to give out helmets, forcing sellers to recommend the use of helmets, increasing awareness campaigns, and imposing fines for not wearing helmets. Conclusions: This study is the first to explore Family helmet use while riding Bicycles and Motorcycles/Quad bikes. Although Parent’s belief in the importance of helmet use for their children was high, it is clear that the level of practice is low. With that the risk of head injuries might be high, our findings suggest that safety interventions for increasing pediatric helmet use are needed to increase helmet use and reduce the risk of head injury and hospitalization.
基金supported by the Natural Science Foundation of Beijing,No.L222126(to LD)。
文摘A major challenge for the efficient treatment of traumatic brain injury is the need for therapeutic molecules to cross the blood-brain barrier to enter and accumulate in brain tissue.To overcome this problem,researchers have begun to focus on nanocarriers and other brain-targeting drug delivery systems.In this review,we summarize the epidemiology,basic pathophysiology,current clinical treatment,the establishment of models,and the evaluation indicators that are commonly used for traumatic brain injury.We also report the current status of traumatic brain injury when treated with nanocarriers such as liposomes and vesicles.Nanocarriers can overcome a variety of key biological barriers,improve drug bioavailability,increase intracellular penetration and retention time,achieve drug enrichment,control drug release,and achieve brain-targeting drug delivery.However,the application of nanocarriers remains in the basic research stage and has yet to be fully translated to the clinic.
基金supported by grants from The University of Connecticut School of Medicine (StartUp Fund)the National Institutes of Health (NIH)(Grant R01-EY029 739)+1 种基金the Connecticut Institute for the Brain and Cognitive Sciences (Research Seed Grant)the BrightFocus Foundation (Grant G2017204)(all to EFT)
文摘Studies from nearly 3 decades ago suggested that,in the central nervous system(CNS),myelination of axons by oligodendrocytes not only helps improve axonal conductivity but also stabilizes circuitry(Colello and Schwab,1994).Over the years,myelin sheaths produced by oligodendrocytes have been found to contain multiple molecules that are inhibitory to axonal growth(e.g.,MAG,NogoA,OMgp,Semaphorins)(Yiu and He,2006;Silver et al.,2014).After white matter injury in the adult CNS,myelin debris from damaged axons and dead oligodendrocytes accumulates in the forming glial scar and exposes these myelin-associated axon growth-inhibitory molecules to the injured axonal stumps,thereby contributing to the inhibition of axonal regrowth.During development,CNS axons reach their postsynaptic targets and stop growing before oligodendrocytes appear and myelinate them(Foran and Peterson,1992;Dangata et al.,1996).Therefore,myelin-associated axon growth-inhibitory molecules interacting with already grown axons during myelination were thought to block axons from promiscuous sprouting and miswiring,thereby stabilizing neural circuitry in the CNS(Colello and Schwab,1994).
