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Therapeutic temperature modulation is associated with pulmonary complications in patients with severe traumatic brain injury

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World Journal of Critical Care Medicine 2015年第4期4卷 296-301页

作者： Kristine H O’Phelan Amedeo Merenda Katherine G Denny Kassandra E Zaila Cynthia Gonzalez departments of Neurology and neurosurgery University of Miami Department of Neurology University of California Davis Hamilton College Division of Neurocritical Care University of California San Diego

AIM: To examine complications associated with the use of therapeutic temperature modulation(mild hypothermia and normothermia) in patients with severe traumatic brain injury(TBI). METHODS: One hundred and fourteen charts were reviewed. Inclusion criteria were: severe TBI with Glasgow Coma Scale(GCS) 24 h and non-penetrating TBI. Patients were divided into two cohorts: the treatment group received therapeutic temperature modulation(TTM) with continuous surface cooling and indwelling bladder temperature probes. The control group received standard treatment with intermittent acetaminophen for fever. Information regarding complications during the time in the ICU was collected as follows: Pneumonia was identified using a combination of clinical and laboratory data. Pulmonary embolism, pneumothorax and deep venous thrombosis were identified based onimaging results. Cardiac arrhythmias and renal failure were extracted from the clinical documentation. acute respiratory distress syndrome and acute lung injury were determined based on chest imaging and arterial blood gas results. A logistic regression was conducted to predict hospital mortality and a multiple regression was used to assess number and type of clinical complications. RESULTS: One hundred and fourteen patients were included in the analysis(mean age = 41.4, SD = 19.1, 93 males), admitted to the Jackson Memorial Hospital Neuroscience ICU and Ryder Trauma Center(mean GCS = 4.67, range 3-9), were identified and included in the analysis. Method of injury included motor vehicle accident(n = 29), motor cycle crash(n = 220), blunt head trauma(n = 212), fall(n = 229), pedestrian hit by car(n = 216), and gunshot wound to the head(n = 27). Ethnicity was primarily Caucasian(n = 260), as well as Hispanic(n = 227) and African American(n = 223); four patients had unknown ethnicity. Patients received either TTM(43) or standard therapy(71). Within the TTM group eight patients were treated with

关键词： Hypothermia Fever Pneumonia Traumatic brain injury Head injury

Incidence and Predictors of Dysphagia Following Anterior Cervical Discectomy and Fusion: Prospective Observational Study

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Open Journal of Modern neurosurgery 2018年第1期8卷 132-141页

作者： Yingda Li Kerry Hitos Su-Thet Mon Natalie Knight Nick Vrodos departments of neurosurgery Flinders Medical Centre Adelaide Australia Department of Surgery The University of Sydney Westmead Hospital Sydney Australia departments of Speech Pathology Flinders Medical Centre Adelaide Australia

The incidence of dysphagia following anterior cervical discectomy and fusion (ACDF) reported in the literature varies due to differences in measures and time intervals applied, ranging from nearly 3/4 at 2 weeks to 13% at 12 months. The most commonly used dysphagia scales remain subjective, non-validated, and do not capture functional impact. Various risk factors have been identified, though few consistently reproduced and none studied in an Australasian context. The aims of this study were to use objective and validated measures, assess both traditional and novel risk factors, and determine the impact of dysphagia on dietary status, length of stay and complications. METHODS: Twenty-nine adults undergoing ACDF for degenerative pathologies were enrolled between March and November 2015 in an Australian institution. Bazaz dysphagia scale, Dysphagia short questionnaire, 3-ounce swallow test and dietary status were assessed preoperatively, and 2 days and 6 weeks postoperatively. Descriptive statistics were used to characterise the study sample and logistic regression modelling performed on risk factors. RESULTS: Dysphagia incidence ranged from 85% on day-2 Dysphagia short questionnaire to zero on 6-week 3-ounce swallow. All measures increased at 2 days and fell by 6 weeks. Failing day-2 3-ounce swallow was the only measure associated with modifications in solids (P = 0.06), showing significant linear correlation (P = 0.02). Respiratory comorbidity increased risk of failing day-2 3-ounce swallow by more than 32-fold (OR: 32.4;95% CI: 1.8 - 587.7;P = 0.019) and scoring moderate or severe on Bazaz by almost 10-times (OR: 9.3;95% CI: 0.9 - 95.95;P = 0.061). Psychiatric history also increased risk of failing day-2 3-ounce swallow by more than 10-fold (OR: 10.9;95% CI: 1 - 123.7;P = 0.054). Failing 3-ounce swallow increased length of stay (5 versus 7 days;P = 0.013). CONCLUSIONS: Incidence of dysphagia following ACDF was dependent on the measure used, though all improved over

关键词： Dysphagia ACDF Incidence Predictors

Alterations of natural killer cells in traumatic brain injury

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Neuroscience Bulletin 2014年第6期30卷 903-912页

作者： Xiao-Dong Kong Sheng Bai Xin Chen Hui-Jie Wei Wei-Na Jin Min-Shu Li Yaping Yan Fu-Dong Shi departments of Neurology and neurosurgery Key Laboratory of Post-trauma Neuro-repair and Regeneration in the Central Nervous SystemMinistry of EducationTianjin Neurological InstituteTianjin Medical University General Hospital Department of Geriatrics Tianjin Geriatrics InstituteTianjin Medical University General Hospital Department of Neurology Barrow Neurological InstituteSt.Joseph's Hospital and Medical CenterPhoenixAZUSA

To investigate the relationship between natural killer（NK） cells and traumatic brain injury（TBI）, we tracked an established phenotype of circulating NK cells at several time points in patients with different grades of TBI. In serial peripheral blood samples, NK cells were prospectively measured by flow cytometry of CD3-CD56＋ lymphocytes. Compared to healthy controls, TBI patients had reductions in both the percentage and the absolute number of NK cells. Furthermore, the magnitude of NK cell reduction correlated with the degree of TBI severity at several time points. That is, NK cell population size was independently associated with lower Glasgow Coma Scale scores. In addition, at some time points, a positive correlation was found between the NK cell counts and Glasgow Outcome Scale scores. Our results indicate that TBI induces a reduction in the number of NK cells, and the magnitude of the reduction appears to parallel the severity of TBI.

关键词： natural killer cells traumatic brain injury central nervous system immunity

Thymosin <i>β</i>4 Improves Neurological Outcome and Enhances Induced Oligodendrogenesis in the Rat after ICH

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World Journal of Neuroscience 2014年第5期4卷 395-405页

作者： Dongmei Yang Yuxia Han Michael Chopp Donald M. Seyfried Department of Physics Oakland University Rochester MI USA departments of neurosurgery Henry Ford Health System Detroit MI USA departments of Neurology Henry Ford Health System Detroit MI USA

Thymosin β4 (Tβ4), a G-actin binding protein, has diverse biological functions. This study tested the effects of Tβ4 on oligodendrogenesis in a rat model of intracerebral hemorrhage (ICH). ICH was induced by stereotactic injection of 100 μm of autologous blood into the striatum in 32 male Wistar rats. The rats were randomly divided into four groups: 1) saline control group (n = 8);2) 3 mg/kg Tβ4-treated group (n = 8);3) 6 mg/kg Tβ4-treated group (n = 8);and 4) 12 mg/kg Tβ4treated group (n = 8). Tβ4 or saline was administered intraperitoneally starting at 24 h post ICH and then every 3 days for 4 additional doses. The neurological functional outcome was evaluated by behavioral tests (i.e., modified Neurological Severity Score and corner turn test) at multiple time points after ICH. Animals were sacrificed at 28 days post ICH, and histological studies were completed. Tβ4 treatment improved neurological functional recovery significantly and increased actively proliferating oligodendrocytic progenitor cells and myelinating oligodendrocytes in the ICH-affected brain tissue, compared with the saline-treated group. The high-dose treatment of Tβ4 showed better restorative effects compared with the low-dose treatment. Tβ4 treatment enhanced ICH-induced oligodendrogenesis that may contribute to the enhanced functional recovery after ICH. Further investigation is warranted to determine the associated underlying mechanisms of Tβ4 treatment for ICH.

关键词： Thymosin β4 Neurogenesis Oligodendrogenesis Intracerebral Hemorrhage

Risk factors for corticosteroid insufficiency during the sub-acute phase of acute traumatic brain injury

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Neural Regeneration Research 2020年第7期15卷 1259-1265页

作者： Xin Chen Yan Chai Shao-Bo Wang Jia-Chong Wang Shu-Yuan Yue Rong-Cai Jiang Jian-Ning Zhang Department of neurosurgery General Hospital of Tianjin Medical UniversityTianjinChina Tianjin Neurological Institute Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous SystemMinistry of EducationTianjin Key Laboratory of InjuriesVariations and Regeneration of Nervous SystemTianjinChina Department of neurosurgery Ordos Central HospitalOrdosInnerMongolia Autonomous RegionChina Department of neurosurgery Affiliated Haikou Hospital of Xiangya Medical CollegeCentral South UniversityChangshaHunan ProvinceChina

Hypothalamic-pituitary-adrenal axis dysfunction may lead to the occurrence of critical illness-related corticosteroid *** illness-related corticosteroid insufficiency can easily occur after traumatic brain injury,but few studies have examined this occurrence.A multicenter,prospective,cohort study was performed to evaluate the function of the hypothalamic-pituitary-adrenal axis and the incidence of critical illness-related corticosteroid insufficiency during the sub-acute phase of traumatic brain *** hundred and forty patients with acute traumatic brain injury were enrolled from the neurosurgical departments of three tertiary-level hospitals in China,and the critical illness-related corticosteroid insufficiency incidence,critical-illness-related corticosteroid insufficiency-related risk factors,complications,and 28-day mortality among these patients was *** illness-related corticosteroid insufficiency was diagnosed in patients with plasma total cortisol levels less than 10μg/dL(275.9 nM)on post-injury day 4 or when serum cortisol was insufficiently suppressed(less than 50%)during a dexamethasone suppression test on post-injury day *** results demonstrated that critical illness-related corticosteroid insufficiency occurred during the sub-acute phase of traumatic brain injury in 5.6%of patients with mild injury,22.5%of patients with moderate injury,and 52.2%of patients with severe *** brain injury-induced critical illness-related corticosteroid insufficiency was strongly correlated to injury severity during the sub-acute stage of traumatic brain *** brain injury patients with critical illness-related corticosteroid insufficiency frequently presented with hemorrhagic cerebral contusions,diffuse axonal injury,brain herniation,and *** in the incidence of hospital-acquired pneumonia,gastrointestinal bleeding,and 28-day mortality were observed between patients with and without critical i

关键词： brain herniation corticosteroid critical illness-related corticosteroid dexamethasone suppression test diffuse axonal injury gastrointestinal bleeding hemorrhagic cerebral contusions hospital-acquired pneumonia insufficiency prognosis traumatic brain injury

Thrombin Preconditioning Reduced iron Induced Neuronal Death Through Activating p44/42 MAPK-P70S6K Pathway:an in Vivo and in Vitro Study

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Thrombin Preconditioning Reduced iron Induced Neuronal Death...

Biological Resources within the Human Body Can be Used to Operate Neural Implants

2009年浙江省神经病学学术年会

作者： Richard F.Keep The Second Affiliated Hospital Medical SchoolZhejiang University departments of neurosurgery University of MichiganAnn ArborMichigan

Our previously studies have showed that preconditioning with a low dose of thrombin attenuated brain edema after intracerebral hemorrhage(ICH),large dose of thrombin and *** the effect of thrombin preconditioning(TPC) on neuronal death was not observed after *** study is going to investigate whether or not thrombin preconditioning reduces neuronal death induced by iron in vivo and in vitro and to determine the roles of thrombin receptors and p44/42MAPK-P70S6K signal transduction *** the in vivo studies,thrombin preconditioning reduced hippocampus neuronal loss and hippocampal swelling 1 day after intrahippocampal iron injection and hippocampal atrophy 7 days after iron *** blots indicated that pretreated with thrombin for 3 days activated p44/42 MAPK,not its downstream kinase *** hippocampus cells were pretreated with thrombin for 7days,P70S6K was also significantly *** the in vitro study,a low dose of thrombin(1U/mL) or thrombin receptor activating peptide preconditioning reduced the lactate dehydrogenase release induced by 500 M ferrous iron for 48 *** blots showed that p44/42 MAPK and P70S6K were activated after TPC in primary neurons,thrombin inhibitor PPACK(D-Phe-Pro-Arg chloromethylketone) eliminated thrombin induced p44/42 MAPK and P70S6K ***,inhibition of p44/42 MAPK activation by PD98059 abolished the thrombin-preconditioning *** indicate that thrombin preconditioning has protective effect on *** protective effect of thrombin preconditioning is partially achieved through activating thrombin receptors and the p44/42 MAPK-P70S6K signal transduction pathway.

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Biological Resources within the Human Body Can be Used to Op...

Dissemination of brain inflammation in traumatic brain injury

International Conference on Neural Interface and Control

作者： Daliang Leon Li Paul A. Roche Brian L. Wessel Robert J. Sclabassi Laboratory for Computational Neuroscience departments of neurosurgery Bioengineering and Electrical Engineering University of Pittsburgh Pittsburgh PA 15260

Implantable neural devices have many therapeutic, diagnostic, and prosthetic applications. Although there have been exciting developments in constructing these devices, two critical problems, data communication between the implanted device and external computers as well as electrical power to the device, have not yet been solved. We investigate these problems using the volume conduction properties of the human body. A prototype implantable device is constructed equipped with a volume conduction data communication channel. A new power delivery antenna is conceptualized, inspired by a study of the power delivery mechanisms of electric fish. Our investigation indicates that the volume conduction resources within the human body may provide a powerful solution to both problems.

关键词： Antenna Design data communication finite element simulation neural engineering neural implants power delivery telemetry volume conduction

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Cellular & Molecular Immunology 2019年第6期16卷 523-530页

作者： Kaibin Shi Jianning Zhang Jing-fei Dong Fu-Dong Shi departments of Neurology and neurosurgery Tianjin Neurological InstituteTianjin Medical University General HospitalTianjin 300052China Center for Neuroinflammation Beijing Tiantan HospitalCapital Medical UniversityBeijing 100050China Department of Neurology Barrow Neurological InstituteSt.Joseph’s Hospital and Medical CenterPhoenixAZ 85013USA BloodWorks Northwest Research Institute Division of HematologyDepartment of MedicineSchool of MedicineUniversity of WashingtonSeattleWA 98195USA

Traumatic brain injury(TBI)is recognized as a global health problem due to its increasing occurrence,challenging treatment,and persistent impacts on brain *** cell death in patients with TBI swiftly causes inflammation in the injured brain areas,which is recognized as focal brain *** brain inflammation causes secondary brain injury by exacerbating brain edema and neuronal death,while also exerting divergent beneficial effects,such as sealing the damaged limitans and removing cellular *** evidence from patients with TBI and studies on animal models suggest that brain inflammation after TBI is not only restricted to the focal lesion but also disseminates to remote areas of the *** dissemination of inflammation has been detected within days after the primary injury and persists *** state of inflammation may be related to remote complications of TBI in patients,such as hyperthermia and hypopituitarism,and may lead to progressive neurodegeneration,such as chronic traumatic *** studies should focus on understanding the mechanisms that govern the initiation and propagation of brain inflammation after TBI and its impacts on post-trauma brain pathology.

关键词： disseminated brain inflammation traumatic brain injury microglia post-injury neurodegeneration

A 32-million year cycle detected in sea-level fluctuations over the last 545 Myr

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Geoscience Frontiers 2020年第6期11卷 2061-2065页

作者： Michael R.Rampino Ken Caldeira departments of Biology and Environmental Studies New York University100 Washington Square EastNew YorkNY10003USA NASA Goddard Institute for Space Studies2880 BroadwayNew YorkNY10025USA Department of Global Ecology Carnegie Institution for Science290 Panama StreetStanfordCA94305USA

Spectral analyses of past relative sea-level oscillations as represented by the ages of 57 Phanerozoic(the last 545 Myr)stratigraphic sequence boundaries from the Canadian Arctic show a strong spectral peak at 32 Myr(>99.9%confidence).These findings concur with previous reports of significant cycles with periods of around 30 Myr in various records of fluctuations of sea level,and in potentially related episodes of tectonism,volcanism,climate,and biotic *** boundaries commonly coincide with stage boundaries based on biostratigraphy,and are correlated with episodes of extinction and times of flood-basalt *** connection between tectonics and sea-level variations may come from changes in rates of ocean-floor spreading and subduction,intraplate stresses from plate-reorganizations,and pulsations of hotspot *** coordinated periodic fluctuations in tectonics,sea level and climate may be modulated by cyclical activity in the Earth’s mantle,although some pacing by astronomical cycles is suspected.

关键词： Sea level Periodicity Sequence boundary