Search

Introduction: Data on the resumption of sporting activity (return-to-sport, RTS) after traumatic spine injuries are mainly available for elite athletes. This study aimed to determine the RTS rate in amateurs after spine injury and to identify factors possibly influencing RTS. Methods: First, a retrospective analysis of clinical data of patients with traumatic spine injuries receiving inpatient treatment at a national trauma center from 2016 to 2020 was performed. Patients up to the age of 60 who were active in sports before the injury were included. Patients with the following relevant concomitant injuries were excluded: spinal cord injury, pelvic injury, extremity injuries, as well as craniocerebral trauma grade 2 or higher. A telephone interview on participants' RTS within the first year after the injury was conducted. Participants with early and those with late or no RTS were compared in univariate analysis regarding potential influencing factors. The level of significance was set to p <.05. Results: Thirty-seven women (39%) and 57 men (61%) were included. The mean age was 44 years (16–60). The numbers of patients per injured segment of the spine were: cervical 15 (16%), thoracic 28 (30%), lumbar 33 (35%), multiple spine segments 18 (19%). Thirty patients (32%) were treated conservatively and 64 (68%) surgically. The RTS rate after six months was 62%, corresponding to 57 patients. Compared to patients with late or no RTS, patients with RTS within six months had a significantly lower BMI (24.6 vs. 27.4 kg/qm, p =.004), had isolated cervical spine injuries significantly more often (24% vs. 6%, p =.020), and had undergone outpatient or inpatient rehabilitation significantly less often (35% vs. 72%, p <.001). There were non-significant trends regarding mean age (42 vs. 46 years, p =.175), surgical therapy (66% vs. 75%, p =.333), and the proportion of patients who, before the injury, had been physically active for at least five hours per week (50% vs. 33%, p =.113). Patients with RTS within six months had sustained their spinal injury in a sports accident twice as often (28% vs. 14%, p =.121). Gender, preexisting medical or spinal conditions, severe injuries (types A4, B or C according to AO Spine), and surgical therapy were not significantly associated with RTS. The RTS rate within twelve months was 81% (76 patients). Conclusion: The RTS rate in amateur athletes after an isolated spinal injury without spinal cord injury was high, with 62% after six and 81% after twelve months. This reflects the effectiveness of the existing treatment and posttreatment concepts. Normal-weight patients and isolated cervical injury are favorable factors for RTS. The use of inpatient rehabilitation as a marker of protracted healing is associated with delayed or no RTS. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Implication for the Profession and Patient Care Patient or Public Contribution This study aimed to establish a comprehensive set of nursing‐sensitive quality indicators (NSQIs) for patients with dysphagia following tracheotomy due to acquired brain injury (ABI), based on the ‘structure‐process‐outcome’ model.A Delphi survey.The research utilised a mixed‐methods approach, including systematic literature reviews, qualitative interviews and two rounds of Delphi expert consultations. A diverse team comprising specialists in dysphagia rehabilitation and nursing management conducted the research, which involved defining and refining NSQIs through extensive evaluations and consensus among recruited experts.The finalised NSQI includes 4 structural indicators, 13 process indicators and 4 outcome indicators, covering key aspects such as resource allocation, patient assessment and clinical outcomes. The expert consensus provides verification. Kendall's harmony coefficients are 0.304 and 0.138 (p < 0.001), respectively, and the mean importance assignments of indicators at all levels are 3.90–5.00. The final care of patients with tracheotomy and dysphagia after brain injury was constructed. The evaluation indicators include a total of 4 first‐level indicators, 23 second‐level indicators and 52 third‐level indicators.The established NSQIs offer a systematic framework to enhance the quality of nursing care for ABI patients with posttracheotomy dysphagia. This model facilitates precise monitoring and proactive management of nursing practices, promising better patient outcomes and streamlined care processes.This study develops targeted NSQIs to improve dysphagia management in ABI patients’ posttracheotomy, fostering better patient outcomes and advancing nursing education through essential specialised training.Expert‐driven insights from experienced clinicians informed the NSQIs, ensuring their relevance and effectiveness in enhancing patient‐centred care. [ABSTRACT FROM AUTHOR]

(1) Introduction: Since electric scooters were launched in 2017, they have become increasingly popular worldwide and a cause of childhood trauma. (2) Case reports: This paper has a double-fold purpose: it reports two cases of epidural hematomas and compares them with electric scooter-related head trauma in the literature. An overview of the literature on this topic was performed to make such a comparison. Our cases are one of almost 52 cm3 and one of 129 cm3, both in two eight-year-olds. (3) Discussion: Although usually mild, traumatic brain injuries following e-scooter falls can also be moderate and severe. Reduced helmet use, high speed, and a lack of experience are the perfect set-up for potential severe injuries. Intracranial bleeds are not frequent, and epidural hematomas are rare in such cases, but they can significantly impact the individual, community, and healthcare system. No other medium- or large-sized epidural hematomas were reported in children sustaining electric scooter-related head trauma. (4) Conclusions: Our review parallels the literature and our hospital's experience. Although there are both similarities and discrepancies between our cases and the literature, mild trauma should not be disregarded, for it may hide serious complications requiring immediate surgery. [ABSTRACT FROM AUTHOR]

Objective: To determine the impacts of pain nursing intervention of patients with craniocerebral trauma combined with ocular trauma after decompressive craniotomy. Method: This was retrospective study. Eighty patients with craniocerebral trauma combined with ocular trauma who underwent unilateral decompressive craniectomy in Baoding No.1 Central Hospital from January 2023 to November 2023 were included and divided into the observation group(n=40) and the control group(n=40) according to different nursing methods. Patients in the control group received conventional nursing intervention, while those in the observation group received pain nursing intervention. The differences in sleep quality, self-care ability, quality of life, psychological state and nursing satisfaction were compared between the two groups. Results: After intervention, the pain degree of both groups was significantly reduced compared with that before intervention, and the reduction degree of the observation group was more than that of the control group, with a statistically significant difference (p<0.05). The SS-QOL scores of both groups were significantly improved compared with before intervention, and the improvement degree of the observation group was significantly better than that of the control group, with a statistically significant difference (p<0.05). The nursing satisfaction score of the observation group was (93.35±3.83) points, which was higher than (83.38±3.59) points of the control group, with a statistically significant difference (t=12.019, P=0.000). Conclusion: Pain nursing intervention shows a variety of benefits in the treatment of patients with craniocerebral trauma combined with ocular trauma after decompressive craniectomy, improving their quality of life, self-care ability and nursing satisfaction. [ABSTRACT FROM AUTHOR]

This study aims to systematically review case reports and case series in order to compare the postoperative course of conservative, endovascular and surgical treatments for traumatic dural arteriovenous fistulas predominantly supplied by the middle meningeal artery (MMAVFs), which usually occur following head trauma or iatrogenic causes. We conducted a comprehensive search of PubMed, Embase, Scopus, Web of Science, and Google Scholar until June 23rd, 2024. Three cohorts were defined based on the treatment modality employed. The primary outcomes were the rates of overall obliteration and postoperative complications, with all-cause mortlality considered as secondary outcome. A total of 61 studies encompassing 78 pooled MMAVFs were included in the qualitative analysis. The predominant demographic consisted of males (53.9%) with a median age of 50.5 (IQR: 33.5–67.5) years. The main etiologies for fistula formation were head trauma (75.6%), cranial neurosurgical procedures (11.5%) and endovascular embolization (8.97%). Venous drainage patterns were categorized as follows based on anatomical confluence: Class I (16.7%), II (14.1%), III (12.8%), IV (14.1%), V (7.7%), and VI (3.9%). Regarding treatment efficacy, the overall obliteration rate was 89.74%, achieved through endovascular (95.83%), surgical (64.29%) or conservative (93.75%) approaches. In terms of safety, the overall postoperative complication rate was 6.49% with an all-cause mortality rate of 8.97%, predominantly observed in the surgical group (35.71%). Our systematic review highlights the challenging management of traumatic MMAVFs, frequently associated with head injuries. Endovascular therapy has emerged as the predominant treatment modality, demonstrating markedly higher rates of fistula obliteration, reduced all-cause mortality, and fewer postoperative complications. Key messages: What is already known on this topic: The middle meningeal artery (MMA) often contributes to the arterial supply of dural arteriovenous fistulas (dAVFs). However, MMA-dominant fistulas are uncommon and typically occur following head trauma or iatrogenic injury. What this study adds: This study compiles the largest dataset to date on the demographics, clinical characteristics, therapeutic options, and postoperative outcomes of MMAVFs. How this study might affect research, practice or policy: By identifying potential therapeutic strategies to enhance postoperative outcomes in MMAVFs, this study contributes valuable insights for developing clinical practice guidelines. [ABSTRACT FROM AUTHOR]

Background: Chronic subdural hematoma (CSDH) is a common complication of neurosurgery. Craniocerebral trauma is the likely cause. There are no reports relating CSDH with nephrotic syndrome. Its pathogenesis is very rare, and there are no previous reports on treatments for this disease. We report a case of chronic subdural hematoma that may be caused by nephrotic syndrome and review the previous literature on this subject. Case summary: We report a rare case of chronic subdural hematoma that may be caused by nephrotic syndrome. After the patient was admitted to the hospital, relevant laboratory tests were conducted, and a large amount of protein was detected in the patient's urine, indicating hypoproteinaemia and hyperlipidemia. The patient was diagnosed with nephrotic syndrome. After the exclusion of related surgical contraindications, the patient underwent trepanation and drainage of the chronic subdural hematoma. Subsequent treatment with oral atorvastatin was provided after surgery. The patient was transferred to the nephrology department for further treatment of nephrotic syndrome if his neurological condition improved. No neurological sequelae were detected at the follow-up visit 3 months after the operation. Conclusion: Chronic subdural hematomas are rarely caused by nephrotic syndrome. Trepanation and drainage may be considered for patients confirmed to have adequate hematoma liquefaction on imaging and who can tolerate craniotomy. Atorvastatin should be supplemented as prophylactic treatment after the operation. Nephrotic syndrome should be treated as soon as the patient's neurological condition is stable. [ABSTRACT FROM AUTHOR]

Clinical and experimental studies have been shown,that after the combined craniocerebral injury, physiological mechanisms are damaged We maintain perfusion pressure. Partially or completely disruptedShares Autoregulating the brain blood flow. In these conditions after the craniocerebral injury, the brain is not able to respond to the systemic violator Wear homeostasis. As a result, various secondary damage ariseIn the brain tissue is predominantly corridor character thatWe are curved in 80-90% of the dead patients. Is currently among the systemsviolations of homeostasis, most often as secondary damaging factors of the headthe brain. The following: hypotension, hypoxemia, sodium exchange and osmotoostomy, hypocapnia and hyperDrip, hyperthermia, extra-causal inflammatory complications, etc. [1,2,3,4,10,11]. [ABSTRACT FROM AUTHOR]

Objective: To reveal the effect of purine 2X3 (P2X3) receptor (P2RX3) gene on neurological function recovery in rats with traumatic brain injury (TBI). Methods: The TBI model of rats was made by craniocerebral injury instrument. After the model establishment, 54 TBI model rats were randomly divided into TBI group (n=10), TBI+NC-sh group (n=11), TBI+P2RX3-sh group (n=11), TBI+NC-OE group (n=11) and TBI+P2RX3-OE group (n=11). Rats which only cut the skin without hitting were taken as Sham group (n=10). Rats in TBI+NC-sh group, TBI+P2RX3-sh group, TBI+NC-OE group and TBI+P2RX3-OE group were injected into the brain with NC-sh, P2RX3-sh, NC-OE and P2RX3-OE respectively. Normal saline was injected into the brain of rats in Sham group and TBI group. Rats were injected again 7 days after the first injection, and the samples were taken 14 days later. The modified neurological deficit score was used to evaluate the neurological function. Cognitive function was evaluated by Morris water maze test. Sucrose preference test and open field test were used to evaluate behavior. The water content of brain tissue was measured by weighing method. Apoptosis was detected by TUNEL staining. The fluorescence intensity of BDNF was detected by immunofluorescence staining. The level of P2RX3 mRNA was detected by RT-qPCR. The protein levels of P2RX3, BDNF, TrkB, p-TrkB, protein kinase B (Akt), p-Akt, Bcl-2 and Bax were detected by Western blot. Results: Compared with TBI group and TBI+NC-sh group, the relative levels of mRNA and protein of P2RX3 in TBI+P2RX3-sh group decreased (P<0.05), neurological function score, escape latency and brain water content were all increased (P<0.05), platform crossing times within 60 s, sucrose preference rate and horizontal and vertical activity scores all decreased (P<0.05), TUNEL positive rate and the relative protein level of Bax increased (P<0.05), the relative fluorescence intensity of BDNF and the relative protein levels of Bcl-2, BDNF, p-TrkB and p-Akt decreased (P < 0.05) . Compared with TBI group and TBI+NC-OE group, the relative levels of mRNA and protein of P2RX3 in TBI+P2RX3-sh group increased (P < 0.05), neurological function score, escape latency and brain water content were all decreased (P < 0.05) platform crossing times within 60 s, sucrose preference rate and horizontal and vertical activity scores all increased (P < 0.05) TUNEL positive rate and the relative protein level of Bax decreased (P < 0.05), the relative fluorescence intensity of BDNF and the relative protein levels of Bcl-2, BDNF, p-TrkB and p-Akt increased (P < 0.05) Conclusion: P2RX3 is up-regulated after TBI in rats, and up-regulation of P2RX3 can promote the recovery of neurological function, and its mechanism is related to the activation of BDNF/TrkB/Akt signal pathway. [ABSTRACT FROM AUTHOR]

Wilder Penfield is known for his contributions to the structure–function relationship of the brain and for the surgical treatment of focal epilepsy. Less well known are his contributions to the study of glial cells and his investigation of their role in human neuropathology. Penfield learned the gold and silver methods for staining neurons, glial cells, and their projections from Charles Sherrington and Pío del Río-Hortega. He and his colleague William Cone established a laboratory for the study of glial cells and human neuropathology using metallic stains, initially at the Presbyterian Hospital in New York City in 1925, and then at the Montreal Neurological Institute in 1928. Penfield, Cone, and their research fellows, building on the findings of Río-Hortega, confirmed the existence of oligodendrocytes and their relationship with myelin, and investigated the putative mesodermal origin of microglia. They discovered the reaction of oligodendrocytes to pathological stressors, and the phagocytic activity of microglia in human gliomas. In this article, we argue that Penfield’s studies of astrocytes, oligodendrocytes, and microglia, and their responses to craniocerebral trauma, epilepsy, malignant brain tumors, and other pathologies of the central nervous system inaugurated a new era in clinical neurocytology and neuropathology. [ABSTRACT FROM AUTHOR]

sTREM-1H and miR-126 play crucial roles in inflammation and immune responses, yet their involvement in patients with pulmonary infection following cranial injury remains understudied. The distribution of pathogens causing infection in patients with pulmonary infection after craniocerebral injury was explored, and the changes in the levels of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and miR-126 in peripheral blood were analyzed. In this study, 60 patients (study group) with postoperative lung infection in craniocerebral injury treated from January 2019 to December 2, 2021, and 60 patients without lung infection were selected as the control group. The study group received anti-infection treatment. The infection pathogen of the study group was tested, and the changes of sTREM-1 and miR-126 levels in the peripheral blood of the study and control groups were recorded to explore the diagnosis and predictive Value of prognostic death. 66 pathogens were detected, including 18 gram-positive bacteria, 42 gram-negative bacteria, and 6 fungi. The sTREM-1 level was higher than the control group, and the miR-126 level was lower than the control group. By ROC curve analysis, the diagnostic AUC values of both patients were 0.907 and 0.848, respectively (P< 0.05). Compared to those in the study group, patients had decreased sTREM-1 levels and increased miR-126 levels after treatment (P< 0.05). Compared with the survival group, patients in the death group had increased sTREM-1 levels and decreased miR-126 levels, and ROC curve analysis, the predicted AUC death values were 0.854 and 0.862, respectively. Gram-negative bacteria, with increased peripheral sTREM-1 levels and decreased miR-126 levels. The levels of sTREM-1 and miR-126 have specific diagnostic and prognostic Values for pulmonary infection after craniocerebral injury. However, the study’s conclusions are drawn from a limited sample and short-term data, which might limit their broader applicability. Future studies with larger populations and longitudinal designs are required to confirm these findings and determine these biomarkers’ robustness across different settings. Further research should also explore how these biomarkers influence patient outcomes in craniocerebral injuries. [ABSTRACT FROM AUTHOR]

Copyright of Nursing Journal / Sestrinski Glasnik is the property of Croatian Nurses Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Combined thoracic and abdominal trauma is considered one of the most severe in the structure of polytrauma, which causes a high frequency of complications – 33-72% and a mortality rate of up to 34%. The purpose of the study was to ensure the quality of the provision of medical services to victims with combined abdominal and thoracic trauma, through clinical assessment of the most significant symptoms and systematization of their manifestations aimed at justifying diagnostic and treatment measures. We conducted a prospective analysis of clinical manifestations in 44 victims with combined abdominal and thoracic trauma, who were treated at the city clinical hospital 16 of Dnipro in the period from 2019 to 2023. The average age of the victims was 41.5±2.4 years, men predominated – 40 (90.9%) people. In 40 (90.9%) victims, only 2 anatomical sites were damaged, 3 anatomical sites were damaged in 3 (6.8%) victims, 4 or more anatomical sites were damaged in 1 (2.3%) injured person. All victims were operated on. Multiple injuries of abdominal organs were observed in 14 (31.2%) victims. Among the injuries of the chest cavity, the most common cause was a lung contusion – 36.4% of cases. Exclusion criteria from the study were craniocerebral injury and contusion or injury to the heart as components of a combined injury. Also, the study did not include victims who received resuscitation measures during admission or at the stage of emergency care. Collection of complaints and anamnesis, examination, palpation, percussion and auscultation were used as research methods. The obtained information made it possible to determine the sequence of use of hardware and instrumental diagnostic methods. For better systematization of clinical symptoms, the latter were divided into three components – abdominal, thoracic and hemodynamic. The most frequent complaint was pain in the abdomen and in the chest area, respectively 75.6% and 82.9%. In the structure of the hemodynamic component, the victims most often complained of a feeling of general weakness – 73.2%. The accuracy of the symptoms detected during the diagnosis of damage to the abdominal organs ranged from 6.8% (Kulenkampf's symptom) to 93.2% pain of the abdominal wall. The diagnostic accuracy of Rozanov's symptom, which indicated damage to the spleen was 68.2%. Despite the fact, that such a symptom as pain during palpation of the chest occurred in 81.8% of victims, its diagnostic efficiency remains quite low – 54.5%. On the other hand, such a symptom as bone crepitation, with an accuracy of 95.5%, allowed us to assert the presence of rib fractures in the victims and hint at the probability of injury to the chest or abdominal organs, which we observed in 44.4% and 88.9% of cases, respectively. Damage to the lungs was also ascertained due to the sufficiently high diagnostic accuracy of the auscultatory symptom – weakening of breathing – 70.5%. Hypotension below 90 mm Hg. (45%; 50%), tachycardia (81.8%; 59.1%) and pallor of the skin (56.8%; 65.9%) showed sufficiently high diagnostic accuracy during the diagnosis of possible intraabdominal and intrapleural bleeding, respectively. The combination of damage to the organs of the abdominal and thoracic cavities was characterized by multifaceted clinical manifestations and signs of multisymptoms. Most of the symptoms taken separately had low accuracy regarding the presence or absence of a certain intracavitary post-traumatic pathology (from 6.8% to 43.2%); however, the combination of several of them indicated the multiplicity of damage to the organs of the abdominal cavity (from 41.7% to 100%). The best diagnostic accuracy was shown by Rozanov's symptoms – 68.2%, which indicated damage to the spleen and crepitation of rib fragments – 95.5%, as well as auscultatory weakening of breathing – 70.5%, which indicated lung damage. [ABSTRACT FROM AUTHOR]

Despite continuous medical advancements, traumatic brain injury (TBI) remains a leading cause of death and disability worldwide. Consequently, there is a pursuit for biomarkers that allow non-invasive monitoring of patients after cranial trauma, potentially improving clinical management and reducing complications and mortality. Aquaporins (AQPs), which are crucial for transmembrane water transport, may be significant in this context. This study included 48 patients, with 27 having acute (aSDH) and 21 having chronic subdural hematoma (cSDH). Blood plasma samples were collected from the participants at three intervals: the first sample before surgery, the second at 15 h, and the third at 30 h post-surgery. Plasma concentrations of AQP1, AQP2, AQP4, and AQP9 were determined using the sandwich ELISA technique. CT scans were performed on all patients pre- and post-surgery. Correlations between variables were examined using Spearman's nonparametric rank correlation coefficient. A strong correlation was found between aquaporin 2 levels and the volume of chronic subdural hematoma and midline shift. However, no significant link was found between aquaporin levels (AQP1, AQP2, AQP4, and AQP9) before and after surgery for acute subdural hematoma, nor for AQP1, AQP4, and AQP9 after surgery for chronic subdural hematoma. In the chronic SDH group, AQP2 plasma concentration negatively correlated with the midline shift measured before surgery (Spearman's ρ −0.54; p = 0.017) and positively with hematoma volume change between baseline and 30 h post-surgery (Spearman's ρ 0.627; p = 0.007). No statistically significant correlation was found between aquaporin plasma levels and hematoma volume for AQP1, AQP2, AQP4, and AQP9 in patients with acute SDH. There is a correlation between chronic subdural hematoma volume, measured radiologically, and serum AQP2 concentration, highlighting aquaporins' potential as clinical biomarkers. [ABSTRACT FROM AUTHOR]

Objectives. This study aimed to determine the degree of authenticity for the test implemented using a programmable installation for monitoring the functions of functional mobility, gait, and the state of the vestibular apparatus in students with disabilities who have sustained a blast traumatic brain injury. Material and methods. The study included a total of 39 first-year students with disabilities after an explosive brain injury. The following methods were used: theoretical analysis of scientific and methodological literature, the method of technical modelling, pedagogical testing, pedagogical experiment, and methods of mathematical statistics. In order to ascertain the efficacy of the proposed intervention, a 10-meter walking test was conducted. Results. The result of our study was the development using information systems and networks of a programmable device for the implementation of the 10-meter walking test, which is used to monitor the recovery of functional mobility, gait, and the state of the vestibular apparatus in students with disabilities after an explosive brain injury. The installation was based on a network of sensors organized according to the Arduino microcontroller platform. Acoustic, optical sensors, distance sensors, proximity sensors, presence sensors, and spatial position sensors have been placed to record the results of the test distance. The sensors, having received an information signal about the student passing the test, transmit it to the controller. In the controller, information is identified, processed, calculated and transferred to a personal computer, where it is displayed on the screen and reproduced graphically. The software ensures maintainability throughout the test, as well as efficiency of data processing, calculation of required parameters and their storage. Data processing is implemented using image analysis systems based on neural networks. According to the findings of testing and correlation analysis, indicators' authenticity degree for the used tests were established, which differed by the means of measuring the results. The level of correlation coefficient between the values for test reliability and validity in the case of fixing the test results using a stopwatch was not found to fall within the "low" and "acceptable" limits, while in the second case, when the results were fixed by a programmed control unit, it reached the "high" level. Conclusions. The use of the developed programmable device in the practical work of inclusive PE provides convenience, functionality, objectivity and reliability of control in the process of rehabilitation of students with disabilities after an explosive craniocerebral injury. What is confirmed by the values of the test authenticity measure obtained during the experiment when fixing the results by the developed installation. [ABSTRACT FROM AUTHOR]

This document presents the findings of a study on risk factors for early death in severe non-brain-injured trauma patients. The study analyzed various indicators, including Glasgow Coma Scale (GCS) score, spinal injury, blood pH, and clotting function, to determine their predictive value for early death. The results showed that lower GCS scores, spinal injury, lower blood pH, and longer activated partial thromboplastin time (APTT) were associated with increased early death. The combination of these indicators had the highest predictive value for early death. However, the study had limitations, such as its retrospective design and small sample size. [Extracted from the article]

Background: Craniocerebral injuries can cause inflammation and oxidative stress, and can have permanent effects on cognitive function. Moreover, over time, excessive expression of inflammatory factors and high levels of oxidative stress will be detrimental to recovery from craniocerebral injury and may exacerbate neurological damage, further damaging neurons and other cellular structures. In this study, we investigated changes in inflammation and stress indicators in patients with severe craniocerebral injuries, and analyzed associations with concurrent cognitive impairment. Methods: 82 patients with severe craniocerebral injuries admitted to Longyou County People's Hospital during January 2022--June 2023 were selected for retrospective study. Levels of inflammatory factors and the degree of oxidative stress were recorded and compared between the acute and chronic phases. Inflammatory measures included interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α) and C-reactive protein (CRP), and oxidative stress indicators included human cortisol (Cor), norepinephrine (NE), and superoxide dismutase (SOD). The patients' cognitive function was evaluated using the Mini-Mental State Examination (MMSE), and the incidence of cognitive impairment was assessed. Spearman's correlation was used to analyze associations between inflammatory and oxidative stress measures and MMSE scores; logistic regression was used to analyze the related factors affecting the patients' concurrent cognitive impairment ; and the receiver operating characteristic (ROC) curve was used to test the predictive value of inflammatory and oxidative stress measures on the patients' concurrent cognitive impairment in the acute phase and the chronic phase. Results: Patients had higher levels of IL-6, IL-10, TNF-α, CRP, Cor, and NE, and lower levels of SOD, in the acute phase compared to the chronic phase (p < 0.05). MMSE scores were higher in the acute phase than in the chronic phase (p < 0.05). A total of 50 cases were complicated by cognitive impairment, and the incidence of cognitive impairment was 60.98%. The levels of IL-6, IL-10, TNF-α, CRP, Cor, and NE in the chronic phase were positively correlated with the concurrent cognitive impairment, and the level of SOD was negatively correlated with the concurrent cognitive impairment (p < 0.05). Single-factor analysis showed that age and levels of IL-6, IL-10, TNF-α, CRP, Cor, and NE were higher in the cognitively impaired group than in the cognitively normal group, SOD levels were lower than in the cognitively normal group, and percentages of below-secondary school and frontal lobe damage were higher than those in the cognitively normal group (p<0.05). Logistic regression analysis showed that below-secondary school, frontal lobe injury, higher levels of IL-6, IL-10, TNF-α, and CRP in the chronic phase, and lower levels of SOD in the chronic phase were all relevant factors affecting the patients' concurrent cognitive impairment. As shown by the ROC curve, the area under the curve (AUC) for the combination of indicators was 0.949, sensitivity was 0.980, and specificity was 0.844. Conclusions: The incidence of cognitive impairment is higher in patients with severe craniocerebral injury, and the levels of inflammation and oxidative stress, which are not conducive to recovery, are higher in patients in the acute stage. The risk of concurrent cognitive impairment is higher in patients with a lower level of literacy, frontal lobe injury, and high levels of inflammatory factors and oxidative stress in the chronic stage; these indicators, therefore, have a significant predictive effect on the prognosis of the patients. [ABSTRACT FROM AUTHOR]

This study aimed to examine the mechanism of occipital condyle fractures (OCFs), their clinical symptoms, computer tomography (CT) scan findings, treatment options, and classification. A retrospective analysis was conducted on 43 patients with OCFs who were admitted to our neurosurgery center between 2017 and 2023. The investigation covered their clinical symptoms, CT scan results, and treatment outcomes. It was found that 25.6% of the patients suffered from severe craniocerebral injuries with Glasgow Coma Scale (GCS) scores of 3–8 points, 9.3% had moderate injuries with GCS scores of 9–12 points, and 65.1% exhibited mild injuries with GCS scores of 13–15 points. Of these patients, 90.7% showed improvement upon discharge, 4.7% succumbed to their injuries, and another 4.7% developed paraplegia. Symptoms indicative of OCF in individuals with CCJ injuries included neck pain, swelling, cranial nerve palsy, and posterior pharyngeal wall swelling. Frequently observed complications in OCF patients included cerebral contusion, occipital bone fractures, and skull base fractures. Employing thin-layer CT scans of the CCJ area, along with sagittal and coronal CT reconstructions, is essential for identifying OCFs. The fractures were classified into 3 types based on the Anderson-Montesano classification, which, when modified, provides enhanced treatment guidance. OCFs are predominantly present in cases of high-energy trauma, with high-resolution thin-layer CT scans serving as the preferred diagnostic method. The application of the modified Anderson-Montesano classification, distinguishing between stable and unstable fractures, facilitates the determination of suitable treatment strategies. Stable OCFs can be managed using a rigid neck brace, while unstable OCFs may require Halo-vest frame fixation or surgical intervention. [ABSTRACT FROM AUTHOR]

Timely identification of elderly patients who are at risk of developing intraoperative hypothermia (IH) is imperative to enable appropriate interventions. This study aimed to develop a nomogram for predicting the risk of IH in elderly patients undergoing resection of craniocerebral tumor, and to validate its effectiveness. Elderly patients who underwent craniocerebral tumor resection at a large tertiary hospital in eastern China between January 2019 and December 2022 were included (n = 988). The study population was divided into a training set and a validation set by time period. Risk factors identified through the Least Absolute Shrinkage and Selection Operator method and logistic regression analysis were used to establish the nomogram. The model was validated internally by Bootstrap method and externally by validation set through receiver operating characteristic curve analysis, Hosmer-Lemeshow test, and decision curve analysis. A total of 273 (27.6%) patients developed IH. Duration of anesthesia (P < 0.001), blood loss (P < 0.001), preoperative temperature (P < 0.001), tumor location (P < 0.001), age (P < 0.05), and mean arterial pressure (P < 0.05) were identified as independent risk factors for IH. A nomogram integrating these 6 factors was constructed. The area under the curve was 0.773 (95% confidence interval: 0.735–0.811) (70.5% specificity and 75.0% sensitivity), indicating good predictive performance. The decision curve analysis demonstrated the clinical benefit of using the nomogram. Our model showed good performance in identifying elderly patients who are at high risk of developing IH during craniocerebral tumor resection. The nomogram can help inform timely preventive interventions. [ABSTRACT FROM AUTHOR]

The aim of this study is to explain the higher incidence of subdural haematomas in elderly people compared to young adult. This research addresses the phenomenon by developing two distinct numerical models of the human head, simulating individuals people aged 77 and 28, respectively. These models are methodically constructed based on medical imaging data acquired through collaboration with hospitals and subsequently verified through empirical experimentation. Studies have shown that the main factor that influences the vulnerability to bridging vein rupture in older adults is the degenerative processes of nervous tissue. The most visible structural damage was observed in the outflow cuff segment. This phenomenon can be primarily attributed to specific geometric parameters associated with this anatomical region. The presented research emphasises the importance of computational models in understanding the pathomechanics of brain structures. As a result of the analyses, it was proven that the neurodegenerative processes of the brain that occur with age are crucial in understanding the higher incidence of subdural haematomas in elderly people. [ABSTRACT FROM AUTHOR]

We investigated the clinical characteristics, fall outcomes, and related factors of falls in patients who were hospitalized in the rehabilitation department, and explored strategies to reduce the incidence of falls and prevent falls in patients. Methods: Data from 60 patients who fell in the rehabilitation department between 2016 and 2021 were analyzed for clinical characteristics, associated factors, incidence of falls, injuries, and patient demographics. Under the random stratified sampling method, 60 patients who did not fall during the same period were selected as the control group, and relevant data was collected. Measurement data were compared using an independent sample t-test. Enumeration data were compared using chi-squared (χ2) test was employed to compare these data between the two groups. Non-parametric data were analyzed using the Mann–Whitney U-test. Factors potentially influencing falls were scrutinized through both univariate and binary logistic regression analyses. Results: The median annual incidence of falls among patients who were hospitalized in the rehabilitation department was 0.04%, while the overall fall injury rate was 60%. Falls were most prevalent within 30 days of hospitalization (71.67%). The most common fall-related condition was craniocerebral disease (83.33%). The incidents of falls location of fall were mainly reported in nearby areas of rehabilitation ward (70%). Most accidents occurred between 7:00 a.m.– 12:00 p.m. and 3:01 p.m.– 6:00 p.m. (63.33%), and dyskinesia was the most common cause of falls (71.67%). There were 39 patients (65.00%) with Barthel Index (BI) scores ranging between 40– 60. Conclusion: Patients in the rehabilitation department had a greater incidence of falls and fall injuries. Within 30 days of admission, patients with moderately dependent craniocerebral disorders and dyskinesia frequently experienced falls during typical daytime shifts in areas characterized by endemic conditions. [ABSTRACT FROM AUTHOR]

Explosion overpressure propagates extracranially and causes craniocerebral injury after being transmitted into the brain. Studies on the extent of skull to reduce impact overpressure are still lacking. Therefore, it is necessary to study the relationship between intracranial pressure (ICP) and external field pressure and the situation of craniocerebral injury under the blast wave. Pressure sensor of ϕ 1.2 mm was disposed 3 mm posterior to the bregma of rat skull, and type I biological shock tube (BST-I) was used as the source of injury while a side-on air pressure sensor was installed at the horizontal position of the ICP sensor. Eleven groups of blast experiments with peak air overpressure ranging from 167 kPa to 482 kPa were performed to obtain the variation law of ICP and injury of rats. Data measured by sensors show that the peak pressure formed in the rat brain are lower than the external air overpressure; the differential pressure between the inside and outside of the brain is 27–231 kPa. When side-on air overpressure is ≤363 kPa, ICP is ≤132 kPa, and the hemorrhage area of the rat's brain is <15%, the injury is minor. When side-on air overpressure is 363 kPa–401 kPa, ICP range is from 132 kPa to 248 kPa, hemorrhage area is about 15%–20%, and the injury increases. When side-on air overpressure is 401 kPa–435 kPa, ICP range from 248 kPa to 348 kPa, the hemorrhage area is about 20%–24%, and the injury is serious. When side-on air overpressure ≥482 kPa, the peak ICP surged to 455 kPa and the peak negative ICP reached -84 kPa, the hemorrhage area exceeded 26%. When the external blast wave is weak, skull can absorb the blast wave better, reducing the pressure by 81.4%, when the external shockwave is strong, skull only reduces the pressure by 5.6%, but both can play certain protective role. The fitting curve of air overpressure and ICP can be used to predict the changes of ICP under different external blast overpressure. Analysis of cranial injury showed that the area of cranial hemorrhage with extremely severe injury increased by 107.9% compared with mild injury, increased by 53.3% compared with moderate injury, and increased by 21.6% compared with severe injury. This work may provide references for the dynamic response of biological cranial and brain injury mechanism under the effect of blast wave. [ABSTRACT FROM AUTHOR]

Large defects on the face after Mohs surgery have posed significant reconstructive challenges. A 90-year-old man presented with melanoma in situ of the central forehead, which resulted in a 4.5cmx4.3cm defect after multiple stages of Mohs surgery. Although different approaches for forehead repair with nasal root involvement are possible, we demonstrate that the V-Y advancement flap and subsequent Burrow graft for nasal root repair represents a viable closure technique for large circular defects of the central forehead. [ABSTRACT FROM AUTHOR]

Context: Penetrating craniocerebral injury associated with depressed skull fracture is an infrequent yet timely neurosurgical emergency. Such injury frequently occurs in the frontal region during traffic accident or stone throw in the civilian setting. As military neurosurgeons, we present our experience in the surgical debridement and reconstruction of this peculiar type of traumatic brain injury. Methods: The patient lies supine, the head in neutral position heal by a Mayfield head clamp. The first step is the debridement of the frontal wound. Then, the depressed skull fracture is operated on using a tailored coronal approach through Merkel dissection plane, in order to keep a free pericranial flap. The bone flap is cut around the depressed skull fracture. Neuronavigation allows to locate the frontal sinus depending on whether it has been breached and thus requires cranialization. Brain and dura mater debridement and plasty are performed. Cranioplasty is performed using either native bone fragments fixed with bone plates or tailored titanium plate if they are too damaged. Conclusion: Performing wounded skin closure first and then a tailored coronal approach with free pericranial flap and a craniotomy encompassing the depressed skull fracture allows to treat frontal penetrating craniocerebral injury in an easy-to-reproduce manner. [ABSTRACT FROM AUTHOR]

Purpose: Pediatric traumatic brain injury (PTBI) is a frequent pathology in the pediatric environment and remains a public health concern in the world. PTBI is the leading cause of death and severe disability in children in countries with limited pediatric trauma legislation. The objective is to report the experience of the management of PTBI in children in Chad. Methods: This report is a prospective study of 256 patients admitted for PTBI over a year period. Result: The incidence was 19.09%. The mean age was 6.2 years with extremes of 1 day and 15 years. The male represented 68.8% with a ratio of 2.2. The transport of the injured patients to health facilities using other means than ambulances in 87.5%. Initial loss of consciousness (IOL) accounted for 79.1% and coma seizures for 34.37%. Public road accidents accounted for 64.5% of causes. Severe traumatic brain injury (TBI) accounted for 24.2%. The cerebral scanner was performed in 37.9% of cases and had shown the association of craniocerebral lesions in 10.1% of cases. Craniocerebral wound trimming was the most common surgical procedure performed in 21.8% of cases, followed by removal of the depressed fracture of skull in 6.2% of cases. Mortality rate was 9% and sequelae 5.4%. Conclusion: PTBI is a frequent neurosurgical pathology in the pediatric setting in Chad. The absence of health insurance in our context makes access to care and radiological examinations very difficult. The prognosis was conditioned by the rapidity of the management and the initial loss of consciousness. [ABSTRACT FROM AUTHOR]

Background: The protective mechanism of dexmedetomidine on the brains of patients undergoing craniocerebral surgery remains unclear. The aim of this study was to examine the impact of dexmedetomidine on cognitive function, oxidative stress, and brain protection in such patients. Methods: Fifty-four patients who underwent craniocerebral surgery at our hospital from January 2020 to June 2023 were retrospectively selected as study subjects. They were divided into two groups: the control group (n = 27) and the study group (n = 27), based on different auxiliary anesthesia protocols. Patients in the study group received dexmedetomidine before anesthesia induction, using a midline intravenous pump to assist anesthesia, while the control group received an equivalent amount of normal saline. The remaining anesthesia induction and maintenance protocols were consistent for both groups. Cognitive function was assessed using the Mini Mental State Examination (MMSE) before and 1 day after surgery for both groups. Oxidative stress indicators, including malondialdehyde (MDA), glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD) levels in the serum of both groups, were measured using enzyme-linked immunosorbent assay (ELISA). Additionally, changes in postoperative brain injury indicators, namely neuron-specific enolase (NSE) and central nervous system-specific protein (S100β), were detected and compared in the serum of both groups. Concurrently, postoperative adverse reactions were recorded for both groups. Results: The MMSE scale scores of both groups of patients 24 hours after surgery were significantly lower than those before surgery. However, the MMSE scale scores of the study group patients were notably higher than those in the control group, with a statistically significant difference (p < 0.05). One hour after surgery, the serum levels of MDA, GSH-Px, and SOD in both groups of patients were significantly elevated compared to pre-surgery levels. Yet, the study group exhibited significantly lower levels of MDA, GSH-Px, and SOD in comparison to the control group, and these differences were statistically significant (p < 0.05). The serum levels of NSE and S100β in both groups were markedly higher than preoperative levels 24 hours after surgery. However, the study group demonstrated significantly lower levels of serum NSE and S100β compared to the control group, with a statistically significant difference (p < 0.05). The incidence of postoperative complications in the study group was 7.41% (2/27), indicating a decreasing trend compared to 18.52% (5/27) in the control group. However, this difference did not reach statistical significance (χ² = 1.477, p = 0.224). Conclusion: Dexmedetomidine-assisted anesthesia in craniocerebral surgery can effectively enhance postoperative cognitive function, mitigate oxidative stress, and facilitate overall postoperative recovery for patients. The intervention exhibits a favorable safety profile with no reported serious adverse reactions, establishing it as a relatively safe and reliable approach. [ABSTRACT FROM AUTHOR]

Background: Decompressive craniectomy (DC) is a neurosurgical technique that is gaining renewed interest due to the worldwide resurgence of head injuries. We aimed to analyze the quality of management and prognosis of patients who underwent this surgery in the context of limited resources. Methods: This was a prospective, longitudinal, descriptive, and analytical study following STROBE, lasting 36 months at the National Hospital of Niamey in patients who had undergone DC. P = 0.05 was considered significant. Results: During our study, we collected 74 cases of DC. The mean age was 32.04 years (10-75 years), with male predominance (91.89%). DC was mainly performed following head trauma (95.95%), the main cause of which was road traffic accidents (76%; 54/71). On admission, most patients presented with altered consciousness (95.95%) and pupillary abnormalities (62.16%). The average time between brain damage and brain scan was 31.28 h, with parenchymal contusion being the most frequent lesion (90.54%). The majority of patients (94.59%) underwent decompressive hemicraniectomy. Postoperative complications accounted for 71.62% of all cases, with 33.78% resulting in death. Among survivors, 55.10% had neurological sequelae at the last consultation (27/49). The main factors associated with the risk of death and morbidity were a Glasgow coma score =8, pupillary abnormality on admission, the presence of signs of brain engagement, and a long admission delay. Conclusion: Our study shows that the impact of limited resources on our care is moderate. Future research will concentrate on long-term monitoring, particularly focusing on the psychosocial reintegration of patients post-DC. [ABSTRACT FROM AUTHOR]

Raised intracranial pressure is common leading cause of mortality in patients suffering from a traumatic craniocerebral injury. Currently, head injury constitutes a major public health problem across the world. Decompressive craniectomy is currently emerging as a preferred treatment strategy for patients suffering from refractory intracranial hypertension, which is unresponsive to appropriate neurocritical care management. The meticulous execution of decompressive craniectomy requires an understanding of anatomy, the pathogenesis of raised intracranial pressure, meticulous surgical technique, proper planning in association with the competent anesthetic team and paramedical staff to provide improved neurological outcome, and a significant reduction in mortality and morbidity. We provide a review of the status and appropriate review of this surgical procedure. High Lights: After over 100 years of the decompressive craniectomy (DC) procedure, clear indications are not present. Great variability exists for this technique, yielding variation in outcomes and creating comparative data. Decompressive craniectomy has been shown to decrease intracranial pressure and mortality. Decompressive craniectomy might increase vegetative state rates. [ABSTRACT FROM AUTHOR]

A topic of current research is the development of a new approach to the diagnosis and treatment of severe brain injury taking into consideration its main pathophysiological mechanism—idiopathic intracranial hypertension syndrome. The goal of this study was to identify Doppler patterns of unfavorable craniocerebral injury conditions to form a consistent algorithm of treatment measures to reduce secondary brain damage in patients with severe craniocerebral trauma. Transcranial Doppler imaging is a prospective method, which allows quick and noninvasive assessment of the intracerebral blood flow dynamics right at the patient's bedside. Due to the operator-dependent nature of this method, clinical interpretation can often be contradictory. As a result, no clear criteria for therapy correction have yet been formulated based on this neuroimaging method. Analysis of the therapy performed allowed us to specify the options for the hyperosmolar solutions for the correction of idiopathic intracranial hypertension syndrome. No statistically significant difference in effectiveness was shown between mannitol and hypertonic saline solutions. [ABSTRACT FROM AUTHOR]

Background. Lesions of the vertebral artery (VA) may develop spontaneously or as a result of severe traumatic cervico-cephalic injuries. Most frequent VA injuries (VAI) result from blunt trauma to the spine or may be due to penetrating lesions. VAI plays a significant role in the broader context of cervical spine trauma by providing insights into the vascular aspects of spinal cord injury (SCI). Upper cervical spine fractures and accompanying subluxation, as well as transverse process fractures extending into the artery bone foramen, are associated with an elevated risk of VAI. Clinical case. A 63-year-old female patient with flaccid C4 AIS-A quadriplegia (global motor score 3/100), vertebral myelopathy, neurogenic bladder, sacral pressure sore, and blindness was transferred from the spinal neurosurgical department. The patient fell from the same level and suffered a mild brain concussion and, apparently, a minor cervical SCI on October 1, 2022. She was asymptomatic, then quickly became tetraplegic, and then blindness added on in a few days. She was operated on on October 7, 2022, for a C6 vertebral body fracture and a C5-6 dislocation. The surgical protocol consisted of anterior spinal cord decompression, dislocation reduction, and mixed anterior fusion with bone grafts and fixation screws. Following the traumatic event, a bilateral posterior cerebral artery (PCA) stroke subsequently produced blindness and partial optic atrophy in both eyes. Serial clinical and imaging examinations confirmed the diagnosis: a subacute bilateral occipital stroke and a chronic lacunar lesion in the right thalamus associated with a severe spinal cord lesion. Anticoagulation has partially improved the neurological outcomes of stroke in the PCA territory. Ethical considerations. The patient's next of kin has given written consent to the case study and to use the radiological images related to the case for academic purposes. The personal identity data was anonymized. The presentation of this clinical case has the approval of the ethics commission of TEHBA (no. 40205/01.09.2023). Discussion. The clinical example is notable for the concurrent development of two severely devastating neurological syndromes, quadriplegia, and blindness, which occurred after an initially minor cervical trauma and progressed gradually Careful clinical and imaging monitoring through detailed serial imaging procedures must be performed for every person with severe cranio-cervical trauma. The clinical example emphasizes the importance of the interprofessional team's participation in the patient's care.over a few days. VA lesions after cervical trauma are considered rare, and the diagnosis is difficult because the vast majority of individuals do not exhibit cerebral neurological symptoms (due to the collateral compensatory blood supply from the circle of Willis). Most of the patients with bilateral or dominant VA occlusions are symptomatic, with rapid (and possibly fatal) ischemic damage to the encephalon, cerebellum, or brainstem. The detection and tracking of evolutionary tendencies required a series of clinical tests, including fundoscopy, and imaging procedures, including native CT, MRI, and MR angiography scans of the brain and spine. Conclusions. Although VAI is a rare complication, in every polytrauma patient with head and neck trauma, VA damage should be suspected. [ABSTRACT FROM AUTHOR]

Introduction: Real-time ultrasound-guided percutaneous kidney biopsy is essential for diagnosis and treatment planning; nonetheless, the optimal puncture approach has yet to be established. In vivo, performing different approaches on the same patient at once is not possible. This study aimed to determine the impact of different approaches on the number of obtained glomeruli and their potential to cause arterial injury using pig kidneys, which are similar to humans. Methods: A total of 120 pig kidneys (60 right-sided kidneys and 60 left-sided kidneys) for research were obtained from a slaughterhouse. The specimens were collected from the lower pole on the sagittal plane of the kidney using three different approaches on the same kidney: caudocranial approach, caudal to cranial; craniocaudal approach, cranial to caudal; and vertical approach, through the surface cortex. Five blinded pediatric nephrologists assessed the number of glomeruli and arterial injuries. Results: Overall, 360 specimens were collected from the kidneys through biopsy using a 16-gauge needle (mean vertical kidney length, 11.2 ± 0.7 cm; mean depth, 3.47 ± 0.23 cm). No significant difference in the incidence of arterial injury was observed between the three approaches (caudocranial vs. craniocaudal vs. vertical approaches: 78% vs. 87% vs. 87%, p = 0.14). In contrast, the vertical approach retrieved significantly more glomeruli than the caudocranial and craniocaudal approaches (caudocranial approach: 7.5 ± 2.8, craniocaudal approach: 7.8 ± 2.7, and vertical approach: 8.9 ± 3.3, p < 0.001). Conclusions: Considering its efficacy and safety profile, the vertical approach may be preferred, as more glomeruli can be obtained without increasing the incidence of arterial injury. Although the results cannot be directly extrapolated to humans due to the differences between species, they still offer important insights into the characteristics of each approach. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 24-year-old woman of periorbital pustules in a initially presenting with mildly itchy lesions associated with recent constipation. Topics include the clinical examination revealing erythematous, edematous plaques with pinhead-sized pustules bilaterally around the periorbital region, scattered erythematous papules on the mandibular region and forehead, and subsequent diagnostic findings ruling out chronic inflammatory bowel disease.

Background Various high-energy tasks in the construction industry can lead to craniocerebral injuries. Construction industry–associated penetrating craniocerebral injuries due to metal foreign bodies have unique characteristics. However, no norms exist for removing metal foreign bodies and preventing secondary trauma. This study aimed to explore the characteristics and treatment of construction industry–associated penetrating craniocerebral injuries due to metal foreign bodies. Methods Data of patients who suffered from penetrating injuries due to metal foreign bodies and were treated in the Zhongshan People's Hospital from 2001 to 2021 were collected based on the causes of injuries to explore disease characteristics and therapeutic effects. Results A total of six patients with penetrating craniocerebral injuries due to metal foreign bodies, who underwent surgeries, were included in the study. Five patients recovered well after the surgery, and one patient died. In four patients, intracranial infection complicated the course after surgery, and two patients had delayed intracranial hematoma. Conclusion Patients with construction industry–associated penetrating craniocerebral injuries due to metal foreign bodies are prone to coma and intracranial vascular injuries. Early surgical removal and prevention of intracranial infection are key to achieving good therapeutic effects. [ABSTRACT FROM AUTHOR]

Head injuries represent a large group of injuries with a high mortality rate. This type of trauma is significant because it can lead to disability and serious mental disorders of the person. The number of head injuries is about 300 per 100,000 people per year, with a mortality rate of 9 to 25 cases per 100,000 people. Aim: To show the number of patients with brain injuries admitted to PHI "Clinic for Neurosurgery" in Skopje in the period of three years (2020-2022) according to: gender, type of cerebral injury and treatment outcome. The aim is also to show the role of the nurse in the treatment of patients with brain injury. Results: In 2020, a total of 56 patients were hospitalized at the Department of Neurosurgery, of which 44 patients were diagnosed with subdural and 12 patients with epidural hematoma. Out of the total number of respondents, 45 patients are men, while 11 patients are women. A total of 25 patients died (44.6%). In 2021, 53 patients were hospitalized, 48 of them with subdural and 5 with epidural hematoma, 34 male patients and 19 female patients. A total of 18 (33.9%) died. During the year 2022, a total of 64 patients were hospitalized, of which 48 patients with subdural and 16 patients with epidural hematoma, 53 male patients and 11 female patients. A total of 12 patients died (18.7%). Conclusion: Due to the high mortality rate it is very important to start early rehabilitation immediately after any type of brain injury. This prevents the occurrence of complications, which can be early and late, reduces the length of the patient's rehabilitation and recovery. Greater education and training of nurses contributes to improved care both in the pre-operative and post-operative period, in order to improve the treatment of patients with brain injuries. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical efficacy of neuromuscular electrical stimulation(NMES) combined with intermittent pneumatic compression in the prevention of lower extremity deep venous thrombosis(LEDVT) in patients with craniocerebral trauma, and to provide evidence for the selection of intervention measures to prevent LEDVT. Methods: A total of 72 patients with craniocerebral trauma who were treated at the Lu'an Hospital Affiliated to Anhui University of Traditional Chinese Medicine from November 2020 to August 2021 were included in the study. They were randomly divided into control group and an observation group, with 36 patients in each group. The control group was given routine measures plus intermittent pneumatic compression intervention, while the observation group was given NMES based on the control group. Patient data were collected and compared between the two groups in terms of LEDVT status, length of bed, hospital stay,coagulation function indicators (prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer (D-D), and fibrinogen (FIB)) levels, blood flow velocity of popliteal vein and common femoral vein,Visual analogue scale (VAS) score, and activities of daily living (ADL) score before and after intervention. Results: The incidence of LEDVT in the observation group was 5.56% (2/36) lower than that 25.00% (9/36) in the control group, and the, length of bed and hospital stay in the observation group was shorter than that in the control group(P<0.05). After intervention, the levels of PT, APTT, D-D, FIB in the two groups were significantly improved compared to those before intervention, and the improvement in the observation group was more significant than that in the control group(P<0.05). After intervention, the blood flow velocity of popliteal vein and common femoral vein and ADL score in the two groups increased compared to those before intervention,while the VAS score decreased compared to those before intervention. The blood flow velocity of popliteal vein and common femoral vein and ADL score in the observation group were higher than those in the control group, while the VAS score were lower than those in the control group (P<0.05). Conclusion: NMES combined with intermittent pneumatic compression can shorten the bedtime and hospitalization time of patients with craniocerebral trauma, improve the coagulation function and blood circulation of patients, reduce the occurrence of LEDVT, and help to alleviate pain and improve their ability of live. [ABSTRACT FROM AUTHOR]

To examine the impact of hyperbaric oxygen intervention on oxidative stress and nerve growth factor in patients with craniocerebral injury.Methods: Using the random number table method, 40 patients with craniocerebral injury who were treated at the First People's Hospital of Nantong were randomly assigned to either the control group or the hyperbaric oxygen group, with 20 patients in each group. The control group received routine intervention for clinical traumatic brain injury, while the hyperbaric oxygen group received additional hyperbaric oxygen intervention during the 7 to 30 days of routine intervention. Indicators of oxidative stress and nerve growth factor levels were compared between the two groups at the time of admission and 30 days after therapy.Results: The serum levels of superoxide dismutase, endothelium-derived relaxing factor—nitric oxide, and nerve growth factor in the hyperbaric oxygen group increased more significantly than in the control group. The serum malondialdehyde concentration was also significantly reduced in the hyperbaric oxygen group.Conclusion: Hyperbaric oxygen intervention can successfully lower systemic oxidative stress response and increase the expression level of nerve growth factor in patients with craniocerebral injury. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Sports Medicine / Medycyna Sportowa is the property of Agencja Wydawnicza Medsportpress Sp. z o. o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Langenbach (1820) first described paranasal sinus mucoceles under the name of hydatids. Roulette (1909) introduced the name mucocele. Paranasal sinus mucocele is the accumulation of mucus secretions and exfoliated epithelium in the sinuses, causing enlargement of the sinus walls. It is considered a cystic, dilatation-eroding lesion. However, the mucocele often occurs as a localized mass, causing bone erosion and displacement of surrounding structures. If left untreated, a nearby mucocele in the brain can become infected and lead to death. Frontal sinuses are often involved; sphenoid, ethmoid, and maxillary mucoceles are rare. Mucoceles usually result from sinus ostium obstruction due to infection, fibrosis, inflammation, trauma, surgery, or obstruction by tumors such as osteomas. Of all causes, patients most often present with cranio-facial trauma (82.97%) and the most common mechanism is human aggression (90.85%).Case Presentation: This 30-year-old male patient presented with a frontal head swelling of one year duration that started after he sustained a stick injury on the frontal head one year ago, and he has an associated frontal headache for one year. There was a 4x5cm frontal, firm, palpable, non-tender lesion extending from the nasion to the frontal head. On the brain CT scan, there was frontal bone erosion at multiple sites with partial frontal sinus opacity, an externally growing mass, and an old frontal sinus fracture noted. Bifrontal craniotomy and bilateral frontal sinus cranialization were done, and the patient was discharged on the third day and seen a month later with complete improvement from headache and swelling.Conclusion: The incidence and pathophysiology of posttraumatic frontal sinus mucoceles are not known yet. The surgical management of mucocele demand a multidisciplinary team involving neurosurgeons, ear nose and throat surgeons, oral and maxillofacial surgeons, ophthalmologists and plastic and reconstructive surgeons. By treating the primary cause, frontal sinus fracture at contact, this case report aims to raise awareness of and prevent frontal sinus mucocele and related complications. [ABSTRACT FROM AUTHOR]

Transplantology is constantly evolving. New challenges are emerging, including those related to transplants after suicide. Concerned for the welfare of donor families who have experienced the trauma of a loved one's suicide, it is important that the donation decision process be as minimally burdensome as possible. Therefore, it is important to raise public awareness of organ donation in the context of suicide. Educating the public can help break down the barriers and false beliefs about the process. Although suicide is a profoundly tragic event, the opportunity to donate an organ to save another person's life is extremely valuable. The purpose of this paper is to show the legal and ethical treatment of organ transplantation from suicidal patients. The article presents a case report of a person who committed suicide, but for whom resuscitation was undertaken in the prehospital setting, despite severe craniocerebral trauma, and a return of spontaneous circulation was achieved. Subsequent in-hospital efforts made it possible to successfully maintain vital functions and declare brain death. The commitment of the medical personnel and the professional discussions with the patient's family made it possible to obtain consent for the donation of seven organs. [ABSTRACT FROM AUTHOR]

Objective: Primary brain injuries, which are the result of severe head trauma and cannot be prevented, are always catastrophic and fatal. Yet, if diagnostic and therapeutic steps are taken promptly after a craniocerebral injury, further brain insults may be prevented and the victim's death can be avoided within 24 hours. Materials and Methods: Source of data, sample size, inclusion criteria, exclusion criteria, statistical methods. Results: One hundred individuals with confirmed cumputer tomography (CT) scan results of severe head trauma participated in this analysis. Seventy men and thirty women accounted for the total number of patients. The research included 70% men and 30% women. The M/F ratio is 2.3:1. Males between the ages of 21 and 30 (a total of 21 patients) had the highest rate of head injury in our analysis. Males had a lower incidence overall, with nine cases in the 0–10 age range, 11 cases in the 11–20 age range, five cases in the 41–50 age range, three cases in the 51–60 age range, and four cases in patients older than 61. Similarly, eight of the female patients were in the 21–30 age range. There were also four patients between the ages of 0 and 10, four between the ages of 11 and 20, two between the ages of 41 and 50, five between the ages of 51 and 60, and three among those older than 61. Summary and Conclusion: Men were more likely than women to sustain a head injury. The majority of the study population consisted of patients between the ages of 21 and 30 and 31 and 40. Injuries were found to most often occur in car crashes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of hyperbaric oxygen (HBO) combined with bronchoalveolar lavage on the clinical efficacy and serum levels of soluble triggering receptor expressed on myeloid cell-1(sTREM-1), high mobil ity group protein B1 (HMGB1) and C-reactive protein/albumin (CRP/Alb) in patients with severe craniocerebral injury and pulmonary infection (PI). Methods: 72 patients with severe craniocerebral injury and PI admitted to Lu'an Hospital Affiliated to Anhui University of Traditional Chinese Medicine from September 2019 to September 2022 were selected as the study subjects. They were divided into observation group and control group according to random number table method, with 36 patients in each group. The control group was treated with bronchoalveolar lavage, while the observation group was treated with HBO combined with bronchoalveolar lavage. Collect the clinical data of the two groups, and compared the clinical efficacy, clinical signs[body temperature, arterial partial pressure of oxygen (PaO2), white blood cell count (WBC)], clinical pulmonary infection score (CPIS), adjusted score of systemic inflammatory response syndrome (ASS) score, glasgow coma score (GCS), serum indicators (sTREM-1, HMGB1, CRP/Alb) before and after treatment. Results: The total effective rate in the observation group was 94.44% higher than 77.78% in the control group (P<0.05); After treatment, the body temperature, WBC, CPIS score and ASS score of the observation group were lower than those of the control group, while PaO2 and GCS scores were higher than those of the control group(P<0.05); After treatment, the serum levels of sTREM-1, HMGB1, CRP/Alb in the observation group were lower than those in the control group(P<0.05). Conclusion: HBO combined with bronchoalveolar lavage in the treatment of severe craniocerebral injury and PI can reduce inflammatory reaction, reduce the degree of PI, reduce clinical signs and improve clinical efficacy. [ABSTRACT FROM AUTHOR]

Introduction: Civilian craniocerebral firearm injuries are extremely lethal. Management includes aggressive resuscitation, early surgical intervention when indicated, and management of intracranial pressure. Patient neurological status and imaging features should be used to guide management and the degree of intervention. Pediatric craniocerebral firearm injuries have a higher survival rate, but are much rarer, especially in children under 15 years old. This paucity of data underscores the importance of reviewing pediatric craniocerebral firearm injuries to determine best practices in surgical and medical management. Case presentation: A 2-year-old female was admitted after suffering a gunshot wound to the left frontal lobe. Upon initial evaluation, the patient displayed agonal breathing and fixed pupils with a GCS score of 3. CT imaging showed a retained ballistic projectile in the right temporal-parietal region with bifrontal hemorrhages, subarachnoid blood, and a 5-mm midline shift. The injury was deemed nonsurvivable and non-operable; thus, treatment was primarily supportive. Upon removal of the endotracheal tube, the patient began breathing spontaneously and improved clinically to a GCS score of 10–12. On hospital day 8, she underwent cranial reconstruction with neurosurgery. Her neurological status continued to improve, and she was able to communicate and follow commands but retained notable left-sided hemiplegia with some left-sided movement. On hospital day 15, she was deemed safe for discharge to acute rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effect of guipizide maleate combined with hyperbaric oxygen therapy on neurophysiological and coagulation indices in patients with heavy craniocerebral injury. Methods: The study involved a total of 80 patients with craniocerebral injuries who were admitted to The 900th Hospital of China Joint Logistic Support Force, Fuzhou, China from January 2017 to June 2021. Patients were randomly divided into study group and a control group comprising 40 patients each. The study group received guipizidine maleate combined with hyperbaric oxygen therapy while control group received hyperbaric oxygen therapy. Differences in neurophysiological and coagulation indices were recorded for the two groups after treatment. Results: Short latency somatosensory evoked potential (SLSEP) N20 wave amplitude of the study group was significantly greater than that of control group (p < 0.05). At 3 months follow-up, Glasgow outcome score (GOS), Karnofsky performance status (KPS) score, and Barthel index in the study group were significantly lower than in control group (p < 0.05). The combined incidence of complications in the study group was 5 % (2/40), which was lower than in control group, 17.50 % (7/40). Conclusion: The combination of guipizide maleate with hyperbaric oxygen has good therapeutic effect on patients with severe craniocerebral injury. It significantly improves neuro-physiological and coagulation indices, reduces the incidence of complications during treatment, and improves neurological function. However, further clinical trials are required to validate these findings. [ABSTRACT FROM AUTHOR]

두경부 외상은 뇌를 포함한 중요 장기들의 손상을 동반하며 특히 혈관 손상의 경우 영구적 장애를 야기하거나 사망에 이르게 할 수 있어서 적시에 치료가 진행되어야 한다. 혈관내 인 터벤션 치료에 대한 문헌적 근거 수준은 높지 않으나 기술의 발전에 힘입어서 혈관 손상의 치료에 대한 좋은 대안이 되고 있다. 고전적인 손상 혈관에 대한 색전술을 통한 치료 이외에 도 개선된 혈관내 기구들을 통해 재건적 혈관 치료가 가능해지고 있어서 적절하게 시행될 경 우 외상 환자의 예후 개선에 기여할 수 있다. 혈관 손상 치료의 방법은 외상 기전에 따라 상이 하며 특정 임상적 상황에서 시술 방법이 달라질 수 있다. 이를 고려한 혈관내 인터벤션을 증 례 중심으로 고찰해 보고자 한다. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Kernohan–Woltman phenomenon is a rare and paradoxical neurological situation in which a transtentorial lesion leads to compression of the contralateral cerebral peduncle responsible for compression of the descending corticospinal fibers with clinical consequence of a motor deficit ipsilateral to the primary lesion. This phenomenon should attract the attention of clinicians in order to avoid unfortunate incidents such as wrong‐side craniotomy in neurosurgical practice. In this work, we report a similar situation. The Kernohan–Woltman notch phenomenon is a rare and paradoxical neurological situation in which transtentorial damage is observed leading to compression of the contralateral cerebral peduncle responsible for compression of descending corticospinal fibers with the clinical consequence of a motor deficit ipsilateral to the primary lesion. This phenomenon has been found in several situations including tumors and cerebral hematomas after craniocerebral trauma. In this work, we have reported the case of a 52‐year‐old man with hemiparesis ipsilateral to a large chronic subdural hematoma. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is a life-threatening injury and the leading cause of death and major disability across all ages. Another important modern medical problem is diabetes mellitus (DM). The study aimed to investigate the hearts of rats under the influence of traumatic brain injury with streptozotocin-induced hyperglycemia. The study was conducted on 40 male rats weighing 180-220 g. DM was induced by a single intraperitoneal injection of streptozotocin (Sigma, USA). TBI was caused by the Impact Acceleration Model-free weight loss in the parieto-occipital area of the rat, according to the developed patent. The animals were removed from the experiment after 3 hours, 1 and 5 days after the inflicted TBI. Heart tissue was taken for histological studies. The sections obtained on a sled microtome were stained with hematoxylin and eosin, as well as Heidenhain. Dystrophic, destructive, and infiltrative processes occurred in the heart when simulating closed brain injury and brain injury on the background of diabetes. Under conditions of craniocerebral injury, they reached a maximum on the first day of the experiment and had stable positive dynamics on the fifth day. In the case of craniocerebral trauma in combination with diabetes, the progression of structural disorders was observed up to the fifth day from the beginning of the experiment. Non-specific morphological changes occur in the myocardium of animals with TBI, which are the morphological substrate of organ failure. The degree of structural changes in the heart against the background of diabetes has a more severe progressive nature due to the development of diabetic microangiopathy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of using mechanical ventilation combined with restrictive fluid resuscitation on the resuscitation of patients with severe craniocerebral injury and the effect on long-term cognitive function. Methods: Ninety patients with severe craniocerebral injury admitted to the emergency department of our hospital from January 2020 to December 2022 were selected as study subjects, and the random number table method was applied to divide all patients into observation and control groups, with 45 cases in each group. All patients were treated with conventional heavy craniocerebral injury, and patients in the control group were given mechanical ventilation immediately after injury and treated with conventional fluid resuscitation measures. In the observation group, mechanical ventilation was given immediately after the injury and restrictive fluid resuscitation was taken, and the effect of first aid, changes in blood gas indexes before and 1 h after emergency treatment, blood urea nitrogen (BUN), serum creatinine (Scr) before and 1 d after emergency treatment were compared between the two groups. The expression levels of blood urea nitrogen (BUN), serum creatinine (Scr), lactate, creatine kinase (CK), and finally S100B protein and melatonin were measured at the time of awakening, 3 d, 6 d and 10 d after the operation. Results: The patients in the observation group had significantly lower awakening time, speaking time, total infusion volume and mortality rate than the control group, and the GOS score of the observation group was significantly higher than that of the control group (P<0.05); There was no significant difference in the comparison of blood oxygen saturation (SpO2) and arterial blood carbon dioxide partial pressure (PaCO2) levels between the two groups before treatment(P<0.05), after treatment, the SpO2 level decreased in the control group and there was no significant change in the observation group, PaCO2 levels decreased in both groups, and the observation group was lower than the control group(P<0.05). Before treatment, there was no significant difference between the expression levels of BUN, Scr, lactate and CK related indexes in the two groups(P＞0.05), after treatment, the CK level increased in the control group, but there was no significant change in the observation group, and the observation group was significantly lower than the control group, and the levels of BUN, Scr and lactate were reduced, and the observation group was significantly lower than the control group (P＜0.05). There was no significant difference in the comparison of S100B protein and melatonin at awakening between the two groups (P>0.05), and S100B protein decreased significantly at 3 d, 6 d and 10 d after surgery and was lower in the observation group than in the control group, and melatonin increased significantly at 3 d, 6 d and 10 d after surgery and was higher in the observation group than in the control group (P<0.05). Conclusions: The use of mechanical ventilation combined with restrictive fluid resuscitation can improve the emergency effect of patients with severe craniocerebral injury, reduce the mortality rate of patients, and improve the level of oxygen saturation and partial pressure of arterial blood carbon dioxide, reduce the damage to the patient's cardiac and renal functions, and reduce the damage to the patient's neurological functions. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability in children. Objectives of our study were to determine the most commonly applied measures in the initial care of children with head trauma before admission to the Pediatric Intensive Care Unit (PICU) and in the first 24 hours after admission to the PICU, as well as to identify measures correlated with the length of stay. Materials and methods: The research was conducted as a retrospective study analyzing data from medical records of patients who had a traumatic head injury and were hospitalized at the Institute for Health Protection of Children and Youth of Vojvodina (IHPYV) from August 2021 to August 2023, in the PICU. Results: The study included 34 children with an average age of 9.43 ± 5.3 years. Boys were statistically significantly more likely to sustain injuries (61.8%). Isolated head injury was present in 19 patients (55.9%), while 15 (44.1%) had associated injuries. The most common mechanism of injury was traffic accident trauma (61.8%). The Glasgow Coma Scale (GCS) averaged 11.38 ± 3.7. The average length of stay in the PICU was 4.18 ± 2.87 days. Eight patients (23.5%) underwent surgery after admission to the PICU and CT diagnostics, while anti-edema therapy was applied in 19 patients (55.9%). Mechanical ventilation was used in 10 patients (29.4%). Patients with lower GCS values had a longer stay in the PICU. GCS was not a suitable parameter for assessing the need for surgery in the first 24 hours of patient treatment in the PICU, nor was it an adequate indicator of the need for mechanical ventilation. Conclusion: The results of our research show that the average age of children was 9.43 ± 5.3 years, predominantly boys. Despite many pediatric patients initially having a low GCS, they ultimately had a positive clinical outcome. Low GCS on admission of pediatric patients with head trauma was statistically significantly associated with a longer hospitalization in the PICU.

Objective: To analyze the effect of early hyperbaric oxygen combined with decompressive craniectomy on severe craniocerebral injury and its effect on neurological function and inflammatory factors. Methods: A total of 106 patients with severe craniocerebral injury admitted to our hospital from January 2018 to October 2021 were selected and randomly divided into matched group and observation group, 53 cases in each group. On this basis, the matched group was treated with decompressive craniectomy, and the observation group was treated with early hyperbaric oxygen combined with decompressive craniectomy. The brain metabolism index,Fugl-Meyer motor function score, neurological function index, inflammatory factors, incidence of serious complications and short-term efficacy were compared between the two groups before and after treatment for 3 months. Results: After treatment, the cerebral oxygen uptake rate (CEO2) and mixed venous oxygen saturation (SVO2) of the observation group were higher than those of the matched group (P＜0.05). After treatment, the upper limb, lower limb and total Fugl-Meyer motor function scores of the observation group were higher than those of the matched group (P＜0.05). After treatment, the levels of brain-derived neurotrophic factor (BDNF), neuronal specific enolase (NSE), S100β protein and glial fibrillary acidic protein (GFAP) in the observation group were lower than those in the matched group,and the levels of nerve growth factor (NGF) were higher than those in the matched group (P＜0.05). The serum levels of C-reactive protein (CRP), interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the observation group after treatment were lower than those in the matched group (P＜0.05). The incidence of serious complications in the observation group was lower than that in the matched group, and the good prognosis rate was higher than that in the matched group (P＜0.05). Conclusion: Early hyperbaric oxygen combined with decompressive craniectomy is effective in the treatment of severe craniocerebral injury, it can effectively optimize the neurological function of patients, inhibit inflammation, promote the recovery of limb motor function, and improve the prognosis, which is worthy of clinical attention. [ABSTRACT FROM AUTHOR]

Cranial imaging (CI) is a widely used diagnostic procedure, especially in acute myeloid leukemia (AML) patients with suspected bleeding or infection. However, common clinical decision rules to guide CI do not apply to AML patients and the diagnostic yield and outcomes of CI for AML patients are largely unknown. We retrospectively evaluated all CI from newly diagnosed non-promyelocytic AML patients receiving intensive induction or consolidation chemotherapy between 2007 and 2019 for imaging indications, diagnostic yield, and consequences. A total of 110 of 462 patients (24%) received CI for 152 imagings in distinct clinical situations. Forty-four patients (40%) had at least one new and acute pathological finding. Main indication was focal neurologic deficit, craniocerebral trauma, and suspected cerebral hypertension. The most common new finding was intracranial hemorrhage (13% of all imagings), followed by sinusitis (9%). CI led to therapy change in 21 patients. There were no clear associations between indications, laboratory values, and a positive imaging. Positive imaging was associated with adverse overall survival. Our study suggests that the overall rate of ordered CI was appropriate and that CI should generally be performed at a low threshold. A systematized approach to CI may further increase diagnostic yield but is complicated by variable clinical presentation. [ABSTRACT FROM AUTHOR]