Concomitant Brain Research Articles

Surgical Efficacy and Prognosis of 54 Cases of Spinal Metastases from Breast Cancer

To analyze the efficacy and complications of spinal metastasis surgery for breast cancer; to understand the survival and the influencing factors; and to verify the predictive ability of the currently used spinal metastasis cancer survival prediction scoring system on 1 year postoperative survival. A retrospective study was conducted of 54 patients with spinal metastases from breast cancer who underwent open surgery after multidisciplinary consultation in our hospital from January 2017 to October 2020. Patient demographic-related variables, breast cancer-related variables, spinal disorder-related variables, and treatment-related variables were collected. Survival curves were plotted using the Kaplan-Meier method, 1-way tests were performed using the log-rank method for factors that might affect prognosis, and candidate variables were included in the Cox model for multifactor analysis. The Tomita score, modified Tokuhashi score, modified Bauer score, and modified Katagiri score were examined by plotting the subject operating characteristic curve and calculating the area under the curve. The area under the curve was used to test the predictive ability of the SORG (Skeletal Oncology Research Group) original version, SORG line graph version, and SORG Web version for 1-year postoperative survival in patients with spinal metastases from breast cancer. The average age was 51.3 ± 8.6 years in 54 patients. Twenty-one patients underwent vertebral body debulking surgery, 32 patients underwent palliative canal decompression, and 1 patient underwent vertebral en bloc resection, with an operative time of 229.3 ± 87.6 minutes and intraoperative bleeding of 1018.1 ± 931.1 mL. Postoperatively, the patient experienced significant pain relief and gradual recovery from nerve injury. Major surgical complications included cerebrospinal fluid leakage, secondary spinal cord injury, spinal tumor progression, and broken fixation. The mean survival was 32.2 months, including a 6-month survival of 90.7%, a 1-year survival of 77.8%, and a 2-year survival of 60.3%. Univariate analysis showed that preoperation with neurologic deficits, hormone-insensitive type, with brain metastases were potential risk factors for poor prognosis. Multifactorial analysis showed that hormone-insensitive type and concomitant brain metastasis were independent risk factors associated with poor prognosis. The SORG Web version had good ability to predict 1-year postoperative survival in patients with spinal metastases from breast cancer. Spinal metastasis from breast cancer has good surgical efficacy, low postoperative recurrence rate, and relatively long survival after surgery. Patients with hormone-insensitive type, with brain metastasis, have a poor prognosis, and SORG Web version can predict patients' 1-year survival more accurately.

Spectrum of concomitant brain vascular lesions in pediatric diffuse gliomas

Cerebrovascular disease represents a threatening factor for brain cancer survivors. However, a comprehensive evaluation of small vessel disease related to gliomas has not yet been performed. This study aims to characterize concomitant vascular lesions in pediatric diffuse gliomas and identify their association with the molecular subgroup of tumors. We performed a retrospective pathological study of biopsy samples of 77 pediatric patients with diffuse gliomas, treated in Belarusian Research Center for Pediatric Oncology, Hematology and Immunology. Eight molecular subgroups were identified by immunohistochemical and cytogenetic studies (H3K27mut, ALT, IDH1mut, BRAFmut-PXA, FGFR1, BRAFmut/FGFR2, RTK, MYB). In each group microvessel density/area (MVD/MVA), tumor vessels co-option and signs of small vessels disease (SVD) were determined. The levels of microvascularization significantly differed between the molecular subgroups of diffuse gliomas, indicating the presence of intrinsic pro-angiogenic activity there. The highest values of MVD/MVA, as well as rate of hemorrhagic necrosis, were found in the BRAFmut/FGFR2, RTK groups. SVD was common in the adjacent tissues of gliomas and occurred in 32.5 % of cases. High grade SVD was associated with the BRAFmut/FGFR2 and IDH1mut subgroups. BRAFmut/FGFR2 tumors were more aggressive and caused cortical microinfarctions in 84,6 % and leukoaraiosis in 87.5 % of cases. IDH1mut tumors were mainly linked with cortical microinfarctions (60 % of cases). The results of the study suggest that concomitant small vascular lesions are common in adjacent tumor tissue and can significantly influence the overall rate of cerebrovascular disease in convalescents with diffuse gliomas.

Dissociable contribution of plasma NfL and p-tau181 to cognitive impairment in Parkinson's disease

BackgroundCognitive dysfunction is a disabling complication in Parkinson's disease (PD). Accuracy of diagnosis of mild cognitive impairment in PD (PD-MCI) depends on the tests performed, which limits results generalization. Blood-based biomarkers could provide additional objective information for PD-MCI diagnosis and progression. Blood neurofilament light chain (NfL), a marker of neuronal injury, has shown good performance for PD disease stratification and progression. While NfL is not disease-specific, phosphorylated-tau at threonine-181 (p-tau181) in blood is a highly specific marker of concomitant brain amyloid-β and tau pathology. MethodsWe investigated the potential of plasma NfL and p-tau181 levels as markers of cognitive impairment in a prospective cohort of 109 PD patients with and without PD-MCI (age 68.1 ± 7 years, education 12.2± 5 years), and 40 comparable healthy controls. After a follow-up of 4 years, we evaluated their predictive value for progression to dementia. ResultsAlthough NfL and p-tau181 levels were significantly increased in PD compared with healthy controls, only NfL levels were significantly higher in PD-MCI compared with PD with normal cognition (PD-NC) at baseline. After a follow-up of 4 years, only NfL predicted progression to dementia (HR 1.23, 95% CI 1.02–1.53; p = 0.038). Significant correlations between fluid biomarkers and neuropsychological examination were only found with NfL levels. ConclusionsPlasma NfL levels objectively differentiates PD-MCI from PD-NC patients, and may serve as a plasma biomarker for predicting progression to dementia in PD. Plasma levels of p-tau181 does not seem to help in differentiating PD-MCI or to predict future cognitive deterioration.

Brain Abnormalities and Epilepsy in Patients with Parry-Romberg Syndrome.

Parry-Romberg syndrome is a rare disorder characterized by progressive hemifacial atrophy. Concomitant brain abnormalities have been reported, frequently resulting in epilepsy, but the frequency and spectrum of brain involvement are not well-established. This study aimed to characterize brain abnormalities in Parry-Romberg syndrome and their association with epilepsy. This is a single-center, retrospective review of patients with a clinical diagnosis of Parry-Romberg syndrome and brain MR imaging. The degree of unilateral hemispheric atrophy, white matter disease, microhemorrhage, and leptomeningeal enhancement was graded as none, mild, moderate, or severe. Other abnormalities were qualitatively reported. Findings were considered potentially Parry-Romberg syndrome-related when occurring asymmetrically on the side affected by Parry-Romberg syndrome. Of 80 patients, 48 (60%) had brain abnormalities identified on MR imaging, with 26 (32%) having abnormalities localized to the side of the hemifacial atrophy. Sixteen (20%) had epilepsy. MR imaging brain abnormalities were more common in the epilepsy group (100% versus 48%, P < .001) and were more frequently present ipsilateral to the hemifacial atrophy in patients with epilepsy (81% versus 20%, P < .001). Asymmetric white matter disease was the predominant finding in patients with (88%) and without (23%) epilepsy. White matter disease and hemispheric atrophy had a higher frequency and severity in patients with epilepsy (P < .001). Microhemorrhage was also more frequent in the epilepsy group (P = .015). Ipsilateral MR imaging brain abnormalities are common in patients with Parry-Romberg syndrome, with a higher frequency and greater severity in those with epilepsy. The most common findings in both groups are white matter disease and hemispheric atrophy, both presenting with greater severity in patients with epilepsy.

Intraoperative Systemic Heparin is Safe for Treatment of Blunt Thoracic Aortic Injury with Concomitant Traumatic Brain Injury

Grading blunt thoracic aortic injuries (BTAI) is a key determinant for reporting and treatment of this condition, but provides no guidance for the safety of intraoperative heparin for patients with concurrent traumatic brain injury (TBI). We sought to compare the impact of intraoperative systemic heparinization on outcomes after thoracic endovascular aneurysm repair (TEVAR) for patients with TBI. We also compared University of Washington (UW) and Society for Vascular Surgery (SVS) grading systems.

Qualitative analysis of the role of teacher rapport on autism spectrum disorder student engagement while scanning for frontal lobe activation using fNIRS

IntroductionPrevious research has indicated that students with Autism Spectrum Disorder (ASD) show lower levels of engagement in the classroom and often struggle to focus in most learning environments compared to neurotypical students. It has been noted that the teacher plays a crucial role in creating a safe learning environment for ASD students. Successful teachers establish rapport with their students in order to create this safe learning environment. When teachers provide encouragement to students or make an effort to engage them through personal conversations, the student is more likely to engage in the material. The purpose of this study was to determine what teacher behaviors result in the highest brain activation in the frontal lobe of ASD students.MethodsTeachers and students wore functional Near Infrared Spectroscopy (fNIRS) NIRSIT systems (Soterix Medical, Inc.) during a 30‐minute simulated math lesson consisting of three phases ‐ didactic instruction, facilitated practice problem solving, and supervised independent study. Teachers with 3 or fewer years experience teaching ASD students, and those with more than 3 years teaching high‐functioning ASD high school students ranging in grade‐level math from 6th grade to 12th grade were recruited for the study. Blood Oxygenation Level Dependence (BOLD) activation of the participants were monitored to indicate what teaching and learning moments resulted in the most frontal lobe activation of the students, and the results were compared between groups. In addition, we used grounded theory thematic analysis to analyze the video recordings of the learning space.ResultsWe observed that teacher rapport was an important factor in engaging students. Friendly remarks and encouragement allowed for students to feel comfortable to engage in learning the material, resulting in a successful lesson flow with increased participation from the students. When students were engaged with material due to teacher rapport, frontal lobe BOLD signal increased. In addition, some students were actively engaged when answering questions or providing explanations for answers, while others showed concomitant brain activation while quietly listening to the teacher or the other student.ConclusionsThe creation of a friendly learning environment is an important component in engaging students and should be emphasized for teachers seeking to engage both ASD students. The results of this study illustrate that students present different behaviors in a learning environment and can be actively engaged even when their behaviors deviate from what is typically defined as engagement.

25-Year experience with adult polytraumatized patients in a European level 1 trauma center: polytrauma between 1995 and 2019. What has changed? A retrospective cohort study

PurposeTo analyze the changes of the clinical characteristics, injury patterns, and mortality rates of polytraumatized patients within the past 25 years in a European Level I trauma center.Methods953 consecutive polytraumatized patients treated at a single-level 1 trauma center between January 1995 and December 2019 were enrolled retrospectively. Polytrauma was defined as AIS ≥ 3 points in at least two different body regions. Retrospective data analysis on changes of clinical characteristics and mortality rates over time.ResultsA significant increase of the average age by 2 years per year of the study could be seen with a significant increase of geriatric patients over time. No changes of the median Injury Severity Score (ISS) could be seen over time, whereas the ISS significantly decreased by patient’s year. The rates of concomitant severe traumatic brain injury (TBI) remained constant over time, and did not increase with rising age of the patients. Although, the mortality rate remained constant over time the relative risk of overall in-hospital mortality increased by 1.7% and the relative risk of late-phase mortality increased by 2.2% per patient’s year.ConclusionThe number of polytraumatized patients remained constant over the 25-year study period. Also, the mortality rates remained stable over time, although a significant increase of the average age of polytraumatized patients could be seen with stable injury severity scores. Severe TBI and age beyond 65 years remained independent prognostic factors on the late-phase survival of polytraumatized patients.Trial registration: NCT04723992.Level of evidence: Prognostic study, level III.

604 From admission to discharge: a total friction burn review from a single institution

IntroductionMost friction burns are adequately managed in an outpatient setting. However, many require hospital admission, operative excision, and extended care especially those that present at trauma or burn centers. There is a wide variance in friction burn management. Our goal is to review the etiology, management, and outcomes of such burns warranting hospitalization.MethodsWe conducted a retrospective review of all friction burns admitted to a single, American Burn Association verified burn center from January 1, 2016 to December 31, 2020. Individual chart analysis was performed using data from the hospital’s burn registry. Statistical analysis was performed using Chi-square and Wilcoxon rank-sum test with p< 0.05 being significant.ResultsEighty-two patients met the inclusion criteria. Mean age was 35.4 years (95% CI 31.6-39.2). The overall mean Total Body Surface Area (TBSA) was 9.0 % (95% CI 7.5-10.6), and mean TBSA of 3rd degree burns was 1.1 % (95% CI 0.6-1.7). The most common mechanism of injury was motorcycle collision (45, 55%), followed by pedestrian struck by automobile (13, 16%). Fifty-four individuals (65%) had a concomitant injury. The most common topical agent used was silver sulfadiazine (52%), followed by bacitracin (21%). Sixteen patients (20%) required ICU level of care. Twenty-eight (34%) patients required surgery for their friction burns and 15 (18%) ultimately required a split-thickness skin graft. The mean number of operations was 2.4 (95% CI 1.6-3.1).Overall, the operative group was younger (29.9 vs 38.3 years, p=0.026), more likely to have a concomitant traumatic brain injury (25% vs 7%, p=0.027) and had a longer hospital length of stay (17.5 vs 3.9 days, p< 0.001). Both groups had a similar overall TBSA (8.5% vs 10.0%, p=0.35), but the operative group had larger surface area comprised of 3rd degree burns (3.05% vs 0.2%, p< 0.001). Eighty-one patients survived with the sole death due to massive hemoptysis.ConclusionsFriction burns resulting in hospital admission are associated with high-energy traumatic mechanisms and concomitant injuries. Patients who need operative intervention of their burns typically require multiple procedures often culminating in a split-thickness skin graft.

Systemic hypertonic saline enhances glymphatic spinal cord delivery of lumbar intrathecal morphine

The blood-brain barrier significantly limits effective drug delivery to central nervous system (CNS) targets. The recently characterized glymphatic system offers a perivascular highway for intrathecally (i.t.) administered drugs to reach deep brain structures. Although periarterial cerebrospinal fluid (CSF) influx and concomitant brain drug delivery can be enhanced by pharmacological or hyperosmotic interventions, their effects on drug delivery to the spinal cord, an important target for many drugs, have not been addressed. Hence, we studied in rats whether enhancement of periarterial flow by systemic hypertonic solution might be utilized to enhance spinal delivery and efficacy of i.t. morphine. We also studied whether the hyperosmolar intervention affects brain or cerebrospinal fluid drug concentrations after systemic administration. Periarterial CSF influx was enhanced by intraperitoneal injection of hypertonic saline (HTS, 5.8%, 20 ml/kg, 40 mOsm/kg). The antinociceptive effects of morphine were characterized, using tail flick, hot plate and paw pressure tests. Drug concentrations in serum, tissue and microdialysis samples were determined by liquid chromatography-tandem mass spectrometry. Compared with isotonic solution, HTS increased concentrations of spinal i.t. administered morphine by 240% at the administration level (T13–L1) at 60 min and increased the antinociceptive effect of morphine in tail flick, hot plate, and paw pressure tests. HTS also independently increased hot plate and paw pressure latencies but had no effect in the tail flick test. HTS transiently increased the penetration of intravenous morphine into the lateral ventricle, but not into the hippocampus. In conclusion, acute systemic hyperosmolality is a promising intervention for enhanced spinal delivery of i.t. administered morphine. The relevance of this intervention should be expanded to other i.t. drugs and brought to clinical trials.

Clinical Features, Treatments, and Prognosis of Intramedullary Spinal Cord Metastases From Lung Cancer: A Case Series and Systematic Review.

ObjectiveIntramedullary spinal cord metastasis from lung cancer (ISCM-LC) are increasing in prevalence. We aim to investigate its clinical features, treatments and prognosis. MethodsWe reported 6 ISCM-LC cases and conducted a systematic review. Descriptive summarization, survival analysis, and multivariate Cox regression analysis were performed to comprehensively study the disease. ResultsAll 6 patients had surgery. One used chemotherapy and the other had targeted drugs. Two patients died of ISCM-LC, 1 died of pulmonary embolism, 1 was alive, and 2 were lost to follow-up. We identified 197 ISCM-LC cases in literature with a mean age of 58 years and male preponderance. Small cell lung cancer accounted for 39.1%. The median interval from lung cancer to ISCM-LC was 7 months. Limb weakness was the most common symptom, and 45% cases progressed rapidly. Concomitant brain, leptomeningeal, and vertebral metastasis occurred to 55.8%, 20%, and 19.5%, respectively. Peritumoral edema appeared in 83.3%. Through survival analysis, we found sex, extraspinal metastasis, pathology, and improved symptoms affected the overall survival. Additionally, gross total resection (GTR) shared similar effectiveness with non-GTR, and other treatments following surgery hardly added extra effect. Surgery, improved symptoms, and sex were 3 independent prognostic factors after adjusting for confounding. The estimated median survival time was 5 months. ConclusionThe overall survival of ISCM-LC remains poor. Surgery is an independent protective factor for survival. Surgery should be considered once tolerated, and GTR might not be necessary. In addition, female patients with improved symptoms after intervention might have better overall survival.

Influence of age on acute traumatic spinal cord injury in Saint Petersburg, Russia.

Retrospective cohort study. To evaluate influence of age after traumatic spinal cord injury (TSCI). 13 specialized hospitals with neurosurgical departments of Saint Petersburg, Russia. Charts of all patients admitted with TSCI to the city hospitals 2012-2016. Demographic and clinical characteristics, surgical interventions, complications, mortality rate, and hospital stays were recorded. 311 patients with TSCI were included. TSCI was more common in younger age. Mean age (SD) was 42.4 (16.8) years. Patients were divided into four age groups: 18-29, 30-44, 45-59 and ≥60 years. The group ≥60 years had the lowest percentage of concomitant traumatic brain injury (TBI), 25%, versus 43% in TSCI < 60 years, p < 0.05. Low falls were the most frequent cause in patients aged 60 years and older, and led to less severe neurological deficits (p < 0.05). Complications were most frequent in motor complete TSCI (AIS A and AIS B) and in persons with combined TSCI and TBI at older age. Total complication rate was 67% at the age of ≥60 years versus 38% <60 years in TSCI with TBI (p < 0.05). Respiratory complications occurred in 67% ≥45 years versus 45% <45 years, p < 0.05. In-hospital mortality rate after TSCI was higher in the oldest age group. Respiratory complications are common and the in-hospital mortality is higher among elderly people. Older patients with TSCI and TBI are at high risk for complications.

Critical care for concomitant severe traumatic brain injury and acute spinal cord injury in the polytrauma patient: illustrative case

BACKGROUNDThe occurrence of traumatic brain injury with spinal cord injury (SCI) in polytrauma patients is associated with significant morbidity. Clinicians face challenges from a decision-making and rehabilitative perspective. Management is complex and understudied. Treatment should be systematic beginning at the scene, focusing on airway resuscitation and hemodynamic stabilization, immobilization, and timely transport. Early operative interventions should be provided, followed by minimizing secondary pathophysiology. The authors present a case to delineate decision-making in the treatment of combined cranial and spinal trauma.OBSERVATIONSA 19-year-old man presented as a level I trauma patient after falling 30 feet as the result of scaffolding collapse. The patient was unresponsive and was intubated; he had an initial Glasgow Coma Scale score of 4. Computed tomography revealed multicompartmental bleeding and herniation, for which supra- and infratentorial decompressive craniectomies were performed. The patient also suffered from thoracic SCI that resulted in complete paraplegia. Multimodality monitoring was used. After stabilization and lengthy rehabilitation, the patient obtained significant functional improvement.LESSONSThe approach to initial management of concomitant head and spine trauma is to establish intracranial stability followed by intraspinal stability. Patients can make considerable recovery, particularly younger patients, who are more likely to benefit from early aggressive interventions and medical treatment.

Spinal cord injury-induced cognitive impairment: a narrative review

Spinal cord injury is a serious damage to the spinal cord that can lead to life-long disability. Based on its etiology, spinal cord injury can be classified as traumatic or non-traumatic spinal cord injury. Furthermore, the pathology of spinal cord injury can be divided into two phases, a primary injury phase, and a secondary injury phase. The primary spinal cord injury phase involves the initial mechanical injury in which the physical force of impact is directly imparted to the spinal cord, disrupting blood vessels, axons, and neural cell membranes. After the primary injury, a cascade of secondary events begins, expanding the zone of neural tissue damage, and exacerbating neurological deficits. Secondary injury is a progressive condition characterized by pro-inflammatory cytokines, reactive oxygen species, oxidative damage, excitatory amino acids such as glutamate, loss of ionic homeostasis, mitochondrial dysfunction, and cell death. This secondary phase lasts for several weeks or months and can be further subdivided into acute, subacute, and chronic. One of the most frequent and devastating complications developed among the spinal cord injury population is cognitive impairment. The risk of cognitive decline after spinal cord injury has been reported to be 13 times higher than in healthy individuals. The exact etiology of this neurological complication remains unclear, however, many factors have been proposed as potential contributors to the development of this disorder, such as concomitant traumatic brain injury, hypoxia, anoxia, autonomic dysfunction, sleep disorders such as obstructive sleep apnea, body temperature dysregulation, alcohol abuse, and certain drugs. This review focuses on a deep understanding of the pathophysiology of spinal cord injury and its relationship to cognitive impairment. We highlight the main mechanisms that lead to the development of this neurological complication in patients with spinal cord injury.

Damaged brain accelerates bone healing by releasing small extracellular vesicles that target osteoprogenitors

Clinical evidence has established that concomitant traumatic brain injury (TBI) accelerates bone healing, but the underlying mechanism is unclear. This study shows that after TBI, injured neurons, mainly those in the hippocampus, release osteogenic microRNA (miRNA)-enriched small extracellular vesicles (sEVs), which targeted osteoprogenitors in bone to stimulate bone formation. We show that miR-328a-3p and miR-150-5p, enriched in the sEVs after TBI, promote osteogenesis by directly targeting the 3′UTR of FOXO4 or CBL, respectively, and hydrogel carrying miR-328a-3p-containing sEVs efficiently repaires bone defects in rats. Importantly, increased fibronectin expression on sEVs surface contributes to targeting of osteoprogenitors in bone by TBI sEVs, thereby implying that modification of the sEVs surface fibronectin could be used in bone-targeted drug delivery. Together, our work unveils a role of central regulation in bone formation and a clear link between injured neurons and osteogenitors, both in animals and clinical settings.

Influence of Antibiotic Management on Microbial Selection and Infectious Complications After Trauma.

Background: The inflammatory response and post-traumatic complications like infections play an important role in the pathophysiology of severe injuries. This study examines the microbiological aspects in anti-infective treatment of trauma patients and their inflammatory response in post-traumatic infections complications.Patients and Methods: A retrospective analysis of prospectively collected data in trauma patients (ISS ≥ 16) over a 1-year period (01/2018 to 12/2018) is provided. Patient population was stratified into severely injured patients without post-traumatic infection (inf-PT), and severely injured patients who developed an infection (inf+PT).Results: Of 114 trauma patients, 45 suffered from post-traumatic infection during the first 10 days of hospitalization. Severely injured patients with concomitant traumatic brain injury (PT+TBI) showed the highest rate of post-traumatic infection. Pro-inflammatory reaction was tracked by levels of Interleukin (IL-)6 (day 3: inf+T 190.8 ± 359.4 pg/dL > inf-PT 56.2 ± 57.7 pg/mL (mean ± SD); p = 0.008) and C-Reactive-Protein (CRP, day 3: inf+PT 15.3 mg/dL > inf-PT 6.7 mg/dL, p = 0.001) which were significantly higher in trauma patients who develop an infectious complication and showed a significant positive correlation with the occurrence of infection. The leading entity of infection was pneumonia followed by infections of the urinary tract mainly caused by gram-negative Enterobacteriaceae. 67.5% of all trauma patients received single-shot antibiosis during initial care in trauma bay. The development of secondary colonization was not relevant positively correlated with single-shot antibiosis (r = 0.013, p = 0.895) and prophylactically calculated antibiotic administration (r = 0.066, p = 0.500).Conclusion: Severely injured trauma patients have an increased risk for development of infectious complications, which mainly is pneumonia followed by infection of the urinary tract mainly caused by gram-negative Enterobacteriaceae. Based on the data in this study, the one-time antibiotic and prophylactic calculated use of antibiotics, like Cephalosporins must be critically discussed in terms of their role in the development of post-traumatic infections and microbial selection.

Sex-based differences in bacterial meningitis in adults: Epidemiology, clinical features, and therapeutic outcomes

BackgroundTo investigate the sex-based differences in clinical features, causative pathogens, and outcomes of hospital-based culture-proven adult bacterial meningitis. ObjectiveThis retrospective study enrolled 621 patients at a tertiary medical center. To compare changes over time, the presentation of disease among the enrolled patients was divided into two equal time periods: the first study period (1986–2002) and the second study period (2003–2019). ResultsOf the 621 patients enrolled in this study, 396 were males and 225 were females. The overall case fatality rate was 30.4% with 30.1% and 31.1% in males and females, respectively. Regarding the causative pathogens, there was a rising incidence of coagulase-negative staphylococcal infections and a decreasing incidence of Klebsiella pneumoniae infection in both male and female in the second study period. The prevalence of patients with nosocomial infection in a postneurosurgical state were 41.9% (68/162) in the first study period and 58.1% (94/162) in the second study period in male group, and 34.8% (32/92) in the first study period and 65.2% (60/92) in the second study period in female group, respectively. Significant factors between the sexes difference included age (P = 0.004), traumatic brain injury (P = 0.01), alcoholism (P < 0.001), brain tumor (P < 0.001), systemic lupus erythematosus (SLE) (P = 0.004), presence of diabetic ketoacidosis/hyperglycemic hyperosmolar state (P = 0.033), brain abscess (P = 0.042), and total protein (P = 0.002) and white blood cell count (P = 0.036) of cerebrospinal fluid data. ConclusionOur study revealed an increase in the number of patients with nosocomial infection with a postneurosurgical state in both male and female in the second study period. Males were younger and frequently presented with a history of head trauma and alcoholism with concomitant brain abscesses while females presented with SLE and brain tumor. The therapeutic outcome did not show differences between the sexes.

Expression of HO1 and PER2 can predict the incidence of delirium in trauma patients with concomitant brain injury

Intensive care unit (ICU)-acquired delirium is associated with adverse outcome in trauma patients with concomitant traumatic brain injury (TBI), but diagnosis remains challenging. Quantifying circadian disruption by analyzing expression of the circadian gene period circadian regulator 2 (PER2) and heme oxygenase 1 (HO1), which determines heme turnover, may prove to be potential diagnostic tools. Expression of PER2 and HO1 was quantified using qPCR from blood samples 1 day and 7 days after trauma. Association analysis was performed comparing mRNA expression levels with parameters of trauma (ISS—injury severity score), delirium, acute kidney injury (AKI) and length of ICU stay. 48 polytraumatized patients were included (equal distribution of TBI versus non-TBI) corrected for ISS, age and gender using a matched pairs approach. Expression levels of PER2 and HO1 were independent of age (PER2: P = 0.935; HO1: P = 0.988), while expression levels were significantly correlated with trauma severity (PER2: P = 0.009; HO1: P < 0.001) and longer ICU length of stay (PER2: P = 0.018; HO1: P < 0.001). High expression levels increased the odds of delirium occurrence (PER2: OR = 4.32 [1.14–13.87]; HO1: OR = 4.50 [1.23–14.42]). Patients with TBI showed a trend towards elevated PER2 (OR = 3.00 [0.84–9.33], P = 0.125), but not towards delirium occurrence (P = 0.556). TBI patients were less likely to develop AKI compared to non-TBI (P = 0.022). Expression levels of PER2 and HO1 correlate with the incidence of delirium in an age-independent manner and may potentially improve diagnostic algorithms when used as delirium biomarkers.Trial registration: German Clinical Trials Register (Trial-ID DRKS00008981; Universal Trial Number U1111-1172-6077; Jan. 18, 2018).

Traumatic Atlanto-Occipital Dislocation-A Comprehensive Analysis of All Case Series Found in the Spinal Trauma Literature.

Traumatic atlanto-occipital dislocation (TAOD) is one of the most devastating traumatic injuries, generally associated with immediate death after high-energy trauma. The aim of this study was to perform a systematic literature review of all cases series of TAOD and present the current state of this entity. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only case series with at least 5 cases were included in the analysis. We focused on survival rates, diagnostic methods, delays in diagnosis, outcomes, and cases successfully treated nonoperatively. A total of 17 articles were included (16 retrospective and 1 prospective study) with 341 patients. Six studies included pediatric patients only. The mean Glasgow Coma Scale at admission was ≤8 in all studies. Many different diagnostic criteria were used, but none of them had high accuracy. The overall mortality rate was 34.8%, but the studies' designs were heterogeneous (some included only survivors). A high rate of concomitant traumatic brain injury was documented in some studies. We found it interesting that some patients were treated with cervical immobilization (37/341; 10.8%), which was generally used in less unstable injuries; however, the majority of patients were managed with an occipito-cervical fusion (193/341; 56.5%). TAOD is a devastating traumatic injury, with a high mortality rate. An MRI may be recommended when there are subtle findings of TAOD and a normal computed tomography scan, such as subarachnoid hemorrhage in the posterior fossa, upper cervical injuries, or consistent neurological findings. Further studies are necessary to identify patients with mild MRI findings and TAOD that may be managed nonoperatively.

Extracorporeal detoxification for septic complications in children during the acute period of severe combined craniocerebral trauma

BACKGROUND: The clinical application of extracorporeal detoxification methods in patients with severe concomitant traumatic brain injury has several features and limitations due to intracranial hypertension, traumatic cerebral edema, and the risk of their growth during extracorporeal detoxification. The modern literature presents the results of using extracorporeal detoxification methods in severe concomitant trauma in children. However, practically no data are available on the possibility of their use in severe concomitant craniocerebral trauma, which determines the relevance of research in this direction.&#x0D; AIM: This study aims to improve the treatment results of affected children with severe concomitant craniocerebral trauma with the addition of septic complications using extracorporeal detoxification methods.&#x0D; MATERIALS AND METHODS: The experience using extracorporeal detoxification methods, including prolonged veno-venous hemodiafiltration combined with LPS sorption and plasma separation membrane in patient intensive care with severe concomitant craniocerebral trauma complicated by sepsis and septic shock development, is presented.&#x0D; RESULTS: The use of extracorporeal detoxification methods contributed to eliminating septic shock, stabilization of hemodynamic and internal homeostasis parameters, and regression of multiple organ failure in patients with severe concomitant traumatic brain injury. Monitoring the intracranial pressure and preventing disequilibrium syndrome development enabled avoiding an increase in intracranial hypertension in studied patients.&#x0D; CONCLUSIONS: Timely and adequate use of extracorporeal detoxification methods improves the clinical course of the acute period of traumatic illness in children with severe concomitant traumatic brain injury. The safe use of efferent therapy methods in patients with severe concomitant traumatic brain injury is ensured by invasive monitoring of intracranial pressure and preventing the development of disequilibrium syndrome.

Damage Control the Liver and Spleen in Case of Concomitant Injury: Literature Review

Until now, the issues of diagnosis and treatment tactics for abdominal injuries remain relevant and far from resolved. The complexity of their diagnosis is often due to the erasure of clinical manifestations, simultaneous damage to various organs of the abdominal cavity and the presence of combined injuries. Thus, concomitant traumatic brain injury with impaired consciousness leads to an increase in the probability of неundiagnosed injuries to internal organs. The state of shock distorts the clinical picture of the "acute abdomen", and the more severe it is, the less pronounced the symptoms of intra-abdominal catastrophe become.