Level Of Consciousness Research Articles

Predictive Performance of Machine Learning–Based Models for Poststroke Clinical Outcomes in Comparison With Conventional Prognostic Scores: Multicenter, Hospital-Based Observational Study

Background Although machine learning is a promising tool for making prognoses, the performance of machine learning in predicting outcomes after stroke remains to be examined. Objective This study aims to examine how much data-driven models with machine learning improve predictive performance for poststroke outcomes compared with conventional stroke prognostic scores and to elucidate how explanatory variables in machine learning–based models differ from the items of the stroke prognostic scores. Methods We used data from 10,513 patients who were registered in a multicenter prospective stroke registry in Japan between 2007 and 2017. The outcomes were poor functional outcome (modified Rankin Scale score >2) and death at 3 months after stroke. Machine learning–based models were developed using all variables with regularization methods, random forests, or boosted trees. We selected 3 stroke prognostic scores, namely, ASTRAL (Acute Stroke Registry and Analysis of Lausanne), PLAN (preadmission comorbidities, level of consciousness, age, neurologic deficit), and iScore (Ischemic Stroke Predictive Risk Score) for comparison. Item-based regression models were developed using the items of these 3 scores. The model performance was assessed in terms of discrimination and calibration. To compare the predictive performance of the data-driven model with that of the item-based model, we performed internal validation after random splits of identical populations into 80% of patients as a training set and 20% of patients as a test set; the models were developed in the training set and were validated in the test set. We evaluated the contribution of each variable to the models and compared the predictors used in the machine learning–based models with the items of the stroke prognostic scores. Results The mean age of the study patients was 73.0 (SD 12.5) years, and 59.1% (6209/10,513) of them were men. The area under the receiver operating characteristic curves and the area under the precision-recall curves for predicting poststroke outcomes were higher for machine learning–based models than for item-based models in identical populations after random splits. Machine learning–based models also performed better than item-based models in terms of the Brier score. Machine learning–based models used different explanatory variables, such as laboratory data, from the items of the conventional stroke prognostic scores. Including these data in the machine learning–based models as explanatory variables improved performance in predicting outcomes after stroke, especially poststroke death. Conclusions Machine learning–based models performed better in predicting poststroke outcomes than regression models using the items of conventional stroke prognostic scores, although they required additional variables, such as laboratory data, to attain improved performance. Further studies are warranted to validate the usefulness of machine learning in clinical settings.

Comparison of Transfer Patterns by Emergency Medical Services in Trauma Patients in a Major U.S. City

Background:Trauma patients are often unable to communicate a preferred destination hospital to EMS due to their injuries and potentially decreased level of consciousness. The destination hospital is thus determined by the EMS team transporting the patient. This study focuses on trauma admissions between Eskenazi and IUH Methodist Hospitals in downtown Indianapolis, both of which are Level 1 trauma centers within one mile of each other. We are interested in identifying differentiating factors between patients that are admitted at these two hospitals, focusing on the injury type as well as the demographic information for each patient, to determine if there are differential transport patterns.
 Methods:We performed a retrospective analysis of patient charts and transport documentation to determine basic demographic and admission data for each patient. We especially took note of the location of EMS pickup, the facility the patient was taken to, and the stated reasons for taking the patient to that specific facility. A simple Google Maps search allowed us to determine if the patient was taken to the facility closest to them, or not.
 Results:We found that among the included patients that were not taken to the nearest Level 1 trauma center, a significant majority were taken to Eskenazi rather than Methodist. Among these patients, a majority were minorities, in contrast with demographic makeup of the patients that were admitted to the closest trauma center.
 Conclusion:This study highlights how complex EMS transfer patterns are based upon diversion, traffic, individual driver preference, and other factors. There is a significant difference in transport patterns between the two hospitals that correlates with a difference in patient demographics.
 Policy Implications:This data indicates a need to monitor these numbers closely going forward, paying special attention to all possible reasons that could impact to which facility a patient is admitted.

An Interesting Case of Chronic Isolated Apathetic Syndrome

An apathy syndrome is defined as a syndrome of primary motivational loss, that is, loss of motivation not attributable to emotional distress, intellectual impairment, or a diminished level of consciousness. The main anatomical correlate of apathy is the medial frontal lobe. Here we report a case of a 49-year-old male who presented with a history of lack of interest for the past 10 months without any other neurological symptoms. He was diagnosed with depression and was receiving treatment from multiple psychiatrists. In view of his persistent symptoms, he approached us and was evaluated. Examination showed anosmia with apathy that paved the way to the orbitofrontal location of the lesion. Psychiatric symptoms may be an unusual presentation of a space-occupying lesion of brain. Strong suspicion and imaging the brain is indicated in all cases to prevent the unnecessary use of psychiatric medicines and their complications.

Does knowledge and concern regarding food supplement safety affect the behavioral intention of consumers? An experimental study on the theory of reasoned action.

In recent years, health crises have led consumers to make more frequent purchases of food supplements. The global food supplement market, which reached $61.20 billion in 2020, is estimated to reach $163.12 billion by 2022 and $350.96 billion by 2032. However, many consumers still have concerns about the safety of food supplements. Within the scope of the research, firstly, the health consciousness (HC) level of food supplement consumers was determined. Secondly, food safety knowledge (FSK) and food safety concerns (FSCs) were measured. Thirdly, consumers' attitudes (ATUs), subjective norms (SNs), and behavioral intentions (BIs) toward food supplements were determined within the scope of the theory of reasoned action. The study used a convenient sampling, and 327 participants were included in the sample population. The data for the analysis was collected using the online survey method in the third quarter of 2023. The relationships between hypothesized items in the structural model were tested using the Smart-PLS. The validity and reliability of the measurement model were evaluated at the start of the structural equation modelling approach using confirmatory factor analysis (CFA). Regression analyses were performed in the structural model phase to evaluate overall fit and suggested relationships by way of the Smart-PLS. In light of the findings, it was determined that the interaction between HC and ATU was mediated by FSK, and the interaction between HC and the SN was mediated by FSK. Consequently, this research presents a variety of theoretical and practical implications to give clues for consumers' health regarding food supplement consumption.

Research hotspots and frontiers of neuromodulation techniques in disorders of consciousness: a bibliometric analysis.

The characteristics of disorders of consciousness (DOC) are changes in arousal and/or awareness caused by severe brain injuries. To date, the management of DOC patients remains a complex and challenging task, and neuromodulation techniques offer a promising solution. However, a bibliometric analysis focusing on neuromodulation techniques in DOC is currently absent. The aim of this study is to provide a bibliometric visualization analysis to investigate the research hotspots and frontiers in the field of neuromodulation techniques in DOC from 2012 to 2022. The publications were collected and retrieved from the Web of Science (WoS) from 2012 to 2022. CiteSpace and Microsoft Excel were utilized perform the first global bibliographic analysis of the literature related to neuromodulation techniques for DOC. The analysis included a total of 338 publications. From 2012 to 2022, a consistent yet irregular increase in the number of articles published on neuromodulation techniques in DOC was observed. Frontiers in Neurology published the highest number of papers (n = 16). Neurosciences represented the main research hotspot category (n = 170). The most prolific country, institution, and author were the USA (n = 105), the University of Liege (n = 41), and Laureys Steven (n = 38), respectively. An analysis of keywords revealed that UWS/VS, MCS, and TMS constituted the primary research trends and focal points within this domain. This bibliometric study sheds light on the current progress and emerging trends of neuromodulation techniques in DOC from 2012 to 2022. The focal topics in this domain encompass the precise diagnosis of consciousness levels in patients suffering from DOC and the pursuit of efficacious neuromodulation-based evaluation and treatment protocols for such patients.

Consciousness and General Anesthesia: Challenges for Measuring the Depth of Anesthesia.

The optimal consciousness level required for general anesthesia with surgery is unclear, but in existing practice, anesthetic oblivion, may be incomplete. This article discusses the concept of consciousness, how it is altered by anesthetics, the challenges for assessing consciousness, currently used technologies for assessing anesthesia levels, and future research directions. Wakefulness is marked by a subjective experience of existence (consciousness), perception of input from the body or the environment (connectedness), the ability for volitional responsiveness, and a sense of continuity in time. Anesthetic drugs may selectively impair some of these components without complete extinction of the subjective experience of existence. In agreement with Sanders et al. (2012), the authors propose that a state of disconnected consciousness is the optimal level of anesthesia, as it likely avoids both awareness and the possible dangers of oversedation. However, at present, there are no reliably tested indices that can discriminate between connected consciousness, disconnected consciousness, and complete unconsciousness.

Clinical Presentation of Ischaemic and Haemorrhagic Stroke and Its Relation to Lipid Profile

Introduction: Stroke is a major health hazard in both developed and developing countries. Dyslipidaemia is one of the important risk factors for stroke. The purpose of the present study was to identify clinical presentations of both ischaemic and haemorrhagic stroke, and to find out correlation between stroke and lipid profile. Methods: The observational study was conducted in the Department of Medicine at Sher-e-Bangla Medical College Hospital, Barishal from April to September 2013 for a period of 6 months. All the stroke patients over 20 years of age of both sexes were selected as study population. After admission at the hospital, history was taken from the patients or the attendants. The clinical presentation was recorded in a pre designed data collection sheet. Fasting lipid profile was measured in every stroke patient. Results: Total 100 stroke patients were enrolled for this study, of them 36 were haemorrhagic and 64 were ischaemic stroke patients. The mean ± SD of age were 63.945 ± 8.84 and 62.26 ± 14.40 in haemorrhagic and ischaemic stroke patients respectively (p>0.05). Among both haemorrhagic and ischaemic stroke patients maximum 61.1% and 60.9% used to have sedentary work. Impaired level of consciousness was more common among the haemorrhagic stroke patients (91.7%) than ischaemic stroke patients (57.8%) group and the association is statistically significant (p=0.001). Limb weakness was the commonest presentation in both haemorrhagic (91.7%) and ischaemic (87.5%) stroke patients. The mean ± SD of total cholesterol was 173.47 ± 61.96 and 178.22 ± 54.79 in haemorrhagic stroke and ischaemic stroke patients respectively (p<0.05). Conclusion: Older age, male sex, sedentary work and dyslipidaemia were susceptible to be affected in stroke. Among lipoproteins, elevated total cholesterols, triglycerides and LDL showed strong correlation with both ischaemic and haemorrhagic strokes. J MEDICINE 2024; 25: 24-28

Predictors of mortality in critically ill children hospitalized with laboratory- confirmed COVID-19 pneumonia

BackgroundChildren with COVID-19 infection had fewer severe symptoms, which made it challenging to publish clinical data for this age group. This study aimed to determine the clinical features, laboratory markers, and predictors of mortality in children hospitalized in Pediatric Critical Care Units with COVID-19 pneumonia.MethodsThis retrospective research included all children between the age of ≥ 1 month and 18 years with laboratory-confirmed COVID-19 pneumonia through reverse transcriptase polymerase chain reaction (RT-PCR) from nasopharyngeal swabs who were admitted to Pediatric Critical Care Units between January 2022 and December 2022.ResultsThe study included 62 patients with confirmed COVID-19 infection. Out of the 62 patients, 43 (69.4%) survived and 19 (30.6%) succumbed. High-grade fever, cough, altered level of consciousness, convulsion, CO-RADS IV, elevated blood CRP, urea, D-dimer, ferritin, and sodium were linked to significantly higher mortality risk. (OR: 15.867, p = 0.001, OR: 1.543, p = 0.044, OR: 7.321, p = 0.026, OR: 15.00, p = 0.017, OR: 10.833, p = 0.001, OR: 1.015, p = 0.032, OR: 1.028, p = 0.040, OR: 3.315, p < 0.0001, OR: 1.004, p = 0.049, OR: 1.111, p = 0.006 respectively).ConclusionOur study revealed high in-hospital mortality among critically ill children with confirmed COVID-19 pneumonia. Identification of critically ill children with risk factors for death, such as high-grade fever, cough, altered consciousness, convulsion, CO-RADS IV and V, and raised inflammatory markers at the time of admission could minimize excess mortality during COVID-19 waves.

Structural Modeling of Early Ambulation Progression in Patients with Acute Stroke: A Covariance Structure Analysis Approach.

This study used structural equation modeling (SEM) to elucidate the causal relationships between Functional Independence Measure (FIM) items and consciousness levels in patients with stroke and low consciousness levels 2 weeks after initiating occupational therapy (OT). This modeling sought to identify the factors influencing the number of days required to get out of bed. SEM was used for multifactorial simultaneous analysis in a study of 22 patients with a Japan Coma Scale score of 20 after stroke. The Glasgow Coma Scale was used to evaluate patients' consciousness level; FIMs were used to evaluate activities of daily living in the ward. Influencing factors, including "bed/chair transfers" and "toilet transfers," were defined as "transfer functions," while factors involving "social interactions," "comprehension," "memory," "problem solving," and "expression" were defined as "cognitive decline." After 2 weeks, standardized coefficients showed that "transfer functions" and "cognitive decline" had effects of -0.33 and -0.25, respectively, on "early ambulation days." Further analysis revealed that improvements in "consciousness level" impacted "early ambulation days," with coefficients of -0.35 for "transfer functions" and 0.14 for "cognitive decline." Through the "consciousness level" observation variable, the coefficients of indirect effects were -0.27 for "transfer function" on "days to get out of bed," 0.38 for "cognitive decline," and -0.06 for "self-care" on "early ambulation days." Improvement in transfer movements and cognitive decline influenced the number of days required to get out of bed without improving consciousness or affecting early ambulation.

A LINGUOCULTUROLOGICAL CHARACTERISTIC – TECHNOLOGY OF DECODING CULTURAL MEANINGS IN THE PROCESS OF LANGUAGE LEARNING

This article solves the problem of the implementation of the linguoculturological aspect in the process of a language teaching, namely, teaching how to decode the cultural meanings of the language. To do this, the author considers theoretical issues: she relies on the concepts of a linguistic persona and cultural meaning, analyzes and compares the functional levels of perception of meaning, formulated in psycholinguistics, and the levels of cultural consciousness, developed in linguocultural studies. To substantiate the practical solution of the indicated problem, the definitions of the concepts of a linguoculturological analysis and a linguoculturological characteristic are separated. The linguoculturological analysis is defined primarily as a tool of linguocultural studies, while the linguoculturological characteristic – as a tool of the methodological science, the use of the latter is aimed at forming the students’ linguistic persona. The stages of linguistic and cultural characteristics of the language are formulated, a universalized definition of this concept is given. The logic of the linguoculturological characteristic is correlated with the functional levels of perception of meaning (I. A. Zimnaya), with the levels of cultural consciousness (N. F. Alefirenko), as the result of which it is proved that the linguoculturological characteristic of a language is based on psychological, mental and speech mechanisms of consciousness and, in the process of a language learning, allows teaching the identification, comprehension, formulation and internalization of cultural meanings contained in the language.

К вопросу экологического сознания населения Хабаровского края

The paper presents the relevance of environmental problems in modern society. In particular, the urgent environmental crises of the Khabarovsk Territory are analyzed. The study considers the pollution of the shores of all water bodies of the region and adjacent water areas with household garbage. The paper provides information on the measures taken by the Ministry of Natural Resources of the Khabarovsk Territory to form ecological awareness of the population. An overview of the quantitative indicators of the campaign «Water of Russia» for three years in the Khabarovsk Territory is provided. The paper also includes other environmental actions carried out within the framework of the regional Eco-marathon. We are also talking about the fact that environmental safety is one of the five subsystems included in the national security system of the Russian Federation. The need to turn public consciousness towards environmental friendliness is justified, the level of consciousness being characterized by high responsibility for actions concerning the environment. Different approaches to the concept of «ecological consciousness» are considered, clarifying the meaning of the term. The indicator of the formation of ecological consciousness is the participation of citizens in eco-volunteer activities. The authors believe that constant work can help to form environmentally responsible public consciousness. The study is feasible in an educational, scientific, campaigning and business environment. It is important to provide information support and promotion of eco-volunteer actions, as well as stimulating and encouraging events. The apper uses methods of analysis, synthesis, systematization, generalization. In conclusion, voluntary environmental public associations create the basis for the formation of sustainable environmental awareness, not only among young people, but also in the professional sphere.

Guide for the treatment of acute altered mental status. Iberoamerican Academy of Pediatric Neurology

In pediatric patients, an acute altered mental status refers to a sudden and significant change in a child's brain function and level of consciousness. It may manifest as confusion, disorientation, agitation, lethargy or even a loss of consciousness. This condition is a medical emergency, and requires immediate evaluation and attention. There are several causes of acute altered mental status in children, including infections of the central nervous system such as meningitis or encephalitis, traumatic brain injury, metabolic disorders, seizures and poisoning, among others. The aim of this study was to analyse, prepare and classify the current literature in order to determine the best recommendations for the treatment of cases of acute altered mental status with various causes in pediatric patients. The study was based on opinions from experts in the field in order to classify the recommendations, and was submitted to the scientific committee of the Iberoamerican Academy of Pediatric Neurology for review. Our guide is an aid for the treatment of this non-specific symptom based on a basic and advanced approach, which can be applied by any pediatric neurologist.

Спіральна динаміка розвитку процесу інтелектуалізації в умовах глобалізаційних змін: методологічні аспекти

The aim of the article is to study the methodological aspects of the spiral dynamics of the development of the process of intellectualization in the context of globalization changes. The article discusses the features of the development of the process of intellectualization in the context of globalization changes through the prism of the theory of spiral dynamics. Spiral dynamics, as a conceptual model of the evolution of human consciousness, allows us to analyze the transformations of society at different stages of its development. The influence of globalization factors on the processes of intellectualization is studied, emphasizing the role of information technology, network society and knowledge economy. The article allocates that the synergetic evolution of human potential is based on different phases of order (stability – homeostasis) or chaos (crisis, danger) under the influence of endogenous and exogenous environment. The analysis of literary sources provided an opportunity to form a methodology for managing the intellectual potential of enterprises in the context of global transformations. The paper focuses on the interaction between different levels of consciousness that determine the evolutionary movement of society, and shows how these interactions form new paradigms of thinking and activity. Also, the challenges and opportunities that arise in the process of intellectualization are considered, strategic approaches to change management based on spiral dynamics are proposed. The results of the study can be useful for scientists, politicians and managers involved in the development of society in the context of globalization.

End-of-life care in the emergency department-Indications for admission and spectrum of care-State of the art

Emergency departments (EDs) and ED observation units provide care for awide range of medical emergencies, serving patients of all ages and conditions. This includes palliative care for patients who are rapidly deteriorating. However, there is limited knowledge about the incidence, reasons for ED visits, modes of arrival, symptoms, leading diagnoses, and the emergency care provided to these patients until the time of death. This retrospective, exploratory study was conducted at the 754-bed Kliniken Maria Hilf academic teaching hospital in Moenchengladbach, Germany. It included patients who died in the ED resuscitation rooms or ED observation unit between 1st of July 2018 and 30th of June 2023. We utilized routine data to analyze the reasons for ED visits, modes of arrival, symptoms, diagnoses and the medical care provided. We also examined differences between oncologic and non-oncologic patients as well as between those requiring cardiopulmonary resuscitation (CPR) and those who did not. The study was approved by an ethics committee and categorical data were analyzed using the χ2-test with Yates correction. P-values < 0.05 were considered significant due to the exploratory nature of the study. During the study period 168,328 patients were treated in the ED, with 43% admitted to the hospital. Of these, 262 died in the ED or ED observation unit. The primary mode of arrival was emergency medical services for 234 patients (89%). The most common symptoms were impaired consciousness (n = 198; 76%) and dyspnea (n = 83; 32%), among arange of others. Comparing non-oncologic (n = 214) and oncologic patients (n = 48), the former showed significantly higher rates of impaired consciousness (174/214 vs. 24/48; p = 0.0001), while dyspnea was more prevalent in oncologic patients (57/214 vs. 26/48; p = 0.0002). Among patients who underwent CPR (n = 147) and those who did not (n = 115), no statistical differences were found in levels of consciousness but asignificant difference in dyspnea (prior to cardiac arrest) was noted (31/147 vs. 52/115; p = 0.0001). Palliative status was documented in 88cases (34%), with palliative care initiated in only 58 (21%). Only three patients (1%) were receiving specialized outpatient palliative care (SAPV). The most common medical interventions were invasive ventilation (n = 160; 61%), opioid administration (n = 145; 55%), CPR (n = 143; 55%), and crystalloid administration (n = 90; 34%). Structured communication with relatives occurred in 188 cases (72%). The incidence of death in alarge German ED was approximately one patient per week. These patients typically presented with symptoms common in critically ill non-trauma cases. The low incidence of SAPV patients (1%) suggests its potential to reduce ED admissions. Oncologic patients were aminority, possibly due to effective outpatient care and lower mortality within the first 24 h after ED admission. Emergency palliative care in the ED could alleviate the burden on intensive care units. Training ED staff in acute palliative care and establishing procedural standards for such care are essential to maintain high-quality treatment, given the frequency of palliative cases in the ED.

Usefulness of the Simple Coma Scale, a Simplified Version of the Glasgow Coma Scale.

The Glasgow Coma Scale (GCS) is the most commonly used consciousness rating scale worldwide. Although it is a sensitive and accurate way of assessing a patient's level of consciousness, it is time-consuming and requires training. We designed the Simple Coma Scale (SCS) as a simplified version of the GCS. In this study, we examined whether the SCS could predict favorable neurogenic outcomes at discharge, survival, and GCS scores in patients with traumatic brain injury (TBI). We analyzed the data of 1,230 patients registered in the Japan Neurotrauma Data Bank (Project 2015) between April 2015 and March 2017. In the SCS, eye, verbal, and motor scores are given based on a 3-point scoring system, with similar wording ("Normal," "Something Wrong," and "None") used for all scores. The SCS is based on a 7-point scale. The Glasgow Outcome Scale was used to assess the outcomes. For the receiver operating characteristic (ROC) curves with the objective variable of good prognosis at discharge in the SCS and GCS, the area under the curve (AUC) for the SCS was 0.740 (95% confidence interval [CI]: 0.711-0.769), and that of the GCS was 0.757 (95% CI: 0.729-0.786). For ROC curves with survival as the objective variable, the AUC of the SCS was 0.751 (95% CI: 0.724-0.778), and that of the GCS was 0.764 (95% CI: 0.737-0.791). The SCS, similar to the GCS, may predict good prognosis and survival at discharge. Further analyses will continue to examine the usefulness and practicality of the SCS.

The meninges.

The dura was first described in ancient Egypt. Hippocrates insisted that it should be protected and not penetrated. Celsus proposed an association between clinical findings and meningeal damage. Galen proposed that the dura was attached only at the sutures, and he was the first to describe the pia in humans. In the Middle Ages, new interest in the management of meningeal injuries arose, with renewed interest in relating clinical changes to intracranial injuries. These associations were neither consistent nor accurate. The Renaissance brought little change. It was in the 18th century that it became clear that the indication for opening the cranium following trauma was to relieve pressure from hematomas. Moreover, the important clinical findings on which to base an indication for intervention were changes in the level of consciousness.

Weighted Hermite Variable Projection Networks for Classifying Visually Evoked Potentials.

The occipital cortex responds to visual stimuli regardless of a patient's level of consciousness or attention, offering a noninvasive diagnostic tool for both ophthalmologists and neurologists. This response signal manifests as a unique waveform referred to as the visually evoked potential (VEP), which can be extracted from the electroencephalogram (EEG) activity of a human being. We propose a trainable VEP representation to disentangle the underlying explanatory factors of the data. To enhance the learning process with domain knowledge, we present an innovative parameterization of classical Hermite functions that effectively captures VEP pattern variations arising from patient-specific factors, disorders, and measurement setup influences. Then, we introduce a differentiable variable projection (VP) layer to fuse Hermite basis function expansions (BFEs) of VEP signals with machine learning (ML) approaches. We prove the existence of an optimal set of parameters in the least-squares sense, assess the representation power of such layers, and calculate their analytical derivatives, which allows us to utilize backpropagation for training. Finally, we evaluate the effectiveness of the proposed learning framework in VEP-based color classification. To achieve this, we have designed a novel measurement system dedicated to intraoperative clinical use cases, which presents new ways for patient monitoring during neurosurgical procedures.

Investigating Factors Affecting Mortality Due to Spinal Cord Trauma in Patients Admitted to the Intensive Care Unit.

This study was conducted to investigate the factors affecting mortality due to spinal cord trauma in patients admitted to the intensive care unit (ICU). This study was conducted in a group of patients who were admitted to the ICU with a Traumatic Spinal Injuries (TSI) diagnosis. The researcher started sampling by assessing the documents of the patients hospitalized in the ICU, and the diagnosis of TSI was confirmed for them. Besides, utilizing a researcher-made checklist, factors affecting the mortality of patients were identified. The data were analyzed using the SPSS software version 16. P<0.05 was considered statistically significant. About 412 (64.2%) patients were men, about 213 (33.2%) of the patients had GCS between 3-8 grade. There were injuries in the pelvis area. Moreover, there was a significant relationship between GCS score status and the number of injury follow-ups in addition to TSI. Therefore, the mortality rate was higher in patients who had lower GCS (Odds ratio=2.32, p<0.001). There was also a significant relationship between the number of injuries and the mortality rate, and patients who had multiple traumas had a higher mortality rate. Besides, a significant relationship was observed between the complications caused by trauma, including cerebrovascular accident, cardiac arrest, acute respiratory distress syndrome (ARDS), pneumonia, and the mortality of patients hospitalized in the SICU (p<0.05). The patients' mortality was influenced by factors such as their level of consciousness, the number of traumas caused in the spinal cord, and the occurrence of comorbidities such as cerebrovascular accident, cardiac arrest, ARDS, and pneumonia. Therefore, it is necessary to take the essential measures to reduce these complications.

Late Middle Ages-Europe.

At the end of the late Middle Ages, there had been changes in indications for surgery, with prophylactic trepanation falling out of favor. The management of wounds and the methods for opening the cranium had become fairly standardized. Narrow non-plunging trepans were the preferred drills, and cranial openings were widened by the use of multiple drill holes connected with chisels of which the lenticular was preferred. Concerns about damaging the dura led Theodoric to delay trepanation until the clinical changes reflected separation of the dura from the cranium, at least in his view. Draining pus remained the main indication for trepanation. In no case was the level of consciousness considered in determining the need to open the cranium.

Cerebral Oxygen Dynamics in a Patient After Subdural Haematoma Removal Surgery: A Case Report.

Near-infrared spectroscopy (NIRS) can be employed for the non-invasive real-time evaluation of cerebral oxygen dynamics. A portable wireless NIRS system has been developed to record measurements using a band worn around the head. In this case report, we describe the clinical findings and cerebral oxygen dynamics of a patient who underwent surgery to remove a left temporal subdural haematoma. The patient was a male in his 70s, who fell while riding a bicycle. Following the gradual onset of gait disturbance, the patient was admitted to our hospital for surgery. After surgical removal of the subdural haematoma, the cerebral oxygen dynamics of the left and right frontal cortical hemispheres were monitored using NIRS in the following sequence: supine, bed-up 70°, sitting, standing, and supine, for 3 min each. Measurements were made on postoperative days (PODs) 2, 3, 7, and 10. Clinically, on POD2, the patient had a decreased level of consciousness, requiring assistance in maintaining each posture. On POD10, his level of consciousness improved and he was able to walk for short distances. The cerebral oxygen dynamics on the injured hemispheres showed the most remarkable changes on POD2 which decreased with the passage of time. NIRS may be useful in non-invasive assessment of the recovery of the cerebral circulation after neurosurgical intervention to inform the medical rehabilitation team on the progress in recovery.