重型颅脑损伤围术期亚低温治疗路径——循证医学指导下的治疗抉择

早期动物实验研究表明亚低温能减轻脑损伤后的继发性损害,促进神经功能恢复,然而对其临床疗效不同研究结果不完全一致.本文应用循证医学思想,检索和评价国内外文献,为重型颅脑损伤患者制定了围术期亚低温实施方案.随访结果表明,亚低温可改善患者预后.     

亚低温治疗的作用机制及其临床应用

目前亚低温治疗的细胞和分子生物学机制的研究仍然不足,其应用的时机、方式、持续时间、并发症的防治及在不同病理过程中亚低温治疗的最佳目标温度选择仍存在很多争议,有待于进一步研究。本文介绍了亚低温的作用机制及其临床应用方面的进展,为医护人员更好地将该疗法应用于临床提供对策。     

亚低温治疗的作用机制及其临床应用

目前亚低温治疗的细胞和分子生物学机制的研究仍然不足,其应用的时机、方式、持续时间、并发症的防治及在不同病理过程中亚低温治疗的最佳目标温度选择仍存在很多争议,有待于进一步研究.本文介绍了亚低温的作用机制及其临床应用方面的进展,为医护人员更好地将该疗法应用于临床提供对策.     

亚低温在重型颅脑损伤患者救治中的应用与思考

重型颅脑损伤是致死、致残的主要原因之一。亚低温（MHT）的应用为重型颅脑损伤患者的救治提供了新的思路和方法,国内外多个临床试验证实了其在救治中的有效性和实用性。本文结合国内外相关诊疗指南、循证医学证据和文献,辩证探讨了MHT在重型颅脑损伤患者救治中的适应证及机制、操作方法及时间窗、并发症及临床决策问题。     

亚低温在重型颅脑损伤患者救治中的应用与思考

重型颅脑损伤是致死、致残的主要原因之一.亚低温(MHT)的应用为重型颅脑损伤患者的救治提供了新的思路和方法,国内外多个临床试验证实了其在救治中的有效性和实用性.本文结合国内外相关诊疗指南、循证医学证据和文献,辩证探讨了MHT在重型颅脑损伤患者救治中的适应证及机制、操作方法及时间窗、并发症及临床决策问题.     

老龄化社会中ICU的困境面面观

高龄、且长期罹患多种疾病的患者,病情一旦进展到必须接受有创机械通气的阶段,则康复机会极小,生存质量极差,不应划入急性可逆性范畴;而应转入社区医疗,加强现代健康观、死亡观教育,提供多种解决方案,不必一概纳入全方位支持监护系统,更不应常规给予有创机械通气、CRRT、亚低温治疗、肠内及肠外营养作为长期替代治疗。     

老龄化社会中ICU的困境面面观

高龄、且长期罹患多种疾病的患者,病情一旦进展到必须接受有创机械通气的阶段,则康复机会极小,生存质量极差,不应划入急性可逆性范畴;而应转入社区医疗,加强现代健康观、死亡观教育,提供多种解决方案,不必一概纳入全方位支持监护系统,更不应常规给予有创机械通气、CRRT、亚低温治疗、肠内及肠外营养作为长期替代治疗.     

树突状细胞疫苗对黑色素瘤患者免疫功能的影响

本文探讨了树突状细胞疫苗治疗黑色素瘤患者后外周血T细胞亚群及NK细胞的变化及其意义。树突状细胞疫苗治疗29例黑色素瘤患者,治疗前及治疗4周后分别采外周血运用流式细胞技术检测T淋巴细胞亚群及NK细胞百分比。对检测结果进行比较分析,树突状细胞疫苗治疗4周后外周血T细胞亚群及NK细胞百分比显著高于治疗前的水平,差异有统计学意义(P0.05)。29例患者中CR 1例,PR 16例,有效率58.62%。患者血常规及肝肾功能检测均正常,未出现明显毒副反应。通过研究发现树突状细胞疫苗可明显提高黑色素瘤患者T细胞亚群及NK细胞百分比,明显改善黑色素瘤患者的免疫功能,临床应用无明显不良反应。     

自然选择与肿瘤转移治疗新策略

微环境以自然选择的方式对肿瘤细胞亚群进行选择,使某些亚克隆更加倾向于向某些位置转移。微环境的自然选择是肿瘤转移的前提条件,始终贯穿于肿瘤发生发展的全过程,从自然选择的角度看肿瘤的转移,研究肿瘤转移需要的微环境,通过破坏转移前微环境,达到预防和治疗肿瘤转移的目的,将为肿瘤转移的治疗开创一条新路。     

自然选择与肿瘤转移治疗新策略

微环境以自然选择的方式对肿瘤细胞亚群进行选择,使某些亚克隆更加倾向于向某些位置转移.微环境的自然选择是肿瘤转移的前提条件,始终贯穿于肿瘤发生发展的全过程,从自然选择的角度看肿瘤的转移,研究肿瘤转移需要的微环境,通过破坏转移前微环境,达到预防和治疗肿瘤转移的目的,将为肿瘤转移的治疗开创一条新路.     

128例重型颅脑损伤患者的临床治疗体会

探讨重型颅脑损伤的治疗方法与经验。观察128例重型颅脑损伤患者的脑部受伤情况,合并伤以及受伤到入院期间的病情变化。临床治愈113例,其中能生活自理者87例,留有后遗症者26例,死亡15例,病死率为11.72%。重型颅脑损伤病死率高,入院后重点合理的检查,积极有效的救治以及规范的康复护理是降低病死率、提高临床治愈率的关键。     

Recovery in Memory Function,and its Relationship to Academic Success,at 24 Months Following Pediatric TBI*

While a number of research papers have reported findings on memory deficits following traumatic brain injury (TBI), only limited studies have monitored the recovery of these skills over time. The present study examined memory ability and its effect on academic success in a group of children who had sustained a mild, moderate, or severe traumatic brain injury (TBI). Results showed that the severe TBI group exhibited greater deficits on memory tasks, irrespective of modality, in the acute, 6-, 12-, and 24-month postinjury stages, in comparison to mild and moderate TBI groups. Performance on academic measures was dependent on both injury severity and task demands. Preinjury academic ability and verbal memory indices best predicted academic success.     

Recovery in memory function, and its relationship to academic success, at 24 months following pediatric TBI.

While a number of research papers have reported findings on memory deficits following traumatic brain injury (TBI), only limited studies have monitored the recovery of these skills over time. The present study examined memory ability and its effect on academic success in a group of children who had sustained a mild, moderate, or severe traumatic brain injury (TBI). Results showed that the severe TBI group exhibited greater deficits on memory tasks, irrespective of modality, in the acute, 6-, 12-, and 24-month postinjury stages, in comparison to mild and moderate TBI groups. Performance on academic measures was dependent on both injury severity and task demands. Preinjury academic ability and verbal memory indices best predicted academic success.     

Norepinephrine and brain damage: alpha noradrenergic pharmacology alters functional recovery after cortical trauma

The goal of these experiments was to evaluate the effects of some drugs affecting noradrenergic (NE) synaptic transmission, commonly prescribed following stroke or traumatic brain injury, on functional recovery. Measurement of recovery from a transient hemiplegia produced by a traumatic unilateral focal contusion in sensorimotor cortex (SMCX) of rats was used to assess the effects of chronic haloperidol (HAL) treatment begun early (1 day) or late (18 days to recovered animals) after injury. Additionally, using the same model, the effects of a single administration of drugs with selective action at NE receptors were also evaluated early or late (30 days) after injury. These drugs were: phenoxybenzamine (PBZ), an alpha 1-NE antagonist; prazosin (PRAZ), an alpha 1-NE antagonist; yohimbine (YOH), an alpha 2-NE antagonist; propranolol (PROP), a beta 1- and 2-NE receptor antagonist; methoxymine (METHOX), an alpha 1-NE agonist; and clonidine (CLON), an alpha 2-NE agonist. The data indicate that drugs with antagonistic effects at alpha 1 NE receptors, including HAL and PRAZ but not PROP, administered early after SMCX contusion retard locomotor recovery. Beneficial effects of enhancing NE transmission by METHOX or YOH were not observed. In animals recovered from beam walk (BW) deficits, a single administration of PBZ or PRAZ (alpha 1 NE antagonists) or CLON (alpha 2 NE agonist) transiently reinstated hemiplegic symptoms. The nonspecific beta NE receptor antagonist PROP had no effect in recovered animals. A single dose of HAL had no effect in recovered animals, but a BW deficit transiently developed in some animals following chronic treatment. The data are discussed with reference to drug contraindications noted in clinical studies of recovery from poststroke aphasia and cognition in demented patients with degenerative brain disease.     

Clinical neuropsychology and brain injury rehabilitation in Israel: A twenty-year perspective

The development of the field of neuropsychology in Israel is primarily the result of the development of rehabilitation services for traumatic brain-injured patients. The responsibility to care for and help disabled veterans has always been an important motivation for the establishment of rehabilitation services. Israel is probably one of the first countries in the world to develop community-based services specifically designed to address the needs of young patients with severe traumatic brain injury. The fairly extensive therapeutic and community services available today for both military and civilian brain-injured persons in Israel are the result of initiatives and funding by the Israel Ministry of Defense's Department of Rehabilitation. There are two principles that characterize most of the programs in Israel: (1) multidimensional remedial intervention and (2) life-time commitment to provide support. The accessibility of patients in a small country enables professionals to conduct follow-up studies in order to evaluate the long-term effects of brain injury. Current developments in neuropsychology are in three directions. First, formal training programs in neuropsychology are being set up. Second, the involvement of neuropsychologists is being extended beyond the treatment of young patients suffering from traumatic brain injury to include the treatment of different brain pathologies in children and the elderly. Third, sophisticated neuroimaging techniques are being applied to studies in cognitive neuropsychology.     

Cognitive Sequelae of Blast-Induced Traumatic Brain Injury: Recovery and Rehabilitation

Blast-related traumatic brain injury (bTBI) poses a significant concern for military personnel engaged in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). Given the highly stressful context in which such injury occurs, psychiatric comorbidities are common. This paper provides an overview of mild bTBI and discusses the cognitive sequelae and course of recovery typical of mild TBI (mTBI). Complicating factors that arise in the context of co-morbid posttraumatic stress disorder (PTSD) are considered with regard to diagnosis and treatment. Relatively few studies have evaluated the efficacy of cognitive rehabilitation in civilian mTBI, but we discuss cognitive training approaches that hold promise for addressing mild impairments in executive function and memory, akin to those seen in OEF/OIF veterans with bTBI and PTSD. Further research is needed to address the patient and environmental characteristics associated with optimal treatment outcome.     

Functional Neuroimaging Studies of Cognitive Recovery After Acquired Brain Damage in Adults

The first two decades of cognitive neuroimaging research have provided a constant increase of the knowledge about the neural organization of cognitive processes. Many cognitive functions (e.g.working memory) can now be associated with particular neural structures, and ongoing research promises to clarify this picture further, providing a new mapping between cognitive and neural function. The main goal of this paper is to outline conceptual issues that are particularly important in the context of imaging changes in neural function through recovery process. This review focuses primarily on studies made in stroke and traumatic brain injury patients, but most of the issues raised here are also relevant to studies using other acquired brain damages. Finally, we summarize aset of methodological issues related to functional neuroimaging that are relevant for the study ofneural plasticity and recovery after rehabilitation. Deceased     

Traumatic brain injury: Implications for practice

This article presents a brief overview of the prevalence and history of traumatic brain injury (TBI), discusses the multidimensional effects of TBI, describes the current focus of TBI rehabilitation, and summarizes outcomes from (re)habilitation work with individuals with traumatic brain injury. The importance of this critical area to rehabilitation personnel is discussed, along with suggestions for future research and evaluation studies.     

Traumatic brain injury: Implications for practice

This article presents a brief overview of the prevalence and history of traumatic brain injury (TBI), discusses the multidimensional effects of TBI, describes the current focus of TBI rehabilitation, and summarizes outcomes from (re)habilitation work with individuals with traumatic brain injury. The importance of this critical area to rehabilitation personnel is discussed, along with suggestions for future research and evaluation studies.