Search

Objective To investigate the effect of hyperbaric oxygen (HBO) therapy on consciousness and prognosis in patients with prolonged disorders of consciousness (pDOC) after hypoxic-ischemic brain injury (HIBI). Methods Clinical data of 78 pDOC patients after HIBI treated in the General Hospital of Southern Theater Command from January 2010 to June 2019 were collected and analyzed retrospectively. In accordance with their treatment, they were divided into control group (n=19) and HBO group (n=59). Then, the HBO group was further assigned into long-course subgroup (n=21) and short-course subgroup (n=38) according to whether the course of disease was longer than 3 months. The patients in the control group received only routine treatment, while those in the HBO group got HBO therapy on the basis of routine treatment. Gender, age, GOS score at admission, and Coma Recovery Scale-Revised (CRS-R) score at admission and discharge were recorded. Glasgow Outcome Scale was used for follow-up survey in 1 year after discharge. Results The HBO group had significantly higher CRS-R score at discharge (11.51±6.33 vs 8.05±4.81), larger proportion of those achieving better consciousness (66.10% vs 26.32%) when compared with the control group (P < 0.05). In 1 year after discharge, the GOS score was significantly higher (2.53±1.12 vs 1.42±0.69) and lower mortality (20.34% vs 68.42%) in HBO group than the control group (P < 0.05). Moreover, in the short-course subgroup, the CRS-R score at discharge was obviously higher (12.45±6.73 vs 8.05±4.81), the proportion of patients with consciousness improved was larger (71.05% vs 26.32%), the GOS score in 1 year after discharge was higher (2.58±1.13 vs 1.42±0.69), and lower mortality rate was lower (18.42% vs 68.42%) when compared with the control group (P < 0.05). And in the long-course subgroup, similiar results of above indicators were seen in comparison with the control group (57.14% vs 26.32%; 2.43±1.12 vs 1.42±0.69; 23.81% vs 68.42%; P < 0.05). Conclusion HBO therapy can improve the consciousness of patients with pDOC after HIBI, even if the course exceeds 3 months. Further more, HBO therapy can improve long-term prognosis and reduce mortality rate in these patients.

Objective: With the global warming, the incidence of heat stroke was significantly higher than before. Severe heat stroke has a high mortality, high morbidity and consolidated central nervous system injury characteristics. The main features of severe heat stroke cerebral injury include cognitive impairment, delirium, convulsions and coma. Its mechanism is related with heat shock induced cerebral tissue ischemia and hypoxia, vascular dysfunction, secondary cascade inflammation and so on. Currently, the main treatment of heat stroke cerebral injury is the hypothermia therapy, dehydration for the reduction of intracranial pressure, naloxone and other cerebral protection and nutrition treatments. Hyperbaric oxygen therapy (HBOT) is effective in treating brain injury. HBOT can alleviate tissue ischemia and hypoxia, improve circulation, reduce cerebral edema, and anti-inflammatory, anti-oxidative damage, anti-apoptosis and other molecular biological effects. HBOT also play a wake up-promoting effect of nerve repair in the cerebral injury. The treatment of cerebral injury has been the difficulty and weakness of heat stroke research. Therefore, this article reviewed the epidemiology, pathogenesis, the therapeutic effect and mechanism of hyperbaric oxygen on cerebral injury in severe heat stroke to clarify the advantages of HBOT and to provide experimental basis for further research.

Objective: To conduct a clinical trial of ketogenic diet (KD) in patients with acute spinal cord injury (SCI) and evaluate its safety and feasibility by measuring blood ketone bodies and blood glucose levels., Method: Ten patients with acute SCI were recruited in the trial during the period from May, 2012 to October, 2013. The patients received a standard KD after fasting for 48 h. The levels of blood ketone, blood glucose and uric ketone were tested daily, and routine blood examination, electrolytes, liver and kidney function, body mass index (BMI), sensory and motor function, and adverse reactions were monitored weekly to assess the safety and feasibility of KD., Results: KD treatment lasted for a mean of 12.9 days (4 to 29 days) in these patients. In all the patients, blood ketone level increased during the fasting and maintained a level above 2.0 mmol/L after taking KD, while the uric ketone level ranged from +++ to ++++. The blood glucose level was in the normal range during KD. Except for blood chloride level and BMI, routine blood test results, electrolytes, liver and kidney function showed no significant changes after KD. No significant changes were observed in the sensation of light touch and pinprick. The average motor ASIA score increased from 33.3 to 35.1 after KD. Gastrointestinal dysfunction (diarrhea, nausea, poor appetite, gastric pain, and abdominal distension) was recorded in 5 patients, hypoglycemia occurred in one patient early after KD, and one patient experienced urticaria during KD. All the adverse reactions were relieved after symptomatic treatments., Conclusion: This preliminary clinical trial demonstrated that KD could increase ketone bodies level and maintain a normal blood glucose level, suggesting its safety and feasibility in patients with acute SCI.