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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.

Background: For patients with disorders of consciousness such as coma, a vegetative state or a minimally conscious state, one challenge is to detect and assess the residual cognitive functions in their brains. Number processing and mental calculation are important brain functions but are difficult to detect in patients with disorders of consciousness using motor response-based clinical assessment scales such as the Coma Recovery Scale-Revised due to the patients' motor impairments and inability to provide sufficient motor responses for number- and calculation-based communication.Methods: In this study, we presented a hybrid brain-computer interface that combines P300 and steady state visual evoked potentials to detect number processing and mental calculation in Han Chinese patients with disorders of consciousness. Eleven patients with disorders of consciousness who were in a vegetative state (n = 6) or in a minimally conscious state (n = 3) or who emerged from a minimally conscious state (n = 2) participated in the brain-computer interface-based experiment. During the experiment, the patients with disorders of consciousness were instructed to perform three tasks, i.e., number recognition, number comparison, and mental calculation, including addition and subtraction. In each experimental trial, an arithmetic problem was first presented. Next, two number buttons, only one of which was the correct answer to the problem, flickered at different frequencies to evoke steady state visual evoked potentials, while the frames of the two buttons flashed in a random order to evoke P300 potentials. The patients needed to focus on the target number button (the correct answer). Finally, the brain-computer interface system detected P300 and steady state visual evoked potentials to determine the button to which the patients attended, further presenting the results as feedback.Results: Two of the six patients who were in a vegetative state, one of the three patients who were in a minimally conscious state, and the two patients that emerged from a minimally conscious state achieved accuracies significantly greater than the chance level. Furthermore, P300 potentials and steady state visual evoked potentials were observed in the electroencephalography signals from the five patients.Conclusions: Number processing and arithmetic abilities as well as command following were demonstrated in the five patients. Furthermore, our results suggested that through brain-computer interface systems, many cognitive experiments may be conducted in patients with disorders of consciousness, although they cannot provide sufficient behavioral responses. [ABSTRACT FROM AUTHOR]

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: The bedside detection of potential awareness in patients with disorders of consciousness (DOC) currently relies only on behavioral observations and tests; however, the misdiagnosis rates in this patient group are historically relatively high. In this study, we proposed a visual hybrid brain-computer interface (BCI) combining P300 and steady-state evoked potential (SSVEP) responses to detect awareness in severely brain injured patients., Approach: Four healthy subjects, seven DOC patients who were in a vegetative state (VS, n = 4) or minimally conscious state (MCS, n = 3), and one locked-in syndrome (LIS) patient attempted a command-following experiment. In each experimental trial, two photos were presented to each patient; one was the patient's own photo, and the other photo was unfamiliar. The patients were instructed to focus on their own or the unfamiliar photos. The BCI system determined which photo the patient focused on with both P300 and SSVEP detections., Main Results: Four healthy subjects, one of the 4 VS, one of the 3 MCS, and the LIS patient were able to selectively attend to their own or the unfamiliar photos (classification accuracy, 66-100%). Two additional patients (one VS and one MCS) failed to attend the unfamiliar photo (50-52%) but achieved significant accuracies for their own photo (64-68%). All other patients failed to show any significant response to commands (46-55%)., Significance: Through the hybrid BCI system, command following was detected in four healthy subjects, two of 7 DOC patients, and one LIS patient. We suggest that the hybrid BCI system could be used as a supportive bedside tool to detect awareness in patients with DOC.