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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: 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.