Combat-related mild traumatic brain injury （cmTBI） has a high incidence in modern warfare. However，it is very easy to be missed and misdiagnosed due to the lack of specific clinical manifestations and effective auxiliary diagnostic methods. If such casualties cannot be diagnosed and treated effectively at an early stage，a variety of sequelae may occur，seriously affecting the life quality and combat effectiveness of military members. This paper mainly focuses on the epidemiological characteristics，injury mechanisms，pathophysiological changes，clinical manifestations，diagnosis and treatment of cmTBI，in order to provide reference and guidance for the diagnosis and treatment of cmTBI.

Objective

To explore the temporal expression patterns of genes related to pyroptosis after traumatic brain injury （TBI） and construct a key molecular competitive endogenous RNA （ceRNA）network，providing a new perspective for further studying intervention targets of neuroinflammation during the acute phase of TBI.

Methods

A controlled cortical impact （CCI） mouse model was established，and groups were set up for sham surgery and different time points after TBI，including 0，1，2，3，4，6，12 h and 1，3，7 d post-injury （n=3 per group） for transcriptome sequencing. Mfuzz clustering analysis was used to explore the temporal expression characteristics of pyroptosis-related genes at the transcriptional level after TBI. Messenger RNA （mRNA） and long non-coding RNA （lncRNA） differentially expressed between TBI 12 h group and sham surgery group were screened. Based on bioinformatics methods，a competitive endogenous RNA （ceRNA） network was constructed using the“miRDB”，“Starbase”，and“LncBase v3.0” databases. The expression levels were verified through a single-cell dataset and RT-qPCR，and the direct binding of key molecules was validated using a dual-luciferase reporter assay.

Results

Pyroptosis-related genes exhibited two expression patterns after TBI，which reach their peak expression at 12 h and 3 d after TBI，respectively. Differential analysis between TBI 12 h group surgery and sham group identified 533 differentially expressed mRNA （432 upregulated and 101 downregulated） and 103 differentially expressed lncRNAs （51 upregulated and 52 downregulated），with Caspase-4，interleukin （IL）-1α，IL-1β，and IL-6 emerging as core pyroptosis mRNAs. The constructed ceRNA network comprised 4 lncRNAs （F630028O10Rik，F730311O21Rik，BE692007，and Mir17Hg），16 microRNAs （including mmumiR-466a-3p，etc.），and 4 core pyroptosis mRNAs （Caspase-4，IL-1α，IL-1β，and IL-6）. Single-cell dataset analysis confirmed the high expression of IL-1β during the acute phase of TBI. The dual-luciferase reporter gene assay verified the direct binding of F630028O10Rik/mmu-miR-466a-3p and mmu-miR-466a-3p/IL-1β. The relative luciferase activity of F630028O10Rik-WT and IL-1β-WT decreased by 16.5% and 27.1%，respectively （P＜0.05）.

Conclusion

The pyroptosis genes after TBI are divided into early genes （peak expression at 12 h） and late genes （peak expression at 3 d），which have different functions. A ceRNA network related to pyroptosis at 12 h after TBI was constructed，revealing that the IL-1β and its ceRNA regulatory axis （F630028O10Rik/miR-466a-3p/IL-1β） may play a central role in neuroinflammation during the acute phase （12 h） after TBI，providing new insights into intervention targets for the acute phase after TBI.

Objective

To explore the neuroprotective effect of corticosterone （CORT） on acute traumatic brain injury （TBI） through quantitative proteomics.

Methods

Fifteen male Sprague-Dawley（SD） rats were selected and randomly divided into a sham operation group，a TBI model group，and a CORT treatment group，with 5 rats in each group. A rat TBI model was established using controlled cortical impact （CCI）. The operation steps of the sham operation group were the same as those of the TBI model group，except that the cortex was not impacted. The CORT treatment group was intraperitoneally injected with CORT （0.3 mg/kg） within 1 h after impact，once a day for 2 consecutive days. At 48 h after TBI，ultra-high performance liquid chromatography and isobaric tags for relative and absolute quantitation（iTRAQ） protein mass spectrometry were used to analyze the differential proteins in the hippocampal tissues between the TBI model group and the CORT treatment group. OmicStudio tools，the Gene Ontology （GO） database，Ingenuity Pathway Analysis （IPA） software，and Cytoscape software were used to plot and analyze the volcano plot of differential protein expression，cellular components，biological processes and molecular functions，canonical enrichment pathways，and the interactions between proteins，respectively.

Results

The results of protein mass spectrometry data showed that a total of 3134 proteins were identified，and there were 71 differentially expressed proteins between the CORT treatment group and the TBI model group. The results of the volcano plot showed that，compared with the TBI model group，there were 28 up-regulated differential proteins ［fold change （FC）≥1.5） and 32 down-regulated differential proteins （FC≤0.65） in the CORT treatment group. The results of bioinformatics analysis （GO and IPA enrichment of canonical pathways） showed that the enriched canonical pathways included liver X receptor/retinoid X receptor （RXR） activation ［-log₁₀（P）=6.96］，farnesoid X receptor/RXR activation ［-log₁₀（P）=6.84］，acute phase response signaling pathway ［-log₁₀（P）=5.81］，etc.. The top 5 proteins in the interaction nodes among the differential proteins included α-1-antichymotrypsin，serum transferrin，plasminogen，complement C3，cytochrome C，etc..

Conclusion

The mechanism of the neuroprotective effect of CORT on TBI may involve regulating coagulation disorders，promoting iron homeostasis，reducing lipid peroxidation，the response to the acute phase，and anti-apoptosis.

Objective

To explore the role of “zero-channel” treatment in improving the prognosis of patients with severe traumatic brain injury （sTBI）.

Methods

Seventy-three patients with sTBI admitted to Neurotrauma Intensive Care Department of Zhujiang Hospital of Southern Medical University from March 2018 to March 2020 through the “green channel” were retrospectively collected and set as the green channel group； 54 patients with sTBI through the “zero-channel” from March 2020 to March 2023 were set as the zero-channel group. The general information，injury severity at admission，channel service time，and prognosis were compared between two groups. Univariate and multivariate Logistic regression analyses were used to identify independent risk factors for the prognosis of patients treated via the “zerochannel”.

Results

The time from admission to examination and from examination to surgery in the zerochannel group for sTBI was shorter than that in the green channel group，and the surgery rate within the“golden hour” and good prognosis rate were higher than that in the green channel group，and differences were statistically significant （P＜0.05）. In the zero-channel group，there were 10 cases with good prognosis and 44 cases with poor prognosis. There were statistically significant differences in age，the time from admission to examination and from examination to surgery between the good prognosis group and the poor prognosis group （P＜0.05）. Multivariate Logistic regression analysis showed that age ≥55 years and the time from admission to examination ≥10 min were independent risk factors for poor prognosis in the zerochannel group patients.

Conclusion

Compared to the “green channel”，the “zero-channel” can significantly shorten service time and improve patient prognosis，while age ≥55 years and hospital examination time ≥10 min are independent risk factors for poor prognosis in “zero-channel” patients.

Objective

To investigate the postoperative changes in blood sodium levels in patients with severe traumatic brain injury （sTBI） due to secondary hydrocephalus.

Methods

The clinical data of 130 patients with sTBI admitted to Neurosurgery Department of General Hospital of Northern Theater Command of PLA from June 2012 to June 2023 were retrospectively analyzed. The patients were divided into a secondary hydrocephalus group （32 cases） and a non-secondary hydrocephalus group （98 cases）according to whether they developed hydrocephalus after surgery. By comparing the general data of the two groups and the changes of blood sodium level after operation，the combined model of the change rate of blood sodium level and the secondary hydrocephalus group was established. The correlation between postoperative blood sodium changes and cerebrospinal fluid pressure （CSFP） parameters in the secondary hydrocephalus group was analyzed using a stepwise Logistic regression model. Multiple Logistic regression analysis was used to explore the potential risk factors of secondary hydrocephalus after sTBI.The restricted cubic spline model was used to estimate the relationship between sodium levels and postoperative secondary hydrocephalus and the dose-response relationship.

Results

There were significant differences in the head injury site，preoperative and postoperative GCS score，intraventricular hemorrhage，clear structure of the aqueduct and annulus，incidence of postoperative large cerebral infarction，and postoperative intracranial infection rate between 2 groups （P＜0.05）. The serum sodium level in both groups significantly increased on the second day after surgery，and the serum sodium level in the secondary hydrocephalus group was much higher than that in the non-secondary hydrocephalus group from 2 to 28 d after surgery，with statistical significance （P＜0.05）. Stepwise Logistic regression model analysis showed that different serum sodium levels were significantly correlated with soluble Fas （sFas，OR=1.495，95%CI： 1.133-1.967，P=0.009），sFas ligand （sFasL，OR=1.307，95%CI： 1.106-1.748，P=0.011），CSFP （OR=1.608，95%CI： 1.276-2.308，P=0.004） and regression of amplitude and pressure （RAP，OR=1.328，95%CI： 1.025-1.768，P=0.006） in cerebrospinal fluid. Multivariate Logistic regression analysis showed that postoperative intraventricular hemorrhage，postoperative intracranial infection，postoperative large area cerebral infarction，postoperative sFas，sFasL，CSFP，RAP elevation，and serum sodium level ≥149.76 mmol/L 2 d after surgery were all independent risk factors for postoperative secondary hydrocephalus （P＜0.05）. The results of the restricted cubic spline model showed that there was a nonlinear dose-response relationship between the level of blood sodium and the intensity of postoperative secondary hydrocephalus.

Conclusion

The postoperative changes in blood sodium levels in sTBI patients are closely associated with secondary hydrocephalus and have a certain predictive value for postoperative secondary hydrocephalus.

Objective

To investigate the effect of high-frequency electrosurgical unit on postoperative temporalis muscle atrophy in frontotemporal craniotomy.

Methods

A total of 91 patients who underwent frontotemporal craniotomy in Neurosurgery Department of Fuyang People's Hospital Affiliated to Anhui Medical University from September 2023 to March 2024 were prospectively selected and randomly divided into two groups using a random number table method： the study group （n=48） using high-frequency electrosurgical unit during surgery and the control group （n=43） using periosteal peeler and bipolar electrocoagulation during surgery. The time taken to separate the temporalis muscle，the amount of bleeding during separation of the temporalis muscle，and the amount of postoperative drainage were compared between two groups. The postoperative imaging data of the patients were collected，and the temporalis muscle volume was measured by three-dimensional reconstruction to compare the degree of postoperative temporalis muscle atrophy between two groups. The perioperative clinical data and followup data of patients were statistically analyzed，and incidence of adverse events such as postoperative mouth opening limitation，facial sensory disturbance，chewing pain，and temporal depression were compared between two groups.

Results

Compared with the control group，the study group had a shorter temporalis muscle separation time，less blood loss during temporalis muscle separation，and less postoperative drainage，and the differences were statistically significant （P＜0.05）； At 1 and 3 months after surgery，compared with the control group，the temporalis muscle atrophy in the study group was more severe，and the difference was statistically significant （P＜0.05）； During the postoperative follow-up period，the incidence of postoperative chewing pain in the study group was higher than that in the control group，and the difference was statistically significant （P＜0.05）.

Conclusion

During frontotemporal craniotomy ，the use of high-frequency electrosurgery to separate the temporalis muscle can effectively shorten the time for separating the temporalis muscle，reduce the amount of bleeding during separation of the temporalis muscle and the amount of drainage after surgery. The rational use of high-frequency electrosurgical unit can alleviate temporal atrophy to a certain extent，reduce the patient's anxiety and improve the patient's quality of life.

Objective

To analyze the clinical efficacy of Endoport combined with small bone window microsurgery in patients with long-term oral aspirin induced basal ganglia hemorrhage （LA-BGH）.

Methods

A retrospective analysis was made of 39 critical patients with spontaneous basal ganglia hemorrhage with large hematoma volume admitted to Neurosurgery Department of the 901^st Hospital of the Joint Logistics Support Force of PLA from January 2021 to January 2024. Among them，14 patients were critical patients with LA-BGH （observation group），and 25 were critical patients with conventional hypertensive basal ganglia hemorrhage （control group）. After admission，both groups of patients were treated with Endoport combined with small bone window microsurgery in emergency，and the surgical conditions，clinical effects and predicted results of the two groups were analyzed and compared.

Results

The surgery time of the observation group was longer than that of the control group，and the intraoperative blood output was higher than that of the control group，with statistically significant differences （P＜0.05）；There was no statistically significant difference in the NICU hospitalization time，hematoma clearance rate within 6 h after surgery，perihematoma edema area at 7 d after surgery，and incidence of perioperative complications between the two groups （P＞0.05）. The mRs scores of the observation group were higher than those of the control group at 6 months after surgery，but the difference was not statistically significant（P＞0.05）.

Conclusion

For critically ill patients with large basal ganglia hemorrhage caused by longterm oral aspirin，Endoport combined with small bone window microsurgery is a safe and effective emergency surgical approach.

Objective

To investigate the management strategies for intraoperative frontal sinus opening during craniotomy and the diagnosis/treatment of postoperative secondary local infections.

Methods

A retrospective analysis was performed on 11 patients with a history of frontal sinus manipulation during prior craniotomy，who developed local infections secondary to frontal sinusitis and underwent surgical treatment at Neurosurgery Department of The First Affiliated Hospital of Xinjiang Medical University from July 2020 to January 2024. All patients underwent a combined surgical protocol：local craniotomy debridement，pedicled temporal muscle flap packing into the frontal sinus，and endoscopic transnasal frontal sinusotomy. Postoperative incidence rates of intracranial infection and cerebrospinal fluid leakage were documented. One month after surgery，cranial imaging examinations and nasal endoscopy were performed to evaluate the condition of the frontal sinus opening. Long-term outcomes were monitored for 6-42 months to evaluate frontal sinusitis recurrence.

Results

All 11 patients achieved successful wound healing with no instances of cerebrospinal fluid leakage or intracranial infection. One-month postoperative imaging confirmed complete resolution of local inflammation，while nasal endoscopy demonstrated patent frontal sinus ostia during the follow-up period，none of the patients exhibited recurrence of frontal sinusitis.

Conclusion

The standardized treatment of the frontal sinus during craniotomy surgery is a prerequisite for avoiding the occurrence of frontal sinusitis. “local craniotomy debridement+pedicled temporal muscle flap packing into the frontal sinus+endoscopic transnasal frontal sinusotomy” is an effective method for treating secondary local infections in frontal sinusitis.

China's plateau regions are vast. With the improvement of transportation and economic conditions，the number of people traveling to plateau areas has increased significantly，leading to a rise in the incidence of accidental injuries，among which traumatic brain injury （TBI） stands out. The particularity of the plateau environment poses many challenges for the treatment of TBI patients. This review focuses on the pre-hospital treatment of TBI in plateau environments，summarizing the impact of plateau environmental factors on TBI，the clinical characteristics and pre-hospital treatment difficulties of plateau TBI，the modernization of pre-hospital emergency care and the strategy of technology transfer for plateau TBI，as well as the key points of pre-hospital treatment. The aim of this review is to provide a scientific basis and practical guidance for the pre-hospital emergency care of TBI in plateau areas.