To explore the research hotspots and trends in the field of TBI by bibliometric analysis of the literature on traumatic brain injury (TBI).

The relevant literature on TBI research from 2016 to 2020 were retrieved based on the core database of Web of Science. The annual distribution, author, institution, country, journal, citation and keywords of published articles were analyzed through CiteSpace.5.8.R3 and the research hotspots and trends in the field of TBI were discussed according to the word frequency, centrality and clustering of keywords.

(1) A total of 14 991 articles were included after screening. The United States was the country with the most publications, and Harvard Medical School was the institution with the most publications. (2) Oxidative stress, mortality, children’s TBI, post-traumatic stress disorder, and rehabilitation treatment have been the hot spots in the field of TBI in recent 5 years. (3) TBI model and injury effect-biological mechanism-diagnosis and treatment guidelines-individual treatment is the research trend in the field of TBI research.

The damage effect, molecular mechanism, reliability and effectiveness of treatment in the adolescent population are the focus and direction of current and future research in the field of TBI.

To explore the efficiency of multidisciplinary treatment (MDT) in the diagnosis and treatment of patients with central nervous system (CNS).

The clinical data of 49 patients who attended the Neurosurgery MDT Clinic of the Second People’s Hospital of Shenzhen from June 2019 to June 2020 were retrospectively analyzed. Before MDT diagnosis and treatment, the feasible diagnosis and treatment of these patients had been discussed by the specialists, which would be compared with the diagnosis and treatment plan after MDT, to analyze the changes in diagnosis and treatment. These changes in diagnosis and treatment were further divided into two categories: major changes and minor changes according to literatures reporting criteria. The types and proportions of changes in diagnosis and treatment indexes before and after MDT were compared and analyzed statistically.

Pre- and post-MDT diagnosis were consistent in 33 cases (67.3%), and were modified in 16 cases (32.7%). Of the diagnosis modified cases, 7 cases (14.3%) were major changes, and 9 cases were minor changes (18.3%). Pre- and post-treatment were consistent in 26 cases (53.1%), while 23 cases (46.9%) were changed, among which 15 cases (30.6%) were major changes, and 8 cases were minor changes (16.3%). There was no significant difference in the change rate and degree of diagnosis and treatment between different types of nerve tumors before and after MDT (P>0.05). The proportion of treatment changes in patients with recurrent tumors before and after MDT was higher than that in patients with primary tumors, and the proportion of major changes was higher than that of minor changes (P<0.05). At the same time, the proportion of treatment changes in patients with recurrent glioma before and after MDT was higher than that in patients with primary glioma (P<0.05).

There was no difference in MDT efficiency among different tumor types, but there was a significant difference in the efficiency of MDT of the diagnosis and treatment for recurrent CNS tumors, suggesting that due to the complexity of diagnosis and treatment, recurrent neuroneoplastic diseases need more intervention of MDT.

To investigate the predictive value of systemic immune-inflammation index (SII) on the early prognosis of patients with acute traumatic brain injury (TBI).

Patients with acute TBI admitted to Critical Care Medicine Department of Xuzhou Central Hospital from January 2018 to December 2021 were selected as the research objects, and the clinical data, blood test indexes were collected and SII was calculated. Patients were followed up for 30 d and divided into good prognosis group (GOS 4-5) and poor prognosis group (GOS 1-3) according to GOS score. Independent risk factors for poor prognosis in patients with acute TBI were analysed using univariate and multi-factor Logistic regression, and the area under the curve (AUC) was calculated by plotting the subject operating characteristic (ROC) curve. The predictive value of SII on the prognosis of patients with acute TBI was analyzed. The optimal cut-off value of SII was calculated and divided into high and low value groups to assess the 30 d risk of death in both groups.

A total of 164 patients with acute TBI were included, 84 (51.2%) in the good prognosis group and 80 (48.8%) in the poor prognosis group. There were no significant differences in age, sex, mean arterial pressure, heart rate, hemoglobin, leukocyte count, neutrophil count, monocyte count, platelet count and MLR between the good prognosis group and the poor prognosis group (all P>0.05); There were significant differences in lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), platelet to lymphocyteratio ratio, systemic inflammation response index (SIRI) and SII among the groups (all P<0.05).The SII values were significantly higher in the poor prognosis group than in the good prognosis group, with a statistically significant difference (P<0.01). Multi-factor Logistic regression analysis showed that SII was an independent risk factor for poor prognosis in patients with acute TBI (OR=1.275, 95%CI: 1.123-1.448, P<0.01). ROC curve analysis showed that SII predicted poor prognosis with an AUC of 0.925 (95%CI: 0.874-0.960) , sensitivity 87.50% and specificity 82.14%, and its predictive value was better than that of NLR. The optimal cut-off value for SII was 15.95, with a statistically significant higher mortality in SII>15.95 group (39.5%) than in SII≤15.95 group (6.4%) (relative risk 1.547, 95%CI: 1.292-1.854).

SII is closely associated with early poor prognosis and mortality risk in patients with acute TBI. The higher the level of SII, the worse the short-term prognosis of patients and the higher the risk of death, and SII has a high predictive value for short-term adverse outcomes in patients with acute TBI.

To explore the relationship between the random blood glucose level and the outcome of severe traumatic brain injury (sTBI) patients with stress hyperglycemia during hospitalization.

The in-hospital medical records of 85 patients with sTBI and first-admission random blood glucose>11.1 mmol/L admitted to the Neurosurgical Intensive Care Unit of the First Affiliated Hospital of Air Force Military Medical University from October 2013 to June 2022 were retrospectively analyzed. Patients were divided into good outcome group (GOS>3 score) and poor outcome group (GOS≤3 score) according to their GOS score at discharge. The general information of two groups was compared, the multivariate Logistic regression analysis was used to identify risk factors affecting patient prognosis, and the relationship between random blood glucose levels during hospitalization and prognosis was analyzed.

Of the 85 patients included, 67 had poor outcome and 18 had good outcome. The difference in random blood glucose levels between the two groups during hospitalization was statistically significant (P<0.05), and blood glucose>11.1 mmol/L was an independent risk factor for the prognosis of sTBI patients. During hospitalization, 26 patients developed concurrent infections, including 3 in the group with good outcome and 23 in the group with poor outcome, there was no statistically significant difference in infection rates between the two groups (P>0.05). Patients with random blood glucose>11.1 mmol/L had significantly higher infection rates compared to those with ≤11.1 mmol/L, but the differences were not statistically significant (P>0.05).

Randomized blood glucose levels during hospitalization in patients with sTBI and SH are associated with prognosis, and blood glucose levels>11.1 mmol/L are independent risk factors for the prognosis of sTBI patients.

To systematically compare the cell damage characteristics of stretch injury model, oxygen-glucose deprivation (OGD) model and hydrogen peroxide (H₂O₂)-treated oxidative stress model, and to provide a reference for the selection of cell models in TBI research.

After resuscitation of frozen HT-22 cells, HT-22 cells were seeded in Six-well plates, which were divided into experimental group and control group. The experimental group prepared cell stretch injury models, OGD models, and oxidative stress injury models respectively. The control group was cultured normally without any special treatment. The changes of cell morphology were observed by microscope, and cell viability was tested by CCK-8 analysis; cell proteins were extracted, and changes of apoptosis markers (Bcl-2, Bax), necroptosis markers (RIPK3, RIPK1), ferroptosis markers (ACSL4, GPX4, SLC7A11) were detected by Western blot.

Compared with the control group, all three injury models led to abnormal morphological changes in different degrees, restricted proliferation or cell shedding in HT-22 cells, indicating cell damage. CCK-8 analysis showed that the cell viability in different model treatment groups was significantly reduced (P<0.05). The results of Western blot demonstrated that the expression of GPX4, SLC7A11, Bax, RIPK3 and RIPK1 proteins in cells treated with 3.0 PSI tensile strength was significantly increased, with statistical significance (P<0.05). After OGD treatment for 12 h, the expression of SLC7A11 and Bax was significantly up-regulated, with statistical significance (P<0.05). After 800 μmol/L hydrogen peroxide treatment, the expression of Bcl-2 and RIPK1 proteins was significantly up-regulated, with statistical significance (P<0.05).

The stretch model can better reflect the complex injury characteristics after TBI, and the OGD and H₂O₂ treatment models are more suitable for studying specific injury pathways.

To compare the mechanism of triptolide (TP) and methylprednisolone (MP) in regulating autophagy and apoptosis, and promoting the repair of spinal cord injury (SCI), so as to provide a theoretical basis and new selective drugs for new alternative drugs for clinical replacement of MP for SCI.

After establishing the SCI model, 60 THY-YFP transgenic mice were randomly divided into sham-operated group (Sham group), DMSO solution treatment group (DMSO group), MP experimental group and TP experimental group. Mice in TP experimental group, DMSO and Sham group were intraperitoneally injected with TP (0.002 mg/10 g), the same amount of 5% DMSO and 0.9% NaCl solution immediately after surgery, and had been continuously administrated for 7 d. Mice in MP experimental group were intraperitoneally injected with MP solution (0.3 mg/10 g) at 30 min, 6 h and 24 h after surgery. BMC was used to evaluate motor function, HE staining and Nissl staining were used to detect the histological changes of the spinal cord, Western blot and immunofluorescence staining were used to detect the levels of autophagy-related proteins (Beclin-1, LC3B, and p62) and apoptosis-related proteins (Bcl-2, Bax, and caspase-3).

After TP intervention, the BMS motor function score of SCI mice gradually increased over time, the number of neurons increased, the autophagy-related protein, Beclin-1 and LC3B increased and p62 decreased, the apoptosis-related protein, caspase-3, Bax decreased and the anti-apoptotic protein Bcl-2 increased. Regardless of motor function evaluation, histological changes, enhanced autophagy and reduced apoptosis after SCI, TP experimental group was superior to DMSO group, but no significant difference was found between TP experimental group and MP experimental group (P>0.05).

TP can promote the recovery of spinal cord motor function after injury by up-regulating autophagy and inhibiting apoptosis in acute neck SCI, and has the same potential protective effect on SCI compared with MP.

To investigate the effect of folic acid on Parkinson's like injury in mouse HT22 cells.

Mouse HT22 cells were used as the study subjects, and were randomly divided into four groups: Control group, MPP⁺ group (Model group), Folic acid group and MPP⁺ + Folic acid (Treatment group). CCK-8, LDH, TUNEL and immunofluorescence assay were used to detect the effect of folic acid on cell viability and expression of NLRP3 induced by MPP⁺. The effects of folic acid on the expression of NLRP3, ASC and Caspase-1 after MPP⁺-induced cell injury were detected by Western blot and qPCR. ELISA was used to detect the effect of folic acid on the expression of interleukin (IL)-18 and IL-1β after MPP⁺-induced cell injury. Finally, Western blot was used to examine the expression of ASC, Caspase-1, IL-18 and IL-1β after CY-09 treatment.

MPP⁺ can cause Parkinson’s like injury to HT22 cells. The results of CCK-8, LDH and TUNEL experiments showed folic acid can significantly alleviate the decrease of cell viability and the increase of apoptotic cells caused by injury. Immunofluorescence test showed that folic acid could reduce the increase of NLRP3 fluorescence intensity in injured cells. Western blot and qPCR test showed that folic acid decreased the increase of NLRP3, ASC and Caspase-1 in protein level and mRNA level. ELISA results showed that folic acid treatment significantly alleviated the secretion of intracellular IL-18 and IL-1β after injury. Finally, Western blot showed that CY-09 could block the increase of ASC, Caspase-1 and IL-18 and IL-1β protein levels in cells after injury.

Folic acid can cause Parkinson's like injury to HT22 cells by decreasing IL-18 and IL-1β expression and protecting MPP⁺, and the potential protective mechanism may be closely related to the NLRP3/ASC/Caspase-1 signaling pathway.

To explore the related risk factors in platelet dysfunction in patients with traumatic brain injury (TBI).

The clinical data of 97 patients with craniocerebral trauma in the Neurosurgery Department of Nanning Second People’s Hospital from July 2020 to December 2021 were retrospectively analyzed. The clinical data include: gender, age, GCS score, multiple trauma, open craniocerebral trauma, fibrinogen concentration, prothrombin time (PT), activated partial thromboplastin time (APTT), platelet count and platelet function were collected after hospitalization. Patients were divided into abnormal platelet function group (MA value<50 mm) and normal platelet function group (50 ≤MA value ≤70) according to the maximum blood clot firmness value. Univariate and multivariate Logistic regression analysis were used to determine the risk factors in platelet dysfunction after TBI. The receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to evaluate the predictive value of the related risk factors for platelet dysfunction after TBI.

Among 97 patients, 38 patients were in abnormal platelet function group and 59 patients in normal platelet function group. The results of single factor analysis showed that there were significant differences between the two groups in GCS score, fibrinogen concentration, PT, APTT, platelet number and platelet function (P<0.05). The results of binary Logistic regression analysis showed that the GCS score (OR=0.765, 95%CI: 0.618-0.947), fibrinogen concentration (OR=0.073, 95%CI: 0.014-0.387) were the influencing factors of platelet dysfunction in patients with TBI (P<0.05); AUC of GCS score is 0.827 (95%CI: 0.618-0.947), AUC of fibrinogen concentration is 0.915 (95%CI: 0.014-0.387).

Low GCS score and low fibrinogen concentration are prone to platelet dysfunction after TBI. Among them, the GCS score has a certain predictive accuracy, and the fibrinogen concentration has a high predictive accuracy.

To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on the recovery of neural dysfunction and the expression of DJ-1 in the model of traumatic brain injury (TBI) in mice.

Thirty healthy male C57BL/6J mice from 8 to 12 weeks were randomly divided into Sham group, TBI group and rTMS group, with 10 mice in each group. In Sham group, only bone window was opened without striking cerebral cortex; In TBI group and rTMS group, the controlled cortical impact injury (CCI) model was used, and the model was prepared by the methods of fixed strike velocity (3 m/s), residence time (200 ms) and strike depth (3.0 mm). At 24 h after model preparation, Sham group and rTMS group were treated with rTMS (frequency: 1 Hz, duration: 25 s, 5 times/d, continuous treatment: 14 d), and TBI group was put into the closed coil during treatment. The neurological deficit scores and behavioral tests were performed on mice before and after treatment. After 14 d of treatment, hematoxylin eosin (HE) staining was used to observe the histopathological changes; Immunohistochemical technique was used to detect the expression of DJ-1 in neurons around the trauma focus; TUNEL staining was used to detect apoptosis in the injured area; The protein expression of DJ-1 was detected by Western blot.

At 7 and 14 d after trauma, the mNSS scores in TBI group and rTMS group were significantly higher than those in Sham group, and the mNSS scores in rTMS group were lower than those in TBI group (P<0.05). The mNSS score of rTMS group decreased to below 6 at 14 d after trauma. In the behavioral experiment, the balance beam experiment results showed that the time for mice to pass the balance beam after trauma was significantly increased, and the motor function of mice gradually recovered with the extension of time. The time for mice in rTMS group to pass the balance beam was significantly shorter than that in TBI group, with statistically significant differences (P<0.05); The results of rod turning test showed that the time of mice staying on the rod was significantly reduced after trauma, and the time of mice staying on the rod was gradually increased with the prolongation of valve time. However, the time of mice staying in rTMS group was significantly longer than that in TBI group, and the difference was statistically significant (P<0.05). The brain histopathology of TBI model mice showed that the brain injury area was obviously damaged, the damage focus was limited and gradually repaired. Compared with Sham group and TBI group, the expression of DJ-1 in rTMS group was significantly increased (P<0.05).

rTMS can effectively promote the recovery of nerve function and trauma focal area in injured mice. It is speculated that rTMS can promote the expression of DJ-1 in the body, reduce the neurological deficit score and trauma area.

To explore the reasons and treatment strategies of common complications after cranioplasty.

The clinical data of 158 patients with cranioplasty, from June 2014 to January 2016, were analyzed retrospective about complications condition and prognosis.

Twenty-six patients (16.46%) had complications after operation, including epidural hematoma (3 cases), subcutaneous effusion and hemorrhage (5 cases), scalp incision infection (12 cases), intracranial infection (1 case), repair material leakage (2 cases), epilepsy after operation (3 cases). And postoperative complications were related with older age, large skull defect area, long repair time interval.

Cranioplasty is one of conventional surgery of neurosurgery, and its complications induces the pain of patient. It has important clinical significance to perform strictly operation steps and to reduce the surgical complications.

To explore the effect of sulbactam on brain tissue injury in rats with focal cerebral ischemia-reperfusion.

Thirty male SD rats were selected and randomly divided into a sham group, a model group and a sulbactam group, with 10 rats in each group. The right cerebral ischemia-reperfusion model was prepared by thread embolism method. Thirty minutes after cerebral ischemia, the model group was intraperitoneally injected with 10 μL normal saline, the sulbactam group was intraperitoneally injected with 10 μL sulbactam, and the sham group was not given any intervention. Longa score was used to evaluate the neurological function of rats, Image-ProExpress imaging was used to analyze cerebral infarction volume, and immunohistochemical staining was used to detect serum glial glutamate transporter-1 (GLT-1) levels. Thirty days after surgery, Morris water maze was used to test learning and memory function, and the escape latency on days 1, 2, 3, 4, and 5 was compared.

The neurological function score and cerebral infarction volume in the sham group were 0, while those in the sulbactam group were significantly lower than those in the model group (P<0.05). The serum GLT-1 levels of the three groups were statistically significant (P<0.05), the serum GLT-1 levels of the sulbactam group and the model group were significantly higher than those of the sham group, while the sulbactam group was significantly lower than the model group (P<0.05). On the first day of test, the escape latency of the three groups was not statistically significant (P>0.05). On the 2^nd to 5^th day of testing, the escape latency of the three groups was statistically significant (P<0.05), the escape latency of the sulbactam group and the model group was significantly higher than that of the sham group (P<0.05), and the escape latency of the sulbactam group was significantly lower than that of the model group (P<0.05).

Sulbactam can effectively improve nerve function, learning and memory function, reduce cerebral infarction volume and serum GLT-1 level in rats with focal cerebral ischemia-reperfusion.

To explore the clinical effect of different terms cranioplasty following large decompressive craniectomy in the treatment of severe traumatic brain injury (sTBI).

Retrospective analysis of clinical data of 94 patients with decompressive craniectomy, admitted to our hospitals from January 2012 to June 2017, was performed; these patients were divided into early treatment group (given treatment within 1-3 months, n=53), and late treatment group (given treatment 3-6 months, n=41); the differences of complications and survival quality between the two groups were respectively observed.

After 1 year of cranioplasty, the complications of early treatment group had a higher rate than the late treatment group (χ²=5.502, P<0.05). There is no significant difference of GOS and KPS grade between the two groups before cranioplasty, but 1 year later after cranioplasty, early treatment group had a higher grade of GOS and KPS than the late treatment group (P<0.05). Furthermore, compared of CSS and MMSE between the two different treatment groups, there was significant difference between the postoperative score and preperative (P<0.05). Meantime, the CSS and MMSE of early treatment group got significantly different scores than the late treatment group (P<0.05).

Early cranioplasty following decompressive craniectomy helps improving the prognosis, reducing complications, promoting recovery and the quality of life.

To investigate the risk factors of delayed intracranial hemorrhage (DICH) after ventriculo-peritoneal shunt (VPS) for communicating hydrocephalus (CHP), to construct a nomogram model for predicting the occurrence of DICH after surgery, and the prediction effect of the model was evaluated.

A case-control study was conducted on 307 CHP patients who underwent VPS surgery in Neurosurgery Department of Huai'an Second People's Hospital from February 2016 to August 2021. They were divided into the DICH group (n=49) and the control group (n=258) according to whether DICH occurred after surgery. The basic data (including age, gender, primary disease, whether combined with underlying diseases, the history of previous craniocerebral surgery, the history of anticoagulant use, presence or absence of skull defects, etc.) and treatment information (side puncture, adjustment of the shunt valve within 1 week) were collected for single factor analysis, multivariate Logistic regression analysis was used to determine the risk factors of postoperative CHP, and ROC curve and calibration curve were used to evaluate the predictive ability of the nomogram model. Another 104 CHP patients who underwent VPS were selected as the validation set, and the nomogram model was externally validated.

The age, the proportion of previous craniocerebral surgery history, the proportion of skull defects, and the proportion of adjustment of the shunt valve within 1 week in the DICH group were significantly higher than those in the control group (P<0.05); Logistic regression analysis showed that the age, the history of previous craniocerebral surgery, skull defect, and adjustment of the shunt valve within 1 week were the main risk factors for DICH after VPS in patients with CHP (P<0.05); ROC curve analysis results showed that the constructed nomogram prediction model of DICH after VPS in CHP patients had good discrimination [area under curve (AUC) was 0.858, 95%CI: 0.804-0.913] and accuracy (goodness of fit HL test χ²=7.831, P=0.396); Among 104 cases in the validation set, 16 cases developed DICH, with an incidence of 15.38%. The AUC in the external validation was 0.792 (95%CI: 0.729-0.855). The goodness of fit HL test of the calibration curve (χ²=8.319, P=0.351), indicating high accuracy.

The nomogram model based on four risk factors, including age, the history of previous craniocerebral surgery, skull defect, and adjustment of the shunt valve within 1 week, has a high predictive efficacy for the occurrence of DICH in CHP patients after VPS.