To analyze the electroencephalogram (EEG) background activity and characteristic waveform of patients with disorders of consciousness (DOC) before and after treatment, compare the differences of EEG components in patients with different levels of consciousness and different prognosis, and explore the EEG activity patterns and characteristics of DOC patients in the sleeping period.

Six DOC patients admitted to the Neurosurgery Department of Peking University International Hospital from January to April 2020 were collected with coma recovery scale-revised score before and after treatment, and long-term video electroencephalogram monitoring was conducted more than 16 h, in which the characteristics of EEG activity, sleeping EEG cycle and composition of DOC patients were analyzed.

Patients with different levels of consciousness were likely to have occipital α rhythm. The healthy side was the dominant side, and was not inhibited when the eyes were opened. However, patients with good consciousness level were more likely to have occipital α rhythm. Patients with better prognosis were more likely to have sleep spindles.

DOC patients whether with occipital α rhythm or any characteristic of sleep EEG components have certain suggestive significance for the level of consciousness and prognosis, and the periodicity of sleep EEG needs to be investigated, which has certain reference significance for the clinical treatment rhythm regulation and sleep consciousness correlation understanding of DOC patients.

To assessing the safety, feasibility, efficacy and optimal cell dose of human leukocyte antigen (HLA≥4∶6) matched umbilical cord blood mononuclear cells (UCBMC) in the therapy of chronic complete spinal cord injury (SCI), and the effect of combined use of methylprednisolone (MP) and lithium carbonate on cell transplantation.

Twenty patients with SCI admitted to Department of Neurosurgery of 920 Hospital of Joint Logistics Support Force from February 2011 to January 2014 were selected and divided into 5 groups (group A, B, C, D, E) according to the random number table method, with 4 subjects in each group. UCBMC was injected at 4 points (2 points in each side) at the upper and lower edge of the injured spinal nerve. Group A, group B and group C were injected with 4, 8 and 16 μL (100 000 UCBMC/μL, 6.4 million cells) to the upper and lower dorsal root of SCI, group D received 16 μL cell injection plus 30 mg/kg MP intravenous injection, group E received 16 μL cell injection plus MP and 6-week oral lithium carbonate (750 mg/d). The subjects underwent intensive walking training for 3-6 months. The primary outcome was American Spinal Injury Association (ASIA) scores. Secondary outcomes include walking index of spinal cord injury (WISCI) and spinal cord independence measure (SCIM).

Twenty subjects averaged 7 years after C3-T11 SCI. Before treatment, 16 subjects (80%) could not walk 10 m even with assistance, and 18 subjects (90%) need assistance for bladder or bowel care. At 41-87 weeks, ASIA motor scores did not change but WISCI and SCIM scores improved. Fifteen subjects (75%) could walk 10 m with assistance, 12 subjects (60%) did not need assistance for bladder care or bowel care, 5 subjects converted from complete to incomplete. Meanwhile none of subjects lost further neurological functions.

UCBMC and locomotor training improved WISCI and SCIM but not motor scores. We hypothesize that UCMBC transplants stimulate growth of axons that activate central pattern generators for locomotion, micturition, and defecation. Combined use of MP and lithium carbonate had no obvious effect on cell transplantation.

To build a predictive score of progression to brain death within 7 d in acute neurocritical patients, which was used to guide clinical decision-making (palliative treatment or organ donation) of such patients.

From May 2017 to April 2019, acute neurocritical patient admitted in the Department of Neurosurgery and Critical Medicine of the First Affiliated Hospital of Sun Yat-Sen University were prospectively enrolled, the related factor of brain injury in those patients were dynamically record. According to the time of admission, the patients were divided into two parts: training set (from May 2017 to April 2018) and validation set (from May 2018 to April 2019). In the training set, 7 d after the occurrence of severe brain injury (GCS<8) was taken as the grouping factor; the univariate and multivariate analysis were used to screen the factors related to the progression to brain death within 7 d, and the Cox regression was used to build area under curve (AUC) curve; a neurology predictive score was built, and its performance was tested in the validation set.

Two hundred and thirty-one patients were included in the study, 139 patients entered the training set and 92 entered the validation set. In the training set, the univariate and multivariate analysis showed: mechanical ventilation with endotracheal intubation (OR=4.87, 95%CI: 1.36-17.35), light reflex absence (OR=4.86, 95%CI: 1.75-33.92), cough reflex absence (OR=4.43, 95%CI: 1.97-20.21) and midline shift ≥5 mm (OR=3.82, 95%CI: 1.05-12.32) were related with progression to brain death within 7 d. In the validation set, the results are consistent with the training set. A score was built based on those related factors, and the AUC of score was 0.84. Further grading of score, the positive predictive rate (progressing to brain death within 7 d) of 4-6 points was 85.7%, while the negative predictive rate (not progressing to brain death) of 0-3 points was 74.3%.

The neurological score based on brain injury assessment can predict the progression to brain death in acute neurocritical patients, but the results need further external validation.

Transcranial doppler (TCD) can dynamically and non-invasively monitor and evaluate cerebral hemodynamic changes, and intracranial pressure (ICP) is an important indicator for assessing the intracranial condition of patients with traumatic brain injury. In clinical work, an accurate and convenient non-invasive ICP monitoring method has been being explored. Because TCD has the advantages of non-invasive, low-cost and quick at the bedside, and the detection of cerebral blood flow spectrum by TCD can also indirectly evaluate ICP changes. This is great significance for clinical guidance of treatment. Now this article combines domestic and foreign research, and combines ICP monitoring technology and TCD technology, the formula and method of establishing ICP evaluation model based on pulsatility index in the previous literature are integrated, and the research progress of TCD cerebral blood flow spectrum evaluation ICP is reviewed.

A high proportion of patients with traumatic brain injury in the Department of Neurosurgery disease spectrum, there are many cases of craniocerebral injury need surgical treatment, preoperative evaluation is the key to the success of surgery in neurosurgery. There are five factors to consider to assess the risk for preoperative, preoperative evaluation of both is worthy of study of six related factors, and finally by the general principle of "medical/patient ratio" to determine the value of surgery. Therefore, preoperative evaluation of patients with craniocerebral injury is of great significance in the surgical treatment, "medical/patient ratio" in the clinical more prominent in the work.

To assess the diagnostic value of susceptibility weighted imaging (SWI) for severe hemorrhagic diffuse axonal injury (DAI) and their correlation with evaluation of iniury severity and outcome.

Thirty patients with clinically diagnosed severe hemorrhagic DAI, from December 2013 to December 2015 in Department of Neurotrauma, First Hospital of Jilin University, underwent CT, routine T1 weighted imaging (T1WI), T2 weighted image (T2WI), fluid attenuated inversion recovery (FLAIR), DWI and SWI scanning. Respective signal characteristics and distribution features were detected. Number of DAI lesions detected in each sequence were compared and analyzed for correlation with GCS and GOS.

By contrast, SWI provided relatively better detection of intracranial micro-hemorrhage lesions (P<0.05), and then DWI, FLAIR, T2WI, T1WI, CT. Lesion numbers on SWI and DWI were negatively correlated with GCS on admission and GOS at follow-up(P<0.05), moreover SWI had the better correlation. Lesion numbers on FLAIR, T2WI, T1WI and CT suspectively were negatively correlated with GCS on admission, but were not correlated with GOS at follow-up(P>0.05).

SWI can be pretty sensitive and effective to detect intracranial micro-hemorrhage lesions in severe hemorrhagic DAI patients and therefore supply more help for early diagnosis and treatment of severe hemorrhagic DAI as well as prognosis evaluation.

To assessed electroencephalographic (EEG) reactivity of patients with trauma coma to make quantitative analysis of EEG reactivity. To explore the role of quantitative analysis of EEG reactivity on the evaluation for prognosis of patients with trauma coma.

Sixty-six patients with trauma coma were selected for this study that was in line with the standard of study in 2013 March to 2014 June in Department of Neurosurgery of Ji’nan Military General Hospital of Chinese people′s Liberation Army. EEG reactivity of these patients were recorded on admission, a week, two weeks, three weeks and 4 weeks after trauma. Then, the changes in percentage of absolute power for EEG reactivity were analyzed quantitatively in different groups.

(1) Pain-induced percentage of reactivity was higher (44%-56%) than auditory reactivity (10.17%-16.67%) and visual reactivity (0%-13.33%) (P<0.05). (2) The prognosis of patients with EEG reactivity of the accuracy of prediction is respectively: 77.27% on admission, 1 week 76.27%, 2 weeks 86.53%, 3 weeks 91.11%, 4 weeks 88.89%. (3) The rate for well prognosis in trauma coma patients displaying positive percentage changes in absolute power for EEG reactivity during the whole recording duration was 82.6%, while, the rate for poor prognosis in trauma coma patients displaying negative percentage changes during the whole recording duration was 100%. The rate for well prognosis for those patients displaying dynamic (from negative to positive) percentage was 62.5%, while, the rate for poor prognosis for those patients displaying dynamic (from positive to negative) percentage was 92.9%.

EEG reactivity and its quantitative analysis is an important method for the evaluation on prognosis of patients with trauma coma.

To study the value of star weighted angiography (SWAN) in the diagnostic grading and prognostic evaluation of patients with brain DAI.

Fifty patients with brain DAI hospitalized in Department of Neurosurgery of Ji’nan Military General Hospital during 2013 January to 2015 March, were selected to receive 3.0T MRI, including sequences of T1WI、T2WI、FLAIR and SWAN. The number of the lesions and distributional characteristics in each sequence was analyzed. Furthermore, the correlativity of the grading and prognosis in patients with DAI in combination with GCS score and GOS score was also analyzed.

(1) The detection rate of cerebral microbleeds through SWAN was significantly higher than that with the method of T1WI、T2WI and FLAIR. (2) SWAN detected lesion distribution, diffuse brain swelling and brain stem injury is closely related to the GCS score grading and GOS score. (3) The prognosis of DAI displayed polarization state, the higher grade of the GCS score, the lower of GOS score, and the greater value of the risk of death.

SWAN was a reliable method for the grading of clinical diagnosis and prognosis assessment in the patients of DAI after TBI, and the accuracy of diagnosis of DAI was second only to pathological diagnosis.

To investigate the clinical application value and the changing regularity of several metrics of diffusion tensor imaging (DTI) in consciousness disorder patients(DOC).

The patient who were diagnosed with DOC(VS group was 66, MCS group was 9) were recruited at The Bayi Brain Hospital affiliated to Beijing PLA Hospital from Jun. 2014 to Dec. 2015 to examined with DTI. The evaluating metrics data of brainstem, subcortical thalamus related regions of interesting (ROI) were collected respectively. The data of ROI between the two groups were compared, then correlated the mean FA and MD value with the clinical CRS-R in ROI.

The FA of the VS group was significantly lower than that at MCS group (P<0.05). The MD of the VS group was significantly higher than that at MCS group (P<0.05). The mean FA and MD value of ROI correlated with clinical CRS-R score well, expecially in thalamus.

DTI has certain clinical significance on imaging grading DOC. The degree of consciousness disorder greater, the MD is higher and the FA is lower.