Study of the Immediately Detection of Mild Traumatic Brain Injury by Feature Engineering on Electroencephalography

The electroencephalographic (EEG) diagnosis of mild traumatic brain injury (mTBI) is not usually timely, and the detection is often performed several hours or days after the trauma, leading to a decrease in the accuracy of its detection. In this study, EEG signals are recorded immediately after mTBI by connecting a bipolar single lead to injured animals. And three types of EEG features, namely time domain, frequency domain, and nonlinear dynamics, are screened for optimal feature subset in mTBI detection. First, EEG signals of animals are recorded before and after establishing the animal model of mTBI. Second, signal preprocessing, feature extraction, and feature preprocessing are performed to obtain the full-feature dataset, and 1442 feature subsets are obtained by 15 feature reduction algorithms extracted from combinations of 47 features. Ultimately, the support vector machines and K-nearest neighbor algorithms are trained and tested respectively, and their performance is comprehensively compared to determine the optimal feature subset for mTBI detection. In the EEG dataset collected in this study, a total of eight feature subsets extracted from combinations of original 47 features and classification models with 100% accuracy are obtained. This study shows the perspective of immediately detecting mTBI based on a bipolar single-lead EEG.

A 6-year survey of road traffic accidents in Southwest China: Emphasis on traumatic brain injury

BACKGROUND

The objective of this study is to provide an up-to-date overview of the patterns of injuries, especially traumatic brain injury (TBI) caused by RTAs and to discuss some of the public health consequences.

METHODS

A scientific team was established to collect road traffic accidents occurring between 2013 and 2018 in Chongqing, Southwest China. For each accident, the environment-, vehicle-, and person- variables were analyzed and determined. The overall injury distribution and TBI patterns of four types of road users (driver, passenger, motorcyclist and pedestrian) were compared. The environmental and time distribution of accidents with TBI were shown by bar and pie chart. The risks of severe brain injury whether motorcyclist wearing helmets or not were compared and the risk factors of severe TBI in pedestrian were determined by odds ratio analysis.

RESULTS

This study enrolled 2131 accidents with 2741 persons of all kind of traffic participants, 1149 of them suffered AIS1+ head injury and 1598(58%) died in 7 days. The most common cause of deaths is due to head injury with 714(85%) and 1266(79%) persons died within 2 hours. Among 423 persons suffered both skull fracture and intracranial injury, 102 (24.1%) have an intracranial injury but no skull fractures, while none of the skull fractures without intracranial injury was found. Besides, motorcyclists without a helmet were at higher risks for all the brain injury categories. The risk of pedestrian suffering severe TBI at an impact speed of more than 70 km/h is 100 times higher than that with an impact speed of less than 40 km/h.

CONCLUSION

It is urgently needed to develop a more reliable brain injury evaluation criterion for better protection of the road users. We believe that strengthening the emergency care to head injury at the scene is the most effective way to reduce traffic fatality.

Preliminary injury risk estimation for occupants involved in frontal crashes by combining computer simulations and real crashes

The fatality rate can be dramatically reduced with the help of emergency medical services. The purpose of this study was to establish a computational algorithm to predict the injury severity, so as to improve the timeliness, appropriateness, and efficacy of medical care provided. The computer simulations of full-frontal crashes with rigid wall were carried out using LS-DYNA and MADYMO under different collision speeds, airbag deployment time, and seatbelt wearing condition, in which a total of 84 times simulation was conducted. Then an artificial neural network is adopted to construct relevance between head and chest injuries and the injury risk factors; 37 accident cases with Event Data Recorder data and information on occupant injury were collected to validate the model accuracy through receiver operating characteristic analysis. The results showed that delta-v, seatbelt wearing condition, and airbag deployment time were important factors in the occupant's head and chest injuries. When delta-v increased, the occupant had significantly higher level of severe injury on the head and chest; there is a significant difference of Head Injury Criterion and Combined Thoracic Index whether the occupant wore seatbelt. When the airbag deployment time was less than 20 ms, the severity of head and chest injuries did not significantly vary with the increase of deployment time. However, when the deployment time exceeded 20 ms, the severity of head and chest injuries significantly increased with increase in deployment time. The validation result of the algorithm showed that area under the curve = 0.747, p < 0.05, indicating a medium level of accuracy, nearly to previous model. The computer simulation and artificial neural network have a great potential for developing injury risk estimation algorithms suitable for Advanced Automatic Crash Notification applications, which could assist in medical decision-making and medical care.

Parameter sensitivity analysis of pedestrian head dynamic response and injuries based on coupling simulations

There are a very limited number of reports studying on the dynamic response and injuries of pedestrian head in the scenarios with head hitting windshield. This study aims to investigate the significant factors that affect the dynamic response and injuries of pedestrian head through finite element-multi-body coupling simulations. Two finite element vehicle models and two multi-body pedestrian human models were used to build the coupling simulations. Orthogonal experimental design and analysis of variance were used for parameter combination and data analysis. This study demonstrated that the dynamic response of pedestrian head and HIC15 were strongly associated with collision speed and pedestrian orientation. Vehicle type had a significant influence on the dynamic response of pedestrian head and HIC15, while there was no significant relationship between the dynamic response of pedestrian head and HIC15 and the size of pedestrian human models. Collision speed, pedestrian orientation, and vehicle type should be prioritized over the other collision parameters in the study of head injury mechanism and reconstruction of vehicle-pedestrian collisions in the scenarios with head hitting windshield.

Intracranial aneurysms: experience in treating 500 patients

OBJECTIVE

To summarize the experience in surgical treatment of patients with intracranial aneurysms.

METHODS

The measures used in the treatment of 500 patients with intracranial aneurysms were retrospectively reviewed with regard to timing of surgery, induced-hypotensive anesthesia, brain protection combined with temporal occlusion of the feeding artery, dynamically monitoring of transcranial Doppler ultrasound, antivasospasm treatment, techniques of direct surgery, and endovascular embolization.

RESULTS

In 465 patients undergoing surgery, intraoperative rupture was observed in 27(6.2%), postoperative death in 13 (2.7%), hemipalsy in 8(2.2%), and vegetative state in 2 (5.0%). The operative mortality was 3.8% in 210 patients before 1990, while 1.9% in 255 patients after 1990.

CONCLUSION

The outcome of patients with intracranial aneurysms can be markedly improved by comprehensive measures.

[Clinico-transcranial Doppler sonography monitoring on vasospasm and delayed cerebral ischemia after resection of intracranial tumors]

The occurrence of vasospasm and delayed cerebral ischemia after resection of intracranial tumor has not received extensive attention clinically, and is often misdiagnosed and improperly treated as surgical brain damage or brain swelling. Seventy-two patients with intracranial tumor were continuously monitored pre- and postoperatively by means of neurological assessment and transcranial Doppler sonography. Vasospasm was found in 35 (48.6%) patients (18 mild, 13 moderate and 4 severe vasospasm). No significant difference among age, sex, surgical approaches, pathological diagnosis, duration of surgery, amount of blood loss and transfusion during surgery were found, but significant difference was seen in cisternal hemorrhage on CT scan and the amount of blood in cerebrospinal fluid. The cause and features of postoperative vasospasm were discussed, transcranial Doppler sonography played an important role in the diagnosis of vasospasm. To decrease the amount of blood in basal cistern by microsurgery in preventing vasospasm and to differentiate vasospasm from brain swelling are helpful to confirm the coexistent or causal relation based on neurological assessment, CT imagine, transcranial Doppler sonography and ICP monitoring both in deciding therapeutic strategy and successfully controlling vasospasm. Nimotop played a key role in preventing brain damage from vasospasm and cerebral swelling.

[Comprehensive treatment of intracranial aneurysm complicated by postoperative vasospasm]

Forty six patients suffered from intracranial aneurysm complicated by postoperative vasospasm and delayed cerebral ischemia were monitored dynamically both by clinical observation of neurologic status and multiple items such as transcranial Doppler, serum osmolality, intracranial pressure and other somatic physiologic items related to monitoring. Patients were intensively and comprehensively treated according to individualized grading of vasospasm. Forty four patients (95.6%) were completely recovered from postoperative vasospasm and delayed cerebral ischemia, while 2 patients (4.3%) complicated by hemipalsy as a consequence of delayed cerebral ischemia. The occurrence of vasospasm and delayed cerebral ischemia, the criteria of TCD grading, the valuableness of multiple physiologic items and problems related to comprehensive treatment are discussed.

[The role of serum osmolality monitoring in patients with severe intracranial lesion]

We dynamically determined serum osmolality in 1379 patients with severe intracranial lesion for 2843 times between January 1992 and July 1995. Using auto-control and after abandoned osmolality related interference factors we obtained the following results. Quantitative correlation analysis on the level of serum osmolality, intracranial pressure and the dose of mannitol showed that there was a negative correlation between the level of serum osmolality and intracranial pressure, while a positive correlation existed between the intracranial pressure and the dose of mannitol. The reasonable dose of mannitol was that which elevated the level of serum osmolality some 15-20 mOsm/kgH2O than its normal upper limit. The level of serum osmolality increesed to raised up 20-30 mOsm/kgH2O after administration of a single dose of mannitol. Complication increased with the increased level of osmolality of 300 mOsm/kgH2O, a warning level. An elevation of osmolality over 320 mOsm/kgH2O was considered the critical level for developing acute renal failure. The level of over 330 mOsm/kg H2O was another warning level for inducing nonketotic hyperosmotic diabetic coma. The efficious duration of mannitol, two different ways of diminishing or withdrawing the dose of mannitol, and the more safer velocity for correcting the state of hyperosmolality were also discussed. We conclude that to monitor the dynamic change of serum osmolality from time to time is of great help in lowering the incidence and mortality of hyperosmotic complications. Serum osmolality monitoring plays an important role in making fluid balance and compromizing the contradiction between dehydration and infusion as well as prevention and therapy of hyperosmotic complications, and outcome estimation as well.