Sleep disturbances are common in patients with prolonged disorders of consciousness (pDoC) and are closely correlated with clinical outcomes. With an increasing number of pDoC patients undergoing surgery under general anaesthesia (GA), this study characterized sleep patterns in pDoC patients and evaluated the effects of GA on consciousness and nocturnal sleep. We prospectively enrolled 30 pDoC patients (14 in vegetative state [VS] and 16 in minimally conscious state [MCS]) undergoing spinal cord stimulation and 12 healthy controls. Among pDoC patients, 19 (10 VS, 9 MCS) with complete pre- and postoperative PSG data were analysed for GA effects. Controls underwent one overnight polysomnography (PSG); pDoC patients underwent pre- and postoperative PSG. Consciousness was assessed with Coma Recovery Scale-Revised (CRS-R) before and after surgery. Compared with controls, pDoC patients presented significantly impaired sleep structure, including reduced total sleep time (TST), decreased NREM Stage 2 sleep, diminished slow-wave sleep (SWS), reduced rapid eye movement (REM) sleep duration and percentage relative to TST (all p < 0.05). No significant short-term changes in CRS-R scores were observed following GA. Although GA significantly prolonged TST (p = 0.039), with numerical increases in absolute NREM and SWS durations, no statistically significant changes were observed in sleep stage percentages relative to TST (all p > 0.05). Subgroup analysis showed no significant within-group changes in sleep stage percentages in either the VS or MCS group. These findings suggest that GA increases TST without statistically significant changes in sleep structure in pDoC patients.

(Objective) Since the revision of the Organ Transplant Law in our country in 2010, the primary source of deceased organ donation has shifted from donation after cardiac death (DCD) to donation after brain death (DBD). Although the graft survival rate of living donor (LD) kidney transplantation has generally surpassed that of deceased donor kidney transplantation, few studies have directly compared outcomes between DCD and DBD. (Subjects and methods) We conducted a retrospective analysis of 213 patients who underwent kidney transplantation at our institution between 2011 and 2023. ABO-incompatible transplants and those with pre-existing anti-donor HLA antibodies were excluded. Patients were categorized into three groups according to donor status: DCD (n = 25), DBD (n = 39), and LD (n = 149). (Results) The median recipient ages were 56 years (DCD), 52 years (DBD), and 41 years (LD), while the median donor ages were 47 years (DCD), 45 years (DBD), and 61 years (LD). The proportion of HLA-DR 0 mismatch was 36% in DCD, 59% in DBD, and 24.8% in LD. Graft survival rates at 10 years were 83.2% for DCD; 100% for DBD; and 88.3% for LD, respectively.Multivariate analysis identified biopsy proven rejection as the only independent predictor of graft survival. (Conclusion) Despite the disadvantages of longer ischemic times and dialysis durations prior to transplantation, DBD grafts demonstrated the highest graft survival rates. These favorable outcomes may be attributed to a lower frequency of HLA-DR mismatches and reduced incidence of rejection.

Objective There is a paucity of studies evaluating computed tomography (CT) scores in patients with Glasgow Coma Scale (GCS) scores of 3-8. This study assessed the associations between risk factors (including admission GCS score, head Abbreviated Injury Scale (AIS) score, brain mass effect score (MES), and age) and unfavorable outcomes (including in-hospital mortality, adverse outcomes, failure to follow commands at hospital discharge, and failure to follow commands at three months) in mechanically ventilated patients with intracranial hemorrhage (ICH) and GCS scores of 3-8. In relation to these outcomes, we also compared the MES with the Marshall (MAR) classification and Rotterdam (ROT) score. Methods The adult blunt trauma cohort had ICH, GCS 3-8, need for mechanical ventilation, and level I trauma center admission (2018-2024). The GCS, age, AIS, ventilator status, intensive care unit (ICU) stay, hospital stay, and hospital mortality were obtained from the trauma registry. Adverse outcomes included hospital death, ICU stay ≥18 days, or hospital stay >20 days. MES indicated the presence (1) or absence (0) for each of the following: basal cistern compression, midline shift, and lateral ventricle compression (0-3). Brain CT images were reviewed to compute MES, MAR, and ROT. Electronic medical records (EMRs) were reviewed to determine following command status at hospital discharge and at three months after injury. Results Among the 148 blunt trauma patients, univariate associations with mortality were MES (p < 0.01), GCS (p = 0.46), age ≥70 (p < 0.01), and AIS (p < 0.01); multivariate associations were MES (p < 0.01), age ≥70 (p < 0.01), and AIS (p > 0.10). For adverse outcomes, univariate associations were MES (p < 0.01), GCS (p = 0.46), age ≥70 (p = 0.04), and AIS (p < 0.01); multivariate associations were MES (p < 0.01), age ≥70 (p > 0.05), and AIS (p > 0.05). For failure to follow commands at discharge, univariate associations were MES (p < 0.01), GCS (p = 0.75), age (p = 0.01), and AIS (p < 0.01); multivariate associations were MES (p < 0.01), age (p = 0.01), and AIS (p > 0.10). For failure to follow commands at three months, univariate associations were MES (p < 0.01), GCS (p = 0.30), age (p < 0.01), and AIS (p < 0.01); multivariate associations were MES (p < 0.01), age (p < 0.01), and AIS (p > 0.10). MES correlated strongly with MAR (p < 0.01; r = 0.83) and ROT (p < 0.01; r = 0.82). In multivariate stepwise continuous score regression (MCR), mortality and adverse outcome were associated with MES (both p < 0.01), but not MAR or ROT (both p > 0.05). For failure to follow commands at discharge and three months, MCR showed an association with ROT (both p < 0.01), but not MES or MAR (both p > 0.05). In multivariate stepwise dichotomous score regression (MDR), mortality and adverse outcomes were associated with MES ≥2 (both p < 0.01), but not MAR ≥4 or ROT ≥4 (both p > 0.05). Failure to follow commands at discharge was associated with ROT ≥4 (p < 0.01), but not MES ≥2 or MAR ≥4 (p > 0.05). Failure to follow commands at three months was associated with MES ≥2 (p < 0.01), but not MAR ≥4 or ROT ≥4 (p > 0.05). Conclusions MES was a better predictor of adverse outcomes than AIS and GCS in comatose patients with ICH. MES was competitive with other established brain CT scores for predicting adverse outcomes. Further studies are needed to confirm these findings.

Bilateral subdural hematomas occurring simultaneously with subarachnoid hemorrhage in a traumatic context are rare and pose considerable diagnostic challenges. Comorbidities such as diabetes and HIV may further worsen prognosis and complicate management. This case underscores the vital importance of early diagnosis and multidisciplinary care in patients with subacute subdural hematomas and subarachnoid hemorrhage, particularly when compounded by comorbidities in resource‑limited settings. We report the case of a 44-year-old housewife who was diabetic and living with HIV. She presented with severe headaches followed by altered consciousness with severe coma, and Cushing's triad two weeks after a minor head trauma. Brain CT scan revealed a bilateral panhemispheric subacute subdural hematoma (SASDH) associated with subarachnoid hemorrhage. Management consisted of emergent bilateral burr hole craniotomy for drainage, combined with measures to reduce intracranial pressure and prevent secondary brain injury of systemic origin. Her course was complicated by infection and hypertensive crisis; both were successfully managed. Glycemic control was achieved and antiretroviral therapy optimized. Clinical and radiological outcomes were ultimately favorable. This case underscores the importance of early diagnosis and multidisciplinary management of subdural hematomas in patients with diabetes and HIV. Beyond timely surgical intervention with burr‑hole craniotomy, comprehensive intensive care - including vigilant monitoring, early detection, and prompt control of complications - can significantly improve survival and optimize neurological outcomes.

Face blindness, also called prosopagnosia, is the inability to recognize familiar faces and is often secondary to dysfunction of the fusiform gyrus. This symptom can be part of dementia or be related to a lesion in this anatomical structure. We present the case of a 78-year-old female patient, with a diagnosis of dementia without prosopagnosia, who developed an episode of transient loss of consciousness. A brain computed tomography scan revealed an extensive right hemispheric chronic subdural hematoma. Patient underwent urgent hematoma drainage after deterioration of the neurological condition, with sudden reduction of Glasgow Coma Scale. Postoperatively, patient developed inability to recognize the faces of family members for 48 hours. Transient prosopagnosia is an infrequent symptom in dementia. In this case, we hypothesized that, when involving right basal temporal structures, treatment of chronic subdural hematoma may determine a transient prosopagnosia. After hematoma drainage, the concavity of the fusiform gyrus and the inferior-medial surface of the temporal lobe might crush against the skull base, causing alterations of the microcirculation and temporary flow deficits at this level. We defined this phenomenon, onomatopoeically, "squash effect."

BackgroundPelvic binders are used in prehospital settings for early stabilization when pelvic fractures are suspected. Although a rapid and cost-effective tool, uncertainties persist regarding their use prior to radiological confirmation of pelvic fracture.MethodsA review of adult patients with a pelvic fracture requiring trauma team activation who were admitted to a tertiary trauma center between 2020 and 2023 was conducted. The radiological studies were reviewed by four consultant orthopedic surgeons and were classified according to whether the application of a pelvic binder would be mechanically favorable, neutral, or potentially unfavorable. The area under the curve (AUC) was calculated to evaluate the ability of specific physiologic and injury-related variables (hypotension, tachycardia, shock index, Injury Severity Score (ISS), Glasgow Coma Scale, and mechanism of injury) to discriminate pelvic fracture morphologies for which pelvic binder application would be favorable.ResultsA total of 298 patients were included in the current investigation. Of these patients, applying a pelvic binder was favorable in 17% of cases (95% CI: 13%-22%, N = 50), would be mechanically neutral in 28% of cases (95% CI: 23%-33%, N = 82), and was potentially unfavorable in 56% of cases (95% CI: 50%-61%, N = 166) (P < .001). All investigated variables demonstrated limited discriminatory ability for identifying patients for whom pelvic binder application was favorable, with most AUCs <0.60. The highest predictive performance was observed for the ISS [AUC (95% CI): 0.65 (0.58-0.73)].ConclusionIn trauma patients with CT-confirmed pelvic ring injuries, readily available prehospital variables such as hemodynamic instability, associated injury patterns, and mechanism of injury appear to be insufficient for reliably identifying patients with a fracture morphology that could be amenable to pelvic binder application.

This study aimed to evaluate the predictive value of coagulation biomarkers, particularly D-dimer and fibrin degradation products (FDP), in the development of secondary progressive hemorrhagic injury (PHI) following traumatic brain injury (TBI). We conducted a retrospective cohort study based on hospital medical record data. All enrolled TBI patients were divided into a PHI group (n = 51) and a non-PHI group (n = 151) for comparison based on whether PHI occurred during hospitalization. Comprehensive coagulation profiles, including D-dimer, FDP, Prothrombin time, thrombin time, fibrinogen (FIB), and activated partial thromboplastin time (APTT), were analyzed. Multivariate logistic regression was performed to identify independent risk factors. The incidence of PHI was 25.25% (51/202). PHI patients demonstrated significantly higher systolic blood pressure (154.00 mm Hg vs 139.00 mm Hg, P = .002) and longer hospital stays (20.00 days vs 13.00 days, P = .007). Coagulation analysis revealed lower FIB (2.75 g/L vs 3.04 g/L, P = .021) and APTT (28.90 seconds vs 29.90 seconds, P = .048), but markedly elevated D-dimer (9162.00 ng/mL vs 3191.00 ng/mL, P = .001) and FDP levels (73.77 μg/mL vs 22.19 μg/mL, P = .003) in the PHI group. Logistic regression identified Glasgow Coma Scale score as an independent risk factor [adjusted odds ratio = 1.558, 95% confidence interval = 1.056-2.298, P = .025] and APTT as a protective factor (odds ratio = 0.937, 95% confidence interval = 0.915-0.959, P < .001) of secondary PHI in patients with TBI. Coagulation dysfunction, characterized by elevated D-dimer and FDP and decreased FIB, was significantly associated with PHI development in TBI patients. Multivariable logistic regression revealed that only Glasgow Coma Scale score and APTT remained significant and were independent predictors of secondary PHI.