Recent advances in traumatic brain injury

Relationship between NLR and PLR Ratios and the Occurrence and Prognosis of Progressive Hemorrhagic Injury in Patients with Traumatic Brain Injury

OBJECTIVE

This study aimed to evaluate the relationship between neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) ratios and the occurrence and prognosis of progressive hemorrhagic injury (PHI) in patients with traumatic brain injury (TBI).

METHODS

This retrospective study included 166 TBI patients. Clinical data were collected and NLR and PLR were assessed. Receiver operating characteristic (ROC) curve analysis was conducted to assess the predictive value of NLR and PLR for PHI occurrence in TBI patients. Logistic regression analysis was performed to identify risk factors influencing PHI development and poor neurological prognosis.

RESULTS

The PHI group (n = 77) exhibited significantly higher NLR and PLR ratios than the non-PHI group (n = 89). Independent risk factors for PHI occurrence included higher Abbreviated Injury Scale scores, absent pupillary reflexes, lower Glasgow Coma Scale (GCS) scores, and elevated NLR and PLR ratios. The combined use of NLR and PLR ratios demonstrated superior predictive performance for PHI occurrence, with a higher area under the curve (AUC: 0.843) and sensitivity (77.9%, cutoff values: 17.19 for NLR and 196.33 for PLR) compared to NLR alone (AUC: 0.794, sensitivity: 53.2%, cutoff value: 21.78) or PLR alone (AUC: 0.665, sensitivity: 53.2%, cutoff value: 235.48). For poor neurological prognosis, higher AIS scores, lower GCS scores, and elevated NLR ratios were identified as independent risk factors.

CONCLUSION

TBI patients with elevated NLR and PLR ratios are at increased risk of developing PHI. In severe TBI cases, patients with high NLR ratios during the early stages tend to experience poor neurological outcomes.

Constructed transferrin receptor-targeted liposome for the delivery of fluvoxamine to improve prognosis in a traumatic brain injury mouse model

The dysregulation of blood-brain barrier (BBB) activates pathological mechanisms such as neuroinflammation after traumatic brain injury (TBI), and glymphatic system dysfunction accelerates toxic waste accumulation after TBI. It is essential to find an effective way to inhibit inflammation and repair BBB and glymphatic system after TBI; however, effective and lasting drug therapy remains challenging because BBB severely prevents drugs from being delivered to central nervous system. Transferrin receptors (TfRs) are mainly expressed on brain capillary endothelial cells. Here, we report a TfR-targeted nanomedicine for TBI treatment by penetrating BBB and delivering fluvoxamine (Flv). The TfR-targeted polypeptide liposome loaded with Flv (TPL-Flv) implements cell targeting ability on human umbilical vein endothelial cells (HUVECs) in vitro detected by flow cytometry, and drug safety was proved through cell viability analysis and blood routine and biochemistry analysis. Afterwards, we established a controlled cortical impact model to explore TPL-Flv administration effects on TBI mice. We confirmed that TPL-Flv could stimulate CXCR4/SDF-1 signaling pathway, activate Treg cells, and inhibit inflammation after TBI. TPL-Flv treatment also alleviated BBB disruption and restored aquaporin-4 (AQP4) polarization, as well as reversed glymphatic dysfunction. Furthermore, TPL-Flv accomplished remarkable improvement of motor and cognitive functions. These findings demonstrate that TPL-Flv can effectively cross BBB and achieve drug delivery to cerebral tissue, validating its potential to improve therapeutic outcomes for TBI.

Targeting capabilities of engineered extracellular vesicles for the treatment of neurological diseases

Recent advances in research on extracellular vesicles have significantly enhanced their potential as therapeutic agents for neurological diseases. Owing to their therapeutic properties and ability to cross the blood-brain barrier, extracellular vesicles are recognized as promising drug delivery vehicles for various neurological conditions, including ischemic stroke, traumatic brain injury, neurodegenerative diseases, glioma, and psychosis. However, the clinical application of natural extracellular vesicles is hindered by their limited targeting ability and short clearance from the body. To address these limitations, multiple engineering strategies have been developed to enhance the targeting capabilities of extracellular vesicles, thereby enabling the delivery of therapeutic contents to specific tissues or cells. Therefore, this review aims to highlight the latest advancements in natural and targeting-engineered extracellular vesicles, exploring their applications in treating traumatic brain injury, ischemic stroke, Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis, glioma, and psychosis. Additionally, we summarized recent clinical trials involving extracellular vesicles and discussed the challenges and future prospects of using targeting-engineered extracellular vesicles for drug delivery in treating neurological diseases. This review offers new insights for developing highly targeted therapies in this field.

Hydrogen combined with needle-embedding therapy alleviates traumatic brain injury by inhibiting NLRP3 inflammasome activation via STING signaling pathway

BACKGROUND

Traumatic brain injury (TBI) is a primary cause of disability and death worldwide and with unmet effective therapies. Molecular hydrogen (H2) exerts latent therapeutic means for TBI. Nevertheless, few studies have illustrated the roles of hydrogen combined with needle-embedding therapy (H2 + NET) in TBI and its exact mechanism remains unclear. Here, we elucidated the underlying mechanisms of H2 + NET in the TBI progression.

METHODS

Controlled cortical impact (CCI) method was conducted to construct TBI mouse model. The mNSS test was used for neurological function measurement. Nissl staining for evaluating neuronal injury, TUNEL assay for determining neuronal apoptosis and ELISA assay was applied for adenosine, ATP level and inflammatory cytokines determination. The relative mRNA levels of inflammatory elements were assessed by qRT-PCR analysis. Iba-1, NLRP3 and STING expression were determined through immunofluorescence staining. The expression of NLRP3 inflammasome related proteins and STING signaling pathway associated proteins were evaluated using Western blot.

RESULTS

H2 or NET treatment mitigated brain injury and reduced brain water content in CCI-induced TBI mouse model. CCI induction promoted microglia activation and inflammatory response, thereby activating the NLRP3 inflammasome activity and STING signaling pathway, which was partly reversed by H2 or NET treatment. However, H2 + NET significantly ameliorated brain oedema, and further inhibited inflammatory response, NLRP3 inflammasome activation and STING pathway activation in TBI mice when compared to the H2 or NET alone treatment group.

CONCLUSION

Hydrogen combined with needle-embedding therapy acts as a promising intervention method for TBI through inhibiting NLRP3 inflammasome activation via STING signaling pathway.

Galectin-3 activates microglia and promotes neurological impairment via NLRP3/pyroptosis pathway following traumatic brain injury

BACKGROUND

Externally caused traumatic brain injury (TBI) poses a woeful worldwide health concern, bringing about disability, death, and prolonged neurological impairment. Increased galectin-3 levels have been linked to unfavorable outcomes in several neurological conditions. This study explores the role of galectin-3 in TBI, specifically examining its contribution to neuroinflammation.

METHODS

BV2 microglia cells treated with lipopolysaccharide (LPS) and a mouse model of TBI were applied to investigate the impact of galectin-3 on neuroinflammation following TBI. Western blotting and immunofluorescence labeling were applied for evaluating protein levels and colocalization. Adeno-associated virus (AAV) that targets microglia was used to knock down galectin-3 in microglia. Nissl staining and the modified neurologic severity score were employed in evaluating neural survival and neurological function, and the cognitive impairment following TBI was assessed by the Y-Maze and Morri water maze test.

RESULTS

Galectin-3 expression was shown to rise dramatically after TBI, peaking between days five and seven. In vitro, BV2 cells treated with LPS showed reduced NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome activation when galectin-3 was inhibited. In LPS-activated microglia, galectin-3 inhibition specifically decreased the expression of Toll-like receptor 4 (TLR4), nuclear factor-κB (NF-κB), p-NF-κB, NLRP3, Apoptosis-associated speck-like protein containing a CARD (ASC), caspase-1, and Gasdermin D (GSDMD). Injection with AAV containing siRNA to knock down galectin-3 in microglia was operated on mice in vivo. Following TBI, this knockdown led to reduced NLRP3 inflammasome activation, neuronal death, neurological impairments and cognitive impairment.

CONCLUSIONS

Our foundings indicate that modulating microglia-derived galectin-3 following TBI to reduce neuroinflammation could serve as a promising therapeutic strategy.

Irisin suppressed the progression of TBI via modulating AMPK/MerTK/autophagy and SYK/ROS/inflammatory signaling

Irisin is a hormone-like peptide secreted by muscle tissues and generated by hydrolysis of type III fibronectin domain-containing protein 5 by proteolytic hydrolases. Whether Irisin has a potential protective role in traumatic brain injury (TBI). In this study, we will investigate the relevant research progress of Irisin's protective role in traumatic brain injury (TBI) in recent years in terms of attenuating oxidative stress, inhibiting pyroptosis, suppressing inflammatory response, and improving autophagy, with the aim of providing valuable references for the diagnosis and treatment of traumatic brain injury (TBI). Utilize bioinformatics analysis to study the interactions between genes in TBI (Traumatic Brain Injury). Construct a TBI mouse model to observe the effects of Irisin on TBI. The Morris water maze test is used to assess the learning and spatial memory abilities of mice, TUNEL fluorescence is used to detect cell apoptosis, Nissl staining is employed to observe the survival of hippocampal neurons in mice, and HE staining is used to observe the extent of brain injury in mice. Western blot is used to detect protein expression in both in vivo and in vitro experiments. Q-PCR is employed to detect the levels of proteins related to autophagy/pyroptosis/inflammation. Irisin promotes MerTK overexpression by enhancing AMPK activation. Irisin can increase the expression of LC3I and Beclin-1 proteins, indicating the promotion of autophagic response. Additionally, Irisin reduces ROS levels and decreases SYK expression, thereby inhibiting the inflammatory response. Irisin improves the learning and spatial memory abilities of TBI mice and reduces cell apoptosis, as well as decreases hippocampal neuron death. HE staining shows that the brain injury in mice treated with Irisin is significantly alleviated. Irisin can enhance the expression of phosphorylated AMPK and phosphorylated MerTK proteins, promote autophagic response, and inhibit pyroptosis/inflammatory response. Correction experiments confirmed that after stimulation with an AMPK agonist, the expression of phosphorylated MerTK protein is significantly increased, autophagic response is enhanced, and pyroptosis/inflammatory response is weakened. When treated with a MerTK inhibitor during AMPK agonist stimulation, the autophagic response is weakened while pyroptosis/inflammatory response is enhanced. Irisin can inhibit the progression of traumatic brain injury by regulating AMPK/MerTK/autophagy and SYK/ROS/inflammatory signaling.

Risk Factors for Postoperative Infections in Severe Traumatic Brain Injury Patients Undergoing Emergency Craniotomy

Background and Aim

Severe traumatic brain injury (TBI) patients undergoing emergency craniotomy are at high risk of postoperative infections. This study aims to identify the risk factors associated with these infections to improve patient outcomes.

Methods

A retrospective cohort study was conducted, including 312 severe TBI patients who underwent emergency craniotomy at Brain Hospital of Hunan Province between December 2019 and December 2021. Clinical data were collected, and both univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative infections.

Results

Among the 312 patients, 57 (18.3%) developed postoperative infections. Multivariate analysis identified several significant risk factors, including older age (OR=1.75, 95% CI: 1.23-2.49), prolonged surgery duration (OR=2.01, 95% CI: 1.38-2.92), presence of preoperative infection (OR=2.59, 95% CI: 1.64-4.09), and lower Glasgow Coma Scale (GCS) score on admission (OR=1.82, 95% CI: 1.21-2.74).

Conclusion

Identifying patients at high risk for postoperative infections can help guide preventive measures and improve outcomes in severe TBI patients undergoing emergency craniotomy.

Impact of Temporal Resolution on Autocorrelative Features of Cerebral Physiology from Invasive and Non-Invasive Sensors in Acute Traumatic Neural Injury: Insights from the CAHR-TBI Cohort

Therapeutic management during the acute phase of traumatic brain injury (TBI) relies on continuous multimodal cerebral physiologic monitoring to detect and prevent secondary injury. These high-resolution data streams come from various invasive/non-invasive sensor technologies and challenge clinicians, as they are difficult to integrate into management algorithms and prognostic models. Data reduction techniques, like moving average filters, simplify data but may fail to address statistical autocorrelation and could introduce new properties, affecting model utility and interpretation. This study uses the CAnadian High-Resolution TBI (CAHR-TBI) dataset to examine the impact of temporal resolution changes (1 min to 24 h) on autoregressive integrated moving average (ARIMA) modeling for raw and derived cerebral physiologic signals. Stationarity tests indicated that the majority of the signals required first-order differencing to address persistent trends. A grid search identified optimal ARIMA parameters (p,d,q) for each signal and resolution. Subgroup analyses revealed population-specific differences in temporal structure, and small-scale forecasting using optimal parameters confirmed model adequacy. Variations in optimal structures across signals and patients highlight the importance of tailoring ARIMA models for precise interpretation and performance. Findings show that both raw and derived indices exhibit intrinsic ARIMA components regardless of resolution. Ignoring these features risks compromising the significance of models developed from such data. This underscores the need for careful resolution considerations in temporal modeling for TBI care.

Potential Correlation Between Molecular Biomarkers and Oxidative Stress in Traumatic Brain Injury

Diagnosing traumatic brain injury (TBI) remains challenging due to an incomplete understanding of its neuropathological mechanisms. TBI is recognised as a complex condition involving both primary and secondary injuries. Although oxidative stress is a non-specific molecular phenomenon observed in various neuropathological conditions, it plays a crucial role in brain injury response and recovery. Due to these aspects, we aimed to evaluate the interaction between some known TBI molecular biomarkers and oxidative stress in providing evidence for its possible relevance in clinical diagnosis and outcome prediction. We found that while many of the currently validated molecular biomarkers interact with oxidative pathways, their patterns of variation could assist the diagnosis, prognosis, and outcomes prediction in TBI cases.

Current Management and Future Challenges in the Management of Severe Traumatic Brain Injury

Background and Objectives: Severe Traumatic Brain Injury (TBI) is one of the devastating injuries occurring in all ages across the globe. Despite many advancements in the management of severe TBI, mortality and morbidities remain high. Evidence-based management in severe TBI has reduced mortality. The purpose of this review is to discuss the current management and present the future challenges in this patient cohort. Materials and Methods: A literature review was conducted to identify the current practice patterns and guidelines of severe TBI. We examined the literature regarding medical and surgical managements of the severe TBI. Results: Initial management of severe TBI includes stabilization of the primary injury and prevention of secondary insult to brain. Hemodynamic, intracranial pressure and cerebral perfusion pressure monitoring, antiseizure prophylaxis, hyperosmolar therapy, sedation, medical induced coma, and nutritional and ventilatory support are part of the medical management. Operative intervention includes craniotomy and decompressive craniectomy. Most of the current practices are recommended by the Brain Trauma Foundation (BTF). These guidelines are based on the existing literature, however, some of the recommendations by the BTF lack level one evidence. Conclusions: BTF guidelines provide recommendations in the management of severe TBI. High quality prospective randomized trials are needed to further explore the new modalities and interventions in the field of severe TBI.

Exploring Molecular Pathways in Exercise-Induced Recovery from Traumatic Brain Injury

Traumatic brain injury (TBI) is functional damage or brain injury due to external forces and is a leading cause of death and disability in children and adults. It causes disruption of the blood-brain barrier (BBB), infiltration of peripheral blood cells, oxidative stress, neuroinflammation and apoptosis, neural excitotoxicity, and mitochondrial dysfunction. Studies have shown that PE can be applied as a non-pharmacological therapy and effectively improve functional recovery from TBI. Recovery from TBI can benefit from both pre- or post-TBI exercise through various mechanisms for neurorepair and rehabilitation of behavior and cognition, including alleviation of TBI-induced oxidative stress, upregulation of heat-shock proteins, reduction of TBI-induced inflammation, promotion of secretion of neurotrophic factors to facilitate neural regeneration, suppression of TBI-induced apoptosis to reduce brain injury, and stabilization of mitochondrial function for better cellular function. This review article provides an overview of the effect of pre- and post-TBI exercise on recovery of neurofunctions and cognition following TBI, summarizes the potential regulatory networks and cellular and biological processes involved in recovery of brain functions, and outlines the molecular mechanisms underlying exercise-induced improvement of TBI, including regulation of gene expression and activation of heat-shock proteins and neurotrophic factors under different exercise schemes. These mechanisms involve TBI-induced oxidative stress, upregulation of heat-shock proteins, inflammation, secretion of neurotrophic factors, and TBI-induced apoptosis. Due to high heterogeneity in human TBI, the outcome of exercise intervention is affected by the injury type and severity of TBI. More studies are needed to investigate the application of various exercise approaches that fits TBI under different circumstances, and to elucidate the detailed pathogenesis mechanisms of TBI to develop more patient-tailored interventions.

Transferrin and Borneol-Enhanced Liposomes for Targeted Rapamycin Delivery in TBI

Background

The therapeutic potential of rapamycin (RAPA) for traumatic brain injury (TBI) is limited by its low bioavailability and poor penetration across the blood-brain barrier (BBB). We developed transferrin-modified rapamycin and borneol co-delivery liposomes (TF-RAPA/BO-LIP) to overcome these barriers, aiming to enhance both drug delivery to the brain and the treatment efficacy.

Methods

We employed the emulsion-solvent evaporation method to prepare TF-RAPA/BO-LIP and characterized their particle size, zeta potential, morphology, stability, and encapsulation efficiency. Pharmacokinetic studies were conducted in SD rats, and drug concentration was analyzed using LC-MS/MS. The brain-targeting capability and therapeutic efficacy were evaluated through in vitro cellular uptake studies, and in vivo in a TBI mouse model using both neurological and cognitive assessments.

Results

TF-RAPA/BO-LIP displayed optimal characteristics (95 nm particle size, >90% encapsulation efficiency) and demonstrated enhanced stability. Pharmacokinetic analyses revealed reduced drug clearance and increased drug concentration-time curve area, indicating improved systemic and brain-specific drug bioavailability. Notably, TF-RAPA/BO-LIP achieved significantly higher RAPA accumulation in the brain tissue. Importantly, treatment with TF-RAPA/BO-LIP significantly ameliorated neurological deficits and improved spatial memory in TBI mice, as evidenced by behavioral tests.

Conclusion

Our study highlights TF-RAPA/BO-LIP as a promising strategy for delivering RAPA across the BBB, substantially enhancing its therapeutic efficacy for TBI. This novel liposomal system not only improves RAPA bioavailability but also offers significant neuroprotection, potentially transforming the clinical management of TBI.

Observational Study of Microbial Colonization and Infection in Neurological Intensive Care Patients Based on Electronic Health Records

Background/Objectives: Patients with central nervous system injuries who are hospitalized in intensive care units (ICUs) are at high risk for nosocomial infections. Limited data are available on the incidence and patterns of microbial colonization and infection in this patient population. Methods: To fill this gap, we performed an electronic health record-based study of 1614 chronic patients with brain injury admitted to the ICU from 2017 to 2023. Results: Among the infectious complications, pneumonia was the most common (n = 879; 54.46%). Sepsis was diagnosed in 54 patients, of whom 46 (85%) were diagnosed with pneumonia. The only pathogen that showed an association with the development of pneumonia and sepsis in colonized patients was Pseudomonas aeruginosa (pneumonia: p = 7.2 × 10-9; sepsis: p = 1.7 × 10-5). Bacterial isolates from patients with and without pneumonia did not differ in pathogen titer or dynamics, but patients with monomicrobial culture were more likely to develop pneumonia than patients with polymicrobial culture (1 vs. 2 pathogens, p = 0.014; 1 + 2 pathogens vs. 3 + 4 pathogens, p = 2.8 × 10-6), although the pathogen titer was lower in monoculture than in polyculture. Bacterial isolates from all patients and all culture sites showed high levels of multidrug resistance (Gram-negative bacteria: 88-100%; Gram-positive bacteria: 48-97%), with no differences in multidrug-resistant organism (MDRO) colonization and infection rates. Conclusions: Our results highlight the high burden of MDROs in neurological ICUs and provide novel ecosystem-based insights into mono- and polymicrobial colonization and infection development. These findings may be useful for developing strategies to protect against infections.

Global Burden of Traumatic Brain Injury in 204 Countries and Territories From 1990 to 2021

INTRODUCTION

This study aimed to evaluate the burden and underlying causes of traumatic brain injury (TBI) in 204 countries and territories from 1990 to 2021.

METHODS

Utilizing data from the Global Burden of Disease 2021 study, which derived estimates of TBI burden from hospital and emergency department records, national surveys, and claims data, the incidence, prevalence, and years lived with disability (YLDs) associated with TBI were analyzed. A comparative analysis of TBI burden by location, age, sex, and sociodemographic index was performed, along with an underlying assessment of 15 major causes contributing to age-standardized incidence rates. Analyses were conducted in 2024.

RESULTS

In 2021, there were 20.84 million (95% uncertainty interval [UI]=18.13, 23.84) incident cases and 37.93 million (95% UI=36.33, 39.77) prevalent cases of TBI globally, resulting in 5.48 million (95% UI=3.87, 7.33) YLDs. While the absolute number increased from 1990 to 2021, age-standardized rates of TBI incidence, prevalence, and YLDs showed a significant decline. These rates generally increased with age and were higher in males than females. The highest age-standardized prevalence and YLD rates were observed in Eastern and Central Europe. Globally, falls were the leading cause of TBI in 2021, followed by road injuries, interpersonal violence, and exposure to mechanical forces.

CONCLUSIONS

Despite declines in age-standardized rates, the total number of TBI cases and associated disabilities has risen since 1990, indicating a persistent global burden. Targeted interventions are urgently needed in high-burden regions like Eastern and Central Europe, with focus on leading causes and vulnerable populations.

Incidence and mortality related risk factors in patients with severe traumatic brain injury: A meta‑analysis

The present study aimed to clarify the onset of traumatic brain injury (TBI) and identify mortality-related risk factors in patients with severe TBI, to enable the early identification of high-risk individuals and timely implementation of prevention and treatment strategies to minimize mortality rates. Comprehensive database searches were conducted across Web of Science, PubMed, CINAHL and EMBASE, covering publications from database inception until October 17, 2023. Search terms in English included 'head trauma', 'brain trauma', 'mortality', 'death' and 'risk factor'. In total, two independent researchers screened and extracted the data on mortality onset and associated risk factors in patients with severe TBI. Meta-analysis was performed using R 4.2.2. A total of 33 cohort studies, including 71,718 patients with severe TBI, were selected for meta-analysis. The data indicated an overall mortality rate of 27.8% (95%CI: 22.5-33.2%) from database inception until October 17, 2023. Subgroup analysis revealed a mortality rate of 25.2% (95%CI: 20.2-30.1%) in developed countries, compared with 38.0% (95%CI: 21.4-54.7%) in developing countries. Additionally, the mean age of deceased patients was significantly higher compared with that of survivors (41.53±16.47). Key risk factors found to be associated with mortality included anemia [relative risk (RR), 1.42; 95%CI, 1.04-1.93], diabetes mellitus (RR, 1.40; 95%CI, 1.00-1.96), coagulopathy (RR, 4.31; 95%CI, 2.31-8.05), shock (RR, 3.41; 95%CI, 2.31-5.04) and systolic blood pressure≤90 mmHg (RR, 2.32; 95%CI, 1.65-3.27). Furthermore, pre-hospital intubation (RR, 1.48; 95%CI, 1.13-1.92),hypotension (RR, 2.04; 95%CI: 1.58, 2.63), hypoxemia (RR, 1.42; 95%CI: 1.13, 1.79), subdural hemorrhage (RR, 1.99; 95%CI: 1.50, 2.62), subarachnoid hemorrhage (RR, 1.64; 95%CI: 1.09, 2.47) and subdural hematoma (SDH; RR, 1.50; 95%CI: 1.04, 2.17). was identified to be a significant risk factor during hospitalization treatment. These results suggest that various factors, such as age, anemia, diabetes, shock, hypotension, hypoxemia, trauma scores and brain injury types, can all contribute to mortality risk in patients with severe TBI. Addressing these risk factors will likely be important for reducing mortality in this patient population.

Unlocking the potential of high-resolution multimodality neuromonitoring for traumatic brain injury management: lessons and insights from cases, events, and patterns

Multimodality neuromonitoring represents a crucial cornerstone for patient management after acute brain injury. Despite the potential of multimodality neuromonitoring (particularly high-resolution neuromonitoring data) to transform care, its full benefits are not yet universally realized. There remains a critical need to integrate the interpretation of complex patterns and indices into the real-time clinical decision-making processes. This requires a multidisciplinary approach, to evaluate and discuss the implications of observed patterns in a timely manner, ideally in close temporal proximity to their occurrence. Such a collaborative effort could enable clinicians to harness the full potential of multimodal data. In this educational case-based scoping review, we aim to provide clinicians, researchers, and healthcare professionals with detailed, compelling examples of potential applications of multimodality neuromonitoring, focused on high-resolution modalities within the field of traumatic brain injury. This case series showcases how neuromonitoring modalities such as intracranial pressure, brain tissue oxygenation, near-infrared spectroscopy, and transcranial Doppler can be integrated with cerebral microdialysis, neuroimaging and systemic physiology monitoring. The aim is to demonstrate the value of a multimodal approach based on high-resolution data and derived indices integrated in one monitoring tool, allowing for the improvement of diagnosis, monitoring, and treatment of patients with traumatic brain injury. For this purpose, key concepts are covered, and various cases have been described to illustrate how to make the most of this advanced monitoring technology.

Impact of Microglia-Derived Extracellular Vesicles on Resident Central Nervous System Cell Populations After Acute Brain Injury Under Various External Stimuli Conditions

Acute brain injuries (ABI) caused by various emergencies can lead to structural and functional damage to brain tissue. Common causes include traumatic brain injury, cerebral hemorrhage, ischemic stroke, and heat stroke. Globally, ABI represent a significant portion of neurosurgical cases. Previous studies have emphasized the significant therapeutic potential of stem cell-derived extracellular vesicles (EVs). Recent research indicates that EVs extracted from resident cells in the central nervous system (CNS) also show therapeutic potential following brain injury. Microglia, as innate immune cells of the CNS, respond to changes in the internal environment by altering their phenotype and secreting EVs that impact various CNS cells, including neurons, astrocytes, oligodendrocytes, endothelial cells, neural stem cells (NSCs), and microglia themselves. Notably, under different external stimuli, microglia can either promote neuronal survival, angiogenesis, and myelin regeneration while reducing glial scarring and inflammation, or they can exert opposite effects. This review summarizes and evaluates the current research findings on how microglia-derived EVs influence various CNS cells after ABI under different external stimuli. It analyzes the interaction mechanisms between EVs and resident CNS cells and discusses potential future research directions and clinical applications.

Discovery of KDM5D as a novel biomarker for traumatic brain injury identified through bioinformatics analysis

Background and aim

Traumatic brain injury (TBI) poses a significant burden on the global economy due to its poor treatment and prognosis. Current TBI markers do not comprehensively reflect the disease status. Therefore, identifying more meaningful biomarkers is beneficial for improving the prognosis and clinical treatment of TBI patients.

Methods

The gene expression profile of TBI was obtained from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were subjected to enrichment analysis, and key potential genes were identified through the protein-protein interaction network and cytoHubba modules. ROC curves were used to construct diagnostic models for hub genes. Immunofluorescence experiments were conducted to detect the expression of candidate biomarkers in TBI rat models. Finally, we investigated the expression of TBI biomarkers in normal human organs and pan-cancer tumor tissues, and evaluated their correlation with immune infiltration in different tumors.

Results

A total of 44 DEGs were identified across four brain regions of TBI patients. Enrichment analysis revealed that these genes were primarily involved in intracellular and cell signal transduction pathways. Furthermore, three hub genes- RPS4Y1, KDM5D and NLGN4Y-were identified through different module analysis. The ROC curve diagnostic model also confirmed that these genes also have high diagnostic value in serum. Subsequently, the presence of Kdm5d was detected in the brain tissue of TBI rats through immunofluorescence experiments. Compared to normal rats, Kdm5d expression increased in the cortical area of ​​TBI rats, with no significant change in the hippocampus area, aligning with observations in TBI patients. Immune infiltration analysis demonstrated changes in immune cell subsets in HIP and PCx, revealing that plasma cells and CD8 T cells were lowly expressed in TBI (HIP) and while neutrophils was under-expressed in TBI (PCx). Pan-cancer analysis indicated that KDM5D was significantly up-regulated in 23 cancers, down-regulated in 3 cancers, and significantly associated with immune infiltration in 10 cancers.

Conclusion

Based on the results of bioinformatics analysis and animal experiments, KDM5D serves as a potential biomarker for the diagnosis and prognosis of TBI. Additionally, research on KDM5D may develop into new serum markers, providing new indicators for further clinical liquid biopsy and aiding in the prevention of both TBI and tumors to a certain extent.

Investigating the Potential Therapeutic Targeting of the JAK-STAT Pathway in Cerebrovascular Diseases: Opportunities and Challenges

Cerebrovascular disease (CVD) is a significant neurological condition resulting from pathological changes in the brain's blood supply and is currently the leading cause of death and disability worldwide. The progression of CVD is closely associated with endothelial damage, plaque formation, and thrombosis, driven by long-term alterations in vascular endothelial cells, smooth muscle cells, microglia, and other immune-inflammatory cells. Among the key molecular pathways involved, the Janus kinase/signal transducer and activator of transcription (JAK-STAT) signaling pathway plays a central role. Dysregulation of the JAK-STAT pathway is implicated in the pathogenesis of CVD by influencing the aforementioned cell types and associated pathological processes. Importantly, the role of the JAK-STAT pathway varies across different types of CVD and throughout different stages of disease progression (e.g., pre-morbid, acute, and chronic phases). This review examines the composition, activation, and regulation of the JAK-STAT pathway and summarizes recent findings on its involvement in CVD. We discuss the distinct roles of JAK-STAT signaling in various CVD conditions, the potential reasons for these differences, and explore the clinical translational prospects and technical challenges of targeting the JAK-STAT pathway for therapeutic intervention in CVD.

Nicotinamide adenine dinucleotide alleviates neuroinflammation in rats with traumatic brain injury

OBJECTIVE

To characterize the pathology and pathophysiological processes within 6 h after Traumatic brain injury (TBI) in rats, elucidate the neuroprotective effects and the underlying mechanisms of Nicotinamide Adenine Dinucleotide (NAD) in the early stage of TBI to explore the feasibility and clinical benefits of applying NAD directly to the localized injury after TBI.

MATERIAL AND METHODS

54 male Sprague-Dawley (SD) rats aged 6-8 weeks were randomly assigned equally to three groups, sham-operated surgery (SO) with saline treatment (SO + Saline), TBI with saline treatment (TBI + Saline), and TBI with 10 μM NAD treatment (TBI + NAD). The whole brain tissues were collected at 1, 3, and 6 h following the procedure. Levels of biomarkers for TBI including S100β, TNF-α, occludin, PPARβ/δ were measured.

RESULTS

Significant neuroinflammation was observed in the rat brains after TBI, which peaked at 3 h following injury. Significant changes in S100β, TNF-α, PPARβ/δ, and occluding were also observed. Treatment with NAD significantly alleviated neuroinflammation at 1 h following TBI.

CONCLUSIONS

TBI caused severe neuroinflammation in rat brains, which peaked at 3 h following injury. Treatment with NAD alleviated neuroinflammation in TBI rats.

Development and validation of intracranial hypertension prediction models based on radiomic features in patients with traumatic brain injury: an exploratory study based on CENTER-TBI data

BACKGROUND

Head computed tomography (CT) is a routinely performed examination to assess the intracranial condition of patients with traumatic brain injury (TBI), and radiological findings can help to indicate the presence of intracranial hypertension. At present, the prediction of intracranial hypertension is mainly based on manual discrimination of imaging characteristics. The aim of our study was to establish a model to predict intracranial hypertension via fully automatic CT image segmentation, rigorous radiomic feature extraction and reliable model development and validation.

METHODS

Patients admitted to the intensive care unit (ICU) who underwent intracranial pressure (ICP) monitoring were included in our study. For the development cohort, we extracted data from the CENTER-TBI database and randomly divided the data into a training group and a test group. For the validation cohort, we extracted data from patients admitted to the Shanghai General Hospital. Patients whose initial recorded ICP value was greater than or equal to 20 mmHg were defined as having intracranial hypertension. Radiological features, including imaging characteristics and three categories of radiomic features, were extracted from the head CT. Feature selection was performed for all radiological findings. A morphological model was built on the basis of selected imaging characteristics. First-order, second-order and third-order models were built on the basis of selected radiomic features. A comprehensive model was built on the basis of all selected radiological findings. The performances of these five models were assessed by four classifiers, including logistic regression (LR), random forest (RF), multilayer perceptron (MLP), and extreme gradient boosting (XGB), from which the best classifier was selected. After the process of model training and external validation, we ultimately used the optimal classifier to generate a prediction model with greater predictive power and stability.

RESULTS

Five models were built, including a morphological model, first-order model, second-order model, third-order model and comprehensive model. The optimal classifier was the logistic regression (LR) classifier, with which the morphological, first-order, second-order, third-order and comprehensive models had AUCs of 0.75, 0.77, 0.76, 0.86, and 0.83 and F1 scores of 0.54, 0.73, 0.63, 0.72, and 0.75, respectively, in the external validation group.

CONCLUSIONS

We successfully established a model for predicting intracranial hypertension on the basis of radiomic features. This model may serve as an approach for intracranial hypertension prediction in TBI patients.

Therapeutic potential of flavonoids in neuroprotection: brain and spinal cord injury focus

Flavonoids in fruits, vegetables, and plant-based drinks have potential neuroprotective properties, with clinical research focusing on their role in reducing oxidative stress, controlling inflammation, and preventing apoptosis. Some flavonoids, such as quercetin, kaempferol, fisetin, apigenin, luteolin, chrysin, baicalein, catechin, epigallocatechin gallate, naringenin, naringin, hesperetin, genistein, rutin, silymarin, and daidzein, have been presented to help heal damage to the central nervous system by affecting key signaling pathways including PI3K/Akt and NF-κB. This review systematically analyzed articles on flavonoids, neuroprotection, and brain and spinal cord injury from primary medical databases like Scopus, PubMed, and Web of Science. Flavonoids enhance antioxidant defenses, reduce pro-inflammatory cytokine production, and aid cell survival and repair by focusing on specific molecular pathways. Clinical trials are also exploring the application of preclinical results to therapeutic approaches for patients with spinal cord injury and traumatic brain injury. Flavonoids can enhance injury healing, reduce lesion size, and enhance synaptic plasticity and neurogenesis. The full potential of flavonoids lies in their bioavailability, dose, and administration methods, but there are still challenges to overcome. This review explores flavonoid-induced neuroprotection, its clinical implications, future research opportunities, and molecular mechanisms, highlighting the potential for innovative CNS injury therapies and improved patient health outcomes.

The U-shaped relationship between serum osmolality and in-hospital mortality in patients with traumatic brain injury: a retrospective study based on the MIMIC-IV database

BACKGROUND

Disturbances in serum osmolality are associated with poor prognosis in many diseases and are more likely to occur in patients with traumatic brain injury (TBI). However, studies correlating serum osmolality and patient prognosis are lacking. Therefore, this study investigated the correlation between serum osmolality and in-hospital all-cause mortality in patients with TBI based on a large sample of TBI patients from the Medical Information Mart for Intensive Care-IV (MIMIV-IV) database.

METHODS

Patients were categorized into 4 groups based on serum osmolality levels and the association between serum osmolality and in-hospital all-cause mortality was assessed by constructing univariate and multivariate logistic regression analyses. Restricted cubic spline (RCS) curves were plotted to further assess nonlinear associations between study variables and outcomes. Kaplan-Meier analysis was used to assess the survival of patients in each group, and differences between groups were assessed by the log-rank test. Sensitivity analysis was used to assess whether this association was established in different populations.

RESULTS

This study covered 1587 patients. The Q3 group had the lowest in-hospital mortality (7.6%). After fully adjusting for confounders, either lower or higher serum osmolality levels were associated with in-hospital all-cause mortality (Q1 vs. Q3: OR, 2.244 [1.333-3.857] p = 0.003; Q4 vs. Q3: OR, 2.160 [1.295-3.681] p = 0.004). The RCS curves showed a U-shaped correlation, with the inflection point located at a serum osmolality of 295.4 mmol/L level.

CONCLUSIONS

There was a U-shaped relationship between serum osmolality and in-hospital all-cause mortality in TBI patients. Patients had the lowest in-hospital mortality when serum osmolarity was maintained at 295.4 mmol/L.

A comprehensive literature review on the effects of saffron and its bioactive components on traumatic brain injury (TBI)

Traumatic brain injury (TBI) is a leading cause of death in accidents, sports, and warfare. Additionally, TBI imposes a significant financial burden on individuals and governments, necessitating substantial financial support. It also severely diminishes the quality of life for patients and their caregivers. TBI is consisted of two distinct phases: the primary and secondary phases. The primary phase consists of numerous events that occur immediately after the injury or concussion but the second phase takes times and include several of responsive cascades that human body express against TBI. After TBI incidence, several cellular and molecular pathways (inflammatory, apoptotic, anti-oxidant) will be dysregulated. Over the years, numerous therapeutic approaches have been implemented to treat this debilitating condition, aiming to alleviate its symptoms and complications, while enhancing patients' quality of life. Consequently, the search for more efficient with less adverse effects therapeutic methods remains a priority. One herbal medication that has recently garnered considerable attention is saffron. Data were collected from Scopus, Google Scholar, PubMed, and Cochrane Library for clinical, in vivo and in vitro studies published in English between 1992 and Jan 2025. Search terms included "TBI" OR "Traumatic brain injury" AND "Saffron" AND "Safranal" AND "Crocin" AND "Crocetin" AND "Kaempferol". The initial search yielded approximately 3,000 manuscripts. After screening and full-text evaluation, as detailed in the search methodology, ten experiments (in-vitro & in-vivo) were ultimately included. Saffron showed to modulate various signaling pathways and cytokines such as NF-kB, NLRP3, Nrf2, HO-1, Bcl2, and Bax, which will lead to the improvement of TBI sign and symptoms and increase the quality of life. It has been demonstrated that this compound could play a multifactorial role in TBI treatment such as reduction in inflammation, apoptosis, and oxidative stress, while modulating microglia activation. The findings suggest that saffron may play a pivotal role in treating TBI and mitigating its complications by regulating various pathophysiological pathways. However, more clinical trials are necessary to evaluate saffron's effectiveness in individuals diagnosed with TBI. Clinical trials should focus on various areas such as saffrons' safety profile, adverse effects, the exact mechanism of action, its' impact on acute and chronic TBI, rehabilitation, and long-term neuroprotection.

Mesenchymal stem cells and their extracellular vesicle therapy for neurological disorders: traumatic brain injury and beyond

Traumatic brain injury (TBI) is a complex condition involving mechanisms that lead to brain dysfunction and nerve damage, resulting in significant morbidity and mortality globally. Affecting ~50 million people annually, TBI's impact includes a high death rate, exceeding that of heart disease and cancer. Complications arising from TBI encompass concussion, cerebral hemorrhage, tumors, encephalitis, delayed apoptosis, and necrosis. Current treatment methods, such as pharmacotherapy with dihydropyridines, high-pressure oxygen therapy, behavioral therapy, and non-invasive brain stimulation, have shown limited efficacy. A comprehensive understanding of vascular components is essential for developing new treatments to improve blood vessel-related brain damage. Recently, mesenchymal stem cells (MSCs) have shown promising results in repairing and mitigating brain damage. Studies indicate that MSCs can promote neurogenesis and angiogenesis through various mechanisms, including releasing bioactive molecules and extracellular vesicles (EVs), which help reduce neuroinflammation. In research, the distinctive characteristics of MSCs have positioned them as highly desirable cell sources. Extensive investigations have been conducted on the regulatory properties of MSCs and their manipulation, tagging, and transportation techniques for brain-related applications. This review explores the progress and prospects of MSC therapy in TBI, focusing on mechanisms of action, therapeutic benefits, and the challenges and potential limitations of using MSCs in treating neurological disorders.

Sufentanil enhances the cortical neurogenesis of rats with traumatic brain injury via PI3K/AKT signal pathway

This study aimed to explore the effects of Sufentanil on the cortical neurogenesis of rats with traumatic brain injury (TBI) and investigate the potential mechanisms. Rats with TBI model were prepared and divided into sham + vehicle, TBI + vehicle, TBI + Sufentanil and TBI + Sufentanil + LY294002 (PI3K/AKT signal pathway inhibitor) four groups. The oxidative stress, inflammation, nerve cell damage, melatonin, brain-derived neurotrophic factor (BDNF), neuron regeneration and p-AKT protein level in the cortex were detected with ELISA, TUNEL, qRT-PCR, immunofluorescence and Western blot. Pain behavioral test was assessed with mechanical withdrawal threshold (MWT). The results showed Sufentanil significantly decreased the oxidative stress and inflammation levels, increased melatonin and BDNF levels, protected the nerve cells from damage, enhanced the regeneration of immature or mature neurons and the p-AKT protein expression in the cortex, and boosted MWT in TBI rats. While the rats with TBI were treated with LY294002 and Sufentanil together, the abovementioned effects of Sufentanil on the TBI rats were partially reversed. Our results indicate Sufentanil enhances the cortical neurogenesis and inhibits mechanical allodynia of rats with TBI through suppressing the oxidative stress, inflammation response and increasing the melatonin and BDNF levels partly via PI3K/AKT signal pathway.

Serpina3n in neonatal microglia mediates its protective role for damaged adult microglia by alleviating extracellular matrix remodeling-induced tunneling nanotubes degradation in a cell model of traumatic brain injury

Traumatic brain injury (TBI) induces significant neuroinflammation, primarily driven by microglia. Neonatal microglia (NMG) may have therapeutic potential by modulating the inflammatory response of damaged adult microglia (AMG). This study investigates the influence of NMG on AMG function through extracellular matrix (ECM) remodeling and the formation of tunneling nanotubes (TnTs), with a focus on the role of Serpina3n. We established an in vitro TBI model using a 3D Transwell system, co-culturing damaged AMG with NMG. Viral vector transfection was employed to manipulate Serpina3n expression in NMG. Quantitative real-time PCR, Western blotting, and ELISA were utilized to assess inflammatory markers, ECM remodeling proteins, and TnTs-related proteins. Co-culturing with NMG significantly inhibited M1 polarization of AMG and reduced the release of pro-inflammatory cytokines while promoting M2 polarization and increasing the production of anti-inflammatory cytokines. NMG expressed higher levels of Serpina3n, which played a crucial role in reducing Granzyme B, matrix metalloproteinase (MMP) 2 and MMP9 expression, thereby mitigating ECM remodeling. Inhibition of Serpina3n in NMG increased pro-inflammatory markers and decreased TnTs formation proteins, whereas overexpression of M-sec in AMG counteracted these effects. This highlights the importance of TnTs in maintaining microglial function and promoting an anti-inflammatory environment. In conclusion, NMG improve the function of damaged AMG by modulating ECM remodeling and promoting TnTs formation through the action of Serpina3n.

Improving Patient Outcomes in mTBI: The Role of Integrated Nursing Interventions in the Emergency Department

Background

Traumatic brain injury (TBI) is a major cause of morbidity and mortality, often requiring emergency department (ED) management. Integrated Nursing Interventions play a critical role in the care of TBI patients, but limited research has evaluated their efficacy in this setting. This study aims to assess the impact of Integrated Nursing Interventions on patient outcomes and complications in the ED.

Methods

This retrospective study included 246 patients with mild traumatic brain injury (mTBI) treated in the emergency department from January 2022 to December 2022. Of these, 138 patients received Integrated Nursing Interventions, while 108 did not. Baseline characteristics, clinical outcomes, and complications were compared between the two groups. Descriptive statistics, logistic regression, and receiver operating characteristic (ROC) curve analysis were used to evaluate the effect of nursing interventions on outcomes such as mortality, complications, and hospital stay.

Results

Among the 246 mTBI patients, those receiving Integrated Nursing Interventions (n=138, 56.1%) experienced significantly lower rates of adverse events, including perioperative intracranial hemorrhage (4.3% vs 12.0%, P=0.025) and shorter hospital stays (6±2 days vs 11±3 days, P<0.001). The study sample included 56.5% female, with 80.1% age ≤ 80. Integrated Nursing Interventions refer to coordinated care strategies that combine multiple nursing approaches tailored to address both physical and psychological needs of patients. For instance, the use of patient education combined with individualized pain management strategies. Logistic regression analysis revealed that Integrated Nursing Interventions were associated with a significant reduction in in-hospital mortality (OR=1.828, 95% CI: 1.619-2.318, P<0.001). ROC curve analysis demonstrated strong predictive accuracy for outcomes such as readmission rate (AUC=0.757), 30-day mortality (AUC=0.836), and 90-day mortality (AUC=0.760).

Conclusion

Integrated Nursing Interventions in the emergency department significantly improve patient outcomes for mTBI patients, reducing mortality, complications, and length of hospital stay. These interventions, which include early assessment, timely intervention, patient education, and collaborative care, are essential for optimizing TBI management. The high predictive value of these interventions further underscores their importance in emergency care. Future research should focus on the long-term effects of Integrated Nursing Interventions on patient outcomes across different age groups, particularly in chronic disease management. Further studies could explore the role of digital health tools in enhancing integrated care.

Use of amantadine in traumatic brain injury: an updated meta-analysis of randomized controlled trials

Introduction

Amantadine has been shown to accelerate cognitive and functional brain recovery after cerebrovascular accidents. However, the efficacy of this drug in TBI patients remains poorly defined.

Methods

We performed a systematic review and meta-analysis of randomized trials (RCTs) evaluating the effects of amantadine in TBI patients. The Cochrane, Embase, and PubMed databases were systematically searched for trials published up to March 24, 2024. Data from previous RCTs were extracted and quality assessed according to Cochrane recommendations. Means and standard deviations with 95% confidence intervals were aggregated across studies. The primary outcomes assessed were Glasgow Coma Scale (GCS), Mini Mental State Examination (MMSE) and the Disability Rating Scale (DRS).

Results

From 1,292 database results, 6 studies with 426 patients were included, of which 205 received amantadine (48.12%). The Glasgow Coma Scale score on day 7 (MD 1.50; 95% CI 0.08-2.92; p = 0.038; I 2 = 68%) was significantly higher in patients treated with amantadine than those treated with placebo. The Mini Mental State Examination (MD 3.23; 95% CI 0.53-5.94; p = 0.019; I 2 = 0%) was also better in patients treated with amantadine. No significant differences in Disability Rating Scale, day 3 GCS, Glasgow Outcome Scale (GOS), length of hospital stay, or duration of mechanical ventilation were observed between amantadine and placebo groups.

Conclusion

In our analysis, TBI patients benefit from the use of amantadine in the day 7 GCS score and show better results in the MMSE test, but placebo patients benefit from not using amantadine in the DRS between weeks 3 and 4. No other statistically significant results were found related to the use of this medication.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_ record.php?ID=CRD42024538110, CRD42024538110.

Unraveling the complexity of acute subdural hematoma in elderly patients: The impact of anticoagulant therapy and the pursuit of better outcomes

BACKGROUND

Acute subdural hematoma (ASDH) is a critical and often fatal condition, particularly in elderly patients receiving anticoagulant therapy. With a growing global aging population, the incidence of traumatic brain injuries, including ASDH, is projected to rise, presenting significant challenges in clinical management. This study evaluates the outcomes of surgically treated ASDH in patients aged 65 years and older, comparing those who received anticoagulant therapy with those who did not. It also aims to identify the main risk factors for poor outcomes and explore preventive strategies in this vulnerable population.

METHODS

A retrospective analysis was conducted on 90 patients aged 65 years and older who underwent surgery for ASDH at our institution between 2018 and 2023. Patients were categorized into two groups based on anticoagulant therapy use. Demographic data, mechanisms of injury, clinical presentations, and outcomes, including mortality and reoperation rates, were analyzed. Radiological assessments included hematoma thickness, midline shift, and the presence of residual hematoma.

RESULTS

No significant differences were observed in hematoma thickness, midline shift, or mortality between patients receiving anticoagulant therapy and those not on anticoagulants. However, a significant association was found between anticoagulant use and the mechanism of injury; patients on anticoagulants were more likely to sustain ASDH from low-energy trauma, such as a fall from the same level (p=0.005). Despite the high mortality rates associated with ASDH in elderly patients, the multidisciplinary approach employed, including the prompt reversal of coagulopathy, likely contributed to the observed outcomes.

CONCLUSION

Acute subdural hematoma in elderly patients, particularly those receiving anticoagulant therapy, remains a challenging problem with a high rate of poor outcomes. This study highlights the urgent need for preventive measures to mitigate the risks associated with even minor trauma, especially in patients on anticoagulants. Our findings underscore the importance of appropriate management protocols, including the timely reversal of coagulopathy, in improving survival rates within this high-risk population. Further research is needed to develop and validate comprehensive preventive strategies and to investigate long-term outcomes in these patients.

Mild Hypothermia Therapy Reduces the Incidence of Early Cerebral Herniation and Decompressive Craniectomy after Mechanical Thrombectomy for Acute Ischemic Stroke with Large Infarction

The application value of mechanical thrombectomy (MT) in acute large-vessel occlusion cerebral infarction has been confirmed, but considering the poor prognosis of large-core infarction (LCI), the current guidelines and practices are based on anterior circulation small-core infarction. Reducing the perioperative complications of thrombectomy in LCIs is the key to saving more patients previously considered unsuitable for thrombectomy. Patients with acute anterior circulation cerebral infarction who were admitted to Suining Central Hospital of Sichuan Province from January 2022 to December 2023 and whose Alberta Stroke Program Early Computed Tomography Score value was 3-5 (the score range was 0-10, and the lower the score was, the larger the infarct area) or whose infarct core volume was ≥70 mL and who received MT were enrolled consecutively. The patients were grouped based on whether they were treated with mild hypothermia (mild hypothermia treatment group vs. conventional treatment group). Patients who were evaluated preoperatively for large-core cerebral infarction and underwent mild hypothermia treatment were performed immediately after MT. The clinical data of the patients were collected. The primary outcome events were the incidence of cerebral hernia within one week after the operation and the rate of requiring decompressive craniectomy (%). The secondary outcome was the modified Rankin scale (mRS) score at 90 days (the score range was 0-6, and the higher the score was, the greater the degree of functional disability). A total of 64 patients were included. Twenty-nine patients were assigned to the mild hypothermia treatment group, and 35 patients were assigned to the conventional treatment group. There was no significant difference in the baseline data between the two groups. The proportions of cerebral hernia and the need for decompressive craniectomy within one week after the operation were significantly lower in the mild hypothermia treatment group than in the conventional treatment group (31% vs. 57.1%, odds ratio [OR] 0.338, 95% confidence interval [CI] 0.120-0.948; p = 0.037). The proportion of patients who underwent decompressive craniectomy in the mild hypothermia treatment group was significantly lower (13.8% vs. 42.8%, OR 0.213, 95% CI 0.061-0.745, p = 0.011). There was no significant difference in the mRS score between the two groups at 90 days (4.31 ± 1.75 vs. 4.48 ± 1.57, p = 0.456) or in the proportion of patients with a good prognosis (mRS 0-3) between the two groups (OR 0.569, 95% CI 0.18-1.793, p = 0.333). Mild hypothermia treatment can reduce the incidence of early cerebral hernia and the need for decompressive craniectomy in patients with acute large-core cerebral infarction after MT; this treatment can be used as an important adjuvant treatment after thrombectomy for LCI, but may not change the long-term prognosis.

Comprehensive Transcriptome-Wide Profiling of 5-Methylcytosine Modifications in Long Non-Coding RNAs in a Rat Model of Traumatic Brain Injury

Traumatic brain injury (TBI) poses a major global health challenge, leading to serious repercussions for those affected and imposing considerable financial strains on families and healthcare systems. RNA methylation, especially 5-methylcytosine (m5C), plays a crucial role as an epigenetic modification in regulating RNA at the level of post-transcriptional regulation. However, the impact of TBI on the m5C methylation profile of long non-coding RNAs (lncRNAs) remains unexplored. In the present study, we conducted a thorough transcriptome-wide examination of m5C methylation in lncRNAs in a rat TBI model utilizing MeRIP-Seq. Our results revealed significant differences in the amount and distribution of m5C methylation in lncRNAs between TBI and control groups, indicating profound changes in m5C methylation following TBI. Bioinformatic analyses linked these specifically methylated transcripts to pathways involved in immune response, neural repair, and lipid metabolism, providing insight into possible mechanisms underlying TBI pathology. These findings offer novel perspectives on the post-transcriptional modifications in lncRNA m5C methylation following TBI, which may contribute to understanding the disease mechanisms and developing targeted therapeutic strategies.

Incidence of pressure injury in patients with moderate and severe traumatic brain injury: a systematic review

BACKGROUND

Patients with moderate and severe traumatic brain injury (TBI) admitted to the intensive care unit (ICU) may develop pressure injury (PI) due to haemodynamic instability caused by the disease, lack of mobility in bed, as well as intense and prolonged compression in prominent bone areas.

OBJECTIVE

The objective of this review is to assess the incidence and identify risk factor for the development of PI in patients with moderate and severe TBI admitted to the ICU.

METHOD

Searches were conducted in the PubMed, CINAHL, Scopus, Embase, Web of Science, Google Scholar, Trove and Open Grey databases, including all records found up to May 2023. Patients with moderate and severe TBI admitted to the ICU were included in this review.

RESULTS

A total of 368 studies on PI and TBI were identified in the databases. Two authors assessed study bias and extracted data, wit. h a third reviewer as arbitrator. Six studies met the inclusion and exclusion criteria in the review. The incidence of PI varied between 6.5% and 20% among the included studies. Only two studies applied the Braden Scale, which identified stage II lesions (52.6% and 51.5%), located in the sacral region (78.9% and 54.6%). The risk factors identified in the studies for the development of PI were mechanical ventilation, TBI severity, vasoactive drugs, age, fever, use of enteral nutrition, haemoglobin levels and time to perform tracheostomy.

CONCLUSION

The incidence of PI in moderate and severe patients was similar to that found in ICU patients. There were significant differences across the various studies in the ways in which data were collected and reported.

TRIAL REGISTRATION NUMBER

The protocol has been deposited in the PROSPERO repository (CRD42023428817).

Influencing factors on neurological prognosis after traumatic brain injury and the role of brain tissue oxygen pressure (PbtO2) monitoring

OBJECTIVE

To identify factors influencing neurological prognosis following traumatic brain injury (TBI) and to analyze the role of brain tissue oxygen pressure (PbtO2) monitoring in prognostication.

METHODS

In this case-control study, medical records of 412 individuals diagnosed with TBI were thoroughly examined and analyzed. The patients were divided into two groups based on their prognosis at three months post-injury: Good Prognosis (n = 321) and Poor Prognosis (n = 91). Demographic and clinical characteristics, brain tissue oxygen partial pressure, radiological and laboratory findings, treatment interventions, and complications were compared between the two groups. Logistic regression analysis was conducted to identify the risk factors for neurological prognosis, and the predictive value of these factors was evaluated using receiver operating characteristic (ROC) curve analysis.

RESULTS

The study identified associations between Injury Severity Score (ISS), Glasgow Coma Scale (GCS), PbtO2 levels, radiological findings (diffuse axonal injury and subarachnoid hemorrhage), and laboratory parameters (platelet count and arterial oxygen partial pressure (PaO2)) with neurological prognosis following TBI. Initial PbtO2 levels demonstrated independent predictive value for poor neurological outcomes (Area Under the Curve (AUC) = 0.804).

CONCLUSION

The study highlights the prognostic significance of injury severity, brain tissue oxygenation, radiological findings, and laboratory parameters in determining neurological outcomes following TBI. Furthermore, the findings emphasize the potential of PbtO2 monitoring as a valuable tool in prognostic assessment.

Knockout of neutrophil cytosolic factor 1 ameliorates neuroinflammation and motor deficit after traumatic brain injury

Traumatic brain injury (TBI) is a predominant cause of long-term disability in adults, yet the molecular mechanisms underpinning the neuropathological processes associated with it remain inadequately understood. Neutrophil cytosolic factor 1 (NCF1, also known as p47phox) is one of the cytosolic components of NADPH oxidase NOX2. In this study, we observed a reduction in the volume of TBI-induced brain lesions in NCF1-knockout mice compared to controls. Correspondingly, the neuronal loss induced by TBI was mitigated in the NCF1-knockout mice. Behavioral analysis also demonstrated that the motor coordination deficit following TBI was mitigated by the depletion of NCF1. Mechanistically, our findings revealed that NCF1 deficiency attenuated TBI-induced inflammatory responses by inhibiting the release of proinflammatory factors and reducing neutrophil infiltration into the brain parenchyma. Additionally, our results indicated that NCF1 deficiency significantly decreased the levels of reactive oxygen species in neutrophils. Taken together, our findings indicate that NCF1 plays a crucial role in the regulation of brain injury and secondary inflammation post-TBI.

Aberrant error monitoring in traumatic brain injuries: A meta-analysis of event-related potential studies

OBJECTIVE

Although individuals with traumatic brain injuries (TBI) often manifest altered error monitoring, evidence using event-related potentials (ERPs) to index these cortical processes is inconsistent. Therefore, this meta-analysis study aimed to comprehensively compare the error-related negativity (ERN) and error positivity (Pe) between individuals with TBI and healthy controls (HC) from the existing literature.

METHODS

Literature search was performed using PubMed/MEDLINE, Web of Science, and Cochrane Library. The effect sizes (Hedges' g) in the comparisons of ERN and Pe amplitudes between TBI and HC groups were employed by a random-effect, inverse-variance weighted model. The effects of age, TBI severity and experimental tasks on both ERP components were also examined.

RESULTS

Random-effect models showed decreased ERN (g = 0.361, p = 0.010), but intact Pe (g = 0.105, p = 0.443), in those with TBI compared to HC. A further analysis revealed that the adult patients (g = 0.326, p = 0.038), but not the youth patients, showed significant reduction of ERN as compared to the HC. However, we did not find moderating effects of TBI severity and experimental paradigms on either ERN or Pe.

CONCLUSIONS

ERN and Pe reflect separate neurophysiological mechanisms and different aspects of error monitoring in TBI. Our findings suggest that attenuated ERN amplitude may be an electrophysiological parameter of error monitoring deficits in TBI.

MiR-3571 modulates traumatic brain injury by regulating the PI3K/AKT signaling pathway via Fbxo31

To investigate the effect of miR-3571 on traumatic brain injury (TBI) via the regulation of neuronal apoptosis through F-box-only protein 31/phosphoinositide 3-kinase/protein kinase B (Fbxo31/PI3K/AKT). We established TBI rat and cell models. Hematoxylin‒eosin (HE) and Nissl staining were used to observe brain injury and the number of Nissl bodies, respectively. Cell proliferation and apoptosis were assessed by 5-ethynyl-2'-deoxyuridine (EdU), terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL), and flow cytometry. Gene and protein expression was measured via reverse transcription quantitative polymerase chain reaction (RT‒qPCR), Western blotting, and enzyme-linked immunosorbent assay (ELISA). In this study, miR-3571 was highly expressed in TBI models. Inhibition of miR-3571 expression can suppress autophagy, reduce the expression of proinflammatory cytokines, and reduce neuronal apoptosis, thus alleviating the pathological conditions of tissue congestion, edema and structural damage after TBI. These experiments demonstrated that miR-3571 could target and regulate the level of Fbxo31. Knockdown of Fbxo31 weakened the remission effect of the miR-3571 inhibitor on TBI and promoted neurological damage; moreover, overexpression of Fbxo31 enhanced the protective effect on neural function, whereas the PI3K/AKT pathway inhibitor LY294002 increased the damage caused by miR-3571 on neural function and weakened the protective effect of Fbxo31. In conclusion, miR-3571 regulates the PI3K/AKT signaling pathway by reducing Fbxo31 expression, promotes neuronal apoptosis and exacerbates TBI.

Annexin-A1 tripeptide enhances functional recovery and mitigates brain damage in traumatic brain injury by inhibiting neuroinflammation and preventing ANXA1 nuclear translocation in mice

This study explores the role and mechanism of Annexin-A1 Tripeptide (ANXA1sp) in mitigating neuronal damage and promoting functional recovery in a mouse model of traumatic brain injury (TBI). Our goal is to identify ANXA1sp as a potential therapeutic drug candidate for TBI treatment. Adult male C57BL/6J mice were subjected to controlled cortical impact (CCI) to simulate TBI, supplemented by an in vitro model of glutamate-induced TBI in HT22 cells.  We assessed neurological deficits using the Modified Neurological Severity Score (mNSS), tested sensorimotor functions with beam balance and rotarod tests, and evaluated cognitive performance via the Morris water maze. Neuronal damage was quantified using Nissl and TUNEL staining, while microglial activation and inflammatory responses were measured through immunostaining, quantitative PCR (qPCR), Western blotting, and ELISA. Additionally, we evaluated cell viability in response to glutamate toxicity using the Cell Counting Kit-8 (CCK-8) assay and lactate dehydrogenase (LDH) release. Intraperitoneal administration of ANXA1sp significantly enhanced neurological outcomes, markedly reducing sensorimotor and cognitive impairments caused by TBI. This treatment resulted in a significant reduction in lesion volume and decreased neuronal cell death in the ipsilateral cortex. Moreover, ANXA1sp effectively diminished microglial activation around the brain lesion and decreased the levels of pro-inflammatory markers such as IL-6, IL-1β, TNF-α, and TGF-β in the cortex, indicating a significant reduction in neuroinflammation post-TBI. ANXA1sp also offered protection against neuronal cell death induced by glutamate toxicity, primarily by inhibiting the nuclear translocation of ANXA1, highlighting its potential as a neuroprotective strategy in TBI management. Administration of ANXA1sp significantly reduced neuroinflammation and neuronal cell death, primarily by blocking the nuclear translocation of ANXA1. This treatment substantially reduced brain damage and improved neurological functional recovery after TBI. Consequently, ANXA1sp stands out as a promising neuroprotective agent for TBI therapy.

Neurogenic potential of NG2 in neurotrauma: a systematic review

Regenerative approaches towards neuronal loss following traumatic brain or spinal cord injury have long been considered a dogma in neuroscience and remain a cutting-edge area of research. This is reflected in a large disparity between the number of studies investigating primary and secondary injury as therapeutic targets in spinal cord and traumatic brain injuries. Significant advances in biotechnology may have the potential to reshape the current state-of-the-art and bring focus to primary injury neurotrauma research. Recent studies using neural-glial factor/antigen 2 (NG2) cells indicate that they may differentiate into neurons even in the developed brain. As these cells show great potential to play a regenerative role, studies have been conducted to test various manipulations in neurotrauma models aimed at eliciting a neurogenic response from them. In the present study, we systematically reviewed the experimental protocols and findings described in the scientific literature, which were peer-reviewed original research articles (1) describing preclinical experimental studies, (2) investigating NG2 cells, (3) associated with neurogenesis and neurotrauma, and (4) in vitro and/or in vivo, available in PubMed/MEDLINE, Web of Science or SCOPUS, from 1998 to 2022. Here, we have reviewed a total of 1504 papers, and summarized findings that ultimately suggest that NG2 cells possess an inducible neurogenic potential in animal models and in vitro. We also discriminate findings of NG2 neurogenesis promoted by different pharmacological and genetic approaches over functional and biochemical outcomes of traumatic brain injury and spinal cord injury models, and provide mounting evidence for the potential benefits of manipulated NG2 cell ex vivo transplantation in primary injury treatment. These findings indicate the feasibility of NG2 cell neurogenesis strategies and add new players in the development of therapeutic alternatives for neurotrauma.

Fish skin dressing for wound regeneration: A bioactive component review of omega-3 PUFAs, collagen and ECM

Wound healing is a complex biological process that involves several stages, including hemostasis, inflammation, proliferation, and remodeling. Traditional wound dressings, to a certain extent, can provide wound protection but are limited in promoting wound healing, reducing scar formation, and preventing bacterial infections. In recent years, with the advancement of research in biomedical materials, fish skin dressings have become a research hotspot in the field of tissue regeneration due to their remarkable biocompatibility and precious bioactive components. However, current research on fish skin dressings remains focused on clinical treatment. To further deepen and promote the development of fish skin dressings, we put emphasis on discussing main bioactive components in fish skin. This article has reviewed the advantages of fish skin dressings in wound regeneration, especially the promotive effects of its main bioactive components-Omega-3 polyunsaturated fatty acids, collagen derived from fish skin, and the extracellular matrix of fish skin-on the wound healing process. Besides, by critically summarizing the research issues of each bioactive component, this review assists researchers in better defining the next direction of research, thereby designing the optimal dressing for different types of wounds.

Neutrophil-albumin ratio serves as a superior prognostic biomarker for traumatic brain injury

Traumatic brain injury (TBI) represents a common and severe medical condition necessitating prompt risk stratification to enhance patient outcomes. Although substantial research has been conducted on the prognostic utility of various biomarkers for TBI, no single biomarker has been definitively recognized as the most precise predictor of disease outcomes. In comparison to other markers, the neutrophil-albumin ratio (NAR) has emerged as a cost-effective and reproducible inflammatory biomarker, demonstrating potential in evaluating the severity of inflammation and prognosticating outcomes in infections and cerebrovascular diseases. This study evaluated the prognostic significance of the NAR in comparison to two other readily accessible and cost-effective composite indices: the Neutrophil-Lymphocyte Ratio (NLR) and the Platelet-Lymphocyte Ratio (PLR) in individuals with TBI. We conducted a retrospective cohort analysis involving 297 hospitalized TBI patients, gathering comprehensive demographic, anthropometric, medical, clinical, laboratory, and imaging data to assess the expression changes of these biomarkers. Our findings suggest that both the NAR and the NLR possess predictive value regarding prognosis following TBI. However, receiver operating characteristic (ROC) curve analysis revealed that NAR outperformed NLR as a prognostic predictor. In conclusion, our examination of blood biochemistry composite indicators indicates that, while both NAR and NLR serve as significant prognostic markers, NAR is a more effective predictor of outcomes in patients with TBI.

Antisecretory Factor 16 (AF16): A Promising Avenue for the Treatment of Traumatic Brain Injury-An In Vitro Model Approach

Traumatic brain injury (TBI) is caused by an external mechanical force to the head, resulting in abnormal brain functioning and clinical manifestations. Antisecretory factor (AF16) is a potential therapeutic agent for TBI treatment due to its ability to inhibit fluid secretion and decrease inflammation, intracranial pressure, and interstitial fluid build-up, key hallmarks presented in TBI. Here, we investigated the effect of AF16 in an in vitro model of neuronal injury, as well as its impact on key components of the autophagy pathway and mitochondrial dynamics. N2Awt cells were treated with AF16, injured using a scratch assay, and analysed using confocal microscopy, correlative light and electron microscopy (CLEM), flow cytometry, and western blotting. Our results reveal that AF16 enhances autophagy activity, regulates mitochondrial dynamics, and provides protection as early as 6 h post-injury. Fluorescently labelled AF16 was observed to localise to lysosomes and the autophagy compartment, suggesting a role for autophagy and mitochondrial quality control in conferring AF16-associated neuronal protection. This study concludes that AF16 has potential as a therapeutic agent for TBI treatment through is regulation of autophagy and mitochondrial dynamics.

Prognostic value of computed tomography and magnetic resonance imaging findings in acute traumatic brain injury in prediction of poor neurological outcome and mortality: a systematic review and meta-analysis

Traumatic brain injury (TBI) is a major cause of morbidity and mortality, impacting healthcare systems and economies. Early identification of poor outcomes is crucial for effective treatment. This systematic review assesses the prognostic value of computed tomography (CT) and magnetic resonance imaging (MRI) findings in predicting poor neurological outcomes and mortality in the acute phase of TBI. A comprehensive search of Scopus, MEDLINE, and Web of science databases was performed to identify studies examining CT and MR-based imaging findings and their association with poor outcomes as assessed by Glasgow outcome score as well as mortality within the early acute phase of TBI following injury/admission. Qualitative evaluation of included studies revealed several imaging sequences that modify the outcome of the patients, including extra-axial and intra-axial hemorrhage, swirl sign, contrast extravasation, midline shift, closed and open cranial cisterns, signs of edema, presence of cranial fractures, intracranial hemorrhage, cerebral microbleeds, diffuse axonal injury, apparent diffusion coefficient and fractional anisotropy in diffusion tensor imaging, as well as, concentrations of brain metabolites(N-acetyl aspartate, Creatinine, Choline, Myo-inositol, glutamate, and glutamine) in magnetic resonance spectroscopy. Among these markers, subarachnoid hemorrhage (SAH) and subdural hematoma (SDH) emerged as the most predictive of poor outcomes based on meta-analysis findings. SAH was significantly associated with an increased risk of mortality (OR: 3.35, 95% CI: 2.41-4.65, I²=51.3%) and poor outcomes (OR: 2.69, 95% CI: 2.44-2.96, I²=0%). Similarly, SDH correlated with higher mortality risk (OR: 2.44, 95% CI: 2.14-2.78, I²=0%) and worse outcomes (OR: 2.00, 95% CI: 1.12-3.59, I²=60.9%). In contrast, epidural hematoma (EDH) was linked to better outcomes (OR: 0.60, 95% CI: 0.52-0.68, I²=0%) but not significantly associated with mortality (OR: 0.38, 95% CI: 0.09-1.65, I²=73.7%). The results of this systematic review and meta-analysis provide an overview of clinically feasible imaging markers of prognostic value and may inform clinical decision-making in the future.

Traumatic brain injury: Advances in coagulopathy (Review)

Trauma is a prevalent cause of coagulopathy, with traumatic brain injury (TBI) accompanied by coagulation disorders particularly linked to adverse outcomes. TBI is distinguished by minimal bleeding volume and unique injury sites, which precipitate complex coagulation disturbances. Historically, research into trauma-induced coagulopathy has primarily concentrated on the molecular biology and pathophysiology of endogenous anticoagulation and inflammation. Nonetheless, recognizing that cells are the fundamental units of structure and function in all living organisms, the present review aimed to distill our understanding of coagulopathy post-TBI by elucidating the intricate cellular mechanisms involving endothelial cells, neutrophils and platelets. Additionally, this study evaluates the strengths and weaknesses of various diagnostic tools and discusses the characteristics of pharmacological treatments and potential therapies for patients with TBI and coagulation disorders. The aim of this review is to amalgamate recent updates in mechanistic research and innovative diagnostic and therapeutic methodologies, thereby fostering the progression of precision medicine within this specialized domain.

Fecal microbiota transplantation alleviates cognitive impairment by improving gut microbiome composition and barrier function in male rats of traumatic brain injury following gas explosion

Background

Dysbiosis of gut microbiota (GM) is intricately linked with cognitive impairment and the incidence of traumatic brain injury (TBI) in both animal models and human subjects. However, there is limited understanding of the impact and mechanisms of fecal microbiota transplantation (FMT) on brain and gut barrier function in the treatment of TBI induced by gas explosion (GE).

Methods

We have employed FMT technology to establish models of gut microbiota dysbiosis in male rats, and subsequently conducted non-targeted metabolomics and microbiota diversity analysis to explore the bacteria with potential functional roles.

Results

Hematoxylin-eosin and transmission electron microscopy revealed that GE induced significant pathological damage and inflammation responses, as well as varying degrees of mitochondrial impairment in neuronal cells in the brains of rats, which was associated with cognitive decline. Furthermore, GE markedly elevated the levels of regulatory T cell (Tregs)-related factors interleukin-10, programmed death 1, and fork head box protein P3 in the brains of rats. Similar changes in these indicators were also observed in the colon; however, these alterations were reversed upon transfer of normal flora into the GE-exposed rats. Combined microbiome and metabolome analysis indicated up-regulation of Clostridium_T and Allobaculum, along with activation of fatty acid biosynthesis after FMT. Correlation network analysis indirectly suggested a causal relationship between FMT and alleviation of GE-induced TBI. FMT improved intestinal structure and up-regulated expression of tight junction proteins Claudin-1, Occludin, and ZO-1, potentially contributing to its protective effects on both brain and gut.

Conclusion

Transplantation of gut microbiota from healthy rats significantly enhanced cognitive function in male rats with traumatic brain injury caused by a gas explosion, through the modulation of gut microbiome composition and the improvement of both gut and brain barrier integrity via the gut-brain axis. These findings may offer a scientific foundation for potential clinical interventions targeting gas explosion-induced TBI using FMT.

Progress on the Mechanisms and Neuroprotective Benefits of Dexmedetomidine in Brain Diseases

INTRODUCTION

Dexmedetomidine, a highly specific α2 agonist, has been extensively utilized in clinical sedation and surgical anesthesia since its introduction in 2000 due to its excellent sympatholytic, sedative, and analgesic effects. This review aimed to identify new approaches for the treatment of patients with brain disorders by thoroughly describing the mechanism of action of dexmedetomidine and examining its neuroprotective effects from the standpoints of basic and clinical research.

METHODS

The PubMed and Web of Science databases were searched using the keywords dexmedetomidine and related brain diseases, although relevant articles from the last decade were included for detailed summarization and analysis.

RESULTS

Dexmedetomidine has shown strong neuroprotective effects, such as protection of the blood-brain barrier, decreased neuronal death, maintained hemodynamic stability, and reduced postoperative agitation and cognitive dysfunction. Furthermore, dexmedetomidine has been shown to exert various neuroprotective effects, including anti-inflammatory and antioxidative stress effects, modulation of autophagy, and reduction of apoptosis in cerebral diseases.

CONCLUSIONS

Dexmedetomidine acts as a neuroprotective agent against brain diseases during all phases of treatment. However, clinical trials with larger sample sizes are required to optimize dosage and dosing strategies.

Comparison of ketorolac intravenous versus acetaminophen intravenous in treating headache following head trauma: a semi-experimental study

BACKGROUND

Post-traumatic headache is a disabling secondary headache disorder often attributed to traumatic brain injury and affects millions of individuals worldwide. Few studies have been done on the treatment needs of these patients in emergency departments. The purpose was to compare the effectiveness of ketorolac intravenous versus acetaminophen intravenous in reducing headaches in patients following head trauma.

METHODS

This was a semi-experimental study in which the participants were assigned two groups. In the acetaminophen intravenous group, 1 g acetaminophen and in the ketorolac intravenous group, 60 mg of this drug was injected. Statistical analysis was done with IBM SPSS statistical software version 21, and a P-value less than 0.05 was considered statistically significant.

RESULTS

Among samples after 6 h from the injection, the pain score in the ketorolac intravenous group was less than the acetaminophen intravenous group (P = 0.006). Also, the pain reduction rate in the ketorolac intravenous group was more than the acetaminophen intravenous group from before the injection until 2 h after it (P = 0.01) and before injection until 6 h after it (P = 0.001). The frequency of drowsiness in 2 and 6 h after drug administration in the ketorolac intravenous group was lower than the acetaminophen intravenous group, which is significant in 2 h after drug administration (P = 0.038). The verbal analog scale score comparison for two groups 2 h before medicine administration with pain control score (P = 0.03) and 6 h with pethidine use control (P = 0.003) is significant.

CONCLUSIONS

According to this study, ketorolac's intravenous effect on pain control is better than that of acetaminophen intravenous. With more samples, we can express the survey results more decisively in the future.

Application of Fluorescent Composite Materials as a Sustained Release System in Treatment of Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a multifactorial disease characterized by oxidative stress and follicular dysfunction, leading to menstrual irregularities, hyperandrogenism, and infertility. Traditional drug delivery methods often result in drug loss and side effects on normal tissues. To address these issues, we synthesized two novel Co(II)-containing coordination polymers (CPs), {[Co(L)(H2O)2]·2H2O}n (1) and {[Co(L)(H2O)2]·1.5H2O}n (2), through the reaction of the T-shaped ligand (4 - 3'-pyridyl-,6 - 4'-carboxylphenyl)picolinic acid (H2L) with Co(NO3)2·6H2O via a solvothermal process. Fluorescence spectroscopy revealed that the fluorescence emission of the CPs originates from the ligand, indicating their potential application as blue fluorescence materials. Subsequently, we encapsulated these CPs with hyaluronic acid (HA) and carboxymethyl chitosan (CMCS) hydrogels to create two types of metal gel particles carrying spironolactone (HA/CMCS-CPs@spironolactone). SEM and TEM analyses showed that the material consists of tightly stacked sheet-like structures with an average size of approximately 100 nm. Thermogravimetric analysis (TGA) indicated that the material begins to decompose at around 115 °C, demonstrating good thermal stability. We assessed the inhibitory effects of these materials on oxidative stress induced by PCOS. The results showed that both types of spironolactone-loaded metal gel particles significantly reduced malondialdehyde (MDA) levels, particularly the particles constructed with CP2. HA/CMCS-CP1@spironolactone reduced MDA levels by approximately 17% and 46% at low and high concentrations, respectively, while HA/CMCS-CP2@spironolactone decreased MDA levels by about 55% and 39% at high and low concentrations, respectively. Therefore, the novel drug delivery system reported in this study has the potential to become a safe and effective option for the localized treatment of PCOS.

Pcv-aCO2/Ca-cvO2 Combined with Optic Nerve Sheath Diameter in Predicting Elevated Intracranial Pressure of Patients with Traumatic Brain Injury in Prehospital Setting

Purpose

To investigate a correlation between the central venous minus arterial CO2 pressure to arterial minus central venous O2 content ratio (Pcv-aCO2/Ca-cvO2) combined with optic nerve sheath diameter (ONSD) in predicting prehospital elevated intracranial pressure (ICP) in traumatic brain injury (TBI) patients.

Patients and Methods

This was a prospective observational study of all adult TBI patients from the surgical intensive care unit who underwent invasive ICP monitoring between January 2023 and December 2023. Using a Delica MVU-6300 machine with 14-5 MHz linear probe to measure ONSD. We drew blood samples for arterial and central venous blood gases to measure and calculate the following indicators such as Pcv-aCO2, Ca-cvO2, and Pcv-aCO2/Ca-cvO2 ratio. ONSD and Pcv-aCO2/Ca-cvO2 were recorded during the first 3 days after admission. Simultaneous ICP values were gained from the invasive monitoring. Associations between ONSD, Pcv-aCO2/Ca-cvO2 and simultaneous ICP were explored by Spearman correlation analysis. We constructed an ROC curve to identify the ONSD and Pcv-aCO2/Ca-cvO2 cutoff for the evaluation of elevated ICP.

Results

We included 54 patients aged mean 57.13 (standard deviation 4.02) years and 24 (44%) were male. A significant correlation was observed between ONSD and ICP (r = 0.74, P < 0.01). The AUC was 0.861 (95% CI: 0.727-0.951), with a best cutoff value of 5.62 mm. Using a cutoff of 5.62mm, ONSD had a sensitivity of 92.8%, specificity of 80.4%. The Pcv-aCO2/Ca-cvO2 ratio also significantly correlated with ICP (r = 0.70, P < 0.01). The AUC was 0.791 (95% CI: 0.673-0.889). The optimal Pcv-aCO2/Ca-cvO2 value for predicting elevated ICP was 1.98 mmHg/mL. Using a cutoff of 1.98 mmHg/mL, Pcv-aCO2/Ca-cvO2 had a sensitivity of 87.3%, specificity of 77.2%. The AUC for ONSD combined with Pcv-aCO2/Ca-cvO2 was 0.952 (95% CI: 0.869-0.971), which had a sensitivity of 95.1%, specificity of 93.9%.

Conclusion

Pcv-aCO2/Ca-cvO2 combined with ONSD performed best in predicting elevated intracranial pressure of patients with TBI in a prehospital setting. Our findings provide a crucial tool to improve earlier management of these patients in prehospital care, where the availability and utilization of invasive monitoring is limited. It could lead to significant changes in how TBI patients are monitored and treated before reaching a hospital.

Incidence of pediatric traumatic brain injury (TBI) during the working hours of parents and caregivers in Saudi Arabia: A survey study

Background

Traumatic brain injury (TBI) is a common result of external physical forces that damage the brain, affecting over 50 million people annually, with a higher prevalence in males. Children aged 0-4 years are the most susceptible, particularly in low-and middle-income countries, where 90% of TBI-related deaths occur. TBI significantly affects children's quality of life. This study aimed to estimate the incidence of pediatric TBI during working hours among parents and caregivers in Saudi Arabia.

Methods

A questionnaire-based cross-sectional survey was conducted over 2 months, from July to August 2023. The survey data were electronically gathered using a questionnaire sent over social media channels. It includes working as a caregiver for children in Saudi Arabia.

Results

Involving 395 respondents, the primary focus was on child head injuries occurring during the working hours of parents and caregivers. Most respondents were in the 36-45 age bracket, predominantly female (66.1%) and married (81.8%). The age of the child at the time of injury was significantly associated with head injuries during parents' and caregivers' working hours, with the highest incidence among children aged 7-14 years (83.1%). The severity of the injury, hospital admission, need for intensive care, and surgical intervention were significantly associated with child injuries during these hours.

Conclusion

In this study, we found a significantly higher incidence of head injuries in children during the working hours of both parents and caregivers. Factors such as longer work hours, the presence of a nanny, more children, male gender, and older child age were associated with this risk.