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Watson JD, Perrin PB, Arango-Lasprilla JC. Disparities between native americans and white individuals in global outcome trajectories over the 5 years after traumatic brain injury: A model systems study. PLoS One 2025; 20:e0321279. [PMID: 40198598 PMCID: PMC11978045 DOI: 10.1371/journal.pone.0321279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 02/28/2025] [Indexed: 04/10/2025] Open
Abstract
PURPOSE Traumatic brain injury (TBI) can lead to a host of challenges and negatively impacts Native Americans more than any other ethnic group in the U.S. Despite this, little research exists on Native Americans with TBI. The current study examined disparities in global outcome trajectories (overall level of function post-injury) between Native Americans and White individuals in the 5 years following TBI and whether sociodemographic or injury-related characteristics could account for this disparity. METHOD The current study used a sample of 75 Native Americans demographically matched by sex, age, and injury severity to 75 White individuals from the U.S. Traumatic Brian Injury Model Systems (TBIMS) database (n = 150). A series of hierarchical linear models (HLMs) was used to examine longitudinal global outcome trajectories between the two groups. RESULTS Native Americans showed lower global outcome scores than their White counterparts with this difference worsening (i.e., growing larger) over time. The difference in scores and the differential movement over time were associated with differences between the ethnic groups in employment at the time of injury, substance use patterns, and type of insurance. CONCLUSION This study highlights the need for identification of and early intervention for risk factors that predict disparities in rehabilitation outcomes and points to the need for greater access to culturally informed care for Native Americans with TBI.
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Affiliation(s)
- Jack D. Watson
- Informatics, Decision Enhancement, and Analytic Sciences Center, Salt Lake City Department of Veterans Affairs, Salt Lake City, Utah, United States of America
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of, Medicine, Salt Lake City, Utah, United States of America
| | - Paul B. Perrin
- School of Data Science and Department of Psychology, University of Virginia, Charlottesville, Virginia, United States of America
- Central Virginia Veterans Affairs Health Care System,
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Mohammadzadeh I, Niroomand B, Tajerian A, Shahnazian Z, Nouri Z, Mortezaei A. Coagulopathy at admission in traumatic brain injury and its association with hematoma progression: A systematic review and meta-analysis of 2411 patients. Clin Neurol Neurosurg 2025; 249:108699. [PMID: 39753029 DOI: 10.1016/j.clineuro.2024.108699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 12/16/2024] [Accepted: 12/19/2024] [Indexed: 02/26/2025]
Abstract
Progressive hemorrhagic injury (PHI) is a frequent complication of traumatic brain injury (TBI). This study aims to investigate the impact of coagulation factors (platelet [PLT], prothrombin time [PT], activated partial thromboplastin time [aPTT], international normalized ratio 1, fibrinogen [Fg], D-dimer [Dd], and fibrin [Fib]) at admission and PHI development through a comprehensive systematic review and meta-analysis based on PRISMA 2020 guideline. Databases including PubMed, Scopus, Web of Science, and Embase were searched up to March 2024. Controlled observational studies examining the relationship between coagulation tests at admission and PHI in isolated TBI cases were included. Risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist, and statistical analyses were performed using Stata software, employing Hedge's g to measure effect sizes. Sixteen studies encompassing 2411 TBI patients were included. Significant associations were found between decreased PLT (g = -0.243, P = 0.007), increased aPTT (g = 0.117, P = 0.037), increased INR (g = 0.217, P = 0.0202), elevated Dd levels (g = 1.57, P = 0.0084), and decreased Fg levels (g = -0.26, P = 0.0001) with the risk of developing PHI. PT showed no significant effect on PHI risk (g = 0.19, P = 0.0372). Our results suggest that elevated INR, Dd levels, and aPTT are linked to an increased risk of PHI. Conversely, higher PLT and Fg levels appear to be associated with a reduced PHI risk. Notably, Dd demonstrated stronger predictive power for PHI.
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Affiliation(s)
- Ibrahim Mohammadzadeh
- Skull Base Research Center, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Behnaz Niroomand
- Skull Base Research Center, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Amin Tajerian
- School of Medicine, Arak University of Medical Sciences, Arak, Iran.
| | - Zahra Shahnazian
- Medical student research committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Nouri
- Medical student research committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ali Mortezaei
- Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran.
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Hajivalili M, Nikkhoo N, Salahi S, Hosseini M. Traumatic brain Injury: Comprehensive overview from pathophysiology to Mesenchymal stem Cell-Based therapies. Int Immunopharmacol 2025; 146:113816. [PMID: 39708488 DOI: 10.1016/j.intimp.2024.113816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 11/16/2024] [Accepted: 12/05/2024] [Indexed: 12/23/2024]
Abstract
Traumatic brain injury (TBI) is a disastrous phenomenon which is considered to cause high mortality and morbidity rate. Regarding the importance of TBI due to its prevalence and its effects on the brain and other organs, finding new therapeutic methods and improvement of conventional therapies seems to be vital. TBI involves a complex physiological mechanism, with inflammation being a key component among various contributing factors. After incidence of TBI, inflammation can act as a double-edged sword in the process. Inflammation actually plays its role both as initiator and progressive index during TBI which can accumulate myeloid and lymphoid immune cells and trigger cell death pathways. Through this study we made this concept bold that that besides conventional therapies that could be used for traumatic brain injury, treatments based on mesenchyme stem cells (MSCs) and their derivatives including secretomes and exosomes demonstrate more efficacies particularly in preventing secondary injuries caused by TBI. Of note, we highlighted the valuable features of MSC-based therapies such as self-direction toward inflamed tissues and amplifying neuro-regenerative aspects. We listed possible challenges in the way of reaching this therapy to clinic to provide a clear and updated of the field.
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Affiliation(s)
- Mahsa Hajivalili
- Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Nima Nikkhoo
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sarvenaz Salahi
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Maryam Hosseini
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Sethi P, Mehan S, Khan Z, Maurya PK, Kumar N, Kumar A, Tiwari A, Sharma T, Das Gupta G, Narula AS, Kalfin R. The SIRT-1/Nrf2/HO-1 axis: Guardians of neuronal health in neurological disorders. Behav Brain Res 2025; 476:115280. [PMID: 39368713 DOI: 10.1016/j.bbr.2024.115280] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 09/10/2024] [Accepted: 09/30/2024] [Indexed: 10/07/2024]
Abstract
SIRT1 (Sirtuin 1) is a NAD+-dependent deacetylase that functions through nucleoplasmic transfer and is present in nearly all mammalian tissues. SIRT1 is believed to deacetylate its protein substrates, resulting in neuroprotective actions, including reduced oxidative stress and inflammation, increased autophagy, increased nerve growth factors, and preserved neuronal integrity in aging or neurological disease. Nrf2 is a transcription factor that regulates the genes responsible for oxidative stress response and substance detoxification. The activation of Nrf2 guards cells against oxidative damage, inflammation, and carcinogenic stimuli. Several neurological abnormalities and inflammatory disorders have been associated with variations in Nrf2 activation caused by either pharmacological or genetic factors. Recent evidence indicates that Nrf2 is at the center of a complex cellular regulatory network, establishing it as a transcription factor with genuine pleiotropy. HO-1 is most likely a component of a defense mechanism in cells under stress, as it provides negative feedback for cell activation and mediator synthesis. This mediator is upregulated by Nrf2, nitric oxide (NO), and other factors in various inflammatory states. HO-1 or its metabolites, such as CO, may mitigate inflammation by modulating signal transduction pathways. Neurological diseases may be effectively treated by modulating the activity of HO-1. Multiple studies have demonstrated that SIRT1 and Nrf2 share an important connection. SIRT1 enhances Nrf2, activates HO-1, protects against oxidative injury, and decreases neuronal death. This has been associated with numerous neurodegenerative and neuropsychiatric disorders. Therefore, activating the SIRT1/Nrf2/HO-1 pathway may help treat various neurological disorders. This review focuses on the current understanding of the SIRT1 and Nrf2/HO-1 neuroprotective processes and the potential therapeutic applications of their target activators in neurodegenerative and neuropsychiatric disorders.
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Affiliation(s)
- Pranshul Sethi
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, Moga (Affiliated to IK Gujral Punjab Technical University, Jalandhar), Moga, Punjab 144603, India
| | - Sidharth Mehan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, Moga (Affiliated to IK Gujral Punjab Technical University, Jalandhar), Moga, Punjab 144603, India.
| | - Zuber Khan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, Moga (Affiliated to IK Gujral Punjab Technical University, Jalandhar), Moga, Punjab 144603, India
| | - Pankaj Kumar Maurya
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, Moga (Affiliated to IK Gujral Punjab Technical University, Jalandhar), Moga, Punjab 144603, India
| | - Nitish Kumar
- SRM Modinagar College of Pharmacy, SRM Institute of Science and Technology (Deemed to be University), Delhi-NCR Campus, Modinagar, Ghaziabad, Uttar Pradesh 201204, India
| | - Aakash Kumar
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, Moga (Affiliated to IK Gujral Punjab Technical University, Jalandhar), Moga, Punjab 144603, India
| | - Aarti Tiwari
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, Moga (Affiliated to IK Gujral Punjab Technical University, Jalandhar), Moga, Punjab 144603, India
| | - Tarun Sharma
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, Moga (Affiliated to IK Gujral Punjab Technical University, Jalandhar), Moga, Punjab 144603, India
| | - Ghanshyam Das Gupta
- Department of Pharmaceutics, ISF College of Pharmacy (Affiliated to IK Gujral Punjab Technical University, Jalandhar), Moga, Punjab 144603, India
| | - Acharan S Narula
- Narula Research, LLC, 107 Boulder Bluff, Chapel Hill, NC 27516, USA
| | - Reni Kalfin
- Institute of Neurobiology, Bulgarian Academy of Sciences, Acad. G. Bonchev St., Block 23, Sofia 1113, Bulgaria; Department of Healthcare, South-West University "NeofitRilski", Ivan Mihailov St. 66, Blagoevgrad 2700, Bulgaria
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Akrami H, Cui W, Kim PE, Heck CN, Irimia A, Jerbi K, Nair D, Leahy RM, Joshi AA. Prediction of Post Traumatic Epilepsy Using MR-Based Imaging Markers. Hum Brain Mapp 2024; 45:e70075. [PMID: 39560185 PMCID: PMC11574740 DOI: 10.1002/hbm.70075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 09/10/2024] [Accepted: 10/28/2024] [Indexed: 11/20/2024] Open
Abstract
Post-traumatic epilepsy (PTE) is a debilitating neurological disorder that develops after traumatic brain injury (TBI). Despite the high prevalence of PTE, current methods for predicting its occurrence remain limited. In this study, we aimed to identify imaging-based markers for the prediction of PTE using machine learning. Specifically, we examined three imaging features: Lesion volumes, resting-state fMRI-based measures of functional connectivity, and amplitude of low-frequency fluctuation (ALFF). We employed three machine-learning methods, namely, kernel support vector machine (KSVM), random forest, and an artificial neural network (NN), to develop predictive models. Our results showed that the KSVM classifier, with all three feature types as input, achieved the best prediction accuracy of 0.78 AUC (area under the receiver operating characteristic (ROC) curve) using nested cross-validation. Furthermore, we performed voxel-wise and lobe-wise group difference analyses to investigate the specific brain regions and features that the model found to be most helpful in distinguishing PTE from non-PTE populations. Our statistical analysis uncovered significant differences in bilateral temporal lobes and cerebellum between PTE and non-PTE groups. Overall, our findings demonstrate the complementary prognostic value of MR-based markers in PTE prediction and provide new insights into the underlying structural and functional alterations associated with PTE.
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Affiliation(s)
- Haleh Akrami
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Wenhui Cui
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Paul E Kim
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Christianne N Heck
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Andrei Irimia
- Department of Radiology, University of Southern California, Los Angeles, California, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Karim Jerbi
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
- Psychology Department, Université de Montréal, Montreal, Quebec, Canada
- Mila, Quebec AI Research Center, Montreal, Quebec, Canada
| | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Neurological Institute, Cleveland, Ohio, USA
| | - Richard M Leahy
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Anand A Joshi
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
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Bitar R, Khan UM, Rosenthal ES. Utility and rationale for continuous EEG monitoring: a primer for the general intensivist. Crit Care 2024; 28:244. [PMID: 39014421 PMCID: PMC11251356 DOI: 10.1186/s13054-024-04986-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/09/2024] [Indexed: 07/18/2024] Open
Abstract
This review offers a comprehensive guide for general intensivists on the utility of continuous EEG (cEEG) monitoring for critically ill patients. Beyond the primary role of EEG in detecting seizures, this review explores its utility in neuroprognostication, monitoring neurological deterioration, assessing treatment responses, and aiding rehabilitation in patients with encephalopathy, coma, or other consciousness disorders. Most seizures and status epilepticus (SE) events in the intensive care unit (ICU) setting are nonconvulsive or subtle, making cEEG essential for identifying these otherwise silent events. Imaging and invasive approaches can add to the diagnosis of seizures for specific populations, given that scalp electrodes may fail to identify seizures that may be detected by depth electrodes or electroradiologic findings. When cEEG identifies SE, the risk of secondary neuronal injury related to the time-intensity "burden" often prompts treatment with anti-seizure medications. Similarly, treatment may be administered for seizure-spectrum activity, such as periodic discharges or lateralized rhythmic delta slowing on the ictal-interictal continuum (IIC), even when frank seizures are not evident on the scalp. In this setting, cEEG is utilized empirically to monitor treatment response. Separately, cEEG has other versatile uses for neurotelemetry, including identifying the level of sedation or consciousness. Specific conditions such as sepsis, traumatic brain injury, subarachnoid hemorrhage, and cardiac arrest may each be associated with a unique application of cEEG; for example, predicting impending events of delayed cerebral ischemia, a feared complication in the first two weeks after subarachnoid hemorrhage. After brief training, non-neurophysiologists can learn to interpret quantitative EEG trends that summarize elements of EEG activity, enhancing clinical responsiveness in collaboration with clinical neurophysiologists. Intensivists and other healthcare professionals also play crucial roles in facilitating timely cEEG setup, preventing electrode-related skin injuries, and maintaining patient mobility during monitoring.
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Affiliation(s)
- Ribal Bitar
- Department of Neurology, Massachusetts General Hospital, 55 Fruit St., Lunder 644, Boston, MA, 02114, USA
| | - Usaamah M Khan
- Department of Neurology, Massachusetts General Hospital, 55 Fruit St., Lunder 644, Boston, MA, 02114, USA
| | - Eric S Rosenthal
- Department of Neurology, Massachusetts General Hospital, 55 Fruit St., Lunder 644, Boston, MA, 02114, USA.
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Razavi SM, Arab ZN, Niknejad A, Hosseini Y, Fouladi A, Khales SD, Shahali M, Momtaz S, Butler AE, Sukhorukov VN, Jamialahmadi T, Abdolghaffari AH, Sahebkar A. Therapeutic effects of anti-diabetic drugs on traumatic brain injury. Diabetes Metab Syndr 2024; 18:102949. [PMID: 38308863 DOI: 10.1016/j.dsx.2024.102949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/05/2024]
Abstract
AIMS In this narrative review, we have analyzed and synthesized current studies relating to the effects of anti-diabetic drugs on traumatic brain injury (TBI) complications. METHODS Eligible studies were collected from Scopus, Google Scholar, PubMed, and Cochrane Library for clinical, in-vivo, and in-vitro studies published on the impact of anti-diabetic drugs on TBI. RESULTS Traumatic brain injury (TBI) is a serious brain disease that is caused by any type of trauma. The pathophysiology of TBI is not yet fully understood, though physical injury and inflammatory events have been implicated in TBI progression. Several signaling pathways are known to play pivotal roles in TBI injuries, including Nuclear factor erythroid 2-related factor 2 (Nrf2), High mobility group box 1 protein/Nuclear factor kappa B (HMGB1/NF-κB), Adiponectin, Mammalian Target of Rapamycin (mTOR), Toll-Like Receptor (TLR), Wnt/β-catenin, Janus Kinase/Signal Transducers and Activators of Transcription (JAK/STAT), Nod-like receptor protein3 (NLRP3) inflammasome, Phosphoglycerate kinase 1/Kelch-like ECH-associated protein 1 (PGK1/KEAP1)/Nrf2, and Mitogen-activated protein kinase (MAPK) . Recent studies suggest that oral anti-diabetic drugs such as biguanides, thiazolidinediones (TZDs), sulfonylureas (SUs), sodium-glucose cotransporter-2 inhibitors (SGLT2is), dipeptidyl peptidase-4 inhibitors (DPPIs), meglitinides, and alpha-glucosidase inhibitors (AGIs) could have beneficial effects in the management of TBI complications. These drugs may downregulate the inflammatory pathways and induce antioxidant signaling pathways, thus alleviating complications of TBI. CONCLUSION Based on this comprehensive literature review, antidiabetic medications might be considered in the TBI treatment protocol. However, evidence from clinical trials in patients with TBI is still warranted.
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Affiliation(s)
- Seyed Mehrad Razavi
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Zahra Najafi Arab
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Amirhossein Niknejad
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Yasamin Hosseini
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Abtin Fouladi
- GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saba Darban Khales
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mostafa Shahali
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeideh Momtaz
- GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj, Iran; Department of Toxicology and Pharmacology, School of Pharmacy, and Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Alexandra E Butler
- Research Department, Royal College of Surgeons in Ireland Bahrain, Adliya, Bahrain
| | - Vasily N Sukhorukov
- Institute of General Pathology and Pathophysiology, Moscow, Russia; Institute of Experimental Cardiology Named after Academician V.N. Smirnov, Federal State Budgetary Institution National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Moscow, Russia
| | - Tannaz Jamialahmadi
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hossein Abdolghaffari
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Waithe OY, Shaji CA, Childs EW, Tharakan B. Determination of Blood-Brain Barrier Hyperpermeability Using Intravital Microscopy. Methods Mol Biol 2024; 2711:117-127. [PMID: 37776453 PMCID: PMC12045329 DOI: 10.1007/978-1-0716-3429-5_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
The blood vessels that vascularize the central nervous system (CNS) exhibit unique properties, termed the blood-brain barrier (BBB). The BBB allows these blood vessels to tightly regulate the movement of ions, molecules, and cells between the blood and the brain. The BBB is held together by tight junctions of the neighboring endothelial cells of the barrier, more specifically by tight junction proteins (TJPs) which can take the form of either integral transmembrane proteins or accessory cytoplasmic membrane proteins. BBB permeability can furthermore be affected by various factors, including but not limited to TJP expression, size, shape, charge, and type of extravascular molecules, as well as the nature of the vascular beds. The BBB is essential for the proper maintenance of CNS function, and its structural integrity has been implicated in several disorders and conditions. For instance, it has been shown that in the cases of traumatic brain injury (TBI), TBI-associated edema, and increased intracranial pressure are primarily caused by cases of hyperpermeability seen because of BBB dysfunction. Intravital microscopy is one of the most reliable methods for measuring BBB hyperpermeability in rodent models of BBB dysfunction in vivo. Here, we describe the surgical and imaging methods to determine the changes in BBB permeability at the level of the pial microvasculature in a mouse model of TBI using intravital microscopy.
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Affiliation(s)
- O'lisa Yaa Waithe
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Ed W Childs
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Binu Tharakan
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA.
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Waithe OY, Peng X, Childs EW, Tharakan B. Measurement of Blood-Brain Barrier Hyperpermeability Using Evans Blue Extravasation Assay. Methods Mol Biol 2024; 2711:177-184. [PMID: 37776457 DOI: 10.1007/978-1-0716-3429-5_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Blood-brain barrier (BBB) dysfunction and hyperpermeability have been implicated in a myriad of brain pathologies. The Evans Blue assay is one of the most popular methods for studying BBB integrity and permeability in rodent models of brain disorders. Under normal physiological conditions, the BBB is impermeable to albumin, so Evans Blue when injected intravenously binds to serum albumin and remains restricted within blood vessels. In traumatic and ischemic injuries, and other brain pathologies that result in BBB hyperpermeability, neighboring endothelial cells partially lose their close contacts to each other, and the BBB becomes permeable to proteins such as albumin. This paracellular leak of Evans blue-bound albumin is considered a reliable indicator of BBB dysfunction and hyperpermeability. Here, we describe the procedures for the evaluation of BBB integrity and hyperpermeability using Evans Blue extravasation assay in a mouse model of traumatic brain injury. The method described here focuses on intravenous injection of Evans Blue followed by Evans Blue dye extraction. This is followed by the measurement of fluorescence intensity of Evans Blue to determine the dye extravasation as a direct indicator of BBB hyperpermeability.
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Affiliation(s)
- O'lisa Yaa Waithe
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Xu Peng
- Department of Medical Physiology, Texas A&M University College of Medicine, Bryan, TX, USA
| | - Ed W Childs
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Binu Tharakan
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA.
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Freidin D, Har-Even M, Rubovitch V, Murray KE, Maggio N, Shavit-Stein E, Keidan L, Citron BA, Pick CG. Cognitive and Cellular Effects of Combined Organophosphate Toxicity and Mild Traumatic Brain Injury. Biomedicines 2023; 11:1481. [PMID: 37239152 PMCID: PMC10216664 DOI: 10.3390/biomedicines11051481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Traumatic brain injury (TBI) is considered the most common neurological disorder among people under the age of 50. In modern combat zones, a combination of TBI and organophosphates (OP) can cause both fatal and long-term effects on the brain. We utilized a mouse closed-head TBI model induced by a weight drop device, along with OP exposure to paraoxon. Spatial and visual memory as well as neuron loss and reactive astrocytosis were measured 30 days after exposure to mild TBI (mTBI) and/or paraoxon. Molecular and cellular changes were assessed in the temporal cortex and hippocampus. Cognitive and behavioral deficits were most pronounced in animals that received a combination of paraoxon exposure and mTBI, suggesting an additive effect of the insults. Neuron survival was reduced in proximity to the injury site after exposure to paraoxon with or without mTBI, whereas in the dentate gyrus hilus, cell survival was only reduced in mice exposed to paraoxon prior to sustaining a mTBI. Neuroinflammation was increased in the dentate gyrus in all groups exposed to mTBI and/or to paraoxon. Astrocyte morphology was significantly changed in mice exposed to paraoxon prior to sustaining an mTBI. These results provide further support for assumptions concerning the effects of OP exposure following the Gulf War. This study reveals additional insights into the potentially additive effects of OP exposure and mTBI, which may result in more severe brain damage on the modern battlefield.
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Affiliation(s)
- Dor Freidin
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (D.F.); (M.H.-E.)
| | - Meirav Har-Even
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (D.F.); (M.H.-E.)
| | - Vardit Rubovitch
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (D.F.); (M.H.-E.)
| | - Kathleen E. Murray
- Laboratory of Molecular Biology, VA New Jersey Health Care System, Research & Development, East Orange, NJ 07018, USA
- Rutgers School of Graduate Studies, Newark, NJ 07103, USA
| | - Nicola Maggio
- Department of Neurology, The Chaim Sheba Medical Center, Ramat Gan 52626202, Israel
- Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Efrat Shavit-Stein
- Department of Neurology, The Chaim Sheba Medical Center, Ramat Gan 52626202, Israel
- Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Lee Keidan
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (D.F.); (M.H.-E.)
| | - Bruce A. Citron
- Laboratory of Molecular Biology, VA New Jersey Health Care System, Research & Development, East Orange, NJ 07018, USA
- Rutgers School of Graduate Studies, Newark, NJ 07103, USA
- Department of Pharmacology, Physiology & Neuroscience, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Chaim G. Pick
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (D.F.); (M.H.-E.)
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- Sylvan Adams Sports Institute, Tel Aviv University, Tel Aviv 6997801, Israel
- The Dr. Miriam and Sheldon G. Adelson Chair and Center for the Biology of Addictive Diseases, Tel Aviv University, Tel Aviv 6997801, Israel
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11
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Wexler TL, Reifschneider K, Backeljauw P, Cárdenas JF, Hoffman AR, Miller BS, Yuen KCJ. Growth Hormone Deficiency following Traumatic Brain Injury in Pediatric and Adolescent Patients: Presentation, Treatment, and Challenges of Transitioning from Pediatric to Adult Services. J Neurotrauma 2023. [PMID: 36825511 DOI: 10.1089/neu.2022.0384] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Traumatic brain injury (TBI) is increasingly recognized, with an incidence of approximately 110 per 100,000 in pediatric populations and 618 per 100,000 in adolescent and adult populations. TBI often leads to cognitive, behavioral, and physical consequences, including endocrinopathies. Deficiencies in anterior pituitary hormones (e.g., adrenocorticotropic hormone, thyroid-stimulating hormone, gonadotropins, and growth hormone [GH]) can negatively impact health outcomes and quality of life post-TBI. This review focuses on GH deficiency (GHD), the most common post-TBI pituitary hormone deficiency. GHD is associated with abnormal body composition, lipid metabolism, bone mineral density, executive brain functions, behavior, and height outcomes in pediatric, adolescent, and transition-age patients. Despite its relatively frequent occurrence, post-TBI GHD has not been well studied in these patients; hence, diagnostic and treatment recommendations are limited. Here, we examine the occurrence and diagnosis of TBI, retrospectively analyze post-TBI hypopituitarism and GHD prevalence rates in pediatric and adolescent patients, and discuss appropriate GHD testing strategies and GH dosage recommendations for these patients. We place particular emphasis on the ways in which testing and dosage recommendations may change during the transition phase. We conclude with a review of the challenges faced by transition-age patients and how these may be addressed to improve access to adequate healthcare. Little information is currently available to help guide patients with TBI and GHD through the transition phase and there is a risk of interrupted care; therefore, a strength of this review is its emphasis on this critical period in a patient's healthcare journey.
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Affiliation(s)
- Tamara L Wexler
- Department of Rehabilitation Medicine, NYU Langone Health, New York, New York, USA
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kent Reifschneider
- Children's Hospital of The King's Daughters, Eastern Virginia Medical Center, Norfolk, Virginia, USA
| | - Philippe Backeljauw
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Javier F Cárdenas
- Barrow Concussion and Brain Injury Center, Barrow Neurological Institute, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona, USA
| | - Andrew R Hoffman
- Department of Medicine, Division of Endocrinology, Metabolism and Gerontology, Stanford University School of Medicine, Stanford, California, USA
| | - Bradley S Miller
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Minnesota Medical School, M Health Fairview Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Kevin C J Yuen
- Barrow Pituitary Center, Barrow Neurological Institute, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona, USA
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12
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Torimitsu S, Nishida Y, Takano T, Yajima D, Inokuchi G, Makino Y, Motomura A, Chiba F, Yamaguchi R, Hoshioka Y, Iwase H. Statistical analysis of the thickness and biomechanical properties of Japanese children's skulls. Forensic Sci Int 2023; 344:111580. [PMID: 36753838 DOI: 10.1016/j.forsciint.2023.111580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The structure and strength of a child's skull are important in accurately determining what and how external forces were applied when examining head injuries. The aims of this study were to measure skull thickness and strength in children, evaluate sex differences, and investigate the correlation between skull thickness and strength and age. MATERIALS AND METHODS Skulls were obtained from 42 Japanese dead bodies under 20 years of age. During the autopsies, bone samples were taken from each skull. The length, width, and central thickness of the skulls were measured using calipers. Three-point bending tests were conducted, and bending load and displacement were recorded. Bending stress and bending strain were calculated, and Young's modulus, 0.2% proof stress, and maximum stress were obtained. RESULTS In cases under 1.5 years old, 14 out of 46 male samples and 20 out of 40 female samples did not fracture during the three-point bending test, though no significant sex differences were detected. No significant differences in age, sample thickness, Young's modulus, 0.2% proof stress, or maximum stress were detected between the sexes. The sample thickness, Young's modulus, 0.2% proof stress, and maximum stress increased significantly and logarithmically with age (R2 = 0.761-0.899). Although age correlated with thickness, Young's modulus, and maximum stress more in females than in males, 0.2% proof stress correlated slightly better in males than in females. CONCLUSION The skulls of preschool children, in particular, are thin, have low strength, and are at high risk of fracturing even with relatively small external forces. Unlike adults, no significant sex differences in skull thickness or strength were observed in children.
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Affiliation(s)
- Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Yoshifumi Nishida
- Department of Mechanical Engineering, Tokyo Institute of Technology, 2-12-1, O-okayama, Meguro-ku, Tokyo 152-8552, Japan; Artificial Intelligence Research Center (AIRC), The National Institute of Advanced Industrial Science and Technology (AIST), 2-4-7, Aomi, Koto-ku, Tokyo 135-0064, Japan.
| | - Tachio Takano
- Artificial Intelligence Research Center (AIRC), The National Institute of Advanced Industrial Science and Technology (AIST), 2-4-7, Aomi, Koto-ku, Tokyo 135-0064, Japan.
| | - Daisuke Yajima
- Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba 286-8686, Japan.
| | - Go Inokuchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Ayumi Motomura
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba 286-8686, Japan.
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Yumi Hoshioka
- Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
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13
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Elser H, Gottesman RF, Walter AE, Coresh J, Diaz-Arrastia R, Mosley TH, Schneider ALC. Head Injury and Long-term Mortality Risk in Community-Dwelling Adults. JAMA Neurol 2023; 80:260-269. [PMID: 36689218 PMCID: PMC9871946 DOI: 10.1001/jamaneurol.2022.5024] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/18/2022] [Indexed: 01/24/2023]
Abstract
Importance Head injury is associated with significant short-term morbidity and mortality. Research regarding the implications of head injury for long-term survival in community-dwelling adults remains limited. Objective To evaluate the association of head injury with long-term all-cause mortality risk among community-dwelling adults, with consideration of head injury frequency and severity. Design, Setting, and Participants This cohort study included participants with and without head injury in the Atherosclerosis Risk in Communities (ARIC) study, an ongoing prospective cohort study with follow-up from 1987 through 2019 in 4 US communities in Minnesota, Maryland, North Carolina, and Mississippi. Of 15 792 ARIC participants initially enrolled, 1957 were ineligible due to self-reported head injury at baseline; 103 participants not of Black or White race and Black participants at the Minnesota and Maryland field centers were excluded due to race-site aliasing; and an additional 695 participants with missing head injury date or covariate data were excluded, resulting in 13 037 eligible participants. Exposures Head injury frequency and severity, as defined via self-report in response to interview questions and via hospital-based International Classification of Diseases diagnostic codes (with head injury severity defined in the subset of head injury cases identified using these codes). Head injury was analyzed as a time-varying exposure. Main Outcomes and Measures All-cause mortality was ascertained via linkage to the National Death Index. Data were analyzed between August 5, 2021, and October 23, 2022. Results More than one-half of participants were female (57.7%; 42.3% men), 27.9% were Black (72.1% White), and the median age at baseline was 54 years (IQR, 49-59 years). Median follow-up time was 27.0 years (IQR, 17.6-30.5 years). Head injuries occurred among 2402 participants (18.4%), most of which were classified as mild. The hazard ratio (HR) for all-cause mortality among individuals with head injury was 1.99 (95% CI, 1.88-2.11) compared with those with no head injury, with evidence of a dose-dependent association with head injury frequency (1 head injury: HR, 1.66 [95% CI, 1.56-1.77]; 2 or more head injuries: HR, 2.11 [95% CI, 1.89-2.37]) and severity (mild: HR, 2.16 [95% CI, 2.01-2.31]; moderate, severe, or penetrating: HR, 2.87 [95% CI, 2.55-3.22]). Estimates were similar by sex and race, with attenuated associations among individuals aged 54 years or older at baseline. Conclusions and Relevance In this community-based cohort with more than 3 decades of longitudinal follow-up, head injury was associated with decreased long-term survival time in a dose-dependent manner, underscoring the importance of measures aimed at prevention and clinical interventions to reduce morbidity and mortality due to head injury.
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Affiliation(s)
- Holly Elser
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
| | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| | - Alexa E. Walter
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ramon Diaz-Arrastia
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
| | - Thomas H. Mosley
- The MIND Center, University of Mississippi Medical Center, Jackson
| | - Andrea L. C. Schneider
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
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14
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Kothala LP, Jonnala P, Guntur SR. Localization of mixed intracranial hemorrhages by using a ghost convolution-based YOLO network. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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nikbakht A, kargar_soleimanabad S, Siahposht-Khachaki A, Farzin D. The effect of Riluzole on neurological outcomes, blood-brain barrier, brain water and neuroinflammation in traumatic brain injury. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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16
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Wu YH, Park TIH, Kwon E, Feng S, Schweder P, Dragunow M, Shim V, Rosset S. Analyzing pericytes under mild traumatic brain injury using 3D cultures and dielectric elastomer actuators. Front Neurosci 2022; 16:994251. [PMID: 36440264 PMCID: PMC9684674 DOI: 10.3389/fnins.2022.994251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/26/2022] [Indexed: 08/05/2024] Open
Abstract
Traumatic brain injury (TBI) is defined as brain damage due to an external force that negatively impacts brain function. Up to 90% of all TBI are considered in the mild severity range (mTBI) but there is still no therapeutic solution available. Therefore, further understanding of the mTBI pathology is required. To assist with this understanding, we developed a cell injury device (CID) based on a dielectric elastomer actuator (DEA), which is capable of modeling mTBI via injuring cultured cells with mechanical stretching. Our injury model is the first to use patient-derived brain pericyte cells, which are ubiquitous cells in the brain involved in injury response. Pericytes were cultured in our CIDs and mechanically strained up to 40%, and by at least 20%, prior to gene expression analysis. Our injury model is a platform capable of culturing and stretching primary human brain pericytes. The heterogeneous response in gene expression changes in our result may suggest that the genes implicated in pathological changes after mTBI could be a patient-dependent response, but requires further validation. The results of this study demonstrate that our CID is a suitable tool for simulating mTBI as an in vitro stretch injury model, that is sensitive enough to induce responses from primary human brain pericytes due to mechanical impacts.
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Affiliation(s)
- Yi-Han Wu
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
| | - Thomas I-H Park
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
- Department of Pharmacology, The Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Eryn Kwon
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Sheryl Feng
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
- Department of Pharmacology, The Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Mike Dragunow
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
- Department of Pharmacology, The Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Vickie Shim
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Samuel Rosset
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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17
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Faghihpirayesh R, Ruf S, Rocca ML, Garner R, Vespa P, Erdogmus D, Duncan D. Automatic Detection of EEG Epileptiform Abnormalities in Traumatic Brain Injury using Deep Learning. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:302-305. [PMID: 34891296 PMCID: PMC8860400 DOI: 10.1109/embc46164.2021.9630242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Traumatic brain injury (TBI) is a sudden injury that causes damage to the brain. TBI can have wide-ranging physical, psychological, and cognitive effects. TBI outcomes include acute injuries, such as contusion or hematoma, as well as chronic sequelae that emerge days to years later, including cognitive decline and seizures. Some TBI patients develop posttraumatic epilepsy (PTE), or recurrent and unprovoked seizures following TBI. In recent years, significant efforts have been made to identify biomarkers of epileptogenesis, the process by which a normal brain becomes capable of generating seizures. These biomarkers would allow for a higher standard of care by identifying patients at risk of developing PTE as candidates for antiepileptogenic interventions. In this paper, we use deep neural network architectures to automatically detect potential biomarkers of PTE from electroencephalogram (EEG) data collected between post-injury day 1-7 from patients with moderate-to-severe TBI. Continuous EEG is often part of multimodal monitoring for TBI patients in intensive care units. Clinicians review EEG to identify the presence of epileptiform abnormalities (EAs), such as seizures, periodic discharges, and abnormal rhythmic delta activity, which are potential biomarkers of epileptogenesis. We show that a recurrent neural network trained with continuous EEG data can be used to identify EAs with the highest accuracy of 80.78%, paving the way for robust, automated detection of epileptiform activity in TBI patients.
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18
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Wu YH, Rosset S, Lee TR, Dragunow M, Park T, Shim V. In Vitro Models of Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2021; 38:2336-2372. [PMID: 33563092 DOI: 10.1089/neu.2020.7402] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Traumatic brain injury (TBI) is a major public health challenge that is also the third leading cause of death worldwide. It is also the leading cause of long-term disability in children and young adults worldwide. Despite a large body of research using predominantly in vivo and in vitro rodent models of brain injury, there is no medication that can reduce brain damage or promote brain repair mainly due to our lack of understanding in the mechanisms and pathophysiology of the TBI. The aim of this review is to examine in vitro TBI studies conducted from 2008-2018 to better understand the TBI in vitro model available in the literature. Specifically, our focus was to perform a detailed analysis of the in vitro experimental protocols used and their subsequent biological findings. Our review showed that the uniaxial stretch is the most frequently used way of load application, accounting for more than two-thirds of the studies reviewed. The rate and magnitude of the loading were varied significantly from study to study but can generally be categorized into mild, moderate, and severe injuries. The in vitro studies reviewed here examined key processes in TBI pathophysiology such as membrane disruptions leading to ionic dysregulation, inflammation, and the subsequent damages to the microtubules and axons, as well as cell death. Overall, the studies examined in this review contributed to the betterment of our understanding of TBI as a disease process. Yet, our review also revealed the areas where more work needs to be done such as: 1) diversification of load application methods that will include complex loading that mimics in vivo head impacts; 2) more widespread use of human brain cells, especially patient-matched human cells in the experimental set-up; and 3) need for building a more high-throughput system to be able to discover effective therapeutic targets for TBI.
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Affiliation(s)
- Yi-Han Wu
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Center for Brain Research, The University of Auckland, Auckland, New Zealand
| | - Samuel Rosset
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Tae-Rin Lee
- Advanced Institute of Convergence Technology, Seoul National University, Seoul, Korea
| | - Mike Dragunow
- Center for Brain Research, The University of Auckland, Auckland, New Zealand
- Department of Pharmacology, The University of Auckland, Auckland, New Zealand
| | - Thomas Park
- Center for Brain Research, The University of Auckland, Auckland, New Zealand
- Department of Pharmacology, The University of Auckland, Auckland, New Zealand
| | - Vickie Shim
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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Arpalahti A, Haapanen A, Puolakkainen T, Abio A, Thorén H, Snäll J. Assault-related facial fractures: does the injury mechanism matter? Int J Oral Maxillofac Surg 2021; 51:91-97. [PMID: 34175177 DOI: 10.1016/j.ijom.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 12/30/2022]
Abstract
This study clarified the injury characteristics and occurrence of associated injuries in patients with assault-related facial fractures. Data from 840 assault-related facial fracture patients were included; demographic factors, facial fracture type, associated injuries, alcohol use, and injury mechanisms were recorded. Assault mechanisms most often included combinations of different mechanisms (57.5%) and resulted in the victim falling (50.1%). The perpetrator was most commonly a stranger (52.5%) and acted alone (57.7%). A total of 123 patients (14.6%) had associated injuries, with the most common being traumatic brain injury. Associated injuries occurred most frequently in patients with combined fractures of the facial thirds (24.2%) and upper third fractures (42.9%). The most significant differentiating factors for associated injuries were the number of perpetrators, falling, the use of an offensive weapon, and if the events of the assault remained unknown. In adjusted logistic regression analyses, statistically significant associations with associated injuries were found for age (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03-1.07; P < 0.001), falling due to the assault (OR 2.87, 95% CI 1.49-5.50; P = 0.002), and upper third facial fractures (OR 6.93, 95% CI 2.06-23.33; P = 0.002). A single punch also caused severe injuries and should therefore not be overlooked, as this can be as dangerous as other assault mechanisms.
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Affiliation(s)
- A Arpalahti
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - A Haapanen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - T Puolakkainen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Abio
- Injury Epidemiology and Prevention Research Group, Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland; Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Germany
| | - H Thorén
- Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Turku, Turku, Finland; Department of Oral and Maxillofacial Diseases, Turku University Hospital, Turku, Finland
| | - J Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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20
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Dahroug AH, Zaytoun TM, Anwar Hussien MS. EFFECT OF PROGESTRONE IN PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY. ALEXANDRIA JOURNAL OF MEDICINE 2021. [DOI: 10.1080/20905068.2021.1880041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Amr Hassan Dahroug
- Department of Critical Care, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Tayseer Mohamed Zaytoun
- Department of Critical Care, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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21
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Ambika S, Atiya A, Ravi A, Mani R, Bhattacharya B, Praveen S, Hussaindeen JR. Visual profile of acquired brain injury in Indian cohort: a retrospective study. Brain Inj 2020; 34:1168-1174. [PMID: 32687723 DOI: 10.1080/02699052.2020.1792985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE With the increasing global prevalence of acquired brain injury (ABI), the burden of visual problems as a sequelae to ABI is on the rise. This study reports the visual profile of patients with ABI seen in Neuro-Optometry Clinic (NOC) at a tertiary eye-care center in Southern India. METHODS A retrospective study was carried out between January 2014 and December 2015. Medical records of patients diagnosed with ABI referred by Neuro-Ophthalmologists to the NOC were reviewed. The detailed history, clinical findings of neuro assessment and management details were recorded. RESULTS Of the 241 patients with ABI, 208 had Traumatic Brain Injury (TBI) and 33 had Cerebro-Vascular Accident (CVA). The mean (SD) age of patients with TBI was 35 ± 14 years and CVA was 52 ± 16 years. Binocular diplopia (61%) was seen predominantly in TBI due to vertical deviation (31%). Cranial nerve palsy was most common in TBI (55%) than CVA (36%) and visual field defects were most frequently seen in CVA (27%). CONCLUSION Cranial nerve paresis and restrictive strabismus with diplopia were the most common presentations in TBI and visual field defects in CVA. A neuro-optometric evaluation is recommended to identify visual dysfunctions and provide appropriate management options. ABBREVIATIONS ABI: Acquired Brain Injury; TBI: Traumatic Brain Injury; CVA: Cerebrovascular Accident; NOC: Neuro-Optometry Clinic; NSBVA: Non-Strabismic binocular vision anomalies; OMD: Oculomotor dysfunction; VFD: Visual field defect; GON: Glaucomatous optic neuropathy.
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Affiliation(s)
- S Ambika
- Neuro -Ophthalmology Department, Sankara Nethralaya, Unit of Medical Research Foundation , Chennai, India
| | - Ayisha Atiya
- Neuro -Optometry Clinic, Sankara Nethralaya, Unit of Medical Research Foundation , Chennai, India
| | - Aishwarya Ravi
- Neuro -Optometry Clinic, Sankara Nethralaya, Unit of Medical Research Foundation , Chennai, India.,Srimathi Sundari Subramanian Department of Visual Pyschophysics, Unit of Medical Research Foundation , Chennai, India
| | - Revathy Mani
- Neuro -Optometry Clinic, Sankara Nethralaya, Unit of Medical Research Foundation , Chennai, India
| | - Bidisha Bhattacharya
- Neuro -Optometry Clinic, Sankara Nethralaya, Unit of Medical Research Foundation , Chennai, India
| | - Smita Praveen
- Neuro -Ophthalmology Department, Sankara Nethralaya, Unit of Medical Research Foundation , Chennai, India
| | - Jameel Rizwana Hussaindeen
- Neuro -Optometry Clinic, Sankara Nethralaya, Unit of Medical Research Foundation , Chennai, India.,Srimathi Sundari Subramanian Department of Visual Pyschophysics, Unit of Medical Research Foundation , Chennai, India
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Scimone MT, Cramer HC, Hopkins P, Estrada JB, Franck C. Application of mild hypothermia successfully mitigates neural injury in a 3D in-vitro model of traumatic brain injury. PLoS One 2020; 15:e0229520. [PMID: 32236105 PMCID: PMC7112206 DOI: 10.1371/journal.pone.0229520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/07/2020] [Indexed: 12/12/2022] Open
Abstract
Therapeutic hypothermia (TH) is an attractive target for mild traumatic brain injury (mTBI) treatment, yet significant gaps in our mechanistic understanding of TH, especially at the cellular level, remain and need to be addressed for significant forward progress to be made. Using a recently-established 3D in-vitro neural hydrogel model for mTBI we investigated the efficacy of TH after compressive impact injury and established critical treatment parameters including target cooling temperature, and time windows for application and maintenance of TH. Across four temperatures evaluated (31.5, 33, 35, and 37°C), 33°C was found to be most neuroprotective after 24 and 48 hours post-injury. Assessment of TH administration onset time and duration showed that TH should be administered within 4 hours post-injury and be maintained for at least 6 hours for achieving maximum viability. Cellular imaging showed TH reduced the percentage of cells positive for caspases 3/7 and increased the expression of calpastatin, an endogenous neuroprotectant. These findings provide significant new insight into the biological parameter space that renders TH effective in mitigating the deleterious effects of cellular mTBI and provides a quantitative foundation for the future development of animal and preclinical treatment protocols.
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Affiliation(s)
- Mark T. Scimone
- School of Engineering, Brown University, Providence, RI, United States of America
- Center for Biomedical Engineering, Brown University, Providence, RI, United States of America
| | - Harry C. Cramer
- School of Engineering, Brown University, Providence, RI, United States of America
- Center for Biomedical Engineering, Brown University, Providence, RI, United States of America
| | - Paul Hopkins
- School of Engineering, Brown University, Providence, RI, United States of America
- Center for Biomedical Engineering, Brown University, Providence, RI, United States of America
| | - Jonathan B. Estrada
- Department of Mechanical Engineering, University of Michigan—Ann Arbor, Ann Arbor, MI, United States of America
| | - Christian Franck
- Mechanical Engineering, University of Wisconsin–Madison, Madison, WI, United States of America
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Rasheed W, Tang TB. Anomaly Detection of Moderate Traumatic Brain Injury Using Auto-Regularized Multi-Instance One-Class SVM. IEEE Trans Neural Syst Rehabil Eng 2020; 28:83-93. [DOI: 10.1109/tnsre.2019.2948798] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Lenski M, Biczok A, Neufischer K, Tonn JC, Briegel J, Thon N. Significance of cerebrospinal fluid inflammatory markers for diagnosing external ventricular drain–associated ventriculitis in patients with severe traumatic brain injury. Neurosurg Focus 2019; 47:E15. [DOI: 10.3171/2019.8.focus19407] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/23/2019] [Indexed: 11/06/2022]
Abstract
ObjectiveThe aim of this study was to investigate the diagnostic potential of the inflammatory markers interleukin-6 (IL-6), total leukocyte count (TLC), and protein in the CSF and IL-6, C-reactive protein, and white blood cell count in the serum for the early diagnosis of ventriculitis in patients with traumatic brain injury (TBI) and an external ventricular drain compared with patients without ventriculitis.MethodsRetrospective data from 40 consecutive patients with TBI and an external ventricular drain treated in the authors’ intensive care unit between 2013 and 2017 were analyzed. For all markers, arithmetical means and standard deviations, area under the curve (AUC), cutoff values, sensitivity, specificity, positive likelihood ratio (LR), and negative LR were calculated and correlated with presence or absence of ventriculitis.ResultsThere were 35 patients without ventriculitis and 5 patients with ventriculitis. The mean ± SD IL-6 concentration in CSF was significantly increased, with 6519 ± 4268 pg/mL at onset of ventriculitis compared with 1065 ± 1705 pg/mL in patients without ventriculitis (p = 0.04). Regarding inflammatory markers in CSF, IL-6 showed the highest diagnostic potential for differentiation between the presence and absence of ventriculitis (AUC 0.938, cutoff 4064 pg/mL, sensitivity 100%, specificity 92.3%, positive LR 13, and negative LR 0), followed by TLC (AUC 0.900, cutoff 64.5 /µL, sensitivity 100%, specificity 80%, positive LR 5.0, and negative LR 0) and protein (AUC 0.876, cutoff 31.5 mg/dL, sensitivity 100%, specificity 62.5%, positive LR 2.7, and negative LR 0).ConclusionsThe level of IL-6 in CSF has the highest diagnostic value of all investigated inflammatory markers for detecting ventriculitis in TBI patients at an early stage. In particular, CSF IL-6 levels higher than the threshold of 4064 pg/mL were significantly associated with the probability of ventriculitis.
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Affiliation(s)
| | | | | | | | - Josef Briegel
- 2Anästhesiologische Klinik, Klinikum Großhadern, Ludwig Maximilian Universität München, Munich, Germany
| | - Niklas Thon
- 1Neurochirurgische Klinik und Poliklinik, and
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25
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Mader MM, Leidorf A, Hecker A, Heimann A, Mayr PSM, Kempski O, Alessandri B, Wöbker G. Evaluation of a New Multiparameter Brain Probe for Simultaneous Measurement of Brain Tissue Oxygenation, Cerebral Blood Flow, Intracranial Pressure, and Brain Temperature in a Porcine Model. Neurocrit Care 2019; 29:291-301. [PMID: 29949006 PMCID: PMC6208836 DOI: 10.1007/s12028-018-0541-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND A novel multiparameter brain sensor (MPBS) allows the simultaneous measurement of brain tissue oxygenation (ptiO2), cerebral blood flow (CBF), intracranial pressure (ICP), and brain temperature with a single catheter. This laboratory investigation evaluates the MPBS in an animal model in relation to established reference probes. METHODS The study group consisted of 17 juvenile male pigs. Four MPBS and four reference probes were implanted per pig and compared simultaneously. The measured parameters were challenged by standardized provocations such as hyperoxia, dobutamine, and norepinephrine application, hypercapnia and hypoxia in combination with and without a controlled cortical impact (CCI) injury. Mean values over 2 min were collected for predefined time points and were analyzed using Bland-Altman plots. RESULTS The protocol was successfully conducted in 15 pigs of which seven received CCI. ICP and ptiO2 were significantly influenced by the provocations. Subtraction of MPBS from reference values revealed a mean difference (limits of agreement) of 3.7 (- 20.5 to 27.9) mm Hg, - 2.9 (- 7.9 to 2.1) mm Hg, and 5.1 (- 134.7 to 145.0) % for ptiO2, ICP, and relative CBF, respectively. CONCLUSIONS The MPBS is a promising measurement tool for multiparameter neuromonitoring. The conducted study demonstrates the in vivo functionality of the probe. Comparison with standard probes revealed a deviation which is mostly analogous to other multiparameter devices. However, further evaluation of the device is necessary before it can reliably be used for clinical decision making.
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Affiliation(s)
- Marius M Mader
- Institute for Neurosurgical Pathophysiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany.,Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Leidorf
- Institute for Neurosurgical Pathophysiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Andreas Hecker
- Institute for Neurosurgical Pathophysiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Axel Heimann
- Institute for Neurosurgical Pathophysiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Petra S M Mayr
- Institute for Neurosurgical Pathophysiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Oliver Kempski
- Institute for Neurosurgical Pathophysiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Beat Alessandri
- Institute for Neurosurgical Pathophysiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Gabriele Wöbker
- HELIOS Universitätsklinikum Wuppertal, University Witten/Herdecke, 42283 , Wuppertal, Germany
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26
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Abstract
Concussion, also referred to as mild traumatic brain injury (MTBI), is a common pediatric condition. This article reviews global perspectives on the epidemiology, treatment, and prognosis of concussion in children. A Pubmed search was conducted using Clinical Queries with the key terms "concussion" and "mild traumatic brain injury," and the search was limited to "children." The search strategy included meta-analyses, randomized controlled trials, clinical trials, and reviews. The majority of publications were from Canada and the United States. Prevalence estimates vary widely according to case definition and studied population. Due to under-reporting and to the widely varying definitions of concussion, it is difficult to estimate how common the condition is. Common causes of concussions include sports injuries, motor vehicle collisions, bicycle accidents, falls, and assaults. Diagnosis is mainly clinical. Because concussion results from a disturbance in brain function rather than structural injury, neuroimaging studies, such as computed tomography and magnetic resonance imaging, are not routinely recommended. Treatment generally involves physical and cognitive rest, with a gradual return to activities, whereas prolonged rest may actually worsen outcomes. Helmets when bicycling, skiing, snowboarding, motor biking, placing age limits on certain types of contact sports, and encouragement of fair play are recommended to decrease the impact of head injuries but they do not prevent concussions. Overall outcomes are generally favorable. The symptoms and signs of concussion usually resolve within 10 days; most patients recover in 48-72 hours. Global perspectives on management and prognosis are lacking. Concussions or MTBIs are common childhood injuries and the prognosis is good but information is predominantly from Canada and the USA. Research in other countries in particular low and middle income countries is vital to have a global perspective on MTBI.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong; PICU, The Hong Kong Children's Hospital, Hong Kong.
| | - Alexander K C Leung
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Alcy R Torres
- Department of Pediatrics, Division of Child Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA
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27
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Klimova B, Maresova P, Kuca K. Combat Military Personnel and Selective Risk Factors for the Development of Dementias - A Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/1573400515666190114155451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
:
Due to the growth of life expectancies and the increasing number of elderly population all
over the world, there is a risk of growth of aging diseases such as dementia. Recent research studies
also indicate that there will be a growing number of military veterans who will be affected by dementia,
already at the age of 55+ years. In the case of combat military personnel, the most common
dementias are Alzheimer’s disease and vascular dementia. These two dementias are very similar
because their main symptoms are the same. The purpose of this review is to explore two main risk
factors influencing the development of the dementias. These include posttraumatic stress disorder
(PTSD) and traumatic brain injury (TBI). Furthermore, the authors of this study focus on the exploration
of the treatment of PTSD and TBI in order to delay the development of dementias among
combat military personnel.
:
For the purpose of this study, a method of literature review of available sources exploring these two
main risk factors of dementia among combat military personnel was used. Based on the evaluation
of these literature sources, possibilities of pharmacological and non-pharmacological approaches to
the treatment and care of these people were described.
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Affiliation(s)
- Blanka Klimova
- Department of Neurology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Petra Maresova
- Faculty of Informatics and Management, University of Hradec Kralove, Rokitanského 62, 50003, Hradec Kralove, Czech Republic
| | - Kamil Kuca
- Philosophical Faculty, University of Hradec Kralove, Rokitanského 62, 50003, Hradec Kralove, Czech Republic
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28
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Yang LH, Wang WF, Zhang SH, Fan ZX, Xiao JQ. Neuromuscular electrical stimulation on hearing loss caused by skull base fracture: A protocol for systematic review of randomized controlled trial. Medicine (Baltimore) 2019; 98:e14650. [PMID: 30813207 PMCID: PMC6408040 DOI: 10.1097/md.0000000000014650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/01/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This systematic review aims to investigate the effectiveness and safety of neuromuscular electrical stimulation (NMES) on hearing loss (HL) caused by skull base fracture (SBF). METHODS We will retrieve the following electronic databases of Cochrane Library, PUBMED, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database from the inception to January 1, 2019 for relevant RCTs of NMES for HL caused by SBF. Two experienced authors will independently perform the study selection, data extraction, and methodology quality assessment. A 3rd author will solve any disagreements between 2 authors through discussion. RESULTS This study will provide a high-quality synthesis of latest evidence of NMES for HL caused by SBF from comprehensive assessments, including hearing loss evaluation, hearing threshold, quality of life, and any relevant adverse events. CONCLUSION The expected results of this systematic review will provide the up-to-date evidence to assess the effectiveness and safety of NEMS for patients with HL caused by SBF. ETHICS AND DISSEMINATION The results of this study will be disseminated through publication in a peer-reviewed journal or will be presented at an associated conference meeting. This study will not use individual patient data, thus, the ethical approval is not needed. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019120195.
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Affiliation(s)
| | - Wei-feng Wang
- Department of Neurosurgery, First Affiliated Hospital of Jiamusi University
| | - Shu-hong Zhang
- Department of Biology, Basic Medicine School of Jiamusi University, Jiamusi
| | | | - Jian-qi Xiao
- Department of Neurosurgery, The First Hospital of Qiqihar City, Qiqihar, China
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29
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Lee SA, Kim MK. Effect of Low Frequency Repetitive Transcranial Magnetic Stimulation on Depression and Cognition of Patients with Traumatic Brain Injury: A Randomized Controlled Trial. Med Sci Monit 2018; 24:8789-8794. [PMID: 30513530 PMCID: PMC6289027 DOI: 10.12659/msm.911385] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study was conducted to investigate the effects of low frequency repetitive transcranial magnetic stimulation (rTMS) of the right dorsolateral prefrontal cortex on depression and cognition in patients with traumatic brain injury. MATERIAL AND METHODS To accomplish this, 13 patients who were diagnosed with traumatic brain injury were divided into an experimental group (n=7) and a control group (n=6). The experimental group received rTMS during a 30-minute session 5 days per week for 2 weeks; the control group received sham rTMS. The patients were then evaluated for depression using the Montgomery-Asberg Depression Rating Scale (MADRS) and for cognitive function using the Trail Making Test (TMT) and the Stroop Color Word Test (SCWT). RESULTS A significant decrease in MADRS, TMT, and SCWT was observed after the intervention in the experimental group (P<0.01), and there was a significant difference in the change value of MADRS, TMT, and SCWT compared to the control group (P<0.01). Moreover, the effect size for gains in the experimental group and control group was very strong for MADRS, TMT, and SCWT (effect size=1.44, 1.49, and 1.24 respectively). CONCLUSIONS The results of this study suggest that application of low frequency rTMS to the right dorsolateral prefrontal cortex of patients with traumatic brain injury has a positive effect on depression and cognition.
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Affiliation(s)
- Si A Lee
- Department of Physical Therapy, Graduate School, Daegu University, Jillyang, Gyeongsan, Gyeongbuk, South Korea
| | - Myoung-Kwon Kim
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Jillyang, Gyeongsan, Gyeongbuk, South Korea
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30
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Amoo M, O'Halloran PJ, Leo AM, O'Loughlin A, Mahon P, Lim C. Outcomes of emergency neurosurgical intervention in neuro-critical care patients with traumatic brain injury at Cork University Hospital. Br J Neurosurg 2018; 32:585-589. [PMID: 30394116 DOI: 10.1080/02688697.2018.1522416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Traumatic Brain Injury (TBI) is a major cause of death and disability; the leading cause of mortality and morbidity in previously healthy people aged under 40 in the United Kingdom (UK). There are currently little official Irish statistics regarding TBI or outcome measures following TBI, although it is estimated that over 2000 people per year sustain TBI in Ireland. We performed a retrospective cohort study of TBI patients who were managed in the intensive care unit (ICU) at CUH between July 2012 and December 2015. Demographic data were compiled by patients' charts reviews. Using the validated Glasgow outcome scale extended (GOS-E) outcome measure tool, we interviewed patients and/or their carers to measure functional outcomes. Descriptive statistical analyses were performed. Spearman's correlation analysis was used to assess association between different variables using IBM's Statistical Package for the Social Sciences (SPSS) 20. In the 42-month period, 102 patients were identified, mainly males (81%). 49% had severe TBI and 56% were referred from other hospitals. The mean age was 44.7 and a most of the patients were previously healthy, with 65% of patients having ASA I or II. Falls accounted for the majority of the TBI, especially amongst those aged over 50. The 30-day mortality was 25.5% and the mean length of hospital stay (LOS-H) was 33 days. 9.8% of the study population had a good recovery (GOS-E 8), while 7.8% had a GOS-E score of 3 (lower sever disability). Patients with Extra-Dural haemorrhage had better outcomes compared with those with SDH or multi-compartmental haemorrhages (p = 0.007). Older patients had a higher mortality, with the highest mortality (37.5%) among those over 50 years old (p = 0.009). TBI is associated with significant morbidity and mortality. Despite the young mean age and low ASA the mortality, morbidity and average LOS-H were significant, highlighting the health and socioeconomic burden of TBI.
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Affiliation(s)
- Michael Amoo
- a Department of Neurological Surgery , Cork University Hospital , Cork , Ireland
| | - Philip J O'Halloran
- a Department of Neurological Surgery , Cork University Hospital , Cork , Ireland
| | - Anne-Marie Leo
- b Department of Anaesthesia , Cork University Hospital , Cork Ireland
| | - Aoife O'Loughlin
- b Department of Anaesthesia , Cork University Hospital , Cork Ireland
| | - Padraig Mahon
- b Department of Anaesthesia , Cork University Hospital , Cork Ireland
| | - Chris Lim
- a Department of Neurological Surgery , Cork University Hospital , Cork , Ireland
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31
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Kuharić J, Grabušić K, Tokmadžić VS, Štifter S, Tulić K, Shevchuk O, Lučin P, Šustić A. Severe Traumatic Brain Injury Induces Early Changes in the Physical Properties and Protein Composition of Intracranial Extracellular Vesicles. J Neurotrauma 2018; 36:190-200. [PMID: 29690821 DOI: 10.1089/neu.2017.5515] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Extracellular vesicles (EVs) are membranous nanostructures that can indicate undergoing processes in organs and thus help in diagnostics and prognostics. They are secreted by all cells, contained in body fluids, and able to transfer proteins, lipids and nucleic acids to distant cells. Intracranial EVs were shown to change their composition after severe traumatic brain injury (TBI) and therefore to have biomarker potential to evaluate brain events. Properties of intracranial EVs early after TBI, however, have not been characterized. Here, we assessed cerebrospinal fluid (CSF) up to seven days after isolated severe TBI for physical properties of EVs and their proteins associated with neuroregeneration. These findings were compared with healthy controls and correlated to patient outcome. The study included 17 patients with TBI and 18 healthy controls. EVs in TBI-CSF were visualized by electron microscopy and confirmed by immunoblotting for membrane associated Flotillin-1 and Flotillin-2. Using nanoparticle tracking analysis, we detected the highest range in EV concentration at day 1 after injury and significantly increased EV size at days 4-7. CSF concentrations of neuroregeneration associated proteins Flotillin-1, ADP-ribosylation Factor 6 (Arf6), and Ras-related protein Rab7a (Rab7a) were monitored by enzyme-linked immunosorbent assays. Flotillin-1 was detected solely in TBI-CSF in about one third of tested patients. Unfavorable outcomes included decreasing Arf6 concentrations and a delayed Rab7a concentration increase in CSF. CSF concentrations of Arf6 and Rab7a were negatively correlated. Our data suggest that the brain response within several days after severe TBI includes shedding of EVs associated with neuroplasticity. Extended studies with a larger number of participants and CSF collected at shorter intervals are necessary to further evaluate neuroregeneration biomarker potential of Rab7a, Arf6, and Flotillin-1.
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Affiliation(s)
- Janja Kuharić
- 1 Department of Anaesthesia, Resuscitation and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,2 Department of Anaesthesia and Intensive Care Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Kristina Grabušić
- 3 Department of Biotechnology, University of Rijeka, Rijeka, Croatia
| | - Vlatka Sotošek Tokmadžić
- 1 Department of Anaesthesia, Resuscitation and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,2 Department of Anaesthesia and Intensive Care Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia.,4 Department of Clinical Medical Sciences II, Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
| | - Sanja Štifter
- 5 Department of General Pathology and Pathological Anatomy, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,6 Department of Pathology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Ksenija Tulić
- 7 Department of Physiology and Immunology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Olga Shevchuk
- 8 Leibniz Institut für Analytische Wissenschaften, ISAS Campus, Dortmund, Germany
| | - Pero Lučin
- 7 Department of Physiology and Immunology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Alan Šustić
- 1 Department of Anaesthesia, Resuscitation and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,2 Department of Anaesthesia and Intensive Care Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia.,4 Department of Clinical Medical Sciences II, Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
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32
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Vascak M, Jin X, Jacobs KM, Povlishock JT. Mild Traumatic Brain Injury Induces Structural and Functional Disconnection of Local Neocortical Inhibitory Networks via Parvalbumin Interneuron Diffuse Axonal Injury. Cereb Cortex 2018; 28:1625-1644. [PMID: 28334184 PMCID: PMC5907353 DOI: 10.1093/cercor/bhx058] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/20/2017] [Indexed: 12/18/2022] Open
Abstract
Diffuse axonal injury (DAI) plays a major role in cortical network dysfunction posited to cause excitatory/inhibitory imbalance after mild traumatic brain injury (mTBI). Current thought holds that white matter (WM) is uniquely vulnerable to DAI. However, clinically diagnosed mTBI is not always associated with WM DAI. This suggests an undetected neocortical pathophysiology, implicating GABAergic interneurons. To evaluate this possibility, we used mild central fluid percussion injury to generate DAI in mice with Cre-driven tdTomato labeling of parvalbumin (PV) interneurons. We followed tdTomato+ profiles using confocal and electron microscopy, together with patch-clamp analysis to probe for DAI-mediated neocortical GABAergic interneuron disruption. Within 3 h post-mTBI tdTomato+ perisomatic axonal injury (PSAI) was found across somatosensory layers 2-6. The DAI marker amyloid precursor protein colocalized with GAD67 immunoreactivity within tdTomato+ PSAI, representing the majority of GABAergic interneuron DAI. At 24 h post-mTBI, we used phospho-c-Jun, a surrogate DAI marker, for retrograde assessments of sustaining somas. Via this approach, we estimated DAI occurs in ~9% of total tdTomato+ interneurons, representing ~14% of pan-neuronal DAI. Patch-clamp recordings of tdTomato+ interneurons revealed decreased inhibitory transmission. Overall, these data show that PV interneuron DAI is a consistent and significant feature of experimental mTBI with important implications for cortical network dysfunction.
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Affiliation(s)
- Michal Vascak
- Department of Anatomy and Neurobiology, Virginia Commonwealth University Medical Center, PO Box 980709, Richmond, VA 23298-0709, USA
| | - Xiaotao Jin
- Department of Anatomy and Neurobiology, Virginia Commonwealth University Medical Center, PO Box 980709, Richmond, VA 23298-0709, USA
| | - Kimberle M Jacobs
- Department of Anatomy and Neurobiology, Virginia Commonwealth University Medical Center, PO Box 980709, Richmond, VA 23298-0709, USA
| | - John T Povlishock
- Department of Anatomy and Neurobiology, Virginia Commonwealth University Medical Center, PO Box 980709, Richmond, VA 23298-0709, USA
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33
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Armstrong RA. Visual problems associated with traumatic brain injury. Clin Exp Optom 2018; 101:716-726. [PMID: 29488253 DOI: 10.1111/cxo.12670] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) and its associated concussion are major causes of disability and death. All ages can be affected but children, young adults and the elderly are particularly susceptible. A decline in mortality has resulted in many more individuals living with a disability caused by TBI including those affecting vision. This review describes: (1) the major clinical and pathological features of TBI; (2) the visual signs and symptoms associated with the disorder; and (3) discusses the assessment of quality of life and visual rehabilitation of the patient. Defects in primary vision such as visual acuity and visual fields, eye movement including vergence, saccadic and smooth pursuit movements, and in more complex aspects of vision involving visual perception, motion vision ('akinopsia'), and visuo-spatial function have all been reported in TBI. Eye movement dysfunction may be an early sign of TBI. Hence, TBI can result in a variety of visual problems, many patients exhibiting multiple visual defects in combination with a decline in overall health. Patients with chronic dysfunction following TBI may require occupational, vestibular, cognitive and other forms of physical therapy. Such patients may also benefit from visual rehabilitation, including reading-related oculomotor training and the prescribing of spectacles with a variety of tints and prism combinations.
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34
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Ludwig PE, Thankam FG, Patil AA, Chamczuk AJ, Agrawal DK. Brain injury and neural stem cells. Neural Regen Res 2018; 13:7-18. [PMID: 29451199 PMCID: PMC5840995 DOI: 10.4103/1673-5374.224361] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 12/26/2022] Open
Abstract
Many therapies with potential for treatment of brain injury have been investigated. Few types of cells have spurred as much interest and excitement as stem cells over the past few decades. The multipotentiality and self-renewing characteristics of stem cells confer upon them the capability to regenerate lost tissue in ischemic or degenerative conditions as well as trauma. While stem cells have not yet proven to be clinically effective in many such conditions as was once hoped, they have demonstrated some effects that could be manipulated for clinical benefit. The various types of stem cells have similar characteristics, and largely differ in terms of origin; those that have differentiated to some extent may exhibit limited capability in differentiation potential. Stem cells can aid in decreasing lesion size and improving function following brain injury.
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Affiliation(s)
- Parker E. Ludwig
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE, USA
| | - Finosh G. Thankam
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE, USA
| | - Arun A. Patil
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE, USA
- Department of Neurosurgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Andrea J. Chamczuk
- Department of Neurosurgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Devendra K. Agrawal
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE, USA
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Alluri H, Shaji CA, Davis ML, Tharakan B. A Mouse Controlled Cortical Impact Model of Traumatic Brain Injury for Studying Blood-Brain Barrier Dysfunctions. Methods Mol Biol 2018; 1717:37-52. [PMID: 29468582 DOI: 10.1007/978-1-4939-7526-6_4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. It is a silently growing epidemic with multifaceted pathogenesis, and current standards of treatments aim to target only the symptoms of the primary injury, while there is a tremendous need to explore interventions that can halt the progression of the secondary injuries. The use of a reliable animal model to study and understand the various aspects the pathobiology of TBI is extremely important in therapeutic drug development against TBI-associated complications. The controlled cortical impact (CCI) model of TBI described here, uses a mechanical impactor to inflict a mechanical injury into the mouse brain. This method is a reliable and reproducible approach to inflict mild, moderate or severe injuries to the animal for studying TBI-associated blood-brain barrier (BBB) dysfunctions, neuronal injuries, brain edema, neurobehavioral changes, etc. The present method describes how the CCI model could be utilized for determining the BBB dysfunction and hyperpermeability associated with TBI. Blood-brain barrier disruption is a hallmark feature of the secondary injury that occur following TBI, frequently associated with leakage of fluid and proteins into the extravascular space leading to vasogenic edema and elevation of intracranial pressure. The method described here focuses on the development of a CCI-based mouse model of TBI followed by the evaluation of BBB integrity and permeability by intravital microscopy as well as Evans Blue extravasation assay.
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Affiliation(s)
- Himakarnika Alluri
- Department of Surgery, Texas A&M University Health Science Center, College of Medicine, Baylor Scott and White Research Institute, Temple, TX, USA
| | - Chinchusha Anasooya Shaji
- Department of Surgery, Texas A&M University Health Science Center, College of Medicine, Baylor Scott and White Research Institute, Temple, TX, USA
| | - Matthew L Davis
- Department of Surgery, Texas A&M University Health Science Center, College of Medicine, Baylor Scott and White Research Institute, Temple, TX, USA
| | - Binu Tharakan
- Department of Surgery, Texas A&M University Health Science Center, College of Medicine, Baylor Scott and White Research Institute, Temple, TX, USA.
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Administration of Protocatechuic Acid Reduces Traumatic Brain Injury-Induced Neuronal Death. Int J Mol Sci 2017; 18:ijms18122510. [PMID: 29168791 PMCID: PMC5751113 DOI: 10.3390/ijms18122510] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 01/27/2023] Open
Abstract
Protocatechuic acid (PCA) was first purified from green tea and has shown numerous biological activities, including anti-apoptotic, anti-inflammatory, and anti-atherosclerotic effects. The effect of PCA on traumatic brain injury (TBI)-induced neuronal death has not previously been evaluated. TBI is defined as damage to the brain resulting from external mechanical force, such as rapid acceleration or deceleration, impact, blast waves, or penetration by a projectile. TBI causes neuronal death in the hippocampus and cerebral cortex. The present study aimed to evaluate the therapeutic potential of PCA on TBI-induced neuronal death. Here, TBI was induced by a controlled cortical impact model using rats. PCA (30 mg/kg) was injected into the intraperitoneal (ip) space immediately after TBI. Neuronal death was evaluated with Fluoro Jade-B (FJB) staining at 24 h after TBI. Oxidative injury was detected by 4-hydroxy-2-nonenal (4HNE), glutathione (GSH) concentration was analyzed by glutathione adduct with N-ethylmaleimide (GS-NEM) staining at 24 h after TBI, and microglial activation in the hippocampus was detected by CD11b immunohistochemistry at one week after TBI. We found that the proportion of degenerating neurons, oxidative injury, GSH depletion, and microglia activation in the hippocampus and cortex were all reduced by PCA treatment following TBI. Therefore, our study suggests that PCA may have therapeutic potential in preventing TBI-induced neuronal death.
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Schimmel SJ, Acosta S, Lozano D. Neuroinflammation in traumatic brain injury: A chronic response to an acute injury. Brain Circ 2017; 3:135-142. [PMID: 30276315 PMCID: PMC6057689 DOI: 10.4103/bc.bc_18_17] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/02/2017] [Accepted: 09/05/2017] [Indexed: 02/06/2023] Open
Abstract
Every year, approximately 1.4 million US citizens visit emergency rooms for traumatic brain injuries. Formerly known as an acute injury, chronic neurodegenerative symptoms such as compromised motor skills, decreased cognitive abilities, and emotional and behavioral changes have caused the scientific community to consider chronic aspects of the disorder. The injury causing impact prompts multiple cell death processes, starting with neuronal necrosis, and progressing to various secondary cell death mechanisms. Secondary cell death mechanisms, including excitotoxicity, oxidative stress, mitochondrial dysfunction, blood-brain barrier disruption, and inflammation accompany chronic traumatic brain injury (TBI) and often contribute to long-term disabilities. One hallmark of both acute and chronic TBI is neuroinflammation. In acute stages, neuroinflammation is beneficial and stimulates an anti-inflammatory response to the damage. Conversely, in chronic TBI, excessive inflammation stimulates the aforementioned secondary cell death. Converting inflammatory cells from pro-inflammatory to anti-inflammatory may expand the therapeutic window for treating TBI, as inflammation plays a role in all stages of the injury. By expanding current research on the role of inflammation in TBI, treatment options and clinical outcomes for afflicted individuals may improve. This paper is a review article. Referred literature in this paper has been listed in the references section. The data sets supporting the conclusions of this article are available online by searching various databases, including PubMed. Some original points in this article come from the laboratory practice in our research center and the authors' experiences.
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Affiliation(s)
| | - Sandra Acosta
- Center of Excellence for Aging and Brain, Tampa, FL, USA
| | - Diego Lozano
- School of Medicine, University of Miami School of Medicine, Miami, FL, USA
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Shinoda J, Asano Y. Disorder of Executive Function of the Brain after Head Injury and Mild Traumatic Brain Injury - Neuroimaging and Diagnostic Criteria for Implementation of Administrative Support in Japan. Neurol Med Chir (Tokyo) 2017; 57:199-209. [PMID: 28381654 PMCID: PMC5447811 DOI: 10.2176/nmc.ra.2016-0293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The diagnotic criteria for disorder of the executive function of the brain (DEFB) as a syndrome of sequela were administratively established (ad-DEFB) in Japan in 2006 to support disabled patients whose impairment, limited to cognition (memory, attention, execution, and behavior), emerges after organic brain injuries regardless of physical deficits. However, some patients suffering from traumatic brain injury (TBI) have been excluded from receiving medico-social services. In particular, this tendency is more prominent in patients with mild TBI because no lesions are apparent on conventional computed tomography (CT) or magnetic resonance imaging (MRI) in the chronic phase. Recent development of new MRI neuroimaging modalities and positron emission tomography (PET) imaging makes it possible to detect regions of minute organic lesions and metabolic dysfunction in the brain where organic lesions may be absent or cannot be detected on conventional CT or MRI. In this review, we discuss diagnostic criteria for mild TBI and ad-DEFB, the relationship between the two disorders, characteristic neuroimaging [(MRI and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET)] of diffuse brain injury including cerebral concussion, which is the principal cause of mild TBI, and suggested pathological mechanisms of ad-DEFB in DBI.
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Affiliation(s)
- Jun Shinoda
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine
| | - Yoshitaka Asano
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine
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Abstract
Disorders of learning and memory have a large social and economic impact in today's society. Unfortunately, existing medical treatments have shown limited clinical efficacy or potential for modification of the disease course. Deep brain stimulation is a successful treatment for movement disorders and has shown promise in a variety of other diseases including psychiatric disorders. The authors review the potential of neuromodulation for the treatment of disorders of learning and memory. They briefly discuss learning circuitry and its involvement in Alzheimer disease and traumatic brain injury. They then review the literature supporting various targets for neuromodulation to improve memory in animals and humans. Multiple targets including entorhinal cortex, fornix, nucleus basalis of Meynert, basal ganglia, and pedunculopontine nucleus have shown a promising potential for improving dysfunctional memory by mechanisms such as altering firing patterns in neuronal networks underlying memory and increasing synaptic plasticity and neurogenesis. Significant work remains to be done to translate these findings into durable clinical therapies.
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Affiliation(s)
- Sarah K B Bick
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emad N Eskandar
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
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Swanson TM, Isaacson BM, Cyborski CM, French LM, Tsao JW, Pasquina PF. Traumatic Brain Injury Incidence, Clinical Overview, and Policies in the US Military Health System Since 2000. Public Health Rep 2017; 132:251-259. [PMID: 28135424 DOI: 10.1177/0033354916687748] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Exposure to explosive armaments during Operation Iraqi Freedom and Operation Enduring Freedom contributed to approximately 14% of the 352 612 traumatic brain injury (TBI) diagnoses in the US military between 2000 and 2016. The US Department of Defense issued guidelines in 2009 to (1) standardize TBI diagnostic criteria; (2) classify TBI according to mechanism and severity; (3) categorize TBI symptoms as somatic, psychological, or cognitive; and (4) systematize types of care given during the acute and rehabilitation stages of TBI treatment. Polytrauma and associated psychological and neurologic conditions may create barriers to optimal rehabilitation from TBI. Given the completion of recent combat operations and the transition of TBI patients into long-term care within the US Department of Veterans Affairs system, a review of the literature concerning TBI is timely. Long-term follow-up care for patients who have sustained TBI will remain a critical issue for the US military.
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Affiliation(s)
- Thomas M Swanson
- 1 Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,2 The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.,3 Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Brad M Isaacson
- 1 Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,2 The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Cherina M Cyborski
- 1 Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,4 National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Louis M French
- 1 Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,4 National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,5 Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA
| | - Jack W Tsao
- 1 Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,6 Bureau of Medicine and Surgery, Wounded, Ill and Injured, US Navy, Falls Church, VA, USA
| | - Paul F Pasquina
- 1 Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,7 Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
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The Potential Therapeutic Effects of Artesunate on Stroke and Other Central Nervous System Diseases. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1489050. [PMID: 28116289 PMCID: PMC5223005 DOI: 10.1155/2016/1489050] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/20/2016] [Indexed: 12/31/2022]
Abstract
Artesunate is an important agent for cerebral malaria and all kinds of other severe malaria because it is highly efficient, lowly toxic, and well-tolerated. Loads of research pointed out that it had widespread pharmacological activities such as antiparasites, antitumor, anti-inflammation, antimicrobes activities. As we know, the occurrence and development of neurological disorders usually refer to intricate pathophysiologic mechanisms and multiple etiopathogenesis. Recent progress has also demonstrated that drugs with single mechanism and serious side-effects are not likely the candidates for treatment of the neurological disorders. Therefore, the pluripotent action of artesunate may result in it playing an important role in the prevention and treatment of these neurological disorders. This review provides an overview of primary pharmacological mechanism of artesunate and its potential therapeutic effects on neurological disorders. Meanwhile, we also briefly summarize the primary mechanisms of artemisinin and its derivatives. We hope that, with the evidence presented in this review, the effect of artesunate in prevention and curing for neurological disorders can be further explored and studied in the foreseeable future.
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Gómez C, Poza J, Gutiérrez MT, Prada E, Mendoza N, Hornero R. Characterization of EEG patterns in brain-injured subjects and controls after a Snoezelen(®) intervention. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 136:1-9. [PMID: 27686698 DOI: 10.1016/j.cmpb.2016.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 07/18/2016] [Accepted: 08/12/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to assess the changes induced in electroencephalographic (EEG) activity by a Snoezelen(®) intervention on individuals with brain-injury and control subjects. METHODS EEG activity was recorded preceding and following a Snoezelen(®) session in 18 people with cerebral palsy (CP), 18 subjects who have sustained traumatic brain-injury (TBI) and 18 controls. EEG data were analyzed by means of spectral and nonlinear measures: median frequency (MF), individual alpha frequency (IAF), sample entropy (SampEn) and Lempel-Ziv complexity (LZC). RESULTS Our results showed decreased values for MF, IAF, SampEn and LZC as a consequence of the therapy. The main changes between pre-stimulation and post-stimulation conditions were found in occipital and parietal brain areas. Additionally, these changes are more widespread in controls than in brain-injured subjects, which can be due to cognitive deficits in TBI and CP groups. CONCLUSIONS Our findings support the notion that Snoezelen(®) therapy affects central nervous system, inducing a slowing of oscillatory activity, as well as a decrease of EEG complexity and irregularity. These alterations seem to be related with higher levels of relaxation of the participants.
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Affiliation(s)
- Carlos Gómez
- Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain.
| | - Jesús Poza
- Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain; IMUVA, Instituto de Investigación en Matemáticas, Universidad de Valladolid, Valladolid, Spain
| | - María T Gutiérrez
- Centro de Referencia Estatal (CRE) para la Atención a Personas con Grave Discapacidad y Dependencia, San Andrés del Rabanedo, León, Spain
| | - Esther Prada
- Centro de Referencia Estatal (CRE) para la Atención a Personas con Grave Discapacidad y Dependencia, San Andrés del Rabanedo, León, Spain
| | - Nuria Mendoza
- Departamento de Actividad Física y Ciencias del Deporte, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain; IMUVA, Instituto de Investigación en Matemáticas, Universidad de Valladolid, Valladolid, Spain
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43
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Lendraitienė E, Petruševičienė D, Savickas R, Žemaitienė I, Mingaila S. The impact of physical therapy in patients with severe traumatic brain injury during acute and post-acute rehabilitation according to coma duration. J Phys Ther Sci 2016; 28:2048-54. [PMID: 27512262 PMCID: PMC4968504 DOI: 10.1589/jpts.28.2048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/07/2016] [Indexed: 01/18/2023] Open
Abstract
[Purpose] The aim of study was to evaluate the impact of physical therapy on the recovery of motor and mental status in patients who sustained a severe traumatic brain injury, according to coma duration in acute and post-acute rehabilitation. [Subjects and Methods] The study population comprised patients with levels of consciousness ranging from 3 to 8 according to Glasgow Coma Scale score. The patients were divided into 2 groups based on coma duration as follows: group 1, those who were in a coma up to 1 week, and group 2, those who were in a coma for more than 2 weeks. The recovery of the patients' motor function was evaluated according to the Motor Assessment Scale and the recovery of mental status according to the Mini-Mental State Examination. [Results] The evaluation of motor and mental status recovery revealed that the patients who were in a coma up to 1 week recovered significantly better after physical therapy during the acute rehabilitation than those who were in a coma for longer than 2 weeks. [Conclusion] The recovery of motor and mental status of the patients in acute rehabilitation was significantly better for those in a coma for a shorter period.
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Affiliation(s)
- Eglė Lendraitienė
- Department of Rehabilitation, Medical Academy of Lithuanian
University of Health Sciences, Lithuania
- Department of Neurorehabilitation, Hospital of Lithuanian
University of Health Sciences, Lithuania
| | - Daiva Petruševičienė
- Department of Rehabilitation, Medical Academy of Lithuanian
University of Health Sciences, Lithuania
| | - Raimondas Savickas
- Department of Rehabilitation, Medical Academy of Lithuanian
University of Health Sciences, Lithuania
- Department of Neurorehabilitation, Hospital of Lithuanian
University of Health Sciences, Lithuania
| | - Ieva Žemaitienė
- Department of Rehabilitation, Medical Academy of Lithuanian
University of Health Sciences, Lithuania
| | - Sigitas Mingaila
- Department of Rehabilitation, Medical Academy of Lithuanian
University of Health Sciences, Lithuania
- Department of Neurorehabilitation, Hospital of Lithuanian
University of Health Sciences, Lithuania
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Ulrichsen KM, Kaufmann T, Dørum ES, Kolskår KK, Richard G, Alnæs D, Arneberg TJ, Westlye LT, Nordvik JE. Clinical Utility of Mindfulness Training in the Treatment of Fatigue After Stroke, Traumatic Brain Injury and Multiple Sclerosis: A Systematic Literature Review and Meta-analysis. Front Psychol 2016; 7:912. [PMID: 27445888 PMCID: PMC4917545 DOI: 10.3389/fpsyg.2016.00912] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/02/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fatigue is a common symptom following neurological illnesses and injuries, and is rated as one of the most debilitating sequela in conditions such as stroke, traumatic brain injury (TBI), and multiple sclerosis (MS). Yet effective treatments are lacking, suggesting a pressing need for a better understanding of its etiology and mechanisms that may alleviate the symptoms. Recently mindfulness-based interventions have demonstrated promising results for fatigue symptom relief. OBJECTIVE Investigate the efficacy of mindfulness-based interventions for fatigue across neurological conditions and acquired brain injuries. MATERIALS AND METHODS Systematic literature searches were conducted in PubMed, Medline, Web of Science, and PsycINFO. We included randomized controlled trials applying mindfulness-based interventions in patients with neurological conditions or acquired brain injuries. Four studies (N = 257) were retained for meta-analysis. The studies included patients diagnosed with MS, TBI, and stroke. RESULTS The estimated effect size for the total sample was -0.37 (95% CI: -0.58, -0.17). CONCLUSION The results indicate that mindfulness-based interventions may relieve fatigue in neurological conditions such as stroke, TBI, and MS. However, the effect size is moderate, and further research is needed in order to determine the effect and improve our understanding of how mindfulness-based interventions affect fatigue symptom perception in patients with neurological conditions.
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Affiliation(s)
| | - Tobias Kaufmann
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, NORMENT: Norwegian Centre for Mental Disorders Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, OsloNorway
| | - Erlend S. Dørum
- Sunnaas Rehabilitation Hospital HT, NesoddenNorway
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, NORMENT: Norwegian Centre for Mental Disorders Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, OsloNorway
- Department of Psychology, University of Oslo, OsloNorway
| | - Knut K. Kolskår
- Sunnaas Rehabilitation Hospital HT, NesoddenNorway
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, NORMENT: Norwegian Centre for Mental Disorders Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, OsloNorway
- Department of Psychology, University of Oslo, OsloNorway
| | - Geneviève Richard
- Sunnaas Rehabilitation Hospital HT, NesoddenNorway
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, NORMENT: Norwegian Centre for Mental Disorders Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, OsloNorway
- Department of Psychology, University of Oslo, OsloNorway
| | - Dag Alnæs
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, NORMENT: Norwegian Centre for Mental Disorders Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, OsloNorway
| | - Tone J. Arneberg
- Department of Behavioural Sciences, Oslo and Akershus University College of Applied Sciences, OsloNorway
| | - Lars T. Westlye
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, NORMENT: Norwegian Centre for Mental Disorders Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, OsloNorway
- Department of Psychology, University of Oslo, OsloNorway
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Lu C, Xia J, Bin W, Wu Y, Liu X, Zhang Y. Advances in diagnosis, treatments, and molecular mechanistic studies of traumatic brain injury. Biosci Trends 2016; 9:138-48. [PMID: 26166367 DOI: 10.5582/bst.2015.01066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Traumatic brain injury (TBI) is a main cause of death and disability around the world especially in soldiers, children, and young men. Since its clinical diagnosis and treatment cannot predict its prognosis, novel diagnostic techniques need to be developed, insight into its molecular mechanisms needs to be gleaned, and alternative and complementary medicine (ACM) approaches to its treatment need to be developed. This review summarizes the new diagnostic methods used in clinical practice, such as imaging of structural abnormalities after TBI and measurement of prognosis-related biomarkers. This review also describes the cellular mechanisms of traditional Chinese medicine in terms of intracellular signaling pathways, the extracellular microenvironment, and stem cells. This review concludes by describing experimental and clinical studies of the use of traditional Chinese medicine as a form of ACM to treat TBI. This review helps to understand advances in the field of TBI diagnosis and treatment.
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Affiliation(s)
- Chunyu Lu
- Department of Neurosurgery, The People's Hospital of Huaibei
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Abstract
Axonal microtubule (MT) bundles crosslinked by microtubule-associated protein (MAP) tau are responsible for vital biological functions such as maintaining mechanical integrity and shape of the axon as well as facilitating axonal transport. Breaking and twisting of MTs have been previously observed in damaged undulated axons. Such breaking and twisting of MTs is suggested to cause axonal swellings that lead to axonal degeneration, which is known as "diffuse axonal injury". In particular, overstretching and torsion of axons can potentially damage the axonal cytoskeleton. Following our previous studies on mechanical response of axonal MT bundles under uniaxial tension and compression, this work seeks to characterize the mechanical behavior of MT bundles under pure torsion as well as a combination of torsional and tensile loads using a coarse-grained computational model. In the case of pure torsion, a competition between MAP tau tensile and MT bending energies is observed. After three turns, a transition occurs in the mechanical behavior of the bundle that is characterized by its diameter shrinkage. Furthermore, crosslink spacing is shown to considerably influence the mechanical response, with larger MAP tau spacing resulting in a higher rate of turns. Therefore, MAP tau crosslinking of MT filaments protects the bundle from excessive deformation. Simultaneous application of torsion and tension on MT bundles is shown to accelerate bundle failure, compared to pure tension experiments. MAP tau proteins fail in clusters of 10-100 elements located at the discontinuities or the ends of MT filaments. This failure occurs in a stepwise fashion, implying gradual accumulation of elastic tensile energy in crosslinks followed by rupture. Failure of large groups of interconnecting MAP tau proteins leads to detachment of MT filaments from the bundle near discontinuities. This study highlights the importance of torsional loading in axonal damage after traumatic brain injury.
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Affiliation(s)
- Carole Lazarus
- Molecular Cell Biomechanics Laboratory, Departments of Bioengineering and Mechanical Engineering, University of California, Berkeley, California
| | - Mohammad Soheilypour
- Molecular Cell Biomechanics Laboratory, Departments of Bioengineering and Mechanical Engineering, University of California, Berkeley, California
| | - Mohammad R K Mofrad
- Molecular Cell Biomechanics Laboratory, Departments of Bioengineering and Mechanical Engineering, University of California, Berkeley, California.
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Zhang K, Jiang W, Ma T, Wu H. Comparison of early and late decompressive craniectomy on the long-term outcome in patients with moderate and severe traumatic brain injury: a meta-analysis. Br J Neurosurg 2016; 30:251-7. [PMID: 26828333 DOI: 10.3109/02688697.2016.1139052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Several studies have searched whether early decompressive craniectomy (DC) can improve the long-term outcome of patients with moderate and severe traumatic brain injury (TBI). However, the effects of early DC remain unclear. The purpose of this meta-analysis was to assess whether early DC (time to surgery after injury <24 h) is better than late DC (>24 h) after moderate and severe TBI. METHOD Two reviewers independently searched Pubmed, Embase, ISI web of science, the Cochrane Library and Scopus databases from inception to 4 November 2014. Studies comparing the long-term outcome of patients following early and late DC after TBI were included. The long-term outcomes were evaluated by Glasgow Outcome Score, Extended Glasgow Outcome Score. Newcastle-Ottawa Scale was used to assess the methodological quality of included studies. Characteristics of the selected studies were extracted. Pooled results were presented by odds ratios (ORs) with 95% CIs. I(2) was used to test heterogeneity. Pearson correlation coefficient was used to detect the relationship between bilateral pupil abnormality and unfavourable outcome. RESULTS Five articles were eligible for this meta-analysis. The pooled results of comparison of unfavourable outcome and mortality revealed no significant difference in the early and late groups (ORs: 1.469; 95% CIs: 0.495-4.362; p > 0.05; I(2 )=70.5% and ORs: 1.262; 95% CIs: 0.385-4.137; p > 0.05; I(2 )=77.6%, respectively). Pearson correlation coefficient indicated that bilateral pupil abnormality was positive related to the unfavourable outcomes and mortality (r = 0.833; p < 0.05) (0.829; p < 0.05). CONCLUSION Bilateral pupil abnormality is positive related to unfavourable outcome and mortality in the patients following DC after moderate and severe TBI. Early DC may be more helpful to improve the long-term outcome of patients with refractory raised intracranial cerebral pressure after moderate and severe TBI. However, more RCTs with better control of patients with bilateral pupil abnormality divided into the early and late groups are needed in the future.
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Affiliation(s)
- Kai Zhang
- a Department of General Surgery , the Second Affiliated Hospital of Soochow University , Soochow , Jiangsu , P.R. China ;,b Department of Hepatobiliary Surgery , the Affiliated Yixing Hospital of Jiangsu University , Yixing , Jiangsu , P.R. China
| | - Wenjie Jiang
- c Department of Anesthesiology , the Affiliated Yixing Hospital of Jiangsu University , Yixing , Jiangsu , P.R. China
| | - Tieliang Ma
- d Central Laboratory , the Affiliated Yixing Hospital of Jiangsu University , Yixing , Jiangsu , P.R. China
| | - Haorong Wu
- a Department of General Surgery , the Second Affiliated Hospital of Soochow University , Soochow , Jiangsu , P.R. China
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Luo L, Chai Y, Jiang R, Chen X, Yan T. Cortisol Supplement Combined with Psychotherapy and Citalopram Improves Depression Outcomes in Patients with Hypocortisolism after Traumatic Brain Injury. Aging Dis 2015; 6:418-25. [PMID: 26618043 DOI: 10.14336/ad.2015.0507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/07/2015] [Indexed: 11/01/2022] Open
Abstract
Depression is one of the most prevalent psychiatric disorders in people with Traumatic brain injury (TBI). Depression after TBI is closely related with social and psychological factors and hypothalamic-pituitary -adrenal (HPA) axis dysfunction. However, there is a lack of evidence regarding effective treatment approaches for depression. A total of 68 patients with depression following closed TBI were recruited. Glasgow Coma Scale score (GCS) was employed to demonstrate the severity of neurological deficits and Glasgow Outcome Scale (GOS) was employed to measure functional outcome after TBI. The severity of depression was quantified using the Beck Depression Inventory-II (BDI-II) in line with DSM-IV. Citalopram and Prednisone were administered to subjects with normal cortisol levels or hypocortisolism separately, based on psychotherapeutic interventions. We investigated the relationship between degree of depression of TBI patients and the severity and progression of TBI with the therapeutic effects of Citalopram in combination with psychotherapeutic and Prednisone in depressed patients. There was no relationship between the severity of depression and the severity and progression of TBI. The basic treatment of psychotherapeutic interventions could partially relieve depressive symptoms. Combination of psychotherapeutic support and Citalopram significantly improved depressive symptoms in patients with normal cortisol levels, but not in hypocortisolic patients. Combination of Prednisone administration with psychotherapeutic treatment and Citalopram significantly improved depression outcome in hypocortisolic patients after TBI. Hypocortisolism after TBI may regulate depression. Combination of Prednisone with psychotherapeutic treatment and Citalopram may provide better therapeutic effects in depression patients with hypocortisolism after TBI.
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Affiliation(s)
- Lanlan Luo
- 1 Neurology of Tianjin Medical University General Hospital, Tianjin, China ; 2 Tianjin Neurological Institute, Tianjin, China
| | - Yan Chai
- 2 Tianjin Neurological Institute, Tianjin, China
| | - Rongcai Jiang
- 2 Tianjin Neurological Institute, Tianjin, China ; 3 Neurosurgery of Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Chen
- 2 Tianjin Neurological Institute, Tianjin, China ; 3 Neurosurgery of Tianjin Medical University General Hospital, Tianjin, China
| | - Tao Yan
- 1 Neurology of Tianjin Medical University General Hospital, Tianjin, China ; 2 Tianjin Neurological Institute, Tianjin, China
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Lozano D, Gonzales-Portillo GS, Acosta S, de la Pena I, Tajiri N, Kaneko Y, Borlongan CV. Neuroinflammatory responses to traumatic brain injury: etiology, clinical consequences, and therapeutic opportunities. Neuropsychiatr Dis Treat 2015; 11:97-106. [PMID: 25657582 PMCID: PMC4295534 DOI: 10.2147/ndt.s65815] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Traumatic brain injury (TBI) is a serious public health problem accounting for 1.4 million emergency room visits by US citizens each year. Although TBI has been traditionally considered an acute injury, chronic symptoms reminiscent of neurodegenerative disorders have now been recognized. These progressive neurodegenerative-like symptoms manifest as impaired motor and cognitive skills, as well as stress, anxiety, and mood affective behavioral alterations. TBI, characterized by external bumps or blows to the head exceeding the brain's protective capacity, causes physical damage to the central nervous system with accompanying neurological dysfunctions. The primary impact results in direct neural cell loss predominantly exhibiting necrotic death, which is then followed by a wave of secondary injury cascades including excitotoxicity, oxidative stress, mitochondrial dysfunction, blood-brain barrier disruption, and inflammation. All these processes exacerbate the damage, worsen the clinical outcomes, and persist as an evolving pathological hallmark of what we now describe as chronic TBI. Neuroinflammation in the acute stage of TBI mobilizes immune cells, astrocytes, cytokines, and chemokines toward the site of injury to mount an antiinflammatory response against brain damage; however, in the chronic stage, excess activation of these inflammatory elements contributes to an "inflamed" brain microenvironment that principally contributes to secondary cell death in TBI. Modulating these inflammatory cells by changing their phenotype from proinflammatory to antiinflammatory would likely promote therapeutic effects on TBI. Because neuroinflammation occurs at acute and chronic stages after the primary insult in TBI, a treatment targeting neuroinflammation may have a wider therapeutic window for TBI. To this end, a better understanding of TBI etiology and clinical manifestations, especially the pathological presentation of chronic TBI with neuroinflammation as a major component, will advance our knowledge on inflammation-based disease mechanisms and treatments.
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Affiliation(s)
- Diego Lozano
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Gabriel S Gonzales-Portillo
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sandra Acosta
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Ike de la Pena
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Naoki Tajiri
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Yuji Kaneko
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Cesar V Borlongan
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Dhaliwal SK, Meek BP, Modirrousta MM. Non-Invasive Brain Stimulation for the Treatment of Symptoms Following Traumatic Brain Injury. Front Psychiatry 2015; 6:119. [PMID: 26379560 PMCID: PMC4549551 DOI: 10.3389/fpsyt.2015.00119] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/10/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a common cause of physical, psychological, and cognitive impairment, but many current treatments for TBI are ineffective or produce adverse side effects. Non-invasive methods of brain stimulation could help ameliorate some common trauma-induced symptoms. OBJECTIVE This review summarizes instances in which repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS) have been used to treat symptoms following a TBI. A subsequent discussion attempts to determine the value of these methods in light of their potential risks. METHODS The research databases of PubMed/MEDLINE and PsycINFO were electronically searched using terms relevant to the use of rTMS and tDCS as a tool to decrease symptoms in the context of rehabilitation post-TBI. RESULTS Eight case-studies and four multi-subject reports using rTMS and six multi--subject studies using tDCS were found. Two instances of seizure are discussed. CONCLUSION There is evidence that rTMS can be an effective treatment option for some post-TBI symptoms, such as depression, tinnitus, and neglect. Although the safety of this method remains uncertain, the use of rTMS in cases of mild TBI without obvious structural damage may be justified. Evidence on the effectiveness of tDCS is mixed, highlighting the need for additional investigations.
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Affiliation(s)
| | - Benjamin P Meek
- Department of Psychiatry, University of Manitoba , Winnipeg, MB , Canada
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