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Firearms Are Now the Leading Cause of Traumatic Brain Injury-Related Mortality in Children. 枪支现在是造成儿童脑外伤相关死亡的主要原因。
Pub Date : 2023-11-23 eCollection Date: 2023-01-01 DOI: 10.1089/neur.2023.0069
Samantha R Neuman, Cordelia Mannix, Rebekah Mannix

Recent studies have demonstrated a significant change in the epidemiology of injury fatalities in children, most notably a marked increase in firearm-related deaths. Few studies have specifically addressed pediatric TBI-related mortality trends. Studying these trends is important for both clinical preparedness and public health interventions. The purpose of this study therefore is to examine recent trends in mechanisms, intents, and rates of pediatric TBI fatalities. Data regarding fatalities from TBI for children <18 years of age from 2011 to 2021 were extracted from the Centers for Disease Control and Prevention, National Center for Health Statistics' web-based injury statistics query and reporting system. We found that firearms became the leading cause of TBI fatalities in children by 2021, most frequently attributable to self-harm. Taken together, the findings from this study underscore the importance in monitoring the changing epidemiology of pediatric TBI fatalities.

最近的研究表明,儿童伤害死亡的流行病学发生了重大变化,最明显的是与枪支相关的死亡人数明显增加。很少有研究专门探讨与小儿创伤性脑损伤相关的死亡率趋势。研究这些趋势对于临床准备和公共卫生干预都非常重要。因此,本研究的目的是探讨儿科创伤性脑损伤致死的机制、意图和比率的最新趋势。有关儿童创伤性脑损伤死亡的数据
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引用次数: 0
Long-Term Functional Outcome and Quality of Life in Long-Term Traumatic Brain Injury Survivors. 脑外伤长期存活者的长期功能结果和生活质量。
Pub Date : 2023-11-22 eCollection Date: 2023-01-01 DOI: 10.1089/neur.2023.0064
Wivi Taalas, Rahul Raj, Juha Öhman, Jari Siironen

Early functional outcome assessments of traumatic brain injury (TBI) survivors may underestimate the long-term consequences of TBI. We assessed long-term temporal changes in functional outcome and quality of life in intensive care unit-managed long-term TBI survivors. This prospective, longitudinal study included 180 patients admitted to a single university hospital during 2000-2002 alive at 15 years post-TBI. Baseline characteristics, including imaging information, were collected. Functional outcome was assessed early (6-24 months) and late (15 years) using the Glasgow Outcome Scale (GOS) and the extended GOS (GOSE). Quality of life was measured at 15 years using the EuroQol Five Dimensions Five Levels (EQ-5D-5L) questionnaire. GOS and GOSE were dichotomized into favorable and unfavorable outcome. An index score was computed for EQ-5D-5L results at 15 years by a standardized valuation protocol. Of 180 patients, 118 replied to 15-year questionnaires. Median age at time of injury was 34 years (interquartile range, 19-45). Using the GCS to assess TBI severity, 67% had a moderate-to-severe TBI. Ninety-seven percent had favorable early functional outcome, and 72% had late favorable functional outcome. Logistic regression found higher age, lower GCS, and Marshall CT III to significantly predict late unfavorable functional outcome. Higher age and Marshall CT III were significant predictors of functional outcome deterioration. Median EQ-5D-5L index score for all patients was 0.88 (0.66-1.00) and correlated positively with GOSE. Most long-term TBI survivors with early favorable outcome also have late favorable functional outcome. Higher age and diffuse brain injury are associated with neurological deterioration. Quality of life was strongly linked to functional outcome.

对创伤性脑损伤(TBI)幸存者的早期功能结果评估可能低估了 TBI 的长期后果。我们对重症监护室管理的长期创伤性脑损伤幸存者的功能结果和生活质量的长期时间变化进行了评估。这项前瞻性纵向研究纳入了 2000-2002 年间在一家大学医院住院的 180 名患者,他们在 TBI 术后 15 年仍健在。研究人员收集了包括影像学信息在内的基线特征。使用格拉斯哥结果量表(GOS)和扩展 GOS(GOSE)对早期(6-24 个月)和晚期(15 年)的功能结果进行了评估。15 年后的生活质量采用 EuroQol Five Dimensions Five Levels (EQ-5D-5L) 问卷进行测量。GOS 和 GOSE 被二分为有利和不利结果。通过标准化评估方案计算出 15 年后 EQ-5D-5L 结果的指数得分。在 180 名患者中,有 118 人回答了 15 年的调查问卷。受伤时的中位年龄为 34 岁(四分位数间距为 19-45 岁)。使用 GCS 评估创伤性脑损伤的严重程度,67% 的患者为中度至重度创伤性脑损伤。97%的患者早期功能恢复良好,72%的患者晚期功能恢复良好。逻辑回归发现,较高的年龄、较低的 GCS 和马歇尔 CT III 可显著预测后期不利的功能预后。较高的年龄和马歇尔 CT III 是功能预后恶化的重要预测因素。所有患者的 EQ-5D-5L 指数中位数为 0.88(0.66-1.00),与 GOSE 呈正相关。大多数早期预后良好的长期创伤性脑损伤幸存者的晚期功能预后也很好。高龄和弥漫性脑损伤与神经功能恶化有关。生活质量与功能预后密切相关。
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引用次数: 0
Long-Term Outcomes Over 20 Years in Persons With Persistent Disorders of Consciousness After Traumatic Brain Injury. 外伤性脑损伤后持续意识障碍患者20年以上的长期预后
Pub Date : 2023-11-21 eCollection Date: 2023-01-01 DOI: 10.1089/neur.2023.0080
Youhei Nakamura, Tadahiko Shiozaki, Hiroshi Ito, Shunichiro Nakao, Hiroshi Ogura, Jun Oda

The long-term outcomes of patients with disorders of consciousness after traumatic brain injury (TBI) is unclear. We investigated the long-term outcomes over 20 years in patients who were in a persistent vegetative state (VS). We conducted a retrospective cohort study using a review of medical records and collected data by telephone and written interviews with patients and their families. We included patients who were treated for TBI at our hospital, between October 1996 and January 2003 and who were in a persistent VS, defined as a Disability Rating Scale (DRS) score of ≥22 at 1 month after TBI. The DRS was administered at 1 month, 6 months, 1 year, and then annually out to 20 years. We evaluated their clinical course until July 2021 with the DRS. We analyzed 35 patients in a persistent VS attributable to TBI. We were able to confirm the 20-year outcomes for 26 of the 35 patients (74%); at 20 years post-TBI, 19 (54%) patients were found to be deceased and 7 (20%) were alive. Over the 20-year study period, 23 of the 35 patients (65.7%) emerged from a persistent VS. Among the 35 patients in a persistent VS at 1 month post-TBI, 20 (57%) emerged from a persistent VS within 1 year, and 3 patients (8.6%) emerged from a persistent VS after more than a year after injury. DRS scores improved up to 9 years post-injury, whereas the change in DRS scores from 10 to 20 years post-injury was within ±1 point in all patients. We found that patients with persistent VS attributable to TBI may show improvement in functional disability up to 10 years post-injury. On the other hand, no substantial improvement in functional disability was observed after the 10th year.

创伤性脑损伤(TBI)后意识障碍患者的长期预后尚不清楚。我们调查了持续植物人状态(VS)患者超过20年的长期结果。我们进行了一项回顾性队列研究,回顾了医疗记录,并通过电话和对患者及其家属的书面采访收集了数据。我们纳入了1996年10月至2003年1月期间在我院接受TBI治疗的持续性VS患者,定义为TBI后1个月残疾评定量表(DRS)评分≥22分。DRS分别在1个月,6个月,1年,然后每年进行一次,直到20年。我们用DRS评估了他们的临床过程,直到2021年7月。我们分析了35例可归因于TBI的持续性VS患者。我们能够确认35例患者中26例(74%)的20年预后;在脑外伤后20年,19例(54%)患者死亡,7例(20%)患者存活。在20年的研究期间,35例患者中有23例(65.7%)出现持续性VS, 35例患者在tbi后1个月出现持续性VS, 20例(57%)在1年内出现持续性VS, 3例(8.6%)在损伤后1年多后出现持续性VS。损伤后9年DRS评分改善,而损伤后10 - 20年DRS评分变化在±1分以内。我们发现,脑外伤引起的持续性VS患者在损伤后10年内可能表现出功能残疾的改善。另一方面,在第10年后,没有观察到功能障碍的实质性改善。
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引用次数: 0
E-Bikes (Electrical Bicycles and Scooters) Related Neurosurgical Injuries in the Adult Population: A Single-Center Experience. 成人中与电动自行车(电动自行车和踏板车)相关的神经外科损伤:单中心经验。
Pub Date : 2023-11-16 eCollection Date: 2023-01-01 DOI: 10.1089/neur.2023.0071
Carla Richetta, Yevgeny Karepov

E-bikes (electrical bicycles and scooters) have been increasingly used as a means of transportation, especially among young adults. E-bikers have more accidents, at higher velocities and more severe kinematics, increasing the rate of neurosurgical injuries. Severe neurosurgical injury patterns result in significant morbidity and mortality. We collected data regarding adult patients (>18 years old), who suffered e-bike-related neurosurgical injuries, in a single tertiary medical center in Israel, between July 2019 and June 2020. Fifty-eight consecutive patients were included in this study. The average age was 34.9, and the average Glasgow Coma Scale (GCS) score upon admission was 13.2 and was significantly lower in operated patients (10.75). Fifty-four patients were riders; 51 (94.5%!) were not wearing a helmet. Fifty percent of patients had multiple types of trauma. Six patients suffered a spinal injury. Sixteen patients required either cranial or spinal surgery. Three patients died, and 1 remained in a vegetative state. Median Glasgow Outcome Scale-Extended (GOS-E) score at follow-up was 7.1. Operated patients stayed significantly longer in the intensive care unit (ICU) and in the hospital, and their GOS-E scores at discharge and follow-up were significantly lower. Most spinal injuries underwent surgery. Patients who wore helmets had significantly higher GCS scores and a shorter stay in the ICU and hospital. The unacceptable reality of the careless use of this transportation and the unique kinematics lead to severe neurosurgical injuries, comorbidities, and even mortality. Our results reflect the risks of e-bikes in the adult population. Most of our patients were in the mid-age group, and almost none had used a helmet. The results of this study highlight the potential need for neurosurgical treatment, and the need for long-term rehabilitation and follow-up, reflecting the emotional and financial toll of these injuries. Once again, this study showed that helmets save lives and emphasized the importance of protecting our heads.

电动自行车(电动自行车和踏板车)已经越来越多地被用作一种交通工具,尤其是在年轻人中。骑电动自行车的人有更多的事故,速度更快,运动更剧烈,增加了神经外科损伤的几率。严重的神经外科损伤模式导致显著的发病率和死亡率。我们收集了2019年7月至2020年6月期间在以色列一个三级医疗中心遭受电动自行车相关神经外科损伤的成年患者(>18岁)的数据。58例连续患者纳入本研究。平均年龄34.9岁,入院时格拉斯哥昏迷评分(GCS)平均为13.2分,手术患者的GCS评分明显低于住院患者(10.75分)。54名患者是骑手;51人(94.5%)未戴安全帽。50%的病人有多种创伤。6名患者出现脊髓损伤。16名患者需要颅脑或脊柱手术。3名患者死亡,1名仍处于植物人状态。随访时格拉斯哥结局扩展量表(GOS-E)评分中位数为7.1。手术患者在重症监护病房(ICU)和医院的住院时间明显延长,出院和随访时GOS-E评分明显降低。大多数脊柱损伤都进行了手术。戴头盔的患者GCS评分明显更高,在ICU和医院的住院时间也更短。不可接受的现实是,不小心使用这种运输和独特的运动学导致严重的神经外科损伤,合并症,甚至死亡。我们的研究结果反映了电动自行车在成年人中的风险。我们的大多数病人都是中年人,几乎没有人戴过头盔。这项研究的结果强调了神经外科治疗的潜在需求,以及长期康复和随访的需求,反映了这些损伤的情感和经济代价。这项研究再次表明,头盔可以挽救生命,并强调了保护我们头部的重要性。
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引用次数: 0
A Research Protocol to Study the Priming Effects of Breathing Low Oxygen on Enhancing Training-Related Gains in Walking Function for Persons With Spinal Cord Injury: The BO2ST Trial. 研究低氧呼吸对脊髓损伤患者步行功能增强的启动效应的研究方案:BO2ST试验。
Pub Date : 2023-11-06 eCollection Date: 2023-01-01 DOI: 10.1089/neur.2023.0036
William M Muter, Linda Mansson, Christopher Tuthill, Shreya Aalla, Stella Barth, Emily Evans, Kelly McKenzie, Sara Prokup, Chen Yang, Milap Sandhu, W Zev Rymer, Victor R Edgerton, Parag Gad, Gordon S Mitchell, Samuel S Wu, Guogen Shan, Arun Jayaraman, Randy D Trumbower

Brief episodes of low oxygen breathing (therapeutic acute intermittent hypoxia; tAIH) may serve as an effective plasticity-promoting primer to enhance the effects of transcutaneous spinal stimulation-enhanced walking therapy (WALKtSTIM) in persons with chronic (>1 year) spinal cord injury (SCI). Pre-clinical studies in rodents with SCI show that tAIH and WALKtSTIM therapies harness complementary mechanisms of plasticity to maximize walking recovery. Here, we present a multi-site clinical trial protocol designed to examine the influence of tAIH + WALKtSTIM on walking recovery in persons with chronic SCI. We hypothesize that daily (eight sessions, 2 weeks) tAIH + WALKtSTIM will elicit faster, more persistent improvements in walking recovery than either treatment alone. To test our hypothesis, we are conducting a placebo-controlled clinical trial on 60 SCI participants who randomly receive one of three interventions: tAIH + WALKtSTIM; Placebo + WALKtSTIM; and tAIH + WALKtSHAM. Participants receive daily tAIH (fifteen 90-sec episodes at 10% O2 with 60-sec intervals at 21% O2) or daily placebo (fifteen 90-sec episodes at 21% O2 with 60-sec intervals at 21% O2) before a 45-min session of WALKtSTIM or WALKtSHAM. Our primary outcome measures assess walking speed (10-Meter Walk Test), endurance (6-Minute Walk Test), and balance (Timed Up and Go Test). For safety, we also measure pain levels, spasticity, sleep behavior, cognition, and rates of systemic hypertension and autonomic dysreflexia. Assessments occur before, during, and after sessions, as well as at 1, 4, and 8 weeks post-intervention. Results from this study extend our understanding of the functional benefits of tAIH priming by investigating its capacity to boost the neuromodulatory effects of transcutaneous spinal stimulation on restoring walking after SCI. Given that there is no known cure for SCI and no single treatment is sufficient to overcome walking deficits, there is a critical need for combinatorial treatments that accelerate and anchor walking gains in persons with lifelong SCI.

Trial registration: ClinicalTrials.gov, NCT05563103.

短暂的低氧呼吸发作(治疗性急性间歇缺氧;tAIH)可能作为一种有效的可塑性促进引物,以增强慢性(>1年)脊髓损伤(SCI)患者经皮脊髓刺激增强步行治疗(WALKtSTIM)的效果。对脊髓损伤啮齿动物的临床前研究表明,tAIH和WALKtSTIM疗法利用可塑性的互补机制来最大限度地恢复行走。在这里,我们提出了一项多地点临床试验方案,旨在研究tAIH + WALKtSTIM对慢性脊髓损伤患者行走恢复的影响。我们假设每天(8次,2周)tAIH + WALKtSTIM比单独治疗更能促进步行恢复的更快、更持久的改善。为了验证我们的假设,我们正在对60名SCI参与者进行一项安慰剂对照临床试验,他们随机接受三种干预措施之一:tAIH + WALKtSTIM;安慰剂+ WALKtSTIM;和tAIH + WALKtSHAM。参与者在进行45分钟的WALKtSTIM或WALKtSHAM治疗前,每天接受tAIH治疗(15次90秒,10%氧气,间隔60秒,21%氧气)或安慰剂治疗(15次90秒,21%氧气,间隔60秒,21%氧气)。我们的主要结果测量评估步行速度(10米步行测试),耐力(6分钟步行测试)和平衡(计时起来和走测试)。为了安全起见,我们还测量了疼痛水平、痉挛、睡眠行为、认知、全身性高血压和自主神经反射障碍的发生率。评估在治疗前、治疗中、治疗后以及干预后1周、4周和8周进行。本研究的结果扩展了我们对tAIH启动的功能益处的理解,通过研究其增强经皮脊髓刺激对脊髓损伤后恢复行走的神经调节作用的能力。鉴于目前还没有已知的治愈脊髓损伤的方法,也没有单一的治疗方法足以克服行走缺陷,因此迫切需要联合治疗来加速和固定终身脊髓损伤患者的行走能力。试验注册:ClinicalTrials.gov, NCT05563103。
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引用次数: 0
Correlation of Insulin-Like Growth Factor 1 With Cognitive Functions in Mild Traumatic Brain Injury Patients 胰岛素样生长因子1与轻度外伤性脑损伤患者认知功能的相关性
Pub Date : 2023-11-01 DOI: 10.1089/neur.2023.0085
Ju-Chi Ou, Yin-Hsun Feng, Kai-Yun Chen, Yung-Hsiao Chiang, Tsung-I Hsu, Chung-Che Wu
Mild traumatic brain injury (mTBI) is a prevalent health concern with variable recovery trajectories, necessitating reliable prognostic markers. Insulin-like growth factor 1 (IGF-1) emerges as a potential candidate because of its role in cellular growth, repair, and neuroprotection. However, limited studies investigate IGF-1 as a prognostic marker in mTBI patients. This study aimed to explore the correlation of IGF-1 with cognitive functions assessed using the Wisconsin Card Sorting Test (WCST) in mTBI patients. We analyzed data from 295 mTBI and 200 healthy control participants, assessing demographic characteristics, injury causes, and IGF-1 levels. Cognitive functions were evaluated using the WCST. Correlation analyses and regression models were used to investigate the associations between IGF-1 levels, demographic factors, and WCST scores. Significant differences were observed between mTBI and control groups in the proportion of females and average education years. Falls and traffic accidents were identified as the primary causes of mTBI. The mTBI group demonstrated worse cognitive outcomes on the WCST, except for the “Learning to Learn” index. Correlation analyses revealed significant relationships between IGF-1 levels, demographic factors, and specific WCST scores. Regression models demonstrated that IGF-1, age, and education years significantly influenced various WCST scores, suggesting their roles as potential prognostic markers for cognitive outcomes in mTBI patients. We provide valuable insights into the potential correlation of IGF-1 with cognitive functions in mTBI patients, particularly in tasks requiring cognitive flexibility and problem solving.
轻度创伤性脑损伤(mTBI)是一种普遍存在的健康问题,其恢复轨迹多变,需要可靠的预后标志物。胰岛素样生长因子1 (IGF-1)因其在细胞生长、修复和神经保护中的作用而成为潜在的候选者。然而,很少有研究将IGF-1作为mTBI患者的预后指标。本研究旨在探讨IGF-1与mTBI患者认知功能的相关性,采用威斯康星卡片分类测验(WCST)评估。我们分析了295名mTBI参与者和200名健康对照者的数据,评估了人口统计学特征、损伤原因和IGF-1水平。使用WCST评估认知功能。使用相关分析和回归模型来研究IGF-1水平、人口统计学因素和WCST评分之间的关系。mTBI组与对照组在女性比例和平均受教育年限上存在显著差异。跌倒和交通事故被确定为mTBI的主要原因。除了“学会学习”指数外,mTBI组在WCST上表现出更差的认知结果。相关分析显示IGF-1水平、人口统计学因素和特定WCST评分之间存在显著关系。回归模型显示,IGF-1、年龄和受教育年限显著影响各种WCST评分,表明它们是mTBI患者认知结局的潜在预后指标。我们为IGF-1与mTBI患者认知功能的潜在相关性提供了有价值的见解,特别是在需要认知灵活性和解决问题的任务中。
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引用次数: 0
Characterization of Traumatic Brain Injury in a Gyrencephalic Ferret Model Using the Novel Closed Head Injury Model of Engineered Rotational Acceleration (CHIMERA) 利用新型工程旋转加速度闭合性脑损伤模型(CHIMERA)表征脑白头雪貂创伤性脑损伤模型
Pub Date : 2023-11-01 DOI: 10.1089/neur.2023.0047
Justin L. Krieg, Anna V. Leonard, Renee J. Tuner, Frances Corrigan
Traumatic brain injury (TBI) results from mechanical force to the brain and leads to a series of biochemical responses that further damage neurons and supporting cells. Clinically, most TBIs result from an impact to the intact skull, making closed head TBI pre-clinical models highly relevant. However, most of these closed head TBI models use lissencephalic rodents, which may not transduce biomechanical load in the same manner as gyrencephalic humans. To address this translational gap, this study aimed to characterize acute axonal injury and microglial responses in ferrets—the smallest gyrencephalic mammal. Injury was induced in male ferrets (Mustela furo; 1.20–1.51 kg; 6–9 months old) with the novel Closed Head Injury Model of Engineered Rotational Acceleration (CHIMERA) model. Animals were randomly allocated to either sham (n = 4), a 22J (joules) impact (n = 4), or a 27J impact (n = 4). Axonal injury was examined histologically with amyloid precursor protein (APP), neurofilament M (RMO 14.9) (RMO-14), and phosphorylated tau (AT180) and the microglial response with ionized calcium-binding adaptor molecule 1 at 24 h post-injury in gray and white matter regions. Graded axonal injury was observed with modest increases in APP and RMO-14 immunoreactivity in the 22J TBI group, mostly within the corpus callosum and fornix and more extensive diffuse axonal injury encompassing gray matter structures like the thalamus and hypothalamus in the 27J group. Accompanying microglial activation was only observed in the 27J group, most prominently within the white matter tracts in response to the larger amounts of axonal injury. The 27J, but not the 22J, group showed an increase in AT180 within the base of the sulci post-injury. This could suggest that the strain may be highest in this region, demonstrating the different responses in gyrencephalic compared to lissencephalic brains. The CHIMERA model in ferrets mimic many of the histopathological features of human closed head TBI acutely and provides a promising model to investigate the pathophysiology of TBI.
创伤性脑损伤(TBI)是由机械力作用于大脑引起的,并导致一系列生化反应,进一步损害神经元和支持细胞。临床上,大多数脑损伤是由于对完整颅骨的冲击造成的,这使得闭合性脑损伤临床前模型具有很高的相关性。然而,大多数闭式脑损伤模型使用的是无脑啮齿动物,它们可能不会以与脑回动物相同的方式传递生物力学载荷。为了解决这一翻译空白,本研究旨在表征雪貂(最小的脑回哺乳动物)的急性轴突损伤和小胶质细胞反应。雄性雪貂(Mustela furo;1.20 - -1.51公斤;6-9个月大的婴儿)使用新型的封闭头部损伤模型的工程旋转加速度(CHIMERA)模型。动物被随机分配到假手术组(n = 4)、22J(焦耳)撞击组(n = 4)和27J撞击组(n = 4)。用淀粉样蛋白前体蛋白(APP)、神经丝M (RMO 14.9) (RMO-14)和磷酸化tau (AT180)检测轴突损伤,并在损伤后24小时在灰质和白质区域用离子钙结合接头分子1观察小胶质细胞的反应。在22J脑损伤组中,APP和RMO-14免疫反应性轻度增加,主要发生在胼胝体和穹窿内,而在27J脑损伤组中,更广泛的弥漫性轴索损伤包括丘脑和下丘脑等灰质结构。伴随的小胶质细胞激活仅在27J组中观察到,最明显的是在白质束中对大量轴突损伤做出反应。27J组损伤后脑沟底部的AT180增加,而22J组则没有。这可能表明该菌株可能在该区域最高,表明脑回畸形与无脑畸形大脑的反应不同。雪貂CHIMERA模型能较好地模拟人类闭合性脑损伤的许多组织病理特征,为研究脑损伤的病理生理学提供了一种有前景的模型。
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引用次数: 1
Perspectives on Data Sharing in Persons With Spinal Cord Injury 脊髓损伤患者数据共享的展望
Pub Date : 2023-11-01 DOI: 10.1089/neur.2023.0035
Freda M. Warner, Bobo Tong, Jessie McDougall, Kathleen A. Martin Ginis, Alexander G. Rabchevsky, Jacquelyn J. Cragg, John L.K. Kramer
Open data sharing of clinical research aims to improve transparency and support novel scientific discoveries. There are also risks, including participant identification and the potential for stigmatization. The perspectives of persons participating in research are needed to inform open data-sharing policies. The aim of the current study was to determine perspectives on data sharing in persons with spinal cord injury (SCI), including risks and benefits, and types of data people are most willing to share. A secondary aim was to examine predictors of willingness to share data. Persons with SCIs in the United States and Canada completed a survey developed and disseminated through various channels, including our community partner, the North American Spinal Cord Injury Consortium. The study collected data from 232 participants, with 52.2% from Canada and 42.2% from the United States, and the majority completed the survey in English. Most participants had previously participated in research and had been living with an SCI for ≥5 years. Overall, most participants reported that the potential benefits of data sharing outweighed the negatives, with persons with SCI seen as the most trustworthy partners for data sharing. The highest levels of concern were that information could be stolen and companies might use the information for marketing purposes. Persons with SCI were generally supportive of data sharing for research purposes. Clinical trials should consider including a statement on open data sharing in informed consents to better acknowledge the contribution of research participants in future studies.
临床研究的开放数据共享旨在提高透明度并支持新的科学发现。也存在风险,包括参与者身份识别和污名化的可能性。参与研究人员的观点需要为开放数据共享政策提供信息。当前研究的目的是确定脊髓损伤(SCI)患者数据共享的观点,包括风险和收益,以及人们最愿意共享的数据类型。第二个目的是检验共享数据意愿的预测因素。美国和加拿大的脊髓损伤患者完成了一项调查,该调查通过各种渠道进行了开发和传播,包括我们的社区合作伙伴北美脊髓损伤协会。该研究收集了232名参与者的数据,其中52.2%来自加拿大,42.2%来自美国,大多数人用英语完成了调查。大多数参与者以前参加过研究,并且患有SCI≥5年。总体而言,大多数参与者报告说,数据共享的潜在好处大于坏处,SCI患者被视为数据共享最值得信赖的伙伴。最令人担忧的是,信息可能被盗,公司可能将这些信息用于营销目的。SCI患者通常支持为研究目的共享数据。临床试验应考虑在知情同意书中加入关于开放数据共享的声明,以更好地承认研究参与者在未来研究中的贡献。
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引用次数: 0
Retrospective Observational Study of Patients With Subdural Hematoma Treated With Idarucizumab 依达鲁珠单抗治疗硬膜下血肿患者的回顾性观察研究
Pub Date : 2023-11-01 DOI: 10.1089/neur.2023.0065
Eiichi Suehiro, Hideyuki Ishihara, Yohei Kogeichi, Tsunenori Ozawa, Koichi Haraguchi, Masaru Honda, Yumie Honda, Makoto Inaba, Ryusuke Kabeya, Naoaki Kanda, Kenta Koketsu, Nobukuni Murakami, Hidetoshi Nakamoto, Kotaro Oshio, Kuniyasu Saigusa, Takashi Shuto, Shuichi Sugiyama, Kenji Suzuyama, Tsuguaki Terashima, Mitsuharu Tsuura, Mitsutoshi Nakada, Hitoshi Kobata, Toshio Higashi, Nobuyuki Sakai, Michiyasu Suzuki
Use of anticoagulants is increasing with the aging of societies. The safe first-line drug is likely to be a direct oral anticoagulant (DOAC), but outcomes of treatment of traumatic brain injury (TBI) with anticoagulants are uncertain. Therefore, we examined the clinical effect of idarucizumab as reversal therapy in elderly patients with TBI who were treated with dabigatran. A retrospective multi-center observational study was performed in patients ≥65 years of age who developed acute traumatic subdural hematoma during treatment with dabigatran and underwent reversal therapy with idarucizumab. The items examined included patient background, neurological and imaging findings at arrival, course after admission, complications, and outcomes. A total of 23 patients were enrolled in the study. The patients had a mean age of 78.9 years. Cause of TBI was fall in 60.9% of the subjects. Mean Glasgow Coma Scale score at arrival was 8.7; anisocoria was present in 31.8% of cases. Exacerbation of consciousness was found in 30.4%, but only in 13.3% of subjects treated with idarucizumab before consciousness and imaging findings worsened. Dabigatran was discontinued in 81.8% of cases after hematoma development, with a mean withdrawal period of 12.1 days. The favorable outcome rate was 21.7%, and mortality was 39.1%. In multi-variate analysis, timing of idarucizumab administration was associated with a favorable outcome. There were ischemic complications in 3 cases (13.1%), and all three events occurred ≥7 days after administration of idarucizumab. These findings suggest that in cases that develop hematoma during treatment with dabigatran, it is important to administer idarucizumab early and restart dabigatran after conditions stabilize.
抗凝血剂的使用随着社会的老龄化而增加。安全的一线药物可能是直接口服抗凝剂(DOAC),但使用抗凝剂治疗创伤性脑损伤(TBI)的结果尚不确定。因此,我们研究了idarucizumab作为逆转疗法在接受达比加群治疗的老年TBI患者中的临床效果。一项回顾性多中心观察性研究对≥65岁、在达比加群治疗期间出现急性外伤性硬膜下血肿并接受依达鲁单抗逆转治疗的患者进行了研究。检查的项目包括患者背景、到达时的神经学和影像学发现、入院后的病程、并发症和结果。共有23名患者参加了这项研究。患者的平均年龄为78.9岁。60.9%的受试者发生TBI的原因为跌倒。到达时格拉斯哥昏迷评分平均为8.7分;31.8%的病例存在异色性。30.4%的患者意识恶化,但在接受依达鲁珠单抗治疗的患者中,在意识和影像学表现恶化之前,意识恶化仅占13.3%。81.8%的血肿患者停药达比加群,平均停药期为12.1天。良好转归率为21.7%,死亡率为39.1%。在多变量分析中,idarucizumab给药的时机与有利的结果相关。3例(13.1%)出现缺血性并发症,这3例事件均发生在给予依达鲁珠单抗后≥7天。这些发现表明,在使用达比加群治疗期间出现血肿的病例中,早期给药依达鲁单抗并在病情稳定后重新使用达比加群是很重要的。
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引用次数: 0
Antipsychotic Drugs: The Antithesis to Neurorehabilitation in Models of Pre-Clinical Traumatic Brain Injury. 抗精神病药物:临床前创伤性脑损伤模型中神经康复的拮抗剂。
Pub Date : 2023-10-31 eCollection Date: 2023-01-01 DOI: 10.1089/neur.2023.0082
Nicholas S Race, Eleni H Moschonas, Jeffrey P Cheng, Corina O Bondi, Anthony E Kline

Sixty-nine million traumatic brain injuries (TBIs) are reported worldwide each year, and, of those, close to 3 million occur in the United States. In addition to neurobehavioral and cognitive deficits, TBI induces other maladaptive behaviors, such as agitation and aggression, which must be managed for safe, accurate assessment and effective treatment of the patient. The use of antipsychotic drugs (APDs) in TBI is supported by some expert guidelines, which suggests that they are an important part of the pharmacological armamentarium to be used in the management of agitation. Despite the advantages of APDs after TBI, there are significant disadvantages that may not be fully appreciated clinically during decision making because of the lack of a readily available updated compendium. Hence, the aim of this review is to integrate the existing findings and present the current state of APD use in pre-clinical models of TBI. The studies discussed were identified through PubMed and the University of Pittsburgh Library System search strategies and reveal that APDs, particularly those with dopamine2 (D2) receptor antagonism, generally impair the recovery process in rodents of both sexes and, in some instances, attenuate the potential benefits of neurorehabilitation. We believe that the compilation of findings represented by this exhaustive review of pre-clinical TBI + APD models can serve as a convenient source for guiding informed decisions by critical care clinicians and physiatrists contemplating APD use for patients exhibiting agitation.

据报道,全世界每年有6900万例创伤性脑损伤,其中近300万例发生在美国。除了神经行为和认知缺陷外,TBI还会诱发其他适应不良行为,如激动和攻击,必须对这些行为进行管理,以便对患者进行安全、准确的评估和有效的治疗。抗精神病药物(APD)在创伤性脑损伤中的使用得到了一些专家指南的支持,这表明它们是用于治疗躁动的药理学药物的重要组成部分。尽管TBI后APD具有优势,但由于缺乏现成的更新简编,在决策过程中,临床上可能无法充分认识到其显著的缺点。因此,本综述的目的是整合现有研究结果,并介绍APD在TBI临床前模型中的应用现状。所讨论的研究是通过PubMed和匹兹堡大学图书馆系统的搜索策略确定的,并表明APD,特别是那些具有多巴胺2(D2)受体拮抗作用的APD,通常会损害两性啮齿动物的恢复过程,在某些情况下,会削弱神经康复的潜在益处。我们相信,这篇对临床前TBI+APD模型的详尽综述所代表的研究结果汇编,可以作为指导重症监护临床医生和物理治疗师做出知情决策的方便来源,这些临床医生和物理学家考虑将APD用于表现出激动的患者。
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引用次数: 0
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Neurotrauma reports
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