首页 > 最新文献

Neurotrauma reports最新文献

英文 中文
Management of Pediatric Mild Traumatic Brain Injury Patients: S100b, Glial Fibrillary Acidic Protein, and Heart Fatty-Acid-Binding Protein Promising Biomarkers. 小儿轻度脑外伤患者的管理:S100b、胶质纤维酸性蛋白和心脏脂肪酸结合蛋白有望成为生物标志物。
IF 1.8 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-31 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2024.0027
Anne-Cécile Chiollaz, Virginie Pouillard, Fabian Spigariol, Fabrizio Romano, Michelle Seiler, Céline Ritter Schenk, Christian Korff, Céline Habre, Fabienne Maréchal, Verena Wyss, Lyssia Gruaz, Marcel Lamana-Vallverdu, Elvira Chocano, Lluis Sempere Bordes, Carlos Luaces-Cubells, María Méndez-Hernández, José Antonio Alonso Cadenas, María José Carpio Linde, Paula de la Torre Sanchez

Children are highly vulnerable to mild traumatic brain injury (mTBI). Blood biomarkers can help in their management. This study evaluated the performances of biomarkers, in discriminating between children with mTBI who had intracranial injuries (ICIs) on computed tomography (CT+) and (1) patients without ICI (CT-) or (2) both CT- and in-hospital-observation without CT patients. The aim was to rule out the need of unnecessary CT scans and decrease the length of stay in observation in the emergency department (ED). Newborns to teenagers (≤16 years old) with mTBI (Glasgow Coma Scale > 13) were included. S100b, glial fibrillary acidic protein (GFAP), and heart fatty-acid-binding protein (HFABP) performances to identify patients without ICI were evaluated through receiver operating characteristic curves, where sensitivity was set at 100%. A total of 222 mTBI children sampled within 6 h since their trauma were reported. Nineteen percent (n = 43/222) underwent CT scan examination, whereas the others (n = 179/222) were kept in observation at the ED. Sixteen percent (n = 7/43) of the children who underwent a CT scan had ICI, corresponding to 3% of all mTBI-included patients. When sensibility (SE) was set at 100% to exclude all patients with ICI, GFAP yielded 39% specificity (SP), HFABP 37%, and S100b 34% to rule out the need of CT scans. These biomarkers were even more performant: 52% SP for GFAP, 41% for HFABP, and 39% for S100b, when discriminating CT+ versus both in-hospital-observation and CT- patients. These markers can significantly help in the management of patients in the ED, avoiding unnecessary CT scans, and reducing length of stay for children and their families.

儿童极易受到轻微创伤性脑损伤(mTBI)的影响。血液生物标志物有助于对他们进行管理。本研究评估了生物标志物在区分计算机断层扫描(CT+)显示有颅内损伤(ICIs)的轻度脑损伤儿童和(1)无颅内损伤(ICIs)的患者(CT-)或(2)CT-和院内观察无CT患者的性能。目的是排除不必要的 CT 扫描,缩短急诊科(ED)的观察时间。研究对象包括患有 mTBI(格拉斯哥昏迷量表>13)的新生儿至青少年(≤16 岁)。通过接收器操作特征曲线评估了S100b、神经胶质纤维酸性蛋白(GFAP)和心脏脂肪酸结合蛋白(HFABP)在识别无ICI患者方面的性能,灵敏度设定为100%。共报告了 222 名在创伤后 6 小时内采样的 mTBI 儿童。19%的儿童(n = 43/222)接受了 CT 扫描检查,而其他儿童(n = 179/222)则在急诊室接受观察。在接受 CT 扫描的儿童中,16%(n = 7/43)患有 ICI,占所有 mTBI 患者的 3%。如果将排除所有 ICI 患者的敏感性(SE)设为 100%,则排除 CT 扫描需要的特异性(SP)为 GFAP 39%、HFABP 37%、S100b 34%。这些生物标记物的表现甚至更好:在区分 CT+患者与院内观察和 CT- 患者时,GFAP 的特异性为 52%,HFABP 为 41%,S100b 为 39%。这些标记物对急诊室患者的管理大有帮助,可避免不必要的 CT 扫描,缩短儿童及其家人的住院时间。
{"title":"Management of Pediatric Mild Traumatic Brain Injury Patients: S100b, Glial Fibrillary Acidic Protein, and Heart Fatty-Acid-Binding Protein Promising Biomarkers.","authors":"Anne-Cécile Chiollaz, Virginie Pouillard, Fabian Spigariol, Fabrizio Romano, Michelle Seiler, Céline Ritter Schenk, Christian Korff, Céline Habre, Fabienne Maréchal, Verena Wyss, Lyssia Gruaz, Marcel Lamana-Vallverdu, Elvira Chocano, Lluis Sempere Bordes, Carlos Luaces-Cubells, María Méndez-Hernández, José Antonio Alonso Cadenas, María José Carpio Linde, Paula de la Torre Sanchez","doi":"10.1089/neur.2024.0027","DOIUrl":"10.1089/neur.2024.0027","url":null,"abstract":"<p><p>Children are highly vulnerable to mild traumatic brain injury (mTBI). Blood biomarkers can help in their management. This study evaluated the performances of biomarkers, in discriminating between children with mTBI who had intracranial injuries (ICIs) on computed tomography (CT+) and (1) patients without ICI (CT-) or (2) both CT- and in-hospital-observation without CT patients. The aim was to rule out the need of unnecessary CT scans and decrease the length of stay in observation in the emergency department (ED). Newborns to teenagers (≤16 years old) with mTBI (Glasgow Coma Scale > 13) were included. S100b, glial fibrillary acidic protein (GFAP), and heart fatty-acid-binding protein (HFABP) performances to identify patients without ICI were evaluated through receiver operating characteristic curves, where sensitivity was set at 100%. A total of 222 mTBI children sampled within 6 h since their trauma were reported. Nineteen percent (<i>n</i> = 43/222) underwent CT scan examination, whereas the others (<i>n</i> = 179/222) were kept in observation at the ED. Sixteen percent (<i>n</i> = 7/43) of the children who underwent a CT scan had ICI, corresponding to 3% of all mTBI-included patients. When sensibility (SE) was set at 100% to exclude all patients with ICI, GFAP yielded 39% specificity (SP), HFABP 37%, and S100b 34% to rule out the need of CT scans. These biomarkers were even more performant: 52% SP for GFAP, 41% for HFABP, and 39% for S100b, when discriminating CT+ versus both in-hospital-observation and CT- patients. These markers can significantly help in the management of patients in the ED, avoiding unnecessary CT scans, and reducing length of stay for children and their families.</p>","PeriodicalId":74300,"journal":{"name":"Neurotrauma reports","volume":"5 1","pages":"529-539"},"PeriodicalIF":1.8,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11271147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Cumulative Incidence of Post-Traumatic Epilepsy After Mild Traumatic Brain Injury: A Systematic Review and Individual Participant Data Meta-Analysis Protocol. 轻度脑外伤后创伤后癫痫的累积发病率:系统综述与个体参与者数据元分析协议》。
IF 1.8 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-31 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0117
Joshua Z Goldenberg, Richard Davis Batson, Mary Jo Pugh, Heather Zwickey, Jennifer Beardsley, Maurice P Zeegers, Michael Freeman

A precise understanding of the latency to post-traumatic epilepsy (PTE) following a traumatic brain injury (TBI) is necessary for optimal patient care. This precision is currently lacking despite a surprising number of available data sources that could address this pressing need. Following guidance from the Cochrane Collaboration and Joanna Briggs Institute, we conduct a systematic review to address the research questions: What is the cumulative incidence of PTE following mild TBI (mTBI; concussion), and what is the distribution of the latency to onset? We designed a comprehensive search of medical databases and gray literature sources. Citations will be screened on both abstract and full-text levels, independently and in duplicate. Studies will be evaluated for risk of bias independently and in duplicate using published instruments specific to incidence/prevalence studies. Data will be abstracted independently and in duplicate using piloted extraction forms. Disagreements will be resolved by consensus or third-party adjudication. Evidence synthesis will involve pairwise and individual participant data meta-analysis with heterogeneity explored via a set of predetermined subgroups. The robustness of the findings will be subjected to sensitivity analyses based on the risk of bias, outlier studies, and mTBI definitional criteria. The overall certainty in the estimates will be reported using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). This protocol presents an innovative and impactful approach to build on the growing body of knowledge surrounding post-mTBI PTE. Through a precise understanding of the latency period, this study can contribute to early detection, tailored interventions, and improved outcomes, leading to a substantial impact on patient care and quality of life.

准确了解创伤性脑损伤 (TBI) 后发生创伤后癫痫 (PTE) 的潜伏期对于优化患者护理非常必要。尽管有数量惊人的可用数据源可以满足这一迫切需求,但目前还缺乏这种精确性。根据 Cochrane 协作组织和乔安娜-布里格斯研究所的指导,我们开展了一项系统性综述,以解决以下研究问题:轻度 TBI(mTBI;脑震荡)后 PTE 的累积发病率是多少?我们对医学数据库和灰色文献资料进行了全面检索。我们将在摘要和全文两个层面对引文进行独立、重复的筛选。将使用已发布的发病率/流行率研究专用工具对研究进行独立评估,评估结果一式两份。将使用试行的数据提取表对数据进行一式两份的独立摘要。出现分歧时,将通过共识或第三方裁定来解决。证据综合将包括配对分析和单个参与者数据荟萃分析,并通过一组预先确定的分组探讨异质性。将根据偏倚风险、离群研究和 mTBI 定义标准对研究结果的稳健性进行敏感性分析。将使用 GRADE(建议、评估、发展和评价分级)报告估算结果的总体确定性。本方案提出了一种创新而有影响力的方法,以不断增长的有关创伤后脑损伤后 PTE 的知识为基础。通过对潜伏期的精确了解,这项研究可有助于早期检测、有针对性的干预和改善预后,从而对患者护理和生活质量产生重大影响。
{"title":"The Cumulative Incidence of Post-Traumatic Epilepsy After Mild Traumatic Brain Injury: A Systematic Review and Individual Participant Data Meta-Analysis Protocol.","authors":"Joshua Z Goldenberg, Richard Davis Batson, Mary Jo Pugh, Heather Zwickey, Jennifer Beardsley, Maurice P Zeegers, Michael Freeman","doi":"10.1089/neur.2023.0117","DOIUrl":"10.1089/neur.2023.0117","url":null,"abstract":"<p><p>A precise understanding of the latency to post-traumatic epilepsy (PTE) following a traumatic brain injury (TBI) is necessary for optimal patient care. This precision is currently lacking despite a surprising number of available data sources that could address this pressing need. Following guidance from the Cochrane Collaboration and Joanna Briggs Institute, we conduct a systematic review to address the research questions: What is the cumulative incidence of PTE following mild TBI (mTBI; concussion), and what is the distribution of the latency to onset? We designed a comprehensive search of medical databases and gray literature sources. Citations will be screened on both abstract and full-text levels, independently and in duplicate. Studies will be evaluated for risk of bias independently and in duplicate using published instruments specific to incidence/prevalence studies. Data will be abstracted independently and in duplicate using piloted extraction forms. Disagreements will be resolved by consensus or third-party adjudication. Evidence synthesis will involve pairwise and individual participant data meta-analysis with heterogeneity explored via a set of predetermined subgroups. The robustness of the findings will be subjected to sensitivity analyses based on the risk of bias, outlier studies, and mTBI definitional criteria. The overall certainty in the estimates will be reported using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). This protocol presents an innovative and impactful approach to build on the growing body of knowledge surrounding post-mTBI PTE. Through a precise understanding of the latency period, this study can contribute to early detection, tailored interventions, and improved outcomes, leading to a substantial impact on patient care and quality of life.</p>","PeriodicalId":74300,"journal":{"name":"Neurotrauma reports","volume":"5 1","pages":"522-528"},"PeriodicalIF":1.8,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11257128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association of Auditory Interference and Ocular-Motor Response with Subconcussive Head Impacts in Adolescent Football Players. 青少年足球运动员的听觉干扰和眼球运动反应与头部次撞击的关系
IF 1.8 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-31 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0125
Zachary S Bellini, Grace O Recht, Taylor R Zuidema, Kyle A Kercher, Sage H Sweeney, Jesse A Steinfeldt, Keisuke Kawata

The aim of this study was to examine whether neuro-ophthalmological function, as assessed by the King-Devick test (KDT), alters during a high school football season and to explore the role of auditory interference on the sensitivity of KDT. During the 2021 and 2022 high school football seasons, football players' neuro-ophthalmological function was assessed at five time points (preseason, three in-season, postseason), whereas control athletes were assessed at preseason and postseason. Two-hundred ten football players and 80 control athletes participated in the study. The year 1 cohort (n = 94 football, n = 10 control) was tested with a conventional KDT, whereas the year 2 cohort (n = 116 football, n = 70 control) was tested with KDT while listening to loud traffic sounds to induce auditory interference. There were improvements in KDT during a season among football players, regardless of conventional KDT (preseason 53.4 ± 9.3 vs. postseason 46.4 ± 8.5 sec; β = -1.7, SE = 0.12, p < 0.01) or KDT with auditory interference (preseason 52.3 ± 11.5 vs. postseason 45.1 ± 9.5 sec; β = -1.7, SE = 0.11, p < 0.001). The degree of improvement was similar between the tests, with no significant group-by-time interaction (β = -0.08, SE = 0.17, p = 0.65). The control athletes also improved KDT performance at a similar degree as the football cohorts in both KDT conditions. Our data suggest that KDT performance improves during a season, regardless of auditory interference or head impact exposure. KDT performance was not impacted by a noisy environment, supporting its sideline utility for screening more severe forms of injury.

本研究旨在探讨在高中橄榄球赛季中,通过 King-Devick 测试(KDT)评估的神经眼科功能是否会发生变化,并探索听觉干扰对 KDT 灵敏度的影响。在 2021 年和 2022 年高中橄榄球赛季期间,在五个时间点(季前赛、季中赛、季后赛)对橄榄球运动员的神经眼科功能进行了评估,而在季前赛和季后赛对对照组运动员进行了评估。共有 210 名足球运动员和 80 名对照组运动员参加了这项研究。第一年的队列(94 名足球运动员,10 名对照组运动员)使用传统的 KDT 进行测试,而第二年的队列(116 名足球运动员,70 名对照组运动员)则使用 KDT 进行测试,同时聆听响亮的交通声音以诱发听觉干扰。在一个赛季中,不论是传统的 KDT(季前赛 53.4 ± 9.3 vs. 季后赛 46.4 ± 8.5 秒;β = -1.7, SE = 0.12, p < 0.01)还是听觉干扰下的 KDT(季前赛 52.3 ± 11.5 vs. 季后赛 45.1 ± 9.5 秒;β = -1.7, SE = 0.11, p < 0.001),足球运动员的 KDT 都有所提高。不同测试之间的改善程度相似,没有明显的组间时间交互作用(β = -0.08,SE = 0.17,p = 0.65)。对照组运动员在两种 KDT 条件下的 KDT 成绩提高程度也与足球组相似。我们的数据表明,无论听觉干扰或头部撞击情况如何,KDT 成绩在一个赛季中都会提高。KDT 性能不受嘈杂环境的影响,这支持了其在筛查更严重形式损伤时的边线效用。
{"title":"Association of Auditory Interference and Ocular-Motor Response with Subconcussive Head Impacts in Adolescent Football Players.","authors":"Zachary S Bellini, Grace O Recht, Taylor R Zuidema, Kyle A Kercher, Sage H Sweeney, Jesse A Steinfeldt, Keisuke Kawata","doi":"10.1089/neur.2023.0125","DOIUrl":"10.1089/neur.2023.0125","url":null,"abstract":"<p><p>The aim of this study was to examine whether neuro-ophthalmological function, as assessed by the King-Devick test (KDT), alters during a high school football season and to explore the role of auditory interference on the sensitivity of KDT. During the 2021 and 2022 high school football seasons, football players' neuro-ophthalmological function was assessed at five time points (preseason, three in-season, postseason), whereas control athletes were assessed at preseason and postseason. Two-hundred ten football players and 80 control athletes participated in the study. The year 1 cohort (<i>n</i> = 94 football, <i>n</i> = 10 control) was tested with a conventional KDT, whereas the year 2 cohort (<i>n</i> = 116 football, <i>n</i> = 70 control) was tested with KDT while listening to loud traffic sounds to induce auditory interference. There were improvements in KDT during a season among football players, regardless of conventional KDT (preseason 53.4 ± 9.3 vs. postseason 46.4 ± 8.5 sec; β = -1.7, SE = 0.12, <i>p</i> < 0.01) or KDT with auditory interference (preseason 52.3 ± 11.5 vs. postseason 45.1 ± 9.5 sec; β = -1.7, SE = 0.11, <i>p</i> < 0.001). The degree of improvement was similar between the tests, with no significant group-by-time interaction (β = -0.08, SE = 0.17, <i>p</i> = 0.65). The control athletes also improved KDT performance at a similar degree as the football cohorts in both KDT conditions. Our data suggest that KDT performance improves during a season, regardless of auditory interference or head impact exposure. KDT performance was not impacted by a noisy environment, supporting its sideline utility for screening more severe forms of injury.</p>","PeriodicalId":74300,"journal":{"name":"Neurotrauma reports","volume":"5 1","pages":"512-521"},"PeriodicalIF":1.8,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
"Roberto Rodríguez" General Teaching Hospital of Moron, Ciego De Avila, Cuba, Neurosurgery and Pediatric Intensive Care Services Pediatric Neuromonitoring in Severe Head Trauma. 古巴谢戈德阿维拉莫龙 "罗伯托-罗德里格斯 "教学总医院,神经外科和儿科重症监护服务严重头部创伤的儿科神经监测。
IF 1.8 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-29 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2024.0031
Daysi Abreu Pérez, Angel J Lacerda Gallardo, Jose Antonio Gálvez

Among all types of trauma in children, traumatic brain injury has the greatest potential for the development of devastating consequences, with nearly three million affected each year in the world. A controlled, nonrandomized experimental study was carried out in pediatric patients with severe traumatic brain injury, whose objective was to evaluate the use of continuous multimodal neuromonitoring (MMN) of intracranial parameters as a guide in the treatment of children of different age-groups. The patients were divided into two groups according to the treatment received; clinical and imaging monitoring was performed in both. Group I included those whose treatment was guided by MMN of intracranial parameters such as intracranial pressure, cerebral perfusion pressure, and intracranial compliance, and group II included those who had only clinical and imaging monitoring. Eighty patients were studied, 41 in group I and 39 in group II. There were no significant differences between the groups with respect to the sociodemographic variables and the results; as a consequence, both forms of treatment were outlined, for patients with MMN and for those who only have clinical and imaging monitoring. It is concluded that both treatment schemes can be used depending on technological availability, although the scheme with MMN is optimal.

在所有类型的儿童创伤中,脑外伤最有可能造成破坏性后果,全世界每年有近 300 万人受到脑外伤的影响。我们在严重脑外伤的儿童患者中开展了一项非随机对照实验研究,目的是评估颅内参数连续多模态神经监测(MMN)作为不同年龄组儿童治疗指南的使用情况。根据所接受的治疗将患者分为两组,两组均进行临床和影像学监测。第一组包括以颅内压、脑灌注压和颅内顺应性等颅内参数 MMN 指导治疗的患者,第二组包括仅接受临床和影像学监测的患者。共研究了 80 名患者,其中 I 组 41 人,II 组 39 人。在社会人口学变量和结果方面,各组之间没有明显差异;因此,对 MMN 患者和仅接受临床和影像学监测的患者,两种治疗方式均适用。结论是,两种治疗方案都可以使用,具体取决于技术的可用性,但 MMN 方案是最佳方案。
{"title":"\"Roberto Rodríguez\" General Teaching Hospital of Moron, Ciego De Avila, Cuba, Neurosurgery and Pediatric Intensive Care Services Pediatric Neuromonitoring in Severe Head Trauma.","authors":"Daysi Abreu Pérez, Angel J Lacerda Gallardo, Jose Antonio Gálvez","doi":"10.1089/neur.2024.0031","DOIUrl":"10.1089/neur.2024.0031","url":null,"abstract":"<p><p>Among all types of trauma in children, traumatic brain injury has the greatest potential for the development of devastating consequences, with nearly three million affected each year in the world. A controlled, nonrandomized experimental study was carried out in pediatric patients with severe traumatic brain injury, whose objective was to evaluate the use of continuous multimodal neuromonitoring (MMN) of intracranial parameters as a guide in the treatment of children of different age-groups. The patients were divided into two groups according to the treatment received; clinical and imaging monitoring was performed in both. Group I included those whose treatment was guided by MMN of intracranial parameters such as intracranial pressure, cerebral perfusion pressure, and intracranial compliance, and group II included those who had only clinical and imaging monitoring. Eighty patients were studied, 41 in group I and 39 in group II. There were no significant differences between the groups with respect to the sociodemographic variables and the results; as a consequence, both forms of treatment were outlined, for patients with MMN and for those who only have clinical and imaging monitoring. It is concluded that both treatment schemes can be used depending on technological availability, although the scheme with MMN is optimal.</p>","PeriodicalId":74300,"journal":{"name":"Neurotrauma reports","volume":"5 1","pages":"497-511"},"PeriodicalIF":1.8,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11257106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141736335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Associations Between Intracranial Pressure Extremes and Continuous Metrics of Cerebrovascular Pressure Reactivity in Acute Traumatic Neural Injury: A Scoping Review. 急性创伤性神经损伤中颅内压极值与脑血管压力反应性连续指标之间的关系:范围综述》。
IF 1.8 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-29 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0115
Kevin Y Stein, Fiorella Amenta, Logan Froese, Alwyn Gomez, Amanjyot Singh Sainbhi, Nuray Vakitbilir, Younis Ibrahim, Abrar Islam, Tobias Bergmann, Izabella Marquez, Frederick A Zeiler

Cerebrovascular pressure reactivity plays a key role in maintaining constant cerebral blood flow. Unfortunately, this mechanism is often impaired in acute traumatic neural injury states, exposing the already injured brain to further pressure-passive insults. While there has been much work on the association between impaired cerebrovascular reactivity following moderate/severe traumatic brain injury (TBI) and worse long-term outcomes, there is yet to be a comprehensive review on the association between cerebrovascular pressure reactivity and intracranial pressure (ICP) extremes. Therefore, we conducted a systematic review of the literature for all studies presenting a quantifiable statistical association between a continuous measure of cerebrovascular pressure reactivity and ICP in a human TBI cohort. The methodology described in the Cochrane Handbook for Systematic Reviews was used. BIOSIS, Cochrane Library, EMBASE, Global Health, MEDLINE, and SCOPUS were all searched from their inceptions to March of 2023 for relevant articles. Full-length original works with a sample size of ≥10 patients with moderate/severe TBI were included in this review. Data were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A total of 16 articles were included in this review. Studies varied in population characteristics and statistical tests used. Five studies looked at transcranial Doppler-based indices and 13 looked at ICP-based indices. All but two studies were able to present a statistically significant association between cerebrovascular pressure reactivity and ICP. Based on the findings of this review, impaired reactivity seems to be associated with elevated ICP and reduced ICP waveform complexity. This relationship may allow for the calculation of patient-specific ICP thresholds, past which cerebrovascular reactivity becomes persistently deranged. However, further work is required to better understand this relationship and improve algorithmic derivation of such individualized ICP thresholds.

脑血管压力反应在维持恒定脑血流方面发挥着关键作用。不幸的是,这种机制在急性创伤性神经损伤状态下往往会受到损害,使已经受伤的大脑进一步受到压力被动性损伤。关于中度/重度创伤性脑损伤(TBI)后脑血管反应性受损与更差的长期预后之间的关系已有很多研究,但关于脑血管压力反应性与颅内压(ICP)极值之间的关系还没有全面的综述。因此,我们对所有在人类 TBI 队列中连续测量脑血管压力反应性与 ICP 之间存在可量化统计关联的研究文献进行了系统性回顾。采用了《Cochrane 系统综述手册》中描述的方法。在 BIOSIS、Cochrane 图书馆、EMBASE、Global Health、MEDLINE 和 SCOPUS 中检索了自其成立至 2023 年 3 月的所有相关文章。样本量≥10 例中度/重度创伤性脑损伤患者的长篇原创文章被纳入本综述。数据按照《系统综述和元分析首选报告项目》进行报告。本综述共纳入 16 篇文章。研究的人群特征和使用的统计检验方法各不相同。5 项研究关注基于经颅多普勒的指数,13 项研究关注基于 ICP 的指数。除两项研究外,其他所有研究均显示脑血管压力反应性与 ICP 之间存在统计学意义上的显著关联。根据本综述的研究结果,反应性受损似乎与 ICP 升高和 ICP 波形复杂性降低有关。根据这种关系,可以计算出患者特定的 ICP 阈值,超过该阈值,脑血管反应性就会持续失常。然而,要更好地理解这种关系并改进这种个体化 ICP 阈值的算法推导,还需要进一步的工作。
{"title":"Associations Between Intracranial Pressure Extremes and Continuous Metrics of Cerebrovascular Pressure Reactivity in Acute Traumatic Neural Injury: A Scoping Review.","authors":"Kevin Y Stein, Fiorella Amenta, Logan Froese, Alwyn Gomez, Amanjyot Singh Sainbhi, Nuray Vakitbilir, Younis Ibrahim, Abrar Islam, Tobias Bergmann, Izabella Marquez, Frederick A Zeiler","doi":"10.1089/neur.2023.0115","DOIUrl":"10.1089/neur.2023.0115","url":null,"abstract":"<p><p>Cerebrovascular pressure reactivity plays a key role in maintaining constant cerebral blood flow. Unfortunately, this mechanism is often impaired in acute traumatic neural injury states, exposing the already injured brain to further pressure-passive insults. While there has been much work on the association between impaired cerebrovascular reactivity following moderate/severe traumatic brain injury (TBI) and worse long-term outcomes, there is yet to be a comprehensive review on the association between cerebrovascular pressure reactivity and intracranial pressure (ICP) extremes. Therefore, we conducted a systematic review of the literature for all studies presenting a quantifiable statistical association between a continuous measure of cerebrovascular pressure reactivity and ICP in a human TBI cohort. The methodology described in the Cochrane Handbook for Systematic Reviews was used. BIOSIS, Cochrane Library, EMBASE, Global Health, MEDLINE, and SCOPUS were all searched from their inceptions to March of 2023 for relevant articles. Full-length original works with a sample size of ≥10 patients with moderate/severe TBI were included in this review. Data were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A total of 16 articles were included in this review. Studies varied in population characteristics and statistical tests used. Five studies looked at transcranial Doppler-based indices and 13 looked at ICP-based indices. All but two studies were able to present a statistically significant association between cerebrovascular pressure reactivity and ICP. Based on the findings of this review, impaired reactivity seems to be associated with elevated ICP and reduced ICP waveform complexity. This relationship may allow for the calculation of patient-specific ICP thresholds, past which cerebrovascular reactivity becomes persistently deranged. However, further work is required to better understand this relationship and improve algorithmic derivation of such individualized ICP thresholds.</p>","PeriodicalId":74300,"journal":{"name":"Neurotrauma reports","volume":"5 1","pages":"483-496"},"PeriodicalIF":1.8,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11257139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Correlation Between Volume and Pressure of Intracranial Space With Craniectomy Surface Area and Brain Herniation: A Phantom-Based Study. 颅内空间体积和压力与颅骨切除表面积和脑疝之间的相关性:基于模型的研究。
Q3 CLINICAL NEUROLOGY Pub Date : 2024-03-27 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2024.0006
Sudip Kumar Sengupta, Rohit Aggarwal, Manish Kumar Singh

There are proponents of decompressive craniectomy (DC) and its various modifications who claim reasonable clinical outcomes for each of them. Clinical outcome in cases of traumatic brain injury, managed conservatively or aided by different surgical techniques, depends on multiple factors, which vary widely among patients and have complex interplay, making it difficult to compare one case with another in absolute terms. This forms the basis of the perceived necessity to have a standard model to study, compare, and strategize in this field. We designed a phantom-based model and present the findings of the study aimed at establishing a correlation of the volume of intracranial space and changes in intracranial pressure (ICP) with surface area of the craniectomy defect created during DC and brain herniation volume. A roughly hemispherical radio-opaque container was scanned on a 128-slice computed tomography scanner. Craniectomies of different sizes and shapes were marked on the walls of the phantom. Two spherical sacs of stretchable materials were subsequently placed inside the phantom, fixed to three-way connectors, filled with water, and connected with transducers. The terminals of the transducer cables were coupled with the display monitor through a signal amplifier and processor module. Parts of the wall of the phantom were removed to let portions of the sac herniate through the defect, simulating a DC. Volume measurements using AW volume share 7® software were done. Resection of a 12.7 × 11.5 cm part of the wall resulted in a 10-cm-diameter defect in the wall. Volume differential of 35 mL created a midline shift of 5 mm to the side with lesser volume. When measuring pressure in two stretchable sacs contained inside the phantom, there always remained a pressure differential ranging from 1 to 2 mm Hg in different recordings, even with sacs on both sides containing an equal volume of fluids. Creating a circular wall defect of 10 cm in diameter with an intracavitary pressure of 35 mm Hg on the ipsilateral sac and 33 mm on the contralateral sac recorded with intact walls, resulted in a true volume expansion of 48.411 cm3. The herniation resulted in a reduction of pressure in both sacs, with the pressure recorded as 25 mm in the ipsilateral sac and 24 mm in the contralateral sac. The findings closely matched those of the other model-based studies. Refinement of the materials used is likely to provide a valid platform to study cranial volume, ICP, craniectomy size, and brain prolapse volume in real time. The model will help in pre-operatively choosing the most appropriate technique between a classical DC, a hinge craniotomy, and an expansive cranioplasty technique in cases of refractory raised ICP.

有些人支持减压开颅术(DC)及其各种改良方法,并声称每种方法都能取得合理的临床疗效。脑外伤病例的临床疗效取决于多种因素,这些因素在患者之间差异很大,而且相互影响十分复杂,因此很难将一个病例与另一个病例进行绝对比较。因此,我们认为有必要建立一个标准模型,以便在这一领域进行研究、比较和制定战略。我们设计了一个基于模型的模型,并展示了研究结果,该模型旨在建立颅内空间体积和颅内压(ICP)变化与 DC 期间形成的颅骨切除缺损表面积和脑疝体积之间的相关性。在 128 层计算机断层扫描仪上对一个大致呈半球形的放射性不透明容器进行扫描。不同大小和形状的颅骨切口被标记在模型壁上。随后,将两个由可拉伸材料制成的球形囊放入模型内,固定在三通连接器上,注入水,并连接上传感器。传感器电缆的终端通过信号放大器和处理器模块与显示监视器相连。移除部分模型壁,让部分囊疝出,模拟直流。使用 AW volume share 7® 软件进行体积测量。切除 12.7 × 11.5 厘米的部分腔壁后,腔壁上出现了一个直径为 10 厘米的缺损。35 毫升的容积差导致中线向容积较小的一侧偏移 5 毫米。在测量模型内部两个可拉伸囊的压力时,即使两侧囊中的液体量相等,在不同的记录中也始终存在 1 到 2 毫米汞柱的压力差。在同侧囊壁完整的情况下,在同侧囊壁上产生 35 毫米汞柱的腔内压力,在对侧囊壁上产生 33 毫米汞柱的腔内压力,形成直径为 10 厘米的圆形囊壁缺损,从而导致 48.411 立方厘米的真实体积膨胀。疝气导致两个膀胱的压力降低,同侧膀胱的压力记录为 25 毫米,对侧膀胱的压力记录为 24 毫米。研究结果与其他基于模型的研究结果非常吻合。对所用材料的改进有可能为实时研究颅容量、ICP、开颅手术大小和脑脱垂体积提供一个有效的平台。该模型将有助于术前在经典 DC、铰链开颅术和扩张性开颅术之间选择最适合难治性 ICP 升高病例的技术。
{"title":"Correlation Between Volume and Pressure of Intracranial Space With Craniectomy Surface Area and Brain Herniation: A Phantom-Based Study.","authors":"Sudip Kumar Sengupta, Rohit Aggarwal, Manish Kumar Singh","doi":"10.1089/neur.2024.0006","DOIUrl":"10.1089/neur.2024.0006","url":null,"abstract":"<p><p>There are proponents of decompressive craniectomy (DC) and its various modifications who claim reasonable clinical outcomes for each of them. Clinical outcome in cases of traumatic brain injury, managed conservatively or aided by different surgical techniques, depends on multiple factors, which vary widely among patients and have complex interplay, making it difficult to compare one case with another in absolute terms. This forms the basis of the perceived necessity to have a standard model to study, compare, and strategize in this field. We designed a phantom-based model and present the findings of the study aimed at establishing a correlation of the volume of intracranial space and changes in intracranial pressure (ICP) with surface area of the craniectomy defect created during DC and brain herniation volume. A roughly hemispherical radio-opaque container was scanned on a 128-slice computed tomography scanner. Craniectomies of different sizes and shapes were marked on the walls of the phantom. Two spherical sacs of stretchable materials were subsequently placed inside the phantom, fixed to three-way connectors, filled with water, and connected with transducers. The terminals of the transducer cables were coupled with the display monitor through a signal amplifier and processor module. Parts of the wall of the phantom were removed to let portions of the sac herniate through the defect, simulating a DC. Volume measurements using AW volume share 7<sup>®</sup> software were done. Resection of a 12.7 × 11.5 cm part of the wall resulted in a 10-cm-diameter defect in the wall. Volume differential of 35 mL created a midline shift of 5 mm to the side with lesser volume. When measuring pressure in two stretchable sacs contained inside the phantom, there always remained a pressure differential ranging from 1 to 2 mm Hg in different recordings, even with sacs on both sides containing an equal volume of fluids. Creating a circular wall defect of 10 cm in diameter with an intracavitary pressure of 35 mm Hg on the ipsilateral sac and 33 mm on the contralateral sac recorded with intact walls, resulted in a true volume expansion of 48.411 cm<sup>3</sup>. The herniation resulted in a reduction of pressure in both sacs, with the pressure recorded as 25 mm in the ipsilateral sac and 24 mm in the contralateral sac. The findings closely matched those of the other model-based studies. Refinement of the materials used is likely to provide a valid platform to study cranial volume, ICP, craniectomy size, and brain prolapse volume in real time. The model will help in pre-operatively choosing the most appropriate technique between a classical DC, a hinge craniotomy, and an expansive cranioplasty technique in cases of refractory raised ICP.</p>","PeriodicalId":74300,"journal":{"name":"Neurotrauma reports","volume":"5 1","pages":"293-303"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10979661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Robotic Postural Training With Epidural Stimulation for the Recovery of Upright Postural Control in Individuals With Motor Complete Spinal Cord Injury: A Pilot Study. 通过硬膜外刺激进行机器人姿势训练,帮助运动性完全脊髓损伤患者恢复直立姿势控制:试点研究。
Q3 CLINICAL NEUROLOGY Pub Date : 2024-03-15 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2024.0013
Enrico Rejc, Collin Bowersock, Tanvi Pisolkar, Isirame Omofuma, Tatiana Luna, Moiz Khan, Victor Santamaria, Beatrice Ugiliweneza, Claudia A Angeli, Gail F Forrest, Joel Stein, Sunil Agrawal, Susan J Harkema

Activity-based training and lumbosacral spinal cord epidural stimulation (scES) have the potential to restore standing and walking with self-balance assistance after motor complete spinal cord injury (SCI). However, improvements in upright postural control have not previously been addressed in this population. Here, we implemented a novel robotic postural training with scES, performed with free hands, to restore upright postural control in individuals with chronic, cervical (n = 5) or high-thoracic (n = 1) motor complete SCI, who had previously undergone stand training with scES using a walker or a standing frame for self-balance assistance. Robotic postural training re-enabled and/or largely improved the participants' ability to control steady standing, self-initiated trunk movements and upper limb reaching movements while standing with free hands, receiving only external assistance for pelvic control. These improvements were associated with neuromuscular activation pattern adaptations above and below the lesion. These findings suggest that the human spinal cord below the level of injury can generate meaningful postural responses when its excitability is modulated by scES, and can learn to improve these responses. Upright postural control improvements can enhance functional motor recovery promoted by scES after severe SCI.

以活动为基础的训练和腰骶部脊髓硬膜外刺激(scES)有可能在运动性完全脊髓损伤(SCI)后通过自我平衡辅助恢复站立和行走。然而,在这一人群中,直立姿势控制的改善以前还没有涉及。在这里,我们使用 scES 进行了一种新颖的机器人姿势训练,这种训练是用双手进行的,目的是恢复慢性颈椎(5 人)或高胸椎(1 人)运动性完全脊髓损伤患者的直立姿势控制能力。机器人姿势训练使参与者重新获得和/或在很大程度上提高了控制稳定站立、自发躯干运动和上肢伸展运动的能力,同时他们还能双手自由站立,仅在骨盆控制方面接受外部辅助。这些改善与病变部位上下的神经肌肉激活模式适应有关。这些研究结果表明,当脊髓兴奋性受到 scES 调节时,损伤水平以下的人体脊髓可以产生有意义的姿势反应,并且可以通过学习改善这些反应。直立姿势控制的改善可以增强严重损伤后通过scES促进的功能性运动恢复。
{"title":"Robotic Postural Training With Epidural Stimulation for the Recovery of Upright Postural Control in Individuals With Motor Complete Spinal Cord Injury: A Pilot Study.","authors":"Enrico Rejc, Collin Bowersock, Tanvi Pisolkar, Isirame Omofuma, Tatiana Luna, Moiz Khan, Victor Santamaria, Beatrice Ugiliweneza, Claudia A Angeli, Gail F Forrest, Joel Stein, Sunil Agrawal, Susan J Harkema","doi":"10.1089/neur.2024.0013","DOIUrl":"10.1089/neur.2024.0013","url":null,"abstract":"<p><p>Activity-based training and lumbosacral spinal cord epidural stimulation (scES) have the potential to restore standing and walking with self-balance assistance after motor complete spinal cord injury (SCI). However, improvements in upright postural control have not previously been addressed in this population. Here, we implemented a novel robotic postural training with scES, performed with free hands, to restore upright postural control in individuals with chronic, cervical (<i>n</i> = 5) or high-thoracic (<i>n</i> = 1) motor complete SCI, who had previously undergone stand training with scES using a walker or a standing frame for self-balance assistance. Robotic postural training re-enabled and/or largely improved the participants' ability to control steady standing, self-initiated trunk movements and upper limb reaching movements while standing with free hands, receiving only external assistance for pelvic control. These improvements were associated with neuromuscular activation pattern adaptations above and below the lesion. These findings suggest that the human spinal cord below the level of injury can generate meaningful postural responses when its excitability is modulated by scES, and can learn to improve these responses. Upright postural control improvements can enhance functional motor recovery promoted by scES after severe SCI.</p>","PeriodicalId":74300,"journal":{"name":"Neurotrauma reports","volume":"5 1","pages":"277-292"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Longitudinal Biochemical and Behavioral Alterations in a Gyrencephalic Model of Blast-Related Mild Traumatic Brain Injury. 爆炸所致轻度脑损伤颅脑模型的纵向生化和行为改变
Q3 CLINICAL NEUROLOGY Pub Date : 2024-03-14 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2024.0002
Shiyu Tang, Su Xu, Donna Wilder, Alexandre E Medina, Xin Li, Gary M Fiskum, Li Jiang, Venkata R Kakulavarapu, Joseph B Long, Rao P Gullapalli, Venkatasivasai Sujith Sajja

Blast-related traumatic brain injury (bTBI) is a major cause of neurological disorders in the U.S. military that can adversely impact some civilian populations as well and can lead to lifelong deficits and diminished quality of life. Among these types of injuries, the long-term sequelae are poorly understood because of variability in intensity and number of the blast exposure, as well as the range of subsequent symptoms that can overlap with those resulting from other traumatic events (e.g., post-traumatic stress disorder). Despite the valuable insights that rodent models have provided, there is a growing interest in using injury models using species with neuroanatomical features that more closely resemble the human brain. With this purpose, we established a gyrencephalic model of blast injury in ferrets, which underwent blast exposure applying conditions that closely mimic those associated with primary blast injuries to warfighters. In this study, we evaluated brain biochemical, microstructural, and behavioral profiles after blast exposure using in vivo longitudinal magnetic resonance imaging, histology, and behavioral assessments. In ferrets subjected to blast, the following alterations were found: 1) heightened impulsivity in decision making associated with pre-frontal cortex/amygdalar axis dysfunction; 2) transiently increased glutamate levels that are consistent with earlier findings during subacute stages post-TBI and may be involved in concomitant behavioral deficits; 3) abnormally high brain N-acetylaspartate levels that potentially reveal disrupted lipid synthesis and/or energy metabolism; and 4) dysfunction of pre-frontal cortex/auditory cortex signaling cascades that may reflect similar perturbations underlying secondary psychiatric disorders observed in warfighters after blast exposure.

爆炸相关创伤性脑损伤(bTBI)是美军神经系统疾病的一个主要原因,也会对一些平民造成不利影响,并可能导致终生功能障碍和生活质量下降。在这些类型的伤害中,人们对长期后遗症的了解甚少,因为爆炸暴露的强度和次数各不相同,而且随后出现的一系列症状可能与其他创伤事件(如创伤后应激障碍)导致的症状重叠。尽管啮齿类动物模型提供了宝贵的见解,但人们对使用具有更接近人脑的神经解剖学特征的物种来建立损伤模型的兴趣与日俱增。为此,我们建立了雪貂脑爆炸损伤模型,雪貂会在与作战人员原发性爆炸损伤十分相似的条件下接受爆炸暴露。在这项研究中,我们使用体内纵向磁共振成像、组织学和行为评估方法,对遭受爆炸后的大脑生化、微观结构和行为特征进行了评估。在遭受爆炸的雪貂身上发现了以下变化:1) 与前额叶皮质/杏仁轴功能障碍有关的决策冲动性增强;2) 谷氨酸水平短暂升高,这与早先在创伤后亚急性阶段的发现一致,并可能与伴随的行为缺陷有关;3) 脑内 N-乙酰天冬氨酸水平异常升高,可能显示脂质合成和/或能量代谢紊乱;以及 4) 前额叶皮层/听觉皮层信号级联功能障碍,可能反映了在爆炸暴露后的战斗人员中观察到的继发性精神障碍的类似扰动。
{"title":"Longitudinal Biochemical and Behavioral Alterations in a Gyrencephalic Model of Blast-Related Mild Traumatic Brain Injury.","authors":"Shiyu Tang, Su Xu, Donna Wilder, Alexandre E Medina, Xin Li, Gary M Fiskum, Li Jiang, Venkata R Kakulavarapu, Joseph B Long, Rao P Gullapalli, Venkatasivasai Sujith Sajja","doi":"10.1089/neur.2024.0002","DOIUrl":"10.1089/neur.2024.0002","url":null,"abstract":"<p><p>Blast-related traumatic brain injury (bTBI) is a major cause of neurological disorders in the U.S. military that can adversely impact some civilian populations as well and can lead to lifelong deficits and diminished quality of life. Among these types of injuries, the long-term sequelae are poorly understood because of variability in intensity and number of the blast exposure, as well as the range of subsequent symptoms that can overlap with those resulting from other traumatic events (e.g., post-traumatic stress disorder). Despite the valuable insights that rodent models have provided, there is a growing interest in using injury models using species with neuroanatomical features that more closely resemble the human brain. With this purpose, we established a gyrencephalic model of blast injury in ferrets, which underwent blast exposure applying conditions that closely mimic those associated with primary blast injuries to warfighters. In this study, we evaluated brain biochemical, microstructural, and behavioral profiles after blast exposure using <i>in vivo</i> longitudinal magnetic resonance imaging, histology, and behavioral assessments. In ferrets subjected to blast, the following alterations were found: 1) heightened impulsivity in decision making associated with pre-frontal cortex/amygdalar axis dysfunction; 2) transiently increased glutamate levels that are consistent with earlier findings during subacute stages post-TBI and may be involved in concomitant behavioral deficits; 3) abnormally high brain <i>N</i>-acetylaspartate levels that potentially reveal disrupted lipid synthesis and/or energy metabolism; and 4) dysfunction of pre-frontal cortex/auditory cortex signaling cascades that may reflect similar perturbations underlying secondary psychiatric disorders observed in warfighters after blast exposure.</p>","PeriodicalId":74300,"journal":{"name":"Neurotrauma reports","volume":"5 1","pages":"254-266"},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Twenty Years of Blast-Induced Neurotrauma: Current State of Knowledge. 爆炸诱发神经创伤二十年:知识现状》。
Q3 CLINICAL NEUROLOGY Pub Date : 2024-03-14 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2024.0001
Tarun Sachdeva, Shailesh G Ganpule

Blast-induced neurotrauma (BINT) is an important injury paradigm of neurotrauma research. This short communication summarizes the current knowledge of BINT. We divide the BINT research into several broad categories-blast wave generation in laboratory, biomechanics, pathology, behavioral outcomes, repetitive blast in animal models, and clinical and neuroimaging investigations in humans. Publications from 2000 to 2023 in each subdomain were considered. The analysis of the literature has brought out salient aspects. Primary blast waves can be simulated reasonably in a laboratory using carefully designed shock tubes. Various biomechanics-based theories of BINT have been proposed; each of these theories may contribute to BINT by generating a unique biomechanical signature. The injury thresholds for BINT are in the nascent stages. Thresholds for rodents are reasonably established, but such thresholds (guided by primary blast data) are unavailable in humans. Single blast exposure animal studies suggest dose-dependent neuronal pathologies predominantly initiated by blood-brain barrier permeability and oxidative stress. The pathologies were typically reversible, with dose-dependent recovery times. Behavioral changes in animals include anxiety, auditory and recognition memory deficits, and fear conditioning. The repetitive blast exposure manifests similar pathologies in animals, however, at lower blast overpressures. White matter irregularities and cortical volume and thickness alterations have been observed in neuroimaging investigations of military personnel exposed to blast. Behavioral changes in human cohorts include sleep disorders, poor motor skills, cognitive dysfunction, depression, and anxiety. Overall, this article provides a concise synopsis of current understanding, consensus, controversies, and potential future directions.

爆炸诱发神经创伤(BINT)是神经创伤研究的一个重要损伤范例。这篇简短的文章总结了目前有关 BINT 的知识。我们将 BINT 研究分为几大类--实验室中的爆炸波产生、生物力学、病理学、行为结果、动物模型中的重复爆炸以及人类的临床和神经影像学研究。每个子领域都考虑了 2000 年至 2023 年的出版物。通过对文献的分析,我们发现了一些突出的方面。在实验室中使用精心设计的冲击管可以合理地模拟初级爆炸波。已经提出了各种基于生物力学的 BINT 理论;每种理论都可能通过产生独特的生物力学特征而导致 BINT。BINT 的损伤阈值尚处于初级阶段。啮齿类动物的阈值已得到合理确定,但人类还没有此类阈值(以原始爆炸数据为指导)。单次爆炸暴露动物研究表明,神经元病变主要由血脑屏障通透性和氧化应激引起,具有剂量依赖性。这些病变通常是可逆的,恢复时间与剂量有关。动物的行为变化包括焦虑、听觉和识别记忆缺陷以及恐惧条件反射。重复爆炸在动物身上表现出类似的病理现象,但爆炸超压较低。在对暴露于爆炸的军事人员进行的神经影像学调查中观察到白质不规则以及皮质体积和厚度的改变。人类队列中的行为变化包括睡眠障碍、运动技能低下、认知功能障碍、抑郁和焦虑。总之,这篇文章简明扼要地概述了当前的认识、共识、争议和潜在的未来方向。
{"title":"Twenty Years of Blast-Induced Neurotrauma: Current State of Knowledge.","authors":"Tarun Sachdeva, Shailesh G Ganpule","doi":"10.1089/neur.2024.0001","DOIUrl":"10.1089/neur.2024.0001","url":null,"abstract":"<p><p>Blast-induced neurotrauma (BINT) is an important injury paradigm of neurotrauma research. This short communication summarizes the current knowledge of BINT. We divide the BINT research into several broad categories-blast wave generation in laboratory, biomechanics, pathology, behavioral outcomes, repetitive blast in animal models, and clinical and neuroimaging investigations in humans. Publications from 2000 to 2023 in each subdomain were considered. The analysis of the literature has brought out salient aspects. Primary blast waves can be simulated reasonably in a laboratory using carefully designed shock tubes. Various biomechanics-based theories of BINT have been proposed; each of these theories may contribute to BINT by generating a unique biomechanical signature. The injury thresholds for BINT are in the nascent stages. Thresholds for rodents are reasonably established, but such thresholds (guided by primary blast data) are unavailable in humans. Single blast exposure animal studies suggest dose-dependent neuronal pathologies predominantly initiated by blood-brain barrier permeability and oxidative stress. The pathologies were typically reversible, with dose-dependent recovery times. Behavioral changes in animals include anxiety, auditory and recognition memory deficits, and fear conditioning. The repetitive blast exposure manifests similar pathologies in animals, however, at lower blast overpressures. White matter irregularities and cortical volume and thickness alterations have been observed in neuroimaging investigations of military personnel exposed to blast. Behavioral changes in human cohorts include sleep disorders, poor motor skills, cognitive dysfunction, depression, and anxiety. Overall, this article provides a concise synopsis of current understanding, consensus, controversies, and potential future directions.</p>","PeriodicalId":74300,"journal":{"name":"Neurotrauma reports","volume":"5 1","pages":"243-253"},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Assessment of Frequency and Predictive Value of Comorbidities in Patients With Disorders of Consciousness in the Acute Setting. 评估急性期意识障碍患者合并症的发生率和预测价值。
Q3 CLINICAL NEUROLOGY Pub Date : 2024-03-14 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0120
Gennaro Saporito, Luca Gentili, Angelo Cacchio, Alfonsina Casalena, Stefano Necozione, Alessandro Ricci, Federica Venturoni, Franco Marinangeli, Francesca Pistoia

Medical comorbidities are frequent in patients with disorders of consciousness (DoC) and their impact on outcomes is under investigation. The aim of this study was to investigate patients with DoC in the acute stage and the influence of comorbidities. Patients admitted to intensive care units and neurological units with a diagnosis of coma, vegetative state/unresponsive wakefulness syndrome (VS/UWS), and minimally conscious state (MCS) were investigated through the Glasgow Coma Scale (GCS), the Coma Recovery Scale - Revised (CRS-R) and the Comorbidities Coma Scale (CoCos). Forty-three patients (21 men and 22 women; mean age at admission: 60.4 ± 21.0) were included in the study. The most frequent diagnosis at admission was coma (72%) followed by VS/UWS (14%) and MCS (14%). The most frequent brain injury was subarachnoid hemorrhage (46%). At the 6-month follow-up, 19 patients had died (44%), 15 showed a full recovery of consciousness (35%), 7 were in a condition of emergence from MCS (16%), and 2 showed a persistent VS/UWS (5%). Forty-two (98%) patients showed at least one comorbidity: presence of life-support device (92.9%), anemia (76.2%), arterial hypertension (66,7%), hydrocephalus (45.3%), and respiratory infections (45.2%) were those most frequently reported. At the Multivariable Cox regression, the presence of renal disease (hazard ratio [HR] 33.37; p = 0.033) and malnutrition (HR 14.52; p = 0.001) were predictors of missed recovery of full consciousness. Although adverse outcomes are generally predicted by the severity of brain damage, the presence of medical comorbidities in an acute phase could influence outcomes and long-term prognosis.

意识障碍(DoC)患者常合并有内科疾病,这些疾病对治疗效果的影响正在研究之中。本研究旨在调查急性期意识障碍患者及其合并症的影响。研究人员通过格拉斯哥昏迷量表(GCS)、昏迷恢复量表-修订版(CRS-R)和合并症昏迷量表(CoCos)对重症监护病房和神经科病房收治的诊断为昏迷、植物状态/无反应清醒综合征(VS/UWS)和微意识状态(MCS)的患者进行了调查。研究共纳入 43 名患者(21 名男性,22 名女性;入院时平均年龄:60.4 ± 21.0)。入院时最常见的诊断是昏迷(72%),其次是VS/UWS(14%)和MCS(14%)。最常见的脑损伤是蛛网膜下腔出血(46%)。在 6 个月的随访中,19 名患者死亡(44%),15 名患者意识完全恢复(35%),7 名患者摆脱了 MCS(16%),2 名患者出现持续 VS/UWS(5%)。42名患者(98%)至少患有一种并发症:最常见的并发症包括生命支持装置(92.9%)、贫血(76.2%)、动脉高血压(66.7%)、脑积水(45.3%)和呼吸道感染(45.2%)。在多变量考克斯回归中,肾脏疾病(危险比 [HR] 33.37;p = 0.033)和营养不良(危险比 14.52;p = 0.001)是预示意识完全丧失的因素。虽然脑损伤的严重程度通常可以预测不良预后,但急性期合并症的存在也会影响预后和长期预后。
{"title":"Assessment of Frequency and Predictive Value of Comorbidities in Patients With Disorders of Consciousness in the Acute Setting.","authors":"Gennaro Saporito, Luca Gentili, Angelo Cacchio, Alfonsina Casalena, Stefano Necozione, Alessandro Ricci, Federica Venturoni, Franco Marinangeli, Francesca Pistoia","doi":"10.1089/neur.2023.0120","DOIUrl":"10.1089/neur.2023.0120","url":null,"abstract":"<p><p>Medical comorbidities are frequent in patients with disorders of consciousness (DoC) and their impact on outcomes is under investigation. The aim of this study was to investigate patients with DoC in the acute stage and the influence of comorbidities. Patients admitted to intensive care units and neurological units with a diagnosis of coma, vegetative state/unresponsive wakefulness syndrome (VS/UWS), and minimally conscious state (MCS) were investigated through the Glasgow Coma Scale (GCS), the Coma Recovery Scale - Revised (CRS-R) and the Comorbidities Coma Scale (CoCos). Forty-three patients (21 men and 22 women; mean age at admission: 60.4 ± 21.0) were included in the study. The most frequent diagnosis at admission was coma (72%) followed by VS/UWS (14%) and MCS (14%). The most frequent brain injury was subarachnoid hemorrhage (46%). At the 6-month follow-up, 19 patients had died (44%), 15 showed a full recovery of consciousness (35%), 7 were in a condition of emergence from MCS (16%), and 2 showed a persistent VS/UWS (5%). Forty-two (98%) patients showed at least one comorbidity: presence of life-support device (92.9%), anemia (76.2%), arterial hypertension (66,7%), hydrocephalus (45.3%), and respiratory infections (45.2%) were those most frequently reported. At the Multivariable Cox regression, the presence of renal disease (hazard ratio [HR] 33.37; <i>p</i> = 0.033) and malnutrition (HR 14.52; <i>p</i> = 0.001) were predictors of missed recovery of full consciousness. Although adverse outcomes are generally predicted by the severity of brain damage, the presence of medical comorbidities in an acute phase could influence outcomes and long-term prognosis.</p>","PeriodicalId":74300,"journal":{"name":"Neurotrauma reports","volume":"5 1","pages":"267-276"},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Neurotrauma reports
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1