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Risk of Long-Term Ischemic Stroke in Patients With Traumatic Brain Injury and Incident Hypertension 脑外伤和高血压患者长期缺血性中风的风险
Pub Date : 2024-04-01 DOI: 10.1089/neur.2024.0015
Farid Radmanesh, Saef Izzy, Ran S. Rotem, Zabreen Tahir, Quinn J. Rademaker, Taha Yahya, Ahmad Mashlah, Herman A. Taylor, Marc G. Weisskopf, Ross Zafonte, Aaron L. Baggish, R. Grashow
Traumatic brain injury (TBI) is independently associated with hypertension and ischemic stroke. The goal of this study was to determine the interplay between TBI and incident hypertension in the occurrence of post-TBI stroke. This prospective study used a hospital-based registry to identify patients without pre-existing comorbidities. TBI patients (n = 3664) were frequency matched on age, sex, and race to non-TBI patients (n = 1848). Follow-up started 6 months post-TBI or study entry and extended up to 10 years. To examine hypertension's role in post-TBI stroke, we used logistic regression models to calculate the effect estimates for stroke in four exposure categories that included TBI or hypertension in isolation and in combination. Second, we calculated the conditional direct effect (CDE) of TBI in models that considered hypertension as intermediary. Third, we examined whether TBI effect was modified by antihypertensive medication use. The 10-year cumulative incidence of stroke was higher in the TBI group (4.7%) than the non-TBI group (1.3%; p < 0.001). TBI patients who developed hypertension had the highest risk of stroke (odds ratio [OR] = 4.83, 95% confidence interval [CI] = 2.53–9.23, p < 0.001). The combined effect estimates were less than additive, suggesting an overlapping biological pathway. The total effect of TBI (OR = 3.16, 95% CI = 1.94–5.16, p < 0.001) was higher than the CDE that accounted for hypertension (OR = 2.45, 95% CI = 0.93–6.47, p = 0.06). Antihypertensives attenuated the TBI effect, suggesting that the TBI effect on stroke is partially mediated through hypertension. TBI is an independent risk factor for long-term stroke, and the underlying biological pathway may partly operate through TBI-precipitated hypertension. These findings suggest that screening for hypertension may mitigate stroke risk in TBI.
创伤性脑损伤(TBI)与高血压和缺血性中风密切相关。本研究旨在确定创伤性脑损伤和高血压在创伤性脑损伤后中风发生中的相互作用。这项前瞻性研究使用了医院登记册来识别无并发症的患者。创伤性脑损伤患者(n = 3664)与非创伤性脑损伤患者(n = 1848)在年龄、性别和种族上进行了频率匹配。随访从创伤后或研究开始后 6 个月开始,长达 10 年。为了研究高血压在创伤后脑卒中中的作用,我们使用逻辑回归模型计算了四个暴露类别中脑卒中的效应估计值,其中包括创伤后脑卒中或高血压单独或合并暴露。其次,我们计算了将高血压视为中间因素的模型中创伤性脑损伤的条件直接效应(CDE)。第三,我们研究了创伤性脑损伤的影响是否会因服用降压药而改变。创伤性脑损伤组中风的 10 年累积发病率(4.7%)高于非创伤性脑损伤组(1.3%;P < 0.001)。发生高血压的创伤性脑损伤患者中风风险最高(几率比 [OR] = 4.83,95% 置信区间 [CI] = 2.53-9.23,p < 0.001)。综合效应估计值小于相加值,表明存在重叠的生物学途径。创伤性脑损伤的总效应(OR = 3.16,95% CI = 1.94-5.16,p < 0.001)高于考虑高血压的 CDE(OR = 2.45,95% CI = 0.93-6.47,p = 0.06)。抗高血压药物减弱了创伤性脑损伤的影响,表明创伤性脑损伤对中风的影响部分是通过高血压介导的。创伤性脑损伤是长期中风的一个独立危险因素,其潜在的生物学途径可能部分是通过创伤性脑损伤诱发的高血压来实现的。这些研究结果表明,筛查高血压可减轻创伤性脑损伤的中风风险。
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引用次数: 0
Sex Differences in Adult Incarceration After Pediatric Traumatic Brain Injury 小儿脑外伤后成人监禁的性别差异
Pub Date : 2024-04-01 DOI: 10.1089/neur.2023.0066
Anurag Modak, Kyle E. Zappi, Alexander J. Catoya, Mehdi S. Lemdani, Gretchen M. Koller, Laurel Seltzer, Ryan E. Radwanski, Susan C. Pannullo
Pediatric traumatic brain injury (pTBI) is a major risk factor associated with adulthood incarceration. Most research into the link between pTBI and adulthood incarceration has focused on incarcerated males, who comprise the vast majority of incarcerated adults, particularly in industrialized nations. In this review, we sought to identify sex-related differences in the incidence and pathophysiology of pTBI and subsequent risk of adulthood incarceration. A scoping review was undertaken using PubMed, Scopus, Ovid, and the Cochrane Library. Articles analyzing sex-related differences in pTBI and adult incarceration rates, studies conducted on an incarcerated population, and cohort studies, cross-sectional studies, clinical trials, systematic reviews, or meta-analyses were included in this review. Of the 85 unique results, 25 articles met our inclusion criteria. Male children are 1.5 times more likely to suffer a TBI than females; however, the prevalence of incarcerated adults with a history of pTBI is ∼35–45% for both sexes. Neurophysiologically, female sex hormones are implicated in neuroprotective roles, mitigating central nervous system (CNS) damage post-TBI, although this role may be more complex, given that injury severity and sequelae have been correlated with male sex whereas increased mortality has been correlated with female sex. Further investigation into the relationship between estrogen and subsequent clinical measurements of CNS function is needed to develop interventions that may alleviate the pathophysiological consequences of pTBI.
小儿创伤性脑损伤(pTBI)是与成年监禁相关的一个主要风险因素。有关小儿创伤性脑损伤与成年期监禁之间联系的大多数研究都集中在男性监禁者身上,他们占成年监禁者的绝大多数,尤其是在工业化国家。在本综述中,我们试图找出 pTBI 的发病率和病理生理学方面与性别有关的差异,以及随后的成年监禁风险。我们使用 PubMed、Scopus、Ovid 和 Cochrane 图书馆进行了范围界定综述。本综述收录了分析 pTBI 和成年监禁率中性别差异的文章、针对监禁人群进行的研究、队列研究、横断面研究、临床试验、系统综述或荟萃分析。在 85 项独特的结果中,有 25 篇文章符合我们的纳入标准。男性儿童遭受创伤性脑损伤的几率是女性的 1.5 倍;然而,在有创伤性脑损伤病史的被监禁成年人中,男女患病率均为 35%至 45%。从神经生理学角度看,女性性激素具有神经保护作用,可减轻创伤后中枢神经系统(CNS)的损伤,但这一作用可能更为复杂,因为损伤的严重程度和后遗症与男性性别相关,而死亡率的增加则与女性性别相关。需要进一步研究雌激素与随后的中枢神经系统功能临床测量之间的关系,以制定可能减轻创伤后综合症病理生理后果的干预措施。
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引用次数: 0
Slowing of Parameterized Resting-State Electroencephalography After Mild Traumatic Brain Injury 轻度脑外伤后参数化静息状态脑电图变慢
Pub Date : 2024-04-01 DOI: 10.1089/neur.2024.0004
Mark C. Nwakamma, Alexandra M. Stillman, Laurel Gabard-Durnam, James F. Cavanagh, Charles H. Hillman, Timothy P. Morris
Reported changes in electroencephalography (EEG)-derived spectral power after mild traumatic brain injury (mTBI) remains inconsistent across existing literature. However, this may be a result of previous analyses depending solely on observing spectral power within traditional canonical frequency bands rather than accounting for the aperiodic activity within the collected neural signal. Therefore, the aim of this study was to test for differences in rhythmic and arrhythmic time series across the brain, and in the cognitively relevant frontoparietal (FP) network, and observe whether those differences were associated with cognitive recovery post-mTBI. Resting-state electroencephalography (rs-EEG) was collected from 88 participants (56 mTBI and 32 age- and sex-matched healthy controls) within 14 days of injury for the mTBI participants. A battery of executive function (EF) tests was collected at the first session with follow-up metrics collected approximately 2 and 4 months after the initial visit. After spectral parameterization, a significant between-group difference in aperiodic-adjusted alpha center peak frequency within the FP network was observed, where a slowing of alpha peak frequency was found in the mTBI group in comparison to the healthy controls. This slowing of week 2 (collected within 2 weeks of injury) aperiodic-adjusted alpha center peak frequency within the FP network was associated with increased EF over time (evaluated using executive composite scores) post-mTBI. These findings suggest alpha center peak frequency within the FP network as a candidate prognostic marker of EF recovery and may inform clinical rehabilitative methods post-mTBI.
据报道,轻度脑外伤(mTBI)后脑电图(EEG)得出的频谱功率变化在现有文献中仍不一致。然而,这可能是由于以前的分析仅仅依赖于观察传统标准频带内的频谱功率,而没有考虑到所收集的神经信号中的非周期性活动。因此,本研究旨在测试整个大脑以及与认知相关的顶叶前部(FP)网络中节律性和节律性时间序列的差异,并观察这些差异是否与创伤性脑损伤后的认知恢复有关。研究人员收集了 88 名参与者(56 名创伤性脑损伤患者和 32 名年龄和性别匹配的健康对照者)的静息态脑电图(rs-EEG),其中创伤性脑损伤患者在受伤后 14 天内进行了静息态脑电图检查。在首次治疗时收集了一系列执行功能(EF)测试,并在首次就诊后约 2 个月和 4 个月收集了随访指标。在对频谱进行参数化处理后,观察到 FP 网络内经非周期性调整的阿尔法中心峰频率存在显著的组间差异,与健康对照组相比,mTBI 组的阿尔法峰频率有所减慢。第 2 周(受伤后 2 周内收集)FP 网络内经周期性调整的阿尔法中心峰频率的减慢与创伤后随着时间推移(使用执行力综合评分进行评估)EF 的增加有关。这些发现表明,FP网络内的α中心峰值频率是EF恢复的候选预后标志物,可为创伤性脑损伤后的临床康复方法提供参考。
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引用次数: 0
Brain Fluid Clearance After Traumatic Brain Injury Measured Using Dynamic Positron Emission Tomography 利用动态正电子发射断层扫描测量脑外伤后的脑液清除率
Pub Date : 2024-04-01 DOI: 10.1089/neur.2024.0010
Tracy Butler, Julia Schubert, Nikolaos A. Karakatsanis, Xiuyuan Hugh Wang, K. Xi, Yeona Kang, Kewei Chen, Liangdong Zhou, Edward K. Fung, Abigail Patchell, Abhishek Jaywant, Yi Li, Gloria C. Chiang, Lidia Glodzik, H. Rusinek, M. D. de Leon, Federico Turkheimer, Sudhin A. Shah
Brain fluid clearance by pathways including the recently described paravascular glymphatic system is a critical homeostatic mechanism by which metabolic products, toxins, and other wastes are removed from the brain. Brain fluid clearance may be especially important after traumatic brain injury (TBI), when blood, neuronal debris, inflammatory cells, and other substances can be released and/or deposited. Using a non-invasive dynamic positron emission tomography (PET) method that models the rate at which an intravenously injected radiolabeled molecule (in this case 11C-flumazenil) is cleared from ventricular cerebrospinal fluid (CSF), we estimated the overall efficiency of brain fluid clearance in humans who had experienced complicated-mild or moderate TBI 3–6 months before neuroimaging (n = 7) as compared to healthy controls (n = 9). While there was no significant difference in ventricular clearance between TBI subjects and controls, there was a significant group difference in dependence of ventricular clearance upon tracer delivery/blood flow to the ventricles. Specifically, in controls, ventricular clearance was highly, linearly dependent upon blood flow to the ventricle, but this relation was disrupted in TBI subjects. When accounting for blood flow and group-specific alterations in blood flow, ventricular clearance was slightly (non-significantly) increased in TBI subjects as compared to controls. Current results contrast with past studies showing reduced glymphatic function after TBI and are consistent with possible differential effects of TBI on glymphatic versus non-glymphatic clearance mechanisms. Further study using multi-modal methods capable of assessing and disentangling blood flow and different aspects of fluid clearance is needed to clarify clearance alterations after TBI.
通过包括最近描述的血管旁甘油系统在内的途径清除脑液,是将代谢产物、毒素和其他废物排出大脑的一种重要的平衡机制。创伤性脑损伤(TBI)后,血液、神经元碎片、炎症细胞和其他物质可能会释放和/或沉积,此时脑液清除可能尤为重要。我们使用一种非侵入性动态正电子发射断层扫描(PET)方法,模拟静脉注射的放射性标记分子(在本例中为 11C-氟马西尼)从脑室脑脊液(CSF)中清除的速度,估算了在神经成像前 3-6 个月经历过复杂-轻度或中度创伤性脑损伤的人(n = 7)与健康对照组(n = 9)相比脑液清除的总体效率。虽然创伤性脑损伤受试者和对照组在脑室清除率方面没有明显差异,但在脑室清除率对示踪剂输送/脑室血流的依赖性方面存在明显的组间差异。具体来说,在对照组中,心室清除率与流向心室的血流量呈高度线性关系,但在创伤性脑损伤受试者中,这种关系被打破。当考虑到血流量和血流量的组别特异性变化时,与对照组相比,创伤性脑损伤受试者的心室清除率略有增加(无显著性)。目前的研究结果与过去显示创伤后血流功能减弱的研究结果形成鲜明对比,并与创伤后血流清除机制与非血流清除机制可能受到的不同影响相一致。需要使用能够评估和区分血流和液体清除不同方面的多模式方法进行进一步研究,以明确创伤后的清除改变。
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引用次数: 0
The Australian Traumatic Brain Injury Initiative: Review and Recommendations for Outcome Measures for Use With Adults and Children After Moderate-to-Severe Traumatic Brain Injury 澳大利亚创伤性脑损伤倡议:中重度脑损伤后成人和儿童使用的结果测量方法回顾与建议
Pub Date : 2024-04-01 DOI: 10.1089/neur.2023.0127
Jennie L Ponsford, Amelia J. Hicks, Matthew K. Bagg, Ruby K. Phyland, Sarah L. Carrier, A. James, Natasha A. Lannin, N. Rushworth, Terence J. O'Brien, Peter A. Cameron, D. J. Cooper, Regina Hill, Belinda J Gabbe, Melinda Fitzgerald
The Australian Traumatic Brain Injury Initiative (AUS-TBI) aims to select a set of measures to comprehensively predict and assess outcomes following moderate-to-severe traumatic brain injury (TBI) across Australia. The aim of this article was to report on the implementation and findings of an evidence-based consensus approach to develop AUS-TBI recommendations for outcome measures following adult and pediatric moderate-to-severe TBI. Following consultation with a panel of expert clinicians, Aboriginal and Torres Strait Islander representatives and a Living Experience group, and preliminary literature searches with a broader focus, a decision was made to focus on measures of mortality, everyday functional outcomes, and quality of life. Standardized searches of bibliographic databases were conducted through March 2022. Characteristics of 75 outcome measures were extracted from 1485 primary studies. Consensus meetings among the AUS-TBI Steering Committee, an expert panel of clinicians and researchers and a group of individuals with lived experience of TBI resulted in the production of a final list of 11 core outcome measures: the Functional Independence Measure (FIM); Glasgow Outcome Scale-Extended (GOS-E); Satisfaction With Life Scale (SWLS) (adult); mortality; EuroQol-5 Dimensions (EQ5D); Mayo-Portland Adaptability Inventory (MPAI); Return to Work /Study (adult and pediatric); Functional Independence Measure for Children (WEEFIM); Glasgow Outcome Scale Modified for Children (GOS-E PEDS); Paediatric Quality of Life Scale (PEDS-QL); and Strengths and Difficulties Questionnaire (pediatric). These 11 outcome measures will be included as common data elements in the AUS-TBI data dictionary. Review Registration PROSPERO (CRD42022290954).
澳大利亚创伤性脑损伤倡议(Australian Traumatic Brain Injury Initiative,AUS-TBI)旨在选择一套措施来全面预测和评估澳大利亚中重度创伤性脑损伤(TBI)后的结果。本文旨在报告循证共识方法的实施情况和研究结果,该方法旨在为成人和儿童中重度创伤性脑损伤后的结果测量制定 AUS-TBI 建议。在咨询了专家临床医师小组、土著居民和托雷斯海峡岛民代表以及生活体验小组,并进行了重点更广泛的初步文献检索后,决定将重点放在死亡率、日常功能结果和生活质量的测量上。截至 2022 年 3 月,对文献数据库进行了标准化检索。从 1485 项主要研究中提取了 75 项结果测量的特征。澳大利亚创伤性脑损伤指导委员会、临床医生和研究人员专家小组以及具有创伤性脑损伤生活经验的个人召开了共识会议,最终确定了 11 项核心结果测量指标:功能独立性量表 (FIM);格拉斯哥结果量表扩展版 (GOS-E);生活满意度量表 (SWLS)(成人);死亡率;EuroQol-5 Dimensions (EQ5D);Mayo-Portland 适应性量表 (MPAI);重返工作/学习(成人和儿童);儿童功能独立性量表(WEEFIM);格拉斯哥儿童结果量表(GOS-E PEDS);儿科生活质量量表(PEDS-QL);以及优势与困难问卷(儿科)。这 11 项结果测量将作为通用数据元素纳入 AUS-TBI 数据字典。审查注册 PROSPERO (CRD42022290954)。
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引用次数: 0
Applying the Consensus Criteria for Traumatic Encephalopathy Syndrome Retrospectively to Case Studies of Boxers from the 20th Century 将创伤性脑病综合征的共识标准应用于 20 世纪拳击手的案例研究中
Pub Date : 2024-04-01 DOI: 10.1089/neur.2023.0134
Grant L Iverson, Andrew J Gardner, Rudolph J. Castellani, A. Kissinger-Knox
There are no validated diagnostic criteria for traumatic encephalopathy syndrome (TES). During the early and middle 20th century, TES was described as a clinical condition that was experienced by some high-exposure boxers—and it was believed to reflect chronic traumatic brain injury. Consensus criteria for the diagnosis of TES were published in 2021. We applied the consensus criteria for TES retrospectively to cases of chronic brain damage in boxers described in articles published in the 20th century that were obtained from narrative and systematic reviews. The sample included 157 boxers identified in 21 articles published between 1929 and 1999. Two authors reviewed each case description and coded the criteria for TES. For the core clinical features, cognitive impairment was noted in 63.1%, and in 28.7% of cases the person's cognitive functioning appeared to be broadly normal. Neurobehavioral dysregulation was present in 25.5%. One third (34.4%) were identified as progressive, 30.6% were not progressive, and the course could not be clearly determined in 35.0%. In total, 29.9% met the TES consensus criteria, 28.0% did not, and 42.0% had insufficient information to make a diagnostic determination. TES, in the 20th century, was described as a neurological condition, not a psychiatric disorder—and this supports the decision of the 2021 consensus group to remove primary and secondary psychiatric diagnoses from being a core diagnostic feature. Future research is needed to determine whether, or the extent to which, cognitive impairment or neurobehavioral dysregulation described as characterizing TES are associated with chronic traumatic encephalopathy neuropathological change.
创伤性脑病综合征(TES)目前尚无有效的诊断标准。在 20 世纪早期和中期,创伤性脑病被描述为一些高暴露拳击手的一种临床症状--人们认为它反映了慢性创伤性脑损伤。2021 年发布了 TES 诊断共识标准。我们对 20 世纪发表的文章中描述的拳击手慢性脑损伤病例应用了 TES 的共识标准,这些文章是从叙事性和系统性综述中获得的。样本包括 1929 年至 1999 年间发表的 21 篇文章中确定的 157 名拳击手。两位作者审阅了每篇病例描述,并对 TES 标准进行了编码。就核心临床特征而言,63.1%的病例存在认知障碍,28.7%的病例认知功能大致正常。25.5%的患者存在神经行为失调。三分之一(34.4%)的患者被确定为进行性疾病,30.6%为非进行性疾病,35.0%的患者病程无法明确确定。总共有 29.9% 符合 TES 共识标准,28.0% 不符合,42.0% 信息不足,无法做出诊断。在 20 世纪,TES 被描述为一种神经系统疾病,而非精神疾病--这也支持了 2021 年共识小组的决定,即取消将原发性和继发性精神疾病诊断作为核心诊断特征。未来需要进行研究,以确定被描述为 TES 特征的认知障碍或神经行为失调是否或在多大程度上与慢性创伤性脑病的神经病理变化有关。
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引用次数: 0
The Australian Traumatic Brain Injury Initiative: Statement of Working Principles and Rapid Review of Methods to Define Data Dictionaries for Neurological Conditions 澳大利亚创伤性脑损伤倡议:工作原则声明和神经疾病数据字典定义方法快速审查
Pub Date : 2024-04-01 DOI: 10.1089/neur.2023.0116
Matthew K. Bagg, Amelia J. Hicks, S. Hellewell, Jennie L Ponsford, Natasha A. Lannin, Terence J. O'Brien, Peter A. Cameron, D. J. Cooper, N. Rushworth, Belinda J Gabbe, Melinda Fitzgerald
The Australian Traumatic Brain Injury Initiative (AUS-TBI) aims to develop a health informatics approach to collect data predictive of outcomes for persons with moderate-severe TBI across Australia. Central to this approach is a data dictionary; however, no systematic reviews of methods to define and develop data dictionaries exist to-date. This rapid systematic review aimed to identify and characterize methods for designing data dictionaries to collect outcomes or variables in persons with neurological conditions. Database searches were conducted from inception through October 2021. Records were screened in two stages against set criteria to identify methods to define data dictionaries for neurological conditions (International Classification of Diseases, 11th Revision: 08, 22, and 23). Standardized data were extracted. Processes were checked at each stage by independent review of a random 25% of records. Consensus was reached through discussion where necessary. Thirty-nine initiatives were identified across 29 neurological conditions. No single established or recommended method for defining a data dictionary was identified. Nine initiatives conducted systematic reviews to collate information before implementing a consensus process. Thirty-seven initiatives consulted with end-users. Methods of consultation were “roundtable” discussion (n = 30); with facilitation (n = 16); that was iterative (n = 27); and frequently conducted in-person (n = 27). Researcher stakeholders were involved in all initiatives and clinicians in 25. Importantly, only six initiatives involved persons with lived experience of TBI and four involved carers. Methods for defining data dictionaries were variable and reporting is sparse. Our findings are instructive for AUS-TBI and can be used to further development of methods for defining data dictionaries.
澳大利亚创伤性脑损伤倡议(Australian Traumatic Brain Injury Initiative,AUS-TBI)旨在开发一种健康信息学方法,以收集可预测全澳中重度创伤性脑损伤患者预后的数据。数据字典是这一方法的核心;然而,迄今为止还没有对定义和开发数据字典的方法进行系统性回顾。本快速系统性综述旨在确定和描述设计数据字典的方法,以收集神经系统疾病患者的结果或变量。数据库搜索从开始到 2021 年 10 月进行。根据设定的标准分两个阶段对记录进行筛选,以确定定义神经系统疾病(国际疾病分类,第 11 次修订:08、22 和 23)数据字典的方法。提取标准化数据。在每个阶段都会对 25% 的随机记录进行独立审查,以检查流程。必要时通过讨论达成共识。在 29 种神经系统疾病中确定了 39 项举措。在定义数据字典方面,没有发现任何既定或推荐的方法。九项计划在实施共识流程之前进行了系统性回顾以整理信息。37 项计划咨询了最终用户。协商方法包括 "圆桌 "讨论(30 人)、协助讨论(16 人)、迭代讨论(27 人)以及经常面谈(27 人)。研究人员参与了所有活动,临床医生参与了 25 项活动。重要的是,只有六项活动有创伤性脑损伤患者参与,四项活动有照护者参与。定义数据字典的方法各不相同,报告也很少。我们的研究结果对澳大拉西亚-创伤后应激障碍具有指导意义,可用于进一步制定数据字典的定义方法。
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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。
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":null,"pages":null},"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。
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。
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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
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":null,"pages":null},"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
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Neurotrauma reports
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