Brain injury最新文献

Objective: Extracellular vesicles (EVs) derived from regenerative mesenchymal stem cells might safely treat traumatic brain injury (TBI). We evaluated the safety and efficacy of a human bone marrow derived mesenchymal stem cell EVs (hBM-MSC EV) investigational product (IP) in a patient with severe TBI.

Design: A single case study employing an IP with a strong safety profile in over 200 patients.

Method: The patient was dosed intravenously three times/week in the first week of six successive months. Functional Independence Measure (FIM) and Functional Assessment Measure (FAM) were performed to quantify effects. Safety monitoring was performed every week for nine months.

Results: No adverse events occurred. Within eight weeks FIM and FAM scores improved by 48-55% and were sustained for the entire 36 weeks. All specific outcome items assessed by FIM and FAM that were initially low showed sustained improvements ranging from 41% to 233%, with the greatest improvements seen in locomotion, mobility and cognitive function.

Conclusion: After moderate improvement with conventional therapy, the substantial improvement observed following introduction of the IP suggests that hBM-MSC EVs may offer a novel and safe means to improve TBI patient outcomes. Appropriate randomized, controlled clinical trials to conclusively evaluate this therapeutic option are indicated.

Purpose: To develop a series of infographics providing persons with traumatic brain injury (TBI) and their circle of care with evidence-based information on sex and gender topics in TBI.

Materials and methods: We employed an iterative participatory design engaging knowledge users, scientists, and experts in brain injury and patient education. To inform infographic content, we conducted an information needs assessment with knowledge users through semi-structured interviews and referred to our previously published evidence syntheses on TBI topics. We followed principles of graphic design and science communication to create materials reflecting lived experiences of knowledge users.

Results: We created a series of infographics with actionable messages and visual representations of evidence-based information. We achieved a Flesch Reading-Ease score of 60.1, corresponding to a Grade 7/8 reading level. The infographics met the color contrast criteria of the Web Content Accessibility Guidelines. Knowledge users found the material useful, visually appealing, and helpful in understanding complex topics.

Conclusions: There is value in merging art and science to develop educational materials that meet the unique information needs of knowledge users. Iterative participatory design engaging diverse stakeholders is essential for co-creating knowledge translation tools to improve access to health information and quality of care after TBI.

Objectives: Medical complications occur frequently in MCS and influence advance medical decision-making. This study aimed to report on medical complications and advance medical decision-making in a nationwide group of MCS patients.

Methods: In this descriptive cross-sectional study, clinical and advance medical decision-making characteristics were collected in a survey, completed by the treating physician.

Results: The MCS population consisted of 32 patients: 65.6% traumatic etiology, 68.8% male. Patients had a median of five complications: hypertonia/spasticity (81.3%) and pneumonia (50.0%) occurred most frequently. Most patients had curative goals: three patients had a fully curative treatment scenarios, 29 a curative scenario with ≥ 1 treatment restrictions, two a palliative and two a symptomatic scenario. Conversations about advance medical decision-making were complicated by disputes with next of kin, inability to evaluate medical treatment because of medical instability, next of kin not being ready to discuss medical treatment, or a treatment scenario explicitly based on requests of next of kin.

Conclusion: Medical complications are common in MCS patients and advance medical decision making was complicated. This legitimates realization of specialized care across acute, post-acute and long-term care. Further longitudinal research into advance medical decision-making is recommended.

Primary objective: The purpose of this study was to explore how 'quality' is understood for traumatic brain injury (TBI) rehabilitation from the perspectives of the rehabilitation recipients, their families and the providing clinicians.

Research design: A participatory study using a mixed-methods, triangulation design.

Methods: The study involved 1. a systematic literature search; 2. Individual semi-structured interviews with people with TBI and/or their caregivers and TBI rehabilitation clinicians, and 3. an online consensus process.

Outcomes and results: 22 participants (7 people with TBI, 8 caregivers, 7 clinicians) participated in individual interviews. Their transcribed data were coded into broad categories via in-depth reflexive, thematic analysis; these categories were then mapped to 13 quality domains extracted from the literature. The emergent themes were then presented to the individuals, via an electronic consensus tool in two rounds. This resulted in 12 prioritized domains of quality that encompass service features, staff qualities and effectiveness.

Conclusion: These evidence-informed and consensus-agreed indicators for quality may help guide both the provision and evaluation of TBI rehabilitation, that is valued and meaningful.

Objective: To investigate brain injury (BI) associations' perspectives regarding the impacts of the second year of the COVID-19 pandemic on individuals with BI and BI associations services across Canada.

Methods: This qualitative descriptive study included 26 representatives of Canadian BI associations that participated in six online focus groups to discuss the effects of the second year of the pandemic on clients living with BI and on the provision of community services.

Results: Findings revealed three main themes: 1) ongoing pandemic-related challenges faced by clients living with BI, including worsening mental health and basic needs insecurities, difficulties faced by clients in adhering to safety measures, and ongoing technological issues; 2) ongoing adaptations to accommodate clients' needs, including offering tailored services, ensuring consistent and transparent safety measures, and providing hybrid services; and 3) developing a sustainable 'new normal' aligned with association mandates and resources by expanding networks and building resilience.

Conclusion: The unfolding of the pandemic has brought increased challenges for people with BI and reinforced the need for adapted, clear, and accessible public health information to ensure the safety of vulnerable populations in times of crisis. It is essential to bolster community-based associations that provide direct care to people with BI.

Objective: To identify risk factors in people with heart disease prior to undergoing cardiac surgery and to provide a prediction model.

Methods: 106 patients who underwent cardiac surgery were selected by convenience sampling method. Case-control study design was used to divide them into control and observation groups according to whether there was postoperative brain injury. General demographic data, perioperative surgery, postoperative recovery, past medical history and preoperative conditions, laboratory test indicators were collected. Univariate and multivariate Logistic regression analyses were performed to select influencing factors. A nomogram model for predicting postoperative brain injury was established.

Results: Univariate Logistic regression analysis showed that age, female, stroke, diabetes mellitus, perioperative administration of dexmedetomidine, intraoperative use of cardiopulmonary bypass were related factors for postoperative brain injury(p < 0.05). Multivariate Logistic regression analysis showed that females, history of stroke, and intraoperative use of cardiopulmonary bypass were risk factors, and perioperative administration of dexmedetomidine was protective factor(p < 0.05). Nomogram model was established with an AUC of 0.847 and accuracy of 84.7%.

Conclusion: Preoperative stroke history and females are risk factors for brain injury after coronary artery bypass grafting under cardiopulmonary bypass, and perioperative use of dexmedetomidine is protective factor.

Objectives: To investigate the effect of multiple seasons of play on serum S100B concentration in male professional rugby players, while also assessing the acute effects following a season of play and concussion.

Methods: A prospective study of professional male rugby players over three seasons (2016/17 to 2018/19) was conducted. Serum sampling was carried out during pre-season, post-season and following a concussion; sustained during match play at a home game (between 2-24hrs), during each season. Serum S100B concentrations were determined by ELISA assay.

Results: Fourteen players sustained 24 concussions over three seasons, of which 13 samples (54%) were collected. Pre- and post-season serum S100B remained stable across multiple seasons. S100B concentration increased significantly following concussion compared with pre-season (p = 0.002) and post-season (p = 0.009), reflective in a 3.23-fold-change post-concussion, with no difference found between pre- and post-season values. S100B concentration measured at post-season was not significantly different for players who had a concussion during a season and players who did not.

Conclusion: S100B remains stable across multiple seasons of play in professional rugby players. As concussion results in a temporary increase in S100B concentration, returning to pre-season values by post-season, S100B may be a useful diagnostic marker for improving existing management protocols for sports-related concussions.

Introduction: Dodecafluoropentane emulsion (DDFPe) administration has previously demonstrated improved gas exchange in single-organ perfusion models. This could translate to prevention of brain injury in cardiac arrest.

Methods: We induced cardiac arrest in 12 pigs, performing CPR after 5-minute downtime. Pigs were randomly assigned to DDFPe (n = 7) or saline placebo (n = 5) groups. Neurologic injury biomarkers were measured at baseline, after return of spontaneous circulation (ROSC), and every 24 hours in survivors. Blinded Neurological Alertness Score, Neurological Dysfunction Score, and Overall Performance Score was performed in addition to histopathological scoring of parietal and hippocampal sections.

Results: One placebo and four DDFPe pigs survived the 96-hour observation period. The odds ratio for ROSC was 7.2 (p = 0.22). Survival odds ratio was 4.6 (p = 0.29). All surviving animals had impaired motor responses that recovered by 72 hours. DDFPe animals showed better neuro-behavioral scores than placebo.

Conclusion: The findings of this novel study provide a proof of concept and early signal toward efficacy of intravenous DDFPe in cardiac arrest. The trend toward improved ROSC and functional survival may reflect improved microcirculatory gas exchange in DDFPe animals. Improving gas exchange in brain microcirculation during resuscitation from cardiac arrest may provide a significant therapeutic benefit.

Background: A significant portion of youth sustain a concussion every year, with around 30% experiencing persistent post-concussion symptoms (PPCS). Research has shown exercising just below the exertion level that provokes symptoms can lead to more rapid recovery. However, youth often struggle to adhere to exercise recommendations following concussion.

Methods: We conducted structured qualitative interviews (n = 32) with concussed youth and their parents to examine factors influencing motivation to engage in exercise post-concussion. Questions were framed through the lens of Self-Determination Theory (SDT) and Thematic Analysis was used to code and analyze transcripts.

Results: Four primary factors appeared to motivate youth to exercise after receiving a concussion: 1) social support, 2) accountability, 3) goal setting, and 4) structure. Utilizing the lens of SDT, one could theorize that including social support and accountability helped fulfill the need of relatedness, setting goals helped fulfill the need of autonomy, and providing program structure helped fulfill the need for competence.

Conclusions: Our results suggest that Self-Determination Theory may be a useful frame for examining exercise adherence post-concussion. Incorporating social support, accountability, goal setting and structure could increase the effectiveness of exercise prescription post-concussion and should be the focus of further study.

Objective: To evaluate the correlation between withdrawal of life-sustaining therapy (WLST) and established prognostic indicators, as well as identify additional factors that may influence the timing of WLST.

Methods: This retrospective case-control study examined adult patients admitted between 8/1/18 and 7/31/21 with severe TBI. A case group of 164 individuals who underwent WLST after TBI was matched 1:1 to a control group of 164 individuals with TBI who did not undergo WLST. Clinical indicators of poor prognosis were recorded, and functional recovery of control subjects was evaluated using Glasgow Outcome Scale Extended (GOSE).

Results: The study involved 328 individuals (66 ± 19.9 years). Significant findings revealed lower GCS scores and shorter hospital stays in the case group compared to controls. Bilaterally absent pupillary responses were more common in cases (54.8%) and associated with shorter time to WLST and poorer functional outcomes in controls. Palliative care consultations and DNR code status were associated with time to WLST and functional outcomes. Non-geriatric control patients had better functional outcomes at follow-up (GOSE 6.3 ± 1.7) than geriatric patients (3.1 ± 1.5).

Conclusions: These findings emphasize the importance of standardized guidelines, objective indicators, and avoiding nihilism in making WLST decisions as many control subjects achieved functional recovery at varying levels of independence.