Brain injury最新文献

Background: Memantine is thought to function as a neuroprotective agent because of its impact on the progression of various neurodegenerative diseases. This study examines memantine's neuroprotective effects in reducing complications resulting from brain injuries.

Methods: The keywords were searched in the PubMed, Scopus, and Web of Science databases. Human studies were excluded. SYRCLE's RoB was utilized to assess the quality of the studies.

Results: Of 1543 articles reviewed up to November 20, 2024, 51 met the established inclusion and exclusion criteria. The results indicated a strong association between memantine administration and: 1) decreased infarct size, reduced number of apoptotic cells, less brain edema, lower oxidative stress index, and diminished inflammatory responses, alongside improved neurobehavioral outcomes in ischemic stroke models; 2) less hematoma expansion, reduced brain edema and damage, decreased inflammation, and notable enhancement in neurobehavioral function and survival in hemorrhagic stroke models, coupled with the prevention of delayed cerebral vasospasm in subarachnoid hemorrhage cases; and 3) diminished brain injury, reduced infarct volume, less oxidative stress, and marked improvement in neurofunctional recovery in traumatic brain injury models.

Conclusions: Memantine's potential neuroprotective properties could improve neurofunctional outcomes for patients with acute brain injuries.

Objective: This study assessed the relationship between insulin-like growth factor 1 (IGF-1) level and symptom severity in adolescents with traumatic brain injury (TBI), focusing on correlation with post-injury symptom severity, depression, and anxiety.

Design: This retrospective observational study included adolescents aged 13-17 years (n = 52) with mild TBI (mTBI, n = 30) or moderate/severe TBI (msTBI, n = 22), based on best Glasgow Coma Scale score recorded in the first 24 h post-injury. Participants were 3-12 months post-TBI with available IGF-1 values and complete Rivermead Post Concussion Symptoms Questionnaire (RPQ-13), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) responses. Outcome measures were correlated with IGF-1 z-scores with Kendall's Tau analysis.

Results: RPQ-13 and GAD-7 scores were significantly higher in msTBI (p = 0.0472 and p = 0.0085, respectively). IGF-1 z-scores negatively correlated with RPQ-13 scores in mTBI (tau = -0.65, p < 0.0001) and msTBI (tau = -0.85, p < 0.0001), and with GAD-7 scores in mTBI (tau = -0.30, p = 0.0302) and msTBI (tau = -0.39, p = 0.0144). Only msTBI demonstrated a significant negative correlation between IGF-1 z-score and PHQ-9 scores (tau = -0.82, p < 0.0001).

Conclusions: Adolescents with msTBI experienced greater post-injury symptom severity and anxiety than those with mTBI. Low IGF-1 levels correlated with greater post-injury symptom severity, anxiety, and depression (msTBI only), supporting IGF-1 as a potential biomarker in adolescent TBI.

Primary objective: This study investigates the effect and underlying mechanisms of IL-18 binding protein (IL-18BP) on anxiety-like behaviors in rats following traumatic brain injury (TBI).

Methods and procedures: Thirty-six Sprague-Dawley rats were divided into three groups: sham, TBI, and TBI+IL-18BP. Anxiety-like behaviors were evaluated using the open field and elevated plus maze tests. Immunofluorescence staining was performed to assess the number of neurons, activated astrocytes, and the proportion of astrocytes positive for NLRP3 and IL-18. IL-18 levels in serum and cerebrospinal fluid (CSF) were quantified via ELISA. Western blot analysis was conducted to measure the expression of NLRP3, cleaved caspase-1 (cl-caspase-1), and N-GSDMD in the amygdala.

Main outcomes and results: Thirty days post-TBI, both the TBI and TBI+IL-18BP groups exhibited increased anxiety-like behaviors, elevated IL-18 levels in serum and CSF, greater activation of astrocytes in the amygdala, a higher percentage of NLRP3 and IL-18-positive astrocytes, and upregulated expression of pyroptosis-related proteins compared to the sham group (p < 0.05). However, the TBI+IL-18BP group showed significant reductions in these parameters compared to the TBI group (p < 0.05).

Conclusions: IL-18BP appears to mitigate anxiety-like behaviors in TBI rats, likely through a mechanism that involves reducing astrocyte apoptosis.

Objectives: To summarize patient perspectives after participating in a behavioral intervention designed to improve adherence to positive airway pressure therapy in Veterans with traumatic brain injury (TBI) and obstructive sleep apnea. The four-module adherence intervention was based on Motivational Interviewing and Cognitive Behavior Therapy principles and was adapted for persons with cognitive impairments.

Methods: Post-intervention semi-structured interviews were conducted with 13 patients with moderate-to-severe TBI. This qualitative study used a pragmatic and deductive approach with the Health Belief Model as the overarching framework. Two qualitative researchers coded and analyzed data with saturation reached after six interviews.

Results: The sample mean age was 51.4 years (SD = 10.8), who were on average 9.4 years post-TBI (SD = 10.1) and 6.8 years (SD = 5.1) post-OSA diagnosis. Patient feedback was organized into four themes that aligned with the Health Belief Model and two themes pertaining to logistics.

Conclusions: Participation in this adherence intervention was associated with increased awareness of OSA severity, its impact on them, and treatment benefits. Future research should examine the effectiveness of the intervention in real world clinical settings and obtain consumer input from treating clinicians to optimize the program and patient health and functioning.

Objective: The primary objective was to investigate the association between and the predictive value of hippocampal volume on verbal episodic memory (VEM), in participants with chronic moderate-to-severe TBI (MS-TBI).

Method: Nighty-one individuals with MS-TBI (males = 82, females = 9) were included (mean age = 33.57 years; mean educational level = 12.20 years; mean time since injury = 5.16 years). To assess VEM the Immediate Recall 1st Try, AVLT Total, Short and Long Delay Recall and Recognition trials of the Auditory Verbal Learning Test (AVLT) Greek Version, and the Immediate and Delayed Recall tasks from the Logical Memory subtest (Wechsler Memory Scale-III) were implemented. T1-weighted magnetic resonance images were used to extract global volumes and unilateral and bilateral hippocampal volume.

Results: Bilateral hippocampal volume was positively associated with the AVLT Long Delay Recall scores. Also, the left hippocampal volume was positively correlated with the AVLT Long Delay Recall and the LM Delayed Recall scores. Finally, the left hippocampal volume predicted performance on the LM Delayed and the AVLT Long Delay Recall tasks.

Conclusion: These findings suggest a potential role of the hippocampus in VEM performance in chronic MS-TBI and highlight the need for further research to clarify these associations and guide the development of targeted memory interventions.

Background: Acute neck pain following a concussion has been identified as a symptom associated with a delay in symptom resolution and persistent post-concussion symptoms (PPCS), but little is known about the relationship between the presence of acute neck pain and other known risk factors of delayed return to play (RTP) such as sex, sport contact level, and race.

Methods: This study reports the findings of a secondary data analysis of a prospective cohort study sample from the Concussion Assessment, Research, and Education (CARE) Consortium. We examined the possible mediating effects of neck pain severity on known factors of delayed RTP (sex, sport contact level, and race) following a suspected concussion.

Results: While neck pain was identified as significant predictor of delayed RTP (b = .046, S.E.  = .021, Wald χ²(1) = 4.745, p = 0.029), no interaction effect was observed between neck pain and the explored mediating factors of sex, sport contact level, and race.

Conclusions: These results suggest that independent of an individual's sex, sport contact level, and/or race, the presence of neck pain following a suspected concussion should be further evaluated and differentially diagnosed to rule out comorbid pathologies that may be contributing to PPCS following a suspected concussion.

Objectives: This study aims to find the incidence of pulmonary embolism (PE) in traumatic brain injury (TBI) and the impact of comorbidities on the development of PE in the United States.

Methods: This is a retrospective study of inpatient subjects from 2016 to 2020 in the United Stateswith TBI collected from the Healthcare Cost and Utilization Project (HCUP). Patients were evaluated for demographics, types of TBI, comorbidities, and complications. Regression statistical analyses were conducted to find the odds of developing PE after TBI.

Results: 219,005 TBI cases were included, of which 1,367 developed PE (0.6%). The cohort was mostly white (71%), and males (60%), with a mean age of 61.75 y/o. The patients who developed PE were younger (60.36 vs. 61.76, p < 0.001), had longer hospital stays (18.6 vs. 6.8 days, p < 0.001), and had significantly higher mortality (14% vs. 8%, p < 0.001). In multivariate analysis, having lower DVT (OR 10.16 [9.07-11.39], p < 0.001), upper DVT (OR 2.78 [2.26-3.42], p < 0.001), pneumonia (OR 1.35 [1.21-1.51], p < 0.001), myocardial infarction (OR 1.28 [1.00-1.63], p = 0.049), and sepsis (OR 1.26 [1.08-1.48], p = 0.004), had the highest association with developing PE following TBI.

Conclusions: Our data show that the incidence of PE in TBI patients is low; however, it is lethal with longer hospital stay. The risk of PE is higher in those with comorbidities such as paralysis, AIDS/HIV, metastatic cancer, and fluid/electrolyte disorders.

Introduction: Prolonged disorders of consciousness (pDoC) patients require specialized care to support recovery and manage complications, but information regarding the location and scope of dedicated centers is lacking. We conducted an international survey among specialists in this field to identify centers serving this population and developed a publicly available online resource for care providers, families, stakeholders, and neuroscientists involved in the care and management of people with pDoC.

Methods: A 17-question survey was distributed online between May 2022 and May 2024 to IBIA (International Brain Injury Association) members and sent to other professional societies involved in pDoC care. Responses were then grouped and analyzed based on geographic regions (Europe/UK, USA, and others).

Results: We collected data from 153 centers across 35 countries. Most centers indicated they accepted patients of all etiologies and ages, with regional differences in length of stay, access pathways, and discharge criteria. Nearly all centers were reported to provide caregiver training and counseling. A link to the map with centers contact information had been published on the IBIA website (https://www.internationalbrain.org/membership/ibia-special-interest-groups/disorders-of-consciousness-special-interest-group/disorders-of-consciousness-programs-project).

Discussion and conclusions: Our survey allowed the creation of the first preliminary international map of centers specialized in pDoC available online to families and providers. Future efforts are needed to identify other relevant centers of care, increase geographical representation, and foster collaboration to improve care accessibility and outcomes for patients with pDoC.

Objective: The acute effects of concussion and head impacts in collegiate student-athletes have been characterized, but not the effects at career end. We investigated how lifetime concussion history, sport contact exposure, and years of primary sport participation (YoP) associate with collegiate student-athlete health at institutional-exit.

Methods: Collegiate student-athletes (n = 3,663) enrolled in the CARE Consortium cohort study completed eight assessments within 1 year of institutional-exit spanning physical/behavioral, mental and cognitive health, and neurobehavioral symptoms. Separate multivariable linear regressions assessed how sport contact exposure, concussion history (number), and YoP influence questionnaire scores, adjusting for sex, Race, and self-reported athlete-identity and resiliency scores.

Results: Concussion history was associated with adverse scores within certain physical/behavioral, mental, and symptom health. Contact-exposed student-athletes reported improved scores on some cognitive, mental, and symptom health assessments. Greater YoP was associated with improved scores on two mental health questionnaires.

Conclusions: Lifetime concussion history is associated with self-reported health outcomes at institutional-exit, though small effect sizes suggest limited clinical consequence. Higher contact-exposure sports and increased YoP were associated with improved scores on some clinical measures. Further longitudinal monitoring is encouraged to evaluate health-related changes over time, to support student-athletes as they transition out of collegiate sports.

Introduction: Persistent concussion symptoms (PCS) after mild traumatic brain injury (mTBI) interfere with daily functioning. The study aimed to replicate findings of our previous work showing the efficacy of an intensive exposure therapy for PCS.

Method: A replication was conducted with four participants (age M = 25.5, time-since-injury M = 13.25), using a multiple-baseline multi-phase (A-B-C-D-E) single-case experimental design. A randomly assigned baseline (A) preceded the 4-week exposure intervention (B - exploration, C - active exposure, D - booster) conducted by psychologists, with a 4-week follow-up (E). The primary measures, including active avoidance, believability, satisfaction, and symptom experience, were assessed daily on visual analogue scales. Secondary measures of symptom severity, catastrophizing, activity avoidance, anxiety, depression, societal participation and therapeutic alliance were measured across four time points.

Results: Significant effects were shown in visual and Tau-U analysis for all participants on all primary measures comparing baseline and intervention phases. For all primary measures, the pooled standardized mean difference (PSMD) was high. Clear improvements were seen on all secondary measures except anxiety.

Conclusions: The findings of this study further confirmed the efficacy for this intensive exposure therapy for PCS, adding further evidence for exposure therapy in this patient population. Replication in other samples is needed.