Brain injury最新文献

Purpose of research: This review explores the therapeutic potential of hyperbaric oxygen therapy (HBOT) in treating neonatal hypoxic-ischemic encephalopathy (HIE), focusing on its mechanisms of action, combination strategies, and current research gaps.

Principal results: HBOT enhances neuroprotection by increasing arterial oxygen content, promoting neural tissue repair, modulating gene expression, and reducing oxidative stress. When combined with therapies such as therapeutic hypothermia, neurotrophic agents, antioxidants, or phenobarbital, HBOT exhibits synergistic effects. Clinical studies have demonstrated superior outcomes with HBOT-hypothermia combinations versus monotherapies. However, current literature lacks stratified analyses based on HIE severity, head-to-head comparisons of combination strategies, and long-term follow-up data. Moreover, most existing reviews focus solely on mechanisms, underrepresenting clinical applications.

Conclusions: HBOT holds promise as a non-invasive adjunct therapy for neonatal HIE, especially in combination with established treatments. Its safety has improved with advances in neonatal care, allowing broader clinical use. Nonetheless, standardized protocols, stratified clinical trials, and molecular-level studies are needed to optimize therapeutic strategies and enhance outcomes in affected infants.

Introduction: In Canada, concussions are common among children aged 3-12 years. Caregivers play a vital role in their child's post-concussion care, highlighting the need for resources tailored to children and caregivers. Although many online pediatric concussion resources exist, their suitability for younger children and caregivers remains unclear.

Objective: To identify and assess the quality, readability, usability, and suitability of online concussion resources for children aged 3-12 years and their caregivers.

Methods: A four-phased systematic search strategy was used and involved: 1) searching Canadian children's hospital websites, 2) applying pre-established inclusion/exclusion criteria, 3) evaluating content quality, and 4) evaluating resources for suitability, readability, and usability.

Results: The search yielded 738 resources.17 met the final criteria. Among these, 82.4% (n = 14) required the ability to read text, 11.8% (n = 2) specified the age of the resource targeted, and 5.9% (n = 1) focused on return to play beyond organized sport.

Conclusions: The identified resources offer accurate concussion information for children and caregivers, but lack specificity for their intended audience and accessibility for nonreaders. Future resources should consider specifying the intended age group, improving accessibility for nonreaders, and including information about important activities for this age group such as returning to active play.

Background: Severe isolated traumatic brain injury (TBI) represents a complex and understudied population. Limited evidence exists on predictors of cranial decompression. This study aims to quantify the rate and identify factors associated with cranial decompression in severe isolated TBI using a large national database.

Methods: Data from the 2019-2021 American College of Surgeons Trauma Quality Program was analyzed. Severe TBI was defined as a head Abbreviated Injury Scale (AIS) score ≥ 3. Demographics, vitals, comorbidities, and in-hospital complications were assessed using multivariable models to identify predictors of cranial decompression.

Results: A total of 303,766 adults with severe isolated TBI were included (mean age 59.8; 64.2% male; 75.0% white). Cranial decompression was performed in 13.5% (n = 41,045). Univariate analysis showed significant differences in demographics, mechanism of injury, ICU admission, CT findings, midline shift, cerebral monitoring, blood product use, and complications. Multivariable analysis revealed that males, younger age, falls as the mechanism of injury, higher GCS, ICU admission, CT findings, need for cerebral monitoring, presence of midline shift, thromboembolism prophylaxis, and requirement for blood product transfusions, were strong predictors of cranial decompression.

Conclusion: This study provides valuable insights into the independent predictors for the need of cranial decompression in severe isolated TBI patients.

Purpose: The purpose of this literature review was to assess and evaluate the neurophysiological and visual effects of cannabis, nicotine, and e-cigarettes on patients with traumatic brain injury (TBI).

Methods: In this review, a literature search was performed using PubMed and Google Scholar resources. In addition, a literature search within cited references was also performed for this review. A total of seventy-two(72) publications as referenced were used for this review.

Discussion: This literature review is intended to address the neurophysiological and visual impairments of patients with TBI through a systematic review to identify the side effects of substance abuse disorders (SUDs) and specifically describe the impacts of cannabis, nicotine, and e-cigarettes on TBI patients, and conclude the current findings.

Conclusion: This systematic evaluation is beneficial for the healthcare community and provides the potential to better assess the effects of these different harmful substances on patients who have suffered trauma to their brains.

Objectives: This cross-sectional study aims to describe objective and subjective cognitive functioning and to explore the relationship between cognition, participation, fatigue, and psychological symptoms, in adults aged 18-64 with mild stroke.

Methods: Fifty-seven adults (mean age = 52 years; 51% women) who were hospitalized after a mild stroke were recruited. They completed a short telephone cognitive assessment and online questionnaires on average six months after stroke (range: 3-13).

Results: Results suggest that mean scores of cognitive tests fell within the average normative range, although an underestimation of cognitive impairment cannot be ruled out. Moreover, compared to a normal distribution, a greater proportion of participants had average or below average cognitive performances. The most common subjective cognitive complaints were mental slowness (54% of sample), memory difficulties (51%), concentration difficulties 51%), and multitasking (47%). Objective cognitive performance was not associated with subjective cognitive complaints. Subjective cognitive complaints, performance on a cognitive flexibility test, and symptoms of anxiety, depression, post-traumatic stress, and fatigue significantly correlated with participation. Subjective cognitive functioning was the most significantly associated factor with participation according to regression analyses.

Conclusion: These results raise the importance of implementing rehabilitation services that target cognitive complaints to promote better participation in this population.

Background: Stigma toward acquired brain injury (ABI) is often driven by a lack of knowledge and familiarity, which may reduce willingness to interact with survivors, affecting their well-being and recovery.

Methods: This study explored the relationship between ABI knowledge, familiarity, and willingness to interact among the general public (n = 308), general practitioners (n = 105), and neurorehabilitation professionals (n = 123). A cross-sectional survey of 536 participants assessed knowledge (Common Misconceptions About Traumatic Brain Injury Questionnaire), familiarity (Familiarity Scale), and willingness to interact (Social Interaction Scale). Data were analyzed using Rasch modeling, principal component analysis, non-parametric tests, and a multivariate linear model.

Results: Knowledge and familiarity explained a small yet significant portion of the variance in willingness to interact. Misconceptions were most common in the general public, yet general practitioners and rehabilitation professionals also showed gaps in understanding invisible impairments, and recovery. Rehabilitation professionals had the highest work-related familiarity, while general practitioners showed the highest willingness to interact.

Discussion: Findings highlight the need for psychoeducation and contact-based interventions to reduce misconceptions and improve attitudes toward ABI survivors. Enhancing knowledge and familiarity may help reduce stigma, emphasizing the importance of further research and targeted interventions.

Objective: Emotional experience is based, among other factors, on physiological reactivity (PR) and the awareness of this reactivity corresponding to interoception. After a traumatic brain injury (TBI), patients exhibit reduced PR and interoception, raising questions about the integrity of their emotional experience.

Method: To examine this issue, 26 men with moderate to severe TBI (age: 37 ± 11) and 26 healthy male controls (age: 35 ± 14) watched emotional films (amusement, tenderness, anger, disgust). PR was measured via electrodermal activity (EDA) and heart rate variability (HRV). After each film, an emotional evaluation was completed using the Differential Emotional Scale (DES). Interoception was measured through a heartbeat counting (HBC) task and the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire.

Results: Compared to controls, TBI participants scored lower on the MAIA Emotional Awareness and Noticing subscales, and exhibited lower EDA and HRV during the anger and tenderness films. However, emotional evaluations and HBC task scores were similar between groups. Positive correlations were found between emotional evaluation and the MAIA scale.

Conclusion: These results suggest a dissociation between emotional experience and PR after TBI and decreased interoceptive sensitivity. Since interoception links PR and emotional experience, exploring the impact of reduced interoception on this dissociation could improve our understanding of post-TBI emotional functioning.

Background: Encephalitis can lead to acquired brain injury (ABI) with neuropsychiatric consequences. Emotional adjustment is important for ensuring positive, long-term outcomes. The transdiagnostic cognitive behavioral therapy (T-CBT) model offers a way of understanding adjustment post-encephalitis but has not yet been tested. We qualitatively assessed whether the T-CBT model accurately captured recovery experiences post-encephalitis and whether experiences differed between infectious and autoimmune encephalitis.

Methods: A directed content analysis was used to inductively code spoken experiences of encephalitis survivors (n = 15), as told through public podcasts, and apply a deductive coding framework built from the T-CBT model. A second inductive content analysis was used to explore the podcast interview questions.

Results: The T-CBT model broadly captured the experiences of emotional adjustment post-encephalitis. Threat to self-identity and responses to these threats, amongst other contextual factors, were important. An additional major category emerged to capture the impact of encephalitis on close others. No discernible pattern was found between survivors of infectious (n = 6) and autoimmune (n = 6) encephalitis.

Conclusions: The T-CBT model with additional systemic factors can help to understand emotional adjustment after encephalitis and provides a rationale for psychological therapy as a treatment during the recovery phase.

Background: Cells universally employ an efficiency-driven metabolic switch mechanism during nutritional changes, growth, and differentiation, transitioning from oxidative phosphorylation (OXPHOS) to glycolysis to ensure survival under hypoxic conditions or high energy demands. In cerebral ischemia, inadequate blood supply causes oxygen and energy deprivation, prompting brain cells to initiate glycolytic reprogramming to meet urgent energy needs. While this adaptation is a temporary solution, it may lead to lactic acidosis, aggravated inflammation, and increased free radical production. Prolonged reperfusion with sustained glycolysis can exacerbate brain cell damage, potentially causing irreversible harm.

Objectives: This review systematically examines the dynamic changes in glucose metabolic transport mechanisms and the roles of immediate, early, intermediate, and late responder cells, along with their regulatory factors, in glycolytic reprogramming.

Methods: Using a temporal analysis framework based on the body's natural response sequence to pathological events, we elucidate how cells at different stages collaborate to address glucose metabolism reprogramming under pathological conditions.

Conclusions: Reversing glucose metabolism reprogramming and inhibiting glycolysis may improve the pathological processes of ischemic stroke, offering potential therapeutic benefits.