Brain injury最新文献

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.

Objective: To explore the survival time of adult chronic patients with Disorders of Consciousness (DOC).

Methods: We retrospectively considered 244 chronic DOC patients in 14 long-term care (LTC) facilities from 2017 to 2020. We considered patients' demographics (age, sex) and clinical (etiology, Body Mass Index) variables to explore any difference in survival probabilities. For longitudinal descriptive purposes, time from acute events and total scores at different clinical scales addressing patients' level of consciousness and disability were also considered.

Results: At the end of the 3-year follow-up period, 136 patients out of 244 died. The median overall survival was 67.6 months from the acute event, with significantly longer survival for younger patients and patients with traumatic etiology. However, almost all traumatic patients fall into the youngest patients' group.

Conclusion: During LTC hospitalization, chronic DOC patients showed a high level of disability and their clinical profile remained stable unless comorbidities or clinical complications arose. Age at the acute event is the main factor explaining survival probability, while the role of etiology, an already-known relevant factor for prognosis in the acute and post-acute phases, might be secondary in the chronic phase.

Background: Sports participation benefits children but increases the risk of mild traumatic brain injury (mTBI) and orthopedic injury (OI). This study examines risks of mTBI vs. OI associated with specific sports and benefits of sports participation.

Method: This is a cross-sectional study analyzing baseline data from the Adolescent Brain Cognitive Development (ABCD) Study, with a sample of 11,055 children aged 9-10. Generalized linear mixed-effects models were used to examine whether the risks of mTBI and OI differed across individual sports.

Results: Compared to children who had not participated in climbing, those who participated had a higher risk of mTBI than OI (ratio of odds ratio = 1.881, p = 0.013). Sports participation was associated with better behavioral/emotional outcomes, with stronger benefits for mTBI children compared to those with no injury (p = 0.043), but no significant difference between mTBI and OI groups.

Conclusion: Different sports have distinct risks for mTBI and OI in children. Behavioral benefits of sports were more pronounced for children with mTBI than for uninjured children but similar between mTBI and OI groups. While causal connections cannot be established with the current study design, these findings suggest the need for sport-specific and injury-specific strategies to mitigate risks and maximize benefits of youth sports.

Objective: To investigate the presence of specific family functioning trajectories in the 7-10 years after pediatric traumatic brain injury (TBI) and explore predictors associated with these trajectories.

Methods: One hundred and thirty-seven families of children aged 1-12 years who experienced traumatic brain injury were prospectively recruited from a single site, statewide tertiary pediatric hospital. Assessments of family functioning were undertaken using the Intimacy, Conflict and Parenting Style: Family Functioning Scale at preinjury, 6-months, 12-months, 30-months, and 7-10 years. Group-based trajectory modeling was used to identify latent trajectories of functioning. Associations with child, family, and injury characteristics were explored.

Results: We identified four distinct family intimacy profiles, four conflict profiles, and three parenting style profiles. Profiles were characterized by their level of functioning, which remained mostly stable from pre-injury levels across the 7-10 years post-injury. Trajectory membership was not reliably related to characteristics of the child, family, or injury.

Conclusions: These findings suggest that, while families operate at different levels of intimacy, conflict, and parenting flexibility, these do not change after a child's TBI. Given the established role of family functioning in shaping recovery outcomes, assessments of pre-injury family functioning may enable identification of families with children at risk for poorer outcomes post-TBI.

Objective: To investigate if colored overlays influences reading performance in adults with an acquired brain injury (ABI).

Methods: An experimental cross-sectional study where patients with ABI and reading-related visual discomfort (n = 25) were recruited from an outpatient rehabilitation clinic. Reading speed with and without colored overlays was investigated using the Wilkins Rate of Reading Test (WRRT) and coherent text. Eye movements were recorded with the Readalyzer. The Visual Discomfort Scale (VDS) was used for symptom assessment.

Results: Reading of WRRT was faster with an overlay (3.9%, p = 0.04). Participants with lower baseline reading speed (without overlay) showed greater improvements when reading the WRRT (median increase 10.9, 4.6-67.0%) and coherent text (median increase17.5, 5.5-93.2%). Improvements were reflected in significantly fewer progressive and regressive saccades, and shorter fixation durations. Improvements in reading speed correlated positively with VDS score (p = 0.05).

Conclusions: The findings support the theory that colored overlays can facilitate reading in some patients. Possible mechanisms are discussed in relation to reading ability, visual, and cognitive functions. Further research will be needed to increase the understanding of sensory visual stress and the effect of colored overlays in the ABI population.

Objectives: Neonatal hypoxic-ischemic encephalopathy (HIE) is brain damage caused by reduced blood/oxygen supply during the perinatal period. There is no adequate treatment currently. The kinase WNK3 is associated with cerebral edema and stroke prognosis, so we assessed its expression in a neonatal rat model of HIE.

Methods: The Rice method was used to induce HIE in 7-day-old rat pups by ligating the left carotid artery followed by hypoxia exposure. Rats were divided into sham, 6 h, 12 h, 24 h, and 48 h groups (n = 5 each). Neurological function was evaluated by negative geotaxis, righting reflex, and Morris water maze tests. WNK3 expression was measured by Western blotting, RT-PCR, immunohistochemistry, and immunofluorescence in brain samples.

Results: HIE rats showed significant neurological impairments in short and long-term tests compared to shams. Negative geotaxis and righting reflex times were prolonged in HIE rats (all p < 0.01), and Morris water maze performance was impaired at 4 weeks (p < 0.05). Western blotting revealed an approximate three-fold increase in cortical WNK3 protein expression by 48 h post-HIE (p < 0.001), while RT-PCR showed reduced WNK3 mRNA expression with a nadir at 6 h, a partial rebound at 24 h, and a decline again at 48 h. Histological staining confirmed increased proportions of WNK3-positive cells in peri-infarct cortex after HIE (p < 0.001).

Conclusion: Our study demonstrated a dissociation between WNK3 protein (upregulated ~3-fold) and mRNA (downregulated except for a transient 24 h rebound) in neonatal HIE, suggesting post-transcriptional regulation. The WNK3 upregulation may contribute to cerebral edema formation and neurological deficits. These findings are correlative; larger, sex-balanced studies incorporating WNK3 inhibition, direct brain water measurements, and integration with hypothermia therapy are warranted to test WNK3 as a therapeutic target in neonatal HIE.

Objective: Advanced neuroimaging methods have the ability to demonstrate neurobiological factors and detect potential underlying neuropathology associated with mild traumatic brain injury (mTBI), even in the absence of standard, conventional clinical computed tomography (CT) and/or magnetic resonance (MR) imaging (MRI) results.

Methods: This is Part III of a four-part series of critiques about the limitations of traditional neuropsychological methods in the clinical as well as research-based assessment of the mTBI patient.

Results: Part III reviews advanced quantitative image analysis methods used to examine brain structure, neural network integrity and functional connectivity following mTBI. Furthermore, this review demonstrates the relationship between symptom burden following mTBI and detecting underlying neuropathology, where traditional neuropsychological tests may reflect no impairment. Significant neuroimaging associations implicating neurobiological, pathophysiological and neuropathological underpinnings associated with mTBI may be demonstrated where traditional neuropsychological measures may be unrevealing.

Conclusions: Characterizations from traditional neuropsychological measures as independent tests indicating no lasting sequelae from mTBI, especially after three-months post-injury from mTBI need to be viewed within the context of what advanced neuroimaging can demonstrate. Future directions involving the integration of advanced neuroimaging developments applicable to the mTBI patient are reviewed, especially when integrated with neuropsychological methods.