Correlation of ubiquitin C terminal hydrolase and S100ß with cognitive deficits in young adults with mild traumatic brain injury.

OBJECTIVE: To study the acute phase serum biomarkers in patients with mild traumatic brain injury (mTBI) and to correlate them with short term cognitive deficits. MATERIALS AND METHODS: This is a prospective observational study conducted at a tertiary care center for neurotrauma. The participants included patients with mTBI (n = 20) and age, gender, and education-status matched healthy controls (n = 20). In both the groups, the serum concentrations of biomarkers ubiquitin C terminal hydrolase (UCH-L1) and S100 calcium-binding protein B (S100B) were measured. Both the groups underwent neuropsychological tests. The serum tests were done in the acute stage after injury and the neuropsychological tests were done 3 months after injury. RESULTS: There was no significant increase in the serum S100B and UCH-L1 levels in patients with mTBI. Patients with mTBI had significant cognitive deficits at 3 months after injury, which was suggestive of involvement of diffuse areas of the brain, in particular, the premotor, prefrontal, and medial inferior frontal lobes and the basitemporal region. The correlation of biomarkers with cognitive deficits in patients with mTBI was found in the following domains: working memory, verbal learning, verbal fluency, and visual memory. CONCLUSION: The serum biomarkers of mTBI have a correlation with selective domains of neuropsychological outcome.

The vascular protective role of oestradiol: a focus on postmenopausal oestradiol deficiency and aneurysmal subarachnoid haemorrhage.

The steroid hormone, oestradiol, has pleiotropic functions. The protective effects of oestradiol are attributed to its anti-inflammatory, antioxidant, anti-atherogenic, anti-apoptotic, vasodilatory activities and regulation of micro RNA. Oestradiol upregulates endothelial nitric oxide synthase gene expression and increases the production of nitric oxide, an important vasodilator. It suppresses the renin-angiotensin system and monitors haemodynamic stress. The hormone maintains the integrity of blood vessels by reducing oxidative stress while upregulating the expression of antioxidant enzymes and prevents vascular inflammation by regulating pro- and anti-inflammatory cytokines. Aneurysmal subarachnoid haemorrhage (aSAH) occurring as a consequence of the rupture of an intracranial aneurysm is a devastating cerebrovascular event, representing 5-7% of all strokes. Postmenopausal women are more susceptible to aSAH compared to men in the same age group. This gender disparity has been attributed to reduced levels of the vascular protective hormone oestradiol following menopause. This review is focused on the protective role of oestradiol on vasculature and how the drop in oestradiol levels after menopause dramatically increases the incidence of aSAH in women. During menopause, oestradiol deficiency may affect vascular integrity causing dysregulation of vascular homeostasis by affecting the renin-angiotensin-aldosterone system (RAAS) and inflammatory and apoptotic cascades, resulting in the weakening of the cerebral arterial wall and potentially to development of an aneurysm and its rupture. In view of the role of oestradiol in maintaining vascular integrity, treatments involving hormone replacement could be a promising approach in postmenopausal women who are at risk of developing or rupturing an intracranial aneurysm.

Neuroimmunology of Traumatic Brain Injury: A Longitudinal Study of Interdependency of Inflammatory Markers and Heart Rate Variability in Severe Traumatic Brain Injury.

The aim of the present study is to evaluate the interdependency between heart rate variability (HRV) and inflammatory markers in patients with severe traumatic brain injury (TBI). A prospective exploratory study was done with a sample size of 89 patients. HRV of these patients was recorded using a telemetric device. The recordings were made on day 1 of the patients' admission into the intensive care unit followed by serial recordings on day 3 and day 10. Serum samples of the patients were also collected on these days for analysis of interleukin (IL)-1ß, IL-6, IL-10, and tumor necrosis factor alpha levels using enzyme-linked immunosorbent assay kits. The outcome assessment was done using the Disability Rating Scale at discharge and Glasgow Outcome Scale-Extended at 6 months post-trauma. The data were analyzed by grouping the patients on based on mortality and outcome. In the present study, there was significant subclinical autonomic dysfunction in patients with severe TBI. Among the serum cytokines, levels of IL-10 had a significant impact on outcome. An increase in IL-10 levels correlated with the unfavorable outcome. This study highlights the association between the HRV parameters and immune response. The timely management of both autonomic and immune dysfunction in patients with severe TBI may have an impact in preventing the secondary injury process.