Loss of microglial Arid1a exacerbates microglial scar formation via elevated CCL5 after traumatic brain injury.

Traumatic brain injury (TBI) is an acquired insult to the brain caused by an external mechanical force, potentially resulting in temporary or permanent impairment. Microglia, the resident immune cells of the central nervous system, are activated in response to TBI, participating in tissue repair process. However, the underlying epigenetic mechanisms in microglia during TBI remain poorly understood. ARID1A (AT-Rich Interaction Domain 1 A), a pivotal subunit of the multi-protein SWI/SNF chromatin remodeling complex, has received little attention in microglia, especially in the context of brain injury. In this study, we generated a Arid1a cKO mouse line to investigate the potential roles of ARID1A in microglia in response to TBI. We found that glial scar formation was exacerbated due to increased microglial migration and a heightened inflammatory response in Arid1a cKO mice following TBI. Mechanistically, loss of ARID1A led to an up-regulation of the chemokine CCL5 in microglia upon the injury, while the CCL5-neutralizing antibody reduced migration and inflammatory response of LPS-stimulated Arid1a cKO microglia. Importantly, administration of auraptene (AUR), an inhibitor of CCL5, repressed the microglial migration and inflammatory response, as well as the glial scar formation after TBI. These findings suggest that ARID1A is critical for microglial response to injury and that AUR has a therapeutic potential for the treatment of TBI.

Volumetric modulated arc therapy total body irradiation improves toxicity outcomes compared to 2D total body irradiation.

Introduction: Volumetric modulated arc therapy (VMAT) total body irradiation (TBI) allows for greater organ sparing with improved target coverage compared to 2D-TBI. However, there is limited evidence of whether improved organ sparing translates to decreases in toxicities and how its toxicities compare to those of the 2D technique. We aimed to compare differences in toxicities among patients treated with TBI utilizing VMAT and 2D techniques. Methods/materials: A matched-pair single-institution retrospective analysis of 200 patients treated with TBI from 2014 to 2023 was performed. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method and compared using log-rank tests. Differences in characteristics and toxicities between the VMAT and 2D cohorts were compared using Fisher's exact test. Results: Of the 200 patients analyzed, 100 underwent VMAT-TBI, and 100 underwent 2D-TBI. The median age for VMAT-TBI and 2D-TBI patients was 13.7 years and 16.2 years, respectively (p = 0.25). In each cohort, 53 patients were treated with myeloablative regimens (8-13.76 Gy), and 47 were treated with non-myeloablative regimens (2-4 Gy). For the entire VMAT-TBI cohort, lung Dmean, kidney Dmean, and lens Dmax were spared to 60.6% ± 5.0%, 71.0% ± 8.5%, and 90.1% ± 3.5% of prescription, respectively. For the non-myeloablative VMAT-TBI cohort, testis/ovary Dmax, brain, and thyroid Dmean were spared to 33.4% ± 7.3%, 75.4% ± 7.0%, and 76.1% ± 10.5%, respectively. For 2D-TBI, lungs were spared using partial-transmission lung blocks for myeloablative regimens. The VMAT-TBI cohort experienced significantly lower rates of any grade of pneumonitis (2% vs. 12%), nephrotoxicity (7% vs. 34%), nausea (68% vs. 81%), skin (16% vs. 35%), and graft versus host disease (GVHD) (42% vs. 62%) compared to 2D-TBI patients. For myeloablative regimen patients, rates of pneumonitis (0% vs. 17%) and nephrotoxicity (9% vs. 36%) were significantly lower with VMAT-TBI versus 2D-TBI (p < 0.01). Median follow-up was 14.3 months, and neither median OS nor PFS for the entire cohort was reached. In the VMAT versus 2D-TBI cohort, the 1-year OS was 86.0% versus 83.0% (p = 0.26), and the 1-year PFS was 86.6% and 80.0% (p = 0.36), respectively. Conclusion: Normal tissue sparing with VMAT-TBI compared to the 2D-TBI translated to significantly lower rates of pneumonitis, renal toxicity, nausea, skin toxicity, and GVHD in patients, while maintaining excellent disease control.

Nigella sativa extract abrogates traumatic brain injury-induced memory impairment in adult mice.

Background: Traumatic brain injury (TBI) is an increasing widespread cause of disability and mortality, typically leading to dementia and memory impairment. Objective: This study aims to investigate the neuroprotective potential of Nigella sativa extract against TBI induced memory impairment in adult albino mice. Methods: Adult male mice were divided into four groups randomly: Control, Nigella sativa extract alone, TBI alone and TBI plus Nigella sativa extract. TBI induction was carried out in mice using a weight dropping method then Nigella sativa extract (10 mg/kg) was administered intraperitoneally for two weeks. Morris water maze and Y-maze tests were used to measure memory improvement ability and Western blot technique was used to analyse the neuroinflammatory and synaptic protein markers. Results: Nigella sativa extract significantly decreased phosphorylated c-Jun N-terminal kinase (p-JNK), Tumor necrosis factor-alpha (TNF-α), and nuclear factor kappa B (NF-κB) proteins to reduce TBI-induced neuroinflammation accompanied by the restoration of both pre- and post-synaptic protein expression in adult mice model. Furthermore, Nigella sativa extract enhanced both short and long-term spatial memory against TBI in adult mice model. Conclusion: Nigella sativa extract abrogated neuroinflammation mediated memory impairment in TBI mice model. Further research is needed to determine Nigella sativa extract ingredients detail completely and to understand its mechanisms of neuroprotection in reducing memory impairments associated with traumatic brain injury and other neurodegenerative diseases.

The Ambivalent Role of miRNA-21 in Trauma and Acute Organ Injury.

Since their initial recognition, miRNAs have been the subject of rising scientific interest. Especially in recent years, miRNAs have been recognized to play an important role in the mediation of various diseases, and further, their potential as biomarkers was recognized. Rising attention has also been given to miRNA-21, which has proven to play an ambivalent role as a biomarker. Responding to the demand for biomarkers in the trauma field, the present review summarizes the contrary roles of miRNA-21 in acute organ damage after trauma with a specific focus on the role of miRNA-21 in traumatic brain injury, spinal cord injury, cardiac damage, lung injury, and bone injury. This review is based on a PubMed literature search including the terms "miRNA-21" and "trauma", "miRNA-21" and "severe injury", and "miRNA-21" and "acute lung respiratory distress syndrome". The present summary makes it clear that miRNA-21 has both beneficial and detrimental effects in various acute organ injuries, which precludes its utility as a biomarker but makes it intriguing for mechanistic investigations in the trauma field.

Traumatic brain injuries: a neuropsychological review.

The best predictor of functional outcome in victims of traumatic brain injury (TBI) is a neuropsychological evaluation. An exponential growth of research into TBI has focused on diagnosis and treatment. Extant literature lacks a comprehensive neuropsychological review that is simultaneously scholarly and practical. In response, our group included, and went beyond a general overview of TBI's, which commonly include definition, types, severity, and pathophysiology. We incorporate reasons behind the use of particular neuroimaging techniques, as well as the most recent findings on common neuropsychological assessments conducted in TBI cases, and their relationship to outcome. In addition, we include tables outlining estimated recovery trajectories of different age groups, their risk factors and we encompass phenomenological studies, further covering the range of existing-promising tools for cognitive rehabilitation/remediation purposes. Finally, we highlight gaps in current research and directions that would be beneficial to pursue.

Tracheobronchial injury after blunt thoracic trauma-lessons to learn in diagnosis, treatment, and postoperative care: a case series.

Background: Tracheobronchial injury (TBI) is the subsuming term to describe rare and mostly traumatic damage to the tracheobronchial tree. Prehospital mortality is significant. TBI patients may face delayed diagnosis, challenging perioperative care, and prolonged recovery. The focus of this case series is to identify issues that represent common hurdles and potential problems in the diagnosis, treatment, and postoperative care of patients with TBI. Case Description: This is a single-center retrospective case-series study of four patients who experienced TBI following blunt thoracic trauma in the study period from January 1, 2020, to December 31, 2023. The mean age of the patients was 48 years, with patient age ranging from 24 to 59 years. One patient was female and the other three were male. Two patients sustained injuries to the main bronchi, while the others sustained injuries to more peripheral parts of the tracheobronchial tree. Three patients were secondary transfers to our hospital, while the other was a primary admission. All four patients underwent surgery for their TBI. The duration of hospitalization ranged from 10 to 60 days. The two patients with main stem bronchus injury required the longest hospitalization. The same two patients required extracorporeal membrane oxygenation therapy. We experienced no mortality, and all patients were discharged for post-hospital rehabilitation. Conclusions: TBI management requires a multidisciplinary and experienced team. One must be aware of the classic clinical presentation: dyspnea, soft tissue emphysema, and hemoptysis. Cases in which a history of trauma is associated with dyspnea and/or chest wall/mediastinal emphysema require early bronchoscopy as the diagnostic gold standard. The use of "Minimum-intensity projection" (MinIP) reconstructions can help identify TBI in computed tomography scans. Extracorporeal membrane oxygenation therapy is to be considered in selected cases. Surgical repair must focus on preventing parenchymal loss by reconstructing the bronchial defect while avoiding anatomical resection. Postoperative care should consider the possibility of bronchial denervation and its potential complications.

Racial and Ethnic Differences in Traumatic Brain Injury Outcomes From 2009 to 2023: Protocol for a Systematic Review.

BACKGROUND: In 2009, Gary and colleagues reviewed prior research examining racial and ethnic differences in outcomes after traumatic brain injury (TBI). Over the past 15 years, advances in research and changes in the demographic composition of the United States warrant a comprehensive understanding of racial and ethnic disparities after TBI. OBJECTIVE: A systematic review will be conducted to examine racial and ethnic differences in TBI outcomes from 2009 to 2023. METHODS: Preliminary searches and study screening processes will identify relevant English-language articles published from January 2009 to December 2023 using the CINAHL, Gale OneFile, PsycINFO (Ovid), and PubMed electronic databases. Relevant articles will include quantitative or mixed method approaches, involve individuals with TBI or their caregivers, and compare 2 or more groups by race or ethnicity on post-TBI outcomes. Quality will be assessed using the Newcastle-Ottawa Scale. This systematic review protocol was developed following PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Results will be summarized, and a subgroup analysis may be conducted based on demographics (eg, age, gender, or sex). RESULTS: We have already identified abstracts using the search strategy for all 4 of the included electronic databases. We recently updated the search and will begin abstract screening of the additional abstracts identified from the last search completed in January 2024. This systematic review is anticipated to be completed by fall 2024, and its findings will be disseminated to the scientific community, persons with TBI, caregivers, and the lay audience. CONCLUSIONS: This systematic review will advance our understanding regarding outcome disparities among minoritized individuals with TBI, examine progress over the past 15 years in minimizing barriers encountered by these racial and ethnic groups, and provide professionals with a roadmap illustrating existing gaps in rehabilitation care, making way for further development and implementation of evidence-based interventions to improve health equity in TBI outcomes. TRIAL REGISTRATION: PROSPERO CRD42023394529; https://tinyurl.com/53mtcz9b. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/58763.

Memory Loss and Missteps: Investigating Fall Risks in Alzheimer's and Dementia Patients.

Background: Degenerative diseases such as Alzheimer's disease and dementia are significant health concerns among older adults in the United States, contributing substantially to the high incidence of falls in this population. This study aims to investigate the incidence and prevalence of falls among older adults diagnosed with Alzheimer's disease and dementia and explore the association between these conditions and the occurrence of traumatic brain injuries (TBIs). Methods: A retrospective cohort study was conducted using data from 17,000 older adults aged 65 and above, arrived at the hospital with fall related injuries, obtained from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) between January 1, 2019, and December 31, 2023. Data included demographic information, diagnosis codes (ICD-10), and details on falls, Alzheimer's disease, dementia, and TBIs. Descriptive statistics and logistic regression analyses were performed using TriNetX analytical tools. Results: Older adults with Alzheimer's disease (incidence proportion: 3.11%, prevalence: 4.81%) and dementia (incidence proportion: 12.46%, prevalence: 17.06%) had a significantly higher incidence of falls compared to those without these conditions. Females showed a slightly higher incidence of falls than males. Logistic regression analysis indicated that patients with Alzheimer's disease had a reduced risk of TBIs (OR = 0.765, 95% CI: 0.588-0.996, p = 0.047), while those with unspecified dementia had an increased risk (OR = 1.161, 95% CI: 1.002-1.346, p = 0.047). Conclusions: Our study reveals a higher risk of falls and traumatic brain injuries (TBIs) in older adults with dementia compared to those with Alzheimer's disease. These findings underscore the need for targeted fall prevention strategies and educational programs for caregivers.

Examination of Congruity between Subjective and Objective Working Memory in Veterans with Mild TBI and Relation to Psychiatric Symptoms and Childhood Trauma.

OBJECTIVES: There is conflicting evidence regarding congruence between subjective cognitive decline and objective cognitive performance for individuals with a history of mild traumatic brain injury (mTBI). The current study investigated the congruity between subjective and objective cognition, particularly working memory, among veterans with an mTBI history, accounting for post-traumatic stress disorder (PTSD) and childhood trauma. METHODS: Participants included 35 veterans with a history of mTBI sustained during deployment. Participants completed measures of subjective [i.e., Behavioral Inventory Rating of Executive Functioning (BRIEF)] and objective working memory (i.e., WAIS-IV working memory index). Congruity between subjective and objective working memory was examined using linear regression. Bonferroni-corrected correlations were run to explore relationships among working memory, psychiatric symptoms, mTBI severity, and childhood trauma. RESULTS: Among Veterans with mTBI, subjective working memory and objective working memory performance were not significantly related (p > 0.05); however, the overall model was significant (p < 0.0001), and childhood trauma was a notable predictor (p = 0.02). Greater PTSD, depression, and sleep symptoms were significantly related to increased subjective working memory concerns, even after Bonferroni adjustments (ps < 0.0001). Better objective working memory was significantly related to a fewer number of childhood traumatic events; however, this did not sustain corrections. The majority of individuals (67%) endorsed significant working memory complaints, despite objectively performing within normal limits (within 1 SD and above). CONCLUSIONS: Subjective-objective working memory congruity among veterans with mTBI was limited. Subjective, but not objective, working memory concerns were associated with greater PTSD, depression, and sleep symptoms. Childhood trauma was a notable factor that contributed to both subjective and objective cognitive concerns. There remains clinical value in assessing subjective cognitive concerns given the strong relationships with psychiatric problems and, hence, a focus for intervention.

The Effect of Ultra-Late Cranioplasty in a Patient with Long-Term Disorders of Consciousness.

BACKGROUND/OBJECTIVES: Cranioplasty (CP) is the main surgical procedure aiming to repair a morphological defect in the skull. It has been shown that early CP is useful for patients with traumatic brain injury (TBI) to achieve functional recovery, whereas few studies have investigated the clinical effects of ultra-late CP on TBI outcomes. METHODS: Here, we describe the clinical course over 2 years of a TBI patient who underwent CP 19 months after fronto-parietal decompressive craniectomy (DC) of a limited size. RESULTS: We found that after ultra-late CP, a meaningful functional recovery (cognitive and motor), with emergence from a minimally conscious state and recovery of functional communication, was revealed. CONCLUSIONS: Our preliminary findings contribute to the actual debate on the timing of CP for this neurosurgical procedure's therapeutic success, as early CP has already been shown.

A Systematic Review of Traumatic Brain Injury in Modern Rodent Models: Current Status and Future Prospects.

According to the Centers for Disease Control and Prevention (CDC), the national public health agency of the United States, traumatic brain injury is among the leading causes of mortality and disability worldwide. The consequences of TBI include diffuse brain atrophy, local post-traumatic atrophy, arachnoiditis, pachymeningitis, meningocerebral cicatrices, cranial nerve lesions, and cranial defects. In 2019, the economic cost of injuries in the USA alone was USD 4.2 trillion, which included USD 327 billion for medical care, USD 69 billion for work loss, and USD 3.8 trillion for the value of statistical life and quality of life losses. More than half of this cost (USD 2.4 trillion) was among working-age adults (25-64 years old). Currently, the development of new diagnostic approaches and the improvement of treatment techniques require further experimental studies focused on modeling TBI of varying severity.

Traumatic Brain Injury in Companion Animals: Pathophysiology and Treatment.

Traumatic brain injuries (TBI) are common in dogs and cats that have sustained head trauma from a variety of causes. In moderate to severe TBI, damage from both the primary and secondary injuries can be life-threatening. TBI management may be further complicated by concurrent injuries in polytrauma patients. Thorough initial and serial examinations are key in detecting neurologic changes quickly and guiding treatment. Intensive treatments such as nursing care, fluid therapy, hyperosmolar agents, analgesia, sedation, anticonvulsants, oxygen supplementation, surgery, and rehabilitation may be employed in TBI management. Prognostication resources for an individual patient are limited and a perceived poor prognosis may worsen clinical outcomes. In this paper, we review the pathophysiology of TBI, identification, injury stratification and prognosis of patients with TBI as well as propose treatment and monitoring recommendations for companion animals based on severity of TBI.

Effect of Decompressive Craniectomy on Intracranial Pressure Waveforms and Vascular Reactivity: A Systematic Scoping Review.

Decompressive craniectomy (DC) primarily aims at decreasing intracranial pressure (ICP) by allowing for the brain tissue to expand. However, it is uncertain to what extent DC impacts the transmission of vasogenic slow waves and thus the validity and utility of the pressure reactivity index (PRx). The purpose of this systematically performed scoping review is to assess the current knowledge of the impact of DC on ICP waveforms and measures of vascular reactivity. This scoping review considered studies including patients over 18 years old suffering from acute brain injuries (ABIs), who underwent secondary DC and had a perioperative (pre/post-DC) recording of ICP or waveform analysis. A search was conducted in EMBASE, PubMed, Web of Science, Scopus, and Medline from November 2023 till January 2024, yielding 787 studies. Duplicated studies were automatically removed, and two researchers independently screened the remaining studies. After examining 586 titles and abstracts, 38 full-text studies were assessed for eligibility, and 4 studies were included in the final review. The review suggests that cerebrovascular reactivity and slow waves are altered after DC, with positive PRx values and reduced slow power. One study suggested that the nature of slow waves and interactions is on the whole largely preserved. However, the findings should be interpreted with caution due to methodological limitations and the low number of studies.

Comparative analysis of meningeal transcriptomes in birds: Potential pathways of resilience to repeated impacts.

The meninges and associated vasculature (MAV) play a crucial role in maintaining cerebral integrity and homeostasis. Recent advances in transcriptomic analysis have illuminated the significance of the MAV in understanding the complex physiological interactions at the interface between the skull and the brain after exposure to mechanical stress. To investigate how physiological responses may confer resilience against repetitive mechanical stress, we performed the first transcriptomic analysis of avian MAV tissues using the Downy Woodpecker (Dryobates pubescens) and Tufted Titmouse (Baeolophus bicolor) as the comparison species. Our findings reveal divergences in gene expression profiles related to immune response, cellular stress management, and protein translation machinery. The male woodpeckers exhibit a tailored immune modulation strategy that potentially dampens neuroinflammation while preserving protective immunity. Overrepresented genes involved in cellular stress responses suggest enhanced mechanisms for mitigating damage and promoting repair. Additionally, the enrichment of translation-associated pathways hints at increased capacity for protein turnover and cellular remodeling vital for recovery. Our study not only fills a critical gap in avian neurobiology but also lays the groundwork for research in comparative neuroprotection.

Applications of machine learning in pediatric traumatic brain injury (pTBI): a systematic review of the literature.

OBJECTIVE: Pediatric traumatic brain injury (pTBI) is a heterogeneous condition requiring the development of clinical decision rules (CDRs) for the optimal management of these patients. Machine learning (ML) is a novel artificial intelligence (AI) predictive tool with various applications in modern neurosurgery, including the creation of CDRs for patients with pTBI. In the present study, we summarized the current literature on the applications of ML in pTBI. METHODS: A systematic review was conducted following the PRISMA guidelines. The literature search included PubMed/MEDLINE, SCOPUS, and ScienceDirect databases. We included observational or experimental studies focusing on the applications of ML in patients with pTBI under 18 years of age. RESULTS: A total of 18 articles were included in our systematic review. Of these articles, 16 were retrospective cohorts, 1 was a prospective cohort, and 1 was a case-control study. Of these articles, ten concerned ML applications in predicting the outcome of pTBI patients, while 8 reported applications of ML in predicting the need for CT scans. Artificial Neuronal Network (ANN) and Random Forest (RF) were the most commonly utilized models for the creation of predictive algorithms. The accuracy of the ML algorithms to predict the need for CT scan in pTBI cases ranged from 0.790 to 0.999, and the Area Under Curve (AUC) ranged from 0.411 (95%CI: 0.354-0.468) to 0.980 (95%CI: 0.950-1.00). The model with the maximum accuracy to predict the need for CT scan was a Deep ANN model, while the model with the maximum AUC was Ensemble Learning. The model with the maximum accuracy to predict the outcome (favorable vs. unfavorable) of patients with TBI was a support vector machine (SVM) model with 94.0% accuracy, whereas the model with the highest AUC was an ANN model with an AUC of 0.991. CONCLUSION: In the present systematic review, conventional and novel ML models were utilized to either predict the presence of intracranial trauma or the prognosis of children with pTBI. However, most of the reported ML algorithms have not been externally validated and are pending further research.

The weight of care: exploring the challenges faced by primary caregivers of children with traumatic brain injuries.

Background: Traumatic brain injury (TBI) is a leading cause of death and disability in children, yet the full impact on their primary caregivers remains largely uncharted. This study seeks to delineate the current scope of the caregiving burden and to identify the key determinants that shape it, aiming to enhance clinical interventions and caregiving approaches. Methods: We conducted a comprehensive survey of primary caregivers of pediatric TBI patients admitted to a top-tier children's hospital in China, spanning the period from January 15 to November 15, 2023. The Zarit Burden Interview (ZBI) served as the primary tool for gauging the level of caregiver burden, while the Simplified Coping Style Questionnaire (SCSQ) provided insights into their coping strategies. Results: Our survey encompassed 284 primary caregivers of TBI children. The average ZBI score for this cohort was 40.57±10.41, indicating a considerable burden. Correlational analysis uncovered robust links between the burden of caregivers and several pivotal factors: the severity of TBI (r=0.496), intensive care unit (ICU) stay (r=0.525), monthly household income (r=0.604), and reliance on negative coping mechanisms (r=0.493), all of which were statistically significant (P<0.05). Further, a multiple linear regression analysis affirmed that the severity of TBI, ICU admissions, monthly income, and negative coping styles were independent predictors of caregiver burden (P<0.05). Conclusions: The findings underscore the substantial burden shouldered by primary caregivers of TBI children. It is imperative to direct targeted support towards caregivers from economically disadvantaged backgrounds and those who tend to adopt negative coping strategies, to alleviate their burden.

Superior Survival After Unrelated Allogeneic Stem Cell Transplantation With Low-Dose ATG Compared to Low-Dose TBI in Myeloablative Fludarabine/Busulfan-Based Regimen for MDS on Behalf of the Adult MDS Working Group of the JSTCT.

The fludarabine/intravenous busulfan 12.8 mg/kg (FB4) regimen is an effective conditioning regimen in allogeneic hematopoietic stem cell transplantation for myelodysplastic syndrome (MDS); however, limited data is available on the prognostic impact of FB4 with low-dose anti-thymoglobulin (ATG ≤ 5 mg/kg) or low-dose total body irradiation (TBI ≤ 4 Gy). Therefore, we retrospectively evaluated the outcomes in 280 adults with de novo MDS who underwent their first transplantation from an unrelated donor between 2009 and 2018. Median age was 61 yr (range, 16 to 70 yr). In the FB4 alone (FB4), FB4 plus ATG (FB4-ATG), and FB4 plus TBI (FB4-TBI) groups, 3-yr overall survival (OS) rates were 39.9%, 64.8%, and 43.7%; 3-yr nonrelapse mortality (NRM) were 32.1%, 22.1%, and 27.1%; and 3-yr relapse incidences were 34.7%, 21.2%, and 28.9%, respectively. The multivariate analyses showed that FB4-ATG group significantly correlated with better OS (hazard Ratio [HR], 0.51; 95% confidence interval [CI], 0.27 to 0.95; P = .032) than FB4 group. FB4-ATG group tended to correlate with lower NRM (HR, 0.36; 95% CI, 0.13 to 1.06; P = .063) than FB4 group. In comparison with FB4-TBI group, FB4-ATG group showed better OS (HR 0.52, 95% CI 0.27 to 0.99, P = .049) and NRM (HR 0.034, 95% CI 0.11 to 0.92, P = .034). No significant differences were observed in OS and NRM between the FB4-TBI and FB4 groups. The present study demonstrated that the FB4 plus low-dose ATG regimen improved OS and NRM, but FB4 plus low-dose TBI regimen had no clear benefit over FB4 alone, in MDS patients who used unrelated donors.

Chronic headaches after traumatic brain injury: Diagnostic complexity associated with increased cost.

BACKGROUND: Chronic headache after traumatic brain injury (TBI) is a common, yet disabling, disorder whose diverse clinical characteristics and treatment needs remain poorly defined. OBJECTIVE: To examine diagnostic coding patterns and cost among military Veterans with comorbid chronic headache and TBI. METHODS: We identified 141,125 post-9/11 era Veterans who served between 2001 and 2019 with a headache disorder diagnosed after TBI. We first identified patterns of Complex Headache Combinations (CHC) and then compared the patterns of healthcare costs in 2022-dollar values in the three years following the TBI diagnosis. RESULTS: Veterans had diverse individual headache and CHC diagnoses with uniformly high cost of care. Post-whiplash and post-TBI CHCs were common and consistently associated with higher costs after TBI than those with other types of headache and CHCs. Post-TBI migraine had the highest unadjusted mean inpatient ($27,698), outpatient ($61,417), and pharmacy ($4,231) costs, which persisted even after adjustment for confounders including demographic, military, and clinical characteristics. CONCLUSION: Headache diagnoses after TBI, particularly those diagnosed with post-traumatic headache, are complex, and associated with dual high cost and care burdens. More research is needed to examine whether this higher expenditure reflects more intensive treatment and better outcomes or refractory headache with worse outcomes.

Mild and Severe Blood Alcohol Concentration Effects on Trauma and Traumatic Brain Injury Outcomes.

INTRODUCTION: Reported outcomes for trauma patients (TPs) with elevated blood alcohol concentration (BAC) have been mixed. Previous studies suggest that positive BAC might lead to lower venous thromboembolism (VTE) rates and mortality. This study expands upon these findings by examining the association of various levels of BAC, with additional emphasis on traumatic brain injury (TBI) patients. We hypothesize that both mild and severe-BAC levels in TPs are associated with decreased risk of VTE and mortality. METHODS: A retrospective review of the 2017 Trauma Quality Improvement Program was performed on adults (≥18 y old) screened for BAC on admission. Patients deceased on arrival and positive for drugs were excluded. We compared three groups: no-BAC, mild-BAC (0-70 mg/dL), and-severe BAC (>80 mg/dL) for associated risk of VTE and mortality. RESULTS: From 203,535 tested patients, 118,427 (58.2%) had no-BAC, 19,813 (9.7%) had mild-BAC, and 65,295 (32.1%) had severe-BAC. The associated risk of VTE was lower for mild-BAC (odds ratios [OR] 0.69, 0.58-0.82, P < 0.001) and severe-BAC (OR 0.80, 0.72-0.89, P < 0.001). This persisted in TBI patients, with mild-BAC (OR 0.67, 0.51-0.89, P = 0.006) and severe-BAC (OR 0.75, 0.64-0.89, P < 0.001) groups exhibiting lower associated VTE risk. However, the associated mortality risk was lower only in severe-BAC patients (OR 0.90, 0.83-0.97, P = 0.009). CONCLUSIONS: A positive BAC is linked to a reduced associated risk of VTE in TPs, including those with TBI. Notably, only the severe-BAC group demonstrated a lower associated risk of mortality. This merits future research including identification of basic science pathways that may be targeted to improve outcomes.

Global traumatic brain injury intracranial pressure: from monitoring to surgical decision.

Traumatic brain injury (TBI) is a significant global public health issue, heavily impacting human health, especially in low-and middle-income areas. Despite numerous guidelines and consensus statements, TBI fatality rates remain high. The pathogenesis of severe TBI is closely linked to rising intracranial pressure (ICP). Elevated intracranial pressure can lead to cerebral herniation, resulting in respiratory and circulatory collapse, and ultimately, death. Managing intracranial pressure (ICP) is crucial in neuro-intensive care. Timely diagnosis and precise treatment of elevated ICP are essential. ICP monitoring provides real-time insights into a patient's condition, offering invaluable guidance for comprehensive management. ICP monitoring and standardization can effectively reduce secondary nerve damage, lowering morbidity and mortality rates. Accurately assessing and using true ICP values to manage TBI patients still depends on doctors' clinical experience. This review discusses: (a) Epidemiological disparities of traumatic brain injuries across countries with different income levels worldwide; (b) The significance and function of ICP monitoring; (c) Current status and challenges of ICP monitoring; (d) The impact of decompressive craniectomy on reducing intracranial pressure; and (e) Management of TBI in diverse income countries. We suggest a thorough evaluation of ICP monitoring, head CT findings, and GCS scores before deciding on decompressive craniectomy. Personalized treatment should be emphasized to assess the need for surgical decompression in TBI patients, offering crucial insights for clinical decision-making.