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1.
Zhonghua Yi Xue Za Zhi ; 101(3): 218-223, 2021 Jan 19.
Artigo em Chinês | MEDLINE | ID: mdl-33455149

RESUMO

Objective: To investigate the prognostic factors of severe traumatic brain injury (sTBI) and the predictive value of serum translocator protein (TSPO) combined with the reverse shock index multiplied by Glasgow coma scale score (rSIG). Methods: A total of 104 patients with sTBI treated in the Third Affiliated Hospital of Soochow University from June 2017 to June 2019 were enrolled and divided into two groups according to their 90-day prognosis evaluated by Glasgow prognosis score (GOS): 61 cases in good prognosis group, including 42 males and 19 females, the average age was (52.6±4.1) years; 43 cases in poor prognosis group, including 32 males and 11 females, the average age was (53.2±4.4) years. The clinical data, rSIG and serum TSPO levels were compared between the two groups. The prognostic factors were analyzed by the univariate analysis and logistic regression model, and the predictive value of rSIG combined with serum TSPO was evaluated by the receiver operating characteristic curve (ROC). Results: The time from injury to recovery, dilated pupils on admission, blood glucose level, serum TSPO level, CT midline shift ≥5 mm, cerebral herniation and postoperative complications were independent risk factors associated with the prognosis of sTBI patients, while the rSIG was protective factor associated with the prognosis of sTBI patients (all P<0.05). The average value of rSIG in the good prognosis group was significantly higher than that in the poor prognosis group (11.6±3.2 vs 6.6±2.0, t=9.021, P<0.05). The average serum level of TSPO in the good prognosis group was lower than that in the poor prognosis group ((1.3±0.3) vs (3.1±1.1) µg/L, t=12.350, P<0.05). The area under the curve (AUC) of the combination of rSIG value and TSPO level for predicting the poor prognosis of sTBI patients was 0.920 (95%CI: 0.808-0.978), which was significantly higher than that of rSIG or TSPO alone (both P<0.05). The overall sensitivity and the specificity of the combination were 80.0% and 92.0%, respectively. The rSIG value and serum TSPO level was significantly negatively correlated in sTBI patients (r=-0.439, P<0.05). Conclusions: sTBI patients who show a low rSIG value and high expression of serum TSPO tend to have bad prognosis. The combined application of rSIG and serum TSPO can effectively predict the poor prognosis in sTBI patients.


Assuntos
Lesões Encefálicas Traumáticas , Choque , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Receptores de GABA , Estudos Retrospectivos
3.
Life Sci ; 264: 118631, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33131748

RESUMO

AIMS: Traumatic brain injury (TBI) is a common nervous system injury. However, the detailed mechanisms about functional dysregulation and dignostic biomarkers post-TBI are still unclear. So we aimed to identify potential differentially expressed proteins and genes in TBI for clinical diagnosis and therapeutic purposes. MAIN METHODS: Rat TBI model was established by the weight-drop method. First, through TMT-proteomics, we screened for the change in the proteins expression profile acute phase post-TBI. The DAVID and Reactome databases were used to analyze and visualize the dysregulation proteins. Then, using publicly available microarray datasets GSE45997, differentially expressed genes (DGEs) were identified for the 24 h post-TBI stage. Also, the proteomic data were compared with microarray data to analyze the similarity. KEY FINDINGS: We found significant proteomics and transcriptomic changes in post-TBI samples. 989, 881, 832, 1057 proteins were quantitated at 1 h, 6 h, 24 h, and 3 d post-injury correspondingly. Concerning proteomics findings, oxygen transport, acute-phase response, and negative regulation of endopeptidase activity were influenced throughout the acute phrase of TBI. Also, pathways related to scavenging of heme from plasma, binding, and uptake of ligands by scavenger receptors were highly enriched in all time-points of TBI samples. SIGNIFICANCE: We noticed that the interaction-networks trend to get complicated with more node connections following the progression of TBI. We inferred that Hk-1, PRKAR2A, and MBP could be novel candidate biomarkers related to time-injury in acute-phase TBI. Also, Ceruloplasmin and Complement C3 were found to be important proteins and genes are involved in the TBI.


Assuntos
Biomarcadores/metabolismo , Lesões Encefálicas Traumáticas/metabolismo , Proteômica/métodos , Animais , Encéfalo/metabolismo , Lesões Encefálicas Traumáticas/diagnóstico , Biologia Computacional , Modelos Animais de Doenças , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Masculino , Análise de Sequência com Séries de Oligonucleotídeos , Oxigênio/metabolismo , Proteoma , Ratos , Ratos Sprague-Dawley , Transcriptoma
4.
J Surg Res ; 257: 101-106, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818778

RESUMO

BACKGROUND: Penetrating traumatic brain injury (pTBI) is the most lethal form of TBI, with mortality rates as high as 90%. This high mortality rate leads many providers to feel that the treatment of pTBI is futile. Contrary to this point of view, several studies have shown that victims of pTBI who present with a Glasgow Coma Scale (GCS) ≥6 have a reasonable chance of a meaningful outcome. This study sought to investigate outcomes of pTBI patients based on GCS score who underwent neurosurgical intervention (craniotomy or craniectomy) and compare them with patients who did not undergo surgical intervention. MATERIALS AND METHODS: The study represents a secondary analysis of the data that were collected from 2006 to 2016 from 17 institutions as part of a multi-center study, investigating clinical outcomes for adult patients sustaining pTBI and surviving >72 h. Patients were divided into those with GCS 3-5 and those with GCS ≥6. Within these groups, patients were stratified by whether they received surgical intervention, compared with standard non-surgical care. Patient level data (age and gender), clinical data (Injury Severity Score and Abbreviated Injury Score), GCS on admission, post-op infection rates, and outcomes data (mortality, length of stay [LOS], intensive care unit LOS) were collected. Both groups were compared using independent sample t-test or chi-squared test. RESULTS: Seven hundred twenty patients with pTBI were identified over 11 y, out of which 336 (46.7%) underwent surgery. The mean Injury Severity Score and Abbreviated Injury Score on admission were higher in the surgical intervention group than their non-surgical counterpart in patients with a GCS ≥6 (P < 0.0001). Patients with GCS of 3-5 with surgical intervention demonstrated a higher survival rate than non-surgical patients (P < 0.0001). In the GCS ≥6 group, surgical intervention did not impact near-term mortality. Intensive care unit LOS was significantly longer in the surgical intervention group in patients with GCS ≥ 6 (P < 0.0001) and GCS of 3-5 (P < 0.0001), as was total hospital LOS (P < 0.0001). Patients with a GCS 3-5 and ≥6 who underwent surgical intervention were more likely to develop a central nervous system infection (P = 0.016; P = 0.017). CONCLUSIONS: Surgical intervention in pTBI patients with GCS 3-5 results in improved mortality but comes at a cost of increased resource utilization in the form of longer LOS and higher infection rate. On the other hand, in patients with GCS ≥6, surgery does not provide significant benefits in patient survival. Future prospective studies providing insight as to the impact of surgery on the resource utilization and quality of survival would be beneficial in determining the need for surgical intervention in this population.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Lesões Encefálicas Traumáticas/terapia , Ferimentos Penetrantes/cirurgia , Ferimentos Penetrantes/terapia , Adulto , Lesões Encefálicas Traumáticas/mortalidade , Craniotomia , Feminino , Escala de Coma de Glasgow , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
5.
J Surg Res ; 257: 42-49, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818783

RESUMO

BACKGROUND: Recent studies have examined the effects of marijuana in various populations; however, there has been limited research on the effect of marijuana use in severely injured trauma patients. We hypothesized that preinjury use of marijuana would be associated with improved outcomes in severely injured trauma patients. METHODS: All adult (18+ y) level I and level II trauma activations who presented to two large regional trauma centers between 2014 and 2018 were reviewed. Delta-9-tetrahydrocannabinol (THC)- indicated absence of drugs confirmed by testing and as THC + confirmed THC without another drug present. RESULTS: Of the 4849 patients included, 1373 (28.3%) were THC+. The THC + cohort was younger, had more males, and was more likely to be injured by penetrating mechanism (P < 0.001 for all) than THC-. THC + patients had shorter median length of stay (LOS) (P < 0.001) and intensive care unit LOS (P < 0.001). Mortality rate was lower in the THC + group (4.3% versus 7.6%, P < 0.001), but not in multivariate analysis. THC + patients with traumatic brain injury had shorter hospital LOS (P = 0.025) and shorter ventilator days (P = 0.033) than THC- patients. In patients with Injury Severity Score ≥16, THC + patients had significantly lower intensive care unit LOS (P = 0.009) and mortality (19.3% versus 25.0% P = 0.038) than drug-negative patients. CONCLUSIONS: Although preinjury use of marijuana does not improve survival in trauma patients, it may provide some improvement in outcomes in patients with traumatic brain injury and those that are more severely injured (Injury Severity Score ≥16). The mechanism behind this finding needs further evaluation.


Assuntos
Uso da Maconha , Ferimentos e Lesões/terapia , Adulto , Lesões Encefálicas Traumáticas , Cuidados Críticos , Dronabinol/análise , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Razão de Chances , Centros de Traumatologia , Resultado do Tratamento , Ferimentos e Lesões/mortalidade , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/terapia
6.
J Surg Res ; 257: 493-500, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32916502

RESUMO

BACKGROUND: Blood pressure alterations in patients with traumatic brain injury (TBI) have been shown to be associated with increased mortality. However, there is paucity of data describing the optimal emergency department (ED) systolic blood pressure (SBP) target during the initial evaluation. The aim of our study was to assess the association between SBP on presentation and mortality in patients with TBI. METHODS: We performed a retrospective (2015-2016) review of the American College of Surgeons Trauma Quality Improvement Program database and included all adult (age ≥18y) trauma patients who had TBI on presentation. The outcome measure was in-hospital mortality at different ED-SBP values. A subanalysis by age and TBI severity in accordance with the Glasgow Coma Scale (GCS) was performed (mild (GCS ≥13), moderate (GCS 9-12), and severe (≤8)). Multivariate logistic regression analysis was performed. RESULTS: A total of 94,411 adult trauma patients with TBI were included. Mean age was 59 ± 21y, 62% were male, and median GCS was 15 [14-15]. Mean SBP was 147 ± 28 mmHg, and overall mortality was 8.6%. The lowest rate of mortality was noticed at ED SBP between 110 and 149 mmHg, whereas the highest mortality was at admission SBP <90 mmHg and SBP >190 mmHg. On regression analysis, SBP between 130 and 149 mmHg (odds ratio = 0.92; P = 0.68) was not associated with increased odds of mortality relative to SBP between 110 and 129 mmHg. On subanalysis based on severity of TBI (mild 80.9%, moderate 5.3%, and severe 13.8%), patients with SBP between 110 and 149 mmHg were less likely to die across all TBI groups. CONCLUSIONS: The optimal ED-SBP range for patients with TBI seems to be age and severity dependent. The optimum range might guide clinicians in developing resuscitation protocols for managing patients with TBI. LEVEL OF EVIDENCE: Level III Prognostic.


Assuntos
Pressão Sanguínea , Lesões Encefálicas Traumáticas/mortalidade , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/fisiopatologia , Serviço Hospitalar de Emergência/normas , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos , Estados Unidos/epidemiologia
7.
Ann Vasc Surg ; 70: 566.e11-566.e14, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32800884

RESUMO

Traumatism of head arteries is rare, but among them, the superficial temporal artery is the most exposed and less protected vessel. A pseudoaneurysm of the superficial temporal artery may occur after blunt head trauma in old patients or during vigorous activity in younger people. Diagnosis should be made primarily upon history and physical examination, while duplex ultrasound is appropriate to confirm the diagnosis and CT scan to exclude other possible concomitant pathologies. Direct surgical treatment is the first and main option to solve bleeding and prevent future complications. Here reported the case of an old woman treated for a post-traumatic STA pseudoaneurysm.


Assuntos
Falso Aneurisma/etiologia , Lesões Encefálicas Traumáticas/etiologia , Traumatismos Cranianos Fechados/etiologia , Artérias Temporais/lesões , Lesões do Sistema Vascular/etiologia , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/cirurgia , Feminino , Traumatismos Cranianos Fechados/diagnóstico por imagem , Traumatismos Cranianos Fechados/cirurgia , Humanos , Ligadura , Artérias Temporais/diagnóstico por imagem , Artérias Temporais/cirurgia , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia
8.
Emerg Med Clin North Am ; 39(1): 133-154, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218654

RESUMO

Management of acute neurologic disorders in the emergency department is multimodal and may require the use of medications to decrease morbidity and mortality secondary to neurologic injury. Clinicians should form an individualized treatment approach with regard to various patient specific factors. This review article focuses on the pharmacotherapy for common neurologic emergencies that present to the emergency department, including traumatic brain injury, central nervous system infections, status epilepticus, hypertensive emergencies, spinal cord injury, and neurogenic shock.


Assuntos
Serviço Hospitalar de Emergência , Doenças do Sistema Nervoso/tratamento farmacológico , Anticonvulsivantes/uso terapêutico , Lesões Encefálicas Traumáticas/tratamento farmacológico , Infecções do Sistema Nervoso Central/tratamento farmacológico , Emergências , Humanos , Pressão Intracraniana/efeitos dos fármacos , Neurofarmacologia , Estado Epiléptico/tratamento farmacológico
9.
Emerg Med Clin North Am ; 39(1): 203-216, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218658

RESUMO

There are subtle physiologic and pharmacologic principles that should be understood for patients with neurologic injuries. These principles are especially true for managing patients with traumatic brain injuries. Prevention of hypotension and hypoxemia are major goals in the management of these patients. This article discusses the physiology, pitfalls, and pharmacology necessary to skillfully care for this subset of patients with trauma. The principles endorsed in this article are applicable both for patients with traumatic brain injury and those with spinal cord injuries.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Sedação Consciente , Indução e Intubação de Sequência Rápida , Lesões Encefálicas Traumáticas/fisiopatologia , Sedação Consciente/métodos , Serviço Hospitalar de Emergência , Humanos , Indução e Intubação de Sequência Rápida/métodos
10.
Emerg Med Clin North Am ; 39(1): 217-225, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218659

RESUMO

The emergency department is where the patient and potential ethical challenges are first encountered. Patients with acute neurologic illness introduce a unique set of dilemmas related to the pressure for ultra-early prognosis in the wake of rapidly advancing treatments. Many with neurologic injury are unable to provide autonomous consent, further complicating the picture, potentially asking uncertain surrogates to make quick decisions that may result in significant disability. The emergency department physician must take these ethical quandaries into account to provide standard of care treatment.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Assistência Terminal/ética , Manuseio das Vias Aéreas/ética , Manuseio das Vias Aéreas/métodos , Beneficência , Morte Encefálica/diagnóstico , Lesões Encefálicas Traumáticas/diagnóstico , Serviço Hospitalar de Emergência/ética , Procedimentos Endovasculares/ética , Ética Médica , Humanos , Consentimento Livre e Esclarecido/ética , Prognóstico , Acidente Vascular Cerebral/terapia , Obtenção de Tecidos e Órgãos/ética
11.
Medicine (Baltimore) ; 99(49): e22452, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33285671

RESUMO

RATIONALE: Limb-kinetic apraxia (LKA) is a disorder of movement execution that is a result of injury to the corticofugal tracts (CFTs) from the secondary motor area. We report on a patient with traumatic brain injury (TBI) and complete monoplegia due to LKA, which was mainly ascribed to injury of the CFT from the secondary motor area using diffusion tensor tractography. PATIENT CONCERNS: A 35-year-old male was struck by a car from the side during riding an autocycle and received direct head trauma as a result of falling to ground. He lost consciousness for approximately 1 month and experienced continuous post-traumatic amnesia after the accident. The patient's Glasgow Coma Scale score was 3 and he showed quadriparesis including complete monoplegia of his left arm since the onset of TBI. DIAGNOSES: The patient diagnosed complete monoplegia due to LKA after traumatic brain injury. INTERVENTIONS: He underwent conservative management for TBI followed by rehabilitation at approximately 2 months after onset. OUTCOMES: At 32-month after onset, weakness on left arm (Manual Muscle Test [MMT]:0) and partial weakness of left leg (MMT:3). OUTCOMES: Results of electromyography and nerve conduction studies of left extremities were normal. Motor evoked potential values obtained from the abductor pollicis brevis muscle (APB) were: right APB latency 22.3msec, amplitude 1.6mV; left APB latency 22.8msec, amplitude 1.5mV. After 2 weeks of administration of dopaminergic drugs for improvement of LKA, left arm weakness had recovered to level that permitted movement against gravity (MMT:3). Diffusion tensor tractography at 32-month after onset showed right corticospinal tract discontinuation at the pontine level and partial tearing of the left corticospinal tract at the subcortical white matter. In addition, the left CFT from the supplementary motor area showed partial tearing at the subcortical white matter. LESSONS: The LKA due to injury of the left supplementary motor area-CFT was demonstrated in a patient with complete monoplegia following TBI. Accurate diagnosis of LKA is important for successful rehabilitation because LKA is known to respond to dopaminergic drug treatment.


Assuntos
Apraxia Ideomotora/complicações , Lesões Encefálicas Traumáticas/complicações , Hemiplegia/etiologia , Adulto , Escala de Coma de Glasgow , Hemiplegia/reabilitação , Humanos , Masculino
13.
BMC Bioinformatics ; 21(Suppl 17): 481, 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33308142

RESUMO

BACKGROUND: Prediction of patient outcome in medical intensive care units (ICU) may help for development and investigation of early interventional strategies. Several ICU scoring systems have been developed and are used to predict clinical outcome of ICU patients. These scores are calculated from clinical physiological and biochemical characteristics of patients. Heart rate variability (HRV) is a correlate of cardiac autonomic regulation and has been evident as a marker of poor clinical prognosis. HRV can be measured from the electrocardiogram non-invasively and monitored in real time. HRV has been identified as a promising 'electronic biomarker' of disease severity. Traumatic brain injury (TBI) is a subset of critically ill patients admitted to ICU, with significant morbidity and mortality, and often difficult to predict outcomes. Changes of HRV for brain injured patients have been reported in several studies. This study aimed to utilize the continuous HRV collection from admission across the first 24 h in the ICU in severe TBI patients to develop a patient outcome prediction system. RESULTS: A feature extraction strategy was applied to measure the HRV fluctuation during time. A prediction model was developed based on HRV measures with a genetic algorithm for feature selection. The result (AUC: 0.77) was compared with earlier reported scoring systems (highest AUC: 0.76), encouraging further development and practical application. CONCLUSIONS: The prediction models built with different feature sets indicated that HRV based parameters may help predict brain injury patient outcome better than the previously adopted illness severity scores.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Frequência Cardíaca/fisiologia , Algoritmos , Área Sob a Curva , Lesões Encefálicas Traumáticas/patologia , Eletrocardiografia , Humanos , Unidades de Terapia Intensiva , Modelos Logísticos , Prognóstico , Curva ROC , Índice de Gravidade de Doença
14.
BMC Med Inform Decis Mak ; 20(1): 336, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33317528

RESUMO

BACKGROUND: The study aimed to introduce a machine learning model that predicts in-hospital mortality in patients on mechanical ventilation (MV) following moderate to severe traumatic brain injury (TBI). METHODS: A retrospective analysis was conducted for all adult patients who sustained TBI and were hospitalized at the trauma center from January 2014 to February 2019 with an abbreviated injury severity score for head region (HAIS) ≥ 3. We used the demographic characteristics, injuries and CT findings as predictors. Logistic regression (LR) and Artificial neural networks (ANN) were used to predict the in-hospital mortality. Accuracy, area under the receiver operating characteristics curve (AUROC), precision, negative predictive value (NPV), sensitivity, specificity and F-score were used to compare the models` performance. RESULTS: Across the study duration; 785 patients met the inclusion criteria (581 survived and 204 deceased). The two models (LR and ANN) achieved good performance with an accuracy over 80% and AUROC over 87%. However, when taking the other performance measures into account, LR achieved higher overall performance than the ANN with an accuracy and AUROC of 87% and 90.5%, respectively compared to 80.9% and 87.5%, respectively. Venous thromboembolism prophylaxis, severity of TBI as measured by abbreviated injury score, TBI diagnosis, the need for blood transfusion, heart rate upon admission to the emergency room and patient age were found to be the significant predictors of in-hospital mortality for TBI patients on MV. CONCLUSIONS: Machine learning based LR achieved good predictive performance for the prognosis in mechanically ventilated TBI patients. This study presents an opportunity to integrate machine learning methods in the trauma registry to provide instant clinical decision-making support.


Assuntos
Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Mortalidade Hospitalar , Aprendizado de Máquina , Respiração Artificial/efeitos adversos , Adulto , Lesões Encefálicas Traumáticas/diagnóstico , Estudos de Coortes , Previsões , Humanos , Escala de Gravidade do Ferimento , Pessoa de Meia-Idade , Modelos Estatísticos , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
15.
PLoS One ; 15(12): e0242811, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33315925

RESUMO

INTRODUCTION: The high failure rate of clinical trials in traumatic brain injury (TBI) may be attributable, in part, to the use of untested or insensitive measurement instruments. Of more than 1,000 clinical outcome assessment measures (COAs) for TBI, few have been systematically vetted to determine their performance within specific "contexts of use (COU)." As described in guidance issued by the U.S. Food and Drug Administration (FDA), the COU specifies the population of interest and the purpose for which the COA will be employed. COAs are commonly used for screening, diagnostic categorization, outcome prediction, and establishing treatment effectiveness. COA selection typically relies on expert consensus; there is no established methodology to match the appropriateness of a particular COA to a specific COU. We developed and pilot-tested the Evidence-Based Clinical Outcome assessment Platform (EB-COP) to systematically and transparently evaluate the suitability of TBI COAs for specific purposes. METHODS AND FINDINGS: Following a review of existing literature and published guidelines on psychometric standards for COAs, we developed a 6-step, semi-automated, evidence-based assessment platform to grade COA performance for six specific purposes: diagnosis, symptom detection, prognosis, natural history, subgroup stratification and treatment effectiveness. Mandatory quality indicators (QIs) were identified for each purpose using a modified Delphi consensus-building process. The EB-COP framework was incorporated into a Qualtrics software platform and pilot-tested on the Glasgow Outcome Scale-Extended (GOSE), the most widely-used COA in TBI clinical studies. CONCLUSION: The EB-COP provides a systematic methodology for conducting more precise, evidence-based assessment of COAs by evaluating performance within specific COUs. The EB-COP platform was shown to be feasible when applied to a TBI COA frequently used to detect treatment effects and can be modified to address other populations and COUs. Additional testing and validation of the EB-COP are warranted.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Ensaios Clínicos como Assunto , Medicina Baseada em Evidências , Avaliação de Resultados em Cuidados de Saúde , Humanos , Prognóstico , Psicometria , Software
16.
Wiad Lek ; 73(10): 2127-2132, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33310934

RESUMO

OBJECTIVE: The aim: To investigate the effect of water-soluble form of quercetin on the indices reflecting the progression of oxidative-nitrosative stress in the cerebral tissues and the periodontium of rats after experimental TBI. PATIENTS AND METHODS: Materials and methods: The studies were conducted on 30 white rats of the Wistar line weighing 180-220 g, divided into 3 groups: the 1st group included pseudo-injured animals (subjected to ether anaesthesia, fixation without TBI modeling), the 2nd group included the animals exposed to modeled moderate TBI, the 3rd group involved the rats, which were given injections with water-soluble form of quercetin (corvitin, "Borshchahivskiy CPP", Ukraine) intraperitoneally in a daily dose of 10 mg/kg recalculated for quercetin for 7 days following the TBI modeling. The formation of superoxide radical anion (.О2 -), activity of NO-synthase - total (NOS), its constitutive and inducible isoforms (cNOS, iNOS) - and concentration of peroxynitrite were evaluated spectrophotometrically. The level of lipid peroxidation (LPO) in the tissues was evaluated by the formation of a stained trimethine complex during the reaction of tiobarbituric acid (TBA). The activity of the antioxidant system was assessed by increasing in the concentration of TBA active products during 1.5 hour incubation in iron-ascorbate buffer solution, as well as by the activity of antioxidant enzymes - superoxide dismutase (SOD) and catalase. RESULTS: Results: The use of quercetin under the experimental conditions significantly reduced the О2 - generation by NADPH- and NADH-dependent electron transport chains by 30.2 and 35.0% (in the cerebral hemispheres) and by 23.5 and 32.5% (in the soft periodontal tissues), respectively, compared to the findings in the 2nd group. The production of this radical by leukocyte NADPH oxidase in these organs was inferior to the value of the 2nd group by 39.3 and 29.9%. We revealed that the use of quercetin in the experimental conditions probably reduced the activity of NOS, including iNOS, by 38.2 and 45.3% (in the cerebral hemispheres) and by 53.5 and 66.9% (in the soft periodontal tissues), respectively, compared with the findings in the 2nd group. Under these conditions, the cNOS activity went up by 50.0% and doubled, the peroxynitrite content was lower by 19.5 and 32.1% than that in the 2nd group. The administration of quercetin in the experimental conditions significantly reduced the concentration of TBA-active products in the homogenate of cerebral hemispheres and soft periodontal tissues. The development of decompensated LPO is also confirmed by a decrease in the activity of SOD and catalase. CONCLUSION: Conclusions: on the 7th day after modeling moderate TBI in rats the signs of oxidative-nitrosative stress are found not only in locus morbi (in the tissue of the cerebral hemisphere), but also in distant organs (periodontal tissues). Applying of water-soluble form of quercetin significantly reduces signs of oxidative-nitrosative stress in the tissue of the cerebral hemisphere of rats, as well as in periodontal tissues on the 7th day after moderate TBI modeling.


Assuntos
Lesões Encefálicas Traumáticas , Estresse Nitrosativo , Animais , Catalase/metabolismo , Estresse Oxidativo , Quercetina , Ratos , Ratos Wistar , Superóxido Dismutase/metabolismo , Ucrânia
17.
Artigo em Inglês | MEDLINE | ID: mdl-33233364

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is commonly associated with cardiac dysfunction, which may be reflected by abnormal electrocardiograms (ECG) and/or contractility. TBI-related cardiac disorders depend on the type of cerebral injury, the region of brain damage and the severity of the intracranial hypertension. Decompressive craniectomy (DC) is commonly used to reduce intra-cranial hypertension (ICH). Although DC decreases ICH rapidly, its effect on ECG has not been systematically studied. The aim of this study was to analyze the changes in ECG in patients undergoing DC. METHODS: Adult patients without previously known cardiac diseases treated for isolated TBI with DC were studied. ECG variables, such as: spatial QRS-T angle (spQRS-T), corrected QT interval (QTc), QRS and T axes (QRSax and Tax, respectively), STJ segment and the index of cardio-electrophysiological balance (iCEB) were analyzed before DC and at 12-24 h after DC. Changes in ECG were analyzed according to the occurrence of cardiac arrhythmias and 28-day mortality. RESULTS: 48 patients (17 female and 31 male) aged 18-64 were studied. Intra-cranial pressure correlated with QTc before DC (p < 0.01, r = 0.49). DC reduced spQRS-T (p < 0.001) and QTc interval (p < 0.01), increased Tax (p < 0.01) and changed STJ in a majority of leads but did not affect QRSax and iCEB. The iCEB was relatively increased before DC in patients who eventually experienced cardiac arrhythmias after DC (p < 0.05). Higher post-DC iCEB was also noted in non-survivors (p < 0.05), although iCEB values were notably heart rate-dependent. CONCLUSIONS: ICP positively correlates with QTc interval in patients with isolated TBI, and DC for relief of ICH reduces QTc and spQRS-T. However, DC might also increase risk for life-threatening cardiac arrhythmias, especially in ICH patients with notably prolonged QTc before and increased iCEB after DC.


Assuntos
Arritmias Cardíacas/etiologia , Lesões Encefálicas Traumáticas/cirurgia , Craniectomia Descompressiva/métodos , Hipertensão Intracraniana/cirurgia , Adolescente , Adulto , Arritmias Cardíacas/fisiopatologia , Lesões Encefálicas Traumáticas/complicações , Eletrocardiografia , Feminino , Humanos , Hipertensão Intracraniana/etiologia , Pressão Intracraniana , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
19.
J Vis Exp ; (165)2020 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-33226021

RESUMO

Traumatic brain injury (TBI) is a large-scale public health problem. Mild TBI is the most prevalent form of neurotrauma and accounts for a large number of medical visits in the United States. There are currently no FDA-approved treatments available for TBI. The increased incidence of military-related, blast-induced TBI further accentuates the urgent need for effective TBI treatments. Therefore, new preclinical TBI animal models that recapitulate aspects of human blast-related TBI will greatly advance the research efforts into the neurobiological and pathophysiological processes underlying mild to moderate TBI as well as the development of novel therapeutic strategies for TBI. Here we present a reliable, reproducible model for the investigation of the molecular, cellular, and behavioral effects of mild to moderate blast-induced TBI. We describe a step-by-step protocol for closed-head, blast-induced mild TBI in rodents using a bench-top setup consisting of a gas-driven shock tube equipped with piezoelectric pressure sensors to ensure consistent test conditions. The benefits of the setup that we have established are its relative low-cost, ease of installation, ease of use and high-throughput capacity. Further advantages of this non-invasive TBI model include the scalability of the blast peak overpressure and the generation of controlled reproducible outcomes. The reproducibility and relevance of this TBI model has been evaluated in a number of downstream applications, including neurobiological, neuropathological, neurophysiological and behavioral analyses, supporting the use of this model for the characterization of processes underlying the etiology of mild to moderate TBI.


Assuntos
Traumatismos por Explosões/patologia , Lesões Encefálicas Traumáticas/patologia , Animais , Comportamento Animal , Modelos Animais de Doenças , Explosões , Humanos , Masculino , Camundongos Endogâmicos C57BL , Pressão , Reprodutibilidade dos Testes
20.
BMC Neurol ; 20(1): 399, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33138778

RESUMO

BACKGROUND: Recent studies regarding the effects of erythropoietin (EPO) for treating traumatic brain injury (TBI) have been inconsistent. This study conducts a meta-analysis of randomized controlled trials (RCTs) to assess the safety and efficacy of EPO for TBI patients at various follow-up time points. METHODS: A literature search was performed using PubMed, Web of Science, MEDLINE, Embase, Google Scholar and the Cochrane Library for RCTs studying EPO in TBI patients published through March 2019. Non-English manuscripts and non-human studies were excluded. The assessed outcomes include mortality, neurological recovery and associated adverse effects. Dichotomous variables are presented as risk ratios (RR) with a 95% confidence interval (CI). RESULTS: A total of seven RCTs involving 1197 TBI patients (611 treated with EPO, 586 treated with placebo) were included in this study. Compared to the placebo arm, treatment with EPO did not improve acute hospital mortality or short-term mortality. However, there was a significant improvement in mid-term (6 months) follow-up survival rates. EPO administration was not associated with neurological function improvement. Regarding adverse effects, EPO treatment did not increase the incidence of thromboembolic events or other associated adverse events. CONCLUSIONS: This meta-analysis indicates a slight mortality benefit for TBI patients treated with EPO at mid-term follow-up. EPO does not improve in-hospital mortality, nor does it increase adverse events including thrombotic, cardiovascular and other associated complications. Our analysis did not demonstrate a significant beneficial effect of EPO intervention on the recovery of neurological function. Future RCTs are required to further characterize the use of EPO in TBI.


Assuntos
Lesões Encefálicas Traumáticas/tratamento farmacológico , Eritropoetina/administração & dosagem , Adulto , Humanos , Avaliação de Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto
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