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1.
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
2.
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
3.
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
4.
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
5.
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
6.
JAMA Netw Open ; 3(10): e2016869, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33057642

RESUMO

Importance: Prehospital plasma administration improves survival in injured patients at risk for hemorrhagic shock and transported by air ambulance. Traumatic brain injury (TBI) is a leading cause of death following trauma, but few early interventions improve outcomes. Objective: To assess the association between prehospital plasma and survival in patients with TBI. Design, Setting, and Participants: The Prehospital Air Medical Plasma (PAMPer) trial was a pragmatic, multicenter, phase 3, cluster randomized clinical trial involving injured patients who were at risk for hemorrhagic shock during air medical transport to a trauma center. The trial was conducted at 6 US sites with 9 level-I trauma centers (comprising 27 helicopter emergency services bases). The original trial analyzed 501 patients, including 230 patients who were randomized to receive plasma and 271 randomized to standard care resuscitation. This secondary analysis of a predefined subgroup included patients with TBI. Data analysis was performed from October 2019 to February 2020. Interventions: Patients were randomized to receive standard care fluid resuscitation or 2 units of thawed plasma. Main Outcomes and Measures: The primary outcome was mortality at 30 days. Patients with TBI were prespecified as a subgroup for secondary analysis and for measurement of markers of brain injury. The 30-day survival benefit of prehospital plasma in subgroups with and without TBI as diagnosed by computed tomography was characterized using Kaplan-Meier survival analysis and Cox proportional hazard regression. Results: In total, 166 patients had TBI (median [interquartile range] age, 43.00 [25.00-59.75] years; 125 men [75.3%]). When compared with the 92 patients who received standard care, the 74 patients with TBI who received prehospital plasma had improved 30-day survival even after adjustment for multiple confounders and assessment of the degree of brain injury with clinical variables and biomarkers (hazard ratio [HR], 0.55; 95% CI, 0.33-0.94; P = .03). Receipt of prehospital plasma was associated with improved survival among patients with TBI with a prehospital Glasgow Coma Scale score of less than 8 (HR, 0.56; 95% CI, 0.35-0.91) and those with polytrauma (HR, 0.50; 95% CI, 0.28-0.89). Patients with TBI transported from the scene of injury had improved survival following prehospital plasma administration (HR, 0.45; 95% CI, 0.26-0.80; P = .005), whereas patients who were transferred from an outside hospital showed no difference in survival for the plasma intervention (HR, 1.00; 95% CI, 0.33-3.00; P = .99). Conclusions and Relevance: These findings are exploratory, but they suggest that receipt of prehospital plasma is associated with improved survival in patients with computed tomography-positive TBI. The prehospital setting may be a critical period to intervene in the care of patients with TBI. Future studies are needed to confirm the clinical benefits of early plasma resuscitation following TBI and concomitant polytrauma. Trial Registration: ClinicalTrials.gov Identifier: NCT01818427.


Assuntos
Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência/métodos , Hidratação/métodos , Plasma , Choque Hemorrágico/prevenção & controle , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Estados Unidos
7.
Lancet Neurol ; 19(12): 1033-1042, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33098755

RESUMO

Health-care professionals and researchers have a legal and ethical responsibility to inform patients before carrying out diagnostic tests or treatment interventions as part of a clinical study. Interventional research in emergency situations can involve patients with some degree of acute cognitive impairment, as is regularly the case in traumatic brain injury and ischaemic stroke. These patients or their proxies are often unable to provide informed consent within narrow therapeutic time windows. International regulations and national laws are criticised for being inconclusive or restrictive in providing solutions. Currently accepted consent alternatives are deferred consent, exception from consent, or waiver of consent. However, these alternatives appear under-utilised despite being ethically permissible, socially acceptable, and regulatorily compliant. We anticipate that, when the requirements for medical urgency are properly balanced with legal and ethical conduct, the increased use of these alternatives has the potential to improve the efficiency and quality of future emergency interventional studies in patients with an inability to provide informed consent.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Estudos Clínicos como Assunto , Serviços Médicos de Emergência , Consentimento Livre e Esclarecido , /terapia , Estudos Clínicos como Assunto/ética , Estudos Clínicos como Assunto/legislação & jurisprudência , Serviços Médicos de Emergência/ética , Serviços Médicos de Emergência/legislação & jurisprudência , Humanos , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/legislação & jurisprudência
8.
PLoS One ; 15(10): e0240528, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33045030

RESUMO

BACKGROUND: Trauma is a leading cause of death and disability worldwide. In low- and middle-income countries (LMICs), trauma patients have a higher risk of experiencing delays to care due to limited hospital resources and difficulties in reaching a health facility. Reducing delays to care is an effective method for improving trauma outcomes. However, few studies have investigated the variety of care delays experienced by trauma patients in LMICs. The objective of this study was to describe the prevalence of pre- and in-hospital delays to care, and their association with poor outcomes among trauma patients in a low-income setting. METHODS: We used a prospective traumatic brain injury (TBI) registry from Kilimanjaro Christian Medical Center in Moshi, Tanzania to model nine unique delays to care. Multiple regression was used to identify delays significantly associated with poor in-hospital outcomes. RESULTS: Our analysis included 3209 TBI patients. The most common delay from injury occurrence to hospital arrival was 1.1 to 4.0 hours (31.9%). Most patients were evaluated by a physician within 15.0 minutes of arrival (69.2%). Nearly all severely injured patients needed and did not receive a brain computed tomography scan (95.0%). A majority of severely injured patients needed and did not receive oxygen (80.8%). Predictors of a poor outcome included delays to lab tests, fluids, oxygen, and non-TBI surgery. CONCLUSIONS: Time to care data is informative, easy to collect, and available in any setting. Our time to care data revealed significant constraints to non-personnel related hospital resources. Severely injured patients with the greatest need for care lacked access to medical imaging, oxygen, and surgery. Insights from our study and future studies will help optimize resource allocation in low-income hospitals thereby reducing delays to care and improving trauma outcomes in LMICs.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Serviços Médicos de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Hospitais/provisão & distribução , Tempo para o Tratamento/estatística & dados numéricos , Adolescente , Adulto , Países em Desenvolvimento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tanzânia , Resultado do Tratamento , Adulto Jovem
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2416-2420, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018494

RESUMO

Traumatic brain injury (TBI) is a leading cause of death and disability yet treatment strategies remain elusive. Advances in machine learning present exciting opportunities for developing personalized medicine and informing laboratory research. However, their feasibility has yet to be widely assessed in animal research where data are typically limited or in the TBI field where each patient presents with a unique injury. The Operation Brain Trauma Therapy (OBTT) has amassed an animal dataset that spans multiple types of injury, treatment strategies, behavioral assessments, histological measures, and biomarker screenings. This paper aims to analyze these data using supervised learning techniques for the first time by partitioning the dataset into acute input metrics (i.e. 7 days post-injury) and a defined recovery outcome (i.e. memory retention). Preprocessing is then applied to transform the raw OBTT dataset, e.g. developing a class attribute by histogram binning, eliminating borderline cases, and applying principal component analysis (PCA). We find that these steps are also useful in establishing a treatment ranking; Minocycline, a therapy with no significant findings in the OBTT analyses, yields the highest percentage recovery in our ranking. Furthermore, of the seven classifiers we have evaluated, Naïve Bayes achieves the best performance (67%) and yields significant improvement over our baseline model on the preprocessed dataset with borderline elimination. We also investigate the effect of testing on individual treatment groups to evaluate which groups are difficult to classify, and note the interpretive qualities of our model that can be clinically relevant.Clinical Relevance- These studies establish methods for better analyzing multivariate functional recovery and understanding which measures affect prognosis following traumatic brain injury.


Assuntos
Lesões Encefálicas Traumáticas , Animais , Teorema de Bayes , Encéfalo , Lesões Encefálicas Traumáticas/terapia , Humanos , Aprendizado de Máquina , Medicina de Precisão
12.
Cochrane Database Syst Rev ; 10: CD006811, 2020 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-33126293

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is a major cause of death and disability, with an estimated 5.5 million people experiencing severe TBI worldwide every year. Observational clinical studies of people with TBI suggest an association between raised body temperature and unfavourable outcome, although this relationship is inconsistent. Additionally, preclinical models suggest that reducing temperature to 35 °C to 37.5 °C improves biochemical and histopathological outcomes compared to reducing temperature to a lower threshold of 33 °C to 35 °C. It is unknown whether reducing body temperature to 35 °C to 37.5 °C in people admitted to hospital with TBI is beneficial, has no effect, or causes harm. This is an update of a review last published in 2014. OBJECTIVES: To assess the effects of pharmacological interventions or physical interventions given with the intention of reducing body temperature to 35 °C to 37.5 °C in adults and children admitted to hospital after TBI. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, and PubMed on 28 November 2019. We searched clinical trials registers, grey literature and references lists of reviews, and we carried out forward citation searches of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) with participants of any age admitted to hospital following TBI. We included interventions that aimed to reduce body temperature to 35 °C to 37.5 °C: these included pharmacological interventions (such as paracetamol, or non-steroidal anti-inflammatory drugs), or physical interventions (such as surface cooling devices, bedside fans, or cooled intravenous fluids). Eligible comparators were placebo or usual care. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion, extracted data, and assessed risks of bias. We assessed the certainty of the evidence with GRADE. MAIN RESULTS: We included one RCT with 41 participants. This study recruited adult participants admitted to two intensive care units in Australia, and evaluated a pharmacological intervention. Researchers gave participants 1 g paracetamol or a placebo intravenously at four-hourly intervals for 72 hours. We could not be certain whether intravenous paracetamol influenced mortality at 28 days (risk ratio 2.86, 95% confidence interval 0.32 to 25.24). We judged the evidence for this outcome to be very low certainty, meaning we have very little confidence in this effect estimate, and the true result may be substantially different to this effect. We downgraded the certainty for imprecision (because the evidence was from a single study with very few participants), and study limitations (because we noted a high risk of selective reporting bias). This study was otherwise at low risk of bias. The included study did not report the primary outcome for this review, which was the number of people with a poor outcome at the end of follow-up (defined as death or dependency, as measured on a scale such as the Glasgow Outcome Score), or any of our secondary outcomes, which included the number of people with further intracranial haemorrhage, extracranial haemorrhage, abnormal intracranial pressure, or pneumonia or other serious infections. The only other completed trial that we found was of a physical intervention that compared advanced fever control (using a surface cooling device) versus conventional fever control in 12 participants. The trial was published as an abstract only, with insufficient details to allow inclusion, so we have added this to the 'studies awaiting classification' section, pending further information from the study authors or publication of the full study report. We identified four ongoing studies that will contribute evidence to future updates of the review if they measure relevant outcomes and, in studies with a mixed population, report data separately for participants with TBI. AUTHORS' CONCLUSIONS: One small study contributed very low-certainty evidence for mortality to this review. The uncertainty is largely driven by limited research into reduction of body temperature to 35 °C to 37.5 °C in people with TBI. Further research that evaluates pharmacological or physical interventions, or both, may increase certainty in this field. We propose that future updates of the review, and ongoing and future research in this field, incorporate outcomes that are important to the people receiving the interventions, including side effects of any pharmacological agent (e.g. nausea or vomiting), and discomfort caused by physical therapies.


Assuntos
Acetaminofen/administração & dosagem , Antipiréticos/administração & dosagem , Temperatura Corporal , Lesões Encefálicas Traumáticas/terapia , Hipotermia Induzida/métodos , Adulto , Viés , Temperatura Corporal/efeitos dos fármacos , Lesões Encefálicas Traumáticas/mortalidade , Humanos , Hipotermia Induzida/mortalidade , Injeções Intravenosas , Placebos
14.
Complement Ther Clin Pract ; 40: 101216, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32891292

RESUMO

OBJECTIVE: This study aims to investigate the effect of music therapy integrated with family recollection on physiological parameters of patients with traumatic brain injury who are admitted to Intensive Care Units. METHODS: Sixty patients were selected through convenience sampling and were then randomly assigned to the intervention group and control group. In the intervention group and for 6 consecutive days, the patients received a combination of music and auditory stimulation twice a day for 15 minutes. The patients' physiological parameters were measured before the intervention, and then 10 minutes and finally 30 minutes after the intervention. The data were analyzed using multilevel modeling method through MLwiN version 2.27. RESULTS: The results showed that there was no significant difference between the two groups in terms of demographic factors and the duration of coma. However, the results of the two-level multiple linear models which were performed for 6 consecutive days indicated a significant decrease in systolic blood pressure, diastolic blood pressure, respiratory rate and heart rate for the patients in the intervention group as compared to the patients in the control group (P < 0.0001). Nevertheless, no significant difference was observed in temperature and oxygen saturation (P > 0.05). CONCLUSION: Integration of music therapy with family recollection can moderate physiological parameters. Therefore, it is recommended to use this cost-effective treatment along with the routine treatments, especially for patients with traumatic brain injury.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Musicoterapia/métodos , Adulto , Pressão Sanguínea/fisiologia , Método Duplo-Cego , Feminino , Frequência Cardíaca/fisiologia , Hospitalização , Humanos , Masculino , Taxa Respiratória/fisiologia , Resultado do Tratamento
15.
Zhongguo Zhen Jiu ; 40(8): 851-6, 2020 Aug 12.
Artigo em Chinês | MEDLINE | ID: mdl-32869594

RESUMO

OBJECTIVE: To observe the effect of electroacupuncture (EA) on neuronal apoptosis in rats with traumatic brain injury (TBI), and to explore the action mechanism of EA on improving the brain nerve function of TBI. METHODS: A total of 88 6-week-old SD rats were randomly divided into a sham operation group, a model group, an EA group and a LY294002+EA group, 22 rats in each group. The TBI model on the left side was established by the improved Feeney's free fall method. After modeling for 24 h, the rats in the EA group and LY294002+EA group were treated with acupuncture at "Baihui" (GV 20) for 10 min and pricking acupuncture at "Shuigou" (GV 26) for 20 s; EA was applied at "Neiguan" (PC 6) and "Zusanli" (ST 36) on the right side (discontinuous wave, 2 Hz of frequency, 1 mA of intensity) for 10 min, once a day for 3 days. After 3 days of intervention, the TUNEL method was used to detect the level of neuron apoptosis in left cerebral cortex; the Western blot method was used to detect the expression of Akt, p-Akt, Bcl-2, Bax, Cyt-C and Caspase-9 in the left cerebral cortex. RESULTS: After 3-day treatment, compared with the sham group, the number of neuronal apoptosis in the left cortex was increased in the model group (P<0.01), and the expression of Bax, Cyt-C and Caspase-9 protein was increased (P<0.01), and the expression of p-Akt/Akt, Bcl-2 was decreased (P<0.01). Compared with the model group, the number of neuronal apoptosis in the left cortex was decreased in the EA group (P<0.01), and the expression of Bax, Cyt-C and Caspase-9 was decreased (P<0.01), and the expression of p-Akt/Akt and Bcl-2 was increased (P<0.01). Compared with the LY294002+EA group, the number of neuronal apoptosis in the left cortex was decreased in the EA group (P<0.01), and the expression of Bax, Caspase-9 and Cyt-C was decreased (P<0.01, P<0.05), and the expression of p-Akt/Akt and Bcl-2 was increased (P<0.01). CONCLUSION: EA could significantly reduce the neuronal apoptosis in rats with TBI, and its mechanism may be related to the activation of PI3K/Akt signaling pathway.


Assuntos
Pontos de Acupuntura , Apoptose , Lesões Encefálicas Traumáticas , Eletroacupuntura , Animais , Lesões Encefálicas Traumáticas/terapia , Fosfatidilinositol 3-Quinases/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Ratos , Ratos Sprague-Dawley , Transdução de Sinais
16.
Zhen Ci Yan Jiu ; 45(9): 714-9, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32959553

RESUMO

OBJECTIVE: To investigate the expression of apoptosis-related proteins Fas and FasL in the brain tissue of rats with traumatic brain injury and the effect of electroacupuncture on the expression of Fas and FasL, so as to explore the effective time window of electroacupuncture in the treatment of traumatic brain injury. METHODS: Sprague-Dawley rats were randomly divided into blank group, sham-operation group, model group, and electroacupuncture treatment groups 1, 2, and 3. Traumatic brain injury was induced by the modified Feeney free-fall impact device, and for the rats in the electroacupuncture treatment groups 1, 2, and 3, electroacupuncture started at 4 hours and on days 3 and 7, respectively, after modeling and lasted to day 14. The Morris water maze test was used to evaluate learning and memory ability, and immunofluorescence assay and Western blot were used to observe the changes in the expression of Fas and FasL in traumatic brain tissue. RESULTS: Compared with the blank group and the sham-operation group, the model group had a lower percentage of time spent in the target quadrant from the 3rd day folowing modeling; after electroacupuncture intervention, the electroacupuncture treatment groups showed a gradual increase in the time spent in the target quadrant, and on day 7,10 and 14, electroacupuncture treatment group 1 had a significantly higher percentage than the model group (P<0.05). On day 14, electroacupuncture treatment group 2 had a significantly higher percentage than the model group (P<0.05). After electroacupuncture intervention, all groups except the blank group and the sham-operation group had increases in the expression of Fas and FasL in brain tissue, which reached the highest level on day 7 after modeling and then tended to decrease; compared with electroacupuncture treatment groups 2 and 3 and the model group, electroacupuncture treatment group 1 had significant reductions in the expression of Fas and FasL (P<0.05, P<0.01); compared with electroacupuncture treatment group 3 and the model group, electroacupuncture treatment group 2 had significant decreases in the expression of Fas and FasL (P<0.05) on day 14 after modeling; compared with the model group, electroacupuncture treatment group 3 had significant reductions in the expression of Fas and FasL in brain tissue on day 14 after modeling (P<0.05). CONCLUSION: Early electroacupuncture intervention can regulate the apoptosis receptor pathway by down-regulating Fas and FasL to exert a therapeutic effect on traumatic brain injury and help with the recovery of cognition and memory ability after traumatic brain injury.


Assuntos
Lesões Encefálicas Traumáticas , Eletroacupuntura , Animais , Encéfalo , Lesões Encefálicas Traumáticas/genética , Lesões Encefálicas Traumáticas/terapia , Memória , Ratos , Ratos Sprague-Dawley
18.
Am Surg ; 86(7): 826-829, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32916072

RESUMO

BACKGROUND: The need to reverse the coagulation impairment caused by chronic antiplatelet agents in traumatic brain injury (TBI) patients with acute traumatic intracerebral hemorrhage (TICH) remains controversial. We sought to determine whether emergent platelet transfusion reduces the incidence of hemorrhage expansion, mortality, or need for neurosurgical intervention such as intracranial pressure (ICP) monitoring, burr holes, or craniotomy. METHODS: All adult blunt TICH patients (age ≥16 years) over a 4-year period were retrospectively reviewed. Patients with penetrating TBI, blunt TBI without TICH on admission computed tomography (CT), receiving warfarin, not on antiplatelet agents, or requiring immediate operative intervention were excluded. Patients were divided into 2 groups depending on whether they received a platelet transfusion: reversal group (RV) versus no reversal group (NR). Patient outcomes were analyzed using Mann-Whitney U and Fisher's exact tests. RESULTS: 169 blunt TBI patients on chronic antiplatelet therapy were studied (102 RV group, 67 NR group). The groups were well matched with regard to age, Injury Severity Score, Abbreviated Injury Scale-head, Glasgow Coma Score, mechanism of injury, need for intubation, time to initial CT scan, and hospital length of stay. Immediate platelet transfusion did not alter the occurrence of TICH extension on follow-up CT (26% vs 21%, P = .71), TBI-specific mortality (9% vs 13%, P = .45), need for ICP monitor (2% vs 3%, P = 1.0), burr hole (1% vs 3%, P = .56), or craniotomy (1% vs 3%, P = .56). DISCUSSION: Immediate platelet transfusion is unnecessary in blunt TBI patients on chronic antiplatelet therapy who do not require immediate craniotomy.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Hemorragia Cerebral Traumática/prevenção & controle , Inibidores da Agregação de Plaquetas/administração & dosagem , Transfusão de Plaquetas , Ferimentos não Penetrantes/terapia , Adolescente , Adulto , Idoso , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/mortalidade , Hemorragia Cerebral Traumática/epidemiologia , Craniotomia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/mortalidade , Adulto Jovem
19.
NeuroRehabilitation ; 47(2): 143-152, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32741786

RESUMO

BACKGROUND: Traumatic Brain Injury (TBI) is characterized by a highly heterogenous profile in terms of pathophysiology, clinical presentation and outcome. OBJECTIVE: This is the first population study investigating the epidemiology and outcomes of moderate-to-severe TBI in Cyprus. Patients treated in the Intensive Care Unit (ICU) of Nicosia General Hospital, the only Level 1 Trauma Centre in the country, were recruited between January 2013 and December 2016. METHODS: This was an observational cohort study, using longitudinal methods and six-month follow-up. Patients (N = 203) diagnosed with TBI were classified by the Glasgow Coma Scale at the Emergency Department as moderate or severe. RESULTS: Compared to international multicentre studies, the current cohort demonstrates a different case mix that includes older age, more motor vehicle collisions and lower mortality rates. There was a significantly higher proportion of injured males. Females were significantly older than males. There were no sex differences in the type, severity or place of injury. Sex did not yield differences in mortality or outcomes or on injury indices predicting outcomes. In contrast, older age was a predictor of higher mortality rates and worse outcomes. CONCLUSION: Trends as described in the study emphasize the importance of continuous evaluation of TBI epidemiology and outcome in different countries.


Assuntos
Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Cuidados Críticos/tendências , Vigilância da População , Adulto , Idoso , Lesões Encefálicas Traumáticas/diagnóstico , Estudos de Coortes , Chipre/epidemiologia , Serviço Hospitalar de Emergência/tendências , Feminino , Seguimentos , Escala de Coma de Glasgow/tendências , Humanos , Unidades de Terapia Intensiva/tendências , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Resultado do Tratamento , Adulto Jovem
20.
Sci Rep ; 10(1): 12989, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32737368

RESUMO

Remote ischemic conditioning (RIC), transient restriction and recirculation of blood flow to a limb after traumatic brain injury (TBI), can modify levels of pathology-associated circulating protein. This study sought to identify TBI-induced molecular alterations in plasma and whether RIC would modulate protein and metabolite levels at 24 h after diffuse TBI. Adult male C57BL/6 mice received diffuse TBI by midline fluid percussion or were sham-injured. Mice were assigned to treatment groups 1 h after recovery of righting reflex: sham, TBI, sham RIC, TBI RIC. Nine plasma metabolites were significantly lower post-TBI (six amino acids, two acylcarnitines, one carnosine). RIC intervention returned metabolites to sham levels. Using proteomics analysis, twenty-four putative protein markers for TBI and RIC were identified. After application of Benjamini-Hochberg correction, actin, alpha 1, skeletal muscle (ACTA1) was found to be significantly increased in TBI compared to both sham groups and TBI RIC. Thus, identified metabolites and proteins provide potential biomarkers for TBI and therapeutic RIC in order to monitor disease progression and therapeutic efficacy.


Assuntos
Actinas/sangue , Lesões Encefálicas Traumáticas , Precondicionamento Isquêmico , Proteômica , Animais , Biomarcadores/sangue , Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/terapia , Modelos Animais de Doenças , Masculino , Camundongos
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