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1.
Adv Exp Med Biol ; 1232: 47-53, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893393

RESUMO

Cerebrovascular reactivity (CVR) is a compensatory mechanism where blood vessels dilate in response to a vasodilatory stimulus, and is a biomarker of vascular reserve and microvascular health. Impaired CVR indicates microvascular hemodynamic dysfunction, which is implicated in traumatic brain injury (TBI) and associated with long-term neurological deficiency. Recently we have shown that anodal transcranial direct current stimulation (tDCS) caused prolonged dilatation of cerebral arterioles that increased brain microvascular flow and tissue oxygenation in traumatized mouse brain and was associated with neurologic improvement. Here we evaluate the effects of tDCS on impaired CVR and microvascular cerebral blood flow (mCBF) regulation after TBI. TBI was induced in mice by controlled cortical impact (CCI). Cortical microvascular tone, mCBF, and tissue oxygen supply (by nicotinamide adenine dinucleotide, NADH) were measured by two-photon laser scanning microscopy before and after anodal tDCS (0.1 mA/15 min). CVR and mCBF regulation were evaluated by measuring changes in arteriolar diameters and NADH during hypercapnia test before and after tDCS. Transient hypercapnia was induced by 60-s increase of CO2 concentration in the inhalation mixture to 10%. As previously, anodal tDCS dilated arterioles which increased arteriolar blood flow volume that led to an increase in capillary flow velocity and the number of functioning capillaries, thereby improving tissue oxygenation in both traumatized and sham animals. In sham mice, transient hypercapnia caused transient dilatation of cerebral arterioles with constant NADH, reflecting intact CVR and mCBF regulation. In TBI animals, arteriolar dilatation response to hypercapnia was diminished while the NADH level increased (tissue oxygen supply decreased), reflecting impaired CVR and mCBF regulation. Anodal tDCS enhanced reactivity in parenchymal arterioles in both groups (especially in TBI mice) and restored CVR thereby prevented the reduction in tissue oxygen supply during hypercapnia. CVR has been shown to be related to nitric oxide elevation due to nitric oxide synthases activation, which can be sensitive to the electrical field induced by tDCS.


Assuntos
Lesões Encefálicas Traumáticas , Circulação Cerebrovascular , Estimulação Transcraniana por Corrente Contínua , Animais , Encéfalo/patologia , Lesões Encefálicas Traumáticas/terapia , Circulação Cerebrovascular/fisiologia , Hipercapnia , Camundongos
2.
World Neurosurg ; 133: e105-e114, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31479786

RESUMO

BACKGROUND: For patients with TBI, traditional methods such as clinical examination and imaging data are the primary references used for deciding whether to operate or not. Intracranial pressure (ICP) monitoring based on lateral ventricles or parenchymal pressure is a more direct reflection of ICP. However, the research on whether the outcome results of ICP monitoring are better than results based on clinical signs and imaging is sparse. Therefore, we compared treatment results for patients with TBI based on ICP monitoring and traditional methods. METHODS: This retrospective study included patients with TBI admitted to our collaborative hospitals between January 1, 2012, and December 31, 2013. All patients enrolled were divided into a traditional methods group and ICP monitoring group. Follow-up treatment was determined by ICP monitoring value or traditional methods in the 2 groups. Propensity matching scores were used to ensure that baseline characteristics of patients in the 2 groups were consistent. RESULTS: A significant association was found between the initial ICP value and neurologic deterioration (odds ratio 1.24; P < 0.001), and nonlinear correlation achieved the best fit (R2 = 0.547). Both 6-month good recovery rate and favorable outcome rate were higher in the ICP monitoring group than the traditional methods group by propensity score analysis (P < 0.05). CONCLUSIONS: For patients with TBI with cerebral contusion volume >20 mL, both 6-month good recovery rate and favorable outcome rate were significantly higher in the ICP monitoring group than the traditional methods group.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Hipertensão Intracraniana/etiologia , Pressão Intracraniana , Monitorização Fisiológica , Adulto , Idoso , Lesões Encefálicas Traumáticas/terapia , Cuidados Críticos , Feminino , Escala de Coma de Glasgow , Humanos , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
3.
Anaesthesia ; 75(1): 45-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31520421

RESUMO

Traumatic brain injury patients frequently undergo tracheal intubation. We aimed to assess current intubation practice in Europe and identify variation in practice. We analysed data from patients with traumatic brain injury included in the prospective cohort study collaborative European neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI) in 45 centres in 16 European countries. We included patients who were transported to hospital by emergency medical services. We used mixed-effects multinomial regression to quantify the effects on pre-hospital or in-hospital tracheal intubation of the following: patient characteristics; injury characteristics; centre; and trauma system characteristics. A total of 3843 patients were included. Of these, 1322 (34%) had their tracheas intubated; 839 (22%) pre-hospital and 483 (13%) in-hospital. The fit of the model with only patient characteristics predicting intubation was good (Nagelkerke R2 64%). The probability of tracheal intubation increased with the following: younger age; lower pre-hospital or emergency department GCS; higher abbreviated injury scale scores (head and neck, thorax and chest, face or abdomen abbreviated injury score); and one or more unreactive pupils. The adjusted median odds ratio for intubation between two randomly chosen centres was 3.1 (95%CI 2.1-4.3) for pre-hospital intubation, and 2.7 (95%CI 1.9-3.5) for in-hospital intubation. Furthermore, the presence of an anaesthetist was independently associated with more pre-hospital intubation (OR 2.9, 95%CI 1.3-6.6), in contrast to the presence of ambulance personnel who are allowed to intubate (OR 0.5, 95%CI 0.3-0.8). In conclusion, patient and injury characteristics are key drivers of tracheal intubation. Between-centre differences were also substantial. Further studies are needed to improve the evidence base supporting recommendations for tracheal intubation.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Intubação Intratraqueal/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença
4.
Artigo em Russo | MEDLINE | ID: mdl-31793550

RESUMO

Article is devoted to topical issues of complex diagnosis and treatment of the consequences of traumatic brain injury (TBI) in children, adolescents and adults. Craniocerebral trauma is one of the most important problems of modern neurology, due to the high frequency and severity of disability. In recent years, there has been a steady increase in effects of TBI, a significant part of which are asthenic, autonomic, cognitive, emotional and motor disorders. Factors affecting the severity of the consequences of TBI are: the severity of the injury, the age, at which the injury occurred, the time elapsed since the injury, the localization of the lesion. After mild TBI, the structure of cognitive impairment is dominated by memory and attention disorders (75%), visual-motor coordination, as well as asthenic disorders (88%), chronic headaches (95%). After moderate and severe TBI, there are more pronounced impairment of cognitive and motor functions accompanied by pathological neurological symptoms in 94-100% of children, which leads to difficulties in learning, self-service and has a negative impact on social adaptation. The article describes in detail the modern methods of complex diagnosis, as well as pathogenetically justified methods of drug therapy of cognitive disorders in patients with the consequences of TBI. The high efficacy of the modern cytoprotective drug Cytoflavin in the treatment of the effects of TBI is shown.


Assuntos
Concussão Encefálica , Lesões Encefálicas Traumáticas , Disfunção Cognitiva , Transtornos da Memória , Adolescente , Adulto , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Criança , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/terapia , Humanos , Memória , Transtornos da Memória/diagnóstico , Transtornos da Memória/etiologia , Transtornos da Memória/terapia
5.
Medicine (Baltimore) ; 98(44): e17806, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689863

RESUMO

Hypoalbuminemia and anemia are frequent among in patients with traumatic brain injury (TBI). We assess whether serum albumin and hemoglobin at admission can predict outcome in children with moderate to severe TBI.This retrospective study was conducted in a tertiary pediatric hospital between May 2012 and Jun 2018 included children with an admission Glasgow Coma Scale of ≤13.A total of 213 patients were included of whom 45 died in hospital. Multivariate logistic regression showed that hypoalbuminemia (serum albumin <30 g/L) was independently associated with mortality (adjusted odds ratio [OR] = 3.059; 95% confidence interval [CI]: 1.118-8.371; P = .030) in children with moderate to severe TBI, while anemia (hemoglobin <90 g/L) was not independently associated with mortality (adjusted OR = 1.742; 95% CI: 0.617-4.916; P = .295). Serum albumin was significantly superior to hemoglobin (area under the curve [AUC] 0.738 vs AUC 0.689, P < .05) under receiver operating characteristic curve analysis. Hypoalbuminemia was also associated with reduced 14-day ventilation-free days, 14-day intensive care unit (ICU)-free days, and 28-day hospital-free days.Serum albumin at admission was superior to hemoglobin in predicting the mortality in children with moderate to severe TBI and also associated with reduced ventilator-free, ICU-free, and hospital-free days.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/mortalidade , Hemoglobina A Glicada/metabolismo , Mortalidade Hospitalar , Albumina Sérica/metabolismo , Anemia/complicações , Anemia/diagnóstico , Biomarcadores/sangue , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/terapia , Estudos de Casos e Controles , Criança , Pré-Escolar , Cuidados Críticos , Feminino , Escala de Coma de Glasgow , Humanos , Hipoalbuminemia/complicações , Hipoalbuminemia/diagnóstico , Masculino , Valor Preditivo dos Testes , Respiração Artificial , Estudos Retrospectivos
6.
Zhongguo Zhen Jiu ; 39(10): 1075-80, 2019 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-31621260

RESUMO

OBJECTIVE: To observe the effect of bloodletting acupuncture at twelve jing-well points of hand on microcirculatory disturbance in mice with traumatic brain injury (TBI), and to explore the protective effect of bloodletting therapy on TBI. METHODS: Sixty clean adult male C57BL/6J mice were randomly divided into a sham-operation group, a model group and a treatment group, 20 mice in each group. The TBI model was established by using electronic controlled cerebral cortex impact instrument in the model group and the treatment group. The mice in the treatment group were treated with bloodletting acupuncture at bilateral "Shaoshang" (LU 11), "Shangyang" (LI 1), "Zhongchong" (PC 9), "Guanchong" (TE 1), "Shaochong" (HT 9) and "Shaoze" (SI 1) immediately after trauma. The mice in the sham-operation group only opened the bone window but did not receive the strike. The regional cerebral blood flow (rCBF) was monitored by laser speckle contrast analysis (LASCA) using a PeriCam PSI System before trauma, immediately after trauma and 1, 2, 12, 24, 48, 72 h after trauma. The brain water content was measured by wet-dry weight method 24 h after trauma. The severity of functional impairment at 2, 12, 24, 48 and 72 h after trauma was evaluated by modified neurological scale scores (mNSS). RESULTS: ① 2 h after trauma, the mNSS in the model group and treatment group were >7 points, suggesting the successful establishment of model; compared with the sham-operation group, the mNSS was increased significantly from 12 to 72 h after trauma in the model group ( all P<0.01), but the mNSS in the treatment group was significantly lower than that in the model group from 2 to 24 h after trauma (P<0.01, P<0.05). ② Compared with the sham-operation group, rCBF in the model group was decreased significantly immediately after trauma (P<0.01), and the rCBF in the model group was lower than that in the sham-operation group from 1 to 72 h after trauma ( all P<0.01); rCBF in the treatment group began to rise and was significantly higher than that in the model group 1-2 h after trauma (P<0.01); 12-48 h after trauma, the increasing of rCBF in the two groups tended to be gentle until 72 h after injury, and rCBF in the model group was decreased while that in the treatment group continued to rise and was higher than that in the model group (P<0.01). ③ 24 h after trauma, the brain water content in the model group was significantly higher than that in the sham-operation group (P<0.01), and brain water content in the treatment group was significantly lower than that in the model group (P<0.01). CONCLUSION: The bloodletting acupuncture at twelve jing-well points of hand could improve microcirculation disturbance, increase microcirculation perfusion, alleviate secondary brain edema and promote the recovery of nerve function in mice with TBI.


Assuntos
Terapia por Acupuntura , Sangria , Lesões Encefálicas Traumáticas , Pontos de Acupuntura , Animais , Lesões Encefálicas Traumáticas/terapia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microcirculação , Distribuição Aleatória
7.
World Neurosurg ; 132: e21-e27, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521754

RESUMO

BACKGROUND: To investigate role of Low-dose, Early Fresh frozen plasma Transfusion (LEFT) therapy in preventing perioperative coagulopathy and improving long-term outcome after severe traumatic brain injury (TBI). METHODS: A prospective, single-center, parallel-group, randomized trial was designed. Patients with severe TBI were eligible. We used a computer-generated randomization list and closed opaque envelops to randomly allocate patients to treatment with fresh frozen plasma (5 mL/kg body weight; LEFT group) or normal saline (5 mL/kg body weight; NO LEFT group) after admission in the operating room. RESULTS: Between January 1, 2018, and November 31, 2018, 63 patients were included and randomly allocated to LEFT (n = 28) and NO LEFT (n = 35) groups. The final interim analysis included 20 patients in the LEFT group and 32 patients in the NO LEFT group. The study was terminated early for futility and safety reasons because a high proportion of patients (7 of 20; 35.0%) in the LEFT group developed new delayed traumatic intracranial hematoma after surgery compared with the NO LEFT group (3 of 32; 9.4%) (relative risk, 5.205; 95% confidence interval, 1.159-23.384; P = 0.023). Demographic characteristics and indexes of severity of brain injury were similar at baseline. CONCLUSIONS: LEFT therapy was associated with a higher incidence of delayed traumatic intracranial hematoma than normal fresh frozen plasma transfusion in patients with severe TBI. A restricted fresh frozen plasma transfusion protocol, in the right clinical setting, may be more appropriate in patients with TBIs.


Assuntos
Transfusão de Sangue/métodos , Lesões Encefálicas Traumáticas/terapia , Plasma , Idoso , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/cirurgia , Craniotomia , Método Duplo-Cego , Feminino , Hematoma Subdural Agudo/cirurgia , Hematoma Subdural Agudo/terapia , Humanos , Hemorragia Intracraniana Traumática/complicações , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Prevenção Secundária , Resultado do Tratamento
8.
J Comput Assist Tomogr ; 43(5): 690-696, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490891

RESUMO

PURPOSE: The aim of the study was to refine and validate the NeuroImaging Radiological Interpretation System (NIRIS), which was developed to predict management and clinical outcome based on noncontrast head computerized tomography findings in patients suspected of acute traumatic brain injury (TBI). METHODS: We assessed the performance of the NIRIS score in a prospective, single-center cohort of patients suspected of TBI (n = 648) and compared the performance of NIRIS with that of the Marshall and Rotterdam scoring systems. We also revised components of the NIRIS scoring system using decision tree methodologies implemented on pooled data from the retrospective and prospective studies (N = 1190). RESULTS: The NIRIS performed similarly to the Marshall and Rotterdam scoring systems in predicting mortality and markedly better in terms of predicting more granular elements of disposition and management of TBI patients, such as admission, follow-up imaging, intensive care unit stay, and neurosurgical procedures. The revised NIRIS classification correctly predicted disposition and outcome in 91.2% (331/363) after excluding patients with other major extracranial traumatic injuries or intracranial nontraumatic injuries. CONCLUSIONS: The present study further demonstrates the predictive value of NIRIS in guiding standardized clinical management and decision-making regarding treatment options for TBI patients.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico por imagem , Neuroimagem/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Tomada de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Índices de Gravidade do Trauma
10.
World Neurosurg ; 131: 126-132, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31301445

RESUMO

Traumatic brain injury (TBI) refers to any insult to the brain resulting in primary (direct) and secondary (indirect) damage to the brain parenchyma. Secondary damage is often linked to the molecular mechanisms that occur post TBI and result in excitotoxicity, neuroinflammation and cytokine damage, oxidative damage, and eventual cell death as prominent mechanisms of cell damage. We present a review highlighting the relation of each of these mechanisms with TBI, their mode of damaging brain tissue, and therapeutic correlation. We also mention the long-term sequelae and their pathophysiology in relation to TBI focusing on Parkinson disease, Alzheimer disease, epilepsy, and chronic traumatic encephalopathy. Understanding of the molecular mechanisms is important in order to realize the secondary and long-term sequelae that follow primary TBI and to devise targeted therapy for quick recovery accordingly.


Assuntos
Lesões Encefálicas Traumáticas/metabolismo , Animais , Lesões Encefálicas Traumáticas/terapia , Humanos
11.
World Neurosurg ; 130: 115-121, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31284053

RESUMO

Traumatic brain injury (TBI) represents a major health care problem and a significant social and economic issue worldwide. Considering the generalized failure in introducing effective drugs and clinical protocols, there is an urgent need for efficient treatment modalities, able to improve devastating posttraumatic morbidity and mortality. In this work, the status of brain trauma research is analyzed in all its aspects, including basic and translational science and clinical trials. Implicit and explicit challenges to different lines of research are discussed and clinical trial structures and outcomes are scrutinized, along with possible explanations for systematic therapeutic failures and their implications for future development of drug and clinical trials. Despite significant advances in basic and clinical research in recent years, no specific therapeutic protocols for TBI have been shown to be effective. New potential therapeutic targets have been identified, following a better understanding of pathophysiologic mechanisms underlying TBI, although with disappointing results. Several reasons can be pinpointed at different levels, from inaccurate animal models of disease to faulty preclinical and clinical trials, with poor design and subjective outcome measures. Distinct strategies can be delineated to overcome specific shortcomings of research studies. Identifying and contextualizing the failures that have dominated TBI research is mandatory. This review analyzes current approaches and discusses possible strategies for improving outcomes.


Assuntos
Pesquisa Biomédica/métodos , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Modelos Animais de Doenças , Animais , Pesquisa Biomédica/tendências , Ensaios Clínicos como Assunto/métodos , Humanos
12.
Emerg Med Clin North Am ; 37(3): 529-544, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262419

RESUMO

Central nervous system hemorrhage has multiple pathophysiologic etiologies, including intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and traumatic brain injury (TBI). Given the nuances intrinsic to each of these etiologies and pathophysiologic processes, optimal blood pressure varies significantly and depends on type of hemorrhage and individual characteristics. This article reviews the most current evidence regarding blood pressure targets and provides guidance on reversal of anticoagulation for TBI, ICH, and SAH. It also describes the assessment, optimal therapeutic targets, and interventions to treat intracranial hypertension that can result from TBI, ICH, or SAH.


Assuntos
Hemorragias Intracranianas/terapia , Hipertensão Intracraniana/terapia , Anti-Hipertensivos/uso terapêutico , Antitrombinas/uso terapêutico , Pressão Sanguínea , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/terapia , Medicina de Emergência , Hemostáticos/uso terapêutico , Humanos , Hemorragias Intracranianas/diagnóstico , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/etiologia , Transfusão de Plaquetas , Vasodilatadores/uso terapêutico
13.
Curr Pain Headache Rep ; 23(9): 62, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31359173

RESUMO

PURPOSE OF THE REVIEW: Traumatic brain injury (TBI) is a major public health concern in the USA and worldwide. Sleep disruption and headaches are two of the most common problems reported by patients after TBI. In this manuscript, we review the current knowledge regarding the relation between post-traumatic sleep disruption and headaches. We also describe the role of the glymphatic system as a potential link between TBI, sleep, and headaches. RECENT FINDINGS: Recent studies show a reciprocal relation between post-traumatic sleep disruption and headaches: patients with sleep disruption after TBI report more headaches, and post-traumatic headaches are a risk factor for developing disrupted sleep. Despite this clinical association, the exact mechanisms linking post-traumatic sleep disruption and headaches are not well understood. The glymphatic pathway, a newly described brain-wide network of perivascular spaces that supports the clearance of interstitial solutes and wastes from the brain, is active primarily during sleep, and becomes dysfunctional after TBI. We propose a model where changes in glymphatic function caused by TBI and post-traumatic sleep disruption may impair the clearance of neuropeptides involved in the pathogenesis of post-traumatic headaches, such as CGRP. The relation between TBI, post-traumatic sleep disruption, and post-traumatic headaches, although well documented in the literature, remains poorly understood. Dysfunction of the glymphatic system caused by TBI offers a novel and exiting explanation to this clinically observed phenomenon. The proposed model, although theoretical, could provide important mechanistic insights to the TBI-sleep-headache association.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Sistema Glinfático/fisiologia , Cefaleia Pós-Traumática/epidemiologia , Transdução de Sinais/fisiologia , Transtornos do Sono-Vigília/epidemiologia , Lesões Encefálicas Traumáticas/metabolismo , Lesões Encefálicas Traumáticas/terapia , Humanos , Cefaleia Pós-Traumática/metabolismo , Cefaleia Pós-Traumática/terapia , Transtornos do Sono-Vigília/metabolismo , Transtornos do Sono-Vigília/terapia
14.
J Neurosurg Pediatr ; 23(6): 661-669, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31153150

RESUMO

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children both in the United States and throughout the world. Despite valiant efforts and multiple clinical trials completed over the last few decades, there are no high-level recommendations for pediatric TBI available in current guidelines. In this review, the authors explore key findings from the major pediatric clinical trials in children with TBI that have shaped present-day recommendations and the insights gained from them. The authors also offer a perspective on potential efforts to improve the efficacy of future clinical trials in children following TBI.


Assuntos
Lesões Encefálicas Traumáticas , Ensaios Clínicos como Assunto/métodos , Transtornos do Neurodesenvolvimento/etiologia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/terapia , Saúde Global/estatística & dados numéricos , Humanos , Transtornos do Neurodesenvolvimento/epidemiologia , Estados Unidos/epidemiologia
15.
Behav Neurol ; 2019: 6937832, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31191738

RESUMO

Objective: To provide a brief and comprehensive summary of recent research regarding psychological interventions for patients surviving a traumatic brain injury. Methods: A bibliographical search was performed in PubMed, Cochrane Library, PsycNET, Scopus, ResearchGate, and Google Scholar online databases. Analysis included distribution by year of publication, age stage of participants (paediatric, adult), location of the research team, study design, type of intervention, and main outcome variables. Results: The initial search eliciting 1541 citations was reduced to 62 relevant papers. Most publications had adult samples (88.7%). The United States outstands as the country with more research (58.1%); Latin America countries provided no results. Cognitive behavioural therapy (CBT) was the most widely used approach for treatment of (sub)clinical mental disturbances (41.9%). Neuropsychological interventions were scarce (4.8%). Outcome measures included psychiatric disorders (e.g., posttraumatic stress disorder (PTSD), depression, and anxiety) (37.1%), postconcussive symptoms (16.1%), cognitive and functional deficits (48.1%), and social and psychological dimensions (62.9%). Conclusions: CBT outstands as the preferred therapeutic approach for treating behavioural and emotional disturbances. Also, other related therapies such as dialectical behaviour, mindfulness, and acceptance and commitment therapies have been proposed, and probably in the years to come, more literature regarding their effectiveness will be available. On the other hand, evidence showed that interventions from the field of neuropsychology are minimal if compared with its contribution to assessment. Future research should be aimed at performing studies on more diverse populations (e.g., nonmilitary communities and paediatric and Latin American populations) and at controlling designs to examine the therapeutic efficacy of psychotherapeutic and neurocognitive rehabilitation interventions and compare amelioration by injury severity, age of patients, and clinical profile, in the hopes of creating better guidelines for practitioners.


Assuntos
Lesões Encefálicas Traumáticas/psicologia , Lesões Encefálicas Traumáticas/terapia , Psicoterapia/métodos , Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Terapia Cognitivo-Comportamental/tendências , Depressão/terapia , Transtorno Depressivo/terapia , Humanos , Transtornos de Estresse Pós-Traumáticos/terapia
16.
EBioMedicine ; 44: 607-617, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31202815

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is recognized as a metabolic disease, characterized by acute cerebral glucose hypo-metabolism. Adaptive metabolic responses to TBI involve the utilization of alternative energy substrates, such as ketone bodies. Cerebral microdialysis (CMD) has evolved as an accurate technique allowing continuous sampling of brain extracellular fluid and assessment of regional cerebral metabolism. We present the successful application of a combined hypothesis- and data-driven metabolomics approach using repeated CMD sampling obtained routinely at patient bedside. Investigating two patient cohorts (n = 26 and n = 12), we identified clinically relevant metabolic patterns at the acute post-TBI critical care phase. METHODS: Clinical and CMD metabolomics data were integrated and analysed using in silico and data modelling approaches. We used both unsupervised and supervised multivariate analysis techniques to investigate structures within the time series and associations with patient outcome. FINDINGS: The multivariate metabolite time series exhibited two characteristic brain metabolic states that were attributed to changes in key metabolites: valine, 4-methyl-2-oxovaleric acid (4-MOV), isobeta-hydroxybutyrate (iso-bHB), tyrosyine, and 2-ketoisovaleric acid (2-KIV). These identified cerebral metabolic states differed significantly with respect to standard clinical values. We validated our findings in a second cohort using a classification model trained on the cerebral metabolic states. We demonstrated that short-term (therapeutic intensity level (TIL)) and mid-term patient outcome (6-month Glasgow Outcome Score (GOS)) can be predicted from the time series characteristics. INTERPRETATION: We identified two specific cerebral metabolic patterns that are closely linked to ketometabolism and were associated with both TIL and GOS. Our findings support the view that advanced metabolomics approaches combined with CMD may be applied in real-time to predict short-term treatment intensity and long-term patient outcome.


Assuntos
Lesões Encefálicas Traumáticas/metabolismo , Encéfalo/metabolismo , Corpos Cetônicos/metabolismo , Adulto , Biomarcadores , Lesões Encefálicas Traumáticas/líquido cefalorraquidiano , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Cromatografia Líquida , Biologia Computacional/métodos , Feminino , Escala de Coma de Glasgow , Humanos , Pressão Intracraniana , Masculino , Metaboloma , Metabolômica/métodos , Microdiálise , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Prognóstico , Curva ROC , Estudos Retrospectivos , Espectrometria de Massas em Tandem
17.
J Clin Neurosci ; 66: 209-219, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31085075

RESUMO

BACKGROUND: Traumatic brain injury (TBI) can causes numerous cognitive impairments usually in the aspects of problem-solving, executive function, memory, and attention. Several studies has suggested that rehabilitation treatment interventions can be effective in treating cognitive symptoms of brain injury. Virtual reality (VR) technology potential as a useful tool for the assessment and rehabilitation of cognitive processes. OBJECTIVES: The aims of present systematic review are to examine effects of VR training intervention on cognitive function, and to identify effective VR treatment protocol in patients with TBI. METHODS: PubMed, Scopus, PEDro, REHABDATA, EMBASE, web of science, and MEDLINE were searched for studies investigated effect of VR on cognitive functions post TBI. The methodological quality were evaluated using PEDro scale. The results of selected studies were summarized. RESULTS: Nine studies were included in present study. Four were randomized clinical trials, case studies (n = 3), prospective study (n = 1), and pilot study (n = 1). The scores on the PEDro ranged from 0 to 7 with a mean score of 3. The results showed improvement in various cognitive function aspects such as; memory, executive function, and attention in patients with TBI after VR training. CONCLUSION: Using different VR tools with following treatment protocol; 10-12 sessions, 20-40 min in duration with 2-4 sessions per week may improves cognitive function in patients with TBI. There was weak evidence for effects of VR training on attention post TBI.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/terapia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/terapia , Terapia Cognitivo-Comportamental/métodos , Terapia de Exposição à Realidade Virtual/métodos , Atenção/fisiologia , Lesões Encefálicas Traumáticas/psicologia , Cognição/fisiologia , Transtornos Cognitivos/psicologia , Função Executiva/fisiologia , Humanos , Memória/fisiologia , Projetos Piloto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Resultado do Tratamento
18.
Pediatr Ann ; 48(5): e192-e196, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31067334

RESUMO

Pediatric head injuries are common and may present with varying degrees of altered mental status in children. The approach to evaluation, diagnosis, treatment, and prevention of further injury is important in achieving good health outcomes after a head injury. In this article, we review the pathophysiology, classifications, signs and symptoms, and management of traumatic brain injury. We also discuss the importance of preventing a secondary injury during recovery by educating families about head injury sequelae and return-to-play guidelines. [Pediatr Ann. 2019;48(5):e192-e196.].


Assuntos
Lesões Encefálicas Traumáticas , Transtornos da Consciência/etiologia , Adolescente , Lesões Encefálicas Traumáticas/classificação , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/terapia , Criança , Maus-Tratos Infantis/diagnóstico , Pré-Escolar , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/fisiopatologia , Transtornos da Consciência/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Prognóstico , Prevenção Secundária/métodos
19.
J Med Life ; 12(1): 71-74, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31123528

RESUMO

We aim to demonstrate that multidisciplinary treatment through neurosurgical intervention, pharmacotherapy, rehabilitation, speech, and psychological therapy is the most promising treatment approach for patients with severe craniocerebral injuries. Here we describe two clinical cases who presented with an unexpectedly positive outcome as both patients regained mobility and the ability to function independently after receiving multimodal therapy.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Idoso , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Terapia Combinada , Feminino , Humanos , Masculino , Tomografia Computadorizada por Raios X , Adulto Jovem
20.
Int J Mol Sci ; 20(11)2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31142002

RESUMO

Mesenchymal stem cells (MSCs) are emerging as a potential therapeutic intervention for brain injury due to their neuroprotective effects and safe profile. However, the homing ability of MSCs to injury sites still needs to be improved. Fibroblast Growth Factor 21 (FGF21) was recently reported to enhance cells migration in different cells type. In this study, we investigated whether MSCs that overexpressing FGF21 (MSC-FGF21) could exhibit enhanced homing efficacy in brain injury. We used novel Molday IONEverGreen™ (MIEG) as cell labeling probe that enables a non-invasive, high-sensitive and real-time MRI tracking. Using a mouse model of traumatic brain injury (TBI), MIEG labeled MSCs were transplanted into the contralateral lateral ventricle followed by real-time MRI tracking. FGF21 retained MSC abilities of proliferation and morphology. MSC-FGF21 showed significantly greater migration in transwell assay compared to control MSC. MIEG labeling showed no effects on MSCs' viability, proliferation and differentiation. Magnetic resonance imaging (MRI) revealed that FGF21 significantly enhances the homing of MSC toward injury site. Histological analysis further confirmed the MRI findings. Taken together, these results show that FGF21 overexpression and MIEG labeling of MSC enhances their homing abilities and enables non-invasive real time tracking of the transplanted cells, provides a promising approach for MSC based therapy and tracking in TBI.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Movimento Celular , Fatores de Crescimento de Fibroblastos/genética , Transplante de Células-Tronco Mesenquimais/métodos , Células-Tronco Mesenquimais/fisiologia , Animais , Células Cultivadas , Fatores de Crescimento de Fibroblastos/metabolismo , Masculino , Células-Tronco Mesenquimais/metabolismo , Camundongos , Camundongos Endogâmicos C57BL
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