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1.
Codas ; 32(1): e20180306, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31664312

RESUMO

PURPOSE: Search for reliability and validity evidence for the Montreal Communication Evaluation Brief Battery (MEC B) for adults with right brain damage. METHODS: Three hundred twenty-four healthy adults and 26 adults with right brain damage, aged 19-75 years, with two or more years of education were evaluated with MEC B. The MEC B Battery contains nine tasks that aim to evaluate communicative abilities as discourse, prosody, lexical-semantic and pragmatic process. Two sources of reliability evidence were used: internal consistency (Cronbach's alpha) and interrater reliability. Construct validity was evaluated comparing the Montreal Communication Evaluation Battery (MEC), expanded version and MEC B tasks. RESULTS: Internal consistence was satisfactory and the interrater reliability was considered excellent, as were correlations between MEC Battery and MEC B Battery tasks. CONCLUSION: The MEC B Battery showed satisfactory reliability and validity evidences. It can be used as outcome measure of intervention programs and assist speech therapists to plan rehabilitation programs.


Assuntos
Lesões Encefálicas/fisiopatologia , Transtornos da Comunicação/diagnóstico , Testes Neuropsicológicos/estatística & dados numéricos , Adulto , Idoso , Brasil , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fonoterapia/métodos
2.
Handb Clin Neurol ; 163: 19-34, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31590730

RESUMO

Patients with focal frontal lobe damage have long been a crucial source of information about the role of this region in human behavior. This method remains the only means to provide inferentially powerful loss-of-function evidence for many regions within the human frontal lobes. This chapter demonstrates modern focal lesion research methods, focusing on specific subregions within prefrontal cortex, and their contributions to widely studied aspects of executive function and decision-making. Examples of such studies are reviewed in detail, to demonstrate the strengths, limitations, and logic of lesion methods. The evidence provided by such studies is considered in relation to converging evidence from other cognitive neuroscience methods. The tensions between modular and network views of prefrontal function are also addressed. Lesion studies straddle fundamental and clinical neuroscience, allowing basic advances in this area to be readily translated to psychiatric and neurologic disorders. This unique position, as well as the ability to test causal claims, explains the staying power of this classic approach to understanding the brain basis of behavior.


Assuntos
Atenção/fisiologia , Lesões Encefálicas/fisiopatologia , Tomada de Decisões/fisiologia , Função Executiva/fisiologia , Lobo Frontal/fisiologia , Lobo Frontal/lesões , Lobo Frontal/fisiopatologia , Humanos , Testes Neuropsicológicos
3.
Handb Clin Neurol ; 163: 473-483, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31590747

RESUMO

The frontal lobe plays a crucial role in human motor behavior. It is one of the last areas of the brain to mature, especially the prefrontal regions. After a brief historical perspective on the perceived dichotomy between the view of the brain as a static organ and that of a plastic, constantly changing structure, we discuss the stability/plasticity dilemma including examples of documented cortical reorganization taking place at multiple spatial and temporal scales. We pose that while plasticity is needed for motor learning, stability of the system is necessary for storage and maintenance of memorized skills. We discuss how this plasticity/stability dilemma is resolved along the life span and after a brain injury. We then examine the main challenges that clinicians have to overcome to promote recovery of function in patients with brain lesions, including attempts to use neurostimulation techniques as adjuvant to training-based customary neurorehabilitation.


Assuntos
Lesões Encefálicas/fisiopatologia , Lobo Frontal/fisiologia , Plasticidade Neuronal/fisiologia , Recuperação de Função Fisiológica/fisiologia , Humanos , Aprendizagem/fisiologia , Reabilitação Neurológica
4.
Neurology ; 93(13): e1281-e1287, 2019 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-31484715

RESUMO

OBJECTIVE: To determine whether ascending arousal network (AAn) connectivity is reduced in patients presenting with traumatic coma. METHODS: We performed high-angular-resolution diffusion imaging in 16 patients with acute severe traumatic brain injury who were comatose on admission and in 16 matched controls. We used probabilistic tractography to measure the connectivity probability (CP) of AAn axonal pathways linking the brainstem tegmentum to the hypothalamus, thalamus, and basal forebrain. To assess the spatial specificity of CP differences between patients and controls, we also measured CP within 4 subcortical pathways outside the AAn. RESULTS: Compared to controls, patients showed a reduction in AAn pathways connecting the brainstem tegmentum to a region of interest encompassing the hypothalamus, thalamus, and basal forebrain. When each pathway was examined individually, brainstem-hypothalamus and brainstem-thalamus CPs, but not brainstem-forebrain CP, were significantly reduced in patients. Only 1 subcortical pathway outside the AAn showed reduced CP in patients. CONCLUSIONS: We provide initial evidence for the reduced integrity of axonal pathways linking the brainstem tegmentum to the hypothalamus and thalamus in patients presenting with traumatic coma. Our findings support current conceptual models of coma as being caused by subcortical AAn injury. AAn connectivity mapping provides an opportunity to advance the study of human coma and consciousness.


Assuntos
Nível de Alerta/fisiologia , Lesões Encefálicas/fisiopatologia , Tronco Encefálico/fisiopatologia , Estado de Consciência/fisiologia , Adulto , Prosencéfalo Basal/fisiopatologia , Lesões Encefálicas/complicações , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/fisiopatologia , Feminino , Humanos , Masculino , Vias Neurais/fisiopatologia , Tálamo/fisiologia
5.
Traffic Inj Prev ; 20(sup1): S27-S31, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31381455

RESUMO

Objective: Fatal brain injuries result from physiological changes in brain tissues, subsequent to primary damage caused by head impact. Although efforts have been made in past studies to estimate the probability of brain injury, none of them involved prediction of such physiological changes. The goal of this study was to evaluate the fatality prediction capability of a novel approach that predicts an increase in intracranial pressure (ICP) due to primary head injury to estimate the fatality rate using clinical data that correlate ICP with fatality rate. Methods: A total of 12 sets of head acceleration time histories were used to represent no, severe, and fatal brain injury. They were obtained from the literature presenting head kinematics data in noninjurious volunteer sled tests or from accident reconstruction for severe and fatal injury cases. These were first applied to a Global Human Body Models Consortium (GHBMC) head-brain model to predict nodal displacement time histories of the brain, which were then fed into FEBio to predict ICP. A Weibull distribution was applied to the data for the relationship between fatality rate and ICP obtained from a clinical paper to estimate fatality rate from ICP (procedure A). Fatality rate was also estimated by applying the temporal and spatial maximum value of maximum principal strain (MPSmax) obtained from the GHBMC simulation to an injury probability function for MPSmax (procedure B). Estimated fatality rates were compared between the 2 procedures. Results: Both procedures estimated higher average fatality rate for higher injury severity. The average fatality rate for procedure A without ischemia representation and procedure B was 72.4 and 51.0% for the fatal injury group and 8.2 and 21.7% for the severe injury group, respectively, showing that procedure A provides more distinct classification between fatal and nonfatal brain injury. It was also found that representation of ischemia in procedure A provides results sensitive to injury severity and impact conditions, requiring further validation of the initial estimate for the relationship between brain compression and ischemic cell death. Conclusions: Prediction of the probability of fatality by means of a combination of simulations of the primary brain deformation and subsequent ICP increase was found to be more distinct compared to the prediction of primary injury alone combined with the injury probability function from a past study in the select 12 head impact cases.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Lesões Encefálicas/mortalidade , Adulto , Idoso , Lesões Encefálicas/etiologia , Lesões Encefálicas/fisiopatologia , Humanos , Pressão Intracraniana/fisiologia , Pessoa de Meia-Idade , Pedestres , Probabilidade , Adulto Jovem
6.
Mol Med Rep ; 20(4): 3363-3370, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31432127

RESUMO

The present study aimed to explore the effects of histone deacetylase 6 (HDAC6) on brain injury in rats induced by apolipoprotein E4 (APOE4) and amyloid ß protein alloform 1­40 (Aß1­40) copolymerization. The rats were randomly divided into four groups: Control group, sham group, APOE4 + Aß1­40 co­injection group (model group) and HDAC6 inhibitor group (HDAC6 group). The brain injury model was established by co­injection of APOE4 + Aß1­40. Morris water maze experiment was used to observe the spatial memory and learning the ability of rats. Histological changes of the hippocampus were observed by hematoxylin and eosin staining. The mRNA expression levels of choline acetyltransferase (ChAT) and HDAC6 were detected by reverse transcription­quantitative PCR. Immunohistochemistry was used to detect the protein expression of HDAC6. Western blotting was used to detect the protein expression levels of HDAC6, microtubule­associated protein tau and glycogen synthase kinase 3ß (GSK3ß). APOE4 and Aß1­40 co­aggregation decreased the short­term spatial memory and learning ability of rats, whereas inhibition of HDAC6 activity attenuated the injury. Inhibition of HDAC6 activity resulted in an attenuation of the APOE4 and Aß1­40 co­aggregation­induced increase in the number of dysplastic hippocampal cells. Further experiments demonstrated that APOE4 and Aß1­40 co­aggregation decreased the expression levels of ChAT mRNA, and the phosphorylation levels of tau GSK3ß protein in the hippocampus, whereas inhibition of HDAC6 activity resulted in increased expression of ChAT mRNA, tau protein and GSK3ß phosphorylation. The inhibition of HDAC6 activity was also demonstrated to reduce brain injury induced by APOE4 and Aß1­40 co­aggregation in model rats.


Assuntos
Peptídeos beta-Amiloides/metabolismo , Apolipoproteína E4/metabolismo , Lesões Encefálicas/metabolismo , Regulação Enzimológica da Expressão Gênica/efeitos dos fármacos , Hipocampo/metabolismo , Desacetilase 6 de Histona/biossíntese , Inibidores de Histona Desacetilases/farmacologia , Fragmentos de Peptídeos/metabolismo , Agregação Patológica de Proteínas/metabolismo , Animais , Lesões Encefálicas/patologia , Lesões Encefálicas/fisiopatologia , Colina O-Acetiltransferase/biossíntese , Hipocampo/patologia , Hipocampo/fisiopatologia , Desacetilase 6 de Histona/antagonistas & inibidores , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Agregação Patológica de Proteínas/patologia , Agregação Patológica de Proteínas/fisiopatologia , Ratos , Ratos Sprague-Dawley , Memória Espacial/efeitos dos fármacos , Proteínas tau/metabolismo
7.
Mol Med Rep ; 20(4): 3395-3405, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31432130

RESUMO

Cerebral ischemic injury is a major cause of death and long­term disability worldwide that leads to neurological and behavioral deficits, and for which successful treatments are still lacking. Ras homolog family member A (RhoA) and Rho­associated coiled­coil containing protein kinase (ROCK) are associated with the growth of neurons and the movement of neuronal growth cones. RhoA/ROCK inhibitors have been demonstrated to promote the recovery of motor function following nerve injury, but the underlying mechanism requires further investigation. The present study aimed to investigate the effects of the ROCK inhibitor Y­27632 on middle cerebral artery occlusion (MCAO)­induced cerebral ischemic injury. Rats were randomly assigned to the Control, Y­27632, MCAO + Vehicle or MCAO + Y­27632 group. Firstly, infarct volume, cognitive ability and cerebral injury were assessed. Secondly, indicators of cerebral inflammation, oxidative stress and apoptosis were evaluated. Finally, the expression of recombinant glial fibrillary acidic protein (GFAP) and allograft inflammatory factor 1 (AIF1) in the brain were measured to assess the activation of astrocytes and microglia, respectively. The results showed that Y­27632 effectively increased the survival rate and behavioral performance of rats, and attenuated the cerebral injury, oxidative stress and cerebral inflammation levels following MCAO. The disturbance in hippocampal neurons caused by MCAO was also alleviated following treatment with Y­27632. Neuronal apoptosis was also decreased following Y­27632 treatment, as demonstrated by the TUNEL assay and the expression levels of Caspases­3, 8 and 9 and Bax/Bcl­2 ratio. The levels of GFAP and AIF1 were increased by MCAO and further promoted by Y­27632, indicating the activation of astrocytes and microglia. In conclusion, the present study offered evidence of a protective effect of Y­27632 administration on cerebral ischemia/reperfusion induced behavioral and hippocampal damage by activating astrocytes and microglia.


Assuntos
Amidas/farmacologia , Apoptose/efeitos dos fármacos , Comportamento Animal/efeitos dos fármacos , Lesões Encefálicas , Piridinas/farmacologia , Traumatismo por Reperfusão , Quinases Associadas a rho/antagonistas & inibidores , Animais , Lesões Encefálicas/tratamento farmacológico , Lesões Encefálicas/metabolismo , Lesões Encefálicas/patologia , Lesões Encefálicas/fisiopatologia , Hipocampo/metabolismo , Hipocampo/patologia , Hipocampo/fisiopatologia , Masculino , Proteínas do Tecido Nervoso/metabolismo , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/tratamento farmacológico , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologia
8.
NeuroRehabilitation ; 45(1): 19-24, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31403952

RESUMO

BACKGROUND: Reliable evaluation is of utmost importance to the therapist and the patient. There is no data about the test-retest reproducibility of 6-Minute Walk Test (6MWT) and Energy Expenditure Index (EEI) for children and adolescents with an Acquired Brain Injury (ABI) in the sub-acute phase. OBJECTIVE: To determine test-retest reproducibility and smallest real differences (SRDs) of the 6MWT and EEI in children and adolescents with an ABI during rehabilitation in the sub-acute phase. Our second aim was to assess the correlation between the objective measure, the EEI, and the subjective perception of physical exertion obtained by using the pictorial children's effort rating scale (PCERT). METHODS: Twenty eight participants (12.5±4.3 years; 10 females) with an ABI in the sub-acute phase were asked to perform the 6MWT twice during their hospitalization. Heart rate was monitored during rest and throughout the 6MWT to calculate the EEI. Intra-class correlation coefficients (ICCs) and SRDs of the 6MWT and EEI were determined. RESULTS: Test-retest reproducibility was excellent for the 6MWT (ICC = 0.98, SRD = 65.73 m) and EEI tests (ICC = 0.99, SRD = 0.65 beats/m). Excluding one participant who walked extremely slowly resulted in ICC = 0.97, SRD = 67.01 m for the 6MWT, and ICC = 0.91, SRD = 0.25 beats/m for the EEI. No significant correlations were found between the EEI and PCERT. CONCLUSIONS: 6MWT and EEI are reliable measures in children and adolescents with an ABI during hospitalization in the sub-acute phase.


Assuntos
Lesões Encefálicas/fisiopatologia , Metabolismo Energético , Teste de Esforço/normas , Caminhada , Adolescente , Criança , Teste de Esforço/métodos , Feminino , Frequência Cardíaca , Humanos , Masculino , Reprodutibilidade dos Testes
9.
Medicine (Baltimore) ; 98(27): e16315, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277175

RESUMO

Driving is an essential activity for community engagement in patients with brain injury. However, brain injury patients have cognitive-perceptual deficits and low independence in daily activities. The aims of this study were to identify the driving errors of brain injury patients and determine their relevance to cognitive-perception function and daily activity level. This study was conducted at a single rehabilitation hospital. Thirty-one brain injury patients were included in the study. The patients underwent a driving-scene-based simulator evaluation in the rehabilitation clinic. Driving errors were checked using automatic software. Perceptual ability was measured using Motor-free Visual Perceptual Test (MVPT) and Cognitive-perceptual Assessment for Driving (CPAD). A linear relationship was found between the driving aptitude score, steering wheel and judgment, simultaneous operation items, total score of road course test, and cognitive-perceptual functions and daily activity levels of the participants (P <.05). The general factors that affected driving errors included driving experience, age, part of the hemispheric affected, and presence of vascular injury (P <.05). In addition, the Korean version of Mini-Mental State Examination (K-MMSE) score and the CPAD score correlated with driving errors (P <.05). The total error score of the participants correlated with the Korean version of the Modified Barthel Index (K-MBI) score (P <.05).These findings suggest that driving experience and age have more influence on driving error than perceptual level due to brain damage. In addition, it was found that the basic level of daily living influences overall operating errors.


Assuntos
Atividades Cotidianas , Condução de Veículo/psicologia , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/psicologia , Cognição/fisiologia , Percepção/fisiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia
10.
BMC Med Imaging ; 19(1): 53, 2019 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277606

RESUMO

BACKGROUND: The invasive method for intracranial pressure measurement is 'gold standard' but not always feasible because the intraventricular catheter/ intraparenchymal micro transducer used in the measurement of intracranial pressure measurement may cause complications. Imaging modalities with clinical examination protocol have a lack of specificity and accuracy. The objective of the study was to compare the accuracy of diagnostic parameters of ultrasound measurements in patients with brain injury underwent invasive intracranial pressure measurement method. METHODS: Data of invasive intracranial pressure measurement method and ultrasound measurements of 185 patients with brain injury who required admission diagnosis were included in the analysis. Pearson correlation was tested for diagnostic parameters. Logistical regression analysis was performed for diagnostic parameters of death patients to evaluate independent parameter of mortality. RESULTS: Straight sinus flow velocities, middle cerebral artery flow velocities, and optic nerve sheath diameter were correlated with intracranial pressure (p < 0.0001 for all). Arterial blood pressure (p = 0.127) and middle cerebral artery pulsatility index (p = 0.06) were not correlated with intracranial pressure. A total of 47 patients died during the study period. Intracranial pressure (p = 0.015) and optic nerve sheath diameter (p = 0.035) were found to be independent predictor of mortality. CONCLUSIONS: Ultrasound measurement especially optic nerve sheath diameter can be successfully used instead of invasive intracranial pressure measurement method in patients with brain injury. LEVEL OF EVIDENCE: III.


Assuntos
Lesões Encefálicas/mortalidade , Lesões Encefálicas/fisiopatologia , Pressão Intracraniana , Monitorização Fisiológica/métodos , Velocidade do Fluxo Sanguíneo , Lesões Encefálicas/diagnóstico por imagem , Feminino , Humanos , Modelos Logísticos , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia Doppler Transcraniana
11.
NeuroRehabilitation ; 44(4): 545-554, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282434

RESUMO

BACKGROUND: Neurosensory stimulation is effective in enhancing the recovery process of severely brain-injured patients with disorders of consciousness. Multisensory environments are found in nature, recognized as beneficial to many medical conditions. Recent advances detected covert cognition in patients behaviorally categorized as un- or minimally responsive; a state described as cognitive motor dissociation (CMD). OBJECTIVE: To determine effectiveness of a neurosensory stimulation approach enhanced by outdoor therapy, in the early phases of recovery in patients presenting with CMD. METHODS: A prospective non-randomized crossover study was performed. A two-phase neurosensory procedure combined identical individually goal assessed indoor and outdoor protocols. All sessions were video-recorded and observations rated offline. The frequency of volitional behavior was measured using a behavioral grid. RESULTS: Fifteen patients participated in this study. The outdoor group patients had statistically significant higher number of intentional behaviors than the indoor group on seven features of the grid. Additionally, for all items assessed, total amount of behaviors in the outdoor condition where higher than those in the indoor condition. CONCLUSIONS: Although preliminary, this study provides robust evidence supporting the effectiveness and appropriateness of an outdoor neurosensory intervention in patients with covert cognition, to improve adaptive goal-oriented behavior. This may be a step towards helping to restore functional interactive communication.


Assuntos
Lesões Encefálicas/terapia , Transtornos Cognitivos/terapia , Cognição/fisiologia , Recuperação de Função Fisiológica/fisiologia , Terapia Recreacional/métodos , Sensação/fisiologia , Adulto , Idoso , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/psicologia , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Estado de Consciência/fisiologia , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Ocupacional/métodos , Terapia Ocupacional/psicologia , Modalidades de Fisioterapia/psicologia , Estudos Prospectivos , Terapia Recreacional/psicologia , Adulto Jovem
12.
Med Sci Monit ; 25: 5062-5067, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31283752

RESUMO

BACKGROUND Movement deficits in limbs ipsilesional to the damaged hemisphere in individuals with stroke have been established through various motor tasks. Nevertheless, there has been little evidence regarding hindrance of motor skill acquisition on the ipsilesional limb in patients with stroke. Therefore, we attempted to demonstrate whether the characteristics of ipsilesional deficits involved motor learning insufficiency in stroke survivors with unilateral brain damage. MATERIAL AND METHODS Thirty-six participants (18 patients with stroke and 18 normal individuals) were recruited. Patients with stroke performed a visuo-spatial tracking task in the upper limb ipsilesional to the injured hemisphere, and normal participants did the same task with the upper limb matched for the same side. The participants were required to track a target sine wave as accurately as possible while the wave was displayed on the computer screen for 15 seconds. An accuracy index was calculated for each of the trials. RESULTS We found that motor skill learning improved in both stroke and normal groups with repetitive practice. However, the normal group exhibited greater motor skill acquisition than in comparison the stroke group for motor skill improvement. Statistical analyses revealed significant differences in time effects and time x group interactions. CONCLUSIONS Our findings provide evidence that individuals with stroke might have difficulty in performing visuo-spatial movements and acquiring motor skills with the ipsilateral upper limb. Improvement of ipsilesional limb function increases self-care activity in daily life. Therefore, we recommend that clinicians adopt remedial strategies for ipsilesional limbs.


Assuntos
Destreza Motora/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Extremidade Superior/fisiopatologia , Idoso , Lesões Encefálicas/fisiopatologia , China , Feminino , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral/métodos
13.
N Engl J Med ; 380(26): 2497-2505, 2019 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-31242361

RESUMO

BACKGROUND: Brain activation in response to spoken motor commands can be detected by electroencephalography (EEG) in clinically unresponsive patients. The prevalence and prognostic importance of a dissociation between commanded motor behavior and brain activation in the first few days after brain injury are not well understood. METHODS: We studied a prospective, consecutive series of patients in a single intensive care unit who had acute brain injury from a variety of causes and who were unresponsive to spoken commands, including some patients with the ability to localize painful stimuli or to fixate on or track visual stimuli. Machine learning was applied to EEG recordings to detect brain activation in response to commands that patients move their hands. The functional outcome at 12 months was determined with the Glasgow Outcome Scale-Extended (GOS-E; levels range from 1 to 8, with higher levels indicating better outcomes). RESULTS: A total of 16 of 104 unresponsive patients (15%) had brain activation detected by EEG at a median of 4 days after injury. The condition in 8 of these 16 patients (50%) and in 23 of 88 patients (26%) without brain activation improved such that they were able to follow commands before discharge. At 12 months, 7 of 16 patients (44%) with brain activation and 12 of 84 patients (14%) without brain activation had a GOS-E level of 4 or higher, denoting the ability to function independently for 8 hours (odds ratio, 4.6; 95% confidence interval, 1.2 to 17.1). CONCLUSIONS: A dissociation between the absence of behavioral responses to motor commands and the evidence of brain activation in response to these commands in EEG recordings was found in 15% of patients in a consecutive series of patients with acute brain injury. (Supported by the Dana Foundation and the James S. McDonnell Foundation.).


Assuntos
Lesões Encefálicas/fisiopatologia , Encéfalo/fisiopatologia , Cognição/fisiologia , Eletroencefalografia , Atividade Motora/fisiologia , Máquina de Vetores de Suporte , Adulto , Idoso , Área Sob a Curva , Lesões Encefálicas/psicologia , Feminino , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Prognóstico , Estudos Prospectivos , Valores de Referência , Inconsciência/fisiopatologia
15.
Khirurgiia (Mosk) ; (5): 57-63, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169820

RESUMO

AIM: To study the effectiveness of intraoperative administration of Cytoflavine for the prevention of ischemic brain injury during cerebral aneurysm (CA) clipping with temporary occlusion of the leading artery under general anesthesia. MATERIAL AND METHODS: The prospective cohort single-center study included 40 patients with CA ( the main group - 27 patients with intraoperative administration of cytoflavine; the comparison group -13 patients without use of cytoflavine), who underwent aneurism clipping with temporary occlusion of the afferent artery. We assesed the intraoperative state of the brain, the time of awakening and extubation of patients after surgery, neurological deficit and local ischemic changes in the area of surgery according to the CT of the brain in the early postoperative period, resuscitation bed-day and the relationship of these indicators with the duration of temporary occlusion of the afferent artery in the selected groups of patients. RESULTS: In intergroup comparison, patients of the main group treated with intraoperative cytoflavin showed a reduction in the time of awakening (p=0.013) and the time of extubation (p=0.01) both with temporary occlusion of the afferent artery and in patients without temporary occlusion (p<0.05). The duration of resuscitation bed-day decreased in the main group of patients receiving intraoperatively cytoflavine (p=0.01), as well as in patients in the comparison group without temporary occlusion (p<0.05). CONCLUSION: Temporary occlusion of the afferent artery with short intervals of vessel occlusion in combination with intraoperative intravenous administration of cytoflavine expands the tolerability to artery occlusion in patients operated in the 'cold' period, reduces the possibility of neurological deficit, reduces the recovery period and resuscitation bed-day after surgical clipping CA.


Assuntos
Lesões Encefálicas/prevenção & controle , Isquemia Encefálica/fisiopatologia , Encéfalo/irrigação sanguínea , Mononucleotídeo de Flavina/administração & dosagem , Inosina Difosfato/administração & dosagem , Aneurisma Intracraniano/fisiopatologia , Fármacos Neuroprotetores/administração & dosagem , Procedimentos Neurocirúrgicos/efeitos adversos , Niacinamida/administração & dosagem , Succinatos/administração & dosagem , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Encéfalo/cirurgia , Lesões Encefálicas/etiologia , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/cirurgia , Isquemia Encefálica/etiologia , Isquemia Encefálica/cirurgia , Combinação de Medicamentos , Mononucleotídeo de Flavina/farmacologia , Humanos , Inosina Difosfato/farmacologia , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/cirurgia , Cuidados Intraoperatórios , Fármacos Neuroprotetores/farmacologia , Procedimentos Neurocirúrgicos/métodos , Niacinamida/farmacologia , Estudos Prospectivos , Succinatos/farmacologia , Técnicas de Sutura
16.
Crit Care ; 23(1): 234, 2019 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-31253189

RESUMO

BACKGROUND: Brain injury (BI) induces a state of immunodepression leading to pneumonia. We investigated the invariant natural killer T (iNKT) cell compartment. METHODS: This is an observational study in two surgical intensive care units (ICUs) of a single institution and a research laboratory. Clinical data and samples from a prospective cohort were extracted. Severe brain-injured patients (n = 33) and sex- and age-matched healthy donors (n = 40) were studied. RESULTS: We observed the presence of IL-10 in serum, a loss of IFN-γ and IL-13 production by peripheral blood mononuclear cells (PBMCs) following IL-2 stimulation, and downregulation of HLA-DR expression on both monocytes and B cells early after BI. Inversely, CD1d, the HLA class I-like molecule involved in antigen presentation to iNKT cells, was over-expressed on patients' monocytes and B cells. The antigen-presenting activity to iNKT cells of PBMCs was increased in the patients who developed pneumonia, but not in those who remained free of infection. Frequencies of iNKT cells among PBMCs were dramatically decreased in patients regardless of their infection status. Following amplification, an increased frequency of CD4+ iNKT cells producing IL-4 was noticed in the group of patients free of infection compared with those who became infected and with healthy donors. Finally, serum from BI patients inhibited the iNKT cells' specific response as well as the non-specific IL-2 stimulation of PBMCs, and the expression of the beta-2 adrenergic receptor was elevated at the surface of patients T lymphocytes. CONCLUSIONS: We observed severe alterations of the iNKT cell compartment, including the presence of inhibitory serum factors. We demonstrate for the first time that the decreased capacity to present antigens is not a generalized phenomenon because whereas the expression of HLA-DR molecules is decreased, the capacity for presenting glycolipids through CD1d expression is higher in patients.


Assuntos
Lesões Encefálicas/fisiopatologia , Compartimento Celular/fisiologia , Células T Matadoras Naturais/ultraestrutura , Lesões Encefálicas/patologia , Cardiotônicos/uso terapêutico , Hidratação/métodos , Hidratação/tendências , Humanos
17.
Crit Care ; 23(1): 198, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159847

RESUMO

BACKGROUND: In recent years, argon has been shown to exert neuroprotective effects in an array of models. However, the mechanisms by which argon exerts its neuroprotective characteristics remain unclear. Accumulating evidence imply that argon may exert neuroprotective effects via modulating the activation and polarization of microglia/macrophages after ischemic stroke. In the present study, we analyzed the underlying neuroprotective effects of delayed argon application until 7 days after reperfusion and explored the potential mechanisms. METHODS: Twenty-one male Wistar rats underwent transient middle cerebral artery occlusion or sham surgery randomly for 2 h using the endoluminal thread model. Three hours after transient middle cerebral artery occlusion induction and 1 h after reperfusion, animals received either 50% vol Argon/50% vol O2 or 50% vol N2/50% vol O2 for 1 h. The primary outcome was the 6-point neuroscore from 24 h to d7 after reperfusion. Histological analyses including infarct volume, survival of neurons (NeuN) at the ischemic boundary zone, white matter integrity (Luxol Fast Blue), microglia/macrophage activation (Iba1), and polarization (Iba1/Arginase1 double staining) on d7 were conducted as well. Sample size calculation was performed using nQuery Advisor + nTerim 4.0. Independent t test, one-way ANOVA and repeated measures ANOVA were performed, respectively, for statistical analysis (SPSS 23.0). RESULTS: The 6-point neuroscore from 24 h to d7 after reperfusion showed that tMCAO Ar group displayed significantly improved neurological performance compared to tMCAO N2 group (p = 0.026). The relative numbers of NeuN-positive cells in the ROIs of tMCAO Ar group significantly increased compared to tMCAO N2 group (p = 0.010 for cortex and p = 0.011 for subcortex). Argon significantly suppressed the microglia/macrophage activation as revealed by Iba1 staining (p = 0.0076) and promoted the M2 microglia/macrophage polarization as revealed by Iba1/Arginase 1 double staining (p = 0.000095). CONCLUSIONS: Argon administration with a 3 h delay after stroke onset and 1 h after reperfusion significantly alleviated neurological deficit within the first week and preserved the neurons at the ischemic boundary zone 7 days after stroke. Moreover, argon reduced the excessive microglia/macrophage activation and promoted the switch of microglia/macrophage polarization towards the anti-inflammatory M2 phenotype. Studies making efforts to further elucidate the protective mechanisms and to benefit the translational application are of great value.


Assuntos
Argônio/farmacologia , Lesões Encefálicas/fisiopatologia , Encefalite/prevenção & controle , Acidente Vascular Cerebral/tratamento farmacológico , Análise de Variância , Animais , Argônio/uso terapêutico , Lesões Encefálicas/etiologia , Lesões Encefálicas/patologia , Modelos Animais de Doenças , Encefalite/fisiopatologia , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/tratamento farmacológico , Infarto da Artéria Cerebral Média/fisiopatologia , Masculino , Fármacos Neuroprotetores/farmacologia , Fármacos Neuroprotetores/uso terapêutico , Distribuição Aleatória , Ratos , Ratos Wistar/lesões , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologia
18.
Ann Biomed Eng ; 47(9): 2033-2044, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31054004

RESUMO

Exposure to blast waves is suspected to cause primary traumatic brain injury. However, existing finite-element (FE) models of the rat head lack the necessary fidelity to characterize the biomechanical responses in the brain due to blast exposure. They neglect to represent the cerebral vasculature, which increases brain stiffness, and lack the appropriate brain material properties characteristic of high strain rates observed in blast exposures. To address these limitations, we developed a high-fidelity three-dimensional FE model of a rat head. We explicitly represented the rat's cerebral vasculature and used high-strain-rate material properties of the rat brain. For a range of blast overpressures (100 to 230 kPa) the brain-pressure predictions matched experimental results and largely overlapped with and tracked the incident pressure-time profile. Incorporating the vasculature decreased the average peak strain in the cerebrum, cerebellum, and brainstem by 17, 33, and 18%, respectively. When compared with our model based on rat-brain properties, the use of human-brain properties in the FE model led to a three-fold reduction in the strain predictions. For simulations of blast exposure in rats, our findings suggest that representing cerebral vasculature and species-specific brain properties has a considerable influence in the resulting brain strain but not the pressure predictions.


Assuntos
Traumatismos por Explosões/fisiopatologia , Lesões Encefálicas/fisiopatologia , Encéfalo/irrigação sanguínea , Modelos Biológicos , Animais , Fenômenos Biomecânicos , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Explosões , Análise de Elementos Finitos , Cabeça/anatomia & histologia , Cabeça/diagnóstico por imagem , Cabeça/fisiopatologia , Pressão Intracraniana , Masculino , Ratos Sprague-Dawley , Microtomografia por Raio-X
19.
Arch Phys Med Rehabil ; 100(10): 1945-1963, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31078616

RESUMO

OBJECTIVE: To assess the evidence of the effectiveness of noninvasive brain stimulation (NIBS) for rehabilitation of pediatric motor disorders after brain injury. DATA SOURCES: Ovid, Cochrane, Science Direct, Web of Science, EBSCOhost, PubMed, and Google Scholar databases were searched up to August 2017 by 2 independent reviewers. STUDY SELECTION: Randomized controlled trials (RCTs) published in English were included if they met the following criteria. POPULATION: Pediatric patients with motor disorders following brain injury. INTERVENTION: NIBS, including transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS). OUTCOMES: Measures related to motor disorders (upper limb functional abilities, gait, balance, and spasticity). Fourteen RCTs were included (10 studies used tDCS, while 4 studies used rTMS). DATA EXTRACTION: Predefined data were tabulated by 1 reviewer and verified by another reviewer. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale; also levels of evidence adapted from Sackett were used. DATA SYNTHESIS: A grouped meta-analysis was performed on balance, gait parameters, and upper limb function. Data were pooled using a random-effects model to assess the immediate effect and 1-month follow-up of NIBS. According to the PEDro scale, 3 studies were excellent, 8 studies were good, and 3 studies were fair. The level of evidence of all of the included studies was 1b, except for 3 studies with grade 2a. There were significant improvements in all upper limb functions (standardized mean differences [SMDs] ranging from 0.94 to 1.83 [P values=.0001]), balance (SMDs ranging between -0.48 to 0.83 [P values<.05]) and some gait variables. CONCLUSION: Pediatric patients with brain injury can be safely stimulated by NIBS, and there is evidence for the efficacy of rTMS in improving upper limb function, and tDCS in improving balance and majority of gait variables with persisted effects for 1 month. The efficacy of spasticity is uncertain.


Assuntos
Lesões Encefálicas/reabilitação , Transtornos Neurológicos da Marcha/reabilitação , Espasticidade Muscular/reabilitação , Estimulação Transcraniana por Corrente Contínua , Estimulação Magnética Transcraniana , Lesões Encefálicas/fisiopatologia , Criança , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Espasticidade Muscular/fisiopatologia , Pediatria , Equilíbrio Postural/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Extremidade Superior/fisiopatologia
20.
Cogn Neuropsychol ; 36(5-6): 282-299, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31131723

RESUMO

Gestures might serve communicative functions by supplementing spoken expressions or restorative functions by facilitating speech production. Also, speakers with speech deficits use gestures to compensate for their speech impairments. In this study, we examined gesture use in speakers with and without speech impairments and how spoken spatial expressions changed when gestures were restrained. Six patients with speech problems and with left frontal and/or temporal lesions and 20 neurotypical controls described motion events in 3 different conditions (spontaneous gesture, only speech, and only gesture). In addition to the group analyses, we ran case analyses. Results showed that patients used more gestures compared to controls. Gestures served both communicative and restorative functions for patients whereas controls only used gestures for communicative purposes. Case analyses revealed that there were differential patterns among patients. Overall, gesture production is multifunctional and gestures serve different functions for different populations as well as within a population.


Assuntos
Lesões Encefálicas/fisiopatologia , Gestos , Linguagem , Comunicação Manual , Lesões Encefálicas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fala , Distúrbios da Fala/complicações , Distúrbios da Fala/fisiopatologia
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