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Musso N, Bivona D, Bonomo C, Bonacci P, D'Ippolito ME, Boccagni C, Rubino F, De Tanti A, Lucca LF, Pingue V, Colombo V, Estraneo A, Stefani S, Andriolo M, Bagnato S. Investigating microRNAs as biomarkers in disorders of consciousness: a longitudinal multicenter study. Sci Rep 2023; 13:18415. [PMID: 37891240 PMCID: PMC10611795 DOI: 10.1038/s41598-023-45719-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/23/2023] [Indexed: 10/29/2023] Open
Abstract
MicroRNAs (miRNAs) are involved in gene regulation and may affect secondary brain injury and recovery in patients with disorders of consciousness (DoC). This study investigated the role of five miRNAs (150-5p, 132-3p, 23b-3p, 451a, and 16-5p) in prolonged DoC. miRNA levels were assessed in serum samples from 30 patients with unresponsive wakefulness syndrome or minimally conscious state due to traumatic or hypoxic-ischemic brain injury (TBI, HIBI) at baseline (1-3 months) and 6 months post-injury. Patients' diagnoses were determined using the Coma Recovery Scale revised, and functional outcomes were evaluated 6 months after injury with the Glasgow Outcome Scale Extended (GOSE) and the Functional Independence Measure (FIM). Compared to healthy controls, patients with TBI had lower levels of miRNAs 150-5p, 132-3p, and 23b-3p at baseline, while patients with HIBI had lower levels of miRNA 150-5p at baseline and 6 months post-injury and a reduction of miRNA 451a at baseline. Higher levels of miRNAs 132-3p and 23b-3p were associated with better outcomes in TBI patients as indicated by GOSE and FIM scores. This study highlights distinct miRNA dysregulated patterns in patients with prolonged DoC, dependent on etiology and post-injury time, and suggests that miRNAs 132-3p and 23b-3p may serve as prognostic biomarkers.
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Affiliation(s)
- Nicolò Musso
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123, Catania, Italy
| | - Dalida Bivona
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123, Catania, Italy
| | - Carmelo Bonomo
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123, Catania, Italy
| | - Paolo Bonacci
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123, Catania, Italy
| | | | - Cristina Boccagni
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation, 90015, Cefalù, Italy
| | - Francesca Rubino
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation, 90015, Cefalù, Italy
| | | | - Lucia Francesca Lucca
- RAN (Research in Advanced Neuro-Rehabilitation), S. Anna Institute, 80067, Crotone, Italy
| | - Valeria Pingue
- Neurorehabilitation and Spinal Units, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | | | - Anna Estraneo
- Don Gnocchi Foundation IRCCS, 50124, Florence, Italy
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123, Catania, Italy
| | - Maria Andriolo
- Clinical Pathology Laboratory, Provincial Health Authority of Caltanissetta, 93100, Caltanissetta, Italy
| | - Sergio Bagnato
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation, 90015, Cefalù, Italy.
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Xiao X, Chen W, Zhang X. The effect and mechanisms of music therapy on the autonomic nervous system and brain networks of patients of minimal conscious states: a randomized controlled trial. Front Neurosci 2023; 17:1182181. [PMID: 37250411 PMCID: PMC10213399 DOI: 10.3389/fnins.2023.1182181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/13/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Music therapy has been employed as an alternative treatment modality for the arousal therapy of patients with disorders of consciousness (DOC) in clinical settings. However, due to the absence of continuous quantitative measurements and the lack of a non-musical sound control group in most studies, the identification of the specific impact of music on DOC patients remains challenging. In this study, 20 patients diagnosed with minimally consciousness state (MCS) were selected, and a total of 15 patients completed the experiment. Methods All patients were randomly assigned to three groups: an intervention group (music therapy group, n = 5), a control group (familial auditory stimulation group, n = 5), and a standard care group (no sound stimulation group, n = 5). All three groups received 30 min of therapy five times a week for a total of 4 weeks (20 times per group, 60 times in total). Autonomic nervous system (ANS) measurements, Glasgow Coma Scale (GCS), and functional magnetic resonance-diffusion tensor imaging (fMRI-DTI) were used to measure the peripheral nervous system indicators and brain networks, and to evaluate patients' behavior levels. Results The results reveal that PNN50 (p = 0.0004**), TP (p = 0.0003**), VLF (p = 0.0428**), and LF/HF (p = 0.0001**) in the music group were significantly improved compared with the other two groups. Such findings suggest that the ANS of patients with MCS exhibits higher activity levels during music exposure compared to those exposed to family conversation or no auditory stimulation. In fMRI-DTI detection, due to the relative activity of ANS in the music group, the ascending reticular activation system (ARAS) in the brain network also exhibited significant nerve fiber bundle reconstruction, superior temporal gyrus (STG), transverse temporal gyrus (TTG), inferior temporal gyrus (ITG), limbic system, corpus callosum, subcorticospinal trace, thalamus and brainstem regions. In the music group, the reconstructed network topology was directed rostrally to the diencephalon's dorsal nucleus, with the brainstem's medial region serving as the hub. This network was found to be linked with the caudal corticospinal tract and the ascending lateral branch of the sensory nerve within the medulla. Conclusion Music therapy, as an emerging treatment for DOC, appears to be integral to the awakening of the peripheral nervous system-central nervous system based on the hypothalamic-brainstem-autonomic nervous system (HBA) axis, and is worthy of clinical promotion. The research was supported by the Beijing Science and Technology Project Foundation of China, No. Z181100001718066, and the National Key R&D Program of China No. 2022YFC3600300, No. 2022YFC3600305.
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Affiliation(s)
- Xiang Xiao
- School of Music and Dance, Hunan First Normal University, Changsha, Hunan, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Wenyi Chen
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Music Artificial Intelligence and Music Information Technology, Central Conservatory of Music, Beijing, China
- Music Therapy Center, China Rehabilitation Research Center, Beijing, China
| | - Xiaoying Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
- Department of Music Artificial Intelligence and Music Information Technology, Central Conservatory of Music, Beijing, China
- Music Therapy Center, China Rehabilitation Research Center, Beijing, China
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Cerebrospinal Fluid and Blood Biomarkers in Patients with Post-Traumatic Disorders of Consciousness: A Scoping Review. Brain Sci 2023; 13:brainsci13020364. [PMID: 36831907 PMCID: PMC9954419 DOI: 10.3390/brainsci13020364] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/12/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
(1) Background: Cerebrospinal fluid (CSF) and blood biomarkers are emerging tools used to obtain information on secondary brain damage and to improve diagnostic and prognostic accuracy for patients with prolonged post-traumatic disorders of consciousness (DoC). We synthesized available data from studies evaluating CSF and blood biomarkers in these patients. (2) Methods: A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist to identify and synthesize data from relevant studies. Studies were identified by PubMed and manual searches. Those involving patients with unresponsive wakefulness syndrome or in a minimally conscious state for >28 days, evaluating CSF or blood biomarkers, and conducted on patients with traumatic brain injuries older than 16 years were included in the review. (3) Results: In total, 17 studies were included. Findings on neurofilament light chain, proteins, metabolites, lipids, amyloid-β, tau, melatonin, thyroid hormones, microtubule-associated protein 2, neuron-specific enolase, and brain-derived neurotrophic factor were included in the qualitative synthesis. (4) Conclusions: The most promising applications for CSF and blood biomarkers are the monitoring of secondary neurodegeneration, support of DoC diagnoses, and refinement of prognoses, although current evidence remains too scarce to recommend such uses of these biomarkers in clinical practice.
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Transcutaneous vagal nerve stimulation to treat disorders of consciousness: Protocol for a double-blind randomized controlled trial. Int J Clin Health Psychol 2023; 23:100360. [PMCID: PMC9712558 DOI: 10.1016/j.ijchp.2022.100360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Patients with disorders of consciousness (DoC) are a challenging population prone to misdiagnosis with limited effective treatment options. Among neuromodulation techniques, transcutaneous auricular vagal nerve stimulation (taVNS) may act through a bottom-up manner to modulate thalamo-cortical connectivity and promote patients’ recovery. In this clinical trial, we aim to (1) assess the therapeutic clinical effects of taVNS in patients with DoC; (2) investigate the neural mechanisms underlying the effects of its action; (3) assess the feasibility and safety of the procedure in this challenging population; (4) define the phenotype of clinical responders; and (5) assess the long-term efficacy of taVNS in terms of functional outcomes. Methods We will conduct a prospective parallel randomized controlled double-blind clinical trial investigating the effects of taVNS as a treatment in DoC patients. Forty-four patients in the early period post-injury (7 to 90 days following the injury) will randomly receive 5 days of either active bilateral vagal stimulation (45 min duration with 30s alternative episodes of active/rest periods; 3mA; 200-300μs current width, 25Hz.) or sham stimulation. Behavioural (i.e., Coma Recovery Scale-Revised, CRS-R) and neurophysiological (i.e., high-density electroencephalography, hd-EEG) measures will be collected at baseline and at the end of the 5-day treatment. Analyses will seek for changes in the CRS-R and the EEG metrics (e.g., alpha band power spectrum, functional connectivity) at the group and individual (i.e., responders) levels. Discussion These results will allow us to investigate the vagal afferent network and will contribute towards a definition of the role of taVNS for the treatment of patients with DoC. We aim to identify the neural correlates of its action and pave the way to novel targeted therapeutic strategies. Clinical trial registration Clinicaltrials.gov n° NCT04065386.
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Zheng R, Qi Z, Thibaut A, Wang Z, Xu Z, Di H, Wu X, Mao Y, Laureys S. Clinical application of neuromodulation therapy in patients with disorder of consciousness: A pooled analysis of 544 participants. NeuroRehabilitation 2023; 53:491-503. [PMID: 37927281 DOI: 10.3233/nre-230103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND The number of patients with disorders of consciousness (DoC) has increased dramatically with the advancement of intensive care and emergency medicine, which brings tremendous economic burdens and even ethical issues to families and society. OBJECTIVE To evaluate the effectiveness of neuromodulation therapy for patients with DoC. METHODS First, we conducted a literature review of individual patient data (IPD) on PubMed, EMBASE, and Cochrane-controlled trials following PRISMA guidelines. Then, we collected neuromodulation cases from our institution. Finally, we conducted a pooled analysis using the participants from the medical literature (n = 522) and our local institutions (n = 22). RESULTS In this pooled analysis of 544 patients with DoC with a mean age of 46.33 years, our results revealed that patients have improved CRS-R scores [1.0 points (95% CI, 0.57-1.42)] after neuromodulation. Among them, patients have better effectiveness in traumatic than non-traumatic etiology (P < 0.05). The effectiveness of consciousness improvement could be affected by the age, baseline consciousness state, and duration of stimulation. Compared with non-invasive intervention, an invasive intervention can bring more behavioral improvement (P < 0.0001) to MCS rather than UWS/VS patients. Importantly, neuromodulation is a valuable therapy even years after the onset of DoC. CONCLUSION This pooled analysis spotlights that the application of neuromodulation can improve the behavioral performance of patients with DoC. A preliminary trend is that age, etiology, baseline consciousness state, and stimulation duration could impact its effectiveness.
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Affiliation(s)
- Ruizhe Zheng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- School of Basic Medical Sciences, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and Ministry of Education's (MOE) Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Zengxin Qi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- School of Basic Medical Sciences, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and Ministry of Education's (MOE) Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Aurore Thibaut
- GIGA Consciousness Research Unit, Coma Science Group, Liège University, Liège, Belgium
- GIGA Consciousness, Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Zhe Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- School of Basic Medical Sciences, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and Ministry of Education's (MOE) Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Zeyu Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- School of Basic Medical Sciences, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and Ministry of Education's (MOE) Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Haibo Di
- International Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Xuehai Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- School of Basic Medical Sciences, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and Ministry of Education's (MOE) Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- School of Basic Medical Sciences, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and Ministry of Education's (MOE) Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Steven Laureys
- GIGA Consciousness Research Unit, Coma Science Group, Liège University, Liège, Belgium
- GIGA Consciousness, Centre du Cerveau, Liège University Hospital, Liège, Belgium
- International Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre, Laval University, Quebec, QC, Canada
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Jang SH, Cho MJ. Transcutaneous auricular vagus nerve stimulation in disorders of consciousness: A mini-narrative review. Medicine (Baltimore) 2022; 101:e31808. [PMID: 36550876 PMCID: PMC9771208 DOI: 10.1097/md.0000000000031808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In this mini review, 6 studies that investigated the effects of transcutaneous auricular vagus nerve stimulation (taVNS) in patients with disorders of consciousness (DOC) were reviewed. Generally, the application of taVNS in patients with DOC appears to be effective (positive results in 5 of 6 studies) and safe. Furthermore, 4 studies that evaluated changes in the brain following taVNS reported positive results (2 studies, functional magnetic resonance imaging and 2 studies, electroencephalography). Based on our review of the 6 studies, we believe that research and clinical application of taVNS in DOC are in the initial stages and have the following limitations. First, there is a shortage of studies on this topic, with only 6 studies, 2 of which were case reports. Second, 5 studies were performed without control or sham groups. Third, there was no standardization of treatment schedules and electrical stimulation parameters. Therefore, further studies to overcome the above limitations should be encouraged; further original studies involving a larger number of patients in the control or sham groups are needed. However, studies on the optimal conditions (treatment schedule and electrical stimulation parameters) for taVNS in patients with DOC are necessary. Furthermore, neuroimaging studies should be undertaken to elucidate the neurological mechanisms for the recovery of impaired consciousness in DOC and the lasting effects of taVNS on the brain.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea
| | - Min Jye Cho
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea
- * Correspondence: Min Jye Cho, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Daegu 705-717, Republic of Korea (e-mail: )
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Bagnato S, D’Ippolito ME, Boccagni C, De Tanti A, Lucca LF, Pingue V, Colombo V, Rubino F, Andriolo M. Six-month outcomes in patients with hemorrhagic and non-hemorrhagic traumatic disorders of consciousness. Neurol Sci 2022; 43:6511-6516. [DOI: 10.1007/s10072-022-06335-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/08/2022] [Indexed: 12/01/2022]
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8
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Servider J, Saadon JR, Adachi J, Shen E, Mikell CB, Mofakham S. Cortical recordings reveal hidden early signs of recovery following traumatic brain injury: A case report. Brain Res 2022; 1786:147903. [PMID: 35381214 DOI: 10.1016/j.brainres.2022.147903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/02/2022]
Abstract
Prognosticating recovery of consciousness after severe traumatic brain injury (TBI) is a difficult task. Understanding the mechanism of recovery of consciousness in these patients will undoubtedly help clarify this issue. Recent research has underscored the importance of electrophysiological data in characterizing the state of the brain during this period of unconsciousness. Here, we investigated cortical electrophysiological recordings from a single TBI patient and discovered that high-frequency activity associated with the return of consciousness reappeared in a spatiotemporal fashion. We observed a shift toward higher frequencies first in the anterior cingulate cortex, and then later in the dorsolateral prefrontal cortex. This finding suggests that recovery may originate in more internal cortices and progress to superficial ones. Although this observation occurred in a single patient, it points to a potential mechanism for recovery of normal cortical activity in the return of consciousness following TBI.
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Affiliation(s)
- John Servider
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Jordan R Saadon
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Joseph Adachi
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Erica Shen
- Department of Neurosurgery, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Charles B Mikell
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Sima Mofakham
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA; Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, NY, USA.
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Biomarkers of Brain Injury: A Window on Mechanisms of Injury and Recovery in the Brain. Brain Sci 2022; 12:brainsci12030362. [PMID: 35326318 PMCID: PMC8946249 DOI: 10.3390/brainsci12030362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/06/2022] [Indexed: 01/09/2023] Open
Abstract
The decision-making process regarding management after severe acute brain injury is based on clinical evaluation and depends on the injury etiology as well as radiological and neurophysiological data [...]
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