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Viitasalo V, Laakko E, Hakkarainen AJ, Oura P. Background characteristics and neuropathology findings of medico-legal autopsy cases with and without β-amyloid precursor protein positive diffuse traumatic axonal injury. Leg Med (Tokyo) 2024; 70:102495. [PMID: 39053137 DOI: 10.1016/j.legalmed.2024.102495] [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: 06/29/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
The postmortem diagnosis of diffuse traumatic axonal injury (dTAI) relies on β-amyloid precursor protein (β-APP) immunohistochemistry. Most reports of factors associating with dTAI are decades old. We compared background characteristics and neuropathology findings of today's Finnish medico-legal autopsy cases with and without β-APP-positive dTAI (dTAI+ and dTAI-, respectively). The cases had suffered a head injury prior to death and underwent a full neuropathological examination including β-APP stain. Background and circumstantial data as well as neuropathology findings were collected from police documents, medical records, and autopsy and neuropathology reports. Prevalence ratios were calculated for each factor to facilitate comparisons between the dTAI+ and dTAI- groups. The dataset comprised 57 cases (66.7% males), with 17 classified as dTAI+ and 40 as dTAI-. Based on prevalence ratios, the factors that had at least two-fold prevalence among dTAI+ cases compared to dTAI- cases were: an unknown injury mechanism; concurrent epidural or subdural haemorrhage; and an accidental manner of death. In contrast, the factors that had at least two-fold prevalence among dTAI- cases compared to dTAI+ cases were: a short postinjury survival (<30 min); concurrent intracerebral/ventricular haemorrhage or contusion; vermal atrophy; and a natural or homicidal manner of death. This study revealed differences in circumstantial features and neuropathology findings between dTAI+ and dTAI- cases in today's medico-legal autopsy material. Data on typical case profiles may help estimate the prior probability of dTAI not only in medico-legal autopsies but also among living patients with head injuries.
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Affiliation(s)
- Ville Viitasalo
- Department of Forensic Medicine, University of Helsinki, P.O. Box 21, FI-00014 Helsinki, Finland; Forensic Medicine Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Essi Laakko
- Department of Forensic Medicine, University of Helsinki, P.O. Box 21, FI-00014 Helsinki, Finland
| | - Antti J Hakkarainen
- Department of Forensic Medicine, University of Helsinki, P.O. Box 21, FI-00014 Helsinki, Finland; Forensic Medicine Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Petteri Oura
- Department of Forensic Medicine, University of Helsinki, P.O. Box 21, FI-00014 Helsinki, Finland; Forensic Medicine Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
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Tanhai G, Chahardehi AM, Sohrabi MA, Afshoon M, Saberian P, Pourshams M, Ghasemi D, Motaghi SM, Arefnezhad R, Niknam Z. Ameliorative properties of quercetin in the treatment of traumatic brain injury: a mechanistic review based on underlying mechanisms. Mol Biol Rep 2024; 51:695. [PMID: 38796674 DOI: 10.1007/s11033-024-09641-z] [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] [Received: 12/15/2023] [Accepted: 05/13/2024] [Indexed: 05/28/2024]
Abstract
Traumatic brain injury (TBI) is a leading cause of disability worldwide, with an estimated annual incidence of 27-69 million. TBI is a severe condition that can lead to high mortality rates and long-term cognitive, behavioral, and physical impairments in young adults. It is a significant public health concern due to the lack of effective treatments available. Quercetin, a natural flavonoid found in various fruits and vegetables, has demonstrated therapeutic potential with anti-inflammatory, antioxidant, and neuroprotective properties. Recently, some evidence has accentuated the ameliorating effects of quercetin on TBI. This review discusses quercetin's ability to reduce TBI-related damage by regulating many cellular and molecular pathways. Quercetin in vitro and in vivo studies exhibit promise in reducing inflammation, oxidative stress, apoptosis, and enhancing cognitive function post-TBI. Further clinical investigation into quercetin's therapeutic potential as a readily available adjuvant in the treatment of TBI is warranted in light of these findings. This review adds to our knowledge of quercetin's potential in treating TBI by clarifying its mechanisms of action.
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Affiliation(s)
- Golale Tanhai
- Department of Psychology and Counseling, Faculty of Humanities, Kermanshah Branch, Islamic Azad University, Kermanshah, Iran
| | | | | | - Maryam Afshoon
- Clinical Research Development Unit, Valiasr Educational Hospital, Abadan University of Medical Sciences, Abadan, Iran
| | - Parsa Saberian
- Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Maryam Pourshams
- Department of Psychiatry, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Darioush Ghasemi
- Kimia Andisheh Teb Medical and Research Laboratory Co., Tehran, Iran
| | | | | | - Zahra Niknam
- Neurophysiology Research Center, Cellular and Molecular Medicine Research Institute, Urmia University of Medical Sciences, Urmia, Iran.
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Lilley RL, Kabaliuk N, Reynaud A, Devananthan P, Smith N, Docherty PD. A Novel Experimental Approach for the Measurement of Vibration-Induced Changes in the Rheological Properties of Ex Vivo Ovine Brain Tissue. SENSORS (BASEL, SWITZERLAND) 2024; 24:2022. [PMID: 38610233 PMCID: PMC11014318 DOI: 10.3390/s24072022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Abstract
Increased incidence of traumatic brain injury (TBI) imposes a growing need to understand the pathology of brain trauma. A correlation between the incidence of multiple brain traumas and rates of behavioural and cognitive deficiencies has been identified amongst people that experienced multiple TBI events. Mechanically, repetitive TBIs may affect brain tissue in a similar way to cyclic loading. Hence, the potential susceptibility of brain tissue to mechanical fatigue is of interest. Although temporal changes in ovine brain tissue viscoelasticity and biological fatigue of other tissues such as tendons and arteries have been investigated, no methodology currently exists to cyclically load ex vivo brain tissue. A novel rheology-based approach found a consistent, initial stiffening response of the brain tissue before a notable softening when subjected to a subsequential cyclic rotational shear. History dependence of the mechanical properties of brain tissue indicates susceptibility to mechanical fatigue. Results from this investigation increase understanding of the fatigue properties of brain tissue and could be used to strengthen therapy and prevention of TBI, or computational models of repetitive head injuries.
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Affiliation(s)
- Rebecca L. Lilley
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
| | - Natalia Kabaliuk
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
- Biomolecular Interaction Centre, Christchurch 8140, New Zealand
| | - Antoine Reynaud
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
- École Nationale Supérieure de Mécanique et des Microtechniques, 25000 Besançon, France
| | - Pavithran Devananthan
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
- Biomolecular Interaction Centre, Christchurch 8140, New Zealand
| | - Nicole Smith
- Department of Electrical Engineering, University of Canterbury, Christchurch 8140, New Zealand;
| | - Paul D. Docherty
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
- Institute for Technical Medicine, Furtwangen University, 78120 Villingen Schwenningen, Germany
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Tracy BM, Srinivas S, Nahum KD, Wahl WL, Gelbard RB. The effect of amantadine on acute cognitive disability after severe traumatic brain injury: An institutional pilot study. Surgery 2024; 175:907-912. [PMID: 37981556 DOI: 10.1016/j.surg.2023.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/13/2023] [Accepted: 09/26/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Amantadine is used in the post-acute care setting to improve cognitive function after a traumatic brain injury. Its utility in the acute postinjury period is unknown. In this pilot study, we sought to examine the effect of amantadine on short-term cognitive disability among patients with a severe traumatic brain injury and hypothesized that patients receiving amantadine would have a greater improvement in disability throughout their acute hospitalization. METHODS We performed a prospective, observational study of patients ≥18 years with severe traumatic brain injury (Glasgow Coma Scale ≤8) at a level I trauma center between 2020 and 2022. Patients with penetrating trauma, death within 48 hours of admission, and no radiographic evidence of intracranial pathology were excluded. Patients were grouped according to whether they received amantadine. Our primary outcome was the change in cognitive disability, measured by the Disability Rating Scale (DRS), over the index hospitalization. RESULTS There were 55 patients in the cohort: 41.8% (n = 23) received amantadine and 58.2% (n = 32) did not. There were higher rates of motor vehicle collisions (65.2% vs 46.9%, P = .02), diffuse axonal injury (47.8% vs 18.8%, P = .02), intracranial pressure monitor use (73.9% vs 21.9%, P = .0001), and propranolol use (73.9% vs 21.9%, P = .0001) in the amantadine. There was a larger improvement in DRS scores among patients receiving amantadine (7.8 vs 3.6, P = .001), and amantadine independently predicted improvement in DRS scores (β, 1.61; 95% confidence interval, 0.20-3.02, P = .03). Rates of discharge to traumatic brain injury rehabilitation were significantly higher in the amantadine group (73.9% vs 21.9%, P = .0002). CONCLUSION Among patients with severe traumatic brain injury, amantadine use in the acute postinjury period may be associated with an improvement in cognitive disability and discharge to traumatic brain injury rehabilitation.
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Affiliation(s)
- Brett M Tracy
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Shruthi Srinivas
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH. https://twitter.com/ssrinivasmd
| | - Kelly D Nahum
- Department of Surgery, Montefiore Medical Center, Bronx, NY
| | - Wendy L Wahl
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Rondi B Gelbard
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
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McNamara R, Meka S, Anstey J, Fatovich D, Haseler L, Jeffcote T, Udy A, Bellomo R, Fitzgerald M. Development of Traumatic Brain Injury Associated Intracranial Hypertension Prediction Algorithms: A Narrative Review. J Neurotrauma 2023; 40:416-434. [PMID: 36205570 PMCID: PMC9986028 DOI: 10.1089/neu.2022.0201] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic intracranial hypertension (tIH) is a common and potentially lethal complication of moderate to severe traumatic brain injury (m-sTBI). It often develops with little warning and is managed reactively with the tiered application of intracranial pressure (ICP)-lowering interventions administered in response to an ICP rising above a set threshold. For over 45 years, a variety of research groups have worked toward the development of technology to allow for the preemptive management of tIH in the hope of improving patient outcomes. In 2022, the first operationalizable tIH prediction system became a reality. With such a system, ICP lowering interventions could be administered prior to the rise in ICP, thus protecting the patient from potentially damaging tIH episodes and limiting the overall ICP burden experienced. In this review, we discuss related approaches to ICP forecasting and IH prediction algorithms, which collectively provide the foundation for the successful development of an operational tIH prediction system. We also discuss operationalization and the statistical assessment of tIH algorithms. This review will be of relevance to clinicians and researchers interested in development of this technology as well as those with a general interest in the bedside application of machine learning (ML) technology.
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Affiliation(s)
- Robert McNamara
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
- School of Medicine, Curtin University, Bentley, Western Australia, Australia
- Address correspondence to: Robert McNamara, BMBS, FCICM, Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Western Australia, Australia 6001
| | - Shiv Meka
- Data Innovation Laboratory, Western Australian Department of Health, Perth, Western Australia, Australia
| | - James Anstey
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Daniel Fatovich
- Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Luke Haseler
- Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Toby Jeffcote
- Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia
| | - Andrew Udy
- Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
- Data Analytics Research and Evaluation, Austin Hospital, Melbourne, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, Western Australia, Australia
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Axonal injury is detected by βAPP immunohistochemistry in rapid death from head injury following road traffic collision. Int J Legal Med 2022; 136:1321-1339. [PMID: 35488928 PMCID: PMC9375765 DOI: 10.1007/s00414-022-02807-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022]
Abstract
The accumulation of βAPP caused by axonal injury is an active energy-dependent process thought to require blood circulation; therefore, it is closely related to the post-injury survival time. Currently, the earliest reported time at which axonal injury can be detected in post-mortem traumatic brain injury (TBI) tissue by βAPP (Beta Amyloid Precursor Protein) immunohistochemistry is 35 min. The aim of this study is to investigate whether βAPP staining for axonal injury can be detected in patients who died rapidly after TBI in road traffic collision (RTC), in a period of less than 30 min. We retrospectively studied thirty-seven patients (group 1) died very rapidly at the scene; evidenced by forensic assessment of injuries short survival, four patients died after a survival period of between 31 min and 12 h (group 2) and eight patients between 2 and 31 days (group 3). The brains were comprehensively examined and sampled at the time of the autopsy, and βAPP immunohistochemistry carried out on sections from a number of brain areas. βAPP immunoreactivity was demonstrated in 35/37 brains in group 1, albeit with a low frequency and in a variable pattern, and with more intensity and frequency in all brains of group 2 and 7/8 brains from group 3, compared with no similar βAPP immunoreactivity in the control group. The results suggest axonal injury can be detected in those who died rapidly after RTC in a period of less than 30 min, which can help in the diagnosis of severe TBI with short survival time.
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Benaroya H. Brain energetics, mitochondria, and traumatic brain injury. Rev Neurosci 2021; 31:363-390. [PMID: 32004148 DOI: 10.1515/revneuro-2019-0086] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/13/2019] [Indexed: 12/13/2022]
Abstract
We review current thinking about, and draw connections between, brain energetics and metabolism, and between mitochondria and traumatic brain injury. Energy is fundamental to proper brain function. Its creation in a useful form for neurons and glia, and consistently in response to the brain's high energy needs, is critical for physiological pathways. Dysfunction in the mechanisms of energy production is at the center of neurological and neuropsychiatric pathologies. We examine the connections between energetics and mitochondria - the organelle responsible for almost all the energy production in the cell - and how secondary pathologies in traumatic brain injury result from energetic dysfunction. This paper interweaves these topics, a necessity since they are closely coupled, and identifies where there exist a lack of understanding and of data. In addition to summarizing current thinking in these disciplines, our goal is to suggest a framework for the mathematical modeling of mechanisms and pathways based on optimal energetic decisions.
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Affiliation(s)
- Haym Benaroya
- Department of Mechanical and Aerospace Engineering, Rutgers University, 98 Brett Road, Piscataway, NJ 08854, USA
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Tracy BM, Silverman ME, Cordero-Caballero C, Durr EA, Gelbard RB. Dual Neurostimulant Therapy May Optimize Acute Neurorecovery for Severe Traumatic Brain Injuries. J Surg Res 2021; 268:546-551. [PMID: 34464892 DOI: 10.1016/j.jss.2021.07.037] [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: 03/02/2021] [Revised: 07/05/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neurostimulants (NS) can be used to treat patients with a traumatic brain injury (TBI) with altered levels of consciousness. We sought to determine if amantadine alone (monotherapy) versus amantadine + methylphenidate (dual therapy) would correlate with better neurorecovery (NR) among acutely hospitalized patients with a severe TBI. METHODS We performed a retrospective review of adult patients admitted to our level I trauma center from 2016-2019 with a severe TBI. NR was calculated by dividing the difference between admission and discharge Glasgow Coma Scale (GCS) scores by 12. Resulting ratios were used to divide the cohort into two groups: excellent NR (1) and non-excellent NR (<1). RESULTS A total of 76 patients comprised the cohort; 19.7% (n = 15) had excellent NR. The excellent NR group had a larger proportion of patients receiving dual therapy compared to the non-excellent group (86.7% versus 59%, P = 0.04). In monotherapy (n = 27), amantadine was initiated 13 (8-20) d following injury and treatment lasted 7 (2-16) d. In dual therapy (n = 49), amantadine was initiated 12 (6-19) d following injury and continued for 9 (4-25.5) d. Methylphenidate was initiated 15 (7-20.5) d following injury and continued for 5 (2-13.5) d. After adjusting for confounders, dual versus monotherapy predicted excellent NR (OR 5.4, 95% CI 1.2 - 38.9, P = 0.03). CONCLUSIONS During the acute hospitalization for a severe TBI, dual NS therapy compared to monotherapy is associated with an increased likelihood of excellent NR. Larger prospective trials are warranted to validate these findings.
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Affiliation(s)
- Brett M Tracy
- Division of Trauma, Critical Care, Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Michael E Silverman
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia; Division of Acute Care Surgery, Grady Memorial Hospital, Atlanta, Georgia
| | - Carlos Cordero-Caballero
- Division of Trauma, Critical Care, Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Emily A Durr
- Division of Acute Care Surgery, Grady Memorial Hospital, Atlanta, Georgia
| | - Rondi B Gelbard
- Division of Acute Care Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Farajzadeh Khosroshahi S, Yin X, K Donat C, McGarry A, Yanez Lopez M, Baxan N, J Sharp D, Sastre M, Ghajari M. Multiscale modelling of cerebrovascular injury reveals the role of vascular anatomy and parenchymal shear stresses. Sci Rep 2021; 11:12927. [PMID: 34155289 PMCID: PMC8217506 DOI: 10.1038/s41598-021-92371-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/07/2021] [Indexed: 01/28/2023] Open
Abstract
Neurovascular injury is often observed in traumatic brain injury (TBI). However, the relationship between mechanical forces and vascular injury is still unclear. A key question is whether the complex anatomy of vasculature plays a role in increasing forces in cerebral vessels and producing damage. We developed a high-fidelity multiscale finite element model of the rat brain featuring a detailed definition of the angioarchitecture. Controlled cortical impacts were performed experimentally and in-silico. The model was able to predict the pattern of blood-brain barrier damage. We found strong correlation between the area of fibrinogen extravasation and the brain area where axial strain in vessels exceeds 0.14. Our results showed that adjacent vessels can sustain profoundly different axial stresses depending on their alignment with the principal direction of stress in parenchyma, with a better alignment leading to larger stresses in vessels. We also found a strong correlation between axial stress in vessels and the shearing component of the stress wave in parenchyma. Our multiscale computational approach explains the unrecognised role of the vascular anatomy and shear stresses in producing distinct distribution of large forces in vasculature. This new understanding can contribute to improving TBI diagnosis and prevention.
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Affiliation(s)
| | - Xianzhen Yin
- Shanghai Institute of Materia Medica, Shanghai, China
| | - Cornelius K Donat
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Blast Injury Studies, Imperial College London, London, UK
| | - Aisling McGarry
- Department of Brain Sciences, Imperial College London, London, UK
| | | | - Nicoleta Baxan
- Biological Imaging Centre, Imperial College London, London, UK
| | - David J Sharp
- Department of Brain Sciences, Imperial College London, London, UK
| | - Magdalena Sastre
- Department of Brain Sciences, Imperial College London, London, UK
| | - Mazdak Ghajari
- Dyson School of Design Engineering, Imperial College London, London, UK
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