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Nattino G, Lemeshow S, Carrara G, Rossi C, Brissy O, Chieregato A, Csomos A, Fleming JM, Giugni A, Gradisek P, Kaps R, Kyprianou T, Lazar I, Mikaszewska-Sokolewicz M, Paci G, Xirouchaki N, Bertolini G. A Model Predicting the 6-Month Disability of Patients With Traumatic Brain Injury to Assess the Quality of Care in Intensive Care Units: Results from the CREACTIVE Study. J Neurotrauma 2024; 41:e1948-e1960. [PMID: 38468542 DOI: 10.1089/neu.2023.0529] [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: 03/13/2024] Open
Abstract
Assessing quality of care is essential for improving the management of patients experiencing traumatic brain injury (TBI). This study aimed at devising a rigorous framework to evaluate the quality of TBI care provided by intensive care units (ICUs) and applying it to the Collaborative Research on Acute Traumatic Brain Injury in Intensive Care Medicine in Europe (CREACTIVE) consortium, which involved 83 ICUs from seven countries. The performance of the centers was assessed in terms of patients' outcomes, as measured by the 6-month Glasgow Outcome Scale-Extended (GOS-E). To account for the between-center differences in the characteristics of the admitted patients, we developed a multinomial logistic regression model estimating the probability of a four-level categorization of the GOS-E: good recovery (GR), moderate disability (MD), severe disability (SD), and death or vegetative state (D/VS). A total of 5928 patients admitted to the participating ICUs between March 2014 and March 2019 were analyzed. The model included 11 predictors and demonstrated good discrimination (area under the receiver operating characteristic [ROC] curve in the validation set for GR: 0.836, MD: 0.802, SD: 0.706, D/VS: 0.890) and calibration, both overall (Hosmer-Lemeshow test p value: 0.87) and in several subgroups, defined by prognostically relevant variables. The model was used as a benchmark for assessing quality of care by comparing the observed number of patients experiencing GR, MD, SD, and D/VS to the corresponding numbers expected in each category by the model, computing observed/expected (O/E) ratios. The four center-specific ratios were assembled with polar representations and used to provide a multidimensional assessment of the ICUs, overcoming the loss of information consequent to the traditional dichotomizations of the outcome in TBI research. The proposed framework can help in identifying strengths and weaknesses of current TBI care, triggering the changes that are necessary to improve patient outcomes.
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Affiliation(s)
- Giovanni Nattino
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Stanley Lemeshow
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Greta Carrara
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Carlotta Rossi
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Obou Brissy
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Arturo Chieregato
- Neurointensive Care Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Akos Csomos
- Hungarian Army Medical Center, Budapest, Hungary
| | - Joanne M Fleming
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Aimone Giugni
- Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital, Bologna, Italy
| | - Primoz Gradisek
- Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rafael Kaps
- General Hospital Novo Mesto, Novo Mesto, Slovenia
| | - Theodoros Kyprianou
- University of Nicosia Medical School, Nicosia, Cyprus
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Isaac Lazar
- Pediatric Intensive Care Unit, Soroka Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | | | - Giulia Paci
- Hospital Nursing Management, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | | | - Guido Bertolini
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
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Zhou M, Li R, Hua H, Dai Y, Yin Z, Li L, Zeng J, Yang M, Zhao J, Tan R. The role of tetrahydrocurcumin in disease prevention and treatment. Food Funct 2024; 15:6798-6824. [PMID: 38836693 DOI: 10.1039/d3fo05739a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
In recent decades, natural compounds derived from herbal medicine or dietary sources have played important roles in prevention and treatment of various diseases and have attracted more and more attention. Curcumin, extracted from the Curcumae Longae Rhizoma and widely used as food spice and coloring agent, has been proven to possess high pharmacological value. However, the pharmacological application of curcumin is limited due to its poor systemic bioavailability. As a major active metabolite of curcumin, tetrahydrocurcumin (THC) has higher bioavailability and stability than curcumin. Increasing evidence confirmed that THC had a wide range of biological activities and significant treatment effects on diseases. In this paper, we reviewed the research progress on the biological activities and therapeutic potential of THC on different diseases such as neurological disorders, metabolic syndromes, cancers, and inflammatory diseases. The extensive pharmacological effects of THC involve the modulation of various signaling transduction pathways including MAPK, JAK/STAT, NF-κB, Nrf2, PI3K/Akt/mTOR, AMPK, Wnt/β-catenin. In addition, the pharmacokinetics, drug combination and toxicology of THC were discussed, thus providing scientific basis for the safe application of THC and the development of its dietary supplements and drugs.
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Affiliation(s)
- Mengting Zhou
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Translational Chinese Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Quality Evaluation of Traditional Chinese Medicine, Sichuan Engineering Technology Research Center of Genuine Regional Drug, Sichuan Provincial Engineering Research Center of Formation Principle and Quality Evaluation of Genuine Medicinal Materials, Sichuan Institute for Translational Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, China.
| | - Rui Li
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Hua
- Translational Chinese Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Quality Evaluation of Traditional Chinese Medicine, Sichuan Engineering Technology Research Center of Genuine Regional Drug, Sichuan Provincial Engineering Research Center of Formation Principle and Quality Evaluation of Genuine Medicinal Materials, Sichuan Institute for Translational Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, China.
| | - Ying Dai
- Translational Chinese Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Quality Evaluation of Traditional Chinese Medicine, Sichuan Engineering Technology Research Center of Genuine Regional Drug, Sichuan Provincial Engineering Research Center of Formation Principle and Quality Evaluation of Genuine Medicinal Materials, Sichuan Institute for Translational Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, China.
| | - Zhujun Yin
- Translational Chinese Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Quality Evaluation of Traditional Chinese Medicine, Sichuan Engineering Technology Research Center of Genuine Regional Drug, Sichuan Provincial Engineering Research Center of Formation Principle and Quality Evaluation of Genuine Medicinal Materials, Sichuan Institute for Translational Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, China.
| | - Li Li
- Translational Chinese Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Quality Evaluation of Traditional Chinese Medicine, Sichuan Engineering Technology Research Center of Genuine Regional Drug, Sichuan Provincial Engineering Research Center of Formation Principle and Quality Evaluation of Genuine Medicinal Materials, Sichuan Institute for Translational Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, China.
| | - Jin Zeng
- Translational Chinese Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Quality Evaluation of Traditional Chinese Medicine, Sichuan Engineering Technology Research Center of Genuine Regional Drug, Sichuan Provincial Engineering Research Center of Formation Principle and Quality Evaluation of Genuine Medicinal Materials, Sichuan Institute for Translational Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, China.
| | - Mengni Yang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Translational Chinese Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Quality Evaluation of Traditional Chinese Medicine, Sichuan Engineering Technology Research Center of Genuine Regional Drug, Sichuan Provincial Engineering Research Center of Formation Principle and Quality Evaluation of Genuine Medicinal Materials, Sichuan Institute for Translational Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, China.
| | - Junning Zhao
- Translational Chinese Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Quality Evaluation of Traditional Chinese Medicine, Sichuan Engineering Technology Research Center of Genuine Regional Drug, Sichuan Provincial Engineering Research Center of Formation Principle and Quality Evaluation of Genuine Medicinal Materials, Sichuan Institute for Translational Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, China.
- National Key Laboratory of Drug Regulatory Science, National Medical Products Administration (NMPA), Beijing 100038, China.
| | - Ruirong Tan
- Translational Chinese Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Quality Evaluation of Traditional Chinese Medicine, Sichuan Engineering Technology Research Center of Genuine Regional Drug, Sichuan Provincial Engineering Research Center of Formation Principle and Quality Evaluation of Genuine Medicinal Materials, Sichuan Institute for Translational Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, China.
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Guo J, Li Z, Yao Y, Fang L, Yu M, Wang Z. Curcumin in the treatment of inflammation and oxidative stress responses in traumatic brain injury: a systematic review and meta-analysis. Front Neurol 2024; 15:1380353. [PMID: 38798711 PMCID: PMC11116723 DOI: 10.3389/fneur.2024.1380353] [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: 02/02/2024] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
Background and aim Traumatic brain injury (TBI), a leading cause of high morbidity and mortality, represents a significant global public health challenge. Currently, no effective treatment for TBI exists. Curcumin, an active compound extracted from the root of Curcuma longa, has demonstrated neuroprotective properties both in vitro and in vivo. Notably, it has shown potential in reducing oxidative stress and inflammation and enhancing redox balance. This paper conducts a systematic review and meta-analysis to explore curcumin's role in TBI animal models extensively. The findings offer valuable insights for future human clinical trials evaluating curcumin as a therapeutic supplement or nutraceutical in TBI management. Methods Comprehensive literature searches were conducted across MEDLINE, Embase, Cochrane, Web of Science, and Google Scholar databases. These searches aimed to identify relevant manuscripts in all languages, utilizing the keywords "curcumin" and "traumatic brain injury." Results The final quantitative analysis included 18 eligible articles corresponding to animal studies. The analysis revealed that curcumin significantly reduced inflammatory cytokines, including IL-1β (p = 0.000), IL-6 (p = 0.002), and TNF-α (p = 0.000), across various concentrations, time points, and administration routes. Additionally, curcumin markedly enhanced the activity of oxidative stress markers such as SOD (p = 0.000), Sir2 (p = 0.000), GPx (p = 0.000), and Nrf2 (p = 0.000), while reducing MDA (p = 0.000), 4-HNE (p = 0.001), and oxyprotein levels (p = 0.024). Furthermore, curcumin improved cerebral edema (p = 0.000) and upregulated neuroprotective factors like synapsin I (p = 0.019), BDNF (p = 0.000), and CREB (p = 0.000), without reducing mNSS (p = 0.144). About autophagy and apoptosis, curcumin increased the activity of Beclin-1 (p = 0.000) and Bcl-2 (p = 0.000), while decreasing caspase-3 (p = 0.000), the apoptosis index (p = 0.000), and P62 (p = 0.002). Conclusion Curcumin supplementation positively affects traumatic brain injury (TBI) by alleviating oxidative stress and inflammatory responses and promoting neuroprotection. It holds potential as a therapeutic agent for human TBI. However, this conclusion necessitates further substantiation through high-quality literature and additional randomized controlled trials (RCTs). Systematic Review Registration https://www.crd.york.ac.uk/prospero/. The registration number of PROSPERO: CRD42023452685.
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Affiliation(s)
- Jinfeng Guo
- The Nursing Department of Anhui College of Traditional Chinese Medicine, Wuhu, Anhui, China
| | - Zhengjie Li
- The Nursing Department of Anhui College of Traditional Chinese Medicine, Wuhu, Anhui, China
| | - Yun Yao
- The Nursing Department of Anhui College of Traditional Chinese Medicine, Wuhu, Anhui, China
| | - Lei Fang
- The Nursing Department of Anhui College of Traditional Chinese Medicine, Wuhu, Anhui, China
| | - Mingdi Yu
- The Nursing Department of Anhui College of Traditional Chinese Medicine, Wuhu, Anhui, China
| | - Zuhui Wang
- The Outpatient and Emergency Department of Wuhu Hospital of Traditional Chinese Medicine, Wuhu, Anhui, China
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Nattino G, Gamberini L, Brissy O, Carrara G, Chesnut R, Chiarini V, Chieregato A, Csomos A, Fleming JM, Gradisek P, Kaps R, Kyprianou T, Lazar I, Lemeshow S, Mikaszewska-Sokolewicz M, Paci G, Rossi C, Temkin N, Xirouchaki N, Giugni A, Bertolini G. Comparative Effectiveness of Intracranial Pressure Monitoring on 6-Month Outcomes of Critically Ill Patients With Traumatic Brain Injury. JAMA Netw Open 2023; 6:e2334214. [PMID: 37755832 PMCID: PMC10534270 DOI: 10.1001/jamanetworkopen.2023.34214] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/25/2023] [Indexed: 09/28/2023] Open
Abstract
Importance While the relationship between persistent elevations in intracranial pressure (ICP) and poorer outcomes is well established for patients with traumatic brain injury (TBI), there is no consensus on how ICP measurements should drive treatment choices, and the effectiveness of ICP monitoring remains unknown. Objective To evaluate the effectiveness of ICP monitoring on short- and mid-term outcomes of patients with TBI. Design, Setting, and Participants CREACTIVE was a prospective cohort study that started in March 2014 and lasted 5 years. More than 8000 patients with TBI were enrolled at 83 intensive care units (ICUs) from 7 countries who joined the CREACTIVE Consortium. Patients with TBI who met the Brain Trauma Foundation guidelines for ICP monitoring were selected for the current analyses, which were performed from January to November 2022. Exposure Patients who underwent ICP monitoring within 2 days of injury (exposure group) were propensity score-matched to patients who were not monitored or who underwent monitoring 2 days after the injury (control group). Main Outcome and Measure Functional disability at 6 months as indicated by Glasgow Outcome Scale-Extended (GOS-E) score. Results A total of 1448 patients from 43 ICUs in Italy and Hungary were eligible for analysis. Of the patients satisfying the ICP-monitoring guidelines, 503 (34.7%) underwent ICP monitoring (median [IQR] age: 45 years [29-61 years]; 392 males [77.9%], 111 females [22.1%]) and 945 were not monitored (median [IQR] age: 66 years [48-78 years]; 656 males [69.4%], 289 females [30.6%]). After matching to balance the variables, worse 6-month recovery was observed for monitored patients compared with nonmonitored patients (death/vegetative state: 39.2% vs 40.6%; severe disability: 33.2% vs 25.4%; moderate disability: 15.7% vs 14.9%; good recovery: 11.9% vs 19.1%, respectively; P = .005). Monitored patients received medical therapies significantly more frequently. Conclusions and Relevance In this cohort study, ICP monitoring was associated with poorer recovery and more frequent medical interventions with their relevant adverse effects. Optimizing the value of ICP monitoring for TBI requires further investigation on monitoring indications, clinical interventions, and management protocols.
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Affiliation(s)
- Giovanni Nattino
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Lorenzo Gamberini
- Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital, Bologna, Italy
| | - Obou Brissy
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Greta Carrara
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Randall Chesnut
- Department of Neurological Surgery and School of Global Health, University of Washington, Seattle
| | - Valentina Chiarini
- Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital, Bologna, Italy
| | - Arturo Chieregato
- Neurointensive Care Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Akos Csomos
- Hungarian Army Medical Center, Budapest, Hungary
| | - Joanne M. Fleming
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Primoz Gradisek
- Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rafael Kaps
- General Hospital Novo Mesto, Novo Mesto, Slovenia
| | - Theodoros Kyprianou
- University of Nicosia Medical School, Nicosia, Cyprus
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Isaac Lazar
- Pediatric Intensive Care Unit, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Stanley Lemeshow
- Division of Biostatistics, College of Public Health, Ohio State University, Columbus
| | | | - Giulia Paci
- Hospital Nursing Management, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | - Carlotta Rossi
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Nancy Temkin
- Department of Neurological Surgery and Department of Biostatistics, University of Washington, Seattle
| | | | - Aimone Giugni
- Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital, Bologna, Italy
| | - Guido Bertolini
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
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Little A, Byrne C, Coetzer R. The effectiveness of cognitive behaviour therapy for reducing anxiety symptoms following traumatic brain injury: A meta-analysis and systematic review. NeuroRehabilitation 2021; 48:67-82. [PMID: 33361617 DOI: 10.3233/nre-201544] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anxiety is a common neuropsychological sequela following traumatic brain injury (TBI). Cognitive Behaviour Therapy (CBT) is a recommended, first-line intervention for anxiety disorders in the non-TBI clinical population, however its effectiveness after TBI remains unclear and findings are inconsistent. OBJECTIVE There are no current meta-analyses exploring the efficacy of CBT as an intervention for anxiety symptoms following TBI, using controlled trials. The aim of the current study, therefore, was to systematically review and synthesize the evidence from controlled trials for the effectiveness of CBT for anxiety, specifically within the TBI population. METHOD Three electronic databases (Web of Science, PubMed and PsycInfo) were searched and a systematic review of intervention studies utilising CBT and anxiety related outcome measures in a TBI population was performed through searching three electronic databases. Studies were further evaluated for quality of evidence based on Reichow's (2011) quality appraisal tool. Baseline and outcome data were extracted from the 10 controlled trials that met the inclusion criteria, and effect sizes were calculated. RESULTS A random effects meta-analysis identified a small overall effect size (Cohen's d) of d = -0.26 (95%CI -0.41 to -0.11) of CBT interventions reducing anxiety symptoms following TBI. CONCLUSIONS This meta-analysis tentatively supports the view that CBT interventions may be effective in reducing anxiety symptoms in some patients following TBI, however the effect sizes are smaller than those reported for non-TBI clinical populations. Clinical implications and limitations of the current meta-analysis are discussed.
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Affiliation(s)
- Alice Little
- North Wales Clinical Psychology Programme, School of Psychology, Bangor University, UK
| | - Christopher Byrne
- North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, NHS Wales, UK.,School of Psychology, Bangor University, UK
| | - Rudi Coetzer
- North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, NHS Wales, UK.,School of Psychology, Bangor University, UK
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Mismatch between Tissue Partial Oxygen Pressure and Near-Infrared Spectroscopy Neuromonitoring of Tissue Respiration in Acute Brain Trauma: The Rationale for Implementing a Multimodal Monitoring Strategy. Int J Mol Sci 2021; 22:ijms22031122. [PMID: 33498736 PMCID: PMC7865258 DOI: 10.3390/ijms22031122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/21/2022] Open
Abstract
The brain tissue partial oxygen pressure (PbtO2) and near-infrared spectroscopy (NIRS) neuromonitoring are frequently compared in the management of acute moderate and severe traumatic brain injury patients; however, the relationship between their respective output parameters flows from the complex pathogenesis of tissue respiration after brain trauma. NIRS neuromonitoring overcomes certain limitations related to the heterogeneity of the pathology across the brain that cannot be adequately addressed by local-sample invasive neuromonitoring (e.g., PbtO2 neuromonitoring, microdialysis), and it allows clinicians to assess parameters that cannot otherwise be scanned. The anatomical co-registration of an NIRS signal with axial imaging (e.g., computerized tomography scan) enhances the optical signal, which can be changed by the anatomy of the lesions and the significance of the radiological assessment. These arguments led us to conclude that rather than aiming to substitute PbtO2 with tissue saturation, multiple types of NIRS should be included via multimodal systemic- and neuro-monitoring, whose values then are incorporated into biosignatures linked to patient status and prognosis. Discussion on the abnormalities in tissue respiration due to brain trauma and how they affect the PbtO2 and NIRS neuromonitoring is given.
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Intracranial pressure monitoring following traumatic brain injury: evaluation of indications, complications, and significance of follow-up imaging-an exploratory, retrospective study of consecutive patients at a level I trauma center. Eur J Trauma Emerg Surg 2020; 48:863-870. [PMID: 33351163 PMCID: PMC7754179 DOI: 10.1007/s00068-020-01570-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/02/2020] [Indexed: 12/04/2022]
Abstract
Background Measurement of intracranial pressure (ICP) is an essential part of clinical management of severe traumatic brain injury (TBI). However, clinical utility and impact on clinical outcome of ICP monitoring remain controversial. Follow-up imaging using cranial computed tomography (CCT) is commonly performed in these patients. This retrospective cohort study reports on complication rates of ICP measurement in severe TBI patients, as well as on findings and clinical consequences of follow-up CCT. Methods We performed a retrospective clinical chart review of severe TBI patients with invasive ICP measurement treated at an urban level I trauma center between January 2007 and September 2017. Results Clinical records of 213 patients were analyzed. The mean Glasgow Coma Scale (GCS) on admission was 6 with an intra-hospital mortality of 20.7%. Overall, complications in 12 patients (5.6%) related to the invasive ICP-measurement were recorded of which 5 necessitated surgical intervention. Follow-up CCT scans were performed in 192 patients (89.7%). Indications for follow-up CCTs included routine imaging without clinical deterioration (n = 137, 64.3%), and increased ICP values and/or clinical deterioration (n = 55, 25.8%). Follow-up imaging based on clinical deterioration and increased ICP values were associated with significantly increased likelihoods of worsening of CCT findings compared to routinely performed CCT scans with an odds ratio of 5.524 (95% CI 1.625–18.773) and 6.977 (95% CI 3.262–14.926), respectively. Readings of follow-up CCT imaging resulted in subsequent surgical intervention in six patients (3.1%). Conclusions Invasive ICP-monitoring in severe TBI patients was safe in our study population with an acceptable complication rate. We found a high number of follow-up CCT. Our results indicate that CCT imaging in patients with invasive ICP monitoring should only be considered in patients with elevated ICP values and/or clinical deterioration.
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Oliverio R, Karelina K, Weil ZM. Sex, Drugs, and TBI: The Role of Sex in Substance Abuse Related to Traumatic Brain Injuries. Front Neurol 2020; 11:546775. [PMID: 33192975 PMCID: PMC7604288 DOI: 10.3389/fneur.2020.546775] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022] Open
Abstract
Traumatic brain injuries (TBI) are a significant public health problem costing billions of dollars in healthcare costs and lost productivity while simultaneously reducing the quality of life for both patients and caregivers. Substance abuse is closely interconnected with TBI, as intoxicated individuals are at a greater risk of suffering brain injuries, and TBI may serve as a risk factor for the subsequent development of substance use disorders. There are also prominent sex differences in the etiology, epidemiology, and consequences of TBI. For instance, men are more likely to be injured on sporting fields or in auto accidents, while women are disproportionately likely to suffer TBI associated with intimate partner violence. Moreover, while men are much more likely to suffer TBI during late adolescence–young adulthood, sex differences in the incidence of TBI are much less prominent during other developmental epochs. Further, there are prominent sex differences in substance abuse biology; for example, while more men meet diagnostic criteria for substance abuse disorders, women tend to advance from casual use to addiction more quickly. In this paper, we will discuss the emerging clinical and preclinical evidence that these sex differences in TBI and substance abuse interact and may be prominent determinates of long-term outcomes.
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Affiliation(s)
- Robin Oliverio
- Department of Neuroscience and Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV, United States
| | - Kate Karelina
- Department of Neuroscience and Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV, United States
| | - Zachary M Weil
- Department of Neuroscience and Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV, United States
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Liao J, Yang H, Yu J, Liang X, Chen Z. Progress in the Application of Ultrasound Elastography for Brain Diseases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2093-2104. [PMID: 32385862 DOI: 10.1002/jum.15317] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/28/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
Ultrasound (US) can be used to evaluate the brain structure and nervous system damage. Patients with neurologic symptoms need rapid, noninvasive imaging with high spatial resolution and tissue contrast. Magnetic resonance imaging is currently the most sensitive and specific imaging method for evaluating neuropathologic conditions. This approach does present some challenges, such as the need to transport patients who may be seriously ill to the magnetic resonance imaging suite and the need for patients to remain for a considerable time. Cranial US provides a very valuable imaging method for clinicians, which can make a rapid diagnosis and evaluation without ionizing radiation. The main disadvantage of cranial US is its low sensitivity and specificity for subtle/early lesions. In recent years, with the rapid development of anatomic and functional US technology, the practicability of US diagnosis and intervention has been greatly improved. Ultrasound elastography may have the potential to improve the sensitivity and specificity of various cranial nerve conditions. Ultrasound elastography has received considerable critical attention, and an increasing number of studies have recognized its critical role in evaluating brain diseases. At present, US elastography has been applied to the evaluation of traumatic brain injury, ischemic stroke, intraoperative brain tumors, and hypoxic ischemic encephalopathy. The latest animal experiments and human clinical trial developments in the applications of US elastography for brain diseases are summarized in this review.
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Affiliation(s)
- Jianyi Liao
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huihui Yang
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jinsui Yu
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaowen Liang
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhiyi Chen
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Zhang J, Yi T, Cheng S, Zhang S. Glucagon-like peptide-1 receptor agonist Exendin-4 improves neurological outcomes by attenuating TBI- induced inflammatory responses and MAPK activation in rats. Int Immunopharmacol 2020; 86:106715. [PMID: 32570036 DOI: 10.1016/j.intimp.2020.106715] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/06/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022]
Abstract
Traumatic brain injury (TBI) can be exacerbated and prolonged for months or even years by chronic inflammatory processes with long-term consequences on neurodegeneration and neurological impairment. However, there are no clear pharmacological therapies of benefit to manage neurological dysfunctions, which, relating to the molecular mechanisms underlying the behavioral deficits after TBI, have yet to be fully identified. Recently, a glucagon-like peptide 1 (GLP-1) agonist, Exendin-4, was approved not only for the treatment of type 2 diabetes mellitus, but it also played a neurotrophic role in various CNS neurological diseases. In this study, we evaluated the neuroprotective effects of Exendin-4 on neurological outcome, cerebral blood flow, neurodegeneration, and inflammatory responses by utilizing a cortical contusion impact injury (CCI) model in rats. We found that TBI rats displayed neurological impairments, neurodegeneration, reduction of cerebral blood flow, and inflammatory responses, while Exendin-4 promoted neurological, cognitive, and cerebral blood flow recovery and attenuated neural degeneration and inflammatory cytokines after TBI. Furthermore, Exendin-4 treatment significantly diminished the TBI-induced overexpression of TNFα and IL-1β, as well as phosphorylation of p38 and ERK1/2. These data suggest a strong beneficial action of the glucagon-like peptide-1 receptor agonist Exendin-4 in improving neurological outcomes by attenuating inflammatory responses induced by traumatic brain injury, which is of therapeutic potential for TBI.
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Affiliation(s)
- Jun Zhang
- Graduate School of Tianjin Medical University, Tianjin 300070, China
| | - Tailong Yi
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Neurotrauma Repair of the Characteristic Medical Center of Chinese People's Armed Police Force (PAP), Tianjin 300162, China
| | - Shixiang Cheng
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Neurotrauma Repair of the Characteristic Medical Center of Chinese People's Armed Police Force (PAP), Tianjin 300162, China.
| | - Sai Zhang
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Neurotrauma Repair of the Characteristic Medical Center of Chinese People's Armed Police Force (PAP), Tianjin 300162, China.
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11
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Forouzanfar F, Read MI, Barreto GE, Sahebkar A. Neuroprotective effects of curcumin through autophagy modulation. IUBMB Life 2019; 72:652-664. [DOI: 10.1002/iub.2209] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Fatemeh Forouzanfar
- Neuroscience Research CenterMashhad University of Medical Sciences Mashhad Iran
- Department of Neuroscience, Faculty of MedicineMashhad University of Medical Sciences Mashhad Iran
| | - Morgayn I. Read
- Department of PharmacologySchool of Medical Sciences, University of Otago Dunedin New Zealand
| | - George E. Barreto
- Department of Biological SciencesUniversity of Limerick Limerick Ireland
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile Santiago Chile
| | - Amirhossein Sahebkar
- Halal Research Center of IRI, FDA Tehran Iran
- Biotechnology Research CenterPharmaceutical Technology Institute, Mashhad University of Medical Sciences Mashhad Iran
- Neurogenic Inflammation Research CenterMashhad University of Medical Sciences Mashhad Iran
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12
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Sheng C, Peng W, Xia Z, Wang Y. Plasma and cerebrospinal fluid pharmacokinetics of hydroxysafflor yellow A in patients with traumatic brain injury after intravenous administration of Xuebijing using LC-MS/MS method. Xenobiotica 2019; 50:545-551. [PMID: 31524030 DOI: 10.1080/00498254.2019.1668983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hydroxysafflor yellow A (HSYA) is the most pharmaceutically relevant compound in Xuebijing (XBJ) for traumatic brain injury (TBI) treatment. We aimed to investigate biofluids pharmacokinetics of HSYA from XBJ to ensure the drug safety and to guide the clinical use.A sensitive, rapid and reliable liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was applied to investigate pharmacokinetics of HSYA in TBI patients after intravenous administration of XBJ. Non-compartmental methods using DAS 3.0 software were applied to analyse the pharmacokinetic parameters.A similar half-life (Plasmat1/2: 14.55 ± 3.51 h vs. CSFt1/2: 15.73 ± 3.63) was observed. HSYA reached the peak level rapidly, but exhibited a strongly slow absorption phase from blood to cerebrospinal fluid (CSF, PlasmaTmax: 0.69 ± 0.26 h vs. CSFTmax: 4.0 ± 2.62 h). HSYA exhibited much higher Cmax (PlasmaCmax: 9342.76 ± 2489.23 μg/L vs. CSFCmax: 98.08 ± 14.51 μg/L) and AUC0-t (PlasmaAUC0-t: 57490.5 ± 5560.3 μg h/L vs. CSFAUC0-t: 1851.6 ± 269.1 μg h/L), yet a shorter CL (PlasmaCL: 0.02 ± 0.002 L/h/kg vs. CSFCL: 0.55 ± 0.01 L/h/kg) in plasma than in CSF. The AUCCSF/AUCplasma of HSYA was almost 3.37%.In summary, the results demonstrate that part of HSYA come across blood-brain barrier after XBJ administration. This study provides evidence for better understanding the pharmacokinetics and potential for clinical guidance of XBJ for TBI treatment.
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Affiliation(s)
- Chenxia Sheng
- Laboratory of Ethnopharmacology, Institute of Integrative Medicine, Xiangya Hospital, Central South University, Changsha, China.,Department of Traditional Chinese Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Weijun Peng
- Department of Traditional Chinese Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zian Xia
- Laboratory of Ethnopharmacology, Institute of Integrative Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Wang
- Laboratory of Ethnopharmacology, Institute of Integrative Medicine, Xiangya Hospital, Central South University, Changsha, China
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13
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Huang G, Cao X, Li Y, Zhou C, Li L, Wang K, Li H, Yu P, Jin Y, Gao L. Gene expression profile of the hippocampus of rats subjected to traumatic brain injury. J Cell Biochem 2019; 120:15776-15789. [PMID: 31074048 DOI: 10.1002/jcb.28848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Guo‐Hui Huang
- Department of Neurosurgery Shanghai Tenth People's Hospital, Tongji University School of Medicine Shanghai China
| | - Xiang‐Yuan Cao
- Department of Neurosurgery Shanghai Tenth People's Hospital, Tongji University School of Medicine Shanghai China
| | - Yuan‐Yuan Li
- Department of Endocrinology Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Cheng‐Cheng Zhou
- Department of Neurosurgery Shanghai Tenth People's Hospital, Tongji University School of Medicine Shanghai China
| | - Lei Li
- Department of Neurosurgery Shanghai Tenth People's Hospital, Tongji University School of Medicine Shanghai China
| | - Ke Wang
- Department of Neurosurgery Shanghai Tenth People's Hospital, Tongji University School of Medicine Shanghai China
| | - Hong Li
- Department of Neurosurgery Shanghai Tenth People's Hospital, Tongji University School of Medicine Shanghai China
| | - Peng Yu
- Department of Neurosurgery Shanghai Tenth People's Hospital, Tongji University School of Medicine Shanghai China
| | - Yi Jin
- Department of Neurosurgery Shanghai Tenth People's Hospital, Tongji University School of Medicine Shanghai China
| | - Liang Gao
- Department of Neurosurgery Shanghai Tenth People's Hospital, Tongji University School of Medicine Shanghai China
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14
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Dong HJ, Zhao ML, Li XH, Chen YS, Wang J, Chen MB, Wu S, Wang JJ, Liang HQ, Sun HT, Tu Y, Zhang S, Xiong J, Chen C. Hypothermia-Modulating Matrix Elasticity of Injured Brain Promoted Neural Lineage Specification of Mesenchymal Stem Cells. Neuroscience 2018; 377:1-11. [DOI: 10.1016/j.neuroscience.2018.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 12/15/2022]
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15
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Zhao ML, Chen SJ, Li XH, Wang LN, Chen F, Zhong SJ, Yang C, Sun SK, Li JJ, Dong HJ, Dong YQ, Wang Y, Chen C. Optical Depolarization of DCX-Expressing Cells Promoted Cognitive Recovery and Maturation of Newborn Neurons via the Wnt/β-Catenin Pathway. J Alzheimers Dis 2018; 63:303-318. [PMID: 29614674 DOI: 10.3233/jad-180002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Ming-Liang Zhao
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
| | - Shi-Jin Chen
- Department of Cardiology, Yichang Second People’s Hospital, Hubei, China
| | - Xiao-Hong Li
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
| | - Li-Na Wang
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
| | - Feng Chen
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
| | - Shi-Jiang Zhong
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
| | - Cheng Yang
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
| | - Sheng-Kai Sun
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
| | - Jian-Jun Li
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
| | - Hua-Jiang Dong
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
| | - Yue-Qing Dong
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
| | - Yi Wang
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
| | - Chong Chen
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
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Yang YJ, Chien WC, Chung CH, Hong KT, Yu YL, Hueng DY, Chen YH, Ma HI, Chang HA, Kao YC, Yeh HW, Tzeng NS. Risk of Erectile Dysfunction After Traumatic Brain Injury: A Nationwide Population-Based Cohort study in Taiwan. Am J Mens Health 2018; 12:913-925. [PMID: 29325484 PMCID: PMC6131467 DOI: 10.1177/1557988317750970] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introduction: In our study, we aimed to investigate the association between a traumatic
brain injury (TBI) and subsequent erectile dysfunction (ED). This is a
population-based study using the claims dataset from The National Health
Insurance Research Database. Methods: We included 72,642 patients with TBI aged over 20 years, retrospectively,
selected from the longitudinal health insurance database during 2000–2010,
according to the ICD-9-CM. The control group consisted of 217,872 patients
without TBI that were randomly chosen from the database at a ratio of 1:3,
with age- and index year matched. Cox proportional hazards analysis was used
to estimate the association between the TBI and subsequent ED. Results: After a 10-year follow-up, the incidence rate of ED was higher in the TBI
patients when compared with the non-TBI control group (24.66 and 19.07 per
100,000, respectively). Patients with TBI had a higher risk of developing ED
than the non-TBI cohort after the adjustment of the confounding factors,
such as age, comorbidity, residence of urbanization and locations, seasons,
level of care, and insured premiums (adjusted hazard ratio (HR) = 2.569, 95%
CI [1.890, 3.492], p < .001). Conclusion: This is the first study using a comprehensive nationwide database to analyze
the association of ED and TBI in the Asian population. After adjusted the
confounding factors, patients with TBI have a significantly higher risk of
developing ED, especially organic ED, than the general population. This
finding might remind clinicians that it’s crucial in early identification
and treatment of ED in post-TBI patients.
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Affiliation(s)
- Yun-Ju Yang
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wu-Chien Chien
- 2 Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,3 School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chi-Hsiang Chung
- 2 Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,3 School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.,4 Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC
| | - Kun-Ting Hong
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yi-Lin Yu
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Dueng-Yuan Hueng
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yuan-Hao Chen
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsin-I Ma
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsin-An Chang
- 5 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,6 Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yu-Chen Kao
- 5 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,7 Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hui-Wen Yeh
- 5 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,8 Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsin-Chu, Taiwan, ROC.,9 Department of Nursing, Tri-Service General Hospital, and School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC.,10 Department of Nursing, Kang Ning University (Taipei Campus), Taipei, Taiwan, ROC
| | - Nian-Sheng Tzeng
- 5 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,6 Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC
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17
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Tapper J, Skrifvars MB, Kivisaari R, Siironen J, Raj R. Primary decompressive craniectomy is associated with worse neurological outcome in patients with traumatic brain injury requiring acute surgery. Surg Neurol Int 2017; 8:141. [PMID: 28781918 PMCID: PMC5523471 DOI: 10.4103/sni.sni_453_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/06/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The role of decompressive craniectomy in treating raised intracranial pressure (ICP) after traumatic brain injuries (TBI) is controversial. The aim of this study was to assess the differences in prognosis of patients initially treated by decompressive craniectomy, craniotomy, or conservatively. METHODS We conducted a single-center retrospective study on adult blunt TBI patients admitted to a neurosurgical intensive care unit during 2009-2012. Patients were divided into three groups based on their initial treatment - decompressive craniectomy, craniotomy, and conservative. Primary outcome was 6-month Glasgow Outcome Scale (GOS) dichotomized to favorable outcome (independent) and unfavorable outcome (dependent). The association between initial treatment and outcome was assessed using a logistic regression model adjusting for case-mix using known predictors of outcome. RESULTS Of the 822 included patients, 58 patients were in the craniectomy group, 401 patients in the craniotomy group, and 363 patients in the conservatively treated group. Overall, 6-month unfavorable outcome was 48%. After adjusting for case-mix, patients in the decompressive craniectomy group had a statistical significantly higher risk for poor neurological outcome compared to patients in the conservative group (OR 3.06, 95% CI 1.45-6.42) and craniotomy group (OR 3.61, 95% CI 1.74-7.51). CONCLUSION In conclusion, patients requiring primary decompressive craniectomy had a higher risk for poor neurological outcome compared to patients undergoing craniotomy or were conservatively treated. It is plausible that the poor prognosis is related to the TBI severity itself rather than the intervention. Further prospective randomized trials are required to establish the role of decompressive craniectomy in the treatment of patients with TBI.
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Affiliation(s)
- Julius Tapper
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Markus B. Skrifvars
- Department of Anesthesiology, Intensive Care and Pain Medicine, Division of Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Australian and New Zealand Intensive Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jari Siironen
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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18
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Establishment of an ideal time window model in hypothermic-targeted temperature management after traumatic brain injury in rats. Brain Res 2017. [PMID: 28629741 DOI: 10.1016/j.brainres.2017.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although hypothermic-targeted temperature management (HTTM) holds great potential for the treatment of traumatic brain injury (TBI), translation of the efficacy of hypothermia from animal models to TBI patientshas no entire consistency. This study aimed to find an ideal time window model in experimental rats which was more in accordance with clinical practice through the delayed HTTM intervention. Sprague-Dawley rats were subjected to unilateral cortical contusion injury and received therapeutic hypothermia at 15mins, 2 h, 4 h respectively after TBI. The neurological function was evaluated with the modified neurological severity score and Morris water maze test. The brain edema and morphological changes were measured with the water content and H&E staining. Brain sections were immunostained with antibodies against DCX (a neuroblast marker) and GFAP (an astrocyte marker). The apoptosis levels in the ipsilateral hippocampi and cortex were examined with antibodies against the apoptotic proteins Bcl-2, Bax, and cleaved caspase-3 by the immunofluorescence and western blotting. The results indicated that each hypothermia therapy group could improve neurobehavioral and cognitive function, alleviate brain edema and reduce inflammation. Furthermore, we observed that therapeutic hypothermia increased DCX expression, decreased GFAP expression, upregulated Bcl-2 expression and downregulated Bax and cleaved Caspase-3 expression. The above results suggested that HTTM at 2h or even at 4h post-injury revealed beneficial brain protection similarly, despite the best effect at 15min post-injury. These findings may provide relatively ideal time window models, further making the following experimental results more credible and persuasive.
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19
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Faried A, Bachani AM, Sendjaja AN, Hung YW, Arifin MZ. Characteristics of Moderate and Severe Traumatic Brain Injury of Motorcycle Crashes in Bandung, Indonesia. World Neurosurg 2017; 100:195-200. [DOI: 10.1016/j.wneu.2016.12.133] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 11/25/2022]
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20
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Gao Y, Li J, Wu L, Zhou C, Wang Q, Li X, Zhou M, Wang H. Tetrahydrocurcumin provides neuroprotection in rats after traumatic brain injury: autophagy and the PI3K/AKT pathways as a potential mechanism. J Surg Res 2016; 206:67-76. [PMID: 27916377 DOI: 10.1016/j.jss.2016.07.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 06/30/2016] [Accepted: 07/07/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tetrahydrocurcumin provides neuroprotection in multiple neurologic disorders by modulating oxidative stress, inflammatory responses, and autophagy. However, in traumatic brain injury (TBI), it is unclear whether a beneficial effect of tetrahydrocurcumin exists. In this study, we hypothesized that administration of tetrahydrocurcumin provides neuroprotection in a rat model of TBI. MATERIAL AND METHODS Behavioral studies were performed by recording and analyzing beam-walking scores. The role of tetrahydrocurcumin on neurons death was assessed via Nissl staining. We then performed Western blot analyses, terminal deoxynucleotidyl transferase 2'-deoxyuridine-5'-triphosphate (dUTP) nick end labeling assays and immunofluorescence staining to evaluate autophagy and apoptosis. Phospho-protein kinase B (p-AKT) was also assessed via Western blotting. RESULTS Our data indicated that administration of tetrahydrocurcumin alleviated brain edema, attenuated TBI-induced neuron cell death, decreased the degree of apoptosis and improved neurobehavioral function, which were accompanied by enhanced autophagy and phospho-AKT after TBI. Moreover, the autophagy inhibitor 3-methyladenine and the PI3K kinase inhibitor LY294002 partially reversed the neuroprotection of tetrahydrocurcumin after TBI. CONCLUSIONS This study indicates that tetrahydrocurcumin protects neurons from TBI-induced apoptotic neuronal death, which may be through modulation autophagy and PI3K/AKT pathways. Thus, tetrahydrocurcumin may be an attractive therapeutic agent for TBI.
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Affiliation(s)
- Yongyue Gao
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Jie Li
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China.
| | - Lingyun Wu
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Chenhui Zhou
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Qiang Wang
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Xiang Li
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Mengliang Zhou
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Handong Wang
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China.
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21
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Recent imaging advances in neurology. J Neurol 2015; 262:2182-94. [PMID: 25808503 DOI: 10.1007/s00415-015-7711-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 01/08/2023]
Abstract
Over the recent years, the application of neuroimaging techniques such as magnetic resonance imaging (MRI) and positron emission tomography (PET) has considerably advanced the understanding of complex neurological disorders. PET is a powerful molecular imaging tool, which investigates the distribution and binding of radiochemicals attached to biologically relevant molecules; as such, this technique is able to give information on biochemistry and metabolism of the brain in health and disease. MRI uses high intensity magnetic fields and radiofrequency pulses to provide structural and functional information on tissues and organs in intact or diseased individuals, including the evaluation of white matter integrity, grey matter thickness and brain perfusion. The aim of this article is to review the most recent advances in neuroimaging research in common neurological disorders such as movement disorders, dementia, epilepsy, traumatic brain injury and multiple sclerosis, and to evaluate their contribution in the diagnosis and management of patients.
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22
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Calikoglu C, Aytekin H, Akgül O, Akgül MH, Gezen AF, Akyuz F, Cakir M. Effect of pregabalin in preventing secondary damage in traumatic brain injury: an experimental study. Med Sci Monit 2015; 21:813-20. [PMID: 25785578 PMCID: PMC4374647 DOI: 10.12659/msm.893887] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background In this study we aimed to explore the effects of pregabalin on a traumatic brain injury model in rats. Material/Methods This study included 40 adult male Sprague-Dawley rats randomized into 4 groups, each of which contained equal numbers of animals. The control group had no head trauma and thus was not treated. The trauma group had head trauma but was not treated. The pregabalin group had no head trauma but was treated by pregabalin. The trauma + pregabalin group had head trauma treated with pregabalin. The biopsy samples taken from the study animals were histopathologically examined for the presence of edema, inflammation, and neuronal damage. Results All animals in the trauma group had edema, inflammation, and neuronal damage. Four subjects in the control group, 6 in the pregabalin group, and 4 in the trauma + pregabalin group had edema; inflammation was present in 1 subject in the control group, 3 subjects in the pregabalin group, and 3 subjects in the trauma + pregabalin group; neuronal damage existed in 1 subject in the control group, 1 subject in the pregabalin group, and 6 subjects in the trauma + pregabalin group. The trauma group had significantly higher edema and neuronal damage scores than the other groups. Similarly, inflammation was significantly more prevalent in the trauma group than the control and trauma + pregabalin groups. Conclusions The results of the present study indicated anti-edema, anti-inflammatory, and neuroprotective effects of pregabalin in an experimental head trauma model in rats. Pregabalin may thus be beneficial in humans with acute TBI by relieving concomitant edema and inflammation.
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Affiliation(s)
- Cagatay Calikoglu
- Department of Neurosurgery, Atatürk University, Faculty of Medicine, Erzurum, Turkey
| | - Hikmet Aytekin
- Department of Neurosurgery, Private Anadolu Hostpital, Zonguldak, Turkey
| | - Osman Akgül
- Department of Neurosurgery, Düzce State Hospital, Düzce, Turkey
| | | | | | | | - Murteza Cakir
- Department of Neurosurgery, Atatürk University, Faculty of Medicine, Erzurum, Turkey
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Zhang ZY, Zhang LX, Dong XQ, Yu WH, Du Q, Yang DB, Shen YF, Wang H, Zhu Q, Che ZH, Liu QJ, Jiang L, Du YF. Comparison of the performances of copeptin and multiple biomarkers in long-term prognosis of severe traumatic brain injury. Peptides 2014; 60:13-7. [PMID: 25076464 DOI: 10.1016/j.peptides.2014.07.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 07/18/2014] [Accepted: 07/18/2014] [Indexed: 01/17/2023]
Abstract
Enhanced blood levels of copeptin correlate with poor clinical outcomes after acute critical illness. This study aimed to compare the prognostic performances of plasma concentrations of copeptin and other biomarkers like myelin basic protein, glial fibrillary astrocyte protein, S100B, neuron-specific enolase, phosphorylated axonal neurofilament subunit H, Tau and ubiquitin carboxyl-terminal hydrolase L1 in severe traumatic brain injury. We recruited 102 healthy controls and 102 acute patients with severe traumatic brain injury. Plasma concentrations of these biomarkers were determined using enzyme-linked immunosorbent assay. Their prognostic predictive performances of 6-month mortality and unfavorable outcome (Glasgow Outcome Scale score of 1-3) were compared. Plasma concentrations of these biomarkers were statistically significantly higher in all patients than in healthy controls, in non-survivors than in survivors and in patients with unfavorable outcome than with favorable outcome. Areas under receiver operating characteristic curves of plasma concentrations of these biomarkers were similar to those of Glasgow Coma Scale score for prognostic prediction. Except plasma copeptin concentration, other biomarkers concentrations in plasma did not statistically significantly improve prognostic predictive value of Glasgow Coma Scale score. Copeptin levels may be a useful tool to predict long-term clinical outcomes after severe traumatic brain injury and have a potential to assist clinicians.
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Affiliation(s)
- Zu-Yong Zhang
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Li-Xin Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, China
| | - Xiao-Qiao Dong
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China.
| | - Wen-Hua Yu
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Quan Du
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Ding-Bo Yang
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Yong-Feng Shen
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Hao Wang
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Qiang Zhu
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Zhi-Hao Che
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Qun-Jie Liu
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Li Jiang
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Yuan-Feng Du
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
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Yang DB, Yu WH, Dong XQ, Du Q, Shen YF, Zhang ZY, Zhu Q, Che ZH, Liu QJ, Wang H, Jiang L, Du YF. Plasma copeptin level predicts acute traumatic coagulopathy and progressive hemorrhagic injury after traumatic brain injury. Peptides 2014; 58:26-9. [PMID: 24905622 DOI: 10.1016/j.peptides.2014.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 05/27/2014] [Accepted: 05/27/2014] [Indexed: 01/13/2023]
Abstract
Higher plasma copeptin levels correlate with poor clinical outcomes after traumatic brain injury. Nevertheless, their links with acute traumatic coagulopathy and progressive hemorrhagic injury are unknown. Therefore, we aimed to investigate the relationship between plasma copeptin levels, acute traumatic coagulopathy and progressive hemorrhagic injury in patients with severe traumatic brain injury. We prospectively studied 100 consecutive patients presenting within 6h from head trauma. Progressive hemorrhagic injury was present when the follow-up computerized tomography scan reported any increase in size or number of the hemorrhagic lesion, including newly developed ones. Acute traumatic coagulopathy was defined as an activated partial thromboplastic time greater than 40s and/or international normalized ratio greater than 1.2 and/or a platelet count less than 120×10(9)/L. We measured plasma copeptin levels on admission using an enzyme-linked immunosorbent assay in a blinded fashion. In multivariate logistic regression analysis, plasma copeptin level emerged as an independent predictor of progressive hemorrhagic injury and acute traumatic coagulopathy. Using receiver operating characteristic curves, we calculated areas under the curve for progressive hemorrhagic injury and acute traumatic coagulopathy. The predictive performance of copeptin was similar to that of Glasgow Coma Scale score. However, copeptin did not obviously improve the predictive value of Glasgow Coma Scale score. Thus, copeptin may help in the prediction of progressive hemorrhagic injury and acute traumatic coagulopathy after traumatic brain injury.
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Affiliation(s)
- Ding-Bo Yang
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Wen-Hua Yu
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Xiao-Qiao Dong
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China.
| | - Quan Du
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Yong-Feng Shen
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Zu-Yong Zhang
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Qiang Zhu
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Zhi-Hao Che
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Qun-Jie Liu
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Hao Wang
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Li Jiang
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
| | - Yuan-Feng Du
- Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China
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