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Harris S, Bowren M, Anderson SW, Tranel D. Does brain damage caused by stroke versus trauma have different neuropsychological outcomes? A lesion-matched multiple case study. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:428-442. [PMID: 35130098 PMCID: PMC9631467 DOI: 10.1080/23279095.2022.2033242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Traumatic brain injury (TBI) and stroke both have the potential to cause significant damage to the brain, with resultant neuropsychological impairments. How these different mechanisms of injury influence cognitive and behavioral changes associated with brain damage, however, is not well understood. Moreover, previous research directly comparing TBI and stroke has not accounted carefully for lesion location and size. Here, using a detailed lesion-matching approach that was used previously to compare neuropsychological outcomes in stroke versus tumor, we compared the neuropsychological profiles of 14 patients with focal lesions caused by TBI to those of 27 lesion-matched patients with stroke. Each patient with TBI was matched to two patients with stroke, based on lesion location and size (except 1 TBI case where only 1 stroke match was available). Demographic attributes (age, gender, handedness, education) were also matched in the TBI: stroke triplets, as much as possible. The patients with TBI versus stroke had similar performances across all cognitive and behavioral measures, with no significant or clinically meaningful differences. A supplemental analysis on developmental- versus adult-onset TBI cases (with their respective stroke matches) also yielded non-significant results, with TBI and stroke groups being statistically indistinguishable. Our results suggest that focal lesions caused by TBI versus stroke have similar neuropsychological outcomes in the chronic recovery phase, when location and size of lesion are comparable across TBI versus stroke mechanisms of injury.
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Affiliation(s)
- Shana Harris
- Departments of Neurology (Division of Neuropsychology and Cognitive Neuroscience) and Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Mark Bowren
- Departments of Neurology (Division of Neuropsychology and Cognitive Neuroscience) and Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Steven W Anderson
- Departments of Neurology (Division of Neuropsychology and Cognitive Neuroscience) and Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Daniel Tranel
- Departments of Neurology (Division of Neuropsychology and Cognitive Neuroscience) and Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
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Arora K, Vats V, Kaushik N, Sindhawani D, Saini V, Arora DM, Kumar Y, Vashisht E, Singh G, Verma PK. A Systematic Review on Traumatic Brain Injury Pathophysiology and Role of Herbal Medicines in its Management. Curr Neuropharmacol 2023; 21:2487-2504. [PMID: 36703580 PMCID: PMC10616914 DOI: 10.2174/1570159x21666230126151208] [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: 09/02/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a worldwide problem. Almost about sixtynine million people sustain TBI each year all over the world. Repetitive TBI linked with increased risk of neurodegenerative disorder such as Parkinson, Alzheimer, traumatic encephalopathy. TBI is characterized by primary and secondary injury and exerts a severe impact on cognitive, behavioral, psychological and other health problem. There were various proposed mechanism to understand complex pathophysiology of TBI but still there is a need to explore more about TBI pathophysiology. There are drugs present for the treatment of TBI in the market but there is still need of more drugs to develop for better and effective treatment of TBI, because no single drug is available which reduces the further progression of this injury. OBJECTIVE The main aim and objective of structuring this manuscript is to design, develop and gather detailed data regarding about the pathophysiology of TBI and role of medicinal plants in its treatment. METHOD This study is a systematic review conducted between January 1995 to June 2021 in which a consultation of scientific articles from indexed periodicals was carried out in Science Direct, United States National Library of Medicine (Pubmed), Google Scholar, Elsvier, Springer and Bentham. RESULTS A total of 54 studies were analyzed, on the basis of literature survey in the research area of TBI. CONCLUSION Recent studies have shown the potential of medicinal plants and their chemical constituents against TBI therefore, this review targets the detailed information about the pathophysiology of TBI and role of medicinal plants in its treatment.
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Affiliation(s)
- Kaushal Arora
- Department of Pharmaceutical Sciences Maharshi Dayanand University, Rohtak, Haryana, 124001, India
| | - Vishal Vats
- Department of Pharmaceutical Sciences Maharshi Dayanand University, Rohtak, Haryana, 124001, India
| | - Nalin Kaushik
- Department of Pharmaceutical Sciences, Chaudhary Bansi Lal University, Bhiwani, Haryana, 127031, India
| | - Deepanshu Sindhawani
- Department of Pharmaceutical Sciences Maharshi Dayanand University, Rohtak, Haryana, 124001, India
| | - Vaishali Saini
- Department of Pharmaceutical Sciences Maharshi Dayanand University, Rohtak, Haryana, 124001, India
| | - Divy Mohan Arora
- Department of Pharmaceutical Sciences Guru Jambheshwar University of Science & Technology, Hisar, Haryana, 125001, India
| | - Yogesh Kumar
- Sat Priya College of Pharmacy, Rohtak, Haryana, 124001, India
| | - Etash Vashisht
- Department of Pharmaceutical Sciences Maharshi Dayanand University, Rohtak, Haryana, 124001, India
| | - Govind Singh
- Department of Pharmaceutical Sciences Maharshi Dayanand University, Rohtak, Haryana, 124001, India
| | - Prabhakar Kumar Verma
- Department of Pharmaceutical Sciences Maharshi Dayanand University, Rohtak, Haryana, 124001, India
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Caliendo ET, Kim N, Edasery D, Askin G, Nowak S, Gerber LM, Baum KT, Blackwell LS, Koterba CH, Hoskinson KR, Kurowski BG, McLaughlin M, Tlustos SJ, Watson WD, Niogi SN, Suskauer SJ, Shah SA. Acute Imaging Findings Predict Recovery of Cognitive and Motor Function after Inpatient Rehabilitation for Pediatric Traumatic Brain Injury: A Pediatric Brain Injury Consortium Study. J Neurotrauma 2021; 38:1961-1968. [PMID: 33504256 PMCID: PMC8418527 DOI: 10.1089/neu.2020.7437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children; survivors experience long-term cognitive and motor deficits. To date, studies predicting outcome following pediatric TBI have primarily focused on acute behavioral responses and proxy measures of injury severity; unsurprisingly, these measures explain very little of the variance following heterogenous injury. In adults, certain acute imaging biomarkers help predict cognitive and motor recovery following moderate to severe TBI. This multi-center, retrospective study, characterizes the day-of-injury computed tomographic (CT) reports of pediatric, adolescent, and young adult patients (2 months to 21 years old) who received inpatient rehabilitation services for TBI (n = 247). The study also determines the prognostic utility of CT findings for cognitive and motor outcomes assessed by the Pediatric Functional Independence Measure, converted to age-appropriate developmental functional quotient (DFQ), at discharge from rehabilitation. Subdural hematomas (66%), contusions (63%), and subarachnoid hemorrhages (59%) were the most common lesions; the majority of subjects had less severe Rotterdam CT scores (88%, ≤ 3). After controlling for age, gender, mechanism of injury, length of acute hospital stay, and admission DFQ in multivariate regression analyses, the highest Rotterdam score (β = -25.2, p < 0.01) and complete cisternal effacement (β = -19.4, p < 0.05) were associated with lower motor DFQ, and intraventricular hemorrhage was associated with lower motor (β = -3.7, p < 0.05) and cognitive DFQ (β = -4.9, p < 0.05). These results suggest that direct detection of intracranial injury provides valuable information to aid in prediction of recovery after pediatric TBI, and needs to be accounted for in future studies of prognosis and intervention.
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Affiliation(s)
| | - Nayoung Kim
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York, USA
- Blythedale Children's Hospital, Valhalla, New York, USA
| | - David Edasery
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Gulce Askin
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Sophie Nowak
- Blythedale Children's Hospital, Valhalla, New York, USA
| | - Linda M. Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Katherine T. Baum
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Laura S. Blackwell
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Christine H. Koterba
- Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kristen R. Hoskinson
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brad G. Kurowski
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Matthew McLaughlin
- Division of Pediatric Rehabilitation Medicine, Children's Mercy, Kansas City, Missouri, USA
- University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Sarah J. Tlustos
- Department of Rehabilitation, Children's Hospital Colorado and Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - William D. Watson
- Blythedale Children's Hospital, Valhalla, New York, USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Sumit N. Niogi
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Stacy J. Suskauer
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Departments of Physical Medicine & Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sudhin A. Shah
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York, USA
- Blythedale Children's Hospital, Valhalla, New York, USA
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Montivero AJ, Ghersi MS, Silvero C MJ, Artur de la Villarmois E, Catalan-Figueroa J, Herrera M, Becerra MC, Hereñú CB, Pérez MF. Early IGF-1 Gene Therapy Prevented Oxidative Stress and Cognitive Deficits Induced by Traumatic Brain Injury. Front Pharmacol 2021; 12:672392. [PMID: 34234671 PMCID: PMC8255687 DOI: 10.3389/fphar.2021.672392] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022] Open
Abstract
Traumatic Brain Injury (TBI) remains a leading cause of morbidity and mortality in adults under 40 years old. Once primary injury occurs after TBI, neuroinflammation and oxidative stress (OS) are triggered, contributing to the development of many TBI-induced neurological deficits, and reducing the probability of critical trauma patients´ survival. Regardless the research investment on the development of anti-inflammatory and neuroprotective treatments, most pre-clinical studies have failed to report significant effects, probably because of the limited blood brain barrier permeability of no-steroidal or steroidal anti-inflammatory drugs. Lately, neurotrophic factors, such as the insulin-like growth factor 1 (IGF-1), are considered attractive therapeutic alternatives for diverse neurological pathologies, as they are neuromodulators linked to neuroprotection and anti-inflammatory effects. Considering this background, the aim of the present investigation is to test early IGF-1 gene therapy in both OS markers and cognitive deficits induced by TBI. Male Wistar rats were injected via Cisterna Magna with recombinant adenoviral vectors containing the IGF-1 gene cDNA 15 min post-TBI. Animals were sacrificed after 60 min, 24 h or 7 days to study the advanced oxidation protein products (AOPP) and malondialdehyde (MDA) levels, to recognize the protein oxidation damage and lipid peroxidation respectively, in the TBI neighboring brain areas. Cognitive deficits were assessed by evaluating working memory 7 days after TBI. The results reported significant increases of AOPP and MDA levels at 60 min, 24 h, and 7 days after TBI in the prefrontal cortex, motor cortex and hippocampus. In addition, at day 7, TBI also reduced working memory performance. Interestingly, AOPP, and MDA levels in the studied brain areas were significantly reduced after IGF-1 gene therapy that in turn prevented cognitive deficits, restoring TBI-animals working memory performance to similar values regarding control. In conclusion, early IGF-1 gene therapy could be considered a novel therapeutic approach to targeting neuroinflammation as well as to preventing some behavioral deficits related to TBI.
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Affiliation(s)
- Agustín J Montivero
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de, Córdoba, Argentina
| | - Marisa S Ghersi
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de, Córdoba, Argentina
| | - M Jazmín Silvero C
- Instituto Multidisciplinario de Biología Vegetal (IMBIV-CONICET), Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de, Córdoba, Argentina
| | - Emilce Artur de la Villarmois
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de, Córdoba, Argentina
| | - Johanna Catalan-Figueroa
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de, Córdoba, Argentina.,Escuela de Química y Farmacia, Facultad de Medicina, Universidad Católica del Maule, Talca, Chile
| | - Macarena Herrera
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de, Córdoba, Argentina
| | - María Cecilia Becerra
- Instituto Multidisciplinario de Biología Vegetal (IMBIV-CONICET), Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de, Córdoba, Argentina
| | - Claudia B Hereñú
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de, Córdoba, Argentina
| | - Mariela F Pérez
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de, Córdoba, Argentina
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Juliano AC, Lequerica AH, Marino C, Marchetta C, DeLuca J. Inpatient length of stay moderates the relationship between payer source and functional outcomes in pediatric brain injury. Brain Inj 2020; 34:1395-1400. [PMID: 32755417 DOI: 10.1080/02699052.2020.1802666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the extent to which race/ethnicity, length of rehabilitation hospital stay (LOS), and payer source contribute to functional status following inpatient rehabilitation in children with acquired brain injury (ABI). DESIGN Retrospective cohort study from a pediatric rehabilitation hospital including 485 individuals with ABI. METHODS Functional Independence Measure for Children (WeeFIM) scores were transformed into age-corrected Developmental Functional Quotients (DFQ) to examine the effects of race/ethnicity, LOS, and payer source (public insurance vs. private) on functional outcomes while controlling for year of admission, admission DFQ, time to rehabilitation, age, and brain injury aetiology. RESULTS Discharge DFQ scores tended to be lower for children with public insurance as well as those with longer LOS. There was no main effect of race/ethnicity, but a significant interaction effect for payer source×LOS (p < .001) was found. Further breakdown of the interaction showed lower discharge DFQ scores for children with public insurance primarily when LOS exceeded 28 days (p = .001). CONCLUSION Children with ABI who have both public insurance and LOS beyond 4 weeks tend to have poorer functional outcomes after inpatient rehabilitation. Because all children were receiving services at the same facility, payer source may be functioning as a proxy for other sociodemographic factors.
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Affiliation(s)
- Anthony C Juliano
- Center for Neuroscience and Neuropsychology Research, Kessler Foundation , West Orange, New Jersey, USA.,Children's Specialized Hospital Research Center , New Brunswick, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School , Newark, New Jersey, USA
| | - Anthony H Lequerica
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School , Newark, New Jersey, USA.,Center for Traumatic Brain Injury Research, Kessler Foundation , West Orange, New Jersey, USA
| | - Cherylynn Marino
- Center for Neuroscience and Neuropsychology Research, Kessler Foundation , West Orange, New Jersey, USA.,Children's Specialized Hospital Research Center , New Brunswick, New Jersey, USA
| | - Claire Marchetta
- Children's Specialized Hospital Research Center , New Brunswick, New Jersey, USA
| | - John DeLuca
- Center for Neuroscience and Neuropsychology Research, Kessler Foundation , West Orange, New Jersey, USA.,Children's Specialized Hospital Research Center , New Brunswick, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School , Newark, New Jersey, USA.,Department of Neurology, Rutgers University, New Jersey Medical School , Newark, New Jersey, USA
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Dornbos D, Monson C, Look A, Huntoon K, Smith LGF, Leonard JR, Dhall SS, Sribnick EA. Validation of the Surgical Intervention for Traumatic Injury scale in the pediatric population. J Neurosurg Pediatr 2020; 26:92-97. [PMID: 32276255 DOI: 10.3171/2020.2.peds19474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 02/05/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While the Glasgow Coma Scale (GCS) has been effective in describing severity in traumatic brain injury (TBI), there is no current method for communicating the possible need for surgical intervention. This study utilizes a recently developed scoring system, the Surgical Intervention for Traumatic Injury (SITI) scale, which was developed to efficiently communicate the potential need for surgical decompression in adult patients with TBI. The objective of this study was to apply the SITI scale to a pediatric population to provide a tool to increase communication of possible surgical urgency. METHODS The SITI scale uses both radiographic and clinical findings, including the GCS score on presentation, pupillary examination, and CT findings. To examine the scale in pediatric TBI, a neurotrauma database at a level 1 pediatric trauma center was retrospectively evaluated, and the SITI score for all patients with an admission diagnosis of TBI between 2010 and 2015 was calculated. The primary endpoint was operative intervention, defined as a craniotomy or craniectomy for decompression, performed within the first 24 hours of admission. RESULTS A total of 1524 patients met inclusion criteria for the study during the 5-year span: 1469 (96.4%) were managed nonoperatively and 55 (3.6%) patients underwent emergent operative intervention. The mean SITI score was 4.98 ± 0.31 for patients undergoing surgical intervention and 0.41 ± 0.02 for patients treated nonoperatively (p < 0.0001). The area under the receiver operating characteristic (AUROC) curve was used to examine the diagnostic accuracy of the SITI scale in this pediatric population and was found to be 0.98. Further evaluation of patients presenting with moderate to severe TBI revealed a mean SITI score of 5.51 ± 0.31 in 40 (15.3%) operative patients and 1.55 ± 0.02 in 221 (84.7%) nonoperative patients, with an AUROC curve of 0.95. CONCLUSIONS The SITI scale was designed to be a simple, objective communication tool regarding the potential need for surgical decompression after TBI. Application of this scale to a pediatric population reveals that the score correlated with the perceived need for emergent surgical intervention, further suggesting its potential utility in clinical practice.
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Affiliation(s)
- David Dornbos
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- 2Department of Neurological Surgery, University of Tennessee Health Science Center and Semmes Murphey Clinic, Memphis, Tennessee
| | | | - Andrew Look
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kristin Huntoon
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Luke G F Smith
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey R Leonard
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- 3Division of Pediatric Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio; and
| | - Sanjay S Dhall
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | - Eric A Sribnick
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- 3Division of Pediatric Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio; and
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Pavlova V, Filipova E, Uzunova K, Kalinov K, Vekov T. Pioglitazone Therapy and Fractures: Systematic Review and Meta- Analysis. Endocr Metab Immune Disord Drug Targets 2019; 18:502-507. [PMID: 29683100 DOI: 10.2174/1871530318666180423121833] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/22/2018] [Accepted: 04/03/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Thiazolidinediones are a group of synthetic medications used in type 2 diabetes treatment. Among available thiazolidinediones, pioglitazone is gaining increased attention due to its lower cardiovascular risk in type 2 diabetes mellitus sufferers and seems a promising future therapy. Accumulating evidence suggests that diabetic patients may exert bone fractures due to such treatments. Simultaneously, the female population is thought to be at greater risk. Still, the safety outcomes of pioglitazone treatment especially in terms of fractures are questionable and need to be clarified. METHODS We searched MEDLINE, Scopus, PsyInfo, eLIBRARY.ru electronic databases and clinical trial registries for studies reporting an association between pioglitazone and bone fractures in type 2 diabetes mellitus patients published before Feb 15, 2016. Among 1536 sources that were initially identified, six studies including 3172 patients proved relevant for further analysis. RESULT Pooled analysis of the included studies demonstrated that after treatment with pioglitazone patients with type 2 diabetes mellitus had no significant increase in fracture risk [odds ratio (OR): 1.18, 95% confidence interval (CI): 0.82 to 1.71, p=0.38] compared to other antidiabetic drugs or placebo. Additionally, no association was found between the risk of fractures and pioglitazone therapy duration. The gender of the patients involved was not relevant to the risk of fractures, too. CONCLUSION Pioglitazone treatment in diabetic patients does not increase the incidence of bone fractures. Moreover, there is no significant association between patients' fractures, their gender and the period of exposure to pioglitazone. Additional longitudinal studies need to be undertaken to obtain more detailed information on bone fragility and pioglitazone therapy.
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Affiliation(s)
- Velichka Pavlova
- Science Department, Tchaikapharma High-Quality Medicines, Inc., 1 G.M. Dimitrov Blvd, 1172 Sofia, Bulgaria
| | - Elena Filipova
- Science Department, Tchaikapharma High-Quality Medicines, Inc., 1 G.M. Dimitrov Blvd, 1172 Sofia, Bulgaria
| | - Katya Uzunova
- Science Department, Tchaikapharma High-Quality Medicines, Inc., 1 G.M. Dimitrov Blvd, 1172 Sofia, Bulgaria
| | - Krassimir Kalinov
- Department of Informatics, New Bulgarian University, 21 Montevideo Street, 1618 Sofia, Bulgaria
| | - Toni Vekov
- Medical University, Faculty of Pharmacy, Dean, Pleven, Bulgaria
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Abstract
OBJECTIVES Head trauma is one of the main causes of death in childhood and often leaves severe disability with serious neurological damage. Appropriate treatment must be provided immediately to improve outcomes. This study was performed to identify factors associated with a poor prognosis at an early stage of severe head injury in children. METHODS The subjects were registered in the Japan Neurotrauma Data Bank. They were 119 children (mean age, 8 years; male, 67.2%) with severe head injury registered during a period of 4 years (from July 1, 2004 to June 30, 2006 and from July 1, 2009 to June 30, 2011). Univariate and multivariate analyses were performed to examine relationships among factors and outcome 6 months after discharge. Logistic regression analysis was performed to develop models for poor prognosis and death. RESULTS Outcome was evaluated based on the Glasgow Outcome Scale: 73 children (61.3%) had good recovery, 11 (9.2%) had moderate disability, 8 (6.7%) had severe disability, 4 (3.3%) were in a vegetative state, and 23 (19.3%) had died. Four factors were identified as predictors of a poor prognosis: serum glucose level greater than or equal to 200 mg/dL, Glasgow Coma Scale score on admission less than or equal to 5, presence of mydriasis, and presence of traumatic subarachnoid hemorrhage. Three factors were identified as predictors of death: serum glucose level greater than or equal to 200 mg/dL, Glasgow Coma Scale score on admission less than or equal to 5, and presence of mydriasis. CONCLUSIONS Using these predictors, subsequent exacerbation may be predicted just after arrival at the hospital and appropriate treatment can be provided immediately.
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The Association Between the Functional Status Scale and the Pediatric Functional Independence Measure in Children Who Survive Traumatic Brain Injury. Pediatr Crit Care Med 2018; 19:1046-1053. [PMID: 30119094 PMCID: PMC6218283 DOI: 10.1097/pcc.0000000000001710] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the association between the Functional Status Scale and Pediatric Functional Independence Measure scores during the rehabilitation stay in children who survive traumatic brain injury. DESIGN Secondary analysis of a prospective observational cohort study. SETTING Tertiary care children's hospital with a level 1 trauma center and inpatient rehabilitation service. PATIENTS Sixty-five children less than 18 years old admitted to an ICU with acute traumatic brain injury and subsequently transferred to the inpatient rehabilitation service. INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS Functional Status Scale and Pediatric Functional Independence Measure at transfer to rehabilitation and Pediatric Functional Independence Measure at discharge from rehabilitation. The median age of the cohort was 7.1 years (interquartile range, 0.8-12.3 yr), and 29% were female. Nearly all of the children were healthy prior to the traumatic brain injury: six patients (9.2%) had a baseline Functional Status Scale score greater than 6. At the time of transfer to inpatient rehabilitation, total Functional Status Scale and Pediatric Functional Independence Measure scores had the expected negative correlation due to increasing disability resulting in lower scores in Pediatric Functional Independence Measure and higher scores in Functional Status Scale (r = -0.49; 95% CI, -0.62 to -0.35). Among subjects with less disability as measured by lower total Functional Status Scale scores, we found substantial variability in the total Pediatric Functional Independence Measure scores. In contrast, Pediatric Functional Independence Measure scores were consistently low among subjects with a wide range of higher total Functional Status Scale scores (more disability). CONCLUSIONS Although proprietary and more time-intensive, the Pediatric Functional Independence Measure has advantages relative to the Functional Status Scale for less severely injured patients and task-specific measurements. The Functional Status Scale may have advantages relative to the Pediatric Functional Independence Measure for more severely injured patients. Further investigations are needed to characterize changes in the Functional Status Scale during the rehabilitation stay and after discharge.
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10
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Zhao RT, Zhou J, Dong XL, Bi CW, Jiang RC, Dong JF, Tian Y, Yuan HJ, Zhang JN. Circular Ribonucleic Acid Expression Alteration in Exosomes from the Brain Extracellular Space after Traumatic Brain Injury in Mice. J Neurotrauma 2018; 35:2056-2066. [PMID: 29409384 DOI: 10.1089/neu.2017.5502] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Rui-ting Zhao
- Department of Pharmacy, General Hospital, Tianjin Medical University, Tianjin, China
| | - Ju Zhou
- Department of Pharmacy, General Hospital, Tianjin Medical University, Tianjin, China
| | - Xin-long Dong
- Department of Neurosurgery, General Hospital, Tianjin Neurological Institute, Tianjin Medical University, Tianjin, China
| | - Chong-wen Bi
- Department of Pharmacy, General Hospital, Tianjin Medical University, Tianjin, China
| | - Rong-cai Jiang
- Department of Neurosurgery, General Hospital, Tianjin Neurological Institute, Tianjin Medical University, Tianjin, China
| | - Jing-fei Dong
- Bloodworks Research Institute, Bloodworks Northwest, Seattle, Washington
- Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Ye Tian
- Department of Neurosurgery, General Hospital, Tianjin Neurological Institute, Tianjin Medical University, Tianjin, China
| | - Heng-jie Yuan
- Department of Pharmacy, General Hospital, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, General Hospital, Tianjin Neurological Institute, Tianjin Medical University, Tianjin, China
| | - Jian-ning Zhang
- Department of Neurosurgery, General Hospital, Tianjin Neurological Institute, Tianjin Medical University, Tianjin, China
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Dewan S, Schimmel S, Borlongan CV. Treating childhood traumatic brain injury with autologous stem cell therapy. Expert Opin Biol Ther 2018; 18:515-524. [PMID: 29421958 PMCID: PMC6086119 DOI: 10.1080/14712598.2018.1439473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Neonatal traumatic brain injury (TBI) is a significant cause of developmental disorders. Autologous stem cell therapy may enhance neonatal brain plasticity towards repair of the injured neonatal brain. AREAS COVERED The endogenous neonatal anti-inflammatory response can be enhanced through the delivery of anti-inflammatory agents. Stem cell therapy stands as a robust approach for sequestering the inflammation-induced cell death in the injured brain. Here, we discuss the use of umbilical cord blood cells and bone marrow stromal cells for acute and chronic treatment of experimental neonatal TBI. Autologous stem cell transplantation may dampen neuroinflammation. Clinical translation of this stem cell therapy will require identifying the therapeutic window post-injury and harvesting ample supply of transplantable autologous stem cells. Stem cell banking of cryopreserved cells may allow readily available transplantable cells and circumvent the unpredictable nature of neonatal TBI. Harnessing the anti-inflammatory properties of stem cells is key in combating the progressive neurodegeneration after the initial injury. EXPERT OPINION Combination treatments, such as with hypothermia, may enhance the therapeutic effects of stem cells. Stem cell therapy has immense potential as a stand-alone or adjunctive therapy for treating neuroinflammation associated with neonatal TBI acutely and for preventing further progression of the injury.
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Affiliation(s)
- Shyam Dewan
- Center of Excellence for Aging and Brain Repair, Department of Neurosugery and Brain Repair, University of South Florida Morsani College of Medicine. 3515 E. Fletcher Avenue, Tampa, FL 33613, USA
| | - Samantha Schimmel
- Center of Excellence for Aging and Brain Repair, Department of Neurosugery and Brain Repair, University of South Florida Morsani College of Medicine. 3515 E. Fletcher Avenue, Tampa, FL 33613, USA
| | - Cesar V. Borlongan
- Center of Excellence for Aging and Brain Repair, Department of Neurosugery and Brain Repair, University of South Florida Morsani College of Medicine. 3515 E. Fletcher Avenue, Tampa, FL 33613, USA
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Stefanović B, Đurić O, Stanković S, Mijatović S, Doklestić K, Stefanović B, Jovanović B, Marjanović N, Kalezić N. Elevated Serum Protein S100B and Neuron Specific Enolase Values as Predictors of Early Neurological Outcome After Traumatic Brain Injury. J Med Biochem 2017; 36:314-321. [PMID: 30581328 PMCID: PMC6294083 DOI: 10.1515/jomb-2017-0018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 03/25/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The objective of our study was to determine the serum concentrations of protein S100B and neuron specific enolase (NSE) as well as their ability and accuracy in the prediction of early neurological outcome after a traumatic brain injury. METHODS A total of 130 polytraumatized patients with the associated traumatic brain injuries were included in this prospective cohort study. Serum protein S100B and NSE levels were measured at 6, 24, 48 and 72 hours after the injury. Early neurological outcome was scored by Glasgow Outcome Scale (GOS) on day 14 after the brain injury. RESULTS The protein S100B concentrations were maximal at 6 hours after the injury, which was followed by an abrupt fall, and subsequently slower release in the following two days with continual and significantly increased values (p<0.0001) in patients with poor outcome. Secondary increase in protein S100B at 72 hours was recorded in patients with lethal outcome (GOS 1). Dynamics of NSE changes was characterized by a secondary increase in concentrations at 72 hours after the injury in patients with poor outcome. CONCLUSION Both markers have good predictive ability for poor neurological outcome, although NSE provides better discriminative potential at 72 hours after the brain injury, while protein S100B has better discriminative potential for mortality prediction.
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Affiliation(s)
- Branislava Stefanović
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Anesthesiology, Emergency Center, Clinical Center of Serbia, Belgrade, Serbia
| | - Olivera Đurić
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Institute for Epidemiology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Stanković
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Srđan Mijatović
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Emergency Surgery, Emergency Center, Clinical Center of Serbia, Belgrade, Serbia
| | - Krstina Doklestić
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Emergency Surgery, Emergency Center, Clinical Center of Serbia, Belgrade, Serbia
| | - Branislav Stefanović
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Emergency Surgery, Emergency Center, Clinical Center of Serbia, Belgrade, Serbia
| | - Bojan Jovanović
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Anesthesiology, Emergency Center, Clinical Center of Serbia, Belgrade, Serbia
| | - Nataša Marjanović
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Anesthesiology, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Nevena Kalezić
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Anesthesiology, Clinic for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia
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Fuentes MM, Jimenezb N, Apkona SD, Rivarab FP. Functional outcomes during inpatient rehabilitation for American Indian and Alaska Native children with traumatic brain injury. J Pediatr Rehabil Med 2016; 9:133-41. [PMID: 27285806 PMCID: PMC5099074 DOI: 10.3233/prm-160376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE American Indian/Alaska Native (AI/AN) people have the highest traumatic brain injury (TBI)-related mortality in the United States, but little is known about AI/AN children who survive traumatic brain injury (TBI). This study compares function and factors associated with discharge function between AI/AN and White children with TBI during inpatient rehabilitation. METHODS Retrospective national cohort study of 114 AI/AN and 7,267 White children aged 6 months-18 years who received inpatient TBI rehabilitation between 2002-2012 at facilities utilizing the Uniform Data System for Medical Rehabilitation\scriptsize®. The outcome measure was developmental functional quotients (DFQ is the FIM\scriptsize® or WeeFIM\scriptsize® score divided by age norms x 100) at discharge. RESULTS AI/AN race was not associated with motor (regression coefficient (β) 0.18, 95% confidence interval (CI) -2.39, 2.76) or cognitive (β -1.54, 95% CI -3.75, 0.67) function. Among a subgroup with loss of consciousness > 24 hours (AI/AN n= 13, White n= 643), AI/AN race was associated with lower motor DFQ (β -12.83, 95% CI -25.39, -0.34). CONCLUSIONS Overall, AI/AN race was not associated with inpatient rehabilitation function for children with TBI, but providers should not assume AI/ANs with more severe injuries have equitable outcomes.
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Affiliation(s)
- Molly M. Fuentes
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Nathalia Jimenezb
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Susan D. Apkona
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Frederick P. Rivarab
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Ciccia AH, Threats T. Role of contextual factors in the rehabilitation of adolescent survivors of traumatic brain injury: emerging concepts identified through modified narrative review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2015; 50:436-451. [PMID: 25721403 DOI: 10.1111/1460-6984.12153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/01/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Recently research in traumatic brain injury (TBI) intervention has identified the benefits of contextualized, embedded, functionally based approaches to maximize treatment outcomes. An essential component of contextualized intervention is the direct and purposeful consideration of the broader context, in which the person with TBI functions. However, systematic consideration of contextual factors remains limited both in research and clinical practice. AIMS The purposes of this modified narrative review were (1) to provide a succinct review of the available literature regarding the contextual factors that are specific to adolescent survivors of TBI, one of highest incidence groups for brain injury; (2) to connect these contextual factors to the direct long-term management of TBI and to identify their potential impact on outcome; and (3) to highlight areas that are open to research and clinical advances that could enhance positive outcomes for adolescent survivors of TBI. The framework of the World Health Organization's (WHO) International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY; 2007) was used as a foundation for this review. METHODS & PROCEDURES A systematic literature search was conducted using databases and hand searches. A total of 102 articles were originally identified. Twenty-five original research articles, eight review papers and four expert opinion papers met inclusion and exclusion criteria and were included in the final review. MAIN CONTRIBUTION The body of research specifically focused on contextual factors is an emerging area. Early findings indicate that a focus on the direct modification of contextual factors is promising for the facilitation of positive outcomes long into the chronic phase of management for adolescences who have survived a TBI. The contextual factors included in this review were the overall ability of the school to support a student post-TBI, family psychosocial risk (sibling/sibling relationships/stress/burden/support), coping style (TBI survivor and their caregivers), and socioeconomic status of the family. Given the promise of these findings, research and clinical application efforts should be focused on identifying well-prescribed rehabilitation paradigms that capitalize on the modification of contextual factors throughout the recovery process. CONCLUSIONS & IMPLICATIONS The results of this modified narrative review provide an initial summary of the available evidence for addressing contextual factors in the rehabilitation process for adolescents with TBI. This is an area that is wide open for both systematic research and clinical application and holds potential to improve long-term outcome for survivors of adolescent TBI.
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Affiliation(s)
- Angela Hein Ciccia
- Department of Psychological Sciences, Program in Communication Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Travis Threats
- Department of Communication Sciences and Disorders, McGannon Hall, St. Louis, MO, USA
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Examining acute rehabilitation outcomes for children with total functional dependence after traumatic brain injury: a pilot study. J Head Trauma Rehabil 2014; 28:361-70. [PMID: 22613944 DOI: 10.1097/htr.0b013e31824da031] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine in a pilot cohort factors associated with functional outcome at discharge and 3-month follow-up after discharge from inpatient rehabilitation in children with severe traumatic brain injury (TBI) who entered rehabilitation with the lowest level of functional skills. PARTICIPANTS Thirty-nine children and adolescents (3-18 years old) who sustained a severe TBI and had the lowest possible rating at rehabilitation admission on the Functional Independence Measure for Children (total score = 18). METHODS Retrospective review of data collected as part of routine clinical care. RESULTS At discharge, 59% of the children were partially dependent for basic activities, while 41% remained dependent for basic activities. Initial Glasgow Coma Scale score, time to follow commands, and time from injury to rehabilitation admission were correlated with functional status at discharge. Time to follow commands and time from injury to rehabilitation admission were correlated with functional status at 3-month follow-up. Changes in functional status during the first few weeks of admission were associated with functional status at discharge and follow-up. CONCLUSIONS Even children with the most severe brain injuries, who enter rehabilitation completely dependent for all daily activities, have the potential to make significant gains in functioning by discharge and in the following few months. Assessment of functional status early in the course of rehabilitation contributes to the ability to predict outcome from severe TBI.
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Suppressed cytokine expression immediatey following traumatic brain injury in neonatal rats indicates an expeditious endogenous anti-inflammatory response. Brain Res 2014; 1559:65-71. [PMID: 24602693 DOI: 10.1016/j.brainres.2014.02.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 01/30/2014] [Accepted: 02/24/2014] [Indexed: 11/21/2022]
Abstract
The timing of therapeutic intervention in traumatic brain injury (TBI) is critical. Although immediate cell death cascades have become established in adult TBI, the pathophysiology underlying neonatal TBI is poorly understood. The objective of the present study was to determine the role of cytokine regulation following TBI in neonatal rats. Seven-day-old Sprague-Dawley rats were subjected to TBI using the controlled cortical impact (CCI) injury model. Age-matched littermates that did not receive TBI served as the controls. Immediately following TBI, rats were euthanized, and the brains were divided into the ipsilateral and contralateral hemispheres then flash frozen. A BioRad 23-Plex panel was used to measure cytokine levels. Surprisingly, the data revealed that 18 of the 23 cytokines analyzed were significantly downregulated in the hemisphere contralateral to the TBI impacted hemisphere. IL-5, IL-6 and MIP-3a were significantly suppressed in both ipsilateral and contralateral hemispheres of neonatal TBI rats compared to the control rats. A parallel study processing the plasma of the same cohort of neonatal rats revealed no difference in the same cytokines analyzed in the brain tissue, suggesting highly localized cytokine suppression in the brain during early injury. In stark contrast to the reported early pro-inflammatory response exhibited in adult TBI, the present neonatal TBI study demonstrated a reversed cytokine profile of downregulation. These results suggest a robust, immediate anti-inflammatory response mounted by the contralateral hemisphere of the young brain.
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Rus D, Chereches RM, Peek-Asa C, Marton-Vasarhely EO, Oprescu F, Brinzaniuc A, Mocean F. Paediatric head injuries treated in a children's emergency department from Cluj-Napoca, Romania. Int J Inj Contr Saf Promot 2014; 23:206-13. [PMID: 24479864 DOI: 10.1080/17457300.2013.872671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of the study was to describe paediatric head injuries and identify factors that led to advanced care. Incident cases of head injuries that sought care from December 2008 to October 2010 at Children's Emergency Hospital Cluj-Napoca were evaluated. The main outcome was transfer or admission to advanced care. From a total of 3053 children treated for an injury, 1541 (50.4%) presented with head injury. A total of 960 (62.3%) of the children with a head injury required advanced care treatment. Young children were more likely to suffer a head injury than older children, but a higher proportion of older children required advanced care (70.3%). Children who suffered a head injury as a consequence of road traffic were almost five times more likely to require advanced care (OR: 4.97; 3.09-8.06) than being released. Our results suggest that data on injuries provide evidence-based information on the nature of injuries children are prone to, and what activity, type, and mechanism of injury impact Romanian children.
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Affiliation(s)
- Diana Rus
- a Department of Health Management and Public Health , University of Medicine and Pharmacy Iuliu Hatieganu , Cluj-Napoca , Romania
| | - Razvan Mircea Chereches
- b Center for Health Policy and Public Health , Babes-Bolyai University , Cluj-Napoca , Romania
| | - Corinne Peek-Asa
- c Department of Occupational and Environmental Health , University of Iowa , Iowa City , United States of America
| | | | - Florin Oprescu
- d School of Health and Environmental Health , University of Sunshine Coast , Queensland , Australia
| | - Alexandra Brinzaniuc
- b Center for Health Policy and Public Health , Babes-Bolyai University , Cluj-Napoca , Romania
| | - Floarea Mocean
- a Department of Health Management and Public Health , University of Medicine and Pharmacy Iuliu Hatieganu , Cluj-Napoca , Romania
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Kotecha RS, Jacoby P, Cole CH, Gottardo NG. Morbidity in survivors of child and adolescent meningioma. Cancer 2013; 119:4350-7. [PMID: 24052192 PMCID: PMC4209112 DOI: 10.1002/cncr.28366] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/20/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND The extent of initial surgical resection has been identified as the strongest prognostic indicator for survival in child and adolescent meningioma. Given the paucity of data concerning long-term outcome, the authors undertook a meta-analysis to analyze morbidity in survivors of this disease. METHODS Individual patient data were obtained from 19 case series published over the last 23 years through direct communication with the authors. Ordinal logistic regression models were used to assess the influence of risk factors on morbidity. RESULTS Of 261 patients, 48% reported a completely normal life with no morbidity, and 25% had moderate/severe meningioma-associated morbidity at last follow-up. Multivariate analysis identified relapse as the only independent variable associated with an increased risk of morbidity (odds ratio, 4.02; 95% confidence interval, 2.11-7.65; P ≤ .001). Univariate analysis also revealed an increased risk for patients with neurofibromatosis (odds ratio, 1.90; 95% confidence interval, 1.04-3.48; P = .04). Subgroup analysis identified a higher incidence of morbidity among patients who had intracranial tumors with a skull base location compared with a nonskull base location (P ≤ .001). Timing at which morbidity occurred was available for 70 patients, with persistence of preoperative tumor-related symptoms in 67% and as a result of therapy in 20%. CONCLUSIONS The majority of survivors of child and adolescent meningioma had no or only mild long-term morbidity, whereas 25% had moderate/severe morbidity, with a significantly increased risk in patients with relapsed disease. In the majority, morbidity occurred as a consequence of the tumor itself, justifying aggressive surgery to achieve gross total resection. However, for patients with neurofibromatosis and skull base meningioma, a more cautious surgical approach should be reserved.
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Affiliation(s)
- Rishi S Kotecha
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia; School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia; Telethon Institute for Child Health Research and Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
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Gray MP, Woods D, Hadjikoumi I. Early access to rehabilitation for paediatric patients with traumatic brain injury. Eur J Trauma Emerg Surg 2012; 38:423-31. [DOI: 10.1007/s00068-012-0177-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 12/31/2011] [Indexed: 10/28/2022]
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Lippert-Grüner M. Early rehabilitation of comatose patients after traumatic brain injury. Neurol Neurochir Pol 2011; 44:475-80. [PMID: 21082492 DOI: 10.1016/s0028-3843(14)60138-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE As a result of improvements in the rescue system and progress in intensive care therapy, an increasing number of patients have survived severe traumatic brain injury in recent years. Early and consistent administration of the correct rehabilitation programme is of crucial importance for the restoration and improvement of cerebral function, as well as social reintegration. This prospective study was conducted at the neurosurgical department of a university hospital to assess the one-year outcome of comatose patients after severe traumatic brain injury. MATERIAL AND METHODS Twenty-seven patients were included. Patients received multimodal early-onset stimulation and continuous inpatient and outpatient rehabilitation therapy. One-year outcome was assessed by means of the Glasgow Outcome Scale, Barthel Index, Functional Independence Measure (FIM) and need of care. RESULTS Seven patients died, 4 remained in a vegetative state, 7 were severely disabled, 6 were moderately disabled, and 3 achieved a good recovery 12 months after injury. Median Barthel Index was 65 and median FIM score was 84. The majority of patients were still at least intermittently dependent on care. CONCLUSION Despite intensive rehabilitation treatment, severe traumatic brain injury is still burdened with significant mortality and morbidity.
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Delta-alpha ratio correlates with level of recovery after neurorehabilitation in patients with acquired brain injury. Clin Neurophysiol 2009; 120:1039-45. [PMID: 19398371 DOI: 10.1016/j.clinph.2009.01.021] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 12/23/2008] [Accepted: 01/31/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore the relationship between three QEEG global indexes and their association with functional outcome after neurorehabilitation in non-acute acquired brain injury (ABI) patients (traumatic brain injury and stroke). METHODS Twenty-one adult ABI patients in post-acute phase were studied. Delta-alpha ratio (DAR), Power Ratio Index (PRI) and Mean Brain Symmetry Index (mBSI) were calculated from resting-state EEG taken at admission. These indexes and other clinical variables were correlated with functional recovery achieved after six months of neurorehabilitation. RESULTS DAR showed the highest strength of association with the functional outcome measure (rho=-0.65, P=0.002). The other QEEG indexes and clinical variables showed modest non-significant correlations. A posteriori group analysis showed higher DAR in patients with poor recovery as compared to good recovery patients. CONCLUSIONS Functional recovery after neurorehabilitation appears to be associated with a number of clinical and neurophysiological variables. Among the latter, the ratio between delta and alpha may play a significant role in predicting and monitoring functional rehabilitation outcome. SIGNIFICANCE Neurophysiological assessment of ABI patients may be an important tool in monitoring and predicting outcomes after neurorehabilitation.
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