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Fesharaki-Zadeh A. Navigating the Complexities of Traumatic Encephalopathy Syndrome (TES): Current State and Future Challenges. Biomedicines 2023; 11:3158. [PMID: 38137378 PMCID: PMC10740836 DOI: 10.3390/biomedicines11123158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a unique neurodegenerative disease that is associated with repetitive head impacts (RHI) in both civilian and military settings. In 2014, the research criteria for the clinical manifestation of CTE, traumatic encephalopathy syndrome (TES), were proposed to improve the clinical identification and understanding of the complex neuropathological phenomena underlying CTE. This review provides a comprehensive overview of the current understanding of the neuropathological and clinical features of CTE, proposed biomarkers of traumatic brain injury (TBI) in both research and clinical settings, and a range of treatments based on previous preclinical and clinical research studies. Due to the heterogeneity of TBI, there is no universally agreed-upon serum, CSF, or neuroimaging marker for its diagnosis. However, as our understanding of this complex disease continues to evolve, it is likely that there will be more robust, early diagnostic methods and effective clinical treatments. This is especially important given the increasing evidence of a correlation between TBI and neurodegenerative conditions, such as Alzheimer's disease and CTE. As public awareness of these conditions grows, it is imperative to prioritize both basic and clinical research, as well as the implementation of necessary safe and preventative measures.
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Affiliation(s)
- Arman Fesharaki-Zadeh
- Department of Neurology and Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
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Corrick S, Lesyk N, Yang E, Campbell S, Villa-Roel C, Rowe BH. Role of sex and gender in concussion outcome differences among patients presenting to the emergency department: a systematic review. Inj Prev 2023; 29:537-544. [PMID: 37507213 DOI: 10.1136/ip-2022-044822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE This systematic review aimed to identify research involving adults presenting to the emergency department (ED) with a concussion to document the reporting of sex and/or gender according to the Canadian Institutes of Health Research (CIHR) guidelines, the prevalence of sex and gender-based analysis (SGBA) and to summarise sex and/or gender-based differences in ED presentation, management and outcomes. DESIGN Systematic review. METHODS Electronic databases and grey literature were searched to identify studies that recruited adult patients with concussion from the ED. Two independent reviewers identified eligible studies, assessed quality and extracted data. A descriptive summary of the evidence was generated, and sex and/or gender reporting was examined for accuracy according to standardised criteria. RESULTS Overall, 126 studies were included in the analyses. A total of 80 (64%) studies reported sex and/or gender as demographic information, of which 51 (64%) included sex and/or gender in their analysis; however, 2 (3%) studies focused on an SGBA. Sex was more accurately reported in alignment with CIHR definitions than gender (94% vs 12%; p<0.0001). In total, 25 studies used an SGBA for outcomes of interest. Males and females experience different causes of concussion, 60% of studies documented that females had less frequent CT scanning while in the ED, and 57% of studies reported that postconcussion syndrome was more prevalent in females and women. CONCLUSION This systematic review highlighted that sex is reported more accurately than gender, approximately half of studies did not report either sex and/or gender as demographic information, and one-third of studies did not include SGBA. There were important sex and gender differences in the cause, ED presentation, management and outcomes of concussions. PROSPERO REGISTRATION NUMBER CRD42021258613.
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Affiliation(s)
- Shaina Corrick
- Emergency Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas Lesyk
- Emergency Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Esther Yang
- Emergency Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Cristina Villa-Roel
- Emergency Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Brian H Rowe
- Emergency Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- Clinical Epidemiology, School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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3
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Kim SY, Yeh PH, Ollinger JM, Morris HD, Hood MN, Ho VB, Choi KH. Military-related mild traumatic brain injury: clinical characteristics, advanced neuroimaging, and molecular mechanisms. Transl Psychiatry 2023; 13:289. [PMID: 37652994 PMCID: PMC10471788 DOI: 10.1038/s41398-023-02569-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is a significant health burden among military service members. Although mTBI was once considered relatively benign compared to more severe TBIs, a growing body of evidence has demonstrated the devastating neurological consequences of mTBI, including chronic post-concussion symptoms and deficits in cognition, memory, sleep, vision, and hearing. The discovery of reliable biomarkers for mTBI has been challenging due to under-reporting and heterogeneity of military-related mTBI, unpredictability of pathological changes, and delay of post-injury clinical evaluations. Moreover, compared to more severe TBI, mTBI is especially difficult to diagnose due to the lack of overt clinical neuroimaging findings. Yet, advanced neuroimaging techniques using magnetic resonance imaging (MRI) hold promise in detecting microstructural aberrations following mTBI. Using different pulse sequences, MRI enables the evaluation of different tissue characteristics without risks associated with ionizing radiation inherent to other imaging modalities, such as X-ray-based studies or computerized tomography (CT). Accordingly, considering the high morbidity of mTBI in military populations, debilitating post-injury symptoms, and lack of robust neuroimaging biomarkers, this review (1) summarizes the nature and mechanisms of mTBI in military settings, (2) describes clinical characteristics of military-related mTBI and associated comorbidities, such as post-traumatic stress disorder (PTSD), (3) highlights advanced neuroimaging techniques used to study mTBI and the molecular mechanisms that can be inferred, and (4) discusses emerging frontiers in advanced neuroimaging for mTBI. We encourage multi-modal approaches combining neuropsychiatric, blood-based, and genetic data as well as the discovery and employment of new imaging techniques with big data analytics that enable accurate detection of post-injury pathologic aberrations related to tissue microstructure, glymphatic function, and neurodegeneration. Ultimately, this review provides a foundational overview of military-related mTBI and advanced neuroimaging techniques that merit further study for mTBI diagnosis, prognosis, and treatment monitoring.
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Affiliation(s)
- Sharon Y Kim
- School of Medicine, Uniformed Services University, Bethesda, MD, USA
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA
| | - Ping-Hong Yeh
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John M Ollinger
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Herman D Morris
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Maureen N Hood
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Vincent B Ho
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Kwang H Choi
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA.
- Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, MD, USA.
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA.
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Mikolić A, Steyerberg EW, Polinder S, Wilson L, Zeldovich M, von Steinbuechel N, Newcombe VF, Menon DK, van der Naalt J, Lingsma HF, Maas AI, van Klaveren D. Prognostic Models for Global Functional Outcome and Post-Concussion Symptoms Following Mild Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study. J Neurotrauma 2023; 40:1651-1670. [PMID: 37078144 PMCID: PMC10458380 DOI: 10.1089/neu.2022.0320] [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: 04/21/2023] Open
Abstract
After mild traumatic brain injury (mTBI), a substantial proportion of individuals do not fully recover on the Glasgow Outcome Scale Extended (GOSE) or experience persistent post-concussion symptoms (PPCS). We aimed to develop prognostic models for the GOSE and PPCS at 6 months after mTBI and to assess the prognostic value of different categories of predictors (clinical variables; questionnaires; computed tomography [CT]; blood biomarkers). From the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we included participants aged 16 or older with Glasgow Coma Score (GCS) 13-15. We used ordinal logistic regression to model the relationship between predictors and the GOSE, and linear regression to model the relationship between predictors and the Rivermead Post-concussion Symptoms Questionnaire (RPQ) total score. First, we studied a pre-specified Core model. Next, we extended the Core model with other clinical and sociodemographic variables available at presentation (Clinical model). The Clinical model was then extended with variables assessed before discharge from hospital: early post-concussion symptoms, CT variables, biomarkers, or all three categories (extended models). In a subset of patients mostly discharged home from the emergency department, the Clinical model was extended with 2-3-week post-concussion and mental health symptoms. Predictors were selected based on Akaike's Information Criterion. Performance of ordinal models was expressed as a concordance index (C) and performance of linear models as proportion of variance explained (R2). Bootstrap validation was used to correct for optimism. We included 2376 mTBI patients with 6-month GOSE and 1605 patients with 6-month RPQ. The Core and Clinical models for GOSE showed moderate discrimination (C = 0.68 95% confidence interval 0.68 to 0.70 and C = 0.70[0.69 to 0.71], respectively) and injury severity was the strongest predictor. The extended models had better discriminative ability (C = 0.71[0.69 to 0.72] with early symptoms; 0.71[0.70 to 0.72] with CT variables or with blood biomarkers; 0.72[0.71 to 0.73] with all three categories). The performance of models for RPQ was modest (R2 = 4% Core; R2 = 9% Clinical), and extensions with early symptoms increased the R2 to 12%. The 2-3-week models had better performance for both outcomes in the subset of participants with these symptoms measured (C = 0.74 [0.71 to 0.78] vs. C = 0.63[0.61 to 0.67] for GOSE; R2 = 37% vs. 6% for RPQ). In conclusion, the models based on variables available before discharge have moderate performance for the prediction of GOSE and poor performance for the prediction of PPCS. Symptoms assessed at 2-3 weeks are required for better predictive ability of both outcomes. The performance of the proposed models should be examined in independent cohorts.
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Affiliation(s)
- Ana Mikolić
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, United Kingdom
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Virginia F.J. Newcombe
- Division of Anesthesia, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - David K. Menon
- Division of Anesthesia, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Hester F. Lingsma
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Andrew I.R. Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - David van Klaveren
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
- Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies/Tufts Medical Center, Boston, Massachusetts, USA
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Pei Y, Kemp AM, O'Brien KH. Investigating the Student in Returning to Learn After Concussion: A Systematic Review and Meta-Analysis. THE JOURNAL OF SCHOOL HEALTH 2023; 93:594-620. [PMID: 36852558 DOI: 10.1111/josh.13307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/14/2022] [Accepted: 02/05/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Examine concussion effects on academic outcomes, including student perspectives. METHODS This study included a systematic review and meta-analysis examining post-concussion school attendance, academic performance, perceptions of academic difficulty, and accommodations for students in elementary through college settings. The analysis considered pre- and post-injury factors, along with injury factors that contribute to post-concussion academic outcomes. RESULTS The systematic review showed that students with concussion miss more school days and perceive higher levels of academic difficulty, but results about academic performance varied. Meta-analysis yielded small concussion effects on school absence and academic performance and moderate effects on perceptions of academic difficulty. Female sex, older age, history of migraine, prior concussions, severe or persistent symptoms, vestibular-ocular motor, and cognitive disruptions are risk factors, but these moderators were not identified in the meta-analysis due to lack of effect sizes. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY This study confirmed negative concussion effects on academic absences, performance, and perceptions of academic difficulty. Identified contributing factors will guide future practices to support students returning to learn after concussion. CONCLUSIONS Negative impacts to academics from concussion may be amplified by complicating factors. Future investigations are needed to confirm risk factors and mitigating effects of early identification and post-injury supports.
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Affiliation(s)
- Yalian Pei
- Communication Sciences and Special Education, University of Georgia, 110 Carlton Street, Athens, GA, 30602
| | - Amy M Kemp
- Communication Sciences and Special Education, University of Georgia, 110 Carlton Street, Athens, GA, 30602
| | - Katy H O'Brien
- Communication Sciences and Special Education, University of Georgia, 110 Carlton Street, Athens, GA 30602; Courage Kenny Rehabilitation Institute Allina Health, 800 E 28th St, Minneapolis, MN, 55407
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Zhao P, Zhu P, Zhang D, Yin B, Wang Y, Hussein NM, Yan Z, Liu X, Bai G. Sex Differences in Cerebral Blood Flow and Serum Inflammatory Cytokines and Their Relationships in Mild Traumatic Brain Injury. Front Neurol 2022; 12:755152. [PMID: 35153973 PMCID: PMC8825420 DOI: 10.3389/fneur.2021.755152] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to investigate sex differences in cerebral blood flow (CBF) and serum inflammatory cytokines, as well as their correlations in patients with acute-stage mild traumatic brain injury (mTBI). Forty-one patients with mTBI and 23 matched healthy controls underwent 3D-pseudo-continuous arterial spin labeling imaging on 3T magnetic resonance imaging. The patients underwent cognitive evaluations and measurement of a panel of ten serum cytokines: interleukin (IL)-1I, IL-4, IL-6, IL-8, IL-10, IL-12, C–C motif chemokine ligand 2, interferon-gamma, nerve growth factor-beta (β-NGF), and tumor necrosis factor-alpha (TNF-α). Spearman rank correlation analysis was performed to evaluate the relationship between inflammation levels and CBF. We found that both male and female patients showed increased IL-1L and IL-6 levels. Female patients also demonstrated overexpression of IL-8 and low expression of IL-4. As for CBF levels, three brain regions [the right superior frontal gyrus (SFG_R), left putamen, and right precuneus] increased in male patients while three brain regions [the right superior temporal gyrus (STG_R), left middle occipital gyrus, and right postcentral (PoCG_R)] decreased in female patients. Furthermore, the STG_R in female controls was positively correlated with β-NGF while the right PoCG_R in female patients was negatively correlated with IL-8. In addition, compared with male patients, female patients showed decreased CBF in the right pallidum, which was negatively correlated with IL-8. These findings revealed abnormal expression of serum inflammatory cytokines and CBF levels post-mTBI. Females may be more sensitive to inflammatory and CBF changes and thus more likely to get cognitive impairment. This may suggest the need to pay closer attention to the female mTBI group.
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Affiliation(s)
- Pinghui Zhao
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Pingyi Zhu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Danbin Zhang
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bo Yin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Wang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nimo Mohamed Hussein
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhihan Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaozheng Liu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- China-USA Neuroimaging Research Institute, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Xiaozheng Liu
| | - Guanghui Bai
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Wenzhou Key Laboratory of Basic Science and Translational Research of Radiation Oncology, Wenzhou, China
- *Correspondence: Guanghui Bai
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Haddadi K, Moradi S, Asadian L, Montazer SH, Hosseininejad SM, Golikhatir I, Abedian Kenari S, Alaee A, Bozorgi F. Aldolase C Profiling in Serum after Mild Traumatic Brain Injury: A Prospective Cohort Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:33-39. [PMID: 35017775 PMCID: PMC8743369 DOI: 10.30476/ijms.2021.87692.1831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/03/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND After a traumatic brain injury (TBI), in addition to clinical indices, the serum level of neurological biomarkers may provide valuable diagnostic and prognostic information. The present study aimed to investigate the aldolase C (ALDOC) profile in serum for early diagnosis of brain damage in patients with mild TBI (mTBI) presented to the Emergency Department (ED). METHODS A single-center prospective cohort study was carried out in 2018-2019 at Imam Khomeini Hospital affiliated with Mazandaran University of Medical Sciences, Sari, Iran. A total of 89 patients with mTBI were enrolled in the study. Blood samples were taken within three hours after head trauma to measure ALDOC serum levels. Brain CT scan was used as the gold standard. Statistical analysis was performed using the Kruskal Wallis, Mann-Whitney U, and Chi square tests. The receiver-operating characteristic (ROC) curve plot was used to determine the optimal cutoff point for ALDOC. The sensitivity and specificity of the determined cutoff point were calculated. P values less than 0.05 were considered statistically significant. RESULTS Of the 89 patients, the CT scan findings showed a positive TBI in 30 (33.7%) of the patients and in 59 (66.3%) a negative TBI. The median ALDOC serum level in the patients with positive CT scan findings (8.35 ng/mL [IQR: 1.65]) was significantly higher than those with negative CT scan findings (5.3 ng/mL [IQR: 6.9]) (P<0.001). The optimal cutoff point for ALDOC serum level was 6.95 ng/mL, and the area under the curve was 99.6% (P<0.001). The sensitivity and specificity of the determined cutoff point were 100% and 98%, respectively. CONCLUSION The ALDOC serum level in patients with mTBI significantly correlates with the pathologic findings of the brain CT scan. This biomarker, with 100% sensitivity, is a suitable tool to detect brain structural abnormalities in mTBI patients.
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Affiliation(s)
- Kaveh Haddadi
- Department of Neurosurgery, School of Medicine, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Siavash Moradi
- Education Development Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leila Asadian
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Hosein Montazer
- Department of Emergency Medicine, School of Medicine, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Mohammad Hosseininejad
- Department of Emergency Medicine, School of Medicine, Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iraj Golikhatir
- Department of Emergency Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saeid Abedian Kenari
- Immunogenetics Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abdulrassol Alaee
- Department of Radiology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Farzad Bozorgi
- Department of Emergency Medicine, School of Medicine, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Mozaffari K, Dejam D, Duong C, Ding K, French A, Ng E, Preet K, Franks A, Kwan I, Phillips HW, Kim DY, Yang I. Systematic Review of Serum Biomarkers in Traumatic Brain Injury. Cureus 2021; 13:e17056. [PMID: 34522534 PMCID: PMC8428323 DOI: 10.7759/cureus.17056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 12/20/2022] Open
Abstract
Traumatic brain injury (TBI) is responsible for the majority of trauma-related deaths and is a leading cause of disability. It is characterized by an inflammatory process involved in the progression of secondary brain injury. TBI is measured by the Glasgow Coma Scale (GCS) with scores ranging from 15-3, demonstrating mild to severe brain injury. Apart from this clinical assessment of TBI, compendiums of literature have been published on TBI-related serum markers.Herein we create a comprehensive appraisal of the most prominent serum biomarkers used in the assessment and care of TBI.The PubMed, Scopus, Cochrane, and Web of Science databases were queried with the terms “biomarker” and “traumatic brain injury” as search terms with only full-text, English articles within the past 10 years selected. Non-human studies were excluded, and only adult patients fell within the purview of this analysis. A total of 528 articles were analyzed in the initial search with 289 selected for screening. A further 152 were excluded for primary screening. Of the remaining 137, 54 were included in the final analysis. Serum biomarkers were listed into the following broad categories for ease of discussion: immune markers and markers of inflammation, hormones as biomarkers, coagulation and vasculature, genetic polymorphisms, antioxidants and oxidative stress, apoptosis and degradation pathways, and protein markers. Glial fibrillary acidic protein(GFAP), S100, and neurons specific enolase (NSE) were the most prominent and frequently cited markers. Amongst these three, no single serum biomarker demonstrated neither superior sensitivity nor specificity compared to the other two, therefore noninvasive panels should incorporate these three serum biomarkers to retain sensitivity and maximize specificity for TBI.
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Affiliation(s)
- Khashayar Mozaffari
- Neurosurgery, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA
| | - Dillon Dejam
- Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Courtney Duong
- Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Kevin Ding
- Neurosurgery, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA
| | - Alexis French
- Neurosurgery, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA
| | - Edwin Ng
- Neurosurgery, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA
| | - Komal Preet
- Neurosurgery, University of California, Los Angeles, USA
| | - Alyssa Franks
- Neurosurgery, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA
| | - Isabelle Kwan
- Neurosurgery, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA
| | - H Westley Phillips
- Neurosurgery, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA
| | - Dennis Y Kim
- Biomedical Sciences, Harbor University of California Los Angeles Medical Center, Los Angeles, USA
| | - Isaac Yang
- Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, USA
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Gozt AK, Hellewell SC, Thorne J, Thomas E, Buhagiar F, Markovic S, Van Houselt A, Ring A, Arendts G, Smedley B, Van Schalkwyk S, Brooks P, Iliff J, Celenza A, Mukherjee A, Xu D, Robinson S, Honeybul S, Cowen G, Licari M, Bynevelt M, Pestell CF, Fatovich D, Fitzgerald M. Predicting outcome following mild traumatic brain injury: protocol for the longitudinal, prospective, observational Concussion Recovery ( CREST) cohort study. BMJ Open 2021; 11:e046460. [PMID: 33986061 PMCID: PMC8126315 DOI: 10.1136/bmjopen-2020-046460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Mild traumatic brain injury (mTBI) is a complex injury with heterogeneous physical, cognitive, emotional and functional outcomes. Many who sustain mTBI recover within 2 weeks of injury; however, approximately 10%-20% of individuals experience mTBI symptoms beyond this 'typical' recovery timeframe, known as persistent post-concussion symptoms (PPCS). Despite increasing interest in PPCS, uncertainty remains regarding its prevalence in community-based populations and the extent to which poor recovery may be identified using early predictive markers. OBJECTIVE (1) Establish a research dataset of people who have experienced mTBI and document their recovery trajectories; (2) Evaluate a broad range of novel and established prognostic factors for inclusion in a predictive model for PPCS. METHODS AND ANALYSIS The Concussion Recovery Study (CREST) is a prospective, longitudinal observational cohort study conducted in Perth, Western Australia. CREST is recruiting adults aged 18-65 from medical and community-based settings with acute diagnosis of mTBI. CREST will create a state-wide research dataset of mTBI cases, with data being collected in two phases. Phase I collates data on demographics, medical background, lifestyle habits, nature of injury and acute mTBI symptomatology. In Phase II, participants undergo neuropsychological evaluation, exercise tolerance and vestibular/ocular motor screening, MRI, quantitative electroencephalography and blood-based biomarker assessment. Follow-up is conducted via telephone interview at 1, 3, 6 and 12 months after injury. Primary outcome measures are presence of PPCS and quality of life, as measured by the Post-Concussion Symptom Scale and the Quality of Life after Brain Injury questionnaires, respectively. Multivariate modelling will examine the prognostic value of promising factors. ETHICS AND DISSEMINATION Human Research Ethics Committees of Royal Perth Hospital (#RGS0000003024), Curtin University (HRE2019-0209), Ramsay Health Care (#2009) and St John of God Health Care (#1628) have approved this study protocol. Findings will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER ACTRN12619001226190.
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Affiliation(s)
- Aleksandra Karolina Gozt
- Curtin Health Innovation Research Institute, Curtin University Faculty of Health Sciences, Bentley, Western Australia, Australia
- Perron Institute of Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Sarah Claire Hellewell
- Curtin Health Innovation Research Institute, Curtin University Faculty of Health Sciences, Bentley, Western Australia, Australia
| | - Jacinta Thorne
- Curtin Health Innovation Research Institute, Curtin University Faculty of Health Sciences, Bentley, Western Australia, Australia
| | - Elizabeth Thomas
- Centre for Clinical Research Excellence, School of Population Health, Curtin University, Bentley, Western Australia, Australia
- Division of Surgery, Faculty of Health & Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Francesca Buhagiar
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Shaun Markovic
- Australian Alzheimer's Research Foundation, Nedlands, Western Australia, Australia
- The Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
| | - Anoek Van Houselt
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Alexander Ring
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University Faculty of Health Sciences, Bentley, Western Australia, Australia
| | - Glenn Arendts
- Emergency Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia
| | - Ben Smedley
- Emergency Department, Rockingham General Hospital, Cooloongup, Western Australia, Australia
| | - Sjinene Van Schalkwyk
- Emergency Department, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Philip Brooks
- Emergency Department, Saint John of God Midland Public Hospital, Midland, Western Australia, Australia
- School of Medicine, The University of Notre Dame and Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - John Iliff
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
- Emergency Department, Saint John of God Hospital Murdoch, Murdoch, Western Australia, Australia
- Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
- Royal Flying Doctor Service- Western Operations, Jandakot, Western Australia, Australia
| | - Antonio Celenza
- Emergency Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Division of Emergency Medicine, School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - Ashes Mukherjee
- Emergency Department, Armadale Health Service, Mount Nasura, Western Australia, Australia
| | - Dan Xu
- Centre for Clinical Research Excellence, School of Population Health, Curtin University, Bentley, Western Australia, Australia
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Suzanne Robinson
- Centre for Clinical Research Excellence, School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Stephen Honeybul
- Statewide Director of Neurosurgery, Department of Health Government of Western Australia, Perth, Western Australia, Australia
- Head of Department, Sir Charles Gairdner Hospital, Royal Perth Hospital and Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Gill Cowen
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Melissa Licari
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
- Telethon Kids Institute, West Perth, Western Australia, Australia
| | - Michael Bynevelt
- Division of Surgery, School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
- The Neurological Intervention & Imaging Service of Western Australia at Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Carmela F Pestell
- Curtin Health Innovation Research Institute, Curtin University Faculty of Health Sciences, Bentley, Western Australia, Australia
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Daniel Fatovich
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia
- Emergency Medicine, Royal Perth Hospital, The University of Western Australia, Perth, Western Australia, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University Faculty of Health Sciences, Bentley, Western Australia, Australia
- Perron Institute of Neurological and Translational Science, Nedlands, Western Australia, Australia
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10
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Sun Y, Wang S, Gan S, Niu X, Yin B, Bai G, Yang X, Jia X, Bai L, Zhang M. Serum Neuron-Specific Enolase Levels Associated with Connectivity Alterations in Anterior Default Mode Network after Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:1495-1505. [PMID: 33687275 DOI: 10.1089/neu.2020.7372] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is the most prevalent neurological insult and leads to long-lasting cognitive impairment. Neuroimaging studies have discovered abnormalities in brain network connectivity following mTBI as the underlying neural basis of cognitive deficits. However, the pathophysiologic mechanisms involved in imaging alterations remain elusive. Proteins neuron-specific enolase (NSE) and ubiquitin C terminal hydrolase 1 are reliable markers for neuronal cell-body damage, both of which have been demonstrated to be increased in serum following mTBI. Therefore, we conducted a longitudinal study to examine relationships between abnormal brain network connectivity and serum neuronal biomarkers and their associations with cognitive recovery following mTBI. Sixty patients were followed-up at 1 week and 3 months post-injury and 41 controls were recruited. Resting-state functional magnetic resonance imaging was used to build a functional connectivity matrix within large-scale intrinsic networks, and their topological properties were analyzed using graph theory measures. We found that, compared with controls, mTBI patients showed significant decreases in a number of nodal characteristics in default mode network (DMN), salience network, and executive network (p < 0.05, false discovery rate corrected) at 3 months post-injury. Linear regression analysis found elevated serum NSE in acute phase could predict lower efficiency and degree centrality of anterior DMN at 3 months post-injury. In addition, efficiency and degree centrality of anterior DMN were negatively associated with working memory. Our study showed neuronal injury was associated with alterations in brain network connectivity after mTBI. These findings can facilitate capability to predict the brain functional outcomes and cognitive recovery in mTBI.
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Affiliation(s)
- Yingxiang Sun
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shan Wang
- Department of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Shuoqiu Gan
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Xuan Niu
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bo Yin
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guanghui Bai
- Department of Radiology, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xuefei Yang
- Department of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Xiaoyan Jia
- Department of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Lijun Bai
- Department of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Ming Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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11
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Abstract
Traumatic brain injury (TBI) affects millions of people around the world and amongst other effects, causes cognitive decline, neurodegenerative disease and increased risk of seizures and sensory disturbances. Excitotoxicity and apoptosis occur after TBI and are mediated through the N-methyl-D-aspartate (NMDA)-type glutamate receptor. Memantine is effective in blocking excessive activity of NMDA-type glutamate receptors and reduces the progression of dementia and may have benefits after TBI. Here, we performed a systematic review of the literature to evaluate whether memantine is effective in improving outcomes, including cognitive function in patients with TBI. Our search yielded only 4 randomized control trials (RCTs) that compared the effects of memantine to placebos, standard treatment protocols or piracetam. A single RCT reported that serum neuron-specific enolase (NSE) levels were significantly reduced (p = 0.009) in the memantine compared to the control group, and this coincided with reported significant day-to-day improvements in Glasgow Coma Scale (GCS) for patients receiving memantine. The remaining RCTs investigated the effects of memantine on cognitive function using 26 standardized tests for assessing cognition function. One RCT reported significant improvements in cognitive function across all domains whilst the other two RCTs, reported that patients in the memantine group underperformed in all cognitive outcome measures. This review shows that despite laboratory and clinical evidence reporting reduced serum NSE and improved GCS, supporting the existence of the neuroprotective properties, there is a lack of reported evidence from RCTs to suggest that memantine directly leads to cognitive improvements in TBI patients.
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12
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Shepley BR, Ainslie PN, Hoiland RL, Donnelly J, Sekhon MS, Zetterberg H, Blennow K, Bain AR. Negligible influence of moderate to severe hyperthermia on blood-brain barrier permeability and neuronal parenchymal integrity in healthy men. J Appl Physiol (1985) 2021; 130:792-800. [PMID: 33444119 DOI: 10.1152/japplphysiol.00645.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
With growing use for hyperthermia as a cardiovascular therapeutic, there is surprisingly little information regarding the acute effects it may have on the integrity of the neurovascular unit (NVU). Indeed, relying on animal data would suggest hyperthermia comparable to levels attained in thermal therapy will disrupt the blood-brain barrier (BBB) and damage the cerebral parenchymal cells. We sought to address the hypothesis that controlled passive hyperthermia is not sufficient to damage the NVU in healthy humans. Young men (n = 11) underwent acute passive heating until +2°C or absolute esophageal temperature of 39.5°C. The presence of BBB opening was determined by trans-cerebral exchange kinetics (radial-arterial and jugular venous cannulation) of S100B. Neuronal parenchymal damage was determined by the trans-cerebral exchange of tau protein, neuron-specific enolase (NSE), and neurofilament-light protein (NF-L). Cerebral blood flow to calculate exchange kinetics was measured by duplex ultrasound of the right internal carotid and left vertebral artery. Passive heating was performed via a warm-water perfused suit. In hyperthermia, there was no increase in the cerebral exchange of S100B (P = 0.327), tau protein (P = 0.626), NF-L (P = 0.447), or NSE (P = 0.908) suggesting the +2°C core temperature is not sufficient to acutely stress the NVU in healthy men. However, there was a significant condition effect (P = 0.028) of NSE, corresponding to a significant increase in arterial (P = 0.023) but not venous (P = 0.173) concentrations in hyperthermia, potentially indicating extra-cerebral release of NSE. Collectively, results from the present study support the notion that in young men there is little concern for NVU damage with acute hyperthermia of +2 °C.NEW & NOTEWORTHY The acute effects of passive whole-body hyperthermia on the integrity of the neurovascular unit (NVU) in humans have remained unclear. We demonstrate that passive heating for ∼1 h until an increase of +2°C esophageal temperature in healthy men does not increase the cerebral release of neuronal parenchymal stress biomarkers, suggesting the NVU integrity is maintained. This preliminary study indicates passive heating is safe for the brain, at least in young healthy men.
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Affiliation(s)
- Brooke R Shepley
- University of Windsor, Faculty of Human Kinetics, Department of Kinesiology, Windsor, ON, Canada
| | - Philip N Ainslie
- University of British Columbia, Kelowna, Centre for Heart Lung and Vascular Health, Vancouver, BC, Canada
| | - Ryan L Hoiland
- University of British Columbia, Kelowna, Centre for Heart Lung and Vascular Health, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, Vancouver General Hospital, Vancouver, BC, Canada
| | - Joseph Donnelly
- Brain Physics Laboratory, Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Mypinder S Sekhon
- University of British Columbia, Kelowna, Centre for Heart Lung and Vascular Health, Vancouver, BC, Canada.,Division of Critical Care Medicine and Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Anthony R Bain
- University of Windsor, Faculty of Human Kinetics, Department of Kinesiology, Windsor, ON, Canada
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13
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Buhagiar F, Fitzgerald M, Bell J, Allanson F, Pestell C. Neuromodulation for Mild Traumatic Brain Injury Rehabilitation: A Systematic Review. Front Hum Neurosci 2020; 14:598208. [PMID: 33362494 PMCID: PMC7759622 DOI: 10.3389/fnhum.2020.598208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/20/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Mild traumatic brain injury (mTBI) results from an external force to the head or body causing neurophysiological changes within the brain. The number and severity of symptoms can vary, with some individuals experiencing rapid recovery, and others having persistent symptoms for months to years, impacting their quality of life. Current rehabilitation is limited in its ability to treat persistent symptoms and novel approaches are being sought to improve outcomes following mTBI. Neuromodulation is one technique used to encourage adaptive neuroplasticity within the brain. Objective: To systematically review the literature on the efficacy of neuromodulation in the mTBI population. Method: A systematic review was conducted using Medline, Embase, PsycINFO, PsycARTICLES and EBM Review. Preferred Reporting Items for Systematic Reviews and the Synthesis Without Meta-analysis reporting guidelines were used and a narrative review of the selected studies was completed. Fourteen articles fulfilled the inclusion criteria which were published in English, investigating an adult sample and using a pre- and post-intervention design. Studies were excluded if they included non-mild TBI severities, pediatric or older adult populations. Results: Thirteen of fourteen studies reported positive reductions in mTBI symptomatology following neuromodulation. Specifically, improvements were reported in post-concussion symptom ratings, headaches, dizziness, depression, anxiety, sleep disturbance, general disability, cognition, return to work and quality of life. Normalization of working memory activation patterns, vestibular field potentials, hemodynamics of the dorsolateral prefrontal cortex and excessive delta wave activity were also seen. The studies reviewed had several methodological limitations including small, heterogenous samples and varied intervention protocols, limiting generalisability. Further research is required to understand the context in which neuromodulation may be beneficial. Conclusions: While these positive effects are observed, limitations included unequal representation of neuromodulation modalities in the literature, and lack of literature describing the efficacy of neuromodulation on the development or duration of persistent mTBI symptoms. Better clarity regarding neuromodulation efficacy could have a significant impact on mTBI patients, researchers, clinicians, and policy makers, facilitating a more productive post-mTBI population. Despite the limitations, the literature indicates that neuromodulation warrants further investigation. PROSPERO registration number: CRD42020161279.
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Affiliation(s)
- Francesca Buhagiar
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Sarich Neuroscience Research Institute, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute Building, Nedlands, WA, Australia
| | - Jason Bell
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Fiona Allanson
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Carmela Pestell
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
- Curtin University, Perth, WA, Australia
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14
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Lippa SM, Werner JK, Miller MC, Gill JM, Diaz-Arrastia R, Kenney K. Recent Advances in Blood-Based Biomarkers of Remote Combat-Related Traumatic Brain Injury. Curr Neurol Neurosci Rep 2020; 20:54. [PMID: 32984931 DOI: 10.1007/s11910-020-01076-w] [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] [Accepted: 09/17/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Traumatic brain injury (TBI) is highly prevalent among service members and Veterans (SMVs) and associated with changes in blood-based biomarkers. This manuscript reviews candidate biomarkers months/years following military-associated TBI. RECENT FINDINGS Several blood-based biomarkers have been investigated for diagnostic or prognostic use to inform care years after military-associated TBI. The most promising include increased levels of plasma/serum and exosomal proteins reflecting neuronal, axonal and/or vascular injury, and inflammation, as well as altered microRNA expression and auto-antibodies of central nervous system markers. Diagnostic and prognostic biomarkers of remote TBI outcomes remain in the discovery phase. Current evidence does not yet support single or combination biomarkers for clinical diagnostic use remotely after injury, but there are promising candidates that require validation in larger, longitudinal studies. The use of prognostic biomarkers of future neurodegeneration, however, holds much promise and could improve treatments and/or preventive measures for serious TBI outcomes.
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Affiliation(s)
- Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - J Kent Werner
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Sleep Medicine, WRNMMC, Bethesda, MD, USA.,CNRM, USUHS, Bethesda, MD, USA
| | - Matthew C Miller
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jessica M Gill
- CNRM, USUHS, Bethesda, MD, USA.,Brain Tissue Injury, NINR, NIH, Bethesda, MD, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA. .,Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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15
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Use of Blood Biomarkers in the Assessment of Sports-Related Concussion-A Systematic Review in the Context of Their Biological Significance. Clin J Sport Med 2018; 28:561-571. [PMID: 29035978 DOI: 10.1097/jsm.0000000000000478] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To critically review current knowledge on the positive and negative predictive value of blood biomarkers for concussion; to illustrate the clinical and biological contexts that help evaluate the use of these markers in sport-related traumatic brain injuries (TBIs). METHODS This systematic review was performed in accordance with PRISMA guidelines. We reviewed the measurement, clinical utility, endpoint, and biological significance of blood biomarkers in concussion. RESULTS A total of 4352 publications were identified. Twenty-six articles relating to blood biomarkers were included in the review. Four common blood biomarkers, namely S100B, tau, neuron-specific enolase (NSE), and glial fibrillary acidic protein (GFAP), were examined. Overall, the studies showed S100B measurement and use, either acutely or at several time points, can distinguish injured from noninjured patients with an uncertain degree of utility in predicting mortality. At present, S100B has largely become an acceptable biomarker of TBI; however, studies have begun to highlight the need to incorporate clinical symptoms instead of S100B concentration in isolation on the basis of inconsistent results and lack of specificity across published studies. Further research is needed to evaluate and validate the use of tau, NSE, and GFAP as a diagnostic aid in the management of concussion and TBI. CONCLUSIONS At present, blood biomarkers have only a limited role in the evaluation and management of concussion. Although several biomarkers of brain injury have been identified, continued research is required. S100B holds promise as the most clinically useful diagnostic biomarker. Blood biomarkers, in combination with other clinical data, such as head computed tomography, would maximize the diagnostic accuracy. The methodological limitations evident in blood biomarker research results in the need for the clinical utility of blood biomarker use in concussion to be further explored.
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16
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Karnati HK, Garcia JH, Tweedie D, Becker RE, Kapogiannis D, Greig NH. Neuronal Enriched Extracellular Vesicle Proteins as Biomarkers for Traumatic Brain Injury. J Neurotrauma 2018; 36:975-987. [PMID: 30039737 DOI: 10.1089/neu.2018.5898] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Traumatic brain injury (TBI) is a major cause of injury-related death throughout the world and lacks effective treatment. Surviving TBI patients often develop neuropsychiatric symptoms, and the molecular mechanisms underlying the neuronal damage and recovery following TBI are not well understood. Extracellular vesicles (EVs) are membranous nanoparticles that are divided into exosomes (originating in the endosomal/multi-vesicular body [MVB] system) and microvesicles (larger EVs produced through budding of the plasma membrane). Both types of EVs are generated by all cells and are secreted into the extracellular environment, and participate in cell-to-cell communication and protein and RNA delivery. EVs enriched for neuronal origin can be harvested from peripheral blood samples and their contents quantitatively examined as a window to follow potential changes occurring in brain. Recent studies suggest that the levels of exosomal proteins and microRNAs (miRNAs) may represent novel biomarkers to support the clinical diagnosis and potential response to treatment for neurological disorders. In this review, we focus on the biogenesis of EVs, their molecular composition, and recent advances in research of their contents as potential diagnostic tools for TBI.
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Affiliation(s)
- Hanuma Kumar Karnati
- 1 Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Joseph H Garcia
- 1 Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - David Tweedie
- 1 Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Robert E Becker
- 1 Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland.,2 Aristea Translational Medicine Corporation, Park City, Utah
| | - Dimitrios Kapogiannis
- 3 Laboratory of Neurosciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Nigel H Greig
- 1 Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
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17
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Spotlight on Neurotrauma Research in Canada's Leading Academic Centers. J Neurotrauma 2018; 35:1986-2004. [PMID: 30074875 DOI: 10.1089/neu.2018.29017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Di Pietro V, Yakoub KM, Scarpa U, Di Pietro C, Belli A. MicroRNA Signature of Traumatic Brain Injury: From the Biomarker Discovery to the Point-of-Care. Front Neurol 2018; 9:429. [PMID: 29963002 PMCID: PMC6010584 DOI: 10.3389/fneur.2018.00429] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022] Open
Abstract
Traumatic brain injury (TBI) is a serious problem that causes high morbidity and mortality around the world. Currently, no reliable biomarkers are used to assess the severity and predict the recovery. Many protein biomarkers were extensively studied for diagnosis and prognosis of different TBI severities such as S-100β, glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), neurofilament light chain (NFL), cleaved tau protein (C-tau), and ubiquitin C-terminal hydrolase-L1 (UCH-L1). However, none of these candidates is currently used in the clinical practice, due to relatively low sensitivity, for the diagnosis of mild TBI (mTBI) or mild to moderate TBI (MMTBI) patients who are clinically well and do not have a detectable intracranial pathology on the scans. MicroRNAs (miRNAs or miRs) are a class of small endogenous molecular regulators, which showed to be altered in different pathologies, including TBI and for this reason, their potential role in diagnosis, prognosis and therapeutic applications, is explored. Promising miRNAs such as miR-21, miR-16 or let-7i were identified as suitable candidate biomarkers for TBI and can differentiate mild from severe TBI. Also, they might represent new potential therapeutic targets. Identification of miRNA signature in tissue or biofluids, for several pathological conditions, is now possible thanks to the introduction of new high-throughput technologies such as microarray platform, Nanostring technologies or Next Generation Sequencing. This review has the aim to describe the role of microRNA in TBI and to explore the most commonly used techniques to identify microRNA profile. Understanding the strengths and limitations of the different methods can aid in the practical use of miRNA profiling for diverse clinical applications, including the development of a point-of-care device.
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Affiliation(s)
- Valentina Di Pietro
- Neurotrauma and Ophthalmology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Surgical Reconstruction and Microbiology Research Centre, National Institute for Health Research, Queen Elizabeth Hospital, Birmingham, United Kingdom.,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Illinois, IL, United States
| | - Kamal M Yakoub
- Surgical Reconstruction and Microbiology Research Centre, National Institute for Health Research, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Ugo Scarpa
- Surgical Reconstruction and Microbiology Research Centre, National Institute for Health Research, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Cinzia Di Pietro
- BioMolecular, Genome and Complex Systems BioMedicine Unit, Section of Biology and Genetics G Sichel, Department of Biomedical Sciences and Biotechnology, University of Catania, Catania, Italy
| | - Antonio Belli
- Neurotrauma and Ophthalmology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Surgical Reconstruction and Microbiology Research Centre, National Institute for Health Research, Queen Elizabeth Hospital, Birmingham, United Kingdom
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19
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Awwad HO, Durand CD, Gonzalez LP, Tompkins P, Zhang Y, Lerner MR, Brackett DJ, Sherry DM, Awasthi V, Standifer KM. Post-blast treatment with Nociceptin/Orphanin FQ peptide (NOP) receptor antagonist reduces brain injury-induced hypoxia and signaling proteins in vestibulomotor-related brain regions. Behav Brain Res 2018; 340:183-194. [PMID: 27793733 DOI: 10.1016/j.bbr.2016.10.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/17/2016] [Accepted: 10/24/2016] [Indexed: 12/14/2022]
Abstract
Mild traumatic brain injury (mTBI) diagnoses have increased due to aggressive sports and blast-related injuries, but the cellular mechanisms and pathology underlying mTBI are not completely understood. Previous reports indicate that Nociceptin Orphanin/FQ (N/OFQ), an endogenous neuropeptide, contributes to post-injury ischemia following mechanical brain injury, yet its specific role in cerebral hypoxia, vestibulomotor function and injury marker expression following blast-induced TBI is not known. This study is the first to identify a direct association of N/OFQ and its N/OFQ peptide (NOP) receptor with TBI-induced changes following a single 80psi head blast exposure in male rats. N/OFQ and NOP receptor expression increased in brain tissue and plasma following TBI, concurrent with vestibular dysfunction but preceding hypoxia and appearance of injury markers compared to sham rats. A single post-blast treatment with the NOP receptor antagonist, SB-612111, transiently improved acute vestibulomotor performance. It also prevented increases in markers of TBI-induced hypoxia, pro-apoptotic proteins and injury seen 8-10days post-blast. This study reveals an apparent role for the N/OFQ-NOP receptor system in blast TBI and suggests potential therapeutic utility of NOP receptor antagonists for mTBI.
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Affiliation(s)
- Hibah O Awwad
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Oklahoma Center for Neuroscience, Oklahoma City, OK, USA.
| | - Cindy D Durand
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Larry P Gonzalez
- Oklahoma Center for Neuroscience, Oklahoma City, OK, USA; Department of Psychiatry & Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Paul Tompkins
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Yong Zhang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Oklahoma Center for Neuroscience, Oklahoma City, OK, USA
| | - Megan R Lerner
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA; Oklahoma city VA Medical Center, Oklahoma City, OK 73117, USA
| | - Daniel J Brackett
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - David M Sherry
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Oklahoma Center for Neuroscience, Oklahoma City, OK, USA; Department of Cell Biology, College of Medicine, University of Oklahoma Health Sciences Center, USA
| | - Vibhudutta Awasthi
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kelly M Standifer
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Oklahoma Center for Neuroscience, Oklahoma City, OK, USA; Department of Cell Biology, College of Medicine, University of Oklahoma Health Sciences Center, USA
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Wang KK, Yang Z, Zhu T, Shi Y, Rubenstein R, Tyndall JA, Manley GT. An update on diagnostic and prognostic biomarkers for traumatic brain injury. Expert Rev Mol Diagn 2018; 18:165-180. [PMID: 29338452 PMCID: PMC6359936 DOI: 10.1080/14737159.2018.1428089] [Citation(s) in RCA: 298] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major worldwide neurological disorder of epidemic proportions. To date, there are still no FDA-approved therapies to treat any forms of TBI. Encouragingly, there are emerging data showing that biofluid-based TBI biomarker tests have the potential to diagnose the presence of TBI of different severities including concussion, and to predict outcome. Areas covered: The authors provide an update on the current knowledge of TBI biomarkers, including protein biomarkers for neuronal cell body injury (UCH-L1, NSE), astroglial injury (GFAP, S100B), neuronal cell death (αII-spectrin breakdown products), axonal injury (NF proteins), white matter injury (MBP), post-injury neurodegeneration (total Tau and phospho-Tau), post-injury autoimmune response (brain antigen-targeting autoantibodies), and other emerging non-protein biomarkers. The authors discuss biomarker evidence in TBI diagnosis, outcome prognosis and possible identification of post-TBI neurodegernative diseases (e.g. chronic traumatic encephalopathy and Alzheimer's disease), and as theranostic tools in pre-clinical and clinical settings. Expert commentary: A spectrum of biomarkers is now at or near the stage of formal clinical validation of their diagnostic and prognostic utilities in the management of TBI of varied severities including concussions. TBI biomarkers could serve as a theranostic tool in facilitating drug development and treatment monitoring.
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Affiliation(s)
- Kevin K Wang
- a Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Emergency Medicine, Psychiatry, Neuroscience and Chemistry , University of Florida , Gainesville , Florida , USA
| | - Zhihui Yang
- a Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Emergency Medicine, Psychiatry, Neuroscience and Chemistry , University of Florida , Gainesville , Florida , USA
| | - Tian Zhu
- a Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Emergency Medicine, Psychiatry, Neuroscience and Chemistry , University of Florida , Gainesville , Florida , USA
| | - Yuan Shi
- b Department Of Pediatrics, Daping Hospital, Chongqing , Third Military Medical University , Chongqing , China
| | - Richard Rubenstein
- c Laboratory of Neurodegenerative Diseases and CNS Biomarker Discovery, Departments of Neurology and Physiology/Pharmacology , SUNY Downstate Medical Center , Brooklyn , NY , USA
| | - J Adrian Tyndall
- d Department of Emergency Medicine , University of Florida , Gainesville , Florida , USA
| | - Geoff T Manley
- e Brain and Spinal Injury Center , San Francisco General Hospital , San Francisco , CA , USA
- f Department of Neurological Surgery , University of California, San Francisco , San Francisco , CA , USA
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Mercier E, Tardif PA, Cameron PA, Batomen Kuimi BL, Émond M, Moore L, Mitra B, Frenette J, De Guise E, Ouellet MC, Bordeleau M, Le Sage N. Prognostic Value of S-100β Protein for Prediction of Post-Concussion Symptoms after a Mild Traumatic Brain Injury: Systematic Review and Meta-Analysis. J Neurotrauma 2018; 35:609-622. [PMID: 28969486 DOI: 10.1089/neu.2017.5013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This systematic review and meta-analysis aimed to determine the prognostic value of S-100β protein to identify patients with post-concussion symptoms after a mild traumatic brain injury (mTBI). A search strategy was submitted to seven databases from their inception to October 2016. Individual patient data were requested. Cohort studies evaluating the association between S-100β protein level and post-concussion symptoms assessed at least seven days after the mTBI were considered. Outcomes were dichotomized as persistent (≥3 months) or early (≥7 days <3 months). Our search strategy yielded 23,298 citations of which 29 studies including between seven and 223 patients (n = 2505) were included. Post-concussion syndrome (PCS) (16 studies) and neuropsychological symptoms (9 studies) were the most frequently assessed outcomes. The odds of having persistent PCS (odds ratio [OR] 0.62, 95% confidence interval [CI]: 0.34-1.12, p = 0.11, I2 0% [n = five studies]) in patients with an elevated S-100β protein serum level were not significantly different from those of patients with normal values while the odds of having early PCS (OR 1.67, 95% CI: 0.98-2.85, p = 0.06, I2 38% [n = five studies]) were close to statistical significance. Similarly, having an elevated S-100β protein serum level was not associated with the odds of returning to work at six months (OR 2.31, 95% CI: 0.50-10.64, p = 0.28, I2 22% [n = two studies]). Overall risk of bias was considered moderate. Results suggest that the prognostic biomarker S-100β protein has a low clinical value to identify patients at risk of persistent post-concussion symptoms. Variability in injury to S-100ß protein sample time, mTBI populations, and outcomes assessed could potentially explain the lack of association and needs further evaluation.
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Affiliation(s)
- Eric Mercier
- 1 Département de Médecine Familiale et Médecine d'Urgence, Faculté de Médecine, Université Laval , Québec, Canada .,2 Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec, Université Laval , Québec, Canada .,3 Emergency and Trauma Centre, The Alfred Hospital , Alfred Health, Australia .,4 School of Public Health and Preventive Medicine, Monash University , Melbourne, Victoria, Australia
| | - Pier-Alexandre Tardif
- 2 Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec, Université Laval , Québec, Canada
| | - Peter A Cameron
- 3 Emergency and Trauma Centre, The Alfred Hospital , Alfred Health, Australia .,4 School of Public Health and Preventive Medicine, Monash University , Melbourne, Victoria, Australia .,5 National Trauma Research Institute , The Alfred Hospital, Melbourne, Victoria, Australia
| | - Brice Lionel Batomen Kuimi
- 2 Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec, Université Laval , Québec, Canada
| | - Marcel Émond
- 1 Département de Médecine Familiale et Médecine d'Urgence, Faculté de Médecine, Université Laval , Québec, Canada .,6 Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Vieillissement, Centre de recherche du CHU de Québec, Université Laval , Québec, Canada
| | - Lynne Moore
- 2 Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec, Université Laval , Québec, Canada .,6 Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Vieillissement, Centre de recherche du CHU de Québec, Université Laval , Québec, Canada .,7 Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval , Québec, Canada
| | - Biswadev Mitra
- 3 Emergency and Trauma Centre, The Alfred Hospital , Alfred Health, Australia .,4 School of Public Health and Preventive Medicine, Monash University , Melbourne, Victoria, Australia .,5 National Trauma Research Institute , The Alfred Hospital, Melbourne, Victoria, Australia
| | - Jérôme Frenette
- 8 Centre de Recherche et Centre Hospitalier Universitaire de Québec , Québec, Canada
| | - Elaine De Guise
- 9 Research-Institute, McGill University Health Centre , Montreal, Québec, Canada .,10 Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montréal , Québec, Canada
| | - Marie-Christine Ouellet
- 2 Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec, Université Laval , Québec, Canada .,8 Centre de Recherche et Centre Hospitalier Universitaire de Québec , Québec, Canada
| | - Martine Bordeleau
- 2 Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec, Université Laval , Québec, Canada
| | - Natalie Le Sage
- 1 Département de Médecine Familiale et Médecine d'Urgence, Faculté de Médecine, Université Laval , Québec, Canada .,2 Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec, Université Laval , Québec, Canada
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22
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Peacock WF, Van Meter TE, Mirshahi N, Ferber K, Gerwien R, Rao V, Sair HI, Diaz-Arrastia R, Korley FK. Derivation of a Three Biomarker Panel to Improve Diagnosis in Patients with Mild Traumatic Brain Injury. Front Neurol 2017; 8:641. [PMID: 29250027 PMCID: PMC5714862 DOI: 10.3389/fneur.2017.00641] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/15/2017] [Indexed: 12/21/2022] Open
Abstract
Background Nearly 5 million emergency department (ED) visits for head injury occur each year in the United States, of which <10% of patients show abnormal computed tomography (CT) findings. CT negative patients frequently suffer protracted somatic, behavioral, and neurocognitive dysfunction. Our goal was to evaluate biomarkers to identify mild TBI (mTBI) in patients with suspected head injury. Methods An observational ED study of head-injured and control patients was conducted at Johns Hopkins University (HeadSMART). Head CT was obtained (ACEP criteria) in patients with Glasgow Coma Scale scores of 13–15 and aged 18–80. Three candidate biomarker proteins, neurogranin (NRGN), neuron-specific enolase (NSE), and metallothionein 3 (MT3), were evaluated by immunoassay (samples <24 h from injury). American Congress of Rehabilitation Medicine (ACRM) criteria were used for diagnosis of mTBI patients for model building. Univariate analysis, logistic regression, and random forest (RF) algorithms were used for data analysis in R. Overall, 662 patients were studied. Statistical models were built using 328 healthy controls and 179 mTBI patients. Results Median time from injury was 5.9 h (IQR, 4.0; range 0.8–24 h). mTBI patients had elevated NSE, but decreased MT3 versus controls (p < 0.01 for each). NRGN was also elevated but within 2–6 h after injury. In the derivation set, the best model to distinguish mTBI from healthy controls used three markers, age, and sex as covariates (C-statistic = 0.91, sensitivity 98%, specificity 72%). Panel test accuracy was validated with the 155 remaining ACRM+ mTBI patients. Applying the RF model to the ACRM+ mTBI validation set resulted in 78% correctly classified as mTBI (119/153). CT positive and CT negative validation subsets were 91% and 75% correctly classified. In samples taken <2 h from injury, 100% (10/10) samples classified correctly, indicating that hyperacute testing is possible with these biomarker assays. The model accuracy varied from 72–100% overall, and had greater accuracy with increasing severity, as shown by comparing CT+ with CT− (91% versus 75%), and Injury Severity Score ≥16 versus <16 (88% versus 72%, respectively). Objective blood tests, detecting NRGN, NSE, and MT3, can be used to identify mTBI, irrespective of neuroimaging findings.
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Affiliation(s)
- W Frank Peacock
- Department of Emergency Medicine, Ben Taub Hospital, Houston, TX, United States
| | - Timothy E Van Meter
- Program for Neurological Diseases, ImmunArray, Inc., Richmond, VA, United States
| | - Nazanin Mirshahi
- Program for Neurological Diseases, ImmunArray, Inc., Richmond, VA, United States
| | - Kyle Ferber
- Program for Neurological Diseases, ImmunArray, Inc., Richmond, VA, United States
| | - Robert Gerwien
- Gerwien Statistical Consulting, Newington, CT, United States
| | - Vani Rao
- Department of Psychiatry and Behavioral Science, Johns Hopkins Bayview Medical Center, Baltimore, MD, United States
| | - Haris Iqbal Sair
- Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Ramon Diaz-Arrastia
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, PA, United States
| | - Frederick K Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
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23
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Mercier E, Tardif PA, Cameron PA, Émond M, Moore L, Mitra B, Ouellet MC, Frenette J, de Guise E, Le Sage N. Prognostic value of neuron-specific enolase (NSE) for prediction of post-concussion symptoms following a mild traumatic brain injury: a systematic review. Brain Inj 2017; 32:29-40. [PMID: 29157007 DOI: 10.1080/02699052.2017.1385097] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND This systematic review aimed to determine the prognostic value of neuron-specific enolase (NSE) to predict post-concussion symptoms following mild traumatic brain injury (TBI). METHODS Seven databases were searched for studies evaluating the association between NSE levels and post-concussion symptoms assessed ≥ 3 months (persistent) or ≥ 7 days < 3 months (early) after mild TBI. Two researchers independently screened studies for inclusion, extracted data and appraised quality using the Quality in Prognostic Studies (QUIPS) tool. RESULTS The search strategy yielded a total of 23,298 citations from which 8 cohorts presented in 10 studies were included. Studies included between 45 and 141 patients (total 608 patients). The outcomes most frequently assessed were post-concussion syndrome (PCS, 12 assessments) and neuropsychological performance deficits (10 assessments). No association was found between an elevated NSE serum level and PCS. Only one study reported a statistically significant association between a higher NSE serum level and alteration of at least three cognitive domains at 2 weeks but this association was no longer significant at 6 weeks. Overall, risk of bias of the included studies was considered moderate. CONCLUSIONS Early NSE serum level is not a strong independent predictor of post-concussion symptoms following mild TBI.
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Affiliation(s)
- Eric Mercier
- a Département de Médecine Familiale et Médecine d'Urgence, Faculté de Médecine , Université Laval , Québec , Canada.,b Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec , Université Laval , Québec , Canada.,c Emergency and Trauma Centre , The Alfred Hospital, Alfred Health , Melbourne , Australia.,d School of Public Health and Preventive Medicine , Monash University , Melbourne , Australia
| | - Pier-Alexandre Tardif
- b Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec , Université Laval , Québec , Canada
| | - Peter A Cameron
- c Emergency and Trauma Centre , The Alfred Hospital, Alfred Health , Melbourne , Australia.,d School of Public Health and Preventive Medicine , Monash University , Melbourne , Australia.,e National Trauma Research Institute , The Alfred Hospital , Melbourne , VIC , Australia
| | - Marcel Émond
- a Département de Médecine Familiale et Médecine d'Urgence, Faculté de Médecine , Université Laval , Québec , Canada.,b Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec , Université Laval , Québec , Canada.,f Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Vieillissement, Centre de recherche du CHU de Québec , Université Laval , Québec , Canada
| | - Lynne Moore
- b Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec , Université Laval , Québec , Canada.,g Département de Médecine Sociale et Préventive, Faculté de Médecine , Université Laval , Québec , Canada
| | - Biswadev Mitra
- c Emergency and Trauma Centre , The Alfred Hospital, Alfred Health , Melbourne , Australia.,d School of Public Health and Preventive Medicine , Monash University , Melbourne , Australia.,e National Trauma Research Institute , The Alfred Hospital , Melbourne , VIC , Australia
| | - Marie-Christine Ouellet
- b Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec , Université Laval , Québec , Canada.,h Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS) , Québec , Québec , Canada
| | - Jérôme Frenette
- h Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS) , Québec , Québec , Canada
| | - Elaine de Guise
- i Research-Institute , McGill University Health Centre , Montreal , Québec , Canada.,j Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) , Montréal , Québec , Canada
| | - Natalie Le Sage
- a Département de Médecine Familiale et Médecine d'Urgence, Faculté de Médecine , Université Laval , Québec , Canada.,b Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec , Université Laval , Québec , Canada
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Nelson LD, Furger RE, Ranson J, Tarima S, Hammeke TA, Randolph C, Barr WB, Guskiewicz K, Olsen CM, Lerner EB, McCrea MA. Acute Clinical Predictors of Symptom Recovery in Emergency Department Patients with Uncomplicated Mild Traumatic Brain Injury or Non-Traumatic Brain Injuries. J Neurotrauma 2017; 35:249-259. [PMID: 29017409 DOI: 10.1089/neu.2017.4988] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
There is a subset of patients with mild traumatic brain injury (mTBI) who report persistent symptoms that impair their functioning and quality of life. Being able to predict which patients will experience prolonged symptom recovery would help clinicians target resources for clinical follow-up to those most in need, and would facilitate research to develop precision medicine treatments for mTBI. The purpose of this study was to investigate the predictors of symptom recovery in a prospective sample of emergency department trauma patients with either mTBI or non-mTBI injuries. Subjects were examined at several time points from within 72 h to 45 days post-injury. We quantified and compared the value of a variety of demographic, injury, and clinical assessment (symptom, neurocognitive) variables for predicting self-reported symptom duration in both mTBI (n = 89) and trauma control (n = 73) patients. Several injury-related and neuropsychological variables assessed acutely (< 72 h) post-injury predicted symptom duration, particularly loss of consciousness (mTBI group), acute somatic symptom burden (both groups), and acute reaction time (both groups), with reasonably good model fit when including all of these variables (area under the receiver operating characteristic curve [AUC] = 0.76). Incorporating self-reported litigation involvement modestly increased prediction further (AUC = 0.80). The results highlight the multifactorial nature of mTBI recovery, and injury recovery more generally, and the need to incorporate a variety of variables to achieve adequate prediction. Further research to improve this model and validate it in new and more diverse trauma samples will be useful to build a neurobiopsychosocial model of recovery that informs treatment development.
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Affiliation(s)
- Lindsay D Nelson
- 1 Department of Neurosurgery and Neuroscience Research Center, Medical College of Wisconsin , Milwaukee, Wisconsin.,2 Department of Neurology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Robyn E Furger
- 1 Department of Neurosurgery and Neuroscience Research Center, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Jana Ranson
- 1 Department of Neurosurgery and Neuroscience Research Center, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Sergey Tarima
- 3 Division of Biostatistics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Thomas A Hammeke
- 4 Department of Psychiatry, Medical College of Wisconsin , Milwaukee, Wisconsin
| | | | - William B Barr
- 6 Department of Neurology, New York University School of Medicine , New York, New York
| | - Kevin Guskiewicz
- 7 Departments of Exercise and Sport Science & Orthopedics, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Christopher M Olsen
- 8 Neuroscience Research Center and Department of Pharmacology and Toxicology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - E Brooke Lerner
- 9 Department of Emergency Medicine, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Michael A McCrea
- 1 Department of Neurosurgery and Neuroscience Research Center, Medical College of Wisconsin , Milwaukee, Wisconsin.,2 Department of Neurology, Medical College of Wisconsin , Milwaukee, Wisconsin
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Mercier E, Tardif PA, Emond M, Ouellet MC, de Guise É, Mitra B, Cameron P, Le Sage N. Characteristics of patients included and enrolled in studies on the prognostic value of serum biomarkers for prediction of postconcussion symptoms following a mild traumatic brain injury: a systematic review. BMJ Open 2017; 7:e017848. [PMID: 28963310 PMCID: PMC5623519 DOI: 10.1136/bmjopen-2017-017848] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Mild traumatic brain injury (mTBI) has been insufficiently researched, and its definition remains elusive. Investigators are confronted by heterogeneity in patients, mechanism of injury and outcomes. Findings are thus often limited in generalisability and clinical application. Serum protein biomarkers are increasingly assessed to enhance prognostication of outcomes, but their translation into clinical practice has yet to be achieved. A systematic review was performed to describe the adult populations included and enrolled in studies that evaluated the prognostic value of protein biomarkers to predict postconcussion symptoms following an mTBI. DATA SOURCES Searches of MEDLINE, Embase, CENTRAL, CINAHL, Web of Science, PsycBITE and PsycINFO up to October 2016. DATA SELECTION AND EXTRACTION Two reviewers independently screened for potentially eligible studies, extracted data and assessed the overall quality of evidence by outcome using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS A total of 23 298 citations were obtained from which 166 manuscripts were reviewed. Thirty-six cohort studies (2812 patients) having enrolled between 7 and 311 patients (median 89) fulfilled our inclusion criteria. Most studies excluded patients based on advanced age (n=10 (28%)), neurological disorders (n=20 (56%)), psychiatric disorders (n=17 (47%)), substance abuse disorders (n=13 (36%)) or previous traumatic brain injury (n=10 (28%)). Twenty-one studies (58%) used at least two of these exclusion criteria. The pooled mean age of included patients was 39.3 (SD 4.6) years old (34 studies). The criteria used to define a mTBI were inconsistent. The most frequently reported outcome was postconcussion syndrome using the Rivermead Post-Concussion Symptoms Questionnaire (n=18 (50%)) with follow-ups ranging from 7 days to 5 years after the mTBI. CONCLUSIONS Most studies have recruited samples that are not representative and generalisable to the mTBI population. These exclusion criteria limit the potential use and translation of promising serum protein biomarkers to predict postconcussion symptoms.
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Affiliation(s)
- Eric Mercier
- Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec, Université Laval, Quebec, Canada
- Département de Médecine Familiale et Médecine d’Urgence, Faculté de Médecine, Université Laval, Quebec, Canada
- Emergency and Trauma Centre, The Alfred Hospital, Alfred Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Pier-Alexandre Tardif
- Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec, Université Laval, Quebec, Canada
| | - Marcel Emond
- Département de Médecine Familiale et Médecine d’Urgence, Faculté de Médecine, Université Laval, Quebec, Canada
- Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Vieillissement, Centre de recherche du CHU de Québec, Université Laval, Quebec, Canada
| | - Marie-Christine Ouellet
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Quebec, Canada
| | - Élaine de Guise
- Research-Institute, McGill University Health Centre, Quebec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Quebec, Canada
| | - Biswadev Mitra
- Emergency and Trauma Centre, The Alfred Hospital, Alfred Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter Cameron
- Emergency and Trauma Centre, The Alfred Hospital, Alfred Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Natalie Le Sage
- Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec, Université Laval, Quebec, Canada
- Département de Médecine Familiale et Médecine d’Urgence, Faculté de Médecine, Université Laval, Quebec, Canada
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Foks KA, Cnossen MC, Dippel DW, Maas AI, Menon D, van der Naalt J, Steyerberg EW, Lingsma HF, Polinder S, on behalf of CENTER-TBI investigato. Management of Mild Traumatic Brain Injury at the Emergency Department and Hospital Admission in Europe: A Survey of 71 Neurotrauma Centers Participating in the CENTER-TBI Study. J Neurotrauma 2017; 34:2529-2535. [DOI: 10.1089/neu.2016.4919] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kelly A. Foks
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maryse C. Cnossen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Diederik W.J. Dippel
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Andrew I.R. Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - David Menon
- Division of Anaesthesia, University of Cambridge/Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Joukje van der Naalt
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hester F. Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Abou-El-Hassan H, Dia B, Choucair K, Eid SA, Najdi F, Baki L, Talih F, Eid AA, Kobeissy F. Traumatic brain injury, diabetic neuropathy and altered-psychiatric health: The fateful triangle. Med Hypotheses 2017; 108:69-80. [PMID: 29055405 DOI: 10.1016/j.mehy.2017.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 07/25/2017] [Accepted: 08/06/2017] [Indexed: 12/11/2022]
Abstract
Traumatic brain injury is a detrimental medical condition particularly when accompanied by diabetes. There are several comorbidities going along with diabetes including, but not limited to, kidney failure, obesity, coronary artery disease, peripheral vascular disease, hypertension, stroke, neuropathies and amputations. Unlike diabetes type 1, diabetes type 2 is more common in adults who simultaneously suffer from other comorbid conditions making them susceptible to repetitive fall incidents and sustaining head trauma. The resulting brain insult exacerbates current psychiatric disorders such as depression and anxiety, which, in turn, increases the risk of sustaining further brain traumas. The relationship between diabetes, traumatic brain injury and psychiatric health constitutes a triad forming a non-reversible vicious cycle. At the proteomic and psychiatric levels, cellular, molecular and behavioral alterations have been reported with the induction of non-traumatic brain injury in diabetic models such as stroke. However, research into traumatic brain injury has not been systematically investigated. Thus, in cases of diabetic neuropathy complicated with traumatic brain injury, utilizing fine structural and analytical techniques allows the identification of key biological markers that can then be used as innovative diagnostics as well as novel therapeutic targets in an attempt to treat diabetes and its sequelae especially those arising from repetitive mild brain trauma.
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Affiliation(s)
- Hadi Abou-El-Hassan
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Batoul Dia
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Khalil Choucair
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Stephanie A Eid
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Farah Najdi
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Lama Baki
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Farid Talih
- Department of Psychiatry, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Assaad A Eid
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
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Mokhtari M, Nayeb-Aghaei H, Kouchek M, Miri MM, Goharani R, Amoozandeh A, Akhavan Salamat S, Sistanizad M. Effect of Memantine on Serum Levels of Neuron-Specific Enolase and on the Glasgow Coma Scale in Patients With Moderate Traumatic Brain Injury. J Clin Pharmacol 2017; 58:42-47. [PMID: 28724200 DOI: 10.1002/jcph.980] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/19/2017] [Indexed: 12/31/2022]
Abstract
Traumatic brain injury (TBI) is a major cause of disability and death globally. Despite significant progress in neuromonitoring and neuroprotection, pharmacological interventions have failed to generate favorable results. We examined the effect of memantine on serum levels of neuron-specific enolase (NSE), a marker of neuronal damage, and the Glasgow Coma Scale (GCS) in patients with moderate TBI. Patients were randomly assigned to the control group (who received standard TBI management) and the treatment group (who, alongside their standard management, received enteral memantine 30 mg twice daily for 7 days). Patients' clinical data, GCS, findings of head computed tomography, and serum NSE levels were collected during the study. Forty-one patients were randomized into the control and treatment groups, 19 and 22 patients respectively. Baseline characteristics and serum NSE levels were not significantly different between the 2 groups. The mean serum NSE levels for the memantine and the control groups on day 3 were 7.95 ± 2.86 and 12.33 ± 7.09 ng/mL, respectively (P = .05), and on day 7 were 5.03 ± 3.25 and 10.04 ± 5.72 ng/mL, respectively (P = .003). The mean GCS on day 3 was 12.3 ± 2.0 and 10.9 ± 1.9 in the memantine and control groups, respectively (P = .03). Serum NSE levels and GCS changes were negatively correlated (r = -0.368, P = .02). Patients with moderate TBI who received memantine had significantly reduced serum NSE levels by day 7 and marked improvement in their GCS scores on day 3 of the study.
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Affiliation(s)
- Majid Mokhtari
- Department of Critical Care and Anesthesiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Nayeb-Aghaei
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehran Kouchek
- Department of Critical Care and Anesthesiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mir Mohammad Miri
- Department of Critical Care and Anesthesiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Goharani
- Department of Critical Care and Anesthesiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Amoozandeh
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Akhavan Salamat
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Sistanizad
- Department of Critical Care and Anesthesiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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29
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Abstract
Biomarkers are key tools and can provide crucial information on the complex cascade of events and molecular mechanisms underlying traumatic brain injury (TBI) pathophysiology. Obtaining a profile of distinct classes of biomarkers reflecting core pathologic mechanisms could enable us to identify and characterize the initial injury and the secondary pathologic cascades. Thus, they represent a logical adjunct to improve diagnosis, track progression and activity, guide molecularly targeted therapy, and monitor therapeutic response in TBI. Accordingly, great effort has been put into the identification of novel biomarkers in the past 25 years. However, the role of brain injury markers in clinical practice has been long debated, due to inconsistent regulatory standards and lack of reliable evidence of analytical validity and clinical utility. We present a comprehensive overview of the markers currently available while characterizing their potential role and applications in diagnosis, monitoring, drug discovery, and clinical trials in TBI. In reviewing these concepts, we discuss the recent inclusion of brain damage biomarkers in the diagnostic guidelines and provide perspectives on the validation of such markers for their use in the clinic.
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30
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Ghoshal S, Bondada V, Saatman KE, Guttmann RP, Geddes JW. Phage display for identification of serum biomarkers of traumatic brain injury. J Neurosci Methods 2016; 272:33-37. [PMID: 27168498 DOI: 10.1016/j.jneumeth.2016.04.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND The extent and severity of traumatic brain injuries (TBIs) can be difficult to determine with current diagnostic methods. To address this, there has been increased interest in developing biomarkers to assist in the diagnosis, determination of injury severity, evaluation of recovery and therapeutic efficacy, and prediction of outcomes. Several promising serum TBI biomarkers have been identified using hypothesis-driven approaches, largely examining proteins that are abundant in neurons and non-neural cells in the CNS. NEW METHOD An unbiased approach, phage display, was used to identify serum TBI biomarkers. In this proof-of-concept study, mice received a TBI using the controlled cortical impact model of TBI (1mm injury depth, 3.5m/s velocity) and phage display was utilized to identify putative serum biomarkers at 6h postinjury. RESULTS An engineered phage which preferentially bound to injured serum was sequenced to identify the 12-mer 'recognizer' peptide expressed on the coat protein. Following synthesis of the recognizer peptide, pull down, and mass spectrometry analysis, the target protein was identified as glial fibrillary acidic protein (GFAP). COMPARISON WITH EXISTING METHODS AND CONCLUSIONS GFAP has previously been identified as a promising TBI biomarker. The results provide proof of concept regarding the ability of phage display to identify TBI serum biomarkers. This methodology is currently being applied to serum biomarkers of mild TBI.
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Affiliation(s)
- Sarbani Ghoshal
- Spinal Cord & Brain Injury Research Center, University of Kentucky, Lexington, KY, USA
| | - Vimala Bondada
- Spinal Cord & Brain Injury Research Center, University of Kentucky, Lexington, KY, USA
| | - Kathryn E Saatman
- Spinal Cord & Brain Injury Research Center, University of Kentucky, Lexington, KY, USA
| | - Rodney P Guttmann
- Department of Gerontology, University of Kentucky, Lexington, KY, USA
| | - James W Geddes
- Spinal Cord & Brain Injury Research Center, University of Kentucky, Lexington, KY, USA.
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Schulte S, Rasmussen NN, McBeth JW, Richards PQ, Yochem E, Petron DJ, Strathmann FG. Utilization of the clinical laboratory for the implementation of concussion biomarkers in collegiate football and the necessity of personalized and predictive athlete specific reference intervals. EPMA J 2016; 7:1. [PMID: 26823691 PMCID: PMC4730649 DOI: 10.1186/s13167-016-0050-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/12/2016] [Indexed: 05/29/2023]
Abstract
Background A continued interest in concussion biomarkers makes the eventual
implementation of identified biomarkers into routine concussion assessment an
eventual reality. We sought to develop and test an interdisciplinary approach that
could be used to integrate blood-based biomarkers into the established concussion
management program for a collegiate football team. Methods We used a CLIA-certified laboratory for all testing and chose
biomarkers where clinically validated testing was available as would be required
for results used in clinical decision making. We summarized the existing methods
and results for concussion assessment across an entire season to identify and
demonstrate the challenges with the eventual integration of a parallel process
using blood-based tests for concussion management. We analyzed the results of the
biomarkers chosen for trends consistent with the outcome assessments provided from
the current concussion management protocols. Results Baseline samples were collected with three additional
post-concussion samples collected at three separate time points from players with
a diagnosed concussion (n = 12). A summary of
results from currently used concussion assessment tools were compared to the
representative biomarkers S100B and NSE results. Nine sport-related concussions
occurred during practice and three during play. For S100B, 50 % had follow-up
testing results lower than the post-injury result. In contrast, 92 % of NSE
follow-up results were lower than post-injury. One hundred percent of the results
for S100B and NSE were within the athlete-derived reference intervals upon
return-to-play and season end. Conclusions The reported workflow provides a framework for the eventual
implementation of biomarkers for concussion assessment into existing assessment
protocols and strengthens the need for reliance on clinical laboratory testing.
Athlete-specific reference intervals will be required to adequately interpret
results. Electronic supplementary material The online version of this article (doi:10.1186/s13167-016-0050-x) contains supplementary material, which is available to authorized
users.
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Affiliation(s)
- Stefanie Schulte
- Department of Psychology, University of Utah School of Medicine, Salt Lake City, UT 84108 USA ; Department of Exercise and Sport Science, University of Utah School of Medicine, Salt Lake City, UT 84108 USA
| | - Natalie N Rasmussen
- Department of Pathology, University of Utah School of Medicine, 500 Chipeta Way mail code 115, Salt Lake City, UT 84108 USA ; ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT 84108 USA
| | - Joseph W McBeth
- Department of Athletics, University of Utah School of Medicine, Salt Lake City, UT 84108 USA
| | - Patrick Q Richards
- Department of Athletics, University of Utah School of Medicine, Salt Lake City, UT 84108 USA
| | - Eric Yochem
- Department of Athletics, University of Utah School of Medicine, Salt Lake City, UT 84108 USA
| | - David J Petron
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT 84108 USA
| | - Frederick G Strathmann
- Department of Pathology, University of Utah School of Medicine, 500 Chipeta Way mail code 115, Salt Lake City, UT 84108 USA ; ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT 84108 USA
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Kulbe JR, Geddes JW. Current status of fluid biomarkers in mild traumatic brain injury. Exp Neurol 2016; 275 Pt 3:334-352. [PMID: 25981889 PMCID: PMC4699183 DOI: 10.1016/j.expneurol.2015.05.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 05/05/2015] [Accepted: 05/08/2015] [Indexed: 01/07/2023]
Abstract
Mild traumatic brain injury (mTBI) affects millions of people annually and is difficult to diagnose. Mild injury is insensitive to conventional imaging techniques and diagnoses are often made using subjective criteria such as self-reported symptoms. Many people who sustain a mTBI develop persistent post-concussive symptoms. Athletes and military personnel are at great risk for repeat injury which can result in second impact syndrome or chronic traumatic encephalopathy. An objective and quantifiable measure, such as a serum biomarker, is needed to aid in mTBI diagnosis, prognosis, return to play/duty assessments, and would further elucidate mTBI pathophysiology. The majority of TBI biomarker research focuses on severe TBI with few studies specific to mild injury. Most studies use a hypothesis-driven approach, screening biofluids for markers known to be associated with TBI pathophysiology. This approach has yielded limited success in identifying markers that can be used clinically, additional candidate biomarkers are needed. Innovative and unbiased methods such as proteomics, microRNA arrays, urinary screens, autoantibody identification and phage display would complement more traditional approaches to aid in the discovery of novel mTBI biomarkers.
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Affiliation(s)
- Jacqueline R Kulbe
- Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, 40536-0509, USA,; Department of Anatomy and Neurobiology, College of Medicine, University of Kentucky, Lexington, KY, 40536-0509, USA
| | - James W Geddes
- Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, 40536-0509, USA,; Department of Anatomy and Neurobiology, College of Medicine, University of Kentucky, Lexington, KY, 40536-0509, USA.
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Abstract
Years of research in the field of neurotrauma have led to the concept of applying systems biology as a tool for biomarker discovery in traumatic brain injury (TBI). Biomarkers may lead to understanding mechanisms of injury and recovery in TBI and can be potential targets for wound healing, recovery, and increased survival with enhanced quality of life. The literature available on neurotrauma studies from both animal and clinical studies has provided rich insight on the molecular pathways and complex networks of TBI, elucidating the proteomics of this disease for the discovery of biomarkers. With such a plethora of information available, the data from the studies require databases with tools to analyze and infer new patterns and associations. The role of different systems biology tools and their use in biomarker discovery in TBI are discussed in this chapter.
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Toman E, Harrisson S, Belli T. Biomarkers in traumatic brain injury: a review. J ROY ARMY MED CORPS 2015; 162:103-8. [PMID: 26527607 DOI: 10.1136/jramc-2015-000517] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/11/2015] [Indexed: 12/23/2022]
Abstract
Biomarkers allow physiological processes to be monitored, in both health and injury. Multiple attempts have been made to use biomarkers in traumatic brain injury (TBI). Identification of such biomarkers could allow improved understanding of the pathological processes involved in TBI, diagnosis, prognostication and development of novel therapies. This review article aims to cover both established and emerging TBI biomarkers along with their benefits and limitations. It then discusses the potential value of TBI biomarkers to military, civilian and sporting populations and the future hopes for developing a role for biomarkers in head injury management.
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Affiliation(s)
- Emma Toman
- Major Trauma Service, Queen Elizabeth Hospital, Birmingham, UK
| | - S Harrisson
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - T Belli
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK University of Birmingham, Birmingham, UK
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Wolf H, Frantal S, Pajenda G, Leitgeb J, Sarahrudi K, Hajdu S. Analysis of S100 calcium binding protein B serum levels in different types of traumatic intracranial lesions. J Neurotrauma 2015; 32:23-7. [PMID: 25068442 DOI: 10.1089/neu.2013.3202] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The objective of this study was to determine whether the type of intracranial traumatic lesions, the number of simultaneous traumatic lesions, and the occurrence of skull and facial bone fractures have an influence on S100 calcium binding protein B (S100B) serum levels. Patients with blunt traumatic brain injury were prospectively enrolled into this cohort study over a period of 13 months. Venous blood samples were obtained prior to emergency cranial CT scan in all patients within 3 h after injury. The patients were then assigned into six groups: 1) concussion, 2) epidural hematoma, 3) subdural hematoma, 4) subarachnoid hemorrhage, 5) brain contusions, and 6) brain edema. The study included 1696 head trauma patients with a mean age of 57.7 ± 25.3 years, and 126 patients (8%) had 182 traumatic lesions on CT. Significant differences in S100B serum levels were found between cerebral edema and the other four bleeding groups: epidural p = 0.0002, subdural p < 0.0001, subarachnoid p = 0.0001, brain contusions p = 0.0003, and concussion p < 0.0001. Significant differences in S100B values between patients with one or two intracranial lesions (p = 0.014) or with three (p < 0.0001) simultaneous intracranial lesions were found. In patients with intracranial traumatic lesions, skull fractures, as well as skull and facial bone fractures occurring together, were identified as significant additional factors for the increase in serum S100B levels (p < 0.0001). Older age was also associated with elevated S100B serum levels (p < 0.0001). Our data show that peak S100B serum levels were found in patients with cerebral edema and brain contusions.
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Affiliation(s)
- Harald Wolf
- 1 Department for Trauma Surgery, Medical University of Vienna , Vienna, Austria
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36
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Schulte S, Podlog LW, Hamson-Utley JJ, Strathmann FG, Strüder HK. A systematic review of the biomarker S100B: implications for sport-related concussion management. J Athl Train 2015; 49:830-50. [PMID: 25299445 DOI: 10.4085/1062-6050-49.3.33] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Elevated levels of the astroglial protein S100B have been shown to predict sport-related concussion. However, S100B levels within an athlete can vary depending on the type of physical activity (PA) engaged in and the methodologic approach used to measure them. Thus, appropriate reference values in the diagnosis of concussed athletes remain undefined. The purpose of our systematic literature review was to provide an overview of the current literature examining S100B measurement in the context of PA. The overall goal is to improve the use of the biomarker S100B in the context of sport-related concussion management. DATA SOURCES PubMed, SciVerse Scopus, SPORTDiscus, CINAHL, and Cochrane. STUDY SELECTION We selected articles that contained (1) research studies focusing exclusively on humans in which (2) either PA was used as an intervention or the test participants or athletes were involved in PA and (3) S100B was measured as a dependent variable. DATA EXTRACTION We identified 24 articles. Study variations included the mode of PA used as an intervention, sample types, sample-processing procedures, and analytic techniques. DATA SYNTHESIS Given the nonuniformity of the analytical methods used and the data samples collected, as well as differences in the types of PA investigated, we were not able to determine a single consistent reference value of S100B in the context of PA. Thus, a clear distinction between a concussed athlete and a healthy athlete based solely on the existing S100B cutoff value of 0.1 μg/L remains unclear. However, because of its high sensitivity and excellent negative predictive value, S100B measurement seems to have the potential to be a diagnostic adjunct for concussion in sports settings. We recommend that the interpretation of S100B values be based on congruent study designs to ensure measurement reliability and validity.
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Affiliation(s)
- Stefanie Schulte
- Department of Exercise and Sport Science, University of Utah, Salt Lake City
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Heidari K, Vafaee A, Rastekenari AM, Taghizadeh M, Shad EG, Eley R, Sinnott M, Asadollahi S. S100B protein as a screening tool for computed tomography findings after mild traumatic brain injury: Systematic review and meta-analysis. Brain Inj 2015; 29:1146-1157. [PMID: 26067622 DOI: 10.3109/02699052.2015.1037349] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PRIMARY OBJECTIVE To determine whether S100B protein in serum can predict intracranial lesions on computed tomography (CT) scan after mild traumatic brain injury (MTBI). RESEARCH DESIGN Systematic review and meta-analysis Methods and procedures: A literature search was conducted using Medline, Embase, Cochrane, Google Scholar, CINAHL, SUMSearch, Bandolier, Trip databases, bibliographies from identified articles and review article references. Eligible articles were defined as observational studies including patients with MTBI who underwent post-traumatic head CT scan and assessing the screening role of S100B protein. MAIN OUTCOMES AND RESULTS There was a significant positive association between S100B protein concentration and positive CT scan (22 studies, SMD = 1.92, 95% CI = 1.29-2.45, I2 = 100%; p < 0.001). The pooled sensitivity and specificity values for a cut-point range = 0.16-0.20 µg L-1 were 98.65 (95% CI = 95.53-101.77; I2 = 0.0%) and 50.69 (95% CI = 40.69-60.69; I2 = 76.3%), respectively. The threshold for serum S100B protein with 99.63 (95% CI = 96.00-103.25; I2 = 0.0%) sensitivity and 46.94 (95% CI = 39.01-54.87; I2 = 95.5%) specificity was > 0.20 µg L-1. CONCLUSIONS After MTBI, serum S100B protein levels are significantly associated with the presence of intracranial lesions on CT scan. Measuring the protein could be useful in screening high risk MTBI patients and decreasing unnecessary CT examinations.
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Affiliation(s)
- Kamran Heidari
- a Department of Emergency Medicine , Loghmane-Hakim Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Ali Vafaee
- a Department of Emergency Medicine , Loghmane-Hakim Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | | | - Mehrdad Taghizadeh
- a Department of Emergency Medicine , Loghmane-Hakim Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Ensieh Ghaffari Shad
- c School of Medicine, Alborz University of Medical Sciences , Karaj , Tehran , Iran
| | - Rob Eley
- d Department of Emergency Medicine , Princess Alexandra Hospital , Queensland , Australia.,e School of Medicine, The University of Queensland , Brisbane , Australia , and
| | - Michael Sinnott
- d Department of Emergency Medicine , Princess Alexandra Hospital , Queensland , Australia
| | - Shadi Asadollahi
- f School of Medicine, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Reis C, Wang Y, Akyol O, Ho WM, Ii RA, Stier G, Martin R, Zhang JH. What's New in Traumatic Brain Injury: Update on Tracking, Monitoring and Treatment. Int J Mol Sci 2015; 16:11903-65. [PMID: 26016501 PMCID: PMC4490422 DOI: 10.3390/ijms160611903] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI), defined as an alteration in brain functions caused by an external force, is responsible for high morbidity and mortality around the world. It is important to identify and treat TBI victims as early as possible. Tracking and monitoring TBI with neuroimaging technologies, including functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), positron emission tomography (PET), and high definition fiber tracking (HDFT) show increasing sensitivity and specificity. Classical electrophysiological monitoring, together with newly established brain-on-chip, cerebral microdialysis techniques, both benefit TBI. First generation molecular biomarkers, based on genomic and proteomic changes following TBI, have proven effective and economical. It is conceivable that TBI-specific biomarkers will be developed with the combination of systems biology and bioinformation strategies. Advances in treatment of TBI include stem cell-based and nanotechnology-based therapy, physical and pharmaceutical interventions and also new use in TBI for approved drugs which all present favorable promise in preventing and reversing TBI.
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Affiliation(s)
- Cesar Reis
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Yuechun Wang
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Physiology, School of Medicine, University of Jinan, Guangzhou 250012, China.
| | - Onat Akyol
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
| | - Wing Mann Ho
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Neurosurgery, University Hospital Innsbruck, Tyrol 6020, Austria.
| | - Richard Applegate Ii
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Gary Stier
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Robert Martin
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - John H Zhang
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA.
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Rathbone ATL, Tharmaradinam S, Jiang S, Rathbone MP, Kumbhare DA. A review of the neuro- and systemic inflammatory responses in post concussion symptoms: Introduction of the "post-inflammatory brain syndrome" PIBS. Brain Behav Immun 2015; 46:1-16. [PMID: 25736063 DOI: 10.1016/j.bbi.2015.02.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 02/08/2015] [Accepted: 02/09/2015] [Indexed: 12/22/2022] Open
Abstract
Post-concussion syndrome is an aggregate of symptoms that commonly present together after head injury. These symptoms, depending on definition, include headaches, dizziness, neuropsychiatric symptoms, and cognitive impairment. However, these symptoms are common, occurring frequently in non-head injured controls, leading some to question the existence of post-concussion syndrome as a unique syndrome. Therefore, some have attempted to explain post-concussion symptoms as post-traumatic stress disorder, as they share many similar symptoms and post-traumatic stress disorder does not require head injury. This explanation falls short as patients with post-concussion syndrome do not necessarily experience many key symptoms of post-traumatic stress disorder. Therefore, other explanations must be sought to explain the prevalence of post-concussion like symptoms in non-head injury patients. Many of the situations in which post-concussion syndrome like symptoms may be experienced such as infection and post-surgery are associated with systemic inflammatory responses, and even neuroinflammation. Post-concussion syndrome itself has a significant neuroinflammatory component. In this review we examine the evidence of neuroinflammation in post-concussion syndrome and the potential role systemic inflammation plays in post-concussion syndrome like symptoms. We conclude that given the overlap between these conditions and the role of inflammation in their etiologies, a new term, post-inflammatory brain syndromes (PIBS), is necessary to describe the common outcomes of many different inflammatory insults. The concept of post-concussion syndrome is in its evolution therefore, the new term post-inflammatory brain syndromes provides a better understanding of etiology of its wide-array of symptoms and the wide array of conditions they can be seen in.
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Affiliation(s)
| | - Surejini Tharmaradinam
- Division of Pediatric Neurology, Department of Pediatrics, McMaster Children's Hospital, Pediatric Neurology, MUMC 3A, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Shucui Jiang
- Division of Neurosurgery, Department of Surgery, and Hamilton Neurorestorative Group, McMaster University, HSC 4E15, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada
| | - Michel P Rathbone
- Department of Medicine, Division of Neurology, McMaster University - Juravinski Hospital, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
| | - Dinesh A Kumbhare
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, University Health Network - Toronto Rehab - University Centre, 550 University Ave, Toronto, Ontario M5G 2A2, Canada
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40
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Silverberg ND, Gardner AJ, Brubacher JR, Panenka WJ, Li JJ, Iverson GL. Systematic Review of Multivariable Prognostic Models for Mild Traumatic Brain Injury. J Neurotrauma 2015; 32:517-26. [DOI: 10.1089/neu.2014.3600] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Noah D. Silverberg
- University of British Columbia and GF Strong Rehab Centre, Vancouver, British Columbia, Canada
| | - Andrew J. Gardner
- Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Waratah, New South Wales, Australia
| | - Jeffrey R. Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jun Jian Li
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Massachusetts General Hospital Sport Concussion Clinic; and Red Sox Foundation and Massachusetts General Hospital Home Base Program, Charlestown, Massachusetts
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41
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Ding J, Ding Z, Yuan F, Guo J, Chen H, Gao W, Wang R, Gu Y, Chen J, Guo Y, Tian H. Proteomics analysis after traumatic brain injury in rats: the search for potential biomarkers. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:342-9. [PMID: 25992526 DOI: 10.1590/0004-282x20150006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/27/2014] [Indexed: 01/28/2023]
Abstract
Many studies of protein expression after traumatic brain injury (TBI) have identified biomarkers for diagnosing or determining the prognosis of TBI. In this study, we searched for additional protein markers of TBI using a fluid perfusion impact device to model TBI in S-D rats. Two-dimensional gel electrophoresis and mass spectrometry were used to identify differentially expressed proteins. After proteomic analysis, we detected 405 and 371 protein spots within a pH range of 3-10 from sham-treated and contused brain cortex, respectively. Eighty protein spots were differentially expressed in the two groups and 20 of these proteins were identified. This study validated the established biomarkers of TBI and identified potential biomarkers that could be examined in future work.
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Affiliation(s)
- Jun Ding
- Shanghai Jiaotong University, China
| | - Zhengang Ding
- Chinese Medicine Hospital of Huangdao District, China
| | | | | | - Hao Chen
- Shanghai Jiaotong University, China
| | | | - Ren Wang
- Shanghai Jiaotong University, China
| | - Yi Gu
- Shanghai Jiaotong University, China
| | | | - Yan Guo
- Shanghai Jiaotong University, China
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42
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Buonora JE, Yarnell AM, Lazarus RC, Mousseau M, Latour LL, Rizoli SB, Baker AJ, Rhind SG, Diaz-Arrastia R, Mueller GP. Multivariate analysis of traumatic brain injury: development of an assessment score. Front Neurol 2015; 6:68. [PMID: 25870583 PMCID: PMC4378282 DOI: 10.3389/fneur.2015.00068] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/12/2015] [Indexed: 01/14/2023] Open
Abstract
Important challenges for the diagnosis and monitoring of mild traumatic brain injury (mTBI) include the development of plasma biomarkers for assessing neurologic injury, monitoring pathogenesis, and predicting vulnerability for the development of untoward neurologic outcomes. While several biomarker proteins have shown promise in this regard, used individually, these candidates lack adequate sensitivity and/or specificity for making a definitive diagnosis or identifying those at risk of subsequent pathology. The objective for this study was to evaluate a panel of six recognized and novel biomarker candidates for the assessment of TBI in adult patients. The biomarkers studied were selected on the basis of their relative brain-specificities and potentials to reflect distinct features of TBI mechanisms including (1) neuronal damage assessed by neuron-specific enolase (NSE) and brain derived neurotrophic factor (BDNF); (2) oxidative stress assessed by peroxiredoxin 6 (PRDX6); (3) glial damage and gliosis assessed by glial fibrillary acidic protein and S100 calcium binding protein beta (S100b); (4) immune activation assessed by monocyte chemoattractant protein 1/chemokine (C–C motif) ligand 2 (MCP1/CCL2); and (5) disruption of the intercellular adhesion apparatus assessed by intercellular adhesion protein-5 (ICAM-5). The combined fold-changes in plasma levels of PRDX6, S100b, MCP1, NSE, and BDNF resulted in the formulation of a TBI assessment score that identified mTBI with a receiver operating characteristic (ROC) area under the curve of 0.97, when compared to healthy controls. This research demonstrates that a profile of biomarker responses can be used to formulate a diagnostic score that is sensitive for the detection of mTBI. Ideally, this multivariate assessment strategy will be refined with additional biomarkers that can effectively assess the spectrum of TBI and identify those at particular risk for developing neuropathologies as consequence of a mTBI event.
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Affiliation(s)
- John E Buonora
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA ; U.S. Army Graduate Program in Anesthesia Nursing, Academy of Health Sciences, Joint Base San Antonio , Fort Sam Houston, TX , USA
| | - Angela M Yarnell
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience Research, Walter Reed Army Institute of Research , Silver Spring, MD , USA
| | - Rachel C Lazarus
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - Michael Mousseau
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - Lawrence L Latour
- Stroke Branch, National Institute of Neurological Disorders and Stroke , Bethesda, MD , USA ; Defence Research and Development Canada, Toronto Research Centre , Toronto, ON , Canada
| | - Sandro B Rizoli
- Department of Anesthesia, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto , Toronto, ON , Canada ; Department of Surgery, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto , Toronto, ON , Canada ; Department of Critical Care Medicine, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto , Toronto, ON , Canada
| | - Andrew J Baker
- Department of Anesthesia, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto , Toronto, ON , Canada ; Department of Surgery, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto , Toronto, ON , Canada ; Department of Critical Care Medicine, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto , Toronto, ON , Canada ; Brain Injury Laboratory, Li Ka Shing Knowledge Institute, Cara Phelan Centre for Trauma Research, Keenan Research Centre University of Toronto , Toronto, ON , Canada
| | - Shawn G Rhind
- Defence Research and Development Canada, Toronto Research Centre , Toronto, ON , Canada
| | - Ramon Diaz-Arrastia
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - Gregory P Mueller
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
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43
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Expert consensus document: Mind the gaps—advancing research into short-term and long-term neuropsychological outcomes of youth sports-related concussions. Nat Rev Neurol 2015; 11:230-44. [PMID: 25776822 DOI: 10.1038/nrneurol.2015.30] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sports-related concussions and repetitive subconcussive exposure are increasingly recognized as potential dangers to paediatric populations, but much remains unknown about the short-term and long-term consequences of these events, including potential cognitive impairment and risk of later-life dementia. This Expert Consensus Document is the result of a 1-day meeting convened by Safe Kids Worldwide, the Alzheimer's Drug Discovery Foundation, and the Andrews Institute for Orthopaedics and Sports Medicine. The goal is to highlight knowledge gaps and areas of critically needed research in the areas of concussion science, dementia, genetics, diagnostic and prognostic biomarkers, neuroimaging, sports injury surveillance, and information sharing. For each of these areas, we propose clear and achievable paths to improve the understanding, treatment and prevention of youth sports-related concussions.
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44
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Krohn M, Dreßler J, Bauer M, Schober K, Franke H, Ondruschka B. Immunohistochemical investigation of S100 and NSE in cases of traumatic brain injury and its application for survival time determination. J Neurotrauma 2015; 32:430-40. [PMID: 25211554 DOI: 10.1089/neu.2014.3524] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The availability of markers able to provide insight into protein changes in the central nervous system after fatal traumatic brain injury (TBI) is limited. The present study reports on the semi-quantitative assessments of the immunopositive neuroglial cells (both astrocytes and oligodendrocytes) and neurons for S100 protein (S100), as well as neuronal specific enolase (NSE), in the cerebral cortex, hippocampus, and cerebellum with regard to survival time and cause of death. Brain tissues of 47 autopsy cases with TBI (survival times ranged between several minutes and 34 d) and 10 age- and gender-matched controls (natural deaths) were examined. TBI cases were grouped according to their survival time in acute death after brain injury (ABI, n = 25), subacute death after brain injury (SBI, n = 18) and delayed death after brain injury (DBI, n = 4). There were no significant changes in the percentages of S100-stained astrocytes between TBI and control cases. The percentages of S100-positive oligodendrocytes in the pericontusional zone (PCZ) in cases with SBI were significantly lower than in controls (p < 0.05) and in the ABI group (p < 0.05). In the hippocampus, S100-positive oligodendrocytes were significantly lower in cases with ABI and SBI (both, p < 0.05), compared with controls. It is of particular interest that there were also S100-positive neurons in the PCZ and hippocampus in TBI cases after more than 2 h survival but not in ABI cases or controls. The percentages of NSE-positive neurons in the hippocampus were likewise significantly lower in cases with ABI, compared with controls (p < 0.05) but increased in cases with SBI in PCZ (p < 0.05). In conclusion, the present findings emphasize that S100 and NSE-immunopositivity might be useful for detecting the cause and process of death due to TBI. Further, S100-positivity in neurons may be helpful to estimate the survival time of fatal injuries in legal medicine.
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Affiliation(s)
- Michael Krohn
- 1 Institute of Legal Medicine, University of Leipzig , Germany
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45
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Buki A, Kovacs N, Czeiter E, Schmid K, Berger RP, Kobeissy F, Italiano D, Hayes RL, Tortella FC, Mezosi E, Schwarcz A, Toth A, Nemes O, Mondello S. Minor and repetitive head injury. Adv Tech Stand Neurosurg 2015; 42:147-92. [PMID: 25411149 DOI: 10.1007/978-3-319-09066-5_8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability in the young, active population and expected to be the third leading cause of death in the whole world until 2020. The disease is frequently referred to as the silent epidemic, and many authors highlight the "unmet medical need" associated with TBI.The term traumatically evoked brain injury covers a heterogeneous group ranging from mild/minor/minimal to severe/non-salvageable damages. Severe TBI has long been recognized to be a major socioeconomical health-care issue as saving young lives and sometimes entirely restituting health with a timely intervention can indeed be extremely cost efficient.Recently it has been recognized that mild or minor TBI should be considered similarly important because of the magnitude of the patient population affected. Other reasons behind this recognition are the association of mild head injury with transient cognitive disturbances as well as long-term sequelae primarily linked to repeat (sport-related) injuries.The incidence of TBI in developed countries can be as high as 2-300/100,000 inhabitants; however, if we consider the injury pyramid, it turns out that severe and moderate TBI represents only 25-30 % of all cases, while the overwhelming majority of TBI cases consists of mild head injury. On top of that, or at the base of the pyramid, are the cases that never show up at the ER - the unreported injuries.Special attention is turned to mild TBI as in recent military conflicts it is recognized as "signature injury."This chapter aims to summarize the most important features of mild and repetitive traumatic brain injury providing definitions, stratifications, and triage options while also focusing on contemporary knowledge gathered by imaging and biomarker research.Mild traumatic brain injury is an enigmatic lesion; the classification, significance, and its consequences are all far less defined and explored than in more severe forms of brain injury.Understanding the pathobiology and pathomechanisms may aid a more targeted approach in triage as well as selection of cases with possible late complications while also identifying the target patient population where preventive measures and therapeutic tools should be applied in an attempt to avoid secondary brain injury and late complications.
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Affiliation(s)
- Andras Buki
- MTA-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary,
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Abstract
Mild traumatic brain injury (TBI) is common but accurate diagnosis and defining criteria for mild TBI and its clinical consequences have been problematic. Mild TBI causes transient neurophysiologic brain dysfunction, sometimes with structural axonal and neuronal damage. Biomarkers, such as newer imaging technologies and protein markers, are promising indicators of brain injury but are not ready for clinical use. Diagnosis relies on clinical criteria regarding depth and duration of impaired consciousness and amnesia. These criteria are particularly difficult to confirm at the least severe end of the mild TBI continuum, especially when relying on subjective, retrospective accounts. The postconcussive syndrome is a controversial concept because of varying criteria, inconsistent symptom clusters and the evidence that similar symptom profiles occur with other disorders, and even in a proportion of healthy individuals. The clinical consequences of mild TBI can be conceptualized as two multidimensional disorders: (1) a constellation of acute symptoms that might be termed early phase post-traumatic disorder (e.g., headache, dizziness, imbalance, fatigue, sleep disruption, impaired cognition), that typically resolve in days to weeks and are largely related to brain trauma and concomitant injuries; (2) a later set of symptoms, a late phase post-traumatic disorder, evolving out of the early phase in a minority of patients, with a more prolonged (months to years), sometimes worsening set of somatic, emotional, and cognitive symptoms. The later phase disorder is highly influenced by a variety of psychosocial factors and has little specificity for brain injury, although a history of multiple concussions seems to increase the risk of more severe and longer duration symptoms. Effective early phase management may prevent or limit the later phase disorder and should include education about symptoms and expectations for recovery, as well as recommendations for activity modifications. Later phase treatment should be informed by thoughtful differential diagnosis and the multiplicity of premorbid and comorbid conditions that may influence symptoms. Treatment should incorporate a hierarchical, sequential approach to symptom management, prioritizing problems with significant functional impact and effective, available interventions (e.g., headache, depression, anxiety, insomnia, vertigo).
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Affiliation(s)
- Douglas I Katz
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Acquired Brain Injury Program, Braintree Rehabilitation Hospital, Braintree, MA, USA.
| | - Sara I Cohen
- Acquired Brain Injury Program, Braintree Rehabilitation Hospital, Braintree, MA, USA; Department of Physical Medicine and Rehabilitation, Tufts Medical School, Boston, MA, USA
| | - Michael P Alexander
- Concussion/TBI Program, Beth Israel Deaconess Medical Center, Boston, MA, USA; Spaulding Hospital Cambridge, Cambridge, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
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47
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Chou SHY, Robertson CS. Monitoring biomarkers of cellular injury and death in acute brain injury. Neurocrit Care 2014; 21 Suppl 2:S187-214. [PMID: 25208676 PMCID: PMC7888263 DOI: 10.1007/s12028-014-0039-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Molecular biomarkers have revolutionalized diagnosis and treatment of many diseases, such as troponin use in myocardial infarction. Urgent need for high-fidelity biomarkers in neurocritical care has resulted in numerous studies reporting potential candidate biomarkers. METHODS We performed an electronic literature search and systematic review of English language articles on cellular/molecular biomarkers associated with outcome and with disease-specific secondary complications in adult patients with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), traumatic brain injury (TBI), and post-cardiac arrest hypoxic ischemic encephalopathic injuries (HIE). RESULTS A total of 135 articles were included. Though a wide variety of potential biomarkers have been identified, only neuron-specific enolase has been validated in large cohorts and shows 100% specificity for poor outcome prediction in HIE patients not treated with therapeutic hypothermia. There are many promising candidate blood and CSF biomarkers in SAH, AIS, ICH, and TBI, but none yet meets criteria for routine clinical use. CONCLUSION Current studies vary significantly in patient selection, biosample collection/processing, and biomarker measurement protocols, thereby limiting the generalizability of overall results. Future large prospective studies with standardized treatment, biosample collection, and biomarker measurement and validation protocols are necessary to identify high-fidelity biomarkers in neurocritical care.
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Affiliation(s)
- Sherry H-Y Chou
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,
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48
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Strathmann FG, Schulte S, Goerl K, Petron DJ. Blood-based biomarkers for traumatic brain injury: Evaluation of research approaches, available methods and potential utility from the clinician and clinical laboratory perspectives. Clin Biochem 2014; 47:876-88. [DOI: 10.1016/j.clinbiochem.2014.01.028] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/05/2014] [Accepted: 01/23/2014] [Indexed: 01/06/2023]
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49
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Walder B, Robin X, Rebetez MML, Copin JC, Gasche Y, Sanchez JC, Turck N. The prognostic significance of the serum biomarker heart-fatty acidic binding protein in comparison with s100b in severe traumatic brain injury. J Neurotrauma 2014; 30:1631-7. [PMID: 23590685 DOI: 10.1089/neu.2012.2791] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The outcome after severe traumatic brain injury (TBI) is largely unfavorable, with approximately two thirds of patients suffering from severe disabilities or dying during the first 6 months. Existing predictive models displayed only limited utility for outcome prediction in individual patients. Time courses of heart-fatty acidic binding protein (H-FABP) and their association with outcome were investigated and compared with S100b. Forty-nine consecutive patients with severe TBI (sTBI; Head component of the Abbreviated Injury Scale [HAIS] >3) with mono and multiple trauma were enrolled in this study. Enzyme-linked immunosorbent assay measured blood concentrations of H-FABP and S100b at 6, 12, 24, and 48 h after TBI. Outcome measures were conscious state at 14 days (Glasgow Coma Scale), disability (Glasgow Outcome Scale Extended; GOSE), and mortality at 3 months. Univariate logistic regression analysis and receiver operating characteristic curves analysis were carried out. Maximal H-FABP and S100b concentrations were observed at 6 h after TBI (34.4±34.0 and 0.64±0.99 ng/mL, respectively). Patients with multi-trauma had significantly higher H-FABP concentrations at 24 and 48 h (22.6±25.6 and 12.4±18.2 ng/mL, respectively), compared to patients with mono trauma (6.9±5.1 and 3.7±4.2 ng/mL, respectively). In the first 48 h, H-FABP and S100b were inversely correlated with the GOSE at 3 months; H-FABP at 48 h predicted mortality with 75% sensitivity and 93% specificity. Early blood levels of H-FABP after sTBI have prognostic significance for survival and disability.
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Affiliation(s)
- Bernhard Walder
- 1 Division of Anaesthesiology, University Hospitals of Geneva , Geneva, Switzerland
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50
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Patel S. Role of proteomics in biomarker discovery and psychiatric disorders: current status, potentials, limitations and future challenges. Expert Rev Proteomics 2014; 9:249-65. [DOI: 10.1586/epr.12.25] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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