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Syzdykbayev M, Kazymov M, Aubakirov M, Kurmangazina A, Kairkhanov E, Kazangapov R, Bryzhakhina Z, Imangazinova S, Sheinin A. A Modern Approach to the Treatment of Traumatic Brain Injury. MEDICINES (BASEL, SWITZERLAND) 2024; 11:10. [PMID: 38786549 PMCID: PMC11123131 DOI: 10.3390/medicines11050010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/18/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024]
Abstract
Background: Traumatic brain injury manifests itself in various forms, ranging from mild impairment of consciousness to severe coma and death. Traumatic brain injury remains one of the leading causes of morbidity and mortality. Currently, there is no therapy to reverse the effects associated with traumatic brain injury. New neuroprotective treatments for severe traumatic brain injury have not achieved significant clinical success. Methods: A literature review was performed to summarize the recent interdisciplinary findings on management of traumatic brain injury from both clinical and experimental perspective. Results: In the present review, we discuss the concepts of traditional and new approaches to treatment of traumatic brain injury. The recent development of different drug delivery approaches to the central nervous system is also discussed. Conclusions: The management of traumatic brain injury could be aimed either at the pathological mechanisms initiating the secondary brain injury or alleviating the symptoms accompanying the injury. In many cases, however, the treatment should be complex and include a variety of medical interventions and combination therapy.
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Affiliation(s)
- Marat Syzdykbayev
- Department of Hospital Surgery, Anesthesiology and Reanimatology, Semey Medical University, Semey 071400, Kazakhstan
| | - Maksut Kazymov
- Department of General Practitioners, Semey Medical University, Semey 071400, Kazakhstan
| | - Marat Aubakirov
- Department of Pediatric Surgery, Semey Medical University, Semey 071400, Kazakhstan
| | - Aigul Kurmangazina
- Committee for Medical and Pharmaceutical Control of the Ministry of Health of the Republic of Kazakhstan for East Kazakhstan Region, Ust-Kamenogorsk 070004, Kazakhstan
| | - Ernar Kairkhanov
- Pavlodar Branch of Semey Medical University, Pavlodar S03Y3M1, Kazakhstan
| | - Rustem Kazangapov
- Pavlodar Branch of Semey Medical University, Pavlodar S03Y3M1, Kazakhstan
| | - Zhanna Bryzhakhina
- Department Psychiatry and Narcology, Semey Medical University, Semey 071400, Kazakhstan
| | - Saule Imangazinova
- Department of Therapy, Astana Medical University, Astana 010000, Kazakhstan
| | - Anton Sheinin
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv 69978, Israel
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Kocik VI, April MD, Rizzo JA, Dengler BA, Schauer SG. A Review of Electrolyte, Mineral, and Vitamin Changes After Traumatic Brain Injury. Mil Med 2024; 189:e101-e109. [PMID: 37192042 DOI: 10.1093/milmed/usad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/27/2023] [Accepted: 03/24/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Despite the prevalence of traumatic brain injury (TBI) in both civilian and military populations, the management guidelines developed by the Joint Trauma System involve minimal recommendations for electrolyte physiology optimization during the acute phase of TBI recovery. This narrative review aims to assess the current state of the science for electrolyte and mineral derangements found after TBI. MATERIALS AND METHODS We used Google Scholar and PubMed to identify literature on electrolyte derangements caused by TBI and supplements that may mitigate secondary injuries after TBI between 1991 and 2022. RESULTS We screened 94 sources, of which 26 met all inclusion criteria. Most were retrospective studies (n = 9), followed by clinical trials (n = 7), observational studies (n = 7), and case reports (n = 2). Of those, 29% covered the use of some type of supplement to support recovery after TBI, 28% covered electrolyte or mineral derangements after TBI, 16% covered the mechanisms of secondary injury after TBI and how they are related to mineral and electrolyte derangements, 14% covered current management of TBI, and 13% covered the potential toxic effects of the supplements during TBI recovery. CONCLUSIONS Knowledge of mechanisms and subsequent derangements of electrolyte, mineral, and vitamin physiology after TBI remains incomplete. Sodium and potassium tended to be the most well-studied derangements after TBI. Overall, data involving human subjects were limited and mostly involved observational studies. The data on vitamin and mineral effects were limited, and targeted research is needed before further recommendations can be made. Data on electrolyte derangements were stronger, but interventional studies are needed to assess causation.
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Affiliation(s)
| | - Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- 40th Forward Resuscitative Surgical Detachment, Fort Carson, CO 80902, USA
| | - Julie A Rizzo
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Bradley A Dengler
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Steven G Schauer
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
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Choudhary A, Kumar A, Sharma R, Khurana L, Jain S, Sharma S, Kumar D, Sharma S. Optimal vitamin D level ameliorates neurological outcome and quality of life after traumatic brain injury: a clinical perspective. Int J Neurosci 2023; 133:417-425. [PMID: 33930999 DOI: 10.1080/00207454.2021.1924706] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Deficiency of vitamin D along with traumatic brain injury (TBI) augments the risk of injury severity. This possibly affects the therapeutic regimen prescribed for TBI which may pessimistically affects its outcome. METHODS Studies literature search was conducted in Google Scholar and PubMed. The inclusions were studies performed clinically on both male and female. All included studies' references were also reviewed to find any additional relevance related to this review. Studies published in English were considered for this review. This review focuses upon the incidence of vitamin D deficiency in TBI and how it affects the Quality of life of the sufferer. RESULTS A total of 176 studies were reviewed and 58 were thoroughly focussed for review as they met inclusion criteria. These studies demonstrate that levels of vitamin D influence the recovery outcome after TBI. Vitamin D deficiency has been found to cause more deterioration in severe TBI than in patients with mild TBI. CONCLUSION Paucity of vitamin D significantly affects the outcome after brain injury. This clearly validates the necessity for screening of vitamin D levels in neurological deficit in order to reduce the risk of morbidity in terms of neurocognitive disorder.
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Affiliation(s)
- Ajay Choudhary
- Department of Neurosurgery, PGIMER, Dr. R.M.L. Hospital, New Delhi, India
| | - Ashok Kumar
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, Rajasthan, India
| | - Rajesh Sharma
- Department of Neurosurgery, PGIMER, Dr. R.M.L. Hospital, New Delhi, India
| | - Lipika Khurana
- Institute of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India
| | - Smita Jain
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, Rajasthan, India
| | - Shallu Sharma
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, Rajasthan, India
| | - Deepak Kumar
- Department of Physical Medicine and Rehabilitation, PGIMER, Dr. R.M.L. Hospital, New Delhi, India
| | - Swapnil Sharma
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, Rajasthan, India
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A pathway phenotype linking metabolic, immune, oxidative, and opioid pathways with comorbid depression, atherosclerosis, and unstable angina. CNS Spectr 2022; 27:676-690. [PMID: 34039448 DOI: 10.1017/s1092852921000432] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is strong comorbidity between atherosclerosis (ATS) and depression which is attributed to increased atherogenicity, insulin resistance (IR), and immune and oxidative stress. AIM OF THE STUDY To examine the role of the above pathways and mu-opioid receptor (MOR), β-endorphin levels, zinc, copper, vitamin D3, calcium, and magnesium in depression due to ATS/unstable angina (UA). METHODS Biomarkers were assayed in 58 controls and 120 ATS patients divided into those with moderate and severe depression according to the Beck Depression Inventory-II (BDI-II) scores >19 and >29, respectively. RESULTS Neural network and logistic regression models showed that severe depression due to ATS/UA was best predicted by interleukin-6 (IL-6), UA, MOR, zinc, β-endorphin, calcium and magnesium, and that moderate depression was associated with IL-6, zinc, MOR, β-endorphin, UA, atherogenicity, IR, and calcium. Neural networks yielded a significant discrimination of severe and moderate depression with an area under the receiver operating curves of 0.831 and 0.931, respectively. Using Partial Least Squares path analysis, we found that 66.2% of the variance in a latent vector extracted from ATS/UA clinical features, and the BDI-II scores, atherogenicity, and IR could be explained by the regression on IL-6, IL-10, zinc, copper, calcium, MOR, and age. The BDI-II scores increased from controls to ATS to UA class III to UA class IV. CONCLUSIONS Immune activation, the endogenous opioid system, antioxidants, trace elements, and macrominerals modulate a common core shared by increased depressive symptoms, ATS, UA, atherogenicity, and IR.
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Li N, Yao M, Liu J, Zhu Z, Lam TL, Zhang P, Kiang KMY, Leung GKK. Vitamin D Promotes Remyelination by Suppressing c-Myc and Inducing Oligodendrocyte Precursor Cell Differentiation after Traumatic Spinal Cord Injury. Int J Biol Sci 2022; 18:5391-5404. [PMID: 36147469 PMCID: PMC9461656 DOI: 10.7150/ijbs.73673] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/13/2022] [Indexed: 11/22/2022] Open
Abstract
Demyelination due to oligodendrocytes loss occurs after traumatic spinal cord injury (TSCI). Several studies have suggested the therapeutic potential of vitamin D (VitD) in demyelinating diseases. However, experimental evidence in the context of TSCI is limited, particularly in the presence of prior VitD-deficiency. In the present study, a contusion and a transection TSCI rat model were used, representing mild and severe injury, respectively. Motor recovery was assessed in rats with normal VitD level or with VitD-deficiency after 8 weeks' treatment post-TSCI (Cholecalciferol, 500 IU/kg/day). The impact on myelin integrity was examined by transmission electron microscopy and studied in vitro using primary culture of oligodendrocytes. We found that VitD treatment post-TSCI effectively improved hindlimb movement in rats with normal VitD level irrespective of injury severity. However, cord-transected rats with prior deficiency did not seem to benefit from VitD supplementation. Our data further suggested that having sufficient VitD was essential for persevering myelin integrity after injury. VitD rescued oligodendrocytes from apoptotic cell death in vitro and enhanced their myelinating ability towards dorsal root axons. Enhanced myelination was mediated by increased oligodendrocyte precursor cells (OPCs) differentiation into oligodendrocytes in concert with c-Myc downregulation and suppressed OPCs proliferation. Our study provides novel insights into the functioning of VitD as a regulator of OPCs differentiation as well as strong preclinical evidence supporting future clinical testing of VitD for TSCI.
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Affiliation(s)
- Ning Li
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,Department of Neurosurgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Min Yao
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,School of Pharmaceutical Sciences, Health Science Centre, Shenzhen University, Shenzhen, China
| | - Jiaxin Liu
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Zhiyuan Zhu
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,Department of Functional Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Tsz-Lung Lam
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Pingde Zhang
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Karrie Mei-Yee Kiang
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Gilberto Ka-Kit Leung
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Banjac Baljak V, Mihajlovic G, Zivlak-Radulovic N, Nezic L, Miskovic M, Banjac V. Association between Vitamin D and Cognitive Deficiency in Alcohol Dependence. Healthcare (Basel) 2022; 10:healthcare10091772. [PMID: 36141384 PMCID: PMC9498855 DOI: 10.3390/healthcare10091772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/22/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
There are still not enough findings to elucidate how exactly alcohol use impairs cognitive abilities. Some studies have shown that there is a link between alcohol intake and vitamin D levels, but these findings are inconsistent so further research is needed. The aim of this study was to investigate the association between serum vitamin D levels and cognitive impairment in alcohol-dependent individuals. A case-control study was carried out including a total of N = 132 respondents with a medical history of alcoholism, and healthy volunteers. The Montreal Cognitive Assessment (MoCa) and Addenbrooke’s Cognitive Examination-Revised (ACE-R) screening tools were used for cognitive status assessment and serum vitamin D levels analysis (blood samples of respondents). Significant difference (p = 0.022), was found in vitamin D levels in the alcohol-dependent group with cognitive deficiency 13.7 ± 9.4 (ng/mL), alcohol-dependent group without cognitive deficiency 19.5 ± 11.2 (ng/mL) and healthy controls 19.9 ± 11.1 (ng/mL), respectively. Furthermore, vitamin D levels were significantly different across all groups based on MoCa (p = 0.016) and ACE-R (p = 0.004) scores. All three groups exhibited vitamin D deficiency. A significant correlation was found between vitamin D deficiency and cognitive impairment, but it yielded no significant difference in alcohol-dependent individuals.
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Affiliation(s)
- Visnja Banjac Baljak
- Clinic of Psychiatry, University Clinical Center of the Republic of Srpska, 78 000 Banjaluka, Bosnia and Herzegovina
- Correspondence: ; Tel.: +387-65-462-496
| | - Goran Mihajlovic
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, 34 000 Kragujevac, Serbia
| | - Nera Zivlak-Radulovic
- Clinic of Psychiatry, University Clinical Center of the Republic of Srpska, 78 000 Banjaluka, Bosnia and Herzegovina
| | - Lana Nezic
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, 78 000 Banja Luka, Bosnia and Herzegovina
| | - Mirjana Miskovic
- Clinic of Psychiatry, University Clinical Center of the Republic of Srpska, 78 000 Banjaluka, Bosnia and Herzegovina
| | - Vesna Banjac
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, 78 000 Banja Luka, Bosnia and Herzegovina
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Zhang Y, Wu Y, Guo J, Xie F, Gong X, Wang Y, Zhang Y. Correlation between vitamin D and cognitive function in patients with traumatic brain injury in China. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:1015-1019. [PMID: 33237839 DOI: 10.1080/23279095.2020.1842409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study investigated changes in vitamin D levels in traumatic brain injury (TBI) patients and the relationship between vitamin D levels and cognitive function. METHODS Thirty-five TBI patients in our hospital were randomly selected, and baseline data were collected. 25-Hydroxyvitamin D (25(OH)D) plasma levels were determined within a month of hospitalization, and awareness and cognitive function were assessed using the Glasgow Coma Scale (GCS) and the Mini Mental State Examination (MMSE), respectively, on the day of blood collection. The data were statistically analyzed. RESULTS The MMSE and GCS scores were positively correlated (p < 0.05); higher MMSE scores were associated with higher GCS scores. Moreover, the total score was positively correlated with directional ability, memory, and attention, suggesting high internal consistency of the MMSE score, but no significant correlation with other indicators was observed. 25(OH)D was positively correlated with the injury site (p < 0.05), suggesting that frontal damage has a significant impact on the plasma level of 25(OH)D. CONCLUSION The plasma vitamin D level in TBI patients may indicate frontal lobe damage. The overall plasma level of 25(OH)D in TBI patients was not significantly correlated with cognitive function, but the incidence of cognitive impairment was higher with 25(OH)D level between 10 and 30 ng/ml.
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Affiliation(s)
- Yi Zhang
- Department of Rehabilitation Medicine, The First People's Hospital of Changzhou & Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yehuan Wu
- Department of Rehabilitation Medicine, The First People's Hospital of Changzhou & Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jing Guo
- Department of Rehabilitation Medicine, The First People's Hospital of Changzhou & Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Fan Xie
- Department of Rehabilitation Medicine, The First People's Hospital of Changzhou & Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xianyu Gong
- Department of Rehabilitation Medicine, The First People's Hospital of Changzhou & Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ya Wang
- Department of Rehabilitation Medicine, The First People's Hospital of Changzhou & Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yu Zhang
- Department of Rehabilitation Medicine, The First People's Hospital of Changzhou & Third Affiliated Hospital of Soochow University, Changzhou, China
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Jung E, Ro YS, Park JH, Moon SB, Lee SGW, Park GJ, Ryu HH, Shin SD. Vitamin D Deficiency and Prognosis after Traumatic Brain Injury with Intracranial Injury: A Multi-Center Observational Study. J Neurotrauma 2022; 39:1408-1416. [PMID: 35678067 DOI: 10.1089/neu.2022.0053] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Vitamin D may be important for neuroprotection after traumatic brain injury (TBI) by modifying the inflammatory response. The objective of this study was to evaluate the association between vitamin D deficiency and functional and survival outcomes in patients with TBI and intracranial injury. This study was a prospective multi-center cohort study conducted on adult TBI patients, with intracranial hemorrhage or diffuse axonal injury confirmed by radiological examination, admitted to five participating emergency departments (EDs) from December 2018 to June 2020. The study outcomes were good functional recovery at hospital discharge and survival at 6-months after injury. The primary exposure was serum vitamin D deficiency (0-10 ng/mL). Multi-level logistic regression analysis was performed to estimate the association between vitamin D deficiency and the study outcomes. Among 606 patients, 101 (16.7%) patients had vitamin D deficiency at the time of ED arrival. Good functional recovery was observed in 65.2% (395/606) of total population, and this proportion was significantly lower in the vitamin D deficiency group than the non-deficiency group (56.4 vs. 66.9%, p = 0.04, adjusted odds ratio (OR; 95% confidence interval [CI]): 0.56 (0.36-0.88)). Overall survival rate at 6 months after injury was 79.5% (434/546), and patients with vitamin D deficiency had significantly lower likelihood of survival at 6 months than patients without deficiency [75.0 vs. 80.3%, adjusted OR (95% CI): 0.59 (0.39-0.89)]. Vitamin D deficiency is associated with poor functional outcomes at hospital discharge and mortality at 6-months after injury in TBI patients with intracranial hemorrhage or diffuse axonal injury.
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Affiliation(s)
- Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Sung Bae Moon
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, School of Medicine Kyungpook National University and Kyungpook National University Hospital, Daegu, Korea
| | - Stephen Gyung Won Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Gwan Jin Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
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Vitamin D Protects against Traumatic Brain Injury via Modulating TLR4/MyD88/NF-κB Pathway-Mediated Microglial Polarization and Neuroinflammation. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3363036. [PMID: 35872863 PMCID: PMC9307360 DOI: 10.1155/2022/3363036] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/30/2022] [Accepted: 06/10/2022] [Indexed: 12/23/2022]
Abstract
Vitamin D (VD) deficiency is associated with neuroinflammation and neurocognitive deficits in patients with traumatic brain injury (TBI). The present study was aimed at investigating the therapeutic effects of VD and the molecular mechanisms after TBI. After the intraperitoneal injection of VD (1 μg/kg), sensorimotor and cognitive function was assessed via a series of behavioral tests in TBI rats. Traumatic outcomes were investigated by brain edema, blood-brain barrier (BBB) disruption, and morphologic staining. In vitro, cellular viability and cytotoxicity in primary hippocampal neurons were detected via the MTT method and LDH release. Hippocampal oxidative stress-related enzymes and proinflammatory mediators and the serum concentration of VD were analyzed by ELISA. The expression of VDR, TLR4, MyD88, and NF-κB p65 was measured by Western blot. Furthermore, the levels of M1/M2 microglial markers were quantified using real-time PCR and Western blot. VD treatment significantly increased the serum level of VD and the hippocampal expression of VDR. VD not only effectively alleviated neurocognitive deficits, brain edema, and BBB disruption but also promoted hippocampal neuronal survival in vivo and in vitro. Moreover, VD therapy prevented excessive neuroinflammation and oxidative stress caused by TBI. Mechanically, the hippocampal expression of TLR4, MyD88, and nuclear NF-κB p65 was elevated in the TBI group but robustly restrained by VD treatment. Taken together, VD provides an important neuroprotection through modulating hippocampal microglial M2 polarization and neuroinflammation via the TLR4/MyD88/NF-κB pathway.
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Emmez G, Baha Bulduk E, Yıldırım Z. Neuroprotective effects of adrenomedullin in experimental traumatic brain injury model in rats. ULUS TRAVMA ACIL CER 2022; 28:736-742. [PMID: 35652861 PMCID: PMC10443013 DOI: 10.14744/tjtes.2021.01954] [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: 01/16/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Traumatic brain injuries cause damages in the brain in several ways, which include cell death because of edema, disruption of the blood-brain barrier, shear stress, and ischemia. In this study, we investigated the effects of adrenomedullin (AM) on oxidative stress and inflammation after head traumas in a rat model. METHODS Eighteen male adult Wistar albino rats were randomized into three groups (n=6). No traumas were applied to the con-trol (C) group. Traumas were applied in line with Marmarau trauma model in the trauma group. The rats in the AM treatment group were treated with post-traumatic 12 μg/kg i.p. AM in addition to the trauma group. The rats were followed for 7 days in all groups and were then sacrificed. Brain tissues and blood samples were taken. RESULTS In the trauma group, both tissue and serum MDA, TNF-α, and IL-6 levels were significantly increased compared to the control group (p<0.05). In the AM-treated group, serum TNF-α levels were significantly decreased compared to the trauma group (p<0.05). In the trauma group, both tissue and serum GSH levels were significantly decreased compared to the control group (p<0.05). In the trauma group, serum Vitamin D3 levels were significantly decreased compared to the control group (p<0.05). In the AM-treated group, both tissue and serum GSH levels were significantly increased compared to the trauma group (p<0.05). CONCLUSION These results indicate that AM has neuroprotective effects on traumatic brain injury in a rat model.
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Affiliation(s)
- Gökçen Emmez
- Department of Anesthesiology and Reanimation, Gazi University Faculty of Medicine, Ankara-Turkey
| | - Erkut Baha Bulduk
- Department of Neurosurgery, Atılım University Faculty of Medicine, Ankara-Turkey
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Vitamin D Status and Cognitive and Functional Outcomes in Patients With Traumatic Brain Injury. TOP CLIN NUTR 2021. [DOI: 10.1097/tin.0000000000000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kunces LJ, Keenan J, Schmidt CM, Schmidt MA. Molecular Deficits Relevant to Concussion Are Prevalent in Top-Ranked Football Players Entering the National Football League Draft. J Strength Cond Res 2021; 35:3139-3144. [PMID: 34533486 DOI: 10.1519/jsc.0000000000004131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Kunces, LJ, Keenan, J, Schmidt, CM, and Schmidt, MA. Molecular deficits relevant to concussion are prevalent in top-ranked football players entering the National Football League draft. J Strength Cond Res XX(X): 000-000, 2021-Characterization of blood variants in athletes entering the highly competitive contact environment of professional football can help us understand the risk for brain injury. When coupled with longitudinal follow-up of future concussion incidence and trajectory, it may provide additional insight into factors that influence brain injury. We observed the metabolic phenotype of collegiate football players entering the 2016 National Football League (NFL) draft. The principal aims were to characterize the molecular status of individual athletes and quantify the prevalence of athletes with multiple concurrent molecular deficits. Blood was taken from 30 elite American collegiate football players 7 weeks before the NFL scouting combine and 15 weeks before entering the NFL draft. Average results revealed suboptimal values in Omega-3 Index (avg ± std, 4.66 ± 1.16%), arachidonic acid:eicosapentaenoic acid fatty acid ratio (29.13 ± 10.78), homocysteine (11.4 ± 3.4 µmol·L-1), vitamin D (30 ± 11.4 ng·ml-1), and red blood cell magnesium (4.1 ± 0.8 mg·dl-1). Using sport-optimized reference ranges from previously published research, 10% presented with 3, 40% presented with 4, and 50% of athletes presented with 5 suboptimal values at once. We conclude molecular deficits in this cohort entering the NFL draft were common, with a significant number of athletes presenting with multiple suboptimal levels. The significant commonality of the suboptimal biomarkers is relevance to brain health and function. This data warrant extensive metabolic phenotyping and consideration of prophylactic precision nutrition countermeasures by the multidisciplinary staff for athletes entering contact environments.
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Affiliation(s)
- Laura J Kunces
- Onegevity Health, New York, New York; Thorne HealthTech, Summerville, South Carolina; EXOS, Phoenix, Arizona; and Advanced Pattern Analysis & Countermeasures Group, Boulder, Colorado
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Tan X, Gao L, Cai X, Zhang M, Huang D, Dang Q, Bao L. Vitamin D 3 alleviates cognitive impairment through regulating inflammatory stress in db/db mice. Food Sci Nutr 2021; 9:4803-4814. [PMID: 34531993 PMCID: PMC8441317 DOI: 10.1002/fsn3.2397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/18/2021] [Accepted: 05/26/2021] [Indexed: 12/12/2022] Open
Abstract
Patients with type 2 diabetes mellitus (T2DM) have a higher risk to develop cognitive impairment. Several studies reported the potential roles of vitamin D in prevention of cognitive impairment, but the mechanism remains unclear. The present study aims to investigate the protective effects of vitamin D3 on cognitive impairment in db/db mice and to explore the possible mechanism. Twelve-week-old male db/db mice were randomly administrated with low, medium, and high dose of vitamin D3 (LVD, MVD, and HVD groups, respectively) and equivalent volume vitamin D3 solvent (corn oil, DM group) intragastrically. Eight age-matched db/m mice were given equivalent volume corn oil as normal group. After 16 weeks of vitamin D3 treatment, the concentrations of fasting serum glucose in three vitamin D3 groups (especially the 1,000 IU/kg·bw dose) were significantly decreased compared with DM group. Pathology revealed that the neuron damage was reduced in vitamin D3 groups. MVD intervention significantly shortened the escape latency on day 5 and extended time in the target quadrant. Mice in HVD group had significantly higher exploration time and discrimination index compared with the DM group mice. Moreover, vitamin D3 treatment has increased the phosphorylation of cAMP-response element-binding protein and the expression of brain-derived neurotrophic factor and vitamin D receptor. This treatment, meanwhile, has decreased the expression of tumor necrosis factor-α, the phosphorylation of inhibitor kappa Bα (IκBα), and nuclear factor-κB p65 (NF-κB p65) in the hippocampus of db/db mice. These results suggest that vitamin D3 alleviated cognitive impairment in the hippocampus of db/db mice. Down-regulation of the NF-κB signaling pathway-related proteins IκBα and p65 might be one of the possible mechanisms.
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Affiliation(s)
- Xiaomu Tan
- Neurology DepartmentLuhe HospitalCapital Medical UniversityBeijingChina
| | - Lifang Gao
- School of Public HealthBeijing Key Laboratory of Environmental ToxicologyCapital Medical UniversityBeijingChina
| | - Xiaxia Cai
- School of Public HealthBeijing Key Laboratory of Environmental ToxicologyCapital Medical UniversityBeijingChina
| | - Mingyuan Zhang
- School of Public HealthBeijing Key Laboratory of Environmental ToxicologyCapital Medical UniversityBeijingChina
| | - Dongxu Huang
- School of Public HealthBeijing Key Laboratory of Environmental ToxicologyCapital Medical UniversityBeijingChina
| | - Qinyu Dang
- School of Public HealthBeijing Key Laboratory of Environmental ToxicologyCapital Medical UniversityBeijingChina
| | - Lei Bao
- Department of Clinical NutritionPeking University International HospitalBeijingChina
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14
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Low Vitamin D Level Is Associated with Acute Deep Venous Thrombosis in Patients with Traumatic Brain Injury. Brain Sci 2021; 11:brainsci11070849. [PMID: 34202164 PMCID: PMC8301832 DOI: 10.3390/brainsci11070849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 12/03/2022] Open
Abstract
Vitamin D and its association with venous thromboembolism (VTE) have been studied in common rehabilitation populations, such as spinal cord injury and ischemic stroke groups. This study explores the relationship between vitamin D levels and acute deep venous thrombosis (DVT) in the traumatic brain injury (TBI) population. This is a retrospective cohort study that analyzes the relationship between vitamin D levels and the prevalence of DVT during acute inpatient rehabilitation. In this population, 62% (117/190) of patients had low vitamin D levels upon admission to acute rehabilitation. Furthermore, 21% (24/117) of patients in the low vitamin D group had acute DVT during admission to acute rehabilitation. In contrast, only 8% (6/73) of patients in the normal vitamin D group had acute DVT during admission to acute rehabilitation. Fisher’s exact tests revealed significant differences between individuals with low and normal vitamin D levels (p = 0.025). In conclusion, a vitamin D level below 30 ng/mL was associated with increased probability of the occurrence of acute DVT in individuals with moderate–severe TBI.
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15
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Lim KH, Jang J, Park J. Prevalence and clinical impact of vitamin D deficiency in critically ill Korean patients with traumatic injuries: a single-center, prospective, observational study. Acute Crit Care 2021; 36:92-98. [PMID: 33910318 PMCID: PMC8182161 DOI: 10.4266/acc.2020.00801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background This study investigated the prevalence and impact of 25-hydroxyvitamin D (25(OH) vitamin D) deficiency in critically ill Korean patients with traumatic injuries. Methods This prospective observational cohort study assessed the 25(OH) vitamin D status of consecutive trauma patients admitted to the trauma intensive care unit (TICU) of Kyungpook National University Hospital between January and December 2018. We analyzed the prevalence of 25(OH) vitamin D deficiency and its impact on clinical outcomes. Results There were no significant differences in the duration of mechanical ventilation (MV), lengths of TICU and hospital stays, and rates of nosocomial infection and mortality between patients with 25(OH) vitamin D <20 ng/ml and those with 25(OH) vitamin D ≥20 ng/ml within 24 hours of TICU admission. The duration of MV and lengths of TICU and hospital stays were shorter and the rate of nosocomial infection was lower in patients with 25(OH) vitamin D level ≥20 ng/ml on day 7 of hospitalization. The duration of MV, lengths of TICU and hospital stays, and nosocomial infection rate were significantly lower in patients with increased concentrations compared with those with decreased concentrations on day 7 of hospitalization, but the mortality rate did not differ significantly. Conclusions The 25(OH) vitamin D level measured within 24 hours after TICU admission was unrelated to clinical outcomes in critically ill patients with traumatic injuries. However, patients with increased 25(OH) vitamin D level after 7 days of hospitalization had better clinical outcomes than those with decreased levels.
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Affiliation(s)
- Kyoung Hoon Lim
- Trauma Center, Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jihoon Jang
- Trauma Center, Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jinyoung Park
- Trauma Center, Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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16
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Yousuf S, Atif F, Espinosa-Garcia C, Harris W, Turan N, Stein DG. Stroke-Induced Peripheral Immune Dysfunction in Vitamin D-Deficient Conditions: Modulation by Progesterone and Vitamin D. Mol Neurobiol 2021; 58:950-963. [PMID: 33063282 DOI: 10.1007/s12035-020-02129-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022]
Abstract
Vitamin D deficiency (Ddef) alters morphology and outcomes after a stroke. We investigated the interaction of Ddef following post-stroke systemic inflammation and evaluated whether administration of progesterone (P) or vitamin D (D) will improve outcomes. Ddef rats underwent stroke with lipopolysaccharide (LPS)-induced systemic inflammation. Rats were randomly divided into 9 groups and treated with P, D, or vehicle for 4 days. At day 4, rats were tested on different behavioral parameters. Markers of neuronal inflammation, endoplasmic reticulum stress, oxidative stress, white matter integrity, and apoptosis were measured along with immune cell populations from the spleen, thymus, and blood. Severely altered outcomes were observed in the Ddef group compared to the D-sufficient (Dsuf) group. Stroke caused peripheral immune dysfunction in the Dsuf group which was worse in the Ddef group. Systemic inflammation exacerbated injury outcomes in the Dsuf group and these were worse in the Ddef group. Monotherapy with P/D showed beneficial functional effects but the combined treatment showed better outcomes than either alone. Ddef as a comorbid condition with stroke worsens stroke outcomes and can delay functional recovery. Combination treatment with P and D might be promising for future stroke therapeutics in Ddef.
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Affiliation(s)
- Seema Yousuf
- Department of Emergency Medicine, Brain Research Laboratory, Emory University, 615 Michael Street, Room 655A, Atlanta, GA, 30322, USA.
| | - Fahim Atif
- Department of Emergency Medicine, Brain Research Laboratory, Emory University, 615 Michael Street, Room 655A, Atlanta, GA, 30322, USA
| | | | - Wayne Harris
- School of Medicine, Department of Hematology-Oncology, Emory University, Atlanta, GA, 30322, USA
| | - Nefize Turan
- Department of Neurology, School of Medicine, Tufts University, Boston, MA, 0211, USA
| | - Donald G Stein
- Department of Emergency Medicine, Brain Research Laboratory, Emory University, 615 Michael Street, Room 655A, Atlanta, GA, 30322, USA
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17
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Saadatmand K, Khan S, Hassan Q, Hautamaki R, Ashouri R, Lua J, Doré S. Benefits of vitamin D supplementation to attenuate TBI secondary injury? Transl Neurosci 2021; 12:533-544. [PMID: 34992852 PMCID: PMC8678475 DOI: 10.1515/tnsci-2020-0195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/25/2022] Open
Abstract
Vitamin D supplementation has been shown to improve outcomes for patients suffering from a variety of illnesses such as stroke and cancer. Vitamin D deficiencies have been associated with longer hospital stays, greater severity of symptoms, and death in some complex cases. Due to vitamin D’s burgeoning role in improving patient outcomes, a new sector of research is focusing on the lesser-known implications of vitamin D on health. Traumatic brain injury (TBI) affects approximately 69 million people worldwide per year. Here, we summarize the current scientific understanding of vitamin D dynamics with TBI to elucidate a potential way to lessen the cascade of secondary damage after an initial insult, with the goal of improving overall patient outcomes. Because vitamin D supplementation has been correlated with better outcomes in other pathologies involving immune and inflammatory molecules, it is important to study the potential effect of vitamin D deficiency (VDD) and supplementation on TBI outcomes. Research on vitamin D supplementation in TBI remains in the preliminary stages. There is still much to learn about vitamin D deficiency, dosage, variants of supplementary forms, mechanisms, and its role in TBI.
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Affiliation(s)
- Kiana Saadatmand
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Saba Khan
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Quaratulain Hassan
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Raymond Hautamaki
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Rani Ashouri
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Josh Lua
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Sylvain Doré
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.,Departments of Psychiatry, Pharmaceutics, Psychology, and Neuroscience, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
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18
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Arabi SM, Sedaghat A, Ehsaei MR, Safarian M, Ranjbar G, Rezaee H, Rezvani R, Tabesh H, Norouzy A. Efficacy of high-dose versus low-dose vitamin D supplementation on serum levels of inflammatory factors and mortality rate in severe traumatic brain injury patients: study protocol for a randomized placebo-controlled trial. Trials 2020; 21:685. [PMID: 32727558 PMCID: PMC7388115 DOI: 10.1186/s13063-020-04622-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 07/18/2020] [Indexed: 11/25/2022] Open
Abstract
Background Traumatic brain injury (TBI) is the most common trauma worldwide and is a leading cause of injury-related death and disability. Inflammation is initiated as a result of the TBI, which is in association with severity of illness and mortality in brain trauma patients, especially in subdural hemorrhage and epidural hemorrhage cases. A high percentage of adults admitted to the intensive care unit with TBI are diagnosed with vitamin D deficiency; this deficiency may induce impaired immune responses and increase the risk of infections. Vitamin D intervention has been shown to modulate pro- and anti-inflammatory cytokines in non-critically ill patients, but to date, there is no substantial data on the effectiveness of vitamin D for the improvement of immune function in traumatic brain injury patients. Methods/design A randomized clinical trial (RCT) will be performed on 74 Iranian adults 18–65 years old with brain trauma and will be treated daily with vitamin D supplements (100,000 IU oral drop) or a similar placebo (1000 IU) for 5 days. Discussion If this randomized clinical trial demonstrates reductions in inflammatory cytokines, it would provide evidence for a multicenter clinical trial to evaluate the efficacy of vitamin D supplementation in neurocritically ill patients. Since vitamin D supplements are inexpensive and safe, this clinical trial could have the potential to improve clinical outcomes in traumatic brain injury patients through reduction of inflammation and infection-associated morbidity and mortality rates. Trial registration Iranian Registry of Clinical Trials, IRCT20180619040151N3. Registered on 10 August 2019.
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Affiliation(s)
- Seyed Mostafa Arabi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Sedaghat
- Cardiac Anesthesia Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Ehsaei
- Department of Neurosurgery, Shahid Kamiab Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Safarian
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Golnaz Ranjbar
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Rezaee
- Department of Neurosurgery, Shahid Kamiab Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Rezvani
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Tabesh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdolreza Norouzy
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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19
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Dubiel R, Williams B, Sullivan E, Callender L, Bennett M, Driver S. Prevalence of 25-hydroxyvitamin D deficiency in the acute rehabilitation population following traumatic brain injury. NeuroRehabilitation 2019; 45:513-517. [PMID: 31868688 DOI: 10.3233/nre-192888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the prevalence of vitamin D deficiency among individuals with traumatic brain injury (TBI) undergoing acute inpatient rehabilitation. SETTING Inpatient rehabilitation. PARTICIPANTS Participants were admitted from November 1st, 2010 through June 30th, 2015 with diagnosis of mild-severe TBI and had serum 25 OH vitamin D levels checked upon admission. 369 out of 845 met inclusion. DESIGN Retrospective cohort. MAIN MEASURES 25 OH vitamin D, vitamin D treatment. RESULTS The majority of patients were male (67%), Caucasian (89%) with private insurance (61%) and a mean age of 43.5±21.0 years. 25 OH vitamin D levels were categorized: deficient (<20 ng/mL), insufficient (20-29.9 ng/mL), and sufficient (≥30 ng/mL). There were 95 (26%) patients that were deficient, 131 (36%) that were insufficient, and 143 (39%) that were sufficient. Race/ethnicity was found to be significant (p = 0.0145) with the largest percentage of Hispanics found in the insufficient and deficient categories, and the largest percentage of Blacks in the deficient category. Most patients with deficient or insufficient vitamin D levels were prescribed vitamin D replacement during their rehab stay (p < 0.0001). CONCLUSION The majority of patients undergoing acute inpatient rehabilitation were found to have insufficient or deficient vitamin D levels, therefore it should be routinely screened and treated as indicated.
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Affiliation(s)
- Rosemary Dubiel
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA.,Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Benecia Williams
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA.,Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Erin Sullivan
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
| | - Librada Callender
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA.,Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Monica Bennett
- Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Simon Driver
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA.,Baylor University Medical Center at Dallas, Dallas, TX, USA
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20
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Polich G, Iaccarino MA, Zafonte R. Psychopharmacology of traumatic brain injury. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:253-267. [PMID: 31727216 DOI: 10.1016/b978-0-444-64012-3.00015-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The pathophysiology of traumatic brain injury (TBI) can be highly variable, involving functional and/or structural damage to multiple neuroanatomical networks and neurotransmitter systems. This wide-ranging potential for physiologic injury is reflected in the diversity of neurobehavioral and neurocognitive symptoms following TBI. Here, we aim to provide a succinct, clinically relevant, up-to-date review on psychopharmacology for the most common sequelae of TBI in the postacute to chronic period. Specifically, treatment for neurobehavioral symptoms (depression, mania, anxiety, agitation/irritability, psychosis, pseudobulbar affect, and apathy) and neurocognitive symptoms (processing speed, attention, memory, executive dysfunction) will be discussed. Treatment recommendations will reflect general clinical practice patterns and the research literature.
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Affiliation(s)
- Ginger Polich
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States.
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21
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Scaramella J, Kirihennedige N, Broad E. Key Nutritional Strategies to Optimize Performance in Para Athletes. Phys Med Rehabil Clin N Am 2018; 29:283-298. [PMID: 29627089 DOI: 10.1016/j.pmr.2018.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Para athletes are a high-risk population for inadequate dietary intake leading to insufficiencies in nutrients important to athletic performance. This is partly due to minimal support and resources, especially in sport nutrition education, combined with limited prior nutrition knowledge and risks associated with different impairment types. Inadequate energy, carbohydrate, protein, iron, and vitamin D status are of particular concern in Para athletes. Assessment of these key nutrients, along with sport nutrition education, is needed to empower Para athletes with the knowledge to understand their individual nutrition needs and maximize athletic performance.
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Affiliation(s)
- Jacque Scaramella
- Sport Performance, United States Olympic Committee (US Paralympics), 2800 Olympic Parkway, Chula Vista, CA 91915, USA
| | - Nuwanee Kirihennedige
- Sport Performance, United States Olympic Committee (US Paralympics), 1 Olympic Plaza, Colorado Springs, CO 80909, USA
| | - Elizabeth Broad
- Sport Performance, United States Olympic Committee (US Paralympics), 2800 Olympic Parkway, Chula Vista, CA 91915, USA.
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22
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Physical Frailty and Cognitive Functioning in Korea Rural Community-Dwelling Older Adults. J Clin Med 2018; 7:jcm7110405. [PMID: 30384463 PMCID: PMC6262608 DOI: 10.3390/jcm7110405] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 01/16/2023] Open
Abstract
Cognitive frailty is a heterogeneous clinical manifestation characterized by the simultaneous presence of physical frailty and cognitive impairment. The objective of this study was to investigate the association between physical frailty and cognitive function in rural community-dwelling older Korean adults, taking four cognitive domains into account. We carried out a cross-sectional population-based study which enrolled 104 community-dwelling elderly. Physical frailty phenotype, as well as its individual criteria, were used. Cognitive functioning was examined in the four domains of memory, processing speed, cognitive flexibility, and working memory. Demographic data, lipid profile, muscle strength, physical function, and 25-hydroxyvitamin D (25[OH]D) concentration collected from questionnaire interviews and assessments were included. Of the 104 older adults (77% female), 24.3% were classified as robust, 49.6% as prefrail, and 16.5% as frail. Linear regression analyses showed that the severity of frailty index was associated with four cognitive domains Muscle strength (i.e., Grip strength, Knee extensor and flexor), physical function (i.e., SPPB and Gait speed), and 25[OH]D were associated with poorer cognitive function. Within our population of Korean rural community-dwelling older adults, physical frailty status, muscle strength, physical functions, and biochemical measurements were associated with poorer cognitive function. Synchronicity of physical frailty and cognitive dysfunction may contribute to the negative health-related effects associated with aging.
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23
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Intiso D, Fontana A, Copetti M, Di Rienzo F. Serum vitamin D deficiency in subjects with severe acquired brain injury and relationship with functional severity. Brain Inj 2018; 32:1817-1823. [PMID: 30339483 DOI: 10.1080/02699052.2018.1537512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Vitamin D may be important for the development and function of the nervous system. Low serum vitamin D levels have been detected in several neurological diseases. OBJECTIVE To ascertain the relationship between 25(OH)D serum level and disability in subjects with severe acquired brain injury (sABI). DESIGN Prospective cross-sectional study Methods: Consecutive subjects with sABI admitted to neuro-rehabilitation were enrolled. A sample of subjects from the neurological ward was considered the control group. Vitamin D serum levels and blood parameters were measured at admission. Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS), and Level of Cognitive Functioning (LCF) were used in assessing disability. RESULTS A total of 104 subjects (34 F, 70 M; mean age 53.9 ± 15.2 years) were enrolled: 54 (19 F, 35 M) with sABI and 50 (15 F, 35 M) subjects as control group. Deficient mean serum levels of vitamin D (19.2 ± 9.4 ng/mL) were detected in the subjects with sABI and a significant inverse correlation between vitamin D serum levels and DRS score was detected (p = 0.04). CONCLUSION Subjects with sABI showed vitamin D deficiency that might correlate to disability severity. The reason is unclear and might represent a secondary phenomenon resulting from the inflammatory process.
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Affiliation(s)
- D Intiso
- a Unit of Neuro-rehabilitation, and Rehabilitation Medicine , IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo , Foggia , Italy
| | - A Fontana
- b Unit of Biostatistics , IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo , Foggia , Italy
| | - M Copetti
- b Unit of Biostatistics , IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo , Foggia , Italy
| | - F Di Rienzo
- a Unit of Neuro-rehabilitation, and Rehabilitation Medicine , IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo , Foggia , Italy
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24
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Stein DG, Sayeed I. Repurposing and repositioning neurosteroids in the treatment of traumatic brain injury: A report from the trenches. Neuropharmacology 2018; 147:66-73. [PMID: 29630902 DOI: 10.1016/j.neuropharm.2018.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/28/2018] [Accepted: 04/05/2018] [Indexed: 01/01/2023]
Abstract
The field of neuroprotection after brain injuries has been littered with failed clinical trials. Finding a safe and effective treatment for acute traumatic brain injury remains a serious unmet medical need. Repurposing drugs that have been in use for other disorders is receiving increasing attention as a strategy to move candidate drugs more quickly to trial while reducing the very high cost of new drug development. This paper describes our own serendipitous discovery of progesterone's neuroprotective potential, and the strategies we are using in repurposing and developing this hormone for use in brain injuries-applications very different from its classical uses in treating disorders of the reproductive system. We have been screening and testing a novel analog that maintains progesterone's therapeutic properties while overcoming its physiochemical challenges, and testing progesterone in combination treatment with another pleiotropic hormone, vitamin D. Finally, our paper, in the context of the problems and pitfalls we have encountered, surveys some of the factors we found to be critical in the clinical translation of repurposed drugs. This article is part of the Special Issue entitled 'Drug Repurposing: old molecules, new ways to fast track drug discovery and development for CNS disorders'.
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Affiliation(s)
- Donald G Stein
- Emory University School of Medicine, Department of Emergency Medicine, 1365 B Clifton Rd NE, Suite 5100, Atlanta, GA, 30322, USA.
| | - Iqbal Sayeed
- Emory University School of Medicine, Department of Emergency Medicine, 1365 B Clifton Rd NE, Suite 5100, Atlanta, GA, 30322, USA.
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25
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Drake DF, Hudak AM, Robbins W. Integrative Medicine in Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2017; 28:363-378. [DOI: 10.1016/j.pmr.2016.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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26
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Vitamin D Deficiency in Traumatic Brain Injury and Its Relationship with Severity of Injury and Quality of Life: A Prospective, Observational Study. J Neurotrauma 2017; 34:1448-1456. [DOI: 10.1089/neu.2016.4494] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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