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Kim JT, Song K, Han SW, Youn DH, Jung H, Kim KS, Lee HJ, Hong JY, Cho YJ, Kang SM, Jeon JP. Modeling of the brain-lung axis using organoids in traumatic brain injury: an updated review. Cell Biosci 2024; 14:83. [PMID: 38909262 PMCID: PMC11193205 DOI: 10.1186/s13578-024-01252-2] [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: 03/04/2024] [Accepted: 05/24/2024] [Indexed: 06/24/2024] Open
Abstract
Clinical outcome after traumatic brain injury (TBI) is closely associated conditions of other organs, especially lungs as well as degree of brain injury. Even if there is no direct lung damage, severe brain injury can enhance sympathetic tones on blood vessels and vascular resistance, resulting in neurogenic pulmonary edema. Conversely, lung damage can worsen brain damage by dysregulating immunity. These findings suggest the importance of brain-lung axis interactions in TBI. However, little research has been conducted on the topic. An advanced disease model using stem cell technology may be an alternative for investigating the brain and lungs simultaneously but separately, as they can be potential candidates for improving the clinical outcomes of TBI.In this review, we describe the importance of brain-lung axis interactions in TBI by focusing on the concepts and reproducibility of brain and lung organoids in vitro. We also summarize recent research using pluripotent stem cell-derived brain organoids and their preclinical applications in various brain disease conditions and explore how they mimic the brain-lung axis. Reviewing the current status and discussing the limitations and potential perspectives in organoid research may offer a better understanding of pathophysiological interactions between the brain and lung after TBI.
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Affiliation(s)
- Jong-Tae Kim
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, 24252, Republic of Korea
| | - Kang Song
- Department of Green Chemical Engineering, Sangmyung University, Cheonan, 31066, Republic of Korea
| | - Sung Woo Han
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, 24252, Republic of Korea
| | - Dong Hyuk Youn
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, 24252, Republic of Korea
| | - Harry Jung
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, 24252, Republic of Korea
| | - Keun-Suh Kim
- Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Hyo-Jung Lee
- Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Ji Young Hong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hallym University College of Medicine, Chuncheon, 24252, Republic of Korea
| | - Yong-Jun Cho
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, 24252, Republic of Korea
| | - Sung-Min Kang
- Department of Green Chemical Engineering, Sangmyung University, Cheonan, 31066, Republic of Korea.
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, 24252, Republic of Korea.
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2
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Park H, Lee CH. The Impact of Pulmonary Disorders on Neurological Health (Lung-Brain Axis). Immune Netw 2024; 24:e20. [PMID: 38974208 PMCID: PMC11224666 DOI: 10.4110/in.2024.24.e20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/30/2024] [Accepted: 05/23/2024] [Indexed: 07/09/2024] Open
Abstract
The brain and lungs, vital organs in the body, play essential roles in maintaining overall well-being and survival. These organs interact through complex and sophisticated bi-directional pathways known as the 'lung-brain axis', facilitated by their close proximity and neural connections. Numerous studies have underscored the mediation of the lung-brain axis by inflammatory responses and hypoxia-induced damage, which are pivotal to the progression of both pulmonary and neurological diseases. This review aims to delve into how pulmonary diseases, including acute/chronic airway diseases and pulmonary conditions, can instigate neurological disorders such as stroke, Alzheimer's disease, and Parkinson's disease. Additionally, we highlight the emerging research on the lung microbiome which, drawing parallels between the gut and lungs in terms of microbiome contents, may play a significant role in modulating brain health. Ultimately, this review paves the way for exciting avenues of future research and therapeutics in addressing respiratory and neurological diseases.
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Affiliation(s)
- Hongryeol Park
- Department of Tissue Morphogenesis, Max-Planck Institute for Molecular Biomedicine, Muenster 48149, Germany
| | - Chan Hee Lee
- Department of Biomedical Science, Hallym University, Chuncheon 24252, Korea
- Program of Material Science for Medicine and Pharmaceutics, Hallym University, Chuncheon 24252, Korea
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3
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Pastor IS, Para I, Vesa ȘC, Florian IȘ. Identifying predictive factors for mortality in patients with TBI at a neurosurgery department. J Med Life 2023; 16:554-558. [PMID: 37305827 PMCID: PMC10251389 DOI: 10.25122/jml-2023-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Traumatic brain injury (TBI) can have severe consequences in most cases. Many therapeutic and neurosurgical strategies have been improved to optimize patient outcomes. However, despite adequate surgery and intensive care, death can still occur during hospitalization. TBI often results in protracted hospital stays in neurosurgery departments, indicating the severity of brain injury. Several factors related to TBI are predictive of longer hospital stays and in-hospital mortality rates. This study aimed to identify predictive factors for intrahospital days of death due to TBI. This was a longitudinal, retrospective, analytical, observational study that included 70 TBI-related deaths admitted to the Neurosurgery Clinic in Cluj-Napoca for a period of four years (January 2017 to December 2021) using a cohort model. We identified some clinical data related to intrahospital death after TBI. The severity of TBI was classified as mild (n=9), moderate(n=13), and severe (n=48) and was associated with significantly fewer hospital days (p=0.009). Patients with associated trauma, such as vertebro-medullary or thoracic trauma, were more likely to die after a few days of hospitalization (p=0.007). Surgery applied in TBI was associated with a higher median number of days until death compared to conservative treatment. A low GCS was an independent predictive factor for early intrahospital mortality in patients with TBI. In conclusion, clinical factors such as the severity of injury, low GCS, and polytrauma are predictive of early intrahospital mortality. Surgery was associated with prolonged hospitalization.
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Affiliation(s)
- Iulia-Sevastiana Pastor
- Department of Neurosurgery, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana Para
- 4 Department of Internal Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ștefan Cristian Vesa
- Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Ștefan Florian
- Department of Neurosurgery, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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4
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Khalili H, Rismani M, Nematollahi MA, Masoudi MS, Asadollahi A, Taheri R, Pourmontaseri H, Valibeygi A, Roshanzamir M, Alizadehsani R, Niakan A, Andishgar A, Islam SMS, Acharya UR. Prognosis prediction in traumatic brain injury patients using machine learning algorithms. Sci Rep 2023; 13:960. [PMID: 36653412 PMCID: PMC9849475 DOI: 10.1038/s41598-023-28188-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Predicting treatment outcomes in traumatic brain injury (TBI) patients is challenging worldwide. The present study aimed to achieve the most accurate machine learning (ML) algorithms to predict the outcomes of TBI treatment by evaluating demographic features, laboratory data, imaging indices, and clinical features. We used data from 3347 patients admitted to a tertiary trauma centre in Iran from 2016 to 2021. After the exclusion of incomplete data, 1653 patients remained. We used ML algorithms such as random forest (RF) and decision tree (DT) with ten-fold cross-validation to develop the best prediction model. Our findings reveal that among different variables included in this study, the motor component of the Glasgow coma scale, the condition of pupils, and the condition of cisterns were the most reliable features for predicting in-hospital mortality, while the patients' age takes the place of cisterns condition when considering the long-term survival of TBI patients. Also, we found that the RF algorithm is the best model to predict the short-term mortality of TBI patients. However, the generalized linear model (GLM) algorithm showed the best performance (with an accuracy rate of 82.03 ± 2.34) in predicting the long-term survival of patients. Our results showed that using appropriate markers and with further development, ML has the potential to predict TBI patients' survival in the short- and long-term.
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Affiliation(s)
- Hosseinali Khalili
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maziyar Rismani
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Mohammad Sadegh Masoudi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arefeh Asadollahi
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Reza Taheri
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hossein Pourmontaseri
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran.,Bitab Knowledge Enterprise, Fasa University of Medical Sciences, Fasa, Iran
| | - Adib Valibeygi
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Mohamad Roshanzamir
- Department of Computer Engineering, Faculty of Engineering, Fasa University, Fasa, 74617-81189, Iran
| | - Roohallah Alizadehsani
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Geelong, Australia
| | - Amin Niakan
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aref Andishgar
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.,Cardiovascular Division, The George Institute for Global Health, Newtown, Australia.,Sydney Medical School, University of Sydney, Camperdown, Australia
| | - U Rajendra Acharya
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore, Singapore.,Department of Biomedical Engineering, School of Science and Technology, Singapore University of Social Sciences, Singapore, Singapore.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung City, Taiwan
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5
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TBI and risk of death in military veterans over 14 years: Injury severity, timing, and cause of death. J Psychiatr Res 2022; 156:200-205. [PMID: 36257114 DOI: 10.1016/j.jpsychires.2022.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/26/2022] [Accepted: 09/16/2022] [Indexed: 01/20/2023]
Abstract
The objective of this study was to determine the association of traumatic brain injury (TBI) with mortality in military veterans and whether this association differs as a function of TBI severity, timing, and cause of death. This national cohort study used U.S. Department of Veterans Affairs' (VA) data of patients 18 years and older with TBI diagnoses (N = 213,290) and 1:1 propensity-matched comparison random sample of patients without TBI (N = 213,290). The main outcome measure was mortality within 6 months of TBI diagnosis and longer-term (after 6 months). Cox proportional hazards models were used to examine risk of all-cause mortality according to TBI severity and Fine-Gray proportional hazards regression to examine time to cause-specific mortality, accounting for competing risk of other deaths. For patients with moderate-to-severe TBI (compared with no TBI), hazard ratios (HRs) for mortality were highest within first 6 months of injury (fully-adjusted HR: 2.42, 95% CI: 2.32-2.53); for mild TBIs, HRs for mortality were lower and relatively constant over time (fully-adjusted HR within first 6 months: 1.33, 95% CI: 1.26-1.39). Veterans with mild and moderate-to-severe TBI had higher risk of future death over short term for 9 out 10 of the U.S. leading causes of death, with only unintentional injury, stroke, and suicide showing differences by TBI severity. Associations attenuated significantly from within to after 6 months TBI diagnosis. These findings indicate that adults with TBI are at increased risk of majority of leading causes of death, with differential risk by TBI severity and timing of death.
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Qiao H, Yang J, Wang C. Effect of Cluster Nursing Based on Risk Management Strategy on Urinary Tract Infection in Patients With Severe Craniocerebral Injury. Front Surg 2022; 8:826835. [PMID: 35187052 PMCID: PMC8850279 DOI: 10.3389/fsurg.2021.826835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To observe the effect of cluster nursing based on risk management strategy in the management of urinary tract infection in patients with severe craniocerebral injury. Methods A total of 116 patients with severe craniocerebral injury who were admitted to our hospital from March 2019 to March 2021 were included. They were divided into the control group (58 patients) and the observation group (58 patients). The control group received routine nursing care and the observation group received cluster nursing based on risk management strategy. The incidence of catheter-associated urinary tract infection (CAUTI), the results of bacterial culture on the surface of the urinary catheter, the incidence of nursing risk events, the duration of placing the urinary catheter, the length of hospital stay, and hospital costs as well as the patient satisfaction score were compared between the two groups. The knowledge, attitude, and practice scale for prevention of catheter infection and the competence evaluation scale of nurses were used to evaluate the sense-control ability and core competence of the interveners. Results The total incidence of CAUTI in the observation group was (6.90%) lower than that in the control group (20.69%) (p < 0.05). The bacterial culture results on the catheter surface of patients in the observation group before and after 6 and 12 h of catheter cleaning were better than those of patients in the control group (p < 0.05). The duration of indwelling urinary catheter, hospitalization time, and hospitalization expenses of patients in the observation group were lower than those of patients in the control group (p < 0.05). The incidence rate of nursing risk events in the observation group was (1.72%) lower than that in the control group (11.86%) (p < 0.05). The overall satisfaction score of patients and the control and core ability scores of nursing staff in the observation group were higher than those in the control group (p < 0.05). Conclusion Cluster nursing based on risk management strategy can effectively reduce the incidence of nursing risk events and the probability of UTI in patients with severe craniocerebral injury, shorten the duration of indwelling urinary catheter and hospitalization.
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Affiliation(s)
- Hongbin Qiao
- The Hospital Infection Management Department, Chongqing Southeast Hospital, Chongqing, China
| | - Jing Yang
- The Department of Respiratory and Critical Care Medicine, Chongqing People's Hospital, Chongqing, China
| | - Cui Wang
- The Hospital Infection Management Department, Chongqing Southeast Hospital, Chongqing, China
- *Correspondence: Cui Wang
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7
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Ma RN, He YX, Bai FP, Song ZP, Chen MS, Li M. Machine Learning Model for Predicting Acute Respiratory Failure in Individuals With Moderate-to-Severe Traumatic Brain Injury. Front Med (Lausanne) 2022; 8:793230. [PMID: 35004766 PMCID: PMC8739486 DOI: 10.3389/fmed.2021.793230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background: There is a high incidence of acute respiratory failure (ARF) in moderate or severe traumatic brain injury (M-STBI), worsening outcomes. This study aimed to design a predictive model for ARF. Methods: Adult patients with M-STBI [3 ≤ Glasgow Coma Scale (GCS) ≤ 12] with a definite history of brain trauma and abnormal head on CT images, obtained from September 2015 to May 2017, were included. Patients with age >80 years or <18 years, multiple injuries with TBI upon admission, or pregnancy (in women) were excluded. Two models based on machine learning extreme gradient boosting (XGBoost) or logistic regression, respectively, were developed for predicting ARF within 48 h upon admission. These models were evaluated by out-of-sample validation. The samples were assigned to the training and test sets at a ratio of 3:1. Results: In total, 312 patients were analyzed including 132 (42.3%) patients who had ARF. The GCS and the Marshall CT score, procalcitonin (PCT), and C-reactive protein (CRP) on admission significantly predicted ARF. The novel machine learning XGBoost model was superior to logistic regression model in predicting ARF [area under the receiver operating characteristic (AUROC) = 0.903, 95% CI, 0.834–0.966 vs. AUROC = 0.798, 95% CI, 0.697–0.899; p < 0.05]. Conclusion: The XGBoost model could better predict ARF in comparison with logistic regression-based model. Therefore, machine learning methods could help to develop and validate novel predictive models.
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Affiliation(s)
- Rui Na Ma
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospitals of Fourth Military Medical University, Xi'an, China
| | - Yi Xuan He
- Neurocritical Care Unit, Department of Neurosurgery, The Second Affiliated Hospitals of Fourth Military Medical University, Xi'an, China
| | - Fu Ping Bai
- Department of Neurosurgery, Lin Fen Center Hospital, Lin Fen, China
| | - Zhi Peng Song
- Neurocritical Care Unit, Department of Neurosurgery, The Second Affiliated Hospitals of Fourth Military Medical University, Xi'an, China
| | - Ming Sheng Chen
- Neurocritical Care Unit, Department of Neurosurgery, The Second Affiliated Hospitals of Fourth Military Medical University, Xi'an, China
| | - Min Li
- Neurocritical Care Unit, Department of Neurosurgery, The Second Affiliated Hospitals of Fourth Military Medical University, Xi'an, China
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8
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McDonald SJ, Sharkey JM, Sun M, Kaukas LM, Shultz SR, Turner RJ, Leonard AV, Brady RD, Corrigan F. Beyond the Brain: Peripheral Interactions after Traumatic Brain Injury. J Neurotrauma 2021; 37:770-781. [PMID: 32041478 DOI: 10.1089/neu.2019.6885] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability, and there are currently no pharmacological treatments known to improve patient outcomes. Unquestionably, contributing toward a lack of effective treatments is the highly complex and heterogenous nature of TBI. In this review, we highlight the recent surge of research that has demonstrated various central interactions with the periphery as a potential major contributor toward this heterogeneity and, in particular, the breadth of research from Australia. We describe the growing evidence of how extracranial factors, such as polytrauma and infection, can significantly alter TBI neuropathology. In addition, we highlight how dysregulation of the autonomic nervous system and the systemic inflammatory response induced by TBI can have profound pathophysiological effects on peripheral organs, such as the heart, lung, gastrointestinal tract, liver, kidney, spleen, and bone. Collectively, this review firmly establishes TBI as a systemic condition. Further, the central and peripheral interactions that can occur after TBI must be further explored and accounted for in the ongoing search for effective treatments.
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Affiliation(s)
- Stuart J McDonald
- Department Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia
| | - Jessica M Sharkey
- Discipline of Anatomy and Pathology, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mujun Sun
- Department Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Lola M Kaukas
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sandy R Shultz
- Department Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Renee J Turner
- Discipline of Anatomy and Pathology, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anna V Leonard
- Discipline of Anatomy and Pathology, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rhys D Brady
- Department Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Frances Corrigan
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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9
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Wang M, Li J, Li W, Tian H, Kang X. The effect of EBN combined with integrated hierarchical accountability nursing on patients with severe pneumonia. Am J Transl Res 2021; 13:5610-5616. [PMID: 34150165 PMCID: PMC8205829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the effects of evidence-based nursing (EBN) combined with integrated hierarchical accountability nursing on patients with severe pneumonia (SP). METHODS 72 SP patients admitted to our hospital from March 2019 to March 2020 were recruited as the study cohort and randomly divided into control group (36 patients) or research group (36 patients). The control group underwent conventional nursing, and the research group underwent EBN combined with integrated hierarchical accountability nursing plus. The patients' respiratory function, inflammatory factor levels, hospital stay durations, mechanical ventilation times, complication rates, and nursing satisfaction levels were compared between the two groups. RESULTS Before the nursing, there were no significant differences in the FVC, TLC, MVV, or VC levels between the two groups (P>0.05). After the nursing, the FVC, TLC, MVV, and VC levels in the research group were all lower than they were in the control group (all P<0.05). Before the nursing, the WBC, CRP, and PCT levels in the two groups were similar (P>0.05). After the nursing, the WBC, CRP, and PCT levels in the research group were significantly lower than they were in the control group (P<0.05). The hospital stay durations and mechanical ventilation times in the research group were shorter than they were in the control group (P<0.05). The complication rate in the research group was lower than it was in the control group (5.56% vs. 27.78% P<0.05). The nursing satisfaction level in the research group was higher than it was in the control group (97.22% vs. 77.78% P<0.05). CONCLUSION EBN combined with integrated hierarchical accountability nursing has a good application effect on patients with SP. It can significantly improve patients' respiratory function and inflammatory factor levels, reduce the duration of patient hospital stays, reduce their mechanical ventilation times, and complication rate, and enhance their satisfaction with the nursing. Thus, it is worthy of further promotion.
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Affiliation(s)
- Meiqin Wang
- Department of Emergency Critical Care Medicine, The People’s Hospital of LangfangLangfang, Hebei, China
| | - Jing Li
- Department of Emergency Critical Care Medicine, The People’s Hospital of LangfangLangfang, Hebei, China
| | - Wei Li
- Department of Emergency Critical Care Medicine, The People’s Hospital of LangfangLangfang, Hebei, China
| | - Huichao Tian
- Department of Emergency Critical Care Medicine, The People’s Hospital of LangfangLangfang, Hebei, China
| | - Xinyun Kang
- Nursing Department, Hebei PetroChina Central HospitalLangfang, Hebei, China
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10
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Liu HY, Liao KM, Liang FW, Hung YC, Wang JJ, Shen TC, Ho CH. The risk of pulmonary tuberculosis after traumatic brain injury. Sci Rep 2021; 11:7840. [PMID: 33837282 PMCID: PMC8035358 DOI: 10.1038/s41598-021-87332-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/23/2021] [Indexed: 11/09/2022] Open
Abstract
After traumatic brain injury (TBI), an inflammatory response in the brain might affect the immune system. The risk of pulmonary infection reportedly increases in patients with TBI. We aimed to evaluate the risk of tuberculosis (TB) in patients with TBI in Taiwan. All participants were selected from the intensive care unit (ICU). Patients with TBI were defined as patients in ICU with intracranial injury, and comparison cohort were patients in ICU without TBI diagnosis. There was a significant difference in TB risk between the patients with TBI and the comparison cohort according to age and the Charlson’s comorbidity index (CCI) score. Thus, we divided patients based on CCI into three groups for further analysis: mild (CCI = 0), moderate (CCI = 1/2), severe (CCI > 2). Mild-CCI group had a lower TB incidence rate (0.74%) and longer time to TB development (median: 2.43) than the other two groups. Moderate-CCI group had 1.52-fold increased risk of TB infection (p < 0.0001) compared with mild-CCI group. In the severe-CCI group, patients aged ≥ 80 years had 1.91-fold risk of TB compared with mild-CCI group (p = 0.0481). Severe-CCI group had significantly higher mortality than the mild-CCI group (p = 0.0366). Patients with TBI and more comorbidities had higher risk of TB infection with higher mortality rate.
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Affiliation(s)
- Hsin-Yueh Liu
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
| | - Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
| | - Fu-Wen Liang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chieh Hung
- Department of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, No 901, Zhonghua Road, Yongkang District, Tainan City 710, Taiwan.,Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.,AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan City, Taiwan
| | - Te-Chun Shen
- School of Medicine, China Medical University, Taichung, Taiwan. .,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, Taichung, 404, Taiwan.
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, No 901, Zhonghua Road, Yongkang District, Tainan City 710, Taiwan.
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11
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Hong ZJ, Firek M, Zachary B, Mörs K, Schindler C, Marzi I, Yu JC, Coimbra R. The effect of age and sex on outcomes following isolated moderate to severe traumatic brain injury. Eur J Trauma Emerg Surg 2020; 48:871-880. [PMID: 32929551 DOI: 10.1007/s00068-020-01491-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The impact of female sex on traumatic brain injury (TBI) outcomes remains controversial. The combined impact of age and sex on TBI outcomes must be clarified. We hypothesized that females have better outcomes than males in the premenopausal age group. METHODS Data from the 2007-2016 National Trauma Data Bank of the Committee on Trauma-American College of Surgeons were used. Of a total of 686,549 patients with moderate to severe TBI (AIS ≥ 3), 251,491 were female. Comparison analyses of clinical characteristics and outcomes between females and males were conducted at different age groups: < 45 years, 45-55, and > 55 years. Logistic regressions were performed to assess the impact of age and female sex on mortality and complications. RESULTS Mortality rate between females and males aged < 45 and 45-55 years was similar, but significantly reduced in the > 55 years group. After multivariate logistic regression analysis controlling for multiple confounding factors, we found that females aged > 55 years had markedly decreased risk of mortality (AOR: 0.857, 95% CI 0.835-0.879, p < 0.001) and complications. CONCLUSION Female patients in the postmenopausal stage have better outcomes following TBI than males, but pre- and perimenopausal females do not, suggesting that female sexual hormones may not provide a significant protective effect on clinical outcomes following isolated moderate to severe TBI.
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Affiliation(s)
- Zhi-Jie Hong
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, 26520 Cactus Ave., CPC Building, Suite 102-5, Riverside, Moreno Valley, CA, 92555, USA.,Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Matthew Firek
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, 26520 Cactus Ave., CPC Building, Suite 102-5, Riverside, Moreno Valley, CA, 92555, USA
| | - Bishoy Zachary
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, 26520 Cactus Ave., CPC Building, Suite 102-5, Riverside, Moreno Valley, CA, 92555, USA
| | - Katharina Mörs
- Department of Trauma, Hand and Reconstructive Surgery, University of Frankfurt, Frankfurt, Germany
| | - Cora Schindler
- Department of Trauma, Hand and Reconstructive Surgery, University of Frankfurt, Frankfurt, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University of Frankfurt, Frankfurt, Germany
| | - Jyh-Cherng Yu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, 26520 Cactus Ave., CPC Building, Suite 102-5, Riverside, Moreno Valley, CA, 92555, USA. .,Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA.
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12
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Sun M, Brady RD, Wanrooy B, Mychasiuk R, Yamakawa GR, Casillas-Espinosa PM, Wong CHY, Shultz SR, McDonald SJ. Experimental traumatic brain injury does not lead to lung infection. J Neuroimmunol 2020; 343:577239. [PMID: 32302792 DOI: 10.1016/j.jneuroim.2020.577239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 12/13/2022]
Abstract
Traumatic brain injury (TBI) patients often experience post-traumatic infections, especially in the lung. Pulmonary infection is associated with unfavorable outcomes and increased mortality rates in TBI patients; however, our understanding of the underlying mechanisms is poor. Here we used a lateral fluid percussion injury (LFPI) model in rats to investigate whether TBI could lead to spontaneous lung infection. Analysis of bacterial load in lung tissue indicated no occurrence of spontaneous lung infection at 24 h, 48 h, and 7 d following LFPI. This may suggest that exogenous infectious agents play a crucial role in post-TBI infection in patients.
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Affiliation(s)
- Mujun Sun
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia.
| | - Rhys D Brady
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia.
| | - Brooke Wanrooy
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia.
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia.
| | - Glenn R Yamakawa
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia.
| | - Pablo M Casillas-Espinosa
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia.
| | - Connie H Y Wong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia.
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia.
| | - Stuart J McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Melbourne, VIC 3086, Australia.
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13
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Incidence and Effect of Diabetes Insipidus in the Acute Care of Patients with Severe Traumatic Brain Injury. Neurocrit Care 2020; 33:718-724. [PMID: 32207035 DOI: 10.1007/s12028-020-00955-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Literature on diabetes insipidus (DI) after severe traumatic brain injury (TBI) is scarce. Some studies have reported varying frequencies of DI and have showed its association with increased mortality, suggesting it as a marker of poor outcome. This knowledge gap in the acute care consequences of DI in severe TBI patients led us to conceive this study, aimed at identifying risk factors and quantifying the effect of DI on short-term functional outcomes and mortality. METHODS We assembled a historic cohort of adult patients with severe TBI (Glasgow Coma Scale ≤ 8) admitted to the intensive care unit (ICU) of a tertiary-care university hospital over a 6-year period. Basic demographic characteristics, clinical information, imaging findings, and laboratory results were collected. We used logistic regression models to assess potential risk factors for the development of DI, and the association of this condition with death and unfavorable functional outcomes [modified Rankin scale (mRS)] at hospital discharge. RESULTS A total of 317 patients were included in the study. The frequency of DI was 14.82%, and it presented at a median of 2 days (IQR 1-3) after ICU admission. Severity according to the Abbreviated Injury Scale (AIS) score of the head, intracerebral hemorrhage, subdural hematoma, and skull base fracture was suggested as risk factors for DI. Diagnosis of DI was independently associated death (OR 4.34, CI 95% 1.92-10.11, p = 0.0005) and unfavorable outcome (modified Rankin Scale = 4-6) at discharge (OR 7.38; CI 95% 2.15-37.21, p = 0.0047). CONCLUSIONS Diabetes insipidus is a frequent and early complication in patients with severe TBI in the ICU and is strongly associated with increased mortality and poor short-term outcomes. We provide clinically useful risk factors that will help detect DI early to improve prognosis and therapy of patients with severe TBI.
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14
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Catlin J, Leclerc JL, Shukla K, Marini SM, Doré S. Role of the PGE 2 receptor subtypes EP1, EP2, and EP3 in repetitive traumatic brain injury. CNS Neurosci Ther 2019; 26:628-635. [PMID: 31617678 PMCID: PMC7248542 DOI: 10.1111/cns.13228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 01/02/2023] Open
Abstract
Aims The goal was to explore the signaling pathways of PGE2 to investigate therapeutic effects against secondary injuries following TBI. Methods Young (4.9 ± 1.0 months) and aged (20.4 ± 1.4 months) male wild type (WT) C57BL/6 and PGE2 EP1, 2, and 3 receptor knockout mice were selected to either receive sham or repetitive concussive head injury. Immunohistochemistry protocols with Iba1 and GFAP were performed to evaluate microgliosis and astrogliosis in the hippocampus, two critical components of neuroinflammation. Passive avoidance test measured memory function associated with the hippocampus. Results No differences in hippocampal microgliosis were found when aged EP2−/− and EP3−/− mice were compared with aged WT mice. However, the aged EP1−/− mice had 69.2 ± 7.5% less hippocampal microgliosis in the contralateral hemisphere compared with WT aged mice. Compared with aged EP2−/− and EP3−/−, EP1−/− aged mice had 78.9 ± 5.1% and 74.7 ± 6.2% less hippocampal microgliosis in the contralateral hemisphere. Within the EP1−/− mice, aged mice had 90.7 ± 2.7% and 81.1 ± 5.6% less hippocampal microgliosis compared with EP1−/− young mice in the contralateral and ipsilateral hemispheres, respectively. No differences were noted in all groups for astrogliosis. There was a significant difference in latency time within EP1−/−, EP2−/−, and EP3−/− on day 1 and day 2 in aged and young mice. Conclusion These findings demonstrate that the PGE2 EP receptors may be potential therapeutic targets to treat repetitive concussions and other acute brain injuries.
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Affiliation(s)
- James Catlin
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Jenna L Leclerc
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Krunal Shukla
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Sarah M Marini
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Sylvain Doré
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA.,Department of Neurology, Psychiatry, and Pharmaceutics, University of Florida, Gainesville, FL, USA
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