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Graham NSN, Zimmerman KA, Bertolini G, Magnoni S, Oddo M, Zetterberg H, Moro F, Novelli D, Heslegrave A, Chieregato A, Fainardi E, Fleming JM, Garbero E, Abed-Maillard S, Gradisek P, Bernini A, Sharp DJ. Multicentre longitudinal study of fluid and neuroimaging BIOmarkers of AXonal injury after traumatic brain injury: the BIO-AX-TBI study protocol. BMJ Open 2020; 10:e042093. [PMID: 33172948 PMCID: PMC7656955 DOI: 10.1136/bmjopen-2020-042093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/29/2020] [Accepted: 10/21/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION AND AIMS Traumatic brain injury (TBI) often results in persistent disability, due particularly to cognitive impairments. Outcomes remain difficult to predict but appear to relate to axonal injury. Several new approaches involving fluid and neuroimaging biomarkers show promise to sensitively quantify axonal injury. By assessing these longitudinally in a large cohort, we aim both to improve our understanding of the pathophysiology of TBI, and provide better tools to predict clinical outcome. METHODS AND ANALYSIS BIOmarkers of AXonal injury after TBI is a prospective longitudinal study of fluid and neuroimaging biomarkers of axonal injury after moderate-to-severe TBI, currently being conducted across multiple European centres. We will provide a detailed characterisation of axonal injury after TBI, using fluid (such as plasma/microdialysate neurofilament light) and neuroimaging biomarkers (including diffusion tensor MRI), which will then be related to detailed clinical, cognitive and functional outcome measures. We aim to recruit at least 250 patients, including 40 with cerebral microdialysis performed, with serial assessments performed twice in the first 10 days after injury, subacutely at 10 days to 6 weeks, at 6 and 12 months after injury. ETHICS AND DISSEMINATION The relevant ethical approvals have been granted by the following ethics committees: in London, by the Camberwell St Giles Research Ethics Committee; in Policlinico (Milan), by the Comitato Etico Milano Area 2; in Niguarda (Milan), by the Comitato Etico Milano Area 3; in Careggi (Florence), by the Comitato Etico Regionale per la Sperimentazione Clinica della Regione Toscana, Sezione area vasta centro; in Trento, by the Trento Comitato Etico per le Sperimentazioni Cliniche, Azienda Provinciale per i Servizi Sanitari della Provincia autonoma di Trento; in Lausanne, by the Commission cantonale d'éthique de la recherche sur l'être humain; in Ljubljana, by the National Medical Ethics Committee at the Ministry of Health of the Republic of Slovenia. The study findings will be disseminated to patients, healthcare professionals, academics and policy-makers including through presentation at conferences and peer-reviewed publications. Data will be shared with approved researchers to provide further insights for patient benefit. TRIAL REGISTRATION NUMBER NCT03534154.
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Affiliation(s)
- Neil Samuel Nyholm Graham
- Department of Brain Sciences, Imperial College London, London, UK
- UK DRI Centre for Care Research and Technology, London, UK
| | - Karl A Zimmerman
- Department of Brain Sciences, Imperial College London, London, UK
- UK DRI Centre for Care Research and Technology, London, UK
| | - Guido Bertolini
- Public Health, IRCCS-'Mario Negri' Institute for Pharmacological Research, Ranica, Italy
| | - Sandra Magnoni
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, Trento, Italy
| | - Mauro Oddo
- Department of Intensive Care Medicine, CHUV Lausanne University Hospital, Lausanne, Switzerland
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg Sahlgrenska Academy, Mölndal, Sweden
| | - Federico Moro
- Public Health, IRCCS-'Mario Negri' Institute for Pharmacological Research, Ranica, Italy
| | - Deborah Novelli
- Public Health, IRCCS-'Mario Negri' Institute for Pharmacological Research, Ranica, Italy
| | | | - Arturo Chieregato
- Neurorianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Enrico Fainardi
- Department of Experimental and Clinical Sciences, Careggi University Hospital, University of Firenze, Florence, Italy
| | - Joanne M Fleming
- Public Health, IRCCS-'Mario Negri' Institute for Pharmacological Research, Ranica, Italy
| | - Elena Garbero
- Public Health, IRCCS-'Mario Negri' Institute for Pharmacological Research, Ranica, Italy
| | - Samia Abed-Maillard
- Department of Intensive Care Medicine, CHUV Lausanne University Hospital, Lausanne, Switzerland
| | - Primoz Gradisek
- Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Center, Ljubljana, Slovenia
| | - Adriano Bernini
- Department of Intensive Care Medicine, CHUV Lausanne University Hospital, Lausanne, Switzerland
| | - David J Sharp
- Department of Brain Sciences, Imperial College London, London, UK
- UK DRI Centre for Care Research and Technology, London, UK
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Graham NSN, Junghans C, Downes R, Sendall C, Lai H, McKirdy A, Elliott P, Howard R, Wingfield D, Priestman M, Ciechonska M, Cameron L, Storch M, Crone MA, Freemont PS, Randell P, McLaren R, Lang N, Ladhani S, Sanderson F, Sharp DJ. SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes. J Infect 2020; 81:411-419. [PMID: 32504743 PMCID: PMC7836316 DOI: 10.1016/j.jinf.2020.05.073] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/30/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To understand SARS-Co-V-2 infection and transmission in UK nursing homes in order to develop preventive strategies for protecting the frail elderly residents. METHODS An outbreak investigation involving 394 residents and 70 staff, was carried out in 4 nursing homes affected by COVID-19 outbreaks in central London. Two point-prevalence surveys were performed one week apart where residents underwent SARS-CoV-2 testing and had relevant symptoms documented. Asymptomatic staff from three of the four homes were also offered SARS-CoV-2 testing. RESULTS Overall, 26% (95% CI 22-31) of residents died over the two-month period. All-cause mortality increased by 203% (95% CI 70-336) compared with previous years. Systematic testing identified 40% (95% CI 35-46) of residents as positive for SARS-CoV-2, and of these 43% (95% CI 34-52) were asymptomatic and 18% (95% CI 11-24) had only atypical symptoms; 4% (95% CI -1 to 9) of asymptomatic staff also tested positive. CONCLUSIONS The SARS-CoV-2 outbreak in four UK nursing homes was associated with very high infection and mortality rates. Many residents developed either atypical or had no discernible symptoms. A number of asymptomatic staff members also tested positive, suggesting a role for regular screening of both residents and staff in mitigating future outbreaks.
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Affiliation(s)
- N S N Graham
- UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK; Department of Brain Sciences, Imperial College London, UK
| | - C Junghans
- Department of Primary Care and Public Health, Imperial College London, UK
| | - R Downes
- Department of Elderly Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - C Sendall
- Department of Elderly Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - H Lai
- UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK; Department of Brain Sciences, Imperial College London, UK
| | - A McKirdy
- North West London Health Protection Team, Public Health England, 61 Colindale Avenue, Colindale, London NW9 5EQ, UK
| | - P Elliott
- UK DRI Centre at Imperial, Imperial College London, UK; MRC Centre for Environment and Health, Imperial College London, UK; BHF Centre of Excellence, Imperial College London, UK; Imperial NIHR Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, UK
| | - R Howard
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London W1T 7NF, UK
| | - D Wingfield
- Department of Metabolism, Digestion and Reproduction, Imperial College London, UK; Department of Primary Care and Public Health, Imperial College London, UK
| | - M Priestman
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - M Ciechonska
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - L Cameron
- Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - M Storch
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - M A Crone
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - P S Freemont
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - P Randell
- North West London Pathology, Charing Cross Hospital, London W6 8RF, UK; Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - R McLaren
- Park Medical Centre, Hammersmith, London W6 0QG, UK
| | - N Lang
- Hammersmith and Fulham Council, 3 Shortlands, Hammersmith W6 8DA, UK
| | - S Ladhani
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - F Sanderson
- Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK.
| | - D J Sharp
- UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK; Department of Brain Sciences, Imperial College London, UK
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