1
|
Marroney N, Beattie J, Hildebrand N, Flint T, Smith RM. Does training therapists to manage benign paroxysmal positional vertigo in patients with acute traumatic brain injury reduce vestibular neurology referrals? Brain Inj 2022; 36:822-826. [PMID: 35133230 DOI: 10.1080/02699052.2022.2034955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Dizziness is common in patients with acute traumatic brain injury (aTBI). However, patients are not always managed by the ward team but instead are referred to a visiting vestibular neurology team or referred for outpatient follow-up. We aimed to ascertain whether training trauma ward therapists to manage a common form of post-traumatic dizziness (Benign paroxysmal positional vertigo [BPPV]) reduced referrals to a visiting vestibular neurology team. DESIGN Referrals of patients with aTBI with complaints of dizziness to the visiting vestibular neurology team were audited from the Major Trauma Centre at Imperial College Healthcare NHS Foundation Trust, London, UK. Ward therapists subsequently received training on management of BPPV. Referrals to the vestibular neurology service were re-audited. Therapist confidence in assessing and treating BPPV was also assessed pre and post-training. RESULTS Pre-training, referral rate to the visiting vestibular neurology service was eight patients per month. Following training, referrals to the vestibular neurology service reduced by 35%. Therapist confidence improved significantly following training. CONCLUSIONS Training trauma ward therapists to manage BPPV reduced referrals to a visiting vestibular neurology service. Further research is necessary to assess implications for service and patient level parameters, such as length of stay and time to discharge.
Collapse
Affiliation(s)
- Natalie Marroney
- Physiotherapy Department, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jenna Beattie
- Occupational Therapy Department, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Natalie Hildebrand
- Physiotherapy Department, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Thomas Flint
- Physiotherapy Department, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Rebecca M Smith
- Brain and Vestibular Group, Neuro-otology Unit, Department of Brain Sciences, Imperial College London, London, UK
| |
Collapse
|
2
|
Chinese Head Trauma Study Collaborators. Chinese Head Trauma Data Bank: Effect of Gender on the Outcome of Patients With Acute Traumatic Brain Injury. J Neurotrauma 2021; 38:1164-7. [PMID: 23039042 DOI: 10.1089/neu.2011.2134] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Gender may be related with the outcome of patients with acute traumatic brain injury (TBI). We explored the effect of gender on the outcome of 7145 patients with acute TBI. There was no statistical difference between male and female sex in the causes of trauma, age, Glasgow Coma Scale score, computed tomgraphy findings, and surgical management. The mortality of 7145 patients with acute TBI in males and females was 7.48% and 7.22%, respectively, with the corresponding unfavorable outcomes of 16.05% and 17.23%, respectively (p > 0.05 in both cases). The mortality of 1626 patients with severe TBI in males and females was 19.68% and 20.72%, respectively, with the corresponding unfavorable outcomes of 46.96% and 48.85%, respectively (p > 0.05 in both cases). Our data suggest that sex does not play a role in the outcome of patients with acute TBI.
Collapse
|
3
|
Tsukamoto T, Kajikawa S, Hitomi T, Funaki T, Urushitani M, Takahashi R, Ikeda A. [Scalp-recorded cortical spreading depolarizations (CSDs) of EEG with time constant of 2 seconds in a patient with acute traumatic brain injury]. Rinsho Shinkeigaku 2020; 60:473-478. [PMID: 32536664 DOI: 10.5692/clinicalneurol.60.cn-001421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
An 82-year-old female suffered from head trauma, and developed acute consciousness disturbance 6 days after the event. Head CT showed the acute subdural hematoma in the left temporooccipital area and the patient underwent emergency hematoma evacuation and decompression. However, her consciousness disturbance became worse after surgery. Intermittent large negative infraslow shifts (lasting longer than 40 seconds) were recorded in the right posterior quadrant by scalp EEG with TC of 2 sec, that was defined as cortical spreading depolarizations (CSDs). Clinically consciousness disturbance sustained poor until 1 month after surgery in spite of treatment by anti-epileptic drugs. CSDs were observed on the right side where head injury most likely occurred. It may explain the sustained consciousness disturbance associated with significant prolonged ischemia. Once scalp EEG could record CSDs in this particular patient, the degree and its prognosis of traumatic head injury were estimated.
Collapse
Affiliation(s)
- Takahito Tsukamoto
- Department of Neurology, Kyoto University Graduate School of Medicine
- Department of Neurology, Shiga University of Medical Science
| | - Shunsuke Kajikawa
- Department of Neurology, Kyoto University Graduate School of Medicine
| | - Takefumi Hitomi
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine
| | - Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | | | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine
| |
Collapse
|
4
|
Zheng F, Zhou YT, Feng DD, Li PF, Tang T, Luo JK, Wang Y. Metabolomics analysis of the hippocampus in a rat model of traumatic brain injury during the acute phase. Brain Behav 2020; 10:e01520. [PMID: 31908160 PMCID: PMC7010586 DOI: 10.1002/brb3.1520] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) has increased in rank among traumatic injuries worldwide. Traumatic brain injury is a serious obstacle given that its complex pathology represents a long-term process. Recently, systems biology strategies such as metabolomics to investigate the multifactorial nature of TBI have facilitated attempts to find biomarkers and probe molecular pathways for its diagnosis and therapy. METHODS This study included a group of 20 rats with controlled cortical impact and a group of 20 sham rats. We utilized mNSS tests to investigate neurological metabolic impairments on day 1 and day 3. Furthermore, we applied metabolomics and bioinformatics to determine the metabolic perturbation caused by TBI during the acute period in the hippocampus tissue of controlled cortical impact (CCI) rats. Notably, TBI-protein-metabolite subnetworks identified from a database were assessed for associations between metabolites and TBI by the dysregulation of related enzymes and transporters. RESULTS Our results identified 7 and 8 biomarkers on day 1 and day 3, respectively. Additionally, related pathway disorders showed effects on arginine and proline metabolism as well as taurine and hypotaurine metabolism on day 3 in acute TBI. Furthermore, according to metabolite-protein database searches, 25 metabolite-protein pairs were established as causally associated with TBI. Further, bioinformation indicated that these TBI-associated proteins mainly take part in 5'-nucleotidase activity and carboxylic acid transmembrane transport. In addition, interweaved networks were constructed to show that the development of TBI might be affected by metabolite-related proteins and their protein pathways. CONCLUSION The overall results show that acute TBI is susceptible to metabolic disorders, and the joint metabolite-protein network analysis provides a favorable prediction of TBI pathogenesis mechanisms in the brain. The signatures in the hippocampus might be promising for the development of biomarkers and pathways relevant to acute TBI and could further guide testable predictions of the underlying mechanism of TBI.
Collapse
Affiliation(s)
- Fei Zheng
- College of Electrical and Information Engineering, Hunan University, Changsha, China
| | - Yan-Tao Zhou
- College of Electrical and Information Engineering, Hunan University, Changsha, China
| | - Dan-Dan Feng
- Laboratory of Ethnopharmacology, Institute of Integrated Traditional Chinese and Western Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Peng-Fei Li
- Laboratory of Ethnopharmacology, Institute of Integrated Traditional Chinese and Western Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Tao Tang
- Laboratory of Ethnopharmacology, Institute of Integrated Traditional Chinese and Western Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Jie-Kun Luo
- Laboratory of Ethnopharmacology, Institute of Integrated Traditional Chinese and Western Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Wang
- Laboratory of Ethnopharmacology, Institute of Integrated Traditional Chinese and Western Medicine, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
5
|
Feng D, Xia Z, Zhou J, Lu H, Zhang C, Fan R, Xiong X, Cui H, Gan P, Huang W, Peng W, He F, Wang Z, Wang Y, Tang T. Metabolomics reveals the effect of Xuefu Zhuyu Decoction on plasma metabolism in rats with acute traumatic brain injury. Oncotarget 2017; 8:94692-94710. [PMID: 29212259 PMCID: PMC5706905 DOI: 10.18632/oncotarget.21876] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 09/03/2017] [Indexed: 12/13/2022] Open
Abstract
Xuefu Zhuyu Decoction (XFZY), an important traditional Chinese herbal formula, has been reported effective on traumatic brain injury (TBI) in rats. However, its cerebral protection mechanism has not been clarified at the metabolic level. This work aims to explore the global metabolic characteristics of XFZY in rats during the acute phase of TBI on days 1 and 3. A plasma metabolomics method based on gas chromatography-mass spectrometry coupled with univariate analysis and multivariate statistical analysis was performed in three groups (Sham, Vehicle, XFZY). Then, a pathway analysis using MetaboAnalyst 3.0 was performed to illustrate the pathways of therapeutic action of XFZY in TBI. XFZY treatment attenuates neurological dysfunction and cortical lesion volume post-injury on day 3, and reverses the plasma metabolite abnormalities (glutamic acid, lactic acid, 3-hydroxybutyric acid, and ribitol, etc.). These differential metabolites are mainly involved in D-glutamine and D-glutamate metabolism, alanine, aspartate and glutamate metabolism, and inositol phosphate metabolism. Our study reveals potential biomarkers and metabolic networks of acute TBI and neuroprotection effects of XFZY, and shows this metabolomics approach with MetaboAnalyst would be a feasible way to systematically study therapeutic effects of XFZY on TBI.
Collapse
Affiliation(s)
- Dandan Feng
- Institute of Integrative Chinese Medicine, Xiangya Hospital, Central South University, Changsha 410008, P.R. China
| | - Zian Xia
- Institute of Integrative Chinese Medicine, Xiangya Hospital, Central South University, Changsha 410008, P.R. China
| | - Jing Zhou
- Institute of Integrative Chinese Medicine, Xiangya Hospital, Central South University, Changsha 410008, P.R. China
| | - Hongmei Lu
- Research Center of Modernization of Traditional Chinese Medicines, College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, P.R. China
| | - Chunhu Zhang
- Institute of Integrative Chinese Medicine, Xiangya Hospital, Central South University, Changsha 410008, P.R. China
| | - Rong Fan
- Institute of Integrative Chinese Medicine, Xiangya Hospital, Central South University, Changsha 410008, P.R. China
| | - Xingui Xiong
- Institute of Integrative Chinese Medicine, Xiangya Hospital, Central South University, Changsha 410008, P.R. China
| | - Hanjin Cui
- Institute of Integrative Chinese Medicine, Xiangya Hospital, Central South University, Changsha 410008, P.R. China
| | - Pingping Gan
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, P.R. China
| | - Wei Huang
- Institute of Integrative Chinese Medicine, Xiangya Hospital, Central South University, Changsha 410008, P.R. China
| | - Weijun Peng
- Department of Integrated Chinese and Western Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, P.R. China
| | - Feng He
- Department of Hepatobiliary Surgery, Xiangya Hospital, Central South University, Changsha 410008, P.R. China
| | - Zhiming Wang
- Department of Hepatobiliary Surgery, Xiangya Hospital, Central South University, Changsha 410008, P.R. China
| | - Yang Wang
- Institute of Integrative Chinese Medicine, Xiangya Hospital, Central South University, Changsha 410008, P.R. China
| | - Tao Tang
- Institute of Integrative Chinese Medicine, Xiangya Hospital, Central South University, Changsha 410008, P.R. China
| |
Collapse
|
6
|
Chen S, Shi Q, Zheng S, Luo L, Yuan S, Wang X, Cheng Z, Zhang W. Role of α-II-spectrin breakdown products in the prediction of the severity and clinical outcome of acute traumatic brain injury. Exp Ther Med 2016; 11:2049-53. [PMID: 27168849 DOI: 10.3892/etm.2016.3153] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 01/18/2016] [Indexed: 12/12/2022] Open
Abstract
αII-spectrin breakdown products are regarded as potential biomarkers for traumatic brain injury (TBI). The aim of the present study was to further evaluate these biomarkers by assessing their clinical utility in predicting the severity of injury and clinical outcome of patients with TBI. Eligible patients with acute TBI (n=17), defined by a Glasgow Coma Scale (GCS) score of ≤8, were enrolled. Ventricular cerebrospinal fluid (CSF) was sampled from each patient at 24, 72 and 120 h following TBI. An immunoblot assay was used to determine the concentrations of SBDPs in the CSF samples. The concentrations of SBDPs combined with the GCS score at 24 h after injury and the Glasgow Outcome Score (GOS) at 30 days after injury were compared and analyzed. The levels of SBDPs in CSF were markedly increased following acute TBI in comparison with those in the control group. In the early period after TBI, the levels of SBDPs were closely associated with GCS score. Comparisons of the SBDP levels with the severity of injury revealed significant differences between patients with the most severe brain injury and patients with severe brain injury in the first 24 h post-injury (P<0.05). The levels and dynamic changes of SBDPs in CSF exhibited a close association with GOS at 30 days after injury. The levels of SBDPs differed significantly between patients grouped according to prognosis (P<0.05). These results suggest that in the early period after TBI, the levels and dynamic changes of SBDPs in CSF can be useful in the prediction of the severity of injury and clinical outcome of patients.
Collapse
|