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Background: Immediate evaluation and management of brain trauma patients improves disease outcomes and reduces the neurobehavioral consequences of the injury. Emergency nurses are expected to manage patients based on the best available evidence.Aim: The present study was performed with aim to develop and implement an evidence-based care package for the management of brain trauma patients.Method: This semi-experimental study was conducted on 60 nurses in the emergency departments from November 2022 to May 2023. The subjects were randomly assigned to intervention (n=30) and control (n=30) groups. The data collection tool included a demographic questionnaire and a brain trauma management checklist. The intervention included 4 training workshops based on the comprehensive evidence-based care package during two weeks. Both groups were assessed through a checklist before and after the intervention during 8 weeks.Results: There was a significant difference between the two groups in the mean scores of care management before the intervention (p

Traumatic brain injury (TBI) has become a major source of disability worldwide, increasing the interest in algorithms that use artificial intelligence (AI) to optimize the interpretation of imaging studies, prognosis estimation, and critical care issues. In this study we present a bibliometric analysis and mini-review on the main uses that have been developed for TBI in AI. The results informing this review come from a Scopus database search as of April 15, 2023. The bibliometric analysis was carried out via the mapping bibliographic metrics method. Knowledge mapping was made in the VOSviewer software (V1.6.18), analyzing the "link strength" of networks based on co-occurrence of key words, countries co-authorship, and co-cited authors. In the mini-review section, we highlight the main findings and contributions of the studies. A total of 495 scientific publications were identified from 2000 to 2023, with 9262 citations published since 2013. Among the 160 journals identified, The Journal of Neurotrauma, Frontiers in Neurology , and PLOS ONE were those with the greatest number of publications. The most frequently co-occurring key words were: "machine learning", "deep learning", "magnetic resonance imaging", and "intracranial pressure". The United States accounted for more collaborations than any other country, followed by United Kingdom and China. Four co-citation author clusters were found, and the top 20 papers were divided into reviews and original articles. AI has become a relevant research field in TBI during the last 20 years, demonstrating great potential in imaging, but a more modest performance for prognostic estimation and neuromonitoring. [ABSTRACT FROM AUTHOR]

Current literature finds females have improved outcomes over their male counterparts after severe traumatic brain injury (TBI), while the opposite seems to be true for mild TBI. This begs the question as to what may be driving these sex differences after TBI. Estrogen is thought to be neuroprotective in certain diseases, and its actions have been shown to influence mitochondrial function. Mitochondrial impairment is a major hallmark of TBI, and interestingly, this dysfunction has been shown to be more severe in males than females after brain injury. This suggests estrogen could be playing a role in promoting "mitoprotection" following TBI. Despite the existence of estrogen receptors in mitochondria, few studies have examined the direct role of estrogen on mitochondrial function, and no studies have explored this after TBI. We hypothesized ex vivo treatment of isolated mitochondria with 17β-estradiol (E2) would improve mitochondrial function after experimental TBI in mice. Total mitochondria from the ipsilateral (injured) and contralateral (control) cortices of male and female mice were isolated 24 h post-controlled severe cortical impact (CCI) and treated with vehicle, 2 nM E2, or 20 nM E2 immediately before measuring reactive oxygen species (ROS) production, bioenergetics, electron transport chain complex (ETC) activities, and β-oxidation of palmitoyl carnitine. Protein expression of oxidative phosphorylation (OXPHOS) complexes was also measured in these mitochondrial samples to determine whether this influenced functional outcomes with respect to sex or injury. While mitochondrial ROS production was affected by CCI in both sexes, there were other sex-specific patterns of mitochondrial injury 24 h following severe CCI. For instance, mitochondria from males were more susceptible to CCI-induced injury with respect to bioenergetics and ETC complex activities, whereas mitochondria from females showed only Complex II impairment and reduced β-oxidation after injury. Neither concentration of E2 influenced ETC complex activities themselves, but 20 nM E2 appeared to uncouple mitochondria isolated from the contralateral cortex in both sexes, as well as the injured ipsilateral cortex of females. These studies highlight the significance of measuring mitochondrial dysfunction in both sexes after TBI and also shed light on another potential neuroprotective mechanism in which E2 may attenuate mitochondrial dysfunction after TBI in vivo. [ABSTRACT FROM AUTHOR]

Blast-related mild traumatic brain injury (mTBI) is recognized as the "signature injury" of the Iraq and Afghanistan wars. Sleep disruption, mTBI, and neuroinflammation have been individually linked to cerebral perivascular space (PVS) dilatation. Dilated PVSs are putative markers of impaired cerebrospinal fluid (CSF) and interstitial fluid exchange, which plays an important role in removing cerebral waste. The aim of this cross-sectional, retrospective study was to define associations between biomarkers of inflammation and MRI-visible PVS (MV-PVS) burden in Veterans after blast-related mTBI (blast-mTBI) and controls. The CSF and plasma inflammatory biomarker concentrations were compared between blast-mTBI and control groups and correlated with MV-PVS volume and number per white matter cm3. Multiple regression analyses were performed with inflammatory biomarkers as predictors and MV-PVS burden as the outcome. Correction for multiple comparisons was performed using the Banjamini-Hochberg method with a false discovery rate of 0.05. There were no group-wise differences in MV-PVS burden between Veterans with blast-mTBI and controls. Greater MV-PVS burden was significantly associated with higher concentrations of several proinflammatory biomarkers from CSF (i.e., eotaxin, MCP-1, IL-6, IL-8) and plasma (i.e., MCP-4, IL-13) in the blast-mTBI group only. After controlling for sleep time and symptoms of post-traumatic stress disorder, temporal MV-PVS burden remained significantly associated with higher CSF markers of inflammation in the blast-mTBI group only. These data support an association between central, rather than peripheral, neuroinflammation and MV-PVS burden in Veterans with blast-mTBI independent of sleep. Future studies should continue to explore the role of blast-mTBI related central inflammation in MV-PVS development, as well as investigate the impact of subclinical exposures on MV-PVS burden. [ABSTRACT FROM AUTHOR]

Background: Brain injury and coma after trauma are major health problems all over the world as the hemodynamic indicators of patients fluctuate and their clinical conditions deteriorate. Consequently, the demand for professional care will increase. Accordingly, this study aimed to explain the experiences of people caring for comatose patients with head injury.Methods: The present study was conducted using a conventional qualitative content analysis approach. The participants were selected through purposive sampling and the sampling process continued until data saturation. A total of 17 nurses and 3 head nurses working in the intensive care units (ICUs) of Sabzevar University of Medical Sciences in 2022 participated in the study.Results: Data analysis led to the identification of three main categories and nine subcategories including clarification of needs (understanding patients’ needs based on symptoms, intensive vision, application of care knowledge), continuous care to facilitate transition (skilled and quality care, progress monitoring, continuity in care and teamwork), and empathic support (living in the patient’s world, therapeutic relationship, and conscience-oriented actions. As a result, “targeted care” was detected as the main theme of the study.Conclusion: According to the results of the current study, in order for nurses to perform targeted care to get patients out of critical situations as quickly as possible, first a detailed examination is required to identify the patients’ needs and problems. Then, continuous nursing care with comprehensive support should be provided to the patients. The results of this study can instill motivation in care and improve its quality, ultimately leading to patient-centered nursing and treatment.

Abstract Background Headache is a prevalent and debilitating symptom following traumatic brain injury (TBI). Large-scale, prospective cohort studies are needed to establish long-term headache prevalence and associated factors after TBI. This study aimed to assess the frequency and severity of headache after TBI and determine whether sociodemographic factors, injury severity characteristics, and pre- and post-injury comorbidities predicted changes in headache frequency and severity during the first 12 months after injury. Methods A large patient sample from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study was used. Patients were stratified based on their clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU) in the acute phase. Headache was assessed using a single item from the Rivermead Post-Concussion Symptoms Questionnaire measured at baseline, 3, 6 and 12 months after injury. Mixed-effect logistic regression analyses were applied to investigate changes in headache frequency and associated predictors. Results A total of 2,291 patients responded to the headache item at baseline. At study enrolment, 59.3% of patients reported acute headache, with similar frequencies across all strata. Female patients and those aged up to 40 years reported a higher frequency of headache at baseline compared to males and older adults. The frequency of severe headache was highest in patients admitted to the ICU. The frequency of headache in the ER stratum decreased substantially from baseline to 3 months and remained from 3 to 6 months. Similar trajectory trends were observed in the ICU and ADM strata across 12 months. Younger age, more severe TBI, fatigue, neck pain and vision problems were among the predictors of more severe headache over time. More than 25% of patients experienced headache at 12 months after injury. Conclusions Headache is a common symptom after TBI, especially in female and younger patients. It typically decreases in the first 3 months before stabilising. However, more than a quarter of patients still experienced headache at 12 months after injury. Translational research is needed to advance the clinical decision-making process and improve targeted medical treatment for headache. Trial registration ClinicalTrials.gov NCT02210221.

Introduction: Since the introduction of e-scooters in Germany in 2019, they are becoming more and more popular and associated injuries have increased significantly. The aim of this study was to assess the injury patterns after e-scooter accidents. Materials and Methods: From May 2019 to October 2022, all consecutive patients who presented at our emergency department (ED) following e-scooter accidents were included in our study and retrospectively analyzed. Results: A total of 271 patients were included in our study. The mean age was 33 years. 38% of the patients were female and 62% were male. Most common injuries were traumatic brain injuries in 38% of the patients together with fractures affecting the upper limb (17%). An operative treatment was necessary in 40 patients. Most of the patients presented at night and about 30% were under the influence of alcohol. Conclusions: Our study shows one of the largest cohort of patients suffering e-scooter accidents in Europe. Compulsory helmet use, stricter alcohol controls and locking periods could contribute significantly to safety. [ABSTRACT FROM AUTHOR]

Background: Severe traumatic brain injuries (TBIs) are an important health issue worldwide, which are associated with harmful side effects. This meta-analysis investigates the cognitive and functional outcomes in severe brain trauma cases. It assesses the impact on memory, verbal and visual abilities, attention, learning, and the presence of depression. The study provides a comprehensive overview of the consequences of severe brain trauma injury on cognitive and functional domains. Objective: The main objective of the current comprehensive meta-analysis study is to assess and analyze the impact of severe TBI on functional and cognitive outcomes, including verbal, visual, attention, learning, memory, and emotional stability. Methods: We collected data from three online databases, including PubMed, Cochrane Library, and Embase. Case-control trials related to severe TBI association with cognitive and functional outcomes were included. Verbal strength, visual functions, learning abilities, attention, memory, and depression were considered primary outcomes. Results: We have included 13 case-control studies with 1,442 subjects in this meta-analysis, which provide adequate data to determine the pooled effect size for targeted outcomes. The effect of severe TBI on the inducement of depression and impairment of memory, verbal, visual, attention, and learning abilities compared to the control group showed statistically significant outcomes (p < 0.05). Conclusion: Severe TBI is strongly associated with impaired cognitive and functional abilities, including visual and verbal disabilities, impaired memory, depression inducement, attention deficits, and learning disabilities. [ABSTRACT FROM AUTHOR]

Background: Headache is a prevalent and debilitating symptom following traumatic brain injury (TBI). Large-scale, prospective cohort studies are needed to establish long-term headache prevalence and associated factors after TBI. This study aimed to assess the frequency and severity of headache after TBI and determine whether sociodemographic factors, injury severity characteristics, and pre- and post-injury comorbidities predicted changes in headache frequency and severity during the first 12 months after injury. Methods: A large patient sample from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study was used. Patients were stratified based on their clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU) in the acute phase. Headache was assessed using a single item from the Rivermead Post-Concussion Symptoms Questionnaire measured at baseline, 3, 6 and 12 months after injury. Mixed-effect logistic regression analyses were applied to investigate changes in headache frequency and associated predictors. Results: A total of 2,291 patients responded to the headache item at baseline. At study enrolment, 59.3% of patients reported acute headache, with similar frequencies across all strata. Female patients and those aged up to 40 years reported a higher frequency of headache at baseline compared to males and older adults. The frequency of severe headache was highest in patients admitted to the ICU. The frequency of headache in the ER stratum decreased substantially from baseline to 3 months and remained from 3 to 6 months. Similar trajectory trends were observed in the ICU and ADM strata across 12 months. Younger age, more severe TBI, fatigue, neck pain and vision problems were among the predictors of more severe headache over time. More than 25% of patients experienced headache at 12 months after injury. Conclusions: Headache is a common symptom after TBI, especially in female and younger patients. It typically decreases in the first 3 months before stabilising. However, more than a quarter of patients still experienced headache at 12 months after injury. Translational research is needed to advance the clinical decision-making process and improve targeted medical treatment for headache. Trial registration: ClinicalTrials.gov NCT02210221. [ABSTRACT FROM AUTHOR]

BACKGROUND: Knowledge about quality of life following brain trauma is necessary to improve public health programmes. METHODS: A cross-sectional study was conducted at Ghazi al-Hariri Surgical Specialties Hospital, Dr. Saad Al-Witry Neuroscience Hospital in the Baghdad governorate, and Baqubah General Hospital in the Diyala governorate from first January to the end of April 2022. The study's target population was patients aged 18 years and older with traumatic brain injury six to 12 months post-injury, Quality of life was evaluated by a structured questionnaire using the quality of life after brain injury (QOLIBRI) scale RESULTS: A total of 225 participants were included. The highest proportion (52.9%) was within the age group of 18-29 years. The male-to-female ratio was 3.09:1. Road traffic accidents were the main cause of brain damage, affecting 67.6% and 52.7%, respectively. The average levels of satisfaction with thinking ability, emotions, independence, and social relationships were 56.9%, 52.9%, 42.2% and 43.6%, respectively. The average levels of dissatisfaction with feelings and physical activity were 48.4% and 53.8%, respectively. CONCLUSION: Most patients with traumatic brain injury had average overall satisfaction with their thinking abilities, emotions, independence, and social relationships. Majority of them had an average level of discontent with their feelings and a low level of discontent with their physical activity. [ABSTRACT FROM AUTHOR]

Introduction: The management of traumatic brain injury is challenging as patients with apparent mild head trauma may develop late complications. Some patients may develop an intracranial hemorrhage several days after the injury. Hence, emergency doctors may be more liable to malpractice claims. Also, histological examination can reveal forensic evidence in cases of unclear death. Therefore, it is of great importance to highlight the medicolegal and histological aspects of traumatic brain injury(TBI). Aim of the Work: To highlight the medicolegal and histological aspects of mild traumatic brain injury. Materials and Methods: Thirty adult female albino rats were included. The animals were divided into three groups: Group I (Control group). Group II:it included10rats, they were sacrificed 6 hours after closed head impact model. Group III: It included 10 rats, which were sacrificed 7 days after closed head impact model. At the end of the experiment, the specimens were taken and processed for immunohistochemical and histological studies. Results: Examination of frontal cerebrum sections after 6hours revealed dilated congested blood vessels of pia matter. The cerebrum showed dark shrunken neurons with swelling of neuroglia. Inflammatory cells and rod shaped microglia. The medulla showed widely separated nerve fibers. After 7 days, the cerebrum showed apparent decrease in neurons and inflammatory cells. This was confirmed by increase in GFAP reaction (gliosis). The medulla showed thinning of nerve fibers. Conclusion: Histological examination can be used to seek forensic evidence for TBI in absence of gross findings. Even with apparent mild head injuries, significant microscopic cerebral changes may be found. So, some patients will require inhospital observation and cannot be safely discharged. In patients who can go home, discharge instructions need to be clear and documented. Also, in unclear deaths, brain tissue blocks may reveal evidence of TBI. [ABSTRACT FROM AUTHOR]

Objective: An increased intracranial pressure (ICP) caused by brain trauma is a leading factor of morbidity and mortality. This elevated pressure diminishes cerebral perfusion pressure (CPP) and cerebral blood flow (CBF). Currently, several ICP monitoring modalities exist, such as optic nerve sheath diameter (ONSD) and jugular venous oxygen saturation (SvjO2). This study aimed to determine the role of measuring ONSD and SjvO2 in monitoring changes in consciousness in post-surgical patients with the potential for increased intracranial pressure in moderately severe brain trauma. Design: An observational study with a prospective approach. Setting: Conducted at Dr. Wahidin Sudiro-husodo Central General Hospital Makassar and educational network hospitals. Patient and participants: The participants were patients aged over 17 years old with head trauma with increased intracranial pressure who were scheduled to undergo cranial surgery and were being treated in the Intensive Care Unit (ICU) and Resuscitation Room. Interventions: ONSD, SjvO2, and consciousness . measurements in subjects with potential increased ICP improved 24 hours and 48 hours after surgery. Measurement and results: The post-op ONSD and SjvO2 values significantly decreased compared to pre-op. There was a significant negative correlation between post-op ONSD and post-op Glasgow Coma Scale (GCS), where a decrease in ONSD indicated an increase in GCS in patients with moderate brain trauma. The ONSD and SjvO2 values in the post-op severe head trauma group did not correlate with post-op GCS improvement in patients with severe brain trauma. Conclusions: The mean values of ONSD and SjvO2 in individuals with traumatic brain injuries and elevated intracranial pressure exhibited a decline post-surgery. This decrease aligned with improved consciousness levels and elevated intracranial pressure following surgical intervention. Consequently, the investigation established an association between ONSD, SjvO2, and GCS, indicating their potential utility as dynamic monitoring indicators for individuals with head trauma and increased intracranial pressure. [ABSTRACT FROM AUTHOR]

Pressure ulcers (PUs) are a common complication in postoperative patients with traumatic brain injury, and this study used a meta‐analysis to assess the effects of comprehensive nursing applied in PUs intervention in postoperative patients with traumatic brain injury. A computerised systematic search of the PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database (CBM), VIP and Wanfang databases was performed to collect publicly available articles on randomised controlled trials (RCTs) on the effects of comprehensive nursing interventions in postoperative patients with traumatic brain injury published up to August 2023. Two researchers independently completed the search and screening of the literature, extraction of data and quality assessment of the included literature based on the inclusion and exclusion criteria. Meta‐analysis was performed using RevMan 5.4 software. Twenty‐eight articles were finally included, for a cumulative count of 2641 patients, of which 1324 were in the intervention group and 1317 in the control group. The results of the meta‐analysis showed that, compared with conventional nursing, comprehensive nursing intervention helped to reduce the incidence of PUs in postoperative patients with traumatic brain injury (5.14% vs. 19.67%, odds ratio [OR]: 0.22, 95% confidence interval [CI]: 0.16–0.29, p < 0.00001) and reduced the incidence of postoperative complications (7.87% vs. 25.84%, OR: 0.22, 95% CI: 0.11–0.43, p < 0.0001), while increasing patient satisfaction (96.67% vs. 75.33%, OR: 9.5, 95% CI: 3.63–24.88, p < 0.00001). This study concludes that a comprehensive nursing intervention applied to postoperative patients with traumatic brain injury can significantly reduce the incidence of PUs and postoperative complications as well as improve nursing satisfaction, and it is recommended for clinical promotion. However, due to the limitations of the studies' number and quality, more high‐quality, large‐sample RCTs are needed to further validate the conclusions of this study. [ABSTRACT FROM AUTHOR]

Background: Currently, the use of spinal cord electrical stimulations for patients with severe disorders of consciousness after traumatic brain injury remains limited, and long-term follow-up studies are even scarcer. To date, there have been few reports using near-infrared spectroscopy to evaluate the clinical effects and optimal parameters of spinal cord electrical stimulation for severe consciousness disorders. This report describes a case of a patient with severe disturbance of consciousness after traumatic brain injury who underwent spinal cord electrical stimulation implantation. Advanced near-infrared spectroscopy was employed to monitor and evaluate postoperative efficacy. The findings of this case report will provide a reference for the clinical treatment of severe consciousness disturbances. Methods: A patient diagnosed with a severe disturbance of consciousness following traumatic brain injury presented symptoms of coma and lack of voluntary activity. The treatment regimen included conventional approaches (medication combined with rehabilitation training) and adjustments to the spinal cord electrical stimulation parameters. Advanced functional near-infrared spectroscopy (fNIRS) was used to explore changes in brain functional connectivity strength and assess clinical efficacy. Results: The integration of conventional treatment and continuous modification of spinal cord electrical stimulation parameters, combined with fNIRS monitoring, demonstrated that conventional treatment and spinal cord electrical stimulation displayed a positive effect on increasing brain functional strength connection. The Glasgow Coma Scale(GCS) score significantly improved from the baseline. Optimal results were observed with spinal cord stimulation settings at 4.5 V amplitude, 210 μs pulse width, and 70 Hz frequency, operating from 8:00–20:00 in a cycling mode of 15 min on and 15 min off, where improvements in consciousness were markedly evident. Conclusions: Patients with severe disturbances of consciousness after traumatic brain injury recover slowly. Conventional treatment combined with spinal cord electrical stimulation can improve the degree of disturbance of consciousness and promote recovery from the condition.

Introduction Traumatic brain injury (TBI) is among the main causes of death and neurological sequelae worldwide. Injuries are classified as diffuse (diffuse axonal injury and brain swelling) or focal (cerebral contusion [CCo], epidural hematoma, and acute subdural hematoma). Among all TBIs, CCos are the most frequent focal lesion, and treatment modalities are many. Hematoma evacuation using large craniotomies has been well described in the literature. The main goal of the present study is to discuss the advantages of minimally invasive approaches for the treatment of CCos, regarding operative time, blood loss, and postoperative tomographic results.

It has long been asserted that failure to recover from central nervous system diseases is due to the system’s intricate structure and the regenerative incapacity of adult neurons. Yet over recent decades, numerous studies have established that endogenous neurogenesis occurs in the adult central nervous system, including humans’. This has challenged the long-held scientific consensus that the number of adult neurons remains constant, and that new central nervous system neurons cannot be created or renewed. Herein, we present a comprehensive overview of the alterations and regulatory mechanisms of endogenous neurogenesis following central nervous system injury, and describe novel treatment strategies that target endogenous neurogenesis and newborn neurons in the treatment of central nervous system injury. Central nervous system injury frequently results in alterations of endogenous neurogenesis, encompassing the activation, proliferation, ectopic migration, differentiation, and functional integration of endogenous neural stem cells. Because of the unfavorable local microenvironment, most activated neural stem cells differentiate into glial cells rather than neurons. Consequently, the injury-induced endogenous neurogenesis response is inadequate for repairing impaired neural function. Scientists have attempted to enhance endogenous neurogenesis using various strategies, including using neurotrophic factors, bioactive materials, and cell reprogramming techniques. Used alone or in combination, these therapeutic strategies can promote targeted migration of neural stem cells to an injured area, ensure their survival and differentiation into mature functional neurons, and facilitate their integration into the neural circuit. Thus can integration replenish lost neurons after central nervous system injury, by improving the local microenvironment. By regulating each phase of endogenous neurogenesis, endogenous neural stem cells can be harnessed to promote effective regeneration of newborn neurons. This offers a novel approach for treating central nervous system injury.

Subconcussive head impacts are associated with the development of acute and chronic cognitive deficits. We recently reported that high-frequency head impact (HFHI) causes chronic cognitive deficits in mice through synaptic changes. To better understand the mechanisms underlying HFHI-induced memory decline, we used TRAP2/Ai32 transgenic mice to enable visualization and manipulation of memory engrams. We labeled the fear memory engram in male and female mice exposed to an aversive experience and subjected them to sham or HFHI. Upon subsequent exposure to natural memory recall cues, sham, but not HFHI, mice successfully retrieved fearful memories. In sham mice the hippocampal engram neurons exhibited synaptic plasticity, evident in amplified AMPA:NMDA ratio, enhanced AMPA-weighted tau, and increased dendritic spine volume compared with nonengram neurons. In contrast, although HFHI mice retained a comparable number of hippocampal engram neurons, these neurons did not undergo synaptic plasticity. This lack of plasticity coincided with impaired activation of the engram network, leading to retrograde amnesia in HFHI mice. We validated that the memory deficits induced by HFHI stem from synaptic plasticity impairments by artificially activating the engram using optogenetics and found that stimulated memory recall was identical in both sham and HFHI mice. Our work shows that chronic cognitive impairment after HFHI is a result of deficiencies in synaptic plasticity instead of a loss in neuronal infrastructure, and we can reinstate a forgotten memory in the amnestic brain by stimulating the memory engram. Targeting synap-tic plasticity may have therapeutic potential for treating memory impairments caused by repeated head impacts. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality, especially in teenagers to young adults. In recent decades, different biomarkers and/or staining protocols have been employed to evaluate the postinjury development of pathological structures, but they have produced many contradictory findings. Since correctly identifying the underlying neuroanatomical changes is critical to advancing TBI research, we compared three commonly used markers for their ability to detect TBI pathological structures: Fluoro-Jade C, the rabbit monoclonal antibody Y188 against amyloid precursor protein and the NeuroSilver kit were used to stain adjacent slices from naïve or injured mouse brains harvested at different time points from 30 min to 3 months after lateral fluid percussion injury. Although not all pathological structures were stained by all markers at all time points, we found damaged neurons and deformed dendrites in gray matter, punctate and perivascular structures in white matter, and axonal blebs and Wallerian degeneration in both gray and white matter. The present study demonstrates the temporal and structural sensitivities of the three biomarkers: each marker is highly effective for a set of pathological structures, each of which in turn emerges at a particular time point. Furthermore, the different biomarkers showed different abilities at detecting identical types of pathological structures. In contrast to previous studies that have used a single biomarker at a single time range, the present report strongly recommends that a combination of different biomarkers should be adopted and different time points need to be checked when assessing neuropathology after TBI. [ABSTRACT FROM AUTHOR]

In the management of severe traumatic brain injuries (TBIs), controlling intracranial pressure (ICP) is a pivotal therapeutic goal. Historically, mannitol has been the recommended first-line osmotic agent; however, concerns surrounding its use, including hypotension, rebound ICP elevation, and renal toxicity, have prompted a quest for alternative strategies. Hypertonic saline (HS) has emerged as a promising substitute, demonstrating efficacy in reducing ICP without compromising cerebral perfusion. This comprehensive analysis explores the comparative effectiveness of Mannitol and Hypertonic Saline in the context of severe TBIs. While Mannitol has been a longstanding choice, recent attention has shifted towards HS due to its reported superiority in ICP reduction. Concerns associated with mannitol, such as hypotension and rebound ICP, are juxtaposed against the potential advantages offered by HS. The scarcity of clinical studies focusing on TBI-related outcomes, such as patient survival and long-term benefits, is highlighted, underscoring a critical gap in the current knowledge landscape. The review aims to provide a nuanced understanding of the comparative effectiveness of Mannitol and Hypertonic Saline, considering not only ICP control but also broader patient outcomes. By addressing the suitability of these agents in diverse clinical settings, this analysis seeks to guide clinicians in making informed decisions tailored to individual patient needs.

Current literature finds females have improved outcomes over their male counterparts after severe traumatic brain injury (TBI), while the opposite seems to be true for mild TBI. This begs the question as to what may be driving these sex differences after TBI. Estrogen is thought to be neuroprotective in certain diseases, and its actions have been shown to influence mitochondrial function. Mitochondrial impairment is a major hallmark of TBI, and interestingly, this dysfunction has been shown to be more severe in males than females after brain injury. This suggests estrogen could be playing a role in promoting “mitoprotection” following TBI. Despite the existence of estrogen receptors in mitochondria, few studies have examined the direct role of estrogen on mitochondrial function, and no studies have explored this after TBI. We hypothesized ex vivo treatment of isolated mitochondria with 17β-estradiol (E2) would improve mitochondrial function after experimental TBI in mice. Total mitochondria from the ipsilateral (injured) and contralateral (control) cortices of male and female mice were isolated 24 h post-controlled severe cortical impact (CCI) and treated with vehicle, 2 nM E2, or 20 nM E2 immediately before measuring reactive oxygen species (ROS) production, bioenergetics, electron transport chain complex (ETC) activities, and β-oxidation of palmitoyl carnitine. Protein expression of oxidative phosphorylation (OXPHOS) complexes was also measured in these mitochondrial samples to determine whether this influenced functional outcomes with respect to sex or injury. While mitochondrial ROS production was affected by CCI in both sexes, there were other sex-specific patterns of mitochondrial injury 24 h following severe CCI. For instance, mitochondria from males were more susceptible to CCI-induced injury with respect to bioenergetics and ETC complex activities, whereas mitochondria from females showed only Complex II impairment and reduced β-oxidation after injury. Neither concentration of E2 influenced ETC complex activities themselves, but 20 nM E2 appeared to uncouple mitochondria isolated from the contralateral cortex in both sexes, as well as the injured ipsilateral cortex of females. These studies highlight the significance of measuring mitochondrial dysfunction in both sexes after TBI and also shed light on another potential neuroprotective mechanism in which E2 may attenuate mitochondrial dysfunction after TBI in vivo.

Soccer players are at risk of suffering cranial injuries in the short and long term. There is growing concern that this may lead to traumatic brain injury in soccer players. Magnetic resonance spectroscopy (MRS) is an analytical method that enables the measurement of changes in brain metabolites that usually occur before significant structural changes. This study aimed to use MRS to compare variations in brain metabolite levels between retired soccer players and a control group. Twenty retired professional soccer players and 22 controls underwent magnetic resonance imaging, including MRS sequences and Mini-Mental State Examination (MMSE). Metabolite analysis was conducted based on absolute concentration and relative ratios. N-acetyl-aspartate, choline, glutamate, glutamine, and myoinositol were the metabolites of interest for the statistical analysis. Retired soccer players had an average age of 57.8 years, whereas the control group had an average age of 63.2 years. Median cognitive evaluation score, assessed using the MMSE, was 28 [26?29] for athletes and 29 [28?30] for controls (p?=?0.01). Uni- and multi-variate analyses of the absolute concentration of metabolites (mM) between former athletes and controls did not yield any statistically significant results. Comparison of metabolites to creatine ratio concentrations did not yield any statistically significant results. There were no changes in concentrations of brain metabolites that indicated brain metabolic changes in retired soccer players compared with controls.

Background Traumatic brain injury (TBI) is one of the leading causes of death among young people worldwide. Chloroquine, an antimalarial drug, has been shown to easily cross the blood-brain barrier (BBB) and inhibit autophagy in a variety of disorders, including Alzheimer disease and brain ischemia. We investigated the effects of chloroquine on neuronal protection after induction of brain trauma in male rats. Methods A total of 120 male Wistar rats were treated with chloroquine at doses of 1.5, 3, and 6 mg/kg intraperitoneally after induction of diffuse TBIs. The veterinary coma scale was used to assess short-term neurological deficits. BBB disruption was evaluated using the Evans Blue dye method 6-hour post-injury. Vestibulomotor function was evaluated using the beam walk and beam balance methods. Histopathological changes in the brain tissue in different groups were evaluated using light microscopy and hematoxylin-eosin staining. Brain water and cerebrospinal fluid (CSF) contents of matrix metalloproteinase 9 (MMP-9) were assessed using the wet/dry method and enzyme-linked immunosorbent assay, respectively. Results The results showed that injecting chloroquine (3 and 6 mg/kg) 30 minutes after TBI significantly reduced brain edema and BBB disruption, and recovered neurological deficits post-TBI (P

Previous studies of human traumatic brain injury (TBI) have shown diffuse axonal injury as varicosities or spheroids in white matter (WM) bundles when using immunoperoxidase‐ABC staining with 22C11, a mouse monoclonal antibody against amyloid precursor protein (APP). These findings have been interpreted as TBI‐induced axonal pathology. In a mouse model of TBI however, when we used immunofluorescent staining with 22C11, as opposed to immunoperoxidase staining, we did not observe varicosities or spheroids. To explore this discrepancy, we performed immunofluorescent staining with Y188, an APP knockout‐validated rabbit monoclonal that shows baseline immunoreactivity in neurons and oligodendrocytes of non‐injured mice, with some arranged‐like varicosities. In gray matter after injury, Y188 intensely stained axonal blebs. In WM, we encountered large patches of heavily stained puncta, heterogeneous in size. Scattered axonal blebs were also identified among these Y188‐stained puncta. To assess the neuronal origin of Y188 staining after TBI we made use of transgenic mice with fluorescently labeled neurons and axons. A close correlation was observed between Y188‐stained axonal blebs and fluorescently labeled neuronal cell bodies/axons. By contrast, no correlation was observed between Y188‐stained puncta and fluorescent axons in WM, suggesting that these puncta in WM did not originate from axons, and casting further doubt on the nature of previous reports with 22C11. As such, we strongly recommend Y188 as a biomarker for detecting damaged neurons and axons after TBI. With Y188, stained axonal blebs likely represent acute axonal truncations that may lead to death of the parent neurons. Y188‐stained puncta in WM may indicate damaged oligodendrocytes, whose death and clearance can result in secondary demyelination and Wallerian degeneration of axons. We also provide evidence suggesting that 22C11‐stained varicosities or spheroids previously reported in TBI patients might be showing damaged oligodendrocytes, due to a cross‐reaction between the ABC kit and upregulated endogenous biotin. [ABSTRACT FROM AUTHOR]

Background: Rouleaux agglutination is a common cause of difficult blood typing, but it is rarely reported in patients with acute brain trauma. Methods: This article describes a 69-year-old male with head injury who was admitted to the hospital. Blood typing showed type O, Rh(D) positive, but the Rh(D) control was also positive. After ruling out the possibility of the patient having abnormal autoantibodies, it was suspected that rouleaux agglutination might be the cause. Microscopic examination of the specimen revealed rouleaux agglutination, which was believed to be the cause of the false-positive Rh(D) control result. The patient's red blood cells were treated with physiological saline and retested by microcolumn gel card testing. Results: The retest showed negative Rh(D) control results, indicating normal results. The patient subsequently received normal blood transfusion. Conclusions: Laboratory personnel should be aware of the possibility of difficult blood typing caused by rouleaux agglutination in various diseases, especially in relatively rare traumatic diseases. [ABSTRACT FROM AUTHOR]

Background: Necroptosis, a newly defined regulatable necrosis with membrane disruption, has been demonstrated to participate in trauma brain injury (TBI) related neuronal cell death. Heat shock protein 70 (HSP70) is a stress protein with neuroprotective activity, but the potential protective mechanisms are not fully understood. Methods and results: Here, we investigated the effects of HSP70 regulators in a cellular TBI model induced by traumatic neuronal injury (TNI) and glutamate treatment. We found that necroptosis occurred in cortical neurons after TNI and glutamate treatment. Neuronal trauma markedly upregulated HSP70 protein expression within 24 h. The results of immunostaining and lactate dehydrogenase release assay showed that necroptosis following neuronal trauma was inhibited by HSP70 activator TRC051384 (TRC), but promoted by the HSP70 inhibitor 2-phenylethyenesulfonamide (PES). In congruent, the expression and phosphorylation of receptor interacting protein kinase 3 (RIPK3) and mixed lineage kinase domain-like protein (MLKL) were differently regulated by HSP70. Furthermore, the expression of HSP90α induced by neuronal trauma was further promoted by PES but decreased by TRC. The data obtained from western blot showed that the phosphorylation of RIPK3 and MLKL induced by HSP70 inhibition were reduced by RIPK3 inhibitor GSK-872 and HSP90α inhibitor geldanamycin (GA). Similarly, inhibition of HSP90α with GA could partially prevented the increased necroptosis induced by PES. Conclusions: Taken together, HSP70 activation exerted protective effects against neuronal trauma via inhibition of necroptosis. Mechanistically, the HSP90α-mediated activation of RIPK3 and MLKL is involved in these effects. [ABSTRACT FROM AUTHOR]

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with exposure to head trauma. In 2015, a panel of neuropathologists funded by the NINDS/NIBIB defined preliminary consensus neuropathological criteria for CTE, including the pathognomonic lesion of CTE as "an accumulation of abnormal hyperphosphorylated tau (p-tau) in neurons and astroglia distributed around small blood vessels at the depths of cortical sulci and in an irregular pattern," based on review of 25 tauopathy cases. In 2016, the consensus panel met again to review and refine the preliminary criteria, with consideration around the minimum threshold for diagnosis and the reproducibility of a proposed pathological staging scheme. Eight neuropathologists evaluated 27 cases of tauopathies (17 CTE cases), blinded to clinical and demographic information. Generalized estimating equation analyses showed a statistically significant association between the raters and CTE diagnosis for both the blinded (OR = 72.11, 95% CI = 19.5-267.0) and unblinded rounds (OR = 256.91, 95% CI = 63.6-1558.6). Based on the challenges in assigning CTE stage, the panel proposed a working protocol including a minimum threshold for CTE diagnosis and an algorithm for the assessment of CTE severity as "Low CTE" or "High CTE" for use in future clinical, pathological, and molecular studies.

Objective: The aim of this study was to investigate phosphorylated tau (p-tau181) protein in plasma in a cohort of mild traumatic brain injury (mTBI) patients and a cohort of concussed athletes. Methods: This pilot study comprised two independent cohorts. The first cohort--part of a Traumatic Head Injury Neuroimaging Classification (THINC) study--with a mean age of 46 years was composed of uninjured controls (UIC, n = 30) and mTBI patients (n = 288) recruited from the emergency department with clinical computed tomography (CT) and research magnetic resonance imaging (MRI) findings. The second cohort--with a mean age of 19 years--comprised 133 collegiate athletes with (n = 112) and without (n = 21) concussions. The participants enrolled in the second cohort were a part of a multicenter, prospective, case-control study conducted by the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium at six CARE Advanced Research Core (ARC) sites between 2015 and 2019. Blood was collected within 48 h of injury for both cohorts. Plasma concentration (pg/ml) of p-tau181 was measured using the Single Molecule Array ultrasensitive assay. Results: Concentrations of plasma p-tau181 in both cohorts were significantly elevated compared to controls within 48 h of injury, with the highest concentrations of p-tau181 within 18 h of injury, with an area under the curve (AUC) of 0.690-0.748, respectively, in distinguishing mTBI patients and concussed athletes from controls. Among the mTBI patients, the levels of plasma p-tau181 were significantly higher in patients with positive neuroimaging (either CT+/MRI+, n = 74 or CT-/MRI+, n = 89) compared to mTBI patients with negative neuroimaging (CT-/MRI-, n = 111) findings and UIC (P-values < 0.05). Conclusion: These findings indicate that plasma p-tau181 concentrations likely relate to brain injury, with the highest levels in patients with neuroimaging evidence of injury. Future research is needed to replicate and validate this protein assay's performance as a possible early diagnostic biomarker for mTBI/concussions. [ABSTRACT FROM AUTHOR]

The loss of cerebral autoregulation (CA) is a common and detrimental secondary injury mechanism following acute brain injury and has been associated with worse morbidity and mortality. However patient outcomes have not as yet been conclusively proven to have improved as a result of CA-directed therapy. While CA monitoring has been used to modify CPP targets, this approach cannot work if the impairment of CA is not simply related to CPP but involves other underlying mechanisms and triggers, which at present are largely unknown. Neuroinflammation, particularly inflammation affecting the cerebral vasculature, is an important cascade that occurs following acute injury. We hypothesise that disturbances to the cerebral vasculature can affect the regulation of CBF, and hence the vascular inflammatory pathways could be a putative mechanism that causes CA dysfunction. This review provides a brief overview of CA, and its impairment following brain injury. We discuss candidate vascular and endothelial markers and what is known about their link to disturbance of the CBF and autoregulation. We focus on human traumatic brain injury (TBI) and subarachnoid haemorrhage (SAH), with supporting evidence from animal work and applicability to wider neurologic diseases. [ABSTRACT FROM AUTHOR]

During evolution, the development of bone was critical for many species to thrive and function in the boundary conditions of Earth. Furthermore, bone also became a storehouse for calcium that could be mobilized for reproductive purposes in mammals and other species. The critical nature of bone for both function and reproductive needs during evolution in the context of the boundary conditions of Earth has led to complex regulatory mechanisms that require integration for optimization of this tissue across the lifespan. Three important regulatory variables include mechanical loading, sex hormones, and innervation/neuroregulation. The importance of mechanical loading has been the target of much research as bone appears to subscribe to the "use it or lose it" paradigm. Furthermore, because of the importance of post-menopausal osteoporosis in the risk for fractures and loss of function, this aspect of bone regulation has also focused research on sex differences in bone regulation. The advent of space flight and exposure to microgravity has also led to renewed interest in this unique environment, which could not have been anticipated by evolution, to expose new insights into bone regulation. Finally, a body of evidence has also emerged indicating that the neuroregulation of bone is also central to maintaining function. However, there is still more that is needed to understand regarding how such variables are integrated across the lifespan to maintain function, particularly in a species that walks upright. This review will attempt to discuss these regulatory elements for bone integrity and propose how further study is needed to delineate the details to better understand how to improve treatments for those at risk for loss of bone integrity, such as in the post-menopausal state or during prolonged space flight. [ABSTRACT FROM AUTHOR]

Background Although intracranial traumas by penetrating foreign objects are not absolute rarities, the nature of trauma, the kind of object, and its trajectory make them a one of a kind case every time they occur. Whereas high-velocity traumas mostly result in fatalities, it is the low-velocity traumas that demand an individualized surgical strategy. Methods We present a case report of a 33-year-old patient who was admitted to our department with a self-inflicted transorbital pen injury to the brain. The authors recall the incident and the technique of the pen removal. Results Large surgical exposure of the pen trajectory was considered too traumatic. Therefore, we opted to remove the pen and have an immediate postoperative computed tomography (CT) scan. Due to its fragility, the pen case could only be removed with a screwdriver, inserted into the case. Post-op CT scan showed a small bleeding in the right peduncular region, which was treated conservatively. The patient was transferred back to intensive care unit and woken up the next day. She lost visual function on her right eye, but suffered from no further neurologic deficit. Conclusion Surgical management of removal of intracranial foreign bodies is no routine procedure. Although some would favor a large surgical exposure, we could not think of an approach to do so without maximum surgical efforts. We opted for a minimal surgical procedure with immediate CT scan and achieved an optimal result. We find this case to be worth considering when deciding on a strategy in the future. [ABSTRACT FROM AUTHOR]

Background and aim. The aim of the study was to determine the impact of prior anticoagulant treatment on the characteristics of intracranial hematomas. Methods. We included in this retrospective study 135 patients who were diagnosed with subdural hematoma in the context of traumatic brain injury. We recorded the demographic and clinical data, the paraclinical examinations and the characteristics of subdural hematoma evidenced by preoperative computed tomography (CT). We also reported the other brain injuries, entailed by primary and secondary lesions, as described by CT. Results. The anticoagulation therapy was recorded in 35 patients, at the moment of diagnosis. Acute subdural hematoma was recorded in 89 (65.9%) patients, 21 (60%) of these had anticoagulation therapy on admission. There were 46 (34.1%) patients with chronic subdural hematoma, 14 (40%) of these were on anticoagulant therapy. The midline shift was significantly moved in patients with anticoagulation therapy. The thickness of the subdural hematoma was significantly higher in patients with anticoagulation. We did not find any significant association of the other brain lesions (cranial fracture, extradural hematoma, intraparenchymal hematoma, nor intracranial hypertension, brain herniation, brain swelling), and the presence of anticoagulation therapy. Conclusion. The study showed that anticoagulants significantly influence some neuroimaging aspects of the SDH in head trauma. [ABSTRACT FROM AUTHOR]

We created a novel air-filled bicycle helmet. The aims of this study were (i) to assess the head injury mitigation performance of the proposed helmet and (ii) to compare those performance results against the performance results of an expanded polystyrene (EPS) traditional bicycle helmet. Two bicycle helmet types were subjected to impacts in guided vertical drop tests onto a flat anvil: EPS helmets and air-filled helmets (Bumpair). The maximum acceleration value recorded during the test on the Bumpair helmet was 86.76 ± 3.06 g, while the acceleration during the first shock on the traditional helmets reached 207.85 ± 5.55 g (p < 0.001). For the traditional helmets, the acceleration increased steadily over the number of shocks. There was a strong correlation between the number of impacts and the response of the traditional helmet (cor = 0.94; p < 0.001), while the Bumpair helmets showed a less significant dependence over time (cor = 0.36; p = 0.048), meaning previous impacts had a lower consequence. The air-filled helmet significantly reduced the maximal linear acceleration when compared to an EPS traditional helmet, showing improvements in impact energy mitigation, as well as in resistance to repeated impacts. This novel helmet concept could improve head injury mitigation in cyclists. [ABSTRACT FROM AUTHOR]

Objective To observe the effects of rTMS on cognitive function in patients with traumatic brain injury. Methods A total of 160 patients with traumatic brain injury admitted to Yan’an Hospital of Kunming City from January 2021 to January 2022 were selected as the research objects and randomly divided according to the admission sequence number by random number table method. There were 80 cases in the treatment group and 80 cases in the control group. The control group was given sham rTMS stimulation on the basis of conventional drug treatment and cognitive training, while the treatment group was given true rTMS stimulation on the basis of conventional drug treatment and cognitive training, once a day, for a total of 4 weeks. Mini-Mental State Examination ( Mini-mental State Examination) was performed before and 4 weeks after treatment. The cognitive function of the two groups was evaluated by MoCA, MMSE, RBMT. Results Intra-group comparison: the MMSE scores ( orientation ability, memory ability, recall ability, calculation ability) of the treatment group were all improved compared with those before treatment ( P < 0.05), while the MMSE scores ( orientation ability, immediate memory ability) of the control group were only improved compared with those before treatment ( P < 0.05). In the treatment group, the RBMT scores ( remembering surname and given name, remembering artifact, remembering convention, picture recognition, immediate path memory, orientation) were all in- creased compared with those before treatment ( P < 0.05), while in the control group, the RBMT scores ( remembering surname and given name, remembering artifact, picture recognition, orientation) were only increased compared with those before treatment ( P < 0.05). The MoCA scores ( memory, language, calculation, orientation) in the treatment group were higher than those before treatment ( P < 0.05), while the MoCA scores ( memory, orientation) in the control group were only higher than those before treatment ( P < 0.05). Comparison between groups: After treatment, the total scores of MMSE, RBMT and MoCA in the treatment group were higher than those in the control group ( P < 0.05) . Conclusion rTMS can effectively improve the cognitive function of patients with traumatic brain injury. [ABSTRACT FROM AUTHOR]

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Background and purpose: Traumatic brain injury (TBI) is one of the most complex diseases of the central nervous system (CNS). Nesfatin is an 82-amino acid effective polypeptide in CNS. In this study, we investigated the role of nesfatin in neuron protection in the process of diffuse concussion in rats and also its effect on the level of matrix metalloproteinase-9. Materials and methods: In this experimental study, 56 Wistar rats were subjected to TBI by the Marmaru method. After 30 minutes, nesfatin was injected intraperitoneally at different doses, and repeated on second and third days. The results of Veterinary Coma Scale, beam walk and beam balance tests were recorded at Pre-TBI, immediately after TBI, 24, 48, and 72 hours after TBI. After 72 hours, CSF was collected from the cisterna magna and used for ELISA test to measure the matrix metalloproteinase-9. Results: Intraperitoneal administration of nesfatin at 50 µg/kg and 10 µg/kg can reduce cerebral edema, destruction of the blood-brain barrier, and neurological and balance-motor scores (P0.05). Conclusion: Nesfatin has been able to affect the consequences of trauma and reduce brain edema, accelerate the improvement of blood-brain barrier and neurological and balance scores. Probably part of these neuroprotective effects is through reduction of MMP-9.

Background and purpose: Allicin has a wide range of pharmacological functions, all of which can be demonstrated in anti-inflammatory, antioxidant, antifungal and anti-tumor activities. In this research, we investigated the neuroprotective role of allicin in the process of diffuse traumatic brain injury and its effect on interleukin levels and histological changes in rats. Materials and methods: In this experimental study, Wistar rats (n=56) underwent diffuse controlled brain injury by Marmarou method, and 30 minutes later, the drug was injected intraperitoneally at different doses. Veterinary Coma Scale was used and Beam Walk and Beam Balance movement and balance tests were taken at pre-traumatic times, immediately after recovery from the trauma, and 24, 48, and 72 hours after the trauma. Results: Findings showed that allicin at 25 mg/kg and 50 mg/kg can reduce these differences compared to the control group (Sham and Intact) (P

Traumatic brain injury continues to be a severe health problem worldwide due to its significant mortality and morbidity. Computed Tomography and Glasgow coma scale are the main diagnostic methods used to determine the severity of traumatic brain injury today. However, both methods have their limitations. Therefore, biomarkers that can reliably reflect the extent of post-traumatic brain injury and microscopic pathological events have been sought for a long time. Our study aims to investigate whether serum adropin levels can be a biomarker used in adult head trauma. The study was designed as a prospective study of adult patients admitted to the emergency department with isolated head trauma. A demographic information form was filled for each individual participating in the study. All patient evaluations were made by emergency medicine specialists. The study population consisted of patients who required computerized brain tomography at the time of admission. The blood samples were obtained within the first hour of admission to the emergency room. Adropin levels in the patient group were statistically significant ly higher than in the control group (p=<0.001). Besides, no statistically significant difference was found in serum Adropin levels between the patient group who had bleeding and fractures determined in the brain tomography and those with no pathological findings (p=0.723). We think that adropin may have protective or curative effects on the human brain. [ABSTRACT FROM AUTHOR]

Background: Brain injuries are the most common cause of death in productive age. Besides the extent of the injury, other systemic factors can also affect the outcome. Patients suffering from severe brain injury often experience extracranial inflammatory complications during the early period of treatment. Here, we investigate the changes in immunity in patients with brain injury. Methods: 121 patients and 92 healthy controls were included in the research. Blood samples were collected on admission and analyzed by flow cytometry and biochemical methods. Multiple clusters of differentiation (CD) and antibody levels were investigated. The results were compared between patients and controls. In addition, results of two classes of severity (Glasgow Coma Scale, GCS, of 3–5 vs. 6–8) were also compared. Results: Parameters of humoral immunity in patients immediately after admission were significantly lower than those from healthy donors, with the exception of IgE elevated as much as to resemble allergic reaction (p < 0.01). Of cellular parameters, only natural killer (NK) cluster CD56 + was elevated (p < 0.01). Extracranial infectious complications were more common in patients with GCS 3–5. Conclusions: Strong immune system disorders were observed in patients after severe brain injury, which may contribute to the worse outcome in such patients. [ABSTRACT FROM AUTHOR]

ObjectiveThe aim of this study was to investigate phosphorylated tau (p-tau181) protein in plasma in a cohort of mild traumatic brain injury (mTBI) patients and a cohort of concussed athletes.MethodsThis pilot study comprised two independent cohorts. The first cohort—part of a Traumatic Head Injury Neuroimaging Classification (THINC) study—with a mean age of 46 years was composed of uninjured controls (UIC, n = 30) and mTBI patients (n = 288) recruited from the emergency department with clinical computed tomography (CT) and research magnetic resonance imaging (MRI) findings. The second cohort—with a mean age of 19 years—comprised 133 collegiate athletes with (n = 112) and without (n = 21) concussions. The participants enrolled in the second cohort were a part of a multicenter, prospective, case-control study conducted by the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium at six CARE Advanced Research Core (ARC) sites between 2015 and 2019. Blood was collected within 48 h of injury for both cohorts. Plasma concentration (pg/ml) of p-tau181 was measured using the Single Molecule Array ultrasensitive assay.ResultsConcentrations of plasma p-tau181 in both cohorts were significantly elevated compared to controls within 48 h of injury, with the highest concentrations of p-tau181 within 18 h of injury, with an area under the curve (AUC) of 0.690–0.748, respectively, in distinguishing mTBI patients and concussed athletes from controls. Among the mTBI patients, the levels of plasma p-tau181 were significantly higher in patients with positive neuroimaging (either CT+/MRI+, n = 74 or CT−/MRI+, n = 89) compared to mTBI patients with negative neuroimaging (CT−/MRI−, n = 111) findings and UIC (P-values < 0.05).ConclusionThese findings indicate that plasma p-tau181 concentrations likely relate to brain injury, with the highest levels in patients with neuroimaging evidence of injury. Future research is needed to replicate and validate this protein assay's performance as a possible early diagnostic biomarker for mTBI/concussions.

ObjectiveInjury severity after traumatic brain injury (TBI) is a well-established risk factor for the development of post-traumatic epilepsy (PTE). However, whether lesion location influences the susceptibility of seizures and development of PTE longitudinally has yet to be defined. We hypothesized that lesion location, specifically in the temporal lobe, would be associated with an increased incidence of both early seizures and PTE. As secondary analysis measures, we assessed the degree of brain atrophy and functional recovery, and performed a between-group analysis, comparing patients who developed PTE with those who did not develop PTE.MethodsWe assessed early seizure incidence (n = 90) and longitudinal development of PTE (n = 46) in a prospective convenience sample of patients with moderate-severe TBI. Acutely, patients were monitored with prospective cEEG and a high-resolution Magnetic Resonance Imaging (MRI) scan for lesion location classification. Chronically, patients underwent a high-resolution MRI, clinical assessment, and were longitudinally monitored for development of epilepsy for a minimum of 2 years post-injury.ResultsEarly seizures, occurring within the first week post-injury, occurred in 26.7% of the patients (n = 90). Within the cohort of subjects who had evidence of early seizures (n = 24), 75% had a hemorrhagic temporal lobe injury on admission. For longitudinal analyses (n = 46), 45.7% of patients developed PTE within a minimum of 2 years post-injury. Within the cohort of subjects who developed PTE (n = 21), 85.7% had a hemorrhagic temporal lobe injury on admission and 38.1% had early (convulsive or non-convulsive) seizures on cEEG monitoring during their acute ICU stay. In a between-group analysis, patients with PTE (n = 21) were more likely than patients who did not develop PTE (n = 25) to have a hemorrhagic temporal lobe injury (p

Background & objectives: Brain trauma is one of the most common causes of damage to the central nervous system which can lead to death and long-term disability. The present study aimed at investigating the effect of 8 weeks of swimming exercise on the level of memory and interleukin 10 (IL-10) in the hippocampus and prefrontal cortex of mice with brain trauma. Methods: 40 male NMRI mice were randomly divided into four groups (control, swimming, trauma, swimming + trauma). After completing the exercise protocol, induction of trauma was performed by the weight -drop method. Ten days after trauma induction, the mice were evaluated for spatial memory with Y-maze test. The IL- 10 level was measured using ELISA technique. One-way analysis of variance and Tukey post hoc test were used for statistical analysis at a significance level of p

Introduction: Targeted temperature management plays an important role in the treatment of myriad critical illnesses. Non-invasive, quick-onset options for isolated brain temperature control remain lacking. The goal of this study was to assess the safety and efficacy of a novel intranasal high flow cooled air device using a large animal model. Methods: Yorkshire swine were instrumented with temperature probes in the rectum, brain, ear, and snout, and a novel intranasal cooled air device was applied to half. The primary outcome was effectiveness of brain and snout cooling by the study device. Secondary outcomes included tympanic cooling and absence of rectal cooling, CT, CT perfusion, and histologic evidence of injury in the short- and medium-term. Results: 10 animals (54.7 kgs.+/- 19.4 SD) underwent non-survival evaluation, 3 underwent delayed evaluation (56.1 kgs.+/-6.4). From baseline to cooling period, intranasal (38.1 °C vs. 34.9 °C, p = 0.01), intracranial (38.6 °C vs. 37.2 °C, p = 0.01) and tympanic temperatures (38.3 °C vs. 37.5 °C, p = 0.01) decreased, while rectal temperature remained unchanged.After cooling, nasal temperature (34.9 °C vs. 37.6 °C, p = 0.004) and intracranial temperatures (37.2 °C vs. 37.9 °C, p = 0.01) increased. Rectal temperatures remained unchanged. A mixed effects model showed association between temperature and study period (p

Background and purpose: Traumatic brain injury (TBI) is one of the most complex diseases of the central nervous system (CNS). Nesfatin is an 82-amino acid effective polypeptide in CNS. In this study, we investigated the role of nesfatin in neuron protection in the process of diffuse concussion in rats and also its effect on the level of matrix metalloproteinase-9. Materials and methods: In this experimental study, 56 Wistar rats were subjected to TBI by the Marmaru method. After 30 minutes, nesfatin was injected intraperitoneally at different doses, and repeated on second and third days. The results of Veterinary Coma Scale, beam walk and beam balance tests were recorded at Pre-TBI, immediately after TBI, 24, 48, and 72 hours after TBI. After 72 hours, CSF was collected from the cisterna magna and used for ELISA test to measure the matrix metalloproteinase-9. Results: Intraperitoneal administration of nesfatin at 50 µg/kg and 10 µg/kg can reduce cerebral edema, destruction of the blood-brain barrier, and neurological and balance-motor scores (P<0.0001) compared with the control group (Sham and Intact) (P<0.0001). Nesfatin was not found effective at 20µg/kg (P>0.05). Conclusion: Nesfatin has been able to affect the consequences of trauma and reduce brain edema, accelerate the improvement of blood-brain barrier and neurological and balance scores. Probably part of these neuroprotective effects is through reduction of MMP-9. [ABSTRACT FROM AUTHOR]

To investigate the utility of melatonin supplementation as a treatment option for individuals with sleep disturbance after traumatic brain injury (TBI). A systematic search was conducted in 6 electronic databases (Medline, AMED, CINAHL, Embase, Scopus, and SPORTDiscus) from earliest records to April 2022. Studies were eligible for inclusion if they met the following criteria: a) human participants with sleep disturbance after TBI, b) melatonin or melatonergic agent used as an intervention to treat sleep disturbance, and c) outcomes of melatonin administration reported. All TBI severity types (mild, moderate, and severe) were eligible. The initial search retrieved a total of 595 articles, with 9 studies meeting the eligibility criteria. Two reviewers independently extracted data from eligible studies and assessed methodological quality. Extracted data consisted of participant and injury characteristics, melatonin interventional properties, and sleep outcome. Methodological quality was assessed via the Downs and Black checklist. A total of 251 participants with TBI-induced sleep disturbance (mean age range: 14.0-42.5 years) were included. Melatonin, Circadin (prolonged-release melatonin), or Ramelteon (melatonin receptor agonist) were administered. Dosages and intervention duration ranged from 2 to 10 mg and 3 to 12 weeks, respectively. Eight out of 9 studies reported positive outcomes after melatonin treatment. Significant improvements in subjective sleep quality, objective sleep efficiency, and total sleep time were found with melatonin. Reductions in self-reported fatigue, anxiety, and depressive symptoms were also observed with melatonin treatment. No serious adverse events were reported after melatonin administration. Melatonin has good tolerability after short-term use and the potential to be a therapeutic agent for those with sleep disturbance after TBI. Melatonin was shown to be beneficial to sleep quality, sleep duration, and sleep efficiency. Additional clinically relevant outcomes of improved mental health suggest that melatonin use may be a promising treatment option for individuals experiencing co-occurring disorders of mood and sleep disturbance post-injury. [ABSTRACT FROM AUTHOR]

Objective To investigate the correlation between ubiquitin carboxy-terminal hydrolase-1（UCHL1） level and cognitive function in patients with concussion caused by brain trauma.Methods A total of 126 patients with concussion caused by brain trauma admitted in this hospital from January 2018 to November 2019 were selected as the observation group, and divided into the high group（>65 points） and the low group（≤6 points） with the median score of cognitive function as the boundary, with 63 cases in each group.And 100 patients who underwent physical examination in this hospital during the same period were selected as the control group.The clinical data of the observation group after admission were recorded, including age, gender, BMI,time of admission, clinical signs, etc.The patients′ cognitive function was evaluated according to the memory test of the Wechsler Intelligence Test, and the UCHL1 levels of the two groups were compared and analyzed.Results The UCHL1 level of patients in the observation group was significantly higher than those in the control group; the cognitive function scores of patients in the high group was significantly higher than those in the low group; the UCHL1 levels of patients in the high group was significantly lower than those in the low group, and the differences were all statistically significant（P<0.05）.Comparing the age, gender, education level and UCHL1 level of patients in the high and low groups, the differences were statistically significant（P<0.05）.The age, gender, education level and UCHL1 level were all influencing factors, among which age and UCHL1 level were independent risk factors with statistically significant differences（P<0.05）.Conclusion The level of UCHL1 in patients with concussion caused by brain trauma can be used as an independent risk factor for cognitive function.The detection of UCHL1 level can accurately reflect the cognitive function and prognosis of patients. [ABSTRACT FROM AUTHOR]