Brain Injury Group Research Articles

Effect of sevoflurane anesthesia on cognitive impairment in rats with traumatic brain injury

Objective To evaluate the effect of sevoflurane anesthesia on cognitive impairment in rats with traumatic brain injury. Methods One hundred and and twenty healthy male Wistar rats, aged 2-3 months, weighing 190-220 g, were assigned into 4 groups (n=30 each) using a random number table method: control group (group C), traumatic brain injury group (group T), sevoflurane anesthesia group (group S), and traumatic brain injury plus sevoflurane anesthesia group (group T+ S). A 40 g hammer was freely dropped onto the left parietal bone window from a height of 20 cm to establish the traumatic brain injury model in T and T+ S groups.Twelve days later, S and T+ S groups inhaled 3% sevoflurane for 3 h, and C and T groups inhaled pure oxygen for 3 h. On 1 day before anesthesia and 3 and 7 days after anesthesia, 10 rats in each group were randomly selected for performing Morris water maze test.Rats were sacrificed after the end of Morris water maze test, and the hippocampal tissues were obtained for determination of the apoptosis rate of hippocampal neurons, cytoplasmic calcium concentration [Ca2+ ]i (by flow cytometry), expression of glucose-regulated protein 78 (GRP78) and CCAAT/enhancer-binding protein homologous protein (CHOP) (by immunohistochemistry), and expression of caspase-3 and caspase-12 (by Western blot). Results Compared with group C, the escape latency was significantly prolonged, the number of crossing platform was decreased, the apoptosis rate of hippocampal neurons and [Ca2+ ]i were increased, and the expression of caspase-3, caspase-12, GRP78 and CHOP in hippocampal tissues was up-regulated in S, T and T+ S groups (P<0.05). Compared with T and S groups, the escape latency was significantly prolonged, the number of crossing platform was decreased, the apoptosis rate of hippocampal neurons and [Ca2+ ]i were increased, and the expression of caspase-3, caspase-12, GRP78 and CHOP in hippocampal tissues was up-regulated in group T+ S (P<0.05). Conclusion Sevoflurane anesthesia can accentuate cognitive impairment in rats with traumatic brain injury, and the mechanism may be related to aggravating the degree of endoplasmic reticulum stress-induced calcium overload and increasing the apoptosis rate of hippocampal neurons. Key words: Anesthetics, inhalation; Brain injuries, traumatic; Cognition disorders

Personal Problems Questionnaire (PPQ): Normative Data and Utility in Assessing Acquired Neurological Impairment

The Personal Problems Questionnaire (PPQ) is a measure designed to assess acquired cognitive, emotional, and physical complaints. The present study sought to develop a normative database to allow clinicians and researchers to assess self-reported complaints among people with disabilities, and evaluate the response consistency and validity of their self-report. 404 community-dwelling participants (n 200 males, 204 females) completed the PPQ, as well as an acquired brain injury (ABI) group (n 59), mainly following stroke and traumatic brain injuries, and seen for clinical (i.e., non-forensic) evaluations. Multiple regression analyses were conducted to derive norms from the healthy community sample taking into account age, gender, and educational level. Normative T scores and cut-off points for the Clinical and Validity scales were derived, respectively, and used to assess the responses of the ABI group. The results indicated that the ABI group showed good response consistency and elevated scores on the Clinical scales, indicating that the PPQ is likely to be useful in detecting acquired disabilities. On the other hand, scores on the Validity scales were not elevated, indicating that the measures were unaffected by the ABI participants' cognitive difficulties. The PPQ provides a comprehensive assessment of complaints and response validity and the present study provides further data to assist with its use and interpretation.

Participation seven years after severe childhood traumatic brain injury

Purpose: Participation in home, school and community activities is considered as the ultimate aim of rehabilitation. The aims of this study were to examine participation seven years post-severe childhood traumatic brain injury and factors associated with participation.Materials and methods: Participants were enrolled in the Traumatisme Grave de l’Enfant (Severe Childhood Injury) cohort study following severe accidental childhood traumatic brain injury. Participation seven years post-injury, was examined using parent- and self-report forms of the Child and Adolescent Scale of Participation among 37 patients [62% males, mean age 15.4 years (SD = 4.4), mean length of coma 6.68 days (SD = 4.96)] and 33 matched controls.Results: Parent reports indicated significantly lower participation among patients compared to controls, but the self-reports did not. In the traumatic brain injury group, parent-reported participation was variable, with 22% of the patients clearly showing greater restrictions than controls. Participation restrictions were significantly associated with injury severity, poor functional outcome one-year post-injury, executive and behavioral difficulties and higher fatigue levels seven years post-injury, but not with pre-injury nor family factors.Conclusions: Several years after severe childhood traumatic brain injury, participation appears to depend more on injury-related factors than on environmental factors. In self-reports assessments of participation, it could be difficult for children and adolescents to distinguish capacity from performance.Implications for rehabilitationParticipation outcomes were highly variable in a sample of patients who sustained severe childhood traumatic brain injury.Participation should be assessed systematically following severe traumatic brain injury, both initially but also in the long-term, ideally using a combination of self- and proxy-report measures.Among patients with severe injuries, the influence of initial brain injury severity markers on participation seems much stronger than that of social/family environment factors.Children’s and adolescents’ self-reported participation assessed with the Child and Adolescent Scale of Participation may be difficult to interpret.

Changes and significance of serum intestinal fatty acid binding protein in children with traumatic brain injury complicated with gastrointestinal dysfunction

Objective To study the changes and significance of serum intestinal fatty acid binding protein (IFABP) in children with traumatic brain injury(TBI) complicaled with acute gastrointestinal injury(AGI). Methods A total of 95 children suffering from TBI hospitalized in the PICU of the First Affiliated Hospital of Zhengzhou University from January 2017 to March 2018 were enrolled in the study.According to the modified Glasgow coma score combined with clinical classification criteria for acute closed head injury, the cases were devided into mild(43 cases), moderate (23 cases), and severe(29 cases). Children were graded according to AGI (AGI Ⅰ42 cases, AGI Ⅱ 30 cases, AGI Ⅲ 13 cases, and AGI Ⅳ 10 cases). Thirty healthy children who underwent physical examination at outpatient service were enrolled as the control group.Blood samples were collected at the time of admission and on the 3rd day after admission.Serum IFABP was detected by ELISA, and the differences of serum IFABP concentrations were compared among groups.The correlations between IFABP with TBI classification and AGI grade were analyzed.The receiver operating characteristic (ROC) curve was drawn, and the predictive values of IFABP for the diagnosis of children with TBI complicated with AGI were evaluated. Results On the day of admission, the serum levels of IFABP in mild, moderate and severe brain injury group were significantly higher than that in control group (all P<0.01). And serum IFABP concentration gradually increased with the increase of brain injury (all P<0.01). Serum IFABP levels in children with AGI grade Ⅰto Ⅳ were significantly higher than those in control group (all P<0.01). The levels of serum IFABP also increased with the increase of AGI level (all P<0.01). The concentration of serum IFABP was positively correlated with the grade of TBI and AGI (rs=0.82, P<0.01; rs=0.70, P<0.01). In each group, the levels of serum IFABP on the 3rd day after admission were lower than those on admission (all P<0.01). The ROC curve analysis showed that serum IFABP was of high diagnostic value in children with TBI complicated with AGI, and the area under the ROC curve was 0.88.When the cutoff value of IFABP was 431.36 ng/L, the sensitivity and specificity were 71.61% and 90.00%, respectively. Conclusion Serum IFABP can be used as a sensitive indicator for the early diagnosis and disease assessment in children with TBI complicated with gastrointestinal dysfunction. Key words: Intestinal fatty acid binding protein; Traumatic brain injury; Gastrointestinal dysfunction; Children

The bridge between cognition and behavior in acquired brain injury: A graph theoretical approach.

BackgroundThe assumption is that executive dysfunctions (EF), associated with frontal lobe injury, are responsible for behavioral disturbances. Some studies do not find a relationship between EF and behavior following frontal lobe lesions. Our main goal of this study was to use a novel statistical method, graph theory, to analyze this relationship in different brain injury groups; frontal lobe damage, non‐frontal lobe damage, and controls. Within the frontal group, we expect to find a pattern of executive nodes that are highly interconnected.MethodsFor each group, we modeled the relationship between executive functions and behavior as a network of interdependent variables. The cognitive tests and the behavioral questionnaire are the “nodes” in the network, while the relationships between the nodes were modeled as the correlations between two nodes corrected for the correlation with all other nodes in the network. Sparse networks were estimated within each group using graphical LASSO. We analyzed the relative importance of the nodes within a network (centrality) and the clustering (modularity) of the different nodes.ResultsNetwork analysis showed distinct patterns of relationships between EF and behavior in the three subgroups. The performance on the verbal learning test is the most central node in all the networks. In the frontal group, verbal memory forms a community with working memory and fluency. The behavioral nodes do not differentiate between groups or form clusters with cognitive nodes. No other communities were found for cognitive and behavioral nodes.ConclusionThe cognitive phenotype of the frontal lobe damaged group, with its stability and proportion, might be theoretically interpreted as a potential “buffer” for possible cognitive executive deficits. This might explain some of the ambiguity found in the literature. This alternative approach on cognitive test scores provides a different and possibly complimentary perspective of the neuropsychology of brain‐injured patients.

Magnetic resonance spectroscopy data in the prognosis of consciousness recovery in patients with vegetative state

To study the prognostic value of magnetic resonance spectroscopy (MRS) in patients with vegetative state/unresponsive wakefulness syndrome (VS/UWS). Thirty-four patients with VS/UWS underwent multi-voxel MRS (thalamus, globus pallidus, putamen, internal capsules, fornix, brainstem, temporal and frontal cortex). Subjects were grouped according to etiology: 22 patients with traumatic brain injury (TBI) (group 1) and 12 patients with a hypoxia (group 2). The groups were matched by age and duration of UWS (mean 2, 3 months). The CRS-R was used to identify the first signs of consciousness during hospitalization and 6-12 months later. Outcomes of the patients with TBI were as follows: chronic VS/UWS (n=6), minimally conscious state (MCS) plus (n=9), emergence from MCS (EMCS) (n=7). Outcomes of the patients with hypoxia were: chronic vegetative state (n=10), minimally conscious state (MCS) (n=2). The decrease in the NAA/Cr ratio in thalamus, capsula interna, temporal cortex are correlated with poor outcome in both groups. Higher rates of NAA/Cr in these structures are correlated with further recovery of consciousness. The decrease in the ratio of NAA Cr and NAA/NAA+Cho+Cr in the midbrain is correlated with poor outcome only in UWS with hypoxia. The results suggest that the MRS allows to more accurately predicting the outcome in VS/UWS patients with hypoxic brain damage, as well as in UWS patients with TBI, who have recovered consciousness to the level of EMCS.

Whole brain and corpus callosum diffusion tensor metrics: How do they correlate with visual and verbal memory performance in chronic traumatic brain injury.

This research investigates the chronic effect of moderate to severe traumatic brain injury on brain white matter integrity, as reflected by diffusion tensor imaging metrics, and the assessment of their correlation to neuropsychological response. Thirteen male participants with traumatic brain injury (8.4 years average post-injury time) were compared to a matched group of neurologically healthy controls. None of the traumatic brain injury subjects had received post-acute neurocognitive and/or neuropsychological rehabilitation. Between-group comparison of fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity was performed for the whole brain and corpus callosum. An extensive battery of visual and verbal memory tasks was employed for the comparative assessment of neurocognitive performance. Between-group and within-group performance differences were correlated with fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity of corpus callosum. Significant changes in global fractional anisotropy, mean diffusivity, and radial diffusivity were associated with traumatic brain injury. Visual memory capacity was reduced in traumatic brain injury, and this deficit was correlated to white matter integrity loss at the corpus callosum. Participants with traumatic brain injury underperformed controls in verbal memory as well, but no correlation with corpus callosum diffusion tensor imaging properties was established. Between-group performance difference was correlated with corpus callosum diffusion metrics in several tasks. Significant correlations were found between corpus callosum diffusion tensor imaging metrics and neuropsychological response within the traumatic brain injury group. Changes in whole brain and corpus callosum diffusion tensor metrics inflicted by moderate to severe traumatic brain injury are still evident several years post-injury and relate to neurocognitive impairment, while loss of white matter integrity seems to correlate with episodic and working memory impairment.

Glutamine supplementation provides neuroprotection by inhibiting microglia-mediated neuroinflammatory response after traumatic brain injury in rats

Objective To investigate the effects and mechanisms of Glutamine(Gln) supplementation on neurobehavioral outcome, neuronal apoptosis, microglia polarization, and neuroinflammatory response after traumatic brain injury (TBI) in rats. Methods TBI animal models were established using Feeney's method. Sixty Wistar rats were randomly divided into three groups: control group (Con), traumatic brain injury group (TBI), and glutamine supplementation group (TBI+ Gln). We measured rat behavioral outcomes by modified neurologic severity score (mNSS) tests at day 1, 3, 7 and 14 after TBI. Apoptotic neurons were determined by Nissl staining. The microglia polarization relatived protein (Iba-1, CD16, CD86) expressions in TBI cerebral cortices were determined by immunohistochemistry staining and western blotting, respectively. While, the serum levels of tumor necrosis factor-α(TNF-α), interleukin (IL)-1 and interferon (IFN)-γ were tested by enzyme linked immunosorbent Assay (ELISA). Results Compared with the Con group, the levels of neurobehavioral outcome, neurons apoptosis, microglia polarization and neuroinflammatory factors were significantly increased in the other two groups(P=0.00). Compared with the TBl group, glutamin supplementation improved neurobehavioral outcome[7 d: (10.74±0.25)points vs. (8.94±0.24) points, P=0.01; 14 d: (8.77±0.16)points vs. (7.43±0.13)points, P=0.03]. Meanwhile, glutamin supplementation suppressed the apoptotic rates of neurons [3 d: (80.18±8.38)% vs.(65.47±7.02)%, P=0.01; 7 d: (58.90±6.12)% vs.(42.73±4.88)%, P=0.01; 14 d: (39.56±2.95)% vs.(31.12±3.16)%, P=0.01], inhibited protein expressions of Iba-1 and CD16, and increased the protein expression of CD86, which promoted the phenotypic shift of microglia from M1 to M2 phenotype, inhibited microglial activation, and thus reduced TBI-induced neuroinflammatory factors [TNF-α: (125.42±12.81)pg/ml vs. (74.36±9.25)pg/ml, P=0.01; IL-1: (69.04±8.48)pg/ml vs. (34.73±3.92)pg/ml, P=0.01; TNF-α: (89.75±9.40)pg/ml vs. (45.62±6.64)pg/ml, P=0.02]. Conclusion Glutamine supplementation can markedly reduce neuron apoptosis and improve neurological outcomes after TBI, possibly mediated by promoting the phenotypic shift of microglia from M1 to M2 phenotype and thus reducing TBI-induced neuroinflammatory factors. Key words: Traumatic brain injury; Glutamine; Microglia; Inflammatory response; Neuroprotection

Subtle Motor Signs in Children With Chronic Traumatic Brain Injury.

The aim of the study was to characterize subtle motor signs in children with moderate-severe traumatic brain injury in the chronic phase of injury. Fourteen children with moderate (n = 6) or severe (n = 8) traumatic brain injury, ages 11-18 yrs, who had sustained their injury at least 1-yr before study participation (range 1-14 yrs since injury), and 14 matched typically developing controls were examined using the Physical and Neurological Examination of Subtle Signs (PANESS). To examine the neural correlates of subtle motor signs, measures of total cerebral volume and motor/premotor volume were derived from magnetic resonance imaging. Children with traumatic brain injury had significantly poorer PANESS performance than controls on the total timed subscore, proximal overflow, and the PANESS total score. Participants with severe traumatic brain injury had greater proximal overflow than those with moderate injury, after controlling for age at injury. Across all participants, greater proximal overflow correlated with reduced total cerebral volume, whereas within the traumatic brain injury group, reduced motor/premotor volume correlated with lower PANESS total score. The study highlights the importance of examining subtle motor signs including overflow during clinical evaluation of chronic pediatric traumatic brain injury and establishes the clinical utility of the PANESS as a measure sensitive to chronic subtle motor signs in this population. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Define subtle motor signs including motor overflow; (2) Identify subtle motor signs such as motor overflow during clinical evaluation of children with brain injury; and (3) Explain the relevance of examining subtle motor signs in chronic pediatric brain injury during clinical evaluations. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Factors Associated with Difficulty in Returning to School in Students After Traumatic Brain Injury.

Traumatic brain injury (TBI) often causes behavioral problems and difficulties with school work, but the specific factors associated with difficulty in returning to school after TBI still remain unclear. The purpose of this study was to investigate factors associated with difficulty in returning to school within 1 year of injury in students with traumatic brain injury. This study is a secondary analysis of existing data sets. We recruited patients aged 16 years in the United States with a primary rehabilitation diagnosis of TBI registered in the Traumatic Brain Injury Model Systems National Database. We compared variables between the students who returned to school and those who did not return to school. In addition, subgroup analyses were performed focused on traumatic brain injury severity. We excluded those were received <10 years of schooling, and 309 eligible students were identified for the analysis. Of these, 246 (80%) did not return to school within 1 year of injury. There were fewer cases of severe TBI in the group of students who returned to school than in the group who did not return to school (29% vs 44%, P = 0.03). The duration of rehabilitation was significantly longer in the group who returned to school than in the group who did not return to school (mean days 40 vs 29, P = 0.001), and a subgroup analysis showed in the severe traumatic brain injury group (mean days 46 vs 29; P = 0.02) and the non-severe traumatic brain injury group (mean days 37 vs 26; P = 0.02) similar results. Insufficient amount of rehabilitation was associated with difficulty in returning to school in students after TBI, regardless of the severity of the injury.

Clinical significance of detecting serum melatonin and SBDPs in brain injury in preterm infants

To investigate the clinical values of serum melatonin and αII spectrin cleavage products (SBDPs) in assessing the severity of brain injury in preterm infants. Sixty-four premature infants in total were selected and classified into the brain injury group (BI, n=30) and the non-brain injury group (CON, n=34) according to cranial imaging examination. The serum melatonin and SBDPs were detected by ELISA. All the preterm infants were received NBNA testing at 40 weeks of corrected gestational age. The levels of melatonin and SBDPs in the BI group were significantly higher than the CON group (p<0.05) and the levels in the infants with severe brain injury were significantly higher than those with mild brain injury (p<0.05), as well as exhibiting a negative correlation with the NBNA score at 40 weeks of corrected gestational age (p<0.05). Detecting melatonin and SBDPs has clinical value in diagnosing and assessing the severity of brain injury in preterm infants.

Persistent Postconcussion Symptoms After Injury.

Children with mTBI (n = 119), complicated mild traumatic brain injury (cmTBI) (n = 110), or orthopedic injury (OI) (n = 118), recruited from emergency departments, were enrolled in a prospective, longitudinal cohort study. Caregivers completed retrospective surveys to characterize preinjury demographic, child, and family characteristics. PCSs were assessed using a validated rating scale. With multivariable general linear models adjusted for preinjury symptoms, we examined predictors of PCSs 3, 6, and 12 months after injury in children ages 4 to 8, 9 to 12, and 13 to 15 years at injury. With logistic regression, we examined predictors of chronic PCSs 1 year after traumatic brain injury. Postinjury somatic, emotional, cognitive, and fatigue PCSs were similar in the mTBI and cmTBI groups and significantly elevated compared with the OI group. PCS trajectories varied with age and sex. Adolescents had elevated PCSs that improved; young children had lower initial symptoms and less change. Despite similar preinjury PCSs, girls had elevated symptoms across all time points compared with boys. PCS vulnerability factors included female sex, adolescence, preinjury mood problems, lower income, and family discord. Social capital was a protective factor. PCSs persisted in 25% to 31% of the traumatic brain injury group and 18% of the OI group at 1 year postinjury. The odds of chronic PCSs were almost twice as high in girls as in boys and were >4 times higher in young children with cmTBI than in those with mTBI. A significant minority of children with mTBI and OI have PCSs that persisted 1 year after injury.

EFFECT OF COMBINATION TREATMENT OF CANDESARTAN AND CURCUMIN ON TRAUMATIC BRAIN INJURY IN MICE

Traumatic brain injury (TBI) is a severe condition and a major cause of death and disability, particularly in young adults. Traumatic brain injury invokes a complex inflammatory, oxidative and apoptotic responses. The present experimental study was designed to assess the effect of combination treatment of curcumin and candesartan on TBI in mice. Mice were classified into six groups (Sham, TBI and TBI post-treated with vehicle, curcumin, candesartan or combination of curcumin + candesartan for 7 days), n=12 each. Mice were anesthetized and then placed under a weight-drop device.The animals were killed by cervical dislocation, brains were rapidly isolated and homogenized. Traumatic brain injury group showed significant increment in MDA, TNF-Alpha, caspase-3 as compared to sham group and these effects were significantly ameliorated by curcumin, candesartan or their combination treatment. Also total antioxidant capacity (TAC) decreased markedly in the TBI group and increased significantly by concurrent treatment with curcumin &/or candesartan. Furthermore, histopathological examination confirmed these findings. Collectively these findings indicate that curcumin and candesartan have potential anti-inflammatory, anti-apoptotic and antioxidant effects. Accordingly, curcumin or candesartan might be employed as a therapeutic agent for TBI and their combination succeeded in adding better effects than the individual drugs.

Longitudinal Microstructural Changes in Traumatic Brain Injury in Rats: A Diffusional Kurtosis Imaging, Histology, and Behavior Study

Traumatic brain injury is a major public health problem worldwide. Accurately evaluating the brain microstructural changes in traumatic brain injury is crucial for the treatment and prognosis assessment. This study aimed to assess the longitudinal brain microstructural changes in traumatic brain injury in the rat using diffusional kurtosis imaging. Diffusional kurtosis imaging was performed in a group of 5 rats at preinjury and 3, 14, and 28 days after traumatic brain injury. The diffusional kurtosis imaging parameters were measured in the bilateral cortex, hippocampus, and corpus callosum. Another 4 groups of 5 rats were used in brain immunohistochemistry analysis of neuron (neuron-specific nuclear protein [NeuN]), astroglia (glial fibrillary acidic protein [GFAP]), microglia (ionized calcium binding adaptor molecule 1 [Iba-1]), and myelin (myelin basic protein [MBP]) in the same area as the diffusional kurtosis imaging parameter measurements. Furthermore, 2 groups of 6 rats underwent a Morris water maze test at 28 days after traumatic brain injury. The diffusional kurtosis imaging parameters, immunohistochemistry results, and Morris water maze test results were compared longitudinally or between traumatic brain injury and control groups. Compared with baseline, traumatic brain injury in the rat showed higher mean kurtosis and mean diffusivity values in the ipsilateral perilesional cortex and hippocampus and lower fractional anisotropy values in the corpus callosum (P < .05). The traumatic brain injury group showed higher staining of GFAP and Iba-1 and lower immunohistochemistry staining of NeuN and MBP in all ipsilateral ROIs (P < .05). There was no significant difference in the contralateral ROIs in diffusional kurtosis imaging parameters or immunohistochemistry results. The Morris water maze test revealed lower platform crossing times in the probe test (P < .05). Our study indicated that there were longitudinal changes in diffusional kurtosis imaging parameters, accompanied by multiple pathologic changes at different time points following traumatic brain injury, and that mean kurtosis is more sensitive to detect microstructural changes, especially in gray matter, than mean diffusivity and fractional anisotropy.

Comparing disability between traumatic brain injury and spinal cord injury using the 12-item WHODAS 2.0 and the WHO minimal generic data set covering functioning and health

Objective: To compare disability between two patient groups using short validated tools based on International Classification of Functioning, Disability and Health (ICF). Design: Cross-sectional study. Setting: University hospital specialist outpatient clinic. Subjects: A total of 94 patients with traumatic brain injury and 59 with spinal cord injury. Main measures: Disability evaluated using self-reported and proxy 12-item WHODAS 2.0 (World Health Organization Disability Assessment Schedule), and physician-rated WHO minimal generic data set covering functioning and health. Results: The two measures used showed severe but very different disabilities in these patient groups. Disability was assessed worse by physicians in the spinal cord injury population (sum 15.8 vs. 12.7, P = 0.0001), whereas disability assessed by the patients did not differ significantly between the two groups (sum 18.4 vs. 21.2). Further analysis revealed that in patients with “high disability” (the minimal generic data set score ⩾15), self-reported functioning was more severely impaired in the traumatic brain injury group compared to the spinal cord injury group (29.7 vs. 21.4, P < 0.0001), with no difference between these two diagnostic groups in patients with “low disability” (the minimal generic data set below 15). Patients with traumatic brain injury perceived more difficulties in cognition, getting along and participation, patients with spinal cord injury in mobility and self-care. Conclusion: Both generic measures were able to detect severe disability but also to detect differences between two patient populations with different underlying diagnoses.

Experimental study of expression of hypoxia-inducible factor-1α and its role in traumatic brain injury

Decades of traumatic brain injury (TBI) research have not led to the development of novel drugs that successfully improve the outcome of injured patients. Thus, new research approaches or medicine are required. Vascular injury is the primary key event that can cause a range of secondary injury, and become a key part of TBI repairmen. Reduced blood flow is one pathophysiological symptom of TBI. Regenerative mechanisms are then initiated to reduce cellular damage, including the activation of hypoxia-inducible transcription factor 1 (HIF-1). Successful revascularization can provide critical neurovascular microenvironment, which produces effective perfusion to promote nerve repair and growth by clearing Toxic factors, providing nutrition, and making it a critical treatment for TBI. Ninety-six male SD rats were divided into four groups: sham group ( n = 8), control (sham operate, n = 8), traumatic brain injury group (TBI group, n = 40) and TBI treated with 2ME2 group ( n = 40). Feeney's method was applied to establish TBI model. At the time point 6 h, 24 h, 3d, 7d, 14d after modeling, the expression of PHD2/HIF-1α/VEGF/Ang-1 were observed by RT-PCR\Western blot analysis. Compared with sham-operated controls, the expression of HIF-1α in TBI group have been significantly ( P < 0.05) enhanced, which related to the degradation of PHD2 following TBI induction. HIF-1α expression began to increase after 6 h, within 24 h to 3d reached peak and fall to common levels before 7d. Nevertheless, VEGF/Ang-1 expression was remarkably ( P < 0.01) decreased after inhibition of HIF-1α by 2-ME-2. The expression of HIF-1α increased after experimental TBI, which can induce its downstream target gene expression to promote the repairment of injured vascular and angiogenesis.

Impact of fluid challenge increase in cardiac output on the relationship between systemic and cerebral hemodynamics in severe sepsis compared to brain injury and controls

BackgroundCognitive dysfunction and delirium after ICU are frequent and may partially result from brain ischemia episodes. We hypothesized that systemic inflammation (severe sepsis or septic shock) modifies the control of brain circulation and the relation between systemic and cerebral hemodynamic after a positive response to fluid challenge (FC).MethodsThree groups of patients were studied if they increased stroke volume (SV) > 10% after 250 or 500 ml of crystalloids: control group: patients free of comorbidity anesthetized for orthopedic surgery; sepsis group: patients with severe sepsis or septic shock (classic definition); brain injury (BI) group: trauma brain jury or hemorrhagic stroke with no detectable systemic inflammation. The measurements before and after FC were mean arterial blood pressure (MAP) (radial catheter); SV and cardiac output (CO; transesophageal Doppler); bilateral middle cerebral artery (MCAv) velocity with peak systolic (PSV) and end diastolic (EDV) values (transcranial Doppler); end-tidal CO2. The role of MAP increase was investigated by an arbitrarily threshold increase of 5%, called responder in CO and MAP (RR). The remaining patients were call responders in CO and non-responders in MAP (RnR). Nonparametric tests were used for statistical analysis.ResultsAmong the 86 screened patients, 66 have completed the protocol: 17 in control group; 38 in sepsis group; and 11 in BI group. All patients increased SV > 10% after FC. Only the sepsis group increased MAP [+ 12 (2–25%), p < 0.05] with a significant increase in PSV and EDV [(17 (3–30)% and 17 (12–42)%, respectively (p < 0.05)], which did not change in the two other groups. The septic RR or RnR had similar variations in MCAv after FC. The baseline MAP < or > baseline median MAP had similar MCAv.ConclusionsAfter a FC-induced increase in SV, MCAv (PSV and EDV) increased only in septic group, mostly independently from MAP increase and from baseline MAP level. Cerebral perfusion becomes passively dependent on systemic blood flow, suggesting a modification of the control of cerebrovascular tone in sepsis-induced systemic inflammation. This information has been considered in the clinical management of septic patients.

Clinical Nursing Practice for Fracture Healing Vs. Fracture Merge Cerebral Injury

This paper aims to observe fracture healing quality in rabbits after cerebral injury and compare it with the subcutaneous fracture healing. Purebred New Zealand white rabbits are randomly chosen as two groups, i.e. fracture merge brain injury group and simple fracture group. For the latter group: under the anesthesia, saw the right ulnar midpiece off rabbit, build a standard right ulnar fracture model. For the former group, repeat the above procedure for right ulnar fracture model, a linear acceleration brain injury model is also built. After anesthesia, place a stainless-steel gasket between the coronal and lambdoidal sutures, wait until the rabbit fully awakens, let it lie prostrate on a sponge mat, and then fall down from a height. The results show that bone mineral density of the fracture merge brain injury group is higher than that of simple fracture group. It is concluded that the healing quality of the fracture merge brain injury group is significantly better than that of simple fracture group. Hence one can see that the high-quality nursing service model can effectively facilitate fracture healing of patients and accelerate the recovery of the function of the ill limb.

Use of Diffusional Kurtosis Imaging and Dynamic Contrast-Enhanced MR Imaging to Predict Posttraumatic Epilepsy in Rabbits.

Finding a reliable biomarker to thoroughly assess the brain structure changes in posttraumatic epilepsy is of great importance. Our aim was to explore the value of diffusional kurtosis imaging combined with dynamic contrast-enhanced MR imaging in the evaluation of posttraumatic epilepsy. A modified weight-drop device was used to induce traumatic brain injury. Rabbits were exposed to traumatic brain injury or sham injury. Diffusional kurtosis imaging and dynamic contrast-enhanced MR imaging were performed 1 day after injury. Posttraumatic epilepsy was investigated 3 months after injury. The traumatic brain injury group was further divided into 2 groups: the posttraumatic epilepsy and the non-posttraumatic epilepsy groups. Mean kurtosis and volume transfer coefficient values in the cortex, hippocampus, and thalamus were analyzed. After follow-up, the experimental animals were sacrificed for Nissl staining. The posttraumatic epilepsy group comprised 8 rabbits. In the ipsilateral cortex, the volume transfer coefficient in the traumatic brain injury group was higher than that in the sham group; the volume transfer coefficient in the posttraumatic epilepsy group was higher than that in the non-posttraumatic epilepsy group. In the ipsilateral hippocampus, the volume transfer coefficient in the posttraumatic epilepsy group was higher than that in the non-posttraumatic epilepsy and sham groups. No difference was observed between the non-posttraumatic epilepsy and sham groups. In the ipsilateral cortex, mean kurtosis in the traumatic brain injury group was lower than that in the sham group, and mean kurtosis in the posttraumatic epilepsy group was lower than that in the non-posttraumatic epilepsy group. In the ipsilateral thalamus and hippocampus, mean kurtosis in the traumatic brain injury group was lower than that in the sham group, and mean kurtosis in the posttraumatic epilepsy group was lower than that in the non-posttraumatic epilepsy group. In the contralateral thalamus, mean kurtosis in the traumatic brain injury group was lower than that in the sham group; however, no difference was observed between the posttraumatic epilepsy and non-posttraumatic epilepsy groups. Diffusional kurtosis imaging and dynamic contrast-enhanced MR imaging could be used to predict the occurrence of posttraumatic epilepsy in rabbits exposed to experimental traumatic brain injury.

Can gestational exercise have a positive effect on cognitive functions resulting from brain injury A rat study

Aim: The effects of gestational exercise on potential pathological conditions is not known yet. Therefore, in the present study, it was aimed to evaluate the effects of forced running exercise on LPS-induced brain damage in pregnant rats. Method: Pregnant females in the experimental group were forced to exercise 30 min daily for five days a week. Lipopolysaccharide (LPS) induced brain injury model was created by administering 500 µg/kg body weight of LPS on gestational days 18 and 19. To evaluate injury histopathologically, brain tissues were fixed at the postnatal day seven through transcardial perfusion (n=4 pups/group). When the remaining pups reached 30-day of age, Morris water maze test (MWM) was performed to assess memory and learning, open filed (OP) and elevated plus maze (EPM) for testing anxiety, and Porsolt test (PT) for evaluating depression. The groups were defined as brain injury group (BI, n=13) and exercise+brain injury group (E+BI, n=7). Results: The results obtained from MWM test indicated that animals found the platform in a shorter duration and distance at the day five compared to the day three. However, there was no significant difference between the groups. No significant difference was found in OP test regarding the distance traveled, time spent at the margins, movement at the center and the time spent as immobile. However, in the EPM test, the offspring at the BI group displayed higher mobility and increased number of entry to the open arms compared to the E+BI groups (p=0.01). There was no significant difference regarding mobility duration and total distance traveled in the PT test. Conclusion: In the present study, we tested the impact of gestational exercise using the brain injury model. The results of the EPM test suggests that the gestational exercise can suppress the stress factors in the pregnant females with brain injury leading to the prevention of hyperactivity-induced negative learning behavior.