Brain Injury Research Research Articles

Epidemiological study of traumatic spinal cord injuries: experience from a specialized spine center in Iran.

A cross-sectional study. This study was performed for epidemiological assessment of Iranian Traumatic Spinal Cord Injuries (TSCI), referred to a specialized spine center. Patient recruitment and evaluations were conducted at the Brain and Spinal Injury Research Center, Tehran, Iran. This study was performed from September 2011 to March 2015 on 1137 consecutive TSCIs. History, clinicoradiological findings as well as chronic complications and social integration were recorded. The capture-recapture method was used to calculate a rough estimation of TSCI prevalence in Tehran Province. Our report includes 1137 cases with a mean age of 29.1 years (s.d.=11.2 year)-79.2% of them being male (M/F=3.8/1). Rough estimation of TSCI prevalence in Tehran province was 2.36 per 10 000 population. Regarding etiology, 61.8% were due to motor vehicle accident (MVA), followed by falling 24.5%, heavy drop 5.2%, violence 3.8%, sport 2.8% and others causes 1.9%. Regarding injury level, 31.5% were cervical, 57.9% thoracic and 10.6% lumbar. Complete lesions were 53.5% of patients and 46.5% were incomplete. Most common neurological type was T1-S5 (American Spinal Injury Association Impairment Scale: A, B, C, 61.7%). Most common complications included urinary tract infection followed by pressure sore (grade III and IV, 37.5%), autonomic dysreflexia (37%) and neuropathic pain (31.2%). Substance abuse was observed in 8.8% of cases. Overall, ~25% in our cases were employed after TSCI. Secondary divorce was also much more frequent than normal matched controls. MVA was the most common cause for TSCI. The elderly subjects were less frequent among our patients than more developed countries. The high rate of unemployment and divorce in our cases deserves special consideration.

Real-time, whole-brain, temporally resolved pressure responses in translational head impact.

Theoretical debate still exists on the role of linear acceleration ( a lin) on the risk of brain injury. Recent injury metrics only consider head rotational acceleration ( a rot) but not a lin, despite that real-world on-field head impacts suggesting a lin significantly improves a concussion risk function. These controversial findings suggest a practical challenge in integrating theory and real-world experiment. Focusing on tissue-level mechanical responses estimated from finite-element (FE) models of the human head, rather than impact kinematics alone, may help address this debate. However, the substantial computational cost incurred (runtime and hardware) poses a significant barrier for their practical use. In this study, we established a real-time technique to estimate whole-brain a lin-induced pressures. Three hydrostatic atlas pressures corresponding to translational impacts (referred to as 'brain print') along the three major axes were pre-computed. For an arbitrary a lin profile at any instance in time, the atlas pressures were linearly scaled and then superimposed to estimate whole-brain responses. Using 12 publically available, independently measured or reconstructed real-world a lin profiles representative of a range of impact/injury scenarios, the technique was successfully validated (except for one case with an extremely short impulse of approx. 1 ms). The computational cost to estimate whole-brain pressure responses for an entire a lin profile was less than 0.1 s on a laptop versus typically hours on a high-end multicore computer. These findings suggest the potential of the simple, yet effective technique to enable future studies to focus on tissue-level brain responses, rather than solely relying on global head impact kinematics that have plagued early and contemporary brain injury research to date.

The Relationship Between Dietary Intakes of Amino Acids and Bone Mineral Density Among Individuals with Spinal Cord Injury.

The effect of dietary protein intake on bone mineral density (BMD) has not been explained in patients with spinal cord injury (SCI). In this study, we looked at the relationship between BMD and higher protein intake in patients with SCI while controlling for possible confounders. Patients with SCI, who were referred to the Brain and Spinal Cord Injury Research Center between November 2010 and April 2012, were included in the study. In total, the dietary intakes of 103 patients were assessed by 24-hour dietary recall interviews. We used dual-energy X-ray absorptiometry to measure BMD in the femoral neck, trochanter, intertrochanteric zone, hip, and lumbar vertebras. Eighty-six men and 17 women participated in this study. Protein intake was negatively associated with the BMD of lumbar vertebrae (p = 0.001, r = -0.37 for T-score and p = 0.030, r = -0.24 for Z-score). The BMD of lumbar vertebrae were negatively associated with intake of tryptophan, isoleucine, lysine, cysteine, and tyrosine (p = 0.007, 0.005, 0.009, 0.008, and 0.008 for T-score, respectively). Higher intakes of threonine, leucine, methionine, phenylalanine, valine, and histidine were related to a lower BMD of lumbar vertebrae (p = 0.006, 0.010, 0.009, 0.010, 0.009, and 0.008 respectively for T-scores). We found that high protein intake led to a lower BMD of lumbar vertebrae in patients with SCI after controlling for confounders including demographic and injury-related characteristics and calcium intake. No relationship between higher amino acids intake and BMD of the femur and hip was detected. Intake of alanine, arginine, and aspartic acid were not related to BMD.

Effective Teaching Strategies for Patient Education in Individuals With Spinal Cord Injury in Iran

Background: Spinal cord injury (SCI) causes multiple complications, which can be prevented or minimized, through patient education (PE). Individuals with SCI are different, according to culture, socioeconomic status, level of education, access to educational facilities, and geographic region. Therefore, different teaching strategies should be used to increase effectiveness of education. Objectives: The aim of this study is to evaluate the perspectives of individuals with SCI, about their preferred methods of PE. Patients and Methods: This was a descriptive cross-sectional study undertaken at the brain and spinal cord injury research center (BASIR), Tehran university of medical sciences, Tehran, Iran. The participants comprised of 119 SCI persons (81 men and 38 women), with mean age of 32 ± 10.5 years, referred to BASIR clinic to receive outpatient rehabilitation, in 2012. The patients were asked about their views, concerning preferred methods of PE. Results: Most participants (94%) appreciated to be informed concerning their illness. The two most preferred education methods were educational movies by CD or DVD (44%) and lectures or face classes (36%), followed by educational TV programs (30%), brochures (24%), education via internet or computer-aided (14.3%), and, finally, educational books (2%). Conclusions: Health care providers should take into account the differences between individuals with SCI, to use effective teaching strategies. Also, they should apply appropriate teaching methods and more than one teaching strategy, in relation to the different time and situation. Effective PE, in individuals with SCI, can increase their knowledge and motivation in self-care, improve satisfaction, prevent complications and make the PE more effective.

Traumatic brain injury related research in India: An overview of published literature.

Aim:This paper provides an overview of publications by Indian researchers on traumatic brain injury between 1966 and 2014, to set up a platform for evaluating and synthesizing the results and findings from brain injury research in India.Materials and Methods:All published articles from India related to brain injury since 1966 to 2014 were retrieved from PubMed using the search for (“craniocerebral trauma”[MeSH Terms] OR (“craniocerebral”[All Fields] AND “trauma”[All Fields]) OR “craniocerebral trauma”[All Fields] OR (“head”[All Fields] AND “injury”[All Fields]) OR “head injury”[All Fields]) AND (“India”[MeSH Terms] OR “India”[All Fields]) A data base for variables like study type/category, year of publication, place of study institutes and departments to which the corresponding author belonged or where the study was conducted and the journal of publication was developed in FileMaker Pro 13 Advanced® software. Frequencies and percentages was obtained using R statistics software.Results:A total of 624 original research articles from India were reviewed. There was a substantial increase in the number of publications from 2006 (175) to 2014 (213). Eighty percent of studies were primary clinical observational type. Only 1.6% of studies were on animal experiments. Original research articles were about 55.8%. One fourth of the studies are prospective in nature. Researchers from 46 medical departments have been involved in publishing papers on traumatic brain injury. Among these, the neurosurgery department has published highest number of publications (262), followed by the forensic medicine (32) and the neurology (21). Many institutes from 22 states have contributed in brain injury research. Delhi alone had published nearly one-fourth (23%) of papers. Eleven states had published papers in collaboration with other countries. Papers were published both in national and international journals. Neurology India had published 20.6% of papers.Conclusion:There is rapid increase in publications since last decade with multi departmental integration and international collaborations. However with existing brain injury resources in our country much more research work at both basic and clinical level should be encouraged.

Consequences of hepatic damage after traumatic brain injury: current outlook and potential therapeutic targets.

Consequences of hepatic damage after traumatic brain injury: current outlook and potential therapeutic targets.

Is the pattern of dietary amino acids intake associated with serum lipid profile and blood pressure among individuals with spinal cord injury?

Objective: The probable effect of dietary amino acids intake pattern on serum lipid profile and blood pressure (BP) have not yet been described among individuals with spinal cord injury (SCI).Design: Cross-sectional.Setting: Tertiary rehabilitation center.Participants: People with SCI referred to Brain and Spinal Cord Injury Research Center between 2011 and 2014.Outcome measures: Dietary intakes were assessed by recording consumed foods by 24-hour dietary recall interviews using Nutritionist IV 3.5.3 modified for Iranian foods. Partial correlation test with adjustment for age, weight, body mass index, total energy intake, total fat, cholesterol and carbohydrate intake, and injury-related variables was used.Results: Dietary intake of lysine was positively related to levels of fasting plasma glucose (FPG), triglyceride (TG), systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P < 0.0001, 0.046, 0.002 and 0.009, respectively). There was a positive significant relationship between the intake of cysteine and levels of TG and SBP as well (P : 0.027 and 0.048, respectively). Higher intakes of threonine and leucine had a negative relationship with TG level (P : 0.001 and 0.026, respectively). Furthermore, tyrosine, threonine and leucine were inversely correlated to blood pressure. Total cholesterol level was only related to intake of threonine and leucine (P : 0.004 and 0.012, respectively). FPG was positively associated with intake of all amino acids except for cysteine, glutamic acid, threonine, leucine and histidine.Conclusion: In the present study, the pattern of relationships between dietary intake of amino acids and serum lipid profile and BP has been described among people with SCI.

Traumatic brain injury research highlights in 2015

Traumatic brain injury research highlights in 2015

Traumatic Brain Injury Research in Brazil: A Bibliometric Study

Traumatic brain injury (TBI) is responsible for high rates of morbidity and mortality, constituting an important public health problem throughout the world. Improving medical research on systemic trauma is a critical issue to understand its impact and develop strategies for prevention and treatment. This paper presents an overview of medical research performed in Brazil about TBI comparing it with the production on the same topic with other countries and with publications about different neurological and non-neurological diseases. It is possible to notice that Brazil has a deficiency in the scientific production on TBI given its importance. Greater integration between the research centers could help meliorate the production and quality of the papers and encourage further studies on the theme, in the quest to minimize the shortage of publications that can be seen today.

Bringing attention into higher focus within the traumatic brain injury research agenda.

Traumatic brain injury (TBI) holds a unique position within children’s health. It has been clear for decades that TBI is the leading cause of death and disability of children (1,2). However, only recently has the impact of TBI on developing brain gained the attention of the public and lay press due to the attention paid toward injuries in sports such as football, boxing and others. Guidelines for caring for children with mild (3-5) and severe (6) injuries have been assiduously developed from the available literature, yet the proven therapies have remained elusive. Recently, the National Institute of Neurological Disorders and Stroke (NINDS), the European Commission and the Canadian Institutes of Health Research have led (and funded) efforts to address the burden of TBI with the International Initiative for Traumatic Brain Injury Research (InTBIR) with the goal of “working together to improve outcomes and lessen the global burden of TBI by 2020” (7).

Potential Impact of a Validated Screening Tool for Pediatric Abusive Head Trauma

To conduct a retrospective, theoretical comparison of actual pediatric intensive care unit (PICU) screening for abusive head trauma (AHT) vs AHT screening guided by a previously validated 4-variable clinical prediction rule (CPR) in datasets used by the Pediatric Brain Injury Research Network to derive and validate the CPR. We calculated CPR-based estimates of abuse probability for all 500 patients in the datasets. Next, we demonstrated a positive and very strong correlation between these estimates of abuse probability and the overall diagnostic yields of our patients' completed skeletal surveys and retinal examinations. Having demonstrated this correlation, we applied mean estimates of abuse probability to predict additional, positive abuse evaluations among patients lacking skeletal survey and/or retinal examination. Finally, we used these predictions of additional, positive abuse evaluations to extrapolate and compare AHT detection (and 2 other measures of AHT screening accuracy) in actual PICU screening for AHT vs AHT screening guided by the CPR. Our results suggest that AHT screening guided by the CPR could theoretically increase AHT detection in PICU settings from 87%-96% (P < .001), and increase the overall diagnostic yield of completed abuse evaluations from 49%-56% (P = .058), while targeting slightly fewer, though not significantly less, children for abuse evaluation. Applied accurately and consistently, the recently validated, 4-variable CPR could theoretically improve the accuracy of AHT screening in PICU settings.

Our Experiences in Center-TBI Study

Introduction Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) represents a focused European effort to advance the care of patients with TBI, within the broader international framework. The Clinical Center of Vojvodina, Serbia, is the only medical center in the region currently actively participating in this project, where multidisciplinary professionals work hard 24/7 to contribute to the revolution in the TBI management and care guidelines.

Magnetic Resonance Spectroscopy for Traumatic Brain Injury.

Magnetic resonance spectroscopy (MRS) provides a noninvasive tool to assess metabolic change in the brain following head injury. Observable metabolites reflect neuronal density and viability, glial density, membrane injury, and hypoxia or ischemia. MRS has been used in traumatic brain injury (TBI) research for nearly 20 years and this article reviews the MRS findings in the adult TBI population.Although MRS observations are heterogeneous, there are consistent patterns in TBI with the neuronal metabolite N-acetyl-aspartate (NAA) significantly reduced in the vast majority of studies, while the membrane related choline signal (Cho) is almost equally found to be elevated. The glial metabolites myo-inositol is often observed to be increased postinjury and this elevation persists into the chronic phase, which is interpreted as revealing gliosis. Observation of elevated lactate levels are sporadic and mainly in acute studies in severely injured subjects. In general, these spectral changes show a dependency on injury severity and acute changes relate to both neuropsychological deficits and to long-term outcome.

Assessing Blood Brain Barrier Permeability in Traumatic Brain Injury Research

The blood brain barrier plays an important role in traumatic brain injury, serving at the crossroads of secondary injury and potential therapies. In regards to trauma, this barrier contains an array of cellular and molecular components that protect the central nervous system from derangements in water homeostasis and inflammation. Preclinical and clinical assays have been developed to describe and quantify blood brain barrier permeability in relation to the integrity of these blood brain barrier components and the handling of edema. This review will discuss both preclinical and clinical molecular and imaging techniques that are used to assess blood brain barrier function and recovery following traumatic brain injury.

Performance of Male and Female C57BL/6J Mice on Motor and Cognitive Tasks Commonly Used in Pre-Clinical Traumatic Brain Injury Research.

To date, clinical trials have failed to find an effective therapy for victims of traumatic brain injury (TBI) who live with motor, cognitive, and psychiatric complaints. Pre-clinical investigators are now encouraged to include male and female subjects in all translational research, which is of particular interest in the field of neurotrauma given that circulating female hormones (progesterone and estrogen) have been demonstrated to exert neuroprotective effects. To determine whether behavior of male and female C57BL6/J mice is differentially impaired by TBI, male and cycling female mice were injured by controlled cortical impact and tested for several weeks with functional assessments commonly employed in pre-clinical research. We found that cognitive and motor impairments post-TBI, as measured by the Morris water maze (MWM) and rotarod, respectively, were largely equivalent in male and female animals. However, spatial working memory, assessed by the y-maze, was poorer in female mice. Female mice were generally more active, as evidenced by greater distance traveled in the first exposure to the open field, greater distance in the y-maze, and faster swimming speeds in the MWM. Statistical analysis showed that variability in all behavioral data was no greater in cycling female mice than it was in male mice. These data all suggest that with careful selection of tests, procedures, and measurements, both sexes can be included in translational TBI research without concern for effect of hormones on functional impairments or behavioral variability.

Who Gets Head Trauma or Recruited in Mild Traumatic Brain Injury Research?

Mild traumatic brain injury (mTBI) is a public health problem. Outcome from mTBI is heterogeneous in part due to pre-injury individual differences that typically are not well described or understood. Pre-injury health characteristics of all consecutive patients (n=3023) who underwent head computed tomography due to acute head trauma in the emergency department of Tampere University Hospital, Finland, between August 2010 and July 2012 were examined. Patients were screened to obtain a sample of working age adults with no pre-injury medical or mental health problems who had sustained a "pure" mTBI. Of all patients screened, 1990 (65.8%) fulfilled the mTBI criteria, 257 (8.5%) had a more severe TBI, and 776 (25.7%) had a head trauma without obvious signs of brain injury. Injury-related data and participant-related data (e.g., age, sex, diagnosed diseases, and medications) were collected from hospital records. The most common pre-injury diseases were circulatory (39.4%-43.2%), neurological (23.7%-25.2%), and psychiatric (25.8%-27.5%) disorders. Alcohol abuse was present in 18.4%-26.8%. The most common medications were for cardiovascular (33.1%-36.6%), central nervous system (21.4%-30.8%), and blood clotting and anemia indications (21.5%-22.6%). Of the screened patients, only 2.5% met all the enrollment criteria. Age, neurological conditions, and psychiatric problems were the most common reasons for exclusion. Most of the patients sustaining an mTBI have some pre-injury diseases or conditions that could affect clinical outcome. By excluding patients with pre-existing conditions, the patients with known risk factors for poor outcome remain poorly studied.

Organotypic Hippocampal Slices as Models for Stroke and Traumatic Brain Injury.

Organotypic hippocampal slice cultures (OHSCs) have been used as a powerful ex vivo model for decades. They have been used successfully in studies of neuronal death, microglial activation, mossy fiber regeneration, neurogenesis, and drug screening. As a pre-animal experimental phase for physiologic and pathologic brain research, OHSCs offer outcomes that are relatively closer to those of whole-animal studies than outcomes obtained from cell culture in vitro. At the same time, mechanisms can be studied more precisely in OHSCs than they can be in vivo. Here, we summarize stroke and traumatic brain injury research that has been carried out in OHSCs and review classic experimental applications of OHSCs and its limitations.

Children and youth with 'unspecified injury to the head': implications for traumatic brain injury research and surveillance.

BackgroundThe case definition for traumatic brain injury (TBI) often includes ‘unspecified injury to the head’ diagnostic codes. However, research has shown that the inclusion of these codes leads to false positives. As such, it is important to determine the degree to which inclusion of these codes affect the overall numbers and profiles of the TBI population. The objective of this paper was to profile and compare the demographic and clinical characteristics, intention and mechanism of injury, and discharge disposition of hospitalized children and youth aged 19 years and under using (1) an inclusive TBI case definition that included ‘unspecified injury to the head’ diagnostic codes, (2) a restricted TBI case definition that excluded ‘unspecified injury to the head ‘diagnostic codes, and (3) the ‘unspecified injury to the head’ only case definition.MethodsThe National Ambulatory Care Reporting System and the Discharge Database from Ontario, Canada, were used to identify cases between fiscal years 2003/04 and 2009/10.ResultsThe rate of TBI episodes of care using the inclusive case definition for TBI (2,667.2 per 100,000) was 1.65 times higher than that of the restricted case definition (1,613.3 per 100,000). ‘Unspecified injury to the head’ diagnostic codes made up of 39.5 % of all cases identified with the inclusive case definition. Exclusion of ‘unspecified injury to the head’ diagnostic code in the TBI case definition resulted in a significantly higher proportion of patients in the intensive care units (p < .0001; 18.5 % vs. 22.2 %) and discharged to a non-home setting (p < .0001; 9.9 % vs. 11.6 %).ConclusionInclusion of ‘unspecified injury to the head’ diagnostic codes resulted in significant changes in numbers, healthcare use, and causes of TBI. Careful consideration of the inclusion of ‘unspecified injury to the head’ diagnostic codes in the case definition of TBI for the children and youth population is important, as it has implications for the numbers used for policy, resource allocation, prevention, and planning of healthcare services. This paper can inform future work on reaching consensus on the diagnostic codes for defining TBI in children and youth.

Cooling methodology: to influence or to control the temperature?

The 2010 Guidelines on cardiopulmonary resuscitation and post-resuscitation care, based on the landmark studies on therapeutic hypothermia, state that hypothermia can be induced and maintained with inexpensive means such as simple ice packs and/or wet towels [1]. Indeed there is no method that has proven superior for survival or good neurological outcome. However, this approach comes at the price of an increased burden on nursing staff and greater temperature fluctuations. Also such means do not allow active gradual and controlled rewarming. While effective in contributing to rapid cooling, simple and inexpensive means may result in greater temperature fluctuations and corresponding modifications in heart rate and electrolyte plasma concentrations. Notably this strategy requires close and constant supervision of nursing staff, a distraction from other important aspects of patient care. Several studies demonstrate that influencing patient temperature will not allow a steady maintenance phase, controlled rewarming and, most importantly, ensuring strict normothermia once rewarming is concluded in patients with evidence of persisting neurological injury [2,3]. In essence, rather than speed it is control that is most desirable. This one of the lessons learned from the recent Target Temperature Management Trial [4]. In this study a less selected population than previous trials was treated at either 33 or 36°C followed by strict normothermia with an automatic feedback device for temperature management. The study demonstrated an extremely high survival rate (approximately 50%) and good neurological outcome regardless of the temperature regimen. Managing temperature at 36°C may overcome many of the contraindications of therapeutic hypothermia at 33°C, but is at the same time more challenging and hardly feasible without automatic feedback devices. Post-rewarming fever is also difficult to manage. Fever is associated with poor outcome. Even if causation has not been proven, normothermia is currently a therapeutic objective of modern post-resuscitation care. Influencing temperature is not enough to ensure strict normothermia. In the Target Temperature Management trial, active temperature management was maintained for a minimum of 72 hours in unconscious patients. In other fields of application of hypothermia, such as traumatic brain injury treatment and research, protocols dictate prolonged temperature management and extremely slow controlled rewarming based on intracranial pressure. In conclusion, modern treatment protocols advocate management of temperature, and thus control rather than influence, just like strict management of other vital parameters, is considered a standard of care for the critically ill.

Chapter 2 traumatic brain injury research in military populations.

Traumatic brain injury (TBI) in all of its forms--blast, concussive, and penetrating--has been an unfortunate sequela of warfare since ancient times. The continued evolution of military munitions and armor on the battlefield, as well as the insurgent use of improvised explosive devices, has led to blast-related TBI whose long-term effects on behavior and cognition are not yet known. Advances in medical care have greatly increased survival from these types of injuries. Therefore, an understanding of the potential health effects of TBI is essential. This review focuses on specific aspects of military-related TBI. There exists a large body of literature reporting the environmental conditions, forces, and staging of injury. Many of these studies are focused on the neuropathology of TBI, due to blast overpressure waves, and the emergence of large numbers of mild blast-related TBI cases.