Journal of neurotrauma
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Journal of neurotrauma · Apr 2012
Randomized Controlled TrialCerebral microdialysis effects of propofol versus midazolam in severe traumatic brain injury.
Propofol, an anesthetic agent acting as an analogue of vitamin E, has been advocated to be an ideal neuroprotective agent both in animal models and in clinical practice, due to its positive effects on oxidative stress. Nevertheless, no studies have compared this agent to another sedative agent used for sedation after traumatic brain injury (TBI). The objective was to compare the effects of propofol to midazolam on cerebral biomarkers at the acute phase of severe TBI patients. ⋯ No difference between groups was observed for the L:P ratio (time effect p=0.201, treatment effect p=0.401, time×treatment interaction p=0.101). Similarly, no difference was observed for glutamate (time effect p=0.930, treatment effect p=0.651, time×treatment interaction p=0.353), glycerol (time effect p=0.223, treatment effect p=0.922, time×treatment interaction p=0.308), or glucose (time effect p=0.116, treatment effect p=0.088, time×treatment interaction p=0.235). These results do not support a difference between propofol and midazolam for sedation for the cerebral metabolic profile in severe TBI.
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Journal of neurotrauma · Apr 2012
Psychiatric disorders and health-related quality of life after severe traumatic brain injury: a prospective study.
Traumatic brain injury (TBI) is a major cause of death and disability and impairs health-related quality of life (HRQOL). Psychiatric disorders have been recognized as major components of TBI morbidity, yet few studies have addressed the relationship between these outcomes. Sample size, selection bias, and retrospective design, are methodological limitations for TBI-related psychiatric studies. ⋯ In comparison to patients without personality changes, patients with personality changes experienced a decline in general health and impairments in physical and social functioning. Patients with MDD showed impairment in all SF-36 domains compared to non-depressed patients. This prospective TBI-related psychiatric study is the first to demonstrate a significant association between MDD, personality changes, and HRQOL, following severe TBI in a well-defined sample of patients.
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Journal of neurotrauma · Apr 2012
Clinical TrialReconstruction of cranial defects with individually formed cranial prostheses made of polypropylene polyester knitwear: an analysis of 48 consecutive patients.
This article presents a new method of cranioplasty in which polypropylene polyester knitwear was used as the filling material. The basis for prosthesis shaping was a three-dimensional model of the defect made according to the patient's CT scans. Previously, such material has never been a subject of computer-aided design and computer-aided manufacturing (CAD/CAM) individual forming. ⋯ The coverage and the aesthetic results were very good in all cases. Two patients had postoperative complications. The cranioplastic solution described here is a valuable addition to the existing reconstructive methods, because of the low cost of the implant, the ease of its adjustment to the shape of the defect, and the short time of preparation.
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Journal of neurotrauma · Apr 2012
Mild traumatic brain injury is associated with impaired hippocampal spatiotemporal representation in the absence of histological changes.
Mild traumatic brain injury (mTBI) accounts for the majority of head trauma cases. Despite some lasting cognitive, emotional, and behavioral deficits, there are frequently no overt morphological defects, suggesting that changes may result from alterations in the physiology of individual neurons. We investigated hippocampal neural activity in rats during a working memory task to determine the effect of mTBI on cellular physiology. ⋯ Examination of single-neuron spiking activity revealed no significant difference in firing rates or spike characteristics, but rats exposed to mTBI were found to have significantly fewer cells with activity spatiotemporally correlated with location in the maze ("task-specific cells," p<0.05 by Fisher's exact test). Memory deficits, including disorganized patterns of hippocampal neural activity after mTBI, were seen in rats. Because it is seen in the absence of clear morphological defects, these data suggest that functional impairment after mTBI may result from alterations in the activity of individual neurons.
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Journal of neurotrauma · Apr 2012
Validity of a pediatric version of the Glasgow Outcome Scale-Extended.
The Glasgow Outcome Scale (GOS) and its most recent revision, the GOS-Extended (GOS-E), provide the gold standard for measuring traumatic brain injury (TBI) outcome. The GOS-E exhibits validity when used with adults and some adolescents, but validity with younger children is not established. Because the GOS-E lacks the developmental specificity necessary to evaluate children, toddlers, and infants, we modified the original version to create the GOS-E Pediatric Revision (GOS-E Peds), a developmentally appropriate structured interview, to classify younger patients. ⋯ The GOS-E Peds is sensitive to severity of injury and is associated with changes in TBI sequelae over time. This pediatric revision provides a valid outcome measure in infants, toddlers, children, and adolescents through age 16. Findings support using the GOS-E Peds as the primary outcome variable in pediatric clinical trials.