Journal of neurotrauma
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Journal of neurotrauma · Jan 2018
Psychosocial and executive function recovery trajectories one year after pediatric traumatic brain injury: the influence of age and injury severity.
Time since traumatic brain injury (TBI) and developmental stage at injury may affect the trajectory of outcomes associated with adjustment and school success. We prospectively enrolled a cohort of 519 children with either TBI or orthopedic injury (OI) age 2.5-15 years to examine children's psychosocial and executive function outcomes at 3- and 12-months post-injury. Outcome measures included the Child Behavior Checklist (CBCL), Strengths and Difficulties Questionnaire (SDQ), and Behavior Rating Inventory of Executive Function (BRIEF) ratings. ⋯ Hispanic ethnicity and strong social capital were positively associated with multiple outcomes. Children's recovery trajectories differed by injury severity, time since injury, and developmental stage when injured. Schools need to reassess children's skills over time as new problems in behavior and learning may emerge.
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Journal of neurotrauma · Jan 2018
ReviewMedusa's Head: The Complement System in Traumatic Brain and Spinal Cord Injury.
Traumatic brain injury (TBI) and spinal cord injury (SCI) are critical medical conditions and a public health problem for which limited therapeutic options are available. The complement cascade is activated after TBI and SCI, and the resulting effects have been investigated in gene-knockout and pharmacological models. ⋯ The role of upstream classical, alternative, or extrinsic complement activation cascades remains unclear. Although several issues remain to be investigated, current evidence supports the investigation of a number of complement-targeting agents targeting C3 or C5, such as eculizumab, for repurposing in TBI and SCI treatment.
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Journal of neurotrauma · Jan 2018
Randomized Controlled Trial Multicenter StudyCause and timing of death and sub-group differential effects of erythropoietin in the EPO-TBI study.
The EPO-TBI study randomized 606 patients with moderate or severe traumatic brain injury (TBI) to be treated with weekly epoetin alfa (EPO) or placebo. Six month mortality was lower in EPO treated patients in an analysis adjusting for TBI severity. Knowledge of possible differential effects by TBI injury subtype and acute neurosurgical treatment as well as timing and cause of death (COD) will facilitate the design of future interventional TBI trials. ⋯ However, EPO appeared more effective in patients with an injury type not requiring a neurosurgical operation prior to intensive care unit (ICU) admission (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.14-0.61, p = 0.001, p for interaction = 0.003) and in this subgroup, fewer patients died of cerebral causes in the EPO than in the placebo group (5% compared with 14%, p = 0.03). In conclusion, most TBI deaths were from cerebral causes that occurred during the first 2 weeks, and were related to withdrawal of care. EPO appeared to specifically reduce cerebral deaths in the important subgroup of patients with a diffuse type of injury not requiring a neurosurgical intervention prior to randomization.
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Journal of neurotrauma · Jan 2018
A systematic review of psychological interventions for sleep and fatigue after mild traumatic brain injury.
This review evaluated the evidence for psychological interventions to improve sleep and reduce fatigue after mild traumatic brain injury (mTBI). Eight electronic databases were searched up until August 2016 for studies that: 1) included adults; 2) tested intervention effectiveness on sleep quality and fatigue post-acutely; and 3) applied a broadly-defined psychological intervention (e.g., cognitive behavioral therapy [CBT], counseling, or education). Only randomized controlled trials were eligible for inclusion. ⋯ All but one study targeted general post-concussion symptoms rather than sleep or fatigue specifically. This runs the risk that the potential benefits of a targeted approach are underestimated in this literature, and future sleep- and fatigue-focused interventions are recommended. It is tentatively concluded that compared with standard care or the provision of generic advice, small improvements in sleep and fatigue are observed through psychological intervention post-mTBI.
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Journal of neurotrauma · Jan 2018
SKELETAL MUSCLE ATROPHY AND DEGENERATION IN A MOUSE MODEL OF TRAUMATIC BRAIN INJURY.
Atrophy is thought to be a primary mode of muscle loss in neuromuscular injuries. The differential effects of central and peripheral injuries on atrophy and degeneration/regeneration in skeletal muscle tissue have not been well described. This study investigated skeletal muscle atrophy and degeneration/regeneration in an animal model of traumatic brain injury (TBI). ⋯ Injured soleus FAs were smaller than sham soleus (p = 0.02) and injured TA (p < 0.001). Mean CNs were higher in the TBI-injured TA than in other muscles. Differential TBI-induced atrophy and degeneration/regeneration in lower limb muscles suggests that muscle responses to cortical injury involve more complex changes than those observed with simple disuse atrophy.