Journal of neurotrauma
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Journal of neurotrauma · Jun 2019
Multicenter Study Observational StudyThe Temporal Relationship of Mental Health Problems and Functional Limitations following mTBI: A TRACK-TBI and TED Study.
Mental health problems, such as depression and anxiety, are often associated with functional limitations after traumatic brain injury (TBI), prompting researchers to explore which of these TBI-related sequelae tends to precede the other. Past studies among patients with injuries ranging in severity have predominantly reported that functional impairments predict subsequent psychological concerns, rather than the other way around; however, it remains unclear whether this directionality holds for individuals with mild TBI (mTBI). The present study utilized a cross-lagged panel design within a structural equation modeling analytical framework to explore the longitudinal relationships of symptoms of depression and anxiety to functional status among 717 adult mTBI patients, with assessments occurring at 2 weeks and 3 months post-injury. ⋯ This pattern was particularly pronounced among patients with normal head computed tomography (CT) results; however, results were less clear cut among those subjects whose injuries were accompanied by intracranial abnormalities detected on CT imaging, suggesting the possibility of a more reciprocal relationship in the case of CT-positive mTBI. These results may serve to partially explain the incidence of persistent functional limitations observed among subsets of mTBI patients in past studies. Findings likewise highlight the importance of assessment and treatment for mental health problems after mTBI as an important factor to promote psychological well-being and functional recovery.
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Journal of neurotrauma · Jun 2019
Downstream TRPM4 Polymorphisms are associated with Intracranial Hypertension and Statistically Interact with ABCC8 Polymorphisms in a Prospective Cohort of Severe Traumatic Brain Injury.
Sulfonylurea-receptor-1(SUR1) and its associated transient-receptor-potential cation channel subfamily-M (TRPM4) channel are key contributors to cerebral edema and intracranial hypertension in traumatic brain injury (TBI) and other neurological disorders. Channel inhibition by glyburide is clinically promising. ABCC8 (encoding SUR1) single-nucleotide polymorphisms (SNPs) are reported as predictors of raised intracranial pressure (ICP). ⋯ Both clustered downstream, spanning a region encoding the channel pore and interacting with SUR1. If validated, this may guide risk stratification and eventually inform treatment-responder classification for SUR1-TRPM4 inhibition in TBI. Larger studies are warranted.
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Journal of neurotrauma · Jun 2019
Continuous Thermal Diffusion-Based Cerebral Blood Flow Monitoring in Adult Traumatic Brain Injury: A Scoping Systematic Review.
Thermal diffusion flowmetry (TDF) is an appealing candidate for monitoring of cerebral blood flow (CBF) in neurocritical-care patients as it provides absolute measurements with a high temporal resolution, potentially allowing for bedside intervention that could mitigate secondary injury. We performed a systematic review of TDF-regional(r)CBF measurements and their association with (1) patient functional outcome, (2) other neurophysiological parameters, and (3) imaging-based tissue outcomes. We searched MEDLINE, EMBASE, SCOPUS, BIOSIS, GlobalHealth, and the Cochrane Databases from inception to October 2018 and relevant conference proceedings published over the last 5 years. ⋯ In conclusion, despite being based on a relatively weak body of evidence, the available literature suggests a link between consistently abnormal TDF-rCBF values, intracranial hypertension, and poor functional outcome. TDF-rCBF also appears to correlate well with regional measurements of brain tissue oxygenation. Currently, such monitoring should be considered experimental, requiring much further evaluation prior to widespread adoption.
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Journal of neurotrauma · Jun 2019
Automatic quantification of CT features in Acute Traumatic Brain Injury.
Traumatic brain injury is a complex and diverse medical condition with a high frequency of intracranial abnormalities. These can typically be visualized on a computed tomography (CT) scan, which provides important information for further patient management, such as the need for operative intervention. In order to quantify the extent of acute intracranial lesions and associated secondary injuries, such as midline shift and cisternal compression, visual assessment of CT images has limitations, including observer variability and lack of quantitative interpretation. ⋯ Median volume differences between expert assessments and icobrain are 0.07 mL for acute intracranial lesions and -0.01 mL for cistern segmentation. Correlation between expert assessments and icobrain is 0.91 for volume of acute intracranial lesions and 0.94 for volume of the cisterns. For midline shift computations, median error is -0.22 mm, with a correlation of 0.93 with expert assessments.
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Journal of neurotrauma · Jun 2019
Comparative StudyA Comparison of Youth Flag and Tackle Football Head Impact Biomechanics.
Our purpose was to describe the youth flag football head impact burden and make comparisons with youth tackle football. Head impact frequency and magnitude (linear acceleration [g], rotational acceleration [rad/s2]) were collected from 25 tackle and 25 flag youth football players over one season. Athlete exposure (AE) was defined as one player participating in one session. ⋯ Our preliminary sample of youth flag football players sustained less frequent head impacts at higher rotational accelerations than tackle football players. Flag football is considered a limited-contact sport, but little is known about the true head impact burden. Our findings may be important for policymakers when debating potential changes to youth football participation.