Journal of neurotrauma
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Journal of neurotrauma · Dec 2017
Observational StudyImpact of Blood Pressure, Lesion level and Physical Activity on Aortic Augmentation Index in Persons with SCI.
Individuals with chronic spinal cord injury (SCI) are at a heightened risk of cardiovascular disease (CVD) resulting from autonomic nervous system dysfunction, physical inactivity, and increased inflammatory processes. Arterial stiffness (AS) is recognized as an independent risk factor for CVD and, specifically, pulse wave analysis (PWA) has proven to be a useful tool to predict and track structural arterial changes that reflect arteriosclerosis. The augmentation index (AI) can be used to estimate AS and is derived from the amplitude and timing of the blood pressure (BP) wave reflection in a peripheral artery. ⋯ The association between age and AI was not significant in the SCI population; however, there was a direct association between AI and level of injury. Further, AI was inversely associated with seated systolic blood pressure (SBP) and was increased in individuals who reported orthostatic hypotension (OH) and in those who were physically inactive. In conclusion, individuals with higher cord lesions have more severe cardiovascular autonomic disruption, leading to orthostatic BP dysregulation and physical inactivity, which appear to contribute independently to increased AS in these individuals.
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Journal of neurotrauma · Dec 2017
Systemic Administration of Exosomes Released from Mesenchymal Stromal Cells Attenuates Apoptosis, Inflammation and Promotes Angiogenesis after Contusion Spinal Cord Injury in Rats.
Spinal cord injury (SCI) is one of the most common devastating injuries, which causes permanent disabilities such as paralysis and loss of movement or sensation. The precise pathogenic mechanisms of the disease remain unclear, and, as of yet, there is no effective cure. Mesenchymal stem cells (MSCs) show promise as an effective therapy in the experimental models of SCI. ⋯ Expression levels of proapoptotic protein (Bcl-2-associated X protein) and proinflammatory cytokines (tumor necrosis factor alpha and interleukin [IL]-1β) were significantly decreased after MSCs-exosomes treatment, whereas expression levels of antiapoptotic (B-cell lymphoma 2) and anti-inflammatory (IL-10) proteins were upregulated. Further, administration of MSCs-exosomes significantly promoted angiogenesis. These results show, for the first time, that systemic administration of MSCs-exosomes attenuated cell apoptosis and inflammation, promoted angiogenesis, and promoted functional recovery post-SCI, suggesting that MSCs-exosomes hold promise as a novel therapeutic strategy for treating SCI.
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Journal of neurotrauma · Dec 2017
Risk Factors for Mild Traumatic Brain Injury and Subsequent Post-traumatic Stress Disorder and Mental Health Disorders among US Army Soldiers.
The purpose of this study was to determine the association of mild traumatic brain injury (mTBI) with subsequent post-traumatic stress disorder (PTSD) and mental health disorders (MHD), and the intervening role of acute stress disorder (ASD). This matched case-control study utilized the Total Army Injury and Health Outcomes Database (TAIHOD) to analyze soldiers' (n = 1,261,297) medical encounter data between 2002 and 2011. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to identify: mTBI (following Centers for Disease Control [CDC] surveillance definition for mTBI), MHD (ICD-9 codes for depression and anxiety, excluding PTSD), PTSD (ICD-9 309.81), and ASD (ICD-9 308.3). ⋯ A sub-analysis of the mTBI-only soldiers found that a diagnosis ASD, compared with a diagnosis of no ASD, was associated with greater risk for subsequent PTSD (RR 2.13, 95% CI 1.96-2.32) and MHD (RR 1.90, 95% CI 1.72-2.09) following mTBI. Results indicate that soldiers with previous mTBI have a higher risk for PTSD and MHD, and that ASD may also mediate PTSD and MHD risk subsequent to mTBI. These data may help guide important surveillance and clinical rehabilitation considerations for high-risk populations.
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Journal of neurotrauma · Dec 2017
Prefrontal cortical thickening after mild traumatic brain injury: a 1-year MRI study.
The objective of this study was to evaluate group-by-time interactions between gray matter morphology of healthy controls and that of patients with mild traumatic brain injury (mTBI) as they transitioned from acute to chronic stages, and to relate these findings to long-term cognitive alterations to identify distinct recovery trajectories between good outcome (GO) and poor outcome (PO). High-resolution T1-weighted magnetic resonance images were acquired in 49 mTBI patients within 7 days and 1 year post-injury and at equivalent times in 49 healthy controls. Using linear mixed-effects models, we performed mass-univariate analyses and associated the results of the interaction with changes in cognitive performance. ⋯ Thickness of the prefrontal cortex is subject to structural alterations during the first year after mTBI. Beside beneficial neuroplasticity, a prolonged state of neuroinflammation for symptomatic patients (maladaptive neuroplasticity) cannot be excluded. If the underlying cellular processes responsible for cortical thickening following mTBI have been determined, brain stimulation or even pharmacological intervention targeting the prefrontal cortex might promote endogenous neural restoration.
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Journal of neurotrauma · Dec 2017
The association between dual-task gait after concussion and prolonged symptom duration.
Quantitative gait measurements can identify persistent postconcussion impairments. However, their prognostic utility after injury to identify the likelihood of prolonged concussion symptoms remains unknown. Our objective was to examine if dual-task gait performance measures are independently associated with persistent (> 28 days) concussion symptoms among a sample of athletes. ⋯ After adjusting for potential confounding variables, greater dual-task average gait speed costs were independently associated with prolonged symptom duration (aOR = 0.908; 95% CI = 0.835-0.987). Examinations of dual-task gait may provide useful information during multifaceted concussion examinations. Quantitative assessments that simultaneously test multiple domains, such as dual tasks, may be clinically valuable after a concussion to identify those more likely to experience symptoms for >28 days after injury.