Journal of neurotrauma
-
Journal of neurotrauma · Oct 2017
Head Impact Density: A model to explain the elusive concussion threshold.
Concussion is a heterogeneous injury occurring throughout a range of impact magnitudes. Consequently, research focusing on a single or set of variables at the time of injury to understand concussive biomechanics has been thwarted by low injury prediction sensitivity. The current study examined the role of Impact Density in estimating concussive injury risk. ⋯ The measure of Impact Density, however, revealed differences between the Concussed and Control athletes. These data suggest that the biomechanical threshold for concussion fluctuates downwardly with a greater impact magnitude and number with a return to pre-impact levels with time, suggesting physiological vulnerability to repeated head impacts. The current results highlight that time between impacts, not just impact magnitude, influences risk for concussion.
-
Journal of neurotrauma · Oct 2017
Does normobaric hyperoxia cause oxidative stress in the injured brain? A microdialysis study using 8-iso-PGF2α as a biomarker.
Significant controversy exists regarding the potential clinical benefit of normobaric hyperoxia (NBO) in patients with traumatic brain injury (TBI). This study consisted of two aims: 1) to assess whether NBO improves brain oxygenation and metabolism and 2) to determine whether this therapy may increase the risk of oxidative stress (OxS), using 8-iso-Prostaglandin F2α (PGF2α) as a biomarker. Thirty-one patients with a median admission Glasgow Coma Scale score of 4 (min: 3, max: 12) were monitored with cerebral microdialysis and brain tissue oxygen sensors and treated with fraction of inspired oxygen (FiO2) of 1.0 for 4 h. ⋯ In the five patients with brain lactate concentration ([Lac]brain) > 3.5 mmol/L at baseline, NBO induced a marked reduction in both [Lac]brain and lactate-to-pyruvate ratio. Although these differences were not statistically significant, together with the results of our previous study, they suggest that TBI patients would benefit from receiving NBO when they show indications of disturbed brain metabolism. These findings, in combination with increasing evidence that TBI metabolic crises are common without brain ischemia, open new possibilities for the use of this accessible therapeutic strategy in TBI patients.
-
Journal of neurotrauma · Oct 2017
The 5th Annual One Mind Summit: Lessons Learned About "Science Informing Brain Health Policies and Practice".
Advances in science frequently precede changes in clinical care by several years or even decades. To better understand the path to translation, we invited experts to share their perspectives at the 5th Annual One Mind Summit: "Science Informing Brain Health Policies and Practice," which was held on May 24-25, 2016, in Crystal City, VA. ⋯ The Summit identified key steps, including the need for professional endorsement and clinical guidelines or policies, acceptance by regulators and payers, dissemination and training for clinicians, patient advocacy, and learning healthcare models. The path to implementation was discussed broadly, as well as in the context of a specific project to implement concussion screening in emergency and urgent care centers throughout the United States.
-
Journal of neurotrauma · Oct 2017
Recovery from coma post-cardiac arrest is dependent on the orexin pathway.
Cardiac arrest (CA) affects >550,000 people annually in the United States whereas 80-90% of survivors suffer from a comatose state. Arousal from coma is critical for recovery, but mechanisms of arousal are undefined. Orexin-A, a hypothalamic excitatory neuropeptide, has been linked to arousal deficits in various brain injuries. ⋯ This is of considerable clinical interest given that suvorexant recently received U. S. Food and Drug Administration approval for insomnia treatment.
-
Journal of neurotrauma · Oct 2017
Bone marrow-derived endothelial progenitor cell treatment in a model of lateral fluid percussion injury in rats: Evaluation of acute and subacute outcome measures.
Traumatic brain injury (TBI) continues to be a serious health care issue while therapies to treat TBI remain elusive. Promising results from the use of endothelial progenitor cells (EPCs) in numerous disease states highlight the pleiotropic capacity of this cell type. We have previously demonstrated that EPC-conditioned media reduces axonal degeneration subsequent to in vitro oxygen-glucose deprivation insult and concurrently improves white matter and microvascular outcome in vivo after mid-line fluid percussion injury. ⋯ Behavioral testing using the Morris Water Maze and rotarod demonstrated significant improvement in locomotor function, as measured by the rotarod task, but no significant differences in spatial memory ability. The data suggest that EPCs contribute to improvements in the early phase of secondary injury through inhibition of apoptosis whereas the effects on longer-term recovery were less clearly defined. There is potential in the use of EPCs to treat secondary injury post-TBI; however, optimization of their effects through increased duration or homing capacities remains to be examined.