Journal of neurotrauma
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Journal of neurotrauma · Nov 2014
Bilateral Contusion-Compression Model of Incomplete Traumatic Cervical Spinal Cord Injury (SCI).
Despite the increasing incidence and prevalence of cervical spinal cord injury (cSCI), we lack clinically relevant animal models that can be used to study the pathomechanisms of this injury and test new therapies. Here, we characterize a moderate cervical contusion-compression model in rats that is similar to incomplete traumatic cSCI in humans. We characterized the effects of 18-g clip-compression injury at cervical level C6 over an 8-week recovery period. ⋯ Sensory-evoked potentials recorded from the forelimb and Hoffman reflex recorded from the hindlimb confirmed the fore- and hindlimb deficits observed in our neurobehavioral analysis. Here, we have characterized a clip-compression model of incomplete cSCI that closely models this condition in humans. This work directly addresses the current lack of clinically relevant models of cSCI and will thus contribute to improved success in the translation of putative therapies into the clinic.
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Journal of neurotrauma · Oct 2014
Comparative StudyPredicting outcome after traumatic brain injury: development of prognostic scores based on the IMPACT and the APACHE II.
Prediction models are important tools for heterogeneity adjustment in clinical trials and for the evaluation of quality of delivered care to patients with traumatic brain injury (TBI). We sought to improve the predictive performance of the IMPACT (International Mission for Prognosis and Analysis of Clinical Trials) prognostic model by combining it with the APACHE II (Acute Physiology and Chronic Health Evaluation II) for 6-month outcome prediction in patients with TBI treated in the intensive care unit. A total of 890 patients with TBI admitted to a large urban level 1 trauma center in 2009-2012 comprised the study population. ⋯ Internal validation using split-sample and resample bootstrap techniques yielded equivalent results, indicating low grade of overestimation. Our findings show that by combining the APACHE II with the IMPACT, improved 6-month outcome predictive performance is achieved. This may be applicable for heterogeneity adjustment in forthcoming TBI studies.
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Journal of neurotrauma · Oct 2014
CCR2 deficiency impairs macrophage infiltration and improves cognitive function after traumatic brain injury.
Traumatic brain injury (TBI) provokes inflammatory responses, including a dramatic rise in brain macrophages in the area of injury. The pathway(s) responsible for macrophage infiltration of the traumatically injured brain and the effects of macrophages on functional outcomes are not well understood. C-C-chemokine receptor 2 (CCR2) is known for directing monocytes to inflamed tissues. ⋯ These data demonstrate that Ccr2 directs the majority of macrophage homing to the brain early after TBI and indicates that Ccr2 may facilitate harmful responses. Lack of Ccr2 improves functional recovery and neuronal survival. These results suggest that therapeutic blockade of CCR2-dependent responses may improve outcomes following TBI.
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Journal of neurotrauma · Oct 2014
Neurocognition in the emergency department following a mild traumatic brain injury in youth.
Abstract The early cognitive effects from a mild traumatic brain injury (mTBI) are poorly understood in youth. The aim of this study was to examine acute neurocognitive functioning in children and adolescents who presented to the emergency department (ED) after an mTBI. Youth 8-17 years of age with an mTBI (n=77; mean age, 13.6 years; 95% confidence interval [CI], 13.0-14.2) and an orthopedic injury control (OIC) group (n=28; mean age, 13.9 years; 95% CI, 13.1-14.7) underwent a very brief computerized neurocognitive assessment (four subtests from CNS Vital Signs) in a pediatric trauma hospital ED. ⋯ Further, cognitive functioning appears to worsen as more time passes since the mTBI. Neurocognitive deficits are detectable in youth with an mTBI who present to the ED, despite having a Glasgow Coma Scale score of 15/15 and normal neuroimaging (or their presentation does not warrant neuroimaging). Their profile appears to include preserved accuracy on cognitive measures, but at the expense of slower psychomotor speed and longer reaction time.
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Journal of neurotrauma · Oct 2014
Comparative StudyDoes isolated traumatic subarachnoid hemorrhage merit a lower intensity level of observation than other TBI?
Evidence is emerging that isolated traumatic subarachnoid hemorrhage (ITSAH) may be a milder form of traumatic brain injury (TBI). If true, ITSAH may not benefit from intensive care unit (ICU) admission, which would, in turn, decrease resource utilization. We conducted a retrospective review of all TBI admissions to our institution between February 2010 and November 2012 to compare the presentation and clinical course of subjects with ITSAH to all other TBI. ⋯ Our results suggest that ITSAH are less-severe brain injuries than other TBI. ITSAH patients with GCS scores of 13-15 demonstrate low rates of clinical progression, and when progression occurs, it resolves without further intervention. This subset of TBI patients does not appear to benefit from ICU admission.