Journal of neurotrauma
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Journal of neurotrauma · Oct 2013
A Prospective Evaluation of the Temporal Matrix Metalloproteinase Response after Severe Traumatic Brain Injury in Humans.
Abstract Accumulating pre-clinical data suggests that matrix metalloproteinase (MMP) expression plays a critical role in the pathophysiology of secondary brain injury. We conducted a prospective multimodal monitoring study in order to characterize the temporal MMP response after severe traumatic brain injury (TBI) in eight critically ill humans and its relationship with outcomes. High-cutoff, cerebral microdialysis (n=8); external ventricular drainage (n=3); and arterial and jugular venous bulb catheters were used to collect microdialysate, cerebrospinal fluid, and arterial and jugular bulb blood over 6 days. ⋯ Mean microdialysate levels of MMP-8 also rose with increasing intracranial pressure (ICP), whereas those of MMP-7 decreased with increasing cerebral perfusion pressure (CPP). Significant changes in the mean microdialysate concentrations of MMP-1, -2, -3, and -9 and MMP-1, -2, -3, -7, and -9 also occurred with increases in microdialysate glucose and the lactate/pyruvate ratio, respectively. These results imply that monitoring of MMPs following severe TBI in humans is feasible, and that their expression may be associated with clinical outcomes, ICP, CPP, and cerebral metabolism.
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Journal of neurotrauma · Oct 2013
Trend and Geographic Analysis for Traumatic Brain Injury Mortality and Cost Based on MarketScan Database.
The objective of the current research was to examine the current epidemiology of traumatic brain injury (TBI); to determine the effects of geographic region, co-morbidities, year of injury, injury severity, and demographics on hospital costs, length of stay (LOS), and mortality. All subjects were drawn from the Thomason Reuters MarketScan(®) database. Statistical methods used included descriptive analysis, bivariate analysis, logistic regression, and the Geographic Information System (GIS) software, ArcMap. ⋯ Both overall mortality and median LOS have remained relatively stable over the years. Hospital cost, however, has increased for the elderly population even after accounting for the inflation. There is significant geographic variation for both mortality and hospital costs.
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Journal of neurotrauma · Oct 2013
Complexity Analysis of Resting State Magnetoencephalography Activity in Traumatic Brain Injury Patients.
Diagnosis of mild traumatic brain injuries (TBIs) has been difficult because of the absence of obvious focal brain lesions, using conventional computed tomography (CT) or magnetic resonance imaging (MRI) scans, in a large percentage of TBIs. One useful measure that can characterize potential tissue and neural network damage objectively is Lempel-Ziv complexity (LZC) applied to magnetoencephalography (MEG) signals. LZC is a model-independent estimator of system complexity that estimates the number of different patterns in a sequence. ⋯ Resting state MEG data were acquired, and the LZCs were analyzed across the whole brain. Our results indicated reduced complexity in multiple brain areas in TBI patients relative to the healthy controls. In addition, we detected several neuropsychological measures associated with motor responses, visual perception, and memory, correlated with LZC, which likely explains some of the cognitive deficits in TBI patients.
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Journal of neurotrauma · Oct 2013
Working Memory and Corpus Callosum Microstructural Integrity after Pediatric Traumatic Brain Injury: A Diffusion Tensor Tractography Study.
Deficits in working memory (WM) are a common consequence of pediatric traumatic brain injury (TBI) and are believed to contribute to difficulties in a range of cognitive and academic domains. Reduced integrity of the corpus callosum (CC) after TBI may disrupt the connectivity between bilateral frontoparietal neural networks underlying WM. In the present investigation, diffusion tensor imaging (DTI) tractography of eight callosal subregions (CC1-CC8) was examined in relation to measures of verbal and visuospatial WM in 74 children sustaining TBI and 49 typically developing comparison children. ⋯ DTI metrics, especially radial diffusivity, in predictive callosal subregions accounted for significant variance in WM over and above remaining callosal subregions. Reduced microstructural integrity of the CC, particularly in subregions connecting parietal and temporal cortices, may act as a neuropathological mechanism contributing to long-term WM deficits. The future clinical use of neuroanatomical biomarkers may allow for the early identification of children at highest risk for WM deficits and earlier provision of interventions for these children.
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Journal of neurotrauma · Oct 2013
Serum Brain Biomarker Level, Neurocognitive Performance, and Self-Reported Symptom Changes in Soldiers Repeatedly Exposed to Low-Level Blast: A Breacher Pilot Study.
"Breachers" are a unique military and law enforcement population because they are routinely exposed to low-level blast (LLB) during training and operations. This repeated exposure has been associated with symptoms similar to that of sports concussion. This study examined effects of repeated exposure to LLB during an explosive entry course. ⋯ The difference between individuals expressing the highest biomarker load during breacher training (Top 5) and those with the lowest biomarker load (Bottom 5) is reflected in neurocognitive performance deficits and self-reported symptoms. This suggests a measureable degree of brain perturbation linked to LLB exposure. Follow-up studies are underway to expand upon these results.