Journal of neurotrauma
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Traumatic brain injuries (TBI) impose a significant burden on the health care system. The aim of the current study was to explore variation in costs in a group of rehabilitation patients in Victoria, Australia, following complicated mild-to-severe TBI treated under the accident compensation system administered by the Transport Accident Commission. Study participants included 1237 individuals with mild-to-severe TBI recruited consecutively from a TBI rehabilitation program. ⋯ Higher hospital and medical costs were associated with these factors, but also with other physical injuries, lower education, pre-injury unemployment, living outside the city, speaking English at home, and, in the case of medical costs, older age and having had pre-injury psychiatric treatment. Higher paramedical costs were associated with most of these variables, but also with being employed prior to injury and being female. In line with the multifaceted nature of TBI, the current findings suggest that both injury-related and demographic factors determine costs following injury.
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Journal of neurotrauma · Sep 2013
Rehabilitation outcome of unconscious traumatic brain injury patients.
Outcome prediction of traumatic brain injury (TBI) patients with severe disorders of consciousness (DOC) at the end of their time in an intensive care setting is important for clinical decision making and counseling of relatives, and constitutes a major challenge. Even the question of what constitutes an improved outcome is controversially discussed. We have conducted a retrospective cohort study for the rehabilitation dynamics and outcome of TBI patients with DOC. ⋯ In conclusion, despite a strong negative selection, a substantial proportion of severe TBI patients with DOC achieve functional improvements or at least emerge from MCS within the inpatient rehabilitation phase. In order to avoid self-fulfilling prophecies in decision making, it is important to be aware of the fact that the beginning of clinical improvement may take several months after brain injury. In this study, separation of both of the functional outcome groups started by 7 weeks post-injury.
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Journal of neurotrauma · Sep 2013
17β-estradiol confers protection after traumatic brain injury in the rat and involves activation of g protein-coupled estrogen receptor 1.
Abstract Traumatic brain injury (TBI) is a significant public health problem in the United States. Despite preclinical success of various drugs, to date all clinical trials investigating potential therapeutics have failed. Recently, sex steroid hormones have sparked interest as possible neuroprotective agents after traumatic injury. ⋯ We also report a significant reduction in astrogliosis in the ipsilateral cortex, hilus, and CA 2/3 region of the hippocampus. Finally, these effects were observed to be chiefly dose-dependent for E2, with the 5 mg/kg dose generating a more robust level of protection. Our findings further elucidate estrogenic compounds as a clinically relevant pharmacotherapeutic strategy for treatment of secondary injury following TBI, and intriguingly, reveal a novel potential therapeutic target in GPER.
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Journal of neurotrauma · Sep 2013
Long-term in vivo imaging of viscoelastic properties of the mouse brain after controlled cortical impact.
Traumatic brain injury (TBI) presents a variety of causes and symptoms, thus making the development of reliable diagnostic methods and therapeutic treatments challenging. Magnetic resonance elastography (MRE) is a technique that allows for a noninvasive assessment of the mechanical properties of soft biological tissue, such as tissue stiffness, storage modulus, and loss modulus. Importantly, by quantifying the changes in the stiffness of tissue that is often associated with disease, MRE is able to detect tissue pathologies at early stages. ⋯ For both groups, we observed a significant drop in the stiffness of the impacted region immediately following the injury; the 0.75 mm animals experienced increased tissue softness that lasted longer than that for the 0.5 mm group. Although the shear stiffness, storage modulus, and loss modulus parameters all followed the same trend, the tissue stiffness yielded the most statistically significant results. Overall, this article introduces a transformative technique for mechanically mapping the brain and detecting brain diseases and injury.
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Journal of neurotrauma · Sep 2013
Dose- and Time-Dependent Neuroprotective Effects of Pycnogenol(®) following Traumatic Brain Injury.
After traumatic brain injury (TBI), both primary and secondary injury cascades are initiated, leading to neuronal death and cognitive dysfunction. We have previously shown that the combinational bioflavonoid, Pycnogenol (PYC), alters some secondary injury cascades and protects synaptic proteins when administered immediately following trauma. The purpose of the present study was to explore further the beneficial effects of PYC and to test whether it can be used in a more clinically relevant fashion. ⋯ PYC treatment significantly protected both the cortex and hippocampus from injury-related declines in pre- and post-synaptic proteins. These results demonstrate that a single i.v. treatment of PYC is neuroprotective after TBI with a therapeutic window of at least 4 h post trauma. The natural bioflavonoid PYC may provide a possible therapeutic intervention in neurotrauma.