Journal of neurotrauma
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Journal of neurotrauma · Nov 2009
Difficulty of elderly SCI subjects to translate motor recovery--"body function"--into daily living activities.
The objective of this retrospective analysis was to determine whether outcome of body functions and activities as well as length of stay of inpatient rehabilitation is related to age in patients with traumatic spinal cord injury (SCI). Data were collected from a European network of 17 SCI rehabilitation centers (EM-SCI); a total of 237 traumatic SCI subjects were included. Assessments were performed at 1, 6, and 12 months after SCI. ⋯ Length of stay was not associated with age. It was concluded that age is an important determining factor for functional outcome after SCI and that elderly patients have difficulties in translating an improvement in neurological outcome into functional changes. Therefore, rehabilitation approaches in elderly subjects should focus on functional training.
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Journal of neurotrauma · Nov 2009
Human amnion-derived multipotent progenitor cell treatment alleviates traumatic brain injury-induced axonal degeneration.
To identify a viable cell source with potential neuroprotective effects, we studied amnion-derived multipotent progenitor (AMP) cells in a rat model of penetrating ballistic-like brain injury (PBBI). AMP cells were labeled with fluorescent dye PKH26 and injected in rats immediately following right hemispheric PBBI or sham PBBI surgery by ipsilateral i.c.v. administration. At 2 weeks post-injury, severe necrosis developed along the PBBI tract and axonal degeneration was prominent along the corpus callosum (cc) and in the ipsilateral thalamus. ⋯ None of the labeled AMP cells appeared to express neural differentiation, as evidenced by the lack of double labeling with nestin, S-100, GFAP, and MAP-2 immunostaining. In conclusion, AMP cell migration was specifically induced by PBBI and requires SVZ homing, yet the neuroprotective effect of intracerebral ventrical treatment using AMP cells was not limited to the area where the cells were present. This suggests that the attenuation of the secondary brain injury following PBBI was likely to be mediated by mechanisms other than cell replacement, possibly through delivery or sustained secretion of neurotrophic factors.
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Journal of neurotrauma · Nov 2009
The novel nitric oxide synthase inhibitor 4-amino-tetrahydro-L-biopterine prevents brain edema formation and intracranial hypertension following traumatic brain injury in mice.
Brain edema formation, resulting in increased intracranial pressure (ICP), is one of the most deleterious consequences of traumatic brain injury (TBI). Nitric oxide (NO) has previously been shown to be involved in the damage of the blood-brain barrier (BBB) and, thus, in the formation of post-traumatic brain edema; however, this knowledge never resulted in a clinically relevant therapeutic option because available NO synthase inhibitors have serious side effects in man. The aim of the current study was to investigate the therapeutic efficacy of VAS203, a novel tetrahydrobiopterine (BH3)-based NOS inhibitor, in experimental TBI. ⋯ When administered 30 min after experimental TBI (controlled cortical impact, 2.2 mg/kg/min i.v., n = 7 per group), VAS203 prevented any further increase in ICP or deterioration of cerebral blood flow. This effect was dose-dependent and long-lasting (i.e., 24 h after trauma, brain edema formation was still significantly reduced [-40%, p < 0.008; n = 7 per group] and functional improvements were present up to 7 days after TBI [p < 0.02 on post-trauma day 6; n = 8 per group]). Therefore, VAS203 may represent a promising candidate for the treatment of acute intracranial hypertension following TBI.
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Journal of neurotrauma · Oct 2009
The economic impact of S-100B as a pre-head CT screening test on emergency department management of adult patients with mild traumatic brain injury.
Recent research suggests that serum S-100B may serve as a good pre-head computed tomography (CT) screening test because of its high sensitivity for abnormal head CT scans. The potential economic impact of using S-100B in the emergency department setting for management of adult patients with isolated mild traumatic brain injury (mTBI) has not been evaluated despite its clinical implementation in Europe. Using evidence from the literature, we constructed a decision tree to compare the average cost per patient of using S-100B as a pre-head CT screening test to the current practice of ordering CT scans based on patients' presenting symptoms without the aid of S-100B. ⋯ Generally speaking, if blood test results require less time than imaging, and if head CT scan rates for patients with isolated mTBI are relatively high, using S-100B will lower costs. Recommendations for using S-100B as a screening tool should account for setting-specific characteristics and their consequent economic impacts. Despite its high sensitivity and excellent negative predictive value, serum S-100B has low specificity and low positive predictive value, limiting its ability to reduce numbers of CT scans and hospital costs.
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Journal of neurotrauma · Oct 2009
Implications of reduced callosal area for social skills after severe traumatic brain injury in children.
The corpus callosum has been shown to be particularly vulnerable to the effects of traumatic brain injury (TBI) in childhood, and severe injury frequently results in a smaller corpus callosum post-injury. However, the long-term effects of TBI on the integrity of the callosum, as well as the potential functional significance of callosal injury are poorly understood. Some studies suggest the corpus callosum may be involved in social skills, which are often reduced following TBI. ⋯ In addition, callosal size correlated significantly with social skills, suggesting that callosal atrophy may be related to poorer social skills after TBI. These findings highlight the persistence of callosal abnormalities, which may be a result of interrupted neural development after childhood TBI. The results further underscore the potential importance of the corpus callosum for social competence after TBI.