Journal of neurotrauma
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Journal of neurotrauma · Dec 2020
Multicenter Study Observational StudyExosomal MicroRNAs in Military Persons with Mild Traumatic Brain Injury: Preliminary Results from a Chronic Effects of Neurotrauma Consortium (CENC) Biomarker Discovery Project.
Chronic symptoms after mild traumatic brain injury (mTBI) are common among veterans and service members, and represent a significant source of morbidity, with those who sustain multiple mTBIs at greatest risk. Exosomal micro-RNAs (miRNAs), mediators of intercellular communication, may be involved in chronic TBI symptom persistence. Exosomal miRNA (exomiR) was extracted from 153 participants enrolled in the Chronic Effect of Neurotrauma Consortium (CENC) longitudinal study (no TBI, n = 35; ≥ 3 mTBIs (rTBI), n = 45; 1-2 mTBIs, n = 73). ⋯ TBI history and neurobehavioral symptom survey scores negatively and significantly correlated with hsa-miR-103a-3p expression. Participants with remote mTBI have distinct exomiR profiles, which are significantly linked to inflammatory and neuronal repair pathways. These profiles suggest that analysis of exosomal miRNA expression may provide novel insights into the underlying pathobiology of chronic TBI symptom persistence.
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Journal of neurotrauma · Dec 2020
ReviewBeyond binary: the influence of sex and gender on outcome after traumatic brain injury.
Traumatic brain injury (TBI) affects millions of individuals each year and is a leading cause of death and disability worldwide. TBI is heterogeneous and outcome is influenced by a combination of factors that include injury location, severity, genetics, and environmental factors. More recently, sex as a biological variable has been incorporated into TBI research, although there is conflicting literature regarding clinical outcomes in males versus females after TBI. ⋯ Social constructs regarding gender impact an individual's vulnerability to violence and consequent TBI, including the successful reintegration to society after TBI. We call for incorporation of gender beyond the binary in TBI education, research, and clinical care. Precision medicine necessarily must progress beyond the binary to treat individuals after TBI.
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Journal of neurotrauma · Dec 2020
Meta AnalysisNon-invasive techniques for multimodal monitoring in Traumatic Brain Injury (TBI): systematic review and meta-analysis.
Monitoring brain oxygenation and intracranial pressure non-invasively and continuously is of paramount importance in traumatic brain injury (TBI). The primary motivation of this study was to identify and provide robust evidence of the most effective techniques for the non-invasive multimodal monitoring for traumatic brain injury. Two reviewers independently searched PubMed, Embase, Scopus, the Cochrane Library, and the Web of Science between January 15, 2010, and January 22, 2020. ⋯ A meta-analysis on non-invasive ICP monitoring revealed a strong pooled correlation coefficient of 0.725 (95 % confidence interval [CI]: 0.450-0.874; I2 91.31%) between transcranial Doppler and the gold standard ICP monitoring. The current meta-analysis has shown that the two most prominent and widely used technologies for non-invasive monitoring in TBI are near-infrared spectroscopy and transcranial Doppler. Both techniques could be considered for the future development of a single non-invasive and continuous multimodal monitoring device for TBI.
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Journal of neurotrauma · Dec 2020
Mortality Secondary to Unintentional Poisoning after Inpatient Rehabilitation among Individuals with Moderate to Severe Traumatic Brain Injury.
Studies have shown reduced life expectancy following moderate-severe traumatic brain injury (TBI) with death from unintentional poisoning (UP) being 11 times higher following TBI than in the general population. The characteristics of those who die of unintentional poisoning are compared with the characteristics of those who die of other causes (OC) in a retrospective cohort who received inpatient rehabilitation following TBI and enrolled in the TBI Model Systems National Database between 1989 and 2017 (n = 15,835 cases with 2,238 deaths recorded). Seventy-eight cases (3.5%) of deaths were the result of UP, 76% were the result of OC, and 20.5% were from an unknown cause. ⋯ Adults who receive inpatient rehabilitation for TBI who die from UP are distinguishable from those who die of OC. Factors such as pre-injury substance use in the context of functional independence may be regarded as targets for prevention and/or intervention to reduce substance use and substance-related mortality among survivors of moderate-severe TBI. The current findings may have implications for medical care, surveillance, prevention, and health promotion.
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Journal of neurotrauma · Dec 2020
The prevalence and stability of sleep-wake disturbance and fatigue throughout the first year after mild traumatic brain injury.
In this prospective, longitudinal study, we aimed to determine the prevalence and stability of sleep-wake disturbance (SWD) and fatigue in a large representative sample of patients (Trondheim mild traumatic brain injury [mTBI] follow-up study). We included 378 patients with mTBI (age 16-60), 82 matched trauma controls with orthopedic injuries, and 83 matched community controls. Increased sleep need, poor sleep quality, excessive daytime sleepiness, and fatigue were assessed at 2 weeks, 3 months, and 12 months after injury. ⋯ In patients with mTBI who experienced SWDs and fatigue 2 weeks after injury, around half still had problems at 3 months and approximately one third at 12 months. Interestingly, we observed limited overlap between the different symptom measures; a large number of patients reported one specific problem with SWD or fatigue rather than several problems. In conclusion, our results provide strong evidence that mTBI contributes significantly to the development and maintenance of SWDs and fatigue.