Articles: traumatic-brain-injuries.
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Ther Hypothermia Temp Manag · Mar 2016
Comprehensive Evaluation of Neuroprotection Achieved by Extended Selective Brain Cooling Therapy in a Rat Model of Penetrating Ballistic-Like Brain Injury.
Brain hypothermia has been considered as a promising alternative to whole-body hypothermia in treating acute neurological disease, for example, traumatic brain injury. Previously, we demonstrated that 2-hours selective brain cooling (SBC) effectively mitigated acute (≤24 hours postinjury) neurophysiological dysfunction induced by a penetrating ballistic-like brain injury (PBBI) in rats. This study evaluated neuroprotective effects of extended SBC (4 or 8 hours in duration) on sub-acute secondary injuries between 3 and 21 days postinjury (DPI). ⋯ The protective effects of SBC on delayed axonal injury (silver staining) were evident out to 14 DPI. In conclusion, the CCA cooling method of SBC produced neuroprotection measured across multiple domains that were evident days/weeks beyond the cooling duration and in the absence of overt adverse effects. These "proof-of-concept" results suggest that SBC may provide an attractive neuroprotective approach for clinical considerations.
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Pediatr Crit Care Me · Mar 2016
Retracted PublicationPreferential Protection of Cerebral Autoregulation and Reduction of Hippocampal Necrosis With Norepinephrine After Traumatic Brain Injury in Female Piglets.
Traumatic brain injury contributes to morbidity in children and boys is disproportionately represented. Cerebral autoregulation is impaired after traumatic brain injury, contributing to poor outcome. Cerebral perfusion pressure is often normalized by the use of vasopressors to increase mean arterial pressure. In prior studies, we observed that phenylephrine prevented impairment of autoregulation in female but exacerbated in male piglets after fluid percussion injury. In contrast, dopamine prevented impairment of autoregulation in both sexes after fluid percussion injury, suggesting that pressor choice impacts outcome. The extracellular signal-regulated kinase isoform of mitogen-activated protein kinase produces hemodynamic impairment after fluid percussion injury, but the role of the cytokine interleukin-6 is unknown. We investigated whether norepinephrine sex-dependently protects autoregulation and limits histopathology after fluid percussion injury and the role of extracellular signal-regulated kinase and interleukin-6 in that outcome. ⋯ Norepinephrine protects autoregulation and limits hippocampal neuronal cell necrosis via modulation of extracellular signal-regulated kinase mitogen-activated protein kinase and interleukin-6 after fluid percussion injury in a sex-dependent manner.
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Observational Study
On-field management and return-to-play in sports-related concussion in children: Are children managed appropriately?
On-field management and return-to-play guidelines aim to ensure the identification and appropriate management of the concussed athlete. Compliance with current guidelines in many settings is unknown. We assessed whether key components of current concussion guidelines are being followed in child athletes. ⋯ Many children with sports related-concussion are not formally assessed on-field and continue to play. On-field concussion management and return to play practices are often suboptimal. Awareness and education of coaches, teachers, parents and children need to be improved.
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Sleep disturbances are frequently reported following traumatic brain injury (TBI); however, the exact disturbances remain unclear. This meta-analysis aimed to characterize sleep disturbance in community dwelling patients with TBI as compared to controls. ⋯ The evidence suggests that TBI is associated with widespread objective and subjective sleep deficits. The present results highlight the need for physicians to monitor and address sleep deficits following TBI.
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Advances in technology have resulted in a plethora of invasive neuromonitoring options for practitioners to manage while caring for the complex needs of the critical care patient. Although many types of invasive neuromonitoring are available to the practitioner, intraparenchymal monitors and external ventricular devices are used most frequently in the clinical setting and are the focus of this article. In addition, multimodality monitoring has been noted to confer a survival benefit in patients with this complex type of invasive neuromonitoring and is discussed as well.