Articles: traumatic-brain-injuries.
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Curr. Opin. Neurol. · Dec 2018
ReviewStimulation of N-methyl-D-aspartate receptors by exogenous and endogenous ligands improves outcome of brain injury.
The failure of N-methyl-D-aspartate receptor (NMDAR) antagonists as a treatment for human traumatic brain injury (TBI) and stroke, along with preclinical findings of a persistent hypofunctional state of these receptors after brain injury, resulted in a new focus on NMDAR agonists, specifically those acting via the glycine site of the NMDAR. This article reviews the recent literature on positive modulators of the glycine site as a new modality for improving cognitive function in central nervous system pathology, including traumatic and ischemic brain injuries, neuroinflammation, and neuropsychiatric disorders. ⋯ Taken together, the preclinical and clinical studies provide new, additional support for the notion that activation of the glycine/serine site should be considered a novel therapeutic approach to cognitive impairments. Specifically, as DCS is an approved drug, its translation into clinical practice should be advocated.
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Experimental neurology · Dec 2018
ReviewCriteria to define mild, moderate, and severe traumatic brain injury in the mouse controlled cortical impact model.
Traumatic brain injury (TBI) is a major health concern in the United States resulting in a substantial number of hospitalizations and in a broad spectrum of symptoms and disabilities. In the clinical setting, neurological responsiveness and structural imaging are used to classify mild, moderate and severe TBI. To evaluate the complex secondary and severity-specific injury response, investigators have relied on pre-clinical rodent models. ⋯ Inconsistent with clinical evaluation, injury severity in the CCI model has predominately relied on the extent of tissue damage. In the present review, we discuss variations in surgical parameters for injury induction as well as the criteria used to determine injury severity. Additionally, we propose guiding principles for the induction and defining of mild, moderate and severe TBI in the craniectomy-dependent experimental mouse CCI model.
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The field of neurotrauma research faces a reproducibility crisis. In response, research leaders in traumatic brain injury (TBI) and spinal cord injury (SCI) are leveraging data curation and analytics methods to encourage transparency, and improve the rigor and reproducibility. Here we review the current challenges and opportunities that come from efforts to transform neurotrauma's big data to knowledge. ⋯ We are on the threshold of a new era in data collection, curation, and analysis. The next phase of big data in neurotrauma research will require responsible data stewardship, a culture of data-sharing, and the illumination of 'dark data'.
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Review Case Reports
Extensive dural ossification following decompressive posttraumatic craniectomy: a case report and review of the Literature.
We present a case of almost complete bifrontal dural ossification after decompressive craniectomy for severe traumatic brain injury. ⋯ We focus on the clinical implications of this phenomenon, in terms of its surgical management and how it may influence the timing of cranioplasty. Furthermore, we discuss the main pathophysiologic models described in the literature.
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Malignant infarction of the middle cerebral artery (MCI) is life threatening. It is associated with a mortality as high as 80%, and survival often at the expense of serious disability. Limited success of medical therapies has resulted in decompressive craniectomy (DC) being increasingly used as a treatment for MCI, although evidence of its efficacy is inconclusive. In this study, the efficacy of DC in improving survival, or survival free of severe disability, was assessed. ⋯ Early DC reduces mortality but does not appear to improve favourable outcomes in patients younger or older than 60 years after MCI. RCTs incorporating quality of life assessments are warranted for MCI patients, in addition to defining the optimal timing and benefits of DC in older patients.