Metabolic alterations in patients who develop traumatic brain injury (TBI)-induced hypopituitarism.

Science.gov (United States)

Prodam, F; Gasco, V; Caputo, M; Zavattaro, M; Pagano, L; Marzullo, P; Belcastro, S; Busti, A; Perino, C; Grottoli, S; Ghigo, E; Aimaretti, G

2013-08-01

Hypopituitarism is associated with metabolic alterations but in TBI-induced hypopituitarism data are scanty. The aim of our study was to evaluate the prevalence of naïve hypertension, dyslipidemia, and altered glucose metabolism in TBI-induced hypopituitarism patients. Cross-sectional retrospective study in a tertiary care endocrinology center. 54 adult patients encountering a moderate or severe TBI were evaluated in the chronic phase (at least 12 months after injury) after-trauma. Presence of hypopituitarism, BMI, hypertension, fasting blood glucose and insulin levels, oral glucose tolerance test (if available) and a lipid profile were evaluated. The 27.8% of patients showed various degrees of hypopituitarism. In particular, 9.3% had total, 7.4% multiple and 11.1% isolated hypopituitarism. GHD was present in 22.2% of patients. BMI was similar between the two groups. Hypopituitaric patients presented a higher prevalence of dyslipidemia (phypopituitaric patients. In particular, triglycerides (phypopituitaric TBI patients. We showed that long-lasting TBI patients who develop hypopituitarism frequently present metabolic alterations, in particular altered glucose levels, insulin resistance and hypertriglyceridemia. In view of the risk of premature cardiovascular death in hypopituitaric patients, major attention has to been paid in those who encountered a TBI, because they suffer from the same comorbidities and may present other deterioration factors due to complex pharmacological treatments and restriction in participation in life activities and healthy lifestyle. Copyright © 2013 Elsevier Ltd. All rights reserved.

Altered caudate connectivity is associated with executive dysfunction after traumatic brain injury.

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De Simoni, Sara; Jenkins, Peter O; Bourke, Niall J; Fleminger, Jessica J; Hellyer, Peter J; Jolly, Amy E; Patel, Maneesh C; Cole, James H; Leech, Robert; Sharp, David J

2018-01-01

Traumatic brain injury often produces executive dysfunction. This characteristic cognitive impairment often causes long-term problems with behaviour and personality. Frontal lobe injuries are associated with executive dysfunction, but it is unclear how these injuries relate to corticostriatal interactions that are known to play an important role in behavioural control. We hypothesized that executive dysfunction after traumatic brain injury would be associated with abnormal corticostriatal interactions, a question that has not previously been investigated. We used structural and functional MRI measures of connectivity to investigate this. Corticostriatal functional connectivity in healthy individuals was initially defined using a data-driven approach. A constrained independent component analysis approach was applied in 100 healthy adult dataset from the Human Connectome Project. Diffusion tractography was also performed to generate white matter tracts. The output of this analysis was used to compare corticostriatal functional connectivity and structural integrity between groups of 42 patients with traumatic brain injury and 21 age-matched controls. Subdivisions of the caudate and putamen had distinct patterns of functional connectivity. Traumatic brain injury patients showed disruption to functional connectivity between the caudate and a distributed set of cortical regions, including the anterior cingulate cortex. Cognitive impairments in the patients were mainly seen in processing speed and executive function, as well as increased levels of apathy and fatigue. Abnormalities of caudate functional connectivity correlated with these cognitive impairments, with reductions in right caudate connectivity associated with increased executive dysfunction, information processing speed and memory impairment. Structural connectivity, measured using diffusion tensor imaging between the caudate and anterior cingulate cortex was impaired and this also correlated with measures of

Adolescent and Young Adult Injuries in Developing Economies: A Comparative Analysis from Oman and Kenya.

Science.gov (United States)

Bachani, Abdulgafoor M; Taber, Niloufer; Mehmood, Amber; Hung, Yuen Wai; Botchey, Isaac; Al-Kashmiri, Ammar; Hyder, Adnan A

Adolescence is a distinct period of rapid and dramatic biological, cognitive, psychological, and social development. The burden of injuries among young people (aged 10-24) is both substantial and maldistributed across regions and levels of economic development. Our objective was to compare sociodemographic correlates of injury cause, intentionality, and mortality between Kenya and Oman, 2 countries with different levels of economic development and position in the demographic and epidemiologic transitions. Data on 566 patients in Oman and 5859 in Kenya between 10 and 24 years old were extracted from 2 separate multicenter trauma registries. Multivariable log binomial and Poisson regressions were used to evaluate social and demographic factors associated with injury cause, intentionality, and mortality. Literature on adolescent development was used to parameterize variables, and Akaike information criteria were used in the final model selections. The trauma registry data indicated a substantial burden of adolescent and young adult injury in both Oman and Kenya, particularly among males. The data indicated significant differences between countries (P < .001) in age category, gender distributions, level of education, occupation, cause of injury, and place where injury occurred. Consistent with other literature, road traffic injuries emerged as the most common type of injury as well as the most severe and fatal, with interpersonal violence also resulting in severe injury across contexts. Both road traffic injuries and interpersonal violence were more common among older adolescents and young adults. Education and being in school were protective against injury, after controlling for gender, age category, occupation, and country. A rising burden of injuries among young people has been documented in every region of the world, irrespective on income status or level of development. Cost-effective injury control measures targeting this age group exist, including involvement

A distinct regulatory region of the Bmp5 locus activates gene expression following adult bone fracture or soft tissue injury.

Science.gov (United States)

Guenther, Catherine A; Wang, Zhen; Li, Emma; Tran, Misha C; Logan, Catriona Y; Nusse, Roel; Pantalena-Filho, Luiz; Yang, George P; Kingsley, David M

2015-08-01

Bone morphogenetic proteins (BMPs) are key signaling molecules required for normal development of bones and other tissues. Previous studies have shown that null mutations in the mouse Bmp5 gene alter the size, shape and number of multiple bone and cartilage structures during development. Bmp5 mutations also delay healing of rib fractures in adult mutants, suggesting that the same signals used to pattern embryonic bone and cartilage are also reused during skeletal regeneration and repair. Despite intense interest in BMPs as agents for stimulating bone formation in clinical applications, little is known about the regulatory elements that control developmental or injury-induced BMP expression. To compare the DNA sequences that activate gene expression during embryonic bone formation and following acute injuries in adult animals, we assayed regions surrounding the Bmp5 gene for their ability to stimulate lacZ reporter gene expression in transgenic mice. Multiple genomic fragments, distributed across the Bmp5 locus, collectively coordinate expression in discrete anatomic domains during normal development, including in embryonic ribs. In contrast, a distinct regulatory region activated expression following rib fracture in adult animals. The same injury control region triggered gene expression in mesenchymal cells following tibia fracture, in migrating keratinocytes following dorsal skin wounding, and in regenerating epithelial cells following lung injury. The Bmp5 gene thus contains an "injury response" control region that is distinct from embryonic enhancers, and that is activated by multiple types of injury in adult animals. Copyright © 2015 Elsevier Inc. All rights reserved.

Adding insult to brain injury: young adults' experiences of residing in nursing homes following acquired brain injury.

Science.gov (United States)

Dwyer, Aoife; Heary, Caroline; Ward, Marcia; MacNeela, Pádraig

2017-08-28

There is general consensus that adults under age 65 with acquired brain injury residing in nursing homes is inappropriate, however there is a limited evidence base on the issue. Previous research has relied heavily on third-party informants and qualitative studies have been of questionable methodological quality, with no known study adopting a phenomenological approach. This study explored the lived experiences of young adults with brain injury residing in aged care facilities. Interpretative phenomenological analysis was employed to collect and analyze data from six semi-structured interviews with participants regarding their experiences of living in nursing homes. Two themes were identified, including "Corporeal prison of acquired brain injury: broken selves" and "Existential prison of the nursing home: stagnated lives". Results illustrated that young adults with acquired brain injury can experience aged care as an existential prison in which their lives feel at a standstill. This experience was characterized by feelings of not belonging in a terminal environment, confinement, disempowerment, emptiness and hope for greater autonomy through rehabilitation. It is hoped that this study will provide relevant professionals, services and policy-makers with insight into the challenges and needs of young adults with brain injury facing these circumstances. Implications for rehabilitation This study supports the contention that more home-like and age-appropriate residential rehabilitation services for young adults with acquired brain injury are needed. As development of alternative accommodation is a lengthy process, the study findings suggest that the interim implementation of rehabilitative care in nursing homes should be considered. Taken together with existing research, it is proposed that nursing home staff may require training to deliver evidence-based rehabilitative interventions to those with brain injury. The present findings add support to the call for systemic

Diffusion MRI and the Detection of Alterations Following Traumatic Brain Injury

Science.gov (United States)

2017-06-13

vascular injury, disruption of water home- ostasis), changes in tissue composition (e.g., increased or decreased cellu- larity), and alterations in...related alterations Tissue environment Expected diffusion changes Major citations dMRI evidence Neurons cell loss necrosis and apoptosis atrophy...structure and signaling, vascular coupling, and waste removal, among others. Astrocytes are at least as numerous as neurons in the brain (Herculano-Houzel

Cartilage Injuries in the Adult Knee

Science.gov (United States)

Moyad, Thomas F.

2011-01-01

Cartilage injuries are frequently recognized as a source of significant morbidity and pain in patients with previous knee injuries. The majority of patients who undergo routine knee arthroscopy have evidence of a chondral defect. These injuries represent a continuum of pathology from small, asymptomatic lesions to large, disabling defects affecting a major portion of one or more compartments within the knee joint. In comparison to patients with osteoarthritis, individuals with isolated chondral surface damage are often younger, significantly more active, and usually less willing to accept limitations in activities that require higher impact. At the present time, a variety of surgical procedures exist, each with their unique indications. This heterogeneity of treatment options frequently leads to uncertainty regarding which techniques, if any, are most appropriate for patients. The purpose of this review is to describe the workup and discuss the management techniques for cartilage injuries within the adult knee. PMID:26069581

The impact of pre-injury anticoagulation therapy in the older adult patient experiencing a traumatic brain injury: A systematic review.

Science.gov (United States)

Smith, Karen; Weeks, Susan

2012-01-01

studies, the overall incidence of hospitalized TBI patients was 235 incidents/per 100,000 individuals, with a mortality rate of 15.4 deaths/per 100,000 of the population.The association between medications that alter a patient's coagulation function and adverse trauma outcome continues to be an important area of interest and study. The percentage of Americans on anticoagulant and antiplatelet agents continues to increase with the long-term trend towards longer life expectancies. Older adults are prescribed anticoagulants and antiplatelet agents to prevent thromboembolic complications of artial fibrillation; prosthetic cardiac valves; cerebral, coronary, and peripheral vascular disease; as well as several other medical conditions. One of the most frequently prescribed anticoagulant medications is warfarin. The prevalence of warfarin use in the Unites States is unknown, but the Food and Drug Administration (FDA) estimates that more than 31 million prescriptions were written in 2004. Newer, more potent antiplatelet medications like clopidogrel (Plavix) pose an even greater risk for uncontrolled bleeding in trauma patients. The uncertainty regarding the impact on trauma outcomes is compounded by the variable response of patients to anticoagulant or antiplatelet medication for an associated comorbidity. Evidence suggests that outcomes for TBI are worse, and there may be delayed intracranial hemorrhage in this population of patients.According to a Western Australian study, trauma patients are theoretically at risk for prolonged major bleeding. Studies of traumatic intracranial hemorrhage (ICH) suggest that patients taking anticoagulants have two to six times greater mortality. Mina et al. noted that the trauma patient with preinjury anticoagulation such as warfarin or even aspirin who had an intracranial injury had a four to five fold higher risk of death than the non-anticoagulated patient. Franko et al. concluded that mortality of patients over age 70 was significantly higher

Brachial plexus injury in adults: Diagnosis and surgical treatment strategies

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Mukund R Thatte

2013-01-01

Full Text Available Adult post traumatic Brachial plexus injury is unfortunately a rather common injury in young adults. In India the most common scenario is of a young man injured in a motorcycle accident. Exact incidence figures are not available but of the injuries presenting to us about 90% invole the above combination This article reviews peer-reviewed publications including clinical papers, review articles and Meta analysis of the subject. In addition, the authors′ experience of several hundred cases over the last 15 years has been added and has influenced the ultimate text. Results have been discussed and analysed to get an idea of factors influencing final recovery. It appears that time from injury and number of roots involved are most crucial.

The adult spinal cord injury without radiographic abnormalities syndrome: magnetic resonance imaging and clinical findings in adults with spinal cord injuries having normal radiographs and computed tomography studies.

Science.gov (United States)

Kasimatis, Georgios B; Panagiotopoulos, Elias; Megas, Panagiotis; Matzaroglou, Charalambos; Gliatis, John; Tyllianakis, Minos; Lambiris, Elias

2008-07-01

Spinal cord injury without radiographic abnormalities (SCIWORA) is thought to represent mostly a pediatric entity and its incidence in adults is rather underreported. Some authors have also proposed the term spinal cord injury without radiologic evidence of trauma, as more precisely describing the condition of adult SCIWORA in the setting of cervical spondylosis. The purpose of the present study was to evaluate adult patients with cervical spine injuries and radiological-clinical examination discrepancy, and to discuss their characteristics and current management. During a 16-year period, 166 patients with a cervical spine injury were admitted in our institution (Level I trauma center). Upper cervical spine injuries (occiput to C2, 54 patients) were treated mainly by a Halo vest, whereas lower cervical spine injuries (C3-T1, 112 patients) were treated surgically either with an anterior, or posterior procedure, or both. Seven of these 166 patients (4.2%) had a radiologic-clinical mismatch, i.e., they presented with frank spinal cord injury with no signs of trauma, and were included in the study. Magnetic resonance imaging was available for 6 of 7 patients, showing intramedullary signal changes in 5 of 6 patients with varying degrees of compression from the disc and/or the ligamentum flavum, whereas the remaining patient had only traumatic herniation of the intervertebral disc and ligamentum flavum bulging. Follow-up period was 6.4 years on average (1-10 years). This retrospective chart review provides information on adult patients with cervical spinal cord injuries whose radiographs and computed tomography studies were normal. It furthers reinforces the pathologic background of SCIWORA in an adult population, when evaluated by magnetic resonance imaging. Particularly for patients with cervical spondylosis, special attention should be paid with regard to vascular compromise by predisposing factors such as smoking or vascular disease, since they probably contribute in

Prevalence and Determinants of Fall-Related Injuries among Older Adults in Ecuador

Directory of Open Access Journals (Sweden)

Carlos H. Orces

2014-01-01

Full Text Available Objectives. To estimate the prevalence and determinants of fall-related injuries in the previous year among adults aged 60 years or older in Ecuador. Methods. The prevalence of fall-related injuries was estimated using cross-sectional data from the first national survey of Health, Wellbeing, and Aging study. Logistic regression models were used to examine the associations between participants’ demographic characteristics and fall-related injuries. Results. Of 5,227 participants with a mean age of 72.6 years, 11.4% (95% CI, 10.3%–12.7% reported a fall-related injury in Ecuador, representing an estimated 136,000 adults aged 60 years or older. Fall-related injuries were more frequently reported among older adults residing in the most urbanized and populated provinces of the country. After controlling for potential confounders, self-reported race as Indigenous (OR 2.2; 95% CI, 2.11–2.31, drinking alcohol regularly (OR 2.54; 95% CI, 2.46–2.63, subjects with greater number of comorbid conditions (OR 2.03; 95% CI, 1.97–2.08, and urinary incontinence (OR 1.83; 95% CI, 1.79–1.87 were factors independently associated with increased odds of sustaining fall-related injuries. Conclusions. Fall-related injuries represent a considerable burden for older adults in Ecuador. The present findings may assist public health authorities to implement fall prevention programs among subjects at higher risk for this type of injury.

Penetrating abdominal injuries in adults seen at two teaching ...

African Journals Online (AJOL)

Objective: To determine the pattern and management outcome of penetrating abdominal injuries (PAI) in the two main teaching hospitals in Ghana. Study Design: A prospective ... Conclusion: Stab wounds are the main penetrating abdominal injuries seen mostly among young male adults in Ghana. Management was by a ...

Elevator-related injuries to older adults in the United States, 1990 to 2006.

Science.gov (United States)

Steele, Gregory K; O'Neil, Joseph; Huisingh, Carrie; Smith, Gary A

2010-01-01

Elevators remain one of the safest forms of transportation; however, they are still associated with deaths and injuries. This study describes the epidemiology of elevator-related injuries among adults aged 65 years and older in the United States between 1990 and 2006, through a retrospective analysis of data from the National Electronic Injury Surveillance System of the U.S. Consumer Product Safety Commission. Proportions with 95% confidence intervals were calculated by age group for cause of injury, injured body region, injury type, and locale. Rate ratios with 95% confidence interval were calculated to determine any association between the body region injured, type of injury, and cause of injury categories. There were an estimated 44,870 elevator-related injuries in older adults. The mean age was 79.5 years, and approximately 75% were women. More than half of the injuries (51.4%) were caused from a slip, trip, or fall. Soft-tissue injuries were the most common injury type (48.0%). The upper extremities were the most commonly injured body region (26.2%). Almost 15% (14.5%) of those injured required hospital admission. Of those admitted, more than 40% were for a fractured hip. Injuries associated with passenger elevators occur fairly frequently among older adults, are often associated with slip, trip or falls, and can be severe enough to require hospital admission. Older adults should use caution when stepping on or off an elevator. Awareness of the risk and the circumstances leading to falls allows for better direction of intervention strategies.

Weather warnings predict fall-related injuries among older adults.

Science.gov (United States)

Mondor, Luke; Charland, Katia; Verma, Aman; Buckeridge, David L

2015-05-01

weather predictions are a useful tool for informing public health planning and prevention strategies for non-injury health outcomes, but the association between winter weather warnings and fall-related injuries has not been assessed previously. to examine the association between fall-related injuries among older adults and government-issued winter weather warnings. using a dynamic cohort of individuals ≥65 years of age who lived in Montreal between 1998 and 2006, we identified all fall-related injuries from administrative data using a validated set of diagnostic and procedure codes. We compared rates of injuries on days with freezing rain or snowstorm warnings to rates observed on days without warnings. We also compared the incidence of injuries on winter days to non-winter days. All analyses were performed overall and stratified by age and sex. freezing rain alerts were associated with an increase in fall-related injuries (incidence rate ratio [IRR] = 1.20, 95% confidence interval [CI]: 1.08-1.32), particularly among males (IRR = 1.31, 95% CI: 1.10-1.56), and lower rates of injuries were associated with snowstorm alerts (IRR = 0.89, 95% CI: 0.80-0.99). The rate of fall-related injuries did not differ seasonally (IRR = 1.00, 95% CI: 0.97-1.03). official weather warnings are predictive of increases in fall-related injuries among older adults. Public health agencies should consider using these warnings to trigger initiation of injury prevention strategies in advance of inclement weather. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Fatigue in adults with traumatic brain injury

DEFF Research Database (Denmark)

Mollayeva, Tatyana; Kendzerska, Tetyana; Mollayeva, Shirin

2013-01-01

BACKGROUND: Despite strong indications that fatigue is the most common and debilitating symptom after traumatic brain injury, little is known about its frequency, natural history, or relation to other factors. The current protocol outlines a strategy for a systematic review that will identify......, assess, and critically appraise studies that assessed predictors for fatigue and the consequences of fatigue on at least two separate time points following traumatic brain injury. METHODS/DESIGN: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, CINAHL, and PsycINFO will be systematically...... searched for relevant peer-reviewed studies. Reference lists of eligible papers will also be searched. All English language studies with a longitudinal design that focus on fatigue in adults with primary-impact traumatic brain injury will be included. Studies on fatigue following brain injury due...

Diabetes and risk of hospitalized fall injury among older adults.

Science.gov (United States)

Yau, Rebecca K; Strotmeyer, Elsa S; Resnick, Helaine E; Sellmeyer, Deborah E; Feingold, Kenneth R; Cauley, Jane A; Vittinghoff, Eric; De Rekeneire, Nathalie; Harris, Tamara B; Nevitt, Michael C; Cummings, Steven R; Shorr, Ronald I; Schwartz, Ann V

2013-12-01

To determine whether older adults with diabetes are at increased risk of an injurious fall requiring hospitalization. The longitudinal Health, Aging, and Body Composition Study included 3,075 adults aged 70-79 years at baseline. Hospitalizations that included ICD-9-Clinical Modification codes for a fall and an injury were identified. The effect of diabetes with and without insulin use on the rate of first fall-related injury hospitalization was assessed using proportional hazards models. At baseline, 719 participants had diabetes, and 117 of them were using insulin. Of the 293 participants who were hospitalized for a fall-related injury, 71 had diabetes, and 16 were using insulin. Diabetes was associated with a higher rate of injurious fall requiring hospitalization (hazard ratio [HR] 1.48 [95% CI 1.12-1.95]) in models adjusted for age, race, sex, BMI, and education. In those participants using insulin, compared with participants without diabetes, the HR was 3.00 (1.78-5.07). Additional adjustment for potential intermediaries, such as fainting in the past year, standing balance score, cystatin C level, and number of prescription medications, accounted for some of the increased risk associated with diabetes (1.41 [1.05-1.88]) and insulin-treated diabetes (2.24 [1.24-4.03]). Among participants with diabetes, a history of falling, poor standing balance score, and A1C level ≥8% were risk factors for an injurious fall requiring hospitalization. Older adults with diabetes, in particular those using insulin, are at greater risk of an injurious fall requiring hospitalization than those without diabetes. Among those with diabetes, poor glycemic control may increase the risk of an injurious fall.

Cathepsin B-dependent motor neuron death after nerve injury in the adult mouse

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Sun, Li; Wu, Zhou; Baba, Masashi [Department of Aging Science and Pharmacology, Faculty of Dental Sciences, Kyushu University, Maidashi 3-1-1, Fukuoka 812-8582 (Japan); Peters, Christoph [Institute fuer Molekulare Medizin und Zellforshung, Albert-Ludwings-Universitaet Freiburg, D-79104 Freiburg (Germany); Uchiyama, Yasuo [Department of Cell Biology and Neuroscience, Juntendo University Graduate School of Medicine, Tokyo (Japan); Nakanishi, Hiroshi, E-mail: nakan@dent.kyushu-u.ac.jp [Department of Aging Science and Pharmacology, Faculty of Dental Sciences, Kyushu University, Maidashi 3-1-1, Fukuoka 812-8582 (Japan)

2010-08-27

Research highlights: {yields} Cathepsin B (CB), a lysosomal cysteine protease, is expressed in neuron and glia. {yields} CB increased in hypogrossal nucleus neurons after nerve injury in adult mice. {yields} CB-deficiency significantly increased the mean survival ratio of injured neurons. {yields} Thus, CB plays a critical role in axotomy-induced neuronal death in adult mice. -- Abstract: There are significant differences in the rate of neuronal death after peripheral nerve injury between species. The rate of neuronal death of motor neurons after nerve injury in the adult rats is very low, whereas that in adult mice is relatively high. However, the understanding of the mechanism underlying axotomy-induced motor neuron death in adult mice is limited. Cathepsin B (CB), a typical cysteine lysosomal protease, has been implicated in three major morphologically distinct pathways of cell death; apoptosis, necrosis and autophagic cell death. The possible involvement of CB in the neuronal death of hypogrossal nucleus (HGN) neurons after nerve injury in adult mice was thus examined. Quantitative analyses showed the mean survival ratio of HGN neurons in CB-deficient (CB-/-) adult mice after nerve injury was significantly greater than that in the wild-type mice. At the same time, proliferation of microglia in the injured side of the HGN of CB-/- adult mice was markedly reduced compared with that in the wild-type mice. On the injured side of the HGN in the wild-type adult mice, both pro- and mature forms of CB markedly increased in accordance with the increase in the membrane-bound form of LC3 (LC3-II), a marker protein of autophagy. Furthermore, the increase in CB preceded an increase in the expression of Noxa, a major executor for axotomy-induced motor neuron death in the adult mouse. Conversely, expression of neither Noxa or LC3-II was observed in the HGN of adult CB-/- mice after nerve injury. These observations strongly suggest that CB plays a critical role in axotomy

Cathepsin B-dependent motor neuron death after nerve injury in the adult mouse

International Nuclear Information System (INIS)

Sun, Li; Wu, Zhou; Baba, Masashi; Peters, Christoph; Uchiyama, Yasuo; Nakanishi, Hiroshi

2010-01-01

Research highlights: → Cathepsin B (CB), a lysosomal cysteine protease, is expressed in neuron and glia. → CB increased in hypogrossal nucleus neurons after nerve injury in adult mice. → CB-deficiency significantly increased the mean survival ratio of injured neurons. → Thus, CB plays a critical role in axotomy-induced neuronal death in adult mice. -- Abstract: There are significant differences in the rate of neuronal death after peripheral nerve injury between species. The rate of neuronal death of motor neurons after nerve injury in the adult rats is very low, whereas that in adult mice is relatively high. However, the understanding of the mechanism underlying axotomy-induced motor neuron death in adult mice is limited. Cathepsin B (CB), a typical cysteine lysosomal protease, has been implicated in three major morphologically distinct pathways of cell death; apoptosis, necrosis and autophagic cell death. The possible involvement of CB in the neuronal death of hypogrossal nucleus (HGN) neurons after nerve injury in adult mice was thus examined. Quantitative analyses showed the mean survival ratio of HGN neurons in CB-deficient (CB-/-) adult mice after nerve injury was significantly greater than that in the wild-type mice. At the same time, proliferation of microglia in the injured side of the HGN of CB-/- adult mice was markedly reduced compared with that in the wild-type mice. On the injured side of the HGN in the wild-type adult mice, both pro- and mature forms of CB markedly increased in accordance with the increase in the membrane-bound form of LC3 (LC3-II), a marker protein of autophagy. Furthermore, the increase in CB preceded an increase in the expression of Noxa, a major executor for axotomy-induced motor neuron death in the adult mouse. Conversely, expression of neither Noxa or LC3-II was observed in the HGN of adult CB-/- mice after nerve injury. These observations strongly suggest that CB plays a critical role in axotomy-induced mortor neuron

Altered sleep composition after traumatic brain injury does not affect declarative sleep-dependent memory consolidation

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Janna eMantua

2015-06-01

Full Text Available Individuals with a history of traumatic brain injury (TBI often report sleep disturbances, which may be caused by changes in sleep architecture or reduced sleep quality (greater time awake after sleep onset, poorer sleep efficiency, and sleep stage proportion alterations. Sleep is beneficial for memory formation, and herein we examine whether altered sleep physiology following TBI has deleterious effects on sleep-dependent declarative memory consolidation. Participants learned a list of word pairs in the morning or evening, and recall was assessed 12-hrs later, following an interval awake or with overnight sleep. Young adult participants (18-22 yrs were assigned to one of four experimental groups: TBI Sleep (n=14, TBI Wake (n=12, non-TBI Sleep (n=15, non-TBI Wake (n=15. Each TBI participant was >1 yr post-injury. Sleep physiology was measured with polysomnography. Memory consolidation was assessed by comparing change in word-pair recall over 12-hr intersession intervals. The TBI group spent a significantly greater proportion of the night in SWS than the non-TBI group at the expense of NREM1. The TBI group also had marginally lower EEG delta power during SWS in the central region. Intersession changes in recall were greater for intervals with sleep than without sleep in both groups. However, despite abnormal sleep stage proportions for individuals with a TBI history, there was no difference in the intersession change in recall following sleep for the TBI and non-TBI groups. In both Sleep groups combined, there was a positive correlation between Intersession Change and the proportion of the night in NREM2 + SWS. Overall, sleep composition is altered following TBI but such deficits do not yield insufficiencies in sleep-dependent memory consolidation.

Intraindividual variability in physical and emotional functioning: comparison of adults with traumatic brain injuries and healthy adults.

Science.gov (United States)

Burton, Catherine L; Hultsch, David F; Strauss, Esther; Hunter, Michael A

2002-08-01

Recent research has shown that individuals with certain neurological conditions demonstrate greater intraindividual variability on cognitive tasks compared to healthy controls. The present study investigated intraindividual variability in the domains of physical functioning and affect/stress in three groups: adults with mild head injuries, adults with moderate/severe head injuries, and healthy adults. Participants were assessed on 10 occasions and results indicated that (a) individuals with head injuries demonstrated greater variability in dominant finger dexterity and right grip strength than the healthy controls; (b) increased variability tended to be associated with poorer performance/report both within and across tasks; and (c) increased variability on one task was associated with increased variability on other tasks. The findings suggest that increased variability in physical function, as well as cognitive function, represents an indicator of neurological compromise.

Ultrafine Particulate Matter Combined With Ozone Exacerbates Lung Injury in Mature Adult Rats With Cardiovascular Disease.

Science.gov (United States)

Wong, Emily M; Walby, William F; Wilson, Dennis W; Tablin, Fern; Schelegle, Edward S

2018-05-01

Particulate matter (PM) and ozone (O3) are dominant air pollutants that contribute to development and exacerbation of multiple cardiopulmonary diseases. Mature adults with cardiovascular disease (CVD) are particularly susceptible to air pollution-related cardiopulmonary morbidities and mortalities. The aim was to investigate the biologic potency of ultrafine particulate matter (UFPM) combined with O3 in the lungs of mature adult normotensive and spontaneously hypertensive (SH) Wistar-Kyoto rats. Conscious, mature adult male normal Wistar-Kyoto (NW) and SH rats were exposed to one of the following atmospheres: filtered air (FA); UFPM (∼ 250 μg/m3); O3 (1.0 ppm); or UFPM + O3 (∼ 250 μg/m3 + 1.0 ppm) combined for 6 h, followed by an 8 h FA recovery period. Lung sections were evaluated for lesions in the large airways, terminal bronchiolar/alveolar duct regions, alveolar parenchyma, and vasculature. NW and SH rats were similarly affected by the combined-pollutant exposure, displaying severe injury in both large and small airways. SH rats were particularly susceptible to O3 exposure, exhibiting increased injury scores in terminal bronchioles and epithelial degeneration in large airways. UFPM-exposure groups had minimal histologic changes. The chemical composition of UFPM was altered by the addition of O3, indicating that ozonolysis promoted compound degradation. O3 increased the biologic potency of UFPM, resulting in greater lung injury following exposure. Pathologic manifestations of CVD may confer susceptibility to air pollution by impairing normal lung defenses and responses to exposure.

Youth Versus Adult “Weightlifting” Injuries Presenting to United States Emergency Rooms: Accidental Versus Nonaccidental Injury Mechanisms

OpenAIRE

Myer, Gregory D.; Quatman, Carmen E.; Khoury, Jane; Wall, Eric J.; Hewett, Timothy E.

2009-01-01

Myer, GD, Quatman, CE, Khoury, J, Wall, EJ, and Hewett, TE. Youth versus adult “weightlifting” injuries presenting to united states emergency rooms: accidental versus nonaccidental injury mechanisms. J Strength Cond Res 23(7): 2054–2060, 2009—Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. emergency rooms by age, type, and mechanism of injury. W...

Ultrastructural alterations in adult Schistosoma mansoni caused by artemether

Directory of Open Access Journals (Sweden)

Shuhua Xiao

2002-07-01

Full Text Available Progress has been made over the last decade with the development and clinical use of artemether as an agent against major human schistosome parasites. The tegument has been identified as a key target of artemether, implying detailed studies on ultrastructural damage induced by this compound. We performed a temporal examination, employing a transmission electron microscope to assess the pattern and extent of ultrastructural alterations in adult Schistosoma mansoni harboured in mice treated with a single dose of 400 mg/kg artemether. Eight hours post-treatment, damage to the tegument and subtegumental structures was seen. Tegumental alterations reached a peak 3 days after treatment and were characterized by swelling, fusion of distal cytoplasma, focal lysis of the tegumental matrix and vacuolisation. Tubercles and sensory organelles frequently degenerated or collapsed. Typical features of subtegumental alterations, including muscle fibres, syncytium and parenchyma tissues, were focal or extensive lysis, vacuolisation and degeneration of mitochondria. Severe alterations were also observed in gut epithelial cells and vitelline cells of female worms. Our findings of artemether-induced ultrastructural alterations in adult S. mansoni confirm previous results obtained with juvenile S. mansoni and S. japonicum of different ages.

Functional neuroanatomy of executive function after neonatal brain injury in adults who were born very preterm.

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Anastasia K Kalpakidou

Full Text Available Individuals who were born very preterm (VPT; <33 gestational weeks are at risk of experiencing deficits in tasks involving executive function in childhood and beyond. In addition, the type and severity of neonatal brain injury associated with very preterm birth may exert differential effects on executive functioning by altering its neuroanatomical substrates. Here we addressed this question by investigating with functional magnetic resonance imaging (fMRI the haemodynamic response during executive-type processing using a phonological verbal fluency and a working memory task in VPT-born young adults who had experienced differing degrees of neonatal brain injury. 12 VPT individuals with a history of periventricular haemorrhage and ventricular dilatation (PVH+VD, 17 VPT individuals with a history of uncomplicated periventricular haemorrhage (UPVH, 13 VPT individuals with no history of neonatal brain injury and 17 controls received an MRI scan whilst completing a verbal fluency task with two cognitive loads ('easy' and 'hard' letters. Two groups of VPT individuals (PVH+VD; n = 10, UPVH; n = 8 performed an n-back task with three cognitive loads (1-, 2-, 3-back. Results demonstrated that VPT individuals displayed hyperactivation in frontal, temporal, and parietal cortices and in caudate nucleus, insula and thalamus compared to controls, as demands of the verbal fluency task increased, regardless of type of neonatal brain injury. On the other hand, during the n-back task and as working memory load increased, the PVH+VD group showed less engagement of the frontal cortex than the UPVH group. In conclusion, this study suggests that the functional neuroanatomy of different executive-type processes is altered following VPT birth and that neural activation associated with specific aspects of executive function (i.e., working memory may be particularly sensitive to the extent of neonatal brain injury.

Neuroimaging in adult penetrating brain injury: a guide for radiographers

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Temple, Nikki; Donald, Cortny; Skora, Amanda; Reed, Warren

2015-01-01

Penetrating brain injuries (PBI) are a medical emergency, often resulting in complex damage and high mortality rates. Neuroimaging is essential to evaluate the location and extent of injuries, and to manage them accordingly. Currently, a myriad of imaging modalities are included in the diagnostic workup for adult PBI, including skull radiography, computed tomography (CT), magnetic resonance imaging (MRI) and angiography, with each modality providing their own particular benefits. This literature review explores the current modalities available for investigating PBI and aims to assist in decision making for the appropriate use of diagnostic imaging when presented with an adult PBI. Based on the current literature, the authors have developed an imaging pathway for adult penetrating brain injury that functions as both a learning tool and reference guide for radiographers and other health professionals. Currently, CT is recommended as the imaging modality of choice for the initial assessment of PBI patients, while MRI is important in the sub-acute setting where it aids prognosis prediction and rehabilitation planning, Additional follow-up imaging, such as angiography, should be dependent upon clinical findings

Neuroimaging in adult penetrating brain injury: a guide for radiographers

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Temple, Nikki; Donald, Cortny; Skora, Amanda [Discipline of Medical Radiation Sciences, The University of Sydney, Lidcombe, New South Wales (Australia); Reed, Warren, E-mail: warren.reed@sydney.edu.au [Medical Image Optimisation and Perception Group, Discipline of Medical Radiation Sciences, The University of Sydney, Lidcombe, New South Wales (Australia)

2015-06-15

Penetrating brain injuries (PBI) are a medical emergency, often resulting in complex damage and high mortality rates. Neuroimaging is essential to evaluate the location and extent of injuries, and to manage them accordingly. Currently, a myriad of imaging modalities are included in the diagnostic workup for adult PBI, including skull radiography, computed tomography (CT), magnetic resonance imaging (MRI) and angiography, with each modality providing their own particular benefits. This literature review explores the current modalities available for investigating PBI and aims to assist in decision making for the appropriate use of diagnostic imaging when presented with an adult PBI. Based on the current literature, the authors have developed an imaging pathway for adult penetrating brain injury that functions as both a learning tool and reference guide for radiographers and other health professionals. Currently, CT is recommended as the imaging modality of choice for the initial assessment of PBI patients, while MRI is important in the sub-acute setting where it aids prognosis prediction and rehabilitation planning, Additional follow-up imaging, such as angiography, should be dependent upon clinical findings.

Head injuries (TBI) to adults and children in motor vehicle crashes.

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Viano, David C; Parenteau, Chantal S; Xu, Likang; Faul, Mark

2017-08-18

This is a descriptive study. It determined the annual, national incidence of head injuries (traumatic brain injury, TBI) to adults and children in motor vehicle crashes. It evaluated NASS-CDS for exposure and incidence of various head injuries in towaway crashes. It evaluated 3 health databases for emergency department (ED) visits, hospitalizations, and deaths due to TBI in motor vehicle occupants. Four databases were evaluated using 1997-2010 data on adult (15+ years old) and child (0-14 years old) occupants in motor vehicle crashes: (1) NASS-CDS estimated the annual incidence of various head injuries and outcomes in towaway crashes, (2) National Hospital Ambulatory Medical Care Survey (NHAMCS)-estimated ED visits for TBI, (3) National Hospital Discharge Survey (NHDS) estimated hospitalizations for TBI, and (4) National Vital Statistics System (NVSS) estimated TBI deaths. The 4 databases provide annual national totals for TBI related injury and death in motor vehicle crashes based on differing definitions with TBI coded by the Abbreviated Injury Scale (AIS) in NASS-CDS and by International Classification of Diseases (ICD) in the health data. Adults: NASS-CDS had 16,980 ± 2,411 (risk = 0.43 ± 0.06%) with severe head injury (AIS 4+) out of 3,930,543 exposed adults in towaway crashes annually. There were 49,881 ± 9,729 (risk = 1.27 ± 0.25%) hospitalized with AIS 2+ head injury, without death. There were 6,753 ± 882 (risk = 0.17 ± 0.02%) fatalities with a head injury cause. The public health data had 89,331 ± 6,870 ED visits, 33,598 ± 1,052 hospitalizations, and 6,682 ± 22 deaths with TBI. NASS-CDS estimated 48% more hospitalized with AIS 2+ head injury without death than NHDS occupants hospitalized with TBI. NASS-CDS estimated 29% more deaths with AIS 3+ head injury than NVSS occupant TBI deaths but only 1% more deaths with a head injury cause. Children: NASS-CDS had 1,453 ± 318 (risk = 0.32 ± 0.07%) with severe head injury (AIS 4+) out of 454,973 exposed

Alteration of renal excretion pathways in gentamicin-induced renal injury in rats.

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Ma, Yan-Rong; Luo, Xuan; Wu, Yan-Fang; Zhang, Tiffany; Zhang, Fan; Zhang, Guo-Qiang; Wu, Xin-An

2018-02-20

The kidney plays a major part in the elimination of many drugs and their metabolites, and drug-induced kidney injury commonly alters either glomerular filtration or tubular transport, or both. However, the renal excretion pathway of drugs has not been fully elucidated at different stages of renal injury. This study aimed to evaluate the alteration of renal excretion pathways in gentamicin (GEN)-induced renal injury in rats. Results showed that serum cystatin C, creatinine and urea nitrogen levels were greatly increased by the exposure of GEN (100 mg kg -1 ), and creatinine concentration was increased by 39.7% by GEN (50 mg kg -1 ). GEN dose-dependently upregulated the protein expression of rOCT1, downregulated rOCT2 and rOAT1, but not affected rOAT2. Efflux transporters, rMRP2, rMRP4 and rBCRP expressions were significantly increased by GEN(100), and the rMATE1 level was markedly increased by GEN(50) but decreased by GEN(100). GEN(50) did not alter the urinary excretion of inulin, but increased metformin and furosemide excretion. However, GEN(100) resulted in a significant decrease of the urinary excretion of inulin, metformin and p-aminohippurate. In addition, urinary metformin excretions in vivo were significantly decreased by GEN(100), but slightly increased by GEN(50). These results suggested that GEN(50) resulted in the induction of rOCTs-rMATE1 and rOAT3-rMRPs pathway, but not changed the glomerular filtration rate, and GEN(100)-induced acute kidney injury caused the downregulated function of glomerular filtration -rOCTs-rMATE1 and -rOAT1-rMRPs pathway. Copyright © 2018 John Wiley & Sons, Ltd.

Adult Connection in Assault Injury Prevention among Male Youth in Low-Resource Urban Environments.

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Culyba, Alison J; Miller, Elizabeth; Ginsburg, Kenneth R; Branas, Charles C; Guo, Wensheng; Fein, Joel A; Richmond, Therese S; Halpern-Felsher, Bonnie L; Wiebe, Douglas J

2018-04-26

Strengths-based strategies to reduce youth violence in low-resource urban communities are urgently needed. Supportive adolescent-adult relationships may confer protection, but studies have been limited by self-reported composite outcomes. We conducted a population-based case-control study among 10- to 24-year-old males in low-resource neighborhoods to examine associations between supportive adult connection and severe assault injury. Cases were victims of gunshot assault injury (n = 143) and non-gun assault injury (n = 206) from two level I trauma centers. Age- and race-matched controls (n = 283) were recruited using random digit dial from the same catchment. Adolescent-adult connections were defined by: (1) brief survey questions and (2) detailed family genograms. Analysis used conditional logistic regression. There were no significant associations between positive adult connection, as defined by brief survey questions, and either gunshot or non-gun assault injury among adolescents with high prior violence involvement (GSW OR = 2.46, 95% CI 0.81-7.49; non-gun OR = 1.59, 95% CI 0.54-4.67) or low prior violence involvement (GSW OR = 0.92, 95% CI 0.34-2.44; non-gun OR = 1.96, 95% CI 0.73-5.28). In contrast, among adolescents with high levels of prior violence involvement, reporting at least one supportive adult family member in the family genogram was associated with higher odds of gunshot assault injury (OR = 4.01, 95% CI 1.36-11.80) and non-gun assault injury (OR = 4.22, 95% CI 1.48-12.04). We were thus unable to demonstrate that positive adult connections protected adolescent males from severe assault injury in this highly under-resourced environment. However, at the time of injury, assault-injured adolescents, particularly those with high prior violence involvement, reported high levels of family support. The post-injury period may provide opportunities to intervene to enhance and leverage family connections to explore how to

Structural and Functional Alterations in Neocortical Circuits after Mild Traumatic Brain Injury

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Vascak, Michal

National concern over traumatic brain injury (TBI) is growing rapidly. Recent focus is on mild TBI (mTBI), which is the most prevalent injury level in both civilian and military demographics. A preeminent sequelae of mTBI is cognitive network disruption. Advanced neuroimaging of mTBI victims supports this premise, revealing alterations in activation and structure-function of excitatory and inhibitory neuronal systems, which are essential for network processing. However, clinical neuroimaging cannot resolve the cellular and molecular substrates underlying such changes. Therefore, to understand the full scope of mTBI-induced alterations it is necessary to study cortical networks on the microscopic level, where neurons form local networks that are the fundamental computational modules supporting cognition. Recently, in a well-controlled animal model of mTBI, we demonstrated in the excitatory pyramidal neuron system, isolated diffuse axonal injury (DAI), in concert with electrophysiological abnormalities in nearby intact (non-DAI) neurons. These findings were consistent with altered axon initial segment (AIS) intrinsic activity functionally associated with structural plasticity, and/or disturbances in extrinsic systems related to parvalbumin (PV)-expressing interneurons that form GABAergic synapses along the pyramidal neuron perisomatic/AIS domains. The AIS and perisomatic GABAergic synapses are domains critical for regulating neuronal activity and E-I balance. In this dissertation, we focus on the neocortical excitatory pyramidal neuron/inhibitory PV+ interneuron local network following mTBI. Our central hypothesis is that mTBI disrupts neuronal network structure and function causing imbalance of excitatory and inhibitory systems. To address this hypothesis we exploited transgenic and cre/lox mouse models of mTBI, employing approaches that couple state-of-the-art bioimaging with electrophysiology to determine the structuralfunctional alterations of excitatory and

Analysis of Injury Incidences in Male Professional Adult and Elite Youth Soccer Players: A Systematic Review.

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Pfirrmann, Daniel; Herbst, Mark; Ingelfinger, Patrick; Simon, Perikles; Tug, Suzan

2016-05-01

The incidence of injury for elite youth and professional adult soccer players is an important concern, but the risk factors for these groups are different. To summarize and compare the injury incidences and injury characteristics of male professional adult and elite youth soccer players. We searched MEDLINE and Web of Science using the search terms elite, international, European, soccer, football, injury, injuries, epidemiology, incidence, prevalence, not female, not American football, and not rugby. We also used the search terms professional for studies on professional adult soccer players and high-level, soccer academy, youth, adolescent, and young for studies on elite youth soccer players. Eligible studies were published in English, had a prospective cohort design, and had a minimum study period of 6 months. To ensure that injury data were assessed in relationship to the athlete's individual exposure, we included only studies that reported on injuries and documented exposure volume. Two independent reviewers applied the selection criteria and assessed the quality of the studies. A total of 676 studies were retrieved from the literature search. Eighteen articles met the inclusion criteria: 6 for elite youth and 12 for professional adult soccer players. Injury rates were higher for matches than for training for both youth and adult players. Youth players had a higher incidence of training injuries than professionals. Efforts must be made to reduce the overall injury rate in matches. Therefore, preventive interventions, such as adequately enforcing rules and focusing on fair play, must be analyzed and developed to reduce match-related injury incidences. Reducing training injuries should be a particular focus for youth soccer players.

Youth Versus Adult “Weightlifting” Injuries Presenting to United States Emergency Rooms: Accidental Versus Nonaccidental Injury Mechanisms

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Myer, Gregory D.; Quatman, Carmen E.; Khoury, Jane; Wall, Eric J.; Hewett, Timothy E.

2014-01-01

Myer, GD, Quatman, CE, Khoury, J, Wall, EJ, and Hewett, TE. Youth versus adult “weightlifting” injuries presenting to united states emergency rooms: accidental versus nonaccidental injury mechanisms. J Strength Cond Res 23(7): 2054–2060, 2009—Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. emergency rooms by age, type, and mechanism of injury. We hypothesized that older athletes would sustain greater percentages of joint sprains and muscle strains, whereas younger athletes would sustain a greater percentage of accidental injuries that would result in an increased percentage of fractures in youths. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System was queried from 2002 to 2005 using the CPSC code for “Weightlifting.” Subjects between the ages of 8 and 30 were grouped by age categories 8 to 13 (elementary/middle school age), 14 to 18 (high school), 19 to 22 (college), and 23 to 30 (adult). Injuries were classified as “accidental” if caused by dropped weight or improper equipment use. Multiple logistic regression was used to compare accidental injuries between age groups. The sample consisted of 4, 111 patients. Accidental injuries decreased (p 14 to 18 > 19 to 22 years = 23 to 30 years. Conversely, sprain/strain injuries increased in each successive age group (p injuries (n = 2, 565) showed that the oldest categories (19–22 and 23–30 yr) demonstrated a greater percentage of sprains and strains relative to younger age categories (p injuries sustained in the 8 to 13 group were to the hand and foot and were most often related to “dropping” and “pinching” in the injury descriptions, and there was an increased percentage of fractures in the 8 to 13 group relative to all other groups (p injuries are the result of accidents that are potentially

Alterations in the Timing of Huperzine A Cerebral Pharmacodynamics in the Acute Traumatic Brain Injury Setting.

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Damar, Ugur; Gersner, Roman; Johnstone, Joshua T; Kapur, Kush; Collins, Stephen; Schachter, Steven; Rotenberg, Alexander

2018-01-15

Traumatic brain injury (TBI) may affect the pharmacodynamics of centrally acting drugs. Paired-pulse transcranial magnetic stimulation (ppTMS) is a safe and noninvasive measure of cortical gamma-aminobutyric acid (GABA)-mediated cortical inhibition. Huperzine A (HupA) is a naturally occurring acetylcholinesterase inhibitor with newly discovered potent GABA-mediated antiepileptic capacity, which is reliably detected by ppTMS. To test whether TBI alters cerebral HupA pharmacodynamics, we exposed rats to fluid percussion injury (FPI) and tested whether ppTMS metrics of cortical inhibition differ in magnitude and temporal pattern in injured rats. Anesthetized adult rats were exposed to FPI or sham injury. Ninety minutes post-TBI, rats were injected with HupA or saline (0.6 mg/kg, intraperitoneally). TBI resulted in reduced cortical inhibition 90 min after the injury (N = 18) compared to sham (N = 13) controls (p = 0.03). HupA enhanced cortical inhibition after both sham injury (N = 6; p = 0.002) and TBI (N = 6; p = 0.02). The median time to maximum HupA inhibition in sham and TBI groups were 46.4 and 76.5 min, respectively (p = 0.03). This was consistent with a quadratic trend comparison that projects HupA-mediated cortical inhibition to last longer in injured rats (p = 0.007). We show that 1) cortical GABA-mediated inhibition, as measured by ppTMS, decreases acutely post-TBI, 2) HupA restores lost post-TBI GABA-mediated inhibition, and 3) HupA-mediated enhancement of cortical inhibition is delayed post-TBI. The plausible reasons of the latter include 1) low HupA volume of distribution rendering HupA confined in the intravascular compartment, therefore vulnerable to reduced post-TBI cerebral perfusion, and 2) GABAR dysfunction and increased AChE activity post-TBI.

Adult sports-related traumatic brain injury in United States trauma centers.

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Winkler, Ethan A; Yue, John K; Burke, John F; Chan, Andrew K; Dhall, Sanjay S; Berger, Mitchel S; Manley, Geoffrey T; Tarapore, Phiroz E

2016-04-01

OBJECTIVE Sports-related traumatic brain injury (TBI) is an important public health concern estimated to affect 300,000 to 3.8 million people annually in the United States. Although injuries to professional athletes dominate the media, this group represents only a small proportion of the overall population. Here, the authors characterize the demographics of sports-related TBI in adults from a community-based trauma population and identify predictors of prolonged hospitalization and increased morbidity and mortality rates. METHODS Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from adults (age ≥ 18 years) across 5 sporting categories-fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged hospital length of stay (LOS), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α sports-related TBIs were documented in the NTDB, which represented 18,310 incidents nationally. Equestrian sports were the greatest contributors to sports-related TBI (45.2%). Mild TBI represented nearly 86% of injuries overall. Mean (± SEM) LOSs in the hospital or intensive care unit (ICU) were 4.25 ± 0.09 days and 1.60 ± 0.06 days, respectively. The mortality rate was 3.0% across all patients, but was statistically higher in TBI from roller sports (4.1%) and aquatic sports (7.7%). Age, hypotension on admission to the emergency department (ED), and the severity of head and extracranial injuries were statistically significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Traumatic brain injury during aquatic sports was similarly associated with prolonged ICU and hospital LOSs, medical complications, and failure to be discharged to

Lifetime History of Traumatic Brain Injury and Current Disability Among Ohio Adults.

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Yi, Honggang; Corrigan, John D; Singichetti, Bhavna; Bogner, Jennifer A; Manchester, Kara; Guo, Jinhong; Yang, Jingzhen

2017-10-27

To examine the associations between lifetime history of traumatic brain injury (TBI) with loss of consciousness (LOC) and several types of current disability among adult, noninstitutionalized residents of Ohio. 2014 Ohio Behavioral Risk Factors Surveillance System participants (n = 6998). Statewide population-based survey. Lifetime history of TBI with LOC (number and severity of injury, age of first injury), and number and type of disability (vision, cognition, mobility, self-care, and/or independent living). Of the 6998 participants, 1325 reported lifetime history of TBI with LOC, and 1959 reported currently having one or more disabilities. When weighted, these represented 21.7% and 23.7% of Ohio's noninstitutionalized adult population, respectively. Adults with a history of TBI with LOC showed greater odds of any disability compared with adults with no history (odds ratio = 2.49; 95% confidence interval = 1.97-3.15). The likelihood of having any and each type of disability increased as the number of TBIs or the severity of worst TBI increased, regardless of sustaining first TBI before or after the age of 15 years. Lifetime history of TBI with LOC is significantly associated with disability among Ohio adults. Further research on the natural course of the relation and preventive strategies is warranted.

A comparison study of pelvic fractures and associated abdominal injuries between pediatric and adult blunt trauma patients.

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Swaid, Forat; Peleg, Kobi; Alfici, Ricardo; Olsha, Oded; Givon, Adi; Kessel, Boris

2017-03-01

Pelvic fractures are a marker of severe injury, mandating a thorough investigation for the presence of associated injuries. Anatomical and physiological differences between adults and children may lead to a different impact of pelvic fractures on these populations. The purpose of this study is to compare pelvic fractures between pediatric and adult blunt trauma victims, mainly regarding their severity and associated intraabdominal injuries. A retrospective study involving blunt trauma patients suffering pelvic fractures, according to the records of the Israeli National Trauma Registry. Patients included children, aged 0-14years, and adults between 15 and 64years. The presence and severity of associated injuries were assessed. Overall, 7621 patients aged 0-64years were identified with pelvic fractures following blunt trauma. The incidence of pelvic fractures in children was (0.8%), as compared to 4.3% in adults, p 25. Adults sustained significantly more moderate to severe pelvic fractures (AIS≥3) than children (26.7% vs. 17.4%, psplenic and hepatic injuries (p=0.026, p=0.0004, respectively). Among children, a similar correlation was not demonstrated. Adults involved in blunt trauma are more likely to sustain pelvic fractures, and these are generally more severe fractures, as compared to children suffering from blunt trauma. Nonetheless, mortality rates were found similar in both groups. The only associated injury with statistically significant difference in incidence among the two groups was rectal injury. In adults, but not in children, higher grade pelvic fractures correlated with more severe concomitant splenic or hepatic injuries. The level of evidence for this study is III (3). Copyright © 2016 Elsevier Inc. All rights reserved.

Injury prevention for adult male soccer players. Blessure preventie voor volwassen, mannelijke voetballers

NARCIS (Netherlands)

Beijsterveldt, A.M.C. van

2013-01-01

Soccer causes the largest number of injuries each year (18% of all sports injuries) in the Netherlands. The aim of this dissertation is to contribute to the body of evidence on injury prevention for adult male soccer players. Chapter 1 is a general introduction and presents the “sequence of

Dysphagia and Speech-Language Pathology Involvement Following Chemical Ingestion Injury: A Review of 44 Cases Admitted to a Quaternary Australian Hospital (2008-2012).

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Rumbach, Anna F; Cremer, Rebecca

2017-11-08

This study aimed to explore the clinical characteristics of an adult chemical ingestion population and examine the course of return to oral intake post injury and speech-language pathologist (SLP) involvement during the initial acute-care admission. A retrospective chart review of adults admitted to a quaternary hospital for the treatment of an acute chemical ingestion injury between 2008 and 2012 was conducted. Forty-four adults (23 men, 21 women) were identified as receiving treatment for ingestion injury, of whom 18 (40.91%) required altered oral intake. Of those requiring altered oral intake, 50% were referred to SLPs. Individuals requiring altered oral intake were significantly (p < .05) older, more likely to be men, and present with more severe injuries requiring longer ICU and hospital admissions following intentional chemical ingestions than those who were able to commence a normal oral diet without any alteration or nonoral supplementation. By discharge, 15.91% (n = 7) of the total cohort had not resumed normal oral intake. Return to oral intake post chemical ingestion injury can be protracted and complex. Referrals to SLPs were limited. These data may aid prognostic insight as well as provide (a) collateral information to assist discharge planning and follow-up and (b) background for evaluating the potential for SLP involvement.

Plasticity and alterations of trunk motor cortex following spinal cord injury and non-stepping robot and treadmill training.

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Oza, Chintan S; Giszter, Simon F

2014-06-01

Spinal cord injury (SCI) induces significant reorganization in the sensorimotor cortex. Trunk motor control is crucial for postural stability and propulsion after low thoracic SCI and several rehabilitative strategies are aimed at trunk stability and control. However little is known about the effect of SCI and rehabilitation training on trunk motor representations and their plasticity in the cortex. Here, we used intracortical microstimulation to examine the motor cortex representations of the trunk in relation to other representations in three groups of chronic adult complete low thoracic SCI rats: chronic untrained, treadmill trained (but 'non-stepping') and robot assisted treadmill trained (but 'non-stepping') and compared with a group of normal rats. Our results demonstrate extensive and significant reorganization of the trunk motor cortex after chronic adult SCI which includes (1) expansion and rostral displacement of trunk motor representations in the cortex, with the greatest significant increase observed for rostral (to injury) trunk, and slight but significant increase of motor representation for caudal (to injury) trunk at low thoracic levels in all spinalized rats; (2) significant changes in coactivation and the synergy representation (or map overlap) between different trunk muscles and between trunk and forelimb. No significant differences were observed between the groups of transected rats for the majority of the comparisons. However, (3) the treadmill and robot-treadmill trained groups of rats showed a further small but significant rostral migration of the trunk representations, beyond the shift caused by transection alone. We conclude that SCI induces a significant reorganization of the trunk motor cortex, which is not qualitatively altered by non-stepping treadmill training or non-stepping robot assisted treadmill training, but is shifted further from normal topography by the training. This shift may potentially make subsequent rehabilitation with

ANOTHER "LETHAL TRIAD"-RISK FACTORS FOR VIOLENT INJURY AND LONG-TERM MORTALITY AMONG ADULT VICTIMS OF VIOLENT INJURY.

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Laytin, Adam D; Shumway, Martha; Boccellari, Alicia; Juillard, Catherine J; Dicker, Rochelle A

2018-04-14

Mental illness, substance abuse, and poverty are risk factors for violent injury, and violent injury is a risk factor for early mortality that can be attenuated through hospital-based violence intervention programs. Most of these programs focus on victims under the age of 30 years. Little is known about risk factors or long-term mortality among older victims of violent injury. To explore the prevalence of risk factors for violent injury among younger (age < 30 years) and older (age 30 ≥ years) victims of violent injury, to determine the long-term mortality rates in these age groups, and to explore the association between risk factors for violent injury and long-term mortality. Adults with violent injuries were enrolled between 2001 and 2004. Demographic and injury data were recorded on enrollment. Ten-year mortality rates were measured. Descriptive analysis and logistic regression were used to compare older and younger subjects. Among 541 subjects, 70% were over age 30. The overall 10-year mortality rate was 15%, and was much higher than in the age-matched general population in both age groups. Risk factors for violent injury including mental illness, substance abuse, and poverty were prevalent, especially among older subjects, and were each independently associated with increased risk of long-term mortality. Mental illness, substance abuse, and poverty constitute a "lethal triad" that is associated with an increased risk of long-term mortality among victims of violent injury, including both younger adults and those over age 30 years. Both groups may benefit from targeted risk-reduction efforts. Emergency department visits offer an invaluable opportunity to engage these vulnerable patients. Copyright © 2018 Elsevier Inc. All rights reserved.

Factors affecting mortality in severe traumatic brain injury in adults at ...

African Journals Online (AJOL)

Objective: To assess factors contributing to mortality of adult patients admitted to intensive care units for severe traumatic brain injury (TBI). Patients and methods: This is a retrospective, descriptive and analytical study. Included in the study were all adults patients admitted for severe TBI. From the hospital records, ...

Management of spleen injuries in the adult trauma population: a ten-year experience.

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Cadeddu, Margherita; Garnett, Anna; Al-Anezi, Khaled; Farrokhyar, Forough

2006-12-01

Increasing awareness of the postoperative risks associated with splenectomies has led physicians and surgeons to use an alternative nonoperative strategy in handling traumatic spleen injuries. Our primary objective was to compare clinical outcomes between operative and nonoperative managements in adult patients with blunt splenic injuries. The secondary objective was to assess the changes in the patterns of managing splenic injuries in the past 10 years. We performed a retrospective chart review on 266 adult patients with a spleen injury who were admitted to a tertiary trauma centre in Ontario between 1992 and 2001. We grouped and compared the patients according to the treatment received, either operative or nonoperative. Frequencies and confidence intervals are reported. Categorical variables were compared with chi-square or Fisher's exact tests. Continuous variables were reported as median and quartile (Q) and were compared with the nonparametric Mann-Whitney U test. Of 266 patients, 118 had surgery and 148 were managed nonoperatively. The mortality rate was similar between operative and nonoperative groups (9.3% v. 6.8%, p = 0.49), respectively. The rate of any complication was 47.9% for the operative group and 37.9% for the nonoperative group. The median length of stay in hospital was significantly higher in the operative group than in the nonoperative group (21.0 [Q 11.0-40.5] v. 14.0 [Q 7.0-31.5] d, p trauma has increased over time and has acceptable mortality and complication rates in selected patients. Additional prospective studies are needed to assess the feasibility and safety of nonoperative management in adult spleen injuries. Furthermore, the management of traumatic spleen injuries with respect to associated injuries, such as head injuries or intra-abdominal injuries, needs ongoing evaluation.

The utility of presacral drainage in penetrating rectal injuries in adult and pediatric patients.

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Savoie, Kate B; Beazley, Thomas M; Cleveland, Brent; Khaneki, Sina; Markel, Troy A; Hammer, Peter M; Savage, Stephanie; Williams, Regan F

2017-11-01

With changing weaponry associated with injuries in civilian trauma, there is no clinical census on the utility of presacral drainage (PSD) in penetrating rectal injuries (PRIs), particularly in pediatric patients. Patients with PRI from July 2004-June 2014 treated at two free-standing children's hospitals and two adult level 1 trauma centers were compared by age (pediatric patients ≤16 years) and PSD. A stratified analysis was performed based on age. The primary outcome was pelvic/presacral abscess. We identified 81 patients with PRI; 19 pediatric, 62 adult. Forty patients had PSD; only three pediatric patients had a drain. Adult patients were more likely to have sustained gunshot wounds (84%), whereas pediatric patients were more likely to sustain impalement injuries (59%). Pediatric patients were more likely to have distal extraperitoneal injuries (56% versus 27% in adults, P = 0.03). PSD was more common in adult patients (59% versus 14%, P = 0.0004), African-Americans (71% versus 11% Caucasian, P adult and pediatric patients. There were three cases of pelvic/presacral abscess, all in the adult patients (P = 0.31); one patient with PSD and two without PSD (P = 0.58). In stratified analysis, there were no differences in any infectious complication between those with and without PSD. Pelvic/presacral abscess is a rare complication of PRI, especially in pediatric patients. PSD is not associated with decreased rates of infectious complications and may not be necessary in the treatment of PRI. Copyright © 2017 Elsevier Inc. All rights reserved.

Adult tibial intercondylar eminence fracture: evaluation with MR imaging

International Nuclear Information System (INIS)

Toye, Leon R.; Cummings, Dean P.; Armendariz, Gus

2002-01-01

Tibial intercondylar eminence (TIE) fractures are well described in the pediatric orthopedic literature. Adult TIEs are much less common, and limited literature exists on the subject. Adult knee hyperextension injuries commonly result in anterior cruciate ligament (ACL) injury; however, with significant trauma, a TIE enters the differential diagnosis. Identification and classification of TIE fractures typically has been provided by radiography. The incidence of concomitant injuries with magnetic resonance (MR) imaging in patients with adult TIE fractures has not been determined. We present a case of an adult type III TIE fracture seen on radiography that only with further MR imaging revealed a concomitant lateral tibial plateau fracture. Utilization of MR imaging altered the surgeon's course of treatment and postoperative care. Radiographic and MR images and a review of the literature are provided. (orig.)

Trends in fall-related injuries among older adults treated in emergency departments in the USA.

Science.gov (United States)

Orces, Carlos H; Alamgir, Hasanat

2014-12-01

To examine national trends in fall-related injuries among older adults treated in emergency departments (ED) and project these injuries until the year 2030. The Web-based Injury Statistics Query and Reporting System was used to generate data on fall-related injuries treated in ED. Joinpoint regression analysis was used to examine the average annual change in injury rates over time. Fall-related injury and hospitalisation rates increased on average by 2% (95% CI 1.5% to 2.7%) and by 4% (95% CI 2.9% to 5.0%) per year, respectively. Assuming the increase in fall-related injury rates remains unchanged, the number of fall-related injuries may increase to 5.7 million by the year 2030. Fall-related injuries among older adults treated in ED increased in the USA during the study period. Moreover, a marked increase in the number of these injuries may occur over the next decades. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Traumatic brain injury alters methionine metabolism: implications for pathophysiology

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Pramod K Dash

2016-04-01

Full Text Available Methionine is an essential proteinogenic amino acid that is obtained from the diet. In addition to its requirement for protein biosynthesis, methionine is metabolized to generate metabolites that play key roles in a number of cellular functions. Metabolism of methionine via the transmethylation pathway generates S-adenosylmethionine (SAM that serves as the principal methyl (-CH3 donor for DNA and histone methyltransferases to regulate epigenetic changes in gene expression. SAM is also required for methylation of other cellular proteins that serve various functions and phosphatidylcholine synthesis that participate in cellular signaling.. Under conditions of oxidative stress, homocysteine (which is derived from SAM enters the transsulfuration pathway to generate glutathione, an important cytoprotective molecule against oxidative damage. As both experimental and clinical studies have shown that traumatic brain injury (TBI alters DNA and histone methylation and causes oxidative stress, we examined if TBI alters the plasma levels of methionine and its metabolites in human patients. Blood samples were collected from healthy volunteers (n = 20 and patients with mild TBI (GCS > 12; n = 20 or severe TBI (GCS < 8; n = 20 within the first 24 hours of injury. The levels of methionine and its metabolites in the plasma samples were analyzed by either liquid chromatography-mass spectrometry or gas chromatography-mass spectrometry (LC-MS or GC-MS. Severe TBI decreased the levels of methionine, SAM, betaine and 2-methylglycine as compared to healthy volunteers, indicating a decrease in metabolism through the transmethylation cycle. In addition, precursors for the generation of glutathione, cysteine and glycine were also found to be decreased as were intermediate metabolites of the gamma-glutamyl cycle (gamma-glutamyl amino acids and 5-oxoproline. Mild TBI also decreased the levels of methionine, α-ketobutyrate, 2 hydroxybutyrate and glycine, albeit to lesser

The "sequence of prevention" for musculoskeletal injuries among adult recreational footballers: A systematic review of the scientific literature.

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Kilic, Ozgur; Kemler, Ellen; Gouttebarge, Vincent

2018-02-02

To gather epidemiological information related to all steps of Van Mechelen's "sequence of prevention" for musculoskeletal injuries among adult recreational football players. A systematic review of the scientific literature was conducted in Medline via Pubmed. Therefore, two highly sensitive search strategies based on three groups of keywords (and related search terms) were used. In total, 33 relevant original studies were included in our systematic review. The results of our systematic review showed that the incidence of musculoskeletal injuries among recreational adult football players ranged from 9.6 to 15.8 injuries per 1000 exposure hours. These injuries are especially located in the ankle, knee, groin and hamstring, being associated with previous injury and match exposure. The FIFA11 + injury prevention programme and the Nordic Hamstring Exercise (NHE) were found to be effective for the reduction or prevention of musculoskeletal injuries among adult recreational football players. Our systematic review showed that musculoskeletal injuries are common among recreational adult football players, while effective preventive programmes are available. Further studies should focus on the identification and understanding of the key factors responsible for the optimal adoption, implementation and maintenance of these measures. Copyright © 2018 Elsevier Ltd. All rights reserved.

Effectiveness of an injury prevention programme for adult male amateur soccer players: a cluster-randomised controlled trial

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van Beijsterveldt, Anna M C; van de Port, Ingrid G L; Krist, Mark R; Schmikli, Sandor L; Stubbe, Janine H; Frederiks, Janet E; Backx, Frank J G

2012-01-01

Background The incidence rate of soccer injuries is among the highest in sports, particularly for adult male soccer players. Purpose To investigate the effect of the ‘The11’ injury prevention programme on injury incidence and injury severity in adult male amateur soccer players. Study design Cluster-randomised controlled trial. Methods Teams from two high-level amateur soccer competitions were randomly assigned to an intervention (n=11 teams, 223 players) or control group (n=12 teams, 233 players). The intervention group was instructed to perform The11 in each practice session during one soccer season. The11 focuses on core stability, eccentric training of thigh muscles, proprioceptive training, dynamic stabilisation and plyometrics with straight leg alignment. All participants of the control group continued their practice sessions as usual. Results In total, 427 injuries were recorded, affecting 274 of 456 players (60.1%). Compliance with the intervention programme was good (team compliance=73%, player compliance=71%). Contrary to the hypothesis, injury incidences were almost equal between the two study groups: 9.6 per 1000 sports hours (8.4–11.0) for the intervention group and 9.7 (8.5–11.1) for the control group. No significant differences were found in injury severity, but a significant difference was observed in the location of the injuries: players in the intervention group sustained significantly less knee injuries. Conclusions This study did not find significant differences in the overall injury incidence or injury severity between the intervention and control group of adult male soccer players. More research is recommended, focusing on injury aetiology and risk factors in adult male amateur soccer players. PMID:22878257

Preventing musculoskeletal injuries among recreational adult volleyball players: design of a randomised prospective controlled trial.

Science.gov (United States)

Gouttebarge, Vincent; Zwerver, Johannes; Verhagen, Evert

2017-08-02

Both acute and overuse injuries are common among recreational volleyball players, especially finger/wrist, ankle, shoulder and knee injuries. Consequently, an intervention ('VolleyVeilig') was developed to prevent or reduce the occurrence of finger/wrist, shoulder, knee and ankle injuries among recreational volleyball players. This article describes the design of a study evaluating the effectiveness of the developed intervention on the one-season occurrence of finger/wrist, shoulder, knee and ankle injuries among recreational adult volleyball players. A randomized prospective controlled trial with a follow-up period of one volleyball season will be conducted. Participants will be healthy recreational adult volleyball players (18 years of age or older) practicing volleyball (training and/or match) at least twice a week. The intervention ('VolleyVeilig') consists of a warm-up program based on more than 50 distinct exercises (with different variations and levels). The effect of the intervention programme on the occurrence of injuries will be compared to volleyball as usual. Outcome measures will be incidence of acute injury (expressed as number of injuries per 1000 h of play) and prevalence of overuse injuries (expressed as percentage). This study will be one of the first randomized prospective controlled trials evaluating the effectiveness of an intervention on the occurrence of both acute and overuse injuries among recreational adult volleyball players. Outcome of this study could possibly lead to the nationwide implementation of the intervention in all volleyball clubs in The Netherlands, ultimately resulting in less injuries. Dutch Trial Registration NTR6202 , registered February 1st 2017. Version 3, February 2017.

Increased risk of unintentional injuries in adults with disabilities: a systematic review and meta-analysis.

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Shi, Xiuquan; Wheeler, Krista K; Shi, Junxin; Stallones, Lorann; Ameratunga, Shanthi; Shakespeare, Tom; Xiang, Huiyun

2015-04-01

An increased risk of unintentional injuries among individuals with disability has been reported in many studies, yet quantitative syntheses of findings from previous studies have not been done. We conducted a systematic review and meta-analysis to characterize the relationship between pre-existing disability and unintentional injuries. We searched 14 electronic databases to identify original research published between Jan 1, 1990 and Feb 28, 2013. Included studies reported the odds ratio (OR) or relative risk (RR) of unintentional injuries in adults 18+ years of age with pre-existing disabilities compared with adults without disabilities. Twenty six eligible studies were included covering 54,586 individuals with disabilities. We conducted quality assessments and then analyzed the pooled effects using random-effect models. The pooled OR of unintentional injuries was 1.77 (95% CI 1.51-2.07) for all studies in individuals with disabilities compared with individuals without disabilities. The pooled ORs were 1.87 (95% CI 1.52-2.30) for overall unintentional injuries, 1.64 (95% CI 1.39-1.94) for falls-related injuries, 1.62 (95% CI 1.24-2.13) for occupational injuries, and 1.91 (95% CI 1.59-2.30) for non-occupational injuries. Compared with adults without disabilities, individuals with disabilities are at a significantly higher risk of unintentional injuries. Evidence about the association between cognitive disabilities and unintentional injuries is weak. Future researchers are encouraged to use International Classification of Functioning, Disability and Health (ICF) to classify disability and use rigorous evaluation methods to assess and implement the most appropriate injury prevention efforts to mitigate the risks identified. Copyright © 2015 Elsevier Inc. All rights reserved.

A population-based study examining injury among older adults with and without dementia

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Lynn Meuleners

2017-04-01

Older adults with dementia were at increased risk of an admission for an injury compared to those without dementia. Multifactorial injury prevention programs should target older people with dementia, those over 85 years, living alone and with a history of previous falls.

Intermittent Hypoxia Causes Inflammation and Injury to Human Adult Cardiac Myocytes.

Science.gov (United States)

Wu, Jing; Stefaniak, Joanna; Hafner, Christina; Schramel, Johannes Peter; Kaun, Christoph; Wojta, Johann; Ullrich, Roman; Tretter, Verena Eva; Markstaller, Klaus; Klein, Klaus Ulrich

2016-02-01

Intermittent hypoxia may occur in a number of clinical scenarios, including interruption of myocardial blood flow or breathing disorders such as obstructive sleep apnea. Although intermittent hypoxia has been linked to cardiovascular and cerebrovascular disease, the effect of intermittent hypoxia on the human heart is not fully understood. Therefore, in the present study, we compared the cellular responses of cultured human adult cardiac myocytes (HACMs) exposed to intermittent hypoxia and different conditions of continuous hypoxia and normoxia. HACMs were exposed to intermittent hypoxia (0%-21% O2), constant mild hypoxia (10% O2), constant severe hypoxia (0% O2), or constant normoxia (21% O2), using a novel cell culture bioreactor with gas-permeable membranes. Cell proliferation, lactate dehydrogenase release, vascular endothelial growth factor release, and cytokine (interleukin [IL] and macrophage migration inhibitory factor) release were assessed at baseline and after 8, 24, and 72 hours of exposure. A signal transduction pathway finder array was performed to determine the changes in gene expression. In comparison with constant normoxia and constant mild hypoxia, intermittent hypoxia induced earlier and greater inflammatory response and extent of cell injury as evidenced by lower cell numbers and higher lactate dehydrogenase, vascular endothelial growth factor, and proinflammatory cytokine (IL-1β, IL-6, IL-8, and macrophage migration inhibitory factor) release. Constant severe hypoxia showed more detrimental effects on HACMs at later time points. Pathway analysis demonstrated that intermittent hypoxia primarily altered gene expression in oxidative stress, Wnt, Notch, and hypoxia pathways. Intermittent and constant severe hypoxia, but not constant mild hypoxia or normoxia, induced inflammation and cell injury in HACMs. Cell injury occurred earliest and was greatest after intermittent hypoxia exposure. Our in vitro findings suggest that intermittent hypoxia

Combination of Radiation and Burn Injury Alters FDG Uptake in Mice

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Carter, Edward A.; Winter, David; Tolman, Crystal; Paul, Kasie; Hamrahi, Victoria; Tompkins, Ronald; Fischman, Alan J.

2012-01-01

Radiation exposure and burn injury have both been shown to alter glucose utilization in vivo. The present study was designed to study the effect of burn injury combined with radiation exposure, on glucose metabolism in mice using [18F] Fluorodeoxyglucose (18FDG). Groups of male mice weighing approximately 30g were studied. Group 1 was irradiated with a 137Cs source (9 Gy). Group 2 received full thickness burn injury on 25% total body surface area followed by resuscitated with saline (2mL, IP). Group 3 received radiation followed 10 minutes later by burn injury. Group 4 were sham treated controls. After treatment, the mice were fasted for 23 hours and then injected (IV) with 50 µCi of 18FDG. One hour post injection, the mice were sacrificed and biodistribution was measured. Positive blood cultures were observed in all groups of animals compared to the shams. Increased mortality was observed after 6 days in the burn plus radiated group as compared to the other groups. Radiation and burn treatments separately or in combination produced major changes in 18FDG uptake by many tissues. In the heart, brown adipose tissue (BAT) and spleen, radiation plus burn produced a much greater increase (p<0.0001) in 18FDG accumulation than either treatment separately. All three treatments produced moderate decreases in 18FDG accumulation (p<0.01) in the brain and gonads. Burn injury, but not irradiation, increased 18FDG accumulation in skeletal muscle; however the combination of burn plus radiation decreased 18FDG accumulation in skeletal muscle. This model may be useful for understanding the effects of burns + irradiation injury on glucose metabolism and in developing treatments for victims of injuries produced by the combination of burn plus irradiation. PMID:23143615

Herbicide injury induces DNA methylome alterations in Arabidopsis

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Gunjune Kim

2017-07-01

Full Text Available The emergence of herbicide-resistant weeds is a major threat facing modern agriculture. Over 470 weedy-plant populations have developed resistance to herbicides. Traditional evolutionary mechanisms are not always sufficient to explain the rapidity with which certain weed populations adapt in response to herbicide exposure. Stress-induced epigenetic changes, such as alterations in DNA methylation, are potential additional adaptive mechanisms for herbicide resistance. We performed methylC sequencing of Arabidopsis thaliana leaves that developed after either mock treatment or two different sub-lethal doses of the herbicide glyphosate, the most-used herbicide in the history of agriculture. The herbicide injury resulted in 9,205 differentially methylated regions (DMRs across the genome. In total, 5,914 of these DMRs were induced in a dose-dependent manner, wherein the methylation levels were positively correlated to the severity of the herbicide injury, suggesting that plants can modulate the magnitude of methylation changes based on the severity of the stress. Of the 3,680 genes associated with glyphosate-induced DMRs, only 7% were also implicated in methylation changes following biotic or salinity stress. These results demonstrate that plants respond to herbicide stress through changes in methylation patterns that are, in general, dose-sensitive and, at least partially, stress-specific.

The epidemiology of sports-related injuries in older adults: a central European epidemiologic study.

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Kammerlander, Christian; Braito, Matthias; Kates, Stephen; Jeske, Christian; Roth, Tobias; Blauth, Michael; Dallapozza, Christian

2012-10-01

The population is rapidly aging and remaining more active over the age of 65. An increasing number of sports related injuries in individuals 65 and older are thus anticipated. The aim of this study is to analyze the epidemiology of sports injuries in the age group aged 65 and older. Data from the medical records of adults aged 65 years and older who were treated for sports-related injuries at a level one trauma center between December 1994 and February 2008 was collected and statistically analyzed. A total of 2635 patients met our inclusion criteria. There were 1647 men (62.5%) and 988 women (37.5%) with a mean age of 70.9 years. The yearly number of injuries doubled during the study period (1996-2007). The most common mechanism of injury was a simple fall from standing height (69%). Nearly 75% of all injuries occurred during alpine skiing, cycling or mountain climbing. The median Injury Severity Score was 4. Minor injuries and wounds (40%) were recorded most commonly followed by fractures (27%), sprains, ligament injuries (19%) and injuries of muscles and tendons (6%). The most frequent diagnoses were minor injuries to the head and ligament injuries around the knee joint. Injuries to the upper extremities occurred in 33.7%, injuries to the lower extremities in 29.4% and injuries to the head occurred in 20% of the patients. Women sustained substantially more fractures than men. Adults aged 65 and older are remaining active in sports, which results in higher numbers of sports related injuries in this age group. Identification of type, mechanism and distribution of the injuries can help with the recognition of risk factors for injury. This may enable us to develop appropriate preventative measures to reduce the incidence, and morbidity of such injuries.

Early endocrine alterations reflect prolonged stress and relate to one year functional outcome in patients with severe brain injury

DEFF Research Database (Denmark)

Marina, Djordje; Klose, Marianne; Nordenbo, Annette

2015-01-01

OBJECTIVE: Severe brain injury poses a risk of developing acute and chronic hypopituitarism. Pituitary hormone alterations developed in the early recovery phase after brain injury may have implications for long-term functional recovery. The objective was to assess the pattern and prevalence...

[A study on incidence of injury and its socio-economic loss in children and young adults].

Science.gov (United States)

Wang, S; Guo, C; Zhang, G; Lu, G; Li, L; Lin, H; Fan, C; Huang, G; Zhou, C; Lu, Y

2000-07-01

To study the current status of incidence of injury among children and young adults and the causes of common injuries, and to estimate its socio-economic loss and extent of harmfulness. Pupils in 19 primary and middle schools aged 7 to 18 years, totaling 14,533, were recruited with stratified cluster sampling during 1998 to 1999 in Guangzhou, Maoming, Jiangmen and Shantou. Judgement for injury was based on the following criteria: (1) diagnosed and treated in hospitals or school clinics, (2) a half-day off or more due to injury, and (3) emergency management by pupils' parents or teachers. There were 6 941 pupils suffered from varied injures during the year, with an incidence rate of 47.76% (50.08% for boys and 45.02% for girls). Incidence rate of injury was higher in the middle school pupils (13 - 18 years old, 58.49%) than that in the primary school pupils (7 - 12 years old, 40.08%). The incidence increased significantly with age, with a peak at ages of 13 - 15. Major causes of injuries resulted from falls, injury by sharp articles, collision, traffic injuries and burn/scalds, etc, which usually occurred due to carelessness in sports, playing, walking, bike-riding and working. Frequency of multiple injuries related to the educational level of parents and depended on whether or not an only-child in family. There were 2,173 injured pupils (accounting for 31.3% of the total) visited clinics or emergency department in hospitals and 627 (9.0%) hospitalized for treatment. Twenty-eight percent of the injured pupils were absent from school, with an average absenteeism of 5.6 days. There were 154 injured pupils with transient disability and 53 with permanent disability, with a disability rate of 410.47 per 100,000. Cost for their medical care averaged 81.5 yuan RMB per injured pupil. Injury was a common and frequently-happened incident among children and young adults and could seriously affect their health, development and growth, studying and their future of children and

HIV, Vascular and Aging Injuries in the Brain of Clinically Stable HIV-Infected Adults: A 1H MRS Study

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Cysique, Lucette A.; Moffat, Kirsten; Moore, Danielle M.; Lane, Tammy A.; Davies, Nicholas W. S.; Carr, Andrew; Brew, Bruce J.; Rae, Caroline

2013-01-01

Background Cardiovascular disease (CVD) and premature aging have been hypothesized as new risk factors for HIV associated neurocognitive disorders (HAND) in adults with virally-suppressed HIV infection. Moreover, their significance and relation to more classical HAND biomarkers remain unclear. Methods 92 HIV− infected (HIV+) adults stable on combined antiretroviral therapy (cART) and 30 age-comparable HIV-negative (HIV−) subjects underwent 1H Magnetic Resonance Spectroscopy (MRS) of the frontal white matter (targeting HIV, normal aging or CVD-related neurochemical injury), caudate nucleus (targeting HIV neurochemical injury), and posterior cingulate cortex (targeting normal/pathological aging, CVD-related neurochemical changes). All also underwent standard neuropsychological (NP) testing. CVD risk scores were calculated. HIV disease biomarkers were collected and cerebrospinal fluid (CSF) neuroinflammation biomarkers were obtained in 38 HIV+ individuals. Results Relative to HIV− individuals, HIV+ individuals presented mild MRS alterations: in the frontal white matter: lower N-Acetyl-Aspartate (NAA) (pHIV*age interaction was associated with lower frontal white matter NAA. CVD risk factors were associated with lower posterior cingulate cortex and caudate NAA in both groups. Past acute CVD events in the HIV+ group were associated with increased mIo in the posterior cingulate cortex. HIV duration was associated with lower caudate NAA; greater CNS cART penetration was associated with lower mIo in the posterior cingulate cortex and the degree of immune recovery on cART was associated with higher NAA in the frontal white matter. CSF neopterin was associated with higher mIo in the posterior cingulate cortex and frontal white matter. Conclusions In chronically HIV+ adults with long-term viral suppression, current CVD risk, past CVD and age are independent factors for neuronal injury and inflammation. This suggests a tripartite model of HIV, CVD and age likely driven by

Repeated exposure to methamphetamine induces sex-dependent hypersensitivity to ischemic injury in the adult rat heart.

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Boyd R Rorabaugh

Full Text Available We previously reported that adult female, but not male rats that were prenatally exposed to methamphetamine exhibit myocardial hypersensitivity to ischemic injury. However, it is unknown whether hypersensitivity to ischemic injury develops when rats are exposed to methamphetamine during adulthood. The goal of this study was to determine whether methamphetamine exposure during adulthood sensitizes the heart to ischemic injury.Adult male and female rats received daily injections of methamphetamine (5 mg/kg or saline for 10 days. Their hearts were isolated on day 11 and subjected to a 20 min ischemic insult on a Langendorff isolated heart apparatus. Cardiac contractile function was measured by an intraventricular balloon, and infarct size was measured by triphenyltetrazolium chloride staining.Hearts from methamphetamine-treated females exhibited significantly larger infarcts and suppressed postischemic recovery of contractile function compared to hearts from saline-treated females. In contrast, methamphetamine had no effect on infarct size or contractile recovery in male hearts. Subsequent experiments demonstrated that hypersensitivity to ischemic injury persisted in female hearts following a 1 month period of abstinence from methamphetamine. Myocardial protein kinase C-ε expression, Akt phosphorylation, and ERK phosphorylation were unaffected by adult exposure to methamphetamine.Exposure of adult rats to methamphetamine sex-dependently increases the extent of myocardial injury following an ischemic insult. These data suggest that women who have a heart attack might be at risk of more extensive myocardial injury if they have a recent history of methamphetamine abuse.

Repeated exposure to methamphetamine induces sex-dependent hypersensitivity to ischemic injury in the adult rat heart

Science.gov (United States)

Seeley, Sarah L.; Stoops, Thorne S.; D’Souza, Manoranjan S.

2017-01-01

Background We previously reported that adult female, but not male rats that were prenatally exposed to methamphetamine exhibit myocardial hypersensitivity to ischemic injury. However, it is unknown whether hypersensitivity to ischemic injury develops when rats are exposed to methamphetamine during adulthood. The goal of this study was to determine whether methamphetamine exposure during adulthood sensitizes the heart to ischemic injury. Methods Adult male and female rats received daily injections of methamphetamine (5 mg/kg) or saline for 10 days. Their hearts were isolated on day 11 and subjected to a 20 min ischemic insult on a Langendorff isolated heart apparatus. Cardiac contractile function was measured by an intraventricular balloon, and infarct size was measured by triphenyltetrazolium chloride staining. Results Hearts from methamphetamine-treated females exhibited significantly larger infarcts and suppressed postischemic recovery of contractile function compared to hearts from saline-treated females. In contrast, methamphetamine had no effect on infarct size or contractile recovery in male hearts. Subsequent experiments demonstrated that hypersensitivity to ischemic injury persisted in female hearts following a 1 month period of abstinence from methamphetamine. Myocardial protein kinase C-ε expression, Akt phosphorylation, and ERK phosphorylation were unaffected by adult exposure to methamphetamine. Conclusions Exposure of adult rats to methamphetamine sex-dependently increases the extent of myocardial injury following an ischemic insult. These data suggest that women who have a heart attack might be at risk of more extensive myocardial injury if they have a recent history of methamphetamine abuse. PMID:28575091

Surgical treatment of adult traumatic brachial plexus injuries: an overview

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Mario G. Siqueira

2011-06-01

Full Text Available Traumatic injuries to the brachial plexus in adults are severely debilitating. They generally affect young individuals. A thorough understanding of the anatomy, clinical evaluation, imaging and electrodiagnostic assessments, treatment options and proper timing of surgical interventions will enable nerve surgeons to offer optimal care to patients. Advances in microsurgical technique have improved the outcome for many of these patients. The treatment options offer patients with brachial plexus injuries the possibility of achieving elbow flexion, shoulder stability with limited abduction and the hope of limited but potentially useful hand function.

Youth versus adult "weightlifting" injuries presenting to United States emergency rooms: accidental versus nonaccidental injury mechanisms.

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Myer, Gregory D; Quatman, Carmen E; Khoury, Jane; Wall, Eric J; Hewett, Timothy E

2009-10-01

Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. emergency rooms by age, type, and mechanism of injury. We hypothesized that older athletes would sustain greater percentages of joint sprains and muscle strains, whereas younger athletes would sustain a greater percentage of accidental injuries that would result in an increased percentage of fractures in youths. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System was queried from 2002 to 2005 using the CPSC code for "Weightlifting." Subjects between the ages of 8 and 30 were grouped by age categories 8 to 13 (elementary/middle school age), 14 to 18 (high school), 19 to 22 (college), and 23 to 30 (adult). Injuries were classified as "accidental" if caused by dropped weight or improper equipment use. Multiple logistic regression was used to compare accidental injuries between age groups. The sample consisted of 4,111 patients. Accidental injuries decreased (p 14 to 18 > 19 to 22 years = 23 to 30 years. Conversely, sprain/strain injuries increased in each successive age group (p injuries (n = 2,565) showed that the oldest categories (19-22 and 23-30 yr) demonstrated a greater percentage of sprains and strains relative to younger age categories (p injuries sustained in the 8 to 13 group were to the hand and foot and were most often related to "dropping" and "pinching" in the injury descriptions, and there was an increased percentage of fractures in the 8 to 13 group relative to all other groups (p injuries are the result of accidents that are potentially preventable with increased supervision and stricter safety guidelines.

Neighborhood Factors and Fall-Related Injuries among Older Adults Seen by Emergency Medical Service Providers

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Sungmin Lee

2017-02-01

Full Text Available Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS. Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed the risk factors at the neighborhood level. This study examines the characteristics of neighborhood environments associated with fall injuries reported to EMS providers. A total of 13,163 EMS records from 2011 to 2014 involving adults aged 65 and older in the city of San Antonio (TX, USA were analyzed at the census tract level (n = 264. Negative binomial regression was used to identify significant census tract-based neighborhood environmental variables associated with the count of fall injuries in each census tract. Adjusting for exposure variable and the size of the census tract, neighborhoods with higher residential stability, captured as the percent of those who lived in the same house as the previous year were associated with decreased count of fall injuries. Neighborhoods with higher residential density and having a higher vacancy rate were associated with increased count of fall injuries. The study highlights the importance of stable and safe neighborhoods in reducing fall risks among older adults, which should be considered a prerequisite for promoting age-friendly environments.

Neighborhood Factors and Fall-Related Injuries among Older Adults Seen by Emergency Medical Service Providers.

Science.gov (United States)

Lee, Sungmin; Lee, Chanam; Rodiek, Susan

2017-02-08

Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS). Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed the risk factors at the neighborhood level. This study examines the characteristics of neighborhood environments associated with fall injuries reported to EMS providers. A total of 13,163 EMS records from 2011 to 2014 involving adults aged 65 and older in the city of San Antonio (TX, USA) were analyzed at the census tract level (n = 264). Negative binomial regression was used to identify significant census tract-based neighborhood environmental variables associated with the count of fall injuries in each census tract. Adjusting for exposure variable and the size of the census tract, neighborhoods with higher residential stability, captured as the percent of those who lived in the same house as the previous year were associated with decreased count of fall injuries. Neighborhoods with higher residential density and having a higher vacancy rate were associated with increased count of fall injuries. The study highlights the importance of stable and safe neighborhoods in reducing fall risks among older adults, which should be considered a prerequisite for promoting age-friendly environments.

Severe street and mountain bicycling injuries in adults: a comparison of the incidence, risk factors and injury patterns over 14 years.

Science.gov (United States)

Roberts, Derek J; Ouellet, Jean-Francois; Sutherland, Francis R; Kirkpatrick, Andrew W; Lall, Rohan N; Ball, Chad G

2013-06-01

Street and mountain bicycling are popular recreational activities and prevalent modes of transportation with the potential for severe injury. The purpose of this investigation was to compare the incidence, risk factors and injury patterns among adults with severe street versus mountain bicycling injuries. We conducted a retrospective cohort study using the Southern Alberta Trauma Database of all adults who were severely injured (injury severity score [ISS] ≥ 12) while street or mountain bicycling between Apr. 1, 1995, and Mar. 31, 2009. Among 11 772 severely injured patients, 258 (2.2%) were injured (mean ISS 17, hospital stay 6 d, mortality 7%) while street (n = 209) or mountain bicycling (n = 49). Street cyclists were often injured after being struck by a motor vehicle, whereas mountain bikers were frequently injured after faulty jump attempts, bike tricks and falls (cliffs, roadsides, embankments). Mountain cyclists were admitted more often on weekends than weekdays (61.2% v. 45.0%, p = 0.040). Injury patterns were similar for both cohorts (all p > 0.05), with trauma to the head (67.4%), extremities (38.4%), chest (34.1%), face (26.0%) and abdomen (10.1%) being common. Spinal injuries, however, were more frequent among mountain cyclists (65.3% v. 41.1%, p = 0.003). Surgical intervention was required in 33.3% of patients (9.7% open reduction internal fixation, 7.8% spinal fixation, 7.0% craniotomy, 5.8% facial repair and 2.7% laparotomy). With the exception of spine injuries, severely injured cyclists display similar patterns of injury and comparable outcomes, regardless of style (street v. mountain). Helmets and thoracic protection should be advocated for injury prevention.

Alterations of cerebral blood flow and cerebrovascular reserve in patients with chronic traumatic brain injury accompanying deteriorated intelligence

International Nuclear Information System (INIS)

Song, Ho Chun; Bom, Hee Seung

2000-01-01

The purpose of this study was to evaluate alterations of regional cerbral blood flow (CBF) and cerebrovascular reserve (CVR), and correlation between these alternations and cognitive dysfunctin in patients with chronic traumatic brain injury (TBI) and normal brain MRI findings. Thirty TBI patients and 19 healthy volunteers underwent rest/acetazolaminde brain SPECT using Tc-99m HMPAO. Korean-Wechsler Adult Intelligence scale test was also performed in the patient group. Statistical analysis was performed with statistical parametric mapping software (SPM '97). CBF was diminished in the left hemisphere including Wernicke's area in all patients with lower verbal scale scores. In addition, a reduction in CBF in the right frontal, temporal and parietal cortices was related with depressed scores in information, digital span, arithmetic and similarities. In patients with lower performance scale scores, CBF was mainly diminished in the right hemisphere including superior temporal and supramarginal gyri, premotor, primary somatomotor and a part of prefrontal cortices, left frontal lobe and supramarginal gyrus. CVR was diminished in sixty-four Brodmann's areas compared to control. A reduction in CVR was demonstrated bilaterally in the frontal and temporal lobes in patients with lower scores in both verbal and performance tests, and in addition, both inferior parietal and occipital lobes in information subset. Alterations of CBF and CVR were demonstrated in the symptomatic TBI patients with normal MRI finding. These alterations were correlated with the change of intelligence, of which the complex functions are subserved by multiple interconnected cortical structures.=20

Patellar dislocations in children, adolescents and adults: A comparative MRI study of medial patellofemoral ligament injury patterns and trochlear groove anatomy

International Nuclear Information System (INIS)

Balcarek, Peter; Walde, Tim Alexander; Frosch, Stephan; Schuettrumpf, Jan P.; Wachowski, Martin M.; Stuermer, Klaus M.; Frosch, Karl-Heinz

2011-01-01

Purpose: The first aim was to compare medial patellofemoral ligament injury patterns in children and adolescents after first-time lateral patellar dislocations with the injury patterns in adults. The second aim was to evaluate the trochlear groove anatomy at different developmental stages of the growing knee joint. Materials and methods: Knee magnetic resonance (MR) images were collected from 22 patients after first-time patellar dislocations. The patients were aged 14.2 years (a range of 11-15 years). The injury pattern of the medial patellofemoral ligament was analysed, and trochlear dysplasia was evaluated with regard to sulcus angle, trochlear depth and trochlear asymmetry. The control data consisted of MR images from 21 adult patients who were treated for first-time lateral patellar dislocation. Results: After patellar dislocation, injury to the medial patellofemoral ligament was found in 90.2% of the children and in 100% of the adult patients. Injury patterns of the medial patellofemoral ligament were similar between the study group and the control group with regard to injury at the patellar attachment site (Type I), to the midsubstance (Type II) and to injury at the femoral origin (Type III) (all p > 0.05). Combined lesions (Type IV) were significantly less frequently observed in adults when compared to the study group (p = 0.02). The magnitude of trochlear dysplasia was similar in children, adolescents and adults with regard to all three of the measured parameter-values (all p > 0.05). In addition, the articular cartilage had a significant effect on the distal femur geometry in both paediatrics and adults. Conclusion: First, the data from our study indicated that the paediatric medial patellofemoral ligament injury patterns, as seen on MR images, were similar to those in adults. Second, the trochlear groove anatomy and the magnitude of trochlear dysplasia, respectively, did not differ between adults and paediatrics with patellar instability. Thus

Patellar dislocations in children, adolescents and adults: A comparative MRI study of medial patellofemoral ligament injury patterns and trochlear groove anatomy

Energy Technology Data Exchange (ETDEWEB)

Balcarek, Peter, E-mail: peter.balcarek@med.uni-goettingen.de [Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine, 37075 Goettingen (Germany); Walde, Tim Alexander; Frosch, Stephan; Schuettrumpf, Jan P.; Wachowski, Martin M.; Stuermer, Klaus M. [Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine, 37075 Goettingen (Germany); Frosch, Karl-Heinz [Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg (Germany)

2011-09-15

Purpose: The first aim was to compare medial patellofemoral ligament injury patterns in children and adolescents after first-time lateral patellar dislocations with the injury patterns in adults. The second aim was to evaluate the trochlear groove anatomy at different developmental stages of the growing knee joint. Materials and methods: Knee magnetic resonance (MR) images were collected from 22 patients after first-time patellar dislocations. The patients were aged 14.2 years (a range of 11-15 years). The injury pattern of the medial patellofemoral ligament was analysed, and trochlear dysplasia was evaluated with regard to sulcus angle, trochlear depth and trochlear asymmetry. The control data consisted of MR images from 21 adult patients who were treated for first-time lateral patellar dislocation. Results: After patellar dislocation, injury to the medial patellofemoral ligament was found in 90.2% of the children and in 100% of the adult patients. Injury patterns of the medial patellofemoral ligament were similar between the study group and the control group with regard to injury at the patellar attachment site (Type I), to the midsubstance (Type II) and to injury at the femoral origin (Type III) (all p > 0.05). Combined lesions (Type IV) were significantly less frequently observed in adults when compared to the study group (p = 0.02). The magnitude of trochlear dysplasia was similar in children, adolescents and adults with regard to all three of the measured parameter-values (all p > 0.05). In addition, the articular cartilage had a significant effect on the distal femur geometry in both paediatrics and adults. Conclusion: First, the data from our study indicated that the paediatric medial patellofemoral ligament injury patterns, as seen on MR images, were similar to those in adults. Second, the trochlear groove anatomy and the magnitude of trochlear dysplasia, respectively, did not differ between adults and paediatrics with patellar instability. Thus

The diagnostic accuracy of 1.5T magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries.

Science.gov (United States)

Wade, Ryckie G; Itte, Vinay; Rankine, James J; Ridgway, John P; Bourke, Grainne

2018-03-01

Identification of root avulsions is of critical importance in traumatic brachial plexus injuries because it alters the reconstruction and prognosis. Pre-operative magnetic resonance imaging is gaining popularity, but there is limited and conflicting data on its diagnostic accuracy for root avulsion. This cohort study describes consecutive patients requiring brachial plexus exploration following trauma between 2008 and 2016. The index test was magnetic resonance imaging at 1.5 Tesla and the reference test was operative exploration of the supraclavicular plexus. Complete data from 29 males was available. The diagnostic accuracy of magnetic resonance imaging for root avulsion(s) of C5-T1 was 79%. The diagnostic accuracy of a pseudomeningocoele as a surrogate marker of root avulsion(s) of C5-T1 was 68%. We conclude that pseudomeningocoles were not a reliable sign of root avulsion and magnetic resonance imaging has modest diagnostic accuracy for root avulsions in the context of adult traumatic brachial plexus injuries. III.

Risk factors for falls and fall-related injuries in adults 85 years of age and older.

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Grundstrom, Anna C; Guse, Clare E; Layde, Peter M

2012-01-01

Falls are a leading cause of morbidity and mortality in older adults. No previous studies on risk factors for falls have focused on adults 85 years and older, the most rapidly growing segment of adults. We examined demographic, health, and behavioral risk factors for falls and fall-related injuries in adults 65 years and older, with a particular focus on adults 85 years and older. We analyzed self-reported information from the Behavioral Risk Factor Surveillance System (BRFSS) for 2008. Data was available for 120,923 people aged 65 or older and 12,684 people aged 85 or older. Of those aged 85 or older, 21.3% reported at least one fall in the past 3 months and 7.2% reported at least one fall related injury requiring medical care or limiting activity for a day or longer. Below average general health, male sex, perceived insufficient sleep, health problems requiring assistive devices, alcohol consumption, increasing body mass index and history of stroke were all independently associated with a greater risk of falls or fall related injuries. The greater risk of falling in those 85 years and older appeared to be due to the deterioration of overall health status with age; among those with excellent overall health status, there was no greater risk of falling in adults 85 years and older compared to those 65-84 years of age. Our results suggest that those with risk factors for falls and fall-related injuries may be appropriate targets for evidence-based fall prevention programs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Exploratory multinomial logit model-based driver injury severity analyses for teenage and adult drivers in intersection-related crashes.

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Wu, Qiong; Zhang, Guohui; Ci, Yusheng; Wu, Lina; Tarefder, Rafiqul A; Alcántara, Adélamar Dely

2016-05-18

Teenage drivers are more likely to be involved in severely incapacitating and fatal crashes compared to adult drivers. Moreover, because two thirds of urban vehicle miles traveled are on signal-controlled roadways, significant research efforts are needed to investigate intersection-related teenage driver injury severities and their contributing factors in terms of driver behavior, vehicle-infrastructure interactions, environmental characteristics, roadway geometric features, and traffic compositions. Therefore, this study aims to explore the characteristic differences between teenage and adult drivers in intersection-related crashes, identify the significant contributing attributes, and analyze their impacts on driver injury severities. Using crash data collected in New Mexico from 2010 to 2011, 2 multinomial logit regression models were developed to analyze injury severities for teenage and adult drivers, respectively. Elasticity analyses and transferability tests were conducted to better understand the quantitative impacts of these factors and the teenage driver injury severity model's generality. The results showed that although many of the same contributing factors were found to be significant in the both teenage and adult driver models, certain different attributes must be distinguished to specifically develop effective safety solutions for the 2 driver groups. The research findings are helpful to better understand teenage crash uniqueness and develop cost-effective solutions to reduce intersection-related teenage injury severities and facilitate driver injury mitigation research.

Anterior Cingulate Volumetric Alterations in Treatment-Naive Adults with ADHD: A Pilot Study

Science.gov (United States)

Makris, Nikos; Seidman, Larry J.; Valera, Eve M.; Biederman, Joseph; Monuteaux, Michael C.; Kennedy, David N.; Caviness, Verne S., Jr.; Bush, George; Crum, Katherine; Brown, Ariel B.; Faraone, Stephen V.

2010-01-01

Objective: We sought to examine preliminary results of brain alterations in anterior cingulate cortex (ACC) in treatment-naive adults with ADHD. The ACC is a central brain node for the integration of cognitive control and allocation of attention, affect and drive. Thus its anatomical alteration may give rise to impulsivity, hyperactivity and…

Quantifying Risk Factors for Long-Term Sleep Problems After Burn Injury in Young Adults.

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Lee, Austin F; Ryan, Colleen M; Schneider, Jeffrey C; Kazis, Lewis E; Li, Nien Chen; Rose, Mary; Liang, Matthew H; Wang, Chao; Palmieri, Tina; Meyer, Walter J; Pidcock, Frank S; Reilly, Debra; Sheridan, Robert L; Tompkins, Ronald G

Restorative sleep is an important component of quality of life. Disturbances in sleep after burn injury were reported but all based on uncontrolled or nonstandardized data. The occurrence and the effect of long-term sleep problems in young adult burn survivors have not been well defined. This 5-year (2003-2008) prospective multicenter longitudinal study included adults with burn injuries ages 19 to 30 years who completed the Young Adult Burn Outcome Questionnaire (YABOQ) up to 36 months after injury. The items measured 15 patient-reported outcomes including physical, psychological, and social statuses and symptoms such as itch and pain. Scores of these 15 YABOQ outcome domains were standardized to a mean of 50 and a SD of 10 based on an age-matched nonburned reference group of young adults. Sleep quality was assessed using the item 'How satisfied are you now with your sleep,' rated by a 5-point Likert scale. Patients responding with very and somewhat dissatisfied were classified as having sleep dissatisfaction and the remaining as less or not dissatisfied. The associations between sleep dissatisfaction (yes/no) and YABOQ outcome domains were analyzed longitudinally using mixed-effect generalized linear models, adjusted for %TBSA burned, age, gender, and race. Generalized estimating equations were used to take into account correlated error resulting from repeated surveys on each patient over time. One hundred and fifty-two burn survivors participated in the YABOQ survey at baseline and during the follow-up who had at least one survey with a response to the sleep item. Among them, sleep dissatisfaction was twice as prevalent (76/152, 50%) when compared with the nonburned reference group (29/112, 26%). The likelihood of a burn survivor being dissatisfied with sleep was reduced over time after the burn injury. Sleep dissatisfaction following burns was significantly associated, in a dose-dependent manner, with increasing burn size (P = .001). Better sleep was associated

Fall Risk Assessment Predicts Fall-Related Injury, Hip Fracture, and Head Injury in Older Adults.

Science.gov (United States)

Nilsson, Martin; Eriksson, Joel; Larsson, Berit; Odén, Anders; Johansson, Helena; Lorentzon, Mattias

2016-11-01

To investigate the role of a fall risk assessment, using the Downton Fall Risk Index (DFRI), in predicting fall-related injury, fall-related head injury and hip fracture, and death, in a large cohort of older women and men residing in Sweden. Cross sectional observational study. Sweden. Older adults (mean age 82.4 ± 7.8) who had a fall risk assessment using the DFRI at baseline (N = 128,596). Information on all fall-related injuries, all fall-related head injuries and hip fractures, and all-cause mortality was collected from the Swedish Patient Register and Cause of Death Register. The predictive role of DFRI was calculated using Poisson regression models with age, sex, height, weight, and comorbidities as covariates, taking time to outcome or end of study into account. During a median follow-up of 253 days (interquartile range 90-402 days) (>80,000 patient-years), 15,299 participants had a fall-related injury, 2,864 a head injury, and 2,557 a hip fracture, and 23,307 died. High fall risk (DFRI ≥3) independently predicted fall-related injury (hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 1.39-1.49), hip fracture (HR = 1.51, 95% CI =1.38-1.66), head injury (HR = 1.12, 95% CI = 1.03-1.22), and all-cause mortality (HR = 1.39, 95% CI = 1.35-1.43). DFRI more strongly predicted head injury (HR = 1.29, 95% CI = 1.21-1.36 vs HR = 1.08, 95% CI = 1.04-1.11) and hip fracture (HR = 1.41, 95% CI = 1.30-1.53 vs HR = 1.08, 95% CI = 1.05-1.11) in 70-year old men than in 90-year old women (P Fall risk assessment using DFRI independently predicts fall-related injury, fall-related head injury and hip fracture, and all-cause mortality in older men and women, indicating its clinical usefulness to identify individuals who would benefit from interventions. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

Young adult's own and parental social characteristics predict injury morbidity: a register-based follow-up of 135,000 men and women.

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Remes, Hanna; Martikainen, Pekka

2015-04-28

Sociodemographic differences in injury mortality are well-established, but population-level studies on social patterns of injury morbidity remain few in numbers, particularly among young adults. Yet injuries are the leading cause of mortality, morbidity and disability among young people. Studies among children have shown steep social gradients in severe injuries, but less is known on the social patterning of injuries in late adolescence and early adulthood, when young people are in the process of becoming independent adults. This study examines how young adults' current living arrangements, education, main economic activity, and parental social background are associated with hospital-treated injuries in late adolescence and early adulthood. The study uses prospective, individual-level data gathered from several administrative sources. From a representative 11% sample of the total Finnish population, we included young people between ages 17-29 years during the follow-up (N = 134,938). We used incidence rates and Cox proportional hazards models to study hospital-treated injuries and poisonings in 1998-2008. Higher rates of injury were found among young adults living alone, single mothers, the lower educated and the non-employed, as well as those with lower parental social background, experience of childhood family changes or living with a single parent, and those who had left the parental home at a young age. Injury risks were consistently higher among young adults with lower education, but current living arrangements and main economic activity showed some age-related nuances in the associations: both earlier and later than average transitions in education, employment, and family formation associated with increased injury risks. The social differentials were strongest in poisonings, intentional self-harm, and assaults, but social patterns were also found in falls, traffic-related injuries and other unintentional injuries, underlining the existence of multiple

Resilience and the rehabilitation of adult spinal cord injury survivors: A qualitative systematic review.

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Kornhaber, Rachel; Mclean, Loyola; Betihavas, Vasiliki; Cleary, Michelle

2018-01-01

To synthesize the qualitative research evidence that explored how survivors of adult spinal cord injury experience and make sense of resilience. Spinal cord injury is often a sudden and unexpected life-changing event requiring complex and long-term rehabilitation. The development of resilience is essential in determining how spinal cord injury survivors negotiate this injury and rehabilitation. A qualitative systematic review and thematic synthesis of the research evidence. CINAHL, PubMed, Embase, Scopus and PsycINFO were searched, no restriction dates were used. Methodological quality was assessed using the Critical Appraisal Skills Programme checklist. Thematic synthesis focused on how survivors of adult spinal cord injury experience and make sense of resilience. Six qualitative research articles reported the experiences of 84 spinal cord injury survivors. Themes identified were: uncertainty and regaining independence; prior experiences of resilience; adopting resilient thinking; and strengthening resilience through supports. Recovery and rehabilitation following spinal cord survivors is influenced by the individual's capacity for resilience. Resilience may be influenced by previous life experiences and enhanced by supportive nursing staff encouraging self-efficacy. Survivors identified the need for active involvement in decision-making about their care to enable a sense of regaining control of their lives. This has the potential to have a significant impact on their self-efficacy and in turn health outcomes. © 2017 John Wiley & Sons Ltd.

A cross-sectional study of elite adult Irish dancers: biopsychosocial traits, pain, and injury.

Science.gov (United States)

Cahalan, Roisin; Purtill, Helen; O'Sullivan, Peter; O'Sullivan, Kieran

2015-03-01

Despite its growing popularity, scant research exists concerning musculoskeletal pain and injury in Irish dancing (ID). This study aimed to record the biopsychosocial characteristics of elite adult Irish dancers and to investigate potential relationships between these characteristics and musculoskeletal pain and injury. One hundred and four professional Irish dancers, elite competitive Irish dancers, and dancers in full time education studying ID completed a questionnaire providing data on dance and activity levels, physical and psychological health, and pain and injury history. Of these subjects, 84 underwent 1. a physical screening of lower limb flexibility, which involved balance and endurance; 2. a number of functional tests; and 3. anthropometric, biomechanical, and anatomical assessments. Subjects were divided into "significantly injured (SI)" and "not significantly injured (NSI)" categories based on the severity and impact of self-reported pain and injury. Thirty-three (31.7%) subjects were classified as SI and 71 (68.3%) as NSI. The factors significantly associated with being SI were female sex (p = 0.036), higher number of subjective general health (p = 0.001) and psychological (p = 0.036) complaints, low mood (p = 0.01), heightened catastrophizing (p = 0.047), and failure always to complete a warm-up (p = 0.006). A self-reported injury rate of 76.9% over the previous 5 years was reported. The mean number of injuries sustained to all body parts over the previous 5 years was 1.49, with a mean of 126.1 days lost annually to injury. Foot and ankle injuries were most prevalent. It was concluded that there is a significant level of musculoskeletal pain and injury in elite adult ID. A complex combination of biopsychosocial factors appears to be associated with pain and injury.

Differences in health, participation and life satisfaction outcomes in adults following paediatric- versus adult-sustained spinal cord injury

NARCIS (Netherlands)

Ma, J. K.; Post, M. W. M.; Gorter, J. W.; Ginis, K. A. Martin

2016-01-01

Study design: Cross-sectional. Objectives: To compare differences in self-reported health status, participation and life satisfaction outcomes between adults with a spinal cord injury (SCI) sustained during paediatric (P) versus adulthood (A) years. Setting: Ontario, Canada. Methods: Secondary

Leisure time physical activity among older adults with long-term spinal cord injury.

Science.gov (United States)

Jörgensen, S; Martin Ginis, K A; Lexell, J

2017-09-01

Cross-sectional. To describe participation in leisure time physical activity (LTPA) (amount, intensity and type) among older adults with long-term spinal cord injury (SCI), and to investigate the associations with sociodemographics, injury characteristics and secondary health conditions (SHCs). Home settings in southern Sweden. Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS). The physical activity recall assessment for people with SCI was used to assess LTPA among 84 men and 35 women (mean age 63.5 years, mean time since injury 24 years, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D). Associations were analyzed statistically using hierarchical multivariable regression. Twenty-nine percent reported no LTPA, whereas 53% performed moderate-to-heavy intensity LTPA. The mean minutes per day of total LTPA was 34.7 (±41.5, median 15, range 0-171.7) and of moderate-to-heavy LTPA 22.5 (±35.1, median 5.0, range 0-140.0). The most frequently performed activities were walking and wheeling. Sociodemographics, injury characteristics and SHCs (bowel-related and bladder-related problems, spasticity and pain) explained 10.6% and 13.4%, respectively, of the variance in total and moderate-to-heavy LTPA. Age and wheelchair use were significantly, negatively associated with total LTPA. Women, wheelchair users and employed participants performed significantly less moderate-to-heavy LTPA than men, those using walking devices/no mobility device and unemployed participants. Many older adults with long-term SCI do not reach the amount or intensity of LTPA needed to achieve fitness benefits. Research is needed on how to increase LTPA and to identify modifiable factors that could enhance their participation.

Extensive cortical rewiring after brain injury.

Science.gov (United States)

Dancause, Numa; Barbay, Scott; Frost, Shawn B; Plautz, Erik J; Chen, Daofen; Zoubina, Elena V; Stowe, Ann M; Nudo, Randolph J

2005-11-02

Previously, we showed that the ventral premotor cortex (PMv) underwent neurophysiological remodeling after injury to the primary motor cortex (M1). In the present study, we examined cortical connections of PMv after such lesions. The neuroanatomical tract tracer biotinylated dextran amine was injected into the PMv hand area at least 5 months after ischemic injury to the M1 hand area. Comparison of labeling patterns between experimental and control animals demonstrated extensive proliferation of novel PMv terminal fields and the appearance of retrogradely labeled cell bodies within area 1/2 of the primary somatosensory cortex after M1 injury. Furthermore, evidence was found for alterations in the trajectory of PMv intracortical axons near the site of the lesion. The results suggest that M1 injury results in axonal sprouting near the ischemic injury and the establishment of novel connections within a distant target. These results support the hypothesis that, after a cortical injury, such as occurs after stroke, cortical areas distant from the injury undergo major neuroanatomical reorganization. Our results reveal an extraordinary anatomical rewiring capacity in the adult CNS after injury that may potentially play a role in recovery.

Lifestyle and health conditions of adults with spinal cord injury.

Science.gov (United States)

Xavier de França, Inacia Sátiro; Cruz Enders, Bertha; Silva Coura, Alexsandro; Pereira Cruz, Giovanna Karinny; da Silva Aragão, Jamilly; Carvalho de Oliveira, Déborah Raquel

2014-01-01

. To describe the lifestyle of adults with spinal cord injury and explore its relation with some health conditions. Cross sectional study, in which a questionnaire containing sociodemographic, habits and health conditions variables was used. Forty-seven people with spinal cord injury participated and answered the self-report questionnaire. The group under study was predominantly male (92%), under 40 years of age (47%), and had low educational level (76%). The most frequent risk factors related to the lifestyle were: smoking (28%), alcohol consumption (36%), coffee consumption (92%) and being physically inactive (64%). Association was found between having four or more risk factors related to lifestyle and the loss of appetite, as well as constipation. . The actual inadequate lifestyle is associated with the health conditions of patients, and the nursing team should pay special attention to the education and promotion of health related to people with spinal cord injury.

Probability of Regenerating a Normal Limb After Bite Injury in the Mexican Axolotl (Ambystoma mexicanum).

Science.gov (United States)

Thompson, Sierra; Muzinic, Laura; Muzinic, Christopher; Niemiller, Matthew L; Voss, S Randal

2014-06-01

Multiple factors are thought to cause limb abnormalities in amphibian populations by altering processes of limb development and regeneration. We examined adult and juvenile axolotls ( Ambystoma mexicanum ) in the Ambystoma Genetic Stock Center (AGSC) for limb and digit abnormalities to investigate the probability of normal regeneration after bite injury. We observed that 80% of larval salamanders show evidence of bite injury at the time of transition from group housing to solitary housing. Among 717 adult axolotls that were surveyed, which included solitary-housed males and group-housed females, approximately half presented abnormalities, including examples of extra or missing digits and limbs, fused digits, and digits growing from atypical anatomical positions. Bite injury likely explains these limb defects, and not abnormal development, because limbs with normal anatomy regenerated after performing rostral amputations. We infer that only 43% of AGSC larvae will present four anatomically normal looking adult limbs after incurring a bite injury. Our results show regeneration of normal limb anatomy to be less than perfect after bite injury.

Alterations of cerebral blood flow and cerebrovascular reserve in patients with chronic traumatic brain injury accompanying deteriorated intelligence

Energy Technology Data Exchange (ETDEWEB)

Song, Ho Chun; Bom, Hee Seung [Chonnam National Univ. Hospital, Kwangju (Korea, Republic of)

2000-06-01

The purpose of this study was to evaluate alterations of regional cerbral blood flow (CBF) and cerebrovascular reserve (CVR), and correlation between these alternations and cognitive dysfunctin in patients with chronic traumatic brain injury (TBI) and normal brain MRI findings. Thirty TBI patients and 19 healthy volunteers underwent rest/acetazolaminde brain SPECT using Tc-99m HMPAO. Korean-Wechsler Adult Intelligence scale test was also performed in the patient group. Statistical analysis was performed with statistical parametric mapping software (SPM '97). CBF was diminished in the left hemisphere including Wernicke's area in all patients with lower verbal scale scores. In addition, a reduction in CBF in the right frontal, temporal and parietal cortices was related with depressed scores in information, digital span, arithmetic and similarities. In patients with lower performance scale scores, CBF was mainly diminished in the right hemisphere including superior temporal and supramarginal gyri, premotor, primary somatomotor and a part of prefrontal cortices, left frontal lobe and supramarginal gyrus. CVR was diminished in sixty-four Brodmann's areas compared to control. A reduction in CVR was demonstrated bilaterally in the frontal and temporal lobes in patients with lower scores in both verbal and performance tests, and in addition, both inferior parietal and occipital lobes in information subset. Alterations of CBF and CVR were demonstrated in the symptomatic TBI patients with normal MRI finding. These alterations were correlated with the change of intelligence, of which the complex functions are subserved by multiple interconnected cortical structures.

Variation of Blunt Traumatic Injury with Age in Older Adults: Statewide Analysis 2011-14

Directory of Open Access Journals (Sweden)

Emily Earl-Royal

2016-11-01

Full Text Available Introduction: Traumatic injury is a leading cause of death and disability in adults ≥ 65 years old, but there are few epidemiological studies addressing this issue. The aim of this study was to assess how characteristics of blunt traumatic injuries in adults ≥ 65 vary by age. Methods: Using data from the a single-state trauma registry, this retrospective cohort study examined injured patients ≥ 65 admitted to all Level I and Level II trauma centers in Pennsylvania between 2011 and 2014 (n=38,562. Patients were stratified by age into three subgroups (age 65-74; 75-84; ≥85. We compared demographics, injury, and system-level across groups. Results: We found significant increases in the proportion of female gender, (48.6% vs. 58.7% vs. 67.7%, white race (89.1% vs. 92.6% vs. 94.6%, and non-Hispanic ethnicity (97.5% vs. 98.6% vs. 99.4% across advancing age across age groups, respectively. As age increased, the proportion of falls (69.9% vs. 82.1% vs. 90.3%, in-hospital mortality (4.6% vs. 6.2% vs. 6.8%, and proportion of patients arriving to the hospital via ambulance also increased (73.6% vs. 75.8% vs. 81.1%, while median injury severity plateaued (9.0% all groups and the proportion of Level I trauma alerts (10.6% vs. 8.2% vs. 6.7% decreased. We found no trend between age and patient transfer status. The five most common diagnoses were vertebral fracture, rib fracture, head contusion, open head wound, and intracranial hemorrhage, with vertebral fracture and head contusion increasing with age, and rib fracture decreasing with age. Conclusion: In a large cohort of older adults with trauma (n= 38,000, we found, with advancing age, a decrease in trauma alert level, despite an increase in mortality and a decrease in demographic diversity. This descriptive study provides a framework for future research on the relationship between age and blunt traumatic injury in older adults.

Evaluation of Altered Drug Pharmacokinetics in Critically Ill Adults Receiving Extracorporeal Membrane Oxygenation.

Science.gov (United States)

Ha, Michael A; Sieg, Adam C

2017-02-01

Extracorporeal membrane oxygenation (ECMO) is a life-support modality used in patients with refractory cardiac and/or respiratory failure. A significant resurgence in the use ECMO has been seen in recent years as a result of substantial improvements in technology and survival benefit. With expanding ECMO use, a better understanding of how ECMO affects drug pharmacokinetics (PK) is necessary. The vast majority of PK studies in patients receiving ECMO have been conducted within neonatal or pediatric populations or within a controlled environment (e.g., in vitro or ex vivo). Because of significant differences in absorption, distribution, metabolism, and excretion, it may be inappropriate to extrapolate these PK data to adults. Thus, the aims of this review are to evaluate the changes in drug PK during ECMO and to summarize the available PK data for common drugs used in the adult critically ill patients during ECMO support. A search of the PubMed (1965-July 2016), EMBASE (1965-July 2016), and Cochrane Controlled Trial Register databases was performed. All relevant studies describing PK alterations during ECMO in ex vivo experiments and in adults were included. Evaluation of the data indicated that drug PK in adults receiving ECMO support may be significantly altered. Factors influencing these alterations are numerous and have intricate relationships with each other but can generally be classified as ECMO circuit factors, drug factors, and patient factors. Commonly used drugs in these patients include antimicrobials, sedatives, and analgesics. PK data for most of these drugs are generally lacking; however, recent research efforts in this patient population have provided some limited guidance in drug dosing. With an improved understanding of altered drug PK secondary to ECMO therapy, optimization of pharmacotherapy within this critically ill population continues to move forward. © 2016 Pharmacotherapy Publications, Inc.

WITHDRAWN: Exercise for treating isolated anterior cruciate ligament injuries in adults.

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Trees, Amanda H; Howe, Tracey E; Dixon, John; White, Lisa

2011-05-11

The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. Injury causes pain, effusion and inflammation leading to the inability to fully activate the thigh muscles. Regaining muscular control is essential if the individual wishes to return to pre-injury level of function and patients will invariably be referred for rehabilitation. To present the best evidence for effectiveness of exercise used in the rehabilitation of isolated ACL injuries in adults, on return to work and pre-injury levels of activity. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (Feb 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2005), MEDLINE (1996 to March 2005), EMBASE (1980 to March 2005), other databases and reference lists of articles. Randomised controlled trials and quasi-randomised trials testing exercise programmes designed to rehabilitate adults with isolated ACL injuries. Trials where participants were randomised to receive any combination of the following: no care, usual care, a single-exercise intervention, and multiple-exercise interventions, were included. The primary outcome measures of interest were returning to work and return to pre-injury level of activity post treatment, at six months and one year. Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials. Nine trials involving 391 participants were included. Only two trials, involving 76 participants, reported conservative rehabilitation and seven trials, involving 315 participants, evaluated rehabilitation following ACL reconstruction. Methodological quality scores varied considerably across the trials, with the nature of participant and assessor blinding poorly reported. Trial comparisons fell into six categories. Pooling of data was rarely possible due to lack of appropriate

Extrinsic and intrinsic factors associated with non-contact injury in adult pace bowlers: a systematic review protocol.

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Olivier, Benita; Stewart, Aimee; Taljaard, Tracy; Burger, Elaine; Brukner, Peter; Orchard, John; Gray, Janine; Botha, Nadine; Mckinon, Warrick

2015-01-01

Review question: which extrinsic and intrinsic factors are associated with non-contact injury in adult cricket pace bowlers?Review objective: the objective of this review is to determine the extrinsic and intrinsic factors associated with non-contact injury in adult pace bowlers. Cricket is generally considered to be a sport of low injury risk compared to other sports. In cricket, the pace bowler strives towards the adoption of a bowling technique with a relatively low injury threat that will, at the same time, allow for a fast (>120km/hr) and accurate delivery to the opposing batsman. However, of all the various roles of the cricket player, the pace bowler has the highest risk of injury, especially for low back and lower limb (lower quarter) injury. The reason for this high risk of injury is due to the inherent, high-load biomechanical nature of the pace bowling action. The high prevalence of injury amongst pace bowlers highlights the great need for research into factors associated with injury.Both extrinsic and intrinsic factors work in combination to predispose the bowler to injury. Extrinsic or environment-related factors include bowling workload (the numbers of overs a bowler bowls), player position (first, second or third change) and time of play (morning or afternoon). A high bowling workload has been linked with a higher risk of injury in pace bowlers. Foster et al. found in an observational study that bowling too many overs in a single spell or bowling too many spells may increase the pace bowler's risk of sustaining a low back injury. In another observational study, Dennis et al. found that an exceptionally high bowling workload as well as an uncommonly low bowling workload is associated with injury risk. The major extrinsic factors for bowling injury identified by Orchard et al. are a high number of match overs bowled in the previous week, number of days of play and bowling second (batting first) in a match. Extrinsic factors are known to make the bowler

Posterior urethral injuries associated with pelvic injuries in young adults: computerized finite element model creation and application to improve knowledge and prevention of these lesions.

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Bréaud, J; Baqué, P; Loeffler, J; Colomb, F; Brunet, C; Thollon, L

2012-05-01

Young adult males involved in motorcycle accidents are particularly at risk for posterior urethral injury whenever pelvic injury occurs. Posterior urethral injuries remain problematic because their diagnosis may be missed, and during the initial treatment response the urethral injury can be aggravated by urethral catheterization. Few anatomical and clinical tools exist that establish a correlation between injuries and fractures of the pelvic ring and the risk of posterior urethral injury. Based on experience with traffic accident modeling, a computerized finite element model was conceived integrating the specific anatomic structures concerned. This model was extrapolated from a CAT scan of a young adult. The anatomic structures concerned in urethral and pelvic ring trauma (PRT) were isolated, placed in 3D and given biomechanical properties. The model was verified according to available experiments on PRT. To apply the model, we recreated a lateral impact mechanism on the pelvic ring. Stretching between the prostatic and membranous portions of the urethra (before and after visualization of a pelvic fracture) as well as timing of injury was studied. The model's application permitted us to analyze precisely the link between lateral impact trauma of the pelvic ring and lesions of the posterior urethra and to identify an urethra stretching prior to visualization of a pelvic fracture. Utilization of the model with other mechanisms of injury should allow for better comprehension of this associated trauma, improved prevention, iatrogenic aggravation of, and care for, these serious injuries. © Springer-Verlag 2011

Adolescent social defeat alters markers of adult dopaminergic function.

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Novick, Andrew M; Forster, Gina L; Tejani-Butt, Shanaz M; Watt, Michael J

2011-08-10

Stressful experiences during adolescence can alter the trajectory of neural development and contribute to psychiatric disorders in adulthood. We previously demonstrated that adolescent male rats exposed to repeated social defeat stress show changes in mesocorticolimbic dopamine content both at baseline and in response to amphetamine when tested in adulthood. In the present study we examined whether markers of adult dopamine function are also compromised by adolescent experience of social defeat. Given that the dopamine transporter as well as dopamine D1 receptors act as regulators of psychostimulant action, are stress sensitive and undergo changes during adolescence, quantitative autoradiography was used to measure [(3)H]-GBR12935 binding to the dopamine transporter and [(3)H]-SCH23390 binding to dopamine D1 receptors, respectively. Our results indicate that social defeat during adolescence led to higher dopamine transporter binding in the infralimbic region of the medial prefrontal cortex and higher dopamine D1 receptor binding in the caudate putamen, while other brain regions analyzed were comparable to controls. Thus it appears that social defeat during adolescence causes specific changes to the adult dopamine system, which may contribute to behavioral alterations and increased drug seeking. Copyright © 2011 Elsevier Inc. All rights reserved.

Lifestyle and health conditions of adults with spinal cord injury

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Inacia Sátiro Xavier de França

2014-07-01

Full Text Available Objective. To describe the lifestyle of adults with spinal cord injury and explore its relation with some health conditions. Methodology. Cross sectional study, in which a questionnaire containing sociodemographic, habits and health conditions variables was used. Forty-seven people with spinal cord injury participated and answered the self-report questionnaire. Results. The group under study was predominantly male (92%, under 40 years of age (47%, and had low educational level (76%. The most frequent risk factors related to the lifestyle were: smoking (28%, alcohol consumption (36%, coffee consumption (92% and being physically inactive (64%. Association was found between having four or more risk factors related to lifestyle and the loss of appetite, as well as constipation. Conclusion. The actual inadequate lifestyle is associated with the health conditions of patients, and the nursing team should pay special attention to the education and promotion of health related to people with spinal cord injury.

Cortical neurogenesis in adult rats after ischemic brain injury: most new neurons fail to mature

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Qing-quan Li

2015-01-01

Full Text Available The present study examines the hypothesis that endogenous neural progenitor cells isolated from the neocortex of ischemic brain can differentiate into neurons or glial cells and contribute to neural regeneration. We performed middle cerebral artery occlusion to establish a model of cerebral ischemia/reperfusion injury in adult rats. Immunohistochemical staining of the cortex 1, 3, 7, 14 or 28 days after injury revealed that neural progenitor cells double-positive for nestin and sox-2 appeared in the injured cortex 1 and 3 days post-injury, and were also positive for glial fibrillary acidic protein. New neurons were labeled using bromodeoxyuridine and different stages of maturity were identified using doublecortin, microtubule-associated protein 2 and neuronal nuclei antigen immunohistochemistry. Immature new neurons coexpressing doublecortin and bromodeoxyuridine were observed in the cortex at 3 and 7 days post-injury, and semi-mature and mature new neurons double-positive for microtubule-associated protein 2 and bromodeoxyuridine were found at 14 days post-injury. A few mature new neurons coexpressing neuronal nuclei antigen and bromodeoxyuridine were observed in the injured cortex 28 days post-injury. Glial fibrillary acidic protein/bromodeoxyuridine double-positive astrocytes were also found in the injured cortex. Our findings suggest that neural progenitor cells are present in the damaged cortex of adult rats with cerebral ischemic brain injury, and that they differentiate into astrocytes and immature neurons, but most neurons fail to reach the mature stage.

Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review.

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Olowu, Wasiu A; Niang, Abdou; Osafo, Charlotte; Ashuntantang, Gloria; Arogundade, Fatiu A; Porter, John; Naicker, Saraladevi; Luyckx, Valerie A

2016-04-01

Access to diagnosis and dialysis for acute kidney injury can be life-saving, but can be prohibitively expensive in low-income settings. The burden of acute kidney injury in sub-Saharan Africa is presumably high but remains unknown. We did a systematic review to assess outcomes of acute kidney injury in sub-Saharan Africa and identify barriers to care. We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles published between Jan 1, 1990, and Nov 30, 2014. We scored studies, and all were of medium-to-low quality. We made a pragmatic decision to include all studies to best reflect reality, and did a descriptive analysis of extracted data. This study is registered with PROSPERO, number CRD42015015690. We identified 3881 records, of which 41 met inclusion criteria, including 1403 adult patients and 1937 paediatric patients. Acute kidney injury in sub-Saharan Africa is severe, with 1042 (66%) of 1572 children and 178 (70%) 253 of adults needing dialysis in studies reporting dialysis need. Only 666 (64%) of 1042 children (across 11 studies) and 58 (33%) of 178 adults (across four studies) received dialysis when needed. Overall mortality was 34% in children and 32% in adults, but rose to 73% in children and 86% in adults when dialysis was needed but not received. Major barriers to access to care were out-of-pocket costs, erratic hospital resources, late presentation, and female sex. Patients in these studies are those with resources to access care. In view of overall study quality, data interpretation should be cautious, but high mortality and poor access to dialysis are concerning. The global scarcity of resources among patients and health centres highlights the need for a health-system-wide approach to prevention and management of acute kidney injury in sub-Saharan Africa. None. Copyright © 2016 Olowu et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Savings in acute care costs if all older adults treated for fall-related injuries completed matter of balance.

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Howland, Jonathan; Shankar, Kalpana Narayan; Peterson, Elizabeth W; Taylor, Alyssa A

Falls among older adults are a common and serious public health problem. Evidence-based fall prevention programs delivered in community settings and targeting older adults living independently are increasingly deployed throughout the nation. These programs tend to be offered by public and private organizations that serve older adults, and recruitment usually occurs through direct marketing to the target population, rather than through referrals from healthcare providers. Matter of Balance , a program developed to reduce fear of falling and associated activity restriction in community-dwelling older adults, is currently being delivered in 38 of the 50 United States. In this study, we estimate the one-year medical care cost savings if older adults treated at Massachusetts hospitals for fall-related injuries were referred by healthcare providers to participate in Matter of Balance . Data from several sources were used for this study. We estimated annual cost savings in older adult falls recidivism for a hypothetical 100 patients presenting at an emergency department for a fall-related injury, assuming that all were referred to, and 50 % completed, Matter of Balance . This cost-saving estimate was subsequently expanded based on the actual number (43,931) of older adult patients presenting at, and discharged from Massachusetts emergency departments for all fall-related injuries in 2012. Cost savings were calculated for two additional participation rates: 25 % and 75 %. The return on investment (ROI), was calculated based on the percentage of return per each dollar invested. The calculated ROI for Matter of Balance was 144 %. Statewide savings ranged from $2.79 million assuming a 25 % participation rate to $8.37 million, assuming a 75 % participation rate. Referral to evidence-based falls prevention programs of older adult patients presenting at EDs with a fall-related injury could reduce subsequent falls and associated treatment costs.

Intrauterine ethanol exposure results in hypothalamic oxidative stress and neuroendocrine alterations in adult rat offspring.

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Dembele, Korami; Yao, Xing-Hai; Chen, Li; Nyomba, B L Grégoire

2006-09-01

Prenatal ethanol (EtOH) exposure is associated with low birth weight, followed by increased appetite, catch-up growth, insulin resistance, and impaired glucose tolerance in the rat offspring. Because EtOH can induce oxidative stress, which is a putative mechanism of insulin resistance, and because of the central role of the hypothalamus in the regulation of energy homeostasis and insulin action, we investigated whether prenatal EtOH exposure causes oxidative damage to the hypothalamus, which may alter its function. Female rats were given EtOH by gavage throughout pregnancy. At birth, their offspring were smaller than those of non-EtOH rats. Markers of oxidative stress and expression of neuropeptide Y and proopiomelanocortin (POMC) were determined in hypothalami of postnatal day 7 (PD7) and 3-mo-old (adult) rat offspring. In both PD7 and adult rats, prenatal EtOH exposure was associated with decreased levels of glutathione and increased expression of MnSOD. The concentrations of lipid peroxides and protein carbonyls were normal in PD7 EtOH-exposed offspring, but were increased in adult EtOH-exposed offspring. Both PD7 and adult EtOH-exposed offspring had normal neuropeptide Y and POMC mRNA levels, but the adult offspring had reduced POMC protein concentration. Thus only adult offspring preexposed to EtOH had increased hypothalamic tissue damage and decreased levels of POMC, which could impair melanocortin signaling. We conclude that prenatal EtOH exposure causes hypothalamic oxidative stress, which persists into adult life and alters melanocortin action during adulthood. These neuroendocrine alterations may explain weight gain and insulin resistance in rats exposed to EtOH early in life.

Near-drowning: clinical course of lung injury in adults.

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Gregorakos, Leonidas; Markou, Nikolaos; Psalida, Vasiliki; Kanakaki, Maria; Alexopoulou, Anastasia; Sotiriou, Eva; Damianos, Anastasios; Myrianthefs, Pavlos

2009-01-01

Although anoxic encephalopathy is the most dreaded consequence of submersion accidents, respiratory involvement is also very common in these patients. Nevertheless, few data are available about the clinical course and resolution of lung injury in adult victims of near-drowning. Our goal was to study the clinical manifestations of near-drowning and the course of respiratory involvement in a retrospective cohort of adult, mostly elderly patients. Our study included adult patients who were hospitalized after near-drowning in seawater over an 8-year period. Forty-three patients (26 female, 17 male), with an age range of 18-88 years old, were studied. Most (79%) of the patients were elderly (>60 years). In the Emergency Department two patients were comatose and required intubation. Another patient was intubated within the first 24 h because of ARDS. At presentation, all patients but two had a PaO(2)/FiO(2) near-drowning in adult immersion victims are often severe. Nevertheless, in noncomatose patients at least, intubation can often be avoided and quick improvement is the rule while a good outcome is usually expected even in elderly patients.

Neuromuscular interactions around the knee in children, adults and elderly

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Kellis, Eleftherios; Mademli, Lida; Patikas, Dimitrios; Kofotolis, Nikolaos

2014-01-01

Although injury and neuromuscular activation patterns may be common for all individuals, there are certain factors which differentiate neuromuscular activity responses between children, adults and elderly. The purpose of this study is to review recent evidence on age differences in neural activation and muscle balances around the knee when performing single joint movements. Particularly, current evidence indicates that there are some interesting similarities in the neuromuscular mechanisms by which children or the elderly differ compared with adults. Both children and elderly display a lower absolute muscle strength capacity than adults which cannot fully be explained by differences in muscle mass. Quadriceps activation failure is a common symptom of all knee injuries, irrespective of age but it is likely that its effect is more evident in children or adults. While one might expect that antagonist co-activation would differ between age categories, it appears that this is not the case. Although hamstring: quadriceps ratio levels are altered after knee injury, it is not clear whether this is an age specific response. Finally, evidence suggests that both children and the elderly display less stiffness of the quadriceps muscle-tendon unit than adults which affects their knee joint function. PMID:25232523

Injury survey in Choi Kwang Do (CKD) martial art practitioners around the world: CKD is a safe form of training for adults.

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Jee, Yong-Seok; Eun, Denny

2018-02-01

Among the many sports and activities to choose from, martial arts are becoming increasingly popular for health and fitness. Due to the different nature of the various styles of martial arts, injuries are not uncommon. Though there have been studies on the injury rates of several martial art styles, there have been none regarding Choi Kwang Do (CKD), a noncompetitive martial art with relaxed and fluid movements designed to promote health and fitness for people of all ages. The purpose of this study was to examine the rate of injury for adults training in CKD to find out whether this is a safe style of martial art for adults. This study found the prevalence, causes, severity, and types of injuries from CKD practitioners around the world through an online survey targeting adults (n=122), aged 18 or older, with varying years of training experience. The annual rate of injury was 11.73 for every 100 CKD practitioners. There was no correlation between the length of training experience and injury. Training frequency and duration had no significant relationship with injury rates. A significant positive relationship between training intensity and injury existed ( P =0.009). The results of the study found that CKD can be an attractive option for adults of any age who are looking to learn a martial art or choose a physical activity with a low risk of injury, however the training intensity should be kept at a level that is not excessively high.

Corpus callosum vasculature predicts white matter microstructure abnormalities following pediatric mild traumatic brain injury.

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Wendel, Kara M; Lee, Jeong Bin; Affeldt, Bethann; Hamer, Mary; Harahap-Carrillo, Indira S; Pardo, Andrea C; Obenaus, Andre

2018-05-09

Emerging data suggest that pediatric traumatic brain injury (TBI) is associated with impaired developmental plasticity and poorer neuropsychological outcomes than adults with similar head injuries. Unlike adult mild TBI (mTBI), the effects of mTBI on white matter (WM) microstructure and vascular supply are not well-understood in the pediatric population. The cerebral vasculature plays an important role providing necessary nutrients and removing waste. To address this critical element, we examined the microstructure of the corpus callosum (CC) following pediatric mTBI using diffusion tensor imaging (DTI), and investigated myelin, oligodendrocytes, and vasculature of WM with immunohistochemistry. We hypothesized that pediatric mTBI leads to abnormal WM microstructure and impacts the vasculature within the CC, and that these alterations to WM vasculature contribute to the long-term altered microstructure. We induced a closed head injury mTBI at postnatal day 14, then at 4, 14, and 60 days post injury (DPI) mice were sacrificed for analysis. We observed persistent changes in apparent diffusion coefficient (ADC) within the ipsilateral CC following mTBI, indicating microstructural changes, but surprisingly changes in myelin and oligodendrocyte densities were minimal. However, vasculature features of the ipsilateral CC such as vessel density, length, and number of junctions were persistently altered following mTBI. Correlative analysis showed a strong inverse relationship between ADC and vessel density at 60 DPI, suggesting increased vessel density following mTBI may restrict WM diffusion characteristics. Our findings suggest that WM vasculature contributes to the long-term microstructural changes within the ipsilateral CC following mTBI.

Mitochondrial Optic Atrophy (OPA) 1 Processing Is Altered in Response to Neonatal Hypoxic-Ischemic Brain Injury

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Baburamani, Ana A.; Hurling, Chloe; Stolp, Helen; Sobotka, Kristina; Gressens, Pierre; Hagberg, Henrik; Thornton, Claire

2015-01-01

Perturbation of mitochondrial function and subsequent induction of cell death pathways are key hallmarks in neonatal hypoxic-ischemic (HI) injury, both in animal models and in term infants. Mitoprotective therapies therefore offer a new avenue for intervention for the babies who suffer life-long disabilities as a result of birth asphyxia. Here we show that after oxygen-glucose deprivation in primary neurons or in a mouse model of HI, mitochondrial protein homeostasis is altered, manifesting as a change in mitochondrial morphology and functional impairment. Furthermore we find that the mitochondrial fusion and cristae regulatory protein, OPA1, is aberrantly cleaved to shorter forms. OPA1 cleavage is normally regulated by a balanced action of the proteases Yme1L and Oma1. However, in primary neurons or after HI in vivo, protein expression of YmelL is also reduced, whereas no change is observed in Oma1 expression. Our data strongly suggest that alterations in mitochondria-shaping proteins are an early event in the pathogenesis of neonatal HI injury. PMID:26393574

Unintentional fall injuries associated with walkers and canes in older adults treated in U.S. emergency departments.

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Stevens, Judy A; Thomas, Karen; Teh, Leesia; Greenspan, Arlene I

2009-08-01

To characterize nonfatal, unintentional, fall-related injuries associated with walkers and canes in older adults. Surveillance data of injuries treated in hospital emergency departments (EDs), January 1, 2001, to December 31, 2006. The National Electronic Injury Surveillance System All Injury Program, which collects data from a nationally representative stratified probability sample of 66 U.S. hospital EDs. People aged 65 and older treated in EDs for 3,932 nonfatal unintentional fall injuries and whose records indicated that a cane or a walker was involved in the fall. Sex, age, whether the fall involved a cane or walker, primary diagnosis, part of the body injured, disposition, and location and circumstances of the fall. An estimated 47,312 older adult fall injuries associated with walking aids were treated annually in U.S. EDs: 87.3% with walkers, 12.3% with canes, and 0.4% with both. Walkers were associated with seven times as many injuries as canes. Women's injury rates exceeded those for men (rate ratios=2.6 for walkers, 1.4 for canes.) The most prevalent injuries were fractures and contusions or abrasions. Approximately one-third of subjects were hospitalized for their injuries. Injuries and hospital admissions for falls associated with walking aids were frequent in this highly vulnerable population. The results suggest that more research is needed to improve the design of walking aids. More information also is needed about the circumstances preceding falls, both to better understand the contributing fall risk factors and to develop specific and effective fall prevention strategies.

Gamma-interferon alters globin gene expression in neonatal and adult erythroid cells

International Nuclear Information System (INIS)

Miller, B.A.; Perrine, S.P.; Antognetti, G.; Perlmutter, D.H.; Emerson, S.G.; Sieff, C.; Faller, D.V.

1987-01-01

The effect of gamma-interferon on fetal hemoglobin synthesis by purified cord blood, fetal liver, and adult bone marrow erythroid progenitors was studied with a radioligand assay to measure hemoglobin production by BFU-E-derived erythroblasts. Coculture with recombinant gamma-interferon resulted in a significant and dose-dependent decrease in fetal hemoglobin production by neonatal and adult, but not fetal, BFU-E-derived erythroblasts. Accumulation of fetal hemoglobin by cord blood BFU-E-derived erythroblasts decreased up to 38.1% of control cultures (erythropoietin only). Synthesis of both G gamma/A gamma globin was decreased, since the G gamma/A gamma ratio was unchanged. Picograms fetal hemoglobin per cell was decreased by gamma-interferon addition, but picograms total hemoglobin was unchanged, demonstrating that a reciprocal increase in beta-globin production occurred in cultures treated with gamma-interferon. No toxic effect of gamma-interferon on colony growth was noted. The addition of gamma-interferon to cultures resulted in a decrease in the percentage of HbF produced by adult BFU-E-derived cells to 45.6% of control. Fetal hemoglobin production by cord blood, fetal liver, and adult bone marrow erythroid progenitors, was not significantly affected by the addition of recombinant GM-CSF, recombinant interleukin 1 (IL-1), recombinant IL-2, or recombinant alpha-interferon. Although fetal progenitor cells appear unable to alter their fetal hemoglobin program in response to any of the growth factors added here, the interaction of neonatal and adult erythroid progenitors with gamma-interferon results in an altered expression of globin genes

Differential Neural Processing of Social Exclusion and Inclusion in Adolescents with Non-Suicidal Self-Injury and Young Adults with Borderline Personality Disorder

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Rebecca C. Brown

2017-11-01

Full Text Available IntroductionNon-suicidal self-injury (NSSI is a symptom of borderline personality disorder (BPD. However, NSSI often occurs independently of BPD. Altered neural processing of social exclusion has been shown in adolescents with NSSI and adults with BPD with additional alterations during social inclusion in BPD patients. Aims of this study were to investigate differences in neural processing of social inclusion and exclusion situations between adolescents with NSSI and young adults with BPD and NSSI.MethodsUsing fMRI, neural processing of positive and negative social situations (paradigm: “Cyberball” was explored. Participants were 14 adolescents with NSSI, but without BPD (Mage = 15.4; SD = 1.9, 15 adults with BPD and NSSI (Mage = 23.3; SD = 4.1, as well as 15 healthy adolescents (Mage = 14.5; SD = 1.7, and 16 healthy adults (Mage = 23.2; SD = 4.4.ResultsBehavioral results showed enhanced feelings of social exclusion in both patient groups as compared to healthy controls but only the NSSI group showed enhanced activation during social exclusion versus inclusion compared to the other groups. While both NSSI and BPD groups showed enhanced activation in the ventral anterior cingulate cortex during social exclusion as compared to their age-matched controls, enhanced activation during social inclusion as compared to a passive watching condition was mainly observed in the BPD group in the dorsolateral and dorsomedial prefrontal cortex, and the anterior insula.DiscussionWhile neural processing of social exclusion was pronounced in adolescents with NSSI, BPD patients also showed increased activity in a per se positive social situation. These results might point toward a higher responsiveness to social exclusion in adolescents with NSSI, which might then develop into a generalized increased sensitivity to all kinds of social situations in adults with BPD.

Differential Neural Processing of Social Exclusion and Inclusion in Adolescents with Non-Suicidal Self-Injury and Young Adults with Borderline Personality Disorder.

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Brown, Rebecca C; Plener, Paul L; Groen, Georg; Neff, Dominik; Bonenberger, Martina; Abler, Birgit

2017-01-01

Non-suicidal self-injury (NSSI) is a symptom of borderline personality disorder (BPD). However, NSSI often occurs independently of BPD. Altered neural processing of social exclusion has been shown in adolescents with NSSI and adults with BPD with additional alterations during social inclusion in BPD patients. Aims of this study were to investigate differences in neural processing of social inclusion and exclusion situations between adolescents with NSSI and young adults with BPD and NSSI. Using fMRI, neural processing of positive and negative social situations (paradigm: "Cyberball") was explored. Participants were 14 adolescents with NSSI, but without BPD (M age  = 15.4; SD = 1.9), 15 adults with BPD and NSSI (M age  = 23.3; SD = 4.1), as well as 15 healthy adolescents (M age  = 14.5; SD = 1.7), and 16 healthy adults (M age  = 23.2; SD = 4.4). Behavioral results showed enhanced feelings of social exclusion in both patient groups as compared to healthy controls but only the NSSI group showed enhanced activation during social exclusion versus inclusion compared to the other groups. While both NSSI and BPD groups showed enhanced activation in the ventral anterior cingulate cortex during social exclusion as compared to their age-matched controls, enhanced activation during social inclusion as compared to a passive watching condition was mainly observed in the BPD group in the dorsolateral and dorsomedial prefrontal cortex, and the anterior insula. While neural processing of social exclusion was pronounced in adolescents with NSSI, BPD patients also showed increased activity in a per se positive social situation. These results might point toward a higher responsiveness to social exclusion in adolescents with NSSI, which might then develop into a generalized increased sensitivity to all kinds of social situations in adults with BPD.

The Adhesion Molecule-Characteristic HNK-1 Carbohydrate Contributes to Functional Recovery After Spinal Cord Injury in Adult Zebrafish.

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Ma, Liping; Shen, Hui-Fan; Shen, Yan-Qin; Schachner, Melitta

2017-07-01

The human natural killer cell antigen-1 (HNK-1) is functionally important in development, synaptic activity, and regeneration after injury in the nervous system of several mammalian species. It contains a sulfated glucuronic acid which is carried by neural adhesion molecules and expressed in nonmammalian species, including zebrafish, which, as opposed to mammals, spontaneously regenerate after injury in the adult. To evaluate HNK-1's role in recovery of function after spinal cord injury (SCI) of adult zebrafish, we assessed the effects of the two HNK-1 synthesizing enzymes, glucuronyl transferase and HNK-1 sulfotransferase. Expression of these two enzymes was increased at the messenger RNA (mRNA) level 11 days after injury in the brainstem nuclei that are capable of regrowth of severed axons, namely, the nucleus of medial longitudinal fascicle and intermediate reticular formation, but not at earlier time points after SCI. mRNA levels of glucuronyl transferase and sulfotransferase were increased in neurons, not only of these nuclei but also in the spinal cord caudal to the injury site at 11 days. Mauthner neurons which are not capable of regeneration did not show increased levels of enzyme mRNAs after injury. Reducing protein levels of the enzymes by application of anti-sense morpholinos resulted in reduction of locomotor recovery for glucuronyl transferase, but not for HNK-1 sulfotransferase. The combined results indicate that HNK-1 is upregulated in expression only in those neurons that are intrinsically capable of regeneration and contributes to regeneration after spinal cord injury in adult zebrafish in the absence of its sulfate moiety.

Product related adult genitourinary injuries treated at emergency departments in the United States from 2002 to 2010.

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Bagga, Herman S; Tasian, Gregory E; Fisher, Patrick B; McCulloch, Charles E; McAninch, Jack W; Breyer, Benjamin N

2013-04-01

We describe the epidemiological features of adult genitourinary injuries related to consumer products and determined the patient cohorts, products and situations associated with increased genitourinary injury risk. The National Electronic Injury Surveillance System, a data set validated to provide a probability sample of injury related emergency department presentations in the United States, was analyzed to characterize genitourinary injuries from 2002 to 2010. We analyzed 3,545 observations to derive national estimates. An estimated 142,144 adults (95% CI 115,324-168,964) presented to American emergency departments with genitourinary injuries from 2002 to 2010. Of the injuries 69% occurred in men. A large majority of injuries involved the external genitalia. The most common categories of products involved were sporting items in 30.2% of cases, clothing articles in 9.4% and furniture in 9.2%. The highest prevalence of injury was at ages 18 to 28 years (37.5%), which was most often related to sports equipment, such as bicycles. Older cohorts (age greater than 65 years) more commonly sustained injuries during falls and often in the bathroom during use of a shower or tub. Of all patients 88% were evaluated and treated in the emergency department without inpatient admission, although the admission rate increased with increasing patient age. Acute genitourinary injury is often associated with common consumer items and with identifiable high risk cohorts, products and situations. Consumers, practitioners and safety champions can use our epidemiological data to prioritize and develop strategies aimed at the prevention, limitation and informed treatment of such injuries. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

WITHDRAWN: Exercise for treating anterior cruciate ligament injuries in combination with collateral ligament and meniscal damage of the knee in adults.

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Trees, Amanda H; Howe, Tracey E; Grant, Margaret; Gray, Heather G

2011-05-11

The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. The ACL may be damaged in isolation but often other ligaments and menisci are implicated. The injury may be managed surgically or conservatively. Injury causes pain, effusion and inflammation leading to alteration in muscle function. Regaining muscular control is essential if the individual wishes to return to pre-injury level of function and patients will invariably be referred for rehabilitation. To present the best evidence for effectiveness of exercise used in the treatment of ACL injuries in combination with collateral ligament and meniscal damage to the knee in adults, on return to work and pre-injury levels of activity. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (October 2006), Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 3), MEDLINE (1996 to October 2006), EMBASE (1980 to October 2006), other databases and reference lists of articles. We included randomised controlled trials and quasi-randomised trials testing exercise programmes designed to treat adults with ACL injuries in combination with collateral ligament and meniscal damage. Included trials randomised participants to receive any combination of the following: no care, usual care, a single-exercise intervention, and multiple-exercise interventions. The primary outcome measures of interest were returning to work and return to pre-injury level of activity post treatment, at six months and one year. Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials. Five trials (243 participants) evaluated different exercise programmes following ACL reconstruction and one trial (100 participants) compared supervised with self-monitored exercises as part of conservative treatment. No study compared the effect of exercise versus

An exploration of the experiences of young adults who acquired a brain injury

OpenAIRE

Schrover, Isabella

2015-01-01

In the United Kingdom at least 15,600 young adults are admitted to hospital following an acquired brain injury each year. For those who survive, the brain injury-related consequences to their psychological well-being (e.g. feelings of anxiety and low mood, low self-esteem) and social environment (e.g. very limited social support, loss of relationships and friendships) are understood to be the ones that have the most effect on a young person’s life in the long term. The social environment, suc...

Neonatal GLP1R activation limits adult adiposity by durably altering hypothalamic architecture

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Andrea V. Rozo

2017-07-01

Conclusion: These observations suggest that the acute activation of GLP1R in neonates durably alters hypothalamic architecture to limit adult weight gain and adiposity, identifying GLP1R as a therapeutic target for obesity prevention.

Cortex-dependent recovery of unassisted hindlimb locomotion after complete spinal cord injury in adult rats

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Manohar, Anitha; Foffani, Guglielmo; Ganzer, Patrick D; Bethea, John R; Moxon, Karen A

2017-01-01

After paralyzing spinal cord injury the adult nervous system has little ability to ‘heal’ spinal connections, and it is assumed to be unable to develop extra-spinal recovery strategies to bypass the lesion. We challenge this assumption, showing that completely spinalized adult rats can recover unassisted hindlimb weight support and locomotion without explicit spinal transmission of motor commands through the lesion. This is achieved with combinations of pharmacological and physical therapies that maximize cortical reorganization, inducing an expansion of trunk motor cortex and forepaw sensory cortex into the deafferented hindlimb cortex, associated with sprouting of corticospinal axons. Lesioning the reorganized cortex reverses the recovery. Adult rats can thus develop a novel cortical sensorimotor circuit that bypasses the lesion, probably through biomechanical coupling, to partly recover unassisted hindlimb locomotion after complete spinal cord injury. DOI: http://dx.doi.org/10.7554/eLife.23532.001 PMID:28661400

Camellia sinensis Prevents Perinatal Nicotine-Induced Neurobehavioral Alterations, Tissue Injury, and Oxidative Stress in Male and Female Mice Newborns

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Ajarem, Jamaan S.; Al-Basher, Gadh; Allam, Ahmed A.

2017-01-01

Nicotine exposure during pregnancy induces oxidative stress and leads to behavioral alterations in early childhood and young adulthood. The current study aimed to investigate the possible protective effects of green tea (Camellia sinensis) against perinatal nicotine-induced behavioral alterations and oxidative stress in mice newborns. Pregnant mice received 50 mg/kg C. sinensis on gestational day 1 (PD1) to postnatal day 15 (D15) and were subcutaneously injected with 0.25 mg/kg nicotine from PD12 to D15. Nicotine-exposed newborns showed significant delay in eye opening and hair appearance and declined body weight at birth and at D21. Nicotine induced neuromotor alterations in both male and female newborns evidenced by the suppressed righting, rotating, and cliff avoidance reflexes. Nicotine-exposed newborns exhibited declined memory, learning, and equilibrium capabilities, as well as marked anxiety behavior. C. sinensis significantly improved the physical development, neuromotor maturation, and behavioral performance in nicotine-exposed male and female newborns. In addition, C. sinensis prevented nicotine-induced tissue injury and lipid peroxidation and enhanced antioxidant defenses in the cerebellum and medulla oblongata of male and female newborns. In conclusion, this study shows that C. sinensis confers protective effects against perinatal nicotine-induced neurobehavioral alterations, tissue injury, and oxidative stress in mice newborns. PMID:28588748

Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-incomecountries: results from the WHO Study on global AGEing and adult health (SAGE).

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Stewart Williams, Jennifer; Kowal, Paul; Hestekin, Heather; O'Driscoll, Tristan; Peltzer, Karl; Yawson, Alfred; Biritwum, Richard; Maximova, Tamara; Salinas Rodríguez, Aarón; Manrique Espinoza, Betty; Wu, Fan; Arokiasamy, Perianayagam; Chatterji, Somnath

2015-06-23

In 2010 falls were responsible for approximately 80 % of disability stemming from unintentional injuries excluding traffic accidents in adults 50 years and over. Falls are becoming a major public health problem in low- and middle-income countries (LMICs) where populations are ageing rapidly. Nationally representative standardized data collected from adults aged 50 years and over participating in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, the Russian Federation and South Africa are analysed. The aims are to identify the prevalence of, and risk factors for, past-year fall-related injury and to assess associations between fall-related injury and disability. Regression methods are used to identify risk factors and association between fall-related injury and disability. Disability was measured using the WHO Disability Assessment Schedule Version 2.0 (WHODAS 2.0). The prevalence of past-year fall-related injuries ranged from 6.6 % in India to 1.0 % in South Africa and was 4.0 % across the pooled countries. The proportion of all past-year injuries that were fall-related ranged from 73.3 % in the Russian Federation to 44.4 % in Ghana. Across the six countries this was 65.7 %. In the multivariable logistic regression, the odds of past-year fall-related injury were significantly higher for: women (OR: 1.27; 95 % CI: 0.99,1.62); respondents who lived in rural areas (OR: 1.36; 95 % CI: 1.06,1.75); those with depression (OR: 1.43; 95 % CI: 1.01,2.02); respondents who reported severe or extreme problems sleeping (OR: 1.54; 95 % CI: 1.15,2.08); and those who reported two or more (compared with no) chronic conditions (OR: 2.15; 95 % CI: 1.45,3.19). Poor cognition was also a significant risk factor for fall-related injury. The association between fall-related injury and the WHODAS measure of disability was highly significant (Prisk factors for falls in older adults in this group of LMICs. Clinicians and

Tocilizumab-Induced Acute Liver Injury in Adult Onset Still’s Disease

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Michael Drepper

2013-01-01

Full Text Available Background. Tocilizumab, a monoclonal humanized anti-IL-6 receptor antibody, is used in treatment of refractory adult onset Still’s disease (AOSD. Mild to moderate liver enzyme elevation is a well-known side effect, but severe liver injury has only been reported in 3 cases in the literature. Case. A young female suffering from corticoid and methotrexate refractory AOSD was treated by tocilizumab. After 19 months of consecutive treatment, she developed acute severe liver injury. Liver biopsy showed extensive hepatocellular necrosis with ballooned hepatocytes, highly suggestive of drug-induced liver injury. No other relevant drug exposure beside tocilizumab was recorded. She recovered totally after treatment discontinuation and an initial 3-day course of intravenous N-acetylcysteine with normalization of liver function tests after 6 weeks. Conclusion. Acute severe hepatitis can be associated with tocilizumab as documented in this case. Careful monitoring of liver function tests is warranted during tocilizumab treatment.

Predicting impulsive self-injurious behavior in a sample of adult women.

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Black, Emma B; Mildred, Helen

2013-01-01

Different types of self-injury have been classified as reflecting impulsive and compulsive characteristics (article by Simeon and Favazza [Self-injurious Behaviors: Assessment and Treatment {pp 1-28}. Washington, DC: American Psychiatric Publishing, Inc, 2001]). The current research used a prospective design to evaluate whether there is a progression between these different types of self-injurious behaviors (SIB) over time. Support was found for a progression from compulsive SIB (including hair pulling, nail-biting, skin picking, scratching, and preventing wounds from healing) to impulsive SIB (including cutting, burning, carving, pin sticking, and punching) in a group of adult women (N = 106). Other factors hypothesized to be linked to this outcome were disordered eating, age, and personality facets of impulsivity (specifically, urgency and lack of perseverance). Of these variables, only urgency positively predicted impulsive SIB at the study's conclusion. These findings are discussed, limitations of the study are noted, and directions for future research are outlined.

Altered metabolites of the rat hippocampus after mild and moderate traumatic brain injury - a combined in vivo and in vitro 1 H-MRS study.

Science.gov (United States)

Singh, Kavita; Trivedi, Richa; Verma, Ajay; D'souza, Maria M; Koundal, Sunil; Rana, Poonam; Baishya, Bikash; Khushu, Subash

2017-10-01

Traumatic brain injury (TBI) has been shown to affect hippocampus-associated learning, memory and higher cognitive functions, which may be a consequence of metabolic alterations. Hippocampus-associated disorders may vary depending on the severity of injury [mild TBI (miTBI) and moderate TBI (moTBI)] and time since injury. The underlying hippocampal metabolic irregularities may provide an insight into the pathological process following TBI. In this study, in vivo and in vitro proton magnetic resonance spectroscopy ( 1 H-MRS) data were acquired from the hippocampus region of controls and TBI groups (miTBI and moTBI) at D0 (pre-injury), 4 h, Day 1 and Day 5 post-injury (PI). In vitro MRS results indicated trauma-induced changes in both miTBI and moTBI; however, in vivo MRS showed metabolic alterations in moTBI only. miTBI and moTBI showed elevated levels of osmolytes indicating injury-induced edema. Altered levels of citric acid cycle intermediates, glutamine/glutamate and amino acid metabolism indicated injury-induced aberrant bioenergetics, excitotoxicity and oxidative stress. An overall similar pattern of pathological process was observed in both miTBI and moTBI, with the distinction of depleted N-acetylaspartate levels (indicating neuronal loss) at 4 h and Day 1 and enhanced lactate production (indicating heightened energy depletion leading to the commencement of the anaerobic pathway) at Day 5 in moTBI. To the best of our knowledge, this is the first study to investigate the hippocampus metabolic profile in miTBI and moTBI simultaneously using in vivo and in vitro MRS. Copyright © 2017 John Wiley & Sons, Ltd.

Nestin- and doublecortin-positive cells reside in adult spinal cord meninges and participate in injury-induced parenchymal reaction.

Science.gov (United States)

Decimo, Ilaria; Bifari, Francesco; Rodriguez, Francisco Javier; Malpeli, Giorgio; Dolci, Sissi; Lavarini, Valentina; Pretto, Silvia; Vasquez, Sandra; Sciancalepore, Marina; Montalbano, Alberto; Berton, Valeria; Krampera, Mauro; Fumagalli, Guido

2011-12-01

Adult spinal cord has little regenerative potential, thus limiting patient recovery following injury. In this study, we describe a new population of cells resident in the adult rat spinal cord meninges that express the neural stem/precursor markers nestin and doublecortin. Furthermore, from dissociated meningeal tissue a neural stem cell population was cultured in vitro and subsequently shown to differentiate into functional neurons or mature oligodendrocytes. Proliferation rate and number of nestin- and doublecortin-positive cells increased in vivo in meninges following spinal cord injury. By using a lentivirus-labeling approach, we show that meningeal cells, including nestin- and doublecortin-positive cells, migrate in the spinal cord parenchyma and contribute to the glial scar formation. Our data emphasize the multiple roles of meninges in the reaction of the parenchyma to trauma and indicate for the first time that spinal cord meninges are potential niches harboring stem/precursor cells that can be activated by injury. Meninges may be considered as a new source of adult stem/precursor cells to be further tested for use in regenerative medicine applied to neurological disorders, including repair from spinal cord injury. Copyright © 2011 AlphaMed Press.

Autophagy Limits Endotoxemic Acute Kidney Injury and Alters Renal Tubular Epithelial Cell Cytokine Expression.

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Jeremy S Leventhal

Full Text Available Sepsis related acute kidney injury (AKI is a common in-hospital complication with a dismal prognosis. Our incomplete understanding of disease pathogenesis has prevented the identification of hypothesis-driven preventive or therapeutic interventions. Increasing evidence in ischemia-reperfusion and nephrotoxic mouse models of AKI support the theory that autophagy protects renal tubular epithelial cells (RTEC from injury. However, the role of RTEC autophagy in septic AKI remains unclear. We observed that lipopolysaccharide (LPS, a mediator of gram-negative bacterial sepsis, induces RTEC autophagy in vivo and in vitro through TLR4-initiated signaling. We modeled septic AKI through intraperitoneal LPS injection in mice in which autophagy-related protein 7 was specifically knocked out in the renal proximal tubules (ATG7KO. Compared to control littermates, ATG7KO mice developed more severe renal dysfunction (24hr BUN 100.1mg/dl +/- 14.8 vs 54.6mg/dl +/- 11.3 and parenchymal injury. After injection with LPS, analysis of kidney lysates identified higher IL-6 expression and increased STAT3 activation in kidney lysates from ATG7KO mice compared to controls. In vitro experiments confirmed an altered response to LPS in RTEC with genetic or pharmacological impairment of autophagy. In conclusion, RTEC autophagy protects against endotoxin induced injury and regulates downstream effects of RTEC TLR4 signaling.

Pathophysiological links between traumatic brain injury and post-traumatic headaches [version 1; referees: 3 approved

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Robert L. Ruff

2016-08-01

Full Text Available This article reviews possible ways that traumatic brain injury (TBI can induce migraine-type post-traumatic headaches (PTHs in children, adults, civilians, and military personnel. Several cerebral alterations resulting from TBI can foster the development of PTH, including neuroinflammation that can activate neural systems associated with migraine. TBI can also compromise the intrinsic pain modulation system and this would increase the level of perceived pain associated with PTH. Depression and anxiety disorders, especially post-traumatic stress disorder (PTSD, are associated with TBI and these psychological conditions can directly intensify PTH. Additionally, depression and PTSD alter sleep and this will increase headache severity and foster the genesis of PTH. This article also reviews the anatomic loci of injury associated with TBI and notes the overlap between areas of injury associated with TBI and PTSD.

Sperm mRNA transcripts are indicators of sub-chronic low dose testicular injury in the Fischer 344 rat.

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Sara E Pacheco

Full Text Available Current human reproductive risk assessment methods rely on semen and serum hormone analyses, which are not easily comparable to the histopathological endpoints and mating studies used in animal testing. Because of these limitations, there is a need to develop universal evaluations that reliably reflect male reproductive function. We hypothesized that toxicant-induced testicular injury can be detected in sperm using mRNA transcripts as indicators of insult. To test this, we exposed adult male Fischer 344 rats to low doses of model testicular toxicants and classically characterized the testicular injury while simultaneously evaluating sperm mRNA transcripts from the same animals. Overall, this study aimed to: 1 identify sperm transcripts altered after exposure to the model testicular toxicant, 2,5-hexanedione (HD using microarrays; 2 expand on the HD-induced transcript changes in a comprehensive time course experiment using qRT-PCR arrays; and 3 test these injury indicators after exposure to another model testicular toxicant, carbendazim (CBZ. Microarray analysis of HD-treated adult Fischer 344 rats identified 128 altered sperm mRNA transcripts when compared to control using linear models of microarray analysis (q<0.05. All transcript alterations disappeared after 3 months of post-exposure recovery. In the time course experiment, time-dependent alterations were observed for 12 candidate transcripts selected from the microarray data based upon fold change and biological relevance, and 8 of these transcripts remained significantly altered after the 3-month recovery period (p<0.05. In the last experiment, 8 candidate transcripts changed after exposure to CBZ (p<0.05. The two testicular toxicants produced distinct molecular signatures with only 4 overlapping transcripts between them, each occurring in opposite directions. Overall, these results suggest that sperm mRNA transcripts are indicators of low dose toxicant-induced testicular injury in the rat.

The influence of secondary conditions on job acquisition and retention in adults with spinal cord injury.

Science.gov (United States)

Meade, Michelle A; Forchheimer, Martin B; Krause, James S; Charlifue, Susan

2011-03-01

To examine the associations of job acquisition and job retention to secondary conditions, hospitalizations, and nursing home stays for adults with spinal cord injury (SCI). Retrospective analysis of longitudinal data from multicenter study. Community setting. Two samples of adults participating in the SCI Model Systems; the first sample consisted of persons who reported being unemployed at follow-up (n=9501); the second sample consisted of those who reported working at follow-up (n=5,150). Not applicable. Job acquisition (change from not working at 1 anniversary of injury to working at the following data collection) and job retention (maintenance of work between 2 assessment periods). Discrete time hazard modeling was used to assess how secondary conditions affect job acquisition. After controlling for the effects of demographic and injury characteristics, hospitalizations within the last 12 months were associated with decreased chance of having obtained employment. Hierarchic logistic regression analyses were used to examine job retention. Hospitalizations and the presence of PUs were associated with lower odds of job retention once demographic and injury characteristics were controlled. Secondary conditions from the previous assessment period were not significantly related to either job acquisition or job retention after the variance from demographic and injury characteristics and current secondary conditions were controlled. Hospitalization, as well as a limited number of secondary conditions, were associated with reduced odds of both job acquisition and job retention among adults with SCI. Interventions that can prevent secondary conditions and reduce the need for hospitalizations may be beneficial in improving employment for this population. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Exposure to bisphenol A in young adult mice does not alter ovulation but does alter the fertilization ability of oocytes

International Nuclear Information System (INIS)

Moore-Ambriz, Teresita Rocio; Acuña-Hernández, Deyanira Guadalupe; Ramos-Robles, Brenda; Sánchez-Gutiérrez, Manuel; Santacruz-Márquez, Ramsés; Sierra-Santoyo, Adolfo; Piña-Guzmán, Belem

2015-01-01

Follicle growth culminates in ovulation, which allows for the expulsion of fertilizable oocytes and the formation of corpora lutea. Bisphenol A (BPA) is present in many consumer products, and it has been suggested that BPA impairs ovulation; however, the underlying mechanisms are unknown. Therefore, this study first evaluated whether BPA alters ovulation by affecting folliculogenesis, the number of corpora lutea or eggs shed to the oviduct, ovarian gonadotropin responsiveness, hormone levels, and estrous cyclicity. Because it has been suggested (but not directly confirmed) that BPA exerts toxic effects on the fertilization ability of oocytes, a second aim was to evaluate whether BPA impacts the oocyte fertilization rate using an in vitro fertilization assay and mating. The possible effects on early zygote development were also examined. Young adult female C57BL/6J mice (39 days old) were orally dosed with corn oil (vehicle) or 50 μg/kg bw/day BPA for a period encompassing the first three reproductive cycles (12–15 days). BPA exposure did not alter any parameters related to ovulation. Moreover, BPA exposure reduced the percentage of fertilized oocytes after either in vitro fertilization or mating, but it did not alter the zygotic stages. The data indicate that exposure to the reference dose of BPA does not impact ovulation but that it does influence the oocyte quality in terms of its fertilization ability. - Highlights: • Bisphenol A targets the fertilization ability of oocytes. • Bisphenol A does not alter ovulation. • Young adult females may be susceptible to the effects of bisphenol A on fertilization.

Exposure to bisphenol A in young adult mice does not alter ovulation but does alter the fertilization ability of oocytes

Energy Technology Data Exchange (ETDEWEB)

Moore-Ambriz, Teresita Rocio; Acuña-Hernández, Deyanira Guadalupe; Ramos-Robles, Brenda [Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav-IPN), Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, México D.F. 07360, México (Mexico); Sánchez-Gutiérrez, Manuel [Área Académica de Medicina, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo 42000, México (Mexico); Santacruz-Márquez, Ramsés; Sierra-Santoyo, Adolfo [Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav-IPN), Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, México D.F. 07360, México (Mexico); Piña-Guzmán, Belem [Instituto Politécnico Nacional-UPIBI, México D.F. 07738, México (Mexico); and others

2015-12-15

Follicle growth culminates in ovulation, which allows for the expulsion of fertilizable oocytes and the formation of corpora lutea. Bisphenol A (BPA) is present in many consumer products, and it has been suggested that BPA impairs ovulation; however, the underlying mechanisms are unknown. Therefore, this study first evaluated whether BPA alters ovulation by affecting folliculogenesis, the number of corpora lutea or eggs shed to the oviduct, ovarian gonadotropin responsiveness, hormone levels, and estrous cyclicity. Because it has been suggested (but not directly confirmed) that BPA exerts toxic effects on the fertilization ability of oocytes, a second aim was to evaluate whether BPA impacts the oocyte fertilization rate using an in vitro fertilization assay and mating. The possible effects on early zygote development were also examined. Young adult female C57BL/6J mice (39 days old) were orally dosed with corn oil (vehicle) or 50 μg/kg bw/day BPA for a period encompassing the first three reproductive cycles (12–15 days). BPA exposure did not alter any parameters related to ovulation. Moreover, BPA exposure reduced the percentage of fertilized oocytes after either in vitro fertilization or mating, but it did not alter the zygotic stages. The data indicate that exposure to the reference dose of BPA does not impact ovulation but that it does influence the oocyte quality in terms of its fertilization ability. - Highlights: • Bisphenol A targets the fertilization ability of oocytes. • Bisphenol A does not alter ovulation. • Young adult females may be susceptible to the effects of bisphenol A on fertilization.

Peripheral Nerve Injury in Developing Rats Reorganizes Representation Pattern in Motor Cortex

Science.gov (United States)

Donoghue, John P.; Sanes, Jerome N.

1987-02-01

We investigated the effect of neonatal nerve lesions on cerebral motor cortex organization by comparing the cortical motor representation of normal adult rats with adult rats that had one forelimb removed on the day of birth. Mapping of cerebral neocortex with electrical stimulation revealed an altered relationship between the motor cortex and the remaining muscles. Whereas distal forelimb movements are normally elicited at the lowest threshold in the motor cortex forelimb area, the same stimuli activated shoulder and trunk muscles in experimental animals. In addition, an expanded cortical representation of intact body parts was present and there was an absence of a distinct portion of motor cortex. These data demonstrate that representation patterns in motor cortex can be altered by peripheral nerve injury during development.

A Scoping Review of the Associations of Golf with Eye Injuries in Adults and Children

Science.gov (United States)

2016-01-01

Introduction. Sport presents a risk of ocular trauma and accounts for a significant number of eye injuries that require hospital admission. The sport of golf presents a risk to eyesight from fast moving objects such as golf clubs and balls. This study aims to investigate the associations of golf with eye injuries and the reasons that these injuries occur. Material/Methods. A literature search was conducted using the databases MEDLINE, Web of Science, SPORTDiscus, and PsycINFO. Grey literature was searched using the WHO international clinical trials registry platform, Google Scholar, and ProQuest. Data was extracted using a standardised form and summarised into a report. Results and Discussion. Twenty-three studies were found relating to eye injuries in golf. Injuries appear to be rare, but more frequent in men and children. Injuries resulted in high rates of enucleation and visual impairment. Children sustained more injury from golf clubs whereas adults sustained more injuries from golf balls. Conclusion. Efforts are needed to encourage golf participants to understand the risks of ocular and indeed other head injuries. Initiatives to provide appropriate supervision and education on this topic are merited. Further research is needed to investigate the circumstances of eye injury in golf and assess the effects of interventions aimed at reducing risk of injury. PMID:27504485

Enteral Tube Feeding Alters the Oral Indigenous Microbiota in Elderly Adults ▿ †

OpenAIRE

Takeshita, Toru; Yasui, Masaki; Tomioka, Mikiko; Nakano, Yoshio; Shimazaki, Yoshihiro; Yamashita, Yoshihisa

2011-01-01

Enteral tube feeding is widely used to maintain nutrition for elderly adults with eating difficulties, but its long-term use alters the environment of the oral ecosystem. This study characterized the tongue microbiota of tube-fed elderly adults by analyzing the 16S rRNA gene. The terminal restriction fragment length polymorphism (T-RFLP) profiles of 44 tube-fed subjects were compared with those of 54 subjects fed orally (average age, 86.4 ± 6.9 years). Bar-coded pyrosequencing data were also ...

Comparison of the clinical presentation and visual outcome in open globe injuries in adults and children over 30 months.

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Gupta, Arvind; Srinivasan, Renuka; Babu, K Ramesh; Setia, Sajita

2010-01-01

To compare the clinical presentation and final visual outcome of open globe injuries in children and adults in a referral hospital over a 30-month period. This is an institutional-based prospective study of open globe injuries cases presenting in the emergency department between July 2003 and December 2005. Patients were divided in 2 groups: group 1, children (2-15 years), and group 2, adults (>15 years). All the patients were admitted and emergency surgical interventions were undertaken. The clinical features at presentation and the final visual acuity are compared. Chi-square and Fisher exact tests were used for statistical analysis. Ninety and 84 patients were included in group 1 and group 2, respectively. The most common places of injuries were home or while playing outdoor games in group 1 (67%) and workplace in group 2 (53.5%). The presenting features were significantly more grave in group 2. These included poor presenting visual acuity (p=0.012), vitreous prolapse (p=0.002), presence of relative afferent pupillary defect (p=0.001), and incidence of endophthalmitis (p=0.004). Time interval between injury and surgical intervention (p=0.018) was better in group 2. Other features, such as presence of hyphema, uveal tissue prolapse, cataract, intraocular foreign body, and length or location of laceration were similar in both groups. The final visual outcome was similar in the groups (p = 0.21), with approximately half of the patients achieving vision of 20/60 or better in each group. The majority of injuries in children and adults occurred in their homes or workplaces, respectively. Although the clinical presentations of open globe injuries were significantly more grave in adults than in children, the final visual outcomes were similar.

Neighborhood Factors and Fall-Related Injuries among Older Adults Seen by Emergency Medical Service Providers

OpenAIRE

Lee, Sungmin; Lee, Chanam; Rodiek, Susan

2017-01-01

Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS). Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed the risk factors at the neighborhood level. This study examines the characteristics of neighborhood environments associated with fall injuries reported to EMS providers. A total of 13,163 EMS records from 201...

Deaths and hospital admissions as a result of home injuries among young and middle-aged New Zealand adults.

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Kool, Bridget; Chelimo, Carol; Robinson, Elizabeth; Ameratunga, Shanthi

2011-12-16

New Zealand lacks a comprehensive national profile of home injuries, this information is necessary to develop effective targeted injury prevention initiatives. This study describes the epidemiology of unintentional home injuries resulting in death or admission to hospital among young and middle-age New Zealanders. Cases were selected from Ministry of Health public hospital discharge (2000-2009) and mortality data (1998-2007), and included all 20-64 year olds where the place of injury occurrence was classified as 'home'. Only initial hospitalisations with a stay of 24 hours or longer were included. The circumstances of injury were coded according to the ICD-10 external cause categories. Mean annual rates of death or hospitalisation were calculated using census and intercensal denominator data. On average 4000 young and middle-age adults are admitted to hospital and 60 die annually as a result of unintentional injuries sustained at home. Overall, mortality rates were highest amongst males, older adults (50 to 64 years), and Māori. The leading causes of unintentional home injury deaths were poisoning, falls, and burns. Hospitalisation rates were highest among males, the older age groups (> 40 years), and Maori. As age increased so did the incidence of hospital admission. The leading contributors resulting in admission to hospital were falls, cutting or piercing, overexertion, and poisoning. Injuries due to falls had the highest median length of hospital stay and in-hospital mortality rate. As deprivation increased so did the frequency of hospital admissions due to fall and cutting or piercing injuries. Poisonings and falls are the leading causes of unintentional home injury death among young and middle-aged New Zealanders. In addition, falls are a significant contributor to home injury resulting in admission to hospital. The large numbers of home injuries occurring each year in New Zealand, mean that even moderately successful injury prevention interventions could

Humor, Rapport, and Uncomfortable Moments in Interactions with Adults with Traumatic Brain Injury

Science.gov (United States)

Kovarsky, Dana; Schiemer, Christine; Murray, Allison

2011-01-01

We examined uncomfortable moments that damaged rapport during group interactions between college students in training to become speech-language pathologists and adults with traumatic brain injury. The students worked as staff in a community-based program affiliated with a university training program that functioned as a recreational gathering…

Anabolic steroids and head injury.

Science.gov (United States)

Mills, James D; Bailes, Julian E; Turner, Ryan C; Dodson, Sean C; Sakai, Jun; Maroon, Joseph C

2012-01-01

The suggestion has been made that neurological changes seen in the syndrome of chronic traumatic encephalopathy may be due to exogenous anabolic steroid use rather than traumatic brain injury. To determine whether administration of anabolic steroids alters the pathophysiology of traumatic brain injury. Sixty adult male Sprague-Dawley rats and a linear acceleration model of traumatic brain injury were used. Experimental groups were (1) preinjury anabolic steroids, (2) preinjury placebo carrier, (3) anabolic steroids without injury, (4) no steroids and no injury, (5) postinjury placebo carrier, and (6) postinjury anabolic steroids. Following a 30-day recovery, rats were euthanized, and brainstem white matter tracts underwent fluorescent immunohistochemical processing and labeling of β-amyloid precursor protein (APP), a marker of axonal injury. Digital imaging and statistical analyses were used to determine whether anabolic steroid administration resulted in a significant change in the number of injured axons. There was no statistically significant difference in number of APP-positive axons by immunohistochemical analysis between respective anabolic steroid and placebo groups. Using a standard acceleration-deceleration model of mild traumatic brain injury, we have shown successful visualization of traumatically injured axons with antibody staining of APP. Our results indicate no statistically significant effect of anabolic steroids on the number of APP-positive axons. With the use of this model, and within its limitations, we see no adverse effect or causative role of anabolic steroid administration on the brain following mild traumatic brain injury using APP counts as a marker for anatomic injury.

Injury Signals Cooperate with Nf1 Loss to Relieve the Tumor-Suppressive Environment of Adult Peripheral Nerve

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Sara Ribeiro

2013-10-01

Full Text Available Schwann cells are highly plastic cells that dedifferentiate to a progenitor-like state following injury. However, deregulation of this plasticity, may be involved in the formation of neurofibromas, mixed-cell tumors of Schwann cell (SC origin that arise upon loss of NF1. Here, we show that adult myelinating SCs (mSCs are refractory to Nf1 loss. However, in the context of injury, Nf1-deficient cells display opposing behaviors along the wounded nerve; distal to the injury, Nf1−/− mSCs redifferentiate normally, whereas at the wound site Nf1−/− mSCs give rise to neurofibromas in both Nf1+/+ and Nf1+/− backgrounds. Tracing experiments showed that distinct cell types within the tumor derive from Nf1-deficient SCs. This model of neurofibroma formation demonstrates that neurofibromas can originate from adult SCs and that the nerve environment can switch from tumor suppressive to tumor promoting at a site of injury. These findings have implications for both the characterization and treatment of neurofibromas.

Switching adolescent high-fat diet to adult control diet restores neurocognitive alterations

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Chloe Boitard

2016-11-01

Full Text Available In addition to metabolic and cardiovascular disorders, obesity is associated with adverse cognitive and emotional outcomes. Its growing prevalence in adolescents is particularly alarming since this is a period of ongoing maturation for brain structures (including the hippocampus and amygdala and for the hypothalamic-pituitary-adrenal (HPA stress axis, which is required for cognitive and emotional processing. We recently demonstrated that adolescent, but not adult, high-fat diet (HF exposure leads to impaired hippocampal function and enhanced amygdala function through HPA axis alteration (Boitard et al., 2014; Boitard et al., 2012; Boitard et al., 2015. Here, we assessed whether the effects of adolescent HF consumption on brain function are permanent or reversible. After adolescent exposure to HF, switching to a standard chow diet restored levels of hippocampal neurogenesis and normalized enhanced HPA axis reactivity, amygdala activity and avoidance memory. Therefore, while the adolescent period is highly vulnerable to the deleterious effects of diet-induced obesity, adult exposure to a standard diet appears sufficient to reverse alterations of brain function.

Adult Reconstructive Surgery: A High-Risk Profession for Work-Related Injuries.

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Alqahtani, Saad M; Alzahrani, Mohammad M; Tanzer, Michael

2016-06-01

Adult reconstructive surgery is an orthopedic subspecialty characterized by surgical tasks that are physical, repetitive, and require some degree of stamina from the surgeon. This can result strain and/or injury of the surgeon's musculoskeletal system. This study investigates the prevalence of work-related injuries among arthroplasty surgeons. A modified version of the physical discomfort survey was sent to surgeon members of the Hip Society, the International Hip Society, and the Canadian Orthopedic Arthroplasty via email. One hundred and eighty-three surgeons completed the survey. Overall, 66.1% of the arthroplasty surgeons reported that they had experienced a work-related injury. The most common injuries that occurred were low back pain (28%), lateral epicondylitis of the elbow (14%), shoulder tendonitis (14%), lumbar disc herniation (13%), and wrist arthritis (12%). Overall, 27% of surgeons took time off from work because of the injury. As the number of disorders diagnosed increased, there was a significant increase in the incidence of requiring time off work because of the disorder (P increased the risk of the surgeon requiring time off because of the disorder were age >55 years, practicing for more than >20 years, and performing >100 total hip arthroplasty procedures per year (P < .05). In addition, 31% of the orthopedic surgeons surveyed required surgery for their injury. Although most studies concentrate on the importance of patient safety and thus the quality of the health care system, the surgeon's safety is also considered an integral part of this system's quality. This study highlights a high prevalence of musculoskeletal work-related injuries among arthroplasty surgeons and indicates the need for the identification of preventive measures directed toward improving the operative surgical environment and work ergonomics for the surgeons. Copyright © 2015 Elsevier Inc. All rights reserved.

Underreporting of Fall Injuries of Older Adults: Implications for Wellness Visit Fall Risk Screening.

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Hoffman, Geoffrey J; Ha, Jinkyung; Alexander, Neil B; Langa, Kenneth M; Tinetti, Mary; Min, Lillian C

2018-04-17

To compare the accuracy of and factors affecting the accuracy of self-reported fall-related injuries (SFRIs) with those of administratively obtained FRIs (AFRIs). Retrospective observational study SETTING: United States PARTICIPANTS: Fee-for-service Medicare beneficiaries aged 65 and older (N=47,215). We used 24-month self-report recall data from 2000-2012 Health and Retirement Study data to identify SFRIs and linked inpatient, outpatient, and ambulatory Medicare data to identify AFRIs. Sensitivity and specificity were assessed, with AFRIs defined using the University of California at Los Angeles/RAND algorithm as the criterion standard. Logistic regression models were used to identify sociodemographic and health predictors of sensitivity. Overall sensitivity and specificity were 28% and 92%. Sensitivity was greater for the oldest adults (38%), women (34%), those with more functional limitations (47%), and those with a prior fall (38%). In adjusted results, several participant factors (being female, being white, poor functional status, depression, prior falls) were modestly associated with better sensitivity and specificity. Injury severity (requiring hospital care) most substantively improved SFRI sensitivity (73%). An overwhelming 72% of individuals who received Medicare-reimbursed health care for FRIs failed to report a fall injury when asked. Future efforts to address underreporting in primary care of nonwhite and healthier older adults are critical to improve preventive efforts. Redesigned questions-for example, that address stigma of attributing injury to falling-may improve sensitivity. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Which Extrinsic and Intrinsic Factors are Associated with Non-Contact Injuries in Adult Cricket Fast Bowlers?

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Olivier, Benita; Taljaard, Tracy; Burger, Elaine; Brukner, Peter; Orchard, John; Gray, Janine; Botha, Nadine; Stewart, Aimee; Mckinon, Warrick

2016-01-01

The high prevalence of injury amongst cricket fast bowlers exposes a great need for research into the risk factors associated with injury. Both extrinsic (environment-related) and intrinsic (person-related) risk factors are likely to be implicated within the high prevalence of non-contact injury amongst fast bowlers in cricket. Identifying and defining the relative importance of these risk factors is necessary in order to optimize injury prevention efforts. The objective of this review was to assess and summarize the scientific literature related to the extrinsic and intrinsic factors associated with non-contact injury inherent to adult cricket fast bowlers. A systematic review was performed in compliance with the PRISMA guidelines. This review considered both experimental and epidemiological study designs. Studies that included male cricket fast bowlers aged 18 years or above, from all levels of play, evaluating the association between extrinsic/intrinsic factors and injury in fast bowlers were considered for inclusion. The three-step search strategy aimed at finding both published and unpublished studies from all languages. The searched databases included MEDLINE via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Controlled Trials Register in the Cochrane Library, Physiotherapy Evidence Database (PEDro), ProQuest 5000 International, ProQuest Health and Medical Complete, EBSCO MegaFile Premier, Science Direct, SPORTDiscus with Full Text and SCOPUS (prior to 28 April 2015). Initial keywords used were 'cricket', 'pace', 'fast', 'bowler', and 'injury'. Papers which fitted the inclusion criteria were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). A total of 16 studies were determined to be suitable for inclusion in this

Pattern of traumatic dental injuries in the permanent dentition among children, adolescents, and adults

DEFF Research Database (Denmark)

Lauridsen, Eva; Hermann, Nuno Vibe; Gerds, Thomas Alexander

2012-01-01

and fracture types among children, adolescents, and adults, and to analyze the distribution and prevalence of combination injuries. MATERIAL AND METHOD: The study group included 4754 patients (3186 men and 1568 women) with 10 166 traumatized permanent incisors treated at Copenhagen University Hospital......BACKGROUND: Traumatic dental injuries (TDI) comprise six types of luxation and seven types of tooth fractures. The risk of pulp necrosis is increased in teeth with combination injuries where fractures and luxations occur concomitantly. AIM: To report and compare the distributions of luxations......, Rigshospitalet. Differences in the distributions of trauma types among age groups (children 20 years) and distributions of concomitant crown fractures for each luxation type were analyzed with the Chi-square test. RESULTS: A total of 7464 teeth (73.4%) had suffered...

Systematic review of self-reported prognosis in adults after mild traumatic brain injury

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Cassidy, John David; Cancelliere, Carol; Carroll, Linda J

2014-01-01

accepted and form our evidence base of prognostic studies. Of these, 23 addressed self-reported outcomes in adults, including 2 of the 3 original ICoMP research studies. These studies show that common postconcussion symptoms are not specific to MTBI/concussion and occur after other injuries as well. Poor...... recovery after MTBI is associated with poorer premorbid mental and physical health status and with more injury-related stress. Most recover over 1 year, but persistent symptoms are more likely in those with more acute symptoms and more emotional stress. CONCLUSIONS: Common subjective symptoms after MTBI......OBJECTIVE: To update the mild traumatic brain injury (MTBI) prognosis review published by the World Health Organization Task Force in 2004. DATA SOURCES: MEDLINE, PsycINFO, Embase, CINAHL, and SPORTDiscus were searched from 2001 to 2012. We included published, peer-reviewed studies with more than...

Dynamic alteration of the colonic microbiota in intestinal ischemia-reperfusion injury.

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Fan Wang

Full Text Available Intestinal ischemia-reperfusion (I/R plays an important role in critical illnesses. Gut flora participate in the pathogenesis of the injury. This study is aimed at unraveling colonic microbiota alteration pattern and identifying specific bacterial species that differ significantly as well as observing colonic epithelium change in the same injury model during the reperfusion time course.Denaturing gradient gel electrophoresis (DGGE was used to monitor the colonic microbiota of control rats and experimental rats that underwent 0.5 hour ischemia and 1, 3, 6, 12, 24, and 72 hours following reperfusion respectively. The microbiota similarity, bacterial diversity and species that characterized the dysbiosis were estimated based on the DGGE profiles using a combination of statistical approaches. The interested bacterial species in the gel were cut and sequenced and were subsequently quantified and confirmed with real-time PCR. Meanwhile, the epithelial barrier was checked by microscopy and D-lactate analysis. Colonic flora changed early and differed significantly at 6 hours after reperfusion and then started to recover. The shifts were characterized by the increase of Escherichia coli and Prevotella oralis, and Lactobacilli proliferation together with epithelia healing.This study shows for the first time that intestinal ischemia-reperfusion results in colonic flora dysbiosis that follows epithelia damage, and identifies the bacterial species that contribute most.

Alcohol Consumption at Any Level Increases Risk of Injury Caused by Others: Data from the Study on Global AGEing and Adult Health

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Thomas Clausen

2015-01-01

Full Text Available Background Alcohol use is a well-known risk factor for injury. However, information is needed about alcohol drinking patterns and the risk of injury among older adults in low- and middle-income countries as this population grows. We aimed to examine the influence of drinking patterns on the burden of injury and investigate factors associated with different types of injury in older populations in six emerging economies. Methods Data from more than 37,0 adults aged 50 years and older were included from the Study on Global AGEing and Adult Health (SAGE Wave 1 conducted in six emerging economies, namely, China, Ghana, India, Mexico, Russia, and South Africa. We investigated past-year reported injuries from falls, traffic accidents, and being hit or stabbed. Alcohol drinking patterns were measured as lifetime abstinence, ever but not past- week use, and gender-specific past-week low-risk and high-risk use. We stratified by gender and used logistic regression models to observe the association between alcohol drinking pattern and risk of injury by controlling for other factors. Results During the year prior to interview, 627 (2.2% subjects reported bodily injury resulting from a car accident, 1,156 (4.2% from a fall, and 339 (.9% from being hit or stabbed during the past year. For women, only being a high-risk drinker increased the risk of being hit or stabbed, whereas for men, all levels of drinking were associated with an increased risk of being hit or stabbed. We observed a higher risk of being hit or stabbed from past-week high-risk drinking among women (odds ratio [OR] = 6.09, P < 0.01 than among men (OR = 3.57, P < 0.01. We observed no association between alcohol drinking pattern and injury due to car accidents for either women or men. Conclusions The risk of experiencing injury due to violence increased with level of alcohol exposure of the victim. The increase in alcohol use in emerging economies calls for further study into the consequences of

Characterization of Proliferating Neural Progenitors after Spinal Cord Injury in Adult Zebrafish.

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Subhra Prakash Hui

Full Text Available Zebrafish can repair their injured brain and spinal cord after injury unlike adult mammalian central nervous system. Any injury to zebrafish spinal cord would lead to increased proliferation and neurogenesis. There are presences of proliferating progenitors from which both neuronal and glial loss can be reversed by appropriately generating new neurons and glia. We have demonstrated the presence of multiple progenitors, which are different types of proliferating populations like Sox2+ neural progenitor, A2B5+ astrocyte/ glial progenitor, NG2+ oligodendrocyte progenitor, radial glia and Schwann cell like progenitor. We analyzed the expression levels of two common markers of dedifferentiation like msx-b and vimentin during regeneration along with some of the pluripotency associated factors to explore the possible role of these two processes. Among the several key factors related to pluripotency, pou5f1 and sox2 are upregulated during regeneration and associated with activation of neural progenitor cells. Uncovering the molecular mechanism for endogenous regeneration of adult zebrafish spinal cord would give us more clues on important targets for future therapeutic approach in mammalian spinal cord repair and regeneration.

Body and Corporality in adolescents and young adults with spinal cord injury.

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Duarte Torres, Diana Milena; Torres Bolaños, Yuri Marcela; Moreno Fergusson, María Elisa

2016-04-01

To describe the meaning given by adolescents and young adults to the changes in their bodies and corporality after a spinal cord injury. Qualitative study based on symbolic interactionism in which 12 adolescents and young adults, who had suffered spinal cord injury 6 months or more before, participated. The information was recollected through a series of in-depth interviews and field journals. The guidelines proposed by Corbin and Strauss were followed for the process of codification and categorization of the data. Four categories were identified that describe the meanings given by participants to the changes in their bodies and corporality: Transformation of self-image, living with contradictions in the relationships with others, withstanding the burden of a disability and adapting to the new conditions. The results allow for the comprehension of the meanings that are given by the people who have suffered a spinal cord lesion to their situation. This will in turn open the possibility of offering these people a better individual nursing care that focuses more on the particular needs, so that both they and their families can be helped on their way to adaptation to the new situation.

Treatment with analgesics after mouse sciatic nerve injury does not alter expression of wound healing-associated genes

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Matt C Danzi

2016-01-01

Full Text Available Animal models of sciatic nerve injury are commonly used to study neuropathic pain as well as axon regeneration. Administration of post-surgical analgesics is an important consideration for animal welfare, but the actions of the analgesic must not interfere with the scientific goals of the experiment. In this study, we show that treatment with either buprenorphine or acetaminophen following a bilateral sciatic nerve crush surgery does not alter the expression in dorsal root ganglion (DRG sensory neurons of a panel of genes associated with wound healing. These findings indicate that the post-operative use of buprenorphine or acetaminophen at doses commonly suggested by Institutional Animal Care and Use Committees does not change the intrinsic gene expression response of DRG neurons to a sciatic nerve crush injury, for many wound healing-associated genes. Therefore, administration of post-operative analgesics may not confound the results of transcriptomic studies employing this injury model.

An ex vivo spinal cord injury model to study ependymal cells in adult mouse tissue.

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Fernandez-Zafra, Teresa; Codeluppi, Simone; Uhlén, Per

2017-08-15

Traumatic spinal cord injury is characterized by an initial cell loss that is followed by a concerted cellular response in an attempt to restore the damaged tissue. Nevertheless, little is known about the signaling mechanisms governing the cellular response to injury. Here, we have established an adult ex vivo system that exhibits multiple hallmarks of spinal cord injury and allows the study of complex processes that are difficult to address using animal models. We have characterized the ependymal cell response to injury in this model system and found that ependymal cells can become activated, proliferate, migrate out of the central canal lining and differentiate in a manner resembling the in vivo situation. Moreover, we show that these cells respond to external adenosine triphosphate and exhibit spontaneous Ca 2+ activity, processes that may play a significant role in the regulation of their response to spinal cord injury. This model provides an attractive tool to deepen our understanding of the ependymal cell response after spinal cord injury, which may contribute to the development of new treatment options for spinal cord injury. Copyright © 2017 Elsevier Inc. All rights reserved.

Spinal Cord Injury 101

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Full Text Available ... Topic Resources Peer Counseling Blog About Media Donate Spinal Cord Injury Medical Expert Videos Topics menu Topics Spinal Cord Injury 101 Adult Injuries Spinal Cord Injury 101 ...

Road work on memory lane--functional and structural alterations to the learning and memory circuit in adults born very preterm.

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Salvan, Piergiorgio; Froudist Walsh, Seán; Allin, Matthew P G; Walshe, Muriel; Murray, Robin M; Bhattacharyya, Sagnik; McGuire, Philip K; Williams, Steven C R; Nosarti, Chiara

2014-11-15

Very preterm (VPT) birth is considered a risk factor not only for neurological impairment, but also for reduced function in several cognitive domains in childhood and later in life. Individuals who were born VPT are more likely to demonstrate learning and memory difficulties compared to term-born controls. These problems contribute to more VPT-born children repeating grades and underachieving in school. This, in turn, affects their prospects in adult life. Here we aimed to 1) study how the VPT-born adult brain functionally recruited specific areas during learning, i.e. encoding and recall across four repeated blocks of verbal stimuli, and to investigate how these patterns of activation differed from term-born subjects; and 2) probe the microstructural differences of white-matter tracts connecting these areas to other parts of the learning and memory network. To investigate these functional-structural relationships we analyzed functional and diffusion-weighted MRI. Functional-MRI and a verbal paired associate learning (VPAL) task were used to extract Blood Oxygenation Level Dependent (BOLD) activity in 21 VPT-born adults (memory network, including anterior cingulate and caudate body during encoding and thalamus/parahippocampal gyrus during cued recall. Altered activation in thalamus/parahippocampal gyrus may be explained by reduced connections between these areas and the hippocampus, which may be a direct consequence of neonatal hypoxic/ischemic injury. These results could reflect the effect of adaptive plastic processes associated with high-order cognitive functions, at least when the cognitive load remains relatively low, as ex-preterm young adults displayed unimpaired performance in completing the verbal paired associate learning task. Copyright © 2013 Elsevier Inc. All rights reserved.

Spinal Cord Injury 101

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Full Text Available ... Topic Resources Peer Counseling Blog About Media Donate Spinal Cord Injury Medical Expert Videos Topics menu Topics Spinal Cord Injury 101 Adult Injuries Spinal Cord Injury 101 David ...

[Psychological alterations in patients with adult celiac disease].

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Martínez Cerezo, Francisco J; Castillejo, Gemma; Guillen, Núria; Morente, Vanessa; Simó, Josep M; Tena, Francisco J; Marsal, Joan; Pascual, Domingo

2014-04-01

Patients with recently-diagnosed adult celiac disease were evaluated with the Gastrointestinal Symptom rating Scale (GSRS) and Psychological General Well-Being Index (PGWBI) to evaluate their psychological alterations, the association between any alterations and gastrointestinal symptoms, and their outcome after starting a gluten-free diet. The patients underwent nutritional assessment and then started a gluten-free diet; they were reassessed 6 months later. Quantitative variables are expressed as the median and 25th-75th percentiles. We included 21 patients, 17 women and 4 mena, with a mean age of 43 years (31-47). The results of histological analysis were compatible with Marsh I lesions in 6 patients, Marsh IIIa in 6 and Marsh IIIb in 9. At baseline, 8 patients showed severe psychological distress, 4 showed moderate distress and 9 showed no distress. The GSRS score was 34 (17-43) and the PGWBI was 64 (48-87), with a significant correlation between the 2 indexes (rho=-.58, P=.006). At 6 months, 3 patients had severe psychological distress, 5 had moderate distress, 9 showed no distress and 4 showed psychological well-being. The GSRS score at 6 months was 13 (8-17) and the PGWBI was 83 (68-95) (P<.05 compared with baseline data for the 3 indicators). The 6 axes of the PGWBI showed significant improvement. At 6 months, no correlation was found between the GSRS and PGWBI. Patients with celiac disease have psychological alterations whose intensity is related to gastrointestinal symptoms. These symptoms improve after the start of a gluten-free diet. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

Association between sports type and overuse injuries of extremities in adults: a systematic review.

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Chéron, Charlène; Le Scanff, Christine; Leboeuf-Yde, Charlotte

2017-01-01

Sports injuries are often described as overuse or traumatic. Little is known about the frequency of overuse injuries and, in particular, if they vary between different types of sporting activities. To identify any differences between sports in relation to diagnoses of overuse injuries of the extremities (OIE) and anatomical areas most likely to be injured in adults and to compare these findings with those reported in youngsters, as identified in a previous review. A search was made in May 2015 and again in April 2016 in PubMed, SportDiscus, PsycInfo, and Web of Sciences. Search terms were « overuse injuries OR cumulative trauma disorders OR musculoskeletal injuries » AND « extremity OR limb » AND « physical activity OR sport OR risk factor OR exercises ». Inclusion criteria were: 1) prospective, or cross-sectional study design; 2) at least 1/3 of the population should be ≥ 19 years; 3) articles must clearly state if reported cases were classified as traumatic or overuse injuries in relation to a particular sports type, 4) sample size >50, and 5) articles must not deal with specific occupational subpopulations nor with clinical populations. A blinded systematic review was conducted and results reported per anatomical site of injury and diagnosis for the different sports. In all, 10 of 1435 identified articles were included, studying soccer, beach-volleyball and triathlon. In general, the incidence estimates were low, never above 2.0/1000 h of practice, similar to results seen in children/adolescents. The incidence estimates and the diagnoses of OIE were given only in 4 articles on soccer, making comparisons between sports impossible. As in children/adolescents, the lower limb is more often affected than the upper but contrary to young people the injured site in adults is more often the knee and above, and there were also differences in the diagnoses for the two age groups. The literature does not permit to identify clearly the difference in the

Utility of the Croatian translation of the community integration questionnaire-revised in a sample of adults with moderate to severe traumatic brain injury.

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Tršinski, Dubravko; Tadinac, Meri; Bakran, Žarko; Klepo, Ivana

2018-02-23

To examine the utility of the Community Integration Questionnaire-Revised, translated into Croatian, in a sample of adults with moderate to severe traumatic brain injury. The Community Integration Questionnaire-Revised was administered to a sample of 88 adults with traumatic brain injury and to a control sample matched by gender, age and education. Participants with traumatic brain injury were divided into four subgroups according to injury severity. The internal consistency of the Community Integration Questionnaire-Revised was satisfactory. The differences between the group with traumatic brain injury and the control group were statistically significant for the overall Community Integration Questionnaire-Revised score, as well as for all the subscales apart from the Home Integration subscale. The community Integration Questionnaire-Revised score varied significantly for subgroups with different severity of traumatic brain injury. The results show that the Croatian translation of the Community Integration Questionnaire-Revised is useful in assessing participation in adults with traumatic brain injury and confirm previous findings that severity of injury predicts community integration. Results of the new Electronic Social Networking scale indicate that persons who are more active on electronic social networks report better results for other domains of community integration, especially social activities. Implications for rehabilitation The Croatian translation of the Community Integration Questionnaire-Revised is a valid tool for long-term assessment of participation in various domains in persons with moderate to severe traumatic brain injury Persons with traumatic brain injury who are more active in the use of electronic social networking are also more integrated into social and productivity domains. Targeted training in the use of new technologies could enhance participation after traumatic brain injury.

Procedural discourse performance in adults with severe traumatic brain injury at 3 and 6 months post injury.

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Stubbs, Elin; Togher, Leanne; Kenny, Belinda; Fromm, Davida; Forbes, Margaret; MacWhinney, Brian; McDonald, Skye; Tate, Robyn; Turkstra, Lyn; Power, Emma

2018-01-01

There is limited research on communicative recovery during the early stages after a severe traumatic brain injury (TBI) in adults. In the current study 43 people with severe TBI described a simple procedure at 3 and 6 months post injury and this was compared to the description provided by 37 healthy speakers. Linguistic productivity and the presence of macrostructural discourse elements were analysed. No change occurred in productivity in the TBI group between the two time points. There was increased use of relevant information (macrostructure) over time for the TBI group, reflecting improvement. People with TBI differed from controls in speech rate and in two out of three macrostructural categories at both time points, indicating difficulties even after 12 weeks of recovery. Overall, the quality, rather than the quantity of discourse was disordered for participants with TBI. Findings indicate that procedural discourse is sensitive to discourse deficits of people with TBI and can be used to map recovery during the sub-acute phase.

Comparison of transportation related injury mechanisms and outcome of young road users and adult road users, a retrospective analysis on 24,373 patients derived from the TraumaRegister DGU®.

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Brockamp, Thomas; Schmucker, Uli; Lefering, Rolf; Mutschler, Manuel; Driessen, Arne; Probst, Christian; Bouillon, Bertil; Koenen, Paola

2017-06-14

Most young people killed in road crashes are known as vulnerable road users. A combination of physical and developmental immaturity as well as inexperience increases the risk of road traffic accidents with a high injury severity rate. Understanding injury mechanism and pattern in a group of young road users may reduce morbidity and mortality. This study analyzes injury patterns and outcomes of young road users compared to adult road users. The comparison takes into account different transportation related injury mechanisms. A retrospective analysis using data collected between 2002 and 2012 from the TraumaRegister DGU® was performed. Only patients with a transportation related injury mechanism (motor vehicle collision (MVC), motorbike, cyclist, and pedestrian) and an ISS ≥ 9 were included in our analysis. Four different groups of young road users were compared to adult trauma data depending on the transportation related injury mechanism. Twenty four thousand three hundred seventy three, datasets were retrieved to compare all subgroups. The mean ISS was 23.3 ± 13.1. The overall mortality rate was 8.61%. In the MVC, the motorbike and the cyclist group, we found young road users having more complex injury patterns with a higher AIS pelvis, AIS head, AIS abdomen and AIS of the extremities and also a lower GCS. Whereas in these three sub-groups the adult trauma group only had a higher AIS thorax. Only in the group of the adult pedestrians we found a higher AIS pelvis, AIS abdomen, AIS thorax, a higher AIS of the extremities and a lower GCS. This study reports on the most common injuries and injury patterns in young trauma patients in comparison to an adult trauma sample. Our analysis show that in contrast to more experienced road users our young collective refers to be a vulnerable trauma group with an increased risk of a high injury severity and high mortality rate. We indicate a striking difference in terms of the region of injury and the mechanism of

Influence of mild traumatic brain injury during pediatric stage on short-term memory and hippocampal apoptosis in adult rats.

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Park, Mi-Sook; Oh, Hyean-Ae; Ko, Il-Gyu; Kim, Sung-Eun; Kim, Sang-Hoon; Kim, Chang-Ju; Kim, Hyun-Bae; Kim, Hong

2014-06-01

Traumatic brain injury (TBI) is a leading cause of neurological deficit in the brain, which induces short- and long-term brain damage, cognitive impairment with/without structural alteration, motor deficits, emotional problems, and death both in children and adults. In the present study, we evaluated whether mild TBI in childhood causes persisting memory impairment until adulthood. Moreover, we investigated the influence of mild TBI on memory impairment in relation with hippocampal apoptosis. For this, step-down avoidance task, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay, and immunohistochemistry for caspase-3 were performed. Male Sprague-Dawley rats were used in the experiments. The animals were randomly divided into two groups: sham-operation group and TBI-induction group. The mild TBI model was created with an electromagnetic contusion device activated at a velocity of 3.0 m/sec. The results showed that mild TBI during the pediatric stage significantly decreased memory retention. The numbers of TUNEL-positive and caspase-3-positive cells were increased in the TBI-induction group compared to those in the sham-operation group. Defective memory retention and apoptosis sustained up to the adult stage. The present results shows that mild TBI induces long-lasting cognitive impairment from pediatric to adult stages in rats through the high level of apoptosis. The finding of this study suggests that children with mild TBI may need intensive treatments for the reduction of long-lasting cognitive impairment by secondary neuronal damage.

Association of Reduced eGFR and Albuminuria with Serious Fall Injuries among Older Adults.

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Bowling, C Barrett; Bromfield, Samantha G; Colantonio, Lisandro D; Gutiérrez, Orlando M; Shimbo, Daichi; Reynolds, Kristi; Wright, Nicole C; Curtis, Jeffrey R; Judd, Suzanne E; Franch, Harold; Warnock, David G; McClellan, William; Muntner, Paul

2016-07-07

Falls are common and associated with adverse outcomes in patients on dialysis. Limited data are available in earlier stages of CKD. We analyzed data from 8744 Reasons for Geographic and Racial Differences in Stroke Study participants ≥65 years old with Medicare fee for service coverage. Serious fall injuries were defined as a fall-related fracture, brain injury, or joint dislocation using Medicare claims. Hazard ratios (HRs) for serious fall injuries were calculated by eGFR and albumin-to-creatinine ratio (ACR). Among 2590 participants with CKD (eGFRfall injury compared with age-matched controls without a fall injury was calculated. Overall, 1103 (12.6%) participants had a serious fall injury over 9.9 years of follow-up. The incidence rates per 1000 person-years of serious fall injuries were 21.7 (95% confidence interval [95% CI], 20.3 to 23.2), 26.6 (95% CI, 22.6 to 31.3), and 38.3 (95% CI, 31.2 to 47.0) at eGFR levels ≥60, 45-59, and fall injuries were 0.91 (95% CI, 0.76 to 1.09) and 1.09 (95% CI, 0.86 to 1.37) for eGFR=45-59 and fall and age-matched controls were 21.0% and 5.5%, respectively. Elevated ACR but not lower eGFR was associated with serious fall injuries. Evaluation for fall risk factors and fall prevention strategies should be considered for older adults with elevated ACR. Copyright © 2016 by the American Society of Nephrology.

Association of Adult Attention Deficit/Hyperactivity Disorder and Traffic Injuries in Tabriz - Iran

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Arash Jodeiri Eslami

2011-06-01

Full Text Available "nObjective: Nowadays, it is well known that the attention-deficit/hyperactivity disorder (ADHD is not confined to children and adolescents. Recent data showed that a considerable portion of the general adult population may be affected by ADHD. On the other hand, the impact of ADHD on driving performance, a major area of adult life, has gained enthusiasm. More recent studies revealed an association between adult ADHD and undesirable driving problems. This study was performed to determine the association between presence of adult ADHD and traffic injuries. "nMethods: In this case-control study, in a 13 month period,  140 subjects (70 drivers/riders injured in traffic accidents ,and 70 age- and sex-matched non traumatic controls were selected to participate in the study and were placed in two groups . Subjects with psychiatric comorbidities were excluded. The Conners' Adult ADHD Rating Scale (CAARS self-report (screening version was used for screening adult ADHD in both groups. Finally, the occurrence of this condition was compared between the case and control groups. "nResults: Sixty- nine males and one female were recruited in each group with a mean age of 29.31±9.32 (18-61 years in the case and 29.03±9.07 (range: 18-60 years in the control groups (P > 0.05. Previous history of traffic accident was significantly higher in the case group (15.7% vs. 4.3%, P=0.024. The mean driving time in a day was also significantly higher in the case group. In the case group, the scores of CAARS (the ADHD index, ADHD symptoms total, inattentive subscale and hyperactive/impulsive subscale were positive (higher than 70 in 4.3, 10, 7.1 and 10 percent of patients respectively. Among the controls, the corresponding proportions were 4.3, 14.3, 8.6 and 8.6 percent respectively. The two groups were comparable for the mentioned rates. "nConclusion: The results of this study revealed no significant association between ADHD and traffic injuries in Tabriz- Iran

Clinical and Community Strategies to Prevent Falls and Fall-Related Injuries Among Community-Dwelling Older Adults.

Science.gov (United States)

Taylor-Piliae, Ruth E; Peterson, Rachel; Mohler, Martha Jane

2017-09-01

Falls in older adults are the result of several risk factors across biological and behavioral aspects of the person, along with environmental factors. Falls can trigger a downward spiral in activities of daily living, independence, and overall health outcomes. Clinicians who care for older adults should screen them annually for falls. A multifactorial comprehensive clinical fall assessment coupled with tailored interventions can result in a dramatic public health impact, while improving older adult quality of life. For community-dwelling older adults, effective fall prevention has the potential to reduce serious fall-related injuries, emergency room visits, hospitalizations, institutionalization, and functional decline. Copyright © 2017 Elsevier Inc. All rights reserved.

Rapid recovery and altered neurochemical dependence of locomotor central pattern generation following lumbar neonatal spinal cord injury.

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Züchner, Mark; Kondratskaya, Elena; Sylte, Camilla B; Glover, Joel C; Boulland, Jean-Luc

2018-01-15

were two main locomotor frequencies, but injured spinal cords exhibited a shift towards the higher frequency. Injury also altered the neurochemical dependence of locomotor CPG output, such that injured spinal cords, unlike control spinal cords, were incapable of generating low frequency rhythmic coordinated activity in the presence of NMDA and dopamine alone. Thus, the neonatal spinal cord also exhibits remarkable functional recovery after lumbar injuries, but the neurochemical sensitivity of locomotor circuitry is modified in the process. © 2017 The Authors. The Journal of Physiology © 2017 The Physiological Society.

Efficacy of a movement control injury prevention programme in adult men’s community rugby union: a cluster randomised controlled trial

Science.gov (United States)

Attwood, Matthew J; Roberts, Simon P; Trewartha, Grant; England, Mike E; Stokes, Keith A

2018-01-01

Background Exercise programmes aimed at reducing injury have been shown to be efficacious for some non-collision sports, but evidence in adult men’s collision sports such as rugby union is lacking. Objective To evaluate the efficacy of a movement control injury prevention exercise programme for reducing match injuries in adult men’s community rugby union players. Methods 856 clubs were invited to participate in this prospective cluster randomised (single-blind) controlled trial where clubs were the unit of randomisation. 81 volunteered and were randomly assigned (intervention/control). A 42-week exercise programme was followed throughout the season. The control programme reflected ‘normal practice’ exercises, whereas the intervention focused on proprioception, balance, cutting, landing and resistance exercises. Outcome measures were match injury incidence and burden for: (1) all ≥8 days time-loss injuries and (2) targeted (lower limb, shoulder, head and neck, excluding fractures and lacerations) ≥8 days time-loss injuries. Results Poisson regression identified no clear effects on overall injury outcomes. A likely beneficial difference in targeted injury incidence (rate ratio (RR), 90% CI=0.6, 0.4 to 1.0) was identified, with a 40% reduction in lower-limb incidence (RR, 90% CI=0.6, 0.4 to 1.0) and a 60% reduction in concussion incidence (RR, 90% CI=0.4, 0.2 to 0.7) in the intervention group. Comparison between arms for clubs with highest compliance (≥median compliance) demonstrated very likely beneficial 60% reductions in targeted injury incidence (RR, 90% CI=0.4, 0.2 to 0.8) and targeted injury burden (RR, 90% CI=0.4, 0.2 to 0.7). Conclusions The movement control injury prevention programme resulted in likely beneficial reductions in lower-limb injuries and concussion. Higher intervention compliance was associated with reduced targeted injury incidence and burden. PMID:29055883

Community-acquired acute kidney injury in adults in Africa.

Science.gov (United States)

Adu, Dwomoa; Okyere, Perditer; Boima, Vincent; Matekole, Michael; Osafo, Charlotte

We review recent published data on demographics, causes, diagnoses, treatment, and outcome of acute kidney injury (AKI) in Africa. A review of the incidence, etiology, diagnoses, and treatment of AKI in adults in Africa from studies published between the years 2000 and 2015. The incidence of AKI in hospitalized patients in Africa ranges from 0.3 to 1.9% in adults. Between 70 and 90% of cases of AKI are community acquired. Most patients with AKI are young with a weighted mean age of 41.3 standard deviation (SD) 9.3 years, and a male to female ratio of 1.2 : 1.0. Medical causes account for between 65 and 80% of causes of AKI. This is followed by obstetric causes in 5 - 27% of cases and surgical causes in 2 - 24% of cases. In the reported studies, between 17 and 94% of patients who needed dialysis received this. The mortality of AKI in adults in Africa ranged from 11.5 to 43.5%. Most reported cases of AKI in Africa originate in the community. The low incidence of hospital-acquired AKI is likely to be due to under ascertainment. Most patients with AKI in Africa are young and have a single precipitating cause. Prominent among these are infection, pregnancy complications and nephrotoxins. Early treatment can improve clinical outcomes.

The association between adverse childhood experiences and adult traumatic brain injury/concussion: a scoping review.

Science.gov (United States)

Ma, Zechen; Bayley, Mark T; Perrier, Laure; Dhir, Priya; Dépatie, Lana; Comper, Paul; Ruttan, Lesley; Lay, Christine; Munce, Sarah E P

2018-01-12

Adverse childhood experiences are significant risk factors for physical and mental illnesses in adulthood. Traumatic brain injury/concussion is a challenging condition where pre-injury factors may affect recovery. The association between childhood adversity and traumatic brain injury/concussion has not been previously reviewed. The research question addressed is: What is known from the existing literature about the association between adverse childhood experiences and traumatic brain injury/concussion in adults? All original studies of any type published in English since 2007 on adverse childhood experiences and traumatic brain injury/concussion outcomes were included. The literature search was conducted in multiple electronic databases. Arksey and O'Malley and Levac et al.'s scoping review frameworks were used. Two reviewers independently completed screening and data abstraction. The review yielded six observational studies. Included studies were limited to incarcerated or homeless samples, and individuals at high-risk of or with mental illnesses. Across studies, methods for childhood adversity and traumatic brain injury/concussion assessment were heterogeneous. A positive association between adverse childhood experiences and traumatic brain injury occurrence was identified. The review highlights the importance of screening and treatment of adverse childhood experiences. Future research should extend to the general population and implications on injury recovery. Implications for rehabilitation Exposure to adverse childhood experiences is associated with increased risk of traumatic brain injury. Specific types of adverse childhood experiences associated with risk of traumatic brain injury include childhood physical abuse, psychological abuse, household member incarceration, and household member drug abuse. Clinicians and researchers should inquire about adverse childhood experiences in all people with traumatic brain injury as pre-injury health conditions can

Quantification of dendritic and axonal growth after injury to the auditory system of the adult cricket Gryllus bimaculatus

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Alexandra ePfister

2013-08-01

Full Text Available Dendrite and axon growth and branching during development are regulated by a complex set of intracellular and external signals. However, the cues that maintain or influence adult neuronal morphology are less well understood. Injury and deafferentation tend to have negative effects on adult nervous systems. An interesting example of injury-induced compensatory growth is seen in the cricket, Gryllus bimaculatus. After unilateral loss of an ear in the adult cricket, auditory neurons within the central nervous system sprout to compensate for the injury. Specifically, after being deafferented, ascending neurons (AN-1 and AN-2 send dendrites across the midline of the prothoracic ganglion where they receive input from auditory afferents that project through the contralateral auditory nerve (N5. Deafferentation also triggers contralateral N5 axonal growth. In this study, we quantified AN dendritic and N5 axonal growth at 30 hours, as well as at 3, 5, 7, 14 and 20 days after deafferentation in adult crickets. Significant differences in the rates of dendritic growth between males and females were noted. In females, dendritic growth rates were non-linear; a rapid burst of dendritic extension in the first few days was followed by a plateau reached at 3 days after deafferentation. In males, however, dendritic growth rates were linear, with dendrites growing steadily over time and reaching lengths, on average, twice as long as in females. On the other hand, rates of N5 axonal growth showed no significant sexual dimorphism and were linear. Within each animal, the growth rates of dendrites and axons were not correlated, indicating that independent factors likely influence dendritic and axonal growth in response to injury in this system. Our findings provide a basis for future study of the cellular features that allow differing dendrite and axon growth patterns as well as sexually dimorphic dendritic growth in response to deafferentation.

Efficacy of a movement control injury prevention programme in adult men's community rugby union: a cluster randomised controlled trial.

Science.gov (United States)

Attwood, Matthew J; Roberts, Simon P; Trewartha, Grant; England, Mike E; Stokes, Keith A

2018-03-01

Exercise programmes aimed at reducing injury have been shown to be efficacious for some non-collision sports, but evidence in adult men's collision sports such as rugby union is lacking. To evaluate the efficacy of a movement control injury prevention exercise programme for reducing match injuries in adult men's community rugby union players. 856 clubs were invited to participate in this prospective cluster randomised (single-blind) controlled trial where clubs were the unit of randomisation. 81 volunteered and were randomly assigned (intervention/control). A 42-week exercise programme was followed throughout the season. The control programme reflected 'normal practice' exercises, whereas the intervention focused on proprioception, balance, cutting, landing and resistance exercises.Outcome measures were match injury incidence and burden for: (1) all ≥8 days time-loss injuries and (2) targeted (lower limb, shoulder, head and neck, excluding fractures and lacerations) ≥8 days time-loss injuries. Poisson regression identified no clear effects on overall injury outcomes. A likely beneficial difference in targeted injury incidence (rate ratio (RR), 90% CI=0.6, 0.4 to 1.0) was identified, with a 40% reduction in lower-limb incidence (RR, 90% CI=0.6, 0.4 to 1.0) and a 60% reduction in concussion incidence (RR, 90% CI=0.4, 0.2 to 0.7) in the intervention group. Comparison between arms for clubs with highest compliance (≥median compliance) demonstrated very likely beneficial 60% reductions in targeted injury incidence (RR, 90% CI=0.4, 0.2 to 0.8) and targeted injury burden (RR, 90% CI=0.4, 0.2 to 0.7). The movement control injury prevention programme resulted in likely beneficial reductions in lower-limb injuries and concussion. Higher intervention compliance was associated with reduced targeted injury incidence and burden. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is

Analysis of Altered Baseline Brain Activity in Drug-Naive Adult Patients with Social Anxiety Disorder Using Resting-State Functional MRI

OpenAIRE

Qiu, Changjian; Feng, Yuan; Meng, Yajing; Liao, Wei; Huang, Xiaoqi; Lui, Su; Zhu, Chunyan; Chen, Huafu; Gong, Qiyong; Zhang, Wei

2015-01-01

Objective We hypothesize that the amplitude of low-frequency fluctuations (ALFF) is involved in the altered regional baseline brain function in social anxiety disorder (SAD). The aim of the study was to analyze the altered baseline brain activity in drug-naive adult patients with SAD. Methods We investigated spontaneous and baseline brain activities by obtaining the resting-state functional magnetic resonance imaging data of 20 drug-na?ve adult SAD patients and 19 healthy controls. Voxels wer...

Blood Pressure, Antihypertensive Polypharmacy, Frailty, and Risk for Serious Fall Injuries Among Older Treated Adults With Hypertension.

Science.gov (United States)

Bromfield, Samantha G; Ngameni, Cedric-Anthony; Colantonio, Lisandro D; Bowling, C Barrett; Shimbo, Daichi; Reynolds, Kristi; Safford, Monika M; Banach, Maciej; Toth, Peter P; Muntner, Paul

2017-08-01

Antihypertensive medication and low systolic blood pressure (BP) and diastolic BP have been associated with an increased falls risk in some studies. Many older adults have indicators of frailty, which may increase their risk for falls. We contrasted the association of systolic BP, diastolic BP, number of antihypertensive medication classes taken, and indicators of frailty with risk for serious fall injuries among 5236 REGARDS study (Reasons for Geographic and Racial Difference in Stroke) participants ≥65 years taking antihypertensive medication at baseline with Medicare fee-for-service coverage. Systolic BP and diastolic BP were measured, and antihypertensive medication classes being taken assessed through a pill bottle review during a study visit. Indicators of frailty included low body mass index, cognitive impairment, depressive symptoms, exhaustion, impaired mobility, and history of falls. Serious fall injuries were defined as fall-related fractures, brain injuries, or joint dislocations using Medicare claims through December 31, 2014. Over a median of 6.4 years, 802 (15.3%) participants had a serious fall injury. The multivariable-adjusted hazard ratio for a serious fall injury among participants with 1, 2, or ≥3 indicators of frailty versus no frailty indicators was 1.18 (95% confidence interval, 0.99-1.40), 1.49 (95% confidence interval, 1.19-1.87), and 2.04 (95% confidence interval, 1.56-2.67), respectively. Systolic BP, diastolic BP, and number of antihypertensive medication classes being taken at baseline were not associated with risk for serious fall injuries after multivariable adjustment. In conclusion, indicators of frailty, but not BP or number of antihypertensive medication classes, were associated with increased risk for serious fall injuries among older adults taking antihypertensive medication. © 2017 American Heart Association, Inc.

CT-based injury classification

International Nuclear Information System (INIS)

Mirvis, S.E.; Whitley, N.O.; Vainright, J.; Gens, D.

1988-01-01

Review of preoperative abdominal CT scans obtained in adults after blunt trauma during a 2.5-year period demonstrated isolated or predominant liver injury in 35 patients and splenic injury in 33 patients. CT-based injury scores, consisting of five levels of hepatic injury and four levels of splenic injury, were correlated with clinical outcome and surgical findings. Hepatic injury grades I-III, present in 33 of 35 patients, were associated with successful nonsurgical management in 27 (82%) or with findings at celiotomy not requiring surgical intervention in four (12%). Higher grades of splenic injury generally required early operative intervention, but eight (36%) of 22 patients with initial grade III or IV injury were managed without surgery, while four (36%) of 11 patients with grade I or II injury required delayed celiotomy and splenectomy (three patients) or emergent rehospitalization (one patient). CT-based injury classification is useful in guiding the nonoperative management of blunt hepatic injury in hemodynamically stable adults but appears to be less reliable in predicting the outcome of blunt splenic injury

Body mass index, falls, and injurious falls among U.S. adults: Findings from the 2014 Behavioral Risk Factor Surveillance System.

Science.gov (United States)

Ylitalo, Kelly R; Karvonen-Gutierrez, Carrie A

2016-10-01

Falls are an important health concern because they are associated with loss of independence and disability, particularly among women. We determined the age- and sex-specific prevalence of injurious falls among adults in the United States and examined the impact of obesity on fall risk. Self-reported falls, injurious falls, and health histories were obtained from 280,035 adults aged 45-79years in the 2014 Behavioral Risk Factor Surveillance System. Body mass index was categorized as underweight (fall in the previous 12months. Mid-life women 55-59years reported the highest prevalence of injurious falls (15.4%). Among mid-life women, overweight was associated with injurious falls (RR=1.17; 95% CI: 1.08, 1.28), but overweight was not associated with falling among other age-sex groups. Class II/III obesity was associated with injurious falls among all age-sex groups. After considering the mediators like health conditions (depression, cardiovascular disease, diabetes, arthritis) and behaviors (physical activity, sleep), the association of class II/III obesity and injurious fall risk persisted only among mid-life women (RR=1.23; 95% CI: 1.12, 1.36). Not only are mid-life women at high risk for falls, but the class II/III obesity is a risk factor for injurious falls. Targeting mid-life women for fall and injury prevention is an important aim for practitioners, particularly given unique correlates of falling for this group. Copyright © 2016 Elsevier Inc. All rights reserved.

Diet, age, and prior injury status differentially alter behavioral outcomes following concussion in rats.

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Mychasiuk, Richelle; Hehar, Harleen; van Waes, Linda; Esser, Michael J

2015-01-01

Mild traumatic brain injury (mTBI) or concussion affects a large portion of the population and although many of these individuals recover completely, a small subset of people experience lingering symptomology and poor outcomes. Little is known about the factors that affect individual susceptibility or resilience to poor outcomes after mTBI and there are currently no biomarkers to delineate mTBI diagnosis or prognosis. Based upon the growing literature associated with caloric intake and altered neurological aging and the ambiguous link between repetitive mTBI and progressive neurodegeneration, the current study was designed to examine the effect of a high fat diet (HFD), developmental age, and repetitive mTBI on behavioral outcomes following a mTBI. In addition, telomere length was examined before and after experimental mTBI. Sprague Dawley rats were maintained on a HFD or standard rat chow throughout life (including the prenatal period) and then experienced an mTBI/concussion at P30, P30 and P60, or only at P60. Behavioral outcomes were examined using a test battery that was administered between P61-P80 and included; beam-walking, open field, elevated plus maze, novel context mismatch, Morris water task, and forced swim task. Animals with a P30 mTBI often demonstrated lingering symptomology that was still present during testing at P80. Injuries at P30 and P60 rarely produced cumulative effects, and in some tests (i.e., beam walking), the first injury may have protected the brain from the second injury. Exposure to the high fat diet exacerbated many of the behavioral deficits associated with concussion. Finally, telomere length was shortened following mTBI and was influenced by the animal's dietary intake. Diet, age at the time of injury, and the number of prior concussion incidents differentially contribute to behavioral deficits and may help explain individual variations in susceptibility and resilience to poor outcomes following an mTBI. Copyright © 2014

Toll-like receptor 2 mediates ischemia-reperfusion injury of the small intestine in adult mice.

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Toshio Watanabe

Full Text Available Toll-like receptor 2 (TLR2 recognizes conserved molecular patterns associated with both gram-negative and gram-positive bacteria, and detects some endogenous ligands. Previous studies demonstrated that in ischemia-reperfusion (I/R injury of the small intestine, the TLR2-dependent signaling exerted preventive effects on the damage in young mice, but did not have a significant effect in neonatal mice. We investigated the role of TLR2 in adult ischemia-reperfusion injury in the small intestine. Wild-type and TLR2 knockout mice at 16 weeks of age were subjected to intestinal I/R injury. Some wild-type mice received anti-Ly-6G antibodies to deplete circulating neutrophils. In wild-type mice, I/R induced severe small intestinal injury characterized by infiltration by inflammatory cells, disruption of the mucosal epithelium, and mucosal bleeding. Compared to wild-type mice, TLR2 knockout mice exhibited less severe mucosal injury induced by I/R, with a 35%, 33%, and 43% reduction in histological grading score and luminal concentration of hemoglobin, and the numbers of apoptotic epithelial cells, respectively. The I/R increased the activity of myeloperoxidase (MPO, a marker of neutrophil infiltration, and the levels of mRNA expression of tumor necrosis factor-α (TNF-α, intercellular adhesion molecule-1 (ICAM-1, and cyclooxygenase-2 (COX-2 in the small intestine of the wild-type mice by 3.3-, 3.2-, and 13.0-fold, respectively. TLR2 deficiency significantly inhibited the I/R-induced increase in MPO activity and the expression of mRNAs for TNF-α and ICAM-1, but did not affect the expression of COX-2 mRNA. I/R also enhanced TLR2 mRNA expression by 2.9-fold. TLR2 proteins were found to be expressed in the epithelial cells, inflammatory cells, and endothelial cells. Neutrophil depletion prevented intestinal I/R injury in wild-type mice. These findings suggest that TLR2 may mediate I/R injury of the small intestine in adult mice via induction of inflammatory

Distinct subcortical volume alterations in pediatric and adult OCD

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Boedhoe, Premika S.W.; Schmaal, Lianne; Abe, Yoshinari; Ameis, Stephanie H.; Arnold, Paul D.; Batistuzzo, Marcelo C.; Benedetti, Francesco; Beucke, Jan C.; Bollettini, Irene; Bose, Anushree; Brem, Silvia; Calvo, Anna; Cheng, Yuqi; Cho, Kang Ik K.; Dallaspezia, Sara; Denys, Damiaan; Fitzgerald, Kate D.; Fouche, Jean-Paul; Giménez, Mònica; Gruner, Patricia; Hanna, Gregory L.; Hibar, Derrek P.; Hoexter, Marcelo Q.; Huyser, Chaim; Ikari, Keisuke; Jahanshad, Neda; Kathmann, Norbert; Kaufmann, Christian; Koch, Kathrin; Kwon, Jun Soo; Lazaro, Luisa; Liu, Yanni; Lochner, Christine; Marsh, Rachel; Martínez-Zalacaín, Ignacio; Mataix-Cols, David; Menchón, José M.; Minuzzii, Luciano; Nakamae, Takashi; Nakao, Tomohiro; Narayanaswamy, Janardhanan C.; Piras, Fabrizio; Piras, Federica; Pittenger, Christopher; Reddy, Y.C. Janardhan; Sato, Joao R.; Simpson, H. Blair; Soreni, Noam; Soriano-Mas, Carles; Spalletta, Gianfranco; Stevens, Michael C.; Szeszko, Philip R.; Tolin, David F.; Venkatasubramanian, Ganesan; Walitza, Susanne; Wang, Zhen; van Wingen, Guido A.; Xu, Jian; Xu, Xiufeng; Yun, Je-Yeon; Zhao, Qing; Thompson, Paul M.; Stein, Dan J.; van den Heuvel, Odile A.

2016-01-01

Objective Structural brain imaging studies in Obsessive-Compulsive Disorder (OCD) have produced inconsistent findings. This may be partially due to limited statistical power from relatively small samples and clinical heterogeneity related to variation in disease profile and developmental stage. Methods To address these limitations, we conducted a meta- and mega-analysis of data from OCD sites worldwide. T1 images from 1,830 OCD patients and 1,759 controls were analyzed, using coordinated and standardized processing, to identify subcortical brain volumes that differ in OCD patients and healthy controls. We additionally examined potential modulating effects of clinical characteristics on morphological differences in OCD patients. Results The meta-analysis indicated that adult patients had significantly smaller hippocampal volumes (Cohen’s d=−0.13; p=5.1x10−3, % difference −2.80) and larger pallidum volumes (d=0.16; p=1.6x10−3, % difference 3.16) compared to adult controls. Both effects were stronger in medicated patients compared to controls (d=−0.29; p=2.4x10−5, % difference −4.18 and d=0.29; p=1.2x10−5, % difference 4.38, respectively). Unmedicated pediatric patients had larger thalamic volumes (d=0.38, p=2.1x10−3) compared to pediatric controls. None of these findings were mediated by sample characteristics such as mean age or field strength. Overall the mega-analysis yielded similar results. Conclusion Our study indicates a different pattern of subcortical abnormalities in pediatric versus adult OCD patients. The pallidum and hippocampus seem to be of importance in adult OCD, whereas the thalamus seems to be key in pediatric OCD. This highlights the potential importance of neurodevelopmental alterations in OCD, and suggests that further research on neuroplasticity in OCD may be useful. PMID:27609241

Prion replication occurs in endogenous adult neural stem cells and alters their neuronal fate: involvement of endogenous neural stem cells in prion diseases.

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Aroa Relaño-Ginès

Full Text Available Prion diseases are irreversible progressive neurodegenerative diseases, leading to severe incapacity and death. They are characterized in the brain by prion amyloid deposits, vacuolisation, astrocytosis, neuronal degeneration, and by cognitive, behavioural and physical impairments. There is no treatment for these disorders and stem cell therapy therefore represents an interesting new approach. Gains could not only result from the cell transplantation, but also from the stimulation of endogenous neural stem cells (NSC or by the combination of both approaches. However, the development of such strategies requires a detailed knowledge of the pathology, particularly concerning the status of the adult neurogenesis and endogenous NSC during the development of the disease. During the past decade, several studies have consistently shown that NSC reside in the adult mammalian central nervous system (CNS and that adult neurogenesis occurs throughout the adulthood in the subventricular zone of the lateral ventricle or the Dentate Gyrus of the hippocampus. Adult NSC are believed to constitute a reservoir for neuronal replacement during normal cell turnover or after brain injury. However, the activation of this system does not fully compensate the neuronal loss that occurs during neurodegenerative diseases and could even contribute to the disease progression. We investigated here the status of these cells during the development of prion disorders. We were able to show that NSC accumulate and replicate prions. Importantly, this resulted in the alteration of their neuronal fate which then represents a new pathologic event that might underlie the rapid progression of the disease.

Non-concomitant cortical structural and functional alterations in sensorimotor areas following incomplete spinal cord injury

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Yu Pan

2017-01-01

Full Text Available Brain plasticity, including anatomical changes and functional reorganization, is the physiological basis of functional recovery after spinal cord injury (SCI. The correlation between brain anatomical changes and functional reorganization after SCI is unclear. This study aimed to explore whether alterations of cortical structure and network function are concomitant in sensorimotor areas after incomplete SCI. Eighteen patients with incomplete SCI (mean age 40.94 ± 14.10 years old; male:female, 7:11 and 18 healthy subjects (37.33 ± 11.79 years old; male:female, 7:11 were studied by resting state functional magnetic resonance imaging. Gray matter volume (GMV and functional connectivity were used to evaluate cortical structure and network function, respectively. There was no significant alteration of GMV in sensorimotor areas in patients with incomplete SCI compared with healthy subjects. Intra-hemispheric functional connectivity between left primary somatosensory cortex (BA1 and left primary motor cortex (BA4, and left BA1 and left somatosensory association cortex (BA5 was decreased, as well as inter-hemispheric functional connectivity between left BA1 and right BA4, left BA1 and right BA5, and left BA4 and right BA5 in patients with SCI. Functional connectivity between both BA4 areas was also decreased. The decreased functional connectivity between the left BA1 and the right BA4 positively correlated with American Spinal Injury Association sensory score in SCI patients. The results indicate that alterations of cortical anatomical structure and network functional connectivity in sensorimotor areas were non-concomitant in patients with incomplete SCI, indicating the network functional changes in sensorimotor areas may not be dependent on anatomic structure. The strength of functional connectivity within sensorimotor areas could serve as a potential imaging biomarker for assessment and prediction of sensory function in patients with incomplete SCI

A Meta-Analysis of Soccer Injuries on Artificial Turf and Natural Grass

Directory of Open Access Journals (Sweden)

Jay H. Williams

2013-01-01

Full Text Available The goal of this investigation was to determine if playing or training on third-generation artificial turf (AT surfaces increases the incidence rate of injuries compared to natural grass (NG surfaces. This was accomplished by a meta-analysis performed on previously published research. Eight studies met the criteria of competitive soccer players, participation on both surfaces, and presentation of both exposure time and injury occurrence. Exposure time and injury incidence values were used to generate injury rate ratios (IRRs, AT/NG for all injuries as well as specific injuries. Subgroup analyses were also performed by condition (match or training, gender, and age (youth or adult. The overall IRR was 0.86 ( suggesting a lower injury risk on AT than NG. However, there was considerable heterogeneity between studies. Analyses of individual injuries and subgroups found that in many cases IRR values were significantly less than 1.0. In no case was the IRR significantly greater than 1.0. Based on this, it appears that the risk of sustaining an injury on AT under some conditions might be lowered compared to NG. However, until more is known about how issues such as altered playing styles affect injury incidence, it is difficult to make firm conclusions regarding the influence of AT on player safety.

A theoretical framework for understanding neuromuscular response to lower extremity joint injury.

Science.gov (United States)

Pietrosimone, Brian G; McLeod, Michelle M; Lepley, Adam S

2012-01-01

Neuromuscular alterations are common following lower extremity joint injury and often lead to decreased function and disability. These neuromuscular alterations manifest in inhibition or abnormal facilitation of the uninjured musculature surrounding an injured joint. Unfortunately, these neural alterations are poorly understood, which may affect clinical recognition and treatment of these injuries. Understanding how these neural alterations affect physical function may be important for proper clinical management of lower extremity joint injuries. Pertinent articles focusing on neuromuscular consequences and treatment of knee and ankle injuries were collected from peer-reviewed sources available on the Web of Science and Medline databases from 1975 through 2010. A theoretical model to illustrate potential relationships between neural alterations and clinical impairments was constructed from the current literature. Lower extremity joint injury affects upstream cortical and spinal reflexive excitability pathways as well as downstream muscle function and overall physical performance. Treatment targeting the central nervous system provides an alternate means of treating joint injury that may be effective for patients with neuromuscular alterations. Disability is common following joint injury. There is mounting evidence that alterations in the central nervous system may relate to clinical changes in biomechanics that may predispose patients to further injury, and novel clinical interventions that target neural alterations may improve therapeutic outcomes.

Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: A systematic review

NARCIS (Netherlands)

Olthof, Dominique C.; Joosse, Pieter; van der Vlies, Cornelis H.; de Haan, Rob J.; Goslings, J. Carel

2013-01-01

BACKGROUND: Contradictory findings are reported in the literature concerning prognostic factors for failure of nonoperative management (NOM) in the treatment of adults with blunt splenic injury. The objective of this systematic review was to identify prognostic factors for failure of NOM, with or

Management of pediatric blunt splenic injury at a rural trauma center.

Science.gov (United States)

Bird, Julio J; Patel, Nirav Y; Mathiason, Michelle A; Schroeppel, Thomas J; D'huyvetter, Cecile J; Cogbill, Thomas H

2012-10-01

Patterns for nonoperative management of pediatric blunt splenic injuries (BSIs) vary significantly within and between institutions. The indications for repeated imaging, duration of activity restrictions, as well as the impact of volume and type of trauma center (pediatric vs. adult) on outcomes remain unclear. A retrospective review of all patients younger than 16 years with BSI managed at a rural American College of Surgeons-verified adult Level II trauma center from January 1995 to December 2008 was completed. Patients were identified from the trauma registry by DRG International Classification of Diseases-9th Rev. (865.00-865.09) and management codes (41.5, 41.43, and 41.95). Variables reviewed included demographics, mechanism of injury, Injury Severity Score, grade of splenic injury, degree of hemoperitoneum, presence of arterial phase contrast blush on computed tomography at admission, admission and nadir hemoglobin level, blood transfused, length of stay, disposition, outpatient clinical and radiographic follow-up, interval of return to unrestricted activity, and clinical outcomes. During the 13-year study period, 38 children with BSI were identified. Thirty-seven (97%) were successfully managed nonoperatively. Median grade of splenic injury was 3 (range, 1-5); 73% had moderate-to-large hemoperitoneum. Median Injury Severity Score was 10 (range, 4-34). Three patients with isolated contrast blush on initial computed tomography were successfully managed nonoperatively with no angiographic intervention. One patient failed nonoperative management and underwent successful splenorrhaphy. All patients were discharged home. Thirty-day mortality was zero. Median follow-up duration was 5.5 years, with no late complications identified. Of the patients successfully managed nonoperatively, 92% had their follow-up at our institution; 74% underwent subsequent imaging, and none resulted in intervention or alteration of management plan. Pediatric BSI can be managed in adult

Is performance on the Wechsler test of adult reading affected by traumatic brain injury?

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Mathias, J L; Bowden, S C; Bigler, E D; Rosenfeld, J V

2007-11-01

The validity of the National Adult Reading Test (NART) as a predictor of premorbid IQ when used with patients who have sustained a traumatic brain injury (TBI) has been questioned in recent years. This study examined whether performance on the Wechsler Test of Adult Reading (WTAR) is similarly affected by TBI in the first year after an injury. The WTAR scores of participants who had sustained a mild TBI (N=82), moderate TBI (N=73), severe TBI (N=61) or an orthopaedic injury (N=95) were compared (cross-sectional study). A subset of 21 mild TBI, 31 moderate TBI, 26 severe TBI and 21 control group participants were additionally reassessed 6 months later to assess the impact of recovery on WTAR scores (longitudinal study). The severe TBI group had significantly lower scores on the WTAR than the mild TBI, moderate TBI and control groups in the cross-sectional study, despite being matched demographically. The findings from the longitudinal study revealed a significant group difference and a small improvement in performance over time but the interaction between group and time was not significant, suggesting that the improvements in WTAR performance over time were not restricted to more severely injured individuals whose performance was temporarily suppressed. These findings suggest that reading performance may be affected by severe TBI and that the WTAR may underestimate premorbid IQ when used in this context, which may cause clinicians to underestimate the cognitive deficits experienced by these patients.

MicroRNAs as diagnostic markers and therapeutic targets for traumatic brain injury

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Bridget Martinez

2017-01-01

Full Text Available Traumatic brain injury (TBI is characterized by primary damage to the brain from the external mechanical force and by subsequent secondary injury due to various molecular and pathophysiological responses that eventually lead to neuronal cell death. Secondary brain injury events may occur minutes, hours, or even days after the trauma, and provide valuable therapeutic targets to prevent further neuronal degeneration. At the present time, there is no effective treatment for TBI due, in part, to the widespread impact of numerous complex secondary biochemical and pathophysiological events occurring at different time points following the initial injury. MicroRNAs control a range of physiological and pathological functions such as development, differentiation, apoptosis and metabolism, and may serve as potential targets for progress assessment and intervention against TBI to mitigate secondary damage to the brain. This has implications regarding improving the diagnostic accuracy of brain impairment and long-term outcomes as well as potential novel treatments. Recent human studies have identified specific microRNAs in serum/plasma (miR-425-p, -21, -93, -191 and -499 and cerebro-spinal fluid (CSF (miR-328, -362-3p, -451, -486a as possible indicators of the diagnosis, severity, and prognosis of TBI. Experimental animal studies have examined specific microRNAs as biomarkers and therapeutic targets for moderate and mild TBI (e.g., miR-21, miR-23b. MicroRNA profiling was altered by voluntary exercise. Differences in basal microRNA expression in the brain of adult and aged animals and alterations in response to TBI (e.g., miR-21 have also been reported. Further large-scale studies with TBI patients are needed to provide more information on the changes in microRNA profiles in different age groups (children, adults, and elderly.

Revisited: A Systematic Review of Therapeutic Hypothermia for Adult Patients Following Traumatic Brain Injury.

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Watson, Hannah I; Shepherd, Andrew A; Rhodes, Jonathan K J; Andrews, Peter J D

2018-06-01

Therapeutic hypothermia has been of topical interest for many years and with the publication of two international, multicenter randomized controlled trials, the evidence base now needs updating. The aim of this systematic review of randomized controlled trials is to assess the efficacy of therapeutic hypothermia in adult traumatic brain injury focusing on mortality, poor outcomes, and new pneumonia. The following databases were searched from January 1, 2011, to January 26, 2018: Cochrane Central Register of Controlled Trial, MEDLINE, PubMed, and EMBASE. Only foreign articles published in the English language were included. Only articles that were randomized controlled trials investigating adult traumatic brain injury sustained following an acute, closed head injury were included. Two authors independently assessed at each stage. Quality was assessed using the Cochrane Collaboration's tool for assessing the risk of bias. All extracted data were combined using the Mantel-Haenszel estimator for pooled risk ratio with 95% CIs. p value of less than 0.05 was considered statistically significant. All statistical analyses were conducted using RevMan 5 (Cochrane Collaboration, Version 5.3, Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Twenty-two studies with 2,346 patients are included. Randomized controlled trials with a low risk of bias show significantly more mortality in the therapeutic hypothermia group (risk ratio, 1.37; 95% CI, 1.04-1.79; p = 0.02), whereas randomized controlled trials with a high risk of bias show the opposite with a higher mortality in the control group (risk ratio, 0.70; 95% CI, 0.60-0.82; p < 0.00001). Overall, this review is in-keeping with the conclusions published by the most recent randomized controlled trials. High-quality studies show no significant difference in mortality, poor outcomes, or new pneumonia. In addition, this review shows a place for fever control in the management of traumatic brain injury.

Injury, disability and quality of life after the 2009 earthquake in Padang, Indonesia: a prospective cohort study of adult survivors

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Mondastri K. Sudaryo

2012-05-01

Full Text Available Background: On 30 September 2009, a 7.6 magnitude earthquake severely hit the coast of Padang city in West Sumatra, Indonesia leaving about 1,117 people dead and injuring another 3,515. Health consequences such as physical injury, co-morbidity, disability and quality of life over time are seldom reported among survivors after earthquakes. Objectives: To investigate the associations between injury, disability and quality of life amongst adult survivors in Padang city after the 2009 earthquake.Design/Methods: A prospective cohort study was conducted to compare adult injured (184 and adult non-injured (93 subjects over a 6-month period. Data on physical injury, co-morbidities, disability and quality of life were collected through interviews and measured quantitatively in three phases, i.e. at baseline, end of 3 and 6 months. Results: Disability scores were consistently and significantly higher among injured subjects compared to non-injured, even when adjusted for co-morbidities (i.e. acute symptoms and chronic diseases. The highest disability score amongst injured subjects was attributed to ‘feeling discomfort/pain’. Quality of life attribute (QLA scores, were significantly lower amongst injured people as compared to those non-injured even when adjusted for co-morbidities. The lowest QLA item score amongst the injured was ‘pain, depression and anxiety’. Significant and consistent negative correlations were found between disability and QLA scores in both the injured and non-injured groups. Conclusion: Physical injury is significantly correlated with both higher disability and lower quality of life, while disability has significant negative correlation with quality of life. The findings suggest that, through disability, injury may contribute to decreased quality of life. It is therefore recommended to promptly and adequately treat injuries after disasters to prevent any potential for disability and hence restore quality of life.

Alterations of parenchymal microstructure, neuronal connectivity and cerebrovascular resistance at adolescence following mild to moderate traumatic brain injury in early development.

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Parent, Maxime; Li, Ying; Santhakumar, Vijayalakshmi; Hyder, Fahmeed; Sanganahalli, Basavaraju G; Kannurpatti, Sridhar

2018-06-01

TBI is a leading cause of morbidity in children. To investigate outcome of early developmental TBI during adolescence, a rat model of fluid percussion injury was developed, where previous work reported deficits in sensorimotor behavior and cortical blood flow at adolescence. 1 Based on the non-localized outcome, we hypothesized that multiple neurophysiological components of brain function, namely neuronal connectivity, synapse/axonal microstructural integrity and neurovascular function are altered and magnetic resonance imaging (MRI) methods could be used to determine regional alterations. Adolescent outcomes of developmental TBI were studied 2-months after injury, using functional MRI (fMRI) and Diffusion Tensor Imaging (DTI). fMRI based resting state functional connectivity (RSFC), representing neural connectivity, was significantly altered between sham and TBI. RSFC strength decreased in the cortex, hippocampus and thalamus accompanied by decrease in the spatial extent of their corresponding RSFC networks and inter-hemispheric asymmetry. Cerebrovascular reactivity to arterial CO2 changes diminished after TBI across both hemispheres, with a more pronounced decrease in the ipsilateral hippocampus, thalamus and motor cortex. DTI measures of fractional anisotropy (FA) and apparent diffusion coefficient (ADC), reporting on axonal and microstructural integrity of the brain, indicated similar inter-hemispheric asymmetry, with highest change in the ipsilateral hippocampus and regions adjoining the ipsilateral thalamus, hypothalamus and amygdala. TBI-induced corpus callosal microstructural alterations indicated measurable changes in inter-hemispheric structural connectivity. Hippocampus, thalamus and select cortical regions were most consistently affected in multiple imaging markers. The multi-modal MRI results demonstrate cortical and subcortical alterations in neural connectivity, cerebrovascular resistance and parenchymal microstructure in the adolescent brain

Multi-disciplinary rehabilitation for acquired brain injury in adults of working age.

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Turner-Stokes, Lynne; Pick, Anton; Nair, Ajoy; Disler, Peter B; Wade, Derick T

2015-12-22

Evidence from systematic reviews demonstrates that multi-disciplinary rehabilitation is effective in the stroke population, in which older adults predominate. However, the evidence base for the effectiveness of rehabilitation following acquired brain injury (ABI) in younger adults has not been established, perhaps because this scenario presents different methodological challenges in research. To assess the effects of multi-disciplinary rehabilitation following ABI in adults 16 to 65 years of age. We ran the most recent search on 14 September 2015. We searched the Cochrane Injuries Group Specialised Register, The Cochrane Library, Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), Embase Classic+Embase (OvidSP), Web of Science (ISI WOS) databases, clinical trials registers, and we screened reference lists. Randomised controlled trials (RCTs) comparing multi-disciplinary rehabilitation versus routinely available local services or lower levels of intervention; or trials comparing an intervention in different settings, of different intensities or of different timing of onset. Controlled clinical trials were included, provided they met pre-defined methodological criteria. Three review authors independently selected trials and rated their methodological quality. A fourth review author would have arbitrated if consensus could not be reached by discussion, but in fact, this did not occur. As in previous versions of this review, we used the method described by Van Tulder 1997 to rate the quality of trials and to perform a 'best evidence' synthesis by attributing levels of evidence on the basis of methodological quality. Risk of bias assessments were performed in parallel using standard Cochrane methodology. However, the Van Tulder system provided a more discriminative evaluation of rehabilitation trials, so we have continued to use it for our primary synthesis of evidence. We subdivided trials in terms of

[Copy number alterations in adult patients with mature B acute lymphoblastic leukemia treated with specific immunochemotherapy].

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Ribera, Jordi; Zamora, Lurdes; García, Olga; Hernández-Rivas, Jesús-María; Genescà, Eulàlia; Ribera, Josep-Maria

2016-12-02

Unlike Burkitt lymphoma, molecular abnormalities other than C-MYC rearrangements have scarcely been studied in patients with mature B acute lymphoblastic leukemia (B-ALL). The aim of this study was to analyze the frequency and prognostic significance of copy number alterations (CNA) in genes involved in lymphoid differentiation, cell cycle and tumor suppression in adult patients with B-ALL. We have analyzed by multiplex ligation-dependent probe amplification the genetic material from bone marrow at diagnosis from 25 adult B-ALL patients treated with rituximab and specific chemotherapy. The most frequent CNA were alterations in the 14q32.33 region (11 cases, 44%) followed by alterations in the cell cycle regulator genes CDKN2A/B and RB1 (16%). No correlation between the presence of specific CNA and the clinical-biologic features or the response to therapy was found. The high frequency of CNA in the 14q32.33 region, CDKN2A/B and RB1 found in our study could contribute to the aggressiveness and invasiveness of mature B-ALL. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Inflammatory and apoptotic alterations in serum and injured tissue after experimental polytrauma in mice: distinct early response compared with single trauma or "double-hit" injury.

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Weckbach, Sebastian; Hohmann, Christoph; Braumueller, Sonja; Denk, Stephanie; Klohs, Bettina; Stahel, Philip F; Gebhard, Florian; Huber-Lang, Markus S; Perl, Mario

2013-02-01

The exact alterations of the immune system after polytrauma leading to sepsis and multiple-organ failure are poorly understood. Thus, the early local and systemic inflammatory and apoptotic response was characterized in a new polytrauma model and compared with the alterations seen after single or combined injuries. Anesthetized C57BL/6 mice were subjected to either blunt bilateral chest trauma (Tx), closed head injury, right femur fracture including contralateral soft tissue injury, or a combination of injuries (PTx). After 2 hours or 6 hours, animals were sacrificed, and the systemic as well as the local pulmonary immune response (bronchoalveolar lavage [BAL]/plasma cytokines, lung myeloperoxidase [MPO] activity, and alveolocapillary barrier dysfunction) were evaluated along with lung/brain apoptosis (lung caspase 3 Western blotting, immunohistochemistry, and polymorphonuclear leukocytes [PMN] Annexin V). Hemoglobin, PO2 saturation, and pH did not differ between the experimental groups. Local BAL cytokines/chemokines were significantly increased in almost all groups, which included Tx. There was no further enhancement of this local inflammatory response in the lungs in case of PTx. At 2 hours, all groups except sham and closed head injury alone revealed an increased activity of lung MPO. However, 6 hours after injury, lung MPO remained increased only in the PTx group. Increased BAL protein levels were found, reflecting enhanced lung leakage in all groups with Tx 6 hours after trauma. Only after PTx was neutrophil apoptosis significantly decreased, whereas lung caspase 3 and plasma interleukin 6/keratinocyte chemoattractant (KC) were substantially increased. The combination of different injuries leads to an earlier systemic inflammatory response when compared with the single insults. Interestingly, only after PTx but not after single or double hits was lung apoptosis increased, and PMN apoptosis was decreased along with a prolonged presence of neutrophils in the

A comparison of health outcomes in older versus younger adults following a road traffic crash injury: a cohort study.

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Bamini Gopinath

Full Text Available Given the aging demographics of most developed countries, understanding the public health impact of mild/moderate road traffic crash injuries in older adults is important. We aimed to determine whether health outcomes (pain severity and quality of life measures over 24 months differ significantly between older (65+ and younger adults (18-64.Prospective cohort study of 364, 284 and 252 participants with mild/moderate injury following a vehicle collision at baseline, 12 and 24 months, respectively. A telephone-administered questionnaire obtained information on socio-economic, pre- and post-injury psychological and heath characteristics.At baseline, there were 55 (15.1% and 309 (84.9% participants aged ≥65 and 18-64 years, respectively. At 12- and 24-month follow-up, older compared to younger participants who had sustained a mild/moderate musculoskeletal injury had lower physical functioning (3.9-units lower Short Form-12 Physical Composite Score, multivariable-adjusted p = 0.03 at both examinations. After multivariable adjustment, older (n = 45 versus younger (n = 207 participants had lower self-perceived health status (8.1-units lower European Quality of Life-5 Dimensions Visual Acuity Scale scores at 24 months, p = 0.03, 24 months later.Older compared to younger participants who sustained a mild/moderate injury following a road-traffic crash demonstrated poorer physical functioning and general health at 24 months.

Pain and anxiety experiences of South African adult burn injury patients during physiotherapy management

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L.D. Morris

2010-01-01

Full Text Available A dequate management of procedural pain during physiotherapy management plays an important role in building a trusting relationship betweenthe burn victim and the physiotherapist, and in ensuring desirable functional outcomes. However, the burn pain management regimens currently utilized inburn units, primarily consist of traditional pharmacologic analgesics which areassociated with numerous side-effects and alone are often reported as inadequateto alleviate procedural pain, warranting safer and effective adjunct therapies.Prior to the introduction and implementation of adjunct therapies into a developing world, it is imperative that the current situation in a burn unit, in terms of whether or not the pain management regimens in place are adequate, is first assessed, due to cost concerns. The following short report exemplifies the pain and anxiety experiences of a small number of burn injury patients during physiotherapy at the Tygerberg Hospital adult burn unit, South A frica.  It was hypothesized that the results of this study would underpin whether adult burn injury patients in a developing countryrequire adjunct therapies during physiotherapy management to supplement traditional pharmacologic analgesics inmanaging their procedural pain and subsequent anxiety.

Epidemiology and predictors of cervical spine injury in adult major trauma patients: a multicenter cohort study.

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Hasler, Rebecca M; Exadaktylos, Aristomenis K; Bouamra, Omar; Benneker, Lorin M; Clancy, Mike; Sieber, Robert; Zimmermann, Heinz; Lecky, Fiona

2012-04-01

Patients with cervical spine injuries are a high-risk group, with the highest reported early mortality rate in spinal trauma. This cohort study investigated predictors for cervical spine injury in adult (≥ 16 years) major trauma patients using prospectively collected data of the Trauma Audit and Research Network from 1988 to 2009. Univariate and multivariate logistic regression analyses were used to determine predictors for cervical fractures/dislocations or cord injury. A total of 250,584 patients were analyzed. Median age was 47.2 years (interquartile range, 29.8-66.0) and Injury Severity Score 9 (interquartile range, 4-11); 60.2% were male. Six thousand eight hundred two patients (2.3%) sustained cervical fractures/dislocations alone. Two thousand sixty-nine (0.8%) sustained cervical cord injury with/without fractures/dislocations; 39.9% of fracture/dislocation and 25.8% of cord injury patients suffered injuries to other body regions. Age ≥ 65 years (odds ratio [OR], 1.45-1.92), males (females OR, 0.91; 95% CI, 0.86-0.96), Glasgow Coma Scale (GCS) score sports injuries (OR, 3.51; 95% CI, 2.87-4.31), road traffic collisions (OR, 3.24; 95% CI, 3.01-3.49), and falls >2 m (OR, 2.74; 95% CI, 2.53-2.97) were predictive for fractures/dislocations. Age sports injuries (OR, 4.42; 95% CI, 3.28-5.95), road traffic collisions (OR, 2.58; 95% CI, 2.26-2.94), and falls >2 m (OR, 2.24; 95% CI, 1.94-2.58) were predictors for cord injury. 3.5% of patients suffered cervical spine injury. Patients with a lowered GCS or systolic blood pressure, severe facial fractures, dangerous injury mechanism, male gender, and/or age ≥ 35 years are at increased risk. Contrary to common belief, head injury was not predictive for cervical spine involvement.

Moderate perinatal thyroid hormone insufficiency alters visual system function in adult rats.

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Boyes, William K; Degn, Laura; George, Barbara Jane; Gilbert, Mary E

2018-04-21

Thyroid hormone (TH) is critical for many aspects of neurodevelopment and can be disrupted by a variety of environmental contaminants. Sensory systems, including audition and vision are vulnerable to TH insufficiencies, but little data are available on visual system development at less than severe levels of TH deprivation. The goal of the current experiments was to explore dose-response relations between graded levels of TH insufficiency during development and the visual function of adult offspring. Pregnant Long Evans rats received 0 or 3 ppm (Experiment 1), or 0, 1, 2, or 3 ppm (Experiment 2) of propylthiouracil (PTU), an inhibitor of thyroid hormone synthesis, in drinking water from gestation day (GD) 6 to postnatal day (PN) 21. Treatment with PTU caused dose-related reductions of serum T4, with recovery on termination of exposure, and euthyroidism by the time of visual function testing. Tests of retinal (electroretinograms; ERGs) and visual cortex (visual evoked potentials; VEPs) function were assessed in adult offspring. Dark-adapted ERG a-waves, reflecting rod photoreceptors, were increased in amplitude by PTU. Light-adapted green flicker ERGs, reflecting M-cone photoreceptors, were reduced by PTU exposure. UV-flicker ERGs, reflecting S-cones, were not altered. Pattern-elicited VEPs were significantly reduced by 2 and 3 ppm PTU across a range of stimulus contrast values. The slope of VEP amplitude-log contrast functions was reduced by PTU, suggesting impaired visual contrast gain. Visual contrast gain primarily reflects function of visual cortex, and is responsible for adjusting sensitivity of perceptual mechanisms in response to changing visual scenes. The results indicate that moderate levels of pre-and post-natal TH insufficiency led to alterations in visual function of adult rats, including both retinal and visual cortex sites of dysfunction. Copyright © 2018. Published by Elsevier B.V.

Acute Ozone (O3) Exposure Accelerates Diet-Induced Pulmonary Injury and Metabolic Alterations in a Rat Model of Type II Diabetes

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Abstract for Society of Toxicology, March 22-25, 2015, San Diego, CAAcute Ozone (O3) Exposure Accelerates Diet-Induced Pulmonary Injury and Metabolic Alterations in a Rat Model of Type II DiabetesS.J. Snow1,3, D. Miller2, V. Bass2, M. Schladweiler3, A. Ledbetter3, J. Richards3, C...

Adult attention-deficit hyperactivity disorder, risky behaviors, and motorcycle injuries: a case-control study

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Sadeghi-Bazargani H

2015-08-01

Full Text Available Homayoun Sadeghi-Bazargani,1,2 Leili Abedi,3 Minoo Mahini,4 Shahrokh Amiri,5 Davoud Khorasani-Zavareh6 1Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2World Health Organization Collaborating Center on Safe Community Promotion, Stockholm, Sweden; 3Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, 4Department of Counseling, Aras International Campus, University of Tehran, Jolfa, 5Research Center of Psychiatry and Behavioral Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, 6Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran Background: The aim of this study was to assess the association of motorcycle traffic injuries with motorcycle riding behavior and subtypes of attention-deficit hyperactivity disorder (ADHD while controlling for individual correlates of motorcycle traffic injuries.Methods: A case-control study was carried out in 298 patients with motorcycle trauma along with 151 control patients admitted to the Shohada and Imam Reza university hospitals as the two referral specialty centers in the East Azarbyjan Province of Iran in 2013. The Persian version of the Motorcycle Riding Behavior Questionnaire and the Persian version of Conner’s Adult ADHD Rating Scales (the self-report short version were used to assess riding behavior and screen for adult ADHD, respectively. The scale has four subscales, comprising subscale A (inattention, subscale B (hyperactivity, impulsivity, subscale C (A + C, and subscale D (ADHD index. The statistical analysis was done using Stata version 11.Results: All subjects were male and aged 13–79 years. Approximately 54% of the participants were married and 13% had academic education. Approximately 18% of the motorcycle riders stated that their motorcycle riding was only for fun purposes. More than two thirds of the participants did not

Searching for a neurologic injury's Wechsler Adult Intelligence Scale-Third Edition profile.

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Gonçalves, Marta A; Moura, Octávio; Castro-Caldas, Alexandre; Simões, Mário R

2017-01-01

This study aimed to investigate the presence of a Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) cognitive profile in a Portuguese neurologic injured sample. The Portuguese WAIS-III was administered to 81 mixed neurologic patients and 81 healthy matched controls selected from the Portuguese standardization sample. Although the mixed neurologic injury group performed significantly lower than the healthy controls for the majority of the WAIS-III scores (i.e., composite measures, discrepancies, and subtests), the mean scores were within the normal range and, therefore, at risk of being unobserved in a clinical evaluation. ROC curves analysis showed poor to acceptable diagnostic accuracy for the WAIS-III composite measures and subtests (Working Memory Index and Digit Span revealed the highest accuracy for discriminating between participants, respectively). Multiple regression analysis showed that both literacy and the presence of brain injury were significant predictors for all of the composite measures. In addition, multiple regression analysis also showed that literacy, age of injury onset, and years of survival predicted all seven composite measures for the mixed neurologic injured group. Despite the failure to find a WAIS-III cognitive profile for mixed neurologic patients, the results showed a significant influence of brain lesion and literacy in the performance of the WAIS-III.

Weight-training injuries. Common injuries and preventative methods.

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Mazur, L J; Yetman, R J; Risser, W L

1993-07-01

The use of weights is an increasingly popular conditioning technique, competitive sport and recreational activity among children, adolescents and young adults. Weight-training can cause significant musculoskeletal injuries such as fractures, dislocations, spondylolysis, spondylolisthesis, intervertebral disk herniation, and meniscal injuries of the knee. Although injuries can occur during the use of weight machines, most apparently happen during the aggressive use of free weights. Prepubescent and older athletes who are well trained and supervised appear to have low injury rates in strength training programmes. Good coaching and proper weightlifting techniques and other injury prevention methods are likely to minimise the number of musculoskeletal problems caused by weight-training.

Pharmacological interventions for self-injurious behaviour in adults with intellectual disabilities.

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Rana, Fareez; Gormez, Aynur; Varghese, Susan

2013-04-30

Self-injurious behaviour among people with intellectual disability is relatively common and often persistent. Self-injurious behaviour continues to present a challenge to clinicians. It remains poorly understood and difficult to ameliorate despite advances in neurobiology and psychological therapies. There is a strong need for a better evidence base in prescribing and monitoring of drugs in this population, especially since none of the drugs are actually licensed for self-injurious behaviour. To determine clinical effectiveness of pharmacological interventions in management of self-injurious behaviour in adults with intellectual disability. We searched the following databases on 19 February 2012: CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, Science Citation Index, Social Science Citation Index, Conference Proceedings Citation Index - Science, Conference Proceedings Citation Index - Social Science and Humanities, ZETOC and WorldCat. We also searched ClinicalTrials.gov, ICTRP and the reference lists of included trials. We included randomised controlled trials that examined drug interventions versus placebo for self-injurious behaviour (SIB) in adults with intellectual disability. Two review authors independently extracted data and assessed risk of bias for each trial using a data extraction form. We present a narrative summary of the results is presented. We did not consider meta-analysis was appropriate due to differences in study designs, differences between interventions and heterogeneous outcome measures. We found five double-blind placebo-controlled trials that met our inclusion criteria. These trials assessed effectiveness and safety of drugs in a total of 50 people with intellectual disability demonstrating SIB. Four trials compared the effects of naltrexone versus placebo and one trial compared clomipramine versus placebo.One of the naltrexone versus placebo trials reported that naltrexone had clinically significant effects (≥ 33% reduction) on the daily

Estimated rate of agricultural injury: the Korean Farmers’ Occupational Disease and Injury Survey

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Chae, Hyeseon; Min, Kyungdoo; Youn, kanwoo; Park, Jinwoo; Kim, Kyungran; Kim, Hyocher; Lee, Kyungsuk

2014-01-01

Objectives This study estimated the rate of agricultural injury using a nationwide survey and identified factors associated with these injuries. Methods The first Korean Farmers’ Occupational Disease and Injury Survey (KFODIS) was conducted by the Rural Development Administration in 2009. Data from 9,630 adults were collected through a household survey about agricultural injuries suffered in 2008. We estimated the injury rates among those whose injury required an absence of more than 4 days. ...

"Help seniors live better, longer: prevent brain injury": an overview of CDC's education initiative to prevent fall-related TBI among older adults.

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Sarmiento, Kelly; Langlois, Jean A; Mitchko, Jane

2008-01-01

Falls are the leading cause of traumatic brain injury (TBI) among older adults aged 75 and older. Despite this burden, many older adults, their caregivers, and professionals are not aware of the importance of TBI as an outcome of falls among older adults. To address this important public health problem, the Centers for Disease Control and Prevention (CDC) developed the "Help Seniors Live Better, Longer: Prevent Brain Injury" initiative to help raise awareness about methods to prevent, recognize and respond to fall-related TBIs among older adults aged 75 and older. The initiative was launched in March 2008, in collaboration with 26 participating organizations, and included a multipronged outreach strategy to help blanket the country with the messages of the initiative at the national, state, and local levels. Adherence to a logical, comprehensive health-education approach has proven to be highly effective in furthering the initial goals of the project.

Rapid reorganization of adult rat motor cortex somatic representation patterns after motor nerve injury.

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Sanes, J N; Suner, S; Lando, J F; Donoghue, J P

1988-01-01

The potential for peripheral nerve injury to reorganize motor cortical representations was investigated in adult rats. Maps reflecting functional connections between the motor cortex and somatic musculature were generated with intracortical electrical stimulation techniques. Comparison of cortical somatotopic maps obtained in normal rats with maps generated from rats with a facial nerve lesion indicated that the forelimb and eye/eyelid representations expanded into the normal vibrissa area. R...

Depressive symptoms among older adults with long-term spinal cord injury: Associations with secondary health conditions, sense of coherence, coping strategies and physical activity

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Sophie Jörgensen

2017-07-01

Full Text Available Objectives: To assess the presence of depressive symptoms among older adults with long-term spinal cord injury and investigate the association with sociodemographic and injury characteristics; and to determine how potentially modifiable factors, i.e. secondary health conditions, sense of coherence, coping strategies and leisure-time physical activity, are associated with depressive symptoms. Design: Cross-sectional study. Subjects: A total of 122 individuals (70% men, injury levels C1–L5, American Spinal Injury Association Impairment Scale A–D, mean age 63 years, mean time since injury 24 years. Methods: Data from the Swedish Aging with Spinal Cord Injury Study, collected using the Geriatric Depression Scale-15, the 13-item Sense of Coherence Scale, the Spinal Cord Lesion-related Coping Strategies Questionnaire and the Physical Activity Recall Assessment for people with Spinal Cord Injury. Associations were analysed using multivariable linear regression. Results: A total of 29% reported clinically relevant depressive symptoms and 5% reported probable depression. Sense of coherence, the coping strategy Acceptance, neuropathic pain and leisure-time physical activity explained 53% of the variance in depressive symptoms. Conclusion: Older adults with long-term spinal cord injury report a low presence of probable depression. Mental health may be supported through rehabilitation that strengthens the ability to understand and confront life stressors, promotes acceptance of the injury, provides pain management and encourages participation in leisure-time physical activity.

Primary repair for pediatric colonic injury: Are there differences among adult and pediatric trauma centers?

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Khan, Muhammad; Jehan, Faisal; O'Keeffe, Terence; Pandit, Viraj; Kulvatunyou, Narong; Tang, Andrew; Gries, Lynn; Joseph, Bellal

2017-12-01

Management of colonic injuries (colostomy [CO] versus primary anastomosis [PA]) among pediatric patients remains controversial. The aim of this study was to assess outcomes in pediatric trauma patient with colonic injury undergoing operative intervention. The National Trauma Data Bank (2011-2012) was queried including patients with isolated colonic injury undergoing exploratory laparotomy with PA or CO with age ≤18 y. Missing value analysis was performed. Patients were stratified into two groups: PA and CO. Outcome measures were mortality, in-hospital complications, and hospital length of stay. Multivariate regression analysis was performed. A total of 1151 patients included. Mean ± standard deviation age was 11.61 ± 2.8 y, and median [IQR] Injury Severity Score was 12 [8-16]; 39% (n = 449) of the patients had CO, and 35.6% (n = 410) were managed in pediatric trauma centers (PC). Patients with CO had a higher Injury Severity Score (P trauma centers (AC). Moreover, there was no difference in mortality between the AC and the PC (P = 0.79). Our data demonstrate no difference in mortality in pediatric trauma patients with colonic injury who undergo primary repair or CO. However, adult trauma centers had lower rates of CO performed as compared to a similar cohort of patients managed in pediatric trauma centers. Further assessment of the reasons underlying such differences will help improve patient outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

The spleen not taken: Differences in management and outcomes of blunt splenic injuries in teenagers cared for by adult and pediatric trauma teams in a single institution.

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OʼConnor, Sean C; Doud, Andrea N; Sieren, Leah M; Miller, Preston R; Zeller, Kristen A

2017-09-01

Nonoperative management (NOM) of blunt splenic injury, initially touted for the care of pediatric patients, has become the standard of care for stable trauma patients of all ages. In our institution, trauma patients younger than 16 years are managed by the pediatric surgery service and patients 16 years or older are managed by the adult trauma service. Angioembolization is routinely used for adults with blunt splenic injury but rarely used for pediatric patients. A retrospective chart review was performed to determine if more liberal use of angioembolization increases the success rate of NOM of blunt splenic injury in adolescents. Using our institutional trauma registry, we performed a retrospective chart review of 13- to 18-year-olds admitted with blunt splenic injury from 2007 to 2015. One hundred thirty-three patients were identified; 59 were 13- to 15-year-olds and cared for by the Pediatric Trauma service, whereas 74 were 16- to 18-year-olds and cared for by the Adult Trauma service. The cohorts were compared with respect to imaging performed, grade of injury, Injury Severity Score, presence of active extravasation or pseudoaneurysm, interventions performed, blood transfused, intensive care unit days, length of stay, complications, and 30-day mortality rates. There were no significant differences in Injury Severity Score, incidence of active extravasation or pseudoaneurysm identified on computed tomography, or grade of injury between the two cohorts. More patients underwent angioembolization in the "adult" group (p = 0.001) with no difference in the success rate of NOM (p = 0.117). The overall failure rate of NOM of high-grade injuries was only 4.1%. Failure of NOM in high-grade injuries is rare; as a result, the number needed to treat with prophylactic angioembolization would be around 37 patients, resulting in undue risk to many patients with no therapeutic benefit. No improvement in failure rate was seen with aggressive angioembolization, though a larger

Effect of square stepping exercise for older adults to prevent fall and injury related to fall: systematic review and meta-analysis of current evidences

OpenAIRE

Fisseha, Berihu; Janakiraman, Balamurugan; Yitayeh, Asmare; Ravichandran, Hariharasudhan

2017-01-01

Falls and fall related injuries become an emerging health problem among older adults. As a result a review of the recent evidences is needed to design a prevention strategy. The aim of this review was to determine the effect of square stepping exercise (SSE) for fall down injury among older adults compared with walking training or other exercises. An electronic database search for relevant randomized control trials published in English from 2005 to 2016 was conducted. Articles with outcome me...

Endosulfan affects health variables in adult zebrafish (Danio rerio) and induces alterations in larvae development

DEFF Research Database (Denmark)

Velasco-Santamaria, Y. M.; Handy, R. D.; Sloman, K. A.

2011-01-01

to controls. Both concentrations of endosulfan caused a 4.0 fold increase in Na(+)K(+)-ATPase activity compared to controls (ANOVA, p ANOVA, p ... alterations in the progeny of fish exposed to endosulfan were observed. Heart beat frequency was significantly lower in larvae from exposed adults to 0.16 mu g/L compared to the control (ANOVA, p

Spinal Cord Injury 101

Medline Plus

Full Text Available ... Living with SCI Personal Experiences by Topic Resources Peer ... Adult Injuries Spinal Cord Injury 101 David Chen, MD Preventing Pressure Sores Mary Zeigler, MS Transition from Hospital to ...

Fatal traumatic brain injury in older adults in Austria 1980-2012: an analysis of 33 years.

Science.gov (United States)

Brazinova, Alexandra; Mauritz, Walter; Majdan, Marek; Rehorcikova, Veronika; Leitgeb, Johannes

2015-05-01

traumatic brain injury (TBI) is a significant public health problem. Developed countries report a significant increase of TBI in older adults in the past decades. The objective of this study was to investigate the changes in TBI-related mortality in older Austrians (65 years or older) between 1980 and 2012 (33 years) and to identify possible causes for these changes. data from Statistics Austria on mortality in Austria between 1980 and 2012 were screened and data on TBI-related mortality in adults aged 65 and older were extracted and analysed, based on the diagnostic codes of the International Classification of Diseases, 10th and 9th revision. Mortality rates were calculated for 5-year age groups; standardized mortality rates were calculated for the total. Mechanism of injury was analysed for all events, both sexes and individual age groups. between 1980 and 2012, 16,204 people aged 65 or older died from TBI in Austria; 61% of these were male. Fatal TBI cases and mortality rates increased in the oldest age groups (80 years or older). Half of the fatal TBI cases were caused by falls, 22% by traffic accidents and 17% by suicides. Rate of fall-related fatal TBI increased and rate of traffic accident-related fatal TBI decreased with age. preventive measures introduced in the past decades in the developed countries have contributed to a decrease in traffic injuries. However, falls in the older population are on the rise, mainly due to ageing of the population, throughout the reported period. It is important to take preventive measures to stop the epidemics of fall-related TBIs and fatalities in older adults. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Neurotrophic factors and receptors in the immature and adult spinal cord after mechanical injury or kainic acid.

Science.gov (United States)

Widenfalk, J; Lundströmer, K; Jubran, M; Brene, S; Olson, L

2001-05-15

Delivery of neurotrophic factors to the injured spinal cord has been shown to stimulate neuronal survival and regeneration. This indicates that a lack of sufficient trophic support is one factor contributing to the absence of spontaneous regeneration in the mammalian spinal cord. Regulation of the expression of neurotrophic factors and receptors after spinal cord injury has not been studied in detail. We investigated levels of mRNA-encoding neurotrophins, glial cell line-derived neurotrophic factor (GDNF) family members and related receptors, ciliary neurotrophic factor (CNTF), and c-fos in normal and injured spinal cord. Injuries in adult rats included weight-drop, transection, and excitotoxic kainic acid delivery; in newborn rats, partial transection was performed. The regulation of expression patterns in the adult spinal cord was compared with that in the PNS and the neonate spinal cord. After mechanical injury of the adult rat spinal cord, upregulations of NGF and GDNF mRNA occurred in meningeal cells adjacent to the lesion. BDNF and p75 mRNA increased in neurons, GDNF mRNA increased in astrocytes close to the lesion, and GFRalpha-1 and truncated TrkB mRNA increased in astrocytes of degenerating white matter. The relatively limited upregulation of neurotrophic factors in the spinal cord contrasted with the response of affected nerve roots, in which marked increases of NGF and GDNF mRNA levels were observed in Schwann cells. The difference between the ability of the PNS and CNS to provide trophic support correlates with their different abilities to regenerate. Kainic acid delivery led to only weak upregulations of BDNF and CNTF mRNA. Compared with several brain regions, the overall response of the spinal cord tissue to kainic acid was weak. The relative sparseness of upregulations of endogenous neurotrophic factors after injury strengthens the hypothesis that lack of regeneration in the spinal cord is attributable at least partly to lack of trophic support.

The provision of aids and adaptations, risk assessments, and incident reporting and recording procedures in relation to injury prevention for adults with intellectual disabilities: cohort study.

Science.gov (United States)

Finlayson, J; Jackson, A; Mantry, D; Morrison, J; Cooper, S-A

2015-06-01

Adults with intellectual disabilities (IDs) experience a higher incidence of injury, compared with the general population. The aim of this study was to investigate the provision of aids and adaptations, residential service providers' individual risk assessments and training in these, and injury incident recording and reporting procedures, in relation to injury prevention. Interviews were conducted with a community-based cohort of adults with IDs (n = 511) who live in Greater Glasgow, Scotland, UK and their key carer (n = 446). They were asked about their aids and adaptations at home, and paid carers (n = 228) were asked about individual risk assessments, their training, and incident recording and reporting procedures. Four hundred and twelve (80.6%) of the adults with IDs had at least one aid or adaptation at home to help prevent injury. However, a proportion who might benefit, were not in receipt of them, and surprisingly few had temperature controlled hot water or a bath thermometer in place to help prevent burns/scalds, or kitchen safety equipment to prevent burns/scalds from electric kettles or irons. Fifty-four (23.7%) of the paid carers were not aware of the adult they supported having had any risk assessments, and only 142 (57.9%) had received any training on risk assessments. Considerable variation in incident recording and reporting procedures was evident. More work is needed to better understand, and more fully incorporate, best practice injury prevention measures into routine support planning for adults with IDs within a positive risk-taking and risk reduction framework. © 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Drinker prototype alteration and cue reminders as strategies in a tailored web-based intervention reducing adults' alcohol consumption: randomized controlled trial.

Science.gov (United States)

van Lettow, Britt; de Vries, Hein; Burdorf, Alex; Boon, Brigitte; van Empelen, Pepijn

2015-02-04

Excessive alcohol use is a prevalent and worldwide problem. Excessive drinking causes a significant burden of disease and is associated with both morbidity and excess mortality. Prototype alteration and provision of a cue reminder could be useful strategies to enhance the effectiveness of online tailored interventions for excessive drinking. Through a Web-based randomized controlled trial, 2 strategies (ie, prototype alteration and cue reminders) within an existing online personalized feedback intervention (Drinktest) aimed to reduce adults' excessive drinking. It was expected that both strategies would add to Drinktest and would result in reductions in alcohol consumption by intrinsic motivation and the seizure of opportunities to act. Participants were recruited online and through printed materials. Excessive drinking adults (N=2634) were randomly assigned to 4 conditions: original Drinktest, Drinktest plus prototype alteration, Drinktest plus cue reminder, and Drinktest plus prototype alteration and cue reminder. Evaluation took place at 1-month posttest and 6-month follow-up. Differences in drinking behavior, intentions, and behavioral willingness (ie, primary outcomes) were assessed by means of longitudinal multilevel analyses using a last observation carried forward method. Measures were based on self-reports. All conditions showed reductions in drinking behavior and willingness to drink, and increased intentions to reduce drinking. Prototype alteration (B=-0.15, Pprototypes. Thus, prototype alteration and cue reminder usage may be feasible and simple intervention strategies to promote reductions in alcohol consumption among adults, with an effect up to 6 months. Nederlands Trial Register (NTR): 4169; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4169 (Archived by WebCite at http://www.webcitation.org/6VD2jnxmB).

Caustic Injury In Adults – A Study For 3 Year Period

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Radenkova-Saeva J.

2016-10-01

Full Text Available The aim of the study is to present the results of a 3-year clinico-epidemiological investigation of caustic injury in adults. The study includes 43 patients with acute corrosive ingestion, hospitalized in the Toxicology Clinic, University Hospital “N. I. Pirogov”, Sofia, Bulgaria, for the period 01.01. 2010-31.12.2012. The methods used include: clinical observation and examination, clinical laboratory, imaging, and psychiatric methods and tests. 43 patients between the ages of 22 and 82 with acute corrosive ingestions have been observed. Eleven were male (25.6% and 32 female (74.4%. All ingestions were intentional. Alkaline agents were used by all of the patients. The severity of poisonings varied from moderate to extremely severe. Different complications were seen in 82% of the cases - severe bleeding, perforation, fistula or/and stricture formation. Two of the patients have undergone surgical intervention - coloesophagoplastic - and have recovered completely. The motivation in different age groups was also studied. Psychiatric comorbidity occurred in patients as depressive and schizoaffective disorder, as well as existential crises. Acute corrosive ingestions by alkaline agents cause severe pathology. The severity and complex character of the injuries require good coordination between different medical specialists.

Peripheral injury of pelvic visceral sensory nerves alters GFRa (GDNF family receptor alpha localization in sensory and autonomic pathways of the sacral spinal cord

Directory of Open Access Journals (Sweden)

Shelley Lynne Forrest

2015-04-01

Full Text Available GDNF (glial cell line-derived neurotrophic factor, neurturin and artemin use their co-receptors (GFRα1, GFRα2 and GFRα3, respectively and the tyrosine kinase Ret for downstream signalling. In rodent dorsal root ganglia (DRG most of the unmyelinated and some myelinated sensory afferents express at least one GFRα. The adult function of these receptors is not completely elucidated but their activity after peripheral nerve injury can facilitate peripheral and central axonal regeneration, recovery of sensation, and sensory hypersensitivity that contributes to pain. Our previous immunohistochemical studies of spinal cord and sciatic nerve injuries in adult rodents have identified characteristic changes in GFRα1, GFRα2 or GFRα3 in central spinal cord axons of sensory neurons located in dorsal root ganglia. Here we extend and contrast this analysis by studying injuries of the pelvic and hypogastric nerves that contain the majority of sensory axons projecting to the pelvic viscera (e.g., bladder and lower bowel. At 7 d, we detected some effects of pelvic but not hypogastric nerve transection on the ipsilateral spinal cord. In sacral (L6-S1 cord ipsilateral to nerve injury, GFRα1-immunoreactivity (IR was increased in medial dorsal horn and CGRP-IR was decreased in lateral dorsal horn. Pelvic nerve injury also upregulated GFRα1- and GFRα3-IR terminals and GFRα1-IR neuronal cell bodies in the sacral parasympathetic nucleus that provides the spinal parasympathetic preganglionic output to the pelvic nerve. This evidence suggests peripheral axotomy has different effects on somatic and visceral sensory input to the spinal cord, and identifies sensory-autonomic interactions as a possible site of post-injury regulation.

Wechsler Adult Intelligence Scale-Third Edition profiles and their relationship to self-reported outcome following traumatic brain injury.

Science.gov (United States)

Harman-Smith, Yasmin E; Mathias, Jane L; Bowden, Stephen C; Rosenfeld, Jeffrey V; Bigler, Erin D

2013-01-01

Neuropsychological assessments of outcome after traumatic brain injury (TBI) are often unrelated to self-reported problems after TBI. The current study cluster-analyzed the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) subtest scores from mild, moderate, and severe TBI (n=220) and orthopedic injury control (n=95) groups, to determine whether specific cognitive profiles are related to people's perceived outcomes after TBI. A two-stage cluster analysis produced 4- and 6-cluster solutions, with the 6-cluster solution better capturing subtle variations in cognitive functioning. The 6 clusters differed in the levels and profiles of cognitive performance, self-reported recovery, and education and injury severity. The findings suggest that subtle cognitive impairments after TBI should be interpreted in conjunction with patient's self-reported problems.

Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma.

Science.gov (United States)

Ho, Vanessa Phillis; Patel, Nimitt J; Bokhari, Faran; Madbak, Firas G; Hambley, Jana E; Yon, James R; Robinson, Bryce R H; Nagy, Kimberly; Armen, Scott B; Kingsley, Samuel; Gupta, Sameer; Starr, Frederic L; Moore, Henry R; Oliphant, Uretz J; Haut, Elliott R; Como, John J

2017-01-01

Traumatic injury to the pancreas is rare but is associated with significant morbidity and mortality, including fistula, sepsis, and death. There are currently no practice management guidelines for the medical and surgical management of traumatic pancreatic injuries. The overall objective of this article is to provide evidence-based recommendations for the physician who is presented with traumatic injury to the pancreas. The MEDLINE database using PubMed was searched to identify English language articles published from January 1965 to December 2014 regarding adult patients with pancreatic injuries. A systematic review of the literature was performed, and the Grading of Recommendations Assessment, Development and Evaluation framework was used to formulate evidence-based recommendations. Three hundred nineteen articles were identified. Of these, 52 articles underwent full text review, and 37 were selected for guideline construction. Patients with grade I/II injuries tend to have fewer complications; for these, we conditionally recommend nonoperative or nonresectional management. For grade III/IV injuries identified on computed tomography or at operation, we conditionally recommend pancreatic resection. We conditionally recommend against the routine use of octreotide for postoperative pancreatic fistula prophylaxis. No recommendations could be made regarding the following two topics: optimal surgical management of grade V injuries, and the need for routine splenectomy with distal pancreatectomy. Systematic review, level III.

Development and psychometric properties of an informant assessment scale of theory of mind for adults with traumatic brain injury.

Science.gov (United States)

Zhang, Dengke; Pang, Yanxia; Cai, Weixiong; Fazio, Rachel L; Ge, Jianrong; Su, Qiaorong; Xu, Shuiqin; Pan, Yinan; Chen, Sanmei; Zhang, Hongwei

2016-08-01

Impairment of theory of mind (ToM) is a common phenomenon following traumatic brain injury (TBI) that has clear effects on patients' social functioning. A growing body of research has focused on this area, and several methods have been developed to assess ToM deficiency. Although an informant assessment scale would be useful for examining individuals with TBI, very few studies have adopted this approach. The purpose of the present study was to develop an informant assessment scale of ToM for adults with traumatic brain injury (IASToM-aTBI) and to test its reliability and validity with 196 adults with TBI and 80 normal adults. A 44-item scale was developed following a literature review, interviews with patient informants, consultations with experts, item analysis, and exploratory factor analysis (EFA). The following three common factors were extracted: social interaction, understanding of beliefs, and understanding of emotions. The psychometric analyses indicate that the scale has good internal consistency reliability, split-half reliability, test-retest reliability, inter-rater reliability, structural validity, discriminate validity and criterion validity. These results provide preliminary evidence that supports the reliability and validity of the IASToM-aTBI as a ToM assessment tool for adults with TBI.

The Reliability, Validity, and Feasibility of Physical Activity Measurement in Adults With Traumatic Brain Injury: An Observational Study

NARCIS (Netherlands)

Hassett, L.; Moseley, A.; Harmer, A.; van der Ploeg, H.P.

2015-01-01

Objective: To determine the reliability and validity of the Physical Activity Scale for Individuals with a Physical Disability (PASIPD) in adults with severe traumatic brain injury (TBI) and estimate the proportion of the sample participants who fail to meet the World Health Organization guidelines

Incidence of severe work-related injuries among young adult workers in Brazil: analysis of compensation data.

Science.gov (United States)

Sousa Santana, Vilma; Villaveces, Andrés; Bangdwala, Shrikant L; Runyan, Carol W; Albuquerque Oliveira, Paulo Rogerio

2012-08-01

To obtain national estimates of the annual cumulative incidence and incidence density of severe non-fatal injuries using compensation benefits data from the Brazilian National Social Security Institute (INSS), and to describe their sociodemographic distribution among workers aged under 25 years. Data are records of health-related compensation benefits from the Ministry of Social Insurance's information system of compensation benefits of the INSS recorded in 2006. Injuries were cases classified under chapter XIX, ICD-10. The assessment of their relation with work was made by INSS's occupational physician experts. The study population comprised young workers aged 16-24 years. 59,381 workers received compensation benefits for injuries in the study year. Among them 14,491 (24.4%) were work related, 12,501 (86.3%) were male and 1990 were female workers (13.7%). The annual cumulative incidence rate of work-related injuries (ACI-WI) was 2.9×1000 workers, higher among men (4.2×1000) than women (1.0×1000). The incidence density rate (IDR-WI) was 0.7/1000 full-time equivalent (FTE), higher for men (0.97/1000 FTE) than women (0.24/1000 FTE). Both morbidity measures were higher in the younger group (16-19 years), and inversely related to wage, especially for women in the younger group. Logging, extraction, food/beverage and construction industries had higher ACI-WI and IDR-WI for adolescents and young adult workers of both sex groups. These findings suggest that the Brazilian labour laws limiting young adult workers in hazardous settings need to be expanded, adding occupations in other extractive industries and certain types of work in the food/beverage manufacturing industries. Social inequalities associated with sex need to be examined further with more detailed data.

Neurophysiological correlates of persistent psycho-affective alterations in athletes with a history of concussion.

Science.gov (United States)

Moore, Robert Davis; Sauve, William; Ellemberg, Dave

2016-12-01

Understanding the neuropathological underpinnings of sport-related concussion are critical for diagnosis, prognosis, and remediation. Although electro-encephalographic (EEG) methods have proven invaluable for understanding psycho-affective pathologies in various clinical conditions, they have not been used to understand the psycho-affective outcomes of concussive injuries. Accordingly, we evaluated the relation of electroencephalographic (EEG) power in collegiate athletes to psycho-affective measures. We predicted that athletes with a history of concussion would exhibit alterations in frontal EEG asymmetries indicative of increased depression, anxiety and more general mood disturbance. During this cross-sectional study, resting EEG and measures of mood and affect, including the Beck Depression Inventory-II (BDI-II) and Profile of Mood States (POMS) were collected in 81 young-adult male athletes (52 concussion history; 29 controls). All athletes with a history of concussion (9+ months from injury) reported to be symptom free, and all participants were actively taking part in their sport at the time of testing. Compared to control athletes, the athletes with a history of concussion exhibited alterations in frontal-alpha and frontal-beta asymmetry (p's psycho-affective health before they manifest as clinical disorders.

Altering CO2 during reperfusion of ischemic cardiomyocytes modifies mitochondrial oxidant injury.

Science.gov (United States)

Lavani, Romeen; Chang, Wei-Tien; Anderson, Travis; Shao, Zuo-Hui; Wojcik, Kimberly R; Li, Chang-Qing; Pietrowski, Robert; Beiser, David G; Idris, Ahamed H; Hamann, Kimm J; Becker, Lance B; Vanden Hoek, Terry L

2007-07-01

species. Altering CO2 content during reperfusion can significantly affect myocardial postresuscitation injury, in part by modifying mitochondrial oxidants and NO synthase-induced NO production.

Aging, physical activity and sports injuries. An overview of common sports injuries in the elderly.

Science.gov (United States)

Kallinen, M; Markku, A

1995-07-01

Illness and aging both cause many structural and functional alterations in the human body, rendering elderly people liable to overloading of the musculoskeletal and cardiovascular systems. It should, however, be kept in mind that immobilisation and inactivity have even more deleterious effects on structures and functions in the elderly than in younger adults. Most physically active elderly people are selected individuals with respect to their superior health and physical capacity compared with inactive persons of the same age, thus making it possible to further improve their physical capacity. They will, however, be affected by some of the drawbacks of physical overloading, mostly due to the diminished ability of aging body systems to adapt to high levels of loading. The safety margin of an exercise dose tends to decline with aging. Exertional injuries are common among the elderly, and are connected mostly with degenerative aging processes. Acute injuries are common in those elderly people participating in sport activities which demand high coordination, reaction time, and balance capabilities, such as ball games, down-hill skiing, and gymnastics. Muscle has been reported to be the most commonly acutely injured tissue among active elderly athletes. The lower extremities are the most susceptible to injury. A large proportion of injuries (acute and exertional) are mild and can be treated by brief cessation of training and competition activities. Some of the injuries are, however, long term and cause disability not only during training and competition, but also in the normal activities of daily living. It is important that these injuries are treated as soon as possible and in the most effective way, similarly to injuries suffered by younger people. In treating elderly people, it is most important to avoid the detrimental effects of immobilisation; this requires active treatment and rehabilitation with compensatory exercise therapy. The best 'treatment' for sports

Magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries: protocol for a systematic review of diagnostic accuracy.

Science.gov (United States)

Wade, Ryckie G; Takwoingi, Yemisi; Wormald, Justin C R; Ridgway, John P; Tanner, Steven; Rankine, James J; Bourke, Grainne

2018-05-19

Adult brachial plexus injuries (BPI) are becoming more common. The reconstruction and prognosis of pre-ganglionic injuries (root avulsions) are different to other types of BPI injury. Preoperative magnetic resonance imaging (MRI) is being used to identify root avulsions, but the evidence from studies of its diagnostic accuracy are conflicting. Therefore, a systematic review is needed to address uncertainty about the accuracy of MRI and to guide future research. We will conduct a systematic search of electronic databases alongside reference tracking. We will include studies of adults with traumatic BPI which report the accuracy of preoperative MRI (index test) against surgical exploration of the roots of the brachial plexus (reference standard) for detecting either of the two target conditions (any root avulsion or any pseudomeningocoele as a surrogate marker of root avulsion). We will exclude case reports, articles considering bilateral injuries and studies where the number of true positives, false positives, false negatives and true negatives cannot be derived. The methodological quality of the included studies will be assessed using a tailored version of the QUADAS-2 tool. Where possible, a bivariate model will be used for meta-analysis to obtain summary sensitivities and specificities for both target conditions. We will investigate heterogeneity in the performance of MRI according to field strength and the risk of bias if data permits. This review will summarise the current diagnostic accuracy of MRI for adult BPI, identify shortcomings and gaps in the literature and so help to guide future research. PROSPERO CRD42016049702 .

Occult external iliac vein injury after anterior dislocation of the sacroiliac joint in adult patient

Directory of Open Access Journals (Sweden)

Yueju Liu

2017-03-01

Full Text Available Anterior dislocation of the sacroiliac joint, characterized by dislocation of the ilium anterior to the sacrum, is a subtype of complete posterior pelvic ring disruption. This injury occurs mostly in children. We present an adult patient with anterior dislocation of the sacroiliac joint. It was associated with numerous complications. To the best of our knowledge, it is only the second case reported in the literature.

Evaluation of use of reading comprehension strategies to improve reading comprehension of adult college students with acquired brain injury.

Science.gov (United States)

Griffiths, Gina G; Sohlberg, McKay Moore; Kirk, Cecilia; Fickas, Stephen; Biancarosa, Gina

2016-01-01

Adults with mild to moderate acquired brain injury (ABI) often pursue post-secondary or professional education after their injuries in order to enter or re-enter the job market. An increasing number of these adults report problems with reading-to-learn. The problem is particularly concerning given the growing population of adult survivors of ABI. Despite the rising need, empirical evaluation of reading comprehension interventions for adults with ABI is scarce. This study used a within-subject design to evaluate whether adult college students with ABI with no more than moderate cognitive impairments benefited from using reading comprehension strategies to improve comprehension of expository text. Integrating empirical support from the cognitive rehabilitation and special education literature, the researchers designed a multi-component reading comprehension strategy package. Participants read chapters from an introductory-level college anthropology textbook in two different conditions: strategy and no-strategy. The results indicated that reading comprehension strategy use was associated with recall of more correct information units in immediate and delayed free recall tasks; more efficient recall in the delayed free recall task; and increased accuracy recognising statements from a sentence verification task designed to reflect the local and global coherence of the text. The findings support further research into using reading comprehension strategies as an intervention approach for the adult ABI population. Future research needs include identifying how to match particular reading comprehension strategies to individuals, examining whether reading comprehension performance improves further through the incorporation of systematic training, and evaluating texts from a range of disciplines and genres.

Dual diagnosis of mental illness and substance use disorder and injury in adults recently released from prison: a prospective cohort study

Directory of Open Access Journals (Sweden)

Jesse T Young, MPH

2018-05-01

Full Text Available Summary: Background: People with mental illness and substance use disorder are over-represented in prisons. Injury-related mortality is elevated in people released from prison, and both mental illness and substance use disorder are risk factors for injury. Effective care coordination during the transition between criminal justice and community service providers improves health outcomes for people released from prison. However, the health outcomes and support needs of people with dual diagnosis (co-occurring mental illness and substance use disorder released from prison are poorly understood. Here we aim to examine the association between dual diagnosis and non-fatal injury in adults released from prison. Methods: Pre-release interview data collected between Aug 1, 2008, and July 31, 2010, from a representative sample of sentenced adults (≥18 years in Queensland, Australia, were linked, retrospectively and prospectively, to person-level, state-wide emergency department and hospital records. We identified dual diagnoses from inpatient, emergency department, and prison medical records. We modelled the association between mental health status and all injury resulting in hospital contact by fitting a multivariate Cox regression, adjusting for sociodemographic, health, and criminogenic covariates, and replacing missing covariate data by multiple imputation. Findings: In 1307 adults released from prison, there were 2056 person-years of follow-up (median 495 days, IQR 163–958. The crude injury rates were 996 (95% CI 893–1112 per 1000 person-years for the dual diagnosis group, 538 (441–657 per 1000 person-years for the mental illness only group, 413 (354–482 per 1000 person-years for the substance use disorder only group, and 275 (247–307 per 1000 person-years for the no mental disorder group. After adjusting for model covariates, the dual diagnosis (adjusted hazard rate ratio 3·27, 95% CI 2·30–4·64; p<0·0001 and mental illness only (1�

Dual diagnosis of mental illness and substance use disorder and injury in adults recently released from prison: a prospective cohort study.

Science.gov (United States)

Young, Jesse T; Heffernan, Ed; Borschmann, Rohan; Ogloff, James R P; Spittal, Matthew J; Kouyoumdjian, Fiona G; Preen, David B; Butler, Amanda; Brophy, Lisa; Crilly, Julia; Kinner, Stuart A

2018-05-01

People with mental illness and substance use disorder are over-represented in prisons. Injury-related mortality is elevated in people released from prison, and both mental illness and substance use disorder are risk factors for injury. Effective care coordination during the transition between criminal justice and community service providers improves health outcomes for people released from prison. However, the health outcomes and support needs of people with dual diagnosis (co-occurring mental illness and substance use disorder) released from prison are poorly understood. Here we aim to examine the association between dual diagnosis and non-fatal injury in adults released from prison. Pre-release interview data collected between Aug 1, 2008, and July 31, 2010, from a representative sample of sentenced adults (≥18 years) in Queensland, Australia, were linked, retrospectively and prospectively, to person-level, state-wide emergency department and hospital records. We identified dual diagnoses from inpatient, emergency department, and prison medical records. We modelled the association between mental health status and all injury resulting in hospital contact by fitting a multivariate Cox regression, adjusting for sociodemographic, health, and criminogenic covariates, and replacing missing covariate data by multiple imputation. In 1307 adults released from prison, there were 2056 person-years of follow-up (median 495 days, IQR 163-958). The crude injury rates were 996 (95% CI 893-1112) per 1000 person-years for the dual diagnosis group, 538 (441-657) per 1000 person-years for the mental illness only group, 413 (354-482) per 1000 person-years for the substance use disorder only group, and 275 (247-307) per 1000 person-years for the no mental disorder group. After adjusting for model covariates, the dual diagnosis (adjusted hazard rate ratio 3·27, 95% CI 2·30-4·64; pmental illness only (1·87, 1·19-2·95; p=0·0071) groups were at increased risk of injury after

Humidifier disinfectant-associated lung injury in adults: Prognostic factors in predicting short-term outcome

International Nuclear Information System (INIS)

Koo, Hyun Jung; Do, Kyung-Hyun; Chae, Eun Jin; Kim, Hwa Jung; Song, Joon Seon; Jang, Se Jin; Hong, Sang-Bum; Huh, Jin Won; Lee, En; Hong, Soo-Jong

2017-01-01

To identify clinical and radiologic findings that affect disease severity and short-term prognosis of humidifier disinfectant-associated lung injury in adults and to compare computed tomography (CT) findings between the patients with and without death or lung transplantation. Fifty-nine adults (mean age, 34 years; M/F = 12:47) were enrolled in this retrospective study. Medical records and prospective surveillance data were used to assess clinical and radiological factors associated with a poor clinical outcome. Multivariate generalized estimating equation models were used to analyse serial CT findings. Overall cumulative major events including lung transplantation and mortality were assessed using the Kaplan-Meier method. Almost half needed ICU admission (47.5 %) and 17 died (28.8 %). Young age, peripartum and low O_2 saturation were factors associated with ICU admission. On initial chest radiographs, consolidation (P < 0.001) and ground-glass opacity (P = 0.01) were significantly noted in patients who required ICU admission. CT findings including consolidation (odds ratio (OR), 1.02), pneumomediastinum (OR, 1.66) and pulmonary interstitial emphysema (OR, 1.61) were the risk factors for lung transplantation and mortality. Clinical and radiologic findings are related to the risks of lung transplantation and mortality of humidifier disinfectant-associated lung injury. Consolidation, pneumomediastinum and pulmonary interstitial emphysema were short-term prognostic CT findings. (orig.)

Humidifier disinfectant-associated lung injury in adults: Prognostic factors in predicting short-term outcome

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Koo, Hyun Jung; Do, Kyung-Hyun; Chae, Eun Jin [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul (Korea, Republic of); Kim, Hwa Jung [University of Ulsan College of Medicine, Cancer Center, Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul (Korea, Republic of); Song, Joon Seon; Jang, Se Jin [University of Ulsan College of Medicine, Department of Pathology, Asan Medical Center, Seoul (Korea, Republic of); Hong, Sang-Bum; Huh, Jin Won [University of Ulsan College of Medicine, Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Seoul (Korea, Republic of); Lee, En [Inje University Haundae Paik Hospital, Department of Pediatrics, Busan (Korea, Republic of); Hong, Soo-Jong [University of Ulsan College of Medicine, Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, Seoul (Korea, Republic of)

2017-01-15

To identify clinical and radiologic findings that affect disease severity and short-term prognosis of humidifier disinfectant-associated lung injury in adults and to compare computed tomography (CT) findings between the patients with and without death or lung transplantation. Fifty-nine adults (mean age, 34 years; M/F = 12:47) were enrolled in this retrospective study. Medical records and prospective surveillance data were used to assess clinical and radiological factors associated with a poor clinical outcome. Multivariate generalized estimating equation models were used to analyse serial CT findings. Overall cumulative major events including lung transplantation and mortality were assessed using the Kaplan-Meier method. Almost half needed ICU admission (47.5 %) and 17 died (28.8 %). Young age, peripartum and low O{sub 2} saturation were factors associated with ICU admission. On initial chest radiographs, consolidation (P < 0.001) and ground-glass opacity (P = 0.01) were significantly noted in patients who required ICU admission. CT findings including consolidation (odds ratio (OR), 1.02), pneumomediastinum (OR, 1.66) and pulmonary interstitial emphysema (OR, 1.61) were the risk factors for lung transplantation and mortality. Clinical and radiologic findings are related to the risks of lung transplantation and mortality of humidifier disinfectant-associated lung injury. Consolidation, pneumomediastinum and pulmonary interstitial emphysema were short-term prognostic CT findings. (orig.)

Bone alterations by stress in athletes

International Nuclear Information System (INIS)

Doege, H.

1990-01-01

This report describes our experiences with the bone imaging in athletes. We studied 10 athletes and 10 other patients with spondylolisthesis of the lumbar spine and 16 athletes with suspicion of alterations of extremities. An increased uptake of this radiopharmaceutical was detected in six of 10 athletes with spondylolisthesis caused probably by stress fracture. Bone scans were negative in seven of 16 athletes with suspicion of lesion of extremities. In the remaining 9 patients scans were abnormal and showed periosteal injuries, epiphyseal alteration, joint abnormalities, tibial stress fractures and couvert fracture. It was also abnormal in bone injuries not evident in radiography. (orig.) [de

Sucrose exposure in early life alters adult motivation and weight gain.

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Cristianne R M Frazier

2008-09-01

Full Text Available The cause of the current increase in obesity in westernized nations is poorly understood but is frequently attributed to a 'thrifty genotype,' an evolutionary predisposition to store calories in times of plenty to protect against future scarcity. In modern, industrialized environments that provide a ready, uninterrupted supply of energy-rich foods at low cost, this genetic predisposition is hypothesized to lead to obesity. Children are also exposed to this 'obesogenic' environment; however, whether such early dietary experience has developmental effects and contributes to adult vulnerability to obesity is unknown. Using mice, we tested the hypothesis that dietary experience during childhood and adolescence affects adult obesity risk. We gave mice unlimited or no access to sucrose for a short period post-weaning and measured sucrose-seeking, food consumption, and weight gain in adulthood. Unlimited access to sucrose early in life reduced sucrose-seeking when work was required to obtain it. When high-sugar/high-fat dietary options were made freely-available, however, the sucrose-exposed mice gained more weight than mice without early sucrose exposure. These results suggest that early, unlimited exposure to sucrose reduces motivation to acquire sucrose but promotes weight gain in adulthood when the cost of acquiring palatable, energy dense foods is low. This study demonstrates that early post-weaning experience can modify the expression of a 'thrifty genotype' and alter an adult animal's response to its environment, a finding consistent with evidence of pre- and peri-natal programming of adult obesity risk by maternal nutritional status. Our findings suggest the window for developmental effects of diet may extend into childhood, an observation with potentially important implications for both research and public policy in addressing the rising incidence of obesity.

Sucrose exposure in early life alters adult motivation and weight gain.

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Frazier, Cristianne R M; Mason, Peggy; Zhuang, Xiaoxi; Beeler, Jeff A

2008-09-17

The cause of the current increase in obesity in westernized nations is poorly understood but is frequently attributed to a 'thrifty genotype,' an evolutionary predisposition to store calories in times of plenty to protect against future scarcity. In modern, industrialized environments that provide a ready, uninterrupted supply of energy-rich foods at low cost, this genetic predisposition is hypothesized to lead to obesity. Children are also exposed to this 'obesogenic' environment; however, whether such early dietary experience has developmental effects and contributes to adult vulnerability to obesity is unknown. Using mice, we tested the hypothesis that dietary experience during childhood and adolescence affects adult obesity risk. We gave mice unlimited or no access to sucrose for a short period post-weaning and measured sucrose-seeking, food consumption, and weight gain in adulthood. Unlimited access to sucrose early in life reduced sucrose-seeking when work was required to obtain it. When high-sugar/high-fat dietary options were made freely-available, however, the sucrose-exposed mice gained more weight than mice without early sucrose exposure. These results suggest that early, unlimited exposure to sucrose reduces motivation to acquire sucrose but promotes weight gain in adulthood when the cost of acquiring palatable, energy dense foods is low. This study demonstrates that early post-weaning experience can modify the expression of a 'thrifty genotype' and alter an adult animal's response to its environment, a finding consistent with evidence of pre- and peri-natal programming of adult obesity risk by maternal nutritional status. Our findings suggest the window for developmental effects of diet may extend into childhood, an observation with potentially important implications for both research and public policy in addressing the rising incidence of obesity.

Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1. Liver and spleen

International Nuclear Information System (INIS)

Becker, C.D.; Terrier, F.; Mentha, G.

1998-01-01

Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. Hepatic and splenic injuries can be detected by means of CT with a high accuracy. The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage. (orig.)

Adolescent Alcohol Exposure Persistently Impacts Adult Neurobiology and Behavior

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Vetreno, Ryan P.; Broadwater, Margaret A.; Robinson, Donita L.

2016-01-01

Adolescence is a developmental period when physical and cognitive abilities are optimized, when social skills are consolidated, and when sexuality, adolescent behaviors, and frontal cortical functions mature to adult levels. Adolescents also have unique responses to alcohol compared with adults, being less sensitive to ethanol sedative–motor responses that most likely contribute to binge drinking and blackouts. Population studies find that an early age of drinking onset correlates with increased lifetime risks for the development of alcohol dependence, violence, and injuries. Brain synapses, myelination, and neural circuits mature in adolescence to adult levels in parallel with increased reflection on the consequence of actions and reduced impulsivity and thrill seeking. Alcohol binge drinking could alter human development, but variations in genetics, peer groups, family structure, early life experiences, and the emergence of psychopathology in humans confound studies. As adolescence is common to mammalian species, preclinical models of binge drinking provide insight into the direct impact of alcohol on adolescent development. This review relates human findings to basic science studies, particularly the preclinical studies of the Neurobiology of Adolescent Drinking in Adulthood (NADIA) Consortium. These studies focus on persistent adult changes in neurobiology and behavior following adolescent intermittent ethanol (AIE), a model of underage drinking. NADIA studies and others find that AIE results in the following: increases in adult alcohol drinking, disinhibition, and social anxiety; altered adult synapses, cognition, and sleep; reduced adult neurogenesis, cholinergic, and serotonergic neurons; and increased neuroimmune gene expression and epigenetic modifiers of gene expression. Many of these effects are specific to adolescents and not found in parallel adult studies. AIE can cause a persistence of adolescent-like synaptic physiology, behavior, and sensitivity

Spinal Cord Swelling and Alterations in Hydrostatic Pressure After Acute Injury

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2017-10-01

within four weeks following injury, and 3) neurologic level of injury at or below C8. The rational for the selection of low cervical /high thoracic...Brain : a journal of neurology 2002;125(Pt 11):2567–2578. 4. Jutzeler CR, Huber E, Callaghan MF, et al. Association of pain and CNS structural...changes after spinal cord injury. Scientific Reports 2016;6 5. Jutzeler CR, Curt A, Kramer JLK. Relationship between chronic pain and brain

Expression of developmental myosin and morphological characteristics in adult rat skeletal muscle following exercise-induced injury.

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Smith, H K; Plyley, M J; Rodgers, C D; McKee, N H

1999-07-01

The extent and stability of the expression of developmental isoforms of myosin heavy chain (MHCd), and their association with cellular morphology, were determined in adult rat skeletal muscle fibres following injury induced by eccentrically-biased exercise. Adult female Wistar rats [274 (10) g] were either assigned as non-exercised controls or subjected to 30 min of treadmill exercise (grade, -16 degrees; speed, 15 m x min(-1)), and then sacrificed following 1, 2, 4, 7, or 12 days of recovery (n = 5-6 per group). Histologically and immunohistologically stained serial, transverse cryosections of the soleus (S), vastus intermedius (VI), and tibialis anterior (TA) muscles were examined using light microscopy and digital imaging. Fibres staining positively for MHCd (MHCd+) were seldom detected in the TA. In the VI and S, higher proportions of MHCd+ fibres (0.8% and 2.5%, respectively) were observed in rats at 4 and 7 days post-exercise, in comparison to all other groups combined (0.2%, 1.2%; P < or = 0.01). In S, MHCd+ fibres were observed less frequently by 12 days (0.7%) than at 7 days (2.6%) following exercise. The majority (85.1%) of the MHCd+ fibres had morphological characteristics indicative of either damage, degeneration, repair or regeneration. Most of the MHCd+ fibres also expressed adult slow, and/or fast myosin heavy chain. Quantitatively, the MHCd+ fibres were smaller (< 2500 microm2) and more angular than fibres not expressing MHCd. Thus, there was a transient increase in a small, but distinct population of MHCd+ fibres following unaccustomed, functional exercise in adult rat S and VI muscles. The observed close coupling of MHCd expression with morphological changes within muscle fibres suggests that these characteristics have a common, initial exercise-induced injury-related stimulus.

Radiology of musculoskeletal stress injuries

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Keats, T.E.

1989-01-01

With the new emphasis on physical fitness, musculoskeletal stress injuries are being seen with greater frequency in children and adults, and in locations that are not widely associated with stress injury. Some of the injuries continue to be mistaken for signs of more serious illnesses, such as infection and neoplasm, and this may lead to unnecessary investigative effort. This book covers both the classic stress injuries and the new manifestations

Subtoxic Alterations in Hepatocyte-Derived Exosomes: An Early Step in Drug-Induced Liver Injury?

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Holman, Natalie S; Mosedale, Merrie; Wolf, Kristina K; LeCluyse, Edward L; Watkins, Paul B

2016-06-01

Drug-induced liver injury (DILI) is a significant clinical and economic problem in the United States, yet the mechanisms that underlie DILI remain poorly understood. Recent evidence suggests that signaling molecules released by stressed hepatocytes can trigger immune responses that may be common across DILI mechanisms. Extracellular vesicles released by hepatocytes, principally hepatocyte-derived exosomes (HDEs), may constitute one such signal. To examine HDE alterations as a function of drug-induced stress, this work utilized prototypical hepatotoxicant acetaminophen (APAP) in male Sprague-Dawley (SD) rats, SD rat hepatocytes, and primary human hepatocytes. HDE were isolated using ExoQuick precipitation reagent and analyzed by quantification of the liver-specific RNAs albumin and microRNA-122 (miR-122). In vivo, significant elevations in circulating exosomal albumin mRNA were observed at subtoxic APAP exposures. Significant increases in exosomal albumin mRNA were also observed in primary rat hepatocytes at subtoxic APAP concentrations. In primary human hepatocytes, APAP elicited increases in both exosomal albumin mRNA and exosomal miR-122 without overt cytotoxicity. However, the number of HDE produced in vitro in response to APAP did not increase with exosomal RNA quantity. We conclude that significant drug-induced alterations in the liver-specific RNA content of HDE occur at subtoxic APAP exposures in vivo and in vitro, and that these changes appear to reflect selective packaging rather than changes in exosome number. The current findings demonstrate that translationally relevant HDE alterations occur in the absence of overt hepatocellular toxicity, and support the hypothesis that HDE released by stressed hepatocytes may mediate early immune responses in DILI. © The Author 2016. Published by Oxford University Press on behalf of the Society of Toxicology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Axonal Elongation into Peripheral Nervous System ``Bridges'' after Central Nervous System Injury in Adult Rats

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David, Samuel; Aguayo, Albert J.

1981-11-01

The origin, termination, and length of axonal growth after focal central nervous system injury was examined in adult rats by means of a new experimental model. When peripheral nerve segments were used as ``bridges'' between the medulla and spinal cord, axons from neurons at both these levels grew approximately 30 millimeters. The regenerative potential of these central neurons seems to be expressed when the central nervous system glial environment is changed to that of the peripheral nervous system.

The epidemiological trends of head injury in the largest Canadian adult trauma center from 1986 to 2007.

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Cadotte, David W; Vachhrajani, Shobhan; Pirouzmand, Farhad

2011-06-01

This study documents the epidemiology of head injury over the course of 22 years in the largest Level I adult trauma center in Canada. This information defines the current state, changing pattern, and relative distribution of demographic factors in a defined group of trauma patients. It will aid in hypothesis generation to direct etiological research, administrative resource allocation, and preventative strategies. Data on all the trauma patients treated at Sunnybrook Health Sciences Centre (SHSC) from 1986 to 2007 were collected in a consecutive, prospective fashion. The authors reviewed these data from the Sunnybrook Trauma Registry Database in a retrospective fashion. The aggregate data on head injury included demographic data, cause of injury, and Injury Severity Score (ISS). The collected data were analyzed using univariate techniques to depict the trend of variables over years. The authors used the length of stay (LOS) and number of deaths per year (case fatality rate) as crude measures of outcome. A total of 16,678 patients were treated through the Level I trauma center at SHSC from January 1986 to December 2007. Of these, 9315 patients met the inclusion criteria (ISS > 12, head Abbreviated Injury Scale score > 0). The median age of all trauma patients was 36 years, and 69.6% were male. The median ISS of the head-injury patients was 27. The median age of this group of patients increased by 12 years over the study period. Motorized vehicle accidents accounted for the greatest number of head injuries (60.3%) although the relative percentage decreased over the study period. The median transfer time of patients sustaining a head injury was 2.58 hours, and there was an approximately 45 minute improvement over the 22-year study period. The median LOS in our center decreased from 19 to 10 days over the study period. The average case fatality rate was 17.4% over the study period. In multivariate analysis, more severe injuries were associated with increased LOS as

Exploring factors facilitating adults with spinal cord injury rejoining the workforce: a pilot study.

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Wilbanks, Susan R; Ivankova, Nataliya V

2015-01-01

Return-to-work (RTW) rates after spinal cord injury (SCI) in the USA are very low and are continuing to decline. Previous research has attempted to identify factors facilitating RTW; however, the phenomenon of RTW involves many personal factors and predicting RTW success remains difficult. The purpose of this pilot study was to explore the factors facilitating adults with SCI rejoining the workforce in an urban area in order to identify items that may be emphasized in the rehabilitation process. The study was completed using qualitative methods. Four adults who had acquired a traumatic SCI in adulthood and were currently employed participated. Their experiences in RTW after injury were collected via semi-structured interviews and photography of assistive devices. The most common facilitating factor was motivation, with family and rehabilitation professionals serving as extrinsic motivators. Other facilitators were resources and perceived benefits. Motivation and resources were important facilitators, including rehabilitation professional's personal influence and therapies, and resource assistance from state agencies. The results indicate that practitioners can play an important role in influencing RTW, and resources from state agencies are helpful when individuals know how to access and utilize them. Assistive technology supports successful return to work after SCI. Motivation strongly influences return to work after SCI and can be influenced by rehabilitation professionals, family and community members. Patients should be well informed about how to access assistance programs such as vocational rehabilitation.

The role of long-term label-retaining cells in the regeneration of adult mouse kidney after ischemia/reperfusion injury.

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Liu, Xiangchun; Liu, Haiying; Sun, Lina; Chen, Zhixin; Nie, Huibin; Sun, Aili; Liu, Gang; Guan, Guangju

2016-04-30

Label-retaining cells (LRCs) have been recognized as rare stem and progenitor-like cells, but their complex biological features in renal repair at the cellular level have never been reported. This study was conducted to evaluate whether LRCs in kidney are indeed renal stem/progenitor cells and to delineate their potential role in kidney regeneration. We utilized a long-term pulse chase of 5-bromo-2'-deoxyuridine (BrdU)-labeled cells in C57BL/6J mice to identify renal LRCs. We tracked the precise morphological characteristics and locations of BrdU(+)LRCs by both immunohistochemistry and immunofluorescence. To examine whether these BrdU(+)LRCs contribute to the repair of acute kidney injury, we analyzed biological characteristics of BrdU(+)LRCs in mice after ischemia/reperfusion (I/R) injury. The findings revealed that the nuclei of BrdU(+) LRCs exhibited different morphological characteristics in normal adult kidneys, including nuclei in pairs or scattered, fragmented or intact, strongly or weakly positive. Only 24.3 ± 1.5 % of BrdU(+) LRCs co-expressed with Ki67 and 9.1 ± 1.4 % of BrdU(+) LRCs were positive for TUNEL following renal I/R injury. Interestingly, we found that newly regenerated cells formed a niche-like structure and LRCs in pairs tended to locate in this structure, but the number of those LRCs was very low. We found a few scattered LRCs co-expressed Lotus tetragonolobus agglutinin (LTA) in the early phase of injury, suggesting differentiation of those LRCs in mouse kidney. Our findings suggest that LRCs are not a simple type of slow-cycling cells in adult kidneys, indicating a limited role of these cells in the regeneration of I/R injured kidney. Thus, LRCs cannot reliably be considered stem/progenitor cells in the regeneration of adult mouse kidney. When researchers use this technique to study the cellular basis of renal repair, these complex features of renal LRCs and the purity of real stem cells among renal LRCs should be considered.

Injuries in Slow-Pitch Softball.

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Loosli, Alvin R.; And Others

1988-01-01

Review of sports medicine records of 285 softball players and responses of 200 adult softball players to a questionnaire regarding injuries leads to suggestions about ways to prevent softball injuries, including preseason conditioning and strengthening. (Author/CB)

Head Injury, from Men to Model

NARCIS (Netherlands)

W.A. van den Brink (Willem Aart)

2000-01-01

textabstractIn well developed countries, injury is the leading cause of death and disability among young adults. In less developed countries the incidence of injury is high and rapidly increasing, but the relative mortality due to injuries is overshadowed by other causes, such as infections and

When an adult female seeks ritual genital alteration: ethics, law, and the parameters of participation.

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Cantor, Julie D

2006-04-01

Ritual genital cutting for women, a common practice in Africa and elsewhere around the world, remains dangerous and controversial. In recent years, a 14-year-old girl living in Sierra Leone exsanguinated and died following a ritualistic genital cutting. Hoping to avoid that fate, women with backgrounds that accept ritual genital cutting may, when they reach majority age, ask plastic surgeons to perform genital alterations for cultural reasons. Although plastic surgeons routinely perform cosmetic procedures, unique ethical and legal concerns arise when an adult female patient asks a surgeon to spare her the tribal elder's knife and alter her genitalia according to tradition and custom. Misinformation and confusion about this issue exist. This article explores the ethical and legal issues relevant to this situation and explains how the thoughtful surgeon should proceed.

The value of the injury severity score in pediatric trauma: Time for a new definition of severe injury?

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Brown, Joshua B; Gestring, Mark L; Leeper, Christine M; Sperry, Jason L; Peitzman, Andrew B; Billiar, Timothy R; Gaines, Barbara A

2017-06-01

The Injury Severity Score (ISS) is the most commonly used injury scoring system in trauma research and benchmarking. An ISS greater than 15 conventionally defines severe injury; however, no studies evaluate whether ISS performs similarly between adults and children. Our objective was to evaluate ISS and Abbreviated Injury Scale (AIS) to predict mortality and define optimal thresholds of severe injury in pediatric trauma. Patients from the Pennsylvania trauma registry 2000-2013 were included. Children were defined as younger than 16 years. Logistic regression predicted mortality from ISS for children and adults. The optimal ISS cutoff for mortality that maximized diagnostic characteristics was determined in children. Regression also evaluated the association between mortality and maximum AIS in each body region, controlling for age, mechanism, and nonaccidental trauma. Analysis was performed in single and multisystem injuries. Sensitivity analyses with alternative outcomes were performed. Included were 352,127 adults and 50,579 children. Children had similar predicted mortality at ISS of 25 as adults at ISS of 15 (5%). The optimal ISS cutoff in children was ISS greater than 25 and had a positive predictive value of 19% and negative predictive value of 99% compared to a positive predictive value of 7% and negative predictive value of 99% for ISS greater than 15 to predict mortality. In single-system-injured children, mortality was associated with head (odds ratio, 4.80; 95% confidence interval, 2.61-8.84; p 0.05). For multisystem injury, all body region AIS scores were associated with mortality except extremities. Sensitivity analysis demonstrated ISS greater than 23 to predict need for full trauma activation, and ISS greater than 26 to predict impaired functional independence were optimal thresholds. An ISS greater than 25 may be a more appropriate definition of severe injury in children. Pattern of injury is important, as only head and chest injury drive mortality

Morphological and functional alterations in adult boar epididymis: Effects of prenatal and postnatal administration of flutamide

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Chojnacka Katarzyna

2011-02-01

Full Text Available Abstract Background The dynamic cross-talk between epididymal cells is hormonally regulated and, in part, through direct cell-to-cell interactions. To date, no information is available regarding possible impact of anti-androgens on the proteins involved in the gap junctional communication within the boar epididymis. Thus, a question arised whether prenatal or postnatal exposure to an anti-androgen flutamide alters the expression of gap junction protein - connexin43 (Cx43 and androgen receptor (AR expression in the caput, corpus and cauda epididymis and leads to delayed effects on morphology and function of adult pig epididymis. Methods First two experimental groups received flutamide prenatally on gestational days 20-28 and 80-88 (GD20 and GD80 and further two groups were exposed to flutamide postanatally on days 2-10 and 90-98 after birth (PD2 and PD90. Epididymides were collected from adult boars. Routine histology was performed using hematoxylin-eosin staining. The expression of Cx43 and AR were analyzed using immunohistochemistry and Western blotting. Both analyses were supported by quantitative approaches to demonstrate the variations of the expression levels following the treatment. Apoptotic cells were identified using TUNEL assay. Results Histological examination revealed differences in epididymal morphology of flutamide-exposed boars when compared to controls. Scarce spermatic content were seen within the corpus and cauda lumina of GD20, PD2 and PD90 groups. Concomitantly, frequency of epididymal cell apoptosis was significantly higher (p p p p Conclusions The region-specific alterations in the epididymis morphology and scarce spermatic content within the lumina of the corpus and cauda indicate that flutamide can induce delayed effects on the epididymal function of the adult boar by decrease in AR protein levels that results in altered androgen signaling. This may cause disturbances in androgen-dependent processes including Cx43

Brain injury and altered brain growth in preterm infants: predictors and prognosis.

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Kidokoro, Hiroyuki; Anderson, Peter J; Doyle, Lex W; Woodward, Lianne J; Neil, Jeffrey J; Inder, Terrie E

2014-08-01

To define the nature and frequency of brain injury and brain growth impairment in very preterm (VPT) infants by using MRI at term-equivalent age and to relate these findings to perinatal risk factors and 2-year neurodevelopmental outcomes. MRI scans at term-equivalent age from 3 VPT cohorts (n = 325) were reviewed. The severity of brain injury, including periventricular leukomalacia and intraventricular and cerebellar hemorrhage, was graded. Brain growth was assessed by using measures of biparietal width (BPW) and interhemispheric distance. Neurodevelopmental outcome at age 2 years was assessed across all cohorts (n = 297) by using the Bayley Scales of Infant Development, Second Edition (BSID-II) or Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), and evaluation for cerebral palsy. Of 325 infants, 107 (33%) had some grade of brain injury and 33 (10%) had severe injury. Severe brain injury was more common in infants with lower Apgar scores, necrotizing enterocolitis, inotropic support, and patent ductus arteriosus. Severe brain injury was associated with delayed cognitive and motor development and cerebral palsy. Decreased BPW was related to lower gestational age, inotropic support, patent ductus arteriosus, necrotizing enterocolitis, prolonged parenteral nutrition, and oxygen at 36 weeks and was associated with delayed cognitive development. In contrast, increased interhemispheric distance was related to male gender, dexamethasone use, and severe brain injury. It was also associated with reduced cognitive development, independent of BPW. At term-equivalent age, VPT infants showed both brain injury and impaired brain growth on MRI. Severe brain injury and impaired brain growth patterns were independently associated with perinatal risk factors and delayed cognitive development. Copyright © 2014 by the American Academy of Pediatrics.

Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury.

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Cogan, Alison M; Blanchard, Jeanine; Garber, Susan L; Vigen, Cheryl Lp; Carlson, Mike; Clark, Florence A

2017-07-01

To investigate the efficacy of behavioral or educational interventions in preventing pressure ulcers in community-dwelling adults with spinal cord injury (SCI). Cochrane, Clinical Trials, PubMed, and Web of Science were searched in June 2016. The search combined related terms for pressure ulcers, spinal cord injury, and behavioral intervention. Each database was searched from its inception with no restrictions on year of publication. Inclusion criteria required that articles were (a) published in a peer-reviewed journal in English, (b) evaluated a behavioral or educational intervention for pressure ulcer prevention, (c) included community-dwelling adult participants aged 18 years and older with SCI, (d) measured pressure ulcer occurrence, recurrence, or skin breakdown as an outcome, and (e) had a minimum of 10 participants. All study designs were considered. Two reviewers independently screened titles and abstracts. Extracted information included study design, sample size, description of the intervention and control condition, pressure ulcer outcome measures, and corresponding results. The search strategy yielded 444 unique articles of which five met inclusion criteria. Three were randomized trials and two were quasi-experimental designs. A total of 513 participants were represented. The method of pressure ulcer or skin breakdown measurement varied widely among studies. Results on pressure ulcer outcomes were null in all studies. Considerable methodological problems with recruitment, intervention fidelity, and participant adherence were reported. At present, there is no positive evidence to support the efficacy of behavioral or educational interventions in preventing pressure ulcer occurrence in adults with SCI.

Altered spontaneous brain activity in patients with acute spinal cord injury revealed by resting-state functional MRI.

Directory of Open Access Journals (Sweden)

Ling Zhu

Full Text Available Previous neuroimaging studies have provided evidence of structural and functional reorganization of brain in patients with chronic spinal cord injury (SCI. However, it remains unknown whether the spontaneous brain activity changes in acute SCI. In this study, we investigated intrinsic brain activity in acute SCI patients using a regional homogeneity (ReHo analysis based on resting-state functional magnetic resonance imaging.A total of 15 patients with acute SCI and 16 healthy controls participated in the study. The ReHo value was used to evaluate spontaneous brain activity, and voxel-wise comparisons of ReHo were performed to identify brain regions with altered spontaneous brain activity between groups. We also assessed the associations between ReHo and the clinical scores in brain regions showing changed spontaneous brain activity.Compared with the controls, the acute SCI patients showed decreased ReHo in the bilateral primary motor cortex/primary somatosensory cortex, bilateral supplementary motor area/dorsal lateral prefrontal cortex, right inferior frontal gyrus, bilateral dorsal anterior cingulate cortex and bilateral caudate; and increased ReHo in bilateral precuneus, the left inferior parietal lobe, the left brainstem/hippocampus, the left cingulate motor area, bilateral insula, bilateral thalamus and bilateral cerebellum. The average ReHo values of the left thalamus and right insula were negatively correlated with the international standards for the neurological classification of spinal cord injury motor scores.Our findings indicate that acute distant neuronal damage has an immediate impact on spontaneous brain activity. In acute SCI patients, the ReHo was prominently altered in brain regions involved in motor execution and cognitive control, default mode network, and which are associated with sensorimotor compensatory reorganization. Abnormal ReHo values in the left thalamus and right insula could serve as potential biomarkers for

Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1. Liver and spleen

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Becker, C.D.; Terrier, F. [Department of Radiology, Division of Diagnostic and Interventional Radiology, Geneva University Hospital, Geneva (Switzerland); Mentha, G. [Department of Surgery, Division of Abdominal Surgery, Geneva University Hospital, Geneva (Switzerland)

1998-05-01

Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. Hepatic and splenic injuries can be detected by means of CT with a high accuracy. The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage. (orig.) With 11 figs., 5 tabs., 64 refs.

Effect of nerve injury on the number of dorsal root ganglion neurons and autotomy behavior in adult Bax-deficient mice

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Lyu C

2017-08-01

Full Text Available Chuang Lyu,1,2 Gong-Wei Lyu,3 Aurora Martinez,4 Tie-Jun Sten Shi4 1State Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute of Chinese Academy of Agricultural Sciences, Harbin, People’s Republic of China; 2Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden; 3Department of Neurology, 1st Hospital of Harbin Medical University, Harbin, People’s Republic of China; 4Department of Biomedicine, University of Bergen, Bergen, Norway Background: The proapoptotic molecule BAX, plays an important role in mitochondrial apoptotic pathway. Dorsal root ganglion (DRG neurons depend on neurotrophic factors for survival at early developmental stages. Withdrawal of neurotrophic factors will induce apoptosis in DRG neurons, but this type of cell death can be delayed or prevented in neonatal Bax knockout (KO mice. In adult animals, evidence also shows that DRG neurons are less dependent upon neurotrophic factors for survival. However, little is known about the effect of Bax deletion on the survival of normal and denervated DRG neurons in adult mice. Methods: A unilateral sciatic nerve transection was performed in adult Bax KO mice and wild-type (WT littermates. Stereological method was employed to quantify the number of lumbar-5 DRG neurons 1 month post-surgery. Nerve injury-induced autotomy behavior was also examined on days 1, 3, and 7 post-surgery. Results: There were significantly more neurons in contralateral DRGs of KO mice as compared with WT mice. The number of neurons was reduced in ipsilateral DRGs in both KO and WT mice. No changes in size distributions of DRG neuron profiles were detected before or after nerve injury. Injury-induced autotomy behavior developed much earlier and was more serious in KO mice. Conclusion: Although postnatal death or loss of DRG neurons is partially prevented by Bax deletion, this effect cannot interfere with long-term nerve injury-induced neuronal loss. The exaggerated self

Age-Dependent Schwann Cell Phenotype Regulation Following Peripheral Nerve Injury.

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Chen, Wayne A; Luo, T David; Barnwell, Jonathan C; Smith, Thomas L; Li, Zhongyu

2017-12-01

Schwann cells are integral to the regenerative capacity of the peripheral nervous system, which declines after adolescence. The mechanisms underlying this decline are poorly understood. This study sought to compare the protein expression of Notch, c-Jun, and Krox-20 after nerve crush injury in adolescent and young adult rats. We hypothesized that these Schwann cell myelinating regulatory factors are down-regulated after nerve injury in an age-dependent fashion. Adolescent (2 months old) and young adult (12 months old) rats (n = 48) underwent sciatic nerve crush injury. Protein expression of Notch, c-Jun, and Krox-20 was quantified by Western blot analysis at 1, 3, and 7 days post-injury. Functional recovery was assessed in a separate group of animals (n = 8) by gait analysis (sciatic functional index) and electromyography (compound motor action potential) over an 8-week post-injury period. Young adult rats demonstrated a trend of delayed onset of the dedifferentiating regulatory factors, Notch and c-Jun, corresponding to the delayed functional recovery observed in young adult rats compared to adolescent rats. Compound motor action potential area was significantly greater in adolescent rats relative to young adult rats, while amplitude and velocity trended toward statistical significance. The process of Schwann cell dedifferentiation following peripheral nerve injury shows different trends with age. These trends of delayed onset of key regulatory factors responsible for Schwann cell myelination may be one of many possible factors mediating the significant differences in functional recovery between adolescent and young adult rats following peripheral nerve injury.

Altered movement patterns and muscular activity during single and double leg squats in individuals with anterior cruciate ligament injury.

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Trulsson, Anna; Miller, Michael; Hansson, Gert-Åke; Gummesson, Christina; Garwicz, Martin

2015-02-13

Individuals with Anterior Cruciate Ligament (ACL) injury often show altered movement patterns, suggested to be partly due to impaired sensorimotor control. Here, we therefore aimed to assess muscular activity during movements often used in ACL-rehabilitation and to characterize associations between deviations in muscular activity and specific altered movement patterns, using and further exploring the previously developed Test for substitution Patterns (TSP). Sixteen participants (10 women) with unilateral ACL rupture performed Single and Double Leg Squats (SLS; DLS). Altered movement patterns were scored according to TSP, and Surface Electromyography (SEMG) was recorded bilaterally in six hip, thigh and shank muscles. To quantify deviations in muscular activity, SEMG ratios were calculated between homonymous muscles on injured and non-injured sides, and between antagonistic muscles on the same side. Correlations between deviations of injured/non-injured side SEMG ratios and specific altered movement patterns were calculated. Injured/non-injured ratios were low at transition from knee flexion to extension in quadriceps in SLS, and in quadriceps and hamstrings in DLS. On injured side, the quadriceps/hamstrings ratio prior to the beginning of DLS and end of DLS and SLS, and tibialis/gastrocnemius ratio at end of DLS were lower than on non-injured side. Correlations were found between specific altered movement patterns and deviating muscular activity at transition from knee flexion to extension in SLS, indicating that the more deviating the muscular activity on injured side, the more pronounced the altered movement pattern. "Knee medial to supporting foot" correlated to lower injured/non-injured ratios in gluteus medius (rs = -0.73, p = 0.001), "lateral displacement of hip-pelvis-region" to lower injured/non-injured ratios in quadriceps (rs = -0.54, p = 0.03) and "displacement of trunk" to higher injured/non-injured ratios in gluteus medius (rs = 0.62, p = 0

SPINE INJURY IN MULAGO HOSPITAL

African Journals Online (AJOL)

the best outcome in patients with Cervical Spine injury ICSI}. ... which indicates the likely level and pattern of injury ... All trauma patients with altered level ... from arrival In hospital to review bya clinician. ... one ofthe 29 patierns had an op-en mouth view taken. .... Domeier, H_ M. Time reliability of pre-hospital c inical.

Community integration after severe traumatic brain injury in adults.

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Truelle, Jean-Luc; Fayol, Patrick; Montreuil, Michèle; Chevignard, Mathilde

2010-12-01

Despite being the main cause of death and disability in young adults, traumatic brain injury (TBI) is a rather neglected epidemic. Community integration of persons with TBI was, until recently, insufficiently informed by clinical research. To bridge the gap between rehabilitation and community re-entry, the first task is to assess the person, using TBI-specific outcome measures. The second task is to provide re-entry programs, the effectiveness of which is assessed by those measures, using well designed studies. There are very few such studies. However, there are some effective comprehensive programs and others which are specifically targeted dealing mainly with return to work, behavior, and family issues. The complex psychological and environmental components of the disability require individualized and often long-term care. For persons with severe TBI trying to achieve the best possible community integration a new semiology is required, not just limited to medical care, but also involving social and psychological care that is tailored to the needs of each individual and family, living within his/her environment. Currently, only a minority benefit from well validated programs.

MicroRNA changes in rat mesentery and serum associated with drug-induced vascular injury

International Nuclear Information System (INIS)

Thomas, Roberta A.; Scicchitano, Marshall S.; Mirabile, Rosanna C.; Chau, Nancy T.; Frazier, Kendall S.; Thomas, Heath C.

2012-01-01

Regulatory miRNAs play a role in vascular biology and are involved in biochemical and molecular pathways dysregulated during vascular injury. Collection and integration of functional miRNA data into these pathways can provide insight into pathogenesis at the site of injury; the same technologies applied to biofluids may provide diagnostic or surrogate biomarkers. miRNA was analyzed from mesentery and serum from rats given vasculotoxic compounds for 4 days. Fenoldopam, dopamine and midodrine each alter hemodynamics and are associated with histologic evidence of vascular injury, while yohimbine is vasoactive but does not cause histologic evidence of vascular injury in rat. There were 38 and 35 miRNAs altered in a statistically significant manner with a fold change of 2 or greater in mesenteries of fenoldopam- and dopamine-dosed rats, respectively, with 9 of these miRNAs shared. 10 miRNAs were altered in rats given midodrine; 6 were shared with either fenoldopam or dopamine. In situ hybridization demonstrated strong expression and co-localization of miR-134 in affected but not in adjacent unaffected vessels. Mesenteric miRNA expression may provide clarity or avenues of research into mechanisms involved in vascular injury once the functional role of specific miRNAs becomes better characterized. 102 miRNAs were altered in serum from rats with drug-induced vascular injury. 10 miRNAs were commonly altered in serum from dopamine and either fenoldopam or midodrine dosed rats; 18 of these 102 were also altered in mesenteries from rats with drug-induced vascular injury, suggesting their possible utility as peripheral biomarkers. -- Highlights: ► Mesentery and serum were examined from rats given vasoactive compounds for 4 days. ► 72 miRNAs were altered in mesenteries from rats with vascular injury. ► miR-134 was localized to affected but not adjacent unaffected vessels. ► 102 miRNAs were changed in serum from rats with vascular injury. ► 18 miRNAs changed in both

A prospective evaluation of a pressure ulcer prevention and management E-Learning Program for adults with spinal cord injury.

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Brace, Jacalyn A; Schubart, Jane R

2010-08-01

Pressure ulcers are a common complication of spinal cord injury (SCI). Pressure ulcer education programs for spinal cord injured individuals have been found to have a positive effect on care protocol adherence. A prospective study was conducted among hospitalized spinal cord-injured men and women to determine if viewing the Pressure Ulcer Prevention and Management Education for Adults with Spinal Cord Injury: E-Learning Program affects their knowledge scores. A 20-question multiple-choice pre-/post learning test was developed and validated by 12 rehabilitation nurses. Twenty (20) patients (13 men, seven women; mean age 49 years, [SD: 18.26] with injuries to the cervical [seven], thoracic [six], and lumbar [six] regions) volunteered. Most (42%) had completed high school and time since SCI ranged from 2 weeks to 27 years. Eighteen (18) participants completed both the pre- and post test. Of those, 16 showed improvement in pressure ulcer knowledge scores. The median scores improved from 65 (range 25 to 100) pre-program to 92.5 (range 75 to 100) post-program. Descriptive statistics, Student's t-test, and analysis of variance (ANOVA) were used to analyze the data. The results suggest that a single viewing of this e-learning program could improve pressure ulcer knowledge of hospitalized adults with SCI. Research to ascertain the effects of this and other educational programs on pressure ulcer rates is needed.

Softball injuries treated in US EDs, 1994 to 2010.

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Birchak, John C; Rochette, Lynne M; Smith, Gary A

2013-06-01

Softball is a popular participant sport in the United States. This study investigated the epidemiology of softball injuries with comparisons between children and adults. Data from the National Electronic Injury Surveillance System for patients 7 years and older treated in an emergency department (ED) for a softball injury from 1994 through 2010 were analyzed. An estimated 2107823 (95% confidence interval [CI], 1736417-2479229) patients were treated in US EDs for a softball injury during the 17-year study period. The annual number of injuries decreased by 23.0% from 1994 to 2010 (P softball injuries increased significantly during the study period (P = .035). The most commonly injured body regions were the hand/wrist (22.2%) and face (19.3%). Being hit by a ball was the most common mechanism of injury (52.4%) and accounted for most of face (89.6%) and head (75.7%) injuries. Injuries associated with running (relative risk, 2.36; 95% CI, 1.97-2.82) and diving for a ball (relative risk, 4.61; 95% CI, 3.50-6.09) were more likely to occur among adult than pediatric patients. To our knowledge, this is the first study to investigate softball injuries using a nationally representative sample. Softball is a common source of injury among children and adults. Increased efforts are needed to promote safety measures, such as face guards, mouth guards, safety softballs, and break-away bases, to decrease these injuries. Copyright © 2013 Elsevier Inc. All rights reserved.

Consecutive Isoproterenol and Adenosine Treatment Confers Marked Protection against Reperfusion Injury in Adult but Not in Immature Heart: A Role for Glycogen

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Martin Lewis

2018-02-01

Full Text Available Consecutive treatment of adult rat heart with isoproterenol and adenosine (Iso/Aden, known to consecutively activate PKA/PKC signaling, is cardioprotective against ischemia and reperfusion (I/R. Whether this is cardioprotective in an immature heart is unknown. Langendorff–perfused hearts from adult and immature (60 and 14 days old male Wistar rats were exposed to 30 min ischemia and 120 min reperfusion, with or without prior perfusion with 5 nM Iso for 3 min followed by 30 μM Aden for 5 min. Changes in hemodynamics (developed pressure and coronary flow and cardiac injury (Lactate Dehydrogenase (LDH release and infarct size were measured. Additional hearts were used to measure glycogen content. Iso induced a similar inotropic response in both age groups. Treatment with Iso/Aden resulted in a significant reduction in time to the onset of ischemic contracture in both age groups whilst time to peak contracture was significantly shorter only in immature hearts. Upon reperfusion, the intervention reduced cardiac injury and functional impairment in adults with no protection of immature heart. Immature hearts have significantly less glycogen content compared to adult. This work shows that Iso/Aden perfusion confers protection in an adult heart but not in an immature heart. It is likely that metabolic differences including glycogen content contribute to this difference.

Acute and long-term pituitary insufficiency in traumatic brain injury

DEFF Research Database (Denmark)

Klose, M; Juul, A; Struck, J

2007-01-01

To assess the prevalence of hypopituitarism following traumatic brain injury (TBI), describe the time-course and assess the association with trauma-related parameters and early post-traumatic hormone alterations.......To assess the prevalence of hypopituitarism following traumatic brain injury (TBI), describe the time-course and assess the association with trauma-related parameters and early post-traumatic hormone alterations....

Endogenous neural stem cells in central canal of adult rats acquired limited ability to differentiate into neurons following mild spinal cord injury

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Liu, Yuan; Tan, Botao; Wang, Li; Long, Zaiyun; Li, Yingyu; Liao, Weihong; Wu, Yamin

2015-01-01

Endogenous neural stem cells in central canal of adult mammalian spinal cord exhibit stem cell properties following injury. In the present study, the endogenous neural stem cells were labeled with Dil to track the differentiation of cells after mild spinal cord injury (SCI). Compared with 1 and 14 days post mild injury, the number of endogenous neural stem cells significantly increased at the injured site of spinal cord on 3 and 7 days post-injury. Dil-labeled βIII-tublin and GFAP expressing cells could be detected on 7 days post-injury, which indicated that the endogenous neural stem cells in central canal of spinal cord differentiated into different type of neural cells, but there were more differentiated astrocytes than the neurons after injury. Furthermore, after injury the expression of inhibitory Notch1 and Hes1 mRNA began to increase at 6 hours and was evident at 12 and 24 hours, which maintained high levels up to 7 days post-injury. These results indicated that a mild SCI in rat is sufficient to induce endogenous neural stem cells proliferation and differentiation. However, the ability to differentiate into neurons is limited, which may be, at least in part, due to high expression of inhibitory Notch1 and Hes1 genes after injury. PMID:26097566

The first description of severe anemia associated with acute kidney injury and adult minimal change disease: a case report

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Qian Yimei

2009-01-01

Full Text Available Abstract Introduction Acute kidney injury in the setting of adult minimal change disease is associated with proteinuria, hypertension and hyperlipidemia but anemia is usually absent. Renal biopsies exhibit foot process effacement as well as tubular interstitial inflammation, acute tubular necrosis or intratubular obstruction. We recently managed a patient with unique clinical and pathological features of minimal change disease, who presented with severe anemia and acute kidney injury, an association not previously reported in the literature. Case presentation A 60-year-old Indian-American woman with a history of hypertension and diabetes mellitus for 10 years presented with progressive oliguria over 2 days. Laboratory data revealed severe hyperkalemia, azotemia, heavy proteinuria and progressively worsening anemia. Urine eosinophils were not seen. Emergent hemodialysis, erythropoietin and blood transfusion were initiated. Serologic tests for hepatitis B, hepatitis C, anti-nuclear antibodies, anti-glomerular basement membrane antibodies and anti-neutrophil cytoplasmic antibodies were negative. Complement levels (C3, C4 and CH50 were normal. Renal biopsy unexpectedly displayed 100% foot process effacement. A 24-hour urine collection detected 6.38 g of protein. Proteinuria and anemia resolved during six weeks of steroid therapy. Renal function recovered completely. No signs of relapse were observed at 8-month follow-up. Conclusion Adult minimal change disease should be considered when a patient presents with proteinuria and severe acute kidney injury even when accompanied by severe anemia. This report adds to a growing body of literature suggesting that in addition to steroid therapy, prompt initiation of erythropoietin therapy may facilitate full recovery of renal function in acute kidney injury.

Beneficial Effects of Coenzyme Q10 in Reduction of Testicular Tissue Alteration Following Induction of Diabetes in Adult Rats

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Kianifard Davoud

2015-03-01

Full Text Available Background and Aims: Various types of infertility are associated with uncontrolled hyperglycemia and diabetes. Development of oxidative stress is one the most important factors in the alteration of spermatogenesis in diabetic conditions. Consequently, the reduction of oxidative stress with antioxidant compounds can be effective in the reduction of tissue alterations. The aim of this study was to evaluate the efficacy of coenzyme Q10 in improvement of spermatogenesis in adult diabetic rats. Material and Methods: 32 adult rats were divided into four groups of control and treatment. Coenzyme Q10 (10 mg/kg body weight - b.w. was administrated to one control and one diabetic (intraperitoneal injection of 45 mg/kg b.w. of Streptozotocin groups. Blood concentrations of FSH, LH and Testosterone were measured. Histology of testicular tissue and sperm analysis were considered for evaluation of spermatogenesis. Results: Administration of Coenzyme Q10 led to increase of pituitary gonadotropins levels in diabetic rats. Testosterone levels were not changed significantly. Testicular morphology, spermatogenic indices and sperm analysis were improved in treated diabetic rats. Conclusions: The results of this study suggest that the use of Coenzyme Q10 has positive effects in reduction of spermatogenic alterations following induction of experimental diabetes in rats.

Calpain Inhibition Reduces Axolemmal Leakage in Traumatic Axonal Injury

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János Sándor

2009-12-01

Full Text Available Calcium-induced, calpain-mediated proteolysis (CMSP has recently been implicated to the pathogenesis of diffuse (traumatic axonal injury (TAI. Some studies suggested that subaxolemmal CMSP may contribute to axolemmal permeability (AP alterations observed in TAI. Seeking direct evidence for this premise we investigated whether subaxolemmal CMSP may contribute to axolemmal permeability alterations (APA and pre-injury calpain-inhibition could reduce AP in a rat model of TAI. Horseradish peroxidase (HRP, a tracer that accumulates in axons with APA was administered one hour prior to injury into the lateral ventricle; 30 min preinjury a single tail vein bolus injection of 30 mg/kg MDL-28170 (a calpain inhibitor or its vehicle was applied in Wistar rats exposed to impact acceleration brain injury. Histological detection of traumatically injured axonal segments accumulating HRP and statistical analysis revealed that pre-injury administration of the calpain inhibitor MDL-28170 significantly reduced the average length of HRP-labeled axonal segments. The axono-protective effect of pre-injury calpain inhibition recently demonstrated with classical immunohistochemical markers of TAI was further corroborated in this experiment; significant reduction of the length of labeled axons in the drug-treated rats implicate CMSP in the progression of altered AP in TAI.

Altered network topology in pediatric traumatic brain injury

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Dennis, Emily L.; Rashid, Faisal; Babikian, Talin; Mink, Richard; Babbitt, Christopher; Johnson, Jeffrey; Giza, Christopher C.; Asarnow, Robert F.; Thompson, Paul M.

2017-11-01

Outcome after a traumatic brain injury (TBI) is quite variable, and this variability is not solely accounted for by severity or demographics. Identifying sub-groups of patients who recover faster or more fully will help researchers and clinicians understand sources of this variability, and hopefully lead to new therapies for patients with a more prolonged recovery profile. We have previously identified two subgroups within the pediatric TBI patient population with different recovery profiles based on an ERP-derived (event-related potential) measure of interhemispheric transfer time (IHTT). Here we examine structural network topology across both patient groups and healthy controls, focusing on the `rich-club' - the core of the network, marked by high degree nodes. These analyses were done at two points post-injury - 2-5 months (post-acute), and 13-19 months (chronic). In the post-acute time-point, we found that the TBI-slow group, those showing longitudinal degeneration, showed hyperconnectivity within the rich-club nodes relative to the healthy controls, at the expense of local connectivity. There were minimal differences between the healthy controls and the TBI-normal group (those patients who show signs of recovery). At the chronic phase, these disruptions were no longer significant, but closer analysis showed that this was likely due to the loss of power from a smaller sample size at the chronic time-point, rather than a sign of recovery. We have previously shown disruptions to white matter (WM) integrity that persist and progress over time in the TBI-slow group, and here we again find differences in the TBI-slow group that fail to resolve over the first year post-injury.

PEDIATRIC HEAD INJURIES, MECHANISM TO MANAGEMENT: EXPERIENCE OF A SINGLE CENTER

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Pankaj

2016-01-01

Full Text Available INTRODUCTION Head injury is very common in modern life. Patients of any age group may have head injury however mechanism of head injury, pathophysiology and outcome of head injury is quite different in adults as compared to children. Road traffic accident is a common mode of head injury in adults while fall from height and household abuse is common mode in children. In Western countries, there is a separate registry system for pediatric head injury but there is no such system exist in india. Our present study is focused on pediatric head injury and evaluation of factors that affect the final outcome in pediatric patients.

Enteral tube feeding alters the oral indigenous microbiota in elderly adults.

Science.gov (United States)

Takeshita, Toru; Yasui, Masaki; Tomioka, Mikiko; Nakano, Yoshio; Shimazaki, Yoshihiro; Yamashita, Yoshihisa

2011-10-01

Enteral tube feeding is widely used to maintain nutrition for elderly adults with eating difficulties, but its long-term use alters the environment of the oral ecosystem. This study characterized the tongue microbiota of tube-fed elderly adults by analyzing the 16S rRNA gene. The terminal restriction fragment length polymorphism (T-RFLP) profiles of 44 tube-fed subjects were compared with those of 54 subjects fed orally (average age, 86.4 ± 6.9 years). Bar-coded pyrosequencing data were also obtained for a subset of the subjects from each group (15 tube-fed subjects and 16 subjects fed orally). The T-RFLP profiles demonstrated that the microbiota of the tube-fed subjects was distinct from that of the subjects fed orally (permutational multivariate analysis of variance [perMANOVA], P < 0.001). The pyrosequencing data revealed that 22 bacterial genera, including Corynebacterium, Peptostreptococcus, and Fusobacterium, were significantly more predominant in tube-fed subjects, whereas the dominant genera in the subjects fed orally, such as Streptococcus and Veillonella, were present in much lower proportions. Opportunistic pathogens rarely detected in the normal oral microbiota, such as Corynebacterium striatum and Streptococcus agalactiae, were often found in high proportions in tube-fed subjects. The oral indigenous microbiota is disrupted by the use of enteral feeding, allowing health-threatening bacteria to thrive.

How evidence based is the management of two common sports injuries in a sports injury clinic?

OpenAIRE

Murray, I; Murray, S; MacKenzie, K; Coleman, S; Cullen, M

2005-01-01

Objectives: To examine the diagnosis and management of adults attending a sports injury clinic, to establish to what extent the management of the two most common injuries treated at this clinic is evidence based, and to explore factors that affect management.

Prevalence of traumatic brain injury in the general adult population: a meta-analysis.

Science.gov (United States)

Frost, R Brock; Farrer, Thomas J; Primosch, Mark; Hedges, Dawson W

2013-01-01

Traumatic brain injury (TBI) is a significant public-health concern. To understand the extent of TBI, it is important to assess the prevalence of TBI in the general population. However, the prevalence of TBI in the general population can be difficult to measure because of differing definitions of TBI, differing TBI severity levels, and underreporting of sport-related TBI. Additionally, prevalence reports vary from study to study. In this present study, we used meta-analytic methods to estimate the prevalence of TBI in the adult general population. Across 15 studies, all originating from developed countries, which included 25,134 adults, 12% had a history of TBI. Men had more than twice the odds of having had a TBI than did women, suggesting that male gender is a risk factor for TBI. The adverse behavioral, cognitive and psychiatric effects associated with TBI coupled with the high prevalence of TBI identified in this study indicate that TBI is a considerable public and personal-health problem. Copyright © 2012 S. Karger AG, Basel.

Prevalence of traumatic brain injury among children, adolescents and young adults: prospective evidence from a birth cohort.

Science.gov (United States)

McKinlay, A; Grace, R C; Horwood, L J; Fergusson, D M; Ridder, E M; MacFarlane, M R

2008-02-01

Little is known about the incidence and prevalence of traumatic brain injury (TBI), particularly for infants, children and young adults. The purpose of this study was to provide an accurate estimate of the incidence and prevalence of TBIs for individuals between 0-25 years of age. A birth cohort of 1265 individuals was used, for which information regarding TBI events, both hospitalized and non-hospitalized, had been recorded. The average incidence for this age group ranged from 1.10-2.36 per 100 per year, with an overall prevalence of approximately 30%. The most common source of injury was falls for individuals 0-14 years of age and contact sports and motor vehicle accidents for 15-25 year olds. Approximately one third of the individuals who experienced a TBI went on to have one or more additional injuries. The incidence rates reported here are much higher than those previously found. It is clear that TBIs constitute a major health issue and therefore it is important to have accurate information to enable planning for primary healthcare services and to inform prevention programmes.

Cold injuries.

Science.gov (United States)

Kruse, R J

1995-01-01

There are two categories of cold injury. The first is hypothermia, which is a systemic injury to cold, and the second is frostbite, which is a local injury. Throughout history, entire armies, from George Washington to the Germans on the Russian Front in World War II, have fallen prey to prolonged cold exposure. Cold injury is common and can occur in all seasons if ambient temperature is lower than the core body temperature. In the 1985 Boston Marathon, even though it was 76 degrees and sunny, there were 75 runners treated for hypothermia. In general, humans adapt poorly to cold exposure. Children are at particular risk because of their relatively greater surface area/body mass ratio, causing them to cool even more rapidly than adults. Because of this, the human's best defense against cold injury is to limit his/her exposure to cold and to dress appropriately. If cold injury has occurred and is mild, often simple passive rewarming such as dry blankets and a warm room are sufficient treatment.

Changes in microtubule-associated protein tau during peripheral nerve injury and regeneration

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Guang-bin Zha

2016-01-01

Full Text Available Tau, a primary component of microtubule-associated protein, promotes microtubule assembly and/or disassembly and maintains the stability of the microtubule structure. Although the importance of tau in neurodegenerative diseases has been well demonstrated, whether tau is involved in peripheral nerve regeneration remains unknown. In the current study, we obtained sciatic nerve tissue from adult rats 0, 1, 4, 7, and 14 days after sciatic nerve crush and examined tau mRNA and protein expression levels and the location of tau in the sciatic nerve following peripheral nerve injury. The results from our quantitative reverse transcription polymerase chain reaction analysis showed that compared with the uninjured control sciatic nerve, mRNA expression levels for both tau and tau tubulin kinase 1, a serine/threonine kinase that regulates tau phosphorylation, were decreased following peripheral nerve injury. Our western blot assay results suggested that the protein expression levels of tau and phosphorylated tau initially decreased 1 day post nerve injury but then gradually increased. The results of our immunohistochemical labeling showed that the location of tau protein was not altered by nerve injury. Thus, these results showed that the expression of tau was changed following sciatic nerve crush, suggesting that tau may be involved in peripheral nerve repair and regeneration.

Preliminary evidence of altered neural response during intertemporal choice of losses in adult attention-deficit hyperactivity disorder.

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Tanaka, Saori C; Yahata, Noriaki; Todokoro, Ayako; Kawakubo, Yuki; Kano, Yukiko; Nishimura, Yukika; Ishii-Takahashi, Ayaka; Ohtake, Fumio; Kasai, Kiyoto

2018-04-30

Impulsive behaviours are common symptoms of attention-deficit hyperactivity disorder (ADHD). Although previous studies have suggested functional models of impulsive behaviour, a full explanation of impulsivity in ADHD remains elusive. To investigate the detailed mechanisms behind impulsive behaviour in ADHD, we applied an economic intertemporal choice task involving gains and losses to adults with ADHD and healthy controls and measured brain activity by functional magnetic resonance imaging. In the intertemporal choice of future gains, we observed no behavioural or neural difference between the two groups. In the intertemporal choice of future losses, adults with ADHD exhibited higher discount rates than the control participants. Furthermore, a comparison of brain activity representing the sensitivity of future loss in the two groups revealed significantly lower activity in the striatum and higher activity in the amygdala in adults with ADHD than in controls. Our preliminary findings suggest that an altered size sensitivity to future loss is involved in apparent impulsive choice behaviour in adults with ADHD and shed light on the multifaceted impulsivity underlying ADHD.

Association between seeking oral health information online and knowledge in adults with spinal cord injury: A pilot study

Science.gov (United States)

Yuen, Hon K.; Azuero, Andres; London, Steven

2011-01-01

Objective To characterize adults with spinal cord injury (SCI) who seek oral health information online, and investigate whether seeking oral health information online is associated with oral health knowledge and behaviors. Methods An online oral health survey was posted on the South Carolina Spinal Cord Injury Association website. Respondents were 192 adult residents of the US ages 19–83 years who identified themselves as having SCI occurring at least 1 year before the survey date. Results About 12% (n = 23) of the respondents searched oral health information online in the past 12 months. Significant associations between the proportion of respondents who searched for oral health information online and socio-demographic and the proportion of respondents who engaged in various oral health behaviors were not detected. However, multivariable logistic regression indicated that respondents who searched oral health information online in the past 12 months have 3.4 times the odds of possessing adequate oral health knowledge compared to respondents who did not search oral health information online (adjusted odds ratio = 3.41, 95% confidence interval = 1.35, 8.62, P = 0.01). Conclusions Given the significant association between seeking oral health information online and adequate oral health knowledge, this study suggests that online oral health information may be a potential avenue for dental health professionals to supplement oral health education in adults with SCI. PMID:21903017

Management of adult blunt hepatic trauma.

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Kozar, Rosemary A; McNutt, Michelle K

2010-12-01

To review the nonoperative and operative management of blunt hepatic injury in the adult trauma population. Although liver injury scale does not predict need for surgical intervention, a high-grade complex liver injury should alert the physician to a patient at increased risk of hepatic complications following nonoperative management. Blunt hepatic injury remains a frequent intraabdominal injury in the adult trauma population. The management of blunt hepatic injury has undergone a major paradigm shift from mandatory operative exploration to nonoperative management. Hemodynamic instability with a positive focused abdominal sonography for trauma and peritonitis are indications for emergent operative intervention. Although surgical intervention for blunt hepatic trauma is not as common as in years past, it is imperative that the current trauma surgeon be familiar with the surgical skill set to manage complex hepatic injuries. This study represents a review of both nonoperative and operative management of blunt hepatic injury.

Peer mentoring of adults with spinal cord injury: a transformational leadership perspective.

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Beauchamp, Mark R; Scarlett, Louisa J; Ruissen, Geralyn R; Connelly, Catherine E; McBride, Christopher B; Casemore, Sheila; Martin Ginis, Kathleen A

2016-09-01

Drawing from the tenets of transformational leadership theory, the purpose of this study was to examine the nature of effective peer mentoring of adults with a spinal cord injury (SCI) from the perspective of mentees. The study utilised a qualitative methodology (informed by a social constructionist approach), involving 15 adult mentees with a SCI (mean age = 47.2; mean time since injury = 14.5 years), in which data were obtained via semi-structured interviews. The results revealed that effective mentoring, as used by mentors with SCIs, closely aligns with the core components of transformational leadership. Specifically, all four dimensions of transformational leadership (idealised influence, inspirational motivation, individualised consideration and intellectual stimulation) as displayed by mentors with a SCI were evident in their interactions with mentees. Participants who perceived their mentors to use transformational leadership behaviours reported increases in motivation, self-confidence, hope and overall well-being, relatedness with their mentor, greater comfort/acceptance of their situation, a redefined sense of their limitations, as well as greater engagement in various life pursuits. Displays of transformational leadership by peer mentors (i.e. transformational mentoring) were reported by mentees to be associated with a range of adaptive psychological and behavioural outcomes. The results have the potential to inform the development and dissemination of peer mentor-based interventions and initiatives. Implications for Rehabilitation Within the context of spinal cord injury (SCI) rehabilitation, positive peer mentorship is reflected in mentors' use of transformational leadership behaviours (idealised influence, inspirational motivation, individualised consideration and intellectual stimulation). When SCI peer mentors use transformational leadership behaviours, mentees report a redefined sense of their limitations, and increased self-confidence, hope

An evaluation of reading comprehension of expository text in adults with traumatic brain injury.

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Sohlberg, McKay Moore; Griffiths, Gina G; Fickas, Stephen

2014-05-01

This project was conducted to obtain information about reading problems of adults with traumatic brain injury (TBI) with mild-to-moderate cognitive impairments and to investigate how these readers respond to reading comprehension strategy prompts integrated into digital versions of text. Participants from 2 groups, adults with TBI (n = 15) and matched controls (n = 15), read 4 different 500-word expository science passages linked to either a strategy prompt condition or a no-strategy prompt condition. The participants' reading comprehension was evaluated using sentence verification and free recall tasks. The TBI and control groups exhibited significant differences on 2 of the 5 reading comprehension measures: paraphrase statements on a sentence verification task and communication units on a free recall task. Unexpected group differences were noted on the participants' prerequisite reading skills. For the within-group comparison, participants showed significantly higher reading comprehension scores on 2 free recall measures: words per communication unit and type-token ratio. There were no significant interactions. The results help to elucidate the nature of reading comprehension in adults with TBI with mild-to-moderate cognitive impairments and endorse further evaluation of reading comprehension strategies as a potential intervention option for these individuals. Future research is needed to better understand how individual differences influence a person's reading and response to intervention.

Characterization of intrinsic properties of cingulate pyramidal neurons in adult mice after nerve injury

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Chen Tao

2009-12-01

Full Text Available Abstract The anterior cingulate cortex (ACC is important for cognitive and sensory functions including memory and chronic pain. Glutamatergic excitatory synaptic transmission undergo long-term potentiation in ACC pyramidal cells after peripheral injury. Less information is available for the possible long-term changes in neuronal action potentials or intrinsic properties. In the present study, we characterized cingulate pyramidal cells in the layer II/III of the ACC in adult mice. We then examined possible long-term changes in intrinsic properties of the ACC pyramidal cells after peripheral nerve injury. In the control mice, we found that there are three major types of pyramidal cells according to their action potential firing pattern: (i regular spiking (RS cells (24.7%, intrinsic bursting (IB cells (30.9%, and intermediate (IM cells (44.4%. In a state of neuropathic pain, the population distribution (RS: 21.3%; IB: 31.2%; IM: 47.5% and the single action potential properties of these three groups were indistinguishable from those in control mice. However, for repetitive action potentials, IM cells from neuropathic pain animals showed higher initial firing frequency with no change for the properties of RS and IB neurons from neuropathic pain mice. The present results provide the first evidence that, in addition to synaptic potentiation reported previously, peripheral nerve injury produces long-term plastic changes in the action potentials of cingulate pyramidal neurons in a cell type-specific manner.

Alterations in Cortical Sensorimotor Connectivity following Complete Cervical Spinal Cord Injury: A Prospective Resting-State fMRI Study.

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Akinwunmi Oni-Orisan

Full Text Available Functional magnetic resonance imaging (fMRI studies have demonstrated alterations during task-induced brain activation in spinal cord injury (SCI patients. The interruption to structural integrity of the spinal cord and the resultant disrupted flow of bidirectional communication between the brain and the spinal cord might contribute to the observed dynamic reorganization (neural plasticity. However, the effect of SCI on brain resting-state connectivity patterns remains unclear. We undertook a prospective resting-state fMRI (rs-fMRI study to explore changes to cortical activation patterns following SCI. With institutional review board approval, rs-fMRI data was obtained in eleven patients with complete cervical SCI (>2 years post injury and nine age-matched controls. The data was processed using the Analysis of Functional Neuroimages software. Region of interest (ROI based analysis was performed to study changes in the sensorimotor network using pre- and post-central gyri as seed regions. Two-sampled t-test was carried out to check for significant differences between the two groups. SCI patients showed decreased functional connectivity in motor and sensory cortical regions when compared to controls. The decrease was noted in ipsilateral, contralateral, and interhemispheric regions for left and right precentral ROIs. Additionally, the left postcentral ROI demonstrated increased connectivity with the thalamus bilaterally in SCI patients. Our results suggest that cortical activation patterns in the sensorimotor network undergo dynamic reorganization following SCI. The presence of these changes in chronic spinal cord injury patients is suggestive of the inherent neural plasticity within the central nervous system.

Cerebral vascular structure in the motor cortex of adult mice is stable and is not altered by voluntary exercise.

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Cudmore, Robert H; Dougherty, Sarah E; Linden, David J

2017-12-01

The cerebral vasculature provides blood flow throughout the brain, and local changes in blood flow are regulated to match the metabolic demands of the active brain regions. This neurovascular coupling is mediated by real-time changes in vessel diameter and depends on the underlying vascular network structure. Neurovascular structure is configured during development by genetic and activity-dependent factors. In adulthood, it can be altered by experiences such as prolonged hypoxia, sensory deprivation and seizure. Here, we have sought to determine whether exercise could alter cerebral vascular structure in the adult mouse. We performed repeated in vivo two-photon imaging in the motor cortex of adult transgenic mice expressing membrane-anchored green fluorescent protein in endothelial cells (tyrosine endothelial kinase 2 receptor (Tie2)-Cre:mTmG). This strategy allows for high-resolution imaging of the vessel walls throughout the lifespan. Vascular structure, as measured by capillary branch point number and position, segment diameter and length remained stable over a time scale of months as did pericyte number and position. Furthermore, we compared the vascular structure before, during, and after periods of voluntary wheel running and found no alterations in these same parameters. In both running and control mice, we observed a low rate of capillary segment subtraction. Interestingly, these rare subtraction events preferentially remove short vascular loops.

Imaging of cervical spine injuries of childhood

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Khanna, Geetika; El-Khoury, Georges Y. [University of Iowa Hospitals and Clinics, Department of Radiology, 3951 JPP, Iowa, IA (United States)

2007-06-15

Cervical spine injuries of children, though rare, have a high morbidity and mortality. The pediatric cervical spine is anatomically and biomechanically different from that of adults. Hence, the type, level and outcome of cervical spine injuries in children are different from those seen in adults. Normal developmental variants seen in children can make evaluation of the pediatric cervical spine challenging. This article reviews the epidemiology of pediatric cervical spine trauma, normal variants seen in children and specific injuries that are more common in the pediatric population. We also propose an evidence-based imaging protocol to avoid unnecessary imaging studies and minimize radiation exposure in children. (orig.)

Inhalation Injury: State of the Science 2016.

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Foster, Kevin N; Holmes, James H

This article summarizes research conducted over the last decade in the field of inhalation injury in thermally injured patients. This includes brief summaries of the findings of the 2006 State of the Science meeting with regard to inhalation injury, and of the subsequent 2007 Inhalation Injury Consensus Conference. The reviewed studies are categorized in to five general areas: diagnosis and grading; mechanical ventilation; systemic and inhalation therapy; mechanistic alterations; and outcomes.

31P NMR characterization of graded traumatic brain injury in rats

International Nuclear Information System (INIS)

Vink, R.; McIntosh, T.K.; Yamakami, I.; Faden, A.I.

1988-01-01

Irreversible tissue injury following central nervous system trauma is believed to result from both mechanical disruption at the time of primary insult, and more delayed autodestructive processes. These delayed events are associated with various biochemical changes, including alterations in phosphate energy metabolism and intracellular pH. Using 31 P NMR, we have monitored the changes in phosphorus energy metabolism and intracellular pH in a single hemisphere of the rat brain over an 8-h period following graded, traumatic, fluid percussion-induced brain injury. Following trauma the ratio of phosphocreatine to inorganic phosphate (PCr/Pi) declined in each injury group. This decline was transitory with low injury (1.0 +/- 0.5 atm), biphasic with moderate (2.1 +/- 0.4 atm) and high (3.9 +/- 0.9 atm) injury, and sustained following severe injury (5.9 +/- 0.7 atm). The initial PCr/Pi decline in the moderate and high injury groups was associated with intracellular acidosis; however, the second decline occurred in the absence of any pH changes. Alterations in ATP occurred only in severely injured animals and such changes were associated with marked acidosis and 100% mortality rate. After 4h, the posttraumatic PCr/Pi ratio correlated linearly with the severity of injury. We suggest that a reduced posttraumatic PCr/Pi ratio may be indicative of altered mitochondrial energy production and may predict a reduced capacity of the cell to recover from traumatic injury

Hematological alterations and splenic T lymphocyte polarization at the crest of snake venom induced acute kidney injury in adult male mice.

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Nasim, Farhat; Das, Sreyasi; Mishra, Roshnara; Mishra, Raghwendra

2017-08-01

Snake venom induced acute kidney injury (SAKI) is of great clinical relevance in tropical countries. Involvement of T cell, a key mediator of AKI and its remission, is least explored in SAKI. In the present study the in vivo hematological alterations and associated splenic T cell polarization is probed in order to investigate the immune response at the crest of Russell's viper venom (RVV) induced AKI in experimental murine model. Based on a dose and time kinetic study intra muscular injection dose of 20 μg RVV/100 gm body weight of mice and incubation period of 60 h was selected for induction of SAKI. Renal involvement in SAKI group was confirmed from oliguria, significantly elevated urinary microprotein (p < 0.001), decreased urinary creatinine (p = 0.003) and creatinine clearance (p < 0.001) compared to control. Hematological analyses revealed a significant neutrophilic leukocytosis (p < 0.001) associated with a reduced lymphocyte percentage (p < 0.001) favoring a state of acute inflammation in SAKI group. Immunophenotyping study of splenocytes showed a significant decrease in CD4 + /CD8 + ratio (p < 0.001) with a significant increase in regulatory (CD25 + FoxP3 + ) helper and cytotoxic subset of T cell (p < 0.001). Significant increase in IL-10+ regulatory helper and cytotoxic T cell (p < 0.001) further confirmed the internal milieu favoring immunosuppression. Apart from these the CD25 - FoxP3 + reservoir regulatory T cells were also found to be significantly elevated in SAKI group compared to that of control (p < 0.001). Taken together, the results of the present study clearly indicated a state of acute inflammation and splenic T cell polarization towards regulatory subset at the crest of SAKI. Copyright © 2017 Elsevier Ltd. All rights reserved.

Nonsuicidal self-injury, suicidal thoughts and suicide attempts among sexual minority youth in Ireland during their emerging adult years.

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Power, Emmet; Coughlan, Helen; Clarke, Mary; Kelleher, Ian; Lynch, Fionnuala; Connor, Dearbhla; Fitzpatrick, Carol; Harley, Michelle; Cannon, Mary

2016-10-01

This study aimed to examine whether or not sexual minority youth constitute an at-risk group for nonsuicidal self-injury, suicidal ideation or suicide attempts during their emerging adult years. Using data from the Challenging Times Study, a population-based study of psychopathology and suicide in Ireland, analyses were conducted to test the associations between sexual minority status and the odds of any lifetime experience of nonsuicidal self-injury, suicidal thoughts or suicide attempts among Irish youth aged 19-24 years. Sexual minority youth had 6.6-fold (95% CI 1.7-24.7) increased risk of nonsuicidal self-injury, a 5.0-fold (95% CI 1.3-18.3) increased risk of suicidal ideation, a 7.7-fold (95% CI 1.8-32.0) increased risk of suicide intent and a 6.8-fold (95% CI 1.6-27.6) increased risk of a suicide attempt during their lifetime compared to their heterosexual peers. This study shows that emerging adulthood is a period of risk for suicide and nonsuicidal self-injurious behaviour among sexual minority youth. © 2015 Wiley Publishing Asia Pty Ltd.

Complete reorganization of the motor cortex of adult rats following long-term spinal cord injuries.

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Tandon, Shashank; Kambi, Niranjan; Mohammed, Hisham; Jain, Neeraj

2013-07-01

Understanding brain reorganization following long-term spinal cord injuries is important for optimizing recoveries based on residual function as well as developing brain-controlled assistive devices. Although it has been shown that the motor cortex undergoes partial reorganization within a few weeks after peripheral and spinal cord injuries, it is not known if the motor cortex of rats is capable of large-scale reorganization after longer recovery periods. Here we determined the organization of the rat (Rattus norvegicus) motor cortex at 5 or more months after chronic lesions of the spinal cord at cervical levels using intracortical microstimulation. The results show that, in the rats with the lesions, stimulation of neurons in the de-efferented forelimb motor cortex no longer evokes movements of the forelimb. Instead, movements of the body parts in the adjacent representations, namely the whiskers and neck were evoked. In addition, at many sites, movements of the ipsilateral forelimb were observed at threshold currents. The extent of representations of the eye, jaw and tongue movements was unaltered by the lesion. Thus, large-scale reorganization of the motor cortex leads to complete filling-in of the de-efferented cortex by neighboring representations following long-term partial spinal cord injuries at cervical levels in adult rats. © 2013 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

Validation of the Community Integration Questionnaire in the adult burn injury population.

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Gerrard, Paul; Kazis, Lewis E; Ryan, Colleen M; Shie, Vivian L; Holavanahalli, Radha; Lee, Austin; Jette, Alan; Fauerbach, James A; Esselman, Peter; Herndon, David; Schneider, Jeffrey C

2015-11-01

With improved survival, long-term effects of burn injuries on quality of life, particularly community integration, are important outcomes. This study aims to assess the Community Integration Questionnaire's psychometric properties in the adult burn population. Data were obtained from a multicenter longitudinal data set of burn survivors. The psychometric properties of the Community Integration Questionnaire (n = 492) were examined. The questionnaire items were evaluated for clinical and substantive relevance; validation procedures were conducted on different samples of the population; construct validity was assessed using exploratory factor analysis; internal consistency reliability was examined using Cronbach's α statistics; and item response theory was applied to the final models. The CIQ-15 was reduced by two questions to form the CIQ-13, with a two-factor structure, interpreted as self/family care and social integration. Item response theory testing suggests that Factor 2 captures a wider range of community integration levels. Cronbach's α was 0.80 for Factor 1, 0.77 for Factor 2, and 0.79 for the test as a whole. The CIQ-13 demonstrates validity and reliability in the adult burn survivor population addressing issues of self/family care and social integration. This instrument is useful in future research of community reintegration outcomes in the burn population.

Acute Exposure to Microcystin-Producing Cyanobacterium Microcystis aeruginosa Alters Adult Zebrafish (Danio rerio Swimming Performance Parameters

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Luiza Wilges Kist

2011-01-01

Full Text Available Microcystins (MCs are toxins produced by cyanobacteria (blue-green algae, primarily Microcystis aeruginosa, forming water blooms worldwide. When an organism is exposed to environmental perturbations, alterations in normal behavioral patterns occur. Behavioral repertoire represents the consequence of a diversity of physiological and biochemical alterations. In this study, we assessed behavioral patterns and whole-body cortisol levels of adult zebrafish (Danio rerio exposed to cell culture of the microcystin-producing cyanobacterium M. aeruginosa (MC-LR, strain RST9501. MC-LR exposure (100 μg/L decreased by 63% the distance traveled and increased threefold the immobility time when compared to the control group. Interestingly, no significant alterations in the number of line crossings were found at the same MC-LR concentration and time of exposure. When animals were exposed to 50 and 100 μg/L, MC-LR promoted a significant increase (around 93% in the time spent in the bottom portion of the tank, suggesting an anxiogenic effect. The results also showed that none of the MC-LR concentrations tested promoted significant alterations in absolute turn angle, path efficiency, social behavior, or whole-body cortisol level. These findings indicate that behavior is susceptible to MC-LR exposure and provide evidence for a better understanding of the ecological consequences of toxic algal blooms.

Role of physical activity in the occurrence of falls and fall-related injuries in community-dwelling adults over 50 years old.

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Pereira, Catarina L N; Baptista, Fátima; Infante, Paulo

2014-01-01

This study examined the effect of the type, level and amount of physical activity in falls and fall-related injuries. Participants were 506 community-dwelling adults aged >50 years (390 women: 67.7 ± 6.8 years and 116 men: 69.6 ± 6.6 years). Falls, fall-related injuries (slight and severe), and physical activity (type, level and energy expenditure) were evaluated by questionnaires. Confounders included co-morbidities, fear of falling, environmental hazards and physical fitness. After adjustment for confounders, logistic analysis revealed that the likelihood of falling decreased by 2% for each 100 metabolic expenditure (MET-min/week) of total physical activity and increased by 5% for each 100 MET-min/week of vigorous-intensity physical activity; total physical activity >1125 MET-min/week and vigorous physical activity physical activity level, increased physical activity levels diminished the likelihood of the occurrence of severe fall-related injuries by 76% (moderate) and 58% (high; p active, especially sufficiently active, reduces fall-related injuries by decreasing falls and by safeguarding against severe injuries when falls occur. At least 1125 MET-min/week of total physical activity including >500 MET-min/week of vigorous intensity seems to prevent falls and, therefore, fall-related injuries.

Adults with initial metabolic syndrome have altered muscle deoxygenation during incremental exercise.

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Machado, Alessandro da Costa; Barbosa, Thales Coelho; Kluser Sales, Allan Robson; de Souza, Marcio Nogueira; da Nóbrega, Antonio Claudio Lucas; Silva, Bruno Moreira

2017-02-01

Reduced aerobic power is independently associated with metabolic syndrome (MetS) incidence and prevalence in adults. This study investigated whether muscle deoxygenation (proxy of microvascular O 2 extraction) during incremental exercise is altered in MetS and associated with reduced oxygen consumption ( V˙O 2peak ). Twelve men with initial MetS (no overt diseases and medication-naive; mean ± SD, age 38 ± 7 years) and 12 healthy controls (HCs) (34 ± 7 years) completed an incremental cycling test to exhaustion, in which pulmonary ventilation and gas exchange (metabolic analyzer), as well as vastus lateralis deoxygenation (near infrared spectroscopy), were measured. Subjects with MetS, in contrast to HCs, showed lower V˙O 2peak normalized to total lean mass, similar V˙O 2 response to exercise, and earlier break point (BP) in muscle deoxygenation. Consequently, deoxygenation slope from BP to peak exercise was greater. Furthermore, absolute V˙O 2peak was positively associated with BP in correlations adjusted for total lean mass. MetS, without overt diseases, altered kinetics of muscle deoxygenation during incremental exercise, particularly at high-intensity exercise. Therefore, the balance between utilization and delivery of O 2 within skeletal muscle is impaired early in MetS natural history, which may contribute to the reduction in aerobic power. © 2017 The Obesity Society.

Outcome of decompressive craniectomy (DC) for severe traumatic brain injury (stbi) in adults

International Nuclear Information System (INIS)

Qasmi, S.A.; Ghaffar, A.; Akram, M.

2015-01-01

To evaluate the outcomes of decompressive craniectomy (DC) in adults with severe traumatic brain injury (STBI). Study Design: Observational cross-sectional. Place and Duration of Study: Neurosurgical unit CMH Rawalpindi from July, 2011 to June 2014. Material and Methods: Total of 39 patients who underwent DC for STBI were included in the study. Patients of both sexes and of age range 20 - 48 (32.03 +- 8.01) years were included in the study. The DC was performed within 24 and after 24 hours. Parameters recorded were mortality, neurological outcome / complications like brain herniation, wound dehiscence, cerebrospinal fluid (CSF) leak, contusion expansion, sinking flap syndrome, subdural hygromas and hydrocephalus. Data was analyzed by using SPSS version 17 and descriptive statistics, frequency, rate and percentage was computed for presentation of qualitative outcomes. Results: Favourable neurological outcome was seen in 21 patients (53.85%) where as 6 patients (15.38%) had moderate to severe disability and 3 patients (7.69%) were vegetative respectively. Patients operated within 24 hours and with Glasgow coma scale (GCS) range 6-8 had better outcome. Overall 9 patients (23.08%) did not survive the injury and procedure. Conclusion: As high mortality is associated with STBI, DC is an effective option to lower down the refractory intracranial hypertension with an acceptable surgical outcome. (author)

Emergency department management of smoke inhalation injury in adults [digest].

Science.gov (United States)

Otterness, Karalynn; Ahn, Christine; Nusbaum, Jeffrey; Gupta, Nachi

2018-03-01

Smoke inhalation injury portends increased morbidity and mortality in fire-exposed patients. Upper airway thermal burns, inflammation from lower airway irritants, and systemic effects of carbon monoxide and cyanide can contribute to injury. A standardized diagnostic protocol for inhalation injury is lacking, and management remains mostly supportive. Clinicians should maintain a high index of suspicion for concomitant traumatic injuries. Diagnosis is mostly clinical, aided by bronchoscopy and other supplementary tests. Treatment includes airway and respiratory support, lung protective ventilation, 100% oxygen or hyperbaric oxygen therapy for carbon monoxide poisoning, and hydroxocobalamin for cyanide toxicity. Due to its progressive nature, many patients with smoke inhalation injury warrant close monitoring for development of airway compromise. [Points & Pearls is a digest of Emergency Medicine Practice.].

Brain-Derived Neurotrophic Factor (BDNF) in Traumatic Brain Injury-Related Mortality: Interrelationships Between Genetics and Acute Systemic and Central Nervous System BDNF Profiles.

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Failla, Michelle D; Conley, Yvette P; Wagner, Amy K

2016-01-01

Older adults have higher mortality rates after severe traumatic brain injury (TBI) compared to younger adults. Brain-derived neurotrophic factor (BDNF) signaling is altered in aging and is important to TBI given its role in neuronal survival/plasticity and autonomic function. Following experimental TBI, acute BDNF administration has not been efficacious. Clinically, genetic variation in BDNF (reduced signaling alleles: rs6265, Met-carriers; rs7124442, C-carriers) can be protective against acute mortality. Postacutely, these genotypes carry lower mortality risk in older adults and greater mortality risk among younger adults. Investigate BDNF levels in mortality/outcome following severe TBI in the context of age and genetic risk. Cerebrospinal fluid (CSF) and serum BDNF were assessed prospectively during the first week following severe TBI (n = 203) and in controls (n = 10). Age, BDNF genotype, and BDNF levels were assessed as mortality/outcome predictors. CSF BDNF levels tended to be higher post-TBI (P = .061) versus controls and were associated with time until death (P = .042). In contrast, serum BDNF levels were reduced post-TBI versus controls (P BDNF serum and gene * age interactions were mortality predictors post-TBI in the same multivariate model. CSF and serum BDNF tended to be negatively correlated post-TBI (P = .07). BDNF levels predicted mortality, in addition to gene * age interactions, suggesting levels capture additional mortality risk. Higher CSF BDNF post-TBI may be detrimental due to injury and age-related increases in pro-apoptotic BDNF target receptors. Negative CSF and serum BDNF correlations post-TBI suggest blood-brain barrier transit alterations. Understanding BDNF signaling in neuronal survival, plasticity, and autonomic function may inform treatment. © The Author(s) 2015.

Injuries in mountain biking.

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Gaulrapp, H; Weber, A; Rosemeyer, B

2001-01-01

Despite still growing attraction mountain biking as a matter of sports traumatology still lacks relevant data based on large cross-sectional surveys. To obtain an overview of risk factors, types, and main body sites of injuries occurring in mountain biking we assessed the results of a questionnaire answered by 3873 athletes. A total of 8133 single lesions were reported by 3474 athletes, 36% of whom regularly participated in competitions. The incidence of injuries in mountain biking is comparable to that in other outdoor sports, the majority of injuries being minor. Mountain biking athletes were found to have an overall injury risk rate of 0.6% per year and 1 injury per 1000 h of biking. The main risk factors included slippery road surface, cyclist's poor judgement of the situation, and excessive speed, representing personal factors that could be altered by preventive measures. Of all injuries 14% were due to collision with some part of the bike, especially the pedals and the handlebar. While 75% of the injuries were minor, such as skin wounds and simple contusions, 10% were so severe that hospitalization was required. A breakdown of the injuries according to body site and frequency of occurrence is presented.

Gestational exposure to diethylstilbestrol alters cardiac structure/function, protein expression and DNA methylation in adult male mice progeny

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Haddad, Rami, E-mail: rami.haddad@mail.mcgill.ca [Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 chemin Cote Ste Catherine, Montréal, Québec, Canada H3T 1E2 (Canada); Division of Experimental Medicine, Department of Medicine, McGill University, 850 Sherbrooke Street, Montréal, Québec, Canada H3A 1A2 (Canada); Kasneci, Amanda, E-mail: amanda.kasneci@mail.mcgill.ca [Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 chemin Cote Ste Catherine, Montréal, Québec, Canada H3T 1E2 (Canada); Mepham, Kathryn, E-mail: katherine.mepham@mail.mcgill.ca [Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 chemin Cote Ste Catherine, Montréal, Québec, Canada H3T 1E2 (Canada); Division of Experimental Medicine, Department of Medicine, McGill University, 850 Sherbrooke Street, Montréal, Québec, Canada H3A 1A2 (Canada); Sebag, Igal A., E-mail: igal.sebag@mcgill.ca [Division of Cardiology, Jewish General Hospital, 3755 chemin Cote Ste Catherine, Montréal, Québec, Canada H3T 1E2 (Canada); and others

2013-01-01

Pregnant women, and thus their fetuses, are exposed to many endocrine disruptor compounds (EDCs). Fetal cardiomyocytes express sex hormone receptors making them potentially susceptible to re-programming by estrogenizing EDCs. Diethylstilbestrol (DES) is a proto-typical, non-steroidal estrogen. We hypothesized that changes in adult cardiac structure/function after gestational exposure to the test compound DES would be a proof in principle for the possibility of estrogenizing environmental EDCs to also alter the fetal heart. Vehicle (peanut oil) or DES (0.1, 1.0 and 10.0 μg/kg/da.) was orally delivered to pregnant C57bl/6n dams on gestation days 11.5–14.5. At 3 months, male progeny were left sedentary or were swim trained for 4 weeks. Echocardiography of isoflurane anesthetized mice revealed similar cardiac structure/function in all sedentary mice, but evidence of systolic dysfunction and increased diastolic relaxation after swim training at higher DES doses. The calcium homeostasis proteins, SERCA2a, phospholamban, phospho-serine 16 phospholamban and calsequestrin 2, are important for cardiac contraction and relaxation. Immunoblot analyses of ventricle homogenates showed increased expression of SERCA2a and calsequestrin 2 in DES mice and greater molecular remodeling of these proteins and phospho-serine 16 phospholamban in swim trained DES mice. DES increased cardiac DNA methyltransferase 3a expression and DNA methylation in the CpG island within the calsequestrin 2 promoter in heart. Thus, gestational DES epigenetically altered ventricular DNA, altered cardiac function and expression, and reduced the ability of adult progeny to cardiac remodel when physically challenged. We conclude that gestational exposure to estrogenizing EDCs may impact cardiac structure/function in adult males. -- Highlights: ► Gestational DES changes cardiac SERCA2a and CASQ2 expression. ► Echocardiography identified systolic dysfunction and increased diastolic relaxation. ► DES

Neuroprotective effect corilagin in spinal cord injury rat model by ...

African Journals Online (AJOL)

Background: Neurological functions get altered in a patient suffering from spinal cord injury (SCI). Present study evaluates the neuroprotective effect of corilagin in spinal cord injury rats by inhibiting nuclear factor-kappa B (NF-κB), inflammatory mediators and apoptosis. Materials and method: Spinal cord injury was ...

Acute Kidney Injury in the Elderly

Science.gov (United States)

Abdel-Kader, Khaled; Palevsky, Paul

2009-01-01

Synopsis The aging kidney undergoes a number of important anatomic and physiologic changes that increase the risk of acute kidney injury (formerly acute renal failure) in the elderly. This article reviews these changes and discusses the diagnoses frequently encountered in the elderly patient with acute kidney injury. The incidence, staging, evaluation, management, and prognosis of acute kidney injury are also examined with special focus given to older adults. PMID:19765485

Injury Response of Resected Human Brain Tissue In Vitro

NARCIS (Netherlands)

Verwer, Ronald W. H.; Sluiter, Arja A.; Balesar, Rawien A.; Baaijen, Johannes C.; de Witt Hamer, Philip C.; Speijer, Dave; Li, Yichen; Swaab, Dick F.

2015-01-01

Brain injury affects a significant number of people each year. Organotypic cultures from resected normal neocortical tissue provide unique opportunities to study the cellular and neuropathological consequences of severe injury of adult human brain tissue in vitro. The in vitro injuries caused by

The Inflammatory Continuum of Traumatic Brain Injury and Alzheimer’s Disease

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Kokiko-Cochran, Olga N.; Godbout, Jonathan P.

2018-01-01

The post-injury inflammatory response is a key mediator in long-term recovery from traumatic brain injury (TBI). Moreover, the immune response to TBI, mediated by microglia and macrophages, is influenced by existing brain pathology and by secondary immune challenges. For example, recent evidence shows that the presence of beta-amyloid and phosphorylated tau protein, two hallmark features of AD that increase during normal aging, substantially alter the macrophage response to TBI. Additional data demonstrate that post-injury microglia are “primed” and become hyper-reactive following a subsequent acute immune challenge thereby worsening recovery. These alterations may increase the incidence of neuropsychiatric complications after TBI and may also increase the frequency of neurodegenerative pathology. Therefore, the purpose of this review is to summarize experimental studies examining the relationship between TBI and development of AD-like pathology with an emphasis on the acute and chronic microglial and macrophage response following injury. Furthermore, studies will be highlighted that examine the degree to which beta-amyloid and tau accumulation as well as pre- and post-injury immune stressors influence outcome after TBI. Collectively, the studies described in this review suggest that the brain’s immune response to injury is a key mediator in recovery, and if compromised by previous, coincident, or subsequent immune stressors, post-injury pathology and behavioral recovery will be altered. PMID:29686672

Incidence, aetiology and injury characteristics of traumatic spinal cord injury in Stockholm, Sweden: A prospective, population-based update.

Science.gov (United States)

Joseph, Conran; Andersson, Nina; Bjelak, Sapko; Giesecke, Kajsa; Hultling, Claes; Nilsson Wikmar, Lena; Phillips, Julie; Seiger, Åke; Stenimahitis, Vasilios; Trok, Katarzyna; Åkesson, Elisabet; Wahman, Kerstin

2017-05-16

To update the incidence rate, aetiology and injury characteristics of acutely-injured adults with traumatic spinal cord injury in Stockholm, Sweden, using international standards of reporting. Prospective, (regional) population-based observation. Forty-nine consecutively enrolled individuals. A surveillance system of newly-injured adults with traumatic spinal cord injury was implemented for an 18-month period. The International Spinal Cord Injury Core Data Set was used to collect data on those who survived the first 7 days post-injury. After an 18-month period, 49 incident cases were registered, of whom 45 were included in this study. The crude incidence rate was 19.0 per million, consisting mainly of men (60%), and the mean age of the cohort was 55 years (median 58). Causes of injury were almost exclusively limited to falls and transport-related events, accounting for 58% and 40% of cases, respectively. The incidence has remained stable when compared with the previous study; however, significant differences exist for injury aetiology (p = 0.004) and impairment level (p = 0.01) in that more fall- and transport-related spinal cord injury occurred, and a larger proportion of persons was left with resultant tetraplegia, in the current study, compared with more sport-related injuries and those left with paraplegia in the previous study. The incidence rate appeared to remain stable in Stockholm, Sweden. However, significant changes in injury aetiology and impairment-level post injury were found, compared with the previous study. There remains a need for developing fall-related prevention strategies in rehabilitation settings as well as in population-based programmes.

Biomechanics Associated with Patellofemoral Pain and ACL Injuries in Sports.

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Weiss, Kaitlyn; Whatman, Chris

2015-09-01

Epidemiology' (STROBE) guidelines was used to rate observational research. Fifteen journal articles focusing on ACL injuries and PFPS in sports met the inclusion criteria. These included three associated with both ACL injuries and PFPS across multiple time points. There was limited evidence for an association between ankle biomechanics and knee injury, with only one ACL injury study identifying decreased plantar flexion in association with injury. Only prospective studies can determine biomechanical risk factors associated with ACL injuries and PFPS. Case studies and case-control studies do not allow for the determination of risk factors associated with both ACL injuries and PFPS as there is no certainty regarding the presence of the observed biomechanics prior to the onset of injury. Further, each study design has its own set of limitations. Lastly, the majority of the studies included in this review had adult female participants. By evaluating several different study designs looking at knee injuries during high-risk manoeuvres, we were able to obtain a holistic perspective of biomechanics associated with PFPS and ACL injuries. Looking at different biomechanical research approaches allowed us to assess not only the mechanism of injury, but also to look for commonalities in biomechanics (in particular, altered frontal plane mechanics at the knee and altered sagittal plane mechanics at the knee and hip) between injured and uninjured participants pre-injury, at the time of injury, and following injury, to better understand potential causes of PFPS and ACL injury. Development of injury prevention programmes should focus on correcting these mechanics observed across the three time points during high-risk manoeuvres as this may help decrease the prevalence of ACL injury and PFPS. Programmes focusing not only on neuromuscular training, but also skill-specific training focused on correcting mechanics during these high-risk manoeuvres may be of greatest benefit regarding prevention

Post-dexamethasone Cortisol, Self-inflicted Injury, and Suicidal Ideation among Depressed Adolescent Girls

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Beauchaine, Theodore P.; Crowell, Sheila E.; Hsiao, Ray C.

2014-01-01

Although the dexamethasone suppression test (DST) has limited use as a marker of depression given inadequate sensitivity and specificity, it marks prospective risk for suicide among adults. However, few studies have examined associations between the DST, suicidal ideation, and self-inflicted injury (SII) among adolescents, even though SII is the single best predictor of eventual suicide. We evaluated the DST as a correlate of suicidal ideation and retrospective reports of self-inflicted injury (SII) among adolescent girls, ages 13–17, with histories of depression (n=28) or depression/self-harm (n=29). Lower post-DST cortisol was associated with suicidal ideation and SII, over-and-above parent-reports and combined parent-/self-reports of internalizing and externalizing behavior. These findings are consistent with recent acquired capacity models of stress-related psychopathology in which hypothalamic-pituitary adrenal (HPA) axis function is altered through epigenetic/allostatic mechanisms among vulnerable individuals who incur adversity early in life. PMID:25208812

The nature of self-esteem and its relationship to anxiety and depression in adult acquired brain injury

OpenAIRE

Longworth, Catherine; Deakins, Joseph; Rose, David; Gracey, Fergus

2016-01-01

Acquired brain injury (ABI) has a negative impact on self-esteem, which is in turn associated with mood disorders, maladaptive coping and reduced community participation. The aim of the current research was to explore self-esteem as a multi-dimensional construct and identify which factors are associated with symptoms of anxiety or depression. Eighty adults with ABI aged 17–56 years completed the Robson Self-Esteem Scale (RSES), of whom 65 also completed the Hospital Anxiety and Depression Sca...

Social connectedness, stressful life events, and self-injurious thoughts and behaviors among young adults.

Science.gov (United States)

Macrynikola, Natalia; Miranda, Regina; Soffer, Ariella

2018-01-01

Preventing self-injurious thoughts and behaviors (SITBs) is particularly challenging on commuter campuses, given lower social cohesion and higher levels of stress than among traditional college populations. The present study examined the relationship between stressful life events (SLEs) and risk for different forms of SITBs, along with the potential buffering role of social connectedness, in a diverse sample of young adults from a commuter college. Participants were 1712 (81% female; 61% racial/ethnic minority; 20% sexual minority) undergraduate and graduate students from a public commuter college in New York City. Participants completed an anonymous survey that inquired about lifetime and recent (past 12months) history of suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI), along with social connectedness and lifetime history of SLEs. Lower levels of social connectedness and exposure to a higher number of SLEs were associated with engaging in SITBs in the past year, particularly both suicide attempts and non-suicidal self-injury. However, social connectedness did not buffer against the impact of SLEs on SITBs. Data are cross-sectional, limiting conclusions about directionality, and females were overrepresented. Identifying ways to increase social connectedness on diverse commuter campuses may help decrease risk of SITBs. However, it may not buffer against the impact of SLEs on risk of SITBs. Future studies should examine contextual variables (e.g., type and timing of social support) that may play a role in protecting against SITBs, particularly for those with a history of adversity. Copyright © 2017 Elsevier Inc. All rights reserved.

Ocular firework injuries at New Year's eve.

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Sacu, Stefan; Ségur-Eltz, Nikolaus; Stenng, Karin; Zehetmayer, Martin

2002-01-01

To prospectively study mechanisms and injury characteristics of ocular firework burns. A prospective analysis of all patients with firework injuries attending the Department of Ophthalmology, University of Vienna, between 1994 and 2001. We looked for classes of fireworks and mechanisms of injuries. The number of diagnoses was established and their severity classified. During this period (8 years) we identified 116 eyes of 102 patients. 67/102 (66%) of all injuries were caused by class II and III fireworks. Patients ranged between 4 and 83 years. Ocular injuries occurred more frequently in males (69, 68%) and affected the right eye in 53 patients (52.5%). Ocular firework injuries to minors (under the age of 18 years) occurred in 48 (49%). The most common types of injury were skin and corneal erosions and abrasions (32/116, 28%). 11/116 eyes (10%) had severe injuries. 8 of 11 severe injuries (72%) occurred in minors (<18 years). 2 patients (1.7%) developed permanent blindness. In 32/116 patients (28%), the ocular trauma resulted in visual impairment, mainly due to corneal scars or retinal pathologies. In all patients, the severity index was 1.4 +/- 0.8. In minors the severity index was 1.6 +/- 1.0, in adults 1.2 +/- 0.5 (p = 0.013). Injuries in minors were significantly more severe than those in adults. Possible preventive measures include legislation, education of minors and eye protection. Copyright 2002 S. Karger AG, Basel

Short-term Risk of Serious Fall Injuries in Older Adults Initiating and Intensifying Treatment with Antihypertensive Medication

Science.gov (United States)

Shimbo, Daichi; Bowling, C. Barrett; Levitan, Emily B.; Deng, Luqin; Sim, John J.; Huang, Lei; Reynolds, Kristi; Muntner, Paul

2016-01-01

Background Antihypertensive medication use has been associated with an increased risk of falls in some but not all studies. Few data are available on the short-term risk of falls following antihypertensive medication initiation and intensification. Methods and Results We examined the association between initiating and intensifying antihypertensive medication and serious fall injuries in a case-crossover study of 90,127 Medicare beneficiaries who were ≥65 years old and had a serious fall injury between July 1, 2007 and December 31, 2012, based on emergency department and inpatient claims. Antihypertensive medication initiation was defined by a prescription fill with no fills in the prior year. Intensification was defined by the addition of a new antihypertensive class, and, separately, titration by the addition of a new class or increase in dosage of a current class. Exposures were ascertained for the 15 days before the fall (case period) and six 15-day earlier periods (control periods). Overall, 272, 1508, and 3113 Medicare beneficiaries initiated, added a new class of antihypertensive medication or titrated therapy, respectively, within 15 days of their serious fall injury. The odds for a serious fall injury was increased during the 15 days following antihypertensive medication initiation [odds ratio, OR, 1.36 (95% CI 1.19, 1.55)], adding a new class [OR 1.16 (95% CI 1.10, 1.23)], and titration [OR 1.13 (95% CI 1.08, 1.18)]. These associations were attenuated beyond 15 days. Conclusions Antihypertensive medication initiation and intensification was associated with a short-term, but not long-term, increased risk of serious fall injuries among older adults. PMID:27166208

Alterations in the Genital Microbiota in Women With Spinal Cord Injury.

Science.gov (United States)

Pires, Cristhiane V G; Linhares, Iara M; Serzedello, Felipe; Fukazawa, Eiko I; Baracat, Edmund C; Witkin, Steven S

2016-02-01

To evaluate the vaginal and cervical microbiota in women with spinal cord injury compared with mobile women. Fifty-two women with spinal cord injury (study group) and 57 mobile women (control group) were evaluated in a case-control study. All answered a structured questionnaire and were submitted to the following microbiological tests: microscopic examination of vaginal secretions for Trichomonas vaginalis and yeasts, Nugent score by Gram stain, bacterial culture, yeast culture, and endocervical sampling for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma species. Candida species detected by direct microscopic examination of vaginal fluid was more common in women with spinal cord injuries than in control women: 17.3% (9/52) compared with 3.5% (2/57), respectively (P=.017). However, the frequency of yeast-positive cultures was similar in both groups (21.2% [10/52] compared with 15.8% [14/57]). Women with spinal cord injury were more likely to have positive vaginal cultures for Escherichia coli (15.4% [8/52] compared with 0% [0/57], P=.002) and Corynebacterium species (25.0% [13/52] compared with 8.8% [5/57], P=.037) and less likely for Lactobacillus species (63.5% [33/52] compared with 94.7% [54/57], Pvaginal microbiota away from a Lactobacillus species-dominated flora and a higher concentration of vaginal Candida species than do mobile women.

Preventing Older Adult Falls and TBI

Centers for Disease Control (CDC) Podcasts

2008-03-05

This podcast provides tips on how older adults can prevent falls and related injuries, such as traumatic brain injuries (TBI).  Created: 3/5/2008 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 3/7/2008.

A systematic review of the efficacy of self-management programs for increasing physical activity in community-dwelling adults with acquired brain injury (ABI).

Science.gov (United States)

Jones, Taryn M; Dean, Catherine M; Hush, Julia M; Dear, Blake F; Titov, Nickolai

2015-04-19

Individuals living with acquired brain injury, typically caused by stroke or trauma, are far less likely to achieve recommended levels of physical activity for optimal health and well-being. With a growing number of people living with chronic disease and disability globally, self-management programs are seen as integral to the management of these conditions and the prevention of secondary health conditions. However, to date, there has been no systematic review of the literature examining the efficacy of self-management programs specifically on physical activity in individuals with acquired brain injury, whether delivered face-to-face or remotely. Therefore, the purpose of this review is to evaluate the efficacy of self-management programs in increasing physical activity levels in adults living in the community following acquired brain injury. The efficacy of remote versus face-to-face delivery was also examined. A systematic review of the literature was conducted. Electronic databases were searched. Two independent reviewers screened all studies for eligibility, assessed risk of bias, and extracted relevant data. Five studies met the inclusion criteria for this review. Studies were widely heterogeneous with respect to program content and delivery characteristics and outcomes, although all programs utilized behavioral change principles. Four of the five studies examined interventions in which physical activity was a component of a multifaceted intervention, where the depth to which physical activity specific content was covered, and the extent to which skills were taught and practiced, could not be clearly established. Three studies showed favorable physical activity outcomes following self-management interventions for stroke; however, risk of bias was high, and overall efficacy remains unclear. Although not used in isolation from face-to-face delivery, remote delivery via telephone was the predominant form of delivery in two studies with support for its inclusion

Differential gene expression in the EphA4 knockout spinal cord and analysis of the inflammatory response following spinal cord injury.

Directory of Open Access Journals (Sweden)

Kathryn M Munro

Full Text Available Mice lacking the axon guidance molecule EphA4 have been shown to exhibit extensive axonal regeneration and functional recovery following spinal cord injury. To assess mechanisms by which EphA4 may modify the response to neural injury a microarray was performed on spinal cord tissue from mice with spinal cord injury and sham injured controls. RNA was purified from spinal cords of adult EphA4 knockout and wild-type mice four days following lumbar spinal cord hemisection or laminectomy only and was hybridised to Affymetrix All-Exon Array 1.0 GeneChips™. While subsequent analyses indicated that several pathways were altered in EphA4 knockout mice, of particular interest was the attenuated expression of a number of inflammatory genes, including Arginase 1, expression of which was lower in injured EphA4 knockout compared to wild-type mice. Immunohistological analyses of different cellular components of the immune response were then performed in injured EphA4 knockout and wildtype spinal cords. While numbers of infiltrating CD3+ T cells were low in the hemisection model, a robust CD11b+ macrophage/microglial response was observed post-injury. There was no difference in the overall number or spread of macrophages/activated microglia in injured EphA4 knockout compared to wild-type spinal cords at 2, 4 or 14 days post-injury, however a lower proportion of Arginase-1 immunoreactive macrophages/activated microglia was observed in EphA4 knockout spinal cords at 4 days post-injury. Subtle alterations in the neuroinflammatory response in injured EphA4 knockout spinal cords may contribute to the regeneration and recovery observed in these mice following injury.

Alterations in cardiac autonomic control in spinal cord injury

DEFF Research Database (Denmark)

Biering-Sørensen, Fin; Biering-Sørensen, Tor; Liu, Nan

2018-01-01

parasympathetic cardiac control. Decreases in sympathetic activity result in heart rate and the arterial blood pressure changes, and may cause arrhythmias, in particular bradycardia, with the risk of cardiac arrest in those with cervical or high thoracic injuries. The objective of this review is to give an update...

Effects of age and acute muscle fatigue on reactive postural control in healthy adults.

Science.gov (United States)

Papa, Evan V; Foreman, K Bo; Dibble, Leland E

2015-12-01

Falls can cause moderate to severe injuries such as hip fractures and head trauma in older adults. While declines in muscle strength and sensory function contribute to increased falls in older adults, skeletal muscle fatigue is often overlooked as an additional contributor to fall risk. The purpose of this investigation was to examine the effects of acute lower extremity muscle fatigue and age on reactive postural control in healthy adults. A sample of 16 individuals participated in this study (8 healthy older adults and 8 healthy young persons). Whole body kinematic and kinetic data were collected during anterior and posterior reproducible fall tests before (T0) and immediately after (T1) eccentric muscle fatiguing exercise, as well as after 15-min (T15) and 30-min (T30) of rest. Lower extremity joint kinematics of the stepping limb during the support (landing) phase of the anterior fall were significantly altered by the presence of acute muscle fatigue. Step velocity was significantly decreased during the anterior falls. Statistically significant main effects of age were found for step length in both fall directions. Effect sizes for all outcomes were small. No statistically significant interaction effects were found. Muscle fatigue has a measurable effect on lower extremity joint kinematics during simulated falls. These alterations appear to resolve within 15 min of recovery. The above deficits, coupled with a reduced step length, may help explain the increased fall risk in older adults. Copyright © 2015 Elsevier Ltd. All rights reserved.

EFFECTS OF AGE AND ACUTE MUSCLE FATIGUE ON REACTIVE POSTURAL CONTROL IN HEALTHY ADULTS

Science.gov (United States)

Papa, Evan V.; Foreman, K. Bo; Dibble, Lee E.

2015-01-01

BACKGROUND Falls can cause moderate to severe injuries such as hip fractures and head trauma in older adults. While declines in muscle strength and sensory function contribute to increased falls in older adults, skeletal muscle fatigue is often overlooked as an additional contributor to fall risk. The purpose of this investigation was to examine the effects of acute lower extremity muscle fatigue and age on reactive postural control in healthy adults. METHODS A sample of 16 individuals participated in this study (8 healthy older adults and 8 healthy young persons). Whole body kinematic and kinetic data were collected during anterior and posterior reproducible fall tests before (T0) and immediately after (T1) eccentric muscle fatiguing exercise, as well as after 15-minutes (T15) and 30-minutes (T30) of rest. FINDINGS Lower extremity joint kinematics of the stepping limb during the support (landing) phase of the anterior fall were significantly altered by the presence of acute muscle fatigue. Step velocity was significantly decreased during the anterior falls. Statistically significant main effects of age were found for step length in both fall directions. Effect sizes for all outcomes were small. No statistically significant interaction effects were found. INTERPRETATION Muscle fatigue has a measurable effect on lower extremity joint kinematics during simulated falls. These alterations appear to resolve within 15 minutes of recovery. The above deficits, coupled with a reduced step length, may help explain the increased fall risk in older adults. PMID:26351001

Individualization of a Manualized Pressure Ulcer Prevention Program: Targeting Risky Life Circumstances Through a Community-Based Intervention for People with Spinal Cord Injury

Science.gov (United States)

Vaishampayan, Ashwini; Clark, Florence; Carlson, Mike; Blanche, Erna Imperatore

2012-01-01

Purpose To sensitize practitioners working with individuals with spinal cord injury to the complex life circumstances that are implicated in the development of pressure ulcers, and to document the ways that interventions can be adapted to target individual needs. Methods Content analysis of weekly fidelity/ quality control meetings that were undertaken as part of a lifestyle intervention for pressure ulcer prevention in community-dwelling adults with spinal cord injury. Results Four types of lifestyle-relevant challenges to ulcer prevention were identified: risk-elevating life circumstances, communication difficulties, equipment problems, and individual personality issues. Intervention flexibility was achieved by changing the order of treatment modules, altering the intervention content or delivery approach, or going beyond the stipulated content. Conclusion Attention to recurrent types of individual needs, along with explicit strategies for tailoring manualized interventions, has potential to enhance pressure ulcer prevention efforts for adults with spinal cord injury. Target audience This continuing education article is intended for practitioners interested in learning about a comprehensive, context-sensitive, community-based pressure ulcer prevention program for people with spinal cord injury. Objectives After reading this article, the reader should be able to: Describe some of the contextual factors that increase pressure ulcer risk in people with spinal cord injury living in the community.Distinguish between tailored and individualized intervention approaches.Identify the issues that must be taken into account to design context-sensitive, community-based pressure ulcer prevention programs for people with spinal cord injury.Describe approaches that can be used to individualize manualized interventions. PMID:21586911

Nosographic profile of soccer injuries according to the age group

Directory of Open Access Journals (Sweden)

Karoline Pegoraro Silveira

2013-05-01

Full Text Available Soccer is one of the world’s most popular team sports and corresponds to one ofthe leading causes of sports injuries (SI. This study aimed to analyze the nosographic profile of the sports injuries common to soccer, according to theage group: childhood, youth and adulthood. We selected 209 soccer players, from amateurs to professional players of a sports club from Campo Grande/MS.Participants were divided into four age groups: G1 (childhood, G2 (juvenile,G3 (teenagers and G4 (adults. To obtain information about the injuries, we used a morbidity survey. Generally, 74 athletes reported sports injuries, with register of 92 SI. Concerning injury types, muscle injuries totalized 43.47%, followed by joint damage (34.78% and tendon injury (14.13%, respectively (p 0.05. A higher proportion of registers involved medical-therapeutic approach and asymptomatic return. The evidence shows a higher rate of muscle and joint injuries by contact in the lower limbs in soccer practitioners, regardless of age group. The practice of training seemsto be the main cause of injuries in adolescents and adults.

Injuries in Aleppo, Syria; first population-based estimates and characterization of predominant types

Directory of Open Access Journals (Sweden)

Maziak Wasim

2006-03-01

Full Text Available Abstract Background Despite the growing burden of injuries worldwide, Syria and many other Arab countries still lack population-based estimates of different types of injuries. This study aims toprovide first population-based estimates of major injuries in Syria and characterize groups at increased risk. Methods An interviewer-administered population-based survey of adults 18–65 years residing in Aleppo, Syria was conducted in 2004. The study sample involved 2038 household representatives in Aleppo (45.2% men, mean age 35.3 ± 12.1, response rate 86%. We inquired about participants self-reported injuries in the past year that required medical attention as well as injuries among their household members. When reported, injuries were further assessed according to type, place, and outcome. Results Overall, there was 153 self-reported injuries in the past year (77.3 per 1000 adult respondents, 93.1 per 1000 in men and 64.4 per 1000 in women, p = 0.02. Other than gender, injuries differed by age (the older age group being least affected, and place of occurrence, as men were more likely to sustain traffic injuries and be injured outside the home. Injuries were reported among 236 household members (21.0 per 1000, and were slightly more frequent in children than adults (22.0 per 1000 for children, and 19.7 per 1000 for adults, p = 0.2. Traffic injuries, falls, and poisoning (food were by far the most common types of injury experienced by participants as well as their household members. Falls and traffic injuries seem to have caused most morbidity for the injured, while burns, although not frequently reported, were associated with an unfavorable outcome in the majority of cases. Conclusion This information provides baseline information about the burden of different injuries in Syria, and the sociodemographic factors related to them.

Trampoline injuries.

Science.gov (United States)

Nysted, M; Drogset, J O

2006-12-01

To describe the mechanism, location and types of injury for all patients treated for trampoline-associated injuries at St Olav's University Hospital, Trondheim, Norway, from March 2001to October 2004. Patients were identified from a National Injury Surveillance System. All patients were asked to complete a standard questionnaire at their first visit at the hospital. Most data were recorded prospectively, but data on the mechanism of injury, the number of participants on the trampoline at the time of injury, adult supervision and whether the activity occurred at school or in another organised setting were collected retrospectively. A total of 556 patients, 56% male and 44% female, were included. The mean age of patients was 11 (range 1-62) years. 77% of the injuries occurred on the body of the trampoline, including falls on to the mat, collisions with another jumper, falls on to the frame or the springs, and performing a somersault, whereas 22% of the people fell off the trampoline. In 74% of the cases, more than two people were on the trampoline, with as many as nine trampolinists noted at the time of injury. For children Trampolining can cause serious injuries, especially in the neck and elbow areas of young children. The use of a trampoline is a high-risk activity. However, a ban is not supported. The importance of having safety guidelines for the use of trampolines is emphasised.

Trampoline-related injuries to children.

Science.gov (United States)

Smith, G A; Shields, B J

1998-07-01

To describe the epidemiological features of trampoline-related injuries among children treated in an urban pediatric emergency department. A descriptive study of a consecutive series of patients. The emergency department of a large, urban, academic children's hospital. Children treated for trampoline-related injuries from May 1, 1995, through April 30, 1997. Two hundred fourteen children were treated for trampoline-related injuries during the study period, representing, on average, 1 child treated approximately every 3 days. Children ranged in age from 1 to 16 years (mean [SD], 9.4 [3.6] years). The area of the body most commonly injured was a lower extremity (36.0%), followed by an upper extremity (31.8%), the head (14.5%), the trunk (9.8%), and the neck (7.9%). The most common type of injury was a soft tissue injury (51.9%), followed by fracture (34.6%) and laceration (11.7%). Several patterns of trampoline-related injury were identified. Extremity fractures were more common in the upper extremities (P=.006; relative risk [RR]=1.64; 95% confidence interval [CI], 1.16-2.31); however, soft tissue injuries were more common in the lower extremities (P=.006; RR=1.66; 95% CI, 1.16-2.38). Lacerations were associated with injury to the head region (Ptrampoline was located in the backyard in 96% (119/124) of cases. Adult supervision was present at the time of injury for 55.6% (65/117) of children, including 73.3% (22/30) of children younger than 6 years. Parents reported that they had been aware of the potential dangers of trampolines before the injury event (73% [81/111]), that their child had previously attempted a flip on a trampoline (56.9% [66/116]), that this was not the child's first injury on a trampoline (10% [12/120]), and that their child continued to use a trampoline after the current injury event (54.8% [63/115]). Trampoline-related injuries to children treated in the emergency department are almost exclusively associated with the use of backyard trampolines

Plasticity Induced by Intermittent Theta Burst Stimulation in Bilateral Motor Cortices Is Not Altered in Older Adults

Directory of Open Access Journals (Sweden)

Daina S. E. Dickins

2015-01-01

Full Text Available Numerous studies have reported that plasticity induced in the motor cortex by transcranial magnetic stimulation (TMS is attenuated in older adults. Those investigations, however, have focused solely on the stimulated hemisphere. Compared to young adults, older adults exhibit more widespread activity across bilateral motor cortices during the performance of unilateral motor tasks, suggesting that the manifestation of plasticity might also be altered. To address this question, twenty young (65 years underwent intermittent theta burst stimulation (iTBS whilst attending to the hand targeted by the plasticity-inducing procedure. The amplitude of motor evoked potentials (MEPs elicited by single pulse TMS was used to quantify cortical excitability before and after iTBS. Individual responses to iTBS were highly variable, with half the participants showing an unexpected decrease in cortical excitability. Contrary to predictions, however, there were no age-related differences in the magnitude or manifestation of plasticity across bilateral motor cortices. The findings suggest that advancing age does not influence the capacity for, or manifestation of, plasticity induced by iTBS.

Plasticity Induced by Intermittent Theta Burst Stimulation in Bilateral Motor Cortices Is Not Altered in Older Adults

Science.gov (United States)

Dickins, Daina S. E.; Sale, Martin V.

2015-01-01

Numerous studies have reported that plasticity induced in the motor cortex by transcranial magnetic stimulation (TMS) is attenuated in older adults. Those investigations, however, have focused solely on the stimulated hemisphere. Compared to young adults, older adults exhibit more widespread activity across bilateral motor cortices during the performance of unilateral motor tasks, suggesting that the manifestation of plasticity might also be altered. To address this question, twenty young (65 years) underwent intermittent theta burst stimulation (iTBS) whilst attending to the hand targeted by the plasticity-inducing procedure. The amplitude of motor evoked potentials (MEPs) elicited by single pulse TMS was used to quantify cortical excitability before and after iTBS. Individual responses to iTBS were highly variable, with half the participants showing an unexpected decrease in cortical excitability. Contrary to predictions, however, there were no age-related differences in the magnitude or manifestation of plasticity across bilateral motor cortices. The findings suggest that advancing age does not influence the capacity for, or manifestation of, plasticity induced by iTBS. PMID:26064691

Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq

National Research Council Canada - National Science Library

Hoge, Charles W; McGurk, Dennis; Thomas, Jeffrey L; Cox, Anthony L; Engel, Charles C; Castro, Carl A

2008-01-01

.... Validated clinical instruments were used to compare soldiers reporting mild traumatic brain injury, defined as an injury with loss of consciousness or altered mental status (e.g., dazed or confused...

Clinical Findings in Patients with Splenic Injuries: Are Injuries to the Left Lower Chest Important?

Directory of Open Access Journals (Sweden)

Schneir, Aaron

2001-07-01

Full Text Available The purpose of this study was to describe the clinical findings in patients with splenic injury and to determine if isolated left lower chest injury may be the single clinical indicator of splenic injury. The medical records of all adult blunt trauma patients with splenic injury over a 14 month period were reviewed. Significant left lower chest injury was considered present if the patient had left sided pleuritic chest pain with tenderness to ribs 7-12 or if these ribs were visualized as fractured on any imaging study. Patients were considered to have clinical findings suggestive of splenic injury if they had pre-hospital or emergency department hypotension, abdominal pain or tenderness, a Glasgow coma scale < 15, or gross hematuria. Ninety patients had splenic injury. Thirty-nine (43%. 95% CI 33, 54% patients had significant left lower chest injury. In five (6%. 95% CI 2, 12% patients, injury to this portion of the chest was the single indicator of splenic injury. Nearly half the patients with splenic injury will have significant injury to the left lower chest and this finding may be the only indicator of splenic injury.

The relational neurobehavioral approach: can a non-aversive program manage adults with brain injury-related aggression without seclusion/restraint?

Science.gov (United States)

Kalapatapu, Raj K; Giles, Gordon M

2017-11-01

The Relational Neurobehavioral Approach (RNA) is a set of non-aversive intervention methods to manage individuals with brain injury-related aggression. New data on interventions used in the RNA and on how the RNA interventions can be used with patients with acquired brain injury (ABI) who have differing levels of functional impairment are provided in this paper. The study was conducted over a 6-week period in a secure 65-bed program for individuals with ABI that is housed in two units of a skilled nursing facility (SNF). Implementation of the RNA was compared between two units that housed patients with differing levels of functional impairment (n = 65 adults). Since this was a hierarchical clustered dataset, Generalized Estimating Equations regression was used in the analyses. RNA interventions used to manage the 495 aggressive incidents included the following: Aggression ignored, Closer observation, Talking to patient, Reassurance, Physical distraction, Isolation without seclusion, Immediate medication by mouth, Holding patient. Different interventions were implemented differentially by staff based on level of functional impairment and without use of seclusion or mechanical restraint. The RNA can be used to non-aversively manage aggression in patients with brain injury and with differing levels of functional impairment. Programs adopting the RNA can potentially manage brain injury-related aggression without seclusion or mechanical restraint. Implications for Rehabilitation The Relational Neurobehavioral Approach (RNA) is a set of non-aversive intervention methods to manage individuals with brain injury-related aggression. RNA methods can be used to manage aggression in patients with brain injury who have differing levels of functional impairment. Successful implementation of the RNA may allow for the management of brain injury-related aggression without seclusion or mechanical restraint.

Kidney Dysfunction in Adult Offspring Exposed In Utero to Type 1 Diabetes Is Associated with Alterations in Genome-Wide DNA Methylation.

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Jean-François Gautier

Full Text Available Fetal exposure to hyperglycemia impacts negatively kidney development and function.Our objective was to determine whether fetal exposure to moderate hyperglycemia is associated with epigenetic alterations in DNA methylation in peripheral blood cells and whether those alterations are related to impaired kidney function in adult offspring.Twenty nine adult, non-diabetic offspring of mothers with type 1 diabetes (T1D (case group were matched with 28 offspring of T1D fathers (control group for the study of their leukocyte genome-wide DNA methylation profile (27,578 CpG sites, Human Methylation 27 BeadChip, Illumina Infinium. In a subset of 19 cases and 18 controls, we assessed renal vascular development by measuring Glomerular Filtration Rate (GFR and Effective Renal Plasma Flow (ERPF at baseline and during vasodilatation produced by amino acid infusion.Globally, DNA was under-methylated in cases vs. controls. Among the 87 CpG sites differently methylated, 74 sites were less methylated and 13 sites more methylated in cases vs. controls. None of these CpG sites were located on a gene known to be directly involved in kidney development and/or function. However, the gene encoding DNA methyltransferase 1 (DNMT1--a key enzyme involved in gene expression during early development--was under-methylated in cases. The average methylation of the 74 under-methylated sites differently correlated with GFR in cases and controls.Alterations in methylation profile imprinted by the hyperglycemic milieu of T1D mothers during fetal development may impact kidney function in adult offspring. The involved pathways seem to be a nonspecific imprinting process rather than specific to kidney development or function.

Intersex and liver alterations induced by long-term sublethal exposure to 17α-ethinylestradiol in adult male Cnesterodon decemmaculatus (Pisces: Poeciliidae).

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Young, Brian Jonathan; López, Gabriela Carina; Cristos, Diego Sebastián; Crespo, Diana Cristina; Somoza, Gustavo Manuel; Carriquiriborde, Pedro

2017-07-01

The aim of the present study was to assess the responses of the gonopodium morphology and the gonadal and liver histology of adult male Cnesterodon decemmaculatus to sublethal long-term exposure concentrations of 17α-ethinylestradiol (EE2). Two experiments were conducted exposing the fish to waterborne concentrations of EE2 ranging from 20 ng/L to 200 ng/L for 8 wk, 12 wk, and 16 wk. Intersex gonads were observed after 8 wk and 16 wk in fish exposed to 200 ng EE2/L and 100 ng EE2/L, respectively. Oocytes' development from testis germ cells and replacement of the efferent duct periodic acid-Schiff-positive secretion surrounding spermatozeugmata by parenchymal tissue and duct structure alterations were the major observed changes in the gonads. In contrast, no response was observed in the gonopodium morphology. Liver histology was also altered, showing increasing steatosis, single-cell necrosis to generalized necrosis, and disruption of acinar organization from 100 ng EE2/L to 200 ng EE2/L. In summary, the present results showed that although EE2 was not able to alter the morphology of a developed gonopodium, it was capable of inducing development of testicular oocytes in adult male C. decemmaculatus at environmentally relevant concentrations. Thus, externally normal but intersex C. decemmaculatus males would be expected in the wastewater-receiving streams that the species inhabits. According to the literature, the present study would be the first indicating estrogen-induced intersex in adult male poeciliid. Environ Toxicol Chem 2017;36:1738-1745. © 2016 SETAC. © 2016 SETAC.

Review of adult head injury admissions into the intensive care unit of ...

African Journals Online (AJOL)

The most common mode of injury was road traffic accident. All the patients admitted to ICU had either moderate or severe head injury, with 73.7% having severe head injury. About 26.3% of the patients had associated cervical spine injuries and 50% had various musculoskeletal and soft tissue injuries. Cranial computed ...

Analysis of spatiotemporal metabolomic dynamics for sensitively monitoring biological alterations in cisplatin-induced acute kidney injury.

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Irie, Miho; Hayakawa, Eisuke; Fujimura, Yoshinori; Honda, Youhei; Setoyama, Daiki; Wariishi, Hiroyuki; Hyodo, Fuminori; Miura, Daisuke

2018-01-29

Clinical application of the major anticancer drug, cisplatin, is limited by severe side effects, especially acute kidney injury (AKI) caused by nephrotoxicity. The detailed metabolic mechanism is still largely unknown. Here, we used an integrated technique combining mass spectrometry imaging (MSI) and liquid chromatography-mass spectrometry (LC-MS) to visualize the diverse spatiotemporal metabolic dynamics in the mouse kidney after cisplatin dosing. Biological responses to cisplatin was more sensitively detected within 24 h as a metabolic alteration, which is much earlier than possible with the conventional clinical chemistry method of blood urea nitrogen (BUN) measurement. Region-specific changes (e.g., medulla and cortex) in metabolites related to DNA damage and energy generation were observed over the 72-h exposure period. Therefore, this metabolomics approach may become a novel strategy for elucidating early renal responses to cisplatin, prior to the detection of kidney damage evaluated by conventional method. Copyright © 2018. Published by Elsevier Inc.

Evoked electromyography to rocuronium in orbicularis oris and gastrocnemius in facial nerve injury in rabbits.

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Xing, Yian; Chen, Lianhua; Li, Shitong

2013-11-01

Muscles innervated by the facial nerve show different sensitivities to muscle relaxants than muscles innervated by somatic nerves, especially in the presence of facial nerve injury. We compared the evoked electromyography (EEMG) response of orbicularis oris and gastrocnemius in with and without a non-depolarizing muscle relaxant in a rabbit model of graded facial nerve injury. Differences in EEMG response and inhibition by rocuronium were measured in the orbicularis oris and gastrocnemius muscles 7 to 42 d after different levels of facial nerve crush injuries in adult rabbits. Baseline EEMG of orbicularis oris was significantly smaller than those of the gastrocnemius. Gastrocnemius was more sensitive to rocuronium than the facial muscles (P rocuronium was negatively correlated with the magnitude of facial nerve injury but the sensitivity to rocuronium was not. No significant difference was found in the onset time and the recovery time of rocuronium among gastrocnemius and normal or damaged facial muscles. Muscles innervated by somatic nerves are more sensitive to rocuronium than those innervated by the facial nerve, but while facial nerve injury reduced EEMG responses, the sensitivity to rocuronium is not altered. Partial neuromuscular blockade may be a suitable technique for conducting anesthesia and surgery safely when EEMG monitoring is needed to preserve and protect the facial nerve. Additional caution should be used if there is a risk of preexisting facial nerve injury. Copyright © 2013 Elsevier Inc. All rights reserved.

Self-Injurious Behavior: An Animal Model of an Autism Endophenotype

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2012-01-01

alterations in specific DARPP-32-mediated signaling mechanisms. 15. SUBJECT TERMS Autism , self-injurious behavior, neuroscience, dopamine , DARPP-32...Injurious Behavior: An Animal Model of an Autism Endophenotype Darragh Devine University of Florida Gainesville, FL 32611 Autism , self...injurious behavior, neuroscience, dopamine , DARPP-32, stress, anxiety Abstract on next page. 75 dpdevine@ufl.edu REPORT DOCUMENTATION PAGE Form Approved

Firework injuries presenting to a national burn's unit.

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Jones, D; Lee, W; Rea, S; Donnell, M O; Eadie, P A

2004-09-01

The sale to the general public of fireworks is illegal in Ireland. However, many fireworks are readily available on the black market from illegal traders. The number of firework injuries presenting to our unit during the three week run-up to Hallowe'en October 2001 was recorded. In addition, each patient was contacted to determine how the fireworks were obtained, the average amount of money spent, and the level of adult supervision present at the time of injury. A total of 19 patients presented, 18 from the local catchment area, with a mean age of 16 yrs (range 5-46 yrs). Thirteen patients required admission. Sixteen patients sustained hand injuries including burns, and three sustained burns to other body areas. The amount of money spent varied between adults and children, the average amount among the paediatric group was Euro 2-4, but Euro 45 in the adult group. None were willing to identify the local source of their fireworks, but most fireworks originated in Northern Ireland. This small review highlights an ongoing problem in Ireland; fireworks are illegal, yet they are easily and cheaply available without quality or safety controls. Our public awareness campaign has failed to reach its target audience, and the illegal traders who sell these often inferior products are seldom charged. Children and adults will continue to sustain serious injuries as a result.

Humor-A Rehabilitative Tool in the Post-Intensive Care of Young Adults With Acquired Brain Injury.

Science.gov (United States)

O'Reilly, Kate

The aim of the study was to describe how paid carers use humor in providing compassionate post-intensive rehabilitation care to young adults with acquired brain injury (ABI) who are unable to perform or direct their own care. This is a qualitative study underpinned by symbolic interactionism. Paid carers in a residential aged care facility were interviewed. Interview data were analyzed using grounded theory methods of coding, comparative analysis, memoing, and theoretical sampling. With young adult's assent, paid carers appropriately used humor, at times even crude humor, as a rehabilitative tool to activate and elicit responses from young people with ABI who could not perform or direct their own care. The use of humor while caring for this population demonstrated that compassion still exists within nursing; however, it may not always be reverent. Humor may be an effective way to provide compassionate care and can be used as a rehabilitative tool to elicit responses from young people with ABI who have no means of verbal communication.

A cross-sectional examination of non-suicidal self-injury, disordered eating, impulsivity, and compulsivity in a sample of adult women.

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Black, Emma B; Mildred, Helen

2014-12-01

Non-suicidal self-injury has been classed as having both impulsive and compulsive characteristics (Simeon & Favazza, 2001). These constructs have been related to disordered eating behaviors such as vomiting (Favaro & Santonastaso, 1998). Utilizing an international sample of adult females, this paper further explored this model, aiming to identify whether all types of disordered eating could be classified as impulsive or compulsive, and whether the impulsive and compulsive groupings reflect underlying trait impulsivity and compulsivity. The hypothesized impulsive and compulsive dimensions did not emerge from the data. Notably however, all self-injurious and disordered eating behaviors were linked to Urgency (an impulsivity facet) to varying degrees; no relationship with trait compulsivity was found. These findings are discussed, study limitations are noted, and relevance for clinical practice is outlined.

The Wechsler Test of Adult Reading as a Measure of Premorbid Intelligence Following Traumatic Brain Injury.

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Steward, Kayla A; Novack, Thomas A; Kennedy, Richard; Crowe, Michael; Marson, Daniel C; Triebel, Kristen L

2017-02-01

The current study sought to determine whether the Wechsler Test of Adult Reading (WTAR) provides a stable estimate of premorbid intellectual ability in acutely injured patients recovering from traumatic brain injury (TBI). A total of 135 participants (43 mild TBI [mTBI], 40 moderate/severe TBI [msevTBI], 52 healthy controls) were administered the WTAR at 1 and 12 months post-injury. Despite similar demographic profiles, participants with msevTBI performed significantly worse than controls on the WTAR at both time points. Moreover, the msevTBI group had a significant improvement in WTAR performance over the 1-year period. In contrast, those participants with mTBI did not significantly differ from healthy controls and both the mTBI and control groups demonstrated stability on the WTAR over time. Results indicate that word-reading tests may underestimate premorbid intelligence during the immediate recovery period for patients with msevTBI. Clinicians should consider alternative estimation measures in this TBI subpopulation. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Pedestrian injury risk and the effect of age.

Science.gov (United States)

Niebuhr, Tobias; Junge, Mirko; Rosén, Erik

2016-01-01

Older adults and pedestrians both represent especially vulnerable groups in traffic. In the literature, hazards are usually described by the corresponding injury risks of a collision. This paper investigates the MAIS3+F risk (the risk of sustaining at least one injury of AIS 3 severity or higher, or fatal injury) for pedestrians in full-frontal pedestrian-to-passenger car collisions. Using some assumptions, a model-based approach to injury risk, allowing for the specification of individual injury risk parameters for individuals, is presented. To balance model accuracy and sample size, the GIDAS (German In-depth Accident Study) data set is divided into three age groups; children (0-14); adults (15-60); and older adults (older than 60). For each group, individual risk curves are computed. Afterwards, the curves are re-aggregated to the overall risk function. The derived model addresses the influence of age on the outcome of pedestrian-to-car accidents. The results show that older people compared with younger people have a higher MAIS3+F injury risk at all collision speeds. The injury risk for children behaves surprisingly. Compared to other age groups, their MAIS3+F injury risk is lower at lower collision speeds, but substantially higher once a threshold has been exceeded. The resulting injury risk curve obtained by re-aggregation looks surprisingly similar to the frequently used logistic regression function computed for the overall injury risk. However, for homogenous subgroups - such as the three age groups - logistic regression describes the typical risk behavior less accurately than the introduced model-based approach. Since the effect of demographic change on traffic safety is greater nowadays, there is a need to incorporate age into established models. Thus far, this is one of the first studies incorporating traffic participant age to an explicit risk function. The presented approach can be especially useful for the modeling and prediction of risks, and for the

Wechsler Adult Intelligence Scale-Revised Block Design broken configuration errors in nonpenetrating traumatic brain injury.

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Wilde, M C; Boake, C; Sherer, M

2000-01-01

Final broken configuration errors on the Wechsler Adult Intelligence Scale-Revised (WAIS-R; Wechsler, 1981) Block Design subtest were examined in 50 moderate and severe nonpenetrating traumatically brain injured adults. Patients were divided into left (n = 15) and right hemisphere (n = 19) groups based on a history of unilateral craniotomy for treatment of an intracranial lesion and were compared to a group with diffuse or negative brain CT scan findings and no history of neurosurgery (n = 16). The percentage of final broken configuration errors was related to injury severity, Benton Visual Form Discrimination Test (VFD; Benton, Hamsher, Varney, & Spreen, 1983) total score and the number of VFD rotation and peripheral errors. The percentage of final broken configuration errors was higher in the patients with right craniotomies than in the left or no craniotomy groups, which did not differ. Broken configuration errors did not occur more frequently on designs without an embedded grid pattern. Right craniotomy patients did not show a greater percentage of broken configuration errors on nongrid designs as compared to grid designs.

Environmental Subconcussive Injury, Axonal Injury, and Chronic Traumatic Encephalopathy

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Wendy A. Morley

2018-03-01

Full Text Available Brain injury occurs in two phases: the initial injury itself and a secondary cascade of precise immune-based neurochemical events. The secondary phase is typically functional in nature and characterized by delayed axonal injury with more axonal disconnections occurring than in the initial phase. Axonal injury occurs across the spectrum of disease severity, with subconcussive injury, especially when repetitive, now considered capable of producing significant neurological damage consistent with axonal injury seen in clinically evident concussion, despite no observable symptoms. This review is the first to introduce the concept of environmental subconcussive injury (ESCI and sets out how secondary brain damage from ESCI once past the juncture of microglial activation appears to follow the same neuron-damaging pathway as secondary brain damage from conventional brain injury. The immune response associated with ESCI is strikingly similar to that mounted after conventional concussion. Specifically, microglial activation is followed closely by glutamate and calcium flux, excitotoxicity, reactive oxygen species and reactive nitrogen species (RNS generation, lipid peroxidation, and mitochondrial dysfunction and energy crisis. ESCI damage also occurs in two phases, with the primary damage coming from microbiome injury (due to microbiome-altering events and secondary damage (axonal injury from progressive secondary neurochemical events. The concept of ESCI and the underlying mechanisms have profound implications for the understanding of chronic traumatic encephalopathy (CTE etiology because it has previously been suggested that repetitive axonal injury may be the primary CTE pathogenesis in susceptible individuals and it is best correlated with lifetime brain trauma load. Taken together, it appears that susceptibility to brain injury and downstream neurodegenerative diseases, such as CTE, can be conceptualized as a continuum of brain resilience. At one end

Comparison of tibial shaft ski fractures in children and adults.

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Hamada, Tomo; Matsumoto, Kazu; Ishimaru, Daichi; Sumi, Hiroshi; Shimizu, Katsuji

2014-09-01

To examine whether child and adult skiers have different risk factors or mechanisms of injury for tibial shaft fractures. Descriptive epidemiological study. Prospectively analyzed the epidemiologic factors, injury types, and injury mechanisms at Sumi Memorial Hospital. This study analyzed information obtained from 276 patients with tibial fractures sustained during skiing between 2004 and 2012. We focused on 174 ski-related tibial shaft fractures with respect to the following factors: age, gender, laterality of fracture, skill level, mechanism of fracture (fall vs collision), scene of injury (steepness of slope), snow condition, and weather. Fracture pattern was graded according to Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification and mechanical direction [external (ER) or internal rotation (IR)]. Tibial shaft fractures were the most common in both children (89.3%) and adults (47.4%). There were no significant differences in gender, side of fracture, mechanism of fracture, snow condition, or weather between children and adults. Skill levels were significantly lower in children than in adults (P differences in some of these parameters, suggesting that child and adult skiers have different risk factors or mechanisms of injury for tibial shaft fractures.

Transient risk factors of acute occupational injuries

DEFF Research Database (Denmark)

Østerlund, Anna H; Lander, Flemming; Nielsen, Kent

2017-01-01

Objectives The objectives of this study were to (i) identify transient risk factors of occupational injuries and (ii) determine if the risk varies with age, injury severity, job task, and industry risk level. Method A case-crossover design was used to examine the effect of seven specific transient...... risk factors (time pressure, disagreement with someone, feeling sick, being distracted by someone, non-routine task, altered surroundings, and broken machinery and materials) for occupational injuries. In the study, 1693 patients with occupational injuries were recruited from a total of 4002...... in relation to sex, age, job task, industry risk level, or injury severity. Conclusion Use of a case-crossover design identified several worker-related transient risk factors (time pressure, feeling sick, being distracted by someone) that led to significantly increased risks for occupational injuries...

Nosographic profile of soccer injuries according to the age group

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Karoline Pegoraro Silveira

2013-04-01

Full Text Available DOI: http://dx.doi.org/10.5007/1980-0037.2013v15n4p476 Soccer is one of the world’s most popular team sports and corresponds to one ofthe leading causes of sports injuries (SI. This study aimed to analyze the nosographic profile of the sports injuries common to soccer, according to the age group: childhood, youth and adulthood. We selected 209 soccer players, from amateurs to professional players of a sports club from Campo Grande/MS. Participants were divided into four age groups: G1 (childhood, G2 (juvenile,G3 (teenagers and G4 (adults. To obtain information about the injuries, we used a morbidity survey. Generally, 74 athletes reported sports injuries, with register of 92 SI. Concerning injury types, muscle injuries totalized 43.47%, followed by joint damage (34.78% and tendon injury (14.13%, respectively (p 0.05. A higher proportion of registers involved medical-therapeutic approach and asymptomatic return. The evidence shows ahigher rate of muscle and joint injuries by contact in the lower limbs in soccer practitioners, regardless of age group. The practice of training seems to be the main cause of injuries in adolescents and adults.

Spinal cord injury reveals multilineage differentiation of ependymal cells.

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Konstantinos Meletis

2008-07-01

Full Text Available Spinal cord injury often results in permanent functional impairment. Neural stem cells present in the adult spinal cord can be expanded in vitro and improve recovery when transplanted to the injured spinal cord, demonstrating the presence of cells that can promote regeneration but that normally fail to do so efficiently. Using genetic fate mapping, we show that close to all in vitro neural stem cell potential in the adult spinal cord resides within the population of ependymal cells lining the central canal. These cells are recruited by spinal cord injury and produce not only scar-forming glial cells, but also, to a lesser degree, oligodendrocytes. Modulating the fate of ependymal progeny after spinal cord injury may offer an alternative to cell transplantation for cell replacement therapies in spinal cord injury.

Dendrite Injury Triggers DLK-Independent Regeneration

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Michelle C. Stone

2014-01-01

Full Text Available Axon injury triggers regeneration through activation of a conserved kinase cascade, which includes the dual leucine zipper kinase (DLK. Although dendrites are damaged during stroke, traumatic brain injury, and seizure, it is not known whether mature neurons monitor dendrite injury and initiate regeneration. We probed the response to dendrite damage using model Drosophila neurons. Two larval neuron types regrew dendrites in distinct ways after all dendrites were removed. Dendrite regeneration was also triggered by injury in adults. Next, we tested whether dendrite injury was initiated with the same machinery as axon injury. Surprisingly, DLK, JNK, and fos were dispensable for dendrite regeneration. Moreover, this MAP kinase pathway was not activated by injury to dendrites. Thus, neurons respond to dendrite damage and initiate regeneration without using the conserved DLK cascade that triggers axon regeneration.

Environmental estrogen(s) induced swimming behavioural alterations in adult zebrafish (Danio rerio).

Science.gov (United States)

Goundadkar, Basavaraj B; Katti, Pancharatna

2017-09-01

The present study is an attempt to investigate the effects of long-term (75days) exposure to environmental estrogens (EE) on the swimming behaviour of zebrafish (Danio rerio). Adult zebrafish were exposed semi-statically to media containing commonly detected estrogenic water contaminants (EE2, DES and BPA) at a concentration (5ng/L) much lower than environmentally recorded levels. Time spent in swimming, surface preference, patterns and path of swimming were recorded (6mins) for each fish using two video cameras on day 15, 30 60 and 75. Video clips were analysed using a software program. Results indicate that chronic exposure to EE leads to increased body weight and size of females, reduced (Pswimming time, delay in latency, increased (P<0.05) immobility, erratic movements and freezing episodes. We conclude that estrogenic contamination of natural aquatic systems induces alterations in locomotor behaviour and associated physiological disturbances in inhabitant fish fauna. Copyright © 2017 Elsevier B.V. All rights reserved.

Vibrotactile Feedback Alters Dynamics Of Static Postural Control In Persons With Parkinson's Disease But Not Older Adults At High Fall Risk.

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High, Carleigh M; McHugh, Hannah F; Mills, Stephen C; Amano, Shinichi; Freund, Jane E; Vallabhajosula, Srikant

2018-06-01

Aging and Parkinson's disease are often associated with impaired postural control. Providing extrinsic feedback via vibrotactile sensation could supplement intrinsic feedback to maintain postural control. We investigated the postural control response to vibrotactile feedback provided at the trunk during challenging stance conditions in older adults at high fall risk and individuals with Parkinson's disease compared to healthy older adults. Nine older adults at high fall risk, 9 persons with Parkinson's disease and 10 healthy older adults performed 30s quiet standing on a force platform under five challenging stance conditions with eyes open/closed and standing on firm/foam surface with feet together, each with and without vibrotactile feedback. During vibrotactile feedback trials, feedback was provided when participants swayed >10% over the center of their base of support. Participants were instructed vibrations would be in response to their movement. Magnitude of postural sway was estimated using center of pressure path length, velocity, and sway area. Dynamics of individuals' postural control was evaluated using detrended fluctuation analysis. Results showed that vibrotactile feedback induced a change in postural control dynamics among persons with Parkinson's disease when standing with intact intrinsic visual input and altered intrinsic somatosensory input, but there was no change in sway magnitude. However, use of vibrotactile feedback did not significantly alter dynamics of postural control in older adults with high risk of falling or reduce the magnitude of sway. Considering the effects of vibrotactile feedback were dependent on the population and stance condition, designing an optimal therapeutic regimen for balance training should be carefully considered and be specific to a target population. Furthermore, our results suggest that explicit instructions on how to respond to the vibrotactile feedback could affect training outcome. Copyright © 2018 The

Altered structural brain changes and neurocognitive performance in pediatric HIV

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Santosh K. Yadav

2017-01-01

Full Text Available Pediatric HIV patients often suffer with neurodevelopmental delay and subsequently cognitive impairment. While tissue injury in cortical and subcortical regions in the brain of adult HIV patients has been well reported there is sparse knowledge about these changes in perinatally HIV infected pediatric patients. We analyzed cortical thickness, subcortical volume, structural connectivity, and neurocognitive functions in pediatric HIV patients and compared with those of pediatric healthy controls. With informed consent, 34 perinatally infected pediatric HIV patients and 32 age and gender matched pediatric healthy controls underwent neurocognitive assessment and brain magnetic resonance imaging (MRI on a 3 T clinical scanner. Altered cortical thickness, subcortical volumes, and abnormal neuropsychological test scores were observed in pediatric HIV patients. The structural network connectivity analysis depicted lower connection strengths, lower clustering coefficients, and higher path length in pediatric HIV patients than healthy controls. The network betweenness and network hubs in cortico-limbic regions were distorted in pediatric HIV patients. The findings suggest that altered cortical and subcortical structures and regional brain connectivity in pediatric HIV patients may contribute to deficits in their neurocognitive functions. Further, longitudinal studies are required for better understanding of the effect of HIV pathogenesis on brain structural changes throughout the brain development process under standard ART treatment.

Cognitive function in childhood and early adulthood and injuries later in life

DEFF Research Database (Denmark)

Osler, Merete; Andersen, Anne-Marie Nybo; Laursen, Bjarne

2007-01-01

BACKGROUND: It has been suggested that cognitive function in childhood is a modifiable risk factor for adult injury. This study examines the relationship between cognitive function measured at the age of 12 and 18 years and fatal and non-fatal injuries later in adult life. METHODS: A total of 11 ...

Traumatic brain injury due to pressure cooker explosion in a child: case report

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Calderon-Miranda Willem Guillermo

2016-06-01

Full Text Available Traumatic brain injury is a common condition in the emergency services, affecting the pediatric and adult population significantly. Patterns of head injury as well as management principles in children are important differences compared to adults. Traumatic brain injury by Domestic pressure cooker is rare and has not been described in children, which to our knowledge is the first report in the literature of this nature.

Lap belt injuries in children.

LENUS (Irish Health Repository)

McGrath, N

2010-07-01

The use of adult seat belts without booster seats in young children may lead to severe abdominal, lumbar or cervical spine and head and neck injuries. We describe four characteristic cases of lap belt injuries presenting to a tertiary children\\'s hospital over the past year in addition to a review of the current literature. These four cases of spinal cord injury, resulting in significant long-term morbidity in the two survivors and death in one child, arose as a result of lap belt injury. These complex injuries are caused by rapid deceleration characteristic of high impact crashes, resulting in sudden flexion of the upper body around the fixed lap belt, and consequent compression of the abdominal viscera between the lap belt and spine. This report highlights the dangers of using lap belts only without shoulder straps. Age-appropriate child restraint in cars will prevent these injuries.

Frequency of injuries, in particular dental injuries, in ski jumping and Nordic combined.

Science.gov (United States)

Stillhard, Angela; Buschor, Cornel; Krastl, Gabriel; Kühl, Sebastian; Filippi, Andreas

This study investigates the frequency of injuries, in particular dental injuries, among ski jumpers and Nordic combined athletes. It also examines the level of knowledge regarding tooth protection and tooth rescue boxes in this population. Of the 465 sportswomen and sportsmen who took part in the study, 230 (62.5%) of the 368 ski jumpers and 56 (56.5%) of the 97 Nordic combined athletes had sustained an injury. In both disciplines injury was most likely among professionals. The survey participants reported injuries to the limbs (n = 216), head and lips (n = 273 and n = 253, respectively), torso or spine (n = 249), teeth (n = 246), nose (n = 229) and jaw (n = 26). Dental injuries were more common among professionals than either amateur or junior ski jumpers, whereas, among the Nordic combined athletes, juniors were most likely to sustain a dental injury. Overall, the frequency of dental injury was significantly (p = 0.019) higher among adults 12.7% (n = 234) than junior athletes 6.1% (n = 212). The level of awareness of mouthguards and tooth rescue boxes varied between countries. The high injury rate recorded in this study demonstrates that ski jumping contains a considerable risk of injury, including tooth damage. Consequently, it seems reasonable to inform skiing organisations, trainers and athletes about the potential benefits of mouthguards and tooth rescue boxes in order to reduce the risk of dental injury.

Digital comparison of healthy young adults and borderline patients engaged in non-suicidal self-injury.

Science.gov (United States)

Stroehmer, Rachel; Edel, Marc A; Pott, Steffi; Juckel, Georg; Haussleiter, Ida S

2015-01-01

It still remains unclear whether non-suicidal self-injury (NSSI) in young adult populations represents an actual symptom leading to psychiatric illness, constitutes a disorder itself or is rather a cultural peer influence. The purpose of this web-based qualitative cross-sectional study was to characterize NSSI (type of injury, frequency, tools, body parts, circumstances) in 50 patients with borderline personality disorder (NSSI + BPD) in direct comparison with 50 age and gender matched non-clinical young adults (NSSI - BPD), all of them currently or previously engaged in NSSI. Self-harming participants completed an open-access, anonymous 75-items questionnaire including the temperament questionnaire briefTEMPS-M. The mean age of NSSI onset was 20.56 ± 6.36 (NSSI + BPD) and 17.5 ± 9.28 years (NSSI - BPD), respectively (p = 0.261). NSSI - BPD participants (1) rarely sought out medical treatment (p < 0.001) and differed significantly from BPD patients; They (2) reported more often fear and disappointment as feelings preceding their self-harm (p < 0.001 each); (3) cut themselves in more locations (p = 0.005) and (4) in rather hidden areas (lower limb, proximal) (p = 0.002); (5) had lower depressive temperament scores (p = 0.007); and (6) scored generally fewer character traits "at risk" (p = 0.043) with a lower total score (p = 0.018). NSSI tended to onset slightly earlier in life and in different shape when BPD was absent. Our findings support current approaches of early NSSI recognition and identification of risk profiles. Further prospective studies, which have to be sufficiently large and longitudinal, are needed and of great importance.

A Survey of Georgia Adult Protective Service Staff: Implications for Older Adult Injury Prevention and Policy

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Strasser, Sheryl

2011-07-01

that are not well understood by APS staff. Soliciting input from intended trainees allows public health educators to tailor and improve training sessions. Trainee input may result in optimization of policy implementation, which may result in greater injury prevention and protection of older adults vulnerable to abuse, neglect and exploitation. [West J Emerg Med. 2011;12(3:357-364.

A survey of georgia adult protective service staff: implications for older adult injury prevention and policy.

Science.gov (United States)

Strasser, Sheryl M; Kerr, Judith; King, Patricia S; Payne, Brian; Beddington, Sarah; Pendrick, Danielle; Leyda, Elizabeth; McCarty, Frances

2011-07-01

. Soliciting input from intended trainees allows public health educators to tailor and improve training sessions. Trainee input may result in optimization of policy implementation, which may result in greater injury prevention and protection of older adults vulnerable to abuse, neglect and exploitation.

Conjugated Linoleic Acid Administration Induces Amnesia in Male Sprague Dawley Rats and Exacerbates Recovery from Functional Deficits Induced by a Controlled Cortical Impact Injury.

Directory of Open Access Journals (Sweden)

Rastafa I Geddes

Full Text Available Long-chain polyunsaturated fatty acids like conjugated linoleic acids (CLA are required for normal neural development and cognitive function and have been ascribed various beneficial functions. Recently, oral CLA also has been shown to increase testosterone (T biosynthesis, which is known to diminish traumatic brain injury (TBI-induced neuropathology and reduce deficits induced by stroke in adult rats. To test the impact of CLA on cognitive recovery following a TBI, 5-6 month old male Sprague Dawley rats received a focal injury (craniectomy + controlled cortical impact (CCI; n = 17 or Sham injury (craniectomy alone; n = 12 and were injected with 25 mg/kg body weight of Clarinol® G-80 (80% CLA in safflower oil; n = 16 or saline (n = 13 every 48 h for 4 weeks. Sham surgery decreased baseline plasma progesterone (P4 by 64.2% (from 9.5 ± 3.4 ng/mL to 3.4 ± 0.5 ng/mL; p = 0.068, T by 74.6% (from 5.9 ± 1.2 ng/mL to 1.5 ± 0.3 ng/mL; p 0.05 animals by post-injury day 29, but rapidly reversed by post-injury day 1 the hypoadrenalism in Sham (11-DOC: 372.6 ± 36.6 ng/mL; corticosterone: 202.6 ± 15.6 ng/mL and CCI-injured (11-DOC: 384.2 ± 101.3 ng/mL; corticosterone: 234.6 ± 43.8 ng/mL animals. In Sham surgery animals, CLA did not alter body weight, but did markedly increase latency to find the hidden Morris Water Maze platform (40.3 ± 13.0 s compared to saline treated Sham animals (8.8 ± 1.7 s. In CCI injured animals, CLA did not alter CCI-induced body weight loss, CCI-induced cystic infarct size, or deficits in rotarod performance. However, like Sham animals, CLA injections exacerbated the latency of CCI-injured rats to find the hidden MWM platform (66.8 ± 10.6 s compared to CCI-injured rats treated with saline (30.7 ± 5.5 s, p < 0.05. These results indicate that chronic treatment of CLA at a dose of 25 mg/kg body weight in adult male rats over 1-month 1 does not reverse craniectomy- and craniectomy + CCI-induced hypogonadism, but does reverse

Prevention of unintentional childhood injury.

Science.gov (United States)

Theurer, Wesley M; Bhavsar, Amit K

2013-04-01

Unintentional injury accounts for 40 percent of childhood deaths annually, most commonly from motor vehicle crashes. The proper use of child restraints is the most effective strategy to prevent injury or death. Motor vehicle restraint guidelines have recently been revised to an age-based system that delays the progression in type of restraint for most children. Strategies to prevent suffocation in children include using appropriate bedding, positioning babies on their backs to sleep, and removing items from the sleep and play environment that could potentially entrap or entangle the child. Fencing that isolates a swimming pool from the yard and surrounding area and "touch" adult supervision (i.e., an adult is in the water and able to reach and grab a child) have been shown to be most effective in preventing drownings. Swimming lessons are recommended for children older than four years. Poison prevention programs have been shown to improve prevention behavior among caregivers, but may not decrease poisoning incidence. Syrup of ipecac is not recommended. Smoke detector maintenance, a home escape plan, and educating children about how to respond during a fire emergency are effective strategies for preventing fire injuries or death. Fall injuries may be reduced by not using walkers for infants and toddlers or bunk beds for children six years and younger. Consistent helmet use while bicycling reduces head and brain injuries. Although direct counseling by physicians appears to improve some parental safety behaviors, its effect on reducing childhood injuries is uncertain. Community-based interventions can be effective in high-risk populations.

Effects of mobile Internet use on college student pedestrian injury risk.

Science.gov (United States)

Byington, Katherine W; Schwebel, David C

2013-03-01

College-age individuals have the highest incidence of pedestrian injuries of any age cohort. One factor that might contribute to elevated pedestrian injuries among this age group is injuries incurred while crossing streets distracted by mobile devices. Examine whether young adult pedestrian safety is compromised while crossing a virtual pedestrian street while distracted using the Internet on a mobile "smartphone." A within-subjects design was implemented with 92 young adults. Participants crossed a virtual pedestrian street 20 times, half the time while undistracted and half while completing an email-driven "scavenger hunt" to answer mundane questions using mobile Internet on their cell phones. Six measures of pedestrian behavior were assessed during crossings. Participants also reported typical patterns of street crossing and mobile Internet use. Participants reported using mobile Internet with great frequency in daily life, including while walking across streets. In the virtual street environment, pedestrian behavior was greatly altered and generally more risky when participants were distracted by Internet use. While distracted, participants waited longer to cross the street (F=42.37), missed more safe opportunities to cross (F=42.63), took longer to initiate crossing when a safe gap was available (F=53.03), looked left and right less often (F=124.68), spent more time looking away from the road (F=1959.78), and were more likely to be hit or almost hit by an oncoming vehicle (F=29.54; all psmobile Internet experience. Pedestrian behavior was influenced, and generally considerably riskier, when participants were simultaneously using mobile Internet and crossing the street than when crossing the street with no distraction. This finding reinforces the need for increased awareness concerning the risks of distracted pedestrian behavior. Copyright © 2012 Elsevier Ltd. All rights reserved.

Retinoid Signaling in Pancreatic Cancer, Injury and Regeneration

Science.gov (United States)

Colvin, Emily K.; Susanto, Johana M.; Kench, James G.; Ong, Vivienna N.; Mawson, Amanda; Pinese, Mark; Chang, David K.; Rooman, Ilse; O'Toole, Sandra A.; Segara, Davendra; Musgrove, Elizabeth A.; Sutherland, Robert L.; Apte, Minoti V.; Scarlett, Christopher J.; Biankin, Andrew V.

2011-01-01

Background Activation of embryonic signaling pathways quiescent in the adult pancreas is a feature of pancreatic cancer (PC). These discoveries have led to the development of novel inhibitors of pathways such as Notch and Hedgehog signaling that are currently in early phase clinical trials in the treatment of several cancer types. Retinoid signaling is also essential for pancreatic development, and retinoid therapy is used successfully in other malignancies such as leukemia, but little is known concerning retinoid signaling in PC. Methodology/Principal Findings We investigated the role of retinoid signaling in vitro and in vivo in normal pancreas, pancreatic injury, regeneration and cancer. Retinoid signaling is active in occasional cells in the adult pancreas but is markedly augmented throughout the parenchyma during injury and regeneration. Both chemically induced and genetically engineered mouse models of PC exhibit a lack of retinoid signaling activity compared to normal pancreas. As a consequence, we investigated Cellular Retinoid Binding Protein 1 (CRBP1), a key regulator of retinoid signaling known to play a role in breast cancer development, as a potential therapeutic target. Loss, or significant downregulation of CRBP1 was present in 70% of human PC, and was evident in the very earliest precursor lesions (PanIN-1A). However, in vitro gain and loss of function studies and CRBP1 knockout mice suggested that loss of CRBP1 expression alone was not sufficient to induce carcinogenesis or to alter PC sensitivity to retinoid based therapies. Conclusions/Significance In conclusion, retinoid signalling appears to play a role in pancreatic regeneration and carcinogenesis, but unlike breast cancer, it is not mediated directly by CRBP1. PMID:22220202

Retinoid signaling in pancreatic cancer, injury and regeneration.

Directory of Open Access Journals (Sweden)

Emily K Colvin

Full Text Available BACKGROUND: Activation of embryonic signaling pathways quiescent in the adult pancreas is a feature of pancreatic cancer (PC. These discoveries have led to the development of novel inhibitors of pathways such as Notch and Hedgehog signaling that are currently in early phase clinical trials in the treatment of several cancer types. Retinoid signaling is also essential for pancreatic development, and retinoid therapy is used successfully in other malignancies such as leukemia, but little is known concerning retinoid signaling in PC. METHODOLOGY/PRINCIPAL FINDINGS: We investigated the role of retinoid signaling in vitro and in vivo in normal pancreas, pancreatic injury, regeneration and cancer. Retinoid signaling is active in occasional cells in the adult pancreas but is markedly augmented throughout the parenchyma during injury and regeneration. Both chemically induced and genetically engineered mouse models of PC exhibit a lack of retinoid signaling activity compared to normal pancreas. As a consequence, we investigated Cellular Retinoid Binding Protein 1 (CRBP1, a key regulator of retinoid signaling known to play a role in breast cancer development, as a potential therapeutic target. Loss, or significant downregulation of CRBP1 was present in 70% of human PC, and was evident in the very earliest precursor lesions (PanIN-1A. However, in vitro gain and loss of function studies and CRBP1 knockout mice suggested that loss of CRBP1 expression alone was not sufficient to induce carcinogenesis or to alter PC sensitivity to retinoid based therapies. CONCLUSIONS/SIGNIFICANCE: In conclusion, retinoid signalling appears to play a role in pancreatic regeneration and carcinogenesis, but unlike breast cancer, it is not mediated directly by CRBP1.

Alteration of Diastereoisomeric and Enantiomeric Profiles of Hexabromocyclododecanes (HBCDs) in Adult Chicken Tissues, Eggs, and Hatchling Chickens.

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Zheng, Xiaobo; Qiao, Lin; Sun, Runxia; Luo, Xiaojun; Zheng, Jing; Xie, Qilai; Sun, Yuxin; Mai, Bixian

2017-05-16

The concentrations and enantiomer fractions (EFs) of α-, β-, and γ-hexabromocyclododecanes (HBCDs) were measured in chicken diet sources (soil and chicken feed), home-raised adult chicken (Gallus domesticus) tissues, eggs during incubation, and hatchling chicken tissues. HBCD concentrations were not detected-0.69 ng/g dry weight (dw) and 25.6-48.4 ng/g dw in chicken feed and soil, respectively. HBCDs were detected in all adult chicken tissues, except the brain, at median levels of 13.1-44.0 ng/g lipid weight (lw). The proportions of α-HBCD in total HBCDs increased from 51% in soil to more than 87% in adult chicken tissues. The accumulation ratios (ARs) of α-HBCD from diet to adult chicken tissues were 4.27 for liver, 11.2 for fat, and 7.64-12.9 for other tissues, respectively. The AR and carry-over rate (COR) of α-HBCD from diet to eggs were 22.4 and 0.226, respectively. The concentrations of α-HBCD in hatchling chicken liver (median: 35.4 ng/g lw) were significantly lower than those in hatchling chicken pectoral muscle (median: 130 ng/g lw). The EFs of α-HBCD decreased from soil to adult chicken tissues and from eggs to hatchling chicken liver. Meanwhile, the EFs of γ-HBCD increased from soil to adult chicken tissues. These results indicate the preferential enrichment of (-)-α-HBCD and (+)-γ-HBCD in chickens. The alteration of diastereoisomeric and enantiomeric patterns of HBCDs might be influenced by the different absorption and elimination rates of the six HBCD enantiomers as well as variations in HBCD metabolism in chickens.

Cell proliferation and apoptosis in optic nerve and brain integration centers of adult trout Oncorhynchus mykiss after optic nerve injury

Science.gov (United States)

Pushchina, Evgeniya V.; Shukla, Sachin; Varaksin, Anatoly A.; Obukhov, Dmitry K.

2016-01-01

Fishes have remarkable ability to effectively rebuild the structure of nerve cells and nerve fibers after central nervous system injury. However, the underlying mechanism is poorly understood. In order to address this issue, we investigated the proliferation and apoptosis of cells in contralateral and ipsilateral optic nerves, after stab wound injury to the eye of an adult trout Oncorhynchus mykiss. Heterogenous population of proliferating cells was investigated at 1 week after injury. TUNEL labeling gave a qualitative and quantitative assessment of apoptosis in the cells of optic nerve of trout 2 days after injury. After optic nerve injury, apoptotic response was investigated, and mass patterns of cell migration were found. The maximal concentration of apoptotic bodies was detected in the areas of mass clumps of cells. It is probably indicative of massive cell death in the area of high phagocytic activity of macrophages/microglia. At 1 week after optic nerve injury, we observed nerve cell proliferation in the trout brain integration centers: the cerebellum and the optic tectum. In the optic tectum, proliferating cell nuclear antigen (PCNA)-immunopositive radial glia-like cells were identified. Proliferative activity of nerve cells was detected in the dorsal proliferative (matrix) area of the cerebellum and in parenchymal cells of the molecular and granular layers whereas local clusters of undifferentiated cells which formed neurogenic niches were observed in both the optic tectum and cerebellum after optic nerve injury. In vitro analysis of brain cells of trout showed that suspension cells compared with monolayer cells retain higher proliferative activity, as evidenced by PCNA immunolabeling. Phase contrast observation showed mitosis in individual cells and the formation of neurospheres which gradually increased during 1–4 days of culture. The present findings suggest that trout can be used as a novel model for studying neuronal regeneration. PMID:27212918

Transient activation of Wnt/β-catenin signaling reporter in fibrotic scar formation after compression spinal cord injury in adult mice.

Science.gov (United States)

Yamagami, Takashi; Pleasure, David E; Lam, Kit S; Zhou, Chengji J

2018-02-19

After traumatic spinal cord injury (SCI), a scar may form with a fibrotic core (fibrotic scar) and surrounding reactive astrocytes (glial scar) at the lesion site. The scar tissue is considered a major obstacle preventing regeneration both as a physical barrier and as a source for secretion of inhibitors of axonal regeneration. Understanding the mechanism of scar formation and how to control it may lead to effective SCI therapies. Using a compression-SCI model on adult transgenic mice, we demonstrate that the canonical Wnt/β-catenin signaling reporter TOPgal (TCF/Lef1-lacZ) positive cells appeared at the lesion site by 5 days, peaked on 7 days, and diminished by 14 days post injury. Using various representative cell lineage markers, we demonstrate that, these transiently TOPgal positive cells are a group of Fibronectin(+);GFAP(-) fibroblast-like cells in the core scar region. Some of them are proliferative. These results indicate that Wnt/β-catenin signaling may play a key role in fibrotic scar formation after traumatic spinal cord injury. Copyright © 2018 Elsevier Inc. All rights reserved.

Pediatric acquired brain injury.

Science.gov (United States)

Bodack, Marie I

2010-10-01

Although pediatric patients are sometimes included in studies about visual problems in patients with acquired brain injury (ABI), few studies deal solely with children. Unlike studies dealing with adult patients, in which mechanisms of brain injury are divided into cerebral vascular accident (CVA) and traumatic brain injury (TBI), studies on pediatric patients deal almost exclusively with traumatic brain injury, specifically caused by accidents. Here we report on the vision problems of 4 pediatric patients, ages 3 to 18 years, who were examined in the ophthalmology/optometry clinic at a children's hospital. All patients had an internally caused brain injury and after the initial insult manifested problems in at least one of the following areas: acuity, binocularity, motility (tracking or saccades), accommodation, visual fields, and visual perceptual skills. Pediatric patients can suffer from a variety of oculo-visual problems after the onset of head injury. These patients may or may not be symptomatic and can benefit from optometric intervention. Copyright © 2010 American Optometric Association. Published by Elsevier Inc. All rights reserved.

Fear learning alterations after traumatic brain injury and their role in development of posttraumatic stress symptoms.

Science.gov (United States)

Glenn, Daniel E; Acheson, Dean T; Geyer, Mark A; Nievergelt, Caroline M; Baker, Dewleen G; Risbrough, Victoria B

2017-08-01

It is unknown how traumatic brain injury (TBI) increases risk for posttraumatic stress disorder (PTSD). One potential mechanism is via alteration of fear-learning processes that could affect responses to trauma memories and cues. We utilized a prospective, longitudinal design to determine if TBI is associated with altered fear learning and extinction, and if fear processing mediates effects of TBI on PTSD symptom change. Eight hundred fifty two active-duty Marines and Navy Corpsmen were assessed before and after deployment. Assessments included TBI history, PTSD symptoms, combat trauma and deployment stress, and a fear-potentiated startle task of fear acquisition and extinction. Startle response and self-reported expectancy and anxiety served as measures of fear conditioning, and PTSD symptoms were measured with the Clinician-Administered PTSD Scale. Individuals endorsing "multiple hit" exposure (both deployment TBI and a prior TBI) showed the strongest fear acquisition and highest fear expression compared to groups without multiple hits. Extinction did not differ across groups. Endorsing a deployment TBI was associated with higher anxiety to the fear cue compared to those without deployment TBI. The association of deployment TBI with increased postdeployment PTSD symptoms was mediated by postdeployment fear expression when recent prior-TBI exposure was included as a moderator. TBI associations with increased response to threat cues and PTSD symptoms remained when controlling for deployment trauma and postdeployment PTSD diagnosis. Deployment TBI, and multiple-hit TBI in particular, are associated with increases in conditioned fear learning and expression that may contribute to risk for developing PTSD symptoms. © 2017 Wiley Periodicals, Inc.

Magnetic resonance imaging of knee injuries in children

International Nuclear Information System (INIS)

King, S.J.

1997-01-01

The appearances of knee injuries on MR imaging are less well documented in children than adults. Some patterns of injury are shared by both groups of patients, e. g. meniscal damage. The frequency of specific injuries may differ, e. g. anterior cruciate ligament (ACL) tear. Congenital abnormality, coexistent pathology and previous treatment of the knee appear to be associated with meniscal problems. Discoid menisci are seen most frequently in children and have unique features on MR scans. Cruciate ligament tears are difficult to diagnose in the smallest children. The ACL may not be identified due to its small size. Normal bone marrow signal may be confused with marrow infiltration or bone microfracture. Radiographically occult fractures around the knee appear to be strongly associated with ligamentous injury as in adult patients. Osteochondral fractures, osteochondral lesions and articular cartilage damage are revealed on MR scans, but their long-term effects are uncertain. It is possible to diagnose a range of knee injuries on MR scans in children. The biggest diagnostic challenge is in pre-school children. (orig.). With 9 figs., 1 tab

Larval Population Density Alters Adult Sleep in Wild-Type Drosophila melanogaster but Not in Amnesiac Mutant Flies

Directory of Open Access Journals (Sweden)

Michael W. Chi

2014-08-01

Full Text Available Sleep has many important biological functions, but how sleep is regulated remains poorly understood. In humans, social isolation and other stressors early in life can disrupt adult sleep. In fruit flies housed at different population densities during early adulthood, social enrichment was shown to increase subsequent sleep, but it is unknown if population density during early development can also influence adult sleep. To answer this question, we maintained Drosophila larvae at a range of population densities throughout larval development, kept them isolated during early adulthood, and then tested their sleep patterns. Our findings reveal that flies that had been isolated as larvae had more fragmented sleep than those that had been raised at higher population densities. This effect was more prominent in females than in males. Larval population density did not affect sleep in female flies that were mutant for amnesiac, which has been shown to be required for normal memory consolidation, adult sleep regulation, and brain development. In contrast, larval population density effects on sleep persisted in female flies lacking the olfactory receptor or83b, suggesting that olfactory signals are not required for the effects of larval population density on adult sleep. These findings show that population density during early development can alter sleep behavior in adulthood, suggesting that genetic and/or structural changes are induced by this developmental manipulation that persist through metamorphosis.

The immunological consequences of injury.

LENUS (Irish Health Repository)

Ni Choileain, N

2012-02-03

Immediate and early trauma death rates are determined by "first hits" such as hypoxia, hypotension and organ injury, while late mortality correlates closely with "second hits" such as infection. An imbalance between the early systemic inflammatory response (SIRS), and the later compensatory counter-inflammatory response (CARS), is considered to be responsible for much post-traumatic morbidity and mortality. From a clinical perspective, this remains a significant healthcare problem, which has stimulated decades of experimental and clinical research aimed at understanding the functional effects of injury on the immune system. This review describes the impact of injury on the innate and adaptive immune systems. Though it is worth noting that the features of the immune response to injury overlap in many areas with immune dysregulation in sepsis, we attempt here to elucidate the mechanism by which injury predisposes to infection rather than to describe the alterations in host immunity consequent to established sepsis.

Neuromuscular prehabilitation to prevent osteoarthritis after a traumatic joint injury.

Science.gov (United States)

Tenforde, Adam S; Shull, Pete B; Fredericson, Michael

2012-05-01

Post-traumatic osteoarthritis (PTOA) is a process resulting from direct forces applied to a joint that cause injury and degenerative changes. An estimated 12% of all symptomatic osteoarthritis (OA) of the hip, knee, and ankle can be attributed to a post-traumatic cause. Neuromuscular prehabilitation is the process of improving neuromuscular function to prevent development of PTOA after an initial traumatic joint injury. Prehabilitation strategies include restoration of normative movement patterns that have been altered as the result of traumatic injury, along with neuromuscular exercises and gait retraining to prevent the development of OA after an injury occurs. A review of the current literature shows that no studies have been performed to evaluate methods of neuromuscular prehabilitation to prevent PTOA after a joint injury. Instead, current research has focused on management strategies after knee injuries, the value of exercise in the management of OA, and neuromuscular exercises after total knee arthroplasty. Recent work in gait retraining that alters knee joint loading holds promise for preventing the development of PTOA after joint trauma. Future research should evaluate methods of neuromuscular prehabilitation strategies in relationship to the outcome of PTOA after joint injury. Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

A novel inhibitor of p75-neurotrophin receptor improves functional outcomes in two models of traumatic brain injury.

Science.gov (United States)

Delbary-Gossart, Sandrine; Lee, Sangmi; Baroni, Marco; Lamarche, Isabelle; Arnone, Michele; Canolle, Benoit; Lin, Amity; Sacramento, Jeffrey; Salegio, Ernesto A; Castel, Marie-Noelle; Delesque-Touchard, Nathalie; Alam, Antoine; Laboudie, Patricia; Ferzaz, Badia; Savi, Pierre; Herbert, Jean-Marc; Manley, Geoffrey T; Ferguson, Adam R; Bresnahan, Jacqueline C; Bono, Françoise; Beattie, Michael S

2016-06-01

The p75 neurotrophin receptor is important in multiple physiological actions including neuronal survival and neurite outgrowth during development, and after central nervous system injury. We have discovered a novel piperazine-derived compound, EVT901, which interferes with p75 neurotrophin receptor oligomerization through direct interaction with the first cysteine-rich domain of the extracellular region. Using ligand binding assays with cysteine-rich domains-fused p75 neurotrophin receptor, we confirmed that EVT901 interferes with oligomerization of full-length p75 neurotrophin receptor in a dose-dependent manner. Here we report that EVT901 reduces binding of pro-nerve growth factor to p75 neurotrophin receptor, blocks pro-nerve growth factor induced apoptosis in cells expressing p75 neurotrophin receptor, and enhances neurite outgrowth in vitro Furthermore, we demonstrate that EVT901 abrogates p75 neurotrophin receptor signalling by other ligands, such as prion peptide and amyloid-β. To test the efficacy of EVT901 in vivo, we evaluated the outcome in two models of traumatic brain injury. We generated controlled cortical impacts in adult rats. Using unbiased stereological analysis, we found that EVT901 delivered intravenously daily for 1 week after injury, reduced lesion size, protected cortical neurons and oligodendrocytes, and had a positive effect on neurological function. After lateral fluid percussion injury in adult rats, oral treatment with EVT901 reduced neuronal death in the hippocampus and thalamus, reduced long-term cognitive deficits, and reduced the occurrence of post-traumatic seizure activity. Together, these studies provide a new reagent for altering p75 neurotrophin receptor actions after injury and suggest that EVT901 may be useful in treatment of central nervous system trauma and other neurological disorders where p75 neurotrophin receptor signalling is affected. © The Author (2016). Published by Oxford University Press on behalf of the

Manipulation of nitric oxide in an animal model of acute liver injury ...

African Journals Online (AJOL)

We evaluated the impact of altering nitric oxide release on acute liver injury, the associated gut injury and bacterial translocation, at different time intervals. Methods: An acute rat liver injury model induced by D-galactosamine was used. Sprague Dawley rats were divided into four main groups: normal control, acute liver ...

A cross-sectional study of emergency care utilization and associated costs of violent-related (assault) injuries in the United States.

Science.gov (United States)

Monuteaux, Michael C; Fleegler, Eric W; Lee, Lois K

2017-11-01

Violent-related (assault) injuries are a leading cause of death and disability in the United States. Many violent injury victims seek treatment in the emergency department (ED). Our objectives were to (1) estimate rates of violent-related injuries evaluated in United States EDs, (2) estimate linear trends in ED visits for violent-related injuries from 2000 to 2010, and (3) to determine the associated health care and work-loss costs. We examined adults 18 years and older from a nationally representative survey (the National Hospital Ambulatory Medical Care Survey) of ED visits, from 2000 to 2010. Violent injury was defined using International Classification of Diseases-9th Rev.-Clinical Modification, diagnosis and mechanism of injury codes. We calculated rates of ED visits for violent injuries. Medical and work-loss costs accrued by these injuries were calculated for 2005, inflation-adjusted to 2011 dollars using the WISQARS Cost of Injury Reports. An annual average of 1.4 million adults were treated for violent injuries in EDs from 2000 to 2010, comprising 1.6% (95% confidence interval, 1.5%-1.6%) of all US adult ED visits. Young adults (18-25 years), men, nonwhites, uninsured or publically insured patients, and those residing in high poverty urban areas were at increased risk for ED visits for violent injury. The 1-year, inflation-adjusted medical and work-loss cost of violent-inflicted injuries in adults in the United States was US $49.5 billion. Violent injuries account for over one million ED visits annually among adults, with no change in rates over the past decade. Young black men are at especially increased risk for ED visits for violent injuries. Overall, violent-related injuries resulted in substantial financial and societal costs. Epidemiological study, level III.

Lifestyle intervention for adults with spinal cord injury: Results of the USC-RLANRC Pressure Ulcer Prevention Study.

Science.gov (United States)

Carlson, Mike; Vigen, Cheryl Lp; Rubayi, Salah; Blanche, Erna Imperatore; Blanchard, Jeanine; Atkins, Michal; Bates-Jensen, Barbara; Garber, Susan L; Pyatak, Elizabeth A; Diaz, Jesus; Florindez, Lucia I; Hay, Joel W; Mallinson, Trudy; Unger, Jennifer B; Azen, Stanley Paul; Scott, Michael; Cogan, Alison; Clark, Florence

2017-04-17

Medically serious pressure injuries (MSPrIs), a common complication of spinal cord injury (SCI), have devastating consequences on health and well-being and are extremely expensive to treat. We aimed to test the efficacy of a lifestyle-based intervention designed to reduce incidence of MSPrIs in adults with SCI. A randomized controlled trial (RCT), and a separate study wing involving a nonrandomized standard care control group. Rancho Los Amigos National Rehabilitation Center, a large facility serving ethnically diverse, low income residents of Los Angeles County. Adults with SCI, with history of one or more MSPrIs over the past 5 years: N=166 for RCT component, N=66 in nonrandomized control group. The Pressure Ulcer Prevention Program, a 12-month lifestyle-based treatment administered by healthcare professionals, largely via in-home visits and phone contacts. Blinded assessments of annualized MSPrI incidence rates at 12 and 24 months, based on: skin checks, quarterly phone interviews with participants, and review of medical charts and billing records. Secondary outcomes included number of surgeries and various quality-of-life measures. Annualized MSPrI rates did not differ significantly between study groups. At 12 months, rates were .56 for intervention recipients, .48 for randomized controls, and .65 for nonrandomized controls. At follow-up, rates were .44 and .39 respectively for randomized intervention and control participants. Evidence for intervention efficacy was inconclusive. The intractable nature of MSPrI threat in high-risk SCI populations, and lack of statistical power, may have contributed to this inability to detect an effect. ClinicalTrials.gov NCT01999816.

Heritable IUGR and adult metabolic syndrome are reversible and associated with alterations in the metabolome following dietary supplementation of 1-carbon intermediates.

Science.gov (United States)

Seferovic, Maxim D; Goodspeed, Danielle M; Chu, Derrick M; Krannich, Laura A; Gonzalez-Rodriguez, Pablo J; Cox, James E; Aagaard, Kjersti M

2015-06-01

Metabolic syndrome (MetS), following intrauterine growth restriction (IUGR), is epigenetically heritable. Recently, we abrogated the F2 adult phenotype with essential nutrient supplementation (ENS) of intermediates along the 1-carbon pathway. With the use of the same grandparental uterine artery ligation model, we profiled the F2 serum metabolome at weaning [postnatal day (d)21; n = 76] and adulthood (d160; n = 12) to test if MetS is preceded by alterations in the metabolome. Indicative of developmentally programmed MetS, adult F2, formerly IUGR rats, were obese (621 vs. 461 g; P metabolome at weaning (randomForest analysis; class error metabolome accompany heritable IUGR, precede adult-onset MetS, and are partially amenable to dietary intervention. © FASEB.

Moderate injury in motor-sensory cortex causes behavioral deficits accompanied by electrophysiological changes in mice adulthood.

Directory of Open Access Journals (Sweden)

Wei Ouyang

Full Text Available Moderate traumatic brain injury (TBI in children often happen when there's a sudden blow to the frontal bone, end with long unconscious which can last for hours and progressive cognitive deficits. However, with regard to the influences of moderate TBI during children adulthood, injury-induced alterations of locomotive ability, long-term memory performance, and hippocampal electrophysiological firing changes have not yet been fully identified. In this study, lateral fluid percussion (LFP method was used to fabricate moderate TBI in motor and somatosensory cortex of the 6-weeks-old mice. The motor function, learning and memory function, extracellular CA1 neural spikes were assessed during acute and subacute phase. Moreover, histopathology was performed on day post injury (DPI 16 to evaluate the effect of TBI on tissue and cell morphological changes in cortical and hippocampal CA1 subregions. After moderate LFP injury, the 6-weeks-old mice showed severe motor deficits at the early stage in acute phase but gradually recovered later during adulthood. At the time points in acute and subacute phase after TBI, novel object recognition (NOR ability and spatial memory functions were consistently impaired in TBI mice; hippocampal firing frequency and burst probability were hampered. Analysis of the altered burst firing shows a clear hippocampal theta rhythm drop. These electrophysiological impacts were associated with substantially lowered NOR preference as compared to the sham group during adulthood. These results suggest that moderate TBI introduced at motorsenory cortex in 6-weeks-old mice causes obvious motor and cognitive deficits during their adulthood. While the locomotive ability progressively recovers, the cognitive deficits persisted while the mice mature as adult mice. The cognitive deficits may be attributed to the general suppressing of whole neural network, which could be labeled by marked reduction of excitability in hippocampal CA1

Moderate injury in motor-sensory cortex causes behavioral deficits accompanied by electrophysiological changes in mice adulthood.

Science.gov (United States)

Ouyang, Wei; Yan, Qichao; Zhang, Yu; Fan, Zhiheng

2017-01-01

Moderate traumatic brain injury (TBI) in children often happen when there's a sudden blow to the frontal bone, end with long unconscious which can last for hours and progressive cognitive deficits. However, with regard to the influences of moderate TBI during children adulthood, injury-induced alterations of locomotive ability, long-term memory performance, and hippocampal electrophysiological firing changes have not yet been fully identified. In this study, lateral fluid percussion (LFP) method was used to fabricate moderate TBI in motor and somatosensory cortex of the 6-weeks-old mice. The motor function, learning and memory function, extracellular CA1 neural spikes were assessed during acute and subacute phase. Moreover, histopathology was performed on day post injury (DPI) 16 to evaluate the effect of TBI on tissue and cell morphological changes in cortical and hippocampal CA1 subregions. After moderate LFP injury, the 6-weeks-old mice showed severe motor deficits at the early stage in acute phase but gradually recovered later during adulthood. At the time points in acute and subacute phase after TBI, novel object recognition (NOR) ability and spatial memory functions were consistently impaired in TBI mice; hippocampal firing frequency and burst probability were hampered. Analysis of the altered burst firing shows a clear hippocampal theta rhythm drop. These electrophysiological impacts were associated with substantially lowered NOR preference as compared to the sham group during adulthood. These results suggest that moderate TBI introduced at motorsenory cortex in 6-weeks-old mice causes obvious motor and cognitive deficits during their adulthood. While the locomotive ability progressively recovers, the cognitive deficits persisted while the mice mature as adult mice. The cognitive deficits may be attributed to the general suppressing of whole neural network, which could be labeled by marked reduction of excitability in hippocampal CA1 subregion.

Assessment of neuro-optometric rehabilitation using the Developmental Eye Movement (DEM) test in adults with acquired brain injury.

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Kapoor, Neera; Ciuffreda, Kenneth Joseph

This pilot study sought to determine the efficacy of using the Developmental Eye Movement (DEM) test in the adult, acquired brain injury (ABI) population to quantify clinically the effects of controlled, laboratory-performed, oculomotor-based vision therapy/vision rehabilitation. Nine adult subjects with mild traumatic brain injury (mTBI) and five with stroke were assessed before and after an eight-week, computer-based, versional oculomotor (fixation, saccades, pursuit, and simulated reading) training program (9.6h total). The protocol incorporated a cross-over, interventional design with and without the addition of auditory feedback regarding two-dimensional eye position. The clinical outcome measure was the Developmental Eye Movement (DEM) test score (ratio, errors) taken before, midway, and immediately following training. For the DEM ratio parameter, improvements were found in 80-89% of the subjects. For the DEM error parameter, improvements were found in 100% of the subjects. Incorporation of the auditory feedback component revealed a trend toward enhanced performance. The findings were similar for both DEM parameters, as well as for incorporation of the auditory feedback, in both diagnostic groups. The results of the present study demonstrated considerable improvements in the DEM test scores following the oculomotor-based training, thus reflecting more time-optimal and accurate saccadic tracking after the training. The DEM test should be considered as another clinical test of global saccadic tracking performance in the ABI population. Copyright © 2017 Spanish General Council of Optometry. All rights reserved.

Selective alteration of adult hippocampal neurogenesis and impaired spatial pattern separation performance in the RSK2-deficient mouse model of Coffin-Lowry syndrome.

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Castillon, Charlotte; Lunion, Steeve; Desvignes, Nathalie; Hanauer, André; Laroche, Serge; Poirier, Roseline

2018-07-01

Adult neurogenesis is involved in certain hippocampus-dependent cognitive functions and is linked to psychiatric diseases including intellectual disabilities. The Coffin-Lowry syndrome (CLS) is a developmental disorder caused by mutations in the Rsk2 gene and characterized by intellectual disabilities associated with growth retardation. How RSK2-deficiency leads to cognitive dysfunctions in CLS is however poorly understood. Here, using Rsk2 Knock-Out mice, we characterized the impact of RSK2 deficiency on adult hippocampal neurogenesis in vivo. We report that the absence of RSK2 does not affect basal proliferation, differentiation and survival of dentate gyrus adult-born neurons but alters the maturation progression of young immature newborn neurons. Moreover, when RSK2-deficient mice were submitted to spatial learning, in contrast to wild-type mice, proliferation of adult generated neurons was decreased and no pro-survival effect of learning was observed. Thus, learning failed to recruit a selective population of young newborn neurons in association with deficient long-term memory recall. Given the proposed role of the dentate gyrus and of adult-generated newborn neurons in hippocampal-dependent pattern separation function, we explored this function in a delayed non-matching to place task and in an object-place pattern separation task and report severe deficits in spatial pattern separation in Rsk2-KO mice. Together, this study reveals a previously unknown role for RSK2 in the early stages of maturation and learning-dependent involvement of adult-born dentate gyrus neurons. These alterations associated with a deficit in the ability of RSK2-deficient mice to finely discriminate relatively similar spatial configurations, may contribute to cognitive dysfunction in CLS. Copyright © 2018 Elsevier Inc. All rights reserved.

A STUDY OF OCULAR INJURIES IN CHILDREN

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Ravi Kumar Diddigam

2016-06-01

Full Text Available BACKGROUND Worldwide, ocular trauma is an important cause of eye morbidity and a leading cause of non-congenital monocular blindness among children. In general, children are more susceptible to eye injuries because of their immature motor skills, limited common sense, tendency to imitate adult behaviour without evaluating risks, lessened emotional control, relative ignorance, and natural curiosity. Adult supervision is extremely important in preventing accidents. 1 PATIENTS AND METHODS The material for this study consisted of paediatric patients below 15 years of age who presented with history of different types of ocular injuries during the period from March 2007 to February 2010. In all cases, a thorough history was obtained from patients and their parents regarding the circumstances leading to the injury, the exact nature of the event and the object causing the injury. All the patients were also subjected to complete ophthalmic examination and followed up for 6 months. RESULTS 34 (68% were males and 16 (32% were females. The average age was 10.9 years (range 1-15 years. The highest incidence of blunt injuries was seen in age group of 11-15 years (58%. 20 (40% injuries occurred during domestic and leisure activities, 7(14% injuries occurred at work, 13 (26% during sports, 6 (12% were due to assault and 4 (8% from RTAs. CONCLUSION Blunt trauma to the eye causes a wide variety of damage to ocular tissues. Anterior or posterior segments are preferentially involved. Males were observed to be at increased risk for an eye injury necessitating admission to hospital.

Changes in the Severity and Injury Sources of Thoracic Aorta Injuries due to Vehicular Crashes

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Ryb, Gabriel; Dischinger, Patricia; Kerns, Timothy; Burch, Cynthia; Rabin, Joseph; Ho, Shiu

2013-01-01

Research using the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) suggested a decreased adjusted risk of thoracic aorta injuries (TAI) for newer vehicles during near-side crashes and an increased adjusted TAI risk during frontal crashes. This study attempted to explore possible explanations of these findings. Adult front seat occupants in the Crash Injury Research and Engineering Network (CIREN) database through June 2012 were studied. TAI cases were compared with ...

Screening for violence risk factors identifies young adults at risk for return emergency department visit for injury.

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Hankin, Abigail; Wei, Stanley; Foreman, Juron; Houry, Debra

2014-08-01

Homicide is the second leading cause of death among youth aged 15-24. Prior cross-sectional studies, in non-healthcare settings, have reported exposure to community violence, peer behavior, and delinquency as risk factors for violent injury. However, longitudinal cohort studies have not been performed to evaluate the temporal or predictive relationship between these risk factors and emergency department (ED) visits for injuries among at-risk youth. The objective was to assess whether self-reported exposure to violence risk factors in young adults can be used to predict future ED visits for injuries over a 1-year period. This prospective cohort study was performed in the ED of a Southeastern US Level I trauma center. Eligible participants were patients aged 18-24, presenting for any chief complaint. We excluded patients if they were critically ill, incarcerated, or could not read English. Initial recruitment occurred over a 6-month period, by a research assistant in the ED for 3-5 days per week, with shifts scheduled such that they included weekends and weekdays, over the hours from 8AM-8PM. At the time of initial contact in the ED, patients were asked to complete a written questionnaire, consisting of previously validated instruments measuring the following risk factors: a) aggression, b) perceived likelihood of violence, c) recent violent behavior, d) peer behavior, e) community exposure to violence, and f) positive future outlook. At 12 months following the initial ED visit, the participants' medical records were reviewed to identify any subsequent ED visits for injury-related complaints. We analyzed data with chi-square and logistic regression analyses. Three hundred thirty-two patients were approached, of whom 300 patients consented. Participants' average age was 21.1 years, with 60.1% female, 86.0% African American. After controlling for participant gender, ethnicity, or injury complaint at time of first visit, return visits for injuries were significantly

Acute intermittent hypoxia and rehabilitative training following cervical spinal injury alters neuronal hypoxia- and plasticity-associated protein expression.

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Hassan, Atiq; Arnold, Breanna M; Caine, Sally; Toosi, Behzad M; Verge, Valerie M K; Muir, Gillian D

2018-01-01

One of the most promising approaches to improve recovery after spinal cord injury (SCI) is the augmentation of spontaneously occurring plasticity in uninjured neural pathways. Acute intermittent hypoxia (AIH, brief exposures to reduced O2 levels alternating with normal O2 levels) initiates plasticity in respiratory systems and has been shown to improve recovery in respiratory and non-respiratory spinal systems after SCI in experimental animals and humans. Although the mechanism by which AIH elicits its effects after SCI are not well understood, AIH is known to alter protein expression in spinal neurons in uninjured animals. Here, we examine hypoxia- and plasticity-related protein expression using immunofluorescence in spinal neurons in SCI rats that were treated with AIH combined with motor training, a protocol which has been demonstrated to improve recovery of forelimb function in this lesion model. Specifically, we assessed protein expression in spinal neurons from animals with incomplete cervical SCI which were exposed to AIH treatment + motor training either for 1 or 7 days. AIH treatment consisted of 10 episodes of AIH: (5 min 11% O2: 5 min 21% O2) for 7 days beginning at 4 weeks post-SCI. Both 1 or 7 days of AIH treatment + motor training resulted in significantly increased expression of the transcription factor hypoxia-inducible factor-1α (HIF-1α) relative to normoxia-treated controls, in neurons both proximal (cervical) and remote (lumbar) to the SCI. All other markers examined were significantly elevated in the 7 day AIH + motor training group only, at both cervical and lumbar levels. These markers included vascular endothelial growth factor (VEGF), brain-derived neurotrophic factor (BDNF), and phosphorylated and nonphosphorylated forms of the BDNF receptor tropomyosin-related kinase B (TrkB). In summary, AIH induces plasticity at the cellular level after SCI by altering the expression of major plasticity- and hypoxia-related proteins at spinal regions

The use of antioxidants in the treatment of traumatic brain injury.

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Venegoni, Whitney; Shen, Qiuhua; Thimmesch, Amanda R; Bell, Meredith; Hiebert, John B; Pierce, Janet D

2017-06-01

The aim of this study was to discuss secondary traumatic brain injury, the mitochondria and the use of antioxidants as a treatment. One of the leading causes of death globally is traumatic brain injury, affecting individuals in all demographics. Traumatic brain injury is produced by an external blunt force or penetration resulting in alterations in brain function or pathology. Often, with a traumatic brain injury, secondary injury causes additional damage to the brain tissue that can have further impact on recovery and the quality of life. Secondary injury occurs when metabolic and physiologic processes alter after initial injury and includes increased release of toxic free radicals that cause damage to adjacent tissues and can eventually lead to neuronal necrosis. Although antioxidants in the tissues can reduce free radical damage, the magnitude of increased free radicals overwhelms the body's reduced defence mechanisms. Supplementing the body's natural supply of antioxidants, such as coenzyme Q10, can attenuate oxidative damage caused by reactive oxygen species. Discussion paper. Research literature published from 2011-2016 in PubMed, CINAHL and Cochrane. Prompt and accurate assessment of patients with traumatic brain injury by nurses is important to ensure optimal recovery and reduced lasting disability. Thus, it is imperative that nurses be knowledgeable about the secondary injury that occurs after a traumatic brain injury and aware of possible antioxidant treatments. The use of antioxidants has potential to reduce the magnitude of secondary injury in patients who experience a traumatic brain injury. © 2017 John Wiley & Sons Ltd.

Esophageal cancer related gene-4 is a choroid plexus-derived injury response gene: evidence for a biphasic response in early and late brain injury.

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Sonia Podvin

Full Text Available By virtue of its ability to regulate the composition of cerebrospinal fluid (CSF, the choroid plexus (CP is ideally suited to instigate a rapid response to traumatic brain injury (TBI by producing growth regulatory proteins. For example, Esophageal Cancer Related Gene-4 (Ecrg4 is a tumor suppressor gene that encodes a hormone-like peptide called augurin that is present in large concentrations in CP epithelia (CPe. Because augurin is thought to regulate senescence, neuroprogenitor cell growth and differentiation in the CNS, we evaluated the kinetics of Ecrg4 expression and augurin immunoreactivity in CPe after CNS injury. Adult rats were injured with a penetrating cortical lesion and alterations in augurin immunoreactivity were examined by immunohistochemistry. Ecrg4 gene expression was characterized by in situ hybridization. Cell surface augurin was identified histologically by confocal microscopy and biochemically by sub-cellular fractionation. Both Ecrg4 gene expression and augurin protein levels were decreased 24-72 hrs post-injury but restored to uninjured levels by day 7 post-injury. Protein staining in the supraoptic nucleus of the hypothalamus, used as a control brain region, did not show a decrease of auguin immunoreactivity. Ecrg4 gene expression localized to CPe cells, and augurin protein to the CPe ventricular face. Extracellular cell surface tethering of 14 kDa augurin was confirmed by cell surface fractionation of primary human CPe cells in vitro while a 6-8 kDa fragment of augurin was detected in conditioned media, indicating release from the cell surface by proteolytic processing. In rat CSF however, 14 kDa augurin was detected. We hypothesize the initial release and proteolytic processing of augurin participates in the activation phase of injury while sustained Ecrg4 down-regulation is dysinhibitory during the proliferative phase. Accordingly, augurin would play a constitutive inhibitory function in normal CNS while down

Identification of sperm mRNA biomarkers associated with testis injury during preclinical testing of pharmaceutical compounds

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Dere, Edward; Spade, Daniel J.; Hall, Susan J.; Altemus, Aimee; Smith, James D.; Phillips, Jonathan A.; Moffit, Jeffrey S.; Blanchard, Kerry T.; Boekelheide, Kim

2017-01-01

The human testis is sensitive to toxicant-induced injury but current methods for detecting adverse effects are limited, insensitive and unreliable. Animal studies use sensitive histopathological endpoints to assess toxicity, but require testicular tissue that is not available during human clinical trials. More sensitive and reliable molecular biomarkers of testicular injury are needed to better monitor testicular toxicity in both clinical and preclinical. Adult male Wistar Han rats were exposed for 4 weeks to compounds previously associated with testicular injury, including cisplatin (0, 0.2, 0.3, or 0.4 mg/kg/day), BI665915 (0, 20, 70, 100 mg/kg/d), BI665636 (0, 20, 100 mg/kg/d) or BI163538 (0, 70, 150, 300 mg/kg/d) to evaluate reproductive toxicity and assess changes in sperm mRNA levels. None of the compounds resulted in any significant changes in body, testis or epididymis weights, nor were there decreases in testicular homogenization resistant spermatid head counts. Histopathological evaluation found that only BI665915 treatment caused any testicular effects, including minor germ cell loss and disorganization of the seminiferous tubule epithelium, and an increase in the number of retained spermatid heads. A custom PCR-array panel was used to assess induced changes in sperm mRNA. BI665915 treatment resulted in a significant increase in clusterin (Clu) levels and decreases in GTPase, IMAP family member 4 (Gimap4), prostaglandin D2 synthase (Ptgds) and transmembrane protein with EGF like and two follistatin like domains 1 (Tmeff1) levels. Correlation analysis between transcript levels and quantitative histopathological endpoints found a modest association between Clu with retained spermatid heads. These results demonstrate that sperm mRNA levels are sensitive molecular indicators of testicular injury that can potentially be translated into a clinical setting. - Highlights: • Testing of pharmaceutical compounds identified altered sperm mRNA transcripts. �

Identification of sperm mRNA biomarkers associated with testis injury during preclinical testing of pharmaceutical compounds

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Dere, Edward [Division of Urology, Rhode Island Hospital, Providence, RI (United States); Department of Pathology and Laboratory Medicine, Brown University, Providence, RI (United States); Spade, Daniel J.; Hall, Susan J. [Department of Pathology and Laboratory Medicine, Brown University, Providence, RI (United States); Altemus, Aimee; Smith, James D.; Phillips, Jonathan A.; Moffit, Jeffrey S.; Blanchard, Kerry T. [Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (United States); Boekelheide, Kim, E-mail: kim_boekelheide@brown.edu [Department of Pathology and Laboratory Medicine, Brown University, Providence, RI (United States)