The Young Male Syndrome—An Analysis of Sex, Age, Risk Taking and Mortality in Patients With Severe Traumatic Brain Injuries

Higher risk taking is particularly characteristic for males between 15 and 35 years, the age when intrasexual competition is the strongest. This fitness-maximizing strategy, however, also has negative consequences; previous data revealed that males have a significantly higher tendency to die in accidents. This retrospective study aimed to assess whether age-related risk taking, often associated with the reproductive competition between males, and referred to as the Young Male Syndrome (YMS), may play a role in the high incidence of severe traumatic brain injury (sTBI) in young males. Derived from the available evidence and the main assumptions of the YMS, we expected that men, especially when they are in the age when their reproductive potential peaks, are more likely to suffer sTBI from highly risky behaviors that also lead to higher mortality. It was also expected that alcohol intoxication makes the demographic pattern of sTBI even more similar to what previous research on the YMS implies. We analyzed demographic data of patients with sTBI (N = 365) registered in a clinical database. To this end, we built Generalized Linear Mixed Models (GLMM) to reveal which of the demographic characteristics are the best predictors for risky behaviors leading to sTBI and death as a consequence of the injury. The data suggest that younger people acquired sTBI from riskier behaviors compared to members of older age groups, irrespective of their sex. Moreover, being male and being alcohol intoxicated also contributed significantly to risk-taking behavior. Mortality rate after the injury, however, increased with the age of the patient and did not depend on the riskiness of the behavior. The results indicate that the demographic distribution of the specific patient population in our focus cannot be simply explained by the YMS. However, higher incidence rates of males among the patients are in line with the core assumptions of the YMS. These data indicate that epidemiological studies should also take into consideration evolutionary theories and highlight the importance of age and sex specific prevention strategies

Traumatic axonal injury in the spinal cord evoked by traumatic brain injury

Although it is well known that traumatic brain injury (TBI) evokes traumatic axonal injury (TAI) within the brain, TBI-induced axonal damage in the spinal cord (SC) has been less extensively investigated. Detection of such axonal injury in the spinal cord would further the complexity of TBI while also challenging some functional neurobehavioral endpoints frequently used to assess recovery in various models of TBI. To assess TAI in the spinal cord associated with TBI, we analyzed the craniocervical junction (CCJ), cervico-thoracic (CT), and thoraco-lumber (ThL) spinal cord in a rodent model of impact acceleration of TBI of varying severities. Rats were transcardially fixed with aldehydes at 2, 6, and 24 h post-injury (n � 36); each group included on sham-injured rodent. Semi-serial vibratome sections were reacted with antibodies targeting TAI via alteration in cytoskeletal integrity or impaired axonal transport. Consistent with previous observations in this model, the CCJ contained numerous injured axons. Immunoreactive, damaged axonal profiles were also detected as caudal, as the ThL spinal cord displayed morphological characteristics entirely consistent with those described in the brainstem and the CCJ. Quantitative analyses demonstrated that the occurrence and extent of TAI is positively associated with the impact/energy of injury and negatively with the distance from the brainstem. These observations show that TBI can evoke TAI in regions remote from the injury site, including the spinal cord itself. This finding is relevant to shaken baby syndrome as well as during the analysis of data in functional recovery in various models of TBI

Biomarkerek szerepe a koponya/agysérülés súlyosságának, kimenetelének és a therápia hatékonyságának megítélésében = The role of biomarkers in the assessment of injury-severity, outcome and therapeutic efficacy in traumatic brain injury

A kutatás legfőbb eredményei az alábbiak: 1., Elsőként igazoltuk, hogy a súlyos kopnyasérültek liquorában a traumától eltelt idővel összefüggésben intakt spectrin és lebontási termékei szaporodnak fel; ezek megjelenése a koponya sérülésre specifikus jelenségnek tekinthető, ráadásul e lebontási termékek koncentrációja valószínűsíthetően összefüggést mutat a koponyasérülés súlyosságával és a kimenetellel is. E vizsgálatok a Munkacsoport Department of Defense (US) támogatású multicentrikus klinikai tanulmány előkészítésében és kivitelezésében történő részvételét eredményezték. 2., Patkány kísérletes traumás modellben végzett experimentális therápiás vizsgálatok során a diffúz axon károsodás gátlását igazoltuk posttraumás pituitary adenylate cyclase activating peptide adásával impakt akcelerációs és centralis folyadék percussiós modellen. 3., Elsőként írtuk le a különböző súlyosságú koponyasérülés hatására a gerincvelőben létrejövő diffúz axonális károsodás jelenségét. 4. A klinikai adatbázis feldolgozása során a morbiditási-mortalitási esélyeket meghatározó, az intézményi ellátás auditálására is lehetőséget nyújtó, a Marshall score és a Rotterdam score validálásán, továbbfejlesztésén alapuló CT-klasszifikációs rendszert dolgoztunk ki. A három éves kutatómunka során 20 közlemény, könyvfejezet és kongresszusi kivonat született, a peer reviewed közlemények kumulatív impakt faktora 17 feletti. | Major achievements of the project are the following: 1., We have provided the first evidence that traumatic brain injury in human leads to the accumulation of intact spectrin and its? breakdown products and that the appearance of these substances in the cerebrospinal fluid follows a well defined temporal pattern while also associated with injury severity and most probably with outcome, too. 2., Posttraumatic application of pituitary adenylate cyclase activating peptide resulted in the inhibition of diffuse axonal injury both in the impact acceleration- as well as the central fluid percussion model of diffuse traumatic brain injury in rats. 3., These studies provided the first description of diffuse axonal injury in the spinal cord evoked by/associated with diffuse traumatic brain injury of various severity. 4., We have developed a new scoring system based upon the first posttraumatic non-contrast skull CT scan that is capable of predicting outcome and represents an updated version and combination of the Rotterdam-score and the Marshall-classification. This three-years project led to the accumulation of 20 publications of various forms including peer reviewed articles with an impact factor of over 17

Kinetics of the cellular immune response following closed head injury

Background Tube-feeding or nutritional support is a therapy for people who can’t get enough nutrition by eating or drinking. You may need it if you have difficulty swallowing, loss of appetite, are severely malnourished or have inability to absorb nutrients through your digestive system. There are several diagnoses associated with tube-feeding, depending on the persons diagnose and users state the user can be tied to the tube-feeding equipment from 3 to 18 hours a day. In Sweden there are around 1500-3000 adults in need of tube-feeding outside the hospitals.   Method This report is made by Cindy Sjöblom and is an individual student’s work. The project is her dissertation and final project at the two year Masters program Advanced Product Design at Umeå Institute of Design. The project has been executed during 20 weeks the spring 2015. The project is based on the design process which includes the following phases; Research & Analysing, Ideation & Concept’s and Detailing & Visualization. The Research & Analysis phase has included; Product analysis, user interviews & observations, market outlook, anatomical knowledge, problem listing and opportunity findings. The Ideation & Concept’s phase has included; Inspiration, persona creation, creative workshop, sketching, concepts creation, mock-up building, user testing & feedback. The Detailing & Visualization phase has included; 3D modelling, moodboard creation, sketching, final model building, photo shooting, video recording, documentation, presentation and a poster and exhibition stand at Umeå Institute of Design and at Semcon, Gothenburg. Result Tubie is an ambulatory tube-feeding system to facilitate an active everyday life for people in need of enteral nutrition. Tubie consists out of six parts; A nutrition pump and a wireless charging station, a nutrition bag and an external tubing, a wearable waist band and an application for a smart device to be able to control the pump. Unlike traditional enteral nutritions systems, Tubie is designed with a focus on the users in a home environment and their need for a more active lifestyle and discreet usage in social environments. Tubie is simply discreet due to its wearable features that allows the user to wear it underneath the clothing as well as control the pump via a smart device with an adaptable pre-alarm that sounds like any other text message or ring tone

CSF and Plasma Amyloid-beta Temporal Profiles and Relationships with Neurological Status and Mortality after Severe Traumatic Brain Injury

The role of amyloid-β (Aβ) neuropathology and its significant changes in biofluids after traumatic brain injury (TBI) is still debated. We used ultrasensitive digital ELISA approach to assess amyloid-β1-42 (Aβ42) concentrations and time-course in cerebrospinal fluid (CSF) and in plasma of patients with severe TBI and investigated their relationship to injury characteristics, neurological status and clinical outcome. We found decreased CSF Aβ42 levels in TBI patients acutely after injury with lower levels in patients who died 6 months post-injury than in survivors. Conversely, plasma Aβ42 levels were significantly increased in TBI with lower levels in patients who survived. A trend analysis showed that both CSF and plasma Aβ42 levels strongly correlated with mortality. A positive correlation between changes in CSF Aβ42 concentrations and neurological status as assessed by Glasgow Coma Scale (GCS) was identified. Our results suggest that determination of Aβ42 may be valuable to obtain prognostic information in patients with severe TBI as well as in monitoring the response of the brain to injury

Minimálisan invazív, endoszkóppal asszisztált, transcribriform reszekció a koponyaalap rosszindulatú daganatainak sebészetében = Minimally invasive endoscopic transcribriform resection of malignant lesions of the skull base

Absztrakt: Bevezetés: A koponyaalapot is érintő rosszindulatú sinonasalis daganatok legtöbb típusa sebészi ellátást tesz szükségessé. Az esetek nagy részében ma már lehetőség nyílik minimálisan invazív, craniofacialis külső feltárás nélküli, endoszkópos műtétet végezni. Célkitűzés: Közleményünkben a koponyaalapot destruáló rosszindulatú daganatok sebészi megoldása céljából alkalmazott endoszkópos transcribriform feltárással szerzett tapasztalatainkról számolunk be. Módszer: 2015. február és 2017. július között négy férfi és 1 nőbetegen hajtottunk végre műtétet. Az átlagéletkor 64,6 év volt (59–70, medián: 66). Minden műtét az orrüregen keresztül, minimálisan invazív behatolással, endoszkópos vizualizáció mellett történt, a koponyaalap transcribriform feltárásával és reszekciójával. A műtét indikációját 2 esetben Kadish szerinti C-stádiumú esthesioneuroblastoma, 1 esetben T3N0 sinonasalis nem differenciált carcinoma, 1 esetben T1N0 intestinalis típusú adenocarcinoma, illetve további 1 esetben T4N0-laphámcarcinoma képezte. Eredmények: A betegek követési ideje 14 és 46 hónap között alakult, átlagosan 22,8 hónap volt. A műtétek során intraoperatív szövődmény nem lépett fel. A posztoperatív időszakban egy beteg esetében liquorrhoea, illetve emellett pneumocephalus alakult ki, melyek lumbalis drenázs alkalmazása és konzervatív kezelés mellett rendeződtek. Az utánkövetés során egyik beteg esetében sem észleltünk recidívát. Következtetés: Az elülső koponyaalap rosszindulatú daganatainak sebészi megoldásaként az endoszkópos, transnasalis, transcribriform feltárással végzett reszekció kiváló alternatívája a külső feltárásból végzett műtéteknek a biztonságos kivitelezhetőség és a megfelelő onkológiai eredmény elérésének szempontjából is. Orv Hetil. 2019; 160(40): 1584–1590. | Abstract: Introduction: Malignant tumours of the sinonasal region – including those with invasion of the skull base – necessitate surgical resection. The majority of the cases give an opportunity to perform the procedure via minimally invasive, endoscopic approach, without external, craniofacial surgery. Aim: To assess our clinical experience in treating anterior skull base malignancies, performing minimally invasive endoscopic transcribriform resection. Method: Between February 2015 and July 2017, four male and one female patient underwent minimally invasive, endoscopic skull base procedure. The mean age was 64.6 years (59–70, median: 66). Every surgery was performed via transnasal, endoscopic transcribriform approach. In two cases Kadish C esthesioneuroblastomas, while in one case a T3N0 sinonasal non-differentiated carcinoma, a T1N0 intestinal type adenocarcinoma and a T4N0 squamous cell carcinoma was the indication of surgery, respectively. Results: The mean follow-up time was 22.8 months, between 14 and 46 months. Intraoperative complications did not occur during the procedures. Regarding the postoperative period, liquorrhoea and pneumocephalus occurred in one case. Complications were solved with lumbar drainage. During follow-up, neither residual nor recurrent tumour was observed in our patients. Conclusion: Endoscopic transcribriform resection of the skull base malignancies is a safe and viable alternative to the traditional open approach. Orv Hetil. 2019; 160(40): 1584–1590

Finite element reconstruction of decompressive craniectomy

Traumatic brain injuries (TBIs) have a devastating global epidemiological importance since they contribute to the mortality and morbidity in the society with a considerably large extent. After TBI the injured brain tissue tends to swell leading to the increment of the intracranial pressure (ICP) which can cause serious neurological damage and death. Therefore, a main goal of the neurosurgical procedure is the reduction of ICP which is possible via decompressive craniectomy (DC). However, its optimal execution regarding the size and the location of the skull opening is controversial. In this paper the reconstruction of DC is performed by finite element (FE) simulations. The applied modelling strategy is presented and patient-specific FE models are constructed with different levels of anatomic details which can predict the post-operative response of the brain tissue for a given pre-operative state. These models are validated by reconstructing real life DC case, where the predicted displacements and ICP are compared to their observed value measured by neurosurgeons. Results confirm the applicability of the above described modelling procedure, implying that such models can be used to optimize DC in the future based on the biomechanical response of the highly deformable brain tissue

Single Mild Traumatic Brain Injury Induces Persistent Disruption of the Blood-Brain Barrier, Neuroinflammation and Cognitive Decline in Hypertensive Rats

Traumatic brain injury (TBI) induces blood-brain barrier (BBB) disruption, which contributes to secondary injury of brain tissue and development of chronic cognitive decline. However, single mild (m)TBI, the most frequent form of brain trauma disrupts the BBB only transiently. We hypothesized, that co-morbid conditions exacerbate persistent BBB disruption after mTBI leading to long term cognitive dysfunction. Since hypertension is the most important cerebrovascular risk factor in populations prone to mild brain trauma, we induced mTBI in normotensive Wistar and spontaneously hypertensive rats (SHR) and we assessed BBB permeability, extravasation of blood-borne substances, neuroinflammation and cognitive function two weeks after trauma. We found that mTBI induced a significant BBB disruption two weeks after trauma in SHRs but not in normotensive Wistar rats, which was associated with a significant accumulation of fibrin and increased neuronal expression of inflammatory cytokines TNFα, IL-1β and IL-6 in the cortex and hippocampus. SHRs showed impaired learning and memory two weeks after mild TBI, whereas cognitive function of normotensive Wistar rats remained intact. Future studies should establish the mechanisms through which hypertension and mild TBI interact to promote persistent BBB disruption, neuroinflammation and cognitive decline to provide neuroprotection and improve cognitive function in patients with mTBI