(RSS) Karim's Weblog
Random snippets and thoughts - hopefully mostly trauma related!
Authors
- Karim Brohi
- trauma.org; London
(RSS) Trauma Research Blog
Selected new & juicy research papers, with editorial comment.
Authors
- Karim Brohi
- trauma.org; London
Recent Posts:
PubMed ID: 19627946
PM R. 2009 Jun;1(6):560-75
Authors: Devine JM, Zafonte RD.
Abstract:
OBJECTIVE: Physical exercise has been shown to play an ever-broadening role in the maintenance of overall health and has been implicated in the preservation of cognitive function in both healthy elderly and demented populations. Animal and human studies of acquired brain injury (ABI) from trauma or vascular causes also suggest a possible role for physical exercise in enhancing cognitive recovery. DATA SOURCES: A review of the literature was conducted to explore the current understanding of how physical exercise impacts the molecular, functional, and neuroanatomic status of both intact and brain-injured animals and humans. STUDY SELECTION: Searches of the MEDLINE, CINHAL, and PsychInfo databases yielded an extensive collection of animal studies of physical exercise in ABI. Animal studies strongly tie physical exercise to the upregulation of multiple neural growth factor pathways in brain-injured animals, resulting in both hippocampal neurogenesis and functional improvements in memory. DATA EXTRACTION: A search of the same databases for publications involving physical exercise in human subjects with ABI yielded 24 prospective and retrospective studies. DATA SYNTHESIS: Four of these evaluated cognitive outcomes in persons with ABI who were involved in physical exercise. Three studies cited a positive association between exercise and improvements in cognitive function, whereas one observed no effect. Human exercise interventions varied greatly in duration, intensity, and level of subject supervision, and tools for assessing neurocognitive changes were inconsistent. CONCLUSIONS: There is strong evidence in animal ABI models that physical exercise facilitates neurocognitive recovery. Physical exercise interventions are safe in the subacute and rehabilitative phases of recovery for humans with ABI. In light of strong evidence of positive effects in animal studies, more controlled, prospective human interventions are warranted to better explore the neurocognitive effects of physical exercise on persons with ABI.Notes & Commentary:
PubMed ID: 19479650
Ultrastruct Pathol. 2009;33(3):102-11
Authors: Castejon OJ
Abstract:
In a vascular anomaly showing moderate edema, the extracellular space appeared apparently normal, exhibiting a membrane to membrane space of about 20 nm in width. In congenital hydrocephalus, this space appeared notably enlarged and occupied by an electron transparent, nonproteinaceous interstitial edema fluid, due to abnormal accumulation of cerebrospinal fluid. In brain trauma, the distended extracellular space contained either electron-lucid nonproteinaceous or electron-dense proteinaceous edema fluid. Hemorrhagic foci, fibrinoid material, and non-nervous invading cells, such as macrophages and monocytes, were also found. In brain tumors, the widened extracellular space showed electron-dense proteinaceous edema fluid and bundles of fibrinoid material. The enlarged extracellular space found in congenital hydrocephalus, vascular anomalies, brain trauma, and tumors is closely related to the clinical symptoms exhibited by the patients under study.Notes & Commentary:
How simplistic our clinical view of traumatic brain injury is. We think only of intracranial pressure, perfusion pressure, and cerebral oxygen delivery & utilization. We understand cerebral oedema only as a hydrostatic effect to be treated with osmotic therapy. This study shows that cerebral oedema in traumatic brain injury is far from a simple fluid shift but is instead a complex phenomenon, probably containing a complex of proinflammatory and coagulant mediators of the innate immune system. We need to rapidly develop a more complex approach to our clinical understanding of these injuries if we are to make any progress in their management - progress which has been relatively disappointing over the past few decades.
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