Ability of S100B to predict post-concussion syndrome in paediatric patients who present to the emergency department with mild traumatic brain injury.

INTRODUCTION: Among children who sustain mild traumatic brain injury (mTBI), 10-30% develop a cluster of cognitive, physical, and emotional symptoms commonly referred to as post-concussion syndrome (PCS). Symptoms typically resolve within 7-10 days, but a minority of patients report symptoms that persist for months or even years. The aim of our study was to identify a neurobiochemical marker after mTBI that can predict the presence of post-concussion syndrome three months after head injury in paediatric patients. MATERIALS AND METHODS: Children between 7 and 16 years of age who had head trauma and no other complaints were included. Three months after the initial visit, participants or parents/guardians were interviewed in person about the children's PCS symptoms using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). RESULTS: The mean value of S100B protein in serum in 38 patients without signs of PCS was 0.266 µg L-1, with a 95% confidence interval (CI) of 0.221 - 0.310 µg L-1. Among the 22 patients with signs of PCS, the mean value of S100B protein in serum was 0.845 µg L-1, with a 95% CI of 0.745-0.945 µg L-1. Patients with signs of PCS had higher S100B protein levels than those without signs of PCS (p < 0.0001). CONCLUSIONS: Our prospective study showed that S100B protein is a useful neurobiomarker for detecting paediatric patients at risk for post-concussion syndrome. We found that the biomarker S100B correlated with the severity of traumatic brain injury (number of lesions on CT) and the presence of post-concussion syndrome.

Serum S100B Levels Can Predict Computed Tomography Findings in Paediatric Patients with Mild Head Injury.

INTRODUCTION: Traumatic brain injuries (TBIs) are very common in paediatric populations, in which they are also a leading cause of death. Computed tomography (CT) overuse in these populations results in ionization radiation exposure, which can lead to lethal malignancies. The aims of this study were to investigate the accuracy of serum S100B levels with respect to the detection of cranial injury in children with mild TBI and to determine whether decisions regarding the performance of CT can be made based on biomarker levels alone. MATERIALS AND METHODS: This was a single-center prospective cohort study that was carried out from December 2016 to December 2017. A total of 80 children with mild TBI who met the inclusion criteria were included in the study. The patients were between 2 and 16 years of age. We determined S100B protein levels and performed head CTs in all the patients. RESULTS: Patients with cranial injury, as detected by CT, had higher S100B protein levels than those without cranial injury (p < 0.0001). We found that patients with cranial injury (head CT+) had higher mean S100B protein levels (0.527 µg L-1, 95% confidence interval (CI) 0.447-0.607 µg L-1) than did patients without cranial injury (head CT-) (0.145 µg L-1, 95% CI 0.138-0.152 µg L-1). Receiver operating characteristic (ROC) curve analysis clearly showed that S100B protein levels differed between patients with and without cranial injury at 3 hours after TBI (AUC = 0.893, 95% CI 0.786-0.987, p = 0.0001). CONCLUSION: Serum S100B levels cannot replace clinical examinations or CT as tools for identifying paediatric patients with mild head injury; however, serum S100B levels can be used to identify low-risk patients to prevent such patients from being exposed to radiation unnecessarily.

Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008-2012.

BACKGROUND: Chronic subdural hematoma (CSDH) is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. MATERIALS AND METHODS: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008-2012. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Patients were analyzed in many aspects such as age, gender, etiological factors, clinical features, localization, diagnoses, methods of surgical interventions, recurrences and mortality of patients. RESULTS: From 137 patients with CSDH, 106 (77.3%) were males and 31 (22.7%) females. Average age of patients was 62.85 years. Analyzed according to the decades, the highest number of causes with CSDH was between 70 and 79 years (46%). The head trauma has been responsible for CSDH in 88 patients (64.3%), while the main symptom was headache (92 patients or 67.1%). One burr-hole trepanation with closed drainage system has been used in majority of cases (in 101 patients or 73.7%). The recurrence of CSDH was 6.5%, whereas mortality 2.9%. CONCLUSION: CSDH is more common in elderly patients. The male-female ratio is 3.4:1. Like other authors we also think that treatment with one burr-hole and drainage is a method of choice, because of its simplicity and safety.

Biomechanical properties of the sciatic nerve following repair: effects of topical application of hyaluronic acid or tacrolimus.

UNLABELLED: Recovery following nerve repair can be evaluated based on electrophysiological and morphological assessments of biomechanical properties. This study compared the effects of topical hyaluronic acid (HA), tacrolimus (FK-506) or saline administration on the biomechanical properties of the sciatic nerve at 12 weeks after nerve repair. MATERIALS AND METHODS: Eighteen male European rabbits (Oryctolagus cuniculus) (weight from 2.5 to 3 kg) were randomly assigned to one of the following experimental groups (six animals per group): Saline, HA, or FK-506. The non-transected left leg was used as a control group (eighteen sciatic nerves). Biomechanical assays were performed and statistically analyzed. RESULTS: The average maximal load, elastic limit load, maximal stress, and elastic limit strain of the control group were significantly different (P<0.001) from those of all three experimental groups. Moreover, the other examined parameters (i.e., maximal displacement, elastic limit stress, and maximal strain) were significantly different between the control group and all three experimental groups (P<0.0001). However, no significant differences in any of the biomechanical parameters were observed between the experimental groups (P>0.05). At 12 weeks after nerve repair, Saline, HA, and FK-506 groups displayed average maximal stress values that were 72.6%, 77.38%, and 73.8% of those in the control group (100%), respectively. CONCLUSION: The biomechanical properties of the HA and FK-506 groups were similar to those of the saline group at 12 weeks after nerve repair.

Electrophysiological and functional evaluation of peroneal nerve regeneration in rabbit following topical hyaluronic acid or tacrolimus application after nerve repair.

AIMS AND OBJECTIVES: To investigate and compare the effects of hyaluronic acid (HA), tacrolimus (FK-506) and saline on peripheral nerve regeneration in vivo after topical application at the site of nerve repair. MATERIALS AND METHODS: In the present study, 48 adult male European rabbits (Oryctolagus cuniculus), ranging in weight from 2.5 to 3 kg, were randomly assigned to three experimental groups: Group I (saline), Group II (HA) and Group III (FK-506). After transection and immediate repair of the right sciatic nerve of each rabbit, the nerve repair sites were wrapped with an absorbable gelatin sponge soaked that contained saline, HA and FK-506 in Groups I, II and III, respectively. The left hind leg was used as a control. To evaluate the effects of HA and FK-506 on nerve regeneration, electrophysiological measurements were acquired at 6 and 12 weeks after nerve repair and toe-spreading index (TSI) experiments were conducted at 4, 8 and 12 weeks after nerve repair. RESULTS: Motor nerve conduction velocity (MNCV) was improved in Groups II and III compared to Group I, but no differences between Groups II and III were observed. After 12 weeks, however, the MNCV in Groups I, II and III was 40.04%, 51.16% and 50.42%, respectively, of that in the control group (100%). In addition, at 12 weeks, Grade 4 TSI scores were observed in Groups II and III. CONCLUSION: Electrophysiological analyses and functional evaluations based on the TSI indicate that HA and FK-506 exert similar, positive effects on nerve regeneration that are superior to those observed in response to saline treatment.

Application of topical pharmacological agents at the site of peripheral nerve injury and methods used for evaluating the success of the regenerative process.

Traumatic injuries of the peripheral nerves are very common. Surgical repair of the damaged nerve is often complicated by scar tissue formation around the damaged nerve itself. The main objective of this study is to present the recent data from animal experimental studies where pharmacological topical agents are used at the site of peripheral nerve repair. Some of the most commonly topical agents used are tacrolimus (FK506), hyaluronic acid and its derivatives, and melatonin, whereas methylprednisolone and vitamin B12 have been used less. These studies have shown that the abovementioned substances have neuroprotective and neuroregenerative properties though different mechanisms. The successes of the regenerative process of the nerve repair in experimental research, using topical agents, can be evaluated using variety of methods such as morphological, electrophysiologic, and functional evaluation. However, most authors agree that despite good microsurgical repair and topical application of these substances, full regeneration and functional recovery of the nerve injured are almost never achieved.