Serum Amyloid A1/Toll-Like Receptor-4 Axis, an Important Link between Inflammation and Outcome of TBI Patients.

Traumatic brain injury (TBI) is one of the leading causes of mortality and disability worldwide without any validated biomarker or set of biomarkers to help the diagnosis and evaluation of the evolution/prognosis of TBI patients. To achieve this aim, a deeper knowledge of the biochemical and pathophysiological processes triggered after the trauma is essential. Here, we identified the serum amyloid A1 protein-Toll-like receptor 4 (SAA1-TLR4) axis as an important link between inflammation and the outcome of TBI patients. Using serum and mRNA from white blood cells (WBC) of TBI patients, we found a positive correlation between serum SAA1 levels and injury severity, as well as with the 6-month outcome of TBI patients. SAA1 levels also correlate with the presence of TLR4 mRNA in WBC. In vitro, we found that SAA1 contributes to inflammation via TLR4 activation that releases inflammatory cytokines, which in turn increases SAA1 levels, establishing a positive proinflammatory loop. In vivo, post-TBI treatment with the TLR4-antagonist TAK242 reduces SAA1 levels, improves neurobehavioral outcome, and prevents blood-brain barrier disruption. Our data support further evaluation of (i) post-TBI treatment in the presence of TLR4 inhibition for limiting TBI-induced damage and (ii) SAA1-TLR4 as a biomarker of injury progression in TBI patients.

Evaluation of smartphone-integrated magnetometers in detection of safe electromagnetic devices for use near programmable shunt valves: a proof-of-concept study.

OBJECTIVE: External magnetic forces can have an impact on programmable valve mechanisms and potentially alter the opening pressure. As wearable technology has begun to permeate mainstream living, there is a clear need to provide information regarding safety of these devices for use near a programmable valve (PV). The aim of this study was to evaluate the magnetic fields of reference devices using smartphone-integrated magnetometers and compare the results with published shunt tolerances. METHODS: Five smartphones from different manufacturers were used to evaluate the magnetic properties of various commonly used (n = 6) and newer-generation (n = 10) devices using measurements generated from the internal smartphone magnetometers. PV tolerance testing using calibrated magnets of varying field strengths was also performed by smartphone magnetometers. RESULTS: All tested smartphone-integrated magnetometers had a factory sensor saturation point at around 5000 µT or 50 Gauss (G). This is well below the threshold at which a magnet can potentially deprogram a shunt, based on manufacturer reports as well as the authors' experimental data with a threshold of more than 300 G. While many of the devices did saturate the smartphone sensors at the source, the magnetic flux density of the objects decreases significantly at 2 inches. CONCLUSIONS: The existence of an upper limit on the magnetometers of all the smartphones used, although well below the published deprogramming threshold for modern programmable valves, does not allow us to give precise recommendations on those devices that saturate the sensor. Based on the authors' experimental data using smartphone-integrated magnetometers, they concluded that devices that measure < 40 G can be used safely close to a PV.

Not all ventriculomegaly is created equal: diagnostic overview of fetal, neonatal and pediatric ventriculomegaly.

Fetal ventriculomegaly refers to a condition in which there is enlargement of the ventricular spaces, typically on prenatal ultrasound. It can be associated with other CNS or extra-CNS abnormalities, and this relationship is crucial to understand as it affects overall neonatal outcome. Isolated ventriculomegaly has been described in the literature with variable clinical outcome. Typically, outcome is based on the etiology and degree of ventriculomegaly. When associated with a pathologic condition, ventriculomegaly can be a result of hydrocephalus. While initial diagnosis is usually made on prenatal ultrasound, fetal magnetic resonance imaging is preferred to further elucidate any associated CNS malformations. In this paper, the authors aim to provide a comprehensive review of the diagnosis, associated etiologies, prognosis, and treatment options related to fetal, neonatal, and pediatric ventriculomegaly and hydrocephalus. In addition, preliminary data is provided from our institutional cohort of patients with a prenatal diagnosis of ventriculomegaly followed through the perinatal period.

Análisis de los factores que influyen en el resultado final del traumatismo craneal moderado / Analysis of the factors influencing the final outcome of moderate head injury

Introducción: El traumatismo craneoencefálico (TCE) es un fenómeno muy frecuente, asociado a elevadas tasas de morbilidad. Objetivo: Describir una serie amplia de pacientes adultos, mayores de 14 años, que sufren TCE moderado atendidos en el Hospital Universitario de Getafe, entre los años 2005 y 2015, estudiar el perfil epidemiológico y analizar el diagnóstico y el tratamiento efectuados, así como establecer los principales factores pronósticos que influyen en el resultado final. Método: Se ha realizado un estudio retrospectivo, de revisión de historias clínicas y entrevistas telefónicas. Resultados: Se ha estudiado un total de 66 pacientes que sufren TCE moderado. El TCE moderado es más frecuente en varones, y el mecanismo causante más común es el accidente de tráfico. Conclusiones: El presente estudio establece la necesidad de ingreso hospitalario, ya sea en planta de Neurocirugía o en la Unidad de Cuidados Intensivos (UCI), en función de la situación clínica del paciente y de los hallazgos radiológicos encontrados en la Tomografía Computarizada (TC). Las variables que han resultado determinantes de la evolución adversa en el paciente que sufre trauma craneal moderado son los hallazgos patológicos en la TC, la existencia de focalidad neurológica, la presencia de deterioro clínico, la edad avanzada, los hallazgos en la TC de control, y los atropellos, caídas e impactos directos como mecanismos causantes. Existe diferencia de pronóstico entre pacientes con puntuación de 11 y 12, con una evolución más parecida al del paciente que sufre trauma leve, y los que obtienen 9 y 10 puntos, con un pronóstico más similar al del trauma grave.

Introduction: Head injuries are very frequent and associated with high morbidity rates. This paper describes a large series of patients, all ≥14 years old, who suffered moderate head injuries and were treated at the University Hospital of Getafe, between 2005 and 2015 (n = 66). Our aims were (1) to examine patients' epidemiological profile; (2) to describe the best diagnostic and therapeutic measures performed; and (3) to identify the main determinants of final outcome. Methods: This was a combined retrospective and prospective study, consisting first of a review of medical records, followed by telephone interviews of eligible patients to determine final outcomes. Results: Sixty-six patients with moderate head injuries were studied. In this series, most patients were males, and the most common causative mechanism was a traffic accident. The needs for hospital admission, admission into the Neurosurgery service, and admission to Intensive Care Unit (ICU) were determined by patients' clinical presentation and radiological findings. Risk factors for a poor final neurological outcome were the presence of neurological defects during the initial clinical examination, findings on brain computerized tomography (CT), and patient age. The Glasgow Coma Scale was poor at predicting the final outcome in these patients with moderate head injuries, incapable of distinguishing between patients with a score of 11 or 12, more similar to mild trauma, and those with scores of 9 or 10 points, more similar to severe head trauma. Conclusions: In this series of adolescent and adult patients with moderate head injuries, the best predictors of final outcome were the initial presence/absence of neurological defects and CT findings, and patient age. The Glasgow Coma Scale was less useful.