Serum microRNAs associated with concussion in football players.

Mild Traumatic Brain Injury (mild TBI)/concussion is a common sports injury, especially common in football players. Repeated concussions are thought to lead to long-term brain damage including chronic traumatic encephalopathy (CTE). With the worldwide growing interest in studying sport-related concussion the search for biomarkers for early diagnosis and progression of neuronal injury has also became priority. MicroRNAs are short, non-coding RNAs that regulate gene expression post-transcriptionally. Due to their high stability in biological fluids, microRNAs can serve as biomarkers in a variety of diseases including pathologies of the nervous system. In this exploratory study, we have evaluated changes in the expression of selected serum miRNAs in collegiate football players obtained during a full practice and game season. We found a miRNA signature that can distinguish with good specificity and sensitivity players with concussions from non-concussed players. Furthermore, we found miRNAs associated with the acute phase (let-7c-5p, miR-16-5p, miR-181c-5p, miR-146a-5p, miR-154-5p, miR-431-5p, miR-151a-5p, miR-181d-5p, miR-487b-3p, miR-377-3p, miR-17-5p, miR-22-3p, and miR-126-5p) and those whose changes persist up to 4 months after concussion (miR-17-5p and miR-22-3p).

Minimally Invasive Management of Civilian Gunshot Wounds to the Lumbar Spine: A Case Series and Technical Report.

BACKGROUND: Treatment of penetrating gunshot wounds (GSW) to the spine remains controversial. The decision to operate is often based on surgeon preference and experience. We present a case series of 7 patients who underwent minimally invasive thoracolumbar/sacral decompression and bullet removal at a level 1 trauma center. OBJECTIVE: To describe the use of minimally invasive techniques to achieve decompression and bullet removal for GSW to the spine. METHODS: From 2010 to 2017, 7 patients with spinal GSW underwent minimally invasive decompression and bullet removal at an academic level 1 trauma center. RESULTS: Patient ages ranged from 20 to 55 yr (mean: 31 yr). The mechanisms of injury were GSW to the abdomen/pelvis (n = 6) and direct GSW to the spine (n = 1). Based on the neurological examination, the injuries were characterized as complete (n = 1) or incomplete (n = 6). Decompression and bullet removal were performed using a tubular retractor system. All patients with incomplete injuries who had postdischarge follow-up demonstrated some neurologic recovery. There were no postoperative wound infections, cerebrospinal fluid (CSF) fistulas, or other complications related to the procedure. CONCLUSION: Minimally invasive decompression and bullet removal is a safe technique that may help reduce the risk of postoperative infections and CSF fistulas in patients with GSW to the lumbar spine compared to the standard open technique. This approach appears to be particularly beneficial in patients with incomplete injuries and neuropathic pain refractory to medical treatment.

Racial Disparities in Cranial Gunshot Wounds: Intent and Survival.

BACKGROUND: Gunshot wounds (GSW) to the head are associated with the highest mortality of all gun-related injuries, with assault reported as the leading cause of penetrating GSW. Several studies have explored factors and trends related to assault and self-inflicted GSW separately. The aim of this study was to investigate epidemiological characteristics and racial differences collectively in patients with GSW to the head by examining associations to injury intent and survival. METHOD: A retrospective study was performed by accessing the hospital trauma registry at our regional Level 1 Trauma Center. A query of neurosurgery consults with penetrating trauma was completed from January 2008 to October 2013. Patients with penetrating intracranial GSW were included in the study. A chi-square test was used to evaluate association between patients' characteristics and intent of injury. Logistic regression analyses predicting intent of injury and survival were also conducted. RESULTS: Of 111 patients, the majority were male (87.4 %). Most were African American (57.7 %) and Caucasian (35.1 %). Compared to African Americans, Caucasian patients were more likely to inflict self-harm (odds ratio (OR) 16.369 (95 % confidence interval (CI) 5.633-47.571), p < 0.0001), while African Americans (OR 26.413 (95 % CI 8.957-77.890), p < 0.0001) were more likely to be victims of assault. Race and other demographic variables did not predict survival nor did intent of injury (p = 0.368). CONCLUSION: This study reports that there are racial disparities between assault GSW and self-inflicted GSW. However, neither race nor intent is a predictor of survival outcome. Targeted efforts are needed to reduce occurrence of cranial GSW events in order to decrease associated morbidity and mortality.

A 14-Year Review of Socioeconomics and Sociodemographics Relating to Intracerebral Abscess, Subdural Empyema, and Epidural Abscess in Southeastern Louisiana.

BACKGROUND: Secondary intracranial infections are a persistent health concern despite advancements in medicine and improvements in surgical care. Previous studies have reported on the incidence of infection and outcomes in the immunocompromised patient, yet few studies have investigated demographic elements linked to contracting a secondary intracranial infection, a preventable disease. OBJECTIVE: The aim of this study was to uniquely describe immunocompetent pediatric patients with secondary intracranial infections and further examine the socioeconomic and sociodemographic factors that may put them at higher risk of acquiring an infection. METHODS: A retrospective review was conducted for patients presenting with intracranial infections to the regional Children's Hospital between 2001 and 2014. Patients with a previous history of neurosurgical disease or procedure were excluded. A Z test for proportions was performed to detect significant variations between demographic groups. RESULTS: A total of 41 patients were included in the study sample. From 2001 to 2014, 63.4% of patients diagnosed with intracranial infections were white, and 36.5% were other/nonwhite. This incidence of infection varied significantly between white and nonwhite (P = .015). At Children's Hospital, 19.5% of patients were privately insured and 80.5% had public health insurance. The most notable variation of a secondary intracranial infection was health insurance; 51% of Louisiana children carry public insurance, yet they represent more than 80% of disease incidence (P < .001). CONCLUSION: Improving access to care and treatment for underinsured populations may contribute to a decrease in secondary intracranial infection cases. ABBREVIATIONS: CHD, congenital heart diseaseED, emergency departmentICD-9, International Classification of Diseases, Ninth RevisionRR, relative risk.