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621. Head CT Guidelines Following Concussion among the Youngest Trauma Patients: Can We Limit Radiation Exposure Following Traumatic Brain Injury? Full Text available with Trip Pro

, head injury characteristics, clinical indicators for head CT scan (severe mechanism, physical exam findings of basilar skull fracture, non-frontal scalp hematoma, Glasgow Coma Scale score, loss of consciousness, neurologic deficit, altered mental status, vomiting, headache, amnesia, irritability, behavioral changes, seizures, lethargy), CT results, and hospital course were collected.One-hundred thirty-three patients (78.2%) received a head CT scan, 7 (5.3%) of which demonstrated fractures

2018 Kansas Journal of Medicine

622. Corneal Cap Thickness and Its Effect on Visual Acuity and Corneal Biomechanics in Eyes Undergoing Small Incision Lenticule Extraction Full Text available with Trip Pro

) and a refractive spherical equivalent of -3.00 D to -8.00 D were included. It was designed randomly to undergo SMILE with a 110 μm cap thickness in one eye and 150 μm cap thickness in the other. Ophthalmic examinations included best-corrected and uncorrected visual acuity (UCVA); refractive status, contrast sensitivity, and objective visual quality were evaluated at 2 h, 4 h, and 24 h postoperatively; while at 3 months after the procedure, corrected intraocular pressure (IOP), higher order aberrations (HOAs (...) and corrected IOP by Corvis ST were significantly higher in the 110 μm group at 3 months postoperatively (P < 0.05). No statistically significant differences were found in manifest refraction, UCVA, SR, OSI, MTF cutoff, and mesopic and photopic contrast sensitivity at low frequency, photopic contrast sensitivity at high frequency, endothelial density, corneal coma, and total HOAs at 3 months after the procedure. No visual decline was found in the patients in this study.Both 110 μm and 150 μm cap thickness

2018 Journal of ophthalmology Controlled trial quality: uncertain

623. Effects of salvianolic acid on cerebral perfusion in patients after acute stroke: A single-center randomized controlled trial Full Text available with Trip Pro

Effects of salvianolic acid on cerebral perfusion in patients after acute stroke: A single-center randomized controlled trial Hypoperfusion following acute stroke is common in the infarct core and periphery tissues. The present study evaluated the efficacy of salvianolic acid (SA) on the cerebral perfusion of patients who had suffered from acute stroke using perfusion-weighted magnetic resonance imaging (PWI) to examine the blood perfusion of the affected brain tissue prior to and following (...) treatment. Patients who were admitted to PLA 153 Central Hospital within 72 h of acute stroke symptom onset and had a Glasgow coma scale ≥5 were randomized into two groups: SA and control groups. Patients in the SA group were administered SA 0.13 g/day for 14 days. PWI was performed for all patients at admission and post-treatment. The National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were applied to assess neurological function at admission and 3 months post treatment

2018 Experimental and therapeutic medicine Controlled trial quality: uncertain

624. Association Of Seizure Occurrence With Aneurysm Treatment Modality In Aneurysmal Subarachnoid Hemorrhage Patients Full Text available with Trip Pro

Association Of Seizure Occurrence With Aneurysm Treatment Modality In Aneurysmal Subarachnoid Hemorrhage Patients Data on new-onset seizures after treatment of aneurysmal subarachnoid hemorrhage (aSAH) patients are limited and variable. We examined the association between new-onset seizures after aSAH and aneurysm treatment modality, as well their relationship with initial clinical severity of aSAH and outcomes.This is a retrospective cohort study of all aSAH patients admitted to our (...) institution over a 6-year period. 'Seizures' were defined as any observed clinical seizure or electrographic seizure on continuous electroencephalogram (cEEG) recordings, as determined by the reviewing neurophysiologist. Subgroup analyses were performed in low-grade (Hunt-Hess 1-3) and high-grade (Hunt-Hess 4-5) patients. Outcomes measures were Glasgow Coma Score (GCS) at intensive care unit (ICU) discharge and modified Rankin Scale (mRS) at outpatient follow-up.There were 282 patients with aSAH; 203

2018 Neurocritical care

625. Natural History of Isolated Skull Fractures in Children Full Text available with Trip Pro

for the elevation of the depressed skull fracture. Analyzing the NTDB yielded similar results. In 5,194 children with isolated SFs and a normal neurological examination on presentation, there were no fatalities and 249 (4.8%) required neurosurgical intervention, almost all involving craniotomy/craniectomy and/or elevation of the SF segments. In conclusion, children with non-depressed isolated skull fractures and a normal Glasgow coma scale (GCS) at the time of initial presentation are at extremely low risk (...) Natural History of Isolated Skull Fractures in Children Head injury is the most common cause of neurologic disability and mortality in children. We had hypothesized that in children with isolated skull fractures (SFs) and a normal neurological examination on presentation, the risk of neurosurgical intervention is very low. We retrospectively reviewed the medical records of all children aged six to sixteen years presenting to our Level 1 trauma center with traumatic brain injuries between

2018 Cureus

626. Therapeutic hypothermia to reduce intracranial pressure after traumatic brain injury: the Eurotherm3235 RCT. Full Text available with Trip Pro

Therapeutic hypothermia to reduce intracranial pressure after traumatic brain injury: the Eurotherm3235 RCT. Traumatic brain injury (TBI) is a major cause of disability and death in young adults worldwide. It results in around 1 million hospital admissions annually in the European Union (EU), causes a majority of the 50,000 deaths from road traffic accidents and leaves a further ≈10,000 people severely disabled.The Eurotherm3235 Trial was a pragmatic trial examining the effectiveness (...) hypothermia.The primary outcome measure was the GOSE [range 1 (dead) to 8 (upper good recovery)] at 6 months after the injury as assessed by an independent collaborator, blind to the intervention. A priori subgroup analysis tested the relationship between minimisation factors including being aged < 45 years, having a post-resuscitation Glasgow Coma Scale (GCS) motor score of < 2 on admission, having a time from injury of < 12 hours and patient outcome.We enrolled 387 patients from 47 centres in 18 countries

2018 Health technology assessment (Winchester, England) Controlled trial quality: predicted high

627. Effects of 20 Hz Repetitive Transcranial Magnetic Stimulation on Disorders of Consciousness: A Resting-State Electroencephalography Study Full Text available with Trip Pro

Effects of 20 Hz Repetitive Transcranial Magnetic Stimulation on Disorders of Consciousness: A Resting-State Electroencephalography Study Repetitive transcranial magnetic stimulation (rTMS) has been proposed as an experimental approach for the treatment of disorders of consciousness (DOC). To date, there has been little research into the use of rTMS in DOC and the therapeutic effects have been variously documented. This study aimed to examine the effects of 20 Hz rTMS (...) on the electroencephalography (EEG) reactivity and clinical response in patients with DOC and to explore the neuromodulatory effects of high-frequency rTMS. In this randomized, sham-controlled, crossover study, real or sham 20 Hz rTMS was applied to the left primary motor cortex (M1) of patients with DOC for 5 consecutive days. Evaluations were blindly performed at the baseline (T0), immediately after the end of the 5 days of treatment (T1) and 1 week after the treatment (T2) using the JFK coma recovery scale-revised (CRS

2018 Neural plasticity Controlled trial quality: uncertain

628. Non-invasive Ventilation Versus High Flow Oxygen

, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: Diagnosis of pneumonia based on at least two clinical/laboratory criteria and 1 radiologic criterion among the following: Clinical criteria: fever, cough, purulent sputum, pulmonary examination positive for signs consistent with pneumonia Laboratory criteria: leukocytosis (White blood cells >10000/mcL) or leukopenia (White blood cells < 4000/mcL), rise of the inflammatory markers Radiologic (...) respiratory failure - e.g. pulmonary embolism, acute respiratory distress syndrome (ARDS), pulmonary oedema Hemodynamic instability with necessity for use of inotropes and/or vasopressors Indication for endotracheal intubation (ETI): Glasgow Coma Scale (GCS) <8, agitation, device intolerance, respiratory arrest Immunosuppression (chronic immunosuppressive therapy, clinical history positive for any immunodeficiency - congenital or acquired) Do Not Resuscitate (DNR) and Do Not Intubate (DNI) indication

2018 Clinical Trials

629. Cerebral Aneurysms in Judicial Precedents Full Text available with Trip Pro

Cerebral Aneurysms in Judicial Precedents From November 30, 2016, the Korean Government carried the revised Medical Dispute Mediation and Arbitration Act into effect. Mediation will start automatically without agreements of the defendant, when the outcome of the patient was death, coma more than a month or severe disability. Cerebral aneurysm has a definite risk of bad outcome, especially in the worst condition. Any surgical intervention to this lesion has its own high risk of complications (...) of the independent medical examination. To avoid medical disputes, shared decision making seems to be useful, especially in cases of high risk condition or procedures.

2018 Journal of Korean Neurosurgical Society

630. Delayed Post-hypoxic Leukoencephalopathy: A Case Series and Review of the Literature Full Text available with Trip Pro

by a recovery phase with subsequent delayed clinical decline. Patient 1 suffered hypoxia from drug-induced respiratory depression and lack of post-operative positive airway pressure (PAP) support. Her neurological exam on follow-up revealed progressive cognitive decline. Magnetic resonance imaging (MRI) brain showed bilateral white matter changes involving the centrum semiovale. Patient 2 developed a generalized tonic-clonic seizure during an endobronchial biopsy procedure and was found to have multiple air (...) emboli on computed tomography (CT) head scan. She was initially in a drug-induced coma for her seizures. Electroencephalography (EEG) on day 14 of admission showed changes consistent with diffuse encephalopathy. MRI brain showed bilateral white matter changes particularly at the watershed zones and in the centrum semiovale. DPHL is a rare and under-recognized clinical entity that requires clinical suspicion and detailed evaluation for diagnosis. Neuroimaging studies can provide prognostic information

2018 Cureus

631. Neuregulin-1 attenuates experimental cerebral malaria (ECM) pathogenesis by regulating ErbB4/AKT/STAT3 signaling Full Text available with Trip Pro

Neuregulin-1 attenuates experimental cerebral malaria (ECM) pathogenesis by regulating ErbB4/AKT/STAT3 signaling Human cerebral malaria (HCM) is a severe form of malaria characterized by sequestration of infected erythrocytes (IRBCs) in brain microvessels, increased levels of circulating free heme and pro-inflammatory cytokines and chemokines, brain swelling, vascular dysfunction, coma, and increased mortality. Neuregulin-1β (NRG-1) encoded by the gene NRG1, is a member of a family (...) tissue damage.In the current study, we examined how NRG-1 treatment attenuates pathogenesis and mortality associated with ECM. We examined whether NRG-1 protects against CXCL10- and heme-induced apoptosis using human brain microvascular endothelial (hCMEC/D3) cells and M059K neuroglial cells. hCMEC/D3 cells grown in a monolayer and a co-culture system with 30 μM heme and NRG-1 (100 ng/ml) were used to examine the role of NRG-1 on blood brain barrier (BBB) integrity. Using the in vivo ECM model, we

2018 Journal of neuroinflammation

632. Emotional reserve and prolonged post-concussive symptoms and disability: a Swedish prospective 1-year mild traumatic brain injury cohort study. Full Text available with Trip Pro

Emotional reserve and prolonged post-concussive symptoms and disability: a Swedish prospective 1-year mild traumatic brain injury cohort study. Prolonged post-concussive symptoms (PCS) affect a significant minority of patients withmild traumatic brain injury (mTBI). The aetiology is multifactorial depending on preinjury as well as peri-injury and postinjury factors. In this study, we examine outcome from an emotional reserve perspective.Prospective cohort study.Patients were recruited from (...) three emergency departments in major university hospitals in Stockholm, Sweden. Follow-up data were collected in an outpatient setting at one of the recruiting hospitals.122 patients with a history of blunt head trauma (aged 15-65 years; admitted for mTBI within 24 hours after trauma (Glasgow Coma Scale score of 14-15, loss of consciousness <30 min and/or post-traumatic amnesia <24 hours). Exclusion criteria were other significant physical injury and other major neurological disorder, including

2018 BMJ open

633. Predictors of Severe Clinical Course in Children With Carbon Monoxide Poisoning. (Abstract)

in the acute phase of poisoning.A total of 331 patients diagnosed with CO poisoning in Hacettepe University Children's Hospital, Pediatric Emergency Unit, between January 2004 and March 2014 were included in the study. Their demographic characteristics, presenting complaints, physical examination findings, Glasgow Coma Scale scores, carboxyhemoglobin, leukocyte, hemoglobin, troponin T, pH and lactate levels, type of treatment (normobaric or hyperbaric oxygen), intensive care unit admissions, and outcome (...) of poisoning were investigated.Ninety-three patients were given hyperbaric oxygen. Fifty-one patients were admitted to the pediatric intensive care unit, 18 patients have had a severe clinical course, and 6 patients have died. The risk factors associated with severe disease course were determined to be low Glasgow Coma Scale score, high leukocyte count, and high troponin T levels at presentation.Glasgow Coma Scale score, leukocyte count, and troponin T level may be beneficial in predicting clinical

2018 Pediatric Emergency Care

634. Comparison of Outcomes in DeBakey Type AI Versus AII Aortic Dissection. (Abstract)

Comparison of Outcomes in DeBakey Type AI Versus AII Aortic Dissection. The DeBakey classification divides type A acute aortic dissection (AAD) into type I and type II; the latter limited to the ascending aorta. We endeavored to examine differences in DeBakey groups in a contemporary registry. We divided 1,872 patients with noniatrogenic AAD from the International Registry of Acute Aortic Dissection into type I (n = 1691, 90.3%) and type II (n = 181, 9.7%). Patients with type II AAD were older (...) . On presentation, patients with type I AAD reported more back and abdominal pain and were more likely to have pulse deficit. Intramural hematoma was more frequent in type II AAD. Most patients with both types were treated surgically. Lower rates of renal failure, coma, mesenteric and limb ischemia were noted in those with type II AAD. In-hospital death was less frequent (16.6% vs 22.5%) after type II AAD, a trend that did not reach significance. There was no difference in the incidence of new dissection, rapid

2018 American Journal of Cardiology

635. Retrospective analysis of alcohol testing in trauma team activation patients at a Canadian tertiary trauma centre. Full Text available with Trip Pro

, and to elucidate patient-level, injury-level and system-level factors associated with BAC testing.Retrospective cohort study.Tertiary trauma centre in Halifax, Canada.2306 trauma patients who required activation of the trauma team.The primary outcome was the rate of BAC testing among TTA patients. Trends in BAC testing over time and across patient and injury characteristics were described. Multivariable logistic regression examined patient-level, injury-level and system-level factors associated (...) with testing.Overall, 61% of TTA patients received BAC testing despite existence of a mandatory testing protocol. Rates of BAC testing rose steadily over the study period from 33% in 2000 to 85% in 2010. Testing varied considerably across patient-level, injury-level and system-level characteristics. Key factors associated with testing were male gender, younger age, lower Injury Severity Score, scene Glasgow Coma Scale score <9, direct transport to hospital and presentation between midnight and 09:00 hours

2018 BMJ open

636. Disagreement Between Clinicians and Score in Decision-Making Capacity of Critically Ill Patients. (Abstract)

Disagreement Between Clinicians and Score in Decision-Making Capacity of Critically Ill Patients. To compare the assessment of decision-making capacity of ICU patients by attending clinicians (physicians, nurses, and residents) with a capacity score measured by the Mini-Mental Status Examination, completed by Aid to Capacity Evaluation if necessary. The primary outcome was agreement between physicians' assessments and the score. Secondary outcomes were agreement between nurses' or residents (...) decision-making capacity (n = 92/206 [45%]) than score (n = 34/206 [17%]; absolute difference 28% [95% CI, 20-37%]; p = 0.001). There was a high disagreement between assessments of all clinicians and score (Kappa coefficient 0.39 [95% CI, 0.29-0.50] for physicians; 0.39 [95% CI, 0.27-0.52] for nurses; and 0.46 [95% CI, 0.35-0.58] for residents). The main factor associated with disagreement was a Glasgow Coma Scale score between 10 and 15 (odds ratio, 2.92 [1.18-7.19], p = 0.02 for physicians; 4.97

2018 Critical Care Medicine

637. Traumatic Minor Intracranial Hemorrhage: Management by Non-neurosurgeon Consultants in a Regional Trauma Center is Safe and Effective. (Abstract)

Traumatic Minor Intracranial Hemorrhage: Management by Non-neurosurgeon Consultants in a Regional Trauma Center is Safe and Effective. There is debate concerning the need for specialist neurosurgical transfer of patients presenting to Level II trauma centers with a minimal head injury (Glasgow Coma Scale ≥13) and a small non-progressive intracranial bleeding (ICB).A retrospective chart analysis was performed assessing the outcomes of adult patients presenting with a minor traumatic ICB (...) on initial CT scan (minimal subarachnoid hemorrhage; small-width subdural hematoma without shift; punctate cerebral contusion). Patients with extradural hematomas and those patients on antiplatelet or anticoagulant therapy were excluded from the protocol.Overall 291 cases were assessed (mean age 69.9 years) with 75% of cases presenting after a fall. There was deterioration of neurological status in 11 patients (3.8%) with 8 hospital transfers and 5 with an abnormal neurological examination (NE). Two

2018 World Journal of Surgery

638. Treatment of Insomnia for Adolescents With Mild Traumatic Brain Injury

of this study is to examine the treatment of sleep disturbance using cognitive-behavioural therapy for insomnia (CBT-I) in those adolescents who have a protracted recovery from their mTBI. This represents a novel treatment option for this patient population and is anticipated to improve outcomes and quality of life. Condition or disease Intervention/treatment Phase Mild Traumatic Brain Injury Post-Concussion Syndrome Insomnia Behavioral: Cognitive Behavioural Therapy for Insomnia Not Applicable Study Design (...) -weeks later) ] The PSQI is a widely used brief self-report measure of sleep quality aimed at examining the facets of sleep disturbance. It is composed of 19 items that measure sleep disruptions in the month prior to questionnaire completion. The PSQI contains seven subscales: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medications, and daytime dysfunction, which are combined into a total sleep quality score. The total PSQI raw

2018 Clinical Trials

639. Is There a Benefit of Whole Body Computed Tomography (WBCT) for Patients With Only High Velocity Road Traffic Collision (RTC) Vittel Criteria?

Vittel criteria of gravity, normal clinical examination of the thorax, abdomen and pelvis and Glasgow Coma Scale (GCS) score of 15. Criteria Inclusion Criteria: Consecutives patients consulting the emergency department between August 1st 2016 and July 31th 2017 : Older than 18 y.o. WBCT performed, Victim of a high velocity RTC as defined by the presence of at least one criteria of the kinetics elements of the Vittel Criteria Normal physical exam of the chest, abdomen and pelvis, GCS score of 15 (...) . ClinicalTrials.gov Identifier: NCT03679416 Recruitment Status : Completed First Posted : September 20, 2018 Last Update Posted : September 25, 2018 Sponsor: Rennes University Hospital Information provided by (Responsible Party): Rennes University Hospital Study Details Study Description Go to Brief Summary: For victims of high velocity RTC, with no other Vittel criteria of gravity, normal clinical examination of the thorax, abdomen and pelvis and Glasgow Coma Scale (GCS) score of 15 : Study of clinically

2018 Clinical Trials

640. Weaning Algorithm for Mechanical VEntilation

one year after hospital discharge, up to 24 months. ] -Sf-36 Health Related Quality of life (patient and carers) EQ-5D-5L [ Time Frame: Until one year after hospital discharge, up to 24 months. ] EQ-5D-5L St George's Respiratory Questionnaire [ Time Frame: Until one year after hospital discharge, up to 24 months. ] St George's Respiratory Questionnaire mini Mental State examination [ Time Frame: Until one year after hospital discharge, up to 24 months. ] mini Mental State examination PTSS-14 (...) on screening. Respiratory failure likely requiring extracorporeal support. Severe cardiogenic shock likely requiring extracorporeal support. Severe isolated right heart failure. Head trauma or other conditions where intra-cranial pressure may be elevated and tight regulation of arterial CO2 level is paramount. Primary (non-overdose related) neurological patients (Glasgow coma score <10, neurologic damage with limited prognosis, stroke hemiplegia). End stage liver disease. Repeated ICU admission within same

2018 Clinical Trials

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