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  1. Article ; Online: Integration of Biomarkers Into a Signature Profile of Persistent Traumatic Brain Injury Involving Autoimmune Processes Following Water Hammer Injury From Repetitive Head Impacts

    Steven Kornguth / Neal Rutledge

    Biomarker Insights, Vol

    2018  Volume 13

    Abstract: Objectives: To assemble an algorithm that will describe a “Signature” predictive of an individual’s vulnerability to persistent traumatic brain injury (TBI) Subjects and Methods: Studies of athletes and warriors who are subjected to repeated head impacts ...

    Abstract Objectives: To assemble an algorithm that will describe a “Signature” predictive of an individual’s vulnerability to persistent traumatic brain injury (TBI) Subjects and Methods: Studies of athletes and warriors who are subjected to repeated head impacts with rapid acceleration/deceleration forces are used to assist in the diagnosis and management of TBI-affected individuals. Data from multiple areas, including clinical, anatomical, magnetic resonance imaging, cognitive function, and biochemical analyses, are integrated to provide a Signature of persistent TBI. Results: Studies to date indicate that susceptibility to TBI results from an interaction between host genetic and structural vulnerability factors and force and torque of impact on the head and torso. The host factors include molecular markers affecting immune and inflammatory responses to stress/insult as well as anatomical features such as the degree of transcortical fiber projections and vascular malformations. The host response to forceful impact includes the release of intracellular neural proteins and nucleic acids into the cerebrospinal fluid and vascular compartment as well as mobilization of cytokines and macrophages into the central nervous system with subsequent activation of microglia and inflammatory responses including autoimmune processes. Maximum impact to the base of the sulci via a “water hammer effect” is consistent with the localization of microvascular and inflammatory responses in the affected brain region. Conclusions: An assessment of an individuals’ predisposition to persistent TBI with delayed cognitive deficits and behavioral changes requires an understanding of host vulnerability (genetic factors and brain structure) and external stressors (force and torque of impact as well as repetitive head injury and time interval between impacts). An algorithm that has utility in predicting vulnerability to TBI will include qualitative and quantitative measures of the host factors weighted against post impact markers of neural injury. ...
    Keywords Medicine (General) ; R5-920
    Subject code 306
    Language English
    Publishing date 2018-10-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Multicenter Prospective Clinical Series Evaluating Radiofrequency Ablation in the Treatment of Painful Spine Metastases.

    Bagla, Sandeep / Sayed, Dawood / Smirniotopoulos, John / Brower, Jayson / Neal Rutledge, J / Dick, Bradley / Carlisle, James / Lekht, Ilya / Georgy, Bassem

    Cardiovascular and interventional radiology

    2016  Volume 39, Issue 9, Page(s) 1289–1297

    Abstract: Background: Radiofrequency ablation (RFA) of vertebral body metastases (VBM) has been reported as safe and effective in retrospective studies. This single-arm prospective multicenter clinical study evaluates RFA in the treatment of painful VBM.: ... ...

    Abstract Background: Radiofrequency ablation (RFA) of vertebral body metastases (VBM) has been reported as safe and effective in retrospective studies. This single-arm prospective multicenter clinical study evaluates RFA in the treatment of painful VBM.
    Methods: Fifty patients with VBM were prospectively enrolled during a 13-month period at eight US centers under an IRB-approved study. Percutaneous RFA was performed under imaging guidance with cement augmentation at the discretion of the operator. Pain, disability and quality of life were evaluated at baseline, prior to discharge, days 3, 7, 30 and 90 using the Numerical Pain Rating Scale, Oswestry Disability Index (ODI), the Functional Assessment of Cancer Therapy-General 7 (FACT-G7) and Functional Assessment of Cancer Therapy Quality-of-Life Measurement in Patients with Bone Pain (FACT-BP). Adverse events were monitored throughout this time interval.
    Results: Twenty-six male and 24 female patients (mean age 61.0) underwent 69 treatments (30 thoracic and 39 lumbar). Cement augmentation was performed in 96 % of reported levels. Significant improvement in mean scores for pain, disability and cancer-specific health-related quality of life from baseline to all time intervals was seen. NRPS improved from 5.9 to 2.1 (p < 0.0001). ODI improved from 52.9 to 37.0 (p < 0.08). FACT-G7 improved form 10.9 to 16.2 (p = 0.0001). FACT-BP improved from 22.6 to 38.9 (p < 0.001). No complications related to the procedure were reported.
    Conclusion: RFA with cement augmentation safely and effectively reduces pain and disability rapidly, while increasing quality of life in patients suffering from vertebral body metastases.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Bone Cements/therapeutic use ; Catheter Ablation/methods ; Female ; Humans ; Male ; Middle Aged ; Pain/complications ; Pain/surgery ; Pain Measurement ; Prospective Studies ; Quality of Life ; Spinal Neoplasms/complications ; Spinal Neoplasms/secondary ; Spinal Neoplasms/surgery ; Spine/surgery ; Treatment Outcome ; Young Adult
    Chemical Substances Bone Cements
    Language English
    Publishing date 2016-09
    Publishing country United States
    Document type Journal Article ; Multicenter Study
    ZDB-ID 603082-8
    ISSN 1432-086X ; 0342-7196 ; 0174-1551
    ISSN (online) 1432-086X
    ISSN 0342-7196 ; 0174-1551
    DOI 10.1007/s00270-016-1400-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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