• The Korean Journal of Physiology and Pharmacology
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• v.28 no.3
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• pp.239-252
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• 2024

Dexmedetomidine displays multiple mechanisms of neuroprotection in ameliorating ischemic brain injury. In this study, we explored the beneficial effects of dexmedetomidine on blood-brain barrier (BBB) integrity and neuroinflammation in cerebral ischemia/reperfusion injury. Sprague-Dawley rats were subjected to middle cerebral artery occlusion (MCAO) for 1.5 h and reperfusion for 24 h to establish a rat model of cerebral ischemia/reperfusion injury. Dexmedetomidine (9 ㎍/kg) was administered to rats 30 min after MCAO through intravenous injection, and SB203580 (a p38 MAPK inhibitor, 200 ㎍/kg) was injected intraperitoneally 30 min before MCAO. Brain damages were evaluated by 2,3,5-triphenyltetrazolium chloride staining, hematoxylin-eosin staining, Nissl staining, and brain water content assessment. BBB permeability was examined by Evans blue staining. Expression levels of claudin-5, zonula occludens-1, occludin, and matrix metalloproteinase-9 (MMP-9) as well as M1/M2 phenotypes-associated markers were assessed using immunofluorescence, RT-qPCR, Western blotting, and gelatin zymography. Enzyme-linked immunosorbent assay was used to examine inflammatory cytokine levels. We found that dexmedetomidine or SB203580 attenuated infarct volume, brain edema, BBB permeability, and neuroinflammation, and promoted M2 microglial polarization after cerebral ischemia/reperfusion injury. Increased MMP-9 activity by ischemia/reperfusion injury was inhibited by dexmedetomidine or SB203580. Dexmedetomidine inhibited the activation of the ERK, JNK, and p38 MAPK pathways. Moreover, activation of JNK or p38 MAPK reversed the protective effects of dexmedetomidine against ischemic brain injury. Overall, dexmedetomidine ameliorated brain injury by alleviating BBB permeability and promoting M2 polarization in experimental cerebral ischemia/reperfusion injury model by inhibiting the activation of JNK and p38 MAPK pathways.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.81-88
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• 2013

Purpose: Among patients with multiple traumatic fractures, a tendency to form more callus exists in groups with multiple fractures combined with traumatic brain injury. This retrospective study evaluated the hematologic factors that might be useful to predict callus formation by comparing serologic tests and clinical and radiologic results in two groups. Methods: From January 2000 to December 2010, patients with femur shaft fractures were divided in two groups: one without traumatic brain injury (control group: 32 cases), and the other with traumatic brain injury (study group: 44 cases). We evaluated routine serologic exams and the amount of callus formation during the follow-up period. Results: Only the alkaline phosphatase level was statistically different between the two groups, not the White blood cell count, C-reactive protein, total calcium, and lactate dehydrogenase level. The amount of callus formation on the antero-posterior radiograph at the last follow up period was 74.9% in the study group and 42.1% in the control group. Then lateral radiograph showed 73.2% callus formation rate in the study group and 31.8% in the control group. Conclusion: In routine serologic exams, the two groups had no significant differences, except for the alkaline phosphatase level. The group with traumatic brain injury had much more callus formation, but there was no reliable factor to predict callus formation on the routine serologic exam.

• Journal of Korean Neurosurgical Society
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• v.55 no.5
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• pp.293-295
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• 2014

Post-traumatic cerebral infarction (PTCI) is a secondary insult which causes global cerebral hypoxia or hypoperfusion after traumatic brain injury, and carries a remarkable high mortality rate. PTCI is usually caused by blunt brain injury with gross hematoma and/or brain herniation. Herein, we present the case of a 91-year-old male who had sustained PTCI following a low-energy penetrating craniocerebral injury due to a nail without evidence of hematoma. The patient survived after a decompressive craniectomy, but permanent neurological damage occurred. This is the first case of profound PTCI following a low-energy penetrating craniocerebral nail injury and reminds clinicians of possibility this rare dreadful complication for care of head-injured patients.

• The Journal of Korean Physical Therapy
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• v.13 no.3
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• pp.791-797
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• 2001

After brain injury, patients show a wide range in the degree of recovery. By a variety of mechanisms, the human brain is constantly undergoing plastic changes. Spontaneous recovery from brain injury in the chronic stage omes about because of plasticity. The brain regions are altered. resulting in functionally modified cortical network. This review cnsidered the neural plasticity from cellular and molecular mechanisms of synapse formation to behavioural recovery from brain injury in elderly humans. The stimuli required to elicit plasticity are thought to be activity-dependent elements. especially exercise and learning. Knowledge about the physiology of brain plasticity has led to the development of methods for rehabilitation.

• Korean Journal of Adult Nursing
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• v.21 no.5
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• pp.489-503
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• 2009

Purpose: This study was conducted to test criterion-related validity of the Critical Patients' Severity Classification System (CPSCS) developed by the Hospital Nurses' Association by examining relationships with brain injury severity measured by Glasgow Coma Scale (GCS), recovery state measured by Glasgow Outcome Scale (GOS), and days of stay in ICU of brain injury patients. Methods: Prospective correlational research design was adopted by including 194 brain injury patients admitted to ICU of one university hospital. Results: The score of CPSCS appeared to significantly discriminate the severity of brain injury. Among nursing activities in CPSCS, Respiratory therapy, IV Infusion and Medication, Monitoring, Activities of Daily Living (ADL), Treatment and Procedure were significant to discriminate the severity of brain injury. Respiratory therapy, Vital Signs, and Monitoring appeared to significantly discriminate the recovery states of 1- and 3-months. Nursing activities significantly contributed to predict the days of ICU stay were Respiratory therapy, ADL, and Teaching and Emotional Support. Conclusion: CPSCS developed by the Hospital Nurses Association appeared to be valid to discriminate or predict brain injury severity, recovery states, and days of stay in ICU for brain injury patients.

• Journal of Trauma and Injury
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• v.21 no.2
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• pp.71-77
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• 2008

Purpose: The Glasgow Coma Scale (GCS), though it is widely used for triage, has been criticized as being unnecessarily complex. Recently, a 3-point Simplified Motor Score (SMS, defined as obeys commands=2; localizes pain=1; withdrawals to pain or worse=0) was developed from the motor component of the GCS and was found to have a similar test performance for triage after traumatic brain injury when compared with the GCS as the criterion standard. The purpose of this study was to validate the SMS. Methods: We analyzed the patients who visited Kyungpook National University Hospital emergency center after traumatic brain injury from 2006 January to 2006 June. The test performance of the GCS, its motor component, and SMS relative to three clinically relevant traumatic brain injury outcomes (abnormal brain CT scans, Abbreviated Injury Scale $(AIS){\geq}4$, and mortality) were evaluated with areas under the receiver operating characteristic curves (AUCs). Results: Of 504 patients included in the analysis, 25.6% had an abnormal brain CT scans, 13.1% had $AIS{\geq}4$, and 5.0% died. The AUCs for the GCS, its motor component, and SMS with respect to the abnormal CT scans were 0.776, 0.715, and 0.716, and respectively, those for $AIS{\geq}4$ and mortality, were 0.969, 0.973, and 0.968, and 0.931, 0.909, and 0.909, respectively. Conclusion: The 3-point SMS demonstrated similar test performance when compared with the 15-point GCS score and its motor component for triage after traumatic brain injury in our populations.

• The Journal of Korean Physical Therapy
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• v.35 no.6
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• pp.190-194
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• 2023

Purpose: Traumatic brain injury (TBI) refers to brain damage caused by external forces or trauma. TBIs can vary in severity and result from accidents, falls, sports injuries, assaults, or other forms of physical trauma. The prefrontal cortex (PFC) is known have roles in various cognitive functions. We report on a patient with traumatic brain injury who showed prefrontal symptoms after injury of thalamocortical connections between mediodorsal nuclei (MD) of thalamus and PFC. Methods: A 54-year-old, male patient suffered a TBI as a result of a heavy object falling on his head. After onset of TBI, he showed typical symptoms of prefrontal lobe injury, including personality changes, memory impairment, and general cognition problem. The thalamocortical connections between MD and PFC (ventrolateral prefrontal cortex (VLPFC), dorsolateral prefrontal cortex (DLPFC), and obrbitofrontal cortex (OFC)) were reconstructed using diffusion tensor tractography. In terms of fractional anisotropy value, the right thalamocortical connections to the OFC were significantly lower than those of control subjects. Results: The value of mean diffusivity in the right thalamocortical connections to the DLPFC was significantly higher than that of control subjects. By contrast, both VLPFC and left OFC showed significant decrement in the tract volume of thalamocortical connections compared with that of control subjects. Conclusion: We reported on a patient who showed cognitive and neuropsychiatric impairment due to global injury of the thalamocoritcal connections between MD and PFC following TBI.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.19 no.1
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• pp.37-45
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• 2012

Purpose: This study was conducted in order to identify the brain injury patients's disability degree and educational needs of family caregivers. Methods: A convenience sample of 94 families with brain injury patients, who have been receiving treatment at the neurological intensive care unit and neurosurgery ward, were used. Data was collected with a self-report questionnaire from September 5 to November 28, 2011, and was analyzed using SAS program. Results: 'Defecation/urination' disability was the highest score of patient's physical disability and the next ranking was 'paralysis'. 'Memory impairment' disability was the highest score of patient's cognitive disability, and the next ranking was 'personality changes'. Overall, educational needs of family caregivers scored 4.15 out of the perfect score of 5. The factor, which scored highest, was 'information related with disease'. In addition, educational needs of family caregivers were positively related with patient's degree of. Conclusion: Educational needs of family caregivers are distinct, according to the disability degree of brain injury patient. Therefore, the study suggests the development of individualized educational program for family with brain injury patient.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.15 no.9
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• pp.5495-5501
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• 2014

Individuals with a left frontal brain injury show significant impairments in their speech ability. The aims of the present study were (1) to assess and compare the ability of speech acts comprehension and executive function between individuals with a left frontal brain injury and normal individuals, and (2) to investigate the correlation of speech act comprehension ability factors. The study's subjects were 18 individuals with a left frontal brain injury and 18 normal control adults of the same age, gender, and educational age. The following results were obtained. First, the group of individuals with a left frontal brain injury had lower speech act comprehension, executive function than the normal control group. Second, the speech act comprehension ability of the individuals with a left frontal brain injury showed a high correlation with the executive function.

• Journal of Korean Academy of Nursing
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• v.36 no.4
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• pp.621-629
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• 2006

Purpose. The purpose of this study was to identify the clinical variables that predict functional and cognitive recovery at 1- and 6-month in both severe and moderate/mild traumatic brain injury patients. Methods. The subjects of this study were 82 traumatically brain-injured patients who were admitted to a Neurological Intensive Care Unit at a university hospital. Potential prognostic factors included were age, motor and pupillary response, systolic blood pressure, heart rate, and the presence of intracranial hematoma at admission. Results. The significant predictors of functional disability in severe traumatic brain injury subjects were, age, systolic blood pressure, the presence of intracranial hematoma, motor response, and heart rate at admission. In moderate/mild traumatic brain injury patients, motor response, abnormal pupil reflex, and heart rate at admission were identified as significant predictors of functional disability. On the other hand, the significant predictors of cognitive ability for severe traumatic brain injury patients were motor response and the presence of intracranial hematoma at admission, whereas those for moderate/mild patients were motor response, pupil reflex, systolic blood pressure at admission, and age. Conclusions. The results of the present study indicate that the significant predictors of TBI differ according to TBI severity on admission, outcome type, and outcome measurement time. This can be meaningful to critical care nurses for a better understanding on the prediction of brain injury patients. On the other hand, the model used in the present study appeared to produce relatively low explicabilities for functional and cognitive recovery although a direct comparison of our results with those of others is difficult due to differences in outcome definition and validation methods. This implies that other clinical variables should be added to the model used in the present study to increase its predicting power for determining functional and cognitive outcomes.