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Huang C.-T.,Chi Mei Medical Center | Lin W.-C.,Chiali Chi Mei Hospital | Ho C.-H.,Chia Nan University of Pharmacy and Science | Tung L.-C.,Chi Mei Medical Center | And 3 more authors.
Journal of Head Trauma Rehabilitation | Year: 2014

To investigate the incidence of dysphagia and medical resource utilization in a nationwide population of pediatric patients with traumatic brain injury (TBI).Subjects' data were obtained from the Taiwan National Health Insurance Research Database.Between 2000 and 2008, 6290 children less than 18 years old who had received surgery post-TBI were included in the study.Retrospective study. Main Outcome Measure: Biographic data and medical utilization results.Of all the children postsurgery after TBI, 12.3% were categorized as having severe dysphagia. The occurrence of severe dysphagia was not related to sex but was statistically and significantly related to a younger mean age. The relationship between age and dysphagia also showed an interestingly biphasic distribution, mostly in the subgroups of 1 to 3 and 16 to 18 years of age. The medical resource utilization was higher in severely dysphagia patients, but only 8.4% received intervention by a speech language pathologist.Severe dysphagia among postsurgical pediatric patients after TBI is relatively common, and those with severe dysphagia have a greater need for medical services. However, the ratio of such patients who receive swallowing treatment is still low in Taiwan. Clinicians are prompted to pay more attention to the impairment in functional oral intake of children postsurgery after TBI. ©2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Wee H.-Y.,Liouying | Lim S.-W.,Chiali Chi Mei Hospital | Chio C.-C.,Chi Mei Medical Center | Niu K.-C.,Chi Mei Medical Center | And 4 more authors.
Journal of Surgical Research | Year: 2015

Background The neuroprotective mechanisms of hyperbaric oxygen (HBO) therapy on traumatic brain injury (TBI) remain unclear, especially neuronal apoptosis associations such as the expression of tumor necrosis factor alpha (TNF-α), transforming growth-interacting factor (TGIF), and TGF-β1 after TBI. The aim of this study was to investigate the neuroprotective effects of HBO therapy in a rat model of TBI. Materials and methods The experimental rats were randomly divided into three groups as follows: TBI + normobaric air (21% O2 at one absolute atmosphere), TBI + HBO, and sham-operated normobaric air. The TBI + HBO rats received 100% O2 at 2.0 absolute atmosphere for 1 h immediately after TBI. Local and systemic TNF-α expression, neuropathology, levels of the neuronal apoptosis-associated proteins TGIF and TGF-β1, and functional outcome were evaluated 72 h after the onset of TBI. Results Compared to the TBI control groups, the running speed of rats on the TreadScan after TBI was significantly attenuated by HBO therapy. The TBI-induced local and systemic TNF-α expression, neuronal damage score, and neuronal apoptosis were also significantly reduced by HBO therapy. Moreover, HBO treatment attenuated the expression of TGIF but increased TGF-β1 expression in neurons. Conclusions We concluded that treatment of TBI with HBO during the acute phase of injury can decrease local and systemic proinflammatory cytokine TNF-α production, resulting in neuroprotective effects. We also suggest that decreased levels of TGIF and increased levels of TGF-β in the injured cortex leading to decreased neuronal apoptosis is one mechanism by which functional recovery may occur. © 2015 Elsevier Inc. All rights reserved.

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