Background: Patients with non-penetrating traumatic brain injuries (TBI) are at high risk for damage to ventral prefrontal brain regions, due to the brain’s acceleration into the bony ridges of the anterior portions of the skull. Current neuropsychological assessments of these patients focus mainly on the assessment of so-called “executive functions,” which are associated with dorsolateral prefrontal regions. Ventral prefrontal pathology is more likely to disrupt social and emotional functions, but assessments of these abilities using objective measurements that require patients to demonstrate their competence are rare. Mounting evidence suggests that chronic social and emotional deficits are common in TBI, and that these difficulties result in significant functional impairments post-injury, making clear the need to develop and use objective assessment tools during clinical neuropsychological assessments. Methods: In the current project, the Global Interpersonal Skills Test (GIST), a questionnaire measure of social skills with both a self-rated and an informant-rated version, was developed, along with three novel or adapted performance-based measures of social and emotional functioning. The first novel measure was the Assessments of Social Context (ASC), a video-based task examining comprehension of social context using non-verbal cues, including the identification of emotions, intensions and positive or negative attitudes of one person towards another. The second task was the Awareness of Interoception Test (AIT), a heartbeat detection paradigm adapted from previous literature that measures participants’ sensitivity to their cardiac function, which is implicated in basic emotional functioning. The third task was the Social Interpretations Task (SIT), an animation-based task adapted from previous literature examining participants’ ability to apply a social interpretation to stimuli that are not inherently social in nature. All novel tasks were developed and piloted with healthy undergraduates. A group of patients with moderate to severe TBI (N = 16), and a group of non-brain damaged controls (N = 16) underwent neuropsychological testing. Standard neuropsychological measures including the Wechsler Test of Adult Reading, Digit Span and Digit Symbol Coding from the Wechsler Adult Intelligence Scale, phonemic (FAS) and semantic fluency (Animals) from the Verbal Fluency Test, and the Trail Making Test, as well as the novel measures to both patients with TBI and controls were administered. The following predictions were made: vi 1) The novel performance-based measures of social abilities would be more sensitive to the presence of moderate and severe TBI than the standard neuropsychological measures of cognition; 2) On the informant version of the GIST, but not the self-report version, patients would have scores than controls; 3) Patients’ performance on the ASC would be less accurate than controls’, and this difference would be associated with real-world social skills, measured by the informant-version of the GIST; 4) Patients’ AIT performance would be less accurate than controls’, and this would be related to their self-rated emotional changes; 5) Patients’ SIT performance would be less accurate than controls’, and this difference would be associated with real-world social skills, again measured by the informant-version of the GIST. Findings: Findings were consistent with these hypotheses: 1) A statistically significant logistic regression revealed that a Social composite variable comprising the ASC, AIT and SIT was more sensitive to the presence of TBI (β = 9.59, p < .05) than a Cognitive composite variable comprising Digit Symbol Coding, Trails B completion time, and Phonemic Fluency (β = 0.006, p = .466). 2) A multivariate analysis of variance (MANOVA) revealed that informants of patients gave lower GIST scores to patients than the informants of controls (F(1,28) = 22.2, p < 0.0001), whereas there were no differences between groups on the self-rated version of the GIST (F(1,28) = .35, p = .56); 3) Patients’ ASC performance was significantly poorer than controls’ on a MANOVA (F(1,31) = 21.7, p < .0001), and ASC total scores were significantly correlated with GIST informant scores, using Spearman’s rank-order correlations (ρ(31) = .624, p < .0001). 4) Patients’ AIT performance was significantly poorer than controls’ using an independent samples t test (t(13) = 1.43, p < 0.005), and qualitative investigation of subjective reports of emotional change among patients suggested a potential relationship between emotional changes and AIT performance. vii 5) Patients’ SIT performance was significantly poorer than controls on an independent samples t test (t(30) = -2.12, p < 0.05), and SIT scores were significantly correlated with GIST informant scores, using Spearman’s rank-order correlations (ρ(31) = .460, p < .0001). Interpretation: This research represents a preliminary step in the development of clinically useful measures of social and emotional difficulties following TBI. Given the small sample size of the patient group, and the presence of co-morbid difficulties among some of the participants in this research, further testing of these measures in larger, more homogeneous samples would strengthen the current results, as would using a comparison group of people with milder TBI, rather than neuro-typical controls. The complexity of social behaviour requires that the current measures be further validated against other real-world assessments of social ability, and that assessments of other aspects of social behaviour be conducted. Nonetheless, the measures described here are a promising start to supplementing the neuropsychological toolkit in an area that requires further development at the present time.

Thesis (M.A.)--Miami University, Dept. of Speech Pathology and Audiology, 2004. / Title from first page of PDF document. Includes bibliographical references (p. 54-59).

Orientador: Liciana Vaz de Arruda Silveira / Resumo: Introdução: O traumatismo cranioencefálico constitui um dos principais problemas de saúde pública e está entre as principais causas de morte, incapacidade ou invalidez. As suas características variam de acordo com a população envolvida, sendo de expressiva importância o conhecimento das características das internações de modo a elaborar diretrizes básicas para programas de prevenção e também intervenções específicas na área assistencial. Objetivos: Caracterizar o perfil epidemiológico do traumatismo cranioencefálico (TCE) na Unidade de Terapia Intensiva do Hospital de Base de Bauru e elaborar um Guia de orientações pós-alta hospitalar para o cuidador. Métodos: Estudo quantitativo, retrospectivo e de natureza documental, baseado na análise de prontuários eletrônicos de pacientes vítimas de traumatismo cranioencefálico internados no período de janeiro a julho de 2016. Resultados: Foram admitidos 156 pacientes (29,65%) com traumatismo cranioencefálico; 139 prontuários atendiam os critérios de inclusão e foram analisados. Houve predomínio de idosos e adultos (idade 41 anos ou mais), representando 58,28% da amostra; prevalência do sexo masculino (82%) e traumatismos causados por quedas (39,57%), seguidos de espancamentos (15,11%) e acidentes motociclísticos (14,39%). Desses pacientes, 24 evoluíram a óbito; 19 pacientes receberam alta com algum déficit (neurológico, motor ou visual) e com 27 dispositivos invasivos. Conclusão: Apesar das altas taxas de prevalência de traumatismo cra... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Despite evidence indicating negative consequences of repetitive head impacts (RHIs) on the brain, the long-term effects remain largely unknown. Contact sports, such as football, expose players to multiple collisions. Professional sports players have undergone thousands of concussive and sub-concussive RHIs over their careers. In this study we used structural 3T MRI to evaluate cortical thickness of 86 former NFL players (mean age ± SD = 54.9 ± 7.9 years old) and 24 former professional non-contact sport athletes as controls (mean age ± SD =57.2 ± 6.9 years old). Cortical thickness was compared between groups using FreeSurfer. The NFL players displayed decreased cortical thickness in the right temporal lobe and fusiform gyrus (cluster-wise p-value=0.0003, 90% CI=0.0001-0.0005) and the left pre- and postcentral gyrus (cluster-wise p-value=0.0096, 90% CI=0.0084-0.0109). When looking only at NFL subjects impaired in measurements of mood and behavior (n=36) compared to controls, NFL players displayed a similar but more extensive cluster of decreased cortical thickness in the right temporal lobe and fusiform gyrus (cluster-wise p-value=0.0001, 90% CI=0.0000-0.0002) and in the left supramarginal gyrus and pre- and postcentral gyrus, (cluster-wise p-value=0.0002, 90% CI=0.0000-0.0004). Reduced cortical thickness in NFL players is suggestive of the long-term effects of RHIs. Still, future studies are necessary for examining the time-course of damage and the implications of regional cortical thinning.

L'œdème cérébral et l'hypoxie cérébrale post-traumatiques sont les acteurs principaux de l'apparition des lésions ischémiques secondaires. L'erythropoïétine (Epo) sous sa forme recombinante humaine possède une activité anti-oedémateuse dans un modèle expérimental de TC diffus. Son action sur l'hypoxie cérébrale post-traumatique reste néammoins méconnue. De plus, les effets indésirables hématologiques de l'Epo ont conduit à la synthèse de dérivés de l'Epo ne possèdant pas d'activité hématopoïétique comme l'érythropoïetine carbamylée (CEpo). Dans ce contexte, mon travail de thèse a eu pour but d'évaluer les propriétés de l'Epo et de la CEpo dans le modèle de TC diffus. Un traitement intraveineux par CEpo à la dose de 50 µg/Kg a ainsi permis de diminuer précocemment l'œdème cérébral post-traumatique évalué in vivo par IRM de diffusion et ex vivo par gravimétrie spécifique. Cette propriété a impliqué l'inhibition de la phosphorylation de la voie Erk et s'est accompagnée de l'amélioration des fonctions motrices et cognitives jusqu'à 10 jours après le TC. Après une étude de validation sur des rats sains soumis à différentes conditions d'oxygénation, une méthode de mesure IRM de la saturation locale en oxygène (lSO2) cérébrale combinant l'effet BOLD avec la mesure du volume sanguin cérébral a montré une diminution de l'oxygénation cérébrale post-traumatique. Cette hypoxie cérébrale n'était pas en lien avec une diminution du débit sanguin cérébral attestée par méthode de premier passage d'un agent de constraste. Un collapsus des capillaires cérébraux était par ailleurs retrouvé en microscopie électronique. L'Epo à la dose de 5000 UI/Kg a été capable de restaurer l'oxygénation cérébrale en diminuant l'œdème astrocytaire péricapillaire. L'ensemble de ce travail a permis d'établir les bénéfices d'un traitement par Epo ou par CEpo sur l'œdème cérébral et l'hypoxie cérébrale post-traumatiques. / Post-traumatic brain oedema and brain hypoxia play a key role for the development of secondary ischaemic lesions. Erythopoïetin (Epo) is an anti-oedematous agent in the impact-acceleration model. However its action on brain hypoxia remains unkonwn. Neuroprotective derivatives of Epo that lack haematopoïétic properties, like carbamylated Epo (CEpo), have been developped to counter Epo side effects. In this context, our study aimed to assess the effect of Epo and CEpo on post-traumatic diffuse brain oedema and brain oxygenation. CEpo (50 µg/Kg) decreased brain oedema assessed by diffusion-weighted MRI and specific gravimetry 6 hours after the trauma. The anti-oedematous effect of CEpo was linked to Erk inhibition and was associated with an improvement of cognitive and motor functions, evaluated until 10 days after the insult. MRI using the combination of BOLD contrast and blood volume fraction measurement demonstrated a decrease of local brain oxygenation in our model, without franck ischemia (measurement of mild transit time by a first passage method). Epo (5000 UI/Kg) improved brain oxygenation by decreasing post-traumatic cerebral capillaries collapse due to astrocytic end-foot swelling. All these results demonstrated that Epo and CEpo could be seen as promising neuroprotective agents in traumatic brain injury.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Studies over recent years have highlighted the important role of creatine in health and in treating various neurological diseases. However, its role in secondary damage induced by traumatic brain injury (TBI) is not fully understood. The aim of this study was to evaluate the effect of creatine supplementation on the oxidative damage and susceptibility to seizures after TBI. For this, we used the model of fluid percussion injury (FPI) in rats, where brain damage is caused by a liquid column that causes a pressure on the dura intact of animal, which was previously exposed. Our results revealed that at 4 and 8 days after TBI, there was increased oxidative damage characterized by increased protein carbonylation and levels of species thiobarbituric acid reactive substances (TBARS), and also there was a reduction in Na+, K+ -ATPase activity. Statistical analysis (two way ANOVA) also revealed that creatine supplementation (300 mg / kg orally), beginning 30 minutes after TBI and continuing until 3, or 7 days after injury, reduced protein carbonylation and TBARS when analyzed at 4 and 8 days after injury. However, creatine supplementation did not protect the inhibition of Na+, K+-ATPase 4 and 8 days after TBI. Furthermore, the analysis electroencephalographic (EEG) showed that injection of a subconvulsant dose (35 mg / kg, intraperitoneally) of pentylenetetrazol (PTZ), 4 but not 8 days after TBI, decreased latency to the tonic- clonic seizures and increased the time spend in generalized seizure, when compared to the control group. Creatine supplementation had no effect on the convulsive parameters induced by PTZ injection. The experiments in this study suggest that in this experimental model of TBI, oxidative damage seems not to be directly involved in susceptibility to seizures after neuronal injury since the antioxidant capacity exerted by creatine does not protect against PTZ-induced seizures after TBI / Estudos realizados ao longo dos últimos anos têm destacado o importante papel da creatina na saúde bem como no tratamento de diversas doenças neurológicas. Entretanto, seu papel no dano secundário induzido por traumatismo cranioencefálico (TCE) não está totalmente compreendido. O objetivo de nosso estudo foi avaliar o efetio da suplementação com creatina sobre o dano oxidativo e suscetibilidade a convulsões após TCE. Para isto, utilizamos o modelo de lesão por percussão de fluido (LPF) em ratos, onde a lesão encefálica é provocada por uma coluna líquida que exerce uma pressão sobre a duramáter intacta dos animais, a qual foi previamente exposta. Nossos resultados revelaram que em 4 e 8 dias após TCE, houve o aumento do dano oxidativo caracterizado pelo aumento de carbonilação protéica e dos níveis de espécies reativas ao ácido tiobarbitúrico (TBARS) e, também, houve uma redução da atividade da enzima Na+, K+-ATPase. A análise estatística (ANOVA de duas vias) também revelou que a suplementação com creatina (300 mg/kg, via oral), iniciando 30 minutos após o TCE e prolongando-se até o 3º, ou 7º dia após a lesão, reduziu a carbonilação protéica e os níveis de TBARS, quando analisado no 4º e 8º dia após a injuria. Entretanto a suplementação com creatina não protegeu da inibição da enzima Na+, K+-ATPase 4 e 8 dias após a TCE. Além disso, a análise eletroencefalográfica (EEG) revelou que a injeção de uma dose subconvulsivante (35 mg/Kg, intraperitoneal) de pentilenotetrazol (PTZ), em 4, mas não em 8 dias após TCE, diminuiu a latência para as convulsões tônico-clônicas generalizadas e aumentou o tempo de sua duração, quando comparado ao grupo controle. A suplementação de creatina não exerceu qualquer efeito sobre os parâmetros convulsivos induzidos pela injeção de PTZ. Os experimentos realizados no presente estudo sugerem que, neste modelo experimental de TCE, o dano oxidativo parece não estar diretamente envolvido na suscetibilidade a convulsões após lesão neuronal uma vez que, a capacidade antioxidante exercida pela creatina não protege das crises convulsivas induzidas por PTZ após TCE.

abstract: The objective of this small animal pre-clinical research project was to study quantitatively the long-term micro- and macro- structural brain changes employing multiparametric MRI (Magnetic Resonance Imaging) techniques. Two separate projects make up the basis of this thesis. The first part focuses on obtaining prognostic information at early stages in the case of Traumatic Brain Injury (TBI) in rat animal model using imaging data acquired at 24-hours and 7-days post injury. The obtained parametric T2 and diffusion values from DTI (Diffusion Tensor Imaging) showed significant deviations in the signal intensities from the control and were potentially useful as an early indicator of the severity of post-traumatic injury damage. DTI was especially critical in distinguishing between the cytotoxic and vasogenic edema and in identification of injury regions resolving to normal control values by day-7. These results indicate the potential of quantitative MRI as a clinical marker in predicting prognosis following TBI. The second part of this thesis focuses on studying the effect of novel therapeutic strategies employing dendritic cell (DC) based vaccinations in mice glioma model. The treatment cohorts included comparing a single dose of Azacytidine drug vs. mice getting three doses of drug per week. Another cohort was used as an untreated control group. The MRI results did not show any significant changes in between the two treated cohorts with no reduction in tumor volumes compared to the control group. The future studies would be focused on issues regarding the optimal dose for the application of DC vaccine. Together, the quantitative MRI plays an important role in the prognosis and diagnosis of the above mentioned pathologies, providing essential information about the anatomical location, micro-structural tissue environment, lesion volume and treatment response. / Dissertation/Thesis / Masters Thesis Bioengineering 2014

Submitted by Jean Medeiros (jeanletras@uepb.edu.br) on 2017-03-17T12:45:33Z No. of bitstreams: 1 PDF - Fábio Henrique Costa Ferreira.pdf: 13187089 bytes, checksum: d4ae565d43e98eb970955e2f76203929 (MD5) / Approved for entry into archive by Secta BC (secta.csu.bc@uepb.edu.br) on 2017-03-22T15:19:26Z (GMT) No. of bitstreams: 1 PDF - Fábio Henrique Costa Ferreira.pdf: 13187089 bytes, checksum: d4ae565d43e98eb970955e2f76203929 (MD5) / Made available in DSpace on 2017-03-22T15:19:26Z (GMT). No. of bitstreams: 1 PDF - Fábio Henrique Costa Ferreira.pdf: 13187089 bytes, checksum: d4ae565d43e98eb970955e2f76203929 (MD5) Previous issue date: 2016-11-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Objective: To identify the prevalence of traumatic brain injury (TBI) in traffic accident victims with motorcycle assisted in a hospital of emergency and trauma. Methods: Cross- sectional study with a probabilistic sample composed by 309 medical records of patients victims of traffic accidents involving motorcycles during the period from January to December 2014, attended in Hospital Dom Luiz Gonzaga Fernandes in Campina Grande - PB. The research instrument consisted of a form containing the following variables: gender, age, day and hospitalization time, presence and type of bone fracture, presence of TCE, helmet, Glasgow coma scale, Marshall classification and the occurrence of death. It was realized a descriptive analysis of data using SPSS software 18. For bivariate analyzes were used the chi - square test and Fisher's exact, considering the value of statistical significance (p <0.05). Results: The prevalence of traumatic brain injury in traffic accident victims with motorcycle was 24.3%. There was a predominance of male victims (79.6%) and the age group of 21-30 years. It was found that the highest frequency of hospital admissions were recorded on Sundays (31.1%) and Saturdays (15.9%), predominantly night shifts (36.9%) and afternoon (28.8%).It was found statistically significant differences in the associations between TCE and helmet use (p = 0.008) and TCE and death (p = 0.001). Conclusion: It was observed a high prevalence of TBI in motorcycles traffic accident victims. The non-use of the helmet was associated with a higher frequency of TBI and the victims with TBI had higher risk to progress to death. / Objetivo: Identificar a prevalência de trauma cranioencefálico (TCE) em vítimas de acidente de trânsito com motocicleta atendidas em um hospital de emergência e trauma. Métodos: Estudo transversal com amostra probabilística composta de 309 prontuários de pacientes vítimas de acidentes de trânsito com motocicletas, no período de Janeiro a Dezembro de 2014, atendidas no Hospital Regional de Emergência e Trauma Dom Luiz Gonzaga Fernandes, em Campina Grande – PB. O instrumento de pesquisa consistiu de um formulário contendo as seguintes variáveis: sexo, faixa etária, dia da semana e horário de internação, presença e tipo de fratura óssea, presença de TCE, uso de capacete, escala de coma de Glasgow, classificação de Marshall e ocorrência de óbito. Realizou-se análise descritiva dos dados através do software SPSS 18. Para análises bivariadas foram empregados os testes de Qui-Quadrado e Exato de Fisher, considerando-se o valor de significância estatística ( p < 0,05). Resultados: A prevalência de traumatismo cranioencefálico em vítimas de acidentes de trânsito com motocicleta foi de 24,3%. Houve predomínio de vítimas do sexo masculino (79,6%) e da faixa etária de 21-30 anos. Verificou-se que as maiores frequências de internações foram registradas aos domingos (31,1%) e sábados (15,9%), predominando os turnos da noite (36,9%) e tarde (28,8%). Observaram-se diferenças estatisticamente significantes para as associações entre TCE e uso de capacete (p = 0,008) e TCE e óbito (p = 0,001). Conclusão: Pôde-se observar uma elevada prevalência de TCE em vítimas de acidentes de trânsito com motocicletas. A não-utilização do capacete foi associada a uma maior frequência de TCE e as vítimas que apresentaram TCE apresentaram maior chance de evoluir para o óbito.

The consequences resulting from Traumatic brain injury (TBI) cause disabilities or physical disabilities (motor, visual, among others), cognitive (memory, attention, learning, among others) and or behavioral/emotional (loss of self-confidence, depression, anxiety, difficulty of Self-Control, irritability, aggression, among others) that can be temporary or permanent. The study aimed to perform the validation of content and clinical aspects of nursing diagnosis of ""Labile emotional control" in treated TBI outpatients. Methodological and descriptive study that used the model of Fehring for validation. The research was developed in two steps: Content validation and clinical validation. In the former, there was the participation of 31 experts to evaluate, by means of electronic questionnaire, the taxonomic structure of NANDA International concerning the diagnosis "Labile emotional control". The later was performed in the outpatient clinic of the University Hospital of the Federal University of Sergipe, between the months of August and September 2016 with a sample consisting of 40 patients in two distinct groups with mild TBI (n=20) and moderate TBI (n=20). For comparison of proportions among groups the z test (two groups) was used and with Bonferroni correction (3 groups). The results showed that the majority of experts considered the domain 05 (perception/cognition), Class 4 (cognition) and the wording (Labile emotional control) suitable for diagnosis, although they suggested modifications in the current definition of diagnosis Two of the defining characteristics were considered major (removal of the social situation and the expression of incoherent emotions with the triggering factor) and 11 secondary (removal of the professional situation, lack of contact with the eyes, crying without excessive feel sorrow, uncontrollable crying, involuntary crying, difficulty using facial expressions, embarrassment on the expression of emotions, tears, laughter in excess without feeling happiness, uncontrollable laughter and involuntary laughter. The total score of the diagnosis “Labile emotional control” was 0.69, considered valid. In the clinical validation, the characteristics that are considered important for the mild TBI were: professional situation leave, avoidance of social situation, embarrassment on the expression of emotions, expression of emotions would be inconsistent with the triggering factor and the secondary were absence of eye contact, excessive crying without feeling sadness, uncontrollable crying , involuntary crying, difficulty using facial expressions and tears and the irrelevant ones were laughter in excess without feeling happiness, uncontrollable laughters and involuntary laughter. In the moderate TBI group the following were identified as main characteristics: professional situation leaves, avoidance of social situation, excessive crying without feeling sadness, embarrassment on the expression of emotions, expression of emotions would be inconsistent with the triggering factor and the secondary were absence of eye contact, uncontrollable crying, involuntary crying, difficulty using facial expressions, tears, uncontrollable laughter and involuntary laughter. The total score was similar in both groups, 0.74, considered to be validated for the NANDA Taxonomy-I. It is concluded that almost all of the defining characteristics were considered valid for the diagnosis "Labile Emotional Control" in TBI. / As consequências advindas do Trauma Cranioencefálico (TCE) provocam deficiências ou incapacidades físicas (motora, visual, entre outras), cognitivas (memoria, atenção, aprendizagem, entre outras) e ou comportamentais/emocionais (perda de autoconfiança, depressão, ansiedade, dificuldade de autocontrole, irritabilidade, agressão, entre outras) que podem ser temporárias ou permanentes. O estudo objetivou realizar a validação de conteúdo e clínica do diagnóstico de Enfermagem “Controle emocional instável” em pacientes com TCE atendidos ambulatoriamente. Estudo metodológico e descritivo que utilizou o modelo de Fehring para a validação. Foi desenvolvido em duas etapas: validação de conteúdo e clínica. Na primeira, houve a participação de 31 experts para avaliar, por meio de questionário eletrônico, a estrutura taxonômica da NANDA International relativo ao diagnóstico “Controle emocional instável”. A segunda etapa foi realizada no ambulatório do Hospital Universitário da Universidade Federal de Sergipe, entre os meses de agosto e setembro de 2016 com uma amostra constituída por 40 pacientes em dois grupos distintos com TCE leve (n=20) e TCE moderado (n=20). Para comparação de proporções entre grupos foi utilizado o teste Z (dois grupos) e correção de Bonferroni (3 grupos). Os resultados apontaram que a maioria dos experts considerou o domínio 05 (Percepção/cognição), a Classe 4 (Cognição) e o enunciado (Controle emocional instável) adequados ao diagnóstico, embora tenham sugerido modificações na definição atual do diagnóstico. Duas características definidoras foram consideradas principais (afastamento da situação social e expressão de emoções incoerentes com o fator desencadeador) e 11 secundárias (afastamento da situação profissional, ausência de contato com o olhar, choro excessivo sem sentir tristeza, choro incontrolável, choro involuntário, dificuldade de usar expressões faciais, embaraço relativo à expressão das emoções, lágrimas, risadas em excesso sem sentir felicidade, risadas incontroláveis e risadas involuntárias. O escore total do diagnóstico “Controle emocional instável” foi de 0,69, considerado válido. Na validação clínica, as características consideradas principais para o grupo do TCE leve foram: afastamento da situação profissional, afastamento da situação social, embaraço relativo à expressão das emoções, expressão de emoções incoerentes com o fator desencadeador e as secundários foram ausência no contato pelo olhar, choro excessivo sem sentir tristeza, choro incontrolável, choro involuntário, dificuldade de usar expressões faciais e lágrimas e as irrelevantes concerne a risada em excesso sem sentir felicidade, risadas incontroláveis e risadas involuntárias. No grupo do TCE moderado foram identificadas como características principais o afastamento da situação profissional, afastamento da situação social, choro excessivo sem sentir tristeza, embaraço relativo à expressão das emoções, expressão de emoções incoerentes com o fator desencadeador e as secundárias foram ausência no contato pelo olhar, choro incontrolável, choro involuntário, dificuldade de usar expressões faciais, lágrimas, risadas incontroláveis e risadas involuntárias. O escore total foi semelhante nos dois grupos, 0,74, considerado validado para a Taxonomia da NANDA-I. Conclui-se que a quase totalidade das características definidoras foram consideradas válidas para o diagnóstico “Controle emocional instável” no TCE. / Aracaju, SE

En raison de la complexité de sa pathogenèse, le traumatisme crânien (TC) entraîne de nombreuses lésions cérébrales pour lesquelles il n’existe aucun traitement neuroprotecteur. Il est aujourd’hui clairement établi que la neuro-inflammation est fortement impliquée dans les conséquences post-traumatiques. Cette neuro-inflammation se manifeste entre autres par l’induction de la cyclo-oxygénase de type 2 (COX-2). Bien que plusieurs données soient en faveur d’un rôle délétère de cette enzyme au cours de ce processus dévastateur, l’implication de la COX-2 dans les lésions induites par le TC reste encore controversée. Dans un modèle du TC par percussion mécanique chez la souris, nous avons mis en évidence une augmentation précoce et transitoire du contenu cérébral en COX-2 à 6 et 12 heures après le trauma. Cette induction protéique était à l’origine d’une production accrue de la prostacycline. Cependant, l’inhibition préférentielle de COX-2 était sans effet sur l’œdème cérébral et le déficit neurologique, deux indicateurs de pertinence clinique. Ces données montrent que la COX-2 ne peut pas constituer à elle seule une cible intéressante pour le traitement des conséquences post-traumatiques malgré son induction et son activité après le trauma. Par ailleurs, nous avons montré un effet bénéfique induit par l’indométacine au niveau fonctionnel, ce qui est en faveur d’un rôle délétère des COXs dans le déficit neurologique post-traumatique. Cet effet bénéfique peut impliquer uniquement la COX-1 ou en association avec la COX-2. Ces données constituent un argument supplémentaire qui s’ajoute à plusieurs preuves récentes fournies par la littérature en faveur d’un rôle délétère de COX-1 dans la neuro-inflammation. Malheureusement, ce rôle ne pourra pas être confirmé dans notre modèle car les inhibiteurs sélectifs de COX-1 disponibles à ce jour sont inexploitables dans nos conditions expérimentales. Ce travail constitue une nouvelle piste pour évaluer l’intérêt de l’inhibition des COXs au cours de la phase précoce de la prise en charge du patient traumatisé crânien. La bonne tolérance de l’usage à court terme des inhibiteurs de COX, leur disponibilité sur le marché, leur prix abordable, leur simplicité d’administration, leurs caractéristiques pharmacocinétiques et pharmacodynamiques bien connus sont des facteurs suscitant un intérêt croissant d’élargir le spectre de leurs utilisations en clinique et de la mise en place de nouveaux essais thérapeutiques dans les années à venir. / Because of its complex pathology, Traumatic Brain Injury (TBI) leads to numerous cerebral lesions for which there is no neuroprotective treatment. It is clearly known nowadays that neuro-inflammation is highly involved in post-traumatic consequences. This devastating process is manifested among others by the induction of cyclo-oxygenase type 2 (COX-2). Although many data are in agreement with a deleterious role of COX-2 in neuro-inflammation, the implication of this isoform in the TBI-induced lesions is still controversial. In a mouse model of TBI induced by mechanical percussion, we have shown an early and a transitory increase in the cerebral content of COX-2 at 6 and 12 hours after trauma. This protein induction was the source of an increased production of prostacyclin. However, the preferential inhibition of COX-2 had no effect against cerebral œdema and neurological deficit, two indicators of high clinical relevance. These data show that COX-2 cannot be considered by itself as an interesting target for the treatment of post-traumatic consequences despite its induction and activity after trauma. Besides, we have shown a beneficial effect that was induced by indomethacin at the functional level. This effect highly suggests a deleterious role of COXs in the post-traumatic neurological deficit. This neuroprotection could solely involve COX-1 or both COX isoforms. In accordance with several proofs that were recently supplied by literature, our data constitute an additional argument suggesting a deleterious role of COX-1 in neuro-inflammation. Unfortunately, this hypothesis cannot be confirmed in our model of TBI because the selective inhibitors of COX-1 available this day cannot be exploited in our experimental conditions. This experimental work is a new indication to evaluate the potential interest of COXs inhibition during the early phase of clinical management of patients with TBI. The good tolerance of the short-term intake of COX inhibitors, their availability on the market, their affordable price, their simple way of administration, their well-known pharmacokinetic and pharmacodynamic characteristics increase the need to widen the spectrum of their therapeutic indications and to design new clinical trials during the upcoming years.