Previously, circulating total antioxidant capacity (TAC) in traumatic brain injury (TBI) patients has been scarcely studied and only in studies of small sample size (lower than 55 TBI patients) In one study were found higher serum TAC in non-survivor than in survivor TBI patients; however, an association between circulating TAC and mortality in patients with TBI has not been previously reported Thus, the objective of this study was to determine whether there is an association between circulating TAC, peroxidation state and mortality in patients with severe TBI This was a multicenter, observational and prospective study was carried out in six Spanish Intensive Care Units We included patients with severe TBI defined as Glasgow Coma Scale (GCS) lower than 9 We excluded patients with Injury Severity Score (ISS) in non-cranial aspects higher than 9 We measured serum TAC on day 1 of TBI The 30-day mortality was established as endpoint Non-surviving TBI patients (N = 27) showed higher serum TAC (P < 0001) than survivor ones (N = 73) Logistic regression analyses showed that serum TAC higher than 259 nmol/mL were associated with 30-day mortality controlling for APACHE-II and CT classification (OR = 440; 95 % CI = 114–1698; P = 003), controlling for GCS and age (OR = 588; 95 % CI = 157–2206; P = 0009), and controlling for CT classification and admission abnormal pupils (OR = 389; 95 % CI = 130–1161; P = 002) There was an association between serum TAC and malondialdehyde (a biomarker of lipid peroxidation) levels (rho = 025; p = 001), APACHE-II score (rho = 023; p = 003) and GCS (rho = −021; p = 004) To our knowledge, our series is the largest reporting data on circulating TAC in patients with severe TBI The most relevant and new findings of our study were that there is an association between circulating TAC and peroxidation state and mortality in patients with severe TBI

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Total antioxidant capacity is associated with mortality of patients with severe traumatic brain injury

Objective: Oxidation is involved in secondary brain injury after traumatic brain injury (TBI). Increased concentrations of total antioxidant capacity (TAC) in blood at the time of admission for TBI have been found in non-surviving patients. The main objective of this study was to determine the role of serum TAC levels at any time during the first week of TBI for the prediction of early mortality. Methods: Isolated (<10 points in non-cranial aspects of Injury Severity Score) and severe (<9 points in Glasgow Coma Scale) TBI patients were included. Serum TAC concentrations at days 1, 4, and 8 of TBI were determined. The end-point study was 30-day mortality. Results: Higher serum TAC levels at days 1 (p < 0.001), 4 (p < 0.001), and 8 (p = 0.002) of TBI were found in non-surviving (n = 34) than in surviving patients (n = 90). The area under curve (95% Confidence Interval) for prediction of 30-day mortality by serum TAC concentrations at days 1, 4, and 8 of TBI were 0.79 (0.71–0.86; p < 0.001), 0.87 (0.79–0.93; p < 0.001), and 0.76 (0.67–0.84; p = 0.006) respectively. Conclusions: The novelty of our study was the ability to predict 30-day mortality by serum TAC concentrations at any time during the first week of TBI.

Traumatic Brain Injury Patients Mortality and Serum Total Antioxidant Capacity.

OBJECTIVE
The benefits of exercise in TBI have been proven. However, the time-dependent effects of exercise initiation and the involved mechanisms are controversial. We investigated the effects of preconditioning, continuous, early, and delayed treadmill exercise on motor behavior, brain edema, inflammation, and oxidative stress in experimental traumatic brain injury (TBI).


MATERIALS AND METHODS
48 male rats were assigned into two groups: sedentary control (Sham and TBI) and exercise groups: 1MB (preconditioning, initiation beginning at 1 month before trauma), 1MBA (continuous, initiation beginning at 1 month before and continuing 1 month after trauma), 24hA (early, initiation beginning at 24 h after trauma), and 1WA (delay, initiation beginning at 1 week after trauma). The rats in exercise groups were forced to run on a treadmill five days a week for 30 minutes per day. Rotarod and open file were used to assess motor behavior. ELISA was also used to measure total antioxidant capacity (TAC), tumor necrosis factor-alpha (TNF-α), and malondialdehyde (MDA) in serum and CSF. Results: Exercise significantly decreased neurological impairments, motor deficits, and apoptosis compared with the sedentary group. Early (within 24 hours) and ongoing (1 MBA) exercise significantly improved motor behavior after TBI. In addition, these exercise programs inhibited brain edema and the number of apoptotic cells. MDA and TNF-α levels increased in all exercise groups, but the effects were greater after early exercise than after delayed exercise, resulting in a significant decrease in TAC levels in serum and CSF. We discovered a positive correlation between MDA, TAC, and TNF-α concentrations in serum and CSF.


CONCLUSION
Our finding suggests that early exercise (24hA) and 1MBA groups afford neuroprotection and reduce the second injury consequence, probably by reducing neuronal apoptosis and oxidative stress.

Protective Effects of Early Exercise on Neuroinflammation, and Neurotoxicity Associated by Traumatic Brain Injury: a behavioral and neurochemical approach.

Prognostic value of total antioxidant capacity to predict functional outcome in traumatic brain injury patients.

The pathophysiological mechanisms of brain lesions after craniocerebral trauma (CCT) are associated with the effects of primary and secondary damaging factors. Here, we studied the changes in the indices of oxidative stress, including the content of malondialdehyde (MDA), the total antioxidant activity (TAA), the MDA/TAA coefficient, albumin, and the levels of the markers of secondary damage, such as nitric oxide (NO
 x
 ) and glucose in the blood serum of patients with CCT of moderate severity. A total of 29 patients with CCT were examined on days 1, 3, and 5 of their stay in a hospital. On day 5 of the posttraumatic period, we observed the exhaustion of the antioxidant system expressed in the increased MDA/TAA coefficient and decreased TAA in patients with CCT of moderate severity. The NO
 x
 level was decreased on day 1 and on days 3 and 5 it was similar to the norm. The glucose level was normal during the entire observation period. A significant positive correlation between the MDA/TAA index and traumatic subarachnoid hemorrhage was revealed on day 5, which reflected the relationship between oxidative stress and the lesion volume. This should be taken into account for the selection of a therapeutic approach.

The changes in the indices of oxidative stress and the levels of nitric oxide and glucose in patients with craniocerebral trauma of moderate severity

Traumatic brain injury is a common cause of death after trauma. The aim of this study was to investigate the relationship between oxidative stress parameters and, outcomes and clinical findings in patients with isolated traumatic brain injuries. Fifty-four patients who were admitted into the emergency department of Ankara Ataturk Training and Research hospital with isolated blunt traumatic brain injuries and 33 healthy adults as control group, were included in this study. Serum oxidant status was evaluated by measuring Total Oxidant Status (TOS) levels in patients with traumatic brain injury and in healthy individuals. Serum antioxidant status was evaluated by measuring Total Antioxidant Status (TAS) levels. Then, also Oxidative Stress Index (OSI) was calculated. A total of 54 patients with isolated traumatic brain injuries (mean age 36.7 ± 18.3 years; 60.4% male, 39.6% female) were enrolled. TOS and OSI levels increased in patient group compared to the control group. High levels of OSI, TOS and TAS were observed in patients who finally became dead. A significant correlation between symptoms including nausea, vomitus, loss of consciousness, seizing and TOS, OSI levels of all patients have been observed. Moreover, there was a meaningful correlation between Glaskow Coma Scale (GCS) score, TOS and OSI levels of patients. The oxidative stress parameters may be valuable prognostic markers in traumatic brain injury patients. It can be concluded that oxidative stress parameters may be valuable in the assessment of clinical severity and in predicting outcome of traumatic brain injury patients. Key words:

Oxidative stress in isolated blunt traumatic brain injury

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Oxidative stress in isolated blunt traumatic brain injury