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  • 1
    Online Resource
    Online Resource
    Cerebrovascular Response in Infants and Young Children following Severe Traumatic Brain Injury: A Preliminary Report
    S. Karger AG ; 1997
    In:  Pediatric Neurosurgery Vol. 26, No. 4 ( 1997), p. 200-207
    Details
    In: Pediatric Neurosurgery, S. Karger AG, Vol. 26, No. 4 ( 1997), p. 200-207
    Type of Medium: Online Resource
    ISSN: 1016-2291 , 1423-0305
    URL: Article
    DOI: 10.1159/000121192
    Language: English
    Publisher: S. Karger AG
    Publication Date: 1997
    detail.hit.zdb_id: 1483546-0
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  • 2
    Online Resource
    Online Resource
    α-Synuclein Levels Are Elevated in Cerebrospinal Fluid following Traumatic Brain Injury in Infants and Children: The Effect of Therapeutic Hypothermia
    S. Karger AG ; 2010
    In:  Developmental Neuroscience Vol. 32, No. 5-6 ( 2010), p. 385-395
    Details
    In: Developmental Neuroscience, S. Karger AG, Vol. 32, No. 5-6 ( 2010), p. 385-395
    Abstract: α-Synuclein is one of the most abundant proteins in presynaptic terminals. Normal expression of α-synuclein is essential for neuronal survival and it prevents the initiation of apoptosis in neurons through covalent cross-linking of cytochrome c released from mitochondria. Exocytosis of α-synuclein occurs with neuronal mitochondrial dysfunction, making its detection in cerebrospinal fluid (CSF) of children after severe traumatic brain injury (TBI) a potentially important marker of injury. Experimental therapeutic hypothermia (TH) improves mitochondrial function and attenuates cell death, and therefore may also affect CSF α-synuclein concentrations. We assessed α-synuclein levels in CSF of 47 infants and children with severe TBI using a commercial ELISA for detection of monomeric protein. 23 patients were randomized to TH based on published protocols where cooling (32–33°C) was initiated within 6–24 h, maintained for 48 h, and then followed by slow rewarming. CSF samples were obtained continuously via an intraventricular catheter for 6 days after TBI. Control CSF (n = 9) was sampled from children receiving lumbar puncture for CSF analysis of infection that was proven negative. Associations of initial Glasgow Coma Scale (GCS) score, age, gender, treatment, mechanism of injury and Glasgow Outcome Scale (GOS) score with CSF α-synuclein were compared by multivariate regression analysis. CSF α-synuclein levels were elevated in TBI patients compared to controls (p = 0.0093), with a temporal profile showing an early, approximately 5-fold increase on days 1–3 followed by a delayed, 〉 10-fold increase on days 4–6 versus control. α-Synuclein levels were higher in patients treated with normothermia versus hypothermia (p = 0.0033), in patients aged 〈 4 years versus ≧4 years (p 〈 0.0001), in females versus males (p = 0.0007), in nonaccidental TBI versus accidental TBI victims (p = 0.0003), and in patients with global versus focal injury on computed tomography of the brain (p = 0.046). Comparisons of CSF α-synuclein levels with initial GCS and GOS scores were not statistically significant. Further studies are needed to evaluate the conformational status of α-synuclein in CSF, and whether TH affects α-synuclein aggregation.
    Type of Medium: Online Resource
    ISSN: 0378-5866 , 1421-9859
    URL: Article
    DOI: 10.1159/000321342
    RVK:
    XG 8817
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2010
    detail.hit.zdb_id: 1482201-5
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  • 3
    Online Resource
    Online Resource
    Improving Cost-effectiveness and Access to Cognitive Behavior Therapy for Depression: Providing Remote-Ready, Computer-Assisted Psychotherapy in Times of Crisis and Beyond
    S. Karger AG ; 2020
    In:  Psychotherapy and Psychosomatics Vol. 89, No. 5 ( 2020), p. 307-313
    Details
    In: Psychotherapy and Psychosomatics, S. Karger AG, Vol. 89, No. 5 ( 2020), p. 307-313
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 There is growing evidence that computer-delivered or computer-assisted forms of cognitive behavior therapy (CCBT) are helpful, but cost-effectiveness versus standard therapies is not well established. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To evaluate the cost-effectiveness of a therapist-supported method for CCBT in comparison to standard cognitive behavior therapy (CBT). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 A total of 154 drug-free major depressive disorder outpatients were randomly assigned to either 16 weeks of standard CBT (up to twenty 50-min sessions) or CCBT using the 〈 i 〉 Good Days Ahead 〈 /i 〉 program (including up to 5.5 h of therapist contact). Outcomes were assessed at baseline, weeks 8 and 16, and at 3 and 6 months post-treatment. Economic analyses took into account the costs of services received and work/social role impairment. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 In the context of almost identical efficacy, a form of CCBT that used only about one third the amount of therapist contact as conventional CBT was highly cost-effective compared to conventional therapy and reduced the adjusted cost of treatment by USD 945 per patient. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 A method of CCBT that blended internet-delivered modules and abbreviated therapeutic contact reduced the cost of treatment substantially without adversely affecting outcomes. Results suggest that use of this approach can more than double the access to CBT. Because clinician support in CCBT can be provided by telephone, videoconference, and/or email, this highly efficient form of treatment could be a major advance in remote treatment delivery.
    Type of Medium: Online Resource
    ISSN: 0033-3190 , 1423-0348
    URL: Article
    DOI: 10.1159/000508143
    RVK:
    CU 5500
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 1472321-9
    SSG: 5,2
    SSG: 15,3
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  • 4
    Online Resource
    Online Resource
    Relationship of Intracranial Pressure and Cerebral Perfusion Pressure with Outcome in Young Children after Severe Traumatic Brain Injury
    S. Karger AG ; 2010
    In:  Developmental Neuroscience Vol. 32, No. 5-6 ( 2010), p. 413-419
    Details
    In: Developmental Neuroscience, S. Karger AG, Vol. 32, No. 5-6 ( 2010), p. 413-419
    Abstract: Traumatic brain injury (TBI) is the most common cause of death for children less than 18 years of age. Current standards of care for children with severe TBI include monitoring of intracranial pressure (ICP), and goal-directed therapies to minimize ICP and optimize cerebral perfusion pressure (CPP; the mathematical difference between the mean arterial pressure and ICP). Current guidelines for ICP and CPP thresholds suggest that age-based thresholds should be adopted, but few studies have included the youngest children affected by TBI (those 〈 2 years of age). We performed a retrospective analysis of our pediatric neurotrauma database to determine if ICP and CPP thresholds associated with favorable neurological outcome could be determined, or if the number of episodic alterations in the parameters (ICP 〉 15 or 〉 20 mm Hg; CPP 〈 40 mm Hg, 〈 45 mm Hg or 〈 50 mm Hg) was different between children with favorable and unfavorable outcomes (based on dichotomous Glasgow Outcome Scale score at 6 months after TBI). Data from 22 children (of whom 81% had suffered from inflicted childhood neurotrauma) were analyzed in the first 7 days. Children with unfavorable outcome had more hourly readings of CPP of 〈 45 mm Hg compared to children with favorable outcome [median (25–75%): 2 (1–31) vs. 0 (0–2); p 〈 0.05]. There was no difference between the number of hourly readings of ICP of 〉 20 mm Hg between the outcome groups [median (25–75%): favorable 0 (0–1) vs. unfavorable 1 (0–4); p = 0.17]. To our knowledge, this is the first exploratory report to test if CPP and ICP thresholds can be established for this young population of children after TBI, and it suggests a CPP target threshold of 45 mm Hg. Despite good ICP control in this population, there was still a 50% incidence of unfavorable outcome, suggesting that there may be unique physiologic parameters that need to be targeted in infants with severe TBI. A prospective study is needed to fully determine what goals should be targeted for this vulnerable population.
    Type of Medium: Online Resource
    ISSN: 0378-5866 , 1421-9859
    URL: Article
    DOI: 10.1159/000316804
    RVK:
    XG 8817
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2010
    detail.hit.zdb_id: 1482201-5
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  • 5
    Online Resource
    Online Resource
    Mitochondrial Heat Shock Protein 60 Is Increased in Cerebrospinal Fluid following Pediatric Traumatic Brain Injury
    S. Karger AG ; 2006
    In:  Developmental Neuroscience Vol. 28, No. 4-5 ( 2006), p. 336-341
    Details
    In: Developmental Neuroscience, S. Karger AG, Vol. 28, No. 4-5 ( 2006), p. 336-341
    Abstract: Mitochondrial dysfunction occurs after traumatic brain injury (TBI) and contributes significantly to subsequent cell death. Heat shock protein 60 (hsp60) is a predominantly mitochondrial protein with important homeostatic functions. Induction of hsp60 has been demonstrated in cerebral ischemia models, possibly reflecting mitochondrial stress. We measured hsp60 concentration in the cerebrospinal fluid (CSF) of 34 infants and children after severe TBI and of 7 control patients by ELISA. Peak CSF hsp60 concentration was increased in TBI patients versus controls (0.84 ng/ml, range 0–44.59, vs. 0.0 ng/ml, range 0–0.48; p 〈 0.05). Induction of hsp60 occurred early after the injury. Peak hsp60 concentration was independently associated with the severity of injury, defined as the admission Glasgow Coma Scale score. These data suggest that increased hsp60 in CSF might reflect the severity of early mitochondrial stress or damage after TBI.
    Type of Medium: Online Resource
    ISSN: 0378-5866 , 1421-9859
    URL: Article
    DOI: 10.1159/000094159
    RVK:
    XG 8817
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2006
    detail.hit.zdb_id: 1482201-5
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  • 6
    Online Resource
    Online Resource
    Identifying Risk for Attrition during Treatment for Depression
    S. Karger AG ; 2009
    In:  Psychotherapy and Psychosomatics Vol. 78, No. 6 ( 2009), p. 372-379
    Details
    In: Psychotherapy and Psychosomatics, S. Karger AG, Vol. 78, No. 6 ( 2009), p. 372-379
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Understanding patients’ ambivalence about treatment persistence may be useful in tailoring retention interventions for individual patients with major depressive disorder. 〈 i 〉 Methods: 〈 /i 〉 Participants (n = 265) with major depressive disorder were enrolled into an 8-week trial with a selective serotonin reuptake inhibitor. At baseline and week 2, the participants were asked about their intent to return for the next visit, complete the study and continue in the study should they experience side effects or no improvement. Dropouts were defined as participants who discontinued attending clinic visits before completing the trial. 〈 i 〉 Results: 〈 /i 〉 Participants who at baseline reported an uncertain/negative intent to continue if they experienced side effects or no improvement dropped out at a significantly higher rate by weeks 6 and 8. Uncertain/negative intent at week 2 predicted attrition at all following visits. Dropouts without side effects were more likely to have reported an uncertain/negative intent to attend at both baseline and week 2, while dropouts who experienced side effects were more likely to have reported an uncertain/negative intent to attend only at baseline. Positive intent to continue was associated with greater symptom improvement in both dropouts and completers despite the possibility of lack of efficacy. 〈 i 〉 Conclusions: 〈 /i 〉 Participants’ pretreatment concerns about continuing antidepressant treatment in the presence of side effects signals challenges to the completion of a full 8-week acute phase treatment, even if the participant does not develop side effects. Individualized review of concerns and tailoring appropriate interventions may be necessary to reduce attrition.
    Type of Medium: Online Resource
    ISSN: 0033-3190 , 1423-0348
    URL: Article
    DOI: 10.1159/000235977
    RVK:
    CU 5500
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2009
    detail.hit.zdb_id: 1472321-9
    SSG: 5,2
    SSG: 15,3
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