The overall hypothesis of this proposal is that traumatic brain injury (TBI) causes a reduction in CBF in the early post-injury period that contributes to the brain damage by 2-mechanisms: 1-if the reduction in CBF is severe enough and lasts long enough, ischemic injury (primary ischemia; occurs 2- if the reduction is CBF is more modest, ischemic injury may not occur, but the brain is more susceptible to secondary insults (secondary ischemia). Global reductions in CBF severe enough to result in ischemic injury (CBF,18 ml/100g/min) occur with very severe injuries and this finding is associated with a high mortality rate. Regional reductions in CBF severe enough to result in ischemic injury (rCBF<18 ml/100g/min) occur more commonly and are typically found in areas of brain contusion and underlying evacuated extracerebral hematomas. Even more commonly, a moderate reduction in CBF which is compensated by increased cerebral oxygen extraction occurs during the first few hours after TBI. This program projects will approach the problem of vascular changes after traumatic brain injury with both clinical and laboratory studies. There are 3 projects and 3 cores in the program project. Project 1. Regulation of Cerebral Blood Flow after Traumatic Brain Injury. Project 2. Increased Vascular Resistance after Traumatic Brain Injury. Project 3. L-arginine Treatment of a Reduced CBF after Traumatic Brain Injury. Core A. Administrative Core Core B. Statistical and Modeling Core Core C. Analytical Lab Core

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Research Program Projects (P01)
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National Institute of Neurological Disorders and Stroke Initial Review Group (NSD)
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Michel, Mary E
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Baylor College of Medicine
Schools of Medicine
United States
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Rubin, Maria Laura; Chan, Wenyaw; Yamal, Jose-Miguel et al. (2017) A joint logistic regression and covariate-adjusted continuous-time Markov chain model. Stat Med 36:4570-4582
Aisiku, Imoigele P; Yamal, Jose-Miguel; Doshi, Pratik et al. (2016) The incidence of ARDS and associated mortality in severe TBI using the Berlin definition. J Trauma Acute Care Surg 80:308-12
Aisiku, Imo P; Yamal, Jose-Miguel; Doshi, Pratik et al. (2016) Plasma cytokines IL-6, IL-8, and IL-10 are associated with the development of acute respiratory distress syndrome in patients with severe traumatic brain injury. Crit Care 20:288
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Yamal, Jose-Miguel; Rubin, M Laura; Benoit, Julia S et al. (2015) Effect of Hemoglobin Transfusion Threshold on Cerebral Hemodynamics and Oxygenation. J Neurotrauma 32:1239-45
Yamal, Jose-Miguel; Robertson, Claudia S; Rubin, M Laura et al. (2014) Enrollment of racially/ethnically diverse participants in traumatic brain injury trials: effect of availability of exception from informed consent. Clin Trials 11:187-94
Robertson, Claudia S; Yamal, Jose-Miguel; Tilley, Barbara C (2014) Erythropoietin for traumatic brain injury--reply. JAMA 312:1929
Robertson, Claudia S; Hannay, H Julia; Yamal, José-Miguel et al. (2014) Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial. JAMA 312:36-47

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