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PubMed2001

Effect of penicillin on postoperative endodontic pain and swelling in symptomatic necrotic teeth.

The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of penicillin on postoperative pain and swelling in symptomatic necrotic teeth. Forty-one emergency patients participated and each had a clinical diagnosis of a symptomatic necrotic tooth with associated periapical radiolucency. After endodontic treatment patients randomly received a 7-day oral dose (twenty-eight 500 mg capsules to be taken every 6 h) of either penicillin or a placebo control in a double-blind manner. Patients also received ibuprofen; acetaminophen with codeine (30 mg); and a 7-day diary to record pain, percussion pain, swelling, and number and type of pain medication taken. The majority of patients with symptomatic necrotic teeth had significant postoperative pain and require analgesic medication to manage this pain. The administration of penicillin postoperatively did not significantly (p > 0.05) reduce pain, percussion pain, swelling, or the number of analgesic medications taken for symptomatic necrotic teeth with periapical radiolucencies.

Acetaminophen↗
PubMed2002

Effect of drainage upon access on postoperative endodontic pain and swelling in symptomatic necrotic teeth.

The purpose of this retrospective study was to determine the effect of drainage upon access on postoperative endodontic pain and swelling in symptomatic necrotic teeth. One hundred twenty-four emergency patients participated and each had a clinical diagnosis of a symptomatic necrotic tooth with an associated periapical radiolucency. The occurrence of drainage upon access was timed and recorded. After endodontic treatment, patients received ibuprofen, acetaminophen with codeine (30 mg), and a 6-day diary to record pain, percussion pain, swelling, and number and type of pain medication taken. The majority of patients with symptomatic necrotic teeth had significant postoperative pain and required analgesic medication to manage this pain. Obtaining short-term drainage upon access (average of 1.85 min) did not significantly (p > 0.05) reduce pain, percussion pain, swelling, or the number of analgesic medications taken for symptomatic necrotic teeth with periapical radiolucencies.

Acetaminophen↗
PubMed1988

Failure of autoregulation after closed head injury: an experimental model.

Cats were subjected to a 3.5-atm fluid percussion impact administered to the cerebral cortex. Near-infrared spectrophotometry (NIRS) was used to measure the quantity of oxyhemoglobin and total hemoglobin in the illuminated tissue as well as the cytochrome a, a3 redox state. Corroborative data were obtained by freezing brains with liquid nitrogen and measuring cortical concentrations of ATP, creatine phosphate (CP), and lactate. Immediately postimpact there was a rise in mean arterial pressure with a 38% increase of highly oxygenated blood and a shift toward oxidation in the cytochrome a, a3 redox state. By 4 hours postimpact, cytochrome a, a3 was becoming progressively reduced despite the persistence of hyperemia. This was associated with a significant (p less than 0.01) decrease in ATP and CP concentration. Additional studies in which a 0.5-sec, 100-v electrical seizure was induced before and after fluid percussion demonstrated significant differences in seizure response, indicating a failure of autoregulation.

Adenosine Triphosphate↗
PubMed1998

Inducible nitric oxide synthase expression after traumatic brain injury and neuroprotection with aminoguanidine treatment in rats.

OBJECTIVE: We investigated the time course of inducible nitric oxide synthase (iNOS) enzymatic activity and immunocytochemical localization of iNOS expression after traumatic brain injury (TBI), as well as the possible role of iNOS in the pathogenesis of TBI. METHODS: Male Sprague-Dawley rats were anesthetized and underwent moderate parasagittal fluid-percussion brain injury. Rats were decapitated 5 minutes, 6 hours, 1 day, 3 days, 7 days, or 14 days later, and iNOS enzymatic activities were measured (n = 6-8). To determine whether nitric oxide produced by iNOS contributed to the histopathological consequences of TBI, inhibition of iNOS activity using aminoguanidine (intraperitoneal injections of 100 mg/kg aminoguanidine [n = 9] or vehicle [n = 8], twice each day) was conducted for 3 days. RESULTS: Significantly elevated iNOS activity was detected at 3 days (276.8+/-72.3% of contralateral value, means +/- standard errors; P < 0.05), and the most robust increase occurred 7 days after TBI (608.0+/-127.0%, P < 0.01) in the injured parietal cerebral cortex. Immunostaining for iNOS and glial fibrillary acidic protein, at 3 and 7 days after TBI, revealed that the major cellular sources of iNOS expression were cortical Layer 1 astrocytes and macrophages within the subarachnoid space. Administration of aminoguanidine did not reduce contusion volume significantly; however, treatment reduced total cortical necrotic neuron counts (1367.6+/-210.3; P < 0.01, compared with vehicle, 2808.5+/-325.1). CONCLUSION: These data indicate that iNOS is expressed after moderate parasagittal fluid-percussion brain injury, in a time-dependent manner, and that inhibition of iNOS synthesis improves histopathological outcomes. Thus, inhibition of iNOS activation may represent a potential therapeutic strategy for the treatment of TBI.

Animals↗
PubMed2005

Kinetic therapy improves oxygenation in critically ill pediatric patients.

OBJECTIVE: To compare changes in oxygenation after manual turning and percussion (standard therapy) and after automated rotation and percussion (kinetic therapy). DESIGN: Randomized crossover trial. SETTING: General and cardiac pediatric intensive care units. PATIENTS: Intubated and mechanically ventilated pediatric patients who had an arterial catheter and no contraindications to using a PediDyne bed. INTERVENTIONS: Patients were placed on a PediDyne bed (Kinetic Concepts) and received 18 hrs blocks of standard and kinetic therapy in an order determined by randomization. MEASUREMENTS AND MAIN RESULTS: Arterial blood gases were measured every 2 hrs during each phase of therapy. Oxygenation index and arterial-alveolar oxygen tension difference [P(A-a)O(2)] were calculated. Indexes calculated at baseline and after each 18-hr phase of therapy were analyzed. Fifty patients were enrolled. Data from 15 patients were either not collected or not used due to reasons that included violation of protocol and inability to tolerate the therapies in the study. Indexes of oxygenation were not normally distributed and were compared using Wilcoxon signed rank testing. Both therapies led to improvements in oxygenation, but only those from kinetic therapy achieved statistical significance. In patients receiving kinetic therapy first, median oxygenation index decreased from 7.4 to 6.19 (p = .015). The median P(A-a)O(2) decreased from 165.2 to 126.4 (p = .023). There were continued improvements in oxygenation after the subsequent period of standard therapy, with the median oxygenation index decreasing to 5.52 and median P(A-a)O(2) decreasing to 116.0, but these changes were not significant (p = .365 and .121, respectively). When standard therapy was first, the median oxygenation index decreased from 8.83 to 8.71 and the median P(a-a)o(2) decreased from 195.4 to 186.6. Neither change was significant. Median oxygenation index after the subsequent period of kinetic therapy was significantly lower (7.91, p = .044) and median P(A-a)O(2) trended lower (143.4, p = .077). CONCLUSIONS: Kinetic therapy is more efficient than standard therapy at improving oxygenation and produces improvements in oxygenation that are more persistent.

Analysis of Variance↗
PubMedDate not supplied

Importance of calcitonin gene-related peptide, adenosine and reactive oxygen species in cerebral autoregulation under normal and diseased conditions.

1. Mechanisms regulating cerebral circulation, including autoregulation of cerebral blood flow (CBF), have been widely investigated. Vasodilators such as nitric oxide, prostacyclin, calcitonin gene-related peptide (CGRP) and K+ channel openers are well known to have important roles in the physiological and pathophysiological control of CBF autoregulation. In the present review, the focus is on the mechanism(s) of altered CBF autoregulation after traumatic brain injury and subarachnoid haemorrhage (SAH) and on the effect of adenovirus-mediated transfer of Cu/Zn superoxide dismutase (SOD)-1 in amelioration of impaired CBF autoregulation. 2. The roles of CGRP and adenosine are particularly emphasized, both being implicated in the autoregulatory vasodilation of the pial artery in response to hypotension. 3. After fluid percussion injury, production of NADPH oxidase-derived superoxide anion and activation of tyrosine kinase links the inhibition of K+ channels to impaired autoregulatory vasodilation in response to acute hypotension and alterations in CBF autoregulation in rat pial artery. 4. Subarachnoid haemorrhage during the acute stage causes an increase in NADPH oxidase-dependent superoxide formation in cerebral vessels in association with activated tyrosine phosphorylation-coupled increased expression of gp91phox mRNA and membrane translocation of Rac protein, thereby resulting in a significant reduction of autoregulatory vasodilation. 5. Fluid percussion injury and SAH-induced overproduction of superoxide anion in cerebral vessels contributes to the impairment of CBF autoregulation and administration of recombinant adenovirus-mediated transfer of the Cu/Zn SOD-1 gene effectively ameliorates the impairment of CBF autoregulation of the pial artery.

Adenosine↗
PubMed2005

Routine neonatal postextubation chest physiotherapy: a randomized controlled trial.

OBJECTIVE: To test the effects of a neonatal postextubation programme on the incidence of postextubation collapse and adverse outcomes. METHODS: A randomized controlled trial was carried out at the Mater Mothers' Hospital, Brisbane. Mechanically ventilated infants were randomized into one of two groups, physiotherapy group--which involved a regimen of chest wall percussion and oropharyngeal suctioning and control group - which involved suctioning without the percussion unless indicated. Chest X-rays were taken at 6 h and at 24 h postextubation. The primary outcome measure was postextubation collapse as determined by a paediatric radiologist blinded to the group allocation. RESULTS: One hundred and seventy-seven neonates were enrolled in the trial between 1997 and 1999. After an interim analysis, the trial was stopped early. No statistically significant difference was shown in the rate of postextubation collapse (15 of 87 (17.2%) physiotherapy group and 17 of 86 (19.8%) control group (P = 0.85)). No differences were shown between the groups in the number of apnoeic or bradycardic events, duration of requirement for supplemental oxygen or the need for re-intubation within 24 h postextubation. CONCLUSION: The results of this trial suggest that a routine neonatal postextubation chest physiotherapy programme for all infants is not indicated. There was no evidence that chest physiotherapy is associated with any adverse outcomes.

Data Collection↗
PubMed2000

Granule cell hyperexcitability in the early post-traumatic rat dentate gyrus: the 'irritable mossy cell' hypothesis.

1. Cytochemical and in vitro whole-cell patch clamp techniques were used to investigate granule cell hyperexcitability in the dentate gyrus 1 week after fluid percussion head trauma. 2. The percentage decrease in the number of hilar interneurones labelled with either GAD67 or parvalbumin mRNA probes following trauma was not different from the decrease in the total population of hilar cells, indicating no preferential survival of interneurones with respect to the non-GABAergic hilar cells, i.e. the mossy cells. 3. Dentate granule cells following trauma showed enhanced action potential discharges, and longer-lasting depolarizations, in response to perforant path stimulation, in the presence of the GABAA receptor antagonist bicuculline. 4. There was no post-traumatic alteration in the perforant path-evoked monosynaptic excitatory postsynaptic currents (EPSCs), or in the intrinsic properties of granule cells. However, after trauma, the monosynaptic EPSC was followed by late, polysynaptic EPSCs, which were not present in controls. 5. The late EPSCs in granule cells from fluid percussion-injured rats were not blocked by the NMDA receptor antagonist 2-amino-5-phosphonovaleric acid (APV), but were eliminated by both the non-NMDA glutamate receptor antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) and the AMPA receptor antagonist GYKI 53655. 6. In addition, the late EPSCs were not present in low (0.5 mM) extracellular calcium, and they were also eliminated by the removal of the dentate hilus from the slice. 7. Mossy hilar cells in the traumatic dentate gyrus responded with significantly enhanced, prolonged trains of action potential discharges to perforant path stimulation. 8. These data indicate that surviving mossy cells play a crucial role in the hyperexcitable responses of the post-traumatic dentate gyrus.

2-Amino-5-phosphonovalerate↗
PubMed1990

Effect of noncompetitive blockade of N-methyl-D-aspartate receptors on the neurochemical sequelae of experimental brain injury.

Pharmacological inhibition of excitatory neurotransmission attenuates cell death in models of global and focal ischemia and hypoglycemia, and improves neurological outcome after experimental spinal cord injury. The present study examined the effects of the noncompetitive N-methyl-D-aspartate receptor blocker MK-801 on neurochemical sequelae following experimental fluid-percussion brain injury in the rat. Fifteen minutes after fluid-percussion brain injury (2.8 atmospheres), animals received either MK-801 (1 mg/kg, i.v.) or saline. MK-801 treatment significantly attenuated the development of focal brain edema at the site of injury 48 h after brain injury, significantly reduced the increase in tissue sodium, and prevented the localized decline in total tissue magnesium that was observed in injured tissue of saline-treated animals. Using phosphorus nuclear magnetic resonance spectroscopy, we also observed that MK-801 treatment improved brain metabolic status and promoted a significant recovery of intracellular free magnesium concentrations that fell precipitously after brain injury. These results suggest that excitatory amino acid neurotransmitters may be involved in the pathophysiological sequelae of traumatic brain injury and that noncompetitive N-methyl-D-aspartate receptor antagonists may effectively attenuate some of the potentially deleterious neurochemical sequelae of brain injury.

Adenosine Triphosphate↗
PubMed2002

A randomized clinical trial of analgesia in children with acute abdominal pain.

OBJECTIVE: To evaluate the effects of intravenous morphine on pain reduction, physical examination, and diagnostic accuracy in children with acute abdominal pain. METHODS: A randomized, double-blind, placebo-controlled clinical trial was conducted at an emergency department of a tertiary care children's hospital. Children aged 5-18 years with abdominal pain of < or =5 days' duration, pain score > or =5 on a 0-10 visual analog scale, and need for surgical evaluation were eligible. Following the initial assessment, patients were randomized to receive either 0.1 mg/kg morphine or an equal volume of saline. The pediatric emergency medicine physician and surgical consultant independently recorded the areas of tenderness to palpation and percussion, and their diagnoses before the study medication and 15 to 30 minutes later. RESULTS: Sixty patients were enrolled, and 29 received morphine and 31 received saline. The demographic characteristics between the two groups were similar. The median reduction of pain score between the two study groups was 2 (95% CI = 1 to 4; p = 0.002). There was no significant change in the areas of tenderness in both study groups. Children with surgical conditions had persistent tenderness to palpation and/or percussion. There was no significant change in the diagnostic accuracy between the study groups and between the physician groups. All patients requiring laparotomy were identified and no significant complication was noted in the morphine group. CONCLUSIONS: Intravenous morphine provides significant pain reduction to children with acute abdominal pain without adversely affecting the examination, and morphine does not affect the ability to identify children with surgical conditions.

Abdomen, Acute↗
PubMed1990

Polyamine analysis of infected root canal contents related to clinical symptoms.

The contents of infected root canals were collected by mechanical and chemical debridement. Intracanal polyamines were identified and quantified by HPLC in all canals examined, however, no histamine was detected in any canal. The relationship between the amount of each polyamine and clinical signs of the teeth was analyzed statistically. The teeth without clinical signs tended to have limited varieties and smaller amounts of polyamines. Using chi 2, the amounts were significantly greater in teeth with spontaneous pain, swelling and putrescent odor (p less than 0.01), with exudate (p less than 0.025) and with percussion pain (p less than 0.1) than in teeth without. Amounts of putrescine (p less than 0.05) and total polyamines (p less than 0.01) were greater in teeth with spontaneous pain and percussion pain than in teeth without clinical sign, and those with root canal exudate also had greater amounts of total polyamines than those without (p less than 0.01). The amounts of cadaverine, however, from the teeth with gingival fistulae, was greater than from those without (p less than 0.05). No significant relationship was established between the amount of each polyamine and the presence of putrescent odor or gingival swelling. Intracanal polyamines, especially putrescine may leak out through apical foramen and may be implicated in pain production by eliciting acute inflammatory response in the periapical tissues.

Adolescent↗
PubMed1999

Post-operative symptoms and healing after endodontic treatment of infected teeth using pulsed Nd:YAG laser.

Forty-four teeth in 38 patients, diagnosed with chronic apical periodontitis, were endodontically treated. Root canals were shaped using a step-back technique with 5% NaOCl and 3% H2O2 as irrigants. In half of the teeth the canal terminus was irradiated with pulsed Nd:YAG laser (1 W, 15 pps, 1 s). All canals were then obturated with laterally condensed gutta-percha points and sealer, and final radiographs were obtained. Occurrence of spontaneous pain was recorded 1 day after treatment. Percussion pain was recorded after 1 week, and then at 3 and 6 months after treatment. Radiographic follow-up was performed at 3 and 6 months. Percussion pain was significantly less (P < 0.05) in the laser-treated group than in the control group, both 1 week and 3 months after treatment. Other differences between the groups were not significant. These results suggested that the clinical application of pulsed Nd:YAG laser might be advantageous for the treatment of infected root canals.

Adult↗
PubMed2006

Traumatic intrusion of permanent teeth. Part 1. An epidemiological study of 216 intruded permanent teeth.

An epidemiological study of traumatic intrusion of permanent teeth was performed on 216 teeth in 151 patients treated over a 50-year period at a major trauma center in Denmark (Copenhagen). This analysis showed that intrusion of permanent teeth was of rare injury only affecting 1.9% of traumatic injuries involving permanent teeth. The main etiologic factor appeared to be falling which resulted in axial impacts on maxillary or mandibular teeth. The most common injury patterns were intrusion without additional injuries (33.5%) and intrusion with crown fractures (60.5%). A few cases were combinations of intrusion and either crown/root-fractures or root fractures (6%). Most often one tooth was intruded (46.3%), followed by two teeth (32.4% ) and three or more teeth (21.3%). The majority of intruded teeth were displaced 2-8 mm. The age group of 6-12 years of age was most frequently involved and boys appeared to experience intrusion injuries more frequently than girls, and at an earlier age. Maxillary central and lateral incisors are the primary victims of intrusions and this seems to be identical to other trauma types and is possibly related to the known exposure to impacts of maxillary incisors. The reliability of clinical findings, such as lack of mobility (81.8%), metallic percussion tone (72.5%), and no pain to percussion (66%) was reasonably high, whereas a radiographic feature such as the obliteration of the periodontal ligament space appeared to be only a partly reliable diagnostic tool (52%).

Accidental Falls↗
PubMed2003

Transient root resorption after dental trauma: the clinician's dilemma.

UNLABELLED: The diagnostic shortcomings encountered in the clinical evaluation of pulpal and periodontal healing subsequent to trauma comprise a major problem in dental traumatology. An acute dental trauma may imply impact to the hard dental tissues and damage to the pulp and periodontium (including surrounding alveolar bone). In the case of luxation injuries, the trauma often results in rupture of the neurovascular supply at the level of the apical foramen, whereas in a root fracture, the same occurs at the level of the fracture. Conventional diagnostic criteria for pulpal status (coronal discoloration, loss of pulpal sensibility, tenderness to percussion, and radiographic change [i.e., resorption]) reflect, only indirectly, certain parameters of healing. These parameters are based empirically on clinical findings after dental caries and dental restorative techniques, where the pulp has an intact neurovascular supply apically. In these situations, long-standing bacterial or chemical attack can lead to irreversible change. In contrast, following traumatic impact, a presumably intact pulp is deprived of its neurovascular supply instantaneously. In the absence of infection, events following acute dental trauma aim at either tissue repair or regeneration. Thus, based on a series of long-term clinical studies, it was found that all conventional signs, with the exception of tenderness to percussion, could be signs of pulpal healing, as well as signs of pulpal death. Based on the results of these studies, this report discusses the significance of radiographic change (resorption) in relation to pulpal and periodontal healing following acute trauma. Moreover, implications of tooth luxation with respect to the long-term prognosis following crown, crown-root, and root fractures are discussed. CLINICAL SIGNIFICANCE: Whenever possible, it is to the patient's advantage that pulp vitality be preserved. Correct diagnostic techniques and patient selection enable the clinician to decide when endodontic therapy is appropriate and when intelligent observation is the "treatment" of choice.

Dental Pulp↗
PubMed2000

Measurements and efficient simulations of bowed bars

Bowing bar percussion instruments is an increasing part of the repertoire of modern composition and performance. Yet the system has not been studied systematically. In this paper experimental measurements of bars of bar percussion instruments bowed by a double bass bow and by a bowing machine are presented. They examine the relationships between performance parameters and perceptional parameters which are relevant for musical performance. In addition, a new efficient simulation method using a time-domain approach has been developed and the measured results are compared to the simulation. Most measurement results are in good qualitative agreement with the known results of the bowed string. The spectrum of the bowed bar is observed to be harmonic, independent of the harmonicity or inharmonicity of the eigenfrequencies of the bar. Important distinctions from the known results of the bowed string are the weakness or independence of bowing force and velocity on the fundamental frequency and the spectral content of the produced sound. Simulations show qualitative agreement with the measurements.

Journal Article↗
PubMed2004

Novel missense mutation in the caveolin-3 gene in a Belgian family with rippling muscle disease.

Rippling muscle disease (RMD) is a rare muscle disorder characterised by muscle stiffness, exercise induced myalgia, and cramp-like sensations. It is genetically heterogeneous and can be acquired, but most cases show autosomal dominant inheritance due to mutations in the caveolin-3 (CAV3) gene. We report a novel heterozygous missense mutation in CAV3 in a Belgian family with autosomal dominant RMD. A 40 year old woman complained of fatigue, exercise induced muscle pain, and muscle cramps since the age of 35. Neurological examination revealed percussion induced rapid muscle contractions (PIRCs) and localised muscle mounding on percussion; muscle rippling was not observed. Creatine kinase (CK) was elevated but electromyography and nerve conduction studies were normal. Fluorescence immunohistochemistry revealed reduced caveolin-3 and dysferlin staining in a quadriceps muscle biopsy. Western blot analysis confirmed severely reduced caveolin-3 levels, whereas dysferlin was normal. Sequence analysis of the two coding exons of CAV3 revealed a hitherto unreported heterozygous C82A transversion in the first exon, predicting a Pro28Thr amino acid exchange. Thr patient's first degree relatives did not present with neuromuscular complaints, but PIRCs, muscle mounding, and muscle rippling were found in the mother, who also carried the CAV3 mutation.

Adult↗
PubMed1989

Clinical findings in cattle with dilatation and torsion of the caecum.

Dilatation and torsion of the caecum is usually an acute illness with signs of ileus and this paper presents the clinical findings from 111 heifers and cows with the condition. On admission 61 per cent of the animals had been ill for less than 24 hours; the general condition was disturbed in 58 per cent of the animals, 39 per cent showed signs of colic; the rectal temperature was abnormal in 55 per cent, the heart rate in 40 per cent and the respiration rate in 52 per cent of the animals; rumen motility was reduced or absent in 85 per cent. One or more tests for foreign bodies were positive in 58 per cent, and swinging auscultation and percussion auscultation on the right side, either alone or in combination, were positive in 83 per cent of the animals. On rectal examination it was possible to palpate a pathologically distended, displaced or twisted caecum in 95 per cent of the animals. In 87 per cent defecation was reduced or absent. The most reliable diagnostic investigations were rectal examination and swinging and percussion auscultation on the right side.

Animals↗
PubMed1995

Influence of brain injury on opioid-induced pial artery vasodilation.

This study was designed to investigate the effect of fluid percussion brain injury on opioid-induced pial artery vasodilation in the newborn pig. Previous observations have shown that brain injury produces pial artery vasoconstriction associated with elevated cerebral spinal fluid (CSF) opioid levels in the piglet. Additionally, opioids produce pial vasodilation that is attenuated by the nitric oxide (NO) synthase inhibitor NG-nitro-L-arginine (L-NNA). Anesthetized newborn pigs equipped with a closed cranial window were connected to a percussion device consisting of a saline-filled cylindrical reservoir with a metal pendulum. Brain injury of moderate severity (1.9-2.3 atm) was produced by allowing the pendulum to strike a piston on the cylinder. Methionine enkephalin (Met), an endogenous mu-opioid agonist in physiological and pharmacological concentrations (10(-10), 10(-8), 10(-6) M), produced vasodilation that was attenuated following brain injury (7 +/- 1 vs. 3 +/- 1%, 11 +/- 1 vs. 5 +/- 1% and 16 +/- 1 vs. 8 +/- 1% for 10(-10), 10(-8), 10(-6) M Met before and after injury, respectively, n = 5). Met-induced dilation was associated with increased cortical periarachnoid CSF guanosine 3',5'-cyclic monophosphate (cGMP), and these biochemical changes were blunted by brain injury (342 +/- 12 and 640 +/- 13 fmol/ml vs. 267 +/- 6 and 321 +/- 17 fmol/ml for control and Met 10(-6) M before and after injury, respectively, n = 5). Leucine enkephalin, an endogenous delta-agonist, induced pial dilation and associated changes in CSF cGMP, which were similarly altered by brain injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗