Studies using traditional treatment strategies for mild traumatic brain injury (TBI) have produced limited clinical success. Interest in treatment for mild TBI is at an all time high due to its association with the development of chronic traumatic encephalopathy and other neurodegenerative diseases, yet therapeutic options remain limited. Traditional pharmaceutical interventions have failed to transition to the clinic for the treatment of mild TBI. As such, many pre-clinical studies are now implementing non-pharmaceutical therapies for TBI. These studies have demonstrated promise, particularly those that modulate secondary injury cascades activated after injury. Because no TBI therapy has been discovered for mild injury, researchers now look to pharmaceutical supplementation in an attempt to foster success in human clinical trials. Non-traditional therapies, such as acupuncture and even music therapy are being considered to combat the neuropsychiatric symptoms of TBI. In this review, we highlight alternative approaches that have been studied in clinical and pre-clinical studies of TBI, and other related forms of neural injury. The purpose of this review is to stimulate further investigation into novel and innovative approaches that can be used to treat the mechanisms and symptoms of mild TBI.

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Background The USMLE Step 1 score helps differentiate applicants for competitive residency programs. Students frequently ask medical educators how to prepare for this high-stakes exam. Multiple resources exist such as books, training programs, and question banks. The purpose of this study is to provide medical educators with data on which resources correlate with higher exam scores. Methods 164 medical students at West Virginia University School of Medicine were given a survey following the completion of Step 1. The survey contained questions about resources used and exam date. De-identified data was paired with class quartile rankings and Step 1 scores. Average Step 1 scores were calculated for each resource and a student's t-test was used to compare between groups. Test dates were also broken into quintiles and average Step 1 scores were compared between groups. Results Students who used the USMLE World question bank had higher Step 1 scores (M=229, SE=1.4) compared to students who did not use this resource (M=215, SE=4.2). Commercial preparation courses were not associated with improved scores. The timing of when the exam was taken was also not associated with significant differences between scores. Conclusions Interactive study options offer the best choice to improve USMLE Step 1 scores.

Patients that suffer a mild traumatic brain injury (TBI) with intracranial hemorrhage are commonly admitted to an intensive care unit with repeat imaging in 12 to 24 hours. This is costly to the health-care system. This study aimed to evaluate this practice and to identify criteria to triage patients to lower levels of monitored care. A retrospective review was performed at a university-based Level I trauma center. Patients with mild TBI were included. Data were collected on demographics, neurological status at 6, 12, and 24 hours, CT scan results, and medical or surgical interventions were required. A total of 389 patients were evaluated, 53 had a documented neurological decline while being admitted. Factors found to be associated with a neurological decline included Glasgow Coma Scale (GCS) < 15 ( P = 0.002), age greater than 55 ( P < 0.001), and warfarin use ( P = 0.039). Aspirin and Plavix were not associated with neurological decline. No patient age <55 with a GCS of 15 had a documented decline. Several risk factors were found to be associated with neurological decline after mild TBI. These include age, GCS < 15, and warfarin use. Patients aged <55 with GCS 15, posed minimal risk for deterioration. Patients aged <55 and with a GCS of 15 can be admitted to a monitored step-down bed with less frequent neurological checks.

Multimodal therapy—surgery, radiation therapy, and chemotherapy—the foundation of modern cancer treatment, has led to dramatic improvements in survival. How the three disciplines coalesced to conquer Wilms’ tumor is a compelling story that includes two of history's greatest discoveries, X-rays and antibiotics. By the mid-20th century both fields had matured to where dedicated clinicians and creative scientists could apply them to Wilms’ tumor and achieve successive improvements in survival. William Ladd was able to achieve a zero operative mortality by 1940, but was left with a 32 per cent survival with surgery alone. Robert Gross and Edwin Neuhauser combined surgery and radiotherapy and achieve 47 per cent survival rate in 1950. Sidney Farber and his colleagues added an antibiotic, dactinomycin, to the treatment regimen and reached 80 per cent survival rate in 1966. The National Wilms’ Tumor Study, organized in 1968, was a multidisciplinary effort of surgeons, radiotherapists, and pediatric oncologists across the country. By the 1990s, the National Wilms’ Tumor Study achieved survival rates above 95 per cent while minimizing long-term effects through shortening courses of chemotherapy and radiation. The story of Wilms’ tumor serves as a paragon for all types of cancer, in both children and adults.