Concussion History and Cognitive Function in a Large Cohort of Adolescent Athletes

BACKGROUND

The incidence of reported concussions in the adolescent population is increasing, yet research on the effects of concussions in this population is minimal and inconclusive.

PURPOSE

To assess the association between concussion and performance on a cognitive test battery.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

Using multivariate models, the authors assessed the association between concussion and performance on a cognitive test battery among 5616 high school and junior high school athletes. The researchers utilized a global cognitive score and scores for 5 domains: verbal memory, visual memory, visual motor, reaction time, and impulse control. Each cognitive score was converted to a z score with the mean and SD of the nonconcussed population. Results from each model were then interpreted as change in the standardized unit score. In the models, concussion was evaluated as ever having a concussion, number of concussions, time since last concussion, and age at first concussion.

RESULTS

Ever having a concussion was associated with a mean decrease of 0.11 standardized units (95% CI, -0.20 to -0.01) on the global cognitive score and lower scores in all cognitive domains. Each additional concussion was associated with lower scores on global cognitive function (effect estimate, -0.06; 95% CI, -0.11 to -0.02), verbal memory, visual memory, and impulse control. Concussion in early childhood was associated with lower global cognition (effect estimate, -0.05; 95% CI, -0.08 to -0.01), visual memory, and motor visual scores as compared with concussions in later childhood. The associations between time since last concussion and cognitive test scores were nonlinear, and on all tests, lower scores were observed even ≥1 year after the concussion.

CONCLUSION

On the basis of objective performance metrics for cognitive function, concussions had a more persistent effect on cognitive function than previously thought. The age at which an individual has his or her first concussion may be an important factor in determining long-lasting cognitive effects.

B cell activation and proliferation increase intracellular zinc levels

Zinc ions serve as second messengers in major cellular pathways, including the regulation pathways of proliferation and their proper regulation is necessary for homeostasis and a healthy organism. Accordingly, expression of zinc transporters can be altered in various cancer cell lines and is often involved in producing elevated intracellular zinc levels. In this study, human B cells were infected with Epstein–Barr virus (EBV) to generate immortalized cells, which revealed traits of tumor cells, such as high proliferation rates and an extended lifespan. These cells showed differentially altered zinc transporter expression with ZIP7 RNA and protein expression being especially increased as well as a corresponding increased phosphorylation of ZIP7 in EBV-transformed B cells. Accordingly, free zinc levels were elevated within these cells. To prove whether the observed changes resulted from immortalization or rather high proliferation, free zinc levels in in vitro activated B cells and in freshly isolated B cells expressing the activation marker CD69 were determined. Here, comparatively increased zinc levels were found, suggesting that activation and proliferation, but not immortalization, act as crucial factors for the elevation of intracellular free zinc.

Changes in tibial bone microarchitecture in female recruits in response to 8 weeks of U.S. Army Basic Combat Training

BACKGROUND

U.S. Army Basic Combat Training (BCT) is a physically-demanding program at the start of military service. Whereas animal studies have shown that increased mechanical loading rapidly alters bone structure, there is limited evidence of changes in bone density and structure in humans exposed to a brief period of unaccustomed physical activity.

PURPOSE

We aimed to characterize changes in tibial bone density and microarchitecture and serum-based biochemical markers of bone metabolism in female recruits as a result of 8 weeks of BCT.

METHODS

We collected high-resolution peripheral quantitative computed tomographic images of the distal tibial metaphysis and diaphysis (4% and 30% of tibia length from the distal growth plate, respectively) and serum markers of bone metabolism before and after BCT. Linear mixed models were used to estimate the mean difference for each outcome from pre- to post-BCT, while controlling for race/ethnicity, age, and body mass index.

RESULTS

91 female BCT recruits volunteered and completed this observational study (age = 21.5 ± 3.3 yrs). At the distal tibial metaphysis, cortical thickness, trabecular thickness, trabecular number, bone volume/total volume, and total and trabecular volumetric bone density (vBMD) increased significantly by 1-2% (all p < 0.05) over the BCT period, whereas trabecular separation, cortical tissue mineral density (TMD), and cortical vBMD decreased significantly by 0.3-1.0% (all p < 0.05). At the tibial diaphysis, cortical vBMD and cortical TMD decreased significantly (both -0.7%, p < 0.001). Bone strength, estimated by micro finite element analysis, increased by 2.5% and 0.7% at the distal tibial metaphysis and diaphysis, respectively (both p < 0.05). Among the biochemical markers of bone metabolism, sclerostin decreased (-5.7%), whereas bone alkaline phosphatase, C-telopeptide cross-links of type 1 collagen, tartrate-resistance acid phosphatase, and 25(OH)D increased by 10-28% (all p < 0.05).

CONCLUSION

BCT leads to improvements in trabecular bone microarchitecture and increases in serum bone formation markers indicative of new bone formation, as well as increases in serum bone resorption markers and decreases in cortical vBMD consistent with intracortical remodeling. Together, these results demonstrate specific changes in trabecular and cortical bone density and microarchitecture following 8 weeks of unaccustomed physical activity in women.

Enhanced ZnR/GPR39 Activity in Breast Cancer, an Alternative Trigger of Signaling Leading to Cell Growth

Acquired resistance to the estrogen receptor (ER) antagonist tamoxifen, is a major obstacle in treatment of breast cancer. Changes in Zn2+ accumulation and distribution are associated with tamoxifen-resistance and breast cancer progression. The Zn2+-sensing G-protein coupled receptor, ZnR/GPR39, triggers signaling leading to cell growth, but a role for this receptor in breast cancer in unknown. Using fluorescence imaging, we found Zn2+-dependent Ca2+ release, mediated by ZnR/GPR39 activity, in TAMR tamoxifen-resistant cells derived from MCF-7 cells, but not in ER-expressing MCF-7 or T47D cells. Furthermore, ZnR/GPR39 signaling was monitored in ER negative BT20, MDA-MB-453 and JIMT-1 cells. Expression of ZnR/GPR39 was increased in grade 3 human breast cancer biopsies compared to grade 2. Consistently, analysis of two breast cancer patient cohorts, GDS4057 and TCGA, indicated that in ER-negative tumors higher ZnR/GPR39 mRNA levels are associated with more aggressive tumors. Activation of ZnR/GPR39 in TAMR cells triggered MAPK, mTOR and PI3K signaling. Importantly, enhanced cell growth and invasiveness was observed in the ER negative breast cancer cells, TAMR, MDA-MB-453 and BT20 cells but not in the ER expressing MCF-7 cells. Thus, we suggest ZnR/GPR39 as a potential therapeutic target for combination treatment in breast cancer, particularly relevant in ER negative tumors.

Phosphorylation of zinc channel ZIP7 drives MAPK, PI3K and mTOR growth and proliferation signalling

Zinc is an essential trace element participating in diverse biological processes. Cellular zinc levels are strictly controlled by two families of transport proteins: ZIP channels (SLC39A) and ZnT transporters (SLC30A). ZIP channels increase cytosolic zinc levels by importing zinc into cells or releasing zinc from intracellular stores such as the ER. Among all the 14 human members of the ZIP family, ZIP7 is a gatekeeper of zinc release from intracellular stores, requiring post-translational activation by phosphorylation on residues S275 and S276, resulting in activation of multiple downstream pathways. Employing site-directed mutagenesis, we investigated the importance of these individual serine residues as well as other predicted phosphorylation sites on ZIP7, showing that all four sites are required for maximal ZIP7 activation. Using phosphor-protein arrays, we also discovered the major signalling pathways that were activated as a direct result of ZIP7-mediated zinc release from intracellular stores. These data reveal the role of ZIP7-mediated zinc release from intracellular stores in driving major pathways, such as MAPK, mTOR and PI3K-AKT, involved in providing cell survival and proliferation and often over activated in cancer.

The virtual maze: A behavioural tool for measuring trust

Trusting another person may depend on our level of generalised trust in others, as well as perceptions of that specific person’s trustworthiness. However, many studies measuring trust outcomes have not discussed generalised versus specific trust. To measure specific trust in others, we developed a novel behavioural task. Participants navigate a virtual maze and make a series of decisions about how to proceed. Before each decision, they may ask for advice from two virtual characters they have briefly interviewed earlier. We manipulated the virtual characters’ trustworthiness during the interview phase and measured how often participants approached and followed advice from each character. We also measured trust through ratings and an investment game. Across three studies, we found participants followed advice from a trustworthy character significantly more than an untrustworthy character, demonstrating the validity of the maze task. Behaviour in the virtual maze reflected specific trust rather than generalised trust, whereas the investment game picked up on generalised trust as well as specific trust. Our data suggest the virtual maze task may provide an alternative behavioural approach to measuring specific trust in future research, and we demonstrate how the task may be used in traditional laboratories.

Hyperglycemia-Induced Changes in ZIP7 and ZnT7 Expression Cause Zn2+ Release From the Sarco(endo)plasmic Reticulum and Mediate ER Stress in the Heart

Changes in cellular free Zn²⁺ concentration, including those in the sarco(endo)plasmic reticulum [S(E)R], are primarily coordinated by Zn²⁺ transporters (ZnTs) whose identity and role in the heart are not well established. We hypothesized that ZIP7 and ZnT7 transport Zn²⁺ in opposing directions across the S(E)R membrane in cardiomyocytes and that changes in their activity play an important role in the development of ER stress during hyperglycemia. The subcellular S(E)R localization of ZIP7 and ZnT7 was determined in cardiomyocytes and in isolated S(E)R preparations. Markedly increased mRNA and protein levels of ZIP7 were observed in ventricular cardiomyocytes from diabetic rats or high-glucose-treated H9c2 cells while ZnT7 expression was low. In addition, we observed increased ZIP7 phosphorylation in response to high glucose in vivo and in vitro. By using recombinant-targeted Förster resonance energy transfer sensors, we show that hyperglycemia induces a marked redistribution of cellular free Zn²⁺, increasing cytosolic free Zn²⁺ and lowering free Zn²⁺ in the S(E)R. These changes involve alterations in ZIP7 phosphorylation and were suppressed by small interfering RNA-mediated silencing of CK2α. Opposing changes in the expression of ZIP7 and ZnT7 were also observed in hyperglycemia. We conclude that subcellular free Zn²⁺ redistribution in the hyperglycemic heart, resulting from altered ZIP7 and ZnT7 activity, contributes to cardiac dysfunction in diabetes.

Monitoring cytosolic and ER Zn(2+) in stimulated breast cancer cells using genetically encoded FRET sensors

The Zn(2+)-specific ion channel ZIP7 has been implicated to play an important role in releasing Zn(2+) from the ER. External stimulation of breast cancer cells has been proposed to induce phosphorylation of ZIP7 by CK2α, resulting in ZIP7-mediated Zn(2+) release from the ER into the cytosol. Here, we examined whether changes in cytosolic and ER Zn(2+) concentrations can be detected upon such external stimuli. Two previously developed FRET sensors for Zn(2+), eZinCh-2 (Kd = 1 nM at pH 7.1) and eCALWY-4 (Kd = 0.63 nM at pH 7.1), were expressed in both the cytosol and the ER of wild-type MCF-7 and TamR cells. Treatment of MCF-7 and TamR cells with external Zn(2+) and pyrithione, one of the previously used triggers, resulted in an immediate increase in free Zn(2+) in both cytosol and ER, suggesting that Zn(2+) was directly transferred across the cellular membranes by pyrithione. Cells treated with a second trigger, EGF/ionomycin, showed no changes in intracellular Zn(2+) levels, neither in multicolor imaging experiments that allowed simultaneous imaging of cytosolic and ER Zn(2+), nor in experiments in which cytosolic and ER Zn(2+) were monitored separately. In contrast to previous work using small-molecule fluorescent dyes, these results indicate that EGF-ionomycin treatment does not result in significant changes in cytosolic Zn(2+) levels as a result from Zn(2+) release from the ER. These results underline the importance of using genetically encoded fluorescent sensors to complement and verify intracellular imaging experiments with synthetic fluorescent Zn(2+) dyes.

Paediatric extracorporeal priming procedures: does low temperature priming promote histamine release?

We have recently reported pathologically elevated plasma histamine levels in adult patients undergoing cardiac surgery throughout the perioperative period. We have found markedly higher histamine levels in paediatric practice. The priming volume of the smallest extracorporeal systems is invariably greater than the circulating blood volume of neonates and infants, necessitating the use of stored donor blood in the initial priming procedure. In 40 paediatric cases, arbitrarily selected, sampling from the arterial port of the oxygenator prior to the initiation of bypass revealed massively elevated plasma histamine levels (>30ng/ml) in those extracorporeal circuits in which the priming volume was smallest and the priming temperature lowest - at 10-12°C. It is clear that the use of donor blood (in this series less than five days old) may contribute to the delivery of histamine into the paediatric patient's circulation at the onset of cardiopulmonary bypass and that the priming temperature may play a role.

Histamine release during cardiopulmonary bypass

Plasma histamine concentrations were measured in 15 adult patients undergoing open-heart surgery (coronary artery bypass grafting) and in three control patients undergoing major noncardiac surgery. Plasma histamine levels rose in both open-heart and control patients in the early phase of operation before the onset of cardiopulmonary bypass (CPB). In the open-heart patients, significant elevations in plasma histamine concentrations occurred in the first 30 minutes of CPB (p < 0.05) in spite of haemodilution (median 36%). Plasma histamine changed neither by the application of X-clamp nor by its removal. No significant differences were observed between pulsatile and nonpulsatile flow of bypass perfusion. Two of the three patients who required infusion of sodium nitroprusside had high concentrations of plasma histamine (over 2ng/ml) throughout the observation period. DC shock induced an immediate response in histamine release. In the immediate post-CPB period when spontaneous circulation was resumed, the open-heart surgery patients exhibited a second rapid rise in plasma histamine, significantly higher than in the control patients (p < 0.05) in whom elevation in plasma histamine levels was not seen in the postoperative period. One of the CPB patients with persistent high histamine in the postoperative period had severe bronchospasm. Thus, in patients undergoing open-heart surgery, histamine release occurs at the onset of CPB and soon after the discontinuation of CPB. H1 + H2 blockade may be indicated in those at risk from histamine-mediated responses or receiving sodium nitroprusside or DC shocks.

The effect of normothermic cardiopulmonary bypass on hepatic blood flow in the dog

Hepatic blood flow was investigated in two groups of eight anaesthetized dogs during and after one hour of either pulsatile or non-pulsatile cardiopulmonary bypass (CPB). Mean perfusion pressure was maintained at 60 mmHg. Hepatic arterial (HA) and portal venous (PV) blood flows were measured using electromagnetic flow probes, and hepatic O 2 consumption determined. The results demonstrate that: (a) pulsatile CPB reduces peripheral vascular resistance during and after perfusion, and more effectively preserves pump flow rate and cardiac output than non-pulsatile CPB; (b) total liver blood flow is sustained more effectively by pulsatile CPB than by non-pulsatile CPB due to relative preservation of both HA and PV flows; (c) hepatic O2 consumption is only marginally better preserved during and after pulsatile CPB than with non-pulsatile perfusion. We conclude that: (a) pulsatile CPB tends to maintain hepatic blood flow through a relative reduction in HA vascular resistance and an improvement in PV flow produced passively by a greater pump flow rate; (b) pulsatile CPB less effectively benefits hepatic O2 consumption because of poor O2 uptake from the hepatic PV blood supply.

Performance characteristics of a new arterial line filter

A new 40 micron polyester screen arterial line filter with integral automatic blood gas separator has been designed with the potential for improved removal characteristics for gas microbubbles and massive air. A simple in vitro evaluation has been carried out comparing the new filter (Pall EC+) against a standard widely-used reference arterial line filter (Pall EC 3840). The filters have been compared in terms of their haemodynamic performance, specifically pressure drop at incremental flow rates and haemolysis characteristics measuring generated plasma free haemoglobin. In addition, the relative abilities of the test and reference filters to remove gaseous microbubbles, and also to vent massive air introduced into the test circuits have been assessed using an ultrasound based microbubble detection system. The results of the studies indicate that the test and reference filters are identical in terms of haemodynamics, with maximal pressure drops of 30 mmHg at 4-5 litres mean flow rate. Neither filter is associated with significant haemolysis in bovine blood test circuits flowing at 4 I/min for 60 minutes. However, the EC+ filter has significantly superior performance over the reference EC 3840 filter in both microbubble removal and in removal of nitrogen gas introduced directly into the test circuit at up to 5 litres gas/min ( p < 0.01). The new EC+ filter appears to offer safety in terms of haemodynamics and haemolysis, while providing maximal protection against massive arterial gas embolism.

A double blind clinical trial of Iloprost during cardiopulmonary bypass

Twenty patients undergoing elective coronary surgery were randomized to receive either the prostacyclin analogue Iloprost (Zk 36374) 5 ng/kg/min for 30 minutes before cardiopulmonary bypass (CPB) increasing to 10 ng/kg/min during CPB, or placebo, to investigate any beneficial effect on platelet preservation, or protection of the central nervous system during clinical CPB. Originally 50 patients were to have entered the trial, but unacceptable hypotensive effects occu rred in five patients who received Iloprost, lead i ng to early data analysis. No significant improvement in platelet number, volume or function; bleeding time; arterial line filter δ dry weight; retinal microembolism; or neuropsychological function, attributable to Iloprost, could be identified. The role and optimal dose of Iloprost in clinical CPB remains to be established.

Head injury at early ages is associated with risk of Parkinson's disease

INTRODUCTION

The literature on the effect of head injuries on the risk of PD is inconclusive. Some researchers have hypothesized that studies that have seen an effect are simply capturing injury related to pre-clinical PD. However in animal models brain inflammation, which can be initiated by head trauma, has been shown to produce PD-like effects. Furthermore, animal studies have found that early life inflammation in particular is of relevance for PD pathology.

METHODS

We conducted an unmatched case-control study of 379 neurologist confirmed PD patients and 230 controls from the greater Boston, Massachusetts area with questionnaire data on history of head injury and other covariates. We used multivariable logistic regression to estimate adjusted odds ratios (OR) and their corresponding 95% confidence intervals (CI) for PD.

RESULTS

When we excluded injuries that occurred less than 10 years prior to the diagnosis of PD (in order to avoid reverse causation), we found an increased risk of PD associated with a head injury that resulted in a loss of consciousness, but it did not reach statistical significance (OR = 1.57; 95% CI = 0.89-2.80). We found a significant (p = 0.04) effect of age at first head injury. For every 5 year earlier age at first head injury with loss of consciousness the OR for PD was 1.37 (95% CI: 1.01-1.86).

CONCLUSION

Our results suggest that head injury in early life increases the risk of PD.