1
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Gilmore N, Tseng CEJ, Maffei C, Tromly SL, Deary KB, McKinney IR, Kelemen JN, Healy BC, Hu CG, Ramos-Llordén G, Masood M, Cali RJ, Guo J, Belanger HG, Yao EF, Baxter T, Fischl B, Foulkes AS, Polimeni JR, Rosen BR, Perl DP, Hooker JM, Zürcher NR, Huang SY, Kimberly WT, Greve DN, Mac Donald CL, Dams-O’Connor K, Bodien YG, Edlow BL. Impact of repeated blast exposure on active-duty United States Special Operations Forces. Proc Natl Acad Sci U S A 2024; 121:e2313568121. [PMID: 38648470 PMCID: PMC11087753 DOI: 10.1073/pnas.2313568121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
United States (US) Special Operations Forces (SOF) are frequently exposed to explosive blasts in training and combat, but the effects of repeated blast exposure (RBE) on SOF brain health are incompletely understood. Furthermore, there is no diagnostic test to detect brain injury from RBE. As a result, SOF personnel may experience cognitive, physical, and psychological symptoms for which the cause is never identified, and they may return to training or combat during a period of brain vulnerability. In 30 active-duty US SOF, we assessed the relationship between cumulative blast exposure and cognitive performance, psychological health, physical symptoms, blood proteomics, and neuroimaging measures (Connectome structural and diffusion MRI, 7 Tesla functional MRI, [11C]PBR28 translocator protein [TSPO] positron emission tomography [PET]-MRI, and [18F]MK6240 tau PET-MRI), adjusting for age, combat exposure, and blunt head trauma. Higher blast exposure was associated with increased cortical thickness in the left rostral anterior cingulate cortex (rACC), a finding that remained significant after multiple comparison correction. In uncorrected analyses, higher blast exposure was associated with worse health-related quality of life, decreased functional connectivity in the executive control network, decreased TSPO signal in the right rACC, and increased cortical thickness in the right rACC, right insula, and right medial orbitofrontal cortex-nodes of the executive control, salience, and default mode networks. These observations suggest that the rACC may be susceptible to blast overpressure and that a multimodal, network-based diagnostic approach has the potential to detect brain injury associated with RBE in active-duty SOF.
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Affiliation(s)
- Natalie Gilmore
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Chieh-En J. Tseng
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Chiara Maffei
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Samantha L. Tromly
- Institute of Applied Engineering, University of South Florida, Tampa, FL33612
| | | | - Isabella R. McKinney
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Jessica N. Kelemen
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Brian C. Healy
- Harvard T.H. Chan School of Public Health, Boston, MA02115
| | - Collin G. Hu
- United States Army Special Operations Aviation Command, Fort Liberty, NC28307
- Department of Family Medicine, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD20814
| | - Gabriel Ramos-Llordén
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Maryam Masood
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Ryan J. Cali
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Jennifer Guo
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Heather G. Belanger
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL33613
| | - Eveline F. Yao
- Office of the Air Force Surgeon General, Falls Church, VA22042
| | - Timothy Baxter
- Institute of Applied Engineering, University of South Florida, Tampa, FL33612
| | - Bruce Fischl
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | | | - Jonathan R. Polimeni
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Bruce R. Rosen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Daniel P. Perl
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD20814
| | - Jacob M. Hooker
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Nicole R. Zürcher
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Susie Y. Huang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - W. Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Douglas N. Greve
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | | | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY10029
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY10029
| | - Yelena G. Bodien
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA02129
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
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2
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Zhu X, Chu X, Wang H, Liao Z, Xiang H, Zhao W, Yang L, Wu P, Liu X, Chen D, Xie J, Dai W, Li L, Wang J, Zhao H. Investigating neuropathological changes and underlying neurobiological mechanisms in the early stages of primary blast-induced traumatic brain injury: Insights from a rat model. Exp Neurol 2024; 375:114731. [PMID: 38373483 DOI: 10.1016/j.expneurol.2024.114731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 02/21/2024]
Abstract
The utilization of explosives and chemicals has resulted in a rise in blast-induced traumatic brain injury (bTBI) in recent times. However, there is a dearth of diagnostic biomarkers and therapeutic targets for bTBI due to a limited understanding of biological mechanisms, particularly in the early stages. The objective of this study was to examine the early neuropathological characteristics and underlying biological mechanisms of primary bTBI. A total of 83 Sprague Dawley rats were employed, with their heads subjected to a blast shockwave of peak overpressure ranging from 172 to 421 kPa in the GI, GII, and GIII groups within a closed shock tube, while the body was shielded. Neuromotor dysfunctions, morphological changes, and neuropathological alterations were detected through modified neurologic severity scores, brain water content analysis, MRI scans, histological, TUNEL, and caspase-3 immunohistochemical staining. In addition, label-free quantitative (LFQ)-proteomics was utilized to investigate the biological mechanisms associated with the observed neuropathology. Notably, no evident damage was discernible in the GII and GI groups, whereas mild brain injury was observed in the GIII group. Neuropathological features of bTBI were characterized by morphologic changes, including neuronal injury and apoptosis, cerebral edema, and cerebrovascular injury in the shockwave's path. Subsequently, 3153 proteins were identified and quantified in the GIII group, with subsequent enriched neurological responses consistent with pathological findings. Further analysis revealed that signaling pathways such as relaxin signaling, hippo signaling, gap junction, chemokine signaling, and sphingolipid signaling, as well as hub proteins including Prkacb, Adcy5, and various G-protein subunits (Gnai2, Gnai3, Gnao1, Gnb1, Gnb2, Gnb4, and Gnb5), were closely associated with the observed neuropathology. The expression of hub proteins was confirmed via Western blotting. Accordingly, this study proposes signaling pathways and key proteins that exhibit sensitivity to brain injury and are correlated with the early pathologies of bTBI. Furthermore, it highlights the significance of G-protein subunits in bTBI pathophysiology, thereby establishing a theoretical foundation for early diagnosis and treatment strategies for primary bTBI.
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Affiliation(s)
- Xiyan Zhu
- Department of Military Traffic Injury Prevention and Control, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiang Chu
- Cognitive Development and Learning and Memory Disorders Translational Medicine Laboratory, Children's Hospital, Chongqing Medical University, Chongqing, China; Emergency department, Daping Hospital, Army Medical University, Chongqing, China
| | - Hao Wang
- Neurosurgery department, Daping Hospital, Army Medical University, Chongqing, China
| | - Zhikang Liao
- Department of Military Traffic Injury Prevention and Control, Daping Hospital, Army Medical University, Chongqing, China
| | - Hongyi Xiang
- Department of Military Traffic Injury Prevention and Control, Daping Hospital, Army Medical University, Chongqing, China
| | - Wenbing Zhao
- Department of Military Traffic Injury Prevention and Control, Daping Hospital, Army Medical University, Chongqing, China
| | - Li Yang
- Department of Military Traffic Injury Prevention and Control, Daping Hospital, Army Medical University, Chongqing, China
| | - Pengfei Wu
- Department of Military Traffic Injury Prevention and Control, Daping Hospital, Army Medical University, Chongqing, China
| | - Xing Liu
- Department of Military Traffic Injury Prevention and Control, Daping Hospital, Army Medical University, Chongqing, China
| | - Diyou Chen
- Department of Military Traffic Injury Prevention and Control, Daping Hospital, Army Medical University, Chongqing, China
| | - Jingru Xie
- Department of Military Traffic Injury Prevention and Control, Daping Hospital, Army Medical University, Chongqing, China
| | - Wei Dai
- Department of Military Traffic Injury Prevention and Control, Daping Hospital, Army Medical University, Chongqing, China
| | - Lei Li
- Trauma Medical Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Jianmin Wang
- Department of Weapon Bioeffect Assessment, Daping Hospital, Army Medical University, Chongqing, China.
| | - Hui Zhao
- Department of Military Traffic Injury Prevention and Control, Daping Hospital, Army Medical University, Chongqing, China.
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3
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Dougan CE, Roberts BL, Crosby AJ, Karatsoreos I, Peyton SR. Acute and Chronic Neural and Glial Response to Mild Traumatic Brain Injury in the Hippocampus. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.01.587620. [PMID: 38617329 PMCID: PMC11014627 DOI: 10.1101/2024.04.01.587620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Traumatic brain injury (TBI) is an established risk factor for developing neurodegenerative disease. However, how TBI leads from acute injury to chronic neurodegeneration is limited to post-mortem models. There is a lack of connections between in vitro and in vivo TBI models that can relate injury forces to both macroscale tissue damage and brain function at the cellular level. Needle-induced cavitation (NIC) is a technique that can produce small cavitation bubbles in soft tissues, which allows us to relate small strains and strain rates in living tissue to ensuing acute and chronic cell death, tissue damage, and tissue remodeling. Here, we applied NIC to mouse brain slices to create a new model of TBI with high spatial and temporal resolution. We specifically targeted the hippocampus, which is a brain region critical for learning and memory and an area in which injury causes cognitive pathologies in humans and rodent models. By combining NIC with patch-clamp electrophysiology, we demonstrate that NIC in the Cornu Ammonis (CA)3 region of the hippocampus dynamically alters synaptic release onto CA1 pyramidal neurons in a cannabinoid 1 receptor (CB1R)-dependent manner. Further, we show that NIC induces an increase in extracellular matrix proteins associated with neural repair that is mitigated by CB1R antagonism. Together, these data lay the groundwork for advanced approaches in understanding how TBI impacts neural function at the cellular level, and the development of treatments that promote neural repair in response to brain injury.
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Affiliation(s)
- Carey E. Dougan
- Department of Chemical Engineering, University of Massachusetts Amherst, Amherst, MA 01003, USA
- Department of Chemistry and Department of Engineering, Smith College, Northampton, MA 01063
| | - Brandon L. Roberts
- Neuroscience and Behavior Program, and Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA
- Department of Zoology & Physiology, University of Wyoming, Laramie, WY 83072, USA
- Department of Animal Science, University of Wyoming, Laramie, WY 83072, USA
| | - Alfred J. Crosby
- Department of Polymer Science and Engineering, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Ilia Karatsoreos
- Neuroscience and Behavior Program, and Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Shelly R. Peyton
- Department of Chemical Engineering, University of Massachusetts Amherst, Amherst, MA 01003, USA
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4
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Kawauchi S, Kono A, Muramatsu Y, Hennes G, Seki S, Tominaga S, Haruyama Y, Komuta Y, Nishidate I, Matsukuma S, Wang Y, Sato S. Meningeal damage and interface astroglial scarring in the rat brain exposed to a laser-induced shock wave(s). J Neurotrauma 2024. [PMID: 38534205 DOI: 10.1089/neu.2023.0572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
In the past decade, signature clinical neuropathology of blast-induced traumatic brain injury has been under intense debate, but interface astroglial scarring (IAS) seems to be convincing. In this study, we examined whether IAS could be replicated in the rat brain exposed to a laser-induced shock wave(s) (LISW[s]), a tool that can produce a pure shock wave (primary mechanism) without dynamic pressure (tertiary mechanism). Under certain conditions, we observed astroglial scarring in the subpial glial plate (SGP), grey-white matter junctions (GM-WM), ventricular wall (VW) and regions surrounding cortical blood vessels, accurately reproducing clinical IAS. We also observed shock wave impulse-dependent meningeal damage (dural microhemorrhage) in vivo by transcranial near-infrared reflectance imaging. Importantly, there were significant correlations between the degree of dural microhemorrhage and the extent of astroglial scarring more than 7 days post-exposure, suggesting an association of meningeal damage with astroglial scarring. The results demonstrated that the primary mechanism alone caused the IAS and meningeal damage, both of which are attributable to acoustic impedance mismatching at multilayered tissue boundaries. The time course of glial fibrillary acidic protein (GFAP) immunoreactivity depended not only on the LISW conditions but also on the regions. In the SGP, significant increases in GFAP immunoreactivity were observed at 3 days post-exposure, while in the GM-WM and VW, GFAP immunoreactivity was not significantly increased before 14 days post-exposure, suggesting different pathological mechanisms. With the high-impulse single exposure or the multiple exposure (low impulse), fibrotic reaction or fibrotic scar formation was observed, in addition to astroglial scarring, in the cortical surface region. Although there are some limitations, this seems to be the first report on the shock wave-induced IAS rodent model. The model may be useful to explore potential therapeutic approaches for IAS.
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Affiliation(s)
- Satoko Kawauchi
- National Defense Medical College, 13077, Division of Bioinformation and Therapeutic Systems, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa, Tokorozawa, Saitama, Japan, 359-8513;
| | - Akemi Kono
- Division of Bioinformation and Therapeutic Systems, National Defense Medical College Research Institute, Tokorozawa, Saitama, Japan;
| | - Yuriko Muramatsu
- Division of Bioinformation and Therapeutic Systems, National Defense Medical College Research Institute, Tokorozawa, Saitama, Japan;
| | - Grant Hennes
- DRDC Suffield Research Centre, Medicine Hat, Alberta, Canada;
| | - Shuta Seki
- Japan Self Defense Force Central Hospital, Medical Material Department, Setagaya, Tokyo, Japan;
| | - Susumu Tominaga
- National Defense Medical College, 13077, Department of Pathology and Laboratory Medicine, Tokorozawa, Saitama, Japan;
| | - Yasue Haruyama
- National Defense Medical College, 13077, Division of Bioinformation and Therapeutic Systems, National Defense Medical College Research Institute, Tokorozawa, Saitama, Japan;
| | - Yukari Komuta
- National Defense Medical College, 13077, Division of Bioinformation and Therapeutic Systems, National Defense Medical College Research Institute, Tokorozawa, Saitama, Japan;
| | - Izumi Nishidate
- Tokyo University of Agriculture and Technology, Graduate School of Bio-Applications & Systems Engineering, 2-24-16, Naka-cho,, Koganei-shi,, Tokyo, Japan, 184-8588;
| | - Susumu Matsukuma
- National Defense Medical College, 13077, Department of Pathology and Laboratory Medicine, Tokorozawa, Saitama, Japan;
| | - Yushan Wang
- DRDC Suffield Research Centre, P.O. Box 4000, Medicine Hat, Alberta, Canada, T1A8K6;
| | - Shunichi Sato
- National Defense Medical College, 13077, Division of Bioinformation and Therapeutic Systems, Research Institute, 3-2, Namiki, Tokorozawa, Saitama, Japan, 359-8513;
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5
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Martin EJ, Santacruz C, Mitevska A, Jones IE, Krishnan G, Gao FB, Finan JD, Kiskinis E. Traumatic injury causes selective degeneration and TDP-43 mislocalization in human iPSC-derived C9orf72-associated ALS/FTD motor neurons. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.21.586073. [PMID: 38585915 PMCID: PMC10996466 DOI: 10.1101/2024.03.21.586073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
A hexanucleotide repeat expansion (HRE) in C9orf72 is the most common genetic cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). However, patients with the HRE exhibit a wide disparity in clinical presentation and age of symptom onset suggesting an interplay between genetic background and environmental stressors. Neurotrauma as a result of traumatic brain or spinal cord injury has been shown to increase the risk of ALS/FTD in epidemiological studies. Here, we combine patient-specific induced pluripotent stem cells (iPSCs) with a custom-built device to deliver biofidelic stretch trauma to C9orf72 patient and isogenic control motor neurons (MNs) in vitro. We find that mutant but not control MNs exhibit selective degeneration after a single incident of severe trauma, which can be partially rescued by pretreatment with a C9orf72 antisense oligonucleotide. A single incident of mild trauma does not cause degeneration but leads to cytoplasmic accumulation of TDP-43 in C9orf72 MNs. This mislocalization, which only occurs briefly in isogenic controls, is eventually restored in C9orf72 MNs after 6 days. Lastly, repeated mild trauma ablates the ability of patient MNs to recover. These findings highlight alterations in TDP-43 dynamics in C9orf72 ALS/FTD patient MNs following traumatic injury and demonstrate that neurotrauma compounds neuropathology in C9orf72 ALS/FTD. More broadly, our work establishes an in vitro platform that can be used to interrogate the mechanistic interactions between ALS/FTD and neurotrauma.
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Affiliation(s)
- Eric J. Martin
- The Ken & Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Citlally Santacruz
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Angela Mitevska
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Ian E. Jones
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Gopinath Krishnan
- RNA Therapeutics Institute, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Fen-Biao Gao
- RNA Therapeutics Institute, University of Massachusetts Medical School, Worcester, MA 01605, USA
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - John D. Finan
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Evangelos Kiskinis
- The Ken & Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Simpson Querrey Institute, Northwestern University, Chicago, Illinois 60611, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
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6
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Elster N, Boutillier J, Bourdet N, Magnan P, Naz P, Willinger R, Deck C. Design of a simplified cranial substitute with a modal behavior close to that of a human skull. Front Bioeng Biotechnol 2024; 12:1297730. [PMID: 38585709 PMCID: PMC10995299 DOI: 10.3389/fbioe.2024.1297730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/27/2024] [Indexed: 04/09/2024] Open
Abstract
Individuals exposed to the propagation of shock waves generated by the detonation of explosive charges may suffer Traumatic Brain Injury. The mechanism of cranial deflection is one of many hypotheses that could explain the observed brain damage. To investigate this physical phenomenon in a reproducible manner, a new simplified cranial substitute was designed with a mechanical response close to that of a human skull when subjected to this type of loading. As a first step, a Finite Element Model was employed to dimension the new substitute. The objective was indeed to obtain a vibratory behavior close to that of a dry human skull over a wide range of frequencies up to 10 kHz. As a second step, the Finite Element Model was used together with Experimental Modal Analyses to identify the vibration modes of the substitute. A shaker excited the structure via a metal rod, while a laser vibrometer recorded the induced vibrations at defined measurement points. The results showed that despite differences in material properties and geometry, the newly developed substitute has 10/13 natural frequencies in common with those of dry human skulls. When filled with a simulant of cerebral matter, it could therefore be used in future studies as an approximation to assess the mechanical response of a simplified skull substitute to a blast threat.
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Affiliation(s)
- Natacha Elster
- French-German Research Institute of Saint-Louis, Saint-Louis, France
| | | | | | - Pascal Magnan
- French-German Research Institute of Saint-Louis, Saint-Louis, France
| | - Pierre Naz
- French-German Research Institute of Saint-Louis, Saint-Louis, France
| | - Rémy Willinger
- ICube Laboratory, Strasbourg University, Strasbourg, France
| | - Caroline Deck
- ICube Laboratory, Strasbourg University, Strasbourg, France
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Sachdeva T, Ganpule SG. Twenty Years of Blast-Induced Neurotrauma: Current State of Knowledge. Neurotrauma Rep 2024; 5:243-253. [PMID: 38515548 PMCID: PMC10956535 DOI: 10.1089/neur.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Blast-induced neurotrauma (BINT) is an important injury paradigm of neurotrauma research. This short communication summarizes the current knowledge of BINT. We divide the BINT research into several broad categories-blast wave generation in laboratory, biomechanics, pathology, behavioral outcomes, repetitive blast in animal models, and clinical and neuroimaging investigations in humans. Publications from 2000 to 2023 in each subdomain were considered. The analysis of the literature has brought out salient aspects. Primary blast waves can be simulated reasonably in a laboratory using carefully designed shock tubes. Various biomechanics-based theories of BINT have been proposed; each of these theories may contribute to BINT by generating a unique biomechanical signature. The injury thresholds for BINT are in the nascent stages. Thresholds for rodents are reasonably established, but such thresholds (guided by primary blast data) are unavailable in humans. Single blast exposure animal studies suggest dose-dependent neuronal pathologies predominantly initiated by blood-brain barrier permeability and oxidative stress. The pathologies were typically reversible, with dose-dependent recovery times. Behavioral changes in animals include anxiety, auditory and recognition memory deficits, and fear conditioning. The repetitive blast exposure manifests similar pathologies in animals, however, at lower blast overpressures. White matter irregularities and cortical volume and thickness alterations have been observed in neuroimaging investigations of military personnel exposed to blast. Behavioral changes in human cohorts include sleep disorders, poor motor skills, cognitive dysfunction, depression, and anxiety. Overall, this article provides a concise synopsis of current understanding, consensus, controversies, and potential future directions.
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Affiliation(s)
- Tarun Sachdeva
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee, India
| | - Shailesh G. Ganpule
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee, India
- Department of Design, Indian Institute of Technology Roorkee, Roorkee, India
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8
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Wang Z, Xu P, Ren Z, Yu L, Zuo Z, Liu S. Dynamics of cavitation bubbles in viscous liquids in a tube during a transient process. ULTRASONICS SONOCHEMISTRY 2024; 104:106840. [PMID: 38457940 PMCID: PMC10940912 DOI: 10.1016/j.ultsonch.2024.106840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
We experimentally, numerically, and theoretically investigate the dynamics of cavitation bubbles in viscous liquids in a tube during a transient process. In experiments, cavitation bubbles are generated by a modified tube-arrest setup, and the bubble evolution is captured with high-speed imaging. Numerical simulations using OpenFOAM are employed to validate our quasi-one-dimensional theoretical model, which effectively characterizes the bubble dynamics. We find that cavitation onset is minimally affected by the liquid viscosity. However, once cavitation occurs, various aspects of bubble dynamics, such as the maximum bubble length, bubble lifetime, collapse time, and collapse speed, are closely related to the liquid viscosity. We further establish that normalized bubble dynamics are solely determined by the combination of the Reynolds number and the Euler number. Moreover, we also propose a new dimensionless number, Ca2, to predict the maximum bubble length, a critical factor in determining the occurrence of liquid column separation.
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Affiliation(s)
- Zhichao Wang
- State Key Laboratory of Hydroscience and Engineering, and Department of Energy and Power Engineering, Tsinghua University, 100084 Beijing, China
| | - Peng Xu
- State Key Laboratory of Hydroscience and Engineering, and Department of Energy and Power Engineering, Tsinghua University, 100084 Beijing, China
| | - Zibo Ren
- State Key Laboratory of Hydroscience and Engineering, and Department of Energy and Power Engineering, Tsinghua University, 100084 Beijing, China
| | - Liufang Yu
- Research Institute of Chemical Defence, 102205 Beijing, China
| | - Zhigang Zuo
- State Key Laboratory of Hydroscience and Engineering, and Department of Energy and Power Engineering, Tsinghua University, 100084 Beijing, China.
| | - Shuhong Liu
- State Key Laboratory of Hydroscience and Engineering, and Department of Energy and Power Engineering, Tsinghua University, 100084 Beijing, China.
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9
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Kennelly TR, Eshraghi J, Dabiri S, Vlachos PP. An experimentally validated cavitation inception model for spring-driven autoinjectors. Int J Pharm 2024; 652:123753. [PMID: 38159583 DOI: 10.1016/j.ijpharm.2023.123753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
Cavitation, the formation and collapse of vapor-filled bubbles, poses a problem in spring-driven autoinjectors (AIs). It occurs when the syringe accelerates abruptly during activation, causing pressure fluctuations within the liquid. These bubbles expand and then collapse, generating shock waves that can harm both the device and the drug molecules. This issue stems from the syringe's sudden acceleration when the driving rod hits the plunger. To better understand cavitation in AIs, we explore how design factors like drive spring force, air gap size, and fluid viscosity affect its likelihood and severity. We use a dynamic model for spring-driven autoinjectors to predict and analyze the factors contributing to cavitation initiation and severity. This model predicts the motion of AI components, such as the displacement and velocity of the syringe barrel, and allows us to investigate pressure wave propagation and the subsequent dynamics of cavitation under various operating conditions. We investigated different air gap heights (from 1 to 4 mm), drive spring forces (from 8 to 30 N), and drug solution viscosities (from 1 to 18 cp) to assess cavitation inception based on operational parameters. Results reveal that AI dynamics and cavitation onset and severity strongly depend upon AI operating parameters, namely drive spring force and air gap height. The maximum syringe acceleration increases with spring stiffness and decreases with air gap height; increases in air gap height prolong the time interval of syringe acceleration but diminish the maximum syringe acceleration. From actuation to injection, air gap pressure peaks twice, first due to impact with the rod/plunger and secondly due to the deacceleration event upon injection. The maximum air gap pressure increases with spring stiffness and decreases with air gap height. Results show that maximum cavitation bubble radii and collapse-driven extension rates occur with higher driver spring forces, smaller air gap heights, and less viscous solutions. A cavitation criterion is developed for cavitation in autoinjectors that concludes that cavitation in autoinjectors depends on the peak syringe acceleration.
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Affiliation(s)
- Tyler R Kennelly
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47906, United States.
| | - Javad Eshraghi
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47906, United States; Eli Lilly and Company, Indianapolis, IN 46225, United States
| | - Sadegh Dabiri
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47906, United States
| | - Pavlos P Vlachos
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47906, United States
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10
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Chen DY, Zhu XY, Ma W, Shao SF, Zhang L, Xie JR, Wang YL, Zhao H. Blast injuries with contrasting outcomes treated by military surgery strategies: A case report. Chin J Traumatol 2024:S1008-1275(24)00003-8. [PMID: 38350782 DOI: 10.1016/j.cjtee.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 02/15/2024] Open
Abstract
The treatment strategy for blast injuries is closely linked to the clinical outcome of blast injury casualties. However, the application of military surgery experience to blast injuries caused by production safety accidents is relatively uncommon. In this study, the authors present 2 cases of blast injuries caused by one gas explosion, both cases involved individuals of the same age and gender and experienced similar degree of injury. The authors highlight the importance of using a military surgery treatment strategy, specifically emphasizing the need to understand the concept of damage control and disposal. It is recommended that relevant training in this area should be strengthened to improve the clinical treatment of such injuries. This study provides a valuable reference for healthcare professionals dealing with blast injuries.
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Affiliation(s)
- Di-You Chen
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China; Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Xi-Yan Zhu
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Wei Ma
- Department of Wound Infection and Drug, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Shi-Feng Shao
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Liang Zhang
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Jing-Ru Xie
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Yao-Li Wang
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, China.
| | - Hui Zhao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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11
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Yamamoto EA, Koike S, Luther M, Dennis L, Lim MM, Raskind M, Pagulayan K, Iliff J, Peskind E, Piantino JA. Perivascular Space Burden and Cerebrospinal Fluid Biomarkers in US Veterans With Blast-Related Mild Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 38185848 DOI: 10.1089/neu.2023.0505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Blast-related mild traumatic brain injury (mTBI) is recognized as the "signature injury" of the Iraq and Afghanistan wars. Sleep disruption, mTBI, and neuroinflammation have been individually linked to cerebral perivascular space (PVS) dilatation. Dilated PVSs are putative markers of impaired cerebrospinal fluid (CSF) and interstitial fluid exchange, which plays an important role in removing cerebral waste. The aim of this cross-sectional, retrospective study was to define associations between biomarkers of inflammation and MRI-visible PVS (MV-PVS) burden in Veterans after blast-related mTBI (blast-mTBI) and controls. The CSF and plasma inflammatory biomarker concentrations were compared between blast-mTBI and control groups and correlated with MV-PVS volume and number per white matter cm3. Multiple regression analyses were performed with inflammatory biomarkers as predictors and MV-PVS burden as the outcome. Correction for multiple comparisons was performed using the Banjamini-Hochberg method with a false discovery rate of 0.05. There were no group-wise differences in MV-PVS burden between Veterans with blast-mTBI and controls. Greater MV-PVS burden was significantly associated with higher concentrations of several proinflammatory biomarkers from CSF (i.e., eotaxin, MCP-1, IL-6, IL-8) and plasma (i.e., MCP-4, IL-13) in the blast-mTBI group only. After controlling for sleep time and symptoms of post-traumatic stress disorder, temporal MV-PVS burden remained significantly associated with higher CSF markers of inflammation in the blast-mTBI group only. These data support an association between central, rather than peripheral, neuroinflammation and MV-PVS burden in Veterans with blast-mTBI independent of sleep. Future studies should continue to explore the role of blast-mTBI related central inflammation in MV-PVS development, as well as investigate the impact of subclinical exposures on MV-PVS burden.
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Affiliation(s)
- Erin A Yamamoto
- Department of Neurological Surgery, Division of Child Neurology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA
| | - Seiji Koike
- Biostatistics and Design Program, Division of Child Neurology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA
| | - Madison Luther
- Department of Pediatrics, Division of Child Neurology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA
| | - Laura Dennis
- Department of Pediatrics, Division of Child Neurology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA
| | - Miranda M Lim
- Veterans Affairs VISN20 Northwest MIRECC, VA Portland Health Care System, Portland, Oregon, USA
- Oregon Alzheimer's Disease Research Center, Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- Veterans Affairs (V.A.) Northwest (VISN 20) Mental Illness, Research, Education, and Clinical Center (MIRECC), Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Murray Raskind
- Veterans Affairs (V.A.) Northwest (VISN 20) Mental Illness, Research, Education, and Clinical Center (MIRECC), Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kathleen Pagulayan
- Veterans Affairs (V.A.) Northwest (VISN 20) Mental Illness, Research, Education, and Clinical Center (MIRECC), Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeffrey Iliff
- Veterans Affairs (V.A.) Northwest (VISN 20) Mental Illness, Research, Education, and Clinical Center (MIRECC), Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Elaine Peskind
- Veterans Affairs (V.A.) Northwest (VISN 20) Mental Illness, Research, Education, and Clinical Center (MIRECC), Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Juan A Piantino
- Department of Pediatrics, Division of Child Neurology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA
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12
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Kilgore MO, Hubbard WB. Effects of Low-Level Blast on Neurovascular Health and Cerebral Blood Flow: Current Findings and Future Opportunities in Neuroimaging. Int J Mol Sci 2024; 25:642. [PMID: 38203813 PMCID: PMC10779081 DOI: 10.3390/ijms25010642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Low-level blast (LLB) exposure can lead to alterations in neurological health, cerebral vasculature, and cerebral blood flow (CBF). The development of cognitive issues and behavioral abnormalities after LLB, or subconcussive blast exposure, is insidious due to the lack of acute symptoms. One major hallmark of LLB exposure is the initiation of neurovascular damage followed by the development of neurovascular dysfunction. Preclinical studies of LLB exposure demonstrate impairment to cerebral vasculature and the blood-brain barrier (BBB) at both early and long-term stages following LLB. Neuroimaging techniques, such as arterial spin labeling (ASL) using magnetic resonance imaging (MRI), have been utilized in clinical investigations to understand brain perfusion and CBF changes in response to cumulative LLB exposure. In this review, we summarize neuroimaging techniques that can further our understanding of the underlying mechanisms of blast-related neurotrauma, specifically after LLB. Neuroimaging related to cerebrovascular function can contribute to improved diagnostic and therapeutic strategies for LLB. As these same imaging modalities can capture the effects of LLB exposure in animal models, neuroimaging can serve as a gap-bridging diagnostic tool that permits a more extensive exploration of potential relationships between blast-induced changes in CBF and neurovascular health. Future research directions are suggested, including investigating chronic LLB effects on cerebral perfusion, exploring mechanisms of dysautoregulation after LLB, and measuring cerebrovascular reactivity (CVR) in preclinical LLB models.
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Affiliation(s)
- Madison O. Kilgore
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 40536, USA;
| | - W. Brad Hubbard
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 40536, USA;
- Department of Physiology, University of Kentucky, Lexington, KY 40536, USA
- Lexington Veterans’ Affairs Healthcare System, Lexington, KY 40502, USA
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13
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Abid A, Paracha M, Çepele I, Paracha A, Rueve J, Fidahussain A, Rehman H, Engelhardt M, Alyasiry N, Siddiqui Z, Vasireddy S, Kadariya B, Rao N, Das R, Rodriguez W, Meyer D. Examining the relationship between head trauma and opioid use disorder: A systematic review. J Opioid Manag 2024; 20:63-76. [PMID: 38533717 DOI: 10.5055/jom.0846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To examine recent literature and determine common clinical risk factors between antecedent traumatic brain injury (TBI) and the following development of opioid misuse and provide a framework for clinical identification of at-risk subjects and evaluate potential treatment implications within this association. DESIGN A comprehensive systematic literature search of PubMed was conducted for articles between 2000 and December 2022. Studies were included if the human participant had any head trauma exposure and any chronic opioid use or dependence. After eligibility criteria were applied, 16 studies were assessed for thematic trends. RESULTS Opioid use disorder (OUD) risks are heightened in cohorts with head trauma exposed to opioids while in the hospital, specifically with tramadol and oxycodone. Chronic pain was the most common predictor of long-term OUD, and continuous somatic symptoms associated with the TBI can lead to long-term opioid usage. Individuals who present with coexisting psychiatric conditions pose significantly more risk associated with a higher risk of long-term opioid use. CONCLUSION Findings indicate that therapists and clinicians must consider a risk profile for persons with TBI and follow an integrated care approach to account for mental health, prior substance misuse, presenting somatic symptoms, and current medication regimen during evaluation.
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Affiliation(s)
- Ali Abid
- Saint Louis University, St. Louis, Missouri. ORCID: https://orcid.org/0000-0001-5786-4051
| | | | - Iva Çepele
- Saint Louis University, St. Louis, Missouri
| | - Awais Paracha
- Saint Louis University School of Medicine, St. Louis, Missouri
| | | | | | | | - McKimmon Engelhardt
- Midwestern University Chicago College of Osteopathic Medicine, Chicago, Illinois
| | | | - Zohair Siddiqui
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - Satvik Vasireddy
- Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada
| | - Bishal Kadariya
- Edward Via College of Osteopathic Medicine, Blacksburg, Virginia
| | - Nikith Rao
- Midwestern University Chicago College of Osteopathic Medicine, Chicago, Illinois
| | - Rohan Das
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - Wilson Rodriguez
- Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Dixie Meyer
- Department of Family and Community Medicine, Saint Louis University, St. Louis, Missouri
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14
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Sajja V, Shoge R, McNeil E, Van Albert S, Wilder D, Long J. Comparison of Biomechanical Outcome Measures From Characteristically Different Blast Simulators and the Influence of Exposure Location. Mil Med 2023; 188:288-294. [PMID: 37948259 DOI: 10.1093/milmed/usad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/06/2023] [Accepted: 05/23/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Simulation of blast exposure in the laboratory has been inconsistent across laboratories. This is primarily because of adoption of the shock wave-generation techniques that are used in aerodynamic tests as opposed to application of blast exposures that are relevant to combat and training environments of a Warfighter. Because of the differences in blast signatures, characteristically different pathological consequences are observed among the preclinical studies. This is also further confounded by the varied exposure positioning of the animal subject (e.g., inside the blast simulator vs. at the mouth of the simulator). In this study, we compare biomechanical responses to blast exposures created in an advanced blast simulator (ABS) that generates "free-field"-like blast exposure with those produced by a traditionally applied cylindrical blast simulator (CBS) that generates a characteristically different blast signature. In addition, we have tested soft-armor vest protective responses with the ABS and CBS to compare the biomechanical responses to this form of personal protective equipment in each setting in a rodent model. MATERIALS AND METHODS Anesthetized male Sprague-Dawley rats (n = 6) were surgically probed with an intrathoracic pressure (ITP) transducer and an intracranial pressure (ICP) transducer directed into the lateral cerebral ventricle (Millar, Inc.). An ABS for short-duration blast or a CBS for long-duration blast was used to expose animals to an incident blast overpressure of 14.14 psi (impulse: 30.27 psi*msec) or 16.3 psi (impulse: 71.9 psi*msec) using a custom-made holder (n = 3-4/group). An external pitot probe located near the animal was used to measure the total pressure (tip) and static gauge (side-on) pressure. Data were recorded using a TMX-18 data acquisition system (AstroNova Inc.). MATLAB was used to analyze the recordings to identify the peak amplitudes and rise times of the pressure traces. Peak ICP, peak ITP, and their impulses were normalized by expressing them relative to the associated peak static pressure. RESULTS Normalized impulse (ABS: 1.02 ± 0.03 [vest] vs. 1.02 ± 0.01 [no-vest]; CBS: 1.21 ± 0.07 [vest] vs. 1.01 ± 0.01 [no-vest]) and peak pressure for ICP (ABS: 1.03 ± 0.03 [vest] vs. 0.99 ± 0.04 [no-vest]; CBS: 1.06 ± 0.08 [vest] vs. 1.13 ± 0.06 [no-vest]) remained unaltered when comparisons are made between vest and no-vest groups, and the normalized peak ITP (ABS: 1.50 ± 0.02 [vest] vs. 1.24 ± 0.16 [no-vest]; CBS: 1.71 ± 0.20 [vest] vs. 1.37 ± 0.06 [no-vest]) showed a trend of an increase in the vest group compared to the no-vest group. However, impulses in short-duration ABS (0.94 ± 0.06 [vest] vs. 0.92 ± 0.13 [no-vest]) blast remained unaltered, whereas a significant increase of ITP impulse (1.21 ± 0.07 [vest] vs. 1.17 ± 0.01 [no-vest]) in CBS was observed. CONCLUSIONS The differences in the biomechanical response between ABS and CBS could be potentially attributed to the higher dynamic pressures that are imparted from long-duration CBS blasts, which could lead to chest compression and rapid acceleration/deceleration. In addition, ICP and ITP responses occur independently of each other, with no evidence of thoracic surge.
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Affiliation(s)
| | | | - Elizabeth McNeil
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | | | - Donna Wilder
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Joseph Long
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
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15
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Akin FW, Swan AA, Kalvesmaki A, Hall CD, Riska KM, Stressman KD, Nguyen H, Amuan M, Pugh MJ. Factors That Impact the Long-Term Outcome of Postconcussive Dizziness Among Post-9/11 Veterans. Am J Audiol 2023; 32:706-720. [PMID: 37040302 DOI: 10.1044/2023_aja-22-00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
PURPOSE The primary aim of this study was to examine the factors associated with long-term outcomes of postconcussive disruptive dizziness in Veterans of the post-9/11 wars. METHOD For this observational cohort study, the Neurobehavioral Symptom Inventory-Vestibular subscale (NSI-V) score was used as an outcome measure for dizziness in 987 post-9/11 Veterans who indicated disruptive dizziness at an initial Veterans Health Administration Comprehensive Traumatic Brain Injury Evaluation (CTBIE). An NSI-V change score was calculated as the difference in the scores obtained at the initial CTBIE and on a subsequent survey. Differences in the NSI-V change scores were examined for demographics, injury characteristics, comorbidities, and vestibular and balance function variables, and multiple linear regression analyses were used to explore associations among the variables and the NSI-V change score. RESULTS The majority of Veterans (61%) demonstrated a decrease in the NSI-V score, suggesting less dizziness on the survey compared with the CTBIE; 16% showed no change; and 22% had a higher score. Significant differences in the NSI-V change score were observed for traumatic brain injury (TBI) status, diagnoses of post-traumatic stress disorder (PTSD), headache and insomnia, and vestibular function. Multivariate regressions revealed significant associations between the NSI-V change score and the initial CTBIE NSI-V score, education level, race/ethnicity, TBI status, diagnoses of PTSD or hearing loss, and vestibular function. CONCLUSIONS Postconcussive dizziness can continue for years following an injury. Factors associated with poor prognosis include TBI, diagnoses of PTSD or hearing loss, abnormal vestibular function, increased age, identification as a Black Veteran, and high school education level.
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Affiliation(s)
- Faith W Akin
- Vestibular and Balance Laboratory, James H. Quillen VA Medical Center, Mountain Home, TN
- Department of Audiology & Speech-Language Pathology, East Tennessee State University, Johnson City
| | - Alicia A Swan
- Department of Psychology, The University of Texas at San Antonio
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio
| | - Andrea Kalvesmaki
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Courtney D Hall
- Vestibular and Balance Laboratory, James H. Quillen VA Medical Center, Mountain Home, TN
- Physical Therapy Program, East Tennessee State University, Johnson City
| | - Kristal M Riska
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC
| | - Kara D Stressman
- Vestibular and Balance Laboratory, James H. Quillen VA Medical Center, Mountain Home, TN
| | - Huong Nguyen
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Megan Amuan
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
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16
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Arnold B, Ramakrishnan R, Wright A, Wilson K, VandeVord PJ. An automated rat grimace scale for the assessment of pain. Sci Rep 2023; 13:18859. [PMID: 37914795 PMCID: PMC10620195 DOI: 10.1038/s41598-023-46123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023] Open
Abstract
Pain is a complex neuro-psychosocial experience that is internal and private, making it difficult to assess in both humans and animals. In pain research, animal models are prominently used, with rats among the most commonly studied. The rat grimace scale (RGS) measures four facial action units to quantify the pain behaviors of rats. However, manual recording of RGS scores is a time-consuming process that requires training. While computer vision models have been developed and utilized for various grimace scales, there are currently no models for RGS. To address this gap, this study worked to develop an automated RGS system which can detect facial action units in rat images and predict RGS scores. The automated system achieved an action unit detection precision and recall of 97%. Furthermore, the action unit RGS classifiers achieved a weighted accuracy of 81-93%. The system's performance was evaluated using a blast traumatic brain injury study, where it was compared to trained human graders. The results showed an intraclass correlation coefficient of 0.82 for the total RGS score, indicating that the system was comparable to human graders. The automated tool could enhance pain research by providing a standardized and efficient method for the assessment of RGS.
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Affiliation(s)
- Brendan Arnold
- School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg, VA, USA
| | | | - Amirah Wright
- School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Kelsey Wilson
- School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Pamela J VandeVord
- School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg, VA, USA.
- Veterans Affairs Medical Center, Salem, VA, USA.
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 440 Kelly Hall, 325 Stanger St., Blacksburg, VA, 24060, USA.
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17
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Çalışkan C, Dağ N, Kınık K. Analysis of the Medical Consequences of Global Terrorist Attacks in Turkic States in the Last 50 Years by Weapon and Attack Type. Disaster Med Public Health Prep 2023; 17:e514. [PMID: 37859454 DOI: 10.1017/dmp.2023.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVE This research aimed to conduct an epidemiological analysis of the terrorist attacks, which took place in the Turkic states between 1970 and 2019, and their medical consequences in terms of weapons and attack types. The data collected from this research will be valuable for the development of preventive systems against attacks on Turkic states and offer insights on how to effectively prepare for potential future attacks. METHODS The population of the research consisted of the weapons and types of attacks of the terrorist attacks in the Turkic states drawn from the Global Terrorism Database provided free of charge by START. The number of deaths, injuries, property damage, primary weapons, and types of attacks were analyzed by country. RESULTS Between 1970 and 2019, 4629 terrorist incidents occurred and 7496 people lost their lives and 10 928 people were injured. Among the types of weapons, the number of people who lost their lives was mostly in firearms, whereas the number of the injured was mostly in explosive weapons. Among the types of attacks, the number of people who lost their lives was mostly observed in the armed attack, whereas the injuries occurred mostly in the bombing attacks. Among the Turkic states, Turkey is the country most affected in terms of medical outcomes. CONCLUSION The terrorist attacks in the Turkic states reached their maximum number in the last 10 years. It is predicted that this number will increase further in the next years and affect more people medically.
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Affiliation(s)
- Cüneyt Çalışkan
- Department of Emergency Aid and Disaster Management, Hamidiye Faculty of Health Sciences, University of Health Sciences, Istanbul, Turkey
| | - Nihal Dağ
- Department of Disaster Medicine, Hamidiye Institute of Health Sciences, University of Health Sciences, Istanbul, Turkey
| | - Kerem Kınık
- Department of Emergency Aid and Disaster Management, Hamidiye Faculty of Health Sciences, University of Health Sciences, Istanbul, Turkey
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18
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Zhang L, Yang Q, Yuan R, Li M, Lv M, Zhang L, Xie X, Liang W, Chen X. Single-nucleus transcriptomic mapping of blast-induced traumatic brain injury in mice hippocampus. Sci Data 2023; 10:638. [PMID: 37730716 PMCID: PMC10511629 DOI: 10.1038/s41597-023-02552-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023] Open
Abstract
As a significant type of traumatic brain injury (TBI), blast-induced traumatic brain injury (bTBI) frequently results in severe neurological and psychological impairments. Due to its unique mechanistic and clinical features, bTBI presents diagnostic and therapeutic challenges compared to other TBI forms. The hippocampus, an important site for secondary injury of bTBI, serves as a key niche for neural regeneration and repair post-injury, and is closely associated with the neurological outcomes of bTBI patients. Nonetheless, the pathophysiological alterations of hippocampus underpinning bTBI remain enigmatic, and a corresponding transcriptomic dataset for research reference is yet to be established. In this investigation, the single-nucleus RNA sequencing (snRNA-seq) technique was employed to sequence individual hippocampal nuclei of mice from bTBI and sham group. Upon stringent quality control, gene expression data from 17,278 nuclei were obtained, with the dataset's reliability substantiated through various analytical methods. This dataset holds considerable potential for exploring secondary hippocampal injury and neurogenesis mechanisms following bTBI, with important reference value for the identification of specific diagnostic and therapeutic targets for bTBI.
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Affiliation(s)
- Lingxuan Zhang
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Qiuyun Yang
- Department of Forensic Genetics, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
- West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Ruixuan Yuan
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Manrui Li
- Department of Forensic Genetics, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Meili Lv
- Department of Immunology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Lin Zhang
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Xiaoqi Xie
- Department of Critical Care Medicine, Sichuan University, Chengdu, 610041, China.
| | - Weibo Liang
- Department of Forensic Genetics, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China.
| | - Xiameng Chen
- Department of Forensic Pathology and Forensic Clinical Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China.
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19
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Skelton LA, Ramachandra Rao S, Allen RS, Motz CT, Pardue MT, Fliesler SJ. Retinal gliosis and phenotypic diversity of intermediate filament induction and remodeling upon acoustic blast overpressure (ABO) exposure to the rat eye. Exp Eye Res 2023; 234:109585. [PMID: 37481225 PMCID: PMC10730083 DOI: 10.1016/j.exer.2023.109585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/22/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
Traumatic brain injury (TBI) caused by acoustic blast overpressure (ABO) is frequently associated with chronic visual deficits in military personnel and civilians. In this study, we characterized retinal gliotic response in adult male rats following a single ABO exposure directed to one side of the head. Expression of gliosis markers and intermediate filaments was assessed at 48 h and 1 wk post-ABO exposure, in comparison to age-matched non-exposed control retina. In response to a single ABO exposure, type III IF, glial fibrillary acidic protein (GFAP) was variably induced in a subpopulation of retinal Müller glia in ipsilateral eyes. ABO-exposed eyes exhibited radial Müller glial GFAP filament extension through the inner plexiform layer (IPL) and the inner nuclear layer (INL) through the retina in both the nasal quadrant and juxta-optic nerve head (jONH) eye regions at 1 wk post-ABO. We observed an ∼6-fold increase (p ≤ 0.05) in radial glial GFAP immunolabeling in the IPL in both eye regions, in comparison to regionally matched controls. Similarly, GFAP extension through the INL into the outer retina was elevated ∼3-fold, p ≤ 0.05 in the nasal retina, but exhibited wider variability in the jONH retina. In contrast, constitutive type III IF vimentin exhibited greater remodeling in retinal Müller glia through the jONH retina compared to the nasal retina in response to ABO. We observed areas of lateral vimentin remodeling through the Müller glial end-feet, and greater mid-outer retinal radial vimentin IF extension in a subpopulation of glia at 1 wk post-ABO. We also observed a significant increase in total retinal levels of the type III IF desmin in ABO-exposed retina vs. controls (∼1.6-fold, p ≤ 0.01). In addition, ABO-exposure elicited varied glial induction of developmentally regulated type VI family IFs (nestin and synemin) in subpopulations of Müller cells at 48 h and 1 wk post-ABO. We demonstrate that multiple glial phenotypes emerge in the rat retina following a single ABO exposure, rather than a global homogeneous retinal glial response, involving less well characterized IF protein forms which warrant further investigation in the context of ABO-induced retinal gliosis.
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Affiliation(s)
- Lara A Skelton
- Research Service, VA Western NY Healthcare System - Buffalo VAMC, Buffalo, NY, USA
| | - Sriganesh Ramachandra Rao
- Research Service, VA Western NY Healthcare System - Buffalo VAMC, Buffalo, NY, USA; Departments of Ophthalmology and Biochemistry and Neuroscience Graduate Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Rachael S Allen
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System - Atlanta VAMC, Decatur, GA, USA
| | - Cara T Motz
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System - Atlanta VAMC, Decatur, GA, USA
| | - Machelle T Pardue
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System - Atlanta VAMC, Decatur, GA, USA; Wallace H. Coulter Dept. of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Steven J Fliesler
- Research Service, VA Western NY Healthcare System - Buffalo VAMC, Buffalo, NY, USA; Departments of Ophthalmology and Biochemistry and Neuroscience Graduate Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
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20
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Rowe CJ, Mang J, Huang B, Dommaraju K, Potter BK, Schobel SA, Gann ER, Davis TA. Systemic inflammation induced from remote extremity trauma is a critical driver of secondary brain injury. Mol Cell Neurosci 2023; 126:103878. [PMID: 37451414 DOI: 10.1016/j.mcn.2023.103878] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
Blast exposure, commonly experienced by military personnel, can cause devastating life-threatening polysystem trauma. Despite considerable research efforts, the impact of the systemic inflammatory response after major trauma on secondary brain injury-inflammation is largely unknown. The aim of this study was to identify markers underlying the susceptibility and early onset of neuroinflammation in three rat trauma models: (1) blast overpressure exposure (BOP), (2) complex extremity trauma (CET) involving femur fracture, crush injury, tourniquet-induced ischemia, and transfemoral amputation through the fracture site, and (3) BOP+CET. Six hours post-injury, intact brains were harvested and dissected to obtain biopsies from the prefrontal cortex, striatum, neocortex, hippocampus, amygdala, thalamus, hypothalamus, and cerebellum. Custom low-density microarray datasets were used to identify, interpret and visualize genes significant (p < 0.05 for differential expression [DEGs]; 86 neuroinflammation-associated) using a custom python-based computer program, principal component analysis, heatmaps and volcano plots. Gene set and pathway enrichment analyses of the DEGs was performed using R and STRING for protein-protein interaction (PPI) to identify and explore key genes and signaling networks. Transcript profiles were similar across all regions in naïve brains with similar expression levels involving neurotransmission and transcription functions and undetectable to low-levels of inflammation-related mediators. Trauma-induced neuroinflammation across all anatomical brain regions correlated with injury severity (BOP+CET > CET > BOP). The most pronounced differences in neuroinflammatory-neurodegenerative gene regulation were between blast-associated trauma (BOP, BOP+CET) and CET. Following BOP, there were few DEGs detected amongst all 8 brain regions, most were related to cytokines/chemokines and chemokine receptors, where PPI analysis revealed Il1b as a potential central hub gene. In contrast, CET led to a more excessive and diverse pro-neuroinflammatory reaction in which Il6 was identified as the central hub gene. Analysis of the of the BOP+CET dataset, revealed a more global heightened response (Cxcr2, Il1b, and Il6) as well as the expression of additional functional regulatory networks/hub genes (Ccl2, Ccl3, and Ccl4) which are known to play a critical role in the rapid recruitment and activation of immune cells via chemokine/cytokine signaling. These findings provide a foundation for discerning pathophysiological consequences of acute extremity injury and systemic inflammation following various forms of trauma in the brain.
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Affiliation(s)
- Cassie J Rowe
- Cell Biology and Regenerative Medicine Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA.
| | - Josef Mang
- Cell Biology and Regenerative Medicine Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Benjamin Huang
- Cell Biology and Regenerative Medicine Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Kalpana Dommaraju
- Student Bioinformatics Initiative (SBI), Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Benjamin K Potter
- Cell Biology and Regenerative Medicine Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Seth A Schobel
- Cell Biology and Regenerative Medicine Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA; Surgical Critical Care Initiative (SC2i), Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Eric R Gann
- Cell Biology and Regenerative Medicine Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA; Surgical Critical Care Initiative (SC2i), Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Thomas A Davis
- Cell Biology and Regenerative Medicine Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
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21
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Ge M, Wang Y, Wu T, Li H, Yang C, Chen T, Feng H, Xu D, Yao J. Serum-based Raman spectroscopic diagnosis of blast-induced brain injury in a rat model. BIOMEDICAL OPTICS EXPRESS 2023; 14:3622-3634. [PMID: 37497497 PMCID: PMC10368048 DOI: 10.1364/boe.495285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 07/28/2023]
Abstract
The diagnosis of blast-induced traumatic brain injury (bTBI) is of paramount importance for early care and clinical therapy. Therefore, the rapid diagnosis of bTBI is vital to the treatment and prognosis in clinic. In this paper, we reported a new strategy for label-free bTBI diagnosis through serum-based Raman spectroscopy. The Raman spectral characteristics of serum in rat were investigated at 3 h, 24 h, 48 h and 72 h after mild and moderate bTBIs. It has been demonstrated that both the position and intensity of Raman characteristic peaks exhibited apparent differences in the range of 800-3000cm-1 compared with control group. It could be inferred that the content, structure and interaction of biomolecules in the serum were changed after blast exposure, which might help to understand the neurological syndromes caused by bTBI. Furthermore, the control group, mild and moderate bTBIs at different times (a total of 9 groups) were automatically classified by combining principal component analysis and four machine learning algorithms (quadratic discriminant analysis, support vector machine, k-nearest neighbor, neural network). The highest classification accuracy, sensitivity and precision were up to 95.4%, 95.9% and 95.7%. It is suggested that this method has great potential for high-sensitive, rapid, and label-free diagnosis of bTBI.
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Affiliation(s)
- Meilan Ge
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China
- Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
| | - Yuye Wang
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China
- Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
| | - Tong Wu
- School of Marine Science and Technology, Tianjin University, Tianjin 300072, China
| | - Haibin Li
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China
- Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
| | - Chuanyan Yang
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Tunan Chen
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Hua Feng
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Degang Xu
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China
- Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
| | - Jianquan Yao
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China
- Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
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22
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Zhao Q, Zhang J, Li H, Li H, Xie F. Models of traumatic brain injury-highlights and drawbacks. Front Neurol 2023; 14:1151660. [PMID: 37396767 PMCID: PMC10309005 DOI: 10.3389/fneur.2023.1151660] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Traumatic brain injury (TBI) is the leading cause for high morbidity and mortality rates in young adults, survivors may suffer from long-term physical, cognitive, and/or psychological disorders. Establishing better models of TBI would further our understanding of the pathophysiology of TBI and develop new potential treatments. A multitude of animal TBI models have been used to replicate the various aspects of human TBI. Although numerous experimental neuroprotective strategies were identified to be effective in animal models, a majority of strategies have failed in phase II or phase III clinical trials. This failure in clinical translation highlights the necessity of revisiting the current status of animal models of TBI and therapeutic strategies. In this review, we elucidate approaches for the generation of animal models and cell models of TBI and summarize their strengths and limitations with the aim of exploring clinically meaningful neuroprotective strategies.
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Affiliation(s)
- Qinghui Zhao
- Institute of Physical Culture, Huanghuai University, Zhumadian, China
| | - Jianhua Zhang
- Institute of Physical Culture, Huanghuai University, Zhumadian, China
| | - Huige Li
- Institute of Physical Culture, Huanghuai University, Zhumadian, China
| | - Hongru Li
- Zhumadian Central Hospital, Zhumadian, China
| | - Fei Xie
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
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23
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Saar-Ashkenazy R, Naparstek S, Dizitzer Y, Zimhoni N, Friedman A, Shelef I, Cohen H, Shalev H, Oxman L, Novack V, Ifergane G. Neuro-psychiatric symptoms in directly and indirectly blast exposed civilian survivors of urban missile attacks. BMC Psychiatry 2023; 23:423. [PMID: 37312064 DOI: 10.1186/s12888-023-04943-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/07/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Blast-explosion may cause traumatic brain injury (TBI), leading to post-concussion syndrome (PCS). In studies on military personnel, PCS symptoms are highly similar to those occurring in post-traumatic stress disorder (PTSD), questioning the overlap between these syndromes. In the current study we assessed PCS and PTSD in civilians following exposure to rocket attacks. We hypothesized that PCS symptomatology and brain connectivity will be associated with the objective physical exposure, while PTSD symptomatology will be associated with the subjective mental experience. METHODS Two hundred eighty nine residents of explosion sites have participated in the current study. Participants completed self-report of PCS and PTSD. The association between objective and subjective factors of blast and clinical outcomes was assessed using multivariate analysis. White-matter (WM) alterations and cognitive abilities were assessed in a sub-group of participants (n = 46) and non-exposed controls (n = 16). Non-parametric analysis was used to compare connectivity and cognition between the groups. RESULTS Blast-exposed individuals reported higher PTSD and PCS symptomatology. Among exposed individuals, those who were directly exposed to blast, reported higher levels of subjective feeling of danger and presented WM hypoconnectivity. Cognitive abilities did not differ between groups. Several risk factors for the development of PCS and PTSD were identified. CONCLUSIONS Civilians exposed to blast present higher PCS/PTSD symptomatology as well as WM hypoconnectivity. Although symptoms are sub-clinical, they might lead to the future development of a full-blown syndrome and should be considered carefully. The similarities between PCS and PTSD suggest that despite the different etiology, namely, the physical trauma in PCS and the emotional trauma in PTSD, these are not distinct syndromes, but rather represent a combined biopsychological disorder with a wide spectrum of behavioral, emotional, cognitive and neurological symptoms.
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Affiliation(s)
- R Saar-Ashkenazy
- Faculty of Social-Work, Ashkelon Academic College, 12 Ben Tzvi St, PO Box 9071, 78211, Ashkelon, Israel.
- Department of Cognitive-Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - S Naparstek
- Department of Psychology Ben-Gurion, University of the Negev, Beer-Sheva, Israel
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Y Dizitzer
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - N Zimhoni
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - A Friedman
- Department of Cognitive-Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Medical Neuroscience, Dalhousie University, Halifax, NS, B3H4R2, Canada
| | - I Shelef
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Diagnostic Imaging, Soroka University Medical Center, Beer-Sheva, Israel
| | - H Cohen
- Anxiety and Stress Research Unit, Faculty of Health Sciences, Ministry of Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - H Shalev
- Department of Psychiatry, Soroka University Medical Center, Beer-Sheva, Israel
| | - L Oxman
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - V Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - G Ifergane
- Department of Neurology, Soroka University Medical Center, Beer-Sheva, Israel
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24
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Kumar RG, Klyce D, Nakase-Richardson R, Pugh MJ, Walker WC, Dams-O'Connor K. Associations of Military Service History and Health Outcomes in the First Five Years After Traumatic Brain Injury. J Neurotrauma 2023; 40:1173-1186. [PMID: 36401499 PMCID: PMC10259615 DOI: 10.1089/neu.2022.0340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
For many years, experts have recognized the importance of studying traumatic brain injury (TBI) among active-duty service members and veterans. A majority of this research has been conducted in Veterans Administration (VA) or Department of Defense settings. However, far less is known about military personnel who seek their medical care outside these settings. Studies that have been conducted in civilian settings have either not enrolled active duty or veteran participants, or failed to measure military history, precluding study of TBI outcomes by military history. The purpose of the present study was to determine associations between military history and medical (prevalence of 25 comorbid health conditions), cognition (Brief Test of Adult Cognition by Telephone), and psychological health (Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-7, suicidality [9th item from PHQ-9]) in the first 5 years after TBI. In this prospective study, we analyzed data from the TBI Model Systems National Database. Participants were 7797 individuals with TBI admitted to one of 21 civilian inpatient rehabilitation facilities from April 1, 2010, to November 19, 2020, and followed up to 5 years. We assessed the relationship between military history (any versus none, combat exposure, service era, and service duration) and TBI outcomes. We found specific medical conditions were significantly more prevalent 1 year post-TBI among individuals who had a history of combat deployment (lung disorders, post-traumatic stress disorder [PTSD], and sleep disorder), served in post-draft era (chronic pain, liver disease, arthritis), and served >4 years (high cholesterol, PTSD, sleep disorder). Individuals with military history without combat deployment had modestly more favorable cognition and psychological health in the first 5 years post-injury relative to those without military history. Our data suggest that individuals with TBI with military history are heterogeneous, with some favorable and other deleterious health outcomes, relative to their non-military counterparts, which may be driven by characteristics of service, including combat exposure and era of service.
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Affiliation(s)
- Raj G. Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Klyce
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
- Mental Health Service, Central Virginia VA Health Care System, Richmond, Virginia, USA
- Sheltering Arms Institute, Richmond, Virginia, USA
| | - Risa Nakase-Richardson
- Mental Health and Behavior Sciences, Defense Health Agency TBI Center of Excellence, James A. Haley Veterans Hospital, Tampa, Florida, USA
- Pulmonary/Sleep Medicine Division, Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - William C. Walker
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
- Sheltering Arms Institute, Richmond, Virginia, USA
- PM&R Service, Richmond Veterans Affairs Medical Center, Central Virginia Veterans Affairs Health Care System, Richmond, Virginia, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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25
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Hellewell SC, Granger DA, Cernak I. Blast-Induced Neurotrauma Results in Spatially Distinct Gray Matter Alteration Alongside Hormonal Alteration: A Preliminary Investigation. Int J Mol Sci 2023; 24:ijms24076797. [PMID: 37047768 PMCID: PMC10094760 DOI: 10.3390/ijms24076797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
Blast-induced neurotrauma (BINT) frequently occurs during military training and deployment and has been linked to long-term neuropsychological and neurocognitive changes, and changes in brain structure. As military personnel experience frequent exposures to stress, BINT may negatively influence stress coping abilities. This study aimed to determine the effects of BINT on gray matter volume and hormonal alteration. Participants were Canadian Armed Forces personnel and veterans with a history of BINT (n = 12), and first responder controls (n = 8), recruited due to their characteristic occupational stress professions. Whole saliva was collected via passive drool on the morning of testing and analyzed for testosterone (pg/mL), cortisol (μg/dL), and testosterone/cortisol (T/C) ratio. Voxel-based morphometry was performed to compare gray matter (GM) volume, alongside measurement of cortical thickness and subcortical volumes. Saliva analyses revealed distinct alterations following BINT, with significantly elevated testosterone and T/C ratio. Widespread and largely symmetric loci of reduced GM were found specific to BINT, particularly in the temporal gyrus, precuneus, and thalamus. These findings suggest that BINT affects hypothalamic-pituitary-adrenal and -gonadal axis function, and causes anatomically-specific GM loss, which were not observed in a comparator group with similar occupational stressors. These findings support BINT as a unique injury with distinct structural and endocrine consequences.
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Affiliation(s)
- Sarah C Hellewell
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- The Perron Institute for Neurological and Translational Science, Perth, WA 6009, Australia
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, Irvine, CA 92697, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ibolja Cernak
- Department of Biomedical Sciences, Mercer University School of Medicine, Columbus, GA 31902, USA
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26
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Double Blast Wave Primary Effect on Synaptic, Glymphatic, Myelin, Neuronal and Neurovascular Markers. Brain Sci 2023; 13:brainsci13020286. [PMID: 36831830 PMCID: PMC9954059 DOI: 10.3390/brainsci13020286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Explosive blasts are associated with neurological consequences as a result of blast waves impact on the brain. Yet, the neuropathologic and molecular consequences due to blast waves vs. blunt-TBI are not fully understood. An explosive-driven blast-generating system was used to reproduce blast wave exposure and examine pathological and molecular changes generated by primary wave effects of blast exposure. We assessed if pre- and post-synaptic (synaptophysin, PSD-95, spinophilin, GAP-43), neuronal (NF-L), glymphatic (LYVE1, podoplanin), myelin (MBP), neurovascular (AQP4, S100β, PDGF) and genomic (DNA polymerase-β, RNA polymerase II) markers could be altered across different brain regions of double blast vs. sham animals. Twelve male rats exposed to two consecutive blasts were compared to 12 control/sham rats. Western blot, ELISA, and immunofluorescence analyses were performed across the frontal cortex, hippocampus, cerebellum, and brainstem. The results showed altered levels of AQP4, S100β, DNA-polymerase-β, PDGF, synaptophysin and PSD-95 in double blast vs. sham animals in most of the examined regions. These data indicate that blast-generated changes are preferentially associated with neurovascular, glymphatic, and DNA repair markers, especially in the brainstem. Moreover, these changes were not accompanied by behavioral changes and corroborate the hypothesis for which an asymptomatic altered status is caused by repeated blast exposures.
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27
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Lee SJ, Logsdon AF, Yagi M, Baskin BM, Peskind ER, Raskind MM, Cook DG, Schindler AG. The dynorphin/kappa opioid receptor mediates adverse immunological and behavioral outcomes induced by repetitive blast trauma. J Neuroinflammation 2022; 19:288. [PMID: 36463243 PMCID: PMC9719647 DOI: 10.1186/s12974-022-02643-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/11/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Adverse pathophysiological and behavioral outcomes related to mild traumatic brain injury (mTBI), posttraumatic stress disorder (PTSD), and chronic pain are common following blast exposure and contribute to decreased quality of life, but underlying mechanisms and prophylactic/treatment options remain limited. The dynorphin/kappa opioid receptor (KOR) system helps regulate behavioral and inflammatory responses to stress and injury; however, it has yet to be investigated as a potential mechanism in either humans or animals exposed to blast. We hypothesized that blast-induced KOR activation mediates adverse outcomes related to inflammation and affective behavioral response. METHODS C57Bl/6 adult male mice were singly or repeatedly exposed to either sham (anesthesia only) or blast delivered by a pneumatic shock tube. The selective KOR antagonist norBNI or vehicle (saline) was administered 72 h prior to repetitive blast or sham exposure. Serum and brain were collected 10 min or 4 h post-exposure for dynorphin A-like immunoreactivity and cytokine measurements, respectively. At 1-month post-exposure, mice were tested in a series of behavioral assays related to adverse outcomes reported by humans with blast trauma. RESULTS Repetitive but not single blast exposure resulted in increased brain dynorphin A-like immunoreactivity. norBNI pretreatment blocked or significantly reduced blast-induced increase in serum and brain cytokines, including IL-6, at 4 h post exposure and aversive/anxiety-like behavioral dysfunction at 1-month post-exposure. CONCLUSIONS Our findings demonstrate a previously unreported role for the dynorphin/KOR system as a mediator of biochemical and behavioral dysfunction following repetitive blast exposure and highlight this system as a potential prophylactic/therapeutic treatment target.
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Affiliation(s)
- Suhjung Janet Lee
- grid.413919.70000 0004 0420 6540VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, S182, 1660 South Columbian Way, Seattle, WA 98108 USA
| | - Aric F. Logsdon
- grid.413919.70000 0004 0420 6540VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, S182, 1660 South Columbian Way, Seattle, WA 98108 USA ,grid.34477.330000000122986657Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA 98195 USA
| | - Mayumi Yagi
- grid.413919.70000 0004 0420 6540VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, S182, 1660 South Columbian Way, Seattle, WA 98108 USA
| | - Britahny M. Baskin
- grid.34477.330000000122986657Graduate Program in Neuroscience, University of Washington, Seattle, WA 98195 USA
| | - Elaine. R. Peskind
- grid.413919.70000 0004 0420 6540VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108 USA ,grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195 USA
| | - Murray M. Raskind
- grid.413919.70000 0004 0420 6540VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108 USA ,grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195 USA
| | - David G. Cook
- grid.413919.70000 0004 0420 6540VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, S182, 1660 South Columbian Way, Seattle, WA 98108 USA ,grid.34477.330000000122986657Graduate Program in Neuroscience, University of Washington, Seattle, WA 98195 USA ,grid.34477.330000000122986657Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA 98195 USA ,grid.34477.330000000122986657Department of Pharmacology, University of Washington, Seattle, WA 98195 USA
| | - Abigail. G. Schindler
- grid.413919.70000 0004 0420 6540VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, S182, 1660 South Columbian Way, Seattle, WA 98108 USA ,grid.34477.330000000122986657Graduate Program in Neuroscience, University of Washington, Seattle, WA 98195 USA ,grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195 USA ,grid.34477.330000000122986657Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA 98195 USA
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Wang H, Chen H, Liu C, Yuan L, Bao Y, Zhao G, Wang D, Song G. Successful resuscitation and multidisciplinary management of penetrating brain injury caused by tire explosion: A case report. Medicine (Baltimore) 2022; 101:e32048. [PMID: 36451440 PMCID: PMC9704937 DOI: 10.1097/md.0000000000032048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
RATIONALE Penetrating brain injury (PBI) is a rare trauma that presents as a difficult and serious surgical emergency for neurosurgeons in clinical practice. Our patient was admitted with a PBI caused by a tire explosion, which is an extremely rare cause of injury. PATIENT CONCERNS We report a case of a 28-year-old male patient who suffered a PBI when a tire exploded while it was being inflated with a high-pressure air pump. DIAGNOSES The patient was diagnosed with PBI presenting with multiple comminuted skull fractures, massive bone fragments with foreign bodies penetrating the underlying brain tissue of the top right frontal bone, multiple cerebral contusions, and intracranial hematoma. INTERVENTIONS Emergency combined multidisciplinary surgery was performed for the removal of the fragmented bone pieces, hematoma, and foreign bodies; decompression of the debridement flap; reconstruction of the anterior skull base; and repair of the dura mater. OUTCOMES The patient was successfully resuscitated and discharged 1 month later and is now recovering well. LESSONS Patients with PBI are critically ill. Therefore, timely, targeted examinations and appropriate multidisciplinary interventions through a green channel play a key role in assessing the condition, developing protocols, and preventing complications.
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Affiliation(s)
- Haozhan Wang
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Hao Chen
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Changtong Liu
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Long Yuan
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Yonggang Bao
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Guodong Zhao
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Dengqin Wang
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Guohong Song
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
- * Correspondence: Guohong Song, The Affiliated Hospital of Jining Medical University, No. 89 Guhuai Street, Jining 272000, Shandong Province, China (e-mail: )
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Büttner-Kunert J, Blöchinger S, Falkowska Z, Rieger T, Oslmeier C. Interaction of discourse processing impairments, communicative participation, and verbal executive functions in people with chronic traumatic brain injury. Front Psychol 2022; 13:892216. [PMID: 36275227 PMCID: PMC9586152 DOI: 10.3389/fpsyg.2022.892216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Especially in the chronic phase, individuals with traumatic brain injury (TBI) (IwTBI) may still have impairments at the discourse level, even if these remain undetected by conventional aphasia tests. As a consequence, IwTBI may be impaired in conversational behavior and disadvantaged in their socio-communicative participation. Even though handling discourse is thought to be a basic requirement for participation and quality of life, only a handful of test procedures assessing discourse disorders have been developed so far. The MAKRO Screening is a recently developed screening tool designed to assess discourse impairments. The test construction is based on psycholinguistic frameworks and the concept of macro-rules, which refer to cognitive functions responsible for organizing and reducing complex information (e.g., propositional content) in discourse. Aim The aim of our study was to investigate discourse processing in IwTBI in different tasks and to assess problems in communicative participation in the post-acute and chronic phase. In this context, we also aimed to analyze the influence of the severity of the initial impairment and the verbal executive abilities on the discourse performance. Additionally, the impact of macrolinguistic discourse impairments and verbal fluency on perceived communicative participation was targeted in our analysis. Methods Data from 23 IwTBI (moderate to severe) and 23 healthy control subjects have been analyzed. They completed two subtests of the MAKRO screening: Text production and Inferences. Discourse performance was examined in relation to measures of semantic fluency and verbal task-switching. Socio-communicative problems were evaluated with the German version of the La Trobe Communication Questionnaire (LCQ). Results IwTBI showed lower test results than the control group in the two subtests of the MAKRO-Screening. Difficulties in picture-based narrative text production also indicated greater perceived difficulties in communicative participation (LCQ). We also found that the subject’s performance on the MAKRO-Screening subtests can partly be explained by underlying dysexecutive symptoms (in terms of verbal fluency and verbal task switching) and the severity of their injury. The preliminary results of our study show that cognitive-linguistic symptoms in IwTBI are also evident in the chronic phase. These can be detected with procedures referring to the discourse level, such as the MAKRO-Screening. The assessment of discourse performance should be an integral part in the rehabilitation of IwTBI in order to detect cognitive-linguistic communication disorders and to evaluate their impact on socio-communicative participation.
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Affiliation(s)
- Julia Büttner-Kunert
- Department of Linguistics, Project NEUROPRAG, Ludwig Maximilians University, Munich, Germany
- Department of Linguistics, Speech-Language-Therapy, Ludwig Maximilians University, Munich, Germany
- *Correspondence: Julia Büttner-Kunert,
| | - Sarah Blöchinger
- Department of Linguistics, Project NEUROPRAG, Ludwig Maximilians University, Munich, Germany
- Department of Linguistics, Speech-Language-Therapy, Ludwig Maximilians University, Munich, Germany
| | - Zofia Falkowska
- Department of Linguistics, Project NEUROPRAG, Ludwig Maximilians University, Munich, Germany
- Department of Linguistics, Speech-Language-Therapy, Ludwig Maximilians University, Munich, Germany
| | - Theresa Rieger
- Department of Linguistics, Speech-Language-Therapy, Ludwig Maximilians University, Munich, Germany
| | - Charlotte Oslmeier
- Department of Linguistics, Speech-Language-Therapy, Ludwig Maximilians University, Munich, Germany
- Speech-Language Therapy Unit, NEUROKOM, Bad Tölz, Germany
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30
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Yu X, Nguyen TT, Wu T, Ghajari M. Non-Lethal Blasts can Generate Cavitation in Cerebrospinal Fluid While Severe Helmeted Impacts Cannot: A Novel Mechanism for Blast Brain Injury. Front Bioeng Biotechnol 2022; 10:808113. [PMID: 35875481 PMCID: PMC9302597 DOI: 10.3389/fbioe.2022.808113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Cerebrospinal fluid (CSF) cavitation is a likely physical mechanism for producing traumatic brain injury (TBI) under mechanical loading. In this study, we investigated CSF cavitation under blasts and helmeted impacts which represented loadings in battlefield and road traffic/sports collisions. We first predicted the human head response under the blasts and impacts using computational modelling and found that the blasts can produce much lower negative pressure at the contrecoup CSF region than the impacts. Further analysis showed that the pressure waves transmitting through the skull and soft tissue are responsible for producing the negative pressure at the contrecoup region. Based on this mechanism, we hypothesised that blast, and not impact, can produce CSF cavitation. To test this hypothesis, we developed a one-dimensional simplified surrogate model of the head and exposed it to both blasts and impacts. The test results confirmed the hypothesis and computational modelling of the tests validated the proposed mechanism. These findings have important implications for prevention and diagnosis of blast TBI.
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Affiliation(s)
- Xiancheng Yu
- HEAD lab, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
- Centre for Blast Injury Studies, Imperial College London, London, United Kingdom
- *Correspondence: Xiancheng Yu,
| | - Thuy-Tien Nguyen
- Centre for Blast Injury Studies, Imperial College London, London, United Kingdom
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Tianchi Wu
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Mazdak Ghajari
- HEAD lab, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
- Centre for Blast Injury Studies, Imperial College London, London, United Kingdom
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31
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Kawauchi S, Yoshida K, Osawa T, Muramatsu Y, Nawashiro H, Karna SP, Gupta RK, Nishidate I, Sato S. Effects of isolated and combined exposure of the brain and lungs to a laser-induced shock wave(s) on physiological and neurological responses in rats. J Neurotrauma 2022; 39:1533-1546. [PMID: 35652331 DOI: 10.1089/neu.2022.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Blast-induced traumatic brain injury (bTBI) has been suggested to be caused by direct head exposure and by torso exposure to a shock wave (thoracic hypotheses). However, it is unclear how torso exposure affects the brain in real-time. This study applied a mild-impulse laser-induced shock wave(s) (LISW[s]) only to the brain (Group 1), lungs (Group 2), or to the brain and lungs (Group 3) in rats. Since LISWs are unaccompanied by a dynamic pressure in principle, the effects of acceleration can be excluded, allowing analysis of the pure primary mechanism. For all rat groups, real-time monitoring of the brain and systemic responses were conducted for up to 1 h postexposure and motor function assessments for up to 7 days postexposure. As previously reported, brain exposure alone caused cortical spreading depolarization (CSD), followed by long-lasting hypoxemia/oligemia in the cortices (Group 1). It was found that even LISW application only to the lungs caused prolonged hypoxemia and mitochondrial dysfunction in the cortices (Group 2). Importantly, CSD and mitochondrial dysfunction were significantly exacerbated by combined exposure (Group 3) compared with those caused by brain exposure alone (Group 1). Motor dysfunction was observed in all groups, but their time courses depended on the exposure schemes. Rats of Group 1 exhibited the most evident motor dysfunction at 1 day postexposure, and it did not change much for up to 7 days postexposure. Alternatively, two groups of rats with lung exposure (Groups 2&3) exhibited continuously aggravated motor functions for up to 7 days postexposure, suggesting different mechanisms for motor dysfunction caused by brain exposure and that caused by lung exposure. As for the reported thoracic hypotheses, our observations seem to support the volumetric blood surge and vago-vagal reflex. Overall, the results of this study indicate the importance of the torso guard to protect the brain.
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Affiliation(s)
- Satoko Kawauchi
- National Defense Medical College, 13077, Division of Bioinformation and Therapeutic Systems, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa, Tokorozawa, Saitama, Japan, 359-8513;
| | - Keiichiro Yoshida
- National Defense Medical College, 13077, Division of Bioinformation and Therapeutic Systems, National Defense Medical College Research Institute, Tokorozawa, Saitama, Japan;
| | - Takuya Osawa
- Tokyo University of Agriculture and Technology, Graduate School of Bio-Applications & Systems Engineering, Koganei, Japan;
| | - Yuriko Muramatsu
- National Defense Medical College, 13077, Division of Bioinformation and Therapeutic Systems, National Defense Medical College Research Institute, Tokorozawa, Saitama, Japan;
| | - Hiroshi Nawashiro
- Tokorozawa Central Hospital, Division of Neurosurgery, Tokorozawa, Japan;
| | - Shashi P Karna
- US Army Combat Capabilities Development Command Army Research Laboratory, Aberdeen Proving Ground, United States;
| | - Raj K Gupta
- US Army Medical Research and Development Command, 19919, DoD Blast Injury Research Program Coordinating Office, Fort Detrick, Maryland, United States;
| | - Izumi Nishidate
- Tokyo University of Agriculture and Technology, Graduate School of Bio-Applications & Systems Engineering, Koganei, Japan;
| | - Shunichi Sato
- National Defense Medical College, 13077, Division of Bioinformation and Therapeutic Systems, Research Institute, 3-2, Namiki, Tokorozawa, Saitama, Japan, 359-8513;
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32
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Hawryluk GW, Selph S, Lumba-Brown A, Totten AM, Ghajar J, Aarabi B, Ecklund J, Shackelford S, Adams B, Adelson D, Armonda RA, Benjamin J, Boone D, Brody D, Dengler B, Figaji A, Grant G, Harris O, Hoffer A, Kitigawa R, Latham K, Neal C, Okonkwo DO, Pannell D, Rosenfeld JV, Rosenthal G, Rubiano A, Stein DM, Stippler M, Talbot M, Valadka A, Wright DW, Davis S, Bell R. Rationale and Methods for Updated Guidelines for the Management of Penetrating Traumatic Brain Injury. Neurotrauma Rep 2022; 3:240-247. [PMID: 35919507 PMCID: PMC9279118 DOI: 10.1089/neur.2022.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Penetrating traumatic brain injury (pTBI) affects civilian and military populations resulting in significant morbidity, mortality, and healthcare costs. No up-to-date and evidence-based guidelines exist to assist modern medical and surgical management of these complex injuries. A preliminary literature search revealed a need for updated guidelines, supported by the Brain Trauma Foundation. Methodologists experienced in TBI guidelines were recruited to support project development alongside two cochairs and a diverse steering committee. An expert multi-disciplinary workgroup was established and vetted to inform key clinical questions, to perform an evidence review and the development of recommendations relevant to pTBI. The methodological approach for the project was finalized. The development of up-to-date evidence- and consensus-based clinical care guidelines and algorithms for pTBI will provide critical guidance to care providers in the pre-hospital and emergent, medical, and surgical settings.
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Affiliation(s)
| | - Shelley Selph
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Angela Lumba-Brown
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California, USA
| | - Annette M. Totten
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Jamshid Ghajar
- Stanford Neuroscience Health Center, Stanford University School of Medicine, Stanford University, Palo Alto, California, USA
| | - Bizhan Aarabi
- University of Maryland Neurosurgery Associates, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
| | - James Ecklund
- Inova Neuroscience and Spine Institute, Fairfax, Virginia, USA
| | - Stacy Shackelford
- Joint Trauma System, Department of Defense, Center of Excellence for Trauma, Baltimore, Maryland, USA
| | - Britton Adams
- Independent Duty Medical Technician (IDMT), Hurlburt Field, Florida, USA
| | - David Adelson
- Barrow Neurological Institute at Phoenix Children's Hospital, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Rocco A. Armonda
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - John Benjamin
- Anaethesia and Critical Care, Uniformed Services University, Bethesda, Maryland, USA
| | - Darrell Boone
- Department of Surgery, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - David Brody
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Bradley Dengler
- Department of Neurosurgery, Uniformed Services University, Bethesda, Maryland, USA
| | - Anthony Figaji
- Department of Neurosurgery, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Gerald Grant
- Department of Neurosurgery, Duke University, Raleigh, North Carolina, USA
| | - Odette Harris
- Department of Neurosurgery, Stanford University School of Medicine, Stanford University, Palo Alto, California, USA
| | - Alan Hoffer
- Department of Neurosurgery, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ryan Kitigawa
- McGovern Medical School, University of Texas, Houston, Texas, USA
| | - Kerry Latham
- Adult Outpatient Behavioral Health, Bethesda, Maryland, USA
| | - Christopher Neal
- Department of Neurosurgery Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dylan Pannell
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Guy Rosenthal
- Hadassah University Medical Center, Jerusalem, Israel
| | - Andres Rubiano
- INUB-Meditech Research Group, Neuroscience Institute, Universidad El Bosque, Bogota, Colombia
| | - Deborah M. Stein
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Martina Stippler
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Max Talbot
- Royal Canadian Medical Service, Canadian Armed Forces, Canadian Forces Base Borden, Ontario, Canada
| | - Alex Valadka
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - David W. Wright
- Department of Emergency Medicine, Emory University, Atlanta, Georgia, USA
| | - Shelton Davis
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Randy Bell
- Department of Neurosurgery, Uniformed Services University, Bethesda, Maryland, USA
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33
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Edlow BL, Bodien YG, Baxter T, Belanger H, Cali R, Deary K, Fischl B, Foulkes AS, Gilmore N, Greve DN, Hooker JM, Huang SY, Kelemen JN, Kimberly WT, Maffei C, Masood M, Perl D, Polimeni JR, Rosen BR, Tromly S, Tseng CEJ, Yao EF, Zurcher NR, Mac Donald CL, Dams-O'Connor K. Long-Term Effects of Repeated Blast Exposure in United States Special Operations Forces Personnel: A Pilot Study Protocol. J Neurotrauma 2022; 39:1391-1407. [PMID: 35620901 PMCID: PMC9529318 DOI: 10.1089/neu.2022.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Emerging evidence suggests that repeated blast exposure (RBE) is associated with brain injury in military personnel. United States (U.S.) Special Operations Forces (SOF) personnel experience high rates of blast exposure during training and combat, but the effects of low-level RBE on brain structure and function in SOF have not been comprehensively characterized. Further, the pathophysiological link between RBE-related brain injuries and cognitive, behavioral, and physical symptoms has not been fully elucidated. We present a protocol for an observational pilot study, Long-Term Effects of Repeated Blast Exposure in U.S. SOF Personnel (ReBlast). In this exploratory study, 30 active-duty SOF personnel with RBE will participate in a comprehensive evaluation of: 1) brain network structure and function using Connectome magnetic resonance imaging (MRI) and 7 Tesla MRI; 2) neuroinflammation and tau deposition using positron emission tomography; 3) blood proteomics and metabolomics; 4) behavioral and physical symptoms using self-report measures; and 5) cognition using a battery of conventional and digitized assessments designed to detect subtle deficits in otherwise high-performing individuals. We will identify clinical, neuroimaging, and blood-based phenotypes that are associated with level of RBE, as measured by the Generalized Blast Exposure Value. Candidate biomarkers of RBE-related brain injury will inform the design of a subsequent study that will test a diagnostic assessment battery for detecting RBE-related brain injury. Ultimately, we anticipate that the ReBlast study will facilitate the development of interventions to optimize the brain health, quality of life, and battle readiness of U.S. SOF personnel.
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Affiliation(s)
- Brian L Edlow
- Harvard Medical School, 1811, 175 Cambridge Street - Suite 300, Boston, Massachusetts, United States, 02115.,Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Yelena G Bodien
- Massachusetts General Hospital, 2348, Department of Neurology, 101 Merrimac, Boston, Massachusetts, United States, 02114;
| | - Timothy Baxter
- University of South Florida, 7831, Institute for Applied Engineering, Tampa, Florida, United States;
| | - Heather Belanger
- University of South Florida, 7831, Department of Psychiatry and Behavioral Neurosciences, Tampa, Florida, United States;
| | - Ryan Cali
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Katryna Deary
- Navy SEAL Foundation, Virginia Beach, Virginia, United States;
| | - Bruce Fischl
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Room 2301, 149 13th Street, Charlestown, Massachusetts, United States, 02129-2020.,Massachusetts General Hospital;
| | - Andrea S Foulkes
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Natalie Gilmore
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Douglas N Greve
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Jacob M Hooker
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Susie Y Huang
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Jessica N Kelemen
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - W Taylor Kimberly
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Chiara Maffei
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Maryam Masood
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Daniel Perl
- Uniformed Services University of the Health Sciences, 1685, Pathology, 4301 Jones Bridge Road, Room B3138, Bethesda, Maryland, United States, 20814;
| | - Jonathan R Polimeni
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Bruce R Rosen
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States;
| | - Samantha Tromly
- University of South Florida, 7831, Institute for Applied Engineering, Tampa, Florida, United States;
| | - Chieh-En J Tseng
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Eveline F Yao
- United States Special Operations Command, Office of the Surgeon General, MacDill Air Force Base, United States;
| | - Nicole R Zurcher
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Christine L Mac Donald
- University of Washington, 7284, Department of Neurological Surgery, Seattle, Washington, United States;
| | - Kristen Dams-O'Connor
- Icahn School of Medicine at Mount Sinai, 5925, Rehabilitation Medicine, One Gustave Levy Place, Box 1163, New York, New York, United States, 10029; kristen.dams-o'
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34
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He Z, Lang L, Hui J, Ma Y, Yang C, Weng W, Huang J, Zhao X, Zhang X, Liang Q, Jiang J, Feng J. Brain Extract of Subacute Traumatic Brain Injury Promotes the Neuronal Differentiation of Human Neural Stem Cells via Autophagy. J Clin Med 2022; 11:jcm11102709. [PMID: 35628836 PMCID: PMC9145659 DOI: 10.3390/jcm11102709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/03/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
Background: After a traumatic brain injury (TBI), the cell environment is dramatically changed, which has various influences on grafted neural stem cells (NSCs). At present, these influences on NSCs have not been fully elucidated, which hinders the finding of an optimal timepoint for NSC transplantation. Methods: Brain extracts of TBI mice were used in vitro to simulate the different phase TBI influences on the differentiation of human NSCs. Protein profiles of brain extracts were analyzed. Neuronal differentiation and the activation of autophagy and the WNT/CTNNB pathway were detected after brain extract treatment. Results: Under subacute TBI brain extract conditions, the neuronal differentiation of hNSCs was significantly higher than that under acute brain extract conditions. The autophagy flux and WNT/CTNNB pathway were activated more highly within the subacute brain extract than in the acute brain extract. Autophagy activation by rapamycin could rescue the neuronal differentiation of hNSCs within acute TBI brain extract. Conclusions: The subacute phase around 7 days after TBI in mice could be a candidate timepoint to encourage more neuronal differentiation after transplantation. The autophagy flux played a critical role in regulating neuronal differentiation of hNSCs and could serve as a potential target to improve the efficacy of transplantation in the early phase.
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Affiliation(s)
- Zhenghui He
- Brain Injury Center, Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; (Z.H.); (L.L.); (J.H.); (Y.M.); (C.Y.); (J.J.)
| | - Lijian Lang
- Brain Injury Center, Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; (Z.H.); (L.L.); (J.H.); (Y.M.); (C.Y.); (J.J.)
| | - Jiyuan Hui
- Brain Injury Center, Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; (Z.H.); (L.L.); (J.H.); (Y.M.); (C.Y.); (J.J.)
| | - Yuxiao Ma
- Brain Injury Center, Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; (Z.H.); (L.L.); (J.H.); (Y.M.); (C.Y.); (J.J.)
| | - Chun Yang
- Brain Injury Center, Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; (Z.H.); (L.L.); (J.H.); (Y.M.); (C.Y.); (J.J.)
| | - Weiji Weng
- Department of Biochemistry and Molecular Cell Biology, Shanghai Key Laboratory for Tumor Microenvironment and Inflammation, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China;
| | - Jialin Huang
- Shanghai Institute of Head Trauma, Shanghai 200127, China;
| | - Xiongfei Zhao
- Shanghai Angecon Biotechnology Co., Ltd., Shanghai 201318, China; (X.Z.); (X.Z.)
| | - Xiaoqi Zhang
- Shanghai Angecon Biotechnology Co., Ltd., Shanghai 201318, China; (X.Z.); (X.Z.)
| | - Qian Liang
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Jiyao Jiang
- Brain Injury Center, Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; (Z.H.); (L.L.); (J.H.); (Y.M.); (C.Y.); (J.J.)
- Shanghai Institute of Head Trauma, Shanghai 200127, China;
| | - Junfeng Feng
- Brain Injury Center, Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; (Z.H.); (L.L.); (J.H.); (Y.M.); (C.Y.); (J.J.)
- Shanghai Institute of Head Trauma, Shanghai 200127, China;
- Correspondence: ; Tel.: +86-136-1186-0825
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Pavel DG, Henderson TA, DeBruin S. The Legacy of the TTASAAN Report-Premature Conclusions and Forgotten Promises: A Review of Policy and Practice Part I. Front Neurol 2022; 12:749579. [PMID: 35450131 PMCID: PMC9017602 DOI: 10.3389/fneur.2021.749579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Brain perfusion single photon emission computed tomography (SPECT) scans were initially developed in 1970's. A key radiopharmaceutical, hexamethylpropyleneamine oxime (HMPAO), was originally approved in 1988, but was unstable. As a result, the quality of SPECT images varied greatly based on technique until 1993, when a method of stabilizing HMPAO was developed. In addition, most SPECT perfusion studies pre-1996 were performed on single-head gamma cameras. In 1996, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) issued a report regarding the use of SPECT in the evaluation of neurological disorders. Although the TTASAAN report was published in January 1996, it was approved for publication in October 1994. Consequently, the reported brain SPECT studies relied upon to derive the conclusions of the TTASAAN report largely pre-date the introduction of stabilized HMPAO. While only 12% of the studies on traumatic brain injury (TBI) in the TTASAAN report utilized stable tracers and multi-head cameras, 69 subsequent studies with more than 23,000 subjects describe the utility of perfusion SPECT scans in the evaluation of TBI. Similarly, dementia SPECT imaging has improved. Modern SPECT utilizing multi-headed gamma cameras and quantitative analysis has a sensitivity of 86% and a specificity of 89% for the diagnosis of mild to moderate Alzheimer's disease-comparable to fluorodeoxyglucose positron emission tomography. Advances also have occurred in seizure neuroimaging. Lastly, developments in SPECT imaging of neurotoxicity and neuropsychiatric disorders have been striking. At the 25-year anniversary of the publication of the TTASAAN report, it is time to re-examine the utility of perfusion SPECT brain imaging. Herein, we review studies cited by the TTASAAN report vs. current brain SPECT imaging research literature for the major indications addressed in the report, as well as for emerging indications. In Part II, we elaborate technical aspects of SPECT neuroimaging and discuss scan interpretation for the clinician.
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Affiliation(s)
- Dan G Pavel
- Pathfinder Brain SPECT Imaging, Deerfield, IL, United States.,The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States
| | - Theodore A Henderson
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,The Synaptic Space, Inc., Denver, CO, United States.,Neuro-Luminance, Inc., Denver, CO, United States.,Dr. Theodore Henderson, Inc., Denver, CO, United States
| | - Simon DeBruin
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Good Lion Imaging, Columbia, SC, United States
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Colamaria A, Blagia M, Carbone F, Fochi NP. Blast-related traumatic brain injury: Report of a severe case and review of the literature. Surg Neurol Int 2022; 13:151. [PMID: 35509563 PMCID: PMC9062926 DOI: 10.25259/sni_1134_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/01/2022] [Indexed: 11/14/2022] Open
Abstract
Background: Traumatic brain injury (TBI) is a well-known brain dysfunction commonly encountered in activities such as military combat or collision sports. The etiopathology can vary depending on the context and bomb explosions are becoming increasingly common in war zones, urban terrorist attacks, and civilian criminal feuds. Blast-related TBI may cause the full severity range of neurotrauma, from a mild concussion to severe, penetrating injury. Recent classifications of the pathophysiological mechanisms comprise five factors that reflect the gravity of the experienced trauma and suggest to the clinician different pathways of injury and consequent pathology caused by the explosion. Case Description: In the present report, the authors describe a case of 26 years old presenting with blast-related severe TBI caused by the detonation of an explosive in an amusement arcade. Surgical decompression to control intracranial pressure and systemic antibiotic treatment to manage and prevent wound infections were the main options available in a civilian hospital. Conclusion: While numerous studies examined the burden of blast-related brain injuries on service members, few papers have tackled this problem in a civilian setting, where hospitals are not sufficiently equipped, and physicians lack the necessary training. The present case demonstrates the urgent need for evidence-based diagnostic and therapeutic protocols in civilian hospitals that would improve the outcome of such patients.
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Affiliation(s)
| | - Maria Blagia
- Department of Neurosurgery, Giovanni XXIII Hospital, Bari,
| | - Francesco Carbone
- Department of Neurosurgery, University of Foggia, Foggia, Puglia, Italy
| | - Nicola Pio Fochi
- Department of Neurosurgery, University of Foggia, Foggia, Puglia, Italy
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Golub VM, Reddy DS. Post-Traumatic Epilepsy and Comorbidities: Advanced Models, Molecular Mechanisms, Biomarkers, and Novel Therapeutic Interventions. Pharmacol Rev 2022; 74:387-438. [PMID: 35302046 PMCID: PMC8973512 DOI: 10.1124/pharmrev.121.000375] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Post-traumatic epilepsy (PTE) is one of the most devastating long-term, network consequences of traumatic brain injury (TBI). There is currently no approved treatment that can prevent onset of spontaneous seizures associated with brain injury, and many cases of PTE are refractory to antiseizure medications. Post-traumatic epileptogenesis is an enduring process by which a normal brain exhibits hypersynchronous excitability after a head injury incident. Understanding the neural networks and molecular pathologies involved in epileptogenesis are key to preventing its development or modifying disease progression. In this article, we describe a critical appraisal of the current state of PTE research with an emphasis on experimental models, molecular mechanisms of post-traumatic epileptogenesis, potential biomarkers, and the burden of PTE-associated comorbidities. The goal of epilepsy research is to identify new therapeutic strategies that can prevent PTE development or interrupt the epileptogenic process and relieve associated neuropsychiatric comorbidities. Therefore, we also describe current preclinical and clinical data on the treatment of PTE sequelae. Differences in injury patterns, latency period, and biomarkers are outlined in the context of animal model validation, pathophysiology, seizure frequency, and behavior. Improving TBI recovery and preventing seizure onset are complex and challenging tasks; however, much progress has been made within this decade demonstrating disease modifying, anti-inflammatory, and neuroprotective strategies, suggesting this goal is pragmatic. Our understanding of PTE is continuously evolving, and improved preclinical models allow for accelerated testing of critically needed novel therapeutic interventions in military and civilian persons at high risk for PTE and its devastating comorbidities.
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Affiliation(s)
- Victoria M Golub
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas
| | - Doodipala Samba Reddy
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas
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38
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Osborne LK, Wright BJ, Bullock‐Yowell E, Mohn RS, Nicholson BC. Assessing US Veterans’ work role functioning: Influences of posttraumatic stress, sense of coherence, and vocational identity. JOURNAL OF EMPLOYMENT COUNSELING 2022. [DOI: 10.1002/joec.12180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Benjamin J. Wright
- School of Psychology The University of Southern Mississippi Hattiesburg Mississippi USA
| | - Emily Bullock‐Yowell
- School of Psychology The University of Southern Mississippi Hattiesburg Mississippi USA
| | - Richard S. Mohn
- School of Education The University of Southern Mississippi Hattiesburg Mississippi USA
| | - Bonnie C. Nicholson
- School of Psychology The University of Southern Mississippi Hattiesburg Mississippi USA
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Baskin B, Lee SJ, Skillen E, Wong K, Rau H, Hendrickson RC, Pagulayan K, Raskind MA, Peskind ER, Phillips PEM, Cook DG, Schindler AG. Repetitive Blast Exposure Increases Appetitive Motivation and Behavioral Inflexibility in Male Mice. Front Behav Neurosci 2022; 15:792648. [PMID: 35002648 PMCID: PMC8727531 DOI: 10.3389/fnbeh.2021.792648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/25/2021] [Indexed: 12/02/2022] Open
Abstract
Blast exposure (via detonation of high explosives) represents a major potential trauma source for Servicemembers and Veterans, often resulting in mild traumatic brain injury (mTBI). Executive dysfunction (e.g., alterations in memory, deficits in mental flexibility, difficulty with adaptability) is commonly reported by Veterans with a history of blast-related mTBI, leading to impaired daily functioning and decreased quality of life, but underlying mechanisms are not fully understood and have not been well studied in animal models of blast. To investigate potential underlying behavioral mechanisms contributing to deficits in executive functioning post-blast mTBI, here we examined how a history of repetitive blast exposure in male mice affects anxiety/compulsivity-like outcomes and appetitive goal-directed behavior using an established mouse model of blast mTBI. We hypothesized that repetitive blast exposure in male mice would result in anxiety/compulsivity-like outcomes and corresponding performance deficits in operant-based reward learning and behavioral flexibility paradigms. Instead, results demonstrate an increase in reward-seeking and goal-directed behavior and a congruent decrease in behavioral flexibility. We also report chronic adverse behavioral changes related to anxiety, compulsivity, and hyperarousal. In combination, these data suggest that potential deficits in executive function following blast mTBI are at least in part related to enhanced compulsivity/hyperreactivity and behavioral inflexibility and not simply due to a lack of motivation or inability to acquire task parameters, with important implications for subsequent diagnosis and treatment management.
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Affiliation(s)
- Britahny Baskin
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States
| | - Suhjung Janet Lee
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Emma Skillen
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Katrina Wong
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Holly Rau
- VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Rebecca C Hendrickson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Kathleen Pagulayan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Murray A Raskind
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Elaine R Peskind
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Paul E M Phillips
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States.,Department of Pharmacology, University of Washington, Seattle, WA, United States
| | - David G Cook
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States.,Department of Pharmacology, University of Washington, Seattle, WA, United States.,Department of Medicine, University of Washington, Seattle, WA, United States
| | - Abigail G Schindler
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States
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Bishop R, Won SJ, Irvine KA, Basu J, Rome ES, Swanson RA. Blast-induced axonal degeneration in the rat cerebellum in the absence of head movement. Sci Rep 2022; 12:143. [PMID: 34996954 PMCID: PMC8741772 DOI: 10.1038/s41598-021-03744-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Blast exposure can injure brain by multiple mechanisms, and injury attributable to direct effects of the blast wave itself have been difficult to distinguish from that caused by rapid head displacement and other secondary processes. To resolve this issue, we used a rat model of blast exposure in which head movement was either strictly prevented or permitted in the lateral plane. Blast was found to produce axonal injury even with strict prevention of head movement. This axonal injury was restricted to the cerebellum, with the exception of injury in visual tracts secondary to ocular trauma. The cerebellar axonal injury was increased in rats in which blast-induced head movement was permitted, but the pattern of injury was unchanged. These findings support the contentions that blast per se, independent of head movement, is sufficient to induce axonal injury, and that axons in cerebellar white matter are particularly vulnerable to direct blast-induced injury.
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Affiliation(s)
- Robin Bishop
- Department of Neurology, University of California at San Francisco, San Francisco, CA, 94158, USA
- (127)Neurology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, USA
| | - Seok Joon Won
- Department of Neurology, University of California at San Francisco, San Francisco, CA, 94158, USA.
- (127)Neurology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, USA.
| | - Karen-Amanda Irvine
- Department of Neurology, University of California at San Francisco, San Francisco, CA, 94158, USA
- (127)Neurology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, USA
- Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (E4-220), Palo Alto, CA, 94304, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, CA, 94305, USA
| | - Jayinee Basu
- Department of Neurology, University of California at San Francisco, San Francisco, CA, 94158, USA
- (127)Neurology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, USA
| | - Eric S Rome
- Department of Neurology, University of California at San Francisco, San Francisco, CA, 94158, USA
- (127)Neurology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, USA
| | - Raymond A Swanson
- Department of Neurology, University of California at San Francisco, San Francisco, CA, 94158, USA
- (127)Neurology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, USA
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41
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Leung KK, Carr FM, Russell MJ, Bremault-Phillips S, Triscott JAC. Traumatic brain injuries among veterans and the risk of incident dementia: A systematic review & meta-analysis. Age Ageing 2022; 51:6394990. [PMID: 34651165 DOI: 10.1093/ageing/afab194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Traumatic brain injuries (TBI) among military veterans are increasingly recognized as important causes of both short and long-term neuropsychological dysfunction. However, the association between TBI and the development of dementia is controversial. This systematic review and meta-analysis sought to quantify the risks of all-cause dementia including Alzheimer's diseases and related dementias (ADRD), and to explore whether the relationships are influenced by the severity and recurrence of head injuries. METHODS Database searches of Medline, Embase, Ovid Healthstar, PubMed and PROSPERO were undertaken from inception to December 2020 and supplemented with grey literature searches without language restrictions. Observational cohort studies examining TBI and incident dementia among veterans were analysed using Dersimonian-Laird random-effects models. RESULTS Thirteen cohort studies totalling over 7.1 million observations with veterans were included. TBI was associated with an increased risk of all-cause dementia (hazard ratio [HR] = 1.95, 95% confidence interval [CI]: 1.55-2.45), vascular dementia (HR = 2.02, 95% CI: 1.46-2.80), but not Alzheimer's disease (HR = 1.30, 95% CI: 0.88-1.91). Severe and penetrating injuries were associated with a higher risk of all-cause dementia (HR = 3.35, 95% CI: 2.47-4.55) than moderate injuries (HR = 2.82, 95% CI: 1.44-5.52) and mild injuries (HR = 1.91, 95% CI: 1.30-2.80). However, the dose-response relationship was attenuated when additional studies with sufficient data to classify trauma severity were included. CONCLUSION TBI is a significant risk factor for incident all-cause dementia and vascular dementia. These results need to be interpreted cautiously in the presence of significant heterogeneity.
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Affiliation(s)
- Karen K Leung
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, T6G 2T4
| | - Frances M Carr
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, T6G 2P4
| | | | - Suzette Bremault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, T6G 2G4
| | - Jean A C Triscott
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, T6G 2T4
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Ma J, Wang J, Deng K, Gao Y, Xiao W, Hou J, Jiang C, Li J, Yu B. The Effect of MaxiK Channel on Regulating the Activation of NLRP3 Inflammasome in Rats of Blast-induced Traumatic Brain Injury. Neuroscience 2021; 482:132-142. [PMID: 34923036 DOI: 10.1016/j.neuroscience.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
Abundant findings including our previous work proved that the NOD-like receptor family, pyrin domain-containing 3 (NLRP3) inflammasome exerts a key role in the process of neuroinflammation following blast-induced traumatic brain injury (bTBI). The opening of potassium channels leads to low K+ environment in cells, which appears to be an essential requirement for NLRP3 inflammasome activation. Notably, MaxiK (BK) channel is significant for K+ transport. The present study is aim to investigate the potential role of MaxiK in the activation of NLRP3 and to evaluate whether MaxiK channel blocker paxilline could confer beneficial effects on attenuating the severity of bTBI in rats. Rats were randomly assigned into five groups (n = 8). MaxiK channel expression was measured in bTBI rats. The effect of paxilline on the expression of NLRP3 inflammasome, the level of inflammatory cytokines, brain injury biomarkers in serum and brain edema were also evaluated in bTBI rats. The results showed that the expression of MaxiK was elevated significantly in the cerebral cortex of bTBI rats. The treatment of MaxiK channel blocker paxilline suppressed the NLRP3 inflammasome expression substantially. In addition, paxilline could also decrease the level of pro-inflammatory cytokines and the biomarkers of brain injury and alleviate brain edema of bTBI rats. Our findings have revealed that MaxiK channel might be involved in the process of neuroinflammation of bTBI. Paxilline could depress neuro-inflammation response and alleviate brain injury by blocking MaxiK channel and subsequently inhibition of NLRP3 inflammasome activation.
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Affiliation(s)
- Jie Ma
- Department of Pharmacy, The General Hospital of Western Theater Command, Chengdu, Sichuan, PR China.
| | - Junrui Wang
- Department of Orthopaedics, Chengdu Second People's Hospital, Chengdu, Sichuan, PR China; Savaid Medical School, University of Chinese Academy of Sciences, Beijing, PR China
| | - Kaiwen Deng
- Department of Pharmacy, The General Hospital of Western Theater Command, Chengdu, Sichuan, PR China
| | - Yu Gao
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, PR China
| | - Wenjing Xiao
- Department of Pharmacy, The General Hospital of Western Theater Command, Chengdu, Sichuan, PR China
| | - Jun Hou
- Department of Pharmacy, The General Hospital of Western Theater Command, Chengdu, Sichuan, PR China
| | - Changqing Jiang
- Department of Pharmacy, The General Hospital of Western Theater Command, Chengdu, Sichuan, PR China
| | - Jing Li
- Department of Pharmacy, The General Hospital of Western Theater Command, Chengdu, Sichuan, PR China
| | - Botao Yu
- Department of Pharmacy, The General Hospital of Western Theater Command, Chengdu, Sichuan, PR China.
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McDonald BZ, Gee CC, Kievit FM. The Nanotheranostic Researcher’s Guide for Use of Animal Models of Traumatic Brain Injury. JOURNAL OF NANOTHERANOSTICS 2021; 2:224-268. [PMID: 35655793 PMCID: PMC9159501 DOI: 10.3390/jnt2040014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Traumatic brain injury (TBI) is currently the leading cause of injury-related morbidity and mortality worldwide, with an estimated global cost of USD 400 billion annually. Both clinical and preclinical behavioral outcomes associated with TBI are heterogeneous in nature and influenced by the mechanism and frequency of injury. Previous literature has investigated this relationship through the development of animal models and behavioral tasks. However, recent advancements in these methods may provide insight into the translation of therapeutics into a clinical setting. In this review, we characterize various animal models and behavioral tasks to provide guidelines for evaluating the therapeutic efficacy of treatment options in TBI. We provide a brief review into the systems utilized in TBI classification and provide comparisons to the animal models that have been developed. In addition, we discuss the role of behavioral tasks in evaluating outcomes associated with TBI. Our goal is to provide those in the nanotheranostic field a guide for selecting an adequate TBI animal model and behavioral task for assessment of outcomes to increase research in this field.
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Long-Term Outcome Following Decompressive Craniectomy in Pediatric Penetrating Blast Brain Injury; a Prospective Study. ARCHIVES OF NEUROSCIENCE 2021. [DOI: 10.5812/ans.117264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Brain penetrating blast injury is a leading cause of early death due to excessively elevated intracranial pressure (ICP), culminating in trans-tentorial herniation. The role of craniectomy to decrease ICP and secondary injuries has been controversial particularly in pediatric patients. Three cases of pediatric penetrating blast injuries undergoing decompressive craniectomy are reported in Methods: The current study was a prospective series, including fifteen cases of pediatric blast-related brain injury referred to the emergency ward during a period of two years. Three survived patients had a Glasgow Coma Scale (GCS) of four along with anisocoric pupillary light reflex (PLR). Decompressive craniectomy and ventriculostomy (EVD) were performed. The patients underwent ICP monitoring for two weeks. Results: Early postoperative GCS (5 days) was 7/15 in all three patients. Two weeks and one month’s GCS were 9 and 14, respectively. After three months, cranioplasty was performed. Long-term follow-up detected no major motor deficits after one year and was associated with excellent school performance. Neuroplasticity resulted in contralateral dominancy and handedness in one case. Conclusions: Survivors of pediatric blast brain injury had a favorable outcome after decompressive craniectomy in the current paper. However, there was a limited number of patients, and the results could not be generalized. Further research in this regard with larger sample size is recommended.
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45
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Bernstein JPK, Sevigny M, Novack TA, Dreer LE, Chung J, Lamberty GJ, Finn JA. Predictors of Driving Status in Service Members and Veterans at 1 Year Posttraumatic Brain Injury: A VA TBI Model Systems Study. J Head Trauma Rehabil 2021; 36:437-446. [PMID: 33741826 DOI: 10.1097/htr.0000000000000668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify predictors of driving status in service members and veterans 1 year following a traumatic brain injury (TBI). SETTING The 5 Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs). PARTICIPANTS A total of 471 service members and veterans (128 with mild/complicated mild TBI and 343 with moderate/severe TBI) who received TBI-focused inpatient rehabilitation at one of the VA PRCs and who participated in a 1-year postinjury follow-up assessment. DESIGN Secondary analysis from the Department of Veterans Affairs Polytrauma Rehabilitation Centers Traumatic Brain Injury Model Systems (VA PRC TBIMS) national database. MAIN MEASURES Primary outcome was a single item that assessed driving status at 1 year postinjury. Predictor variables included demographics; sensory impairment, substance use, and employment status at time of injury; PTSD symptoms reported at study enrollment; and functional impairment rated at rehabilitation discharge. RESULTS In unadjusted bivariate analyses, among those with a mild/complicated mild TBI, older age and greater functional impairment were associated with lower likelihood of driving. Among those with a moderate/severe TBI, discharge to a nonprivate residence, greater functional impairment, and higher PTSD symptoms were linked to lower likelihood of driving. Adjusted multivariate analyses indicated that functional impairment was uniquely associated with driving status in both TBI severity groups. After controlling for other predictors, self-reported PTSD symptoms, particularly dysphoria symptoms, were associated with lower likelihood of driving in both severity groups. CONCLUSION Given the significance of clinician-rated functional impairment and self-reported PTSD symptoms to the prediction of driving status 1 year post-TBI among service members and veterans, rehabilitation efforts to improve functioning and reduce negative affect may have a positive impact on driving and community integration.
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Affiliation(s)
- John P K Bernstein
- Department of Psychology, Louisiana State University, Baton Rouge (Mr Bernstein); Mental Health Service Line (Mr Bernstein and Dr Lamberty) and Extended Care and Rehabilitation (Dr Finn), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; TBI Model Systems National Data and Statistical Center, Craig Hospital, Englewood, Colorado (Mr Sevigny); Departments of Physical Medicine & Rehabilitation (Dr Novack) and Ophthalmology and Visual Sciences (Dr Dreer), University of Alabama-Birmingham School of Medicine; Polytrauma System of Care and Rehabilitation Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Dr Chung); and Department of Psychiatry, University of Minnesota, Minneapolis (Dr Finn)
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The Relationship Between Cognitive Functioning and Symptoms of Depression, Anxiety, and Post-Traumatic Stress Disorder in Adults with a Traumatic Brain Injury: a Meta-Analysis. Neuropsychol Rev 2021; 32:758-806. [PMID: 34694543 DOI: 10.1007/s11065-021-09524-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 09/09/2021] [Indexed: 12/12/2022]
Abstract
A thorough understanding of the relationship between cognitive test performance and symptoms of depression, anxiety, or post-traumatic stress disorder (PTSD) in people with traumatic brain injury (TBI) is important given the high prevalence of these emotional symptoms following injury. It is also important to understand whether these relationships are affected by TBI severity, and the validity of test performance and symptom report. This meta-analysis was conducted to investigate whether these symptoms are associated with cognitive test performance alterations in adults with a TBI. This meta-analysis was prospectively registered on the PROSPERO International Prospective Register of Systematic Reviews website (registration number: CRD42018089194). The electronic databases Medline, PsycINFO, and CINAHL were searched for journal articles published up until May 2020. In total, 61 studies were included, which enabled calculation of pooled effect sizes for the cognitive domains of immediate memory (verbal and visual), recent memory (verbal and visual), attention, executive function, processing speed, and language. Depression had a small, negative relationship with most cognitive domains. These relationships remained, for the most part, when samples with mild TBI (mTBI)-only were analysed separately, but not for samples with more severe TBI (sTBI)-only. A similar pattern of results was found in the anxiety analysis. PTSD had a small, negative relationship with verbal memory, in samples with mTBI-only. No data were available for the PTSD analysis with sTBI samples. Moderator analyses indicated that the relationships between emotional symptoms and cognitive test performance may be impacted to some degree by exclusion of participants with atypical performance on performance validity tests (PVTs) or symptom validity tests (SVTs), however there were small study numbers and changes in effect size were not statistically significant. These findings are useful in synthesising what is currently known about the relationship between cognitive test performance and emotional symptoms in adults with TBI, demonstrating significant, albeit small, relationships between emotional symptoms and cognitive test performance in multiple domains, in non-military samples. Some of these relationships appeared to be mildly impacted by controlling for performance validity or symptom validity, however this was based on the relatively few studies using validity tests. More research including PVTs and SVTs whilst examining the relationship between emotional symptoms and cognitive outcomes is needed.
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Gan S, Shi W, Wang S, Sun Y, Yin B, Bai G, Jia X, Sun C, Niu X, Wang Z, Jiang X, Liu J, Zhang M, Bai L. Accelerated Brain Aging in Mild Traumatic Brain Injury: Longitudinal Pattern Recognition with White Matter Integrity. J Neurotrauma 2021; 38:2549-2559. [PMID: 33863259 DOI: 10.1089/neu.2020.7551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI) initiating long-term effects on white matter integrity resembles brain-aging changes, implying an aging process accelerated by mTBI. This longitudinal study aims to investigate the mTBI-induced acceleration of the brain-aging process by developing a neuroimaging model to predict brain age. The brain-age prediction model was defined using relevance vector regression based on fractional anisotropy from diffusion tensor imaging of 523 healthy individuals. The model was used to estimate the brain-predicted age difference (brain-PAD) between the chronological and estimated brain age in 116 acute mTBI patients and 63 healthy controls. Fifty patients were followed for 6 ∼ 12 months to evaluate the longitudinal changes in brain-PAD. We investigated whether brain-PAD was greater in patients of older age, post-concussion complaints, and apolipoprotein E (APOE) ɛ4 genotype, and whether it had the potential to predict neuropsychological outcomes. The brain-age prediction model predicted brain age accurately (r = 0.96). The brains of mTBI patients in the acute phase were estimated to be "older," with greater brain-PAD (2.59 ± 5.97 years) than the healthy controls (0.12 ± 3.19 years) (p < 0.05), and remained stable 6-12 month post-injury (2.50 ± 4.54 years). Patients who were older or who had post-concussion complaints, rather than APOE ɛ4 genotype, had greater brain-PADs (p < 0.001, p = 0.024). Additionally, brain-PAD in the acute phase predicted information processing speed at the 6 ∼ 12 month follow-up (r = -0.36, p = 0.01). In conclusion, mTBI accelerates the brain-aging process, and brain-PAD may be capable of evaluating aging-associated issues post-injury, such as increased risks of neurodegeneration.
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Affiliation(s)
- Shuoqiu Gan
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wen Shi
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Shan Wang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Yingxiang Sun
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bo Yin
- Department of Neurosurgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guanghui Bai
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoyan Jia
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Chuanzhu Sun
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Xuan Niu
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhuonan Wang
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaofan Jiang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ming Zhang
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lijun Bai
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
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Pieper J, Chang DG, Mahasin SZ, Swan AR, Quinto AA, Nichols S, Diwakar M, Huang C, Swan J, Lee R, Baker DG, Huang M. Brain Amygdala Volume Increases in Veterans and Active-Duty Military Personnel With Combat-Related Posttraumatic Stress Disorder and Mild Traumatic Brain Injury. J Head Trauma Rehabil 2021; 35:E1-E9. [PMID: 31033749 PMCID: PMC6814512 DOI: 10.1097/htr.0000000000000492] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify amygdalar volumetric differences associated with posttraumatic stress disorder (PTSD) in individuals with comorbid mild traumatic brain injury (mTBI) compared with those with mTBI-only and to examine the effects of intracranial volume (ICV) on amygdala volumetric measures. SETTING Marine Corps Base and VA Healthcare System. PARTICIPANTS A cohort of veterans and active-duty military personnel with combat-related mTBI (N = 89). DESIGN Twenty-nine participants were identified with comorbid PTSD and mTBI. The remaining 60 formed the mTBI-only control group. Structural images of brains were obtained with a 1.5-T MRI scanner using a T1-weighted 3D-IR-FSPGR pulse sequence. Automatic segmentation was performed in Freesurfer. MAIN MEASURES Amygdala volumes with/without normalizations to ICV. RESULTS The comorbid mTBI/PTSD group had significantly larger amygdala volumes, when normalized to ICV, compared with the mTBI-only group. The right and left amygdala volumes after normalization to ICV were 0.122% ± 0.012% and 0.118% ± 0.011%, respectively, in the comorbid group compared with 0.115% ± 0.012% and 0.112% ± 0.009%, respectively, in the mTBI-only group (corrected P < .05). CONCLUSIONS The ICV normalization analysis performed here may resolve previous literature discrepancies. This is an intriguing structural finding, given the role of the amygdala in the challenging neuroemotive symptoms witnessed in casualties of combat-related mTBI and PTSD.
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Affiliation(s)
- Joel Pieper
- Department of Internal Medicine, University of California, San Diego, CA, USA
| | - Douglas G. Chang
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA
| | | | - Ashley Robb Swan
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| | - Annemarie Angeles Quinto
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| | - Sharon Nichols
- Department of Neuroscience, University of California, San Diego, CA, USA
| | - Mithun Diwakar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Charles Huang
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - James Swan
- Department of Management Information Systems, San Diego State University, San Diego, CA, USA
| | - Roland Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| | - Dewleen G. Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Mingxiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
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Jitsu M, Niwa K, Suzuki G, Obara T, Iwama Y, Hagisawa K, Takahashi Y, Matsushita Y, Takeuchi S, Nawashiro H, Sato S, Kawauchi S. Behavioral and Histopathological Impairments Caused by Topical Exposure of the Rat Brain to Mild-Impulse Laser-Induced Shock Waves: Impulse Dependency. Front Neurol 2021; 12:621546. [PMID: 34093390 PMCID: PMC8177106 DOI: 10.3389/fneur.2021.621546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/23/2021] [Indexed: 12/26/2022] Open
Abstract
Although an enormous number of animal studies on blast-induced traumatic brain injury (bTBI) have been conducted, there still remain many uncertain issues in its neuropathology and mechanisms. This is partially due to the complex and hence difficult experimental environment settings, e.g., to minimize the effects of blast winds (tertiary mechanism) and to separate the effects of brain exposure and torso exposure. Since a laser-induced shock wave (LISW) is free from dynamic pressure and its energy is spatially well confined, the effects of pure shock wave exposure (primary mechanism) solely on the brain can be examined by using an LISW. In this study, we applied a set of four LISWs in the impulse range of 15–71 Pa·s to the rat brain through the intact scalp and skull; the interval between each exposure was ~5 s. For the rats, we conducted locomotor activity, elevated plus maze and forced swimming tests. Axonal injury in the brain was also examined by histological analysis using Bodian silver staining. Only the rats with exposure at higher impulses of 54 and 71 Pa·s showed significantly lower spontaneous movements at 1 and 2 days post-exposure by the locomotor activity test, but after 3 days post-exposure, they had recovered. At 7 days post-exposure, however, these rats (54 and 71 Pa·s) showed significantly higher levels of anxiety-related and depression-like behaviors by the elevated plus maze test and forced swimming test, respectively. To the best of the authors' knowledge, there have been few studies in which a rat model showed both anxiety-related and depression-like behaviors caused by blast or shock wave exposure. At that time point (7 days post-exposure), histological analysis showed significant decreases in axonal density in the cingulum bundle and corpus callosum in impulse-dependent manners; axons in the cingulum bundle were found to be more affected by a shock wave. Correlation analysis showed a statistically significant correlation between the depression like-behavior and axonal density reduction in the cingulum bundle. The results demonstrated the dependence of behavior deficits and axonal injury on the shock wave impulse loaded on the brain.
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Affiliation(s)
- Motoyuki Jitsu
- Military Medicine Research Unit, Japan Ground Self Defense Force, Tokyo, Japan
| | - Katsuki Niwa
- Military Medicine Research Unit, Japan Ground Self Defense Force, Tokyo, Japan
| | - Go Suzuki
- Military Medicine Research Unit, Japan Ground Self Defense Force, Tokyo, Japan
| | - Takeyuki Obara
- Military Medicine Research Unit, Japan Ground Self Defense Force, Tokyo, Japan
| | - Yukiko Iwama
- Military Medicine Research Unit, Japan Ground Self Defense Force, Tokyo, Japan
| | - Kohsuke Hagisawa
- Military Medicine Research Unit, Japan Ground Self Defense Force, Tokyo, Japan
| | - Yukihiro Takahashi
- Military Medicine Research Unit, Japan Ground Self Defense Force, Tokyo, Japan
| | | | - Satoru Takeuchi
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Japan
| | - Hiroshi Nawashiro
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Japan
| | - Shunichi Sato
- Division of Bioinformation and Therapeutic Systems, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Satoko Kawauchi
- Division of Bioinformation and Therapeutic Systems, National Defense Medical College Research Institute, Tokorozawa, Japan
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50
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Miller ST, Cooper CF, Elsbernd P, Kerwin J, Mejia-Alvarez R, Willis AM. Localizing Clinical Patterns of Blast Traumatic Brain Injury Through Computational Modeling and Simulation. Front Neurol 2021; 12:547655. [PMID: 34093380 PMCID: PMC8173077 DOI: 10.3389/fneur.2021.547655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
Blast traumatic brain injury is ubiquitous in modern military conflict with significant morbidity and mortality. Yet the mechanism by which blast overpressure waves cause specific intracranial injury in humans remains unclear. Reviewing of both the clinical experience of neurointensivists and neurosurgeons who treated service members exposed to blast have revealed a pattern of injury to cerebral blood vessels, manifested as subarachnoid hemorrhage, pseudoaneurysm, and early diffuse cerebral edema. Additionally, a seminal neuropathologic case series of victims of blast traumatic brain injury (TBI) showed unique astroglial scarring patterns at the following tissue interfaces: subpial glial plate, perivascular, periventricular, and cerebral gray-white interface. The uniting feature of both the clinical and neuropathologic findings in blast TBI is the co-location of injury to material interfaces, be it solid-fluid or solid-solid interface. This motivates the hypothesis that blast TBI is an injury at the intracranial mechanical interfaces. In order to investigate the intracranial interface dynamics, we performed a novel set of computational simulations using a model human head simplified but containing models of gyri, sulci, cerebrospinal fluid (CSF), ventricles, and vasculature with high spatial resolution of the mechanical interfaces. Simulations were performed within a hybrid Eulerian—Lagrangian simulation suite (CTH coupled via Zapotec to Sierra Mechanics). Because of the large computational meshes, simulations required high performance computing resources. Twenty simulations were performed across multiple exposure scenarios—overpressures of 150, 250, and 500 kPa with 1 ms overpressure durations—for multiple blast exposures (front blast, side blast, and wall blast) across large variations in material model parameters (brain shear properties, skull elastic moduli). All simulations predict fluid cavitation within CSF (where intracerebral vasculature reside) with cavitation occurring deep and diffusely into cerebral sulci. These cavitation events are adjacent to high interface strain rates at the subpial glial plate. Larger overpressure simulations (250 and 500kPa) demonstrated intraventricular cavitation—also associated with adjacent high periventricular strain rates. Additionally, models of embedded intraparenchymal vascular structures—with diameters as small as 0.6 mm—predicted intravascular cavitation with adjacent high perivascular strain rates. The co-location of local maxima of strain rates near several of the regions that appear to be preferentially damaged in blast TBI (vascular structures, subpial glial plate, perivascular regions, and periventricular regions) suggest that intracranial interface dynamics may be important in understanding how blast overpressures leads to intracranial injury.
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Affiliation(s)
- Scott T Miller
- Computational Solid Mechanics & Structural Dynamics, Sandia National Laboratories, Albuquerque, NM, United States
| | - Candice F Cooper
- Terminal Ballistics Technology, Sandia National Laboratories, Albuquerque, NM, United States
| | - Paul Elsbernd
- Department of Neurology, Brooke Army Medical Center, Fort Sam Houston, TX, United States
| | - Joseph Kerwin
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Ricardo Mejia-Alvarez
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Adam M Willis
- Department of Neurology, Brooke Army Medical Center, Fort Sam Houston, TX, United States.,Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
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