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Vita SM, Cruise SC, Gilpin NW, Molina PE. HISTOLOGICAL COMPARISON OF REPEATED MILD WEIGHT DROP AND LATERAL FLUID PERCUSSION INJURY MODELS OF TRAUMATIC BRAIN INJURY IN FEMALE AND MALE RATS. Shock 2024; 62:398-409. [PMID: 38813916 DOI: 10.1097/shk.0000000000002395] [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: 05/31/2024]
Abstract
ABSTRACT In preclinical traumatic brain injury (TBI) research, the animal model should be selected based on the research question and outcome measures of interest. Direct side-by-side comparisons of different injury models are essential for informing such decisions. Here, we used immunohistochemistry to compare the outcomes from two common models of TBI, lateral fluid percussion (LFP) and repeated mild weight drop (rmWD) in adult female and male Wistar rats. Specifically, we measured the effects of LFP and rmWD on markers of cerebrovascular and tight junction disruption, neuroinflammation, mature neurons, and perineuronal nets in the cortical site of injury, cortex adjacent to injury, dentate gyrus, and the CA 2/3 area of the hippocampus. Animals were randomized into the LFP or rmWD group. On day 1, the LFP group received a craniotomy, and on day 4, injury (or sham procedure; randomly assigned). The rmWD animals underwent either injury or isoflurane only (randomly assigned) on each of those 4 days. Seven days after injury, brains were harvested for analysis. Overall, our observations revealed that the most significant disruptions were evident in response to LFP, followed by craniotomy only, whereas rmWD animals showed the least residual changes compared with isoflurane-only controls, supporting consideration of rmWD as a mild injury. LFP led to longer-lasting disruptions, perhaps more representative of moderate TBI. We also report that craniotomy and LFP produced greater disruptions in females relative to males. These findings will assist the field in the selection of animal models based on target severity of postinjury outcomes and support the inclusion of both sexes and appropriate control groups.
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Affiliation(s)
| | - Shealan C Cruise
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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2
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Clay AM, Carr RL, DuBien JL, To F. Short-term behavioral and histological findings following a single concussive and repeated subconcussive brain injury in a rodent model. Brain Inj 2024; 38:827-834. [PMID: 38704844 DOI: 10.1080/02699052.2024.2349144] [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: 03/19/2023] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
PRIMARY OBJECTIVE It is unclear of the correlation between a mild traumatic brain injury (mTBI) and repeated subconcussive (RSC) impacts with respect to injury biomechanics. Thus, the present study was designed to determine the behavioral and histological differences between a single mTBI impact and RSC impacts with subdivided cumulative kinetic energies of the single mTBI impact. RESEARCH DESIGN Adult male Sprague-Dawley rats were randomly assigned to a single mTBI impact, RSC impact, sham, or repeated sham groups. METHODS AND PROCEDURES Following a weight drop injury, anxiety-like behavior and general locomotive activity and were assessed using the open field test, while motor coordination was evaluated using a rotarod unit. Neuronal loss, astrogliosis, and microgliosis were assessed using NeuN, GFAP and Iba-1 immunohistochemistry. All assessments were undertaken at 3- and 7-days post impact. MAIN OUTCOMES AND RESULTS No behavioral disturbances were observed in injury groups, however, both injury groups did lead to microgliosis following 3-days post-impact. CONCLUSIONS No pathophysiological differences were observed between a single mTBI impact and RSC impacts of the same energy input. Even though a cumulative injury threshold for RSC impacts was not determined, a threshold still may exist where no pathodynamic shift occurs.
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Affiliation(s)
- Anna Marie Clay
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi, USA
| | - Russell L Carr
- Center for Environmental Health Sciences, College of Veterinary Medicine, Mississippi University, Mississippi, USA
| | - Janice L DuBien
- Department of Statistics, Mississippi University, Mississippi, USA
| | - Filip To
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi, USA
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3
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Pearson A, Koprivica M, Eisenbaum M, Ortiz C, Browning M, Vincennie T, Tinsley C, Mullan M, Crawford F, Ojo J. PPARγ activation ameliorates cognitive impairment and chronic microglial activation in the aftermath of r-mTBI. J Neuroinflammation 2024; 21:194. [PMID: 39097742 PMCID: PMC11297749 DOI: 10.1186/s12974-024-03173-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/12/2024] [Indexed: 08/05/2024] Open
Abstract
Chronic neuroinflammation and microglial activation are key mediators of the secondary injury cascades and cognitive impairment that follow exposure to repetitive mild traumatic brain injury (r-mTBI). Peroxisome proliferator-activated receptor-γ (PPARγ) is expressed on microglia and brain resident myeloid cell types and their signaling plays a major anti-inflammatory role in modulating microglial responses. At chronic timepoints following injury, constitutive PPARγ signaling is thought to be dysregulated, thus releasing the inhibitory brakes on chronically activated microglia. Increasing evidence suggests that thiazolidinediones (TZDs), a class of compounds approved from the treatment of diabetes mellitus, effectively reduce neuroinflammation and chronic microglial activation by activating the peroxisome proliferator-activated receptor-γ (PPARγ). The present study used a closed-head r-mTBI model to investigate the influence of the TZD Pioglitazone on cognitive function and neuroinflammation in the aftermath of r-mTBI exposure. We revealed that Pioglitazone treatment attenuated spatial learning and memory impairments at 6 months post-injury and reduced the expression of reactive microglia and astrocyte markers in the cortex, hippocampus, and corpus callosum. We then examined whether Pioglitazone treatment altered inflammatory signaling mechanisms in isolated microglia and confirmed downregulation of proinflammatory transcription factors and cytokine levels. To further investigate microglial-specific mechanisms underlying PPARγ-mediated neuroprotection, we generated a novel tamoxifen-inducible microglial-specific PPARγ overexpression mouse line and examined its influence on microglial phenotype following injury. Using RNA sequencing, we revealed that PPARγ overexpression ameliorates microglial activation, promotes the activation of pathways associated with wound healing and tissue repair (such as: IL10, IL4 and NGF pathways), and inhibits the adoption of a disease-associated microglia-like (DAM-like) phenotype. This study provides insight into the role of PPARγ as a critical regulator of the neuroinflammatory cascade that follows r-mTBI in mice and demonstrates that the use of PPARγ agonists such as Pioglitazone and newer generation TZDs hold strong therapeutic potential to prevent the chronic neurodegenerative sequelae of r-mTBI.
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Affiliation(s)
- Andrew Pearson
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL, 34243, USA.
- The Open University, Walton Hall, Kents Hill, Milton Keynes, MK7 6AA, UK.
| | - Milica Koprivica
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL, 34243, USA
| | - Max Eisenbaum
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL, 34243, USA
- The Open University, Walton Hall, Kents Hill, Milton Keynes, MK7 6AA, UK
| | - Camila Ortiz
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL, 34243, USA
- The Open University, Walton Hall, Kents Hill, Milton Keynes, MK7 6AA, UK
| | | | - Tessa Vincennie
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL, 34243, USA
| | - Cooper Tinsley
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL, 34243, USA
| | - Michael Mullan
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL, 34243, USA
| | - Fiona Crawford
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL, 34243, USA
- The Open University, Walton Hall, Kents Hill, Milton Keynes, MK7 6AA, UK
- James A. Haley Veterans' Hospital, 13000 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Joseph Ojo
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL, 34243, USA
- The Open University, Walton Hall, Kents Hill, Milton Keynes, MK7 6AA, UK
- James A. Haley Veterans' Hospital, 13000 Bruce B Downs Blvd, Tampa, FL, 33612, USA
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4
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Orbach G, Melendes EJ, Warren K, Qiu J, Meehan WP, Mannix R, Guilhaume-Correa F. Visual Impairment in Pre-Clinical Models of Mild Traumatic Brain Injury. J Neurotrauma 2024; 41:1842-1852. [PMID: 38497739 PMCID: PMC11386989 DOI: 10.1089/neu.2023.0574] [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: 03/19/2024] Open
Abstract
Impairment in visual function is common after traumatic brain injury (TBI) in the clinical setting, a phenomenon that translates to pre-clinical animal models as well. In Morris et al. (2021), we reported histological changes following weight-drop-induced TBI in a rodent model including retinal ganglion cell (RGC) loss, decreased electroretinogram (ERG) evoked potential, optic nerve diameter reduction, induced inflammation and gliosis, and loss of myelin accompanied by markedly impaired visual acuity. In this review, we will describe several pre-clinical TBI models that result in injuries to the visual system, indicating that visual function may be impaired following brain injury induced by a number of different injury modalities. This underscores the importance of understanding the role of the visual system and the potential detrimental sequelae to this sensory modality post-TBI. Given that most commonly employed behavioral tests such as the Elevated Plus Maze and Morris Water Maze rely on an intact visual system, interpretation of functional deficits in diffuse models may be confounded by off- target effects on the visual system.
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Affiliation(s)
- Gabriella Orbach
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Eva J Melendes
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kaitlyn Warren
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jianhua Qiu
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - William P Meehan
- Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Fernanda Guilhaume-Correa
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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5
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Khatib A, Post A, Hoshizaki T, Gilchrist MD. Brain trauma characteristics for lightweight and heavyweight fighters in professional mixed martial arts. Sports Biomech 2024; 23:1083-1105. [PMID: 34011240 DOI: 10.1080/14763141.2021.1922740] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
Mixed martial arts (MMA) is a sport where the fighters are at high risk of brain trauma, with characteristics, such as the frequency, magnitude, and interval of head impacts influencing the risk of developing short- and long-term negative brain health outcomes. These characteristics may be influenced by weight class as they may have unique fighting styles. The purpose of this research was to compare frequency, magnitude, and interval of head impacts between lightweight and heavyweight fighters in professional MMA. Frequency, interval, event type, velocity, and location of head impacts were documented for 60 fighters from 15 Lightweight and 15 Heavyweight professional MMA fights. Head impact reconstructions of these events were performed using physical and finite element modelling methods to determine the strain in the brain tissues. The results found that LW and HW fighters sustained similar head impact frequencies and intervals. The LW fighters sustained a significantly higher frequency of very low and high magnitude impacts to the head from punches; HW a larger frequency of high category strains from elbow strikes. These brain trauma profiles reflect different fight strategies and may inform methods to manage and mitigate the long-term effects of repetitive impacts to the head.
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Affiliation(s)
- Ali Khatib
- Department of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Andrew Post
- Department of Human Kinetics, University of Ottawa, Ottawa, Canada
| | | | - Michael D Gilchrist
- Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
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6
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To XV, Cumming P, Nasrallah F. From impact to recovery: tracking mild traumatic brain injury with MRI-a pilot study and case series. BMJ Open Sport Exerc Med 2024; 10:e002010. [PMID: 39104372 PMCID: PMC11298751 DOI: 10.1136/bmjsem-2024-002010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2024] [Indexed: 08/07/2024] Open
Abstract
Background Diagnosis and recovery tracking of mild traumatic brain injury (mTBI) is often challenging due to the lack of clear findings on routine imaging techniques. This also complicates defining safe points for returning to activities. Hypothesis/purpose Quantitative susceptibility mapping (QSM) can provide information about cerebral venous oxygen saturation (CSvO2) in the context of brain injury. We tested the prediction that these imaging modalities would enable the detection of changes and recovery patterns in the brains of patients with mTBI. Study design In a case-control study, we recruited a cohort of 24 contact sport athletes for baseline QSM and resting-state functional MRI (rs-fMRI) scanning. Two of those who subsequently experienced head impact with significant post-injury symptoms underwent scans at 3, 7, 14 and 28 days post-injury; one had a boxing match without classical mTBI symptoms were also followed-up on. Results The cohort baseline QSM measurements of the straight sinus were established. The two injured athletes with post-impact symptoms consistent with mTBI had susceptibility results at days 3 and 7 post-impact that fell below the 25th percentile of the baseline values. The per cent amplitude fluctuation quantified from rs-fMRI agreed with the susceptibility trends in the straight sinus. Conclusion QSM holds promise as a diagnostic tool for tracking mTBI progression or recovery in contact sport head injury.
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Affiliation(s)
- Xuan Vinh To
- The Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
| | - Paul Cumming
- Department of Nuclear Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fatima Nasrallah
- The Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
- The Centre for Advanced Imaging, The University of Queensland, Brisbane, Queensland, Australia
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7
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Yue JK, Etemad LL, Elguindy MM, van Essen TA, Belton PJ, Nelson LD, McCrea MA, Vreeburg RJG, Gotthardt CJ, Tracey JX, Coskun BC, Krishnan N, Halabi C, Eagle SR, Korley FK, Robertson CS, Duhaime AC, Satris GG, Tarapore PE, Huang MC, Madhok DY, Giacino JT, Mukherjee P, Yuh EL, Valadka AB, Puccio AM, Okonkwo DO, Sun X, Jain S, Manley GT, DiGiorgio AM, Badjatia N, Barber J, Bodien YG, Fabian B, Ferguson AR, Foreman B, Gardner RC, Gopinath S, Grandhi R, Russell Huie J, Dirk Keene C, Lingsma HF, MacDonald CL, Markowitz AJ, Merchant R, Ngwenya LB, Rodgers RB, Schneider ALC, Schnyer DM, Taylor SR, Temkin NR, Torres-Espin A, Vassar MJ, Wang KKW, Wong JC, Zafonte RD. Prior traumatic brain injury is a risk factor for in-hospital mortality in moderate to severe traumatic brain injury: a TRACK-TBI cohort study. Trauma Surg Acute Care Open 2024; 9:e001501. [PMID: 39081460 PMCID: PMC11287071 DOI: 10.1136/tsaco-2024-001501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/10/2024] [Indexed: 08/02/2024] Open
Abstract
ABSTRACT Objectives An estimated 14-23% of patients with traumatic brain injury (TBI) incur multiple lifetime TBIs. The relationship between prior TBI and outcomes in patients with moderate to severe TBI (msTBI) is not well delineated. We examined the associations between prior TBI, in-hospital mortality, and outcomes up to 12 months after injury in a prospective US msTBI cohort. Methods Data from hospitalized subjects with Glasgow Coma Scale score of 3-12 were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (enrollment period: 2014-2019). Prior TBI with amnesia or alteration of consciousness was assessed using the Ohio State University TBI Identification Method. Competing risk regressions adjusting for age, sex, psychiatric history, cranial injury and extracranial injury severity examined the associations between prior TBI and in-hospital mortality, with hospital discharged alive as the competing risk. Adjusted HRs (aHR (95% CI)) were reported. Multivariable logistic regressions assessed the associations between prior TBI, mortality, and unfavorable outcome (Glasgow Outcome Scale-Extended score 1-3 (vs. 4-8)) at 3, 6, and 12 months after injury. Results Of 405 acute msTBI subjects, 21.5% had prior TBI, which was associated with male sex (87.4% vs. 77.0%, p=0.037) and psychiatric history (34.5% vs. 20.7%, p=0.010). In-hospital mortality was 10.1% (prior TBI: 17.2%, no prior TBI: 8.2%, p=0.025). Competing risk regressions indicated that prior TBI was associated with likelihood of in-hospital mortality (aHR=2.06 (1.01-4.22)), but not with hospital discharged alive. Prior TBI was not associated with mortality or unfavorable outcomes at 3, 6, and 12 months. Conclusions After acute msTBI, prior TBI history is independently associated with in-hospital mortality but not with mortality or unfavorable outcomes within 12 months after injury. This selective association underscores the importance of collecting standardized prior TBI history data early after acute hospitalization to inform risk stratification. Prospective validation studies are needed. Level of evidence IV. Trial registration number NCT02119182.
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Affiliation(s)
- John K Yue
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Leila L Etemad
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Mahmoud M Elguindy
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Thomas A van Essen
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Patrick J Belton
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lindsay D Nelson
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A McCrea
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rick J G Vreeburg
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Christine J Gotthardt
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Joye X Tracey
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Bukre C Coskun
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Nishanth Krishnan
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Cathra Halabi
- Neurology, University of California San Francisco, San Francisco, California, USA
| | - Shawn R Eagle
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | | | | | | | - Gabriela G Satris
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Phiroz E Tarapore
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Michael C Huang
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Debbie Y Madhok
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Joseph T Giacino
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pratik Mukherjee
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Esther L Yuh
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Alex B Valadka
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ava M Puccio
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - David O Okonkwo
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Geoffrey T Manley
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Anthony M DiGiorgio
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | | | - Neeraj Badjatia
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Jason Barber
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Yelena G Bodien
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Brian Fabian
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Adam R Ferguson
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Brandon Foreman
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Raquel C Gardner
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Shankar Gopinath
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Ramesh Grandhi
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - J Russell Huie
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - C Dirk Keene
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Hester F Lingsma
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Christine L MacDonald
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Amy J Markowitz
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Randall Merchant
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Laura B Ngwenya
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Richard B Rodgers
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Andrea L C Schneider
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - David M Schnyer
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Sabrina R Taylor
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Nancy R Temkin
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Abel Torres-Espin
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Mary J Vassar
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Kevin K W Wang
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Justin C Wong
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Ross D Zafonte
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
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8
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O’Brien WT, Spitz G, Xie B, Major BP, Mutimer S, Giesler LP, Bain J, Evans LJ, Duarte Martins B, Piantella S, Alhassan A, Brady S, Cappellari D, Somma V, McColl T, Symons GF, Gore T, Sun M, Kuek T, Horan S, Bei M, Ponsford JL, Willmott C, Reyes J, Ashton NJ, Zetterberg H, Mitra B, O’Brien TJ, Shultz SR, McDonald SJ. Biomarkers of Neurobiologic Recovery in Adults With Sport-Related Concussion. JAMA Netw Open 2024; 7:e2415983. [PMID: 38848061 PMCID: PMC11161851 DOI: 10.1001/jamanetworkopen.2024.15983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/04/2024] [Indexed: 06/10/2024] Open
Abstract
Importance Sport-related concussion (SRC), a form of mild traumatic brain injury, is a prevalent occurrence in collision sports. There are no well-established approaches for tracking neurobiologic recovery after SRC. Objective To examine the levels of serum glial fibrillary acidic protein (GFAP) and neurofilament light (NfL) in Australian football athletes who experience SRC. Design, Setting, and Participants A cohort study recruiting from April 10, 2021, to September 17, 2022, was conducted through the Victorian Amateur Football Association, Melbourne, Australia. Participants included adult Australian football players with or without SRC. Data analysis was performed from May 26, 2023, to March 27, 2024. Exposure Sport-related concussion, defined as at least 1 observable sign and/or 2 or more symptoms. Main Outcomes and Measures Primary outcomes were serum GFAP and NfL levels at 24 hours, and 1, 2, 4, 6, 8, 12, and 26 weeks. Secondary outcomes were symptoms, cognitive performance, and return to training times. Results Eighty-one individuals with SRC (median age, 22.8 [IQR, 21.3-26.0] years; 89% male) and 56 control individuals (median age, 24.6 [IQR, 22.4-27.3] years; 96% male) completed a total of 945 of 1057 eligible testing sessions. Compared with control participants, those with SRC exhibited higher GFAP levels at 24 hours (mean difference [MD] in natural log, pg/mL, 0.66 [95% CI, 0.50-0.82]) and 4 weeks (MD, 0.17 [95% CI, 0.02-0.32]), and NfL from 1 to 12 weeks (1-week MD, 0.31 [95% CI, 0.12-0.51]; 2-week MD, 0.38 [95% CI, 0.19-0.58]; 4-week MD, 0.31 [95% CI, 0.12-0.51]; 6-week MD, 0.27 [95% CI, 0.07-0.47]; 8-week MD, 0.36 [95% CI, 0.15-0.56]; and 12-week MD, 0.25 [95% CI, 0.04-0.46]). Growth mixture modeling identified 2 GFAP subgroups: extreme prolonged (16%) and moderate transient (84%). For NfL, 3 subgroups were identified: extreme prolonged (7%), moderate prolonged (15%), and minimal or no change (78%). Individuals with SRC who reported loss of consciousness (LOC) (33% of SRC cases) had higher GFAP at 24 hours (MD, 1.01 [95% CI, 0.77-1.24]), 1 week (MD, 0.27 [95% CI, 0.06-0.49]), 2 weeks (MD, 0.21 [95% CI, 0.004-0.42]) and 4 weeks (MD, 0.34 [95% CI, 0.13-0.55]), and higher NfL from 1 week to 12 weeks (1-week MD, 0.73 [95% CI, 0.42-1.03]; 2-week MD, 0.91 [95% CI, 0.61-1.21]; 4-week MD, 0.90 [95% CI, 0.59-1.20]; 6-week MD, 0.81 [95% CI, 0.50-1.13]; 8-week MD, 0.73 [95% CI, 0.42-1.04]; and 12-week MD, 0.54 [95% CI, 0.22-0.85]) compared with SRC participants without LOC. Return to training times were longer in the GFAP extreme compared with moderate subgroup (incident rate ratio [IRR], 1.99 [95% CI, 1.69-2.34]; NfL extreme (IRR, 3.24 [95% CI, 2.63-3.97]) and moderate (IRR, 1.43 [95% CI, 1.18-1.72]) subgroups compared with the minimal subgroup, and for individuals with LOC compared with those without LOC (IRR, 1.65 [95% CI, 1.41-1.93]). Conclusions and Relevance In this cohort study, a subset of SRC cases, particularly those with LOC, showed heightened and prolonged increases in GFAP and NfL levels, that persisted for at least 4 weeks. These findings suggest that serial biomarker measurement could identify such cases, guiding return to play decisions based on neurobiologic recovery. While further investigation is warranted, the association between prolonged biomarker elevations and LOC may support the use of more conservative return to play timelines for athletes with this clinical feature.
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Affiliation(s)
- William T. O’Brien
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Gershon Spitz
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Becca Xie
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Brendan P. Major
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Steven Mutimer
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Lauren P. Giesler
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Jesse Bain
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Lauren J. Evans
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | | | - Stefan Piantella
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Afizu Alhassan
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Shelby Brady
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - David Cappellari
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Vincenzo Somma
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Thomas McColl
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Georgia F. Symons
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Tenae Gore
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Matthew Sun
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Timothy Kuek
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Seamus Horan
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Michael Bei
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Jennie L. Ponsford
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Catherine Willmott
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Australian Football League, Melbourne, Victoria, Australia
| | - Jonathan Reyes
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Australian Football League, Melbourne, Victoria, Australia
| | - Nicholas J. Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Institute Clinical Neuroscience Institute, London, United Kingdom
- NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, United Kingdom
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, University College London Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at University College London, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, Hong Kong SAR, China
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison
| | - Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Terence J. O’Brien
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Sandy R. Shultz
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, Victoria, Australia
- Health Sciences, Vancouver Island University, Nanaimo, British Columbia, Canada
| | - Stuart J. McDonald
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, Victoria, Australia
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9
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Bellini ZS, Recht GO, Zuidema TR, Kercher KA, Sweeney SH, Steinfeldt JA, Kawata K. Association of Auditory Interference and Ocular-Motor Response with Subconcussive Head Impacts in Adolescent Football Players. Neurotrauma Rep 2024; 5:512-521. [PMID: 39101152 PMCID: PMC11295109 DOI: 10.1089/neur.2023.0125] [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: 08/06/2024] Open
Abstract
The aim of this study was to examine whether neuro-ophthalmological function, as assessed by the King-Devick test (KDT), alters during a high school football season and to explore the role of auditory interference on the sensitivity of KDT. During the 2021 and 2022 high school football seasons, football players' neuro-ophthalmological function was assessed at five time points (preseason, three in-season, postseason), whereas control athletes were assessed at preseason and postseason. Two-hundred ten football players and 80 control athletes participated in the study. The year 1 cohort (n = 94 football, n = 10 control) was tested with a conventional KDT, whereas the year 2 cohort (n = 116 football, n = 70 control) was tested with KDT while listening to loud traffic sounds to induce auditory interference. There were improvements in KDT during a season among football players, regardless of conventional KDT (preseason 53.4 ± 9.3 vs. postseason 46.4 ± 8.5 sec; β = -1.7, SE = 0.12, p < 0.01) or KDT with auditory interference (preseason 52.3 ± 11.5 vs. postseason 45.1 ± 9.5 sec; β = -1.7, SE = 0.11, p < 0.001). The degree of improvement was similar between the tests, with no significant group-by-time interaction (β = -0.08, SE = 0.17, p = 0.65). The control athletes also improved KDT performance at a similar degree as the football cohorts in both KDT conditions. Our data suggest that KDT performance improves during a season, regardless of auditory interference or head impact exposure. KDT performance was not impacted by a noisy environment, supporting its sideline utility for screening more severe forms of injury.
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Affiliation(s)
- Zachary S. Bellini
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
- Department of Neuroscience, Pomona College, Claremont, California, USA
| | - Grace O. Recht
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - Taylor R. Zuidema
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
- Program in Neuroscience, The College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
| | - Kyle A. Kercher
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - Sage H. Sweeney
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - Jesse A. Steinfeldt
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana, USA
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
- Program in Neuroscience, The College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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10
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Taylor AM, Mannix R, Zafonte RD, Whalen MJ, Meehan WP. A Randomized, Double-Blind, Placebo-Controlled Clinical Trial Evaluating Transcranial Photobiomodulation as Treatment for Concussion. Med Sci Sports Exerc 2024; 56:822-827. [PMID: 38109202 DOI: 10.1249/mss.0000000000003364] [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: 12/20/2023]
Abstract
INTRODUCTION Literature indicating that transcranial photobiomodulation (tPBM) may enable the brain to recover normal function after concussion, resulting in symptoms reduction, and improved cognitive function after concussion is limited by small sample sizes and lack of controls. METHODS We conducted a randomized, double-blind, placebo-controlled trial examining the effect of 6 wk of tPBM in patients 11 yr or older who received care for persistent postconcussion symptoms between September 2012 and December 2015. Our primary outcome measure was the mean difference in Postconcussion Symptom Scale total score and the raw Immediate Postconcussion Assessment and Cognitive Testing composite scores between study entry and treatment completion. Participants received two, 10-min sessions either with tPBM units or via two placebo units, three times per week. We screened for potential confounding variables using univariable analyses. We entered covariables that differed between the two groups on univariable screening into a regression analysis. We considered adjusted odds ratio that did not cross one statistically significant. RESULTS Forty-eight participants completed the study. Most were female (63%), and a majority sustained their injury during sports or exercise (71%). Despite randomization, those that received tPBM therapy reported a greater number of previous concussions. After adjusting for the effect of previous concussions and multiple comparisons, there were no significant differences between tPBM and placebo groups at 3 or 6 wk of treatment. CONCLUSIONS Despite showing promise in previous investigations, our study did not show benefit to tPBM over placebo therapy in patients experiencing persistent postconcussion symptoms. Further investigation is needed to determine if varying the dose or timing alters the efficacy of tPBM after concussion.
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Affiliation(s)
| | | | - Ralph D Zafonte
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA
| | - Michael J Whalen
- Division of Critical Care Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
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11
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Hubbard WB, Velmurugan GV, Sullivan PG. The role of mitochondrial uncoupling in the regulation of mitostasis after traumatic brain injury. Neurochem Int 2024; 174:105680. [PMID: 38311216 PMCID: PMC10922998 DOI: 10.1016/j.neuint.2024.105680] [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: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
Mitostasis, the maintenance of healthy mitochondria, plays a critical role in brain health. The brain's high energy demands and reliance on mitochondria for energy production make mitostasis vital for neuronal function. Traumatic brain injury (TBI) disrupts mitochondrial homeostasis, leading to secondary cellular damage, neuronal degeneration, and cognitive deficits. Mild mitochondrial uncoupling, which dissociates ATP production from oxygen consumption, offers a promising avenue for TBI treatment. Accumulating evidence, from endogenous and exogenous mitochondrial uncoupling, suggests that mitostasis is closely regulating by mitochondrial uncoupling and cellular injury environments may be more sensitive to uncoupling. Mitochondrial uncoupling can mitigate calcium overload, reduce oxidative stress, and induce mitochondrial proteostasis and mitophagy, a process that eliminates damaged mitochondria. The interplay between mitochondrial uncoupling and mitostasis is ripe for further investigation in the context of TBI. These multi-faceted mechanisms of action for mitochondrial uncoupling hold promise for TBI therapy, with the potential to restore mitochondrial health, improve neurological outcomes, and prevent long-term TBI-related pathology.
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Affiliation(s)
- W Brad Hubbard
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY, USA; Department of Physiology, University of Kentucky, Lexington, KY, USA; Lexington Veterans' Affairs Healthcare System, Lexington, KY, USA.
| | - Gopal V Velmurugan
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY, USA; Department of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Patrick G Sullivan
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY, USA; Lexington Veterans' Affairs Healthcare System, Lexington, KY, USA; Department of Neuroscience, University of Kentucky, Lexington, KY, USA.
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12
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Hubbard WB, Vekaria HJ, Velmurugan GV, Kalimon OJ, Prajapati P, Brown E, Geisler JG, Sullivan PG. Mitochondrial Dysfunction After Repeated Mild Blast Traumatic Brain Injury Is Attenuated by a Mild Mitochondrial Uncoupling Prodrug. J Neurotrauma 2023; 40:2396-2409. [PMID: 37476976 PMCID: PMC10653072 DOI: 10.1089/neu.2023.0102] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Mild traumatic brain injury (mTBI) results in impairment of brain metabolism, which is propagated by mitochondrial dysfunction in the brain. Mitochondrial dysfunction has been identified as a pathobiological therapeutic target to quell cellular dyshomeostasis. Further, therapeutic approaches targeting mitochondrial impairments, such as mild mitochondrial uncoupling, have been shown to alleviate behavioral alterations after TBI. To examine how mild mitochondrial uncoupling modulates acute mitochondrial outcomes in a military-relevant model of mTBI, we utilized repeated blast overpressure of 11 psi peak overpressure to model repeated mild blast traumatic brain injury (rmbTBI) in rats followed by assessment of mitochondrial respiration and mitochondrial-related oxidative damage at 2 days post-rmbTBI. Treatment groups were administered 8 or 80 mg/kg MP201, a prodrug of 2,4 dinitrophenol (DNP) that displays improved pharmacokinetics compared with its metabolized form. Synaptic and glia-enriched mitochondria were isolated using fractionated a mitochondrial magnetic separation technique. There was a consistent physiological response, decreased heart rate, following mbTBI among experimental groups. Although there was a lack of injury effect in mitochondrial respiration of glia-enriched mitochondria, there were impairments in mitochondrial respiration in synaptic mitochondria isolated from the prefrontal cortex (PFC) and the amygdala/entorhinal/piriform cortex (AEP) region. Impairments in synaptic mitochondrial respiration were rescued by oral 80 mg/kg MP201 treatment after rmbTBI, which may be facilitated by increases in complex II and complex IV activity. Mitochondrial oxidative damage in glia-enriched mitochondria was increased in the PFC and hippocampus after rmbTBI. MP201 treatment alleviated elevated glia-enriched mitochondrial oxidative damage following rmbTBI. However, there was a lack of injury-associated differences in oxidative damage in synaptic mitochondria. Overall, our report demonstrates that rmbTBI results in mitochondrial impairment diffusely throughout the brain and mild mitochondrial uncoupling can restore mitochondrial bioenergetics and oxidative balance.
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Affiliation(s)
- W. Brad Hubbard
- Lexington Veterans' Affairs Healthcare System, Lexington, Kentucky, USA
- Department of Physiology, University of Kentucky, Lexington, Kentucky, USA
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - Hemendra J. Vekaria
- Lexington Veterans' Affairs Healthcare System, Lexington, Kentucky, USA
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Gopal V. Velmurugan
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - Olivia J. Kalimon
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Paresh Prajapati
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - Emily Brown
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - John G. Geisler
- Mitochon Pharmaceuticals, Inc., Blue Bell, Pennsylvania, USA
| | - Patrick G. Sullivan
- Lexington Veterans' Affairs Healthcare System, Lexington, Kentucky, USA
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Neuroscience, University of Kentucky, Lexington, Kentucky, USA
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13
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Jacotte-Simancas A, Molina PE, Gilpin NW. Repeated Mild Traumatic Brain Injury and JZL184 Produce Sex-Specific Increases in Anxiety-Like Behavior and Alcohol Consumption in Wistar Rats. J Neurotrauma 2023; 40:2427-2441. [PMID: 37503666 PMCID: PMC10649186 DOI: 10.1089/neu.2023.0088] [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: 07/29/2023] Open
Abstract
Alcohol use disorder (AUD) is highly comorbid with traumatic brain injury (TBI). Previously, using a lateral fluid percussion model (LFP) (an open-head injury model) to generate a single mild to moderate traumatic brain injury (TBI) we showed that TBI produces escalation in alcohol drinking, that alcohol exposure negatively impacts TBI outcomes, and that the endocannabinoid degradation inhibitor (JZL184) confers significant protection from behavioral and neuropathological outcomes in male rodents. In the present study, we used a weight drop model (a closed-head injury model) to produce repeated mild TBI (rmTBI; three TBIs separated by 24 hours) in male and female rats to examine the sex-specific effects on anxiety-like behavior and alcohol consumption, and whether systemic treatment with JZL184 would reverse TBI effects on those behaviors. In two separate studies, adult male and female Wistar rats were subjected to rmTBI or sham procedure using the weight drop model. Physiological measures of injury severity were collected from all animals. Animals in both studies were allowed to consume alcohol using an intermittent 2-bottle choice procedure (12 pre-TBI sessions and 12 post-TBI sessions). Neurological severity and neurobehavioral scores (NSS and NBS, respectively) were tested 24 hours after the final injury. Anxiety-like behavior was tested at 37-38 days post-injury in Study 1-, and 6-8-days post-injury in Study 2. Our results show that females exhibited reduced respiratory rates relative to males with no significant differences between Sham and rmTBI, no effect of rmTBI or sex on righting reflex, and increased neurological deficits in rmTBI groups in both studies. In Study 1, rmTBI increased alcohol consumption in female but not male rats. Male rats consistently exhibited higher levels of anxiety-like behavior than females. The rmTBI did not affect anxiety-like behavior 37-38 days post-injury. In Study 2, rmTBI once again increased alcohol consumption in female but not male rats, and repeated systemic treatment with JZL184 did not affect alcohol consumption. Also in Study 2, rmTBI increased anxiety-like behavior in males but not females and repeated systemic treatment with JZL184 produced an unexpected increase in anxiety-like behavior 6-8 days post-injury. In summary, rmTBI increased alcohol consumption in female rats, systemic JZL184 treatment did not alter alcohol consumption, and both rmTBI and systemic JZL184 treatment increased anxiety-like behavior 6-8 days post-injury in males but not females, highlighting robust sex differences in rmTBI effects.
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Affiliation(s)
- Alejandra Jacotte-Simancas
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol and Drug of Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Patricia E. Molina
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol and Drug of Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Nicholas W. Gilpin
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol and Drug of Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Southeast Louisiana VA Healthcare System, New Orleans, Louisiana, USA
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14
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Ferdousi J, Post A, Karton C, Doelle K, Gilchrist MD, Hoshizaki TB. Head trauma analysis of laboratory reconstructed headers using 1966 Slazenger Challenge and 2018 Telstar 18 soccer balls. Sci Rep 2023; 13:18575. [PMID: 37903796 PMCID: PMC10616227 DOI: 10.1038/s41598-023-45489-2] [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: 03/14/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023] Open
Abstract
Retired soccer players are presenting with early onset neurodegenerative diseases, potentially from heading the ball. It has been proposed that the older composition of soccer balls places higher strains on brain tissues. The purpose of this research was to compare the dynamic head response and brain tissue strain of laboratory reconstructed headers using replicas of the 1966 Slazenger Challenge and 2018 Telstar 18 World Cup soccer balls. Head-to-ball impacts were physically conducted in the laboratory by impacting a Hybrid III head form at three locations and four velocities using dry and wet soccer ball conditions, and computational simulation was used to measure the resulting brain tissue strain. This research showed that few significant differences were found in head dynamic response and maximum principal strain between the dry 1966 and 2018 balls during reconstructed soccer headers. Headers using the wet 1966 soccer ball resulted in higher head form responses at low-velocity headers and lower head responses as velocities increased. This study demonstrates that under dry conditions, soccer ball construction does not have a significant effect on head and brain response during headers reconstructed in the laboratory. Although ball construction didn't show a notable effect, this study revealed that heading the ball, comparable to goalkeeper kicks and punts at 22 m/s, led to maximum principal strains exceeding the 50% likelihood of injury risk threshold. This has implications for the potential risks associated with repetitive heading in soccer for current athletes.
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Affiliation(s)
| | - Andrew Post
- Health Sciences, University of Ottawa, Ottawa, K1N 6N5, Canada
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - Clara Karton
- Health Sciences, University of Ottawa, Ottawa, K1N 6N5, Canada.
| | - Klara Doelle
- Health Sciences, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Michael D Gilchrist
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
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15
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Savitz J, Goeckner BD, Ford BN, Kent Teague T, Zheng H, Harezlak J, Mannix R, Tugan Muftuler L, Brett BL, McCrea MA, Meier TB. The effects of cytomegalovirus on brain structure following sport-related concussion. Brain 2023; 146:4262-4273. [PMID: 37070698 PMCID: PMC10545519 DOI: 10.1093/brain/awad126] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 04/19/2023] Open
Abstract
The neurotrophic herpes virus cytomegalovirus is a known cause of neuropathology in utero and in immunocompromised populations. Cytomegalovirus is reactivated by stress and inflammation, possibly explaining the emerging evidence linking it to subtle brain changes in the context of more minor disturbances of immune function. Even mild forms of traumatic brain injury, including sport-related concussion, are major physiological stressors that produce neuroinflammation. In theory, concussion could predispose to the reactivation of cytomegalovirus and amplify the effects of physical injury on brain structure. However, to our knowledge this hypothesis remains untested. This study evaluated the effect of cytomegalovirus serostatus on white and grey matter structure in a prospective study of athletes with concussion and matched contact-sport controls. Athletes who sustained concussion (n = 88) completed MRI at 1, 8, 15 and 45 days post-injury; matched uninjured athletes (n = 73) completed similar visits. Cytomegalovirus serostatus was determined by measuring serum IgG antibodies (n = 30 concussed athletes and n = 21 controls were seropositive). Inverse probability of treatment weighting was used to adjust for confounding factors between athletes with and without cytomegalovirus. White matter microstructure was assessed using diffusion kurtosis imaging metrics in regions previously shown to be sensitive to concussion. T1-weighted images were used to quantify mean cortical thickness and total surface area. Concussion-related symptoms, psychological distress, and serum concentration of C-reactive protein at 1 day post-injury were included as exploratory outcomes. Planned contrasts compared the effects of cytomegalovirus seropositivity in athletes with concussion and controls, separately. There was a significant effect of cytomegalovirus on axial and radial kurtosis in athletes with concussion but not controls. Cytomegalovirus positive athletes with concussion showed greater axial (P = 0.007, d = 0.44) and radial (P = 0.010, d = 0.41) kurtosis than cytomegalovirus negative athletes with concussion. Similarly, there was a significant association of cytomegalovirus with cortical thickness in athletes with concussion but not controls. Cytomegalovirus positive athletes with concussion had reduced mean cortical thickness of the right hemisphere (P = 0.009, d = 0.42) compared with cytomegalovirus negative athletes with concussion and showed a similar trend for the left hemisphere (P = 0.036, d = 0.33). There was no significant effect of cytomegalovirus on kurtosis fractional anisotropy, surface area, symptoms and C-reactive protein. The results raise the possibility that cytomegalovirus infection contributes to structural brain abnormalities in the aftermath of concussion perhaps via an amplification of concussion-associated neuroinflammation. More work is needed to identify the biological pathways underlying this process and to clarify the clinical relevance of this putative viral effect.
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Affiliation(s)
- Jonathan Savitz
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK 74119, USA
| | - Bryna D Goeckner
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Bart N Ford
- Department of Pharmacology and Physiology, Oklahoma State University Center for Health Sciences, Tulsa, OK 74107, USA
| | - T Kent Teague
- Department of Psychiatry, The University of Oklahoma School of Community Medicine, Tulsa, OK 74135, USA
- Department of Surgery, The University of Oklahoma School of Community Medicine, Tulsa, OK 74135, USA
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, Tulsa, OK 74135, USA
| | - Haixia Zheng
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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16
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Juan SMA, Daglas M, Truong PH, Mawal C, Adlard PA. Alterations in iron content, iron-regulatory proteins and behaviour without tau pathology at one year following repetitive mild traumatic brain injury. Acta Neuropathol Commun 2023; 11:118. [PMID: 37464280 PMCID: PMC10353227 DOI: 10.1186/s40478-023-01603-z] [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: 02/15/2023] [Accepted: 06/12/2023] [Indexed: 07/20/2023] Open
Abstract
Repetitive mild traumatic brain injury (r-mTBI) has increasingly become recognised as a risk factor for the development of neurodegenerative diseases, many of which are characterised by tau pathology, metal dyshomeostasis and behavioural impairments. We aimed to characterise the status of tau and the involvement of iron dyshomeostasis in repetitive controlled cortical impact injury (5 impacts, 48 h apart) in 3-month-old C57Bl6 mice at the chronic (12-month) time point. We performed a battery of behavioural tests, characterised the status of neurodegeneration-associated proteins (tau and tau-regulatory proteins, amyloid precursor protein and iron-regulatory proteins) via western blot; and metal levels using bulk inductively coupled plasma-mass spectrometry (ICP-MS). We report significant changes in various ipsilateral iron-regulatory proteins following five but not a single injury, and significant increases in contralateral iron, zinc and copper levels following five impacts. There was no evidence of tau pathology or changes in tau-regulatory proteins following five impacts, although some changes were observed following a single injury. Five impacts resulted in significant gait deficits, mild anhedonia and mild cognitive deficits at 9-12 months post-injury, effects not seen following a single injury. To the best of our knowledge, we are the first to describe chronic changes in metals and iron-regulatory proteins in a mouse model of r-mTBI, providing a strong indication towards an overall increase in brain iron levels (and other metals) in the chronic phase following r-mTBI. These results bring to question the relevance of tau and highlight the involvement of iron dysregulation in the development and/or progression of neurodegeneration following injury, which may lead to new therapeutic approaches in the future.
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Affiliation(s)
- Sydney M A Juan
- Synaptic Neurobiology Laboratory, The Florey Institute of Neuroscience and Mental Health, The Melbourne Dementia Research Centre, The University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia
| | - Maria Daglas
- Synaptic Neurobiology Laboratory, The Florey Institute of Neuroscience and Mental Health, The Melbourne Dementia Research Centre, The University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia
| | - Phan H Truong
- Synaptic Neurobiology Laboratory, The Florey Institute of Neuroscience and Mental Health, The Melbourne Dementia Research Centre, The University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia
| | - Celeste Mawal
- Synaptic Neurobiology Laboratory, The Florey Institute of Neuroscience and Mental Health, The Melbourne Dementia Research Centre, The University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia
| | - Paul A Adlard
- Synaptic Neurobiology Laboratory, The Florey Institute of Neuroscience and Mental Health, The Melbourne Dementia Research Centre, The University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia.
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17
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Naumenko Y, Yuryshinetz I, Zabenko Y, Pivneva T. Mild traumatic brain injury as a pathological process. Heliyon 2023; 9:e18342. [PMID: 37519712 PMCID: PMC10372741 DOI: 10.1016/j.heliyon.2023.e18342] [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: 11/22/2022] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
Traumatic brain injury (TBI) is defined as dysfunction or other evidence of brain pathology caused by external physical force. More than 69 million new cases of TBI are registered worldwide each year, 80% of them - mild TBI. Based on the physical mechanism of induced trauma, we can separate its pathophysiology into primary and secondary injuries. Many literature sources have confirmed that mechanically induced brain injury initiates ionic, metabolic, inflammatory, and neurovascular changes in the CNS, which can lead to acute, subacute, and chronic neurological consequences. Despite the global nature of the disease, its high heterogeneity, lack of a unified classification system, rapid fluctuation of epidemiological trends, and variability of long-term consequences significantly complicate research and the development of new therapeutic strategies. In this review paper, we systematize current knowledge of biomechanical and molecular mechanisms of mild TBI and provide general information on the classification and epidemiology of this complex disorder.
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Affiliation(s)
- Yana Naumenko
- Bogomoletz Institute of Physiology, Department of Sensory Signalization, Kyiv, Ukraine
| | - Irada Yuryshinetz
- Bogomoletz Institute of Physiology, Department of Sensory Signalization, Kyiv, Ukraine
| | - Yelyzaveta Zabenko
- Bogomoletz Institute of Physiology, Department of Sensory Signalization, Kyiv, Ukraine
| | - Tetyana Pivneva
- Bogomoletz Institute of Physiology, Department of Sensory Signalization, Kyiv, Ukraine
- Kyiv Academic University, Kyiv, Ukraine
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18
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Jacotte-Simancas A, Molina P, Gilpin N. JZL184 increases anxiety-like behavior and does not reduce alcohol consumption in female rats after repeated mild traumatic brain injury. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.30.542943. [PMID: 37398130 PMCID: PMC10312513 DOI: 10.1101/2023.05.30.542943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Alcohol use disorder (AUD) is highly comorbid with traumatic brain injury (TBI). Previously, using a lateral fluid percussion model (LFP) (an open model of head injury) to generate a single mild to moderate traumatic brain injury (TBI), we showed that TBI produces escalation in alcohol drinking, that alcohol exposure negatively impacts TBI outcomes, and that the endocannabinoid degradation inhibitor (JZL184) confers significant protection from behavioral and neuropathological outcomes in male rodents. In the present study, we used a weight drop model (a closed model of head injury) to produce a repeated mild TBI (rmTBI, 3 TBIs, spaced by 24 hours) to examine the sex-specific effects on alcohol consumption and anxiety-like behavior in rats, and whether systemic treatment with JZL184 would reverse TBI effects on those behaviors in both sexes. In two separate studies, adult male and female Wistar rats were subjected to rmTBI or sham using the weight drop model. Physiological measures of injury severity were collected from all animals. Animals in both studies were allowed to consume alcohol using an intermittent 2-bottle choice procedure (12 pre-TBI sessions and 12 post-TBI sessions). Neurological severity and neurobehavioral scores (NSS and NBS, respectively) were tested 24 hours after the final injury. Anxiety-like behavior was tested at 37-38 days post-injury in Study 1, and 6-8 days post-injury in Study 2. Our results show that females exhibited reduced respiratory rates relative to males with no significant differences between Sham and rmTBI, no effect of rmTBI or sex on righting reflex, and increased neurological deficits in rmTBI groups in both studies. In Study 1, rmTBI increased alcohol consumption in female but not male rats. Male rats consistently exhibited higher levels of anxiety-like behavior than females. rmTBI did not affect anxiety-like behavior 37-38 days post-injury. In Study 2, rmTBI once again increased alcohol consumption in female but not male rats, and repeated systemic treatment with JZL184 did not affect alcohol consumption. Also in Study 2, rmTBI increased anxiety-like behavior in males but not females and repeated systemic treatment with JZL184 produced an unexpected increase in anxiety-like behavior 6-8 days post-injury. In summary, rmTBI increased alcohol consumption in female rats, systemic JZL184 treatment did not alter alcohol consumption, and both rmTBI and sub-chronic systemic JZL184 treatment increased anxiety-like behavior 6-8 days post-injury in males but not females, highlighting robust sex differences in rmTBI effects.
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Affiliation(s)
- Alejandra Jacotte-Simancas
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA
- Alcohol and Drug of Abuse Center of Excellence, LSUHSC, New Orleans, LA
| | - Patricia Molina
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA
- Alcohol and Drug of Abuse Center of Excellence, LSUHSC, New Orleans, LA
| | - Nicholas Gilpin
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA
- Alcohol and Drug of Abuse Center of Excellence, LSUHSC, New Orleans, LA
- Southeast Louisiana VA Healthcare System, New Orleans, LA
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19
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Ware JB, Sandsmark DK. Imaging Approach to Concussion. Neuroimaging Clin N Am 2023; 33:261-269. [PMID: 36965944 DOI: 10.1016/j.nic.2023.01.002] [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: 02/20/2023]
Abstract
The acute and long-term neurobiological sequelae of concussion (mild traumatic brain injury [mTBI]) and sub-concussive head trauma have become increasingly apparent in recent decades in part due to neuroimaging research. Although imaging has an established role in the clinical management of mTBI for the identification of intracranial lesions warranting urgent interventions, MR imaging is increasingly employed for the detection of post-traumatic sequelae which carry important prognostic significance. As neuroimaging research continues to elucidate the pathophysiology of TBI underlying prolonged recovery and the development of persistent post-concussive symptoms, there is a strong motivation to translate these techniques into clinical use for improved diagnosis and therapeutic monitoring.
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Affiliation(s)
- Jeffrey B Ware
- Department of Radiology, Neuroradiology Division, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Danielle K Sandsmark
- Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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20
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White MR, VandeVord PJ. Regional variances depict a unique glial-specific inflammatory response following closed-head injury. Front Cell Neurosci 2023; 17:1076851. [PMID: 36909284 PMCID: PMC9996631 DOI: 10.3389/fncel.2023.1076851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023] Open
Abstract
Mild traumatic brain injuries (mTBI) constitute a significant health concern with clinical symptoms ranging from headaches to cognitive deficits. Despite the myriad of symptoms commonly reported following this injury, there is still a lack of knowledge on the various pathophysiological changes that occur. Preclinical studies are at the forefront of discovery delineating the changes that occur within this heterogeneous injury, with the emergence of translational models such as closed-head impact models allowing for further exploration of this injury mechanism. In the current study, male rats were subjected to a closed-head controlled cortical impact (cCCI), producing a concussion (mTBI). The pathological effects of this injury were then evaluated using immunoflourescence seven days following. The results exhibited a unique glial-specific inflammatory response, with both the ipsilateral and contralateral sides of the cortex and hippocampus showing pathological changes following impact. Overall these findings are consistent with glial changes reported following concussions and may contribute to subsequent symptoms.
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Affiliation(s)
- Michelle R. White
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States
| | - Pamela J. VandeVord
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States
- Salem VA Medical Center, Salem, VA, United States
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21
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Wilson RJ, Bell MR, Giordano KR, Seyburn S, Kozlowski DA. Repeat subconcussion in the adult rat gives rise to behavioral deficits similar to a single concussion but different depending upon sex. Behav Brain Res 2023; 438:114206. [PMID: 36356721 DOI: 10.1016/j.bbr.2022.114206] [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: 06/22/2022] [Revised: 10/20/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
Although concussions are a popular focus of neurotrauma research, subconcussions occur with higher frequency but are less well-studied. A subconcussion is an impact to the head that does not result in immediately diagnosable concussion but can result in later neurological consequences. Repeat subconcussions can produce behavioral impairments and neuropathology that is similar to or worse than those seen following a single concussion. The current study modified a previously established closed head injury model of concussion to create a subconcussion model and examines sex differences in behavioral responses to repeated subconcussion in the adult rat. Rats received a single concussion, single or repeat subconcussions, or no impact and behavior was monitored from 2 h through 31 days post-injury. A single concussion or repeat subconcussion resulted in deficits in locomotion, righting reflexes, and recognition memory. The degree of deficit induced by repeat subconcussions were either similar (righting reflexes) or greater/more persistent (locomotor deficits and recognition memory) than that of a concussion. Single subconcussion resulted in acute deficits that were mild and limited to righting reflexes and locomotion. Sex differences were observed in responses to repeat subconcussion: females showed greater deficits in righting reflexes, locomotion, and vestibular function, while males showed greater alterations in anxiety and depressive-like behavior. This study established a model of subconcussive impact where a single subconcussive impact resulted in minimal behavioral deficits but repeat subconcussions resulted in deficits similar to or worse than a single concussion. Our data also suggest sex differences in behavioral responses to both concussive and subconcussive impacts.
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Affiliation(s)
- Rebecca J Wilson
- Department of Biological Sciences, DePaul University, 2325 N. Clifton, Chicago, IL, USA.
| | - Margaret R Bell
- Department of Biological Sciences, DePaul University, 2325 N. Clifton, Chicago, IL, USA; Department of Health Sciences, DePaul University, 1110 W. Belden, Chicago, IL, USA.
| | - Katherine R Giordano
- Department of Biological Sciences, DePaul University, 2325 N. Clifton, Chicago, IL, USA.
| | - Serena Seyburn
- Department of Biological Sciences, DePaul University, 2325 N. Clifton, Chicago, IL, USA.
| | - Dorothy A Kozlowski
- Department of Biological Sciences, DePaul University, 2325 N. Clifton, Chicago, IL, USA; Neuroscience Program, DePaul University, 2325 N. Clifton, Chicago, IL, USA.
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22
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Gharahi H, Garimella HT, Chen ZJ, Gupta RK, Przekwas A. Mathematical model of mechanobiology of acute and repeated synaptic injury and systemic biomarker kinetics. Front Cell Neurosci 2023; 17:1007062. [PMID: 36814869 PMCID: PMC9939777 DOI: 10.3389/fncel.2023.1007062] [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: 07/29/2022] [Accepted: 01/10/2023] [Indexed: 02/09/2023] Open
Abstract
Background Blast induced Traumatic Brain Injury (bTBI) has become a signature casualty of military operations. Recently, military medics observed neurocognitive deficits in servicemen exposed to repeated low level blast (LLB) waves during military heavy weapons training. In spite of significant clinical and preclinical TBI research, current understanding of injury mechanisms and short- and long-term outcomes is limited. Mathematical models of bTBI biomechanics and mechanobiology of sensitive neuro-structures such as synapses may help in better understanding of injury mechanisms and in the development of improved diagnostics and neuroprotective strategies. Methods and results In this work, we formulated a model of a single synaptic structure integrating the dynamics of the synaptic cell adhesion molecules (CAMs) with the deformation mechanics of the synaptic cleft. The model can resolve time scales ranging from milliseconds during the hyperacute phase of mechanical loading to minutes-hours acute/chronic phase of injury progression/repair. The model was used to simulate the synaptic injury responses caused by repeated blast loads. Conclusion Our simulations demonstrated the importance of the number of exposures compared to the duration of recovery period between repeated loads on the synaptic injury responses. The paper recognizes current limitations of the model and identifies potential improvements.
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Affiliation(s)
- Hamidreza Gharahi
- Biomedical and Data Sciences Division, CFD Research Corporation, Huntsville, AL, United States,Hamidreza Gharahi,
| | - Harsha T. Garimella
- Biomedical and Data Sciences Division, CFD Research Corporation, Huntsville, AL, United States
| | - Zhijian J. Chen
- Biomedical and Data Sciences Division, CFD Research Corporation, Huntsville, AL, United States
| | - Raj K. Gupta
- Department of Defense Blast Injury Research Program Coordinating Office, U.S. Army Medical Research and Development Command, Fort Detrick, MD, United States
| | - Andrzej Przekwas
- Biomedical and Data Sciences Division, CFD Research Corporation, Huntsville, AL, United States,*Correspondence: Andrzej Przekwas,
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23
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Kumari M, Arora P, Sharma P, Hasija Y, Rana P, D'souza MM, Chandra N, Trivedi R. Acute metabolic alterations in the hippocampus are associated with decreased acetylation after blast induced TBI. Metabolomics 2023; 19:5. [PMID: 36635559 DOI: 10.1007/s11306-022-01970-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/21/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Blast induced Traumatic brain injury (BI-TBI) is common among military personnels as well as war affected civilians. In the war zone, people can also encounter repeated exposure of blast wave, which may affect their cognition and metabolic alterations. OBJECTIVE In this study we assess the metabolic and histological changes in the hippocampus of rats at 24 h post injury. METHOD Rats were divided into four groups: (i) Sham; (ii) Mild TBI (mi); (iii) Moderate TBI (mo); and (iv) Repetitive mild TBI (rm TBI) and then subjected to different intensities of blast exposure. Hippocampal tissues were collected after 24 h of injury for proton nuclear magnetic resonance spectroscopy (1H NMR spectroscopy) and immunohistochemical (IHC) analysis. RESULTS The metabolic alterations were found in the hippocampal tissue samples and these alterations showed significant change in glutamate, N-Acetylaspartic acid (NAA), acetate, creatine, phosphoethanolamine (PE), ethanolamine and PC/choline concentrations in rmTBI rats only. IHC studies revealed that AH3 (Acetyl histone) positive cells were decreased in rm TBI tissue samples in comparison to other TBI groups and sham rats. This might reflect an epigenetic alteration due to repeated blast exposure at 24 h post injury. Additionally, astrogliosis was observed in miTBI and moTBI hippocampal tissue while no change was observed in rmTBI tissues. CONCLUSION The present study reports altered acetylation in the presence of altered metabolism in hippocampal tissue of blast induced rmTBI at 24 h post injury. Mechanistic understanding of these intertwined processes may help in the development of better therapeutic pathways and agents for blast induced TBI in near future.
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Affiliation(s)
- Megha Kumari
- Radiological, Nuclear and Imaging Sciences (RNAIS), Institute of Nuclear Medicine and Allied Science (INMAS), DRDO, Delhi, India
- Department of Biotechnology, Delhi Technological University, Delhi, 110042, India
| | - Palkin Arora
- Radiological, Nuclear and Imaging Sciences (RNAIS), Institute of Nuclear Medicine and Allied Science (INMAS), DRDO, Delhi, India
- Department of Biochemistry, Panjab University, Chandigarh, 160014, India
| | - Priyanka Sharma
- Radiological, Nuclear and Imaging Sciences (RNAIS), Institute of Nuclear Medicine and Allied Science (INMAS), DRDO, Delhi, India
| | - Yasha Hasija
- Department of Biotechnology, Delhi Technological University, Delhi, 110042, India
| | - Poonam Rana
- Radiological, Nuclear and Imaging Sciences (RNAIS), Institute of Nuclear Medicine and Allied Science (INMAS), DRDO, Delhi, India
| | - Maria M D'souza
- Radiological, Nuclear and Imaging Sciences (RNAIS), Institute of Nuclear Medicine and Allied Science (INMAS), DRDO, Delhi, India
| | - Namas Chandra
- Center for Injury Biomechanics, New Jersey Institute of Technology, 323 Dr Martin Luther King Jr Blvd, Newark, NJ, 07102, USA
| | - Richa Trivedi
- Radiological, Nuclear and Imaging Sciences (RNAIS), Institute of Nuclear Medicine and Allied Science (INMAS), DRDO, Delhi, India.
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Cross-Cultural Adaptation of the Urdu Version of Rosenbaum Concussion Knowledge and Attitude Survey—Student Version in Pakistan. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2023. [DOI: 10.1123/jcsp.2022-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Evaluating athletes’ knowledge of and attitudes toward sports-related concussions is important. However, there is limited research involving South Asian athletes, partly due to the lack of a valid and reliable tool. This study, therefore, aimed to translate and validate the Rosenbaum Concussion Knowledge and Attitude Survey—Student Version, an established tool used to measure knowledge and attitude toward concussion, into Urdu. Rosenbaum Concussion Knowledge and Attitude Survey—Student Version was translated into Urdu using the standard guidelines and then completed by 369 athletes participating in contact sports at different universities in Pakistan. Confirmatory factor analysis was performed on the Concussion Attitude Index items to examine the underlying factorial structure. Construct validity of Concussion Attitude Index factors was also investigated using convergent and discriminant validity. The results showed that the Urdu version of the Rosenbaum Concussion Knowledge and Attitude Survey—Student Version has good psychometric properties and is a valid and reliable tool for evaluating Urdu-speaking athletes’ knowledge of and attitudes toward concussions.
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25
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Abstract
OBJECTIVES The aims of the study were to assess prevalence and management of head impacts in stunt performers and to evaluate performers' quality of life and ability to work after head injury. METHODS Stunt performers completed an online survey about head impacts/head whips history, diagnosed concussions, reasons for not reporting injuries, health care sought after head impacts, attitudes toward on-set concussion management, perceived ability to work as a stunt performer, and health-related quality of life. RESULTS One hundred seventy-three performers (80%) indicated at least one head impact/head whip during their stunt career. Of these, 86% exhibited concussion-like symptoms and 38% received one or more concussion diagnoses. Sixty-five percent continued working with concussion-like symptoms. Short Form-12 mental component scores were suggestive of depression in 42%. CONCLUSIONS Concussion seems to be a serious occupational health issue in stunt performers. We suggest that concussion management, risk reduction, and education should be addressed in this community.
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26
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O'Brien WT, Wright DK, van Emmerik ALJJ, Bain J, Brkljaca R, Christensen J, Yamakawa GR, Chen Z, Giesler LP, Sun M, O'Brien TJ, Monif M, Shultz SR, McDonald SJ. Serum neurofilament light as a biomarker of vulnerability to a second mild traumatic brain injury. Transl Res 2022; 255:77-84. [PMID: 36402367 DOI: 10.1016/j.trsl.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022]
Abstract
A second mild traumatic brain injury (mTBI) sustained prior to neuropathological recovery can lead to exacerbated effects. Without objective indicators of this neuropathology, individuals may return to activities at risk of mTBI when their brain is still vulnerable. With axonal injury recognized as a neuropathological hallmark of mTBI, we hypothesized that serum levels of neurofilament light (NfL), a highly sensitive biomarker of axonal injury, may be predictive of vulnerability to worse outcomes in the event of a second mTBI. Given this hypothesis is difficult to test clinically, we used a two-hit model of mTBI in rats and staggered inter-injury intervals by 1-, 3-, 7-, or 14-days. Repeat-mTBI rats were dichotomized into NfLhigh (NfL>median at the time of re-injury) and NfLlow (NfL<median) groups, with behavior and NfL levels analyzed throughout the 28-days, followed by ex vivo diffusion tensor imaging. NfL levels at the time of the second mTBI were found to be predictive of vulnerability to re-injury, with NfLhigh rats displaying more neurological signs and a greater potentiation of NfL levels after the second mTBI. Importantly, this potentiation phenomenon remained even when limiting analyses to rats with longer inter-injury intervals, providing evidence that vulnerability to re-injury may not be exclusively dependent on inter-injury interval. Finally, NfL levels correlated with, and were predictive of, the severity of neurological signs following the second mTBI. These findings provide evidence that measurement of NfL during mTBI recovery may be reflective of the vulnerability to a second mTBI, and as such may have utility to assist return to sport, duty and work decisions.
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Affiliation(s)
- William T O'Brien
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia
| | - David K Wright
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia
| | | | - Jesse Bain
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia
| | | | | | - Glenn R Yamakawa
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia
| | - Zhibin Chen
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia
| | - Lauren P Giesler
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia; Department of Neurology, Alfred Health, Melbourne, 3004, Australia
| | - Mastura Monif
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia; Department of Neurology, Alfred Health, Melbourne, 3004, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia; Department of Neurology, Alfred Health, Melbourne, 3004, Australia; Health and Human Services, Vancouver Island University, Nanaimo, V9R 5S5, Canada
| | - Stuart J McDonald
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia; Department of Neurology, Alfred Health, Melbourne, 3004, Australia.
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27
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Fronczak KM, Roberts A, Svirsky S, Parry M, Holets E, Henchir J, Dixon CE, Carlson SW. Assessment of behavioral, neuroinflammatory, and histological responses in a model of rat repetitive mild fluid percussion injury at 2 weeks post-injury. Front Neurol 2022; 13:945735. [PMID: 36341117 PMCID: PMC9630846 DOI: 10.3389/fneur.2022.945735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Repetitive mild traumatic brain injury (rmTBI) is a prominent public health concern, with linkage to debilitating chronic sequelae. Developing reliable and well-characterized preclinical models of rmTBI is imperative in the investigation of the underlying pathophysiological mechanisms, as models can have varying parameters, affecting the overall pathology of the resulting injury. The lateral fluid percussion injury (FPI) model is a reliable and frequently used method of TBI replication in rodent subjects, though it is currently relatively underutilized in rmTBI research. In this study, we have performed a novel description of a variation of the lateral repetitive mild FPI (rmFPI) model, showing the graded acute behavioral impairment and histopathology occurring in response to one, two or four mild FPI (1.25 atm) or sham surgeries, implemented 24h apart. Beam walking performance revealed significant motor impairment in injured animals, with dysfunction increasing with additional injury. Based upon behavioral responses and histological observations, we further investigated the subacute pathophysiological outcomes of the dual FPI (dFPI). Immunoreactivity assessments showed that dFPI led to regionally-specific reductions in the post-synaptic protein neurogranin and increased subcortical white matter staining of the presynaptic protein synaptophysin at 2 weeks following dFPI. Immunohistochemical assessments of the microglial marker Iba-1 showed a striking increase in in several brain regions, and assessment of the astrocytic marker GFAP showed significantly increased immunoreactivity in the subcortical white matter and thalamus. With this study, we have provided a novel account of the subacute post injury outcomes occurring in response to a rmFPI utilizing these injury and frequency parameters, and thereby also demonstrating the reliability of the lateral FPI model in rmTBI replication.
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Affiliation(s)
| | - Andrea Roberts
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sarah Svirsky
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Madison Parry
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Erik Holets
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jeremy Henchir
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - C. Edward Dixon
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
- VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Shaun W. Carlson
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
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Toman E, Hodgson S, Riley M, Welbury R, Di Pietro V, Belli A. Concussion in the UK: a contemporary narrative review. Trauma Surg Acute Care Open 2022; 7:e000929. [PMID: 36274785 PMCID: PMC9582316 DOI: 10.1136/tsaco-2022-000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/03/2022] [Indexed: 11/18/2022] Open
Abstract
Concussion has been receiving an increasing amount of media exposure following several high-profile professional sports controversies and multimillion-dollar lawsuits. The potential life-changing sequalae of concussion and the rare, but devasting, second impact syndrome have also gained much attention. Despite this, our knowledge of the pathological processes involved is limited and often extrapolated from research into more severe brain injuries. As there is no objective diagnostic test for concussion. Relying on history and examination only, the diagnosis of concussion has become the rate-limiting step in widening research into the disease. Clinical study protocols therefore frequently exclude the most vulnerable groups of patients such as those with existing cognitive impairment, concurrent intoxication, mental health issues or learning difficulties. This up-to-date narrative review aims to summarize our current concussion knowledge and provides an insight into promising avenues for future research.
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Affiliation(s)
- Emma Toman
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK,Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sam Hodgson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Max Riley
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Richard Welbury
- School of Dentistry, University of Central Lancashire, Preston, UK
| | - Valentina Di Pietro
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK,NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Antonio Belli
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK,Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK,NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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McLarnon M, Boyce SH, Fisher N, Heron N. 'It's All Downhill from Here': A Scoping Review of Sports-Related Concussion (SRC) Protocols in Downhill Mountain Biking (DHI), with Recommendations for SRC Policy in Professional DMB. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12281. [PMID: 36231582 PMCID: PMC9566347 DOI: 10.3390/ijerph191912281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Downhill mountain biking (DHI) is a form of cycling and does not currently have a specific sports-related concussion (SRC) assessment. OBJECTIVE To review the extent, range and nature of research investigating SRC in DMB, provide a summary of key literature findings relating to its identification and management, and then develop a SRC protocol specific to DMB. DESIGN Scoping review as per recognised methods. SETTING Literature-based. The following databases were searched: MEDLINE, EMBASE, Scopus and Web of Science, with no restrictions on date. Results were limited to the English language. PARTICIPANTS Six articles were included in the review from 64 identified articles. The article had to specifically include an analysis of adult downhill riders for inclusion. OUTCOME MEASURES Study type, study group (amateur/professional), concussion incidence, concussion assessment and recommendations. MAIN RESULTS Concussion incidence was identified as between 5-23%. No study outlined a trackside assessment of cyclists or a protocol for return to play where SRC was identified. Several authors identified that riders often continued to participate despite the presence of a concussion. No sport-specific SRC assessment was determined for DHI, and a SRC assessment was therefore developed. CONCLUSIONS This review illustrates the lack of studies and formal protocol in SRC assessment for DHI. In light of this, we propose a three-stage framework specific to the sport to best identify a concussion and act where appropriate while minimising disruption to competition. This framework involves assessing the cyclist on the 'sideline', a second assessment post-event in the medical room and a third assessment the following day. A SRC consensus meeting specific for DHI is suggested with an identified need for updated guidance from UCI, requiring possible rule changes for the sport.
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Affiliation(s)
| | - Stephen H. Boyce
- Emergency Department, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
- Scottish Institute of Sport, Stirling FK9 5PH, UK
| | - Neil Fisher
- UK Athletics, Birmingham B42 2BE, UK
- British Cycling, Manchester M11 4DQ, UK
| | - Neil Heron
- British Cycling, Manchester M11 4DQ, UK
- Centre for Public Health Research, Queen’s University, Belfast BT7 1NN, UK
- Department of General Practice, Keele University, Newcastle ST5 5BG, UK
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30
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Defining Experimental Variability in Actuator-Driven Closed Head Impact in Rats. Ann Biomed Eng 2022; 50:1187-1202. [PMID: 35994166 DOI: 10.1007/s10439-022-03012-0] [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: 05/27/2022] [Accepted: 07/04/2022] [Indexed: 11/01/2022]
Abstract
Traumatic brain injury (TBI) is a world-wide health challenge that lacks tools for diagnosis and treatment. There is a need for translational preclinical models to effectively design clinical tools, however, the diversity of models is a barrier to reproducible studies. Actuator-driven closed head impact (AD-CHI) models have translational advantages in replicating the pathophysiological and behavioral outcomes resulting from impact TBI. The main advantages of AD-CHI protocols include versatility of impact parameters such as impact angle, velocity, depth, and dwell time with the ability to interchange tip types, leading to consistent outcomes without the need for craniectomy. Sources of experimental variability within AD-CHI rat models are identified within this review with the aim of supporting further characterization to improve translational value. Primary areas of variability may be attributed to lack of standardization of head stabilization methods, reporting of tip properties, and performance of acute neurological assessments. AD-CHI models were also found to be more prevalently used among pediatric and repeated TBI paradigms. As this model continues to grow in use, establishing the relationships between impact parameters and associated injury outcomes will reduce experimental variability between research groups and encourage meaningful discussions as the community moves towards common data elements.
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Seifert J, Shah AS, Harezlak J, Rowson S, Mihalik JP, Riggen L, Duma S, Brooks A, Cameron KL, Giza CC, Goldman J, Guskiewicz KM, Houston MN, Jackson JC, McGinty G, Pasquina P, Broglio SP, McAllister TW, McCrea MA, Stemper BD. Time Delta Head Impact Frequency: An Analysis on Head Impact Exposure in the Lead Up to a Concussion: Findings from the NCAA-DOD Care Consortium. Ann Biomed Eng 2022; 50:1473-1487. [PMID: 35933459 PMCID: PMC9652163 DOI: 10.1007/s10439-022-03032-w] [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: 10/20/2021] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
Sport-related concussions can result from a single high magnitude impact that generates concussive symptoms, repeated subconcussive head impacts aggregating to generate concussive symptoms, or a combined effect from the two mechanisms. The array of symptoms produced by these mechanisms may be clinically interpreted as a sport-related concussion. It was hypothesized that head impact exposure resulting in concussion is influenced by severity, total number, and frequency of subconcussive head impacts. The influence of total number and magnitude of impacts was previously explored, but frequency was investigated to a lesser degree. In this analysis, head impact frequency was investigated over a new metric called ‘time delta’, the time difference from the first recorded head impact of the day until the concussive impact. Four exposure metrics were analyzed over the time delta to determine whether frequency of head impact exposure was greater for athletes on their concussion date relative to other dates of contact participation. Those metrics included head impact frequency, head impact accrual rate, risk weighted exposure (RWE), and RWE accrual rate. Athletes experienced an elevated median number of impacts, RWE, and RWE accrual rate over the time delta on their concussion date compared to non-injury sessions. This finding suggests elevated frequency of head impact exposure on the concussion date compared to other dates that may precipitate the onset of concussion.
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Affiliation(s)
- Jack Seifert
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA.,Neuroscience Research Labs, Clement J. Zablocki Veterans Affairs Medical Center, Research 151, 5000 W. National Ave., Milwaukee, WI, 53295, USA
| | - Alok S Shah
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.,Neuroscience Research Labs, Clement J. Zablocki Veterans Affairs Medical Center, Research 151, 5000 W. National Ave., Milwaukee, WI, 53295, USA
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Steven Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Jason P Mihalik
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Larry Riggen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Stefan Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Alison Brooks
- Department of Orthopedics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY, USA
| | - Christopher C Giza
- Departments of Neurosurgery and Pediatrics, UCLA Steve Tisch BrainSPORT Program, David Geffem School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Joshua Goldman
- Departments of Neurosurgery and Pediatrics, UCLA Steve Tisch BrainSPORT Program, David Geffem School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY, USA
| | - Jonathan C Jackson
- Department of Sports Medicine, United States Air Force Academy, Colorado Springs, CO, USA
| | - Gerald McGinty
- Department of Sports Medicine, United States Air Force Academy, Colorado Springs, CO, USA
| | - Paul Pasquina
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | | | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.,Neuroscience Research Labs, Clement J. Zablocki Veterans Affairs Medical Center, Research 151, 5000 W. National Ave., Milwaukee, WI, 53295, USA
| | - Brian D Stemper
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA. .,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA. .,Neuroscience Research Labs, Clement J. Zablocki Veterans Affairs Medical Center, Research 151, 5000 W. National Ave., Milwaukee, WI, 53295, USA.
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32
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McDonald MA, Tayebi M, McGeown JP, Kwon EE, Holdsworth SJ, Danesh-Meyer HV. A window into eye movement dysfunction following mTBI: A scoping review of magnetic resonance imaging and eye tracking findings. Brain Behav 2022; 12:e2714. [PMID: 35861623 PMCID: PMC9392543 DOI: 10.1002/brb3.2714] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022] Open
Abstract
Mild traumatic brain injury (mTBI), commonly known as concussion, is a complex neurobehavioral phenomenon affecting six in 1000 people globally each year. Symptoms last between days and years as microstructural damage to axons and neurometabolic changes result in brain network disruption. There is no clinically available objective biomarker to diagnose the severity of injury or monitor recovery. However, emerging evidence suggests eye movement dysfunction (e.g., saccades and smooth pursuits) in patients with mTBI. Patients with a higher symptom burden and prolonged recovery time following injury may show higher degrees of eye movement dysfunction. Likewise, recent advances in magnetic resonance imaging (MRI) have revealed both white matter tract damage and functional network alterations in mTBI patients, which involve areas responsible for the ocular motor control. This scoping review is presented in three sections: Section 1 explores the anatomical control of eye movements to aid the reader with interpreting the discussion in subsequent sections. Section 2 examines the relationship between abnormal MRI findings and eye tracking after mTBI based on the available evidence. Finally, Section 3 communicates gaps in our knowledge about MRI and eye tracking, which should be addressed in order to substantiate this emerging field.
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Affiliation(s)
- Matthew A McDonald
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Institute, Gisborne, New Zealand
| | - Maryam Tayebi
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Joshua P McGeown
- Mātai Medical Research Institute, Gisborne, New Zealand.,Auckland University of Technology Traumatic Brain Injury Network, Auckland, New Zealand
| | - Eryn E Kwon
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Institute, Gisborne, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Samantha J Holdsworth
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Institute, Gisborne, New Zealand.,Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Eye Institute, Auckland, New Zealand
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Nowinski CJ, Bureau SC, Buckland ME, Curtis MA, Daneshvar DH, Faull RLM, Grinberg LT, Hill-Yardin EL, Murray HC, Pearce AJ, Suter CM, White AJ, Finkel AM, Cantu RC. Applying the Bradford Hill Criteria for Causation to Repetitive Head Impacts and Chronic Traumatic Encephalopathy. Front Neurol 2022; 13:938163. [PMID: 35937061 PMCID: PMC9355594 DOI: 10.3389/fneur.2022.938163] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with a history of repetitive head impacts (RHI). CTE was described in boxers as early as the 1920s and by the 1950s it was widely accepted that hits to the head caused some boxers to become "punch drunk." However, the recent discovery of CTE in American and Australian-rules football, soccer, rugby, ice hockey, and other sports has resulted in renewed debate on whether the relationship between RHI and CTE is causal. Identifying the strength of the evidential relationship between CTE and RHI has implications for public health and medico-legal issues. From a public health perspective, environmentally caused diseases can be mitigated or prevented. Medico-legally, millions of children are exposed to RHI through sports participation; this demographic is too young to legally consent to any potential long-term risks associated with this exposure. To better understand the strength of evidence underlying the possible causal relationship between RHI and CTE, we examined the medical literature through the Bradford Hill criteria for causation. The Bradford Hill criteria, first proposed in 1965 by Sir Austin Bradford Hill, provide a framework to determine if one can justifiably move from an observed association to a verdict of causation. The Bradford Hill criteria include nine viewpoints by which to evaluate human epidemiologic evidence to determine if causation can be deduced: strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experiment, and analogy. We explored the question of causation by evaluating studies on CTE as it relates to RHI exposure. Through this lens, we found convincing evidence of a causal relationship between RHI and CTE, as well as an absence of evidence-based alternative explanations. By organizing the CTE literature through this framework, we hope to advance the global conversation on CTE mitigation efforts.
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Affiliation(s)
- Christopher J. Nowinski
- Concussion Legacy Foundation, Boston, MA, United States,*Correspondence: Christopher J. Nowinski
| | | | - Michael E. Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia,School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Maurice A. Curtis
- Department of Anatomy and Medical Imaging and Centre for Brain Research, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Daniel H. Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, United States,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Richard L. M. Faull
- Department of Anatomy and Medical Imaging and Centre for Brain Research, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Lea T. Grinberg
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, United States,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States,Department of Pathology, University of Sao Paulo Medical School, São Paulo, Brazil,Department of Pathology, University of California, San Francisco, San Francisco, CA, United States
| | - Elisa L. Hill-Yardin
- School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia,Department of Anatomy & Physiology, The University of Melbourne, Parkville, VIC, Australia
| | - Helen C. Murray
- Department of Anatomy and Medical Imaging and Centre for Brain Research, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Alan J. Pearce
- College of Science, Health, and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Catherine M. Suter
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia,School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Adam J. White
- Department of Sport, Health Science, and Social Work, Oxford Brookes University, Oxford, United Kingdom,Concussion Legacy Foundation UK, Cheltenham, United Kingdom
| | - Adam M. Finkel
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Robert C. Cantu
- Concussion Legacy Foundation, Boston, MA, United States,Department of Neurology, Boston University School of Medicine, Boston, MA, United States,Department of Neurosurgery, Emerson Hospital, Concord, MA, United States
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Velayudhan PS, Mak JJ, Gazdzinski LM, Wheeler AL. Persistent white matter vulnerability in a mouse model of mild traumatic brain injury. BMC Neurosci 2022; 23:46. [PMID: 35850624 PMCID: PMC9290236 DOI: 10.1186/s12868-022-00730-y] [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: 03/13/2022] [Accepted: 07/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Following one mild traumatic brain injury (mTBI), there is a window of vulnerability during which subsequent mTBIs can cause substantially exacerbated impairments. Currently, there are no known methods to monitor, shorten or mitigate this window. Methods To characterize a preclinical model of this window of vulnerability, we first gave male and female mice one or two high-depth or low-depth mTBIs separated by 1, 7, or 14 days. We assessed brain white matter integrity using silver staining within the corpus callosum and optic tracts, as well as behavioural performance on the Y-maze test and visual cliff test. Results The injuries resulted in windows of white matter vulnerability longer than 2 weeks but produced no behavioural impairments. Notably, this window duration is substantially longer than those reported in any previous preclinical vulnerability study, despite our injury model likely being milder than the ones used in those studies. We also found that sex and impact depth differentially influenced white matter integrity in different white matter regions. Conclusions These results suggest that the experimental window of vulnerability following mTBI may be longer than previously reported. Additionally, this work highlights the value of including white matter damage, sex, and replicable injury models for the study of post-mTBI vulnerability and establishes important groundwork for the investigation of potential vulnerability mechanisms, biomarkers, and therapies. Supplementary Information The online version contains supplementary material available at 10.1186/s12868-022-00730-y.
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Affiliation(s)
- Prashanth S Velayudhan
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, M5G 0A4, Canada.,Department of Physiology, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Jordan J Mak
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, M5G 0A4, Canada
| | - Lisa M Gazdzinski
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, M5G 0A4, Canada
| | - Anne L Wheeler
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, M5G 0A4, Canada. .,Department of Physiology, University of Toronto, Toronto, ON, M5S 1A8, Canada.
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35
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McCorkle TA, Romm ZL, Raghupathi R. Repeated Mild TBI in Adolescent Rats Reveals Sex Differences in Acute and Chronic Behavioral Deficits. Neuroscience 2022; 493:52-68. [PMID: 35469970 PMCID: PMC10074545 DOI: 10.1016/j.neuroscience.2022.04.014] [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: 11/09/2021] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 01/01/2023]
Abstract
High school students who participate in contact sports are vulnerable to sustaining multiple concussions and exhibit deficits in cognitive function in both the acute and chronic phases and in emotional behavior in the chronic phase. Further, boys are more likely to suffer cognitive problems whereas girls tend to report depression and anxiety. The effects of repetitive mild TBI in adolescent (35-40-day old) male and female Sprague-Dawley rats on object location and spatial working memory (hippocampal-dependent) and object recognition memory (hippocampal-independent) at 1-and-4-weeks post-injury along with trait-dependent anxiety- and depressive-like behaviors at 5 weeks were examined. Compared to sham-injured rats, male brain-injured rats demonstrated significant impairment in both hippocampal-dependent and -independent memory tasks at both time points, whereas female brain-injured rats only exhibited impairment in these tests at the 4-week time point. In contrast, depressive-like behaviors were present in the forced swim test in only the female brain-injured animals at 5 weeks post-injury; anxiety-like behaviors were not evident in either male or female brain-injured animals. Histological analysis at 6 weeks after injury revealed that repeated mild TBI in male and female adolescent rats resulted in increased reactivity of astrocytes and microglia within the corpus callosum below the impact site and in the stratum oriens and stratum pyramidale of the CA2 region of the dorsal hippocampus. Together, these data are indicative of the differences in the temporal pattern of post-traumatic behavioral deficits between male and female animals and that female animals may be more likely to develop deficits in the chronic post-traumatic period.
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Affiliation(s)
- T A McCorkle
- Program in Neuroscience, Graduate School of Biomedical Sciences and Professional Studies, Philadelphia, PA 19129, United States
| | - Z L Romm
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States
| | - R Raghupathi
- Program in Neuroscience, Graduate School of Biomedical Sciences and Professional Studies, Philadelphia, PA 19129, United States; Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States.
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McDonald MA, Holdsworth SJ, Danesh-Meyer HV. Eye Movements in Mild Traumatic Brain Injury: Clinical Challenges. J Eye Mov Res 2022; 15:10.16910/jemr.15.2.3. [PMID: 36439910 PMCID: PMC9691323 DOI: 10.16910/jemr.15.2.3] [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] [Indexed: 09/08/2024] Open
Abstract
Mild traumatic brain injury (mTBI), also known as concussion, is a common injury which affects patients of all demographics. There is a global effort to accurately diagnose and identify patients at highest risk of prolonged symptom burden to facilitate appropriate rehabilitation efforts. Underreporting is common with large numbers not engaging with services, in addition to differences in treatment outcomes according to ethnicity, age, and gender. As patients recover, symptomology evolves which challenges rehabilitative efforts with no clear definition of 'recovered'. This review describes key areas in mTBI such as diagnostic challenges, epidemiology, prognosis, and pathophysiology which serves as an introduction to "Eye Movements in Mild Traumatic Brain Injury: Ocular Biomarkers."
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Affiliation(s)
- Matthew A McDonald
- Department of Ophthalmology, University of Auckland, New Zealand
- Mātai Medical Research Institute, Gisborne, New Zealand
| | - Samantha J Holdsworth
- Department of Anatomy and Medical Imaging, University of Auckland, New Zealand
- Mātai Medical Research Institute, Gisborne, New Zealand
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, University of Auckland, New Zealand
- Eye Institute, Auckland, New Zealand
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Stemper BD, Harezlak J, Shah AS, Rowson S, Mihalik JP, Riggen L, Duma S, Pasquina P, Broglio SP, McAllister TW, McCrea MA. Association between Preseason/Regular Season Head Impact Exposure and Concussion Incidence in NCAA Football. Med Sci Sports Exerc 2022; 54:912-922. [PMID: 35081093 DOI: 10.1249/mss.0000000000002874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Contact sport athletes are exposed to a unique environment where they sustain repeated head impacts throughout the season and can sustain hundreds of head impacts over a few months. Accordingly, recent studies outlined the role that head impact exposure (HIE) has in concussion biomechanics and in the development of cognitive and brain-based changes. Those studies focused on time-bound effects by quantifying exposure leading up to the concussion, or cognitive changes after a season in which athletes had high HIE. However, HIE may have a more prolonged effect. This study identified associations between HIE and concussion incidence during different periods of the college football fall season. METHODS This study included 1120 athlete seasons from six National Collegiate Athletic Association Division I football programs across 5 yr. Athletes were instrumented with the Head Impact Telemetry System to record daily HIE. The analysis quantified associations of preseason/regular season/total season concussion incidence with HIE during those periods. RESULTS Strong associations were identified between HIE and concussion incidence during different periods of the season. Preseason HIE was associated with preseason and total season concussion incidence, and total season HIE was associated with total season concussion incidence. CONCLUSIONS These findings demonstrate a prolonged effect of HIE on concussion risk, wherein elevated preseason HIE was associated with higher concussion risk both during the preseason and throughout the entire fall season. This investigation is the first to provide evidence supporting the hypothesis of a relationship between elevated HIE during the college football preseason and a sustained decreased tolerance for concussion throughout that season.
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Affiliation(s)
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN
| | | | - Steven Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA
| | - Jason P Mihalik
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Larry Riggen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN
| | - Stefan Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA
| | - Paul Pasquina
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI
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Stemper BD, Shah A, Chiariello R, McCarthy C, Jessen K, Sarka B, Seifert J, Budde MD, Wang K, Olsen CM, McCrea M. A Preclinical Rodent Model for Repetitive Subconcussive Head Impact Exposure in Contact Sport Athletes. Front Behav Neurosci 2022; 16:805124. [PMID: 35368301 PMCID: PMC8965565 DOI: 10.3389/fnbeh.2022.805124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Repetitive subconcussive head impact exposure has been associated with clinical and MRI changes in some non-concussed contact sport athletes over the course of a season. However, analysis of human tolerance for repeated head impacts is complicated by concussion and head impact exposure history, genetics, and other personal factors. Therefore, the objective of the current study was to develop a rodent model for repetitive subconcussive head impact exposure that can be used to understand injury mechanisms and tolerance in the human. This study incorporated the Medical College of Wisconsin Rotational Injury Model to expose rats to multiple low-level head accelerations per day over a 4-week period. The peak magnitude of head accelerations were scaled from our prior human studies of contact sport athletes and the number of exposures per day were based on the median (moderate exposure) and 95th percentile (high exposure) number of exposures per day across the human sample. Following the exposure protocol, rats were assessed for cognitive deficits, emotional changes, blood serum levels of axonal injury biomarkers, and histopathological evidence of injury. High exposure rats demonstrated cognitive deficits and evidence of anxiety-like behaviors relative to shams. Moderate exposure rats did not demonstrate either of those behaviors. Similarly, high exposure rats had histopathological evidence of gliosis [i.e., elevated Iba1 intensity and glial fibrillary acidic protein (GFAP) volume relative to shams] in the basolateral amygdala and other areas. Blood serum levels of neurofilament light (NFL) demonstrated a dose response relationship with increasing numbers of low-level head acceleration exposures with a higher week-to-week rate of NFL increase for the high exposure group compared to the moderate exposure group. These findings demonstrate a cumulative effect of repeated low-level head accelerations and provide a model that can be used in future studies to better understand mechanisms and tolerance for brain injury resulting from repeated low-level head accelerations, with scalable biomechanics between the rat and human.
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Affiliation(s)
- Brian D. Stemper
- Joint Department of Biomedical Engineering, Medical College of Wisconsin, Marquette University, Milwaukee, WI, United States
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, United States
- *Correspondence: Brian D. Stemper,
| | - Alok Shah
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
| | - Rachel Chiariello
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
| | - Cassandra McCarthy
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
| | - Kristin Jessen
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Bailey Sarka
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jack Seifert
- Joint Department of Biomedical Engineering, Medical College of Wisconsin, Marquette University, Milwaukee, WI, United States
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
| | - Matthew D. Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kevin Wang
- Gryphon Bio, Inc., South San Francisco, CA, United States
| | - Christopher M. Olsen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
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Sun M, Symons GF, O'Brien WT, Mccullough J, Aniceto R, Lin IH, Eklund M, Brady RD, Costello DM, Chen Z, O'Brien TJ, McDonald SJ, Agoston DV, Shultz SR. Serum protein biomarkers of inflammation, oxidative stress, and cerebrovascular and glial injury in concussed Australian football players. J Neurotrauma 2022; 39:800-808. [PMID: 35176905 DOI: 10.1089/neu.2021.0493] [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: 11/12/2022] Open
Abstract
Clinical decisions related to sports-related concussion (SRC) are challenging due to the heterogenous nature of SRC symptoms coupled with the current reliance on subjective self-reported symptom measures. Sensitive and objective methods that can diagnose SRC and determine recovery would aid clinical management, and there is evidence that SRC induces changes in circulating protein biomarkers indicative of neuroaxonal injury. However, potential blood biomarkers related to other pathobiological responses linked to SRC are still poorly understood. Therefore, here we analyzed blood samples from concussed (male = 30; female = 9) and non-concussed (male = 74; female = 27) amateur Australian rules football players collected during the pre-season (i.e., baseline), and at 2-, 6-, and 13-days post-SRC to determine time dependent changes in serum levels of biomarkers related to glial (i.e., brain lipid-binding protein, BLBP; phosphoprotein enriched in astrocytes 15) and cerebrovascular injury (i.e., von Willebrand factor, claudin-5), inflammation (i.e., fibrinogen, high mobility group box protein 1), and oxidative stress (i.e., 4-hydroxynoneal). In females, BLBP levels were significantly decreased at 2-days post-SRC compared to their pre-season baseline; however, area under the receiver operating characteristic curve (AUROC) analysis found that BLBP was unable to distinguish between SRC and controls. In males, AUROC analysis revealed a statistically significant change at 2-days post-SRC in the serum levels of 4-hydroxynoneal, however the associated AUROC value (0.6373) indicated little clinical utility for this biomarker in distinguishing SRC from controls. There were no other statistically significant findings. These results indicate that the serum biomarkers tested in this study hold little clinical value in the management of SRC at 2-, 6-, and 13-days post-injury.
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Affiliation(s)
- Mujun Sun
- Monash University, Department of Neuroscience, Central Clinical School, Melbourne, Australia;
| | - Georgia F Symons
- Monash University, Neuroscience, Melbourne, Victoria, Australia;
| | | | | | | | | | | | - Rhys D Brady
- Monash University, Neuroscience, The Alfred Centre, Level 6, 99 Commercial Rd, Melbourne, Victoria, Australia, 3004;
| | - Daniel M Costello
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia;
| | - Zhibin Chen
- Monash University, Neuroscience, Melbourne, Victoria, Australia.,Monash University, 2541, Clinical Epidemiology, Melbourne, Victoria, Australia;
| | - Terence J O'Brien
- Monash University, Neuroscience, Melbourne, Victoria, Australia.,Melbourne Health, 6451, Department of Neurology, Parkville, Victoria, Australia.,Alfred Health, 5392, Department of Neurology, Melbourne, Victoria, Australia.,The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia;
| | - Stuart John McDonald
- Monash University Central Clinical School, 161666, Department of Neuroscience, 99 Commercial Road, Melbourne, Victoria, Australia, 3004;
| | - Denes V Agoston
- Uniformed Services University, APG, 4301 Jones Br Rd, Bethesda, Maryland, United States, 20814;
| | - Sandy R Shultz
- Monash University, Neuroscience, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria, Australia, 3004;
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40
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Vale A, Post A, Cournoyer J, Hoshizaki TB, Gilchrist MD. Influence of play type on the magnitude and number of head impacts sustained in youth American football. Comput Methods Biomech Biomed Engin 2021; 25:1195-1210. [PMID: 34788175 DOI: 10.1080/10255842.2021.2003345] [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: 10/19/2022]
Abstract
The magnitude and number of head impacts experienced by young American football players are associated with negative brain health outcomes and may be affected by play-type strategies. The purpose of this research was to examine how play type affects the magnitude and number of head impacts in youth American tackle football. Head impacts were recorded for 30 games in the 5-9 age category and 30 games in the 9-14 age category. Impacts using physical and finite element models were conducted to determine the brain strain. Run plays had a higher head impact frequency in both age groups (p < 0.05). This increase in head impacts was consistent for all positions (p < 0.05), except wide receiver, and offensive line and defensive back in the 9-14 age group (p > 0.05). Both age groups experienced significantly different magnitude proportions with higher numbers of very low and low strain magnitude impacts during run plays (p < 0.05), and a higher proportion of moderate magnitude impacts in the 5-9 age category (p < 0.05). This data can be used to inform and educate teams and coaches and influence decisions around the use of runs and passing plays that may lead to a decrease in head impacts.
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Affiliation(s)
- Adam Vale
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Post
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
| | - Janie Cournoyer
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Michael D Gilchrist
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
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41
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Cai X, Harding IC, Sadaka AH, Colarusso B, Kulkarni P, Ebong E, Qiao J, O'Hare NR, Ferris CF. Mild repetitive head impacts alter perivascular flow in the midbrain dopaminergic system in awake rats. Brain Commun 2021; 3:fcab265. [PMID: 34806002 PMCID: PMC8600963 DOI: 10.1093/braincomms/fcab265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022] Open
Abstract
Head injury is a known risk factor for Parkinson's disease. Disruption in the perivascular clearance of metabolic waste and unwanted proteins is thought to be a contributing factor to disease progression. We hypothesized that repetitive mild head impacts, without evidence of structural brain damage, would increase microgliosis and AQP4 expression and depolarization and alter perivascular flow in the midbrain dopaminergic system. Adult male rats were subjected to sham, or two mild head impacts separated by 48 h. Three weeks later, fully awake rats were imaged using dynamic, contrast-enhanced MRI to follow the distribution of intraventricular gadobenate dimeglumine contrast agent. Images were registered to and analysed using a 3D MRI rat atlas providing site-specific data on 171 different brain areas. Following imaging, rats were tested for cognitive function using the Barnes maze assay. Histological analyses of tyrosine hydroxylase, microglia activation and AQP4 expression and polarization were performed on a parallel cohort of head impacted rats at 20 days post insult to coordinate with the time of imaging. There was no change in the global flux of contrast agent between sham and head impacted rats. The midbrain dopaminergic system showed a significant decrease in the influx of contrast agent as compared to sham controls together with a significant increase in microgliosis, AQP4 expression and depolarization. There were no deficits in cognitive function. The histology showed a significant level of neuroinflammation in the midbrain dopaminergic system 3 weeks post mild repetitive head impact but no loss in tyrosine hydroxylase. MRI revealed no structural brain damage emphasizing the potential serious consequences of mild head impacts on sustained brain neuroinflammation in this area critical to the pathophysiology of Parkinson's.
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Affiliation(s)
- Xuezhu Cai
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA 02115, USA
| | - Ian C Harding
- Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
| | - Aymen H Sadaka
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA 02115, USA
| | - Bradley Colarusso
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA 02115, USA
| | - Praveen Kulkarni
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA 02115, USA
| | - Eno Ebong
- Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115, USA
- Department of Neuroscience, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Ju Qiao
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA 02115, USA
| | - Nick R O'Hare
- Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
| | - Craig F Ferris
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA 02115, USA
- Department of Psychology, Northeastern University, Boston, MA 02115, USA
- Department of Pharmaceutical Sciences, Northeastern University, Boston, MA 02115, USA
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42
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Saleem GT, Fitzpatrick JM, Haider MN, Valera EM. COVID-19-induced surge in the severity of gender-based violence might increase the risk for acquired brain injuries. SAGE Open Med 2021; 9:20503121211050197. [PMID: 34707866 PMCID: PMC8543566 DOI: 10.1177/20503121211050197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/14/2021] [Indexed: 12/18/2022] Open
Abstract
While initial reports have emphasized a global rise in the frequency of intimate partner violence following COVID-19, emerging data are now showing a concerning surge in the severity of COVID-19-induced physical intimate partner violence. One of the most dangerous, frequent, yet hidden consequences of severe physical intimate partner violence is acquired brain injury, including repetitive mild traumatic brain injury and hypoxic brain injury. Although the increase in high-risk physical abuse during COVID-19 is gaining recognition, what still remains absent is the urgent discussion on intimate partner violence-related acquired brain injury during these times. The potential analogous surge in intimate partner violence-related acquired brain injury may have implications for both healthcare providers and healthcare actions/policies as repeated brain injuries have been associated with residual functional deficits and chronic disability. In addition, even in the pre-pandemic times, intimate partner violence-related acquired brain injury is likely unrecognized and/or misclassified due to overlap in symptoms with other comorbid disorders. This review aimed to raise awareness about intimate partner violence-related acquired brain injury within the context of COVID-19. Health actions and policies that should be considered as part of the pandemic response to minimize adverse outcomes associated with intimate partner violence-related acquired brain injury have also been discussed.
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43
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Meliambro J, Karton C, Cournoyer J, Post A, Hoshizaki TB, Gilchrist MD. Comparison of head impact frequency and magnitude in youth tackle football and ice hockey. Comput Methods Biomech Biomed Engin 2021; 25:936-951. [PMID: 34615414 DOI: 10.1080/10255842.2021.1987420] [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: 10/20/2022]
Abstract
Repetitive head impacts are a growing concern for youth and adolescent contact sport athletes as they have been linked to long term negative brain health outcomes. Of all contact sports, tackle football and ice hockey have been reported to have the highest incidence of head or brain injury however, each sporting environment is unique with distinct rules and regulations regarding contact and collisions. The purpose of this research was to measure and compare the head impact frequency and estimated magnitude of brain tissue strain, amongst youth tackle football and ice hockey players during game play. Head impact frequency was documented by video analysis of youth tackle football and ice hockey game play. Impact magnitude was determined through physical laboratory reconstructions and finite element modelling to estimate brain tissue strains. Tackle football demonstrated significantly higher impact frequency (P < 0.01) and magnitude of estimated brain tissue strains (P < 0.01) compared to ice hockey. A significantly higher number of higher strain head impacts were documented in tackle football when compared to ice hockey (P < 0.01). These differences suggest that youth football players may experience increased frequency and magnitude of estimated brain tissue strains in comparison to youth hockey.
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Affiliation(s)
- Julia Meliambro
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Clara Karton
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Janie Cournoyer
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Andrew Post
- School of Human Kinetics, University of Ottawa, Ottawa, Canada.,School of Mechanical & Materials Engineering, University College Dublin, Dublin, Ireland
| | | | - Michael D Gilchrist
- School of Mechanical & Materials Engineering, University College Dublin, Dublin, Ireland
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44
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Leaston J, Qiao J, Harding IC, Kulkarni P, Gharagouzloo C, Ebong E, Ferris CF. Quantitative Imaging of Blood-Brain Barrier Permeability Following Repetitive Mild Head Impacts. Front Neurol 2021; 12:729464. [PMID: 34659094 PMCID: PMC8515019 DOI: 10.3389/fneur.2021.729464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/24/2021] [Indexed: 12/28/2022] Open
Abstract
This was an exploratory study designed to evaluate the feasibility of a recently established imaging modality, quantitative ultrashort time-to-echo contrast enhanced (QUTE-CE), to follow the early pathology and vulnerability of the blood brain barrier in response to single and repetitive mild head impacts. A closed-head, momentum exchange model was used to produce three consecutive mild head impacts aimed at the forebrain separated by 24 h each. Animals were measured at baseline and within 1 h of impact. Anatomical images were collected to assess the extent of structural damage. QUTE-CE biomarkers for BBB permeability were calculated on 420,000 voxels in the brain and were registered to a bilateral 3D brain atlas providing site-specific information on 118 anatomical regions. Blood brain barrier permeability was confirmed by extravasation of labeled dextran. All head impacts occurred in the absence of any structural brain damage. A single mild head impact had measurable effects on blood brain barrier permeability and was more significant after the second and third impacts. Affected regions included the prefrontal ctx, basal ganglia, hippocampus, amygdala, and brainstem. Our findings support the concerns raised by the healthcare community regarding mild head injuries in participants in organized contact sports and military personnel in basic training and combat.
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Affiliation(s)
| | - Ju Qiao
- Center for Translational Neuroimaging, Northeastern University, Boston, MA, United States
| | - Ian C. Harding
- Department of Bioengineering, Northeastern University, Boston, MA, United States
| | | | - Codi Gharagouzloo
- Imaginostics, Inc., Cambridge, MA, United States
- Center for Translational Neuroimaging, Northeastern University, Boston, MA, United States
| | - Eno Ebong
- Department of Chemical Engineering, Northeastern University, Boston, MA, United States
| | - Craig F. Ferris
- Center for Translational Neuroimaging, Northeastern University, Boston, MA, United States
- Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, MA, United States
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45
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Dhote VV, Raja MKMM, Samundre P, Sharma S, Anwikar S, Upaganlawar AB. Sports Related Brain Injury and Neurodegeneration in Athletes. Curr Mol Pharmacol 2021; 15:51-76. [PMID: 34515018 DOI: 10.2174/1874467214666210910114324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/03/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022]
Abstract
Sports deserve a special place in human life to impart healthy and refreshing wellbeing. However, sports activities, especially contact sports, renders athlete vulnerable to brain injuries. Athletes participating in a contact sport like boxing, rugby, American football, wrestling, and basketball are exposed to traumatic brain injuries (TBI) or concussions. The acute and chronic nature of these heterogeneous injuries provides a spectrum of dysfunctions that alters the neuronal, musculoskeletal, and behavioral responses of an athlete. Many sports-related brain injuries go unreported, but these head impacts trigger neurometabolic disruptions that contribute to long-term neuronal impairment. The pathophysiology of post-concussion and its underlying mechanisms are undergoing intense research. It also shed light on chronic disorders like Parkinson's disease, Alzheimer's disease, and dementia. In this review, we examined post-concussion neurobehavioral changes, tools for early detection of signs, and their impact on the athlete. Further, we discussed the role of nutritional supplements in ameliorating neuropsychiatric diseases in athletes.
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Affiliation(s)
- Vipin V Dhote
- Faculty of Pharmacy, VNS Group of Institutions, Bhopal, MP,462044. India
| | | | - Prem Samundre
- Faculty of Pharmacy, VNS Group of Institutions, Bhopal, MP,462044. India
| | - Supriya Sharma
- Faculty of Pharmacy, VNS Group of Institutions, Bhopal, MP,462044. India
| | - Shraddha Anwikar
- Faculty of Pharmacy, VNS Group of Institutions, Bhopal, MP,462044. India
| | - Aman B Upaganlawar
- Faculty of Pharmacy, VNS Group of Institutions, Bhopal, MP,462044. India
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46
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Faillot M, Chaillet A, Palfi S, Senova S. Rodent models used in preclinical studies of deep brain stimulation to rescue memory deficits. Neurosci Biobehav Rev 2021; 130:410-432. [PMID: 34437937 DOI: 10.1016/j.neubiorev.2021.08.012] [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: 02/08/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Abstract
Deep brain stimulation paradigms might be used to treat memory disorders in patients with stroke or traumatic brain injury. However, proof of concept studies in animal models are needed before clinical translation. We propose here a comprehensive review of rodent models for Traumatic Brain Injury and Stroke. We systematically review the histological, behavioral and electrophysiological features of each model and identify those that are the most relevant for translational research.
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Affiliation(s)
- Matthieu Faillot
- Neurosurgery department, Henri Mondor University Hospital, APHP, DMU CARE, Université Paris Est Créteil, Mondor Institute for Biomedical Research, INSERM U955, Team 15, Translational Neuropsychiatry, France
| | - Antoine Chaillet
- Laboratoire des Signaux et Systèmes (L2S-UMR8506) - CentraleSupélec, Université Paris Saclay, Institut Universitaire de France, France
| | - Stéphane Palfi
- Neurosurgery department, Henri Mondor University Hospital, APHP, DMU CARE, Université Paris Est Créteil, Mondor Institute for Biomedical Research, INSERM U955, Team 15, Translational Neuropsychiatry, France
| | - Suhan Senova
- Neurosurgery department, Henri Mondor University Hospital, APHP, DMU CARE, Université Paris Est Créteil, Mondor Institute for Biomedical Research, INSERM U955, Team 15, Translational Neuropsychiatry, France.
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47
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Symons GF, Clough M, Fielding J, O'Brien WT, Shepherd CE, Wright DK, Shultz SR. The Neurological Consequences of Engaging in Australian Collision Sports. J Neurotrauma 2021; 37:792-809. [PMID: 32056505 DOI: 10.1089/neu.2019.6884] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Collision sports are an integral part of Australian culture. The most common collision sports in Australia are Australian rules football, rugby union, and rugby league. Each of these sports often results in participants sustaining mild brain traumas, such as concussive and subconcussive injuries. However, the majority of previous studies and reviews pertaining to the neurological implications of sustaining mild brain traumas, while engaging in collision sports, have focused on those popular in North America and Europe. As part of this 2020 International Neurotrauma Symposium special issue, which highlights Australian neurotrauma research, this article will therefore review the burden of mild brain traumas in Australian collision sports athletes. Specifically, this review will first provide an overview of the consequences of mild brain trauma in Australian collision sports, followed by a summary of the previous studies that have investigated neurocognition, ocular motor function, neuroimaging, and fluid biomarkers, as well as neuropathological outcomes in Australian collision sports athletes. A review of the literature indicates that although Australians have contributed to the field, several knowledge gaps and limitations currently exist. These include important questions related to sex differences, the identification and implementation of blood and imaging biomarkers, the need for consistent study designs and common data elements, as well as more multi-modal studies. We conclude that although Australia has had an active history of investigating the neurological impact of collision sports participation, further research is clearly needed to better understand these consequences in Australian athletes and how they can be mitigated.
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Affiliation(s)
- Georgia F Symons
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Meaghan Clough
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Joanne Fielding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - William T O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Claire E Shepherd
- Neuroscience Research Australia, The University of New South Wales, Sydney, New South Wales, Australia
| | - David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
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48
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Krzyzaniak H, Fatehi Hassanabad A. Cardiovascular Sequalae of Sports-Related Concussions. PM R 2021; 14:1219-1226. [PMID: 34363737 DOI: 10.1002/pmrj.12686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 11/09/2022]
Abstract
We are becoming more aware of sports-related concussions (SRCs). Current return-to-play (RTP) guidelines are often based on subjective clinical symptoms rather than objective physiologic measures. Although evidence is limited, the purpose of this manuscript is to summarize the data pertaining to acute and chronic cardiovascular effects of SRCs, and to determine whether there are objective metrics that could improve currently used RTP protocols. Research shows that SRCs cause cardiovascular autonomic nervous system (CV-ANS) dysfunction induced by decreased baroreceptor sensitivity (BRS). This disturbance persists past the point of clinical symptom resolution and can worsen through subsequent exertion, which may impact long-term recovery. Further studies are needed to establish the most appropriate physiologic metrics for analyzing recovery post-SRC and whether the addition of physiologic measures to RTP guidelines improves recovery from these injuries. This is an understudied area that carries important clinical implications. Larger and more robust trials are warranted to inform the development of guidelines that should focus on lessening the compounding effects of multiple concussions and improve the management of SRCs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Halli Krzyzaniak
- Faculty of Medicine, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Ali Fatehi Hassanabad
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
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49
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Rose SC, Anderson W, Feinberg D, Ganesh A, Green L, Jaffee M, Kaplen M, Lorincz M, De Luigi A, Patel D, Tsao JW, Lee E, Webb A. Quality Improvement in Neurology: Concussion Quality Measurement Set. Neurology 2021; 97:537-542. [PMID: 34321361 DOI: 10.1212/wnl.0000000000012537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/10/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sean C Rose
- Nationwide Childrens Hospital and The Ohio State University, Columbus, OH
| | | | | | | | - Lauren Green
- University of Southern California, Los Angeles, CA
| | | | | | | | | | | | | | - Erin Lee
- American Academy of Neurology, Minneapolis, MN
| | - Adam Webb
- Emory University School of Medicine, Decatur, GA
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50
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Serpa RO, Ferguson L, Larson C, Bailard J, Cooke S, Greco T, Prins ML. Pathophysiology of Pediatric Traumatic Brain Injury. Front Neurol 2021; 12:696510. [PMID: 34335452 PMCID: PMC8319243 DOI: 10.3389/fneur.2021.696510] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022] Open
Abstract
The national incidence of traumatic brain injury (TBI) exceeds that of any other disease in the pediatric population. In the United States the Centers for Disease Control and Prevention (CDC) reports 697,347 annual TBIs in children ages 0–19 that result in emergency room visits, hospitalization or deaths. There is a bimodal distribution within the pediatric TBI population, with peaks in both toddlers and adolescents. Preclinical TBI research provides evidence for age differences in acute pathophysiology that likely contribute to long-term outcome differences between age groups. This review will examine the timecourse of acute pathophysiological processes during cerebral maturation, including calcium accumulation, glucose metabolism and cerebral blood flow. Consequences of pediatric TBI are complicated by the ongoing maturational changes allowing for substantial plasticity and windows of vulnerabilities. This review will also examine the timecourse of later outcomes after mild, repeat mild and more severe TBI to establish developmental windows of susceptibility and altered maturational trajectories. Research progress for pediatric TBI is critically important to reveal age-associated mechanisms and to determine knowledge gaps for future studies.
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Affiliation(s)
- Rebecka O Serpa
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lindsay Ferguson
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Cooper Larson
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Julie Bailard
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Samantha Cooke
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Tiffany Greco
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Mayumi L Prins
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
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