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Hanna M, Ali A, Bhatambarekar P, Modi K, Lee C, Morrison B, Klienberger M, Pfister BJ. Anatomical Features and Material Properties of Human Surrogate Head Models Affect Spatial and Temporal Brain Motion under Blunt Impact. Bioengineering (Basel) 2024; 11:650. [PMID: 39061732 PMCID: PMC11273380 DOI: 10.3390/bioengineering11070650] [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: 06/06/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 07/28/2024] Open
Abstract
Traumatic brain injury (TBI) is a biomechanical problem where the initiating event is dynamic loading (blunt, inertial, blast) to the head. To understand the relationship between the mechanical parameters of the injury and the deformation patterns in the brain, we have previously developed a surrogate head (SH) model capable of measuring spatial and temporal deformation in a surrogate brain under blunt impact. The objective of this work was to examine how material properties and anatomical features affect the motion of the brain and the development of injurious deformations. The SH head model was modified to study six variables independently under blunt impact: surrogate brain stiffness, surrogate skull stiffness, inclusion of cerebrospinal fluid (CSF), head/skull size, inclusion of vasculature, and neck stiffness. Each experimental SH was either crown or frontally impacted at 1.3 m/s (3 mph) using a drop tower system. Surrogate brain material, the Hybrid III neck stiffness, and skull stiffness were measured and compared to published properties. Results show that the most significant variables affecting changes in brain deformation are skull stiffness, inclusion of CSF and surrogate brain stiffness. Interestingly, neck stiffness and SH size significantly affected the strain rate only suggesting these parameters are less important in blunt trauma. While the inclusion of vasculature locally created strain concentrations at the interface of the artery and brain, overall deformation was reduced.
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Affiliation(s)
- Michael Hanna
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA; (M.H.); (A.A.); (P.B.); (K.M.)
| | - Abdus Ali
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA; (M.H.); (A.A.); (P.B.); (K.M.)
| | - Prasad Bhatambarekar
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA; (M.H.); (A.A.); (P.B.); (K.M.)
| | - Karan Modi
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA; (M.H.); (A.A.); (P.B.); (K.M.)
| | - Changhee Lee
- Neurotrauma and Repair Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA; (C.L.)
| | - Barclay Morrison
- Neurotrauma and Repair Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA; (C.L.)
| | - Michael Klienberger
- The Army Research Laboratory, Aberdeen Proving Grounds, Aberdeen, MD 21005, USA;
| | - Bryan J. Pfister
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA; (M.H.); (A.A.); (P.B.); (K.M.)
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Song X, Zhang Y, Tang Z, Du L. Advantages of nanocarriers for basic research in the field of traumatic brain injury. Neural Regen Res 2024; 19:237-245. [PMID: 37488872 PMCID: PMC10503611 DOI: 10.4103/1673-5374.379041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/01/2023] [Accepted: 05/06/2023] [Indexed: 07/26/2023] Open
Abstract
A major challenge for the efficient treatment of traumatic brain injury is the need for therapeutic molecules to cross the blood-brain barrier to enter and accumulate in brain tissue. To overcome this problem, researchers have begun to focus on nanocarriers and other brain-targeting drug delivery systems. In this review, we summarize the epidemiology, basic pathophysiology, current clinical treatment, the establishment of models, and the evaluation indicators that are commonly used for traumatic brain injury. We also report the current status of traumatic brain injury when treated with nanocarriers such as liposomes and vesicles. Nanocarriers can overcome a variety of key biological barriers, improve drug bioavailability, increase intracellular penetration and retention time, achieve drug enrichment, control drug release, and achieve brain-targeting drug delivery. However, the application of nanocarriers remains in the basic research stage and has yet to be fully translated to the clinic.
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Affiliation(s)
- Xingshuang Song
- School of Pharmaceutical Sciences, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
- Department of Pharmaceutics, Beijing Institute of Radiation Medicine, Beijing, China
| | - Yizhi Zhang
- School of Pharmaceutical Sciences, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
- Department of Pharmaceutics, Beijing Institute of Radiation Medicine, Beijing, China
| | - Ziyan Tang
- Department of Pharmaceutics, Beijing Institute of Radiation Medicine, Beijing, China
| | - Lina Du
- School of Pharmaceutical Sciences, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
- Department of Pharmaceutics, Beijing Institute of Radiation Medicine, Beijing, China
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Galindo EJ, Flores RR, Mejia-Alvarez R, Willis AM, Tartis MS. Simultaneous High-Frame-Rate Acoustic Plane-Wave and Optical Imaging of Intracranial Cavitation in Polyacrylamide Brain Phantoms during Blunt Force Impact. Bioengineering (Basel) 2024; 11:132. [PMID: 38391618 DOI: 10.3390/bioengineering11020132] [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: 12/14/2023] [Revised: 01/20/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Blunt and blast impacts occur in civilian and military personnel, resulting in traumatic brain injuries necessitating a complete understanding of damage mechanisms and protective equipment design. However, the inability to monitor in vivo brain deformation and potential harmful cavitation events during collisions limits the investigation of injury mechanisms. To study the cavitation potential, we developed a full-scale human head phantom with features that allow a direct optical and acoustic observation at high frame rates during blunt impacts. The phantom consists of a transparent polyacrylamide material sealed with fluid in a 3D-printed skull where windows are integrated for data acquisition. The model has similar mechanical properties to brain tissue and includes simplified yet key anatomical features. Optical imaging indicated reproducible cavitation events above a threshold impact energy and localized cavitation to the fluid of the central sulcus, which appeared as high-intensity regions in acoustic images. An acoustic spectral analysis detected cavitation as harmonic and broadband signals that were mapped onto a reconstructed acoustic frame. Small bubbles trapped during phantom fabrication resulted in cavitation artifacts, which remain the largest challenge of the study. Ultimately, acoustic imaging demonstrated the potential to be a stand-alone tool, allowing observations at depth, where optical techniques are limited.
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Affiliation(s)
- Eric J Galindo
- Department of Chemical Engineering, New Mexico Institute of Mining and Technology, Socorro, NM 87801, USA
| | - Riley R Flores
- Department of Chemical Engineering, New Mexico Institute of Mining and Technology, Socorro, NM 87801, USA
| | - Ricardo Mejia-Alvarez
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Adam M Willis
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI 48824, USA
- 59th Medical Wing, Office of the Chief Scientist, Lackland AFB, San Antonio, TX 78236, USA
| | - Michaelann S Tartis
- Department of Chemical Engineering, New Mexico Institute of Mining and Technology, Socorro, NM 87801, USA
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Dsouza H, Dávila-Montero BM, Afanador IG, Torres GM, Cao Y, Mejia-Alvarez R, Sepúlveda N. Measuring vibrations on a biofidelic brain using ferroelectret nanogenerator. Sci Rep 2023; 13:8975. [PMID: 37268683 PMCID: PMC10238378 DOI: 10.1038/s41598-023-35782-5] [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: 12/02/2022] [Accepted: 05/23/2023] [Indexed: 06/04/2023] Open
Abstract
Our knowledge of traumatic brain injury has been fast growing with the emergence of new markers pointing to various neurological changes that the brain undergoes during an impact or any other form of concussive event. In this work, we study the modality of deformations on a biofidelic brain system when subject to blunt impacts, highlighting the importance of the time-dependent behavior of the resulting waves propagating through the brain. This study is carried out using two different approaches involving optical (Particle Image Velocimetry) and mechanical (flexible sensors) in the biofidelic brain. Results show that the system has a natural mechanical frequency of [Formula: see text] 25 oscillations per second, which was confirmed by both methods, showing a positive correlation with one another. The consistency of these results with previously reported brain pathology validates the use of either technique, and establishes a new, simpler mechanism to study brain vibrations by using flexible piezoelectric patches. The visco-elastic nature of the biofidelic brain is validated by observing the the relationship between both methods at two different time intervals, by using the information of the strain and stress inside the brain from the Particle Image Velocimetry and flexible sensor, respectively. A non-linear stress-strain relationship was observed and justified to support the same.
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Affiliation(s)
- Henry Dsouza
- Electrical and computer engineering, Michigan State University, 428 S Shaw Lane, East Lansing, MI, 48824, USA
| | | | - Ian Gonzalez Afanador
- Electrical and computer engineering, Michigan State University, 428 S Shaw Lane, East Lansing, MI, 48824, USA
| | - Gerardo Morales Torres
- Electrical and computer engineering, Michigan State University, 428 S Shaw Lane, East Lansing, MI, 48824, USA
| | - Yunqi Cao
- State Key Laboratory of Industrial Control Technology, College of Control Science and Engineering, Zhejiang University, Hangzhou, 310027, Zhejiang, China
| | - Ricardo Mejia-Alvarez
- Mechanical Engineering, Michigan State University, East Lansing, MI, 48824, United States
| | - Nelson Sepúlveda
- Electrical and computer engineering, Michigan State University, 428 S Shaw Lane, East Lansing, MI, 48824, USA.
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Baker AJ, Galindo EJ, Angelos JD, Salazar DK, Sterritt SM, Willis AM, Tartis MS. Mechanical characterization data of polyacrylamide hydrogel formulations and 3D printed PLA for application in human head phantoms. Data Brief 2023; 48:109114. [PMID: 37122918 PMCID: PMC10130753 DOI: 10.1016/j.dib.2023.109114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
To study human traumatic brain injury (TBI) mechanics, a realistic surrogate must be developed for testing in impact experiments. In this data brief, materials used to simulate brain tissue and skull are characterized for application in a full-scale human head phantom. Polyacrylamide hydrogels are implemented as tissue scaffolds and tissue mimics because they are bioinert and tunable. These properties make them ideal for use as brain tissue in studies that simulate head impacts. The objective is to modify hydrogel formulations to have minimal swelling and optical clarity while maintaining properties that mimic brain tissue, such as density, viscoelastic properties, and rheological properties. Secondly, polylactic acid (PLA) polymers are 3D printed to create biomimetic skulls to enclose the hydrogel brain tissue mimic or brain phantom. PLA samples are printed and tested to determine their mechanical strength with the intention of roughly matching human skull properties. Hydrogel data was obtained with an oscillatory rheometer, while PLA samples were tested using a mechanical tester with a 3-point bend setup. The present data brief highlights several hydrogel formulations and compares them to identify the benefits of each formula and reports mechanical values of 3D printed PLA samples with 100% grid infill patterns applied in a skull model.
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Affiliation(s)
- Anthony J.A. Baker
- New Mexico Institute of Mining and Technology, Department of Chemical Engineering, 801 Leroy Place, Socorro, NM 87801, USA
| | - Eric J. Galindo
- New Mexico Institute of Mining and Technology, Department of Chemical Engineering, 801 Leroy Place, Socorro, NM 87801, USA
| | - James D. Angelos
- New Mexico Institute of Mining and Technology, Department of Chemical Engineering, 801 Leroy Place, Socorro, NM 87801, USA
| | - Dustin K. Salazar
- New Mexico Institute of Mining and Technology, Department of Chemical Engineering, 801 Leroy Place, Socorro, NM 87801, USA
| | - Sorcha M. Sterritt
- New Mexico Institute of Mining and Technology, Department of Chemical Engineering, 801 Leroy Place, Socorro, NM 87801, USA
| | - Adam M. Willis
- Michigan State University, Department of Mechanical Engineering, East Lansing MI, 48824, USA
- 59th Medical Wing, Office of the Chief Scientist, Lackland AFM, TX, 78236, USA
| | - Michaelann S. Tartis
- New Mexico Institute of Mining and Technology, Department of Chemical Engineering, 801 Leroy Place, Socorro, NM 87801, USA
- Corresponding author.
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Knutsen AK, Vidhate S, McIlvain G, Luster J, Galindo EJ, Johnson CL, Pham DL, Butman JA, Mejia-Alvarez R, Tartis M, Willis AM. Characterization of material properties and deformation in the ANGUS phantom during mild head impacts using MRI. J Mech Behav Biomed Mater 2023; 138:105586. [PMID: 36516544 PMCID: PMC10169236 DOI: 10.1016/j.jmbbm.2022.105586] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/26/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022]
Abstract
Traumatic brain injury (TBI) is a major health concern affecting both military and civilian populations. Despite notable advances in TBI research in recent years, there remains a significant gap in linking the impulsive loadings from a blast or a blunt impact to the clinical injury patterns observed in TBI. Synthetic head models or phantoms can be used to establish this link as they can be constructed with geometry, anatomy, and material properties that match the human brain, and can be used as an alternative to animal models. This study presents one such phantom called the Anthropomorphic Neurologic Gyrencephalic Unified Standard (ANGUS) phantom, which is an idealized gyrencephalic brain phantom composed of polyacrylamide gel. Here we mechanically characterized the ANGUS phantom using tagged magnetic resonance imaging (MRI) and magnetic resonance elastography (MRE), and then compared the outcomes to data obtained in healthy volunteers. The direct comparison between the phantom's response and the data from a cohort of in vivo human subjects demonstrate that the ANGUS phantom may be an appropriate model for bulk tissue response and gyral dynamics of the human brain under small amplitude linear impulses. However, the phantom's response differs from that of the in vivo human brain under rotational impacts, suggesting avenues for future improvements to the phantom.
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Affiliation(s)
- Andrew K Knutsen
- Center for Neuroscience and Regenerative Medicine, The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20814, USA
| | - Suhas Vidhate
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Grace McIlvain
- Department of Biomedical Engineering, University of Delaware, Newark, DE, 19716, USA
| | - Josh Luster
- Department of Neurology, Brooke Army Medical Center, Fort Sam Houston, TX, 78234, USA
| | - Eric J Galindo
- Department of Chemical Engineering, New Mexico Institute of Mining and Technology, Socorro, NM, 87801, USA
| | - Curtis L Johnson
- Department of Biomedical Engineering, University of Delaware, Newark, DE, 19716, USA
| | - Dzung L Pham
- Center for Neuroscience and Regenerative Medicine, The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20814, USA
| | - John A Butman
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Ricardo Mejia-Alvarez
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, 48824, USA
| | - Michaelann Tartis
- Department of Chemical Engineering, New Mexico Institute of Mining and Technology, Socorro, NM, 87801, USA
| | - Adam M Willis
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, 48824, USA; 59th Medical Wing, Office of the Chief Scientist, Lackland AFB, TX, 78236, USA
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Kerwin J, Yücesoy A, Vidhate S, Dávila-Montero BM, Van Orman JL, Pence TJ, Tartis M, Mejía-Alvarez R, Willis AM. Sulcal Cavitation in Linear Head Acceleration: Possible Correlation With Chronic Traumatic Encephalopathy. Front Neurol 2022; 13:832370. [PMID: 35295830 PMCID: PMC8918564 DOI: 10.3389/fneur.2022.832370] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022] Open
Abstract
Traumatic Brain Injury (TBI) is a significant public health and financial concern that is affecting tens of thousands of people in the United States annually. There were over a million hospital visits related to TBI in 2017. Along with immediate and short-term morbidity from TBI, chronic traumatic encephalopathy (CTE) can have life-altering, chronic morbidity, yet the direct linkage of how head impacts lead to this pathology remains unknown. A possible clue is that chronic traumatic encephalopathy appears to initiate in the depths of the sulci. The purpose of this study was to isolate the injury mechanism/s associated with blunt force impact events. To this end, drop tower experiments were performed on a human head phantom. Our phantom was fabricated into a three-dimensional extruded ellipsoid geometry made out of Polyacrylamide gelatin that incorporated gyri-sulci interaction. The phantom was assembled into a polylactic acid 3D-printed skull, surrounded with deionized water, and enclosed between two optical windows. The phantom received repetitive low-force impacts on the order of magnitude of an average boxing punch. Intracranial pressure profiles were recorded in conjunction with high-speed imaging, 25 k frames-per-second. Cavitation was observed in all trials. Cavitation is the spontaneous formation of vapor bubbles in the liquid phase resulting from a pressure drop that reaches the vapor pressure of the liquid. The observed cavitation was predominately located in the contrecoup during negative pressure phases of local intracranial pressure. To further investigate the cavitation interaction with the brain tissue phantom, a 2D plane strain computational model was built to simulate the deformation of gyrated tissue as a result from the initiation of cavitation bubbles seen in the phantom experiments. These computational experiments demonstrated a focusing of strain at the depths of the sulci from bubble expansion. Our results add further evidence that mechanical interactions could contribute to the development of chronic traumatic encephalopathy and also that fluid cavitation may play a role in this interaction.
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Affiliation(s)
- Joseph Kerwin
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Atacan Yücesoy
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Suhas Vidhate
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Bianca M. Dávila-Montero
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Jacob L. Van Orman
- Department of Neurology, Brooke Army Medical Center, Fort Sam Houston, TX, United States
| | - Thomas J. Pence
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Michaelann Tartis
- Department of Chemical Engineering, New Mexico Institute of Mining and Technology, Socorro, NM, United States
| | - Ricardo Mejía-Alvarez
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
- *Correspondence: Ricardo Mejía-Alvarez
| | - Adam M. Willis
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
- Department of Neurology, Brooke Army Medical Center, Fort Sam Houston, TX, United States
- Adam M. Willis
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Miller ST, Cooper CF, Elsbernd P, Kerwin J, Mejia-Alvarez R, Willis AM. Localizing Clinical Patterns of Blast Traumatic Brain Injury Through Computational Modeling and Simulation. Front Neurol 2021; 12:547655. [PMID: 34093380 PMCID: PMC8173077 DOI: 10.3389/fneur.2021.547655] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
Blast traumatic brain injury is ubiquitous in modern military conflict with significant morbidity and mortality. Yet the mechanism by which blast overpressure waves cause specific intracranial injury in humans remains unclear. Reviewing of both the clinical experience of neurointensivists and neurosurgeons who treated service members exposed to blast have revealed a pattern of injury to cerebral blood vessels, manifested as subarachnoid hemorrhage, pseudoaneurysm, and early diffuse cerebral edema. Additionally, a seminal neuropathologic case series of victims of blast traumatic brain injury (TBI) showed unique astroglial scarring patterns at the following tissue interfaces: subpial glial plate, perivascular, periventricular, and cerebral gray-white interface. The uniting feature of both the clinical and neuropathologic findings in blast TBI is the co-location of injury to material interfaces, be it solid-fluid or solid-solid interface. This motivates the hypothesis that blast TBI is an injury at the intracranial mechanical interfaces. In order to investigate the intracranial interface dynamics, we performed a novel set of computational simulations using a model human head simplified but containing models of gyri, sulci, cerebrospinal fluid (CSF), ventricles, and vasculature with high spatial resolution of the mechanical interfaces. Simulations were performed within a hybrid Eulerian—Lagrangian simulation suite (CTH coupled via Zapotec to Sierra Mechanics). Because of the large computational meshes, simulations required high performance computing resources. Twenty simulations were performed across multiple exposure scenarios—overpressures of 150, 250, and 500 kPa with 1 ms overpressure durations—for multiple blast exposures (front blast, side blast, and wall blast) across large variations in material model parameters (brain shear properties, skull elastic moduli). All simulations predict fluid cavitation within CSF (where intracerebral vasculature reside) with cavitation occurring deep and diffusely into cerebral sulci. These cavitation events are adjacent to high interface strain rates at the subpial glial plate. Larger overpressure simulations (250 and 500kPa) demonstrated intraventricular cavitation—also associated with adjacent high periventricular strain rates. Additionally, models of embedded intraparenchymal vascular structures—with diameters as small as 0.6 mm—predicted intravascular cavitation with adjacent high perivascular strain rates. The co-location of local maxima of strain rates near several of the regions that appear to be preferentially damaged in blast TBI (vascular structures, subpial glial plate, perivascular regions, and periventricular regions) suggest that intracranial interface dynamics may be important in understanding how blast overpressures leads to intracranial injury.
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Affiliation(s)
- Scott T Miller
- Computational Solid Mechanics & Structural Dynamics, Sandia National Laboratories, Albuquerque, NM, United States
| | - Candice F Cooper
- Terminal Ballistics Technology, Sandia National Laboratories, Albuquerque, NM, United States
| | - Paul Elsbernd
- Department of Neurology, Brooke Army Medical Center, Fort Sam Houston, TX, United States
| | - Joseph Kerwin
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Ricardo Mejia-Alvarez
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Adam M Willis
- Department of Neurology, Brooke Army Medical Center, Fort Sam Houston, TX, United States.,Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
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