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Rubio JE, Subramaniam DR, Unnikrishnan G, Sajja VSSS, Van Albert S, Rossetti F, Frock A, Nguyen G, Sundaramurthy A, Long JB, Reifman J. A biomechanical-based approach to scale blast-induced molecular changes in the brain. Sci Rep 2022; 12:14605. [PMID: 36028539 PMCID: PMC9418170 DOI: 10.1038/s41598-022-17967-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/03/2022] [Indexed: 11/09/2022] Open
Abstract
Animal studies provide valuable insights on how the interaction of blast waves with the head may injure the brain. However, there is no acceptable methodology to scale the findings from animals to humans. Here, we propose an experimental/computational approach to project observed blast-induced molecular changes in the rat brain to the human brain. Using a shock tube, we exposed rats to a range of blast overpressures (BOPs) and used a high-fidelity computational model of a rat head to correlate predicted biomechanical responses with measured changes in glial fibrillary acidic protein (GFAP) in rat brain tissues. Our analyses revealed correlates between model-predicted strain rate and measured GFAP changes in three brain regions. Using these correlates and a high-fidelity computational model of a human head, we determined the equivalent BOPs in rats and in humans that induced similar strain rates across the two species. We used the equivalent BOPs to project the measured GFAP changes in the rat brain to the human. Our results suggest that, relative to the rat, the human requires an exposure to a blast wave of a higher magnitude to elicit similar brain-tissue responses. Our proposed methodology could assist in the development of safety guidelines for blast exposure.
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Affiliation(s)
- Jose E Rubio
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, ATTN: FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720-A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Dhananjay Radhakrishnan Subramaniam
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, ATTN: FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720-A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Ginu Unnikrishnan
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, ATTN: FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720-A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Venkata Siva Sai Sujith Sajja
- Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | - Stephen Van Albert
- Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | - Franco Rossetti
- Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | - Andrew Frock
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, ATTN: FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720-A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Giang Nguyen
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, ATTN: FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720-A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Aravind Sundaramurthy
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, ATTN: FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720-A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Joseph B Long
- Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, ATTN: FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA.
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2
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Sundar S, Ponnalagu A. Biomechanical Analysis of Head Subjected to Blast Waves and the Role of Combat Protective Headgear Under Blast Loading: A Review. J Biomech Eng 2021; 143:100801. [PMID: 33954580 DOI: 10.1115/1.4051047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Indexed: 01/10/2023]
Abstract
Blast-induced traumatic brain injury (bTBI) is a rising health concern of soldiers deployed in modern-day military conflicts. For bTBI, blast wave loading is a cause, and damage incurred to brain tissue is the effect. There are several proposed mechanisms for the bTBI, such as direct cranial entry, skull flexure, thoracic compression, blast-induced acceleration, and cavitation that are not mutually exclusive. So the cause-effect relationship is not straightforward. The efficiency of protective headgears against blast waves is relatively unknown as compared with other threats. Proper knowledge about standard problem space, underlying mechanisms, blast reconstruction techniques, and biomechanical models are essential for protective headgear design and evaluation. Various researchers from cross disciplines analyze bTBI from different perspectives. From the biomedical perspective, the physiological response, neuropathology, injury scales, and even the molecular level and cellular level changes incurred during injury are essential. From a combat protective gear designer perspective, the spatial and temporal variation of mechanical correlates of brain injury such as surface overpressure, acceleration, tissue-level stresses, and strains are essential. This paper outlines the key inferences from bTBI studies that are essential in the protective headgear design context.
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Affiliation(s)
- Shyam Sundar
- Department of Civil Engineering, Indian Institute of Technology Madras, Chennai 600036, India
| | - Alagappan Ponnalagu
- Department of Civil Engineering, Indian Institute of Technology Madras, Chennai 600036, India
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Denny JW, Dickinson AS, Langdon GS. Defining blast loading 'zones of relevance' for primary blast injury research: A consensus of injury criteria for idealised explosive scenarios. Med Eng Phys 2021; 93:83-92. [PMID: 34154779 DOI: 10.1016/j.medengphy.2021.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/23/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
Blast injuries remain a serious threat to defence and civilian populations around the world. 'Primary' blast injuries (PBIs) are caused by direct blast wave interaction with the human body, particularly affecting air-containing organs. Work to define blast loading conditions for injury research has received relatively little attention, though with a continued experimental focus on PBIs and idealised explosion assumptions, meaningful test outcomes and subsequent clinical applications, rely on appropriate simulated conditions. This paper critically evaluates and combines existing PBI criteria (grouped into those affecting the auditory system, pulmonary injuries and brain trauma) as a function of idealised blast wave parameters. For clinical blast injury researchers, analysis of the multi-injury criteria indicates zones of appropriate loading conditions for human-scale test items and demonstrates the importance of simulating blast conditions that are both realistic and relevant to the injury type. For certain explosive scenarios, spatial interpretation of the 'zones of relevance' could support emergency response and hazard preparedness by informing triage, patient management and resource allocation, thus leading to improved health outcomes. This work will prove useful to clinical blast injury researchers, blast protection engineers and clinical practitioners involved in the triage, diagnosis, and treatment of PBIs.
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Affiliation(s)
- J W Denny
- Department of Mechanical Engineering, University of Southampton, Southampton, SO17 1BJ, UK.
| | - A S Dickinson
- Department of Mechanical Engineering, University of Southampton, Southampton, SO17 1BJ, UK
| | - G S Langdon
- Department of Civil and Structural Engineering, University of Sheffield, Mappin Street, Sheffield, S1 3JD, UK; Department of Mechanical Engineering, University of Cape Town, Cape Town, South Africa
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4
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Numerical Analysis of EOD Helmet under Blast Load Events Using Human Head Model. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10228227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Brain injury resulting from improved explosives devices (IEDs) is identified as a challenge for force securities to improve protection equipment. This paper focuses on the mechanical response of explosive ordnance disposal (EOD) helmet under different blast loadings. Limited published studies on this type of helmet are available in the scientific literature. The results obtained show the blast performance of the EOD helmet because a decrease in the maximum values in the measured damage parameters is found. Therefore, an EOD helmet minimizes the risks of the severity of injuries on the user showing a low probability of injury.
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Wood GW, Panzer MB, Cox CA, Bass CR. Interspecies Scaling in Blast Pulmonary Trauma. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s41314-018-0013-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Blast injuries affect millions of lives across the globe due to its traumatic after effects on the brain and the whole body. To date, military grade armour materials are designed to mitigate ballistic and shrapnel attacks but are less effective in resisting blast impacts. In order to improve blast absorption characteristics of armours, the first key step is thoroughly understands the effects of blasts on the human body itself. In the last decade, a plethora of experimental and computational work has been carried out to investigate the mechanics and pathophysiology of Traumatic Brain Injury (TBI). However, very few attempts have been made so far to study the effect of blasts on the various other parts of the body such as the sensory organs (eyes and ears), nervous system, thorax, extremities, internal organs (such as the lungs) and the skeletal system. While an experimental evaluation of blast effects on such physiological systems is difficult, developing finite element (FE) models could allow the recreation of realistic blast scenarios on full scale human models and simulate the effects. The current article reviews the state-of-the-art in computational research in blast induced whole-body injury modelling, which would not only help in identifying the areas in which further research is required, but would also be indispensable for understanding body location specific armour design criteria for improved blast injury mitigation.
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Affiliation(s)
- Arnab Chanda
- a Department of Aerospace Engineering and Mechanics , University of Alabama , Tuscaloosa , AL , USA
| | - Christian Callaway
- b Department of Mechanical Engineering , University of Alabama , Tuscaloosa , AL , USA
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Lance RM, Stalcup L, Wojtylak B, Bass CR. Air blast injuries killed the crew of the submarine H.L. Hunley. PLoS One 2017; 12:e0182244. [PMID: 28832592 PMCID: PMC5568114 DOI: 10.1371/journal.pone.0182244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/14/2017] [Indexed: 11/18/2022] Open
Abstract
The submarine H.L. Hunley was the first submarine to sink an enemy ship during combat; however, the cause of its sinking has been a mystery for over 150 years. The Hunley set off a 61.2 kg (135 lb) black powder torpedo at a distance less than 5 m (16 ft) off its bow. Scaled experiments were performed that measured black powder and shock tube explosions underwater and propagation of blasts through a model ship hull. This propagation data was used in combination with archival experimental data to evaluate the risk to the crew from their own torpedo. The blast produced likely caused flexion of the ship hull to transmit the blast wave; the secondary wave transmitted inside the crew compartment was of sufficient magnitude that the calculated chances of survival were less than 16% for each crew member. The submarine drifted to its resting place after the crew died of air blast trauma within the hull.
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Affiliation(s)
- Rachel M. Lance
- Naval Surface Warfare Center Panama City Division, Code E15 Underwater Systems Development and Acquisition, Panama City, Florida, United States of America
- Duke University Department of Biomedical Engineering, Durham, North Carolina, United States of America
| | - Lucas Stalcup
- Duke University Medical School, Durham, North Carolina, United States of America
| | - Brad Wojtylak
- Bureau of Alcohol, Tobacco, Firearms, and Explosives, Wilmington, North Carolina, United States of America
| | - Cameron R. Bass
- Duke University Department of Biomedical Engineering, Durham, North Carolina, United States of America
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8
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Abstract
Multiscale damage due to cavitation is considered as a potential mechanism of traumatic brain injury (TBI) associated with explosion. In this study, we employed a TBI relevant hippocampal ex vivo slice model to induce bubble cavitation. Placement of single reproducible seed bubbles allowed control of size, number, and tissue location to visualize and measure deformation parameters. Maximum strain value was measured at 45 µs after bubble collapse, presented with a distinct contour and coincided temporally and spatially with the liquid jet. Composite injury maps combined this maximum strain value with maximum measured bubble size and location along with histological injury patterns. This facilitated the correlation of bubble location and subsequent jet direction to the corresponding regions of high strain which overlapped with regions of observed injury. A dynamic threshold strain range for tearing of cerebral cortex was estimated to be between 0.5 and 0.6. For a seed bubble placed underneath the hippocampus, cavitation induced damage was observed in hippocampus (local), proximal cerebral cortex (marginal) and the midbrain/forebrain (remote) upon histological evaluation. Within this test model, zone of cavitation injury was greater than the maximum radius of the bubble. Separation of apposed structures, tissue tearing, and disruption of cellular layers defined early injury patterns that were not detected in the blast-exposed half of the brain slice. Ultrastructural pathology of the neurons exposed to cavitation was characterized by disintegration of plasma membrane along with loss of cellular content. The developed test system provided a controlled experimental platform to study cavitation induced high strain deformations on brain tissue slice. The goal of the future studies will be to lower underpressure magnitude and cavitation bubble size for more sensitive evaluation of injury.
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Scott T, Kirkman E, Haque M, Gibb I, Mahoney P, Hardman J. Primary blast lung injury - a review. Br J Anaesth 2017; 118:311-316. [DOI: 10.1093/bja/aew385] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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BODO MICHÈLE, ROTH SÉBASTIEN. UNCERTAINTIES OF IMPACT CONFIGURATION FOR NUMERICAL REPLICATIONS OF REAL-WORLD TRAUMA: A FE ANALYSIS. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416400182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study deals with free fall accident analysis involving adults, and their numerical replications using a finite element model of the human thorax. The main purpose is to determine the role of body position at impact in the thorax injury risk appearance. For this study, cases of real-world free-fall provided by an emergency department were selected and investigated. These cases involved both male and female with an age range of 20 to 63 years, who sustained accidental free-fall with both injured and uninjured cases. The examination of the patients' medical record provided helpful information to accurately perform numerical replications with the finite element model HUByx (Hermaphrodite Universal Biomechanical yx model) which was already validated for various experimental tests in the field of automobile, ballistic impacts and blast. The results of simulations at different impact location allowed highlighting the crucial influence of the body orientation in the risk of thoracic injury occurrence.
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Affiliation(s)
- MICHÈLE BODO
- Université de Bourgogne Franche-Comté, Université de Technologie de Belfort-Montbéliard UTBM, 90010 BELFORT Cedex, France
| | - SÉBASTIEN ROTH
- Université de Bourgogne Franche-Comté, Université de Technologie de Belfort-Montbéliard UTBM, 90010 BELFORT Cedex, France
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11
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Scott T, Hulse E, Haque M, Kirkman E, Hardman J, Mahoney P. Modelling primary blast lung injury: current capability and future direction. J ROY ARMY MED CORPS 2016; 163:84-88. [PMID: 27881470 DOI: 10.1136/jramc-2016-000678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/18/2016] [Accepted: 10/11/2016] [Indexed: 12/27/2022]
Abstract
Primary blast lung injury frequently complicates military conflict and terrorist attacks on civilian populations. The fact that it occurs in areas of conflict or unpredictable mass casualty events makes clinical study in human casualties implausible. Research in this field is therefore reliant on the use of some form of biological or non-biological surrogate model. This article briefly reviews the modelling work undertaken in this field until now and describes the rationale behind the generation of an in silico physiological model.
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Affiliation(s)
- Timothy Scott
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, ICT Centre, Birmingham, UK
| | - E Hulse
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, ICT Centre, Birmingham, UK
| | - M Haque
- Anaesthesia & Critical Care Research Group, Division of Clinical Neuroscience, Nottingham University Hospital, Queens Medical Centre, Nottingham, UK
| | - E Kirkman
- Defence Science and Technology Laboratories, Salisbury, UK
| | - J Hardman
- Anaesthesia & Critical Care Research Group, Division of Clinical Neuroscience, Nottingham University Hospital, Queens Medical Centre, Nottingham, UK
| | - P Mahoney
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, ICT Centre, Birmingham, UK
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Lance RM, Capehart B, Kadro O, Bass CR. Human Injury Criteria for Underwater Blasts. PLoS One 2015; 10:e0143485. [PMID: 26606655 PMCID: PMC4659630 DOI: 10.1371/journal.pone.0143485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 11/05/2015] [Indexed: 11/19/2022] Open
Abstract
Underwater blasts propagate further and injure more readily than equivalent air blasts. Development of effective personal protection and countermeasures, however, requires knowledge of the currently unknown human tolerance to underwater blast. Current guidelines for prevention of underwater blast injury are not based on any organized injury risk assessment, human data or experimental data. The goal of this study was to derive injury risk assessments for underwater blast using well-characterized human underwater blast exposures in the open literature. The human injury dataset was compiled using 34 case reports on underwater blast exposure to 475 personnel, dating as early as 1916. Using severity ratings, computational reconstructions of the blasts, and survival information from a final set of 262 human exposures, injury risk models were developed for both injury severity and risk of fatality as functions of blast impulse and blast peak overpressure. Based on these human data, we found that the 50% risk of fatality from underwater blast occurred at 302±16 kPa-ms impulse. Conservatively, there is a 20% risk of pulmonary injury at a kilometer from a 20 kg charge. From a clinical point of view, this new injury risk model emphasizes the large distances possible for potential pulmonary and gut injuries in water compared with air. This risk value is the first impulse-based fatality risk calculated from human data. The large-scale inconsistency between the blast exposures in the case reports and the guidelines available in the literature prior to this study further underscored the need for this new guideline derived from the unique dataset of actual injuries in this study.
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Affiliation(s)
- Rachel M. Lance
- Code E15 Underwater Systems Development and Acquisition, Naval Surface Warfare Center Panama City Division, Panama City, Florida, United States of America
- Pratt School of Engineering, Duke University, Durham, North Carolina, United States of America
| | - Bruce Capehart
- Veterans Administration Medical Center, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Omar Kadro
- William Beaumont Hospital, Royal Oak, Michigan, United States of America
| | - Cameron R. Bass
- Pratt School of Engineering, Duke University, Durham, North Carolina, United States of America
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Miller AP, Shah AS, Aperi BV, Budde MD, Pintar FA, Tarima S, Kurpad SN, Stemper BD, Glavaski-Joksimovic A. Effects of blast overpressure on neurons and glial cells in rat organotypic hippocampal slice cultures. Front Neurol 2015; 6:20. [PMID: 25729377 PMCID: PMC4325926 DOI: 10.3389/fneur.2015.00020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 01/25/2015] [Indexed: 11/13/2022] Open
Abstract
Due to recent involvement in military conflicts, and an increase in the use of explosives, there has been an escalation in the incidence of blast-induced traumatic brain injury (bTBI) among US military personnel. Having a better understanding of the cellular and molecular cascade of events in bTBI is prerequisite for the development of an effective therapy that currently is unavailable. The present study utilized organotypic hippocampal slice cultures (OHCs) exposed to blast overpressures of 150 kPa (low) and 280 kPa (high) as an in vitro bTBI model. Using this model, we further characterized the cellular effects of the blast injury. Blast-evoked cell death was visualized by a propidium iodide (PI) uptake assay as early as 2 h post-injury. Quantification of PI staining in the cornu Ammonis 1 and 3 (CA1 and CA3) and the dentate gyrus regions of the hippocampus at 2, 24, 48, and 72 h following blast exposure revealed significant time dependent effects. OHCs exposed to 150 kPa demonstrated a slow increase in cell death plateauing between 24 and 48 h, while OHCs from the high-blast group exhibited a rapid increase in cell death already at 2 h, peaking at ~24 h post-injury. Measurements of lactate dehydrogenase release into the culture medium also revealed a significant increase in cell lysis in both low- and high-blast groups compared to sham controls. OHCs were fixed at 72 h post-injury and immunostained for markers against neurons, astrocytes, and microglia. Labeling OHCs with PI, neuronal, and glial markers revealed that the blast-evoked extensive neuronal death and to a lesser extent loss of glial cells. Furthermore, our data demonstrated activation of astrocytes and microglial cells in low- and high-blasted OHCs, which reached a statistically significant difference in the high-blast group. These data confirmed that our in vitro bTBI model is a useful tool for studying cellular and molecular changes after blast exposure.
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Affiliation(s)
- Anna P Miller
- Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, WI , USA ; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin , Milwaukee, WI , USA ; Clement J. Zablocki Veterans Affairs Medical Center , Milwaukee, WI , USA
| | - Alok S Shah
- Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, WI , USA ; Clement J. Zablocki Veterans Affairs Medical Center , Milwaukee, WI , USA
| | - Brandy V Aperi
- Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, WI , USA ; Clement J. Zablocki Veterans Affairs Medical Center , Milwaukee, WI , USA
| | - Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, WI , USA ; Clement J. Zablocki Veterans Affairs Medical Center , Milwaukee, WI , USA
| | - Frank A Pintar
- Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, WI , USA ; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin , Milwaukee, WI , USA ; Clement J. Zablocki Veterans Affairs Medical Center , Milwaukee, WI , USA
| | - Sergey Tarima
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin , Milwaukee, WI , USA
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, WI , USA ; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin , Milwaukee, WI , USA ; Clement J. Zablocki Veterans Affairs Medical Center , Milwaukee, WI , USA
| | - Brian D Stemper
- Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, WI , USA ; Clement J. Zablocki Veterans Affairs Medical Center , Milwaukee, WI , USA
| | - Aleksandra Glavaski-Joksimovic
- Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, WI , USA ; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin , Milwaukee, WI , USA ; Clement J. Zablocki Veterans Affairs Medical Center , Milwaukee, WI , USA
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15
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Elder GA, Stone JR, Ahlers ST. Effects of low-level blast exposure on the nervous system: is there really a controversy? Front Neurol 2014; 5:269. [PMID: 25566175 PMCID: PMC4271615 DOI: 10.3389/fneur.2014.00269] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/29/2014] [Indexed: 12/20/2022] Open
Abstract
High-pressure blast waves can cause extensive CNS injury in human beings. However, in combat settings, such as Iraq and Afghanistan, lower level exposures associated with mild traumatic brain injury (mTBI) or subclinical exposure have been much more common. Yet controversy exists concerning what traits can be attributed to low-level blast, in large part due to the difficulty of distinguishing blast-related mTBI from post-traumatic stress disorder (PTSD). We describe how TBI is defined in human beings and the problems posed in using current definitions to recognize blast-related mTBI. We next consider the problem of applying definitions of human mTBI to animal models, in particular that TBI severity in human beings is defined in relation to alteration of consciousness at the time of injury, which typically cannot be assessed in animals. However, based on outcome assessments, a condition of "low-level" blast exposure can be defined in animals that likely approximates human mTBI or subclinical exposure. We review blast injury modeling in animals noting that inconsistencies in experimental approach have contributed to uncertainty over the effects of low-level blast. Yet, animal studies show that low-level blast pressure waves are transmitted to the brain. In brain, low-level blast exposures cause behavioral, biochemical, pathological, and physiological effects on the nervous system including the induction of PTSD-related behavioral traits in the absence of a psychological stressor. We review the relationship of blast exposure to chronic neurodegenerative diseases noting the paradoxical lowering of Abeta by blast, which along with other observations suggest that blast-related TBI is pathophysiologically distinct from non-blast TBI. Human neuroimaging studies show that blast-related mTBI is associated with a variety of chronic effects that are unlikely to be explained by co-morbid PTSD. We conclude that abundant evidence supports low-level blast as having long-term effects on the nervous system.
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Affiliation(s)
- Gregory A. Elder
- Neurology Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James R. Stone
- Department of Radiology, University of Virginia, Charlottesville, VA, USA
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Stephen T. Ahlers
- Department of Neurotrauma, Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, USA
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16
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Laksari K, Assari S, Seibold B, Sadeghipour K, Darvish K. Computational simulation of the mechanical response of brain tissue under blast loading. Biomech Model Mechanobiol 2014; 14:459-72. [PMID: 25205088 DOI: 10.1007/s10237-014-0616-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 09/02/2014] [Indexed: 12/20/2022]
Abstract
In the present study, numerical simulations of nonlinear wave propagation and shock formation in brain tissue have been presented and a new mechanism of injury for blast-induced neurotrauma (BINT) is proposed. A quasilinear viscoelastic (QLV) constitutive material model was used that encompasses the nonlinearity as well as the rate dependence of the tissue relevant to BINT modeling. A one-dimensional model was implemented using the discontinuous Galerkin finite element method and studied with displacement- and pressure-input boundary conditions. The model was validated against LS-DYNA finite element code and theoretical results for specific conditions that resulted in shock wave formation. It was shown that a continuous wave can become a shock wave as it propagates in the QLV brain tissue when the initial changes in acceleration are beyond a certain limit. The high spatial gradient of stress and strain at the shock front cause large relative motions at the cellular scale at high temporal rates even when the maximum stresses and strains are relatively low. This gradient-induced local deformation may occur away from the boundary and is proposed as a contributing factor to the diffuse nature of BINT.
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Affiliation(s)
- Kaveh Laksari
- Department of Mechanical Engineering, Temple University, Philadelphia, PA, USA
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17
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Singh D, Cronin DS, Haladuick TN. Head and brain response to blast using sagittal and transverse finite element models. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2014; 30:470-489. [PMID: 24293124 DOI: 10.1002/cnm.2612] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 10/08/2013] [Accepted: 10/12/2013] [Indexed: 06/02/2023]
Abstract
Mild traumatic brain injury caused by blast exposure from Improvised Explosive Devices has become increasingly prevalent in modern conflicts. To investigate head kinematics and brain tissue response in blast scenarios, two solid hexahedral blast-head models were developed in the sagittal and transverse planes. The models were coupled to an Arbitrary Lagrangian-Eulerian model of the surrounding air to model blast-head interaction, for three blast load cases (5 kg C4 at 3, 3.5 and 4 m). The models were validated using experimental kinematic data, where predicted accelerations were in good agreement with experimental tests, and intracranial pressure traces at four locations in the brain, where the models provided good predictions for frontal, temporal and parietal, but underpredicted pressures at the occipital location. Brain tissue response was investigated for the wide range of constitutive properties available. The models predicted relatively low peak principal brain tissue strains from 0.035 to 0.087; however, strain rates ranged from 225 to 571 s-1. Importantly, these models have allowed us to quantify expected strains and strain rates experienced in brain tissue, which can be used to guide future material characterization. These computationally efficient and predictive models can be used to evaluate protection and mitigation strategies in future analysis.
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Hue CD, Cao S, Haider SF, Vo KV, Effgen GB, Vogel E, Panzer MB, Bass CR“D, Meaney DF, Morrison B. Blood-Brain Barrier Dysfunction after Primary Blast Injury in vitro. J Neurotrauma 2013; 30:1652-63. [DOI: 10.1089/neu.2012.2773] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Christopher D. Hue
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Siqi Cao
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Syed F. Haider
- Department of Biology, The City College of New York, New York, New York
| | - Kiet V. Vo
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Gwen B. Effgen
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Edward Vogel
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Matthew B. Panzer
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | | | - David F. Meaney
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Barclay Morrison
- Department of Biomedical Engineering, Columbia University, New York, New York
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Shridharani JK, Wood GW, Panzer MB, Capehart BP, Nyein MK, Radovitzky RA, Bass CR'. Porcine head response to blast. Front Neurol 2012; 3:70. [PMID: 22586417 PMCID: PMC3347090 DOI: 10.3389/fneur.2012.00070] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 04/11/2012] [Indexed: 11/23/2022] Open
Abstract
Recent studies have shown an increase in the frequency of traumatic brain injuries related to blast exposure. However, the mechanisms that cause blast neurotrauma are unknown. Blast neurotrauma research using computational models has been one method to elucidate that response of the brain in blast, and to identify possible mechanical correlates of injury. However, model validation against experimental data is required to ensure that the model output is representative of in vivo biomechanical response. This study exposes porcine subjects to primary blast overpressures generated using a compressed-gas shock tube. Shock tube blasts were directed to the unprotected head of each animal while the lungs and thorax were protected using ballistic protective vests similar to those employed in theater. The test conditions ranged from 110 to 740 kPa peak incident overpressure with scaled durations from 1.3 to 6.9 ms and correspond approximately with a 50% injury risk for brain bleeding and apnea in a ferret model scaled to porcine exposure. Instrumentation was placed on the porcine head to measure bulk acceleration, pressure at the surface of the head, and pressure inside the cranial cavity. Immediately after the blast, 5 of the 20 animals tested were apneic. Three subjects recovered without intervention within 30 s and the remaining two recovered within 8 min following respiratory assistance and administration of the respiratory stimulant doxapram. Gross examination of the brain revealed no indication of bleeding. Intracranial pressures ranged from 80 to 390 kPa as a result of the blast and were notably lower than the shock tube reflected pressures of 300–2830 kPa, indicating pressure attenuation by the skull up to a factor of 8.4. Peak head accelerations were measured from 385 to 3845 G’s and were well correlated with peak incident overpressure (R2 = 0.90). One SD corridors for the surface pressure, intracranial pressure (ICP), and head acceleration are presented to provide experimental data for computer model validation.
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Affiliation(s)
- Jay K Shridharani
- Injury Biomechanics Laboratory, Department of Biomedical Engineering, Duke University Durham, NC, USA
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20
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Panzer MB, Matthews KA, Yu AW, Morrison B, Meaney DF, Bass CR. A Multiscale Approach to Blast Neurotrauma Modeling: Part I - Development of Novel Test Devices for in vivo and in vitro Blast Injury Models. Front Neurol 2012; 3:46. [PMID: 22470367 PMCID: PMC3314189 DOI: 10.3389/fneur.2012.00046] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 03/09/2012] [Indexed: 11/16/2022] Open
Abstract
The loading conditions used in some current in vivo and in vitro blast-induced neurotrauma models may not be representative of real-world blast conditions. To address these limitations, we developed a compressed-gas driven shock tube with different driven lengths that can generate Friedlander-type blasts. The shock tube can generate overpressures up to 650 kPa with durations between 0.3 and 1.1 ms using compressed helium driver gas, and peak overpressures up to 450 kPa with durations between 0.6 and 3 ms using compressed nitrogen. This device is used for short-duration blast overpressure loading for small animal in vivo injury models, and contrasts the more frequently used long duration/high impulse blast overpressures in the literature. We also developed a new apparatus that is used with the shock tube to recreate the in vivo intracranial overpressure response for loading in vitro culture preparations. The receiver device surrounds the culture with materials of similar impedance to facilitate the propagation of a single overpressure pulse through the tissue. This method prevents pressure waves reflecting off the tissue that can cause unrealistic deformation and injury. The receiver performance was characterized using the longest helium-driven shock tube, and produced in-fluid overpressures up to 1500 kPa at the location where a culture would be placed. This response was well correlated with the overpressure conditions from the shock tube (R2 = 0.97). Finite element models of the shock tube and receiver were developed and validated to better elucidate the mechanics of this methodology. A demonstration exposing a culture to the loading conditions created by this system suggest tissue strains less than 5% for all pressure levels simulated, which was well below functional deficit thresholds for strain rates less than 50 s−1. This novel system is not limited to a specific type of culture model and can be modified to reproduce more complex pressure pulses.
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Affiliation(s)
- Matthew B Panzer
- Department of Biomedical Engineering, Duke University Durham, NC, USA
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21
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Effgen GB, Hue CD, Vogel E, Panzer MB, Meaney DF, Bass CR, Morrison B. A Multiscale Approach to Blast Neurotrauma Modeling: Part II: Methodology for Inducing Blast Injury to in vitro Models. Front Neurol 2012; 3:23. [PMID: 22375134 PMCID: PMC3285773 DOI: 10.3389/fneur.2012.00023] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 02/07/2012] [Indexed: 01/09/2023] Open
Abstract
Due to the prominent role of improvised explosive devices (IEDs) in wounding patterns of U.S. war-fighters in Iraq and Afghanistan, blast injury has risen to a new level of importance and is recognized to be a major cause of injuries to the brain. However, an injury risk-function for microscopic, macroscopic, behavioral, and neurological deficits has yet to be defined. While operational blast injuries can be very complex and thus difficult to analyze, a simplified blast injury model would facilitate studies correlating biological outcomes with blast biomechanics to define tolerance criteria. Blast-induced traumatic brain injury (bTBI) results from the translation of a shock wave in-air, such as that produced by an IED, into a pressure wave within the skull-brain complex. Our blast injury methodology recapitulates this phenomenon in vitro, allowing for control of the injury biomechanics via a compressed-gas shock tube used in conjunction with a custom-designed, fluid-filled receiver that contains the living culture. The receiver converts the air shock wave into a fast-rising pressure transient with minimal reflections, mimicking the intracranial pressure history in blast. We have developed an organotypic hippocampal slice culture model that exhibits cell death when exposed to a 530 ± 17.7-kPa peak overpressure with a 1.026 ± 0.017-ms duration and 190 ± 10.7 kPa-ms impulse in-air. We have also injured a simplified in vitro model of the blood-brain barrier, which exhibits disrupted integrity immediately following exposure to 581 ± 10.0 kPa peak overpressure with a 1.067 ± 0.006-ms duration and 222 ± 6.9 kPa-ms impulse in-air. To better prevent and treat bTBI, both the initiating biomechanics and the ensuing pathobiology must be understood in greater detail. A well-characterized, in vitro model of bTBI, in conjunction with animal models, will be a powerful tool for developing strategies to mitigate the risks of bTBI.
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Affiliation(s)
- Gwen B Effgen
- Department of Biomedical Engineering, Columbia University New York, NY, USA
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22
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Development of a Finite Element Model for Blast Brain Injury and the Effects of CSF Cavitation. Ann Biomed Eng 2012; 40:1530-44. [DOI: 10.1007/s10439-012-0519-2] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 01/19/2012] [Indexed: 01/13/2023]
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Bass CR, Panzer MB, Rafaels KA, Wood G, Shridharani J, Capehart B. Brain Injuries from Blast. Ann Biomed Eng 2011; 40:185-202. [DOI: 10.1007/s10439-011-0424-0] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Accepted: 09/27/2011] [Indexed: 11/25/2022]
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