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Knapp CP, Papadopoulos E, Loweth JA, Raghupathi R, Floresco SB, Waterhouse BD, Navarra RL. Sex-dependent perturbations in risky choice behavior and prefrontal tyrosine hydroxylase levels induced by repetitive mild traumatic brain injury. Behav Brain Res 2024; 476:115244. [PMID: 39241835 DOI: 10.1016/j.bbr.2024.115244] [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: 06/14/2024] [Revised: 08/30/2024] [Accepted: 09/03/2024] [Indexed: 09/09/2024]
Abstract
Head trauma often impairs cognitive processes mediated within the prefrontal cortex (PFC), leading to impaired decision making and risk-taking behavior. Mild traumatic brain injury (mTBI) accounts for approximately 80 % of reported head injury cases. Most neurological symptoms of a single mTBI are transient; however, growing evidence suggests that repeated mTBI (rmTBI) results in more severe impairments that worsen with each subsequent injury. Although mTBI-induced disruption of risk/reward decision making has been characterized, the potential for rmTBI to exacerbate these effects and the neural mechanisms involved are unknown. Catecholamine neurotransmitters, dopamine (DA) and norepinephrine (NE), modulate PFC-mediated functions. Imbalances in catecholamine function have been associated with TBI and may underlie aberrant decision making. We used a closed head-controlled cortical impact (CH-CCI) model in rats to evaluate the effects of rmTBI on performance of a probabilistic discounting task of risk/reward decision making behavior and expression levels of catecholamine regulatory proteins within the PFC. RmTBI produced transient increases in risky choice preference in both male and female rats, with these effects persisting longer in females. Additionally, rmTBI increased expression of the catecholamine synthetic enzyme, tyrosine hydroxylase (TH), within the orbitofrontal (OFC) region of the PFC in females only. These results suggest females are more susceptible to rmTBI-induced disruption of risk/reward decision making behavior and dysregulation of catecholamine synthesis within the OFC. Together, using the CH-CCI model of rodent rmTBI to evaluate the effects of multiple insults on risk-taking behavior and PFC catecholamine regulation begins to differentiate how mTBI occurrences affect neuropathological outcomes across different sexes.
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Affiliation(s)
- Christopher P Knapp
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, 42 East Laurel Road, Suite 2200, Stratford, NJ 08084, USA.
| | - Eleni Papadopoulos
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, 42 East Laurel Road, Suite 2200, Stratford, NJ 08084, USA.
| | - Jessica A Loweth
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, 42 East Laurel Road, Suite 2200, Stratford, NJ 08084, USA.
| | - Ramesh Raghupathi
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 W. Queen Lane, Philadelphia, PA 19129, USA.
| | - Stan B Floresco
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2136 West Mall, Vancouver, BC V6T 1Z4, Canada.
| | - Barry D Waterhouse
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, 42 East Laurel Road, Suite 2200, Stratford, NJ 08084, USA.
| | - Rachel L Navarra
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, 42 East Laurel Road, Suite 2200, Stratford, NJ 08084, USA.
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Plummer CJ, Abramson N. Acute Concussion. Phys Med Rehabil Clin N Am 2024; 35:523-533. [PMID: 38945648 DOI: 10.1016/j.pmr.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Concussions are the most common type of traumatic brain injury. They result from external force to the head that causes a neuro-metabolic cascade to unfold. This can then lead to a variety of symptoms in the domains of physical, cognition, mood, and sleep. Concussions are a clinical diagnosis but it is important to rule out acute intracranial pathology through a detailed history and physical examination in addition to possible head imaging. Treatment should include an individualized approach that focuses on what domains are affected after concussion.
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Affiliation(s)
- Clausyl J Plummer
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 Children's Way, Nashville, TN 37212, USA.
| | - Nicholas Abramson
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 Children's Way, Nashville, TN 37212, USA
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3
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Ngai A, Hibberd O, Hassan H, Whitehouse DP, Richter S, Newcombe V. Time to resolution of symptoms and recovery after mild traumatic brain injury: protocol for a systematic review and meta-analysis. BMJ Open 2024; 14:e082700. [PMID: 39009455 PMCID: PMC11253732 DOI: 10.1136/bmjopen-2023-082700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/01/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION Mild traumatic brain injury (mTBI) is a leading cause of morbidity and mortality, with approximately 1 out of 200 people each year sustaining an mTBI in Europe. There is a growing awareness that recovery may take months or years. However, the exact time frame of recovery remains ill-defined in the literature. This systematic review aims to record the range of outcome measures used for mTBI and understand the time to recovery for different outcomes. METHODS AND ANALYSIS This protocol complies with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline. A prespecified literature search for articles in the English language will be conducted from database inception to the date of searches using MEDLINE and EMBASE. A trial search was conducted on 5 October 2023 with refinement of the search criteria following this. For each study, screening of the title, abstract and full text, as well as data extraction, will be done by two reviewers, with an adjudicating third reviewer if required. The risk of bias will be assessed using the Cochrane risk of bias tool for clinical trials and the Newcastle Ottawa score for cohort studies. The primary outcome is the time to resolution of symptoms in mTBI patients who have a full recovery, using any validated outcome measure. Results will be categorised by symptom groups, including but not limited to post-concussive symptoms, mental health, functional recovery and health-related quality of life. For mTBI patients who do not recover, this review will also explore the time to the plateau of symptoms and the sequelae of these symptoms. Where possible, meta-analysis will be undertaken, with a narrative review undertaken when this is not possible. Subgroup analyses of patients aged over 64 years, and patients with repetitive head injury, are planned. ETHICAL REVIEW AND DISSEMINATION Ethical review is not required, as no original data will be collected. Results will be disseminated through peer-reviewed publications and academic conferences. PROSPERO REGISTRATION NUMBER CRD42023462797.
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Affiliation(s)
- Adrian Ngai
- School of Clinical Medicine, Cambridge University, Cambridge, UK
| | - Owen Hibberd
- Emergency and Urgent Care Research in Cambridge (EURECA), PACE Section, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Hamda Hassan
- Emergency and Urgent Care Research in Cambridge (EURECA), PACE Section, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Daniel P Whitehouse
- Emergency and Urgent Care Research in Cambridge (EURECA), PACE Section, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Sophie Richter
- Emergency and Urgent Care Research in Cambridge (EURECA), PACE Section, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Virginia Newcombe
- Emergency and Urgent Care Research in Cambridge (EURECA), PACE Section, Department of Medicine, University of Cambridge, Cambridge, UK
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Bielanin JP, Metwally SAH, Oft HCM, Paruchuri SS, Lin L, Capuk O, Pennock ND, Song S, Sun D. NHE1 Protein in Repetitive Mild TBI-Mediated Neuroinflammation and Neurological Function Impairment. Antioxidants (Basel) 2024; 13:836. [PMID: 39061904 PMCID: PMC11274226 DOI: 10.3390/antiox13070836] [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: 04/19/2024] [Revised: 06/30/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Mild traumatic brain injuries (mTBIs) are highly prevalent and can lead to chronic behavioral and cognitive deficits often associated with the development of neurodegenerative diseases. Oxidative stress and formation of reactive oxygen species (ROS) have been implicated in mTBI-mediated axonal injury and pathogenesis. However, the underlying mechanisms and contributing factors are not completely understood. In this study, we explore these pathogenic mechanisms utilizing a murine model of repetitive mTBI (r-mTBI) involving five closed-skull concussions in young adult C57BL/6J mice. We observed a significant elevation of Na+/H+ exchanger protein (NHE1) expression in GFAP+ reactive astrocytes, IBA1+ microglia, and OLIG2+ oligodendrocytes across various brain regions (including the cerebral cortex, corpus callosum, and hippocampus) after r-mTBI. This elevation was accompanied by astrogliosis, microgliosis, and the accumulation of amyloid precursor protein (APP). Mice subjected to r-mTBI displayed impaired motor learning and spatial memory. However, post-r-mTBI administration of a potent NHE1 inhibitor, HOE642, attenuated locomotor and cognitive functional deficits as well as pathological signatures of gliosis, oxidative stress, axonal damage, and white matter damage. These findings indicate NHE1 upregulation plays a role in r-mTBI-induced oxidative stress, axonal damage, and gliosis, suggesting NHE1 may be a promising therapeutic target to alleviate mTBI-induced injuries and restore neurological function.
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Affiliation(s)
- John P. Bielanin
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Shamseldin A. H. Metwally
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Helena C. M. Oft
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Satya S. Paruchuri
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Lin Lin
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Okan Capuk
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Nicholas D. Pennock
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Shanshan Song
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Veterans Affairs Pittsburgh Health Care System, Pittsburgh, PA 15213, USA
| | - Dandan Sun
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Veterans Affairs Pittsburgh Health Care System, Pittsburgh, PA 15213, USA
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Bennys K, Busto GU, Touchon J. Cumulative effects of subsequent concussions on the neural patterns of young rugby athletes: data from event-related potentials. Res Sports Med 2024; 32:609-620. [PMID: 36919531 DOI: 10.1080/15438627.2023.2189594] [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: 12/16/2021] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
Our study aimed at detecting a potential cumulative effect of subsequent concussions on the neural activation patterns of young rugby athletes with or without concussion history. Event-related brain potential (ERP) data from 24 rugby players, 22-year-old on average, were retrospectively examined. All underwent a Sport Concussion Assessment Tool (SCAT2) during preseason and an on-site ERP task (P300) following a recent concussion event (<48 hours). Sixteen players suffered at least one concussion in the previous 3 years and eight were without self-reported past concussion. While no differences were reported between groups regarding symptom appraisal on the SCAT2 assessment, ERP revealed significantly decreased P3b amplitude and a trend for increased P3b latency in players who experienced prior concussions. Our data thus support the cumulative effect of concussions on neuroelectric events in young rugby players, highlighting the importance of managing player's concussion load to reduce the risk of long-term injuries.
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Affiliation(s)
- Karim Bennys
- Memory Resources Research Center for Alzheimer's disease, Department of Neurology, University Hospital of Montpellier, Montpellier, France
- Neurophysiology Unit, Department of Neurology, University Hospital of Montpellier, Montpellier, France
| | - Germain U Busto
- Memory Resources Research Center for Alzheimer's disease, Department of Neurology, University Hospital of Montpellier, Montpellier, France
- Neurophysiology Unit, Department of Neurology, University Hospital of Montpellier, Montpellier, France
| | - Jacques Touchon
- Memory Resources Research Center for Alzheimer's disease, Department of Neurology, University Hospital of Montpellier, Montpellier, France
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Knapp CP, Papadopoulos E, Loweth JA, Raghupathi R, Floresco SB, Waterhouse BD, Navarra RL. Perturbations in risk/reward decision making and frontal cortical catecholamine regulation induced by mild traumatic brain injury. Behav Brain Res 2024; 467:115002. [PMID: 38636779 DOI: 10.1016/j.bbr.2024.115002] [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: 02/23/2024] [Revised: 04/03/2024] [Accepted: 04/14/2024] [Indexed: 04/20/2024]
Abstract
Mild traumatic brain injury (mTBI) disrupts cognitive processes that influence risk taking behavior. Little is known regarding the effects of repetitive mild injury (rmTBI) or whether these outcomes are sex specific. Risk/reward decision making is mediated by the prefrontal cortex (PFC), which is densely innervated by catecholaminergic fibers. Aberrant PFC catecholamine activity has been documented following TBI and may underlie TBI-induced risky behavior. The present study characterized the effects of rmTBI on risk/reward decision making behavior and catecholamine transmitter regulatory proteins within the PFC. Rats were exposed to sham, single (smTBI), or three closed-head controlled cortical impact (CH-CCI) injuries and assessed for injury-induced effects on risk/reward decision making using a probabilistic discounting task (PDT). In the first week post-final surgery, mTBI increased risky choice preference. By the fourth week, males exhibited increased latencies to make risky choices following rmTBI, demonstrating a delayed effect on processing speed. When levels of tyrosine hydroxylase (TH) and the norepinephrine reuptake transporter (NET) were measured within subregions of the PFC, females exhibited dramatic increases of TH levels within the orbitofrontal cortex (OFC) following smTBI. However, both males and females demonstrated reduced levels of OFC NET following rmTBI. These results indicate the OFC is susceptible to catecholamine instability after rmTBI and suggests that not all areas of the PFC contribute equally to TBI-induced imbalances. Overall, the CH-CCI model of rmTBI has revealed time-dependent and sex-specific changes in risk/reward decision making and catecholamine regulation following repetitive mild head injuries.
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Affiliation(s)
- Christopher P Knapp
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA.
| | - Eleni Papadopoulos
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA
| | - Jessica A Loweth
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA
| | - Ramesh Raghupathi
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Stan B Floresco
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Barry D Waterhouse
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA
| | - Rachel L Navarra
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA.
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Ju LS, Zhu J, Morey TE, Gravenstein N, Seubert CN, Setlow B, Martynyuk AE. Neurobehavioral Abnormalities in Offspring of Young Adult Male Rats With a History of Traumatic Brain Injury. J Neurotrauma 2024; 41:969-984. [PMID: 38279844 PMCID: PMC11005382 DOI: 10.1089/neu.2023.0364] [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: 01/29/2024] Open
Abstract
Children of parents with traumatic brain injury (TBI) are more likely to develop psychiatric disorders. This association is usually attributed to TBI-induced changes in parents' personality and families' social environment. We tested the hypothesis that offspring of young adult male rats with TBI develop neurodevelopmental abnormalities in the absence of direct social contact with sires. Male Sprague-Dawley rats (F0 generation) in the TBI group underwent moderate TBI via a midline fluid percussion injury that involved craniectomy under sevoflurane (SEVO) anesthesia for 40 min on post-natal Day 60 (P60), while F0 rats in the control group were placed in a new cage, one per cage, for the equivalent time duration. A subset of F0 rats was sacrificed on P66 to assess acute changes in hypothalamic-pituitary-adrenal (HPA) axis and inflammation markers. The remaining F0 males were mated with naive females on P90 to generate offspring (F1 generation). The F0 males and F1 males and females were sequentially evaluated in the elevated plus maze, for pre-pulse inhibition of acoustic startle, in the Morris water maze, and for resting and stress levels of serum corticosterone starting on ∼P105 (F0) and ∼P60 (F1), followed by tissue collection for further analyses. Acutely, the F0 TBI males had messenger RNA (mRNA) transcripts altered to support an increased hypothalamic and hippocampal Na+-K+-Cl- (Slc12a2) Cl- importer / K+-2Cl- (Slc12a5) Cl- exporter ratio and decreased hippocampal glucocorticoid receptors (Nr3c1), as well as increased serum levels of corticosterone, interleukin-1β (IL-1β), and biomarkers of activated hippocampal microglia and astrocytes. Long-term, F0 TBI rats exhibited increased corticosterone concentrations at rest and under stress, anxiety-like behavior, impaired sensory-motor gating, and impaired spatial memory. These abnormalities were underpinned by reduced mRNA levels of hypothalamic and hippocampal mineralocorticoid receptors (Nr3c2), hippocampal Nr3c1, and hypothalamic brain-derived neurotrophic factor (Bdnf), as well as elevated serum levels of IL-1β, and biomarkers of activated hippocampal microglia and astrocytes. F1 male offspring of TBI sires exhibited abnormalities in all behavioral tests, while their F1 female counterparts had abnormal pre-pulse inhibition responses only. F1 male offspring of TBI sires also had reduced mRNA levels of hippocampal Nr3c1 and Nr3c2, as well as hypothalamic and hippocampal Bdnf, whereas increases in inflammatory markers were more profound in F1 females. These findings suggest that offspring of sires with a history of a moderate TBI that involved craniectomy under SEVO anesthesia for 40 min, develop sex-dependent neurobehavioral abnormalities in the absence of direct social interaction between the sire and the offspring.
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Affiliation(s)
- Ling-Sha Ju
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jiepei Zhu
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Timothy E. Morey
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Nikolaus Gravenstein
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Christoph N. Seubert
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Barry Setlow
- McKnight Brain Institute, University of Florida College of Medicine, Gainesville, Florida, USA
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Anatoly E. Martynyuk
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
- McKnight Brain Institute, University of Florida College of Medicine, Gainesville, Florida, USA
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Gaudiani MA, Castle JP, Wolterink TD, Sprys-Tellner TJ, Haan JW, Sean Lynch T. Analysis of Player Performance and Financial Costs Associated With Implementation of an Updated National Hockey League Concussion Protocol: A Retrospective Comparative Study. Orthop J Sports Med 2024; 12:23259671241231757. [PMID: 38665385 PMCID: PMC11044774 DOI: 10.1177/23259671241231757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/23/2023] [Indexed: 04/28/2024] Open
Abstract
Background An updated National Hockey League (NHL) concussion protocol (NHLCP) was established in the 2016-2017 season to mitigate the negative outcomes of sport-related concussions. However, few studies on the effects of implementing the NHLCP have been performed. Purpose To define concussion incidence and investigate differences in NHL player performance after a concussion during periods before and after NHLCP implementation and assess the financial impact on NHL teams associated with NHLCP implementation. Study Design Cohort study; Level of evidence, 3. Methods This was a retrospective review of NHL players who sustained a concussion before (2000-2001 to 2015-2016 seasons) and after (2016-2017 to 2020-2021 seasons) implementing the NHLCP (pre-NHLCP and post-NHLCP groups). For each group, multiple performance metrics-including 30 days, 1 season, and 3 seasons before and after concussion-were compared for both groups. Return to play, total concussion cost, and association of return to play with cost were investigated using regression analysis. Results A total of 452 players (423 skaters, 29 goalies) sustained concussions during the study period, including 331 players (315 skaters, 16 goalies) in the pre-NHLCP group and 121 players (108 skaters, 13 goalies) in the post-NHLCP group. For both groups, no significant differences in standard performance were observed during the 30-day and 1-season periods before and after concussion. The mean return to play was significantly higher in the pre-NHLCP group than in the post-NHLCP group (20.1 vs 15.7 days; P = .022). The mean adjusted player salary was not different between groups; nonetheless, the mean adjusted replacement player salary was significantly higher in the post-NHLCP group ($744,505 vs $896,942; P = .032). The mean cost of time missed did not differ between groups. The mean return to play time significantly decreased over the entire study period (R2 = 0.33; P = .005), and the mean return to play time was positively associated with cost R2 = 0.215; P = .030). Conclusion Concussion incidence did not change after implementation of the updated NHLCP; nonetheless, players had significantly less missed time from injury after protocol implementation. Changes in player performance 30 days and 1 year before and after concussion injury were not different before and after NHLCP implementation. No differences were found in the financial cost of concussions between the pre- and post-NHLCP groups, and missed time was significantly correlated with mean cost from missed time.
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Affiliation(s)
- Michael A. Gaudiani
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan, USA
| | - Joshua P. Castle
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan, USA
| | | | | | - Jager W. Haan
- College of Human Medicine, Michigan State University, Michigan, USA
| | - T. Sean Lynch
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan, USA
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Bielanin JP, Metwally SAH, Paruchuri SS, Sun D. An overview of mild traumatic brain injuries and emerging therapeutic targets. Neurochem Int 2024; 172:105655. [PMID: 38072207 DOI: 10.1016/j.neuint.2023.105655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 01/01/2024]
Abstract
The majority of traumatic brain injuries (TBIs), approximately 90%, are classified as mild (mTBIs). Globally, an estimated 4 million injuries occur each year from concussions or mTBIs, highlighting their significance as a public health crisis. TBIs can lead to substantial long-term health consequences, including an increased risk of developing Alzheimer's Disease, Parkinson's Disease (PD), chronic traumatic encephalopathy (CTE), and nearly doubling one's risk of suicide. However, the current management of mTBIs in clinical practice and the available treatment options are limited. There exists an unmet need for effective therapy. This review addresses various aspects of mTBIs based on the most up-to-date literature review, with the goal of stimulating translational research to identify new therapeutic targets and improve our understanding of pathogenic mechanisms. First, we provide a summary of mTBI symptomatology and current diagnostic parameters such as the Glasgow Coma Scale (GCS) for classifying mTBIs or concussions, as well as the utility of alternative diagnostic parameters, including imaging techniques like MRI with diffusion tensor imaging (DTI) and serum biomarkers such as S100B, NSE, GFAP, UCH-L1, NFL, and t-tau. Our review highlights several pre-clinical concussion models employed in the study of mTBIs and the underlying cellular mechanisms involved in mTBI-related pathogenesis, including axonal damage, demyelination, inflammation, and oxidative stress. Finally, we examine a selection of new therapeutic targets currently under investigation in pre-clinical models. These targets may hold promise for clinical translation and address the pressing need for more effective treatments for mTBIs.
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Affiliation(s)
- John P Bielanin
- University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Shamseldin A H Metwally
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Satya S Paruchuri
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Dandan Sun
- University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Veterans Affairs Pittsburgh Health Care System, Pittsburgh, PA, 15213, USA.
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10
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Pedrosa M, Martins B, Araújo R. It's in the game: A review of neurological lesions associated with sports. J Neurol Sci 2023; 455:122803. [PMID: 37995461 DOI: 10.1016/j.jns.2023.122803] [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: 07/22/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION The practice of sports may lead to neurological injuries. While relatively uncommon (overall incidence of approximately 2.5%), and mostly benign and transient, some conditions may be life-threatening and permanent. Thus, both clinical neurologists and sports physicians should be aware of their existence and relevance. We aimed to review all sports-related neurological injuries and illnesses reported in the literature. METHODS Following SANRA guidelines, we performed a narrative review and searched PubMed and Scopus databases. Relevant sports were selected based on their recognition as an Olympic sport by the International Olympic Committee. Chronic traumatic encephalopathy (CTE) and other neurodegenerative disorders were not included. RESULTS A total of 292 studies were included concerning 33 different sports. The most reported neurological injury was damage to the peripheral nervous system. Traumatic injuries have also been extensively reported, including cerebral haemorrhage and arterial dissections. Non-traumatic life-threatening events are infrequent but may also occur, e.g. posterior reversible encephalopathy syndrome, cerebral venous thrombosis, and arterial dissections. Some conditions were predominantly reported in specific sports, e.g. yips in baseball and golf, raising the possibility of a common pathophysiology. Spinal cord infarction due to fibrocartilaginous embolism was reported in several sports associated with minor trauma. CONCLUSION Sports-related neurological injuries are increasingly receiving more social and medical attention and are an important cause of morbidity and mortality. This review may serve as a guide to physicians managing these challenging situations.
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Affiliation(s)
| | - Bárbara Martins
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Rui Araújo
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
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11
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Traumatic MicroRNAs: Deconvolving the Signal After Severe Traumatic Brain Injury. Cell Mol Neurobiol 2023; 43:1061-1075. [PMID: 35852739 DOI: 10.1007/s10571-022-01254-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/02/2022] [Indexed: 11/03/2022]
Abstract
History of traumatic brain injury (TBI) represents a significant risk factor for development of dementia and neurodegenerative disorders in later life. While histopathological sequelae and neurological diagnostics of TBI are well defined, the molecular events linking the post-TBI signaling and neurodegenerative cascades remain unknown. It is not only due to the brain's inaccessibility to direct molecular analysis but also due to the lack of well-defined and highly informative peripheral biomarkers. MicroRNAs (miRNAs) in blood are promising candidates to address this gap. Using integrative bioinformatics pipeline including miRNA:target identification, pathway enrichment, and protein-protein interactions analysis we identified set of genes, interacting proteins, and pathways that are connected to previously reported peripheral miRNAs, deregulated following severe traumatic brain injury (sTBI) in humans. This meta-analysis revealed a spectrum of genes closely related to critical biological processes, such as neuroregeneration including axon guidance and neurite outgrowth, neurotransmission, inflammation, proliferation, apoptosis, cell adhesion, and response to DNA damage. More importantly, we have identified molecular pathways associated with neurodegenerative conditions, including Alzheimer's and Parkinson's diseases, based on purely peripheral markers. The pathway signature after acute sTBI is similar to the one observed in chronic neurodegenerative conditions, which implicates a link between the post-sTBI signaling and neurodegeneration. Identified key hub interacting proteins represent a group of novel candidates for potential therapeutic targets or biomarkers.
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12
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Zhuang X, Bennett L, Nandy R, Cordes D, Bernick C, Ritter A. Longitudinal Changes in Cognitive Functioning and Brain Structure in Professional Boxers and Mixed Martial Artists After They Stop Fighting. Neurology 2022; 99:e2275-e2284. [PMID: 36104283 PMCID: PMC9694836 DOI: 10.1212/wnl.0000000000201158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study compares longitudinal changes in cognitive functioning and brain structures in male fighters who transitioned to an inactive fighting status without any further exposure to repetitive head impacts (RHIs) and fighters remaining active with continual exposure to RHIs. METHODS Participants were recruited from the Professional Fighters Brain Health Study. At time point (TP)1, all fighters were active, with continual exposure to RHIs. At TP2, fighters were considered "transitioned" if they had no sanctioned professional fights and had not been sparring for the past 2 years. Fighters were considered "active" if they continued to train and compete. All fighters underwent cognitive testing and 3T MRI at both TPs. A subset of our fighters (50%) underwent blood sampling for the characterization of neurofilament light (NfL) levels at both TPs. Linear mixed-effect models were applied to investigate the potentially different longitudinal trajectories (interaction effect between group and time) of cognitive function measures, NfL levels, and regional thickness measures (derived from structural MRI) between transitioned and active fighters. RESULTS Forty-five male transitioned fighters (aged 31.69 ± 6.27 years [TP1]; 22 boxers, 22 mixed martial artists, and 1 martial artist) and 45 demographically matched male active fighters (aged 30.24 ± 5.44 years [TP1]; 17 boxers, 27 mixed martial artists, and 1 martial artist) were included in the analyses. Significantly different longitudinal trajectories between transitioned and active fighters were observed in verbal memory (p FDR = 4.73E-04), psychomotor speed (p FDR = 4.73E-04), processing speed (p FDR = 3.90E-02), and NfL levels (p = 0.02). Transitioned fighters demonstrated longitudinally improved cognitive functioning and decreased NfL levels, and active fighters demonstrated declines in cognitive performance and stable NfL levels. Of 68 cortical regions inspected, 54 regions demonstrated a consistently changing trajectory, with thickness measures stabilizing on a group level for transitioned fighters and subtly declining over time for active fighters. DISCUSSION After fighters' cessation of RHI exposure, cognitive function and brain thickness measures may stabilize and blood NfL levels may decline. This study could be a starting point to identify potential predictors of individuals who are at a higher risk of RHI-related long-term neurologic conditions.
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Affiliation(s)
- Xiaowei Zhuang
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Lauren Bennett
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Rajesh Nandy
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Dietmar Cordes
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Charles Bernick
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Aaron Ritter
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle.
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13
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Esser T, Gruber C, Bürkner A, Buchmann N, Minzlaff P, Prodinger PM. [Traumatic brain injuries in winter sports : An overview based on the winter sports skiing, snowboarding and ice hockey]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:920-928. [PMID: 36227361 DOI: 10.1007/s00132-022-04318-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
In winter sports, skiers, snowboarders and ice hockey players have the highest risk of traumatic brain injuries (TBI). In skiing/snowboarding severe TBIs are of concern; in ice hockey, repetitive minor TBIs are frequent. The main causes of TBI in recreational skiing are collisions with trees; in professionals falls due to technical or tactical mistakes are the main causes. In ice hockey 10-15% of all injuries are due to a sports-related concussion (SRC), mostly caused by player-opponent contact. The pathomechanism in TBI is a combination of rotational and linear acceleration during head impact, which causes a diffuse axonal injury. Long-term complications such as neurodegenerative diseases and functional deficits are of relevance. Prevention by wearing helmets is effective, but less effective in TBI/SRC than in focal injuries.
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Affiliation(s)
- T Esser
- Abteilung für Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Norbert Kerkel Platz, 83734, Hausham, Deutschland
| | - C Gruber
- Abteilung für Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Norbert Kerkel Platz, 83734, Hausham, Deutschland
| | - A Bürkner
- Abteilung für Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Norbert Kerkel Platz, 83734, Hausham, Deutschland
| | - N Buchmann
- Abteilung für Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Norbert Kerkel Platz, 83734, Hausham, Deutschland
| | - P Minzlaff
- Abteilung für Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Norbert Kerkel Platz, 83734, Hausham, Deutschland
| | - P M Prodinger
- Abteilung für Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Norbert Kerkel Platz, 83734, Hausham, Deutschland.
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14
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Shireen T, Sachs F, Hua SZ. Physical memory of astrocytes. Brain Res 2022; 1796:148076. [PMID: 36084692 DOI: 10.1016/j.brainres.2022.148076] [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: 08/23/2022] [Accepted: 09/02/2022] [Indexed: 11/02/2022]
Abstract
Traumatic brain injury (TBI) is a major risk factor for development of neurodegenerative disorders later in life. Short, repetitive, mechanical impacts can lead to pathology that appears days or months later. The cells have a physical "memory" of mechanical events. The origin of this memory is not known. To examine the properties of this memory, we used a microfluidic chip to apply programmed fluid shear pulses to adherent adult rat astrocytes. These caused a transient rise in intracellular Ca2+. In response to repeated stimuli, 6 to 24 hrs apart, the Ca2+ response increased. This effect lasted longer than 24 hrs. The Ca2+ responses were more sensitive to the number of repetitions than to the rest time between stimuli. We found that inhibiting the Ca2+ influx during conditioning stimulus did not eliminate the stress potentiation, suggesting that mechanical deformation during the primary injury is accountable for the later response. The mechanical mechanism that triggers this long term "memory" may act by plastic deformation of the cytoskeleton.
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Affiliation(s)
- Tasnim Shireen
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY 14260, USA
| | - Frederick Sachs
- Department of Physiology and Biophysics, University at Buffalo, Buffalo, NY 14260, USA
| | - Susan Z Hua
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY 14260, USA; Department of Physiology and Biophysics, University at Buffalo, Buffalo, NY 14260, USA.
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15
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Serum neurofilament light in professional soccer players: goal on safety. Neurol Sci 2022; 43:5087-5090. [DOI: 10.1007/s10072-022-06109-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
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16
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Foecking EM, Segismundo AB, Lotesto KM, Westfall EJ, Bolduan AJ, Peter TK, Wallace DG, Kozlowski DA, Stubbs EB, Marzo SJ, Byram SC. Testosterone treatment restores vestibular function by enhancing neuronal survival in an experimental closed-head repetitive mild traumatic brain injury model. Behav Brain Res 2022; 433:113998. [PMID: 35809692 DOI: 10.1016/j.bbr.2022.113998] [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: 02/28/2022] [Revised: 06/22/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Abstract
Repetitive mild traumatic brain injury (rmTBI) results in a myriad of symptoms, including vestibular impairment. The mechanisms underlying vestibular dysfunction in rmTBI patients remain poorly understood. Concomitantly, acute hypogonadism occurs following TBI and can persist chronically in many patients. Using a repetitive mild closed-head animal model of TBI, the role of testosterone on vestibular function was tested. Male Long Evans Hooded rats were randomly divided into sham or rmTBI groups. Significant vestibular deficits were observed both acutely and chronically in the rmTBI groups. Systemic testosterone was administered after the development of chronic vestibular dysfunction. rmTBI animals given testosterone showed improved vestibular function that was sustained for 175 days post-rmTBI. Significant vestibular neuronal cell loss was, however, observed in the rmTBI animals compared to Sham animals at 175 days post-rmTBI and testosterone treatment significantly improved vestibular neuronal survival. Taken together, these data demonstrate a critical restorative role of testosterone in vestibular function following rmTBI. This study has important clinical implications because it identifies testosterone treatment as a viable therapeutic strategy for the long-term recovery of vestibular function following TBI.
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Affiliation(s)
- Eileen M Foecking
- Loyola University Chicago, Department of Otolaryngology, Burn Shock Trauma Research Institute, Loyola University Chicago, 2160 South 1st Avenue, Maywood, IL 60153, the United States of America; Burn Shock Trauma Research Institute, Loyola University Chicago, 2160 South 1st Avenue, Maywood, IL 60153, the United States of America; Edward Hines Jr. VA Hospital Research Service, Hines, IL 60141, the United States of America.
| | - Arthur B Segismundo
- Loyola University of Chicago, Biomedical Graduate School, 2160 South 1st Avenue, Maywood, IL 60153, the United States of America.
| | - Krista M Lotesto
- Burn Shock Trauma Research Institute, Loyola University Chicago, 2160 South 1st Avenue, Maywood, IL 60153, the United States of America.
| | - Edward J Westfall
- Loyola University Medical Center, Department of Otolaryngology, 2160 South 1st Avenue, Maywood, IL 60153, the United States of America.
| | - Alyssa J Bolduan
- Loyola University Medical Center, Department of Otolaryngology, 2160 South 1st Avenue, Maywood, IL 60153, the United States of America.
| | - Tony K Peter
- Loyola University Medical Center, Department of Otolaryngology, 2160 South 1st Avenue, Maywood, IL 60153, the United States of America.
| | - Douglas G Wallace
- Northern Illinois University, Department of Psychology, 1425 Lincoln Hwy, DeKalb, IL 60115, the United States of America.
| | - Dorothy A Kozlowski
- DePaul University, Department of Biological Sciences and Neuroscience Program, 2325 N., Chicago, IL 60604, the United States of America.
| | - Evan B Stubbs
- Edward Hines Jr. VA Research Service, Hines, IL 60141, the United States of America; Loyola University Medical Center, Department of Otolaryngology, 2160 South 1st Avenue, Maywood, IL 60153, the United States of America.
| | - Sam J Marzo
- Loyola University Medical Center, Department of Otolaryngology, 2160 South 1st Avenue, Maywood, IL 60153, the United States of America.
| | - Susanna C Byram
- Loyola University Medical Center, Department of Anesthesiology and Perioperative Medicine, 2160 South 1st Avenue, Maywood, IL 60153, the United States of America; Edward Hines Jr. VA Hospital Research Service, Hines, IL 60141, the United States of America.
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Shahim P, Zetterberg H. Neurochemical Markers of Traumatic Brain Injury: Relevance to Acute Diagnostics, Disease Monitoring, and Neuropsychiatric Outcome Prediction. Biol Psychiatry 2022; 91:405-412. [PMID: 34857362 DOI: 10.1016/j.biopsych.2021.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 12/13/2022]
Abstract
Considerable advancements have been made in the quantification of biofluid-based biomarkers for traumatic brain injury (TBI), which provide a clinically accessible window to investigate disease mechanisms and progression. Methods with improved analytical sensitivity compared with standard immunoassays are increasingly used, and blood tests are being used in the diagnosis, monitoring, and outcome prediction of TBI. Most work to date has focused on acute TBI diagnostics, while the literature on biomarkers for long-term sequelae is relatively scarce. In this review, we give an update on the latest developments in biofluid-based biomarker research in TBI and discuss how acute and prolonged biomarker changes can be used to detect and quantify brain injury and predict clinical outcome and neuropsychiatric sequelae.
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Affiliation(s)
- Pashtun Shahim
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; UK Dementia Research Institute at University College London, London, United Kingdom; Department of Neurodegenerative Disease, University College London Institute of Neurology, London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China.
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18
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Jildeh TR, Castle JP, Buckley PJ, Abbas MJ, Hegde Y, Okoroha KR. Lower Extremity Injury After Return to Sports From Concussion: A Systematic Review. Orthop J Sports Med 2022; 10:23259671211068438. [PMID: 35111864 PMCID: PMC8801663 DOI: 10.1177/23259671211068438] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Recent studies have suggested increased rates of lower extremity (LE) musculoskeletal injury after a diagnosed concussion, although significant heterogeneity exists. Purpose: To examine the current body of research and determine whether there is an increased risk for LE musculoskeletal injury after a concussion and to identify populations at an increased risk. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review of current literature using MEDLINE and PubMed databases was performed. Keywords included concussion, athlete, lower extremity injury, and return to sport. Inclusion criteria required original research articles written in the English language examining the rate of LE injuries after a diagnosed concussion. Results: A total of 13 studies involving 4349 athletes (88.1% male and 11.9% female; mean age, 19.8 years) met inclusion criteria. Athletes were classified as high school (46.1%), collegiate (17.0%), or professional (36.9%). Of the 13 studies, 4 demonstrated an increased risk of LE injury within 90 days of a diagnosed concussion (odds ratio [OR], 3.44; 95% CI, 2.99-4.42), and 6 revealed an elevated risk of injury within 1 year of concussion (OR, 1.85; 95% CI, 1.73-2.84). Increased risk was seen in professional (OR, 2.49; 95% CI, 2.40-2.72) and collegiate (OR, 2.00; 95% CI, 1.96-2.16) athletes compared with high school athletes (OR, 0.97; 95% CI, 0.89-1.05). A stepwise increase in risk of sustaining an LE injury was observed with multiple concussions, with increasing risk observed from ≥2 (OR, 2.29; 95% CI, 1.85-2.83) to ≥3 (OR, 2.86; 95% CI, 2.36-3.48) career concussions. Conclusion: An increased incidence of LE injuries was observed at 90 days and 1 year after the diagnosis of a concussion. Higher levels of competition, such as at the collegiate and professional levels, resulted in an increased risk of sustaining a subsequent LE injury after a diagnosed concussion. These results suggest an at-risk population who may benefit from injury prevention methods after a concussion. Future studies should focus on identifying which injuries are most common, during what time period athletes are most vulnerable, and methods to prevent injury after return to sports.
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Affiliation(s)
- Toufic R. Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Joshua P. Castle
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Patrick J. Buckley
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muhammad J. Abbas
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Yash Hegde
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Kelechi R. Okoroha
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Andrews E, Jildeh TR, Abbas MJ, Lindsay-Rivera K, Berguson J, Okoroha KR. Concussions in the National Hockey League: Analysis of Incidence, Return to Play, and Performance. Orthop J Sports Med 2022; 10:23259671211052069. [PMID: 35097141 PMCID: PMC8796090 DOI: 10.1177/23259671211052069] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/14/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Concussion injuries are common in professional hockey; however, their effect on player performance remains unclear. Purpose: To quantify the effect of concussions on the performance of position players in the National Hockey League (NHL). Study Design: Cohort study; Level of evidence, 3. Methods: Concussion data from the NHL were collected using publicly available databases for the seasons between 2009-2010 and 2015-2016, coinciding with new NHL concussion rules. Age, body mass index, position, number of concussions during a player’s NHL career, games played, and time on ice were recorded. Basic and advanced performance metrics were collected for 1 season pre- and postconcussion (short-term period) and 3 seasons before and after concussion (long-term period) to assess short- and long-term changes in performance. A control group of players without an identified concussion who competed during the study period was assembled for comparison. Wilcoxon signed rank tests were used to evaluate pre- to postconcussion data in the short- and long-term settings as well as to compare the cohorts at each time point. Results: Overall, 48 players were identified as having a concussion during the study period. Players missed 17.2 ± 15.1 days (mean ± standard deviation) and 7.5 ± 6.9 games postconcussion. There were no significant differences in any metric when pre- and postconcussion intraseason performance was assessed. Athletes who were concussed demonstrated significantly deceased performance metrics (assists per 60 minutes, points per 60 minutes, Corsi percentage, and Fenwick percentage) in the 3 years after the concussion as compared with the year before injury ( P < .05). However, no difference was found between the concussed group and matched control group in the short- or long-term period. Players with concussion played fewer career games (856.4 ± 287.4 vs 725.7 ± 215.0; P < .05) than did controls. Conclusion: A high rate of NHL players were able to return to play after a concussion injury. Players with concussion did not experience a reduction in performance metrics in the short- or long-term setting when compared with matched controls. The concussed cohort maintained a similar workload up to 3 seasons postconcussion but played in fewer career games when compared with matched controls.
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Affiliation(s)
- Erickson Andrews
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Toufic R. Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muhammad J. Abbas
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Jon Berguson
- Department of Orthopaedic Surgery, State University of New York–Downstate Medical Center, Brooklyn, New York, USA
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The Shadow Pandemic: A Qualitative Exploration of the Impacts of COVID-19 on Service Providers and Women Survivors of Intimate Partner Violence and Brain Injury. J Head Trauma Rehabil 2022; 37:43-52. [PMID: 34985033 DOI: 10.1097/htr.0000000000000751] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) affects up to 1 in 3 women over their lifetime and has intensified during the COVID-19 pandemic. Although most injuries are to the head, face, and neck, the intersection of IPV and brain injury (BI) remains largely unrecognized. This article reports on unexplored COVID-19-related impacts on service providers and women survivors of IPV/BI. OBJECTIVES To explore the impact of the COVID-19 pandemic on survivors and service providers. PARTICIPANTS Purposeful sampling through the team's national Knowledge-to-Practice (K2P) network and snowball sampling were used to recruit 24 participants across 4 categories: survivors, executive directors/managers of organizations serving survivors, direct service providers, and employer/union representatives. DESIGN This project used a qualitative, participatory approach using semistructured individual or group interviews. Interviews were conducted via videoconferencing, audio-recorded, and transcribed. Transcripts were thematically analyzed by the research team to identify themes. FINDINGS COVID-19 has increased rates and severity of IPV and barriers to services in terms of both provision and uptake. Three main themes emerged: (1) implications for women survivors of IPV/BI; (2) implications for service delivery and service providers supporting women survivors of IPV/BI; and (3) key priorities. Increased risk, complex challenges to mental health, and the impact on employment were discussed. Adaptability and flexibility of service delivery were identified as significant issues, and increased outreach and adaptation of technology-based services were noted as key priorities. CONCLUSIONS The COVID-19 pandemic has intensified IPV/BI, increased challenges for women survivors and service providers, and accentuated the continued lack of IPV/BI awareness. Recommendations for service delivery and uptake are discussed.
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Ackermans NL, Varghese M, Wicinski B, Torres J, De Gasperi R, Pryor D, Elder GA, Gama Sosa MA, Reidenberg JS, Williams TM, Hof PR. Unconventional animal models for traumatic brain injury and chronic traumatic encephalopathy. J Neurosci Res 2021; 99:2463-2477. [PMID: 34255876 PMCID: PMC8596618 DOI: 10.1002/jnr.24920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 12/11/2022]
Abstract
Traumatic brain injury (TBI) is one of the main causes of death worldwide. It is a complex injury that influences cellular physiology, causes neuronal cell death, and affects molecular pathways in the brain. This in turn can result in sensory, motor, and behavioral alterations that deeply impact the quality of life. Repetitive mild TBI can progress into chronic traumatic encephalopathy (CTE), a neurodegenerative condition linked to severe behavioral changes. While current animal models of TBI and CTE such as rodents, are useful to explore affected pathways, clinical findings therein have rarely translated into clinical applications, possibly because of the many morphofunctional differences between the model animals and humans. It is therefore important to complement these studies with alternative animal models that may better replicate the individuality of human TBI. Comparative studies in animals with naturally evolved brain protection such as bighorn sheep, woodpeckers, and whales, may provide preventive applications in humans. The advantages of an in-depth study of these unconventional animals are threefold. First, to increase knowledge of the often-understudied species in question; second, to improve common animal models based on the study of their extreme counterparts; and finally, to tap into a source of biological inspiration for comparative studies and translational applications in humans.
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Affiliation(s)
- Nicole L Ackermans
- Nash Family Department of Neuroscience, 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
- Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Merina Varghese
- Nash Family Department of Neuroscience, 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
| | - Bridget Wicinski
- Nash Family Department of Neuroscience, 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
| | - Joshua Torres
- Nash Family Department of Neuroscience, 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
| | - Rita De Gasperi
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- General Medical Research Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, USA
| | - Dylan Pryor
- General Medical Research Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, USA
| | - Gregory A Elder
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, 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
- Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Neurology Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, USA
| | - Miguel A Gama Sosa
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- General Medical Research Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, USA
| | - Joy S Reidenberg
- Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Terrie M Williams
- Department of Ecology and Evolutionary Biology, University of California, Santa Cruz, CA, USA
| | - Patrick R Hof
- Nash Family Department of Neuroscience, 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
- Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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22
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Triana-Baltzer G, Van Kolen K, Theunis C, Moughadam S, Slemmon R, Mercken M, Galpern W, Sun H, Kolb H. Development and Validation of a High Sensitivity Assay for Measuring p217 + tau in Cerebrospinal Fluid. J Alzheimers Dis 2021; 77:1417-1430. [PMID: 32831201 PMCID: PMC7683057 DOI: 10.3233/jad-200463] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Early and accurate detection and staging is critical to managing Alzheimer’s disease (AD) and supporting clinical trials. Cerebrospinal fluid (CSF) biomarkers for amyloid-β peptides, tau species, and various neurodegenerative and inflammatory analytes are leading the way in this regard, yet there is room for improved sensitivity and specificity. In particular tau is known to be present in many different fragments, conformations, and post-translationally modified forms. While the exact tau species that might best reflect AD pathology is unknown, a growing body of evidence suggests that forms with high levels of phosphorylation in the mid-region may be especially enriched in AD. Objective: Develop an assay for measuring p217tau in CSF. Methods: Here we describe the development and validation of a novel sELISA for measuring CSF tau species containing phosphorylation at threonines 212 & 217, aka p217 + tau, using the PT3 antibody. Results: While the analyte is present at extremely low levels the assay is sufficiently sensitive and specific to quantitate p217 + tau with excellent precision, accuracy, and dilution linearity, allowing good differentiation between diagnostic subgroups. The p217 + tau measurements appear to track AD pathology better than the commonly used p181tau epitope, suggesting superior diagnostic and staging performance. Finally, the assay can also be configured to differentiate antibody-bound versus antibody-free tau, and therefore can be used to measure target engagement by p217 + tau-targeting immunotherapeutics. Conclusion: The assay for measuring p217 + tau described here is highly sensitive, accurate, precise, dilution linear, and shows good potential for identifying and staging AD.
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Affiliation(s)
| | - Kristof Van Kolen
- Neuroscience Department, Janssen Research and Development, Beerse, Belgium
| | - Clara Theunis
- Neuroscience Department, Janssen Research and Development, Beerse, Belgium
| | - Setareh Moughadam
- Neuroscience Biomarkers, Janssen Research & Development, La Jolla, CA, USA
| | - Randy Slemmon
- Neuroscience Biomarkers, Janssen Research & Development, La Jolla, CA, USA
| | - Marc Mercken
- Neuroscience Department, Janssen Research and Development, Beerse, Belgium
| | - Wendy Galpern
- Neuroscience Experimental Medicine, Janssen Research & Development, Titusville, NJ, USA
| | - Hong Sun
- Neuroscience Clinical Development, Janssen Research & Development, Titusville, NJ, USA
| | - Hartmuth Kolb
- Neuroscience Biomarkers, Janssen Research & Development, La Jolla, CA, USA
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23
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Abstract
Traumatic brain injury (TBI) involves structural damage to the brain regions causing death or disability in patients with lifelong sufferings. Accidental injuries to the brain, besides structural damage, if any, cause activation of various deleterious pathways leading to subsequent neuronal death and permanent dysfunction. However, immediate medical management/treatments could reduce the chances of disability and suffering to the patients. The objective of the current review is to review triggered molecular pathways following TBI and discuss possible targets that could restore brain functions. Understanding the pathologic process is always useful to device novel treatment strategies and may rescue the patient with TBI from death or associated co-morbidities. The current review significantly contributes to improve our understanding about the molecular pathways and neuronal death following TBI and helps us to provide possible targets that could be useful in the management/treatment of TBI.
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Affiliation(s)
- Kajal Bagri
- Department of Pharmaceutical Sciences & Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda, India
| | - Puneet Kumar
- Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, India
| | - Rahul Deshmukh
- Department of Pharmaceutical Sciences & Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda, India
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24
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Hiles-Murison B, Lavender AP, Hackett MJ, Armstrong JJ, Nesbit M, Rawlings S, McGonigle T, Warnock A, Lam V, Mamo JCL, Fitzgerald M, Takechi R. Blood-brain barrier disruption and ventricular enlargement are the earliest neuropathological changes in rats with repeated sub-concussive impacts over 2 weeks. Sci Rep 2021; 11:9261. [PMID: 33927338 PMCID: PMC8084989 DOI: 10.1038/s41598-021-88854-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/19/2021] [Indexed: 01/27/2023] Open
Abstract
Repeated sub-concussive impact (e.g. soccer ball heading), a significantly lighter form of mild traumatic brain injury, is increasingly suggested to cumulatively alter brain structure and compromise neurobehavioural function in the long-term. However, the underlying mechanisms whereby repeated long-term sub-concussion induces cerebral structural and neurobehavioural changes are currently unknown. Here, we utilised an established rat model to investigate the effects of repeated sub-concussion on size of lateral ventricles, cerebrovascular blood-brain barrier (BBB) integrity, neuroinflammation, oxidative stress, and biochemical distribution. Following repeated sub-concussion 3 days per week for 2 weeks, the rats showed significantly enlarged lateral ventricles compared with the rats receiving sham-only procedure. The sub-concussive rats also presented significant BBB dysfunction in the cerebral cortex and hippocampal formation, whilst neuromotor function assessed by beamwalk and rotarod tests were comparable to the sham rats. Immunofluorescent and spectroscopic microscopy analyses revealed no significant changes in neuroinflammation, oxidative stress, lipid distribution or protein aggregation, within the hippocampus and cortex. These data collectively indicate that repeated sub-concussion for 2 weeks induce significant ventriculomegaly and BBB disruption, preceding neuromotor deficits.
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Affiliation(s)
- Bailey Hiles-Murison
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Andrew P Lavender
- School of Science, Psychology and Sport, Federation University Australia, Mount Helen, VIC, Australia
- School of Allied Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Mark J Hackett
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- School of Molecular and Life Sciences, Faculty of Science and Engineering, Curtin University, Bentley, WA, Australia
| | - Joshua J Armstrong
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- School of Molecular and Life Sciences, Faculty of Science and Engineering, Curtin University, Bentley, WA, Australia
| | - Michael Nesbit
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Samuel Rawlings
- School of Allied Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Terrence McGonigle
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Ralph and Patricia Sarich Neuroscience Research Institute, Nedlands, WA, Australia
| | - Andrew Warnock
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Ralph and Patricia Sarich Neuroscience Research Institute, Nedlands, WA, Australia
| | - Virginie Lam
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - John C L Mamo
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Ralph and Patricia Sarich Neuroscience Research Institute, Nedlands, WA, Australia
| | - Ryu Takechi
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia.
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia.
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25
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Zhuang X, Mishra V, Nandy R, Yang Z, Sreenivasan K, Bennett L, Bernick C, Cordes D. Resting-State Static and Dynamic Functional Abnormalities in Active Professional Fighters With Repetitive Head Trauma and With Neuropsychological Impairments. Front Neurol 2020; 11:602586. [PMID: 33362704 PMCID: PMC7758536 DOI: 10.3389/fneur.2020.602586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
Previous neuroimaging studies have identified structural brain abnormalities in active professional fighters with repetitive head trauma and correlated these changes with fighters' neuropsychological impairments. However, functional brain changes in these fighters derived using neuroimaging techniques remain unclear. In this study, both static and dynamic functional connectivity alterations were investigated (1) between healthy normal control subjects (NC) and fighters and (2) between non-impaired and impaired fighters. Resting-state fMRI data were collected on 35 NC and 133 active professional fighters, including 68 impaired fighters and 65 non-impaired fighters, from the Professional Fighters Brain Health Study at our center. Impaired fighters performed worse on processing speed (PSS) tasks with visual-attention and working-memory demands. The static functional connectivity (sFC) matrix was estimated for every pair of regions of interest (ROI) using a subject-specific parcellation. The dynamic functional connectivity (dFC) was estimated using a sliding-window method, where the variability of each ROI pair across all windows represented the temporal dynamics. A linear regression model was fitted for all 168 subjects, and different t-contrast vectors were used for between-group comparisons. An association analysis was further conducted to evaluate FC changes associated with PSS task performances without creating artificial impairment group-divisions in fighters. Following corrections for multiple comparisons using network-based statistics, our study identified significantly reduced long-range frontal-temporal, frontal-occipital, temporal-occipital, and parietal-occipital sFC strengths in fighters than in NCs, corroborating with previously observed structural damages in corresponding white matter tracts in subjects experiencing repetitive head trauma. In impaired fighters, significantly decreased sFC strengths were found among key regions involved in visual-attention, executive and cognitive process, as compared to non-impaired fighters. Association analysis further reveals similar sFC deficits to worse PSS task performances in all 133 fighters. With our choice of dFC indices, we were not able to observe any significant dFC changes beyond a trend-level increased temporal variability among similar regions with weaker sFC strengths in impaired fighters. Collectively, our functional brain findings supplement previously reported structural brain abnormalities in fighters and are important to comprehensively understand brain changes in fighters with repetitive head trauma.
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Affiliation(s)
- Xiaowei Zhuang
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States.,Department of Brain Health, University of Nevada, Las Vegas, NV, United States
| | - Virendra Mishra
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Rajesh Nandy
- School of Public Health, University of North Texas, Fort Worth, TX, United States
| | - Zhengshi Yang
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States.,Department of Brain Health, University of Nevada, Las Vegas, NV, United States
| | - Karthik Sreenivasan
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States.,Department of Brain Health, University of Nevada, Las Vegas, NV, United States
| | - Lauren Bennett
- Pickup Family Neuroscience Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, CA, United States
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States.,UW Medicine, Seattle, WA, United States
| | - Dietmar Cordes
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States.,Department of Brain Health, University of Nevada, Las Vegas, NV, United States.,Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, United States
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26
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Joseph JR, Swallow JS, Willsey K, Almeida AA, Lorincz MT, Fraumann RK, Oppenlander ME, Szerlip NJ, Broglio SP. Pupillary changes after clinically asymptomatic high-acceleration head impacts in high school football athletes. J Neurosurg 2020; 133:1886-1891. [PMID: 31770721 DOI: 10.3171/2019.7.jns191272] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/26/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous studies have shown that clinically asymptomatic high-acceleration head impacts (HHIs) may be associated with neuronal and axonal injury, as measured by advanced imaging and biomarkers. Unfortunately, these methods of measurement are time-consuming, invasive, and costly. A quick noninvasive measurement tool is needed to aid studies of head injury and its biological impact. Quantitative pupillometry is a potential objective, rapid, noninvasive measurement tool that may be used to assess the neurological effects of HHIs. In this study, the authors investigated the effect of HHIs on pupillary metrics, as measured using a pupillometer, in the absence of a diagnosed concussion. METHODS A prospective observational cohort study involving 18 high school football athletes was performed. These athletes were monitored for both the frequency and magnitude of head impacts that they sustained throughout a playing season by using the Head Impact Telemetry System. An HHI was defined as an impact exceeding 95g linear acceleration and 3760 rad/sec2 rotational acceleration. Pupillary assessments were performed at baseline, midseason, after occurrence of an HHI, and at the end of the season by using the NeurOptics NPi-200 pupillometer. The Sport Concussion Assessment Tool, 5th Edition (SCAT5), was also used at each time point. Comparisons of data obtained at the various time points were calculated using a repeated-measures analysis of variance and a t-test. RESULTS Seven athletes sustained HHIs without a related diagnosed concussion. Following these HHIs, the athletes demonstrated decreases in pupil dilation velocity (mean difference 0.139 mm/sec; p = 0.048), percent change in pupil diameter (mean difference 3.643%; p = 0.002), and maximum constriction velocity (mean difference 0.744 mm/sec; p = 0.010), compared to measurements obtained at the athletes' own midseason evaluations. No significant changes occurred between the SCAT5 subtest scores calculated at midseason and those after a high impact, although the effect sizes (Cohen's d) on individual components ranged from 0.41 to 0.65. CONCLUSIONS Measurable changes in pupil response were demonstrated following an HHI. These results suggest that clinically asymptomatic HHIs may affect brain reflex pathways, reflecting a biological injury previously seen when more invasive methods were applied.
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Affiliation(s)
| | | | | | | | | | - Robert K Fraumann
- 5Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
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27
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Adani G, Filippini T, Garuti C, Malavolti M, Vinceti G, Zamboni G, Tondelli M, Galli C, Costa M, Vinceti M, Chiari A. Environmental Risk Factors for Early-Onset Alzheimer's Dementia and Frontotemporal Dementia: A Case-Control Study in Northern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7941. [PMID: 33138082 PMCID: PMC7663191 DOI: 10.3390/ijerph17217941] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022]
Abstract
Background: Early-onset dementia (EOD) is defined as dementia with symptom onset before 65 years. The role of environmental risk factors in the etiology of EOD is still undefined. We aimed at assessing the role of environmental risk factors in EOD etiology, taking into account its different clinical types. Methods: Using a case-control study, we recruited all EOD cases referred to Modena hospitals from 2016 to 2019, while the referent population was drawn from cases' caregivers. We investigated residential history, occupational and environmental exposures to chemicals and lifestyle behaviors through a self-administered questionnaire. We computed the odds ratios of EOD risk (overall and restricting to the Alzheimer's dementia (AD) or frontotemporal dementia (FTD) diagnoses) and the corresponding 95% confidence intervals using an unconditional logistic regression model. Results: Fifty-eight EOD patients (19 FTD and 32 AD) and 54 controls agreed to participate. Most of the investigated exposures, such as occupational exposure to aluminum, pesticides, dyes, paints or thinners, were associated with an increased odds ratio (OR) for FTD but not for AD. Long-term use of selenium-containing dietary supplements was associated with increased OR for EOD and, particularly, for FTD. For both EOD forms, smoking and playing football showed an increased odds ratio, while cycling was associated with increased risk only in FTD. Overall sports practice appeared to be a protective factor for both types. Conclusions: Our results suggest a role of environmental and behavioral risk factors such as some chemical exposures and professional sports in EOD etiology, in particular with reference to FTD. Overall sports practice may be associated with a reduced EOD risk.
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Affiliation(s)
- Giorgia Adani
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.A.); (T.F.); (C.G.); (M.M.)
| | - Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.A.); (T.F.); (C.G.); (M.M.)
| | - Caterina Garuti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.A.); (T.F.); (C.G.); (M.M.)
| | - Marcella Malavolti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.A.); (T.F.); (C.G.); (M.M.)
| | - Giulia Vinceti
- Center for Neurosciences and Neurotechnology, Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (G.V.); (G.Z.)
- Neurology Unit, Modena Policlinico-University Hospital, 41126 Modena, Italy; (M.T.); (C.G.); (A.C.)
| | - Giovanna Zamboni
- Center for Neurosciences and Neurotechnology, Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (G.V.); (G.Z.)
- Neurology Unit, Modena Policlinico-University Hospital, 41126 Modena, Italy; (M.T.); (C.G.); (A.C.)
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Manuela Tondelli
- Neurology Unit, Modena Policlinico-University Hospital, 41126 Modena, Italy; (M.T.); (C.G.); (A.C.)
- Primary Care Department, Modena Local Health Authority, 41124 Modena, Italy
| | - Chiara Galli
- Neurology Unit, Modena Policlinico-University Hospital, 41126 Modena, Italy; (M.T.); (C.G.); (A.C.)
- Primary Care Department, Modena Local Health Authority, 41124 Modena, Italy
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NeuroFARBA), University of Florence, 50139 Florence, Italy
| | - Manuela Costa
- Neurology Unit of Carpi Hospital, Modena Local Health Authority, 41012 Carpi, Italy;
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.A.); (T.F.); (C.G.); (M.M.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Annalisa Chiari
- Neurology Unit, Modena Policlinico-University Hospital, 41126 Modena, Italy; (M.T.); (C.G.); (A.C.)
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28
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Liu Y, Guo C, Ding Y, Long X, Li W, Ke D, Wang Q, Liu R, Wang JZ, Zhang H, Wang X. Blockage of AEP attenuates TBI-induced tau hyperphosphorylation and cognitive impairments in rats. Aging (Albany NY) 2020; 12:19421-19439. [PMID: 33040048 PMCID: PMC7732271 DOI: 10.18632/aging.103841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/29/2020] [Indexed: 01/24/2023]
Abstract
Traumatic brain injury (TBI) is regarded as a high-risk factor for Alzheimer's disease (AD). Asparaginyl endopeptidase (AEP), a lysosomal cysteine protease involved in AD pathogenesis, is normally activated under acidic conditions and also in TBI. However, both the molecular mechanism underlying AEP activation-mediated TBI-related AD pathologies, and the role of AEP as an AD therapeutic target, still remain unclear. Here, we report that TBI induces hippocampus dependent cognitive deficit and synaptic dysfunction, accompanied with AEP activation, I2PP2A (inhibitor 2 of PP2A, also called SET) mis-translocation from neuronal nucleus to cytoplasm, an obvious increase in AEP interaction with SET, and tau hyperphosphorylation in hippocampus of rats. Oxygen-glucose deprivation (OGD), mimicking an acidic condition, also leads to AEP activation, SET mis-translocation, PP2A inhibition, tau hyperphosphorylation, and a decrease in synaptic proteins, all of which are abrogated by AEP inhibitor AENK in primary neurons. Interestingly, AENK restores SET back to the nucleus, mitigates tau pathologies, rescuing TBI-induced cognitive deficit in rats. These findings highlight a novel etiopathogenic mechanism of TBI-related AD, which is initiated by AEP activation, accumulating SET in cytoplasm, and favoring tau pathology and cognitive impairments. Lowering AEP activity by AEP inhibitor would be beneficial to AD patients with TBI.
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Affiliation(s)
- Yi Liu
- Department of Pathophysiology, Weifang Medical University, Weifang 261053, China
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Cuiping Guo
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yi Ding
- Department of Pathophysiology, Weifang Medical University, Weifang 261053, China
| | - Xiaobing Long
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan 430030, China
| | - Wensheng Li
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Dan Ke
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qun Wang
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Rong Liu
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jian-Zhi Wang
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, JS, China
| | - Huaqiu Zhang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan 430030, China
| | - Xiaochuan Wang
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, JS, China
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29
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Koerte IK, Schultz V, Sydnor VJ, Howell DR, Guenette JP, Dennis E, Kochsiek J, Kaufmann D, Sollmann N, Mondello S, Shenton ME, Lin AP. Sex-Related Differences in the Effects of Sports-Related Concussion: A Review. J Neuroimaging 2020; 30:387-409. [PMID: 32533752 PMCID: PMC8221087 DOI: 10.1111/jon.12726] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/30/2020] [Indexed: 01/11/2023] Open
Abstract
Sports-related concussion is a serious health challenge, and females are at higher risk of sustaining a sports-related concussion compared to males. Although there are many studies that investigate outcomes following concussion, females remain an understudied population, despite representing a large proportion of the organized sports community. In this review, we provide a summary of studies that investigate sex-related differences in outcome following sports-related concussion. Moreover, we provide an introduction to the methods used to study sex-related differences after sports-related concussion, including common clinical and cognitive measures, neuroimaging techniques, as well as biomarkers. A literature search inclusive of articles published to March 2020 was performed using PubMed. The studies were reviewed and discussed with regard to the methods used. Findings from these studies remain mixed with regard to the effect of sex on clinical symptoms, concussion-related alterations in brain structure and function, and recovery trajectories. Nonetheless, there is initial evidence to suggest that sex-related differences following concussion are important to consider in efforts to develop objective biomarkers for the diagnosis and prognosis of concussion. Additional studies on this topic are, however, clearly needed to improve our understanding of sex-related differences following concussion, as well as to understand their neurobiological underpinnings. Such studies will help pave the way toward more personalized clinical management and treatment of sports-related concussion.
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Affiliation(s)
- Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Vivian Schultz
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Valerie J Sydnor
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - Jeffrey P Guenette
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Emily Dennis
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Neurology, University of Utah, Salt Lake City, UT
| | - Janna Kochsiek
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - David Kaufmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Radiology, Charité Universitätsmedizin, Berlin, Germany
| | - Nico Sollmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Oasi Research Institute-IRCCS, Troina, Italy
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,VA Boston Healthcare System, Boston, MA
| | - Alexander P Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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30
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Scheffler P, Wolter NE, Namavarian A, Propst EJ, Chan Y. Contact sport related head and neck injuries in pediatric athletes. Int J Pediatr Otorhinolaryngol 2019; 121:6-9. [PMID: 30851511 DOI: 10.1016/j.ijporl.2019.02.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To describe the type and frequency of sports related pediatric head and neck trauma. METHODS The National Electronic Injury Surveillance System (NEISS) was searched for football, basketball, soccer, lacrosse and ice hockey related facial injuries. Cross-sectional analysis of incidence, age, and sex and specific injury diagnoses, mechanisms, and facial locations were performed. We focused on craniofacial and soft tissue injuries and excluded patients with concussion or other neurological injuries. RESULTS A total of 24,905 cases were identified in the NEISS database, corresponding to an estimated, 764,293 emergency department visits. The most hazardous sports were basketball, accounting for 356,188 visits (46.6%), football with 249,633 visits (32.6%), and soccer with 128,113 (14.7%) visits. Lacrosse and ice hockey accounted for 16,869 (1.9%) and 13,490 (1.5%) visits, respectively. There has been a decrease in injuries over the past 10 years, particularly for football (53%), ice hockey (46%), and lacrosse (41%). Soccer (13%) and basketball (9%) noticed the smallest decreases. CONCLUSION Children who play basketball, football and soccer are especially prone to emergency department visits related to the head and neck. Overall, there has been an improvement in number of injuries across the five sports investigated. Sports amenable to head and neck protective equipment saw the largest improvement (football, ice hockey, lacrosse), whereas only small decreases were noted in basketball and soccer. Changes in regulations for sports not amenable to more protective equipment may help decrease adverse events.
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Affiliation(s)
- Patrick Scheffler
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Nikolaus E Wolter
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Otolaryngology, Hospital for Sick Children, Toronto, ON, Canada.
| | - Amirpouyan Namavarian
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Evan J Propst
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Otolaryngology, Hospital for Sick Children, Toronto, ON, Canada.
| | - Yvonne Chan
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Otolaryngology - Head & Neck Surgery, Trillium Health Partners, Mississauga, ON, Canada.
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31
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Patel BH, Okoroha KR, Jildeh TR, Lu Y, Idarraga AJ, Nwachukwu BU, Shen SA, Forsythe B. Concussions in the National Basketball Association: Analysis of Incidence, Return to Play, and Performance From 1999 to 2018. Orthop J Sports Med 2019; 7:2325967119854199. [PMID: 31276004 PMCID: PMC6598335 DOI: 10.1177/2325967119854199] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The effect of concussions on professional athletes has been investigated in many sports. However, few studies have evaluated concussions in National Basketball Association (NBA) players. HYPOTHESIS We hypothesized that concussion incidence has increased, yet the return-to-play (RTP) rate will remain high following the institution of the NBA concussion policy (NBACP). We also hypothesized that the incidence of repeat concussions will be similar to first occurrences and that player performance and game availability will not be significantly affected by sustaining a concussion. STUDY DESIGN Descriptive epidemiology study. METHODS Publicly available records were searched to identify all concussions from NBA seasons 1999-2000 to 2017-2018. Player demographics and information regarding career history were tabulated. Incidence of concussion and RTP timing were evaluated before and after institution of the NBACP (2011). Minutes per game and game score per minute were evaluated pre- versus postconcussion. Player availability and performance were also compared with an age-, body mass index-, position-, and experience-matched control group of players who did not sustain a concussion. RESULTS A total of 189 concussions were reported in the NBA from 1999 to 2018, with a mean ± SD incidence of 9.7 ± 7.3 concussions per season. Following implementation of the NBACP, incidence significantly increased from 5.7 ± 2.8 to 16.7 ± 7.5 concussions per season (P = .007). All players returned to play following first-time concussion after missing 7.7 ± 8.6 days and 3.5 ± 4.1 games. RTP time was not significantly different after implementation of the NBACP (games missed, P = .24; days missed, P = .27), and there was no difference in concussion-free time interval (P = .29). Game score per minute and minutes per game were not significantly affected by sustaining a concussion (both P > .05). CONCLUSION Concussion incidence in NBA players is approximately 17 instances per season since the 2011 institution of a league-wide concussion policy. The number of reported concussions significantly increased following the policy, in line with trends seen in other professional sports leagues. Players have retained a high rate of RTP after 3 to 4 missed games. Player performance and availability are not affected by sustaining a concussion following successful RTP.
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Affiliation(s)
- Bhavik H. Patel
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Kelechi R. Okoroha
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Toufic R. Jildeh
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Yining Lu
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander J. Idarraga
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Benedict U. Nwachukwu
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarek A. Shen
- School of Medicine, University of California, San Diego, San Diego, California USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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32
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Winblad B, Ankarcrona M, Johansson G, Novak P, Peter Thelin E, Zetterberg H, Blennow K. Head trauma in sports and risk for dementia. J Intern Med 2019; 285:591-593. [PMID: 31090251 DOI: 10.1111/joim.12918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- B Winblad
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Solna, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - M Ankarcrona
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Solna, Sweden
| | - G Johansson
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Solna, Sweden
| | - P Novak
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia.,AXON Neuroscience CRM Services SE, Bratislava, Slovakia
| | - E Peter Thelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - H Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,UK Dementia Research Institute at UCL, London, UK.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - K Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
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