1
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Sutar S, Ganpule SG. In Silico Investigation of Biomechanical Response of a Human Brain Subjected to Primary Blast. J Biomech Eng 2024; 146:081007. [PMID: 38421339 DOI: 10.1115/1.4064968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
The brain response to the explosion-induced primary blast waves is actively sought. Over the past decade, reasonable progress has been made in the fundamental understanding of blast traumatic brain injury (bTBI) using head surrogates and animal models. Yet, the current understanding of how blast waves interact with human is in nascent stages, primarily due to the lack of data in human. The biomechanical response in human is critically required to faithfully establish the connection to the aforementioned bTBI models. In this work, the biomechanical cascade of the brain under a primary blast has been elucidated using a detailed, full-body human model. The full-body model allowed us to holistically probe short- (<5 ms) and long-term (200 ms) brain responses. The full-body model has been extensively validated against impact loading in the past. We have further validated the head model against blast loading. We have also incorporated the structural anisotropy of the brain white matter. The blast wave transmission, and linear and rotational motion of the head were dominant pathways for the loading of the brain, and these loading paradigms generated distinct biomechanical fields within the brain. Blast transmission and linear motion of the head governed the volumetric response, whereas the rotational motion of the head governed the deviatoric response. Blast induced head rotation alone produced diffuse injury pattern in white matter fiber tracts. The biomechanical response under blast was comparable to the impact event. These insights will augment laboratory and clinical investigations of bTBI and help devise better blast mitigation strategies.
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Affiliation(s)
- Sunil Sutar
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee 247667, Uttarakhand, India
| | - S G Ganpule
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee 247667, Uttarakhand, India
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2
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Austin TA, Hodges CB, Thomas ML, Szabo YZ, Parr S, Eschler BD, Lantrip C, Twamley E. Meta-analysis of Cognitive Rehabilitation Interventions in Veterans and Service Members With Traumatic Brain Injuries. J Head Trauma Rehabil 2024; 39:258-272. [PMID: 38270528 PMCID: PMC11227399 DOI: 10.1097/htr.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
MAIN OBJECTIVE Cognitive difficulties are some of the most frequently experienced symptoms following mild-to-moderate traumatic brain injuries (TBIs). There is meta-analytic evidence that cognitive rehabilitation improves cognitive functioning after TBI in nonveteran populations but not specifically within the veteran and service member (V/SM) population. The purpose of the current meta-analysis was to examine the effect of cognitive rehabilitation interventions for V/SMs with a history of mild-to-moderate TBI. DESIGN AND MAIN MEASURES This meta-analysis was preregistered with PROSPERO (CRD42021262902) and used the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist for reporting guidelines. Inclusion criteria required studies to have (1) randomized controlled trials; (2) used adult participants (aged 18 years or older) who were US veterans or active-duty service members who had a history of mild-to-moderate TBI; (3) cognitive rehabilitation treatments designed to improve cognition and/or everyday functioning; (4) used objective neuropsychological testing as a primary outcome measure; and (5) been published in English. At least 2 reviewers independently screened all identified abstracts and full-text articles and coded demographic and effect size data. The final search was run on February 24, 2023, using 4 databases (PubMed, PsycINFO, Web of Science, and Google Scholar). Study quality and bias were examined using the revised Cochrane Risk-of-Bias Tool for Randomized Trials. RESULTS We identified 8 articles meeting full criteria (total participants = 564; 97% of whom had a history of mild TBI). Compared with control groups, participants showed a small, but significant, improvement in overall objective neuropsychological functioning after cognitive rehabilitation interventions. Interventions focusing on teaching strategies had a larger effect size than did those focusing on drill-and-practice approaches for both objective neuropsychological test performance and performance-based measures of functional capacity. CONCLUSION There is evidence of cognitive improvement in V/SMs with TBI histories after participation in cognitive rehabilitation. Clinician-administered interventions focusing on teaching strategies may yield the greatest cognitive improvement in this population.
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Affiliation(s)
- Tara A. Austin
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA
- Research Service, VA San Diego Healthcare System, San Diego, CA
- The VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX
| | - Cooper B. Hodges
- School of Social and Behavioral Sciences, Andrews University, Berrien Springs, MI
| | - Michael L. Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO
| | - Yvette Z. Szabo
- The VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX
- California State University, Los Angeles, Department of Psychology, Los Angeles, CA
| | - Sarah Parr
- Department of Psychology and Neuroscience, Baylor University, Waco, TX
| | - Ben D. Eschler
- Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX
| | - Crystal Lantrip
- The VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX
- Department of Psychology and Neuroscience, Baylor University, Waco, TX
| | - Elizabeth Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA
- Research Service, VA San Diego Healthcare System, San Diego, CA
- Department of Psychiatry, University of California San Diego, San Diego, CA
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3
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Liao Y, Li Y, Wang LI, Zhang YE, Sang L, Wang Q, Li P, Xiong K, Qiu M, Zhang J. The injury progression in acute blast-induced mTBI in rats reflected by DTI and immunohistochemical examination. J Neurotrauma 2024. [PMID: 38877821 DOI: 10.1089/neu.2023.0435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
Diffusion tensor imaging (DTI) has emerged as a promising neuroimaging tool for detecting blast-induced mild traumatic brain injury (bmTBI). However, lack of refined acute-phase monitoring and reliable imaging biomarkers hindered its clinical application in early diagnosis of bmTBI, leading to potential long-term disability of patients. Here, we used DTI in a rat model of bmTBI generated by exposing to single lateral blast waves (151.16 and 349.75 kPa, lasting 47.48 ms) released in a confined bioshock tube (BST-I) to investigate whole-brain DTI changes in the acute-phase of bmTBI at 1, 3, 7 days after injury. Combined assessment of immunohistochemical analysis, transmission electron microscopy (TEM) and behavioral readouts allowed for linking DTI changes to synchronous cellular damages and identifying stable imaging biomarkers. The corpus callosum (CC) and brainstem were identified as predominantly affected regions, in which reduced fractional anisotropy (FA) was detected as early as the first day after injury, with a maximum decline occurring at 3 days after injury before returning to near normal levels by 7 days. Axial diffusivity (AD) values within the CC and brainstem also significantly reduced at 3 days after injury. In contrast, the radial diffusivity (RD) in the CC showed acute elevation, peaking at 3 days after injury before normalizing by the 7-day time point. Damages to nerve fibers, including demyelination and axonal degeneration, progressed in lines with changes in DTI parameters, supporting a real-time macroscopic reflection of microscopic neuronal fiber injury by DTI. The most sensitive biomarker was identified as a decrease in FA, AD and an increase in RD within the CC on the third day after injury, supporting the diagnostic utility of DTI in cases of bmTBI in the acute phase.
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Affiliation(s)
- Yalan Liao
- Army Medical University, Department of Medical Imaging, Chongqing, China;
| | - Yang Li
- Air Force Hospital of Western Theater Command, Department of Medical Imaging, Chengdu, China;
| | - L I Wang
- Army Medical University, Department of Medical Imaging, Chongqing, China;
| | - Y E Zhang
- Army Medical University, Department of Medical Imaging, Chongqing, China;
| | - Linqiong Sang
- Army Medical University, Department of Medical Imaging, Chongqing, China;
| | - Qiannan Wang
- Army Medical University, Department of Medical Imaging, Chongqing, China;
| | - Pengyue Li
- Army Medical University, Department of Medical Imaging, Chongqing, China;
| | - Kunlin Xiong
- Army Medical University Daping Hospital, Department of Radiology, Chongqing, China;
| | - Mingguo Qiu
- Army Medical University, Department of Medical Imaging, Chongqing, China;
| | - Jingna Zhang
- Army Medical University, Department of Medical Imaging, Chongqing, China;
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Thanapaul RJRS, Alamneh YA, Finnegan DK, Antonic V, Abu-Taleb R, Czintos C, Boone D, Su W, Sajja VS, Getnet D, Roberds A, Walsh TJ, Bobrov AG. Development of a Combat-Relevant Murine Model of Wound Mucormycosis: A Platform for the Pre-Clinical Investigation of Novel Therapeutics for Wound-Invasive Fungal Diseases. J Fungi (Basel) 2024; 10:364. [PMID: 38786719 PMCID: PMC11122444 DOI: 10.3390/jof10050364] [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: 04/01/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Wound-invasive fungal diseases (WIFDs), especially mucormycosis, have emerged as life-threatening infections during recent military combat operations. Many combat-relevant fungal pathogens are refractory to current antifungal therapy. Therefore, animal models of WIFDs are urgently needed to investigate new therapeutic solutions. Our study establishes combat-relevant murine models of wound mucormycosis using Rhizopus arrhizus and Lichtheimia corymbifera, two Mucorales species that cause wound mucormycosis worldwide. These models recapitulate the characteristics of combat-related wounds from explosions, including blast overpressure exposure, full-thickness skin injury, fascial damage, and muscle crush. The independent inoculation of both pathogens caused sustained infections and enlarged wounds. Histopathological analysis confirmed the presence of necrosis and fungal hyphae in the wound bed and adjacent muscle tissue. Semi-quantification of fungal burden by colony-forming units corroborated the infection. Treatment with liposomal amphotericin B, 30 mg/kg, effectively controlled R. arrhizus growth and significantly reduced residual fungal burden in infected wounds (p < 0.001). This study establishes the first combat-relevant murine model of wound mucormycosis, paving the way for developing and evaluating novel antifungal therapies against combat-associated WIFDs.
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Affiliation(s)
- Rex J. R. Samdavid Thanapaul
- Wound Infections Department, Bacterial Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
- NRC Research Associateship Programs, National Academies of Sciences, Engineering, and Medicine, Washington, DC 20001, USA
| | - Yonas A. Alamneh
- Wound Infections Department, Bacterial Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Daniel K. Finnegan
- Veterinary Services Program, Pathology Department, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Vlado Antonic
- Wound Infections Department, Bacterial Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Rania Abu-Taleb
- Wound Infections Department, Bacterial Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Christine Czintos
- Wound Infections Department, Bacterial Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Dylan Boone
- Wound Infections Department, Bacterial Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Wanwen Su
- Wound Infections Department, Bacterial Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Venkatasivasai S. Sajja
- Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Derese Getnet
- Wound Infections Department, Bacterial Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Ashleigh Roberds
- Wound Infections Department, Bacterial Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Thomas J. Walsh
- Departments of Medicine and Microbiology & Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, VA 23220, USA
| | - Alexander G. Bobrov
- Wound Infections Department, Bacterial Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
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5
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Sachdeva T, Ganpule SG. Twenty Years of Blast-Induced Neurotrauma: Current State of Knowledge. Neurotrauma Rep 2024; 5:243-253. [PMID: 38515548 PMCID: PMC10956535 DOI: 10.1089/neur.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Blast-induced neurotrauma (BINT) is an important injury paradigm of neurotrauma research. This short communication summarizes the current knowledge of BINT. We divide the BINT research into several broad categories-blast wave generation in laboratory, biomechanics, pathology, behavioral outcomes, repetitive blast in animal models, and clinical and neuroimaging investigations in humans. Publications from 2000 to 2023 in each subdomain were considered. The analysis of the literature has brought out salient aspects. Primary blast waves can be simulated reasonably in a laboratory using carefully designed shock tubes. Various biomechanics-based theories of BINT have been proposed; each of these theories may contribute to BINT by generating a unique biomechanical signature. The injury thresholds for BINT are in the nascent stages. Thresholds for rodents are reasonably established, but such thresholds (guided by primary blast data) are unavailable in humans. Single blast exposure animal studies suggest dose-dependent neuronal pathologies predominantly initiated by blood-brain barrier permeability and oxidative stress. The pathologies were typically reversible, with dose-dependent recovery times. Behavioral changes in animals include anxiety, auditory and recognition memory deficits, and fear conditioning. The repetitive blast exposure manifests similar pathologies in animals, however, at lower blast overpressures. White matter irregularities and cortical volume and thickness alterations have been observed in neuroimaging investigations of military personnel exposed to blast. Behavioral changes in human cohorts include sleep disorders, poor motor skills, cognitive dysfunction, depression, and anxiety. Overall, this article provides a concise synopsis of current understanding, consensus, controversies, and potential future directions.
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Affiliation(s)
- Tarun Sachdeva
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee, India
| | - Shailesh G. Ganpule
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee, India
- Department of Design, Indian Institute of Technology Roorkee, Roorkee, India
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6
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Halalmeh DR, Salama HZ, LeUnes E, Feitosa D, Ansari Y, Sachwani-Daswani GR, Moisi MD. The Role of Neuropsychology in Traumatic Brain Injury: Comprehensive Literature Review. World Neurosurg 2024; 183:128-143. [PMID: 38104936 DOI: 10.1016/j.wneu.2023.12.069] [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: 10/18/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
Traumatic brain injury (TBI) is a major public health concern, often leading to significant behavioral and cognitive changes with subsequent impairment in daily functioning and personal interactions. The management of TBI involves a multidisciplinary approach. Neuropsychology has emerged as a critical discipline in assessing, diagnosing, treating, and rehabilitating individuals with TBI. Successful management also requires careful consideration of the patient's cognitive status. Therefore, clinicians must have a comprehensive understanding of the overall clinical picture of the patient at the cognitive and physical level. The primary aim of this research is to explore the role of neuropsychology in TBI management and rehabilitation thoroughly while providing an updated review of the literature. Various neuropsychological assessment tools used to evaluate cognitive functioning in individuals with TBI will be discussed in addition to their validity, reliability, and usefulness in identifying cognitive deficits and developing individualized treatment plans. The findings in this article will have significant implications on the clinical practice of neuropsychology in TBI patients, highlighting the importance of neuropsychological assessment in optimizing the management of this population. The need for increased awareness of neuropsychology among health care professionals, especially in the acute hospital setting, is growing along with the increase in diagnosis of TBI and its complications. Adequate understanding of the complex interplay between cognitive, emotional, and behavioral factors in TBI can inform the development of new interventions and treatment strategies, making it equally as important for patients and their families.
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Affiliation(s)
- Dia R Halalmeh
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA; Department of Surgery, Michigan State University-College of Human Medicine, Traverse City, Michigan, USA; Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, Michigan, USA.
| | | | - Emma LeUnes
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA
| | - David Feitosa
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA
| | - Yusuf Ansari
- Temple University, Philadelphia, Pennsylvania, USA
| | - Gul R Sachwani-Daswani
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, Michigan, USA
| | - Marc D Moisi
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA; Department of Surgery, Michigan State University-College of Human Medicine, Traverse City, Michigan, USA; Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, Michigan, USA
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7
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Iacono D, Hatch K, Murphy EK, Cole RN, Post J, Leonessa F, Perl DP. Proteomic Changes in the Hippocampus after Repeated Explosive-Driven Blasts. J Proteome Res 2024; 23:397-408. [PMID: 38096401 PMCID: PMC10775857 DOI: 10.1021/acs.jproteome.3c00628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 01/06/2024]
Abstract
Repeated blast-traumatic brain injury (blast-TBI) has been hypothesized to cause persistent and unusual neurological and psychiatric symptoms in service members returning from war zones. Blast-wave primary effects have been supposed to induce damage and molecular alterations in the brain. However, the mechanisms through which the primary effect of an explosive-driven blast wave generate brain lesions and induce brain consequences are incompletely known. Prior findings from rat brains exposed to two consecutive explosive-driven blasts showed molecular changes (hyperphosphorylated-Tau, AQP4, S100β, PDGF, and DNA-polymerase-β) that varied in magnitude and direction across different brain regions. We aimed to compare, in an unbiased manner, the proteomic profile in the hippocampus of double blast vs sham rats using mass spectrometry (MS). Data showed differences in up- and down-regulation for protein abundances in the hippocampus of double blast vs sham rats. Tandem mass tag (TMT)-MS results showed 136 up-regulated and 94 down-regulated proteins between the two groups (10.25345/C52B8VP0X). These TMT-MS findings revealed changes never described before in blast studies, such as increases in MAGI3, a scaffolding protein at cell-cell junctions, which were confirmed by Western blotting analyses. Due to the absence of behavioral and obvious histopathological changes as described in our previous publications, these proteomic data further support the existence of an asymptomatic blast-induced molecular altered status (ABIMAS) associated with specific protein changes in the hippocampus of rats repeatedly expsosed to blast waves generated by explosive-driven detonations.
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Affiliation(s)
- Diego Iacono
- DoD/USU
Brain Tissue Repository & Neuropathology Program, Uniformed Services University (USU), Bethesda, Maryland 20814, United States
- Department
of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland 20814, United States
- Department
of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland 20814, United States
- Neuroscience
Program, Department of Anatomy, Physiology & Genetics, Uniformed Services University (USU), Bethesda, Maryland 20814, United States
- The
Henry M. Jackson Foundation for the Advancement of Military Medicine
(HJF), Inc., Bethesda, Maryland 20817, United States
- Neurodegeneration
Disorders Clinic, National Institute of
Neurological Disorders and Stroke, NINDS, NIH, Bethesda, Maryland 20814, United States
| | - Kathleen Hatch
- Department
of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland 20814, United States
| | - Erin K. Murphy
- Department
of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland 20814, United States
| | - Robert N. Cole
- Mass
Spectrometry and Proteomics, Department of Biological Chemistry, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21205, United States
| | - Jeremy Post
- Mass
Spectrometry and Proteomics, Department of Biological Chemistry, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21205, United States
| | - Fabio Leonessa
- Department
of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland 20814, United States
| | - Daniel P. Perl
- DoD/USU
Brain Tissue Repository & Neuropathology Program, Uniformed Services University (USU), Bethesda, Maryland 20814, United States
- Department
of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland 20814, United States
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Ge M, Wang Y, Wu T, Li H, Yang C, Wang Z, Mu N, Chen T, Xu D, Feng H, Yao J. Raman spectroscopic diagnosis of blast-induced traumatic brain injury in rats combined with machine learning. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 304:123419. [PMID: 37738762 DOI: 10.1016/j.saa.2023.123419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/12/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023]
Abstract
Blast-induced traumatic brain injury (bTBI) is a kind of nervous system disease, which results in a major health and economic problem to society. However, the rapid and label-free detection method with high sensitivity is still in great demand for the diagnosis of bTBI, especially for mild bTBI. In this paper, we report a new strategy for bTBI diagnosis through hippocampus and hypothalamus tissues based on Raman spectroscopy. The spectral characteristics of hippocampus and hypothalamus tissues of experimental bTBI in rats have been investigated for mild and moderate degrees at 3 h, 6 h, 24 h, 48 h, 72 h after blast exposure. The results show that the Raman spectra of mild and moderate bTBIs in 300-1700 cm-1 and 2800-3000 cm-1 regions exhibit significant differences at different time points compared with the control group. The main reason is the content change of proteins and lipids in hippocampus and hypothalamus tissues after bTBI. Moreover, four machine learning algorithms are used to automatically identify mild and moderate bTBIs at different time points (a total of 11 groups). The highest diagnostic accuracies are up to 95.3% and 88.5% based on Raman spectra of hippocampus and hypothalamus tissue, respectively. In addition, the classification performance of linear discriminant analysis classifier has been improved after data fusion. It is suggested that there has great potential as an alternative method for high-sensitive, rapid, label-free, economical diagnosis of bTBI.
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Affiliation(s)
- Meilan Ge
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China; Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
| | - Yuye Wang
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China; Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China.
| | - Tong Wu
- School of Marine Science and Technology, Tianjin University, Tianjin 300072, China
| | - Haibin Li
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China; Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
| | - Chuanyan Yang
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Zelong Wang
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China; Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
| | - Ning Mu
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Tunan Chen
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Degang Xu
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China; Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
| | - Hua Feng
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Jianquan Yao
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China; Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
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9
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Kilgore MO, Hubbard WB. Effects of Low-Level Blast on Neurovascular Health and Cerebral Blood Flow: Current Findings and Future Opportunities in Neuroimaging. Int J Mol Sci 2024; 25:642. [PMID: 38203813 PMCID: PMC10779081 DOI: 10.3390/ijms25010642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Low-level blast (LLB) exposure can lead to alterations in neurological health, cerebral vasculature, and cerebral blood flow (CBF). The development of cognitive issues and behavioral abnormalities after LLB, or subconcussive blast exposure, is insidious due to the lack of acute symptoms. One major hallmark of LLB exposure is the initiation of neurovascular damage followed by the development of neurovascular dysfunction. Preclinical studies of LLB exposure demonstrate impairment to cerebral vasculature and the blood-brain barrier (BBB) at both early and long-term stages following LLB. Neuroimaging techniques, such as arterial spin labeling (ASL) using magnetic resonance imaging (MRI), have been utilized in clinical investigations to understand brain perfusion and CBF changes in response to cumulative LLB exposure. In this review, we summarize neuroimaging techniques that can further our understanding of the underlying mechanisms of blast-related neurotrauma, specifically after LLB. Neuroimaging related to cerebrovascular function can contribute to improved diagnostic and therapeutic strategies for LLB. As these same imaging modalities can capture the effects of LLB exposure in animal models, neuroimaging can serve as a gap-bridging diagnostic tool that permits a more extensive exploration of potential relationships between blast-induced changes in CBF and neurovascular health. Future research directions are suggested, including investigating chronic LLB effects on cerebral perfusion, exploring mechanisms of dysautoregulation after LLB, and measuring cerebrovascular reactivity (CVR) in preclinical LLB models.
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Affiliation(s)
- Madison O. Kilgore
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 40536, USA;
| | - W. Brad Hubbard
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 40536, USA;
- Department of Physiology, University of Kentucky, Lexington, KY 40536, USA
- Lexington Veterans’ Affairs Healthcare System, Lexington, KY 40502, USA
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10
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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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11
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Skop KM, Bajor L, Sevigny M, Swank C, Tallavajhula S, Nakase-Richardson R, Miles SR. Exploring the relationship between sleep apnea and vestibular symptoms following traumatic brain injury. PM R 2023; 15:1524-1535. [PMID: 37490363 DOI: 10.1002/pmrj.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/09/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a complex health problem in military veterans and service members (V/SM) that often involves comorbid vestibular impairment. Sleep apnea is another comorbidity that may exacerbate, and/or be exacerbated by, vestibular dysfunction. OBJECTIVE To examine the relationship between sleep apnea and vestibular symptoms in V/SM diagnosed with TBI of any severity. DESIGN Multicenter cohort study; cross-sectional sample. SETTING In-patient TBI rehabilitation units within five Veterans Affairs (VA) Polytrauma Rehabilitation Centers. PARTICIPANTS V/SM with a diagnosis of TBI (N = 630) enrolled in the VA TBI Model Systems study. INTERVENTION Not applicable. METHODS A multivariable regression model was used to evaluate the association between sleep apnea and vestibular symptom severity while controlling for relevant covariates, for example, posttraumatic stress disorder (PTSD). MAIN OUTCOME MEASURES Lifetime history of sleep apnea was determined via best source reporting. Vestibular disturbances were measured with the 3-item Vestibular subscale of the Neurobehavioral Symptom Inventory (NSI). RESULTS One third (30.6%) of the sample had a self-reported sleep apnea diagnosis. Initial analysis showed that participants who had sleep apnea had more severe vestibular symptoms (M = 3.84, SD = 2.86) than those without sleep apnea (M = 2.88, SD = 2.67, p < .001). However, when the data was analyzed via a multiple regression model, sleep apnea no longer reached the threshold of significance as a factor associated with vestibular symptoms. PTSD severity was shown to be significantly associated with vestibular symptoms within this sample (p < .001). CONCLUSION Analysis of these data revealed a relationship between sleep apnea and vestibular symptoms in V/SM with TBI. The significance of this relationship was affected when PTSD symptoms were factored into a multivariable regression model. However, given that the mechanisms and directionality of these relationships are not yet well understood, we assert that in terms of clinical relevance, providers should emphasize screening for each of the three studied comorbidities (sleep apnea, vestibular symptoms, and PTSD).
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Affiliation(s)
- Karen M Skop
- Physical Medicine and Rehabilitation Services, Department of Physical Therapy, James A Haley Veterans' Hospital, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, School of Physical Therapy, Tampa, Florida, USA
| | - Laura Bajor
- Mental Health and Behavioral Sciences Service, James A Haley Veterans' Hospital, Tampa, Florida, USA
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Harvard South Shore Psychiatry Training Program, Brockton, Massachusetts, USA
| | - Mitch Sevigny
- Research Department, Craig Hospital, Englewood, Colorado, USA
| | - Chad Swank
- Baylor Scott & White Research Institute for Rehabilitation, Dallas, Texas, USA
- Baylor Scott White Research Institute, Dallas, Texas, USA
| | - Sudha Tallavajhula
- University of Texas McGovern Medical School, Houston, Texas, USA
- TIRR Memorial Hermann Neurological Sleep Disorders Center, Houston, Texas, USA
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences and Defense and Veterans' Brain Injury Center, James A. Haley Veterans' Hospital, Tampa, Florida, USA
- Morsani College of Medicine, Pulmonary and Sleep Medicine Division, University of South Florida, Tampa, Florida, USA
| | - Shannon R Miles
- Mental Health and Behavioral Sciences Service, James A Haley Veterans' Hospital, Tampa, Florida, USA
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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Sours Rhodes C, Sandlain R, Ollinger J, Bryden D, Dittmer T, DeGraba TJ, Teslovich T. Development of the Blast Ordnance and Occupational Exposure Measure for Self-Reported Lifetime Blast Exposures. Mil Med 2023; 188:3336-3342. [PMID: 35855546 DOI: 10.1093/milmed/usac212] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/10/2022] [Accepted: 06/30/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION To address the military gap in the standardized collection of lifetime blast exposures across clinical and research endeavors, researchers at the National Intrepid Center of Excellence (NICoE) completed a quality improvement project that utilized systematic, iterative focus groups that leveraged the input from various stakeholders including subject matter experts, clinical providers, and service members (SMs) to develop a comprehensive, self-report blast exposure inventory that could be completed within 5-10 minutes. This manuscript outlines the process of the development of this inventory. MATERIALS AND METHODS This project included three phases of focus groups that occurred at the NICoE between August 2020 and March 2021 to collect feedback and input from relevant military stakeholders. The study team utilized related assessments available in the literature, together with clinical experience with the NICoE patient population, to inform the development of an initial draft inventory. Phase 1 consisted of blast injury research subject matter experts who had extensive experience researching and providing clinical care to SMs exposed to blast. Phase 2 consisted of NICoE clinicians across numerous clinical specialties. Phase 3 included current active duty patients in the NICoE intensive outpatient program. RESULTS Following completion of the focus groups, a lifetime blast exposure inventory was developed in the form of a single page table including incoming, outgoing, training, and operational exposures and broken down by levels of weapon systems as well as breaching and explosive ordnance disposal exposures. In addition, select questions related to the first and most recent blast exposures and experience as an instructor for explosive ordnance disposal- and breaching-related training were included. CONCLUSIONS Researchers at the NICoE developed a self-report blast exposure inventory through a quality improvement project that included active, ongoing participation and feedback of clinical experts and military SMs. The end result is a brief, single page inventory that can be administered within 5-10 minutes. Although additional research is needed to refine and validate the inventory, the project team believes that the tool begins to address a long-standing gap in the DoD in the standardized collection of lifetime blast exposures.
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Affiliation(s)
- Chandler Sours Rhodes
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889-5649, USA
| | - Rebecca Sandlain
- Contractor in Support of National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889-5649, USA
| | - John Ollinger
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889-5649, USA
| | | | | | - Thomas J DeGraba
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889-5649, USA
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD 20889-5649, USA
| | - Theresa Teslovich
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889-5649, USA
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Zhang L, Yang Q, Yuan R, Li M, Lv M, Zhang L, Xie X, Liang W, Chen X. Single-nucleus transcriptomic mapping of blast-induced traumatic brain injury in mice hippocampus. Sci Data 2023; 10:638. [PMID: 37730716 PMCID: PMC10511629 DOI: 10.1038/s41597-023-02552-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023] Open
Abstract
As a significant type of traumatic brain injury (TBI), blast-induced traumatic brain injury (bTBI) frequently results in severe neurological and psychological impairments. Due to its unique mechanistic and clinical features, bTBI presents diagnostic and therapeutic challenges compared to other TBI forms. The hippocampus, an important site for secondary injury of bTBI, serves as a key niche for neural regeneration and repair post-injury, and is closely associated with the neurological outcomes of bTBI patients. Nonetheless, the pathophysiological alterations of hippocampus underpinning bTBI remain enigmatic, and a corresponding transcriptomic dataset for research reference is yet to be established. In this investigation, the single-nucleus RNA sequencing (snRNA-seq) technique was employed to sequence individual hippocampal nuclei of mice from bTBI and sham group. Upon stringent quality control, gene expression data from 17,278 nuclei were obtained, with the dataset's reliability substantiated through various analytical methods. This dataset holds considerable potential for exploring secondary hippocampal injury and neurogenesis mechanisms following bTBI, with important reference value for the identification of specific diagnostic and therapeutic targets for bTBI.
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Affiliation(s)
- Lingxuan Zhang
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Qiuyun Yang
- Department of Forensic Genetics, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
- West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Ruixuan Yuan
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Manrui Li
- Department of Forensic Genetics, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Meili Lv
- Department of Immunology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Lin Zhang
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Xiaoqi Xie
- Department of Critical Care Medicine, Sichuan University, Chengdu, 610041, China.
| | - Weibo Liang
- Department of Forensic Genetics, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China.
| | - Xiameng Chen
- Department of Forensic Pathology and Forensic Clinical Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China.
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14
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Campos-Pires R, Ong BE, Koziakova M, Ujvari E, Fuller I, Boyles C, Sun V, Ko A, Pap D, Lee M, Gomes L, Gallagher K, Mahoney PF, Dickinson R. Repetitive, but Not Single, Mild Blast TBI Causes Persistent Neurological Impairments and Selective Cortical Neuronal Loss in Rats. Brain Sci 2023; 13:1298. [PMID: 37759899 PMCID: PMC10526452 DOI: 10.3390/brainsci13091298] [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: 07/31/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Exposure to repeated mild blast traumatic brain injury (mbTBI) is common in combat soldiers and the training of Special Forces. Evidence suggests that repeated exposure to a mild or subthreshold blast can cause serious and long-lasting impairments, but the mechanisms causing these symptoms are unclear. In this study, we characterise the effects of single and tightly coupled repeated mbTBI in Sprague-Dawley rats exposed to shockwaves generated using a shock tube. The primary outcomes are functional neurologic function (unconsciousness, neuroscore, weight loss, and RotaRod performance) and neuronal density in brain regions associated with sensorimotor function. Exposure to a single shockwave does not result in functional impairments or histologic injury, which is consistent with a mild or subthreshold injury. In contrast, exposure to three tightly coupled shockwaves results in unconsciousness, along with persistent neurologic impairments. Significant neuronal loss following repeated blast was observed in the motor cortex, somatosensory cortex, auditory cortex, and amygdala. Neuronal loss was not accompanied by changes in astrocyte reactivity. Our study identifies specific brain regions particularly sensitive to repeated mbTBI. The reasons for this sensitivity may include exposure to less attenuated shockwaves or proximity to tissue density transitions, and this merits further investigation. Our novel model will be useful in elucidating the mechanisms of sensitisation to injury, the temporal window of sensitivity and the evaluation of new treatments.
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Affiliation(s)
- Rita Campos-Pires
- Anaesthetics, Pain Medicine and Intensive Care Division, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
- Royal British Legion Centre for Blast Injury Studies, Imperial College London, London SW7 2AZ, UK
| | - Bee Eng Ong
- Anaesthetics, Pain Medicine and Intensive Care Division, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Mariia Koziakova
- Anaesthetics, Pain Medicine and Intensive Care Division, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Eszter Ujvari
- Anaesthetics, Pain Medicine and Intensive Care Division, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Isobel Fuller
- Anaesthetics, Pain Medicine and Intensive Care Division, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Charlotte Boyles
- Anaesthetics, Pain Medicine and Intensive Care Division, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Valerie Sun
- Anaesthetics, Pain Medicine and Intensive Care Division, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Andy Ko
- Anaesthetics, Pain Medicine and Intensive Care Division, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Daniel Pap
- Anaesthetics, Pain Medicine and Intensive Care Division, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Matthew Lee
- Anaesthetics, Pain Medicine and Intensive Care Division, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Lauren Gomes
- Anaesthetics, Pain Medicine and Intensive Care Division, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Kate Gallagher
- Anaesthetics, Pain Medicine and Intensive Care Division, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Peter F. Mahoney
- Royal British Legion Centre for Blast Injury Studies, Imperial College London, London SW7 2AZ, UK
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - Robert Dickinson
- Anaesthetics, Pain Medicine and Intensive Care Division, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
- Royal British Legion Centre for Blast Injury Studies, Imperial College London, London SW7 2AZ, UK
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15
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Rowe CJ, Mang J, Huang B, Dommaraju K, Potter BK, Schobel SA, Gann ER, Davis TA. Systemic inflammation induced from remote extremity trauma is a critical driver of secondary brain injury. Mol Cell Neurosci 2023; 126:103878. [PMID: 37451414 DOI: 10.1016/j.mcn.2023.103878] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
Blast exposure, commonly experienced by military personnel, can cause devastating life-threatening polysystem trauma. Despite considerable research efforts, the impact of the systemic inflammatory response after major trauma on secondary brain injury-inflammation is largely unknown. The aim of this study was to identify markers underlying the susceptibility and early onset of neuroinflammation in three rat trauma models: (1) blast overpressure exposure (BOP), (2) complex extremity trauma (CET) involving femur fracture, crush injury, tourniquet-induced ischemia, and transfemoral amputation through the fracture site, and (3) BOP+CET. Six hours post-injury, intact brains were harvested and dissected to obtain biopsies from the prefrontal cortex, striatum, neocortex, hippocampus, amygdala, thalamus, hypothalamus, and cerebellum. Custom low-density microarray datasets were used to identify, interpret and visualize genes significant (p < 0.05 for differential expression [DEGs]; 86 neuroinflammation-associated) using a custom python-based computer program, principal component analysis, heatmaps and volcano plots. Gene set and pathway enrichment analyses of the DEGs was performed using R and STRING for protein-protein interaction (PPI) to identify and explore key genes and signaling networks. Transcript profiles were similar across all regions in naïve brains with similar expression levels involving neurotransmission and transcription functions and undetectable to low-levels of inflammation-related mediators. Trauma-induced neuroinflammation across all anatomical brain regions correlated with injury severity (BOP+CET > CET > BOP). The most pronounced differences in neuroinflammatory-neurodegenerative gene regulation were between blast-associated trauma (BOP, BOP+CET) and CET. Following BOP, there were few DEGs detected amongst all 8 brain regions, most were related to cytokines/chemokines and chemokine receptors, where PPI analysis revealed Il1b as a potential central hub gene. In contrast, CET led to a more excessive and diverse pro-neuroinflammatory reaction in which Il6 was identified as the central hub gene. Analysis of the of the BOP+CET dataset, revealed a more global heightened response (Cxcr2, Il1b, and Il6) as well as the expression of additional functional regulatory networks/hub genes (Ccl2, Ccl3, and Ccl4) which are known to play a critical role in the rapid recruitment and activation of immune cells via chemokine/cytokine signaling. These findings provide a foundation for discerning pathophysiological consequences of acute extremity injury and systemic inflammation following various forms of trauma in the brain.
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Affiliation(s)
- Cassie J Rowe
- Cell Biology and Regenerative Medicine Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA.
| | - Josef Mang
- Cell Biology and Regenerative Medicine Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Benjamin Huang
- Cell Biology and Regenerative Medicine Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Kalpana Dommaraju
- Student Bioinformatics Initiative (SBI), Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Benjamin K Potter
- Cell Biology and Regenerative Medicine Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Seth A Schobel
- Cell Biology and Regenerative Medicine Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA; Surgical Critical Care Initiative (SC2i), Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Eric R Gann
- Cell Biology and Regenerative Medicine Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA; Surgical Critical Care Initiative (SC2i), Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Thomas A Davis
- Cell Biology and Regenerative Medicine Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
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16
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Kim SY, Yeh PH, Ollinger JM, Morris HD, Hood MN, Ho VB, Choi KH. Military-related mild traumatic brain injury: clinical characteristics, advanced neuroimaging, and molecular mechanisms. Transl Psychiatry 2023; 13:289. [PMID: 37652994 PMCID: PMC10471788 DOI: 10.1038/s41398-023-02569-1] [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: 10/31/2022] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is a significant health burden among military service members. Although mTBI was once considered relatively benign compared to more severe TBIs, a growing body of evidence has demonstrated the devastating neurological consequences of mTBI, including chronic post-concussion symptoms and deficits in cognition, memory, sleep, vision, and hearing. The discovery of reliable biomarkers for mTBI has been challenging due to under-reporting and heterogeneity of military-related mTBI, unpredictability of pathological changes, and delay of post-injury clinical evaluations. Moreover, compared to more severe TBI, mTBI is especially difficult to diagnose due to the lack of overt clinical neuroimaging findings. Yet, advanced neuroimaging techniques using magnetic resonance imaging (MRI) hold promise in detecting microstructural aberrations following mTBI. Using different pulse sequences, MRI enables the evaluation of different tissue characteristics without risks associated with ionizing radiation inherent to other imaging modalities, such as X-ray-based studies or computerized tomography (CT). Accordingly, considering the high morbidity of mTBI in military populations, debilitating post-injury symptoms, and lack of robust neuroimaging biomarkers, this review (1) summarizes the nature and mechanisms of mTBI in military settings, (2) describes clinical characteristics of military-related mTBI and associated comorbidities, such as post-traumatic stress disorder (PTSD), (3) highlights advanced neuroimaging techniques used to study mTBI and the molecular mechanisms that can be inferred, and (4) discusses emerging frontiers in advanced neuroimaging for mTBI. We encourage multi-modal approaches combining neuropsychiatric, blood-based, and genetic data as well as the discovery and employment of new imaging techniques with big data analytics that enable accurate detection of post-injury pathologic aberrations related to tissue microstructure, glymphatic function, and neurodegeneration. Ultimately, this review provides a foundational overview of military-related mTBI and advanced neuroimaging techniques that merit further study for mTBI diagnosis, prognosis, and treatment monitoring.
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Affiliation(s)
- Sharon Y Kim
- School of Medicine, Uniformed Services University, Bethesda, MD, USA
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA
| | - Ping-Hong Yeh
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John M Ollinger
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Herman D Morris
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Maureen N Hood
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Vincent B Ho
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Kwang H Choi
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA.
- Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, MD, USA.
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA.
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Phillips AK, Keller MF, McClung JP, Steele N, Witkop CT, Wu TJ. Physical Health and Well-being: Updates and the Way Ahead. Mil Med 2023; 188:9-18. [PMID: 37490559 DOI: 10.1093/milmed/usac370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 02/24/2022] [Accepted: 11/14/2022] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION The Women in Combat Summit 2021 "Forging the Future: How Women Enhance the Fighting Force" took place during February 9-11, 2021, via a virtual conference platform. The third and final day of the Summit regarded the physical health and well-being of military women and included the topics of urogenital health, nutrition and iron-deficiency anemia, unintended pregnancy and contraception, and traumatic brain injury. MATERIALS AND METHODS After presentations on the topics earlier, interested conference attendees were invited to participate in focus groups to discuss and review policy recommendations for physical health and well-being in military women. Discussions centered around the topics discussed during the presentations, and suggestions for future Women in Combat Summits were noted. Specifics of the methods of the Summit are presented elsewhere in this supplement. RESULTS We formulated research and policy recommendations for urogenital health, nutrition and iron-deficiency anemia, contraception and unintended pregnancy, and traumatic brain injury. CONCLUSIONS In order to continue to develop the future health of military women, health care providers, researchers, and policymakers should consider the recommendations made in this supplement as they continue to build on the state of the science and forge the future.
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Affiliation(s)
- Angela K Phillips
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD 20762, USA
| | - Margaux F Keller
- Henry Jackson Foundation at the Daniel K. Inouye Graduate School of Nursing, Uniformed Services University, Bethesda, MD 20814, USA
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Nancy Steele
- School of Nursing, University of North Florida, Jacksonville, FL 32224, USA
| | - Catherine T Witkop
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD 20814, USA
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University, Bethesda, MD 20814, USA
| | - T John Wu
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University, Bethesda, MD 20814, USA
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Ge M, Wang Y, Wu T, Li H, Yang C, Chen T, Feng H, Xu D, Yao J. Serum-based Raman spectroscopic diagnosis of blast-induced brain injury in a rat model. BIOMEDICAL OPTICS EXPRESS 2023; 14:3622-3634. [PMID: 37497497 PMCID: PMC10368048 DOI: 10.1364/boe.495285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 07/28/2023]
Abstract
The diagnosis of blast-induced traumatic brain injury (bTBI) is of paramount importance for early care and clinical therapy. Therefore, the rapid diagnosis of bTBI is vital to the treatment and prognosis in clinic. In this paper, we reported a new strategy for label-free bTBI diagnosis through serum-based Raman spectroscopy. The Raman spectral characteristics of serum in rat were investigated at 3 h, 24 h, 48 h and 72 h after mild and moderate bTBIs. It has been demonstrated that both the position and intensity of Raman characteristic peaks exhibited apparent differences in the range of 800-3000cm-1 compared with control group. It could be inferred that the content, structure and interaction of biomolecules in the serum were changed after blast exposure, which might help to understand the neurological syndromes caused by bTBI. Furthermore, the control group, mild and moderate bTBIs at different times (a total of 9 groups) were automatically classified by combining principal component analysis and four machine learning algorithms (quadratic discriminant analysis, support vector machine, k-nearest neighbor, neural network). The highest classification accuracy, sensitivity and precision were up to 95.4%, 95.9% and 95.7%. It is suggested that this method has great potential for high-sensitive, rapid, and label-free diagnosis of bTBI.
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Affiliation(s)
- Meilan Ge
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China
- Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
| | - Yuye Wang
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China
- Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
| | - Tong Wu
- School of Marine Science and Technology, Tianjin University, Tianjin 300072, China
| | - Haibin Li
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China
- Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
| | - Chuanyan Yang
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Tunan Chen
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Hua Feng
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Degang Xu
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China
- Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
| | - Jianquan Yao
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China
- Key Laboratory of Optoelectronics Information Technology (Ministry of Education), Tianjin University, Tianjin 300072, China
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19
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Babov KD, Zabolotna IB, Plakida AL, Volyanska VS, Babova IK, Gushcha SG, Kolker IA. The effectiveness of high-tone therapy in the complex rehabilitation of servicemen with post-traumatic stress disorder complicated by traumatic brain injury. Neurol Sci 2023; 44:1039-1048. [PMID: 36417014 DOI: 10.1007/s10072-022-06510-0] [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: 10/07/2021] [Accepted: 11/14/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION As a result of local military conflicts that have become more frequent over the past decades, the number of military personnel subjected to combat stress has sharply increased. More than 50% of them suffer from combat posttraumatic stress disorder. The most common comorbidity in this category of patients is a traumatic brain injury. Due to the undesirability of the long-term use of pharmacological agents, for rehabilitation, preference should be given to physiotherapeutic procedures. OBJECTS AND METHODS We examined 50 patients with post-traumatic stress disorder in combination with a closed craniocerebral injury. Group 1-25 patients received standard complex treatment at the sanatoriumresort rehabilitation stage (diet therapy, climatotherapy, balneotherapy, exercise therapy, psychotherapy). Group 2-25 patients, in addition to the standard complex treatment, received a course of high-tone therapy. RESULTS Complex rehabilitation of patients with the use of high-tone therapy contributes to a significant decrease in astheno-neurotic (p < 0.05) and asthenic depressive (p < 0.01) syndromes and has a psycho-relaxing effect on anxiety syndrome (p < 0.01). There was also a decrease in the severity of pyramidal symptoms and regression of the vestibulo-atactic syndrome (p < 0.05). The course application of hightone therapy was accompanied by a significant restoration of the elastotonic properties of the vascular wall and an improvement in cerebral perfusion (p < 0.05). Positive dynamics of electrophysiological indicators were noted: a decrease in the intensity of slow rhythms against the background of an increase in the frequency and intensity of the alpha rhythm in both hemispheres (p < 0.05), which indicates the harmonization of the bioelectrical activity of the brain.
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Affiliation(s)
- Kostyantyn D Babov
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine
| | - Iryna B Zabolotna
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine
| | - Alexander L Plakida
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine.
| | | | - Iryna K Babova
- State Institution "South Ukrainian National Pedagogical University Named After K.D. Ushynsky", Odessa, 65020, Ukraine
| | - Sergey G Gushcha
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine
| | - Iryna A Kolker
- Odessa National Medical University, Odessa, 65000, Ukraine
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20
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Double Blast Wave Primary Effect on Synaptic, Glymphatic, Myelin, Neuronal and Neurovascular Markers. Brain Sci 2023; 13:brainsci13020286. [PMID: 36831830 PMCID: PMC9954059 DOI: 10.3390/brainsci13020286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Explosive blasts are associated with neurological consequences as a result of blast waves impact on the brain. Yet, the neuropathologic and molecular consequences due to blast waves vs. blunt-TBI are not fully understood. An explosive-driven blast-generating system was used to reproduce blast wave exposure and examine pathological and molecular changes generated by primary wave effects of blast exposure. We assessed if pre- and post-synaptic (synaptophysin, PSD-95, spinophilin, GAP-43), neuronal (NF-L), glymphatic (LYVE1, podoplanin), myelin (MBP), neurovascular (AQP4, S100β, PDGF) and genomic (DNA polymerase-β, RNA polymerase II) markers could be altered across different brain regions of double blast vs. sham animals. Twelve male rats exposed to two consecutive blasts were compared to 12 control/sham rats. Western blot, ELISA, and immunofluorescence analyses were performed across the frontal cortex, hippocampus, cerebellum, and brainstem. The results showed altered levels of AQP4, S100β, DNA-polymerase-β, PDGF, synaptophysin and PSD-95 in double blast vs. sham animals in most of the examined regions. These data indicate that blast-generated changes are preferentially associated with neurovascular, glymphatic, and DNA repair markers, especially in the brainstem. Moreover, these changes were not accompanied by behavioral changes and corroborate the hypothesis for which an asymptomatic altered status is caused by repeated blast exposures.
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21
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Reeder EL, O'Connell CJ, Collins SM, Traubert OD, Norman SV, Cáceres RA, Sah R, Smith DW, Robson MJ. Increased Carbon Dioxide Respiration Prevents the Effects of Acceleration/Deceleration Elicited Mild Traumatic Brain Injury. Neuroscience 2023; 509:20-35. [PMID: 36332692 DOI: 10.1016/j.neuroscience.2022.10.016] [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: 08/12/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
Acceleration/deceleration forces are a common component of various causes of mild traumatic brain injury (mTBI) and result in strain and shear forces on brain tissue. A small quantifiable volume dubbed the compensatory reserve volume (CRV) permits energy transmission to brain tissue during acceleration/deceleration events. The CRV is principally regulated by cerebral blood flow (CBF) and CBF is primarily determined by the concentration of inspired carbon dioxide (CO2). We hypothesized that experimental hypercapnia (i.e. increased inspired concentration of CO2) may act to prevent and mitigate the actions of acceleration/deceleration-induced TBI. To determine these effects C57Bl/6 mice underwent experimental hypercapnia whereby they were exposed to medical-grade atmospheric air or 5% CO2 immediately prior to an acceleration/deceleration-induced mTBI paradigm. mTBI results in significant increases in righting reflex time (RRT), reductions in core body temperature, and reductions in general locomotor activity-three hours post injury (hpi). Experimental hypercapnia immediately preceding mTBI was found to prevent mTBI-induced increases in RRT and reductions in core body temperature and general locomotor activity. Ribonucleic acid (RNA) sequencing conducted four hpi revealed that CO2 exposure prevented mTBI-induced transcriptional alterations of several targets related to oxidative stress, immune, and inflammatory signaling. Quantitative real-time PCR analysis confirmed the prevention of mTBI-induced increases in mitogen-activated protein kinase kinase kinase 6 and metallothionein-2. These initial proof of concept studies reveal that increases in inspired CO2 mitigate the detrimental contributions of acceleration/deceleration events in mTBI and may feasibly be translated in the future to humans using a medical device seeking to prevent mTBI among high-risk groups.
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Affiliation(s)
- Evan L Reeder
- University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmaceutical Sciences, Cincinnati, OH 45267, USA
| | - Christopher J O'Connell
- University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmaceutical Sciences, Cincinnati, OH 45267, USA
| | - Sean M Collins
- University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmaceutical Sciences, Cincinnati, OH 45267, USA
| | - Owen D Traubert
- University of Cincinnati College of Arts and Sciences, Department of Biological Sciences, Cincinnati, OH 45221, USA
| | - Sophia V Norman
- University of Cincinnati College of Arts and Sciences, Department of Biological Sciences, Cincinnati, OH 45221, USA
| | - Román A Cáceres
- University of Cincinnati College of Medicine, Department of Cancer and Cell Biology Cincinnati, OH 45267, USA
| | - Renu Sah
- University of Cincinnati College of Medicine, Department of Pharmacology and Systems Physiology, Cincinnati, OH 45267, USA
| | | | - Matthew J Robson
- University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmaceutical Sciences, Cincinnati, OH 45267, USA.
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22
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Portillo E, Zi X, Kim Y, Tucker LB, Fu A, Miller LA, Valenzuela KS, Sullivan GM, Gauff AK, Yu F, Radomski KL, McCabe JT, Armstrong RC. Persistent hypersomnia following repetitive mild experimental traumatic brain injury: Roles of chronic stress and sex differences. J Neurosci Res 2023; 101:843-865. [PMID: 36624699 DOI: 10.1002/jnr.25165] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/15/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023]
Abstract
Traumatic brain injury (TBI) is often more complicated than a single head injury. An extreme example of this point may be military service members who experience a spectrum of exposures over a prolonged period under stressful conditions. Understanding the effects of complex exposures can inform evaluation and care to prevent persistent symptoms. We designed a longitudinal series of non-invasive procedures in adult mice to evaluate the effects of prolonged mild stress and head injury exposures. We assessed anxiety, depression, and sleep-wake dysfunction as symptoms that impact long-term outcomes after mild TBI. Unpredictable chronic mild stress (UCMS) was generated from a varied sequence of environmental stressors distributed within each of 21 days. Subsequently, mice received a mild blast combined with closed-head mild TBI on 5 days at 24-h intervals. In males and females, UCMS induced anxiety without depressive behavior. A major finding was reproducible sleep-wake dysfunction through 6- to 12-month time points in male mice that received UCMS with repetitive blast plus TBI events, or surprisingly after just UCMS alone. Specifically, male mice exhibited hypersomnia with increased sleep during the active/dark phase and fragmentation of longer wake bouts. Sleep-wake dysfunction was not found with TBI events alone, and hypersomnia was not found in females under any conditions. These results identify prolonged stress and sex differences as important considerations for sleep-wake dysfunction. Furthermore, this reproducible hypersomnia with impaired wakefulness is similar to the excessive daytime sleepiness reported in patients, including patients with TBI, which warrants further clinical screening, care, and treatment development.
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Affiliation(s)
- Edwin Portillo
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,The Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Xiaomei Zi
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,The Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Yeonho Kim
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,Preclinical Behavior and Modeling Core, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Laura B Tucker
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,Preclinical Behavior and Modeling Core, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Amanda Fu
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,Preclinical Behavior and Modeling Core, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Lauren A Miller
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,The Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Krystal S Valenzuela
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,The Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Genevieve M Sullivan
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,The Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Amina K Gauff
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,The Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Fengshan Yu
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,The Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Kryslaine L Radomski
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,The Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Joseph T McCabe
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Preclinical Behavior and Modeling Core, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Regina C Armstrong
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
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23
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Snapper DM, Reginauld B, Liaudanskaya V, Fitzpatrick V, Kim Y, Georgakoudi I, Kaplan DL, Symes AJ. Development of a novel bioengineered 3D brain-like tissue for studying primary blast-induced traumatic brain injury. J Neurosci Res 2023; 101:3-19. [PMID: 36200530 DOI: 10.1002/jnr.25123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 11/08/2022]
Abstract
Primary blast injury is caused by the direct impact of an overpressurization wave on the body. Due to limitations of current models, we have developed a novel approach to study primary blast-induced traumatic brain injury. Specifically, we employ a bioengineered 3D brain-like human tissue culture system composed of collagen-infused silk protein donut-like hydrogels embedded with human IPSC-derived neurons, human astrocytes, and a human microglial cell line. We have utilized this system within an advanced blast simulator (ABS) to expose the 3D brain cultures to a blast wave that can be precisely controlled. These 3D cultures are enclosed in a 3D-printed surrogate skull-like material containing media which are then placed in a holder apparatus inside the ABS. This allows for exposure to the blast wave alone without any secondary injury occurring. We show that blast induces an increase in lactate dehydrogenase activity and glutamate release from the cultures, indicating cellular injury. Additionally, we observe a significant increase in axonal varicosities after blast. These varicosities can be stained with antibodies recognizing amyloid precursor protein. The presence of amyloid precursor protein deposits may indicate a blast-induced axonal transport deficit. After blast injury, we find a transient release of the known TBI biomarkers, UCHL1 and NF-H at 6 h and a delayed increase in S100B at 24 and 48 h. This in vitro model will enable us to gain a better understanding of clinically relevant pathological changes that occur following primary blast and can also be utilized for discovery and characterization of biomarkers.
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Affiliation(s)
- Dustin M Snapper
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University, Bethesda, Maryland, USA
| | - Bianca Reginauld
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University, Bethesda, Maryland, USA
| | - Volha Liaudanskaya
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, USA
| | - Vincent Fitzpatrick
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, USA
| | - Yeonho Kim
- Preclinical Behavior and Modeling Core, Uniformed Services University, Bethesda, Maryland, USA
| | - Irene Georgakoudi
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, USA
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, USA
| | - Aviva J Symes
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University, Bethesda, Maryland, USA
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24
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Honig MG, Del Mar NA, Moore BM, Reiner A. Raloxifene Mitigates Emotional Deficits after Mild Traumatic Brain Injury in Mice. Neurotrauma Rep 2022; 3:534-544. [DOI: 10.1089/neur.2022.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Marcia G. Honig
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nobel A. Del Mar
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Bob M. Moore
- Department of Pharmaceutical Sciences, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Anton Reiner
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Ophthalmology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
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25
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Al Hariri M, Zgheib H, Abi Chebl K, Azar M, Hitti E, Bizri M, Rizk J, Kobeissy F, Mufarrij A. Assessing the psychological impact of Beirut Port blast: A cross-sectional study. Medicine (Baltimore) 2022; 101:e31117. [PMID: 36253992 PMCID: PMC9575829 DOI: 10.1097/md.0000000000031117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Beirut Port blast's magnitude is considered the third after Hiroshima and Nagasaki atomic bombings. This blast occurred in the densely populated section of Beirut, leaving more than six thousand injured patients. The psychological disturbances were assessed in the blast survivors who presented to the Emergency Department (ED) at the American University of Beirut Medical Center (AUBMC). This was a cross-sectional study at the ED of AUBMC. Identified patients were contacted and consented to participate in the study. Post-Traumatic Stress Disorder (PTSD) was selected as an outcome. Depression, PTSD, and concussion were assessed using patient health questionnaire (PHQ)-9, PTSD checklist for DSM-5 (PCL5), and brain injury symptoms (BISx) tools, respectively. The association of patients and injury characteristics with the study outcome was assessed using logistic regression. 145 participants completed the study procedures. The participants' average age was 39.8 ± 15.4 years, and 60% were males. Almost half of the participants showed depression on PHQ, and 2-thirds had PTSD. The participant's age was negatively associated with PTSD, whereas being a female, having depression, and having a concussion were positively associated with PTSD. The results of this study were in line with the previous literature report except for the association between younger age and PTSD, which warrants further investigations to delineate the reasons.
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Affiliation(s)
- Moustafa Al Hariri
- Vice President for Medical and Health Science Office, QU Health, Qatar University, Doha, Qatar
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hady Zgheib
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karen Abi Chebl
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maria Azar
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Eveline Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Bizri
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jennifer Rizk
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Afif Mufarrij
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- *Correspondence: Afif Mufarrij, Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236/ Riad El-Solh/ Beirut 1107 2020, Lebanon (e-mail: )
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26
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Benjamini D, Priemer DS, Perl DP, Brody DL, Basser PJ. Mapping astrogliosis in the individual human brain using multidimensional MRI. Brain 2022; 146:1212-1226. [PMID: 35953450 PMCID: PMC9976979 DOI: 10.1093/brain/awac298] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/13/2022] [Accepted: 08/06/2022] [Indexed: 11/14/2022] Open
Abstract
There are currently no non-invasive imaging methods available for astrogliosis assessment or mapping in the central nervous system despite its essential role in the response to many disease states, such as infarcts, neurodegenerative conditions, traumatic brain injury and infection. Multidimensional MRI is an increasingly employed imaging modality that maximizes the amount of encoded chemical and microstructural information by probing relaxation (T1 and T2) and diffusion mechanisms simultaneously. Here, we harness the exquisite sensitivity of this imagining modality to derive a signature of astrogliosis and disentangle it from normative brain at the individual level using machine learning. We investigated ex vivo cerebral cortical tissue specimens derived from seven subjects who sustained blast-induced injuries, which resulted in scar-border forming astrogliosis without being accompanied by other types of neuropathological abnormality, and from seven control brain donors. By performing a combined post-mortem radiology and histopathology correlation study we found that astrogliosis induces microstructural and chemical changes that are robustly detected with multidimensional MRI, and which can be attributed to astrogliosis because no axonal damage, demyelination or tauopathy were histologically observed in any of the cases in the study. Importantly, we showed that no one-dimensional T1, T2 or diffusion MRI measurement can disentangle the microscopic alterations caused by this neuropathology. Based on these findings, we developed a within-subject anomaly detection procedure that generates MRI-based astrogliosis biomarker maps ex vivo, which were significantly and strongly correlated with co-registered histological images of increased glial fibrillary acidic protein deposition (r = 0.856, P < 0.0001; r = 0.789, P < 0.0001; r = 0.793, P < 0.0001, for diffusion-T2, diffusion-T1 and T1-T2 multidimensional data sets, respectively). Our findings elucidate the underpinning of MRI signal response from astrogliosis, and the demonstrated high spatial sensitivity and specificity in detecting reactive astrocytes at the individual level, and if reproduced in vivo, will significantly impact neuroimaging studies of injury, disease, repair and aging, in which astrogliosis has so far been an invisible process radiologically.
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Affiliation(s)
- Dan Benjamini
- Correspondence to: Dan Benjamini, PhD National Institutes of Health (NIH), 251 Bayview Blvd., Baltimore, MD 21224, USA E-mail:
| | - David S Priemer
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA,The Department of Defense/Uniformed Services, University Brain Tissue Repository, Bethesda, MD 20814, USA,The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD 20817, USA
| | - Daniel P Perl
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA,The Department of Defense/Uniformed Services, University Brain Tissue Repository, Bethesda, MD 20814, USA
| | - David L Brody
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA,Department of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA,Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - Peter J Basser
- Section on Quantitative Imaging and Tissue Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD 20891, USA,Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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27
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McDonald MA, Tayebi M, McGeown JP, Kwon EE, Holdsworth SJ, Danesh-Meyer HV. A window into eye movement dysfunction following mTBI: A scoping review of magnetic resonance imaging and eye tracking findings. Brain Behav 2022; 12:e2714. [PMID: 35861623 PMCID: PMC9392543 DOI: 10.1002/brb3.2714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022] Open
Abstract
Mild traumatic brain injury (mTBI), commonly known as concussion, is a complex neurobehavioral phenomenon affecting six in 1000 people globally each year. Symptoms last between days and years as microstructural damage to axons and neurometabolic changes result in brain network disruption. There is no clinically available objective biomarker to diagnose the severity of injury or monitor recovery. However, emerging evidence suggests eye movement dysfunction (e.g., saccades and smooth pursuits) in patients with mTBI. Patients with a higher symptom burden and prolonged recovery time following injury may show higher degrees of eye movement dysfunction. Likewise, recent advances in magnetic resonance imaging (MRI) have revealed both white matter tract damage and functional network alterations in mTBI patients, which involve areas responsible for the ocular motor control. This scoping review is presented in three sections: Section 1 explores the anatomical control of eye movements to aid the reader with interpreting the discussion in subsequent sections. Section 2 examines the relationship between abnormal MRI findings and eye tracking after mTBI based on the available evidence. Finally, Section 3 communicates gaps in our knowledge about MRI and eye tracking, which should be addressed in order to substantiate this emerging field.
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Affiliation(s)
- Matthew A McDonald
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Institute, Gisborne, New Zealand
| | - Maryam Tayebi
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Joshua P McGeown
- Mātai Medical Research Institute, Gisborne, New Zealand.,Auckland University of Technology Traumatic Brain Injury Network, Auckland, New Zealand
| | - Eryn E Kwon
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Institute, Gisborne, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Samantha J Holdsworth
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Institute, Gisborne, New Zealand.,Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Eye Institute, Auckland, New Zealand
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Fino PC, Dibble LE, Wilde EA, Fino NF, Johnson P, Cortez MM, Hansen CR, van der Veen SM, Skop KM, Werner JK, Tate DF, Levin HS, Pugh MJV, Walker WC. Sensory Phenotypes for Balance Dysfunction After Mild Traumatic Brain Injury. Neurology 2022; 99:e521-e535. [PMID: 35577572 PMCID: PMC9421603 DOI: 10.1212/wnl.0000000000200602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Recent team-based models of care use symptom subtypes to guide treatments of individuals with chronic effects of mild traumatic brain injury (mTBI). However, these subtypes, or phenotypes, may be too broad, particularly for balance (e.g., vestibular subtype). To gain insight into mTBI-related imbalance, we (1) explored whether a dominant sensory phenotype (e.g., vestibular impaired) exists in the chronic mTBI population, (2) determined the clinical characteristics, symptomatic clusters, functional measures, and injury mechanisms that associate with sensory phenotypes for balance control in this population, and (3) compared the presentations of sensory phenotypes between individuals with and without previous mTBI. METHODS A secondary analysis was conducted on the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium. Sensory ratios were calculated from the sensory organization test, and individuals were categorized into 1 of the 8 possible sensory phenotypes. Demographic, clinical, and injury characteristics were compared across phenotypes. Symptoms, cognition, and physical function were compared across phenotypes, groups, and their interaction. RESULTS Data from 758 Service Members and Veterans with mTBI and 172 individuals with no lifetime history of mTBI were included. Abnormal visual, vestibular, and proprioception ratios were observed in 29%, 36%, and 38% of people with mTBI, respectively, with 32% exhibiting more than 1 abnormal sensory ratio. Within the mTBI group, global outcomes (p < 0.001), self-reported symptom severity (p < 0.027), and nearly all physical and cognitive functioning tests (p < 0.027) differed across sensory phenotypes. Individuals with mTBI generally reported worse symptoms than their non-mTBI counterparts within the same phenotype (p = 0.026), but participants with mTBI in the vestibular-deficient phenotype reported lower symptom burdens than their non-mTBI counterparts (e.g., mean [SD] Dizziness Handicap Inventory = 4.9 [8.1] for mTBI vs 12.8 [12.4] for non-mTBI, group × phenotype interaction p < 0.001). Physical and cognitive functioning did not differ between the groups after accounting for phenotype. DISCUSSION Individuals with mTBI exhibit a variety of chronic balance deficits involving heterogeneous sensory integration problems. While imbalance when relying on vestibular information is common, it is inaccurate to label all mTBI-related balance dysfunction under the vestibular umbrella. Future work should consider specific classification of balance deficits, including specific sensory phenotypes for balance control.
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Affiliation(s)
- Peter C Fino
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA.
| | - Leland E Dibble
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Elisabeth A Wilde
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Nora F Fino
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA.
| | - Paula Johnson
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Melissa M Cortez
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Colby R Hansen
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Susanne M van der Veen
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Karen M Skop
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - J Kent Werner
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - David F Tate
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Harvey S Levin
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Mary Jo V Pugh
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - William C Walker
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
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Raymont V, Fleminger S. Alwyn Lishman's contribution to the neuropsychiatry of head injury (traumatic brain injury); two key papers. Cogn Neuropsychiatry 2022; 27:289-295. [PMID: 35253617 DOI: 10.1080/13546805.2022.2047631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Alwyn Lishman appreciated that if we are to understand the psychological consequences of cerebral disorder we must study the interaction between organic disease and psychological processes. METHODS We have reviewed Lishman's two major publications on the neuropsychiatry of head injury, published in 1968 and 1988, and considered their conclusions in the light of current knowledge. RESULTS In his 1968 paper on the psychiatric sequelae of open head injuries sustained in World War II Lishman demonstrated associations between the type of psychiatric sequelae and the location of the injury. He also found that those with "somatic complaints", such as fatigue or sensitivity to light, showed less evidence of organic injury. In his 1988 paper, he attempted to explain why a mild head injury may be followed by long-lasting symptoms. He suggested that in the absence of complications early, organic, symptoms (physiogenesis) should recover quickly. However, this healthy recovery could be jeopardised by psychological factors (psychogenesis), resulting in long-lasting symptoms. This model of physiogenesis and psychogenesis remains relevant today. CONCLUSIONS The ideas Lishman developed in these two papers were the basis for his huge contribution to the field of neuropsychiatry, and remain relevant today.
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Affiliation(s)
- Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Simon Fleminger
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom of Great Britain and Northern Ireland
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Priemer DS, Iacono D, Rhodes CH, Olsen CH, Perl DP. Chronic Traumatic Encephalopathy in the Brains of Military Personnel. N Engl J Med 2022; 386:2169-2177. [PMID: 35675177 DOI: 10.1056/nejmoa2203199] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Persistent neuropsychiatric sequelae may develop in military personnel who are exposed to combat; such sequelae have been attributed in some cases to chronic traumatic encephalopathy (CTE). Only limited data regarding CTE in the brains of military service members are available. METHODS We performed neuropathological examinations for the presence of CTE in 225 consecutive brains from a brain bank dedicated to the study of deceased service members. In addition, we reviewed information obtained retrospectively regarding the decedents' histories of blast exposure, contact sports, other types of traumatic brain injury (TBI), and neuropsychiatric disorders. RESULTS Neuropathological findings of CTE were present in 10 of the 225 brains (4.4%) we examined; half the CTE cases had only a single pathognomonic lesion. Of the 45 brains from decedents who had a history of blast exposure, 3 had CTE, as compared with 7 of 180 brains from those without a history of blast exposure (relative risk, 1.71; 95% confidence interval [CI], 0.46 to 6.37); 3 of 21 brains from decedents with TBI from an injury during military service caused by the head striking a physical object without associated blast exposure (military impact TBI) had CTE, as compared with 7 of 204 without this exposure (relative risk, 4.16; 95% CI, 1.16 to 14.91). All brains with CTE were from decedents who had participated in contact sports; 10 of 60 contact-sports participants had CTE, as compared with 0 of 165 who had not participated in contact sports (point estimate of relative risk not computable; 95% CI, 6.16 to infinity). CTE was present in 8 of 44 brains from decedents with non-sports-related TBI in civilian life, as compared with 2 of 181 brains from those without such exposure in civilian life (relative risk, 16.45; 95% CI, 3.62 to 74.79). CONCLUSIONS Evidence of CTE was infrequently found in a series of brains from military personnel and was usually reflected by minimal neuropathologic changes. Risk ratios for CTE were numerically higher among decedents who had contact-sports exposure and other exposures to TBI in civilian life than among those who had blast exposure or other military TBI, but the small number of CTE cases and wide confidence intervals preclude causal conclusions. (Funded by the Department of Defense-Uniformed Services University Brain Tissue Repository and Neuropathology Program and the Henry M. Jackson Foundation for the Advancement of Military Medicine.).
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Affiliation(s)
- David S Priemer
- From the Department of Defense-Uniformed Services University Brain Tissue Repository (D.S.P., D.I., C.H.R., D.P.P.), the Departments of Neurology (D.I.), Pathology (D.S.P., D.I., D.P.P.), and Preventative Medicine and Biostatistics (C.H.O.), and the Neuroscience Graduate Program, Department of Anatomy, Physiology, and Genetics (D.I.), F. Edward Hébert School of Medicine, Uniformed Services University, and the Henry M. Jackson Foundation for the Advancement of Military Medicine (D.S.P., D.I., C.H.R.) - both in Bethesda, MD
| | - Diego Iacono
- From the Department of Defense-Uniformed Services University Brain Tissue Repository (D.S.P., D.I., C.H.R., D.P.P.), the Departments of Neurology (D.I.), Pathology (D.S.P., D.I., D.P.P.), and Preventative Medicine and Biostatistics (C.H.O.), and the Neuroscience Graduate Program, Department of Anatomy, Physiology, and Genetics (D.I.), F. Edward Hébert School of Medicine, Uniformed Services University, and the Henry M. Jackson Foundation for the Advancement of Military Medicine (D.S.P., D.I., C.H.R.) - both in Bethesda, MD
| | - C Harker Rhodes
- From the Department of Defense-Uniformed Services University Brain Tissue Repository (D.S.P., D.I., C.H.R., D.P.P.), the Departments of Neurology (D.I.), Pathology (D.S.P., D.I., D.P.P.), and Preventative Medicine and Biostatistics (C.H.O.), and the Neuroscience Graduate Program, Department of Anatomy, Physiology, and Genetics (D.I.), F. Edward Hébert School of Medicine, Uniformed Services University, and the Henry M. Jackson Foundation for the Advancement of Military Medicine (D.S.P., D.I., C.H.R.) - both in Bethesda, MD
| | - Cara H Olsen
- From the Department of Defense-Uniformed Services University Brain Tissue Repository (D.S.P., D.I., C.H.R., D.P.P.), the Departments of Neurology (D.I.), Pathology (D.S.P., D.I., D.P.P.), and Preventative Medicine and Biostatistics (C.H.O.), and the Neuroscience Graduate Program, Department of Anatomy, Physiology, and Genetics (D.I.), F. Edward Hébert School of Medicine, Uniformed Services University, and the Henry M. Jackson Foundation for the Advancement of Military Medicine (D.S.P., D.I., C.H.R.) - both in Bethesda, MD
| | - Daniel P Perl
- From the Department of Defense-Uniformed Services University Brain Tissue Repository (D.S.P., D.I., C.H.R., D.P.P.), the Departments of Neurology (D.I.), Pathology (D.S.P., D.I., D.P.P.), and Preventative Medicine and Biostatistics (C.H.O.), and the Neuroscience Graduate Program, Department of Anatomy, Physiology, and Genetics (D.I.), F. Edward Hébert School of Medicine, Uniformed Services University, and the Henry M. Jackson Foundation for the Advancement of Military Medicine (D.S.P., D.I., C.H.R.) - both in Bethesda, MD
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Wood NI, Hentig J, Hager M, Hill-Pearson C, Hershaw JN, Souvignier AR, Bobula SA. The Non-Concordance of Self-Reported and Performance-Based Measures of Vestibular Dysfunction in Military and Civilian Populations Following TBI. J Clin Med 2022; 11:jcm11112959. [PMID: 35683348 PMCID: PMC9181197 DOI: 10.3390/jcm11112959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
As a predominately young, physically active, and generally healthy population, service members (SMs) with vestibular dysfunction (VD) following a TBI may not be accurately represented by the current civilian reference ranges on assessments of VD. This study enrolled SMs who were referred for vestibular rehabilitation following a mild/moderate TBI. The participants self-reported VD using the Activities-specific Balance Confidence (ABC) scale and the Dizziness Handicap Inventory (DHI) followed by evaluation of vestibular performance using computerized dynamic posturography sensory organizational test (CDP−SOT). Retrospective analysis of these outcomes comparing the study sample of SMs to the reported civilian samples revealed SMs self-reported lower VD with significantly higher balance confidence (ABC: 77.11 ± 14.61, p < 0.05) and lower dizziness (DHI: 37.75 ± 11.74, p < 0.05) than civilians. However, the SMs underperformed in performance-based evaluations compared to civilians with significantly lower CDP−SOT composite and ratio scores (COMP: 68.46 ± 13.46, p < 0.05; VIS: 81.36 ± 14.03, p < 0.01; VEST: 55.63 ± 22.28, p < 0.05; SOM: 90.46 ± 10.17, p < 0.05). Correlational analyses identified significant relationships between the ABC and CDP−SOT composite (r = 0.380, p < 0.01) and ratio scores (VIS: r = 0.266, p < 0.05; VEST: r = 0.352, p < 0.01). These results highlight the importance of recognizing and understanding nuances in assessing VD in SMs to ensure they have access to adequate care and rehabilitation prior to returning to duty.
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Affiliation(s)
- Nicholas I. Wood
- Evans Army Community Hospital, Fort Carson, CO 80913, USA; (N.I.W.); (C.H.-P.); (J.N.H.); (A.R.S.); (S.A.B.)
- Traumatic Brain Injury Center of Excellence, Fort Carson, CO 80913, USA;
- General Dynamics Information Technology, Falls Church, VA 22042, USA
| | - James Hentig
- Evans Army Community Hospital, Fort Carson, CO 80913, USA; (N.I.W.); (C.H.-P.); (J.N.H.); (A.R.S.); (S.A.B.)
- Traumatic Brain Injury Center of Excellence, Fort Carson, CO 80913, USA;
- General Dynamics Information Technology, Falls Church, VA 22042, USA
- Correspondence: ; Tel.: +1-(719)-258-0695
| | - Madison Hager
- Traumatic Brain Injury Center of Excellence, Fort Carson, CO 80913, USA;
| | - Candace Hill-Pearson
- Evans Army Community Hospital, Fort Carson, CO 80913, USA; (N.I.W.); (C.H.-P.); (J.N.H.); (A.R.S.); (S.A.B.)
- Traumatic Brain Injury Center of Excellence, Fort Carson, CO 80913, USA;
- General Dynamics Information Technology, Falls Church, VA 22042, USA
| | - Jamie N. Hershaw
- Evans Army Community Hospital, Fort Carson, CO 80913, USA; (N.I.W.); (C.H.-P.); (J.N.H.); (A.R.S.); (S.A.B.)
- Traumatic Brain Injury Center of Excellence, Fort Carson, CO 80913, USA;
- General Dynamics Information Technology, Falls Church, VA 22042, USA
| | - Alicia R. Souvignier
- Evans Army Community Hospital, Fort Carson, CO 80913, USA; (N.I.W.); (C.H.-P.); (J.N.H.); (A.R.S.); (S.A.B.)
| | - Selena A. Bobula
- Evans Army Community Hospital, Fort Carson, CO 80913, USA; (N.I.W.); (C.H.-P.); (J.N.H.); (A.R.S.); (S.A.B.)
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Colamaria A, Blagia M, Carbone F, Fochi NP. Blast-related traumatic brain injury: Report of a severe case and review of the literature. Surg Neurol Int 2022; 13:151. [PMID: 35509563 PMCID: PMC9062926 DOI: 10.25259/sni_1134_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/01/2022] [Indexed: 11/14/2022] Open
Abstract
Background: Traumatic brain injury (TBI) is a well-known brain dysfunction commonly encountered in activities such as military combat or collision sports. The etiopathology can vary depending on the context and bomb explosions are becoming increasingly common in war zones, urban terrorist attacks, and civilian criminal feuds. Blast-related TBI may cause the full severity range of neurotrauma, from a mild concussion to severe, penetrating injury. Recent classifications of the pathophysiological mechanisms comprise five factors that reflect the gravity of the experienced trauma and suggest to the clinician different pathways of injury and consequent pathology caused by the explosion. Case Description: In the present report, the authors describe a case of 26 years old presenting with blast-related severe TBI caused by the detonation of an explosive in an amusement arcade. Surgical decompression to control intracranial pressure and systemic antibiotic treatment to manage and prevent wound infections were the main options available in a civilian hospital. Conclusion: While numerous studies examined the burden of blast-related brain injuries on service members, few papers have tackled this problem in a civilian setting, where hospitals are not sufficiently equipped, and physicians lack the necessary training. The present case demonstrates the urgent need for evidence-based diagnostic and therapeutic protocols in civilian hospitals that would improve the outcome of such patients.
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Affiliation(s)
| | - Maria Blagia
- Department of Neurosurgery, Giovanni XXIII Hospital, Bari,
| | - Francesco Carbone
- Department of Neurosurgery, University of Foggia, Foggia, Puglia, Italy
| | - Nicola Pio Fochi
- Department of Neurosurgery, University of Foggia, Foggia, Puglia, Italy
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D’Souza EW, MacGregor AJ, Dougherty AL, Olson AS, Champion HR, Galarneau MR. Combat injury profiles among U.S. military personnel who survived serious wounds in Iraq and Afghanistan: A latent class analysis. PLoS One 2022; 17:e0266588. [PMID: 35385552 PMCID: PMC8985965 DOI: 10.1371/journal.pone.0266588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background The U.S. military conflicts in Iraq and Afghanistan had the most casualties since Vietnam with more than 53,000 wounded in action. Novel injury mechanisms, such as improvised explosive devices, and higher rates of survivability compared with previous wars led to a new pattern of combat injuries. The purpose of the present study was to use latent class analysis (LCA) to identify combat injury profiles among U.S. military personnel who survived serious wounds. Methods A total of 5,227 combat casualty events with an Injury Severity Score (ISS) of 9 or greater that occurred in Iraq and Afghanistan from December 2002 to July 2019 were identified from the Expeditionary Medical Encounter Database for analysis. The Barell Injury Diagnosis Matrix was used to classify injuries into binary variables by site and type of injury. LCA was employed to identify injury profiles that accounted for co-occurring injuries. Injury profiles were described and compared by demographic, operational, and injury-specific variables. Results Seven injury profiles were identified and defined as: (1) open wounds (18.8%), (2) Type 1 traumatic brain injury (TBI)/facial injuries (14.2%), (3) disseminated injuries (6.8%), (4) Type 2 TBI (15.4%), (5) lower extremity injuries (19.8%), (6) burns (7.4%), and (7) chest and/or abdominal injuries (17.7%). Profiles differed by service branch, combat location, year of injury, injury mechanism, combat posture at the time of injury, and ISS. Conclusion LCA identified seven distinct and interpretable injury profiles among U.S. military personnel who survived serious combat injuries in Iraq or Afghanistan. These findings may be of interest to military medical planners as resource needs are evaluated and projected for future conflicts, and medical professionals involved in the rehabilitation of wounded service members.
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Affiliation(s)
- Edwin W. D’Souza
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, United States of America
- Leidos, Inc., San Diego, California, United States of America
- * E-mail:
| | - Andrew J. MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, United States of America
- Axiom Resource Management, Inc., San Diego, California, United States of America
| | - Amber L. Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, United States of America
- Leidos, Inc., San Diego, California, United States of America
| | - Andrew S. Olson
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, United States of America
| | - Howard R. Champion
- Uniformed Services University of the Health Sciences, Annapolis, Maryland, United States of America
- Section of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Michael R. Galarneau
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, United States of America
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The Power of Public-Private Partnership in Medical Technology Innovation: Lessons From the Development of Fda-Cleared Medical Devices for Assessment of Concussion. J Clin Transl Sci 2022; 6:e42. [PMID: 35574153 PMCID: PMC9066317 DOI: 10.1017/cts.2022.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/26/2022] Open
Abstract
Given the convergence of the long and challenging development path for medical devices with the need for diagnostic capabilities for mild traumatic brain injury (mTBI/concussion), the effective role of public–private partnership (PPP) can be demonstrated to yield Food and Drug Administration (FDA) clearances and innovative product introductions. An overview of the mTBI problem and landscape was performed. A detailed situation analysis of an example of a PPP yielding an innovative product was further demonstrated. The example of PPP has led to multiple FDA clearances and product introductions in the TBI diagnostic product category where there was an urgent military and public need. Important lessons included defining the primary public and military health objective for new product introduction, the importance of the government–academia–industry PPP triad with a “collaboration towards solutions” Quality-by-Design (QbD) mindset to assure clinical validity with regulatory compliance, the development of device comparators and integration of measurements into a robust, evidence-based statistical and FDA pathway, and the utility of top-down, flexible, practical action while operating within governmental guidelines and patient safety.
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Lawn RB, Jha SC, Liu J, Sampson L, Murchland AR, Sumner JA, Roberts AL, Disner SG, Grodstein F, Kang JH, Kubzansky LD, Chibnik LB, Koenen KC. The association of posttraumatic stress disorder, depression, and head injury with mid-life cognitive function in civilian women. Depress Anxiety 2022; 39:220-232. [PMID: 34970809 PMCID: PMC8901526 DOI: 10.1002/da.23233] [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: 07/06/2021] [Revised: 11/30/2021] [Accepted: 12/12/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Despite evidence linking posttraumatic stress disorder (PTSD), depression, and head injury, separately, with worse cognitive performance, investigations of their combined effects on cognition are limited in civilian women. METHODS The Cogstate Brief Battery assessment was administered in 10,681 women from the Nurses' Health Study II cohort, mean age 64.9 years (SD = 4.6). Psychological trauma, PTSD, depression, and head injury were assessed using online questionnaires. In this cross-sectional analysis, we used linear regression models to estimate mean differences in cognition by PTSD/depression status and stratified by history of head injury. RESULTS History of head injury was prevalent (36%), and significantly more prevalent among women with PTSD and depression (57% of women with PTSD and depression, 21% of women with no psychological trauma or depression). Compared to having no psychological trauma or depression, having combined PTSD and depression was associated with worse performance on psychomotor speed/attention ( β = -.15, p = .001) and learning/working memory ( β = -.15, p < .001). The joint association of PTSD and depression on worse cognitive function was strongest among women with past head injury, particularly among those with multiple head injuries. CONCLUSIONS Head injury, like PTSD and depression, was highly prevalent in this sample of civilian women. In combination, these factors were associated with poorer performance on cognitive tasks, a possible marker of future cognitive health. Head injury should be further explored in future studies of PTSD, depression and cognition in women.
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Affiliation(s)
- Rebecca B Lawn
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shaili C. Jha
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jiaxuan Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laura Sampson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Audrey R. Murchland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer A. Sumner
- Department of Psychology, University of California, Los Angeles, CA, Los Angeles, CA, USA
| | - Andrea L. Roberts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Seth G. Disner
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Francine Grodstein
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Jae H. Kang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Laura D. Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lori B. Chibnik
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston MA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Siedhoff HR, Chen S, Song H, Cui J, Cernak I, Cifu DX, DePalma RG, Gu Z. Perspectives on Primary Blast Injury of the Brain: Translational Insights Into Non-inertial Low-Intensity Blast Injury. Front Neurol 2022; 12:818169. [PMID: 35095749 PMCID: PMC8794583 DOI: 10.3389/fneur.2021.818169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/20/2021] [Indexed: 12/18/2022] Open
Abstract
Most traumatic brain injuries (TBIs) during military deployment or training are clinically "mild" and frequently caused by non-impact blast exposures. Experimental models were developed to reproduce the biological consequences of high-intensity blasts causing moderate to severe brain injuries. However, the pathophysiological mechanisms of low-intensity blast (LIB)-induced neurological deficits have been understudied. This review provides perspectives on primary blast-induced mild TBI models and discusses translational aspects of LIB exposures as defined by standardized physical parameters including overpressure, impulse, and shock wave velocity. Our mouse LIB-exposure model, which reproduces deployment-related scenarios of open-field blast (OFB), caused neurobehavioral changes, including reduced exploratory activities, elevated anxiety-like levels, impaired nesting behavior, and compromised spatial reference learning and memory. These functional impairments associate with subcellular and ultrastructural neuropathological changes, such as myelinated axonal damage, synaptic alterations, and mitochondrial abnormalities occurring in the absence of gross- or cellular damage. Biochemically, we observed dysfunctional mitochondrial pathways that led to elevated oxidative stress, impaired fission-fusion dynamics, diminished mitophagy, decreased oxidative phosphorylation, and compensated cell respiration-relevant enzyme activity. LIB also induced increased levels of total tau, phosphorylated tau, and amyloid β peptide, suggesting initiation of signaling cascades leading to neurodegeneration. We also compare translational aspects of OFB findings to alternative blast injury models. By scoping relevant recent research findings, we provide recommendations for future preclinical studies to better reflect military-operational and clinical realities. Overall, better alignment of preclinical models with clinical observations and experience related to military injuries will facilitate development of more precise diagnosis, clinical evaluation, treatment, and rehabilitation.
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Affiliation(s)
- Heather R. Siedhoff
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
| | - Shanyan Chen
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
| | - Hailong Song
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
| | - Jiankun Cui
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
| | - Ibolja Cernak
- Department of Biomedical Sciences, Mercer University School of Medicine, Macon, GA, United States
| | - David X. Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Ralph G. DePalma
- Office of Research and Development, Department of Veterans Affairs, Washington, DC, United States
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Zezong Gu
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
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Siedhoff HR, Chen S, Balderrama A, Sun GY, Koopmans B, DePalma RG, Cui J, Gu Z. Long-Term Effects of Low-Intensity Blast Non-Inertial Brain Injury on Anxiety-Like Behaviors in Mice: Home-Cage Monitoring Assessments. Neurotrauma Rep 2022; 3:27-38. [PMID: 35141713 PMCID: PMC8820222 DOI: 10.1089/neur.2021.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mild traumatic brain injury induced by low-intensity blast (LIB) exposure poses concerns in military personnel. Using an open-field, non-inertial blast model and assessments by conventional behavioral tests, our previous studies revealed early-phase anxiety-like behaviors in LIB-exposed mice. However, the impact of LIB upon long-term anxiety-like behaviors requires clarification. This study applied a highly sensitive automated home-cage monitoring (HCM) system, which minimized human intervention and environmental changes, to assess anxiety-like responses in mice 3 months after LIB exposure. Initial assessment of 72-h spontaneous activities in a natural cage condition over multiple light and dark phases showed altered sheltering behaviors. LIB-exposed mice exhibited a subtle, but significantly decreased, duration of short shelter visits as compared to sham controls. Other measured responses between LIB-exposed mice and sham controls were insignificant. When behavioral assessments were performed in a challenged condition using an aversive spotlight, LIB-exposed mice demonstrated a significantly higher frequency of movements of shorter distance and duration per movement. Taken together, these findings demonstrated the presence of chronic anxiety-like behaviors assessed by the HCM system under both natural and challenged conditions in mice occurring post-LIB exposure. This model thus provides a platform to test for screening and interventions on anxiety disorders occurring after LIB non-inertial brain injury.
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Affiliation(s)
- Heather R. Siedhoff
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, Missouri, USA
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Shanyan Chen
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, Missouri, USA
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Ashley Balderrama
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, Missouri, USA
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Grace Y. Sun
- Department of Biochemistry, University of Missouri School of Medicine, Columbia, Missouri, USA
| | | | - Ralph G. DePalma
- Office of Research and Development, Department of Veterans Affairs, Washington, DC, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jiankun Cui
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, Missouri, USA
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Zezong Gu
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, Missouri, USA
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, Missouri, USA
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Monroe DC, DuBois SL, Rhea CK, Duffy DM. Age-Related Trajectories of Brain Structure–Function Coupling in Female Roller Derby Athletes. Brain Sci 2021; 12:brainsci12010022. [PMID: 35053766 PMCID: PMC8774127 DOI: 10.3390/brainsci12010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 12/04/2022] Open
Abstract
Contact and collision sports are believed to accelerate brain aging. Postmortem studies of the human brain have implicated tau deposition in and around the perivascular space as a biomarker of an as yet poorly understood neurodegenerative process. Relatively little is known about the effects that collision sport participation has on the age-related trajectories of macroscale brain structure and function, particularly in female athletes. Diffusion MRI and resting-state functional MRI were obtained from female collision sport athletes (n = 19 roller derby (RD) players; 23–45 years old) and female control participants (n = 14; 20–49 years old) to quantify structural coupling (SC) and decoupling (SD). The novel and interesting finding is that RD athletes, but not controls, exhibited increasing SC with age in two association networks: the frontoparietal network, important for cognitive control, and default-mode network, a task-negative network (permuted p = 0.0006). Age-related increases in SC were also observed in sensorimotor networks (RD, controls) and age-related increases in SD were observed in association networks (controls) (permuted p ≤ 0.0001). These distinct patterns suggest that competing in RD results in compressed neuronal timescales in critical networks as a function of age and encourages the broader study of female athlete brains across the lifespan.
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Affiliation(s)
- Derek C. Monroe
- Correspondence: ; Tel.: +1-336-334-5347; Fax: +1-336-334-3238
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Epidemiology, patterns of care and outcomes of traumatic brain injury in deployed military settings: implications for future military operations. J Trauma Acute Care Surg 2021; 93:220-228. [PMID: 34908023 DOI: 10.1097/ta.0000000000003497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is prevalent and highly morbid among Service Members. A better understanding of TBI epidemiology, outcomes, and care patterns in deployed settings could inform potential approaches to improve TBI diagnosis and management. METHODS A retrospective cohort analysis of Service Members who sustained a TBI in deployed settings between 2001 and 2018 was conducted. Among individuals hospitalized with TBI, we compared the demographic characteristics, mechanism of injury, injury type, and severity between combat and non-combat injuries. We compared diagnostic tests and procedures, evacuation patterns, return to duty rates and days in care between individuals with concussion and those with severe TBI. RESULTS There were 46,309 Service Members with TBI and 9,412 who were hospitalized; of those hospitalized, 55% (4,343) had isolated concussion and 9% (796) had severe TBI, of whom 17% (132/796) had polytrauma. Overall mortality was 2% and ranged from 0.1% for isolated concussion to 18% for severe TBI. The vast majority of TBI were evacuated by rotary wing to Role 3 or higher, including those with isolated concussion. As compared to severe TBI, individuals with isolated concussion had fewer diagnostic or surgical procedures performed. Only 6% of Service Members with severe TBI were able to return to duty as compared to 54% of those with isolated concussion. TBI resulted in 123,677 lost duty days; individuals with isolated concussion spent a median of 2 days in care and those with severe TBI spent a median of 17 days in care and a median of 6 days in the intensive care unit. CONCLUSIONS While most TBI in the deployed setting is mild, TBI is frequently associated with hospitalization and polytrauma. Over-triage of mild TBI is common. Improved TBI capabilities applicable to forward settings will be critical to the success of future multi-domain operations with limitations in air superiority. LEVEL OF EVIDENCE Prognostic, Level III.
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Ashina H, Eigenbrodt AK, Seifert T, Sinclair AJ, Scher AI, Schytz HW, Lee MJ, De Icco R, Finkel AG, Ashina M. Post-traumatic headache attributed to traumatic brain injury: classification, clinical characteristics, and treatment. Lancet Neurol 2021; 20:460-469. [PMID: 34022171 DOI: 10.1016/s1474-4422(21)00094-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/19/2022]
Abstract
Post-traumatic headache is a common sequela of traumatic brain injury and is classified as a secondary headache disorder. In the past 10 years, considerable progress has been made to better understand the clinical features of this disorder, generating momentum to identify effective therapies. Post-traumatic headache is increasingly being recognised as a heterogeneous headache disorder, with patients often classified into subphenotypes that might be more responsive to specific therapies. Such considerations are not accounted for in three iterations of diagnostic criteria published by the International Headache Society. The scarcity of evidence-based approaches has left clinicians to choose therapies on the basis of the primary headache phenotype (eg, migraine and tension-type headache) and that are most compatible with the clinical picture. A concerted effort is needed to address these shortcomings and should include large prospective cohort studies as well as randomised controlled trials. This approach, in turn, will result in better disease characterisation and availability of evidence-based treatment options.
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Affiliation(s)
- Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anna K Eigenbrodt
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Alexandra J Sinclair
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ann I Scher
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA
| | - Henrik W Schytz
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Roberto De Icco
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish Knowledge Center on Headache Disorders, Glostrup, Denmark; Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia; Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan.
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Abstract
Sleep is a complex brain state with fundamental relevance for cognitive functions, synaptic plasticity, brain resilience, and autonomic balance. Sleep pathologies may interfere with cerebral circuit organization, leading to negative consequences and favoring the development of neurologic disorders. Conversely, the latter can interfere with sleep functions. Accordingly, assessment of sleep quality is always recommended in the diagnosis of patients with neurologic disorders and during neurorehabilitation programs. This review investigates the complex interplay between sleep and brain pathologies, focusing on diseases in which the association with sleep disturbances is commonly overlooked and whereby major benefits may derive from their proper management.
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Affiliation(s)
- Carlotta Mutti
- Sleep Disorders Center, Department of Medicine and Surgery, Neurology Unit, University of Parma, Via Gramsci 14, Parma 43126, Italy
| | - Francesco Rausa
- Sleep Disorders Center, Department of Medicine and Surgery, Neurology Unit, University of Parma, Via Gramsci 14, Parma 43126, Italy
| | - Liborio Parrino
- Sleep Disorders Center, Department of Medicine and Surgery, Neurology Unit, University of Parma, Via Gramsci 14, Parma 43126, Italy.
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42
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Al-Hajj S, Dhaini HR, Mondello S, Kaafarani H, Kobeissy F, DePalma RG. Beirut Ammonium Nitrate Blast: Analysis, Review, and Recommendations. Front Public Health 2021; 9:657996. [PMID: 34150702 PMCID: PMC8212863 DOI: 10.3389/fpubh.2021.657996] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
A massive chemical detonation occurred on August 4, 2020 in the Port of Beirut, Lebanon. An uncontrolled fire in an adjacent warehouse ignited ~2,750 tons of Ammonium Nitrate (AN), producing one of the most devastating blasts in recent history. The blast supersonic pressure and heat wave claimed the lives of 220 people and injured more than 6,500 instantaneously, with severe damage to the nearby dense residential and commercial areas. This review represents one of the in-depth reports to provide a detailed analysis of the Beirut blast and its health and environmental implications. It further reviews prior AN incidents and suggests actionable recommendations and strategies to optimize chemical safety measures, improve emergency preparedness, and mitigate the delayed clinical effects of blast and toxic gas exposures. These recommended actionable steps offer a starting point for government officials and policymakers to build frameworks, adopt regulations, and implement chemical safety protocols to ensure safe storage of hazardous materials as well as reorganizing healthcare system disaster preparedness to improve emergency preparedness in response to similar large-scale disasters and promote population safety. Future clinical efforts should involve detailed assessment of physical injuries sustained by blast victims, with systemic mitigation and possible treatment of late blast effects involving individuals, communities and the region at large.
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Affiliation(s)
- Samar Al-Hajj
- Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hassan R Dhaini
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Haytham Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care. Massachusetts General Hospital, Boston, MA, United States
| | - Firas Kobeissy
- Department of Biochemistry & Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ralph G DePalma
- Office of Research and Development, Department of Veterans Affairs, Washington, DC, United States
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Asken BM, Rabinovici GD. Identifying degenerative effects of repetitive head trauma with neuroimaging: a clinically-oriented review. Acta Neuropathol Commun 2021; 9:96. [PMID: 34022959 PMCID: PMC8141132 DOI: 10.1186/s40478-021-01197-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND SCOPE OF REVIEW Varying severities and frequencies of head trauma may result in dynamic acute and chronic pathophysiologic responses in the brain. Heightened attention to long-term effects of head trauma, particularly repetitive head trauma, has sparked recent efforts to identify neuroimaging biomarkers of underlying disease processes. Imaging modalities like structural magnetic resonance imaging (MRI) and positron emission tomography (PET) are the most clinically applicable given their use in neurodegenerative disease diagnosis and differentiation. In recent years, researchers have targeted repetitive head trauma cohorts in hopes of identifying in vivo biomarkers for underlying biologic changes that might ultimately improve diagnosis of chronic traumatic encephalopathy (CTE) in living persons. These populations most often include collision sport athletes (e.g., American football, boxing) and military veterans with repetitive low-level blast exposure. We provide a clinically-oriented review of neuroimaging data from repetitive head trauma cohorts based on structural MRI, FDG-PET, Aβ-PET, and tau-PET. We supplement the review with two patient reports of neuropathology-confirmed, clinically impaired adults with prior repetitive head trauma who underwent structural MRI, FDG-PET, Aβ-PET, and tau-PET in addition to comprehensive clinical examinations before death. REVIEW CONCLUSIONS Group-level comparisons to controls without known head trauma have revealed inconsistent regional volume differences, with possible propensity for medial temporal, limbic, and subcortical (thalamus, corpus callosum) structures. Greater frequency and severity (i.e., length) of cavum septum pellucidum (CSP) is observed in repetitive head trauma cohorts compared to unexposed controls. It remains unclear whether CSP predicts a particular neurodegenerative process, but CSP presence should increase suspicion that clinical impairment is at least partly attributable to the individual's head trauma exposure (regardless of underlying disease). PET imaging similarly has not revealed a prototypical metabolic or molecular pattern associated with repetitive head trauma or predictive of CTE based on the most widely studied radiotracers. Given the range of clinical syndromes and neurodegenerative pathologies observed in a subset of adults with prior repetitive head trauma, structural MRI and PET imaging may still be useful for differential diagnosis (e.g., assessing suspected Alzheimer's disease).
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Affiliation(s)
- Breton M. Asken
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94143 USA
| | - Gil D. Rabinovici
- Departments of Neurology, Radiology & Biomedical Imaging, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94143 USA
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Ownbey MR, Pekari TB. Acute Mild Traumatic Brain Injury Assessment and Management in the Austere Setting-A Review. Mil Med 2021; 187:e47-e51. [PMID: 33742658 DOI: 10.1093/milmed/usab104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/15/2021] [Accepted: 03/04/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) continues to be a major source of military-related morbidity and mortality. The insidious short- and long-term sequelae of mild TBIs (mTBIs) have come to light, with ongoing research influencing advances in patient care from point of injury onward. Although the DoDI 6490.11 outlines mTBI care in the deployed setting, there is currently no standardized training requirement on mTBI care in the far-forward deployed setting. As the Joint Trauma System (JTS) is considered to be one of the leaders in standard of care trauma medicine in the deployed environment and is often the go-to resource for forward-deployed medical providers, it is our goal that this review be utilized by the JTS with prominent mTBI resources to disseminate a clinical practice guideline (CPG) appropriate for the far-forward operational environment. MATERIALS AND METHODS The resources used for this review reflect the most current data, knowledge, and recommendations associated with research and findings from reputable sources as the Traumatic Brain Injury Center of Excellence (TBI CoE; formerly the Defense and Veterans Brain Injury Center), the Center for Disease Control and Prevention, as well as prominent journals such as Academic Emergency Medicine, British Journal of Sports Medicine, and JAMA. We searched for articles under keyword searches, limiting results to less than 5 years old, and had military relevance. About 1,740 articles were found using keywords; filters on our search yielded 707 articles, 100 of which offered free full text. The topic of far-forward deployed management of mTBI does not have a robust academic background at this time, and recommendations are derived from a combination of academic evidence in more traditional clinical settings, as well as author's direct experience in managing mTBI casualties in the austere environment. RESULTS At the time of this writing, there is no JTS CPG for management of mTBI and there is no pre-deployment training requirement for medical providers for treating mTBI casualties in the far-forward deployed setting. The TBI CoE does, however, have a multitude of resources available to medical providers to assist with post-mTBI care. In this article, we review these clinical tools, pre-planning considerations including discussions and logistical planning with medical command, appropriate evaluation and treatment for mTBI casualties based on TBI CoE recommendations, the need for uniform and consistent documentation and diagnosis in the acute period, tactical and operational considerations, and other considerations as a medical provider in an austere setting with limited resources for treating casualties with mTBIs. CONCLUSIONS Given the significant morbidity and mortality associated with mTBIs, as well as operational and tactical considerations in the austere deployed setting, improved acute and subacute care, as well as standardization of care for these casualties within their area of operations is necessary. The far-forward deployed medical provider should be trained in management of mTBI, incorporate mTBI-associated injuries into medical planning with their command, and discuss the importance of mTBI management with servicemembers and their units. Proper planning, training, standardization of mTBI management in the deployed setting, and inter-unit cooperation and coordination for mTBI care will help maintain servicemember readiness and unit capability on the battlefield. Standardization in care and documentation in this austere military environment may also assist future research into mTBI management. As there is currently no JTS CPG covering this type of care, the authors recommend sharing the TBI CoE management guideline with medical providers who will be reasonably expected to evaluate and manage mTBI in the austere deployed setting.
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Affiliation(s)
- Misha R Ownbey
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Timothy B Pekari
- Department of Orthopaedic Surgery, Evans Army Community Hospital, Fort Carson, CO 80913, USA
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