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Chung SY, Harrison EM, Englert RM, Belding JN. Effects of Blast-and Impact-Related Concussion on Persistent Sleep Problems. J Head Trauma Rehabil 2024:00001199-990000000-00167. [PMID: 38916404 DOI: 10.1097/htr.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
OBJECTIVE Examine whether concussion mechanism of injury (high-level blast [HLB] vs impact) affects the likelihood of persistent sleep problems in a post-deployment military population. SETTING Post-Deployment Health Assessment and Re-Assessment survey records completed upon return from deployment and approximately 6 months later. PARTICIPANTS Active duty enlisted US Marines who completed both assessments (N = 64 464). DESIGN This retrospective cohort study investigated US Marines deployed between 2008 and 2012. Logistic regression was used to examine persistent sleep problems 6 months after return from deployment. MAIN MEASURES Self-reported sleep problems at reassessment were investigated as the outcome. Predictors included HLB-induced concussions (mbTBI vs none), impact-induced concussions (miTBI vs none), occupational risk of low-level blast, probable posttraumatic stress disorder (PTSD), depression, alcohol misuse, sleep problems upon deployment return, and relevant interactions, adjusting for sex and pay grade. RESULTS With the exception of sex, all main effects in the model were associated with greater likelihood of reporting persistent sleep problems at reassessment. Sleep problems at return from deployment showed the strongest associations with likelihood of reporting sleep problems at reassessment, followed by mbTBI. The latter was exacerbated by PTSD and depression. CONCLUSION mbTBI (vs miTBI) may be more strongly associated with persistent sleep issues that warrant additional monitoring and treatment, particularly among those with probable PTSD and/or depression.
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Affiliation(s)
- Samuel Y Chung
- Author Affiliations: Psychological Health and Readiness Department (Drs Chung and Harrison and Ms Englert and Dr Belding), Naval Health Research Center, San Diego, California; and Leidos, Inc, San Diego, California (Drs Chung and Harrison and Ms Englert)
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Arora P, Sharma A, Trivedi R, Sharma P, Padhy S, Shah S, Dutta SK, Manda K, Rana P. Lipidomic Analysis Reveals Systemic Alterations in Servicemen Exposed to Repeated Occupational Low-Level Blast Waves. Mil Med 2024:usae268. [PMID: 38776149 DOI: 10.1093/milmed/usae268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/02/2024] [Accepted: 05/06/2024] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION Occupational exposure to blast is a prevalent risk experienced by military personnel. While low-level exposure may not manifest immediate signs of illness, prolonged and repetitive exposure may result in neurophysiological dysfunction. Such repeated exposure to occupational blasts has been linked to structural and functional modifications in the brain, adversely affecting the performance of servicemen in the field. These neurological changes can give rise to symptoms resembling concussion and contribute to the development of post-traumatic stress disorder. MATERIALS AND METHODS To understand long-term effects of blast exposure, the study was conducted to assess memory function, serum circulatory protein and lipid biomarkers, and associated concussive symptomology in servicemen. Concussion-like symptoms were assessed using the Rivermead Post-Concussion Symptoms Questionnaire (RPSQ) along with memory function using PGI memory scale. The serum protein biomarkers were quantified using a sandwich ELISA assay, and the serum lipid profile was measured using liquid chromatography-mass spectrometer. RESULTS The findings revealed that repeated low-level blast exposure resulted in impaired memory function, accompanied by elevated levels of serum neurofilament light chain (neuroaxonal injury) and C-reactive protein. Furthermore, alterations in the lipid profile were observed, with an increase in lipid species associated with immune activation. These changes collectively point to systemic inflammation, neuronal injury, and memory dysfunction as pathological characteristics of repeated low-level blast exposure. CONCLUSION The results of our preliminary investigation offer valuable insights for further large-scale study and provide a guiding principle that necessitates a suitable mitigation approach to safeguard the health of personnel against blast overpressure.
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Affiliation(s)
- Palkin Arora
- Radiological, Nuclear and Imaging Sciences (RNAIS), Institute of Nuclear Medicine and Allied Sciences (INMAS), DRDO, Delhi 110054, India
| | - Apoorva Sharma
- Radiological, Nuclear and Imaging Sciences (RNAIS), Institute of Nuclear Medicine and Allied Sciences (INMAS), DRDO, Delhi 110054, India
| | - Richa Trivedi
- Radiological, Nuclear and Imaging Sciences (RNAIS), Institute of Nuclear Medicine and Allied Sciences (INMAS), DRDO, Delhi 110054, India
| | - Priyanka Sharma
- Radiological, Nuclear and Imaging Sciences (RNAIS), Institute of Nuclear Medicine and Allied Sciences (INMAS), DRDO, Delhi 110054, India
| | - Sankarsan Padhy
- RADAR and Sensor Wing, Proof and Experimental Establishment (PXE), DRDO, Chandipur, Balasore, Odisha 756025, India
| | - Shahnawaj Shah
- RADAR and Sensor Wing, Proof and Experimental Establishment (PXE), DRDO, Chandipur, Balasore, Odisha 756025, India
| | - Suman K Dutta
- Military Wing, Proof and Experimental Establishment (PXE), DRDO, Chandipur, Balasore, Odisha 756025, India
| | - Kailash Manda
- Radiological, Nuclear and Imaging Sciences (RNAIS), Institute of Nuclear Medicine and Allied Sciences (INMAS), DRDO, Delhi 110054, India
| | - Poonam Rana
- Radiological, Nuclear and Imaging Sciences (RNAIS), Institute of Nuclear Medicine and Allied Sciences (INMAS), DRDO, Delhi 110054, India
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Wiri S, Wagner C, Longwell J, Adams T, Whitty J, Massow T, Reid J, Dunbar C, Graves W, Gonzales A, Needham CE, Leonessa F, Duckworth JL. Significant Mitigation of Blast Overpressure Exposure During Training by Adjustment of Body Position as Demonstrated With Field Data. Mil Med 2024; 189:e1154-e1160. [PMID: 37966502 DOI: 10.1093/milmed/usad429] [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: 07/06/2023] [Revised: 09/14/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION During training and deployment, service members (SMs) experience blast exposure, which may potentially negatively impact brain health in the short and long term. This article explores if blast exposure mitigation can be effectively achieved for four different weapon training scenarios that are being monitored as part of the CONQUER (COmbat and traiNing QUeryable Exposure/event Repository) program. The training scenarios considered here are a detonating cord linear (det linear) breaching charge, a water breaching charge, a shoulder-fired weapon, and a 120-mm mortar. MATERIALS AND METHODS This article focuses on the efficacy of modification of position and standoff distance on SMs' exposure to blast overpressure. Blast overpressure exposures were measured using BlackBox Biometrics (B3) Blast Gauge System (BGS) sensors worn by SMs during normal training. The BGS involves the use of three gauges/sensors, which are worn on the head, chest, and nondominant shoulder to record surface pressures at multiple locations on the SM. For the breaching charges, we compared the level of exposure when the SMs were directly in front of the blast with a breaching blanket to a modified standoff position around a corner from the charge without a breaching blanket. For the shoulder-fired weapon training, the modified approach simply increased the standoff distance of the SM. Finally, for mortars, blast overpressure exposures were compared for different levels of their ducking height (body position) below the mortar tube at the time of firing. RESULTS Modification of the position of SMs during training with the det linear breaching charge had the highest measured blast exposure percent reduction, at 79%. Both the water breaching charge and shoulder-fired weapon showed lowered peak overpressures on all gauges. The measured percent reduction for the 120-mm mortar was 35%. When the blast gauges did not trigger at the modified standoff distance, the percent reduction was calculated with the assumption that the new overpressures were below ∼3.4 kPa (0.5 psi) (the lowest trigger threshold for the gauges). A figure summarizes the percent reduction for each subject in the training scenarios. CONCLUSIONS Results show that the modification of the SMs' position effectively mitigated blast exposures for all considered weapon scenarios. There was at least a 50% overpressure reduction from the initial to modified standoff distances and a 35% reduction from the change in SM body posture. Based on these observations, new locations and body positioning of SMs during training have been suggested for blast mitigation.
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Affiliation(s)
- Suthee Wiri
- Applied Research Associates, Albuquerque, NM 87110, USA
| | | | | | - Tasha Adams
- Applied Research Associates, Albuquerque, NM 87110, USA
| | - Joshua Whitty
- 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
| | - Todd Massow
- 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
| | - James Reid
- 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
| | - Cyrus Dunbar
- 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
| | - Wallace Graves
- 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
| | | | | | - Fabio Leonessa
- Uniformed Services University of the Health Sciences, Bethesda MD 20814, USA
| | - Josh L Duckworth
- Uniformed Services University of the Health Sciences, Bethesda MD 20814, USA
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Belding JN, Bonkowski J, Englert R. Traumatic brain injury and occupational risk of low-level blast exposure on adverse career outcomes: an examination of administrative and medical separations from Service (2005-2015). Front Neurol 2024; 15:1389757. [PMID: 38689879 PMCID: PMC11058224 DOI: 10.3389/fneur.2024.1389757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Although traumatic brain injury (TBI) has been linked with adverse long-term health, less research has examined whether TBI is linked with non-clinical outcomes including involuntary job loss. Symptoms associated with TBI may influence one's ability to maintain gainful employment including employment in the U.S. military. That influence may impact military service members with exposure to repetitive low-level blast (LLB). Understanding the association between TBI and involuntary job loss outcomes among military populations is particularly important as it may be associated with differences in eligibility for post-service benefits. The purpose of the present research was to determine whether (1) TBI and related conditions are associated with involuntary job loss (i.e., medical and administrative separations from service) among military personnel, and (2) occupational risk of LLB is associated with involuntary job loss in both the presence and absence of clinical diagnoses of TBI and related conditions. Method This research leveraged population-level data from the Career History Archival Medical and Personnel System for enlisted personnel who served on active duty between 2005-2015. Risk of LLB exposure was categorized using military occupational specialty as a proxy. Medical diagnoses were identified using ICD-9 codes. Separations for medical and administrative reasons were identified. Results Risk for administrative separation differed across medical diagnoses of interest, but those who worked in high-risk occupations were more likely to be administratively separated than those working in low-risk occupations. Risk for medical separation was associated with occupational risk of LLB and each of the diagnoses of interest, though significant interactions suggested that the effects of certain diagnoses of interest (e.g., concussion, cognitive problems, postconcussive syndrome, migraines) on medical separations was greater among those working in high-risk occupations. Discussion Taken together, the present research suggests that TBI and associated medical conditions, as well as occupational risk of LLB, are associated with long-term involuntary job loss for medical reasons. This study is the first to demonstrate involuntary military job loss outcomes associated with TBI, mental health conditions, and conditions associated with blast exposure using both inpatient and outpatient population-level data and may have important implications for civilian employment and post-service benefits.
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Affiliation(s)
| | - James Bonkowski
- Naval Health Research Center, San Diego, CA, United States
- Leidos, Inc., San Diego, CA, United States
| | - Robyn Englert
- Naval Health Research Center, San Diego, CA, United States
- Leidos, Inc., San Diego, CA, United States
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Lange RT, French LM, Lippa SM, Gillow KC, Bailie JM, Turner SM, Hungerford LD, Brickell TA. Convergent and Discriminant Validity of the Blast Exposure Threshold Survey in United States Military Service Members and Veterans. J Neurotrauma 2024; 41:934-941. [PMID: 38032755 PMCID: PMC11005380 DOI: 10.1089/neu.2023.0379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
The Blast Exposure Threshold Survey (BETS) is a recently developed and promising new self-report measure of lifetime blast exposure (LBE). However, there are no studies that have examined the psychometric properties of the BETS, which currently limits its clinical utility. The purpose of this study was to examine the convergent and discriminant validity of the BETS by comparing the BETS Generalized Blast Exposure Value (GBEV) to six variables hypothesized to be associated with LBE (i.e., single-item LBE, combat exposure, years in the military, number of combat deployments, and military occupation specialty [MOS]) and three variables hypothesized not to be associated with LBE (i.e., age at the time of injury, estimated pre-morbid Full-Scale Intelligence Quotient [FSIQ], and resilience). Participants were 202 United States service members and veterans prospectively enrolled from three military medical treatment facilities (68.7%) and via community recruitment initiatives (31.3%). Participants completed the BETS, Combat Exposure Scale (CES), Deployment Risk and Resiliency Inventory-2 Combat Experiences (DRRI-2 CE), Traumatic Brain Injury-Quality of Life Resilience scale, and a brief structured interview. For some analyses, participants were classified into two blast risk MOS groups: high (n = 89) and low (n = 94). The BETS GBEV was not significantly correlated with all three non-blast related variables (rs = 0.01 to rs = -0.12). In contrast, GBEV was significantly (p < 0.001) associated with all blast-related variables; single-item LBE (rs = 0.76), CES (rs = 0.58), number of combat deployments (rs = 0.53), DRRI-2 CE (rs = 0.48), and high blast risk MOS (r = 0.36, medium effect size). However, a stronger relationship was found between the blast-related variables and three modified GBEV scores when excluding some small weapons categories; single-item LBE (rs = 0.80-0.82), CES (rs = 0.64-0.67), number of combat deployments (rs = 0.56), DRRI-2 CE (rs = 0.51-0.53), and high blast risk MOS (r = 0.42-0.49, medium-large effect size). This is the first study to examine the psychometric properties of the BETS. Overall, these results offer support for the convergent and discriminant validity of the BETS. In order to ensure that the BETS can be confidently used as a valid and reliable measure of LBE, more research is needed to further examine the psychometric properties of the test, particularly with regard to the establishment of test-retest reliability.
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Affiliation(s)
- Rael T. Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Louis M. French
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sara M. Lippa
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kelly C. Gillow
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Contractor, CICONIX, Annapolis, Maryland, USA
| | - Jason M. Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA
- 33 Area Branch Clinic Camp, Pendleton, California, USA
| | - Stephanie M. Turner
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA
| | - Lars D. Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA
- Naval Medical Center, San Diego, California, USA
| | - Tracey A. Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Stone JR, Avants BB, Tustison NJ, Gill J, Wilde EA, Neumann KD, Gladney LA, Kilgore MO, Bowling F, Wilson CM, Detro JF, Belanger HG, Deary K, Linsenbardt H, Ahlers ST. Neurological Effects of Repeated Blast Exposure in Special Operations Personnel. J Neurotrauma 2024; 41:942-956. [PMID: 37950709 PMCID: PMC11001960 DOI: 10.1089/neu.2023.0309] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023] Open
Abstract
Exposure to blast overpressure has been a pervasive feature of combat-related injuries. Studies exploring the neurological correlates of repeated low-level blast exposure in career "breachers" demonstrated higher levels of tumor necrosis factor alpha (TNFα) and interleukin (IL)-6 and decreases in IL-10 within brain-derived extracellular vesicles (BDEVs). The current pilot study was initiated in partnership with the U.S. Special Operations Command (USSOCOM) to explore whether neuroinflammation is seen within special operators with prior blast exposure. Data were analyzed from 18 service members (SMs), inclusive of 9 blast-exposed special operators with an extensive career history of repeated blast exposures and 9 controls matched by age and duration of service. Neuroinflammation was assessed utilizing positron emission tomography (PET) imaging with [18F]DPA-714. Serum was acquired to assess inflammatory biomarkers within whole serum and BDEVs. The Blast Exposure Threshold Survey (BETS) was acquired to determine blast history. Both self-report and neurocognitive measures were acquired to assess cognition. Similarity-driven Multi-view Linear Reconstruction (SiMLR) was used for joint analysis of acquired data. Analysis of BDEVs indicated significant positive associations with a generalized blast exposure value (GBEV) derived from the BETS. SiMLR-based analyses of neuroimaging demonstrated exposure-related relationships between GBEV, PET-neuroinflammation, cortical thickness, and volume loss within special operators. Affected brain networks included regions associated with memory retrieval and executive functioning, as well as visual and heteromodal processing. Post hoc assessments of cognitive measures failed to demonstrate significant associations with GBEV. This emerging evidence suggests neuroinflammation may be a key feature of the brain response to blast exposure over a career in operational personnel. The common thread of neuroinflammation observed in blast-exposed populations requires further study.
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Affiliation(s)
- James R. Stone
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Brian B. Avants
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Nicholas J. Tustison
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Jessica Gill
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elisabeth A. Wilde
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- George E. Wahlen VA, Salt Lake City Health Healthcare System, Salt Lake City, Utah, USA
| | - Kiel D. Neumann
- Molecular Imaging Research Hub, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Leslie A. Gladney
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Madison O. Kilgore
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - F. Bowling
- U.S. Special Operations Command, Tampa, Florida, USA
| | | | - John F. Detro
- U.S. Special Operations Command, Tampa, Florida, USA
| | - Heather G. Belanger
- Departments of Psychiatry and Behavioral Neurosciences, and Psychology, University of South Florida, Tampa, Florida, USA
- Cognitive Research Corporation, St. Petersburg, Florida, USA
| | - Katryna Deary
- U.S. Special Operations Command, Tampa, Florida, USA
| | | | - Stephen T. Ahlers
- Operational and Undersea Medicine Directorate, Naval Medical Research Command, Silver Spring, Maryland, USA
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Lippa SM, Bailie JM, French LM, Brickell TA, Lange RT. Lifetime blast exposure is not related to cognitive performance or psychiatric symptoms in US military personnel. Clin Neuropsychol 2024:1-23. [PMID: 38494345 DOI: 10.1080/13854046.2024.2328881] [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: 09/25/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
Objective: The present study aimed to examine the impact of lifetime blast exposure (LBE) on neuropsychological functioning in service members and veterans (SMVs). Method: Participants were 282 SMVs, with and without history of traumatic brain injury (TBI), who were prospectively enrolled in a Defense and Veterans Brain Injury Center (DVBIC)-Traumatic Brain Injury Center of Excellence (TBICoE) Longitudinal TBI Study. A cross-sectional analysis of baseline data was conducted. LBE was based on two factors: Military Occupational Speciality (MOS) and SMV self-report. Participants were divided into three groups based on LBE: Blast Naive (n = 61), Blast + Low Risk MOS (n = 96), Blast + High Risk MOS (n = 125). Multivariate analysis of variance (MANOVA) was used to examine group differences on neurocognitive domains and the Minnesota Multiphasic Personality Inventory-2 Restructured Form. Results: There were no statistically significant differences in attention/working memory, processing speed, executive functioning, and memory (Fs < 1.75, ps > .1, ηp2s < .032) or in General Cognition (Fs < 0.95, ps > .3, ηp2s < .008). Prior to correction for covariates, lifetime blast exposure was related to Restructured Clinical (F(18,542) = 1.77, p = .026, ηp2 = .055), Somatic/Cognitive (F(10,550) = 1.99, p = .033, ηp2 = .035), and Externalizing Scales (F(8,552) = 2.17, p = .028, ηp2 = .030); however, these relationships did not remain significant after correction for covariates (Fs < 1.53, ps > .145, ηp2s < .032). Conclusions: We did not find evidence of a relationship between LBE and neurocognitive performance or psychiatric symptoms. This stands in contrast to prior studies demonstrating an association between lifetime blast exposure and highly sensitive blood biomarkers and/or neuroimaging. Overall, findings suggest the neuropsychological impact of lifetime blast exposure is minimal in individuals remaining in or recently retired from military service.
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Affiliation(s)
- Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
- Naval Hospital Camp Pendleton, Oceanside, CA, USA
- General Dynamics Information Technology, Fairfax, VA, USA
| | - Louis M French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
| | - Tracey A Brickell
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
- General Dynamics Information Technology, Fairfax, VA, USA
| | - Rael T Lange
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
- General Dynamics Information Technology, Fairfax, VA, USA
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Elder GA, Gama Sosa MA, De Gasperi R, Perez Garcia G, Perez GM, Abutarboush R, Kawoos U, Zhu CW, Janssen WGM, Stone JR, Hof PR, Cook DG, Ahlers ST. The Neurovascular Unit as a Locus of Injury in Low-Level Blast-Induced Neurotrauma. Int J Mol Sci 2024; 25:1150. [PMID: 38256223 PMCID: PMC10816929 DOI: 10.3390/ijms25021150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Blast-induced neurotrauma has received much attention over the past decade. Vascular injury occurs early following blast exposure. Indeed, in animal models that approximate human mild traumatic brain injury or subclinical blast exposure, vascular pathology can occur in the presence of a normal neuropil, suggesting that the vasculature is particularly vulnerable. Brain endothelial cells and their supporting glial and neuronal elements constitute a neurovascular unit (NVU). Blast injury disrupts gliovascular and neurovascular connections in addition to damaging endothelial cells, basal laminae, smooth muscle cells, and pericytes as well as causing extracellular matrix reorganization. Perivascular pathology becomes associated with phospho-tau accumulation and chronic perivascular inflammation. Disruption of the NVU should impact activity-dependent regulation of cerebral blood flow, blood-brain barrier permeability, and glymphatic flow. Here, we review work in an animal model of low-level blast injury that we have been studying for over a decade. We review work supporting the NVU as a locus of low-level blast injury. We integrate our findings with those from other laboratories studying similar models that collectively suggest that damage to astrocytes and other perivascular cells as well as chronic immune activation play a role in the persistent neurobehavioral changes that follow blast injury.
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Affiliation(s)
- Gregory A. Elder
- Neurology Service, James J. Peters Department of Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA;
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA; (M.A.G.S.); (R.D.G.)
- Mount Sinai Alzheimer’s Disease Research Center and the Ronald M. Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.W.Z.); (P.R.H.)
| | - Miguel A. Gama Sosa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA; (M.A.G.S.); (R.D.G.)
- General Medical Research Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY 10468, USA
| | - Rita De Gasperi
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA; (M.A.G.S.); (R.D.G.)
- Research and Development Service, James J. Peters Department of Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA;
| | - Georgina Perez Garcia
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA;
- Research and Development Service, James J. Peters Department of Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA;
| | - Gissel M. Perez
- Research and Development Service, James J. Peters Department of Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA;
| | - Rania Abutarboush
- Department of Neurotrauma, Operational and Undersea Medicine Directorate, Naval Medical ResearchCommand, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA; (R.A.); (U.K.); (S.T.A.)
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Usmah Kawoos
- Department of Neurotrauma, Operational and Undersea Medicine Directorate, Naval Medical ResearchCommand, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA; (R.A.); (U.K.); (S.T.A.)
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Carolyn W. Zhu
- Mount Sinai Alzheimer’s Disease Research Center and the Ronald M. Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.W.Z.); (P.R.H.)
- Research and Development Service, James J. Peters Department of Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA;
- Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - William G. M. Janssen
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - James R. Stone
- Department of Radiology and Medical Imaging, University of Virginia, 480 Ray C Hunt Drive, Charlottesville, VA 22903, USA;
| | - Patrick R. Hof
- Mount Sinai Alzheimer’s Disease Research Center and the Ronald M. Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.W.Z.); (P.R.H.)
- Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - David G. Cook
- Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA;
- Department of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Stephen T. Ahlers
- Department of Neurotrauma, Operational and Undersea Medicine Directorate, Naval Medical ResearchCommand, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA; (R.A.); (U.K.); (S.T.A.)
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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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Lippa SM, Yeh PH, Kennedy JE, Bailie JM, Ollinger J, Brickell TA, French LM, Lange RT. Lifetime Blast Exposure Is Not Related to White Matter Integrity in Service Members and Veterans With and Without Uncomplicated Mild Traumatic Brain Injury. Neurotrauma Rep 2023; 4:827-837. [PMID: 38156076 PMCID: PMC10754347 DOI: 10.1089/neur.2023.0043] [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: 12/30/2023] Open
Abstract
This study examines the impact of lifetime blast exposure on white matter integrity in service members and veterans (SMVs). Participants were 227 SMVs, including those with a history of mild traumatic brain injury (mTBI; n = 124), orthopedic injury controls (n = 58), and non-injured controls (n = 45), prospectively enrolled in a Defense and Veterans Brain Injury Center (DVBIC)/Traumatic Brain Injury Center of Excellence (TBICoE) study. Participants were divided into three groups based on number of self-reported lifetime blast exposures: none (n = 53); low (i.e., 1-9 blasts; n = 81); and high (i.e., ≥10 blasts; n = 93). All participants underwent diffusion tensor imaging (DTI) at least 11 months post-injury. Tract-of-interest (TOI) analysis was applied to investigate fractional anisotropy and mean, radial, and axial diffusivity (AD) in left and right total cerebral white matter as well as 24 tracts. Benjamini-Hochberg false discovery rate (FDR) correction was used. Regressions investigating blast exposure and mTBI on white matter integrity, controlling for age, revealed that the presence of mTBI history was associated with lower AD in the bilateral superior longitudinal fasciculus and arcuate fasciculus and left cingulum (βs = -0.255 to -0.174; ps < 0.01); however, when non-injured controls were removed from the sample (but orthopedic injury controls remained), these relationships were attenuated and did not survive FDR correction. Regression models were rerun with modified post-traumatic stress disorder (PTSD) diagnosis added as a predictor. After FDR correction, PTSD was not significantly associated with white matter integrity in any of the models. Overall, there was no relationship between white matter integrity and self-reported lifetime blast exposure or PTSD.
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Affiliation(s)
- Sara M. Lippa
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Ping-Hong Yeh
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
| | - Jan E. Kennedy
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA
- Brooke Army Medical Center, Joint Base, San Antonio, Texas, USA
| | - Jason M. Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA
- 33 Area Branch Clinic, Camp Pendleton, California, USA
| | - John Ollinger
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
| | - Tracey A. Brickell
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA
| | - Louis M. French
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Rael T. Lange
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA
- University of British Columbia, Vancouver, British Columbia, USA
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11
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Henion AK, Wang CP, Amuan M, Altalib HH, Towne AR, Hinds SR, Baca C, LaFrance WC, Van Cott AC, Kean J, Roghani A, Kennedy E, Panahi S, Pugh MJV. Role of Deployment History on the Association Between Epilepsy and Traumatic Brain Injury in Post-9/11 Era US Veterans. Neurology 2023; 101:e2571-e2584. [PMID: 38030395 PMCID: PMC10791059 DOI: 10.1212/wnl.0000000000207943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic brain injury (TBI) is a well-established epilepsy risk factor and is common among service members. Deployment-related TBI, where combat/blast may be more common, may have different outcomes than nondeployment-related TBI. This work examined associations of all TBI exposures (not just combat), and epilepsy, while adjusting for comorbidities associated with epilepsy, among veterans by deployment status. METHODS The cohort included post-9/11 veterans with ≥2 years of care in both Veterans Health Administration and Defense Health Agency systems. We identified epilepsy using ICD-9/10-CM codes, antiseizure medication, and service-connected disability for epilepsy. We conducted a logistic regression model with interaction terms for conditions by deployment history that adjusted for demographics and military characteristics. RESULTS The cohort (n = 938,890) included post-9/11 veterans of whom 27,436 (2.92%) had epilepsy. Most veterans had a history of deployment (70.64%), referred to as "deployed." Epilepsy was more common among veterans who were never deployed ("nondeployed") (3.85% vs 2.54%). Deployed veterans were more likely to have had TBI, compared with the nondeployed veterans (33.94% vs 14.24%), but nondeployed veterans with moderate/severe TBI had higher odds of epilepsy compared with deployed veterans (adjusted odds ratio [aOR] 2.92, 95% CI 2.68-3.17 vs aOR 2.01, 95% CI 1.91-2.11). Penetrating TBI had higher odds of epilepsy among the deployed veterans (aOR 5.33, 95% CI 4.89-5.81), whereas the odds of epilepsy for mild TBI did not significantly differ by deployment status. Although most neurologic conditions were more prevalent among the nondeployed veterans, they were often associated with higher odds of epilepsy in the deployed veterans. DISCUSSION Deployment history had a significant differential impact on epilepsy predictors. As expected, penetrating TBI had a greater epilepsy impact among deployed veterans perhaps due to combat/blast. Some epilepsy predictors (moderate/severe TBI, multiple sclerosis, and Parkinson disease) had a stronger association in the nondeployed veterans suggesting a potential healthy warrior effect in which such conditions preclude deployment. Other neurologic conditions (e.g., brain tumor, Alzheimer disease/frontotemporal dementia) had a greater epilepsy impact in the deployed veterans. This may be attributable to deployment-related exposures (combat injury, occupational exposures). A better understanding of deployment effects is critical to provide targeted epilepsy prevention in veterans and military service members.
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Affiliation(s)
- Amy K Henion
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Chen-Pin Wang
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Megan Amuan
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Hamada H Altalib
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Alan R Towne
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Sidney R Hinds
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Christine Baca
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - W Curt LaFrance
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Anne C Van Cott
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Jacob Kean
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Ali Roghani
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Eamonn Kennedy
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Samin Panahi
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Mary Jo V Pugh
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
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12
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Martindale SL, Belding JN, Crawford CD, Rowland JA. Validation of Military Occupational Specialty as a Proxy for Blast Exposure Using the Salisbury Blast Interview. J Neurotrauma 2023; 40:2321-2329. [PMID: 37058360 DOI: 10.1089/neu.2023.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
Abstract Evaluating large data sets precludes the ability to directly measure individual experiences, instead relying on proxies to infer certain constructs. Blast exposure is a construct of study currently in its infancy, resulting in diverse definitions and measurements across studies. The purpose of the present study was to validate military occupational specialty (MOS) as a proxy for blast exposure in combat veterans. A total of 256 veterans (86.33% male) completed the Salisbury Blast Interview (SBI) and Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC) Assessment of Traumatic Brain Injury (MMA-TBI). MOS was collected through record review and categorized into low and high risk for blast exposure. Chi-square analyses and t tests compared SBI metrics between MOS categories. Receiver operating characteristic (ROC) analyses evaluated the diagnostic accuracy of MOS category in determining blast exposure severity. Veterans in high-risk MOS were more likely to have experienced blast and deployment TBI (ps < 0.001) than were those in low-risk MOS. ROC analyses indicated good specificity (81.29-88.00) for blast and deployment TBI outcomes, suggesting that low-risk MOS is generally associated with an absence of blast and deployment TBI outcomes. Sensitivity was low (36.46-51.14), indicating that MOS risk level was not a good predictor of the presence of these outcomes. Results demonstrate that high-risk MOSs will identify individuals with blast exposure and deployment TBI history whereas low-risk MOSs will capture a highly variable group. Accuracy of MOS categorization was not acceptable for diagnostic-level tests; however, results support its use as a screening measure for a history of exposure to blast, use in epidemiological studies, and considerations for military policy.
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Affiliation(s)
- Sarah L Martindale
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MA-MIRECC), Research and Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, North Carolina, USA
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Cameron D Crawford
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MA-MIRECC), Research and Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, North Carolina, USA
| | - Jared A Rowland
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MA-MIRECC), Research and Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, North Carolina, USA
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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13
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Heyburn L, Dahal S, Abutarboush R, Reed E, Urioste R, Batuure A, Wilder D, Ahlers ST, Long JB, Sajja VS. Differential effects on TDP-43, piezo-2, tight-junction proteins in various brain regions following repetitive low-intensity blast overpressure. Front Neurol 2023; 14:1237647. [PMID: 37877029 PMCID: PMC10593467 DOI: 10.3389/fneur.2023.1237647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/15/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Mild traumatic brain injury (mTBI) caused by repetitive low-intensity blast overpressure (relBOP) in military personnel exposed to breaching and heavy weapons is often unrecognized and is understudied. Exposure to relBOP poses the risk of developing abnormal behavioral and psychological changes such as altered cognitive function, anxiety, and depression, all of which can severely compromise the quality of the life of the affected individual. Due to the structural and anatomical heterogeneity of the brain, understanding the potentially varied effects of relBOP in different regions of the brain could lend insights into the risks from exposures. Methods In this study, using a rodent model of relBOP and western blotting for protein expression we showed the differential expression of various neuropathological proteins like TDP-43, tight junction proteins (claudin-5, occludin, and glial fibrillary acidic protein (GFAP)) and a mechanosensitive protein (piezo-2) in different regions of the brain at different intensities and frequency of blast. Results Our key results include (i) significant increase in claudin-5 after 1x blast of 6.5 psi in all three regions and no definitive pattern with higher number of blasts, (ii) significant increase in piezo-2 at 1x followed by significant decrease after multiple blasts in the cortex, (iii) significant increase in piezo-2 with increasing number of blasts in frontal cortex and mixed pattern of expression in hippocampus and (iv) mixed pattern of TDP-3 and GFAP expression in all the regions of brain. Discussion These results suggest that there are not definitive patterns of changes in these marker proteins with increase in intensity and/or frequency of blast exposure in any particular region; the changes in expression of these proteins are different among the regions. We also found that the orientation of blast exposure (e.g. front vs. side exposure) affects the altered expression of these proteins.
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Affiliation(s)
- Lanier Heyburn
- Blast Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Shataakshi Dahal
- Blast Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
- The Geneva Foundation, Tacoma, WA, United States
| | | | - Eileen Reed
- Naval Medical Research Center, Silver Spring, MD, United States
| | - Rodrigo Urioste
- Blast Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Andrew Batuure
- Blast Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Donna Wilder
- Blast Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | | | - Joseph B. Long
- Blast Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
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14
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Jannace KC, Pompeii L, Gimeno Ruiz de Porras D, Perkison WB, Yamal JM, Trone DW, Rull RP. Occupation and Risk of Traumatic Brain Injury in the Millennium Cohort Study. Mil Med 2023; 188:e3057-e3065. [PMID: 35253039 PMCID: PMC9418381 DOI: 10.1093/milmed/usac035] [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: 10/12/2021] [Revised: 12/21/2021] [Accepted: 02/01/2022] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is an occupational health hazard of military service. Few studies have examined differences in military occupational categories (MOC) which take into consideration the physical demands and job requirements across occupational groups. METHODS This study was approved by the University of Texas Health Science Center at Houston Institutional Review Board. Data for this cross-sectional study were obtained from the Naval Health Research Center's Millennium Cohort Study, an ongoing DoD study. Univariate analyses were employed to calculate frequencies and proportions for all variables. Bivariate analyses included unadjusted odds ratios (OR) and 95% CI for the association between all variables and TBI. Multivariable logistic regression was used to calculate adjusted ORs and 95% CIs to assess the association between MOC and TBI, adjusted for potential confounders: sex, race/ethnicity, rank, military status, branch of service, before-service TBI, and panel. Logistic regression models estimated odds of TBI for each MOC, and stratified models estimated odds separately for enlisted and officer MOCs. RESULTS Approximately 27% of all participants reported experiencing a service-related TBI. All MOCs were statistically significantly associated with increased odds of service-related TBI, with a range of 16 to 45%, except for "Health Care" MOCs (OR: 1.01, 95% CI 0.91-1.13). Service members in "Infantry/Tactical Operations" had the highest odds (OR: 1.45, 95% CI 1.31-1.61) of service-related TBI as compared to "Administration & Executives." Among enlisted service members, approximately 28% reported experiencing a service-related TBI. Among enlisted-specific MOCs, the odds of TBI were elevated for those serving in "Infantry, Gun Crews, Seamanship (OR: 1.79, 95% CI 1.58-2.02)," followed by "Electrical/Mechanical Equipment Repairers (OR: 1.23, 95% CI 1.09-1.38)," "Service & Supply Handlers (OR 1.21, 95% CI 1.08-1.37)," "Other Technical & Allied Specialists (OR 1.21, 95% CI 1.02-1.43)," "Health Care Specialists (OR 1.19, 95% CI 1.04-1.36)," and "Communications & Intelligence (OR: 1.16, 95% CI 1.02-1.31)," compared to "Functional Support & Administration." Among officer service members, approximately 24% reported experiencing a service-related TBI. After adjustment the odds of TBI were found to be significant for those serving as "Health Care Officers" (OR: 0.65, 95% CI: 0.52-0.80) and "Intelligence Officers" (OR: 1.27, 95% CI: 1.01-1.61). CONCLUSIONS A strength of this analysis is the breakdown of MOC associations with TBI stratified by enlisted and officer ranks, which has been previously unreported. Given the significantly increased odds of service-related TBI reporting within enlisted ranks, further exploration into the location (deployed versus non-deployed) and mechanism (e.g., blast, training, sports, etc.) for these injuries is needed. Understanding injury patterns within these military occupations is necessary to increase TBI identification, treatment, and foremost, prevention.Results highlight the importance of examining specific occupational categories rather than relying on gross categorizations, which do not account for shared knowledge, skills, and abilities within occupations. The quantification of risk among enlisted MOCs suggests a need for further research into the causes of TBI.
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Affiliation(s)
- Kalyn C Jannace
- Southwest Center for Occupational and Environmental Health, UTHealth School of Public Health, West Houston, TX 77030, USA
- The Center for Rehabilitation Sciences Research, Uniformed Services University for the Advancement of Military Medicine, Bethesda, MD 20817, USA
- The Center for Rehabilitation Sciences Research, Uniformed Services University for the Health Sciences, Bethesda, MD 20814, USA
| | - Lisa Pompeii
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - David Gimeno Ruiz de Porras
- Southwest Center for Occupational and Environmental Health, UTHealth School of Public Health, West Houston, TX 77030, USA
| | - William Brett Perkison
- Southwest Center for Occupational and Environmental Health, UTHealth School of Public Health, West Houston, TX 77030, USA
| | - Jose-Miguel Yamal
- Institute for Stroke and Cerebrovascular Disease, UTHealth School of Public Health, Houston, TX 77030, USA
| | - Daniel W Trone
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA 92152, USA
| | - Rudolph P Rull
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA 92152, USA
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Lipov E, Sethi Z, Nandra G, Frueh C. Efficacy of combined subanesthetic ketamine infusion and cervical sympathetic blockade as a symptomatic treatment of PTSD/TBI in a special forces patient with a 1-year follow-up: A case report. Heliyon 2023; 9:e14891. [PMID: 37089345 PMCID: PMC10119561 DOI: 10.1016/j.heliyon.2023.e14891] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Co-occurrence of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) symptoms are particularly prevalent in the special operations forces' community, along with other related conditions (e.g., endocrine dysregulation, sleep disorders, chronic pain). Ketamine infusion (KI) has been shown to increase neuroplasticity as well as memory improvement and cervical sympathetic block (CSB) has been shown to improve cognitive function, reduce sympathetic overactivity, and improve other symptoms of PTSD. We want to report the efficacious use of a single intervention consisting of bilateral CSB technique with subanesthetic KI X5 in a Special Operations Forces patient, diagnosed with PTSD with comorbid TBI, evaluated during treatment and at 1-year follow-up. We postulated KI and CSB would have a synergistic effect. Our patient received KI starting at 0.5 mg/kg, which was escalated daily. KI was combined with right-sided ultrasound-guided CSB (C6 and C4 levels). This was followed the next day by left-sided CSB and KI. Patient's PTSD symptoms were evaluated using the Posttraumatic Stress Disorder Checklist (PCL-5), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), suicidal ideation and other related factors by Concise Health Risk Tracking Self Report (CHRTSR). All measures were assessed prior to treatment, during treatment, and 394 days after. KI combined with CSB showed immediate and prolonged benefits 394 days later regarding the symptoms of PTSD, anxiety, depression, suicidal ideation, and cognitive deterioration (patient report). KI combined with CSB can markedly reduce symptoms of PTSD, psychiatric comorbidities, and cognitive dysfunction.
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Affiliation(s)
- Eugene Lipov
- Stella Center, Chicago, United States
- Corresponding author.
| | - Zubin Sethi
- Midwestern University Chicago College of Osteopathic Medicine, United States
| | | | - Christopher Frueh
- Department of Psychology, University of Hawaii, Hilo, HI, United States
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16
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Belding JN, Kolaja CA, Rull RP, Trone DW. Single and repeated high-level blast, low-level blast, and new-onset self-reported health conditions in the U.S. Millennium Cohort Study: An exploratory investigation. Front Neurol 2023; 14:1110717. [PMID: 37025202 PMCID: PMC10070873 DOI: 10.3389/fneur.2023.1110717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/13/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction Although previous research suggests that overpressure exposure from either high-level blast (HLB) or low-level blast (LLB) are harmful to health, to date no large-scale studies with representative samples of military personnel have utilized prospective designs and self-reported measures to examine the relationships between blast exposure and health conditions. To address these limitations, this analysis of data from the Millennium Cohort Study (MCS), the largest and longest running study of U.S. service members and veterans, examined (1) whether single or repeated HLB exposure is associated with self-reported diagnoses of illness and injury, (2) whether repeated HLB is associated with greater risk than single HLB, (3) potential adverse consequences of LLB exposure using military occupation as a proxy, and (4) the combined effects of single or repeated HLB and LLB exposure. Method MCS participants who completed the 2011-2013 survey (N = 138,949) were classified as having been exposed to "no," "single," or "repeated" HLB exposure, and into low or high risk of exposure to LLB based on occupation. Participants self-reported diagnosis of 45 medical conditions; newly reported diagnoses were regressed on single and repeated (vs. no) HLB, occupational risk of LLB, and relevant interactions using logistic regression. Results Single and repeated HLB were associated with new onset of 25 and 29 diagnoses, respectively; repeated HLB exposure was associated with greater risk than single HLB exposure for five diagnoses (e.g., PTSD, depression). Occupational risk of LLB was associated with 11 diagnoses (e.g., PTSD, significant hearing loss). Additionally, 14 significant interactions were detected across 11 diagnoses. Discussion Findings suggest that overpressure exposure (including single HLB, repeated HLB, and occupational risk of LLB) may increase the risks of self-reporting clinical diagnoses of PTSD, hearing loss, chronic fatigue syndrome, neuropathy-caused reduced sensation in the hands and feet, depression, vision loss, sinusitis, reflux, and anemia. Furthermore, the combination of HLB and LLB exposure may be associated with greater risk of migraines, PTSD, and impaired fecundity. These findings provide further evidence of the potential adverse consequences associated with overpressure exposure and underscore the necessity of public health surveillance initiatives for blast exposure and/or safety recommendations for training and operational environments.
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Affiliation(s)
- Jennifer N. Belding
- Leidos, San Diego, CA, United States
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, United States
- *Correspondence: Jennifer N. Belding
| | - Claire A. Kolaja
- Leidos, San Diego, CA, United States
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, United States
| | - Rudolph P. Rull
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, United States
| | - Daniel W. Trone
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, United States
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