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Denny JW, Dickinson AS, Langdon GS. Defining blast loading 'zones of relevance' for primary blast injury research: A consensus of injury criteria for idealised explosive scenarios. Med Eng Phys 2021; 93:83-92. [PMID: 34154779 DOI: 10.1016/j.medengphy.2021.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/23/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
Blast injuries remain a serious threat to defence and civilian populations around the world. 'Primary' blast injuries (PBIs) are caused by direct blast wave interaction with the human body, particularly affecting air-containing organs. Work to define blast loading conditions for injury research has received relatively little attention, though with a continued experimental focus on PBIs and idealised explosion assumptions, meaningful test outcomes and subsequent clinical applications, rely on appropriate simulated conditions. This paper critically evaluates and combines existing PBI criteria (grouped into those affecting the auditory system, pulmonary injuries and brain trauma) as a function of idealised blast wave parameters. For clinical blast injury researchers, analysis of the multi-injury criteria indicates zones of appropriate loading conditions for human-scale test items and demonstrates the importance of simulating blast conditions that are both realistic and relevant to the injury type. For certain explosive scenarios, spatial interpretation of the 'zones of relevance' could support emergency response and hazard preparedness by informing triage, patient management and resource allocation, thus leading to improved health outcomes. This work will prove useful to clinical blast injury researchers, blast protection engineers and clinical practitioners involved in the triage, diagnosis, and treatment of PBIs.
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Affiliation(s)
- J W Denny
- Department of Mechanical Engineering, University of Southampton, Southampton, SO17 1BJ, UK.
| | - A S Dickinson
- Department of Mechanical Engineering, University of Southampton, Southampton, SO17 1BJ, UK
| | - G S Langdon
- Department of Civil and Structural Engineering, University of Sheffield, Mappin Street, Sheffield, S1 3JD, UK; Department of Mechanical Engineering, University of Cape Town, Cape Town, South Africa
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Denny JW, Dickinson AS, Langdon GS. Guidelines to inform the generation of clinically relevant and realistic blast loading conditions for primary blast injury research. BMJ Mil Health 2021:bmjmilitary-2021-001796. [PMID: 34035162 DOI: 10.1136/bmjmilitary-2021-001796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/04/2022]
Abstract
'Primary' blast injuries (PBIs) are caused by direct blast wave interaction with the human body, particularly affecting air-containing organs. With continued experimental focus on PBI mechanisms, recently on blast traumatic brain injury, meaningful test outcomes rely on appropriate simulated conditions. Selected PBI predictive criteria (grouped into those affecting the auditory system, pulmonary injuries and brain trauma) are combined and plotted to provide rationale for generating clinically relevant loading conditions. Using blast engineering theory, explosion characteristics including blast wave parameters and fireball dimensions were calculated for a range of charge masses assuming hemispherical surface detonations and compared with PBI criteria. While many experimental loading conditions are achievable, this analysis demonstrated limits that should be observed to ensure loading is clinically relevant, realistic and practical. For PBI outcomes sensitive only to blast overpressure, blast scaled distance was demonstrated to be a useful parameter for guiding experimental design as it permits flexibility for different experimental set-ups. This analysis revealed that blast waves should correspond to blast scaled distances of 1.75<Z<6.0 to generate loading conditions found outside the fireball and of clinical relevance to a range of PBIs. Blast waves with positive phase durations (2-10 ms) are more practical to achieve through experimental approaches, while representing realistic threats such as improvised explosive devices (ie, 1-50 kg trinitrotoluene equivalent). These guidelines can be used by researchers to inform the design of appropriate blast loading conditions in PBI experimental investigations.
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Affiliation(s)
- J W Denny
- Bioengineering Science Research Group, School of Engineering, University of Southampton, Southampton, UK
| | - A S Dickinson
- Bioengineering Science Research Group, School of Engineering, University of Southampton, Southampton, UK
| | - G S Langdon
- Department of Civil and Structural Engineering, University of Sheffield, Sheffield, UK
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Liu GD, Wang N, Wang HM, Li X, Shao JJ, Liu ZF, Jiang M, Wang L, Wang ZK, Li M, Cao XY, Wang J, Zhang R, Chen YD. Military medical research on internal diseases in modern warfare: new concepts, demands, challenges, and opportunities. Mil Med Res 2021; 8:20. [PMID: 33712087 PMCID: PMC7953602 DOI: 10.1186/s40779-021-00313-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 03/05/2021] [Indexed: 12/25/2022] Open
Abstract
Battlefield internal medicine aims at the treatment of combatants and noncombatants with various internal diseases on the battlefield. The military medical research on battlefield internal diseases focuses on the pathogenesis, clinical management, and prevention of internal diseases under military war conditions. In both wartime and peacetime, the soldiers suffer from more internal diseases than surgical wounds. With the introduction of high-tech weapons, including chemical, physical, and biological agents, a large number of special internal illnesses and casualties will appear in future wars. The battles often occur in special environments, such as high or low temperatures, plateau or polar areas, and micro- or hyper-gravity. The current theories of battlefield internal medicine are mainly derived from wars decades ago and cannot meet the needs of military medical support under the conditions of modern warfare. Therefore, the military medical research on battlefield internal medicine should be based on contemporary military situations, focus on the purpose of treating battlefield internal diseases, and adhere to the actual needs of the troops in peacetime and wartime. We should investigate the pathogenesis of battlefield internal diseases and explore the threats that may arise in future wars to ensure the advancement of battlefield internal medicine. This review highlights new concepts, demands, challenges, and opportunities for the further development of military medical research on battlefield internal medicine.
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Affiliation(s)
- Guang-Dong Liu
- Division of Health Services, Chinese PLA General Hospital & Chinese PLA Medical School, Beijing, 100853, China
| | - Nan Wang
- Division of Health Services, Chinese PLA General Hospital & Chinese PLA Medical School, Beijing, 100853, China
| | - Hai-Ming Wang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Xin Li
- Department of Health Services, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Jun-Jie Shao
- The First Clinical Medical College of Inner Mongolia Medical University, Hohhot, 010059, China
| | - Zi-Fan Liu
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Min Jiang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Lin Wang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Zi-Kai Wang
- Department of Gastroenterology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Meng Li
- Department of Hematology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xue-Ying Cao
- Department of Nephrology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Jiang Wang
- Department of Respiratory and Intensive Medicine, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ran Zhang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China.
| | - Yun-Dai Chen
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China.
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Hubler GK, Hoffman SW, Andreadis TD, DePalma RG. Pulsed Microwave Energy Transduction of Acoustic Phonon Related Brain Injury. Front Neurol 2020; 11:753. [PMID: 32849213 PMCID: PMC7417645 DOI: 10.3389/fneur.2020.00753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/18/2020] [Indexed: 01/31/2023] Open
Abstract
Pulsed microwaves above specific energy thresholds have been reported to cause brain injury in animal models. The actual physical mechanism causing brain damage is unexplained while the clinical reality of these injuries remains controversial. Here we propose mechanisms by which pulsed microwaves may injure brain tissue by transduction of microwave energy into damaging acoustic phonons in brain water. We have shown that low intensity explosive blast waves likely initiate phonon excitations in brain tissues. Brain injury in this instance occurs at nanoscale subcellular levels as predicted by physical consideration of phonon interactions in brain water content. The phonon mechanism may also explain similarities between primary non-impact blast-induced mild Traumatic Brain Injury (mTBI) and recent clinical and imaging findings of unexplained brain injuries observed in US embassy personnel possibly due to directed radiofrequency radiation. We describe experiments to elucidate mechanisms, RF frequencies and power levels by which pulsed microwaves potentially injure brain tissue. Pathological documentation of nanoscale brain blast injury has been supported experimentally using transmission electron microscopy (TEM) demonstrating nanoscale cellular damage in the absence of gross or light microscopic findings. Similar studies are required to better define pulsed microwave brain injury. Based upon existing findings, clinical diagnosis of both low intensity blast and microwave-induced brain injury likely will require diffusion tensor imaging (DTI), a specialized water based magnetic resonance imaging (MRI) technique.
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Affiliation(s)
- Graham K Hubler
- The School of Medicine, University of Missouri, Columbia, MO, United States
| | - Stuart W Hoffman
- US Department of Veterans Affairs, Rehabilitation Research and Development Service, Office of Research and Development, Veterans Health Administration, Washington, DC, United States
| | - Tim D Andreadis
- U.S. Naval Research Laboratory, Tactical Electronic Warfare Division, Washington, DC, United States
| | - Ralph G DePalma
- US Department of Veterans Affairs, Office of Research and Development, Veterans Health Administration, Washington, DC, United States.,Department of Surgery, Uniformed University of the Health Sciences, Bethesda, MD, United States
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Cernak I. Understanding blast-induced neurotrauma: how far have we come? Concussion 2017; 2:CNC42. [PMID: 30202583 PMCID: PMC6093818 DOI: 10.2217/cnc-2017-0006] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/08/2017] [Indexed: 12/14/2022] Open
Abstract
Blast injuries, including blast-induced neurotrauma (BINT), are caused by blast waves generated during an explosion. Accordingly, their history coincides with that of explosives. Hence, it is intriguing that, after more than 1000 years of using explosives, our understanding of the pathological consequences of blast and body/brain interactions is extremely limited. Postconflict recovery mechanisms seemingly include the suppression of painful experiences, such as explosive injuries. Unfortunately, ignoring the knowledge generated by previous generations of scientists retards research progress, leading to superfluous and repetitive studies. This article summarizes clinical and experimental findings published about blast injuries and BINT following the wars of the 20th and 21th centuries. Moreover, it offers a personal view on potential factors interfering with the progress of BINT research working toward providing better diagnosis, treatment and rehabilitation for military personnel affected by blast exposure.
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Affiliation(s)
- Ibolja Cernak
- Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall 3–48, Edmonton Alberta, T6G 2G4, Canada
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Obajuluwa AO, Akinyemi AJ, Afolabi OB, Adekoya K, Sanya JO, Ishola AO. Exposure to radio-frequency electromagnetic waves alters acetylcholinesterase gene expression, exploratory and motor coordination-linked behaviour in male rats. Toxicol Rep 2017; 4:530-534. [PMID: 29657919 PMCID: PMC5897318 DOI: 10.1016/j.toxrep.2017.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/12/2017] [Accepted: 09/30/2017] [Indexed: 01/27/2023] Open
Abstract
Humans in modern society are exposed to an ever-increasing number of electromagnetic fields (EMFs) and some studies have demonstrated that these waves can alter brain function but the mechanism still remains unclear. Hence, this study sought to investigate the effect of 2.5 Ghz band radio-frequency electromagnetic waves (RF-EMF) exposure on cerebral cortex acetylcholinesterase (AChE) activity and their mRNA expression level as well as locomotor function and anxiety-linked behaviour in male rats. Animals were divided into four groups namely; group 1 was control (without exposure), group 2-4 were exposed to 2.5 Ghz radiofrequency waves from an installed WI-FI device for a period of 4, 6 and 8 weeks respectively. The results revealed that WiFi exposure caused a significant increase in anxiety level and affect locomotor function. Furthermore, there was a significant decrease in AChE activity with a concomitant increase in AChE mRNA expression level in WiFi exposed rats when compared with control. In conclusions, these data showed that long term exposure to WiFi may lead to adverse effects such as neurodegenerative diseases as observed by a significant alteration on AChE gene expression and some neurobehavioral parameters associated with brain damage.
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Affiliation(s)
| | - Ayodele Jacob Akinyemi
- Biochemistry Department, College of Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | | | - Khalid Adekoya
- Cell Biology and Genetics Department, Faculty of Sciences, University of Lagos, Lagos, Nigeria
| | | | - Azeez Olakunle Ishola
- Anatomy Department, College of Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
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