1
|
Glaser J, Jaeckle S, Beblo T, Mueller G, Eidenmueller AM, Schulz P, Schmehl I, Rogge W, Hollander K, Toepper M, Gonschorek AS. The effect of repeated concussions on clinical and neurocognitive symptom severity in different contact sports. Scand J Med Sci Sports 2024; 34:e14626. [PMID: 38610121 DOI: 10.1111/sms.14626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION The potential consequences of repeated concussions in sport are well documented. However, it remains unclear whether the cumulative impact of sports-related concussions differs between different contact sports. Therefore, the aim of the current study was to investigate the cumulative effects of sports-related concussions on clinical and neurocognitive health in different contact sports. MATERIALS AND METHODS In a prospective multicenter study, we examined 507 (74 females) active professional athletes between 18 and 40 years of age from five different contact sports (soccer, handball, American football, basketball, and ice hockey). Data collection involved concussion history, clinical symptom evaluation, neurocognitive assessment, and the collection of other sports-related information. Composite scores were built for clinical symptoms (such as neck pain and balance disturbances) and for neurocognitive symptoms (such as memory and attention impairments). RESULTS Athletes having suffered 3+ concussions in the past showed disproportionally higher clinical symptom severity than athletes with less than three concussions across all sports. The level of clinical symptom burden in athletes with 3+ concussions indicated mild impairment. The number of past concussions did not affect neurocognitive performance. DISCUSSION Repeated sports-related concussions appear to have a cumulative impact on clinical-but not cognitive-symptom severity. Although clinical symptom burden in athletes with 3+ concussions in the past was not alarmingly high yet in our sample, increased caution should be advised at this point. Despite few exceptions, results are similar for different contact sports, suggesting a similar multidisciplinary concussion management across all types of sport.
Collapse
Affiliation(s)
- Jennifer Glaser
- Concussion Center Hamburg, Neurozentrum, BG Klinikum Hamburg, Hamburg, Germany
| | - Sarah Jaeckle
- Concussion Center Würzburg, Praxis für Sport-Neuropsychologie Würzburg, Wuerzburg, Germany
| | - Thomas Beblo
- Evangelisches Klinikum Bethel gGmbH, University Hospital of Psychiatry and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Gerhard Mueller
- Concussion Center Würzburg, Praxis für Sport-Neuropsychologie Würzburg, Wuerzburg, Germany
| | - Andreas M Eidenmueller
- Concussion Center Würzburg, Praxis für Sport-Neuropsychologie Würzburg, Wuerzburg, Germany
| | - Philipp Schulz
- Evangelisches Klinikum Bethel gGmbH, University Hospital of Psychiatry and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Ingo Schmehl
- Concussion Center Berlin, Klinik für Neurologie, BG Klinikum Unfallkrankenhaus Berlin GmbH, Berlin, Germany
| | - Witold Rogge
- Concussion Center Berlin, Klinik für Neurologie, BG Klinikum Unfallkrankenhaus Berlin GmbH, Berlin, Germany
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Max Toepper
- Evangelisches Klinikum Bethel gGmbH, University Hospital of Psychiatry and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | | |
Collapse
|
2
|
Schwenkreis P, Gonschorek A, Berg F, Meier U, Rogge W, Schmehl I, Kern BC, Meisel HJ, Wohlfarth K, Gross S, Sczesny-Kaiser M, Tegenthoff M, Boschert J, Bruckmoser R, Fürst A, Schaan M, Strowitzki M, Pingel A, Jägers LL, Rudolf H, Trampisch HJ, Lemcke J. Prospective observational cohort study on epidemiology, treatment and outcome of patients with traumatic brain injury (TBI) in German BG hospitals. BMJ Open 2021; 11:e045771. [PMID: 34088707 PMCID: PMC8183205 DOI: 10.1136/bmjopen-2020-045771] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Since 2000/2001, no large-scale prospective studies addressing traumatic brain injury (TBI) epidemiology in Germany have been published. Our aim was to look for a possible shift in TBI epidemiology described in other European countries, to look for possible changes in TBI management and to identify predictors of 1-year outcome especially in patients with mild TBI. DESIGN Observational cohort study. SETTING All patients suffering from a TBI of any degree between 1 October 2014 and 30 September 2015, and who arrived in one of the seven participating BG hospitals within 24 hours after trauma, were included. PARTICIPANTS In total, 3514 patients were included. OUTCOME MEASURES Initial care, acute hospital care and rehabilitation were documented using standardised documentation forms. A standardised telephone interview was conducted 3 and 12 months after TBI in order to obtain information on outcome. RESULTS Peaks were identified in males in the early 20s and mid-50s, and in both sexes in the late 70s, with 25% of all patients aged 75 or older. A fall was the most frequent cause of TBI, followed by traffic accidents (especially bicyclists). The number of head CT scans increased, and the number of conventional X-rays of the skull decreased compared with 2000/2001. Besides, more patients were offered rehabilitation than before. Though most TBI were classified as mild, one-third of the patients participating in the telephone interview after 12 months still reported troubles attributed to TBI. Negative predictors in mild TBI were female gender, intracranial bleeding and Glasgow Coma Scale (GCS) 13/14. CONCLUSION The observed epidemiologic shift in TBI (ie, elderly patients, more falls, more bicyclists) calls for targeted preventive measures. The heterogeneity behind the diagnosis 'mild TBI' emphasises the need for defining subgroups not only based on GCS.
Collapse
Affiliation(s)
- Peter Schwenkreis
- Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Andreas Gonschorek
- Neurology, Berufsgenossenschaftliches Klinikum Hamburg, Hamburg, Germany
| | - Florian Berg
- Neurosurgery, Berufsgenossenschaftliches Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Ullrich Meier
- Neurosurgery, Berufsgenossenschaftliches Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Witold Rogge
- Neurology, Berufsgenossenschaftliches Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Ingo Schmehl
- Neurology, Berufsgenossenschaftliches Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Bodo Christian Kern
- Neurosurgery, Berufsgenossenschaftliches Klinikum Bergmannstrost Halle, Halle, Germany
| | - Hans-Jörg Meisel
- Neurosurgery, Berufsgenossenschaftliches Klinikum Bergmannstrost Halle, Halle, Germany
| | - Kai Wohlfarth
- Neurology, Berufsgenossenschaftliches Klinikum Bergmannstrost Halle, Halle, Germany
| | - Stefan Gross
- Neurology, Berufsgenossenschaftliches Klinikum Hamburg, Hamburg, Germany
| | - Matthias Sczesny-Kaiser
- Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Martin Tegenthoff
- Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Jürgen Boschert
- Neurosurgery, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Germany
| | - Ralf Bruckmoser
- Neurosurgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Andrea Fürst
- Neurology, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Marc Schaan
- Neurorehabilitation, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Martin Strowitzki
- Neurosurgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Andreas Pingel
- Neurosurgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Lisa Linnea Jägers
- Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Henrik Rudolf
- Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | | | - Johannes Lemcke
- Neurosurgery, Berufsgenossenschaftliches Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| |
Collapse
|
3
|
Van der Bruggen B, Goossens H, Everard PA, Stemgée K, Rogge W. Cost-benefit analysis of central softening for production of drinking water. J Environ Manage 2009; 91:541-549. [PMID: 19837505 DOI: 10.1016/j.jenvman.2009.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Revised: 09/20/2009] [Accepted: 09/21/2009] [Indexed: 05/28/2023]
Abstract
Softening drinking water before distribution yields advantages with environmental impact, such as lower household products consumption, less scaling in piping and machines, and the avoidance of decentralized, domestic softeners. Central softening is under consideration in Flanders by the largest water supplier, VMW (Dutch acronym for "Flemish Company for Water Supply"), to deliver soft (15 degrees F) water to their customers. A case study is presented for a region with hard water (47 degrees F). The chosen technique is the pellet reactor, based on precipitation of CaCO(3) by NaOH addition. This softening operation has possibly large impact on the environment and the water consumption pattern. A cost-benefit analysis has been made to estimate the added value of central softening, by investigating the impact on the drinking water company, on their customers, on employment, on environment, on health, etc. The analysis for the region of study revealed benefits for customers which were higher than the costs for the drinking water company. However, pricing of drinking water remains an important problem. A sensitivity analysis of these results has also been made, to evaluate the impact of important hypothesis, and to be able to expand this study to other regions. The conclusions for this part show that softening is beneficial if water hardness is to be decreased by at least 5 degrees F.
Collapse
Affiliation(s)
- B Van der Bruggen
- K.U. Leuven, Department of Chemical Engineering, Laboratory for Applied Physical Chemistry and Environmental Technology, W. de Croylaan 46, B - 3001 Leuven, Belgium.
| | | | | | | | | |
Collapse
|
4
|
Harms H, Prass K, Meisel C, Klehmet J, Rogge W, Drenckhahn C, Göhler J, Bereswill S, Göbel U, Wernecke KD, Wolf T, Arnold G, Halle E, Volk HD, Dirnagl U, Meisel A. Preventive antibacterial therapy in acute ischemic stroke: a randomized controlled trial. PLoS One 2008; 3:e2158. [PMID: 18478129 PMCID: PMC2373885 DOI: 10.1371/journal.pone.0002158] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 03/28/2008] [Indexed: 01/08/2023] Open
Abstract
Background Pneumonia is a major risk factor of death after acute stroke. In a mouse model, preventive antibacterial therapy with moxifloxacin not only prevents the development of post-stroke infections, it also reduces mortality, and improves neurological outcome significantly. In this study we investigate whether this approach is effective in stroke patients. Methods Preventive ANtibacterial THERapy in acute Ischemic Stroke (PANTHERIS) is a randomized, double-blind, placebo-controlled trial in 80 patients with severe, non-lacunar, ischemic stroke (NIHSS>11) in the middle cerebral artery (MCA) territory. Patients received either intravenous moxifloxacin (400 mg daily) or placebo for 5 days starting within 36 hours after stroke onset. Primary endpoint was infection within 11 days. Secondary endpoints included neurological outcome, survival, development of stroke-induced immunodepression, and induction of bacterial resistance. Findings On intention-to treat analysis (79 patients), the infection rate at day 11 in the moxifloxacin treated group was 15.4% compared to 32.5% in the placebo treated group (p = 0.114). On per protocol analysis (n = 66), moxifloxacin significantly reduced infection rate from 41.9% to 17.1% (p = 0.032). Stroke associated infections were associated with a lower survival rate. In this study, neurological outcome and survival were not significantly influenced by treatment with moxifloxacin. Frequency of fluoroquinolone resistance in both treatment groups did not differ. On logistic regression analysis, treatment arm as well as the interaction between treatment arm and monocytic HLA-DR expression (a marker for immunodepression) at day 1 after stroke onset was independently and highly predictive for post-stroke infections. Interpretation PANTHERIS suggests that preventive administration of moxifloxacin is superior in reducing infections after severe non-lacunar ischemic stroke compared to placebo. In addition, the results emphasize the pivotal role of immunodepression in developing post-stroke infections. Trial Registration Controlled-Trials.com ISRCTN74386719
Collapse
Affiliation(s)
- Hendrik Harms
- Department of Neurology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Konstantin Prass
- Department of Neurology, Landesklinikum Waldviertel Horn, Horn, Austria
| | - Christian Meisel
- Institute of Medical Immunology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Juliane Klehmet
- Department of Neurology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Witold Rogge
- Department of Neurology, Unfallkrankenhaus Berlin, Berlin, Germany
| | | | - Jos Göhler
- Department of Neurology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Stefan Bereswill
- Department of Microbiology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Ulf Göbel
- Department of Microbiology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Klaus Dieter Wernecke
- Department of Biometrics and Clinical Epidemiology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Tilo Wolf
- Department of Neurology, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Guy Arnold
- Department of Neurology, Klinikum Sindelfingen-Böblingen, Sindelfingen, Germany
| | - Elke Halle
- Department of Microbiology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Hans-Dieter Volk
- Institute of Medical Immunology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Ulrich Dirnagl
- Department of Neurology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Andreas Meisel
- Department of Neurology, Charité Universitaetsmedizin Berlin, Berlin, Germany
- * E-mail:
| |
Collapse
|
5
|
Harms H, Prass K, Meisel C, Klehmet J, Halle E, Rogge W, Haas W, Schmehl I, Drenckhahn C, Hartmann A, Arnold G, Wernecke K, Dirnagl U, Meisel A. Präventive antiinfektive Therapie nach akutem Schlaganfall: Die klinischen Ergebnisse der PANTHERIS-Studie. Akt Neurol 2006. [DOI: 10.1055/s-2006-952998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
6
|
Harms H, Prass K, Meisel C, Friebe A, Halle E, Rogge W, Schmehl I, Haas W, Volk HD, Arnold G, Dirnagl U, Meisel A. Präventive ANtibakterielle THERapie beim akuten ischämischen Schlaganfall - PANTHERIS-Studie. Akt Neurol 2004. [DOI: 10.1055/s-2004-832971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
7
|
|
8
|
Parala H, Devi A, Rogge W, Birkner A, Fischer RA. Synthesis of GaN particles in porous matrices by chemical vapor infiltration of single molecule precursors. ACTA ACUST UNITED AC 2001. [DOI: 10.1051/jp4:2001360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
9
|
Devi A, Rogge W, Wohlfart A, Hipler F, Becker HW, Fischer RA. A Study of Bisazido(dimethylamino-propyl)gallium as a Precursor for the OMVPE of Gallium Nitride Thin Films in a Cold-Wall Reactor System under Reduced Pressure. ACTA ACUST UNITED AC 2000. [DOI: 10.1002/1521-3862(200010)6:5<245::aid-cvde245>3.0.co;2-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|