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Wang T, Chen Y, Du H, Liu Y, Zhang L, Meng M. Monitoring of Neuroendocrine Changes in Acute Stage of Severe Craniocerebral Injury by Transcranial Doppler Ultrasound Image Features Based on Artificial Intelligence Algorithm. Comput Math Methods Med 2021; 2021:3584034. [PMID: 34956395 PMCID: PMC8694971 DOI: 10.1155/2021/3584034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022]
Abstract
This study was aimed at exploring the application value of transcranial Doppler (TCD) based on artificial intelligence algorithm in monitoring the neuroendocrine changes in patients with severe head injury in the acute phase; 80 patients with severe brain injury were included in this study as the study subjects, and they were randomly divided into the control group (conventional TCD) and the experimental group (algorithm-optimized TCD), 40 patients in each group. An artificial intelligence neighborhood segmentation algorithm for TCD images was designed to comprehensively evaluate the application value of this algorithm by measuring the TCD image area segmentation error and running time of this algorithm. In addition, the Glasgow coma scale (GCS) and each neuroendocrine hormone level were used to assess the neuroendocrine status of the patients. The results showed that the running time of the artificial intelligence neighborhood segmentation algorithm for TCD was 3.14 ± 1.02 s, which was significantly shorter than 32.23 ± 9.56 s of traditional convolutional neural network (CNN) algorithms (P < 0.05). The false rejection rate (FRR) of TCD image area segmentation of this algorithm was significantly reduced, and the false acceptance rate (FAR) and true acceptance rate (TAR) were significantly increased (P < 0.05). The consistent rate of the GCS score and Doppler ultrasound imaging diagnosis results in the experimental group was 93.8%, which was significantly higher than the 80.3% in the control group (P < 0.05). The consistency rate of Doppler ultrasound imaging diagnosis results of patients in the experimental group with abnormal levels of follicle stimulating hormone (FSH), prolactin (PRL), growth hormone (GH), adrenocorticotropic hormone (ACTH), and thyroid stimulating hormone (TSH) was significantly higher than that of the control group (P < 0.05). In summary, the artificial intelligence neighborhood segmentation algorithm can significantly shorten the processing time of the TCD image and reduce the segmentation error of the image area, which significantly improves the monitoring level of TCD for patients with severe craniocerebral injury and has good clinical application value.
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Affiliation(s)
- Tao Wang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Yizhu Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Hangxiang Du
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Yongan Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Lidi Zhang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Mei Meng
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
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Misale P, Hassannia F, Dabiri S, Brandstaetter T, Rutka J. Post-traumatic peripheral vestibular disorders (excluding positional vertigo) in workers following head injury. Sci Rep 2021; 11:23436. [PMID: 34873257 PMCID: PMC8648866 DOI: 10.1038/s41598-021-02987-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/23/2021] [Indexed: 11/08/2022] Open
Abstract
Benign paroxysmal positional vertigo has typically been reported to be the most common cause of post-traumatic dizziness. There is however paucity in the literature about other peripheral vestibular disorders post-head injury. This article provides an overview of other causes of non-positional dizziness post-head trauma from our large institutional experience. The UHN WSIB Neurotology database (n = 4291) between 1998 and 2018 was retrospectively studied for those head-injured workers presenting with non-positional peripheral vestibular disorders. All subjects had a detailed neurotological history and examination and vestibular testing including video nystagmography, video head impulse testing (or a magnetic scleral search coil study), vestibular-evoked myogenic potentials, and audiometry. Imaging studies included routine brain and high-resolution temporal bone CT scans and/or brain MRI. Based on a database of 4291 head-injured workers with dizziness, 244 were diagnosed with non-positional peripheral vertigo. Recurrent vestibulopathy (RV) was the most common cause of non-positional post-traumatic vertigo. The incidence of Meniere's disease in the post-traumatic setting did not appear greater than found in the general population. The clinical spectrum pertaining to recurrent vestibulopathy, Meniere's disease, delayed endolymphatic hydrops, drop attacks, superior semicircular canal dehiscence syndrome, and uncompensated peripheral vestibular loss are discussed.
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Affiliation(s)
- Priyanka Misale
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 8N-873, Toronto, ON, M5G 2C4, Canada
| | - Fatemeh Hassannia
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 8N-873, Toronto, ON, M5G 2C4, Canada.
| | - Sasan Dabiri
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 8N-873, Toronto, ON, M5G 2C4, Canada
| | - Tom Brandstaetter
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 8N-873, Toronto, ON, M5G 2C4, Canada
| | - John Rutka
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 8N-873, Toronto, ON, M5G 2C4, Canada
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Homayounpour M, Gomez NG, Ingram AC, Coats B, Merryweather AS. Cervical Muscle Activation Characteristics and Head Kinematics in Males and Females Following Acoustic Warnings and Impulsive Head Forces. Ann Biomed Eng 2021; 49:3438-3451. [PMID: 34853920 DOI: 10.1007/s10439-021-02890-0] [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: 05/10/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022]
Abstract
Sex, head and neck posture, and cervical muscle preparation are contributing factors in the severity of head and neck injuries. However, it is unknown how these factors modulate the head kinematics. In this study, twenty-four (16 male and 8 female) participants experienced 50 impulsive forces to their heads with and without an acoustic warning. Female participants demonstrated a 71 ms faster (p = 0.002) muscle activation onset compared to males after warning. The magnitude of muscle activation was not significant between sexes. Females exhibited 21% (p < 0.008) greater peak angular velocity in all force directions and 18% (p < 0.04) greater peak angular acceleration in sagittal plane compared to males. Females exhibited 15% (p = 0.03) greater peak linear acceleration compared to males only in sagittal flexion. Preparation attenuated head kinematics significantly (p < 0.03) in 11 out of 18 investigated head kinematics for both sexes. A warning eliciting a startle response 420 ms prior to the impact resulted in significant attenuation of all measured head kinematics in sagittal extension (p < 0.037). In conclusion, both sex and warning type were significant factors in head kinematics. These data provide insight into the complex relationship of muscle activation and sex, and may help identify innovative strategies to reduce head and neck injury risk in sports.
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Affiliation(s)
| | - Nicholas G Gomez
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Alexandra C Ingram
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Brittany Coats
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
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Abstract
Combat sports pose a risk for accumulative injuries to the nervous system, yet fighters have remained an understudied population. Here, our purpose was to determine whether repetitive blows to the head have an effect on vestibular balance reflexes in combat sports athletes. We compared lower-limb muscle responses evoked with electrical vestibular stimuluation (EVS) between fighters (boxing/muay thai) and non-fighter controls. Each participant received stochastic vestibular stimulation (0-25 Hz, ±3 mA) over their mastoid processes while they stood relaxed with their head to the left or right. Surface electromyography was recorded from the medial gastrocnemius and soleus muscles bilaterally. Short and medium latency response (SLR/MLR) peaks were significantly delayed in the fighter group compared to controls. SLR and MLR peak amplitudes were also significantly lower in fighters. Fighter-estimated cumulative repetitive head impact (RHI) events demonstrated strong positive correlations with the timing of SLR and MLR peaks. Cumulative RHI events also negatively correlated with peak MLR amplitude and response gain at frequencies above 5 Hz. Our results provide evidence of a progressive vestibular impairment in combat sports athletes, potentially resulting from blows to the head accumulated in sparring practice and competitive bouts throughout their careers. Taken together, EVS-based vestibular assessments may provide a valuable clinical diagnostic tool and help better inform "return-to-play" and career-length decisions for not only combat sports athletes, but potentially other populations at risk of RHIs.
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Affiliation(s)
- Christopher J Banman
- Faculty of Kinesiology, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Faculty of Kinesiology, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Cumming School of Medicine, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Evidence Sport and Spinal Therapy, Calgary, Alberta, Canada
| | - Tyler Cluff
- Faculty of Kinesiology, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ryan M Peters
- Faculty of Kinesiology, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Neice RJ, Lurski AJ, Bartsch AJ, Plaisted TA, Lowry DS, Wetzel ED. An Experimental Platform Generating Simulated Blunt Impacts to the Head Due to Rearward Falls. Ann Biomed Eng 2021; 49:2886-2900. [PMID: 34184145 DOI: 10.1007/s10439-021-02809-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
Impacts to the back of the head due to rearward falls, also referred to as "backfall" events, represent a common source of TBI for athletes and soldiers. A new experimental apparatus is described for replicating the linear and rotational kinematics of the head during backfall events. An anthropomorphic test device (ATD) with a head-borne sensor suite was configured to fall backwards from a standing height, inducing contact between the rear of the head and a ground surface simulant. A pivoting swing arm and release strap were used to generate consistent and realistic head kinematics. Backfall experiments were performed with the ATD fitted with an American football helmet and the resulting linear and rotational head kinematics, as well as calculated injury metrics, compared favorably with those of football players undergoing similar impacts during games or play reconstructions. This test method complements existing blunt impact helmet performance experiments, such as drop tower and pneumatic ram test methods, which may not be able to fully reproduce head-neck-torso kinematics during a backfall event.
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Affiliation(s)
- R J Neice
- Materials and Manufacturing Sciences Division, U.S. Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, 21005, USA
| | - A J Lurski
- Materials and Manufacturing Sciences Division, U.S. Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, 21005, USA
| | | | - T A Plaisted
- Materials and Manufacturing Sciences Division, U.S. Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, 21005, USA
| | - D S Lowry
- CCDC Data and Analysis Center, Aberdeen Proving Ground, Aberdeen, MD, 21005, USA
| | - E D Wetzel
- Materials and Manufacturing Sciences Division, U.S. Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, 21005, USA.
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Saulacic N, Fujioka-Kobayashi M, Kimura Y, Bracher AI, Zihlmann C, Lang NP. The effect of synthetic bone graft substitutes on bone formation in rabbit calvarial defects. J Mater Sci Mater Med 2021; 32:14. [PMID: 33475862 PMCID: PMC7819904 DOI: 10.1007/s10856-020-06483-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/18/2020] [Indexed: 05/05/2023]
Abstract
The aim of this study was to evaluate the influence of the intensity of the biomimetic hydroxyapatite (HA) coating of α-tricalcium phosphate (α-TCP) on biomaterial degradation and bone formation. Twenty-four female NZW rabbits of approximately 12 weeks of age were used. Critical size defects were randomly treated with 3%:97% HA:α-TCP (BBCP1), 12%:88% HA:α-TCP (BBCP2), and 23%:77% HA:α-TCP (BBCP3), respectively or sham. All defects were covered with a resorbable collagen membrane. Animals were euthanized after 3 and 12 weeks of healing and samples were investigated by micro-CT and histologic analysis. Ingrowth of newly formed woven bone from the original bone at 3-week healing period was observed in all samples. At the 12-week healing period, the new bone in the peripheral area was mainly lamellar and in the central region composed of both woven and lamellar bone. New bony tissue was found on the surface of all three types of granules and at the interior of the BBCP1 granules. Samples with 3% HA showed significantly less residual biomaterial in comparison to the other two groups. Furthermore, BBCP1 significantly promoted new bone area as compared to other three groups and more bone volume as compared to the control. Within its limitations, this study indicated the highest degradation rate in case of BBCP1 concomitant with the highest rate of bone formation. Hence, formation of new bone can be affected by the level of biomimetic HA coating of α-TCP.
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Affiliation(s)
- Nikola Saulacic
- Department of Cranio-Maxillofacial Surgery, Faculty of Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Masako Fujioka-Kobayashi
- Department of Cranio-Maxillofacial Surgery, Faculty of Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasushi Kimura
- Department of Cranio-Maxillofacial Surgery, Faculty of Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Oral and Maxillofacial Surgery, National Defense Medical College Hospital, Saitama, Japan
| | - Ava Insa Bracher
- Department of Cranio-Maxillofacial Surgery, Faculty of Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Niklaus P Lang
- Department of Cranio-Maxillofacial Surgery, Faculty of Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Goyal N, Kumar P. Putting 'CSF-Shift Edema' Hypothesis to Test: Comparing Cisternal and Parenchymal Pressures After Basal Cisternostomy for Head Injury. World Neurosurg 2021; 148:e252-e263. [PMID: 33412318 DOI: 10.1016/j.wneu.2020.12.133] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Increased brain edema in head injury is due to shift of cerebrospinal fluid (CSF) from cisterns at high pressure to brain parenchyma at low pressure. By opening basal cisterns and decreasing the increased cisternal pressure, basal cisternostomy (BC) results in reversal of CSF shift from parenchyma to cisterns, leading to decreased brain edema. Though the CSF-shift edema hypothesis is based on pressure difference between cisterns and brain parenchyma, the relationship of these pressures has not been studied. METHODS A prospective clinical study was conducted from November 2018 to March 2020 including adult patients with head injury who were candidates for standard decompressive hemicraniectomy (DHC). All patients had neurological assessment and head computed tomography preoperatively and postoperatively. All patients underwent BC with DHC. Postoperatively, parenchymal and cisternal pressures and neurological condition were monitored hourly for 72 hours. RESULTS Nine (5 men, 4 women) patients with head injury (mean age, 45.7 years; range, 25-72 years) underwent DHC-BC. Median Glasgow Coma Scale score of patients at admission was 8 (range, 4-14), and median midline shift on computed tomography was 8 mm (range, 7-12 mm). There was a significant difference between opening (25.70 ± 10.48 mm Hg) and closing (11.30 ± 5.95 mm Hg) parenchymal pressures (t9 = 3.963, P = 0.003). Immediate postoperative cisternal pressure was 1-11 mm Hg and was lower than immediate postoperative parenchymal pressure in all except 1 patient. Postoperatively, if cisternal pressure remained low, parenchymal pressure also decreased, and patients showed clinical improvement. Patients showing increased cisternal pressure showed increased parenchymal pressure and clinical worsening. CONCLUSIONS Our study supports the CSF-shift edema hypothesis. Following DHC-BC, cisternal pressure is lowered to near-atmospheric pressure, and its relationship to parenchymal pressure predicts the future course of patients by reversal or re-reversal of CSF shift.
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Affiliation(s)
- Nishant Goyal
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India.
| | - Punit Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India
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Jakob DA, Benjamin ER, Cho J, Demetriades D. Combined head and abdominal blunt trauma in the hemodynamically unstable patient: What takes priority? J Trauma Acute Care Surg 2021; 90:170-176. [PMID: 33048908 DOI: 10.1097/ta.0000000000002970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The management of hypotensive patients with severe combined head and abdominal trauma is challenging, regarding the need, timing, and sequence of craniotomy or laparotomy. The purpose of the present study was to determine whether rare situations requiring craniotomy prior to laparotomy can be identified on admission with simple clinical parameters. We hypothesized that hypotension is rarely associated with the need of a combined procedure, especially in patients with mildly depressed consciousness. METHODS National Trauma Data Bank study, including adult blunt trauma patients with combined severe head (Abbreviated Injury Scale score, ≥ 3) and abdominal injury (Abbreviated Injury Scale score, ≥ 3). Data collection included demographic and clinical characteristics, laparotomy, and craniotomy within 24 hours of admission, types of intracranial pathologies, survival, and hospital stay. Multivariate regression analysis was used to determine factors predictive for the need of both operative procedures. RESULTS Of 25,585 patients with severe combined head and abdominal trauma, 8,744 (34.2%) needed only laparotomy, 534 (2.1%) only craniotomy, and 394 (1.5%) required both procedures within 24 hours of admission. In the subgroup of 4,667 hypotensive patients, 2,421 (51.9%) underwent only laparotomy, 54 (1.2%) only craniotomy, and 79 (1.7%) both procedures within 24 hours of admission. Only 5 (0.7%) of 711 hypotensive patients with Glasgow Coma Scale (GCS) score above 8 who required a laparotomy also needed a craniotomy. Among clinical parameters available on patient's arrival, GCS score of 7 to 8 was independently associated with the highest need for craniotomy in hypotensive patients requiring laparotomy (odds ratio, 7.94; p = 0.004). CONCLUSION The need for craniotomy in patients with severe combined head and abdominal injury requiring exploratory laparotomy is very low. In hypotensive patients requiring laparotomy, GCS score of 7 to 8 was an independent predictor of the need for craniotomy. In hemodynamically unstable patients with a GCS score greater than 8, it may be safer to proceed with a laparotomy first and address the head with a computed tomography scan at a later stage. LEVEL OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Dominik A Jakob
- From the Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County + University of Southern California Medical Center, University of Southern California, Los Angeles, California
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Gabler LF, Huddleston SH, Dau NZ, Lessley DJ, Arbogast KB, Thompson X, Resch JE, Crandall JR. On-Field Performance of an Instrumented Mouthguard for Detecting Head Impacts in American Football. Ann Biomed Eng 2020; 48:2599-2612. [PMID: 33078368 DOI: 10.1007/s10439-020-02654-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/08/2020] [Indexed: 11/26/2022]
Abstract
Wearable sensors that accurately record head impacts experienced by athletes during play can enable a wide range of potential applications including equipment improvements, player education, and rule changes. One challenge for wearable systems is their ability to discriminate head impacts from recorded spurious signals. This study describes the development and evaluation of a head impact detection system consisting of a mouthguard sensor and machine learning model for distinguishing head impacts from spurious events in football games. Twenty-one collegiate football athletes participating in 11 games during the 2018 and 2019 seasons wore a custom-fit mouthguard instrumented with linear and angular accelerometers to collect kinematic data. Video was reviewed to classify sensor events, collected from instrumented players that sustained head impacts, as head impacts or spurious events. Data from 2018 games were used to train the ML model to classify head impacts using kinematic data features (127 head impacts; 305 non-head impacts). Performance of the mouthguard sensor and ML model were evaluated using an independent test dataset of 3 games from 2019 (58 head impacts; 74 non-head impacts). Based on the test dataset results, the mouthguard sensor alone detected 81.6% of video-confirmed head impacts while the ML classifier provided 98.3% precision and 100% recall, resulting in an overall head impact detection system that achieved 98.3% precision and 81.6% recall.
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Affiliation(s)
- Lee F Gabler
- Biomechanics Consulting and Research, LLC, 1627 Quail Run Drive, Charlottesville, VA, 22911, USA.
| | - Samuel H Huddleston
- Biomechanics Consulting and Research, LLC, 1627 Quail Run Drive, Charlottesville, VA, 22911, USA
| | - Nathan Z Dau
- Biomechanics Consulting and Research, LLC, 1627 Quail Run Drive, Charlottesville, VA, 22911, USA
| | - David J Lessley
- Biomechanics Consulting and Research, LLC, 1627 Quail Run Drive, Charlottesville, VA, 22911, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, 19146, USA
| | - Xavier Thompson
- Department of Kinesiology, University of Virginia, Charlottesville, VA, 22904, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, VA, 22904, USA
| | - Jeff R Crandall
- Biomechanics Consulting and Research, LLC, 1627 Quail Run Drive, Charlottesville, VA, 22911, USA
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Deutsch SA. Understanding Abusive Head Trauma: A Primer for the General Pediatrician. Pediatr Ann 2020; 49:e347-e353. [PMID: 32785719 DOI: 10.3928/19382359-20200720-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abusive head trauma (AHT) refers to a well-recognized constellation of injuries caused by the direct application of force to an infant or young child, resulting in trauma to the head, intracranial contents, and/or neck, with potentially devastating health outcomes. Mechanisms of AHT include impulsive injurious acts, such as violent shaking and impact, often due to caregiver frustration or exhaustion. Subdural and retinal hemorrhage, and associated extracranial injury (fractures, abdominal trauma), are common. Suspected victims require laboratory/diagnostic testing and occult injury screening, as well as protective measures by investigative authorities to ensure safety. Medicolegal controversies persist around AHT diagnosis, including alternative hypotheses proffered in court by skeptics despite advances in scientific understanding, biomechanical research, neuroimaging techniques, and perpetrator confessions. Pediatricians play a key role in prevention and reduction of AHT morbidity and mortality through anticipatory guidance and caregiver education about the risks of shaking, normal infant development and behavior, and encouragement of stress reduction strategies. [Pediatr Ann. 2020;49(8):e347-e353.].
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Caccese JB, DeWolf RM, Kaminski TW, Broglio SP, McAllister TW, McCrea M, Buckley TA. Estimated Age of First Exposure to American Football and Neurocognitive Performance Amongst NCAA Male Student-Athletes: A Cohort Study. Sports Med 2020; 49:477-487. [PMID: 30747378 DOI: 10.1007/s40279-019-01069-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Repetitive head impacts in young athletes are potentially detrimental to later life (e.g., age 50 + years) neurological function; however, it is unknown what the short-term effects (e.g., age 20 years) are in collegiate student-athletes. OBJECTIVE The purpose of this study was to determine the effect of the estimated age of first exposure to American tackle football participation on neurocognitive performance and symptom severity scores in collegiate student-athletes. METHODS We used a cohort study in which neurocognitive performance was assessed using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test in 4376 male athletes (age 19.3 ± 1.5 years, mass 96.3 ± 20.3 kg, height 185.0 ± 7.4 cm). Athletes were grouped by sport participation [American football (n = 3462) or non-contact (n = 914)] and estimated age of first exposure [< 12 years (n = 3022) or ≥ 12 years (n = 1354)]. The outcome measures were the four primary cognitive scores and the symptom severity score from ImPACT. We assessed primary outcomes across groups, controlling for age, learning accommodations, and concussion history. RESULTS Neurocognitive performance was not associated with the estimated age of first exposure-by-group interaction. CONCLUSION Our findings indicate that participation in American tackle football before age 12 years does not result in neurocognitive deficits in college. Therefore, we suggest the following: the consequences of early exposure to repetitive head impacts do not manifest by college, the ImPACT test was not sensitive enough to identify the effects of an earlier estimated age of first exposure, or there is no association between an earlier estimated age of first exposure and neurocognitive functioning. Future longitudinal studies are warranted.
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Affiliation(s)
- Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology, University of Delaware, 349 Tower at STAR, 100 Discovery Blvd, Newark, DE, 19713, USA
| | - Ryan M DeWolf
- Massachusetts General Hospital, Institute of Health Professions, Boston, MA, USA
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, 349 Tower at STAR, 100 Discovery Blvd, Newark, DE, 19713, USA
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA
| | - Steven P Broglio
- NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan, Ann Arbor, MI, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, 349 Tower at STAR, 100 Discovery Blvd, Newark, DE, 19713, USA.
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA.
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Wright AD, Smirl JD, Bryk K, Jakovac M, van Donkelaar P. A Prospective Transcranial Doppler Ultrasound-Based Evaluation of the Effects of Repetitive Subconcussive Head Trauma on Neurovascular Coupling Dynamics. Clin J Sport Med 2020; 30 Suppl 1:S53-S60. [PMID: 32132478 DOI: 10.1097/jsm.0000000000000578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effects of repetitive subconcussive head trauma on neurovascular coupling (NVC) responses. DESIGN Prospective cohort study collected between September 2013 and December 2016. SETTING University laboratory. PARTICIPANTS One hundred seventy-nine elite, junior-level (age, 19.6 ± 1.5 years) contact sport (ice hockey, American football) athletes recruited for preseason testing. Fifty-two nonconcussed athletes returned for postseason testing. Fifteen noncontact sport athletes (age, 20.4 ± 2.2 years) also completed preseason and postseason testing. EXPOSURE(S) Subconcussive sport-related head trauma. MAIN OUTCOME MEASURES Dynamics of NVC were estimated during cycles of 20 seconds eyes closed and 40 seconds eyes open to a visual stimulus (reading) by measuring cerebral blood flow (CBF) velocity in the posterior (PCA) and middle (MCA) cerebral arteries via transcranial Doppler ultrasound. RESULTS Both athlete groups demonstrated no significant differences in PCA or MCA NVC dynamics between preseason and postseason, despite exposure to a median of 353.5 (range, 295.0-587.3) head impacts (>2g) over the course of the season for contact sport athletes. CONCLUSIONS Within the context of growing concern over detrimental effects of repetitive subconcussive trauma, the current results encouragingly suggest that the dynamics of NVC responses are not affected by 1 season of participation in junior-level ice hockey or American football. This is an important finding because it indicates an appropriate postseason CBF response to elevated metabolic demand with increases in neural activity.
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Affiliation(s)
- Alexander D Wright
- MD/PhD Program, University of British Columbia, Vancouver, BC, Canada
- Southern Medical Program, Reichwald Health Sciences Centre, University of British Columbia Okanagan, Kelowna, BC, Canada
- Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; and
| | - Jonathan D Smirl
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; and
| | - Kelsey Bryk
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; and
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Michael Jakovac
- Southern Medical Program, Reichwald Health Sciences Centre, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; and
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13
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Jones DA, Gaewsky JP, Somers JT, Gayzik FS, Weaver AA, Stitzel JD. Head injury metric response in finite element ATDs and a human body model in multidirectional loading regimes. Traffic Inj Prev 2020; 20:S96-S102. [PMID: 31951749 DOI: 10.1080/15389588.2019.1707193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 12/05/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Abstract
Objective: The objective was to quantify head injury metric sensitivity of the 50th percentile male Hybrid III, THOR, and Global Human Body Models Consortium simplified occupant (GHBMC M50-OS) to changes in loading conditions in loading regimes that may be experienced by occupants of spaceflight vehicles or highly autonomous vehicles (HAVs) with nontraditional seating configurations.Methods: A Latin hypercube (LHD) design of experiments (DOE) was employed to develop boundary conditions for 455 unique acceleration profiles. Three previously validated finite element (FE) models of the Hybrid III anthropomorphic test device (ATD), THOR ATD, and GHBMC M50-OS were positioned in an upright 90°-90°-90° seat and with a 5-point belt. Acceleration pulses were applied to each of the three occupants in the ± X, +Y, and ± Z directions, with peak resultant acceleration magnitudes ranging from 5 to 20 G and times to peak ranging from 32.5 to 120.8 ms with duration 250 ms, resulting in 1,248 simulations. Head injury metrics included peak linear head acceleration, peak rotational head acceleration, head injury criteria (HIC15), and brain injury criteria (BrIC). Injury metrics were regressed against boundary condition parameters using 2nd order multiple polynomial regression, and compared between occupants using matched pairs Wilcoxon signed rank analysis.Results: Across the 416 matched-simulations that reached normal termination with all three models, HIC15 values ranged from 1.0-396.5 (Hybrid III), 1.2-327.9 (THOR), and 0.6-585.6 (GHBMC). BrIC ranged from 0.03-0.95 (Hybrid III), 0.03-1.21 (THOR), and 0.04-0.84 (GHBMC). Wilcoxon signed rank analysis demonstrated significant pairwise differences between each of the three occupant models for head injury metrics. For HIC15, the largest divergence between GHBMC and the ATDs was observed in simulations with components of combined underbody and rear impact loading. The three models performed most similarly with respect to BrIC output when loaded in a frontal direction. Both the GHBMC and the Hybrid III produced lower values of BrIC than the THOR on average, with the differences most pronounced in rear impact loading.Conclusion: In conclusion, observed differences between the occupant models' head injury metric output were quantified. Loading direction had a large effect on metric outcome and metric comparability across models, with frontal and rear impacts with low vertical acceleration tending to be the most similar. One explanation for these differences could be the differences in neck stiffness between the models that allowed more rotation in the GHBMC and THOR. Care should be taken when using ATDs as human volunteer surrogates in these low energy events.
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Affiliation(s)
- Derek A Jones
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Winston-Salem, North Carolina
| | - James P Gaewsky
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Winston-Salem, North Carolina
| | | | - F Scott Gayzik
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Winston-Salem, North Carolina
| | - Ashley A Weaver
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Winston-Salem, North Carolina
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Winston-Salem, North Carolina
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14
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Manor B, Zhou J, Lo O, Zhu H, Gouskova NA, Yu W, Zafonte R, Lipsitz LA, Travison TG, Pascual‐Leone A. Self-Reported Head Trauma Predicts Poor Dual Task Gait in Retired National Football League Players. Ann Neurol 2020; 87:75-83. [PMID: 31693765 PMCID: PMC6973030 DOI: 10.1002/ana.25638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/07/2019] [Accepted: 11/03/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Symptomatic head trauma associated with American-style football (ASF) has been linked to brain pathology, along with physical and mental distress in later life. However, the longer-term effects of such trauma on objective metrics of cognitive-motor function remain poorly understood. We hypothesized that ASF-related symptomatic head trauma would predict worse gait performance, particularly during dual task conditions (ie, walking while performing an additional cognitive task), in later life. METHODS Sixty-six retired professional ASF players aged 29 to 75 years completed a health and wellness questionnaire. They also completed a validated smartphone-based assessment in their own homes, during which gait was monitored while they walked normally and while they performed a verbalized serial-subtraction cognitive task. RESULTS Participants who reported more symptomatic head trauma, defined as the total number of impacts to the head or neck followed by concussion-related symptoms, exhibited greater dual task cost (ie, percentage increase) to stride time variability (ie, the coefficient of variation of mean stride time). Those who reported ≥1 hit followed by loss of consciousness, compared to those who did not, also exhibited greater dual task costs to this metric. Relationships between reported trauma and dual task costs were independent of age, body mass index, National Football League career duration, and history of musculoskeletal surgery. Symptomatic head trauma was not correlated with average stride times in either walking condition. INTERPRETATION Remote, smartphone-based assessments of dual task walking may be utilized to capture meaningful data sensitive to the long-term impact of symptomatic head trauma in former professional ASF players and other contact sport athletes. ANN NEUROL 2020;87:75-83.
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Affiliation(s)
- Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLifeBostonMA
- Division of Gerontology, Department of MedicineBeth Israel Deaconess Medical CenterBostonMA
- Harvard Medical SchoolBostonMA
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLifeBostonMA
- Division of Gerontology, Department of MedicineBeth Israel Deaconess Medical CenterBostonMA
- Harvard Medical SchoolBostonMA
| | - On‐Yee Lo
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLifeBostonMA
- Division of Gerontology, Department of MedicineBeth Israel Deaconess Medical CenterBostonMA
- Harvard Medical SchoolBostonMA
| | - Hao Zhu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLifeBostonMA
| | - Natalia A. Gouskova
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLifeBostonMA
- Division of Gerontology, Department of MedicineBeth Israel Deaconess Medical CenterBostonMA
- Harvard Medical SchoolBostonMA
| | - Wanting Yu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLifeBostonMA
| | - Ross Zafonte
- Harvard Medical SchoolBostonMA
- Spaulding Rehabilitation Hospital, Massachusetts General Hospital, and Department of Physical Medicine and RehabilitationBrigham and Women's HospitalBostonMA
| | - Lewis A. Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLifeBostonMA
- Division of Gerontology, Department of MedicineBeth Israel Deaconess Medical CenterBostonMA
- Harvard Medical SchoolBostonMA
| | - Thomas G. Travison
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLifeBostonMA
- Division of Gerontology, Department of MedicineBeth Israel Deaconess Medical CenterBostonMA
- Harvard Medical SchoolBostonMA
| | - Alvaro Pascual‐Leone
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLifeBostonMA
- Harvard Medical SchoolBostonMA
- Guttmann Neurorehabilitation InstituteAutonomous University of BarcelonaBadalonaSpain
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15
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Bustamante MC, Cronin DS. Cavitation threshold evaluation of porcine cerebrospinal fluid using a Polymeric Split Hopkinson Pressure Bar-Confinement chamber apparatus. J Mech Behav Biomed Mater 2019; 100:103400. [PMID: 31476553 DOI: 10.1016/j.jmbbm.2019.103400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/14/2019] [Accepted: 08/17/2019] [Indexed: 01/16/2023]
Abstract
Studies investigating mild Traumatic Brain Injury (mTBI) in the military population using experimental head surrogates and Finite Element (FE) head models have demonstrated the existence of transient negative pressures occurring within the head at the contrecoup location to the blast wave impingement. It has been hypothesized that this negative pressure may cause cavitation of cerebrospinal fluid (CSF) and possibly lead to brain tissue damage from cavitation bubble collapse. The cavitation pressure threshold of human CSF is presently unknown, although existing FE studies in the literature have assumed a value of -100 kPa. In the present study, the cavitation threshold of degassed porcine CSF at body temperature (37 °C) was measured using a unique modified Polymeric Split Hopkinson Pressure Bar apparatus, and compared to thresholds of distilled water at various conditions. The loading pulse generated in the apparatus was comparable to experimentally measured pressures resulting from blast exposure, and those predicted by an FE model. The occurrence of cavitation was identified using high-speed imaging and the corresponding pressures were determined using a computational model of the apparatus that was previously developed and validated. The probability of cavitation was calculated (ISO/TS, 18506) from forty-one experimental tests on porcine CSF, representing an upper bound for in vivo CSF. The 50% probability of cavitation for CSF (-0.467 MPa ± 7%) was lower than that of distilled water (-1.37 MPa ± 16%) under the same conditions. The lesser threshold of CSF could be related to the constituents such as blood cells and proteins. The results of this study can be used to inform FE head models subjected to blast exposure and improve prediction of the potential for CSF cavitation and response of brain tissue.
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Affiliation(s)
- M C Bustamante
- Department of Mechanical Engineering, University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada.
| | - D S Cronin
- Department of Mechanical Engineering, University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada.
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16
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Gubari MIM, Norouzy A, Hosseini M, Mohialdeen FA, Hosseinzadeh-Attar MJ. The Relationship between Serum Concentrations of Pro- and Anti-Inflammatory Cytokines and Nutritional Status in Patients with Traumatic Head Injury in the Intensive Care Unit. Medicina (Kaunas) 2019; 55:E486. [PMID: 31443251 PMCID: PMC6723863 DOI: 10.3390/medicina55080486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 01/04/2023]
Abstract
Background and objective: The aim of the present study was to examine the relationship between serum levels of pro-inflammatory cytokines (IL-6, IL-1β, and TNF-α) and anti-inflammatory cytokines (IL-10) measured once at the baseline with changes in nutritional status of patients with traumatic head injury (THI) assessed at three consecutive times (24 h after admission, day 6 and day 13) during hospital stay in the intensive care unit (ICU). Materials and Methods: Sixty-four patients with THI were recruited for the current study (over 10 months). The nutritional status of the patients was determined within 24 h after admission and on days 6 and 13, using actual body weight, body composition analysis, and anthropometric measurements. The APACHE II score and SOFA score were also assessed within 24 h of admission and on days 6 and 13 of patients staying in the ICU. Circulatory serum levels of cytokines (IL-6, IL-1β, TNF-α, and IL-10) were assessed once within 24 h of admission. Results: The current study found a significant reduction in BMI, FBM, LBM, MAUAC, and APM, of THI patients with high serum levels the cytokines, over the course of time from the baseline to day 7 and to day 13 in patients staying in the ICU (p < 0.001). It was also found that patients with low levels of some studied cytokines had significant improvement in their nutritional status and clinical outcomes in term of MAUAC, APM, APACHE II score and SOFA score (p < 0.001 to p < 0.01). Conclusion: THI patients who had high serum levels of studied cytokines were more prone to develop a reduction of nutritional status in terms of BMI, FBM, LBM MAUAC and APM over the course of time from patient admission until day 13 of ICU admission.
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Affiliation(s)
- Mohammed I M Gubari
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran 1416643931, Iran
| | - Abdolreza Norouzy
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran 1416643931, Iran
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran 1417613151, Iran
| | - Fadhil A Mohialdeen
- Community Health Department, Technical College of health, Sulaimani Polytechnic University, Sulaimani 46001, Iraq
| | - Mohammad Javad Hosseinzadeh-Attar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran 1416643931, Iran.
- Centre of Research Excellence in Translating, Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5005, Australia.
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17
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Tsushima WT, Ahn HJ, Siu AM, Yoshinaga K, Choi SY, Murata NM. Effects of repetitive subconcussive head trauma on the neuropsychological test performance of high school athletes: A comparison of high, moderate, and low contact sports. Appl Neuropsychol Child 2019; 8:223-230. [PMID: 29393677 DOI: 10.1080/21622965.2018.1427095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to examine the neuropsychological test results of non-concussed high school athletes playing at three different levels of contact sports. Based on the concussion risk data of 12 different sports, a High Contact group (n=2819; wrestling/martial arts, cheerleading, track and field, football), a Moderate Contact group (n=2323; softball, basketball, soccer), and a Low Contact group (n=1580; baseball, volleyball, water polo, tennis, cross-country) were formed and compared in terms of their scores on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The results revealed that the High Contact group obtained small but statistically poorer performances in ImPACT Visual Memory, Visual Motor Speed, Impulse Control, and Total Symptom scores compared to the Moderate and Low Contact groups. The High Contact group also had poorer Reaction Time scores compared to the Low Contact group. No differences between the Moderate and Low Contact groups were noted. The findings, along with prior similar results, tentatively raise concerns that participant in high contact sports, exposed to repetitive subconcussive head trauma, may be at greater risk for lowered neuropsychological functioning and increased symptoms, compared to other high school athletes. In view of the preliminary nature of this investigation, more research into the effects of frequent head impacts in high school sports is strongly recommended.
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Affiliation(s)
- William T Tsushima
- a Psychiatry and Psychology Department , Straub Medical Center , Honolulu , Hawaii , USA
| | - Hyeong Jun Ahn
- b Office of Biostatistics & Quantitative Health Sciences, John A. Burns School of Medicine , University of Hawaii , Honolulu , Hawaii , USA
| | - Andrea M Siu
- c Hawaii Pacific Health, Research Institute , Honolulu , Hawaii , USA
| | - Kara Yoshinaga
- d Department of Psychology , University of Hawaii at Manoa , Honolulu , Hawaii , USA
| | - So Yung Choi
- e Department of Complementary and Integrative Medicine, John A. Burns School of Medicine , University of Hawaii , Honolulu , Hawaii , USA
| | - Nathan M Murata
- f Department of Kinesiology and Rehabilitation Science , University of Hawaii at Manoa , Honolulu , Hawaii , USA
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18
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Aukema A, van Meer OA, Locher H. [Dyspnea and globus sensation after a minor head injury]. Ned Tijdschr Geneeskd 2019; 163:D2923. [PMID: 30730684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 91-year-old woman visited the emergency department with dyspnea and globus sensation after a minor head injury. A CT-scan of the spine showed a retropharyngeal swelling. MRI and fiberscopy revealed that the swelling was concordant with a retropharyngeal hematoma. The patient was admitted for observation and she was discharged in good clinical condition the day after.
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Affiliation(s)
- Allard Aukema
- LUMC, afd. Spoedeisende Hulp, Leiden
- Contact: A. Aukema
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19
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Li Z, Ji C, Wang L. Development of a child head analytical dynamic model considering cranial nonuniform thickness and curvature - Applying to children aged 0-1 years old. Comput Methods Programs Biomed 2018; 161:181-189. [PMID: 29852960 DOI: 10.1016/j.cmpb.2018.04.022] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/10/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Although analytical models have been used to quickly predict head response under impact condition, the existing models generally took the head as regular shell with uniform thickness which cannot account for the actual head geometry with varied cranial thickness and curvature at different locations. The objective of this study is to develop and validate an analytical model incorporating actual cranial thickness and curvature for child aged 0-1YO and investigate their effects on child head dynamic responses at different head locations. METHODS To develop the new analytical model, the child head was simplified into an irregular fluid-filled shell with non-uniform thickness and the cranial thickness and curvature at different locations were automatically obtained from CT scans using a procedure developed in this study. The implicit equation of maximum impact force was derived as a function of elastic modulus, thickness and radius of curvature of cranium. RESULTS The proposed analytical model are compared with cadaver test data of children aged 0-1 years old and it is shown to be accurate in predicting head injury metrics. According to this model, obvious difference in injury metrics were observed among subjects with the same age, but different cranial thickness and curvature; and the injury metrics at forehead location are significant higher than those at other locations due to large thickness it owns. CONCLUSIONS The proposed model shows good biofidelity and can be used in quickly predicting the dynamics response at any location of head for child younger than 1 YO.
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Affiliation(s)
- Zhigang Li
- School of Mechanical, Electronic and Control Engineering, Beijing Jiaotong University, Beijing 100044, PR China.
| | - Cheng Ji
- School of Mechanical, Electronic and Control Engineering, Beijing Jiaotong University, Beijing 100044, PR China.
| | - Lishu Wang
- Hebei University of Engineering, Handan 056021, PR China.
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20
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Kuo C, Wu L, Loza J, Senif D, Anderson SC, Camarillo DB. Comparison of video-based and sensor-based head impact exposure. PLoS One 2018; 13:e0199238. [PMID: 29920559 PMCID: PMC6007917 DOI: 10.1371/journal.pone.0199238] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 06/04/2018] [Indexed: 11/18/2022] Open
Abstract
Previous research has sought to quantify head impact exposure using wearable kinematic sensors. However, many sensors suffer from poor accuracy in estimating impact kinematics and count, motivating the need for additional independent impact exposure quantification for comparison. Here, we equipped seven collegiate American football players with instrumented mouthguards, and video recorded practices and games to compare video-based and sensor-based exposure rates and impact location distributions. Over 50 player-hours, we identified 271 helmet contact periods in video, while the instrumented mouthguard sensor recorded 2,032 discrete head impacts. Matching video and mouthguard real-time stamps yielded 193 video-identified helmet contact periods and 217 sensor-recorded impacts. To compare impact locations, we binned matched impacts into frontal, rear, side, oblique, and top locations based on video observations and sensor kinematics. While both video-based and sensor-based methods found similar location distributions, our best method utilizing integrated linear and angular position only correctly predicted 81 of 217 impacts. Finally, based on the activity timeline from video assessment, we also developed a new exposure metric unique to American football quantifying number of cross-verified sensor impacts per player-play. We found significantly higher exposure during games (0.35, 95% CI: 0.29-0.42) than practices (0.20, 95% CI: 0.17-0.23) (p<0.05). In the traditional impacts per player-hour metric, we observed higher exposure during practices (4.7) than games (3.7) due to increased player activity in practices. Thus, our exposure metric accounts for variability in on-field participation. While both video-based and sensor-based exposure datasets have limitations, they can complement one another to provide more confidence in exposure statistics.
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Affiliation(s)
- Calvin Kuo
- Department of Mechanical Engineering, Stanford University, Stanford CA, United States of America
| | - Lyndia Wu
- Department of Bioengineering, Stanford University, Stanford CA, United States of America
| | - Jesus Loza
- Department of Mechanical Engineering, Stanford University, Stanford CA, United States of America
| | - Daniel Senif
- Stanford Sports Medicine, Stanford University, Stanford CA, United States of America
| | - Scott C. Anderson
- Stanford Sports Medicine, Stanford University, Stanford CA, United States of America
| | - David B. Camarillo
- Department of Mechanical Engineering, Stanford University, Stanford CA, United States of America
- Department of Bioengineering, Stanford University, Stanford CA, United States of America
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21
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Gaetke-Udager K, London ZN, Woolen S, Parmar H, Bailey JE, Barr DC. An Introductory, Computer-Based Learning Module for Interpreting Noncontrast Head Computed Tomography. MedEdPORTAL 2018; 14:10721. [PMID: 30800921 PMCID: PMC6342421 DOI: 10.15766/mep_2374-8265.10721] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/08/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION New radiology and other residents must quickly assimilate a vast amount of anatomic and pathologic information when learning to interpret noncontrast head computed tomography (CT). No interactive, computer-based module using a search-pattern approach to provide new residents with the groundwork for interpretation of noncontrast head CT previously existed. METHODS We developed such a learning module using PowerPoint. First-year radiology residents completed the module prior to their neuroradiology rotation, and neurology residents completed it during orientation. Residents took 20-question pre- and posttests to assess knowledge and a postmodule survey. Each resident was randomized to one of two pretests and took the opposite as the posttest. Scores were collected over 5 years for radiology residents and 4 years for neurology residents. Statistical analysis of scores was performed using t tests. RESULTS Forty-seven first-year radiology residents and 31 neurology residents completed the module and the pre- and posttests. Scores for all residents either stayed the same or increased, regardless of the order of the versions of the pre- or posttests; the mean score increase was 4 (p < .0001) out of 20. Radiology residents had higher mean scores than neurology residents on the pre- and posttests, which were statistically significant (p < .04 and .0004, respectively). Feedback on the survey was overwhelmingly positive. DISCUSSION This computerized learning module is effective for teaching basic interpretation skills to new radiology and neurology residents. The module allows for asynchronous, programmed learning and the use of a step-by-step search-pattern approach.
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Affiliation(s)
- Kara Gaetke-Udager
- Assistant Professor, Department of Radiology, University of Michigan Medical School
- Residency Program Director, Department of Radiology, University of Michigan Medical School
| | - Zachary N London
- Associate Professor, Department of Neurology, University of Michigan Medical School
- Residency Program Director, Department of Neurology, University of Michigan Medical School
| | - Sean Woolen
- Radiology Resident, Department of Radiology, University of Michigan Medical School
| | - Hemant Parmar
- Professor, Department of Radiology, University of Michigan Medical School
| | - Janet E. Bailey
- Professor, Department of Radiology, University of Michigan Medical School
- Associate Chair of Education, Department of Radiology, University of Michigan Medical School
| | - Daniel C. Barr
- Radiologist, Veterans Administration Medical Center, Salisbury, NC
- Assistant Chief of Imaging, Veterans Administration Medical Center, Salisbury, NC
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22
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Zhang HM, Liu P, Jiang C, Jin XQ, Liu RN, Li SQ, Zhao Y. Notch signaling inhibitor DAPT provides protection against acute craniocerebral injury. PLoS One 2018; 13:e0193037. [PMID: 29447233 PMCID: PMC5814062 DOI: 10.1371/journal.pone.0193037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 02/02/2018] [Indexed: 12/11/2022] Open
Abstract
Notch signaling pathway is involved in many physiological and pathological processes. The γ-secretase inhibitor DAPT inhibits Notch signaling pathway and promotes nerve regeneration after cerebral ischemia. However, neuroprotective effects of DAPT against acute craniocerebral injury remain unclear. In this study, we established rat model of acute craniocerebral injury, and found that with the increase of damage grade, the expression of Notch and downstream protein Hes1 and Hes5 expression gradually increased. After the administration of DAPT, the expression of Notch, Hes1 and Hes5 was inhibited, apoptosis and oxidative stress decreased, neurological function and cognitive function improved. These results suggest that Notch signaling can be used as an indicator to assess the severity of post-traumatic brain injury. Notch inhibitor DAPT can reduce oxidative stress and apoptosis after acute craniocerebral injury, and is a potential drug for the treatment of acute craniocerebral injury.
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MESH Headings
- Animals
- Apoptosis Regulatory Proteins/genetics
- Apoptosis Regulatory Proteins/metabolism
- Basic Helix-Loop-Helix Transcription Factors/antagonists & inhibitors
- Basic Helix-Loop-Helix Transcription Factors/genetics
- Basic Helix-Loop-Helix Transcription Factors/metabolism
- Brain Injuries, Traumatic/pathology
- Brain Injuries, Traumatic/physiopathology
- Brain Injuries, Traumatic/prevention & control
- Craniocerebral Trauma/pathology
- Craniocerebral Trauma/physiopathology
- Craniocerebral Trauma/prevention & control
- Diamines/pharmacology
- Disease Models, Animal
- Down-Regulation/drug effects
- Male
- Neuroprotective Agents/pharmacology
- Oxidative Stress/drug effects
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Rats
- Rats, Sprague-Dawley
- Receptors, Notch/antagonists & inhibitors
- Receptors, Notch/genetics
- Receptors, Notch/metabolism
- Repressor Proteins/antagonists & inhibitors
- Repressor Proteins/genetics
- Repressor Proteins/metabolism
- Signal Transduction/drug effects
- Thiazoles/pharmacology
- Transcription Factor HES-1/antagonists & inhibitors
- Transcription Factor HES-1/genetics
- Transcription Factor HES-1/metabolism
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Affiliation(s)
- Hong-Mei Zhang
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Pei Liu
- Department of Intensive Care Unit, Taihe Hospital, Hubei University of Medicine, Hubei, China
| | - Cheng Jiang
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiao-Qing Jin
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Rui-Ning Liu
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shun-Qing Li
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yan Zhao
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- * E-mail:
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Huang JF, Ou Yang CH, Fu CY, Wu YT. Deep coma does not always predict poor outcomes among patients with polytrauma. Eur J Trauma Emerg Surg 2018; 45:455-460. [PMID: 29427061 DOI: 10.1007/s00068-018-0917-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/31/2018] [Indexed: 11/26/2022]
Abstract
PURPOSES This study aimed to clarify the prognosis of polytrauma patients presenting to the emergency department (ED) with a Glasgow Coma Scale score (GCS) of 3. METHODS A trauma registry system has been established at our institution since 2009. The current study reviewed patients in the registry who presented to the ED with a GCS of 3 from January 2011 to December 2015. Surviving and non-surviving patients were compared to identify the prognostic factors of patient survival. The study also aimed to determine the factors contributing to patients who survived with a GCS > 13 at discharge. RESULTS During the study period, 145 patients were enrolled in the study, 119 of whom (82.1%) did not survive the traumatic insult. Of the 26 survivors, 13 (9.0%) had a GCS of 14 or 15 at discharge. The multiple logistic regression revealed that a lack of bilateral dilated and fixed pupils (BFDP) (OR 5.967, 95% CI 1.780-19.997, p = 0.004) and a GCS > 3 after resuscitation (OR 6.875, 95% CI 2.135-22.138, p = 0.001) were independent prognostic factors of survival. Based on the multiple logistic regression, an age under 40 years (OR 16.405, 95% CI 1.520-177.066, p = 0.021) and a GCS > 3 after resuscitation (OR 12.100, 95% CI 1.058-138.352, p = 0.045) were independent prognostic factors of a GCS > 13 at discharge. CONCLUSION Aggressive resuscitation still provided benefit to polytrauma patients presenting with a GCS of 3, especially those with a rapid response to the resuscitation. Young patients with a deep coma on arrival had a higher probability of functional recovery after resuscitation in the ED.
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Affiliation(s)
- Jen-Fu Huang
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, 5 Fu-Xing Street, Guishan District, Taoyuan City, Taiwan, Republic of China
| | - Chun-Hsiang Ou Yang
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, 5 Fu-Xing Street, Guishan District, Taoyuan City, Taiwan, Republic of China
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, 5 Fu-Xing Street, Guishan District, Taoyuan City, Taiwan, Republic of China.
| | - Yu-Tung Wu
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, 5 Fu-Xing Street, Guishan District, Taoyuan City, Taiwan, Republic of China
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24
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Meng Y, Bottenfield B, Bolding M, Liu L, Adams ML. Sensing Passive Eye Response to Impact Induced Head Acceleration Using MEMS IMUs. IEEE Trans Biomed Circuits Syst 2018; 12:182-191. [PMID: 29377806 DOI: 10.1109/tbcas.2017.2766565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The eye may act as a surrogate for the brain in response to head acceleration during an impact. Passive eye movements in a dynamic system are sensed by microelectromechanical systems (MEMS) inertial measurement units (IMU) in this paper. The technique is validated using a three-dimensional printed scaled human skull model and on human volunteers by performing drop-and-impact experiments with ribbon-style flexible printed circuit board IMUs inserted in the eyes and reference IMUs on the heads. Data are captured by a microcontroller unit and processed using data fusion. Displacements are thus estimated and match the measured parameters. Relative accelerations and displacements of the eye to the head are computed indicating the influence of the concussion causing impacts.
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25
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Gökharman FD, Aydın S, Fatihoğlu E, Koşar PN. Pediatric Emergency Care Applied Research Network head injuryprediction rules: on the basis of cost and effectiveness. Turk J Med Sci 2017; 47:1770-1777. [PMID: 29306237 DOI: 10.3906/sag-1703-206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background/aim: Head injuries are commonly seen in the pediatric population. Noncontrast enhanced cranial CT is the method of choice to detect possible traumatic brain injury (TBI). Concerns about ionizing radiation exposure make the evaluation more challenging. The aim of this study was to evaluate the effectiveness of the Pediatric Emergency Care Applied Research Network (PECARN) rules in predicting clinically important TBI and to determine the amount of medical resource waste and unnecessary radiation exposure.Materials and methods: This retrospective study included 1041 pediatric patients presented to the emergency department. The patients were divided into subgroups of "appropriate for cranial CT", "not appropriate for cranial CT" and "cranial CT/observation of patient; both are appropriate". To determine the effectiveness of the PECARN rules, data were analyzed according to the presence of pathological findings Results: "Appropriate for cranial CT" results can predict pathology presence 118,056-fold compared to the "not appropriate for cranial CT" results. With "cranial CT/observation of patient; both are appropriate" results, pathology presence was predicted 11,457-fold compared to "not appropriate for cranial CT" results.Conclusion: PECARN rules can predict pathology presence successfully in pediatric TBI. Using PECARN can decrease resource waste and exposure to ionizing radiation.
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26
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Tan LB, Tse KM, Tan YH, Sapingi MAB, Tan VBC, Lee HP. Face shield design against blast-induced head injuries. Int J Numer Method Biomed Eng 2017; 33. [PMID: 28329435 DOI: 10.1002/cnm.2884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 01/07/2017] [Accepted: 03/19/2017] [Indexed: 06/06/2023]
Abstract
Blast-induced traumatic brain injury has been on the rise in recent years because of the increasing use of improvised explosive devices in conflict zones. Our study investigates the response of a helmeted human head subjected to a blast of 1 atm peak overpressure, for cases with and without a standard polycarbonate (PC) face shield and for face shields comprising of composite PC and aerogel materials and with lateral edge extension. The novel introduction of aerogel into the laminate face shield is explored and its wave-structure interaction mechanics and performance in blast mitigation is analysed. Our numerical results show that the face shield prevented direct exposure of the blast wave to the face and help delays the transmission of the blast to reduce the intracranial pressures (ICPs) at the parietal lobe. However, the blast wave can diffract and enter the midface region at the bottom and side edges of the face shield, resulting in traumatic brain injury. This suggests that the bottom and sides of the face shield are important regions to focus on to reduce wave ingress. The laminated PC/aerogel/PC face shield yielded higher peak positive and negative ICPs at the frontal lobe, than the original PC one. For the occipital and temporal brain regions, the laminated face shield performed better than the original. The composite face shield with extended edges reduced ICP at the temporal lobe but increases ICP significantly at the parietal lobe, which suggests that a greater coverage may not lead to better mitigating effects.
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Affiliation(s)
- Long Bin Tan
- Department of Mechanical Engineering, National University of Singapore, 21 Lower Kent Ridge Rd, 119077, Singapore
| | - Kwong Ming Tse
- Department of Mechanical Engineering, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Yuan Hong Tan
- Department of Mechanical Engineering, National University of Singapore, 21 Lower Kent Ridge Rd, 119077, Singapore
| | - Mohamad Ali Bin Sapingi
- Department of Mechanical Engineering, National University of Singapore, 21 Lower Kent Ridge Rd, 119077, Singapore
| | - Vincent Beng Chye Tan
- Department of Mechanical Engineering, National University of Singapore, 21 Lower Kent Ridge Rd, 119077, Singapore
| | - Heow Pueh Lee
- Department of Mechanical Engineering, National University of Singapore, 21 Lower Kent Ridge Rd, 119077, Singapore
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27
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Abstract
OBJECTIVE This study evaluated the frequency, magnitude, and location of head impacts in practice drills within a youth football team to determine how head impact exposure varies among different types of drills. METHODS On-field head impact data were collected from athletes participating in a youth football team for a single season. Each athlete wore a helmet instrumented with a Head Impact Telemetry (HIT) System head acceleration measurement device during all preseason, regular season, and playoff practices. Video was recorded for all practices, and video analysis was performed to verify head impacts and assign each head impact to a specific drill. Eleven drills were identified: dummy/sled tackling, install, special teams, Oklahoma, one-on-one, open-field tackling, passing, position skill work, multiplayer tackle, scrimmage, and tackling drill stations. Generalized linear models were fitted to log-transformed data, and Wald tests were used to assess differences in head accelerations and impact rates. RESULTS A total of 2125 impacts were measured during 30 contact practices in 9 athletes (mean age 11.1 ± 0.6 years, mean mass 44.9 ± 4.1 kg). Open-field tackling had the highest median and 95th percentile linear accelerations (24.7 g and 97.8 g, respectively) and resulted in significantly higher mean head accelerations than several other drills. The multiplayer tackle drill resulted in the highest head impact frequency, with an average of 0.59 impacts per minute per athlete, but the lowest 95th percentile linear accelerations of all drills. The front of the head was the most common impact location for all drills except dummy/sled tackling. CONCLUSIONS Head impact exposure varies significantly in youth football practice drills, with several drills exposing athletes to high-magnitude and/or high-frequency head impacts. These data suggest that further study of practice drills is an important step in developing evidence-based recommendations for modifying or eliminating certain high-intensity drills to reduce head impact exposure and injury risk for all levels of play.
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Affiliation(s)
- Mireille E. Kelley
- Virginia Tech–Wake Forest University School of Biomedical Engineering and Sciences; Winston-Salem, North Carolina
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joeline M. Kane
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mark A. Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Logan E. Miller
- Virginia Tech–Wake Forest University School of Biomedical Engineering and Sciences; Winston-Salem, North Carolina
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Alexander K. Powers
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joel D. Stitzel
- Virginia Tech–Wake Forest University School of Biomedical Engineering and Sciences; Winston-Salem, North Carolina
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jillian E. Urban
- Virginia Tech–Wake Forest University School of Biomedical Engineering and Sciences; Winston-Salem, North Carolina
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
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28
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Abstract
RATIONALE Bilateral carotid-cavernous fistula (CCF) is rare and serious extra-ocular disease occurring in clinical which may result in severe complication. Unique manifestations and imaging examinations are important to the diagnosis. PATIENT CONCERNS A case of bilateral carotid-cavernous fistula in an 60-year-old healthy man caused by a head injury is reported. Further clinical symptoms and signs and imaging examinations lead to the correct diagnosis. DIAGNOSES Computed tomography angiography of the brain aroused suspicion of bilateral CCF. On physical examination, intraocular pressure in the right eye was 35 mm Hg, while the other eye was 56 mm Hg. INTERVENTIONS After diagnosis, the patient chose conservative treatment for some reasons. OUTCOMES The symptom of him had relieved in both eyes but no light perception in the right eye after two months telephone follow-up. LESSONS Our case study demonstrated that a highly suspicion must be maintained when managing such patients to prevent serious consequences. At the same time, the early diagnosis and treatment of the disease have a critical relationship to the prognosis of patients, which should be paid attention to.
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29
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Goel V, Lam E, Smith KW, Goel A, Raymont V, Krueger F, Grafman J. Lesions to polar/orbital prefrontal cortex selectively impair reasoning about emotional material. Neuropsychologia 2017; 99:236-245. [PMID: 28263798 PMCID: PMC5496820 DOI: 10.1016/j.neuropsychologia.2017.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 09/08/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
Abstract
While it is widely accepted that lesions to orbital prefrontal cortex lead to emotion related disruptions and poor decision-making, there is very little patient data on this issue involving actual logical reasoning tasks. We tested patients with circumscribed, focal lesions largely confined to polar/orbital prefrontal cortex (BA 10 & 11) (N=17) on logical reasoning tasks involving neutral and emotional content, and compared their performance to that of an age and education-matched normal control group (N=22) and a posterior lesion control group (N=24). Our results revealed a significant group by content interaction driven by a selective impairment in the polar/orbital prefrontal cortex group compared to healthy normal controls and to the parietal patient group, in the emotional content reasoning trials. Subsequent analyses of congruent and incongruent reasoning trials indicated that this impairment was driven by the poor performance of patients with polar/orbital lesions in the incongruent trials. We conclude that the polar/orbital prefrontal cortex plays a critical role in filtering emotionally charged content from the material before it is passed on to the reasoning system in lateral/dorsal regions of prefrontal cortex. Where unfiltered content is passed to the reasoning engine, either as a result of pathology (as in the case of our patients) or as a result of individual differences, reasoning performance suffers.
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Affiliation(s)
- Vinod Goel
- Department of Psychology, York University, Canada; IRCCS Fondazione Ospedale San Camillo, Lido, Venice, Italy
| | - Elaine Lam
- Department of Psychology, York University, Canada
| | | | - Amit Goel
- School of Medicine, University of Western Ontario, Canada
| | - Vanessa Raymont
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Imperial College, London, UK
| | - Frank Krueger
- Department of Molecular Neuroscience, George Mason University, Fairfax, VA, USA; Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Jordan Grafman
- Northwestern University Medical School, Cognitive Neurology and Psychiatry and Behavioral Sciences and Physical Medicine and Rehabilitation, Chicago, IL, USA
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30
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Arshad Q, Roberts RE, Ahmad H, Lobo R, Patel M, Ham T, Sharp DJ, Seemungal BM. Patients with chronic dizziness following traumatic head injury typically have multiple diagnoses involving combined peripheral and central vestibular dysfunction. Clin Neurol Neurosurg 2017; 155:17-19. [PMID: 28212927 DOI: 10.1016/j.clineuro.2017.01.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 07/31/2015] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We hypothesised that chronic vestibular symptoms (CVS) of imbalance and dizziness post-traumatic head injury (THI) may relate to: (i) the occurrence of multiple simultaneous vestibular diagnoses including both peripheral and central vestibular dysfunction in individual patients increasing the chance of missed diagnoses and suboptimal treatment; (ii) an impaired response to vestibular rehabilitation since the central mechanisms that mediate rehabilitation related brain plasticity may themselves be disrupted. METHODS We report the results of a retrospective analysis of both the comprehensive clinical and vestibular laboratory testing of 20 consecutive THI patients with prominent and persisting vestibular symptoms still present at least 6months post THI. RESULTS Individual THI patients typically had multiple vestibular diagnoses and unique to this group of vestibular patients, often displayed both peripheral and central vestibular dysfunction. Despite expert neuro-otological management, at two years 20% of patients still had persisting vestibular symptoms. CONCLUSION In summary, chronic vestibular dysfunction in THI could relate to: (i) the presence of multiple vestibular diagnoses, increasing the risk of 'missed' vestibular diagnoses leading to persisting symptoms; (ii) the impact of brain trauma which may impair brain plasticity mediated repair mechanisms. Apart from alerting physicians to the potential for multiple vestibular diagnoses in THI, future work to identify the specific deficits in brain function mediating poor recovery from post-THI vestibular dysfunction could provide the rationale for developing new therapy for head injury patients whose vestibular symptoms are resistant to treatment.
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Affiliation(s)
- Q Arshad
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College, Fulham Palace Road, London, W6 8RF, UK
| | - R E Roberts
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College, Fulham Palace Road, London, W6 8RF, UK
| | - H Ahmad
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College, Fulham Palace Road, London, W6 8RF, UK
| | - R Lobo
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College, Fulham Palace Road, London, W6 8RF, UK
| | - M Patel
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College, Fulham Palace Road, London, W6 8RF, UK
| | - T Ham
- The Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - D J Sharp
- The Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - B M Seemungal
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College, Fulham Palace Road, London, W6 8RF, UK.
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31
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O'Day KM, Koehling EM, Vollavanh LR, Bradney D, May JM, Breedlove KM, Breedlove EL, Blair P, Nauman EA, Bowman TG. Comparison of head impact location during games and practices in Division III men's lacrosse players. Clin Biomech (Bristol, Avon) 2017; 43:23-27. [PMID: 28178579 DOI: 10.1016/j.clinbiomech.2017.01.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Head impacts have been studied extensively in football, but little similar research has been conducted in men's lacrosse. It is important to understand the location and magnitude of head impacts during men's lacrosse to recognize the risk of head injury. METHODS Descriptive epidemiology study set on collegiate lacrosse fields. Eleven men's lacrosse players (age=20.9±1.13years, mass=83.91±9.04kg, height=179.88±5.99cm) volunteered to participate. We applied X2 sensors behind the right ear of participants for games and practices. Sensors recorded data on linear and rotational accelerations and the location of head impacts. We calculated incidence rates per 1000 exposures with 95% confidence intervals for impact locations and compared the effect of impact location on linear and rotational accelerations with Kruskal-Wallis tests. FINDINGS We verified 167 head impacts (games=112; practices=55). During games, the incidence rate was 651.16 (95% confidence interval=530.57-771.76). The high and low incidence rates for head impact locations during games were: side=410.7 (95% confidence interval=292.02-529.41) and top=26.79 (95% confidence interval=3.53-57.10). For games and practices combined, the impact locations did not significantly affect linear (χ23=6.69, P=0.08) or rotational acceleration (χ23=6.34, P=0.10). INTERPRETATION We suggest further research into the location of head impacts during games and practices. We also suggest player and coach education on head impacts as well as behavior modification in men's lacrosse athletes to reduce the incidence of impacts to the side of the head in an effort to reduce potential injury.
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Jiang J, Marathe AR, Keene JC, Taylor DM. A testbed for optimizing electrodes embedded in the skull or in artificial skull replacement pieces used after injury. J Neurosci Methods 2017; 277:21-29. [PMID: 27979758 PMCID: PMC5253247 DOI: 10.1016/j.jneumeth.2016.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/22/2015] [Revised: 12/06/2016] [Accepted: 12/11/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Custom-fitted skull replacement pieces are often used after a head injury or surgery to replace damaged bone. Chronic brain recordings are beneficial after injury/surgery for monitoring brain health and seizure development. Embedding electrodes directly in these artificial skull replacement pieces would be a novel, low-risk way to perform chronic brain monitoring in these patients. Similarly, embedding electrodes directly in healthy skull would be a viable minimally-invasive option for many other neuroscience and neurotechnology applications requiring chronic brain recordings. NEW METHOD We demonstrate a preclinical testbed that can be used for refining electrode designs embedded in artificial skull replacement pieces or for embedding directly into the skull itself. Options are explored to increase the surface area of the contacts without increasing recording contact diameter to maximize recording resolution. RESULTS Embedding electrodes in real or artificial skull allows one to lower electrode impedance without increasing the recording contact diameter by making use of conductive channels that extend into the skull. The higher density of small contacts embedded in the artificial skull in this testbed enables one to optimize electrode spacing for use in real bone. COMPARISON WITH EXISTING METHODS For brain monitoring applications, skull-embedded electrodes fill a gap between electroencephalograms recorded on the scalp surface and the more invasive epidural or subdural electrode sheets. CONCLUSIONS Embedding electrodes into the skull or in skull replacement pieces may provide a safe, convenient, minimally-invasive alternative for chronic brain monitoring. The manufacturing methods described here will facilitate further testing of skull-embedded electrodes in animal models.
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Affiliation(s)
- JingLe Jiang
- Department of Neurosciences, The Cleveland Clinic, Cleveland, OH 44195, United States; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, United States; Cleveland Functional Electrical Stimulation (FES) Center of Excellence, Louis Stokes VA Medical Center, Cleveland, OH 44106, United States
| | - Amar R Marathe
- Department of Neurosciences, The Cleveland Clinic, Cleveland, OH 44195, United States; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, United States; Cleveland Functional Electrical Stimulation (FES) Center of Excellence, Louis Stokes VA Medical Center, Cleveland, OH 44106, United States; Human Research and Engineering Directorate, US Army Research Laboratory, Aberdeen Proving Ground, MD 21005, United States
| | - Jennifer C Keene
- Department of Neurosciences, The Cleveland Clinic, Cleveland, OH 44195, United States; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, United States; Cleveland Functional Electrical Stimulation (FES) Center of Excellence, Louis Stokes VA Medical Center, Cleveland, OH 44106, United States
| | - Dawn M Taylor
- Department of Neurosciences, The Cleveland Clinic, Cleveland, OH 44195, United States; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, United States; Cleveland Functional Electrical Stimulation (FES) Center of Excellence, Louis Stokes VA Medical Center, Cleveland, OH 44106, United States.
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Abstract
This review focuses on the published literature on vestibular disorders following different types of head and neck trauma. Current knowledge of the different causes and underlying mechanisms of vestibular disorders, as well as the sites of organic damage, is presented. Non-organic mechanisms are also surveyed. The frequency of occurrence of vestibular symptoms, and of other accompanying subjective complaints, associated with different types of trauma is presented and related to the specific causes. Hypotheses about the pathogenesis of traumatic vestibular disorders are presented, and the knowledge derived from animal experiments is also discussed. We believe this to be a very important topic, since vestibular complaints in traumatic patients often remain undiagnosed or underestimated in clinical practice. This review article aims to suggest directions for additional research and to provide guidance to both the scientific and clinical practice communities.
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34
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High impact research: investigating the effects of repetitive head injury. Brain 2017; 140:e6. [PMID: 28031226 DOI: 10.1093/brain/aww294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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35
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Benger J. Why do we shine lights in the eyes of conscious patients after head injury? BMJ 2016; 354:i5235. [PMID: 27694222 DOI: 10.1136/bmj.i5235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jonathan Benger
- Academic Department of Emergency Care, Emergency Department, Bristol Royal Infirmary, Bristol, BS2 8HW
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36
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Schoell SL, Weaver AA, Talton JW, Baker G, Doud AN, Barnard RT, Stitzel JD, Zonfrillo MR. Functional outcomes of motor vehicle crash head injuries in pediatric and adult occupants. Traffic Inj Prev 2016; 17 Suppl 1:27-33. [PMID: 27586099 PMCID: PMC6211837 DOI: 10.1080/15389588.2016.1201203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/07/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The objective of the study was to develop a disability-based metric for motor vehicle crash (MVC) injuries, with a focus on head injuries, and compare the functional outcomes between the pediatric and adult populations. METHODS Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System (NTDB-RDS) for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 3, 4, and 5 head injuries in NASS-CDS 2000-2011. Pediatric (ages 7-18), adult (19-45), middle-aged (46-65), and older adult (66+) patients with an FIM score available who were alive at discharge and had an AIS 3, 4, or 5 injury were included in the study. The NTDB-RDS contains a truncated form of the FIM instrument, including 3 items (self-feed, locomotion, and verbal expression), each graded on a scale of 1 (full functional dependence) to 4 (full functional independence). Patients within each age group were classified as disabled or not disabled based on the FIM scale. The DR was calculated for each age group by dividing the number of patients who sustained a specific injury and were disabled by the number of patients who sustained the specific injury. To account for the impact of more severe associated coinjuries, a maximum AIS (MAIS) adjusted DR (DRMAIS) was also calculated for each injury. DR and DRMAIS ranged from 0 (0% disability risk) to 1 (100% disability risk). RESULTS An analysis of the most frequent FIM components associated with disabling MVC head injuries revealed that disability across all 3 items (self-feed, locomotion, and expression) was the most frequent for pediatric and adult patients. Only locomotion was the most frequent for middle-aged and older adults. The mean DRMAIS for MVC head injuries was 35% for pediatric patients, 36% for adults, 38% for middle-aged adults, and 44% for older adults. Further analysis was conducted by grouping the head injuries into 8 groups based on the structure of injury and injury type. The pediatric population possessed higher DRMAIS values for brain stem injuries as well as loss of consciousness injuries. Older adults possessed higher DRMAIS values for contusion/hemorrhage injuries, epidural hemorrhage, intracerebral hemorrhage, skull fracture, and subdural/subarachnoid hemorrhage. CONCLUSION At-risk populations such as pediatric and older adult patients possessed higher DRMAIS values for different head injuries. Disability in pediatric patients is critical due to loss of quality life years. Disability risk can supplement severity metrics to improve the ability of such metrics to discriminate the severity of different injuries that do not lead to death. Understanding of age-related differences in injury outcomes when compared to adults could inform future age-specific modifications to the AIS.
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Affiliation(s)
- Samantha L. Schoell
- Virginia Tech–Wake Forest University Center for Injury Biomechanics, Winston–Salem, North Carolina
- Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Ashley A. Weaver
- Virginia Tech–Wake Forest University Center for Injury Biomechanics, Winston–Salem, North Carolina
- Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Jennifer W. Talton
- Wake Forest School of Medicine, Division of Public Health Sciences, Winston–Salem, North Carolina
| | - Gretchen Baker
- Virginia Tech–Wake Forest University Center for Injury Biomechanics, Winston–Salem, North Carolina
| | - Andrea N. Doud
- Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Ryan T. Barnard
- Wake Forest School of Medicine, Division of Public Health Sciences, Winston–Salem, North Carolina
| | - Joel D. Stitzel
- Virginia Tech–Wake Forest University Center for Injury Biomechanics, Winston–Salem, North Carolina
- Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Mark R. Zonfrillo
- Alpert Medical School of Brown University and Hasbro Children’s Hospital, Providence, Rhode Island
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Wahid FI, Khan MR, Khan MM, Javaid M, Zada B. Pattern of firearm injuries in head and neck regions at a tertiary care hospital. J PAK MED ASSOC 2016; 66:849-852. [PMID: 27427134] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the characteristics of firearm injuries on head and neck in patients presenting to the Ear Nose and Throat Department of a tertiary care hospital. METHODS This prospective, cross-sectional study was conducted at the Lady Reading Hospital, Peshawar, from June 2014 to May 2015, and comprised victims of firearm injuries. They were subjected to a thorough examination of the wounds specifically and the rest of the Ear, Nose and Throat, Head and Neck regions generally. Data was collected on a proforma. SPSS 16 was used for data analysis. RESULTS Out of the 56 patients, 49(87.5%) were men. The overall mean age was 28.68±1.63 years (range: 6-80 years. Besides, 33(58.9%) patients were in the age range 20-40 years followed by 18(32.1%) below 20 years. Overall, 27(48.2%) patients were jobless and 24(42.9%) had education below grade ten. Pistol was the most commonly-used weapon in 28(50%).Hospital stay was 2-10 days with a mean of 4.37±1.74 days. Single-entry wound on the neck was common 21(37.5%), predominantly on the right side 24(42.9%), while there were 33(58.9%) single-exit wounds, affecting neck in 18(32.1%) cases and on the left side in 19(33.9%). CONCLUSIONS Firearm injuries were common among young men who were illiterate and poor socioeconomically. Homicidal injuries mostly occurred during the daytime. Pistol was the most commonly-used weapon, while wounds on the neck were more common.
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Affiliation(s)
- Fazal I Wahid
- Department of ENT, Head and Neck Surgery, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Riaz Khan
- Govt. Naseerullah Babar Memorial Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Masood Khan
- Department of Dentistry and Maxillofacial Surgery, Medical Teaching Institute (MTI), Lady Reading Hospital, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Javaid
- Department of ENT, Head and Neck Surgery, Khyber Pakhtunkhwa, Pakistan
| | - Bakht Zada
- Department of ENT, Head and Neck Surgery, Khyber Pakhtunkhwa, Pakistan
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Zhou Z, Jiang B, Cao L, Zhu F, Mao H, Yang KH. Numerical simulations of the 10-year-old head response in drop impacts and compression tests. Comput Methods Programs Biomed 2016; 131:13-25. [PMID: 27265045 DOI: 10.1016/j.cmpb.2016.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Studies on traumatic injuries of children indicate that impact to the head is a major cause of severe injury and high mortality. However, regulatory and ethical concerns very much limit development and validation of computer models representing the pediatric head. The purpose of this study was to develop a child head finite element model with high-biofidelity to be used for studying pediatric head injury mechanisms. METHODS A newly developed 10-year-old (YO) pediatric finite element head model was limitedly validated for kinematic and kinetic responses against data from quasi-static compressions and drop tests obtained from an experimental study involving a child-cadaver specimen. The validated model was subsequently used for a fall accident reconstruction and associated injury analysis. RESULTS The model predicted the same shape of acceleration-time histories as was found in drop tests with the largest discrepancy of -8.2% in the peak acceleration at a drop height of 15 cm. Force-deflection responses predicted by the model for compression loading had a maximum discrepancy of 7.5% at a strain rate of 0.3 s(-1). The model-predicted maximum von Mises stress (σv) and principal strain (εp) in the skull, intracranial pressure (ICP), maximum σv and maximum εp in the brain, head injury criterion (HIC), brain injury criterion (BrIC), and head impact power (HIP) were used for analyzing risks of injury in the accident reconstruction. CONCLUSIONS Based on the results of the injury analyses, the following conclusions can be drawn: (1) ICP cannot be used to accurately predict the locations of brain injury, but it may reflect the overall energy level of the impact event. (2) The brain regions predicted by the model to have high σv coincide with the locations of subdural hematoma with transtentorial herniation and the impact position of an actual injury. (3) The brain regions with high εp predicted by the model coincide with locations commonly found where diffuse axonal injuries (DAI) due to blunt-impact and rapid acceleration have taken place.
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Affiliation(s)
- Zhou Zhou
- The State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University, Changsha, Hunan, 410082, China
| | - Binhui Jiang
- The State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University, Changsha, Hunan, 410082, China; Bioengineering Center, Wayne State University, Detroit, MI 48201, USA.
| | - Libo Cao
- The State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University, Changsha, Hunan, 410082, China
| | - Feng Zhu
- The State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University, Changsha, Hunan, 410082, China; Department of Mechanical Engineering, Embry-Riddle Aeronautical University, FL 32114, USA
| | - Haojie Mao
- Bioengineering Center, Wayne State University, Detroit, MI 48201, USA
| | - King H Yang
- Bioengineering Center, Wayne State University, Detroit, MI 48201, USA
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Tani S. [Sports-Related Head Injuries]. No Shinkei Geka 2016; 44:537-543. [PMID: 27384113 DOI: 10.11477/mf.1436203328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Satoshi Tani
- Department of Neurosurgery, Jikei University School of Medicine
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Abstract
Intensivists, surgeons, neurologists, and others involved in pediatric intensive care units (PICUs) have an important investment in both short-and long-term outcomes of children and adolescents with head injury who are treated under their care. Outcomes are most often documented by either single-or multiple-item rating scales and are implemented both during and after hospital care. For this review, the authors have organized the content of rating scales into 6 general classes: (1) mortality prediction, (2) severity, (3) global recovery, (4) activity restrictions, (5) secondary adverse conditions, and (6) limitations in participation, quality of life, and health status. Rating scales that describe the outcomes of children and adolescents after head injury are used to monitor medical and functional recovery, guide clinical management, drive quality assurance initiatives, and conduct clinical research. The authors restrict their selective review to rating scales that describe child outcomes (vs family) and that have been reported and applied in the outcome literature. Although head injury is a major cause of mortality and short-and long-term morbidity in children and adolescents, there is no consensus on which rating scales are optimal for hospital care or community follow-up. Major considerations for clinical use are feasibility, type of outcome information needed, content breadth across multiple ages and levels of recovery, and utility in determining the short-term impact of PICU care on long-term outcome.
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Affiliation(s)
- Stephen M Haley
- Health and Disability Research Institute, Boston University, Boston, Massachusetts 02215-1605, USA.
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Zarutskyi YL, Tkachenko AE. [PECULIARITIES OF COURSE OF TRAUMATIC DISEASE IN THE INJURED PERSONS IN COMBINED CRANIOABDOMINAL TRAUMA]. Klin Khir 2016:5-8. [PMID: 27514081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Prospective investigation of the traumatic disease course was conducted in 71 injured persons, suffering a combined cranioabdominal trauma with the objective to determine the main functional systems and dynamics of their state severity. The occurrence rate and the severity degree of cardiovascular insufficiency were determined--in accordance to indices of the integrative body rheography and integrative dual frequency impedansometry, respiratory insufficiency (PaO₂/FiO₂ ratio), the organ insufficiency severity (in accordance to SOFA scale). There was established, that changes in respiratory and cardiovascular systems are corresponding to the staged pathogenetic characteristics of the traumatic disease periods. So on, it is expedient to perform the urgent and postponed operative interventions in a period of their relative stabilization. The presence of severe craniocerebral trauma, as a part of a combined cranioabdominal trauma causes significant and durable impairment of the functional systems activity.
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Lötsch J, Ultsch A, Eckhardt M, Huart C, Rombaux P, Hummel T. Brain lesion-pattern analysis in patients with olfactory dysfunctions following head trauma. Neuroimage Clin 2016; 11:99-105. [PMID: 26937377 PMCID: PMC4753812 DOI: 10.1016/j.nicl.2016.01.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 11/19/2022]
Abstract
The presence of cerebral lesions in patients with neurosensory alterations provides a unique window into brain function. Using a fuzzy logic based combination of morphological information about 27 olfactory-eloquent brain regions acquired with four different brain imaging techniques, patterns of brain damage were analyzed in 127 patients who displayed anosmia, i.e., complete loss of the sense of smell (n = 81), or other and mechanistically still incompletely understood olfactory dysfunctions including parosmia, i.e., distorted perceptions of olfactory stimuli (n = 50), or phantosmia, i.e., olfactory hallucinations (n = 22). A higher prevalence of parosmia, and as a tendency also phantosmia, was observed in subjects with medium overall brain damage. Further analysis showed a lower frequency of lesions in the right temporal lobe in patients with parosmia than in patients without parosmia. This negative direction of the differences was unique for parosmia. In anosmia, and also in phantosmia, lesions were more frequent in patients displaying the respective symptoms than in those without these dysfunctions. In anosmic patients, lesions in the right olfactory bulb region were much more frequent than in patients with preserved sense of smell, whereas a higher frequency of carriers of lesions in the left frontal lobe was observed for phantosmia. We conclude that anosmia, and phantosmia, are the result of lost function in relevant brain areas whereas parosmia is more complex, requiring damaged and intact brain regions at the same time.
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Affiliation(s)
- Jörn Lötsch
- Institute of Clinical Pharmacology, Goethe - University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Fraunhofer Project Group Translational Medicine and Pharmacology (IME-TMP), Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| | - Alfred Ultsch
- DataBionics Research Group, University of Marburg, Hans-Meerwein-Straße, 35032 Marburg, Germany
| | - Maren Eckhardt
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Caroline Huart
- Department of Otorhinolaryngology, Universite Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Philippe Rombaux
- Department of Otorhinolaryngology, Universite Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
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Haubrich C, Diehl RR, Kasprowicz M, Diedler J, Sorrentino E, Smielewski P, Czosnyka M. Increasing Intracranial Pressure After Head Injury: Impact on Respiratory Oscillations in Cerebral Blood Flow Velocity. Acta Neurochir Suppl 2016; 122:171-5. [PMID: 27165901 DOI: 10.1007/978-3-319-22533-3_35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Experiments have shown that closed-box conditions alter the transmission of respiratory oscillations (R waves) to organ blood flow already at a marginal pressure increase. How does the increasing intracranial pressure (ICP) interact with R waves in cerebral blood flow after head injury (HI)?Twenty-two head-injured patients requiring sedation and mechanical ventilation were monitored for ICP, Doppler flow velocity (FV) in the middle cerebral arteries, and arterial blood pressure (ABP). The analysis included transfer function gains of R waves (9-20 cpm) from ABP to FV, and indices of pressure-volume reserve (RAP) and autoregulation (Mx). Increasing ICP has dampened R-wave gains from day 1 to day 4 after HI in all patients. A large impact (ΔGain /ΔICP right: 0.14 ± 0.06; left: 0.18 ± 0.08) was associated with exhausted reserves (RAP ≥0.85). When RAP was <0.85, rising ICP had a lower impact on R-wave gains (ΔGain /ΔICP right: 0.05 ± 0.02; left: 0.06 ± 0.04; p < 0.05), but increased the pulsatility indices (right: 1.35 ± 0.55; left: 1.25 ± 0.52) and Mx indices (right: 0.30 ± 0.12; left: 0.28 ± 0.08, p < 0.05). Monitoring of R waves in blood pressure and cerebral blood flow velocity has suggested that rising ICP after HI might have an impact on cerebral blood flow directly, even before autoregulation is impaired.
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Affiliation(s)
| | - Rolf R Diehl
- Department of Neurology, Alfried-Krupp-Krankenhaus Essen, Essen, Germany
| | - Magdalena Kasprowicz
- Institute of Biomedical Engineering and Instrumentation, Wroclaw University of Technology, Wroclaw, Poland
| | | | - Enrico Sorrentino
- Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Piotr Smielewski
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Marek Czosnyka
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Joszko K, Wolański W, Burkacki M, Suchoń S, Zielonka K, Muszyński A, Gzik M. Biomechanical analysis of injuries of rally driver with head supporting device. Acta Bioeng Biomech 2016; 18:159-169. [PMID: 28133374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The aim of the study was to develop and verify a model of rally driver with a safety system HANS (head supporting device), which will enable biomechanical analysis of injuries in rally accident. METHODS Simulations were carried out in Madymo® software, the results of which were verified based on sled test performed in the Automotive Industry Institute (PIMOT) in Warsaw. The model being verified allowed us to perform a multivariate simulation of rally accident in terms of assessing effectiveness of protection and usefulness of HANS system. RESULTS Acceleration waveforms of the head and chest were obtained from numerical experiment and also forces and moments occurring in the upper cervical spine. The results obtained allowed driver injuries to be analyzed based on injury criteria of the head and neck: HIC15, NTE, NTF, NCE and NCF. CONCLUSIONS The analysis enabled assessment of the driver safety while using 4 and 5 point harness with HANS system. In further studies the model developed was used to identify factors affecting the safety of a rally driver.
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Affiliation(s)
- Kamil Joszko
- Silesian University of Technology, Faculty of Biomedical Engineering
| | - Wojciech Wolański
- Silesian University of Technology, Faculty of Biomedical Engineering
| | - Michał Burkacki
- Silesian University of Technology, Faculty of Biomedical Engineering
| | - Sławomir Suchoń
- Silesian University of Technology, Faculty of Biomedical Engineering
| | | | | | - Marek Gzik
- Silesian University of Technology, Faculty of Biomedical Engineering
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Khallaf FG, Kehinde EO, Hussein S. Bone Healing and Hormonal Bioassay in Patients with Long-Bone Fractures and Concomitant Head Injury. Med Princ Pract 2016; 25:336-42. [PMID: 26954461 PMCID: PMC5588422 DOI: 10.1159/000445250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 03/07/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim of this study is to investigate healing of fractures in patients with concomitant head injuries and to measure blood hormone levels to elucidate the mechanism of a possible accelerated osteogenesis. MATERIALS AND METHODS One hundred and sixty-two patients were included in this study and divided into 3 cohorts: group A with head injuries only (n = 52); group B with head injuries as well as long-bone fractures (n = 50); group C with long-bone fractures only (n = 60). Fracture-healing parameters including time of appearance and thickness of the bridging callus, and blood hormonal assays were measured and compared using Student's t test. RESULTS The mean time to healing was significantly lower in cohort B (6.9 ± 2.9 weeks) than C (22.4 ± 8.7 weeks; p = 0.001). The mean thickness of the healing callus was significantly higher in cohort B (26.3 ± 9.7 mm) than C (8.1 ± 5.9 mm; p = 0.002). The mean healing rate was also higher in cohort B (4.5 ± 2.3 mm/week) than C (0.38 ± 0.21 mm/week; p = 0.001). Blood hormonal assays in group B showed higher values of parathyroid hormone and growth hormone than in group C. However, adrenaline and noradrenaline values were lower in group B than in group C at all measured time intervals, and correspondingly leptin was lower in all groups (p = 0.001). Corticosteroid values were normal in group B compared to slightly higher values in group C, also at all measured time intervals. CONCLUSION In this study, healing of fractures in patients with concomitant head injuries was accelerated, thereby indicating an involvement of a combined neurohormonal mechanism.
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Affiliation(s)
- Fathy G. Khallaf
- Department of Orthopaedic Surgery, Jahra Hospital, Kuwait, Jabriya
- *Dr. Fathy G. Khallaf, FRCS Glasgow, Department of Orthopaedic Surgery, Jahra Hospital, Ministry of Health, Kuwait (Kuwait), E-Mail
| | - Elijah O. Kehinde
- Department of Surgery, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Sundus Hussein
- Department of Pathology, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
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Andreyev OA, Skobska OE, Kadzhaya NV. [THE WAYS OF OBJECTIVIZATION OF LIGHT CRANIO-CEREBRAL TRAUMA IN ACUTE PERIOD]. Klin Khir 2015:9-12. [PMID: 26939417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In the analysis 41 injured persons were included, ageing (37.3 ± 0.5) yrs old at average with light cranio-cerebral trauma. The patients were examined in accordance to actual recommendations of Ukrainian Ministry of Health, using a tonal the threshold audiometry, computeric stabilography (CS). In accordance to data of computeric tomography, concussion of brain (CB) revealed in 32 patients, contusion of brain of light degree--in 9. Using the method of the factor analysis the factors were established, which have determined 55.1% of integral dispersion of the variants values. The changes of basal principles of statokinesiograms (SKG)--enhancement of the oscillations amplitude of common centre of pressure in sagital square and a square of SKG in a modified functional Romberg test with closed eyes--may be applied as objective criteria of a CB diagnosis.
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Wu X, Yu Y, Hu P, Wang S. [Maintenance effects of acupoint catgut embedding at early time on gastrointestinal function in patients with craniocerebral injury]. Zhongguo Zhen Jiu 2015; 35:439-442. [PMID: 26255513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore the maintenance effects of acupoint catgut embedding at early time on gastrointestinal function in patients with craniocerebral injury. METHODS Sixty craniocerebral injury patients with 5 to 12 points of Glasgow coma scale (GCS), according to treatment order, were alternately divided into an observation group and a control group, 30 cases in each one. Patients in the control group were treated with regular treatment and nursing care. Based on this, patients in the observation group, according to different pathogenesis and symptoms presented within 24 h into hospitalization, were additionally treated with acupoint catgut embedding. The recovery time of borborygmus, time of first anal aerofluxus, time of first defecation, abdominal pressure at different time points, the occurrence rate of complications (upper gastrointestinal hemorrhage, diarrhea, vomiting), time of enteral nutrition tolerance rate reaching 30 kcal/kg x d were observed and recorded. RESULTS The recovery time of borborygmus, time of first anal aerofluxus, time of first defecation and time of enteral nutrition tolerance rate reaching 30 kcal/kg x d in the observation group were all earlier to those in the control group (all P<0.01). At 48 h, 4 d and 7 d into hospitalization, the abdominal pressures in the observation group were all lower than those in the control group [(11.10 +/- 1.47) mmHg vs. (13.50 +/- 1.43) mmHg, (8.40 +/- 1.25) mmHg vs. (11.90 +/- 1.56) mmHg, (6.73 +/- 0.74) mmHg vs. (10.80 +/- 1.30) mmHg, all P<0.01]. There were 8 cases with complications of gastrointestinal hemorrhage, diarrhea and vomiting in the observation group with the occurrence rate o 27% (8/30), which was lower than those in the control group (70.0% (21/30), P<0.01. CONCLUSION The acupoint catgut embedding at early time in craniocerebral injury patients could improve the recovery of gastrointestinal function, reduce intolerance of enteral nutrition and occurrence rate of various complications.
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Wang DH, Kostyun RO, Solomito MJ. The Biomechanics of Cranial Forces During Figure Skating Spinning Elements. Conn Med 2015; 79:133-137. [PMID: 26244218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Several facets of figure skating, such as the forces associated with jumping and landing, have been evaluated, but a comprehensive biomechanical understanding of the cranial forces associated with spinning has yet to be explored. The purpose of this case study was to quantify the cranial rotational acceleration forces generated during spinning elements. This case report was an observational, biomechanical analysis of a healthy, senior-level, female figure skating athlete who is part of an on-going study. A triaxial accelerometer recorded the gravitational forces (G) during seven different spinning elements. Our results found that the layback spin generated significant cranial force and these forces were greater than any of the other spin elements recorded. These forces led to physical findings of ruptured capillaries, dizziness, and headaches in our participant.
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