Blast Injury and Cardiopulmonary Symptoms in U.S. Veterans: Analysis of a National Registry

Jani, Nisha; Falvo, Michael J.; Sotolongo, Anays; Osinubi, Omowunmi; Tseng, Chin‐Lin; Rowneki, Mazhgan; Montopoli, Michael; Morley, Sybil W; Mitchell, Vincent; Helmer, Drew A.

doi:10.7326/m17-0711

Cited by 13 publications

(9 citation statements)

References 4 publications

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“…Moreover, the cumulative effects of BOP on other blast-sensitive organs such as the lung are also undefined, despite the likelihood that the lung may be especially susceptible to disruption with repeated exposures. A recent epidemiological study has shown a stronger association between BOP exposure and cardio-respiratory symptoms than the burn-pit smoke exposure 6 . It is important to understand BOP exposure conditions in which blast-sensitive organs, notably the lung, are compromised or injured.…”

Section: Introductionmentioning

confidence: 94%

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Pulmonary injury risk curves and behavioral changes from blast overpressure exposures of varying frequency and intensity in rats

Sajja

Statz

Walker

et al. 2020

Sci Rep

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At present, there are no set guidelines establishing cumulative limits for blast exposure numbers and intensities in military personnel, in combat or training operations. The objective of the current study was to define lung injury, pathology, and associated behavioral changes from primary repeated blast lung injury under appropriate exposure conditions and combinations (i.e. blast overpressure (BOP) intensity and exposure frequency) using an advanced blast simulator. Male Sprague Dawley rats were exposed to BOP frontally and laterally at a pressure range of ~ 8.5–19 psi, for up to 30 daily exposures. The extent of lung injury was identified at 24 h following BOP by assessing the extent of surface hemorrhage/contusion, Hematoxylin and Eosin staining, and behavioral deficits with open field activity. Lung injury was mathematically modeled to define the military standard 1% lung injury threshold. Significant levels of histiocytosis and inflammation were observed in pressures ≥ 10 psi and orientation effects were observed at pressures ≥ 13 psi. Experimental data demonstrated ~ 8.5 psi is the threshold for hemorrhage/contusion, up to 30 exposures. Modeling the data predicted injury risk up to 50 exposures with intensity thresholds at 8 psi for front exposure and 6psi for side exposures, which needs to be validated further.

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Section: Introductionmentioning

confidence: 94%

“…and cardio-respiratory symptoms than the burn-pit smoke exposure 6 . It is important to understand BOP exposure conditions in which blast-sensitive organs, notably the lung, are compromised or injured.…”

mentioning

confidence: 92%

Pulmonary injury risk curves and behavioral changes from blast overpressure exposures of varying frequency and intensity in rats

Sajja

Statz

Walker

et al. 2020

Sci Rep

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“…As of May 2018, 140,691 had participated. A recent analysis of registry participants reported a statistically significant association between self-reported blast injury with self-reported dyspnea and/or decreased ability to exercise, adjusted for smoking and other exposures, including burn pit smoke ( 106 ). An earlier publication analyzed symptoms and reported health conditions in a subset of registry participants deployed either to a location with a burn pit or to a location without a burn pit, reporting an association between proximity to a burn pit and self-reported respiratory conditions ( 107 ).…”

Section: Airborne Hazards and Open Burn Pit Registrymentioning

confidence: 99%

Respiratory Health after Military Service in Southwest Asia and Afghanistan. An Official American Thoracic Society Workshop Report

Garshick¹,

Abraham²,

Baird³

et al. 2019

Annals ATS

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Since 2001, more than 2.7 million U.S. military personnel have been deployed in support of operations in Southwest Asia and Afghanistan. Land-based personnel experienced elevated exposures to particulate matter and other inhalational exposures from multiple sources, including desert dust, burn pit combustion, and other industrial, mobile, or military sources. A workshop conducted at the 2018 American Thoracic Society International Conference had the goals of: 1 ) identifying key studies assessing postdeployment respiratory health, 2 ) describing emerging research, and 3 ) highlighting knowledge gaps. The workshop reviewed epidemiologic studies that demonstrated more frequent encounters for respiratory symptoms postdeployment compared with nondeployers and for airway disease, predominantly asthma, as well as case series describing postdeployment dyspnea, asthma, and a range of other respiratory tract findings. On the basis of particulate matter effects in other populations, it also is possible that deployers experienced reductions in pulmonary function as a result of such exposure. The workshop also gave particular attention to constrictive bronchiolitis, which has been reported in lung biopsies of selected deployers. Workshop participants had heterogeneous views regarding the definition and frequency of constrictive bronchiolitis and other small airway pathologic findings in deployed populations. The workshop concluded that the relationship of airway disease, including constrictive bronchiolitis, to exposures experienced during deployment remains to be better defined. Future clinical and epidemiologic research efforts should address better characterization of deployment exposures; carry out longitudinal assessment of potentially related adverse health conditions, including lung function and other physiologic changes; and use rigorous histologic, exposure, and clinical characterization of patients with respiratory tract abnormalities.

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“…Therefore, organ systems with high air content, such as the auditory systems, pulmonary and gastrointestinal, are most likely affected by PBI [ 3 ]. Among them, lungs may be particularly susceptible to blast waves given tissue-density gradients [ 9 ]. Although recent studies indicated that blast-induced traumatic brain injury (bTBI) may be more common than previously believed [ 4 , 10 ], primary blast lung injury (PBLI) is still worthy of attention.…”

Section: Introductionmentioning

confidence: 99%

Damage-Associated Molecular Patterns and Their Signaling Pathways in Primary Blast Lung Injury: New Research Progress and Future Directions

Geng

Hou

et al. 2020

IJMS

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Primary blast lung injury (PBLI) is a common cause of casualties in wars, terrorist attacks, and explosions. It can exist in the absence of any other outward signs of trauma, and further develop into acute lung injury (ALI) or a more severe acute respiratory distress syndrome (ARDS). The pathogenesis of PBLI at the cellular and molecular level has not been clear. Damage-associated molecular pattern (DAMP) is a general term for endogenous danger signals released by the body after injury, including intracellular protein molecules (HMGB1, histones, s100s, heat shock proteins, eCIRP, etc.), secretory protein factors (IL-1β, IL-6, IL-10, TNF-α, VEGF, complements, etc.), purines and pyrimidines and their derived degradation products (nucleic acids, ATP, ADP, UDPG, uric acid, etc.), and extracellular matrix components (hyaluronic acid, fibronectin, heparin sulfate, biglycan, etc.). DAMPs can be detected by multiple receptors including pattern recognition receptors (PRRs). The study of DAMPs and their related signaling pathways, such as the mtDNA-triggered cGAS-YAP pathway, contributes to revealing the molecular mechanism of PBLI, and provides new therapeutic targets for controlling inflammatory diseases and alleviating their symptoms. In this review, we focus on the recent progress of research on DAMPs and their signaling pathways, as well as the potential therapeutic targets and future research directions in PBLI.

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Blast Injury and Cardiopulmonary Symptoms in U.S. Veterans: Analysis of a National Registry

Cited by 13 publications

References 4 publications

Pulmonary injury risk curves and behavioral changes from blast overpressure exposures of varying frequency and intensity in rats

Pulmonary injury risk curves and behavioral changes from blast overpressure exposures of varying frequency and intensity in rats

Respiratory Health after Military Service in Southwest Asia and Afghanistan. An Official American Thoracic Society Workshop Report

Damage-Associated Molecular Patterns and Their Signaling Pathways in Primary Blast Lung Injury: New Research Progress and Future Directions

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