Functional Decline 5 Years After Blast Traumatic Brain Injury

Dams-O’Connor, Kristen; Tsao, Jack W.

doi:10.1001/jamaneurol.2017.0176

Cited by 8 publications

(3 citation statements)

References 15 publications

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“…The most well-supported adverse outcomes identified in humans remain self-reported symptomology (e.g., headaches, trouble hearing), particularly among those with greater cumulative exposure (e.g., breacher training instructors) ( 45 , 70 ). However, given the diversity of the outcomes examined to date, much more research is needed to expand our understanding of the potential effects of LLB exposure, including examining whether adverse outcomes associated with repetitive LLB exposure present a threat to performance of duties and/or increased risk of adverse long-term health outcomes, including Alzheimer's disease ( 69 , 72 , 73 ).…”

Section: Discussionmentioning

confidence: 99%

Potential Health and Performance Effects of High-Level and Low-Level Blast: A Scoping Review of Two Decades of Research

et al. 2021

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Although blast exposure has been recognized as a significant source of morbidity and mortality in military populations, our understanding of the effects of blast exposure, particularly low-level blast (LLB) exposure, on health outcomes remains limited. This scoping review provides a comprehensive, accessible review of the peer-reviewed literature that has been published on blast exposure over the past two decades, with specific emphasis on LLB. We conducted a comprehensive scoping review of the scientific literature published between January 2000 and 2019 pertaining to the effects of blast injury and/or exposure on human and animal health. A three-level review process with specific inclusion and exclusion criteria was used. A full-text review of all articles pertaining to LLB exposure was conducted and relevant study characteristics were extracted. The research team identified 3,215 blast-relevant articles, approximately half of which (55.4%) studied live humans, 16% studied animals, and the remainder were non-subjects research (e.g., literature reviews). Nearly all (99.49%) of the included studies were conducted by experts in medicine or epidemiology; approximately half of these articles were categorized into more than one medical specialty. Among the 51 articles identified as pertaining to LLB specifically, 45.1% were conducted on animals and 39.2% focused on human subjects. Animal studies of LLB predominately used shock tubes to induce various blast exposures in rats, assessed a variety of outcomes, and clearly demonstrated that LLB exposure is associated with brain injury. In contrast, the majority of LLB studies on humans were conducted among military and law enforcement personnel in training environments and had remarkable variability in the exposures and outcomes assessed. While findings suggest that there is the potential for LLB to harm human populations, findings are mixed and more research is needed. Although it is clear that more research is needed on this rapidly growing topic, this review highlights the detrimental effects of LLB on the health of both animals and humans. Future research would benefit from multidisciplinary collaboration, larger sample sizes, and standardization of terminology, exposures, and outcomes.

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Section: Discussionmentioning

confidence: 99%

Potential Health and Performance Effects of High-Level and Low-Level Blast: A Scoping Review of Two Decades of Research

et al. 2021

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“…[ 1 2 ] Furthermore, increasing numbers of civilians suffer this trauma in ongoing terrorist attacks. [ 3 4 ] However, the damage accrued from mild-to-moderate explosions is often overlooked because of the slow onset or mildness of the symptoms.…”

Section: Introductionmentioning

confidence: 99%

Blast-Induced Traumatic Brain Injury Triggered by Moderate Intensity Shock Wave Using a Modified Experimental Model of Injury in Mice

Zhou

Wen

Wang

et al. 2018

Chinese Medical Journal

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Background:The increasing frequency of explosive injuries has increased interest in blast-induced traumatic brain injury (bTBI). Various shock tube models have been used to study bTBI. Mild-to-moderate explosions are often overlooked because of the slow onset or mildness of the symptoms. However, heavy gas cylinders and large volume chambers in the model may increase the complexity and danger. This study sought to design a modified model to explore the effect of moderate explosion on brain injury in mice.Methods:Pathology scoring system (PSS) was used to distinguish the graded intensity by the modified model. A total of 160 mice were randomly divided into control, sham, and bTBI groups with different time points. The clinical features, imaging features, neurobehavior, and neuropathology were detected after moderate explosion. One-way analysis of variance followed by Fisher's least significant difference posttest or Dunnett's t 3-test was performed for data analyses.Results:PSS of mild, moderate, and severe explosion was 13.4 ± 2.2, 32.6 ± 2.7 (t = 13.92, P < 0.001; vs. mild group), and 56.6 ± 2.8 (t = 31.37, P < 0.001; vs. mild group), respectively. After moderate explosion, mice showed varied symptoms of malaise, anorexia, incontinence, apnea, or seizure. After bTBI, brain edema reached the highest peak at day 3 (82.5% ± 2.1% vs. 73.8% ± 0.6%, t = 7.76, P < 0.001), while the most serious neurological outcomes occurred at day 1 (Y-maze: 8.25 ± 2.36 vs. 20.00 ± 4.55, t = −4.59, P = 0.048; 29.58% ± 2.84% vs. 49.09% ± 11.63%, t = −3.08, P = 0.008; neurologic severity score: 2.50 ± 0.58 vs. 0.00 ± 0.00, t = 8.65, P = 0.016). We also found that apoptotic neurons (52.76% ± 1.99% vs. 1.30% ± 0.11%, t = 57.20, P < 0.001) and gliosis (2.98 ± 0.24 vs. 1.00 ± 0.00, t = 14.42, P = 0.021) in the frontal were significantly higher at day 3 post-bTBI than sham bTBI.Conclusions:We provide a reliable, reproducible bTBI model in mice that can produce a graded explosive waveform similar to the free-field shock wave in a controlled laboratory environment. Moderate explosion can trigger mild-to-moderate blast damage of the brain.

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“…In the Editorial titled “Functional Decline 5 Years After Blast Traumatic Brain Injury: Sounding the Alarm for a Wave of Disability?” published online May 1, 2017, there were errors in the conflict of interest disclosures. The first sentence should have read “Dr Dams-O’Connor reports receiving grants…” instead of “Dr Tsao.” Also, it should be the Eunice Kennedy Shriver National Institute of Child Health and Development and the National Institute on Disability Independent Living and Rehabilitation Research.…”

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confidence: 94%

Incorrect Conflicts of Interest Disclosures

2017

JAMA Neurol

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Functional Decline 5 Years After Blast Traumatic Brain Injury

Cited by 8 publications

References 15 publications

Potential Health and Performance Effects of High-Level and Low-Level Blast: A Scoping Review of Two Decades of Research

Potential Health and Performance Effects of High-Level and Low-Level Blast: A Scoping Review of Two Decades of Research

Blast-Induced Traumatic Brain Injury Triggered by Moderate Intensity Shock Wave Using a Modified Experimental Model of Injury in Mice

Incorrect Conflicts of Interest Disclosures

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