Concussion最新文献

{"title":"Neurometabolic indicators of mitochondrial dysfunction in repetitive mild traumatic brain injury.","authors":"Susan Kim,&nbsp;Steve C Han,&nbsp;Alexander J Gallan,&nbsp;Jasmeet P Hayes","doi":"10.2217/cnc-2017-0013","DOIUrl":"https://doi.org/10.2217/cnc-2017-0013","url":null,"abstract":"<p><p>Mild traumatic brain injury (mTBI) is a significant national health concern and there is growing evidence that repetitive mTBI (rmTBI) can cause long-term change in brain structure and function. The mitochondrion has been suggested to be involved in the mechanism of TBI. There are noninvasive methods of determining mitochondrial dysfunction through biomarkers and spectroscopy. Mitochondrial dysfunction has been implicated in a variety of neurological consequences secondary to rmTBI through activation of caspases and calpains. The purpose of this review is to examine the mechanism of mitochondrial dysfunction in rmTBI and its downstream effects on neuronal cell death, axonal injury and blood-brain barrier compromise.</p>","PeriodicalId":37006,"journal":{"name":"Concussion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cnc-2017-0013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36481136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the endocannabinoid system as a modulator of the trigeminal pain response to concussion.","authors":"Melanie B Elliott,&nbsp;Sara J Ward,&nbsp;Mary E Abood,&nbsp;Ronald F Tuma,&nbsp;Jack I Jallo","doi":"10.2217/cnc-2017-0010","DOIUrl":"https://doi.org/10.2217/cnc-2017-0010","url":null,"abstract":"<p><p>Post-traumatic headache is the most common symptom of postconcussion syndrome and becomes a chronic neurological disorder in a substantial proportion of patients. This review provides a brief overview of the epidemiology of postconcussion headache, research models used to study this disorder, as well as the proposed mechanisms. An objective of this review is to enhance the understanding of how the endogenous cannabinoid system is essential for maintaining the balance of the CNS and regulating inflammation after injury, and in turn making the endocannabinoid system a potential modulator of the trigeminal response to concussion. The review describes the role of endocannabinoid modulation of pain and the potential for use of phytocannabinoids to treat pain, migraine and concussion.</p>","PeriodicalId":37006,"journal":{"name":"Concussion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cnc-2017-0010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36481139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of using normobaric hypoxic stress in mTBI research.","authors":"Patrick M Regan, Joseph Bleiberg, Paul St Onge, Leonard Temme","doi":"10.2217/cnc-2017-0008","DOIUrl":"10.2217/cnc-2017-0008","url":null,"abstract":"<p><p>Studies of mild traumatic brain injury (mTBI) recovery generally assess patients in unstressed conditions that permit compensation for impairments through increased effort expenditure. This possibility may explain why a subgroup of individuals report persistent mTBI symptoms yet perform normally on objective assessment. Accordingly, the development and utilization of stress paradigms may be effective for enhancing the sensitivity of mTBI assessment. Previous studies, discussed here, indirectly but plausibly support the use of normobaric hypoxia as a stressor in uncovering latent mTBI symptoms due to the overlapping symptomatology induced by both normobaric hypoxia and mTBI. Limited studies by our group and others further support this plausibility through proof-of-concept demonstrations that hypoxia reversibly induces disproportionately severe impairments of oculomotor, pupillometric, cognitive and autonomic function in mTBI individuals.</p>","PeriodicalId":37006,"journal":{"name":"Concussion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094798/pdf/cnc-02-44.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36481134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of early intervention in improving the level of activities and participation in youths after mild traumatic brain injury: a scoping review.","authors":"Caroline van Heugten,&nbsp;Irene Renaud,&nbsp;Christine Resch","doi":"10.2217/cnc-2016-0030","DOIUrl":"https://doi.org/10.2217/cnc-2016-0030","url":null,"abstract":"<p><p>Mild traumatic brain injury in children can lead to persistent cognitive and physical symptoms which can have a negative impact on activities and participation in school and at play. Preventive treatment strategies are preferred because these symptoms are often not recognized and therefore not treated adequately. In this review clinical studies investigating interventions directed at pediatric mild traumatic brain injury are summarized, and clinical recommendations and directions for the future are provided. Results show that the literature is scarce and more high quality studies are needed. Information and education about the injury and its consequences are recommended, with additional follow-up consultation, including individualized advice and reassurance. The interventions should be family-centered and, ideally, the return to activity and participation should be graded and done step-by-step.</p>","PeriodicalId":37006,"journal":{"name":"Concussion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cnc-2016-0030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36481193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the effects of mild traumatic brain injury on the pupillary light reflex.","authors":"Kenneth J Ciuffreda, Nabin R Joshi, James Q Truong","doi":"10.2217/cnc-2016-0029","DOIUrl":"10.2217/cnc-2016-0029","url":null,"abstract":"<p><p>The pupillary light reflex represents an optimal visual system to investigate and exploit in the mild traumatic brain injury (mTBI) population. Static and dynamic aspects of the pupillary light reflex were investigated objectively and quantitatively in the mTBI population. Pupillary responsivity was found to be significantly delayed, slowed and reduced, but symmetrical in nature, and with a smaller baseline diameter, as compared with normals. Several pupillary parameters also discriminated between those with versus without photosensitivity. Thus, dynamic pupillometry provides several objective biomarkers for the presence of mTBI and photosensitivity, gives insight into the global sites of neurological dysfunction and possible related mechanisms, and should result in improved patient care.</p>","PeriodicalId":37006,"journal":{"name":"Concussion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36481192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concussion management knowledge among residents and students and how to improve it.","authors":"Mohammad N Haider,&nbsp;John J Leddy,&nbsp;John G Baker,&nbsp;John M Kiel,&nbsp;Michael Tiso,&nbsp;Karl A Ziermann,&nbsp;Barry S Willer","doi":"10.2217/cnc-2017-0001","DOIUrl":"https://doi.org/10.2217/cnc-2017-0001","url":null,"abstract":"<p><strong>Aim: </strong>Recognition and management of concussion is an area of growing importance. The objective was to measure concussion knowledge among residents and medical students (MS).</p><p><strong>Methods: </strong>Baseline knowledge was assessed by a standardized questionnaire. Control group (family medicine [FM], pediatric medicine [PM] and emergency medicine) residents were given reading material, and intervention group rotated in a clinic (sports medicine residents and MS). Subjects were retested after 36.82 (16.1) days. Pre- and post-intervention test scores were compared.</p><p><strong>Results: </strong>The average baseline knowledge scores were 79.2% for emergency medicine residents, 61.4% for FM, 68.5% for PM, 71.7% for sports medicine residents and 68.0% for MS. Knowledge increase for control group was 1.16% compared with 14.41% for the clinical rotation group (p < 0.0001).</p><p><strong>Conclusion: </strong>PM and FM residents can benefit from more focused education about concussion.</p>","PeriodicalId":37006,"journal":{"name":"Concussion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cnc-2017-0001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36481194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microcavitation: the key to modeling blast traumatic brain injury?","authors":"Christian Franck","doi":"10.2217/cnc-2017-0011","DOIUrl":"https://doi.org/10.2217/cnc-2017-0011","url":null,"abstract":"Traumatic brain injuries (TBIs) are a significant source of deaths and disabilities worldwide with an associated healthcare burden in the billions of dollars [1]. Brain injuries generally result from either direct impact, blast or rapid acceleration and deceleration of the brain, and their severity is graded neurosymptomatically from mild to severe using the Glasgow Coma Scale. While these injuries, which in their mild form include concussions, are generally initiated by mechanical stress waves traveling through the brain resulting in exceeding tissue damage quantified as either compressive, tensile or shearing strains [2–4], blast TBIs have a slightly different origin, and as thus their injury mechanism and pathology remain an active topic of research [5,6]. In blast waves generated from explosions, including improvised explosive devices (IEDs) [6,7], the initial blast-generated shock wave profile features a sudden increase in pressure, often referred to as overpressure, followed by a low magnitude long-range negative pressure tail [5,7]. This profile is significantly different from most civilian blunt head impact scenarios, which, at least initially, are almost entirely composed of fast traveling pressure waves [5]. These shock-like pressure profiles introduce significant pressure changes across the brain on the order of a microto submilliseconds, whereas typical blunt trauma stresses change over the course of milliseconds and above. The classification of blast TBI has its own categorization from primary to quaternary blast injury [6]. Secondary to quaternary blast injuries have correlates in the civilian world whereas primary blast injuries that are classified by the interaction of the blast wave itself with the brain are unique to military and law enforcement personnel. Details of the origin of the injury and its pathology have remained elusive. Part of the challenge in dissecting the details of blast injury lies in the complex physical interaction between the fast moving pressure wave and the compliant brain. Furthermore, our understanding of the deformation behavior of soft brain tissue and its relationship to specific neuropathologies is still in its infancy. Although the initial blast wave is generally a pure pressure wave, it can turn into part pressure and part shear wave upon encountering the complex geometry of the human head and brain. While the traversing pressure wave will cause the tissue to undergo changes in volume, the shear wave can generate significant changes in shape, or shearing strains. In addition, part of the original pressure wave can reflect off a boundary of lower impedance, which is marked by either changes in tissue density or compliance, resulting in a negative, tensile, pressure reflection wave [8]. While a significant body of work has begun to detail the interaction of the compressive part of the wave with brain tissue and its cells [9–12], we will focus our attention here on the negative, or tensile character o","PeriodicalId":37006,"journal":{"name":"Concussion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cnc-2017-0011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36481135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Big Data in traumatic brain injury; promise and challenges.","authors":"Denes V Agoston,&nbsp;Dianne Langford","doi":"10.2217/cnc-2016-0013","DOIUrl":"https://doi.org/10.2217/cnc-2016-0013","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) is a spectrum disease of overwhelming complexity, the research of which generates enormous amounts of structured, semi-structured and unstructured data. This resulting big data has tremendous potential to be mined for valuable information regarding the \"most complex disease of the most complex organ\". Big data analyses require specialized big data analytics applications, machine learning and artificial intelligence platforms to reveal associations, trends, correlations and patterns not otherwise realized by current analytical approaches. The intersection of potential data sources between experimental TBI and clinical TBI research presents inherent challenges for setting parameters for the generation of common data elements and to mine existing legacy data that would allow highly translatable big data analyses. In order to successfully utilize big data analyses in TBI, we must be willing to accept the messiness of data, collect and store all data and give up causation for correlation. In this context, coupling the big data approach to established clinical and pre-clinical data sources will transform current practices for triage, diagnosis, treatment and prognosis into highly integrated evidence-based patient care.</p>","PeriodicalId":37006,"journal":{"name":"Concussion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cnc-2016-0013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36481138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence of dynamic visual acuity impairment in asymptomatic mixed martial arts fighters.","authors":"Merrill R Landers, Robert Donatelli, Jennifer Nash, Randa Bascharon","doi":"10.2217/cnc-2016-0032","DOIUrl":"10.2217/cnc-2016-0032","url":null,"abstract":"<p><strong>Aim: </strong>The purpose of this study was to determine the amount of visual acuity loss with head movement in actively training mixed martial arts (MMA) fighters.</p><p><strong>Methods: </strong>Vestibulo-ocular reflex function of 22 asymptomatic, male MMA fighters (age = 29.2 ± 5.1) was assessed by taking the difference between static visual acuity and the dynamic visual acuity test, in both yaw and pitch planes.</p><p><strong>Results: </strong>The mean static visual acuity testing logMAR was -0.173 (standard deviation [SD] = 0.114). Mean dynamic visual acuity test values decreased with head movement to 0.196 logMAR (SD = 0.103) in yaw; p < 0.001, and to 0.283 logMAR (SD = 0.133) in pitch; p < 0.001.</p><p><strong>Conclusion: </strong>MMA fighters had a decay, beyond normal ranges, in visual acuity during head movement. These decreases may suggest vestibulo-ocular reflex impairment and were unrelated to self-reported concussion history. These results should be cautiously interpreted since there was not a control group.</p>","PeriodicalId":37006,"journal":{"name":"Concussion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6093388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36481195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concussion in motorsport: incidence, awareness and future directions.","authors":"Naomi D Deakin,&nbsp;Peter J Hutchinson","doi":"10.2217/cnc-2017-0004","DOIUrl":"https://doi.org/10.2217/cnc-2017-0004","url":null,"abstract":"ND Deakin receives expenses in exchange for performing baseline and post-concussion neurocognitive testing for the British Touring Car Championship and its associated racing series. PJ Hutchinson is supported by a NIHR Research Professorship and the BRC Cambridge NIHR. PJ is also Chief Medical Officer for the FIA Formula 1 British Grand Prix at Silverstone. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.","PeriodicalId":37006,"journal":{"name":"Concussion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cnc-2017-0004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36481196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}