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blast injuries

Wei Bu, Huiling Ren, Yunping Deng, Nobel Del Mar, Natalie M Guley, Bob M Moore, Marcia G Honig, Anton Reiner
We have previously reported that mild TBI created by focal left-side cranial blast in mice produces widespread axonal injury, microglial activation, and a variety of functional deficits. We have also shown that these functional deficits are reduced by targeting microglia through their cannabinoid type-2 (CB2) receptors using 2-week daily administration of the CB2 inverse agonist SMM-189. CB2 inverse agonists stabilize the G-protein coupled CB2 receptor in an inactive conformation, leading to increased phosphorylation and nuclear translocation of the cAMP response element binding protein (CREB), and thus bias activated microglia from a pro-inflammatory M1 to a pro-healing M2 state...
2016: Frontiers in Neuroscience
Mingxiong Huang, Deborah L Harrington, Ashley Robb, Annemarie Angeles, Sharon Nichols, Angela I Drake, Tao Song, Mithun Diwakar, Charles W Huang, Victoria Risbrough, Anders M Dale, Hauke Bartsch, Scott Matthews, Jeffrey W Huang, Roland R Lee, Dewleen G Baker
Blast mild traumatic brain injury (mTBI) is a leading cause of sustained impairment in military service members and Veterans. However, the mechanism of persistent disability is not fully understood. The present study investigated disturbances in brain functioning in mTBI participants using a source-imaging-based approach to analyze functional connectivity (FC) from resting-state magnetoencephalography (rs-MEG). Study participants included 26 active-duty service members or Veterans who had blast mTBI with persistent post-concussive symptoms and 22 healthy control active-duty service members or Veterans...
October 20, 2016: Journal of Neurotrauma
Nicholas S Szuflita, Chris J Neal, Michael K Rosner, Ralph F Frankowski, Robert G Grossman
Spine injuries are more prevalent among Iraq and Afghanistan veterans than among veterans of previous conflicts. The purpose of this investigation was to characterize the context, mode, and clinical outcomes of spine injuries sustained by U.S. military personnel in theater. Injury and clinical data from patients who sustained a spine injury in Iraq or Afghanistan between 2003 and 2008 were extracted from the Joint Theater Trauma Registry. Fischer's exact test was used to compare demographic variables between battle and nonbattle spine injuries...
October 2016: Military Medicine
Jason S Radowsky, Carlos J Rodriguez, Gary G Wind, Eric A Elster
The application of lessons learned on the battlefield for timely surgical control of lower extremity hemorrhage secondary to blast injuries to the civilian practice for similar wounding patterns from industrial accidents or terrorist activities is imperative. Although simple cut-down procedures are commonly sufficient for the control of blood vessels for distal extremity traumatic amputations, high-thigh or disarticulation wounding patterns often require more complex surgical methods. The following details both the decision-making process and operative techniques for controlling hemorrhage from lower extremity blast injuries...
October 2016: Military Medicine
David R Tribble, Ping Li, Tyler E Warkentien, Bradley A Lloyd, Elizabeth R Schnaubelt, Anuradha Ganesan, William Bradley, Deepak Aggarwal, M Leigh Carson, Amy C Weintrob, Clinton K Murray
The Trauma Infectious Disease Outcomes Study began in June 2009 as combat operations were decreasing in Iraq and increasing in Afghanistan. Our analysis examines the rate of infections of wounded U.S. military personnel from operational theaters in Iraq and Afghanistan admitted to Landstuhl Regional Medical Center between June 2009 and December 2013 and transferred to a participating U.S. hospital. Infection risk factors were examined in a multivariate logistic regression analysis (expressed as odds ratios [OR]; 95% confidence intervals [CI])...
October 2016: Military Medicine
James M Bjork, Thomas K Burroughs, Laura M Franke, Treven C Pickett, Sade E Johns, F Gerard Moeller, William C Walker
In military populations, traumatic brain injury (TBI) also holds potential to increase impulsivity and impair mood regulation due to blast injury effects on ventral frontal cortex - to put military personnel at risk for suicide or substance abuse. We assessed a linkage between depression and impaired behavioral inhibition in 117 blast-exposed service members (SM) and veterans with post-concussion syndrome (PCS), where PCS was defined using a Rivermead Postconcussive Symptom Questionnaire (RPQ) modified to clarify whether each symptom worsened compared to pre-blast...
October 7, 2016: Psychiatry Research
Marc Heincelman, Nithin Karakala, Don C Rockey
Acute lymphoblastic leukemia (ALL) in adults is a relatively rare malignancy. The typical presentation includes signs and symptoms associated with bone marrow failure, including fevers, infections, fatigue, and excessive bruising. In this article, we report an unusual systemic presentation of ALL in a previously healthy 18-year-old man. He initially presented with several-day history of nausea and vomiting, 10-pound weight loss, and right upper quadrant abdominal pain with evidence of acute hepatocellular liver injury (elevations in aspartate aminotransferase/alanine aminotransferase) and elevation in serum creatinine...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Marquitta Smith, Thuvan Piehler, Richard Benjamin, Karen L Farizatto, Morgan C Pait, Michael F Almeida, Vladimir V Ghukasyan, Ben A Bahr
Explosives create shockwaves that cause blast-induced neurotrauma, one of the most common types of traumatic brain injury (TBI) linked to military service. Blast-induced TBIs are often associated with reduced cognitive and behavioral functions due to a variety of factors. To study the direct effects of military explosive blasts on brain tissue, we removed systemic factors by utilizing rat hippocampal slice cultures. The long-term slice cultures were briefly sealed air-tight in serum-free medium, lowered into a 37°C water-filled tank, and small 1...
October 5, 2016: Experimental Neurology
Danielle R Miller, Jasmeet P Hayes, Ginette Lafleche, David H Salat, Mieke Verfaellie
Blast-related mild traumatic brain injury (mTBI) is a common injury of the Iraq and Afghanistan Wars. Research has suggested that blast-related mTBI is associated with chronic white matter abnormalities, which in turn are associated with impairment in neurocognitive function. However, findings are inconsistent as to which domains of cognition are affected by TBI-related white matter disruption. Recent evidence that white matter abnormalities associated with blast-related mTBI are spatially variable raises the possibility that the associated cognitive impairment is also heterogeneous...
October 4, 2016: Brain Imaging and Behavior
Jie Ma, Wenjing Xiao, Junrui Wang, Juan Wu, Jiandong Ren, Jun Hou, Jianwen Gu, Kaihua Fan, Botao Yu
Increasing evidence has demonstrated that inflammatory response plays a crucial role in the pathogenesis of secondary injury following blast-induced traumatic brain injury (bTBI). Propofol, a lipid-soluble intravenous anesthetic, has been shown to possess therapeutic benefit during neuroinflammation on various brain injury models. Recent findings have proved that the NOD-like receptor family, pyrin domain-containing 3 (NLRP3) inflammasome involved in the process of the inflammatory response following brain trauma, may probably be a promising target in the treatment of bTBI...
September 30, 2016: Inflammation
Georgina Perez-Garcia, Miguel A Gama Sosa, Rita De Gasperi, Margaret Lashof-Sullivan, Eric Maudlin-Jeronimo, James R Stone, Fatemeh Haghighi, Stephen T Ahlers, Gregory A Elder
The postconcussion syndrome following mild traumatic brain injuries (mTBI) has been regarded as a mostly benign syndrome that typically resolves in the immediate months following injury. However, in some individuals, symptoms become chronic and persistent. This has been a striking feature of the mostly blast-related mTBIs that have been seen in veterans returning from the recent conflicts in Iraq and Afghanistan. In these veterans a chronic syndrome with features of both the postconcussion syndrome and post-traumatic stress disorder has been prominent...
September 28, 2016: Behavioural Brain Research
Maya Elin O'Neil, Megan Callahan, Kathleen F Carlson, Mai Roost, Benjamin Laman-Maharg, Elizabeth W Twamley, Grant L Iverson, Daniel Storzbach
OBJECTIVE: This study examined symptom reporting related to the 10th Edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) criteria for postconcussional syndrome (PCS) in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans. Our aims were to: (a) examine relationships among PCS symptoms by identifying potential subscales of the British Columbia Postconcussion Symptom Inventory (BC-PSI); and (b) examine group differences in BC-PSI items and subscales in Veterans with and without blast exposure, mild traumatic brain injury (mTBI), and posttraumatic stress disorder (PTSD)...
September 28, 2016: Journal of Clinical and Experimental Neuropsychology
Nicholas J Erdle, Eric G Verwiebe, Joseph C Wenke, Christopher S Smith
Debridement is an integral step in the orthopaedic management of traumatic wounds, from open soft tissue injuries and routine open fracture care to the management of extensive high-energy blast injuries. While the necessity of debridement has been well established, the level of energy and degree of contamination of blast wounds encountered in recent armed conflict has offered a challenge and a new opportunity for military surgeons to revisit the most recent literature to guide our practice with the best evidence currently available...
October 2016: Journal of Orthopaedic Trauma
Heather C Yun, Clinton K Murray, Kenneth J Nelson, Michael J Bosse
Trauma to the extremities is disproportionately represented in casualties of recent conflicts, accounting for >50% of injuries sustained during operations in Iraq and Afghanistan. Infectious complications have been reported in >25% of those evacuated for trauma, and 50% of such patients were treated in the intensive care unit (ICU). Osteomyelitis has been reported in 9% (14% of intensive care unit patients), and deep-wound infection in 27% of type III open-tibia fractures. Infections complicating extremity trauma are frequently caused by multidrug-resistant bacteria and have been demonstrated to lead to failure of limb salvage, unplanned operative take-backs, late amputations, and decreased likelihood of returning to duty...
October 2016: Journal of Orthopaedic Trauma
Ashley A Weaver, Sarah M Stitzel, Joel D Stitzel
A predictive Lagrangian-Eulerian finite element eye model was used to analyze 2.27 and 0.45 kg trinitrotoluene equivalent blasts detonated from 24 different locations. Free air and ground level blasts were simulated directly in front of the eye and at lateral offset locations with box, average, less protective, and more protective orbital anthropometries, resulting in 96 simulations. Injury risk curves were developed for hyphema, lens dislocation, retinal damage, and globe rupture from experimental and computational data to compute risk from corneoscleral stress and intra-ocular pressure computational outputs...
September 19, 2016: Biomechanics and Modeling in Mechanobiology
Grigoris Grigoriadis, Nicolas Newell, Diagarajen Carpanen, Alexandros Christou, Anthony M J Bull, Spyros D Masouros
The complex structural and material behaviour of the human heel fat pad determines the transmission of plantar loading to the lower limb across a wide range of loading scenarios; from locomotion to injurious incidents. The aim of this study was to quantify the hyper-viscoelastic material properties of the human heel fat pad across strains and strain rates. An inverse finite element (FE) optimisation algorithm was developed and used, in conjunction with quasi-static and dynamic tests performed to five cadaveric heel specimens, to derive specimen-specific and mean hyper-viscoelastic material models able to predict accurately the response of the tissue at compressive loading of strain rates up to 150s(-1)...
September 8, 2016: Journal of the Mechanical Behavior of Biomedical Materials
Christopher Connelly, Kathleen Martin, Joel Elterman, Jean A Orman, David Zonies
INTRODUCTION: The purpose of this study was to review the inpatient traumatic brain injury (TBI) screening program at a Role IV regional resource trauma center. TBI has been coined the "signature wound" during current U.S. combat operations. All patients injured in Iraq or Afghanistan who transit through Landstuhl Regional Medical Center (LRMC) undergo an initial TBI screen regardless of anatomic injury. The incidence and factors associated with positive screening for concussion (physical event+alteration of consciousness (AOC)) and TBI diagnoses were examined...
September 7, 2016: Injury
Ping-Hong Yeh, Cheng Guan Koay, Binquan Wang, John Morissette, Elyssa Sham, Justin Senseney, David Joy, Alex Kubli, Chen-Haur Yeh, Victora Eskay, Wei Liu, Louis M French, Terrence R Oakes, Gerard Riedy, John Ollinger
The aim of this study was to apply recently developed automated fiber segmentation and quantification methods using diffusion tensor imaging (DTI) and DTI-based deterministic and probabilistic tractography to access local and global diffusion changes in blast-induced mild traumatic brain injury (bmTBI). Two hundred and two (202) male active US service members who reported persistent post-concussion symptoms for more than 6 months after injury were recruited. An additional forty (40) male military controls were included for comparison...
September 15, 2016: Human Brain Mapping
Stephanie J Karch, José E Capó-Aponte, D Scott McIlwain, Michael Lo, Sridhar Krishnamurti, Roger N Staton, Kendra Jorgensen-Wagers
The objective of this study was to analyze differences in incidence and epidemiologic risk factors for significant threshold shift (STS) and tinnitus in deployed military personnel diagnosed with mild traumatic brain injury (mTBI) due to either a blast exposure or nonblast head injury. A retrospective longitudinal cohort study of electronic health records of 500 military personnel (456 met inclusion criteria) diagnosed with deployment-related mTBI was completed. Chi-square tests and STS incidence rates were calculated to assess differences between blast-exposed and nonblast groups; relative risks and adjusted odds ratios of developing STS or tinnitus were calculated for risk factors...
October 2016: U.S. Army Medical Department Journal
John S Oh, Creighton C Tubb, Thomas P Poepping, Paul Ryan, Jonathan C Clasper, Adrian R Katschke, Caroline Tuman, Michael J Murray
BACKGROUND: The purposes of this study are to define the pattern of injuries sustained by dismounted troops exposed to improvised explosive devices blasts treated at a Role 3 combat support hospital and to assess injury patterns and mortality associated with the mechanism. Our hypothesis was that mortality is associated with pelvic fracture, massive transfusion, high Injury Severity Score (ISS), multiple limb amputations, and transfer from a Role 2 facility. STUDY DESIGN: Retrospective study of 457 patients...
September 2016: Military Medicine
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