TBI: U.S. Territory Veterans Have Greater Mortality Risk Than Mainland Vets

MedicalResearch.com Interview with:
Clara E. Dismuke-Greer, PhD
Health Equity and Rural Outreach Innovation Center
Ralph H. Johnson Department of Veterans Affairs Medical Center
Charleston, SC 29401

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for this study is that previous research we had published had shown that Hispanic U.S. Veterans diagnosed with Traumatic Brain Injury (TBI) had higher risk of mortality than non-Hispanic White U.S. Veterans, even after accounting for the effects of comorbidities as well as socio-demographics. This study sought to investigate further this apparent racial/ethnic disparity.

Using a 10 year cohort followed for up to 14 years, and adjusting for TBI severity as well as comorbidities, socio-demographics and military factors, when we included location (urban vs. rural vs. highly rural vs. U.S. Territory (Puerto Rico, U.S. Virgin Islands, Guam, America Samoa and Mariana Islands), as well as race/ethnicity, we found that the racial/ethnic disparity disappeared, and that it was location which became statistically significant.

Our main findings were that Veterans diagnosed with TBI residing in U.S. Territories have lower survival and higher risk of mortality relative to Veterans residing on the U.S. Mainland , even after statistical adjustment for the factors listed above.

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Girls Recover From Concussions More Slowly Than Boys

MedicalResearch.com Interview with:

Andrée-Anne Ledoux, PhD Children’s Hospital of Eastern Ontario Research Institute Ottawa, Ontario, Canada

Dr. Ledoux

Andrée-Anne Ledoux, PhD
Children’s Hospital of Eastern Ontario Research Institute
Ottawa, Ontario, Canada

MedicalResearch.com: What is the background for this study?

Response: The natural recovery processes from a pediatric concussion remains poorly characterized throughout childhood. Children’s brains go through many phases of growth during development and sex differences exist. Therefore a 6-year-old child may not have the same recovery trajectory as an adolescent because of biopsychosocial differences. Thus, this study explored symptom improvement after concussion while considering these two key demographic factors. Understanding symptom improvement at different stages of development is important in order to provide the best possible care.

The study examined data from 2,716 children and adolescents who had presented at nine emergency departments across Canada and were diagnosed with concussion. We examined the natural progression of self-reported symptom recovery following pediatric concussion over the initial three months after injury. Participants in the study were aged 5 to 18 years old with acute concussion, enrolled from August 1, 2013, to May 31, 2015. We examined different age cohorts – 5 to 7 years of age, 8 to 12 years of age, and 13 to 18 years of age, and investigated how sex is associated with recovery.

Our study represents the largest study to evaluate symptom improvement trajectories in concussed pediatric population. Continue reading

Serum Neurofilament Biomarker Helps Determine if Brain Function Will Recover After Cardiac Arrest

MedicalResearch.com Interview with:

Dr-Marion Moseby-Knappe

Dr. Moseby-Knappe

Marion Moseby-Knappe, MD
Neurologist and Researcher
Center for Cardiac Arrest at Lund University and
Skane University Hospital
Lund, Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our research focuses on improving methods for examining unconscious patients treated on intensive care units after cardiac arrest. If a patient does not wake up within the first days after cardiac arrest, physicians need to evaluate how likely it is that the patient will awaken at all and to which extent there is brain injury.

According to European and American guidelines, decisions on further medical treatment of cardiac arrest patients should always be based on a combination of examinations and not only one single method. Various methods are combined when assessing the patient such as examining different neurologic reflexes, head scans (computed tomography or magnetic resonance imaging), other specialist examinations (electroencephalogram or somatosensory evoked potentials) or blood markers.

Our research focuses on patients included in the largest cardiac arrest trial to date, the Targeted Temperature Management after Out-of-Hospital Cardiac Arrest (TTM) Trial.

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Nationwide Children’s: Multiyear Study of Head Impact During Football Seasons Launched

MedicalResearch.com Interview with:
Sean C. Rose, MD Pediatric sports neurologist and co-director Complex Concussion Clinic Nationwide Children’s Hospital Assistant professor of Pediatrics The Ohio State UniversitySean C. Rose, MD
Pediatric sports neurologist and co-director
Complex Concussion Clinic
Nationwide Children’s Hospital
Assistant professor of Pediatrics
The Ohio State University

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The link between sub-concussive head impacts and declines in neurocognitive function has been reported by some studies, yet refuted by others.  There is very little evidence that has been collected in children as they are sustaining these head impacts.

We initiated a multi-year study of youth football players to provide a more in-depth look at the question.  We measured head impacts using helmet sensors during the 2016 football season.  112 players age 9-18 completed a battery of neurocognitive tests before and after the football season.

We found that neither the total burden of head impacts nor the intensity of individual impacts were associated with changes in testing performance from pre to post-season.

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No Benefit, More Complications with Hypothermia after Traumatic Brain Injury

MedicalResearch.com Interview with:

Jamie Cooper AO BMBS MD FRACP FCICM FAHMS Professor of Intensive Care Medicine Monash University Deputy Director & Head of Research,  Intensive Care & Hyperbaric Medicine The Alfred, Melbourne

Prof. Cooper

Jamie Cooper AO
BMBS MD FRACP FCICM FAHMS
Professor of Intensive Care Medicine
Monash University
Deputy Director & Head of Research,
Intensive Care & Hyperbaric Medicine
The Alfred, Melbourne

MedicalResearch.com: What is the background for this study?

Response: 50-60 million people each year suffer a traumatic brain injury (TBI) . When the injury is severe only one half are able to live independently afterwards.

Cooling the brain (hypothermia) is often used in intensive care units for decades to  decrease inflammation and brain swelling and hopefully to improve outcomes, but clinical staff have had uncertainty whether benefits outweigh complications.

We conducted the largest randomised trial of hypothermia in TBI, in 500 patients, in 6 countries, called POLAR. We started cooling by ambulance staff, to give hypothermia the best chance to benefit patients. We continued for 3-7 days in hospital ind ICU. We measured functional outcomes at 6 months.

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Girls More Likely To Develop Post-Concussive Symptoms After Head Injury

MedicalResearch.com Interview with:

Dr. Ewing-Cobbs PhD Professor in the Department of Pediatrics McGovern Medical School University of Texas Health Science Center at Houston Harriet and Joe Foster Chair in Cognitive Neuroscience

Dr. Ewing-Cobbs

Dr. Linda Ewing-Cobbs PhD
Professor in the Department of Pediatrics
McGovern Medical School
University of Texas Health Science Center at Houston
Harriet and Joe Foster Chair in Cognitive Neuroscience

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Children may have long-lasting psychological and physical symptoms after an injury. Post-concussive symptoms (PCS) are nonspecific cognitive, physical, and mood symptoms such as difficulty concentrating, headache, and irritability. These symptoms occur in approximately 15 to 30% children after mild traumatic brain injury (TBI). Although PCS often resolve within one month, some children experience symptoms for longer periods of time.

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AI: Deep Learning Algorithms Can Detect Critical Head CT Findings

MedicalResearch.com Interview with:
Qure-ai.jpgSasank Chilamkurthy

AI Scientist,
Qure.ai

MedicalResearch.com: What is the background for this study?

Response: Head CT scan is one of the most commonly used imaging protocols besides chest x-ray. They are used for patients with symptoms suggesting stroke, rise in intracranial pressure or head trauma. These manifest in findings like intracranial haemorrhage, midline shift or fracture.

Scans with these critical findings need to be read immediately. But radiologists evaluate the scans on first-come-first-serve basis or based on stat/routine markers set by clinicians. If the scans with critical findings are somehow pushed to the top of radiologists’ work list, it could substantially decrease time to diagnosis and therefore decrease mortality and morbidity associated with stroke/head trauma.

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Almost 2 Million Children Suffer Traumatic Brain Injury Each Year

MedicalResearch.com Interview with:

Juliet Haarbauer-Krupa, PhD Senior Health Scientist Division of Unintentional Injury Prevention CDC

Dr. Haarbauer-Krupa

Juliet Haarbauer-Krupa, PhD
Senior Health Scientist
Division of Unintentional Injury Prevention
CDC

MedicalResearch.com: What is the background for this study?

  • Traumatic brain injury in children results in a large number of emergency department visits each year and can result in long term difficulties
  • The purpose of this study was to estimate lifetime prevalence of TBI in children based on a nationally representative sample of U.S. parents/adults and to describe the association between TBI and other childhood health conditions.
  • CDC researchers examined the National Survey of Children’s Health, a cross-sectional telephone survey of U.S. households, to provide a national estimate of TBI in children.

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“Head CT Choice” Educates Parents of Children with Mild Head Injury

MedicalResearch.com Interview with:

Erik P. Hess MD MSc Professor and Vice Chair for Research Department of Emergency Medicine UAB Medicine | The University of Alabama at Birmingham Birmingham Alabama 35249

Dr. Hess

Erik P. Hess MD MSc
Professor and Vice Chair for Research
Department of Emergency Medicine
UAB Medicine
he University of Alabama at Birmingham
Birmingham Alabama 35249

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: 450,000 children present to U.S emergency departments each year for evaluation of head trauma.  Physicians obtain head computed tomography (CT) scans in 37%-50% of these patients, with less than 10% showing evidence of traumatic brain injury and only 0.2% that require neurosurgical treatment.

In order to avoid unnecessary CT scans and to limit radiation exposure, the Pediatric Emergency Care Applied Research Network (PECARN) developed clinical prediction rules that consist of 6 readily available factors that can be assessed from the history and physical examination.  If none of these risk factors are present, a CT scan is not indicated.

If either of 2 high risk factors such as signs of a skull fracture are present, CT scanning is indicated.

If 1 or 2 non-high risk factors are present, then either CT scanning or observation are recommended, depending on considerations such as parental preference, clinician experience and/or symptom progression.

In this study we designed a parent decision aid, “Head CT Choice” to educate the parent about the difference between a concussion – which does not show up on a CT scan – and a more serious brain injury causing bleeding in or around the brain.  The decision aid also shows parents their child’s risk for a serious brain injury – less than 1% risk in the majority of patients in our trial – what to observe their child at home for should they opt not to obtain a CT scan, and the advantages and disadvantages of CT scanning versus home observation.

In our trial, we did not observe a difference in the rate of head CT scans obtained in the ED but did find that parents who were engaged in shared decision-making using Head CT Choice were more knowledgeable about their child’s risk for serious brain injury, has less difficulty making the decision because they were clearer about the advantages and disadvantages of the diagnostic options, and were more involved in decision-making by their physician.  Parents also less frequently sought additional testing for their child within 1 week of the emergency department visit.

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CDC Guidelines for Diagnosis and Management of Mild Pediatric Traumatic Brain Injury

MedicalResearch.com Interview with:

Matt Breiding, PhD Team Lead, Division of Unintentional Injury Prevention Center for Disease Control and Prevention

Dr. Breiding

Matt Breiding, PhD
Team Lead, Division of Unintentional Injury Prevention
Center for Disease Control and Prevention

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Caused by a bump, blow or jolt to the head or body, a mild traumatic brain injury (mTBI) can lead to short- or long-term problems that can affect how a child thinks, acts, feels, and learns. CDC’s Pediatric mTBI Guideline is based on the most comprehensive review of the science on pediatric mTBI diagnosis and management to date—covering 25 years of research.

The guideline consists of 19 sets of clinical recommendations that cover diagnosis, prognosis, and management and treatment. These recommendations are applicable to healthcare providers who care for pediatric patients with mTBI in all practice settings and outline actions healthcare providers can take to improve the health of their patients with this injury.

The CDC Pediatric mTBI Guideline outlines specific actions healthcare providers can take to help young patients and includes 5 key recommendations.  Specifically, they recommend that physicians:

  1. Refrain from routinely imaging pediatric patients to diagnose mTBI.
  2. Use validated, age-appropriate symptom scales to diagnose mTBI.
  3. Assess for risk factors for prolonged recovery, including: history of mTBI or other brain injury, severe symptom presentation immediately after the injury, and personal characteristics and family history (such as learning difficulties and family and social stressors).
  4. Provide patients with instructions on returning to activity customized to their symptoms.
  5. Counsel patients to return gradually to non-sports activities after no more than a 2-3 days of rest.

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First Potential Treatment For Brain Damage From Cosmic Radiation

MedicalResearch.com Interview with:
“Space Shuttle Model” by terren in Virginia is licensed under CC BY 2.0Susanna Rosi, PhD
Director of Neurocognitive Research
Brain and Spinal Injury Center
Professor in the departments of Physical Therapy and Rehabilitation Science and of Neurological Surgery
UCSF

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: NASA and private space companies like SpaceX plan to send humans to the red planet within the next 15 years — but among the major challenges facing future crewed space missions is how to protect astronauts from the dangerous cosmic radiation of deep space.

In this study we identified the first potential treatment for the brain damage caused by exposure to cosmic rays — a treatment can be given after exposure and that prevents memory impairment in mice exposed to simulated space radiation.

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Vets with Head Injury More Likely To Develop Dementia

MedicalResearch.com Interview with:
Deborah E. Barnes, PhD, MPH Professor, UCSF Weill Institute for Neurosciences Departments of Psychiatry and Epidemiology & Biostatistics University of California, San Francisco: http://profiles.ucsf.edu/deborah.barnes Research Health Sciences Specialist, San Francisco VA Medical Center Senior Investigator, Tideswell at UCSF: http://www.tideswellucsf.org/ Deborah E. Barnes, PhD, MPH

Professor, UCSF Weill Institute for Neurosciences
Departments of Psychiatry and Epidemiology & Biostatistics
University of California, San Francisco: http://profiles.ucsf.edu/deborah.barnes
Research Health Sciences Specialist
San Francisco VA Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

  • Previous studies have found a link between moderate to severe head injuries and increased dementia risk.
  • The association between mild head injuries and dementia – especially mild head injury that doesn’t result in loss of consciousness – is less well established
  • We examined the association between mild head injuries with and without loss of consciousness and dementia diagnoses in nearly 360,000 Veterans receiving care in the VA health care system.
  • We found that Veterans with a head injury diagnoses were two to four times more likely to be diagnosed with dementia than those without head injury diagnoses.
  • The risk of dementia diagnosis was doubled in Veterans who experienced head injury without loss of consciousness compared to those with no head injury. 

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Head Injuries and Concussions Common in Theater Work and Performing Arts

MedicalResearch.com Interview with:

Jeffrey A. (Jeff) Russell, PhD, AT, FIADMS Science and Health in Artistic Performance Division of Athletic Training, School of Applied Health Sciences and Wellness Ohio University Athens, OH 45701

Dr. Jeff Russell

Jeffrey A. (Jeff) Russell, PhD, AT, FIADMS
Science and Health in Artistic Performance
Division of Athletic Training, School of Applied Health Sciences and Wellness
Ohio University
Athens, OH 45701

MedicalResearch.com: What is the background for this study? What are the main findings?

 

 

Response: Everyone knows that enormous attention is given to concussions in sports today. Those involved in performing arts experience many head impacts, too; yet, they receive neither the attention nor the specialized care for concussions that athletes do.

At Ohio University’s Clinic for Science and Health in Artistic Performance (SHAPe Clinic) that I direct, we were seeing a number of theater students suffer concussions. So, Brooke Daniell and I decided explore this trend more closely. This is the first known published research to evaluate the prevalence of head impacts in theater personnel. In the sample we studied, which comprised predominantly those involved in various aspects of theater production, the prevalence of receiving at least one head impact in a theater career was 67%. Of those who sustained at least one head impact from theater, 77% reported three or more head impacts, and 39% reported more than five impacts. More troubling, of those who said they had received a head impact that was accompanied by concussion-like symptoms, 70% indicated that they continued their work, and half of those did not report the incident to anyone.

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TBI Predisposes Kids To Attention Deficit Problems, Even Years After Injury

MedicalResearch.com Interview with:
Dr. Megan E. Narad, PhD

Division of Behavioral Medicine and Clinical Psychology
Cincinnati Children’s Hospital Medical Center | CCHMC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous research has shown that children with a history of traumatic brain injury (TBI) demonstrate difficulties with attention following injury; however, most studies only follow children 2-3 years after injury. Our study followed a group of children with a history of TBI 7-10 years after injury.

The main finding is that those with severe TBI were at greater risk for developing secondary attention deficit hyperactivity disorder (SADHD) than those with orthopedic injury; however, it should also be noted that kids with less severe injuries were also at risk of developing SADHD. In addition to injury severity, environmental factors (maternal education and family functioning) also played a role in SADHD development. It should also be noted that a number of kids developed SADHD >3.5 years after injury suggesting that these difficulties may not surface until many years after injury.

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Rates of Invalid Baseline Concussion Testing May Be Alarmingly High

MedicalResearch.com Interview with:

Christopher Abeare, Ph.D. Associate Professor Clinical Neuropsychology Department of Psychology University of Windsor Windsor, Ontario

Dr. Christopher Abeare

Christopher Abeare, Ph.D.
Associate Professor
Clinical Neuropsychology
Department of Psychology
University of Windsor
Windsor, Ontario

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In this study, we examined the prevalence of invalid performance on baseline neurocognitive testing in sport concussion. Baseline testing is a commonly employed practice in which the cognitive abilities of athletes are assessed pre-season. These baseline test results are then used as a point of comparison against which post-injury neurocognitive test results can be compared, thereby creating a more individualized approach to the assessment of neurocognitive functioning.

However, there has been growing concern about the validity of baseline test results, meaning that there is concern over the degree to which the scores on these baseline tests actually reflect an athlete’s true cognitive ability. There are many reasons why their test scores might not reflect their actual ability, ranging from inattentiveness during testing and lack of appreciation of the importance of doing their best on testing to intentional underperformance (aka “sandbagging” or malingering).

As a result of these concerns, 4 different validity measures have been developed. We compared these 4 validity measures, head to head, in a sample of 7897 athletes aged 10 to 21 years.

We found that 56% of athletes failed at least 1 of these validity measures, suggesting that as many as 56% of  athletes have scores that may not reflect their true ability level. We then tested the hypothesis that age would be related to the proportion of athletes with invalid performance. Our findings supported this hypothesis in that nearly 84% of 10-year-olds failed at least one validity measure and 29% of 21-year-olds failed at least one.  Continue reading

Most Common Brain Injuries in Babies Due to Hypoxia and Bleeding

MedicalResearch.com Interview with:
“Baby” by Victor is licensed under CC BY 2.0
Dr Chris Gale
Clinical Senior Lecturer in Neonatal Medicine
Imperial College London and
Consultant Neonatologist at Chelsea and Westminster Hospital
NHS Foundation Trust

 

 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As part of a drive to make England a safer place to give birth, the Department of Health in England has set a target of reducing the number of babies that incur brain injury during or soon after birth by 20% by 2020 and to halve them by 2030.

Before now United Kingdom health services did not have a standard definition of brain injury in babies and there has been no systematic collection of data for this purpose. With colleagues and in collaboration with the Department of Health, we have devised a practical way to measure the incidence rate of brain injury in babies using routinely recorded data held in the National Neonatal Research Database.

The research estimated that 3,418 babies suffered conditions linked to brain injury at or soon after birth in 2015, which equates to an incidence rate of 5.14 per 1,000 live births. For preterm births (babies born at or less than 37 weeks) the rate was 25.88 per 1,000 live births in 2015, almost six times greater than the rate for full-term births, which was 3.47 per 1,000 live births.

Overall, the research found that the most common type of condition that contributed brain injuries was damage caused by lack of oxygen to the brain, called hypoxic ischaemic encephalopathy; this is seen mainly in term babies. For preterm babies, the largest contributor to brain injuries is from bleeding into and around the ventricles of the brain, a condition called periventricular haemorrhage.

It is also the first time that brain injuries in babies have been measured using data gathered routinely during day to day clinical care on NHS neonatal units. The use of routine data required no additional work for clinical staff and provides a valuable way to measure the effectiveness of interventions to reduce brain injury.

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Micro RNAs in Saliva May Predict Severity of Concussion Injuries

MedicalResearch.com Interview with:

Dr. Steven D. Hicks,  M.D., Ph.D Penn State Health

Dr. Hicks

Dr. Steven D. Hicks,  M.D., Ph.D
Penn State Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous research has shown that small epigenetic molecules called microRNAs are altered in the blood after a traumatic brain injury. Our own pilot research showed that microRNAs were also changed in the saliva after brain injury and that some of these changes mirrored changes in cerebrospinal fluid. In this study we investigated whether salivary microRNA patterns after a concussion could be used to predict the duration and character of symptoms one month after injury.

We found that levels of five microRNAs predicted presence of symptoms one month later with greater accuracy (~85%) than standard surveys of symptom burden (~65%). Interestingly, one of the predictive salivary microRNAs (miR-320c) targets pathways involved in synaptic plasticity and was significantly correlated with attention difficulties one month after concussive injury.   Continue reading

Personality Changes Can Signal Incomplete Recovery After Traumatic Brain Injury

MedicalResearch.com Interview with:

Prof.dr. J van der Naalt PhD Department of Neurology University Medical Center Groningen Groningen, The Netherlands

Prof J van der Naalt

Prof.dr. J van der Naalt PhD
Department of Neurology University Medical Center Groningen
Groningen, The Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Mild traumatic brain injury occurs frequently and is one of the leading cause of morbidity in adults worldwide. It is a major social-economic problem with one in three patients had persistent complaints several months after injury that interfere with resumption of daily activities and work.

One of the most important questions concerns the finding that some patients recover without complaints and others do not after sustaining a mild traumatic brain injury. In a follow-up study with more than 1000 participants we found that personality factors are a major factor in the recovery process. In particular coping, that is the way patients adapt to persistent complaints, is important next to emotional distress and impact of the injury.

In an add-on study with fMRI we found that in the early phase after injury, the interaction between specific brain networks was temporarily changed. However, when regarding persistent posttraumatic complaints , specific personality characteristics significantly determine long term outcome.

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Traumatic Brain Injuries In Baseball Can Be Catastrophic, and Mostly Preventable With Universal Helmet Use

MedicalResearch.com Interview with:

Michael D. Cusimano MD, FRCSC, DABNS, FACS, PhD, MHPE Adjunct Scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital Division of Neurosurgery, St. Michael\'s Hospital Professor of Neurosurgery, Education and Public Health University of Toronto

Dr. Cusimano

Michael D. Cusimano MD, FRCSC, DABNS, FACS, PhD, MHPE
Adjunct Scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital
Division of Neurosurgery, St. Michael\’s Hospital
Professor of Neurosurgery, Education and Public Health
University of Toronto

MedicalResearch.com: What is the background for this study?

Response: Baseball is played by millions annually and is traditionally seen as a low risk sport for head injury when compared to sports like American Football, Ice Hockey and Rugby. Over 6 million children and youth are enrolled in formal baseball or softball leagues annually.

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Traumatic Brain Injury Laws Reduce Rate of Recurrent Concussions in High School Athletes

MedicalResearch.com Interview with:

Jingzhen (Ginger) Yang, PhD, MPH Principal Investigator Associate Professor, Center for Injury Research and Policy The Research Institute at Nationwide Children’s Hospital Dept. of Pediatrics, College of Medicine, The Ohio State University Columbus, Ohio 43205

Dr. Yang

Jingzhen (Ginger) Yang, PhD, MPH
Principal Investigator
Associate Professor, Center for Injury Research and Policy
The Research Institute at Nationwide Children’s Hospital
Dept. of Pediatrics, College of Medicine, The Ohio State University
Columbus, Ohio 43205 

MedicalResearch.com: What is the background for this study?

Response: From 2009-2014, all 50 states and the District of Columbia passed their state TBI laws, more commonly known as concussion laws, to mitigate severe consequences of concussions.

These laws often include 3 core components:

(1) mandatory removal from play following actual or suspected concussions,
(2) requirements to receive clearance to return to play from a licensed health professional, and
(3) education of coaches, parents, and athletes regarding concussion symptoms and signs.

Our study aimed to evaluate whether the laws achieve the intended impact.

MedicalResearch.com: What are the main findings?

Response: The main findings showed that:

  • The rates of new and recurrent concussions initially increase significantly after a law goes into effect. This is likely due to more people – athletes, athletic trainers, coaches, and parents – becoming aware of the signs and symptoms of concussion and actually reporting a potential or actual concussion. Lack of knowledge about concussion signs and symptoms may have resulted in underreporting of concussions during the prelaw period. This trend is consistent across sports in our study and other studies looking at youth sports-related concussions.
  • The rate of recurrent concussions shows a significant decline approximately 2 ½ years after the law is in place. This demonstrates that the laws are having an impact. One of the core function of these laws is to reduce the immediate risk of health consequences caused by continued play with concussion or returning to play too soon without full recovery. The decline in recurrent concussion rates in our study is likely the results of the laws requirements of mandatory removal from play or permission requirements to return to play.
  • Football had the highest average annual concussion rate, followed by girls’ soccer and boys’ wrestling. Males had a higher average annual concussion rate than females. However, when comparing the rates in gender comparable sports (basketball, soccer, baseball/softball), females had almost double the annual rate of concussions as males. These results are consistent with findings from other studies. It is possible that girls have higher risk of concussions than boys or are more likely to report injuries. Future studies are needed to look specifically at these disparities.

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New Biomarker Has Potential For Sideline Diagnosis of Traumatic Brain Injury

MedicalResearch.com Interview with:

Dr-Adrian-Harel.jpg

Dr. Adrian Harel

Dr. Adrian Harel, PhD
Chief Executive Officer
Medicortex Finland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Every 15 seconds, someone in the United States suffers a new head injury. Of the 2.5M people treated in hospital emergency rooms each year, 80,000 become permanently disabled because of TBI. Currently, there are no reliable diagnostic tests to assess the presence or severity of an injury on-site, nor are there any pharmaceutical therapies that could stop the secondary injury from spreading. Accurate diagnostics would benefit especially mild cases of TBI (concussions), which, if occurring repeatedly, may cause neurodegenerative conditions such as Chronic Traumatic Encephalopathy (which is typical for athletes in NFL and Ice-hockey).

We have performed extensive preclinical research comparing fluid biopsies from normal and injured lab animals. The results showed some unique biomarkers released as a biodegradation products after head injury. The data served as the basis and confirmation for our patent applications to protect the biomarker concept.

Medicortex has completed a clinical proof-of-concept trial in collaboration with Turku University Hospital (Tyks). Samples from 12 TBI patients and 12 healthy volunteers were collected and analyzed for the presence and for the level of the biomarker in state-of-the-art laboratories. The study demonstrated the diagnostic potential of the new biomarker in humans and it confirmed the prior preclinical findings. This was a significant milestone for Medicortex.

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MRI Biomarkers Track Cognitive Impairment Due to Head Trauma

MedicalResearch.com Interview with:

Virendra Mishra, Ph.D. Department of Imaging Research Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas

Dr. Virendra Mishra

Virendra Mishra, Ph.D.
Department of Imaging Research
Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Repetitive head trauma has been shown to be a risk factor for various neurodegenerative disorders, mood swings, depression and chronic traumatic encephalopathy. There has been a significant amount of research into identifying an imaging biomarker of mild traumatic brain injury (mTBI) due to repetitive head trauma. Unfortunately, most of the biomarkers have not been able to find a successful translation to clinics. Additionally, the quest for the mTBI imaging biomarker especially using Magnetic Resonance Imaging (MRI) techniques has been done by looking at either the gray matter (T1-weighted) or the white matter (Diffusion Tensor Imaging) independently; and both have shown changes that are associated with repetitive head trauma.

Hence in this study, we wanted to investigate if combining gray matter and white matter information enables us to better predict the fighters who are more vulnerable to cognitive decline due to repetitive head trauma. Our method found seven imaging biomarkers that when combined together in a multivariate sense were able to predict with greater than 73% accuracy those fighters who are vulnerable to cognitive decline both at baseline and follow-up. The imaging biomarkers were indeed a combination of gray and white matter measures of regions reported previously in the literature. A key point in our study was we found the regions predicting cognitive decline without enforcing any assumptions on the regions previously reported.

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Chronic Traumatic Encephalopathy Found In Brains of Nearly All NFL Players Examined

MedicalResearch.com Interview with:

Daniel H. Daneshvar, M.D., Ph.D. Chronic Traumatic Encephalopathy Center Team Up Against Concussions | Founder Boston University

Dr. Daneshvar

Daniel H. Daneshvar, M.D., Ph.D.
Chronic Traumatic Encephalopathy Center
Team Up Against Concussions | Founder
Boston University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive head impacts. CTE was first described in JAMA in 1928. In the 99 years since, just over 100 cases of CTE have been described in the world’s literature.

This study nearly doubles the number of reported cases of CTE, with 177 cases of CTE in football players. Of note, 110 of the 111 athletes who played in the NFL had CTE. This study represents the largest and the most methodologically rigorous description of a series of patients with CTE ever published. Such a richness of data regarding the clinical and pathological features of CTE has never been previously compiled. As such, this study represents an important advance to the medical literature and an enormous scientific advance in our understanding of  chronic traumatic encephalopathy.

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An Ultra-Early Inflammatory Biomarker of Traumatic Brain Injury

MedicalResearch.com Interview with:

Dr Lisa J Hill PhD Institute of Inflammation and Ageing Research Fellow Neuroscience and Ophthalmology Institute of Inflammation and Ageing College of Medical and Dental Sciences University of Birmingham UK

Dr. Hill

Dr Lisa J Hill PhD
Institute of Inflammation and Ageing
Research Fellow
Neuroscience and Ophthalmology
Institute of Inflammation and Ageing
College of Medical and Dental Sciences
University of Birmingham UK 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Traumatic brain injury (TBI) is the leading cause of death and disability among young adults and, according to the World Health Organization, by 2020 TBI will become the world’s leading cause of neurological disability across all age groups.  Early and correct diagnosis of traumatic brain injury is one of the most challenging aspects faced by clinicians. Being able to detect compounds in the blood that help to determine how severe the brain injury is would be of great benefit to patients and aid in their treatment.  Inflammatory markers are particularly suited for biomarker discovery as TBI leads to very early alterations in inflammatory proteins.  The discovery of reliable biomarkers for the management of TBI would improve clinical interventions.

We collected blood samples from 30 injured patients within the first hour of injury prior to the patient arriving at hospital and analysed them. Analysis of protein biomarkers from blood taken within the first hour of injury has never been carried out until now. We used a panel of 92 inflammation-associated human proteins when analysing the blood samples. The analysis identified three inflammatory proteins, known as CST5AXIN1 and TRAIL, as novel biomarkers of TBI.

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Saliva Test Can Predict Concussion Duration in Children

MedicalResearch.com Interview with:

Steven Daniel Hicks, MD, PhD Assistant Professor, Division of Academic General Pediatrics College of Medicine Penn State Health

Dr. Hicks

Steven Daniel Hicks, MD, PhD
Assistant Professor, Division of Academic General Pediatrics
College of Medicine
Penn State Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are about 3 million concussions in the US each year and the majority occur in children. Parents of children with concussions commonly cite length of recovery as a major concern, but pediatricians have no objective or accurate tests for addressing this concern.

Our research group previously identified small regulatory molecules called microRNAs that were altered in both the spinal fluid and saliva in children with traumatic brain injuries. In this study we investigated whether those microRNAs could predict duration of concussion symptoms. In 52 children with concussion we found a set of microRNAs that predict whether concussion symptoms would last beyond one month with over 80% accuracy. This was significantly more accurate than survey based tools such as the sports concussion assessment tool or a modified concussion clinical risk score. Interestingly, the microRNAs with predictive accuracy targeted pathways involved in brain repair and showed correlations with specific concussion symptoms.

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