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Du Z, Zhang J, Wang X, Zhuang Z, Liu Z. Bridging biomechanics with neuropathological and neuroimaging insights for mTBI understanding through multiscale and multiphysics computational modeling. Biomech Model Mechanobiol 2025; 24:361-381. [PMID: 39934580 DOI: 10.1007/s10237-024-01924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 12/27/2024] [Indexed: 02/13/2025]
Abstract
Mild traumatic brain injury (mTBI) represents a significant public health challenge in modern society. An in-depth analysis of the injury mechanisms, pathological forms, and assessment criteria of mTBI has underscored the pivotal role of craniocerebral models in comprehending and addressing mTBI. Research indicates that although existing finite element craniocerebral models have made strides in simulating the macroscopic biomechanical responses of the brain, they still fall short in accurately depicting the complexity of mTBI. Consequently, this paper emphasizes the necessity of integrating biomechanics, neuropathology, and neuroimaging to develop multiscale and multiphysics craniocerebral models, which are crucial for precisely capturing microscopic injuries, establishing pathological mechanical indicators, and simulating secondary and long-term brain functional impairments. The comprehensive analysis and in-depth discussion presented in this paper offer new perspectives and approaches for understanding, diagnosing, and preventing mTBI, potentially contributing to alleviating the global burden of mTBI.
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Affiliation(s)
- Zhibo Du
- School of Aerospace Engineering, Tsinghua University, Beijing, 100084, People's Republic of China
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, 100081, People's Republic of China
| | - Jiarui Zhang
- School of Aerospace Engineering, Tsinghua University, Beijing, 100084, People's Republic of China
| | - Xinghao Wang
- School of Aerospace Engineering, Tsinghua University, Beijing, 100084, People's Republic of China
| | - Zhuo Zhuang
- School of Aerospace Engineering, Tsinghua University, Beijing, 100084, People's Republic of China
| | - Zhanli Liu
- School of Aerospace Engineering, Tsinghua University, Beijing, 100084, People's Republic of China.
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2
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Li Y, Zhu J, Sang P, Bai Y, Lu J, Sun H, Wang S. Effect of Tiaoshen Changzhi acupuncture on behavior and striatum ΔFosB in rats with levodopa-induced dyskinesias. Biotechnol Genet Eng Rev 2024; 40:3916-3930. [PMID: 37212035 DOI: 10.1080/02648725.2023.2204694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/13/2023] [Indexed: 05/23/2023]
Abstract
This study aims to study the effffects of Tiaoshen Changzhi acupuncture on behavior and striatum ΔFosB in rats with Levodopa-induced Dyskinesias (LIDs). In this experimental study, Levodopa-induced Dyskinesia (LID) rat models were established by 6-OHDA double-target injection and randomly assigned to six groups, with ten rats in each group. The rats were subjected to difffferent interventions for 28 days, and their behavior was observed. Additionally, the content of ΔFosB, a marker of neuronal activation, in the rat striatum was detected by immunohistochemistry and qRT-PCR. In contrallateral rotation behavior experiment and AIM experiment, the score of the model group was significantly increased, compared with the model group, the score of the Western medicine group, the ordinary acupuncture group and the Tiaoshen Changzhi group was significantly decreased (P < 0.01), the score of the Western medicine group and the Tiaoshen Changzhi group was significantly lower than the ordinary acupuncture group (P < 0.01), there was no statistical significance between the Western medicine group and the Tiaoshen Changzhi group (P>0.05). In the left forelimb function test, the score of the model group was significantly decreased, and compared with the model group, the left forelimb function score of the Western medicine group, the ordinary acupuncture group and the Tiaoshen Changzhi group were significantly increased (P < 0.01). The left forelimb function score of the Western medicine group and the Tiaoshen Changzhi group was higher than the ordinary acupuncture group (P < 0.05, P < 0.01). There was no statistical significance between Western medicine group and Tiaoshen Changzhi group (P > 0.05). After treatment, the content of ΔFosB in the striatum of the Western medicine group, the ordinary acupuncture group and the Tiaoshen Changzhi acupuncture group all decreased, the Western medicine group was better than the ordinary acupuncture group (P < 0.01), and the Tiaoshen Changzhi acupuncture group was better than the ordinary acupuncture group (P < 0.05). Tiaoshen Changzhi acupuncture can improve the behavioral performance of LID rats, reduce abnormal involuntary movement and contralateral rotation behavior and enhance the motor function of the left forelimb of rats. One of its therapeutic mechanisms for LID may be to reduce the expression level of ΔFosB in the striatum of LID rats, thereby reducing the symptoms of LID rats.
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Affiliation(s)
- Yuan Li
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Jiamin Zhu
- The Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Peng Sang
- Heilongjiang Academy of Traditional Chinese Medicine, Harbin, China
| | - Yan Bai
- Heilongjiang Academy of Traditional Chinese Medicine, Harbin, China
| | - Jinrong Lu
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Hong Sun
- The Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Shun Wang
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China
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3
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Dougan CE, Roberts BL, Crosby AJ, Karatsoreos IN, Peyton SR. Short-term neural and glial response to mild traumatic brain injury in the hippocampus. Biophys J 2024; 123:3346-3354. [PMID: 39091025 PMCID: PMC11480756 DOI: 10.1016/j.bpj.2024.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/28/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024] Open
Abstract
Traumatic brain injury (TBI) is an established risk factor for developing neurodegenerative disease. However, how TBI leads from acute injury to chronic neurodegeneration is limited to postmortem models. There is a lack of connections between in vitro and in vivo TBI models that can relate injury forces to both macroscale tissue damage and brain function at the cellular level. Needle-induced cavitation (NIC) is a technique that can produce small cavitation bubbles in soft tissues, which allows us to relate small strains and strain rates in living tissue to ensuing acute cell death, tissue damage, and tissue remodeling. Here, we applied NIC to mouse brain slices to create a new model of TBI with high spatial and temporal resolution. We specifically targeted the hippocampus, which is a brain region critical for learning and memory and an area in which injury causes cognitive pathologies in humans and rodent models. By combining NIC with patch-clamp electrophysiology, we demonstrate that NIC in the cornu ammonis 3 region of the hippocampus dynamically alters synaptic release onto cornu ammonis 1 pyramidal neurons in a cannabinoid 1 receptor-dependent manner. Further, we show that NIC induces an increase in extracellular matrix protein GFAP associated with neural repair that is mitigated by cannabinoid 1 receptor antagonism. Together, these data lay the groundwork for advanced approaches in understanding how TBI impacts neural function at the cellular level and the development of treatments that promote neural repair in response to brain injury.
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Affiliation(s)
- Carey E Dougan
- Department of Chemical Engineering, University of Massachusetts Amherst, Amherst, Massachusetts; Department of Chemistry and Department of Engineering, Smith College, Northampton, Massachusetts
| | - Brandon L Roberts
- Neuroscience and Behavior Program, and Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts; Department of Zoology & Physiology, University of Wyoming, Laramie, Wyoming; Department of Animal Science, University of Wyoming, Laramie, Wyoming
| | - Alfred J Crosby
- Department of Polymer Science and Engineering, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Ilia N Karatsoreos
- Neuroscience and Behavior Program, and Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts.
| | - Shelly R Peyton
- Department of Chemical Engineering, University of Massachusetts Amherst, Amherst, Massachusetts; Department of Biomedical Engineering, Tufts University, Medford, Massachusetts.
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Duan S, Wang Z, Zhang W, Lu Y, Ma G. Effect of blast orientation, multi-point blasts, and repetitive blasts on brain injury. Med Eng Phys 2024; 127:104163. [PMID: 38692763 DOI: 10.1016/j.medengphy.2024.104163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
Explosions in the battlefield can result in brain damage. Research on the effects of shock waves on brain tissue mainly focuses on the effects of single-orientation blast waves, while there have been few studies on the dynamic response of the human brain to directional explosions in different planes, multi-point explosions and repetitive explosions. Therefore, the brain tissue response and the intracranial pressure (ICP) caused by different blast loadings were numerically simulated using the CONWEP method. In the study of the blast in different directions, the lateral explosion blast wave was found to cause greater ICP than did blasts from other directions. When multi-point explosions occurred in the sagittal plane simultaneously, the ICP in the temporal lobe increased by 37.8 % and the ICP in the parietal lobe decreased by 17.6 %. When multi-point explosions occurred in the horizontal plane, the ICP in the frontal lobe increased by 61.8 % and the ICP in the temporal lobe increased by 12.2 %. In a study of repetitive explosions, the maximum ICP of the second blast increased by 40.6 % over that of the first blast, and that of the third blast increased by 61.2 % over that of the second blast. The ICP on the brain tissue from repetitive blasts can exceed 200 % of that of a single explosion blast wave.
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Affiliation(s)
- Shuhuai Duan
- School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China
| | - Zhidong Wang
- School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China
| | - Wei Zhang
- School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China; State Key Laboratory of Structural Analysis, Optimization and CAE Software for Industrial Equipment, Dalian University of Technology, Dalian, China
| | - Yongtao Lu
- School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China; DUT-BSU joint Institute, Dalian University of Technology, Dalian, China
| | - Guojun Ma
- School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China; DUT-BSU joint Institute, Dalian University of Technology, Dalian, China; State Key Laboratory of Structural Analysis, Optimization and CAE Software for Industrial Equipment, Dalian University of Technology, Dalian, China.
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Varghese N, Morrison B. Partial Depletion of Microglia Attenuates Long-Term Potentiation Deficits following Repeated Blast Traumatic Brain Injury in Organotypic Hippocampal Slice Cultures. J Neurotrauma 2023; 40:547-560. [PMID: 36508265 PMCID: PMC10081725 DOI: 10.1089/neu.2022.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Blast-induced traumatic brain injury (bTBI) has been a health concern in both military and civilian populations due to recent military and geopolitical conflicts. Military service members are frequently exposed to repeated bTBI throughout their training and deployment. Our group has previously reported compounding functional deficits as a result of increased number of blast exposures. In this study, we further characterized the decrease in long-term potentiation (LTP) by varying the blast injury severity and the inter-blast interval between two blast exposures. LTP deficits were attenuated with increasing inter-blast intervals. We also investigated changes in microglial activation; expression of CD68 was increased and expression of CD206 was decreased after multiple blast exposures. Expression of macrophage inflammatory protein (MIP)-1α, interleukin (IL)-1β, monocyte chemoattractant protein (MCP)-1, interferon gamma-inducible protein (IP)-10, and regulated on activation, normal T cell expressed and secreted (RANTES) increased, while expression of IL-10 decreased in the acute period after both single and repeated bTBI. By partially depleting microglia prior to injury, LTP deficits after injury were significantly reduced. Treatment with the novel drug, MW-189, prevented LTP deficits when administered immediately following a repeated bTBI and even when administered only for an acute period (24 h) between two blast injuries. These findings could inform the development of therapeutic strategies to treat the neurological deficits of repeated bTBI suggesting that microglia play a major role in functional neuronal deficits and may be a viable therapeutic target to lessen the neurophysiological deficits after bTBI.
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Affiliation(s)
- Nevin Varghese
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Barclay Morrison
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
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6
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Hanna ME, Pfister BJ. Advancements in in vitro models of traumatic brain injury. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2022. [DOI: 10.1016/j.cobme.2022.100430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Yu X, Ghajari M. Protective Performance of Helmets and Goggles in Mitigating Brain Biomechanical Response to Primary Blast Exposure. Ann Biomed Eng 2022; 50:1579-1595. [PMID: 35296943 PMCID: PMC9652178 DOI: 10.1007/s10439-022-02936-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/15/2022] [Indexed: 12/02/2022]
Abstract
The current combat helmets are primarily designed to mitigate blunt impacts and ballistic loadings. Their protection against primary blast wave is not well studied. In this paper, we comprehensively assessed the protective capabilities of the advanced combat helmet and goggles against blast waves with different intensity and directions. Using a high-fidelity human head model, we compared the intracranial pressure (ICP), cerebrospinal fluid (CSF) cavitation, and brain strain and strain rate predicted from bare head, helmet-head and helmet-goggles-head simulations. The helmet was found to be effective in mitigating the positive ICP (24–57%) and strain rate (5–34%) in all blast scenarios. Goggles were found to be effective in mitigating the positive ICP in frontal (6–16%) and lateral (5–7%) blast exposures. However, the helmet and goggles had minimal effects on mitigating CSF cavitation and even increased brain strain. Further investigation showed that wearing a helmet leads to higher risk of cavitation. In addition, their presence increased the head kinetic energy, leading to larger strains in the brain. Our findings can improve our understanding of the protective effects of helmets and goggles and guide the design of helmet pads to mitigate brain responses to blast.
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Affiliation(s)
- Xiancheng Yu
- Dyson School of Design Engineering, Imperial College London, South Kensington, London, SW72AZ, UK. .,Centre for Blast Injury Studies, Imperial College London, South Kensington, London, SW72AZ, UK.
| | - Mazdak Ghajari
- Dyson School of Design Engineering, Imperial College London, South Kensington, London, SW72AZ, UK.,Centre for Blast Injury Studies, Imperial College London, South Kensington, London, SW72AZ, UK
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Dagro AM, Wilkerson JW, Thomas TP, Kalinosky BT, Payne JA. Computational modeling investigation of pulsed high peak power microwaves and the potential for traumatic brain injury. SCIENCE ADVANCES 2021; 7:eabd8405. [PMID: 34714682 PMCID: PMC8555891 DOI: 10.1126/sciadv.abd8405] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
When considering safety standards for human exposure to radiofrequency (RF) and microwave energy, the dominant concerns pertain to a thermal effect. However, in the case of high-power pulsed RF/microwave energy, a rapid thermal expansion can lead to stress waves within the body. In this study, a computational model is used to estimate the temperature profile in the human brain resulting from exposure to various RF/microwave incident field parameters. The temperatures are subsequently used to simulate the resulting mechanical response of the brain. Our simulations show that, for certain extremely high-power microwave exposures (permissible by current safety standards), very high stresses may occur within the brain that may have implications for neuropathological effects. Although the required power densities are orders of magnitude larger than most real-world exposure conditions, they can be achieved with devices meant to emit high-power electromagnetic pulses in military and research applications.
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Affiliation(s)
- Amy M. Dagro
- U.S. Army Research Laboratory, Aberdeen Proving Ground, MD 21005, USA
| | - Justin W. Wilkerson
- J. Mike ‘66 Department of Mechanical Engineering, Texas A&M University, College Station, TX 77843, USA
| | | | - Benjamin T. Kalinosky
- General Dynamics Information Technology, JBSA Fort Sam Houston, San Antonio, TX 78234, USA
| | - Jason A. Payne
- Air Force Research Laboratory, 711th Human Performance Wing, Airman Systems Directorate, Bioeffects Division, Radio Frequency Bioeffects Branch, JBSA Fort Sam Houston, San Antonio, TX 78234, USA
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Li W, Shepherd DET, Espino DM. Investigation of the Compressive Viscoelastic Properties of Brain Tissue Under Time and Frequency Dependent Loading Conditions. Ann Biomed Eng 2021; 49:3737-3747. [PMID: 34608583 PMCID: PMC8671270 DOI: 10.1007/s10439-021-02866-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 10/25/2022]
Abstract
The mechanical characterization of brain tissue has been generally analyzed in the frequency and time domain. It is crucial to understand the mechanics of the brain under realistic, dynamic conditions and convert it to enable mathematical modelling in a time domain. In this study, the compressive viscoelastic properties of brain tissue were investigated under time and frequency domains with the same physical conditions and the theory of viscoelasticity was applied to estimate the prediction of viscoelastic response in the time domain based on frequency-dependent mechanical moduli through Finite Element models. Storage and loss modulus were obtained from white and grey matter, of bovine brains, using dynamic mechanical analysis and time domain material functions were derived based on a Prony series representation. The material models were evaluated using brain testing data from stress relaxation and hysteresis in the time dependent analysis. The Finite Element models were able to represent the trend of viscoelastic characterization of brain tissue under both testing domains. The outcomes of this study contribute to a better understanding of brain tissue mechanical behaviour and demonstrate the feasibility of deriving time-domain viscoelastic parameters from frequency-dependent compressive data for biological tissue, as validated by comparing experimental tests with computational simulations.
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Affiliation(s)
- Weiqi Li
- Department of Mechanical Engineering, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Duncan E T Shepherd
- Department of Mechanical Engineering, University of Birmingham, Birmingham, B15 2TT, UK
| | - Daniel M Espino
- Department of Mechanical Engineering, University of Birmingham, Birmingham, B15 2TT, UK
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Huang X, Hu X, Zhang L, Cai Z. Craniocerebral Dynamic Response and Cumulative Effect of Damage Under Repetitive Blast. Ann Biomed Eng 2021; 49:2932-2943. [PMID: 33655420 DOI: 10.1007/s10439-021-02746-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/02/2021] [Indexed: 12/11/2022]
Abstract
Soldiers suffer from multiple explosions in complex battlefield environment resulting in aggravated brain injuries. At present, researches mostly focus on the damage to human body caused by single explosion. In the repetitive impact study, small animals are mainly used for related experiments to study brain nerve damage. No in-depth research has been conducted on the dynamic response and damage of human brain under repetitive explosion shock waves. Therefore, this study use the Euler-Lagrange coupling method to construct an explosion shock wave-head fluid-structure coupling model, and numerically simulated the brain dynamic response subjected to single and repetitive blast waves, obtained flow field pressure, skull stress, skull displacement, intracranial pressure to analyze the brain damage. The simulation results of 100 g equivalent of TNT exploding at 1 m in front of the craniocerebral show that repetitive blast increase skull stress, intracranial pressure, skull displacement, and the damage of brain tissue changes from moderate to severe. Repetitive blasts show a certain cumulative damage effect, the severity of damage caused by double blast is 122.5% of single shock, and the severity of damage caused by triple blast is 105.9% of double blast and 131.5% of single blast. The data above shows that it is necessary to reduce soldiers' exposure from repetitive blast waves.
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Affiliation(s)
- Xingyuan Huang
- Hunan University of Science and Technology, Xiangtan, 411201, China
| | - Xiaoping Hu
- Hunan University of Science and Technology, Xiangtan, 411201, China
| | - Lei Zhang
- Research Institute for National Defense Engineering of Academy of Military Science PLA China, Luoyang, 471023, China.
| | - Zhihua Cai
- Hunan University of Science and Technology, Xiangtan, 411201, China.
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Sekine Y, Saitoh D, Yoshimura Y, Fujita M, Araki Y, Kobayashi Y, Kusumi H, Yamagishi S, Suto Y, Tamaki H, Ono Y, Mizukaki T, Nemoto M. Efficacy of Body Armor in Protection Against Blast Injuries Using a Swine Model in a Confined Space with a Blast Tube. Ann Biomed Eng 2021; 49:2944-2956. [PMID: 33686618 PMCID: PMC8510944 DOI: 10.1007/s10439-021-02750-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/05/2021] [Indexed: 01/04/2023]
Abstract
The purpose of this study was to clarify whether or not body armor would protect the body of a swine model using a blast tube built at National Defense Medical College, which is the first such blast tube in Japan. Seventeen pigs were divided into two groups: the body armor group and the non-body armor group. Under intravenous anesthesia, the pigs were tightly fixed in the left lateral position on a table and exposed from the back neck to the upper lumbar back to the blast wave and wind with or without body armor, with the driving pressure of the blast tube set to 3.0 MPa. When the surviving and dead pigs were compared, blood gas analyses revealed significant differences in PaO2, PaCO2, and pH in the super-early phase. All pigs injured by the blast wave and wind had lung hemorrhage. All 6 animals in the body armor group and 6 of the 11 animals in the control group survived for 3 hours after injury. Respiratory arrest immediately after exposure to the blast wave was considered to influence the mortality in our pig model. Body armor may have a beneficial effect in protecting against respiratory arrest immediately after an explosion.
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Affiliation(s)
- Yasumasa Sekine
- Division of Traumatology, Research Institute, National Defense Medical College (NDMC), 3-2 Namiki, Tokorozawa, 359-8513 Japan ,Dept. of Traumatology and Critical Care Medicine, NDMC, 3-2 Namiki, Tokorozawa, 359-8513 Japan ,Dept. of Emergency and Trauma Care, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298 Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College (NDMC), 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Yuya Yoshimura
- Dept. of Traumatology and Critical Care Medicine, NDMC, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Masanori Fujita
- Division of Environmental Medicine, Research Institute, NDMC, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Yoshiyuki Araki
- Dept. of Defense Medicine, NDMC, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | | | - Hitomi Kusumi
- Dept. of Military Nursing, NDMC, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Satomi Yamagishi
- Dept. of Military Nursing, NDMC, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Yuki Suto
- Division of Traumatology, Research Institute, National Defense Medical College (NDMC), 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Hiroshi Tamaki
- Division of Graduate School, Dept. of Academic Affairs, NDMC, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Yosuke Ono
- Department of General Medicine, NDMC, 3-2 Namiki, Tokorozawa, 359-8513 Japan ,Military Medicine Research Unit, Test and Evaluation Command, Japan Ground Self Defense Force, 1-2-24 Ikejiri, setagaya-ku, Tokyo, 154-0004 Japan
| | - Toshiharu Mizukaki
- Dept. of Aeronautics and Astronautics, Tokai University, 4-1-1 Kitakaname, Hiratsuka, Kanagawa 259-1292 Japan
| | - Manabu Nemoto
- Dept. of Emergency and Trauma Care, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298 Japan
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