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Smith JA, Nguyen T, Davis BC, Lahiri DK, Hato T, Obukhov AG, White FA. Propranolol treatment during repetitive mild traumatic brain injuries induces transcriptomic changes in the bone marrow of mice. Front Neurosci 2023; 17:1219941. [PMID: 37817806 PMCID: PMC10561692 DOI: 10.3389/fnins.2023.1219941] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/25/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction There are 1.5 million new mild traumatic brain injuries (mTBI) annually in the US, with many of the injured experiencing long-term consequences lasting months after the injury. Although the post injury mechanisms are not well understood, current knowledge indicates peripheral immune system activation as a causal link between mTBI and long-term side effects. Through a variety of mechanisms, peripheral innate immune cells are recruited to the CNS after TBI to repair and heal the injured tissue; however, the recruitment and activation of these cells leads to further inflammation. Emerging evidence suggests sympathetic nervous system (SNS) activity plays a substantial role in the recruitment of immune cells post injury. Methods We sought to identify the peripheral innate immune response after repeated TBIs in addition to repurposing the nonselective beta blocker propranolol as a novel mTBI therapy to limit SNS activity and mTBI pathophysiology in the mouse. Mice underwent repetitive mTBI or sham injury followed by i.p. saline or propranolol. Isolated mRNA derived from femur bone marrow of mice was assayed for changes in gene expression at one day, one week, and four weeks using Nanostring nCounter® stem cell characterization panel. Results Differential gene expression analysis for bone marrow uncovered significant changes in many genes following drug alone, mTBI alone and drug combined with mTBI. Discussion Our data displays changes in mRNA at various timepoints, most pronounced in the mTBI propranolol group, suggesting a single dose propranolol injection as a viable future mTBI therapy in the acute setting.
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Affiliation(s)
- Jared A. Smith
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Tyler Nguyen
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Brittany C. Davis
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Debomoy K. Lahiri
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Takashi Hato
- Department of Medicine, Indiana University, Indianapolis, IN, United States
| | - Alexander G. Obukhov
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Fletcher A. White
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, United States
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Pirruccio K, Selemon NA, Ahn J, Cahill PJ, Baldwin KD. American football is the youth sporting activity most commonly associated with acute vertebral fractures. PHYSICIAN SPORTSMED 2021; 49:348-354. [PMID: 33078969 DOI: 10.1080/00913847.2020.1838874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Athletics confer cardiovascular fitness and improved cognitive processing in pediatric populations. However, one risk of sports participation is acute vertebral fracture, an injury with significant morbidity. It is currently unknown which sports represent the highest risk of acute vertebral fracture in pediatric populations. This study seeks to identify the youth sporting activities most commonly associated with acute vertebral fractures presenting to United States (U.S.) emergency departments (EDs). METHODS This cross-sectional, retrospective study queries the National Electronic Injury Surveillance System database to report national weighted estimates and demographic characteristics of pediatric patients with acute vertebral fractures presenting to U.S. EDs. RESULTS The mean annual incidence of estimated acute vertebral fractures over the study period was 1,672 (C.I. 1,217-2,126). From 2000-2001 (N = 4,030; C.I. 2,934-5,125) to 2016-2017 (N = 2,559; C.I. 1,681-3,438), there was no significant change in the estimated rate of sports-related acute vertebral fractures in pediatric patients (p = 0.09). American football was identified as the sport most frequently associated with acute vertebral fractures (23.4%; C.I. 17.6-29.3%). We found no appreciable change in the rate of football-related acute vertebral fractures over time, with 48.2% (C.I. 37.3-59.0%) occurring from 2000 to 2008 and 51.8% (C.I. 41.0-62.7%) from 2009 to 2017. CONCLUSIONS While sports-related acute vertebral fractures remain rare injuries in pediatric populations, we identify youth football as the sport associated with the highest risk of such injuries. Despite decreasing football participation rates over our study period, the annual incidence of football-associated acute vertebral fractures has not exhibited a proportional decline. Our findings raise concern that the relative risk of acute vertebral fracture associated with youth football has not significantly decreased over time. Elimination of dangerous tackling technique, improvement in helmet fit and technology, and availability of on-site medical care may contribute to decreased estimates in the future.
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Affiliation(s)
- Kevin Pirruccio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicolas A Selemon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick J Cahill
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Keith D Baldwin
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Mehta NK, Siegel J, Cowan B, Johnson J, Hojjat H, Chung MT, Carron MA. Head and Neck Injury Patterns among American Football Players. Ann Otol Rhinol Laryngol 2021; 131:463-470. [PMID: 34142563 DOI: 10.1177/00034894211026478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
IMPORTANCE American football is a popular high-impact sport, leading to 2.7 million injuries in the United States annually. Recent evidence in football-related neurological damage has spurred national interest in player-safety. Football players injure their head and neck in up to 26% of total injuries. Variation in injury patterns between age groups and correlated hospitalizations for football-related head and neck injury has yet to be characterized. OBJECTIVE Our aim is to evaluate injury patterns among American-football related head and neck trauma. METHODS A retrospective cohort study of patients with football-related head and neck injury in the National Electronic Injury Surveillance System (NEISS). RESULTS Nearly 100 000 ED visits for football-related head and neck injuries occur annually. Males comprised 95% of patients, with a median age of 13. The head comprised 70% of injuries followed by the face (13%). The most common diagnoses were concussions (39%), internal organ injury (26%), and lacerations (11%). Pediatric patients were more likely to sustain concussions while adults experienced more lacerations (P < .05%). Fractures and nerve damage were rare injuries but caused a disproportionate share of hospitalizations. CONCLUSION Pediatric males are most likely to present for emergency care from football-related injury to the head and neck. Evaluating physicians can anticipate concussions, internal organ injury, and lacerations among presenting patients. Concussions, facial fractures, and nerve damage are injuries most likely to lead to hospitalization.
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Affiliation(s)
- Neil K Mehta
- Wayne State University, Department of Otolaryngology, Division of Facial Plastic Surgery, Detroit, MI, USA
| | - Justin Siegel
- Wayne State University, Department of Otolaryngology, Division of Facial Plastic Surgery, Detroit, MI, USA
| | - Brandon Cowan
- Wayne State University, Department of Otolaryngology, Division of Facial Plastic Surgery, Detroit, MI, USA
| | - Jared Johnson
- Wayne State University, Department of Otolaryngology, Division of Facial Plastic Surgery, Detroit, MI, USA
| | - Houmehr Hojjat
- Wayne State University, Department of Otolaryngology, Division of Facial Plastic Surgery, Detroit, MI, USA
| | - Michael T Chung
- Wayne State University, Department of Otolaryngology, Division of Facial Plastic Surgery, Detroit, MI, USA
| | - Michael A Carron
- Wayne State University, Department of Otolaryngology, Division of Facial Plastic Surgery, Detroit, MI, USA
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Yengo-Kahn AM, Kelly PD, Liles DC, McKeithan LJ, Grisham CJ, Khan MS, Lee T, Kuhn AW, Bonfield CM, Zuckerman SL. The cost of a single concussion in American high school football: a retrospective cohort study. Concussion 2020; 5:CNC81. [PMID: 33204493 PMCID: PMC7653506 DOI: 10.2217/cnc-2020-0012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Aim: The potential financial burden of American football-related concussions (FRC) is unknown. Our objective was to describe the healthcare costs associated with an FRC and determine factors associated with increased costs. Methodology/results: A retrospective cohort study of concussed high school football players presenting between November 2017 and March 2020 was undertaken; 144 male high school football players were included. Total costs were about $115,000, for an average direct healthcare cost of $800.10/concussion. Visiting the emergency department (β = 502.29, 95% CI: 105.79–898.61; p = 0.01), the initial post-concussion symptom scale score (β = 0.39, 95% CI: 0.11–0.66; p = 0.01) and a post-concussion syndrome diagnosis (β = 670.37, 95% CI: 98.96–1241.79; p = 0.02) were each independently associated with total costs. Conclusion: A granular understanding of cost-driving factors associated with FRC is the first step in understanding the cost–effectiveness of prevention and treatment methods. The healthcare costs, or the costs incurred by the healthcare system, associated with a single concussion in American high school football are unknown. We reviewed the records of 144 high school football players who received concussion care at our sport concussion center and calculated the direct healthcare costs associated with the appointments, imaging studies and therapies received, when applicable. We found that each concussion results in about $800 of healthcare system spending. A few factors were associated with greater costs, including visiting the emergency department and having symptoms for over 1 month. Furthermore, the more symptoms an athlete had at their first clinic visit, the higher total cost of care. Understanding these costs can potentially help clinicians and researchers determine the best ways to maximize care while minimizing the costs.
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Affiliation(s)
- Aaron M Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Patrick D Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - David C Liles
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lydia J McKeithan
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,School of Medicine, Vanderbilt University, Nashville, TN 37232, USA
| | - Candace J Grisham
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,School of Medicine, Vanderbilt University, Nashville, TN 37232, USA
| | | | - Timothy Lee
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Andrew W Kuhn
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Orthopedic Surgery, Washington University in St Louis, St Louis, MO 63110, USA
| | - Christopher M Bonfield
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Tatlıcıoğlu E, Atalağ O, Kırmızıgil B, Kurt C, Acar MF. Side-to-side asymmetry in lower limb strength and hamstring-quadriceps strength ratio among collegiate American football players. J Phys Ther Sci 2019; 31:884-888. [PMID: 31871371 PMCID: PMC6879405 DOI: 10.1589/jpts.31.884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/07/2019] [Indexed: 11/30/2022] Open
Abstract
[Purpose] The present study aimed to investigate the lower limbs injury risk factors that
are based on conventional Hamstring to Quadriceps ratio and limb asymmetry index in
varsity American football players. [Participants and Methods] Twenty-six varsity American
football players aged 19–27 years and with 2.31 ± 1.29 years of American football
experience from Dogu Akdeniz University volunteered to undergo measurements of average
peak torque for isokinetic flexion and extension of dominant limb and non-dominant limb at
60°·s−1 and 300°·s−1. Hamstring to Quadriceps ratio and limb
asymmetry index were also calculated for Hamstring and Quadriceps muscles. [Results]
Statistical analysis revealed that dominant Quadriceps is stronger than non-dominant
Quadriceps at 60°·s−1 speed. No statistical difference was found between
dominant and non-dominant Hamstring peak torque at 60°·s−1 . Hamstring to
Quadriceps ratio determined as normal both for 60°·s−1 and
300°·s−1according to the currently reported cut off value (H:Q ratio >60).
Hamstring and Quadriceps limb asymmetry index also determined as normal (cut off value for
LSI 10%) at 60°·s−1. However, for both Hamstring and Quadriceps, side- to- side
strength asymmetry at 300°·s−1 was observed. [Conclusion] To prevent possible
lower limb injury and to increase performance, varsity American football players who are
actively training and competing might consider taking strength asymmetry into account to
tailor their strength training program accordingly.
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Affiliation(s)
- Enver Tatlıcıoğlu
- Sports Affair Directorate, Eastern Mediterranean University, Northern Cyprus
| | - Ozan Atalağ
- Department of Kinesiology and Exercise Sciences, University of Hawaii at Hilo, USA
| | - Berkiye Kırmızıgil
- Department of Physiotherapy and Rehabilitation, Eastern Mediterranean University, Northern Cyprus
| | - Cem Kurt
- School of Physical Education and Sports, Trakya University: Balkan Campus, 22030, Edirne, Turkey
| | - Mustafa Ferit Acar
- School of Physical Education and Sports, Girne American Univeristy, Northern Cyprus
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McGinity MJ, Grandhi R, Michalek JE, Rodriguez JS, Trevino AM, McGinity AC, Seifi A. Correction: The impact of tackle football injuries on the American healthcare system with a neurological focus. PLoS One 2018; 13:e0201273. [PMID: 30024960 PMCID: PMC6053222 DOI: 10.1371/journal.pone.0201273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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