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Subramaniam S, Akay M, Anastasio MA, Bailey V, Boas D, Bonato P, Chilkoti A, Cochran JR, Colvin V, Desai TA, Duncan JS, Epstein FH, Fraley S, Giachelli C, Grande-Allen KJ, Green J, Guo XE, Hilton IB, Humphrey JD, Johnson CR, Karniadakis G, King MR, Kirsch RF, Kumar S, Laurencin CT, Li S, Lieber RL, Lovell N, Mali P, Margulies SS, Meaney DF, Ogle B, Palsson B, A. Peppas N, Perreault EJ, Rabbitt R, Setton LA, Shea LD, Shroff SG, Shung K, Tolias AS, van der Meulen MC, Varghese S, Vunjak-Novakovic G, White JA, Winslow R, Zhang J, Zhang K, Zukoski C, Miller MI. Grand Challenges at the Interface of Engineering and Medicine. IEEE Open J Eng Med Biol 2024; 5:1-13. [PMID: 38415197 PMCID: PMC10896418 DOI: 10.1109/ojemb.2024.3351717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 02/29/2024] Open
Abstract
Over the past two decades Biomedical Engineering has emerged as a major discipline that bridges societal needs of human health care with the development of novel technologies. Every medical institution is now equipped at varying degrees of sophistication with the ability to monitor human health in both non-invasive and invasive modes. The multiple scales at which human physiology can be interrogated provide a profound perspective on health and disease. We are at the nexus of creating "avatars" (herein defined as an extension of "digital twins") of human patho/physiology to serve as paradigms for interrogation and potential intervention. Motivated by the emergence of these new capabilities, the IEEE Engineering in Medicine and Biology Society, the Departments of Biomedical Engineering at Johns Hopkins University and Bioengineering at University of California at San Diego sponsored an interdisciplinary workshop to define the grand challenges that face biomedical engineering and the mechanisms to address these challenges. The Workshop identified five grand challenges with cross-cutting themes and provided a roadmap for new technologies, identified new training needs, and defined the types of interdisciplinary teams needed for addressing these challenges. The themes presented in this paper include: 1) accumedicine through creation of avatars of cells, tissues, organs and whole human; 2) development of smart and responsive devices for human function augmentation; 3) exocortical technologies to understand brain function and treat neuropathologies; 4) the development of approaches to harness the human immune system for health and wellness; and 5) new strategies to engineer genomes and cells.
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Affiliation(s)
- Shankar Subramaniam
- Joan and Irwin Jacobs Endowed Chair in Bioengineering and Systems Biology, Distinguished Professor of Bioengineering, Computer Science & Engineering, Cellular & Molecular Medicine, and NanoengineeringUniversity of California San DiegoLa JollaCA92093-0412USA
| | - Metin Akay
- Department of Physical Medicine and Rehabilitation, Harvard Medical SchoolSpaulding Rehabilitation HospitalCharlestownMA02129USA
- Founding Chair of the Biomedical Engineering Department and John S. Dunn Professor of Biomedical EngineeringUniversity of HoustonHoustonTX77204-5060USA
- Donald Biggar Willett Professor in Engineering and Head of the Department of BioengineeringUrbanaIL61801USA
- Senior PartnerArtis VenturesSan FranciscoCA94111USA
| | - Mark A. Anastasio
- Department of Physical Medicine and Rehabilitation, Harvard Medical SchoolSpaulding Rehabilitation HospitalCharlestownMA02129USA
| | - Vasudev Bailey
- Department of Physical Medicine and Rehabilitation, Harvard Medical SchoolSpaulding Rehabilitation HospitalCharlestownMA02129USA
| | - David Boas
- Professor of Biomedical Engineering and Director of Neurophotonics CenterBoston University College of EngineeringBostonMA02215USA
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical SchoolSpaulding Rehabilitation HospitalCharlestownMA02129USA
| | - Ashutosh Chilkoti
- Alan L. Kaganov Professor of Biomedical Engineering and Chair of the Department of Biomedical EngineeringDuke UniversityDurhamNC27708USA
| | - Jennifer R. Cochran
- Senior Associate Vice Provost for Research and Addie and Al Macovski Professor of Bioengineering, Shriram CenterStanford University Schools of Medicine and EngineeringStanfordCA94305USA
| | - Vicki Colvin
- Vernon K Krieble Professor of Chemistry and Professor of EngineeringBrown UniversityProvidenceRI02912USA
| | - Tejal A. Desai
- Sorensen Family Dean of Engineering and Professor of EngineeringBrown UniversityProvidenceRI02912USA
| | - James S. Duncan
- Ebenezer K. Hunt Professor and Chair of Biomedical Engineering, Professor of Radiology & Biomedical ImagingYale UniversityNew HavenCT06520USA
| | - Frederick H. Epstein
- Mac Wade Professor of Biomedical Engineering and Professor of Radiology and Medical Imaging, Associate Dean for ResearchSchool of Engineering and Applied ScienceCharlottesvilleVA22904USA
| | - Stephanie Fraley
- Associate Professor of BioengineeringUniversity of California San DiegoLa JollaCA92093-0412USA
| | - Cecilia Giachelli
- Steven R. and Connie R. Rogel Endowed Professor for Cardiovascular Innovation in BioengineeringAssociate Vice Provost for ResearchSeattleWA98195USA
| | - K. Jane Grande-Allen
- Isabel C. Cameron Professor of Bioengineering, Department of BioengineeringRice UniversityHoustonTX77005USA
| | - Jordan Green
- Biomedical Engineering and Vice Chair for Research and TranslationDepartment of Biomedical EngineeringBaltimoreMD21218USA
| | - X. Edward Guo
- Professor of Biomedical Engineering and Department ChairNew YorkNY10027USA
| | - Isaac B. Hilton
- Assistant Professor of Bioengineering and BioSciencesRice UniversityHoustonTX77005USA
- Department of BioengineeringBioscience Research CollaborativeHoustonTX77030USA
| | - Jay D. Humphrey
- John C. Malone Professor of Biomedical EngineeringYale UniversityNew HavenCT06511USA
| | - Chris R Johnson
- Distinguished Professor of Computer Science, Research Professor of BioengineeringUniversity of UtahSalt Lake CityUT84112-9205USA
| | - George Karniadakis
- The Charles Pitts Robinson and John Palmer Barstow Professor of Applied Mathematics and EngineeringBrown UniversityProvidenceRI02912USA
| | - Michael R. King
- J. Lawrence Wilson Professor of Engineering, Chair, Department of Biomedical Engineering, Professor of Biomedical Engineering, Professor of Radiology and Radiological Sciences5824 Stevenson CenterNashvilleTN351631-1631USA
| | - Robert F. Kirsch
- Allen H. and Constance T. Ford Professor and Chair of Biomedical EngineeringCase Western Reserve UniversityClevelandOH44106USA
- Department of Biomedical EngineeringClevelandOH4410USA
| | - Sanjay Kumar
- California Institute for Quantitative BiosciencesUC BerkeleyBerkeleyCA94720USA
| | - Cato T. Laurencin
- University Professor and Albert and Wilda Van Dusen Distinguished Endowed Professor of Orthopaedic Surgery, CEO, The Cato T. Laurencin Institute for Regenerative EngineeringUconnFarmingtonCT06030-3711USA
| | - Song Li
- Department of BioengineeringUCLA Samueli School of EngineeringLos AngelesCA90095USA
| | - Richard L. Lieber
- Chief Scientific Officer and Senior Vice President, Shirley Ryan Ability Lab, Professor of Physiology and Biomedical EngineeringNorthwestern UniversityEvanstonIL60208USAUSA
| | - Nigel Lovell
- Graduate School of Biomedical EngineeringUniversity of New South WalesSydneyNSW2052Australia
| | - Prashant Mali
- Professor of BioengineeringUniversity of California San DiegoLa JollaCA92093-0412USA
| | - Susan S. Margulies
- Wallace H. Coulter Chair and Professor of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGA30332USA
| | - David F. Meaney
- Professor and Senior Associate DeanPenn EngineeringPhiladelphiaPA19104-6391USA
| | - Brenda Ogle
- Department of Biomedical Engineering, Professor, Department of Pediatrics, Director, Stem Cell InstituteUniversity of Minnesota-Twin CitiesMinneapolisMN55455USA
| | - Bernhard Palsson
- Y.C. Fung Endowed Professor in Bioengineering, Professor of PediatricsUniversity of California San DiegoLa JollaCA92093-0412USA
| | - Nicholas A. Peppas
- Cockrell Family Regents Chair in Engineering, Director, Institute of Biomaterials, Drug Delivery and Regenerative Medicine, Professor, McKetta Department of Chemical Engineering, Department of Biomedical Engineering, Department of Pediatrics, Department of Surgery and Perioperative Care, Dell Medical School, and Division of Molecular Pharmaceutics and Drug Delivery, College of PharmacyThe University of Texas at AustinAustinTX78712-1801USA
| | - Eric J. Perreault
- Vice President for Research, Professor of Biomedical Engineering, Professor of Physical Medicine and RehabilitationNorthwestern UniversityEvanstonIL60208USA
| | - Rick Rabbitt
- Professor of Biomedical Engineering, Neuroscience ProgramSal Lake CityUT84112USA
| | - Lori A. Setton
- Department Chair, Lucy & Stanley Lopata Distinguished Professor of Biomedical EngineeringWashington University in St. Louis, McKelvey School of EngineeringSt. LouisMO63130USA
| | - Lonnie D. Shea
- Biomedical EngineeringUniversity of MichiganAnn ArborMI48109USA
| | - Sanjeev G. Shroff
- Distinguished Professor of and Gerald E. McGinnis Chair in Bioengineering, Professor of Medicine, Swanson School of EngineeringUniversity of PittsburghPittsburghPA15261USA
| | - Kirk Shung
- Professor Emeritus of Biomedical Engineering, Alfred E. Mann Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCA90089USA
| | | | | | - Shyni Varghese
- Professor of Biomedical Engineering, Mechanical Engineering & Materials Science and OrthopaedicsDuke UniversityDurhamNC27710USA
| | - Gordana Vunjak-Novakovic
- University and Mikati Foundation Professor of Biomedical Engineering and Medical SciencesColumbia UniversityNew YorkNY10027USA
| | - John A. White
- Professor and Chair Department of Biomedical EngineeringBoston UniversityBostonMA02215USA
| | - Raimond Winslow
- Director of Life Science and Medical Research; Professor of BioengineeringNortheastern UniversityPortlandME04101USA
| | - Jianyi Zhang
- Department of Biomedical Engineering, T. Michael and Gillian Goodrich Endowed Chair of Engineering Leadership, Professor of Medicine, of Engineering, School of Medicine, School of EngineeringUAB | The University of Alabama at BirminghamU.K.
| | - Kun Zhang
- Chair/Professor of BioengineeringUniversity of California San DiegoLa JollaCA92093-0412USA
| | - Charles Zukoski
- Shelly and Ofer Nemirovsky Provost's Chair and Professor of Chemical Engineering and Materials Science and Biomedical Engineering, Alfred E. Mann Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCA90089USA
| | - Michael I. Miller
- Bessie Darling Massey Professor and Director, Department of Biomedical Engineering, Co-Director, Kavli Neuroscience Discovery InstituteJohns Hopkins University School of Medicine and Whiting School of EngineeringBaltimoreMD21218USA
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Patton DA, Huber CM, Fedonni D, Margulies SS, Master CL, Arbogast KB. Quantifying head impact exposure, mechanisms and kinematics using instrumented mouthguards in female high school lacrosse. Res Sports Med 2023; 31:772-786. [PMID: 35195503 PMCID: PMC9921769 DOI: 10.1080/15438627.2022.2042294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
Current debate exists regarding the need for protective headwear in female lacrosse. To inform this issue, the current study quantified head impact exposure, mechanisms and kinematics in female lacrosse using instrumented mouthguards. A female high school varsity lacrosse team of 17 players wore the Stanford Instrumented Mouthguard (MiG) during 14 competitive games. Video footage was reviewed to remove false-positive recordings and verify head impacts, which resulted in a rate of 0.32 head impacts per athlete-exposure. Of the 31 video-confirmed head impacts, 54.8% were identified as stick contacts, 38.7% were player contacts and 6.5% were falls. Stick contacts had the greatest peak head kinematics. The most common impact site was the side of the head (35.5%), followed by the face/jaw (25.8%), forehead (6.5%), and crown (6.5%). Impacts to the face/jaw region of the head had significantly (p < 0.05) greater peak kinematics compared to other regions of the head, which may have resulted from the interaction of the impacting surface, or the lower jaw, and the sensor. The current study provides initial data regarding the frequency, magnitude and site of impacts sustained in female high school lacrosse. A larger sample size of high quality head impact data in female lacrosse is required to confirm these findings.
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Affiliation(s)
- Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Colin M Huber
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniele Fedonni
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Oeur A, Torp WH, Arbogast KB, Master CL, Margulies SS. Altered Auditory and Visual Evoked Potentials following Single and Repeated Low-Velocity Head Rotations in 4-Week-Old Swine. Biomedicines 2023; 11:1816. [PMID: 37509456 PMCID: PMC10376588 DOI: 10.3390/biomedicines11071816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
Auditory and visually evoked potentials (EP) have the ability to monitor cognitive changes after concussion. In the literature, decreases in EP are commonly reported; however, a subset of studies shows increased cortical activity after injury. We studied auditory and visual EP in 4-week-old female Yorkshire piglets (N = 35) divided into anesthetized sham, and animals subject to single (sRNR) and repeated (rRNR) rapid non-impact head rotations (RNR) in the sagittal direction. Two-tone auditory oddball tasks and a simple white-light visual stimulus were evaluated in piglets pre-injury, and at days 1, 4- and 7 post injury using a 32-electrode net. Traditional EP indices (N1, P2 amplitudes and latencies) were extracted, and a piglet model was used to source-localize the data to estimate brain regions related to auditory and visual processing. In comparison to each group's pre-injury baselines, auditory Eps and brain activity (but not visual activity) were decreased in sham. In contrast, sRNR had increases in N1 and P2 amplitudes from both stimuli. The rRNR group had decreased visual N1 amplitudes but faster visual P2 latencies. Auditory and visual EPs have different change trajectories after sRNR and rRNR, suggesting that injury biomechanics are an important factor to delineate neurofunctional deficits after concussion.
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Affiliation(s)
- Anna Oeur
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA; (A.O.); (W.H.T.)
| | - William H. Torp
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA; (A.O.); (W.H.T.)
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA; (K.B.A.); (C.L.M.)
- Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Christina L. Master
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA; (K.B.A.); (C.L.M.)
- Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA 19104, USA
- Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Susan S. Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA; (A.O.); (W.H.T.)
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Oeur RA, Palaniswamy M, Ha M, Fernandez-Corazza M, Margulies SS. Regional variations distinguish auditory from visual evoked potentials in healthy 4 week old piglets. Physiol Meas 2023; 44:025006. [PMID: 36657178 PMCID: PMC9972182 DOI: 10.1088/1361-6579/acb4da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/19/2023] [Indexed: 01/21/2023]
Abstract
Objective.Evoked potentials (EP), measured using electroencephalographic (EEG) recordings provide an opportunity to monitor cognitive dysfunctions after neurological diseases or traumatic brain injury (TBI). The 4 week old piglet is an established model of paediatric TBI; therefore, healthy piglets were studied to establish feasibility of obtaining responses to auditory and visual stimuli. A secondary aim was to input the EEG data into a piglet computational model to localize the brain sources related to processing. We tested the hypotheses: (1) visual, auditory-standard, and auditory-target stimuli elicit responses, (2) there is an effect of stimulus type, day tested, and electrode region on EPs from EEG, (3) there is an effect of stimulus type, day tested, and brain region on localized sources from a computational model.Approach.Eleven 4 week old female piglets were fitted with a 32-electrode net and presented with a simple white light stimulus and an auditory oddball click train (70 standard; 30 target tones).Main results.N1 andP2 amplitudes were consistently observed for all stimulus types. Significant interaction effects between brain region and stimulus for EP and current density demonstrate that cognitive responses are specific to each modality with auditory localizing to the temporal region and visual to the occipital regions. There was a day effect where larger responses were found on the first day than day 2 and 3 and may be due to the novelty of the stimulus on the first day. Visual stimuli had largerP1 amplitudes and earlier latencies (P1,N1) than auditory which coincides with current density results at 50 ms where larger activations were observed for visual. At 85 ms, auditory had significantly larger current densities coincident with larger and longerN1 amplitudes and latencies than visual.Significance.Auditory and visual processing were successfully and consistently obtained in a porcine model and can be evaluated as a diagnostic assessment for TBI.
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Affiliation(s)
- R Anna Oeur
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Maduran Palaniswamy
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Matthew Ha
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Mariano Fernandez-Corazza
- LEICI Instituto de Investigaciones en Electrónica, Control y Procesamiento de Señales, Facultad de Ingeniería, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States of America,Author to whom any correspondence should be addressed
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Roby PR, Metzger KB, McDonald CC, Corwin DJ, Huber CM, Patton DA, Margulies SS, Grady MF, Master CL, Arbogast KB. Pre- and post-season visio-vestibular function in healthy adolescent athletes. PHYSICIAN SPORTSMED 2022; 50:522-530. [PMID: 34521303 PMCID: PMC8934744 DOI: 10.1080/00913847.2021.1980744] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/10/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate pre - to post-season differences in individual subtests of the Visio-Vestibular Examination (VVE) in healthy middle and high school athletes. METHODS This prospective cohort study recruited participants from a private suburban United States secondary school. Participants completed a demographic questionnaire prior to the start of their season. A proxy for head impact exposure was estimated by incorporating previously published head impact frequencies by team and sport. The VVE was completed pre - and post-season and consisted of 9 subtests: smooth pursuit, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. Generalized estimating equations were employed to assess the relative risk of an abnormal VVE outcome based on testing session (pre - vs. post-season). RESULTS Participants included middle and high school athletes (n = 115; female = 59 (51.3%); median age at first assessment = 14.9 years, [IQR = 13.6, 16.0]) during 2017/18 - 2019/20 school years. During pre-season testing, accommodation (10.0%) and complex tandem gait (9.2%) had the largest proportion of abnormal outcomes, while smooth pursuits (10.6%) and convergence (9.5%) had the largest proportion of abnormal outcomes post-season. When assessing the effect of testing session on the relative risk of any abnormal VVE subtest, there were no significant findings (P ≥ 0.25). Additionally, there were no significant effects of testing session when adjusting for estimated head impact exposure for any VVE subtest (P ≥ 0.25). CONCLUSIONS Visio-vestibular function as measured by the VVE does not change from pre - to post-season in otherwise healthy adolescent athletes. Our findings suggest that the VVE may be stable and robust to typical neurodevelopment occurring in this dynamic age group and help inform post-injury interpretation of visio-vestibular impairments.
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Affiliation(s)
- Patricia R Roby
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristina B Metzger
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine C McDonald
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Corwin
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Colin M Huber
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Declan A Patton
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan S Margulies
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Matthew F Grady
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Sports Medicine Performance Center, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christina L Master
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Sports Medicine Performance Center, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Arbogast KB, Ghosh RP, Corwin DJ, McDonald CC, Mohammed FN, Margulies SS, Barnett I, Master CL. Trajectories of Visual and Vestibular Markers of Youth Concussion. J Neurotrauma 2022; 39:1382-1390. [PMID: 35785959 PMCID: PMC9529314 DOI: 10.1089/neu.2022.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Visual and vestibular deficits, as measured by a visio-vestibular examination (VVE), are markers of concussion in youth. Little is known about VVE evolution post-injury, nor influence of age or sex on trajectory. The objective was to describe the time trend of abnormal VVE elements after concussion. Two cohorts, 11-18 years, were enrolled: healthy adolescents (n = 171) from a high school with VVE assessment before or immediately after their sport seasons and concussed participants (n = 255) from a specialty care concussion program, with initial assessment ≤28 days from injury and VVE repeated throughout recovery during clinical visits. The primary outcome, compared between groups, is the time course of recovery of the VVE examination, defined as the probability of an abnormal VVE (≥2/9 abnormal elements) and modeled as a cubic polynomial of days after injury. We explored whether probability trajectories differed by: age (<14 years vs. 14+ years), sex, concussion history (0 versus 1+), and days from injury to last assessment (≤28 days vs. 29+ days). Overall, abnormal VVE probability peaked at 0.57 at day 8 post-injury, compared with an underlying prevalence of 0.083 for uninjured adolescents. Abnormal VVE probability peaked higher for those 14+ years, female, with a concussion history and whose recovery course was longer than 28 days post-injury, compared with their appropriate strata subgroups. Females and those <14 years demonstrated slower resolution of VVE abnormalities. VVE deficits are common in adolescents after concussion, and the trajectory of resolution varies by age, sex, and concussion history. These data provide insight to clinicians managing concussions on the timing of deficit resolution after injury.
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Affiliation(s)
- Kristy B. Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Riddhi P. Ghosh
- Department of Mathematics and Statistics, Bowling Green State University, Bowling Green, Ohio, USA
| | - Daniel J. Corwin
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Catherine C. McDonald
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fairuz N. Mohammed
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan S. Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Ian Barnett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina L. Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Bluestein D, Dewey CF, Elad D, Gharib MM, Kamm RD, Lieber BB, Margulies SS, Slepian MJ, Tarbell J, Weinbaum SS. In Memoriam: Shmuel Einav, 1942-2022. J Biomech Eng 2022; 144:1141608. [PMID: 35698871 DOI: 10.1115/1.4054797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794
| | - C Forbes Dewey
- Departments of Biological Engineering and Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - David Elad
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Morteza Mory Gharib
- Aeronautics and Bioinspired Engineering, Division of Engineering and Applied Science, California Institute of Technology, Pasadena, CA 91125
| | - Roger D Kamm
- Departments of Biological Engineering and Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Barry B Lieber
- Department of Radiology, Tufts University School of Medicine, Medford, MA 02155
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA 30332
| | - Marvin J Slepian
- Department of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, AZ 85721
| | - John Tarbell
- Biomedical Engineering Department, The City College of New York, New York, NY 10031
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Jain D, Arbogast KB, McDonald CC, Podolak OE, Margulies SS, Metzger KB, Howell DR, Scheiman MM, Master CL. Eye Tracking Metrics Differences among Uninjured Adolescents and Those with Acute or Persistent Post-Concussion Symptoms. Optom Vis Sci 2022; 99:616-625. [PMID: 35848958 PMCID: PMC9361745 DOI: 10.1097/opx.0000000000001921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Eye tracking assessments that include pupil metrics can supplement current clinical assessments of vision and autonomic dysfunction in concussed adolescents. PURPOSE This study aimed to explore the utility of a 220-second eye tracking assessment in distinguishing eye position, saccadic movement, and pupillary dynamics among uninjured adolescents, those with acute post-concussion symptoms (≤28 days since concussion), or those with persistent post-concussion symptoms (>28 days since concussion). METHODS Two hundred fifty-six eye tracking metrics across a prospective observational cohort of 180 uninjured adolescents recruited from a private suburban high school and 224 concussed adolescents, with acute or persistent symptoms, recruited from a tertiary care subspecialty concussion care program, 13 to 17 years old, from August 2017 to June 2021 were compared. Kruskal-Wallis tests were used, and Bonferroni corrections were applied to account for multiple comparisons and constructed receiver operating characteristic curves. Principal components analysis and regression models were applied to determine whether eye tracking metrics can augment clinical and demographic information in differentiating uninjured controls from concussed adolescents. RESULTS Two metrics of eye position were worse in those with concussion than uninjured adolescents, and only one metric was significantly different between acute cases and persistent cases. Concussed adolescents had larger left and right mean, median, minimum, and maximum pupil size than uninjured controls. Concussed adolescents had greater differences in mean, median, and variance of left and right pupil size. Twelve metrics distinguished female concussed participants from uninjured; only four were associated with concussion status in males. A logistic regression model including clinical and demographics data and transformed eye tracking metrics performed better in predicting concussion status than clinical and demographics data alone. CONCLUSIONS Objective eye tracking technology is capable of quickly identifying vision and pupillary disturbances after concussion, augmenting traditional clinical concussion assessments. These metrics may add to existing clinical practice for monitoring recovery in a heterogeneous adolescent concussion population.
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Affiliation(s)
| | | | | | - Olivia E Podolak
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan S Margulies
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | | | | | - Mitchell M Scheiman
- Pennsylvania College of Optometry, Salus University, Philadelphia, Pennsylvania
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Yehya N, Fazelinia H, Taylor DM, Lawrence GG, Spruce LA, Thompson JM, Margulies SS, Seeholzer SH, Worthen GS. Differentiating children with sepsis with and without acute respiratory distress syndrome using proteomics. Am J Physiol Lung Cell Mol Physiol 2022; 322:L365-L372. [PMID: 34984927 PMCID: PMC8873032 DOI: 10.1152/ajplung.00164.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Both sepsis and acute respiratory distress syndrome (ARDS) rely on imprecise clinical definitions leading to heterogeneity, which has contributed to negative trials. Because circulating protein/DNA complexes have been implicated in sepsis and ARDS, we aimed to develop a proteomic signature of DNA-bound proteins to discriminate between children with sepsis with and without ARDS. We performed a prospective case-control study in 12 children with sepsis with ARDS matched to 12 children with sepsis without ARDS on age, severity of illness score, and source of infection. We performed co-immunoprecipitation and downstream proteomics in plasma collected ≤ 24 h of intensive care unit admission. Expression profiles were generated, and a random forest classifier was used on differentially expressed proteins to develop a signature which discriminated ARDS. The classifier was tested in six independent blinded samples. Neutrophil and nucleosome proteins were over-represented in ARDS, including two S100A proteins, superoxide dismutase (SOD), and three histones. Random forest produced a 10-protein signature that accurately discriminated between children with sepsis with and without ARDS. This classifier perfectly assigned six independent blinded samples as having ARDS or not. We validated higher expression of the most informative discriminating protein, galectin-3-binding protein, in children with ARDS. Our methodology has applicability to isolation of DNA-bound proteins from plasma. Our results support the premise of a molecular definition of ARDS, and give preliminary insight into why some children with sepsis, but not others, develop ARDS.
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Affiliation(s)
- Nadir Yehya
- 1Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hossein Fazelinia
- 2Proteomics Core, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Deanne M. Taylor
- 3Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,6Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gladys G. Lawrence
- 4Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lynn A. Spruce
- 2Proteomics Core, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jill M. Thompson
- 1Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan S. Margulies
- 5Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Steven H. Seeholzer
- 2Proteomics Core, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - G. Scott Worthen
- 6Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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10
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Master CL, Podolak OE, Ciuffreda KJ, Metzger KB, Joshi NR, McDonald CC, Margulies SS, Grady MF, Arbogast KB. Utility of Pupillary Light Reflex Metrics as a Physiologic Biomarker for Adolescent Sport-Related Concussion. JAMA Ophthalmol 2021; 138:1135-1141. [PMID: 32970102 DOI: 10.1001/jamaophthalmol.2020.3466] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Concussion diagnosis remains clinical, without objective diagnostic tests available for adolescents. Known deficits in visual accommodation and autonomic function after concussion make the pupillary light reflex (PLR) a promising target as an objective physiological biomarker for concussion. Objective To determine the potential utility of PLR metrics as physiological biomarkers for concussion. Design, Setting, and Participants Prospective cohort of adolescent athletes between ages 12 and 18 years recruited between August 1, 2017, and December 31, 2018. The study took place at a specialty concussion program and private suburban high school and included healthy control individuals (n = 134) and athletes with a diagnosis of sport-related concussion (SRC) (n = 98). Analysis was completed June 30, 2020. Exposures Sports-related concussion and pupillometry assessments. Main Outcomes and Measures Pupillary light reflex metrics (maximum and minimum pupillary diameter, peak and average constriction/dilation velocity, percentage constriction, and time to 75% pupillary redilation [T75]). Results Pupillary light reflex metrics of 134 healthy control individuals and 98 athletes with concussion were obtained a median of 12.0 days following injury (interquartile range [IQR], 5.0-18.0 days). Eight of 9 metrics were significantly greater among athletes with concussion after Bonferroni correction (maximum pupil diameter: 4.83 mm vs 4.01 mm; difference, 0.82; 99.44% CI, 0.53-1.11; minimum pupil diameter: 2.96 mm vs 2.63 mm; difference, 0.33; 99.4% CI, 0.18-0.48; percentage constriction: 38.23% vs 33.66%; difference, 4.57; 99.4% CI, 2.60-6.55; average constriction velocity: 3.08 mm/s vs 2.50 mm/s; difference, 0.58; 99.4% CI, 0.36-0.81; peak constriction velocity: 4.88 mm/s vs 3.91 mm/s; difference, 0.97; 99.4% CI, 0.63-1.31; average dilation velocity, 1.32 mm/s vs 1.22 mm/s; difference, 0.10; 99.4% CI, 0.00-0.20; peak dilation velocity: 1.83 mm/s vs 1.64 mm/s; difference, 0.19; 99.4% CI, 0.07-0.32; and T75: 1.81 seconds vs 1.51 seconds; difference, 0.30; 0.10-0.51). In exploratory analyses, sex-based differences were observed, with girls with concussion exhibiting longer T75 (1.96 seconds vs 1.63 seconds; difference, 0.33; 99.4% CI, 0.02-0.65). Among healthy control individuals, diminished PLR metrics (eg, smaller maximum pupil size 3.81 mm vs 4.22 mm; difference, -0.41; 99.4% CI, -0.77 to 0.05) were observed after exercise. Conclusions and Relevance These findings suggest that enhancement of PLR metrics characterize acute adolescent concussion, while exercise produced smaller pupil sizes and overall slowing of PLR metrics, presumably associated with fatigue. Quantifiable measures of the PLR may serve in the future as objective physiologic biomarkers for concussion in the adolescent athlete.
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Affiliation(s)
- Christina L Master
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Olivia E Podolak
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Kristina B Metzger
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nabin R Joshi
- College of Optometry, State University of New York, New York
| | - Catherine C McDonald
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia.,University of Pennsylvania School of Nursing, Philadelphia
| | - Susan S Margulies
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta
| | - Matthew F Grady
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia
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11
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Huber CM, Patton DA, Jain D, Master CL, Margulies SS, McDonald CC, Arbogast KB. Variations in Head Impact Rates in Male and Female High School Soccer. Med Sci Sports Exerc 2021; 53:1245-1251. [PMID: 33986230 PMCID: PMC8122001 DOI: 10.1249/mss.0000000000002567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Repetitive head impacts in soccer have been linked to short-term neurophysiological deficits, and female soccer players have higher concussion rates than males. These findings have inspired investigation into gender differences in head impact exposure and how head impact rate contributes to the cumulative effect of head impact exposure on neurological outcomes. Various periods of exposure have been used to calculate head impact rates, including head impacts per season, game, and player-hour. PURPOSE The aim of this study was to apply different methodological approaches to quantify and compare head impact rates by gender for two seasons of high school varsity soccer. METHODS Video review was used to confirm all events recorded by a headband-mounted impact sensor and calculate playing time for all players. Impact rates were calculated per athlete exposure (presence and participation) and per player-hour (scheduled game time, individual play time, and absolute time). RESULTS Impact rates per athlete exposure ranged from 2.5 to 3.2 for males and from 1.4 to 1.6 for females, and impact rates per player-hour ranged from 2.7 to 3.8 for males and from 1.0 to 1.6 for females. The exposure calculation method significantly affected head impact rates; however, regardless of approach, the head impact rate for males was higher, up to threefold, than for females. Individual head impact exposure varied substantially within a team with one in five players experiencing no impacts. CONCLUSIONS Overall, the gender differences found in this study indicate that males experience higher head impact exposure compared with females. Future studies are needed to understand potential clinical implications of variability in head impact exposure and reconcile higher female concussion rates with the reduced head impact rates presented herein.
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Affiliation(s)
- Colin M Huber
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA,Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Declan A. Patton
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Divya Jain
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA,Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Christina L. Master
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA,Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, Philadelphia, PA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan S. Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Catherine C. McDonald
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA,School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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12
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Wu T, Hajiaghamemar M, Giudice JS, Alshareef A, Margulies SS, Panzer MB. Evaluation of Tissue-Level Brain Injury Metrics Using Species-Specific Simulations. J Neurotrauma 2021; 38:1879-1888. [PMID: 33446011 PMCID: PMC8219195 DOI: 10.1089/neu.2020.7445] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Traumatic brain injury (TBI) is a significant public health burden, and the development of advanced countermeasures to mitigate and prevent these injuries during automotive, sports, and military impact events requires an understanding of the intracranial mechanisms related to TBI. In this study, the efficacy of tissue-level injury metrics for predicting TBI was evaluated using finite element reconstructions from a comprehensive, multi-species TBI database. The database consisted of human volunteer tests, laboratory-reconstructed head impacts from sports, in vivo non-human primate (NHP) tests, and in vivo pig tests. Eight tissue-level metrics related to brain tissue strain, axonal strain, and strain-rate were evaluated using survival analysis for predicting mild and severe TBI risk. The correlation between TBI risk and most of the assessed metrics were statistically significant, but when injury data was analyzed by species, the best metric was often inconclusive and limited by the small datasets. When the human and animal datasets were combined, the injury analysis was able to delineate maximum axonal strain as the best predictor of injury for all species and TBI severities, with maximum principal strain as a suitable alternative metric. The current study is the first to provide evidence to support the assumption that brain strain response between human, pig, and NHP result in similar injury outcomes through a multi-species analysis. This assumption is the biomechanical foundation for translating animal brain injury findings to humans. The findings in the study provide fundamental guidelines for developing injury criteria that would contribute towards the innovation of more effective safety countermeasures.
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Affiliation(s)
- Taotao Wu
- Center for Applied Biomechanics, University of Virginia, Charlottesville, Virginia, USA
| | - Marzieh Hajiaghamemar
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, Texas, USA
| | - J. Sebastian Giudice
- Center for Applied Biomechanics, University of Virginia, Charlottesville, Virginia, USA
| | - Ahmed Alshareef
- Center for Applied Biomechanics, University of Virginia, Charlottesville, Virginia, USA
| | - Susan S. Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Matthew B. Panzer
- Center for Applied Biomechanics, University of Virginia, Charlottesville, Virginia, USA
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Patton DA, Huber CM, Margulies SS, Master CL, Arbogast KB. NON-HEADER IMPACT EXPOSURE AND KINEMATICS OF MALE YOUTH SOCCER PLAYERS. Biomed Sci Instrum 2021; 57:106-113. [PMID: 36238448 PMCID: PMC9555802 DOI: 10.34107/yhpn9422.04106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Previous studies have investigated the head impact kinematics of purposeful heading in youth soccer; however, less than a third of all head injuries in youth soccer have been found to involve ball contact. The aim of the current study was to identity the head impact kinematics and exposure not associated with purposeful heading of the ball in male youth soccer. Headband-mounted sensors were used to monitor the head kinematics of male junior varsity and middle school teams during games. Video analysis of sensor-recorded events was used to code impact mechanism, surface and site. Junior varsity players had non-header impact rates of 0.28 per athlete-exposure (AE) and 0.37 per player-hour (PH), whereas middle school players had relatively lower non-header impact rates of 0.16 per AE and 0.25 per PH. Such impact rates fell within the large range of values reported by previous studies, which is likely affected by sensor type and recording trigger threshold. The most common non-header impact mechanism in junior varsity soccer was player contact, whereas ball-to-head was the most common non-header impact mechanism in middle school soccer. Non-header impacts for junior varsity players had median peak kinematics of 31.0 g and 17.4 rad/s. Non-header impacts for middle school players had median peak kinematics of 40.6 g and 16.2 rad/s. For non-header impacts, ball impacts to the rear of the head the highest peak kinematics recorded by the sensor. Such data provide targets for future efforts in injury prevention, such as officiating efforts to control player-to-player contact.
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Affiliation(s)
- Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Colin M Huber
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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14
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Huber CM, Patton DA, McDonald CC, Jain D, Simms K, Lallo VA, Margulies SS, Master CL, Arbogast KB. Sport- and Gender-Based Differences in Head Impact Exposure and Mechanism in High School Sports. Orthop J Sports Med 2021; 9:2325967120984423. [PMID: 33738313 PMCID: PMC7933779 DOI: 10.1177/2325967120984423] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Repeated head impacts sustained by athletes have been linked to short-term neurophysiologic deficits; thus, there is growing concern about the number of head impacts sustained in sports. Accurate head impact exposure data obtained via head impact sensors may help identify appropriate strategies across sports and between genders to mitigate repetitive head impacts. Purpose: To quantify sport- and gender-based differences in head impact rate and mechanism for adolescents. Study Design: Cohort study; Level of evidence, 2. Methods: High school female and male varsity soccer, basketball, lacrosse, and field hockey (female only) teams were instrumented with headband-mounted impact sensors during games over 2 seasons of soccer and 1 season of basketball, lacrosse, and field hockey. Video review was used to remove false-positive sensor-recorded events, and the head impact rate per athlete-exposure (AE) was calculated. Impact mechanism was categorized as equipment to head, fall, player to head, or head to ball (soccer only). Results: Male players had significantly higher head impact rates as compared with female players in soccer (3.08 vs 1.41 impacts/AE; rate ratio, 2.2 [95% CI, 1.8-2.6]), basketball (0.90 vs 0.25; 3.6 [2.6-4.6]), and lacrosse (0.83 vs 0.06; 12.9 [10.1-15.8]). Impact mechanism distributions were similar within sports between boys and girls. In soccer, head to ball represented 78% of impacts, whereas at least 88% in basketball were player-to-player contact. Conclusion: Across sports for boys and girls, soccer had the highest impact rate. Male high school soccer, basketball, and lacrosse teams had significantly higher head impact rates than did female teams of the same sport. For girls, basketball had a higher head impact rate than did lacrosse and field hockey, and for boys, basketball had a similar impact rate to lacrosse, a collision sport. Sport differences in the distribution of impact mechanisms create sport-specific targets for reducing head impact exposure.
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Affiliation(s)
- Colin M Huber
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Catherine C McDonald
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Divya Jain
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katherine Simms
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Valerie A Lallo
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Biomedical Engineering Department, Widener University, Chester, Pennsylvania, USA
| | - Susan S Margulies
- Walter H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Huber CM, Patton DA, Wofford KL, Margulies SS, Cullen DK, Arbogast KB. Laboratory Assessment of a Headband-Mounted Sensor for Measurement of Head Impact Rotational Kinematics. J Biomech Eng 2021; 143:024502. [PMID: 32975553 PMCID: PMC10782863 DOI: 10.1115/1.4048574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/31/2020] [Indexed: 11/08/2022]
Abstract
Head impact sensors measure head kinematics in sports, and sensor accuracy is crucial for investigating the potential link between repetitive head loading and clinical outcomes. Many validation studies mount sensors to human head surrogates and compare kinematic measures during loading from a linear impactor. These studies are often unable to distinguish intrinsic instrumentation limitations from variability caused by sensor coupling. The aim of the current study was to evaluate intrinsic sensor error in angular velocity in the absence of coupling error for a common head impact sensor. Two Triax SIM-G sensors were rigidly attached to a preclinical rotational injury device and subjected to rotational events to assess sensor reproducibility and accuracy. Peak angular velocities between the SIM-G sensors paired for each test were correlated (R2 > 0.99, y = 1.00x, p < 0.001). SIM-G peak angular velocity correlated with the reference (R2 = 0.96, y = 0.82x, p < 0.001); however, SIM-G underestimated the magnitude by 15.0% ± 1.7% (p < 0.001). SIM-G angular velocity rise time (5% to 100% of peak) correlated with the reference (R2 = 0.97, y = 1.06x, p < 0.001) but exhibited a slower fall time (100% to 5% of peak) by 9.0 ± 3.7 ms (p < 0.001). Assessing sensor performance when rigidly coupled is a crucial first step to interpret on-field SIM-G rotational kinematic data. Further testing in increasing biofidelic conditions is needed to fully characterize error from other sources, such as coupling.
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Affiliation(s)
- Colin M. Huber
- Department of Bioengineering, University of Pennsylvania, 2716 South Street, Philadelphia, PA 19146; Children's Hospital of Philadelphia, Center for Injury Research and Prevention (CIRP), 2716 South Street, Philadelphia, PA 19146
| | - Declan A. Patton
- Children's Hospital of Philadelphia, Center for Injury Research and Prevention (CIRP), 2716 South Street, Philadelphia, PA 19146
| | - Kathryn L. Wofford
- Department of Neurosurgery, University of Pennsylvania, 3320 Smith Walk, 105 Hayden Hall, Philadelphia, PA 19104
| | - Susan S. Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, U.A. Whitaker Building, 313 Ferst Drive, Suite 2116, Atlanta, GA 30332-0535
| | - D. Kacy Cullen
- Department of Neurosurgery, Center for Brain Injury & Repair, University of Pennsylvania, 3320 Smith Walk, 105E Hayden Hall, Philadelphia, PA 19104; Department of Bioengineering, University of Pennsylvania, 3320 Smith Walk, 105E Hayden Hall, Philadelphia, PA 19104
| | - Kristy B. Arbogast
- Children's Hospital of Philadelphia, Center for Injury Research and Prevention (CIRP), 2716 South Street, Philadelphia, PA 19146; Department of Pediatrics, University of Pennsylvania, 2716 South Street, Philadelphia, PA 19146
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Karlsson M, Yang Z, Chawla S, Delso N, Pukenas B, Elmér E, Hugerth M, Margulies SS, Ehinger J, Hansson MJ, Wang KKW, Kilbaugh TJ. Evaluation of Diffusion Tensor Imaging and Fluid Based Biomarkers in a Large Animal Trial of Cyclosporine in Focal Traumatic Brain Injury. J Neurotrauma 2021; 38:1870-1878. [PMID: 33191835 DOI: 10.1089/neu.2020.7317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
All phase III trials evaluating medical treatments for traumatic brain injury (TBI), performed to date, have failed. To facilitate future success there is a need for novel outcome metrics that can bridge pre-clinical studies to clinical proof of concept trials. Our objective was to assess diffusion tensor imaging (DTI) and biofluid-based biomarkers as efficacy outcome metrics in a large animal study evaluating the efficacy of cyclosporine in TBI. This work builds on our previously published study that demonstrated a reduced volume of injury by 35% with cyclosporine treatment based on magnetic resonance imaging (MRI) results. A focal contusion injury was induced in piglets using a controlled cortical impact (CCI) device. Cyclosporine in a novel Cremophor/Kolliphor EL-free lipid emulsion, NeuroSTAT, was administered by continuous intravenous infusion for 5 days. The animals underwent DTI on day 5. Glial fibrillary acidic protein (GFAP), as a measure of astroglia injury, and neurofilament light (NF-L), as a measure of axonal injury, were measured in blood on days 1, 2, and 5, and in cerebrospinal fluid (CSF) on day 5 post-injury. Normalized fractional anisotropy (FA) was significantly (p = 0.027) higher in in the treatment group, indicating preserved tissue integrity with treatment. For the biomarkers, we observed a statistical trend of a decreased level of NF-L in CSF (p = 0.051), in the treatment group relative to placebo, indicating less axonal injury. Our findings suggest that DTI, and possibly CSF NF-L, may be feasible as translational end-points assessing neuroprotective drugs in TBI.
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Affiliation(s)
- Michael Karlsson
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark.,Mitochondrial Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, USA
| | - Zhihui Yang
- Program for Neurotrauma, Neuroproteomics, and Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
| | - Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine at University of Pennsylvania, Philadelphia, USA
| | - Nile Delso
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, USA
| | - Bryan Pukenas
- Department of Radiology, Perelman School of Medicine at University of Pennsylvania, Philadelphia, USA
| | - Eskil Elmér
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.,Abliva AB, Lund, Sweden
| | | | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Johannes Ehinger
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Magnus J Hansson
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.,Abliva AB, Lund, Sweden
| | - Kevin K W Wang
- Program for Neurotrauma, Neuroproteomics, and Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
| | - Todd J Kilbaugh
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, USA
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Oeur RA, Margulies SS. Target detection in healthy 4-week old piglets from a passive two-tone auditory oddball paradigm. BMC Neurosci 2020; 21:52. [PMID: 33287727 PMCID: PMC7720395 DOI: 10.1186/s12868-020-00601-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/06/2020] [Accepted: 11/16/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Passive auditory oddball tests are effort independent assessments that evaluate auditory processing and are suitable for paediatric patient groups. Our goal was to develop a two-tone auditory oddball test protocol and use this clinical assessment in an immature large animal model. Event-related potentials captured middle latency P1, N1, and P2 responses in 4-week old (N = 16, female) piglets using a custom piglet 32- electrode array on 3 non-consecutive days. The effect of target tone frequency (250 Hz and 4000 Hz) on middle latency responses were tested in a subset of animals. RESULTS Results show that infrequent target tone pulses elicit greater N1 amplitudes than frequent standard tone pulses. There was no effect of day. Electrodes covering the front of the head tend to elicit greater waveform responses. P2 amplitudes increased for higher frequency target tones (4000 Hz) than the regular 1000 Hz target tones (p < 0.05). CONCLUSIONS Two-tone auditory oddball tests produced consistent responses day-to-day. This clinical assessment was successful in the immature large animal model.
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Affiliation(s)
- R Anna Oeur
- Wallace H. Coulter Department of Biomedical Engineering, Emory University, 615 Michael St. Suite 655, Atlanta, GA, USA
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Emory University, 615 Michael St. Suite 655, Atlanta, GA, USA.
- Emory University, Health Sciences Research Building 1760 Haygood Drive, Suite W242, 30322, Atlanta, Georgia.
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18
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Corwin DJ, McDonald CC, Arbogast KB, Mohammed FN, Metzger KB, Pfeiffer MR, Patton DA, Huber CM, Margulies SS, Grady MF, Master CL. Clinical and Device-based Metrics of Gait and Balance in Diagnosing Youth Concussion. Med Sci Sports Exerc 2020; 52:542-548. [PMID: 31524833 DOI: 10.1249/mss.0000000000002163] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Evaluate the discriminatory ability of two clinical measures and one device-based measure of gait and balance for concussed youth. METHODS We enrolled 81 cases and 90 controls age 14-18 yr old from August 2017 to June 2018. Controls were recruited from a suburban high school, and cases were recruited from the concussion program of an academic pediatric tertiary care center. Tests included two clinical measures: 1) complex tandem gait, scored as sway/errors walking forward and backward eyes open and closed; 2) Modified Balance Error Scoring System (mBESS), scored as total number of errors on three standing tasks; and one device-based measure; 3) Modified Clinical Test of Sensory Interaction and Balance (mCTSIB) using the Biodex Biosway Balance System, scored as a sway index. Sensitivity, specificity, ideal cutpoint, and area under the receiver operating characteristic curve (AUC) were calculated for all test components. RESULTS Ideal cutpoint for total number of sway/errors for tandem gait = 5, sensitivity 41%, specificity 90%. Ideal cutpoint for total mBESS errors = 4, sensitivity 55%, specificity 75%. Ideal cutpoint for mCTSIB = 1.37, sensitivity 37%, specificity 88%. Among each test, some individual components outperformed overall composites, in particular tandem gait (specificity forward eyes open = 99%, sensitivity backward eyes closed = 81%). Among the 40 cases and 65 controls with all three assessments, AUC (95% CI) for tandem gait = 0.63 (0.52,0.75), mBESS = 0.70 (0.60,0.81), and mCTSIB = 0.54 (0.42,0.66). CONCLUSIONS A device-based measure of balance did not produce better discriminatory ability than two clinical assessments. Complex tandem gait has the additional benefit of being an easy-to-perform and graded test with highly sensitive and specific individual components.
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Affiliation(s)
| | | | | | - Fairuz N Mohammed
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kristina B Metzger
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Melissa R Pfeiffer
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Declan A Patton
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Colin M Huber
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
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19
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Hajiaghamemar M, Margulies SS. Multi-Scale White Matter Tract Embedded Brain Finite Element Model Predicts the Location of Traumatic Diffuse Axonal Injury. J Neurotrauma 2020; 38:144-157. [PMID: 32772838 DOI: 10.1089/neu.2019.6791] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Finite element models (FEMs) are used increasingly in the traumatic brain injury (TBI) field to provide an estimation of tissue responses and predict the probability of sustaining TBI after a biomechanical event. However, FEM studies have mainly focused on predicting the absence/presence of TBI rather than estimating the location of injury. In this study, we created a multi-scale FEM of the pig brain with embedded axonal tracts to estimate the sites of acute (≤6 h) traumatic axonal injury (TAI) after rapid head rotation. We examined three finite element (FE)-derived metrics related to the axonal bundle deformation and three FE-derived metrics based on brain tissue deformation for prediction of acute TAI location. Rapid head rotations were performed in pigs, and TAI neuropathological maps were generated and colocalized to the FEM. The distributions of the FEM-derived brain/axonal deformations spatially correlate with the locations of acute TAI. For each of the six metric candidates, we examined a matrix of different injury thresholds (thx) and distance to actual TAI sites (ds) to maximize the average of two optimization criteria. Three axonal deformation-related TAI candidates predicted the sites of acute TAI within 2.5 mm, but no brain tissue metric succeeded. The optimal range of thresholds for maximum axonal strain, maximum axonal strain rate, and maximum product of axonal strain and strain rate were 0.08-0.14, 40-90, and 2.0-7.5 s-1, respectively. The upper bounds of these thresholds resulted in higher true-positive prediction rate. In summary, this study confirmed the hypothesis that the large axonal-bundle deformations occur on/close to the areas that sustained TAI.
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Affiliation(s)
- Marzieh Hajiaghamemar
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, Texas, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
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20
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Abstract
Some patients infected with the Coronavirus Disease 2019 (COVID-19) require endotracheal intubation, an aerosol-generating procedure that is believed to result in viral transmission to personnel performing the procedure. Additionally, donning and doffing personal protective equipment can be time consuming. In particular, doffing requires strict protocol adherence to avoid exposure. We describe the Emory Healthcare intubation team approach during the COVID-19 pandemic. This structure resulted in only 1 team member testing positive for COVID-19 despite 253 patient intubations over a 6-week period with 153 anesthesia providers on service.
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Affiliation(s)
| | | | | | | | | | - Susan S Margulies
- Georgia Institute of Technology and Emory University, Atlanta, Georgia
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21
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Hajiaghamemar M, Wu T, Panzer MB, Margulies SS. Embedded axonal fiber tracts improve finite element model predictions of traumatic brain injury. Biomech Model Mechanobiol 2020; 19:1109-1130. [PMID: 31811417 PMCID: PMC7203590 DOI: 10.1007/s10237-019-01273-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/29/2019] [Indexed: 12/23/2022]
Abstract
With the growing rate of traumatic brain injury (TBI), there is an increasing interest in validated tools to predict and prevent brain injuries. Finite element models (FEM) are valuable tools to estimate tissue responses, predict probability of TBI, and guide the development of safety equipment. In this study, we developed and validated an anisotropic pig brain multi-scale FEM by explicitly embedding the axonal tract structures and utilized the model to simulate experimental TBI in piglets undergoing dynamic head rotations. Binary logistic regression, survival analysis with Weibull distribution, and receiver operating characteristic curve analysis, coupled with repeated k-fold cross-validation technique, were used to examine 12 FEM-derived metrics related to axonal/brain tissue strain and strain rate for predicting the presence or absence of traumatic axonal injury (TAI). All 12 metrics performed well in predicting of TAI with prediction accuracy rate of 73-90%. The axonal-based metrics outperformed their rival brain tissue-based metrics in predicting TAI. The best predictors of TAI were maximum axonal strain times strain rate (MASxSR) and its corresponding optimal fraction-based metric (AF-MASxSR7.5) that represents the fraction of axonal fibers exceeding MASxSR of 7.5 s-1. The thresholds compare favorably with tissue tolerances found in in-vitro/in-vivo measurements in the literature. In addition, the damaged volume fractions (DVF) predicted using the axonal-based metrics, especially MASxSR (DVF = 0.05-4.5%), were closer to the actual DVF obtained from histopathology (AIV = 0.02-1.65%) in comparison with the DVF predicted using the brain-related metrics (DVF = 0.11-41.2%). The methods and the results from this study can be used to improve model prediction of TBI in humans.
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Affiliation(s)
- Marzieh Hajiaghamemar
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, U.A. Whitaker Building, 313 Ferst Drive, Atlanta, GA, 30332, USA.
| | - Taotao Wu
- Department of Mechanical and Aerospace Engineering, University of Virginia, 4040 Lewis and Clark Dr., Charlottesville, VA, 22911, USA
| | - Matthew B Panzer
- Department of Mechanical and Aerospace Engineering, University of Virginia, 4040 Lewis and Clark Dr., Charlottesville, VA, 22911, USA
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, U.A. Whitaker Building, 313 Ferst Drive, Atlanta, GA, 30332, USA
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22
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Abstract
BACKGROUND Recent advances in technology have enabled the development of head impact sensors, which provide a unique opportunity for sports medicine researchers to study head kinematics in contact sports. Studies have suggested that video or observer confirmation of head impact sensor data is required to remove false positives. In addition, manufacturer filtering algorithms may be ineffective in identifying true positives and removing true negatives. PURPOSE To (1) identify the percentage of video-confirmed events recorded by headband-mounted sensors in high school soccer through video analysis, overall and by sex; (2) compare video-confirmed events with the classification by the manufacturer filtering algorithms; and (3) quantify and compare the kinematics of true- and false-positive events. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Adolescent female and male soccer teams were instrumented with headband-mounted impact sensors (SIM-G; Triax Technologies) during games over 2 seasons of suburban high school competition. Sensor data were sequentially reduced to remove events recorded outside of game times, associated with players not on the pitch (ie, field) and players outside the field of view of the camera. With video analysis, the remaining sensor-recorded events were identified as an impact event, trivial event, or nonevent. The mechanisms of impact events were identified. The classifications of sensor-recorded events by the SIM-G algorithm were analyzed. RESULTS A total of 6796 sensor events were recorded during scheduled varsity game times, of which 1893 (20%) were sensor-recorded events associated with players on the pitch in the field of view of the camera during verified game times. Most video-confirmed events were impact events (n = 1316, 70%), followed by trivial events (n = 396, 21%) and nonevents (n = 181, 10%). Female athletes had a significantly higher percentage of trivial events and nonevents with a significantly lower percentage of impact events. Most impact events were head-to-ball impacts (n = 1032, 78%), followed by player contact (n = 144, 11%) and falls (n = 129, 10%) with no significant differences between male and female teams. The SIM-G algorithm correctly identified 70%, 52%, and 66% of video-confirmed impact events, trivial events, and nonevents, respectively. CONCLUSION Video confirmation is critical to the processing of head impact sensor data. Percentages of video-confirmed impact events, trivial events, and nonevents vary by sex in high school soccer. Current manufacturer filtering algorithms and magnitude thresholds are ineffective at correctly classifying sensor-recorded events and should be used with caution.
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Affiliation(s)
- Declan A. Patton
- Address correspondence to Declan A. Patton, PhD, Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, 734 Schuylkill Avenue, Philadelphia, PA 19104, USA ()
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Pasquesi SA, Seidi M, Hajiaghamemar M, Margulies SS. Predictions of neonatal porcine bridging vein rupture and extra-axial hemorrhage during rapid head rotations. J Mech Behav Biomed Mater 2020; 106:103740. [PMID: 32250951 DOI: 10.1016/j.jmbbm.2020.103740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/07/2020] [Accepted: 02/26/2020] [Indexed: 11/17/2022]
Abstract
When the head is rotated rapidly, the movement of the brain lags that of the skull. Intracranial contents between the brain and skull include meninges, cerebrospinal fluid (CSF), and cerebral vasculature. Among the cerebral vasculature in this space are the parasagittal bridging veins (BVs), which drain blood from the brain into the superior sagittal sinus (SSS), which is housed within the falx cerebri, adhered to the inner surface of the skull. Differential motion between the brain and skull that may occur during a traumatic event is thought to stretch BVs, causing damage and producing extra-axial hemorrhage (EAH). Finite element (FE) modeling is a technique often used to aid in the understanding and prediction of traumatic brain injury (TBI), and estimation of tissue deformation during traumatic events provides insight into kinematic injury thresholds. Using a FE model of the newborn porcine head with neonatal porcine brain and BV properties, single and cyclic rapid head rotations without impact were simulated. Measured BV failure properties were used to predict BV rupture. By comparing simulation outputs to observations of EAH in a development group of in vivo studies of rapid non-impact head rotations in the piglet, it was determined that failure of 16.7% of BV elements was associated with a 50% risk of EAH, and showed in a separate validation group that this threshold predicted the occurrence of EAH with 100% sensitivity and 100% specificity for single rapid non-impact rotations. This threshold for failed BV elements performed with 90% overall correct prediction in simulations of cyclic rotational head injuries. A 50% risk of EAH was associated with head angular velocities of 94.74 rad/s and angular accelerations of 29.60 krad/s2 in the newborn piglet. Future studies may build on these findings for BV failure in the piglet to develop predictive models for BV failure in human infants.
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Affiliation(s)
| | - Morteza Seidi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, USA
| | - Marzieh Hajiaghamemar
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, USA
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, USA.
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Hajiaghamemar M, Seidi M, Margulies SS. Head Rotational Kinematics, Tissue Deformations, and Their Relationships to the Acute Traumatic Axonal Injury. J Biomech Eng 2020; 142:031006. [PMID: 32073595 PMCID: PMC7104750 DOI: 10.1115/1.4046393] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/07/2020] [Indexed: 12/11/2022]
Abstract
Head rotational kinematics and tissue deformation metrics obtained from finite element models (FEM) have the potential to be used as traumatic axonal injury (TAI) assessment criteria and headgear evaluation standards. These metrics have been used to predict the likelihood of TAI occurrence; however, their ability in the assessment of the extent of TAI has not been explored. In this study, a pig model of TAI was used to examine a wide range of head loading conditions in two directions. The extent of TAI was quantified through histopathology and correlated to the FEM-derived tissue deformations and the head rotational kinematics. Peak angular acceleration and maximum strain rate of axonal fiber and brain tissue showed relatively good correlation to the volume of axonal injury, with similar correlation trends for both directions separately or combined. These rotational kinematics and tissue deformations can estimate the extent of acute TAI. The relationships between the head kinematics and the tissue strain, strain rate, and strain times strain rate were determined over the experimental range examined herein, and beyond that through parametric simulations. These relationships demonstrate that peak angular velocity and acceleration affect the underlying tissue deformations and the knowledge of both help to predict TAI risk. These relationships were combined with the injury thresholds, extracted from the TAI risk curves, and the kinematic-based risk curves representing overall axonal and brain tissue strain and strain rate were determined for predicting TAI. After scaling to humans, these curves can be used for real-time TAI assessment.
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Affiliation(s)
- Marzieh Hajiaghamemar
- Wallace H. Coulter Department of Biomedical Engineering,
Georgia Institute of Technology and Emory University,
Atlanta, GA 30332
e-mail:
| | - Morteza Seidi
- Wallace H. Coulter Department of Biomedical Engineering,
Georgia Institute of Technology and Emory University,
Atlanta, GA 30332
e-mail:
| | - Susan S. Margulies
- Wallace H. Coulter Department of Biomedical Engineering,
Georgia Institute of Technology and Emory University,
Atlanta, GA 30332
e-mail:
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25
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Atlan LS, Margulies SS. Frequency-Dependent Changes in Resting State Electroencephalogram Functional Networks after Traumatic Brain Injury in Piglets. J Neurotrauma 2019; 36:2558-2578. [PMID: 30909806 PMCID: PMC6709726 DOI: 10.1089/neu.2017.5574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Traumatic brain injury (TBI) is a major health concern in children, as it can cause chronic cognitive and behavioral deficits. The lack of objective involuntary metrics for the diagnosis of TBI makes prognosis more challenging, especially in the pediatric context, in which children are often unable to articulate their symptoms. Resting state electroencephalograms (EEG), which are inexpensive and non-invasive, and do not require subjects to perform cognitive tasks, have not yet been used to create functional brain networks in relation to TBI in children or non-human animals; here we report the first such study. We recorded resting state EEG in awake piglets before and after TBI, from which we generated EEG functional networks from the alpha (8-12 Hz), beta (16.5-25 Hz), broad (1-35 Hz), delta (1-3.5 Hz), gamma (30-35 Hz), sigma (13-16 Hz), and theta (4-7.5 Hz) frequency bands. We hypothesize that mild TBI will induce persistent frequency-dependent changes in the 4-week-old piglet at acute and chronic time points. Hyperconnectivity was found in several frequency band networks after TBI. This study serves as proof of concept that the study of EEG functional networks in awake piglets may be useful for the development of diagnostic metrics for TBI in children.
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Affiliation(s)
- Lorre S. Atlan
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan S. Margulies
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
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Hajiaghamemar M, Seidi M, Oeur RA, Margulies SS. Toward development of clinically translatable diagnostic and prognostic metrics of traumatic brain injury using animal models: A review and a look forward. Exp Neurol 2019; 318:101-123. [PMID: 31055005 PMCID: PMC6612432 DOI: 10.1016/j.expneurol.2019.04.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/11/2019] [Accepted: 04/30/2019] [Indexed: 12/11/2022]
Abstract
Traumatic brain injury is a leading cause of cognitive and behavioral deficits in children in the US each year. There is an increasing interest in both clinical and pre-clinical studies to discover biomarkers to accurately diagnose traumatic brain injury (TBI), predict its outcomes, and monitor its progression especially in the developing brain. In humans, the heterogeneity of TBI in terms of clinical presentation, injury causation, and mechanism has contributed to the many challenges associated with finding unifying diagnosis, treatment, and management practices. In addition, findings from adult human research may have little application to pediatric TBI, as age and maturation levels affect the injury biomechanics and neurophysiological consequences of injury. Animal models of TBI are vital to address the variability and heterogeneity of TBI seen in human by isolating the causation and mechanism of injury in reproducible manner. However, a gap between the pre-clinical findings and clinical applications remains in TBI research today. To take a step toward bridging this gap, we reviewed several potential TBI tools such as biofluid biomarkers, electroencephalography (EEG), actigraphy, eye responses, and balance that have been explored in both clinical and pre-clinical studies and have shown potential diagnostic, prognostic, or monitoring utility for TBI. Each of these tools measures specific deficits following TBI, is easily accessible, non/minimally invasive, and is potentially highly translatable between animals and human outcomes because they involve effort-independent and non-verbal tasks. Especially conspicuous is the fact that these biomarkers and techniques can be tailored for infants and toddlers. However, translation of preclinical outcomes to clinical applications of these tools necessitates addressing several challenges. Among the challenges are the heterogeneity of clinical TBI, age dependency of some of the biomarkers, different brain structure, life span, and possible variation between temporal profiles of biomarkers in human and animals. Conducting parallel clinical and pre-clinical research, in addition to the integration of findings across species from several pre-clinical models to generate a spectrum of TBI mechanisms and severities is a path toward overcoming some of these challenges. This effort is possible through large scale collaborative research and data sharing across multiple centers. In addition, TBI causes dynamic deficits in multiple domains, and thus, a panel of biomarkers combining these measures to consider different deficits is more promising than a single biomarker for TBI. In this review, each of these tools are presented along with the clinical and pre-clinical findings, advantages, challenges and prospects of translating the pre-clinical knowledge into the human clinical setting.
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Affiliation(s)
- Marzieh Hajiaghamemar
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
| | - Morteza Seidi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - R Anna Oeur
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
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27
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Atlan LS, Lan IS, Smith C, Margulies SS. Changes in event-related potential functional networks predict traumatic brain injury in piglets. Clin Biomech (Bristol, Avon) 2019; 64:14-21. [PMID: 29933967 PMCID: PMC6274597 DOI: 10.1016/j.clinbiomech.2018.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/19/2018] [Accepted: 05/21/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Traumatic brain injury is a leading cause of cognitive and behavioral deficits in children in the US each year. None of the current diagnostic tools, such as quantitative cognitive and balance tests, have been validated to identify mild traumatic brain injury in infants, adults and animals. In this preliminary study, we report a novel, quantitative tool that has the potential to quickly and reliably diagnose traumatic brain injury and which can track the state of the brain during recovery across multiple ages and species. METHODS Using 32 scalp electrodes, we recorded involuntary auditory event-related potentials from 22 awake four-week-old piglets one day before and one, four, and seven days after two different injury types (diffuse and focal) or sham. From these recordings, we generated event-related potential functional networks and assessed whether the patterns of the observed changes in these networks could distinguish brain-injured piglets from non-injured. FINDINGS Piglet brains exhibited significant changes after injury, as evaluated by five network metrics. The injury prediction algorithm developed from our analysis of the changes in the event-related potentials functional networks ultimately produced a tool with 82% predictive accuracy. INTERPRETATION This novel approach is the first application of auditory event-related potential functional networks to the prediction of traumatic brain injury. The resulting tool is a robust, objective and predictive method that offers promise for detecting mild traumatic brain injury, in particular because collecting event-related potentials data is noninvasive and inexpensive.
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Affiliation(s)
- Lorre S. Atlan
- Department of Bioengineering, University of Pennsylvania, 210 S. 33 St., 240 Skirkanich Hall, Philadelphia, PA 19104-6321, U.S.A
| | - Ingrid S. Lan
- Department of Bioengineering, University of Pennsylvania, 210 S. 33 St., 240 Skirkanich Hall, Philadelphia, PA 19104-6321, U.S.A
| | - Colin Smith
- Academic Department of Neuropathology, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Susan S. Margulies
- Department of Bioengineering, University of Pennsylvania, 210 S. 33 St., 240 Skirkanich Hall, Philadelphia, PA 19104-6321, U.S.A
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Yehya N, Song MJ, Lawrence GG, Margulies SS. HER2 Signaling Implicated in Regulating Alveolar Epithelial Permeability with Cyclic Stretch. Int J Mol Sci 2019; 20:ijms20040948. [PMID: 30813222 PMCID: PMC6412492 DOI: 10.3390/ijms20040948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/11/2019] [Accepted: 02/19/2019] [Indexed: 11/16/2022] Open
Abstract
Mechanical ventilation can be damaging, and can cause or exacerbate ventilator-induced lung injury (VILI). The human epidermal growth factor receptor (HER) ligand neuregulin-1 (NRG1) activates HER2 heterodimerization with HER3, and has been implicated in inflammatory injuries. We hypothesized that HER2 activation contributes to VILI. We analyzed a database of differentially expressed genes between cyclically stretched and unstretched rat alveolar epithelial cells (RAEC) for HER ligands and validated the differential expression. The effect of the ligand and HER2 inhibition on RAEC permeability was tested, and in vivo relevance was assessed in a rat model of VILI. Analysis of our expression array revealed the upregulation of NRG1 and amphiregulin (AREG) with stretch. NRG1 protein, but not AREG, increased after stretch in culture media. Treatment with an NRG1-cleavage inhibitor (TAPI2) or an inhibitor of NRG1-binding (anti-HER3 antibody) reduced HER2 phosphorylation and partially mitigated stretch-induced permeability, with the upregulation of claudin-7. The results were reproduced by treatment with a direct inhibitor of HER2 phosphorylation (AG825). The transfection of microRNA miR-15b, predicted to negatively regulate NRG1, also attenuated stretch-induced permeability, and was associated with lower NRG1 mRNA levels. In rats ventilated at damaging tidal volumes, AG825 partly attenuated VILI. We concluded that cyclic stretch activates HER2 via the HER3 ligand NRG1, leading to increased permeability. Outcomes were mitigated by the downregulation of NRG1, prevention of NRG1 binding, and most strongly by the direct inhibition of HER2. In vivo HER2 inhibition also attenuated VILI. Ligand-dependent HER2 activation is a potential target for reducing VILI.
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Affiliation(s)
- Nadir Yehya
- Department of Bioengineering, University of Pennsylvania, 40 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA 19104, USA.
- Department of Anesthesiology and Critical Care Medicine, Children' Hospital of Philadelphia and University of Pennsylvania, Suite 7C-26, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Min Jae Song
- Department of Bioengineering, University of Pennsylvania, 40 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA 19104, USA.
| | - Gladys G Lawrence
- Department of Bioengineering, University of Pennsylvania, 40 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA 19104, USA.
| | - Susan S Margulies
- Department of Bioengineering, University of Pennsylvania, 40 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA 19104, USA.
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech College of Engineering, Emory University School of Medicine, Atlanta, GA 30332, USA.
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Dolinay T, Aonbangkhen C, Zacharias W, Cantu E, Pogoriler J, Stablow A, Lawrence GG, Suzuki Y, Chenoweth DM, Morrisey E, Christie JD, Beers MF, Margulies SS. Protein kinase R-like endoplasmatic reticulum kinase is a mediator of stretch in ventilator-induced lung injury. Respir Res 2018; 19:157. [PMID: 30134920 PMCID: PMC6106739 DOI: 10.1186/s12931-018-0856-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/06/2018] [Indexed: 12/22/2022] Open
Abstract
Background Acute respiratory distress syndrome (ARDS) is a severe form of lung injury characterized by damage to the epithelial barrier with subsequent pulmonary edema and hypoxic respiratory failure. ARDS is a significant medical problem in intensive care units with associated high care costs. There are many potential causes of ARDS; however, alveolar injury associated with mechanical ventilation, termed ventilator-induced lung injury (VILI), remains a well-recognized contributor. It is thus critical to understand the mechanism of VILI. Based on our published preliminary data, we hypothesized that the endoplasmic reticulum (ER) stress response molecule Protein Kinase R-like Endoplasmic Reticulum Kinase (PERK) plays a role in transmitting mechanosensory signals the alveolar epithelium. Methods ER stress signal responses to mechanical stretch were studied in ex-vivo ventilated pig lungs. To explore the effect of PERK inhibition on VILI, we ventilated live rats and compared lung injury parameters to non-ventilated controls. The effect of stretch-induced epithelial ER Ca2+ signaling on PERK was studied in stretched alveolar epithelial monolayers. To confirm the activation of PERK in human disease, ER stress signaling was compared between ARDS and non-ARDS lungs. Results Our studies revealed increased PERK-specific ER stress signaling in response to overstretch. PERK inhibition resulted in dose-dependent improvement of alveolar inflammation and permeability. Our data indicate that stretch-induced epithelial ER Ca2+ release is an activator of PERK. Experiments with human lung tissue confirmed PERK activation by ARDS. Conclusion Our study provides evidences that PERK is a mediator stretch signals in the alveolar epithelium.
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Affiliation(s)
- Tamás Dolinay
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Chanat Aonbangkhen
- Department of Chemistry University of Pennsylvania, 231 S 34th St, Philadelphia, PA, 19104, USA
| | - William Zacharias
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Edward Cantu
- Department of Surgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Jennifer Pogoriler
- Department of Pathology, Children's Hospital of Philadelphia, 3400 S 34th St, Philadelphia, PA, 19104, USA
| | - Alec Stablow
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd St, Suite 240 Skirkanich Hall Philadelphia, Philadelphia, PA, 19104, USA
| | - Gladys G Lawrence
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd St, Suite 240 Skirkanich Hall Philadelphia, Philadelphia, PA, 19104, USA
| | - Yoshikazu Suzuki
- Department of Surgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - David M Chenoweth
- Department of Chemistry University of Pennsylvania, 231 S 34th St, Philadelphia, PA, 19104, USA
| | - Edward Morrisey
- Department of Medicine, Division of Cardiovascular Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Jason D Christie
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Michael F Beers
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Susan S Margulies
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd St, Suite 240 Skirkanich Hall Philadelphia, Philadelphia, PA, 19104, USA. .,Wallace H. Coulter Department of Biomedical Engineering Georgia Institute of Technology and Emory University, University School of Medicine, U.A. Whitaker Building, 313 Ferst Drive, Suite 2116, Atlanta, GA, 30332-0535, USA.
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Pasquesi SA, Margulies SS. Measurement and Finite Element Model Validation of Immature Porcine Brain-Skull Displacement during Rapid Sagittal Head Rotations. Front Bioeng Biotechnol 2018. [PMID: 29515995 PMCID: PMC5826385 DOI: 10.3389/fbioe.2018.00016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Computational models are valuable tools for studying tissue-level mechanisms of traumatic brain injury, but to produce more accurate estimates of tissue deformation, these models must be validated against experimental data. In this study, we present in situ measurements of brain-skull displacement in the neonatal piglet head (n = 3) at the sagittal midline during six rapid non-impact rotations (two rotations per specimen) with peak angular velocities averaging 51.7 ± 1.4 rad/s. Marks on the sagittally cut brain and skull/rigid potting surfaces were tracked, and peak values of relative brain-skull displacement were extracted and found to be significantly less than values extracted from a previous axial plane model. In a finite element model of the sagittally transected neonatal porcine head, the brain-skull boundary condition was matched to the measured physical experiment data. Despite smaller sagittal plane displacements at the brain-skull boundary, the corresponding finite element boundary condition optimized for sagittal plane rotations is far less stiff than its axial counterpart, likely due to the prominent role of the boundary geometry in restricting interface movement. Finally, bridging veins were included in the finite element model. Varying the bridging vein mechanical behavior over a previously reported range had no influence on the brain-skull boundary displacements. This direction-specific sagittal plane boundary condition can be employed in finite element models of rapid sagittal head rotations.
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Affiliation(s)
- Stephanie A Pasquesi
- Injury Biomechanics Laboratory, Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Susan S Margulies
- Injury Biomechanics Laboratory, Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
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Pasquesi SA, Liu Y, Margulies SS. Repeated Loading Behavior of Pediatric Porcine Common Carotid Arteries. J Biomech Eng 2017; 138:2529648. [PMID: 27306415 DOI: 10.1115/1.4033883] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Indexed: 01/08/2023]
Abstract
Rapid flexion and extension of the neck may occur during scenarios associated with traumatic brain injury (TBI), and understanding the mechanical response of the common carotid artery (CCA) to longitudinal stretch may enhance understanding of contributing factors that may influence CCA vasospasm and exacerbate ischemic injury associated with TBI. Immature (4-week-old) porcine CCAs were tested under subcatastrophic (1.5 peak stretch ratio) cyclic loading at 3 Hz for 30 s. Under subcatastrophic cyclic longitudinal extension, the immature porcine CCA displays softening behavior. This softening can be represented by decreasing peak stress and increasing corner stretch values with an increasing number of loading cycles. This investigation is an important first step in the exploration of fatiguelike behavior in arterial tissue that may be subjected to repeated longitudinal loads.
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Affiliation(s)
- Stephanie A Pasquesi
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA 19104-6321
| | - Yishan Liu
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA 19104-6321
| | - Susan S Margulies
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA 19104-6321 e-mail:
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Atlan LS, Smith C, Margulies SS. Improved prediction of direction-dependent, acute axonal injury in piglets. J Neurosci Res 2017; 96:536-544. [PMID: 28833411 DOI: 10.1002/jnr.24108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/23/2017] [Accepted: 06/14/2017] [Indexed: 01/25/2023]
Abstract
To guide development of safety equipment that reduces sports-related head injuries, we sought to enhance predictive relationships between head movement and acute axonal injury severity. The severity of traumatic brain injury (TBI) is influenced by the magnitude and direction of head kinematics. Previous studies have demonstrated correlation between rotational head kinematics and symptom severity in the adult. More recent studies have demonstrated brain injury age- and direction-dependence, relating head kinematics to white matter tract-oriented strains. We have recently developed and assessed novel rotational head kinematic parameters as predictors of white matter damage in the female immature piglet. We show that many previously published rotational kinematic injury predictor metrics poorly predict acute axonal pathology induced by rapid, non-impact head rotations and that inclusion of cerebral moments of inertia (MOI) in rotational head injury metrics refines prediction of diffuse axonal injury following rapid head rotations for two immature age groups. Rotational Work (RotWork) was the best significant predictor of traumatic axonal injury in both newborn and pre-adolescent piglets following head rotations in the axial, coronal, and sagittal planes. An improvement over current metrics, we find that RotWork, which incorporates head rotation rate, direction, and brain shape, significantly enhanced acute traumatic axonal injury prediction. For similar injury extent, the RotWork threshold is lower for the newborn piglet than the pre-adolescent.
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Affiliation(s)
- Lorre S Atlan
- Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Colin Smith
- Academic Department of Neuropathology, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Susan S Margulies
- Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Dolinay T, Himes BE, Shumyatcher M, Lawrence GG, Margulies SS. Integrated Stress Response Mediates Epithelial Injury in Mechanical Ventilation. Am J Respir Cell Mol Biol 2017; 57:193-203. [PMID: 28363030 DOI: 10.1165/rcmb.2016-0404oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Ventilator-induced lung injury (VILI) is a severe complication of mechanical ventilation that can lead to acute respiratory distress syndrome. VILI is characterized by damage to the epithelial barrier with subsequent pulmonary edema and profound hypoxia. Available lung-protective ventilator strategies offer only a modest benefit in preventing VILI because they cannot impede alveolar overdistension and concomitant epithelial barrier dysfunction in the inflamed lung regions. There are currently no effective biochemical therapies to mitigate injury to the alveolar epithelium. We hypothesize that alveolar stretch activates the integrated stress response (ISR) pathway and that the chemical inhibition of this pathway mitigates alveolar barrier disruption during stretch and mechanical ventilation. Using our established rat primary type I-like alveolar epithelial cell monolayer stretch model and in vivo rat mechanical ventilation that mimics the alveolar overdistension seen in acute respiratory distress syndrome, we studied epithelial responses to mechanical stress. Our studies revealed that the ISR signaling pathway is a key modulator of epithelial permeability. We show that prolonged epithelial stretch and injurious mechanical ventilation activate the ISR, leading to increased alveolar permeability, cell death, and proinflammatory signaling. Chemical inhibition of protein kinase RNA-like endoplasmic reticulum kinase, an upstream regulator of the pathway, resulted in decreased injury signaling and improved barrier function after prolonged cyclic stretch and injurious mechanical ventilation. Our results provide new evidence that therapeutic targeting of the ISR can mitigate VILI.
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Affiliation(s)
- Tamas Dolinay
- 1 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
| | - Blanca E Himes
- 2 Department of Biostatistics, Epidemiology and Informatics, and
| | - Maya Shumyatcher
- 2 Department of Biostatistics, Epidemiology and Informatics, and
| | - Gladys Gray Lawrence
- 3 Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan S Margulies
- 3 Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
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Pasquesi SA, Margulies SS. Failure and Fatigue Properties of Immature Human and Porcine Parasagittal Bridging Veins. Ann Biomed Eng 2017; 45:1877-1889. [PMID: 28405773 DOI: 10.1007/s10439-017-1833-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 04/05/2017] [Indexed: 11/28/2022]
Abstract
Tearing of the parasagittal bridging veins (BVs) is thought to be a source of extra-axial hemorrhage (EAH) associated with abusive traumatic brain injuries (TBIs) in children. However, the pediatric BV mechanical properties are unknown. We subjected porcine adult, porcine newborn, and human infant BVs to either a low rate pull to failure, a high rate pull to failure, or 30 s of cyclic loading followed by a pull to failure. An additional subset of human infant BVs was examined for viscoelastic recovery between two cycling episodes. We found that human infant BVs are stronger than porcine BVs, and BV mechanical properties are rate dependent, but not age dependent. Successive cyclic loading to a uniform level of stretch softened BVs with decaying peak stresses, and shifted their stress-stretch relationship. These data are critical in understanding BV tissue behavior in accidental and abusive trauma scenarios, which in turn may clarify circumstances that may be injurious to young children.
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Affiliation(s)
- Stephanie A Pasquesi
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA, 19104-6321, USA
| | - Susan S Margulies
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA, 19104-6321, USA.
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35
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Song MJ, Davidovich N, Lawrence GG, Margulies SS. Superoxide mediates tight junction complex dissociation in cyclically stretched lung slices. J Biomech 2016; 49:1330-1335. [PMID: 26592435 PMCID: PMC4864146 DOI: 10.1016/j.jbiomech.2015.10.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 12/25/2022]
Abstract
We found that stretching Type I rat alveolar epithelial cell (RAEC) monolayers at magnitudes that correspond to high tidal-volume mechanical ventilation results in the production of reactive oxygen species, including nitric oxide and superoxide. Scavenging superoxide with Tiron eliminated the stretch-induced increase in cell monolayer permeability, and similar results were reported for rats ventilated at large tidal volumes, suggesting that oxidative stress plays an important role in barrier impairment in ventilator-induced lung injury associated with large stretch and tidal volumes. In this communication we show that mechanisms that involve oxidative injury are also present in a novel precision cut lung slices (PCLS) model under identical mechanical loads. PCLSs from healthy rats were stretched cyclically to 37% change in surface area for 1 hour. Superoxide was visualized using MitoSOX. To evaluate functional relationships, in separate stretch studies superoxide was scavenged using Tiron or mito-Tempo. PCLS and RAEC permeability was assessed as tight junction (TJ) protein (occludin, claudin-4 and claudin-7) dissociation from zona occludins-1 (ZO-1) via co-immunoprecipitation and Western blot, after 1h (PCLS) or 10min (RAEC) of stretch. Superoxide was increased significantly in PCLS, and Tiron and mito-Tempo dramatically attenuated the response, preventing claudin-4 and claudin-7 dissociation from ZO-1. Using a novel PCLS model for ventilator-induced lung injury studies, we have shown that uniform, biaxial, cyclic stretch generates ROS in the slices, and that superoxide scavenging that can protect the lung tissue under stretch conditions. We conclude that PCLS offer a valuable platform for investigating antioxidant treatments to prevent ventilation-induced lung injury.
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Affiliation(s)
- Min Jae Song
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Nurit Davidovich
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Gladys G Lawrence
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan S Margulies
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA.
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36
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Coats B, Binenbaum G, Smith C, Peiffer RL, Christian CW, Duhaime AC, Margulies SS. Cyclic Head Rotations Produce Modest Brain Injury in Infant Piglets. J Neurotrauma 2016; 34:235-247. [PMID: 26953505 DOI: 10.1089/neu.2015.4352] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Repetitive back-and-forth head rotation from vigorous shaking is purported to be a central mechanism responsible for diffuse white matter injury, subdural hemorrhage, and retinal hemorrhage in some cases of abusive head trauma (AHT) in young children. Although animal studies have identified mechanisms of traumatic brain injury (TBI) associated with single rapid head acceleration-decelerations at levels experienced in a motor vehicle crash, few experimental studies have investigated TBI from repetitive head rotations. The objective of this study was to systematically investigate the post-injury pathological time-course after cyclic, low-velocity head rotations in the piglet and compare them with single head rotations. Injury metrics were the occurrence and extent of axonal injury (AI), extra-axial hemorrhage (EAH), red cell neuronal/axonal change (RCNAC), and ocular injury (OI). Hyperflexion/extension of the neck were purposefully avoided in the study, resulting in unscaled angular accelerations at the lower end of reported infant surrogate shaking kinematics. All findings were at the mild end of the injury spectrum, with no significant findings at 6 h post-injury. Cyclic head rotations, however, produced modest AI that significantly increased with time post-injury (p < 0.035) and had significantly greater amounts of RCNAC and EAH than noncyclic head rotations after 24 h post-injury (p < 0.05). No OI was observed. Future studies should investigate the contributions of additional physiological and mechanical features associated with AHT (e.g., hyperflexion/extension, increased intracranial pressure from crying or thoracic compression, and more than two cyclic episodes) to enhance our understanding of the causality between proposed mechanistic factors and AHT in infants.
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Affiliation(s)
- Brittany Coats
- 1 Department of Mechanical Engineering, University of Utah , Salt Lake City, Utah
| | - Gil Binenbaum
- 2 Department of Ophthalmology, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.,3 Department of Ophthalmology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Colin Smith
- 4 Department Pathology, Edinburgh University , Edinburgh, Scotland
| | - Robert L Peiffer
- 3 Department of Ophthalmology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Cindy W Christian
- 5 Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Ann-Christine Duhaime
- 6 Department of Neurosurgery, Massachusetts General Hospital and Harvard University , Boston, Massachusetts
| | - Susan S Margulies
- 7 Department of Bioengineering, University of Pennsylvania , Philadelphia, Pennsylvania
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Yehya N, Thomas NJ, Margulies SS. Circulating nucleosomes are associated with mortality in pediatric acute respiratory distress syndrome. Am J Physiol Lung Cell Mol Physiol 2016; 310:L1177-84. [PMID: 27130528 DOI: 10.1152/ajplung.00067.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/21/2016] [Indexed: 12/17/2022] Open
Abstract
Mechanisms underlying pediatric acute respiratory distress syndrome (PARDS) are poorly understood. The recent implication of circulating nucleosomes as pathogenic in sepsis and trauma-associated ARDS in adults led us to investigate the significance of nucleosomes in PARDS. We conducted a prospective, observational study on children with PARDS at the Children's Hospital of Philadelphia between July 2014 and September 2015. Plasma was collected within 48 h of PARDS onset and nucleosomes quantified by enzyme-linked immunosorbent assay. Samples from 76 children with PARDS (11 deaths, 14%) were collected early [median 15 (IQR 7, 21) h] after PARDS onset. Nucleosome levels were higher in nonsurvivors [0.59 AU (IQR 0.46, 0.84)] relative to survivors [0.21 AU (IQR 0.08, 0.33), rank sum P < 0.001]. Nucleosome levels were not associated with either Berlin (P = 0.845) or PALICC (P = 0.886) oxygenation categories, nor with etiology of PARDS (P = 0.527). Nucleosomes were correlated with increasing numbers of nonpulmonary organ failures (P = 0.009 for trend), and were higher in patients whose PaO2 /FiO2 worsened (P = 0.012) over the first 72 h of PARDS. In regression analysis, nucleosome levels were independently associated with mortality after adjusting for either age, severity of illness score, number of nonpulmonary organ failures, vasopressor score, or PaO2 /FiO2 (all P < 0.05). In conclusion, plasma nucleosome levels in early PARDS were associated with increased mortality, correlated with number of nonpulmonary organ failures, and preceded worsening oxygenation. The potential utility of this biomarker for prognostication, risk stratification, and mechanistic insight should be investigated further.
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Affiliation(s)
- Nadir Yehya
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia;
| | - Neal J Thomas
- Department of Pediatrics and Public Health Science, Division of Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey
| | - Susan S Margulies
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
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Maltese MR, Margulies SS. Biofidelic white matter heterogeneity decreases computational model predictions of white matter strains during rapid head rotations. Comput Methods Biomech Biomed Engin 2016; 19:1618-29. [PMID: 27123826 DOI: 10.1080/10255842.2016.1176153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The finite element (FE) brain model is used increasingly as a design tool for developing technology to mitigate traumatic brain injury. We developed an ultra high-definition FE brain model (>4 million elements) from CT and MRI scans of a 2-month-old pre-adolescent piglet brain, and simulated rapid head rotations. Strain distributions in the thalamus, coronal radiata, corpus callosum, cerebral cortex gray matter, brainstem and cerebellum were evaluated to determine the influence of employing homogeneous brain moduli, or distinct experimentally derived gray and white matter property representations, where some white matter regions are stiffer and others less stiff than gray matter. We find that constitutive heterogeneity significantly lowers white matter deformations in all regions compared with homogeneous properties, and should be incorporated in FE model injury prediction.
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Affiliation(s)
- Matthew R Maltese
- a Department of Anesthesiology and Critical Care Medicine , The Children's Hospital of Philadelphia and the Perelman School of Medicine of the University of Pennsylvania , Philadelphia , PA , USA
| | - Susan S Margulies
- b Department of Bioengineering , The University of Pennsylvania , Philadelphia , PA , USA
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Yehya N, Thomas NJ, Meyer NJ, Christie JD, Berg RA, Margulies SS. Circulating markers of endothelial and alveolar epithelial dysfunction are associated with mortality in pediatric acute respiratory distress syndrome. Intensive Care Med 2016; 42:1137-45. [PMID: 27101828 DOI: 10.1007/s00134-016-4352-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/05/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE Angiopoietin 2 (Ang2) and soluble receptor for advanced glycation end products (sRAGE) are markers of endothelial and pulmonary epithelial damage with prognostic implications in adult acute respiratory distress syndrome (ARDS), but unclear significance in pediatric ARDS (PARDS). METHODS This was a prospective, observational study in children with PARDS (2012 Berlin and 2015 PALICC definitions) at the Children's Hospital of Philadelphia. Plasma was collected within 48 h of PARDS onset and biomarkers quantified by enzyme-linked immunosorbent assay. RESULTS In 82 children with PARDS (12 deaths, 15 %), Ang2 and sRAGE were higher in non-survivors than survivors (p < 0.01 for both). Mortality was highest in patients with Ang2 and sRAGE levels both above median values. Ang2 and sRAGE correlated with the number of non-pulmonary organ failures (both p < 0.001). Ang2 was higher in indirect lung injury and in immunocompromised children. In stratified analysis, both Ang2 and sRAGE were associated with mortality only in direct lung injury and in immunocompetent children, with no association evident in indirect lung injury or in immunocompromised children. CONCLUSIONS Ang2 and sRAGE in early PARDS were higher in non-survivors than survivors and strongly correlated with number of non-pulmonary organ failures. When stratified by type of lung injury, Ang2 and sRAGE were associated with mortality only in direct lung injury. Similarly, when stratified by immunocompromised status, Ang2 and sRAGE were associated with mortality only in immunocompetent children. The utility of these biomarkers for prognostication and risk stratification requires investigation.
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Affiliation(s)
- Nadir Yehya
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Suite 7C-26, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Neal J Thomas
- Division of Pediatric Critical Care Medicine, Department of Pediatrics and Public Health Science, Penn State Hershey Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Nuala J Meyer
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Jason D Christie
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 717 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Suite 7C-26, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Susan S Margulies
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA, 19104, USA
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Ferguson MA, Sutton RM, Karlsson M, Sjövall F, Becker LB, Berg RA, Margulies SS, Kilbaugh TJ. Increased platelet mitochondrial respiration after cardiac arrest and resuscitation as a potential peripheral biosignature of cerebral bioenergetic dysfunction. J Bioenerg Biomembr 2016; 48:269-79. [PMID: 27020568 DOI: 10.1007/s10863-016-9657-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/15/2016] [Indexed: 02/02/2023]
Abstract
UNLABELLED Cardiac arrest (CA) results in a sepsis-like syndrome with activation of the innate immune system and increased mitochondrial bioenergetics. OBJECTIVE To determine if platelet mitochondrial respiration increases following CA in a porcine pediatric model of asphyxia-associated ventricular fibrillation (VF) CA, and if this readily obtained biomarker is associated with decreased brain mitochondrial respiration. CA protocol: 7 min of asphyxia, followed by VF, protocolized titration of compression depth to systolic blood pressure of 90 mmHg and vasopressor administration to a coronary perfusion pressure greater than 20 mmHg. PRIMARY OUTCOME platelet integrated mitochondrial electron transport system (ETS) function evaluated pre- and post-CA/ROSC four hours after return of spontaneous circulation (ROSC). Secondary outcome: correlation of platelet mitochondrial bioenergetics to cerebral bioenergetic function. Platelet maximal oxidative phosphorylation (OXPHOSCI+CII), P < 0.02, and maximal respiratory capacity (ETSCI+CII), P < 0.04, were both significantly increased compared to pre-arrest values. This was primarily due to a significant increase in succinate-supported respiration through Complex II (OXPHOSCII, P < 0.02 and ETSCII, P < 0.03). Higher respiration was not due to uncoupling, as the LEAKCI + CII respiration (mitochondrial respiration independent of ATP-production) was unchanged after CA/ROSC. Larger increases in platelet mitochondrial respiratory control ratio (RCR) compared to pre-CA RCR were significantly correlated with lower RCRs in the cortex (P < 0.03) and hippocampus (P < 0.04) compared to sham respiration. Platelet mitochondrial respiration is significantly increased four hours after ROSC. Future studies will identify mechanistic relationships between this serum biomarker and altered cerebral bioenergetics function following cardiac arrest.
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Affiliation(s)
- Michael A Ferguson
- Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th & Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Robert M Sutton
- Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th & Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Michael Karlsson
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, BMC A13, SE-221 84, Lund, Sweden
| | - Fredrik Sjövall
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, BMC A13, SE-221 84, Lund, Sweden
| | - Lance B Becker
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, The Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Robert A Berg
- Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th & Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Susan S Margulies
- School of Engineering and Applied Science, Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, Philadelphia, PA, 19104, USA
| | - Todd J Kilbaugh
- Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th & Civic Center Blvd., Philadelphia, PA, 19104, USA.
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41
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Margulies SS, Kilbaugh T, Sullivan S, Smith C, Propert K, Byro M, Saliga K, Costine BA, Duhaime AC. Establishing a Clinically Relevant Large Animal Model Platform for TBI Therapy Development: Using Cyclosporin A as a Case Study. Brain Pathol 2016; 25:289-303. [PMID: 25904045 DOI: 10.1111/bpa.12247] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/05/2015] [Indexed: 11/26/2022] Open
Abstract
We have developed the first immature large animal translational treatment trial of a pharmacologic intervention for traumatic brain injury (TBI) in children. The preclinical trial design includes multiple doses of the intervention in two different injury types (focal and diffuse) to bracket the range seen in clinical injury and uses two post-TBI delays to drug administration. Cyclosporin A (CsA) was used as a case study in our first implementation of the platform because of its success in multiple preclinical adult rodent TBI models and its current use in children for other indications. Tier 1 of the therapy development platform assessed the short-term treatment efficacy after 24 h of agent administration. Positive responses to treatment were compared with injured controls using an objective effect threshold established prior to the study. Effective CsA doses were identified to study in Tier 2. In the Tier 2 paradigm, agent is administered in a porcine intensive care unit utilizing neurological monitoring and clinically relevant management strategies, and intervention efficacy is defined as improvement in longer term behavioral endpoints above untreated injured animals. In summary, this innovative large animal preclinical study design can be applied to future evaluations of other agents that promote recovery or repair after TBI.
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Cullen DK, Harris JP, Browne KD, Wolf JA, Duda JE, Meaney DF, Margulies SS, Smith DH. A Porcine Model of Traumatic Brain Injury via Head Rotational Acceleration. Methods Mol Biol 2016; 1462:289-324. [PMID: 27604725 DOI: 10.1007/978-1-4939-3816-2_17] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Unique from other brain disorders, traumatic brain injury (TBI) generally results from a discrete biomechanical event that induces rapid head movement. The large size and high organization of the human brain makes it particularly vulnerable to traumatic injury from rotational accelerations that can cause dynamic deformation of the brain tissue. Therefore, replicating the injury biomechanics of human TBI in animal models presents a substantial challenge, particularly with regard to addressing brain size and injury parameters. Here we present the historical development and use of a porcine model of head rotational acceleration. By scaling up the rotational forces to account for difference in brain mass between swine and humans, this model has been shown to produce the same tissue deformations and identical neuropathologies found in human TBI. The parameters of scaled rapid angular accelerations applied for the model reproduce inertial forces generated when the human head suddenly accelerates or decelerates in falls, collisions, or blunt impacts. The model uses custom-built linkage assemblies and a powerful linear actuator designed to produce purely impulsive non-impact head rotation in different angular planes at controlled rotational acceleration levels. Through a range of head rotational kinematics, this model can produce functional and neuropathological changes across the spectrum from concussion to severe TBI. Notably, however, the model is very difficult to employ, requiring a highly skilled team for medical management, biomechanics, neurological recovery, and specialized outcome measures including neuromonitoring, neurophysiology, neuroimaging, and neuropathology. Nonetheless, while challenging, this clinically relevant model has proven valuable for identifying mechanisms of acute and progressive neuropathologies as well as for the evaluation of noninvasive diagnostic techniques and potential neuroprotective treatments following TBI.
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Affiliation(s)
- D Kacy Cullen
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 105E Hayden Hall/3320 Smith Walk, Philadelphia, PA, 19104, USA. .,Department of Neurology, Perelman School of Medicine, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA. .,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - James P Harris
- Department of Neurology, Perelman School of Medicine, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.,Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 105 Hayden Hall/3320 Smith Walk, Philadelphia, PA, USA
| | - Kevin D Browne
- Department of Neurology, Perelman School of Medicine, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.,Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 105 Hayden Hall/3320 Smith Walk, Philadelphia, PA, USA
| | - John A Wolf
- Department of Neurology, Perelman School of Medicine, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.,Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 371 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA, USA
| | - John E Duda
- Department of Neurology, Perelman School of Medicine, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - David F Meaney
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 105C Hayden Hall/3320 Smith Walk, Philadelphia, PA, USA
| | - Susan S Margulies
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA.,Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 105D Hayden Hall/3320 Smith Walk, Philadelphia, PA, USA
| | - Douglas H Smith
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 105E Hayden Hall/3320 Smith Walk, Philadelphia, PA, 19104, USA
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Kilbaugh TJ, Karlsson M, Duhaime AC, Hansson MJ, Elmer E, Margulies SS. Mitochondrial response in a toddler-aged swine model following diffuse non-impact traumatic brain injury. Mitochondrion 2016; 26:19-25. [PMID: 26549476 PMCID: PMC4752861 DOI: 10.1016/j.mito.2015.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 01/19/2023]
Abstract
Traumatic brain injury (TBI) is an important health problem, and a leading cause of death in children worldwide. Mitochondrial dysfunction is a critical component of the secondary TBI cascades. Mitochondrial response in the pediatric brain has limited investigation, despite evidence that the developing brain's response differs from that of the adult, especially in diffuse non-impact TBI. We performed a detailed evaluation of mitochondrial bioenergetics using high-resolution respirometry in a swine model of diffuse TBI (rapid non-impact rotational injury: RNR), and examined the cortex and hippocampus. A substrate-uncoupler-inhibitor-titration protocol examined the role of the individual complexes as well as the uncoupled maximal respiration. Respiration per mg of tissue was also related to citrate synthase activity (CS) as an attempt to control for variability in mitochondrial content following injury. Diffuse RNR stimulated increased complex II-driven respiration relative to mitochondrial content in the hippocampus compared to shams. LEAK (State 4o) respiration increased in both regions, with decreased respiratory ratios of convergent oxidative phosphorylation through complex I and II, compared to sham animals, indicating uncoupling of oxidative phosphorylation at 24h. The study suggests that proportionately, complex I contribution to convergent mitochondrial respiration was reduced in the hippocampus after RNR, with a simultaneous increase in complex-II driven respiration. Mitochondrial respiration 24h after diffuse TBI varies by location within the brain. We concluded that significant uncoupling of oxidative phosphorylation and alterations in convergent respiration through complex I- and complex II-driven respiration reveals therapeutic opportunities for the injured at-risk pediatric brain.
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Affiliation(s)
- Todd J Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA.
| | - Michael Karlsson
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, BMC A13, SE-221 84 Lund, Sweden.
| | - Ann-Christine Duhaime
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, Philadelphia, PA 19104, USA.
| | - Magnus J Hansson
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, BMC A13, SE-221 84 Lund, Sweden.
| | - Eskil Elmer
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, BMC A13, SE-221 84 Lund, Sweden.
| | - Susan S Margulies
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Boston, MA 02114, USA.
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Olson E, Badder C, Sullivan S, Smith C, Propert K, Margulies SS. Alterations in Daytime and Nighttime Activity in Piglets after Focal and Diffuse Brain Injury. J Neurotrauma 2015; 33:734-40. [PMID: 26414329 DOI: 10.1089/neu.2015.4085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We have developed and implemented a noninvasive, objective neurofunctional assessment for evaluating the sustained effects of traumatic brain injury (TBI) in piglets with both diffuse and focal injury types. Derived from commercial actigraphy methods in humans, this assessment continuously monitors the day/night activity of piglets using close-fitting jackets equipped with tri-axial accelerometers to monitor movements of the thorax. Acceleration metrics were correlated (N = 7 naïve piglets) with video images to define values associated with a range of activities, from recumbancy (rest) to running. Both focal (N = 8) and diffuse brain injury (N = 9) produced alterations in activity that were significant 4 days post-TBI. Compared to shams (N = 6) who acclimated to the animal facility 4 days after an anesthesia experience by blurring the distinction between day and night activity, post-TBI time-matched animals had larger fractions of inactive periods during the daytime than nighttime, and larger fractions of active time in the night were spent in high activity (e.g., constant walking, intermittent running) than during the day. These persistent disturbances in rest and activity are similar to those observed in human adults and children post-TBI, establishing actigraphy as a translational metric, used in both humans and large animals, for assessment of injury severity, progressions, and intervention.
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Affiliation(s)
- Emily Olson
- 1 Department of Bioengineering, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Carlie Badder
- 1 Department of Bioengineering, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Sarah Sullivan
- 1 Department of Bioengineering, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Colin Smith
- 2 Department of Neuropathology, University of Edinburgh , Edinburgh, United Kingdom
| | - Kathleen Propert
- 3 Department of Biostatistics and Epidemiology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Susan S Margulies
- 1 Department of Bioengineering, University of Pennsylvania , Philadelphia, Pennsylvania
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45
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Scott GG, Margulies SS, Coats B. Utilizing multiple scale models to improve predictions of extra-axial hemorrhage in the immature piglet. Biomech Model Mechanobiol 2015; 15:1101-19. [DOI: 10.1007/s10237-015-0747-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 11/06/2015] [Indexed: 12/11/2022]
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46
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Kilbaugh TJ, Sutton RM, Karlsson M, Hansson MJ, Naim MY, Morgan RW, Bratinov G, Lampe JW, Nadkarni VM, Becker LB, Margulies SS, Berg RA. Persistently Altered Brain Mitochondrial Bioenergetics After Apparently Successful Resuscitation From Cardiac Arrest. J Am Heart Assoc 2015; 4:e002232. [PMID: 26370446 PMCID: PMC4599507 DOI: 10.1161/jaha.115.002232] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although advances in cardiopulmonary resuscitation have improved survival from cardiac arrest (CA), neurologic injury persists and impaired mitochondrial bioenergetics may be critical for targeted neuroresuscitation. The authors sought to determine if excellent cardiopulmonary resuscitation and postresuscitation care and good traditional survival rates result in persistently disordered cerebral mitochondrial bioenergetics in a porcine pediatric model of asphyxia-associated ventricular fibrillation CA. METHODS AND RESULTS After 7 minutes of asphyxia, followed by ventricular fibrillation, 5 female 1-month-old swine (4 sham) received blood pressure-targeted care: titration of compression depth to systolic blood pressure of 90 mm Hg and vasopressor administration to a coronary perfusion pressure >20 mm Hg. All animals received protocol-based vasopressor support after return of spontaneous circulation for 4 hours before they were killed. The primary outcome was integrated mitochondrial electron transport system (ETS) function. CA animals displayed significantly decreased maximal, coupled oxidative phosphorylating respiration (OXPHOSCI + CII) in cortex (P<0.02) and hippocampus (P<0.02), as well as decreased phosphorylation and coupling efficiency (cortex, P<0.05; hippocampus, P<0.05). Complex I- and complex II-driven respiration were both significantly decreased after CA (cortex: OXPHOSCI P<0.01, ETSCII P<0.05; hippocampus: OXPHOSCI P<0.03, ETSCII P<0.01). In the hippocampus, there was a significant decrease in maximal uncoupled, nonphosphorylating respiration (ETSCI + CII), as well as a 30% reduction in citrate synthase activity (P<0.04). CONCLUSIONS Mitochondria in both the cortex and hippocampus displayed significant alterations in respiratory function after CA despite excellent cardiopulmonary resuscitation and postresuscitation care in asphyxia-associated ventricular fibrillation CA. Analysis of integrated ETS function identifies mitochondrial bioenergetic failure as a target for goal-directed neuroresuscitation after CA. IACUC Protocol: IAC 13-001023.
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Affiliation(s)
- Todd J Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (T.J.K., R.M.S., M.Y.N., R.W.M., G.B., V.M.N., R.A.B.)
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (T.J.K., R.M.S., M.Y.N., R.W.M., G.B., V.M.N., R.A.B.)
| | - Michael Karlsson
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden (M.K., M.J.H.)
| | - Magnus J Hansson
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden (M.K., M.J.H.)
| | - Maryam Y Naim
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (T.J.K., R.M.S., M.Y.N., R.W.M., G.B., V.M.N., R.A.B.)
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (T.J.K., R.M.S., M.Y.N., R.W.M., G.B., V.M.N., R.A.B.)
| | - George Bratinov
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (T.J.K., R.M.S., M.Y.N., R.W.M., G.B., V.M.N., R.A.B.)
| | - Joshua W Lampe
- Department of Emergency Medicine, The Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.W.L., L.B.B.)
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (T.J.K., R.M.S., M.Y.N., R.W.M., G.B., V.M.N., R.A.B.)
| | - Lance B Becker
- Department of Emergency Medicine, The Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.W.L., L.B.B.)
| | - Susan S Margulies
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA (S.S.M.)
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (T.J.K., R.M.S., M.Y.N., R.W.M., G.B., V.M.N., R.A.B.)
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Sullivan S, Coats B, Margulies SS. Biofidelic neck influences head kinematics of parietal and occipital impacts following short falls in infants. Accid Anal Prev 2015; 82:143-153. [PMID: 26072183 PMCID: PMC4515180 DOI: 10.1016/j.aap.2015.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 05/20/2015] [Accepted: 05/28/2015] [Indexed: 06/04/2023]
Abstract
Falls are a major cause of traumatic head injury in children. Understanding head kinematics during low height falls is essential for evaluating injury risk and designing mitigating strategies. Typically, these measurements are made with commercial anthropomorphic infant surrogates, but these surrogates are designed based on adult biomechanical data. In this study, we improve upon the state-of-the-art anthropomorphic testing devices by incorporating new infant cadaver neck bending and tensile data. We then measure head kinematics following head-first falls onto 4 impact surfaces from 3 fall heights with occipital and parietal head impact locations. The biofidelic skull compliance and neck properties of the improved infant surrogate significantly influenced the measured kinematic loads, decreasing the measured impact force and peak angular accelerations, lowering the expected injury risk. Occipital and parietal impacts exhibited distinct kinematic responses in primary head rotation direction and the magnitude of the rotational velocities and accelerations, with larger angular velocities as the head rebounded after occipital impacts. Further evaluations of injury risk due to short falls should take into account the impact surface and head impact location, in addition to the fall height.
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Affiliation(s)
- Sarah Sullivan
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Brittany Coats
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Susan S Margulies
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States.
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48
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Jaber SM, Sullivan S, Hankenson FC, Kilbaugh TJ, Margulies SS. Comparison of Heart Rate and Blood Pressure with Toe Pinch and Bispectral Index for Monitoring the Depth of Anesthesia in Piglets. J Am Assoc Lab Anim Sci 2015; 54:536-544. [PMID: 26424252 PMCID: PMC4587622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 10/17/2014] [Accepted: 01/26/2015] [Indexed: 06/05/2023]
Abstract
Determining depth of anesthesia (DOA) is a clinical challenge in veterinary medicine, yet it is critical for the appropriate oversight of animals involved in potentially painful experimental procedures. Here, we investigated various parameters used to monitor conscious awareness during surgical procedures and refined the application of noxious stimuli to anesthetized animals. Specifically we used a common stimulus, a compressive toe pinch (TP), to determine physiologic changes that accompanied a positive or negative motion response in isoflurane-anesthetized piglets. A positive response was defined as any reflexive withdrawal, whereas a negative response was defined as the absence of motion after stimulation. We also assessed the utility of the bispectral index (BIS) for its ability to predict a motion response to TP. The average of BIS values over 1 min (BISmean) was recorded before and after TP. In piglets with a positive response to TP, heart rate (HR), but not blood pressure (BP), increased significantly, but receiver operating characteristic (ROC) analysis revealed that HR was not a sensitive, specific predictor of TP motion response. Both before and after TP, BISmean was a strong predictor of a positive motion response. We conclude that HR and noninvasive BP changes are not clinically reliable indicators of anesthetic depth when assessed immediately after a peripherally applied compressive force as an indicator stimulus; however, BISmean and response TP are acceptable for assessing DOA in piglets maintained under isoflurane anesthesia.
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Affiliation(s)
- Samer M Jaber
- University Laboratory Animal Resources and Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Animal Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sarah Sullivan
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - F Claire Hankenson
- University Laboratory Animal Resources and Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, USA; Pennsylvania, Campus Animal Resources, Michigan State University, East Lansing, MI, USA
| | - Todd J Kilbaugh
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan S Margulies
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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49
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Elliott MR, Margulies SS, Maltese MR, Arbogast KB. Accounting for sampling variability, injury under-reporting, and sensor error in concussion injury risk curves. J Biomech 2015; 48:3059-65. [PMID: 26296855 DOI: 10.1016/j.jbiomech.2015.07.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 07/21/2015] [Accepted: 07/23/2015] [Indexed: 10/23/2022]
Abstract
There has been recent dramatic increase in the use of sensors affixed to the heads or helmets of athletes to measure the biomechanics of head impacts that lead to concussion. The relationship between injury and linear or rotational head acceleration measured by such sensors can be quantified with an injury risk curve. The utility of the injury risk curve relies on the accuracy of both the clinical diagnosis and the biomechanical measure. The focus of our analysis was to demonstrate the influence of three sources of error on the shape and interpretation of concussion injury risk curves: sampling variability associated with a rare event, concussion under-reporting, and sensor measurement error. We utilized Bayesian statistical methods to generate synthetic data from previously published concussion injury risk curves developed using data from helmet-based sensors on collegiate football players and assessed the effect of the three sources of error on the risk relationship. Accounting for sampling variability adds uncertainty or width to the injury risk curve. Assuming a variety of rates of unreported concussions in the non-concussed group, we found that accounting for under-reporting lowers the rotational acceleration required for a given concussion risk. Lastly, after accounting for sensor error, we find strengthened relationships between rotational acceleration and injury risk, further lowering the magnitude of rotational acceleration needed for a given risk of concussion. As more accurate sensors are designed and more sensitive and specific clinical diagnostic tools are introduced, our analysis provides guidance for the future development of comprehensive concussion risk curves.
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Affiliation(s)
- Michael R Elliott
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, United States; Survey Methodology Program, Institute for Social Research, University of Michigan, Ann Arbor, MI 48109, United States
| | - Susan S Margulies
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Matthew R Maltese
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania, 34th and Civic, Center Blvd, Suite 1150, Philadelphia, PA 19104, United States.
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50
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Song MJ, Davis CI, Lawrence GG, Margulies SS. Local influence of cell viability on stretch-induced permeability of alveolar epithelial cell monolayers. Cell Mol Bioeng 2015; 9:65-72. [PMID: 26958093 DOI: 10.1007/s12195-015-0405-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Ventilator induced lung injury (VILI), often attributed to over-distension of the alveolar epithelial cell layer, can trigger loss of barrier function. Alveolar epithelial cell monolayers can be used as an idealized in vitro model of the pulmonary epithelium, with cell death and tight junction disruption and permeability employed to estimate stretch-induced changes in barrier function. We adapted a method published for vascular endothelial permeability, compare its sensitivity with our previously published method, and determine the relationship between breeches in barrier properties after stretch and regions of cell death After 4-5 days in culture, primary rat alveolar epithelial cells seeded on plasma treated polydimethylsiloxane membrane coated with biotin-labeled fibronectin, or fibronectin alone were stretched in the presence of FITC-tagged streptavidin (biotin-labeled membrane) or BODIPY-ouabain. We found that the FITC-labeling method was a more sensitive indicator of permeability disruption, with significantly larger positively stained areas visible in the presence of stretch and with ATP production inhibitor Antimycin-A. Triple-stained images with Hoescht (nuclei), Ethidium Homodimer (EthD, damaged cell nuclei) and FITC (permeable regions) were used to determine that within permeable regions intact cells were positioned closer to damaged cells than in non-permeable regions. We concluded that local cell death may be an important contributor to barrier integrity.
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Affiliation(s)
- M J Song
- Department of Bioengineering, University of Pennsylvania 210 South 33rd Street, Philadelphia, PA 19104-6321, USA
| | - C I Davis
- Department of Bioengineering, University of Pennsylvania 210 South 33rd Street, Philadelphia, PA 19104-6321, USA
| | - G G Lawrence
- Department of Bioengineering, University of Pennsylvania 210 South 33rd Street, Philadelphia, PA 19104-6321, USA
| | - S S Margulies
- Department of Bioengineering, University of Pennsylvania 210 South 33rd Street, Philadelphia, PA 19104-6321, USA
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