Mechanism of Naozhenning granules in regulating mitochondrial energy metabolism in multiple cerebral concussion rats / 中国药房

OBJECTIVE To explore the mechanism of Naozhenning granules in regulating mitochondrial energy metabolism in hippocampal tissue of multiple cerebral concussion （MCC） model rats. METHODS SPF grade Wistar rats were used to prepare MCC models using the “free fall impact method”. The successfully modeled rats were divided into model group， piracetam group， and Naozhenning granule low-dose， medium-dose and high-dose groups， and a normal group was also set up， with 8 rats in each group. Rats in each treatment group orally administered corresponding drugs at doses of 0.324 g/kg for the piracetam group and 2.25， 4.5 and 9 g/kg for the Naozhenning granule low-dose， medium-dose and high-dose groups； the normal group and model group were given equal volumes of normal saline； once a day， for 14 consecutive days. The motor exploration ability， learning and memory ability of rats were tested； the adenosine triphosphate （ATP） content in the hippocampal tissue of rat was detected； the changes in the mitochondrial structure of hippocampal tissue was observed； the fluorescence intensity of mitochondrial dynamin- related protein 1 （Drp1）， mitochondrial fission protein 1 （Fis1）， mitochondrial fusion 1 （Mfn1）， and optic atrophy protein 1 （Opa1） were detected in the hippocampal tissue of rat； the protein expression levels of peroxisome proliferator activated receptor gamma coactivator-1α（PGC-1α）， nuclear respiratory factor-1（NRF-1），mitochondrial transcription factor A（TFAM）， Wnt-3a，β-catenin in hippocampal tissue of rat were detected. RESULTS Compared with the normal group， the total exercise distance， number of central grid entries， number of upright positions， new object recognition index， mitochondrial ATP content， fluorescence intensity of Mfn1 and Opa1， the protein expression levels of PGC-1α、NRF-1、TFAM、Wnt-3a、 β-catenin in the model group were significantly reduced （P＜0.01）， while the rest time and fluorescence intensity of Drp1 and Fis1 in hippocampal tissue were significantly increased （P＜0.01）. The results of transmission electron microscopy showed that the mitochondria in the hippocampal tissue were significantly swollen， with a large number of broken and reduced cristae， and some mitochondria had myeloid changes in the membrane. Compared with the model group， the levels/contents of the above indicators in rats of each administration group showed varying degrees of reversal， and most of the differences were statistically significant （P＜0.05 or P＜0.01）； the degree of mitochondrial swelling in the hippocampal tissue was reduced， with a small amount of broken and reduced cristae， fuzzy fractures appeared in local areas of the rough endoplasmic reticulum. CONCLUSIONS Naozhenning granules can improve the motor exploration， learning and memory abilities of MCC model rats， repair neuronal damage， and exert neuroprotective effects. Its mechanism may be related to activating Wnt/β-catenin signaling pathway，maintaining the balance of mitochondrial division and fusion，and promoting mitochondrial biosynthesis.

Visual analysis of hot topics in concussion field by finite element method:Improvements in brain injury models,test methods and protective devices / 中国组织工程研究

BACKGROUND:Concussions caused by contact sports or traffic accidents are far more serious and common than people think,and have attracted widespread attention and high attention from the media,medical and sports circles in recent years. OBJECTIVE:To visualize the hot spots and trends in the field of concussion by using the method of bibliometrics,so as to provide some reference for the research in this field in China. METHODS:Based on the core collection database of Web of Science,the keyword retrieval strategy was(TS=(Concussion))AND TS=(Finite element).CiteSpace 6.2.R4 visualization tool was used to visually analyze the author,country,institution,keywords,cited documents,etc. RESULTS AND CONCLUSION:A total of 215 articles were included,with a general upward trend in the number of publications and citations.The distribution of disciplines involves biomedical engineering,biophysics,sports science,clinical neurology,neuroscience and other disciplines,showing a trend of interdisciplinary integration.The author with the most publications is Gilchrist M from University College Dublin,Ireland,the institution with the most publications is the University of Ottawa,and the country with the most publications is the United States.Key word analysis shows that the focus of research is on the establishment of brain injury models to simulate and predict concussion injuries;analysis of concussion injury mechanism;optimal design of protective equipment and devices.Through literature co-citation analysis,it is found that the prediction and evaluation of brain injury is the knowledge base and research hotspot in this field.The research hotspot of finite element application in the field of concussion injury mainly focuses on the prediction of head injury,combined with the exploration of brain injury mechanism and the design and improvement of protective equipment.With the progress of artificial intelligence and materials science,future research hotspots in the field of concussion injury will focus on the improvement of brain injury models,test methods and protective equipment.

Effect of Naozhenning Granules on Energy Metabolism of Cortical Mitochondria in Rat Model of Post-concussion Syndrome / 中国实验方剂学杂志

ObjectiveTo explore the effects of Naozhenning granules on the memory function and neuron cells in the rat model of post-concussion syndrome based on mitochondrial biosynthesis. MethodSPF-grade Wistar rats were used to establish the multiple cerebral concussion （MCC） model by the weight-drop method. The successfully modeled rats were assigned into model， piracetam （0.324 g·kg-1）， and low-， medium-， and high-dose （2.25， 4.5， and 9 g·kg-1， respectively） Naozhenning groups. The rats were administrated with corresponding drugs by gavage and those in the blank group and model group were administrated the same volume of normal saline once a day for 14 days. The general state of rats was observed before and after treatment. The open field test and new object recognition test were conducted to examine the motor and memory abilities of rats. Hematoxylin-eosin staining was employed to observe the pathological changes of cortical neurons in rats. Western blot and real-time polymerase chain reaction were employed to determine the protein and mRNA levels， respectively， of peroxisome proliferator-activated receptor γ-coactivator-1α （PGC-1α）， nuclear respiratory factor-1 （NRF-1）， and transcription factor A mitochondrial （TFAM） in rat cortex. ResultCompared with the blank group， the model group showed anxious and manic mental status， yellow and messy fur， and reduced food intake. In the open field experiment， the model group showed reduced total movement distance， times of entering the central grid， and times of rearing decreased and increased resting time compared with the blank group （P<0.01）. The model group had lower recognition index of new objects than the blank group （P<0.01）. In addition， the modeling caused reduced neurons with sparse distribution and deformed， broken， and irregular nucleoli and down-regulated the mRNA and protein levels of PGC-1α， NRF-1， and TFAM in the cortex （P<0.01）. Compared with the model group， piracetam and Naozhenning improved the mental state， coat color， food intake， and activities of rats. In the open field test， piracetam and Naozhenning increased the total movement distance， the times of entering the central grid， and the times of rearing and shortened the resting time （P<0.05， P<0.01）. The piracetam and Naozhenning groups had higher recognition index of new objects than the model group （P<0.05， P<0.01）. Compared with the model group， the piracetam and Naozhenning groups showed increased neurons with tight arrangement and large and round nuclei， and some cells with irregular morphology and turbid cytoplasm. Furthermore， piracetam and medium-dose Naozhenning upregulated the protein levels of PGC-1α， NRF-1， and TFAM （P<0.01）. Low-dose Naozhenning upregulated the protein levels of NRF-1 and TFAM （P<0.01）， and high-dose Naozhenning upregulated the protein levels of PGC-1α and TFAM in the cortex （P<0.01）. The mRNA levels of PGC-1α， NRF-1， and TFAM in the cortex were upregulated in the piracetam group and Naozhenning groups （P<0.05， P<0.01）. ConclusionNaozhenning granules can improve the motor， memory， and learning， repair the neuronal damage， and protect the nerve function in the rat model of MCC by promoting mitochondrial biosynthesis.

Characteristics of binocular vision and oculomotor function among sports-concussed athletes

Purpose: To compare the binocular vision and oculomotor function between sports?concussed athletes and aged?matched controls. Methods: Thirty mild concussed athletes were recruited and compared with aged?matched controls. All the participants underwent a comprehensive ocular assessment followed by an oculomotor assessment which included tests for accommodation, vergence, eye movements, and reading parameters. Results: Three categories of oculomotor?based deficits were found: convergence insufficiency (40%), accommodative insufficiency (25%), and oculomotor?based reading dysfunctions (20%). A statistically significant reduction in the mean ± SD of the following parameters was noted in concussed athletes v/s controls:? binocular accommodative amplitude: 7.13 ± 1.59 v/s 15.35 ± 2.95 (P < 0.001), convergence amplitude: 14.23 ± 5.00 v/s 5.65 ± 0.90 (P < 0.001), positive fusional vergence for distance: 21.17 ± 8.97 v/s 31.32 ± 6.23 (P < 0.001), vergence facility: 6.47 ± 1.47 v/s 11.84 ± 1.00 (P < 0.001), accommodative facility: 7.10 ± 4.57 v/s 11.67 ± 1.83 (P < 0.001), reading speed: 66.97 ± 17.82 v/s 144.13 ± 24.45 (P = 0.03) and Developmental Eye Movement ratio: 1.40 ± 0.19 v/s 1.17 ± 0.06 (P < 0.001). Conclusion: Concussions caused by sports have a considerable impact on binocular vision and oculomotor parameters. These findings have substantial therapeutic implications in terms of establishing a periodic screening program for athletes so that essential therapy can be provided for a better outcome.

Refinement of saliva mi-rna biomarkers for sport-related concussion / Refinamento de biomarcadores de saliva mi-rna para concussão relacionada ao esporte / Refinamiento de los biomarcadores de mi-arn de la saliva para la conmoción encefálica relacionada con el deporte

ABSTRACT Introduction: The changes in brain structure caused by a sports-related concussion may initially be indistinguishable, however, the irreversible deleterious effects are noted in the long term. An early diagnosis may provide the patient with a better recovery chance and increased survival. For this purpose, this paper studies the feasibility of a diagnosis for concussion by microRNA (mi-RNA) biomarkers contained in the saliva of athletes. Objective: Verify whether salivary miRNAs could be considered good biomarkers for sports concussion. Methodology: Salivary mi-RNA levels were determined from 120 saliva samples of 120 players. There were 43 with a diagnosis of concussion and 77 without a diagnosis of concussion. Samples from players with a concussion were collected 30 minutes prior to activity, samples from individuals who did not engage in physical activity were also compared. Results: On the evaluation of 30 miRNA from individuals with a concussion between contact and non-contact sports there was high detection reliability(P<.05). Both miR-532-5p and miR-182-5p showed reduced amounts of physical activity. The miRNA-532-5p and miRNA-182-5p show significant results among 43 subjects from pre-exercise to post-exercise. The miRNA-4510 showed a significant result (p < 0.05) between contact and non-contact sport types. The amount of miRNA-4510 expanded in 20 individuals in the contact sport at post-exercise but remained normal in the non-contact sports group. Conclusion: The salivary miRNAs are reliable biomarkers for concussion. Evidence Level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução: As alterações da estrutura cerebral provocadas por uma concussão relacionada ao esporte podem ser inicialmente indistinguíveis, porém os efeitos deletérios irreversíveis são notados a longo prazo. Um diagnóstico precoce poderá fornecer ao paciente uma chance maior de recuperação e aumento de sobrevida. Para tanto, estuda-se a viabilidade de um diagnóstico de concussão por biomarcadores de micro RNA (mi-RNA) contidos na saliva de esportistas. Objetivo: verificar se os miRNAs salivares são biomarcadores confiáveis para concussão esportiva. Metodologia: Os níveis de mi-RNA salivares foram determinados a partir de 120 amostras de saliva de 120 jogadores. Haviam 43 com diagnóstico de concussão e 77 sem diagnóstico de concussão. Amostras de jogadores com concussão foram coletadas 30 minutos antes da atividade, amostras de indivíduos que não praticaram atividade física também foram comparadas. Resultados: Na avaliação de 30 mi-RNA de indivíduos com concussão entre esportes de contato e sem contato houve grande confiabilidade de detecção(P<,05). Tanto o miR-532-5p quanto o miR-182-5p mostraram quantidades reduzidas na atividade física. O miRNA-532-5p e o miRNA-182-5p mostram resultados significativos entre 43 indivíduos desde o pré-exercício até o pós-exercício. O miRNA-4510 mostrou um resultado significativo (p < 0,05) entre os tipos de esporte com contato e sem contato. A quantidade de mi-RNA-4510 expandiu-se em 20 pessoas no esporte com contato no pós-exercício, mas permaneceu normal no grupo de esporte sem contato. Conclusão: Conclui-se que os miRNAs salivares são biomarcadores confiáveis para concussão. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción: Los cambios en la estructura cerebral causados por una conmoción encefálica relacionada con el deporte pueden ser inicialmente indistintos, sin embargo, los efectos deletéreos irreversibles se manifiestan a largo plazo. Un diagnóstico anticipado puede proporcionar al paciente una mayor posibilidad de recuperación y una mayor supervivencia. Por lo tanto, se estudia la viabilidad de un diagnóstico de conmoción encefálica mediante los biomarcadores de microARN (mi-ARN) contenidos en la saliva de los deportistas. Objetivo: verificar si los miARN salivales son biomarcadores fiables para la conmoción encefálica deportiva. Metodología: Se determinaron los niveles de mi-ARN salival a partir de 120 muestras de saliva de 120 jugadores. Había 43 con diagnóstico de conmoción encefálica y 77 sin diagnóstico de conmoción encefálica. Las muestras de los jugadores con conmoción encefálica se recogieron 30 minutos antes de la actividad, también se compararon las muestras de los individuos que no practicaban actividad física. Resultados: En la evaluación de 30 miRNA de individuos con conmoción encefálica entre deportes de contacto y sin contacto hubo una alta fiabilidad de detección (P<.05). Tanto miR-532-5p como miR-182-5p mostraron cantidades reducidas en la actividad física. El miRNA-532-5p y el miRNA-182-5p muestran resultados significativos entre los 43 sujetos desde antes del ejercicio hasta después del mismo. El miRNA-4510 mostró un resultado significativo (p < 0,05) entre los tipos de deporte de contacto y de no contacto. La cantidad de miARN-4510 se expandió en 20 individuos en el deporte de contacto en el momento posterior al ejercicio, pero se mantuvo normal en el grupo de deporte sin contacto. Conclusión: Llegamos a la conclusión de que los miARN salivales son biomarcadores fiables para la conmoción encefálica. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Traumatic brain injury in Brazil: an epidemiological study and systematic review of the literature / Traumatismo cranioencefálico no Brasil: um estudo epidemiológico e uma revisão sistemática da literatura

ABSTRACT Background: Traumatic brain injury (TBI) is a serious public health problem worldwide. Although TBI is common in developing countries, there are few epidemiological studies. Objective: To investigate the sociodemographic and clinical features of patients with TBI at the Hospital João XXIII, a public reference center for trauma in Belo Horizonte, Brazil, and to systematically review the available literature on TBI in Brazil. Methods: Clinical and sociodemographic data were collected from electronic medical records for the entire month of July 2016. The literature on epidemiology of TBI in Brazil was systematically reviewed using MeSH/DeCS descriptors in the PubMed and Lilacs databases. Results: Most patients admitted with TBI were male and under 60 years of age. Mild TBI was the most prevalent form and the most common cause of TBI was falls. A Glasgow Coma Scale score below 12, neuroimaging changes on computer tomography, and presence of any medical conditions were significantly associated with longer hospital stay. Brazilian studies showed that TBI affected mainly men and young adults. In addition, mild TBI was the most common TBI severity reported and the most common causes were motor vehicle accidents and falls. Conclusions: Overall, the profile of TBI in this center reflects the data from other Brazilian studies.

RESUMO Antecedentes: O traumatismo cranioencefálico (TCE) representa, mundialmente, um problema sério de saúde pública. Apesar de o TCE ser prevalente em países em desenvolvimento, estudos epidemiológicos permanecem escassos. Objetivo: Investigar as características sociodemográficas e clínicas de pacientes acometidos por TCE no Hospital João XXIII - centro de referência em trauma situado em Belo Horizonte, Brasil - e revisar sistematicamente toda a literatura disponível sobre o TCE no Brasil. Métodos: Os dados clínicos e sociodemográficos foram coletados apenas para o mês de julho, 2016, por meio de prontuários eletrônicos. A literatura sobre a epidemiologia do TCE no Brasil foi sistematicamente revisada usando descritores Medical Subject Headings (MeSH)/Descritores em Ciências da Saúde (DeCS) nos bancos de dados PubMed e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). Resultados: Os pacientes acometidos por TCE eram em sua maioria homens com menos de 60 anos. O TCE leve foi a gravidade mais prevalente entre os casos. O TCE foi causado principalmente por quedas. Escores menores que 12 na escala de Coma de Glasgow mais alterações de neuroimagem em tomografia computadorizada e a presença de qualquer comorbidade médica estão significativamente associados à maior estadia hospitalar. Estudos brasileiros demonstraram que o TCE acomete principalmente homens e adultos jovens. Além disso, o TCE leve foi a gravidade mais comum reportada, e os mecanismos de TCE mais comuns foram acidentes automobilísticos e quedas. Conclusões: O perfil de pacientes acometidos por TCE no centro de referência em questão reflete os dados de outros estudos brasileiros.

Changes of ferroptosis in hippocampal neurons of rats with multiple cerebral concussion / 中华行为医学与脑科学杂志

Objective:To observe the ferroptosis in hippocampal neurons of rats with multiple cerebral concussion (MCC) .Methods:Ninety clean grade male Wistar rats with a body mass of (250±10) g were randomly divided into control group (12 rats) and model group (78 rats) according to the random number table method. The rat of MCC model was prepared by hitting the frontotemporal lobe of rats with free fall method once a day for 3 consecutive days.Then the MCC model rats were randomly divided into 12 h, 24 h, 48 h, 72 h, 7 d and 14 d groups with 12 rats in each group. The balance beam experiment was used to detect the motor coordination function of the rats. The levels of interleukin-β(IL-1β), interleukin-6(IL-6), serum glutathione (GSH), neuron-specific enolase (NSE) in serum of rats were detected by ELISA.The content of iron ion in hippocampus was detected by colorimetry. The mRNA and protein levels of glutathione peroxidase 4(GPX4), ferritin heavy (FTH) and ferritin light(FTL) in the hippocampus were detected by RT-PCR and Western blot. Prussian blue staining was used to observe the iron deposition in brain tissue.The ultrastructural changes of hippocampal neurons and mitochondria were observed by transmission electron microscope. SPSS 24.0 statistical software was used for one-way ANOVA among groups, and LSD test was used for multiple pairwise comparison.Results:In the balance beam experiment, the passing time and motor coordination score of rats in each group were significantly different ( F=30.08, 60.34, both P<0.05). The passing time and motor coordination score of rats in the 48 h group ((87.00±4.74) s, (4.75±0.43)) were significantly higher than those in the control group ((35.13±6.99) s, (0.75±0.23)) (both P<0.05). There was significant difference in the total iron ion content, Fe 2+ content and Fe 3+ content in hippocampus of rats in each group ( F=25.20, 94.42, 40.25, all P<0.05), and the content of Fe 2+ in hippocampus of 48 h group was significantly higher than that of the control group ((10.17±0.05) ng/μL, (8.65±0.01) ng/μL)( P<0.05). In the results of RT-PCR and Western blot, the mRNA and protein levels of GPX4, FTH and FTL in hippocampus of each group were significantly different ( F=37.94, 82.09, 49.01, 71.63, 28.94, 15.78, all P<0.05). The mRNA level and protein level of GPX4 ((1.09±0.01), (0.23±0.01) )and FTL ((1.60±0.03), (0.64±0.02)) in 24 h group were significantly higher than those of the control group (GPX4: (1.00±0.02), (0.17±0.01)), FTL: ((1.00±0.04), (0.32±0.01))(all P<0.05). The mRNA level and protein level of FTH ((0.24±0.03), (0.07±0.01)) in 24 h group were significantly lower than those of the control group((1.00±0.01), (0.67±0.03))(both P<0.05). The results of electron microscope showed that the hippocampal neuronal cells of the model rats were reduced, the nucleolus was broken and the nuclear membrane was shrunk in varying degrees, the mitochondria were swollen and deformed and there were vacuoles, and the cristae in the mitochondria decreased or disappeared. Conclusion:The levels of inflammatory reaction and oxidative stress in the multiple cerebral concussion model rats increase, and the hippocampal neurons show the characteristics of ferroptosis, especially at 24 h and 48 h.

Effect of Naozhenning on Hippocampal Mitochondrial Function in Model Rats with Post-concussion Syndrome / 中国实验方剂学杂志

ObjectiveTo explore the mechanism of Naozhenning on learning and memory ability and neuron damage in hippocampal CA1 region of post-concussion syndrome model rats based on mitochondrial function. MethodMultiple cerebral concussion （MCC） was induced in SPF Wistar rats with the free-fall impact method. Then the model rats were randomly classified into model group （equivalent volume of distilled water）， piracetam （0.43 g·kg-1， ig） group， and low-， medium-， and high-dose NZN （5.4， 10.8， 21.6 g·kg-1， respectively， ig） groups， with 10 rats in each group， and another 10 normal rats were included in the normal control group （equivalent volume of distilled water）. The administration lasted 14 days and then relevant indexes were detected. Morris water maze test was used to observe the changes of learning and memory ability in each group， such as escape latency， residence time in primary quadrant， and times of crossing platform. The pathological changes of hippocampal CA1 region were observed based on hematoxylin-eosin （HE） staining and Nissl staining. The ultrastructure of mitochondria was observed under the transmission electron microscope （TME） and the activity of mitochondrial respiratory chain complex Ⅰ was detected by colorimetry. The content of adenosine triphosphate （ATP） was determined by fluorescence probe and mitochondrial membrane potential （MMP） by fluorescein enzyme-linked fluorescence immunoassay. ResultCompared with the normal control group， the model group showed long escape latency， short residence time in target quadrant， few times of crossing the platform， significant decrease in counts of neurons and Nissl bodies in hippocampal CA1 region， damage of neuronal morphology and mitochondrial structure， and significant reduction of MMP and the content of mitochondrial ATP and respiratory chain complex I （P<0.05， P<0.01）. The NZN groups demonstrated short escape latency， long residence time in target quadrant， increased times of crossing the platform， small number of neurons and Nissl bodies in hippocampal CA1 region， alleviated damage of neuronal morphology and mitochondrial structure， and increase in MMP and the content of mitochondrial ATP and respiratory chain complex I （P<0.05， P<0.01）. ConclusionNZN can improve the learning and memory ability of MCC rats by improving mitochondrial structure and function and alleviating hippocampal neuron injury.

Prevalencia de sindrome post conmocion cerebral en pacientes atendidos en el hospital del niño. un estudio longitudinal de julio a octubre de 2019 / Prevalence of post-concussion syndrome in patients seen at the children's hospital. A longitudinal study from July to October 2019

INTRODUCCIÓN. El síndrome post conmoción cerebral (SPC) es una secuela muy común de la conmoción cerebral (CC). El diagnóstico es desafiante porque los síntomas varían de paciente a paciente, son auto informados, sutiles y los estudios de imagen convencionales pueden o no revelar anomalías mínimas. ¿Cuál es la prevalencia del síndrome post conmoción cerebral en pacientes que fueron atendidos en el Hospital del Niño Dr. Ovidio Aliaga Uría? MATERIAL Y MÉTODO. Estudio descriptivo longitudinal, que enroló 45 pacientes de 1 a 15 años de edad, durante los meses de julio a octubre de 2019. Se utilizó la herramienta SCAT5 modificado como cribado, diagnóstico y seguimiento del SPC. Se evaluó a cada paciente de forma individual en 5 entrevistas planificadas. El análisis descriptivo utilizó medidas de tendencia central y dispersión. Para el análisis inferencial se empleó pruebas de correlación. RESULTADOS. Se encontró una prevalencia del 22,2% (n=10) en el segundo mes de seguimiento que reduce a 6,6% (n=3) hasta el tercer mes. DISCUSIÓN. Las definiciones más aceptadas de SPC son de la Clasificación Internacional de Enfermedades 10a revisión (CIE-10) y del Manual Diagnóstico y Estadístico de los Trastornos Mentales, quinta edición (DSM-5). Las náuseas y la somnolencia son muy comunes después de la conmoción y se resuelven rápidamente (horas o días). La cefalea abarca todo el espectro y ocurre inmediatamente después de la lesión y frecuentemente se vuelve crónica. CONCLUSIÓN. Los pacientes padecieron SPC, no existe un protocolo institucional de diagnóstico y manejo para la recuperación escalonada.

INTRODUCTION. Post-concussion syndrome (PPS) is a very common sequela of concussion (CC). Diagnosis is challenging because symptoms vary from patient to patient, are self-reported, subtle, and conventional imaging studies may or may not reveal minimal abnormalities. What is the prevalence of post-concussion syndrome in patients who were treated at the Hospital del Niño Dr. Ovidio Aliaga Uría? MATERIAL AND METHOD. Longitudinal descriptive study, which enrolled 45 patients from 1 to 15 years of age, during the months of July to October 2019. The modified SCAT5 tool was used for screening, diagnosis and follow-up of the PPS. Each patient was evaluated individually in 5 planned interviews. The descriptive analysis used measures of central tendency and dispersion. Correlation tests were used for inferential analysis. RESULTS. A prevalence of 22.2% (n = 10) was found in the second month of follow-up, which reduces to 6.6% (n = 3) until the third month. DISCUSSION. The most widely accepted definitions of SPC are from the International Classification of Diseases 10th revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Nausea and drowsiness are very common after shock and resolve quickly (hours to days). Headache spans the entire spectrum and occurs immediately after injury and frequently becomes chronic. CONCLUSION. The patients suffered from SPC, there is no institutional diagnostic and management protocol for staggered recovery.

Chronic Traumatic Encephalopathy in Sports Practice: A Literature Review / Encefalopatia traumática crônica na prática de esportes: Uma revisão da literatura

Chronic traumatic encephalopathy (CTE) is a neurodegenerative syndrome caused by repetitive and cumulative head trauma. Due to the widespread practice of contact and collision sports, a discussion of the long-term repercussions of repeated head trauma is imperative. The present literature review, performed through the SciELO, PUBMED, and BVS-Bireme databases, includes studies conducted since the year 2000, which established the relationship between CTE and the practice of sports. The diagnosis of CTE was notably present in individuals practicing sports that involve repeated traumatic brain injuries. The noticeable changes triggered by CTE include a series of clinical and neuropathological manifestations that can help in the differentiation from other tauopathies.

A encefalopatia traumática crônica (ETC) é uma síndrome neurodegenerativa causada por traumatismo craniano repetitivo e cumulativo. Com a prática disseminada de esportes de contato, torna-se importante discutir as repercussões a longo prazo de traumatismos cranianos repetidos. A presente revisão da literatura, executada através das bases de dados SciELO, PUBMED e BVS-Bireme, inclui estudos realizados desde o ano de 2000 que estabeleceram a relação entre a ETC e a prática de esportes. O diagnóstico de ETC esteve notadamente presente em indivíduos praticantes de esportes que envolvem repetidas lesões cerebrais traumáticas. As alterações perceptíveis desencadeadas pela ETC incluem uma série de manifestações clínicas e neuropatológicas, que podem auxiliar na diferenciação de outras tauopatias.

Level of knowledge and misconceptions about brain concussion in Brazilian adults / Nível de conhecimento e de equívocos sobre concussão cerebral em adultos brasileiros

Abstract Background: Brain concussion (BC) is seen as a public health priority due to its high incidence and morbidity rate, among thousands of people around the world. There are needs for fast identification, accurate diagnosis and correct management in order to reduce the short and long-term problems relating to BC. Proper knowledge of BC in the population and among clinicians is a critical factor in achieving this. Objectives: To evaluate the level of self-reported BC knowledge and gaps/misconceptions, and to identify variables correlated with this level. Methods: A cross-sectional descriptive survey was performed. A Brain Concussion Knowledge Questionnaire (BCKQ) that had been created to capture data was widely distributed. Total scores, domain partial scores and percentages of correct and incorrect answers were calculated to ascertain the level of knowledge relating to BC. Results: The sample was formed by 1,247 Brazilian adults (age: 41.7±11.8 years). Partial scores of the BCKQ revealed the existence of poor knowledge and misconceptions in all domains of the questionnaire, especially regarding questions about recovery from and management of BC. Moderate correlations between BCKQ scores and professions (p=0.312; P=0.00) or previous brain concussion knowledge (p=0.489; P=0.00) were observed. In a multiple linear regression model, age, profession and sports practice were predictors of BC knowledge. Conclusion: This first study to analyze the level of BC knowledge in a sample of Brazilian adults suggests that poor knowledge and misconceptions are present. Thus, meaningful and useful information was provided by this study for developing health education programs about BC for the population in order to improve fast diagnosis and correct BC management.

RESUMO Introdução: A concussão cerebral (CC) é considerada prioridade em saúde pública devido à sua alta incidência e taxa de morbidade. Há necessidade de identificação rápida, diagnóstico acurado e manejo correto após essas lesões, com objetivo de reduzir problemas de curto e longo prazo. O conhecimento apropriado da população, atletas e de clínicos é primordial para que isto seja alcançado. Objetivos: Avaliar o nível de conhecimento autorrelatado sobre CC, descrever lacunas/equívocos e identificar variáveis correlacionadas com este nível. Métodos: Foi realizada uma pesquisa descritiva transversal. O Questionário de Conhecimento sobre Concussão Cerebral (QCCC) criado foi amplamente distribuído. Pontuações totais e parciais em domínios e porcentagens de respostas corretas e incorretas foram calculadas para obter o nível de conhecimento sobre CC. Resultados: A amostra foi formada por 1.247 brasileiros adultos (41,7±11,8 anos). Pontuações parciais do QCCC revelaram baixo nível de conhecimento, principalmente em questões sobre recuperação e manejo. Observou-se correlações moderadas entre a pontuação no QCCC e a profissão dos participantes (p=0,312, P=0,00) ou conhecimento prévio sobre CC (p=0,489, P=0,00). A regressão linear múltipla mostrou que a idade, profissão e prática de esportes podem ser preditoras do conhecimento sobre CC. Conclusão: Esse primeiro estudo a analisar o nível de conhecimento sobre CC em uma amostra de adultos brasileiros sugere baixo conhecimento e equívocos sobre esta condição. Assim, informações úteis e significantes foram fornecidas para o desenvolvimento de programas de educação em saúde sobre CC para o público, com objetivo de melhorar a identificação rápida e o manejo correto de concussões.

Brazilian version of the Rivermead Post-Concussion Symptoms Questionnaire / Versão Brasileira do Questionário Rivermead de Sintomas Pós-Concussionais

ABSTRACT Background: After a traumatic brain injury, post-concussion symptoms are commonly reported by patients. Although common, these symptoms are difficult to diagnose and recognize. To date, no instruments evaluating post-concussion symptoms have been culturally translated or adapted to the Brazilian context. Objective: To culturally adapt the Rivermead Post-Concussion Symptoms Questionnaire for use in Brazilian Portuguese. Methods: Cross-cultural adaptation was done in five steps: translation, synthesis of translations, back-translation, evaluation by two expert committees and two pretests among adults in a target population. Results: The semantic, idiomatic, cultural and experimental aspects of the adaptation were considered adequate. The content validity coefficient of the items regarding language clarity, pratical pertinence, relevance and dimensionality were considered adequate for evaluating the desired latent variable. Both pretests demonstrated that the instrument had satisfactory acceptability. Conclusion: The Brazilian version, named Questionário Rivermead de Sintomas pós Concussionais (RPQ-Br), has been adapted, and is ready for use in the Brazilian context.

RESUMO Introdução: Após um traumatismo cranioencefálico, os sintomas pós-concussionais são comumente relatados pelos pacientes e, embora comuns, são difíceis de serem reconhecidos. Até o momento, não existem instrumentos que tenham sido traduzidos ou adaptados culturalmente para o contexto brasileiro. Objetivo: Adaptação transcultural do Rivermead Post Concussion Symptoms Questionnaire para o português do Brasil. Métodos: O processo de adaptação transcultural foi realizado em cinco etapas: tradução, síntese das traduções, retrotradução, avaliação por dois comitês de especialistas e dois pré-testes com adultos da população-alvo. Resultados: Os aspectos semânticos, idiomáticos, culturais e experimentais foram considerados adequados. Os coeficientes de validade de conteúdo dos itens quanto à clareza da linguagem, pertinência teórica, relevância prática e dimensionalidade foram considerados adequados para avaliar a variável latente desejada. Ambos os pré-testes demonstraram aceitabilidade satisfatória do instrumento. Conclusão: A versão brasileira do Questionário Rivermead de Sintomas pós Concussionais (RPQ-Br) foi traduzida e adaptada com sucesso e está pronta para ser utilizada no contexto brasileiro.

The actual conditions of rugby-related head injuries in Japanese high school players: The analysis of injuries reports between April 2009 and March 2016 of Kansai rugby football association / 体力科学

The present study was performed to ascertain the annual changes in the number and nature of traumatic head injuries that occur in high-school rugby matches, and as an exploratory investigation of approaches to improve safety in the future. It was based on injury reports submitted at the time of injury to the Kansai Rugby Football Union between Apr. 2009 and Mar. 2016. The finding was that the mean number of reported cases of traumatic head injury per year during the three pre-amendment years from Apr. 2009 to Mar. 2011 was 18.0, whereas that during the five post-amendment years from Apr. 2012 to Mar. 2016 was 36.2. Of all the traumatic head injuries, those with the highest numbers and proportions of cases for each of the four factors were as follows: (i) occasion of injury: during a match, 115 (48.9%); (ii) condition of the pitch: grass, 105 (44.7%); (iii) school grade: 2, 104 (44.3%); and (iv) cause of injury: tackling, 115 (48.9%). In addition, the odds ratios (ORs) for brain concussion at post-amendment as compared with pre-amendment and for occurrence on grass as compared with on soil were significant 2.83. An exploratory investigation was conducted to clarify whether different factors are associated with the severity of pre- and post-amendment injuries, but no significant ORs were found. In conclusion, the establishment of guidelines related to brain concussion in 2012 increased the number of reports of injuries due to high-school rugby and had a definite effect on prompt treatment of brain concussions.

Analysis of Post-Concussion Syndrome Disability Re-appraisal / 法医学杂志

OBJECTIVES@#To understand the current status of appraisal of post-concussion syndrome disability and the reasons for the changes in re-appraisal opinions.@*METHODS@#The cases that were judged as "post-concussion syndrome and ten-level disability" in the first appraisal and re-appraised for psychiatric impairment by the Academy of Forensic Science in 2019 were analyzed retrospectively.@*RESULTS@#There were 75 cases, including 58 cases with pre-hospital emergency medical records, among which 39 cases were clearly recorded to be without a history of coma; 74 cases had emergency medical records, among which 44 cases were recorded of having a history of coma; 43 cases had follow-up medical records, among which 24 cases had a history of psychiatric follow-up. The most complained symptoms of the appraisee in appraisal and examination include headache, dizziness, poor sleep at night, irritability, memory loss, fatigue and inattention. The main reasons for the re-appraisal application include doubts about the history of coma, doubts about the credibility of mental symptoms, post-concussion syndrome didn't meet the disability criteria, and objections to the original appraisal procedure or the original appraisal agency. The appraisal opinions of a total of 47 cases were changed. Seven of them did not meet the disability criteria, and the main reason was that there was no clear history of coma and no head injury was admitted; the coma history of the 40 other cases had to be confirmed by the court before they can be clearly identified as disabilities. The reason was that the records about the history of coma were inconsistent or there were alterations and additional information.@*CONCLUSIONS@#In the past, the conditions for appraisal of post-concussion syndrome disability were too lax and must be further standardized and strictly controlled.

Hipopituitarismo postraumatismo encefalocraneano: revisión de la literatura y algoritmo de estudio y abordaje terapéutico

Hypopituitarism after moderate or severe traumatic brain injury (TBI) is usually underdiagnosed and therefore undertreated. Its course can be divided in an acute phase during the first 14 days after TBI with 50 to 80% risk of hypopituitarism, and a chronic phase, beginning three months after the event, with a prevalence of hypopituitarism that ranges from 2 to 70%. Its pathophysiology has been addressed in several studies, suggesting that a vascular injury to the pituitary tissue is the most important mechanism during the acute phase, and an autoimmune one during chronic stages. In the acute phase, there are difficulties to correctly interpret pituitary axes. Hence, we propose a simple and cost-effective algorithm to detect and treat a potential hypothalamic-pituitary-adrenal axis impairment and alterations of sodium homeostasis, both of which can be life-threatening. In the chronic phase, post-concussion syndrome is the most important differential diagnosis. Given the high prevalence of hypopituitarism, we suggest that all pituitary axes should be assessed in all patients with moderate to severe TBI, between 3 to 6 months after the event, and then repeated at 12 months after trauma by a specialized team in pituitary disease.

Investigation of pituitary dysfunction in retired professional soccer players / Investigação de disfunção hipofisária em jogadores de futebol profissionais aposentados / Investigación de disfunción hipofisaria en jugadores de fútbol profesionales retirados

ABSTRACT Introduction: It is well-known that pituitary dysfunction can develop as a result of traumatic brain injuries. One reason for such injuries is collision during contact sports. Objectives: The aim of this study was to investigate the effects of heading the ball and concussion on pituitary function in retired soccer players. Methods: Thirty-two retired soccer players, with an average age of 43.38 ± 5.49 (35-59) and 26 sedentary individuals with an average age of 43.31±6.38 (35-59) were included in this study. The subjects were questioned about their soccer-playing background, history of head trauma and concussion, and cardiometabolic diseases. One day one, blood samples were taken to investigate the baseline hematologic and biochemical parameters. On day two, the ACTH stimulation test was conducted, and on day three, glucagon stimulation tests were carried out. Resting EKG, transthoracic ECHO and exercise stress tests (for MET values) were also conducted. For the statistical analysis, The Student's t-test was used to compare the results of the two groups. The level of significance adopted was p<0.05. Results: It was identified that 5 out of 32 soccer players (16%) had experienced concussion during their soccer careers. The growth hormone (GH) levels of 3 retired soccer players (9.2%) and 3 sedentary individuals (10%) was below 1 ng/dl, which was accepted as the threshold value. There were no significant differences between hematological, biochemical and cardiometabolic parameters of the soccer players with low GH levels and those with normal GH levels. There was no significant relationship between the number of headers performed and GH deficiency. Conclusion: Although low GH levels were detected in almost 10% of the retired soccer players, the frequency of hypopituitarism was not higher than in the sedentary control group. Level of evidence I; Prognostic Studies.

RESUMO Introdução: É fato conhecido que a disfunção hipofisária sobrevém em decorrência de lesões cerebrais traumáticas. Uma das razões para essas lesões é a colisão durante esportes de contato. Objetivo: O objetivo deste estudo foi investigar os efeitos do cabeceamento de bola sobre a hipófise e suas funções em jogadores de futebol aposentados. Métodos: Participaram deste estudo 32 jogadores de futebol aposentados com média de idade de 43,38 ± 5,49 (35-59) e 26 indivíduos sedentários com média de idade de 43,31 ± 6,38 (35-59) que foram questionados quanto à experiência como jogador de futebol, história de traumatismo craniano, concussões e doenças cardiometabólicas. No primeiro dia, foram obtidas amostras de sangue para investigar os parâmetros hematológicos e bioquímicos basais. No segundo dia, foi realizado o teste de estimulação com ACTH; no terceiro dia, foram feitos os testes de estimulação com glucagon. Além disso, foram realizados ECG de repouso, ecocardiograma transtorácico e testes de esforço para obter o equivalente metabólico (MET). Na análise estatística, o teste t de Student foi usado na comparação dos resultados dos dois grupos. O nível de significância foi estabelecido em p < 0,05. Resultados: Identificou-se que cinco dos 32 jogadores de futebol (16%) sofreram uma concussão durante a carreira futebolística. Os níveis de hormônio de crescimento (GH) de três jogadores de futebol (9,2%) e de três indivíduos sedentários (10%) foram inferiores a 1 ng/dl, valor que foi aceito como limiar. Não houve diferença significativa entre os parâmetros hematológicos, bioquímicos e cardiometabólicos dos jogadores de futebol com deficiência de GH e os jogadores de futebol com nível normal de GH. Não houve relação significativa entre o número de cabeceamentos e a deficiência de GH. Conclusão: Embora a deficiência de GH tenha sido detectada em quase 10% dos jogadores aposentados, a frequência de hipopituarismo não foi maior do que a dos controles sedentários. Nível de evidência I; Estudos Prognósticos.

RESUMEN Introducción: Es un hecho conocido que la disfunción hipofisaria sobreviene a consecuencia de lesiones cerebrales traumáticas. Una de las razones para esas lesiones es la colisión durante deportes de contacto. Objetivo: El objetivo de este estudio fue investigar los efectos de la cabezada en la pelota sobre la hipófisis y sus funciones en jugadores de fútbol retirados. Métodos: Participaron en este estudio 32 jugadores de fútbol retirados con promedio de edad de 43,38 ± 5,49 (35-59) y 26 individuos sedentarios con promedio de edad de 43,31 ± 6,38 (35-59) que fueron cuestionados cuanto a la experiencia como jugador de fútbol, historia de traumatismo craneano, concusiones y enfermedades cardiometabólicas. En el primer día, fueron obtenidas muestras de sangre para investigar los parámetros hematológicos y bioquímicos basales. En el segundo día, fue realizado el test de estimulación con ACTH. En el tercer día, fueron hechos los tests de estimulación con glucagón. Además, fueron realizados ECG de reposo, ecocardiograma transtorácico y tests de esfuerzo para obtener el equivalente metabólico (MET). En el análisis estadístico se usó el test t de Student en la comparación de los resultados de los dos grupos. El nivel de significancia fue establecido en p<0,05. Resultados: Se identificó que cinco de los 32 jugadores (16%) sufrieron una concusión durante la carrera futbolística. Los niveles de hormona de crecimiento (HC) de tres jugadores de fútbol (9,2%) y de tres individuos sedentarios (10%) fueron inferiores a 1 ng/dl, valor que fue aceptado como umbral. No hubo diferencia significativa entre los parámetros hematológicos, bioquímicos y cardiometabólicos de los jugadores de fútbol con deficiencia de HC y los jugadores de fútbol con niveles normal de HC. No hubo relación significativa entre el número de cabezadas y la deficiencia de HC. Conclusión: Aunque la deficiencia de HC haya sido detectada en casi 10% de los jugadores retirados, la frecuencia de hipopituitarismo no fue superior a la de los controles sedentarios. Nivel de evidencia I; Estudios pronósticos.

Chronic traumatic encephalopathy associated with cumulative soccer heading exposure: A review of the recent literature / 体力科学

Soccer is the most popular sport worldwide, with over 265 million participants. Soccer is unique in that the ball can be directed deliberately and purposefully with the head, an act referred to as ‘heading’. In recent years, there has been concern about the association between repetitive subconcussive head impacts associated with heading and chronic traumatic encephalopathy. Heading causes immediate changes in biochemical and electrophysiological markers of traumatic brain injury, and some studies have reported brain structural changes and dysfunction in former soccer players. In 2019, it was reported that the mortality associated with neurodegenerative diseases was about 3.5 times higher among former professional soccer players. Following that, in early 2020, the guidance have been published to limit heading by age in some regions including England and Scotland. In this review, we will expound the immediate and long-term effects of heading associated with chronic traumatic encephalopathy and the measures that should be taken into consideration in the practice of soccer instruction, based on the latest findings.

Brain Concussion: New Classifications and Current Physiopathological Knowledge of the Disease

The present review paper aims to update the definition and classification of cerebral concussion, highlighting its pathophysiological mechanisms. The high prevalence of cerebral concussion in emergency rooms around the world makes it necessary to know its proper management to avoid its late sequelae, which traditionally compromise cognitive aspects of behavior. New evidence on potential neuroprotective treatments is being investigated.

Effectiveness of hand self-shiatsu to improve sleep following sport-related concussion in young athletes: a proof-of-concept study / 中西医结合学报

OBJECTIVE@#The prevalence of sport-related concussion (SRC) is high and results in a number of serious health consequences. One area that has received minimal research is the relationship between SRC and sleep. The literature shows that sleep deficiency is a frequent negative consequence of SRC. At the same time, sleep deficiency delays recovery from SRC and contributes added risk of symptom recurrence. A 2014 study of chronic pain patients who learned to apply the complementary and alternative medicine intervention hand self-shiatsu (HSS) had promising, sleep-promoting results that warrant further investigation with other populations. This proof-of-concept study explored the feasibility of HSS as an intervention to promote sleep onset and continuity for young adults with SRC.@*METHODS@#This study employed a prospective case-series design, where participants act as their own controls. Baseline and follow-up data included standardized self-reported assessment tools and sleep actigraphy.@*RESULTS@#Seven athletes, aged between 18 and 25 years, participated in the study. Although statistically significant improvement in actigraphy sleep scores between baseline and follow-up was not achieved, metrics for sleep quality and daytime fatigue showed significant improvement.@*CONCLUSION@#These findings support the hypothesis that HSS has the potential to improve sleep and reduce daytime fatigue in young postconcussion athletes. This pilot study provides guidance to refine research protocols and lays a foundation for further, large-sample, controlled studies.

Dizziness in Traumatic Brain Injury: Visual-Vestibular Dysfunction, Neurotological Approach / 대한평형의학회지

Traumatic brain injury (TBI) could give rise to variable clinical manifestations based on the involved structures of our bodies. Although there are no structural abnormalities proven, the patients with mild TBI suffer from chronic dizziness and imbalance. Herein, I will discuss the visuo-vestibular interaction and neurotological finding in TBI, which could demonstrate the clue to the diagnosis and management in dizzy patients with TBI.