Gulf War Veterans Research Articles

Feasibility of Resistance Exercise Training in Gulf War Veterans with Widespread Pain

Roughly 25-33% of US Veterans of Operations Desert Shield or Desert Storm report a constellation of chronic symptoms including fatigue, confusion and widespread pain. Although exercise is routinely prescribed, and found to be efficacious, for many chronic pain conditions; Veterans’ reports of post-exertional exacerbation of symptoms complicates the question of whether exercise should be used as an adjunct treatment to standard care. PURPOSE: To determine the safety and efficacy of a resistance exercise training (RET) program in Gulf War Veterans (GV) with chronic widespread musculoskeletal pain (CMP). METHODS: Gulf Veterans suffering medically unexplained CMP lasting at least 3 months (N=50) were randomized to either 16 weeks of twice weekly RET or wait-list control (WLC). Training was supervised by exercise specialists and consisted of 10 exercises targeting major muscle groups. The program started at a very low intensity [25-35% of estimated 1-repetition maximum (1-RM)] and progressed in small (≤5%) increments. Thus, training was both individualized and standardized. Testing of 1-RM was completed at baseline and reevaluated at 16 weeks. The McGill Pain Questionnaire (MPQ) and Profile of Mood States (POMS) were completed at weeks 1, 6, 12 and 16. Exercisers not completing >50% of training were excluded from statistical analyses (n=4). Average 1-RM values were compared using dependent t-tests, and MPQ and POMS data were evaluated using repeated-measures ANOVAs. RESULTS: The final sample consisted of 22 GV in the RET group, with >90% adherence, and 20 WLC Veterans. No drop outs were due to negative complications with exercise. Following RET, participants on average lifted 67 kg/kg of body weight and significant (p<0.05) 1-RM increases were observed in all 8 lifts. Estimated 1-RM increased by at least 20% for 7 of 8 lifts. Mood scores significantly improved in both groups over the course of the trial with no significant difference between groups. No time or group effects (p>0.05) were observed in MPQ scores. CONCLUSIONS: RET significantly increased strength in GV with CMP. It resulted in no exacerbation of pain symptoms and did not increase mood disturbance. Resistance exercise appears safe and efficacious for Gulf Veterans with widespread pain. Supported by Dept. of Veterans Affairs grant: IO1-CX000383.

Acute Pain And Fatigue Responses To Resistance Exercise Among Gulf War Veterans With Chronic Pain

Acute Pain And Fatigue Responses To Resistance Exercise Among Gulf War Veterans With Chronic Pain

Gender-based Differences among 1990-1991 Gulf War Era Veterans: Demographics, Lifestyle Behaviors, and Health Conditions.

The 1990-1991 Gulf War employed more women servicemembers than any prior conflict. Gender-based differences among veterans of this era have yet to be explored. This study is among the first and most recent to stratify Gulf War veteran demographics, lifestyle factors, and self-reported diagnoses by gender. Data from the cross-sectional Gulf War Era Cohort and Biorepository pilot study (n=1,318; collected between 2014 and 2016), including users and nonusers of the Veterans Health Administration, were used to calculate demographics and adjusted odds ratios. Women veterans were oversampled and comprised approximately 23% of the sample. Women reported similar rates of Veterans Health Administration use (44%) and deployment (67%) as men (46% and 72%, respectively). Women were less likely than men to report frequent alcohol use (adjusted odds ratio [aOR], 0.59; 95% confidence interval [CI], 0.43-0.81; p=.0009) or have a history of smoking (aOR, 0.65; 95% CI, 0.49-0.84; p=.0014). Among common health conditions, women were more likely than men to report a diagnosis of osteoporosis (aOR, 4.24; 95% CI, 2.39-7.51; p<.0001), bipolar disorder (aOR, 2.15; 95% CI, 1.15-4.04; p=.0167), depression (aOR, 2.39; 95% CI, 1.81-3.16; p<.0001), irritable bowel syndrome (aOR, 2.10; 95% CI, 1.43-3.09; p=.0002), migraines (aOR, 2.96; 95% CI, 2.18-4.01; p<.0001), asthma (aOR, 1.86; 95% CI, 1.29-2.67; p=.0008), and thyroid problems (aOR, 4.60; 95% CI, 3.14-6.73; p<.0001). Women were less likely than men to report hypertension (aOR, 0.55; 95% CI, 0.41-0.72; p<.0001), tinnitus (aOR, 0.46; 95% CI, 0.33-0.63; p<.0001), and diabetes (aOR, 0.44; 95% CI, 0.28-0.69; p=.0003). Health differences exist between female and male veterans from the 1990-1991 Gulf War. Gender-specific analyses are needed to better understand the unique health care needs of Gulf War Era veterans and direct future research.

Understanding the antecedents of aggressive behavior in Persian Gulf War veterans within individual, interpersonal, and community contexts

ABSTRACTThe present study applies the social-ecological framework to examine multiple level correlates of aggressive behavior of veterans of the first Gulf War in 1991. Data were collected from the VA‘s Persian Gulf Family Support Programs (PGFSP), and the sample includes 1,519 veterans who participated in the PGFSP. At the individual level, the study finds that younger and female veterans and those with higher self-esteem were less likely to report displaying aggressive behavior. At the interpersonal level, veterans who displayed misconduct in the home are more likely to display aggressive behavior. At the community level, veterans who were in the Air Force was less likely, while those in the Marines were more likely to be aggressive. Implications for practice are discussed.

Influence of Diisopropyl fluorophosphate, an irreversible cholinesterase inhibitor, on metabolic and inflammatory parameters, cardiac function, autonomic modulation, and angiotensin 1–7 receptor

Nowadays, an estimate of 25–32% of approximately 700,000 Gulf War veterans affected by the Gulf War illness (GWI) still experience symptoms associated with their deployment. It is important to emphasize that GWI is an archetypal, medically unexplained, chronic condition. Musculoskeletal pain, cognitive dysfunction, unexplained fatigue, exercise intolerance, chronic diarrhea, rashes, sleep disorders, and respiratory problems are some of the symptoms observed in Gulf War veterans affected by GWI. Understanding the mechanisms involved in GWI is important to provide a better assistance/treatment to this population. In this study, we used mice to verify the influence of Diisopropyl fluorophosphate (DFP), an irreversible cholinesterase inhibitor used to mimic the effects of sarin gas used during the Gulf War, on metabolic and inflammatory parameters, cardiac function (ECHO), autonomic modulation (spectral analysis) and angiotensin 1–7 receptor (Radioligand Binding Assay) in liver. The animals exposed to DFP showed lower levels of glucose (−8%), triglycerides (−23%) and IL‐10 (−32%), lower parasympathetic modulation (−33%), which led to a higher sympathovagal balance. They showed a lower ejection fraction (−13%) and higher myocardial performance index (30%), characterizing a cardiac dysfunction. In addition, they showed higher Bmax for 125/127I‐Angiotensin 1–7 binding assay, which represents a higher number of receptors (28%). Our results show that exposure to DFP leads to alterations on metabolic and inflammatory parameters, cardiac function, autonomic modulation, and renin‐angiotensin‐aldosterone system, which helps us to understand, at least in part, the mechanisms involved in GWI. Further studies are needed to elucidate the whole mechanisms behind GWI.Support or Funding InformationW81XWH‐13‐2‐0085 Morris (PI); Cardiovascular Neuroscience Research Fund 337667 Speth (PI)This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Birth Defects Among 788 Children Born to Gulf War Veterans Based on Physical Examination.

The aim of the study was to examine the prevalence of birth defects among children born to Gulf War veterans. Seven hundred eighty-eight singleton children born after the war to 522 veterans (262 Gulf War-deployed, DV; 260 non-deployed, NDV) underwent physical examinations focusing on major and minor birth defects and other findings. We found no differences between children of DV and NDV in the prevalence of major birth defects or other findings. However, children of DV women were more likely to have minor birth defects compared with children of NDV women (DV 22% NDV 4.8%, odds ratio: 5.47, confidence interval: 2.06, 14.55), mainly due to increased incidence of minor eye and musculoskeletal birth defects. Our data show that deployment of women to the Persian Gulf arena was associated with increased risk of minor birth defects in their offspring.

Mental health in spouses of U.S. Gulf War veterans

Veterans’ spouses are at risk for mental distress and substance use. We examined long term psychological functioning in spouses from a national cohort of 1991 Gulf War era veterans. From clinical interviews, spouses of deployed veterans (n = 488) did not have a greater prevalence of post-war mental disorders compared to spouses of non-deployed veterans (n = 536); however, in couples that were living together since the war, there was an increased risk of anxiety disorders or any one disorder. On questionnaires, the impact varied but was most consistently observed in more severe depression and greater functional impairment in spouses of deployed compared to non-deployed veterans. If a veteran developed post-war anxious/depressive disorders or any one mental disorder, the matched spouse was more likely to develop post-war anxious/depressive disorders or any one mental disorder, respectively. Veteran combat exposure did not similarly increase the risk of spouse post-war mental disorders. Greater spouse self-reported symptomatology was observed in spouses of veterans with anxious/depressive disorders even when controlling for deployment. In summary, the war conferred greater risk for spouse mental disorders and distress for spouses of veterans with mental health disorders, with some increased risk for spouses of deployed veterans, especially in couples together since the war.

Longitudinal study of t-cell somatic mutations conferring glycosylphosphatidylinositol-anchor deficiency in gulf war I veterans exposed to depleted uranium.

Fifty Veterans of the first Gulf War in 1991 exposed to depleted uranium (DU) were studied for glycosylphosphatidylinositol-anchor (GPIa) deficient T-cell mutants on three occasions during the years 2009, 2011, and 2013. GPIa deficiency was determined in two ways: cloning assays employing aerolysin selection and cytometry using the FLAER reagent for positive staining of GPIa cell surface proteins. Subsequent molecular analyses of deficient isolates recovered from cloning assays (Nicklas JA et al. [2019]: Environ Mol Mutagen) revealed apparent incomplete selection in some cloning assays, necessitating correction of original data to afford a more realistic estimate of GPIa deficient mutant frequency (MF) values. GPIa deficient variant frequencies (VFs) determined by cytometry were determined in the years 2011 and 2013. A positive but nonsignificant association was observed between MF and VF values determined on the same blood samples during 2013. Exposure to DU had no effect on either GPIa deficient MF or VFs. Environ. Mol. Mutagen. 60:494-504, 2019. © 2019 Wiley Periodicals, Inc.

Targeting Intracellular Calcium Stores Alleviates Neurological Morbidities in a DFP-Based Rat Model of Gulf War Illness.

Gulf War Illness (GWI) is a chronic multi-symptom disorder afflicting the veterans of the First Gulf War, and includes neurological symptoms characterized by depression and memory deficits. Chronic exposure to organophosphates (OPs) is considered a leading cause for GWI, yet its pathobiology is not fully understood. We recently observed chronic elevations in neuronal Ca2+ levels ([Ca2+]i) in an OP-diisopropyl fluorophosphate (DFP)-based rat model for GWI. This study was aimed at identifying mechanisms underlying elevated [Ca2+]i in this DFP model and investigating whether their therapeutic targeting could improve GWI-like neurological morbidities. Male Sprague-Dawley rats (9 weeks) were exposed to DFP (0.5 mg/kg, s.c., 1×-daily for 5 days) and at 3 months postDFP exposure, behavior was assessed and rats were euthanized for protein estimations and ratiometric Fura-2 [Ca2+]i estimations in acutely dissociated hippocampal neurons. In DFP rats, a sustained elevation in intracellular Ca2+ levels occurred, and pharmacological blockade of Ca2+-induced Ca2+-release mechanisms significantly lowered elevated [Ca2+]i in DFP neurons. Significant reductions in the protein levels of the ryanodine receptor (RyR) stabilizing protein Calstabin2 were also noted. Such a posttranslational modification would render RyR “leaky” resulting in sustained DFP [Ca2+]i elevations. Antagonism of RyR with levetiracetam significantly lower elevated [Ca2+]i in DFP neurons and improved GWI-like behavioral symptoms. Since Ca2+ is a major second messenger molecule, such chronic increases in its levels could underlie pathological synaptic plasticity that expresses itself as GWI morbidities. Our studies show that treatment with drugs targeted at blocking intracellular Ca2+ release could be effective therapies for GWI neurological morbidities.

Rates of Chronic Medical Conditions in 1991 Gulf War Veterans Compared to the General Population.

Prevalence of nine chronic medical conditions in the population-based Ft. Devens Cohort (FDC) of GW veterans were compared with the population-based 2013–2014 National Health and Nutrition Examination Survey (NHANES) cohort. Excess prevalence was calculated as the difference in prevalence estimates from the Ft. Devens and NHANES cohorts; and confidence intervals and p-values are based on the standard errors for the two prevalence estimates. FDC males were at increased risk for reporting seven chronic medical conditions compared with NHANES males. FDC females were at decreased risk for high blood pressure and increased risk for diabetes when compared with NHANES females. FDC veterans reporting war-related chemical weapons exposure showed higher risk of high blood pressure; diabetes; arthritis and chronic bronchitis while those reporting taking anti-nerve gas pills had increased risk of heart attack and diabetes. GW veterans are at higher risk of chronic conditions than the general population and these risks are associated with self-reported toxicant exposures.

Gastrointestinal neuroimmune disruption in a mouse model of Gulf War illness.

Gulf War illness (GWI) is a chronic multisymptom disorder that is prominent in Gulf War veterans. Major unexplained symptoms of GWI include functional gastrointestinal disorders and undiagnosed illnesses, including neurologic disorders. Exposure to the antinerve gas drug pyridostigmine bromide (PB) is linked to the development of GWI, but the exact mechanisms remain unclear. Here, we tested the hypothesis that PB alters gut function by disrupting the neural and immune systems of the intestine. We exposed male and female mice to physiologically comparable amounts of PB that match the dose, route, and time frame of exposure experienced by Gulf War veterans and assessed the acute and chronic impacts on gastrointestinal functions, the functional architecture of the enteric nervous system, and immune responses in the gut and brain. Exposure to PB drove acute alterations to colonic motility and structure in both male and female mice that transitioned to chronic changes in gut functions. PB drove acute alterations to enteric neural and glial activity, glial reactivity, and neuron survival with glial reactivity persisting into the chronic phase in male mice. Despite having no effect on colonic permeability, exposure to PB caused major shifts in the expression of proinflammatory cytokines and chemokines in the colon and brain that suggest immunosuppressive effects. Interestingly, immune disruption was still evident in the colon and brain in female animals at 1 mo following exposure to PB. Together, our results show that the paradigm of PB exposure experienced by veterans of the Persian Gulf War contributes to long-lasting pathophysiology by driving enteric neuroinflammation, promoting immunosuppression, and altering functional anatomy of the colon in a sex-dependent manner.-Hernandez, S., Fried, D. E., Grubišić, V., McClain, J. L., Gulbransen, B. D. Gastrointestinal neuroimmune disruption in a mouse model of Gulf War illness.

Risk factors for upper and lower functional gastrointestinal disorders in Persian Gulf War Veterans during and post-deployment.

Gastroenteritis is a risk factor for irritable bowel syndrome (IBS), but its role in other functional gastrointestinal disorders (FGIDs) is less clear. The aim of this study was to determine the prevalence of FGIDs in Gulf War (GW) Veterans before, during, and after deployment and to determine whether gastroenteritis was a risk factor for upper and lower FGIDs. The Veterans who served during the Persian GW were mailed validated questionnaires inquiring about their bowel habits, psychological and extra-intestinal symptoms, and quality of life (QOL). The lactulose hydrogen breath test (LBT) was performed for small intestinal bacterial overgrowth. Data were analyzed from 468 GW Veterans. The prevalence of FGID before, during, and 16years after deployment was 15.7%, 49.9%, and 64.2%, respectively. New FGIDs during deployment was reported by 41.2%, and during 16years after deployment, 43.7% acquired new FGIDs. FGIDs were associated with psychological disorders, extra-intestinal symptoms, and lower QOL. Gastroenteritis was reported by 44.3% of deployed Veterans and was a risk factor for IBS, dyspepsia, and functional diarrhea post-deployment. The cases and controls did not differ significantly in the frequency of positive LBT. There is an increase in the prevalence of FGIDs during deployment, and it persists after deployment. There is a further increase in the prevalence of FGIDs after deployment. In addition to IBS, gastroenteritis during deployment is a risk factor for dyspepsia and functional diarrhea post-deployment. Therefore, prevention of gastroenteritis during deployment and screening of Veterans for FGIDs post-deployment would be of value for Veterans' long-term health.

Medical Correlates of Chronic Multisymptom Illness in Gulf War Veterans

BackgroundChronic multisymptom illness (CMI) is more prevalent among deployed than nondeployed veterans from the first Gulf War. Objective physiologic markers of CMI are lacking. The purpose of this study is to determine whether measurable abnormalities in the autonomic nervous system or hypothalamic-pituitary adrenal axis would distinguish CMI cases (CMI+) from controls (CMI-) among deployed veterans of the 1990-1991 Gulf War. MethodsThis is a cross-sectional case-control cohort study that examined deployed veterans who participated in the Phase III study: National Health Survey of Gulf War Veterans and Their Families. Autonomic nervous system and hypothalamic-pituitary adrenal axis function-related measures included: 24-hour heart-rate variability, urinary catecholamines and cortisol, hypertension, insulin sensitivity, dyslipidemia, body fat, bone mineral density, and ultrasensitive C-reactive protein. ResultsVeterans of the first Gulf War with CMI (n = 73) and without the condition (n = 111) were studied. Sociodemographic characteristics were similar. Veterans with CMI reported poorer mental and physical functioning, greater use of prescription medications, and more nonroutine clinic visits. These veterans were also more likely to have fibromyalgia syndrome, irritable bowel syndrome, metabolic syndrome, and among males, a larger waist-to-hip ratio. Lower values for a nonlinear heart-rate-variability parameter—the short-term fractal scaling exponent (DFA1), reflecting an increased randomness of beat-to-beat changes in heart rate—were observed in veterans with CMI than those veterans without it (1.28±0.16vs 1.35±0.15; p=0.005). Hypothalamic-pituitary-adrenal axis function measures were similar between the two groups. ConclusionIn this cohort of deployed veterans from the first Gulf War, we identified abnormal heart-rate variability in veterans with CMI compared to veterans without the condition, which suggests abnormal functioning of the autonomic nervous system and possible long-term cardiovascular effects.

The Multiple Hit Hypothesis for Gulf War Illness: Self-Reported Chemical/Biological Weapons Exposure and Mild Traumatic Brain Injury.

The Gulf War Illness Consortium (GWIC) was designed to identify objective biomarkers of Gulf War Illness (GWI) in 1991 Gulf War veterans. The symptoms of GWI include fatigue, pain, cognitive problems, gastrointestinal, respiratory, and skin problems. Neurotoxicant exposures during deployment, such as pesticides, sarin, and pyridostigmine bromide pills have been identified as contributors to GWI. We have also found an association between mild traumatic brain injury (mTBI) and increased rates of GWI. However, the combined impact of these physical and chemical exposures has not yet been explored in GWI. The objective of this study was to examine both self-reported mTBI and exposure to chemical/biological weapons (CBW) as a multiple or two hit model for increased risk of GWI and other chronic health conditions. The study population included 125 Gulf War (GW) veterans from the Boston GWIC. Exposure to CBW was reported in 47.2% of the study population, and 35.2% reported sustaining a mTBI during the war. Results confirmed that those with both exposures (mTBI and CBW) had higher rates of comorbid chronic health conditions while rates of GWI were equivalent for mTBI and CBW or mTBI alone. The timing of exposure to mTBI was found to be strikingly different between those with GWI and those without it. Correspondingly, 42.3% of GWI cases reported experiencing a mTBI during military service while none of the controls did (p = 0.0002). Rates of mTBI before and after the war did not differ between the cases and controls. In addition, 54% of cases compared to 14.3% of controls (p = <0.001) reported being exposed to CBW during military service. The current study examined the relation of the separate and combined effects of exposure to mTBI and CBW in 1991 GW veterans. The findings from this study suggest that both exposure to mTBI and CBW are associated with the development of GWI and multiple chronic health conditions and that combined exposure appears to lead to higher risk of chronic health effects.

Gulf War illness associated with abnormal auditory P1 event-related potential: Evidence of impaired cholinergic processing replicated in a national sample

Our team previously reported event-related potential (ERP) and hyperarousal patterns from a study of one construction battalion of the U.S. Naval Reserve who served during the 1991 Persian Gulf War. We sought to replicate these findings in a sample that was more representative of the entire Gulf War-era veteran population, including male and female participants from four branches of the military. We collected ERP data from 40 veterans meeting Haley criteria for Gulf War syndromes 1–3 and from 22 matched Gulf War veteran controls while they performed an auditory oddball task. Reports of hyperarousal from the ill veterans were significantly greater than those from the control veterans, and P1 amplitudes in Syndromes 2 and 3 were significantly higher than P1 amplitudes in Syndrome 1, replicating our previous findings. Many of the contributors to the generation of the P1 potential are also involved in the regulation of arousal and are modulated by cholinergic and dopaminergic systems—two systems whose dysfunction has been implicated in Gulf War illness. These differences among the three syndrome groups where their means were on either side of controls is a replication of our previous ERP study and is consistent with previous imaging studies of this population.

323 - Can the redox state in serum explain medically unexplained illness among Gulf War veterans?

The redox state of the serum albumin has been extensively examined not only to understand the marvelous compensation the body undergoes to attain homeostasis, but also the constant subtlety with which the oxidative stress is generated at the cellular level, which may transcend to the tissue parenchyma eventually resulting in the inflammation of the whole system. Evaluation of such inflammation although critical, will be hard to measure. We suspected the serum albumin, since it is the major cargo protein in the serum, that is synthesized in the liver, with the contribution of the dietary amino acids and exercise. Albumin is cysteine (Cys) rich and is known to have multiple ligand-binding properties, and can readily bind to free radicals. Our previous studies have shown Cys residues can form s-nitrosothiols (SNO) which have anti-oxidant property and are transported through L-type amino acid transporter. Since GWV were exposed to various neurotoxic chemicals, we suspect neuroinflammation as one of the causes of their illness. As a preliminary effort, we assessed SNO levels in the sera of 20 veterans with Gulf War Illness (GWI) and compared it with the healthy Gulf War Veterans (GWV) primarily to understand some of the unexplained phenomena in GWI. Since the redox state of serum albumin is modulated by physical activity such as exercise where the muscle tissue maintains the adaptive response, we also tested 5 GWI veterans and compared it with 5 healthy veterans that were on exercise treatment. We measured SNO levels in the serum both by DAF and by chemiluminescence. There was a significant reduction in the SNO-albumin level in GWI compared to healthy veterans (p

Double-Blind Placebo-Controlled Study of Rifaximin and Lactulose Hydrogen Breath Test in Gulf War Veterans with Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) occurs in up to 33% of Gulf War (GW) Veterans. Alterations in gut microflora including small intestinal bacterial overgrowth (SIBO) during deployment may play a role in development of IBS. Rifaximin is a minimally absorbed antibiotic speculated to improve IBS symptoms, in part, by restoring normal gut microflora. The aim of this study was to compare rifaximin to placebo on IBS symptoms and quality of life (QOL) in GW Veterans with IBS without constipation. A double-blind, placebo-controlled study was performed. One hundred and twenty-two GW Veterans with IBS (Rome III) from our database and referral to gastroenterology and internal medicine clinics were screened. After a 2-week run-in period, 50 patients were randomized (1:1) to receive either rifaximin 550 gm or placebo twice daily for 2weeks in a double-blind study. Patients were advised not to change their diet or medications during the study. The symptoms assessed were: (1) stool frequency, (2) stool consistency (Bristol stool scale, 1-7, very hard to watery), (3) urgency (1 = yes/0 = no daily for 7days), (4) severity of abdominal pain (0-4, none to severe), (5) severity of bloating (1-4, none to severe), and (6) global improvement scale (1-7, substantially worse to substantially improved). These were recorded for 7 consecutive days and then averaged across the 7days, to generate a continuous variable. The symptom data were compared after 2weeks of treatment. QOL was assessed using IBS-QOL. The lactulose hydrogen breath test (LHBT) was performed at baseline and after 2weeks of treatment. Fifty Veterans were randomized to receive treatment; 3 withdrew and 3 were lost to follow-up. Data were analyzed from 44 patients (38 men, 6 women, median age 52, range 33-77years). Rifaximin was not associated with significant improvement in global symptoms, abdominal pain, bloating, stool urgency, frequency, or consistency (all P ≥ 0.25) or QOL (all P ≥ 0.26). Normalization of SIBO by LHBT was not different between rifaximin- and placebo-treated Veterans (7 vs. 22%, P = 0. 54). Rifaximin was not effective in improving IBS symptoms and QOL in GW Veterans with non-constipated IBS.

An exploratory fMRI study: rTMS in Gulf War Veterans with headaches

Objective: The preliminary study explores the correlated supraspinal effect of repetitive transcranial magnetic stimulation (rTMS) at the left motor cortex in patients with Gulf War Illness related headaches and pain (GWI-HAP) through functional magnetic resonance imaging (FMRI).

Semen Uranium Concentrations in Depleted Uranium Exposed Gulf War Veterans: Correlations with Other Body Fluid Matrices.

Environmental metal exposure, as well as dietary metals, may adversely affect semen quality even as others play an essential role in normal spermatogenesis and fertility. Measures of seminal fluid metals have therefore been of high interest in the last several decades but have shown inconsistent results in correlations with some semen quality parameters. As well, environmental metal measures across various body fluid matrices have not been consistently correlated contrary to what one might hypothesize based on a systemic body burden of metal. This may be due to the body fluid matrices assessed and to other differences in laboratory methods and sample preparation. Measures of uranium, a potentially toxic metal in humans, have not previously been reported in the semen of environmentally metal-exposed populations. We report here uranium seminal fluid results and the high correlation of uranium concentrations across several body fluid matrices in a cohort of military veterans exposed to depleted uranium in combat events during the Iraqi Gulf War. These results inform the risk communication conversation for exposed populations and broaden the public health assessments from various exposure scenarios.

Evidence for Somatic Hypersensitivity in Veterans With Gulf War Illness and Gastrointestinal Symptoms.

Over 25% of Persian Gulf War (PGW) veterans with Gulf War Illness (GWI) (chronic health symptoms of undetermined etiology) developed gastrointestinal (GI) (diarrhea and abdominal pain) and other somatic symptoms. Our study objective was to determine if veterans with GWI and GI symptoms exhibit heightened patterns of somatic pain perception (hypersensitivity) across nociceptive stimuli modalities. Participants were previously deployed GW Veterans with GWI and GI symptoms (n=53); veterans with GWI without GI symptom (n=47); and veteran controls (n=38). We determined pain thresholds for contact thermal, cold pressor, and ischemic stimuli. Veterans with GWI and GI symptoms showed lower pain thresholds (P<0.001) for each stimulus. There was also overlap of somatic hypersensitivities among veterans with GI symptoms with 20% having hypersensitivity to all 3 somatic stimuli. Veterans with GWI and GI symptoms also showed a significant correlation between mechanical visual analog scale abdominal pain ratings and heat pain threshold, cold pressor threshold, and ischemic pain threshold/tolerance. Our findings show that there is widespread somatic hypersensitivity in veterans with GWI/GI symptoms that is positively correlated with abdominal pain ratings. In addition, veterans with somatic hypersensitivity that overlap have the greatest number of extraintestinal symptoms. These findings may have a translational benefit: strategies for developing more effective therapeutic agents that can reduce and/or prevent somatic and GI symptoms in veterans deployed to future military conflicts.