Risk Of Brain Injury Research Articles

D‐HAT: A Diatom‐Inspired Structure for a Helmet Concept Against Trauma

Helmets are critical for minimizing the risk of traumatic brain injuries in road accidents and sports. Traditional designs feature a rigid outer shell and a deformable inner liner of foam for energy absorption. Recent advancements have introduced architected materials as alternatives to conventional foams, offering improved safety and multifunctionality. Herein, a diatom‐inspired architected material optimized for energy absorption in helmet liners is proposed and designed for a new concept of multifunctional helmets. The material is modeled using CAD tools, its performance is evaluated through finite element analysis and quasistatic compression tests on 3D‐printed elastomeric samples, and parametric optimization is applied. The results demonstrate energy absorption comparable to conventional materials, laying the groundwork for future studies on fluid‐dynamic behavior and multifunctional helmet designs.

Relationship between alcohol use and traumatic brain injury: evidence from Mendelian randomization

ABSTRACT Background Observational studies suggest that alcohol consumption increases the risk of traumatic brain injury (TBI); however, the causality of this association remains unclear. Objectives This study aimed to identify which drinking pattern is the primary factor influencing TBI. Method Two-sample Mendelian randomization (MR) was used to assess whether drinking patterns (alcohol consumption, abuse, and intake frequency) are causally associated with TBI risk. Results MR analysis revealed causal effects of alcohol intake frequency [odds ratio (OR) 0.806, 95% confidence interval (CI): 0.665–0.978, p = 0.028, beta: −0.215, se: 0.098], alcohol drinks per week (OR 1.772, 95% CI: 1.140–2.753, p = 0.011, beta: 0.572, se: 0.225), and alcohol abuse (OR 1.095, 95% CI: 1.006–1.192, p = 0.035, beta: 0.091, se: 0.043) on TBI. Additionally, no causal effect of alcohol consumption (OR 0.730, 95% CI: 0.264–2.025, p = 0.546, beta: −0.314, se: 0.520) or average monthly alcohol intake (OR 1.138, 95% CI: 0.805–1.609, p = 0.463, beta: 0.130, se: 0.177) on TBI was observed. Similarly, the effects of TBI on alcohol intake were statistically non-significant. Conclusion Drinking patterns, including alcohol intake frequency and abuse, influence TBI, whereas TBI rarely influences drinking patterns.

Cerebral Microhemorrhages in Children With Congenital Heart Disease: Prevalence, Risk Factors, and Association With Neurodevelopmental Outcomes.

Infants with congenital heart disease require early lifesaving heart surgery, which increases risk for brain injury and neurodevelopmental delay. Cerebral microhemorrhages (CMH) are frequently seen after surgery, but whether they are benign or constitute injury is unknown. One hundred ninety-two infants with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass were evaluated with pre- (n=183) and/or postoperative (n=162) magnetic resonance imaging. Perioperative risk factors for CMH and neurodevelopmental outcomes were analyzed using linear regression. Eighteen-month neurodevelopmental outcomes were assessed in a subset of patients (n=82). The most common congenital heart disease subtypes were hypoplastic left heart syndrome (37%) and transposition of the great arteries (33%). Forty-two infants (23%) had CMH present on magnetic resonance imaging presurgery and 137 infants (85%) postsurgery. We found no significant risk factors for preoperative CMH. In multivariable analysis, neurodevelopmental duration (P<0.0001), use of extracorporeal membrane oxygenation support (P<0.0005), postoperative seizure(s) (P=0.02), and lower birth weight (P=0.03) were associated with new or worsened CMH postoperatively. A higher CMH number was associated with lower motor scores (P=0.01) at 18 months. CMH are common imaging findings in infants with congenital heart disease, particularly after cardiopulmonary bypass conferring adverse impact on neurodevelopmental outcomes at 18 months. Longer duration of cardiopulmonary bypass and extracorporeal membrane oxygenation use demonstrated greatest risk for developing CMH. However, the presence of CMH on preoperative scans indicates yet unidentified nonperioperative risk factors. Neuroprotective strategies to mitigate CMH risk may improve neurodevelopmental outcomes in this vulnerable population.

Research progress on pathogenesis and treatment of febrile seizures.

Febrile seizures (FSs) are the most common pediatric neurological disorder, affecting approximately 5% of children aged 6months to 5years. While most FSs are self-limiting and benign, about 20-30% present as complex FSs (CFSs), which pose a risk of acute brain injury and the development of temporal lobe epilepsy. Various factors, including age, geographical distribution, and type of infection influence the occurrence of FS. Infection is the primary external trigger for FS, while the underlying intrinsic factors are linked to the immature and incomplete myelination of the brain during specific developmental stages. Although the precise pathogenesis of FS is not yet fully understood, it is likely caused by the interaction of immature brain development, fever, neuroinflammation, and genetic susceptibility. This review discussed the pathogenesis of febrile seizures, focusing on factors such as age, fever, neuroinflammation, genetics, and intestinal microbiota, and summarized existing therapeutic approaches. Our review may facilitate the identification of new targets for mechanistic studies and clinical treatment of febrile seizures.

Paroxysmal sympathetic hyperactivity: A common consequence of traumatic brain injury.

Paroxysmal Sympathetic Hyperactivity (PSH) is a challenging and often underrecognized syndrome, commonly arising after a traumatic brain injury (TBI). Characterized by episodic bursts of heightened sympathetic activity, PSH presents with a distinct constellation of symptoms including hypertension, tachycardia, hyperthermia, and diaphoresis. While the exact pathophysiology remains elusive, current evidence suggests that the syndrome results from an imbalance between excitatory and inhibitory neuronal pathways within the central nervous system, leading to dysregulated autonomic responses. The unpredictable nature of PSH episodes can significantly complicate the clinical course of TBI patients, increasing the risk of secondary brain injury and other systemic complications. Management of PSH involves a combination of pharmacological agents, such as beta-blockers, opioids, and sedatives, to modulate sympathetic outflow, alongside non-pharmacological strategies aimed at minimizing environmental triggers. Early recognition and targeted intervention are crucial to improving outcomes. This communication delves into the clinical presentation, underlying mechanisms, and evolving management strategies of PSH, providing insights into its impact on the recovery of TBI patients.

Improving UK data on avoidable perinatal brain injury: review of data dictionaries and consultation.

High quality data is important to understanding epidemiology and supporting improvement efforts in perinatal brain injury. It is not clear which data items relevant to brain injury are captured across UK sources of routinely collected data, nor what needs to be done to ensure that those sources are fit for purpose in improving care. We reviewed data dictionaries of four main UK perinatal data sources and consulted a multi-professional group (N = 27) with expertise in neonatal/maternity care, statistics, and clinical negligence. None of the data sources we reviewed currently captures, on its own, the range of items relevant to brain injury. Data items lack common definitions and ongoing linkage across the different sources. Our consultation identified the need for standardising the definition of avoidable perinatal brain injury, resolving inconsistencies in capturing data, improving linkage of data across existing data sources, and co-designing a strategy for meaningful use of data. Limited standardisation and linkage across UK data sources are key problems in using data to guide improvement efforts aimed at reducing risk of avoidable perinatal brain injury. A programme involving co-design with healthcare professionals and families to improve capture and use of data is now needed. Limited standardisation and linkage across UK data sources currently challenge the use of data as the basis of efforts to reduce risk of avoidable perinatal brain injury. A harmonisation programme involving consultation and co-design with healthcare professionals, families, and other specialists is needed to enable better capture and use of data in this key area. There is need to standardise the definition of avoidable perinatal brain injury, resolve inconsistencies in capturing data, improve linkage of data collected across existing data sources, and co-design a strategy for meaningful use of data.

Portable six-channel laser speckle system for simultaneous measurement of cerebral blood flow and volume with potential applications in characterization of brain injury.

Cerebral blood flow (CBF) and cerebral blood volume (CBV) are key metrics for regional cerebrovascular monitoring. Simultaneous, non-invasive measurement of CBF and CBV at different brain locations would advance cerebrovascular monitoring and pave the way for brain injury detection as current brain injury diagnostic methods are often constrained by high costs, limited sensitivity, and reliance on subjective symptom reporting. We aim to develop a multi-channel non-invasive optical system for measuring CBF and CBV at different regions of the brain simultaneously with a cost-effective, reliable, and scalable system capable of detecting potential differences in CBF and CBV across different regions of the brain. The system is based on speckle contrast optical spectroscopy and consists of laser diodes and board cameras, which have been both tested and investigated for safe use on the human head. Apart from the universal serial bus connection for the camera, the entire system, including its battery power source, is integrated into a wearable headband and is powered by 9-V batteries. The temporal dynamics of both CBF and CBV in a cohort of five healthy subjects were synchronized and exhibited similar cardiac period waveforms across all six channels. The potential use of our six-channel system for detecting the physiological sequelae of brain injury was explored in two subjects, one with moderate and one with significant structural brain damage, where the six-point CBF and CBV measurements were referenced to structural magnetic resonance imaging (MRI) scans. We pave the way for a viable multi-point optical instrument for measuring CBF and CBV. Its cost-effectiveness allows for baseline metrics to be established prior to injury in populations at risk for brain injury.

Outcome prediction for late-onset sepsis after premature birth.

Our aim was to develop a quantitative model for immediately estimating the risk of death and/or brain injury in late-onset sepsis (LOS) in preterm infants, based on objective and measurable data available at the time sepsis is first suspected (i.e., time of blood culture collection). Retrospective study on neonates ≤36 weeks' gestation with a positive blood and/or cerebrospinal fluid culture after 72 hours from birth. Among 3217 preterm live births, 94 cases were included (median gestational age 26.5 weeks' IQR 25.0;28.0), of whom 26 (27.7%) had poor outcomes (17 death; 9 brain injuries). Infants with poor outcomes showed lower postnatal age (11.5 vs 12.5 days, p < 0.001), lower mean blood pressure (30.5 vs 43 mmHg, p < 0.001) and higher lactate levels (4.4 vs 1.5 mmol/l, p < 0.001). Our multivariable model showed good discrimination and calibration (c statistic=0.8618, Hosmer-Lemeshow p = 0.8532), stratifying the population into 3 groups: low-risk (sensitivity 97%, specificity 52%), middle-risk, and high-risk (sensitivity 77%, specificity 80%). This predictive model performs well as a practical and easy-to-use tool to help clinicians early identify the sickest neonates who may benefit from timely and aggressive support (e.g., central line, haemodynamic assessment) and close monitoring (e.g., 1:1 nursing assignment, frequent reassessments). We lack data to early identify the severity of neonatal late-onset sepsis in preterm infants. Delay in treatment contributes to poor prognosis. We developed a model for early prediction of poor outcomes (mortality and brain injuries). The model utilizes immediately available and measurable data at the time sepsis is first suspected. This can help clinicians in tailoring management based on individual risks.

Association between hemolysis markers and neuron-specific enolase in AMICS patients supported with a microaxial flow pump.

Acute myocardial infarction complicated by cardiogenic shock (AMICS) is frequently preceded by out-of-hospital cardiac arrest (OHCA), with risk of anoxic brain injury. Neuron-specific enolase (NSE) is central to neuroprognostication; however, concomitant hemolysis can increase NSE independent of neuronal injury due to the presence of NSE in erythrocytes. This consideration is critical in AMICS patients treated with a microaxial flow pump (Impella, Abiomed), where hemolysis is frequent. We identified consecutive AMICS patients receiving microaxial flow pump support ≥6h from 2014 to 2022 in a tertiary Danish heart center. Peak NSE and hemolysis biomarkers within 72h following microaxial flow pump placement were used for analysis. Hemolysis was defined as plasma-free hemoglobin levels >31.5 µmol/L within 72h from device placement. The population was stratified according to the presence or absence of hemolysis.The final study population comprised 44 patients with eligible NSE and hemolysis biomarkers. The median NSE was 85 µg/L. Patients with hemolysis had significantly higher NSE levels than those without (115 vs. 69 µg/L, p=0.018). NSE levels were similar between OHCA and non-OHCA patients. No significant difference in death from anoxic brain injury was observed between patients with NSE levels above or below 60 µg/L. NSE revealed a significantly moderate correlation with all investigated hemolysis markers. NSE was associated with hemolysis, and not anoxic brain injury, in AMICS patients supported with a microaxial flow pump.

Development and external validation of a machine learning model for brain injury in pediatric patients on extracorporeal membrane oxygenation

BackgroundPatients supported by extracorporeal membrane oxygenation (ECMO) are at a high risk of brain injury, contributing to significant morbidity and mortality. This study aimed to employ machine learning (ML) techniques to predict brain injury in pediatric patients ECMO and identify key variables for future research.MethodsData from pediatric patients undergoing ECMO were collected from the Chinese Society of Extracorporeal Life Support (CSECLS) registry database and local hospitals. Ten ML methods, including random forest, support vector machine, decision tree classifier, gradient boosting machine, extreme gradient boosting, light gradient boosting machine, Naive Bayes, neural networks, a generalized linear model, and AdaBoost, were employed to develop and validate the optimal predictive model based on accuracy and area under the curve (AUC). Patients were divided into retrospective cohort for model development and internal validation, and one cohort for external validation.ResultsA total of 1,633 patients supported by ECMO were included in the model development, of whom 181 experienced brain injury. In the external validation cohort, 30 of the 154 patients experienced brain injury. Fifteen features were selected for the model construction. Among the ML models tested, the random forest model achieved the best performance, with an AUC of 0.912 for internal validation and 0.807 for external validation.ConclusionThe Random Forest model based on machine learning demonstrates high accuracy and robustness in predicting brain injury in pediatric patients supported by ECMO, with strong generalization capabilities and promising clinical applicability.

How does family functioning contribute to child externalizing and internalizing behavior problems after childhood TBI? Evidence from a prospective cohort study.

Despite a well-documented association between childhood traumatic brain injury and elevated risk for internalizing and externalizing behavior problems, the mechanisms through which family functioning contributes to individual variation in these behavioral outcomes remains poorly understood. This prospective cohort study aimed to assess the respective contribution of family functioning and child emotion regulation (ER) to post-injury behavior problems at 1-year follow-up, with a specific focus on evaluating the role of emotional dysregulation in mediating the effects of familial affective responsiveness and communication on child behavioral outcomes. The study included 129 participants, comprising 86 children with medically confirmed mild-to-severe TBI, identified from consecutive hospital admissions, and 43 typically developing (TD) control children, of similar age and sex. Participants ranged in age from 6 to 15 years (mean age = 11.2 years). Parents completed validated assessments of post-acute family functioning and child emotion regulation difficulties at 6 months post-injury, as well as measures of child behavior problems at 1-year post-injury. Although group differences in internalizing behaviors did not reach statistical significance, the TBI group exhibited significantly higher overall externalizing symptoms and was significantly more likely to display clinically elevated symptoms than TD controls at 1-year post-injury. Compared to TD controls, the TBI group displayed significantly greater ER problems, which mediated the effects of lower familial affective responsiveness and communication on child behavior problems 1-year-post-injury. Evidence for these robust, prospective associations suggests that child emotional dysregulation plays a key role in mediating the effect of post-acute family functioning on long-term behavior problems in children with TBI. Early assessment and screening for relevant risk factors may help identify those children and families who could benefit from therapeutic interventions designed to address emotional dysregulation and mitigate risk for post-injury behavioral problems. Importantly, these findings underscore the value of adopting family-centred care approaches in rehabilitation, where involving families in therapeutic processes and addressing family dynamics may enhance child emotion regulation and improve long-term behavioral outcomes.

Plasma brain-related biomarkers and potential therapeutic targets in pediatric ECMO.

Extracorporeal membrane oxygenation (ECMO) is a technique used to support severe cardiopulmonary failure. Its potential life-saving benefits are tempered by the significant risk for acute brain injury (ABI), from both primary pathophysiologic factors and ECMO-related complications through central nervous system cellular injury, blood-brain barrier dysfunction (BBB), systemic inflammation and neuroinflammation, and coagulopathy. Plasma biomarkers are an emerging tool used to stratify risk for and diagnose ABI, and prognosticate neurofunctional outcomes. Components of the neurovascular unit have been rational targets for this inquiry in ECMO. Central nervous system (CNS) neuronal and astroglial cellular-derived neuron-specific enolase (NSE), tau, glial fibrillary acidic protein (GFAP) and S100β elevations have been detected in ABI and are associated with poorer outcomes. Evidence of BBB breakdown through peripheral blood detection of CNS cellular components NSE, GFAP, and S100β, as well as evidence of elevated BBB components vWF and PDGFRβ are associated with higher mortality and worse neurofunctional outcomes. Higher concentrations of pro-inflammatory cytokines (IL-1β, IL-6, IFN-γ, TNF-α) are associated with abnormal neuroimaging, and proteomic expression panels reveal different coagulation and inflammatory responses. Abnormal coagulation profiles are common in ECMO with ongoing studies attempting to describe specific abnormalities either being causal or associated with neurologic outcomes; vWF has shown some promise. Understanding these mechanisms of injury through biomarker analysis supports potential neuroprotective strategies such as individualized blood pressure targets, judicious hypercarbia and hypoxemia correction, and immunomodulation (inhaled hydrogen and N-acetylcysteine). Further research continues to elucidate the role of biomarkers as predictors, prognosticators, and therapeutic targets.

Neurological Biomarker Profiles in Royal Canadian Air Force (RCAF) Pilots and Aircrew.

Military aviators can be exposed to extreme physiological stressors, including decompression stress, G-forces, as well as intermittent hypoxia and/or hyperoxia, which may contribute to neurobiological dysfunction/damage. This study aimed to investigate the levels of neurological biomarkers in military aviators to assess the potential risk of long-term brain injury and neurodegeneration. This cross-sectional study involved 48 Canadian Armed Forces (CAF) aviators and 48 non-aviator CAF controls. Plasma samples were analyzed for biomarkers of glial activation (GFAP), axonal damage (NF-L, pNF-H), oxidative stress (PRDX-6), and neurodegeneration (T-tau), along with S100b, NSE, and UCHL-1. The biomarker concentrations were quantified using multiplexed immunoassays. The aviators exhibited significantly elevated levels of GFAP, NF-L, PRDX-6, and T-tau compared to the CAF controls (p < 0.001), indicating increased glial activation, axonal injury, and oxidative stress. Trends toward higher levels of S100b, NSE, and UCHL-1 were observed but were not statistically significant. The elevated biomarker levels suggest cumulative brain damage, raising concerns about potential long-term neurological impairments. Military aviators are at increased risk for neurobiological injury, including glial and axonal damage, oxidative stress, and early neurodegeneration. These findings emphasize the importance of proactive monitoring and further research to understand the long-term impacts of high-altitude flight on brain health and to develop strategies for mitigating cognitive decline and neurodegenerative risks in this population.

Neonatal Brain Injury Triggers Niche-Specific Changes to Cellular Biogeography.

Preterm infants are at risk for brain injury and neurodevelopmental impairment due, in part, to white matter injury following chronic hypoxia exposure. However, the precise molecular mechanisms by which neonatal hypoxia disrupts early neurodevelopment are poorly understood. Here, we constructed a brain-wide map of the regenerative response to newborn brain injury using high-resolution imaging-based spatial transcriptomics to analyze over 800,000 cells in a mouse model of chronic neonatal hypoxia. Additionally, we developed a new method for inferring condition-associated differences in cell type spatial proximity, enabling the identification of niche-specific changes in cellular architecture. We observed hypoxia-associated changes in region-specific cell states, cell type composition, and spatial organization. Importantly, our analysis revealed mechanisms underlying reparative neurogenesis and gliogenesis, while also nominating pathways that may impede circuit rewiring following neonatal hypoxia. Altogether, our work provides a comprehensive description of the molecular response to newborn brain injury.Significance statement Children born prematurely are at risk for white matter injury and cerebral dysmaturation, which predispose to life-long neurological impairments. Here, we used a mouse model of chronic neonatal hypoxia that mimics some of the features of preterm brain injury and performed high resolution spatial transcriptomics using multiplexed error-robust fluorescence in situ hybridization (MERFISH). We developed a new approach to map cell-cell relationships, which revealed profound changes to cellular organization in response to newborn brain injury. We defined cellular communication networks and signaling pathways that likely contribute to hypoxia-responsive neurogenesis and gliogenesis, as well as cell- and region-specific factors that may disrupt neurologic recovery and repair.

Safety considerations for spinal surgery in patients with deep brain stimulation devices

PurposeDeep brain stimulation (DBS) has been performed for various brain disorders. However, spinal surgery in patients with DBS was been approached with cautious trepidation due to risk of thermal brain injury and device damage from coagulation devices during surgery. This study presents the cases of successful spinal surgery performed after DBS implantation. MethodsWe retrospectively reviewed the patients who received spinal surgery after DBS implantation between April 2001 and November 2022. We reviewed their demographic data, preoperative evaluations, and surgical strategies employed. ResultsAmong 348 patients who underwent DBS implantation, eight patients received spinal surgery. The methods used for diagnosing their spinal conditions varied: two cases of computed tomography (CT) myelogram, one case of CT scan with pre-DBS magnetic resonance imaging (MRI), one case of CT scan only, and four cases of post-DBS MRI. The location of the spinal surgery were one case of cervical spinal surgery, three cases of thoracolumbar spinal surgery, and four cases of lumbar spinal surgery. We followed diagnostic study guidelines and safety considerations tailored to each surgical step. Monopolar and bipolar coagulation devices were used when necessary. There were no cases of complications caused by spine surgery regarding DBS function or DBS implanted site. ConclusionCareful execution of surgical procedures, adherence to safety guidelines, and the use of MRI for diagnosis can ensure safe and successful spinal surgery in patients with DBS implants, minimizing the risk of damage to the DBS system and the brain.

Minor Head Trauma in Children Younger Than 3 Months and Clinical Predictors of Clinically Important Traumatic Brain Injuries.

Major studies have defined clinical rules to regulate the use of computed tomography in children after head trauma. Infants younger than 3 months are considered at higher risk of brain injuries than older children and at the same time at higher risk of radiation-induced damage. Hence, it would be desirable to have clinical decision rules more adapted to this subset of patients. The objectives of this study are to compare the rate of brain injuries in children younger than 3 months or 3 to 24 months and to assess predictors of clinically important traumatic brain injuries (ciTBIs) (the ones causing death, neurosurgical intervention, long intubation, or hospitalization for 2 days or more) in the former group. Records of children younger than 24 months evaluated in a single emergency department for minor head trauma during a 3 years period were retrospectively reviewed. The rates of brain injuries were compared in children younger or older than 3 months. Variables associated with severe lesions were assessed in younger children. The study included 744 patients, 86 (11.6%) aged 0 to 90 days and 658 (88.4%) aged 91 to 730 days. Within the young group, we found higher rates of traumatic brain injuries (14.0% vs 4.1%, P = 0.0008) and ciTBI (8.1% vs 1.5%, P = 0.002) compared with the old group. A significant correlation with ciTBI in the young group was observed for heart rate (odds ratio [OR], 12.3; 95% confidence interval [CI], 2.4-62.4), nonfrontal scalp hematoma (OR, 9.2; 95% CI, 1.8-46.1), severe mechanism (OR, 5.6; 95% CI, 1.1-27.6), presence of hematoma (OR, 6.1; 95% CI, 1.2-30.0), hematoma size >3 cm (OR, 23.8; 95% CI, 4.2-135.6), and hematoma location (OR, 9.2; 95% CI, 1.8-46.1). Children younger than 3 months presenting after minor head trauma constitute a relevant population. Available clinical predictors well correlate with ciTBIs in this age group.

Pediatric Brain Injuries are Associated With Intimate Partner Violence-Related Brain Injuries Among Women in Adulthood.

Prior studies have reported associations between childhood physical abuse and intimate partner violence (IPV). However, there has been limited literature examining the relationship between pediatric brain injuries and IPV-related brain injuries later in life. We examined the association between childhood brain injuries and brain injuries sustained from IPV in adulthood. Participants were recruited through Mass General Brigham's "Rally," social media, and information sheets distributed in locations likely to serve women in current or past abusive relationships (eg, domestic violence shelters, and IPV support programs). Women who have experienced IPV with and without brain injury (n=129), ages 19 to 69. Retrospective, cross-sectional study design. We administered the Ohio State University Traumatic Brain Injury Identification Method and the Brain Injury Severity Assessment to assess brain injury history, and the Childhood Trauma Questionnaire (CTQ). A logistic regression was used to examine the association between pediatric brain injuries and IPV-related brain injuries, adjusting for childhood trauma, years of education, and age. A majority of participants (64.3%) reported experiencing at least 1 IPV-related brain injury, and 30.2% experienced at least 1 childhood brain injury. Child abuse-related brain injuries occurred in 10.9% of the sample, whereas childhood brain injuries from other causes occurred in 19.4% of participants. Participants who sustained at least 1 childhood BI were significantly more likely to sustain a future IPV-related brain injury as an adult (OR=4.652, P =.004). For each additional childhood BI sustained, participants were more likely to sustain an IPV-related BI (OR=3.198, P =.005). This study illustrates a high prevalence of childhood brain injuries among women who have experienced IPV and identifies an association between pediatric brain injuries and brain injuries due to partner violence in adulthood. Our findings speak to the urgency of increasing our understanding of childhood brain injuries and whether they or other related factors might confer an increased risk for brain injuries or possibly IPV later in life.

Abstract 4122507: Fetal Socioeconomic and Environmental Exposures Influence Fetal Brain Growth and Risk of Neonatal Brain Injury in Congenital Heart Disease

Introduction: Fetuses with CHD have smaller total brain volume (TBV) and are at risk for acquired brain white matter injury (WMI), both of which are linked to neurodevelopmental impairments. Social determinants of health (SDOH) and other fetal environmental factors have been linked to fetal brain health in other populations. Our aim was to test our hypothesis that these exposures influence fetal brain growth and postnatal WMI risk in severe CHD. Methods: Our prospective longitudinal cohort study enrolled fetuses with severe CHD to undergo fetal brain MRI and postnatal pre-operative brain MRI. Participants completed home environment surveys on individual SDOH and exposures. Community SDOH metrics were determined using Child Opportunity Index (COI) based on home address. An ‘at risk’ fetus composite was created if there was exposure to: personal/household smoking, welfare/food stamps, or poverty. TBV was calculated at both time points. Presence/degree of WMI was determined on postnatal MRI. Repeated measures analysis and logistic regression were performed to determine association between individual and community SDOH metrics with rate of TBV growth and risk of WMI. Results: 55 participants enrolled (54 fetal scans: mean GA 33.9 wks, 95%CI: 33.7,34.1; 47 neonatal scans: mean GA 39.3 wks 95%CI: 38.9,39.6). Fetal sex, smoking exposure, and several individual SDOH were associated with TBV growth. Adjusting for fetal sex and GA at scan, rate of TBV growth was slower with smoking exposure (coeff: -5.2, 95%CI: -10.3, -0.2, p= 0.04) and trended towards significance for those with welfare/food stamps or poverty. ‘At risk’ fetuses had slower rate of TBV growth than those without risk (coeff: -2.5, 95%CI: -5.0, -0.07, p= 0.04) (Figure 1). There were lower odds of pre-operative WMI with high COI compared to low after adjusting for GA at scan (OR= 0.16, 95%CI: 0.03, 0.9, p= 0.04). Conclusion: Smoking exposure and individual-level SDOH influence brain growth, while community COI is associated with risk of postnatal pre-op WMI in CHD. Our findings identify targets for intervention to optimize brain growth and outcomes in the CHD population, including smoking cessation programs, and nutritional and needs assessment during pregnancy.

Experimental biomechanical investigation of surrogate headforms equipped with Patka helmet against high-velocity ballistic impact

High-velocity bullet impact (velocity: 700 ± 15 m/s) is a significant concern during asymmetric warfare. Ballistic helmets for high-velocity bullet impact and associated biomechanical responses of the headforms are actively sought. Further, data on the performance of ballistic helmets against high-velocity impact are not available in the literature. Toward this end, we have evaluated the performance of Patka (helmet) against high-velocity bullet impact. Patka was mounted on various headforms to assess the perforation of the Patka by the bullet and to measure various biomechanical parameters such as back face deformation (BFD), head kinematics, brain simulant pressures, and neck loads. Bullet impact in front and oblique (30° right to the sagittal axis) orientations were considered. Our results suggest that the Patka was effective in mitigating the high-velocity bullet impact. Perforation of the Patka by the bullet was not observed. BFD in the witness material was negligible (<1 mm). Measured head kinematics and brain simulant pressures were comparable to the quantities typically reported during low- and medium-velocity bullet impacts. Further, most of the biomechanical responses, except angular acceleration and neck force, were below 50% injury risk for mild traumatic brain injury (mTBI). Despite these encouraging trends, the shattering of bullets into fragments was also observed. These fragments traveled a considerable distance at reasonable velocities. This work provides unique insights regarding the performance of Patka and associated biomechanical responses of the headforms against high-velocity bullet impact, with implications in the design and evaluation of futuristic ballistic helmets. TERMINOLOGIES Ballistic threat level: Ballistic threat levels are defined based on the impact velocity of the bullet. Different types of bullets are proposed to achieve the desired impact velocities corresponding to different ballistic threat levels. Ballistic helmet: Ballistic helmet is a type of protective headgear designed to protect the wearer head from potentially fatal impacts during combat operations. Ballistic performance: Ballistic performance of the helmet is evaluated based on the perforation resistance capacity of the helmet and back face deformation (BFD) of the helmet. Back face deformation (BFD): Back face deformation (BFD) of the helmet refers to the localized dent or bulge in the inner layer of the helmet due to ballistic impact. BFD is measured as a depth of indent in the witness material (e.g., Roma Plastilina #1 clay) of the cruciform cavity-based headform. Headform: Headform is a model of the human head replicating a few of the anatomical and material aspects. Headforms can vary in design and complexity based on the intended applications. Patka: Patka is a protective headgear designed to provide ballistic protection to the head against high-velocity threat (impact velocity: 700 ± 15 m/s). Patka is made up of hardened (armour) steel material. Head kinematics: Head kinematics refers to the motion of the head typically measured in terms of linear acceleration and angular velocity. Neck loads: Neck loads refer to the forces and moments experienced by the neck during a static or dynamic event. Brain simulant pressure: Brain simulant pressure is a hydrodynamic pressure generated within the brain simulant.

Testosterone and neurobehavioral outcomes in special operations forces military with multiple mild traumatic brain injury.

U.S. Special Operations Forces (SOF) are at increased risk of multiple mild traumatic brain injury (mmTBI). Testosterone was prescribed for several participants in a VA program designed to address sequelae of mmTBI for SOF. To determine testosterone prevalence in the Palo Alto VA Intensive Evaluation and Treatment Program (IETP) and observe for association between testosterone and neurobehavioral outcomes. A retrospective cohort study included patients in the Palo Alto VA IETP. Sociodemographic data, testosterone blood levels, and neurobehavioral outcomes were collected from medical records. 55 IETP participants were included: six were testosterone users; the rest were classified as non-users. Testosterone use in this population is 11%, higher than reported national averages in the U.S. Of the 6 testosterone users, 2 (33%) had a formal diagnosis of hypogonadism prior to initiation of testosterone. Neurobehavioral outcome scores between testosterone users and non-users failed to show statistically significant differences, except for the PROMIS pain score, which was higher in the testosterone user population. The current study did not find an association between mmTBI, testosterone use, or testosterone level and neurobehavioral outcomes. This study highlights a need to further examine the relationship between hypogonadism, mmTBI, SOF culture around testosterone, and the effects of testosterone use in this population.