Mild traumatic brain injury is associated with effect of inflammation on structural changes of default mode network in those developing chronic pain
JOURNAL OF HEADACHE AND PAIN
Authors: Niu, Xuan; Bai, Lijun; Sun, Yingxiang; Wang, Yuan; Bai, Guanghui; Yin, Bo; Wang, Shan; Gan, Shuoqiu; Jia, Xiaoyan; Liu, Hongjuan
Abstract
Background: Mild traumatic brain injury (mTBI) has a higher prevalence (more than 50%) of developing chronic posttraumatic headache (CPTH) compared with moderate or severe TBI. However, the underlying neural mechanism for CPTH remains unclear. This study aimed to investigate the inflammation level and cortical volume changes in patients with acute PTH (APTH) and further examine their potential in identifying patients who finally developed CPTH at follow-up. Methods: Seventy-seven mTBI patients initially underwent neuropsychological measurements, 9-plex panel of serum cytokines and MRI scans within 7 days post-injury (T-1) and 54 (70.1%) of patients completed the same protocol at a 3-month follow-up (T-2). Forty-two matched healthy controls completed the same protocol at T-1 once. Results: At baseline, mTBI patients with APTH presented significantly increased GM volume mainly in the right dorsal anterior cingulate cortex (dACC) and dorsal posterior cingulate cortex (dPCC), of which the dPCC volume can predict much worse impact of headache on patients' lives by HIT-6 (beta = 0.389, P = 0.007) in acute stage. Serum levels of C-C motif chemokine ligand 2 (CCL2) were also elevated in these patients, and its effect on the impact of headache on quality of life was partially mediated by the dPCC volume (mean [SE] indirect effect, 0.088 [0.0462], 95% CI, 0.01-0.164). Longitudinal analysis showed that the dACC and dPCC volumes as well as CCL2 levels had persistently increased in patients developing CPTH 3 months postinjury. Conclusion: The findings suggested that structural remodelling of DMN brain regions were involved in the progression from acute to chronic PTH following mTBI, which also mediated the effect of inflammation processes on pain modulation.
Health outcomes among former female collegiate gymnasts: the influence of sport specialization, concussion, and disordered eating
PHYSICIAN AND SPORTSMEDICINE
Authors: Sweeney, Emily; Howell, David R.; Seehusen, Corrine N.; Tilley, David; Casey, Ellen
Abstract
Objective: Gymnastics is a popular sport with high injury rates, especially at the collegiate level. There is limited evidence, however, regarding the risks of early specialization in this sport, the rate of concussions in gymnasts, and the long-term effects of disordered eating in gymnasts. We sought to describe health-related outcomes of former collegiate gymnasts and the association with early sport specialization, concussion history, and disordered eating. Methods: We distributed an online survey through social media outlets. A total of 473 former female collegiate gymnasts completed the survey and were grouped according to early (<14 years) specialization, presence or absence of concussion history, and history of disordered eating. We determined the number of participants who had time-loss injuries, injuries requiring surgery, and injuries resulting in retirement. We also evaluated menstrual history, reasons for sport retirement, functional outcome measures, and mental health. Results: The median age of gymnastics specialization was 8 years [interquartile range = 6-11 years]. The proportion of injuries sustained during college did not significantly differ by specialization age. A significantly greater proportion of early specializers required surgery for college sports-related injuries (60% vs. 44%; p = 0.02). Forty-two percent of the respondents reported concussion history, and a greater proportion of those with concussion history reported seeking mental health treatment during college (32% vs. 23%; p = 0.03), and anxiety disorder diagnosis (16% vs. 9%; p = 0.01). Disordered eating history was reported by 34% of the respondents, and this group had a higher proportion of time-loss injury (78% vs 65%; p = 0.004), and osteoporosis (4% vs 0%; p = 0.003) during college, and worse current pain (11.5 vs 10.2; p = 0.007) and physical function (12.2 vs 11.0; p = 0.01) than those without disordered eating. Conclusion: Athletes and clinicians should be aware of the long-term effects of early specialization, concussions, and disordered eating in gymnastics as these issues are common in female collegiate gymnasts.