Traumatic Bridging Vein Failure in Infants

描述(申请人提供)：创伤性脑损伤(TBI)是儿童最常见的死亡原因。轴外出血(EAH，包括硬膜下和蛛网膜下腔出血)具有额外的医学法律意义，因为它经常被用来区分幼儿的意外伤害和虐待伤害的原因。尽管EAH通常被认为是桥静脉(BV)和/或皮质血管撕裂所致，但有一种 缺乏关于BV特性的年龄相关性以及血管破裂数量与EAH程度之间的关系的数据。在这项研究青少年儿童特有的脑损伤机制的建议中，我们的假设是，未成熟头部的快速旋转可导致BV失败，婴儿的生物力学BV特性将显示出比成人更低的BV破裂应力和应变，从而赋予婴儿BV破裂的易感性。此外，我们假设循环伸长将软化BV，使其在重复头部旋转时比单一事件更脆弱。凭借在生物力学测试和有限元分析方面的专业知识，以及来自意外和虐待脑损伤事件的患者研究、动物实验和拟人化玩偶模拟的存档数据，我们能够唯一地确定脑外伤中与EAH相关的机制。在这个探索性的R21拨款申请中，我们的两年目标是利用这些先前的发现，通过新的实验来确定儿童创伤性EAH的机制。在短短两年内，我们将率先确定儿科BV的力学特性(目标1)；将它们集成到用于EAH预测的计算有限元模型(FEMS)中，并验证我们程序的预测能力(目标2)；以及使用FEMS识别单次和周期性头部运动的EAH潜力(目标3)。综上所述，这项基础研究计划的结果将为制定新的伤害预防、临床诊断和减轻伤害的战略提供科学基础，以减少每年新发致衰弱的脑外伤儿童的数量。

DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) is the most common cause of death in childhood. Extra-axial hemorrhage (EAH, which includes subdural and subarachnoid hemorrhage) carries additional medical-legal significance, as it is often used to distinguish between accidental and abusive injury etiologies in young children. Although EAH is generally thought to occur from tearing of bridging veins (BVs) and/or cortical vessels, there is a paucity of data about the age dependence of BV properties, as well as the relationship between number of vessels ruptured and extent of EAH. In this proposal to investigate TBI mechanisms specific to young children, our hypotheses are that rapid rotations of the immature head can produce BV failure, that the biomechanical BV properties of the infant will reveal lower BV rupture stress and strain than the adult, conferring a vulnerability for BV rupture to the infant. n addition, we hypothesize that cyclic elongation will soften the BVs, rendering them more fragile with repeated head rotations than single events. With expertise in biomechanical testing and finite element analysis, and archived data from patient studies, animal experiments and anthropomorphic doll simulations of accidental and abusive TBI events, we are uniquely poised to determine the mechanisms associated with EAH in TBI. In this exploratory R21 grant application, our 2-year goal is to leverage these previous discoveries with new experiments to identify the mechanisms of traumatic EAH in children. In just two years, we will be the first to determine mechanical properties of pediatric BVs (Aim 1); integrate them into computational finite element models (FEMs) for EAH prediction, and validate the predictive capabilities of our procedures (Aim 2); and use the FEMs to identify EAH potential in single and cyclic head movements (Aim 3). Taken together, the results of this basic research plan will provide the scientific foundation for the development of new strategies for injury prevention, clinical diagnosis, and injury mitigation to reduce the number of children with new debilitating TBIs each year.