PAIN INFLUENCES NEUROPSYCHOLOGICAL PERFORMANCE FOLLOWING ELECTRICAL INJURY: A CROSS-SECTIONAL STUDY
DOROCIAK KE, SOBLE JR, RUPERT PA, FINK JW, LEE RC, ANITESCU M, WEISS D, COOKE G, RESCH ZJ, PLISKIN NH.;
Journal of the International Neuropsychological Society
Objective. Electrical injury (EI) is a significant, multifaceted trauma often with multi-domain cognitive sequelae, even when the expected current path does not pass through the brain. Chronic pain (CP) research suggests pain may affect cognition directly and indirectly by influencing emotional distress which then impacts cognitive functioning. As chronic pain may be critical to understanding EI-related cognitive difficulties, the aims of the current study were: examine the direct and indirect effects of pain on cognition following EI and compare the relationship between pain and cognition in EI and CP populations.
Method. This cross-sectional study used data from a clinical sample of 50 patients with EI (84.0% male; Mage = 43.7 years) administered standardized measures of pain (Pain Patient Profile), depression, and neurocognitive functioning. A CP comparison sample of 93 patients was also included.
Results. Higher pain levels were associated with poorer attention/processing speed and executive functioning performance among patients with EI. Depression was significantly correlated with pain and mediated the relationship between pain and attention/processing speed in patients with EI. When comparing the patients with EI and CP, the relationship between pain and cognition was similar for both clinical groups.
Conclusion. Findings indicate that pain impacts mood and cognition in patients with EI, and the influence of pain and its effect on cognition should be considered in the assessment and treatment of patients who have experienced an electrical injury.
AMPHIPHILIC BLOCK COPOLYMER-CATALYZED CELL MEMBRANE SEALING IS LINKED TO DECREASED MEMBRANE TENSION
AATOUK, C., LING, M.X., TITUSHKIN, I.A., CHO, M.R., MCFAUL, C.A., & LEE, R.C. ;
Regenerative Engineering and Translational Medicine
Abstract. The cell plasma membrane suffers structural disruptions from both daily environmental stresses and trauma. Rapid loss of cell viability occurs if membrane integrity is not rapidly restored. Physiological membrane sealing involves alteration of local intermolecular thermodynamics that is manifested by changes in membrane tension which precede reassembly of the membrane planar bilayer structure. Certain block copolymer surfactants, including poloxamer 188 (P188), have been proven to seal-disrupted cell membranes. However, the specific molecular mechanics of poloxamer-mediated membrane sealing remains a target of investigation. A decrease in membrane tension precedes membrane sealing by natural intrinsic cell sealing processes. The effect of P188 on the quasistatic membrane tension of Madin-Darby canine kidney (MDCK) and Swiss 3T3 fibroblasts cells under normal and saponin-permeabilized conditions was measured using laser optical tweezer (LOT)-extracted membrane tethers. The tether trap length of saponin-permeabilized MDCK cell membranes decreased from an uninjured control of 11.28 ± 1.1 μm to 6.43 ± 0.67 μm. Treatment with P188 (0.2 mM) significantly increased the tether trap length to 9.69 ± 1.0 μm (p < 0.05) while the control polymer, polyethylene glycol (0.2 mM) resulted in tether trap length of 7.02 ± 0.73 μm that was not significantly different. Similar observations were made in the saponin-permeabilized fibroblasts. Corresponding fluorescence cell viability assays revealed that P188-treated cells had a higher survival rate. Thus, surfactant copolymer membrane sealing restores the membrane integrity by decreasing the membrane tension.
PHYSICAL MECHANISMS OF TISSUE INJURY IN ELECTRICAL TRAUMA
LEE, R.C. ;
IEEE TRANSACTIONS ON EDUCATION. Vol 34(3); 223-230, 1991
Progress towards an effective therapeutic strategy for victims of electrical trauma depends on advancing knowledge of the physical mechanisms of tissue injury activated by strong electric fields. It is well recognized that rupture of skeletal muscle cell membranes is a prominent clinical feature manifested by victims of electrical trauma. Exposure to either supraphysiologic temperatures or supraphysiologic transmembrane potentials can cause cell membrane disruption. The strong electric fields characteristically established in high-voltage electrical trauma victims generate rapid heating as well as impose destructively large transmembrane potentials in skeletal muscle and nerve tissues. The relative importance of heat versus electrical stress as mechanisms of cellular damage is uncertain in the majority
of victims. This is an active and important arena of bioengineering research. The salient biophysical aspects of this frequently crippling and often fatal injury is reviewed.
HIDDEN REALITIES OF ELECTRICAL INJURIES
McCollum, Kyle BS; Gowrishankar, T.R. PhD; Lee, Raphael C. MD, ScD;
Abstract. The clinical spectrum of electrical injury ranges from the absence of any external physical signs to severe and life-threatening trauma. This article discusses the fundamental concepts and misunderstandings surrounding electrical injuries and the best practices for evaluation and treatment.
A FOLLOW-UP STUDY OF A LARGE GROUP OF CHILDREN STRUCK BY LIGHTNING
L M A SILVA, PHD; M A COOPER, MD; R BLUMENTHAL, MD; N PLISKIN, PHD;
South African Medical Journal 2016
Background. On 11 November 1994, 26 preadolescent girls, 2 adult supervisors, and 7 dogs were sleeping in a tent in rural South Africa when the tent was struck by lightning. Four of the girls and four of the dogs were killed. The 2 adults were unharmed, but all but 3 of the children suffered significant injuries. An article in 2002 detailed the event and examined the medical and psychological changes in the surviving girls.
Objective. To understand the medical and psychological changes secondary to lightning strike years after injury.
Methods. An online questionnaire was prepared that included a checklist of physical and psychological symptoms. Participants were asked to report on both initial and current symptoms. Eleven of the 22 survivors were contacted, and 10 completed the survey.
Results. Participants reported that initial physical symptoms generally resolved over time, with ~10 - 20% continuing to experience physical symptoms. Vision problems persisted in 50% of respondents. Psychological symptoms, overall, had a later onset and were more likely to be chronic or currently experienced. Depression and anxiety, specifically, were higher among the survivors than the reported incidence in South Africa.
Conclusions. Initial and current/chronic physical and psychological symptoms following a lightning strike are reported found, adding to the body of literature on the long-term after-effects of a lightning strike on survivors. A brief discussion on post-traumatic stress disorder symptomatology and post-lightning shock syndrome is provided.
Occupational Electrical Injury: An International Symposium
Occupational Electrical Injury and Safety. Chen, C.-T., Lee, R.C., Shih, J.-X., and Zhong, M.-H. Eds., Annals of the New York Acad. of Science, Vol. 888, 1999
Cell Injury: Mechanisms, Responses & Repair
Cell Injury: Mechanisms, Responses and Repair. Lee, RC., Despa, F., Hamann, KT. Annals of the New York Acad. of Science, Vol. 1066, 2006
Electrical Trauma: The Pathophysiology, Manifestations and Clinical Management
Electrical Trauma: The Pathophysiology, Manifestations, and Clinical Management. Lee, R.C., Burke, J.F. and Cravalho, E.G., Eds., Cambridge University Press, 1992
Electrical Injury: A Multidisciplinary Approach to Prevention, Therapy & Rehabilitation
Electrical Injury: A Multidisciplinary Approach to Prevention, Therapy & Rehabilitation. Lee, R.C., Capelli-Schellpfeffer, M., and Kelley, K.M., Eds., New York Acad. of Science., Vol. 720, 1994