Boston University. University Professors Program Senior theses. / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-02

The severity of injury associated with sport concussions that present with a loss of consciousness or impact seizures is ambiguous. A disconnect between the clinical and biomechanical aspect can be observed throughout the literature pertaining to loss of consciousness and impact seizures. Clinicians have dismissed a loss of consciousness or the presence of impact seizures as an indicator of severity. However, early biomechanical research suggests that loss of consciousness is caused by greater magnitudes of impacts and damage to more vulnerable brain regions. However, this research was conducted on animal and cadaver models and may not adequately represent sport-related concussions. Recent methodologies such as laboratory reconstructions of head impacts and finite element modeling can provide new information on the severity of impact associated with these signs of concussions. Study One compared the magnitudes of head dynamic response and brain tissue deformation between impact representations of punches that lead or do not lead to LOC in boxing. The main findings of this study revealed knockout punches were the result of by unprotected hooks to the mandibular angle resulting in greater brain tissue trauma. Study Two compared cases of concussions with and without LOC in American football. Head dynamic response and brain tissue deformation was also greater in the LOC group in this sport, consistent with boxing impacts. The main predictor of LOC was found to be impact velocity which has implications in terms of prevention. Study Three compared the magnitudes of head dynamic response and brain tissue deformation between cases of concussions with a loss of consciousness and cases of concussion with impact seizures in American football. The two types of clinical presentations had similar severities of brain tissue deformation with the exception of strain rate in the white matter being smaller in cases of impact seizures. The findings of this thesis support the notion that concussions with loss of consciousness or impact seizure represent a more severe injury than concussions without these signs. It may be appropriate to address these signs of injury differently in return to sport protocols to reflect their severity. The findings also suggests that prevention of loss of consciousness should be sport specific. Hooks to the side of the jaw were the primary cause in boxing, whereas LOC could be caused by different event types in American football. However, in both sports, impact velocity and impact location played an important role in the risk for loss of consciousness.

Closed head injuries are common occurrences in North America. Subsequent to a closed head injury (CHI), there are a number of symptoms which are commonly seen, one of which is fatigue. No studies were found which specifically address the issue of fatigue following CHI. Much remains unknown about this symptom, such as the percentage of individuals who experience fatigue as a problem after a CHI, the relationship between the degree of fatigue experienced and the severity of the injury, and the length of time that this problem persists following the injury. The present study explores and describes the problem of fatigue in a population of individuals following a CHI. In this study, 28 individuals who had experienced a CHI (14 with minor injuries and 14 with severe injuries) were each paired with a control subject who had not had a CHI and who was matched to the CHI subject in terms of age, sex, and personality characteristics. All subjects were asked to complete two brief questionnaires, two computerized tasks, and two self-report measures. All 28 subject pairs completed the first four measures and 22 of the pairs completed and returned the last two. The results showed a highly significant difference between the CHI and control groups on all measures. There were no differences between the CHI subgroups (minor end severe) on any of the measures, nor was there a relationship found between length of post traumatic amnesia or length of time post-injury and any of the measures, There was an interaction between the results on the measure of depression and four of the other five variables Further analysis demonstrated differences between the CHI and control groups on all measures after the depression scores were taken into account. These results indicate that fatigue is a serious, long lasting problem for this groups of individuals who have experienced a CHI. Suggestions for future research and for treatment are discussed. / Graduate

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Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

The purpose of this study was to determine the efficacy and toxicity of amonafide in unresectable or recurrent head and neck cancer and to determine if the degree of toxicity with amonafide correlated with the acetylator phenotype of the patient. Thirty patients were registered on the study and received amonafide, 300 mg/m2, over two hours each day for five consecutive days every 21 days. There was one partial response (3%) which lasted four months. The dose-limiting toxicity was myelosuppression. Acetylator phenotype was determined prior to treatment using HPLC to quantitate caffeine metabolites in urine samples after administration of caffeine. This pharmacokinetic evaluation was performed in 21 patients and revealed that (17/21) 81% of the patients were slow acetylators and 19% of the patients were rapid acetylators. No association was found between acetylator phenotype and toxicity in our patient population. Based on this study, it appears that amonafide given at 300 mg/m2 for 5 consecutive days every 21 days is not active in squamous cell carcinoma of the head and neck, and that acetylator status does not correlate with toxicity.

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