IndexTBI in Football CultureImmediate Effects of TBShort-Term Repair MechanismsCurrent Treatment OptionsCurrent Research on TBI and CTEConclusions and Future DirectionsLiterature CitedChronic Traumatic Encephalopathy (CTE) ) is a neurodegenerative disease that has been brought to light in recent years regarding its long-term effects on individuals with repeated head trauma in the form of traumatic brain injury (TBI). CTE has gained notoriety due to recent publications regarding the effects it has had on the world of American football, resulting in a dramatic reduction in the quality of life of current and former players. The disease has caused many long-term effects that affect patients physically and mentally. This review aims to explore the significance of CTE in sport, understand the underlying biology of the disease as we know it now, current approaches to better understand the disease, and steps that need to be taken in the future to fully understand the effects of CTE on players' lives . affected people and potentially prevent its occurrence. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an Original EssayTBI in Football CultureThe United States' obsession with football is easy to see with the sheer number of athletes flocking to play on the gridiron. According to the NFL and NCAA, there are approximately 1.8 million football players spread across the high school, college and professional levels. All of these players carry the risk of injuries associated with the violent contact sport that is soccer. Over the course of a single season, including practices and games, it is estimated that a player receives around 1400-1500 blows to the head. This risk increases at some positions, such as linebackers and linemen, and decreases for other skill positions such as kickers and punters. These strikes can range from basic level strikes to concussive strikes, increasing in frequency throughout games. An estimated 300,000 concussions are diagnosed between the high school and college levels each year. According to the CDC, this makes up 10% of all TBI diagnoses each year. One risk associated with the enormous amount of blows involved in the sport comes from sub-concussive blows that do not lead to directly diagnosable effects, leaving the condition unmonitored and untreated. The overall result of these brain injuries can lead to a greater chance of deterioration in general cognition, with increased deterioration associated with those who played from a younger age. Immediate Effects of Head Trauma According to the CDC, mild versions of head trauma, regularly called concussions, are blows to the head that jolt the brain, causing it to bounce around inside the skull, potentially causing cell damage such as chemical and physical changes or cell death. The immediate effects of a concussion are swelling of the impact area, hypoxic damage to surrounding cells and tissues, and direct damage to axons in the form of a cut (Kiraly 2007). The swelling itself is the result of blood vessels being cut, causing microhemorrhage and resulting in loss of blood flow to regions of the brain. This immediately impacts the cognition of concussion victims analyzed through immediate post-concussion assessment and cognitive testing, resulting in impaired test-taking ability. Swelling also affects the stability of the integrity of surrounding cells by damaging themicrotubules and axonal machinery, leading to immediate effects such as loss of consciousness or slowed reaction times (Johnson 2013). These injuries also affect the cell's ability to repair itself adequately over time, contributing to the development of diseases such as CTE. The tau protein, which is a protein associated with microtubules, particularly the stability of tubulin formation, has been identified as a primary target for understanding the structural irregularities that occur following head trauma, leading to CTE and other neurodegenerative disorders. What are the exact mechanisms that tau protein is responsible for that contribute to the degenerative nature of CTE? Tau proteins are particularly found in greater numbers in neurons, making their presence in the central nervous system more likely. However, they are not the only proteins of their class, microtubule-associated proteins (MAPs) (Harada 1994). Tau protein is particularly important for maintaining the stability and flexibility of the distal portions of nerve axons, as opposed to dendrites and proximal axonal regions that are more actively stabilized by other MAPs. This distinction is important when referring to one of the primary direct effects of a concussion, namely the axonal shearing that occurs during the event. As a result, tau proteins that maintain microtubule stability in the axon are directly affected during axon cleavage. These proteins can be found phosphorylated in fiber bundles in the brain, which are currently used as a marker for CTE in many studies. Fibrous bundles present in large clusters can then affect signaling in surrounding cells, particularly around immunoreactive astrocytes, particularly axons, interfering with normally occurring processes and increasing the likelihood of neurodegenerative disorders such as CTE (McKee 2009) . The last of the three immediate effects of TBI, hypoxic injury, is especially important for understanding why damage occurs immediately and what makes the side effects of TBI last. When swelling occurs, blood flow to other parts of the brain is compromised, leaving the brain in a hypoxic state (Badjatia et. al 2009). As a result, many cells in the immediate vicinity of the affected area die over the next few hours until the swelling disappears. The primary concern regarding cell loss involves axons that begin to swell after the initial injury, potentially leading to their disconnection. This effect, combined with axonal shearing, leads to potentially life-threatening conditions that require immediate medical attention. However, the diagnosis of head trauma is difficult due to the lack of clear physical signs, such as visible bruising or bleeding. Instead, cognitive tests are the only form of immediate testing at the site of the injury. Swelling can be diagnosed using MRI, allowing doctors to correctly diagnose the specific regions of the head affected. Short-term effects of TBI include headaches, sleep disturbances, motor function problems, and memory loss. Deficiencies in motor function may be linked to damaged neurons, leading to a delay or lack of signaling between nerves, ultimately altering subjects' physical abilities before repair. Headaches and sleep loss are due to immediate damage to the brain due to swelling, which causes pain in the former and impaired concentration in the latter. This neuronal damage may also be linked to the effects ofmemory loss as the nerves have signaling problems associated with memory formation. Short-term repair mechanisms Initially after TBI, there are some mechanisms that aim at an immediate response, namely the introduction of pro-inflammatory molecules into the damaged area in the form of nuclear factors and interleukins. These responses, while necessary for stabilization and immediate localization of the lesion, also lead to some of the later effects associated with swelling of brain regions. This swelling also introduces microglia, local macrophage cells, to the target area, allowing the cells to adhere and degrade. Long-Term Effects of TBI and Development into CTE The long-term effects of TBI vary depending on the severity and frequency of past injuries. It is entirely possible to receive no long-term effects with minimal head trauma and proper diagnosis and treatment. However, long-term effects can range from chronic headaches (Suzuki 2017), seizures (Vella 2017), motor and sensory problems (Padula 2017), and behavioral changes. Chronic headaches were observed in subjects with long-term TBI two to four times per hour during a period of sleep, which was significantly higher than the zero observed on average in control subjects. Seizures can be seen up to five months after the injury and are more likely and more severe as the severity of the head injury increases. Motor function is impaired as seen in extreme cases such as in boxers and American football players, i.e. reduced reactivity and memory loss. Behavioral changes are also notable in long-term effects, especially in the form of depressive behavior. In some case studies involving American football players, depression, memory loss, paranoia, poor judgment, anger, aggression, irritability, confusion, and other symptoms were documented at significantly higher rates than in normal subjects. . These bizarre behaviors may also have played a role in the tragic deaths experienced by 80% of the subjects in the form of suicide, high-speed chase, or gunshot wound. Current Treatment Options There are very limited treatment options available for TBI and CTE as part of the delicate nature associated with the injury itself. There are a few different cognitive tests that can be performed as a way to relatively measure a person's ability to respond correctly to cues following a potential case of head trauma. Beyond that, more definitive methods, namely magnetic resonance imaging (MRI), allow for more comprehensive diagnoses than behavioral tests. Treatment options have become available using new therapeutic methods. Human placenta-derived mesenchymal stem cells have been used to minimize traumatic brain injury (Kim 2017). Stem cells are injected into target areas at specific times, 4 and 24 hours after injury. This has been shown to reduce the inflammatory response and minimize damage to surrounding cells associated with swelling and hypoxia. Current Research on TBI and CTEThere are many directions taken as a way to treat TBIs and their development into CTE. The main approaches adopted concern understanding which molecules could be markers of a head injury to allow a correct diagnosis, behavioral studies that aim to understand the ability of subjects immediately following a head injury and the long-term effects that can be observed, and finally the use of organismsmodel to better understand which mechanisms are involved in TBI and CTE. In an effort to find ways to more effectively diagnose head trauma of any nature, researchers have looked for several marker molecules that can be used to determine whether a brain injury has occurred and its severity. Therefore, some markers were considered potential candidates such as CCL11, glial fibrillary acidic protein (GFAP), microtubule-associated protein tau (MAPτ), myelin basic protein (MBP), neurofilament heavy chain protein (NF-H), enolase neuron-specific (NSE), s100ß and ubiquitin C-terminal hydrolase-L-1 (UCHL1). Each of the markers has been found in the blood in association with head trauma and has been associated with different stages of the immediate injuries involved in head trauma. All are more associated with the accumulation of misfolded proteins in the extracellular space within the brain, contributing to the long-term effects mentioned before. To study TBIs en masse, model organisms are used as effective tools to allow researchers to observe the effects of TBIs. Mouse models were particularly chosen as organisms due to their similar brain structure and the number of genes shared between mice and humans. Concussive studies are conducted on mice allowing for the observation of differences in behavior and gene expression, providing further directions in which to continue research. Please note: this is just a sample. Get a customized document from our expert writers now. Get a Custom Essay Conclusion and Future Directions In an effort to better understand TBI and CTE, it is important to delve deeper into the currently established directions. The three main areas to work on in the field would be the development of biomarkers, model organisms and treatment. The development of biomarkers will be absolutely necessary to allow doctors and scientists to adequately diagnose and study the disease in its beginning, development and end. This will enable more effective methods to diagnose and study the disease than the current model for CTE, namely post-mortem brain observation. With the ability to potentially diagnose and monitor CTE as it develops and spreads, it will provide researchers with better information on how to address the disease in the future. Model organisms may represent an effective way to help identify these biomarkers without putting human life at risk. While some model organisms have been developed, others, namely Xenopus laevis, have the potential to enable the study of TBI and CTE in vivo. X. laevis, is a particularly good candidate for this research due to the transparency of the brain in the tadpole stages and the particularly long lifespan of the organism. The transparency of the head will allow for simplified observation of what activity may be occurring in the brain as no skull or non-transparent skin will hinder visibility. In addition to this, the long lifespan of older age, more accurately describing the effects of CTE as it is associated with age compared to humans compared to other model organisms. Therapeutic options to attack the three main symptoms of TBI, namely swelling, hypoxia and axonal shearing, and enable the introduction of improved repair mechanisms as options for the management of TBI and CTE may also arise from these studies. It may be possible to attack the bloating problem by limiting 1994: 10.1016