Thursday, October 25, 2018

Nowinski rebuts book which questions football's role in chronic traumatic encephalopathy

On Tuesday, I posted about a new book out which questions the conclusions drawn by Boston University researchers regarding the connections between football and chronic traumatic encephalopathy (CTE). Today, BU's Chris Nowinski responded in the pages of USA Today.

Chris Nowinski, PhD, CEO of the Concussion Legacy Foundation which has connections to Boston University researchers, said the following in the USA Today article: "I'm happy to ask Merril Hoge who to draft No. 1 next year, but we shouldn't be asking him how to design research studies."

Chris Nowinski, PhD

Tuesday, October 23, 2018

Neuropathologist teams up with former NFL player to write provocative book questioning the extent and cause of CTE among football players

Dr. Peter Cummings
In an Op-Ed piece published today on Yahoo! Sports, neuropathologist Peter Cummings and former NFL player Merril Hoge discuss their skepticism about the science behind the connection between chronic traumatic encephalopathy (CTE) and football. 

Cummings and Hoge just released a book entitled “Brainwashed: The Bad Science Behind CTE and the Plot to Destroy Football” (Amplify, Oct. 23, 2018), describing their take on the conclusions that have been drawn regarding the connection between football and CTE. "We believe that when people know what we know, they’ll start asking tougher, smarter questions, and the 'football causes CTE' connection will be revealed as the pseudoscience that it is," the authors write.

Merril Hoge
The authors later state: "The researchers, especially [Boston University], were all too willing to ride the wave of attention provided by the press without ever copping to the severe weaknesses in their work. As a result, the public is convinced that football causes CTE — and that anyone who says otherwise is a 'denier' — based on work that would not have passed muster in a graduate-level research design course."

We will be on the lookout for reaction to the provocative statements made by Cummings and Hoge. Stay tuned...

Sunday, October 14, 2018

The Ivy League reduces concussion rates in football by moving the kickoff ball just five yards toward opposing team's goalpost

Following an experimental 2016 change to kickoff rules designed to encourage more touchbacks,  Ivy League schools saw reduced rates of concussions on the football field.


A recent study in which Brown University and the seven other Ivy League institutions participated showed that reducing kickoff returns in which players actively try to advance the ball during football games could lessen the number of concussions players suffer on the field.
Results from the study, published this month in the Journal of the American Medical Association, show a sharp decrease in the rate of concussions following the Ivy League’s decision in 2016 to adopt an experimental kickoff rule in league play. Between 2013 and 2015, data show, about 11 concussions occurred for every 1,000 kickoffs. In 2016 and 2017, after the league shifted the kickoff position and the touchback line, the rate of concussions during kickoffs decreased to about 2 in 1,000.
Though the JAMA study published on Oct. 1, its preliminary data prompted the National Collegiate Athletic Association to adopt a kickoff rule change — distinct from the Ivy League’s rule, but with the same intent — for all levels of football for 2016. The study comes months after new National Football League data were released showing that the concussion rates had reached an all-time high in the 2017 season, prompting continued focus on the physical and cognitive effects of head injuries in football.
“Concussions in football are a nationwide concern,” said Phil Estes, Brown’s head football coach. “Players are bigger, faster and stronger than ever before, and that creates more collisions. We in the Ivy League recognize that the sport must adapt to reflect these changes, and we are proud to take part in research that will help make football safer.”
A team of researchers at the University of Pennsylvania, Princeton University and the Ivy League authored the JAMA study. Their data demonstrate that kickoffs are a logical place to start in the quest to reduce the rate of concussions: while kickoffs comprised less than 6 percent of plays in Ivy League games between 2013 and 2015, nearly a quarter of all concussions came during those plays. Kickoff returns, in which one team catches the other’s kick and runs up the field toward the end zone, can leave players more vulnerable to injuries largely due to their running speed upon impact, explained Matt Culp, Brown’s head athletic trainer.
“The kicking team is spread out across the field and running fast, gathering lots of speed as they head toward the receiving team,” Culp said. “In contrast, during regular line-of-scrimmage play, players tend to stay in a more compact formation and may only run 10 to 15 yards down the field.”
Talk of reducing kickoff-related concussions in Ivy League play began earlier in the decade, when a committee of coaches, medical professionals, university administrators and others reviewed nationwide concussion data and research. The investigation not only led Ivy League schools to increase the use of padding and decrease player-on-player contact during football practices, but also to more formal research on the rate of concussion.
A recent game between Brown and Harvard
When that research revealed the high rate of kickoff-return concussions, the Ivy League responded by implementing a new set of experimental rules for intraleague play. Starting in 2016, the league determined, teams would kick off from the 40-yard line rather than the 35-yard line — increasing the kicking team’s chances of landing the ball in the end zone, where returning teams often opt to kneel for a “touchback.” The league also moved the touchback line to the 25-yard line rather than the 20-yard line, providing the receiving team with more incentive to simply catch the ball and kneel rather than run the ball up the field.
Data from the JAMA study show that after 2016, about 48 percent of kickoffs resulted in touchbacks — a stark contrast to the pre-2016 touchback rate of just 17.9 percent.
Culp is glad to see that the new rules have decreased the rate of active kickoff returns and helped to curb concussions, which can be one of the most difficult football injuries to identify and treat. On the field, Culp and his colleagues use the SCAT5 test to determine whether a player has suffered a concussion. The test involves a 22-symptom checklist, a demonstration of balance, a neurological screen and a series of memory-related questions.

Friday, October 12, 2018

Tuesday, October 9, 2018

Young adult with an iridic mass extending into the ciliary body


Melanoma markers were negative. Smooth muscle markers were positive. This case was determined to be an epithelioid leiomyoma. I didn't do electron microscopy to look for mitochondia, but it may well be what Ursula Schlotzer-Schredhardt et al. have called a mitochondria-rich epithelioid leiomyoma (Arch Ophthalmol, Vol 120, January 2002).

Monday, October 8, 2018

Best Post of September 2018: A Case of Posterior Cortical Atrophy

The next in our "Best of the Month" series is from September 7, 2018:

Posterior cortical atrophy (PCA) is a neurodegenerative syndrome that is characterised by progressive decline in visuospatial, visuoperceptual, literacy, and praxic skills. The progressive neurodegeneration affecting parietal, occipital, and occipitotemporal cortices that underlies PCA is attributable to Alzheimer's disease in most patients. However, alternative underlying causes, including dementia with Lewy bodies, corticobasal degeneration, and prion disease, have also been identified, and not all patients with PCA have atrophy on clinical imaging. (Crutch, S. J., Lehmann, M., Schott, J. M., Rabinovici, G. D., Rossor, M. N., & Fox, N. C. (2012). Posterior cortical atrophyLancet Neurology11(2), 170-178)


This is a case of a 60-year-old female with PCA:

Although there is diffuse neocortical atrophy, note the prominent occipital lobe atrophy

Tau stain of temporal lobe section highlights Alzheimer pathology



Pallor of the substantia nigra was noted, and Lewy bodies noted microscopically (see inset)



Alpha-synuclein staining showed neocortical Lewy bodies (here in the frontal lobe)


The final diagnosis was Alzheimer disease and Diffuse Neocortical Lewy Body Disease in the setting of Posterior Cortical Atrophy.

Friday, October 5, 2018

Mesoectodermal Leiomyoma of the Ciliary Body

A 47-year-old woman is suspected of having a ciliary body melanoma (A). Histologic sections (B and C) show large ciliary body tumor composed of tumor cells in a fibrillar cytoplasmic matrix. Electron microscopy (D) shows a dense osmophiliic structure known as a skeinoid fiber.


Immunohistochemistry helped to confirm that this was a leiomyoma.

(Case reported by J. Campbell et al. Ultrastruct Pathol 28:559, 1997.)


Wednesday, October 3, 2018

Alzheimer Society International Congress (ASIC 2019): Call for Abstracts


Abstracts are being accepted for the Alzheimer Society International Congress (ASIC 2019), which will be held on February 18-21, 2019 in San Francisco.

The ASIC 2019 is sponsored by the Alzheimer International Society, a non-profit organization with a mission to support patient care and foster research to find a cure for Alzheimer’s disease. The Society is a professional international society for individuals interested in Alzheimer's and dementia science—including scientists, physicians and other professionals involved in the research and treatments of Alzheimer's disease and other dementias.

ASIC 2019 is a leading forum in Alzheimer research, and dementia care. The Congress will highlight the latest research accomplishment in Alzheimer research, and patient care, as well as to feature innovative drug discovery, dementia technology, breaking news of clinical trials that bring hope to Alzheimer patients.

For more information about the list of topics and the abstract guidelines, please visit the web pages:  http://alzint.com/abstracts.html

The due date for abstract submission is October 15, 2018.

Tuesday, October 2, 2018

“Rising Star Award” in Neurodegenerative Research: Call for Submissions


The Mahoney Institute for Neurosciences (MINS) at the  University of Pennsylvania is has announced a call for submissions for its annual Rising Star Award in neuroscience research. To highlight the “Year of Neurodegenerative Research” on Penn’s campus, the award honors a young researcher for outstanding contributions to neurodegenerative research with a $10,000 personal honorarium at the MINS 35th Annual Retreat and Symposium on April 3, 2019.

Dr. Virginia Lee
“Neurodegenerative disorders are major health problems for the elderly, and there are currently no treatments for any of these diseases,” said Virginia Lee, PhD, director of Penn’s Center for Neurodegenerative Disease and a MINS faculty member. “I am proud that there is a large research community at Penn, including MINS, at the forefront of research elucidating the etiology and pathogenesis of these devastating disorders. We look forward to honoring and facilitating a young researcher to enhance our understanding of age-related neurodegeneration and to advance future therapies.”

In addition, the 2019 award recipient will present a research seminar at the symposium and, before the seminar, a separate introductory lecture on neurodegeneration. Also at the symposium, Prof. Pietro De Camilli, Yale School of Medicine, will give the Sprague Lecture, and Prof. Beth Stevens, Harvard Medical School, will give the Adler Lecture.

Researchers who received their first advanced degree, such as the PhD, in 2005 or more recently are invited to submit a one-page description of their contributions to neurodegenerative research, full curricula vitae, and names of three references in a single PDF file by December 1, 2018, to MINSRisingStarAward@lists.upenn.edu. More information can be found at www.med.upenn.edu/ins.