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The US government has initiated the largest coordinated research programs ever in neurotrauma. The specific focus is to get insight in mechanisms and to provide better treatment for blast induced traumatic brain injuries (BINT, Blast Induced Neuro Trauma) (Ling et al., 2009). The background should probably be well known for anyone working in the field of traumatic brain injuries (TBI). The asymmetric warfare in the recent military conflicts in Iraq and Afghanistan has resulted in numerous attacks with Improvised Explosive Devices (IED) and large losses in terms of deaths and wounded soldiers (Warden, 2006; Terrio et al., 2009). TBI has been identified as major health problem in military personnel returning from service. The injuries range from severe multitrauma to a number of mild TBI that still has to be settled. A large number of research groups with different backgrounds contribute to this effort. In addition, a number of other countries have also ongoing research programs on blast induced brain injuries.
The current research programs are so large and well coordinated so that it is tempting to compare with Apollo Program about 50years ago. Apart from putting man on the moon that program had several positive spinoff effects in many areas, i.e in electronics. Similar spinoff effects might come in from the current programs. It would be logical that these programs can generate important new knowledge in treatment of mildTBI, diffuse axonal injuries (DAI), the role of inflammation in TBI, neuroprotection, rehabilitation of TBI and acute oedema treatment. Many groups are working with advanced computerized mathematical models of the head to provide understanding of propagation of blast waves. Such models will also be important for the design of better injury prevention in road traffic accidents. More detailed criteria for different types of TBI would also be important tools for improvements of safety in vehicles. We can also expect a lot of data from research on more specific biomarkers for TBI (Wang et al., 2005; Agoston et al., 2009) and evaluation of digital EEG to indentify functional changes. New imaging techniques may get an increasing power to identify DAI and regional vascular perfusion defects after TBI.
To mention a few of the specific problems in BINT:
Tragic experience from military conflicts has on previous occasions generated valuable medical knowledge. During the Roman Empire the army physicians learned the lesson not to close contaminated wounds and they also developed an early set of ethical rules, which also included treatment of wounded enemies. We could also mention the Crimean war and its impact on nursing and sanitary principles as well as a war between Russia and Sweden, that resulted in the foundation of the Karolinska institute to provide better training for Army surgeons, exactly 200years ago. During more recent years, the careful examination of TBI patients from the Vietnam War has generated very important general knowledge (Raymont et al., 2008; Koenigs and Grafman, 2009).
Thus, it is a grand challenge to extract all useful information from the current research program on blast induced brain injuries. We can expect to see a number of articles dealing with that problem in this journal.
The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.