文章來源：《經(jīng)濟(jì)學(xué)人》Jul 1th 2023 期 Science & technology 欄目 World?in?a?dish Brain injuries

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On June?23rd a court case brought by more than 200 rugby-union players kicked off in London.?The players claim the sport’s administrators failed in the past to protect them from repeated concussions and blows to the head that, they say, have left them with lifelong brain injuries and early-onset dementia.

6月23日，200多名橄欖球運(yùn)動員在倫敦提起了一場法庭訴訟案。這些球員稱，體育管理者過去未能保護(hù)他們免受反復(fù)的腦震蕩和頭部撞擊，這些傷害導(dǎo)致他們終身腦損傷和早發(fā)性癡呆。

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Concussions and other forms of brain injury have become one of the biggest worries in sports from soccer to ice hockey.?In America the National Football League, which governs American football, has had to pay out hundreds of millions of dollars to brain-damaged players.

從足球到冰球等體育運(yùn)動，腦震蕩和其他形式的腦損傷已成為該領(lǐng)域最大的隱患之一。在美國，負(fù)責(zé)管理美式橄欖球的全國橄欖球聯(lián)盟不得不向腦損傷的運(yùn)動員支付數(shù)億美元的賠償。

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Rugby’s current administrators are scrambling to change things.?Authorities in France, England and New Zealand have changed the rules to lower the legal height of tackles, in the hope that will prevent at least some head impacts.?New rules released in April mean that a player with a suspected concussion must be removed from the pitch immediately.

橄欖球隊(duì)現(xiàn)任管理者正在竭力改變現(xiàn)狀。法國、英格蘭和新西蘭的相關(guān)機(jī)構(gòu)已經(jīng)修改了規(guī)則，降低了擒抱摔倒的法定高度，希望至少能防止一些頭部撞擊。4月發(fā)布的新規(guī)則意味著，疑似患有腦震蕩的球員必須立即離場。

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One of the problems, though, is properly diagnosing concussion in the first place. Currently this is an unreliable art.?Pitch-side doctors must rely on a mix of outward clinical signs and self-reported symptoms, which players keen to return to the fray may underplay.?Away from professionally organised sports, where people take spills or butt heads without medical supervision, it is even harder to decide whether damage has been done.

然而，問題之一是首先要正確診斷出腦震蕩。目前這是一門不可靠的技藝。場邊醫(yī)生必須依靠外在的臨床癥狀和自述癥狀來綜合判斷，而那些渴望重返賽場的球員可能會低報(bào)癥狀。在非職業(yè)組織的體育運(yùn)動中，人們在沒有醫(yī)療監(jiān)督的情況下摔倒或頭部對撞，更難判斷是否造成了腦部損傷。

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Doctors are trying to help.?In May the American Congress of Rehabilitation Medicine published a new set of diagnostic criteria, under which a patient without clear external signs—such as confusion or unconsciousness—would have to report at least two symptoms, such as feeling confused or dizzy, for a concussion to be suspected.?But a new development, pioneered by Adam Shuhendler, a biochemist at the University of Ottawa, may bring more rigour.?Earlier this month, at the Canadian Chemistry Conference in Vancouver, he laid out how a reliable clinical test for concussion might work.

醫(yī)生們正在努力提供幫助。5月，美國康復(fù)醫(yī)學(xué)會公布了一套新的診斷標(biāo)準(zhǔn)，根據(jù)該標(biāo)準(zhǔn)，沒有明顯外部癥狀（例如精神錯亂或意識不清）的患者必須報(bào)告至少2種癥狀（例如感到精神錯亂或頭暈），才能診斷為腦震蕩。但是，渥太華大學(xué)的生物化學(xué)家亞當(dāng)·舒亨德勒開創(chuàng)的一項(xiàng)新進(jìn)展可能帶來更加嚴(yán)謹(jǐn)?shù)脑\斷方法。本月早些時候，在溫哥華舉行的加拿大化學(xué)會議上，他詳細(xì)闡述了如何進(jìn)行可靠的腦震蕩臨床診斷。

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Dr Shuhendler’s specialty is creating dyes that bind to specific molecules in the body.?In this case, the molecules he has in mind are a class of chemicals called aldehydes.?Though these are thought to function as messengers between many different cells in the body, they seem to be produced in greater quantities in response to cellular stress—including from injury.?Perhaps, he thought, the same thing would happen in the brain as well.

舒亨德勒博士的專長是創(chuàng)造出與人體內(nèi)特定分子結(jié)合的染料。在這種情況下，他所考慮的分子是一類被稱為醛的化學(xué)物質(zhì)。盡管這些物質(zhì)被認(rèn)為在人體的許多不同細(xì)胞之間充當(dāng)信使角色，但它們似乎在細(xì)胞應(yīng)激（包括受傷）時產(chǎn)生的數(shù)量更多。他想，也許在大腦中也會發(fā)生同樣的情況。

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The next step was to check if they could spot concussions in mice.?That required concussed mice, which the researchers produced with a device that impacted the animals’ heads with enough force to disorient them for a few seconds, but without causing serious damage.?To make the experience better they gave them painkillers—but they did not sedate them, because a sleeping brain is known to react differently to shocks.?They then injected the mice with the dye and put them in miniature magnetic-resonance imaging (MRI) scanners, which revealed the dye-marked aldehydes.

下一步是檢查是否能夠在小鼠中發(fā)現(xiàn)腦震蕩。這需要有腦震蕩的小鼠，研究人員使用一種裝置擊打小鼠的頭部，力量足以使它們失去方向感幾秒鐘，但并不會造成嚴(yán)重的腦損傷。為了使它們的體驗(yàn)更好，研究人員給它們服用了止痛藥--但沒有給它們注射鎮(zhèn)靜劑，因?yàn)楸娝苤?，睡眠中的大腦對刺激有不同的反應(yīng)。然后研究人員給小鼠注射了染料，并將它們放入微型磁共振成像（MRI）掃描儀中，這些掃描儀顯示了染色的醛類化合物。

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Transferring the technology to humans may take some time. For one thing, the safety of the dye has yet to be proved in people.?Dr Shuhendler thinks one option might be to try the dye with positron emission tomography (PET) scans rather than MRIs.?Though they tend to be more expensive, PET tests are also much more sensitive, and therefore require only trace amounts of dye. That should make getting approval easier.

將該技術(shù)應(yīng)用于人類可能需要一些時間。因?yàn)槲覀冞€需要確保染料在人體中的安全性。舒亨德勒博士建議嘗試使用正電子發(fā)射斷層掃描（PET）而不是磁共振成像（MRI）來檢查染料。盡管PET檢測的成本更高，但它的敏感性也更高，因此只需使用微量的染料。這應(yīng)該使獲得批準(zhǔn)更容易。

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Eventually, it might even be possible to do the diagnosis with a simple blood test.?In the meantime, though, a hospital test that offered a definitive diagnosis of concussion would still be useful, because so many are missed by doctors.?One paper, published in 2018, noted that health statistics suggest around 22m people around the world suffer a mild brain injury every year.?When the researchers tried to correct for undercounting, they arrived at a figure of 55m. But that is still merely an informed guess. It would be useful to be sure.

最終，也許可以通過一項(xiàng)簡單的血液檢測來確診腦震蕩。但與此同時，醫(yī)院提供的腦震蕩檢測仍然是有用的，因?yàn)榻?jīng)常會出現(xiàn)醫(yī)生漏診情況。一篇發(fā)表于2018年的論文指出，健康統(tǒng)計(jì)數(shù)據(jù)表明全球每年約有2200萬人患上輕度腦損傷。當(dāng)研究人員對漏診進(jìn)行修正時，實(shí)際數(shù)字可能達(dá)到5500萬。但這仍然只是一個有根據(jù)的猜測。明確這一點(diǎn)將非常有益。