Introduction The glia-operated glymphatic system, analogous to but separate from the lymphatics in the periphery, is unique to brain and retina, where it is very closely aligned with the arteriolar system. This intimate relationship leads to a “blood vessel like” distribution pattern of glymphatic vessels in the brain. The spatial relationship of glymphatics, including their essential component aquaporin-4 with vascular pericytes of brain arterioles is critical to functionality and is termed “polarization”. Materials and Methods We review the available literature on the factors affecting the resting state of glymphatics under normal conditions, including the important role of sleep in supporting normal glymphatic function (including waste removal) as well as the critical role of “polarization” under normal conditions. We then examine the effects of traumatic brain injury (TBI) or seizures on the glymphatic system and its state of “polarization”. Results Injury, such as TBI, can disrupt polarization resulting in “depolarization” leading to brain edema. Conclusion Damage to the glymphatic system might explain the brain edema so often seen following TBI or other insult. Moreover, similar damage should be expected in response to seizures, which can often be associated with chemical exposures as well as with TBI. Military operations, whether night operations or continuous operations, quite often impose limitations on sleep. As glymphatic function is sleep-dependent, sleep deprivation alone could compromise glymphatic function, as well, and might in addition, explain some of the well-known performance deficits associated with sleep deprivation. Possible effects of submarine and diving operations, chemical agents (including seizures), as well as high altitude exposure and other threats should be considered. In addition to the brain, the retina is also served and protected by the glymphatic system. Accordingly, the effect of military-related risks (e.g., exposure to laser or other threats) to retinal glymphatic function should also be considered. An intact glymphatic system is absolutely essential to support normal central nervous system functionality, including cognition. This effects a broad range of military threats on brain and retinal glymphatics should be explored. Possible preventive and therapeutic measures should be proposed and evaluated, as well.

中文翻译：

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Glymphatics：与军事中枢神经系统损伤相关的医学神经科学的变革性发展

简介 神经胶质手术的淋巴系统，类似于但独立于外围淋巴系统，是大脑和视网膜所独有的，它与小动脉系统非常紧密地对齐。这种密切的关系导致大脑中淋巴管的“血管样”分布模式。glymphatics 的空间关系，包括它们的基本成分 aquaporin-4 与脑小动脉的血管周细胞对功能至关重要，被称为“极化”。材料和方法 我们回顾了有关正常条件下影响淋巴管静息状态的因素的现有文献，包括睡眠在支持正常的淋巴管功能（包括废物清除）中的重要作用以及正常条件下“极化”的关键作用. 然后，我们检查创伤性脑损伤 (TBI) 或癫痫发作对 glymphatic 系统及其“极化”状态的影响。结果 损伤，如 TBI，会破坏极化，导致“去极化”导致脑水肿。结论 对 glymphatic 系统的损害可能解释了在 TBI 或其他损伤后经常出现的脑水肿。此外，预计癫痫发作也会造成类似的损害，这通常与化学物质暴露以及 TBI 相关。军事行动，无论是夜间行动还是连续行动，都经常对睡眠施加限制。由于 glymphatic 功能依赖于睡眠，单独的睡眠剥夺也可能损害 glymphatic 功能，此外，还可能解释与睡眠剥夺相关的一些众所周知的表现缺陷。应考虑潜艇和潜水作业、化学制剂（包括缉获）以及高海拔暴露和其他威胁的可能影响。除了大脑，视网膜也受到淋巴系统的服务和保护。因此，还应考虑军事相关风险（例如，暴露于激光或其他威胁）对视网膜 glymphatic 功能的影响。完整的 glymphatic 系统对于支持包括认知在内的正常中枢神经系统功能是绝对必要的。应该探索这种对大脑和视网膜淋巴组织的广泛军事威胁的影响。还应提出和评估可能的预防和治疗措施。以及高海拔暴露和其他威胁应予以考虑。除了大脑，视网膜也受到淋巴系统的服务和保护。因此，还应考虑军事相关风险（例如，暴露于激光或其他威胁）对视网膜 glymphatic 功能的影响。完整的 glymphatic 系统对于支持包括认知在内的正常中枢神经系统功能是绝对必要的。应该探索这种对大脑和视网膜淋巴组织的广泛军事威胁的影响。还应提出和评估可能的预防和治疗措施。以及高海拔暴露和其他威胁应予以考虑。除了大脑，视网膜也受到淋巴系统的服务和保护。因此，还应考虑军事相关风险（例如，暴露于激光或其他威胁）对视网膜 glymphatic 功能的影响。完整的 glymphatic 系统对于支持包括认知在内的正常中枢神经系统功能是绝对必要的。应该探索这种对大脑和视网膜淋巴组织的广泛军事威胁的影响。还应提出和评估可能的预防和治疗措施。还应考虑暴露于激光或其他威胁）对视网膜淋巴功能的影响。完整的 glymphatic 系统对于支持包括认知在内的正常中枢神经系统功能是绝对必要的。应该探索这种对大脑和视网膜淋巴组织的广泛军事威胁的影响。还应提出和评估可能的预防和治疗措施。还应考虑暴露于激光或其他威胁）对视网膜淋巴功能的影响。完整的 glymphatic 系统对于支持包括认知在内的正常中枢神经系统功能是绝对必要的。应该探索这种对大脑和视网膜淋巴组织的广泛军事威胁的影响。还应提出和评估可能的预防和治疗措施。