Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Role of mitophagy in spinal cord ischemia-reperfusion injury

Spinal cord ischemia-reperfusion injury, a severe form of spinal cord damage, can lead to sensory and motor dysfunction. This injury often occurs after traumatic events, spinal cord surgeries, or thoracoabdominal aortic surgeries. The unpredictable nature of this condition, combined with limited treatment options, poses a significant burden on patients, their families, and society. Spinal cord ischemia-reperfusion injury leads to reduced neuronal regenerative capacity and complex pathological processes. In contrast, mitophagy is crucial for degrading damaged mitochondria, thereby supporting neuronal metabolism and energy supply. However, while moderate mitophagy can be beneficial in the context of spinal cord ischemia-reperfusion injury, excessive mitophagy may be detrimental. Therefore, this review aims to investigate the potential mechanisms and regulators of mitophagy involved in the pathological processes of spinal cord ischemia-reperfusion injury. The goal is to provide a comprehensive understanding of recent advancements in mitophagy related to spinal cord ischemia-reperfusion injury and clarify its potential clinical applications.

Traumatic spinal cord injury: a review of the current state of art and future directions - what do we know and where are we going?

Background

Traumatic spinal cord injury (SCI) remains a devastating condition, with limited functional recovery despite advancements in clinical management and understanding of its mechanisms. SCI pathophysiology involves primary mechanical trauma and secondary neuroimmune and structural changes, leading to neuronal death and chronic functional deficits.

Methods

Through a comprehensive literature review of articles published in the PubMed, MEDLINE, Embase, and Cochrane Reviews Library databases, this article provides an update on the current management of traumatic SCI with a focus on these emerging therapeutic strategies that hold potential for future advancements in the field.

Results

Current management strategies include pre-hospital care, acute clinical interventions, surgical decompression and spine destabilization, and neurorehabilitation. Despite these interventions, SCI patients often fail to fully restore lost functions. Emerging therapies focus on neuroprotection, neuroregeneration, and neuromodulation, leveraging advances in molecular biomarkers, imaging techniques, and cell-based treatments. Neuroprotective agents, including the sodium-glutamate antagonist riluzole, aim to keep cells alive through the secondary injury phase, while regenerative strategies utilize neurotrophic factors and stem cell transplantation or approaches to target inhibitor molecules such as NOGO or RGMa to regenerate new cells, axons, and neural circuits. Neuromodulation techniques, such as electrical and magnetic field stimulation, offer promising avenues for functional recovery. Combining these novel therapies with traditional neurorehabilitation holds potential for improved outcomes.

Conclusions

While significant strides have been made in understanding the mechanisms underlying SCI and in developing novel therapeutic approaches, the challenge and opportunity will be to tailor treatments to fit the heterogenous clinical presentation of patients with SCI and to better understand the heterogeneity in clinical trajectories.

Enhancing m6A modification in the motor cortex facilitates corticospinal tract remodeling after spinal cord injury

JOURNAL/nrgr/04.03/01300535-202506000-00026/figure1/v/2024-08-05T133530Z/r/image-tiff Spinal cord injury typically causes corticospinal tract disruption. Although the disrupted corticospinal tract can self-regenerate to a certain degree, the underlying mechanism of this process is still unclear. N6-methyladenosine (m6A) modifications are the most common form of epigenetic regulation at the RNA level and play an essential role in biological processes. However, whether m6A modifications participate in corticospinal tract regeneration after spinal cord injury remains unknown. We found that expression of methyltransferase 14 protein (METTL14) in the locomotor cortex was high after spinal cord injury and accompanied by elevated m6A levels. Knockdown of Mettl14 in the locomotor cortex was not favorable for corticospinal tract regeneration and neurological recovery after spinal cord injury. Through bioinformatics analysis and methylated RNA immunoprecipitation-quantitative polymerase chain reaction, we found that METTL14 regulated Trib2 expression in an m6A-regulated manner, thereby activating the mitogen-activated protein kinase pathway and promoting corticospinal tract regeneration. Finally, we administered syringin, a stabilizer of METTL14, using molecular docking. Results confirmed that syringin can promote corticospinal tract regeneration and facilitate neurological recovery by stabilizing METTL14. Findings from this study reveal that m6A modification is involved in the regulation of corticospinal tract regeneration after spinal cord injury.

Inflammasome links traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease

Traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease are three distinct neurological disorders that share common pathophysiological mechanisms involving neuroinflammation. One sequela of neuroinflammation includes the pathologic hyperphosphorylation of tau protein, an endogenous microtubule-associated protein that protects the integrity of neuronal cytoskeletons. Tau hyperphosphorylation results in protein misfolding and subsequent accumulation of tau tangles forming neurotoxic aggregates. These misfolded proteins are characteristic of traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease and can lead to downstream neuroinflammatory processes, including assembly and activation of the inflammasome complex. Inflammasomes refer to a family of multimeric protein units that, upon activation, release a cascade of signaling molecules resulting in caspase-induced cell death and inflammation mediated by the release of interleukin-1β cytokine. One specific inflammasome, the NOD-like receptor protein 3, has been proposed to be a key regulator of tau phosphorylation where it has been shown that prolonged NOD-like receptor protein 3 activation acts as a causal factor in pathological tau accumulation and spreading. This review begins by describing the epidemiology and pathophysiology of traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease. Next, we highlight neuroinflammation as an overriding theme and discuss the role of the NOD-like receptor protein 3 inflammasome in the formation of tau deposits and how such tauopathic entities spread throughout the brain. We then propose a novel framework linking traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease as inflammasome-dependent pathologies that exist along a temporal continuum. Finally, we discuss potential therapeutic targets that may intercept this pathway and ultimately minimize long-term neurological decline.

The incidence and determinants of traumatic brain injury deaths occurring outside hospital in Australia

OBJECTIVE

To identify the determinants of death occurring outside of hospital following moderate to severe traumatic brain injury (msTBI) across Australia.

METHODS

Design, setting: Retrospective observational study using National Coronial Information System (NCIS) data.

PARTICIPANTS

People who died during the five-year study period between 2015 and 2020 and were recorded in the NCIS as having intracranial injury as a cause or contributor to death.

MAJOR OUTCOME MEASURES

The primary outcome was the location of death, specifically whether death occurred outside an acute hospital setting.

RESULTS

There were 3751 deaths with msTBI, of which 1064 (28.4%) occurred outside of an acute hospital setting and 605 (16.1%) occurred outside any medical service. The odds of death occurring outside hospital were lower for male patients (odds ratio [OR]: 0.6, 95% confidence interval [CI]: 0.5-0.7), penetrating injuries (OR 5.2, 95% CI: 3.0-8.9) and highest in the Northern Territory followed by Queensland. The odds of death occurring outside any medical service area (e.g. hospital, rehabilitation, nursing home) were higher for: younger adults (OR 3.6, 95% CI: 1.0-12.7), those with penetrating injuries (OR 8.9, 95% CI: 4.5-17.3), and where the time between injury and death was less than 24 h. The odds of death outside any medical service area were less for people with msTBI in South Australia (OR 0.1, 95% CI 0.0-0.2).

CONCLUSION

Approximately, one in six msTBI deaths occurred outside of any medical service area. Opportunities exist to improve access to emergency care for people sustaining msTBI across Australia.

Liberal transfusion strategies reduce sepsis risk and improve neurological recovery in acute brain injury: an updated systematic review and meta-analysis

PURPOSE

To advocate for a Liberal Transfusion Strategy (LTS) in neurocritical care patients with Acute Brain Injury (ABI) and provide updated evidence for optimizing transfusion thresholds in clinical guidelines.

BACKGROUND

Anemia frequently complicates ABI management, often necessitating red blood cell transfusions. However, the optimal hemoglobin (Hb) threshold for transfusion remains controversial. While earlier meta-analyses indicated no significant differences between LTS and restrictive transfusion strategies (RTS), emerging randomized controlled trials (RCTs) emphasize the need for reappraisal within neurocritical care.

METHODS

This meta-analysis included five RCTs involving 2399 patients (1,191 LTS; 1208 RTS) with ABI (subarachnoid hemorrhage, traumatic brain injury, or intracerebral hemorrhage). LTS was defined as transfusion at Hb ≤ 10-9 g/dL, and RTS as transfusion at Hb ≤ 7-8 g/dL. Outcomes assessed included sepsis or septic shock, ICU mortality, unfavorable functional outcomes at six months, venous thromboembolism (VTE), acute respiratory distress syndrome (ARDS), and in-hospital mortality.

RESULTS

RTS significantly increased the risk of sepsis or septic shock (relative risk [RR]: 1.42; 95% confidence interval [CI] 1.08-1.86; p = 0.01) and unfavorable functional outcomes at six months (RR 1.13; 95% CI 1.06-1.21; p = 0.0003). No significant differences were observed in ICU mortality (RR 1.00; 95% CI 0.84-1.20; p = 0.96), VTE (RR: 0.88; 95% CI 0.56-1.38; p = 0.58), ARDS (RR 1.05; 95% CI 0.69-1.61; p = 0.81), or in-hospital mortality (RR 0.98; 95% CI 0.76-1.26; p = 0.89). Heterogeneity was minimal (I2 < 25%).

CONCLUSION

LTS demonstrates the potential to enhance safety and functional recovery in ABI patients by mitigating sepsis risk and promoting favorable neurologic outcomes. Further high-powered RCTs are warranted to validate these findings and refine transfusion protocols.

Neurological, functional, and quality of life outcomes following combined mesenchymal stem cell and Schwann cell therapy in spinal cord injury: a 9-year experience

BACKGROUND

Spinal cord injury (SCI) often results in severe disabilities and significant socioeconomic burdens.

OBJECTIVE

This study aimed to evaluate the effects and safety of co-transplantation of autologous bone marrow-derived mesenchymal stem cells (MSCs) and Schwann cells (SCs) via the intrathecal route in patients with complete spinal cord injury (SCI). The analysis focused on the therapy's impact across various SCI subgroups (cervical vs. thoracolumbar, subacute vs. chronic) and the factors influencing its efficacy.

METHODS

This case series evaluated 106 patients with complete SCI treated with combined cell therapy between August 2013 and September 2022, with a one-year follow-up. Safety profiles were assessed, and neurological and functional outcomes were measured using the American Spinal Injury Association (ASIA) scores, Spinal Cord Independence Measure (SCIM-III), and the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) at 6- and 12-month intervals post-injection. Multiple regression analysis was conducted to evaluate factors associated with outcomes.

RESULTS

Significant improvements were observed in ASIA scores (motor, light touch, and pinprick), SCIM-III scores (total and subscales), and WHOQOL-BREF scores after 12 months. These improvements were consistent across subgroups, regardless of injury level or duration. Multiple regression analysis indicated that improvements in ASIA motor scores were associated with injury level, while improvements in SCIM-III total and mobility scores were associated with time since injury and patient age.

CONCLUSIONS

This study demonstrates significant neurological, functional, and quality of life improvements following combined cell therapy with autologous MSCs and SCs in patients with complete SCI. Future research should investigate potential synergies with other therapies and conduct comparative efficacy analyses.

Blood-Based Protein Biomarkers in the Chronic Phase of Traumatic Brain Injury: A Systematic Review

There has been limited exploration of blood-based biomarkers in the chronic period following traumatic brain injury (TBI). Our objective was to conduct a systematic review of studies examining blood-based protein biomarkers with at least one sample collected 12 months post-TBI in adults (≥16 years). Database searches were conducted in Embase, MEDLINE, and Science Citation Index-Expanded on July 24, 2023. Risk of bias was assessed using modified Joanna Briggs Institute critical appraisal tools. Only 30 of 12,523 articles met inclusion criteria, with samples drawn from 12 months to 48 years. Higher quality evidence (low risk of bias; large samples) identified promising inflammatory biomarkers at 12 months post-injury in both moderate-severe TBI (GFAP) and mild TBI (eotaxin-1, IFN-y, IL-8, IL-9, IL-17A, MCP-1, MIP-1β, FGF-basic, and TNF-α). Studies with low risk of bias but smaller samples also suggest NSE, MME, and CRP may be informative, alongside protein variants for α-syn (10H, D5), amyloid-β (A4, C6T), TDP-43 (AD-TDP 1;2;3;9;11), and tau (D11C). Findings for NfL were inconclusive. Longitudinal data were mostly available for acute samples followed until 12 months post-injury, with limited evaluation of changes beyond 12 months. Associations of some blood-based biomarkers with cognitive, sleep, and functional outcomes were reported. The overall strength of the evidence in this review was limited by the risk of bias and small sample sizes. Replication is required within prospective longitudinal studies that move beyond 12 months post-injury. Novel efforts should be guided by promising neurodegenerative-disease markers and use panels to model polypathology.

Validation of the GCS-Pupil Scale in Traumatic Brain Injury: Incremental Prognostic Value of Pupillary Reactivity with GCS in the Prospective Observational Cohorts CENTER-TBI and TRACK-TBI

To compare the incremental prognostic value of pupillary reactivity captured as part of the Glasgow Coma Scale-Pupils (GCS-P) score or added as separate variable to the GCS+P, in traumatic brain injury (TBI). We analyzed patients enrolled between 2014 and 2018 in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI, n = 3521) and the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI, n = 1439) cohorts. Logistic regression was utilized to quantify the prognostic performances of GCS-P (GCS minus number of unreactive pupils) and GCS+P versus GCS alone according to Nagelkerke's R2. End-points were mortality and unfavorable outcome (Glasgow Outcome Scale-Extended score 1-4) at 6 month post-injury. We estimated 95% confidence intervals (CIs) with bootstrap resampling to summarize the improvement in prognostic capability. In a meta-analysis of CENTER-TBI and TRACK-TBI, GCS as a linear score had a R2 of 25% (95% CI 19-31%) for mortality and 33% (4-41%) for unfavorable outcome. Pupillary reactivity as a separate variable improved the R2 by an absolute value of 6% (4.0-7.7%) and 2% (1.2-3.0%) for mortality and unfavorable outcome, respectively, while comparatively half of this improvement was captured by the GCS-P score (3% [2.1-3.3%], 1% [1-1.7%], respectively). GCS-P showed a stronger association with 6-month outcome after TBI than GCS alone and provides a single integrated score. However, this comes at a loss of clinical and prognostic information compared with GCS+P. For prognostic models, inclusion of GCS and pupillary reactivity as separate factors may be preferable to using a GCS-P summary score.

3D nanofibrous frameworks with on-demand engineered gray and white matters for reconstructing the injured spinal cord

Spinal cord injury (SCI) is a disruptive and heterogeneous medical condition affecting millions of patients worldwide. Due to the absence of medical treatments to effectively restore the lost sensorimotor and autonomic functions, there is an ongoing pursuit of scaffolds aiming to bridge the injured spinal area. Herein, a novel electrospinning modality to construct 3D nanofibrous frameworks (NFFs) in accordance with distinct spinal cord microenvironments is used to engineer a biomimetic hemicord. This scaffolding concept gravitates around the possibility of customizing NFFs with on-demand engineered gray and white matters to replicate the native spinal cytoarchitecture. In particular, a 3D reduced graphene oxide-based fibrous-porous system is developed to imitate the gray matter, while a 3D polycaprolactone (PCL)-chitosan nanofibrous network combined with PCL-graphene microfibers intends to mimic the white matter. The scaffolding components are tested in vitro with embryonic neural progenitor cells, integrated into the biomimetic NFF, and then tested in vivo in paralyzed rats with cervical hemisection. After 4 months of implantation, the scaffold generates both neuroprotective (e.g., limited infiltration of vimentin+ and ED1+ cells) and neuroregenerative (e.g., presence of new blood vessels and neurites) features accompanied with promising signs of forelimb function recovery.

The reliability and validity of brief cognitive screening tools used in traumatic brain injury: A systematic review

Reliable and valid cognitive screening tools are essential in the assessment of those with traumatic brain injury (TBI). Yet, there is no consensus about which tool should be used in clinical practice. This systematic review assessed psychometric properties of cognitive screening tools for detecting cognitive impairment in TBI. Inclusion criteria were: peer-reviewed validation studies of a cognitive screening tool(s); with a sample of adults aged 18-80 diagnosed with TBI (mild-severe); and with psychometrics consistent with COSMIN guidelines. Published literature was retrieved from MEDLINE, Web of Science Core Collection, EMBASE, CINAHL, and PsycINFO on 27 January 2022. A narrative synthesis was performed. Thirty-four studies evaluated the psychometric properties of a total of 22 cognitive screening tools, in a variety of languages. Properties assessed included structural validity, internal consistency, reliability, criterion validity (or diagnostic test accuracy), convergent/divergent validity, and discriminant validity. The Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) were the most widely validated cognitive screening tools for use in TBI. The MoCA had the most promising evidence of its psychometric properties, which has implications for clinical practice. Future research should aim to follow standard criteria for psychometric studies to allow meaningful comparisons across the literature.

Inappropriate antithrombotic use in geriatric patients with complicated traumatic brain injury

BACKGROUND

Preinjury antithrombotic (AT) use is associated with worse outcomes for geriatric (65 years or older) patients with traumatic brain injury (TBI). Previous studies have found that use of AT outside established guidelines is widespread in TBI patients.

METHODS

In this single-center retrospective cross-sectional study, we examined inappropriate AT use among geriatric patients presenting with traumatic intracranial hemorrhage. We reviewed records of patients 65 years or older with preinjury AT use who presented to a Level 1 trauma center with traumatic intracranial hemorrhage between 2016 and 2023. Patient demographics and AT indications/types were extracted. Appropriateness of AT use was determined using established guidelines.

RESULTS

The cohort comprised 207 patients (56.5% male; median age, 77 years). Fall was the most common mechanism of injury (87.9%). At initial presentation, 87.0% of patients had mild TBI (Glasgow Coma Scale scores 13-15). The two most common indications for AT use were atrial fibrillation (41.5%) and venous thromboembolism (14.5%). Anticoagulation therapy was used by 51.7% of patients, antiplatelet therapy by 40.1%, and both by 8.2%. Prescribed AT agents included warfarin (23.2%), direct oral anticoagulants (36.2%), aspirin (32.4%), and clopidogrel (15.0%). Per clinical guidelines, 31 patients (15.0%) were determined to be inappropriately on AT therapy. On multivariable analysis, venous thromboembolism (odds ratio [OR], 5.32; 95% confidence interval [CI], 1.80-15.71; p = 0.002) and arterial stent (OR, 4.69; 95% CI, 1.53-14.37; p = 0.007) were associated with inappropriate AT use; aspirin was the most common inappropriately prescribed AT (OR, 3.59; 95% CI, 1.45-8.91; p = 0.006).

CONCLUSION

Overall, 15% of geriatric TBI patients with preinjury AT use were prescribed this therapy outside of current guidelines. Trauma providers should remain vigilant in identifying such patients and collaborate across multidisciplinary teams to implement interventions that minimize inappropriate AT use.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.

Significance of NMDA receptor-targeting compounds in neuropsychological disorders: An In-depth Review

N-methyl-D-aspartate receptors (NMDARs), a subclass of glutamate-gated ion channels, play an integral role in the maintenance of synaptic plasticity and excitation-inhibition balance within the central nervous system (CNS). Any irregularities in NMDAR functions, whether hypo-activation or over-activation, can destabilize neural networks and impair CNS function. Several decades of experimental and clinical investigations have demonstrated that NMDAR dysfunction is implicated in the pathophysiology of various neurological disorders. Despite designing a long list of compounds that differentially modulate NMDARs, success in developing drugs that can selectively and effectively regulate various NMDAR subtypes while showing encouraging efficacy in clinical settings remains limited. A better understanding of the basic mechanism of NMDAR function, particularly its selective regulation in pathological conditions, could aid in designing effective drugs for the treatment of neurological conditions. Here, we reviewed the experimental and clinical investigations that studied the effects of available NMDAR modulators in various neurological disorders and weighed up the pros and cons of the use of these substances on the improvement of functional outcomes of these disorders. Despite numerous efforts to develop NMDAR modulatory drugs that did not produce the desired outcomes, NMDARs remain a significant target for advancing novel drugs to treat neurological disorders. This article reviews the complexity of NMDAR signaling dysfunction in different neurological diseases, the efforts taken to examine designed compounds targeting specific subtypes of NMDARs, including challenges accompanied by using these substances, and the potential enhancements in drug discovery for NMDAR modulatory compounds by innovative technologies.

Nitric oxide synthases: A delicate dance between bone regeneration and neuronal birth

Spinal cord injury (SCI) is a devastating condition resulting from traumatic or nontraumatic injury/chronic disorder. The pathogenesis of SCI necessitates a comprehensive approach, as it involves therapeutic strategies addressing both bone (spine) and neural (spinal cord) damage. This review centers on the pivotal role of nitric oxide (NO) and its synthesizing enzymes, nitric oxide synthases (NOS), in mediating the crosstalk between osteogenesis and neurogenesis. NO's effects are context-dependent, exhibiting a delicate balance between beneficial and detrimental actions. Reduced levels of nitric oxide (NO), primarily derived from endothelial NOS (eNOS), tipically stimulate osteoblast activity and promote neurogenesis by influencing neural stem cell (NSC) migration and differentiation. Conversely, elevated NO levels, predominantly from inducible NOS (iNOS), tipically triggered by inflammation, inhibit both processes through pro-apoptotic mechanisms. Nevertheless, these phenomena are not merely simplistic; they can be influenced by a variety of other factors. We explore the intricate interplay of NO/NOS with key signaling pathways crucial in neurogenesis and osteogenesis, including mechanical stimuli, Wnt, interleukins, BMPs, NF-κB, etc., revealing their influence on neuroinflammation, neurogenesis, and osteoblast differentiation. The temporal and spatial dynamics of NO/NOS activity and the implications for therapeutic intervention have been discussed. Precise modulation of NO levels and NOS isoforms, potentially through targeted therapies manipulating these interacting signaling pathways, emerges as a promising strategy for promoting bone and neural regeneration. This review highlights the critical need for a balanced approach in therapeutic strategies to harness the beneficial effects of NO/NOS while mitigating its detrimental consequences.

The prescribing patterns and effectiveness of sedatives and analgesics for severe traumatic brain injury patients in Taiwan

BACKGROUND

Traumatic brain injury (TBI) is a major global health challenge associated with high mortality and morbidity. Secondary brain injury caused by disrupted intracranial pressure (ICP) regulation often necessitates sedation; however, guidelines lack specificity for TBI management.

METHODS

This study analyzed sedation and analgesia prescribing patterns and their outcomes in severe TBI patients in Taiwan using National Health Insurance Research Database data (2012-2019). Severe TBI patients intubated during intensive care unit (ICU) hospitalization were included. The primary outcome was 30-day all-cause mortality, with sensitivity analyses for 14-day mortality and 30-day all-cause mortality excluding deaths within 3 days. Inverse probability of treatment weighting (IPTW) was applied to balance patient characteristics across groups. Mortality rates across groups were evaluated using Kaplan-Meier survival analysis. At the same time, the Cox proportional hazards model simultaneously assessed the impact of various risk factors, such as age and comorbidities, on mortality.

RESULTS

Among 6030 patients, sedation and analgesia patterns varied, with midazolam combined with opioids being the most common regimen. Compared to the reference group (sedatives with opioids), the risk of death was highest in the no-prescription group (HR = 2.73, 95 % CI = 2.60-2.86), followed by the sedation-only group (HR = 1.58, 95 % CI = 1.50-1.66) and the opioids-only group (HR = 1.49, 95 % CI = 1.42-1.57; all p < 0.0001). Sensitivity analyses confirmed consistent trends.

CONCLUSIONS

These findings underscore the importance of optimizing sedation practices and enhancing awareness to improve outcomes for severe TBI patients.

Pkd2l1 deletion inhibits the neurogenesis of cerebrospinal fluid-contacting neurons and impedes spinal cord injury repair

Adult neural stem cells (NSCs) offer a promising avenue for restoring spinal cord injury (SCI). However, their precise identity in the mammalian spinal cord remains unclear. Our previous research demonstrated that Pkd2l1-positive cerebrospinal fluid-contacting neurons (CSF-cNs) possess the NSC properties. Furthermore, understanding the role and molecular mechanisms of CSF-cNs as endogenous NSCs in spinal cord repair is crucial for developing effective treatments. This study utilizes a Pkd2l1-/- transgenic mouse model to investigate the role of CSF-cNs in SCI repair. We found that the CSF-cN population was almost absent in Pkd2l1-/- mice. Following SCI, these mice exhibited a significant reduction in the number of NSCs surrounding the central canal. Notably, Pkd2l1-/- mice showed impaired neuronal regeneration and compromised motor function recovery post-SCI. These findings highlight the potential importance of Pkd2l1 as a target for treating SCI by focusing on endogenous NSCs.

Patient Characteristics to Inform Military Medical Evacuation Decision-Making in Mild Isolated Head Injury

INTRODUCTION

Management of head trauma in austere military environments is challenging as current head injury scoring systems have limited triage utility in the absence of advanced imaging. Additionally, unlike the recent past, future conflicts will be characterized by limited opportunities for aeromedical evacuation. We hypothesize that safe hospital discharge within 48 h may be an effective surrogate endpoint to identify patients appropriate for averted or delayed evacuation in military settings. To analyze this, we assess mild head-injured patients for associations between clinical factors and serious head injury patterns or hospital discharge within 48 h.

MATERIALS AND METHODS

This is a secondary analysis of case data collected in a DoD-funded study, "EpiC," a prospective, multicenter cohort study of major trauma in the Western Cape, South Africa, with median time to definitive care of 12.5 h. Patients aged 18-50 years who presented from March 2021 to October 2023 with mild head injury, defined as lowest Glasgow Coma Scale (GCS) ≥14 in the first 24 h, were eligible. Exclusions include any nonminor injury outside the head (Abbreviated Injury Scale score >1). Serious head injury was defined as nonnasal bone facial fractures, skull fractures, or intracranial injury. Clinical characteristics were evaluated for association with serious head injury or hospital discharge before 48 h, calculated as odds ratios (ORs) with 95% confidence intervals.

RESULTS

We identified 2031 patients among whom: the mechanism of injury was blunt in 60%, penetrating in 30%, and both in 11%. A total of 87% of patients were discharged within 48 h. Among patients with blunt head injury, factors most strongly associated with ≤48-h discharge include GCS of 15 (89.3% of patients, OR 5.73, 95% CI 3.84-8.54) and negative or no ordered head imaging (89.3% of patients, OR 13.96, 95% CI 9.58-20.33). Combinations of factors including GCS of 14 and SBP >160 (1.6% of patients, OR 0.14, 95% CI 0.06-0.35) or SBP < 100 (2.2% of patients, OR 0.35, 95% CI 0.15-0.83) were less likely to be discharged by 48 h.

CONCLUSIONS

In a military-relevant, austere, prolonged-care, civilian trauma setting, we identified factors associated with discharge after 48 h or an abnormal computed tomography head. We believe that further evaluation of individual and combinations of clinical factors may prove beneficial in imaging and transport decision-making in remote military settings.

Clinical, Neuroimaging, and Genetic Markers Associated with Cognitive and Functional Outcomes After Traumatic Brain Injury

Background: Traumatic brain injury (TBI) is a major cause of long-term disability worldwide, often leading to progressive cognitive and functional impairments. This study aimed to investigate the underlying factors contributing to long-term deterioration in TBI patients. Methods: We conducted a comprehensive evaluation of 145 patients aged 18-66 years with a documented history of TBI and ongoing cognitive and behavioral deficits. Assessments included neuroimaging, laboratory tests, genetic analysis, and standardized tools such as the Montreal Cognitive Assessment (MoCA) and the Barthel Index. Results: Structural brain abnormalities, including ventricular enlargement and gliosis, were observed in a substantial portion of the cohort. Persistent neuroinflammatory markers were also identified. Genetic analysis revealed a significant association between cognitive decline and polymorphisms in the ACE and PON1 genes. Patients carrying these variants were more likely to exhibit reduced cognitive performance and greater functional limitations. Conclusion: These findings suggest that genetic predisposition, chronic neuroinflammation, and structural brain damage collectively contribute to long-term outcomes following TBI. This highlights the potential of genetic and imaging biomarkers in identifying high-risk individuals and supports the need for personalized approaches to diagnosis, monitoring, and treatment in chronic TBI management.

Clinical manifestations and treatment of hypopituitarism due to traumatic brain injury

Traumatic brain injury (TBI) is a global health problem with rising incidence. In many patients, pituitary hormone deficiencies after TBI are transient; however, in some cases, they can persist or develop in the chronic phase. Post-traumatic hypopituitarism has a variable clinical course, reflecting its complex pathophysiology and incompletely understood risk factors. The diagnosis can be challenging, because symptoms of hypopituitarism may overlap with other TBI manifestations. Confirmatory endocrine testing is often required for diagnosis. Untreated chronic hypopituitarism can adversely affect physical, neurocognitive, and psychosocial rehabilitation; body composition; glucose metabolism; bone metabolism; and quality of life. Screening for hypopituitarism is recommended after moderate or severe TBI and for selected patients with mild TBI and suggestive clinical symptoms. Management requires an individualized multidisciplinary approach and consideration of endocrine pathology. In this review, we discuss the clinical manifestations and current management standards for hypopituitarism in adults with TBI.

Assessment of mesenchymal stem cells for the treatment of spinal cord injury: a systematic review and network meta-analysis

Objective

This study aims to explore the clinical efficacy of mesenchymal stem cell (MSC) transplantation in the treatment of patients with spinal cord injury (SCI) through a network meta-analysis and to discuss the optimal transplantation strategy for treatment.

Methods

We conducted a computer search of clinical randomized controlled studies on MSC treatment for SCI in databases including PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journal Database (VIP), Wanfang Database, and Chinese Biomedical Literature Service System (SinoMed) up to March 2024. Two researchers independently completed literature screening and data extraction according to the inclusion and exclusion criteria and used RevMan 5.4 software to assess the quality of the included studies. Network meta-analysis was performed using Stata 16.0 software.

Results

A total of 18 studies were included in the analysis. The results showed that MSCs significantly improved motor, sensory, and activities of daily living activities after SCI. Network meta-analysis indicated that umbilical cord mesenchymal stem cells (UCMSCs) were the most effective cell source, and intrathecal injection (IT) was the optimal transplantation method.

Conclusion

The study suggests that the current use of UCMSCs for IT transplantation may be the best transplantation strategy for improving functional impairment after SCI. Further high-quality studies are still needed to validate the results of this study and to ensure the reliability of the results.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier [CRD42023466102].

Targeted Delivery of Acid-Responsive Rutin Nanoparticles Based on Aldehyde Adsorption for the Treatment of Spinal Cord Injury in Rats

Spinal cord injury (SCI) can cause irreversible nerve damage, imposing a significant burden on both patients and society. Methylprednisolone (MP), the recommended clinical drug, possesses antioxidant, anti-inflammatory, and antiapoptotic effects. It improves nerve damage by inhibiting secondary pathological processes. However, high-dose MP administration may result in side effects, including diabetes, femoral head necrosis, and infections. Therefore, there is a need to identify safer alternatives to mitigate the issues associated with MP administration. Rutin, a natural small molecule, exhibits multifaceted therapeutic capabilities and high biosafety, making it a promising alternative to MP treatment. However, its poor solubility and rapid metabolism limit its in vivo bioavailability. In this study, a drug-free polypeptide (PAH) containing hydrazide groups on the side chains is designed, which can be used for mitigating secondary SCI through scavenging toxic aldehydes. Then, we utilize PAH to encapsulate rutin and develop aldehyde-responsive nanomedicine for intravenous administration in SCI rats, providing a novel approach for the clinical replacement of MP.

Exploring Molecular Pathways in Exercise-Induced Recovery from Traumatic Brain Injury

Traumatic brain injury (TBI) is functional damage or brain injury due to external forces and is a leading cause of death and disability in children and adults. It causes disruption of the blood-brain barrier (BBB), infiltration of peripheral blood cells, oxidative stress, neuroinflammation and apoptosis, neural excitotoxicity, and mitochondrial dysfunction. Studies have shown that PE can be applied as a non-pharmacological therapy and effectively improve functional recovery from TBI. Recovery from TBI can benefit from both pre- or post-TBI exercise through various mechanisms for neurorepair and rehabilitation of behavior and cognition, including alleviation of TBI-induced oxidative stress, upregulation of heat-shock proteins, reduction of TBI-induced inflammation, promotion of secretion of neurotrophic factors to facilitate neural regeneration, suppression of TBI-induced apoptosis to reduce brain injury, and stabilization of mitochondrial function for better cellular function. This review article provides an overview of the effect of pre- and post-TBI exercise on recovery of neurofunctions and cognition following TBI, summarizes the potential regulatory networks and cellular and biological processes involved in recovery of brain functions, and outlines the molecular mechanisms underlying exercise-induced improvement of TBI, including regulation of gene expression and activation of heat-shock proteins and neurotrophic factors under different exercise schemes. These mechanisms involve TBI-induced oxidative stress, upregulation of heat-shock proteins, inflammation, secretion of neurotrophic factors, and TBI-induced apoptosis. Due to high heterogeneity in human TBI, the outcome of exercise intervention is affected by the injury type and severity of TBI. More studies are needed to investigate the application of various exercise approaches that fits TBI under different circumstances, and to elucidate the detailed pathogenesis mechanisms of TBI to develop more patient-tailored interventions.

Development and validation of a nomogram-based risk prediction model for unfavorable outcomes in pediatric traumatic brain injury: a retrospective study

Introduction

Pediatric traumatic brain injury (PTBI) is linked to significant disability and mortality. This study aimed to identify risk factors for unfavorable outcomes in patients with PTBI and develop a predictive risk model.

Methods

A retrospective analysis was conducted on patients with PTBI treated at the 900th Hospital from September 2021 to June 2023. Univariate and multivariate regression analyses identified risk factors for adverse outcomes and facilitated the creation of a nomogram. The model's predictive accuracy was assessed using Receiver Operating Characteristic (ROC) curves, calibration curves, and Decision Curve Analysis (DCA). External validation was performed with patients with PTBI from Fujian Children's Hospital.

Results

Key findings indicated that a Glasgow Coma Scale (GCS) score ≤8, subdural hematoma, subarachnoid hemorrhage, and coagulopathy were independent risk factors. The nomogram achieved an area under the ROC curve of 0.947 in the development cohort and 0.834 in the external validation cohort, demonstrating a good fit. DCA results confirmed that the nomogram enhanced the prediction of unfavorable outcomes.

Conclusions

This risk prediction model offers high accuracy for early identification of adverse outcomes, enabling timely interventions to improve the quality of life for patients with PTBI.

Semantic-consistent diffusion model for unsupervised traumatic brain injury detection and segmentation from computed tomography images

BACKGROUND

Unsupervised traumatic brain injury (TBI) lesion detection aims to identify and segment abnormal regions, such as cerebral edema and hemorrhages, using only healthy training data. Recent advancements in generative models have achieved success in unsupervised anomaly detection by transforming abnormal patterns into normal counterparts. However, current mask-free image generators often fail to maintain semantic consistency of anatomical structures during the restoration process. This limitation negatively impacts residual-based anomaly detection, particularly in cases where structural deformations occur due to the mass effect of TBI lesions.

PURPOSE

This study aims to develop a semantic-consistent, unsupervised TBI lesion detection and segmentation method that minimizes false positives by preserving normal tissue consistency during the image generation process while addressing mass effect-related tissue deformations.

METHODS

We propose the semantic-consistent diffusion model (SCDM) for unsupervised TBI lesion detection, focusing on the localization and segmentation of various lesion types from noncontrast CT scans of TBI patients. Leveraging the high-quality image generation capabilities of unconditioned diffusion models (DM), we introduce a normal tissue retainment (NTR) regularization to ensure that normal tissues remain unaltered throughout the iterative denoising process. Furthermore, we address normal tissue compression and deformation caused by the mass effect of TBI lesions through diffeomorphic registration, reducing erroneous activations in residual images and final lesion maps.

RESULTS

Extensive experiments were conducted on three publicly available brain lesion datasets and one internal dataset. These datasets comprised 75, 51, 92, and 56 CT scans, respectively. Thirty seven CT scans without TBI lesions were used for training and validation, while the remaining scans were used for testing. The proposed method achieved average DSC of 0.56, 0.51, 0.47, and 0.52 and AUPRC of 0.57, 0.48, 0.53, and 0.50 on the BCIHM, BHSD, Seg-CQ500, and internal datasets, respectively, surpassing state-of-the-art unsupervised methods for TBI lesion detection and segmentation. An ablation study validated the effectiveness of the proposed NTR regularization and diffeomorphic registration-based mass effect simulation.

CONCLUSIONS

The results suggest that the proposed SCDM enables effective TBI lesion detection and segmentation across diverse TBI CT scans. It significantly reduces false positives by addressing inconsistencies in normal tissue during the iterative image restoration process and mitigating mass effect-induced tissue deformations.

Traumatic Brain Injury Diagnostic Interview: Development, Interrater Reliability, and 2-Week Post-Injury Clinical Profiles

Because most traumatic brain injuries (TBIs) do not present with objective indicators (e.g., neuroimaging findings) to confirm the diagnosis, clinicians often rely on self- or observer-reporting of alteration of consciousness (AOC; e.g., loss of consciousness [LOC], amnesia, other signs of altered mental status), and symptoms to make diagnoses. Moreover, there is no universal agreement on signs and symptoms to sufficiently diagnose TBI, which leads to variability and ambiguity in how TBI is diagnosed in clinical and research settings. The lack of standardized procedures for the diagnosis of acute TBI is a major challenge that hampers the ability to evaluate and compare TBI studies and advance the science and treatment of TBI. We present a new semi-structured TBI Diagnostic Interview (TBI-DI), developed for prospective TBI research to collect injury information important to verifying eligibility for the diagnosis of TBI. Specifically, the TBI-DI collects patient (and/or witness) reports of head trauma, AOC (including LOC and amnesia), and TBI-related symptomology. We describe the protocol, interrater reliability of the TBI-DI items to the same audio-recorded interview, and observed injury characteristics for interviews conducted at 2 weeks post-injury. The sample comprised 335 interviews (320 self-reported, 10 informant-reported, and 5 both) collected on individuals with TBI who were prospectively recruited from 4 U.S. level 1 trauma centers from 2019 to 2023. Cohen's kappa was calculated to summarize interrater reliability n = 288 interviews. UpSet plots were created to illustrate the prevalence of distinct profiles of signs of AOC and symptom reporting. Overall, there was a near-perfect agreement between raters for all AOC descriptors (κ = 0.85-0.92) and symptom items (κ ranging from 0.92 to 0.99). We observed diverse profiles of AOC, with 45% manifesting witnessed LOC, post-traumatic amnesia, or other altered mental status. Patients (n = 325) self-reported 256 different combinations of the 14 acute symptoms included in the interview (most commonly experiencing headache, dizziness, fatigue, and difficulty concentrating). The TBI-DI and associated SOP appear well-suited for use in a multicenter prospective study of TBI. Future research should examine the stability of reporting by respondents and the alignment between interview and objective clinical information. The TBI-DI solicits diverse acute diagnostic information that, when combined with clinical information (including confounding factors) and objective injury indicators, may inform more rigorous scientific reporting and evidence-based TBI diagnostic practices.

Mild and moderate traumatic brain injury: Screening, documentation, and referral to concussion services

BACKGROUND AND AIM

Screening of traumatic brain injuries (TBI) using different clinical assessment tools would facilitate diagnosis and effective inpatient follow-up. We aimed to describe rates of diagnosis, classification, documentation, and referral practices for TBI inpatients.

MATERIAL AND METHODS

In a retrospective cohort study, we reviewed electronic clinical records of adult patients admitted to a hospital ward with head trauma from an emergency department (ED) in 2021. Data included demographics, injury, TBI diagnoses, and referral to concussion services. Factors predicting ED physician documentation and referral to concussion services were identified.

RESULTS

Of approximately 34,000 adults admitted from the ED, 1059 presented with head trauma, and 609 (57.5 %) were diagnosed with TBI. There were 553 mild/moderate TBI cases with an incidence rate of 103.4 per 100,000 adult population in Canterbury. 14 % (n = 77) were referred to a concussion service. Predictors of ED-documented TBI included non-isolated head injury (OR:0.60), head CT request (OR:9.12), injured in street/public areas (OR:2.03). Older age and non-isolated head injury decreased odds of concussion service referral (0.96 and 0.46, respectively), while female and ED-documented TBI increased odds of referral (5.8 and 28, respectively).

CONCLUSION

Better documentation of mild/moderate TBI might facilitate health care access, with efficient clinical decision making.

Neuroprotective effect and possible mechanism of edaravone in rat models of spinal cord injury: a systematic review and network meta-analysis

Objective

The present review was developed to critically evaluate the neuroprotective effects of edaravone for experimental rat models of spinal cord injury (SCI) and generalize the possible mechanisms.

Methods

Systematic searches were carried out on databases including PubMed, Embase, Web of Science, Scopus, and Cochrane Library from their inception to March 2024. Controlled studies that assessed the neurological roles of edaravone on rats following SCI were selected. The Basso, Beattie, and Bresnahan (BBB) locomotor rating scale, residual white matter area, and malondialdehyde (MDA) level of the SCI rats were systematically searched by two reviewers.

Results

Ten eligible publications were included. Meta-analyses showed increased BBB scores in edaravone-treated rats compared with control ones. The effect size gradually increased from day 7 (seven studies, n = 246, weighted mean difference (WMD) = 1.96, 95% confidence interval (CI) = 1.23 to 2.68, P < 0.00001) to day 28 (seven studies, n = 222, WMD = 4.41, 95% CI = 3.19 to 5.63, P < 0.00001) after injury and then maintained stably in the following time. Meanwhile, edaravone treatment was associated with an amendment in the spared area of white matter and a lowering in the MDA expression in the lesion area. The subgroup analyses revealed that rats treated with edaravone exhibited superior locomotor recovery in compression injury models than contusion ones. In network analyses, the surface under the cumulative ranking curve gradually increased up to a dose of 5-6 mg/(kg·d) of edaravone, after which it plateaued. Mechanism analysis suggested edaravone can ameliorate oxidative stress, mitigate neuroinflammation, and counteract neuron apoptosis and ferroptosis via multiple signaling pathways to exert its neuroprotective effects.

Conclusion

Collectively, with a protective effect and a systematic action mechanism, edaravone warrants further investigation in SCI research and treatment. Nonetheless, in light of the limitations in the included studies, the findings in this review should be interpreted with caution.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42022374914.

Risk factors for enteral nutrition-associated diarrhea in older patients with severe traumatic brain injury: a retrospective cohort study

BACKGROUND

Severe traumatic brain injury (STBI) is one of the major causes of death and disability worldwide. The incidence and risk factors of enteral nutrition (EN)-associated diarrhea in older patients with STBI remain unclear.

METHODS

A cohort of adult STBI patients were retrospectively studied. The patients were stratified into an older group (≥ 65years) and a young group (< 65 years). All patients received EN for at least 48 h. Demographic, clinical and nutritional data were collected for analysis. We utilize multiple logistic regression models to evaluate predictors of diarrhea.

RESULTS

Among 292 patients with STBI aged 60.38 ± 14.89 years (mean ± standard deviation), 114 cases developed diarrhea, with an incidence of 39.04%. Older patients had a higher incidence of diarrhea than young patients (46.77% vs 33.33%, p = 0.020). Three variables were found to be significantly associated with diarrhea in young STBI patients. In contrast, five variables were significantly associated with this complication in older STBI patients, including acute physiology and chronic health evaluation II score (adjusted OR 1.134, 95% CI 1.019-1.272, p = 0.025), high-fat energy (adjusted OR 1.221, 95% CI 1.055-1.789, p = 0.025), EN duration (adjusted OR 1.105, 95% CI 1.005-1.223, p = 0.044), antibiotics total defined daily dose (DDDs) (adjusted OR 1.076, 95% CI 1.029-1.211, p = 0.039) and tube feeding of potassium (adjusted OR 2.525, 95% CI 1.031-6.450, p = 0.046).

CONCLUSIONS

Enteral nutrition-associated diarrhea was prevalent among STBI patients. Older STBI patients had a higher incidence of diarrhea and more risk factors than young patients. Early management of modifiable risk factors may help reduce the incidence of diarrhea.

Age and pupil size: key predictors of mortality in traumatic brain injury patients with GCS 3

This study investigates the relationship between mortality and specific clinical factors in patients with severe traumatic brain injury (TBI) who present with a Glasgow Coma Scale (GCS) score of 3. Data from 161 adult patients were collected from the Chi-Mei Medical Center in Taiwan, spanning 2010 to 2019. The findings revealed an overall mortality rate of 44.10%, with significant predictors of mortality identified as age and pupil size. The Spearman correlation analysis showed that both age and pupil sizes were positively correlated with mortality rates. Multiple logistic regression confirmed age and left pupil size as strong predictors of mortality. Patients with GCS 3 and both unreactive pupils measuring 4 mm or more experienced the highest mortality rate of 68.39%, while those with pupils less than 4 mm had a lower mortality rate of 32.26%. The study determined optimal cut-off values for age and pupil size using ROC and AUC analysis, highlighting the significance of age in mortality predictions. These findings underscore the critical role of age and pupil size in the prognosis of TBI patients and provide valuable guidance for clinicians managing such cases.

Natural products protect against spinal cord injury by inhibiting ferroptosis: a literature review

Spinal cord injury (SCI) is a severe traumatic condition that frequently results in various neurological disabilities, including significant sensory, motor, and autonomic dysfunctions. Ferroptosis, a recently identified non-apoptotic form of cell death, is characterized by the accumulation of reactive oxygen species (ROS), intracellular iron overload, and lipid peroxidation, ultimately culminating in cell death. Recent studies have demonstrated that ferroptosis plays a critical role in the pathophysiology of SCI, contributing significantly to neural cell demise. Three key cellular enzymatic antioxidants such as glutathione peroxidase 4 (GPX4), ferroptosis suppressor protein 1 (FSP1), and dihydroorotate dehydrogenase (DHODH), have been elucidated as crucial components in the defense against ferroptosis. Natural products, which are bioactive compounds mostly derived from plants, have garnered considerable attention for their potential therapeutic effects. Numerous studies have reported that several natural products can effectively mitigate neural cell death and alleviate SCI symptoms. This review summarizes fifteen natural products containing (-)-Epigallocatechin-3-gallate (EGCG), Proanthocyanidin, Carnosic acid, Astragaloside IV, Trehalose, 8-gingerol, Quercetin, Resveratrol, Albiflorin, Alpha-tocopherol, Celastrol, Hispolon, Dendrobium Nobile Polysaccharide, Silibinin, and Tetramethylpyrazine that have shown promise in treating SCI by inhibiting ferroptosis. Additionally, this review provides an overview of the mechanisms involved in these studies and proposes several perspectives to guide future research directions.

Genetic Confounding in the Association Between Traumatic Brain Injury and Mental Disorder or Suicide

Importance

Traumatic brain injury is common and occurs across all ages. Observational studies have shown that traumatic brain injury is associated with a wide range of mental disorders and suicide. Whether these associations represent a causal effect is, however, difficult to establish, and confounding by genetic liability for mental disorder may play a substantial role.

Objective

To investigate whether observational associations between traumatic brain injury and mental disorder or suicide could be confounded by genetic liability for mental disorder.

Design, Setting, and Participants

This cohort study was conducted from October 2023 to January 2025. The study population consisted of the general population subcohort of the Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH) sample, which is a representative sample of the Danish population born between 1981 and 2008 that has been genotyped.

Exposures

Polygenic risk scores (PRSs) for schizophrenia, bipolar disorder, depression, and attention-deficit/hyperactivity disorder (ADHD) calculated from the genotypes and genome-wide association summary statistics.

Main Outcomes and Measures

The primary outcome was traumatic brain injury, operationalized via hospital diagnoses. The associations between PRSs for schizophrenia, bipolar disorder, depression, and ADHD, respectively, and traumatic brain injury were examined via Cox proportional hazards regression, yielding hazard rate ratios (HRRs) with 95% confidence intervals.

Results

The final cohort consisted of a total of 40 274 individuals, of whom 19 802 (49.2%) were female. A total of 3341 (8.3%) of the cohort members (of whom 1464 [43.8%] were female and 1877 [56.2%] were male) experienced traumatic brain injury during follow-up. All 4 PRSs showed statistically significant positive associations with traumatic brain injury (PRS-schizophrenia: HRR, 1.06; 95% CI, 1.02-1.10; P = .002; PRS-bipolar disorder: HRR, 1.04; 95% CI, 1.00-1.08; P = .04; PRS-depression: HRR, 1.10; 95% CI, 1.06-1.14; P < .001; and PRS-ADHD: HRR, 1.12; 95% CI, 1.08-1.16; P < .001).

Conclusions and Relevance

The results of this cohort study suggest that confounding by genetic liability for mental disorder could explain some of the association between traumatic brain injury and mental disorder or suicide. Consequently, genetic liability for mental disorder should be factored into future studies of these associations to avoid overestimation of causality.

Modeling Spinal Cord Injury in a Dish with Hyperosmotic Stress: Population-Specific Effects and the Modulatory Role of Mesenchymal Stromal Cell Secretome

Innovations in spinal cord injury (SCI) models are crucial for developing effective therapies. This study introduces a novel in vitro SCI model using cultures of primary mixed spinal cord cells from rat pups, featuring key spinal cord cell types. This model offers distinct advantages in terms of feasibility, reproducibility, and cost-effectiveness, requiring only basic cell culture equipment. Following hyperosmotic stress via sorbitol treatment, the model recapitulated SCI pathophysiological hallmarks, with a 65% reduction in cell viability and gradual cell death over 48 h, making it ideal for evaluating neuroprotective agents. Notably, the human adipose tissue stem cell (hASC) secretome provided significant protection: it preserved metabolic viability, reduced β amyloid precursor protein (β-APP) expression in surviving neurons, and modulated the shift in the astrocytic morphotype. A transcriptomic profile of the effect of the hASC secretome treatment showed significant functional enrichments related to cell proliferation and cycle progression pathways. In addition to supporting the use of the hASC secretome as a therapy for SCI, this study is the first to use sorbitol as a hyperosmolar stressor to recapitulate key aspects of SCI pathophysiology. Thereby, this model can be used as a promising platform for evaluating therapeutic agents targeting neuroprotection and neuroregeneration, offering outputs related to cell death, neuronal stress, and protection, as well as induction of glial reactivity.

Effect of in vivo reprogramming of astrocytes combined with exercise training on neurorepair in rats with spinal cord injury

BACKGROUND

The inability of damaged neurons to regenerate and of axons to establish new functional connections leads to permanent functional deficits after spinal cord injury (SCI). Although astrocyte reprogramming holds promise for neurorepair in various disease models, it is not sufficient on its own to achieve significant functional recovery.

METHODS

A rat SCI model was established using a spinal cord impactor. Seven days postsurgery, adeno-associated virus were injected to overexpress the transcription factors NeuroD1 and Neurogenin-2 (Ngn2) in the spinal cord. The rats were then trained to walk on a weight-supported treadmill for 4 weeks, starting 14 days after modeling. The effects of these interventions on motor and sensory functions, as well as spinal cord tissue repair, were subsequently evaluated.

RESULTS

The combination of NeuroD1 and Ngn2 overexpression with weight-supported exercise training significantly improved gait compared to either intervention alone. The group receiving the combined intervention exhibited enhanced sensitivity in sensory assessments. Immunofluorescence analysis revealed increased colocalization of astrocytes and microtubule-associated protein 2-positive neurons in the injury area. These effects were more pronounced than those observed with spinal cord tissue repair alone. Additionally, the combined intervention significantly reduced glial scarring and the size of the injury area.

CONCLUSION

Exercise intervention enhances the reprogramming effects of astrocytes and restores motor function, yielding better results than either intervention alone.

Update on traumatic brain injury in the ICU

PURPOSE OF REVIEW

This review aims to summarize recent developments for the management of severe traumatic brain injury (TBI) in the ICU. Recent advancements in TBI ICU management emphasize a progression toward more multimodal approaches and mitigating secondary brain injury by increased focus on careful systemic management.

RECENT FINDINGS

Invasive monitoring techniques such as continuous intracranial pressure (ICP) and brain tissue oxygen pressure (PbtO 2 ) monitoring are considered standard of care or may become crucial, respectively, for managing severe TBI. Technological advances in noninvasive techniques (e.g. quantitative pupillometry) are likely to advance our diagnostic and prognostic ability. Blood biomarkers, including glial fibrillary acidic protein, neurofilament light chain, and ubiquitin carboxy-terminal hydrolase L1, provide minimally invasive ways to better assess injury severity and predict outcomes. These advancements support personalized care, which will likely influence clinical management strategies in the future.

SUMMARY

ICP monitoring remains a key component of severe TBI management in ICU. Emerging evidence is slowly changing and improving intensive care and patient outcomes and include both brain-targeted therapies and careful systemic intensive care management.

Effect of Engineered Cyanobacterial Capsules on a Neurogenic Bladder after Spinal Cord Injury

The presence of a neurogenic bladder is a severe but common complication of spinal cord injury (SCI). Multiple pathological factors, such as hypoxia, ischemia, and oxidative stress caused by SCI, promote M1 microglial polarization and the release of proinflammatory factors to amplify inflammation. An excessive inflammatory response stimulates the generation of reactive oxygen species (ROS) and induces oxidative stress to promote neuronal ferroptosis, thus leading to bladder dysfunction after SCI. Therefore, promoting the recovery of neural function by regulating the interaction between microglia and neurons is important. For this purpose, we developed an engineered immunoregulatory cyanobacterial capsule named siRNA@Cyanzyme, which consists of MnO2@zeolitic-imidazolate framework@cyanobacteria (Cyanzyme) and a small-interfering RNA targeting ACSL4 (siRNA-ACSL4). Cyanzyme reversed M1 microglial polarization via photosynthetic oxygen to promote anti-inflammatory factor release. MnO2 nanoenzymes grown on the surface of ZIF-8 eliminated excessive ROS to reduce oxidative stress. Moreover, Cyanzyme increased the delivery efficiency of siRNA-ACSL4, which is a key regulator of ferroptosis. Both treatments alleviated GABAergic neuron damage to mitigate bladder dysfunction. Our data demonstrated that siRNA@Cyanzyme effectively reversed M1 microglial polarization, reduced neuronal ferroptosis, and ultimately restored neurogenic bladder function.

An interpretable machine learning model based on optimal feature selection for identifying CT abnormalities in patients with mild traumatic brain injury

Background

Minor head trauma is a frequent cause of emergency department visits, early identification and prediction of mild traumatic brain injury (mTBI) patients with abnormal brain lesions are vital for minimizing unnecessary computed tomography (CT) scans, reducing radiation exposure, and ensuring timely effective treatment and care. This study aims to develop and validate an interpretable machine learning (ML) prediction model using routine laboratory data for guiding clinical decisions on CT scan use in mTBI patients.

Methods

We conducted a multicentre study in China including data from January 2019 to July 2024. Our study included three patient cohorts: a retrospective training cohort (654 patients for training and 163 for internal testing) and two prospective validation cohorts (86 internal and 290 external patients). Fifty-one routine clinical laboratory characteristics, readily available from the electronic medical record (EMR) system within the first 24 h of admission, were collected. Seven ML algorithms were trained to develop predictive models, with the random forest (RF) algorithm used to optimize key feature combinations. Model predictive performance was evaluated using metrics such as the area under the receiver operating characteristic curve (AUC), positive predictive value (PPV), and F1 scores. The SHapley Additive exPlanation (SHAP) was applied to interpret the final model, while decision curve analysis (DCA) was used to assess the clinical net benefit.

Findings

In the derivation cohort, 599 (73.3%) patients had normal CT scans and 218 (26.7%) had abnormal CT scans. The Gradient boosting classifier (GBC) model performed best among the seven ML models, with an AUC of 0.932 (95% CI: 0.900-0.963). After reducing features to 21 (8 biochemical test indicators, 3 coagulation markers, and 10 complete blood cell count indicators) according to feature importance rank, an explainable GBC-final model was established. The final model accurately predicted mTBI patients with abnormal CT in both internal (AUC 0.926, 95% CI: 0.893-0.958) and external (AUC 0.904, 95% CI: 0.835-0.973) validation cohorts. In the prospective cohort, final GBC model achieved AUC of 0.885 (95% CI: 0.753-1.000) and was significantly superior to traditional TBI biomarkers GFAP (AUC: 0.745) and PGP9.5 (AUC: 0.794). DCA revealed that the final model offered greater net benefits than "full intervention" or "no intervention" strategies within a probability threshold range of 0.16-0.93. SHAP analysis identified D-dimer levels, absolute lymphocyte and neutrophil counts, and hematocrit as key high-risk features.

Interpretation

Our optimal feature selection-based ML model accurately and reliably predicts CT abnormalities in mTBI patients using routine test data. By addressing clinicians' concerns regarding transparency and decision-making through SHAP and DCA analyses, we strengthen the potential clinical applicability of our ML model.

Funding

The Natural Science Foundation of Hubei Province, high-level Talent Research Startup Funding of Hubei University of Chinese Medicine, Wuhan Health and Family Planning Scientific Research Fund Project of Hubei Province, and Machine Learning-based Intelligent Diagnosis System for AFP-negative Liver Cancer Project.

Variation in Arterial CO2 is a Stronger Determinant of Brain Tissue Oxygenation Than its Synchronous Value in Critically Ill Patients With Acute Brain Injury

OBJECTIVES

In critically ill patients with acute brain injury (ABI), maintaining intracranial pressure (ICP) and brain tissue oxygenation (PbtO2) within targets could prevent secondary neurologic injury. Tight control of CO2 (Paco2), a potent regulator of cerebrovascular tone, is generally advocated, but its vasomotor effect may be short-lived. Our aim was to compare the effect of the synchronous Paco2 vs. its variation from a previous baseline on PbtO2 and ICP.

DESIGN

We performed a post hoc analysis of a prospective cohort study collecting arterial blood gas (ABG) values alongside synchronous neuromonitoring variables. Linear mixed-effects models were fitted to evaluate the association between Paco2 and/or Paco2 variation from its average of the last 8-24 hr vs. PbtO2 and ICP, while controlling for cerebral perfusion pressure and Pao2.

SETTING

Mixed medical-surgical ICU of Sacré-Coeur Hospital, an academic trauma center in Montreal, Canada.

PATIENTS

All consecutive adult patients admitted for ABI with ICP and PbtO2 monitoring between May 2017 and November 2021.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We included 78 patients with 3047 ABG-neuromonitoring couplets. The model using the variation of Paco2 from its average of the last 24 hr displayed the best performance for the prediction of PbtO2 (coefficient 0.37; 95% CI 0.21-0.53). The strongest predictor of ICP was the variation of Paco2 from its average of the last 8 hr (coefficient 0.17; 95% CI 0.10-0.23).

CONCLUSIONS

Variation in Paco2 from baseline is a more significant determinant of PbtO2 and ICP than the absolute Paco2 value at a given time. There may be a baseline vasomotor reset when patients are exposed to a given level of CO2 for 8 to 24 hr. Therefore, sustained intentional manipulation of Paco2 is unlikely to have lasting effects and slower correction rates of high or low Paco2 could help prevent brain tissue hypoxia or intracranial hypertension, respectively.

Home, but Homebound After Traumatic Brain Injury: Risk Factors and Associations With Nursing Home Entry and Death

OBJECTIVE

To examine risk factors associated with homeboundness 1-year after traumatic brain injury (TBI) and to explore associations between homebound status and risk of future mortality and nursing home entry.

DESIGN

Secondary analysis of a longitudinal prospective cohort study.

SETTING

TBI Model Systems centers.

PARTICIPANTS

Community-dwelling TBI Model Systems participants (n=6595) who sustained moderate-to-severe TBI between 2006 and 2016, and resided in a private residence 1-year postinjury.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Homebound status (leaving home ≤1-2d per week), 5-year mortality, and 2- or 5-year nursing home entry.

RESULTS

In our sample, 14.2% of individuals were homebound 1-year postinjury, including 2% who never left home. Older age, having less than a bachelor's degree, Medicaid insurance, living in the Northeast or Midwest, dependence on others or special services for transportation, unemployment or retirement, and needing assistance for locomotion, bladder management, and social interactions at 1-year postinjury were associated with being homebound. After adjustment for potential confounders and an inverse probability weight for nonrandom attrition bias, being homebound was associated with a 1.69-times (95% confidence interval, 1.35-2.11) greater risk of 5-year mortality, and a nonsignificant but trending association with nursing home entry by 5 years postinjury (RR=1.90; 95% confidence interval, 0.94-3.87). Associations between homeboundness and mortality were consistent by age subgroup (±65y).

CONCLUSIONS

The negative long-term health outcomes among persons with TBI who rarely leave home warrants the need to re-evaluate home discharge as unequivocally positive. The identified risk factors for homebound status, and its associated negative long-term outcomes, should be considered when preparing patients and their families for discharge from acute and postacute rehabilitation care settings. Addressing modifiable risk factors for homeboundness, such as accessible public transportation options and home care to address mobility, could be targets for individual referrals and policy intervention.

Changes in lifespace and participation in community-based occupations of people with acquired brain injury: A mixed methods exploration 6 months following occupational therapy driving assessment

INTRODUCTION

Changes arising from acquired brain injury may influence how individuals engage in valued community-based occupations such as driving. 'Lifespace' describes the area within which a person lives their life and represents opportunity for participation in out-of-home occupations. This study explored lifespace trajectory from pre- to 6 months post-occupational therapy driver assessment, to understand how, why, where, and with whom access and participation in community-based occupations is influenced by assessment outcome.

METHODS

Adults with acquired brain injury referred for occupational therapy driver assessment were recruited to the mixed methods study involving a travel diary, lifespace assessment, and semi-structured interviews. Qualitative analysis was guided by interpretive description.

CONSUMER AND COMMUNITY INVOLVEMENT

No consumer and community involvement RESULTS: Overall, 38 participants (55.3% male) aged 26 to 65 years reported increased lifespace 6 months following the conduct of an occupational therapy driver assessment. There was increased engagement in leisure pursuits (175%), work (23%), and social participation (21%) with reduced participation in health management (-50%) and instrumental activities of daily living (-15.4%) occupations post-OTDA. However, lifespace was significantly related to driver status, with those who had returned to driving more likely to access their community with greater frequency and less support (p < 0.001). Non-drivers experienced a deteriorating restricted lifespace. Analysis of semi-structured interviews (n = 12) created three broad themes that largely differed according to driver status: (i) 'Being me'-reconstructing occupational identity, (ii) opportunities for participation and the influence of choice, and (iii) 'Having connection' and impacts on wellbeing.

CONCLUSION

Driver status influences the trajectory of lifespace following participation in an occupational therapy driver assessment after acquired brain injury. Drivers experienced increased lifespace with greater opportunities to control engagement in community-based occupations with flexibility and spontaneity. Non-drivers reported diminished lifespace and occupational participation trajectories and require further support to facilitate occupational adaptation to increase opportunities for engagement in away-from-home occupations.

PLAIN LANGUAGE SUMMARY

After an acquired brain injury (ABI), many people find it harder to go out and do activities away from home. A common change is losing the ability to drive. An occupational therapy driver assessment (OTDA) checks if someone is ready to drive again. This study looked at how getting back to driving, or not, affected involvement in community activities. People who returned to driving reported doing more activities, more often, and with less help. They spent more time on leisure, work, and social activities. Those who did not drive went out less, visited fewer places, and relied more on others. When they did go out, it was mostly for essential tasks like shopping and health appointments. For those not able to drive, extra services and supports are needed to help build skills. This is the first study to look at how driving is connected to taking part in community activities after a brain injury. More research is needed to confirm findings.

Transcription factor AP-2 Beta, a potential target of repetitive Transspinal magnetic stimulation in spinal cord injury treatment, reduced inflammation and alleviated spinal cord injury

Spinal cord injury (SCI) is a neurodegenerative disease, with a high disability rate. According to the results of mRNA-seq, transcription factor AP-2 Beta (TFAP2B) is a potential target of repetitive Transspinal Magnetic Stimulation (rTSMS) in SCI treatment. Our results demonstrated that rTSMS significantly improved motor function and promoted neuronal survival post-SCI. The result showed that TFAP2B was downregulated following SCI, while significant upregulation after rTSMS treatment, suggesting its pivotal role in neuronal repair. Overexpression of TFAP2B improved Basso Beattie and Bresnahan (BBB) score and athletic ability, and decreased cell apoptosis in SCI rats. Additionally, overexpression of TFAP2B reduced the expression of Iba1 and GFAP in spinal cord, and the expression of PDGFrβ was also reduced in SCI rats after TFAP2B overexpression. Knockdown of TFAP2B reverses the effect of rTSMS treatment in SCI. We found that rTSMS alleviate osteoporosis caused by SCI, resulting in increased BMD, BV/TV, and Tb.Th. rTSMS treatment lowered the RANKL/OPG ratio. In all, our study illustrated TFAP2B is a downstream target of rTSMS for the treatment of SCI, and overexpression of TFAP2B enhanced the therapeutic effect of rTSMS.

Benzbromarone improves blood hypercoagulability after TBI by reducing phosphatidylserine externalization through inhibition of TMEM16F expression

AIMS

Traumatic brain injury-induced coagulopathy (TBI-IC) frequently occurs after TBI, exacerbating the severity of TBI and affecting patient prognosis. Benzbromarone (BBR) is commonly used to treat hyperuricemia; however, its protective effects against TBI-IC remain unknown. Therefore, we explored whether BBR could improve TBI.

MATERIALS AND METHODS

C57BL/6 wild-type mice were subjected to fluid percussion injury to mimic TBI, and BBR was administered intraperitoneally 30 min after TBI. Magnetic resonance imaging (MRI) and Evans blue dye extravasation were used to assess the prognosis, tail bleeding time, ELISA, and coagulation tests assess coagulation function. We further explored the potential mechanism by which BBR alleviates hypercoagulation after TBI using flow cytometry.

KEY FINDINGS

The intraperitoneally injected BBR group showed improved survival and neurological severity scores compared to the TBI group. Subsequently, we found that hypercoagulability developed 3 h after TBI and that the administration of BBR improved this hypercoagulability. BBR also reduced the degree of platelet phosphatidylserine (PS) exposure after TBI, platelet activation, and Ca2+ overload, in addition to inhibition of scramblase activity in procoagulant platelets.

SIGNIFICANCE

Our findings indicate that BBR reduces PS externalization by inhibiting TMEM16F expression, thereby improving blood hypercoagulability after TBI.

Global Burden of Traumatic Brain Injury in 204 Countries and Territories From 1990 to 2021

INTRODUCTION

This study aimed to evaluate the burden and underlying causes of traumatic brain injury (TBI) in 204 countries and territories from 1990 to 2021.

METHODS

Utilizing data from the Global Burden of Disease 2021 study, which derived estimates of TBI burden from hospital and emergency department records, national surveys, and claims data, the incidence, prevalence, and years lived with disability (YLDs) associated with TBI were analyzed. A comparative analysis of TBI burden by location, age, sex, and sociodemographic index was performed, along with an underlying assessment of 15 major causes contributing to age-standardized incidence rates. Analyses were conducted in 2024.

RESULTS

In 2021, there were 20.84 million (95% uncertainty interval [UI]=18.13, 23.84) incident cases and 37.93 million (95% UI=36.33, 39.77) prevalent cases of TBI globally, resulting in 5.48 million (95% UI=3.87, 7.33) YLDs. While the absolute number increased from 1990 to 2021, age-standardized rates of TBI incidence, prevalence, and YLDs showed a significant decline. These rates generally increased with age and were higher in males than females. The highest age-standardized prevalence and YLD rates were observed in Eastern and Central Europe. Globally, falls were the leading cause of TBI in 2021, followed by road injuries, interpersonal violence, and exposure to mechanical forces.

CONCLUSIONS

Despite declines in age-standardized rates, the total number of TBI cases and associated disabilities has risen since 1990, indicating a persistent global burden. Targeted interventions are urgently needed in high-burden regions like Eastern and Central Europe, with focus on leading causes and vulnerable populations.

ISMRM Clinical Focus Meeting 2023: "Imaging the Fire in the Brain"

Set during the Annual Meeting of the International Society for Magnetic Resonance in Medicine (ISMRM), the "Clinical Focus Meeting" (CFM) aims to bridge the gap between innovative magnetic resonance imaging (MRI) scientific research and daily patient care. This initiative is dedicated to maximizing the impact of MRI technology on healthcare outcomes for patients. At the 2023 Annual Meeting, clinicians and scientists from across the globe were invited to discuss neuroinflammation from various angles (entitled "Imaging the Fire in the Brain"). Topics ranged from fundamental mechanisms and biomarkers of neuroinflammation to the role of different contrast mechanisms, including both proton and non-proton techniques, in brain tumors, autoimmune disorders, and pediatric neuroinflammatory diseases. Discussions also delved into how systemic inflammation can trigger neuroinflammation and the role of the gut-brain axis in causing brain inflammation. Neuroinflammation arises from various external and internal factors and serves as a vital mechanism to mitigate tissue damage and provide neuroprotection. Nonetheless, excessive neuroinflammatory responses can lead to significant tissue injury and subsequent neurological impairments. Prolonged neuroinflammation can result in cellular apoptosis and neurodegeneration, posing severe consequences. MRI can be used to visualize these consequences, by detecting blood-brain barrier damage, characterizing brain lesions, quantifying edema, and identifying specific metabolites. It also facilitates monitoring of chronic changes in both the brain and spinal cord over time, potentially leading to better patient outcomes. This paper represents a summary of the 2023 CFM, and is intended to guide the enthusiastic MR user to several key and novel sequences that MRI offers to image pathophysiologic processes underlying acute and chronic neuroinflammation. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 3.

Incidence and mortality related risk factors in patients with severe traumatic brain injury: A meta‑analysis

The present study aimed to clarify the onset of traumatic brain injury (TBI) and identify mortality-related risk factors in patients with severe TBI, to enable the early identification of high-risk individuals and timely implementation of prevention and treatment strategies to minimize mortality rates. Comprehensive database searches were conducted across Web of Science, PubMed, CINAHL and EMBASE, covering publications from database inception until October 17, 2023. Search terms in English included 'head trauma', 'brain trauma', 'mortality', 'death' and 'risk factor'. In total, two independent researchers screened and extracted the data on mortality onset and associated risk factors in patients with severe TBI. Meta-analysis was performed using R 4.2.2. A total of 33 cohort studies, including 71,718 patients with severe TBI, were selected for meta-analysis. The data indicated an overall mortality rate of 27.8% (95%CI: 22.5-33.2%) from database inception until October 17, 2023. Subgroup analysis revealed a mortality rate of 25.2% (95%CI: 20.2-30.1%) in developed countries, compared with 38.0% (95%CI: 21.4-54.7%) in developing countries. Additionally, the mean age of deceased patients was significantly higher compared with that of survivors (41.53±16.47). Key risk factors found to be associated with mortality included anemia [relative risk (RR), 1.42; 95%CI, 1.04-1.93], diabetes mellitus (RR, 1.40; 95%CI, 1.00-1.96), coagulopathy (RR, 4.31; 95%CI, 2.31-8.05), shock (RR, 3.41; 95%CI, 2.31-5.04) and systolic blood pressure≤90 mmHg (RR, 2.32; 95%CI, 1.65-3.27). Furthermore, pre-hospital intubation (RR, 1.48; 95%CI, 1.13-1.92),hypotension (RR, 2.04; 95%CI: 1.58, 2.63), hypoxemia (RR, 1.42; 95%CI: 1.13, 1.79), subdural hemorrhage (RR, 1.99; 95%CI: 1.50, 2.62), subarachnoid hemorrhage (RR, 1.64; 95%CI: 1.09, 2.47) and subdural hematoma (SDH; RR, 1.50; 95%CI: 1.04, 2.17). was identified to be a significant risk factor during hospitalization treatment. These results suggest that various factors, such as age, anemia, diabetes, shock, hypotension, hypoxemia, trauma scores and brain injury types, can all contribute to mortality risk in patients with severe TBI. Addressing these risk factors will likely be important for reducing mortality in this patient population.

Factors influencing on functional independence outcomes after hospitalization and rehabilitation in children with spinal cord injury

OBJECTIVE

This study is to investigate the factors that influence functional autonomy outcomes in children who have undergone rehabilitation for spinal cord injury. The aim is to enhance the clinical guidance provided to inpatients at the China Rehabilitation Research Center, Beijing Bo-ai Hospital. Furthermore, the objective is to optimize rehabilitation interventions and establish a scientific basis.

METHODS

This study employed a retrospective survey method for data collection and analysis. Descriptive analysis, one-way ANOVA analysis, and Multiple logistic regression analysis were utilized to examine the influencing factors associated with the prognosis of functional independence outcomes in children with SCI. The degree of influence of each independent variable on functional independence outcomes was ultimately determined.

RESULTS

The total score of SCIM-III at admission was 41.48 ± 4.089, and the total score of SCIM-III at discharge was 50.05 ± 25.028, resulting in a significant difference in the total score of SCIM-III was (8.57 ± 7.000, p < 0.001).In one-way ANOVA analysis, Self-care: injury segments, damage plane, ASIA, assistive devices, complications, rehabilitation duration treatment, WISCI-II, UEMS and LEMS, BI, and 6WMD groups were statistically significant (p < 0.001). Respiratory and sphincter management: injury segments, ASIA, complications, injury to recovery time interval, rehabilitation duration treatment, WISCI-II, UEMS and LEMS, BI, and 6WMD groups were statistically significant (p < 0.05). Move: age, injury segments, damage plane, rehabilitation duration treatment, WISCI-II, UEMS and LEMS groups were statistically significant (p < 0.05). SCIM-III total score: age, AISA, assistive devices, injury to recovery time interval, rehabilitation duration treatment were statistically significant (p < 0.05). Multiple logistic regression analysis, revealed that the injury to recovery time interval had a negative correlation with the total difference in SCIM-III scale (t = -9.893, p < 0.001; 95%CI-12.006~-7.780), while the duration of rehabilitation treatment (t = 4.245, p < 0.001, 95%CI 2.636 ~ 5.854) had a positive correlation with different age groups (t = 4.002, p < 0.001, 95%CI 2.421 ~ 5.583).

CONCLUSION

The shorter the interval between the time of spinal cord injury and the time of intervention for rehabilitation, the more favorable the functional recovery of the children. Children with SCI who were hospitalized for rehabilitation and achieved 3-month daily functional independence scores were more successful. It is recommended that rehabilitation interventions for children with SCI in this institution should be initiated as early as possible and maintained over time. Among the subjects, the prognosis of functional independence was more favorable in the school-age group (6-18y) than in the preschool group (3-6 y).

Brain-derived neurotrophic factor (BDNF) as biomarker in stem cell-based therapies of preclinical spinal cord injury models: A systematic review

Stem cell-based therapies offer promising treatment for spinal cord injury (SCI) by reducing inflammation, restoring plasticity, and supporting neuroprotection and nerve regeneration. Brain-derived neurotrophic factor (BDNF) is crucial in SCI pathophysiology. This study reviews the impact of stem cells on BDNF expression in preclinical SCI models. A thorough search was performed in PubMed, Scopus, and Web of Science until June 2023, identifying studies on the effects of stem cells on BDNF in SCI. Two researchers reviewed and extracted data from relevant studies. This review is registered in the Prospective Register of Systematic Reviews (PROSPERO) with the registration number [CRD42023441466]. Out of 923 records, 51 studies met the inclusion criteria, involving rats (46 studies) and mice (5 studies). The contusion or compression model was used in 40 studies, and the transection model in 11. The most common stem cell types were bone marrow mesenchymal stem cells (BM-MSCs), neural stem cells (NSCs), and adipose-derived stem cells (ADSCs). BM-MSCs increased BDNF expression in 16 studies, NSCs in 9 studies, and ADSCs in only one study. This review highlights that BM-MSCs and NSCs are effective in enhancing BDNF expression in preclinical SCI models, while other stem cell types may not significantly affect BDNF levels. These findings suggest variability in the effectiveness of different stem cell therapies in modulating BDNF production for SCI treatment.

Burden of falls in China, 1992-2021 and projections to 2030: a systematic analysis for the global burden of disease study 2021

Background

The escalating burden of falls in China necessitates a detailed examination to elucidate its dynamics and trends. Using data from the Global Burden of Disease Study (GBD) 2021, this research assessed the burden of falls in China.

Methods

Data from GBD 2021 were analyzed using Joinpoint regression to identify long-term trends. The impact of mortality and disability-adjusted life years (DALYs) rate for falls was investigated through the age-period-cohort model. Additionally, a decomposition analysis was performed to ascertain the distinct impacts of population growth, aging, and epidemiological changes on the burden of falls from 1992 to 2021. Furthermore, this study employed both the BAPC and Nordpred models to project future burdens of falls.

Results

From 1992 to 2021 in China, the age-standardized rates of falls showed divergent trends. Prevalence and incidence rates increased, while mortality rates generally decreased. Males consistently exhibited higher rates than females. The rates of prevalence, incidence, and mortality exhibit a sharp increase beyond the age of 75 in 2021. Decomposition analysis identified aging as the primary driver of increased prevalence and mortality, particularly in females. Joinpoint regression analysis revealed fluctuating trends in prevalence and incidence with periods of increase and decline, and a general decrease in mortality except during brief intervals. DALYs and years of life lost (YLLs) rates generally decreased, with intervals of stabilization and minor increases, while years lived with disability (YLDs) showed significant fluctuations. By 2030, the projected DALYs rate for falls is expected to rise to approximately 547.4 per 100,000. Fractures of the lower extremity predominated as the leading cause of disability post-fall, with hip fractures increasingly contributing to disability among the older adult. Additionally, from 1992 to 2021, the population attributable fraction (PAF) of low bone mineral density for DALYs due to falls increased to 23.2%, with the PAF reaching 33.3% among women in 2021.

Conclusion

Falls continue to significantly burden public health in China. Our findings highlight the urgent need to develop targeted prevention and intervention strategies that cater to the country's unique demographic characteristics, aiming to mitigate the growing public health impact of falls.

Efficacy of Neurorehabilitation Approaches in Traumatic Brain Injury Patients: A Comprehensive Review

Traumatic brain injury (TBI) represents a significant public health issue, causing long-term disabilities and imposing considerable socioeconomic and healthcare challenges. While advancements in acute care have improved survival rates, the demand for effective neurorehabilitation is increasing. This narrative review explores the evidence on neurorehabilitation strategies for TBI, focusing on interventions targeting cognitive, motor, and psychological recovery. A total of 32 studies were included and categorized into six approaches: non-invasive brain stimulation, virtual reality (VR), computer-based training, telerehabilitation, robot-assisted therapy (RAT), and mixed approaches. Non-invasive brain stimulation techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), showed variable effectiveness in improving cognitive outcomes. VR-based therapies enhanced attention and executive functions, while RAT, such as Lokomat and exoskeletons, improved gait symmetry and functional mobility. Computer-assisted programs demonstrated benefits in rehabilitating social cognition and executive functions. Telerehabilitation and telephone-based treatments provided short-term gains but lacked sustained effects. Overall, cognitive improvements were better described and represented, while several motor improvements lacked consistency. Despite the promising results, significant gaps remain, including heterogeneity in methodologies, small sample sizes, and limited long-term outcome data.

Functional Outcome of Adult Traumatic Brain Injury Patients Treated by Decompressive Craniectomy in an Ethiopian Trauma Center

OBJECTIVE

To describe the long-term functional outcome of traumatic brain injury (TBI) patients treated by decompressive craniectomy (DC).

METHODS

Data was collected on decompressive craniectomy performed on TBI patients admitted between May 1, 2018, and May 1, 2021, using a multi-center, cross-sectional study design. The long-term outcomes of survivors were assessed using a structured extended Glasgow Outcome Scale (GOSE) questionnaire. Descriptive statistics, including frequency, mean, median, and range, were analyzed. Predictors of functional outcomes were determined using multivariate regression analyses.

RESULTS

In this study, 74 patients were examined. The mean age at the time of DC was 33.9 years, with a male:female ratio of 11:1. Primary DC was performed in 93.2% of cases. The in-hospital and overall mortality rates were 24.3% and 36.5% respectively. Overall, a favorable functional outcome (GOSE ≥4) was witnessed in 43 patients (58.1%). Among survivors, 91.5% had favorable outcomes. Age ≥40 years, Glasgow Coma Scale (GCS) score ≤5, chest infections, and noninfectious complications were independent predictors of an unfavorable functional outcome (GOSE<4). Patients with GCS ≤5 fared the worst, with an unfavorable functional outcome rate of 85.7%.

CONCLUSIONS

Our results showed that a significant number of our patients had favorable functional outcome after DC for TBI comparable to results from high-income countries. We found that age, admission GCS, postoperative chest infection, and noninfectious complications were all independent factors predicting unfavorable functional outcome. In particular, patients with GCS ≤5 had a higher rate of mortality and unfavorable outcome.

AI-assisted decision-making in mild traumatic brain injury

OBJECTIVE

This study evaluates the potential use of ChatGPT in aiding clinical decision-making for patients with mild traumatic brain injury (TBI) by assessing the quality of responses it generates for clinical care.

METHODS

Seventeen mild TBI case scenarios were selected from PubMed Central, and each case was analyzed by GPT-4 (March 21, 2024, version) between April 11 and April 20, 2024. Responses were evaluated by four emergency medicine specialists, who rated the ease of understanding, scientific adequacy, and satisfaction with each response using a 7-point Likert scale. Evaluators were also asked to identify critical errors, defined as mistakes in clinical care or interpretation that could lead to morbidity or mortality. The readability of GPT-4's responses was also assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level tools.

RESULTS

There was no significant difference in the ease of understanding between responses with and without critical errors (p = 0.133). However, responses with critical errors significantly reduced satisfaction and scientific adequacy (p < 0.001). GPT-4 responses were significantly more difficult to read than the case descriptions (p < 0.001).

CONCLUSION

GPT-4 demonstrates potential utility in clinical decision-making for mild TBI management, offering scientifically appropriate and comprehensible responses. However, critical errors and readability issues limit its immediate implementation in emergency settings without oversight by experienced medical professionals.