Comparative Efficacy of High-Intensity Training Versus Conventional Training in Individuals With Chronic Traumatic Brain Injury: A Pilot Randomized Controlled Study

高强度训练与常规训练对慢性创伤性脑损伤患者的疗效比较: 一项初步随机对照研究

The purpose of this blinded-assessor randomized trial was to evaluate the effects of HIT focused on stepping practice versus conventional training on walking and secondary outcomes in individuals with TBI. The present study suggests that the amount and intensity of stepping practice may be important determinants of improved locomotor outcomes in patients with chronic TBI, with possible secondary benefits on aerobic capacity/efficiency and cognition.

这项盲法评估者随机试验的目的是评估HIT专注于步行练习与常规训练对TBI患者步行和次要结局的影响。本研究表明，行走练习的数量和强度可能是改善慢性TBI患者运动结果的重要决定因素，可能对有氧能力和认知能力有益处。

REF: Plawecki A, Henderson CE, Lotter JK, et al. Comparative Efficacy of High-Intensity Training Versus Conventional Training in Individuals With Chronic Traumatic Brain Injury: A Pilot Randomized Controlled Study. J Neurotrauma. 2024;41(7-8):807-817. doi:10.1089/neu.2023.0494 PMID: 38204184

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White Matter Organization and Cortical Thickness Differ Among Active Duty Service Members With Chronic Mild, Moderate, and Severe Traumatic Brain Injury

患有慢性轻度，中度和重度创伤性脑损伤的现役军人的白质组织和皮质厚度不同

This study compared findings from whole-brain diffusion tensor imaging (DTI) and volumetric magnetic resonance imaging (MRI) among 90 Active Duty Service Members with chronic mild traumatic brain injury (TBI; n = 52), chronic moderate-to-severe TBI (n = 17), and TBI-negative controls (n = 21). The results provide support for the use of DTI and volumetric MRI to identify differences in white matter microstructure and volume related to TBI. In particular, DTI FA pothole analysis may provide greater sensitivity for detecting subtle forms of white matter injury than conventional DTI FA analyses.

这项研究比较了90名现役军人的全脑弥散张量成像 (DTI) 和磁共振成像 (MRI) 的结果，这些现役军人患有慢性轻度创伤性脑损伤 (TBI; n = 52)，慢性中度至重度TBI (n = 17)，和TBI阴性对照 (n = 21)。结果为使用DTI和MRI识别与TBI相关的白质微观结构和体积的差异提供了支持。DTI FA pothole分析可以提供比常规DTI FA分析更高的灵敏度来检测细微形式的白质损伤。

REF: Gimbel SI, Hungerford LD, Twamley EW, Ettenhofer ML. White Matter Organization and Cortical Thickness Differ Among Active Duty Service Members With Chronic Mild, Moderate, and Severe Traumatic Brain Injury. J Neurotrauma. 2024;41(7-8):818-835. doi:10.1089/neu.2023.0336 PMID: 37800726 PMCID: PMC11005384

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Higher Regional Gray Matter Volume and White Matter Integrity in Individuals With Central Neuropathic Pain After Spinal Cord Injury

脊髓损伤后中枢神经性疼痛患者的区域灰质体积和白质完整性较高

Spinal cord injury (SCI) is a debilitating neurological condition that often leads to central neuropathic pain (CNP). As the fundamental mechanism of CNP is not fully established, its management is one of the most challenging problems among people with SCI. To shed more light on CNP mechanisms, the aim of this cross-sectional study was to compare the brain structure between individuals with SCI and CNP and those without CNP by examining the gray matter (GM) volume and the white matter (WM) integrity. The results suggest that the existence of CNP following SCI is associated with GM and WM structural abnormalities in regions involved in pain intensification and spread, and which may reflect maladaptive neural plasticity in CNP.

脊髓损伤 (SCI) 是一种使人衰弱的神经系统疾病，通常会导致中枢神经性疼痛 (CNP)。由于CNP的基本机制尚未完全建立，其管理是SCI人群中最具挑战性的问题之一。为了进一步阐明CNP机制，这项横断面研究的目的是通过检查灰质 (GM) 体积和白质 (WM) 来比较患有SCI中出现CNP的个体与没有CNP的个体之间的大脑结构完整性。结果表明，SCI后CNP的存在与疼痛加剧和扩散区域的GM和WM结构异常有关，这可能反映了CNP的神经可塑性。

REF: Livny A, Golan Y, Itzhaki N, et al. Higher Regional Gray Matter Volume and White Matter Integrity in Individuals With Central Neuropathic Pain After Spinal Cord Injury. J Neurotrauma. 2024;41(7-8):836-843. doi:10.1089/neu.2023.0146 PMID: 37937697

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Spatial Hotspots and Sociodemographic Profiles Associated With Traumatic Brain Injury in Nova Scotia

新斯科舍省与创伤性脑损伤相关的空间热点和社会人口统计学特征

Traumatic brain injury (TBI) is a leading cause of death and disability, primarily caused by falls and motor vehicle collisions (MVCs). Although many TBIs are preventable, there is a notable lack of studies exploring the association of geographically defined TBI hotspots with social deprivation. Geographic information systems (GIS) can be used to identify at-risk neighborhoods (hotspots) for targeted interventions. This study aims to determine the spatial distribution of TBI by major causes and to explore the sociodemographic and economic characteristics of TBI hotspots and cold spots in Nova Scotia. The findings provide valuable insights for public health officials to design targeted injury prevention strategies in high-risk areas.

创伤性脑损伤 (TBI) 是死亡和残疾的主要原因，主要由跌倒和机动车碰撞 (mvc) 引起。尽管许多TBI是可以预防的，但明显缺乏探索地理定义的TBI热点与社会剥夺之间关系的研究。地理信息系统 (GIS) 可用于识别有风险的社区 (热点)，以进行有针对性的干预。本研究旨在通过主要原因确定TBI的空间分布，并探讨新斯科舍省TBI热点和冷点的社会人口和经济特征。研究结果为公共卫生官员在高风险地区设计有针对性的伤害预防策略提供了宝贵的见解。

REF: Kureshi N, Abidi SSR, Clarke DB, Zeng W, Feng C. Spatial Hotspots and Sociodemographic Profiles Associated With Traumatic Brain Injury in Nova Scotia. J Neurotrauma. 2024;41(7-8):844-861. doi:10.1089/neu.2023.0257 PMID: 38047531

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Longitudinal Associations Between Persistent Post-Concussion Symptoms and Blood Biomarkers of Inflammation and CNS-Injury After Mild Traumatic Brain Injury

轻度创伤性脑损伤后持续性脑震荡后症状与炎症和中枢神经系统损伤的血液生物标志物之间的纵向关联

The aim of our study was to investigate the biological underpinnings of persistent post-concussion symptoms (PPCS) at 3 months following mild traumatic brain injury (mTBI). We demonstrate a role of biological factors on PPCS, including both positive and negative effects of inflammation biomarkers that differed based on sampling time-point after mTBI. PPCS was associated more with acute inflammatory processes, rather than ongoing inflammation or CNS-injury biomarkers. However, the modest discriminative ability of the models suggests other factors are more important in the development of PPCS.

我们研究的目的是调查轻度创伤性脑损伤 (mTBI) 后3个月持续性脑震荡后症状 (ppc) 的生物学基础。我们证明了生物因素对ppc的作用，包括炎症生物标志物的正面和负面影响，其基于mTBI后的采样时间点而不同。PPCS更多地与急性炎症过程相关，而不是持续的炎症或CNS损伤生物标志物。但是，模型的适度区分能力表明其他因素在ppc的发展中更为重要。

REF: Clarke GJB, Skandsen T, Zetterberg H, et al. Longitudinal Associations Between Persistent Post-Concussion Symptoms and Blood Biomarkers of Inflammation and CNS-Injury After Mild Traumatic Brain Injury. J Neurotrauma. 2024;41(7-8):862-878. doi:10.1089/neu.2023.0419 PMID: 38117157

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Dynamic Dysregulation of the Triple Network of the Brain in Mild Traumatic Brain Injury and Its Relationship With Cognitive Performance

轻度创伤性脑损伤中脑三重网络的动态失调及其与认知功能的关系

A triple network model consisting of a default network, a salience network, and a central executive network has recently been used to understand connectivity patterns in cognitively normal versus dysfunctional brains. This study aimed to explore changes in the dynamic connectivity of triplet network in mild traumatic brain injury (mTBI) and its relationship to cognitive performance. Taken together, our findings suggest that the dynamic properties of FC in the triple network of mTBI patients are abnormal, and provide a new perspective on the pathophysiological mechanism of cognitive impairment from the perspective of dynamic FC.

最近，由默认网络，突显网络和中央执行网络组成的三重网络模型已用于理解认知正常与功能失调的大脑中的连接模式。本研究旨在探讨轻度创伤性脑损伤 (mTBI) 患者三重网络动态连接的变化及其与认知功能的关系。总之，我们的研究结果表明mTBI患者三重网络中FC的动态特性异常，并从动态FC的角度为认知障碍的病理生理机制提供了新的视角。

REF: Liu H, Zhang G, Zheng H, et al. Dynamic Dysregulation of the Triple Network of the Brain in Mild Traumatic Brain Injury and Its Relationship With Cognitive Performance. J Neurotrauma. 2024;41(7-8):879-886. doi:10.1089/neu.2022.0257 PMID: 37128187

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Therapy Intensity Level Scale for Traumatic Brain Injury: Clinimetric Assessment on Neuro-Monitored Patients Across 52 European Intensive Care Units

创伤性脑损伤的治疗强度水平量表: 对52个欧洲重症监护病房的神经监测患者的Clinimetric评估

Intracranial pressure (ICP) data from traumatic brain injury (TBI) patients in the intensive care unit (ICU) cannot be interpreted appropriately without accounting for the effect of administered therapy intensity level (TIL) on ICP. A 15-point scale was originally proposed in 1987 to quantify the hourly intensity of ICP-targeted treatment. This scale was subsequently modified-through expert consensus-during the development of TBI Common Data Elements to address statistical limitations and improve usability. The latest 38-point scale (hereafter referred to as TIL) permits integrated scoring for a 24-h period and has a five-category, condensed version (TIL(Basic)) based on qualitative assessment. Here, we perform a total- and component-score analysis of TIL and TIL(Basic) to: 1) validate the scales across the wide variation in contemporary ICP management; 2) compare their performance against that of predecessors; and 3) derive guidelines for proper scale use. In conclusion, our results validate TIL across a spectrum of ICP management and monitoring approaches. TIL is a more sensitive surrogate for pathophysiology than ICP and thus can be considered an intermediate outcome after TBI.

如果不考虑治疗强度水平 (TIL) 对ICP的影响，就无法正确解释重症监护病房 (ICU) 中创伤性脑损伤 (TBI) 患者的颅内压 (ICP) 数据。最初在1987年提出了15分制，以量化ICP靶向治疗的每小时强度。随后，在TBI通用数据元素的开发过程中，通过专家共识对该量表进行了修改，以解决统计局限性并提高可用性。最新的38分量表 (以下简称TIL) 允许在24小时内进行综合评分，并具有基于定性评估的五个类别的精简版本 (TIL (基本))。在这里，我们对TIL和TIL (基本) 进行总分和分量分析，以: 1) 验证当代ICP管理中广泛变化的量表; 2) 将其性能与前辈进行比较; 3) 得出正确使用量表的指南。总之，我们的结果验证了一系列ICP管理和监测方法的TIL。TIL是比ICP更敏感的病理生理学替代物，因此可以被认为是TBI后的中间结果。

REF: Bhattacharyay S, Beqiri E, Zuercher P, et al. Therapy Intensity Level Scale for Traumatic Brain Injury: Clinimetric Assessment on Neuro-Monitored Patients Across 52 European Intensive Care Units. J Neurotrauma. 2024;41(7-8):887-909. doi:10.1089/neu.2023.0377 PMID: 37795563 PMCID: PMC11005383

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Intracranial Pressure-Derived Cerebrovascular Reactivity Indices and Their Critical Thresholds: A Canadian High Resolution-Traumatic Brain Injury Validation Study

颅内压衍生的脑血管反应性指数及其临界阈值: 加拿大高分辨率创伤性脑损伤验证研究

Current neurointensive care guidelines recommend intracranial pressure (ICP) and cerebral perfusion pressure (CPP) centered management for moderate-severe traumatic brain injury (TBI) because of their demonstrated associations with patient outcome. Cerebrovascular reactivity metrics, such as the pressure reactivity index (PRx), pulse amplitude index (PAx), and RAC index, have also demonstrated significant prognostic capabilities with regard to outcome. However, critical thresholds for cerebrovascular reactivity indices have only been identified in two studies conducted at the same center. In this study, we aim to determine the critical thresholds of these metrics by leveraging a unique multi-center database. In this study, we were able to validate the results of the previous two works as well as to reaffirm the ICP and CPP guidelines from the Brain Trauma Foundation (BTF) and the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC).

当前的神经重症监护指南建议以颅内压 (ICP) 和脑灌注压 (CPP) 为中心的中度重度创伤性脑损伤 (TBI) 管理，因为它们与患者预后有关。脑血管反应性指标，例如压力反应性指数 (PRx)，脉搏幅度指数 (PAx) 和RAC指数，也证明了有关结果的重要预测能力。然而，仅在同一中心进行的两项研究中确定了脑血管反应性指数的临界阈值。在这项研究中，我们旨在通过利用独特的多中心数据库来确定这些指标的关键阈值。在这项研究中，我们能够验证前两项工作的结果，并重申脑外伤基金会 (BTF) 和西雅图国际严重创伤性脑损伤共识会议 (SIBICC) 的ICP和CPP指南。

REF: Stein KY, Froese L, Sekhon M, et al. Intracranial Pressure-Derived Cerebrovascular Reactivity Indices and Their Critical Thresholds: A Canadian High Resolution-Traumatic Brain Injury Validation Study. J Neurotrauma. 2024;41(7-8):910-923. doi:10.1089/neu.2023.0374 PMID: 37861325

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Phenotyping Depression After Mild Traumatic Brain Injury: Evaluating the Impact of Multiple Injury, Gender, and Injury Context

轻度创伤性脑损伤后抑郁的表型: 评估多发性损伤，性别和损伤背景的影响

The chronic mental health consequences of mild traumatic brain injury (TBI) are a leading cause of disability. This is surprising given the expectation of significant recovery after mild TBI, which suggests that other injury-related factors may contribute to long-term adverse outcomes. The objective of this study was to determine how number of prior injuries, gender, and environment/context of injury may contribute to depressive symptoms after mild TBI among deployed United States service members and veterans (SMVs). The results suggest that contextual information, gender, and prior injury history may influence long-term mental health outcomes among SMVs with mild TBI exposure.

轻度创伤性脑损伤 (TBI) 的慢性精神卫生后果是导致残疾的主要原因。这是令人惊讶的，因为轻度TBI后有望显著恢复，这表明其他与损伤相关的因素可能会导致长期不良后果。这项研究的目的是确定在部署的美国服务人员和退伍军人 (SMVs) 中，轻度TBI后，先前受伤的数量，性别和受伤的环境/背景如何可能导致抑郁症状。结果表明，背景信息，性别和先前的伤害史可能会影响轻度TBI暴露的smv的长期精神卫生结果。

REF: Kennedy E, Ozmen M, Bouldin ED, et al. Phenotyping Depression After Mild Traumatic Brain Injury: Evaluating the Impact of Multiple Injury, Gender, and Injury Context. J Neurotrauma. 2024;41(7-8):924-933. doi:10.1089/neu.2023.0381 PMID: 38117134

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