Mortality Among Veterans Following Traumatic Brain Injury: A Veterans Administration Traumatic Brain Injury Model System Study

创伤性脑损伤退伍军人的死亡率：一项退伍军人事务部创伤性脑损伤模型系统研究

Few studies have examined long-term mortality following traumatic brain injury (TBI) in a military population. This is a secondary analysis of a prospective, longitudinal study that examines long-term mortality (up to 10 years) post-TBI, including analyses of life expectancy, causes of death, and risk factors for death in service members and veterans (SM/V) who survived the acute TBI and inpatient rehabilitation. The findings indicate that higher disability and less social supportive infrastructure are associated with higher mortality. Our investigation into the vulnerabilities underlying premature mortality and into the major causes of death may help target future prevention, surveillance, and monitoring interventions.

很少有研究对军人人群中创伤性脑损伤（TBI）后的长期死亡率进行过考察。本研究是对一项前瞻性纵向研究的二次分析，旨在研究创伤性脑损伤后的长期死亡率（最长达 10 年），包括对在急性创伤性脑损伤和住院康复治疗后存活的现役军人和退伍军人（SM/V）的预期寿命、死亡原因以及死亡风险因素的分析。研究结果表明，更高的残疾程度和更少的社会支持体系与更高的死亡率相关。我们对导致过早死亡的潜在脆弱因素以及主要死亡原因的调查，或许有助于为未来的预防、监测及监控干预措施确定目标方向。

REF: Wittine LM, Ketchum JM, Silva MA, et al. Mortality Among Veterans Following Traumatic Brain Injury: A Veterans Administration Traumatic Brain Injury Model System Study. J Neurotrauma. 2025;42(7-8):745-757. doi:10.1089/neu.2024.0043 PMID: 38959125

Association of Psychological Resilience, Cognitive Reserve, and Brain Reserve with Post-Concussive Symptoms in Children with Mild Traumatic Brain Injury and Orthopedic Injury: An A-CAP Study

轻度创伤性脑损伤与骨科损伤患儿的心理韧性、认知储备、脑储备与脑震荡后症状的关联：一项 A-CAP 研究

Protective factors, including psychological resilience, cognitive reserve, and brain reserve, may be positively associated with recovery after pediatric mild traumatic brain injury (mTBI) but are yet to be studied concurrently. We sought to examine these factors as moderators of post-concussive symptoms (PCS) in pediatric mTBI compared with mild orthopedic injury (OI). The results highlight the importance of protective factors as predictors of recovery and potential targets for intervention following pediatric mTBI.

包括心理韧性、认知储备和脑储备在内的保护因素，可能与儿童轻度创伤性脑损伤（mTBI）后的恢复呈正相关，但尚未有人同时对这些因素展开研究。我们试图探究，与轻度骨科损伤（OI）相比，这些因素在儿童轻度创伤性脑损伤中对脑震荡后症状（PCS）是否起到调节作用。研究结果突显了保护因素作为儿童轻度创伤性脑损伤后恢复的预测指标以及潜在干预靶点的重要性。

REF: Dharsee S, Laliberté Durish C, Tang K, et al. Association of Psychological Resilience, Cognitive Reserve, and Brain Reserve with Post-Concussive Symptoms in Children with Mild Traumatic Brain Injury and Orthopedic Injury: An A-CAP Study. J Neurotrauma. 2025;42(7-8):731-744. doi:10.1089/neu.2024.0076 PMID: 38874919

A Transdiagnostic, Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI)

创伤性脑损伤后精神病理学的跨诊断分层分类法（HiTOP-TBI）

Psychopathology, including depression, anxiety, and post-traumatic stress, is a significant yet inadequately addressed feature of moderate-severe traumatic brain injury (TBI). Progress in understanding and treating post-TBI psychopathology may be hindered by limitations associated with conventional diagnostic approaches, specifically the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). The Hierarchical Taxonomy of Psychopathology (HiTOP) offers a promising, transdiagnostic alternative to psychiatric classification that may more effectively capture the experiences of individuals with TBI. However, HiTOP lacks validation in the TBI population. To address this gap, we administered a comprehensive questionnaire battery, including 56 scales assessing homogeneous symptom components and maladaptive traits within HiTOP, to 410 individuals with moderate-severe TBI. We evaluated the reliability and unidimensionality of each scale and revised those with psychometric problems. This study presents the most comprehensive empirical classification of psychopathology after TBI to date. It introduces a novel, TBI-specific transdiagnostic questionnaire battery and model, which addresses the limitations of conventional DSM and ICD diagnoses. The empirical structure of psychopathology after TBI largely aligned with the established HiTOP model (e.g., a detachment spectrum). However, these constructs need to be interpreted in relation to the unique experiences associated with TBI (e.g., considering the injury's impact on the person's social functioning). By overcoming the limitations of conventional diagnostic approaches, the HiTOP-TBI model has the potential to accelerate our understanding of the causes, correlates, consequences, and treatment of psychopathology after TBI.

精神病理学问题，包括抑郁、焦虑和创伤后应激等，是中重度创伤性脑损伤（TBI）的一个重要特征，但一直未得到充分关注和解决。对创伤性脑损伤后精神病理学的理解和治疗进展，可能会受到传统诊断方法局限性的阻碍，特别是《精神疾病诊断与统计手册》（DSM）和《国际疾病分类》（ICD）。精神病理学分层分类法（HiTOP）为精神疾病分类提供了一种很有前景的跨诊断替代方法，或许能更有效地捕捉创伤性脑损伤患者的体验。然而，HiTOP 在创伤性脑损伤人群中尚未得到验证。为了填补这一空白，我们对 410 名中重度创伤性脑损伤患者进行了一系列全面的问卷调查，其中包括 56 个量表，用于评估 HiTOP 框架内同质的症状成分和适应不良的特质。我们评估了每个量表的信度和单维性，并对那些存在心理测量问题的量表进行了修订。本研究呈现了迄今为止关于创伤性脑损伤后精神病理学最全面的实证分类。它引入了一种全新的、针对创伤性脑损伤的跨诊断问卷调查体系和模型，解决了传统 DSM 和 ICD 诊断的局限性。创伤性脑损伤后精神病理学的实证结构在很大程度上与已确立的 HiTOP 模型相符（例如，分离谱系）。不过，这些概念需要结合创伤性脑损伤相关的独特体验来进行解释（比如，考虑损伤对患者社会功能的影响）。通过克服传统诊断方法的局限性，HiTOP-TBI 模型有望加快我们对创伤性脑损伤后精神病理学的成因、相关因素、后果以及治疗方法的理解。

REF: Carmichael J, Ponsford J, Gould KR, et al. A Transdiagnostic, Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI). J Neurotrauma. 2025;42(7-8):714-730. doi:10.1089/neu.2024.0006 PMID: 38970424

Vasomotion and Cerebral Blood Flow in Patients With Traumatic Brain Injury and Subarachnoid Hemorrhage: Cerebrovascular Autoregulation Versus Autonomic Control

创伤性脑损伤和蛛网膜下腔出血患者的血管舒缩活动与脑血流量：脑血管自动调节与自主神经调节

This study compared the roles of extraparenchymal autonomic nervous system (ANS) control of cerebral blood flow (CBF) versus intraparenchymal cerebrovascular autoregulation in 487 patients with aneurysmal subarachnoid hemorrhage (SAH) and 413 patients with traumatic brain injury (TBI). The higher optimal CPP in patients with SAH, more passive optimal pressure reactivity, and greater dependence of cerebral on systemic vasomotion indicate that they require more active support by the ANS and systemic circulation for CBF than patients with TBI. CBF in patients with TBI is more reliant on cerebrovascular autoregulation based on metabolic demand. This appears to be deficient following SAH, making the heightened ANS support necessary. Although this support is beneficial, it does not fully compensate for the loss of cerebrovascular autoregulation, as reflected in the problems in the SAH cohort with delayed cerebral ischemia and poor outcome.

本研究比较了 487 例动脉瘤性蛛网膜下腔出血（SAH）患者和 413 例创伤性脑损伤（TBI）患者中，脑实质外自主神经系统（ANS）对脑血流量（CBF）的调控作用与脑实质内脑血管自动调节作用。动脉瘤性蛛网膜下腔出血患者更高的最佳脑灌注压（CPP）、最佳压力反应性，以及大脑对全身血管舒缩活动更强的依赖性，表明与创伤性脑损伤患者相比，他们的脑血流量需要自主神经系统和体循环提供更积极的支持。创伤性脑损伤患者的脑血流量更依赖于基于代谢需求的脑血管自动调节功能。在动脉瘤性蛛网膜下腔出血后，这种自动调节功能似乎存在不足，这使得增强自主神经系统的支持变得必要。尽管这种支持是有益的，但它并不能完全弥补脑血管自动调节功能的丧失，这一点从动脉瘤性蛛网膜下腔出血患者队列中出现的迟发性脑缺血问题和较差的预后情况中得以体现。

REF: Howells T, Hånell A, Svedung Wettervik T, Enblad P. Vasomotion and Cerebral Blood Flow in Patients With Traumatic Brain Injury and Subarachnoid Hemorrhage: Cerebrovascular Autoregulation Versus Autonomic Control. J Neurotrauma. 2025;42(7-8):700-713. doi:10.1089/neu.2024.0426 PMID: 39723450

Brain Imaging Features in Patients with Gunshot Wounds to the Head

头部枪伤患者的脑部影像学特征

This study is to introduce the UChicago PBI Imaging score, a novel characterization of imaging features using head computed tomography (HCT) in patients with gunshot wounds to the head (GSWH) resulting in penetrating brain injury (PBI) and to quantify the association with mortality. This study parallels efforts to refine TBI classification, underscoring the necessity for precise imaging-based classification in PBI to identify imaging biomarkers and ultimately enhance prognostication and targeted treatment.

本研究旨在介绍芝加哥大学穿透性脑损伤影像学评分（UChicago PBI Imaging score），这是一种利用头部计算机断层扫描（HCT）对因头部枪伤（GSWH）导致穿透性脑损伤（PBI）患者的影像学特征进行的全新描述方法，并量化其与死亡率之间的关联。本研究与完善创伤性脑损伤（TBI）分类的相关工作同步进行，强调了在穿透性脑损伤中基于精确影像学进行分类的必要性，以便识别影像学生物标志物，最终改善预后评估和实施精准治疗。

REF: Mansour A, Badillo-Goicoechea E, Alvarado-Dyer R, et al. Brain Imaging Features in Patients with Gunshot Wounds to the Head. J Neurotrauma. 2025;42(7-8):689-699. doi:10.1089/neu.2024.0464 PMID: 39899350

Human Neural Stem Cell Therapy for Traumatic Brain Injury—A Systematic Review of Pre-Clinical Studies

人神经干细胞治疗创伤性脑损伤 —— 临床前研究的系统综述

Human neural stem cells (hNSCs) possess significant therapeutic potential for the treatment of traumatic brain injury (TBI), a leading cause of global death and disability. Recent pre-clinical studies have shown that hNSCs reduce tissue damage and promote functional recovery through neuroprotective and regenerative signaling and cell replacement. Yet the overall efficacy of hNSCs for TBI indications remains unclear. Therefore, this systematic review aims to evaluate hNSC interventions compared with controls in pre-clinical TBI models. Overall, hNSC intervention reduced lesion volume, enhanced MWM performance, and led to trending decreases in acute and chronic neurological deficits at acute and chronic time points. These results suggest hNSCs demonstrate clear efficacy in pre-clinical TBI models. However, further studies are needed to address key questions regarding optimal hNSC administration (e.g., dosing, treatment window) and underlying mechanisms of action prior to progressing to human clinical trials.

创伤性脑损伤（TBI）是导致死亡和残疾的主要原因之一，而人神经干细胞（hNSCs）在治疗创伤性脑损伤方面具有巨大的治疗潜力。近期的临床前研究表明，人神经干细胞可通过神经保护和再生信号传导以及细胞替代作用，减少组织损伤并促进功能恢复。然而，人神经干细胞针对创伤性脑损伤的整体疗效仍不明确。因此，本系统综述旨在评估在创伤性脑损伤模型中，人神经干细胞干预措施相较于对照组的情况。通过这一过程，整合了人神经干细胞给药方案的差异，并确定了关键的空白点。总体而言，人神经干细胞干预减少了损伤体积，提高了水迷宫测试的表现，并在急性和慢性时间点上使神经功能缺损呈现下降趋势。这些结果表明，人神经干细胞在临床前创伤性脑损伤模型中显示出明确的疗效。然而，在推进到人体临床试验之前，仍需开展进一步的研究，以解决有关最佳人神经干细胞给药方式（如剂量、治疗窗口）以及潜在作用机制等关键问题。

REF: Schantz SL, Duberstein KJ, Kaiser EE, West FD. Human Neural Stem Cell Therapy for Traumatic Brain Injury-A Systematic Review of Pre-Clinical Studies. J Neurotrauma. 2025;42(7-8):668-688. doi:10.1089/neu.2024.0544 PMID: 39853240

Evidence for Altered White Matter Organization After Mild Traumatic Brain Injury: A Scoping Review on the Use of Diffusion Magnetic Resonance Imaging and Blood-Based Biomarkers to Investigate Acute Pathology and Relationship to Persistent Post-Concussion Symptoms

轻度创伤性脑损伤后白质结构改变的证据：一项关于运用弥散磁共振成像和基于血液的生物标志物来探究急性病理变化以及与持续性脑震荡后症状之间关系的综述

Mild traumatic brain injury (mTBI) is the most common form of traumatic brain injury. Post-concussive symptoms typically resolve after a few weeks although up to 20% of people experience these symptoms for >3 months, termed persistent post-concussive symptoms (PPCS). Subtle white matter (WM) microstructural damage is thought to underlie neurological and cognitive deficits experienced post-mTBI. Evidence suggests that diffusion magnetic resonance imaging (dMRI) and blood-based biomarkers could be used as surrogate markers of WM organization. We conducted a scoping review according to PRISMA-ScR guidelines, aiming to collate evidence for the use of dMRI and/or blood-based biomarkers of WM organization, in mTBI and PPCS, and document relationships between WM biomarkers and symptoms. The data suggest that dMRI and blood-based biomarkers may be useful proxies of WM organization, although few studies assessed these complementary measures in parallel, and the relationship between modalities remains unclear. Further studies are warranted to assess the benefit of a combined biomarker approach in evaluating alterations to WM organization after mTBI.

轻度创伤性脑损伤（mTBI）是最常见的头部创伤类型。脑震荡后的症状通常在几周后会消失，不过多达 20% 的人会在超过 3 个月的时间仍经历这些症状，这种情况被称为持续性脑震荡后症状（PPCS）。人们认为，轻微的白质（WM）微观结构损伤是轻度创伤性脑损伤后出现神经和认知功能障碍的潜在原因。有证据表明，弥散磁共振成像（dMRI）和基于血液的生物标志物可以用作白质结构的替代标志物。我们根据PRISMA-ScR指南进行了一项综述，旨在整理在轻度创伤性脑损伤和持续性脑震荡后症状方面，使用弥散磁共振成像和基于血液的白质结构生物标志物的相关证据，并记录白质生物标志物与症状之间的关系。数据表明，弥散磁共振成像和基于血液的生物标志物可能是白质结构的有用替代指标，尽管很少有研究同时评估这些互补性指标，而且不同指标之间的关系仍不明确。有必要开展进一步的研究，以评估联合使用生物标志物的方法在评估轻度创伤性脑损伤后白质结构改变方面的益处。

REF: Papini MG, Avila AN, Fitzgerald M, Hellewell SC. Evidence for Altered White Matter Organization After Mild Traumatic Brain Injury: A Scoping Review on the Use of Diffusion Magnetic Resonance Imaging and Blood-Based Biomarkers to Investigate Acute Pathology and Relationship to Persistent Post-Concussion Symptoms. J Neurotrauma. 2025;42(7-8):640-667. doi:10.1089/neu.2024.0039 PMID: 39096132