The Effects of Hyper- and Hypoventilation on Cerebral Physiology in a Healthy and Compromised Brain State: An Experimental Pig Model with State-of-the-Art Neuromonitoring

过度通气与通气不足对健康及受损脑状态的脑生理影响：一项采用前沿神经监测技术的猪实验模型

Arterial carbon dioxide (pCO2) strongly affects cerebrovascular tone and cerebral physiology. While moderate hyperventilation is often used to reduce intracranial pressure (ICP) in acute brain injury, its broader physiological effects remain unclear. In this experimental study, 10 anesthetized pigs underwent multimodal neuromonitoring, including ICP, cerebral perfusion pressure, common autoregulatory indices (pressure reactivity index [PRx], cerebral blood flow index [CBFx], oxygen reactivity index), CBF, brain tissue oxygenation (pbtO2), and microdialysis. The findings underscore the complex and context-dependent effects of pCO2 on cerebral physiology, indicating that ventilatory strategies may both benefit and harm the injured brain depending on individual vulnerability and hemodynamic status.

动脉血二氧化碳分压（pCO₂）对脑血管张力及脑生理状态具有显著影响。尽管适度过度通气常用于降低急性脑损伤患者的颅内压（ICP），但其更广泛的生理效应仍不明确。本实验研究对10头麻醉猪实施多模态神经监测，监测指标包括颅内压、脑灌注压、常用自主调节指标（压力反应指数[PRx]、脑血流量指数[CBFx]、氧反应指数）、脑血流量（CBF）、脑组织氧分压（pbtO₂）及脑微透析。研究结果强调，pCO₂对脑生理的影响复杂且具有情境依赖性，提示通气策略对受损脑组织可能兼具获益与风险，具体取决于个体易损性及血流动力学状态。

[REF: Svedung Wettervik T, Joensen O, Alhamdan M, et al. The Effects of Hyper- and Hypoventilation on Cerebral Physiology in a Healthy and Compromised Brain State: An Experimental Pig Model with State-of-the-Art Neuromonitoring. J Neurotrauma. Published online September 19, 2025. doi:10.1177/08977151251380274 PMID: 40971260]

由人工翻译修正

Longitudinal Effects of Mild Traumatic Brain Injury on the Gut Microbiome and Acoustic Startle Response in Male and Female Rats

轻度创伤性脑损伤对雄性与雌性大鼠肠道菌群及听觉惊跳反应的纵向影响

Traumatic brain injuries (TBI) frequently occur and can lead to lasting negative cognitive, physical, and mental health outcomes. The biological response to even mild TBIs (mTBI) includes well-characterized inflammatory sequelae that start immediately post-injury, remain for weeks, and can develop into long-term systemic inflammation. Studies have shown that TBI influences multiple physiological systems, including the gastrointestinal tract, through bidirectional communication modulated, in part, by the gut microbiome. Brainstem functioning post-TBI, as measured by acoustic startle sensorimotor processing, might play a role in this feedback loop. The current study investigated pre- to post-TBI (lateral fluid percussion injury model) changes in microbial communities and acoustic startle response in male and female rats. This study contributes longitudinal and sex-specific findings to the growing body of research examining the diverse effects of mTBI on the brain and gut microbial communities.

创伤性脑损伤（TBI）较为常见，可导致持久的认知、躯体及心理健康不良结局。即便是轻度创伤性脑损伤（mTBI），其生物学反应也包含特征明确的炎症后遗症，这类反应在损伤后即刻发生、持续数周，并可能进展为长期全身性炎症。研究表明，创伤性脑损伤可通过部分由肠道菌群调控的双向通讯通路，影响胃肠道等多个生理系统。创伤性脑损伤后以听觉惊跳感觉运动加工评估的脑干功能，可能参与这一反馈环路。本研究采用侧向液压冲击损伤模型，探讨了雄性与雌性大鼠创伤性脑损伤前后肠道菌群群落及听觉惊跳反应的变化。该研究为不断增多的、探索轻度创伤性脑损伤对大脑与肠道菌群群落多重影响的研究提供了纵向及性别特异性结果。

[REF: Stamper CE, Cominski TP, Hoisington AJ, et al. Longitudinal Effects of Mild Traumatic Brain Injury on the Gut Microbiome and Acoustic Startle Response in Male and Female Rats. J Neurotrauma. Published online September 3, 2025. doi:10.1177/08977151251372118 PMID: 40899103 PMCID: PMC12504221]

由人工翻译修正

CMX-2043 Treatment Limits Neural Injury Pathophysiology and Promotes Neurological and Cognitive Recovery in a Pediatric Porcine Traumatic Brain Injury Model

10.CMX-2043治疗可减轻神经损伤病理生理改变，并促进幼猪创伤性脑损伤模型的神经与认知功能恢复

Traumatic brain injury (TBI) represents a major global health issue contributing to significant disability and mortality. The TBI-induced secondary injury cascade, characterized by neuroinflammation, neural cell death, and tissue damage, results in lifelong functional deficits. Alpha-N-[(R)-1, 2-dithiolane-3-pentanoyl]l-glutamyl-l-alanine (CMX-2043) is a novel alpha lipoic acid (ALA)-based therapeutic that has neuroprotective, anti-apoptotic, and anti-inflammatory properties that mitigate cellular, tissue, and functional deficits following TBI. In this study, we evaluated the therapeutic efficacy of CMX-2043 on neural injury severity and functional recovery in a clinically relevant porcine TBI model. Collectively, these results observed in a translational large animal porcine model suggest that CMX-2043 holds significant clinical value to potentially mitigate TBI pathophysiology and promote functional recovery.

创伤性脑损伤（TBI）是全球重大公共卫生问题，会导致严重的残疾与死亡。创伤性脑损伤诱发的继发性损伤级联反应以神经炎症、神经细胞死亡及组织损伤为特征，可造成终身的功能缺损。α-N-[(R)-1,2-二硫戊环-3-戊酰基]-L-谷氨酰基-L-丙氨酸（CMX-2043）是一种基于α-硫辛酸（ALA）的新型治疗药物，具有神经保护、抗凋亡及抗炎特性，能够减轻创伤性脑损伤后的细胞、组织及功能损伤。本研究在具有临床转化价值的猪创伤性脑损伤模型中，评估了CMX-2043对神经损伤严重程度及功能恢复的治疗效果。总体而言，在转化型大动物猪模型中观察到的这些结果表明，CMX-2043具有重要的临床价值，有望减轻创伤性脑损伤的病理生理改变并促进功能恢复。

[REF: Schantz SL, LePage TH, Dubrof ST, et al. CMX-2043 Treatment Limits Neural Injury Pathophysiology and Promotes Neurological and Cognitive Recovery in a Pediatric Porcine Traumatic Brain Injury Model. J Neurotrauma. Published online July 30, 2025. doi:10.1177/08977151251363584 PMID: 40736023]

由人工翻译修正

Postconcussive Sleep Problems and Glymphatic Dysfunction Predict Persistent Working Memory Decline

脑震荡后睡眠障碍与类淋巴功能异常可预测持续性工作记忆下降

Persistent working memory decline (PWMD) is a common sequela of mild traumatic brain injury (mTBI), yet reliable biomarkers for predicting long-term working memory outcomes remain lacking. The glymphatic system, a brain-wide waste clearance network, plays a crucial role in cognitive recovery. The diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index, a noninvasive magnetic resonance imaging (MRI)-based technique, offers a promising approach to evaluate perivascular fluid dynamics—a key component of glymphatic function. However, its role in long-term working memory dysfunction remains underexplored, particularly in the presence of traumatic cerebral microbleeds (CMBs) and poor sleep quality—as measured by Pittsburgh Sleep Quality Index (PSQI)—both of which have been suggested to disrupt glymphatic clearance, exacerbate neurovascular impairment, and contribute to cognitive decline. This study aims to investigate the interplay between CMBs, sleep quality, and perivascular fluid dynamics in predicting PWMD after mTBI. The findings highlight the potential of noninvasive MRI-based assessment of perivascular fluid dynamics as an early biomarker for PWMD. Given the essential role of the glymphatic system in sleep and memory, integrating DTI-ALPS with CMB detection and sleep quality evaluation may enhance prognostic accuracy and inform personalized rehabilitation strategies for mTBI patients.

持续性工作记忆下降（PWMD）是轻度创伤性脑损伤（mTBI）的常见后遗症，但目前仍缺乏可预测长期工作记忆结局的可靠生物标志物。类淋巴系统是遍布全脑的废物清除网络，在认知功能恢复中发挥关键作用。沿血管周围空间的弥散张量成像分析（DTIALPS）指数是一项基于磁共振成像（MRI）的无创技术，为评估血管周围液体动力学——类淋巴功能的核心组成部分——提供了极具前景的方法。然而，其在长期工作记忆障碍中的作用仍有待深入研究，尤其是在合并创伤性脑微出血（CMBs）与睡眠质量差（以匹兹堡睡眠质量指数［PSQI］评估）的情况下。现有研究提示，上述两者均可破坏类淋巴清除功能、加重神经血管损伤并导致认知能力下降。本研究旨在探讨脑微出血、睡眠质量与血管周围液体动力学之间的相互作用，以预测轻度创伤性脑损伤后的持续性工作记忆下降。研究结果强调，基于磁共振的无创血管周围液体动力学评估，有望成为持续性工作记忆下降的早期生物标志物。鉴于类淋巴系统在睡眠与记忆中的重要作用，将DTIALPS与脑微出血检测、睡眠质量评估相结合，可提高预后判断准确性，并为轻度创伤性脑损伤患者制定个体化康复方案提供依据。

[REF: Li YT, Chen DY, Kuo DP, et al. Postconcussive Sleep Problems and Glymphatic Dysfunction Predict Persistent Working Memory Decline. J Neurotrauma. Published online September 22, 2025. doi:10.1177/08977151251380701 PMID: 40982305]

由人工翻译修正

Neurocognitive Network Organization in Children with Traumatic Brain Injury

创伤性脑损伤患儿的神经认知网络结构

Pediatric traumatic brain injury (TBI) is the leading cause of acquired disability in children, potentially leading to neurocognitive deficits that affect daily functioning. This study explored the impact of pediatric TBI on neurocognitive network organization and its relation to intelligence and behavior problems. This study indicates that pediatric TBI disrupts the neurocognitive network and is characterized by a less centralized organization compared to peers. Neurocognitive network organization may contribute to our understanding of outcomes following TBI, particularly regarding externalizing behavior problems.

儿童创伤性脑损伤（TBI）是导致儿童后天残疾的首要原因，可能造成影响日常功能的神经认知缺陷。本研究探讨了儿童创伤性脑损伤对神经认知网络结构的影响，及其与智力水平和行为问题的关系。研究结果表明，儿童创伤性脑损伤会破坏神经认知网络，与健康同龄人相比，其网络中心化程度更低。神经认知网络结构有助于我们理解创伤性脑损伤后的预后结局，尤其在外化行为问题方面。

[REF: Kooper CC, Königs M, Steenweg ME, et al. Neurocognitive Network Organization in Children with Traumatic Brain Injury. J Neurotrauma. Published online September 22, 2025. doi:10.1177/08977151251376627 PMID: 40982318]

由人工翻译修正

Action Collaborative on Traumatic Brain Injury Care: Adapted Clinical Practice Guideline

创伤性脑损伤诊疗行动协作组：改编版临床实践指南

Outpatient follow-up care for traumatic brain injury (TBI) is inconsistent. The Action Collaborative on TBI Care, convened under the auspices of the National Academies of Sciences, Engineering, and Medicine, aimed to standardize management with a clinical practice guideline. The Action Collaborative on TBI Care guideline provides recommendations for 11 priority topics: (1) confirm the diagnosis; (2) determine whether emergency department evaluation is required; (3) request neuroimaging and neuropsychological assessment when indicated; (4) screen for social determinants of health; (5) provide guidance on return to usual activities; (6) educate the patient and family; (7) assess for risk of persistent symptoms; (8) prioritize which symptoms to target first; (9) initiate treatment for posttraumatic headache; (10) screen and initiate treatment for mental health disorders; and (11) decide if and when to refer to specialty care.

创伤性脑损伤（TBI）的门诊随访治疗尚不规范。由美国国家科学、工程与医学研究院牵头成立的创伤性脑损伤诊疗行动协作组，旨在通过临床实践指南实现诊疗管理标准化。该创伤性脑损伤诊疗行动协作组指南针对11个优先主题提出推荐意见：（1）明确诊断；（2）判断是否需要急诊评估；（3）必要时申请神经影像学与神经心理学评估；（4）筛查健康的社会决定因素；（5）指导患者回归日常活动；（6）对患者及家属开展健康教育；（7）评估症状持续存在的风险；（8）优先确定需要首先干预的症状；（9）启动创伤后头痛的治疗；（10）筛查精神心理疾病并启动治疗；（11）决定是否及何时转诊至专科诊疗。

[REF: Silverberg ND, Lee K, Mikolić A, et al. Action Collaborative on Traumatic Brain Injury Care: Adapted Clinical Practice Guideline. J Neurotrauma. Published online September 18, 2025. doi:10.1177/08977151251378894 PMID: 40966132]

由人工翻译修正

Volume Loss in the Mammillary Bodies, Fornix, and Other Papez Circuit Structures in Fighters with Traumatic Encephalopathy Syndrome

存在创伤性脑病综合征的搏击运动员其乳头体、穹窿及其他帕佩兹环路结构体积会萎缩

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder that can only be diagnosed on autopsy. Traumatic encephalopathy syndrome (TES) is a proposed diagnostic framework for the clinical syndrome of CTE that is based on patient history and clinical examination. Given that mammillary body and fornix volume loss has been demonstrated in CTE and is measurable on MRI, this study aims to investigate the relationship between TES status and in vivo mammillary body and fornix volumes to support the role of these structures as imaging biomarkers for TES. The decrease in mammillary body and fornix size among TES-positive fighters suggests that increased exposure to repetitive head impacts damages these structures, and that imaging assessment of the mammillary bodies and fornix is a feasible biomarker to support the diagnosis of TES.

慢性创伤性脑病（CTE）是一种仅能通过尸检确诊的神经退行性疾病。创伤性脑病综合征（TES）是基于患者病史与临床检查、用于描述CTE临床表型的拟诊诊断框架。已有研究证实，CTE患者存在乳头体和穹窿体积缩小，且可通过MRI进行量化评估。本研究旨在探讨TES状态与活体乳头体、穹窿体积之间的关系，以验证这些结构作为TES影像学生物标志物的价值。TES阳性的搏击运动员乳头体与穹窿体积减小，提示反复头部撞击暴露增加会损伤这些结构；同时也表明，对乳头体和穹窿的影像学评估可作为支持TES诊断的可行生物标志物。

[REF: Karakasis C, Bernick C, Bullen J, Sakaie K, Jones SE, Lee J. Volume Loss in the Mammillary Bodies, Fornix, and Other Papez Circuit Structures in Fighters with Traumatic Encephalopathy Syndrome. J Neurotrauma. Published online May 12, 2025. doi:10.1089/neu.2025.0011 PMID: 40354182]

由人工翻译修正

Citicoline–Amantadine Trial in Traumatic Brain Injury: A Prospective Randomized Study

胞二磷胆碱金刚烷胺治疗创伤性脑损伤的随机前瞻性研究

Traumatic brain injury (TBI) is a global health problem. Amantadine and citicoline showed considerable effects on neurorecovery from TBI. In a randomized controlled trial, the effects of amantadine and citicoline and their combinations were compared on arousal and behavioral consequences in the early phase of moderate TBI. This study showed that amantadine alone or in combination with citicoline has a favorable effect on the recovery of consciousness and cognitive behavior in patients with moderate TBI and reduces the mechanical ventilation days, hospital, and ICU length of stay.

创伤性脑损伤（TBI）是一个全球性的健康问题。金刚烷胺与胞二磷胆碱对创伤性脑损伤后的神经功能恢复具有显著效果。本项随机对照试验比较了金刚烷胺、胞二磷胆碱单药及联合用药对中度创伤性脑损伤早期觉醒状态与行为相关结局的影响。研究结果显示，单用金刚烷胺或与胞二磷胆碱联合使用，对中度创伤性脑损伤患者的意识及认知行为恢复具有积极作用，并可缩短机械通气时间、住院时长及重症监护室（ICU）住院天数。

[REF: Badre DSEM, Elbeialy MAK, Fathy M. Citicoline-Amantadine Trial in Traumatic Brain Injury: A Prospective Randomized Study. J Neurotrauma. Published online October 1, 2025. doi:10.1177/08977151251375914 PMID: 41027417]

由人工翻译修正

Comparing Two Models of Transition from Inpatient Rehabilitation Following Traumatic Brain Injury: A Pragmatic Comparative Effectiveness Trial

两种创伤性脑损伤后住院康复过渡模式的比较：一项比较效果研究

Moderate to severe traumatic brain injury (msTBI) results in physical, cognitive, behavioral, and psychosocial difficulties. Those who receive inpatient rehabilitation following a msTBI need assistance after discharge. Patients and their families often struggle to find information, manage symptoms, and identify and access relevant services. Inadequate transition services from hospital-based care to the community can perpetuate and amplify the consequences of msTBI. There is a critical need for enhanced transitional care following hospital discharge. The goal of the current study was to compare two existing models for supporting the transition in the United States: 1. The Commission on Accreditation of Rehabilitation Facilities (CARF) model focused on transition planning prior to discharge (denominated Rehabilitation Discharge Plan [RDP]) and 2. The Veterans Health Administration model which provides a more intensive approach, extending beyond discharge, to enhance transitional care services (denominated Rehabilitation Transition Plan [RTP]). The results showed no significant differences between the two interventions on societal participation or HRQoL. Likewise, analysis of trajectory of outcomes did not show treatment group differences, and most patient participants had minimal change across all time points. Preinjury limitations, Medicaid insurance, and lower function contributed to worse outcomes but there was evidence for an interaction with the intervention for clinical sites and whether participants had an enrolled caregiver, which differed by group (increased participation with no enrolled caregiver in RTP, and better HRQoL with a caregiver for RDP). A key limitation of the study was the length of the intervention, with our patient, family, and professional partners reporting that 6 months might be insufficient to address the many needs that arise after msTBI.

中重度创伤性脑损伤（msTBI）会导致躯体、认知、行为及社会心理方面的功能障碍。中重度创伤性脑损伤患者在接受住院康复后，出院时仍需要相关支持。患者及其家属常常在获取信息、症状管理、识别并获得相关服务方面面临困难。从医院照护过渡到社区照护的服务不足，会持续存在甚至加重中重度创伤性脑损伤带来的不良后果。因此，在患者出院后加强过渡性照护已成为迫切需求。本研究旨在比较美国现有的两种过渡支持模式：康复设施认证委员会（CARF）模式：以出院前的过渡规划为核心，称为康复出院计划（RDP）；退伍军人健康管理局模式：提供更强化的干预服务并延伸至出院后，以优化过渡性照护，称为康复过渡计划（RTP）。结果显示，两种干预措施在患者社会参与度或健康相关生活质量（HRQoL）方面均无显著差异。同样，结局轨迹分析也未发现治疗组间存在差异，且大多数患者在所有时间点的变化均很小。损伤前的功能受限、医疗补助保险（Medicaid）及较低的功能水平均与更差的预后相关；但研究发现，干预措施与临床中心、患者是否有照护者入组存在交互作用，且这种交互作用存在组间差异（RTP组中无照护者的患者社会参与度更高，RDP组中有照护者的患者健康相关生活质量更佳）。本研究的一个关键局限性在于干预时长，患者、家属及专业合作人员均表示，6个月的干预可能不足以满足中重度创伤性脑损伤后出现的诸多需求。

[REF: Hoffman JM, Obata T, Ciol MA, et al. Comparing Two Models of Transition from Inpatient Rehabilitation Following Traumatic Brain Injury: A Pragmatic Comparative Effectiveness Trial. J Neurotrauma. Published online September 17, 2025. doi:10.1177/08977151251374298 PMID: 40960892]

由人工翻译修正