Multi-Center Validation of the McGovern Pediatric Blunt Cerebrovascular Injury Screening Score

麦戈文儿童闭合性脑血管损伤筛查评分的多中心验证

Blunt cerebrovascular injury (BCVI) is defined as blunt trauma to the head and neck leading to damage to the vertebral and/or carotid arteries; debate exists regarding which children are considered at high risk for BCVI and in need of angiographic/vessel imaging. We previously proposed a screening tool, the McGovern score, to identify pediatric trauma patients at high risk for BCVI, and we aim to validate the McGovern score by pooling data from multiple pediatric trauma centers. Across all data groups, the McGovern score has a >80% sensitivity (SN) and >98% negative predictive value (NPV). The McGovern score for pediatric BCVI is an effective, generalizable screening tool.

钝性脑血管损伤(BCVI)被定义为头部和颈部的钝性损伤，导致椎动脉和/或颈动脉受损；关于哪些儿童被认为是BCVI的高危人群和需要进行血管造影/血管成像，仍存在争议。我们之前提出了一种筛查工具，McGoven评分，用于确定BCVI的高危儿科创伤患者，我们的目标是通过汇集来自多个儿科创伤中心的数据来验证McGoven评分。在所有数据组中，McGoven评分具有>80%的敏感性(SN)和>98%的阴性预测值(NPV)。儿童BCVI麦戈文评分是一种有效的、可推广的筛查工具。

REF: Venkataraman SS, Herbert JP, Ravindra VM, et al. Multi-Center Validation of the McGovern Pediatric Blunt Cerebrovascular Injury Screening Score. J Neurotrauma. 2023;40(13-14):1451-1458. doi:10.1089/neu.2022.0336 PMID: 36517974 PMCID: PMC10294562

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Prior Concussion History and Clinical Recovery After Sport-Related Concussion in High School Athletes

高中运动员运动性震荡后的既往震荡史与临床康复

Clinical recovery after sport-related concussion varies as a function of pre-injury and acute factors. Whether, or the extent to which, concussion history is associated with clinical outcome after sport-related concussion is uncertain, because research has produced mixed findings. The present study aimed to assess whether a history of previous concussions was associated with prolonged clinical recovery after a subsequent sport-related concussion. Having sustained prior concussions was not associated with time to return to school after a subsequent sport-related concussion. A greater proportion of adolescents, however, with two or more previous concussions experienced a prolonged return to sports. Further research is warranted to identify risk factors for worse outcomes among the subset of adolescents with a history of multiple previous concussions who experience prolonged recoveries.

运动性脑震荡后的临床恢复因损伤前和急性因素而异。脑震荡病史是否或在多大程度上与运动相关脑震荡后的临床结果相关尚不确定，因为研究产生了褒贬不一的结果。本研究旨在评估既往脑震荡病史是否与随后的运动相关脑震荡后较长的临床恢复有关。先前遭受脑震荡与随后的运动相关脑震荡后重返学校的时间无关。然而，有两次或两次以上脑震荡的青少年中，有更大比例的人经历了长期的运动回归。有必要进行进一步的研究，以确定在有多次脑震荡病史的青少年中长期康复的不良结局的危险因素。

REF: Gaudet CE, Iverson GL, Zafonte R, Berkner PD, Cook NE. Prior Concussion History and Clinical Recovery After Sport-Related Concussion in High School Athletes. J Neurotrauma. 2023;40(13-14):1459-1469. doi:10.1089/neu.2022.0358 PMID: 36785985

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Lifetime Traumatic Brain Injury and Cognitive Domain Deficits in Late Life: The PROTECT-TBI Cohort Study

终生创伤性脑损伤与晚年认知领域缺陷：PROTECT-TBI队列研究

Traumatic brain injury (TBI) causes cognitive impairment but it remains contested regarding which cognitive domains are most affected. Further, moderate-severe TBI is known to be deleterious, but studies of mild TBI (mTBI) show a greater mix of negative and positive findings. This study examines the longer-term cognitive effects of TBI severity and number of mTBIs in later life. TBI is associated with fixed, dose, and severity-dependent cognitive deficits. The most sensitive cognitive domains are attention and executive function, with approximately double the effect compared with processing speed and working memory. Post-TBI cognitive rehabilitation should be targeted appropriately to domain-specific effects. Significant long-term cognitive deficits were associated with three or more lifetime mTBIs, a critical consideration when counseling individuals post-TBI about continuing high-risk activities.

创伤性脑损伤(TBI)会导致认知障碍，但关于哪些认知域受到的影响最大，目前仍存在争议。此外，众所周知，中-重度脑外伤是有害的，但对轻度脑损伤(MTBI)的研究显示，负面和积极的研究结果都有。这项研究考察了脑外伤严重程度和晚年MTBI次数对认知的长期影响。脑外伤与固定、剂量和严重程度相关的认知缺陷有关。最敏感的认知领域是注意力和执行功能，与处理速度和工作记忆相比，其影响大约是两倍。脑外伤后的认知康复应适当针对特定领域的影响。重大的长期认知缺陷与三次或三次以上的终生MTBI有关，这是在对脑外伤后持续的高风险活动进行咨询时的一个关键考虑因素。

REF: Lennon MJ, Brooker H, Creese B, et al. Lifetime Traumatic Brain Injury and Cognitive Domain Deficits in Late Life: The PROTECT-TBI Cohort Study. J Neurotrauma. 2023;40(13-14):1423-1435. doi:10.1089/neu.2022.0360 PMID: 36716779

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Non-Invasive Vagus Nerve Stimulation Improves Brain Lesion Volume and Neurobehavioral Outcomes in a Rat Model of Traumatic Brain Injury

无创迷走神经刺激改善创伤性脑损伤大鼠脑损伤体积和神经行为结局

Traumatic brain injury (TBI) continues to be a major cause of death and disability worldwide. This study assessed the effectiveness of non-invasive vagus nerve stimulation (nVNS) in reducing brain lesion volume and improving neurobehavioral performance in a rat model of TBI. In conclusion, the higher dose nVNS (five 2 × 2-min stimulations) reduced brain lesion volume to a level that further refined the role of nVNS therapy for the acute treatment of TBI. Should nVNS prove effective in additional pre-clinical TBI models and later in clinical settings, it would have an enormous impact on the clinical practice of TBI in both civilian and military settings, as it can easily be adopted into routine clinical practice.

创伤性脑损伤(TBI)仍然是世界范围内死亡和残疾的主要原因。本研究评估了无创迷走神经刺激(nVNS)在减少脑损伤大鼠模型脑损伤体积和改善神经行为功能方面的有效性。总之，较高剂量的nVNS(5次2×2分钟刺激)将脑损伤体积缩小到一个水平，进一步完善了nVNS治疗在急性脑外伤治疗中的作用。如果nVNS在其他临床前脑损伤模型和后来的临床环境中被证明有效，它将对民用和军事环境中的脑损伤的临床实践产生巨大影响，因为它可以很容易地应用于常规临床实践。

REF: Divani AA, Salazar P, Ikram HA, et al. Non-Invasive Vagus Nerve Stimulation Improves Brain Lesion Volume and Neurobehavioral Outcomes in a Rat Model of Traumatic Brain Injury. J Neurotrauma. 2023;40(13-14):1481-1494. doi:10.1089/neu.2022.0153 PMID: 36869619 PMCID: PMC10294566

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Clinical Characteristics of and Treatment Strategy for Hydrocephalus in Patients With Severe Disorders of Consciousness

重度意识障碍合并脑积水的临床特点及治疗策略

Making an appropriate diagnosis and administering effective treatment for hydrocephalus in patients with severe disorders of consciousness (DOC) remains controversial and difficult. Given that the typical symptoms are usually concealed by the limited behavioral responsiveness of patients with severe DOC, hydrocephalus diagnosis is likely to be missed in the clinic. Even if not, the presence of hydrocephalus may reduce the likelihood of DOC recovery, posing a conundrum for clinicians. From December 2013 to January 2023, the clinical data and therapeutic schedule of hydrocephalus in patients with severe DOC at Huashan Hospital's Neurosurgical Emergency Center were studied retrospectively. This study summarized several evidence-based treatment experiences of hydrocephalus in patients with DOC.

对严重意识障碍(DOC)患者的脑积水进行适当的诊断和有效的治疗仍然存在争议和困难。鉴于重度DOC患者的典型症状通常被有限的行为反应所掩盖，临床上很可能遗漏脑积水的诊断。即使没有，脑积水的存在也可能降低DOC恢复的可能性，这对临床医生来说是一个难题。对2013年12月至2023年1月华山医院神经外科急救中心收治的重度DOC患者的临床资料和治疗方案进行回顾性研究。本研究总结了DOC患者脑积水的几种循证治疗经验。

REF: Zheng RZ, Xu Z, Wang Z, et al. Clinical Characteristics of and Treatment Strategy for Hydrocephalus in Patients With Severe Disorders of Consciousness. J Neurotrauma. 2023;40(13-14):1402-1414. doi:10.1089/neu.2022.0337 PMID: 36994490

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History of Traumatic Brain Injury in Relation to Cognitive Functioning, Memory Complaints, and Brain Structure in Mid-Life

中年创伤性脑损伤病史与认知功能、记忆主诉和脑结构的关系

In this study, we investigated history of traumatic brain injury with loss of consciousness in relation to cognitive functioning, subjective memory complaints, and brain structure in mid-life. This study included 2005 participants (mean age: 47.6 years, standard deviation: 5.0, women: 65%) from the Origins of Alzheimer's Disease Across the Life Course (ORACLE) study between 2017 and 2020. We found no associations between history of traumatic brain injury and any of the structural brain MRI outcomes. In conclusion, our study suggests that at least one lifetime traumatic brain injury with loss of consciousness in mid-life is associated with long-term subjective memory complaints, but not with cognitive functioning or brain structure.

在这项研究中，我们调查了创伤性脑损伤的病史与认知功能、主观记忆和大脑结构的关系。这项研究包括了2017至2020年间来自Oracle研究的2005名参与者(平均年龄：47.6岁，标准差：5.0，女性：65%)。我们没有发现创伤性脑损伤病史与任何结构性脑MRI结果之间的关联。总而言之，我们的研究表明，至少有一次中年时意识丧失的终生创伤性脑损伤与长期的主观记忆症状有关，而与认知功能或大脑结构无关。

REF: Zijlmans JL, Vernooij MW, Luik AI, Ikram MA. History of Traumatic Brain Injury in Relation to Cognitive Functioning, Memory Complaints, and Brain Structure in Mid-Life. J Neurotrauma. 2023;40(13-14):1415-1422. doi:10.1089/neu.2022.0325 PMID: 36226388

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Prediction of Mortality Among Patients With Isolated Traumatic Brain Injury Using Machine Learning Models in Asian Countries: An International Multi-Center Cohort Study

在亚洲国家使用机器学习模型预测单纯性脑损伤患者的死亡率：一项国际多中心队列研究

Traumatic brain injury (TBI) is a significant healthcare concern in several countries, accounting for a major burden of morbidity, mortality, disability, and socioeconomic losses. Although conventional prognostic models for patients with TBI have been validated, their performance has been limited. Therefore, we aimed to construct machine learning (ML) models to predict the clinical outcomes in adult patients with isolated TBI in Asian countries. Our study suggests that ML techniques might perform better than conventional multi-variate models in predicting the outcomes among adult patients with isolated moderate and severe TBI.

创伤性脑损伤(TBI)在一些国家是一个重要的医疗保健问题，占发病率、死亡率、残疾和社会经济损失的主要负担。尽管传统的脑外伤患者预后预测模型已经得到验证，但它们的性能受到限制。因此，我们的目标是构建机器学习(ML)模型来预测亚洲国家成人孤立性脑损伤患者的临床结果。我们的研究表明，ML技术在预测单纯性、中度和重度脑外伤成人患者预后方面可能比传统的多变量模型表现得更好。

REF: Song J, Shin SD, Jamaluddin SF, et al. Prediction of Mortality Among Patients With Isolated Traumatic Brain Injury Using Machine Learning Models in Asian Countries: An International Multi-Center Cohort Study. J Neurotrauma. 2023;40(13-14):1376-1387. doi:10.1089/neu.2022.0280 PMID: 36656672

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ADAM17 Aggravates the Inflammatory Response by Modulating Microglia Polarization Through the TGF-β1/Smad Pathway Following Experimental Traumatic Brain Injury

ADAM17通过转化生长因子-β-1/Smad通路调节小胶质细胞极化加重实验性脑损伤后的炎症反应

Microglia-mediated neuroinflammatory responses play important roles in secondary neurological injury after traumatic brain injury (TBI). The TGF-β pathway participates in the regulation of M1/M2 phenotype transformation of microglia. TGF-β can activate the Smad pathway by binding to TGF-βRs, which is regulated by the cleavage function of A disintegrin and metalloproteinase 17 (ADAM17). However, the role of ADAM17 and the associated signaling pathways in the pathological process after TBI remain unclear. Herein, we assessed the transformation of microglia M1/M2 phenotype polarization and the neuroinflammatory response after the inhibition of ADAM17. In conclusion, our study suggested that ADAM17 inhibition regulated microglia M1/M2 phenotype polarization through the TGF-β1/Smad pathway and influenced the neuroinflammatory response after TBI.

小胶质细胞介导的神经炎性反应在创伤性脑损伤后继发性神经损伤中起重要作用。TGF-β通路参与了小胶质细胞M1/M2表型转化的调控。TGF-β可通过与TGF-β受体结合而激活Smad途径，该途径受A去整合素和金属蛋白酶17(ADAM17)切割功能的调节。然而，ADAM17及其相关信号通路在颅脑损伤后的病理过程中的作用尚不清楚。在此，我们评估了ADAM17抑制后小胶质细胞M1/M2表型极化的转变和神经炎性反应。综上所述，我们的研究提示，ADAM17抑制通过TGF-β-1/Smad途径调节小胶质细胞M1/M2表型极化，从而影响脑创伤后的神经炎性反应。

REF: Chen X, Yao J, Lai J, et al. ADAM17 Aggravates the Inflammatory Response by Modulating Microglia Polarization Through the TGF-β1/Smad Pathway Following Experimental Traumatic Brain Injury. J Neurotrauma. 2023;40(13-14):1495-1509. doi:10.1089/neu.2022.0373 PMID: 37029898

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Stress Reactivity After Pediatric Traumatic Brain Injury: Relation With Behavioral Adjustment

儿童创伤性脑损伤后应激反应与行为调整的关系

Traumatic injury is linked increasingly to alterations in both stress response systems and psychological health. We investigated reactivity of salivary analytes of the hypothalamic-pituitary-adrenal axis (cortisol) and autonomic nervous system (salivary alpha amylase, sAA) during a psychosocial stress procedure in relation to psychological health outcomes. Our findings highlight altered sAA, but not cortisol reactivity, as a potential mechanism of biological vulnerability associated with poorer adjustment after TBI.

创伤越来越多地与压力反应系统和心理健康的改变联系在一起。我们研究了心理社会应激过程中下丘脑-垂体-肾上腺轴(皮质醇)和自主神经系统(唾液α-淀粉酶，SAA)唾液分析物的反应性与心理健康结果的关系。我们的发现强调了SAA的改变，而不是皮质醇的反应性，这是与颅脑损伤后较差的适应相关的生物脆弱性的潜在机制。

REF: Ewing-Cobbs L, Danna CV, Tolar TD, Granger D, Cox CS Jr, Prasad MR. Stress Reactivity After Pediatric Traumatic Brain Injury: Relation With Behavioral Adjustment. J Neurotrauma. 2023;40(13-14):1436-1450. doi:10.1089/neu.2022.0227 PMID: 36424831 PMCID: PMC10312200

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