Journal of neurotrauma最新文献

{"title":"Role of Circular RNAs in Traumatic Brain Injury and Spinal Cord Injury.","authors":"Vijay Arruri, Suresh L Mehta, Raghu Vemuganti","doi":"10.1177/08977151261449704","DOIUrl":"https://doi.org/10.1177/08977151261449704","url":null,"abstract":"<p><p>Circular RNAs (circRNAs) are a unique class of noncoding RNAs that are formed post-transcriptionally, unlike all other classes of ncRNAs that are transcribed from the genome. They are the only class of RNAs that are closed loops with no 5' and 3' ends. Recent studies showed that mammals form >100,000 unique circRNAs that contain only exons, only introns, or both exons and introns. circRNAs are formed and degraded by various mechanisms, which are specific to this class of RNAs. This review article discusses the functional significance of circRNAs in the pathophysiology of traumatic brain injury and spinal cord injury, with an emphasis on their functionality in controlling mechanisms such as inflammation, oxidative stress, apoptosis, autophagy, neuronal plasticity, neuroprotection, and functional recovery, which are all important for outcomes after an acute central nervous system injury.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"8977151261449704"},"PeriodicalIF":3.8,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ecological Momentary Assessment of Activity Demand and Time-of-Day Effects on Post-Concussion Symptoms.","authors":"Allie J Tracey, Amanda R Rabinowitz","doi":"10.1177/08977151261449593","DOIUrl":"https://doi.org/10.1177/08977151261449593","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Engaging in mentally and/or physically demanding activities post-injury may play a role in post-concussion symptom expression; however, the temporal effects of activity demand on post-concussion symptoms in adults with persistent post-concussion symptoms (PPCS) are unclear. The purpose of this study was to examine activity demand and time-of-day effects of post-concussion symptoms in individuals with PPCS using ecological momentary assessment (EMA). We enrolled 40 adults (60.5% female; mean age = 42.53 ± 11.36 years) with PPCS in our prospective observational study with repeated measures. Participants completed a 20-day EMA period in which they responded to a smartphone app five times per day to report PPCS symptoms and the activities they were currently engaged in. PPCS symptoms were reported using the Post-Concussion Symptom Scale (PCSS), a 22-item symptom inventory that includes total symptoms (possible range = 0-132) and symptom clusters: cognitive-migraine-fatigue (possible range = 0-66), affective (0-18), sleep (0-12), and somatic (0-12). For each activity reported by participants, they were asked to characterize it as mentally demanding, physically demanding, both, or neither. Descriptive statistics captured PCSS scores and characterizations of activity demand. Linear mixed-effects models (LMMs) examined the effects of time of day and activity demand on PCSS symptom scores. During the EMA period, PCSS scores were in the clinically significant range (mean = 24.68 ± 21.04; range = 0-106). Mean symptom domain scores were 16.53 ± 13.84 for cognitive-migraine-fatigue (range = 0-63), 3.25 ± 4.05 for affective (range = 0-18), 1.69 ± 2.59 for sleep (range = 0-12), and 1.05 ± 1.72 for somatic symptoms (range = 0-10). Across all observations (&lt;i&gt;n&lt;/i&gt; = 2,984), among the four activity characterization options, activities were most frequently characterized as neither mentally nor physically demanding (&lt;i&gt;n&lt;/i&gt; = 1,675, 44.3%), and most participants (&lt;i&gt;n&lt;/i&gt; = 26, 68.4%) characterized activities in this category most frequently. Open-ended responses elaborating on activities in this category included \"doing nothing,\" \"sleeping/relaxing,\" \"watching TV,\" and \"eating.\" Linear mixed-effects model (LMM) results (based on 38 participants with &gt;33% response rates) showed that activity demands were significantly associated with symptoms. Mentally demanding activities were associated with increases in total and cognitive-migraine-fatigue symptoms, whereas physically demanding activities were associated with decreases in these symptoms. Mentally demanding and combined mentally and physically demanding activities were also associated with increased affective symptoms. Additionally, time of day was significantly associated with cognitive-migraine-fatigue symptoms, with increases in symptoms later in the day compared with early in the morning. The present findings extend existing literature by demonstrating the utility of EMA for capturing real-time associa","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"8977151261449593"},"PeriodicalIF":3.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review with Qualitative Synthesis of Gut Microbiota Alterations after Acute Brain Injury.","authors":"Emilie Occhiali, Domitille Renard, Camille Molkhou, Gaëtan Kerdelhué, Thomas Clavier, Charles Baulier, Najate Achamrah","doi":"10.1177/08977151261449708","DOIUrl":"https://doi.org/10.1177/08977151261449708","url":null,"abstract":"<p><p>Acute brain injury (ABI), traumatic or nontraumatic, profoundly disrupts the gut microbiota (GM). To provide intensive care physicians with a clearer understanding of this phenomenon, we conducted a systematic review with qualitative synthesis. Due to significant heterogeneity in study designs, populations, and outcomes, a meta-analysis was not feasible. Instead, findings were synthesized thematically, focusing on study types, microbiota metrics, and clinical associations. Across studies, ABI is consistently associated with reduced microbial diversity, a decline in the relative abundance of several species, and increased interindividual variability in GM composition. Notably, phyla, such as Pseudomonadota, Bacteroidota, and Verrucomicrobiota, are frequently enriched, whereas Bacillota tends to be depleted. These patterns of dysbiosis appear largely consistent regardless of ABI etiologies. Furthermore, GM alterations can occur within a few hours postinjury and often return to baseline levels within months. The review highlights the metabolic, immune, and neuronal disruptions induced by ABI, which may contribute to gastrointestinal dysfunction and negatively influence patient prognosis. Moreover, standard intensive care unit (ICU) therapies may exacerbate GM disturbances. Importantly, dysbiosis has been linked to adverse clinical outcomes (delayed recovery, increased mortality). Emerging therapeutic strategies (metabolite supplementation, fecal microbiota transplantation) have shown potential to modulate the GM and support postinjury recovery. However, the underlying mechanisms of ABI-related dysbiosis and its consequences remain incompletely understood. Future research should aim to clarify the pathophysiological drivers of GM disruption, explore the potential prognostic value of GM dynamics, and assess how ICU therapies influence GM evolution. Developing GM-targeted interventions may offer novel opportunities to modulate ABI-related complications and improve patient outcomes.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"8977151261449708"},"PeriodicalIF":3.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Cortical Impact to Inattention: Real-Time Acetylcholine Disruption Links Brain Trauma to Attentional Deficits.","authors":"Eleni H Moschonas, Ellen M Annas, Veronica D Domyslawski, Hong J Young, Shamseldin A H Metwally, Haley E Capeci, Jeffrey P Cheng, Dandan Sun, Anthony E Kline, Corina O Bondi","doi":"10.1177/08977151261449048","DOIUrl":"https://doi.org/10.1177/08977151261449048","url":null,"abstract":"<p><p>Attentional deficits are prevalent and persistent after traumatic brain injury (TBI), yet our understanding of their etiology is incomplete. In uninjured rats, <i>in vivo</i> microdialysis studies show that task-evoked increases in acetylcholine (ACh) in the medial prefrontal cortex (mPFC) correlate with enhanced attentional performance. The goal of this study was to test the hypothesis that TBI decreases task-evoked ACh in the mPFC, compromises nucleus basalis of Meynert (nbM) cholinergic neuron morphology, and impairs attention. Adult male Sprague-Dawley rats trained on the three-choice serial reaction time (3-CSRT) task and then received either a controlled cortical impact or sham injury (<i>n</i> = 10/group). Dialysate samples were collected by <i>in vivo</i> microdialysis before and during the 3-CSRT task, and ACh levels were quantified using high-performance liquid chromatography. Cholinergic neurons in the contralateral/ipsilateral nbM were reconstructed and analyzed using the IMARIS software. The findings revealed a task-evoked decrease in ACh in the TBI group, a significant reduction in soma area/volume in the ipsilateral nbM, and impaired sustained attention as measured by performance on the 3-CSRT task. The findings support the hypothesis that TBI-induced attentional impairments are linked to disrupted real-time cholinergic signaling in the mPFC and associated structural changes in cholinergic neurons. These insights could inform the development of targeted interventions to improve quality of life for TBI survivors.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"8977151261449048"},"PeriodicalIF":3.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Labor and Disability: A Nation-Wide Analysis of Pregnancy Outcomes after Spinal Cord Injury.","authors":"Madison J Michles, Weston C de Lomba, Felicia W Sun, Oliver Y Tang, Jennifer Reavis, Owen P Leary, Bianca Bergsneider, Felipe Bispo, Elaina J Wang, Rahul A Sastry, Jared S Fridley, Adetokunbo A Oyelese, Ziya L Gokaslan, Patricia L Zadnik Sullivan","doi":"10.1177/08977151261438979","DOIUrl":"https://doi.org/10.1177/08977151261438979","url":null,"abstract":"<p><p>Spinal cord injury (SCI) is a challenging clinical entity necessitating multidisciplinary management. While the impact of SCI on male fertility is relatively well-understood, its impact on prepartum, peripartum, and fetal outcomes remains understudied. This study seeks to elucidate prepartum and delivery-related outcomes associated with a history of SCI in pregnant patients. We identified all pregnant patients admitted to United States hospitals with and without a history of SCI in the National Inpatient Sample from 2016 to 2019. For all patients, five outcomes were analyzed: in-hospital death, discharge disposition, prepartum complications, length of stay (LOS), and cost. For patients undergoing delivery during admissions, five additional outcomes were studied: preterm labor, epidural anesthesia administration, performance of cesarean section (CS), delivery-related complications, and fetal outcome. Unadjusted outcomes were summarized using survey-weighted estimates. Adjusted associations between SCI and maternal outcomes were estimated using stabilized inverse probability of treatment weighting (IPTW) with doubly robust models. We identified 367 unweighted SCI admissions, corresponding to a survey-weighted national estimate of 1,835 SCI admissions (0.01%) among 15,073,815 pregnancy admissions. 91.6% of admissions were for delivery, with 32.5% undergoing CS. Pregnant patients with SCI had an average age of 30.3 years, and a plurality of injuries was lumbosacral (20.7%). Among all pregnant admissions, patients with a history of SCI had higher odds of inpatient mortality (OR = 45.54 [95% CI: 8.45-245.40], <i>p</i> < 0.001), lower rates of routine discharge disposition (OR = 0.17, <i>p</i> < 0.001), greater LOS (+50%, <i>p</i> < 0.001), and elevated costs (+49%, <i>p</i> < 0.001). SCI patients were more likely to have prepartum complications of venous thromboembolism (VTE) (OR = 4.01, <i>p</i> = 0.041) and genitourinary infections (OR = 4.26, <i>p</i> < 0.001). SCI patients were significantly less likely to be admitted electively (39.5% vs. 47.9%, <i>p</i> < 0.001) or for delivery (OR = 0.38, <i>p</i> < 0.001). Among admissions for delivery, there were no differences in preterm labor or epidural anesthesia administration, but patients with SCI were less likely to experience delivery-related complications (OR = 0.56, <i>p</i> = 0.017) and stillbirth (OR = 0.05, <i>p</i> = 0.003). SCI patients had significantly higher odds of undergoing CS (OR = 1.88, <i>p</i> = 0.006). These findings suggest that SCI confers substantial excess maternal risk, particularly for mortality, as well as VTE, urinary tract infection, CS, and overall resource utilization. Future work using SCI-specific registries with detailed neurological characterization and longitudinal follow-up is needed to refine risk stratification and inform multidisciplinary guidelines for pregnancy management in this population.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"8977151261438979"},"PeriodicalIF":3.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normative Gray Matter Stiffness Gradients in the Human Brain Predict Patterns of Cortical Injury after Concussion.","authors":"Adnan A Hirad, Steven P Meyers, Arun Venkataraman, Ahmed A Alshareef, Doran Mix, Bradford Z Mahon","doi":"10.1177/08977151261446503","DOIUrl":"https://doi.org/10.1177/08977151261446503","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Finite-element modeling and &lt;i&gt;in vivo&lt;/i&gt; MR strain mapping show that mechanical strain concentrates in the cortex, and late-life neurodegenerative sequelae of traumatic brain injury (TBI) are predominantly gray matter disorders. Nonetheless, &lt;i&gt;in vivo&lt;/i&gt; evidence of acute gray matter damage after mild TBI (mTBI) has remained elusive. The empirical gap derives from a limitation of conventional diffusion tensor metrics, which are blind to the cortex's isotropic yet mechanically relevant solid-phase matrix of soma (glial and neural), dendrites, and extracellular scaffold. Here, we leveraged constrained spherical deconvolution (CSD)-derived \"total\" apparent fiber density (AFD) to index this solid-phase microarchitecture to test two predictions: (1) regional AFD covaries with magnetic resonance elastography (MRE)-derived cortical stiffness, and (2) AFD can detect gray matter injury that tensor metrics miss. We tested the first hypothesis by relating AFD from 349 healthy adults who underwent diffusion MRI to measures of shear modulus from an independent cohort of 59 healthy adults scanned with MRE. The regional distribution of AFD explained 74% of the variance in MRE-measured shear stiffness, indicating AFD is strongly coupled to the microarchitectural features that influence tissue rigidity. We then tested the clinical utility of AFD in three cross-sectional mTBI cohorts-acute (∼72 h), subacute (2 weeks to 90 days), and chronic (&gt;90 days)-each compared with age- and sex-matched controls. Effect sizes were thresholded using Cohen's &lt;i&gt;d&lt;/i&gt;; parcels or tracts with |&lt;i&gt;d&lt;/i&gt;| ≥ 2.0 were chosen to isolate effects that are both statistically extreme and robust to distributional effects and technical noise. Using those criteria, 11 cortical parcels in the acute cohort showed decreased AFD. This expanded to 116 parcels in the subacute group and 106 parcels in the chronic cohort; fractional anisotropy detected no parcels, and mean diffusivity flagged only 7-9 parcels. MRE-based stiffness estimates in healthy controls further stratified the observed abnormalities: compliant cortex (∼1.6 kPa) showed AFD gains during recovery; by contrast, the stiffest cortex (∼3.0 kPa) showed persistent decreases, with baseline modulus accounting for &gt;50% of variance in ΔAFD. Across parcels, baseline stiffness from healthy controls predicted the magnitude of AFD change in both the subacute and chronic cohorts: stiffer cortex showed larger AFD decreases; less stiff cortex showed AFD increases (Spearman ρ ≈ -0.72 to -0.74, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). AFD also revealed robust abnormalities in 12 major white matter tracts across all mTBI cohorts, outperforming diffusion tensor metrics. Because MRE and diffusion MRI were acquired in independent cohorts, these findings should be interpreted as showing that normative region-wise stiffness gradients predict the direction and magnitude of postinjury AFD alterations. This is the first &lt;i&gt;in vivo&lt;/i&gt; evidence that joint diffusion MRI an","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"8977151261446503"},"PeriodicalIF":3.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blast Exposure Does Not Increase Blood Biomarkers of Neurodegeneration in Service Members and Veterans with and Without Uncomplicated Mild TBI.","authors":"Sara Marie Lippa, Jessica Gill, Chen Lai, Jan Kennedy, Lars Hungerford, Jason M Bailie, Tracey Brickell, Louis French, Rael Lange","doi":"10.1177/08977151261446415","DOIUrl":"https://doi.org/10.1177/08977151261446415","url":null,"abstract":"<p><p>Prior investigations of how lifetime blast exposure relates to blood biomarkers of brain injury have been limited by small sample sizes and have produced conflicting results. This investigation examined how lifetime blast exposure relates to glial fibrillary acidic protein (GFAP), ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1), neurofilament light (NfL), tau, and hyperphosphorylated tau (p-tau) in service members and veterans (SMVs) with and without uncomplicated mild TBI (mTBI). Participants were 422 SMVs prospectively enrolled in a Defense and Veterans Brain Injury Center-Traumatic Brain Injury Center of Excellence Longitudinal TBI Study. Participants were divided into four groups based on self-reported lifetime blast exposure history as assessed by a single question: none (<i>n</i> = 93), low (<i>n</i> = 136), medium (<i>n</i> = 71), and high (<i>n</i> = 122). Analysis of Covariance was used to examine group differences on GFAP, UCH-L1, NfL, tau, and p-tau. There was a significant effect of blast exposure group on NfL (<i>p</i> = 0.002, η_p ²= 0.034) and GFAP (<i>p</i> = 0.035, η_p ²= 0.021), but not UCH-L1, tau, or p-tau. <i>Post hoc</i> comparisons with Bonferroni correction indicated NfL was higher in the No Blast group compared with the Low Blast (<i>p</i> = 0.004) group, but not the Medium Blast (<i>p</i> = 0.069) or High Blast (<i>p</i> = 1.0) groups. GFAP did not significantly differ between the groups after Bonferroni correction (ps > 0.05). Overall, the lone finding that survived correction for multiple comparisons suggested that participants with low levels of self-reported blast exposure exhibited lower levels of NfL than participants with no history of blast exposure. There were no differences in UCH-L1, tau, or p-tau based on self-reported blast exposure in a large sample of SMVs with and without mTBI.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"8977151261446415"},"PeriodicalIF":3.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reappraisal of Computerized Tomography Scoring Systems for Outcome Prediction in Traumatic Brain Injury: A Comparative Analysis of Young and Older Adults.","authors":"Ana M Castaño-Leon, Pedro A Gomez, Igor Paredes, Pablo M Munarriz, Amaya Hilario Barrio, Monica Maldonado Luna, Andreea Enmanuela Baciu, Leandro Tosi Ugarte, Carlos E Loynaz Cardona, Sofia Martinez Molina, Alfonso Lagares","doi":"10.1177/08977151261442475","DOIUrl":"https://doi.org/10.1177/08977151261442475","url":null,"abstract":"<p><strong>Background: </strong>Several computerized tomography (CT)-based scoring systems have been developed to grade traumatic brain injury (TBI) and predict outcome. However, most were derived from younger populations, and their performance in older adults-who represent an increasing proportion of TBI patients-remains unclear. This study evaluated the prognostic performance of different CT-based models for short- and long-term outcomes in younger versus older adults (≥65 years).</p><p><strong>Methods: </strong>We retrospectively analyzed 1935 consecutive TBI patients admitted between 2013 and 2024. Individual components of each CT scoring system were recorded from the first CT scan obtained within 24 h after injury. The Marshall CT classification, Neuroimaging Radiological Interpretation System (NIRIS), Rotterdam, Helsinki, and Stockholm CT scores were evaluated. Outcomes included short-term outcomes (TBI-related in-hospital mortality, surgical evacuation of intracranial lesions, intracranial pressure monitoring, and intracranial lesion progression) and long-term outcomes (mortality and unfavorable outcome [Glasgow Outcome Scale {GOS} 1-3] at 6 months). Model performance was assessed using discrimination, calibration, and overall fit. Explanatory contribution of CT findings was evaluated through proportional explained variance. Published equations were applied when available to validate long-term outcome predictions. Internal validation was performed using optimism-corrected bootstrap resampling (1000 iterations).</p><p><strong>Results: </strong>Long-term outcome data were available for 1798 patients (1243 younger and 555 older adults). Overall, prognostic performance was significantly better in younger than in older adults across all outcome measures. The Helsinki CT score demonstrated the best overall performance, with area under the receiver operating characteristic curve values ranging from 0.805 to 0.877. While the Marshall and Rotterdam scores performed comparably to the Helsinki score in predicting in-hospital and 6-month mortality in younger adults, they were significantly less accurate for predicting unfavorable outcomes. The Rotterdam score showed particularly poor performance in older adults. For identifying patients at risk of Marshall CT class deterioration or requiring intracranial pressure monitoring, the NIRIS and Stockholm CT scores performed better, respectively, and maintained noninferior performance in older adults.</p><p><strong>Conclusions: </strong>CT-based prognostic models show reduced accuracy in older adults compared with younger patients. Among the evaluated tools, the Helsinki CT score provided the most reliable prediction of mortality and unfavorable outcome across age groups, including the older adults.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"8977151261442475"},"PeriodicalIF":3.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Neurological Impact of Repetitive Low-Level Blast Overpressure Exposure.","authors":"Antony Sutherland, Stuart J McDonald, Gershon Spitz, Catherine Kelaher, Terence J O'Brien, Sandy R Shultz","doi":"10.1177/08977151261442215","DOIUrl":"https://doi.org/10.1177/08977151261442215","url":null,"abstract":"<p><p>Repetitive low-level blast overpressure exposure is an increasingly recognized occupational hazard for military, law enforcement, and specialist breaching personnel. Unlike high-level blast exposures that commonly result in overt traumatic brain injury, acute low-level blast events have not been demonstrated to produce clinically detectable concussion or neurological injury in isolation. Nevertheless, growing concern has emerged that repeated low-level blast exposure may impart cumulative biomechanical stress, capable of producing biologically and clinically meaningful adverse brain effects over time. This narrative review synthesizes human epidemiological, clinical, neuroimaging, and biomarker evidence published between 2010 and 2025, regarding the neurological impact of repetitive low-level blast exposure. We review exposure contexts and operational epidemiology, blast physics, and candidate mechanistic pathways, including axonal and glial stress, cerebrospinal fluid-tissue interface effects, and blast-related vascular perturbation with blood-brain barrier dysfunction, that are supported by converging human translational findings. Clinical manifestations are examined across cognitive, vestibular, oculomotor, auditory, headache, and psychological domains, highlighting the subtle, cumulative, and often subclinical nature of observed effects. We further evaluate emerging fluid biomarkers and advanced neuroimaging modalities that provide evidence of astroglia activation, axonal stress, neurovascular perturbation, and network-level dysfunction in occupationally exposed cohorts. Importantly, current evidence does not demonstrate that repetitive low-level blast exposure alone is sufficient to cause neurodegenerative disease. Rather, findings support a model in which cumulative low-level blast may act as a modifier of neural vulnerability, particularly in individuals with mixed exposure histories or additional risk factors. We conclude by identifying critical gaps in exposure quantification, longitudinal data, and dose-response modeling, and discuss implications for future research and occupational brain-health surveillance.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"8977151261442215"},"PeriodicalIF":3.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Traumatic Brain Injury on Fracture Healing in Polytrauma.","authors":"Tony Daniel Baldini, Maryam Rahmati, Kiarash Shahlaie, Richard Price, Prism Schneider, Safdar Khan, Mark A Lee, Augustine Mark Saiz","doi":"10.1177/08977151261438945","DOIUrl":"https://doi.org/10.1177/08977151261438945","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) has systemic consequences for patients, including a serendipitous role in enhancing fracture healing. Although most polytraumatic injuries impair bone repair, TBI has been associated with accelerated fracture healing and excessive callus formation. This review explores the current understanding of brain-bone interaction and the mechanisms by which TBI may promote osteogenesis. Key contributing factors include an altered immune response, endocrine modulation, sympathetic signaling, neuropeptide signaling, increased osteogenic factors, and exosomal microRNAs. These components influence many elements of fracture healing, including macrophage polarization, osteoblast differentiation, angiogenesis, and suppression of osteoclast activity. Additionally, the overlap between mechanisms of neurogenic heterotopic ossification and fracture healing in the context of associated TBI will be reviewed. Despite substantial pre-clinical and clinical evidence supporting this phenomenon, its translation to therapeutic strategies remains limited. We will discuss future directions for fracture studies that consider the emerging mechanisms of TBI-induced accelerated fracture repair, the existing complexity and challenges in the field, and the potential role of the evidence in developing novel therapeutic options. Understanding these pathways holds promise for advancing fracture and complex musculoskeletal injury treatment, ultimately improving patient outcomes.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"8977151261438945"},"PeriodicalIF":3.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}