Journal of neurotrauma最新文献

{"title":"SCO-Spondin-Derived Peptide NX210 Promotes Functional Recovery after Spinal Cord Injury in Mice.","authors":"Theresa C Sutherland, Sighild Lemarchant, Ashley J Douthitt, Alexandra H Lopez, Lily Kuhlman, Darijana Horvat, Arthur Sefiani, Sydney M Johnson, Zoha Hassan, Natalie Bachir, Ravali Dundumulla, Michelle Hook, Yann Godfrin, Cédric G Geoffroy","doi":"10.1177/08977151251359983","DOIUrl":"https://doi.org/10.1177/08977151251359983","url":null,"abstract":"<p><p>Spinal cord injury (SCI) represents a major public health issue, as the consequences are often irreversible with no treatment currently available. This results in a growing population living with long-lasting motor, sensory, and/or autonomic impairments directly related to their SCI. Here, we have evaluated the therapeutic potential of a thrombospondin repeats peptide analogue, named NX210, in a mouse hemisection model of SCI. Adult female mice were subjected to a thoracic level 8 dorsal hemisection, and treated with intraperitoneal injections of NX210 starting at 4 h post-injury and then twice a week at 4, 8, or 16 mg/kg. Hind limb motor function was assessed once a week for 10 weeks post-injury using the Basso Mouse Scale (BMS) score and sub-score, the rotarod, and the activity chamber tests. Mice were then sacrificed, and the spinal cords were collected for immunohistochemistry. Interestingly, NX210 improved functional recovery (BMS score and sub-score, latency to fall from the rotarod, spontaneous locomotor activity) with rapid rises in function that were maintained throughout the 10-week study. This was accompanied by a reduction of nociceptive reactivity assessed by the tail flick test. NX210 treatment also increased myelin basic protein and reduced neuron/glial antigen 2 at the injury site 10 weeks post-injury while no significant effects were observed on lesion size, inflammation, and neuron survival. Overall, this study highlights a potential new therapeutic strategy to promote repair and decrease long-lasting functional impairments after SCI.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667788","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":"Retrospective Identification and Characterization of Traumatic Brain Injury-Recommendations from the 2024 National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative Retrospective Classification Working Group.","authors":"John D Corrigan, Michael L Alosco, Joukje van der Naalt, Rachel Sayko Adams, Breton M Asken, Sidney Hinds, Anthony H Lequerica, Virginia Newcombe, Olli Tenovuo, Eve Valera, Deborah Yurgelun-Todd, Adele Doperalski, Hibah O Awwad, Kristen Dams-O'Connor, Andrew I R Maas, Michael A McCrea, Nsini Umoh, Geoffrey T Manley","doi":"10.1089/neu.2024.0590","DOIUrl":"10.1089/neu.2024.0590","url":null,"abstract":"<p><p>The National Institute of Neurological Disorders and Stroke (NINDS) convened experts in traumatic brain injury (TBI) research, policy, clinical practice and people with lived experience to propose a system of injury classification less susceptible to misinterpretation and misrepresentation inherent in the current use of \"mild\", \"moderate\" and \"severe\". One of six working groups addressed Retrospective Classification of TBI. The Working Group consisted of 14 experts in brain injury research representing a breadth of professional disciplines. Initial conclusions based on expert opinion were vetted and revised based on public input at the January 2024 NINDS TBI Classification and Nomenclature Workshop. The Working Group examined five types of methodologies for identifying past TBIs (self/proxy-report, medical record extraction, imaging, fluid-based biomarkers, and performance-based tests). They concluded that self/proxy-report is essential for clinical, research and surveillance applications and that clinicians and researchers should employ elicitation protocols that have been studied and found valid. Medical record extraction was also identified as an invaluable tool for identification of past history of medically attended TBIs; however, there is a need to standardize the case definition employed and procedures used. The use of imaging methods, fluid-based biomarkers, and performance-based assessments in isolation lacked sufficient evidence of both sensitivity and specificity in detecting past histories of TBI to be recommended for this use at this time. The Working Group also evaluated identification of repetitive head impacts (RHI), finding no evidence of a common definition of RHI, a requisite initial step for the development and validation of standardized instruments.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1086-1095"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Assessment on Days 1-14 for the Characterization of Traumatic Brain Injury: Recommendations from the 2024 NINDS Traumatic Brain Injury Classification and Nomenclature Initiative Clinical/Symptoms Working Group.","authors":"David K Menon, Noah D Silverberg, Adam R Ferguson, Thomas J Bayuk, Shubhayu Bhattacharyay, David L Brody, Scott A Cota, Ari Ercole, Anthony Figaji, Guoyi Gao, Christopher C Giza, Fiona Lecky, Rebekah Mannix, Ana Mikolić, Kasey E Moritz, Claudia S Robertson, Abel Torres-Espin, Spyridoula Tsetsou, John K Yue, Hibah O Awad, Kristen Dams-O'Connor, Adele Doperalski, Andrew I R Maas, Michael A McCrea, Nsini Umoh, Geoffrey T Manley","doi":"10.1089/neu.2024.0577","DOIUrl":"10.1089/neu.2024.0577","url":null,"abstract":"&lt;p&gt;&lt;p&gt;The current classification of traumatic brain injury (TBI) primarily uses the Glasgow Coma Scale (GCS) to categorize injuries as mild (GCS 13-15), moderate (GCS 9-12), or severe (GCS ≤8). However, this system is unsatisfactory, as it overlooks variations in injury severity, clinical needs, and prognosis. A recent report by the National Academies of Sciences, Engineering, and Medicine (USA) recommended updating the classification system, leading to a workshop in 2024 by the National Institute of Neurological Disorders and Stroke. This resulted in the development of a new clinical, biomarker, imaging, and modifier (CBI-M) framework, with input from six working groups, including the Clinical/Symptoms Working Group (CSWG). The CSWG included both clinical and non-clinical experts and was informed by individuals with lived experience of TBI and public consultation. The CSWG primarily focused on acute clinical assessment of TBI in hospital settings, with discussion and recommendations based on pragmatic expert reviews of literature. Key areas reviewed included: assessment of neurological status; performance-based assessment tools; age and frailty, pre-existing comorbidities, and prior medication; extracranial injuries; neuroworsening; early physiological insults; and physiological monitoring in critical care. This article reports their discussions and recommendations. The CSWG concluded that the GCS remains central to TBI characterization but must include detailed scoring of eye, verbal, and motor components, with identification of confounding factors and clear documentation of non-assessable components. Pupillary reactivity should be documented in all patients, but recorded separately from the GCS, rather than as an integrated GCS-Pupils score. At ceiling scores on the GCS (14/15), history of loss of consciousness (LoC) and the presence and duration of post-traumatic amnesia should be recorded using validated tools, and acute symptoms documented in patients with a GCS verbal score of 4/5 using standardized rating scales. Additional variables to consider for a more complete characterization of TBI include injury mechanism, acute physiological insults and seizures; and biopsychosocial-environmental factors (comorbidities, age, frailty, socioeconomic status, education, and employment). The CSWG recommended that, for a complete characterization of TBI, disease progression/resolution should be monitored over 14 days. While there was a good basis for the recommendations listed above, evidence for the use of other variables is still emerging. These include: detailed documentation of neurological deficits, vestibulo-oculomotor dysfunction, cognition, mental health symptoms, and (for hospitalized patients) data-driven integrated measures of physiological status and therapy intensity. These recommendations are based on expert consensus due to limited high-quality evidence. Further research is needed to validate and refine these guidelines, ensuring they ca","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1038-1055"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroimaging Characterization of Acute Traumatic Brain Injury with Focus on Frontline Clinicians: Recommendations from the 2024 National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative Imaging Working Group.","authors":"Christine L Mac Donald, Esther L Yuh, Thijs Vande Vyvere, Brian L Edlow, Lucia M Li, Andrew R Mayer, Pratik Mukherjee, Virginia F J Newcombe, Elisabeth A Wilde, Inga K Koerte, Deborah Yurgelun-Todd, Yu-Chien Wu, Ann-Christine Duhaime, Hibah O Awwad, Kristen Dams-O'Connor, Adele Doperalski, Andrew I R Maas, Michael A McCrea, Nsini Umoh, Geoffrey T Manley","doi":"10.1089/neu.2025.0079","DOIUrl":"10.1089/neu.2025.0079","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Neuroimaging screening and surveillance is one of the first frontline diagnostic tools leveraged in the acute assessment (first 24 h postinjury) of patients suspected to have traumatic brain injury (TBI). While imaging, in particular computed tomography, is used almost universally in emergency departments worldwide to evaluate possible features of TBI, there is no currently agreed-upon reporting system, standard terminology, or framework to contextualize brain imaging findings with other available medical, psychosocial, and environmental data. In 2023, the NIH-National Institute of Neurological Disorders and Stroke convened six working groups of international experts in TBI to develop a new framework for nomenclature and classification. The goal of this effort was to propose a more granular system of injury classification that incorporates recent progress in imaging biomarkers, blood-based biomarkers, and injury and recovery modifiers to replace the commonly used Glasgow Coma Scale-based diagnosis groups of mild, moderate, and severe TBI, which have shown relatively poor diagnostic, prognostic, and therapeutic utility. Motivated by prior efforts to standardize the nomenclature for pathoanatomic imaging findings of TBI for research and clinical trials, along with more recent studies supporting the refinement of the originally proposed definitions, the Imaging Working Group sought to update and expand this application specifically for consideration of use in clinical practice. Here we report the recommendations of this working group to enable the translation of structured imaging common data elements to the standard of care. These leverage recent advances in imaging technology, electronic medical record (EMR) systems, and artificial intelligence (AI), along with input from key stakeholders, including patients with lived experience, caretakers, providers across medical disciplines, radiology industry partners, and policymakers. It was recommended that (1) there would be updates to the definitions of key imaging features used for this system of classification and that these should be further refined as new evidence of the underlying pathology driving the signal change is identified; (2) there would be an efficient, integrated tool embedded in the EMR imaging reporting system developed in collaboration with industry partners; (3) this would include AI-generated evidence-based feature clusters with diagnostic, prognostic, and therapeutic implications; and (4) a \"patient translator\" would be developed in parallel to assist patients and families in understanding these imaging features. In addition, important disclaimers would be provided regarding known limitations of current technology until such time as they are overcome, such as resolution and sequence parameter considerations. The end goal is a multifaceted TBI characterization model incorporating clinical, imaging, blood biomarker, and psychosocial and environmental modifiers to better serve p","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1056-1064"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Marking a New Age in Characterization of Acute Traumatic Brain Injury: The National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative.","authors":"Geoffrey T Manley, Kristen Dams-O'Connor, Hibah O Awwad, Adele Doperalski, Nsini Umoh, Andrew I R Maas, Michael A McCrea","doi":"10.1089/neu.2025.0134","DOIUrl":"10.1089/neu.2025.0134","url":null,"abstract":"<p><p>This special issue of the <i>Journal of Neurotrauma</i> features a series of articles reporting the findings and recommendations of each of the six NINDS Initiative Working Groups. The collective efforts of the Working Groups with input from the broader TBI community mark a major step toward gaining more precise characterization of TBI and offer significant advantages over the current state of characterization for both clinicians, researchers, and people with lived experience. On behalf of all those who contributed to what marks a new era of improved characterization of TBI, we express our gratitude to NINDS for spearheading this effort and to the <i>Journal of Neurotrauma</i> for showcasing this important work.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1021-1022"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111021","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":"Toward More Holistic Early Traumatic Brain Injury Evaluation and Care: Recommendations from the 2024 National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative Psychosocial and Environmental Modifiers Working Group.","authors":"Lindsay D Nelson, Lindsay Wilson, Jennifer S Albrecht, David B Arciniegas, Ernest J Barthélemy, Sarah N Fontaine, Raquel C Gardner, Shannon B Juengst, Monique R Pappadis, Jennie Ponsford, Danny G Thomas, Keith Owen Yeates, Kristin Dams-O'Connor, Geoffrey T Manley, Andrew I R Maas, Michael A McCrea, Hibah O Awwad, Adele Doperalski, Nsini Umoh","doi":"10.1089/neu.2024.0569","DOIUrl":"10.1089/neu.2024.0569","url":null,"abstract":"<p><p>Biopsychosocial and environmental factors play a major role in acute clinical presentation, recovery, and outcome of traumatic brain injury (TBI). As part of the 2024 National Institute of Neurological Disorders and Stroke (NINDS) TBI Classification and Nomenclature Initiative, the Psychosocial and Environmental Modifiers (PEM) Working Group was assembled to perform a narrative review and summary of expert opinions regarding how non-TBI factors influence the presenting features and outcomes of TBI and to make recommendations for incorporating these Modifiers into clinical care and research. With input from working group members and other interested parties, we summarize the membership, methods, and outcomes of the PEM Working Group activities. Modifiers were considered with the NINDS Social Determinants of Health Framework in mind and fall under three broad headings: individual-level variables (e.g., demographics, preinjury health, culture), injury-related variables (e.g., cause and context of injury, second insults), and community-/societal-level factors (e.g., family/community support, socioeconomic position, structural racism). Recommendations include steps to increase awareness of Modifiers in health care encounters, identify Modifier-related disparities in TBI-related care and outcomes, better understand the mechanisms by which Modifiers influence TBI-related clinical presentation and outcomes, and intervene to improve the health and well-being of persons exposed to TBI. These recommendations are intended to be a starting point that will evolve as knowledge grows and additional input is incorporated.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1023-1037"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Starting with the End in Mind: Recommendations to Optimize Implementation of a Novel TBI Classification from the 2024 NINDS TBI Classification and Nomenclature Workshop's Knowledge to Practice Working Group.","authors":"Peter Bragge, Molly McNett, Mark Bayley, Maureen Dobbins, Risa Nakase-Richardson, Corinne Peek-Asa, Alexis F Turgeon, Hibah Awwad, Kristen Dams-O'Connor, Adele Doperalski, Andrew Maas, Mike McCrea, Nsini Umoh, Geoff Manley","doi":"10.1089/neu.2024.0576","DOIUrl":"10.1089/neu.2024.0576","url":null,"abstract":"<p><p>The Knowledge to Practice Working Group (K2P WG) was one of six expert groups convened in early 2023 to plan the 2024 National Institute of Neurological Disorders and Stroke Traumatic brain injury (TBI) Classification and Nomenclature Workshop. Recognizing that implementation of revised classification systems is essential to achieve intended impact, the K2P WG's key aims were to foster shared understanding of knowledge translation (KT), build capacity for implementation of a revised TBI classification system, identify and prioritize KT actions, implementation steps and audiences; and make recommendations to advance implementation. The cornerstone of this work was a focused survey to identify \"who needs to do what differently,\" while prioritizing potential implementation actions. Survey findings, dialogue with other working groups, stakeholder discussions, and public feedback were also utilized to support implementation of the revised Clinical, Biomarker, Imaging-Modifiers and retrospective TBI classification system. Forty researchers across five working groups responded to the survey (Response Rate = 59.7%). Fifty-two unique implementation actions were identified. The top 15 priorities across the five working groups comprised six pertaining to clinical practice (e.g., change Glasgow Coma Scale [GCS] assessment); seven focusing on research (e.g., develop tools for measuring psychological and environmental factors); and one each on lived experience (simplified language for patients and families) and other settings (insurance company support for biomarker testing). Twenty-seven stakeholder groups and 18 target settings were identified as being most impacted by the revised classification system. Key recommendations included: develop guidelines based on systematic reviews, clearly explain the rationale for the change, develop implementation toolkits with input from all stakeholders, and embed the new classification in a learning health system database to facilitate implementation strategies based on audits, feedback, and cost-effectiveness analyses.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1096-1108"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood-Based Biomarkers for Improved Characterization of Traumatic Brain Injury: Recommendations from the 2024 National Institute for Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative Blood-Based Biomarkers Working Group.","authors":"Jeffrey J Bazarian, Henrik Zetterberg, András Buki, Bradley A Dengler, Ramon Diaz-Arrastia, Frederick K Korley, Rachel Lazarus, Timothy B Meier, Stefania Mondello, Kasey Moritz, David O Okonkwo, Linda Papa, James B Phillips, Jussi P Posti, Ava M Puccio, Stephanie Sloley, Ewout Steyerberg, Kevin K Wang, Hibah O Awwad, Kristen Dams-O'Connor, Adele Doperalski, Andrew I R Maas, Michael A McCrea, Nsini Umoh, Geoffrey T Manley","doi":"10.1089/neu.2024.0581","DOIUrl":"10.1089/neu.2024.0581","url":null,"abstract":"<p><p>A 2022 report by the National Academies of Sciences, Engineering, and Medicine called for a Traumatic Brain Injury (TBI) Classification Workshop by the National Institutes of Health (NIH) to develop a more precise, evidence-based classification system. The workshop aimed to revise the Glasgow Coma Scale-based system by incorporating neuroimaging and validated blood biomarker tests. In December 2022, the National Institute for Neurological Disorders and Stroke formed six working groups of TBI experts to make recommendations for this revision. This report presents the findings and recommendations from the blood-based biomarker (BBM) working group, including feedback from the workshop and subsequent public review. The application of BBMs in a TBI classification system has potential to allow for a more adaptable and nuanced approach to triage, diagnosis, prognosis, and treatment. Current evidence supports the use of glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1, and S100B calcium-binding protein (S100B) to assist in reclassification of TBI at acute time points (0-24 h) primarily in emergency department settings, while neurofilament light chain (NfL), GFAP, and S100B have utility at subacute time points (1-30 days) in-hospital and intensive care unit settings. Blood levels of these biomarkers reflect the extent of structural brain injury in TBI and may be useful for describing the extent of structural brain injury in a classification system. While there is insufficient evidence to support a role for BBMs at chronic time points (>30 days), emerging evidence suggests that NfL and phosphorylated tau may have a potential future role in this regard. For inclusion in a revised TBI classification system, BBM assays must have appropriate age- and sex-specific reference ranges, be harmonized across platforms, and achieve high analytical precision, including accuracy, linearity, detection limits, selectivity, recovery, reproducibility, and stability. Improving transparency in BBM assay development can be achieved through large-scale data sharing of methods and results. Future research should focus on methods for promoting clinical adoption of BBM results, correlating BBMs with advanced neuroimaging, and on discovering new biomarkers for improved diagnosis and prognosis.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1065-1085"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Factors Affecting the Need for Mechanical Ventilation in Acute Traumatic Cervical Spinal Cord Injury.","authors":"Chonnawee Chaisawasthomrong, Atthaporn Boongird","doi":"10.1089/neu.2025.0006","DOIUrl":"10.1089/neu.2025.0006","url":null,"abstract":"<p><p>Acute traumatic cervical spinal cord injuries (TCSCI) are associated with significant mortality and morbidity, particularly when complicated by neurogenic respiratory failure. While upper cervical-level injuries are established risk factors for mechanical ventilation, patients with acute injuries below the fifth cervical level without significant chest trauma may also require ventilatory support. However, reliable early predictors remain unclear. This study aims to identify the primary predictors of early mechanical ventilation needs in patients with acute TCSCI. We conducted a retrospective analysis of 148 cases of TCSCI treated between 2019 and 2022. Among these, 27 cases (18.24%) required ventilatory support. Multivariate analysis revealed that a compression grade of 2 or higher, exceeding 25% on Computed Tomography (CT) (adjusted odds ratio [aOR]: 10.18; 95% CI: 2.03-50.94; <i>p</i> < 0.001), and a cord contusion length spanning at least two levels on Magnetic Resonance Imaging (MRI) (aOR: 2.11; 95% CI: 1.06-4.22; <i>p</i> = 0.03) were significant independent predictors. CT-based spinal cord compression measurements showed a strong correlation with MRI findings (linear regression coefficient = 0.88, 95% CI: 0.80-0.96; Spearman's rho = 0.90; both <i>p</i> < 0.001). The regression line was closely aligned with the equality line, indicating CT can reliably approximate MRI. Noninferiority testing revealed no significant difference in predicting mechanical ventilation risk between modalities (<i>p</i> = 0.21). Survival analyses stratified by compression grades demonstrated similar predictive performance, with higher compression grades (2-4) associated with increased risk of ventilation over time. These findings suggest that the degree of cord compression and cord contusion length are reliable, noninvasive predictors of the need for mechanical ventilation in TCSCI, emphasizing the importance of early recognition, cost-effective health care management, and prognostic counseling. The Subaxial Injury Classification and Severity Scale demonstrated borderline significance (sensitivity 81.5%, specificity 87.6%). The study found that patients with >25% cervical spinal cord compression had significantly poorer outcomes compared to those with ≤25% compression, including longer hospital stays, lower survival rates, worse pre-treatment neurological status, and higher complication rates. Surgical treatment, particularly the posterior approach, was more common in the >25% compression group; however, post-treatment neurological improvement was observed only in cases of grade 2 degree compression, not grades 3 and 4 in CT and MRI. In contrast, the ≤25% compression group demonstrated better outcomes, with greater post-treatment improvement. [Figure: see text].</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484690","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":"Cardiovascular and Locomotor Recovery Following Hindlimb Muscle Stretching of Rodents with a Clinically Relevant Model of Spinal Cord Injury.","authors":"Morgan Forston, Greta Cesarz, Danni Wood, Alice Shum-Siu, David Magnuson","doi":"10.1089/neu.2024.0349","DOIUrl":"https://doi.org/10.1089/neu.2024.0349","url":null,"abstract":"<p><p>Physical therapy stretching remains one of the most prevalent therapies for patients with spinal cord injury (SCI); however, we have previously shown that daily hindlimb muscle stretching of rats following a T10 SCI significantly disrupts their hindlimb locomotor function, likely through maladaptive sprouting of nociceptive afferents and modulation of lumbar spinal circuitry. Despite these clinically significant findings, mid-thoracic contusion models do not represent a majority of clinical injuries and are not effective for modeling the loss of cardiovascular control and autonomic complications that patients with higher level SCI experience. Therefore, the objective of the current study was to examine the effects of hindlimb stretching on the locomotor and cardiovascular function of rats with a T2 SCI. Twenty-six female Sprague-Dawley rats received a moderate T2 contusion (25 g/cm) and were divided into SCI Control (<i>n</i> = 14) and Stretched (<i>n</i> = 12) groups. Our daily hindlimb stretching protocol was initiated at week 5 post-SCI and administered 5 days/week for 4 weeks before a portion of the animals from each group were euthanized. The remaining animals (Control: <i>n</i> = 8, Stretched: <i>n</i> = 6) recovered for 3 weeks before euthanasia. Locomotor function was assessed using the Basso, Beattie and Bresnahan Open Field Locomotor Scale and kinematic gait analysis. Additionally, cardiovascular indices were collected using echocardiography at baseline, pre-stretching, post-stretching, and post-recovery timepoints. Four weeks of daily stretching led to transient disruption of locomotor function as well as reduced overnight activity followed by robust improvements in locomotion once stretching was no longer administered. Although stretching did not appear to have a dramatic effect on cardiovascular indices, both groups displayed significant changes over time in cardiac output and stroke volume. Furthermore, immunohistochemistry staining revealed that stretching did not exacerbate Calcitonin Gene-Related Protein (CGRP⁺) nociceptor sprouting in the lumbar dorsal horn, contrary to the effects we have shown in T10 stretched animals. Overall, these results indicate that hindlimb stretching following a high-thoracic SCI does not appear to aberrantly modulate lumbar spinal circuitry as has been shown in low thoracic injuries. Additionally, stretching combined with a T2 SCI does not result in cardiovascular dysfunction, although future work must be conducted to determine whether stretching triggers autonomic events and maladaptive plasticity near the spinal lesion.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302248","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}