Journal of neurotrauma最新文献

{"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 Mass, Michael A McCrea, Nsini Umoh, Geoffrey T Manley","doi":"10.1089/neu.2024.0590","DOIUrl":"https://doi.org/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":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Nomogram Predicts the Risk Factors for Post-Traumatic Cerebral Infarction in Polytrauma Patients with Traumatic Brain Injury.","authors":"Jianye Miao, Xin Qian, Zhenjun Miao, Jiayi Li, Litao Zhang, Renguang Zhang, Xianjun Ma, Yousef Rastegar-Kashkooli, Lang Liu, Nan Li, Qian Bai, Jiewen Zhang, Chao Jiang, Simeng Gu, Jian Wang, Junmin Wang","doi":"10.1089/neu.2024.0511","DOIUrl":"https://doi.org/10.1089/neu.2024.0511","url":null,"abstract":"<p><p>Post-traumatic cerebral infarction (PTCI) is a significant complication in polytrauma patients with traumatic brain injury (TBI). Identifying high-risk patients for early intervention is crucial. This study aims to investigate the independent risk factors for PTCI in polytrauma patients with TBI to establish and validate a prediction model. A retrospective analysis was conducted on 511 patients with TBI and multiple injuries admitted between January 2016 and July 2023. The patients were divided into groups based on whether they developed PTCI. Independent risk factors for PTCI were identified using univariable, Lasso, and multivariable logistic regression analysis. A nomogram was established to predict the risk factors for PTCI. The receiver operating characteristic (ROC) area under the curve (AUC), calibration curve, and decision curve analysis (DCA) were used to determine the predictive accuracy, discrimination, and clinical effectiveness of the nomogram, respectively. In addition, the Hosmer-Lemeshow test was used to assess the goodness-of-fit. Clinically significant associations were observed between PTCI and factors such as cerebral hernia, traumatic subarachnoid hemorrhage, basilar skull fracture, shock index, platelets, platelet-lymphocyte ratio (PLR), prothrombin time, international normalized ratio, D-dimer, albumin, injury severity score, and Glasgow coma score (all <i>p</i> < 0.05). These variables screened by Lasso regression were incorporated in multivariate logistic regression. They identified cerebral hernia, basilar skull fracture, PLR, D-dimer, and albumin as independent risk factors for PTCI (all <i>p</i> < 0.05). The analysis results were visually represented using a nomogram. The AUC of the prediction cohort was 0.9 [95% confidence interval (95% confidence intercal (CI)): 0.84, 0.97], and of the validation cohort was 0.87 (95% CI: 0.79, 0.96). The nomogram prediction model demonstrates excellent performance according to the ROC, calibration curve, and DCA, providing valuable insights for the early identification of high-risk PTCI patients.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110942","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":"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":"https://doi.org/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":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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":"https://doi.org/10.1089/neu.2025.0134","url":null,"abstract":"<p><p>This special issue of the <i>Journal of Neurotrauma</i> features a series of manuscripts 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":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-20","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":"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":"https://doi.org/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":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volume Loss in the Mammillary Bodies, Fornix, and Other Papez Circuit Structures in Fighters with Traumatic Encephalopathy Syndrome.","authors":"Christopher Karakasis, Charles Bernick, Jennifer Bullen, Ken Sakaie, Stephen E Jones, Jonathan Lee","doi":"10.1089/neu.2025.0011","DOIUrl":"https://doi.org/10.1089/neu.2025.0011","url":null,"abstract":"<p><p>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 <i>in vivo</i> mammillary body and fornix volumes to support the role of these structures as imaging biomarkers for TES. Additionally, associations with other structures of the Papez circuit and relevant cognitive tests were explored. This observational cohort study used data from a subset of fighters and control participants in the Professional Athletes Brain Health Study (PABHS). The relationship was examined between clinical groups (controls, TES-negative fighters, and TES-positive fighters) and automated measurements of mammillary body and fornix size. Manual measurements were also performed to confirm the automated results and demonstrate clinical relevance. Associations were assessed between mammillary body/fornix size, cognitive scores, and volumes of other structures including components of the Papez circuit. The sample consisted of 177 individuals (61 controls, 46 TES-positive fighters, and 70 TES-negative fighters). Automated measurements of mammillary body volumes were on average ∼7.6 mm³ (15%) smaller in TES-positive fighters than in TES-negative fighters and controls (<i>p</i> < 0.001 for both). Automated measurements of fornix volumes were on average 110.5 mm³ (24%) smaller in TES-positive fighters than in TES-negative fighters and 156.5 mm³ (29%) smaller in TES-positive fighters than in controls (<i>p</i> < 0.001 for both). Similar findings were observed with manual measurements. Decreased mammillary body and fornix size were associated with lower volumes in the other components of the Papez circuit/associated structures (<i>p</i> < 0.01 for all) and worse psychomotor (<i>p</i> = 0.001 for both) and memory (<i>p</i> < 0.001 for both) scores. This 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.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008918","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":"Correlating Magnetoencephalography, Diffusion Kurtosis Imaging, Biomechanics, and Neuropsychology in American Youth Football.","authors":"Natalie M Bell, Fang F Yu, Yin Xi, Amy L Proskovec, James M Holcomb, Sahil Chilukuri, Jillian E Urban, Christopher Vaughan, Jesse C DeSimone, Ben Wagner, Mark A Espeland, Alexander K Powers, Christopher T Whitlow, Joel D Stitzel, Joseph A Maldjian, Elizabeth M Davenport","doi":"10.1089/neu.2024.0222","DOIUrl":"https://doi.org/10.1089/neu.2024.0222","url":null,"abstract":"<p><p>This study investigated the association between repetitive head impacts (RHIs) and multimodal neuroimaging, biomechanical, and neuropsychological data in 72 youth football players and 17 controls, aged 8-12 years. Helmet sensors measured RHI exposure while imaging and psychological data were collected before and after the season. Risk-weighted exposure metrics were calculated to quantify cumulative RHI exposure. Changes in magnetoencephalography (MEG) and diffusion kurtosis imaging were analyzed by calculating voxel-wise difference, and z-score maps were thresholded with respect to controls. Using linear regression, statistically significant positive associations were observed between abnormally increased MEG-measured theta (5-7 Hz) power and RHI measures. No associations were found between RHI and other neuroimaging metrics. Football players and controls exhibited significant yet divergent associations between alpha (8-12 Hz) power as well as mean kurtosis and neuropsychological changes. These findings indicate a potential association between youth football players' exposure to RHI and neurophysiological alterations.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997556","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":"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":"https://doi.org/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":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alterations in Topological Structure and Modular Interactions in Pediatric Patients with Complete Spinal Cord Injury: A Functional Brain Network Study.","authors":"Yu Wang, Ling Wang, Beining Yang, Haotian Xin, Qunya Qi, Yulong Jia, Xianglin Guo, Weimin Zheng, Xin Chen, Fang Li, Chuchu Sun, Qian Chen, Jubao Du, Jie Lu, Nan Chen","doi":"10.1089/neu.2024.0560","DOIUrl":"https://doi.org/10.1089/neu.2024.0560","url":null,"abstract":"<p><p>Traumatic complete spinal cord injury (CSCI) leads to severe impairment of sensory-motor function, and patients often suffer from neuropsychological deficits such as anxiety, depression, and cognitive deficits, which involve different brain functional modules. However, the alterations in modular organization and the interactions between these modules in pediatric patients with CSCI remain unclear. In this study, a total of 70 participants, including 34 pediatric CSCI patients and 36 healthy controls (HCs) aged 6 to 12 years, underwent whole-brain resting-state functional MRI. The functional networks were analyzed via a graph theory approach based on the 90-region Automated Anatomical Labeling (AAL 90) atlas, generating a 90 × 90 correlation matrix. Metrics for nodal, global, and modular scales were calculated to evaluate alterations in the network's topology. Between-group comparisons and partial correlation analysis were performed. Compared to HCs, pediatric CSCI patients exhibited significant decreases in nodal metrics, particularly in subcortical networks (SN) like the bilateral thalamus. Besides, the distribution of core nodes changed, with five newly added core nodes primarily located in the regions of the default mode network (DMN). For modular interactions, patients group presented increased connectivity within the DMN and between the DMN and the attention network (AN) but reduced connectivity between DMN and SN, DMN and vision network (VN), and AN and SN. Notably, the participation coefficient (Pc) of the TPOmid.L (left temporal pole: middle temporal gyrus) was positively correlated with motor scores, suggesting its potential as an indicator for evaluating the motor function in pediatric CSCI patients. Additionally, the patients demonstrated a different modular structure with significantly lower modularity. These findings suggest that functional network and modular alterations chiefly occur in emotional cognition and vision-associated regions, emphasizing the importance to focus on their psychocognitive well-being and providing evidence for visual-feedback related rehabilitation strategies.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023461","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":"Serum Biomarkers as Adjuncts to the National Institute for Health and Care Excellence Head Injury Guidelines (NG232, 2023) When Selecting Patients with Traumatic Brain Injury for Computed Tomography: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study.","authors":"Daniel Whitehouse, Ana Mikolić, Endre Czeiter, Sophie Richter, Andras Buki, Kevin K Wang, Ewout Steyerberg, Andrew Maas, David Menon, Fiona Lecky, Virginia Newcombe","doi":"10.1089/neu.2024.0276","DOIUrl":"https://doi.org/10.1089/neu.2024.0276","url":null,"abstract":"<p><p>This article explores the diagnostic performance of a panel of six biomarkers (glial fibrillary acidic protein [GFAP], neurofilament light [NFL], neuron-specific enolase [NSE], S100 calcium-binding protein B [S100B], total tau [t-tau], and ubiquitin C-terminal hydrolase L1 [UCH-L1]) in the context of the \"2023 UK National Institute for Health and Care Excellence (NICE) Head Injury: Assessment and early management (NG232)\" guideline. Emphasis is placed on subjects where clinical equipoise remains concerning the decision for head computed tomography (CT), medium-risk subjects. All adult subjects from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) dataset with a complete biomarker profile and interpretable CT scan within 24 h of injury were classified as high, medium, and low-risk according to the NICE NG232 Clinical Decision Rule (CDR) for CT head imaging following head injury. In subjects classified as medium-risk, the area under the receiver operating characteristic curve (AUC) was used to assess the diagnostic performance of biomarkers to identify those with (1) CT abnormality or (2) potential neurosurgical lesion, with CT considered the gold standard diagnosis. A time-to-biomarker sub-analysis was performed in subjects with a time from injury to sampling within 6 h, in keeping with current clinical usage of biomarkers. Among 1979 CENTER-TBI participants with sufficient clinical information to facilitate classification, 385 subjects were classified as medium-risk. Biomarker concentrations were significantly higher in those with traumatic CT abnormalities as compared with those without for all biomarkers aside from NSE (all <i>p</i> < 0.05). When sampled within 24 h of injury, GFAP demonstrated the best diagnostic performance for CT abnormality (AUC 0.81 [0.77-0.86]), with NFL, t-tau, and UCH-L1 showing moderate performance. At a threshold to provide a 95% sensitivity, GFAP, NFL, t-tau, and UCH-L1 demonstrated specificities ranging from 18% to 33% corresponding to a potential reduction of total CT images performed in these subjects by 14-23%. S100B and UCH-L1 showed improved performance when biomarker sampling time was limited to 6 h following injury. In intoxicated subjects with a persistent Glasgow Coma Score of 13-14, biomarker levels were significantly higher in subjects with CT abnormality as compared with those without. In conclusion, serum biomarkers demonstrate potential for the reduction in CT scan requirements in those classified as medium-risk in reference to the NG232 CDR criteria. These results highlight a need for further prospective studies on the use of diagnostic TBI biomarkers in current emergency medicine practice, with future consideration given to the integration of biomarkers in the NICE NG232 head injury guidelines.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040494","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}