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Association Between Anatomic and Clinical Indicators of Injury Severity After Moderate-Severe Traumatic Brain Injury: A Pilot Study Using Multiparametric Magnetic Resonance Imaging. 中重度创伤性脑损伤后损伤严重程度的解剖指标与临床指标之间的关联:使用多参数磁共振成像的试点研究。
IF 1.8 Q3 CLINICAL NEUROLOGY Pub Date : 2024-03-13 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0122
Dmitry Esterov, Ziying Yin, Trevor Persaud, Xiang Shan, Mathew C Murphy, Richard L Ehman, John Huston, Allen W Brown

This study sought to identify whether an anatomical indicator of injury severity as measured by multiparametric magnetic resonance imaging (MRI) including magnetic resonance elastography (MRE), is predictive of a clinical measure of injury severity after moderate-severe traumatic brain injury (TBI). Nine individuals who were admitted to acute inpatient rehabilitation after moderate-to-severe TBI completed a comprehensive MRI protocol prior to discharge from rehabilitation, which included conventional MRI with diffusion tensor imaging (DTI). Of those, five of nine also underwent brain MRE to measure the brain parenchyma stiffness. Clinical severity of injury was measured by the length of post-traumatic amnesia (PTA). MRI-assessed non-hemorrhage contusion score and hemorrhage score, DTI-measured white matter fractional anisotropy, and MRE-measured lesion stiffness were all assessed. A higher hemorrhagic score was significantly associated with a longer length of PTA (p = 0.026). Participants with a longer PTA tended to have a higher non-hemorrhage contusion score and softer contusion lesions than the contralateral control side, although the small sample size did not allow for assessment of a significant association. To our knowledge, this is the first report applying MRI/MRE imaging protocol to quantitate altered brain anatomy after moderate-severe TBI and its association with PTA, a known clinical predictor of post-acute outcome. Future larger studies could lead to the development of prediction models that integrate clinical data with anatomical (MRI), structural (DTI), and mechanical (MRE) changes caused by TBI, to inform prognosis and care planning.

本研究旨在确定多参数磁共振成像(MRI)(包括磁共振弹性成像(MRE))所测量的损伤严重程度的解剖指标是否能预测中重度创伤性脑损伤(TBI)后损伤严重程度的临床测量结果。九名中度至重度创伤性脑损伤患者在接受急性住院康复治疗后,在康复出院前完成了全面的核磁共振成像方案,包括常规核磁共振成像和弥散张量成像(DTI)。其中,9 人中有 5 人还接受了脑 MRE,以测量脑实质的硬度。临床损伤严重程度通过创伤后失忆(PTA)时间长短来衡量。核磁共振成像评估的非出血挫伤评分和出血评分、DTI测量的白质分数各向异性以及MRE测量的病变僵硬度都得到了评估。出血评分越高,PTA 时间越长(p = 0.026)。与对侧对照组相比,PTA 时间较长的受试者的非出血挫伤评分往往较高,挫伤病变也较软,但由于样本量较小,无法评估两者之间的显著关联。据我们所知,这是第一份应用 MRI/MRE 成像方案量化中度重度 TBI 后大脑解剖结构改变及其与 PTA 关系的报告,PTA 是已知的急性期后预后的临床预测指标。未来更大规模的研究将有助于开发预测模型,将临床数据与 TBI 引起的解剖(MRI)、结构(DTI)和机械(MRE)变化结合起来,为预后和护理计划提供信息。
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引用次数: 0
Combined Use of Guanfacine and N-Acetylcysteine for the Treatment of Cognitive Deficits After Traumatic Brain Injury. 联合使用关法辛和 N-乙酰半胱氨酸治疗创伤性脑损伤后的认知缺陷。
Q3 CLINICAL NEUROLOGY Pub Date : 2024-03-13 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0124
Siddharth Khasnavis, Timothy Belliveau, Amy Arnsten, Arman Fesharaki-Zadeh

Traumatic Brain Injury (TBI) is a significant contributor to disability across the world. TBIs vary in severity, and most cases are designated mild TBI (mTBI), involving only brief loss of consciousness and no intracranial findings on imaging. Despite this categorization, many persons continue to report persistent cognitive changes in the months to years after injury, with particular impairment in the cognitive and executive functions of the pre-frontal cortex. For these persons, there are no currently approved medications, and treatment is limited to symptom management and cognitive or behavioral therapy. The current case studies explored the use of the alpha-2A adrenoreceptor agonist, guanfacine, combined with the antioxidant, N-acetylcysteine (NAC), in the treatment of post-TBI cognitive symptoms, based on guanfacine's ability to strengthen pre-frontal cortical function, and the open-label use of NAC in treating TBI. Two persons from our TBI clinic were treated with this combined regimen, with neuropsychological testing performed pre- and post-treatment. Guanfacine + NAC improved attention, processing speed, memory, and executive functioning with minimal side effects in both persons. These results encourage future placebo-controlled trials to more firmly establish the efficacy of guanfacine and NAC for the treatment of cognitive deficits caused by TBI.

创伤性脑损伤(TBI)是导致全球残疾的一个重要因素。创伤性脑损伤的严重程度各不相同,大多数病例被认定为轻度创伤性脑损伤(mTBI),仅涉及短暂的意识丧失,影像学检查未发现颅内损伤。尽管有这样的分类,但许多人在受伤后的数月至数年内仍报告有持续的认知变化,尤其是前额叶皮层的认知和执行功能受损。对于这些患者,目前还没有获得批准的药物,治疗方法仅限于症状管理和认知或行为疗法。目前的病例研究探讨了使用α-2A肾上腺素受体激动剂关法辛(guanfacine)结合抗氧化剂N-乙酰半胱氨酸(NAC)治疗创伤后认知症状,这是基于关法辛能够增强前额叶皮质功能,以及NAC在治疗创伤后认知症状中的开放标签使用。我们创伤性脑损伤诊所的两名患者接受了这种联合疗法的治疗,并在治疗前后进行了神经心理学测试。Guanfacine + NAC 可改善两人的注意力、处理速度、记忆力和执行功能,且副作用极小。这些结果鼓励我们在未来开展安慰剂对照试验,以更准确地确定关法辛和 NAC 对治疗创伤性脑损伤引起的认知功能障碍的疗效。
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引用次数: 0
Cognitive and Motor Function Effects of Antipsychotics in Traumatic Brain Injury: A Systematic Review of Pre-Clinical Studies. 抗精神病药物对创伤性脑损伤患者认知和运动功能的影响:临床前研究的系统回顾》。
Q3 CLINICAL NEUROLOGY Pub Date : 2024-03-05 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0108
Gabrielle Cataford, Laurie-Anne Monton, Stephanie Karzon, Camille Livernoche-Leduc, Mar Saavedra-Mitjans, Marie-Julie Potvin, Francis Bernard, Lisa Burry, Caroline Arbour, David R Williamson

Traumatic brain injury (TBI) survivors often suffer from agitated behaviors and will most likely receive pharmacological treatments. Choosing an optimal and safe treatment that will not interfere with neurological recovery remains controversial. By interfering with dopaminergic circuits, antipsychotics may impede processes important to cognitive recovery. Despite their frequent use, there have been no large randomized controlled studies of antipsychotics for the management of agitated behaviors during the acute TBI recovery period. We conducted a systematic review and meta-analysis of pre-clinical studies evaluating the effects of antipsychotics post-TBI on both cognitive and motor recovery. MEDLINE and Embase databases were searched up to August 2, 2023. Pre-clinical studies evaluating the effects of antipsychotics on cognitive and motor functions post-TBI were considered. Risk of bias was evaluated with the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool. We identified 15 studies including a total of 1188 rodents, mostly conducted in male Sprague-Dawley rats using cortical impact injury. The analysis revealed no consistent effect of haloperidol on motor functions, but risperidone was associated with a significant impairment in motor function on day 5 post-injury (7.05 sec; 95% confidence interval [CI]: 1.47, 12.62; I2 = 92%). Other atypical antipsychotics did not result in impaired motor function. When evaluating cognitive function, haloperidol- (23.00 sec; 95% CI: 17.42-28.59; I2 = 7%) and risperidone-treated rats (24.27 sec; 95% CI: 16.18-32.36; I2 = 0%) were consistently impaired when compared to controls. In studies evaluating atypical antipsychotics, no impairments were observed. Clinicians should avoid the regular use of haloperidol and risperidone, and future human studies should be conducted with atypical antipsychotics.

创伤性脑损伤(TBI)幸存者经常会出现激动行为,并很可能会接受药物治疗。选择一种不会干扰神经系统恢复的最佳安全治疗方法仍存在争议。通过干扰多巴胺能回路,抗精神病药物可能会阻碍对认知恢复非常重要的过程。尽管抗精神病药物经常被使用,但目前还没有关于抗精神病药物治疗急性创伤性脑损伤恢复期躁动行为的大型随机对照研究。我们对评估创伤后抗精神病药物对认知和运动恢复影响的临床前研究进行了系统回顾和荟萃分析。对MEDLINE和Embase数据库的检索截止到2023年8月2日。研究考虑了评估抗精神病药物对创伤后认知和运动功能影响的临床前研究。使用实验室动物实验系统回顾中心(SYRCLE)工具对偏倚风险进行了评估。我们确定了 15 项研究,共涉及 1188 只啮齿类动物,这些研究大多以雄性 Sprague-Dawley 大鼠为对象,使用了皮层撞击损伤的方法。分析结果显示,氟哌啶醇对运动功能没有一致的影响,但利培酮与损伤后第 5 天运动功能的显著损害有关(7.05 秒;95% 置信区间 [CI]:1.47,12.62;I2 = 92%)。其他非典型抗精神病药物不会导致运动功能受损。在评估认知功能时,与对照组相比,氟哌啶醇(23.00 秒;95% 置信区间:17.42-28.59;I2 = 7%)和利培酮(24.27 秒;95% 置信区间:16.18-32.36;I2 = 0%)治疗的大鼠的认知功能持续受损。在评估非典型抗精神病药物的研究中,未观察到任何损害。临床医生应避免经常使用氟哌啶醇和利培酮,今后应使用非典型抗精神病药物进行人体研究。
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引用次数: 0
A Perspective on Electrical Stimulation and Sympathetic Regeneration in Peripheral Nerve Injuries. 外周神经损伤中的电刺激和交感神经再生透视。
Q3 CLINICAL NEUROLOGY Pub Date : 2024-03-04 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0133
Tina Tian, Amy M Moore, Paul A Ghareeb, Nicholas M Boulis, Patricia J Ward

Peripheral nerve injuries (PNIs) are common and devastating. The current standard of care relies on the slow and inefficient process of nerve regeneration after surgical intervention. Electrical stimulation (ES) has been shown to both experimentally and clinically result in improved regeneration and functional recovery after PNI for motor and sensory neurons; however, its effects on sympathetic regeneration have never been studied. Sympathetic neurons are responsible for a myriad of homeostatic processes that include, but are not limited to, blood pressure, immune response, sweating, and the structural integrity of the neuromuscular junction. Almost one quarter of the axons in the sciatic nerve are from sympathetic neurons, and their importance in bodily homeostasis and the pathogenesis of neuropathic pain should not be underestimated. Therefore, as ES continues to make its way into patient care, it is not only important to understand its impact on all neuron subtypes, but also to ensure that potential adverse effects are minimized. This piece gives an overview of the effects of ES in animals models and in humans while offering a perspective on the potential effects of ES on sympathetic axon regeneration.

周围神经损伤(PNIs)是一种常见的破坏性损伤。目前的治疗标准依赖于手术干预后缓慢而低效的神经再生过程。实验和临床均表明,电刺激(ES)可改善运动神经元和感觉神经元在周围神经损伤后的再生和功能恢复,但其对交感神经再生的影响却从未被研究过。交感神经元负责无数的平衡过程,包括但不限于血压、免疫反应、出汗和神经肌肉接头结构的完整性。坐骨神经中近四分之一的轴突来自交感神经元,它们在体内平衡和神经病理性疼痛发病机制中的重要性不容低估。因此,随着 ES 不断进入患者护理领域,不仅要了解它对所有神经元亚型的影响,还要确保将潜在的不良影响降至最低。这篇文章概述了 ES 在动物模型和人体中的影响,同时提供了 ES 对交感神经轴突再生的潜在影响的视角。
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引用次数: 0
Non-Invasive Vagal Nerve Stimulation Pre-Treatment Reduces Neurological Dysfunction After Closed Head Injury in Mice. 非侵入性迷走神经刺激预处理可减轻小鼠闭合性颅脑损伤后的神经功能障碍
Q3 CLINICAL NEUROLOGY Pub Date : 2024-02-29 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0058
Andreia Morais, Joon Yong Chung, Limin Wu, Cenk Ayata, Bruce Simon, Michael J Whalen

Non-invasive vagus nerve stimulation (nVNS) has recently been suggested as a potential therapy for traumatic brain injury (TBI). We previously demonstrated that nVNS inhibits cortical spreading depolarization, the electrophysiological event underlying migraine aura, and is relevant to TBI. Our past work also suggests a role for interleukin-1 beta (IL-1β) in cognitive deficits after closed head injury (CHI) in mice. We show that nVNS pre-treatment suppresses CHI-associated spatial learning and memory impairment and prevents IL-1β activation in injured neurons, but not endothelial cells. In contrast, nVNS administered 10 min after CHI was ineffective. These data suggest that nVNS prophylaxis might ameliorate neuronal dysfunction associated with CHI in populations at high risk for concussive TBI.

无创迷走神经刺激(nVNS)最近被认为是治疗创伤性脑损伤(TBI)的一种潜在疗法。我们曾证实,无创迷走神经刺激可抑制皮层扩散性去极化(偏头痛先兆的电生理基础),并与创伤性脑损伤相关。我们过去的研究还表明,白细胞介素-1β(IL-1β)在小鼠闭合性头部损伤(CHI)后的认知障碍中发挥作用。我们的研究表明,nVNS 预处理可抑制 CHI 相关的空间学习和记忆损伤,并防止损伤神经元中的 IL-1β 激活,但不能防止内皮细胞中的 IL-1β 激活。相反,CHI 10 分钟后给予 nVNS 则无效。这些数据表明,在脑震荡性创伤的高危人群中,nVNS 预防可改善与脑震荡相关的神经元功能障碍。
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引用次数: 0
Improvement in Functional Outcome from 6 to 12 Months After Moderate and Severe Traumatic Brain Injury Is Frequent, But May Not Be Detected With the Glasgow Outcome Scale Extended. 中度和重度创伤性脑损伤后 6 至 12 个月的功能性结果改善很常见,但格拉斯哥结果量表扩展版可能无法检测到。
IF 1.8 Q3 CLINICAL NEUROLOGY Pub Date : 2024-02-29 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0109
Rabea Iris Pantelatos, Jonas Stenberg, Turid Follestad, Oddrun Sandrød, Cathrine Elisabeth Einarsen, Anne Vik, Toril Skandsen

The aims of this study were (1) to report outcome and change in outcome in patients with moderate and severe traumatic brain injury (mo/sTBI) between 6 and 12 months post-injury as measured by the Glasgow Outcome Scale Extended (GOSE), (2) to explore if demographic/injury-related variables can predict improvement in GOSE score, and (3) to investigate rate of improvement in Disability Rating Scale (DRS) score, in patients with a stable GOSE. All surviving patients ≥16 years of age who were admitted with mo/sTBI (Glasgow Coma Scale [GCS] score ≤13) to the regional trauma center in Central Norway between 2004 and 2019 were prospectively included (n = 439 out of 503 eligible). GOSE and DRS were used to assess outcome. Twelve-months post-injury, 13% with moTBI had severe disability (GOSE 2-4) versus 27% in sTBI, 26% had moderate disability (GOSE 5-6) versus 41% in sTBI and 62% had good recovery (GOSE 7-8) versus 31% in sTBI. From 6 to 12 months post-injury, 27% with moTBI and 32% with sTBI had an improvement, whereas 6% with moTBI and 6% with sTBI had a deterioration in GOSE score. Younger age and higher GCS score were associated with improved GOSE score. Improvement was least frequent for patients with a GOSE score of 3 at 6 months. In patients with a stable GOSE score of 3, an improvement in DRS score was observed in 22 (46%) patients. In conclusion, two thirds and one third of patients with mo/sTBI, respectively, had a good recovery. Importantly, change, mostly improvement, in GOSE score between 6 and 12 months was frequent and argues against the use of 6 months outcome as a time end-point in research. The GOSE does, however, not seem to be sensitive to actual change in function in the lower categories and a combination of outcome measures may be needed to describe the consequences after TBI.

本研究的目的是:(1) 报告中度和重度创伤性脑损伤(mo/sTBI)患者在伤后 6 至 12 个月期间的预后和预后变化情况,以格拉斯哥预后量表扩展版(GOSE)为衡量标准;(2) 探讨人口学/损伤相关变量是否能预测 GOSE 评分的改善情况;(3) 调查 GOSE 稳定的患者残疾评定量表(DRS)评分的改善率。2004年至2019年期间,挪威中部地区创伤中心收治的所有年龄≥16岁、患有mo/sTBI(格拉斯哥昏迷量表[GCS]评分≤13分)的存活患者均被纳入前瞻性研究(503名符合条件的患者中,n = 439名)。GOSE和DRS用于评估结果。伤后12个月,13%的moTBI患者有重度残疾(GOSE 2-4),而sTBI患者为27%;26%的患者有中度残疾(GOSE 5-6),而sTBI患者为41%;62%的患者恢复良好(GOSE 7-8),而sTBI患者为31%。在伤后 6 至 12 个月,27% 的莫氏创伤性脑损伤患者和 32% 的斯氏创伤性脑损伤患者的 GOSE 评分有所改善,而 6% 的莫氏创伤性脑损伤患者和 6% 的斯氏创伤性脑损伤患者的 GOSE 评分有所恶化。年龄越小、GCS 分数越高,GOSE 分数越高。在 6 个月时 GOSE 评分为 3 分的患者中,病情改善的频率最低。在 GOSE 评分稳定在 3 分的患者中,有 22 人(46%)的 DRS 评分有所改善。总之,分别有三分之二和三分之一的急性和慢性创伤性脑损伤患者恢复良好。重要的是,在 6 个月和 12 个月之间,GOSE 分数经常发生变化,大部分都有所改善,这就反对将 6 个月的结果作为研究的时间终点。不过,GOSE 似乎对较低类别功能的实际变化并不敏感,因此可能需要结合多种结果测量来描述创伤后的后果。
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引用次数: 0
Randomized Controlled Trial of Durotomy as an Adjunct to Routine Decompressive Surgery for Dogs With Severe Acute Spinal Cord Injury. 对严重急性脊髓损伤的犬进行常规减压手术的同时进行硬膜切开术的随机对照试验。
IF 1.8 Q3 CLINICAL NEUROLOGY Pub Date : 2024-02-20 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0129
Nick D Jeffery, John H Rossmeisl, Tom R Harcourt-Brown, Nicolas Granger, Daisuke Ito, Kari Foss, Damian Chase

Although many interventions for acute spinal cord injury (SCI) appear promising in experimental models, translation directly from experimental animals to human patients is a large step that can be problematic. Acute SCI occurs frequently in companion dogs and may provide a model to ease translation. Recently, incision of the dura has been highlighted in both research animals and human patients as a means of reducing intraspinal pressure, with a view to improving perfusion of the injured tissue and enhancing functional recovery. Observational clinical data in humans and dogs support the notion that it may also improve functional outcome. Here, we report the results of a multi-center randomized controlled trial of durotomy as an adjunct to traditional decompressive surgery for treatment of severe thoracolumbar SCI caused by acute intervertebral disc herniation in dogs. Sample-size calculation was based on the proportion of dogs recovering ambulation improving from an expected 55% in the traditional surgery group to 70% in the durotomy group. Over a 3.5-year period, we enrolled 140 dogs, of which 128 had appropriate duration of follow-up. Overall, 65 (51%) dogs recovered ambulation. Recovery in the traditional decompression group was 35 of 62 (56%) dogs, and in the durotomy group 30 of 66 (45%) dogs, associated with an odds ratio of 0.643 (95% confidence interval: 0.320-1.292) and z-score of -1.24. This z-score indicates trial futility to reach the target 15% improvement over traditional surgery, and the trial was terminated at this stage. We conclude that durotomy is ineffective in improving functional outcome for severe acute thoracolumbar SCI in dogs. In the future, these data can be compared with similar data from clinical trials on duraplasty in human patients and will aid in determining the predictive validity of the "companion dog model" of acute SCI.

尽管许多急性脊髓损伤(SCI)干预措施在实验模型中看起来很有前景,但从实验动物直接转化为人类患者是一个很大的步骤,可能会出现问题。急性脊髓损伤经常发生在伴侣犬身上,这可能为简化转化提供了一个模型。最近,在研究动物和人类患者中,切开硬脊膜作为降低椎管内压力的一种手段受到重视,其目的是改善受伤组织的灌注并促进功能恢复。在人类和狗身上观察到的临床数据也支持这一观点,即切开硬脊膜也可以改善功能预后。在此,我们报告了一项多中心随机对照试验的结果,即在犬急性椎间盘突出症引起的严重胸腰椎 SCI 的治疗中,将硬膜切开术作为传统减压手术的辅助手段。样本大小的计算基于犬只恢复行动能力的比例,即传统手术组的预期比例为 55%,而硬膜切开术组的预期比例为 70%。在 3.5 年的时间里,我们招募了 140 只狗,其中 128 只进行了适当的随访。总体而言,65 只(51%)狗恢复了行走能力。传统减压组 62 只狗中有 35 只(56%)康复,而urotomy 组 66 只狗中有 30 只(45%)康复,相关的几率比为 0.643(95% 置信区间:0.320-1.292),Z 值为-1.24。该 Z 值表明试验无法达到比传统手术改善 15%的目标,因此试验在此阶段终止。我们的结论是,在改善犬严重急性胸腰椎 SCI 的功能预后方面,穹隆切开术效果不佳。将来,这些数据可与人类患者杜氏成形术临床试验的类似数据进行比较,并有助于确定急性 SCI "伴侣犬模型 "的预测有效性。
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引用次数: 0
Safety and Efficacy of Riluzole in Traumatic Spinal Cord Injury: A Systematic Review With Meta-Analyses. 利鲁唑治疗创伤性脊髓损伤的安全性和有效性:带 Meta 分析的系统综述。
Q3 CLINICAL NEUROLOGY Pub Date : 2024-02-19 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0114
Luke J Weisbrod, Thomas T Nilles-Melchert, Judith R Bergjord, Daniel L Surdell

Traumatic spinal cord injury (SCI) is a cause of significant morbidity, often resulting in long-term disability. We aimed to compare outcomes after riluzole versus patients who received placebo or standard of care with no specific intervention. MEDLINE, Embase, Scopus, and Cochrane Library database searches yielded 92 records, and five met the study inclusion criteria. Fixed-effect and random-effects models were used to establish odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs) for each outcome. The results of the pooled analysis showed that in patients with acute traumatic SCI, riluzole resulted in increased American Spinal Injury Association (ASIA) motor scores at 3 months (MD 0.26, 95% CI [-0.10,0.61], I2 = 0%; p = 0.157) and 6 months (MD 0.21, 95% CI [-0.17,0.60], I2 = 0%; p = 0.280) and change in ASIA Impairment Scale (AIS) at 3 months (OR 0.59, 95% CI [-0.12,1.30], I2 = 0%, p = 0.101) and 6 months (OR 0.28, 95% CI [-0.50,1.06], I2 = 0%, p = 0.479) in comparison to the control groups, though not to a level of statistical significance. Riluzole resulted in fewer adverse events than the control groups (OR -0.12, 95% CI [-1.59,1.35], I2 = 0%, p = 0.874) and lower mortality (OR -0.20, 95% CI [-1.03,0.63], I2 = 0%, p = 0.640), though also not to a level of statistical significance. These meta-analyses suggest that riluzole for the treatment of traumatic SCI is safe and results in improved neurological outcomes when compared to controls, though not to a level of statistical significance. More robust prospective, randomized studies are necessary to help inform the safety and efficacy of riluzole for traumatic SCI.

创伤性脊髓损伤(SCI)是一种严重的发病原因,通常会导致长期残疾。我们旨在比较利鲁唑与接受安慰剂或无特定干预的标准护理的患者的治疗效果。在 MEDLINE、Embase、Scopus 和 Cochrane Library 数据库中搜索到 92 条记录,其中 5 条符合研究纳入标准。采用固定效应和随机效应模型确定了每种结果的几率比(OR)和平均差(MD),以及 95% 的置信区间(CI)。汇总分析结果显示,在急性创伤性 SCI 患者中,利鲁唑可提高 3 个月时的美国脊柱损伤协会 (ASIA) 运动评分(MD 0.26,95% CI [-0.10,0.61],I2 = 0%;P = 0.157)和 6 个月时的运动评分(MD 0.21,95% CI [-0.17,0.60],I2 = 0%)。60],I2 = 0%;p = 0.280)和 ASIA 损伤量表(AIS)在 3 个月(OR 0.59,95% CI [-0.12,1.30],I2 = 0%,p = 0.101)和 6 个月(OR 0.28,95% CI [-0.50,1.06],I2 = 0%,p = 0.479)时的变化与对照组相比,尽管没有统计学意义。与对照组相比,利鲁唑导致的不良事件较少(OR -0.12,95% CI [-1.59,1.35],I2 = 0%,p = 0.874),死亡率较低(OR -0.20,95% CI [-1.03,0.63],I2 = 0%,p = 0.640),但也未达到统计学意义水平。这些荟萃分析表明,利鲁唑治疗创伤性 SCI 是安全的,与对照组相比,利鲁唑可改善神经功能预后,但未达到统计学显著性水平。有必要开展更多可靠的前瞻性随机研究,以帮助了解利鲁唑治疗创伤性 SCI 的安全性和有效性。
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引用次数: 0
Investigating the Association Between Extended Participation in Collision Sports and Fluid Biomarkers Among Masters Athletes. 研究长期参加碰撞运动与大师级运动员体液生物标志物之间的关系。
Q3 CLINICAL NEUROLOGY Pub Date : 2024-01-30 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0086
Lauren P Giesler, William T O'Brien, Georgia F Symons, Sabrina Salberg, Gershon Spitz, Robb Wesselingh, Terence J O'Brien, Richelle Mychasiuk, Sandy R Shultz, Stuart J McDonald

Traumatic brain injuries (TBIs) and concussions are prevalent in collision sports, and there is evidence that levels of exposure to such sports may increase the risk of neurological abnormalities. Elevated levels of fluid-based biomarkers have been observed after concussions or among athletes with a history of participating in collision sports, and certain biomarkers exhibit sensitivity toward neurodegeneration. This study investigated a cohort of 28 male amateur athletes competing in "Masters" competitions for persons >35 years of age. The primary objective of this study was to compare the levels of blood and saliva biomarkers associated with brain injury, inflammation, aging, and neurodegeneration between athletes with an extensive history of collision sport participation (i.e., median = 27 years; interquartile range = 18-44, minimum = 8) and those with no history. Plasma proteins associated with neural damage and neurodegeneration were measured using Simoa® assays, and saliva was analyzed for markers associated with inflammation and telomere length using quantitative real-time polymerase chain reaction. There were no significant differences between collision and non-collision sport athletes for plasma levels of glial fibrillary acidic protein, neurofilament light, ubiquitin C-terminal hydrolase L1, tau, tau phosphorylated at threonine 181, and brain-derived neurotrophic factor. Moreover, salivary levels of genes associated with inflammation and telomere length were similar between groups. There were no significant differences between groups in symptom frequency or severity on the Sport Concussion Assessment Tool-5th Edition. Overall, these findings provide preliminary evidence that biomarkers associated with neural tissue damage, neurodegeneration, and inflammation may not exhibit significant alterations in asymptomatic amateur athletes with an extensive history of amateur collision sport participation.

创伤性脑损伤(TBI)和脑震荡在碰撞运动中非常普遍,有证据表明,接触此类运动的程度可能会增加神经系统异常的风险。在脑震荡后或曾参加过碰撞运动的运动员中,已观察到基于体液的生物标志物水平升高,某些生物标志物对神经变性表现出敏感性。本研究调查了参加 "大师级 "比赛的 28 名年龄大于 35 岁的男性业余运动员。本研究的主要目的是比较有广泛碰撞运动参与史(即中位数 = 27 年;四分位间范围 = 18-44,最小值 = 8)的运动员与无参与史的运动员之间血液和唾液中与脑损伤、炎症、衰老和神经变性相关的生物标志物水平。使用 Simoa® 检测法测量了与神经损伤和神经变性相关的血浆蛋白,并使用定量实时聚合酶链反应法分析了唾液中与炎症和端粒长度相关的标记物。碰撞运动运动员和非碰撞运动运动员血浆中胶质纤维酸性蛋白、神经丝蛋白、泛素 C 端水解酶 L1、tau、苏氨酸 181 磷酸化的 tau 和脑源性神经营养因子的水平没有明显差异。此外,与炎症和端粒长度相关的基因的唾液水平在各组之间相似。在运动脑震荡评估工具-第 5 版中,各组在症状频率或严重程度上没有明显差异。总之,这些研究结果提供了初步证据,表明与神经组织损伤、神经变性和炎症相关的生物标志物在无症状且有大量业余碰撞运动参与史的业余运动员中可能不会出现明显变化。
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引用次数: 0
Traumatic Brain Injury in the Long-COVID Era. Long-COVID 时代的创伤性脑损伤。
Q3 CLINICAL NEUROLOGY Pub Date : 2024-01-30 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0067
Denes V Agoston

Major determinants of the biological background or reserve, such as age, biological sex, comorbidities (diabetes, hypertension, obesity, etc.), and medications (e.g., anticoagulants), are known to affect outcome after traumatic brain injury (TBI). With the unparalleled data richness of coronavirus disease 2019 (COVID-19; ∼375,000 and counting!) as well as the chronic form, long-COVID, also called post-acute sequelae SARS-CoV-2 infection (PASC), publications (∼30,000 and counting) covering virtually every aspect of the diseases, pathomechanisms, biomarkers, disease phases, symptomatology, etc., have provided a unique opportunity to better understand and appreciate the holistic nature of diseases, interconnectivity between organ systems, and importance of biological background in modifying disease trajectories and affecting outcomes. Such a holistic approach is badly needed to better understand TBI-induced conditions in their totality. Here, I briefly review what is known about long-COVID/PASC, its underlying-suspected-pathologies, the pathobiological changes induced by TBI, in other words, the TBI endophenotypes, discuss the intersection of long-COVID/PASC and TBI-induced pathobiologies, and how by considering some of the known factors affecting the person's biological background and the inclusion of mechanistic molecular biomarkers can help to improve the clinical management of TBI patients.

已知生物背景或储备的主要决定因素,如年龄、生物性别、合并症(糖尿病、高血压、肥胖等)和药物(如抗凝药物)会影响创伤性脑损伤(TBI)后的结局。2019 年冠状病毒疾病(COVID-19;∼375,000 例,仍在统计中!)以及慢性形式的长COVID(也称为SARS-CoV-2感染急性后遗症(PASC))的数据无比丰富,出版物(∼30,000 例,仍在统计中)几乎涵盖了疾病、病理机制、生物标志物、疾病阶段、症状学等各个方面、这为更好地理解和认识疾病的整体性、器官系统之间的相互关联性以及生物背景在改变疾病轨迹和影响预后方面的重要性提供了一个独特的机会。为了更好地理解创伤性脑损伤引发的各种疾病,我们亟需这样一种整体方法。在此,我简要回顾了目前已知的长COVID/PASC、其潜在的疑似病理、创伤性脑损伤诱发的病理生物学变化(换言之,创伤性脑损伤内表型),讨论了长COVID/PASC与创伤性脑损伤诱发的病理生物学的交叉点,以及如何通过考虑影响患者生物背景的一些已知因素和纳入机理分子生物标志物来帮助改善创伤性脑损伤患者的临床管理。
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引用次数: 0
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Neurotrauma reports
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