UNASSIGNED: Impaired self-awareness (SA) after acquired brain injury (ABI) has traditionally been linked to deficits in executive functions. However, conflicting findings about this relationship have been reported in the literature. This inconsistency is probably due to the multicomponent nature of both constructs, as not all aspects of executive functions may be equally relevant to all components of self-awareness. This study explored whether offline SA (i.e. metacognitive knowledge) and online SA (i.e. error detection) relate to a less studied executive component, conflict monitoring/resolution.
UNASSIGNED: Twenty-six patients with ABI performed the Three-Conflict Cognitive Control Task (3CCT), an experimental task that allowed to measure the ability to monitor and solve three different types of conflicts (Distractors-filtering, Spatial Stroop and Simon). Measures of SA were collected: offline SA was based on self-informant discrepancy about patient\'s everyday functional difficulties, and online SA was based on error detection abilities during a performance-based naturalistic task (The Breakfast Conflict Task).
UNASSIGNED: After controlling for global cognition, the conflict monitoring measure of 3CCT demonstarted incremental validity in predicting offline and online SA measured in naturalistic tasks.
UNASSIGNED: Conflict monitoring/resolution seems to be an important component of SA. This finding contributes to further understand the relationship between executive functions and SA. In addition, conflict monitoring/resolution is an executive component that should be considered when designing assessment and intervention strategies to deal with ISA.

OBJECTIVE: To examine the efficacy of an intervention, training to reconnect with emotional awareness therapy (TREAT) at improving alexithymia, emotion dysregulation, anxiety, depression, anger and global positive and negative affect in participants with traumatic brain injury (TBI).
METHODS: Outpatient brain injury rehabilitation center PARTICIPANTS: : Adult participants, who were on average 11.37 years post-complicated mild to severe TBI and also had elevated alexithymia (n=44), who were randomized to immediate treatment (TREAT; n=20) or waitlist control (WLC=24).
METHODS: Randomized, waitlist control trial with 3-month follow-up.
METHODS: Eight session, structured training program that teaches emotional awareness and discrete labeling of emotions.
METHODS: Toronto Alexithymia Scale-20 (TAS-20), Levels of Emotional Awareness Scale (LEAS), Difficulty with Emotion Regulation Scale (DERS), General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9); State-Trait Anger Expression Inventory (STAXI), Positive and Negative Affect Schedule (PANAS); and Patient Global Impression of Change (PGIC).
RESULTS: Thirty-four participants completed the study per protocol. Compared to WLC participants (n=16) who had not yet received the intervention, TREAT participants (n=18) had significantly less alexithymia, emotion dysregulation, anxiety, and depression (all p\'s<.05) within approximately one week of completing the intervention. Before/after results from the pooled sample (n=34) showed significant improvements, immediately and 3 months after the intervention, on all outcomes except the STAXI and the Positive Affect subscale of the PANAS. On the PGIC, a noticeable change in global emotional function and quality of life was reported by 80%. Intent-to-Treat (ITT) analyses (n=38) revealed similar results to the per protocol sample.
CONCLUSIONS: Findings support the efficacy of TREAT for reducing alexithymia and emotion dysregulation in individuals with chronic TBI. While outcomes were also promising for anxiety and depression, more research using attention-control designs are warranted to control for the attention received during treatment.

Reactive changes of glial cells during neuroinflammation impact brain disorders and disease progression. Elucidating the mechanisms that control reactive gliosis may help us to understand brain pathophysiology and improve outcomes. Here, we report that adult ablation of autism spectrum disorder (ASD)-associated CHD8 in astrocytes attenuates reactive gliosis via remodeling chromatin accessibility, changing gene expression. Conditional Chd8 deletion in astrocytes, but not microglia, suppresses reactive gliosis by impeding astrocyte proliferation and morphological elaboration. Astrocyte Chd8 ablation alleviates lipopolysaccharide-induced neuroinflammation and septic-associated hypothermia in mice. Astrocytic CHD8 plays an important role in neuroinflammation by altering the chromatin landscape, regulating metabolic and lipid-associated pathways, and astrocyte-microglia crosstalk. Moreover, we show that reactive gliosis can be directly mitigated in vivo using an adeno-associated virus (AAV)-mediated Chd8 gene editing strategy. These findings uncover a role of ASD-associated CHD8 in the adult brain, which may warrant future exploration of targeting chromatin remodelers in reactive gliosis and neuroinflammation in injury and neurological diseases.

BACKGROUND: The increasing complexity of congenital cardiac surgery has led to greater utilization of extracorporeal membrane oxygenation (ECMO) support for children post-surgery. This study aims to identify risk factors for mortality and brain injury in pediatric patients requiring post-cardiotomy ECMO and to evaluate their neurological outcomes.
METHODS: This retrospective study includes pediatric patients with congenital heart diseases who required ECMO after surgery. Risk factors for in-hospital mortality and brain injury were assessed. Neurodevelopmental status was determined using the Pediatric Cerebral Performance Category (PCPC) Scale at discharge and during follow-up.
RESULTS: Between October 2014 and May 2021, 2651 pediatric patients underwent cardiac surgery, with 90 (3.4%) requiring ECMO. The mean age was 0.6 years, ranging from 1 day to 13 years and 7 months. ECMO was implemented for 45 patients due to CPB weaning failure (NW-CPB), 24 due to postoperative low-cardiac output syndrome (LCOS), and 21 for extracorporeal cardiopulmonary resuscitation (E-CPR). ECMO weaning was achieved in 73 patients (81%), with an overall mortality rate of 36%. Pre-implant lactate levels (OR: 1.13, 95% CI: 1.03-1.25; p = 0.009) and peak bilirubin levels (OR: 1.04, 95% CI: 0.87-1.24; p = 0.69) were risk factors for in-hospital mortality. Survival rates were 79% for LCOS, 60% for NW-CPB, and 48% for E-CPR. Brain injury incidence was 33%, with E-CPR being a significant risk factor (p = 0.006) and NW-CPB being protective (p = 0.001). Follow-up in November 2023 showed significant improvement in neurodevelopmental status (p < 0.001).
CONCLUSIONS: Elevated pre-implant lactate and elevated bilirubin levels during ECMO are major risk factors for mortality. E-CPR is the primary risk factor for brain injury. Follow-up revealed significant improvements in neurodevelopmental outcomes.

This study investigated the behavioral and molecular changes in the telencephalon following needle stab-induced injury in the optic tectum of adult zebrafish. At 3 days post-injury (dpi), there was noticeable structural damage to brain tissue and reduced neuronal proliferation in the telencephalon that persisted until 30 dpi. Neurobehavioral deficits observed at 3 dpi included decreased exploratory and social activities and impaired learning and memory (L/M) functions; all of these resolved by 7 dpi. The injury led to a reduction in telencephalic phosphorylated cAMP response element-binding protein and O-GlcNAcylation, both of which were restored by 30 dpi. There was an increase in GFAP expression and nuclear translocation of NF-κB p65 at 3 dpi, which were not restored by 30 dpi. The injury caused decreased O-GlcNAc transferase and increased O-GlcNAcase levels at 3 dpi, normalizing by 30 dpi. Glucosamine (GlcN) treatment at 3 dpi significantly restored O-GlcNAcylation levels and L/M function, also reducing GFAP activation. Glucose treatment recovered L/M function by 7 dpi, but inhibition of the hexosamine biosynthetic pathway by 6-diazo-5-oxo-L-norleucine blocked this recovery. These findings suggest that the O-GlcNAc pathway is a potential therapeutic target for addressing L/M impairment following traumatic brain injury in zebrafish.

UNASSIGNED: This study pursued a meta-analysis to evaluate the predictive accuracy of machine learning (ML) models in determining disorders of consciousness (DOC) among patients with traumatic brain injury (TBI).
UNASSIGNED: A comprehensive literature search was conducted to identify ML applications in the establishment of a predictive model of DOC after TBI as of August 6, 2023. Two independent reviewers assessed publication eligibility based on predefined criteria. The predictive accuracy was measured using areas under the receiver operating characteristic curves (AUCs). Subsequently, a random-effects model was employed to estimate the overall effect size, and statistical heterogeneity was determined based on I2 statistic. Additionally, funnel plot asymmetry was employed to examine publication bias. Finally, subgroup analyses were performed based on age, ML type, and relevant clinical outcomes.
UNASSIGNED: Final analyses incorporated a total of 46 studies. Both the overall and subgroup analyses exhibited considerable statistical heterogeneity. Machine learning predictions for DOC in TBI yielded an overall pooled AUC of 0.83 (95% CI: 0.82-0.84). Subgroup analysis based on age revealed that the ML model in pediatric patients yielded an overall combined AUC of 0.88 (95% CI: 0.80-0.95); among the model subgroups, logistic regression was the most frequently employed, with an overall pooled AUC of 0.85 (95% CI: 0.83-0.87). In the clinical outcome subgroup analysis, the overall pooled AUC for distinguishing between consciousness recovery and consciousness disorders was 0.84 (95% CI: 0.82-0.85).
UNASSIGNED: The findings of this meta-analysis demonstrated outstanding accuracy of ML models in predicting DOC among patients with brain injuries, which presented substantial research value and potential of ML application in this domain.

OBJECTIVE: To investigate the efficacy of therapeutic hypothermia on mild neonatal hypoxic-ischemic encephalopathy (HIE).
METHODS: A prospective study was performed on 153 neonates with mild HIE who were born from September 2019 to September 2023. These neonates were randomly divided into two groups: therapeutic hypothermia (n=77) and non-therapeutic hypothermia group (n=76). The short-term clinical efficacy of the two groups were compared. Barkovich scoring system was used to analyze the severity of brain injury shown on magnetic resonance imaging (MRI) between the two groups.
RESULTS: There were no significant differences in gestational age, gender, birth weight, mode of birth, and Apgar score between the therapeutic hypothermia and non-therapeutic hypothermia groups (P>0.05). There were no significant differences in the incidence rates of sepsis, arrhythmia, persistent pulmonary hypertension and pulmonary hemorrhage and the duration of mechanical ventilation within the first 72 hours after birth between the two groups. The therapeutic hypothermia group had longer prothrombin time within the first 72 hours after birth and a longer hospital stay (P<0.05). Compared with the non-therapeutic hypothermia group, the therapeutic hypothermia group had lower incidence rates of MRI abnormalities (30% vs 57%), moderate to severe brain injury on MRI (5% vs 28%), and watershed injury (27% vs 51%) (P<0.05), as well as lower medium watershed injury score (0 vs 1) (P<0.05).
CONCLUSIONS: Therapeutic hypothermia can reduce the incidence rates of MRI abnormalities and watershed injury, without obvious adverse effects, in neonates with mild HIE, suggesting that therapeutic hypothermia may be beneficial in neuroprotection in these neonates.
目的: 探讨亚低温对新生儿轻度缺氧缺血性脑病（hypoxic-ischemic encephalopathy, HIE）的治疗效果。方法: 前瞻性纳入2019年9月—2023年9月出生的153例轻度HIE新生儿，随机分为亚低温组（77例）和非亚低温组（76例），比较两组的短期临床效果，并采用Barkovich评分系统分析两组患儿磁共振成像（magnetic resonance imaging, MRI）上脑损伤的严重程度。结果: 亚低温组和非亚低温组胎龄、性别、出生体重、Apgar评分等基线资料的比较差异无统计学意义（P>0.05）。两组生后72 h内败血症、心律失常、持续性肺动脉高压、肺出血的发生率及机械通气时间的比较差异无统计学意义（P>0.05）。亚低温组住院时间及生后72 h内凝血酶原时间长于非亚低温组（P<0.05）。与非亚低温组相比，亚低温组MRI异常发生率（30% vs 57%）、MRI中重度脑损伤发生率（5% vs 28%）、分水岭损伤发生率（27% vs 51%）及中位分水岭损伤评分（0 vs 1）均较低（P<0.05）。结论: 新生儿轻度HIE患儿进行亚低温治疗可降低MRI异常发生率和分水岭损伤发生率，且未见明显不良反应，提示新生儿轻度HIE患儿进行亚低温治疗可能在神经保护方面获益。.

Brain damage triggers diverse cellular and molecular events, with astrocytes playing a crucial role in activating local neuroprotective and reparative signaling within damaged neuronal circuits. Here, we investigated reactive astrocytes using a multidimensional approach to categorize their responses into different subtypes based on morphology. This approach utilized the StarTrack lineage tracer, single-cell imaging reconstruction and multivariate data analysis. Our findings identified three profiles of reactive astrocyte responses, categorized by their effects on cell size- and shape- related morphological parameters: \"moderate\", \"strong,\" and \"very strong\". We also examined the heterogeneity of astrocyte reactivity, focusing on spatial and clonal distribution. Our research revealed a notable enrichment of protoplasmic and fibrous astrocytes within the \"strong\" and \"very strong\" response subtypes. Overall, our study contributes to a better understanding of astrocyte heterogeneity in response to an injury. By characterizing the diverse reactive responses among astrocyte subpopulations, we provide insights that could guide future research aimed at identifying novel therapeutic targets to mitigate brain damage and promote neural repair.

BACKGROUND: The identification of specific circulating miRNAs has been proposed as a valuable tool for elucidating the pathophysiology of brain damage or injury and predicting patient outcomes.
OBJECTIVE: This study aims to apply several bioinformatic tools in order to clarify miRNA interactions with potential genes involved in brain injury, emphasizing the need of using a computational approach to determine the most likely correlations between miRNAs and target genes. Specifically, this study centers on elucidating the roles of miR-34b, miR-34c, miR-135a, miR-200c, and miR-451a.
METHODS: After a careful evaluation of different software available (analyzing the strengths and limitations), we applied three tools, one to perform an analysis of the validated targets (miRTarBase), and two to evaluate functional annotations (miRBase and TAM 2.0).
RESULTS: Research findings indicate elevated levels of miR-135a and miR-34b in patients with traumatic brain injury (TBI) within the first day post-injury, while miR-200c and miR-34c were found to be upregulated after 7 days. Moreover, miR-451a and miR-135a were found overexpressed in the serum, while miRNAs 34b, 34c, and 200c, had lower serum levels at baseline post brain injury.
CONCLUSIONS: This study emphasizes the use of computational methods in determining the most likely relationships between miRNAs and target genes by investigating several bioinformatic techniques to elucidate miRNA interactions with potential genes. Specifically, this study focuses on the functions of miR-34b, miR-34c, miR-135a, miR-200c, and miR-451a, providing an up-to-date overview and suggesting future research directions for identifying theranomiRNAs related to brain injury, both at the tissue and serum levels.

Preterm infants are a high-risk group for brain injury, and it is important to evaluate the neurological recovery of preterm infants. Therefore, this paper evaluates the neurological recovery in preterm infants at high risk of brain injury by amplitude-integrated EEG and GMs scale. The study collected basic information on preterm infants and performed amplitude integrated EEG examination and GMs scale evaluation. Amplitude integrated EEG examination attaches electrodes using multielectrode arrays onto specific areas of the premature head to record brain wave activity to monitor electrical activity in the preterm brain in real time and amplify and process through the signals received by the electrodes to obtain more detailed EEG data. The GMs scale evaluates the developmental and functional status of the child and allows an objective assessment of the development and recovery of neurological function by observing their performance in motor, language, cognition, and social interaction. Analysis of the data by statistical processing. The results showed that early brain injury was evident in high-risk infants. Amplitude integrated EEG parameters can have some predictive value for brain injury. There were also differences in GMs scale assessment between brain injury and non-brain injury. Amplitude integrated EEG combined with GMs scale has certain value in predicting brain injury and can provide an important basis for early intervention in children with preterm brain injury and help to improve their neurodevelopmental outcome.