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BACKGROUND. Rapid diagnosis to facilitate urgent intervention is critical for treatment of acute spinal cord injury (SCI). We hypothesized that a multi-analyte blood biomarker would support point-of-care SCI diagnosis, correlate with injury severity, and predict long-term neurologic outcomes. METHODS. Droplet digital PCR (ddPCR) assays were designed to amplify differentially hypomethylated genomic loci in spinal cord tissue. An optimized ddPCR assay was applied to cell-free DNA (cfDNA) from plasma samples collected from prospectively enrolled acute SCI patients. Targeted proteomic profiling was also performed. Spinal cord--derived cfDNA and plasma proteins were tested for their association with SCI and ability to predict conversion in American Spinal Injury Association (ASIA) score at 6 months. RESULTS. A bespoke ddPCR assay detected spinal cord--derived cfDNA in plasma of 50 patients with acute SCI (AUC: 0.89, 95% CI 0.83-0.95, P < 0.0001). Levels of cfDNA were highest in patients with the most severe injury, i.e., ASIA A, compared with those with ASIA B (P = 0.04), ASIA C (P = 0.009), and ASIA D injuries (P < 0.001). Dimensionality reduction identified 4 candidate proteins (FABP3, REST, IL-6, NF-H) that were integrated with spinal cord--derived cfDNA to derive the Spinal Cord Injury Index (SCII), which has high sensitivity and specificity for SCI diagnosis (AUC: 0.91, 95% CI 0.82-0.99, P < 0.0001), correlates with injury severity (P < 0.0001), and predicts 6-month neurologic improvement (AUC: 0.77, 95% CI 0.61--0.93, P = 0.006). CONCLUSION. The detection of spinal cord--derived cfDNA and plasma protein alterations as part of a multi-analyte blood test can inform SCI diagnosis and prognosis. FUNDING. North American Spine Society Young Investigator Award; Morton Cure Paralysis Fund. [ABSTRACT FROM AUTHOR]

Objective: Oligodendrogliomas present challenges in management despite their favorable prognosis. Optimal therapeutic strategies are not well-established. We aimed to characterize current practice patterns and identify areas of discordance in oligodendroglioma management., Methods: A 20-question survey was distributed February-July 2023 to four professional neurosurgery/neuro-oncology societies to assess practices in oligodendroglioma management. The survey collected data on demographics, diagnostic practices, and treatment decisions. Data analysis was performed using chi-square/Fisher's exact tests., Results: Sixty-three physicians responded, representing 12 countries. Diagnostic practices were consistent among respondents. However, variations in management recommendations were observed. Providers were divided between rarely (36.5%), sometimes (25.4%), and often (30.2%) using TMZ as sole chemotherapy for patients with newly diagnosed oligodendroglioma. For patients with subtotal resection of grade 2 oligodendroglioma, 33.3% of providers recommended upfront radiation/chemotherapy, 27.0% recommended observation, and the remaining 39.7% were divided among options including surgery, chemotherapy, and clinical trials. European providers more frequently recommended surgery (33.3% vs 0.0%), whereas radiation/chemotherapy (35.7% vs 26.7%) or observation (31.0% vs 13.3%) were more commonly recommended by US/Canada providers (p=0.009). Providers also disagreed on adjuvant therapy for grade 3 oligodendroglioma. 47.6% recommended radiation/PCV, and 33.3% recommended radiation/TMZ. This decision varied by region, with European providers more frequently recommending radiation/PCV (86.7% vs 33.3%), and US/Canadian providers more frequently recommending radiation/TMZ (40.5% vs 6.7%; p=0.004)., Conclusion: This study underscores the complexity of oligodendroglioma management and the importance of ongoing research to refine therapeutic strategies. Further studies, especially with the introduction of IDH inhibitors in the practice, are warranted to track practice patterns and reassess recommendations., (Copyright © 2025. Published by Elsevier Inc.)