Frontiers in Neurology最新文献

Objective: This study aims to evaluate key factors influencing the short-term and long-term prognosis of stroke patients, with a particular focus on variables such as body weight, hemoglobin, electrolytes, kidney function, organ function scores, and comorbidities. Stroke poses a significant global health burden, and understanding its prognostic factors is crucial for clinical management.

Methods: This is a retrospective cohort study based on data from the MIMIC-IV database, including stroke patients from 2010 to 2020. A total of 5,110 patients aged 18 and older were included in the study. The exposure variables included body weight and hemoglobin levels, while the outcome variables were the 30-day, 90-day, 1-year, and 3-year mortality risks. Covariates included electrolyte levels, kidney function, organ function scores, and comorbidities. Random forest and gradient boosting tree models were employed for data analysis to assess mortality risk.

Results: Kaplan-Meier survival analysis showed that ischemic stroke patients had the highest 30-day mortality rate at 8.5%, with only 20% 1-year survival. Traumatic subarachnoid hemorrhage patients had the best prognosis, with a 1-year survival rate of 60%. Multivariable Cox regression analysis revealed that each 1-point increase in the Charlson Comorbidity Index raised the 1-year and 3-year mortality risks by 1.39 times (95% CI: 1.10-1.56) and 1.44 times, respectively. Each 1-point increase in the SOFA score increased the 30-day, 90-day, 1-year, and 3-year mortality risks by 2.11 times, 2.03 times, and 1.84 times, respectively. Additionally, lower hemoglobin levels were significantly associated with increased mortality, with 30-day, 90-day, and 1-year mortality risks increasing by 3.33 times, 3.34 times, and 4.16 times, respectively (p < 0.005). Age ≥ 71 years, longer hospital stays, and organ dysfunction were also significant factors affecting mortality.

Conclusion: This study highlights the critical role of stroke type, comorbidity index, SOFA score, hemoglobin levels, and length of hospital stay in stroke prognosis. These findings provide valuable insights for clinical risk assessment and the development of individualized treatment strategies, which may improve the management and outcomes of stroke patients. The predictive model constructed effectively assesses mortality risks in stroke patients, offering support for future clinical practice.

Objective: To systematically evaluate the association between hypertension and hearing loss.

Methods: A standardized search for studies on hypertension and hearing loss in PubMed, Embase, Scopus, and Web of Science was performed using subject terms, free terms, and keyword combinations for the period of library construction to March 2024. Meta-analysis was performed using RevMan 5.4 and STATA 18.0.

Results: A total of 12 studies were included, assessing 594,676 participants. The combined OR using the random effects model was 1.849 (95% CI: 1.549, 2.208). Heterogeneity in this analysis was high (I ² = 98%, p < 0.1), and by sensitivity analysis we found that the heterogeneity may have originated from 3 studies, the removal of which significantly reduced the heterogeneity and had a small effect on the effect size [OR (95%CI): 1.893 (1.834, 1.953), I ² = 0.0%, p = 0.465].

Conclusion: Hypertension may be one of the risk factors for hearing loss. Identification of hypertension can help in early assessment and management of hearing loss risk.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023460001.

HIV-associated neurocognitive disorder (HAND) is a complex neurological complication resulting from human immunodeficiency virus (HIV) infection, affecting about 50% of individuals with HIV and significantly diminishing their quality of life. HAND includes a variety of cognitive, motor, and behavioral disorders, severely impacting patients' quality of life and social functioning. Although combination antiretroviral therapy (cART) has greatly improved the prognosis for HIV patients, the incidence of HAND remains high, underscoring the urgent need to better understand its pathological mechanisms and develop early diagnostic methods. This review highlights the latest advancements in neuroimaging and exosome biomarkers in HAND research. Neuroimaging, particularly magnetic resonance imaging (MRI), offers a non-invasive and repeatable method to monitor subtle changes in brain structure and function, potentially detecting early signs of HAND. Meanwhile, exosomes are nano-sized vesicles secreted by cells that serve as key mediators of intercellular communication, playing a crucial role in the neuropathology of HIV and potentially acting as a critical bridge between peripheral blood and central nervous system lesions. Thus, combining plasma exosome biomarkers with indicators derived from neuroimaging scans may enhance the early diagnosis of HAND. This review summarizes evidence supporting the role of exosomes as reliable biomarkers for early detection and management of HAND. Furthermore, we emphasize the correlation between neuroimaging biomarkers and exosome biomarkers and explore their potential combined use. This review discusses the technical challenges and methodological limitations of integrating these two types of biomarkers and proposes future research directions. This multidisciplinary integrative approach not only promises to improve the neurocognitive health management of HIV patients but may also offer valuable insights for research into other neurodegenerative diseases.

Background: Therapeutic hypothermia improves outcomes in experimental stroke models, especially after ischemia-reperfusion injury. In recent years, the safety and efficacy of hypothermia combining thrombolysis or mechanical thrombectomy have attracted widespread attention. The primary objective of the study was to evaluate the effectiveness and safety of hypothermia by combining reperfusion therapy in acute ischemic stroke patients.

Methods: A systematic search was performed in PubMed, EMBASE, Cochrane Library, and the Clinical Trial Registries on articles published until May 2024. The full-text articles were thoroughly reviewed, and relevant information regarding study characteristics and outcomes was extracted. Mantel-Haenszel (M-H) random-effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). In addition, subgroup analyses were performed focusing on the different hypothermia modalities and duration.

Results: After screening 2,265 articles, 10 studies were included in the present analysis with a total sample size of 785. Forest plots of clinical outcomes were as follows: modified Rankin Scale (mRS) ≤2 at 3 months (RR = 1.28, 95% CI 1.01-1.61, p = 0.04), mortality within 3 months (RR = 0.95, 95% CI 0.69-1.29, p = 0.73), total complications (RR = 1.02, 95% CI 0.89-1.16, p = 0.77) and pneumonia (RR = 1.35, 95% CI 0.76-2.40, p = 0.31). Subgroup analyses indicated a mild protective effect of selective cerebral hypothermia; however, the difference in mortality between the hypothermia and control groups was not statistically significant (RR = 0.88, 95% CI 0.57-1.35, p = 0.55). Patients undergoing hypothermia for 24-48 h experienced a higher rate of overall complications (RR = 1.37, 95% CI 1.01-1.86, p = 0.04) and pneumonia (RR = 2.84, 95% CI 1.05-7.66, p = 0.04).

Conclusion: The preliminary evidence supports the safety and feasibility of hypothermia combined with reperfusion therapy, which should be further investigated in randomized controlled studies.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024556625.

Objective: Intracerebral hemorrhage (ICH) is a common cerebrovascular disease characterized by high mortality and disability rates. Neuritin, significantly expressed in injured brain tissues, is implicated in the molecular mechanisms underlying acute brain injury. We aimed to explore the prognostic and predictive value of serum neuritin in ICH.

Methods: In this prospective cohort study, serum neuritin levels were measured at admission in 202 patients, on post-ICH days 1, 3, 5, 7, and 10 in 54 of these patients, and at the time of enrollment in 100 healthy controls. The Glasgow Coma Scale (GCS) and hematoma volume were used as severity indicators. A poor prognosis was defined as a modified Rankin Scale (mRS) score of 3-6 at 90 days after ICH. END was defined as a decrease of ≥2 points in the GCS score within 24 h of admission. A multivariate logistic regression model was used to assess the independent relationships between serum neuritin levels, END, and poor prognosis.

Results: Serum neuritin levels were significantly increased at the time of patient admission, continued to rise on day 1, peaked on day 3, and then gradually diminished from day 5 until day 10. The levels remained substantially higher in patients compared to healthy controls throughout the 10-day period. The levels were independently related to GCS scores and hematoma volume. In subgroup analyses, the levels showed a linear relationship with the likelihood of experiencing END and poor prognosis at the 90-day mark after ICH. Additionally, the levels were independently associated with END, ordinal mRS scores, and poor prognosis. Under receiver operating characteristic (ROC) curve analysis, serum neuritin levels effectively predicted both END and poor prognosis. Two models incorporating GCS, hematoma volume, and serum neuritin levels were developed and represented using two nomograms separately to estimate END risks and poor prognosis. These models demonstrated clinical efficiency, stability, and validity in ROC, calibration, and decision curve analyses. Internal validation of the models was conducted using a randomly extracted subset of 101 patients. Furthermore, two specific weighted scoring systems were developed to optimize clinical prediction of poor prognosis and END after ICH.

Conclusion: Elevated serum neuritin levels are strongly associated with disease severity, END, and 90-day poor neurological outcomes following ICH, establishing serum neuritin as a potential prognostic biomarker for ICH.

Objective: This study aims to observe the effect of enrichment rehabilitation (ER) on cognitive function in post-stroke patients and to clarify its underlying mechanism.

Methods: Forty patients with post-stroke cognitive impairment (PSCI) meeting the inclusion criteria were randomly assigned to two groups: conventional medical rehabilitation (CM group) and ER intervention (ER group). All patients underwent assessments of overall cognitive function, attention function, and executive function within 24 h before the start of training and within 24 h after the 8 weeks of training. We investigated the altered resting-state functional connectivity (RSFC) with the right dorsolateral prefrontal cortex (DLPFC) in patients with PSCI following ER training through functional magnetic resonance imaging (fMRI). Additionally, twenty people undergoing routine physical examinations in the outpatient department of our hospital were selected as the healthy control (HC) group.

Results: Before training, both groups of PSCI patients exhibited significant impairment in overall cognitive function, attention function, and executive function compared to the HC group. However, there was no significant difference between the two PSCI patient groups. Following 8 weeks of treatment, both PSCI patient groups demonstrated substantial improvement in overall cognitive function, attention function, and executive function. Moreover, the ER group exhibited greater improvement after training compared to the CM group. Despite the improvements, the cognitive behavioral performance assessment scores of both PSCI patient groups remained lower than those of the HC group. RSFC analysis in the ER group revealed strengthened positive functional connectivity between the right DLPFC and the left superior frontal gyrus (SFG) and left anterior cingulate gyrus (ACG), along with decreased functional connectivity between the right DLPFC and the right superior temporal gyrus (STG) and right precentral gyrus post-ER intervention.

Conclusion: ER intervention is more effective than conventional medical rehabilitation in improving the cognitive function of PSCI patients, potentially by augmenting the FC between the right DLPFC and dominant cognitive brain regions, such as the left SFG and left ACG while attenuating the FC between the right DLPFC and non-dominant hemisphere areas including the STG and precentral gyrus within the right hemisphere.

Purpose: Postherpetic neuralgia (PHN) is a type of refractory neuropathic pain that causes significant suffering, disability, economic loss, and medical burden. In this study, we aim to evaluate the efficacy and safety of interferon (IFN)-α1b injection into the intervertebral foramen of patients with PHN.

Patients and methods: This is a study protocol for a randomized, double-blind placebo-controlled multicenter clinical trial. A total of 200 participants with PHN from 11 hospitals will be recruited and randomly assigned to the treatment group administered with IFN-α1b and control group treated with placebo in a 1:1 ratio. Both groups will also receive oral pregabalin 150 mg twice daily and lidocaine injection into the intervertebral foramen as conventional therapy. This trial will involve a screening period, a 2-week intervention, and a 3-month follow-up. The primary outcomes will include the visual analog scale score and duration of pain relief. The secondary outcomes will include the 36-item short-form, dosage and duration of painkillers taken, viral load of varicella-zoster virus DNA, humoral cytokine level, and dosage and frequency of rescue medication. All adverse events and severe adverse events will be assessed during the study.

Conclusion: This study is expected to provide evidence for the efficacy and safety of IFN-α1b injection into the intervertebral foramen in patients with PHN.

Clinical trial registration: https://www.chictr.org.cn/indexEN.html, identifier ChiCTR240008996.

Background: Post COVID-19 condition (PCC) is increasingly recognized as a debilitating condition characterized by persistent symptoms following SARS-CoV-2 infection. Neuropsychological deficits, including cognitive impairments and fatigue, are prevalent in individuals with PCC. The PoCoRe study aimed to evaluate the burden of neuropsychological deficits in PCC patients undergoing multidisciplinary indoor rehabilitation and to describe possible changes in this symptomatology.

Methods: The PoCoRe study, a prospective, non-randomized, controlled longitudinal study, recruited PCC patients from six German indoor rehabilitation centers. Eligible participants underwent comprehensive neuropsychological assessments at admission and discharge. Various measures were employed, including the fatigue scale for motor functioning and cognition (FSMC), the Test Battery for Attention (TAP) and the Montreal Cognitive Assessment (MoCA).

Results: Out of the 1,086 recruited participants, a total of N = 701 participants were included in the main data analysis. The prevalence of fatigue on admission was high (84.6%) and decreased significantly by discharge (77.4%), with a mild effect size. Reaction times on the alertness subtest were abnormal in 70% of patients on admission and 50% on discharge. Sustained attention was abnormal in 55% of patients on admission, decreasing to 43% on discharge. These differences were significant with mild effect sizes. Furthermore, of the 27% of participants with pathological MoCA scores at admission, 63% improved to normative levels during rehabilitation, indicating a significant treatment effect (p ≤ 0.001). However, the MoCA demonstrated limited sensitivity in detecting attention deficits.

Conclusion: The PoCoRe study highlights the high prevalence of neuropsychological deficits and fatigue in PCC patients, with notable improvements observed following multidisciplinary rehabilitation. Challenges remain in accurately identifying and addressing these deficits, underscoring the importance of comprehensive neuropsychological assessment and tailored rehabilitation interventions. Further research is warranted to optimize screening tools and enhance neuropsychological care for PCC patients in both rehabilitation and outpatient settings.

Background: Vojta Therapy (VT) is a neurorehabilitation approach that targets ontogenetic postural function and automatic body posture control. Research has shown its potential to enhance gait ability. However, limited evidence exists regarding its immediate effects on individuals with Down syndrome (DS).

Objectives: This study aimed to assess the immediate effects of one session VT on spatiotemporal gait parameters in individuals with DS.

Design: A non-randomized pilot study was conducted.

Methods: Sixteen individuals with DS (mean age: 17.88 ± 4.57 years, 8 males) participated in this study. Each received a single VT session administered by an experienced physiotherapist. Spatiotemporal gait parameters before and after VT were analyzed using the Vicon motion capture system.

Results: Significant improvements were observed in walking speed (m/s), cadence (steps/min), right step time (s), step length (cm), stride length (cm), and double support time (%GC) following the VT session (P < 0.05). These findings suggest that VT may offer immediate benefits in improving gait parameters for individuals with DS.

Conclusions: Future large-scale studies with more robust designs are necessary to explore the long-term effects of extended VT programs.