Frontiers in Neurology最新文献

Background: Multiple sclerosis (MS) is a debilitating autoimmune disease that mostly affects women.

Objectives: In this study we evaluated the relationship of pelvic muscle strengths with urinary incontinence and quality of life in women with MS.

Materials and methods: In this cross-sectional study 87 women with MS were recruited. Data collected using a demographic questionnaire, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and Quality of Life Questionnaire (QOL-SF-36). A perineometer was used to measure the strengths of pelvic muscle. Data analyzed using Pearson correlation test, and multiple linear regression tests.

Results: There was a positive correlation between pelvic muscle strengths with all domains of quality of life except for body pain and role limitations due to emotional problems. A significant inverse correlation was found between urinary incontinence and all domains of quality of life except for body pain. Also, an inverse correlation was found between muscle strength and urinary incontinence (r = -0.838, p < 0.001). A one-unit increase in the quality of physical life was associated with a 0.15-unit increase in the strengths of pelvic floor muscles (p = 0.035). On the other hand, each additional year of marriage or disease duration significantly weakened pelvic floor muscles by 0.24 and 0.509 units, respectively (p < 0.05).

Conclusion: Our findings showed that pelvic muscle strength, urinary incontinence, and quality of life were significantly interrelated among female patients with MS. An inverse correlation was also found between muscle strength and urinary incontinence. Duration of marriage and length of MS disease were inversely associated with the strength of the pelvic floor muscles. Health providers are recommended to educate MS patients on the importance of pelvic muscle strengths.

Objective: The relationship between small subcortical ischemic infarction remains poorly characterized. Therefore, the present study aimed to investigate the association between artery-to-artery embolization and small subcortical infarctions.

Methods: This retrospective observational cross-sectional study enrolling 230 patients with acute middle cerebral artery (MCA) stroke classified into the microembolic signals-positive (MES+) and MES-negative (MES-) groups. The diffusion weighted imaging (DWI) infarction patterns in the MCA were divided into the territorial, border zone (BZ), cortical, and subcortical infarcts. We set the standard of small subcortical infarction (SCI) into two levels: < 10 mm diameter and <5 mm diameter. Relevant DWI parameters were used to build a nomogram for MES+, using free statistics.

Results: MES occurred in 38 of the 230 cases, yielding a positivity rate of 16.5%. BZ, SCI <10 mm, cortical ischemia (CI), stenosis, white blood cell count, and gender were compared between the MES+ and MES- groups. Multivariate analysis revealed that BZ, SCI < 10 mm, and CI were independently associated with MES. Based on DWI parameters, a nomogram model was built for MES+. The area under the curve of the model was 0.826 (95%CI 0.764 to 0.889). In internal cross-validation, the slope of the calibration curve was 1.000, indicating that the model accurately predicted unsuccessful treatment outcomes.

Conclusion: Small subcortical infarctions are associated with MES. In the present study, we built a predictive nomogram model for MES+ based on small subcortical infarctions and other DWI parameters. This model demonstrated good performance in clinical practice.

Objective: To investigate changes of brain functional activity in patients with acute unilateral vestibulopathy (AUVP) using functional magnetic resonance imaging (fMRI).

Methods: We studied 32 AUVP patients and 30 healthy controls (HC) who received resting-state fMRI scanning. Methods of voxel-based amplitude of low-frequency fluctuation (ALFF) and seed-based functional connectivity (FC) were adopted to compare the difference in brain function between the two groups. In addition, we evaluated the associations between abnormal neuroimaging results and clinical data in AUVP patients.

Results: Compared with HC, patients with AUVP showed lower ALFF in brain regions of bilateral insular, right precentral gyrus, left inferior frontal gyrus and right middle frontal gyrus, as well as higher ALFF in left cerebellar anterior lobe. Using these abnormal brain areas as seeds, we observed decreased FC between left insular and left precuneus in AUVP patients. Furthermore, AUVP patients showed increased FC between left insular and left supplementary motor area. Results of correlation analysis indicated that ALFF value (z-value) in left insular was negatively correlated with the canal paresis value (p = 0.005, r = -0.483), and the FC (z-value) between left insular and left precuneus was negatively correlated with dizziness handicap inventory score (p = 0.012, r = -0.438) in patients with AUVP.

Conclusion: Patients with AUVP during acute period showed altered functional activity and connectivity in brain regions mainly involved in motor control and vestibular information processing. These changes in brain functional activity and connectivity were potentially attributed to decreased vestibular input resulting from unilateral peripheral vestibular impairment.

Objective: Recent studies have indicated a close relationship between intracranial arterial stenosis and white matter hyperintensities (WMHs), but few have reported on the correlation between the characteristics of intracranial arterial wall plaques and WMHs. The aim of this study was to comprehensively assess the correlation between intracranial atherosclerosis plaques and WMHs using 3.0T high-resolution magnetic resonance imaging (HR-MRI).

Patients and methods: Ninety-two ischemic stroke patients with middle cerebral artery (MCA) stenosis <50% on cranial magnetic resonance angiography (MRA) underwent conventional MRI and HR-MRI examinations. T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) images were processed using 2D VBNeT automatic segmentation technology to segment WMH volume. HR-MRI images were analyzed using ImageJ software to evaluate the luminal area, outer wall area, plaque distribution, luminal stenosis rate, remodeling patterns, and other plaque parameters at the stenosis site and reference points of the MCA M1 segment. The correlation between the presence of plaques, plaque distribution, luminal stenosis rate, T1 hyperintensity, remodeling patterns, remodeling ratio (RR), eccentric plaques, and plaque burden with the volume of cerebral WMHs was analyzed.

Results: Compared with the no-plaque group, the plaque group had significantly higher age, male ratio, total WMH volume, periventricular WMH (PVWMH) volume, deep WMH (DWMH) volume, and juxtacortical WMH (JCWMH) volume (all p < 0.05). The Kruskal-Wallis H test showed that patients with plaques on the superior and dorsal sides of the MCA M1 segment had higher levels of total WMH volume, PVWMH volume, DWMH volume, and JCWMH volume than patients with plaques on the inferior and ventral sides (all p < 0.05). Age, diabetes, previous stroke events, plaque distribution, positive remodeling, eccentric plaques, and RR were positively correlated with total WMH volume, PVWMH volume, and JCWMH volume (all p < 0.05). The presence of plaques, plaque distribution, and positive remodeling were independent risk factors for total WMH volume (all p < 0.05).

Conclusion: The presence of intracranial atherosclerotic plaques, plaque distribution, and positive remodeling are closely associated with increased cerebral WMHs burden in patients with ischemic stroke, which further supports the relationship between large artery atherosclerosis and CSVD.

Refractory cancer pain affects 10-20% of patients with advanced malignancies and is not adequately controlled by opioids. The intrathecal therapy is an effective interventional procedure for referral, but the implanted infusion pumps are costly and the refilling requires technical expertise. Hypophysectomy, in its three stages-surgical, chemical, and radiosurgical-has emerged as an alternative for managing this pain. However, the underlying mechanism remains elusive, with existing hypotheses unable to comprehensively account for both the initial and long-term analgesic effects. This literature review explores the historical evolution, clinical outcomes, and hypothesized mechanisms of hypophysectomy for pain relief. Surgical hypophysectomy initially demonstrated an 85.5% success rate but carried significant risks like diabetes insipidus and hypopituitarism. Chemical hypophysectomy reduced invasiveness, achieving 75.1% pain relief with fewer complications. Modern pituitary radiosurgery has improved safety while maintaining high efficacy (initial relief: 95.9%, long-term: 73.5%). The mechanisms underlying pain relief remain unclear but include tumor regression, increased β-endorphins, neuroendocrine modulation, and hypothalamic involvement. A new hypothesis suggests that radiosurgery induces hormone redistribution (e.g., oxytocin, vasopressin) through hypothalamic-pituitary modulation, contributing to both immediate and long-term analgesia. Despite its potential, unresolved issues such as optimal radiation dose, pain assessment standardization, and precise mechanisms limit widespread adoption. This review underscores the need for larger, homogenous studies to validate the safety and efficacy of hypophysectomy in treating refractory cancer pain. These findings offer a promising avenue for improving palliative care in oncology.

Introduction: Stroke is a leading cause of adult disability, and the transition from hospital to home can be fraught with challenges. The HOME Rehab trial is designed to address if better health outcomes for stroke survivors can be achieved with a contextually relevant and tailored occupational therapy discharge planning and support intervention. Process evaluations inform clinical trial findings and future scale up, as well as how to implement a successful intervention effectively into policy and practice. This paper describes the protocol we are using in the HOME Rehab process evaluation planning and activities.

Methods: Using a theoretically informed approach, mixed methods are being used to collect data and address all aspects of the RE-AIM framework. Quantitative data will comprise clinician surveys, trial logs and fidelity checklists as well as screening and recruitment numbers. Semi-structured interviews with trial participants and carers and focus groups with occupational therapists will provide qualitative data. A concurrent triangulation approach will be taken to draw on the strengths of multiple methods to cross-validate findings. The RE-AIM framework will be used to interpret the qualitative and quantitative data together as well as highlight areas of convergence or divergence in the findings. Multiple data sources will be integrated to refine the interpretation of outcomes, understand the context of program delivery, and identify key findings. Drawing on, and integrating data from, multiple perspectives and methods will strengthen the overall findings and provided detailed insights into the causal mechanisms as well as the contextual factors that may influence intervention outcomes.

Discussion: Process evaluations can optimize study outcomes by improving how a complex intervention is implemented, informing the actions of policymakers and clinicians. For the HOME Rehab intervention, the process evaluation may provide valuable data necessary to explain the trial findings, as well as inform future scale-up and implementation if the HOME Rehab intervention is shown to be effective.

Clinical trial registration: https://www.anzctr.org.au, identifier ACTRN12618001360202.

Background: Evidence of the effectiveness of physiotherapy, including muscle strength training, coordination training, aerobic exercise, cycling regimen, balance training, gait training, and activity of daily living training, in patients with degenerative cerebellar ataxia (DCA) was insufficient for clinical decision making. We aimed to explore clinical outcomes and examine the parameters associated with physical impairment and activity in people with DCA based on preregistration (PROSPERO: CRD42024493883).

Methods: The PubMed, Cochrane Library, CHINAL, and PEDro databases were searched for relevant randomized controlled trials (RCTs). Data extraction, quality assessment, and heterogeneity analyses were conducted. The Grading of Recommendations Assessment, Development, and Evaluation framework (GRADE) was used to assess the quality of evidence, and a meta-analysis was performed.

Results: Eighteen RCTs, which included 398 participants, showed a serious risk of bias (RoB) and low certainty of evidence for this primary outcome. For meta-analysis, 315 patients assessed based on the Scale for Assessment and Rating of Ataxia (SARA) were included. Overall, physiotherapy significantly reduced SARA scores (MD = -1.41, [95% CI: -2.16, -0.66]); the subgroup analysis showed that the following interventions exerted significant effects: multi-aspect training program (5 studies, MD = -1.59, [95% CI: -5.15, -0.03]), balance training (3 studies, MD = -1.58, [95% CI: -2.55, -0.62]), and aerobic training (3 studies, MD = -1.65, [95% CI: -2.53, -0.77]). By contrast, vibration (2 studies, MD = -0.56, [95% CI: -2.05, 0.93]) and dual-task training (1 study, MD = 0.24, [95% CI: -6.4, 6.88]) exhibited no significant effects.

Conclusion: Physical therapy, especially multi-aspect physical therapy such as muscle strengthening, coordination training, gait training, and ADL training, may reduce DCA symptoms. Further, balance and aerobic training can be added to the program. However, the estimated effect size may change in future studies because of the serious RoB, very low certainty of evidence, and high heterogeneity with SARA as the primary outcome. High-quality RCTs are required to establish evidence for the effectiveness of physical therapy in patients with DCA.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=493883, identifier: CRD42024493883.

Background: Spontaneous intracerebral hemorrhage (SICH) is the second most common cause of cerebrovascular disease after ischemic stroke, with high mortality and disability rates, imposing a significant economic burden on families and society. This retrospective study aimed to develop and evaluate an interpretable machine learning model to predict functional outcomes 3 months after SICH.

Methods: A retrospective analysis was conducted on clinical data from 380 patients with SICH who were hospitalized at three different centers between June 2020 and June 2023. Seventy percent of the samples were randomly selected as the training set, while the remaining 30% were used as the validation set. Univariate analysis, Least Absolute Shrinkage and Selection Operator (LASSO) regression, and Pearson correlation analysis were used to screen clinical variables. The selected variables were then incorporated into five machine learning models: complementary naive bayes (CNB), support vector machine (SVM), gaussian naive bayes (GNB), multilayer perceptron (MLP), and extreme gradient boosting (XGB), to assess their performance. Additionally, the area under the curve (AUC) values were evaluated to compare the performance of each algorithmic model, and global and individual interpretive analyses were conducted using importance ranking and Shapley additive explanations (SHAP).

Results: Among the 380 patients, 95 ultimately had poor prognostic outcomes. In the validation set, the AUC values for CNB, SVM, GNB, MLP, and XGB models were 0.899 (0.816-0.979), 0.916 (0.847-0.982), 0.730 (0.602-0.857), 0.913 (0.834-0.986), and 0.969 (0.937-0.998), respectively. Therefore, the XGB model performed the best among the five algorithms. SHAP analysis revealed that the GCS score, hematoma volume, blood pressure changes, platelets, age, bleeding location, and blood glucose levels were the most important variables for poor prognosis.

Conclusion: The XGB model developed in this study can effectively predict the risk of poor prognosis in patients with SICH, helping clinicians make personalized and rational clinical decisions. Prognostic risk in patients with SICH is closely associated with GCS score, hematoma volume, blood pressure changes, platelets, age, bleeding location, and blood glucose levels.