首页 > 最新文献

Annals of Clinical and Translational Neurology最新文献

英文 中文
Comprehensive multicentre retrospective analysis for predicting isocitrate dehydrogenase-mutant lower-grade gliomas. 预测异柠檬酸脱氢酶突变低级别胶质瘤的综合多中心回顾性分析。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-18 DOI: 10.1002/acn3.52251
Dongxu Zhao, Lin Duan, Tareq A Juratli, Fazheng Shen, Liyun Zhou, Shulin Cui, Hang Zhang, Hang Ren, Luyao Cheng, Hailan Wang, Wenhan Shi, Tianxiao Li, Ming Li

Objective: To differentiate glioma grading and determine isocitrate dehydrogenase (IDH) mutation status, which are crucial for prognosis assessment and treatment planning in glioma patients.

Methods: This retrospective study included patients diagnosed with adult diffuse glioma from 1 January, 2018 to 31 July, 2023 in two independent institutions. It documented and analysed clinical and radiographic features. A nomogram model was constructed using stepwise regression to predict lower-grade gliomas and IDH mutation status.

Results: A total of 383 adult patients with diffuse glioma were included in the study, with Cohort A (297 patients) serving as the training set and Cohort B (86 patients) serving as the validation cohort. Consistent with previous reports, the Hyper fluid-attenuated inversion recovery (FLAIR) rim sign exhibited higher sensitivity in lower-grade gliomas for IDH mutant gliomas compared with the T2-FLAIR mismatch sign. However, the Hyper FLAIR rim sign was also present in Grade 4 gliomas, and thus, the T2-FLAIR mismatch sign exhibited better clinical efficacy in predicting glioma grade and IDH mutation compared with the Hyper FLAIR rim sign in clinical applications. Meanwhile, preoperative magnetic resonance spectroscopy (MRS) indicators, particularly the Cho/Cr ratio, have shown excellent performance in predicting glioma grade and IDH mutation status. The nomogram developed through stepwise regression demonstrated excellent predictive capabilities in distinguishing glioma grade and IDH mutation status.

Interpretation: Combining imaging and molecular features, the predictive model established in this study offers a reliable non-invasive tool for predicting glioma grading and IDH mutation status, aiding the clinical decision-making process and improving patient management.

摘要区分胶质瘤分级并确定异柠檬酸脱氢酶(IDH)突变状态,这对胶质瘤患者的预后评估和治疗计划至关重要:这项回顾性研究纳入了2018年1月1日至2023年7月31日在两家独立机构确诊的成人弥漫性胶质瘤患者。研究记录并分析了临床和放射学特征。采用逐步回归法构建了一个提名图模型,以预测低级别胶质瘤和IDH突变状态:研究共纳入了 383 名弥漫性胶质瘤成人患者,其中队列 A(297 名患者)为训练集,队列 B(86 名患者)为验证集。与之前的报告一致,与T2-FLAIR错配征象相比,Hyper fluid-attenuated inversion recovery (FLAIR) rim sign在低级别胶质瘤中对IDH突变胶质瘤表现出更高的敏感性。因此,在临床应用中,T2-FLAIR错配征与超FLAIR边缘征相比,在预测胶质瘤等级和IDH突变方面具有更好的临床疗效。同时,术前磁共振波谱(MRS)指标,尤其是Cho/Cr比值,在预测胶质瘤分级和IDH突变状态方面表现出色。通过逐步回归开发的提名图在区分胶质瘤分级和IDH突变状态方面表现出卓越的预测能力:本研究建立的预测模型结合了影像学和分子特征,为预测胶质瘤分级和IDH突变状态提供了可靠的非侵入性工具,有助于临床决策过程和改善患者管理。
{"title":"Comprehensive multicentre retrospective analysis for predicting isocitrate dehydrogenase-mutant lower-grade gliomas.","authors":"Dongxu Zhao, Lin Duan, Tareq A Juratli, Fazheng Shen, Liyun Zhou, Shulin Cui, Hang Zhang, Hang Ren, Luyao Cheng, Hailan Wang, Wenhan Shi, Tianxiao Li, Ming Li","doi":"10.1002/acn3.52251","DOIUrl":"10.1002/acn3.52251","url":null,"abstract":"<p><strong>Objective: </strong>To differentiate glioma grading and determine isocitrate dehydrogenase (IDH) mutation status, which are crucial for prognosis assessment and treatment planning in glioma patients.</p><p><strong>Methods: </strong>This retrospective study included patients diagnosed with adult diffuse glioma from 1 January, 2018 to 31 July, 2023 in two independent institutions. It documented and analysed clinical and radiographic features. A nomogram model was constructed using stepwise regression to predict lower-grade gliomas and IDH mutation status.</p><p><strong>Results: </strong>A total of 383 adult patients with diffuse glioma were included in the study, with Cohort A (297 patients) serving as the training set and Cohort B (86 patients) serving as the validation cohort. Consistent with previous reports, the Hyper fluid-attenuated inversion recovery (FLAIR) rim sign exhibited higher sensitivity in lower-grade gliomas for IDH mutant gliomas compared with the T2-FLAIR mismatch sign. However, the Hyper FLAIR rim sign was also present in Grade 4 gliomas, and thus, the T2-FLAIR mismatch sign exhibited better clinical efficacy in predicting glioma grade and IDH mutation compared with the Hyper FLAIR rim sign in clinical applications. Meanwhile, preoperative magnetic resonance spectroscopy (MRS) indicators, particularly the Cho/Cr ratio, have shown excellent performance in predicting glioma grade and IDH mutation status. The nomogram developed through stepwise regression demonstrated excellent predictive capabilities in distinguishing glioma grade and IDH mutation status.</p><p><strong>Interpretation: </strong>Combining imaging and molecular features, the predictive model established in this study offers a reliable non-invasive tool for predicting glioma grading and IDH mutation status, aiding the clinical decision-making process and improving patient management.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Phenotypic and oncological insights in ANNA1 autoimmunity: Age stratification and biomarker analysis. ANNA1 自身免疫的表型和肿瘤学见解:年龄分层和生物标志物分析
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-18 DOI: 10.1002/acn3.52254
Naveen Kumar Paramasivan, Majed Masoud, Carley Karsten, Anza Zahid, Haidara Kherbek, Anastasia Zekeridou, Sri Raghav Sista, Surendra Dasari, Andrew M Knight, Georgios Mangioris, John R Mills, Andrew McKeon, Sean J Pittock, Divyanshu Dubey

Objective: To describe the phenotypes, oncological associations, biomarker profiles, and outcomes across different age groups in patients with ANNA1 (anti-Hu) autoimmunity.

Methods: A retrospective review of patients with ANNA1-IgG in serum/CSF between January 1, 2001, and December 31,2019 was performed. Patients were classified into three groups based on the age of symptom onset. Phage immunoprecipitation sequencing (PhIP-Seq) and neurofilament light chain (NfL) measurements were done in patient sera/CSF with archived samples.

Results: Of 122 patients, 81 (66%), 20 (16%), and 21 (17%) patients belonged to older adults, young adults, and pediatric groups, respectively. Lung cancer and neuromuscular presentations were more common in older adults (p < 0.001), while limbic encephalitis and neuroblastoma were more common in pediatric patients (p < 0.005). Most young adults (75%) did not have cancer identified. Proportions of patients with a favorable response to immunotherapy were 20%, 30%, and 52% among older adults, young adults, and pediatric groups, respectively. PhIP-Seq demonstrated significant enrichment for ELAVL4 peptides especially for amino acids 240-289, in the majority of samples evaluated (36/67, 54%). ZIC and SOX2 peptides were significantly enriched in those with central nervous system presentations. Serum NfL levels were elevated in patients with cancer and those with poor long-term outcomes.

Interpretation: Young adults with ANNA1 autoimmunity phenotypically resembled older adults but rarely had an underlying cancer. Pediatric patients frequently presented with limbic encephalitis and neuroblastoma and often responded favorably to immunotherapy. Distinct antigenic signatures may underlie differences in clinical presentations. Serum NfL levels may be a biomarker of poor long-term outcomes in ANNA1 autoimmunity.

目的描述ANNA1(抗-Hu)自身免疫患者在不同年龄段的表型、肿瘤关联、生物标志物特征和预后:对2001年1月1日至2019年12月31日期间血清/CSF中含有ANNA1-IgG的患者进行回顾性研究。根据发病年龄将患者分为三组。对患者血清/CSF中的存档样本进行了噬菌体免疫沉淀测序(PhIP-Seq)和神经丝蛋白轻链(NfL)测定:在122名患者中,分别有81人(66%)、20人(16%)和21人(17%)属于老年人组、青年人组和儿童组。肺癌和神经肌肉病变在老年人中更为常见(p 解释:ANNA1自身免疫性疾病患者中,年轻的成年人更容易患上肺癌和神经肌肉病变:患有 ANNA1 自身免疫病的年轻人在表型上与老年人相似,但很少有潜在的癌症。小儿患者常表现为边缘型脑炎和神经母细胞瘤,通常对免疫疗法反应良好。不同的抗原特征可能是临床表现差异的原因。血清NfL水平可能是ANNA1自身免疫性疾病长期疗效不佳的生物标志物。
{"title":"Phenotypic and oncological insights in ANNA1 autoimmunity: Age stratification and biomarker analysis.","authors":"Naveen Kumar Paramasivan, Majed Masoud, Carley Karsten, Anza Zahid, Haidara Kherbek, Anastasia Zekeridou, Sri Raghav Sista, Surendra Dasari, Andrew M Knight, Georgios Mangioris, John R Mills, Andrew McKeon, Sean J Pittock, Divyanshu Dubey","doi":"10.1002/acn3.52254","DOIUrl":"10.1002/acn3.52254","url":null,"abstract":"<p><strong>Objective: </strong>To describe the phenotypes, oncological associations, biomarker profiles, and outcomes across different age groups in patients with ANNA1 (anti-Hu) autoimmunity.</p><p><strong>Methods: </strong>A retrospective review of patients with ANNA1-IgG in serum/CSF between January 1, 2001, and December 31,2019 was performed. Patients were classified into three groups based on the age of symptom onset. Phage immunoprecipitation sequencing (PhIP-Seq) and neurofilament light chain (NfL) measurements were done in patient sera/CSF with archived samples.</p><p><strong>Results: </strong>Of 122 patients, 81 (66%), 20 (16%), and 21 (17%) patients belonged to older adults, young adults, and pediatric groups, respectively. Lung cancer and neuromuscular presentations were more common in older adults (p < 0.001), while limbic encephalitis and neuroblastoma were more common in pediatric patients (p < 0.005). Most young adults (75%) did not have cancer identified. Proportions of patients with a favorable response to immunotherapy were 20%, 30%, and 52% among older adults, young adults, and pediatric groups, respectively. PhIP-Seq demonstrated significant enrichment for ELAVL4 peptides especially for amino acids 240-289, in the majority of samples evaluated (36/67, 54%). ZIC and SOX2 peptides were significantly enriched in those with central nervous system presentations. Serum NfL levels were elevated in patients with cancer and those with poor long-term outcomes.</p><p><strong>Interpretation: </strong>Young adults with ANNA1 autoimmunity phenotypically resembled older adults but rarely had an underlying cancer. Pediatric patients frequently presented with limbic encephalitis and neuroblastoma and often responded favorably to immunotherapy. Distinct antigenic signatures may underlie differences in clinical presentations. Serum NfL levels may be a biomarker of poor long-term outcomes in ANNA1 autoimmunity.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Incremental clinical value of intraplaque neovascularization in predicting recurrent ischemic stroke. 斑块内新生血管在预测缺血性脑卒中复发方面的临床增量价值。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-18 DOI: 10.1002/acn3.52255
Liuping Cui, Ran Liu, Fubo Zhou, Bing Tian, Ying Chen, Yingqi Xing

Objective: Carotid intraplaque neovascularization (IPN) detected by contrast-enhanced ultrasound (CEUS) is a risk factor for recurrent ischemic stroke. However, it is still unclear whether IPN can be used to accurately identify patients with recurrent ischemic stroke in clinical practice. Herein, we investigated the clinical predictive value of IPN for recurrent ischemic stroke in a real-world setting.

Methods: We enrolled 200 patients with ischemic stroke and atherosclerotic carotid stenosis who were followed up for 2 years. The endpoint was recurrent ischemic stroke. Cox regression and subgroup analyses were employed to assess whether treatment affected the relationship between IPN and recurrent ischemic stroke. The net classification index (NRI) and integrated discriminant improvement index (IDI) were used to validate the additional clinical value of IPN in identifying recurrent ischemic stroke.

Results: During the 2-year follow-up, 36 patients experienced recurrent ischemic stroke. Cox regression analyses showed that IPN (grade 2), hypoechoic plaque, high homocysteine levels, and smoking were independent risk factors for recurrent ischemic stroke. Additional IPN evaluation may increase the NRI (0.512; 95% confidence interval [CI]: 0.083-0.624) and IDI (0.151; 95% CI: 0.010-0.213) for identifying high-risk patients with recurrent ischemic stroke. In addition, in the subgroup undergoing revascularization, the proportion of IPN (grade 2) was significantly higher in patients with recurrent ischemic stroke than in patients with nonrecurrent ischemic stroke (p = 0.001).

Interpretation: In clinical settings, IPN, assessed by CEUS, may provide additional clinical value for predicting recurrent ischemic stroke, helping to identify patients with ischemic stroke who require close follow-up.

目的:造影剂增强超声(CEUS)检测到的颈动脉斑块内新生血管(IPN)是缺血性卒中复发的一个危险因素。然而,在临床实践中,IPN 能否用于准确识别复发性缺血性脑卒中患者仍不清楚。在此,我们研究了 IPN 在真实世界中对复发性缺血性卒中的临床预测价值:方法:我们招募了 200 名缺血性脑卒中和颈动脉粥样硬化性狭窄患者,对他们进行了为期 2 年的随访。终点是复发性缺血性中风。采用 Cox 回归和亚组分析评估治疗是否会影响 IPN 与复发性缺血性中风之间的关系。净分类指数(NRI)和综合判别改进指数(IDI)用于验证 IPN 在识别复发性缺血性卒中方面的额外临床价值:结果:在2年的随访期间,36名患者出现了复发性缺血性卒中。Cox回归分析显示,IPN(2级)、低回声斑块、高同型半胱氨酸水平和吸烟是导致复发性缺血性卒中的独立危险因素。额外的 IPN 评估可提高 NRI(0.512;95% 置信区间 [CI]:0.083-0.624)和 IDI(0.151;95% 置信区间:0.010-0.213),用于识别复发性缺血性卒中的高危患者。此外,在接受血管再通的亚组中,复发性缺血性卒中患者的 IPN(2 级)比例明显高于非复发性缺血性卒中患者(P = 0.001):在临床中,CEUS 评估的 IPN 可为预测缺血性卒中复发提供额外的临床价值,有助于识别需要密切随访的缺血性卒中患者。
{"title":"Incremental clinical value of intraplaque neovascularization in predicting recurrent ischemic stroke.","authors":"Liuping Cui, Ran Liu, Fubo Zhou, Bing Tian, Ying Chen, Yingqi Xing","doi":"10.1002/acn3.52255","DOIUrl":"10.1002/acn3.52255","url":null,"abstract":"<p><strong>Objective: </strong>Carotid intraplaque neovascularization (IPN) detected by contrast-enhanced ultrasound (CEUS) is a risk factor for recurrent ischemic stroke. However, it is still unclear whether IPN can be used to accurately identify patients with recurrent ischemic stroke in clinical practice. Herein, we investigated the clinical predictive value of IPN for recurrent ischemic stroke in a real-world setting.</p><p><strong>Methods: </strong>We enrolled 200 patients with ischemic stroke and atherosclerotic carotid stenosis who were followed up for 2 years. The endpoint was recurrent ischemic stroke. Cox regression and subgroup analyses were employed to assess whether treatment affected the relationship between IPN and recurrent ischemic stroke. The net classification index (NRI) and integrated discriminant improvement index (IDI) were used to validate the additional clinical value of IPN in identifying recurrent ischemic stroke.</p><p><strong>Results: </strong>During the 2-year follow-up, 36 patients experienced recurrent ischemic stroke. Cox regression analyses showed that IPN (grade 2), hypoechoic plaque, high homocysteine levels, and smoking were independent risk factors for recurrent ischemic stroke. Additional IPN evaluation may increase the NRI (0.512; 95% confidence interval [CI]: 0.083-0.624) and IDI (0.151; 95% CI: 0.010-0.213) for identifying high-risk patients with recurrent ischemic stroke. In addition, in the subgroup undergoing revascularization, the proportion of IPN (grade 2) was significantly higher in patients with recurrent ischemic stroke than in patients with nonrecurrent ischemic stroke (p = 0.001).</p><p><strong>Interpretation: </strong>In clinical settings, IPN, assessed by CEUS, may provide additional clinical value for predicting recurrent ischemic stroke, helping to identify patients with ischemic stroke who require close follow-up.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Dopaminergic therapy disrupts decision-making in impulsive-compulsive Parkinsonian patients. 多巴胺能疗法会干扰帕金森病冲动强迫症患者的决策。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-18 DOI: 10.1002/acn3.52249
Fabio Taddeini, Erica Ordali, Alessandra Govoni, Francesca Piattellini, Simone Valente, Luca Caremani, Alberto A Vergani, Ahmet Kaymak, Aldo Rustichini, Eleonora Russo, Chiara Rapallini, Silvia Ramat, Alberto Mazzoni

Impulsive-compulsive behaviors (ICB) are common non-motor symptoms of Parkinson's disease (PD) often associated with dopaminergic drugs (DD) therapy. We investigated the acute effects of DD on decision-making in PD patients with ICB (ICB+) and without it (ICB-), and in healthy controls (HC). Participants performed a risk-based decision-making task twice, with PD patients tested before (DD OFF) and after (DD ON) DD intake. In DD OFF, all groups developed a risk-averting strategy. In DD ON, ICB+ patients (but not ICB- nor HC) reverted to riskier choices. We conclude that DD has a specific strong acute effect on ICB+ patients' decision-making.

冲动-强迫行为(ICB)是帕金森病(PD)常见的非运动症状,通常与多巴胺能药物(DD)治疗有关。我们研究了多巴胺能药物对有 ICB(ICB+)和无 ICB(ICB-)帕金森病患者以及健康对照组(HC)决策的急性影响。参与者进行了两次基于风险的决策任务,其中帕金森病患者分别在接受 DD 治疗之前(DD OFF)和之后(DD ON)进行了测试。在 "DD OFF "状态下,所有组别都制定了风险规避策略。在 DD ON 时,ICB+ 患者(而不是 ICB- 或 HC)会重新做出更冒险的选择。我们的结论是,DD 对 ICB+ 患者的决策具有特定的强烈急性影响。
{"title":"Dopaminergic therapy disrupts decision-making in impulsive-compulsive Parkinsonian patients.","authors":"Fabio Taddeini, Erica Ordali, Alessandra Govoni, Francesca Piattellini, Simone Valente, Luca Caremani, Alberto A Vergani, Ahmet Kaymak, Aldo Rustichini, Eleonora Russo, Chiara Rapallini, Silvia Ramat, Alberto Mazzoni","doi":"10.1002/acn3.52249","DOIUrl":"10.1002/acn3.52249","url":null,"abstract":"<p><p>Impulsive-compulsive behaviors (ICB) are common non-motor symptoms of Parkinson's disease (PD) often associated with dopaminergic drugs (DD) therapy. We investigated the acute effects of DD on decision-making in PD patients with ICB (ICB+) and without it (ICB-), and in healthy controls (HC). Participants performed a risk-based decision-making task twice, with PD patients tested before (DD OFF) and after (DD ON) DD intake. In DD OFF, all groups developed a risk-averting strategy. In DD ON, ICB+ patients (but not ICB- nor HC) reverted to riskier choices. We conclude that DD has a specific strong acute effect on ICB+ patients' decision-making.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Determinants of long-term paramagnetic rim lesion evolution in people with multiple sclerosis. 多发性硬化症患者长期顺磁边缘病变演变的决定因素。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-18 DOI: 10.1002/acn3.52253
Jack A Reeves, Alexander Bartnik, Maryam Mohebbi, Murali Ramanathan, Niels Bergsland, Dejan Jakimovski, Gregory E Wilding, Fahad Salman, Ferdinand Schweser, Bianca Weinstock-Guttman, David Hojnacki, Svetlana Eckert, Francesca Bagnato, Michael G Dwyer, Robert Zivadinov

Objective: Baseline paramagnetic rim lesion (PRL) load predicts disease progression in people with multiple sclerosis (pwMS). Understanding how PRLs relate to other known MS-related factors, and the practical utility of PRLs in clinical trials, is crucial for informing clinical decision-making and guiding development of novel disease-modifying treatments (DMTs).

Methods: This study included 152 pwMS enrolled in a larger prospective, longitudinal cohort study who had 3T MRI scans and clinical assessments at baseline and 5- or 10-year follow-ups. PRLs were identified on baseline 3T quantitative susceptibility maps and classified as persisting, disappearing, or newly appearing at follow-up. The relationships between PRL evolution and clinical, radiological, environmental, and genetic characteristics were assessed, and clinical trial sample sizes were estimated using PRL appearance or disappearance as outcome measures.

Results: DMT use was associated with lower odds of new PRL appearance (for high-efficacy DMTs: odds ratio = 0.088, p = 0.024), but not disappearance. Current smoking status was associated with greater baseline PRL number (B = 0.527 additional PRLs, p = 0.013). A 24-month clinical trial in people with progressive MS for a DMT that doubles the rate of PRL rim disappearance would require an estimated 118 people with progressive MS per group at 80% statistical power.

Interpretation: Early MS diagnosis and subsequent DMT initiation may reduce new chronic active inflammation. However, the utility of PRL disappearance or new PRL appearance as outcome measures in clinical trials is limited by potentially large sample sizes that are needed for moderate efficacy drugs.

目的:基线顺磁边缘病变(PRL)负荷可预测多发性硬化症患者(pwMS)的疾病进展。了解PRL与其他已知多发性硬化症相关因素的关系以及PRL在临床试验中的实际效用,对于为临床决策提供信息和指导新型疾病修饰治疗(DMT)的开发至关重要:本研究纳入了152名参加大型前瞻性纵向队列研究的帕金森病患者,他们在基线和5年或10年随访时接受了3T磁共振成像扫描和临床评估。在基线3T定量易感图上确定了PRL,并在随访时将其分为持续存在、消失或新出现。评估了PRL演变与临床、放射学、环境和遗传特征之间的关系,并以PRL出现或消失作为结果测量指标估算了临床试验样本量:使用DMT与较低的新PRL出现几率相关(高效DMT:几率比=0.088,p=0.024),但与消失无关。目前的吸烟状况与更多的基线 PRL 数量相关(B = 0.527 个额外的 PRL,p = 0.013)。对进展期多发性硬化症患者进行为期24个月的临床试验,如果DMT能使PRL边缘消失率增加一倍,则每组估计需要118名进展期多发性硬化症患者,统计功率为80%:早期多发性硬化症诊断和随后的DMT治疗可减少新的慢性活动性炎症。然而,PRL消失或新的PRL出现作为临床试验的结果测量指标,其实用性受到中等疗效药物所需的潜在大样本量的限制。
{"title":"Determinants of long-term paramagnetic rim lesion evolution in people with multiple sclerosis.","authors":"Jack A Reeves, Alexander Bartnik, Maryam Mohebbi, Murali Ramanathan, Niels Bergsland, Dejan Jakimovski, Gregory E Wilding, Fahad Salman, Ferdinand Schweser, Bianca Weinstock-Guttman, David Hojnacki, Svetlana Eckert, Francesca Bagnato, Michael G Dwyer, Robert Zivadinov","doi":"10.1002/acn3.52253","DOIUrl":"10.1002/acn3.52253","url":null,"abstract":"<p><strong>Objective: </strong>Baseline paramagnetic rim lesion (PRL) load predicts disease progression in people with multiple sclerosis (pwMS). Understanding how PRLs relate to other known MS-related factors, and the practical utility of PRLs in clinical trials, is crucial for informing clinical decision-making and guiding development of novel disease-modifying treatments (DMTs).</p><p><strong>Methods: </strong>This study included 152 pwMS enrolled in a larger prospective, longitudinal cohort study who had 3T MRI scans and clinical assessments at baseline and 5- or 10-year follow-ups. PRLs were identified on baseline 3T quantitative susceptibility maps and classified as persisting, disappearing, or newly appearing at follow-up. The relationships between PRL evolution and clinical, radiological, environmental, and genetic characteristics were assessed, and clinical trial sample sizes were estimated using PRL appearance or disappearance as outcome measures.</p><p><strong>Results: </strong>DMT use was associated with lower odds of new PRL appearance (for high-efficacy DMTs: odds ratio = 0.088, p = 0.024), but not disappearance. Current smoking status was associated with greater baseline PRL number (B = 0.527 additional PRLs, p = 0.013). A 24-month clinical trial in people with progressive MS for a DMT that doubles the rate of PRL rim disappearance would require an estimated 118 people with progressive MS per group at 80% statistical power.</p><p><strong>Interpretation: </strong>Early MS diagnosis and subsequent DMT initiation may reduce new chronic active inflammation. However, the utility of PRL disappearance or new PRL appearance as outcome measures in clinical trials is limited by potentially large sample sizes that are needed for moderate efficacy drugs.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Automated assessment of EEG background for neurodevelopmental prediction in neonatal encephalopathy. 自动评估脑电图背景以预测新生儿脑病的神经发育。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-14 DOI: 10.1002/acn3.52233
Micheline Lagacé, Saeed Montazeri, Daphne Kamino, Eva Mamak, Linh G Ly, Cecil D Hahn, Vann Chau, Sampsa Vanhatalo, Emily W Y Tam

Objective: Assess the capacity of brain state of the newborn (BSN) to predict neurodevelopment outcomes in neonatal encephalopathy.

Methods: Trends of BSN, a deep learning-based measure translating EEG background to a continuous trend, were studied from a three-channel montage long-term EEG monitoring from a prospective cohort of 92 infants with neonatal encephalopathy and neurodevelopmental outcomes assessed by Bayley Scales of Infant Development, 3rd edition (Bayley-III) at 18 months. Outcome prediction used categories "Severe impairment" (Bayley-III composite score ≤70 or death) or "Any impairment" (score ≤85 or death).

Results: "Severe impairment" was predicted best for motor outcomes (24 h area under the curve (AUC) = 0.97), followed by cognitive (36 h AUC = 0.90), overall (24 h AUC = 0.84), and language (24 h AUC = 0.82). "Any impairment" was best predicted for motor outcomes (12 h AUC = 0.95), followed by cognitive (24 h AUC = 0.85), overall (12 h AUC = 0.75), and language (12 and 24 h AUC = 0.68). Optimal BSN cutoffs for outcome predictions evolved with the postnatal age. Low BSN scores reached a 100% positive prediction of poor outcomes at 24 h of age.

Interpretation: BSN is an excellent predictor of adverse neurodevelopmental outcomes in survivors of neonatal encephalopathy after therapeutic hypothermia, even at 24 h of life. The trend provides a fully automated, objective, quantified, and reliable interpretation of EEG background. The high temporal resolution supports continuous bedside brain assessment and early prognostication during the initial dynamic recovery phase.

目的:评估新生儿脑状态(BSN)预测新生儿脑病神经发育结局的能力:评估新生儿脑状态(BSN)预测新生儿脑病神经发育结果的能力:BSN是一种基于深度学习的测量方法,可将脑电图背景转化为连续趋势,我们通过对92名新生儿脑病患儿的前瞻性队列进行三通道蒙太奇长期脑电图监测,研究了BSN的趋势,并通过贝利婴儿发育量表第三版(Bayley-III)评估了患儿18个月时的神经发育结果。结果预测采用 "严重损伤"(Bayley-III 综合评分≤70 分或死亡)或 "任何损伤"(评分≤85 分或死亡)类别:结果:"严重损伤 "对运动结果的预测效果最好(24 小时曲线下面积 (AUC) = 0.97),其次是认知(36 小时曲线下面积 = 0.90)、整体(24 小时曲线下面积 = 0.84)和语言(24 小时曲线下面积 = 0.82)。"任何损伤 "对运动结果的预测效果最佳(12 h AUC = 0.95),其次是认知(24 h AUC = 0.85)、整体(12 h AUC = 0.75)和语言(12 和 24 h AUC = 0.68)。预测结果的最佳 BSN 临界值随产后年龄而变化。BSN 分数低的婴儿在出生后 24 小时内对不良预后的预测阳性率达到 100%:BSN能很好地预测治疗性低温后新生儿脑病幸存者的不良神经发育结局,即使是在出生后24小时。该趋势可对脑电图背景进行全自动、客观、量化和可靠的解读。在最初的动态恢复阶段,高时间分辨率支持连续的床旁脑部评估和早期预后。
{"title":"Automated assessment of EEG background for neurodevelopmental prediction in neonatal encephalopathy.","authors":"Micheline Lagacé, Saeed Montazeri, Daphne Kamino, Eva Mamak, Linh G Ly, Cecil D Hahn, Vann Chau, Sampsa Vanhatalo, Emily W Y Tam","doi":"10.1002/acn3.52233","DOIUrl":"10.1002/acn3.52233","url":null,"abstract":"<p><strong>Objective: </strong>Assess the capacity of brain state of the newborn (BSN) to predict neurodevelopment outcomes in neonatal encephalopathy.</p><p><strong>Methods: </strong>Trends of BSN, a deep learning-based measure translating EEG background to a continuous trend, were studied from a three-channel montage long-term EEG monitoring from a prospective cohort of 92 infants with neonatal encephalopathy and neurodevelopmental outcomes assessed by Bayley Scales of Infant Development, 3rd edition (Bayley-III) at 18 months. Outcome prediction used categories \"Severe impairment\" (Bayley-III composite score ≤70 or death) or \"Any impairment\" (score ≤85 or death).</p><p><strong>Results: </strong>\"Severe impairment\" was predicted best for motor outcomes (24 h area under the curve (AUC) = 0.97), followed by cognitive (36 h AUC = 0.90), overall (24 h AUC = 0.84), and language (24 h AUC = 0.82). \"Any impairment\" was best predicted for motor outcomes (12 h AUC = 0.95), followed by cognitive (24 h AUC = 0.85), overall (12 h AUC = 0.75), and language (12 and 24 h AUC = 0.68). Optimal BSN cutoffs for outcome predictions evolved with the postnatal age. Low BSN scores reached a 100% positive prediction of poor outcomes at 24 h of age.</p><p><strong>Interpretation: </strong>BSN is an excellent predictor of adverse neurodevelopmental outcomes in survivors of neonatal encephalopathy after therapeutic hypothermia, even at 24 h of life. The trend provides a fully automated, objective, quantified, and reliable interpretation of EEG background. The high temporal resolution supports continuous bedside brain assessment and early prognostication during the initial dynamic recovery phase.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Intermittent hypoxia training improves cerebral blood flow without cognitive impairment. 间歇性缺氧训练可改善脑血流量,但不会损害认知能力。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-14 DOI: 10.1002/acn3.52248
Qihan Zhang, Qing Wang, Feiyang Jin, Dan Huang, Xunming Ji, Yuan Wang

Objective: Brief exposure to intermittent hypoxia has been shown to potentially induce protective effects in the body. Animal studies suggest that intermittent hypoxia could increase cerebral blood flow and confer resistance to subsequent hypoxic-ischemic injury, yet clinical investigations are limited. This study aimed to evaluate the impact of a moderate short-term intermittent hypoxia protocol on cerebral blood flow and cognitive performance.

Methods: Subjects who met the inclusion criteria were recruited to this study and randomized into the intermittent hypoxia group or the control group, which receives intermittent hypoxia training and sham-intermittent hypoxia training, respectively. Cerebral hemodynamics, cognitive performance, cerebral perfusion pressure, and oxygen saturation were assessed before and after the intervention.

Results: A total of 100 healthy participants were included in this study. Compared to the control group, the intermittent hypoxia group exhibited higher peak systolic blood flow velocity (108.64 ± 22.53 vs. 100.21 ± 19.06, p = 0.049) and cerebrovascular conduction index (0.74 ± 0.17 vs. 0.66 ± 0.21, p = 0.027), and lower cerebrovascular resistance index (1.41 ± 0.29 vs. 1.54 ± 0.36, p = 0.044) following intermittent hypoxia training. Additionally, within-group comparisons revealed that intermittent hypoxia training led to increased cerebral blood flow velocity, elevated cerebrovascular conductance index, and decreased cerebrovascular resistance index (p < 0.05). Other indicators including cognitive function, cerebral perfusion pressure, and oxygen saturation did not exhibit significant differences between groups.

Interpretation: These findings revealed that intermittent hypoxia may represent a safe and effective strategy for improving cerebral blood flow.

目的:研究表明,短暂暴露于间歇性缺氧环境可能会对人体产生保护作用。动物研究表明,间歇性缺氧可增加脑血流量,并对随后的缺氧缺血性损伤产生抵抗力,但临床研究还很有限。本研究旨在评估中度短期间歇性缺氧方案对脑血流量和认知能力的影响:方法:本研究招募了符合纳入标准的受试者,并将其随机分为间歇性缺氧组和对照组,对照组分别接受间歇性缺氧训练和假间歇性缺氧训练。干预前后对脑血流动力学、认知能力、脑灌注压和血氧饱和度进行评估:结果:本研究共纳入了 100 名健康参与者。与对照组相比,间歇性缺氧组在间歇性缺氧训练后表现出更高的收缩期峰值血流速度(108.64 ± 22.53 vs. 100.21 ± 19.06,p = 0.049)和脑血管传导指数(0.74 ± 0.17 vs. 0.66 ± 0.21,p = 0.027),以及更低的脑血管阻力指数(1.41 ± 0.29 vs. 1.54 ± 0.36,p = 0.044)。此外,组内比较显示,间歇性缺氧训练导致脑血流速度增加、脑血管传导指数升高和脑血管阻力指数降低(p 解释:间歇性缺氧训练导致脑血流速度增加、脑血管传导指数升高和脑血管阻力指数降低(p = 0.044):这些研究结果表明,间歇性缺氧可能是一种安全有效的改善脑血流的策略。
{"title":"Intermittent hypoxia training improves cerebral blood flow without cognitive impairment.","authors":"Qihan Zhang, Qing Wang, Feiyang Jin, Dan Huang, Xunming Ji, Yuan Wang","doi":"10.1002/acn3.52248","DOIUrl":"10.1002/acn3.52248","url":null,"abstract":"<p><strong>Objective: </strong>Brief exposure to intermittent hypoxia has been shown to potentially induce protective effects in the body. Animal studies suggest that intermittent hypoxia could increase cerebral blood flow and confer resistance to subsequent hypoxic-ischemic injury, yet clinical investigations are limited. This study aimed to evaluate the impact of a moderate short-term intermittent hypoxia protocol on cerebral blood flow and cognitive performance.</p><p><strong>Methods: </strong>Subjects who met the inclusion criteria were recruited to this study and randomized into the intermittent hypoxia group or the control group, which receives intermittent hypoxia training and sham-intermittent hypoxia training, respectively. Cerebral hemodynamics, cognitive performance, cerebral perfusion pressure, and oxygen saturation were assessed before and after the intervention.</p><p><strong>Results: </strong>A total of 100 healthy participants were included in this study. Compared to the control group, the intermittent hypoxia group exhibited higher peak systolic blood flow velocity (108.64 ± 22.53 vs. 100.21 ± 19.06, p = 0.049) and cerebrovascular conduction index (0.74 ± 0.17 vs. 0.66 ± 0.21, p = 0.027), and lower cerebrovascular resistance index (1.41 ± 0.29 vs. 1.54 ± 0.36, p = 0.044) following intermittent hypoxia training. Additionally, within-group comparisons revealed that intermittent hypoxia training led to increased cerebral blood flow velocity, elevated cerebrovascular conductance index, and decreased cerebrovascular resistance index (p < 0.05). Other indicators including cognitive function, cerebral perfusion pressure, and oxygen saturation did not exhibit significant differences between groups.</p><p><strong>Interpretation: </strong>These findings revealed that intermittent hypoxia may represent a safe and effective strategy for improving cerebral blood flow.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Emergent responsive neurostimulation in pediatric super-refractory epilepsia partialis continua. 小儿超难治性癫痫部分性持续状态的紧急反应性神经刺激。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-14 DOI: 10.1002/acn3.52199
Peter N Hadar, Pranav Nanda, Katherine G Walsh, John McLaren, Alexandra Geffrey, Mirela Simon, Kristopher Kahle, R Mark Richardson, Catherine J Chu

Focal status epilepticus, particularly the motor variant of epilepsia partialis continua (EPC), is a rare condition characterized by near-continuous, chronic focal motor seizures, and associated with poor outcomes. Medications, including anesthetics, are often unsuccessful. Surgical resection can result in motor deficits. We report a medically complex pediatric case of super-refractory EPC that was successfully managed with combined focal resection and responsive neuromodulation. This case introduces neuromodulation as a treatment modality for this challenging condition.

局灶性癫痫状态,尤其是癫痫部分性持续状态(EPC)的运动变异型,是一种罕见的疾病,其特点是近乎持续的慢性局灶性运动性癫痫发作,且预后不佳。包括麻醉剂在内的药物治疗往往无效。手术切除可能导致运动障碍。我们报告了一例病情复杂的超难治性癫痫发作儿科病例,该病例通过联合病灶切除术和反应性神经调控成功治愈。本病例介绍了神经调控作为治疗这种具有挑战性疾病的一种方法。
{"title":"Emergent responsive neurostimulation in pediatric super-refractory epilepsia partialis continua.","authors":"Peter N Hadar, Pranav Nanda, Katherine G Walsh, John McLaren, Alexandra Geffrey, Mirela Simon, Kristopher Kahle, R Mark Richardson, Catherine J Chu","doi":"10.1002/acn3.52199","DOIUrl":"https://doi.org/10.1002/acn3.52199","url":null,"abstract":"<p><p>Focal status epilepticus, particularly the motor variant of epilepsia partialis continua (EPC), is a rare condition characterized by near-continuous, chronic focal motor seizures, and associated with poor outcomes. Medications, including anesthetics, are often unsuccessful. Surgical resection can result in motor deficits. We report a medically complex pediatric case of super-refractory EPC that was successfully managed with combined focal resection and responsive neuromodulation. This case introduces neuromodulation as a treatment modality for this challenging condition.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical features and progression of Parkinson's disease with LRRK2 variants: A prospective study. 帕金森病 LRRK2 变体的临床特征和进展:前瞻性研究
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-11 DOI: 10.1002/acn3.52244
Tingwei Song, Xiaoxia Zhou, Chunyu Wang, Heng Wu, Xinxiang Yan, Jifeng Guo, Beisha Tang, Lifang Lei, Qian Xu

Objective: We established a prospective cohort study to investigate the differences in motor and non-motor symptoms between idiopathic Parkinson's disease (IPD) and Parkinson's disease in carriers of leucine-rich repeat kinase 2 (LRRK2) gene risk variants (LRRK2-PD).

Methods: The study included 1407 individuals with IPD and 649 individuals with LRRK2-PD (comprising 304 with LRRK2-G2385R, 220 with LRRK2-R1628P, and 105 with LRRK2-A419V). Differences in symptoms between LRRK2-PD and IPD were analyzed using LCMM modeling and Cox regression analysis.

Results: The LRRK2-G2385R variant showed slower progression in tremor symptoms and excessive daytime sleepiness compared with IPD. In contrast, symptoms associated with LRRK2-R1628P and LRRK2-A419V were more similar to those of IPD. Survival analysis revealed that LRRK2-PD does not affect life expectancy compared with IPD.

Interpretation: Our extended longitudinal follow-up of LRRK2-PD in the Chinese population provided valuable insights, further confirming the clinical characteristics of the three LRRK2 variants.

研究目的我们建立了一项前瞻性队列研究,以调查特发性帕金森病(IPD)和富亮氨酸重复激酶2(LRRK2)基因风险变异携带者帕金森病(LRRK2-PD)在运动症状和非运动症状方面的差异:研究对象包括1407名IPD患者和649名LRRK2-PD患者(包括304名LRRK2-G2385R携带者、220名LRRK2-R1628P携带者和105名LRRK2-A419V携带者)。采用LCMM建模和Cox回归分析法分析了LRRK2-PD和IPD之间的症状差异:结果:与 IPD 相比,LRRK2-G2385R 变异体的震颤症状和白天过度嗜睡的进展较慢。相比之下,LRRK2-R1628P 和 LRRK2-A419V 的相关症状与 IPD 更为相似。生存分析表明,与IPD相比,LRRK2-PD不会影响预期寿命:我们对中国人群中的LRRK2-PD进行的长期纵向随访提供了有价值的见解,进一步证实了三种LRRK2变异体的临床特征。
{"title":"Clinical features and progression of Parkinson's disease with LRRK2 variants: A prospective study.","authors":"Tingwei Song, Xiaoxia Zhou, Chunyu Wang, Heng Wu, Xinxiang Yan, Jifeng Guo, Beisha Tang, Lifang Lei, Qian Xu","doi":"10.1002/acn3.52244","DOIUrl":"https://doi.org/10.1002/acn3.52244","url":null,"abstract":"<p><strong>Objective: </strong>We established a prospective cohort study to investigate the differences in motor and non-motor symptoms between idiopathic Parkinson's disease (IPD) and Parkinson's disease in carriers of leucine-rich repeat kinase 2 (LRRK2) gene risk variants (LRRK2-PD).</p><p><strong>Methods: </strong>The study included 1407 individuals with IPD and 649 individuals with LRRK2-PD (comprising 304 with LRRK2-G2385R, 220 with LRRK2-R1628P, and 105 with LRRK2-A419V). Differences in symptoms between LRRK2-PD and IPD were analyzed using LCMM modeling and Cox regression analysis.</p><p><strong>Results: </strong>The LRRK2-G2385R variant showed slower progression in tremor symptoms and excessive daytime sleepiness compared with IPD. In contrast, symptoms associated with LRRK2-R1628P and LRRK2-A419V were more similar to those of IPD. Survival analysis revealed that LRRK2-PD does not affect life expectancy compared with IPD.</p><p><strong>Interpretation: </strong>Our extended longitudinal follow-up of LRRK2-PD in the Chinese population provided valuable insights, further confirming the clinical characteristics of the three LRRK2 variants.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prolonged venous transit is associated with worse neurological recovery in successfully reperfused large vessel strokes. 在成功再灌注的大血管脑卒中患者中,静脉过境时间延长与神经功能恢复较差有关。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-11 DOI: 10.1002/acn3.52243
Janet Mei, Hamza Adel Salim, Dhairya A Lakhani, Licia Luna, Aneri Balar, Mona Shahriari, Nathan Z Hyson, Francis Deng, Adam A Dmytriw, Adrien Guenego, Vaibhav Vagal, Victor C Urrutia, Elisabeth B Marsh, Hanzhang Lu, Risheng Xu, Rich Leigh, Dylan Wolman, Gaurang Shah, Benjamin Pulli, Kambiz Nael, Gregory W Albers, Max Wintermark, Jeremy J Heit, Tobias D Faizy, Argye E Hillis, Raf Llinas, Vivek Yedavalli

Objective: Venous outflow (VO) impairment predicts unfavorable outcomes in patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO). Prolonged venous transit (PVT), a visual qualitative VO marker on CT perfusion (CTP) time to maximum (Tmax) maps, has been associated with unfavorable 90-day functional outcomes despite successful reperfusion. This study investigates the association between PVT and percent change on the National Institutes of Health Stroke Scale (NIHSS) among AIS-LVO patients who have undergone successful reperfusion.

Methods: We performed a retrospective analysis of prospectively collected data from consecutive adult AIS-LVO patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/2c/3). PVT+ was defined as Tmax ≥10 s in the superior sagittal sinus, torcula, or both. The primary outcome was continuous NIHSS percent change and dichotomous NIHSS percent change ≥70%. Regression analyses were performed to assess the effect of PVT on NIHSS percent change.

Results: In 119 patients of median (IQR) age 71 (63-81) years, the admission and discharge NIHSS scores were significantly higher in PVT+ patients compared to PVT- patients (17 [14-23.5] vs. 13 [9.5-19], p = 0.011, and 7.5 [4-12] vs. 3 [1-7], p < 0.001, respectively). After adjusting for age, sex, hypertension, diabetes, atrial fibrillation, administration of intravenous thrombolysis (IVT), Alberta Stroke Program Early CT Scores (ASPECTS), mTICI 2c and/or 3, Tmax >6 s volume, and hemorrhagic transformation, PVT+ was significantly associated with lower NIHSS percent change (B = -0.163, 95%CI -0.326 to -0.001, p = 0.049) and was less likely to achieve higher than 70% NIHSS improvement (OR = 0.331, 95% CI 0.127-0.863, p = 0.024).

Interpretation: PVT+ was significantly associated with reduced neurological improvement despite successful reperfusion in AIS-LVO patients, highlighting the critical role of VO impairment in short-term functional outcomes. These findings further validate PVT as a valuable adjunct imaging biomarker derived from CTP for assessing VO profiles in AIS-LVO.

目的大血管闭塞(AIS-LVO)导致的急性缺血性卒中患者静脉流出量(VO)受损预示着不利的预后。静脉转运时间延长(PVT)是 CT 灌注(CTP)时间到最大值(Tmax)图上直观的 VO 定性标记,尽管再灌注成功,但静脉转运时间延长与 90 天功能预后不良有关。本研究调查了成功接受再灌注的 AIS-LVO 患者的 PVT 与美国国立卫生研究院卒中量表(NIHSS)百分比变化之间的关系:我们对前瞻性收集的成功再灌注(改良脑梗塞溶栓疗法 2b/2c/3)的连续成人 AIS-LVO 患者的数据进行了回顾性分析。PVT+定义为上矢状窦、蝶窦或两者的Tmax≥10 s。主要结果为连续 NIHSS 百分比变化和二分 NIHSS 百分比变化≥70%。进行回归分析以评估 PVT 对 NIHSS 百分比变化的影响:在中位(IQR)年龄为 71(63-81)岁的 119 例患者中,PVT+ 患者的入院和出院 NIHSS 评分均显著高于 PVT- 患者(17 [14-23.5] vs. 13 [9.5-19],p = 0.011;7.5 [4-12] vs. 3 [1-7],p = 0.011)。PVT+ 与较低的 NIHSS 百分比变化显著相关(B = -0.163,95%CI -0.326--0.001,p = 0.049),且较少可能实现高于 70% 的 NIHSS 改善(OR = 0.331,95% CI 0.127-0.863,p = 0.024):PVT+与AIS-LVO患者尽管成功再灌注但神经功能改善程度降低有明显相关性,突出了VO损伤在短期功能预后中的关键作用。这些研究结果进一步验证了 PVT 是一种有价值的辅助成像生物标记物,可通过 CTP 评估 AIS-LVO 患者的 VO 状况。
{"title":"Prolonged venous transit is associated with worse neurological recovery in successfully reperfused large vessel strokes.","authors":"Janet Mei, Hamza Adel Salim, Dhairya A Lakhani, Licia Luna, Aneri Balar, Mona Shahriari, Nathan Z Hyson, Francis Deng, Adam A Dmytriw, Adrien Guenego, Vaibhav Vagal, Victor C Urrutia, Elisabeth B Marsh, Hanzhang Lu, Risheng Xu, Rich Leigh, Dylan Wolman, Gaurang Shah, Benjamin Pulli, Kambiz Nael, Gregory W Albers, Max Wintermark, Jeremy J Heit, Tobias D Faizy, Argye E Hillis, Raf Llinas, Vivek Yedavalli","doi":"10.1002/acn3.52243","DOIUrl":"https://doi.org/10.1002/acn3.52243","url":null,"abstract":"<p><strong>Objective: </strong>Venous outflow (VO) impairment predicts unfavorable outcomes in patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO). Prolonged venous transit (PVT), a visual qualitative VO marker on CT perfusion (CTP) time to maximum (Tmax) maps, has been associated with unfavorable 90-day functional outcomes despite successful reperfusion. This study investigates the association between PVT and percent change on the National Institutes of Health Stroke Scale (NIHSS) among AIS-LVO patients who have undergone successful reperfusion.</p><p><strong>Methods: </strong>We performed a retrospective analysis of prospectively collected data from consecutive adult AIS-LVO patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/2c/3). PVT+ was defined as Tmax ≥10 s in the superior sagittal sinus, torcula, or both. The primary outcome was continuous NIHSS percent change and dichotomous NIHSS percent change ≥70%. Regression analyses were performed to assess the effect of PVT on NIHSS percent change.</p><p><strong>Results: </strong>In 119 patients of median (IQR) age 71 (63-81) years, the admission and discharge NIHSS scores were significantly higher in PVT+ patients compared to PVT- patients (17 [14-23.5] vs. 13 [9.5-19], p = 0.011, and 7.5 [4-12] vs. 3 [1-7], p < 0.001, respectively). After adjusting for age, sex, hypertension, diabetes, atrial fibrillation, administration of intravenous thrombolysis (IVT), Alberta Stroke Program Early CT Scores (ASPECTS), mTICI 2c and/or 3, Tmax >6 s volume, and hemorrhagic transformation, PVT+ was significantly associated with lower NIHSS percent change (B = -0.163, 95%CI -0.326 to -0.001, p = 0.049) and was less likely to achieve higher than 70% NIHSS improvement (OR = 0.331, 95% CI 0.127-0.863, p = 0.024).</p><p><strong>Interpretation: </strong>PVT+ was significantly associated with reduced neurological improvement despite successful reperfusion in AIS-LVO patients, highlighting the critical role of VO impairment in short-term functional outcomes. These findings further validate PVT as a valuable adjunct imaging biomarker derived from CTP for assessing VO profiles in AIS-LVO.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Annals of Clinical and Translational Neurology
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1