Pub Date : 2026-01-23DOI: 10.1016/j.jocn.2026.111878
Benjamin K.P. Woo , Jamie O.P. Chung
The dissemination of health information on YouTube presents a paradox where expert-generated content, despite high clinical accuracy, often lacks the engagement seen in non-expert patient narratives. Recent evaluations of Guillain-Barré Syndrome (GBS) videos confirm that while physician-produced content achieves superior objective quality scores, it frequently suffers from low visibility and fails to correlate popularity with scientific validity. This manuscript proposes a shift toward utilizing internal analytics, specifically Average View Duration (AVD) and Click-Through Rate (CTR), alongside a collaborative physician-director production model to bridge the gap between clinical precision and public engagement. We suggest that adopting this hybrid creative model and prioritizing internal engagement metrics over aggregate view counts will better support patients and caregivers, particularly in complex neurological conditions.
{"title":"Utilizing internal analytics and physician-director collaborations to enhance neurological health communication on YouTube","authors":"Benjamin K.P. Woo , Jamie O.P. Chung","doi":"10.1016/j.jocn.2026.111878","DOIUrl":"10.1016/j.jocn.2026.111878","url":null,"abstract":"<div><div>The dissemination of health information on YouTube presents a paradox where expert-generated content, despite high clinical accuracy, often lacks the engagement seen in non-expert patient narratives. Recent evaluations of Guillain-Barré Syndrome (GBS) videos confirm that while physician-produced content achieves superior objective quality scores, it frequently suffers from low visibility and fails to correlate popularity with scientific validity. This manuscript proposes a shift toward utilizing internal analytics, specifically Average View Duration (AVD) and Click-Through Rate (CTR), alongside a collaborative physician-director production model to bridge the gap between clinical precision and public engagement. We suggest that adopting this hybrid creative model and prioritizing internal engagement metrics over aggregate view counts will better support patients and caregivers, particularly in complex neurological conditions.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111878"},"PeriodicalIF":1.8,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Insular glioma (IG) resection is technically demanding and carries a high risk of postoperative neurological deficits, primarily due to ischemic injury to the middle cerebral artery (MCA) perforators. Understanding pre- and postoperative lenticulostriate artery (LSA) anatomy may clarify the tumor-perforator relationship and its clinical impact.
Methods
This prospective single-center study analyzed pre- and postoperative three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA) to assess IG-LSA relationships. The extent of resection (EOR) and complications were correlated with LSA involvement patterns and postoperative reduction in the number of visible LSAs.
Results
LSA involvement patterns included “displaced” (28%), “contact” (56%), and “engulfed” (16%) types. Postoperatively, mean LSA count declined from 3.76 to 3.0 (p = 0.007). Reduction occurred in all patients with engulfed LSAs and in 30% with contact type. Giant IGs were more frequent in contact and engulfed patterns (p = 0.008). Tumors with reduced LSAs were more often oligodendroglioma or glioblastoma than grade 2 astrocytoma (p = 0.004). LSA loss was unrelated to surgical approach but correlated with radical resection (p = 0.019) and neurological deficits (p = 0.001).
Conclusion
IGs with LSA engulfment should undergo subtotal resection, whereas contact-type lesions require intraoperative judgment regarding EOR. Radical resection in giant IGs with unsafe tumor-LSA relationships, especially in aggressive histologies, increases the risk of permanent deficits. Not all single-LSA injuries result in lasting impairment. Routine preoperative 3D-TOF MRA is recommended for evaluating IG resectability and minimizing ischemic complications.
{"title":"Decoding the intricacy of insular glioma-lenticulostriate artery relationship: Results from a prospective comparative study of pre and postoperative magnetic resonance angiographic evaluation","authors":"Sudhakar Madheshiya , Kuntal Kanti Das , Shreyash Rai , Vivek Singh , Sudarsana Gogoi , Prabhakar Mishra , Soumen Kanjilal , Ashutosh Kumar , Ved Prakash Maurya , Pawan Kumar Verma , Kamlesh Singh Bhaisora , Anant Mehrotra , Arun Kumar Srivastava , Awadhesh Kumar Jaiswal","doi":"10.1016/j.jocn.2026.111866","DOIUrl":"10.1016/j.jocn.2026.111866","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Insular glioma (IG) resection is technically demanding and carries a high risk of postoperative neurological deficits, primarily due to ischemic injury to the middle cerebral artery (MCA) perforators. Understanding pre- and postoperative lenticulostriate artery (LSA) anatomy may clarify the tumor-perforator relationship and its clinical impact.</div></div><div><h3>Methods</h3><div>This prospective single-center study analyzed pre- and postoperative three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA) to assess IG-LSA relationships. The extent of resection (EOR) and complications were correlated with LSA involvement patterns and postoperative reduction in the number of visible LSAs.</div></div><div><h3>Results</h3><div>LSA involvement patterns included “displaced” (28%), “contact” (56%), and “engulfed” (16%) types. Postoperatively, mean LSA count declined from 3.76 to 3.0 (p = 0.007). Reduction occurred in all patients with engulfed LSAs and in 30% with contact type. Giant IGs were more frequent in contact and engulfed patterns (p = 0.008). Tumors with reduced LSAs were more often oligodendroglioma or glioblastoma than grade 2 astrocytoma (p = 0.004). LSA loss was unrelated to surgical approach but correlated with radical resection (p = 0.019) and neurological deficits (p = 0.001).</div></div><div><h3>Conclusion</h3><div>IGs with LSA engulfment should undergo subtotal resection, whereas contact-type lesions require intraoperative judgment regarding EOR. Radical resection in giant IGs with unsafe tumor-LSA relationships, especially in aggressive histologies, increases the risk of permanent deficits. Not all single-LSA injuries result in lasting impairment. Routine preoperative 3D-TOF MRA is recommended for evaluating IG resectability and minimizing ischemic complications.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111866"},"PeriodicalIF":1.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146006771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-22DOI: 10.1016/j.jocn.2026.111876
Amani Nawito , Shahenda Al Menabbawy , Basma Bahgat El Sayed , Mohamed Magdy Ahmed Mohamed , Alshaimaa Sobhi Khalil
Diabetic Polyneuropathy (DPN) is a common debilitating complication of Diabetes Mellitus (DM), causing pain which may progress to numbness and motor involvement. DPN may lead to diabetic foot ulcers and possible amputation. Thus, DPN affects the patients’ quality of life and poses a financial burden if not managed early. Nerve conduction studies (NCS) have been used as an objective method for diagnosis of DPN. Neuromuscular Ultrasound (NMUS) is a more comfortable tool used to complement NCS in diagnosis of many diseases. The study aimed to investigate NMUS as a possible screening tool for DPN. The study included 58 patients with Type-II DM who were divided into two groups according to presence/absence of DPN using the modified Toronto clinical neuropathy score (mTCNS). The cross-sectional area (CSA) and muscle thickness (MT) in the upper and lower limbs as well as their corresponding NCS were compared. CSA of posterior tibial nerve and the sural nerve were significantly larger in the group with DPN. A cut-off value 2 mm2 CSA of the sural nerve showed sensitivity of 93.33%, specificity of 64.29% and area under the curve (AUC) was 80% for detecting DPN. This may be used as a complementary tool in certain situations to the corresponding NCS. Disease duration, HbA1c and mTCNS showed a positive correlation with NMUS findings. Patients with microvascular complications showed a significantly larger CSA of some nerves and less MT as compared to those without. NMUS represents a complementary tool to NCS and may be used for screening DPN.
{"title":"Neuromuscular ultrasound and nerve conduction studies as complementary tools for screening of diabetic peripheral neuropathy","authors":"Amani Nawito , Shahenda Al Menabbawy , Basma Bahgat El Sayed , Mohamed Magdy Ahmed Mohamed , Alshaimaa Sobhi Khalil","doi":"10.1016/j.jocn.2026.111876","DOIUrl":"10.1016/j.jocn.2026.111876","url":null,"abstract":"<div><div>Diabetic Polyneuropathy (DPN) is a common debilitating complication of Diabetes Mellitus (DM), causing pain which may progress to numbness and motor involvement. DPN may lead to diabetic foot ulcers and possible amputation. Thus, DPN affects the patients’ quality of life and poses a financial burden if not managed early. Nerve conduction studies (NCS) have been used as an objective method for diagnosis of DPN. Neuromuscular Ultrasound (NMUS) is a more comfortable tool used to complement NCS in diagnosis of many diseases. The study aimed to investigate NMUS as a possible screening tool for DPN. The study included 58 patients with Type-II DM who were divided into two groups according to presence/absence of DPN using the modified Toronto clinical neuropathy score (mTCNS). The cross-sectional area (CSA) and muscle thickness (MT) in the upper and lower limbs as well as their corresponding NCS were compared. CSA of posterior tibial nerve and the sural nerve were significantly larger in the group with DPN. A cut-off value 2 mm<sup>2</sup> CSA of the sural nerve showed sensitivity of 93.33%, specificity of 64.29% and area under the curve (AUC) was 80% for detecting DPN. This may be used as a complementary tool in certain situations to the corresponding NCS. Disease duration, HbA1c and mTCNS showed a positive correlation with NMUS findings. Patients with microvascular complications showed a significantly larger CSA of some nerves and less MT as compared to those without. NMUS represents a complementary tool to NCS and may be used for screening DPN.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111876"},"PeriodicalIF":1.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-22DOI: 10.1016/j.jocn.2026.111852
Giana Dawod, Alis J. Dicpinigaitis, Cenai Zhang, Hooman Kamel, Santosh Murthy, Alexander E. Merkler
Background/Objective
Data regarding the optimal treatment of infectious intracranial aneurysms remains sparse. With growing utilization of endovascular therapy for cerebrovascular disease, we examined trends in endovascular versus neurosurgical treatment of infectious aneurysms and investigated the impact of treatment modality on outcomes.
Methods
Using data from the National Inpatient Sample from 2000 to 2019, we conducted a trends analysis on rates of treatment modalities among hospitalizations with infective endocarditis with ruptured or unruptured cerebral aneurysms. Treatment modalities were categorized as endovascular versus open neurosurgical repair based on ICD-9 and ICD-10 codes. Logistic regressions were utilized to assess the association between treatment modality and the outcomes of in-hospital mortality and discharge disposition.
Results
We identified 24,461 hospitalizations with an infectious intracranial aneurysm in the setting of infective endocarditis. Mean age was 56.0 years (SD, 17.8) and 61.8 % were male. The overall rate of intervention was 5.8 % (95 % CI, 5.0–6.5 %), and this did not change over time (p = 0.669). There was a significant increase in the rate of endovascular repair (APC = 3.6 %; 95 % CI, 1.2 %-8.1 %) and a significant decrease in the rate of open neurosurgical repair (APC = -5.4 %; 95 % CI, −8.1 % to −3.5 %). Treatment modality was not associated with in-hospital mortality (p = 0.698) or non-home discharge disposition (p = 0.897).
Conclusion
Although rates of infectious intracranial aneurysm intervention for infective endocarditis did not change, utilization of endovascular treatment increased while the use of open neurosurgical treatment decreased without adverse effects on mortality rate. Further directions include elucidating predictors of favorable outcomes for undergoing intervention and the most beneficial timing for the procedure during hospitalization.
{"title":"Trends in Intervention Modality for Hospitalizations with Infectious Intracranial Aneurysms: A Nationwide Analysis","authors":"Giana Dawod, Alis J. Dicpinigaitis, Cenai Zhang, Hooman Kamel, Santosh Murthy, Alexander E. Merkler","doi":"10.1016/j.jocn.2026.111852","DOIUrl":"10.1016/j.jocn.2026.111852","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Data regarding the optimal treatment of infectious intracranial aneurysms remains sparse. With growing utilization of endovascular therapy for cerebrovascular disease, we examined trends in endovascular versus neurosurgical treatment of infectious aneurysms and investigated the impact of treatment modality on outcomes.</div></div><div><h3>Methods</h3><div>Using data from the National Inpatient Sample from 2000 to 2019, we conducted a trends analysis on rates of treatment modalities among hospitalizations with infective endocarditis with ruptured or unruptured cerebral aneurysms. Treatment modalities were categorized as endovascular versus open neurosurgical repair based on ICD-9 and ICD-10 codes. Logistic regressions were utilized to assess the association between treatment modality and the outcomes of in-hospital mortality and discharge disposition.</div></div><div><h3>Results</h3><div>We identified 24,461 hospitalizations with an infectious intracranial aneurysm in the setting of infective endocarditis. Mean age was 56.0 years (SD, 17.8) and 61.8 % were male. The overall rate of intervention was 5.8 % (95 % CI, 5.0–6.5 %), and this did not change over time (p = 0.669). There was a significant increase in the rate of endovascular repair (APC = 3.6 %; 95 % CI, 1.2 %-8.1 %) and a significant decrease in the rate of open neurosurgical repair (APC = -5.4 %; 95 % CI, −8.1 % to −3.5 %). Treatment modality was not associated with in-hospital mortality (p = 0.698) or non-home discharge disposition (p = 0.897).</div></div><div><h3>Conclusion</h3><div>Although rates of infectious intracranial aneurysm intervention for infective endocarditis did not change, utilization of endovascular treatment increased while the use of open neurosurgical treatment decreased without adverse effects on mortality rate. Further directions include elucidating predictors of favorable outcomes for undergoing intervention and the most beneficial timing for the procedure during hospitalization.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111852"},"PeriodicalIF":1.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-22DOI: 10.1016/j.jocn.2026.111872
Sıddıka Sena İnan , Kübra Mehel Metin , Arzu Muz , İsmail Eren Durmuş , Suna Akın Takmaz , Levent Ertuğrul İnan
Background
Numerous studies have evaluated greater occipital nerve (GON) blockade for migraine prophylaxis using various techniques and anesthetic agents, yet a standardized protocol remains lacking. Although both lidocaine and bupivacaine are effective compared with placebo, no direct comparison exists. This study aimed to compare the efficacy of lidocaine and bupivacaine in GON blockade for chronic migraine.
Materials and methods
Data from 79 chronic migraine patients who underwent ultrasound-guided GON blockade at the University of Health Sciences Ankara Training and Research Hospital were retrospectively analyzed. Patients received either 1.5 mL of 2% lidocaine + 1 mL saline or 1.5 mL of 0.5% bupivacaine + 1 mL saline. Multivariate path analysis was used to evaluate the factors affecting pain reduction and to adjust for baseline differences. Blocks were administered weekly during the first month and monthly for two subsequent months on the side corresponding to pain. The number of headache days, attack duration, and Visual Analog Scale (VAS) scores were recorded before and after each session.
Results
Both groups showed significant reductions in headache days, attack duration, and VAS scores after treatment. Baseline values were similar except for disease duration, which was significantly longer in the bupivacaine group (p = 0.028). At the first month, the bupivacaine group reported significantly more headache days than the lidocaine group (P = 0.046), but no further intergroup differences were found. Although the lidocaine group showed lower pain scores in the first month in univariate analysis, multivariate path analysis revealed that the treatment group (Lidocaine vs. Bupivacaine) did not have a statistically significant effect on the change in VAS scores (p > 0.05). The baseline VAS score was the only significant predictor of pain reduction (β = -0.70, p < 0.001).
Conclusion
Lidocaine and bupivacaine were both effective for migraine prophylaxis via GON blockade. While lidocaine appeared to provide faster relief initially, regression analysis suggests that baseline pain severity, rather than the choice of agent or disease duration, is the primary determinant of treatment response.
背景：许多研究已经评估了使用各种技术和麻醉剂阻断大枕神经（GON）预防偏头痛的效果，但仍然缺乏标准化的方案。虽然利多卡因和布比卡因与安慰剂相比都有效，但没有直接的比较。本研究旨在比较利多卡因和布比卡因对慢性偏头痛的谷氨酰胺阻断的疗效。材料和方法回顾性分析安卡拉健康科学大学培训和研究医院超声引导下的79例慢性偏头痛患者的数据。患者接受1.5 mL 2%利多卡因+ 1ml生理盐水或1.5 mL 0.5%布比卡因+ 1ml生理盐水。多变量路径分析用于评估影响疼痛减轻的因素，并调整基线差异。第一个月每周给药，随后两个月每月给药。记录每次治疗前后头痛天数、发作持续时间和视觉模拟评分（VAS）。结果两组患者治疗后头痛天数、发作持续时间和VAS评分均显著减少。基线值相似，但布比卡因组的病程明显更长（p = 0.028）。在第一个月，布比卡因组报告的头痛天数明显多于利多卡因组（P = 0.046），但组间无进一步差异。虽然单因素分析中，利多卡因组第一个月疼痛评分较低，但多因素通径分析显示，治疗组（利多卡因vs布比卡因）对VAS评分变化无统计学意义（p > 0.05）。基线VAS评分是疼痛减轻的唯一显著预测因子（β = -0.70, p < 0.001）。结论利多卡因和布比卡因均可通过神经素阻断预防偏头痛。虽然利多卡因最初似乎提供更快的缓解，但回归分析表明，基线疼痛严重程度，而不是药物选择或疾病持续时间，是治疗反应的主要决定因素。
{"title":"Comparison of the efficacy of lidocaine and bupivacaine in GON blockade for prophylaxis of chronic migraine","authors":"Sıddıka Sena İnan , Kübra Mehel Metin , Arzu Muz , İsmail Eren Durmuş , Suna Akın Takmaz , Levent Ertuğrul İnan","doi":"10.1016/j.jocn.2026.111872","DOIUrl":"10.1016/j.jocn.2026.111872","url":null,"abstract":"<div><h3>Background</h3><div>Numerous studies have evaluated greater occipital nerve (GON) blockade for migraine prophylaxis using various techniques and anesthetic agents, yet a standardized protocol remains lacking. Although both lidocaine and bupivacaine are effective compared with placebo, no direct comparison exists. This study aimed to compare the efficacy of lidocaine and bupivacaine in GON blockade for chronic migraine.</div></div><div><h3>Materials and methods</h3><div>Data from 79 chronic migraine patients who underwent ultrasound-guided GON blockade at the University of Health Sciences Ankara Training and Research Hospital were retrospectively analyzed. Patients received either 1.5 mL of 2% lidocaine + 1 mL saline or 1.5 mL of 0.5% bupivacaine + 1 mL saline. Multivariate path analysis was used to evaluate the factors affecting pain reduction and to adjust for baseline differences<strong>.</strong> Blocks were administered weekly during the first month and monthly for two subsequent months on the side corresponding to pain. The number of headache days, attack duration, and Visual Analog Scale (VAS) scores were recorded before and after each session.</div></div><div><h3>Results</h3><div>Both groups showed significant reductions in headache days, attack duration, and VAS scores after treatment. Baseline values were similar except for disease duration, which was significantly longer in the bupivacaine group (p = 0.028). At the first month, the bupivacaine group reported significantly more headache days than the lidocaine group (P = 0.046), but no further intergroup differences were found. Although the lidocaine group showed lower pain scores in the first month in univariate analysis, multivariate path analysis revealed that the treatment group (Lidocaine vs. Bupivacaine) did not have a statistically significant effect on the change in VAS scores (p > 0.05). The baseline VAS score was the only significant predictor of pain reduction (β = -0.70, p < 0.001).</div></div><div><h3>Conclusion</h3><div>Lidocaine and bupivacaine were both effective for migraine prophylaxis via GON blockade. While lidocaine appeared to provide faster relief initially, regression analysis suggests that baseline pain severity, rather than the choice of agent or disease duration, is the primary determinant of treatment response.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111872"},"PeriodicalIF":1.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146006772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-22DOI: 10.1016/j.jocn.2026.111873
Yue Han , Zhe Bian , Haochen Gu , Dunzhu Guo , Rui Li , Liping Liu , Dali Wang , Yanbo Peng
Background
The cumulative defined daily dose (cDDD) enables quantification of statin exposure, balancing therapeutic intensity and patient adherence. However, the relationship between statin cDDD and recurrence risk in ischemic stroke (IS) patients remains unclear.
Objective
The aim of this study was to investigate the impact of statin cDDD on recurrence risk in IS patients.
Methods
This prospective cohort study enrolled 728 patients with acute ischemic stroke (AIS). After 1 year of follow-up, participants were stratified into four groups (Q1-Q4) according to the quartiles of statin cDDD, and Kaplan-Meier curves were used to estimate the risk of stroke recurrence. The association between cDDD and recurrence risk was examined using restricted cubic spline (RCS) and Cox proportional hazards models, with sensitivity analyses employed to assess population heterogeneity and confirm the robustness of the findings.
Results
Kaplan-Meier survival analysis revealed statistically significant differences in recurrence rates across quartiles (P < 0.001). RCS analysis confirmed a nonlinear negative correlation between cDDD and recurrence risk (P for nonlinearity < 0.001). Multivariate Cox regression demonstrated that the recurrence risk in Q4 was 87.7% lower than in Q1. Sensitivity analysis further confirmed that the association between cDDD and IS recurrence risk was independent of antihypertensive or antidiabetic medication use.
Conclusions
Statin cDDD shows a significant nonlinear inverse correlation with stroke recurrence, and exhibits a dose-dependent threshold effect.
{"title":"Association between the cumulative defined daily dose of statins and ischemic stroke recurrence: a cohort study","authors":"Yue Han , Zhe Bian , Haochen Gu , Dunzhu Guo , Rui Li , Liping Liu , Dali Wang , Yanbo Peng","doi":"10.1016/j.jocn.2026.111873","DOIUrl":"10.1016/j.jocn.2026.111873","url":null,"abstract":"<div><h3>Background</h3><div>The cumulative defined daily dose (cDDD) enables quantification of statin exposure, balancing therapeutic intensity and patient adherence. However, the relationship between statin cDDD and recurrence risk in ischemic stroke (IS) patients remains unclear.</div></div><div><h3>Objective</h3><div>The aim of this study was to investigate the impact of statin cDDD on recurrence risk in IS patients.</div></div><div><h3>Methods</h3><div>This prospective cohort study enrolled 728 patients with acute ischemic stroke (AIS). After 1 year of follow-up, participants were stratified into four groups (Q1-Q4) according to the quartiles of statin cDDD, and Kaplan-Meier curves were used to estimate the risk of stroke recurrence. The association between cDDD and recurrence risk was examined using restricted cubic spline (RCS) and Cox proportional hazards models, with sensitivity analyses employed to assess population heterogeneity and confirm the robustness of the findings.</div></div><div><h3>Results</h3><div>Kaplan-Meier survival analysis revealed statistically significant differences in recurrence rates across quartiles (<em>P</em> < 0.001). RCS analysis confirmed a nonlinear negative correlation between cDDD and recurrence risk (<em>P</em> for nonlinearity < 0.001). Multivariate Cox regression demonstrated that the recurrence risk in Q4 was 87.7% lower than in Q1. Sensitivity analysis further confirmed that the association between cDDD and IS recurrence risk was independent of antihypertensive or antidiabetic medication use.</div></div><div><h3>Conclusions</h3><div>Statin cDDD shows a significant nonlinear inverse correlation with stroke recurrence, and exhibits a dose-dependent threshold effect.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111873"},"PeriodicalIF":1.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-17DOI: 10.1016/j.jocn.2026.111863
Nan Xue , Wan Zhang , Xinyan Guo , Tianyu Ma , Mengwen Lu , Xinyi Ye , Min Jiang , Li Sun , Mingjin Yang , Xiaoyu Huang , Yong Zhang , Zhouao Zhang , Yanbo Wang , Ying Sheng
Background
Sleep disorder is increasingly recognized in myasthenia gravis (MG). However, its specific link to bulbar muscle weakness and short-term outcomes is not well established. This study aimed to investigate the prevalence of subjective sleep disorder (based on Pittsburgh Sleep Quality Index [PSQI] score) in a cohort of acetylcholine receptor (AChR) antibody-positive MG patients, and to explore its associations with bulbar muscle weakness, disease severity, and its value for the short-term outcome of MG.
Methods
We conducted a prospective cohort study of 163 AChR-MG patients. Subjective sleep quality was assessed using the PSQI score. Disease severity was evaluated with MG Specific Activities of Daily Living (MG-ADL) score, the Quantitative MG (QMG) score, and Myasthenia Gravis Foundation of America (MGFA) classification. Univariate and multivariable logistic regression were used to identify independent risk factors and establish prediction model for outcome. The predictive values were evaluated by receiver operating characteristic (ROC) curves. Moreover, calibration analysis and decision curve analysis (DCA) of the model were performed.
Results
The median PSQI score was 7.0 (5.0, 9.0) and the prevalence of sleep disorder (PSQI > 5) was 73.6 %. Patients with bulbar weakness had significantly higher PSQI scores than those without (P < 0.001). PSQI score showed significant positive correlations with MG-ADL (r = 0.319, P < 0.001),QMG (r = 0.356, P < 0.001) in MG patients. A higher baseline PSQI score was identified as an independent risk factor for poor outcome at 6 months (odds ratio: 1.642 [95 % CI: 1.340–2.014], P < 0.001), with a area under curve (AUC) of 0.797. A predictive model combining PSQI score, bulbar weakness, and female gender demonstrated good discrimination, with a AUC of 0.840, a sensitivity of 0.688, and a specificity of 0.870.
Conclusion
Poor sleep quality is highly prevalent in AChR-MG and was more serious in patients with bulbar weakness. PSQI score was an independent risk factor for poor short-term outcome. Routine assessment of sleep may aid in risk stratification and personalized management.
背景：睡眠障碍在重症肌无力（MG）中得到越来越多的认识。然而，其与球肌无力和短期预后的具体联系尚不明确。本研究旨在调查主观睡眠障碍（基于匹兹堡睡眠质量指数[PSQI]评分）在乙酰胆碱受体（AChR）抗体阳性MG患者队列中的患病率，并探讨其与球肌无力、疾病严重程度的关系，及其对MG短期预后的价值。方法对163例AChR-MG患者进行前瞻性队列研究。主观睡眠质量采用PSQI评分进行评估。采用MG特定日常生活活动（MG- adl）评分、定量MG （QMG）评分和美国重症肌无力基金会（MGFA）分级评估疾病严重程度。采用单因素和多因素logistic回归识别独立危险因素，建立预后预测模型。采用受试者工作特征（ROC）曲线评价预测价值。对模型进行了标定分析和决策曲线分析（DCA）。结果PSQI评分中位数为7.0(5.0,9.0)，睡眠障碍患病率（PSQI > 5）为73.6%。有球无力的患者PSQI评分明显高于无球无力的患者（P < 0.001）。MG患者PSQI评分与MG- adl （r = 0.319, P < 0.001）、QMG （r = 0.356, P < 0.001）呈显著正相关。较高的基线PSQI评分被确定为6个月预后不良的独立危险因素（优势比：1.642 [95% CI: 1.340-2.014], P < 0.001），曲线下面积（AUC）为0.797。结合PSQI评分、球无力和女性性别的预测模型具有良好的鉴别能力，AUC为0.840，敏感性为0.688，特异性为0.870。结论睡眠质量差在AChR-MG患者中普遍存在，且在球无力患者中更为严重。PSQI评分是短期预后不良的独立危险因素。常规睡眠评估有助于风险分层和个性化管理。
{"title":"Association of sleep disorder with bulbar weakness and short-term outcomes in myasthenia gravis","authors":"Nan Xue , Wan Zhang , Xinyan Guo , Tianyu Ma , Mengwen Lu , Xinyi Ye , Min Jiang , Li Sun , Mingjin Yang , Xiaoyu Huang , Yong Zhang , Zhouao Zhang , Yanbo Wang , Ying Sheng","doi":"10.1016/j.jocn.2026.111863","DOIUrl":"10.1016/j.jocn.2026.111863","url":null,"abstract":"<div><h3>Background</h3><div>Sleep disorder is increasingly recognized in myasthenia gravis (MG). However, its specific link to bulbar muscle weakness and short-term outcomes is not well established. This study aimed to investigate the prevalence of subjective sleep disorder (based on Pittsburgh Sleep Quality Index [PSQI] score) in a cohort of acetylcholine receptor (AChR) antibody-positive MG patients, and to explore its associations with bulbar muscle weakness, disease severity, and its value for the short-term outcome of MG.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study of 163 AChR-MG patients. Subjective sleep quality was assessed using the PSQI score. Disease severity was evaluated with MG Specific Activities of Daily Living (MG-ADL) score, the Quantitative MG (QMG) score, and Myasthenia Gravis Foundation of America (MGFA) classification. Univariate and multivariable logistic regression were used to identify independent risk factors and establish prediction model for outcome. The predictive values were evaluated by receiver operating characteristic (ROC) curves. Moreover, calibration analysis and decision curve analysis (DCA) of the model were performed.</div></div><div><h3>Results</h3><div>The median PSQI score was 7.0 (5.0, 9.0) and the prevalence of sleep disorder (PSQI > 5) was 73.6 %. Patients with bulbar weakness had significantly higher PSQI scores than those without (P < 0.001). PSQI score showed significant positive correlations with MG-ADL (r = 0.319, P < 0.001),QMG (r = 0.356, P < 0.001) in MG patients. A higher baseline PSQI score was identified as an independent risk factor for poor outcome at 6 months (odds ratio: 1.642 [95 % CI: 1.340–2.014], P < 0.001), with a area under curve (AUC) of 0.797. A predictive model combining PSQI score, bulbar weakness, and female gender demonstrated good discrimination, with a AUC of 0.840, a sensitivity of 0.688, and a specificity of 0.870.</div></div><div><h3>Conclusion</h3><div>Poor sleep quality is highly prevalent in AChR-MG and was more serious in patients with bulbar weakness. PSQI score was an independent risk factor for poor short-term outcome. Routine assessment of sleep may aid in risk stratification and personalized management.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111863"},"PeriodicalIF":1.8,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.jocn.2026.111862
Kyle Bennett , Yi Chen Zhao , James King
{"title":"Meningitis secondary to clival communication with the sphenoid sinus","authors":"Kyle Bennett , Yi Chen Zhao , James King","doi":"10.1016/j.jocn.2026.111862","DOIUrl":"10.1016/j.jocn.2026.111862","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111862"},"PeriodicalIF":1.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.jocn.2026.111867
Joshua Estin , Alejandro Lopez , Steven Vanni , Sara Jarret , Karthik Madhavan
Cervical kyphosis in the presence of multilevel disc degeneration poses a significant challenge to surgical correction. Anterior cervical discectomy and fusion (ACDF) is a well-established approach to decompress the neural elements and relieve pain but may not specifically correct kyphosis. We describe an anterior only ACDF approach utilizing a novel lagging technique (Vanni technique) to correct cervical kyphosis. The objective is to reestablish lordosis without adding the morbidity of corpectomies or posterior osteotomies. The ACDF procedure with the lagging technique is summarized in the following steps: (1) multilevel discectomy, (2) lordotic interbody cage placement at each level, (3) lordotic plate positioning secured by a temporary pin, (4) bicortical screw placement bilaterally at each level using a screw exchange lagging technique, allowing the vertebral bodies to be sequentially translated toward the plate using progressively shorter bicortical screws until flush, and (5) final screw tightening and locking to the plate. In two illustrative cases, patients underwent anterior cervical discectomies and fusions from C3 to C7 using the Vanni lagging technique to correct deformity. Postoperative follow up showed improvement in Sagittal Vertical Axis (SVA) and lordosis with solid fusion. The current technique report provides a detailed description of a multilevel ACDF procedure with a novel lagging technique to effectively correct cervical deformity. It obviates the need for more extensive and morbid corpectomies and osteotomies in selected patients with reducible deformities.
{"title":"A novel bicortical alternating screw exchange lagging technique for reduction of cervical spinal deformity","authors":"Joshua Estin , Alejandro Lopez , Steven Vanni , Sara Jarret , Karthik Madhavan","doi":"10.1016/j.jocn.2026.111867","DOIUrl":"10.1016/j.jocn.2026.111867","url":null,"abstract":"<div><div>Cervical kyphosis in the presence of multilevel disc degeneration poses a significant challenge to surgical correction. Anterior cervical discectomy and fusion (ACDF) is a well-established approach to decompress the neural elements and relieve pain but may not specifically correct kyphosis. We describe an anterior only ACDF approach utilizing a novel lagging technique (Vanni technique) to correct cervical kyphosis. The objective is to reestablish lordosis without adding the morbidity of corpectomies or posterior osteotomies. The ACDF procedure with the lagging technique is summarized in the following steps: (1) multilevel discectomy, (2) lordotic interbody cage placement at each level, (3) lordotic plate positioning secured by a temporary pin, (4) bicortical screw placement bilaterally at each level using a screw exchange lagging technique, allowing the vertebral bodies to be sequentially translated toward the plate using progressively shorter bicortical screws until flush, and (5) final screw tightening and locking to the plate. In two illustrative cases, patients underwent anterior cervical discectomies and fusions from C3 to C7 using the Vanni lagging technique to correct deformity. Postoperative follow up showed improvement in Sagittal Vertical Axis (SVA) and lordosis with solid fusion. The current technique report provides a detailed description of a multilevel ACDF procedure with a novel lagging technique to effectively correct cervical deformity. It obviates the need for more extensive and morbid corpectomies and osteotomies in selected patients with reducible deformities.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111867"},"PeriodicalIF":1.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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