Journal of Clinical Neuroscience最新文献_第7页

Association of plasma homocysteine levels with the presence of intracranial aneurysms and the risk of rupture: A systematic review and meta-analysis 血浆同型半胱氨酸水平与颅内动脉瘤存在和破裂风险的关系：一项系统回顾和荟萃分析。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-12-29 DOI: 10.1016/j.jocn.2025.111830

Amirhossein Akhavan-Sigari , Vita Olson , Maria José Pachón-Londoño , Charbel K. Moussalem , Zhen Wang , David J. Park , Chandan Krishna , Steven D. Chang , Fredric B. Meyer , Bernard R. Bendok

Background

The majority of intracranial aneurysms (IAs) remain asymptomatic and undiagnosed throughout a patient’s life. However, IA rupture poses a significant risk of mortality. Elevated homocysteine (Hcy) levels are associated with increased vascular inflammation, leading to endothelial dysfunction and degradation of the extracellular matrix. The objective of this study is to synthesize existing evidence on the association between plasma Hcy levels and IA presence and their rupture risk.

Methods

We conducted a systematic review and meta-analysis to assess plasma Hcy levels in relation to IA presence and rupture risk. Case-control and cohort studies comparing Hcy levels between patients with and without IAs or ruptured and unruptured IAs were included.

Results

A total of seven studies comprising 11,911 participants were included in the review. The studies were divided into two subgroups, four comparing hyperhomocysteinemia (HHcy) status in patients with and without IAs, and three comparing Hcy levels in patients with ruptured and unruptured IAs. Pooled odds ratios (ORs) indicated that HHcy was significantly associated with higher odds of IA presence (OR = 1.87, 95% CI = [1.78–1.97]). Among studies comparing Hcy levels in ruptured and unruptured IAs, there was no significant association between increasing Hcy levels and rupture risk (OR = 1.14, 95 % CI = [0.69–1.88]).

Conclusion

Individuals with HHcy have significantly higher odds of developing IAs, suggesting a potential association between HHcy and IA presence. Increasing Hcy levels were not associated with increased risk of IA rupture. Additional studies evaluating the effect of elevated Hcy levels on IA rupture risk and longitudinal studies evaluating the causal effect of HHcy on IA development are needed.

背景：大多数颅内动脉瘤（IAs）在患者的一生中都是无症状和未确诊的。然而，内腔破裂有很大的死亡风险。高同型半胱氨酸（Hcy）水平与血管炎症增加有关，导致内皮功能障碍和细胞外基质降解。本研究的目的是综合现有的关于血浆Hcy水平和IA存在及其破裂风险之间关系的证据。方法：我们进行了系统回顾和荟萃分析，以评估血浆Hcy水平与IA存在和破裂风险的关系。包括病例对照和队列研究，比较有和没有IAs或破裂和未破裂IAs患者之间的Hcy水平。结果：共纳入7项研究，11,911名受试者。这些研究被分为两个亚组，四个比较有和没有IAs患者的高同型半胱氨酸血症（HHcy）状态，三个比较破裂和未破裂IAs患者的Hcy水平。合并优势比（OR）显示HHcy与较高的IA发生率显著相关（OR = 1.87, 95% CI =[1.78-1.97]）。在比较破裂和未破裂IAs中Hcy水平的研究中，Hcy水平升高与破裂风险之间没有显著关联（OR = 1.14, 95% CI =[0.69-1.88]）。结论：患有HHcy的个体发生IAs的几率明显更高，提示HHcy和IA存在之间可能存在关联。Hcy水平升高与内室破裂风险增加无关。需要进一步的研究来评估Hcy水平升高对IA破裂风险的影响，并进行纵向研究来评估Hcy对IA发展的因果关系。

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引用次数: 0

Neoadjuvant PD1 blockade with laser interstitial thermal therapy for recurrent high-grade glioma 激光间质热治疗复发性高级别胶质瘤的新辅助PD1阻断

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-12-27 DOI: 10.1016/j.jocn.2025.111823

Carter M. Suryadevara , Hayley Donaldson , Hammad A. Khan , Karenna J. Groff , Claire D. Kim , Siddhant Dogra , Jose Gautreaux , Leah Geiser Roberts , Matthew G. Young , Matija Snuderl , David Zagzag , Christopher M. William , J. Ricardo McFaline-Figueroa , Maria del Pilar Guillermo Prieto Eibl , Christine A. Cordova , Sylvia Kurz , Marissa Barbaro , Dimitris G. Placantonakis

Background

While immune checkpoint inhibitors (ICI) induce potent responses against several systemic malignancies, clinical efficacy against high-grade glioma has been limited by immunosuppression, low mutational burden and limited lymphocyte infiltration into tumors. Laser interstitial thermal therapy (LITT) induces coagulative necrosis and disrupts the peritumoral blood–brain barrier (BBB), creating a potentially antigenic milieu. We hypothesized that neoadjuvant and adjuvant ICI would synergize with LITT to potentiate antitumor immune responses and enhance survival.

Methods

This retrospective study is an exploratory case series that includes 9 adult patients with recurrent IDH wild-type glioblastoma (GBM, n = 6), IDH mutant high-grade astrocytoma (n = 2) and H3K27M mutant diffuse midline glioma (n = 1). All patients received neoadjuvant anti-PD1 ICI prior to LITT and most received adjuvant ICI (8/9). Disease burden was followed through radiographic volume segmentation of gadolinium-enhancing disease. Patients were followed for progression-free (PFS) and overall survival (OS).

Results

Patients (age 29–64 years; 7 male, 2 female) had pre-operative mean tumor volumes of 11.15 cm³ (range 2.93–26.09 cm³). Mean ablation volume was 12.08 cm³ (range 5.14–18.60 cm³). There were no perioperative complications. All patients showed an initial increase in gadolinium-enhancing volume after LITT. Seven of 9 (78 %) patients demonstrated subsequent regression in total gadolinium-enhancing volume. Three non-contiguous satellite lesions naïve to laser ablation exhibited complete or near-complete regression in 2 patients. Median PFS was 5.90 months (range 1.00–41.23), and median OS was 9.97 months (range 1.20–41.23).

Conclusions

Combination therapy with neoadjuvant and adjuvant pembrolizumab and LITT is feasible and safe in recurrent high-grade glioma. Responses may be more robust in certain molecular subtypes of glioma. Further studies are needed to investigate this potential synergy.

虽然免疫检查点抑制剂（ICI）对几种全身性恶性肿瘤诱导了有效的应答，但由于免疫抑制、低突变负担和淋巴细胞浸润肿瘤有限，对高级别胶质瘤的临床疗效受到限制。激光间质热疗法（LITT）诱导凝固性坏死，破坏肿瘤周围血脑屏障（BBB），创造潜在的抗原环境。我们假设新辅助和辅助ICI将与LITT协同作用，增强抗肿瘤免疫反应并提高生存率。方法对9例复发性IDH野生型胶质母细胞瘤（GBM, n = 6）、IDH突变高级别星形细胞瘤（n = 2）和H3K27M突变弥漫性中线胶质瘤（n = 1）的成人患者进行回顾性研究。所有患者在LITT前都接受了新辅助抗pd1 ICI，大多数患者接受了辅助ICI（8/9）。通过钆增强疾病的x线片体积分割跟踪疾病负担。随访患者的无进展（PFS）和总生存期（OS）。结果患者年龄29 ~ 64岁，男7例，女2例，术前平均肿瘤体积11.15 cm3（范围2.93 ~ 26.09 cm3）。平均消融体积为12.08 cm3（范围5.14 ~ 18.60 cm3）。无围手术期并发症。所有患者在LITT后均表现出初始钆增强体积的增加。9例患者中有7例（78%）表现出随后的总钆增强体积下降。2例激光消融后的3个非连续卫星性病变naïve完全或接近完全消退。中位PFS为5.90个月（1.00-41.23），中位OS为9.97个月（1.20-41.23）。结论新辅助、辅助派姆单抗联合LITT治疗复发性高级别胶质瘤是可行、安全的。在胶质瘤的某些分子亚型中，反应可能更为强烈。需要进一步的研究来调查这种潜在的协同作用。

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引用次数: 0

Impact of dehydration on functional outcomes in large vessel occlusion stroke 脱水对大血管闭塞性卒中功能结局的影响

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-12-27 DOI: 10.1016/j.jocn.2025.111832

April Pivonka , Manisha Koneru , Abigail Baldwin-LeClair , Jamir Pitton Rissardo , Karan Patel , Avish Patel , Scott Kamen , Lauren Thau , Jared Wolfe , Linda Zhang , Nicholas Vigilante , Mary Penckofer , Michael J. Dubinski , Olga R. Thon , Tudor G. Jovin , Jane Khalife , Hermann Christian Schumacher , Khalid A. Hanafy , James E. Siegler , Jesse M. Thon

Background

Dehydration at stroke onset has been linked to worse outcomes, but its impact in large vessel occlusion (LVO) stroke treated with endovascular thrombectomy (EVT) remains unclear. We evaluated whether dehydration at presentation influences functional recovery in this population.

Methods

A prospectively maintained registry of adults with anterior circulation LVO (ICA, M1, M2) who achieved successful EVT (mTICI ≥ 2B) between 10/2019 and 12/2021 was analyzed. Dehydration was defined as serum osmolality ≥ 295 mOsm/kg and BUN/Cr ≥ 20. Primary outcomes were NIHSS at 24 h and good functional recovery at 90 days (mRS 0–2 or return to baseline). Multivariable logistic regression adjusted for age, sex, baseline NIHSS, ASPECTS, occlusion site, diuretic use, and pre-stroke mRS.

Results

Of 206 patients, 31 were dehydrated at presentation. They were older (median 77 vs. 69 years), more often female, and more likely to use diuretics (p ≤ 0.03). Dehydrated patients had higher NIHSS at 24 h (median 14 vs. 10, p = 0.02) and worse 90-day mRS (p = 0.003). Good functional recovery occurred in 30 % of dehydrated vs. 50 % of non-dehydrated patients (p = 0.04). Dehydration independently predicted lower odds of NIHSS improvement at 24 h (aOR 0.37, 95 % CI 0.14–0.98, p = 0.04), but not worse recovery at 90 days.

Conclusion

Dehydration at presentation is associated with worse early neurological improvement and potentially poorer functional outcomes after EVT for LVO stroke. These findings highlight the importance of recognizing hydration status in this patient population and the need for future studies to confirm these findings and assess potential interventions.

卒中发病时脱水与较差的预后有关，但其对血管内取栓治疗大血管闭塞（LVO）卒中的影响尚不清楚。我们评估了发病时脱水是否会影响该人群的功能恢复。方法对2019年10月至2021年12月期间成功完成EVT （mTICI≥2B）的成人前循环LVO （ICA, M1, M2）进行前瞻性维护登记。脱水定义为血清渗透压≥295 mOsm/kg， BUN/Cr≥20。主要结果为24小时NIHSS和90天良好的功能恢复（mRS 0-2或恢复到基线）。多变量logistic回归校正了年龄、性别、基线NIHSS、ASPECTS、闭塞部位、利尿剂使用和卒中前mrs .结果206例患者中，31例出现脱水。患者年龄较大（中位数为77岁对69岁），多为女性，且更倾向于使用利尿剂（p≤0.03）。脱水患者24小时NIHSS较高（中位数14比10，p = 0.02）， 90天mRS较差（p = 0.003）。脱水患者的功能恢复良好的比例为30%，非脱水患者为50% （p = 0.04）。脱水独立预测24小时NIHSS改善的几率较低（aOR 0.37, 95% CI 0.14-0.98, p = 0.04），但90天恢复情况不差。结论：LVO脑卒中患者在EVT后出现脱水与早期神经系统改善较差和潜在的较差功能预后相关。这些发现强调了在这一患者群体中认识水合状态的重要性，以及未来研究证实这些发现和评估潜在干预措施的必要性。

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引用次数: 0

Association between free thyroxine and free triiodothyronine levels with inflammation markers in acute minor and severe ischemic stroke patients 急性轻度和重度缺血性脑卒中患者游离甲状腺素和游离三碘甲状腺原氨酸水平与炎症标志物的关系

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-12-27 DOI: 10.1016/j.jocn.2025.111827

Omar Khalid Suhail , Muhtada Ali Challoob , Hiba Qasim Mahmoud

Background

Patients with acute ischemic stroke (AIS) frequently exhibit alterations in thyroid function. Though, the association between free thyroxine levels and stroke severity, in addition to the pathophysiological implications of thyroid hormone fluctuations, has not been entirely elucidated and remains unclear in AIS patients.

Aims

To assess the association between free thyroxine (fT4) and free triiodothyronine (fT3) levels and both stroke severity and inflammatory markers in patients’ subsequent acute minor and severe ischemic strokes.

Methods

This study involved 142 patients with acute minor and severe ischemic stroke (104 males and 38 females). Thyroid hormone levels and inflammatory biomarkers were measured for all contributors. Stroke severity was determined utilising the National Institutes of Health Stroke Scale (NIHSS scores). Multiple regression analysis was conducted to control for potential confounders. Furthermore, a receiver operating characteristic (ROC) curve for fT4 was generated to assess its predictive value for stroke severity.

Results

Patients with severe ischemic stroke showed significantly higher fT4 levels and lower fT3 levels in comparison with those who have minor ischemic stroke. Free T3 was negatively correlated with ESR (r = –0.454, P < 0.001), CRP (r = –0.169, P = 0.04), and NIHSS scores (r = –0.547, P < 0.001). In contrast, fT4 was positively correlated with ESR (r = 0.262, P = 0.002), CRP (r = 0.39, P < 0.001), and NIHSS scores (r = 0.418, P < 0.001). Multiple regression analysis displayed that NIHSS scores were independently associated with fT3, whereas both NIHSS scores and CRP were independently associated with fT4. ROC analysis proved that the AUC for fT4 was 0.739 (95 % CI, 0.657–0.822).

Conclusion

Higher fT4 and lower fT3 levels are linked with greater stroke severity and elevated inflammatory markers in patients with acute severe ischemic stroke in comparison with those who experienced minor stroke.

背景：急性缺血性脑卒中（AIS）患者经常表现出甲状腺功能的改变。尽管如此，游离甲状腺素水平与脑卒中严重程度之间的关系，以及甲状腺激素波动的病理生理影响，在AIS患者中尚未完全阐明，目前仍不清楚。目的探讨游离甲状腺素（fT4）和游离三碘甲状腺原氨酸（fT3）水平与急性轻度和重度缺血性卒中患者卒中严重程度和炎症标志物之间的关系。方法142例急性轻、重度缺血性脑卒中患者（男104例，女38例）。测量了所有参与者的甲状腺激素水平和炎症生物标志物。采用美国国立卫生研究院卒中量表（NIHSS评分）确定卒中严重程度。采用多元回归分析控制潜在混杂因素。此外，生成fT4的受试者工作特征（ROC）曲线，以评估其对脑卒中严重程度的预测价值。结果重度缺血性脑卒中患者fT4水平明显高于轻度缺血性脑卒中患者，fT3水平明显低于轻度缺血性脑卒中患者。游离T3与ESR （r = -0.454, P < 0.001）、CRP （r = -0.169, P = 0.04）、NIHSS评分（r = -0.547, P < 0.001）呈负相关。fT4与ESR （r = 0.262, P = 0.002）、CRP （r = 0.39, P < 0.001）、NIHSS评分（r = 0.418, P < 0.001）呈正相关。多元回归分析显示NIHSS评分与fT3独立相关，而NIHSS评分和CRP均与fT4独立相关。ROC分析证实，fT4的AUC为0.739 （95% CI, 0.657-0.822）。结论与轻度脑卒中患者相比，急性重度缺血性脑卒中患者较高的fT4和较低的fT3水平与脑卒中严重程度和炎症标志物升高有关。

{"title":"Association between free thyroxine and free triiodothyronine levels with inflammation markers in acute minor and severe ischemic stroke patients","authors":"Omar Khalid Suhail , Muhtada Ali Challoob , Hiba Qasim Mahmoud","doi":"10.1016/j.jocn.2025.111827","DOIUrl":"10.1016/j.jocn.2025.111827","url":null,"abstract":"<div><h3>Background</h3><div>Patients with acute ischemic stroke (AIS) frequently exhibit alterations in thyroid function. Though, the association between free thyroxine levels and stroke severity, in addition to the pathophysiological implications of thyroid hormone fluctuations, has not been entirely elucidated and remains unclear in AIS patients.</div></div><div><h3>Aims</h3><div>To assess the association between free thyroxine (fT4) and free triiodothyronine (fT3) levels and both stroke severity and inflammatory markers in patients’ subsequent acute minor and severe ischemic strokes.</div></div><div><h3>Methods</h3><div>This study involved 142 patients with acute minor and severe ischemic stroke (104 males and 38 females). Thyroid hormone levels and inflammatory biomarkers were measured for all contributors. Stroke severity was determined utilising the National Institutes of Health Stroke Scale (NIHSS scores). Multiple regression analysis was conducted to control for potential confounders. Furthermore, a receiver operating characteristic (ROC) curve for fT4 was generated to assess its predictive value for stroke severity.</div></div><div><h3>Results</h3><div>Patients with severe ischemic stroke showed significantly higher fT4 levels and lower fT3 levels in comparison with those who have minor ischemic stroke. Free T3 was negatively correlated with ESR (r = –0.454, P < 0.001), CRP (r = –0.169, P = 0.04), and NIHSS scores (r = –0.547, P < 0.001). In contrast, fT4 was positively correlated with ESR (r = 0.262, P = 0.002), CRP (r = 0.39, P < 0.001), and NIHSS scores (r = 0.418, P < 0.001). Multiple regression analysis displayed that NIHSS scores were independently associated with fT3, whereas both NIHSS scores and CRP were independently associated with fT4. ROC analysis proved that the AUC for fT4 was 0.739 (95 % CI, 0.657–0.822).</div></div><div><h3>Conclusion</h3><div>Higher fT4 and lower fT3 levels are linked with greater stroke severity and elevated inflammatory markers in patients with acute severe ischemic stroke in comparison with those who experienced minor stroke.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111827"},"PeriodicalIF":1.8,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839242","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}

引用次数: 0

Socioeconomic factors in high-grade glioma treatment and outcomes: A systematic and narrative review of a heterogeneous evidence Base 高级别胶质瘤治疗和结果的社会经济因素：一个异构证据基础的系统和叙述性回顾

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-12-25 DOI: 10.1016/j.jocn.2025.111826

Pumudu Weerasekara , Chayu Damsinghe , Sunil Lakshman Perera

Introduction

High-Grade Gliomas (HGGs), including glioblastomas (GBM), are aggressive brain tumors with a 5-year survival rate of 7.2% with little understanding on the socioeconomic impact on outcomes. This study aimed to examine how socioeconomic factors of patients and healthcare providers impact treatment choices and outcomes in HGG management through a narrative and manual approach to data collection and synthesis, as a precursor to a systematic review and analysis that will quantitatively approach the question.

Methods

The study initially intended as a meta-analysis based on a literature search performed across MEDLINE, PubMed, and EMBASE using predefined terms was converted to a narrative review in view of the substantial heterogeneity in both socio-economic status (SES) definitions and outcome reporting.

Results and Discussion

A review of 15 out of 261 studies identified 16 SES variable-outcome combinations, namely income (n = 7), a Socioeconomic Status Index (SES index; n = 6), an Area Deprivation Index (ADI; n = 2), and a Frailty Index (n = 1). Median hazard ratio was 0.760 (n = 11), overall survival ranged from 4 – 8.16 months (mean = 5.52 months; n = 4), and incidence ratios > 1 (n = 2); all favoring higher SES groups. Further narrative analysis showcases nuance in the results with survival differences disappearing in longer time frames. The indication of early diagnosis in higher SES categories could also imply that better survival is instead driven by earlier diagnosis rather than a direct impact onto disease progression. Regardless, this overall infers that the SES impacts are limited to a short period of time without affecting eventual prognosis in a meaningful manner.

Conclusion

These findings, based off a limited set of studies, suggest that there is at least a temporary impact of SES differences onto varied dimensions of HGG treatment and outcomes. Reducing effects with time also suggests that these SES differences might have significant implications for palliative care and quality of life care during HGG treatment protocols. Given limited exploration especially outside of HGGs, further studies that investigate more detail onto SES are warranted, particularly in the dimensions of early-diagnosis and palliative care.

高级别胶质瘤（HGGs），包括胶质母细胞瘤（GBM），是侵袭性脑肿瘤，5年生存率为7.2%，对社会经济对预后的影响知之甚少。本研究旨在通过数据收集和合成的叙述和手动方法，研究患者和医疗保健提供者的社会经济因素如何影响HGG管理的治疗选择和结果，作为系统回顾和分析的先驱，将定量地解决这个问题。方法本研究最初是基于在MEDLINE、PubMed和EMBASE上进行的文献检索的荟萃分析，使用预定义的术语，考虑到社会经济地位（SES）定义和结果报告的巨大异质性，本研究转变为叙述性综述。对261项研究中的15项研究的回顾确定了16种社会经济地位可变结果组合，即收入（n = 7），社会经济地位指数（SES指数，n = 6），区域剥夺指数（ADI, n = 2）和虚弱指数（n = 1）。中位风险比为0.760 (n = 11)，总生存期为4 - 8.16个月（平均为5.52个月，n = 4），发病率为>； 1 (n = 2)；都倾向于较高的社会地位群体。进一步的叙述性分析显示了结果的细微差别，生存差异在更长的时间框架内消失。在较高的社会地位类别中，早期诊断的指征也可能意味着更好的生存是由早期诊断驱动的，而不是对疾病进展的直接影响。无论如何，这总体上推断出SES的影响仅限于短时间内，不会以有意义的方式影响最终预后。结论：这些基于有限研究的发现表明，社会经济地位差异对HGG治疗和结果的各个方面至少有暂时的影响。随着时间的推移，效应的减弱也表明，这些社会地位差异可能对HGG治疗方案中的姑息治疗和生活质量护理具有重要意义。鉴于有限的探索，特别是在hgg之外，进一步研究更详细的SES是必要的，特别是在早期诊断和姑息治疗方面。

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引用次数: 0

Reliability of online health information: evaluation of Guillain-Barré Syndrome videos on YouTube 在线健康信息的可靠性：对YouTube上格林-巴罗恩综合征视频的评价

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-12-24 DOI: 10.1016/j.jocn.2025.111825

Murat Alpua , Mehmet Hamamcı

Objective

This study evaluated the content quality and reliability of Guillain-Barré Syndrome (GBS) videos published on YouTube.

Methods

A total of 114 videos were reviewed, starting with the most viewed videos, based on the keyword “Guillain-Barré Syndrome.” Fifty English videos meeting the eligibility criteria were included in the analysis. The videos were evaluated by two independent neurologists using the Global Quality Scale (GQS), mDISCERN, and JAMA criteria.

Results

The mean GQS score for the videos was 3.08 ± 0.75, mDISCERN score was 3.14 ± 0.78, and JAMA score was 2.22 ± 0.76. Thirty-two percent of the videos were produced by health/medical information channels, 18 % by “other” producers, 14 % by patients, 12 % by physicians, and the remainder by associations, TV programs, hospitals, and other healthcare professionals. There were significant differences in quality scores between the producer groups; videos created by physicians had the highest scores for GQS (3.83 ± 0.41) and JAMA (2.83 ± 0.41) (p < 0.05). No significant correlation was found between the number of views and quality metrics, but the number of likes was positively correlated with GQS, mDISCERN, and JAMA scores (p < 0.05). The content quality of the most viewed videos was generally moderate.

Conclusion

Most GBS videos on YouTube have moderate quality and credibility. Higher scores for videos created by healthcare professionals highlight the importance of expert input in online health content. These findings suggest the need to develop scientifically based, accessible video content to reduce the risk of misinformation and increase patient and public health literacy.

目的：评价YouTube上发布的格林-巴勒综合征（GBS）视频的内容质量和可靠性。方法：以“格林-巴罗综合征”为关键词，从观看次数最多的视频开始，对114个视频进行分析。50部符合资格标准的英语视频被纳入分析。视频由两名独立的神经学家使用全球质量量表（GQS）、mDISCERN和JAMA标准进行评估。结果：视频GQS评分平均值为3.08±0.75，mDISCERN评分平均值为3.14±0.78，JAMA评分平均值为2.22±0.76。32%的视频由健康/医疗信息频道制作，18%由“其他”制作人制作，14%由患者制作，12%由医生制作，其余由协会、电视节目、医院和其他医疗保健专业人员制作。生产者组之间的质量得分存在显著差异；医生制作的视频在GQS评分（3.83±0.41）和JAMA评分（2.83±0.41）中得分最高(p)。结论：YouTube上大多数GBS视频质量和可信度中等。医疗保健专业人员制作的视频得分较高，这突出了在线健康内容中专家意见的重要性。这些发现表明，有必要开发基于科学的、可访问的视频内容，以减少错误信息的风险，并提高患者和公众的卫生素养。

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引用次数: 0

The use of Artificial Intelligence in neurosurgical manuscript writing: Journal specific policies and their implementation 人工智能在神经外科稿件写作中的应用：期刊具体政策及其实施。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-12-24 DOI: 10.1016/j.jocn.2025.111819

Brian Carlson , Todd Laffaye , Landon Gray , Abhijith R. Bathini , Anwesha Dubey , Devi Prasad Patra

Introduction

The use of Artificial Intelligence (AI) has grown dramatically in recent years. In addition to its use for data analysis, its applications have extended to manuscript writing. In this article, we analyze the policies within top neurosurgical journals surrounding AI use for manuscript writing, its implementation, and whether disclosure of this practice affects article citation metrics.

Methods

Neurosurgical journals with h-indices ≥ 100 and with “spin*” or “neurosurg*” (including translations in other languages) and no other medical subspecialty within their title were included (n = 9). Each journal’s policy surrounding AI use in manuscript writing was assessed for whether disclosure was mandated, and if so, requirements for the disclosure. A search was performed using each journal’s respective database to find articles that disclosed AI use. Data extracted from each article included: article acceptance and online publication date, type of article, section containing the AI disclosure, total citations, AI program used, and the stated purpose of AI use. A cohort of non-AI-assisted articles was created to assess whether AI disclosure impacts the total number of citations received after publication.

Results

All nine journals mandated disclosure, however, there were variations in the contents required from each disclosure, where in the manuscript the disclosure must be, limitations for AI use, and whether the journal provided a template for how to disclose AI use. A total of 67 publications were included in this review. The journal with the greatest number of articles was World Neurosurgery (n = 41, 61 %), and the journal with the greatest percentage of articles published disclosing AI use since January 1, 2022, was Neurosurgical Focus (0.68 %). Despite the low prevalence across all journals assessed, the rate of growth for articles written with AI has steadily increased. No significant difference was found in the total number of citations between articles that disclosed AI and a cohort of similar articles that did not (W = 85.5, p = 0.69562).

Conclusions

The number of articles declaring AI use was lower than expected. However, such articles have been growing exponentially. Policies surrounding AI use and its implementation varied across journals. We therefore provide recommendations to promote similarity in guidelines between journals, as this will lessen confusion among authors and promote transparency within the medical research community.

近年来，人工智能（AI）的应用急剧增长。除了用于数据分析，它的应用已经扩展到手稿写作。在本文中，我们分析了顶级神经外科期刊中关于人工智能用于手稿写作的政策，其实施情况，以及这种做法的披露是否会影响文章的引用指标。方法：纳入h指数≥100、标题中包含“spin*”或“Neurosurgical *”（包括外文翻译）且标题中没有其他医学亚专科的神经外科期刊（n = 9）。评估了每个期刊关于在手稿写作中使用人工智能的政策，是否强制披露，如果是，披露的要求。使用每个期刊各自的数据库进行搜索，以找到披露人工智能使用的文章。从每篇文章中提取的数据包括：文章接受和在线发表日期、文章类型、包含人工智能披露的部分、总引用次数、使用的人工智能程序和声明的人工智能使用目的。创建了一组非人工智能辅助的文章，以评估人工智能披露是否会影响发表后收到的引用总数。结果：所有9种期刊都要求披露，然而，每种披露要求的内容存在差异，包括稿件中必须披露的内容、人工智能使用的限制以及期刊是否提供了如何披露人工智能使用的模板。本综述共纳入67篇出版物。文章数最多的期刊是《World Neurosurgery》（n = 41, 61%）， 2022年1月1日以后公开人工智能使用的文章数最多的期刊是《Neurosurgical Focus》（0.68%）。尽管在所有被评估的期刊中，人工智能的流行率很低，但用人工智能撰写的文章的增长率一直在稳步增长。在披露人工智能的文章和未披露人工智能的同类文章的总引用次数方面，没有发现显著差异（W = 85.5, p = 0.69562）。结论：声明人工智能应用的文章数量低于预期。然而，这类文章却呈指数级增长。围绕人工智能使用及其实施的政策因期刊而异。因此，我们提出建议，以促进期刊之间指南的相似性，因为这将减少作者之间的混淆，并促进医学研究界的透明度。

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引用次数: 0

Risk factors for subsidence and loss of segmental lordosis segmental lordosisfollowing 1–3-level anterior cervical diskectomy and fusion for degenerative disease: A time-to-event analysis 1-3节段前颈椎间盘切除术和融合治疗退行性疾病后的节段性前凸：时间-事件分析。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-12-23 DOI: 10.1016/j.jocn.2025.111818

Zach Pennington , Derrick Obiri-Yeboah , Abdelrahman Hamouda , Nikita Lakomkin , William E. Krauss , Michelle J. Clarke , Brett A. Freedman , Melvin D. Helgeson , Ahmad N. Nassr , Arjun S. Sebastian , Anthony L. Mikula , Jeremy L. Fogelson , Benjamin D. Elder

Background

Thousands of anterior cervical diskectomy and fusion (ACDF) procedures are performed annually. Increased interbody size offers better immediate segmental lordosis and disc height restoration but may increase the risk of subsequent subsidence. Our objective was to identify factors for subsidence and segmental lordosis loss following ACDF.

Methods

The charts of patients undergoing 1–3 level ACDF at a single-institution were queried for demographics, pre- and postoperative radiographic alignment, bone health (Hounsfield units on CT), procedural details, and interbody characteristics. Outcomes of interest were subsidence ≥2 mm and ≥3° loss in segmental lordosis (SL).

Results

199 patients (median 61.5 yr; 52.8 % male) were included – 98 single-level; 70 two-level, and 31 three-level. Forty treated levels (12.1 %) ≥3° decrease in SLand 19 (5.7 %) experienced ≥2 mm subsidence. Levels showing ≥3° loss of correction occurred in older patients (p = 0.021) and those with greater postoperative C2-7 lordosis (p = 0.002), postoperative SL (p < 0.001), and perioperative change in SL (p < 0.001). Subsidence was associated with allograft spacer use, lower postoperative segmental lordosis (p = 0.022) and greater postoperative disc height (p = 0.023). Decreased time to loss of SL was predicted by greater postoperative C2-7 lordosis (HR 1.04 per °; 95 % CI [1.00, 1.08]; p = 0.041) and greater postoperative SL (HR 1.27 per °; [1.13, 1.43]; p < 0.001). Shorter subsidence time was predicted by allograft [versus titanium] spacer use (HR 21.40; [5.61, 81.54]; p < 0.001) and greater postoperative disc height (HR 1.63 per mm; [1.37, 1.94]; p < 0.001).

Conclusion

Greater disc height predicted subsequent subsidence and greater SL restoration predicted SL loss following 1–3 level ACDF. Matching the interbody to the “natural” disc height of adjacent levels and using titanium versus corticocancellous allograft spacers may reduce the risk of subsidence and loss of correction.

背景：每年进行数千例前路颈椎间盘切除术和融合术（ACDF）。椎体间增大可以更好地立即恢复节段性前凸和椎间盘高度，但可能增加后续下沉的风险。我们的目的是确定ACDF后下沉和节段性前凸损失的因素。方法：对在单一机构接受1-3级ACDF的患者的图表进行查询，包括人口统计学、术前和术后放射学对齐、骨骼健康（CT上的Hounsfield单位）、手术细节和体间特征。关注的结果是沉降 ≥2 mm和 ≥3°的节段性前凸（SL）损失。结果：纳入199例患者（中位61.5 yr；男性52.8 %）- 98例单水平；70个2级，31个3级。40个处理层（12.1 %） ≥3°下降，19个处理层（5.7 %）沉降 ≥2 mm。年龄较大的患者（p = 0.021）、术后C2-7前凸较大的患者（p = 0.002）、术后SL （p ）出现 ≥3°矫正损失的水平。结论：椎间盘高度越大预测后续下沉，SL恢复越好预测1-3级ACDF后SL损失。将椎间体与相邻节段的“自然”椎间盘高度相匹配，并使用钛与皮质松质同种异体植骨垫片可以降低下陷和矫正丧失的风险。

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引用次数: 0

No differences in the proportions of immune cells in CSF of patients with neurosarcoidosis and multiple sclerosis 神经结节病和多发性硬化症患者脑脊液中免疫细胞比例无差异。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-12-23 DOI: 10.1016/j.jocn.2025.111824

Angie H. Kim , Arnaldo A. Arbini , Ilya Kister

Background

Multiple sclerosis (MS) and neurosarcoidosis (NS) can present as similar neuro-radiologic syndromes. Neither disease has pathognomonic clinical or laboratory findings and differentiating between them may be challenging. We hypothesized that cerebrospinal fluid (CSF) immune cell profiles, including CD4/CD8 cell ratio and proportion of B cells, might help to distinguish NS from MS.

Methods

Patients with probable or definite NS who were evaluated at the NYU MS Comprehensive Care Center (New York) and had CSF flow cytometry done as part of diagnostic workup were matched by age, sex, and race/ethnicity to MS patients with available CSF flow cytometry. All patients who received immunomodulatory therapy within 3 months of lumbar puncture were excluded. Flow cytometry was performed using BD FACSCanto™ and FACSCanto™ II Cell Analyzers (BDBiosciences, San Jose, CA) and manually verified by a hematopathologist. Group comparisons were made with an unpaired two-tailed Student’s t-test, Chi-square test, or Wilcoxon rank sum test, as appropriate; p < 0.05 was considered significant.

Results

We identified 19 patients with NS and matched them with 19 MS patients by age, sex, and race/ethnicity (mean age NS v. MS: 56.9 ± 10.8 vs. 56.3 ± 9.7 years, p = 0.858; 68 % female in both groups; 74 % vs. 68 % non-white, p = 0.935). NS patients had significantly higher CSF leukocyte counts (16.0 ± 19.9 vs. 2.1 ± 2.6 cells/mm³, p < 0.0001) and protein levels (101.2 ± 88.9 mg/dL vs. 35.7 ± 19.6, p = 0.003), while MS patients had more CSF-restricted oligoclonal bands (7.7 ± 5.3 vs. 1.7 ± 2.4, p < 0.00042). No differences were found in CSF glucose concentrations or IgG indices. Proportions of all immune cells in CSF were similar in NS and MS, including the CD4/CD8 ratio and percentages of B cells.

Conclusion

Clinically available CSF flow cytometry immune profiles do not offer added discriminatory value for differentiating NS from MS. More granular immunophenotyping may be needed to improve diagnostic precision.

背景：多发性硬化症（MS）和神经结节病（NS）可以表现为相似的神经影像学综合征。这两种疾病都没有典型的临床或实验室发现，区分它们可能具有挑战性。我们假设脑脊液（CSF）免疫细胞谱，包括CD4/CD8细胞比例和B细胞比例，可能有助于区分多发性硬化症和多发性硬化症。方法：在纽约大学多发性硬化症综合护理中心（纽约）评估可能或明确的多发性硬化症患者，并将CSF流式细胞术作为诊断工作的一部分，根据年龄、性别和种族/民族与可用CSF流式细胞术的多发性硬化症患者进行匹配。排除腰椎穿刺后3个月内接受免疫调节治疗的患者。流式细胞术使用BD FACSCanto™和FACSCanto™II细胞分析仪（BDBiosciences, San Jose， CA）进行，并由血液病理学家手工验证。组间比较采用非配对双尾Student's t检验、卡方检验或Wilcoxon秩和检验（视情况而定）；结果：我们确定了19例NS患者，并根据年龄、性别和种族/民族将其与19例MS患者进行匹配（NS与MS的平均年龄：56.9±10.8岁对56.3±9.7岁，p = 0.858；两组中68%为女性；74%对68%为非白人，p = 0.935）。NS患者的脑脊液白细胞计数明显高于NS(16.0±19.9 vs. 2.1±2.6细胞/mm3)，结论：临床上可用的脑脊液流式细胞术免疫图谱不能为NS和ms的鉴别提供额外的鉴别价值，可能需要更多的颗粒免疫表型来提高诊断精度。

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引用次数: 0

Unruptured intracranial aneurysm size should not be the most important factor influencing management decisions: A systematic review of the literature and meta-analysis 未破裂颅内动脉瘤的大小不应该是影响治疗决策的最重要因素：文献和荟萃分析的系统回顾。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-12-23 DOI: 10.1016/j.jocn.2025.111816

Hunter Brooks , Michael Ortiz , Farhan Siddiq , Bharat Guthikonda

Objective

Intracranial aneurysm size has become an important predictor of rupture risk. There is, perhaps, an overdependence on aneurysm size during evaluations for management decisions. However, many ruptured intracranial aneurysms (RIA) in clinical practice are smaller than 7 mm. The purpose of this study is to review the literature and perform a meta-analysis to determine the mean size of RIA in the literature.

Methods

The PubMed, Cochrane, Scopus and Web of Science databases were searched from January 1st, 2000 to October 31st, 2024, following PRISMA guidelines to include clinical studies reporting mean size of RIAs. The pooled mean RIA was calculated. Additional exclusion criteria were applied, and subgroup analyses were performed after dividing the RIAs into a “Lower Risk” group (LRG) and a “Higher Risk” group (HRG) as described in the ISUIA trial.

Results

A total of 9876 aneurysms were captured from 55 included studies. The pooled mean size for RIAs was 6.57 mm (95 % CI [6.14–––7.00]). Thirty-nine (70.9 %) of included studies reported mean RIA size < 7 mm. After application of additional exclusion criteria, 6 studies were included in the subgroup analyses, capturing 2774 RIAs. The pooled mean size for RIAs in the subgroup analyses was 5.58 mm (95 % CI [5.21–––5.94]). There were 2076 RIAs in the LRG. The mean RIA size in the LRG was 5.68 mm (95 % CI [5.26–––6.10]). There were 698 RIAs in the HRG. The mean RIA size in the HRG was 5.54 mm (95 % CI [4.86–––6.22]). Spearman’s Rank correlation revealed a very strong positive correlation between RIA size and parent vessel within the LRG (ρ = 0.871, p < 0.001, 95 % CI [0.60 – 0.96]) and a moderate positive correlation within the HRG (ρ = 0.55, p = 0.22, 95 % CI [0.23 – 0.97]).

Conclusions

The mean size of RIAs in the literature was 6.57 mm. There was a positive correlation between mean RIA size and increasing parent vessel diameter. This supports size ratio (SR) as a more appropriate surrogate for size when assessing rupture risk.

目的：颅内动脉瘤大小已成为动脉瘤破裂风险的重要预测指标。在评估管理决策时，可能过度依赖于动脉瘤的大小。然而，临床上许多破裂的颅内动脉瘤（RIA）小于7mm。本研究的目的是回顾文献，并进行荟萃分析，以确定文献中RIA的平均规模。方法：根据PRISMA指南，检索2000年1月1日至2024年10月31日期间的PubMed、Cochrane、Scopus和Web of Science数据库，纳入报告RIAs平均大小的临床研究。计算混合平均RIA。应用额外的排除标准，并按照ISUIA试验的描述将ria分为“低风险”组（LRG）和“高风险”组（HRG）后进行亚组分析。结果：55项纳入的研究共捕获了9876个动脉瘤。ria的汇总平均大小为6.57 mm （95% CI[6.14—7.00]）。39项（70.9%）纳入的研究报告了平均RIA尺寸。结论：文献中RIA的平均尺寸为6.57 mm。RIA的平均大小与母体血管直径的增加呈正相关。这支持在评估破裂风险时，尺寸比（SR）作为尺寸更合适的替代。

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引用次数: 0