Journal of Neurorestoratology最新文献

英文中文

A predictive model for functionality improvement after stroke rehabilitation 中风康复后功能改善的预测模型

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Journal of Neurorestoratology

Pub Date : 2024-09-17 DOI: 10.1016/j.jnrt.2024.100157

Xue Yang , Qian Liu , Hongmei Zhang, Yihuan Lu, Liqing Yao

Background

This study develops a simple predictive model for identifying stroke patients who have a better chance of showing improved activities of daily living (ADL) outcomes following a stroke.

Methods

The cohort of 489 stroke patients was divided into testing and training groups. Multivariate logistic regression analysis was conducted for each model. Four models were compared using the C statistic (AUC), Akaike's information criterion (AIC), and other metrics. The best model was assessed using a nomogram.

Results

Univariate analysis revealed that several variables measured significantly higher at discharge than at admission, including manual muscle testing, standing, and so on. Multivariate logistic regression analysis revealed that activities-specific balance confidence, Brunnstrom recovery stage for lower extremities, standing, the mini-balance evaluation systems test, and the Hamilton anxiety scale were independent predictors of ADL. Model 1 was found to be more accurate for the prediction of ADL (AUC: training, 0.916 [0.889−0.943] and test, 0.887 [0.806−0.968]; AIC: training, 257.42 and test, 76.79) than model 2 (AUC: training, 0.850 [0.894−0.806] and test, 0.819 [0.715−0.923]; AIC: training, 314.44 and test, 83.78), model 3 (AUC: training, 0.862 [0.901−0.823] and test, 0.830 [0.731−0.929]; AIC: training, 307.76 and test, 86.55), and model 4 (AUC: training, 0.862 [0.901−0.823] and test, 0.833 [0.733−0.932]; AIC: training, 305.8 and test, 86.28).

Conclusion

A multivariate model can be used to predict functionality improvement, as measured by ADL, following hospitalization with a stroke.

背景本研究建立了一个简单的预测模型，用于识别中风后日常生活活动（ADL）改善机会更大的中风患者。方法将 489 名中风患者分为测试组和训练组。每个模型都进行了多变量逻辑回归分析。使用 C 统计量（AUC）、阿凯克信息准则（AIC）和其他指标对四个模型进行比较。结果多元分析显示，出院时测量的几个变量明显高于入院时测量的变量，包括手动肌肉测试、站立等。多变量逻辑回归分析显示，特定活动平衡信心、下肢布伦斯特罗姆恢复阶段、站立、迷你平衡评估系统测试和汉密尔顿焦虑量表是ADL的独立预测指标。结果发现，模型 1 对 ADL 的预测更为准确（AUC：训练为 0.916 [0.889-0.943]，测试为 0.887 [0.806-0.968]；AIC：训练为 257.42，测试为 76.79）高于模型 2（AUC：训练，0.850 [0.894-0.806]，测试，0.819 [0.715-0.923]；AIC：训练，314.44，测试，83.78）、模型 3（AUC：训练，0.862 [0.901-0.结论多变量模型可用于预测脑卒中住院后以 ADL 衡量的功能改善情况。

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引用次数: 0

Predicting stroke risk: An effective stroke prediction model based on neural networks 预测中风风险：基于神经网络的有效中风预测模型

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Journal of Neurorestoratology

Pub Date : 2024-09-07 DOI: 10.1016/j.jnrt.2024.100156

Aakanshi Gupta , Nidhi Mishra , Nishtha Jatana , Shaily Malik , Khaled A. Gepreel , Farwa Asmat , Sachi Nandan Mohanty

Background

Stroke is the leading worldwide cause of disability and death. Effective stroke prevention and management depend on early identification of stroke risk.

Methods

Eight machine learning algorithms are applied to predict stroke risk using a well-curated dataset with pertinent clinical information. This paper describes a thorough investigation of stroke prediction using various machine learning methods.

Results

The empirical evaluation yields encouraging results, with the logistic regression, support vector machine, and K-nearest neighbors models achieving an impressive accuracy of 95.04%, and the random forest and neural network models scoring even better, with accuracies of 95.10% and 95.16%, respectively. The neural network exhibits slightly superior performance, indicating its potential as a reliable model for stroke risk assessment.

Conclusions

The empirical evaluation underscores the ability of neural networks to discern intricate data relationships. These findings offer valuable insights for healthcare professionals and researchers, aiding in the development of improved stroke prevention strategies and timely interventions, ultimately enhancing patient outcomes.

背景中风是全球致残和致死的主要原因。有效的脑卒中预防和管理有赖于早期识别脑卒中风险。方法采用八种机器学习算法，利用精心收集的数据集和相关临床信息预测脑卒中风险。结果实证评估结果令人鼓舞，逻辑回归、支持向量机和 K-nearest neighbors 模型的准确率达到了令人印象深刻的 95.04%，随机森林和神经网络模型的准确率更高，分别为 95.10% 和 95.16%。神经网络的表现略胜一筹，表明它有潜力成为中风风险评估的可靠模型。这些发现为医疗保健专业人员和研究人员提供了宝贵的见解，有助于制定更好的中风预防策略和及时的干预措施，最终改善患者的预后。

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引用次数: 0

Letter to Editor: Authors' response to “Respondence of ‘Brain iron deposition and whole-exome sequencing of non-Wilson's disease hypoceruloplasminemia in a family’” 致编辑的信：作者对"'一个家族非威尔逊氏病低铁蛋白血症的脑铁沉积和全外显子测序'的回应 "的回复

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Journal of Neurorestoratology

Pub Date : 2024-08-26 DOI: 10.1016/j.jnrt.2024.100155

Min Xu, Jian-Zhong Yi, Xiao-Ping Wang

引用次数: 0

Reviving consciousness: The impact of short-term spinal cord stimulation on patients with early-onset prolonged disorders of consciousness 恢复意识：短期脊髓刺激对早发长时间意识障碍患者的影响

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Journal of Neurorestoratology

Pub Date : 2024-08-24 DOI: 10.1016/j.jnrt.2024.100143

Qiang Chen , Weilong Huang , Jianhong Tang , Guohui Ye , Hongliang Meng , Qing Jiang , Linying Ge , HuiChen Li , Lin Liu , Qiuhua Jiang , Dong Wang

Introduction

Managing prolonged disorders of consciousness (pDoC) presents a significant clinical challenge despite numerous available therapies. While short-term spinal cord stimulation (st-SCS) for over 3 months has been recognized as an effective treatment for pDoC, its efficacy within the first 3 months remains unclear. This study explores st-SCS's impact on patients with pDoC for less than 3 months.

Material and methods

We enrolled 141 pDoC patients within 3 months of onset; 104 received st-SCS, and 37 underwent conservative treatment. Consciousness levels were assessed using the Coma Recovery Scale-Revised (CRS-R) before treatment, 2 weeks after, and at 3-month follow-up.

Results

Comparing the data from the 3-month follow-up, we found that, the st-SCS group showed significantly greater improvement in CRS-R scores compared to the control group (p < 0.01), with more patients showing symptom amelioration (51/104 (49%)). Further analysis of the st-SCS treatment group showed significant improvement in CRS-R scores after 2 weeks (T1) and at the 3-month follow-up (T2) compared to baseline (T0). Both consciousness levels and specific CRS-R items improved notably post-treatment. Younger patients (<40 years) with traumatic brain injury and higher initial CRS-R scores were more likely to experience positive outcomes. Additionally, multivariate logistic regression identified etiology, time since injury, and initial CRS-R score as significant predictors of the 3-month outcome (p < 0.05).

Conclusions

st-SCS is an effective treatment for pDoC within 3 months of onset, particularly for younger patients and those with trauma-induced conditions, significantly improving consciousness and outcomes.

导言尽管现有的治疗方法很多，但治疗长时间意识障碍（pDoC）仍是一项重大的临床挑战。虽然持续 3 个月以上的短期脊髓刺激（st-SCS）被认为是治疗意识障碍的有效方法，但其在最初 3 个月内的疗效仍不明确。本研究探讨了st-SCS对发病不足3个月的pDoC患者的影响。材料和方法我们招募了141名发病3个月内的pDoC患者，其中104人接受了st-SCS，37人接受了保守治疗。结果比较 3 个月的随访数据，我们发现，与对照组相比，st-SCS 组的 CRS-R 评分有明显改善（p <0.01），更多患者的症状得到改善（51/104 (49%)）。对 st-SCS 治疗组的进一步分析显示，与基线（T0）相比，CRS-R 评分在 2 周后（T1）和 3 个月随访（T2）时均有显著改善。意识水平和特定的 CRS-R 项目在治疗后都有明显改善。年龄较轻（40 岁）的脑外伤患者和初始 CRS-R 评分较高的患者更有可能获得积极的疗效。此外，多变量逻辑回归确定病因、受伤后时间和初始 CRS-R 评分是 3 个月疗效的重要预测因素（p <0.05）。结论st-SCS 是治疗发病 3 个月内 pDoC 的有效方法，尤其适用于年轻患者和有创伤的患者，可显著改善意识和疗效。

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引用次数: 0

Research hotspots and global trends in transcranial magnetic stimulation for stroke neurorestoration: A 30-year bibliometric analysis 经颅磁刺激治疗脑卒中神经恢复的研究热点和全球趋势：30 年文献计量分析

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Journal of Neurorestoratology

Pub Date : 2024-08-22 DOI: 10.1016/j.jnrt.2024.100148

Haozheng Li , Chong Guan , Dongxiang Fang , Yang Yang , Mengying Hsieh , Zhiyuan Xu , Qing Yang , Yi Wu , Ruiping Hu

Background

Stroke patients often experience various functional impairments. Transcranial magnetic stimulation (TMS) has emerged as a novel non-invasive brain stimulation technique, and has gained widespread attention over the past 30 years for its application in stroke. The present study used bibliometric and content analysis methods to explore the research hotspots and future trends of TMS in stroke, with an aim to provide benefits for subsequent research.

Methods

Publications and reviews related to TMS in stroke from 1992 to 2022 were retrieved from the Web of Science Core Collection database. Data visualization and analysis were performed using CiteSpace, VOSviewer, and Scimago Graphica.

Results

We included 1666 papers in the analysis and noted an increasing trend in annual publication volume. Collaboration network analysis revealed close cooperation among scholars from these major countries and institutions. Emerging keywords included TMS, stroke, recovery, rehabilitation, rTMS, plasticity, cortex, excitability, upper limb, and tDCS. Keyword citation bursts appeared to be shifting toward clinical applications, including functional connectivity, systematic reviews, double-blind studies, connectivity, injury, and dysphagia.

Conclusion

Our study indicates substantial growth in TMS publications and citations in stroke rehabilitation since 2006, suggesting a maturing field that is advancing toward more sophisticated treatment protocols. The increasing relevance of TMS in neurological and rehabilitative applications highlights its potential for promoting post-stroke recovery. Emerging keywords such as brain functional connectivity, systematic reviews, and double-blind studies highlight a shift toward clinical applications. The future of TMS in stroke rehabilitation promises continued growth, interdisciplinary approaches, and improved patient outcomes.

背景中风患者经常会出现各种功能障碍。经颅磁刺激（TMS）作为一种新型的非侵入性脑刺激技术，在过去 30 年中因其在脑卒中中的应用而受到广泛关注。本研究采用文献计量学和内容分析法探讨了脑卒中经颅磁刺激的研究热点和未来趋势，旨在为后续研究提供借鉴。方法从科学网核心收藏数据库中检索了 1992 年至 2022 年与脑卒中经颅磁刺激相关的文献和综述。结果我们分析了1666篇论文，发现年发表量呈上升趋势。合作网络分析显示，这些主要国家和机构的学者之间合作密切。新出现的关键词包括 TMS、中风、恢复、康复、rTMS、可塑性、皮层、兴奋性、上肢和 tDCS。我们的研究表明，自 2006 年以来，TMS 在中风康复领域的发表和引用量大幅增长，这表明该领域正在走向成熟，并向更复杂的治疗方案迈进。TMS 在神经学和康复应用中的相关性日益增强，突显了其促进中风后康复的潜力。大脑功能连接、系统回顾和双盲研究等新兴关键词凸显了向临床应用的转变。TMS 在脑卒中康复领域的未来将是持续增长、跨学科方法和改善患者预后。

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引用次数: 0

Correspondence: “Application of deep brain stimulation and transcranial magnetic stimulation in stroke neurorestoration: A review” 通讯："脑深部刺激和经颅磁刺激在中风神经恢复中的应用：综述

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Journal of Neurorestoratology

Pub Date : 2024-08-22 DOI: 10.1016/j.jnrt.2024.100147

Xiumin Li, Bin Dong, Jie Wang

引用次数: 0

Bilateral hypertrophic olivary degeneration caused by unilateral midbrain infarction: A case report 单侧中脑梗塞导致的双侧肥大性橄榄变性：病例报告

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Journal of Neurorestoratology

Pub Date : 2024-08-17 DOI: 10.1016/j.jnrt.2024.100141

Yuying Sun , Yunfei Zhang , Zhaoyang Lu , Zijie Chen , Jinggui Song , Ping Zhang

Hypertrophic olivary degeneration (HOD) arises from lesions of the dentato-rubro-olivary pathway (Guillain–Mollaret triangle), and bilateral HOD is the rarest. Our patient, a 42-year-old man with bilateral HOD caused by unilateral midbrain infarction, had both increased dizziness and ataxia as the first symptoms. HOD has no effective treatment and is easily misdiagnosed as other diseases in clinical practice. Our case demonstrated unique HOD symptomatology and emphasizes the important role of magnetic resonance imaging in diagnosing HOD. The use of gabapentin relieved nystagmus in our patient and may provide a reference for the future treatment of such patients.

肥厚性橄榄变性（HOD）是由齿状突起-橄榄通路（Guillain-Mollaret 三角区）的病变引起的，双侧 HOD 最为罕见。我们的患者是一名 42 岁的男性，因单侧中脑梗死导致双侧 HOD，最初的症状是头晕加重和共济失调。HOD 没有有效的治疗方法，在临床上很容易被误诊为其他疾病。我们的病例显示了独特的 HOD 症状，并强调了磁共振成像在诊断 HOD 中的重要作用。使用加巴喷丁缓解了患者的眼球震颤，可为今后治疗此类患者提供参考。

引用次数: 0

Topographic and temporal patterns of dyskinesia in multiple system atrophy with predominant parkinsonism 多系统萎缩伴主要帕金森病患者运动障碍的地形和时间模式

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Journal of Neurorestoratology

Pub Date : 2024-08-17 DOI: 10.1016/j.jnrt.2024.100145

Hong Sun , Chong Dong , Yuan Li , Miaomiao Li , Hui Zhang , Xitong Xu , Wei Mao , Piu Chan

Background

Although dyskinesia is well recognized in Parkinson's disease, it is generally under acknowledged in multiple system atrophy (MSA). Reported cases of dyskinesia primarily manifest in patients with MSA with predominant parkinsonism (MSA-P), and characteristically present as orofacial dystonia. However, we have observed other manifestations of dyskinesia in our clinical practice. The current report aims to present the specific manifestations of dyskinesia in MSA-P, with videos.

Methods

We enrolled six patients with MSA-P with dyskinesia from Xuanwu Hospital. Of these, four had clinically established MSA-P and two had clinically probable MSA-P according to the 2022 Movement Disorder Society criteria for MSA diagnosis. All six patients underwent an acute levodopa challenge test, and videos were recorded during the process.

Results

Dyskinesia had a unilateral distribution in four patients. Three patients presented with peak-dose orofacial dystonia; of these, two were associated with blepharospasm and two were associated with limb dystonia. In addition, we observed that one patient had peak-dose distal lower limb dystonia with upper limb chorea, one patient had wearing-off dystonia of the eyelids, and one patient had diphasic generalized chorea mimicking that of Parkinson's disease.

Conclusions

In addition to orofacial dystonia, the topographic patterns of dyskinesia in MSA-P can manifest as limb dystonia, blepharospasm, and generalized chorea. Moreover, the temporal patterns of dyskinesia in MSA-P can be peak-dose, wearing-off, or diphasic.

背景虽然运动障碍在帕金森病中已得到广泛认可，但在多系统萎缩症（MSA）中却未得到充分认识。已报道的运动障碍病例主要表现为以帕金森病为主的多系统萎缩症（MSA-P）患者，其特征性表现为口面部肌张力障碍。然而，我们在临床实践中也观察到了其他表现形式的运动障碍。本报告旨在通过视频介绍 MSA-P 运动障碍的具体表现。根据 2022 年运动障碍协会的 MSA 诊断标准，其中 4 例为临床确诊的 MSA-P，2 例为临床可能的 MSA-P。所有六名患者均接受了急性左旋多巴挑战试验，并对试验过程进行了录像。三名患者出现峰值剂量的口面部肌张力障碍，其中两名患者伴有眼睑痉挛，两名患者伴有肢体肌张力障碍。此外，我们还观察到一名患者有峰值剂量的下肢远端肌张力障碍并伴有上肢舞蹈症，一名患者有磨损性眼睑肌张力障碍，一名患者有模仿帕金森病的二相全身舞蹈症。此外，MSA-P 运动障碍的时间模式可以是峰值剂量型、消退型或双相型。

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引用次数: 0

Respondence to article “Brain iron deposition and whole-exome sequencing of non-Wilson's disease hypoceruloplasminemia in a family” 对文章 "一个家族的非威尔逊氏病低铁蛋白血症的脑铁沉积和全外显子组测序 "的回应

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Journal of Neurorestoratology

Pub Date : 2024-08-16 DOI: 10.1016/j.jnrt.2024.100146

Hui Liu, Shu-Hong Wang

引用次数: 0

GsMTx4 ameliorates spinal cord injury by regulating microglial polarization through the Piezo1/NFκB/STAT6 pathway GsMTx4通过Piezo1/NFκB/STAT6途径调节小胶质细胞极化，从而改善脊髓损伤

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Journal of Neurorestoratology

Pub Date : 2024-08-16 DOI: 10.1016/j.jnrt.2024.100144

Weiwei Zheng , Peng Zhang , Hui Che , Yu Zhang , Xing Yang , Yixin Shen

Objective

Inflammatory reactions are recognized as pivotal in spinal cord injury (SCI), with the anti-inflammatory role of polarized microglia crucial in mitigating such injury. The present study aimed to determine the protective effects of GsMTx4 on functional recovery in a mouse model of SCI and investigate the role of GsMTx4 in cytokine-induced microglial activation and associated molecular mechanisms.

Methods

We assessed the effects of GsMTx4 on motor function in a mouse model of SCI, including neuronal survival and activated microglia in the vicinity of the injury after SCI. We also investigated the effects of GsMTx4 on expression of relevant inflammatory factors involved in cytokine-induced microglial activation and the associated signaling pathways.

Results

GsMTx4 effectively promoted functional recovery in mice and alleviated nerve damage after SCI. Additionally, GsMTx4 facilitated the transition of microglia from the M1 phenotype to the M2 phenotype, suppressed microglial activation, and reduced the expression of corresponding inflammatory mediators. These effects may involve modulation of neurogenic inflammation through the Piezo1/NFκB/STAT6 pathway, at least in part.

Conclusion

GsMTx4 safeguards against SCI by regulating microglial polarization, potentially via the Piezo1/NFκB/STAT6 pathway, offering initial evidence supporting the potential therapeutic efficacy of GsMTx4 for treatment of SCI.

目的炎症反应被认为是脊髓损伤（SCI）的关键因素，而极化小胶质细胞的抗炎作用对减轻这种损伤至关重要。本研究旨在确定 GsMTx4 对 SCI 小鼠模型功能恢复的保护作用，并研究 GsMTx4 在细胞因子诱导的小胶质细胞活化中的作用及相关分子机制。我们还研究了 GsMTx4 对参与细胞因子诱导的小胶质细胞活化的相关炎症因子的表达以及相关信号通路的影响。此外，GsMTx4 还能促进小胶质细胞从 M1 表型向 M2 表型转变，抑制小胶质细胞活化，并减少相应炎症介质的表达。结论 GsMTx4 可能通过 Piezo1/NFκB/STAT6 通路调节小胶质细胞极化，从而预防 SCI，这为 GsMTx4 治疗 SCI 的潜在疗效提供了初步证据。

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