Brain Circulation最新文献

This bibliometric analysis investigates the role of antioxidant therapy in addressing neuropathic pain, emphasizing mechanistic insights and research trends from 2003 to 2024. Neuropathic pain, often unresponsive to standard treatments, is closely associated with oxidative stress as a key factor in its pathophysiology. This study utilizes the Web of Science Core Collection to analyze 699 articles related to "antioxidants" and "neuropathic pain." CiteSpace software was employed to examine publication trends, global collaborations, co-citation networks, and research hotspots. Results indicate a consistent rise in research activity, peaking in 2022, with China, India, and Italy as leading contributors. The University of Florence and Universidade Federal de Santa Maria emerged as prominent institutions, while influential authors included Pol Olga and Trevisan Gabriela. Key studies highlighted oxidative stress and neuropathic pain mechanisms, with neuroinflammation and specific molecular pathways gaining attention as emerging research foci. The findings underscore the growing interest in antioxidant therapies as potential interventions for neuropathic pain. Despite significant advances in understanding underlying mechanisms, there is a need for further exploration of novel antioxidants and their clinical applications. Enhanced international collaboration and the use of advanced molecular techniques are essential to drive future progress in this field.

Background: Stroke patients can have various somatosensory abnormalities and a practice-research gap exists among various measurements and treatments. Integrating case reports that bridge this gap may provide a solution to addressing this issue.

Purpose: This systematic review integrates case reports detailing the physiotherapy management of stroke patients with recognized somatosensory impairments and determines the characteristics related to somatosensory measures, clinical symptoms, and treatments.

Methods: This systematic review was conducted under the Preferred Reporting Items for Systematic Review and Meta-Analysis statement, using PubMed, Cochrane Library, PEDro, CINAHL, and MEDLINE databases for articles published up to February 2024. Two independent authors performed a methodological quality assessment of the case reports.

Results: This review included 11 articles of low methodological quality, comprising 13 cases. Physiotherapists used 11 types of somatosensory measures and conducted 11 types of somatosensory training. However, all articles lacked clinical decision-making, causing inadequate accuracy, transparency, and usefulness in the case reports and physiotherapy management.

Conclusion: Physiotherapy for stroke patients with somatosensory impairments is characterized by a lack of standard somatosensory measures and an unclear effect of somatosensory impairments on motor function, making recovery prediction difficult and causing an unclear process in treatment practices. Addressing this issue requires case reports and clinical research, highlighting the process from somatosensory examination to diagnosis.

Objectives: When presented with acutely ruptured aneurysms, neurosurgeons may elect to use flow diverters (FDs). However, with the limited evidence concerning their safety and the potential thromboembolic and hemorrhagic complications, their use is extremely infrequent and often quite limited. In this study, we evaluated treatment-related complications, as well as clinical and radiological outcomes, in patients treated with FD stents for acutely ruptured intracranial aneurysms.

Materials and methods: We conducted a retrospective review of patients treated with FDs within 15 days postsubarachnoid hemorrhage from 2012 to 2024. Patient demographics, aneurysm characteristics, procedural specifics, along with clinical and imaging follow-ups were assessed.

Results: The study included 30 patients with a mean age of 55.6 years. Most aneurysms were located within the anterior circulation and were either small or medium-sized. Morphologically, aneurysms were saccular (43.3%), blister-like (40%), and fusiform/dissecting (16.7%). The mean time from rupture onset to treatment was 4.4 days. FD release was successfully achieved in all cases. Posttreatment rebleeding occurred in 10% of patients, ischemic complications in 6.7%, and treatment-related mortality was 6.6%, with an overall mortality of 13.3%. At discharge, 70% of patients achieved a favorable functional outcome. The mean available radiological follow-up period was 26 months, with complete aneurysm occlusion observed in 57.1% of patients at 1 month and in 100% of those available (40%) for follow-up after 1 year.

Conclusions: Flow diversion for acutely ruptured aneurysms demonstrates promising outcomes, although careful patient selection and alternative treatment consideration are essential. Future prospective, multicenter studies are needed to validate preliminary findings and optimize treatment protocols for this high-risk patient population.

Introduction: Ongoing research endeavors seek to identify neuroprotective drugs capable of mitigating brain cell necrosis and reperfusion injury by protecting the ischemic penumbra. Despite these efforts, the quest for effective neuroprotective agents remains elusive. Encouragingly, preliminary investigations, including basic experiments and single-center exploratory studies, have demonstrated the neuroprotective properties of normobaric hyperoxia (NBO). In pursuit of validating and expanding upon these findings, we have conducted a multicenter, prospective, randomized, controlled clinical trial known as OPENS-2. However, the OPENS-2 study only assessed outcomes at a 90-day endpoint, leaving uncertainties regarding the potential long-term benefits of NBO in stroke management. Thus, to address this gap in knowledge, we will initiate a long-term follow-up trial, OPENS-2L, building upon the foundation laid by the OPENS-2 study.

Materials and methods: This prospective, randomized controlled clinical trial will enroll 280 patients at a 1:1 ratio. Patients will be randomly divided into the NBO combined with the endovascular treatment group, where they will receive 10 L/min of oxygen through a mask, or the control group, where they will receive 1 L/min of oxygen.

Results: The primary endpoint of this study is the modified Rankin Scale (mRS) score at 1 year. Secondary endpoints include mRS 0-2, mRS 0-3, mRS 0-1 scores, Barthel index, and the EuroQol-5 Dimension score at 1 year. Safety endpoints encompass all-cause mortality at 1 year and the incidence of major vascular events.

Conclusion: If this trial yields positive outcomes, it would furnish crucial evidence for guiding future neuroprotective research endeavors. Overall, the insights gained from this study hold the potential to illuminate the long-term benefits of NBO combined with endovascular treatment in improving stroke outcomes, thereby shaping the landscape of stroke management practices.

Trial registration: ClinicalTrials.gov NCT05039697.

Flow-diverting stents have been increasingly utilized for the treatment of intracranial aneurysms, especially when there are factors that go against coil embolization, such as wide neck and large aneurysm size. However, its use does not guarantee success, especially in giant lesions, and failure to obtain aneurysmal obliteration can result in long-term instability of the aneurysmal wall, leading to aneurysmal growth and late rupture. We present the case of a 65-year-old woman who suffered from a late aneurysmal dilation and rupture, 2 years and 4 months after flow-diverting treatment of a giant ophthalmic segment aneurysm. Although not fully understood, the pathophysiology of this phenomenon has one necessary factor: incomplete aneurysmal obliteration. When this scenario is present, two main factors take place: the augmentation of intrasaccular blood flow after stent delivery and the local inflammation caused by partial thrombus formation and the presence of the stent itself. To prevent this complication, complete aneurysmal obliteration must be assured, and the use of combined techniques is encouraged.

Introduction: Infectious intracranial aneurysms (IIAs), a notable complication of infective endocarditis (IE), pose significant clinical challenges. This study delineates the outcomes, management strategies, and clinical manifestations of IIAs, drawing from a single-center's experience.

Methods: We conducted a retrospective observational analysis at our institution, focusing on patients diagnosed with IE between 2016 and 2022 who were also found to have IIAs. Data analysis was performed utilizing SAS statistical software alongside Microsoft Excel to execute descriptive statistical operations.

Results: Among 862 IE patients, 25 (2.9%) were diagnosed with IIAs, totaling 41 mycotic aneurysms. Of these, 18 patients had a single aneurysm, while 7 had multiple. The cohort's median age was 45 years, with an interquartile range of 27-65 years, and a predominance of male patients (68.3%). Ischemic and hemorrhagic strokes were observed in 58.6% and 87.8% of the cases, respectively. Ruptured IIAs were noted in 58.5% of instances, with the remainder unruptured. The average diameter of ruptured IIAs was 3.3 mm, compared to 2.1 mm for unruptured aneurysms, although this difference was not statistically significant (P = 0.324). The most frequent IIA locations were the distal segments of the posterior and middle cerebral arteries. Patients with ruptured IIAs experienced higher in-hospital mortality rates (29.1%) relative to those with unruptured IIAs (11.7%). Treatment was administered to 58.3% of ruptured IIAs, with no interventions for unruptured aneurysms (P = 0.001). Treatment modalities included surgical resection, n-butyl cyanoacrylate, coils, and Onyx embolization. The treated ruptured IIAs had an average size of 4.4 mm, versus 2.0 mm for untreated aneurysms. Among those treated, the majority were either discharged home (21.4%) or to other facilities (78.6%), with no in-hospital mortalities reported in this group.

Conclusion: The findings suggest that endovascular treatment is a viable and effective option for managing ruptured IIAs, with decisions tailored to individual patient comorbidities. Further multicenter studies are recommended to corroborate these findings and refine treatment strategies for IIAs associated with infective endocarditis.

Background: Congestive heart failure (CHF) has been linked to dementia but for reasons not well understood. Our retrospective cohort study aims to determine if specific measures of CHF severity are associated with cognitive performance or cerebral blood flow velocity (CBFV) among decompensated CHF outpatients.

Materials and methods: One hundred and thirty-eight patients with transthoracic echocardiogram ≤1-year preceding consent were included. Forty-nine patients had concurrent transcranial Doppler ultrasonography administered by a trained technician assessing anterior cerebral artery, middle cerebral artery, and internal carotid artery (ICA) CBFV. CHF characteristics considered were NYHA classification, CHF type (heart failure with preserved ejection fraction vs. heart failure with mildly reduced/reduced ejection fraction), and left ventricular ejection fraction (LVEF; continuous [per 5%] or categorized [≤40%, 40%-55%, and ≥55%]). A trained psychometrist administered a standardized cognitive battery including Rey Auditory Verbal Learning Test, Rey Complex Figure Copy and Immediate Recall test, Letter-Number Sequencing (LNS) test, and Trail Making Tests. Adjusted multivariable linear regression models determined the association between CHF characteristics and standardized cognitive tests as well as between CHF characteristics and standardized CBFV, in distinct models.

Results: On average, NYHA Class 1-2 patients had better LNS scores than NYHA Class 3-4 patients (β: 0.47; 95% CI: 0.09, 0.84). Patients with LVEF 40%-55% had higher ICA CBFVs than those with LVEF ≤40% (β: 13.7; 95% CI: 1.01, 26.39). No associations between other CHF characteristics and either cognitive performance or CBFV were found.

Conclusion: Blood flow may be an important mechanism behind CHF-related cognitive decline, but studies with larger sample sizes and a control group without CHF are needed.

Objectives: There is a paucity of data regarding the long-term hemorrhage/progression outcomes of brain arteriovenous malformation (BAVM). The purpose of this study was to examine the outcomes of surgical treatment alone over a long follow-up period.

Materials and methods: All patients (n = 356) harboring Grade I-III BAVMs who had been surgically treated alone between January 2010 and December 2019 were included. Univariate analysis and multivariate analysis with proportional hazard models were implemented to identify the predictors of hemorrhage-free survival (HFS) (n = 356) and progression-free survival (PFS) (n = 334).

Results: Of the 356 BAVM patients, 233 were male and 123 were female (male-to-female ratio of 1.89:1). Rehemorrhage was observed in 22 (6.2%) patients. The overall HFS rates at 5, 10, and 15 years in the entire cohort were 96.0%, 92.4%, and 91.1%, respectively. A 1 cm³ increase in lesion volume (hazard ratio [HR] = 1.049, 95% confidence interval [CI] = 1.013-1.085; P = 0.007) was a significant adverse factor for HFS. The probabilities of PFS at 5, 10, and 15 years were 94.9%, 90.6%, and 85.5%, respectively. With respect to clinical predictors of PFS, only male sex (HR = 3.146, 95% CI = 1.088-9.098; P = 0.034) was a significant predictor of PFS after surgical treatment in the univariate analysis.

Conclusions: For the majority of patients, surgery remains the first-line treatment for BAVMs. Our study included a significant subset of patients who were successfully managed by surgery alone.