Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function ...Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function in patients with acoustic neuroma.Methods A total of 110 patients with acoustic neuroma who underwent surgery through the retrosigmoid sinus approach were included.Clinical data and raw features from four MRI sequences(T1-weighted,T2-weighted,T1-weighted contrast enhancement,and T2-weighted-Flair images)were analyzed.Spearman correlation analysis along with least absolute shrinkage and selection operator regression were used to screen combined clinical and radiomic features.Nomogram,machine learning,and convolutional neural network(CNN)models were constructed to predict the prognosis of facial nerve function on the seventh day after surgery.Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate model performance.A total of 1050 radiomic parameters were extracted,from which 13 radiomic and 3 clinical features were selected.Results The CNN model performed best among all prediction models in the test set with an area under the curve(AUC)of 0.89(95%CI,0.84–0.91).Conclusion CNN modeling that combines clinical and multi-sequence MRI radiomic features provides excellent performance for predicting short-term facial nerve function after surgery in patients with acoustic neuroma.As such,CNN modeling may serve as a potential decision-making tool for neurosurgery.展开更多
OBJECTIVE： There are no convenient techniques to evaluate the degree of facial nerve injury during a course of acupuncture treatment for Bell＇s palsy. Our previous studies found that observing the electrical respons...OBJECTIVE： There are no convenient techniques to evaluate the degree of facial nerve injury during a course of acupuncture treatment for Bell＇s palsy. Our previous studies found that observing the electrical response of specific facial muscles provided reasonable correlation with the prognosis of electroacupuncture treatment. Hence, we used the new method to evaluate the degree of facial nerve injury in patients with Bell＇s palsy in comparison with the House-Brackmann scale. The relationship between therapeutic effects and prognosis was analyzed to explore an objective method for evaluating Bell＇s palsy. METHODS： The facial nerve function of 68 patients with Bell＇s palsy was assessed with both electrical response grading and the House-Brackmann scale before treatment. Then differences in evaluation results of the two methods were compared. All enrolled patients received electroacupuncture treatment with disperse-dense wave at 1/100 Hz for 4 weeks. After treatment, correlation analysis was conducted to find the relationship between electrical response and therapeutic effects or prognosis. RESULTS： Checking consistency between electrical response grading and House-Brackmann scale： Kappa value 0.028 （P = 0.578）. Correlation analysis： the two methods were correlated with the prognosis, and electrical response grading （rER = 0.789） was better than the House-Brackmann scale （rHB = 0.423）. CONCLUSION： Electrical response grading is superior to the House-Brackmann scale in efficacy and reliability, and can conveniently assess the degree of facial nerve injury. The House-Brackmann scale is suitable for the patients with mild facial nerve injury, but its evaluation quality for severe facial nerve injury is poor.展开更多
Facial synkinesis,a sequela of peripheral facial nerve palsy,is characterized by simultaneous involuntary facial movement during a voluntary desired one.Maladaptive cortical plasticity might be involved in the dysfunc...Facial synkinesis,a sequela of peripheral facial nerve palsy,is characterized by simultaneous involuntary facial movement during a voluntary desired one.Maladaptive cortical plasticity might be involved in the dysfunction of facial muscles.This cohort study investigated the cortical functional alterations in patients with unilateral facial synkinesis,using the task functional magnetic resonance imaging.Facial motor tasks,including blinking and smiling,were performed by 16 patients（aged 30.6 ± 4.5 years,14 females/2 males） and 24 age-and sex-matched healthy controls（aged 29.1 ± 4.2 years,19 females/5 males）.Results demonstrated that activation in the cortico-facial motor representation area was lower during tasks in patients with facial synkinesis compared with healthy controls.Facial movements on either side performed by patients caused more intensive activation of the supplementary motor area on the contralateral side of the affected face,than those on the unaffected side.Our results revealed that there was cortical reorganization in the primary sensorimotor area and the supplementary motor area.This study was registered in Chinese Clinical Trial Registry（registration number： Chi CTR1800014630）.展开更多
Recently,we have shown that manual stimulation of paralyzed vibrissal muscles after facial-facial anastomosis reduced the poly-innervation of neuromuscular junctions and restored vibrissal whisking.Using gene knock ou...Recently,we have shown that manual stimulation of paralyzed vibrissal muscles after facial-facial anastomosis reduced the poly-innervation of neuromuscular junctions and restored vibrissal whisking.Using gene knock outs,we found a differential dependence of manual stimulation effects on growth factors.Thus,insulin-like growth factor-1 and brain-derived neurotrophic factor are required to underpin manual stimulation-mediated improvements,whereas FGF-2 is not.The lack of dependence on FGF-2 in mediating these peripheral effects prompted us to look centrally,i.e.within the facial nucleus where increased astrogliosis after facial-facial anastomosis follows"synaptic stripping".We measured the intensity of Cy3-fluorescence after immunostaining for glial fibrillary acidic protein(GFAP)as an indirect indicator of synaptic coverage of axotomized neurons in the facial nucleus of mice lacking FGF-2(FGF-2^(-/-)mice).There was no difference in GFAP-Cy3-fluorescence(pixel number,gray value range17-103)between intact wildtype mice(2.12±0.37×10~7)and their intact FGF-2^(-/-)counterparts(2.12±0.27×10~7)nor after facial-facial anastomosis+handling(wildtype:4.06±0.32×10~7;FGF-2^(-/-):4.39±0.17×10~7).However,after facial-facial anastomosis,GFAP-Cy3-fluorescence remained elevated in FGF-2^(-/-)-animals(4.54±0.12×10~7),whereas manual otimulation reduced the intensity of GFAP-immunofluorescence in wild type mice to values that were not significantly different from intact mice(2.63±0.39×10).We conclude that FGF-2 is not required to underpin the beneficial effects of manual stimulation at the neuro-muscular junction,but it is required to minimize astrogliosis in the brainstem and,by implication,restore synaptic coverage of recovering facial motoneurons.展开更多
BACKGROUND Treatments involving stem cell(SC)usage represent novel and potentially interesting alternatives in facial nerve reanimation.Current literature includes the use of SC in animal model studies to promote graf...BACKGROUND Treatments involving stem cell(SC)usage represent novel and potentially interesting alternatives in facial nerve reanimation.Current literature includes the use of SC in animal model studies to promote graft survival by enhancing nerve fiber growth,spreading,myelinization,in addition to limiting fibrotic degeneration after surgery.However,the effectiveness of the clinical use of SC in facial nerve reanimation has not been clarified yet.AIM To investigate the histological,neurophysiological,and functional outcomes in facial reanimation using SC,compared to autograft.METHODS Our study is a systematic review of the literature,consistently conducted according to the preferred reporting items for systematic reviews and meta-analyses statement guidelines.The review question was:In facial nerve reanimation on rats,has the use of stem cells revealed as effective when compared to autograft,in terms of histological,neurophysiological,and functional outcomes?Random-effect meta-analysis was conducted on histological and neurophysiological data from the included comparative studies.RESULTS After screening 148 manuscript,five papers were included in our study.43 subjects were included in the SC group,while 40 in the autograft group.The meta-analysis showed no significative differences between the two groups in terms of myelin thickness[CI:-0.10(-0.20,0.00);I^(2)=29%;P=0.06],nerve fibers diameter[CI:0.72(-0.93,3.36);I^(2)=72%;P=0.6],compound muscle action potential amplitude[CI:1.59(0.59,3.77);I^(2)=89%;P=0.15]and latency[CI:0.66(-1.01,2.32);I^(2)=67%;P=0.44].The mean axonal diameter was higher in the autograft group[CI:0.94(0.60,1.27);I^(2)=0%;P≤0.001].CONCLUSION The role of stem cells in facial reanimation is still relatively poorly studied,in animal models,and available results should not discourage their use in future studies on human subjects.展开更多
OBJECTIVE: The objective of this study is to summarize and analyze the brain signal patterns of empathy for pain caused by facial expressions of pain utilizing activation likelihood estimation, a meta-analysis method....OBJECTIVE: The objective of this study is to summarize and analyze the brain signal patterns of empathy for pain caused by facial expressions of pain utilizing activation likelihood estimation, a meta-analysis method. DATA SOURCES: Studies concerning the brain mechanism were searched from the Science Citation Index, Science Direct, PubMed, DeepDyve, Cochrane Library, SinoMed, Wanfang, VIP, China National Knowledge Infrastructure, and other databases, such as SpringerLink, AMA, Science Online, Wiley Online, were collected. A time limitation of up to 13 December 2016 was applied to this study. DATA SELECTION: Studies presenting with all of the following criteria were considered for study inclusion: Use of functional magnetic resonance imaging, neutral and pained facial expression stimuli, involvement of adult healthy human participants over 18 years of age, whose empathy ability showed no difference from the healthy adult, a painless basic state, results presented in Talairach or Montreal Neurological Institute coordinates, multiple studies by the same team as long as they used different raw data. OUTCOME MEASURES: Activation likelihood estimation was used to calculate the combined main activated brain regions under the stimulation of pained facial expression. RESULTS: Eight studies were included, containing 178 subjects. Meta-analysis results suggested that the anterior cingulate cortex(BA32), anterior central gyrus(BA44), fusiform gyrus, and insula(BA13) were activated positively as major brain areas under the stimulation of pained facial expression. CONCLUSION: Our study shows that pained facial expression alone, without viewing of painful stimuli, activated brain regions related to pain empathy, further contributing to revealing the brain's mechanisms of pain empathy.展开更多
目的观察针刺联合火龙罐治疗贝尔面瘫的临床疗效及对面神经功能的影响。方法将72例贝尔面瘫患者按随机数字表法分为对照组(36例)和研究组(36例)。两组均进行相同的基础治疗,对照组另予针刺治疗,研究组另予针刺联合火龙罐治疗。观察两组...目的观察针刺联合火龙罐治疗贝尔面瘫的临床疗效及对面神经功能的影响。方法将72例贝尔面瘫患者按随机数字表法分为对照组(36例)和研究组(36例)。两组均进行相同的基础治疗,对照组另予针刺治疗,研究组另予针刺联合火龙罐治疗。观察两组治疗前后House-Brackmann(H-B)面神经功能分级、面部残疾指数(facial disability index,FDI)[包括躯体功能(facial disability index physical function,FDIP)和社会功能(facial disability index social function,FDIS)评分]以及改良Portmann简易评分的变化,比较两组临床疗效和不良反应发生率。结果治疗后,两组H-B面神经功能分级均优于治疗前(P<0.05),且研究组H-B面神经功能分级优于对照组(P<0.05)。治疗后,两组FDIP和改良Portmann简易评分均高于治疗前(P<0.05),两组FDIS均低于治疗前(P<0.05);研究组FDIP和改良Portmann简易评分均高于对照组(P<0.05),FDIS低于对照组(P<0.05)。研究组总有效率为94.4%,高于对照组的77.8%,差异具有统计学意义(P<0.05)。对照组不良反应发生率为8.3%,与研究组的11.1%比较,差异无统计学意义(P>0.05)。结论在基础治疗下,针刺联合火龙罐治疗贝尔面瘫可促进面神经功能恢复,改善面部症状,提高临床疗效,且安全性较好。展开更多
文摘Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function in patients with acoustic neuroma.Methods A total of 110 patients with acoustic neuroma who underwent surgery through the retrosigmoid sinus approach were included.Clinical data and raw features from four MRI sequences(T1-weighted,T2-weighted,T1-weighted contrast enhancement,and T2-weighted-Flair images)were analyzed.Spearman correlation analysis along with least absolute shrinkage and selection operator regression were used to screen combined clinical and radiomic features.Nomogram,machine learning,and convolutional neural network(CNN)models were constructed to predict the prognosis of facial nerve function on the seventh day after surgery.Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate model performance.A total of 1050 radiomic parameters were extracted,from which 13 radiomic and 3 clinical features were selected.Results The CNN model performed best among all prediction models in the test set with an area under the curve(AUC)of 0.89(95%CI,0.84–0.91).Conclusion CNN modeling that combines clinical and multi-sequence MRI radiomic features provides excellent performance for predicting short-term facial nerve function after surgery in patients with acoustic neuroma.As such,CNN modeling may serve as a potential decision-making tool for neurosurgery.
文摘OBJECTIVE： There are no convenient techniques to evaluate the degree of facial nerve injury during a course of acupuncture treatment for Bell＇s palsy. Our previous studies found that observing the electrical response of specific facial muscles provided reasonable correlation with the prognosis of electroacupuncture treatment. Hence, we used the new method to evaluate the degree of facial nerve injury in patients with Bell＇s palsy in comparison with the House-Brackmann scale. The relationship between therapeutic effects and prognosis was analyzed to explore an objective method for evaluating Bell＇s palsy. METHODS： The facial nerve function of 68 patients with Bell＇s palsy was assessed with both electrical response grading and the House-Brackmann scale before treatment. Then differences in evaluation results of the two methods were compared. All enrolled patients received electroacupuncture treatment with disperse-dense wave at 1/100 Hz for 4 weeks. After treatment, correlation analysis was conducted to find the relationship between electrical response and therapeutic effects or prognosis. RESULTS： Checking consistency between electrical response grading and House-Brackmann scale： Kappa value 0.028 （P = 0.578）. Correlation analysis： the two methods were correlated with the prognosis, and electrical response grading （rER = 0.789） was better than the House-Brackmann scale （rHB = 0.423）. CONCLUSION： Electrical response grading is superior to the House-Brackmann scale in efficacy and reliability, and can conveniently assess the degree of facial nerve injury. The House-Brackmann scale is suitable for the patients with mild facial nerve injury, but its evaluation quality for severe facial nerve injury is poor.
基金supported by the Youth Researcher Foundation of Shanghai Municipal Commission of Health and Family Planning,No.20144Y0095
文摘Facial synkinesis,a sequela of peripheral facial nerve palsy,is characterized by simultaneous involuntary facial movement during a voluntary desired one.Maladaptive cortical plasticity might be involved in the dysfunction of facial muscles.This cohort study investigated the cortical functional alterations in patients with unilateral facial synkinesis,using the task functional magnetic resonance imaging.Facial motor tasks,including blinking and smiling,were performed by 16 patients（aged 30.6 ± 4.5 years,14 females/2 males） and 24 age-and sex-matched healthy controls（aged 29.1 ± 4.2 years,19 females/5 males）.Results demonstrated that activation in the cortico-facial motor representation area was lower during tasks in patients with facial synkinesis compared with healthy controls.Facial movements on either side performed by patients caused more intensive activation of the supplementary motor area on the contralateral side of the affected face,than those on the unaffected side.Our results revealed that there was cortical reorganization in the primary sensorimotor area and the supplementary motor area.This study was registered in Chinese Clinical Trial Registry（registration number： Chi CTR1800014630）.
基金financially supported by the Koln Fortune Programmthe Jean-Uhrmacher FoundationAkdeniz University Research Fund
文摘Recently,we have shown that manual stimulation of paralyzed vibrissal muscles after facial-facial anastomosis reduced the poly-innervation of neuromuscular junctions and restored vibrissal whisking.Using gene knock outs,we found a differential dependence of manual stimulation effects on growth factors.Thus,insulin-like growth factor-1 and brain-derived neurotrophic factor are required to underpin manual stimulation-mediated improvements,whereas FGF-2 is not.The lack of dependence on FGF-2 in mediating these peripheral effects prompted us to look centrally,i.e.within the facial nucleus where increased astrogliosis after facial-facial anastomosis follows"synaptic stripping".We measured the intensity of Cy3-fluorescence after immunostaining for glial fibrillary acidic protein(GFAP)as an indirect indicator of synaptic coverage of axotomized neurons in the facial nucleus of mice lacking FGF-2(FGF-2^(-/-)mice).There was no difference in GFAP-Cy3-fluorescence(pixel number,gray value range17-103)between intact wildtype mice(2.12±0.37×10~7)and their intact FGF-2^(-/-)counterparts(2.12±0.27×10~7)nor after facial-facial anastomosis+handling(wildtype:4.06±0.32×10~7;FGF-2^(-/-):4.39±0.17×10~7).However,after facial-facial anastomosis,GFAP-Cy3-fluorescence remained elevated in FGF-2^(-/-)-animals(4.54±0.12×10~7),whereas manual otimulation reduced the intensity of GFAP-immunofluorescence in wild type mice to values that were not significantly different from intact mice(2.63±0.39×10).We conclude that FGF-2 is not required to underpin the beneficial effects of manual stimulation at the neuro-muscular junction,but it is required to minimize astrogliosis in the brainstem and,by implication,restore synaptic coverage of recovering facial motoneurons.
文摘BACKGROUND Treatments involving stem cell(SC)usage represent novel and potentially interesting alternatives in facial nerve reanimation.Current literature includes the use of SC in animal model studies to promote graft survival by enhancing nerve fiber growth,spreading,myelinization,in addition to limiting fibrotic degeneration after surgery.However,the effectiveness of the clinical use of SC in facial nerve reanimation has not been clarified yet.AIM To investigate the histological,neurophysiological,and functional outcomes in facial reanimation using SC,compared to autograft.METHODS Our study is a systematic review of the literature,consistently conducted according to the preferred reporting items for systematic reviews and meta-analyses statement guidelines.The review question was:In facial nerve reanimation on rats,has the use of stem cells revealed as effective when compared to autograft,in terms of histological,neurophysiological,and functional outcomes?Random-effect meta-analysis was conducted on histological and neurophysiological data from the included comparative studies.RESULTS After screening 148 manuscript,five papers were included in our study.43 subjects were included in the SC group,while 40 in the autograft group.The meta-analysis showed no significative differences between the two groups in terms of myelin thickness[CI:-0.10(-0.20,0.00);I^(2)=29%;P=0.06],nerve fibers diameter[CI:0.72(-0.93,3.36);I^(2)=72%;P=0.6],compound muscle action potential amplitude[CI:1.59(0.59,3.77);I^(2)=89%;P=0.15]and latency[CI:0.66(-1.01,2.32);I^(2)=67%;P=0.44].The mean axonal diameter was higher in the autograft group[CI:0.94(0.60,1.27);I^(2)=0%;P≤0.001].CONCLUSION The role of stem cells in facial reanimation is still relatively poorly studied,in animal models,and available results should not discourage their use in future studies on human subjects.
基金supported by the National Natural Science Foundation of China,No.81473769(to WW),81772430(to WW)a grant from the Training Program of Innovation and Entrepreneurship for Undergraduates of Southern Medical University of Guangdong Province of China in 2016,No.201612121057(to WW)
文摘OBJECTIVE: The objective of this study is to summarize and analyze the brain signal patterns of empathy for pain caused by facial expressions of pain utilizing activation likelihood estimation, a meta-analysis method. DATA SOURCES: Studies concerning the brain mechanism were searched from the Science Citation Index, Science Direct, PubMed, DeepDyve, Cochrane Library, SinoMed, Wanfang, VIP, China National Knowledge Infrastructure, and other databases, such as SpringerLink, AMA, Science Online, Wiley Online, were collected. A time limitation of up to 13 December 2016 was applied to this study. DATA SELECTION: Studies presenting with all of the following criteria were considered for study inclusion: Use of functional magnetic resonance imaging, neutral and pained facial expression stimuli, involvement of adult healthy human participants over 18 years of age, whose empathy ability showed no difference from the healthy adult, a painless basic state, results presented in Talairach or Montreal Neurological Institute coordinates, multiple studies by the same team as long as they used different raw data. OUTCOME MEASURES: Activation likelihood estimation was used to calculate the combined main activated brain regions under the stimulation of pained facial expression. RESULTS: Eight studies were included, containing 178 subjects. Meta-analysis results suggested that the anterior cingulate cortex(BA32), anterior central gyrus(BA44), fusiform gyrus, and insula(BA13) were activated positively as major brain areas under the stimulation of pained facial expression. CONCLUSION: Our study shows that pained facial expression alone, without viewing of painful stimuli, activated brain regions related to pain empathy, further contributing to revealing the brain's mechanisms of pain empathy.
文摘目的观察针刺联合火龙罐治疗贝尔面瘫的临床疗效及对面神经功能的影响。方法将72例贝尔面瘫患者按随机数字表法分为对照组(36例)和研究组(36例)。两组均进行相同的基础治疗,对照组另予针刺治疗,研究组另予针刺联合火龙罐治疗。观察两组治疗前后House-Brackmann(H-B)面神经功能分级、面部残疾指数(facial disability index,FDI)[包括躯体功能(facial disability index physical function,FDIP)和社会功能(facial disability index social function,FDIS)评分]以及改良Portmann简易评分的变化,比较两组临床疗效和不良反应发生率。结果治疗后,两组H-B面神经功能分级均优于治疗前(P<0.05),且研究组H-B面神经功能分级优于对照组(P<0.05)。治疗后,两组FDIP和改良Portmann简易评分均高于治疗前(P<0.05),两组FDIS均低于治疗前(P<0.05);研究组FDIP和改良Portmann简易评分均高于对照组(P<0.05),FDIS低于对照组(P<0.05)。研究组总有效率为94.4%,高于对照组的77.8%,差异具有统计学意义(P<0.05)。对照组不良反应发生率为8.3%,与研究组的11.1%比较,差异无统计学意义(P>0.05)。结论在基础治疗下,针刺联合火龙罐治疗贝尔面瘫可促进面神经功能恢复,改善面部症状,提高临床疗效,且安全性较好。
