BACKGROUND Hematoma expansion(HE)typically portends a poor prognosis in spontaneous intracerebral hemorrhage(ICH).Several radiographic and laboratory values have been proposed as predictive markers of HE.AIM To perfor...BACKGROUND Hematoma expansion(HE)typically portends a poor prognosis in spontaneous intracerebral hemorrhage(ICH).Several radiographic and laboratory values have been proposed as predictive markers of HE.AIM To perform a systematic review and meta-analysis on the association of neu-trophil-to-lymphocyte ratio(NLR)and HE in ICH.A secondary outcome exa-mined was the association of NLR and perihematomal(PHE)growth.METHODS Three databases were searched(PubMed,EMBASE,and Cochrane)for studies evaluating the effect of NLR on HE and PHE growth.The inverse variance me-thod was applied to estimate an overall effect for each specific outcome by combining weighted averages of the individual studies’estimates of the logarithm odds ratio(OR).Given heterogeneity of the studies,a random effect was applied.Risk of bias was analyzed using the Newcastle-Ottawa Scale.The study was conducted following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines.The protocol was registered in PROSPERO(No.CRD42024549924).RESULTS Eleven retrospective cohort studies involving 2953 patients were included in the meta-analysis.Among those,HE was investigated in eight studies,whereas PHE growth was evaluated in three.Blood sample was obtained on admission in ten studies,and at 24 hours in one study.There was no consensus on cut-off value among the studies.NLR was found to be significantly associated with higher odds of HE(OR=1.09,95%CI:1.04-1.15,I2=86%,P<0.01),and PHE growth(OR=1.28,95%CI:1.19-1.38,I2=0%,P<0.01).Qualitative analysis of each outcome revealed overall moderate risk of bias mainly due to lack of control for systemic confounders.CONCLUSION The available literature suggests that a possible association may exist between NLR on admission and HE,and PHE growth.Future studies controlled for systemic confounders should be designed to consolidate this finding.If confirmed,NLR could be added as a readily available and inexpensive biomarker to identify a subgroup of patients at higher risk of developing HE.展开更多
BACKGROUND Administration of thrombolytics for acute ischemic stroke(AIS)via telemedicine has expanded in recent years at institutions without on-site neurology specialists.This helped to improve the care of stroke pa...BACKGROUND Administration of thrombolytics for acute ischemic stroke(AIS)via telemedicine has expanded in recent years at institutions without on-site neurology specialists.This helped to improve the care of stroke patients in rural areas.However,it is uncertain if telemedicine-administered thrombolytics is as safe and effective as inperson evaluation by neurology specialists.AIM The authors conducted a meta-analysis evaluating stroke metrics,safety and outcomes of telemedicine compared to in-person evaluation by neurologist specialist in AIS patients receiving intravenous thrombolytics.METHODS PubMed,EMBASE,and Cochrane were searched for randomized clinical trials and observational cohort studies.The Mantel-Haenszel method or inverse variance,as applicable,were applied to calculate an overall effect estimate for each outcome by combining specific risk ratio(RR)or standardized mean difference(SMD).Risk of bias was analyzed using the Newcastle-Ottawa Scale.Primary outcome examined was door-to-needle time(DTN).Secondary outcomes were symptomatic intracranial hemorrhage(sICH),mortality,and mRS≤2.RESULTS Eleven retrospective cohort studies involving 2350 patients were included in the analysis.Of those,34%(n=794)received thrombolytics via telemedicine.Telemedicine was associated with a significantly longer mean DTN compared to inperson evaluation[SMD:0.72 minutes;95%confidence interval(CI)0.22-1.22;P<0.01],a similar rate of sICH[3.9%vs 4.2%;Odds ratio(OR):0.75;95%CI 0.42-1.37;P=0.35],similar rate of mortality(13.2%vs 14.7%;OR:0.87;95%CI 0.47-1.63;P=0.67),and comparable rate of favorable short-term functional outcome(46.8%vs 50.7%;OR:0.79;95%CI 0.41-1.53;P=0.48).Risk of bias was low to moderate for each outcome.CONCLUSION The available literature suggests that telemedicine is associated with longer DTN compared to in-person evaluation.This difference in stroke metric does not affect safety or outcome.Further studies are needed to understand and address the underlying factors of the longer DTN time.展开更多
Several techniques have been reported to address different endovascular device failures. We report the case of a premature deployment of a covered balloon mounted stent during endovascular repair of a posttraumatic ca...Several techniques have been reported to address different endovascular device failures. We report the case of a premature deployment of a covered balloon mounted stent during endovascular repair of a posttraumatic carotid-cavernous fistula(CCF). A 50-year-old male suffered a fall resulting in loss of consciousness and multiple facial fractures. Five weeks later, he developed decreased left visual acuity, proptosis, chemosis, limited eye movements and cranial/orbit bruit. Cerebral angiography demonstrated a direct left CCF and endovascular repair with a 5.0 mm × 19 mm covered stent was planned. Once in the lacerum segment, increased resistance was encountered and the stent was withdrawn resulting in premature deployment. A 3 mm × 9 mm balloon was advanced over an exchange length microwire and through the stent lumen. Once distal to the stent, the balloon was inflated and slowly pulled back in contact with the stent. All devices were successfully withdrawn as a unit. The use of a balloon to retrieve a prematurely deployed balloon mounted stent is a potential rescue option if leaving the stent in situ carries risks.展开更多
Previous studies examining coherence and connectivity deviations in schizophrenia patients relied on standard coherence measures between recording sites (at the sensor level). A coherence source imaging (CSI) methodol...Previous studies examining coherence and connectivity deviations in schizophrenia patients relied on standard coherence measures between recording sites (at the sensor level). A coherence source imaging (CSI) methodology where coherence is assessed within imaged brain structures (at the source level) was developed recently by our group and applied successfully for detecting coherent areas in the cortical networks of patients with epilepsy. We applied this Magnetoencephalography (MEG)-CSI technique to measure normal and pathological patterns of brain oscillations (biomarkers) in normal subjects and patients diagnosed with schizophrenia. Twelve patients diagnosed with schizophrenia and twelve healthy control subjects were studied. A ten-minute resting state MEG brain scan was performed with eyes open. MEG-CSI analysis was performed to identify the cortical areas that interacted strongly within the 3 - 50 Hz frequency range. Statistically significant increased regions of coherence were detected in schizophrenia patients compared to controls in the right inferior frontal gyrus (BA 47—pars orbitalis), left superior frontal gyrus (BA9— dorsolateral prefrontal cortex), right middle frontal gyrus (BA 10—anterior prefrontal cortex & BA 46—dorsolateral prefrontal cortex), and right cingulate gyrus (BA 24—ventral anterior cingulate cortex). These areas are involved in language, memory, decision making, empathy, executive and, higher cognitive functioning. We conclude that MEG-CSI can detect imaging biomarkers from resting state brain activity in schizophrenia patients that deviates from normal control subjects in several behaviorally salient brain regions. Analysis with MEG-CSI can provide biomarkers of abnormalities in the resting-state. The findings and procedures described can be used to probe the pathophysiology of schizophrenia and possibly detect subtypes.展开更多
1.The complex spectrum of neurodegenerative diseases Epidemiologic data indicate that neurodegenerative diseases(NDDs)show high prevalence with a trend of a progressively growing incidence,especially in aging societie...1.The complex spectrum of neurodegenerative diseases Epidemiologic data indicate that neurodegenerative diseases(NDDs)show high prevalence with a trend of a progressively growing incidence,especially in aging societies.This presents an increasing social and economic burden.展开更多
Glioblastoma accounts for almost half of all intracranial primary malignancies and has the worst prognosis.Because of its high malignancy and frequent recurrence after standard therapy,it is of great signifcance to ex...Glioblastoma accounts for almost half of all intracranial primary malignancies and has the worst prognosis.Because of its high malignancy and frequent recurrence after standard therapy,it is of great signifcance to explore new therapy options.Recently immune therapy has taken remarkable progress in a variety of tumors,among which peptide vaccines utilize peptide sequences based on tumor-specifc antigens or tumor-associated antigen targets to activate selfimmune response against tumor cells.However,due to the particularity of intracranial central nervous system tumors,the application of peptide vaccines in glioblastoma still faces challenges.This article mainly reviews the immune basis and important clinical trial results of peptide vaccine therapy for GBM,analyzes the reasons for its poor efcacy,and proposes the development direction of peptide vaccines for the unique challenges of immunotherapy in GBM.An in-depth understanding and elaboration of the application and related issues of peptide vaccine in the treatment of GBM will help to formulate relevant treatment strategies in future clinical and basic research.展开更多
Background:Promising results from previous studies using cell therapy have paved the way for an innovative treatment option for amyotrophic lateral sclerosis(ALS).There is considerable evidence of immune and inflammat...Background:Promising results from previous studies using cell therapy have paved the way for an innovative treatment option for amyotrophic lateral sclerosis(ALS).There is considerable evidence of immune and inflammatory abnormalities in ALS.Bone marrow mononuclear cells(BMMNCs)possess immunomodulatory properties and could contribute to slowing of disease progression.Objective:Aim of our study was to evaluate the long-term effect of autologous BMMNCs combined with standard treatment on survival duration in a large population and to evaluate effect of type of onset and hormonal status on survival duration in the intervention group.Methods:This controlled,retrospective study spanned over 10 years,5 months;included 216 patients with probable or definite ALS,150 in intervention group receiving autologous BMMNCs and standard treatment,and 66 in control group receiving only standard treatment.The estimated survival duration of control group and intervention group was computed and compared using Kaplan Meier analysis.Survival duration of patients with different types of onset and hormonal status was compared within the intervention group.Results:None of the patients reported any major adverse events related to cell administration or the procedure.Kaplan Meier analysis estimated survival duration in the intervention group to be 91.7 months while 49.7 months in the control group(p=0.008).Within the intervention group,estimated survival was significantly higher(p=0.013)in patients with limb onset(102.3 months)vs.bulbar onset(49.9 months);premenopausal women(93.1 months)vs.postmenopausal women(57.6 months)(p=0.002);and preandropausal men(153.7 months)vs.postandropausal males(56.5 months)(p=0.006).Conclusion:Cell therapy using autologous BMMNCs along with standard treatment offers a promising and safe option for ALS with the potential of long term beneficial effect and increased survival.Limb onset patients,premenopausal women and men≤40 years of age demonstrated better treatment efficacy.展开更多
文摘BACKGROUND Hematoma expansion(HE)typically portends a poor prognosis in spontaneous intracerebral hemorrhage(ICH).Several radiographic and laboratory values have been proposed as predictive markers of HE.AIM To perform a systematic review and meta-analysis on the association of neu-trophil-to-lymphocyte ratio(NLR)and HE in ICH.A secondary outcome exa-mined was the association of NLR and perihematomal(PHE)growth.METHODS Three databases were searched(PubMed,EMBASE,and Cochrane)for studies evaluating the effect of NLR on HE and PHE growth.The inverse variance me-thod was applied to estimate an overall effect for each specific outcome by combining weighted averages of the individual studies’estimates of the logarithm odds ratio(OR).Given heterogeneity of the studies,a random effect was applied.Risk of bias was analyzed using the Newcastle-Ottawa Scale.The study was conducted following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines.The protocol was registered in PROSPERO(No.CRD42024549924).RESULTS Eleven retrospective cohort studies involving 2953 patients were included in the meta-analysis.Among those,HE was investigated in eight studies,whereas PHE growth was evaluated in three.Blood sample was obtained on admission in ten studies,and at 24 hours in one study.There was no consensus on cut-off value among the studies.NLR was found to be significantly associated with higher odds of HE(OR=1.09,95%CI:1.04-1.15,I2=86%,P<0.01),and PHE growth(OR=1.28,95%CI:1.19-1.38,I2=0%,P<0.01).Qualitative analysis of each outcome revealed overall moderate risk of bias mainly due to lack of control for systemic confounders.CONCLUSION The available literature suggests that a possible association may exist between NLR on admission and HE,and PHE growth.Future studies controlled for systemic confounders should be designed to consolidate this finding.If confirmed,NLR could be added as a readily available and inexpensive biomarker to identify a subgroup of patients at higher risk of developing HE.
文摘BACKGROUND Administration of thrombolytics for acute ischemic stroke(AIS)via telemedicine has expanded in recent years at institutions without on-site neurology specialists.This helped to improve the care of stroke patients in rural areas.However,it is uncertain if telemedicine-administered thrombolytics is as safe and effective as inperson evaluation by neurology specialists.AIM The authors conducted a meta-analysis evaluating stroke metrics,safety and outcomes of telemedicine compared to in-person evaluation by neurologist specialist in AIS patients receiving intravenous thrombolytics.METHODS PubMed,EMBASE,and Cochrane were searched for randomized clinical trials and observational cohort studies.The Mantel-Haenszel method or inverse variance,as applicable,were applied to calculate an overall effect estimate for each outcome by combining specific risk ratio(RR)or standardized mean difference(SMD).Risk of bias was analyzed using the Newcastle-Ottawa Scale.Primary outcome examined was door-to-needle time(DTN).Secondary outcomes were symptomatic intracranial hemorrhage(sICH),mortality,and mRS≤2.RESULTS Eleven retrospective cohort studies involving 2350 patients were included in the analysis.Of those,34%(n=794)received thrombolytics via telemedicine.Telemedicine was associated with a significantly longer mean DTN compared to inperson evaluation[SMD:0.72 minutes;95%confidence interval(CI)0.22-1.22;P<0.01],a similar rate of sICH[3.9%vs 4.2%;Odds ratio(OR):0.75;95%CI 0.42-1.37;P=0.35],similar rate of mortality(13.2%vs 14.7%;OR:0.87;95%CI 0.47-1.63;P=0.67),and comparable rate of favorable short-term functional outcome(46.8%vs 50.7%;OR:0.79;95%CI 0.41-1.53;P=0.48).Risk of bias was low to moderate for each outcome.CONCLUSION The available literature suggests that telemedicine is associated with longer DTN compared to in-person evaluation.This difference in stroke metric does not affect safety or outcome.Further studies are needed to understand and address the underlying factors of the longer DTN time.
文摘Several techniques have been reported to address different endovascular device failures. We report the case of a premature deployment of a covered balloon mounted stent during endovascular repair of a posttraumatic carotid-cavernous fistula(CCF). A 50-year-old male suffered a fall resulting in loss of consciousness and multiple facial fractures. Five weeks later, he developed decreased left visual acuity, proptosis, chemosis, limited eye movements and cranial/orbit bruit. Cerebral angiography demonstrated a direct left CCF and endovascular repair with a 5.0 mm × 19 mm covered stent was planned. Once in the lacerum segment, increased resistance was encountered and the stent was withdrawn resulting in premature deployment. A 3 mm × 9 mm balloon was advanced over an exchange length microwire and through the stent lumen. Once distal to the stent, the balloon was inflated and slowly pulled back in contact with the stent. All devices were successfully withdrawn as a unit. The use of a balloon to retrieve a prematurely deployed balloon mounted stent is a potential rescue option if leaving the stent in situ carries risks.
文摘Previous studies examining coherence and connectivity deviations in schizophrenia patients relied on standard coherence measures between recording sites (at the sensor level). A coherence source imaging (CSI) methodology where coherence is assessed within imaged brain structures (at the source level) was developed recently by our group and applied successfully for detecting coherent areas in the cortical networks of patients with epilepsy. We applied this Magnetoencephalography (MEG)-CSI technique to measure normal and pathological patterns of brain oscillations (biomarkers) in normal subjects and patients diagnosed with schizophrenia. Twelve patients diagnosed with schizophrenia and twelve healthy control subjects were studied. A ten-minute resting state MEG brain scan was performed with eyes open. MEG-CSI analysis was performed to identify the cortical areas that interacted strongly within the 3 - 50 Hz frequency range. Statistically significant increased regions of coherence were detected in schizophrenia patients compared to controls in the right inferior frontal gyrus (BA 47—pars orbitalis), left superior frontal gyrus (BA9— dorsolateral prefrontal cortex), right middle frontal gyrus (BA 10—anterior prefrontal cortex & BA 46—dorsolateral prefrontal cortex), and right cingulate gyrus (BA 24—ventral anterior cingulate cortex). These areas are involved in language, memory, decision making, empathy, executive and, higher cognitive functioning. We conclude that MEG-CSI can detect imaging biomarkers from resting state brain activity in schizophrenia patients that deviates from normal control subjects in several behaviorally salient brain regions. Analysis with MEG-CSI can provide biomarkers of abnormalities in the resting-state. The findings and procedures described can be used to probe the pathophysiology of schizophrenia and possibly detect subtypes.
基金funding from the program Investissements d'avenir ANR-10-IAIHU-06
文摘1.The complex spectrum of neurodegenerative diseases Epidemiologic data indicate that neurodegenerative diseases(NDDs)show high prevalence with a trend of a progressively growing incidence,especially in aging societies.This presents an increasing social and economic burden.
基金funded by Beijing Municipal Natural Science Foundation[grant number:7202150].
文摘Glioblastoma accounts for almost half of all intracranial primary malignancies and has the worst prognosis.Because of its high malignancy and frequent recurrence after standard therapy,it is of great signifcance to explore new therapy options.Recently immune therapy has taken remarkable progress in a variety of tumors,among which peptide vaccines utilize peptide sequences based on tumor-specifc antigens or tumor-associated antigen targets to activate selfimmune response against tumor cells.However,due to the particularity of intracranial central nervous system tumors,the application of peptide vaccines in glioblastoma still faces challenges.This article mainly reviews the immune basis and important clinical trial results of peptide vaccine therapy for GBM,analyzes the reasons for its poor efcacy,and proposes the development direction of peptide vaccines for the unique challenges of immunotherapy in GBM.An in-depth understanding and elaboration of the application and related issues of peptide vaccine in the treatment of GBM will help to formulate relevant treatment strategies in future clinical and basic research.
文摘Background:Promising results from previous studies using cell therapy have paved the way for an innovative treatment option for amyotrophic lateral sclerosis(ALS).There is considerable evidence of immune and inflammatory abnormalities in ALS.Bone marrow mononuclear cells(BMMNCs)possess immunomodulatory properties and could contribute to slowing of disease progression.Objective:Aim of our study was to evaluate the long-term effect of autologous BMMNCs combined with standard treatment on survival duration in a large population and to evaluate effect of type of onset and hormonal status on survival duration in the intervention group.Methods:This controlled,retrospective study spanned over 10 years,5 months;included 216 patients with probable or definite ALS,150 in intervention group receiving autologous BMMNCs and standard treatment,and 66 in control group receiving only standard treatment.The estimated survival duration of control group and intervention group was computed and compared using Kaplan Meier analysis.Survival duration of patients with different types of onset and hormonal status was compared within the intervention group.Results:None of the patients reported any major adverse events related to cell administration or the procedure.Kaplan Meier analysis estimated survival duration in the intervention group to be 91.7 months while 49.7 months in the control group(p=0.008).Within the intervention group,estimated survival was significantly higher(p=0.013)in patients with limb onset(102.3 months)vs.bulbar onset(49.9 months);premenopausal women(93.1 months)vs.postmenopausal women(57.6 months)(p=0.002);and preandropausal men(153.7 months)vs.postandropausal males(56.5 months)(p=0.006).Conclusion:Cell therapy using autologous BMMNCs along with standard treatment offers a promising and safe option for ALS with the potential of long term beneficial effect and increased survival.Limb onset patients,premenopausal women and men≤40 years of age demonstrated better treatment efficacy.
