Stress hyperglycemia indexes and early neurological deterioration in spontaneous intracerebral hemorrhage

AIM

To evaluate the relationship of early neurological deterioration (END) with admission glycemia (aG) and new stress hyperglycemia indexes in spontaneous intracerebral hemorrhage (ICH) patients.

METHODS

The present retrospective study included 171 ICH patients from two stroke centers. END was defined as an increase ≥ 4 points in National Institutes of Health Stroke Scale and/or a decrease ≥ 2 points in Glasgow Coma Scale within 72 hours from admission. The included stress hyperglycemia indexes were glycemic gap (GGAP), stress hyperglycemia ratio (SHR), and glucose-glycated hemoglobin ratio. GGAP was calculated as aG - 28,7*glycated hemoglobin + 46,7; SHR as aG / (28,7*glycated hemoglobin - 46,7); Glucose-glycated hemoglobin ratio as aG / glycated hemoglobin. We performed univariate and multivariate analyses for END. The receiver operating characteristic curves were built for END-related glycemic measures; area under curves (AUC) were calculated and compared. The optimized threshold values were calculated, and significant glycemic measures were dichotomized. Univariate and multivariate analyses were performed for the dichotomized measures.

RESULTS

END was present in 21 patients (12.3%) and was significantly associated with GGAP, SHR and glucose-glycated hemoglobin ratio, but not with aG. The AUC of the three stress hyperglycemia indexes did not differ significantly. The optimized cutoffs were 35.68 (sensitivity 0.47, specificity 0.81), 1.15 (sensitivity 0.62, specificity 0.68), and 26.67(sensitivity 0.43, specificity 0.80) for GGAP, SHR, and glucose-glycated hemoglobin ratio respectively. END was also associated with all stress hyperglycemia indexes expressed as categorical variables.

CONCLUSION

GGAP, SHR, and glucose-glycated hemoglobin ratio were predictors of END in ICH patients.

Refined qingkailing attenuates reactive astrocytes and glial scar formation after ischemia stroke via the EGFR/PLCγ pathway

BACKGROUND

Ischemic stroke (IS) is the main cause of disability worldwide, and glial scar can impair neurological recovery during the post-stroke period. Refined qingkailing (RQKL) has been demonstrated to be neuroprotective after IS.

PURPOSE

The purpose of our study was to investigate the effect of RQKL on glial scar after IS.

METHODS

In this work, rats were used as the model subjects for middle cerebral artery occlusion (MCAO), with 7 and 14 days serving as the critical observational intervals. The treatments of oxygen and glucose deprivation/reoxygenation (OGD/R) were applied to primary astrocytes and an astrocyte-neuron co-culture model.

RESULTS

RQKL was effective in improving neurological dysfunction, brain histopathologic manifestations, and reducing the degree of brain atrophy at different stages of glial scar. It also decreased the expression of glial fibrillary acidic protein (GFAP), neurocan, and brevican, and increased the expression of microtubule associated protein 2 (MAP2). In primary astrocyte culture, RQKL reduced the activation and proliferation of astrocytes. In an astrocyte and neuron co-culture model, RQKL decreased the expression of GFAP and brevican in astrocytes, and increased the expression of MAP2 and NF200 in neurons. Epidermal growth factor receptor (EGFR) and p-PLCγ expression was strongly increased following IS, according to both in vivo and in vitro tests, while RQKL decreased EGFR and p-PLCγ expression.

CONCLUSION

When considered collectively, these findings imply that the EGFR/PLCγ signaling pathway is crucial for the activation of astrocytes and the formation of glial scars following IS. Also, RQKL affects neurons by blocking the EGFR/PLCγ signaling pathway on astrocytes, which diminishes the activation of astrocytes and the development of glial scars.

Unraveling Neurodevelopment: Synergistic Effects of Intrinsic Genetic Programs and Extrinsic Environmental Cues

The development of the brain involves the proliferation of neural stem cells (NSCs) and the differentiation of neurogenic cells, including neurons, astrocytes, and oligodendrocytes. The growth and development of other cells in the brain, including microglia and blood vessels, are also crucial for maintaining normal brain function. In the first part, the intrinsic regulatory mechanisms of NSCs during neurogenesis are primarily delved into. This focused on the effects of epigenetic modifications on the proliferation and differentiation of NSCs. Additionally, the phenomenon where their own proliferative behavior leads to the activation of immune-related genes are discussed. Furthermore, the impact of maternal immune activation on neurogenesis are explored. Finally, the reasons underlying differences in brain development between humans and mice are examined. In the second part, the development and origin of microglia, their heterogeneity during the developmental process, and the impact of microglia on the development of surrounding cells are delved into. In the third part, the relationship between the cerebrovascular system and brain development are explored. This includes the communication and interaction between blood vessels and NSCs, as well as the effects of cytokines secreted by blood vessels on synapses and the genesis of glial cells.

Effect of metabolic disorders on reactive gliosis and glial scarring at the early subacute phase of stroke in a mouse model of diabetes and obesity

It is well recognized that type II Diabetes (T2D) and overweight/obesity are established risk factors for stroke, worsening also their consequences. However, the underlying mechanisms by which these disorders aggravate outcomes are not yet clear limiting the therapeutic opportunities. To fill this gap, we characterized, for the first time, the effects of T2D and obesity on the brain repair mechanisms occurring 7 days after stroke, notably glial scarring. In the present study, by performing a 30-minute middle cerebral artery occlusion (MCAO) on db/db (obese diabetics mice) and db/+ (controls) mice, we demonstrated that obese and diabetic mice displayed larger lesions (i.e. increased infarct volume, ischemic core, apoptotic cell number) and worsened neurological outcomes compared to their control littermates. We then investigated the formation of the glial scar in control and db/db mice 7 days post-stroke. Our observations argue in favor of a stronger and more persistent activation of astrocytes and microglia in db/db mice. Furthermore, an increased deposition of extracellular matrix (ECM) was observed in db/db vs control mice (i.e. chondroitin sulfate proteoglycan and collagen type IV). Consequently, we demonstrated for the first time that the db/db status is associated with increased astrocytic and microglial activation 7 days after stroke and resulted in higher deposition of ECM within the damaged area. Interestingly, the injury-induced neurogenesis appeared stronger in db/db as shown by the labeling of migrating neuroblast. This increase appeared correlated to the larger size of lesion. It nevertheless raises the question of the functional integration of the new neurons in db/db mice given the observed dense ECM, known to be repulsive for neuronal migration. Carefully limiting glial scar formation after stroke represents a promising area of research for reducing neuronal loss and limiting disability in diabetic/obese patients.

Impact of galanin receptors 2 and 3 double-knockout on neuroinflammation and functional recovery following traumatic brain injury

Traumatic brain injury (TBI) is one of the world's leading causes of death and disability in young individuals and the mechanism underlying TBI-associated neuroinflammation is poorly understood. The regulatory neuropeptide galanin (GAL) and its three receptors (GAL1-3R) are assumed to modulate the neuroinflammatory response following TBI, especially by signalling via GAL2R and GAL3R. Therefore, the role of GALRs in acute neuroinflammation and functional recovery following moderate Controlled Cortical Impact TBI was studied using GAL2/3R-double-KO (GAL2/3R-KO) mice. Brains and cerebrospinal fluid (CSF) were collected at day 1 and 30 days post TBI. Functional recovery post TBI was assessed by the modified Neurological Severity Score (mNSS), Elevated Plus Maze (EPM) and Morris Water Maze (MWM) test. Post TBI (day 1 to 28 post injury), neurological dysfunction was more severe in GAL2/3R-KO mice than in WT mice. At 1 day post TBI, inflammatory markers and several nerve growth factors significantly increased in the ipsilateral hemisphere, compared to the contralateral hemisphere in both GAL2/3R-KO and WT mice. At 4 days post surgery, TBI mice entered significantly more frequent the open-arms in the EPM compared to Sham-operated mice, suggestive of increased exploratory behaviour in TBI mice. At 30 days post TBI, immunostaining of brain sections revealed significant differences in vascularisation and glial scarring in the cortex when comparing TBI and Sham-operated mice, but genotypes were similar. In summary, the results indicate that GAL2R and/or GAL3R have a neuroprotective role following moderate TBI, as the severity was significantly lower in their presence than in their absence.

Improved drowsiness detection in drivers through optimum pairing of EEG features using an optimal EEG channel comparable to a multichannel EEG system

Multichannel electroencephalography (EEG)-based drowsiness detection (DD) offers higher coverage but comes with increased computational demands, hardware requirements, and user discomfort, whereas single-channel devices are cost-effective and user-friendly but provide lower coverage. We hypothesized that an optimal channel with optimum paired EEG features could achieve coverage comparable to a multichannel system. Subject-specific, EEG-feature-specific thresholding techniques were introduced to classify 927 EEG epochs, derived from visual-based scoring through image processing of fifty drivers' facial expressions during a 50-min driving simulation, using six individual EEG channels with paired features. Ten normalized EEG features were extracted per epoch using discrete wavelet transform (DWT), and seven thresholding techniques were applied to identify the most consistent method across subjects. Epochs were classified as drowsy or wakeful based on whether their normalized values exceeded or fell below a specific threshold. We then assessed the coverage of each channel by comparing EEG patterns with visual-based scoring. To determine the optimal feature pair for classifying each epoch in alignment with visual-based scoring, 45 feature combinations were evaluated. The pairing of power spectral density (PSD) alpha and PSD theta in channels Frontal4 (F4) and Occipital2 (O2) yielded the highest coverage, achieving 96.1% and 95% with corresponding accuracies of 95.4% and 94.7%, respectively. These results slightly surpassed the coverage achieved using six channels with a single feature, with increases of 1.47% for F4 and 0.32% for O2. Our study demonstrates that an optimal EEG channel with optimum paired EEG features can reduce channels from six to one, lowering computational demands for wearable DD devices.

Minimally Invasive Percutaneous Techniques for the Treatment of Cervical Disc Herniation: A Systematic Review and Meta-Analysis

Background: In recent decades, the adoption of minimally invasive (non-endoscopic) cervical techniques has grown significantly. Advancements in surgical instrumentation have broadened the spectrum of available percutaneous interventions, thus providing viable alternative treatment options for patients with prolonged, conservative treatment-resistant ailments due to contained cervical disc herniation. The aim of this study was to perform a systematic review and meta-analysis in order to evaluate the effectiveness and safety of minimally invasive percutaneous (non-endoscopic) cervical techniques. Methods: A comprehensive literature search was conducted using the PubMed, Cochrane Library, and SCOPUS databases up to July 2024, in accordance with the PRISMA guidelines. Outcomes measured included Visual Analogue Scale (VAS) scores, the Neck Disability Index (NDI), and MacNab scores, assessing pain relief and functional recovery. The risk of bias was evaluated using the Cochrane risk of bias tool (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) tool, with statistical analyses conducted in R software (version 4.3.1). Results: Out of 847 records, 21 studies (covering 1580 patients) were included in the final analysis. Five different percutaneous minimally invasive cervical procedures were incorporated into this review: nucleoplasty (n = 973), discectomy (n = 311), a combination of nucleoplasty and discectomy (n = 98), annuloplasty (n = 33), and pulsed radiofrequency (n = 17). The mean patient age was 49.5, with a gender distribution of 47.7% male and 52.3% female. A meta-analysis of six studies on cervical nucleoplasty (400 patients) demonstrated a significant reduction in pain scores, with a standardized mean difference (SMD) of -4.68 (95% CI: -8.77; -0.59, p = 0.032). However, a high heterogeneity (I2 = 98.8%, Q = 407.31, p < 0.001) was observed, indicating significant variability across studies. The reoperation rate among patients was 3.4%, with discitis and device-related complications being the most frequently reported adverse events. Conclusions: Minimally invasive percutaneous cervical interventions provide effective pain relief and functional improvement for patients with cervical disc herniation, as evidenced by reductions in VAS scores and positive MacNab outcomes. The choice of the most appropriate technique should be based on individual clinical scenarios, surgeon expertise, and patient preferences, as no single method demonstrates clear superiority according to clinical outcomes or complication rates.

Cerebral complications after unilateral biportal endoscopic surgery: A case report

BACKGROUND

Unilateral biportal endoscopic (UBE) surgery has developed rapidly during the past decade. Continuous epidural space irrigation is generally considered the principal reason for cerebral complications following UBE surgery. We present a case of mental symptoms during the general anesthesia awakening period due to pneumocephalus.

CASE SUMMARY

A 70-year-old woman with lumbar disc herniation underwent UBE surgery stably under general anesthesia. Uncontrollable hypertension occurred immediately after transfer to the postoperative care unit, accompanied by increased heart rate and tachypnea. During the recovery process, the patient responded to external stimuli but was confused and unable to complete command actions. Neck stiffness and significantly increased muscle strength on the left side indicated the presence of de-cerebrate rigidity. An urgent brain computed tomography scan showed pneumocephalus compressing the brainstem. After receiving analgesia and sedation treatment, the patient was conscious three hours later and recovered rapidly. She was discharged on the fifth postoperative day and followed up for 3 months with no surgical or brain complications.

CONCLUSION

Cerebral complications emerging during the general anesthesia awakening period following UBE surgery are not entirely due to increased intracranial pressure. Pneumocephalus induced by dural injury may also be a potential cause.

Chondroitinase ABC combined with Schwann cell transplantation enhances restoration of neural connection and functional recovery following acute and chronic spinal cord injury

JOURNAL/nrgr/04.03/01300535-202505000-00029/figure1/v/2024-07-28T173839Z/r/image-tiff Schwann cell transplantation is considered one of the most promising cell-based therapy to repair injured spinal cord due to its unique growth-promoting and myelin-forming properties. A the Food and Drug Administration-approved Phase I clinical trial has been conducted to evaluate the safety of transplanted human autologous Schwann cells to treat patients with spinal cord injury. A major challenge for Schwann cell transplantation is that grafted Schwann cells are confined within the lesion cavity, and they do not migrate into the host environment due to the inhibitory barrier formed by injury-induced glial scar, thus limiting axonal reentry into the host spinal cord. Here we introduce a combinatorial strategy by suppressing the inhibitory extracellular environment with injection of lentivirus-mediated transfection of chondroitinase ABC gene at the rostral and caudal borders of the lesion site and simultaneously leveraging the repair capacity of transplanted Schwann cells in adult rats following a mid-thoracic contusive spinal cord injury. We report that when the glial scar was degraded by chondroitinase ABC at the rostral and caudal lesion borders, Schwann cells migrated for considerable distances in both rostral and caudal directions. Such Schwann cell migration led to enhanced axonal regrowth, including the serotonergic and dopaminergic axons originating from supraspinal regions, and promoted recovery of locomotor and urinary bladder functions. Importantly, the Schwann cell survival and axonal regrowth persisted up to 6 months after the injury, even when treatment was delayed for 3 months to mimic chronic spinal cord injury. These findings collectively show promising evidence for a combinatorial strategy with chondroitinase ABC and Schwann cells in promoting remodeling and recovery of function following spinal cord injury.

Applications of Artificial Intelligence in Neurosurgery for Improving Outcomes Through Diagnostics, Predictive Tools, and Resident Education

BACKGROUND

Artificial intelligence (AI) has become an increasingly prominent tool in the field of neurosurgery, revolutionizing various aspects of patient care and surgical practices. AI-powered systems can provide real-time feedback to surgeons, enhancing precision and reducing the risk of complications during surgical procedures. The objective of this study is to review the role of AI in training neurosurgical residents, improving accuracy during surgery, and reducing complications.

METHODS

The literature search method involved searching PubMed using relevant keywords to identify English literature publications, including full texts, and concerning human subject matter from its inception until May 2024, initially generating 247,747 results. Articles were then screened for topic relevancy by abstract contents. Further articles were retrieved from the sources cited by the initially reviewed articles. A comprehensive review was then performed on various studies, including observational studies, case-control studies, cohort studies, clinical trials, meta-analyses, and reviews by 4 reviewers individually and then collectively.

RESULTS

Studies on AI in neurosurgery reach more than 4000 produced over a decade alone. The majority of studies regarding clinical diagnosis, risk prediction, and intraoperative guidance remain retrospective in nature. In its current form, AI-based paradigm performed inferiorly to neurosurgery residents in test taking.

CONCLUSIONS

AI has potential for broad applications in neurosurgery from use as a diagnostic, predictive, intraoperative, or educational tool. Further research is warranted for prospective use of AI-based technology for delivery of neurosurgical care.

[Bertolotti syndrome: an often overlooked cause of specific back pain]

BACKGROUND

Lumbosacral transitional vertebrae (LSTV) are common, with a prevalence of 15-35%, and can be a cause of specific low back pain. The insufficient awareness of this anomaly often leads to delayed diagnosis and treatment.

OBJECTIVE

This study explains the anatomical and biomechanical basis of Bertolotti syndrome and discusses diagnostic and therapeutic options.

MATERIALS AND METHODS

This systematic review was conducted in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The SCOPE criteria (Structuring Comparative Outcome Reporting in Epidemiology) were considered to ensure comprehensive and transparent reporting. A systematic search was performed in PubMed using the search terms 'Bertolotti', 'Bertolotti syndrome', and 'Lumbosacral transitional vertebrae' by a single investigator, resulting in the inclusion of 112 studies. Articles that were not available in English or German were excluded.

RESULTS

Patients with symptomatic Bertolotti syndrome often suffer from chronic low back pain and radiculopathies. Imaging techniques, particularly X‑rays and MRI, play a key role in diagnosis. Conservative treatments show limited success. Surgical resection of the transverse process (processectomy), especially after positive test infiltrations, leads to significant pain relief, particularly in younger patients without degenerative changes.

DISCUSSION

Treatment choice depends on individual anatomy and the presence of degenerative changes. While conservative measures are initially recommended, processectomy shows promising results in carefully selected patients. Fusion surgeries should only be considered in cases of instability. Further studies are needed to confirm the effectiveness of invasive procedures.

Study on the safety and efficacy of Fu's subcutaneous needling for the treatment of lumbar disc herniation: a systematic review and meta analysis of randomized controlled trials

Purpose

Systematic evaluation of the effectiveness and safety of Fu's Subcutaneous Needling (FSN) in the treatment of Lumbar Disc Herniation.

Methods

A systematic search was conducted across four Chinese and four English databases, including China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database (VIP), China Biology Medicine (CBM), PubMed, Cochrane Library, Embase, and Web of Science, to collect randomized controlled trials (RCTs) on the use of Fu's subcutaneous needling for the treatment of lumbar disc herniation published before September 1, 2024. The search was conducted in both Chinese and English, with no restrictions on ethnicity. After rigorous screening of the literature, Meta-analysis was performed using Stata 18.0 and RevMan 5.2.1 software. This study protocol has been registered with the PROSPERO International Prospective Register of Systematic Reviews, with a registration number CRD42024595890.

Results

A total of 17 studies involving 1,467 patients were included. The Meta-analysis results indicated that Fu's subcutaneous needling for lumbar disc herniation was more effective than the control group, with a statistically significant difference. The overall effective rate was: OR = 2.77, 95% CI (1.90, 4.03), Z = 5.31, P < 0.00001. The VAS score was: MD = -1.12,95% CI (-1.35,-0.89),Z = 9.57,P < 0.00001. JOA scores was MD = 4.52, 95% CI (1.83, 7.2), Z = 3.29, P = 0.001.ODI scores with MD = -6.75, 95% CI (-8.42, -5.08), Z = 7.91, P < 0.00001. SF-36 with MD = 8.51, 95% CI (3.64, 13.38), Z = 3.42, P < 0.0006.

Conclusion

FSN has certain advantages and more safety in the treatment of LDH. However, due to the publication bias, the strength of the evidence is insufficient. High-quality, large-sample, multi-center randomized controlled trials are still needed for further research.

Systematic review registration

The protocol for this systematic review was registered on PROSPERO and is available in full on the website (https://www.crd.york.ac.uk/PROSPERO, CRD42024595890).

Hybrid conducting polymer films promote neural outgrowth and neural-electrode integration in vitro

The increase incidence of neurological disorders arising from an aging population has accelerated research into electrical medicine approaches as promising pretreatments options. Achieving chronic therapeutic electrical stimulation is dependent on an optimal charge delivery capacity of a stimulating device. In particular, instability at the electrode-tissue interface is frequently derived from a physicomechanical mismatch in the mechanical properties of the rigid, smooth surface of metallic electrodes and the soft nature of neural tissues, leading to perielectrode scarring, a subsequent reduction in charge transfer capability and decreased stimulation efficacy. This study explores the modification of neural electrodes using electroactive materials to enhance their performance. Specifically, applying sequentially two different conducting polymers, namely polyaniline and poly(3,4-ethylenedioxythiophene), which induced a significant increase in the active surface area of an electrode, moderate hydrophilicity (49 ± 7o), capacitance (19.9 mC/cm2), low impedance (165 ± 6 Ω at 1 kHz), and a fibrillar morphology. Cell culture studies with rat-derived embryonic ventral mesencephalon cells revealed that hybrid conducting polymer coatings supported neural outgrowth and cell adhesion in vitro.

Dysregulated interleukin networks drive immune heterogeneity in Alzheimer's disease: an immunogenomic approach to subgroup classification and predictive modeling

BACKGROUND

Alzheimer's Disease (AD) is marked by intricate immunological alterations, including the dysregulation of interleukin signaling. This study investigates the differential expression and potential roles of interleukins and their receptors in AD patients.

METHODS

We analyzed the GSE48350 dataset to assess the single-sample Gene Set Enrichment Analysis (ssGSEA) scores for interleukins and their receptors between normal and AD groups. Differentially expressed interleukin-related genes (DIGs) were identified. Enrichment analysis was conducted to understand functional implications. LASSO and logistic regression were used to identify key interleukin genes, which were employed to construct a predictive nomogram. This model was validated using the GSE132903 dataset. Unsupervised clustering and immune cell infiltration analyses were performed to examine AD patient heterogeneity.

RESULTS

The ssGSEA scores indicated significantly elevated interleukin and receptor levels in AD patients. A total of 23 DIGs were discovered, and the enrichment analysis emphasized their participation in immune signaling pathways. The nomogram based on key interleukin genes demonstrated strong predictive capability, with an AUC of 0.882 in the training set and 0.837 in the validation set. Unsupervised clustering revealed two AD subgroups with distinct immune profiles and pathway activities. Subgroup C2 exhibited higher immune cell infiltration and pathway activity than subgroup C1.

CONCLUSION

Interleukins and their receptors are significantly upregulated in AD patients, with distinct immune profiles identified in AD subgroups. The predictive nomogram effectively stratifies AD patients based on interleukin gene expression. These findings provide insights into AD's immunological landscape and suggest potential biomarkers for personalized therapeutic strategies.

Oral pharmacological management of Bertolotti syndrome presenting as chronic low back pain - A case report and review of literature

Background

Bertolotti syndrome (BS) is often a missed cause of chronic lower back pain in young individuals, commonly associated with the presence of anomalous lumbosacral transitional vertebrae.

Case presentation

A 19-year-old female with no significant medical or family history presented with persistent lower back pain localized to the gluteal region and posterolateral aspect of the left lower back. The pain worsened over time and limited their movements, including walking. A Ferguson radiograph revealed fusion of the left transverse process of the L5 vertebral segment with the left sacral ala. History, examination findings, and radiological workup confirmed the diagnosis of BS. The patient preferred conservative management, receiving oral pharmacological therapy for six weeks, along with education on preventive measures and routine exercises for postural stability. At a six-month follow-up, the patient remained asymptomatic and managed well.

Conclusions

Conservative oral pharmacological treatment presents a unique and viable alternative to traditional methods for managing BS, which often involve surgery or steroids/anesthetics at the pseudo-articulation site. Given that BS is common yet underdiagnosed in young patients with chronic back pain, this report also underscores the importance of including it in differential diagnoses for chronic lower back pain in this demographic.

BATF2 is a regulator of interferon-γ signaling in astrocytes during neuroinflammation

Astrocytic interferon (IFN)γ signaling is associated with reduced neuroinflammation; however, downstream effectors responsible for regulating this protection are unknown. Here, we identify an IFN-specific transcription factor, basic leucine zipper ATF-like transcription factor (BATF)2, that plays a key role in modulating the consequences of IFNγ signaling in astrocytes. Chromatin immunoprecipitation sequencing revealed that BATF2 binds and prevents the overexpression of IFN regulatory factor (IRF)1 and IRF1 targets such as caspase-1. We also show that Batf2-/- mice exhibit exacerbated clinical disease severity in a murine model of central nervous system autoimmunity and express increased astrocyte-specific IRF1 and caspase-1, suggesting an amplified IFN response in vivo. Additionally, we demonstrate that BATF2 is expressed primarily in astrocytes within multiple sclerosis lesions and that this expression is colocalized with IRF1. Collectively, our results further support evidence of protective functions for IFNγ and implicate BATF2 as a key suppressor of overactive immune signaling in astrocytes during neuroinflammation.

Infarct Growth Rate Predicts Early Neurological Improvement in Ischemic Stroke After Endovascular Thrombectomy

BACKGROUND AND PURPOSE

The infarct growth rate (IGR) is a major modifier of the therapeutic effect of endovascular thrombectomy. The objective of this paper was to explore the utility of the IGR measured by perfusion the imaging in predicting early neurological improvement (ENI) of patients treated with EVT.

METHODS

We reviewed consecutive large vessel occlusive stroke in the anterior circulation and treated by thrombectomy between October 2019 to July 2024. The IGR was defined as the ischemic core volume (apparent diffusion coefficient ≤ 620 × 10-6 mm2/s or relative cerebral blood flow < 30%) divided by the time from stroke onset to imaging. ENI was defined as a reduction ≥ 6 points in the NIH Stroke Scale score at 24 h after the procedure, or an NIH Stroke Scale score of 0 or 1 on day 7 of hospitalization or at discharge if it occurred before day 7.

RESULTS

A total of 407 patients (mean age, 69.3 ± 12.5 years; 63.1% of male) were included, of whom 149 (36.6%) achieved ENI. Among all enrolled patients, 281 patients were classified as slow (IGR < 10 mL/h) and 126 fast progressors (IGR ≥ 10 mL/h). In multivariable analyses, fast progressors had a lower likelihood of achieving ENI after endovascular thrombectomy (odds ratio, 0.442; 95% confidence intervals, 0.269-0.729, p = 0.001) as compared to slow progressors. Subgroup analyses further confirmed these results. Furthermore, the odds of ENI decreased by 7.3% for each 5 mL/h increase in the IGR (odds ratio, 0.927; 95% confidence intervals, 0.875-0.982, p = 0.011).

CONCLUSIONS

The present study found that the pre-treatment IGR was associated with ENI in thrombectomy patients.

Modulation of sweet preference by neurosteroid-sensitive, δ-GABAA receptors in adult mouse gustatory insular cortex

Taste preference is a fundamental driver of feeding behavior, influencing dietary choices and eating patterns. Extensive experimental evidence indicates that the gustatory cortex (GC) is engaged in taste perception, palatability, and preference. However, our knowledge of the neural and neurochemical signals regulating taste preference is limited. Neuromodulators can affect preferences, though their effects on neural circuits for taste are incompletely understood. Neurosteroids are of particular interest, as systemic administration of the neurosteroid allopregnanolone (ALLO), a positive allosteric modulator of extrasynaptic GABAA receptors containing the delta subunit (δ-GABAARs), induces hyperphagia and increases intake of energy-rich food in humans and animals. The δ-GABAARs receptors produce a tonic inhibitory current and are widely distributed in the brain. However, information regarding their expression within gustatory circuits is lacking, and their role in taste preference has not been investigated. Here, we focused on GC to investigate whether activation of δ-GABAARs affects sweet taste preference in adult mice. Our data reveal that δ-GABAARs are expressed in multiple cell types within GC, mediate an ALLO-sensitive tonic current, decrease the behavioral sensitivity to sucrose, and reduce the preference for sweet taste in a cell-type-specific manner. Our findings demonstrate a fundamental role for δ-GABAAR-mediated currents within GC in regulating taste sensitivity and preference in the adult mammalian brain.

Pharmacological interventions for the acute treatment of hyperkalaemia: A systematic review and meta-analysis

BACKGROUND

Hyperkalaemia is a life-threatening electrolyte disturbance and also a potential cause of cardiac arrest. The objective was to assess the effects of acute pharmacological interventions for the treatment of hyperkalaemia in patients with and without cardiac arrest.

METHODS

The review was reported according to PRISMA guidelines and registered on PROSPERO (CRD42023440553). We searched OVID Medline, EMBASE, and CENTRAL on September 9, 2024 for randomized trials, non-randomized trials, observational studies, and experimental animal studies. Two investigators performed abstract screening, full-text review, data extraction, and bias assessment. Outcomes included potassium levels, ECG findings, and clinical outcomes. Certainty of evidence was evaluated using GRADE.

RESULTS

A total of 101 studies were included, with two studies including patients with cardiac arrest. In meta-analyses including adult patients without cardiac arrest, treated with insulin in combination with glucose, inhaled salbutamol, intravenous salbutamol dissolved in glucose, or a combination, the average reduction in potassium was between 0.7 and 1.2 mmol/l (very low to low certainty of evidence). The use of bicarbonate had no effect on potassium levels (very low certainty of evidence). In neonatal and paediatric populations, inhaled salbutamol and intravenous salbutamol reduced the average potassium between 0.9 and 1.0 mmol/l (very low to low certainty of evidence). There was no evidence to support a clinical beneficial effect of calcium for treatment of hyperkalemia.

CONCLUSIONS

Evidence supports treatment with insulin in combination with glucose, inhaled or intravenous sal-butamol, or the combination. No evidence supporting a clinical effect of calcium or bicarbonate for hyperkalaemia was identified.

Low-grade gliomas presenting with hemorrhage: Are intratumoral blood products associated with malignant transformation?

OBJECTIVE

Gliomas are the most common primary tumor in the central nervous system (CNS), with low-grade gliomas (LGG) comprising more than 5 percent of all adult primary CNS tumors. While glioblastoma, the most malignant glioma subtype, is known to present with hemorrhage, LGGs rarely present with hemorrhage. This systematic review investigates LGGs that present as hemorrhage and provides an illustrative case presentation in order to evaluate trends and outcomes for this pathology.

METHODS

A systematic review of the literature was performed to evaluate presentation, treatment, and outcomes for patients with LGG that present as intracranial hemorrhage. Articles included were case series describing surgical approach; literature reviews were excluded. Variables evaluated included presenting symptoms, imaging results, and postoperative outcomes.

RESULTS

The initial screen yielded 1373 articles. Fourteen articles, published between 1977 and 2023, met inclusion criteria. Sixteen (16) patients were identified with LGG that presented initially as hemorrhage. The most common tumors were pilocytic astrocytoma (6/16), subependymoma (4/16), and ependymoma (2/16). The most common presenting symptoms were headaches (9/11) and impaired consciousness (9/11). Eleven patients underwent gross total resection of the tumor, while four patients received partial resection. Outcomes included two mortalities and one recurrence after six months; the thirteen remaining patients had no recurrence at final reported follow-up.

CONCLUSION

LGGs presenting with hemorrhage are associated with more severe initial symptoms. Though very uncommon, it is imperative to recognize the possibility of an underlying low-grade neoplasm in the setting of hemorrhage. Such early identification can lead to expeditious surgical intervention which can alleviate symptoms, lead to diagnosis, and ultimately trigger adjuvant treatment that has the potential to prolong survival. Continued research on the underlying pathophysiology of these hemorrhagic low-grade tumors is needed to further stratify risk in these populations.

Interpretable machine learning to evaluate relationships between DAO/DAOA (pLG72) protein data and features in clinical assessments, functional outcome, and cognitive function in schizophrenia patients

Machine learning has been proposed to utilize D-amino acid oxidase (DAO) and DAO activator (DAOA [or pLG72]) protein levels to ascertain disease status in schizophrenia. However, it remains unclear whether machine learning can effectively evaluate clinical features in relation to DAO and DAOA in schizophrenia patients. We employed an interpretable machine learning (IML) framework including linear regression, least absolute shrinkage and selection operator (Lasso) models, and generalized additive models (GAMs) to analyze DAO/DAOA levels using 380 Taiwanese schizophrenia patients. Additionally, we incorporated 27 parameters encompassing demographic variables, clinical assessments, functional outcomes, and cognitive function as features. The IML framework facilitated linear and non-linear relationships between features and DAO/DAOA. DAO levels demonstrated significant associations with the 17-item Hamilton Depression Rating Scale (HAMD17) based on linear regression. The Lasso model identified four features-HAMD17, age, working memory, and overall cognitive function (OCF)-and highlighted HAMD17 as the most significant feature, using DAO from chronically stable patients. Utilizing DAOA from acutely exacerbated patients, the Lasso model also identified four features-OCF, Scale for the Assessment of Negative Symptoms 20-item, quality of life scale (QLS), and category fluency-and emphasized OCF as the most significant feature. Furthermore, GAMs revealed a non-linear relationship between category fluency and DAO in chronically stable patients, as well as between QLS and DAOA in acutely exacerbated patients. The study suggests that an IML framework holds promise for assessing linear and non-linear relationships between DAO/DAOA and various features in clinical assessments, functional outcomes, and cognitive function in patients with schizophrenia.

Drunk Driver Detection Using Multiple Non-Invasive Biosignals

This study aims to decrease the number of drunk drivers, a significant social problem. Traditional methods to measure alcohol intake include blood alcohol concentration (BAC) and breath alcohol concentration (BrAC) tests. While BAC testing requires blood samples and is impractical, BrAC testing is commonly used in drunk driving enforcement. In this study, the multiple biological signals of electrocardiogram (ECG), photoplethysmogram (PPG), and electrodermal activity (EDA) were collected non-invasively and with minimal driver restraint in a driving simulator. Data were collected from 10 participants for approximately 10 min at BrAC levels of 0.00%, 0.03%, and 0.08%, which align with the latest Korean drunk driving standards. The collected data underwent frequency filtering and were segmented into 30 s intervals with a 10 s overlap to extract heart rate variability (HRV) and pulse arrival time (PAT). Using more than 10 machine learning algorithms, the classification accuracy reached 88%. The results indicate that it is possible to classify a driver's level of intoxication using only non-invasive biological signals within a short period of about 30 s, potentially aiding in the prevention of drunk driving.

Xingnao Jiutan tablets modulate gut microbiota and gut microbiota metabolism to alleviate cerebral ischemia/reperfusion injury

Introduction

Xingnao Jiutan tablets (XNJT), a compound Chinese medicine, have been applied to the treatment of the sequelae of cerebral thrombosis or cerebral hemorrhage, transient cerebral ischemia, and central retinal vein obstruction, etc., but the underlying mechanisms are not yet clear. This research focused on examining the impact of XNJT for cerebral ischemia/reperfusion (MCAO/R) injury, utilizing gut microbiota and metabolomic studies.

Methods

The primary components of XNJT were identified through the application of the HPLC technique. We established a MCAO/ R model in mice and conducted behavioral evaluations, cerebral blood flow measurements, and TTC staining. We used ELISA, high-throughput 16S rDNA gene sequencing, and metabolomics techniques to detect inflammatory factors, microbial populations, and metabolites, respectively. Finally, we performed Spearman correlation analysis to investigate the relationships among gut microbiota and metabolites, comprehensively exploring the mechanisms of XNJT to alleviate cerebral ischemia-reperfusion injury.

Results

We discovered that XNJT effectively enhanced neurological performance, alleviated cerebral infarction, diminished neuronal cell death, and increased cerebral blood flow. Moreover, XNJT downregulated the secretion of pro-inflammatory cytokines like TNF, IL-6, and IL-1b. Additionally, XNJT improved gut microbiota levels in MCAO/R mice, particularly Bacteroides, Firmicutes, Escherichia-Shigella, and Ligilactobacillus. Furthermore, XNJT primarily modulated differential metabolites in the gut through Glycerophospholipid, Linoleic acid, and Sphingolipid metabolism pathways. Spearman correlation analysis revealed significant associations among intestinal microbiota and various metabolites.

Discussion

In summary, our findings suggest that XNJT can improve cerebral ischemia/reperfusion injury outcomes, reduce inflammatory responses, and regulate gut microbiota and differential metabolites. It's possible that the potential mechanisms are connected to controlling gut microbiota and metabolism.

Rare Complications in Endoscopic Spinal Surgery: A Narrative Review of Unique Cases

STUDY DESIGN

Narrative Review.

OBJECTIVES

Endoscopic spine surgery is becoming an increasingly popular approach to treat spinal disease due to its minimally invasive nature. Although certain adverse events are well-reported within the literature, there is a scarcity of information for complications that are rare but still potentially serious. The purpose of this study is to describe these rare complications of endoscopic spine surgery and discuss management and prevention strategies.

METHODS

A search was conducted in PubMed and Embase to review the literature for all adverse events following endoscopic spine surgery, with no restrictions on publication year. Cohort and case report studies describing infrequently reported complications were collected for analysis.

RESULTS

A total of 38 studies were included which described rare complications in 93 patients following endoscopic spine surgery. These included neurological events (seizure, pseudomeningocele, pneumocephalus, upper limb palsy), vascular events (hemorrhage, hematoma, arteriovenous fistula), mechanical events (cage migration, guidewire breakage), and additional events (discal pseudocyst, pulmonary edema, arrhythmia, total spinal anesthesia).

CONCLUSIONS

Endoscopic spine surgery is rapidly evolving and emerging as a popular alternative to conventional approaches. Though regarded as a generally safe form of surgery, it is imperative that surgeons are aware of all complications which may occur, even those that may be infrequently reported in the literature.

Unveiling synergies: Integrating TCM herbal medicine and acupuncture with conventional approaches in stroke management

This review explores the mechanisms and treatment strategies of ischemic stroke, a leading cause of morbidity and mortality worldwide. Ischemic stroke results from the obstruction of blood flow to the brain, leading to significant neurological impairment. The paper categorizes ischemic stroke into subtypes based on etiology, including cardioembolism and large artery atherosclerosis, and discusses the challenges of current therapeutic approaches. Conventional treatments like tissue plasminogen activator (tPA) and surgical interventions are limited by narrow windows and potential complications. The review highlights the promise of acupuncture, which offers neuroprotective benefits by promoting cerebral ischemic tolerance and neural regeneration. Integrating acupuncture with conventional treatments may enhance patient outcomes. Emphasis is placed on understanding the pathophysiology to develop targeted therapies that mitigate neuronal damage and enhance recovery.

C16 peptide and angiopoietin-1 alleviate the side effects of glucocorticoids in a rat multiple sclerosis model

BACKGROUND

Natural glucocorticoids (GCs) have been widely used to treat acute multiple sclerosis (MS) attacks. However, they also cause significant side effects related to immunosuppression. Our previous study found that C16 peptide combined with angiopoietin-1 (Ang-1) inhibited inflammatory cell infiltration and protected blood vessels in animal models of inflammatory neurodegenerative diseases.

METHODS

An acute experimental autoimmune encephalomyelitis model was established in Lewis rats to explore the effects of these drugs on MS. One hundred rats were equally and randomly assigned into five groups: normal control, vehicle, low-dose methylprednisolone (MP), high-dose MP, and C16 + Ang-1 (C+A). Histological examinations, behavioral tests, and high-throughput 16S rRNA gene sequencing were conducted to determine inflammation levels in the central nervous system, neuronal survival, functional recovery and gut microbiota.

RESULTS

The results illustrated that C+A exerted a neuroprotective effect in MS rats, with fewer side effects observed in the C+A group than in the high-dose MP group. The abundance of Campylobacter was increased in vehicle-treated rats, indicating an imbalance of the gut microbiota after MS. The abundance of probiotic Lactobacillus plantarum was increased in the C+A group. Low-dose MP failed to reverse the gut microbiota imbalance, whereas both the C+A and high-dose MP groups exhibited gut microbiota profiles more similar to those of the normal controls, with C+A displaying superior efficacy.

CONCLUSIONS

C16 plus Ang-1 might serve as a complement to GCs for the treatment of MS. Changes in the abundance of Campylobacter and L. plantarum suggest their essential roles in the pathogenesis of MS.

Prevention and management of degenerative lumbar spine disorders through artificial intelligence-based decision support systems: a systematic review

BACKGROUND

Low back pain is the leading cause of disability worldwide with a significant socioeconomic burden; artificial intelligence (AI) has proved to have a great potential in supporting clinical decisions at each stage of the healthcare process. In this article, we have systematically reviewed the available literature on the applications of AI-based Decision Support Systems (DSS) in the clinical prevention and management of Low Back Pain (LBP) due to lumbar degenerative spine disorders.

METHODS

A systematic review of Pubmed and Scopus databases was performed according to the PRISMA statement. Studies reporting the application of DSS to support the prevention and/or management of LBP due to lumbar degenerative diseases were included. The QUADAS-2 tool was utilized to assess the risk of bias in the included studies. The area under the curve (AUC) and accuracy were assessed for each study.

RESULTS

Twenty five articles met the inclusion criteria. Several different machine learning and deep learning algorithms were employed, and their predictive ability on clinical, demographic, psychosocial, and imaging data was assessed. The included studies mainly encompassed three tasks: clinical score definition, clinical assessment, and eligibility prediction and reached AUC scores of 0.93, 0.99 and 0.95, respectively.

CONCLUSIONS

AI-based DSS applications showed a high degree of accuracy in performing a wide set of different tasks. These findings lay the foundation for further research to improve the current understanding and encourage wider adoption of AI in clinical decision-making.

Stress-Induced Hyperglycemia Predicts Poor Outcomes in Primary Intracerebral Hemorrhage Patients

INTRODUCTION

The current literature suggests hyperglycemia can predict poor outcomes in patients with primary intracerebral hemorrhage (ICH). Chronic hyperglycemia is seen in patients with pre-existing diabetes (DM); however, acute hyperglycemia in non-diabetic patients is defined as stress-induced hyperglycemia (SIH). This study explored the influence of hyperglycemia on outcomes of primary ICH patients both in the presence and absence of pre-existing DM.

METHODS

Data regarding admission glucose, pre-existing DM, inpatient mortality, and modified Rankin Scale (mRS) scores at discharge were available for 636 patients admitted to Stony Brook Hospital from January 2011 to December 2022 with a primary diagnosis of ICH. Regression models were used to compare outcomes between patients with admission hyperglycemia and/or pre-existing DM to a control group of normoglycemic and non-diabetic ICH patients.

RESULTS

Patients with SIH had higher inpatient mortality rates and worse mRS scores at discharge (p < 0.001). An association with higher mortality and worse mRS scores at discharge was also seen in patients with hyperglycemia secondary to DM, although the strength of this association was weaker when compared to patients with SIH.

CONCLUSIONS

Our findings suggest that SIH may play a greater role in predicting poor outcomes at discharge rather than a history of poorly controlled DM with chronic hyperglycemia. To develop a more thorough understanding of this topic, prospective studies evaluating the effect of changes in serum glucose during hospital stay on short and long-term outcomes is needed.

A Novel Missense Variant in SORBS2 Is Causative With Familial Alzheimer's Disease

BACKGROUND

Alzheimer's disease (AD) is a common neurodegenerative disorder with a substantial genetic component. Despite advances in elucidating the genetic underpinnings of AD, much of its heritability remains unexplained. Discovering novel genetic variants and understanding their pathogenic roles are crucial challenges in AD research.

OBJECTIVE

This study aimed to identify pathogenic genes and elucidate their role in familial early-onset AD (EOAD).

METHODS

Blood samples from an EOAD pedigree and Sorbin and SH3 Domain-Containing Protein 2 (SORBS2) T189M transgenic mice were analyzed. Cognitive function was assessed via the Morris water maze (MWM). Protein expression was evaluated by western blotting, while amyloid-β (Aβ) levels were quantified via immunohistochemistry and enzyme-linked immunosorbent assay. Inflammatory markers were measured using immunofluorescence and quantitative reverse transcription polymerase chain reaction (PCR). Neuronal morphology, including dendritic and spine alterations, was examined using Golgi staining.

RESULTS

We identified a novel SORBS2 variant (c. 566C>T, p. T189M) in a Han Chinese family, segregating with AD in a Mendelian fashion. SORBS2 T189M transgenic mice exhibited cognitive deficits, cortical Aβ accumulation, and an increased Aβ42/Aβ40 ratio. Additionally, elevated levels of interleukin (IL)-1β, IL-6, tumor necrosis factor α (TNF-α), and ionized calcium-binding adaptor molecule 1 (Iba1)-positive microglia, along with neuronal loss, were observed in the brains of T189M mice.

CONCLUSION

Our study suggest that the SORBS2 T189M variant is a novel candidate causal mutation associated with familial AD in a Chinese pedigree, contributing to AD pathogenesis by promoting neuroinflammation and neuronal injury. Notably, this study is the first to establish a link between SORBS2 mutations and AD.

Exploring the Therapeutic Potential of Glycyrrhiza Compounds in Alzheimer's Disease: A Comprehensive Review

Alzheimer's disease (AD) is a progressive neurodegenerative disorder. Research shows that the development of AD is linked to neuroinflammation, endoplasmic reticulum stress, mitochondrial dysfunction, cell death, and abnormal cholinergic signaling. Glycyrrhiza compounds contain active ingredients and extracts that offer multiple benefits, including targeting various pathways, high efficacy with low toxicity, and long-lasting therapeutic effects. These benefits highlight the significant potential of Glycyrrhiza compounds for preventing and treating AD. This review summarizes recent advancements in Glycyrrhiza compounds for preventing and treating AD. It focuses on their inhibitory effects on key signaling pathways, such as Toll-like receptor 4 (TLR4), nuclear factor-κB (NF-κB), mitogen-activated protein kinase (MAPK), and cholinergic signaling. This study aims to establish a scientific framework for using Glycyrrhiza compounds in the clinical prevention and treatment of AD and to support the development of new therapeutic interventions.

The contribution of cerebral small vessel disease in idiopathic normal pressure hydrocephalus: Insights from a prospective cohort study

INTRODUCTION

Idiopathic normal pressure hydrocephalus (iNPH) and cerebral small vessel disease (CVSD) are age-related diseases, but their prevalence and clinical relationship are unclear.

METHODS

This prospective cohort study enrolled 95 patients with probable iNPH in China and evaluated their CSVD burden using magnetic resonance imaging. Linear regression models were used to analyze the association between CSVD scores and clinical outcomes.

RESULTS

The results showed 78% of the patients had at least one CSVD imaging marker, and higher total CSVD scores were significantly associated with declines in attention, executive function, psychomotor speed, and gait performance after multivariate adjustments. However, the preoperative CSVD score did not affect the post-shunt improvement in modified Rankin scale or iNPH grading scale scores.

DISCUSSION

Our findings suggest that CSVD is prevalent in patients with iNPH and is associated with more severe symptoms, but it may not affect shunt outcomes. Future studies are needed to elucidate the underlying mechanisms.

HIGHLIGHTS

We found that 78% of the patients with idiopathic normal pressure hydrocephalus (iNPH) had at least one type of cerebral small vessel disease (CSVD) imaging marker. The CSVD burden aggravates cognitive and gait impairments in patients with iNPH but may not affect shunt outcomes. The effects of different imaging markers of CSVD on cognition and gait are different and worthy of further investigation.

Early infarct growth rate is associated with symptomatic intracranial hemorrhage after endovascular thrombectomy

Background

Time elapsed from stroke onset and baseline infarct volume is influential on endovascular thrombectomy (EVT) outcomes.

Objectives

This study aimed to explore the utility of early infarct growth rate (EIGR) measured by apparent diffusion coefficient (ADC) in predicting symptomatic intracranial hemorrhage (sICH) of ischemic stroke patients after EVT.

Methods

We retrospectively analyzed patients from the prospectively maintained stroke registry admitted between January 2019 and March 2023, presenting with large vessel occlusive stroke in the anterior circulation. EIGR was defined as ischemic core volume on magnetic resonance perfusion imaging (ADC ⩽620 × 10-6 mm2/s) divided by the time from stroke onset to imaging. sICH was diagnosed according to the Heidelberg Bleeding Classification within 72 h after the procedure.

Results

A total of 315 patients met the inclusion criteria. We observed sICH in 36 (11.4%) patients. After adjusting for the potential confounders, increased EIGR was confirmed to be independently associated with a higher risk of sICH (adjusted odds ratio, 1.033; 95% confidence interval (CI), 1.018-1.048; p = 0.001). Similar results were also confirmed when EIGR was analyzed as a categorical variable. Using a logistic regression model with restricted cubic splines, we found a linear correlation between EIGR and sICH risk (p = 0.001 for linearity). Furthermore, adding EIGR to a model containing conventional risk factors significantly improved risk reclassification for sICH (category-free net reclassification index, 0.393; 95% CI, 0.227-0.560; p = 0.001; integrated discrimination improvement, 0.245; 95% CI, 0.146-0.343; p = 0.001).

Conclusion

Increased EIGR may predict the sICH in ischemic stroke patients who receiving EVT.

Efficient derivation of functional astrocytes from human induced pluripotent stem cells (hiPSCs)

Astrocytes are specialized glial cell types of the central nervous system (CNS) with remarkably high abundance, morphological and functional diversity. Astrocytes maintain neural metabolic support, synapse regulation, blood-brain barrier integrity and immunological homeostasis through intricate interactions with other cells, including neurons, microglia, pericytes and lymphocytes. Due to their extensive intercellular crosstalks, astrocytes are also implicated in the pathogenesis of CNS disorders, such as ALS (amyotrophic lateral sclerosis), Parkinson's disease and Alzheimer's disease. Despite the critical importance of astrocytes in neurodegeneration and neuroinflammation are recognized, the lack of suitable in vitro systems limits their availability for modeling human brain pathologies. Here, we report the time-efficient, reproducible generation of astrocytes from human induced pluripotent stem cells (hiPSCs). Our hiPSC-derived astrocytes expressed characteristic astrocyte markers, such as GFAP, S100b, ALDH1L1 and AQP4. Furthermore, hiPSC-derived astrocytes displayed spontaneous calcium transients and responded to inflammatory stimuli by the secretion of type A1 and type A2 astrocyte-related cytokines.

Consensus Considerations and Good Practice Points for Use of Continuous Glucose Monitoring Systems in Hospital Settings

Continuous glucose monitoring (CGM) systems provide frequent glucose measurements in interstitial fluid and have been used widely in ambulatory settings for diabetes management. During the coronavirus disease 2019 (COVID-19) pandemic, regulators in the U.S. and Canada temporarily allowed for CGM systems to be used in hospitals with the aim of reducing health care professional COVID-19 exposure and limiting use of personal protective equipment. As such, studies on hospital CGM system use have been possible. With improved sensor accuracy, there is increased interest in CGM usage for diabetes management in hospitals. Laboratorians and health care professionals must determine how to integrate CGM usage into practice. The aim of this consensus guidance document is to provide an update on the application of CGM systems in hospital, with insights and opinions from laboratory medicine, endocrinology, and nursing.

MSC Promotes the Secretion of Exosomal lncRNA KLF3-AS1 to Regulate Sphk1 Through YY1-Musashi-1 Axis and Improve Cerebral Ischemia-Reperfusion Injury

Stroke remains the 3rd leading cause of long-term disability globally. Over the past decade, mesenchymal stem cell (MSC) transplantation has been proven as an effective therapy for ischemic stroke. However, the mechanism of MSC-derived exosomal lncRNAs during cerebral ischemia/reperfusion (I/R) remains ambiguous. The oxygen-glucose deprivation/reoxygenation (OGD/R) and middle cerebral artery occlusion (MCAO) rat model were generated. MSCs were isolated and characterized by flow cytometry and histochemical staining, and MSC exosomes were purified and characterized by transmission electron microscopy, flow cytometry and Western blot. Western blot, RT-qPCR and ELISA assay were employed to examine the expression or secretion of key molecules. CCK-8 and TUNEL assays were used to assess cell viability and apoptosis. RNA immunoprecipitation and RNA pull-down were used to investigate the direct association between krüppel-like factor 3 antisense RNA 1 (KLF3-AS1) and musashi-1(MSI1). Yin Yang 1 (YY1)-mediated transcriptional regulation was assessed by chromatin immunoprecipitation and luciferase assays. The histological changes and immunoreactivity of key molecules in brain tissues were examined by H&E and immunohistochemistry. MSCs were successfully isolated and exhibited directionally differential potentials. MSC exosomal KLF3-AS1 alleviated OGD/R-induced inflammation in SK-N-SH and SH-SY5Y cells via modulating Sphk1. Mechanistical studies showed that MSI1 positively regulated KLF3-AS1 expression through its direct binding to KLF3-AS1. YY1 was identified as a transcription activator of MSI1 in MSCs. Functionally, YY1/MSI1 axis regulated the release of MSC exosomal KLF3-AS1 to modulate sphingosine kinase 1 (Sphk1)/NF-κB pathway, thereby ameliorating OGD/R- or cerebral I/R-induced injury. MSCs promote the release of exosomal KLF3-AS1 to regulate Sphk1 through YY1/MSI axis and improve cerebral I/R injury.

Hyperglycemia-induced oxidative stress exacerbates mitochondrial apoptosis damage to cochlear stria vascularis pericytes via the ROS-mediated Bcl-2/CytC/AIF pathway

OBJECTIVES

Diabetes is closely linked to hearing loss, yet the exact mechanisms remain unclear. Cochlear stria vascularis and pericytes (PCs) are crucial for hearing. This study investigates whether high glucose induces apoptosis in the cochlear stria vascularis and pericytes via elevated ROS levels due to oxidative stress, impacting hearing loss.

METHODS

We established a type II diabetes model in C57BL/6J mice and used auditory brainstem response (ABR), Evans blue staining, HE staining, immunohistochemistry, and immunofluorescence to observe changes in hearing, blood-labyrinth barrier (BLB) permeability, stria vascularis morphology, and apoptosis protein expression. Primary cultured stria vascularis pericytes were subjected to high glucose, and apoptosis levels were assessed using flow cytometry, Annexin V-FITC, Hoechst 33342 staining, Western blot, Mitosox, and JC-1 probes.

RESULTS

Diabetic mice showed decreased hearing thresholds, reduced stria vascularis density, increased oxidative stress, cell apoptosis, and decreased antioxidant levels. High glucose exposure increased apoptosis and ROS content in pericytes, while mitochondrial membrane potential decreased, with AIF and cytochrome C (CytC) released from mitochondria to the cytoplasm. Adding oxidative scavengers reduced AIF and CytC release, decreasing pericyte apoptosis.

DISCUSSION

Hyperglycemia may induce mitochondrial apoptosis of cochlear stria vascularis pericytes through oxidative stress.

Accuracy of continuous glucose monitoring systems in intensive care unit patients: a scoping review

PURPOSE

Glycemic control poses a challenge in intensive care unit (ICU) patients and dysglycemia is associated with poor outcomes. Continuous glucose monitoring (CGM) has been successfully implemented in the type 1 diabetes out-patient setting and renewed interest has been directed into the transition of CGM into the ICU. This scoping review aimed to provide an overview of CGM accuracy in ICU patients to inform future research and CGM implementation.

METHODS

We systematically searched PubMed and EMBASE between 5th of December 2023 and 21st of May 2024 and reported findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for scoping reviews (PRISMA-ScR). We assessed studies reporting the accuracy of CGM in the ICU and report study characteristics and accuracy outcomes.

RESULTS

We identified 2133 studies, of which 96 were included. Most studies were observational (91.7%), conducted in adult patients (74%), in mixed ICUs (47.9%), from 2014 and onward, and assessed subcutaneous CGM systems (80%) using arterial blood samples as reference test (40.6%). Half of the studies (56.3%) mention the use of a prespecified reference test protocol. The mean absolute relative difference (MARD) ranged from 6.6 to 30.5% for all subcutaneous CGM studies. For newer factory calibrated CGM, MARD ranged from 9.7 to 20.6%. MARD for intravenous CGM was 5-14.2% and 6.4-13% for intraarterial CGM.

CONCLUSIONS

In this scoping review of CGM accuracy in the ICU, we found great diversity in accuracy reporting. Accuracy varied depending on CGM and comparator, and may be better for intravascular CGM and potentially lower during hypoglycemia.

The Role of Gut Microbiota in Blood-Brain Barrier Disruption after Stroke

Growing evidence has proved that alterations in the gut microbiota have been linked to neurological disorders including stroke. Structural and functional disruption of the blood-brain barrier (BBB) is observed after stroke. In this context, there is pioneering evidence supporting that gut microbiota may be involved in the pathogenesis of stroke by regulating the BBB function. However, only a few experimental studies have been performed on stroke models to observe the BBB by altering the structure of gut microbiota, which warrant further exploration. Therefore, in order to provide a novel mechanism for stroke and highlight new insights into BBB modification as a stroke intervention, this review summarizes existing evidence of the relationship between gut microbiota and BBB integrity and discusses the mechanisms of gut microbiota on BBB dysfunction and its role in stroke.

Pretreatment factors associated with symptomatic stroke in Moyamoya disease patients: A multicenter study

OBJECTIVES

Moyamoya disease (MMD) is a cerebrovascular disorder marked by the progressive steno-occlusion of the bilateral internal carotid arteries and the formation of abnormal collateral vessel networks at the base of the brain. Previous studies have attempted to identify risk factors predictive of postoperative complications to improve patient management. This study aims to identify pretreatment factors associated with post-bypass symptomatic strokes in MMD patients.

METHODS

This study is a multicenter retrospective analysis conducted across 13 academic institutions in North America. A total of 518 patients with MMD were included. Data collected included patient demographics, disease characteristics, and follow-up duration. Stroke-free survival was analyzed using Kaplan-Meier curves. Univariate and multivariable Cox regression analyses were used to identify risk factors for symptomatic stroke.

RESULTS

The median age of the patients was 43 years (IQR, 34-52 years), and 370 (71 %) were females. Multivariable Cox regression identified advanced age (HR 1.03, 95 % CI 1.01-1.05, p = 0.011), female sex (HR 2.03, 95 % CI 1.00-4.11, p = 0.049), diabetes mellitus (HR 2.03, 95 % CI 1.14-3.63, p = 0.016), smoking status (HR 2.27, 95 % CI 1.27-4.05, p = 0.006), and asymptomatic disease (HR 0.37, 95 % CI 0.15-0.93, p = 0.034) as significant factors associated with symptomatic stroke.

CONCLUSION

Advanced age, female sex, diabetes mellitus, and smoking status were significant predictors of symptomatic stroke in MMD patients after bypass surgery. Asymptomatic patients had a reduced risk of stroke. These findings emphasize the importance of managing modifiable risk factors and the potential benefits of early detection in improving clinical outcomes for MMD patients. Further prospective studies are needed to validate these findings.

Unveiling the role of astrogliosis in Alzheimer's disease Pathology: Insights into mechanisms and therapeutic approaches

Alzheimer's disease (AD) is one of the most debilitating age-related disorders that affect people globally. It impacts social and cognitive behavior of the individual and is characterized by phosphorylated tau and Aβ accumulation. Astrocytesmaintain a quiescent, anti-inflammatory state on anatomical level, expressing few cytokines and exhibit phagocytic activity to remove misfolded proteins. But in AD, in response to specific stimuli, astrocytes overstimulate their phagocytic character with overexpressing cytokine gene modules. Upon interaction with generated Aβ and neurofibrillary tangle, astrocytes that are continuously activated release a large number of inflammatory cytokines. This cytokine storm leads to neuroinflammation which is also one of the recognizable features of AD. Astrogliosis eventually promotes cholinergic dysfunction, calcium imbalance, oxidative stress and excitotoxicity. Furthermore, C5aR1, Lcn2/, BDNF/TrkB and PPARα/TFEB signaling dysregulation has a major impact on the disease progression. This review clarifies numerous ways that lead to astrogliosis, which is stimulated by a variety of processes that exacerbate AD pathology and make it a suitable target for AD treatment. Drugs under clinical and preclinical investigations that target several pathways managing astrogliosis and are efficacious in ameliorating the pathology of the disease are also included in this study. D-ALA2GIP, TRAM-34, Genistein, L-serine, MW150 and XPro1595 are examples of few drugs targeting astrogliosis. Therefore, this study may aid in the development of a potent therapeutic agent for ameliorating astrogliosis mediated AD progression.

Glial fibrillary acidic protein in Alzheimer's disease: a narrative review

Astrocytes are fundamental in neural functioning and homeostasis in the central nervous system. These cells respond to injuries and pathological conditions through astrogliosis, a reactive process associated with neurodegenerative diseases such as Alzheimer's disease. This process is thought to begin in the early stages of these conditions. Glial fibrillary acidic protein (GFAP), a type III intermediate filament protein predominantly expressed in astrocytes, has emerged as a key biomarker for monitoring this response. During astrogliosis, GFAP is released into biofluids, making it a candidate for non-invasive diagnosis and tracking of neurodegenerative diseases. Growing evidence positions GFAP as a biomarker for Alzheimer's disease with specificity and disease-correlation characteristics comparable to established clinical markers, such as Aβ peptides and phosphorylated tau protein. To improve diagnostic accuracy, particularly in the presence of confounders and comorbidities, incorporating a panel of biomarkers may be advantageous. This review will explore the potential of GFAP within such a panel, examining its role in early diagnosis, disease progression monitoring and its integration into clinical practice for Alzheimer's disease management.

The Promising Key Factors Mediating Secondary Neuronal Damage in the Perihematomal Region of Intracerebellar Hemorrhage of Mice

ABSTRACT

The underlying mechanisms of secondary neuronal damage following intracerebellar hemorrhage (ICbH) have not yet been clearly understood. Our previous study reported apoptotic neuronal damage in the perihematomal region (PH) in mice. However, the possible key factors causing secondary neuronal damage in ICbH are not yet known. Therefore, we aimed to study the vital factors in the mediation of secondary neuronal damage following ICbH induced by collagenase type VII (0.4 U/μL of saline) into the cerebellum of mice. The mice were grouped into four groups: (1) control group ( n = 12), (2) day-1 group ( n = 12), (3) day-3 group ( n = 12), and (4) day-7 group ( n = 12). All mice underwent behavior assessment following induction of ICbH and were subsequently sacrificed on days 1, 3, and 7. Perihaematoma samples were collected to study morphological changes, immunohistochemistry, nitric oxide (NO) estimation, and oxidative stress markers, respectively. Mouse behavior was disturbed following ICbH on days 3 and 7 compared to the control. In addition, neuronal damage was found in the PH region. Glial fibrillary acidic protein (GFAP) and excitatory amino acid transporter 1 (EAAT1) were highly expressed on day 7, while gamma-aminobutyric acid receptor subunit alpha-1 (GABA A α1)-containing receptor subunit was detected on days 1 and 3. NO increased on day 1 post-induction and decreased on days 3 and 7. The expressions of superoxide dismutase (SOD), catalase (CAT), neuronal nitric oxide synthases (nNOSs), glutathione peroxidase 1, and cyclooxygenase-2 (COX-2) were significantly increased on day 3. Morphological studies of the PH and tissue showed that neuronal damage occurred from day 1 onward and peaked on day 3, associated with alterations in NO, reactive astrocytes (GFAP), glutamate transport regulation (EAAT1), and GABA receptor. Briefly, significant changes in the key markers in the PH regions at different time points are possibly crucial factors facilitating secondary neuronal damage in the PH region. Identifying the time window of these vital changes could help prevent secondary damage and optimize the treatment to occur at proper time points.

Investigating the eye-catching effect in the entrance zone of highway tunnels through heart rate variability analysis

OBJECTIVE

This study aimed to investigate the influence of visual attraction conditions on drivers' cognitive workload and physiological responses, assessed through heart rate variability (HRV) indicators. The study examined four experimental scenarios, including a baseline condition and three visual attractions (landscape-style architecture, tip slogan, and billboard) at tunnel entrances.

METHODS

HRV indicators, including RMSSD, SDNN, LF, and LF/HF ratio, were analyzed to assess cognitive workload and physiological states. The study collected data from a sample of drivers under each experimental scenario and compared the HRV measures across conditions.

RESULTS

The presence of visual attractions at tunnel entrances significantly impacted drivers' HRV. The introduction of visual attractions resulted in decreased RMSSD and SDNN values, indicating increased cognitive workload and reduced adaptability of the autonomic nervous system. Moreover, visual attractions led to increased LF values and LF/HF ratio, suggesting heightened sympathetic activation and potential cognitive engagement.

CONCLUSIONS

Visual attractions have a significant impact on drivers' cognitive workload and physiological responses. Designing tunnel entrances with a balance between visual attractiveness and cognitive demands is essential to optimize drivers' cognitive performance and overall driving experience. These findings provide valuable insights for transportation authorities and designers to create safer and more user-friendly tunnel environments.

Effects of Fu's subcutaneous needling on clinical efficacy and psychological cognitive characteristics in patients with chronic non-specific low back pain: A randomized controlled trial

BACKGROUND AND PURPOSE

Low back pain (LBP) is a major global public health problem. Evidence shows that LBP is also related to cognitive, psychological, and lifestyle factors. Fu's subcutaneous needling (FSN) has been used for the treatment of musculoskeletal problems for many years. This prospective randomized controlled trial aimed to evaluate the clinical efficacy and fear avoidance beliefs of FSN in the treatment of patients with chronic non-specific LBP.

MATERIAL AND METHODS

Ninety participants with chronic non-specific LBP were randomly divided into the FSN and the traditional acupuncture (TA) groups (n = 45) and received either FSN or TA treatment for three consecutive days from December 2021 to March 2023. The primary outcome was pain intensity measured by the visual analogue scale (VAS). Secondary outcomes were trunk extensor endurance (TEE), lumbar range of motion (ROM), and the Fear Avoidance Beliefs Questionnaire (FABQ). Outcome measurements were made before the first treatment and after each treatment. Follow-up assessments of VAS and FABQ scores were conducted one month after treatment.

RESULTS

The FSN group had significantly lower VAS and FABQ scores at each time point after intervention compared to the TA group (P < 0.01). The scores of TEE and lumbar ROM were higher in the FSN group than those in the TA group (P < 0.01). Repeated measures analysis of variance (ANOVA) showed significant time effects, group effects, and interaction effects for VAS, TEE, lumbar ROM, and FABQ in both groups (P < 0.01). One month after treatment, the FSN group had significantly lower VAS and FABQ scores compared to the TA group (P < 0.05).

CONCLUSION

This study suggested that FSN was superior to TA in terms of clinical efficacy and fear-avoidance beliefs in the treatment of chronic non-specific LBP. FSN could be used as an effective clinical treatment.

Biportal Endoscopic Paraspinal Decompression for Epidural Cement Leakage Removal: A Technical Note

OBJECTIVE

We aimed to preliminarily explore the efficacy and safety of unilateral biportal endoscopy for the treatment of epidural cement leaks. We report a patient who underwent epidural cement leakage removal and achieved endoscopic spinal decompression.

METHODS

A 67-year-old female patient underwent biportal endoscopic paraspinal decompression following percutaneous vertebroplasty for an osteoporotic fracture that resulted in neurologic impairment due to epidural cement leakage. A transforaminal biportal endoscopic surgery was performed to remove the leaked cement, and the left L1 and bilateral L2 nerves were decompressed.

RESULTS

The patient's postoperative clinical course was uneventful.

CONCLUSIONS

A paraspinal approach that avoids a posterior approach reduces the need to remove stabilizing facet bone, is truly minimally invasive and does not involve an instrumented fusion, maybe a helpful addition in the minimally invasive spine surgeon's armamentarium.

Alterations in GABAA receptor-mediated inhibition triggered by status epilepticus and their role in epileptogenesis and increased anxiety

The triggers of status epilepticus (SE) in non-epileptic patients can vary widely, from idiopathic causes to exposure to chemoconvulsants. Regardless of its etiology, prolonged SE can cause significant brain damage, commonly resulting in the development of epilepsy, which is often accompanied by increased anxiety. GABAA receptor (GABAAR)-mediated inhibition has a central role among the mechanisms underlying brain damage and the ensuing epilepsy and anxiety. During SE, calcium influx primarily via ionotropic glutamate receptors activates signaling cascades which trigger a rapid internalization of synaptic GABAARs; this weakens inhibition, exacerbating seizures and excitotoxicity. GABAergic interneurons are more susceptible to excitotoxic death than principal neurons. During the latent period of epileptogenesis, the aberrant reorganization in synaptic interactions that follow interneuronal loss in injured brain regions, leads to the formation of hyperexcitable, seizurogenic neuronal circuits, along with disturbances in brain oscillatory rhythms. Reduction in the spontaneous, rhythmic "bursts" of IPSCs in basolateral amygdala neurons is likely to play a central role in anxiogenesis. Protecting interneurons during SE is key to preventing both epilepsy and anxiety. Antiglutamatergic treatments, including antagonism of calcium-permeable AMPA receptors, can be expected to control seizures and reduce excitotoxicity not only by directly suppressing hyperexcitation, but also by counteracting the internalization of synaptic GABAARs. Benzodiazepines, as delayed treatment of SE, have low efficacy due to the reduction and dispersion of their targets (the synaptic GABAARs), but also because themselves contribute to further reduction of available GABAARs at the synapse; furthermore, benzodiazepines may be completely ineffective in the immature brain.

Integrative Korean medicine treatment for low back pain with radiculopathy caused by Bertolotti syndrome: A CARE-compliant article and retrospective review of medical records

RATIONALE

Bertolotti syndrome (BS) is characterized by radiculopathy caused by structural anomalies. Despite the structural deformity, conservative treatment is predominantly recommended due to surgery-related complications. Because of the diagnosis complexity, the incidence and contributing factors of BS, remain controversial. We report the case of a patient with BS who was treated with integrative Korean medicine (IKM). Moreover, we evaluated the epidemiological characteristics of lumbosacral transitional vertebrae (LSTV) from medical records of patients diagnosed with LSTV at 4 different medical clinics of Korean medicine.

PATIENT CONCERNS

A 33-year-old male patient with low back pain and severe radiculopathy was diagnosed with BS (Castellvi Type II) on magnetic resonance imaging at a local orthopedic clinic. Additionally, the medical records of patients with BS who had been treated with IKM in 4 different institutions of Korean medicine were analyzed, and the characteristics of patients suffering from BS were identified.

DIAGNOSES, INTERVENTIONS, AND OUTCOMES

The patient underwent IKM treatment for 40 days as an inpatient. The patient's condition was assessed using the Euroqol 5-dimension index and Oswestry Disability Index, and symptom severity was measured using the Numeric Rating Scale. IKM was effective in improving pain and functional disability without causing any adverse effects. In a retrospective review of medical records, the study identified symptom trends reported by patients with LSTV.

LESSONS

IKM demonstrates potential efficacy in BS management, with notable trends in LSTV-related symptomatology warranting further investigation.

Applications of Artificial Intelligence and Machine Learning in Spine MRI

Diagnostic imaging, particularly MRI, plays a key role in the evaluation of many spine pathologies. Recent progress in artificial intelligence and its subset, machine learning, has led to many applications within spine MRI, which we sought to examine in this review. A literature search of the major databases (PubMed, MEDLINE, Web of Science, ClinicalTrials.gov) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search yielded 1226 results, of which 50 studies were selected for inclusion. Key data from these studies were extracted. Studies were categorized thematically into the following: Image Acquisition and Processing, Segmentation, Diagnosis and Treatment Planning, and Patient Selection and Prognostication. Gaps in the literature and the proposed areas of future research are discussed. Current research demonstrates the ability of artificial intelligence to improve various aspects of this field, from image acquisition to analysis and clinical care. We also acknowledge the limitations of current technology. Future work will require collaborative efforts in order to fully exploit new technologies while addressing the practical challenges of generalizability and implementation. In particular, the use of foundation models and large-language models in spine MRI is a promising area, warranting further research. Studies assessing model performance in real-world clinical settings will also help uncover unintended consequences and maximize the benefits for patient care.

Edaravone Dexborneol ameliorates the cognitive deficits of APP/PS1 mice by inhibiting TLR4/MAPK signaling pathway via upregulating TREM2

Currently, there are no effective therapeutic agents available to treat Alzheimer's disease (AD). However, edaravone dexborneol (EDB), a novel composite agent used to treat acute ischemic stroke, has recently been shown to exert efficacious neuroprotective effects. However, whether EDB can ameliorate cognitive deficits in AD currently remains unclear. To this end, we explored the effects of EDB on AD and its potential mechanisms using an AD animal model (male APP/PS1 mice) treated with EDB for 10 weeks starting at 6 months of age. Subsequent analyses revealed that EDB-treated APP/PS1 mice exhibited improved cognitive abilities compared to untreated APP/PS1 mice. Administration of EDB in APP/PS1 mice further alleviated neuropathological alterations of the hippocampus, including Aβ deposition, pyramidal cell karyopyknosis, and oxidative damage, and significantly decreased the levels of inflammatory cytokines (IL-1β, IL-6 and TNF-α) and COX-2 in the hippocampus of APP/PS1 mice. Transcriptome sequencing analysis demonstrated the critical role of the inflammatory reaction in EDB treatment in APP/PS1 mice, indicating that the alleviation of the inflammatory reaction by EDB in the hippocampus of APP/PS1 mice was linked to the action of the TREM2/TLR4/MAPK signaling pathway. Further in vitro investigations showed that EDB suppressed neuroinflammation in LPS-stimulated BV2 cells by inhibiting the TLR4/MAPK signaling pathway and upregulating TREM2 expression. Thus, the findings of the present study demonstrate that EDB is a promising therapeutic agent for AD-related cognitive dysfunction.