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Ramirez-Garcia G, Escutia-Macedo X, Cook DJ, Moreno-Andrade T, Villarreal-Garza E, Campos-Coy M, Elizondo-Riojas G, Gongora-Rivera F, Garza-Villarreal EA, Fernandez-Ruiz J. Consistent spatial lesion-symptom patterns: A comprehensive analysis using triangulation in lesion-symptom mapping in a cohort of stroke patients. Magn Reson Imaging 2024; 109:286-293. [PMID: 38531463 DOI: 10.1016/j.mri.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/29/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The relationship between brain lesions and stroke outcomes is crucial for advancing patient prognosis and developing effective therapies. Stroke is a leading cause of disability worldwide, and it is important to understand the neurological basis of its varied symptomatology. Lesion-symptom mapping (LSM) methods provide a means to identify brain areas that are strongly associated with specific symptoms. However, inner variations in LSM methods can yield different results. To address this, our study aimed to characterize the lesion-symptom mapping variability using three different LSM methods. Specifically, we sought to determine a lesion symptom core across LSM approaches enhancing the robustness of the analysis and removing potential spatial bias. MATERIAL & METHODS A cohort consisting of 35 patients with either right- or left-sided middle cerebral artery strokes were enrolled and evaluated using the NIHSS at 24 h post-stroke. Anatomical T1w MRI scans were also obtained 24 h post-stroke. Lesion masks were segmented manually and three distinctive LSM methods were implemented: ROI correlation-based, univariate, and multivariate approaches. RESULTS The results of the LSM analyses showed substantial spatial differences in the extension of each of the three lesion maps. However, upon overlaying all three lesion-symptom maps, a consistent lesion core emerged, corresponding to the territory associated with elevated NIHSS scores. This finding not only enhances the spatial accuracy of the lesion map but also underscores its clinical relevance. CONCLUSION This study underscores the significance of exploring complementary LSM approaches to investigate the association between brain lesions and stroke outcomes. By utilizing multiple methods, we can increase the robustness of our results, effectively addressing and neutralizing potential spatial bias introduced by each individual method. Such an approach holds promise for enhancing our understanding of stroke pathophysiology and optimizing patient care strategies.
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Affiliation(s)
- Gabriel Ramirez-Garcia
- Laboratorio de Neuropsicologia, Departamento de Fisiologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico; Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Ximena Escutia-Macedo
- Laboratorio de Neuropsicologia, Departamento de Fisiologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico
| | - Douglas J Cook
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada; Translational Stroke Research Lab, Department of Surgery, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Talia Moreno-Andrade
- Departamento de Neurologia, Hospital Universitario Dr. Jose Eleuterio Gonzalez Universidad Autonoma de Nuevo León, Monterrey, Nuevo Leon, Mexico; Unidad de Neuromodulacion y Plasticidad Cerebral, Centro de Investigacion y Desarrollo en Ciencias de la Salud, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Estefania Villarreal-Garza
- Departamento de Neurologia, Hospital Universitario Dr. Jose Eleuterio Gonzalez Universidad Autonoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Mario Campos-Coy
- Unidad de Neuromodulacion y Plasticidad Cerebral, Centro de Investigacion y Desarrollo en Ciencias de la Salud, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico; Departamento de Imagen Diagnostica, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Guillermo Elizondo-Riojas
- Unidad de Neuromodulacion y Plasticidad Cerebral, Centro de Investigacion y Desarrollo en Ciencias de la Salud, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico; Departamento de Imagen Diagnostica, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Fernando Gongora-Rivera
- Departamento de Neurologia, Hospital Universitario Dr. Jose Eleuterio Gonzalez Universidad Autonoma de Nuevo León, Monterrey, Nuevo Leon, Mexico; Unidad de Neuromodulacion y Plasticidad Cerebral, Centro de Investigacion y Desarrollo en Ciencias de la Salud, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Eduardo A Garza-Villarreal
- Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Juriquilla, Queretaro, Mexico; Departamento de Neurologia, Hospital Universitario Dr. Jose Eleuterio Gonzalez Universidad Autonoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Juan Fernandez-Ruiz
- Laboratorio de Neuropsicologia, Departamento de Fisiologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico; Facultad de Psicologia, Universidad Veracruzana, Xalapa, Veracruz, Mexico.
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Wei C, Xi N, Tang J, Chu Q, Bi Q. Effects of a step-by-step inpatient rehabilitation program on self-care ability and quality of life in patients with acute cerebral infarction following intravascular stent implantation: a prospective cohort study. Front Neurol 2024; 15:1400437. [PMID: 38751890 PMCID: PMC11094644 DOI: 10.3389/fneur.2024.1400437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Objective This study aims to evaluate the influence of a step-by-step inpatient rehabilitation program (SIRP) on the self-care capability and quality of life of patients who have undergone intravascular stent implantation to treat large vessel occlusion during acute cerebral infarction (ACI). Methods This study included a cohort of 90 patients with ACI who received intravascular stent implantations at a tertiary hospital in the Third Affiliated Hospital of Anhui Medical University from January 2020 to February 2024. The patients were followed up for at least 3 months. Cohort grouping was based on the type of nursing care each patient received. The observation group participated in SIRP along with receiving routine nursing care, whereas the control group received only routine nursing care. Key outcome measures included the Barthel index, the National Institute of Health Stroke Scale (NIHSS) score, the incidence of complications, length of hospital stay, and 36-item short-form survey (SF-36) scores. These parameters were compared between the two groups. Results At the time of admission, there were no significant differences in demographic data, NIHSS score, Barthel index, or SF-36 scores between the observation and control groups (all p > 0.05). However, at 3 months postoperatively, the observation group showed significant improvements, with higher average scores in the Barthel index (62.49 ± 7.32 vs. 53.16 ± 4.37, p < 0.001) and SF-36 scores (502.33 ± 14.28 vs. 417.64 ± 9.65, p < 0.001). Additionally, this group had significantly lower NIHSS scores (3.38 ± 1.19 vs. 10.24 ± 2.10, p < 0.001), fewer complications (3 vs. 15, p = 0.002), and shorter hospital stays (12.40 ± 1.68 vs. 15.56 ± 1.87, p < 0.001). Conclusion Implementing SIRP notably enhanced self-care capabilities and overall quality of life, while also reducing complication rates and the length of hospital stays for patients with ACI who underwent intravascular stent implantation. This underscores the potential benefits of incorporating structured rehabilitation programs in the treatment and recovery processes of such patients.
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Affiliation(s)
- Chen Wei
- School of Nursing, Anhui Medical University, Hefei, Anhui Province, China
- The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Nannan Xi
- The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Jieqiong Tang
- The Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui Province, China
| | - Qiangqiang Chu
- The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Qingquan Bi
- School of Nursing, Anhui Medical University, Hefei, Anhui Province, China
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Jühling D, Rajashekar D, Cheng B, Hilgetag CC, Forkert ND, Werner R. Spatial normalization for voxel-based lesion symptom mapping: impact of registration approaches. Front Neurosci 2024; 18:1296357. [PMID: 38298911 PMCID: PMC10828036 DOI: 10.3389/fnins.2024.1296357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024] Open
Abstract
Background Voxel-based lesion symptom mapping (VLSM) assesses the relation of lesion location at a voxel level with a specific clinical or functional outcome measure at a population level. Spatial normalization, that is, mapping the patient images into an atlas coordinate system, is an essential pre-processing step of VLSM. However, no consensus exists on the optimal registration approach to compute the transformation nor are downstream effects on VLSM statistics explored. In this work, we evaluate four registration approaches commonly used in VLSM pipelines: affine (AR), nonlinear (NLR), nonlinear with cost function masking (CFM), and enantiomorphic registration (ENR). The evaluation is based on a standard VLSM scenario: the analysis of statistical relations of brain voxels and regions in imaging data acquired early after stroke onset with follow-up modified Rankin Scale (mRS) values. Materials and methods Fluid-attenuated inversion recovery (FLAIR) MRI data from 122 acute ischemic stroke patients acquired between 2 and 3 days after stroke onset and corresponding lesion segmentations, and 30 days mRS values from a European multicenter stroke imaging study (I-KNOW) were available and used in this study. The relation of the voxel location with follow-up mRS was assessed by uni- as well as multi-variate statistical testing based on the lesion segmentations registered using the four different methods (AR, NLR, CFM, ENR; implementation based on the ANTs toolkit). Results The brain areas evaluated as important for follow-up mRS were largely consistent across the registration approaches. However, NLR, CFM, and ENR led to distortions in the patient images after the corresponding nonlinear transformations were applied. In addition, local structures (for instance the lateral ventricles) and adjacent brain areas remained insufficiently aligned with corresponding atlas structures even after nonlinear registration. Conclusions For VLSM study designs and imaging data similar to the present work, an additional benefit of nonlinear registration variants for spatial normalization seems questionable. Related distortions in the normalized images lead to uncertainties in the VLSM analyses and may offset the theoretical benefits of nonlinear registration.
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Affiliation(s)
- Daniel Jühling
- Institute of Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claus Christian Hilgetag
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Biomedical Artificial Intelligence (bAIome), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Rene Werner
- Institute of Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Biomedical Artificial Intelligence (bAIome), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bonzanino M, Riolo M, Battaglini I, Perna M, De Mattei M. PEALut in the Dietary Management of Patients with Acute Ischemic Stroke: A Prospective Randomized Controlled Clinical Trial. J Clin Med 2024; 13:509. [PMID: 38256644 PMCID: PMC10816980 DOI: 10.3390/jcm13020509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Acute ischemic stroke (AIS), which represents 87% of all strokes, is caused by reduced blood supply to the brain associated with a prolonged inflammatory process that exacerbates brain damage. The composite containing co-ultramicronized Palmitoylethanolamide and luteolin (PEALut) is known to promote the resolution of neuroinflammation, being a promising nutritional approach to contrast inflammatory processes occurring in AIS. This study included 60 patients affected by acute ischemic stroke and undergoing thrombolysis. PEALut 770 mg was administered to 30 patients, twice daily for 90 days, in addition to the standard therapy. Neurological deficit, independence in activities of daily living, disability and cognitive impairment were investigated. In all patients, the severity of AIS defined by the NIHSS score evolved from moderate to minor (p < 0.0001). Patients' independence in daily living activities and disability evaluated using BI and mRS showed a significant improvement over time, with a statistically significant difference in favor of PEALut-treated patients (p < 0.002 for BI, p < 0.0001 for mRS), who achieved also a marked improvement of cognitive function evaluated using MMSE and MoCA tests. PEALut proved to be a safe and effective treatment in addition to thrombolysis in the management of patients with acute ischemic stroke.
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Affiliation(s)
- Massimo Bonzanino
- S. S. Stoke Unit, Dipartimento Area Medica, Ospedale Santa Croce di Moncalieri, ASLTo5, 10024 Moncalieri, Turin, Italy
| | - Marianna Riolo
- S. C. Neurologia, Dipartimento Area Medica, Ospedale Santa Croce di Moncalieri, ASLTo5, 10024 Moncalieri, Turin, Italy
| | - Iacopo Battaglini
- S. C. Neurologia, Dipartimento Area Medica, Ospedale Santa Croce di Moncalieri, ASLTo5, 10024 Moncalieri, Turin, Italy
| | - Marilisa Perna
- S. S. Stoke Unit, Dipartimento Area Medica, Ospedale Santa Croce di Moncalieri, ASLTo5, 10024 Moncalieri, Turin, Italy
| | - Marco De Mattei
- S. C. Neurologia, Dipartimento Area Medica, Ospedale Santa Croce di Moncalieri, ASLTo5, 10024 Moncalieri, Turin, Italy
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Wu L, Shi P, Zhao Y, Shao D, Wu H. Hemorheology and Inflammatory Marker Changes in Patients with Acute Ischemic Stroke after Intravenous Thrombolysis with Mechanical Thrombectomy. Pak J Med Sci 2024; 40:342-346. [PMID: 38356812 PMCID: PMC10862463 DOI: 10.12669/pjms.40.3.8396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/01/2023] [Accepted: 11/15/2023] [Indexed: 02/16/2024] Open
Abstract
Objective To investigate hemorheology and inflammatory marker changes after treatment for acute ischemic stroke (AIS) using intravenous thrombolysis (IVT) with mechanical thrombectomy (MT). Methods We retrospectively reviewed clinical records of patients with AIS (n=83) treated in The First Affiliated Hospital of Bengbu Medical College between January 2021 and December 2022 (n=83). The control group consisted of 38 patients who underwent IVT alone and the observation group consisted of 45 patients who underwent IVT with MT. We compared differences in mean variables related to hemorheology, inflammatory markers, and total efficacy between the two groups. Results We found that hemorheology values (plasma viscosity [PV], whole blood viscosity [WBV], fibrinogen [FIB], and hematocrit [HCT]), and the levels of inflammatory markers (tumor necrosis factor ɑ [TNF-ɑ] and interleukin-6 [IL-6]) were higher in the control group than in the observation group after treatment (P<0.05). In addition, the total efficacy of the observation group (93.3%) was higher than that in the control group (76.3%; P=0.016). Conclusions The clinical efficacy of combined IVT and MT in the treatment of AIS is superior to IVT alone, improving levels of hemorheology and inflammatory markers in patients with AIS.
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Affiliation(s)
- Li Wu
- Li Wu, Department of Neurology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province 233004, P.R. China
| | - Peng Shi
- Peng Shi, Department of Neurology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province 233004, P.R. China
| | - Yujie Zhao
- Yujie Zhao, Department of Neurology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province 233004, P.R. China
| | - Di Shao
- Di Shao, Department of Neurology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province 233004, P.R. China
| | - Hongliang Wu
- Hongliang Wu, Department of Urology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province 233004, P.R. China
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Corominas-Teruel X, Bracco M, Fibla M, Segundo RMS, Villalobos-Llaó M, Gallea C, Beranger B, Toba M, Valero-Cabré A, Colomina MT. High-density transcranial direct current stimulation to improve upper limb motor function following stroke: study protocol for a double-blind randomized clinical trial targeting prefrontal and/or cerebellar cognitive contributions to voluntary motion. Trials 2023; 24:783. [PMID: 38049806 PMCID: PMC10694989 DOI: 10.1186/s13063-023-07680-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 09/27/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Focal brain lesions following a stroke of the middle cerebral artery induce large-scale network disarray with a potential to impact multiple cognitive and behavioral domains. Over the last 20 years, non-invasive brain neuromodulation via electrical (tCS) stimulation has shown promise to modulate motor deficits and contribute to recovery. However, weak, inconsistent, or at times heterogeneous outcomes using these techniques have also highlighted the need for novel strategies and the assessment of their efficacy in ad hoc controlled clinical trials. METHODS We here present a double-blind, sham-controlled, single-center, randomized pilot clinical trial involving participants having suffered a unilateral middle cerebral artery (MCA) stroke resulting in motor paralysis of the contralateral upper limb. Patients will undergo a 10-day regime (5 days a week for 2 consecutive weeks) of a newly designed high-definition transcranial direct current stimulation (HD-tDCS) protocol. Clinical evaluations (e.g., Fugl Meyer, NIHSS), computer-based cognitive assessments (visuo-motor adaptation and AX-CPT attention tasks), and electroencephalography (resting-state and task-evoked EEG) will be carried out at 3 time points: (I) Baseline, (II) Post-tDCS, and (III) Follow-up. The study consists of a four-arm trial comparing the impact on motor recovery of three active anodal tDCS conditions: ipsilesional DLPFC tDCS, contralesional cerebellar tDCS or combined DLPFC + contralesional cerebellar tDCS, and a sham tDCS intervention. The Fugl-Meyer Assessment for the upper extremity (FMA-UE) is selected as the primary outcome measure to quantify motor recovery. In every stimulation session, participants will receive 20 min of high-density tDCS stimulation (HD-tDCS) (up to 0.63 mA/[Formula: see text]) with [Formula: see text] electrodes. Electrode scalp positioning relative to the cortical surface (anodes and cathodes) and intensities are based on a biophysical optimization model of current distribution ensuring a 0.25 V/m impact at each of the chosen targets. DISCUSSION Our trial will gauge the therapeutic potential of accumulative sessions of HD-tDCS to improve upper limb motor and cognitive dysfunctions presented by middle cerebral artery stroke patients. In parallel, we aim at characterizing changes in electroencephalographic (EEG) activity as biomarkers of clinical effects and at identifying potential interactions between tDCS impact and motor performance outcomes. Our work will enrich our mechanistic understanding on prefrontal and cerebellar contributions to motor function and its rehabilitation following brain damage. TRIAL REGISTRATION ClinicalTrials.gov NCT05329818. April 15, 2022.
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Affiliation(s)
- Xavier Corominas-Teruel
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Groupe de Dynamiques Cérébrales, Plasticité Et Rééducation, FRONTLAB Team, Inserm, CNRS, APHP, Hôpital de La Pitié Salpêtrière, Paris, France
- Department of Psychology and Research Center for Behaviour Assessment (CRAMC), Universitat Rovira I Virgili, Neurobehaviour and Health Research Group, NEUROLAB, Tarragona, Spain
| | - Martina Bracco
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Groupe de Dynamiques Cérébrales, Plasticité Et Rééducation, FRONTLAB Team, Inserm, CNRS, APHP, Hôpital de La Pitié Salpêtrière, Paris, France
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Movement Investigation and Therapeutics Team, MOVIT Team, Inserm, CNRS, APHP, Hôpital de La Pitié Salpêtrière, Paris, France
| | - Montserrat Fibla
- Rehabilitation and Physical Medicine Department, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Rosa Maria San Segundo
- Rehabilitation and Physical Medicine Department, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Marc Villalobos-Llaó
- Department of Psychology and Research Center for Behaviour Assessment (CRAMC), Universitat Rovira I Virgili, Neurobehaviour and Health Research Group, NEUROLAB, Tarragona, Spain
| | - Cecile Gallea
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Movement Investigation and Therapeutics Team, MOVIT Team, Inserm, CNRS, APHP, Hôpital de La Pitié Salpêtrière, Paris, France
| | - Benoit Beranger
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Centre de Neuro-Imagerie de Recherche, CENIR, Inserm, CNRS, APHP, Hôpital de La Pitié Salpêtrière, Paris, France
| | - Monica Toba
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Groupe de Dynamiques Cérébrales, Plasticité Et Rééducation, FRONTLAB Team, Inserm, CNRS, APHP, Hôpital de La Pitié Salpêtrière, Paris, France
| | - Antoni Valero-Cabré
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Groupe de Dynamiques Cérébrales, Plasticité Et Rééducation, FRONTLAB Team, Inserm, CNRS, APHP, Hôpital de La Pitié Salpêtrière, Paris, France.
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Centre de Neuro-Imagerie de Recherche, CENIR, Inserm, CNRS, APHP, Hôpital de La Pitié Salpêtrière, Paris, France.
- Dept. Anatomy and Neurobiology, Lab of Cerebral Dynamics, Boston University School of Medicine, Boston, USA.
- Cognitive Neuroscience and Information Tech. Research Program, Open University of Catalonia (UOC), Barcelona, Spain.
| | - Maria Teresa Colomina
- Department of Psychology and Research Center for Behaviour Assessment (CRAMC), Universitat Rovira I Virgili, Neurobehaviour and Health Research Group, NEUROLAB, Tarragona, Spain.
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Moore JA, Wilms M, Gutierrez A, Ismail Z, Fakhar K, Hadaeghi F, Hilgetag CC, Forkert ND. Simulation of neuroplasticity in a CNN-based in-silico model of neurodegeneration of the visual system. Front Comput Neurosci 2023; 17:1274824. [PMID: 38105786 PMCID: PMC10722164 DOI: 10.3389/fncom.2023.1274824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
The aim of this work was to enhance the biological feasibility of a deep convolutional neural network-based in-silico model of neurodegeneration of the visual system by equipping it with a mechanism to simulate neuroplasticity. Therefore, deep convolutional networks of multiple sizes were trained for object recognition tasks and progressively lesioned to simulate neurodegeneration of the visual cortex. More specifically, the injured parts of the network remained injured while we investigated how the added retraining steps were able to recover some of the model's object recognition baseline performance. The results showed with retraining, model object recognition abilities are subject to a smoother and more gradual decline with increasing injury levels than without retraining and, therefore, more similar to the longitudinal cognition impairments of patients diagnosed with Alzheimer's disease (AD). Moreover, with retraining, the injured model exhibits internal activation patterns similar to those of the healthy baseline model when compared to the injured model without retraining. Furthermore, we conducted this analysis on a network that had been extensively pruned, resulting in an optimized number of parameters or synapses. Our findings show that this network exhibited remarkably similar capability to recover task performance with decreasingly viable pathways through the network. In conclusion, adding a retraining step to the in-silico setup that simulates neuroplasticity improves the model's biological feasibility considerably and could prove valuable to test different rehabilitation approaches in-silico.
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Affiliation(s)
- Jasmine A. Moore
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Program, University of Calgary, Calgary, AB, Canada
| | - Matthias Wilms
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Alejandro Gutierrez
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Program, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Kayson Fakhar
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Fatemeh Hadaeghi
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Claus C. Hilgetag
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Health Sciences, Boston University, Boston, MA, United States
| | - Nils D. Forkert
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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Yu S, Chen J, Zhao Y, Liao X, Chen Q, Xie H, Liu J, Sun J, Zhi S. Association analysis of the gut microbiota in predicting outcomes for patients with acute ischemic stroke and H-type hypertension. Front Neurol 2023; 14:1275460. [PMID: 37954644 PMCID: PMC10639143 DOI: 10.3389/fneur.2023.1275460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction H-type hypertension (HHTN) is a subtype of hypertension that tends to worsen the prognosis of acute ischemic stroke (AIS). Recent studies have highlighted the vital role of gut microbiota in both hypertension and AIS, but there is little available data on the relationship between gut microbiota and the progression of AIS patients with HHTN. In this study, we investigated the microbial signature of AIS patients with HHTN and identified characteristic bacteria as biomarkers for predicting prognosis. Methods AIS patients with HHTN (n = 150) and without HHTN (n = 50) were enrolled. All patients received a modified Rankin Scale (mRS) assessment at 3 months after discharge. Fecal samples were collected from the participants upon admission, including 150 AIS patients with HHTN, 50 AIS patients with non-HHTN, and 90 healthy subjects with HHTN. These samples were analyzed using 16S rRNA sequencing to characterize the bacterial taxa, predict functions, and conduct correlation analysis between specific taxa and clinical features. Results Our results showed that the composition of the gut microbiota in HHTN patients differed significantly from that in non-HHTN patients. The abundance of the genera Bacteroides, Escherichia-Shigella, Lactobacillus, Bifidobacterium, and Prevotella in AIS patients with HHTN was significantly increased compared to AIS patients without HHTN, while the genus Streptococcus, Faecalibacterium, and Klebsiella were significantly decreased. Moreover, Bacteroides, Lactobacillus, Bifidobacterium, and Klebsiella in AIS patients with HHTN were more abundant than healthy subjects with HHTN, while Escherichia-Shigella, Blautia, and Faecalibacterium were less abundant. Moreover, the genera Butyricicoccus, Rothia, and Family_XIII_UCG-001 were negatively connected with the NIHSS score, and the genera Butyricicoccus and Rothia were observed to be negatively associated with the mRS score. The genera Butyricicoccus, Romboutsia, and Terrisporobacter were associated with a poor prognosis, whereas the increase in Butyricimonas and Odoribacter was correlated with good outcomes. Generated by eight genera and clinical indexes, the area under the curve (AUC) value of the receiver operating characteristic (ROC) curve achieved 0.739 to effectively predict the prognosis of AIS patients with HHTN. Conclusion These findings revealed the microbial signature of AIS patients with HHTN and further provided potential microbial biomarkers for the clinical diagnosis of AIS patients with HHTN.
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Affiliation(s)
- Shicheng Yu
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiaxin Chen
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yiting Zhao
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaolan Liao
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qionglei Chen
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huijia Xie
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiaming Liu
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jing Sun
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shaoce Zhi
- Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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9
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Chen R, Dadario NB, Cook B, Sun L, Wang X, Li Y, Hu X, Zhang X, Sughrue ME. Connectomic insight into unique stroke patient recovery after rTMS treatment. Front Neurol 2023; 14:1063408. [PMID: 37483442 PMCID: PMC10359072 DOI: 10.3389/fneur.2023.1063408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
An improved understanding of the neuroplastic potential of the brain has allowed advancements in neuromodulatory treatments for acute stroke patients. However, there remains a poor understanding of individual differences in treatment-induced recovery. Individualized information on connectivity disturbances may help predict differences in treatment response and recovery phenotypes. We studied the medical data of 22 ischemic stroke patients who received MRI scans and started repetitive transcranial magnetic stimulation (rTMS) treatment on the same day. The functional and motor outcomes were assessed at admission day, 1 day after treatment, 30 days after treatment, and 90 days after treatment using four validated standardized stroke outcome scales. Each patient underwent detailed baseline connectivity analyses to identify structural and functional connectivity disturbances. An unsupervised machine learning (ML) agglomerative hierarchical clustering method was utilized to group patients according to outcomes at four-time points to identify individual phenotypes in recovery trajectory. Differences in connectivity features were examined between individual clusters. Patients were a median age of 64, 50% female, and had a median hospital length of stay of 9.5 days. A significant improvement between all time points was demonstrated post treatment in three of four validated stroke scales utilized. ML-based analyses identified distinct clusters representing unique patient trajectories for each scale. Quantitative differences were found to exist in structural and functional connectivity analyses of the motor network and subcortical structures between individual clusters which could explain these unique trajectories on the Barthel Index (BI) scale but not on other stroke scales. This study demonstrates for the first time the feasibility of using individualized connectivity analyses in differentiating unique phenotypes in rTMS treatment responses and recovery. This personalized connectomic approach may be utilized in the future to better understand patient recovery trajectories with neuromodulatory treatment.
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Affiliation(s)
- Rong Chen
- The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Nicholas B. Dadario
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Brennan Cook
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Lichun Sun
- The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Xiaolong Wang
- The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Yujie Li
- The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Xiaorong Hu
- Xijia Medical Technology Company Limited, Shenzhen, China
| | - Xia Zhang
- Xijia Medical Technology Company Limited, Shenzhen, China
- International Joint Research Center on Precision Brain Medicine, XD Group Hospital, Xi'an, Shaanxi, China
| | - Michael E. Sughrue
- International Joint Research Center on Precision Brain Medicine, XD Group Hospital, Xi'an, Shaanxi, China
- Omniscient Neurotechnology, Sydney, NSW, Australia
- Cingulum Health, Sydney, NSW, Australia
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10
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Winder AJ, Wilms M, Amador K, Flottmann F, Fiehler J, Forkert ND. Predicting the tissue outcome of acute ischemic stroke from acute 4D computed tomography perfusion imaging using temporal features and deep learning. Front Neurosci 2022; 16:1009654. [PMID: 36408399 PMCID: PMC9672821 DOI: 10.3389/fnins.2022.1009654] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/12/2022] [Indexed: 12/27/2023] Open
Abstract
Predicting follow-up lesions from baseline CT perfusion (CTP) datasets in acute ischemic stroke patients is important for clinical decision making. Deep convolutional networks (DCNs) are assumed to be the current state-of-the-art for this task. However, many DCN classifiers have not been validated against the methods currently used in research (random decision forests, RDF) and clinical routine (Tmax thresholding). Specialized DCNs have even been designed to extract complex temporal features directly from spatiotemporal CTP data instead of using standard perfusion parameter maps. However, the benefits of applying deep learning to source or deconvolved CTP data compared to perfusion parameter maps have not been formally investigated so far. In this work, a modular UNet-based DCN is proposed that separates temporal feature extraction from tissue outcome prediction, allowing for both model validation using perfusion parameter maps as well as end-to-end learning from spatiotemporal CTP data. 145 retrospective datasets comprising baseline CTP imaging, perfusion parameter maps, and follow-up non-contrast CT with manual lesion segmentations were assembled from acute ischemic stroke patients treated with intravenous thrombolysis alone (IV; n = 43) or intra-arterial mechanical thrombectomy (IA; n = 102) with or without combined IV. Using the perfusion parameter maps as input, the proposed DCN (mean Dice: 0.287) outperformed the RDF (0.262) and simple Tmax-thresholding (0.249). The performance of the proposed DCN was approximately equal using features optimized from the deconvolved residual curves (0.286) compared to perfusion parameter maps (0.287), while using features optimized from the source concentration-time curves (0.296) provided the best tissue outcome predictions.
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Affiliation(s)
- Anthony J. Winder
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Matthias Wilms
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Kimberly Amador
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nils D. Forkert
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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