Frontiers in Neurology最新文献

{"title":"Ferroptosis-associated candidate genes in aneurysmal subarachnoid hemorrhage: evidence from human peripheral blood and mouse brain.","authors":"Jia Li, Cong Wang, Hongwen Li, Yafan Liu, Chunchao Cheng, Zilin Zhao, Guifang Jiang, Xiaopeng Cui, Ben Chat Fong Ng, Yan Zhao, Zhuolin Wu, Xinyu Yang","doi":"10.3389/fneur.2026.1823039","DOIUrl":"https://doi.org/10.3389/fneur.2026.1823039","url":null,"abstract":"<p><strong>Background: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) has high morbidity and mortality. Ferroptosis may contribute to aSAH-related brain injury, but its peripheral and brain-associated signatures remain unclear.</p><p><strong>Methods: </strong>Human peripheral-blood dataset GSE36791 (43 aSAH, 18 controls) was analyzed using limma, FerrDb intersection, WGCNA, GO/KEGG enrichment, and PPI-based prioritization. qPCR validation was performed in peripheral blood from 10 aSAH patients and 10 non-SAH controls; aSAH samples were collected within 24 h after rupture. Mean ages were 60.2 ± 7.7 and 63.6 ± 8.9 years, with 5 and 4 males, respectively. Brain-level validation used GSE79416 mouse cortex and OMIX006611 mouse SAH single-cell RNA-seq data. Male C57BL/6 J mice (8 weeks, 20-22 g) underwent cisterna magna autologous blood injection; brain tissues were collected 1 day after SAH (n = 6/group). Immune infiltration and molecular docking were also performed.</p><p><strong>Results: </strong>Among 2,645 DEGs, 35 were ferroptosis-related. MAPK3, STAT3, G6PD, and PGD were prioritized as ferroptosis-associated candidate genes and were upregulated in human aSAH peripheral blood, mouse SAH cortex, and the clinical qPCR cohort. Single-cell analysis showed expression of the corresponding mouse genes across annotated brain cell types, especially immune/glial populations. In mouse SAH brain tissue, MAPK3/ERK1, STAT3, PGD, and G6PD protein levels increased, p-STAT3/STAT3 ratio was elevated, MDA content increased, and GPX4 activity decreased. Immune profiling showed increased neutrophils, mast cells, and activated dendritic cells. Ganoderic acid A was prioritized as a preliminary in silico candidate.</p><p><strong>Conclusion: </strong>MAPK3, STAT3, G6PD, and PGD are ferroptosis-associated candidate genes in aSAH, supported by human peripheral-blood, mouse cortex, single-cell, and mouse brain validation. Ganoderic acid A remains an exploratory in silico candidate requiring further functional validation.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1823039"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empowering recovery: the role of self-management in motor-functional neurological disorder.","authors":"Sara Issak, Richard Antony Kanaan, Glenn Nielsen","doi":"10.3389/fneur.2026.1967513","DOIUrl":"https://doi.org/10.3389/fneur.2026.1967513","url":null,"abstract":"<p><p>A Self-management refers to patients' independent use of knowledge and skills to manage symptoms, maintain health, and respond to setbacks, both during and beyond active therapy. This mini-review summarises the current literature on self-management in motor-FND, including its key components, definitions, and role in supporting recovery during rehabilitation. FND-focused education, strategies to normalise movement, goal setting with graded activity, and the development of a relapse-prevention plan are described as components of self-management. Empirical evidence is limited but promising. Future studies need to examine and operationalise self-management strategies, including the optimal content, type, intensity and delivery. Self-management should empower individuals with motor-FND to become active agents in managing their condition.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1967513"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuromelanin-sensitive magnetic resonance imaging in the diagnosis and assessment of Parkinson's disease.","authors":"Die Zhang, Aishanjiang Yusufujiang, Hongyan Li","doi":"10.3389/fneur.2026.1908455","DOIUrl":"https://doi.org/10.3389/fneur.2026.1908455","url":null,"abstract":"<p><p>Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized primarily by the progressive loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc); noradrenergic neurons in the locus coeruleus (LC) are also frequently affected. Because clinical motor symptoms usually emerge only after substantial neurodegeneration has occurred, there is a compelling need for noninvasive imaging biomarkers capable of detecting early pathological changes. Neuromelanin-sensitive magnetic resonance imaging (NM-MRI) generates neuromelanin-related image contrast in the SNpc and LC and can indirectly reflect the structural integrity of these catecholaminergic nuclei. Current evidence suggests that NM-MRI may be useful for distinguishing patients with PD from healthy controls, supporting the differential diagnosis of selected atypical parkinsonian syndromes and essential tremor, assessing disease stage, monitoring longitudinal change, and evaluating high-risk individuals in the prodromal phase. This review provides an updated account of recent advances in the use of NM-MRI for diagnostic support, differential diagnosis, prodromal assessment, longitudinal monitoring, multimodal imaging, and artificial intelligence-based analysis, and discusses its clinical role relative to other imaging and fluid biomarkers. Combining NM-MRI with complementary imaging measures, such as quantitative susceptibility mapping and diffusion MRI, and with automated analytical methods may further enhance pathological characterization and quantitative assessment. However, the available evidence is derived largely from single-center or case-control studies with limited sample sizes. Substantial variability may arise from differences in scanners, magnetic field strengths, acquisition protocols, and analytical methods, while independent external validation and prospective multicenter longitudinal evidence remain limited. The biological basis of the NM-MRI signal has not been fully established, and artificial intelligence models developed for NM-MRI remain vulnerable to overfitting, limited interpretability, and limited cross-center generalizability. Accordingly, NM-MRI cannot currently serve as a stand-alone diagnostic tool for PD or replace diagnosis based on comprehensive clinical assessment. It is better regarded as a promising complementary imaging biomarker and research tool. Before NM-MRI can be widely used for routine clinical diagnosis, disease monitoring, or as a clinical trial outcome measure, acquisition and analytical methods must be further standardized, and its performance must be evaluated in large, prospective, multicenter longitudinal studies.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1908455"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early neuro biomarker changes and electrophysiological nerve dysfunction in Swedish V50M hereditary transthyretin amyloidosis: a pilot study.","authors":"Sandra Arvidsson, Intissar Anan, Malin Olsson, Victoria Heldestad","doi":"10.3389/fneur.2026.1943011","DOIUrl":"10.3389/fneur.2026.1943011","url":null,"abstract":"<p><strong>Background: </strong>This exploratory pilot study aimed to evaluate serum levels of neurofilament light chain (NfL), peripherin (PRPH), and glial fibrillary acidic protein (GFAP), and to explore their potential associations with nerve conduction studies (NCS) and nerve ultrasound (NUS) in a Swedish cohort of newly diagnosed patients with V50M transthyretin (TTR) amyloidosis (ATTRv).</p><p><strong>Materials and methods: </strong>Seventeen V50M-ATTRv patients exhibiting varying initial clinical symptoms were included for NCS, NUS, and blood analyses of NfL, PRPH, and GFAP.</p><p><strong>Results: </strong>V50M-ATTRv patients had a short disease duration (median, 7 months) and predominantly (52.9%) presented with self-reported neuropathic clinical symptoms at disease onset. Sixteen had recently initiated TTR-stabilizing therapy, whereas one remained untreated. Overall, NfL levels were significantly higher in patients than in age-matched controls (<i>p</i> < 0.001). This difference remained significant among older individuals (<i>p</i> < 0.001), but not among younger individuals (<i>p</i> = 0.071). Patients with an earlier age at disease onset had significantly higher PRPH levels compared with those with later disease onset (<i>p</i> = 0.030). Among younger individuals, PRPH levels were higher in patients compared with age-matched controls, but the difference was not significant (<i>p</i> = 0.200). NCS parameters showed significant associations with both NfL and PRPH, but no such associations were seen with GFAP. None of the neurobiomarkers demonstrated any associations with NUS.</p><p><strong>Conclusion: </strong>In this pilot cohort of newly diagnosed Swedish V50M-ATTR patients, NfL was associated with electrophysiological measures of axonal dysfunction, whereas PRPH showed an exploratory signal of interest in younger patients with early disease onset. Larger longitudinal studies are required to determine whether PRPH may serve as a complementary biomarker for the early detection and monitoring of peripheral nerve involvement in ATTRv. Given the pilot design and limited sample size, the subgroup and regression findings should be considered exploratory and hypothesis-generating.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1943011"},"PeriodicalIF":3.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-specific clinical profiles in patients with acute ischemic stroke and chronic kidney disease.","authors":"Sean Holden-Kapshuck, Danny Pham, Grey Holler, Georgia Roper, Samuel Nathaniel, Austin Dang, Brandon Phillips, Mason Pearce, Richard Goodwin, Thomas I Nathaniel","doi":"10.3389/fneur.2026.1959768","DOIUrl":"10.3389/fneur.2026.1959768","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is common among patients with acute ischemic stroke (AIS) and is associated with worse outcomes. Although sex-related differences in stroke are well recognized, it remains unclear whether clinical characteristics associated with sex differ according to CKD status. We characterized sex-associated clinical profiles among patients with AIS with and without documented CKD.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the PRISMA Health Stroke Registry. Baseline characteristics were compared between patients with and without documented CKD in the overall cohort and after stratification by sex. Multivariable logistic regression with backward likelihood-ratio selection was used to identify independent clinical characteristics associated with documented CKD in the overall cohort and with male sex within the CKD and non-CKD subgroups. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Internal stability was assessed using bootstrap resampling.</p><p><strong>Results: </strong>Among 5,469 patients with AIS, 447 (8.2%) had documented CKD. Independent characteristics associated with CKD included prosthetic heart valve (OR, 3.73), elevated serum creatinine (OR, 2.79), obesity (OR, 2.51), heart failure (OR, 2.21), hypertension (OR, 2.20), African American race (OR, 2.11), and depression (OR, 1.97). In stratified analyses, associations of male sex with sleep apnea, smoking, and diastolic blood pressure ≥80 mmHg were numerically stronger in the CKD group than in the non-CKD group: sleep apnea, OR 4.62 vs. 2.38; smoking, OR 3.19 vs. 1.31; and diastolic blood pressure ≥80 mmHg, OR 2.58 vs. 1.43. However, formal interaction testing did not demonstrate statistically significant effect modification by CKD status. The sex-association model among patients with CKD demonstrated greater apparent discrimination than the corresponding non-CKD model (AUC, 0.785 vs. 0.630).</p><p><strong>Conclusion: </strong>Patients with AIS demonstrated distinct sex-associated clinical profiles according to CKD status. Although several associations were numerically stronger among patients with CKD, formal interaction testing did not establish statistically significant effect modification. These findings characterize clinical heterogeneity among men and women with established AIS and warrant further investigation to determine whether these profiles have implications for treatment or outcomes.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1959768"},"PeriodicalIF":3.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurovascular uncoupling in type 2 diabetes mellitus: multimodal MRI reveals the association between hippocampal and subcortical structures dysfunction and cognitive decline.","authors":"Wenjie Chen, Mingrui Li, Weiyin Vivian Liu, Yangye Zheng, Zhongshao Zhang, Wenfeng Huang, Shutong Huang, Hailing Zhou","doi":"10.3389/fneur.2026.1937804","DOIUrl":"10.3389/fneur.2026.1937804","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the efficiency of neurovascular coupling (NVC) in hippocampal and subcortical structures in type 2 diabetes mellitus (T2DM) and its relations with cognition and glycemic control, and to characterize multimodal MRI features of T2DM-related cognitive decline.</p><p><strong>Methods: </strong>Forty-nine T2DM patients and 43 healthy controls underwent montreal cognitive assessment (MoCA), digit span (DST), clock drawing (CDT), and fasting blood glucose (FBG)/glycated hemoglobin (HbA1c) measurement. High-resolution T1-weighted structural images, three-dimensional arterial spin labeling (3D-ASL) perfusion images, and resting-state functional MRI (rs-fMRI) were acquired on a 3T scanner. Volumes, cerebral blood flow (CBF), fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity (ReHo), degree centrality (DC), and NVC were calculated for bilateral hippocampus, amygdala, anterior thalamus, caudate, nucleus accumbens, putamen, and globus pallidus. Partial correlations assessed associations between imaging metrics, glycemic parameters, and MoCA scores.</p><p><strong>Results: </strong>T2DM had significantly lower MoCA (<i>P</i> < 0.05) but no differences in DST or CDT. Right anterior thalamic volume was reduced. CBF decreased in bilateral hippocampus, bilateral anterior thalamus, and right amygdala. ReHo reduced in right anterior thalamus and left amygdala. NVC decreased in left hippocampus and left amygdala. No basal ganglia differences were found. MoCA negatively correlated with FBG (<i>r</i> = -0.405) and positively with right thalamic volume (<i>r</i> = 0.311). HbA1c and FBG negatively correlated with left anterior thalamic CBF (<i>r</i> = -0.344 and -0.367, <i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>T2DM shows decreased perfusion, reduced regional synchronization, and neurovascular uncoupling in limbic-subcortical structures including hippocampus, anterior thalamus, amygdala, while basal ganglia motor circuits are preserved. Multimodal MRI metrics may provide imaging targets for early identification and intervention.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1937804"},"PeriodicalIF":3.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"World Stroke Organization mechanical thrombectomy workshops combined with the Global Stroke Alliance builds regional capacity.","authors":"Violiza Inoa, Ryna Then, Nicole M Cancelliere, Nitin Goyal, Karelle Spence, Michael J Wells, Andres Fonnegra, Omar Lopez, Fernando Gonzalez, Daniel Mantilla, Alex Eusebio, Cedric Pimentel, Marc Ribo, Manuel Moreu, Serdar Geyik, Ossama Mansour, Songul Senadim Kaytanci, Cagatay Andiç, Atilla Ozcan Ozdemir, Vipul Gupta, Vikram Huded, Octavio Marques Pontes-Neto, Gaurav Goel, Erdem Gurkas, Semih Giray, Raul Nogueira, Laetitia de Villiers, Ruchi Kabra, Rajsrinivas Parthasarathy, Vitor Mendes Pereira, Vu Dang Luu, Jeyaraj Pandian, Sheila Martins, Gillian Gordon Perue","doi":"10.3389/fneur.2026.1866027","DOIUrl":"10.3389/fneur.2026.1866027","url":null,"abstract":"<p><strong>Introduction: </strong>Access to mechanical thrombectomy (MT) remains limited in many low- and middle-income or resource-limited regions because of gaps in trained personnel, procedural experience, public awareness, and stroke-system readiness. The World Stroke Organization paired simulation-based MT workshops with the Global Stroke Alliance to combine hands-on neurointerventional education with regional advocacy, Ministry of Health engagement, public awareness activities, and stakeholder collaboration. This study evaluated the feasibility, scalability, and self-reported educational impact of MT workshops delivered within this broader WSO/GSA capacity-building framework.</p><p><strong>Methods: </strong>A comprehensive 22-h curriculum was developed, incorporating didactic sessions, hands-on simulations, and complex case studies in collaboration with the Global Stroke Alliance between August 2023 and July 2025. The workshops were designed for neurointerventional physicians and tailored to regional needs. Pre- and post-course assessments measured physician confidence in MT procedures, while a three-month follow-up survey evaluated changes in MT volumes and clinical practice. Data were analyzed using summary statistics, chi-square tests, and McNemar's tests as appropriate.</p><p><strong>Results: </strong>Among 112 participating physicians from 24 countries, 81% completed the pre-test and 72% completed the post-test; 67% had paired pre- and post-test responses. The proportion of participants rating themselves as \"very comfortable\" increased from 15% pre-workshop to 41% post-workshop (<i>p</i> < 0.001), with notable improvements in patient selection for MT (15-48%, <i>p</i> < 0.001), procedural access knowledge (15-46%, <i>p</i> < 0.001), thrombectomy technique (9-41%, <i>p</i> < 0.001), and avoiding harmful maneuvers (7-33%, <i>p</i> < 0.001). At 3 months, 32 participants completed follow-up, of whom 37.5% self-reported an increase in overall thrombectomy numbers.</p><p><strong>Conclusion: </strong>Simulation-based MT workshops are feasible and scalable across multiple regions and were associated with improved self-reported procedural confidence and early self-reported changes in clinical practice. These findings support structured hands-on training as one component of broader capacity-building efforts, while highlighting the need for objective procedural volume, patient outcome, and registry-based data to determine the effect of such programs on MT access and stroke care delivery.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1866027"},"PeriodicalIF":3.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Admission TRIAGES score for unfavorable functional outcome after traumatic brain injury: association, prognostic performance, and comparison with the Glasgow coma scale.","authors":"Weicheng Shi, Liang Xing, Jianyang Wu, Zhiwei Wang, Zhengrong Zheng, Rongsi Yang","doi":"10.3389/fneur.2026.1963243","DOIUrl":"10.3389/fneur.2026.1963243","url":null,"abstract":"<p><strong>Background: </strong>The Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate, and Systolic blood pressure (TRIAGES) is a simple trauma score that has shown prognostic value for short-term mortality in traumatic brain injury (TBI), but its relationship with functional outcome remains insufficiently characterized.</p><p><strong>Methods: </strong>We conducted a retrospective single-center cohort study of adults with TBI admitted between June 2017 and May 2026. The primary exposure was the TRIAGES score calculated using age and the first GCS, respiratory rate, and systolic blood pressure values recorded at initial emergency department presentation before any in-hospital therapeutic intervention. Admission GCS was defined as the GCS value obtained at this same initial assessment. The primary outcome was unfavorable functional status at hospital discharge, defined as a discharge Glasgow Outcome Scale (GOS) score of 1-3. Multivariable logistic regression, restricted cubic spline analysis, receiver operating characteristic (ROC) analysis, calibration, Brier score, decision curve analysis, bootstrap internal validation, sensitivity analyses, and subgroup analyses were performed.</p><p><strong>Results: </strong>Among 753 patients, 181 (24.0%) had an unfavorable functional outcome. Each 1-point increase in TRIAGES was independently associated with higher odds of unfavorable functional status after adjustment for sex, injury mechanism, number of non-reactive pupils, and Rotterdam CT score (adjusted odds ratio 2.81, 95% confidence interval 2.29-3.45; <i>p</i> < 0.001). The association was approximately linear (P for non-linearity = 0.366). TRIAGES alone achieved an area under the ROC curve (AUC) of 0.905 compared with 0.890 for admission GCS alone (ΔAUC = 0.015, 95% CI 0.001-0.029; paired DeLong <i>p</i> = 0.034). Within this cohort, a Youden index-derived threshold of TRIAGES ≥3 yielded a sensitivity of 0.956 and specificity of 0.701. Bootstrap internal validation showed an optimism-corrected AUC of 0.905, and the findings remained consistent across multiple sensitivity analyses.</p><p><strong>Conclusion: </strong>Higher TRIAGES scores at initial emergency presentation were independently associated with unfavorable functional status at hospital discharge in adults with TBI. TRIAGES showed good prognostic performance and a small within-cohort increase in discrimination relative to admission GCS alone while retaining the practical advantage of using only four routinely available variables. Prospective multicenter studies with external validation and standardized long-term functional outcomes are warranted.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1963243"},"PeriodicalIF":3.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpretable polar-flow decomposition for torsional nystagmus lateralization in posterior-canal BPPV.","authors":"Yanjun Li, Xiaomin Xu, Lidan Gao, Qiqi Shao, Jie Chen, Wenhuan Wang, Xiaoqing Li, Congcong Sun, Shike Hou, Xiaokai Yang","doi":"10.3389/fneur.2026.1963383","DOIUrl":"10.3389/fneur.2026.1963383","url":null,"abstract":"<p><strong>Objective: </strong>Torsional nystagmus during the Dix-Hallpike maneuver represents a cardinal vestibulo-ocular reflex (VOR) sign in posterior-canal benign paroxysmal positional vertigo (pc-BPPV). This study develops an interpretable framework for automated classification of torsional nystagmus direction and temporal localization of abnormal events from clinical infrared recordings.</p><p><strong>Methods: </strong>Infrared Dix-Hallpike videos were processed via You Only Look Once version 8 nano (YOLOv8n) pupil localization, dynamic iris masking, and Recurrent All-Pairs Field Transforms (RAFT) optical flow. Flow vectors were projected into pupil-centered polar coordinates to extract tangential and radial motion features. A bidirectional gated recurrent unit with attention (BiGRU-attention) network performed segment-level three-class classification with sliding-window patient-level inference.</p><p><strong>Results: </strong>Five-fold cross-validation yielded segment-level accuracy of 94.19% ± 0.88% with balanced F1-scores across all three classes. On an independent 45-patient long-video test set, patient-level accuracy reached 97.78% at 60 frames per second (fps) and 100% (45/45) at 30 fps. Temporal localization achieved mean intersection-over-union (IoU) of 0.899 and 0.896, with hit rates of 96.8 and 100%, respectively.</p><p><strong>Conclusion: </strong>The polar-flow framework enables physiologically interpretable and robust classification of pc-BPPV-related torsional-upbeat nystagmus. By explicitly decomposing eye movements into tangential and radial components, it provides reliable lateralization while demonstrating the potential for clinically meaningful temporal localization of abnormal nystagmus events.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1963383"},"PeriodicalIF":3.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated platelet-to-lymphocyte ratio is associated with stroke-associated pneumonia in acute ischemic stroke: a retrospective cohort study.","authors":"Tingting Duan, Chengfei Xu, Jianmei Zhan, Lanzhen Wang, Zhaoping Wu, Yueqi Xu, Junnan Ye, Ming Yang","doi":"10.3389/fneur.2026.1891885","DOIUrl":"10.3389/fneur.2026.1891885","url":null,"abstract":"<p><strong>Background: </strong>Stroke-associated pneumonia (SAP) is a common and serious complication of acute ischemic stroke (AIS) that substantially worsens clinical outcomes. The platelet-to-lymphocyte ratio (PLR), an accessible composite index derived from routine complete blood counts, may reflect post-stroke immune imbalance. However, its role in predicting SAP in AIS patients remains unexplored.</p><p><strong>Methods: </strong>This retrospective cohort study included 1,745 patients with acute ischemic stroke (AIS) after systematic screening of 2,150 patients. After the original screening, 1,766 eligible patients remained; 21 additional patients with extreme PLR values (>1,000) were excluded. HbA1c missing values were imputed once using multiple imputation by chained equations (MICE) with a random forest estimator. PLR was calculated as platelet count divided by lymphocyte count and log2-transformed. Multivariable logistic regression, generalized additive modeling (GAM), and two-piecewise logistic regression were used to examine associations between PLR and stroke-associated pneumonia (SAP). Subgroup analyses were performed across seven clinical variables with interaction tested by likelihood ratio test. Predictive performance was evaluated by receiver operating characteristic (ROC) analysis and compared with C-reactive protein (CRP) and A2DS2 score using the DeLong test.</p><p><strong>Results: </strong>SAP occurred in 359 patients (20.6%). PLR was higher in patients with SAP than in those without SAP (median 136.17 vs. 113.69, <i>p</i> < 0.001). In the fully adjusted model, log2-PLR remained associated with SAP (OR = 1.36 per 1-unit increase, 95% CI: 1.12-1.65, <i>p</i> = 0.0021). Compared with the lowest quartile, the highest PLR quartile was associated with increased SAP odds (OR = 1.62, 95% CI: 1.03-2.54, <i>p</i> = 0.0386). GAM and two-piecewise regression identified a threshold at PLR = 224.8 (log2-PLR = 7.812). Below this threshold, the association was not significant (OR = 1.21, 95% CI: 0.93-1.57, <i>p</i> = 0.1551), whereas above it the association was significant (OR = 2.06, 95% CI: 1.10-3.87, <i>p</i> = 0.0240). The AUCs were 0.584 for PLR, 0.825 for CRP, and 0.757 for A2DS2. The AUCs of the PLR + CRP and PLR + A2DS2 models were 0.803 and 0.763, respectively.</p><p><strong>Conclusion: </strong>Elevated PLR is associated with SAP in AIS patients, exhibiting a non-linear threshold-dependent relationship. Although standalone discriminatory performance is modest, PLR is universally available from routine blood counts and may serve as a cost-effective tool for early SAP risk stratification. Prospective multicenter validation is warranted.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1891885"},"PeriodicalIF":3.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}