Frontiers in Neurology最新文献

{"title":"Precision medicine for futile recanalization after mechanical thrombectomy in acute ischemic stroke: mechanisms, diagnostics, and tailored therapies.","authors":"Yihua Zhu, Jie Wen, Xingqi Zhao, Haoxuan Li, Gelin Xu","doi":"10.3389/fneur.2026.1962902","DOIUrl":"https://doi.org/10.3389/fneur.2026.1962902","url":null,"abstract":"<p><p>Mechanical thrombectomy has substantially improved outcomes in appropriately selected patients with acute ischemic stroke, yet futile recanalization remains a major clinical challenge. Futile recanalization describes poor functional recovery despite technically successful macrovascular reperfusion, underscoring the incomplete relationship between angiographic reperfusion and tissue-level or microvascular perfusion. This narrative review summarizes current clinical, mechanistic, and translational evidence on the determinants of futile recanalization and evaluates emerging precision-medicine approaches to its prevention and management. Precision imaging has established a role in tissue-based patient selection, and recent randomized trials have expanded thrombectomy evidence to selected patients with large-core infarction. In contrast, current randomized evidence does not support routine endovascular treatment for unselected medium-vessel occlusion populations. We further examine bridging therapy versus direct mechanical thrombectomy, individualized periprocedural management, biomarkers, and decision support based on artificial intelligence. Clinical and imaging phenotypes may provide prognostic or mechanistic information, but no phenotype-based strategy has been prospectively validated to select bridging therapy or direct thrombectomy. Biomarkers currently remain primarily prognostic or exploratory. Artificial intelligence applications are largely focused on diagnostic and prognostic support. treatment-benefit prediction, by contrast, requires evidence of treatment-effect modification and prospective validation. Experimental studies of microvascular no-reflow and thrombo-inflammation provide biological rationale for targeted interventions but do not establish clinical efficacy. Future research should integrate multimodal imaging, biological profiling, and validated decision-support tools to move beyond angiographic success toward individualized strategies focused on tissue integrity and meaningful functional recovery.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1962902"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265635","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":"Explainable machine learning-based prediction of postoperative pulmonary infection after aneurysmal subarachnoid hemorrhage clipping and exploratory analysis of enteral nutrition timing: a dual-cohort retrospective study.","authors":"Lin Li, Xiang Li, Shufang Shi","doi":"10.3389/fneur.2026.1873566","DOIUrl":"https://doi.org/10.3389/fneur.2026.1873566","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pulmonary infection (PPI) is a common complication after microsurgical clipping for aneurysmal subarachnoid hemorrhage (aSAH) and is associated with impaired recovery and greater use of hospital resources.</p><p><strong>Objective: </strong>To develop and temporally validate an explainable machine-learning model for PPI risk stratification and to explore the association between enteral nutrition (EN) initiation timing and subsequent PPI risk.</p><p><strong>Methods: </strong>This dual-cohort retrospective study was reported in accordance with Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis plus Artificial Intelligence (TRIPOD+AI) principles. Candidate predictors were selected using a combined least absolute shrinkage and selection operator (LASSO) regression and random-forest importance strategy. Nine machine-learning algorithms were developed and compared in terms of discrimination, calibration, and clinical utility using decision-curve analysis.</p><p><strong>Results: </strong>In the validation cohort, the Naive Bayes model showed the best overall performance [area under the receiver operating characteristic curve (AUC), 0.811; 95% confidence interval (CI), 0.755-0.855]. SHAP analysis identified the major contributors to the primary 24-h prediction model. Separately, a secondary exploratory analysis of continuous EN initiation timing identified a nonlinear pattern, with a bootstrap median model-derived inflection point of 24.0 h (95% bootstrap interval, 23.0-27.0 h).</p><p><strong>Conclusions: </strong>This explainable model may support early PPI risk stratification after aSAH clipping. The observed EN timing signal should be interpreted as exploratory and warrants prospective validation before clinical implementation.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1873566"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265739","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":"Limited utility of optic nerve sheath diameter for monitoring intracranial pressure in patients with intracranial hemorrhage.","authors":"Beschan Ahmad, Mario Maria Joachim Trappe, Lars-Olav Harnisch, Onnen Moerer, Ibrahim Allam, Fabian Kück, Ilko L Maier","doi":"10.3389/fneur.2026.1932373","DOIUrl":"https://doi.org/10.3389/fneur.2026.1932373","url":null,"abstract":"<p><strong>Introduction: </strong>Monitoring intracranial pressure (ICP) is a key component in the management of patients with intracranial hemorrhage. Transorbital ultrasound (toUS)- based measurement of the optic nerve sheath diameter (ONSD) - has been proposed as a non-invasive surrogate for ICP assessment. However, substantial variability in measurement techniques and cut-off values has raised concerns regarding its reliability. This study aimed to evaluate the association between repeatedly measured ONSD and invasively measured ICP in patients with intracranial hemorrhage and to assess the ability of ONSD to reflect changes in ICP over time.</p><p><strong>Methods: </strong>In this prospective longitudinal study ONSD was measured daily using ultrasound at 3- and 6 mm posterior to the optic disc and compared with simultaneously recorded invasive ICP measurements. A total of 55 patients with intracranial hemorrhage were included, contributing repeated measurements over a mean of 5.47 ± 2.27 days.</p><p><strong>Results: </strong>Overall, the association between ICP and ONSD was weak. In the prespecified primary analysis, ICP was not associated with bilateral mean irONSD at 3 mm (<i>β</i> = 0.004 mm per mmHg, 95% CI - 0.003 to 0.011; <i>p</i> = 0.169; marginal R2 = 0.3%). At 6 mm, a small but statistically significant relationship was detectable at bilateral ICP mean values for outer-reflection ONSD [<i>β</i> = 0.010, 95% CI (0.002-0.019), <i>p</i> = 0.016; marginal r2 = 1.3%].</p><p><strong>Conclusion: </strong>ICP explains less than 2% of the variance in ONSD in this treated cohort with predominantly controlled ICP. These findings question its reliability as a stand-alone tool for serial monitoring of dynamic ICP changes in treated neurocritical care patients and therefore should not be interpreted as a direct substitute for invasive ICP or as a stand-alone measure of short-term ICP change.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1932373"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265678","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":"Imaging phenotype is more strongly associated with early neurological deterioration after acute isolated pontine infarction: a retrospective cohort study.","authors":"Yanxiang Chen, Xiaoqiang Li, Hui Wang, Guonan Zhou","doi":"10.3389/fneur.2026.1913826","DOIUrl":"https://doi.org/10.3389/fneur.2026.1913826","url":null,"abstract":"<p><strong>Background: </strong>Early neurological deterioration (END) is common after acute isolated pontine infarction (IPI), but the relative associations of imaging phenotype and metabolic or coagulation markers with END remain uncertain. We evaluated these domains and developed an exploratory prediction model.</p><p><strong>Methods: </strong>We retrospectively analyzed 162 patients with acute IPI. END was a ≥2-point increase in total National Institutes of Health Stroke Scale (NIHSS) score or a ≥1-point increase in NIHSS motor item 5 or 6 from the admission baseline within 7 days after admission. Imaging was modeled nominally (BAD, LAA, or SAD; SAD as reference). Primary associations were estimated by Firth logistic regression. Four prespecified Firth models were compared by AUC, and the full model underwent 1,000-resample bootstrap validation.</p><p><strong>Results: </strong>END occurred in 49 patients (30.2%). In the full Firth model, BAD (OR 20.70, 95% CI 7.10-70.04; <i>P</i> < 0.001) and LAA (OR 5.06, 95% CI 1.84-15.41; <i>P</i> = 0.001), relative to SAD, were associated with END. Thrombin time (TT) was also associated with END (OR 1.34 per second, 95% CI 1.04-1.73; <i>P</i> = 0.020); diabetes showed borderline evidence of association (<i>P</i> = 0.057), whereas TyG was not independently associated (<i>P</i> = 0.603). The apparent AUC was 0.652 (95% CI 0.562-0.742) for the base model, 0.814 (95% CI 0.745-0.883) for the base-plus-imaging model, 0.716 (95% CI 0.631-0.802) for the base-plus-metabolic/coagulation model, and 0.852 (95% CI 0.792-0.911) for the full model. Discrimination did not differ significantly between the base-plus-imaging and base-plus-metabolic/coagulation models (ΔAUC 0.098, bootstrap 95% CI -0.015-0.180; paired DeLong <i>P</i> = 0.066). All 1,000 bootstrap iterations succeeded; the optimism-corrected AUC was 0.818, with a calibration intercept of -0.023, calibration slope of 0.870, and Brier score of 0.162.</p><p><strong>Conclusion: </strong>In this cohort, BAD and LAA imaging phenotypes were independently associated with END, whereas TyG was not independently associated. However, the direct discrimination advantage of the imaging model over the metabolic/coagulation model was not statistically established. The association with TT is exploratory, and the full model and nomogram require external validation before clinical use.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1913826"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265703","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":"A neuroimmune hypothesis linking chronic cervical inflammation to systemic symptoms: the role of the vagus-NTS axis.","authors":"Min-Chieh Chang","doi":"10.3389/fneur.2026.1881152","DOIUrl":"https://doi.org/10.3389/fneur.2026.1881152","url":null,"abstract":"<p><p>Chronic pain syndromes in women often present with symptoms that do not fully correspond to the anatomical site of detectable pathology. Dyspareunia, vulvar pain, bladder discomfort, glossodynia, headache, dizziness, gastrointestinal symptoms, palpitations, insomnia, and musculoskeletal pain may coexist, suggesting shared neuroimmune and autonomic mechanisms rather than isolated local disease alone. This hypothesis was motivated by two preliminary clinical observations presented at meetings of the Taiwan Association of Obstetrics and Gynecology. The first series, presented in March 2024, involved 28 women with dyspareunia in whom the anatomical location of pain did not consistently correspond to the presumed pathological origin, with symptomatic improvement observed after targeted endocervical treatment. The second series, presented in March 2026, involved 28 women with intractable glossodynia, several of whom had coexisting vulvovaginal or cervical inflammatory findings and reported improvement after gynecologic treatment. These observations are not presented as definitive evidence of causality, but as hypothesis-generating clinical signals. We propose that chronic cervical inflammation may act as a hidden peripheral inflammatory source capable of modulating vagal afferent signaling to the nucleus tractus solitarius. Through interactions with autonomic, hypothalamic, limbic, and cortical networks, persistent cervical inflammatory input may contribute to neuroimmune amplification and systemic symptoms beyond the anatomical location of pain. This model is testable through prospective studies evaluating cervical inflammatory markers, heart rate variability, vagal tone, cytokine profiles, central sensitization indices, and symptom changes after targeted cervical treatment. Pain location may not necessarily indicate pathological origin, and chronic cervical inflammation may represent an underrecognized contributor to systemic neuroimmune symptoms through the vagus-NTS axis.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1881152"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265770","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":"Cenobamate in super-refractory status epilepticus: current evidence from a patient-level synthesis.","authors":"Giovanni Falcicchio, Teresa Francavilla","doi":"10.3389/fneur.2026.1961349","DOIUrl":"https://doi.org/10.3389/fneur.2026.1961349","url":null,"abstract":"<p><strong>Background: </strong>Super-refractory status epilepticus (SRSE) represents a challenging neurological emergency, with limited therapeutic options after conventional intravenous antiseizure medications (ASMs) and continuous anesthetic therapy have failed. Cenobamate has shown remarkable efficacy in drug-resistant focal epilepsy, but its role in SRSE is currently supported only by isolated case reports.</p><p><strong>Methods: </strong>We performed a patient-level synthesis of published cases of cenobamate-treated SRSE, focusing on treatment latency, titration strategy, electroclinical response, concomitant therapies, safety, and functional outcomes.</p><p><strong>Results: </strong>Three publications reporting six patients were identified. Cenobamate was introduced between 13 and 103 days after SRSE onset, following failure of multiple intravenous and oral ASMs, anesthetic agents, and, in most cases, immunomodulatory therapies. Although the timing of treatment initiation varied substantially, electroencephalographic improvement generally occurred within two weeks after cenobamate initiation and was usually accompanied by clinical recovery, successful withdrawal of anesthetic therapy, and liberation from the intensive care unit. Most patients initiated cenobamate at the recommended dose of 12.5 mg/day but underwent individualized dose-escalation schedules compared with the approved outpatient regimen. No cases of drug reaction with eosinophilia and systemic symptoms, severe cardiac adverse events, or treatment discontinuation attributable to cenobamate were reported.</p><p><strong>Conclusions: </strong>Although the available evidence remains limited to a small number of observational reports, this patient-level synthesis identified consistent clinical patterns that support further investigation of cenobamate as an adjunctive therapy for SRSE. At present, no conclusions regarding treatment efficacy can be drawn. Prospective multicenter studies are needed to clarify cenobamate optimal timing, titration strategy, safety, and potential role within SRSE treatment algorithms.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1961349"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265707","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":"Drug-coated balloon, drug-eluting stent, versus bare-metal stent for vertebral artery ostial stenosis: a systematic review and network meta-analysis.","authors":"Zhiqiang Li, Shuhui Wu, Chao Wu, Yue Yin, Xiaofan Xu","doi":"10.3389/fneur.2026.1901781","DOIUrl":"https://doi.org/10.3389/fneur.2026.1901781","url":null,"abstract":"<p><strong>Background: </strong>Stenosis at the origin of the vertebral artery (VAOS) accounts for approximately one in five posterior circulation ischemic events. Bare-metal stents (BMS) have been the conventional endovascular treatment, but restenosis occurs in 11-67% of cases. Drug-coated balloons (DCB) and drug-eluting stents (DES) are alternative strategies; however, no network meta-analysis has compared all three modalities specifically at the vertebral origin.</p><p><strong>Methods: </strong>Five databases-PubMed, Embase, Cochrane CENTRAL, CNKI, and Wanfang-were searched from 2010 through May 2026 for studies comparing at least two of DCB, DES, or BMS in adults with symptomatic VAOS. The search identified 499 records; 393 underwent title and abstract screening after deduplication, from which 60 full-text articles were assessed. A frequentist random-effects network meta-analysis was conducted using the netmeta package (R 4.5.2), with Bayesian sensitivity analysis. The primary endpoint was imaging-confirmed restenosis (≥50%). The protocol was registered with PROSPERO (CRD420261413981).</p><p><strong>Results: </strong>Seven studies (three randomized trials and four observational cohorts, <i>N</i> = 970; range 46-217) met the inclusion criteria. Compared with BMS, both DES (OR 0.27, 95% CI 0.17-0.45) and DCB (OR 0.39, 95% CI 0.18-0.83) reduced restenosis. DES and DCB did not differ significantly from each other (OR 1.42, 95% CI 0.58-3.50). Between-study heterogeneity was modest (<i>I</i> ² = 20.5%). Although the point estimate suggests modest heterogeneity, the wide confidence interval and the small number of studies limit precision. Low <i>I</i> ² in a small network should not be equated with clinical homogeneity. P-scores ranked DES first (88.9%), DCB second (60.7%), and BMS last (0.4%). For perioperative safety, DCB ranked highest (P-score 90.0%).</p><p><strong>Conclusion: </strong>Both DES and DCB reduce restenosis compared with BMS in VAOS. Both DES and DCB are associated with lower restenosis rates than BMS. The relative anti-restenosis efficacy of DES versus DCB remains uncertain due to the absence of direct head-to-head comparisons. Treatment selection should be individualized based on lesion characteristics and procedural considerations. The DCB evidence base remains small, and head-to-head comparisons of DES versus DCB at the vertebral origin are needed.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD420261413981, Identifier: CRD420261413981.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1901781"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265733","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":"Research on dynamic functional connectivity and graph theoretic features of different motor subtypes in Parkinson's disease based on ICA.","authors":"Jia Tang, Shaoge Gao, Yichen Lv, Hao Wang, Yanting Liu, Hongyu Zhou, Jiaqi Yuan, Xueqian Lin, Manyan Hu, Yan Cong, Xin Wang","doi":"10.3389/fneur.2026.1943343","DOIUrl":"https://doi.org/10.3389/fneur.2026.1943343","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study combined independent component analysis (ICA)-derived dynamic functional connectivity (dFNC) with dynamic graph theory analysis methods to analyze the changes in dFNC and dynamic graph theoretic indicators in different motor subtypes of Parkinson's disease (PD)-tremor-dominant (TD) subtype and postural instability/gait difficulty (PIGD) subtype-and healthy controls (HC). We aimed to explore the neural circuitry abnormal mechanisms and differences between the two subtypes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Using a prospective observational study design, from January 2021 to May 2024 at Northern Jiangsu People's Hospital, we enrolled 36 diagnosed PD patients according to inclusion criteria-19 patients with PIGD subtype and 17 patients with TD subtype-along with 19 healthy subjects matched for age, sex, and education level. Resting-state functional magnetic resonance imaging (rs-fMRI), demographic information, and clinical motor function assessment data were collected from all participants. The ICA and dynamic functional network connectivity (dFNC) analysis were performed using the GIFT toolbox platform based on MATLAB. Combined with dynamic graph theory analysis, features such as characteristic path length, clustering coefficient, and node degree were extracted. The dFNC and dynamic graph theoretic indicators of the PIGD group, TD group, and HC group were compared horizontally to clarify the common and specific dynamic abnormalities of brain networks between the two subtypes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Nine functional brain networks were identified through ICA. Significant differences among the three groups were observed in five brain networks: auditory network, left frontoparietal network, right frontoparietal network, ventral attention network, and sensorimotor network. Based on network-to-network functional connectivity analysis using these nine functional brain networks, after strict FDR correction, only inter-network coupling strength between the auditory network and sensorimotor network showed significant group differences (&lt;i&gt;T&lt;/i&gt; = 7.548, FDR-corrected &lt;i&gt;p&lt;/i&gt; = 0.00137). Four recurring functional connectivity states were identified through dFNC analysis. Across all participants, State 2 and State 3 accounted for 38 and 23% of total time, respectively. PIGD patients tended to spend more time in these two low-connectivity states. In terms of temporal properties, only the occurrence frequency of state 4 showed significant differences among the three groups (&lt;i&gt;F&lt;/i&gt; = 4.855, FDR-corrected &lt;i&gt;p&lt;/i&gt; = 0.047). Post-hoc test results showed that HC groups were significantly higher than PIGD groups and presented a trend higher than TD groups, while there was no statistically significant difference between the two PD subtypes. One-way analysis of variance was performed on whole-brain node-to-node functional connectivity and graph theoretic attributes of the three groups; no significant differences were ","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1943343"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265695","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":"Independent association of SOT-composite with berg balance scale scores in Chinese stroke patients: a retrospective cross-sectional study.","authors":"Wenhua Zheng, Wei Shen, Mengyun Li, Gengmao Ma, Minhan Xie, Qingying Leng, Ruixian Zhang, Churong Liu, Xiaolin Zeng, Hanbo Chen","doi":"10.3389/fneur.2026.1918753","DOIUrl":"https://doi.org/10.3389/fneur.2026.1918753","url":null,"abstract":"<p><strong>Objective: </strong>Stroke-related balance dysfunction affects 61-83% of patients, yet the quantitative relationship between sensory integration capacity and functional balance remains inadequately characterized. This study investigated the association between Sensory Organization Test (SOT) composite scores and Berg Balance Scale (BBS) performance in Chinese stroke patients.</p><p><strong>Methods: </strong>This retrospective cross-sectional study analyzed data from 339 stroke patients who received treatment at Guangdong 999 Brain Hospital between January 2021 and December 2023. Exposure variable was SOT-Composite score (0-100 points, measured via NeuroCom Smart EquiTest within 48 h). Outcome variable was Berg Balance Scale total score (0-56 points, assessed within 48 h). Two models were constructed: a Core model adjusting for age, gender, diagnosis, and disease duration, and a Sensitivity model additionally adjusting for Brunnstrom lower-extremity stage and weight symmetry index. Tertile stratification of SOT-Composite scores was performed descriptively to explore dose-response patterns.</p><p><strong>Results: </strong>In the Sensitivity model, each 1-point increase in SOT-Composite score was associated with a 0.2745-point higher Berg Balance Scale score (95% CI: 0.171-0.386, <i>p</i> < 0.001; Core model: <i>β</i> = 0.2471, 95% CI 0.137-0.357, <i>p</i> < 0.001). Standardized coefficient analysis in the Sensitivity model showed Brunnstrom lower-extremity stage had the strongest association (standardized <i>β</i> = 0.4562, <i>p</i> < 0.001), followed by SOT-Composite score (standardized <i>β</i> = 0.2527, <i>p</i> < 0.001). Among sensory subsystems, visual, somatosensory, and vestibular processing ratios were all significantly associated with balance performance (unstandardized <i>β</i> = 0.18, 0.16, and 0.15 BBS points per unit ratio change, respectively).</p><p><strong>Conclusion: </strong>SOT-Composite score was independently associated with Berg Balance Scale performance in stroke patients, even after adjustment for multiple covariates. Whether targeted sensory training can improve balance outcomes warrants evaluation in future prospective intervention studies.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1918753"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265766","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 model using serum biomarkers and intra-/peri-aneurysmal CTA radiomics for discriminating ruptured from unruptured intracranial aneurysms: an external validation retrospective study.","authors":"Juan Liu, Zhipeng Chen, Kun Wang, Chunyue Yan, Fei Wang, Xiaolei Sun","doi":"10.3389/fneur.2026.1867021","DOIUrl":"10.3389/fneur.2026.1867021","url":null,"abstract":"<p><strong>Objective: </strong>To develop an interpretable model that integrates diverse machine learning algorithms, fusion strategies, intra-/perianeurysmal CTA radiomics, and serum biomarkers to differentiate ruptured from unruptured intracranial aneurysms (IAs), and to investigate the underlying biological features associated with rupture status.</p><p><strong>Methods: </strong>Totally, 744 IAs patients who underwent CTA were retrospectively enrolled. Data from Center 1 (<i>N</i> = 423) served as the training set, and data from Center 2 (<i>N</i> = 321) served as the external validation set. Volumes of interest were delineated in intra-aneurysmal and peri-aneurysmal 1 mm regions. The serum inflammation score (SIS) was constructed using serum biomarkers. Seven machine learning classifiers were employed to develop models, and the optimal fusion model was developed by combining all classifiers using arithmetic mean, geometric mean, weighted mean, and logistic regression (LRSLM). Model performance was assessed by the area under the curve (AUC) and decision curve analysis (DCA), while interpretability was evaluated via SHAP, correlation, and restricted cubic spline (RCS) analyses.</p><p><strong>Results: </strong>Among the 11 models, LRSLM exhibited robust performance in the external validation set, achieving an AUC of 0.9177 with good calibration. It also demonstrated high accuracy (0.8847), recall (0.8171), and a low Brier score (0.0999), alongside greater clinical net benefit across a wide range of threshold probabilities (10-85%). Correlation analyses revealed strong positive associations between intra-aneurysmal and peri-aneurysmal radiomic features (Spearman's <i>r</i> = 0.62, 0.72, and 0.84, respectively; all <i>p</i> < 0.001), as well as significant positive correlations between the intra-/perianeurysmal radiomics and SIS (Spearman's <i>r</i> = 0.32, 0.29, 0.32, and 0.34; all <i>p</i> < 0.001). RCS analysis further demonstrated a significant non-linear relationship between the intra-aneurysmal (IRSIAs) and peri-aneurysmal (PRSIAs) radiomic features and an increased incidence of IAs rupture (Non-linear <i>p</i> < 0.05; Overall <i>p</i> < 0.05). SHAP analysis highlighted key radiomics features contributors to the fusion model and supported model interpretability.</p><p><strong>Conclusion: </strong>The LRSLM model achieves robust discriminative performance for differentiating ruptured from unruptured IAs. SHAP analysis enhances the interpretability of the model and may assist in identifying high-risk phenotypic features, although prospective validation is required before predictive clinical application can be considered.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1867021"},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237954","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}