Frontiers in Neurology最新文献

{"title":"Association of postural orthostatic tachycardia syndrome, hypermobility spectrum disorders, and mast cell activation syndrome in young patients; prevalence, overlap and response to therapy depends on the definition.","authors":"Lilian Yao, Kavya Subramaniam, Katherine M Raja, Abi Arunachalam, Aubrey Tran, Tripti Pandey, Sahana Ravishankar, Sahan Suggala, Caitlyn Hendrickson, Andrew J Maxwell","doi":"10.3389/fneur.2025.1513199","DOIUrl":"https://doi.org/10.3389/fneur.2025.1513199","url":null,"abstract":"<p><strong>Background: </strong>The close association of syndromes of orthostatic intolerance with and without postural orthostatic tachycardia syndrome (POTS) with Joint Hypermobility Disorders (JHD) including Hypermobility Spectrum Disorder (HSD) and hypermobile Ehlers Danlos Syndrome (hEDS) and with Mast Cell Activation Syndrome (MCAS) is now firmly established. However, the prevalence of each entity relative to the other is not well established and is affected greatly by the various definitions used for each syndrome. Use of restricting definitions for each syndrome can be problematic in the clinical setting as it under-estimates the presence of disease, thereby preventing clinicians from considering potentially helpful therapeutic options.</p><p><strong>Methods: </strong>A retrospective review of the clinical records of 100 young patients meeting POTS criteria was undertaken to determine the frequency of HSD, near-hEDS, and hEDS as well as the frequency of MCAS using consensus-1, conservative consensus-2, and clinical criteria regardless of lab support. Effectiveness of MCAS therapies was assessed in relation to the method of MCAS diagnosis.</p><p><strong>Results: </strong>From records of 392 patients with orthostatic intolerance syndromes, 100 patients met POTS criteria. The frequency of JHD ranged from 13% using strict criteria of hEDS to 34% using HSD Criteria. The frequency of MCAS ranged from 2% using consensus-1 criteria, to 37% using conservative consensus-2 criteria, to 87% using clinical criteria. Patients diagnosed by clinical criteria with or without the aid of labs responded to therapy similarly to those diagnosed with stricter criteria.</p><p><strong>Conclusion: </strong>Using overly strict criteria to diagnose conditions which have a high prevalence of co-occurrence misses opportunities for potential therapeutic strategies.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1513199"},"PeriodicalIF":2.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011874","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":"Development and validation of a blood biomarker-based model for differentiating stroke etiology in acute large vessel occlusion.","authors":"Weiwei Gao, Renjing Zhu, Jingjing She, Rong Huang, Lijuan Cai, Shouyue Jin, Yanping Lin, Jianzhong Lin, Xingyu Chen, Liangyi Chen","doi":"10.3389/fneur.2025.1567348","DOIUrl":"https://doi.org/10.3389/fneur.2025.1567348","url":null,"abstract":"<p><strong>Objective: </strong>Early differentiation of stroke etiology in acute large vessel occlusion stroke (LVOS) is crucial for optimizing endovascular treatment strategies. This study aimed to develop and validate a prediction model for pre-procedural etiological differentiation based on admission laboratory parameters.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a comprehensive stroke center, enrolling consecutive patients with acute LVOS who underwent endovascular treatment between January 2018 and October 2024. The study cohort (<i>N</i> = 415) was split into training (<i>n</i> = 291) and validation (<i>n</i> = 124) sets using a 7:3 ratio. We applied machine learning techniques-the Boruta algorithm followed by least absolute shrinkage and selection operator regression-for variable selection. The final predictive model was constructed using multivariable logistic regression. Model performance was evaluated through the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis. We then developed a web-based calculator to facilitate clinical implementation.</p><p><strong>Results: </strong>Of 415 enrolled patients, 199 (48.0%) had cardioembolism (CE). The final model incorporated six independent predictors: age [adjusted odds ratio (aOR) 1.03], male sex (aOR 0.35), white blood cell count (aOR 0.86), platelet-large cell ratio (aOR 1.06), aspartate aminotransferase (aOR 1.02), and non-high-density lipoprotein cholesterol (aOR 0.75). The model demonstrated good discriminatory ability in both the training set (AUC = 0.802) and the validation set (AUC = 0.784). Decision curve analysis demonstrated consistent clinical benefit across threshold probabilities of 20%-75%.</p><p><strong>Conclusion: </strong>We developed and internally validated a practical model using routine admission laboratory parameters to differentiate between CE and large artery atherosclerosis in acute LVOS. This readily implementable tool could aid in preoperative decision-making for endovascular intervention.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1567348"},"PeriodicalIF":2.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009989","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":"Effectiveness of a headache awareness campaign on behavioral change.","authors":"Shinsuke Muraoka, Takumi Asai, Naoki Suzuki, Toshihisa Nishizawa, Kazuki Nishida, Basile Chrétien, Ryuta Saito","doi":"10.3389/fneur.2025.1572541","DOIUrl":"https://doi.org/10.3389/fneur.2025.1572541","url":null,"abstract":"<p><p>Headache is a significant public health issue due to its high prevalence, associated disability, and socioeconomic burden. In Japan, awareness of migraine prevention and the risks of medication overuse remains limited. This study examined whether increasing knowledge about headaches through an online educational campaign could lead to behavioral changes, such as more frequent visits to headache clinics and reduced misuse of headache medications. An online educational program on headaches was conducted for 1,829 hospital staff members, who first completed a questionnaire before watching an educational video. Six months later, they completed a second questionnaire to assess behavioral changes. The initial survey revealed that although headaches interfered with work and daily life for approximately 50% of participants, only 20% regularly sought medical care. The most common reason for not visiting a medical facility was reliance on over-the-counter medications. In the follow-up survey, 20% of participants had independently gathered information about headaches, 6% had visited a medical institution for a new headache, and 40% had reduced their use of painkillers after becoming aware of medication overuse headache (MOH). A decision tree model, using the reduction in painkiller use as the outcome, indicated that correct knowledge about migraine, including preventive treatments, and active information-seeking behavior were key factors in promoting behavioral change. These findings suggest that providing online headache education to hospital staff may contribute to improved headache management by increasing awareness of migraine prevention and MOH while reducing excessive painkiller use.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1572541"},"PeriodicalIF":2.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989222","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":"The diagnostic and prediction performance of MR diffusion kurtosis imaging in the glioma molecular classification: a systematic review and meta-analysis.","authors":"Hongfang Zhao, Zonggang Hou, Qifeng He, Xinlong Liu, Jian Xie","doi":"10.3389/fneur.2025.1543619","DOIUrl":"https://doi.org/10.3389/fneur.2025.1543619","url":null,"abstract":"<p><strong>Background: </strong>Although diffusion magnetic resonance imaging (dMRI), particularly diffusion kurtosis imaging (DKI), has demonstrated efficacy in distinguishing between low- and high-grade gliomas, its predictive utility across various molecular genotypes remains unclear. Evaluating the accuracy of DKI and identifying sources of heterogeneity in its predictive performance could advance noninvasive molecular diagnostic methods and support the development of personalized treatment strategies.</p><p><strong>Materials and methods: </strong>A literature search of the PubMed, Web of Science, Cochrane Library, Embase, and Medline databases was performed. The studies retrieved were screened by two researchers (HFZ and ZGH), and those fulfilling the inclusion criteria were subsequently included in the meta-analysis. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. The analyses summarized the mean differences in mean kurtosis (MK) and mean diffusivity (MD) in patients harboring various genotypes using suitable models, and explored heterogeneity. Finally, a bivariate restricted maximum likelihood estimation method and meta-regression analysis were performed to assess diagnostic potential and stability.</p><p><strong>Results: </strong>Fourteen studies comprising 886 patients were included in this meta-analysis. Regarding MK and MD, the mean difference between isocitrate dehydrogenase (<i>IDH</i>) mutation and <i>IDH</i> wild type was -0.21 (95% confidence interval [CI] -0.27 to -0.15; <i>I</i> ² = 93%) and 0.22 (95% CI 0.11 to 0.33; <i>I</i> ² = 92%), respectively. This heterogeneity could be explained by imaging parameters such as repetition time, echo time, maximal <i>b</i>-value, and number of diffusion directions. However, the mean difference did not reflect the genetic status of 1p/19q, <i>α</i>-thalassemia/mental retardation syndrome-X-linked (<i>ATRX</i>) gene, or O₆-methylguanine-DNA-methyltransferase (<i>MGMT</i>). Analysis of diagnostic accuracy revealed that the pooled areas under the curve for MK and MD, based on <i>IDH</i> status, were 0.96 (95% CI 0.93 to 0.97) and 0.76 (95% CI 0.71 to 0.81), respectively. Heterogeneity was not observed for these DKI parameters.</p><p><strong>Conclusion: </strong>MK and MD exhibited potential diagnostic utility in the prediction of glioma molecular status and should be explored in medical practice. These parameters should be compared with other MRI models to develop a stable and suitable genetic molecular prediction method for patients with gliomas.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD42024568923, CRD42024568923.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1543619"},"PeriodicalIF":2.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996701","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":"Secondary sclerosing cholangitis in critically ill patients with febrile infection-related epilepsy syndrome (FIRES): a case series.","authors":"Lorenzo Muccioli, Lidia Di Vito, Elena Pasini, Lorenzo Ferri, Giovanni Vitale, Alessandro Granito, Barbara Mostacci, Manuel Moneti, Laura Licchetta, Rocco Liguori, Paolo Tinuper, Carlo Alberto Castioni, Francesca Bisulli","doi":"10.3389/fneur.2025.1557377","DOIUrl":"https://doi.org/10.3389/fneur.2025.1557377","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the occurrence of secondary sclerosing cholangitis in critically ill patients (SC-CIP) with febrile infection-related epilepsy syndrome (FIRES).</p><p><strong>Methods: </strong>Monocentric retrospective analysis of all adult patients with FIRES admitted from January 2020 to December 2024.</p><p><strong>Results: </strong>Four patients (3 males) with a mean age of 24 years (range: 18-40 years) and no significant medical history presented with cryptogenic FIRES. They required treatment with antiseizure medications (mean: 9; range: 8-10), anesthetics (propofol, midazolam and ketamine in all cases), and immunotherapies. The average duration of status epilepticus (SE) was 57 days (range: 34-90 days), while the mean duration of intensive care unit (ICU) stay was 82 days (range: 58-117 days). All patients developed cholestatic liver disease during their ICU stay, reversible in one case. In the three cases with persistent injury (75%), SC-CIP was diagnosed with MR-colangiography after a mean of 106 days from SE onset.</p><p><strong>Discussion: </strong>The high incidence of SC-CIP in our cohort of patients with FIRES suggests a link between these two rare conditions, likely related to prolonged intensive care, hyperinflammation and polytherapy, including ketamine use. Vigilant monitoring of liver disease progression in critically ill patients with FIRES and similar predisposing factors may allow early recognition of SC-CIP and improved patient outcomes.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1557377"},"PeriodicalIF":2.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012277","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":"Attachment style and its impact on connection to God in individuals with brain injury: behavioral and lesion-based findings.","authors":"Shira Cohen-Zimerman, Irene Cristofori, Patrick McNamara, Frank Krueger, Barry Gordon, Jordan Grafman","doi":"10.3389/fneur.2025.1488890","DOIUrl":"https://doi.org/10.3389/fneur.2025.1488890","url":null,"abstract":"<p><p>Attachment style shapes one's connections with important figures in their life. One such unique relationship is the connection to God (CTG), which may be shaped by attachment style. Stronger CTG has been associated with secure attachment, yet the neural mechanisms underlying this relationship remain unclear. While previous research has implicated the prefrontal cortex (PFC) in CTG, findings have been mixed and may depend on attachment style-an idea that has yet to be directly tested. This study aimed to (1) examine whether individuals with a secure attachment style report higher levels of CTG compared to those with a non-secure attachment style, and (2) identify the brain regions associated with CTG in individuals with secure vs. non-secure attachment. We assessed attachment style and CTG in a sample of male combat veterans (<i>N</i> = 150), the majority of whom had focal traumatic brain injuries (pTBI; <i>N</i> = 119). Brain imaging (CT scans) was also obtained. Behaviorally, after controlling for age, years of education, and brain volume loss, individuals with a secure attachment style reported stronger CTG. Voxel-based lesion-symptom mapping revealed that damage to the right orbitofrontal cortex was associated with stronger CTG in individuals with secure-but not insecure-attachment. These findings suggest that attachment style shapes CTG at both behavioral and neural levels. Moreover, they highlight the potential role of attachment style in TBI recovery, offering insights that could inform spiritually integrated therapeutic interventions and support strategies.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1488890"},"PeriodicalIF":2.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996397","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":"Atypical symptoms and delayed diagnosis are more common in elderly patients with benign paroxysmal positional vertigo: a single-center study.","authors":"Hongyan Li, Yanping Tong, Yan Wang, Meimei Chen, Yu Cui, Xiaolin Wu, Yi Ju","doi":"10.3389/fneur.2025.1575816","DOIUrl":"https://doi.org/10.3389/fneur.2025.1575816","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the clinical characteristics of elderly patients with benign paroxysmal positional vertigo (BPPV), to provide a basis for the accurate diagnosis of elderly BPPV patients.</p><p><strong>Methods: </strong>A retrospective case-control study was conducted to evaluate the clinical data of 12,282 patients diagnosed with BPPV who received treatment at the Vertigo Clinical Diagnosis and Treatment Research Center of Beijing Tiantan Hospital, affiliated with Capital Medical University, between January 2020 and June 2024. Patients were categorized into an elderly group (≥65 years old) and a young-to-middle-aged group (<65 years old). Risk factors, clinical manifestations, and the interval from symptom onset to diagnosis were systematically compared and analyzed.</p><p><strong>Results: </strong>The mean age of elderly BPPV patients was 71.2 ± 5.4 years, with a male-to-female ratio of approximately 1:2. The posterior semicircular canal was the most commonly affected site (62.3%) in elderly patients, and the incidence of horizontal semicircular canal canalolithiasis was higher in the elderly group compared to the young-to-middle-aged group (16.2% vs. 13.6%, <i>p</i> < 0.001). The prevalence of arteriosclerosis-related risk factors (including hypertension, diabetes, hyperlipidemia, and coronary heart disease) was significantly higher (<i>p</i> < 0.001). Elderly patients with BPPV were more likely to experience atypical symptom (40.5% vs. 35.5%, <i>p</i> < 0.001), isolated vestibular symptom episodes lasting more than 1 min (23.1% vs. 21.4%, <i>p</i> = 0.039), and symptoms accompanied by tinnitus (21.0% vs. 18.8%, <i>p</i> = 0.004) and hearing loss (12.7% vs. 8.6%, <i>p</i> < 0.001). The proportion of elderly patients whose vertigo was triggered by typical head or body position changes was significantly lower than that in the younger group (35.3% vs. 39.7%, <i>p</i> < 0.001). Additionally, the time from symptom onset to diagnosis was positively correlated with age (r = 0.122, <i>p</i> < 0.001), and a significantly higher proportion of elderly patients experienced a diagnostic delay exceeding 14 days (35.4% vs. 28.4%, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Elderly patients with BPPV are more likely to present with atypical symptoms, fewer episodes of position-induced vertigo, and a longer symptom duration. Delayed diagnosis is more prevalent among elderly patients.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1575816"},"PeriodicalIF":2.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987115","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":"Endovascular thrombectomy versus intravenous tissue plasminogen activator for vertebrobasilar stroke treatment: insights from the national inpatient sample.","authors":"Ram Saha, Gaurav Nepal, Dhanshree Solanki, Ahmed Shaheen, Mohammed Maan Al-Salihi, Shamser Singh Dalal, Anil Roy","doi":"10.3389/fneur.2025.1417188","DOIUrl":"10.3389/fneur.2025.1417188","url":null,"abstract":"<p><strong>Introduction: </strong>Approximately 20% of patients, who present with acute ischemic stroke are diagnosed with acute vertebrobasilar artery occlusion (VBAO), which is caused by an embolus or ruptured atherosclerotic plaque leading to the formation of an acute thrombus. The mortality rate of VBAO is extremely high without treatment, ranging from 80 to 95%, underscoring the urgent need for effective and timely treatment strategies. In this study, we examined the trends of hospitalizations for Endovascular Thrombectomy (EVT) or intravenous tissue plasminogen activator (IV-tPA) as interventions for VBAO, their outcomes, associated complications, and predictors of mortality in patients undergoing these procedures.</p><p><strong>Methods: </strong>We utilized the National Inpatient Sample (NIS) database to extract data from the years 2016 to 2018, using ICD-10 diagnosis and procedure codes specific to occlusion or thrombosis of the vertebral artery or basilar artery, IV-tPA, and EVT.</p><p><strong>Results: </strong>Between 2016 and 2018, a total of 37,310 patients were admitted with VBAO. Among these, tPA was administered in 2,530 admissions (6.8%), while EVT was performed in 2,330 admissions (6.2%). IV-tPA was more frequently used in the age groups of 65-84 years and, ≥85 years, whereas EVT was more commonly used in the age groups of 18-44 years and 45-64 years. There was no significant difference in usage between men and women. In large hospitals, EVT was more commonly used than IV-tPA (8.1% vs. 7%, <i>p</i> < 0.0001), while in small hospitals, IV-tPA usage was significantly higher (3.8% vs. 2%, <i>p</i> < 0.0001). The all-cause mortality rate was significantly higher in EVT admissions compared to IV-tPA admissions (16.8% vs. 8.1%, <i>p</i> < 0.0001). However, there was no significant difference in the mean length of stay (LOS) between the two modalities.</p><p><strong>Conclusion: </strong>A trend of higher rates of EVT was observed in the younger age group (18-64 years) compared to the older age group, but no significant difference was noted based on sex. The all-cause mortality rate was found to be higher in the EVT group compared to the IV-tPA group. However, there was no significant difference in the length of hospital stay between the two groups.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1417188"},"PeriodicalIF":2.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12071085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968839","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":"Automatic segmentation and quantitative analysis of brain CT volume in 2-year-olds using deep learning model.","authors":"Fengjun Xi, Liyun Tu, Feng Zhou, Yanjie Zhou, Jun Ma, Yun Peng","doi":"10.3389/fneur.2025.1573060","DOIUrl":"https://doi.org/10.3389/fneur.2025.1573060","url":null,"abstract":"<p><strong>Objective: </strong>Our research aims to develop an automated method for segmenting brain CT images in healthy 2-year-old children using the ResU-Net deep learning model. Building on this model, we aim to quantify the volumes of specific brain regions and establish a normative reference database for clinical and research applications.</p><p><strong>Methods: </strong>In this retrospective study, we included 1,487 head CT scans of 2-year-old children showing normal radiological findings, which were divided into training (<i>n</i> = 1,041) and testing (<i>n</i> = 446) sets. We preprocessed the Brain CT images by resampling, intensity normalization, and skull stripping. Then, we trained the ResU-Net model on the training set and validated it on the testing set. In addition, we compared the performance of the ResU-Net model with different kernel sizes (3 × 3 × 3 and 1 × 3 × 3 convolution kernels) against the baseline model, which was the standard 3D U-Net. The performance of the model was evaluated using the Dice similarity score. Once the segmentation model was established, we derived the regional volume parameters. We then conducted statistical analyses to evaluate differences in brain volumes by sex and hemisphere, and performed a Spearman correlation analysis to assess the relationship between brain volume and age.</p><p><strong>Results: </strong>The ResU-Net model we proposed achieved a Dice coefficient of 0.94 for the training set and 0.96 for the testing set, demonstrating robust segmentation performance. When comparing different models, ResU-Net (3,3,3) model achieved the highest Dice coefficient of 0.96 in the testing set, followed by ResU-Net (1,3,3) model with 0.92, and the baseline 3D U-Net with 0.88. Statistical analysis showed that the brain volume of males was significantly larger than that of females in all brain regions (<i>p</i> < 0.05), and age was positively correlated with the volume of each brain region. In addition, specific structural asymmetries were observed between the right and left hemispheres.</p><p><strong>Conclusion: </strong>This study highlights the effectiveness of deep learning for automatic brain segmentation in pediatric CT imaging, providing a reliable reference for normative brain volumes in 2-year-old children. The findings may serve as a benchmark for clinical assessment and research, complementing existing MRI-based reference data and addressing the need for accessible, population-based standards in pediatric neuroimaging.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1573060"},"PeriodicalIF":2.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015131","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":"Predictive value of circulating inflammatory biomarkers for early-onset post-stroke cognitive impairment: a prospective cohort study.","authors":"Weiquan Huang, Libin Liao, Qian Liu, Rongchao Ma, Wentong Hu, Yuan Dai, Luna Wang, Dujuan Sha","doi":"10.3389/fneur.2025.1565613","DOIUrl":"https://doi.org/10.3389/fneur.2025.1565613","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke ranks as the second leading cause of mortality and the third leading cause of disability globally. Post-stroke cognitive impairment (PSCI) is a prevalent complication following acute ischemic stroke, imposing substantial burdens on patients, families, and society. This study aimed to explore the potential of circulating immune-inflammatory markers as predictors of PSCI.</p><p><strong>Methods: </strong>Conducted as a prospective observational cohort study from June 2023 to August 2024 at the Affiliated Drum Tower Hospital, Medical School of Nanjing University, it included patients experiencing their first acute ischemic stroke within 72 h of symptom onset. Cognitive assessments were conducted 7 to 10 days post-stroke using the Montreal Cognitive Assessment (MoCA), with scores below 23 indicating PSCI.</p><p><strong>Results: </strong>A total of 146 patients meeting the inclusion criteria were recruited, with 71 patients exhibiting PSCI during the acute phase of stroke. Compared to patients in the post-stroke no cognitive impairment (PSNCI) group, those with PSCI demonstrated significantly elevated peripheral blood neutrophil-to-lymphocyte ratio (NLR), globulin-to-lymphocyte ratio (GLR), and C-reactive protein-to-lymphocyte ratio (CLR), while the lymphocyte-to-monocyte ratio (LMR) was notably reduced (all <i>p</i> < 0.05). Both univariate and multivariate logistic regression analyses identified GLR as independently associated with PSCI. After adjusting for common clinical variables, the odds ratio (OR) for the highest tertile of GLR compared to the lowest was 6.20 (95% CI, 2.10-18.33; <i>p</i> = 0.001). The optimal GLR cutoff was 18.22, with a sensitivity of 62.0%, specificity of 78.7%, and an area under curve (AUC) of 0.726.</p><p><strong>Conclusion: </strong>This study indicates that elevated circulating GLR levels during the acute phase post-stroke onset are an independent risk factor for early-onset PSCI, even after adjusting for clinically relevant variables.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1565613"},"PeriodicalIF":2.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981625","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}