Journal of Clinical Neuroscience最新文献

{"title":"Development and validation of a diagnostic model for symptomatic large artery atherosclerotic stenosis: integrating lipid metabolism, coagulation, and inflammatory biomarkers","authors":"Yajie Chen ,&nbsp;Qun Xue ,&nbsp;Tingting Huang ,&nbsp;Yuwei Xiong ,&nbsp;Shoucai Zhao ,&nbsp;Yang Xu","doi":"10.1016/j.jocn.2025.111782","DOIUrl":"10.1016/j.jocn.2025.111782","url":null,"abstract":"<div><h3>Background</h3><div>Early diagnosis of symptomatic large artery atherosclerotic stenosis (sLAAS) is crucial for therapeutic decision-making. ​Reliance on imaging for sLAAS diagnosis generates substantial obstacles in resource-constrained settings.​ This challenge ​prompted​ the development of an accessible diagnostic model using routinely available clinical parameters, ​enabling sLAAS diagnosis when advanced imaging is unavailable.</div></div><div><h3>Methods</h3><div>This study included acute ischemic stroke (AIS) patients with imaging-confirmed large artery atherosclerotic stenosis (LAAS). Biomarkers of sLAAS initially filtered by least absolute shrinkage and selection operator (LASSO) regression ​were further assessed​ using multivariable logistic regression. We subsequently developed a clinically applicable diagnostic tool based on a nomogram, and validated​ the model’s performance in a separate cohort.</div></div><div><h3>Results</h3><div>A total of 318 AIS patients with LAAS were included in this study. Multivariable logistic regression confirmed lipoprotein-associated phospholipase A2 (Lp-PLA2), triacylglycerol (TG), fibrinogen (FIB), and aggregate index of systemic inflammation (AISI) as independent biomarkers of sLAAS. The nomogram exhibited strong diagnostic performance, with the area under the receiver operating characteristic curve (AUC-ROC) of 0.860 in the training set and 0.837 in the validation set. Both calibration curves and decision curve analysis (DCA) validated the robust performance of the model.</div></div><div><h3>Conclusions</h3><div>We developed a diagnostic model for sLAAS ​that integrates lipid metabolism, coagulation, and inflammatory biomarkers. This model ​enables accurate sLAAS identification, demonstrating specific value in​ resource-constrained settings.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111782"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Helicobacter pylori infection is associated with the seriousness of carotid atherosclerosis and inflammatory parameters","authors":"Hong Zhao ,&nbsp;Yemeng Chu ,&nbsp;Ying Li ,&nbsp;Yawen Xu ,&nbsp;Zanhua Liu ,&nbsp;Cui Wang","doi":"10.1016/j.jocn.2025.111810","DOIUrl":"10.1016/j.jocn.2025.111810","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Carotid atherosclerosis is an important factor to ischemic stroke. Accumulating evidence indicated that certain viral and bacterial infections may contribute to the initiation and progression of atherosclerotic disease. Hp infection is common in China, however, the role of Hp infection in carotid atherosclerosis is still controversial and inconsistent. In our study, we aimed to determine the seroprevalence of &lt;em&gt;Helicobacter pylori&lt;/em&gt; (Hp) in patients with carotid atherosclerosis and the association between Hp seropositivity and the severity of carotid artery stenosis. The inflammatory serum cytokines of lipoprotein-associated phospholipase A2 (Lp-PLA2) and metalloproteinase-9 (MMP-9) were also tested to explore the possible mechanism of Hp linked atherosclerosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;div&gt;94 participants with carotid atherosclerosis (patient group) and 56 individuals without carotid atherosclerosis (control group) whom all confirmed by color Doppler ultrasound were included in this study. According to the degree of carotid artery stenosis, the patient group was classified into three different subgroup: mild stenosis (&lt;50 % stenosis, n = 30), moderate stenosis (50–69 % stenosis, n = 34) and severe stenosis (≥70 % stenosis, n = 30). An enzyme linked immunosorbent assay (ELISA) for immunoglobulin (Ig) G test for Hp diagnosis was used on all enrolled subjects. Values higher than 30 IU/mL were considered Hp seropositivity. They were also divided into Hp seropositive (n = 77) and Hp seronegative group (n = 73) according to Hp test result. Lp-PLA2 and MMP-9 were also measured in all participants as inflammatory markers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The seropositivity rate for HP reached 62.8 % in patients with carotid atherosclerosis and it was significantly higher than that in controls 32.1 % (&lt;em&gt;P&lt;/em&gt; &lt; 0.001). The Hp-IgG levels in patients group were also significantly higher than those in controls (46.89 ± 22.34 IU/ml vs. 29.84 ± 11.83 IU/ml). Furthermore, the higher HP seropositivity, the more severe the extent of carotid atherosclerosis. Lp-PLA2 and MMP-9 levels in the mild, moderate and severe stenosis of carotid atherosclerosis were statistically higher than in controls. There were 77 (55.7 %) Hp positive and 73 (44.3 %) Hp negative subjects. Hp positive patients had a significantly higher incidence of carotid atherosclerosis (76.6 % vs. 47.9 %), TC levels (5.31 ± 0.7 mmo/l vs. 5.01 ± 0.66 mmo/l) and LDL-C levels (2.62 ± 0.66 mmo/l vs. 2.31 ± 0.61 mmo/l) when compared with Hp negative patients. In addition, Plasma Lp-PLA2 and MMP-9 levels in patients seropositive for Hp were significantly higher than in those seronegative for Hp.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;These results showed evidence that Hp seropositivity had a significantly correlation with carotid atherosclerosis as well as its severity evaluated by ultrasound. Furthermore, chronic infection with Hp might involve the p","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111810"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of immunotherapy on outcomes of cutaneous melanoma and concurrent brain metastasis: a surveillance, epidemiology, and end results analysis of 2010–2020","authors":"James Kelbert ,&nbsp;Tara Ghalambor ,&nbsp;Kennedy Sparling ,&nbsp;Kristin Nosova ,&nbsp;Joseph Georges ,&nbsp;Robert W Bina","doi":"10.1016/j.jocn.2025.111781","DOIUrl":"10.1016/j.jocn.2025.111781","url":null,"abstract":"<div><h3>Introduction</h3><div>Melanoma has the greatest incidence of brain metastases among all cancers and once patients develop melanoma brain metastases (MBM) it is the primary contributor to patient mortality. Following the FDA approval of immune checkpoint inhibitors in 2011, there has been a significant reduction in melanoma patient mortality. Therefore, we investigated the impact of immunotherapy on overall survival (OS) pre and post implementation of immunotherapy in the management of MBM.</div></div><div><h3>Methods</h3><div>Data from patients with MBM upon diagnosis and seen between 2010–2012 and 2018–2020 were collected from Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier survival curves, cox regression models, and log rank tests were conducted using case-listing survival data from Seer*Stat 4.8.2.</div></div><div><h3>Results</h3><div>There were a total of 1426 patients with MBM at diagnosis: 403 patients (304 men and 99 women) from 2010 to 2012 and 1023 patients (715 men and 308 women) from 2018 to 2020. Median OS for patients from the 2010–2012 and 2018–2020 group was 4 months (95 % CIs: 4–5 month) and 14 months (95 % CIs: 12–19 months), respectively. Patients from 2010 to 2012 had a significantly worse (p = 1e−06) 5-year OS of 9.7 % (95 % CIs: 7.2–13.0 %) compared with 33.4 % (95 % CIs: 29.9–37.3 %) in 2018–2020. When stratified by sex, median OS in men was statistically worse compared to women in the 2010–2012 time period, (HR 2.11, p &lt; 2.2e−16), but demonstrated virtually no difference in 2018 to 2020 (HR 1.02, p = 0.63).</div></div><div><h3>Conclusion</h3><div>The introduction of immunotherapy with checkpoint inhibitors significantly improved OS among patients with MBM and may have helped mitigate historical disparities in survival between men and women.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111781"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145692941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effective self-directed learning and performance perception: Insights from the United Kingdom National Undergraduate neuroanatomy competition","authors":"Ameerah Gardee ,&nbsp;Eranga Goonewardena ,&nbsp;Sytske Lub ,&nbsp;Hassan Ismahel ,&nbsp;Attika Chaudhary ,&nbsp;Laulwa Nasser Al-Salloum ,&nbsp;Devansh Mitesh Shah ,&nbsp;Sanskar Ranglani ,&nbsp;Samih Hassan ,&nbsp;Mohammad Ashraf ,&nbsp;Scott Border","doi":"10.1016/j.jocn.2025.111778","DOIUrl":"10.1016/j.jocn.2025.111778","url":null,"abstract":"<div><h3>Background</h3><div>Neuroanatomy is a cornerstone of medical education, yet is perceived by many as daunting. Student-led events, such as the National Undergraduate Neuroanatomy Competition (NUNC), newly re-established in Scotland, provides a platform to address this challenge by fostering academic interest and enhancing learning through extracurricular achievement and specialty talks.</div></div><div><h3>Methods</h3><div>This mixed-methods study analysed data from the 11th NUNC, involving 93 registered medical students. Post-event surveys collated participants’ experiences with institutional neuroanatomy education, preferred learning resources, and self-assessment of their performance in NUNC’s written and practical exams. Quantitative responses were analysed using descriptive and inferential statistics, while qualitative data provided insights into learning preferences and challenges.</div></div><div><h3>Results</h3><div>Of 58 survey respondents, most reported dissatisfaction with the depth and accessibility of institutional neuroanatomy teaching. Online resources (74.1 %) and textbooks (53.4 %) were most frequently used for self-directed learning, in addition to resources provided by students’ institutions. Participants rated both the single-best-answer and spotter exams as difficult, and demonstrated accurate self-assessment of their performance, with modest but significant correlations between perceived and actual scores in both assessments (p = 0.0002).</div><div>These findings highlight a potential dichotomy between reliance on institutional teaching and students’ preferred resources, emphasising the value of supplementary, accessible, and clinically contextualised materials in the learning of future clinicians. Accuracy in self-assessment suggests that NUNC encourages reflective learning and confidence in neuroanatomy knowledge. This has positive implications for the future clinical practice of these participants as it is increasingly common for non-specialist clinicians to be first point-of-contact for neurological presentations.</div></div><div><h3>Conclusion</h3><div>NUNC provides an impactful platform for addressing gaps in neuroanatomy/clinical neuroscience education, promoting self-directed learning, and inspiring confidence among students interested in careers in neuroanatomy-related fields such as neurosurgery, neurology and other neuroanatomy related fields. Future efforts should focus on integrating a broader range of learning modalities into medical curricula to improve the learning experience and establish reliable foundations for future clinical practice.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111778"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In reply: External validation of a grading system predicting ischemia following middle cerebral artery aneurysm clipping","authors":"Cyrus Raki,&nbsp;Leon Lai","doi":"10.1016/j.jocn.2025.111817","DOIUrl":"10.1016/j.jocn.2025.111817","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111817"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the demographics and complications of North American surgical patients with ossification of the posterior longitudinal ligament","authors":"Aaron Phung ,&nbsp;Justin Hyde ,&nbsp;Justin Azmoodeh ,&nbsp;Theodore Quan ,&nbsp;Lancelot Benn ,&nbsp;Christopher P. Bellaire ,&nbsp;Oliver Tannous ,&nbsp;Joseph Ferguson ,&nbsp;Seyed B Kalantar ,&nbsp;David Weiner ,&nbsp;Andrew Mo ,&nbsp;Fred Mo ,&nbsp;Sean Bae ,&nbsp;Ala Alshomali ,&nbsp;Crisanto L. Macaraeg ,&nbsp;Kevin Yoon ,&nbsp;Jonathan P. Japa ,&nbsp;Mark Ehioghae ,&nbsp;Addisu Mesfin","doi":"10.1016/j.jocn.2025.111790","DOIUrl":"10.1016/j.jocn.2025.111790","url":null,"abstract":"<div><h3>Introduction</h3><div>Ossification of the posterior longitudinal ligament (OPLL) is a hyperostotic spinal condition resulting from progressive endochondral ossification of the posterior longitudinal ligament, leading to spinal canal narrowing and spinal cord compression. Primarily seen in East Asian countries, OPLL has been increasingly recognized in North American cohorts. This study aims to evaluate the demographic characteristics and outcomes of patients undergoing surgery for OPLL in a North American cohort.</div></div><div><h3>Methods</h3><div>This was a single-center retrospective cohort study of patients with OPLL undergoing surgery between July 2011 and November 2024. Data collected included demographic information, body mass index (BMI), comorbidities, surgical approach, OPLL classification, and K-line measurement. Estimated blood loss (EBL), intra/post-operative complications, length of stay, and disposition status were also recorded. Descriptive statistics and multivariable analyses were conducted with a p value &lt; 0.05 considered to be statistically significant.</div></div><div><h3>Results</h3><div>In total, 81 patients underwent surgery for OPLL (mean age of 60 years; 50.6 % male). Most of the patients were Black (43 patients, 53.1 %).The mean BMI was 33.1 kg/m². Forty-four patients (54.3 %) had diabetes. Most of the surgeries were elective (88.9 %). The classification of OPLL for the patients were: 31.7 % segmental, 20 % continuous, and 40 % mixed. 73.3 % of the patients had a positive K-line. Surgically, the posterior approach (41 patients, 50.6 %) was more common. A posterior approach was more likely to be utilized for patients with a positive K-line measurement (p = 0.029). Obesity was associated with increased EBL (p = 0.032). Five patients experienced intraoperative complications. The mean length of stay was 6.5 days, and average follow-up was 20.4 months. Three patients (3.7 %) passed post-operatively, and none underwent reoperation.</div></div><div><h3>Conclusion</h3><div>This study highlights the demographic and clinical characteristics of OPLL in a diverse North American cohort. Surgical management, predominantly via anterior or posterior approaches, was associated with low complication rates and no reoperations during follow-up.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111790"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Rosai-Dorfman disease: systematic review and meta-analysis of clinical presentation, diagnosis, and treatment","authors":"Aafreen Azmi ,&nbsp;Daniela A. Perez-Chadid ,&nbsp;Jeremiah H. Wijaya ,&nbsp;Juan P. Avila-Madrigal ,&nbsp;Aditi Gorthy ,&nbsp;Sri Sai Lakshman Akkineni ,&nbsp;Andrew Egladyous ,&nbsp;Nemanja Novakovic ,&nbsp;Morana Vojnic ,&nbsp;Jonathan Sherman ,&nbsp;Anil Nanda","doi":"10.1016/j.jocn.2025.111787","DOIUrl":"10.1016/j.jocn.2025.111787","url":null,"abstract":"<div><h3>Background</h3><div>Spinal Rosai–Dorfman disease (RDD) is a rare histiocytic disorder that can mimic neoplastic and infectious processes, complicating diagnosis and management. Its natural history and optimal treatment strategies remain poorly defined.</div></div><div><h3>Objective</h3><div>To systematically review and perform an individual patient data (IPD) <em>meta</em>-analysis of clinical presentation, diagnostic features, management, and outcomes in adult patients with spinal RDD.</div></div><div><h3>Methods</h3><div>A PRISMA-compliant systematic review was performed using PubMed, Scopus, and Cochrane Library databases. Eligible studies included case reports, case series, and observational studies reporting histologically confirmed spinal RDD in adults (≥18 years). Patient-level data were pooled and analyzed using a one-stage mixed-effects model to identify factors associated with full neurological recovery. Recurrence-free survival (RFS) was assessed using Kaplan–Meier methodology.</div></div><div><h3>Results</h3><div>Sixty-seven studies reporting 85 patients (mean age 42.6  years; 70.6 % male) were included. Thoracic (61.2 %) and cervical (43.5 %) lesions predominated, with extradural (40 %), intradural-extramedullary (24.7 %), and intramedullary (31.8 %) involvement. Surgical resection was performed in 83.5 % of cases; gross total resection (GTR) was achieved in 45.9 %. At a mean follow-up of 19.9  months, 40 % of patients achieved full neurological recovery and 7.1 % experienced recurrence, most within one month postoperatively. Intradural-extramedullary location (RR 4.20, p = 0.008) and GTR (RR 4.31, p = 0.002) independently predicted full recovery, while intramedullary involvement was associated with worse outcomes (RR 0.29, p = 0.019).</div></div><div><h3>Conclusions</h3><div>Intradural-extramedullary location and GTR strongly predict favorable outcomes in spinal RDD, whereas intramedullary disease confers a poorer prognosis. The high early recurrence rate underscores the need for close postoperative surveillance and consideration of adjuvant therapy in high-risk cases. Standardized surgical protocols and prospective IPD studies are needed to refine management and improve long-term outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111787"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of initially chosen non-operative management for spinal ependymoma","authors":"Guang-Hao Zheng ,&nbsp;Yao-Wu Zhang ,&nbsp;Kai Ji ,&nbsp;Hui Qiao ,&nbsp;Xiao Wu ,&nbsp;Yi-Xiang Liu ,&nbsp;Wei-Hao Liu ,&nbsp;Bo Wang ,&nbsp;Chong Wang ,&nbsp;Xing-Yu Liu ,&nbsp;Yong-Zhi Wang ,&nbsp;Wen-Qing Jia","doi":"10.1016/j.jocn.2025.111780","DOIUrl":"10.1016/j.jocn.2025.111780","url":null,"abstract":"<div><h3>Purpose</h3><div>With advancements in imaging, spinal ependymomas are increasingly detected early, often in asymptomatic or mildly symptomatic patients. This study evaluates the clinical and radiological outcomes in patients who initially underwent conservative management but subsequently underwent surgery due to disease progression.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 315 patients diagnosed between 2018 and 2023 identified 10 meeting the inclusion criteria (mean age: 51 years, range: 37–63). Three were asymptomatic, and seven had mild symptoms such as pain or numbness. The mean maximum tumor diameter on sagittal MRI was 23.5 mm. Tumor progression and symptom changes were monitored, with surgery performed as needed.</div></div><div><h3>Results</h3><div>Over a median conservative period of 36 months, all patients eventually required surgery due to symptom progression or tumor growth, with an average tumor size increase of 22 %. Gross total resection was achieved in 80 % of cases under electrophysiological monitoring. After a median follow-up of 31.5 months, 70 % of patients maintained their preoperative modified McCormick scores, while 30 % showed deterioration.</div></div><div><h3>Conclusion</h3><div>Conservative management provides a temporary option, but tumor progression is inevitable. Delayed surgery may risk worse outcomes, making timely intervention advisable for patients with tumor growth, syrinx formation, or worsening neurological symptoms.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111780"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic machine learning approach for cerebral aneurysm feature selection and rupture status classification","authors":"Lior A. Kofman,&nbsp;Calvin G. Ludwig,&nbsp;Emal Lesha,&nbsp;Alexandra Lauric,&nbsp;Adel M. Malek","doi":"10.1016/j.jocn.2025.111803","DOIUrl":"10.1016/j.jocn.2025.111803","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Current methods of intracranial aneurysm rupture risk assessment in the clinical setting depend on user measurements of morphological factors. Recently, machine learning (ML) has been proposed to assist in stratification of aneurysmal rupture risk. While numerous approaches have been taken, most rely on small sample sizes, restrict to specific anatomical locations, or manually balance ruptured and unruptured samples to enhance classification. By using 7 ML classifiers on a retrospective cohort of consecutive aneurysms distributed throughout the cranial vasculature, we present a computational tool that effectively classifies aneurysmal rupture status on a large, generalizable dataset.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Three-dimensional angiograms of patient cerebral aneurysms (&lt;em&gt;n = 678&lt;/em&gt;; 229 ruptured and 449 unruptured aneurysms) enabled computation of 21 aneurysm features. Two datasets were used: morphological features only (MFO), and morphological plus 15 locational features (MLF). After normalization of numerical features and 7:3 training–testing splitting, for feature selection, a multivariate elastic network regression model was trained via 5-fold cross validation. Features were selected on the testing set. For classification, random 7:3 training–testing splitting was performed 100 times independently on each stratus. 8 classifiers (7 ML models and 1 generalized linear model; GLM) were used to assess rupture status. Area under the curve (AUC), sensitivity (SENS), and specificity (SPEC) were evaluated on testing sets. To elucidate the contribution of each feature to aneurysm rupture status assessment, feature importance was calculated for each optimal classifier.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;On the MFO dataset, multiple adaptive regression splines (MARS&lt;sub&gt;MFO&lt;/sub&gt;) exhibited the greatest performance (&lt;em&gt;AUC&lt;sub&gt;mean&lt;/sub&gt; = 0.797, SENS&lt;sub&gt;mean&lt;/sub&gt; = 0.777, SPEC&lt;sub&gt;mean&lt;/sub&gt; = 0.728&lt;/em&gt;), with AUC also significant compared to GLM and three other ML classifiers. Aspect ratio (AR) and undulation index (UI) were the strongest factors. On the MLF dataset, neural networks (NNET&lt;sub&gt;MLF&lt;/sub&gt;) achieved the greatest performance (&lt;em&gt;AUC&lt;sub&gt;mean&lt;/sub&gt; = 0.825, SENS&lt;sub&gt;mean&lt;/sub&gt; = 0.803, SPEC&lt;sub&gt;mean&lt;/sub&gt; = 0.738&lt;/em&gt;), followed by random forests (RF&lt;sub&gt;MLF&lt;/sub&gt;; &lt;em&gt;AUC&lt;sub&gt;mean&lt;/sub&gt; = 0.825, SENS&lt;sub&gt;mean&lt;/sub&gt; = 0.847, SPEC&lt;sub&gt;mean&lt;/sub&gt; = 0.710&lt;/em&gt;). For NNET&lt;sub&gt;MLF&lt;/sub&gt;, AUC was found significant compared to GLM and three other ML classifiers. In neural networks, non-sphericity index (NSI), middle cerebral artery location, and AR were identified as the strongest contributors to rupture status.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;We propose a systematic, user-independent approach to ML aneurysm rupture status classification. MARS&lt;sub&gt;MFO&lt;/sub&gt; and NNET&lt;sub&gt;MLF&lt;/sub&gt; exhibited the highest AUCs and outperform the traditional GLM, suggesting the utility of ML to assess intracrania","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111803"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative depression is associated with higher reoperation rates following anterior cervical discectomy and fusion: a multidimensional evaluation in the post–COVID-19 era","authors":"Puru Sadh ,&nbsp;Alejandro Perez-Albela ,&nbsp;Ishan Shah ,&nbsp;Samuel Bara-Garcia ,&nbsp;Timothy Jeng ,&nbsp;Bryce A. Basques","doi":"10.1016/j.jocn.2025.111777","DOIUrl":"10.1016/j.jocn.2025.111777","url":null,"abstract":"<div><h3>Objective</h3><div>Depression is highly prevalent among patients with degenerative cervical spine disease and has been linked to worse postoperative outcomes across various surgical procedures. Prior studies in anterior cervical discectomy and fusion (ACDF) have primarily focused on limited endpoints such as pain or discharge disposition and were conducted before the COVID-19 pandemic. Given the rise in depression prevalence and its multidimensional impact on functional recovery, resilience, and quality of life in the post-pandemic population, a more comprehensive evaluation of its influence on ACDF outcomes is warranted.</div></div><div><h3>Methods</h3><div>A retrospective review of a prospectively maintained database was performed for patients undergoing ACDF between 2020 and 2022 at a single academic institution. Patients were grouped by presence or absence of a pre-existing complete depression diagnosis that were actively being treated. Demographic, perioperative, radiographic, and multiple PROs, were collected preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Multivariate logistic and linear regression controlled for age, sex, BMI, Charlson Comorbidity Index, smoking status, surgical levels, and relevant preoperative symptoms.</div></div><div><h3>Results</h3><div>Of 302 patients, 134 (44.4 %) had depression. Compared with non-depressed patients, the depression cohort had higher reoperation rates (18.7 % vs. 4.8 %, p = 0.007) Depression was associated with greater persistent arm pain at 2 years (VAS 5.92 vs. 2.67, p &lt; 0.001) and lower PROMIS Physical (38.26 vs. 44.37, p = 0.008) and Mental (41.15 vs. 50.14, p &lt; 0.001) scores at 1 year. No significant differences were found in cervical sagittal alignment or rates of structural complications.</div></div><div><h3>Conclusions</h3><div>Unlike prior ACDF studies, which largely evaluated limited endpoints or smaller cohorts, this study employed multiple PROs alongside clinical and radiographic measures to comprehensively characterize depression’s postoperative impact, in the context of rising depression rates following the COVID-19 pandemic. Preoperative depression independently predicted an approximately fourfold increased risk of reoperation and consistently worse PROs through 2 years after ACDF, despite similar radiographic correction. Routine preoperative mental-health screening and targeted perioperative interventions, such as expectation setting, adherence support, and activity counseling, may improve outcomes for this high-risk population.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111777"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}