Background:Ischemic stroke is a major cause of death and disability worldwide. Current treatments, such as thrombolysis and mechanical thrombectomy, restore perfusion but do not promote tissue repair, highlighting the need for regenerative therapies. Neural stem/progenitor cells (NSPCs) have been extensively explored in preclinical models; however, the mechanisms underlying their therapeutic effects remain incompletely defined. Methods:This study followed the PRISMA guidelines to address the cellular and molecular mechanisms that underlie the neurorestorative effects of transplanted NSPCs in animal models of ischemic stroke. Preclinical studies published between 2013 and 2023 were identified through PubMed, Scopus, and Google Scholar. Eligible studies compared NSPC monotherapy with vehicle-treated controls, and data on transplantation protocols and functional, histological, and biochemical outcomes were extracted for narrative synthesis. Of the 8697 records identified, 25 met the inclusion criteria, with moderate methodological quality (median CAMARADES score: 6/10; range: 3-8). Results:NSPC transplantation significantly improved motor, sensory, and cognitive function while reducing infarct volume, neuronal apoptosis, neuroinflammation, and blood-brain barrier disruption, alongside increased neurotrophic and angiogenic factors (BDNF, GDNF, VEGF, and Ang-1) and modulation of inflammatory mediators. Functional recovery was more consistently associated with paracrine and immunomodulatory mechanisms than with direct neuronal replacement, which occurred less frequently and was often accompanied by astrocytic or oligodendroglial differentiation; astrocytic responses were conflicting, suggesting context-dependent effects. These preclinical mechanisms have not been consistently replicated in early-phase human trials, pointing to immunogenicity and delivery route as key translational barriers. Conclusion:The reparative benefits of NSPC therapy in ischemic stroke are largely attributable to paracrine and immunomodulatory mechanisms, with neuronal replacement playing a minor role. Future studies should focus on strategies to potentiate paracrine activity, improve graft survival, and adopt translationally relevant, comorbidity-inclusive models to advance clinical translation.
Traumatic brain injury (TBI) remains a leading cause of death and long-term disability worldwide, with substantial heterogeneity in recovery trajectories despite advances in acute neurocritical care. Enhanced Recovery After Surgery (ERAS) programmes, which integrate evidence-based, multidisciplinary perioperative care bundles, have demonstrated consistent benefits across multiple surgical specialities and emerging promise in neurosurgical populations. However, the application of enhanced recovery principles to the recovery phase following TBI remains fragmented and insufficiently synthesised. This narrative review examines recovery-phase factors influencing morbidity and mortality after TBI within the conceptual framework of Enhanced Recovery After TBI (ERA-TBI). Focussing specifically on postacute recovery, we synthesise evidence across three interrelated domains: rehabilitation strategies, patient demographics and preexisting conditions. Perioperative surgical techniques and acute intensive care management are considered only insofar as they contextualise recovery-phase outcomes. The reviewed literature demonstrates that early, intensive and multidisciplinary rehabilitation, particularly early mobilisation and structured cognitive or neuropsychological interventions, is associated with improved neurological recovery, functional independence, quality of life and reduced hospital length of stay, without evidence of increased mortality. Emerging technologies, including virtual reality and telerehabilitation, show promising cognitive and functional benefits, although evidence remains limited by heterogeneity and small sample sizes. Patient-level factors strongly modify recovery potential: advanced age, frailty and socioeconomic disadvantage consistently predict poorer outcomes, while access to high-intensity inpatient rehabilitation is a key mediator of morbidity. Preexisting metabolic, cardiovascular and neuropsychiatric comorbidities further exacerbate secondary brain injury, prolong hospitalisation and increase postdischarge mortality risk. Overall, ERA-TBI pathways must move beyond uniform care bundles towards stratified, patient-centred recovery models that integrate biological reserve, social context and comorbidity burden. Standardising the recovery phase through an ERA-TBI framework offers a critical opportunity to reduce variability in outcomes, optimise functional recovery and address the growing global burden of TBI-related disability.
Background:This clinical trial aimed to assess the effectiveness of foot reflexology on restless legs syndrome and sleep quality in patients with multiple sclerosis. Materials and Methods:Sixty-four female patients with multiple sclerosis were randomly assigned to the intervention or sham group. Foot reflexology was taught to the intervention group; it was performed for 4 weeks, three times a week for 26 min each session, by a trained researcher in the morning shift and on three other days in the afternoon at home by the patients themselves. Moreover, the sham group received nonspecific foot massage without applying pressure to the standard reflexology points under similar conditions and durations as those of the intervention group. Data were collected before, immediately after, and 1 month after intervention. Results:The results revealed a significant improvement in sleep quality (p < 0.001) in the intervention group. No significant change was observed in the sham group (p = 0.30). Restless leg syndrome significantly decreased in the intervention group (p < 0.001), whereas it increased in the sham group (p < 0.001). There was a significant difference in the sleep quality after the intervention between the two groups at both the immediate and 1-month follow-ups (p < 0.0001). There was also a significant difference in the restless leg syndrome after the intervention between the two groups at both the immediate and 1-month follow-ups (p < 0.0001). Conclusions:Nurses should be trained in foot reflexology as a noninvasive approach that can be easily implemented.
Background: Cognitive impairment (CI) has been reported with wide variability in neuromyelitis optica spectrum disorder (NMOSD), but its impact on patients' quality of life (QoL) is not well understood. The aim of this study was to describe the cognitive characteristics and various aspects of QoL of NMOSD patients. Methods: This cross-sectional study included 49 NMOSD patients (30 seropositive for AQP4-IgG) and 43 healthy controls (HCs). A set of questionnaires, including information of demographic and clinical characteristics, Multiple Sclerosis Quality of Life-54 (MSQOL-54), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS), was completed. Cognitive assessment was performed using the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) by a trained individual. Results: Based on CI criteria, 24 patients (48.98%) were classified as cognitively impaired, of whom 20 (83.33%) were AQP4-IgG seropositive. There was a strong positive correlation between CI and AQP4-IgG seropositivity (p < 0.05). Seropositive patients performed worse on the PASAT (p < 0.05) and D-KEFS (p < 0.001) tests of MACFIMS. None of the MSQOL-54 subscale scores were significantly affected by AQP4-IgG seropositivity, and there was no significant relationship between the physical or mental health composite score of the MSQOL-54 and CI. Conclusion: Our findings suggest that cognitive impairment is a relevant yet underrecognized feature of NMOSD, particularly among AQP4-IgG seropositive patients. The lack of association between CI and QoL highlights the need for more sensitive, disease-specific assessment tools. Further longitudinal and multicenter research is warranted to clarify the mechanisms and clinical impact of these impairments.
Large vessel occlusion (LVO) requires prompt detection, and CT angiography (CTA) is frequently used due to its short acquisition time and visibility of vessels. Artificial intelligence (AI), including Viz-LVO, CINA-LVO, RAPID-CTA and JLK, may be available as emerging tools for supporting timely and accurate diagnoses. This study aimed to examine and summarise the evidence of AI diagnostic performance in detecting LVO. Scopus, PubMed and ScienceDirect were utilised to search relevant articles before February 2, 2025. Studies were included in the primary outcomes analysis if they reported an overall confusion diagnostic matrix and were included in the secondary outcomes if they reported AI's diagnostic performance by occlusion site. Of the 878 records, 11 articles were included, and 10.937 patients were identified. The pooled sensitivity and specificity were 0.87 (95% CI: 0.76-0.93) and 0.95 (95% CI: 0.91-0.97). The positive likelihood ratio (PLR) showed statistical significance (9.55 (95% CI: 5.79-13.30; p < 0.001; I 2: 99.9%)), whereas the negative likelihood ratio (NLR) was not significant with a pooled value of 0.14 (95% CI: 0.03-0.25; p < 0.624; I 2: 0%). The pooled AUC and DOR were substantial, with a pooled value of 0.87 (95% CI: 0.83-0.92; p < 0.001; I 2: 98.4%) and 4.69 (95% CI: 4.19-5.19; 0.001; I 2: 98.5%), respectively. Three covariates were identified (type of AI, AI software and region). However, significant heterogeneity remains in pooled PLR, AUC and DOR. The anterior circulation occlusion performed was generally acceptable, demonstrating good performance for M1 and ICA-type T occlusion and moderate performance for M2 occlusion. However, poor performance was observed in ICA Type I and posterior circulation occlusion. In conclusion, AI has demonstrated excellent performance in sensitivity, specificity, PLR, AUC and DOR while showing limitations in NLR, suggesting that negative cases detected by AI require careful reevaluation through imaging review and assessment of patients' clinical profiles to ensure better diagnostic accuracy.
Background:Normal pressure hydrocephalus (NPH) is a neurological disorder in older adults, characterized by gait disturbance, urinary incontinence, and cognitive impairment, along with ventriculomegaly and normal intracranial pressure. The management of NPH often involves ventriculoperitoneal shunting (VPS), which can be programmable (P-VPS) or nonprogrammable (NP-VPS). While P-VPS offers the advantage of adjustable pressure settings, its impact on clinical outcomes and complications remains debated, particularly in resource-limited settings like Jordan. Method:A retrospective review was conducted of 38 adult patients diagnosed with idiopathic NPH who underwent VPS placement between 2018 and 2024. Patients were classified into two groups: P-VPS and NP-VPS. Clinical outcomes, including symptom improvement, complication rates, hospital stay duration, and shunt revisions, were analyzed. Statistical comparisons were made using SPSS, with p values < 0.05 considered significant. Results:The study found no significant differences between the two groups in symptom improvement. However, the NP-VPS group had a significantly shorter hospital stay (5.7 ± 3.2 days vs. 14.1 ± 11.9 days, p = 0.007). Complication rates, including infection and shunt revision, were higher in the P-VPS group (20.0% vs. 7.7% for infection; 32.0% vs. 15.4% for revision), though differences were not statistically significant. Conclusion:Both P-VPS and NP-VPS resulted in similar symptom improvements, with NP-VPS showing a trend toward shorter hospital stays and comparable complication rates. Further multicenter studies with larger sample sizes are needed to validate these findings and refine management strategies for NPH.
Background:Accessing multidisciplinary care poses challenges for people living with amyotrophic lateral sclerosis (ALS) due to mobility issues. As ALS care rarely requires hospital-based technology, most care is available through home visits. The Daniella Lipper ALS House Call Program (HCP) at Massachusetts General Hospital (MGH), launched in 2017 in collaboration with Compassionate Care ALS, has pioneered home-based ALS care in Eastern Massachusetts. Methods:A retrospective chart review of ALS and primary lateral sclerosis (PLS) patients enrolled in the HCP at MGH was conducted. Data on demographics, visit details, and procedures performed during home visits were collected from electronic health records for patients seen from January 2024 to December 2024. Results:In 2024, the ALS HCP conducted 959 visits for 142 patients (average age: 68 years, range: 36-93; 47.9% female). Of these patients, 137 (96.5%) were diagnosed with ALS and 5 (3.5%) with PLS. Notably, 61 patients (43%) received care exclusively at home. Key interventions included 44 gastrostomy tube exchanges and 59 respiratory assessments, both of which significantly reduced hospital visits. The average distance traveled by the care team was 30.32 miles per visit. Conclusions:The Daniella Lipper ALS HCP at MGH brings ALS expertise into the patient's home, minimizing travel burdens and ensuring continuity of care. The program illustrates the feasibility and impact of home-based ALS care, suggesting potential for broader implementation across the nation. Development will focus on expanding services, such as tracheostomy changes in the homes, and on creating sustainable models for similar initiatives.
Stroke is one of the leading causes of mortality and morbidity worldwide, and its burden is particularly high in low- and middle-income countries. In Morocco, epidemiological data on stroke subtypes, risk factors, symptoms and early outcomes remain limited. The objective of this study was to better understand stroke profiles in Morocco and identify the predictors of haemorrhagic stroke and poor in-hospital prognosis. A retrospective observational study was conducted including 360 patients admitted to Hospital Mohamed V, Meknes, Morocco. Sociodemographic information, vascular risk factor, clinical presentation, stroke subtype and in-hospital outcomes were collected. Comparisons were made among patients with ischaemic stroke, haemorrhagic stroke and transient ischaemic attack (TIA). Multivariate logistic regression analyses were performed to identify the independent predictor of haemorrhagic stroke and separately predictors of poor prognosis among ischaemic stroke patients. Ischaemic stroke was the most prevalent subtype (94.2%), followed by haemorrhagic stroke (4.7%) and TIA (1.1%). The mean age was 67.6 ± 13.0 years. The most common vascular risk factors were hypertension (68.6%), diabetes (35.8%) and cardiopathy (51.4%). Diabetes was more frequent among ischaemic stroke patients, while hypertension characterized all haemorrhagic stroke cases. Male sex independently predicted haemorrhagic stroke (OR = 3.27; 95% CI: 1.11-9.65; p = 0.032). However, diabetes showed a strong inverse association (OR = 0.082; 95% CI: 0.011-0.636; p = 0.017). Overall, in-hospital prognosis for ischaemic stroke was favourable in 86.7% of cases, and sequalae occurred in 6.2% and mortality in 7.1%. Disturbance of consciousness showed a borderline association with poor prognosis (OR = 2.41; 95% CI: 0.93-6.23; p = 0.070). However, age, sex, hypertension, diabetes and cardiopathy were not independent predictors. The findings indicate that most strokes in Morocco are ischaemic and primarily linked to vascular risk factors, particularly hypertension and diabetes. Male sex increases the likelihood of haemorrhagic stroke, while diabetes shifts risk toward ischaemic stroke. Early neurological severity-especially altered consciousness-is the strongest prognostic indicator.
This prospective study evaluated the impact of nursing interventions based on the Chronic Illness Trajectory Framework (CITF) on anxiety, depression, mental toughness, sleep quality, and ALSFRS-R scores in amyotrophic lateral sclerosis (ALS) patients to enhance care strategies. Eighty ALS patients were enrolled from the Department of Neurology at the First Hospital of Shanxi Medical University between February 2023 and March 2024. Participants were randomly assigned to an intervention group (CITF-based nursing interventions) or a control group (standard care). Over an 8-week period, the intervention group demonstrated significantly lower anxiety and depression scores, higher mental toughness, and improved sleep quality compared to the control group (p < 0.05). Additionally, the intervention group achieved higher ALSFRS-R scores (31.63 ± 3.54 vs. 29.58 ± 3.38) (p < 0.05). These findings indicate that CITF-based nursing interventions effectively reduce negative emotional states, enhance mental resilience, improve sleep quality, and boost overall quality of life in ALS patients. Based on this study, nurses can integrate CITF-based interventions into standard ALS care to enhance patients' emotional well-being and functional outcomes. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2500108691.
Background:Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by the degeneration of dopaminergic neurons in the substantia nigra pars compacta (SNpc). In addition to postural instability, rigidity, tremor, and bradykinesia, patients will experience depression and/or anxiety at any time during PD. Nortriptyline, as a dual reuptake inhibitor of norepinephrine and serotonin, inhibits alpha-synuclein aggregation and may play an important role in improving the pathological effects of PD. Objective:This study investigated the effects of nortriptyline combined with L-DOPA and benserazide on behavioral, histological, and biochemical changes in a rat model of PD. Methods. Forty-nine rats were randomly assigned to seven groups. Except for the control and sham groups, five other groups underwent stereotactic surgery for the 6-OHDA lesion. We performed a tail suspension swing test and an apomorphine-induced rotation test after 1 week to confirm the PD model. After gradual treatment with three doses (5, 10, and 20 mg/kg) of nortriptyline combined with L-DOPA and benserazide, the elevated plus-maze test and open field test were performed to determine motor activities, anxiety, and depression. Tissue alterations were evaluated through Nissl staining, tyrosine hydroxylase immunohistochemistry, and Golgi-Cox staining, whereas oxidative stress levels were determined by analyzing malondialdehyde (MDA), superoxide dismutase (SOD), and total antioxidant capacity (TAC) markers. Results:Our results demonstrate that 10 mg/kg of nortriptyline in combination with L-DOPA and benserazide significantly improved motor activity and reduced the anxiety- and depression-like behaviors of PD. Histological findings also suggested a protective effect of nortriptyline on dopaminergic neurons in the SNpc. Furthermore, the findings from the antioxidant evaluation and the structure of CA1 hippocampal neurons indicated that a dosage of 10 mg/kg of nortriptyline might provide the greatest supportive benefit. Conclusion:Nortriptyline at 10 mg/kg offers a promising adjunctive therapy for alleviating both motor and nonmotor symptoms of PD. However, higher doses may induce anxiogenic effects, suggesting the need for careful dose optimization.
This study aims to establish normative reference values for nerve conduction studies specific to the Bangladeshi population. Data were collected from 258 healthy subjects, grouped by age and sex. Both motor and sensory nerves of the upper and lower limbs were assessed. Using the ordinary least square (OLS) regression method, it is seen that for the left median motor nerve, the mean distal latency is 3.01 ± 0.34 ms, amplitude 18.05 ± 4.73 μV, and conduction velocity 59.67 ± 6.64 m/s. For the left median sensory nerve, the latency is 2.30 ± 0.25 ms, the amplitude is 60.82 ± 23.95 μV, and the velocity is 55.87 ± 4.48 m/s. The findings of this study were compared with previously published international data, revealing significant differences. These results provide neurophysicians with population-specific reference values, enhancing diagnostic accuracy, enabling earlier detection of nerve conduction abnormalities, and guiding more targeted and effective treatment strategies for nerve disorders in Bangladesh.
Background: Hypertension causes narrowing, rupture, or leakage of blood vessels. This causes stroke by interrupting the blood flow to the brain. The prevalence, incidence, and disability of stroke have surged due to poor knowledge, poor practices, and unfavorable attitudes toward stroke prevention. Awareness of the problem, good prevention practices, and a favorable attitudes toward prevention mechanisms are the milestones to prevent stroke among hypertensive patients. Objective: This study was aimed to assess knowledge, attitudes, and practices related to stroke prevention and associated factors among hypertensive patients attending at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022. Method: A cross-sectional study design was conducted at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Chronic Illness Follow-up Clinic from June 01 to July 11, 2022. A systematic random sampling technique was used to select 423 study participants. The data were collected using pretested and structured questionnaires through face-to-face exit interviews and chart reviews. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25 software. The associations between explanatory variables and outcome variables were analyzed by using a multivariable logistic regression model. Results: The findings of this study showed that 48.9% (95% CI: 44.0-53.8), 45.3% (95% CI: 40.4-50.2), and 44.1% (95% CI: 39.3-49.0) of the participants had good knowledge, favorable attitudes, and good practices respectively. The factors associated with good stroke prevention knowledge included urban residence (AOR=1.96 (1.22-3.15)), primary education (AOR=3.67 (1.56-8.61)) or secondary education and above (AOR=2.42 (1.47-3.99)), having monthly income ≥ 5000 Ethiopian birr (AOR=2.59 (1.38-4.87)), prior information about stroke (AOR=2.29 (1.33-3.96)) and strong social support (AOR=3.09 (1.73-5.54)). Similarly, having monthly income ≥ 5000 Ethiopian birr (AOR=2.05 (1.26-3.35)), moderate (AOR=1.76 (1.03-3.03)) and strong social support (AOR=2.27 (1.3-3.96)) and diabetes mellitus comorbidity (AOR=5.8: 95% CI= 3.62-9.31)) were significantly associated with good stroke prevention practices. On the other hand, duration of treatment (AOR=1.68 (1.08-2.59)) was a statistically and positively associated factor with a favorable attitude toward stroke prevention. Conclusion and recommendation: Nearly half of the respondents had good knowledge of stroke prevention and four out of nine participants had favorable attitudes toward stroke prevention and good prevention practices. Health care workers should dessiminate information for hypertensive patients early in their appointment to enhance their knowledge, attitudes and practices toward stroke prevention. Families , friends, neighbors, and the communities at large should support and encourage hypertensive patients to engage in stroke prevention practices.
Background and Purpose ___ This study aimed to explore the potential association between the lowest serum albumin concentration during hospitalization and the prognosis of patients with intracerebral hemorrhage (ICH) in order to provide a scientific basis for selecting and optimizing clinical treatment options. Methods___ A total of 268 patients with ICH were retrospectively analyzed. Univariate and multivariate analyses and ROC curve analyses were used to identify the correlation between the lowest serum albumin concentration and the prognosis of patients with ICH. Results ___ 1. The lowest serum albumin concentration, Glasgow coma score (GCS), and hematoma volume were independent influences on the prognosis of patients with ICH (P<0.05). 2. A good outcome in patients with ICH was predicted when the lowest serum albumin levels were >31.8 g/L (AUC=0.849, P<0.001), the GCS was >11 (AUC=0.878, P<0.001), and the hematoma volume was ≤a3.6 mL (AUC=0.863, P<0.001). 3. The lowest serum albumin concentration was statistically different between GCS (3–8, 9–12, 13–15: 29.30 (3.90), 33.80 (6.85), (36.70 (5.55)) (χ2 =69.696, P<0.001) and had a positive correlation with GCS (rs=0.569). Conclusions___ The lowest serum albumin concentration during hospitalization was an independent influencing factor in the prognoses of patients with ICH, and when serum albumin was greater than 31.8 g/L, it predicted a good outcome. In addition, the degree of consciousness disturbance may have some influence on the serum albumin level, and the specific mechanism needs further study.
Background:Cerebral palsy (CP) is the most common physical disability in childhood, often resulting from early brain injury. Preterm birth (< 37 weeks gestation) is a critical risk factor for CP due to the vulnerability of the immature brain. Despite advances in neonatal care, the risk of CP remains elevated among preterm infants, especially those born very preterm. Existing meta-analyses are limited by outdated data or methodological gaps. Objective:To provide an updated, comprehensive synthesis of the association between preterm birth and CP risk in children, utilizing recent high-quality observational studies worldwide. Methods:A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. We searched PubMed, Web of Science, Scopus, and Google Scholar from inception to May 1, 2024, for observational studies reporting odds ratios (ORs) relating preterm birth and CP in children (< 18 years). Studies were screened independently by two reviewers. Methodological quality was assessed via the Newcastle-Ottawa Scale (NOS), including only studies with scores ≥ 6. A fixed-effects meta-analysis was performed given low heterogeneity (I 2 = 28.04%). Publication bias was evaluated using Egger's test. Results:Sixteen studies encompassing diverse geographic regions and 30,000+ participants were included. The pooled OR for CP in preterm versus term children was 1.02 (95% CI: 0.72-1.31, p < 0.0001), indicating a significantly increased risk associated with preterm birth. No evidence of publication bias was detected (Egger's p = 0.4783). The methodological rigor and consistency of findings across varied populations strengthen the evidence for a global association. Conclusions:While the pooled estimate for the broad preterm birth category was not statistically significant, subgroup analyses confirm that the risk of CP increases significantly with the degree of prematurity. These findings reinforce the need for targeted neurodevelopmental monitoring and early interventions in preterm populations, particularly for those born at lower gestational ages, alongside public health strategies to reduce preterm birth incidence. Future research should stratify risks by degree of prematurity and explore biological modifiers to optimize preventive care.
Background:Anterior skull base tumors (ASBTs) pose significant surgical challenges due to their proximity to critical neurovascular structures. Surgical management has evolved with the adoption of both endoscopic and open approaches. This systematic review synthesizes evidence comparing these approaches in terms of complications, outcomes, and indications. Methods:We conducted a systematic review following the PRISMA guidelines, analyzing studies published between 1981 and 2022. A total of 1200 articles were initially identified from databases including PubMed, MEDLINE, JSTOR, and ScienceDirect, with 60 relevant references ultimately included. Data extraction focused on surgical approaches, tumor types, prevalence, and complications. Results:ASBTs exhibit varying prevalence and associated complications depending on their type. Meningiomas account for nearly one-third of all cases, with an annual incidence of 2 per 100,000 individuals and recurrence rates ranging from 5% for Grade I to 50%-80% for Grade III. Common complications include anosmia (10%-20%), cerebrospinal fluid (CSF) leakage (10%), visual abnormalities, and bleeding (5%-10%). Pituitary adenomas are predominantly secretory, with microadenomas comprising 97% and macroadenomas 70%. They frequently cause damage to the internal carotid artery, optic nerve, and result in CSF leakage. Craniopharyngiomas are reported at 0.1 cases per 100,000 annually, with over 80% situated in the suprasellar region. Cavernous sinus tumors represent less than 3% of all meningiomas, while glomus tumors, more prevalent in females (6:1 ratio), present 1-3 instances per million individuals and can lead to facial paralysis, auditory impairment, and cranial nerve palsies. Chordomas and chondrosarcomas, occurring at 0.08 cases per 100,000, are more common in Caucasian men. Esthesioneuroblastomas constitute 2%-3% of intranasal neoplasms, often resulting in CSF leakage and infection. Craniofacial malignancies predominantly originate from the maxillary (60%-70%) and ethmoid sinuses (10%-15%), while skull base metastasis appears in approximately 4% of cancer patients, typically from breast, lung, renal, and prostate cancers. Surgical approaches also come with distinct complications. The endoscopic endonasal approach (EEA) has a bacterial meningitis rate of 0%-0.69%, with venous thromboembolism (VTE) being rare but more likely in older patients or those with coagulation issues. Cerebral infarction may occur due to vasospasm, subarachnoid hemorrhage, vascular damage, or electrolyte imbalances, while the risk of pneumocephalus is minimized through careful lumbar drain management and sinus precautions. Open surgical approaches commonly result in CSF leaks, meningitis, vascular injury, and visual disturbances. Conclusion:This systematic review synthesizes evidence from 60 studies to propose a decision-making framework. We conclude that the EEA is associated with superior quality of life and reduced morbidity for midline tumors (e.g., tuberculum sellae meningiomas and pituitary adenomas), offering comparable gross total resection rates. In contrast, open approaches remain paramount for tumors with significant lateral extension, massive size, or complex vascular involvement, where maximal exposure facilitates radical resection despite higher associated morbidity. This analysis provides a nuanced evidence base to guide individualized surgical strategy.
Cerebrovascular accident is a neurological disease, characterised by acute onset that lasts for more than 24 h, leading to motor, sensory and cognitive impairments or even death. High-intensity interval training is a type of aerobic training that presents an increase of the > 80% of maximum heart rate, aiming to improve VO2 peak, leading to improvements in various health-related parameters. The purpose of this study was to examine the effectiveness of high-intensity interval training on aerobic and functional capacity for poststroke survivors. Two investigators searched the electronic databases MEDLINE/PUBMED, Cochrane Controlled Trials Register and EBSCO, until August 2024. In this review, 11 studies met the eligible criteria and were included. The statistical analysis was conducted by pooling the mean, standard deviation, and 95% confidence intervals. For the establishment of meta-analysis, the heterogeneity statistical index I 2 was used. From the 11 included studies, 458 stroke survivors were extracted. HIIT yield improvements were observed in VO2 peak (p value = 0.001, 95% CI: 1.72-4.06), 6MWT (p value < 0.001, 95% CI = 38.55-149.41), 10MWT (p value < 0.01, 95% CI = 0.20-0.36), BBS (p value < 0.01, 95% CI = 3.43-7.51), EQ-5D (p value = 0.001, 95% CI = 3.67-15.13), and cognition (p value = 0.009, 95% CI = 0.41-2.89). No significant difference was presented for HR (p value = 0.58, 95% CI = -11.82-21.10), TUG (p value = 0.055, 95% CI = -2.25 to 0.02) and step count (p value = 0.71, 95% CI = -1479-2163). High-intensity interval training is a safe rehabilitation method affecting positively the aerobic capacity and the majority of motor function of stroke survivors.
Background: Individuals with migraine continually seek to understand the causes, or "triggers," of their attacks by considering variables such as foods, weather, stress, mood, behaviors, and sleep. Information-theoretic measures such as "surprisal" offer a novel approach to quantifying the unpredictability and diversity of trigger exposures on a single standardized scale.Objectives: This study aimed to quantify the variability of migraine trigger exposures using surprisal and entropy measures and to evaluate their potential for stratifying individuals based on exposure patterns.Methods: This longitudinal daily diary study included participants with migraine who completed twice-daily electronic diaries reporting exposures to a range of potential headache triggers. Surprisal values were calculated to quantify the unexpectedness of individual trigger exposures, while entropy values captured overall variability in trigger domains such as sleep, mood, daily stressors, dietary behaviors, and environmental encounters.Results: N = 109 individuals self-reported 187 different headache triggers for up to 28 days, resulting in 540,876 trigger measurements. Participants exhibited substantial heterogeneity in surprisal and entropy values across trigger domains, reflecting diverse patterns of exposure both within and between individuals. Morning measures of sleep and mood showed moderate entropy, while evening measures of dietary patterns and environmental encounters exhibited greater variability. A few principal components explained most of the variability in surprisal values, suggesting these dimensions might characterize trigger exposure across variables.Conclusions: These findings reinforce the utility of surprisal measures for capturing nuanced patterns in the vast array of headache trigger data and support their potential as a measurement tool for understanding trigger exposures.
Objective: To investigate the association between lipid profiles and disease severity/cranial nerve involvement in Guillain-Barré syndrome (GBS), providing evidence for early clinical intervention. Methods: This retrospective study enrolled 182 GBS patients (148 males and 34 females) admitted to the First Affiliated Hospital of Shihezi University from December 2019 to April 2024. Patients were stratified into mild (Hughes Functional Disability Scale [HFDS] 1-3) and severe (HFDS 4-6) groups. Multivariate logistic regression (adjusted for age, sex, and antecedent infections) was used to analyze independent associations of low-density lipoprotein cholesterol (LDL-C) and apolipoprotein A (ApoA) with disease severity and cranial nerve involvement. ROC curve analysis determined predictive thresholds. Results: Disease severity: each 1 mmol/L increase in LDL elevated severe disease risk by 2.5-fold (OR = 2.503, p=0.009) and each 0.1 g/L decrease in ApoA reduced severe disease risk by 99.6% (OR = 0.004, p < 0.001). Cranial nerve involvement: LDL ≥ 2.355 mmol/L significantly increased cranial nerve involvement risk (OR = 1.925, p=0.018). Predictive thresholds: LDL ≥ 2.215 mmol/L optimally predicted severe disease and ApoA ≤ 1.071 g/L indicated higher probability of mild disease. Conclusion: Elevated LDL and reduced ApoA are independent risk factors for GBS progression and cranial nerve involvement. Combined detection may aid early identification of high-risk patients. Dyslipidemia likely exacerbates GBS pathology through neuroinflammatory mechanisms, suggesting targeted lipid regulation as a potential therapeutic strategy.
Introduction: Due to anti-inflammatory, antioxidant, immune-modulating, and antiaging properties of astaxanthin, it has been used to treat spinal cord injuries (SCIs). In this meta-analysis study, the effects of astaxanthin on SCI in animal models were investigated. Method: Scopus, PubMed, Web of Science, and Google Scholar databases were searched based on keywords related to astaxanthin and SCI. The primary screening of articles based on the title and abstract and the secondary screening based on the full text of the articles according to inclusion and exclusion criteria were performed. After extracting the data, statistical analysis was done using STATA software. A standardized mean difference (SMD) was used to analyze the results of the reported studies. Subgroup analysis and quality control of articles was also performed. Result: The overall results showed that astaxanthin has a strong effect (SMD = 3.34; 95% CI: 1.90 to 4.78; p < 0.001) on improving motor function after SCI especially when administered in multiple doses over consecutive days. Astaxanthin has a strong effect on reducing lipid peroxidation and increasing antioxidants. Treatment with astaxanthin increased the number of spinal cord neurons and spared white matter. Conclusion: Astaxanthin has the potential to be used as an adjuvant in improving motor behavior, and it is suggested to conduct clinical studies on it.
