ObjectivePost-stroke dysarthria (DYS) severely affects communication, yet cortical morphological alterations remain insufficiently characterized. This study applied surface-based morphometry (SBM) to examine cortical changes in DYS and their association with dysarthria severity assessed by the Frenchay Dysarthria Assessment (FDA).MethodsForty-eight DYS patients and 72 matched controls underwent MRI. Cortical fractal dimension and gyrification were extracted via SBM. Group differences were tested using two-sample t-tests, and correlations with FDA scores were assessed using Spearman analyses.ResultsDYS patients exhibited significantly increased fractal dimension in the left insula and elevated gyrification in bilateral insula, superior temporal and precentral gyri (p < 0.05). Right supramarginal gyrification positively correlated with FDA reflex and respiration subscores (ρ > 0.3, p < 0.05). No significant differences were observed between supratentorial and infratentorial lesions.ConclusionCortical morphological alterations in insula and supramarginal gyrus may contribute to DYS pathophysiology. SBM provides quantitative markers linking cortical architecture to speech motor control, potentially guiding individualized rehabilitation strategies.

Background To understand the factors influencing cardiorespiratory fitness after stroke and the differential effects at varying levels of cardiorespiratory fitness. Methods This prospective study analyzed the factors affecting cardiorespiratory fitness via quantile regression with weighted least squares regression. Results The study included 80 subjects. Both univariate and multivariate quantile regression analyses indicated that higher Fugl-Meyer assessment scores were associated with better cardiorespiratory fitness. The impact of the Fugl-Meyer assessment score on peak oxygen uptake increased with increasing quantiles. Conclusion The FMA score was positively associated with peak oxygen uptake, and quantile regression suggested that this association may vary across the peak oxygen uptake distribution. These findings improve the understanding of the relationship between motor function and cardiorespiratory fitness after stroke and may inform future studies on stratified rehabilitation approaches after further validation. Trial registration Beijing Bo'a.i. Hospital: MR-11-23-043311 (2023-11-15). Retrospectively registered.

OBJECTIVE:To evaluate the feasibility, safety, and preliminary effects of individual music therapy (IMT) on electroencephalography (EEG) cortical activation in patients with minimally conscious state (MCS). DESIGN:This study was pilot randomized, single-blind, and blank-controlled trial. SETTING:China Rehabilitation Research Center (CRRC), Beijing, China. PARTICIPANTS:Sixty-two MCS patients (diagnosed by Coma Recovery Scale-Revised [CRS-R]) were enrolled between March 2024 and July 2025; 43 completed the trial and were randomized. INTERVENTION:The experimental group (n = 22) received 12-week individualized music therapy (30-min sessions, five times per week) delivered by a certified music therapist. COMPARATOR:The control group (n = 21) received routine treatment and rehabilitation training without music intervention. PRIMARY OUTCOME:The change in EEG spectral power (alpha band, 8-13 Hz) over right-hemisphere frontocentral regions from baseline (T1) to post-intervention (T2). RESULTS:The IMT group showed significantly increased alpha power over the right lateral prefrontal cortex, precentral gyrus, and central sulcus at T2 compared T1 (p < 0.05; descriptive comparison), whereas no such change was observed in the control group. No adverse events occurred in either group. CONCLUSION:IMT is feasible and safe in medically fragile MCS patients and may induce right-hemisphere cortical activation. These pilot findings are hypothesis-generating and require confirmation in larger, adequately powered trials. TRIAL REGISTRATION:Chinese Clinical Trial Registry: ChiCTR2500114153, MR-11-24-014167.

N-methyl-D-aspartate receptors (NMDARs) play a context-dependent role in ischemic stroke (IS), contributing to acute excitotoxic injury while also supporting subsequent neuroplasticity. This functional divergence has constrained the therapeutic efficacy of non-selective NMDAR antagonists. During the acute phase, neuronal injury is associated with the redistribution of NMDARs toward extrasynaptic sites and the activation of aberrant non-ionotropic signaling pathways. As the disease progresses, NMDAR-dependent signaling becomes increasingly involved in activity-dependent plasticity, including motor engram consolidation, dendritic remodeling, and large-scale network reorganization. Post-stroke cognitive impairment and depression are increasingly recognized as potential consequences of sustained NMDAR dysregulation, involving interactions with immune signaling and metabolic processes. These observations support a shift toward activity-dependent modulation of NMDAR function, in which neurotoxic signaling is selectively dissociated from physiological receptor activity. Emerging strategies aimed at subunit-specific modulation and disruption of pathological receptor complexes provide a basis for more targeted intervention. Preservation of physiological excitation-inhibition balance may therefore represent a key requirement for optimizing functional recovery after stroke.

BACKGROUND: Reduced cardiopulmonary fitness (CRF) is common in subacute stroke and may limit functional recovery. Timely classification (risk stratification) of CRF status during the subacute phase may help guide rehabilitation when CPET is not readily available. METHODS: 6 relevant features were selected using the Boruta algorithm. Subsequently, nine machine learning (ML) models were developed and evaluated, including logistic regression (LR), elastic net (EN), k-nearest neighbors (KNN), decision tree (DT), extreme gradient boosting (XGB), support vector machine (SVM), random forest (RF), multilayer perceptron (MLP), and Light Gradient Boosting Machine (LightGBM). RESULTS: A total of 114 patients with subacute stroke were included in this study. Among the nine models developed for classifying CRF, RF, SVM, and EN demonstrated the highest discriminative performances, with areas under the receiver operating characteristic (ROC) curve (AUC) of 0.7900, 0.7952, and 0.7905, respectively. Of these models, RF exhibited the greatest clinical applicability. The most important features contributing to classification included age, FMA score, 6MWT distance, sex, lower extremity FMA score, and FAC. CONCLUSION: ML models—particularly RF—most accurately classify concurrent CRF status in subacute stroke using routinely collected variables, supporting clinical triage when CPET is unavailable.

Background:Post-stroke dysphagia is a common and serious complication. Neurorehabilitation strategies include peripheral neuromuscular electrical stimulation (NMES) and central transcranial direct current stimulation (tDCS), which operate via distinct bottom-up and top-down mechanisms, respectively. However, their differential effects on cortical hemodynamic responses during functionally distinct swallowing tasks remain poorly understood. This pilot study aimed to investigate the immediate modulatory effects of NMES and tDCS on cortical hemodynamics during different swallowing tasks in post-stroke patients using functional near-infrared spectroscopy (fNIRS). Methods:Eleven patients with post-stroke dysphagia participated in this exploratory, within-subject, repeated-measures pilot study. A minimum 24-h washout period was maintained between sessions, and the order of intervention conditions was randomized using a computer-generated sequence. Cortical hemodynamic responses, measured by changes in oxygenated hemoglobin (ΔHbO₂), were monitored using a 56-channel fNIRS system. Each participant performed both water swallowing and saliva swallowing tasks under three randomized conditions: a no-stimulation baseline, peripheral stimulation (NMES applied to suprahyoid muscles), and central stimulation (bilateral anodal tDCS over the primary motor cortex). Task-related cortical hemodynamic responses and hemispheric lateralization were analyzed for key regions of interest. Results:The primary analysis identified significant Stimulation × Task interactions in the bilateral frontopolar cortex (FPC), including the ipsilesional FPC, F(2, 20) = 8.44, raw p = 0.002, q = 0.031, partial η2 = 0.458, and the contralesional FPC, F(2, 20) = 7.42, raw p = 0.004, q = 0.031, partial η2 = 0.426. Bonferroni-adjusted simple-effects analyses showed that, under tDCS, water swallowing elicited greater FPC responses than saliva swallowing in both the ipsilesional (p_adj = 0.020) and contralesional (p_adj = 0.008) FPC. During water swallowing, tDCS produced greater contralesional FPC responses than no stimulation (p_adj = 0.006), whereas during saliva swallowing, no stimulation produced greater bilateral FPC responses than tDCS (I-FPC: p_adj = 0.008; C-FPC: p_adj = 0.034) and greater ipsilesional FPC responses than NMES (p_adj = 0.043). Exploratory paired comparisons, with FDR correction applied within each comparison family, further showed that under the no-stimulation condition, saliva swallowing elicited greater bilateral FPC responses than water swallowing (I-FPC: q = 0.018; C-FPC: q = 0.024). Under NMES, water swallowing elicited greater ipsilesional FPC responses than saliva swallowing (q = 0.002). During saliva swallowing, tDCS was associated with greater ipsilesional SMA/PMC responses than NMES (q = 0.014). Conclusion:Acute cortical hemodynamic responses varied according to the combination of stimulation condition and swallowing task, with the strongest evidence arising from the bilateral FPC Stimulation × Task interaction. These findings indicate task-dependent prefrontal hemodynamic responses but do not establish stimulation-specific efficacy, hemispheric reorganization, neuroplasticity, or therapeutic superiority. Larger sham-controlled studies are required to determine the reproducibility and clinical relevance of these acute fNIRS findings. Clinical trial registration:The trial is registered at the International Traditional Medicine Clinical Trial Registry (ITMCTR), Available at: https://itmctr.ccebtcm.org.cn/en/index.html, Identifier ITMCTR2025001814.

Dysarthria is a common motor speech disorder following stroke, which has a severe adverse impact on patients' rehabilitation prognosis and quality of life. Currently, research and understanding of post-stroke dysarthria remain insufficient, and the multiple adverse effects it brings to patients have not received sufficient attention. With increasing attention to functional recovery and long-term quality of life in stroke patients, the scientific assessment and rehabilitation of dysarthria have become important focuses in neurorehabilitation. This article reviews the research progress in its pathophysiological mechanisms, clinical classification, assessment methods, and rehabilitation therapy. This study found that current research in this field mainly has problems such as strong subjectivity in assessment methods, lack of high-level evidence-based medical evidence support for treatment plans, and insufficient individualization. Therefore, on the basis of sorting out the current situation, this article discusses the possible future directions of developing objective assessment tools and precise treatment plans, in order to provide new insights for improving the rehabilitation effect of post-stroke dysarthria.

PURPOSE:This study evaluated alterations in articulation function in children with cleft lip and palate (CLP) before treatment, after treatment, and at 1-year follow-up. METHOD:A pre-post control design with 24 subjects was used, with assessments at 3 time points: before treatment, after treatment, and at 1 year of follow-up. The mean age at treatment initiation was 6.20 years, with 6 females and 18 males. The average duration of education was 2.62 years. Standardized articulation assessments were used to measure the changes in 5 major speech indicators: Percentage Correct Consonants (PCC), Percentage Correct Places (PCP), Percentage Correct Manners (PCM), Cleft Speech Characteristics (CSC), and Phonological Simplification Processes (PSP). RESULTS:Compared with pretreatment, all indicators showed significant short-term changes (P<0.05), with some effects persisting in the long-term follow-up. During follow-up. PCC, PCP, and PSP remained stable during follow-up, whereas CSC and PCM continued to improve (t=2.599, P=0.016; t=-2.86, P=0.009). CONCLUSION:These results showed that the speech abilities learned through training were well integrated and used in daily communication. This study not only confirms the short-term efficacy of speech training but also provides strong evidence of long-lasting improvement in speech function after treatment. The findings provide important data for the establishment of personalized treatment plans, the optimization of intervention strategies, and the paving of the way for large-scale follow-up studies with extended durations.

ObjectiveThis study aimed to characterize the temporal trends in the burden of various stroke subtypes, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs), across different age and sex groups in China from 1990 to 2021 and compare these trends with global data.MethodsThis study utilizes data from the Global Burden of Disease (GBD) 2021 public dataset to examine temporal trends in different stroke subtypes over the past three decades, both globally and in China. Joinpoint regression and autoregressive integrated moving average (ARIMA) models were applied to analyze historical patterns and forecast future trajectories.ResultsThe age-standardized incidence rate (ASIR) and the age-standardized prevalence rate (ASPR) exhibited similar trends, with ischemic stroke (IS) showing an increase, while intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) displayed a decline. The ASIR of IS in China increased from 100.049 to 135.789 per 100,000. In contrast, the ASIR for ICH decreased from 108.931 to 61.153 per 100,000, and the ASIR for SAH declined from 17.957 to 7.811 per 100,000. In terms of mortality and DLAYs, the age-standardized mortality rate (ASMR) and the age-standardized DALYs (ASDR) for IS, ICH, and SAH all declined. Globally, stroke burden decreased for all subtypes, with men generally more affected than women. The highest burden remains in older populations. Projections suggest a continued rise in IS and ICH prevalence, but a stable trend for SAH.ConclusionIn China, although the burden of most stroke subtypes has declined, IS and ICH still require sustained prevention and management efforts, particularly in light of their rising prevalence among men and the older adult.

BACKGROUND:Sleep problems are highly prevalent in children with Autism Spectrum Disorder (ASD), negatively impacting core symptoms, daytime functioning, and family well-being. While behavioral interventions are the first-line treatment, access is often limited. Digital and telehealth delivery models offer a promising approach to increase accessibility. This review systematically evaluates the effectiveness of these technology-based behavioral sleep interventions for youth with ASD. METHODS:Following PRISMA guidelines, we systematically searched five databases for randomized controlled trials (RCTs) and non-randomized studies (NRCTs) of digital or telehealth behavioral sleep interventions for youth (2-18 years) with ASD. The primary outcome was child sleep. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. We conducted random-effects meta-analyses and sensitivity analyses. RESULTS:12 studies met inclusion criteria: 6 RCTs (N = 349) and 6 NRCTs (N = 57). Across RCTs, digital and telehealth interventions significantly improved parent-reported sleep problems compared with controls (pooled SMD = -0.57, 95 % CI -1.10 to -0.03; I2 = 62 %), reflecting a small-to-moderate benefit. Improvements were most evident for sleep initiation outcomes such as sleep-onset delay. In contrast, pooled NRCT results indicated large apparent gains (SMC = -1.03) but with wide confidence intervals and substantial heterogeneity, limiting interpretability. CONCLUSION:Evidence from randomized trials supports that digital and telehealth-delivered behavioral sleep interventions can yield small-to-moderate improvements in caregiver-reported sleep outcomes among autistic youth-particularly in reducing time to sleep onset. Non-randomized findings are encouraging but methodologically uncertain. Future research should prioritize adequately powered RCTs using objective sleep measures, standardized intervention frameworks, and longer follow-up to strengthen causal inference and inform scalable best-practice models.

Spasticity is a common complication after spinal cord injury (SCI) that significantly diminishes quality of life and complicates daily management. As a hallmark of upper motor neuron lesions, spasticity emerges through a complex post-injury process involving the resolution of spinal shock, an imbalance between excitatory and inhibitory signaling, and maladaptive neuronal plasticity, leading to hyperreflexia and chronic spasticity. Severe spasticity frequently results in pain, sleep disturbances, and marked functional impairments. This review systematically integrates motor neuron alterations with corresponding muscle manifestations, providing a comprehensive analysis of the brain–spinal cord–muscle pathway in spasticity pathogenesis. Through an in-depth analysis of the pathological and physiological changes in motor neurons post-SCI, this review offers a novel perspective that unveils the intrinsic mechanisms underlying spasticity formation, thereby establishing a robust theoretical foundation for developing targeted therapeutic strategies.

Automatic assessment of dysarthria remains a highly challenging task due to high variability in acoustic signals and the limited data. Currently, research on the automatic assessment of dysarthria primarily focuses on two approaches: one that utilizes expert features combined with machine learning, and the other that employs data-driven deep learning methods to extract representations. Research has demonstrated that expert features are effective in representing pathological characteristics, while deep learning methods excel at uncovering latent features. Therefore, integrating the advantages of expert features and deep learning to construct a neural network architecture based on expert knowledge may be beneficial for interpretability and assessment performance. In this context, the present paper proposes a vowel graph attention network based on audio-visual information, which effectively integrates the strengths of expert knowledges and deep learning. Firstly, various features were combined as inputs, including knowledge based acoustical features and deep learning based pre-trained representations. Secondly, the graph network structure based on vowel space theory was designed, allowing for a deep exploration of spatial correlations among vowels. Finally, visual information was incorporated into the model to further enhance its robustness and generalizability. The method exhibited superior performance in regression experiments targeting Frenchay scores compared to existing approaches.

The automatic assessment of dysarthria faces major challenges owing to the variability in neurological damage and clinical manifestations among patients. To address these issues, we propose KGMV-Net, a Knowledge-Guided Multi-View Network for automated audio-visual dysarthria assessment. KGMV-Net integrates pathological domain knowledge with multi-view deep representations across acoustic and visual modalities. Specifically, we introduce a feature fusion framework that extracts and combines dysarthria-relevant cues from different spatiotemporal perspectives. In the visual modality, the Knowledge Guided Appearance-Motion (KGAM) module incorporates clinical priors to partition speech into four functional phases, enabling the modeling of articulatory dynamics through Persistence of Appearance (PA) flow and identification of structural asymmetries in critical facial regions. In the audio modality, the Inter-Layer Multi-Scale Fusion (IMSF) module is built on a ResNet backbone and enhanced with Attentional Feature Fusion (AFF) to capture speech characteristics across multiple temporal and spectral scales. Cross-modal coherence is reinforced through the adaptive layer normalization (AdaLN)-based Cross Fusion (ALCF) module, which employs a dual-branch cross-attention mechanism with AdaLN to project heterogeneous features into a unified semantic space. Evaluations on the MSDM dataset show that KGMV-Net achieves state-of-the-art accuracy in predicting dysarthria severity, significantly surpassing existing benchmarks. These findings support KGMV-Net as a reliable, interpretable, and scalable framework for the objective clinical assessment of dysarthria.

Background Aphasia is a common complication after stroke, and traditional speech or language therapy has a limited effect on post-stroke aphasia. This randomized, controlled, open-label study aimed to evaluate the effectiveness of intensive speech and language therapy together with memantine on speech and cognitive function in patients with non-fluent aphasia after stroke. Methods Fifty post stroke non-fluent aphasia patients with unilateral left hemispheric infarction or hemorrhage were recruited and randomly divided into speech language therapy (SLT) group or Memantine group. The SLT group will receive only SLT treatment and placebo, while Memantine group will receive memantine combined with SLT treatment. Primary outcome measure will include the Western Aphasia Battery (WAB)-Aphasia Quotient from baseline to endpoint, Secondary outcomes measure will include Mini-Mental State Examination score. Assessment data were collected at baseline, Week4(Visit 1), Week 8 (Visit 2), Week 12 (Visit 3), and Week 16 (Visit 4). Results On the basis of consistent baseline data, the language function of the two groups improved after treatment (p < 0.001). Compared with the control group, the memantine group had significant benefits in auditory comprehension-AQ at week 4 (p = 0.04), WAB-AQ (p = 0.04) and spontaneous speech-AQ(p = 0.006) at week 8, WAB-AQ(p = 0.01) and spontaneous speech-AQ(p < 0.001), auditory comprehension-AQ(p = 0.03) at week 12, WAB-AQ (p = 0.01) and spontaneous speech-AQ(p < 0.001), auditory comprehension-AQ(p = 0.04) at week 16. The increase in the change of MMSE scores was higher in Memantine group at week 8 (p = 0.04) and week 12(p = 0.048). Conclusion Memantine combined with SLT are useful for improving non-fluency aphasia after stroke, especially spontaneous speech and auditory comprehension. Cognitive function has also improved. Trial registration: www.clinicaltrials.gov ; TRN: NCT00196703;

Objective: The genetic relationship between daily physical activity (PA) levels and functional outcome after ischemic stroke remains unclear. This study aimed to investigate the genetic associations of PA on functional outcome after ischemic stroke using Mendelian randomization (MR). Methods: We conducted two-sample MR analyses using genome-wide association studies (GWASs). This included data on light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) from the UK Biobank, and functional outcome after ischemic stroke from the Genetics of ischemic stroke Functional Outcome (GISCOME). The inverse-variance weighted (IVW) method served as our primary MR analysis approach, supplemented by several sensitivity analyses. Results: In univariable Mendelian randomization (UVMR) analysis, MVPA was significantly associated with a reduced risk of poor functional outcome (OR = 0.15, 95 % CI = 0.04-0.56, P < 0.01), whereas LPA had no genetic relationship (OR = 0.37, 95 % CI = 0.002-51.40, P = 0.69). In multivariate Mendelian randomization (MVMR) analysis adjusting for potentially confounding traits including hypertension, type 2 diabetes, and smoking, the overall patterns between MVPA and poststroke outcome remained (OR = 0.23, 95 % CI = 0.07-0.78, P = 0.02). Conclusion: MVPA is a protective factor for functional outcome after ischemic stroke. This finding is important for the rehabilitation and functional outcome of stroke patients.

The assessment of rehabilitation exercises for neurological and musculoskeletal disorders are crucial for recovery. Traditionally, assessment methods have been subjective, with inherent uncertainty and limitations. This paper introduces a novel multi-modality dataset named FineRehab to prompt the study of rehabilitation movement analysis, leveraging advancements in sensor technology and artificial intelligence. FineRehab collects 16 actions from 50 participants, including both patients with musculoskeletal disorders and healthy individuals, and consists of 4,215 action samples captured by two Kinect cameras and 17 IMUs. To benchmark FineRehab, we present a reliable approach to analyze rehabilitation exercises, and make experiments to evaluate the comprehensive movement quality from across multi-dimensions. Comparative experimental analyses have verified the validity of our dataset in distinguishing between the movement of the normal population and patients, which can offer a quantifiable basis for personalized rehabilitation feedback. The introduction of FineRehab will encourage researchers to apply, develop and adapt various methods for rehabilitation exercise analysis.

Early objective identification and assessment of dysarthria due to neurological deficits are essential for neurorehabilitation. Developing a system to achieve this requires a large-scale database of pathological information with detailed labeling. In the present study, a high-quality Chinese multimodal audio-visual database, consisting of 64 subacute stroke patients and 25 healthy participants, named the "Mandarin Subacute Stroke Dysarthria Multimodal (MSDM) database", was established. The materials of MSDM include a series of speech tasks such as syllables, characters, words, sentences, and spontaneous speech. All audio-visual data in this database were manually annotated and simultaneously verified by experienced researchers. Additionally, comprehensive clinical assessments of speech-motor function (e.g., Frenchay Dysarthria Assessment) and cognitive function (e.g., Montreal Cognitive Assessment) for each individual were included in the database. In conclusion, the MSDM database is believed to provide sufficient data resources for developing automatic assessment and speech recognition methods and contribute to understanding the pathological mechanisms of dysarthria.

目的 观察音乐治疗对脑卒中后认知障碍患者认知功能、运动功能和日常生活活动能力的影响.方法 选取2020年12月至2022年7月北京博爱医院脑卒中后认知障碍的患者48例,随机分为对照组(n = 24)和试验组(n = 24).两组均给予神经内科常规药物治疗、护理和康复治疗,试验组在此基础上增加音乐治疗,共8周.干预前后采用洛文斯顿作业疗法认知评定成套测验(LOTCA)分析认知功能的变化,采用Fugl-Meyer评定量表(FMA)、改良Barthel指数(MBI)评价运动功能和日常生活活动能力.结果 对照组脱落6例.治疗前后,试验组LOTCA总分和FMA评分差值均大于对照组(t＞2.665,P＜0.05);两组MBI评分差值无显著性差异(P＞0.05).结论 音乐治疗可以提高脑卒中后认知障碍患者认知功能和运动功能.

Abstract Background Although there is increasing understanding of the changes in the laboratory parameters of Coronavirus disease 2019 (COVID-19), the correlation between circulating Mid-regional Proadrenomedullin (MR-proADM) and mortality of patients with COVID-19 is not fully understood. In this study, we conducted a systematic review and meta-analysis to evaluate the prognostic value of MR-proADM in patients with COVID-19. Methods The PubMed, Embase, Web of Science, Cochrane Library, Wanfang, SinoMed and Chinese National Knowledge Infrastructure (CNKI) databases were searched from 1 January 2020 to 20 March 2022 for relevant literature. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess quality bias, STATA was employed to pool the effect size by a random effects model, and potential publication bias and sensitivity analyses were performed. Results 14 studies comprising 1822 patients with COVID-19 met the inclusion criteria, there were 1145 (62.8%) males and 677 (31.2%) females, and the mean age was 63.8 ± 16.1 years. The concentration of MR-proADM was compared between the survivors and non-survivors in 9 studies and the difference was significant (P < 0.01), I2 = 46%. The combined sensitivity was 0.86 [0.73–0.92], and the combined specificity was 0.78 [0.68–0.86]. We drew the summary receiver operating characteristic (SROC) curve and calculated the area under curve (AUC) = 0.90 [0.87–0.92]. An increase of 1 nmol/L of MR-proADM was independently associated with a more than threefold increase in mortality (odds ratio (OR) 3.03, 95% confidence interval (CI) 2.26–4.06, I2 = 0.0%, P = 0.633). The predictive value of MR-proADM for mortality was better than many other biomarkers. Conclusion MR-proADM had a very good predictive value for the poor prognosis of COVID-19 patients. Increased levels of MR-proADM were independently associated with mortality in COVID-19 patients and may allow a better risk stratification.

Cleft lip and palate (CLP) is one of the most common craniofacial malformations. Overall, 40–80% of CLP patients have varying degrees of articulation problems after palatoplasty. Previous studies revealed abnormal articulation-related brain function in CLP patients. However, the association between articulation disorders and cortical structure development in CLP patients remains unclear. Twenty-six CLP adolescents (aged 5–14 years; mean 8.88 years; female/male 8/18), twenty-three CLP adults (aged 18–35 years; mean 23.35 years; female/male 6/17), thirty-seven healthy adolescents (aged 5–16 years; mean 9.89 years; female/male 5/16), and twenty-two healthy adults (aged 19–37 years; mean 24.41 years; female/male 19/37) took part in the experiment. The current study aims to investigate developmental changes in cortical structures in CLP patients with articulation disorders using both structural and functional magnetic resonance imaging (MRI). Our results reveal the distinct distribution of abnormal cortical structures in adolescent and adult CLP patients. We also found that the developmental pattern of cortical structures in CLP patients differed from the pattern in healthy controls (delayed cortical development in the left lingual gyrus (t = 4.02, cluster-wise p < 0.05), inferior temporal cortex (z = −4.36, cluster-wise p < 0.05) and right precentral cortex (t = 4.19, cluster-wise p < 0.05)). Mediation analysis identified the cortical thickness of the left pericalcarine cortex as the mediator between age and articulation function (partial mediation effect (a*b = −0.48), 95% confident interval (−0.75, −0.26)). In conclusion, our results demonstrate an abnormal developmental pattern of cortical structures in CLP patients, which is directly related to their articulation disorders.