BACKGROUND:Post-stroke upper limb motor dysfunction is associated with complex alterations in brain function, but the frequency-specific characteristics of spontaneous local neural activity remain incompletely understood. This study investigated multi-metric resting-state functional magnetic resonance imaging (rs-fMRI) alterations in stroke patients with upper limb motor dysfunction and explored their discriminative value using machine-learning classifiers. METHODS:A total of 70 stroke patients and 45 healthy controls (HCs) underwent rs-fMRI. Fractional amplitude of low-frequency fluctuations (fALFF), percent amplitude of fluctuation (PerAF), and wavelet transform-based amplitude of low-frequency fluctuations (Wavelet-ALFF) were calculated across the conventional band (0.01-0.08 Hz), Slow-4 band (0.027-0.073 Hz), and Slow-5 band (0.01-0.027 Hz). Voxel-wise group comparisons were performed with age, sex, and mean framewise displacement as covariates. Lesion mapping, lesion-volume analysis, and a subcortical-lesion subgroup sensitivity analysis were conducted to assess lesion-related effects. Regional features showing significant group differences were used to construct support vector machine (SVM), Random Forest, and XGBoost classifiers, and model performance was evaluated on an independent testing set. RESULTS:Compared with HCs, stroke patients showed widespread frequency-specific alterations in cerebellar, visual, cingulo-motor, temporal, insular, subcortical, and frontal regions. Core abnormalities in cerebellar, visual, cingulate, supplementary motor, and frontal regions were largely retained in the subcortical-lesion subgroup. Lesion volume was negatively correlated with Fugl-Meyer Assessment for Upper Extremity scores. Several nominal associations were observed between Slow-5 fALFF features in visual regions and motor impairment severity, but none survived false discovery rate correction. Among all testing-set models, the SVM classifier using combined multi-metric Slow-4 and Slow-5 features achieved the highest numerical performance, with an AUC of 0.956, accuracy of 0.912, sensitivity of 0.905, and specificity of 0.923. However, DeLong tests showed no statistically significant superiority of sub-frequency features over conventional-band features. CONCLUSIONS:Stroke patients with upper limb motor dysfunction exhibit distributed, frequency-specific alterations in spontaneous local brain activity. Multi-metric rs-fMRI features, particularly combined sub-frequency features, may have exploratory discriminative value, but external validation is needed before they can be considered robust imaging biomarkers.

Background: Aphasia affects approximately one-third of stroke patients and yet its rehabilitation outcomes are often unsatisfactory. More effective strategies are needed to promote recovery.Objective: We aimed to examine the efficacy and safety of the theta-burst stimulation (TBS) on the language area in the superior frontal gyrus (SFG) localized by personalized functional imaging, in facilitating post-stroke aphasia recovery.Methods: This randomized sham-controlled trial uses a parallel design (intermittent TBS [iTBS] in ipsilesional hemisphere vs. continuous TBS [cTBS] in contralesional hemisphere vs. sham group). Participants had aphasia symptoms resulting from their first stroke in the left hemisphere at least one month prior. Participants received three-week speech-language therapy coupled with either active or sham stimulation applied to the left or right SFG. The primary outcome was the change in Western Aphasia Battery-Revised (WAB-R) aphasia quotient after the three-week treatment. The secondary outcome was WAB-R aphasia quotient improvement after one week of treatment.Results: Ninety-seven patients were screened between January 2021 and January 2022, 45 of whom were randomized and 44 received intervention (15 in each active group, 14 in sham). Both iTBS (estimated difference = 14.75, p < 0.001) and cTBS (estimated difference = 13.43, p < 0.001) groups showed significantly greater improvement than sham stimulation after the 3-week intervention and immediately after one week of treatment (p's < 0.001). The adverse events observed were similar across groups. A seizure was recorded three days after the termination of the treatment in the iTBS group.Conclusion: The stimulation showed high efficacy and SFG is a promising stimulation target for post-stroke language recovery.

Brain lesion mapping studies have provided the strongest evidence regarding the neural basis of cognition. However, it remained a problem to identify symptom-specific brain networks accounting for observed clinical and neuroanatomical heterogeneity. Independent component analysis (ICA) is a statistical method that decomposes mixed signals into multiple independent components. We aimed to solve this issue by proposing an independent component-based lesion mapping (ICLM) method to identify the language network in patients with moderate to severe post-stroke aphasia. Lesions were first extracted from 49 patients with post-stroke aphasia as masks applied to fMRI data in a cohort of healthy participants to calculate the functional connectivity (FC) within the masks and non-mask brain voxels. ICA was further performed on a reformatted FC matrix to extract multiple independent networks. Specifically, we found that one of the lesion-related independent components (ICs) highly resembled classical language networks. Moreover, the damaged level within the language-related lesioned network is strongly associated with language deficits, including aphasia quotient, naming, and auditory comprehension scores. In comparison, none of the other two traditional lesion mapping methods found any regions responsible for language dysfunction. The language-related lesioned network extracted with the ICLM method showed high specificity in detecting aphasia symptoms compared with the performance of resting ICs and classical language networks. In total, we detected a precise language network in patients with aphasia and proved its efficiency in the relationship with language symptoms. In general, our ICLM could successfully identify multiple lesion-related networks from complicated brain diseases, and be used as an effective tool to study brain-behavior relationships and provide potential biomarkers of particular clinical behavioral deficits.

目的 观察猪标本超声引导下腰椎经椎间孔硬膜外注射的可行性及准确性.方法 取来自2只巴马小型猪的L1-6节段脊柱及椎旁部分组织,分别在双侧L1-2、L2-3、L3-4、L4-5、L5-6椎间孔完成超声引导下经椎间孔硬膜外穿刺,应用腰椎X线片和CT检测穿刺针位置;大体观察穿刺针入路和针尖位置,记录穿刺针皮肤入针点与后正中线距离、入针深度和入针角度,并进行左右对比.结果 穿刺成功率95％(19/20),其中穿刺针针尖位于椎间孔下缘、腹侧、中央区和旁中央区的占80％(16/20).成功穿刺时,左右侧穿刺针皮肤入针点与后正中线距离、入针深度、入针角度无显著性差异(|t|<1.475,P>0.05).结论 超声引导下经椎间孔硬膜外穿刺有较高准确率.

挥鞭样损伤临床表现多种多样,常见症状为颈痛、头痛、颈椎活动受限等.其机制复杂,不仅与突然的加速-减速机制传导至颈椎关节面、相关韧带、肌肉和神经等造成一系列症状相关,最近发现还可能与脑脊液低容量、纤维肌痛以及中枢神经系统上行网状系统损伤有关.对于不伴有神经功能损伤的患者,进行针对颈部腹侧深层肌肉的等长收缩以及耐力的运动训练可显著改善患者症状,经超声可实时动态检测运动训练组与保守观察组深层与浅层肌肉形变以及形变速率模式不同.运动训练可改善肌肉运动模式,同时修复受损的颈部肌肉.

腰背部疼痛常常由腰椎间盘突出症、腰椎管狭窄症、小关节病变等引起,是目前的常见病和多发病.临床上常使用腰椎注射技术来治疗腰背部疼痛,以往多在无影像设备引导的情况下进行,随着临床对安全性和科学性要求的提高,腰椎注射逐渐开始在影像学的引导下进行.目前在临床上腰椎注射常在X线或CT引导下进行,但由于超声有诸多的优点,比如操作便捷、可以大大减少患者和医护人员接受的辐射量、穿刺整个过程实时可见等,因此逐渐在临床上普及.