Abstract:Objective To explore the standardized treatment strategies for craniocerebral penetrating injury caused by non-firearm foreign body.Methods A retrospective analysis was performed on the clinical data of 16 patients with non-firearm foreign body craniocerebral penetrating injury treated at Ganzhou People's Hospital from January 2017 to June 2024.Based on the foreign body location and imaging characteristics,personalized surgical interventions were carried out,including craniotomy for foreign body removal(10/16),neuronavigation-assisted removal(4/16),and endonasal endoscopic removal(2/16).The presence of residual foreign bodies was assessed within 24-48 h postoperatively by CT or MRI,vascular protection was evaluated within 7 d after surgery by CTA or DSA,and perioperative complications were recorded.Neurological functional prognosis was assessed using the Glasgow Outcome Scale(GOS)at 90 d postoperatively.Results The entry sites of foreign bodies included the orbital compartment(7 cases),frontal region(4 cases),parietal region(3 cases),and nasal region(2 cases).All the 16 patients successfully underwent surgery.The clearance rate of foreign bodies within 24-48 h postoperatively reached 15/16.CTA or DSA performed within 7 d after surgery revealed no new blood vascular injury.Perioperative complications included new neurological deficits(3 cases),delayed traumatic intracranial hematoma(one case),cerebrospinal fluid rhinorrhea(2 cases),epileptic seizure(one case),intracranial infection(2 cases),and brain abscess(one case);all were alleviated after targeted intervention.At 90 d postoperatively,10 patients had achieved good recovery(GOS score 5),4 had moderate disability(GOS score 4),and 2 had severe disability(GOS score 3);there were no cases of death or vegetative state.Conclusions The management of non-firearm foreign body craniocerebral penetrating injury should be based on multidisciplinary collaboration,combined with precise imaging evaluation and individualized surgical strategies.Early removal of the foreign body,rigorous cerebral dura mater repair,and intensified antinfective management are crucial for optimizing outcomes.

Abstract:Objective Based on real-world clinical data,the predictive efficacy of the unweighted machine learning(ML)models for the prognosis of acute ischemic stroke with large vessel occlusion in the anterior circulation(AIS-aLVO)patients after mechanical thrombectomy was evaluated.The optimal model was selected,and the impact of class-weighted strategies on the predictive efficacy of this model was assessed.Methods A total of 191 patients with AIS-aLVO who underwent mechanical thrombectomy from May 2023 to September 2024 in Tianjin Huanhu Hospital were included.Collect their clinical data,such as pre-admission National Institutes of Health Stroke Scale(NIHSS)score,etc.Retrospectively analyze the brain non-contrast CT(NCCT),multi-phase CT angiography(mCTA)and CT perfusion(CTP)examinations of the patients upon admission.The mCTA was used to assess the collateral circulation status;the Alberta Stroke Program Early CT Score(ASPECTS)was used to evaluate the early ischemic changes in the middle cerebral artery(MCA)supply area based on the NCCT;the CTP was used to assess the cerebral perfusion status,and the Mismatch volume,Tmax>4 s volume,Tmax>6 s volume,Tmax>8 s volume and Tmax>10 s volume were obtained.The 90-day modified Rankin Scale(mRS)score after surgery was used as the prognostic evaluation index,and the score>2 was determined as poor prognosis.The Least Absolute Shrinkage and Selection Operator(LASSO)regression was used for feature selection.Logistic regression(LR),random forest(RF),support vector machine(SVM),decision tree(DT),k-nearest neighbor(KNN),and eXtreme Gradient Boosting(XGBoost)algorithms were used to construct unweighted models.The predictive efficacy of the models was evaluated using the receiver operating characteristic(ROC)curve,area under the curve(AUC),calibration curve(Brier score),and decision curve analysis(DCA).The optimal model was selected,and the Shapley additive explanation(SHAP)method was used to analyze the feature importance of this model.At the same time,the impact of the class-weighted strategy on the predictive performance of the model was evaluated.Results The optimal regularization parameter(λ=0.064)of LASSO regression was determined by the ten-fold cross-validation minimum deviation criterion.Four feature variables were selected:ASPECTS score,Tmax>10 s volume,pre-admission NIHSS score,and poor collateral circulation status.Stratified sampling was used to randomly allocate the subjects to the training set(n=133)and the test set(n=58),and unweighted models was established.In the unweighted model,except for the overfitting RF and XGBoost models,the Delong test showed that the pairwise comparison of the AUC values of the remaining models had no statistical significance(P>0.05,for all);however,the unweighted SVM model had the lowest Brier score(0.16),and its calibration ability was the strongest.Within the 15%-30%threshold range,the DCA curve of the unweighted SVM model was the highest,suggesting the highest clinical applicability.There was no statistically significant difference in the AUC values,sensitivity,specificity,accuracy,positive predictive value and negative predictive value between the class-weighted and unweighted SVM models(P>0.05,for all);however,compared with the unweighted SVM model,the Brier score of the class-weighted SVM model was higher(0.17 vs.0.16),and its calibration ability was weakened.Conclusions In a real-world cohort of AIS-aLVO cohort,the unweighted SVM model can accurately predict poor functional outcomes after mechanical thrombectomy without relying on class-weighted,and this method has high clinical translational potential.

Abstract:Objective To externally validate different predictive scoring systems for intracranial hemorrhagic transformation(HT)after intravenous thrombolysis in patients with acute ischemic stroke,and to evaluate the predictive abilities of the different scoring systems.Methods A total of 1157 patients with acute ischemic stroke who received rt-PA intravenous thrombolysis within 4.50 h after symptom onset were collected from July 2010 to August 2023 in The First Affiliated Hospital of Dalian Medical University.According to the imaging examination within 36 h after intravenous thrombolysis,98 cases presented with intracranial HT and 34 cases presented with symptomatic intracranial hemorrhage(sICH).The area under the curve(AUC)of receiver operating characteristic(ROC)curve and the Hosmer-Lemeshow goodness-of-fit test were used to assess the discrimination and calibration of the HAT score,the MSS score,the SEDAN score,the GRASPS score and the SPAN-100 score for the prediction of HT and sICH,respectively.Results The incidence of intracranial HT and sICH were 8.47%(98/1157)and 2.94%(34/1157),respectively.The AUCs of the scoring systems for predicting intracranial HT were 0.625(95%CI:0.563-0.687)for the HAT score,0.663(95%CI:0.609-0.718)for the MSS score,0.641(95%CI:0.581-0.702)for the SEDAN score,and 0.701(95%CI:0.644-0.759)for the GRASPS score.In predicting sICH,the AUCs of the scoring systems were 0.695(95%CI:0.595-0.795)for the HAT score,0.691(95%CI:0.609-0.773)for the MSS score,0.689(95%CI:0.590-0.788)for the SEDAN score,and 0.783(95%CI:0.714-0.852)for the GRASPS score.In addition,the Hosmer-Lemeshow goodness-of-fit tests of the HAT score,the MSS score,the SEDAN score and the GRASPS score were P>0.05 for both validation of intracranial HT and sICH,suggesting that all scoring systems were well calibrated.The sensitivities of the SPAN-100 score for predicting intracranial HT and sICH were 14.30%and 23.50%,respectively,suggesting that the SPAN-100 score has a high risk of underdiagnosis in clinical practice.Conclusions The GRASPS score has a fair predictive ability for predicting intracranial HT and sICH after intravenous thrombolysis in acute ischemic stroke patients.Further external validations with large samples in multiple centers will be needed in different populations.

Abstract:Chronic heart failure(CHF)is a complex syndrome,one of whose pathophysiological features is the abnormal activation of the neurohumoral system,especially the excessive excitation of the sympathetic nerve and the continuous activation of the renin-angiotensin-aldosterone system(RAAS).At the same time,the decreased cardiac output caused by chronic heart failure can lead to cerebral hypoperfusion and significantly affect cognitive function;conversely,cognitive impairment caused by cerebral hypoperfusion could exacerbate cardiac dysfunction,suggesting a close bidirectional regulatory relationship between the heart and the brain.This article aims to systematically explore the mutual influence mechanism between chronic heart failure and the nervous system,elaborating on its pathophysiological basis from multiple dimensions such as the regulation of cardiovascular function by neurohumoral regulation under physiological conditions,the pathological mechanism of autonomic nerve imbalance,neurohumoral disorder and dysfunction of neuro-compensation mechanism during the development of chronic heart failure,and the damage of chronic heart failure to cognitive function,and providing theoretical support and practical guidance for the clinical realization of treatment for brain and heart.

Abstract:Objective To investigate the evolution patterns of hemiplegic gait in young stroke patients and identify targeted timing for walking rehabilitation interventions.Methods A total of 30 young patients with new-onset stroke treated at The 2nd School of Medicine,Wenzhou Medical University between December 2023 and June 2025 were enrolled.Surface electromyography(sEMG)was used to record electromyographic signals including root mean square(RMS),median frequency(MF)and mean power frequency(MPF).Balance function was assessed using the Berg Balance Scale(BBS),walking ability was evaluated with the Functional Ambulation Category Scale(FAC),limb motor function was measured using the Fugl-Meyer Assessment Scale(FMA),activities of daily living were assessed via the modified Barthel Index(mBI),muscle tone was evaluated with the modified Ashworth Scale(MAS),and muscle strength was graded using the Muscle Strength Grading Scale of Medical Research Council(MRC).Results sEMG data at different time points showed statistically significant differences in RMS(F=22.462,P=0.000),MF(F=33.873,P=0.000)and MPF(F=19.841,P=0.000),functional assessment scores including BBS(F=106.724,P=0.000),FAC(F=28.000,P=0.000),FMA(F=42.000,P=0.000)and mBI(F=37.931,P=0.000),as well as muscle tone during knee flexion(χ2=16.133,P=0.000),knee extension(χ2=14.200,P=0.001)and ankle dorsiflexion(χ2=15.867,P=0.000),and muscle strength during hip flexion(χ2=45.267,P=0.000),knee flexion(χ2=42.800,P=0.000),knee extension(χ2=38.933,P=0.000)and ankle dorsiflexion(χ2=52.133,P=0.000).Specifically,RMS(P=0.000,0.000),MF(P=0.000,0.000),MPF(P=0.000,0.000),BBS(P=0.000,0.000),FAC(P=0.000,0.000),FMA(P=0.000,0.000)and mBI(P=0.000,0.000)at 2 and 4 weeks after rehabilitation training were both higher than those before training,and the indicators at 4 weeks after training were also higher than those at 2 weeks after training(P=0.000,0.000,0.000,0.000,0.004,0.000,0.000).The muscle tone in the activities of knee flexion(P=0.000,0.000),knee extension(P=0.004,0.000)and ankle dorsiflexion(P=0.001,0.000)of the affected lower limb at 2 and 4 weeks after rehabilitation training were lower than those before training,while the muscle strength of hip flexion(P=0.000,0.000),knee flexion(P=0.000,0.000),knee extension(P=0.000,0.000)and ankle dorsiflexion(P=0.000,0.000)at 2 and 4 weeks after rehabilitation training were higher than those before training;and the muscle tone at 4 weeks after training were also lower than those at 2 weeks after training(P=0.033,0.042,0.012),while the muscle strength were also higher than those at 2 weeks after training(P=0.000,0.000,0.000,0.000).Conclusions The assessment using sEMG combined with multiple functional scales revealed the temporal characteristics and progressive improvement patterns of gait rehabilitation in young stroke patients.As the duration of rehabilitation treatment increased,neuromuscular function,balance function,walking ability,motor function,activities of daily living,lower limb muscle tone and muscle strength showed continuous and progressive improvement.

Abstract:Objective To investigate the related influencing factors that affect the prognosis of adult glioblastoma(GBM)patients.Methods We conducted a retrospective analysis of the molecular pathological data and follow-up information from 96 GBM patients who underwent tumor surgical resection in The Affiliated Hospital of Xuzhou Medical University between January 2019 and April 2022.The presence of TERT promoter mutation,EGFR amplification,and chromosome 7 gain with chromosome 10 deletion(+7/-10)were detected using next-generation sequencing(NGS)technology.The median survival time(MST)of the patients was calculated using Kaplan-Meier survival curve,and univariate and multivariate Cox proportional hazards regression analyses were performed to identify related influencing factors affecting postoperative survival time.Results The Kaplan-Meier survival curve indicated that the MST for GBM patients was 14.50 months.Cox proportional hazards regression analysis revealed that age>60 years old(HR=2.720,95%CI:1.418-5.216;P=0.003),preoperative Karnofsky Performance Status(KPS)score<80(HR=2.481,95%CI:1.455-4.232;P=0.001),TERT promoter mutation(HR=2.846,95%CI:1.455-5.569;P=0.002),EGFR amplification(HR=3.263,95%CI:1.770-6.015;P=0.000),and the presence of+7/-10(HR=2.349,95%CI:1.272-4.337;P=0.006)were identified as risk factors associated with shortened postoperative survival time.In contrast,gross total resection of the tumor(HR=0.246,95%CI:0.132-0.458;P=0.000)and postoperative combined chemoradiotherapy(HR=0.368,95%CI:0.212-0.639;P=0.000)were protective factors associated with prolonged postoperative survival time.Conclusions GBM patients exhibiting TERT promoter mutation,EGFR amplification and+7/-10 have a poorer prognosis.Routine clinical testing of TERT promoter status,EGFR amplification,and chromosomal copy number variations(+7/-10)are beneficial for accurately assessing patient prognosis.

Abstract:Post-stroke motor dysfunction significantly impacts patients'quality of life.Non-invasive brain stimulation(NIBS)techniques offer novel strategies for stroke rehabilitation,yet single-target transcranial magnetic stimulation(TMS)struggles to precisely modulate the complex network of bilateral hemispheric functional interactions post-stroke.Dual-site transcranial magnetic stimulation(DS-TMS),which dynamically balances neural networks through simultaneous or sequential stimulation of correlated brain regions,exerts its mechanisms via interhemispheric connectivity and intrahemispheric interactions among brain regions.This provides a more precise intervention strategy for motor rehabilitation in post-stroke patients.This review systematically summarizes the technical principles and classifications of DS-TMS,its mechanisms of action within motor network connectivity,and research progress in its application for post-stroke motor dysfunction rehabilitation.We discuss clinical translation prospects,aiming to provide theoretical foundations for optimizing parameters and developing individualized treatment protocols.

Abstract:Stroke,with its high incidence and disability rate,imposes a heavy burden on patients,families and society,urgently requiring safe and effective new treatment methods.Transcutaneous electrical acupoint stimulation(TEAS)is a non-invasive therapy that combines traditional Chinese meridian theory with modern physical factor therapy.Stimulating specific acupoints can not only improve functional disorders such as movement,swallowing,urination and defecation,but also regulate neuropsychological problems such as post-stroke depression and cognitive impairment.Moreover,TEAS can help prevent and treat complications such as deep vein thrombosis of the lower extremities and post-stroke fatigue.TEAS has unique clinical application value in the rehabilitation treatment of stroke.This article systematically reviews the progress in clinical application and mechanisms of TEAS in stroke rehabilitation treatment,and proposes future research directions to promote the standardized and precise application of TEAS.

Abstract:Objective To investigate the treatment mechanism of the intelligent lower limb rehabilitation robot to promote the recovery of motor function in patients with subacute subcortical stroke,based on resting-state fMRI(rs-fMRI)in terms of functional activity and functional connectivity.Methods Twenty-four patients with subacute subcortical stroke were admitted to The Affiliated Hospital of Yunnan University between January 2022 and August 2023.They were randomly assigned to either robot group(conventional rehabilitation treatment combined with robot rehabilitation treatment,n=12)or conventional group(conventional rehabilitation treatment,n=12).Based on the rs-fMRI data,static amplitude of low-frequency fluctuation(sALFF),dynamic amplitude of low-frequency fluctuation(dALFF),static regional homogeneity(sReHo)and dynamic regional homogeneity(dReHo)were calculated to analyze changes in brain functional activity in 2 groups after treatment.The seed-based dynamic functional connectivity(dFC)and static functional connectivity(sFC)analysis methods were used to explore the distribution of changes in functional connectivity between brain regions exhibiting altered functional activity after treatment and other brain regions across the 2 groups.Neurological deficits,lower limb motor function and activities of daily living were assessed using the National Institutes of Health Stroke Scale(NIHSS),the Fugl-Meyer Assessment Scale for Lower Extremity(FMA-LE)and the modified Barthel Index(mBI),respectively.Results The differences in NIHSS score(F=17.806,P=0.000),FMA-LE score(F=51.911,P=0.000)and mBI score(F=130.224,P=0.000)between robot group and conventional group before and after treatment were statistically significant.After treatment,the NIHSS score in robot group(t=-2.785,P=0.004)and conventional group(t=-3.183,P=0.011)were lower than those before treatment,while FMA-LE score(t=7.225,P=0.000;t=2.964,P=0.007)and mBI score(t=9.717,P=0.000;t=6.442,P=0.000)in robot group and conventional group were higher than those before treatment.After treatment,the robot group exhibited decreased sALFF in the right medioventral occipital cortex and left lateral occipital cortex and increased sReHo in the right precuneus(voxel level threshold of P<0.005 and cluster level threshold of P<0.05,for all).Decreased dFC in the right medioventral occipital cortex with right lobule Ⅷ of the cerebellar hemisphere,and decreased sFC with the left medioventral occipital cortex,while increased sFC with the right inferior parietal lobule(voxel level threshold of P<0.005 and cluster level threshold of P<0.05,for all).Increased sFC in the left lateral occipital cortex with right lobule Ⅶ of the cerebellar hemisphere and right inferior parietal lobule(voxel level threshold of P<0.005 and cluster level threshold of P<0.05,for all).The conventional group showed increased sALFF in the left insula and left cingulate gyrus(voxel level threshold of P<0.005 and cluster level threshold of P<0.05,for all).Increased dFC in the left cingulate gyrus with left superior frontal and decreased sFC with the right lateral occipital cortex and right fusiform gyrus(voxel level threshold of P<0.005 and cluster level threshold of P<0.05,for all).The difference in sALFF of the left lateral occipital cortex in robot group was negatively correlated with the difference in mBI score(r=-0.609,P=0.036).Conclusions The intelligent lower limb rehabilitation robot may facilitate the recovery of motor function in patients with subcortical stroke by improving the synchronization of neural activity in the right precuneus,to optimize motor control strategies and by modulating the functional connectivity between the occipital lobule and cerebellum,and between the occipital lobule and parietal lobule to enhance sensorimotor integration.

Abstract:Objective To investigate the risk factors of new-onset ischemic stroke in patients with acute type A aortic dissection(ATAAD)undergoing Sun's procedure.Methods A total of 147 patients with ATAAD who underwent Sun's procedure between January 2015 and May 2024 in Chest Hospital,Tianjin University were included.Patients were divided into new-onset ischemic stroke group(n=21)and no new-onset ischemic stroke group(n=126)based on whether they had newly developed ischemic stroke after surgery.Univariate and multivariate Logistic regression analyses were used to screen for the risk factors of new-onset ischemic stroke after Sun's procedure.Results Logistic regression analysis showed that preoperative stroke(OR=14.731,95%CI:1.740-124.727;P=0.014),elevated preoperative serum creatinine level(OR=1.023,95%CI:1.009-1.038;P=0.002),preoperative New York Heart Association(NYHA)functional class Ⅲ-Ⅳ(OR=8.054,95%CI:2.393-27.111;P=0.001),and incomplete Willis'circle of type C(OR=33.575,95%CI:1.283-878.921;P=0.035)and type D(OR=5.734,95%CI:1.105-29.765;P=0.038)were risk factors for the new-onset ischemic stroke after Sun's procedure in patients with ATAAD.Conclusions Preoperative stroke,elevated preoperative serum creatinine level,NYHA class Ⅲ-Ⅳ,and incomplete Willis'circle of type C and D were risk factors for the new-onset ischemic stroke after Sun's procedure in patients with ATAAD.

Abstract:Objective To explore the effect of vestibular rehabilitation treatment on subjective symptoms,walking function and dynamic balance function of ischemic stroke patients with vestibular symptoms.Methods A total of 27 patients with vestibular symptoms who underwent vestibular rehabilitation treatment in Tianjin Huanhu Hospital from January 2022 to December 2024 were included,and they underwent individualized vestibular rehabilitation treatment,including optokinetic training,gaze stabilization,head and posture stabilization training and walking training for 30 times.Before and after the treatment,a wearable sensor inertial measurement unit was used to perform a 7 Meter Walk Test(7MWT)to assess gait,recorded the gait parameters including stride length,gait speed,percentage of double support phase time,foot strike angle(FSA),toe off angle(TOA),and turning angle velocity.The Activities-Specific Balance Confidence Scale(ABC)to assess subjective balance confidence in completing various tasks,the dizziness/vertigo Visual Analog Scores(VAS)to assess the degree of dizziness/vertigo,the Bucket Test to assess the angle of subjective visual vertical(SVV)deviation,the Dizziness Handicap Inventory(DHI)to assess the degree of dizziness disability,Dynamic Gait Index(DGI)to assess objective balance function,and Timed Up-Go Test(TUGT)to assess dynamic balance and turning ability.Spearman rank correlation analysis to explore the correlation of gait parameter differences with subjective tests and dynamic balance function before and after vestibular rehabilitation treatment.Results After vestibular rehabilitation treatment,stride length(t=-4.877,P=0.000),gait speed(t=-4.458,P=0.000),bipedal FSA(left foot t=-5.590,P=0.000;right foot t=-4.751,P=0.000)and TOA(left foot t=-3.855,P=0.001;right foot t=-3.648,P=0.001),turning angle velocity(t=-5.140,P=0.000),ABC score(Z=-3.861,P=0.000)and DGI score(Z=-4.381,P=0.000)were higher,while percentage of double support phase time(t=-3.940,P=0.000),dizziness/vertigo VAS score(Z=-2.952,P=0.003),SVV(Z=-3.499,P=0.000),DHI score(Z=-3.397,P=0.001)and TUGT time(Z=-3.327,P=0.001)were lower than those of pre-treatment.Spearman rank correlation analysis showed that increase in step length was associated with improvement in ABC(rs=0.464,P=0.015),SVV(rs=-0.469,P=0.014),DGI(rs=0.685,P=0.000)and TUGT(rs=-0.569,P=0.002).The increase in gait speed was associated with improvement in ABC(rs=0.525,P=0.005),SVV(rs=-0.381,P=0.049),DGI(rs=0.734,P=0.000)and TUGT(rs=-0.523,P=0.005).The decrease in percentage of double support phase time was significantly associated with improvement in ABC(rs=-0.504,P=0.007),SVV(rs=0.405,P=0.036),DGI(rs=-0.702,P=0.000)and TUGT(rs=0.559,P=0.002).Conclusions Vestibular rehabilitation treatment can significantly improve the subjective perception of dizziness/vertigo,improve walking ability,ability to perform daily activities,confidence in balance,and dynamic balance function,and reduce the risk of falls in ischemic stroke patients with vestibular symptoms.It provides a basis for the implementation of precise individualized vestibular rehabilitation treatment in ischemic stroke patients with vestibular symptoms.

Abstract:Posterior circulation stroke(PCS)often involves the vestibular oculomotor pathway,vestibular spinal cord pathway,vestibular cerebellar pathway,resulting in severe vestibular dysfunction,presenting symptoms and signs such as vertigo,dizziness,nystagmus and unbalance,which affects the quality of life of PCS patients.Vestibular dysfunction manifests with distinct features depending on the location of the lesion.Early identification and intervention can improve vestibular function and promote vestibular compensation.This article reviews the assessment of vestibular function,and characteristics and rehabilitation of vestibular dysfunction in PCS to improve the awareness of central vestibular dysfunction.

Abstract:Rehabilitation treatment for hemorrhagic stroke not only reduces morbidity and mortality but also promotes functional recovery and improves patient outcomes.With the continuous advancement of neuroscience technologies,the rehabilitation management model for hemorrhagic stroke patients faces both new opportunities and significant challenges.Moving forward,efforts should focus on developing rehabilitation protocols based on functional recovery trajectories specific to hemorrhagic stroke,leveraging large-scale data platforms to strengthen evidence-based practices in rehabilitation medicine.Additionally,it is essential to refine tiered rehabilitation services and establish comprehensive quality control systems throughout the continuum of care,thereby enhancing the effectiveness and efficiency of rehabilitation treatment,and further optimizing management strategies for hemorrhagic stroke.

Abstract:Cerebral ischemia secondary to intracerebral hemorrhage(ICH)in the acute phase can aggravate mortality and disability in ICH patients.The underlying pathophysiology of secondary ischemic is still unclear,and may be closely related to blood pressure fluctuations,hematoma compression,and cerebral small vessel lesions.The prevention methods for this problem include the designation of antihypertensive targets according to cerebral autoregulation(CA)and release of hematoma compression,etc.,and the key is to explore the personalized treatment plan for ICH,which can effectively prevent or alleviate the possibility of nerve damage,and aviod secondary cerebral ischemic.This article mainly expounds the pathophysiological mechanism,early diagnosis and prevention of secondary cerebral ischemia after ICH,aiming to provide clinical guidance for individualized secondary prevention of acute ICH.

Abstract:Objective To report 2 cases of Charcot-Marie-Tooth disease type 4H(CMT4H)caused by FGD4 gene variation and review the relevant literatures,summarizing the clinical and gene mutation characteristics of CMT4H.Methods and Results Two families with CMT4H diagnosed by genetic test in Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine from May 2020 to July 2022 were included.The probands in 2 families were both sporadic patients with onset in early adolescence,manifesting as progressive postural gait abnormalities,difficulty walking,and foot deformities.Nerve electrophysiological examination showed multiple demyelinating damages to sensory and motor nerves.Sural nerve biopsy in proband of family 1 disclosed a decreased density of myelin fibers and demyelinating neuropathy with thickened and excessively folded myelin sheath.Whole exome sequencing(WES)revealed that both probands had compound heterozygous mutations in the FGD4 gene,all of which were novel,and cosegregated with the family members.Conclusions CMT4H is a peripheral neuropathy mainly caused by autosomal recessive demyelination,and case report from 2 families further expand the spectrum of FGD4 gene mutations.

Abstract:Objective To analyze the characteristics of motor function in children with different types of hereditary neuromuscular disease(HNMD).Methods A total of 61 children with HNMD admitted to Peking University First Hospital from January 2018 to January 2024 were enrolled.Manual Muscle Testing was used to evaluate the muscle strength of the limbs,and the percentage of limb muscle strength was subsequently calculated.The Motor Function Measure(MFM)was used to evaluate the overall motor function,the Brooke grade and the Vignos grade were respectively used to assess the motor function status of the upper and lower limbs.Pearson correlation analysis and partial correlation analysis were used to explore the relationships between the MFM total score and domain scores and body mass index(BMI),the percentage of limb muscle strength,Brooke grade and Vignos grade.Results A total of 61 cases of children included 18 of congenital muscular dystrophy(CMD group,29.51%),17 of spinal muscular atrophy(SMA group,27.87%),15 of congenital myopathy(CM group,24.59%),and 11 of Emery-Dreifuss muscular dystrophy(EDMD group,18.03%).There were statistically significant differences in the percentage of limb muscle strength(F=23.749,P=0.000),MFM total score(F=17.445,P=0.000),D1 domain score(F=18.671,P=0.000),D2 domain score(F=10.202,P=0.017),Brooke grade(F=9.313,P=0.025)and Vignos grade(F=22.967,P=0.000)among the 4 groups.Correlation analysis showed that the MFM total score was positively correlated with the percentage of limb muscle strength(r=0.528,P=0.000),and negatively correlated with Brooke grade(r=-0.607,P=0.000)and Vignos grade(r=-0.511,P=0.000);D1 domain score was positively correlated with the percentage of limb muscle strength(r=0.303,P=0.020),and negatively correlated with Vignos grade(r=-0.555,P=0.000);D2 domain score was positively correlated with the percentage of limb muscle strength(r=0.332,P=0.010),and negatively correlated with Brooke grade(r=-0.513,P=0.000);D3 domain score was negatively correlated with Brooke grade(r=-0.469,P=0.000).Conclusions The characteristics of motor function in children with different types of HNMD vary greatly.The specific MFM can assist evaluating the disease severity and analyzing the differences of motor function in children with different types of HNMD.

Abstract:Objective To explore the potential value of expert-identified CT and MRI imaging features in predicting the MGMT promoter methylation status in glioma.Methods A retrospective analysis was conducted in 188 patients in The First Medical Center of Chinese PLA General Hospital from January 2019 to December 2020 with pathologically confirmed glioma.Imaging features were extracted,including calcification,clear lesion margins,peritumoral edema,T2WI/T2-FLAIR mismatch,cortical involvement,subventricular zone involvement,insular involvement,homogeneous signal on T2WI,and enhanced lesions.Pyrosequencing was used to detect the MGMT promoter methylation status.Univariate and multivariate Logistic regression analyses were used to find the imaging feature factors that affect the MGMT promoter methylation status.Then,by plotting the receiver operating characteristic(ROC)curve,verify the predictive efficacy of the imaging features.For the prediction task,further train and test 4 machine learning(ML)models,namely Logistic regression(LR),support vector machine(SVM),random forest(RF),and gradient boosting(GB).Results Logistic regression analysis showed that homogeneous signal on T2WI(OR=2.843,95%CI:1.055-7.658;P=0.039)and enhanced lesions(OR=0.146,95%CI:0.069-0.308;P=0.000)were imaging feature factors affecting the MGMT promoter methylation status.The comprehensive parameters combining both had higher prediction ability compared with homogeneous signal on T2WI(Z=3.961,P=0.000)and enhanced lesions(Z=2.233,P=0.026).The prediction accuracies rates of LR,SVM,RF and GB models were 0.84,0.76,0.68 and 0.76,respectively.However,there were no statistically significant differences in prediction efficacy when comparing the models pairwise(P>0.05,for all).Conclusions Imaging features based on preoperative CT and MRI show promise for non-invasive prediction of MGMT promoter methylation status in glioma.

Abstract:Objective To investigate the electrocorticographic signal activity characteristics in glioma located in the motor area.Methods Total 8 patients undergoing awake craniotomy for motor area-involved glioma in West China Hospital,Sichuan University between October 2024 and February 2025 were enrolled.During the awake state,2 min resting-state electrocorticographic signals were continuously recorded.After preprocessing steps including filtering,signal activity characteristics across θ,α,β,γ1,γ2,γ3,γ4 frequency bands were extracted.Using preoperative MRI data and subdural electrode parameters,individualized brain and electrode models were reconstructed.The spatial relationships between electrodes and tumors during data acquisition were coregistered onto the brain models.Based on the tumor invasion degree into brain tissue beneath the electrodes,the 762 validated electrodes were categorized into 3 groups:normal brain tissue group(n=460),tumor-invaded cortex group(n=274)and tumor-non-invaded cortex group(n=28).Results In the frequency bands of θ(H=249.993,P=0.000),α(H=251.311,P=0.000),β(H=288.834,P=0.000),γ1(H=312.145,P=0.000),γ2(H=263.777,P=0.000),γ3(H=238.691,P=0.000),γ4(H=208.830,P=0.000),the differences in the electrocorticographic signal activity characteristics among the 3 groups were statistically significant.Further pairwise comparisons revealed that the electrocorticographic signal activity characteristics of the normal brain tissue group were higher than those of the tumor-invaded cortex group in the frequency bands of θ(Z=5.711,P=0.000),α(Z=5.823,P=0.000),β(Z=6.907,P=0.000),γ1(Z=7.286,P=0.000),γ2(Z=6.054,P=0.000),γ3(Z=5.247,P=0.000),γ4(Z=4.647,P=0.000),and higher than those of the tumor-non-invaded cortex group in the frequency bands of θ(Z=4.051,P=0.000),α(Z=3.277,P=0.001),β(Z=4.172,P=0.000),γ1(Z=5.013,P=0.000),γ2(Z=4.749,P=0.000),γ3(Z=4.264,P=0.000).The electrocorticographic signal activity characteristics of the tumor-non-invaded cortex group were higher than those of the tumor-invaded cortex group in the frequency bands of θ(Z=-2.071,P=0.038),α(Z=-2.871,P=0.004),β(Z=-2.403,P=0.016).Conclusions This study found that normal brain tissue exhibits higher activity characteristics in electrocorticographic signals compared to glioma tissue.These findings suggest the potential for developing glioma localization techniques based on electrocorticographic signals,which could assist neurosurgeons in achieving more precise glioma resection.