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. 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. 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. 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.

BackgroundParkinson’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.ObjectiveThis 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.ResultsOur 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.ConclusionNortriptyline 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.

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. 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. 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. 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.

[This retracts the article DOI: 10.1155/2015/742059.].

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.

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: Abnormal elevation of transforming growth factor-beta (TGF-β) has been observed among Alzheimer's disease (AD) patients. This may be due to microglia-mediated release of proinflammatory cytokines, which promote neuroinflammation and neuronal apoptosis. Silencing of TGFBR1, a gene encoding TGF-β receptor type I (TGF-βR1), has resulted in neuronal survival from amyloid-beta (Aβ)-induced neurotoxicity. Therefore, the present study investigated the neuroprotective effect of TGF-βR1 inhibitors (RepSox, Galunisertib, and Vactosertib) against Aβ-induced direct neurotoxicity and microglia-mediated neuroinflammation.Methods: The neuroprotective effect of TGF-βR1 inhibitors against Aβ-induced direct neurotoxicity and microglia-mediated neuroinflammation were investigated using the RealTime-Glo™ MT Cell Viability Assay. The inhibitory effect of TGF-βR1 inhibitors on Aβ-induced microglia-mediated production of proinflammatory cytokines (TNF-α and IL-1β) was determined using enzyme-linked immunosorbent assay (ELISA).Results: TGF-βR1 inhibitors (RepSox, Galunisertib, and Vactosertib) at the tested concentrations (6.25–150 nM) showed no significant cytotoxicity effects on SH-SY5Y and BV-2 cells. Moreover, treatments with these inhibitors exhibited neuroprotection on SH-SY5Y cells against Aβ-induced direct neurotoxicity. The trend of cell viability after 24 h treatment also supports the microscopic images of the cells' morphology. Furthermore, pretreatment with these inhibitors conferred indirect neuroprotective effect against Aβ-induced microglia-mediated neuroinflammation by attenuating the production of proinflammatory cytokines (TNF-α and IL-1β).Conclusion: The inhibition of the TGF-β signaling pathway in neuronal and microglia cells by TGF-βR1 inhibitors resulted in neuroprotection against Aβ-induced direct neurotoxicity and microglia-mediated neuroinflammation. Hence, targeting the TGF-β signaling pathway in both neuronal and microglia cells could provide a promising therapeutic strategy in AD.

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.