Cerebral Monitoring Research Articles

Non-Invasive Monitoring of Cerebral Edema Using Ultrasonic Echo Signal Features and Machine Learning

Objectives: Cerebral edema, a prevalent consequence of brain injury, is associated with significant mortality and disability. Timely diagnosis and monitoring are crucial for patient prognosis. There is a pressing clinical demand for a real-time, non-invasive cerebral edema monitoring method. Ultrasound methods are prime candidates for such investigations due to their non-invasive nature. Methods: Acute cerebral edema was introduced in rats by permanently occluding the left middle cerebral artery (MCA). Ultrasonic echo signals were collected at nine time points over a 24 h period to extract features from both the time and frequency domains. Concurrently, histomorphological changes were examined. We utilized support vector machine (SVM), logistic regression (LogR), decision tree (DT), and random forest (RF) algorithms for classifying cerebral edema types, and SVM, RF, linear regression (LR), and feedforward neural network (FNNs) for predicting the cerebral infarction volume ratio. Results: The integration of 16 ultrasonic features associated with cerebral edema development with the RF model enabled effective classification of cerebral edema types, with a high accuracy rate of 97.9%. Additionally, it provided an accurate prediction of the cerebral infarction volume ratio, with an R2 value of 0.8814. Conclusions: Our proposed strategy classifies cerebral edema and predicts the cerebral infarction volume ratio with satisfactory precision. The fusion of ultrasound echo features with machine learning presents a promising non-invasive approach for the monitoring of cerebral edema.

Real-world epilepsy monitoring with ultra long-term subcutaneous EEG: a 15-month prospective study.

Novel subcutaneous electroencephalography (sqEEG) systems enable prolonged, near-continuous cerebral monitoring in real-world conditions. Nevertheless, the feasibility, acceptability and overall clinical utility of these systems remains unclear. We report on the longest observational study using ultra long-term sqEEG to date. We conducted a 15-month prospective, observational study including ten adult people with treatment-resistant epilepsy. After device implantation, patients were asked to record sqEEG, to use an electronic seizure diary and to complete acceptability and usability questionnaires. sqEEG seizures were annotated visually, aided by automated detection. Seizure clustering was assessed via Fano Factor analysis and seizure periodicity at multiple timescales was investigated through circular statistics. Over a median duration of 438 days, ten patients recorded a median 18.8 hours/day, totalling 71,984 hours of real-world sqEEG data. Adherence and acceptability remained high throughout the study. While 754 sqEEG seizures were recorded across patients, over half (52%) of these were not reported in the patient diary. Of the 140 (27%) diary reports not associated with an identifiable sqEEG seizure, the majority (68%) were reported as seizures with preserved awareness. The sqEEG to diary F1 agreement score was highly variable, ranging from 0.06 to 0.97. Patient-specific patterns of seizure clustering and seizure periodicity were observed at multiple (circadian and multidien) timescales. We demonstrate feasibility and high acceptability of ultra long-term (months-years) sqEEG monitoring. These systems help provide real-world, more objective seizure counting compared to patient diaries. It is possible to monitor individual temporal fluctuations of seizure occurrence, including seizure cycles. [I do not have a X/Twitter handle]People with epilepsy may suffer from severe injuries or sudden death due to uncontrolled seizures. Many seizures remain unnoticed by people and unreported to doctors, despite these potentially catastrophic consequences. There is an urgent need to detect seizures more objectively. Our study used a novel device placed under the skin to monitor brainwave activity continuously, at home, for many months, in people with treatment-resistant epilepsy. By monitoring epilepsy from home, we detected many seizures unreported by patients, and we also found predictable patterns (cycles) of seizure occurrence over time. In the future, this type of monitoring could revolutionize epilepsy care, by improving safety, treatment management and reducing uncertainty in patients' daily lives.

Brain Ultrasonography in Critically Ill Septic Patients: A Scoping Review.

Sepsis-associated encephalopathy (SAE) is linked to high mortality and impaired neurologic outcome. Brain ultrasonography (US) is a non-invasive tool for cerebral monitoring. A scoping review of the literature in three databases was performed to answer if brain perfusion is altered in sepsis, to determine the role of brain US in guiding resuscitation and its ability to predict the outcome. Randomized controlled trials, clinical trials, observational studies, and systematic reviews on adults with sepsis or septic shock in the ICU were included. A total of 625 articles were screened, and 34 included. There were 85% observational studies and 15% systematic reviews with or without meta-analysis. The majority of studies had a small sample size and used different metrics. The studies focused on cerebral blood flow (CBF) alterations reporting variable results (CBF increased, normal, or decreased). The findings showed a variable rate of cerebral autoregulation (CAR) impairment, with higher incidence in the early stages of sepsis and associations with poor neurological outcomes. However, the impact of CAR and CBF alterations on neurological outcomes and mortality was not clear. Very few studies were found on resuscitation. In conclusion, brain US can identify cerebral perfusions alterations and its usage in sepsis is promising. However, the current body of evidence for its usage is poor and lacks standardization.

Cerebral near-infrared spectroscopy guided neonatal intensive care management for the preterm infant.

Infants requiring admission to the neonatal intensive care unit (NICU) are particularly vulnerable to developing brain injury. The severity of the underlying clinical conditions and the complexity of care call for continuous, cot-side, non-invasive monitoring tools. Near-infrared spectroscopy (NIRS) measures the regional tissue oxygen saturation of hemoglobin (rStO2) and provides continuous information on the net-result of several factors. Cerebral rStO2 correlates with echocardiography-derived measures of blood flow. Cerebral fractional tissue oxygen extraction provides information on the balance between oxygen supply and demand and can be continuously derived from the combined use of cerebral rStO2 and arterial oxygen saturation. Information on cerebral blood flow autoregulatory capacity can be obtained from combining cerebral rStO2 and invasive blood pressure monitoring by appropriate software. Cerebral rStO2 provides real-time, end-organ information on perfusion-oxygenation, and when interpreted in the clinical context based on pathophysiological principles may be used as a help to guide interventions in the NICU. In this review we will discuss how to optimize NIRS monitoring for application in the NICU, with a particular focus on the preterm infant. IMPACT: Near-infrared spectroscopy (NIRS) provides cot-side, real-time information on blood and oxygen supply to the brain. Therefore, it is a valuable tool to better understand the pathophysiology underlaying disease processes. Current evidence suggests that NIRS-guided treatment in extremely preterm infants during transitional circulation does not improve clinical outcomes. Specific training is needed to maximize potential performance. Pathophysiological interpretation of cerebral NIRS data in the given clinical context may help in decision-making. Appropriate use of this monitoring technique, interpreted concurrently with other routine parameters, is a potential clinical tool to guide interventions in the NICU setting.

Incidence of Concurrent Cerebral Desaturation and Electroencephalographic Burst Suppression in Cardiac Surgery Patients.

Increased intraoperative electroencephalographic (EEG) burst suppression is associated with postoperative delirium. Cerebral desaturation is considered as one of the factors associated with burst suppression. Our study investigates the association between cerebral desaturation and burst suppression by analyzing their concurrence. Additionally, we aim to examine their association with cardiac surgical phases to identify potential for targeted interventions. We retrospectively analyzed intraoperative 1-minute interval observations in 51 patients undergoing cardiac surgery. Processed EEG and cerebral oximetry were collected, with the anesthesiologists blinded to the information. The associations between cerebral desaturation (defined as a 10% decrease from baseline) and burst suppression, as well as with phase of cardiac surgery, were analyzed using the Generalized Logistic Mixed Effect Model. The results were presented as odds ratio and 95% confidence intervals (CIs). A value of P < .05 was considered statistically significant. The odds of burst suppression increased 1.5 times with cerebral desaturation (odds ratio [OR], 1.52, 95% CI, 1.11-2.07; P = .009). Compared to precardiopulmonary bypass (pre-CPB), the odds of cerebral desaturation were notably higher during CPB (OR, 22.1, 95% CI, 12.4-39.2; P < .001) and post-CPB (OR, 18.2, 95% CI, 12.2-27.3; P < .001). However, the odds of burst suppression were lower during post-CPB (OR, 0.69, 95% CI, 0.59-0.81; P < .001) compared to pre-CPB. Compared to pre-CPB, the odds of concurrent cerebral desaturation and burst suppression were notably higher during CPB (OR, 52.3, 95% CI, 19.5-140; P < .001) and post-CPB (OR, 12.7, 95% CI, 6.39-25.2; P < .001). During CPB, the odds of cerebral desaturation (OR, 6.59, 95% CI, 3.62-12; P < .001) and concurrent cerebral desaturation and burst suppression (OR, 10, 95% CI, 4.01-25.1; P < .001) were higher in the period between removal of aortic cross-clamp and end of CPB. During the entire surgery, the odds of burst suppression increased 8 times with higher inhalational anesthesia concentration (OR, 7.81, 95% CI, 6.26-9.74; P < .001 per 0.1% increase). Cerebral desaturation is associated with intraoperative burst suppression during cardiac surgery, most significantly during CPB, especially during the period between the removal of the aortic cross-clamp and end of CPB. Further exploration with simultaneous cerebral oximetry and EEG monitoring is required to determine the causes of burst suppression. Targeted interventions to address cerebral desaturation may assist in mitigating burst suppression and consequently enhance postoperative cognitive function.

Web-based training and certification of clinical staff during the randomised clinical trial SafeBoosC-III

BackgroundSafeBoosC-III is a pragmatic, multinational clinical trial evaluating cerebral oximetry-guided treatment for extremely preterm infants. In total, 1601 infants were randomised across 70 sites in Asia, Europe, and USA. To enhance data quality and patient care, a web-based training program was implemented for staff. We now report on the processes.MethodsAll training modules consisted of initial learning material followed by a case-based quiz, with elaborate responses to correct as well as to wrong answers. Modules covered trial introduction, cerebral oximetry monitoring, treatment guidelines, cerebral ultrasound, and Good Clinical Practice. The introduction module was accessible in eight languages on an online platform, while language versions varied for other modules, due to different needs. Certification was earned upon module completion, relevant to the staff category. The training was not mandatory, but for motivational purposes, principal investigators continuously received local certification rate reports.ResultsA total of 926 out of 2347 staff (39%) obtained certification. Amongst 295 staff who completed the evaluation, 83% rated the program as overall good and 94% found it relevant to clinical practice. Sites exhibited varying certification rates, with 10 at 0%, 43 between 0.1 and 79.9%, and 17 exceeding 80%. There was no correlation between the rate of certification in individual sites and how often the clinical management was changed due to cerebral hypoxia nor a correlation to site-specific estimates of the intervention effect.ConclusionDespite language barriers and a low budget, our web-based training and certification program proved feasible. Only a minority of sites reached 80% certification of staff and an impact on the trial could not be detected.Trial registrationThe SafeBoosC-III trial is registered at ClinicalTrials.gov NCT03770741. The first participant was randomised in June 2019 and recruitment was completed in December 2021.

Differential hypoxemia during peripheral cardiopulmonary bypass.

Minimally invasive cardiac surgery (MICS) for mitral valve repair often uses cardiopulmonary bypass (CPB) through peripheral femoro-femoral cannulation. A rare complication of differential hypoxemia can cause upper body hypoxia. A 38-year-old man with Barlow Syndrome underwent MICS mitral valve repair with peripheral CPB. During the procedure, his right upper limb SpO2 dropped to 65% due to dislodgement of the venous cannula from the superior vena cava (SVC), causing inadequate right heart venous drainage, leading to differential hypoxemia. Repositioning the venous cannula to the SVC restored SpO2 to 100%, allowing the surgery to proceed without complications. Differential hypoxemia happens when deoxygenated blood from the left ventricle mixes with oxygenated CPB blood. A literature review found only one previous case of this complication on peripheral CPB for MICS. Unlike our case, Kanda et al. monitored cerebral hypoxia, underscoring the importance of cerebral oxygenation monitoring in future MICS procedures due to higher stroke risk compared to conventional sternotomy. We recommend cerebral oxygenation monitoring in future MICS to prevent neurological complications, and highlight the need for effective team communication in the cardiac operating theatre.

Radio Frequency-Enabled Cerebral Blood Flow Monitoring and Classification Using Data Augmentation and Machine Learning Techniques

Radio Frequency-Enabled Cerebral Blood Flow Monitoring and Classification Using Data Augmentation and Machine Learning Techniques

Artifact Management for Cerebral Near-Infrared Spectroscopy Signals: A Systematic Scoping Review.

Artifacts induced during patient monitoring are a main limitation for near-infrared spectroscopy (NIRS) as a non-invasive method of cerebral hemodynamic monitoring. There currently does not exist a robust "gold-standard" method for artifact management for these signals. The objective of this review is to comprehensively examine the literature on existing artifact management methods for cerebral NIRS signals recorded in animals and humans. A search of five databases was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search yielded 806 unique results. There were 19 articles from these results that were included in this review based on the inclusion/exclusion criteria. There were an additional 36 articles identified in the references of select articles that were also included. The methods outlined in these articles were grouped under two major categories: (1) motion and other disconnection artifact removal methods; (2) data quality improvement and physiological/other noise artifact filtering methods. These were sub-categorized by method type. It proved difficult to quantitatively compare the methods due to the heterogeneity of the effectiveness metrics and definitions of artifacts. The limitations evident in the existing literature justify the need for more comprehensive comparisons of artifact management. This review provides insights into the available methods for artifact management in cerebral NIRS and justification for a homogenous method to quantify the effectiveness of artifact management methods. This builds upon the work of two existing reviews that have been conducted on this topic; however, the scope is extended to all artifact types and all NIRS recording types. Future work by our lab in cerebral NIRS artifact management will lie in a layered artifact management method that will employ different techniques covered in this review (including dynamic thresholding, autoregressive-based methods, and wavelet-based methods) amongst others to remove varying artifact types.

Cerebral oximetry in high-risk surgical patients: where are we?

This review aims to summarize the latest evidence on the role of near-infrared spectroscopy (NIRS) in monitoring cerebral oxygenation in high-risk surgical patients, including both cardiac and noncardiac surgeries, and to present a new algorithm for its application. NIRS effectively measures brain oxygen saturation noninvasively, proving valuable in cardiac surgeries to reduce neurological complications, though its impact on nonneurological outcomes is less clear. In noncardiac surgeries, NIRS can help prevent complications like postoperative cognitive dysfunction, particularly in high-risk and major surgeries. Studies highlight the variability of cerebral oxygenation impacts based on surgical positions, with mixed results in positions like the beach chair and sitting positions. A structured algorithm for managing cerebral desaturation has been proposed to optimize outcomes by addressing multiple factors contributing to blood oxygen content and delivery. Despite its limitations, including spatial resolution and interindividual variability, NIRS is a useful tool for intraoperative cerebral monitoring. Further studies are needed to confirm its broader applicability in noncardiac surgeries, but current evidence supports its role in reducing postoperative complications especially in cardiac surgeries.

ATLAS: a large array, on-chip compute SPAD camera for multispeckle diffuse correlation spectroscopy.

We present ATLAS, a 512 × 512 single-photon avalanche diode (SPAD) array with embedded autocorrelation computation, implemented in 3D-stacked CMOS technology, suitable for single-photon correlation spectroscopy applications, including diffuse correlation spectroscopy (DCS). The shared per-macropixel SRAM architecture provides a 128 × 128 macropixel resolution, with parallel autocorrelation computation, with a minimum autocorrelation lag-time of 1 µs. We demonstrate the direct, on-chip computation of the autocorrelation function of the sensor, and its capability to resolve changes in decorrelation times typical of body tissue in real time, at long source-detector separations similar to those achieved by the current leading optical modalities for cerebral blood flow monitoring. Finally, we demonstrate the suitability for in-vivo measurements through cuff-occlusion and forehead cardiac signal measurements.

Danggui-Shaoyao-San (DSS) ameliorating cognitive impairment in ischemia–reperfusion vascular dementia mice through miR-124 regulating PI3K/Akt signaling pathway

Vascular dementia (VD) is a disease characterized by cognitive impairment and memory loss due to brain cell damage caused by cerebral vascular ischemia. Danggui-Shaoyao-San (DSS) has been used clinically to treat diseases for centuries. The VD model was established by bilateral common carotid artery (BCCA) repeated ischemia–reperfusion (I/R) and caudal bleeding. Target prediction of DSS and miR-124 in PI3K/Akt signaling pathway by network pharmacology. The effect of DSS on cognitive dysfunction were evaluated through methods such as behavioral experiments, cerebral blood flow monitoring, HE and Nissl staining, western blot, and q-PCR. Prediction result showed that both DSS and miR-124 could target Akt1. DSS treatment significantly reduced hippocampal cell damage, improved learning and memory ability. Mechanically, DSS treatment up-regulated the expression levels of PI3K and Akt protein, and its gene. Bcl-2/Bax index is up-regulated and cell apoptosis reduced. LC3II/LC3I index decreased and autophagy of brain cells increased. Moreover, DSS down-regulated the expression level of miR-124. And inhibition of miR-124 up-regulate the expression of PI3K, Akt. These results suggested that DSS can reduce the content of miR-124 in the hippocampus of VD mice, thus regulating the PI3K/Akt signaling pathway and improving the learning and memory ability of VD mice.

The Association of Cerebral Autoregulation Dysfunction and Postoperative Memory Impairment in Cardiac Surgery Patients.

Background and Objectives: Cardiac surgery is associated with various durations of cerebral autoregulation (CA) impairment and can significantly impact cognitive function. Cognitive functions such as memory, psychomotor speed, and attention are significantly impacted after cardiac surgery, necessitating prioritization of these areas in cognitive function tests. There is a lack of research connecting cerebral autoregulation impairment to specific cognitive function domains after cardiac surgery. This study aimed to determine if impaired cerebral autoregulation is associated with postoperative memory impairment and to test the hypothesis that the duration of this impairment affects the development of postoperative memory issues. Materials and Methods: A prospective study was conducted in 2021-2023. After approval of the Ethics Committee and with patient's written consent, 83 adult patients undergoing elective on-pump coronary artery bypass graft (CABG) surgery were enrolled. All patients were assessed for cognitive function 1 day before surgery using the Mini-Mental state examination (MMSE-2) test as a screening tool and the Hopkins Verbal Learning Test-Revised (HVLT-R) to assess memory specifically. To diagnose possible memory impairment (IM), all patients underwent a repeat assessment of cognitive function on the 7th-10th postoperative day. Cerebral autoregulation monitoring using transcranial Doppler was performed. Cerebral autoregulation status index (Mx) was recorded using Intensive Care Brain Monitoring System software, 9.1.5.23 (Cambridge, UK). Results: According to our research, the incidence of postoperative memory impairment is 30.1%. Temporary cerebral autoregulation impairment occurs in all patients undergoing elective in-pump CABG surgery. The duration of the single longest CA impairment event in seconds (LCAI) and the LCAI dose were higher in patients with postoperative memory impairment, p = 0.006 and p < 0.007, respectively. Conclusions: Cerebral autoregulation impairment is important in developing memory loss after cardiac surgery. The duration and dose of the LCAI event are predictive of postoperative memory impairment.

Enhancing postoperative analgesia in carotid endarterectomy patients: The potential of ultrasound-guided carotid sheath block combined with superficial cervical plexus block: A randomised trial.

Carotid endarterectomy (CEA) is a common procedure conducted under regional anaesthesia, providing real-time cerebral function monitoring. Many different combinations of regional cervical blocks exist, and most offer adequate analgesia in intraoperative and postoperative recovery. This research compares a superficial cervical plexus block (SCB) alone and combined with an ultrasound (US)-guided carotid sheath block (CSB). The primary objective was to explore the length of the sensory block after combining SCB and CSB. Patients scheduled for nonemergency CEA surgery were randomised into two cohorts. The Subject group (28 participants) received US-guided CSB and SCB. The Control group (31 participants) received only an SCB. Both groups received 0.5% levobupivacaine (2 mg/kg) along with 2% lidocaine (2 mg/kg). The sensory block time and its initiation, analgesia and neutrophil-to-lymphocyte ratio (NLR) were recorded before and after the block. The numeric pain rating scale (NPRS) was used to evaluate analgesia every 2 h for 12 h post block. Analysis of variance, Mann-Whitney U or log-rank test was used to analyse the distinction of selected variables. The demographic characteristics were comparable across the cohorts. The Subject group demonstrated a significantly accelerated onset of sensory block (P = 0.029) and an extended time to first analgesia (P = 0.003). The sensory block was also substantially extended in the Subject group (P = 0.040). Postoperative pain (NPRS ≥1) within the first 12 h was more recurrent in the Control group (P = 0.048). NLR showed minimal disparity between the groups (P = 0.125). Combining SCB and US-guided CSB effectively and safely extends postoperative analgesia for CEA surgery.

A novel noninvasive method for dynamic cerebral autoregulation monitoring based on near-field coupling

Dynamical cerebral autoregulation (dCA) is crucial for optimizing blood pressure (BP) management and enhancing the prognosis of stroke patients. This study aims to obtain detailed cerebral blood flow (CBF) based on near-field coupling (NFC) and establish a novel method for evaluating dCA comprehensively. We developed a synchronized monitoring system of photoplethysmography-based mean arterial pressure (MAP) and NFC-based CBF. Fifteen healthy volunteers underwent dCA measurements before and after a body tilt. The multiple CBF parameters derived from NFC, along with synchronized MAP data, were used to compute the new dCA indices. Through a comparative analysis with TCD and NIRS, we studied the ability of NFC to assess dCA accurately and comprehensively. The results show that the trend in CBF changes measured by NFC before and after body tilt corresponded to the fluctuations observed in MAP. Compared to CBFV from TCD and rSO2 from NIRS, the NFC-derived parameters provide both intracranial hemodynamics and microcirculation. The dCA indices from NFC show high consistency with those from TCD, and the RFx-PVD, RFx-VEI, and RFx-HFC are the ideal indices for assessing dCA. The CAT of RFx-HFC has the largest effect size in distinguishing different dCA levels. These results demonstrate the feasibility and reliability of integrating NFC with synchronized MAP data collection to comprehensively and accurately assess dCA. It is expected to overcome the mutual constraints of existing methods in terms of time resolution, detection range and depth, and provide a new solution for continuous bedside assessment of dCA in patients with stroke.

Use of intermediate cervical plexus block in carotid endarterectomy –an alternative to deep cervical plexus block: a case series

IntroductionCarotid endarterectomy is performed for patients with symptomatic carotid artery occlusions. Surgery can be performed under general and regional anesthesia. Traditionally, surgery is performed under deep cervical plexus block which is technically difficult to perform and can cause serious complications. This case series describes 5 cases in which an intermediate cervical plexus block was used in combination with a superficial cervical plexus block for Carotid endarterectomy surgery.MethodsFive patients who were classified as American Society of Anesthesiologists 2–3 were scheduled for Carotid endarterectomy due to symptoms and more than 70% occlusion of the carotid arteries. The procedures were carried out in the University Teaching Hospital- Peradeniya, Sri Lanka. All patients were given superficial cervical plexus block followed by intermediate cervical plexus block using 2% lignocaine and 0.5% plain bupivacaine.ResultsAdequate anesthesia was achieved in 4 patients, and local infiltration was necessary in 1 patient. Two patients developed hoarseness of the voice, which settled 2 h after surgery. Hemodynamic fluctuations were observed in all 5 patients. No serious complications were observed. All 5 patients had uneventful recoveries.DiscussionsRegional anesthesia for CEA is preferable in patients who are medically complicated to undergo anesthesia or in patients for whom cerebral monitoring is not available. Intermediate cervical plexus block is described for thyroid surgeries in literature, but not much details on its use for carotid surgeries. Deep cervical plexus blocks has few serious complications which is not there with the use of ICPB making it a good alternative for CEA surgeries .ConclusionsSuperficial cervical plexus block and intermediate cervical plexus block can be used effectively for providing anesthesia for patients undergoing Carotid endarterectomy. It is safe and easier to conduct than deep cervical plexus block and enables monitoring of cerebral function.

Effects and neural mechanisms of different physical activity on major depressive disorder based on cerebral multimodality monitoring: a narrative review.

Major depressive disorder (MDD) is currently the most common psychiatric disorder in the world. It characterized by a high incidence of disease with the symptoms like depressed mood, slowed thinking, and reduced cognitive function. Without timely intervention, there is a 20-30% risk of conversion to treatment-resistant depression (TRD) and a high burden for the patient, family and society. Numerous studies have shown that physical activity (PA) is a non-pharmacological treatment that can significantly improve the mental status of patients with MDD and has positive effects on cognitive function, sleep status, and brain plasticity. However, the physiological and psychological effects of different types of PA on individuals vary, and the dosage profile of PA in improving symptoms in patients with MDD has not been elucidated. In most current studies of MDD, PA can be categorized as continuous endurance training (ECT), explosive interval training (EIT), resistance strength training (RST), and mind-body training (MBT), and the effects on patients' depressive symptoms, cognitive function, and sleep varied. Therefore, the present study was based on a narrative review and included a large number of existing studies to investigate the characteristics and differences in the effects of different PA interventions on MDD. The study also investigated the characteristics and differences of different PA interventions in MDD, and explained the neural mechanisms through the results of multimodal brain function monitoring, including the intracranial environment and brain structure. It aims to provide exercise prescription and theoretical reference for future research in neuroscience and clinical intervention in MDD.

Cerebral Edema Monitoring and Management Strategies: Results from an International Practice Survey.

Cerebral edema is a common, potentially life-threatening complication in critically ill patients with acute brain injury. However, uncertainty remains regarding best monitoring and treatment strategies, which may result in wide practice variations. A 20-question digital survey on monitoring and management practices was disseminated between July 2022 and May 2023 to clinicians who manage cerebral edema. The survey was promoted through email, social media, medical conferences, and the Neurocritical Care Society Web site. We used the χ2 test, Fisher's exact test, analysis of variance, and logistic regression to report factors associated with practice variation, diagnostic monitoring methods, and therapeutic triggers based on practitioner and institutional characteristics. Of 321 participants from 160 institutions in 30 countries, 65% were from university-affiliated centers, 74% were attending physicians, 38% were woman, 38% had neurology training, and 55% were US-based. Eighty-four percent observed practice variations at their institutions, with "provider preference" being cited most (87%). Factors linked to variation included gender, experience, university affiliation, and practicing outside the United States. University affiliates tended to use more tests (median 3.87 vs. 3.43, p = 0.01) to monitor cerebral edema. Regarding management practices, 20% of respondents' preferred timing for decompressive hemicraniectomy was after 48h, and 37% stated that radiographic findings only would be sufficient to trigger surgery. Fifty percent of respondents reported initiating osmotic therapy based on radiographic indications or prophylactically. There were no significant associations between management strategies and respondent or center characteristics. Twenty-seven percent of respondents indicated that they acquired neuroimaging at intervals of 24h or less. Within this group, attending physicians were more likely to follow this practice (65.5% vs. 34.5%, p = 0.04). Cerebral edema monitoring and management strategies vary. Features associated with practice variations include both practitioner and institutional characteristics. We provide a foundation for understanding practice patterns that is crucial for informing educational initiatives, standardizing guidelines, and conducting future trials.

Design of a Real-Time Monitoring System for Electroencephalogram and Electromyography Signals in Cerebral Palsy Rehabilitation via Wearable Devices

Cerebral palsy is a disorder of central motor and postural development, resulting in limited mobility. Cerebral palsy is often accompanied by cognitive impairment and abnormal behavior, significantly impacting individuals and society. Time, energy, and economic investment in the rehabilitation process is substantial, yet the rehabilitation outcomes often remain unsatisfactory. Additionally, some patients have limited sensory perception during rehabilitation training, making it challenging to effectively regulate exercise intensity. Traditional evaluation methods are mostly based on recovery performance, lack guidance at the neurophysiological level, and have an unequal distribution of medical rehabilitation resources, which pose great challenges to the rehabilitation of patients. Based on the issues mentioned above, this paper proposes a real-time cerebral signal monitoring system based on wearable devices. This system can monitor and store blood oxygen, heart rate, myoelectric, and EEG signals during cerebral palsy rehabilitation, and it can track and monitor signals during the rehabilitation treatment process. The system includes two parts: hardware design and software design. The hardware design includes a data signal acquisition module, a main control chip (ESP32), a muscle electrical sensor module, a brain electrical sensor module, a blood/heart rate acquisition module, etc. It is primarily for real-time signal data acquisition, processing, and uploading to the cloud server. The software design includes functions such as data receiving, data processing, data storage, network configuration, and remote communication and enables the visual monitoring of data signals. The system can achieve real-time monitoring of electromyography, electroencephalography, and blood oxygen levels, as well as the heart rate of patients with cerebral palsy, and adjust rehabilitation training in real-time during the rehabilitation process. At the same time, based on the real-time storage of the original electromyography and electroencephalography data, it can provide auxiliary guidance for later rehabilitation evaluation and effective data support for the entire rehabilitation treatment process.

Biological and Procedural Predictors of Outcome in the Stroke Preclinical Assessment Network (SPAN) Trial.

The SPAN trial (Stroke Preclinical Assessment Network) is the largest preclinical study testing acute stroke interventions in experimental focal cerebral ischemia using endovascular filament middle cerebral artery occlusion (MCAo). Besides testing interventions against controls, the prospective design captured numerous biological and procedural variables, highlighting the enormous heterogeneity introduced by the multicenter structure that might influence stroke outcomes. Here, we leveraged the unprecedented sample size achieved by the SPAN trial and the prospective design to identify the biological and procedural variables that affect experimental stroke outcomes in transient endovascular filament MCAo. The study cohort included all mice enrolled and randomized in the SPAN trial (N=1789). Mice were subjected to 60-minute MCAo and followed for a month. Thirteen biological and procedural independent variables and 4 functional (weight loss and 4-point neuroscore on days 1 and 2, corner test on days 7 and 28, and mortality) and 3 tissue (day 2, magnetic resonance imaging infarct volumes and swelling; day 30, magnetic resonance imaging tissue loss) outcome variables were prospectively captured. Multivariable regression with stepwise elimination was used to identify the predictors and their effect sizes. Older age, active circadian stage at MCAo, and thinner and longer filament silicone tips predicted higher mortality. Older age, larger body weight, longer anesthesia duration, and longer filament tips predicted worse neuroscores, while high-fat diet and blood flow monitoring predicted milder neuroscores. Older age and a high-fat diet predicted worse corner test performance. While shorter filament tips predicted more ipsiversive turning, longer filament tips appeared to predict contraversive turning. Age, sex, and weight interacted when predicting the infarct volume. Older age was associated with smaller infarcts on day 2 magnetic resonance imaging, especially in animals with larger body weights; this association was most conspicuous in females. High-fat diet also predicted smaller infarcts. In contrast, the use of cerebral blood flow monitoring and more severe cerebral blood flow drop during MCAo, longer anesthesia, and longer filament tips all predicted larger infarcts. Bivariate analyses among the dependent variables highlighted a disconnect between tissue and functional outcomes. Our analyses identified variables affecting endovascular filament MCAo outcome, an experimental stroke model used worldwide. Multiple regression refuted some commonly reported predictors and revealed previously unrecognized associations. Given the multicenter prospective design that represents a sampling of real-world conditions, the degree of heterogeneity mimicking clinical trials, the large number of predictors adjusted for in the multivariable model, and the large sample size, we think this is the most definitive analysis of the predictors of preclinical stroke outcome to date. Future multicenter experimental stroke trials should standardize or at least ensure a balanced representation of the biological and procedural variables identified herein as potential confounders.