Clinical Assessment Scale Research Articles

Clinical features and immunotherapy outcomes in antibody-negative autoimmune encephalitis: a retrospective case-control study.

This study aimed to compare clinical features, laboratory findings, and immunotherapy responses between antibody-positive and antibody-negative Autoimmune encephalitis (AE) patients. A retrospective analysis of clinical data from 60 AE patients (33 antibody-positive, 27 antibody-negative) diagnosed at Zhongshan Hospital of Xiamen University between January 1, 2016, and March 1, 2024 was conducted. Disease severity and treatment response were assessed using the modified Rankin Scale (mRS) and the Clinical Assessment Scale for Autoimmune Encephalitis (CASE). Antibody-positive AE patients more frequently presented with multiple symptoms (≥4 symptoms: 39.4% vs. 14.8%, p = 0.036). They demonstrated significantly elevated serum IgG concentrations (p = 0.010) and cerebrospinal fluid (CSF) leukocyte counts (p = 0.014). Conversely, antibody-negative AE patients presented with higher CSF total protein levels (p = 0.025) and albumin quotients (p = 0.018), indicative of more severe blood-brain barrier disruption. Antibody-positive AE patients more frequently received combination first-line immunotherapy (75.8% vs. 48.1%, p = 0.027) and exhibited superior treatment outcomes (90.9% vs. 70%, p = 0.022). Among critically ill patients (peak mRS score: 4-5), improvement in CASE scores was markedly greater in the antibody-positive cohort (median: 4.50 vs. 1.00, p = 0.024). Antibody-positive AE patients manifested a more diverse symptom spectrum, elevated serum IgG concentrations and CSF leukocyte counts, and superior responses to immunotherapy. In contrast, antibody-negative AE patients demonstrated more severe blood-brain barrier dysfunction, as evidenced by higher CSF total protein concentrations and albumin quotients.

Short delay to initiate plasma exchange or immunoadsorption as synergistic therapies for patients in the acute phase of anti-NMDAR encephalitis

Background: Combined first-line therapies have been frequently adopted for patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Plasma exchange (PE) or immunoadsorption (IA) was used as an add-on option following initial immunotherapies, including high-dose steroids and intravenous immunoglobulin (IVIG). However, whether a shorter delay of PE or IA can improve the early recovery prognosis of patients with anti-NMDAR encephalitis remains largely unknown. Objective: To compare short-term clinical improvement between patients with early and late initiation of PE or IA in anti-NMDAR encephalitis. Design: A retrospective study was conducted for patients admitted with anti-NMDAR encephalitis between January 2015 and December 2023 ( n = 29), including 21 patients who received PE or IA as synergistic therapies. Methods: The clinical prognosis was compared between the early PE/IA group and the late PE/IA group in the research. Primary outcome included changes in the Clinical Assessment Scale for Autoimmune Encephalitis (∆CASE) at 90 and 120 days after encephalitis onset. Secondary outcomes included changes in the modified Rankin scale (∆mRS) after 90 and 120 days from encephalitis onset, and the length of intensive care unit (ICU) stay for patients with severe anti-NMDAR encephalitis. Results: The ∆CASE scores after 90 and 120 days from encephalitis onset revealed a significant difference between patients with early and late initiation of PE or IA ( p ⩽ 0.05). A significant difference in the ∆mRS was also found between patients with early and late initiation of PE or IA in severe encephalitis ( p ⩽ 0.05). No significant difference was found in the length of ICU admission ( p = 0.101). Conclusion: Our findings emphasize the importance of considering PE or IA as early as feasible for patients with anti-NMDAR encephalitis, even when steroids and IVIG are in use.

A Case Report of Anti-NMDA Receptor Encephalitis with Ovarian Teratoma Improved by Korean Medicine

Objectives: This study reports on the improvement of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis with ovarian teratoma after Korean medicine treatment.Methods: A patient was treated with Korean medicine treatments, such as acupuncture and herbal medications (<i>Gami-ondam-tang</i> and <i>Samulanshin-tang-gamibang</i>). The patient’s improvement was evaluated using manual muscle testing (MMT), the Mini-Mental State Exam-Korea (MMSE-K), the modified Barthel index (MBI), and the Clinical Assessment Scale in Autoimmune Encephalitis (CASE).Results: After using Korean medicine treatments, the patient’s MMT, MMSE-K, and MBI scores increased, and the CASE score decreased.Conclusion: This case suggests that Korean medicine can be effective in treating the symptoms of anti-NMDA receptor encephalitis.

ARTERIAL HYPOTENSION IN HEART FAILURE PATIENTS INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS

HighlightsArterial hypotension is a factor aggravating the course of heart failure in HIV-infected people in 18.3% of cases, more often accompanied by the development of left ventricular hypertrophy. The risk factor for the development of arterial hypotension in persons infected with the human immunodeficiency virus (HIV) and having HF is the concentration of caspase-6 in the blood serum, which probably indicates the intensification of apoptosis processes in cardiomyocytes. The value of the glomerular filtration rate, calculated by the CKD-EPI formula with the inclusion of the level of cystatin C in the blood serum, is associated with the development of arterial hypotension. AbstractAim. To study the features of arterial hypotension in HIV-infected patients with HF in comparison with patients with normal blood pressure.Methods. The study included 44 patients with arterial hypotension (AHT) and 76 patients with normal blood pressure (BP) with heart failure (HF) and HIV admitted to a multidisciplinary hospital. All patients underwent the same number of examinations conducted personally by the author: echocardiography, noninvasive arteriography, assessment of the severity of HF using the Clinical Status Assessment Scale by V. Yu. Mareeva, six-minute walk test. Additionally, studies such as the determination of the N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP), cystatin C, caspase-6 and lipocaine 2 (NGAl) were conducted in a laboratory.Results. HIV-infected patients with HF are prone to developing AHT in 18.3% of cases. The results of the study indicate the predominance of males with low body mass index and high alcohol consumption in the group of patients with AHT. Moreover, patients with AHT are more likely to have pericardial effusion in front of the anterior wall of the right ventricle greater than 5 mm, anemia, unsuppressed viral load, left ventricular diastolic dysfunction and hypertrophy. At the same time, the level of cystatin C in their blood serum is lower, and the glomerular filtration rate is higher than in patients without AHT. The level of caspase-6 in the blood serum was significantly higher in the group of patients with AHT.Conclusion. HIV-infected patients with HF are prone to developing AHT in 18.3% of cases. The results of the study indicate a significant predominance of patients with LVH in the group of patients with AHT. The concentration of caspase-6 in blood serum equal to 148.35 pg/mL and higher turned out to be a risk factor for the development of AHT in HIV-infected patients with HF, probably indicating an intensification of apoptosis processes in cardiomyocytes. A glomerular filtration rate (GFR) equal to 47.5 mL/min/1.73 m2 and higher, calculated using the CKD-EPI formula with the inclusion of the level of cystatin C in the blood serum, is associated with a high probability of developing AHT. The pattern obtained may indicate both the activation of apoptosis processes against the background of AHT in the cells of the heart muscle, and the preservation of GFR against this background in patients with HF and HIV infection.

Definition and clinical management of haemodialysis central venous catheter local infections (exit site and tunnel infection): An international consensus assessment.

To evaluate the relevance of signs and symptoms for the clinical identification of ESI and TI in HD-CVC, by means of international expert consensus, and to reach a consensus on a definition and clinical management (CM) for these infections. A recent systematic review showed a high heterogeneity in the signs/symptoms used for determining exit site infection (ESI) and tunnel infection (TI) of haemodialysis central venous catheter (HD-CVC). A modified Delphi ranking process was carried out between November 2020 and March 2021, consisting of four rounds using an online questionnaire with a panel of 26 experts from 12 countries. Experts responded on the level of relevance for the identification of ESI and TI, based on a list of 22 signs/symptoms obtained from a previous systematic review, using a 4-point Likert-type scale. After reaching consensus on the signs/symptoms, they followed the same method to reach consensus on the CM. The STROBE Checklist was used to report this study. A high degree of consensus was reached to identify the presence of ESI based on nine signs/symptoms: presence of pain at the exit site (ES) during interdialysis period, with fever ≥38°C do not suspect other cause, local signs at the ES (inflammation, induration, swelling, hyperemia/erythema ≥2 cm from ES) and obvious abscess or purulent exudate at ES; and of TI. Likewise, 5 cm were agreed upon. This Delphi study provides international expert consensus definitions of ESI and TI in HD-CVC, laying the groundwork for the validation of an HD-CVC ES clinical assessment scale for early identification of ESI. In addition, this study provides a series of attitudes to consensual clinics regarding signs/symptoms of local infections in HD-CVC, which may be useful as expert opinion in clinical practice guidelines, when there is insufficient scientific evidence.

Differences in Cortical Activation During Dorsiflexion and Plantarflexion in Chronic Ankle Instability: A Task-fMRI Study.

Chronic ankle instability is a common sports injury that often presents with increased plantarflexion and restricted dorsiflexion. The cumulative effect of peripheral injuries may induce neuroplasticity in the central nervous system. However, the relationship between dorsiflexion or plantarflexion and the central nervous system in patients with chronic ankle instability remains unknown. (1) Is there a difference in region and voxel (volume pixel) of cortical activation during plantarflexion and dorsiflexion between patients with chronic ankle instability and a control group with normal ankle function? (2) Is there a correlation between activation of sensorimotor-related brain regions and three clinical measurement scales of ankle function and disease severity in patients with chronic ankle instability? Between December 2020 and May 2022, we treated 400 patients who had chronic ankle instability. Ten percent (40 patients; mean ± standard deviation age 29 ± 7 years; 17 male patients) were randomly selected to participate in this study. We recruited 42 volunteers with normal ankle function (mean age 28 ± 5 years; 21 male participants) matched by age and education level. A total of 2.5% (1 of 40) of patients with bilateral chronic ankle instability and 30% (12 of 40) with left-sided chronic ankle injury did not meet our inclusion criteria and were excluded from the study. The control group underwent MRI with good image quality. Finally, 27 patients with chronic ankle instability (mean age 26 ± 5 years; 10 male patients) and 42 participants with normal ankle function were enrolled. Ankle function and disease severity were assessed using three clinical scales: the Cumberland Ankle Instability Tool, Karlsson-Peterson Ankle Function Score, and the American Orthopedic Foot and Ankle Society Score. A uniplanar and nonweightbearing ankle dorsiflexion-plantarflexion paradigm (a recognized model or pattern) was performed using a short-block design during the functional MRI scan. This experimental design included a series of on-off periods consisting of movement and a rest period. From 15° of plantarflexion to 15° of dorsiflexion, the manipulator allowed 30° of ankle rotation. The cerebral excitability patterns between patients with chronic ankle instability and controls were analyzed using t-tests. We retained voxels with p values less than 0.05 in a voxel-level family-wise error correction. Clusters with voxel numbers greater than 10 were retained. The Cohen d coefficient was used to calculate between-group effect sizes. Spearman analysis was performed to explore the correlation between activation regions and the three clinical assessment scales. In the patient group, cortical activation was greater during plantarflexion than during dorsiflexion, which was different from that in the control group. The between-group comparison showed that patients with chronic ankle instability had reduced activation in the ipsilateral precuneus (cluster size = 35 voxels [95% CI -0.23 to 0.07]; p < 0.001) during dorsiflexion, whereas during plantarflexion, chronic ankle instability caused increased activation in the ipsilateral superior temporal gyrus (cluster size = 90 voxels [95% CI -0.73 to -0.13]; p < 0.001), precuneus (cluster size = 18 voxels [95% CI -0.56 to -0.19]; p < 0.001), supplementary motor area (cluster size = 57 voxels [95% CI -0.31 to 0.00]; p < 0.001), superior frontal gyrus (cluster size = 43 voxels [95% CI -0.82 to -0.29]; p < 0.001), medial part of the superior frontal gyrus (cluster size = 39 voxels [95% CI 0.41 to 0.78]; p < 0.001), and contralateral postcentral gyrus (cluster size = 100 voxels [95% CI -0.32 to 0.02]; p < 0.001). Patients with chronic ankle instability showed a large effect size compared with controls (Cohen d > 0.8). During plantarflexion, the number of activated voxels in the supplementary motor area had a modest, positive correlation with the Karlsson-Peterson Ankle Function Score (r = 0.52; p = 0.01), and the number of activated voxels in the primary motor cortex (M1) and primary sensory cortex (S1) had a weak, positive correlation with the American Orthopedic Foot and Ankle Society Score in patients with chronic ankle instability (M1: r = 0.45; p = 0.02, S1: r = 0.49; p = 0.01). Compared with volunteers with normal ankle function, patients with chronic ankle instability had increased cortical activation during plantarflexion and decreased cortical activation during dorsiflexion. We analyzed the central neural mechanisms of chronic ankle instability in patients with sports injuries and provided a theoretical basis for the development of new central and peripheral interventions in the future. Because there was a positive correlation between the neural activity in sensorimotor-related regions during plantarflexion and clinical severity, clinicians might one day be able to help patients who have chronic ankle instability with neuromuscular rehabilitation by applying electrical stimulation to specific targets (such as S1M1 and the supplementary motor area) or by increasing activation of sensorimotor neurons through ankle movement.

Changes in aspartate metabolism in the medial-prefrontal cortex of nicotine addicts based on J-edited magnetic resonance spectroscopy.

This study aims to explore the changes of the aspartate (Asp) level in the medial-prefrontal cortex (mPFC) of subjects with nicotine addiction (nicotine addicts [NAs]) using the J-edited 1 H MR spectroscopy (MRS), which may provide a positive imaging evidence for intervention of NA. From March to August 2022, 45 males aged 40-60 years old were recruited from Henan Province, including 21 in NA and 24 in nonsmoker groups. All subjects underwent routine magnetic resonance imaging (MRI) and J-edited MRS scans on a 3.0 T MRI scanner. The Asp level in mPFC was quantified with reference to the total creatine (Asp/Cr) and water (Aspwater-corr , with correction of the brain tissue composition) signals, respectively. Two-tailed independent samples t-test was used to analyze the differences in levels of Asp and other coquantified metabolites (including total N-acetylaspartate [tNAA], total cholinine [tCho], total creatine [tCr], and myo-Inositol [mI]) between the two groups. Finally, the correlations of the Asp level with clinical characteristic assessment scales were performed using the Spearman criteria. Compared with the control group (n = 22), NAs (n = 18) had higher levels of Asp (Asp/Cr: p = .005; Aspwater-corr : p = .004) in the mPFC, and the level of Asp was positively correlated with the daily smoking amount (Asp/Cr: p < .001; Aspwater-corr : p = .004). No significant correlation was found between the level of Asp and the years of nicotine use, Fagerstrom Nicotine Dependence (FTND), Russell Reason for Smoking Questionnaire (RRSQ), or Barratt Impulsivity Scale (BIS-11) score. The elevated Asp level was observed in mPFC of NAs in contrast to nonsmokers, and the Asp level was positively correlated with the amount of daily smoking, which suggests that nicotine addiction may result in elevated Asp metabolism in the human brain.

ДЕПРЕССИВНЫЕ РАССТРОЙСТВА И ПРОГНОЗ У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ ИШЕМИЧЕСКОЙ ЭТИОЛОГИИ

Abstract. Introduction. Clinical depression occurs in 21.5% of patients with heart failure, aggravating both the clinical course and the prognosis of the disease. The aim is to present the findings of the clinical course of chronic heart failure in patients with depressive disorders and to study their prognoses. Material and Methods. The study included 78 patients with heart failure, functional classes 1-4. The degree of depressive disorders was assessed using the Hospital Anxiety and Depression Scale (HADS). Life quality was assessed using the Minnesota Living with Heart Failure Questionnaire. All patients passed a 6-minute walk test and echocardiography. The patient’s clinical condition was assessed according to the clinical condition assessment scale. Prognoses were assessed after 1 year of study. Results and Discussion. Depression level analysis has shown that the clinically pronounced depression is common in patients with heart failure, which corresponds to 9.0 (6.0;11.0) points. In a closer consideration of the structure of disorders, no depression was found in 37.2 % of cases, subclinical depression was found less frequently in patients with heart failure (26.9 %), while clinical depression was found in 35.9 %. All-cause mortality was observed in 7.7 % of cases, while cardiovascular mortality occurred in 4.6 %. Pronounced depression was registered in patients with chronic heart failure, in case of hospital admission. Conclusions. Average depression level in patients with heart failure is 9.0 (6.0; 11.0) points, which corresponds with clinical depression. Depression occurs in 62.8 % of cases and associated with worse clinical condition. Overt clinical depression occurs more frequently in patients with chronic heart failure, who have come up to the event of hospitalization.

Development and validation of Ayurveda based assessment scale for anxiety

BackgroundAnxiety scale based on Ayurveda would help Ayurveda physicians to measure and initiate appropriate treatment strategies. ObjectivesThe objective of the study was to develop a clinical assessment scale for anxiety based on Ayurveda science. Materials and methodsAyurveda assessment scale for anxiety (AAA) was developed and subjected to various psychometric evaluations. Patients of generalized anxiety disorder with social phobia (GAD with SP) (n = 31) meeting DSM-IV-TR criteria and age, sex-matched healthy subjects (n = 31) were enrolled from NIMHANS Psychiatry OPD. Two independent Ayurveda experts evaluated both patients and healthy subjects using AAA, Hamilton Anxiety Rating Scale (HARS), and Beck Anxiety Inventory (BAI). Reliability and validity assessments were carried out. The sensitivity to treatment-induced change was evaluated in a randomized controlled clinical trial. 72 patients of GAD with SP meeting DSM-IV-TR criteria, aged between 20 and 55 years, and either sex participated in the study. The duration of intervention was 30 days. The assessments were done through HARS, BAI, Beck Depression Inventory (BDI), AAA and Clinical Global Impression scales (Severity, Improvement, and Efficacy). ResultsThe Interrater reliability was between - good to very good score. Validity of AAA with HARS and BAI was significant (p < 0.001). Scales recorded significant differences when compared between patients and healthy subjects (p < 0.001). AAA also recorded the sensitivity to treatment-induced changes in a randomized controlled study and noted a large effect size (>0.60). ConclusionsThe psychometric properties such as interrater reliability, validity (criteria, convergent, divergent, face) and sensitivity to change of AAA were promising.

Frequency dependent whole-brain coactivation patterns analysis in Alzheimer's disease.

The brain in resting state has complex dynamic properties and shows frequency dependent characteristics. The frequency-dependent whole-brain dynamic changes of resting state across the scans have been ignored in Alzheimer's disease (AD). Coactivation pattern (CAP) analysis can identify different brain states. This paper aimed to investigate the dynamic characteristics of frequency dependent whole-brain CAPs in AD. We utilized a multiband CAP approach to model the state space and study brain dynamics in both AD and NC. The correlation between the dynamic characteristics and the subjects' clinical index was further analyzed. The results showed similar CAP patterns at different frequency bands, but the occurrence of patterns was different. In addition, CAPs associated with the default mode network (DMN) and the ventral/dorsal visual network (dorsal/ventral VN) were altered significantly between the AD and NC groups. This study also found the correlation between the altered dynamic characteristics of frequency dependent CAPs and the patients' clinical Mini-Mental State Examination assessment scale scores. This study revealed that while similar CAP spatial patterns appear in different frequency bands, their dynamic characteristics in subbands vary. In addition, delineating subbands was more helpful in distinguishing AD from NC in terms of CAP.

Prospective analysis of a TRD cohort over a 1-year follow-up with standard of care in Mexico: results for depression severity, treatment response, disability and QoL from the multicenter, observational TRAL Study

Introduction: Based on TRAL Mexico subsample, clinical outcomes and Patient-Reported Outcomes (PROs) are reported here. Methods: From 697 patients with MDD recruited from 14 Mexican sites, 140 patients with diagnosis of TRD under standard of care (SOC) were included in the 1-year follow-up. Patients with relevant psychiatric comorbidities or active participation in a clinical trial were excluded. Outcomes were obtained from PROs and clinical assessment scales. Results: Patients were mostly female (82.6%), with a mean age of 47.6 years. Only 44.3% of the patients achieved a clinical response, and remission was around 37% (measured through MADRS). Results from PHQ-9, EQ-5D and SDS show significant symptoms and disability for TRD patients in their everyday life after 1-year of follow-up with SOC. Discussion: TRD patients showed a significant burden of the disease, as current SOC fails to deliver clinically meaningful results for the majority of the patients. Response, remission and relapse are far from the desired outcomes Conclusion: Mexico has undertaken relevant and meaningful strategies to improve mental health resources availability, but some unmet needs are yet to be addressed. All involved stakeholders should consider public policies to enhance clinical outcomes and availability of resources.

Application of Multimodal MRI in the Early Diagnosis of Autism Spectrum Disorders: A Review.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder in children. Early diagnosis and intervention can remodel the neural structure of the brain and improve quality of life but may be inaccurate if based solely on clinical symptoms and assessment scales. Therefore, we aimed to analyze multimodal magnetic resonance imaging (MRI) data from the existing literature and review the abnormal changes in brain structural-functional networks, perfusion, neuronal metabolism, and the glymphatic system in children with ASD, which could help in early diagnosis and precise intervention. Structural MRI revealed morphological differences, abnormal developmental trajectories, and network connectivity changes in the brain at different ages. Functional MRI revealed disruption of functional networks, abnormal perfusion, and neurovascular decoupling associated with core ASD symptoms. Proton magnetic resonance spectroscopy revealed abnormal changes in the neuronal metabolites during different periods. Decreased diffusion tensor imaging signals along the perivascular space index reflected impaired glymphatic system function in children with ASD. Differences in age, subtype, degree of brain damage, and remodeling in children with ASD led to heterogeneity in research results. Multimodal MRI is expected to further assist in early and accurate clinical diagnosis of ASD through deep learning combined with genomics and artificial intelligence.

Impact of blood-brain barrier disruption on clinical features and treatment response in patients with newly diagnosed autoimmune encephalitis

AimsBlood-brain barrier (BBB) breakdown is an essential mechanism in inflammatory diseases of the central nervous system. However, the association between BBB integrity and autoimmune encephalitis (AE) has not been investigated. Our study aimed to analyze this relationship in patients with AE between BBB integrity with clinical manifestations and therapeutic responses. MethodsOur study enrolled 147 patients with AE who were newly diagnosed at the First Affiliated Hospital of Zhengzhou University between August 2015 and December 2021. Patients were classified into normal or damaged BBB groups based on cerebrospinal fluid (CSF) albumin/serum albumin (QAlb). To evaluate the severity of the illness, we used the modified Rankin Scale (mRS) and the Clinical Assessment Scale for Autoimmune Encephalitis (CASE). ResultsWe found a higher proportion of males, higher CSF protein, immunoglobulin IgG, and 24-h intrathecal IgG synthesis rate in the damaged BBB group. The improvement rate was lower in the damaged BBB group, but we found that double- or triple-combination immunotherapy had better clinical outcomes than single immunotherapy. In addition, there was a positive correlation between the CASE score and mRS score, and a positive correlation between the CASE score or mRS score and QAlb on admission. ConclusionsBBB integrity is closely related to the clinical features and treatment responses of newly diagnosed AE. Patients with AE and a damaged BBB may benefit from combination immunotherapy.

Digital Motor Biomarkers of Cerebellar Ataxia Using an RGB-Depth Camera-Based Motion Analysis System.

This study aimed to identify quantitative biomarkers of motor function for cerebellar ataxia by evaluating gait and postural control using an RGB-depth camera-based motion analysis system. In 28 patients with degenerative cerebellar ataxia and 33 age- and sex-matched healthy controls, motor tasks (short-distance walk, closed feet stance, and stepping in place) were selected from a previously reported protocol, and scanned using Kinect V2 and customized software. The Clinical Assessment Scale for the Assessment and Rating of Ataxia (SARA) was also evaluated. Compared with the normal control group, the cerebellar ataxia group had slower gait speed and shorter step lengths, increased step width, and mediolateral trunk sway in the walk test (all P < 0.001). Lateral sway increased in the stance test in the ataxia group (P < 0.001). When stepping in place, the ataxia group showed higher arrhythmicity of stepping and increased stance time (P < 0.001). In the correlation analyses, the ataxia group showed a positive correlation between the total SARA score and arrhythmicity of stepping in place (r = 0.587, P = 0.001). SARA total score (r = 0.561, P = 0.002) and gait subscore (ρ = 0.556, P = 0.002) correlated with mediolateral truncal sway during walking. These results suggest that the RGB-depth camera-based motion analyses on mediolateral truncal sway during walking and arrhythmicity of stepping in place are useful digital motor biomarkers for the assessment of cerebellar ataxia, and could be utilized in future clinical trials.

Predicting brain age gap with radiomics and automl: A Promising approach for age-Related brain degeneration biomarkers

The Brain Age Gap (BAG), which refers to the difference between chronological age and predicted neuroimaging age, is proposed as a potential biomarker for age-related brain degeneration. However, existing brain age prediction models usually rely on a single marker and can not discover meaningful hidden information in radiographic images. This study focuses on the application of radiomics, an advanced imaging analysis technique, combined with automated machine learning to predict BAG. Our methods achieve a promising result with a mean absolute error of 1.509 using the Alzheimer’s Disease Neuroimaging Initiative dataset. Furthermore, we find that the hippocampus and parahippocampal gyrus play a significant role in predicting age with interpretable method called SHapley Additive exPlanations. Additionally, our investigation of age prediction discrepancies between patients with Alzheimer’s disease (AD) and those with mild cognitive impairment (MCI) reveals a notable correlation with clinical cognitive assessment scale scores. This suggests that BAG has the potential to serve as a biomarker to support the diagnosis of AD and MCI. Overall, this study presents valuable insights into the application of neuroimaging models in the diagnosis of neurodegenerative diseases.

Efficacy and safety of acetazolamide in patients with NYHA class II-IV decompensated heart failure: protocol of an open-label prospective randomized multicenter study (ORION-A)

Aim. To study the efficacy and safety of acetazolamide administered orally to patients with decompensated heart failure (HF) at the hospital stage within 72 hours from admission, compared with standard therapy.Material and methods. This open-label, prospective, randomized, multicenter study is planned to include 400 patients urgently admitted to hospital with NYHA class II-IV decompensated HF: 200 patients each in the standard therapy group and additional acetazolamide (tablets) group. The primary endpoint includes the number of patients who achieved compensation in accordance with the criteria for diuretic therapy discontinuation. There are secondary endpoints: increase in urine output in the first 72 hours of hospitalization (since randomization), weight loss, 24-hour natriuresis, length of stay in hospital, length of stay in the intensive care unit, 90-day any-cause death, 90-day cardiovascular death, 90-day death due to chronic HF decompensation or acute decompensated HF, the number of pleuro- and pericardiocentesis episodes during the hospitalization, scale for clinical condition assessment of HF patient (SHOKS) at discharge from the hospital, 6-minute walk test at discharge from the hospital. The planned follow-up duration is a hospital period with an assessment of the clinical picture and laboratory parameters. Telemedicine contact with patients is carried out after 14, 30 and 90 days using a structured questionnaire.Conclusion. Analysis of clinical, laboratory and echocardiographic parameters of patients using acetazolamide tablets will make it possible to determine the criteria for the effectiveness of diuretic therapy in patients with decompensated HF in the short and long term.

Abnormal attentional bias in individuals with suicidal ideation during an emotional Stroop task: an event-related potential study.

There is increasing evidence that suicidal individuals exhibit an attentional bias toward negative or suicide-related stimuli, but the underlying neural mechanism remains unclear. This study aimed to investigate the neural mechanism of attentional bias toward emotional stimuli using a modified emotional Stroop task (EST) and to further explore the influencing factor of abnormal attention processing by identifying whether mental disorders or suicidal ideation contributes to attention processing disruptions. Fourteen students with suicidal ideation and mental disorders (SIMDs), sixteen students with suicidal ideation but no mental disorders (SINMDs), and fourteen sex- and age-matched healthy controls (HCs) were recruited. Moreover, 64-channel electroencephalography (EEG) data and behavioral responses were recorded simultaneously during the EST. Participants were instructed to respond to the ink color for various types of words (positive, neutral, negative, and suicide) while ignoring their meanings. Event-related potentials (ERPs) were analyzed to evaluate attention to the stimuli. Spearman correlations between clinical psychological assessment scales and ERP signatures were analyzed to determine the risk factors for suicide. The results showed that the SIMD group exhibited longer early posterior negativity (EPN) latency compared to the SINMD and HC groups, indicating that early attention processing was affected during the EST, and the automatic and rapid processing of emotional information decreased. Furthermore, P300 latency for positive words was positively correlated with current suicidal ideation in the SINMD group, suggesting that delayed responses or additional processing to positive information may lead individuals with suicidal ideation to an incorrect interpretation of external events. Generally, our findings suggest that the neural characteristics of the SIMD group differed from those of the SINMD and HC groups. EPN latency and P300 latency during the EST may be suicide-related neurophysiological indicators. These results provide neurophysiological signatures of suicidal behavior.

Clinical scales in autoimmune encephalitis-A retrospective monocentric cohort study.

Assessing severity of antibody-mediated encephalitis (AE) or paraneoplastic encephalitis (PE) requires valid and reliable scores to guide treatment decisions and predict outcome both in clinical routine and studies. We aimed to validate the prognostic value of the clinical assessment scale in autoimmune encephalitis (CASE) and the anti-NMDAR-encephalitis one-year functional status (NEOS) score in patients suffering from AE and PE in a large monocentric cohort. We retrospectively applied the CASE and NEOS score to patients with definite AE and PE treated at a tertiary hospital. Correlations were established between the CASE and NEOS score and the modified Rankin scale (mRs). Multivariable analyses were calculated to identify predictors of outcome. Thirty-four patients (27 AE, 7 PE) were included. Correlations between mRS and CASE score were strongest in patients with AE compared to PE at all intervals, but in the subgroups (LGI1, NMDAR, GAD, miscellaneous surface antibodies, PE) the correlation was strongest in the interval after baseline. Patients with AE seemed to display better outcomes compared to PE, which was underlined by multivariable analysis. Improvement was mostly observed within 6-12 months after disease onset, after which little or no further improvement was noted with some exception for two patients with anti-NMDARE who recovered substantially even after 12 months of treatment. The NEOS score significantly predicted the outcome at last follow-up in patients with AE with a sensitivity of 79% at a cut-off value of 2 points (AUC 0.79, 95% CI 0.58-0.99, p = 0.04). The CASE and NEOS score are suitable supplementary tools in addition to the mRS for capturing diverse symptoms, for grading and monitoring symptom severity.

Interrater reliability of motor severity scales for hemifacial spasm

To compare the inter-rater reliability (IRR) of five clinical rating scales for video-based assessment of hemifacial spasm (HFS) motor severity. We evaluated the video recordings of 45 HFS participants recruited through the Dystonia Coalition. In Round 1, six clinicians with expertise in HFS assessed the participants’ motor severity with five scales used to measure motor severity of HFS: the Jankovic rating scale (JRS), Hemifacial Spasm Grading Scale (HSGS), Samsung Medical Center (SMC) grading system for severity of HFS spasms (Lee’s scale), clinical grading of spasm intensity (Chen’s scale), and a modified version of the Abnormal Involuntary Movement Scale (Tunc’s scale). In Round 2, clinicians rated the same cohort with simplified scale wording after consensus training. For each round, we evaluated the IRR using the intraclass correlation coefficient [ICC (2,1) single-rater, absolute-agreement, 2-way random model]. The scales exhibited IRR that ranged from “poor” to “moderate”; the mean ICCs were 0.41, 0.43, 0.47, 0.43, and 0.65 for the JRS, HSGS, Lee’s, Chen’s, and Tunc’s scales, respectively, for Round 1. In Round 2, the corresponding IRRs increased to 0.63, 0.60, 0.59, 0.53, and 0.71. In both rounds, Tunc’s scale exhibited the highest IRR. For clinical assessments of HFS motor severity based on video observations, we recommend using Tunc’s scale because of its comparative reliability and because clinicians interpret the scale easily without modifications or the need for consensus training.

Behavioral assessment scale of consciousness for nonhuman primates: A Delphi study.

Nonhuman primates (NHPs) are suitable for being model animals in the study of consciousness and loss of consciousness (LoC) with a similar brain structure and function to humans. However, there is no effective consciousness assessment scale for them. This study aimed to develop a behavioral assessment scale of consciousness for NHPs. We constructed an initial indicator framework based on the clinical consciousness disorder assessment scales and the physiological characteristics, consciousness, and arousal behavior of NHPs. A two-round online Delphi method was conducted by a multidisciplinary expert panel to construct a behavioral assessment scale of consciousness for NHPs. The indicators and descriptions were revised according to the experts' feedback and then sent out for repeated consultations along with a summary of the results of the previous round of consultations. The accepted competencies of indicators were established with mean scores in two scoring criteria (importance and feasibility) ≥4.0, agreement rate with a rating of importance or essential ≥70.0%, and a coefficient of variation ≤0.25, as well as discussions of the research group. Consensus was achieved after the second round of consultations, which was completed by 28 experts who specialized in rehabilitation, neuroscience, psychology, neurosurgery, and neurology. A new behavioral assessment scale of consciousness for NHPs, including 37 items organized hierarchically within seven dimensions including visual function, auditory function, motor function, orofacial movements, arousal, brainstem reflexes, and respiration, was developed in this study. This study has successfully developed a behavioral assessment scale for measuring the conscious state of NHPs or NHP models with LoC. This tool is expected to facilitate future research into the underlying mechanisms of consciousness by providing a detailed and comprehensive means of measurement.