Nomograms for the prediction of decannulation in patients with neurological injury: a study based on clinical practice.

BACKGROUND: Rational prediction of the probability of decannulation in tracheotomy patients is of great importance to clinicians and patients' families. This study aimed to develop a prediction model for decannulation in tracheotomized patients with neurological injury using routine clinical data and blood tests. METHODS: We developed a prediction model based on 186 tracheotomized patients, and data were collected from January 2018 to March 2021. The least absolute shrinkage and selection operator (LASSO) regression model was used to optimize feature selection for the decannulation risk model. The performance of the prediction model was evaluated in terms of discrimination, calibration, and clinical utility using measures such as C-index, calibration plot, and decision curve analysis (DCA). Internal validation was performed through bootstrapping validation. RESULTS: A total of 66.13% (123/186) of patients were decannulated. Predictors included in the prediction nomogram were age, gender, subtype of neurological injury, Glasgow Coma Scale (GCS) score, swallowing function, duration of tracheotomy, procalcitonin (PCT) level, white blood cell (WBC) count, and serum albumin (ALB) level. The predictive model showed good discrimination, with a C-index of 0.755 (95% confidence interval: 0.68-0.83). Internal validation also confirmed a satisfactory C-index of 0.690. The DCA indicated that the nomogram added substantial value in predicting decannulation risk for patients with threshold probabilities falling between >21% and <98% compared to the existing scheme. CONCLUSIONS: This predictive model serves as a valuable instrument for clinicians to quantitatively assess the probability of decannulation in patients with neurological injury, aiding in informed decision-making and patient management.

Research hotspot and frontiers in post-stroke dysphagia: A bibliometric study and visualisation analysis.

BACKGROUND: Dysphagia, a common complication after stroke, significantly hampers the recovery process of patients, both due to dysphagia itself and the additional complications it causes. Although a large number of articles have been published on post-stroke dysphagia (PSD), bibliometric analysis in this field is still lacking. This study aimed to provide a comprehensive understanding of the research hotspots and trends in PSD, thereby guiding future research efforts. METHODS: The Web of Science Core Collection (WoSCC) database was searched for articles related to PSD from 2003 to 2022. Data were visualised and analysed using CiteSpace and VOSviewer. RESULTS: A total of 3102 publications were included in the scientometric analysis, with a gradual increase in the number of papers published each year. The United States emerged as the country with the highest number of publications (625 articles), while the University of Manchester led with the most publications among institutions (67 articles). Notably, Dysphagia was both the most published (254 articles) and the most cited journal (11,141 citations). Among authors, Hamdy S emerged as the most prolific (52 articles), with Martino R being the most cited (1042 citations). CONCLUSION: Based on our findings, we anticipate that research hotspots in PSD will mainly focus on complications due to PSD such as stroke-associated pneumonia, stroke-related sarcopenia. Additionally, exploration into the mechanisms and parameters of noninvasive brain stimulation techniques for the treatment of PSD, as well as the rehabilitation needs of patients with PSD, are expected to be key focal points in future research endeavours.

Validation of the cognitive performance scale of the interRAI-PAC and montreal cognitive assessment.

AIMS: The Cognitive Performance Scale (CPS), a minimum data set instrument of the interRAI, was initially designed to evaluate cognition in residential care and has demonstrated strong diagnostic accuracy. In this study, we evaluated the diagnostic accuracy and validity of the CPS in the post-acute care setting among post-stroke patients hospitalized in rehabilitation wards. DESIGN: Mixed methods. METHODS: The observational study was conducted in rehabilitation wards. Diagnostic accuracy was used to explore the level of agreement between CPS and Montreal Cognitive Assessment (MoCA) in 321 inpatients (62.12 years; 68.2% male). RESULTS: The diagnostic accuracy of the CPS was poor when MoCA was less than 24 as a gold standard, with an area under the curve of 0.69 (standard error 0.03, 95% confidence interval = 0.62-0.75). The CPS had a poor to moderate correlation with MoCA (rs  = -.35).

Post-stroke cognitive impairment: A bibliometric and knowledge-map analysis.

BACKGROUND: Post-stroke cognitive impairment (PSCI) has a negative effect on activities of daily living. OBJECTIVE: Although a number of studies have been published on PSCI, no quantitative studies have yet been conducted. METHOD: CiteSpace and VOSviewer were used to quantitatively analyze PSCI to illustrate the research hotspots and trends in PSCI. All relevant publications were extracted from the Science Citation Index Expanded (SCI-E) of the Web of Science (WoS). RESULTS: A total of 6536 articles were included in this study. From 349 in 2010 to 942 in 2020, the number of publications increased dramatically. The USA maintained the top position worldwide and provided a vital influence. Harvard University was considered the leader in research collaboration among all institutions. Stroke was the most popular journal in this sector and Vincent Mok published the most articles in this area. We analyzed the keywords and identified five research hotspot clusters. By summarizing the literature on PSCI, we considered the publication information regarding different countries, institutions, authors and journals. CONCLUSION: The mechanism of PSCI is an active hotspot. Cerebral vascular disease, especially white matter lesions, also received more attention.

Traumatic brain injury and rTMS-ERPs: Case report and literature review.

Currently, there are no cases of targeted, individualized repeated transcranial magnetic stimulation (rTMS) treatment based on event-related potential (ERPs) results showing the activation of functional brain regions. The identification and treatment of mild cognitive impairment after traumatic brain injury are challenging. rTMS has shown unique advantages in previous studies, with positive effects on noninvasive modulation and neuroplasticity after brain injury. The selection of the rTMS parameters and targets remains controversial. ERPs indicate the cortical activity involved in cognitive processing in patients. Therefore, this study proposes that ERPs can be used as biomarkers of cognitive recovery. The results of this study will guide the development of rTMS protocols for patient treatment. To help clinicians better apply rTMS and ERPs in combination, we conducted a relevant literature review and discussion, detailing the therapeutic mechanisms of the combination of ERPs and rTMS. This will facilitate the precise assessment and personalized treatment of such patients, improve the abnormal processing patterns of patients, and promote their return to life and society.

Exploring the complex pathways between somatosensory impairment, physical ability and affective symptoms following stroke: mediation analyses.

BACKGROUND: Based on the theory of postural control and the role of cognitive capacity, this study analyses how physical ability and somatosensory impairment influence affective symptoms in patients with stroke. METHODS: The cross-sectional study with a consecutive sampling approach was conducted in 10 different rehabilitation departments in Yunnan Province, China between August 2019 and February 2021. A total of 1,058 patients with stroke were included according to the inclusion criteria and exclusive criteria. Their important functions were evaluated including somatosensory measurement, Brunnstrom recovery stage, manual muscle testing (MMT), Barthel index (BI), mini-balance evaluation systems test (Mini-BEST), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety Scale (HAM-A), and Hamilton Depression Scale (HAM-D). Exploratory Factor Analysis was used to construct the measure models. A path analysis was performed to estimate the role of balance impairment and cognitive capacity as mediators in the relationships between somatosensory impairment, physical ability and affective symptoms. RESULTS: By comparing two models, the final model indicated a good global model fit to the data [χ2=243.5, χ2/df=5.181, goodness-of-fit index (GFI) =0.977, comparative five index (CFI) =0.944, Tucker-Lewis index (TLI) =0.922, standardized root mean square residual (SRMR) =0.063, and root mean square error of approximation (RMSEA) =0.063, Akaike information criterion (AIC) =303.51, Bayesian information criterion (BIC) =304.26], although Chi-square test was not significant due to the large sample size. In the path analysis, somatosensory impairment significantly negative influenced balance impairment (P<0.05, ß=-0.061), and physical ability significantly positively affected balance impairment (P<0.001, ß=0.893). A mediation analysis was conducted to show that balance impairment mainly mediated the relationship between physical ability and affective symptoms (R2=0.996), while the relationship between physical ability and affective symptoms was mediated slightly by cognitive capability (R2=0.108). CONCLUSIONS: These results suggest that balance impairment mainly mediates the relationship between physical ability and affective symptoms, while cognitive capacity slightly medicates this relationship. Rehabilitation professionals and family caregivers should pay more attention to balance function, which will help to strengthen the physical ability and improve post-stroke mood disorders.

Prevalence and risk factors of stroke-related sarcopenia at the subacute stage: A case control study.

Purpose: To investigate the prevalence and risk factors of stroke-related sarcopenia (SRS) in hospitalized patients receiving rehabilitation treatment. Methods: Approximately, 259 patients with stroke that satisfied the inclusion and exclusion criteria were consecutively recruited between June 2020 and July 2022. The epidemiologic data, history, clinical data, and measured data of the skeletal muscle index were collected. The patients were divided into the sarcopenia and non-sarcopenia group for comparison and analysis with the univariate and multivariate analysis. Results: SRS was presented in 121 (46.7%) patients with a mean age of 59.6 ± 9.7 years, including 42 women and 79 men. Multivariate logistic regression analysis revealed the following parameters to be significant (p < 0.05) risk factors for SRS: college degree or above (OR, 2.1, 95% CI, 1.1-4.1), ICU stay (OR, 1.7, 95% CI, 1.06-2.8), pneumonia (OR, 1.9, 9% CI, 1.1-3.6), walking ability (OR, 2.6, 95% CI, 1.5-4.6), cognitive impairment (OR, 1.8, 95%, 1.1-2.9), aphasia (OR, 2.1, 95% CI, 1.2-3.5), nasogastric feeding (OR, 3.7, 95%, 1.9-7.3), age (OR, 1.04, 95% CI, 1-1.1), and creatine kinase (OR, 1.1, 95% CI,0.9-1.2). Conclusions: Older age, light weight, severer clinical conditions, cognitive impairment, and significantly decreased levels of albumin, RAG, creatinine, uric acid, red blood cell count, hemoglobin, prealbumin, iron, and creatine kinase are more significantly present in patients with SRS compared with those without SRS.

Study of the Diffusion Tensor Imaging for Preclinical Therapeutic Efficacy of Umbilical Cord Mesenchymal Stem Cell Transplantation in the Treatment of Spinal Cord Injury.

OBJECTIVE: In this study, umbilical cord mesenchymal stem cell (UC-MSC) transplantation was used to treat patients with spinal cord injury (SCI). The microstructural changes of the spinal cord before and after transplantation were observed by diffusion tensor imaging (DTI). METHODS: From January 2014 to May 2015, seven patients who met the inclusion criteria were enrolled in this study. In the experimental group, both UC-MSC transplantation and comprehensive rehabilitation treatment were applied, while the control group received only comprehensive rehabilitation treatment. American Spinal Injury Association (ASIA) sensory and motor scores and the degree of SCI, spasticity, and urine/defecation functions were measured and evaluated together with DTI before the treatment and again at two and six months after the first treatment. RESULTS: From the DTI, the changes in the fractional anisotropy (FA) value and the apparent diffusion coefficient (ADC) value were as follows: in the experimental group, there were significant differences in the FA and ADC values before and after treatment (P < 0.05) with a decreased ADC value and an increased FA value. The differences in the ADC and FA values of the normal layer and the lesion layer before and after treatment were compared. The differences in ADC and FA at the lesion layer before and after transplantation were greater than those of the normal layer, and the differences were statistically significant (P < 0.05). In the experimental group, one patient with incomplete SCI and one patient with a short course of complete SCI improved in terms of light touch, acupuncture sensation, and motor score. One patient with incomplete SCI achieved improvement in spasticity and urine/defecation functions. CONCLUSION: The combination of UC-MSC transplantation and comprehensive rehabilitation therapy could help to promote the structural repair of the spinal nerve in patients with SCI.