Multi-scale analysis of acupuncture mechanisms for motor and sensory cortex activity based on SEEG data.

Acupuncture, a traditional Chinese therapy, is gaining attention for its impact on the brain. While existing electroencephalogram and functional magnetic resonance image research has made significant contributions, this paper utilizes stereo-electroencephalography data for a comprehensive exploration of neurophysiological effects. Employing a multi-scale approach, channel-level analysis reveals notable $\delta $-band activity changes during acupuncture. At the brain region level, acupuncture modulated connectivity between the paracentral lobule and the precentral gyrus. Whole-brain analysis indicates acupuncture's influence on network organization, and enhancing $E_{glob}$ and increased interaction between the motor and sensory cortex. Brain functional reorganization is an important basis for functional recovery or compensation after central nervous system injury. The use of acupuncture to stimulate peripheral nerve trunks, muscle motor points, acupoints, etc., in clinical practice may contribute to the reorganization of brain function. This multi-scale perspective provides diverse insights into acupuncture's effects. Remarkably, this paper pioneers the introduction of stereo-electroencephalography data, advancing our understanding of acupuncture's mechanisms and potential therapeutic benefits in clinical settings.

Orthogonal retrieval algorithm of atmospheric temperature profiles from pure rotational Raman lidar signals.

Aimed at the stability of calibration coefficients in a general non-orthogonal retrieval algorithm (NRA) of pure rotational Raman lidars (PRRLs), an orthogonal retrieval algorithm (ORA) of atmospheric temperature profiles based on the orthogonal basis function is proposed. This algorithm eliminates the correlation between the calibration coefficients in the NRA to reduce the influence of the number of calibration points and the selection scheme on the calibration coefficients. In this paper, the stabilities of calibration coefficients in the NRA and ORA are compared and analyzed, and the data analysis for atmospheric temperature profiles with a time resolution of minute-level are given, based on the developed Cloud Precipitation Potential Evaluation (CPPV) lidar data and the parallel radiosonde temperature data. The analysis results show that coefficients of variation (CVs) of ORA calibration coefficients are one order of magnitude smaller than those of NRA coefficients. The mean deviation of the ORA retrieval results is roughly reduced by 16.1% compared with the NRA, and the root-mean-square deviation is roughly reduced by 15.0% compared with the NRA. Therefore, the temperature retrieval performance of the ORA is better than that of the NRA.

A pilot study on a patient with refractory headache: Personalized deep brain stimulation through stereoelectroencephalography.

The integration of stereoelectroencephalography with therapeutic deep brain stimulation (DBS) holds immense promise as a viable approach for precise treatment of refractory disorders, yet it has not been explored in the domain of headache or pain management. Here, we implanted 14 electrodes in a patient with refractory migraine and integrated clinical assessment and electrophysiological data to investigate personalized targets for refractory headache treatment. Using statistical analyses and cross-validated machine-learning models, we identified high-frequency oscillations in the right nucleus accumbens as a critical headache-related biomarker. Through a systematic bipolar stimulation approach and blinded sham-controlled survey, combined with real-time electrophysiological data, we successfully identified the left dorsal anterior cingulate cortex as the optimal target for the best potential treatment. In this pilot study, the concept of the herein-proposed data-driven approach to optimizing precise and personalized treatment strategies for DBS may create a new frontier in the field of refractory headache and even pain disorders.

IL-21-armored B7H3 CAR-iNKT cells exert potent antitumor effects.

CD1d-restricted invariant NKT (iNKT) cells play a critical role in tumor immunity. However, the scarcity and limited persistence restricts their development and clinical application. Here, we demonstrated that iNKT cells could be efficiently expanded using modified cytokines combination from peripheral blood mononuclear cells. Introduction of IL-21 significantly increased the frequency of CD62L-positive memory-like iNKT cells. iNKT cells armoring with B7H3-targeting second generation CAR and IL-21 showed potent tumor cell killing activity. Moreover, co-expression of IL-21 promoted the activation of Stat3 signaling and reduced the expression of exhaustion markers in CAR-iNKT cells in vitro. Most importantly, IL-21-arming significantly prolonged B7H3 CAR-iNKT cell proliferation and survival in vivo, thus improving their therapeutic efficacy in mouse renal cancer xerograph models without observed cytokine-related adverse events. In summary, these results suggest that B7H3 CAR-iNKT armored with IL-21 is a promising therapeutic strategy for cancer treatment.

The involvement of the human prefrontal cortex in the emergence of visual awareness.

Exploring the neural mechanisms of awareness is a fundamental task of cognitive neuroscience. There is an ongoing dispute regarding the role of the prefrontal cortex (PFC) in the emergence of awareness, which is partially raised by the confound between report- and awareness-related activity. To address this problem, we designed a visual awareness task that can minimize report-related motor confounding. Our results show that saccadic latency is significantly shorter in the aware trials than in the unaware trials. Local field potential (LFP) data from six patients consistently show early (200-300ms) awareness-related activity in the PFC, including event-related potential and high-gamma activity. Moreover, the awareness state can be reliably decoded by the neural activity in the PFC since the early stage, and the neural pattern is dynamically changed rather than being stable during the representation of awareness. Furthermore, the enhancement of dynamic functional connectivity, through the phase modulation at low frequency, between the PFC and other brain regions in the early stage of the awareness trials may explain the mechanism of conscious access. These results indicate that the PFC is critically involved in the emergence of awareness.

Additive interactions between obesity and insulin resistance on hypertension in a Chinese rural population.

BACKGROUND: Adiposity and insulin resistance (IR) are closely associated with hypertension; however, the role of interactions between obesity phenotypes and IR in hypertension is unclear. This study aimed to evaluate the interactions of body mass index (BMI), waist circumference (WC), and body fat percentage (BF%) with IR on hypertension risk. METHODS: We analyzed data from 4888 participants (mean age 57 years, 41.2% men) in the China Northwest Natural Population Cohort, Ningxia Project. BMI, WC, and BF% were determined using bioelectrical impedance analysis devices. IR was estimated using a homeostasis model assessment index (HOMA-IR). Multivariable-adjusted logistic regression was used to evaluate the association between HOMA-IR and hypertension risk. We calculated the relative excess risk and attributable proportion with their 95% confidence intervals (CIs) to assess whether adiposity phenotypes modified the effect of HOMA-IR on hypertension risk. RESULTS: The crude prevalence of hypertension was 52.2%. The multivariable-adjusted odds ratio of HOMA-IR was 1.80 (95% CI: 1.23-2.65) for the risk of hypertension in the highest versus the lowest quartiles, but this association became marginal in models further adjusting for BMI, WC, and BF% (P for trend = 0.056). Relative excess risk and attributable proportion for interaction between high HOMA-IR and high BF% were 0.32 (0.04-0.59) and 0.33 (0.06-0.60), respectively. Additionally, high truncal and leg BF% and high HOMA-IR accounted for the hypertension risk in women, but not in men. We did not observe any significant interactions between BMI or WC and HOMA-IR on hypertension. CONCLUSION: BF% modified the association between IR and increased risk of hypertension in women with high truncal and leg BF%, but not in men.

Evaluating the effect of spinal cord stimulation on patient with disorders of consciousness: A TMS-EEG study.

OBJECTIVE: The application of spinal cord stimulation (SCS) in the treatment of disorders of consciousness (DOC) has attracted attention, but its effect on brain activity is still unknown. Transcranial magnetic stimulation combined with EEG (TMS-EEG) can measure cortical activity, which can evaluate the effect of SCS on DOC. METHODS: We record 20 DOC patients' CRS-R values and TMS-EEG data before and after one-session SCS (Pre-SCS and Post-SCS). 20 DOC patients including 10 patients with unresponsive wakefulness syndrome (UWS) and 10 patients with minimally conscious states (MCS). TMS evoked potential (TEP) was used to measure the changes of cortical activity in DOC patients between Pre-SCS and Post-SCS. Firstly, we used the global mean field potential (GMFP) and fast perturbational complexity index (PCIst) to compare the temporal changes of patients' cortical activity. Then, we obtained the frequency feature (natural frequency, NF) based on the TEP time-frequency analysis, and compared the changes of natural frequency between Pre-SCS and Post-SCS. Finally, the study explored the relationship between the patient's baseline CRS-R values and changes of TMS evoked cortical activity in time and frequency domains. RESULTS: After SCS, MCS and UWS groups almost have no changes of CRS-R values (MCS: 9.9 ± 1.52 at Pre-SCS, 10.2 ± 1.48 at Post-SCS; UWS: 5.6 ± 1.26 at Pre-SCS, 5.7 ± 1.34 at Post-SCS). MCS group showed significant increases of GMFP amplitude (around 100 ms and 300 ms) and PCIst values at Post-SCS (p < 0.05). UWS group had no significant changes (p > 0.05). Besides, SCS induced the significant increases of natural frequency for MCS group(p < 0.05), but not for UWS group. At last, the study found that all patient's baseline CRS-R values were significantly correlated with ΔPCIst (r = 0.67, p < 0.005), and ΔNF (r = 0.72, p < 0.001). CONCLUSIONS: SCS can modulate cortical activity of DOC patient, including temporal complexity and natural frequency. The changes of cortical activity caused by SCS are related to patients' consciousness level. TMS-EEG can evaluate the effect of SCS on DOC patients.

Electrophysiological characteristics of CM-pf in diagnosis and outcome of patients with disorders of consciousness.

BACKGROUND: Deep brain stimulation (DBS) in the centromedian-parafascicular complex (CM-pf) has been reported as a potential therapeutic option for disorders of consciousness (DoC). However, the lack of understanding of its electrophysiological characteristics limits the improvement of therapeutic effect. OBJECTIVE: To investigate the CM-pf electrophysiological characteristics underlying disorders of consciousness (DoC) and its recovery. METHODS: We collected the CM-pf electrophysiological signals from 23 DoC patients who underwent central thalamus DBS (CT-DBS) surgery. Five typical electrophysiological features were extracted, including neuronal firing properties, multiunit activity (MUA) properties, signal stability, spike-MUA synchronization strength (syncMUA), and the background noise level. Their correlations with the consciousness level, the outcome, and the primary clinical factors of DoC were analyzed. RESULTS: 11 out of 23 patients (0/2 chronic coma, 5/13 unresponsive wakefulness syndrome/vegetative state (UWS/VS), 6/8 minimally conscious state minus (MCS-)) exhibited an improvement in the level of consciousness after CT-DBS. In CM-pf, significantly stronger gamma band syncMUA strength and alpha band normalized MUA power were found in MCS- patients. In addition, higher firing rates, stronger high-gamma band MUA power and alpha band normalized power, and more stable theta oscillation were correlated with better outcomes. Besides, we also identified electrophysiological properties that are correlated with clinical factors, including etiologies, age, and duration of DoC. CONCLUSION: We provide comprehensive analyses of the electrophysiological characteristics of CM-pf in DoC patients. Our results support the 'mesocircuit' hypothesis, one proposed mechanism of DoC recovery, and reveal CM-pf electrophysiological features that are crucial for understanding the pathogenesis of DoC, predicting its recovery, and explaining the effect of clinical factors on DoC.

The Influence of Maternal Condition on Fetal Cardiac Function during the Second Trimester.

OBJECTIVE: Maternal health has a direct, profound and lasting effect on the formation and development of the fetal cardiovascular system. The aim of this research was to find whether maternal age, BMI hypertension (GH) or gestational diabetic mellitus (GDM) would affect fetal cardiac function in the second trimester. METHOD: 329 mothers who had a fetal echocardiogram examination at the International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China, from 1 January 2020 to 30 April 2020 were enrolled at the gestational age of 21 to 26 weeks (mean 22.78 ± 1.13 weeks). Single-factor analysis and multi-factor line regression analysis were used to find the contribution values of each factor to fetal cardiac function. RESULTS: at the second trimester, maternal age had a minor influence on the fetal left ventricle diastolic function. Higher maternal BMI could cause a decrease in the fetal diastolic function of both the left and right ventricle and the systolic function of the left ventricle. Maternal hypertension and gestational diabetic mellitus had a profound influence on both the left and right fetal heart ventricles of both systolic and diastolic function. CONCLUSION: maternal condition will have a profound influence on fetal cardiac function as early as the second trimester.

Risk of Cardiovascular Diseases Among Different Metabolic Obesity Phenotypes: A Prospective Observational Study.

Objectives: Various diseases are associated with obesity and metabolism. We sought to investigate the risk of cardiovascular disease (CVD) in diverse metabolic obesity phenotypes. Methods and Results: A prospective observational study of 1517 participants ≥25 years of age without CVD at baseline was conducted. Participants were categorized into four groups based on the condition of central obesity and metabolic health status: metabolically healthy normal weight, metabolically healthy obesity (MHO), metabolically unhealthy normal weight, and metabolically unhealthy obese (MUO). A multivariate Cox regression analysis was used to analyze the relationship between different obesity phenotypes and CVD. During 14830.49 person-years of follow-up, there were 244 incident cases of CVD. Of the 1517 participants, 72 (4.75%) and 812 (53.53%) were classified as having MHO and MUO, respectively. MHO and MUO had a tendency toward a higher risk of CVD [adjusted hazard ratios (HRs) = 1.49, 95% confidence interval (CI): 1.11-2.02 and HR = 1.25, 95% CI: 1.00-1.55, respectively] based on the waist circumference criterion. Conclusion: MHO and MUO can increase the risk of CVD.

Skip DETR: end-to-end Skip connection model for small object detection in forestry pest dataset.

Object detection has a wide range of applications in forestry pest control. However, forest pest detection faces the challenges of a lack of datasets and low accuracy of small target detection. DETR is an end-to-end object detection model based on the transformer, which has the advantages of simple structure and easy migration. However, the object query initialization of DETR is random, and random initialization will cause the model convergence to be slow and unstable. At the same time, the correlation between different network layers is not strong, resulting in DETR is not very ideal in small object training, optimization, and performance. In order to alleviate these problems, we propose Skip DETR, which improves the feature fusion between different network layers through skip connection and the introduction of spatial pyramid pooling layers so as to improve the detection results of small objects. We performed experiments on Forestry Pest Datasets, and the experimental results showed significant AP improvements in our method. When the value of IoU is 0.5, our method is 7.7% higher than the baseline and 6.1% higher than the detection result of small objects. Experimental results show that the application of skip connection and spatial pyramid pooling layer in the detection framework can effectively improve the effect of small-sample obiect detection.

Associations between Low-Carbohydrate Diets and Low-Fat Diets with Frailty in Community-Dwelling Aging Chinese Adults.

Frailty is a major health issue associated with aging. Diet affects frailty status; however, studies on the associations between the low-carbohydrate diet (LCD) score, low-fat diet (LFD) score and frailty in older Chinese adults are scarce. This study aimed to examine the associations between the LCD score, LFD score and risk of frailty in older Chinese adults. We analyzed data from 6414 participants aged ≥ 60 years from the China Northwest Natural Population Cohort: Ningxia Project. Frailty was measured using the frailty index (FI), calculated from 28 items comprising diseases, behavioral disorders and blood biochemistry and classified as robust, pre-frail and frail. LCD and LFD scores were calculated using a validated food frequency questionnaire (FFQ). Multiple logistic regression models were used to evaluate associations between LCD, LFD scores and frail or pre-frail status after adjusting for confounders. Participants' mean age was 66.60 ± 4.15 years, and 47.8% were male. After adjusting for age, sex, educational level, drinking, smoking, BMI, physical activity and total energy, compared to the lowest quartile (Q1: reference), the odds ratios (ORs) for pre-frail and frail status in the highest quartile (Q4) of LCD score were 0.73 (95% confidence intervals: 0.61-0.88; p for trend = 0.017) and 0.73 (95%CI: 0.55-0.95; p for trend = 0.035), respectively. No significant associations were observed between LFD score and either pre-frail or frail status. Our data support that lower-carbohydrate diets were associated with lower pre-frail or frail status, particularly in females, while diets lower in fat were not significantly associated with the risk of either pre-frail or frail status in older Chinese adults. Further intervention studies are needed to confirm these results.

Long-term functional outcomes improved with deep brain stimulation in patients with disorders of consciousness.

BACKGROUND: Deep brain stimulation (DBS) has been preliminarily applied to treat patients with disorders of consciousness (DoCs). The study aimed to determine whether DBS was effective for treating patients with DoC and identify factors related to patients' outcomes. METHODS: Data from 365 patients with DoCs who were consecutively admitted from 15 July 2011 to 31 December 2021 were retrospectively analysed. Multivariate regression and subgroup analysis were performed to adjust for potential confounders. The primary outcome was improvement in consciousness at 1 year. RESULTS: An overall improvement in consciousness at 1 year was achieved in 32.4% (12/37) of the DBS group compared with 4.3% (14/328) of the conservative group. After full adjustment, DBS significantly improved consciousness at 1 year (adjusted OR 11.90, 95% CI 3.65-38.46, p<0.001). There was a significant treatment×follow up interaction (H=14.99, p<0.001). DBS had significantly better effects in patients with minimally conscious state (MCS) compared with patients with vegetative state/unresponsive wakefulness syndrome (p for interaction <0.001). A nomogram based on age, state of consciousness, pathogeny and duration of DoCs indicated excellent predictive performance (c-index=0.882). CONCLUSIONS: DBS was associated with better outcomes in patients with DoC, and the effect was likely to be significantly greater in patients with MCS. DBS should be cautiously evaluated by nomogram preoperatively, and randomised controlled trials are still needed.

Proposal of a Novel Procedure for C2-4 Cervical Spinal Cord Stimulator Implantation to Improve Complete Midline Coverage via Electrode Array in Patients with Disorders of Consciousness: A Retrospective Single-Center Study.

BACKGROUND: Deviation of electrode array from the midline of spinal cords affects the therapeutic outcomes of C2-4 cervical spinal cord stimulation (SCS) in patients with disorders of consciousness (DOC). This study proposed the implementation of a novel C2-3 dural exposure procedure and investigated its efficacy compared to conventional surgery. METHODS: Surgical and postoperative imaging data from 69 patients with DOC who underwent SCS in the lateral decubitus position were retrospectively assessed. The C2-3 dural exposure procedure was performed in 16 patients while the rest underwent conventional surgery. The incidence of electrode deviation was compared, and factors associated with the deviation were investigated. RESULTS: The rate of complete midline coverage by the electrodes in the C2-3 dural exposure group was significantly higher than the conventional group (93.8% vs. 54.7%, p = 0.004). Exposure of the dura between C2-3 was a significant favorable factor for complete midline coverage by the electrode array (odds ratio [OR]: 0.091; 95% confidence interval [CI]: 0.011-0.757; p = 0.027). Electrode positioned ≥5 cm above the lower edge of the C2 vertebra was a significant risk factor for incomplete midline coverage (OR: 1.126; 95% CI: 1.016-1.248; p = 0.023). No difference in operation time, intraoperative bleeding, or surgical site infection was observed between the 2 groups. CONCLUSIONS: The C2-3 dural exposure procedure, performed in the lateral decubitus position, was safe and had higher complete midline coverage than conventional surgery.

The Effect of Offline Medical Resource Distribution on Online Physician-Patient Interaction: Empirical Study With Online and Offline Data.

BACKGROUND: The relationship between online health communities (OHCs) and offline medical care is unclear because both provide physician-patient interaction services and channels. Taking advantage of information and communication technology, patients have been using OHCs widely. However, some physical medical resources (such as hospital beds and medical devices) cannot be replicated by information and communication technologies. Therefore, it is worth studying how offline medical resources affect physician-patient interactions in OHCs and how OHCs help to solve resource scarcity and the uneven distribution of traditional medical treatment. OBJECTIVE: This study aimed to support the notion that physician-patient consultations in OHCs are influenced by the objective distribution of offline health care capital (accessibility and availability) and to provide suggestions for the allocation of medical resources in practice through the judicious use of offline and online channels. METHODS: The empirical data in this study were collected from both online and offline channels. The offline data include 9 years (2006-2014) of medical resource statistics of 31 provincial administrative regions in mainland China. Moreover, data regarding the geolocation-based physician-patient interaction network in the OHC were also collected. The online data come from one of China's largest OHCs. We obtained 92,492 telephone consultation records of 6006 physicians using an automatic web crawler program. Social network analysis was used to visualize the descriptive statistics of the offline geolocation-based physician-patient interaction network in the OHC. A regression model with a squared variable was applied to analyze online and offline empirical data to further test our hypothesis. Two types of robustness tests were used to increase the reliability of the test results of the initial model. RESULTS: The results of our social network analysis show that there is a uniform geographic distribution of patients who use OHCs, whereas the physician relies more on geographic advantage (eg, a higher medical resource capability). Moreover, the empirical results of the regression model support the notion that physician-patient telephone consultations are positively influenced by physicians' online contributions (ßcontribution=.210; P<.001) and capital availability (ßbed=.935; P=.07), and, interestingly, spatial accessibility has an inverted U-shaped effect (ßdistance=.199; P<.001 and ßdistance2=-.00449; P=.008). The results indicate that the use of OHCs, although constrained by offline medical resources, provides a channel for offline resources to flow from areas with high availability to those with low availability. CONCLUSIONS: This study explores the relationship between online and offline channels by investigating online physician-patient interactions and offline medical resources. In particular, this study analyzes the impact of offline channels on online channels and verifies the possibility of OHC capital use shifting from a high-availability area to a low-availability area. In addition, it provides a theoretical and practical basis for understanding the interaction of online and offline channels of medical care.

Deep brain stimulation improves electroencephalogram functional connectivity of patients with minimally conscious state.

AIM: Deep brain stimulation (DBS) is a potential neuromodulatory therapy that enhances recovery from disorders of consciousness, especially minimally conscious state (MCS). This study measured the effects of DBS on the brain and explored the underlying mechanisms of DBS on MCS. METHODS: Nine patients with MCS were recruited for this study. The neuromodulation effects of 100 Hz DBS were explored via cross-control experiments. Coma Recovery Scale-Revised (CRS-R) and EEG were recorded, and corresponding functional connectivity and network parameters were calculated. RESULTS: Our results showed that 100 Hz DBS could improve the functional connectivity of the whole, local and local-local brain regions, while no significant change in EEG functional connectivity was observed in sham DBS. The whole brain's network parameters (clustering coefficient, path length, and small world characteristic) were significantly improved. In addition, a significant increase in the CRS-R and functional connectivity of three MCS patients who received 100 Hz DBS for 6 months were observed. CONCLUSION: This study showed that DBS improved EEG functional connectivity and brain networks, indicating that the long-term use of DBS could improve the level of consciousness of MCS patients.

Association of Non-Insulin-Based Insulin Resistance Indices with Risk of Incident Prediabetes and Diabetes in a Chinese Rural Population: A 12-Year Prospective Study.

Objective: Three non-insulin-based insulin resistance (IR) indices, ie, triglyceride-glucose (TyG) index, triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio, and metabolic score for IR (METS-IR), were considered powerful and simplified alternatives for IR. However, evidence for the association between the three IR indices and incident type 2 diabetes mellitus (T2DM), especially impaired fasting glucose (IFG), remains limited. Therefore, this study aimed to explore the association among IR indices, incident IFG, and T2DM in a rural population cohort. Methods: We analyzed data from 2209 adults (aged 24-75 years) at baseline and from 1205 normoglycemic participants who were followed up. Cox proportional hazards models were used to evaluate the associations between the three indices and IFG or T2DM. Restricted cubic spline curves based on the Cox regression model were used to examine the association between baseline indices and incident T2DM. Results: For the baseline data, logistic analyses demonstrated that the TyG index, TG/HDL-C ratio, and METS-IR had a significantly positive correlation with IFG or T2DM after multivariable adjustment. During a median follow-up of 12.17 years, 157 incident cases of IFG and 97 incident cases of T2DM were noted. The risk of T2DM, but not IFG, was strongly associated with the baseline TyG index in the adjusted model, and participants with the TyG index in the third tertile had a higher risk of developing T2DM (adjusted hazards ratio, 2.84; 95% confidence intervals, 1.26-6.37; p for trend <0.001) than those in the lowest tertile (reference). Moreover, a linear relationship was observed between the TyG index and T2DM incidence. The TG/HDL-C ratio and METS-IR had no significant relationship with the risk of IFG or T2DM. Conclusion: The TyG index is more useful than the TG/HDL-C ratio and METS-IR in predicting T2DM in the normoglycemic population.

Elevated cerebrospinal fluid protein levels associated with poor short-term outcomes after spinal cord stimulation in patients with disorders of consciousness.

Background: Spinal cord stimulation (SCS) is a promising treatment for patients with disorders of consciousness (DoC); however, the laboratory examinations and different electrodes (permanent #39286 vs. temporary percutaneous #3777, Medtronic, USA) that are associated with postoperative outcomes are unclear. The study aims to study the association between the change in postoperative cerebrospinal fluid (CSF) protein level and improvement in consciousness after SCS in DoC patients and to explore whether different electrodes were associated with elevated CSF protein levels. Materials and methods: A total of 66 DoC patients who received SCS treatment from December 2019 to December 2021 were retrospectively analyzed. Patients were grouped according to their elevated CSF protein level. The clinical characteristics of the patients and SCS stimulation parameters were compared. The preoperative sagittal diameter of the spinal canal is the distance from the midpoint of the posterior border of the vertebral body to the midpoint of the posterior wall of the spinal canal at the level of the superior border of C3. The postoperative sagittal diameter of the spinal canal is the distance from the midpoint of the posterior edge of the vertebral body to the anterior edge of the stimulation electrode. Patients with improved postoperative CRS-R scores greater than 3 or who progressed to the MCS + /eMCS were classified as the improved group and otherwise regarded as poor outcome. Results: We found that more DoC patients had elevated CSF protein levels among those receiving SCS treatment with permanent electrodes than temporary percutaneous electrodes (P = 0.001), and elevated CSF protein levels were significantly associated with a reduced sagittal diameter (P = 0.044). In DoC patients receiving SCS treatment, we found that elevated CSF protein levels (P = 0.022) and preoperative diagnosis (P = 0.003) were significantly associated with poor outcomes at 3 months. Logistic regression analysis showed that elevated CSF protein levels were significantly associated with poor outcomes (OR 1.008, 95% CI 1.001-1.016, P = 0.032). Conclusion: The results suggest that reducing the effect of electrode pads on anatomical changes may help improve the outcomes of DoC patients receiving SCS treatment. CSF protein levels are associated with poor postoperative outcomes and whether they are potential biomarkers in DoC patients receiving SCS treatment remain further exploration.

Subdural Effusion Evolves into Chronic Subdural Hematoma after Deep Brain Stimulation Surgery: Case Report and Review of the Literature.

BACKGROUND: Although chronic subdural hematoma (CSDH) has been known for over several hundred years, the etiology and pathogenesis of it are still not completely understood. Neurosurgical procedures resulting in CSDH are a rare clinical complication, and there was no report about how subdural effusion (SDE) evolves into CSDH after deep brain stimulation (DBS) surgery. The formation mechanism of CSDH after surgery, especially in DBS surgery, and the effect of recovery, need to be explored. METHODS: We present two cases, complicated with SDE after DBS surgery, serious dysfunction complications such as hemiplegia and aphasia occurred on the postoperative day 36 and 49 individually, and images showed CSDH. Fusion image showed the bilateral electrodes were significantly shifted. Then, they were performed to drill craniotomy with a closed system drainage. RESULT: The symptoms of hemiplegia and aphasia caused by CSDH were completely recovered, and the follow-up images showed CSDH was disappeared. However, DBS stimulation is poorly effective, it cannot reach the preoperative level, especially in the ipsilateral side of CSDH. CONCLUSIONS: The iatrogenic SDE that evolved into CSDH in the present two cases shows that SDE is one of the causes of CSDH. Patients develop SDE after DBS, which increases the risk of developing CSDH. CSDH after DBS can be successfully treated. however, the postoperative efficacy of DBS will decline.

Obesity Metabolic Phenotype, Changes in Time and Risk of Diabetes Mellitus in an Observational Prospective Study on General Population.

Objectives: To evaluate the distribution and changes in different obesity metabolic phenotypes, as well as their impact on the incidence of type 2 diabetes mellitus (T2DM) in a northwest Chinese population sample. Methods: Data comes from prospective cohort study (n = 1,393, mean follow up = 9.46 years). Participants were classified into four groups through a combination of the Chinese Diabetes Society (CDS) diagnostic criteria for metabolic syndrome with anthropometric measurements: metabolically healthy normal weight (MHNW), metabolically healthy overweight/obese (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy overweight/obese (MUO). Cox regression models with time-dependent covariates were used to evaluate changes in obesity metabolic phenotypes and risk of T2DM. Results: Participants in MUO state had the highest risk of developing T2DM, the incidence density was 12.10/1,000 person-year. The MHO and MUO groups showed an increased risk of incident diabetes based on body mass index (BMI) (HR, 1.29; 95% CI, 1.03-1.61; p = 0.026 and HR, 1.20; 95% CI, 1.02-1.40; p = 0.024 respectively.) Besides, the MHO group had an increased risk of incident diabetes based on waist circumference (WC) (HR, 1.41; 95% CI, 1.10-1.80; p = 0.006). Conclusion: Diabetes is more frequent in the MHO and MUO groups and co-occurrence of obesity and metabolic abnormalities (MA) contributes to the development of T2DM.