Clinical characteristics and rehabilitation potential in children with cerebral palsy based on MRI classification system.

Background: The correlation of clinical characteristics of cerebral palsy (CP) and the magnetic resonance imaging classification system (MRICS) for (CP) is inconsistent. Specifically, the variance in rehabilitation potential across MRICS remains underexplored. Aims: To investigate the clinical characteristics and potential for rehabilitation in children with CP based on MRICS. Materials and methods: Children with CP admitted to the Department of Rehabilitation, Children's Hospital of Chongqing Medical University between 2017 and 2021 were included in the study. Qualified cases underwent a follow-up period of at least one year. The clinical characteristics of CP among different MRICS were analyzed, then the rehabilitation potential was explored by a retrospective cohort study. Results: Among the 384 initially enrolled children, the male-to-female ratio was 2.3:1, and the median age of diagnosis was 6.5 months (interquartile range: 4-12). The most prevalent MRICS categorization was predominant white matter injury (40.6%), followed by miscellaneous (29.2%) and predominant gray matter injury (15.6%). For the predominant white matter injury and miscellaneous categories, spastic diplegia emerged as the leading subtype of CP, with incidences of 59.6% and 36.6%, respectively, while mixed CP (36.7%) was the most common type in children with predominant gray matter. Notably, 76.4% of children with predominant white matter injury were classified as levels I-III on the gross motor function classification system (GMFCS), indicating significantly less severity than other groups (χ2 = 12.438, p = 0.013). No significant difference across MRICS categories was observed for the manual ability classification system (MACS) (H = 8.176, p = 0.085). Rehabilitation potential regarding fine motor function and adaptability based on Gesell assessment was dependent on MRICS over the follow-up period. Children with normal MRI scans exhibited superior rehabilitation outcomes. Commencing rehabilitation at an earlier stage produced consistent and beneficial results in terms of fine motor function and adaptability across all MRICS categories. Moreover, participants below 2 years of age demonstrated enhanced rehabilitation potential regarding fine motor outcomes and adaptability within the MRICS framework. Conclusion: MRICS displayed a significant association with clinical characteristics and rehabilitation efficacy in children with CP.

Osteopontin: An important protein in the formation of kidney stones.

The incidence of kidney stones averages 10%, and the recurrence rate of kidney stones is approximately 10% at 1 year, 35% at 5 years, 50% at 10 years, and 75% at 20 years. However, there is currently a lack of good medicines for the prevention and treatment of kidney stones. Osteopontin (OPN) is an important protein in kidney stone formation, but its role is controversial, with some studies suggesting that it inhibits stone formation, while other studies suggest that it can promote stone formation. OPN is a highly phosphorylated protein, and with the deepening of research, there is growing evidence that it promotes stone formation, and the phosphorylated protein is believed to have adhesion effect, promote stone aggregation and nucleation. In addition, OPN is closely related to immune cell infiltration, such as OPN as a pro-inflammatory factor, which can activate mast cells (degranulate to release various inflammatory factors), macrophages (differentiated into M1 macrophages), and T cells (differentiated into T1 cells) etc., and these inflammatory cells play a role in kidney damage and stone formation. In short, OPN mainly exists in the phosphorylated form in kidney stones, plays an important role in the formation of stones, and may be an important target for drug therapy of kidney stones.

Early Consciousness Disorder in Acute Large Hemispheric Infarction: An Analysis Based on Quantitative EEG and Brain Network Characteristics.

BACKGROUND: Large hemispheric infarction (LHI) is an ischemic stroke affecting at least two-thirds of the middle cerebral artery territory, with or without involvement of the anterior cerebral artery or posterior cerebral artery, and approximately 77% of LHI patients have early consciousness disorder (ECD). We constructed a functional brain network for LHI patients with an acute consciousness disorder to identify new diagnostic markers related to ECDs by analyzing brain network characteristics and mechanisms. METHODS: Between August 1, 2017, and September 30, 2018, patients with acute (< 1 month) LHI were admitted to the neurocritical care unit at Xuanwu Hospital of Capital Medical University. Electroencephalography (EEG) data were recorded, and the MATLAB platform (2017b) was used to calculate spectral power, entropy, coherence and phase synchronization. The quantitative EEG and brain network characteristics of different consciousness states and different frequency bands were analyzed (α = 0.05). EEG data were recorded 38 times in 30 patients, 25 of whom were in the ECD group, while 13 patients were in the conscious group. RESULTS: (1) Spectral power analysis: The conscious group had higher beta relative spectral power across the whole brain, higher alpha spectral power in the frontal-parietal lobe on the infarction contralateral side, and lower theta and delta spectral power in the central-occipital lobe on the infarction contralateral side than the ECD group. (2) Entropy analysis: The conscious group had higher approximate entropy (ApEn) and permutation entropy (PeEn) across the whole brain than the ECD group. (3) Coherence: The conscious group had higher alpha coherence in nearly the whole brain and higher beta coherence in the bilateral frontal-parietal and parietal-occipital lobes than the ECD group. (4) Phase synchronization: The conscious group had higher alpha and beta synchronization in nearly the whole brain, particularly in the frontal-parietal and parietal-occipital lobes, than the ECD group. (5) Graph theory: The conscious group had higher small-worldness in each frequency band than the ECD group. CONCLUSION: In patients with LHI, higher levels of consciousness were associated with more alpha and beta oscillations and fewer delta and theta oscillations. Higher ApEn, PeEn, total brain connectivity, and small-worldness and a wider signal distribution range corresponded to a higher consciousness level.

Neurophysiological predictors of aphasia recovery in patients with large left-hemispheric infarction: a mismatch negativity study.

BACKGROUND: Although the rehabilitation of aphasia has been extensively studied, the prediction of language outcome still has not received sufficient attention. The aim of this study was to predict the language outcome using mismatch negativity (MMN) in patients with large left-hemispheric infarction. METHODS: MMN was elicited by an oddball paradigm in which a standard tone (1000 Hz) and deviant tone (1500 Hz) were presented at 90% and 10% of the number of tones, respectively. The mean amplitudes and laterality indexes (LIs) of MMN were measured over the prefrontal, frontal, central, parietal, temporal, and perisylvian electrodes and both hemispheres during the first 7 days (session 1) and 10 to 20 days (session 2) post-onset. Mixed three-way analysis of variance (ANOVA) was used to investigate differences in these factors between two aphasia groups (the good recovery group and poor recovery group). The predictive value of the most significant LI was also compared with the score of National Institutes of Health Stroke Scale score and low-density volume on computed tomography. RESULTS: A total of 18 patients were enrolled in this study. Mixed three-way ANOVA showed no interaction effect of session × region of interest (ROI) × group (F [3.59, 57.38] = 1.301, P = 0.282) and no interaction effect of ROI × group (F [1.81, 29.01] = 0.71, P = 0.487) and session × group (F [1.00, 16.00] = 0.084, P = 0.776) for MMN amplitude. No interaction effect of session × ROI × group (F [1.79, 28.58] = 0.62, P = 0.530), but an interaction effect of session × group (F [1.00, 16.00] = 5.21, P = 0.036) was found for LIs. In the poor recovery group, the LIs of MMN over all the ROIs, except the parietal area, became more negative at session 2 than those at session 1 (P < 0.05), but this effect was not observed in the good recovery group. Additionally, significant differences were observed in the LIs at session 2 between the two groups (P < 0.05). The LI over the perisylvian area at session 2 had the highest predictive value with an area under the curve of 0.963 (95% confidence interval: 0.884-1.000). An LI score >-0.36 over the perisylvian area suggested good recovery, but a score <-0.36 suggested poor recovery. The LI cut-off value of -0.36 had the highest sensitivity (90.0%) and specificity (87.5%) for predicting a good language outcome at 3 months post-stroke. CONCLUSION: LIs of MMN amplitudes at approximately 2 weeks post left-hemisphere stroke serve as more sensitive predictors of language outcome, among which the LI over the perisylvian area exhibits the best predictive value.

Changes in Event-Related Potentials Underlying Coma Recovery in Patients with Large Left Hemispheric Infarction.

BACKGROUND The aim of this study was to investigate changes in event-related potentials (ERPs) between coma and awakening in patients with large left hemispheric infarction (left LHI). MATERIAL AND METHODS Ten patients with left LHI who suffered coma and survived to awaken were enrolled in this study. The eye-opening subscore of the Glasgow Coma Scale (GCS) was used to assess the extent of patients' arousal. ERPs elicited by the passive oddball paradigm were collected during coma and awakening states, respectively. Peak latencies, peak amplitudes, topography, and time-frequency information of P1, N1, P2, and mismatch negativity (MMN) were compared between the 2 sessions. RESULTS No significant differences in the peak amplitudes and peak latencies of P1 and N1, but significantly greater P2 amplitude with shorter latency in left hemisphere and midline was shown in the awakening state compared with that in coma. A marked shift of P2 topography in response to deviant tones was also seen, from the right centro-parieto-frontal areas during coma to left frontal-midline areas during awakening. MMN waveforms were not detected in 6/10 patients during the coma state, but these 6 patients all recovered to awakening. Evoked oscillations in bilateral hemisphere were profoundly inhibited during the coma state, with poor inter-trial phase synchronization, while obvious activities with broader frequency ranges and consistent inter-trial phase synchronization were observed during awakening state, and different frequency activities were distributed in distinct brain regions. CONCLUSIONS P2 may be a central index of coma recovery and a component of the arousal system. Changes in time-frequency information could provide more information during coma recovery, perhaps including some cognitive processing of the sensory stimulus.

Association of Hyponatremia and Risk of Short- and Long-Term Mortality in Patients with Stroke: A Systematic Review and Meta-Analysis.

BACKGROUND: Hyponatremia is the most common electrolyte disorder in the clinic practice and it is closely related to the prognosis of various diseases. Studies reported that hyponatremia increased the risk of stroke mortality while yielded inconsistent findings during the follow-up period. Thus, a systematic review and meta-analysis to assess the relationship between hyponatremia and the short-term (within 90 days) and long-term (more than 1 year) prognosis of stroke patients was conducted. METHODS: A computerized systematic literature search was performed before November of 2018 for relevant articles evaluating the relationship between hyponatremia and all-cause mortality risk in stroke patients. Pooled relative risk (RR) and hazard risk (HR) with 95% confidence interval (CI) were calculated using DerSimonian-Laird random-effects model. Subgroup analyses were performed according to the follow-up period, types of stroke, different controls, sample size, and sampling time. RESULTS: A total of 12 studies with 21,973 patients were identified. Compared to the nonhyponatremia patients, hyponatremia was associated with a higher risk of all-cause mortality in short-term (RR 1.61, 95% CI 1.33-1.96; HR 1.78 95% CI 1.19-2.75) and long-term follow-up (RR 1.77, 95% CI 1.27-2.47; HR 2.23,95% CI 1.30-3.82). Subgroups analysis showed the similar results in most subgroups. CONCLUSIONS: This meta-analysis concludes that hyponatremia has a significant prognostic value for short- and long-term prognosis to stroke patients.