Comparison of Particulate Steroid Injection vs Nonparticulate Steroid Injection for Lumbar Radicular Pain: A Systematic Review and Meta-analysis.

OBJECTIVE: The objective of this study was to identify the difference on pain intensity and disability between particulate and nonparticulate steroid injections in patients with lumbar radicular pain. Subgroup analysis by study design, type of particulate steroid, and follow-up duration were performed. DATA SOURCES: We performed the literature search in the PubMed, Embase, and Cochrane Library up March, 2023. STUDY SELECTION: Studies, including randomized controlled trials (RCTs) and nonrandomized studies, that compared particulate steroid injection and nonparticulate steroid injection in patients with lumbar radicular pain were independently reviewed by 2 reviewers for eligibility for inclusion. DATA EXTRACTION: Outcomes of interest were pain intensity and disability. Two reviewers independently assessed the quality of included studies using the revised Cochrane Risk of Bias (RoB2.0) tool for RCTs and the Risk of Bias in Nonrandomized Studies of Interventions Tool (ROBINS-I) for nonrandomized studies. Effect sizes were estimated using mean difference (MD) and standardized mean difference (SMD). DATA SYNTHESIS: A total of 10 studies were included in this meta-analysis. The results showed no significant difference in visual analog scale, disability score and the numbers of patients with 50% pain reduction between particulate and nonparticulate steroid injection groups (P>.05). Particulate steroid injections showed significant better effect in pain scale in RCTs (MD=0.62; 95% CI 0.08-1.16, P=.02). In subgroup analysis with steroid types, methylprednisolone showed better effect compared with dexamethasone, while dexamethasone showed better effect compared with betamethasone. CONCLUSIONS: This meta-analysis suggested no significant differences between the particulate and nonparticulate steroid groups in pain or disability score. Therefore, considering the safety profile of nonparticulate steroids, nonparticulate steroid injection may be helpful in patients with lumbar radicular pain.

Low Phase Angle and Skeletal Muscle Index Increase Hospital-Acquired Infections During Stroke Rehabilitation.

OBJECTIVES: Sarcopenia is common in patients with stroke and may increase the risk of medical complications such as infection. However, assessing sarcopenia in stroke patients with consciousness disturbance, aphasia or severe paralysis is challenging. This study aimed to investigate whether a combined assessment of phase angle (PhA) and skeletal muscle index (SMI), estimated using bioelectrical impedance analysis, was associated with 2 common nosocomial infections, hospital-acquired pneumonia (HAP) and urinary tract infection (UTI), during inpatient stroke rehabilitation. DESIGN: Single-center retrospective observational study. SETTINGS AND PARTICIPANTS: A total of 1068 patients with stroke admitted to a rehabilitation hospital between January 2016 and September 2019 were analyzed. METHODS: The study variables included demographic characteristics, comorbidities, stroke severity, blood chemistry and urine analysis, SMI, and PhA obtained using bioelectrical impedance analysis. Patients were classified as normal, low PhA only, low SMI only, and low PhA + SMI. Multivariate Cox proportional analysis was used to determine the variables associated with HAP and UTI. RESULTS: A combination of low PhA + SMI was observed in 429 (40.2%) patients. Over a median follow-up duration of 46 days, HAP occurred in 187 patients (17.5%) and UTI occurred in 155 patients (14.5%). The low PhA + SMI group showed a significantly higher incidence of HAP and UTI than the normal group (32.6% vs 4.6%, P < .001, for HAP; 20.7% vs 6.2%, P < .001, for UTI). In multivariate Cox analyses, low PhA and SMI were associated with significantly higher rates of HAP [hazard ratio (HR) 3.36, 95% CI 1.796-6.304, P < .001] and UTI (HR 1.71, 95% CI 1.002-2.947, P < .05) after adjusting for confounding variables. CONCLUSIONS AND IMPLICATIONS: Combination of low PhA + SMI was independently associated with a higher risk of HAP and UTI in stroke patients who underwent inpatient rehabilitation. Measuring PhA and SMI using bioelectrical impedance analysis might be helpful in establishing care plans in these population.

The Importance of Low-frequency Alpha (8-10 Hz) Waves and Default Mode Network in Behavioral Inhibition.

Objective: : Alpha wave of electroencephalography (EEG) is known to be related to behavioral inhibition. Both the alpha wave and default mode network (DMN) are predominantly activated during resting-state. To study the mechanisms of the trait inhibition, this research investigating the relations among alpha wave, DMN and behavioral inhibition in resting-state. Methods: : We explored the relationship among behavioral inhibition, resting-state alpha power, and DMN. Resting-state EEG, behavioral inhibition/behavioral activation scale (BIS/BAS), Barratt impulsivity scale, and no-go accuracy were assessed in 104 healthy individuals. Three groups (i.e., participants with low/middle/high band power) were formed based on the relative power of each total-alpha, low-alpha (LA), and high-alpha band. Source-reconstructed EEG and functional network measures of 25 DMN regions were calculated. Results: : Significant differences and correlations were found based on LA band power alone. The high LA group had significantly greater BIS, clustering coefficient, efficiency, and strength, and significantly lower path length than low/middle LA group. BIS score showed a significant correlation with functional network measures of DMN. Conclusion: : Our study revealed that LA power is related to behavioral inhibition and functional network measures of DMN of LA band appear to represent significant inhibitory function.

Different risks of early-onset and late-onset Parkinson disease in individuals with mental illness.

We aimed to investigate the association of various mental illnesses, including depression, bipolar disorder, schizophrenia, insomnia, and anxiety, with the risk of early-onset Parkinson's disease (EOPD) (age <50 years) and compare it with that of late-onset PD (LOPD) (age ≥50 years). This nationwide cohort study enrolled 9,920,522 people who underwent a national health screening examination in 2009, and followed up until 31 December 2018. There was a significantly increased risk of EOPD and LOPD in individuals with mental illness, and EOPD showed a stronger association than LOPD (EOPD, hazard ratio (HR) = 3.11, 95% CI: 2.61‒3.72; LOPD, HR = 1.70, 95% CI: 1.66‒1.74; p for interaction <0.0001). Our results suggest that people with mental illnesses aged < 50 years are at a higher risk of PD than those aged ≥50 years. Future studies are warranted to elucidate the pathomechanism of EOPD in relation to mental illness.

Depressive Symptoms and the Subsequent Risk of Parkinson's Disease: A Nationwide Cohort Study.

OBJECTIVE: Only a few studies have focused on depressive symptoms and Parkinson's disease (PD) risk. As a time lag exists from the onset of depressive symptoms to the diagnosis of depression, elucidating the association between depressive symptoms and PD development might be helpful for the early prediction of PD. We investigate the association between depressive symptoms and subsequent PD risk using nationwide population-based cohort database. DESIGN AND SETTING: Cohort study using the Korean National Health Insurance Service data between 2007 and 2017, with longitudinal follow-up until 2019. PARTICIPANTS: A total of 98,296 elderly people responded to a self-reported questionnaire from the National Health Screening Program on depressive symptoms. MEASUREMENTS: The association between depressive symptoms such as 1) decreased activity or motivation, 2) worthlessness, and 3) hopelessness and PD risk was analyzed. RESULTS: During median 5.06-year follow-up, 839 PD cases occurred: 230 in individuals with depressive symptoms and 609 in those without symptoms. Results showed an increased risk of PD development in those with depressive symptoms (HR = 1.47, 95% CI, 1.26-1.71), with dose-response association between the number of depressive symptoms and PD risk. Even in those already diagnosed with depression, combined depressive symptoms were linked to a higher risk compared to those without symptoms (with symptoms, HR = 2.71, 95% CI, 2.00-3.68; without symptoms, HR = 1.84, 95% CI, 1.43-2.36). CONCLUSION: Individuals with depressive symptoms were at an increased risk of developing PD, and there was a dose-response association between the number of depressive symptoms and PD risk.

Effects of mesenchymal stem cell on dopaminergic neurons, motor and memory functions in animal models of Parkinson's disease: a systematic review and meta-analysis.

ABSTRACT: Parkinson's disease is characterized by the loss of dopaminergic neurons in the substantia nigra pars compacta, and although restoring striatal dopamine levels may improve symptoms, no treatment can cure or reverse the disease itself. Stem cell therapy has a regenerative effect and is being actively studied as a candidate for the treatment of Parkinson's disease. Mesenchymal stem cells are considered a promising option due to fewer ethical concerns, a lower risk of immune rejection, and a lower risk of teratogenicity. We performed a meta-analysis to evaluate the therapeutic effects of mesenchymal stem cells and their derivatives on motor function, memory, and preservation of dopaminergic neurons in a Parkinson's disease animal model. We searched bibliographic databases (PubMed/MEDLINE, Embase, CENTRAL, Scopus, and Web of Science) to identify articles and included only peer-reviewed in vivo interventional animal studies published in any language through June 28, 2023. The study utilized the random-effect model to estimate the 95% confidence intervals (CI) of the standard mean differences (SMD) between the treatment and control groups. We use the systematic review center for laboratory animal experimentation's risk of bias tool and the collaborative approach to meta-analysis and review of animal studies checklist for study quality assessment. A total of 33 studies with data from 840 Parkinson's disease model animals were included in the meta-analysis. Treatment with mesenchymal stem cells significantly improved motor function as assessed by the amphetamine-induced rotational test. Among the stem cell types, the bone marrow MSCs with neurotrophic factor group showed largest effect size (SMD [95% CI] = -6.21 [-9.50 to -2.93], P = 0.0001, I2 = 0.0 %). The stem cell treatment group had significantly more tyrosine hydroxylase positive dopaminergic neurons in the striatum ([95% CI] = 1.04 [0.59 to 1.49], P = 0.0001, I2 = 65.1 %) and substantia nigra (SMD [95% CI] = 1.38 [0.89 to 1.87], P = 0.0001, I2 = 75.3 %), indicating a protective effect on dopaminergic neurons. Subgroup analysis of the amphetamine-induced rotation test showed a significant reduction only in the intracranial-striatum route (SMD [95% CI] = -2.59 [-3.25 to -1.94], P = 0.0001, I2 = 74.4 %). The memory test showed significant improvement only in the intravenous route (SMD [95% CI] = 4.80 [1.84 to 7.76], P = 0.027, I2 = 79.6 %). Mesenchymal stem cells have been shown to positively impact motor function and memory function and protect dopaminergic neurons in preclinical models of Parkinson's disease. Further research is required to determine the optimal stem cell types, modifications, transplanted cell numbers, and delivery methods for these protocols.

The Effect of Elastic Eyelid Band Application on Bilateral Severe Ptosis in a Patient With Bilateral Incomplete Claude's Syndrome: A Case Report.

Patients with brainstem stroke can present with various oculomotor disorders, including ptosis. Neurogenic ptosis, which results from total or partial dysfunction of the third cranial nerve and/or the Müller muscle, can significantly restrict activities of daily living and participation in rehabilitation. Therefore, surgical intervention is an effective therapeutic strategy. However, owing to complications associated with incomplete eyelid closure, such as exposure keratitis and corneal injury, patients with neurogenic ptosis should first be observed, as natural recovery without surgery can be expected despite a poor prognosis. We reported the case of a 66-year-old woman with bilateral Claude syndrome who presented with severe bilateral ptosis, quadriparesis, and cognitive impairment after a bilateral midbrain infarction. After 3 months of intensive rehabilitation using soft elastic eyelid bands, her ptosis improved without the need for eyelid bands and visual field significantly increased, with improved functional level to the point of walking independently without assistance. This report demonstrates the potential advantages of the simple yet effective nonsurgical intervention of a soft elastic eyelid band for ptosis to restore significant functional gains in patients with severe bilateral ptosis after acute stroke.

Association between lipid levels and the risk of Parkinson's disease in individuals with diabetes mellitus: A nationwide population-based cohort study.

INTRODUCTION: Many studies have examined the positive association between diabetes mellitus (DM) and the risk of Parkinson's disease (PD). Dyslipidemia has been reported to be prevalent in patients with diabetes; thus, lipid levels and the drugs for dyslipidemia could influence the development of PD in patients with DM. This study aimed to examine the association between lipid levels and the risk of PD in individuals with DM and evaluate whether the association changes with the use of statins. METHODS: This nationwide population-based retrospective cohort study included individuals with DM according to the International Classification of Diseases between 2009 and 2012. Among the 2,361,633 patients with DM followed up for up to 9 years, 17,046 were newly diagnosed with PD. Patients with DM were categorized into quartile groups of total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels. RESULTS: There was an inverse association between lipid levels and PD development in the unadjusted model; however, this relationship became less significant after adjusting the use of statins in triglyceride and total cholesterol. In the analysis stratified by statin use, total cholesterol level was associated with decreased PD risk in non-statin users with DM; however, there was no significant association between total cholesterol level and PD risk in statin users. CONCLUSION: We found an inverse relationship between lipid levels and PD risk in patients with DM, which was influenced by statin use. Future studies about optimal target lipid levels relevant to PD risk considering statin dose in DM patients are needed.

Association between Low Blood Pressure and Subsequent Risk of Parkinson's Disease in Older Adults Aged ≥75 Years.

INTRODUCTION: The association between blood pressure (BP) and incidence of Parkinson's disease (PD) in older adults remains uncertain. Therefore, this study aimed to investigate the association between BP (high or low) and PD incidence in adults aged ≥75 years. METHODS: In this nationwide population-based cohort study, we enrolled participants aged ≥75 years without a prior PD diagnosis who had undergone health examination provided by the Korean National Health Insurance Service at least once from January 1, 2009, to December 31, 2012. The participants were followed up until December 31, 2019, or the date of their death. The Cox proportional hazards model was used to assess the risk of PD depending on systolic BP (SBP), diastolic BP (DBP), and pulse pressure. RESULTS: Overall, 963,525 participants were enrolled in the analysis and followed up until December 31, 2019, or the date of death (40.7% male, mean age 78.5 ± 3.6 years). The mean SBP and DBP were 131.4 ± 16.7 and 77.9 ± 10.3 mm Hg, respectively. During the 10-year follow-up period, 16,414 (1.7%) newly diagnosed cases of PD were reported. A significant inverse dose-response association was found between SBP and PD incidence. In the subgroup analysis, this association was maintained for most variables, including sex, use of antihypertensive medication, comorbidities, alcohol consumption, physical activity, and body mass index, except for smoking status. CONCLUSION: Lower SBP and DBP were associated with a higher PD incidence in older adults. These results may have substantial implications for determining the optimal BP control target in adults aged ≥75 years.

Accessibility for Rehabilitation Therapy According to Socioeconomic Status in Patients With Stroke: A Population-Based Retrospective Cohort Study.

This study aimed to investigate accessibility for rehabilitation therapy according to socioeconomic status (SES) after stroke using nationwide population-based cohort data. We selected patients with a diagnosis with stroke (International Classification of Diseases, 10th Revision code: I60-64) and SES including residential area, income level, and insurance type were also assessed. Receiving continuous rehabilitation therapy was defined as accumulation of "Rehabilitative developmental therapy for disorder of central nervous system (claim code: MM105)" more than 41 times. Logistic regression analyses were performed to investigate the association between SES and rehabilitation therapy using odds ratios (ORs) and 95% confidence intervals (CIs). A total of 18,842 patients with stroke were enrolled. Rural area (OR, 0.745; 95% CI, 0.664-0.836) and medical aid (OR, 0.605; 95% CI, 0.494-0.741) were associated with lower rate of receiving rehabilitation therapy. As for income level, when lowest income group was used as a reference group, low-middle group showed an increased rate of receiving rehabilitation therapy (OR, 1.206; 95% CI, 1.020-1.426). Although rehabilitation therapy after stroke is covered with national health insurance program in Korea, there still existed disparities of accessibility for rehabilitation therapy according to SES. Our results would suggest helpful information for health policy in patients with stroke.

New-onset neurodegenerative diseases as long-term sequelae of SARS-CoV-2 infection: A systematic review and meta-analysis.

The association between SARS-CoV-2 infection with increased risk for new-onset neurodegenerative diseases remains unclear. Therefore, this meta-analysis aims to elucidate whether new-onset neurodegenerative diseases are long-term sequelae of SARS-CoV-2 infection. PubMed/MEDLINE, CENTRAL, and EMBASE were systematically searched for articles published up to January 10, 2023. A systematic review and meta-analysis were performed to calculate the pooled effect size, expressed as hazard ratios (HR) with corresponding 95% confidence interval (CI) of each outcome. Twelve studies involving 33 146 809 individuals (2 688 417 post-COVID-19 cases and 30 458 392 controls) were included in the present meta-analysis. The pooled analyses compared with control groups showed a significant association between SARS-CoV-2 infection and increased risk for new-onset Alzheimer's disease (HR = 1.50, 95% CI 1.22-1.85, I2 = 97%), dementia (HR = 1.66, 95% CI 1.42-1.94, I2 = 91%), and Parkinson's disease (HR = 1.44, 95% CI 1.06-1.95, I2 = 86%) among COVID-19 survivors. SARS-CoV-2 infection may be associated with a higher risk for new-onset neurodegenerative diseases in recovered COVID-19 patients. Future studies are warranted to determine the biological mechanisms underlying the neurodegenerative consequences of COVID-19 as long-term sequelae of SARS-CoV-2 infection.

Prevalence and Mortality Risk of Neurological Disorders during the COVID-19 Pandemic: An Umbrella Review of the Current Evidence.

INTRODUCTION: Coronavirus disease 2019 (COVID-19), a global pandemic, has infected approximately 10% of the world's population. This comprehensive review aimed to determine the prevalence of various neurological disorders in COVID-19 without overlapping meta-analysis errors. METHODS: We searched for meta-analyses on neurological disorders following COVID-19 published up to March 14, 2023. We obtained 1,184 studies, of which 44 meta-analyses involving 9,228,588 COVID-19 patients were finally included. After confirming the forest plot of each study and removing overlapping individual studies, a re-meta-analysis was performed using the random-effects model. RESULTS: The summarized combined prevalence of each neurological disorder is as follows: stroke 3.39% (95% confidence interval, 1.50-5.27), dementia 6.41% (1.36-11.46), multiple sclerosis 4.00% (2.50-5.00), epilepsy 5.36% (-0.60-11.32), Parkinson's disease 0.67% (-1.11-2.45), encephalitis 0.66% (-0.44-1.77), and Guillain-Barré syndrome 3.83% (-0.13-7.80). In addition, the mortality risk of patients with comorbidities of COVID-19 is as follows: stroke OR 1.63 (1.23-2.03), epilepsy OR 1.71 (1.00-2.42), dementia OR 1.90 (1.31-2.48), Parkinson's disease OR 3.94 (-2.12-10.01). CONCLUSION: Our results show that the prevalence and mortality risk may increase in some neurological diseases during the COVID-19 pandemic. Future studies should elucidate the precise mechanisms for the link between COVID-19 and neurological diseases, determine which patient characteristics predispose them to neurological diseases, and consider potential global patient management.

Association between smoking and all-cause mortality in Parkinson's disease.

We aimed to investigate the association between smoking status and all-cause mortality of Parkinson's disease (PD). Among the whole nationwide population data from Korea National Health Insurance Service, newly diagnosed PD was selected, and all-cause mortality was evaluated. The systematic review was performed through a literature search on the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases. Among 26,080 individuals with PD, there was no significant association between smoking status and all-cause mortality in a nationwide cohort study (ex-smoker, HR 0.1.03, 95% CI 0.97-1.10; current smoker, HR 1.06, 95% CI 0.96-1.16). The systematic review, including six prospective cohort studies, also found a nonsignificant association. PD smokers tended to have fewer deaths from neurologic causes but were significantly more likely to die from smoking-related cancers such as lung cancer. We presented a nonsignificant association between smoking and mortality of PD, and cigarette smoking is not recommended in individuals with PD.

Effect of probiotic supplementation on gastrointestinal motility, inflammation, motor, non-motor symptoms and mental health in Parkinson's disease: a meta-analysis of randomized controlled trials.

BACKGROUND: Parkinson's disease (PD) is the second most common neurodegenerative disease worldwide. Gut dysbiosis is hypothesized to cause PD; therefore, whether probiotics can be used as adjuvants in the treatment of PD is being actively investigated. AIMS: We performed a systematic review and meta-analysis to evaluate the effectiveness of probiotic therapy in PD patients. METHODS: PUBMED/MEDLINE, EMBASE, Cochrane, Scopus, PsycINFO and Web of Science databases were searched till February 20, 2023. The meta-analysis used a random effects model and the effect size was calculated as mean difference or standardized mean difference. We assessed the quality of the evidence using the Grade of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Eleven studies involving 840 participants were included in the final analysis. This meta-analysis showed high-quality evidence of improvement in Unified PD Rating Scale Part III motor scale (standardized mean difference [95% confidence interval]) (- 0.65 [- 1.11 to - 0.19]), non-motor symptom (- 0.81 [- 1.12 to - 0.51]), and depression scale (- 0.70 [- 0.93 to -0.46]). Moderate to low quality evidence of significant improvement was observed in gastrointestinal motility (0.83 [0.45-1.10]), quality of life (- 1.02 [- 1.66 to - 0.37]), anxiety scale (- 0.72 [- 1.10 to - 0.35]), serum inflammatory markers (- 5.98 [- 9.20 to - 2.75]), and diabetes risk (- 3.46 [- 4.72 to - 2.20]). However, there were no significant improvements in Bristol Stool Scale scores, constipation, antioxidant capacity, and risk of dyslipidemia. In a subgroup analysis, probiotic capsules improved gastrointestinal motility compared to fermented milk. CONCLUSION: Probiotic supplements may be suitable for improving the motor and non-motor symptoms of PD and reducing depression. Further research is warranted to determine the mechanism of action of probiotics and to determine the optimal treatment protocol.

Menstrual and Reproductive Factors for Gastric Cancer in Postmenopausal Women: The 2007-2020 Korea National Health and Nutrition Examination Survey.

Globally, the incidence of gastric cancer is lower in women than in men. It is thought that menstrual and reproductive factors may be related to their lower incidence of gastric cancer. This cross-sectional study examined menstrual, reproductive, and other factors in 20,784 postmenopausal women from the 2007-2020 Korea National Health and Nutrition Examination Survey (KNHANES). A univariate logistic regression analysis was performed, and then a multivariate logistic regression analysis for significant factors in the univariate analysis was conducted. In the multivariate logistic regression analysis, the age at menarche (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.00-1.06, p = 0.035) and myocardial infarction (OR 2.43, 95% CI 1.05-5.62, p = 0.026) showed a significant association with increased incidence of gastric cancer. The age at menopause (OR 0.97, 95% CI 0.95-1.00, p = 0.03), the age at the first childbirth (OR 0.93, CI 0.89-0.97, p = 0.007), and the experience of alcohol consumption (OR 0.68, 95% CI 0.5-0.91, p = 0.003) showed a significant association with a decreased incidence of gastric cancer. Late menarche, early menopause, early aged first childbirth, and myocardial infarction are estimated to be risk factors for gastric cancer in postmenopausal Korean women.

Machine learning based risk prediction for Parkinson's disease with nationwide health screening data.

Although many studies have been conducted on machine learning (ML) models for Parkinson's disease (PD) prediction using neuroimaging and movement analyses, studies with large population-based datasets are limited. We aimed to propose PD prediction models using ML algorithms based on the National Health Insurance Service-Health Screening datasets. We selected individuals who participated in national health-screening programs > 5 times between 2002 and 2015. PD was defined based on the ICD-code (G20), and a matched cohort of individuals without PD was selected using a 1:1 random sampling method. Various ML algorithms were applied for PD prediction, and the performance of the prediction models was compared. Neural networks, gradient boosting machines, and random forest algorithms exhibited the best average prediction accuracy (average area under the receiver operating characteristic curve (AUC): 0.779, 0.766, and 0.731, respectively) among the algorithms validated in this study. The overall model performance metrics were higher in men than in women (AUC: 0.742 and 0.729, respectively). The most important factor for predicting PD occurrence was body mass index, followed by total cholesterol, glucose, hemoglobin, and blood pressure levels. Smoking and alcohol consumption (in men) and socioeconomic status, physical activity, and diabetes mellitus (in women) were highly correlated with the occurrence of PD. The proposed health-screening dataset-based PD prediction model using ML algorithms is readily applicable, produces validated results, and could be a useful option for PD prediction models.

Network Effects of Brain Lesions Causing Central Poststroke Pain.

OBJECTIVE: This study was undertaken to test whether lesions causing central poststroke pain (CPSP) are associated with a specific connectivity profile, whether these connections are associated with metabolic changes, and whether this network aligns with neuromodulation targets for pain. METHODS: Two independent lesion datasets were utilized: (1) subcortical lesions from published case reports and (2) thalamic lesions with metabolic imaging using 18F- fluorodeoxyglucose positron emission tomography-computed tomography. Functional connectivity between each lesion location and the rest of the brain was assessed using a normative connectome (n = 1,000), and connections specific to CPSP were identified. Metabolic changes specific to CPSP were also identified and related to differences in lesion connectivity. Therapeutic relevance of the network was explored by testing for alignment with existing brain stimulation data and by prospectively targeting the network with repetitive transcranial magnetic stimulation (rTMS) in 7 patients with CPSP. RESULTS: Lesion locations causing CPSP showed a specific pattern of brain connectivity that was consistent across two independent lesion datasets (spatial r = 0.82, p < 0.0001). Connectivity differences were correlated with postlesion metabolism (r = -0.48, p < 0.001). The topography of this lesion-based pain network aligned with variability in pain improvement across 12 prior neuromodulation targets and across 32 patients who received rTMS to primary motor cortex (p < 0.05). Prospectively targeting this network with rTMS improved CPSP in 6 of 7 patients. INTERPRETATION: Lesions causing pain are connected to a specific brain network that shows metabolic abnormalities and promise as a neuromodulation target. ANN NEUROL 2022;92:834-845.

Recurrent atypical leiomyoma in bladder trigone, confused with uterine fibroids: A case report.

BACKGROUND: Tumors originating from the posterior bladder wall can be challenging to diagnose because they may mimic a mass from the uterine cervix. Atypical leiomyoma of the bladder trigone is extremely rare, with few reported cases, and requires caution during surgery to avoid damage to the adjacent ureter. Diagnostic surgery and confirmational pathology are essential to assess whether the tumor is malignant and relieve clinical symptoms. Herein, we describe a case of recurrent leiomyoma with focal atypia in the bladder trigone. CASE SUMMARY: A 29-year-old woman with a uterine fibroid incidentally found at a regular checkup was referred to our hospital. Based on magnetic resonance imaging, either urinary bladder leiomyoma or protrusion of pedunculated uterine cervical fibroid into the bladder was suspected. This leiomyoma in the trigone of the bladder was completely excised by laparotomy, and the patient was discharged without complication. Follow-up outpatient ultrasonography identified tumor recurrence after four years. As focal atypia was identified previously, laparotomy was performed to confirm the pathology. A round solid mass was resected from the posterior bladder wall without injuring either ureteric orifice. This tumor was pathologically diagnosed as a leiomyoma without atypia. Three-year follow-up ultrasonography has revealed no recurrence. CONCLUSION: Atypical leiomyoma in bladder trigone is rare and could be easily mistaken for fibroid in the uterine cervix. To confirm histopathology, surgical excision is mandatory and regular follow-up is necessary to detect recurrence.

Initial BMI and Weight Loss over Time Predict Mortality in Parkinson Disease.

OBJECTIVES: Although weight loss is a frequent symptom in Parkinson disease (PD), there have been few studies on the association between body mass index (BMI) and mortality. The objective of this study was to investigate the association between BMI and change in BMI at diagnosis in patients with PD and all-cause mortality. DESIGN: Cohort study using Korean National Health Insurance Service-Elderly Cohort data. SETTING AND PARTICIPANTS: Patients with new-onset PD were selected using the International Classification of Diseases 10th edition code (G20). Then, patients who were diagnosed more than 3 times with PD and had been prescribed anti-parkinsonian medication for ≥30 days were included. Those with a combined diagnosis of atypical parkinsonism and secondary parkinsonism were excluded. METHODS: The primary outcome was all-cause mortality. Anthropometric data, including height and weight, were obtained from the health screening data to calculate BMI. The Cox proportional hazards model was used to assess mortality risk by BMI. RESULTS: Among the 2703 patients with PD, 492 (18.20%) died during the 11-year follow-up period. There was a significant inverse dose-response relationship between baseline BMI and mortality [<18.5 kg/m2: hazard ratio (HR), 1.872, 95% CI, 1.338-2.494; 23-25 kg/m2: HR, 0.695, 95% CI, 0.546-0.886; 25-30 kg/m2: HR, 0.644, 95% CI, 0.476-0.869; ≥30 kg/m2: HR, 0.396, 95% CI, 0.165-0.950]. Change in BMI of 10% revealed a significant association with mortality. Subgroup analyses by sex showed a significant inverse dose-response relationship between BMI and all-cause mortality only in women. CONCLUSIONS AND IMPLICATIONS: We demonstrated an inverse dose-response association between BMI at diagnosis and mortality in patients with PD, especially in women. Early detection of PD before weight loss progression and proper management might improve mortality. The small number of obese PD participants in our study should be considered when interpreting and generalizing results.

Changes in the Brain Metabolism Associated with Central Post-Stroke Pain in Hemorrhagic Pontine Stroke: An 18F-FDG-PET Study of the Brain.

Central post-stroke pain (CPSP) is an intractable neuropathic pain that can occur following central nervous system injuries. Spino-thalamo-cortical pathway damage contributes to CPSP development. However, brain regions involved in CPSP are unknown and previous studies were limited to supratentorial strokes with cortical lesion involvement. We analyzed the brain metabolism changes associated with CPSP following pontine hemorrhage. Thirty-two patients with isolated pontine hemorrhage were examined; 14 had CPSP, while 18 did not. Brain glucose metabolism was evaluated using 18F-fluorodeoxyglucose-positron emission tomography images. Additionally, regions revealing metabolic correlation with CPSP severity were analyzed. Patients with CPSP showed changes in the brain metabolism in the cerebral cortices and cerebellum. Compared with the control group, the CPSP group showed significant hypometabolism in the contralesional rostral anterior cingulum and ipsilesional primary motor cortex (Puncorrected < 0.001). However, increased brain metabolism was observed in the ipsilesional cerebellum (VI) and contralesional cerebellum (lobule VIIB) (Puncorrected < 0.001). Moreover, increased pain intensity correlated with decreased metabolism in the ipsilesional supplementary motor area and contralesional angular gyrus. This study emphasizes the role of the many different areas of the cortex that are involved in affective and cognitive processing in the development of CPSP.