Publicaciones

Ledged Beam Walking Test Automatic Tracker: Artificial intelligence-based functional evaluation in a stroke model

Ruiz-Vitte A, Gutiérrez-Fernández M, Laso-García F et al. Comput Biol Med. 2025 Mar;186:109689. doi: 10.1016/j.compbiomed.2025.109689. Epub 2025 Jan 24. PMID: 39862465.

https://pubmed.ncbi.nlm.nih.gov/39862465/

Abstract: The quantitative evaluation of motor function in experimental stroke models is essential for the preclinical assessment of new therapeutic strategies that can be transferred to clinical research; however, conventional assessment tests are hampered by the evaluator’s subjectivity. We present an artificial intelligence-based system for the automatic, accurate, and objective analysis of target parameters evaluated by the ledged beam walking test, which offers higher sensitivity than the current methodology based on manual and visual counting. This system employs a residual deep network model, trained with DeepLabCut (DLC) to extract target paretic hindlimb coordinates, which are categorized to provide a ratio measurement of the animal’s neurological deficit. The results correlate with the measurements performed by a professional observer and have greater reproducibility, easing the analysis of motor deficits and providing a reliable and useful tool applicable to other diseases causing motor deficits.

Funding: This study was supported by the Instituto de Salud Carlos III (ISCIII) PI20/00243, co-funded by the European Union; RICORS network RD21/ 0006/0012 and the Next Generation EU funding that finances the actions of the Recovery and Resilience Mechanism; Miguel Servet CPII20/ 00002 to MG-F; FI18/00026 to FL-G. and FI17/00188 to MCG-F and by the Spanish Ministry of University, Recovery, Transformation and Resilience Plan and the Universidad Aut´ onoma de Madrid under grant CA1/RSUE/2021-00753 to DP-A.

Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcome

Guasch-Jiménez M, Dhar R, Kumar A et al.  J Neurointerv Surg. 2025 Mar 17;17(4):354-359. doi: 10.1136/jnis-2024-021641. PMID: 38637151.

https://pubmed.ncbi.nlm.nih.gov/38637151/

Abstract:

Background Cerebral edema (CED) is associated with poorer outcome in patients with acute ischemic stroke (AIS). The aim of the study was to investigate the factors contributing to greater early CED formation in patients with AIS who underwent endovascular therapy (EVT) and its association with functional outcome.

Methods We conducted a multicenter cohort study of patients with an anterior circulation AIS undergoing EVT. The volume of cerebrospinal fluid (CSF) was extracted from baseline and 24-hour follow-up CT using an automated algorithm. The severity of CED was quantified by the percentage reduction in CSF volume between CT scans (∆CSF). The primary endpoint was a shift towards an unfavorable outcome, assessed by modified Rankin Scale (mRS) score at 3 months. Multivariable ordinal logistic regression analyses were performed. The ∆CSF threshold that predicted unfavorable outcome was selected using receiver operating characteristic curve analysis.

Results We analyzed 201 patients (mean age 72.7 years, 47.8% women) in whom CED was assessable for 85.6%. Higher systolic blood pressure during EVT and failure to achieve modified Thrombolysis In Cerebral Infarction (mTICI) 3 were found to be independent predictors of greater CED. ∆CSF was independently associated with the probability of a one-point worsening in the mRS score (common odds ratio (cOR) 1.05, 95% CI 1.03 to 1.08) after adjusting for age, baseline mRS, National Institutes of Health Stroke Scale (NIHSS), and number of passes. Displacement of more than 25% of CSF was associated with an unfavorable outcome (OR 6.09, 95% CI 3.01 to 12.33) and mortality (OR 6.72, 95% CI 2.94 to 15.32).

Conclusions Early CED formation in patients undergoing EVT was affected by higher blood pressure and incomplete reperfusion. The extent of early CED, measured by automated ∆CSF, was associated with worse outcomes.

Funding: Redes de Investigación Con Objetivos de Resultados en Salud (RICORS) RD21/0006/0006, FEDER (Fondo Europeo de Desarrollo Regional) and PI19/00859 grant, Instituto de Salud Carlos III, Ministry of Science and Innovation (Government of Spain).

Nanoparticles for Thrombolytic Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Preclinical Studies

Prego-Domínguez J, Laso-García F, Palomar-Alonso N et al. Pharmaceutics. 2025 Feb 6;17(2):208. doi: 10.3390/pharmaceutics17020208. PMID: 40006575.

https://pubmed.ncbi.nlm.nih.gov/40006575/

Abstract: Background: Recombinant tissue plasminogen activator (rtPA) remains the standard thrombolytic treatment for ischemic stroke. Different types of nanoparticles have emerged as promising tools to improve the benefits and decrease the drawbacks of this therapy. Among them, cell membrane-derived (CMD) nanomedicines have gained special interest due to their capability to increase the half-life of particles in blood, biocompatibility, and thrombus targeting. In order to update and evaluate the efficacy of these nanosystems, we performed a meta-analysis of the selected in vivo preclinical studies. Methods: Preclinical in vivo studies in ischemic stroke models have been identified through a search in the Pubmed database. We included studies of rtPA-nanoparticles, which assessed infarct volume and/or neurological improvement. Nanosystems were compared with free (nonencapsulated) rtPA treatment. Standardized mean differences were computed and pooled to estimate effect sizes for lesion volumes and neurological scores. Subgroup analyses by the risk of bias, type of nanoparticle, and time of administration were also performed. Results: A total of 18 publications were included in the meta-analysis. This was based on defined search inclusion criteria. Our analysis revealed that rtPA-nanoparticles improved both lesion volume and neurological scores compared with the free rtPA treatment. Moreover, CMD nanomedicines showed better evolution of infarct volume compared to the other nanoparticles. Funnel plots of lesion volume exhibited asymmetry and publication bias. Heterogeneity was generally high, and the funnel plot and Egger test showed some evidence of publication bias that did not achieve statistical significance in the trim-and-fill analysis. Conclusions: rtPA-encapsulating nanosystems were shown to decrease infarct volume and improve neurological scales compared to the standard treatment, and CMD nanomedicines had the greatest beneficial effect.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Instituto de Salud Carlos III_ICIII, grant numbers: ICI19/00032, PI20/01014; and the RICORS-ICTUS network: RD21/0006/0003. Xunta de Galicia, grant number: IN607A2022/02. European Union program FEDER, ISCIII Project (AC20/00031), and Euronanomed III Call (Euronanomed2020_143), and Fundación Mutua Madrileña. CC-P would like to thank Sara Borrell (CD23/00005). All authors have read and agreed to the published version of the manuscript.

Burden of incidental cerebral aneurysms on lifestyle and quality of life: a survey of patients in expectant management (the SPICE Study)

Rodríguez-Pardo J, García-Castro J, Gómez-Escalonilla C et al. J Neurointerv Surg. 2025 Jan 27:jnis-2024-022459. doi: 10.1136/jnis-2024-022459. Epub ahead of print. PMID: 39567189,

https://pubmed.ncbi.nlm.nih.gov/39567189/

Abstract:

Background The increasing availability of neuroimaging tests has led to a rise in the identification of incidental unruptured intracranial aneurysms (UIAs). Their management is under debate, with no consensus on their follow-up strategy, which can cause anxiety in patients. Our aim is to evaluate the impact of diagnosis and imaging follow-up on daily activities and quality of life.

Methods A multicenter cross-sectional study was carried out in patients with UIAs undergoing watchful waiting. Exclusion criteria were history of stroke, renal polycystic disease, symptomatic aneurysms, intervention or scheduled for intervention. The patients completed an anonymous 36-question survey about their habits and perceived quality of life after diagnosis through a validated questionnaire (PROMIS).

Results We obtained 73 responses from 183 patients identified in eight hospitals (40%), 68 of which were included in the study (50 women (74%), median (IQR) age 62 (55–70) years). Forty-nine patients (72%) underwent at least one imaging follow-up per year. Forty-two patients (63%) found follow-up tests reassuring and 12 (18%) experienced concern about the results. Nineteen patients (28%) reported adopting a healthier lifestyle since diagnosis, while 13 (19%) acknowledged a negative impact on their daily activities. Forty-six (68%) admitted avoiding or conditioning at least one activity or situation from a list. PROMIS scores were similar to those of the general reference population. Overall, 77% rated their quality of life as ‘good’ or better.

Conclusions The diagnosis of UIAs seems to influence the activities of the majority of patients. However, follow-up yielded more benefit in the form of healthier lifestyles than harm to daily activities, without detriment to their perceived quality of life.

Funding: Language editing has been funded by the Instituto de Salud Carlos III RICORS-ICTUS Network (RD RD21/0006/0012) endorsed by the European Union – NextGenerationEU.

Digital tool as speech and language therapy for patients with post-stroke aphasia

Ruiz Ares G, Martin Alonso M, Rigual R et al. Digit Health. 2025 Jan 29;11:20552076251314551. doi: 10.1177/20552076251314551. PMID: 39882017.

Abstract:

Introduction: New technologies could play a role in post-stroke aphasia (PSA). Our aims were to develop a digital tool; to evaluate its acceptance and usability by patients and caregivers; and to demonstrate its effectiveness in improving language skills in patients with PSA, applying it from the acute phase. Methods: The study consisted of two phases: development of a digital tool; and an interventional before-and-after study. During the first week of admission, the digital tool, VerbalizAPP®, was installed for use with the help of family/caregivers. PSA was evaluated by a summarised version of the Boston Diagnostic Aphasia Examination (sBDAE) with 0–64 points. After 3 months of using VerbalizAPP®, the sBDAE and scales to assess user satisfaction were applied. Results: Forty patients (29 men, mean age 68.3 years) were included. Aphasia description: Broca’s 12 (15.0%), Wernicke’s13 (32.5%), mixed/global 15 (37.5%) cases. Patients began using VerbalizAPP® 4.8 days (range 2–7) after stroke onset. A significant improvement in sBDAE scores was found after 3 months of VerbalizAPP® use: 35.1 (SD 17.6) versus 51.1 (SD 14.4) points; p <.001. Academic level was the only baseline parameter related to outcomes. Comfort of use scored 8.8, and complexity 2.2 points. Expectations were exceeded in 61.1%, and impression of improvement in 83.3% of cases. No adverse effects were reported, and all participants would recommend VerbalizAPP® to other patients. Conclusions: Our results show the effectiveness of VerbalizAPP® for the treatment of PSA. However, larger prospective validation studies should be conducted to recommend its widespread use.

Funding: The authors disclosed receipt of financial support for the research, authorship, and/or publication of this article from the RICORS network under grant RD21/0006/0012, Spanish Ministry of Health-Carlos III Health Institute (ISCIII) and the Next Generation EU funds (Recovery and Resilience Plan).