Liquid biopsy has emerged as a minimally invasive approach for the molecular characterization and longitudinal monitoring of primary central nervous system (CNS) tumors. Although extensively validated in systemic malignancies, its clinical application in CNS tumors is challenged by the blood-brain barrier, low analyte abundance, and heterogeneous assay performance. Recent advances have expanded the spectrum of detectable tumor-derived components, including circulating tumor DNA (ctDNA), cell-free DNA, extracellular vesicles, RNA species, nucleosomes, metabolites, and lipids, across multiple biofluids such as cerebrospinal fluid (CSF), plasma, serum, urine, saliva, and tears. The aim of this study was to review the biological foundations, analytes, biofluids, clinical applications, and technical limitations of liquid biopsy in primary CNS tumors, with emphasis on diagnostic, prognostic, and surveillance value. We synthesized current evidence on tumor-derived analytes detectable through liquid biopsy, their molecular correlates, and their performance across biofluids. CSF is consistently the most informative biofluid for CNS tumors, with higher analyte concentration and superior concordance with tumor tissue compared with plasma. CtDNA in CSF reliably identifies hallmark alterations, including IDH1/2, H3K27M, TERT, BRAF, ATRX, TP53, 1p/19q codeletion, and MYCN amplification, thereby enabling better diagnosis, molecular classification, and therapeutic stratification. Plasma-based assays are less sensitive but remain valuable for longitudinal monitoring, especially when combined with ultrasensitive sequencing or fragmentomic approaches. Emerging biomarkers, including nucleosome footprints, exosomes, proteins, microRNA (miRNA)/long noncoding RNA (lncRNA)/circular RNA (circRNA) signatures, lipidomic panels, and metabolites such as D-2-hydroxyglutarate, show potential for integration into multimodal diagnostics. Liquid biopsy provides a powerful and rapidly evolving tool for the minimally invasive molecular assessment of CNS tumors. While CSF remains the optimal matrix for diagnosis and characterization, advances in ultrasensitive detection methods increasingly support the feasibility of plasma and urine for longitudinal follow-up. Integrating liquid biopsy with advanced imaging and tissue-based data will likely transform diagnostic accuracy, therapeutic decision-making, and real-time monitoring of CNS tumors.
Articulated endoscopic instruments can enhance dexterity within constrained workspaces; however, their complexity and cost limit accessibility for training, prototyping, and early-stage evaluation. Additive manufacturing offers a practical approach for developing mechanically functional, low-cost articulated devices for engineering exploration and simulation-oriented applications. This study describes the mechanical design, bench-top characterization, and preliminary proof-of-concept assessment of two additively manufactured, cable-driven endoscopic prototypes: a flexible endoscope with an integrated working channel and bidirectional distal articulation, and a 4-mm steerable surgical forceps with independent jaw actuation. Both devices were fabricated using fused deposition modeling. Bench-top experiments quantified distal deflection, motion repeatability, force-related behavior, simulated task execution, and user perception. The flexible endoscope achieved effective distal deflections of 178° ± 2° vertically and 171° ± 3° horizontally while maintaining compatibility with standard 2.8-mm endoscopic instruments. During cyclic testing, it demonstrated sub-centimeter positional consistency after 1000 articulation cycles, with 95th percentile errors below 8 mm in both directions. The steerable forceps exhibited a geometric articulation range of 180°, an effective distal deflection of 85° ± 2°, and repeatable tip motion over 500 cycles, with a mean positional error of 0.26 mm. Simulated tasks were completed with high user perception scores for both prototypes. Fabrication costs were USD 166.49 for the endoscope and USD 27.75 for the forceps. These findings suggest that cable-driven architectures combined with additive manufacturing can reproduce key kinematic principles of articulated endoscopic instruments using low-cost fabrication methods. The prototypes should be interpreted as early-stage engineering demonstrators rather than clinically deployable devices.
Interoceptive awareness (IA) supports emotional processing and may be affected in people with Parkinson's disease (PwP), where depression and anxiety are common. We examined associations between IA, neuropsychiatric symptoms, cognition, and disease severity in PwP. In a case-control study, 50 PwP and 25 controls completed the MAIA, HDRS, HARS, MoCA, and MDS-UPDRS. IA did not differ between groups. In PwP, lower MAIA Not-Worrying and Self-Regulation scores correlated with depression, anxiety, and disease severity. In addition, lower MAIA Self-Regulation scores correlated with higher orthostatic hypotension symptoms. Reduced interoceptive confidence in PwP is associated with neuropsychiatric burden and perceived autonomic symptom burden.
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Aging results from the gradual accumulation of molecular and cellular damage, and it is a risk factor for neurodegenerative disease. The aryl hydrocarbon receptor (AhR) is increasingly recognized as a key in the regulatory molecular mechanisms that drive aging. AhR is a cytoplasmic receptor activated by diverse endogenous and exogenous ligands. It modulates cell proliferation and differentiation in development and the adult brain. Besides, AhR participates in multiple physiological mechanisms that become dysregulated with age, including neuroinflammation, gut dysbiosis, stem cell maintenance, genomic stability, lipid metabolism, and mitochondrial function, contributing to the onset of neurodegeneration. These interconnected physiological processes lead to cumulative damage that ultimately impairs physical and cognitive function in older individuals. Activation of AhR by selective ligands has been shown to dampen neuroinflammatory responses and support cognitive integrity, underscoring its regulatory role in central nervous system (CNS) homeostasis. This review plumbs current evidence on how AhR influences the molecular mechanisms of aging and explores its potential as a therapeutic target to preserve brain health and mitigate age-related neurological decline.
Parkinson's disease (PD) is projected to increase substantially in Mexico over coming decades, yet its geographic distribution has not been systematically examined at the state level. This study aimed to evaluate whether PD prevalence in Mexico exhibits geographic clustering, with particular attention to regions characterized by intensive agricultural and industrial activity. We conducted an ecological cross-sectional study using publicly available state-level data from Mexico covering the period 2015-2024. PD case counts were obtained from the national epidemiological surveillance system, and population denominators were derived from the 2020 national census. State-level prevalence was calculated per 100,000 inhabitants as annual averages across the study period. States were grouped into a Northern Hotspot, a Western Hotspot, and remaining states based on geographic clustering patterns and agricultural productivity profiles. Geographic inequality was assessed using the Gini index, Theil index, and coefficient of variation. Regional differences were evaluated with proportion tests and Poisson regression models with population offset, reported as prevalence ratios (PRs) with 95% confidence intervals (CIs). PD prevalence showed substantial geographic heterogeneity across Mexican states over the 2015-2024 period. Colima recorded the highest average prevalence (38.8 per 100,000), followed by Durango (21.4), Sinaloa (14.9), Morelos (14.8), and Chihuahua (13.7 per 100,000). Inequality metrics confirmed marked dispersion in state-level prevalence (Gini 0.419; Theil 0.312; coefficient of variation 0.949). Average prevalence was higher in the Western Hotspot (8.6 per 100,000; PR 1.54, 95% CI 1.44-1.63) and the Northern Hotspot (13.8 per 100,000; PR 2.57, 95% CI 2.42-2.74) compared with the remaining states (4.9 per 100,000). PD prevalence in Mexico exhibits pronounced geographic heterogeneity, with distinct clustering observed in northern and western states. These patterns are consistent with a non-random spatial distribution and highlight regions where agricultural, industrial, and environmental exposures may warrant further investigation. Given the ecological design and important limitations including the absence of age standardization and variability in healthcare access across states, these findings are hypothesis-generating and do not permit causal inference. They underscore the need for more robust epidemiological surveillance, standardized case ascertainment, and individual-level studies to better characterize the determinants of PD distribution in Mexico.
Spinal schwannomas are benign nerve sheath tumors that typically arise in the intradural extramedullary compartment but may occasionally mimic intramedullary lesions on magnetic resonance imaging (MRI). A 43-year-old female presented with progressive upper-limb numbness and weakness, thoracic pain, and dysphagia. MRI showed an apparently intramedullary cervicothoracic lesion, characterized by spinal cord expansion, heterogeneous signal, and absence of clear margins with the cord. The patient underwent C7-D2 laminectomy and complete microsurgical resection of a highly vascularized extramedullary tumor. Histopathology confirmed schwannoma, and postoperative evolution was favorable without new deficits. Cervicodorsal schwannomas can simulate intramedullary tumors, posing a diagnostic challenge. Complete microsurgical resection through a posterior approach provides excellent outcomes.
Normative models of brain morphometry quantify individual deviations from typical anatomical patterns and hold promise for enhancing clinical decision-making. However, their clinical utility depends critically on demonstrating generalizability across diverse ethnoracial populations. We previously developed sex-specific, race-neutral normative models for cortical thickness, surface area, and subcortical volumes using brain scans from a large international sample of healthy individuals, as part of the CentileBrain Project, a global initiative to provide open-access, neuroimaging reference models. The primary aim of the present study was to empirically evaluate the generalizability and accuracy of these pretrained models across multiple ethnoracial groups. To this end, we tested model performance in independent samples of healthy individuals from Africa, Asia, Europe, and the Americas, with ethnoracial classification defined either by self-identification or genetic ancestry (N = 4,862). We further compared performance against normative models developed exclusively from a single-population Chinese cohort. Across all groups, as well as in the pooled sample, the pretrained CentileBrain models demonstrated consistently high accuracy, with relative mean absolute error values below 10% for subcortical volume and surface area and below 5% for cortical thickness. Model performance was highly concordant across self-identified and ancestry-defined groups. In a separate analysis, the CentileBrain models performed comparably to a population-specific model when applied to an independent ancestry-matched sample. These findings provide empirical support for the generalizability of race-neutral normative models developed on large and diverse samples and underscore their potential utility for individualized neuroimaging assessment across ethnoracially diverse populations.
This study examined whether name characteristics influence citation counts in ophthalmology. This was done by assessing 5407 papers published between 2015 and 2020 in four ophthalmology journals. Analyses of first and last authors' names considered factors such as length, consonant sequences, alphabetical order, and popularity. After controlling for the year of publication, the number of authors, and the type of publication, only one association was found to be statistically significant; specifically, that the longer a consonant sequence was in the first-author's forename the more citations their publication received. Future research could address broader datasets and additional academic outcomes.
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Stroke remains a leading cause of death and disability throughout the Americas, disproportionately impacting low-and middle-income countries and underserved populations. In this review, we examine the status of stroke prevention in the Americas. Prevention is essential, yet unequal access to healthcare has led to major disparities - especially among rural populations, ethnic minorities, and lower socioeconomic status. Models like the WHO HEARTS Program demonstrate that evidence-based programs can be tailored to local contexts. Telehealth and digital tools play a critical role in empowering patients, educating communities, and supporting healthcare workers. Despite growing efforts, challenges persist due to health inequities, gaps between policy and implementation, and underinvestment. Strengthening prevention will support countries in achieving the United Nations Sustainable Development Goals, targeting a one-third reduction in premature deaths from non-communicable diseases by 2030. This paper outlines effective strategies for implementing stroke prevention, emphasizing healthy lifestyles, early detection of risk factors, and system-level interventions. O Acidente Vascular Cerebral (AVC) permanece como uma das principais causas de morte e incapacidade em todas as Américas, impactando desproporcionalmente os países de baixa e média renda e as populações vulneráveis. Nesta revisão, examinamos o estado atual da prevenção do AVC nas Américas. A prevenção é essencial; contudo, o acesso desigual aos cuidados de saúde resultou em disparidades significativas – especialmente entre populações rurais, minorias étnicas e indivíduos de baixo nível socioeconômico. Modelos como o Programa HEARTS da OMS demonstram que programas baseados em evidências podem ser adaptados aos contextos locais. A telessaúde e as ferramentas digitais desempenham um papel fundamental na capacitação dos pacientes, na educação das comunidades e no apoio aos profissionais de saúde. Apesar dos esforços crescentes, os desafios persistem devido às iniquidades em saúde, às lacunas entre a política e a implementação, e ao subfinanciamento. O fortalecimento da prevenção apoiará os países no alcance dos Objetivos de Desenvolvimento Sustentável das Nações Unidas, visando uma redução de um terço nas mortes prematuras por doenças crônicas não transmissíveis até 2030. Este artigo apresenta estratégias eficazes para a implementação da prevenção do AVC, enfatizando estilos de vida saudáveis, a detecção precoce de fatores de risco e intervenções em nível sistêmico. El ataque cerebrovascular sigue siendo una de las principales causas de muerte y discapacidad en las Américas, afectando de manera desproporcionada a los países de ingresos bajos y medianos, así como a las poblaciones desatendidas. En esta revisión, examinamos el estado de la prevención del accidente cerebrovascular en las Américas. La prevención es esencial; sin embargo, el acceso desigual a la atención sanitaria ha provocado disparidades importantes, especialmente entre las poblaciones rurales, las minorías étnicas y los grupos de nivel socioeconómico bajo. Modelos como la Iniciativa HEARTS de la OMS demuestran que los programas basados en evidencia pueden adaptarse a los contextos locales. La telesalud y las herramientas digitales desempeñan un papel fundamental en el empoderamiento de los pacientes, la educación de las comunidades y el apoyo a los trabajadores de la salud. A pesar de los crecientes esfuerzos, persisten los desafíos debido a las inequidades en salud, las brechas entre la política y la implementación, y la inversión insuficiente. El fortalecimiento de la prevención apoyará a los países en el logro de los Objetivos de Desarrollo Sostenible de las Naciones Unidas, con la meta de reducir en un tercio las muertes prematuras por enfermedades no transmisibles para el año 2030. Este artículo describe estrategias efectivas para implementar la prevención del accidente cerebrovascular, enfatizando los estilos de vida saludables, la detección temprana de factores de riesgo y las intervenciones a nivel sistémico.
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Revealing neurobiological markers of antipsychotic nonresponse in psychosis may aid outcome prediction and inform novel treatment targets. To examine differences in neurometabolites in antipsychotic nonresponsive compared to antipsychotic-responsive psychosis using individual participant data and meta-analysis. Web of Science was searched for studies published between January 1, 1980, and November 1, 2025. Authors of 21 eligible studies identified before August 2024 were invited to contribute individual participant data. Eighteen studies examining neurometabolites by treatment response in psychosis contributed individual participant data for the mega-analysis. These studies plus a further 5 studies were included in the meta-analyses of standardized mean differences and variability. Individual participant data were analyzed using linear mixed models with study as a random effect. Subgroup analyses examined prospective designs and treatment-resistant samples. Published group means and standard deviations were extracted for meta-analyses. Group differences in glutamate, glutamate plus glutamine, choline, myo-inositol, N-acetylaspartate, γ-aminobutyric acid, and glutathione in the medial frontal cortex, dorsolateral prefrontal cortex, thalamus, and basal ganglia. The mega-analysis included 1189 participants from 18 studies; of these, 476 were treatment nonresponders (mean [SD] age, 33.0 [12.5] years; 340 male), 427 were treatment responders (mean [SD] age, 30.3 [11.5] years; 299 male), and 286 were healthy control individuals (mean [SD] age, 31.0 [12.5] years; 170 male). Compared with the antipsychotic response group, nonresponders showed elevations in medial frontal glutamate (Glass Δ = 0.21; P = .02), glutamate plus glutamine (Glass Δ = 0.29; P = .002), choline (Glass Δ = 0.22; P = .03), and myo-inositol (Glass Δ = 0.35; P = .001); similar elevations were observed relative to control individuals. Elevated medial frontal glutamate plus glutamine in antipsychotic nonresponders compared with responders was also observed prospectively in first-episode psychosis (Glass Δ = 0.41; P = .002), whereas myo-inositol elevations were greatest in individuals meeting criteria for treatment-resistance (Glass Δ = 0.64; P = .001). The meta-analysis of 23 studies (1844 participants) also showed elevated medial frontal choline and myo-inositol in antipsychotic nonresponse compared with response. These findings provide evidence of an association between antipsychotic nonresponse in psychosis with elevations in medial frontal glutamate, choline, and myo-inositol. The presence of elevations in these markers supports the continued investigation of glutamate-acting and inflammatory pathway-associated interventions for psychosis and schizophrenia.
Intracerebral hemorrhage (ICH) is a severe stroke subtype with high global mortality and morbidity. This study quantifies the global burden and time trend of ICH from 1990 to 2021, and constructs a predictive model for 2036. We focus on health disparities to inform targeted prevention and intervention. Utilizing Global Burden of Disease data, this study evaluated ICH incidence, prevalence, mortality, and disability-adjusted life years from 1990 to 2021. The study examined global, regional, and national levels. The estimated annual percentage change quantified trends. Frontier analysis examined variations by development. A Bayesian age-period-cohort model projected future burden. These methods provide a more comprehensive and actionable assessment than previous studies. The global burden of ICH increased substantially in absolute numbers from 1990 to 2021, with incident cases and deaths rising by 46.05% and 41.29%, respectively. In 2021, ICH caused 3,308,367 deaths [95% uncertainty interval (UI): 3,021,075-3,594,725]. However, age-standardized rates showed a consistent decline over time, with the age-standardized incidence rate was 40.83 (95% UI: 36.20-45.21) and the mortality rate was 39.09 (95% UI: 35.65-42.25) per 100,000, respectively. The burden of ICH was strongly associated with socio-demographic development. Lower Socio-demographic Index (SDI) regions bearing disproportionately higher mortality and DALY burdens. In contrast, higher SDI regions generally exhibited declining trends in age-standardized rates. ICH remains a critical global public health challenge. Although the overall age-standardized burden has decreased, pronounced disparities persist, especially in less developed regions. Focused public health action, equitable resource distribution, and stronger health systems are critical to closing these gaps.
Stroke remains a leading cause of death and disability across the Americas, disproportionately affecting low- and middle-income countries. According to the 2023 Global Burden of Disease (GBD) Study, the Americas recorded approximately 1.2 million incident strokes and 15.7 million prevalent cases. This narrative review synthesizes epidemiological evidence on stroke trends in the Americas, with emphasis on disparities in healthcare access. We integrated estimates from the GBD, peer-reviewed studies and national surveillance systems. Although age-standardized stroke rates declined after 1990, recent analyses demonstrate a concerning resurgence, particularly among younger adults. Stroke incidence, prevalence, and disability burden vary widely across countries. Latin America and the Caribbean show higher incidence but lower prevalence than high-income settings, reflecting limited access to acute care and higher case fatality. Socioeconomic and racial inequities drive delayed treatment and poorer functional outcomes. Over 75% of stroke burden is attributable to modifiable risk factors. Urgent system-level action is needed. O acidente vascular cerebral (AVC) permanece como uma das principais causas de morte e incapacidade nas Américas, afetando de forma desproporcional os países de baixa e média renda. De acordo com o estudo Global Burden of Disease (GBD) 2023, as Américas registraram aproximadamente 1.2 milhão de casos incidentes de AVC e 15.7 milhões de casos prevalentes. Esta revisão narrativa sintetiza evidências epidemiológicas sobre as tendências do AVC nas Américas, com ênfase nas desigualdades no acesso à assistência em saúde. Foram integradas estimativas do GBD, estudos revisados por pares e sistemas nacionais de vigilância. Embora as taxas de AVC padronizadas por idade tenham diminuído após 1990, análises recentes demonstram uma preocupante retomada do aumento, particularmente entre adultos mais jovens. A incidência, prevalência e carga de incapacidade por AVC variam amplamente entre os países. A América Latina e o Caribe apresentam maior incidência, porém menor prevalência em comparação com países de alta renda, refletindo acesso limitado ao cuidado agudo e maior letalidade. Desigualdades socioeconômicas e raciais contribuem para atrasos no tratamento e piores desfechos funcionais. Mais de 75% da carga de AVC é atribuível a fatores de risco modificáveis, ressaltando a necessidade urgente de ações em nível de sistema de saúde. El accidente cerebrovascular (ictus) sigue siendo una de las principales causas de mortalidad y discapacidad en las Américas, afectando de manera desproporcionada a los países de ingresos bajos y medianos. Según el estudio Global Burden of Disease (GBD) 2023, las Américas registraron aproximadamente 1.2 millones de casos incidentes de ictus y 15.7 millones de casos prevalentes. Esta revisión narrativa sintetiza la evidencia epidemiológica sobre las tendencias del ictus en las Américas, con énfasis en las desigualdades en el acceso a la atención sanitaria. Se integraron estimaciones del GBD, estudios revisados por pares y sistemas nacionales de vigilancia. Aunque las tasas de ictus ajustadas por edad disminuyeron después de 1990, análisis recientes muestran una preocupante reaparición del aumento, particularmente entre adultos más jóvenes. La incidencia, la prevalencia y la carga de discapacidad por ictus varían ampliamente entre los países. América Latina y el Caribe presentan una mayor incidencia, pero una menor prevalencia en comparación con los países de altos ingresos, lo que refleja un acceso limitado a la atención aguda y una mayor letalidad. Las desigualdades socioeconómicas y raciales contribuyen a retrasos en el tratamiento y a peores resultados funcionales. Más del 75% de la carga del ictus es atribuible a factores de riesgo modificables, lo que subraya la necesidad urgente de acciones a nivel de los sistemas de salud.
Recurrent malignant gliomas, particularly glioblastoma, remain among the most challenging entities in neuro-oncology, with nearly universal relapse and limited survival despite aggressive multimodal upfront treatment. Management at recurrence is heterogeneous and lacks a universally accepted standard of care, reflecting modest efficacy of available therapies and marked biological divergence between primary and recurrent tumors. This review provides a comprehensive and critical synthesis of current evidence supporting active salvage strategies, including repeat surgery, reirradiation, systemic therapies, and tumor-treating fields, highlighting indications, outcomes, and limitations. Special emphasis is placed on patient selection, extent of resection, modern radiotherapy techniques, and the role of molecularly refined approaches, which benefit only small, well-defined subgroups. Given the limited survival gains achievable with oncologic treatments, the review further addresses the central role of early integrated palliative care in recurrent malignant glioma, encompassing symptom control, home-based support, advance care planning, and end-of-life decision-making. Particular attention is paid to palliative (terminal) sedation and the ethical-legal framework surrounding euthanasia and medical aid in dying, with specific reference to the Spanish context. Overall, this article aims to contextualize therapeutic decision-making within an integrated, patient-centered model that balances potential oncologic benefit with quality of life, functional preservation, and respect for patient values.
Posterior fossa surgery requires precise anatomic orientation within a restricted operative corridor. The trochlear nerve [cranial nerve (CN) IV], although small and often overlooked, has distinctive cisternal relationships that may serve as a reproducible landmark. This study characterizes CN IV anatomy and highlights its role in guiding safe microsurgical approaches. Five alcohol-fixed, silicone-injected adult cadaveric heads were dissected under ×10 to ×40 magnification after suboccipital craniotomy. The cisternal course of CN IV was traced from its dorsal brainstem exit to the tentorial edge, with attention to quadrigeminal, cerebellomesencephalic, and ambient portions. Four clinical cases of posterior fossa lesions treated via supracerebellar infratentorial approaches were reviewed to correlate anatomic findings with operative utility. CN IV consistently emerged dorsally below the inferior colliculus, marking the midbrain-pons transition and aqueduct-fourth ventricle boundary. Its cisternal trajectory divided adjacent sulci and venous channels into 4 quadrants, providing reproducible orientation within the cerebellomesencephalic fissure. In the ambient cistern, CN IV coursed between the posterior cerebral and superior cerebellar arteries. In all clinical cases, intraoperative identification of CN IV facilitated orientation and complete lesion resection without new neurological deficits. The trochlear nerve is a reliable intraoperative landmark in posterior fossa surgery. Recognition of its cisternal relationships enhances orientation, improves dissection accuracy, and reduces risk in approaches to deep-seated posterior fossa lesions.
ICH is a severe form of stroke with increasing global burden. Although more common in older adults, ICH in younger individuals (≤50 years) is a clinically distinct but understudied subgroup. This secondary analysis of the INTERACT3 trial compared baseline characteristics, management and outcomes between younger and older ICH patients. INTERACT3 was a stepped-wedge, cluster-randomised trial conducted in 122 hospitals across 10 countries (2017-2021), evaluating a bundled care intervention for acute ICH. This sub-study analysed 7031 patients and compared demographics, imaging features, in-hospital treatment and 6-month outcomes between age groups. Primary outcomes were functional status (mRS), mortality and quality of life (EQ-5D-3L). Outcomes were analysed using generalised linear-mixed models accounting for clustering by hospital (random effect) and fixed effects for time period and cluster treatment assignment, with additional adjustment for pre-specified patient-level covariates. Of 7031 patients, 1351 (19.2%) were aged ≤ 50 years. Younger patients were more often male (70.8% vs 62.4%, P < .0001), had higher body mass index (BMI) (25.3 vs 23.8 kg/m2, P < .0001) and were more likely to smoke (36.1% vs 21.4%) and consume alcohol (33.2% vs 13.3%). Despite having slightly larger haematoma volumes (18.0 vs 15.0 mL, P < .0001), younger patients had significantly better outcomes, with lower 6-month mortality (9.1% vs 16.6%; adjusted OR 0.42; 95% CI, 0.33-0.54) and reduced rates of death or disability (46.5% vs 57.8%; OR 0.56; 95% CI, 0.48-0.65). A significant age-by-treatment interaction was observed (P = .0251). Younger ICH patients demonstrated a distinct risk profile and better recovery, and benefiting more from bundled care interventions. These findings highlight the importance of early, intensive management and tailored prevention strategies targeting modifiable lifestyle risks in younger populations.
Pituitary adenomas are the third most common intracranial tumor. Due to their growth, they may cause endocrine disturbances, compression, and visual deficits, particularly visual field defects. The Visual Field Index (VFI) is an objective parameter that accurately quantifies visual improvement or deterioration. Transsphenoidal resection is the first-line treatment; therefore, pre- and postoperative visual assessment is essential for follow-up and prognosis. To correlate pre- and postoperative VFI in patients with pituitary adenomas who underwent microscopic transsphenoidal surgery at the Centro Médico Nacional de Occidente. A retrospective study of patients operated on between January 2020 and January 2024 was conducted, including those with pre- and postoperative automated perimetry. Both sexes and all ages were included, provided they had complete medical records, magnetic resonance imaging, and visual field testing. VFI values were compared using descriptive and correlational analyses. Thirty-two patients were analyzed (mean age 54 years); 29 had comorbidities, with hypothyroidism being the most common (56%). The most frequent visual deficit was bitemporal hemianopia (60%). In the right eye, the mean VFI increased from 50.1% to 56.1% (p = 0.002); the median increased from 55% to 68.5% (p = 0.001). In the left eye, the mean changed from 54.6% to 56.7% (p = 0.472); the median from 55.5% to 64.5% (p = 0.537). A greater proportion of improvement was observed in the right eye. In diabetic patients, a reduction in left-eye VFI was noted. Postoperative VFI showed an overall increase following microscopic transsphenoidal resection, supporting its usefulness as a practical and objective parameter for evaluating visual function. los adenomas hipofisarios son el tercer tumor intracraneal más frecuente. Por su crecimiento pueden causar alteraciones endocrinas, compresión y déficit visual, especialmente campimétrico. El índice de campo visual (VFI) es un parámetro objetivo que cuantifica con precisión la mejoría o deterioro visual. La resección transesfenoidal es el tratamiento de primera línea, por lo que la evaluación visual pre y posoperatoria es clave para el seguimiento y pronóstico. asociar el VFI pre y posoperatorio en pacientes con adenomas hipofisarios intervenidos mediante abordaje transesfenoidal microscópico en el Centro Médico Nacional de Occidente. estudio retrospectivo de pacientes operados entre enero de 2020 y enero de 2024, con campimetría digital pre y posquirúrgica. Se incluyeron ambos sexos y todas las edades con expediente completo, resonancia magnética y campimetría. Se compararon valores de VFI mediante análisis descriptivo y correlacional. se analizaron 32 pacientes (edad promedio 54 años); 29 presentaban comorbilidades, predominando hipotiroidismo (56%). El déficit visual más frecuente fue hemianopsia bitemporal (60%). En el ojo derecho, el VFI promedio aumentó de 50.1% a 56.1% (p = 0.002); mediana de 55% a 68.5% (p = 0.001). En el izquierdo, el promedio pasó de 54.6% a 56.7% (p = 0.472); mediana de 55.5% a 64.5% (p = 0.537). Se observó mayor proporción de mejoría en el ojo derecho. En pacientes diabéticos hubo reducción del VFI izquierdo. el VFI posoperatorio mostró incremento global tras resección transesfenoidal microscópica, siendo un parámetro útil y práctico para evaluar la función visual.
Chronic kidney disease (CKD) is a prevalent systemic disorder associated with cognitive impairment affecting memory, executive function, and attention, reflecting a disruption of the kidney-brain axis. This narrative review synthesizes current evidence regarding the pathophysiological mechanisms underlying CKD-associated cognitive decline and evaluates the therapeutic potential of resveratrol as a neuroprotective strategy. Cognitive impairment in CKD arises from uremic toxin accumulation, chronic inflammation, oxidative stress, and cerebrovascular dysfunction, leading to disruption of the blood-brain barrier and impaired synaptic plasticity. Additional contributors include glymphatic dysfunction, mitochondrial impairment, and Klotho deficiency. Preclinical evidence indicates that resveratrol mitigates oxidative stress and neuroinflammation, enhances mitochondrial function via SIRT1/PGC-1α signaling, improves endothelial function, and restores Klotho expression. However, clinical evidence remains limited and sometimes inconsistent. Resveratrol represents a biologically plausible therapeutic approach for CKD-related cognitive impairment, although further well-designed clinical studies are required to establish its efficacy and translational potential.