Background Visualizing the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 and predicting future disease burdens at global, regional, and national levels can help health policymakers develop evidence-based ischemic stroke (IS) prevention and cure strategies. Methods We stratify epidemiological parameters by sex, age, the World Bank’s classification of economies, and sociodemographic index (SDI) levels. We use frontier analysis to assess whether the burden of ischemic stroke (IS) in each country aligns with its level of economic development. We apply the Autoregressive Integrated Moving Average (ARIMA) model and the Bayesian age-period-cohort (BAPC) model to predict the burden of IS over the next 15 years. Results Here we show that IS accounts for 69.9 million prevalent cases, 7.8 million incident cases, 3.6 million deaths, and 70.4 million DALYs in 2021. In men, the global DALY rate of IS increases up to age 90–94 years and then decreases; however, for women, the rate increases up to the oldest age group (≥95 years). Regionally, we find that the association between the SDI and the age-standardized DALY rate of IS starts relatively flat, with a small peak up to a sociodemographic index of about 0.7, and then declines rapidly. Factors contributing most to the DALY rates for IS are high systolic blood pressure, high LDL cholesterol, and air pollution. Conclusions The disease burden of IS in medium-high SDI countries is still high, which means we could not meet the Sustainable Development Goal targets by 2030. Countries should formulate prevention and control measures suitable for their national conditions based on risk factors.

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

Stereotactic biopsy (STB) is commonly used in the pathological diagnosis of intracranial lesions. The associated complication and mortality rates are low, but few reports with large sample sizes have assessed the complications of STB for lesions in the brain midline. To evaluate the complications of STB of lesions in the sellar region, pineal region, and brainstem. This was a retrospective analysis of patients who underwent STB of lesions in the sellar region, pineal region, and brainstem at the Neurosurgery Department, Sixth Medical Center, PLA General Hospital, China, between January 2015 and December 2017. The rates of and possible reasons for surgical complications (including bleeding) and mortality were analyzed. A total of 145 patients underwent STB of midline brain lesions, including 16 (11.0%) in the sellar region, 18 (12.4%) in the pineal region, and 111 (76.6%) in the brainstem. Successful biopsy of the sellar region, pineal region, and brainstem was achieved in 16/16 (100%), 18/18 (100%), and 107/111 (96.4%) patients, respectively. There were no complications following STB of lesion in the sellar or pineal regions. Complications occurred in 17/111 patients (15.3%) during/after brainstem biopsy, three of whom died (2.7%). The main clinical manifestations were facioplegia, facial pain, changes in blood pressure and heart rate, and difficulty breathing. STB of lesions in the sellar region, pineal region, and brainstem had a high success rate, but mortality was 2.7%. The occurrence of complications (15.3%) was closely related to the anatomical and functional characteristics of the region biopsied.

Rationale: Spinal cord injury (SCI) leads to limited regenerative capacity and severe energy deficiency in the injury microenvironment. This study aimed to develop a biomimetic piezoelectric hydrogel system that could recapitulate the native tissue microenvironment while enabling wireless physical regulation for SCI repair.

Background: ChatGPT (OpenAI) has shown great potential in clinical diagnosis and could become an excellent auxiliary tool in clinical practice. This study investigates and evaluates ChatGPT in diagnostic capabilities by comparing the performance of GPT-3.5 and GPT-4.0 across model iterations. Objective: This study aims to evaluate the precise diagnostic ability of GPT-3.5 and GPT-4.0 for colon cancer and its potential as an auxiliary diagnostic tool for surgeons and compare the diagnostic accuracy rates between GTP-3.5 and GPT-4.0. We precisely assess the accuracy of primary and secondary diagnoses and analyze the causes of misdiagnoses in GPT-3.5 and GPT-4.0 according to 7 categories: patient histories, symptoms, physical signs, laboratory examinations, imaging examinations, pathological examinations, and intraoperative findings. Methods: We retrieved 316 case reports for intestinal cancer from the Chinese Medical Association Publishing House database, of which 286 cases were deemed valid after data cleansing. The cases were translated from Mandarin to English and then input into GPT-3.5 and GPT-4.0 using a simple, direct prompt to elicit primary and secondary diagnoses. We conducted a comparative study to evaluate the diagnostic accuracy of GPT-4.0 and GPT-3.5. Three senior surgeons from the General Surgery Department, specializing in Colorectal Surgery, assessed the diagnostic information at the Chinese PLA (People’s Liberation Army) General Hospital. The accuracy of primary and secondary diagnoses was scored based on predefined criteria. Additionally, we analyzed and compared the causes of misdiagnoses in both models according to 7 categories: patient histories, symptoms, physical signs, laboratory examinations, imaging examinations, pathological examinations, and intraoperative findings. Results: Out of 286 cases, GPT-4.0 and GPT-3.5 both demonstrated high diagnostic accuracy for primary diagnoses, but the accuracy rates of GPT-4.0 were significantly higher than GPT-3.5 (mean 0.972, SD 0.137 vs mean 0.855, SD 0.335; t285=5.753; P<.001). For secondary diagnoses, the accuracy rates of GPT-4.0 were also significantly higher than GPT-3.5 (mean 0.908, SD 0.159 vs mean 0.617, SD 0.349; t285=–7.727; P<.001). GPT-3.5 showed limitations in processing patient history, symptom presentation, laboratory tests, and imaging data. While GPT-4.0 improved upon GPT-3.5, it still has limitations in identifying symptoms and laboratory test data. For both primary and secondary diagnoses, there was no significant difference in accuracy related to age, gender, or system group between GPT-4.0 and GPT-3.5. Conclusions: This study demonstrates that ChatGPT, particularly GPT-4.0, possesses significant diagnostic potential, with GPT-4.0 exhibiting higher accuracy than GPT-3.5. However, GPT-4.0 still has limitations, particularly in recognizing patient symptoms and laboratory data, indicating a need for more research in real-world clinical settings to enhance its diagnostic capabilities.

Zhou C, et al. J Clin Neurol. 2021 Apr;17(2):220-228. https://doi.org/10.3988/jcn.2021.17.2.220