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Enhancing Attention Network Spatiotemporal Dynamics for Motor Rehabilitation in Parkinson's Disease.

Pei G, Hu M, Ouyang J, Jin Z, Wang K, Meng D, Wang Y, Chen K, Wang L, Cao LZ, Funahashi S, Yan T, Fang B

pubmed logopapersJan 1 2025
Optimizing resource allocation for Parkinson's disease (PD) motor rehabilitation necessitates identifying biomarkers of responsiveness and dynamic neuroplasticity signatures underlying efficacy. A cohort study of 52 early-stage PD patients undergoing 2-week multidisciplinary intensive rehabilitation therapy (MIRT) was conducted, which stratified participants into responders and nonresponders. A multimodal analysis of resting-state electroencephalography (EEG) microstates and functional magnetic resonance imaging (fMRI) coactivation patterns was performed to characterize MIRT-induced spatiotemporal network reorganization. Responders demonstrated clinically meaningful improvement in motor symptoms, exceeding the minimal clinically important difference threshold of 3.25 on the Unified PD Rating Scale part III, alongside significant reductions in bradykinesia and a significant enhancement in quality-of-life scores at the 3-month follow-up. Resting-state EEG in responders showed a significant attenuation in microstate C and a significant enhancement in microstate D occurrences, along with significantly increased transitions from microstate A/B to D, which significantly correlated with motor function, especially in bradykinesia gains. Concurrently, fMRI analyses identified a prolonged dwell time of the dorsal attention network coactivation/ventral attention network deactivation pattern, which was significantly inversely associated with microstate C occurrence and significantly linked to motor improvement. The identified brain spatiotemporal neural markers were validated using machine learning models to assess the efficacy of MIRT in motor rehabilitation for PD patients, achieving an average accuracy rate of 86%. These findings suggest that MIRT may facilitate a shift in neural networks from sensory processing to higher-order cognitive control, with the dynamic reallocation of attentional resources. This preliminary study validates the necessity of integrating cognitive-motor strategies for the motor rehabilitation of PD and identifies novel neural markers for assessing treatment efficacy.

Radiomics of Dynamic Contrast-Enhanced MRI for Predicting Radiation-Induced Hepatic Toxicity After Intensity Modulated Radiotherapy for Hepatocellular Carcinoma: A Machine Learning Predictive Model Based on the SHAP Methodology.

Liu F, Chen L, Wu Q, Li L, Li J, Su T, Li J, Liang S, Qing L

pubmed logopapersJan 1 2025
To develop an interpretable machine learning (ML) model using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) radiomic data, dosimetric parameters, and clinical data for predicting radiation-induced hepatic toxicity (RIHT) in patients with hepatocellular carcinoma (HCC) following intensity-modulated radiation therapy (IMRT). A retrospective analysis of 150 HCC patients was performed, with a 7:3 ratio used to divide the data into training and validation cohorts. Radiomic features from the original MRI sequences and Delta-radiomic features were extracted. Seven ML models based on radiomics were developed: logistic regression (LR), random forest (RF), support vector machine (SVM), eXtreme Gradient Boosting (XGBoost), adaptive boosting (AdaBoost), decision tree (DT), and artificial neural network (ANN). The predictive performance of the models was evaluated using receiver operating characteristic (ROC) curve analysis and calibration curves. Shapley additive explanations (SHAP) were employed to interpret the contribution of each variable and its risk threshold. Original radiomic features and Delta-radiomic features were extracted from DCE-MRI images and filtered to generate Radiomics-scores and Delta-Radiomics-scores. These were then combined with independent risk factors (Body Mass Index (BMI), V5, and pre-Child-Pugh score(pre-CP)) identified through univariate and multivariate logistic regression and Spearman correlation analysis to construct the ML models. In the training cohort, the AUC values were 0.8651 for LR, 0.7004 for RF, 0.6349 for SVM, 0.6706 for XGBoost, 0.7341 for AdaBoost, 0.6806 for Decision Tree, and 0.6786 for ANN. The corresponding accuracies were 84.4%, 65.6%, 75.0%, 65.6%, 71.9%, 68.8%, and 71.9%, respectively. The validation cohort further confirmed the superiority of the LR model, which was selected as the optimal model. SHAP analysis revealed that Delta-radiomics made a substantial positive contribution to the model. The interpretable ML model based on radiomics provides a non-invasive tool for predicting RIHT in patients with HCC, demonstrating satisfactory discriminative performance.

Principles for Developing a Large-Scale Point-of-Care Ultrasound Education Program: Insights from a Tertiary University Medical Center in Israel.

Dayan RR, Karni O, Shitrit IB, Gaufberg R, Ilan K, Fuchs L

pubmed logopapersJan 1 2025
Point-of-care ultrasound (POCUS) has transformed bedside diagnostics, yet its operator-dependent nature and lack of structured training remain significant barriers. To address these challenges, Ben Gurion University (BGU) developed a longitudinal six-year POCUS curriculum, emphasizing early integration, competency-based training, and scalable educational strategies to enhance medical education and patient care. To implement a structured and scalable POCUS curriculum that progressively builds technical proficiency, clinical judgment, and diagnostic accuracy, ensuring medical students effectively integrate POCUS into clinical practice. The curriculum incorporates hands-on training, self-directed learning, a structured spiral approach, and peer-led instruction. Early exposure in physics and anatomy courses establishes a foundation, progressing to bedside applications in clinical years. Advanced technologies, including AI-driven feedback and telemedicine, enhance skill retention and address faculty shortages by providing scalable solutions for ongoing assessment and feedback. Since its implementation in 2014, the program has trained hundreds of students, with longitudinal proficiency data from over 700 students. Internal studies have demonstrated that self-directed learning modules match or exceed in-person instruction for ultrasound skill acquisition, AI-driven feedback enhances image acquisition, and early clinical integration of POCUS positively influences patient care. Preliminary findings suggest that telemedicine-based instructor feedback improves cardiac ultrasound proficiency over time, and AI-assisted probe manipulation and self-learning with ultrasound simulators may further optimize training without requiring in-person instruction. A structured longitudinal approach ensures progressive skill acquisition while addressing faculty shortages and training limitations. Cost-effective strategies, such as peer-led instruction, AI feedback, and telemedicine, support skill development and sustainability. Emphasizing clinical integration ensures students learn to use POCUS as a targeted diagnostic adjunct rather than a broad screening tool, reinforcing its role as an essential skill in modern medical education.
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