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•This study offers the first evidence of compensatory neuroplastic remodeling in the contralateral prefrontal cortex of children with drug-resistant epilepsy before hemispherotomy.•Cortical thickness of the anterior cingulate gyrus emerges as the strongest predictor of motor recovery after surgery.•An abnormal increase in gray-matter volume within the temporal pole and adjacent temporal regions forecasts poorer functional outcomes.•Integrating VBM and SBM provides a comprehensive map of gray-matter alterations across the pre- and postoperative phases. Hemispherotomy (HS) is an effective treatment option to control seizures for children with pharmacoresistant epilepsy. We aimed to explore the alteration of the gray matter structure before and after surgery and identify the specific brain regions associated with preoperative neuropsychological development and postoperative motor development. We conducted a retrospective study of magnetic resonance imaging (MRI) results, clinical parameters and follow-up data in 46 children who underwent hemispherotomy (HS) at our hospital between 2018 and 2022, and 32 controls were included. Voxel-based morphometry (VBM) and surface-based morphometry (SBM) techniques were employed to quantify the alteration of the gray matter structure. We used Spearman rank correlation and logistic regression models to analyze the influence of different factors on neuropsychological development and motor outcome. 46 children with pharmacoresistant epilepsy undergoing hemispherotomy and 32 control subjects were recruited for this study. The patients were divided into two groups according to their surgical side: 29 patients with the left hemispherotomy (13 females, 17 months [IQR, 26 months]) and 17 patients with the right hemispherotomy (11 females, 19 months [IQR, 27.5 months]). Finally, 36 patients completed 13.80±1.54 months (LHS)/ 11.53±1.73 months (RHS) of follow-up, and 89.0 % remained completely seizure-free (outcome scale class IA). The prefrontal cortex showed a positive correlation with neuropsychological development before surgery. Cortical thickness (CT) of the anterior cingulate gyrus was an independent protective factor [OR=18.19, 95 % CI (1.56–212.43), P = 0.021] for motor function prognosis after surgery, while gray matter volume (GMV) of the temporal pole of the middle temporal gyrus was an independent risk factor [OR=0.07, 95 % CI (0.01–0.85), P = 0.037] after surgery. Preoperative remodeling of prefrontal cortical gray matter structures in the contralateral hemisphere was performed for functional compensation. After surgery, the prefrontal and cingulate cortices resumed the normal developmental trajectories, with the cingulate cortex determining postoperative motor outcome. However, there is irreversible gray matter damage to the temporal lobe, leading to corresponding functional developmental deficits.

ObjectivesFocal cortical dysplasia (FCD) represents one of the most common causes of refractory epilepsy in children. Deep learning demonstrates great power in tissue discrimination by analyzing MRI data. A prediction model was built and verified using 3D full-resolution nnU-Net for automatic lesion detection and segmentation of children with FCD II.MethodsHigh-resolution brain MRI structure data from 65 patients, confirmed with FCD II by pathology, were retrospectively studied. Experienced neuroradiologists segmented and labeled the lesions as the ground truth. Also, we used 3D full-resolution nnU-Net to segment lesions automatically, generating detection maps. The algorithm was trained using fivefold cross-validation, with data partitioned into training (N = 200) and testing (N = 15). To evaluate performance, detection maps were compared to expert manual labels. The Dice-Sørensen coefficient (DSC) and sensitivity were used to assess the algorithm performance.ResultsThe 3D nnU-Net showed a good performance for FCD lesion detection at the voxel level, with a sensitivity of 0.73. The best segmentation model achieved a mean DSC score of 0.57 on the testing dataset.ConclusionThis pilot study confirmed that 3D full-resolution nnU-Net can automatically segment FCD lesions with reliable outcomes. This provides a novel approach to FCD lesion detection.Critical relevance statementOur fully automatic models could process the 3D T1-MPRAGE data and segment FCD II lesions with reliable outcomes.Key points• Simplified image processing promotes the DL model implemented in clinical practice.• The histopathological confirmed lesion masks enhance the clinical credibility of the AI model.• The voxel-level evaluation metrics benefit lesion detection and clinical decisions.

ObjectivesAccurate segmentation of focal cortical dysplasia (FCD) lesions from MR images plays an important role in surgical planning and decision but is still challenging for radiologists and clinicians. In this study, we introduce a novel transformer-based model, designed for the end-to-end segmentation of FCD lesions from multi-channel MR images.MethodsThe core innovation of our proposed model is the integration of a convolutional neural network-based encoder-decoder structure with a multiscale transformer to augment the feature representation of lesions in the global field of view. Transformer pathways, composed of memory- and computation-efficient dual-self-attention modules, leverage feature maps from varying depths of the encoder to discern long-range interdependencies among feature positions and channels, thereby emphasizing areas and channels relevant to lesions. The proposed model was trained and evaluated on a public-open dataset including MR images of 85 patients using both subject-level and voxel-level metrics.ResultsExperimental results indicate that our model offers superior performance both quantitatively and qualitatively. It successfully identified lesions in 82.4% of patients, with a low false-positive lesion cluster rate of 0.176 ± 0.381 per patient. Furthermore, the model achieved an average Dice coefficient of 0.410 ± 0.288, outperforming five established methods.ConclusionIntegration of the transformer could enhance the feature presentation and segmentation performance of FCD lesions. The proposed model has the potential to serve as a valuable assistive tool for physicians, enabling rapid and accurate identification of FCD lesions. The source code and pre-trained model weights are available at https://github.com/zhangxd0530/MS-DSA-NET.Critical relevance statementThis multiscale transformer-based model performs segmentation of focal cortical dysplasia lesions, aiming to help radiologists and clinicians make accurate and efficient preoperative evaluations of focal cortical dysplasia patients from MR images.Key PointsThe first transformer-based model was built to explore focal cortical dysplasia lesion segmentation.Integration of global and local features enhances the segmentation performance of lesions.A valuable benchmark for model development and comparative analyses was provided.

Approximately 75% of epilepsy cases emerge in childhood, and 10%–30% of these pediatric epilepsy cases are resistant to standard drug therapies; however, the underlying causes of resistance remain poorly understood. Focal cortical dysplasia (FCD) is a primary contributor to pediatric epilepsy and is often associated with drug resistance. We performed single-nucleus RNA sequencing (snRNA-seq) and patch-clamp recording of fresh brain tissue samples that were obtained from pediatric FCD patients during surgery. Our study revealed significant transcriptomic changes across multiple subtypes of excitatory neurons and GABAergic neurons. Among the identified neuronal subtypes, the three inhibitory neuronal subtypes PVALB_RGS5, VIP_CRH, and SST_PENK presented prominent transcriptomic alterations related to epilepsy. The expression of genes enriched in epilepsy-related signaling pathways, especially those associated with excitatory/inhibitory (E/I) balance and energy metabolism, was significantly altered in these neuronal subtypes. Differentially expressed genes (DEGs) in the PVALB_RGS5 subtype were particularly enriched in pathways related to synaptic function. Recordings from fast-spiking (FS)/parvalbumin-containing neurons in brain sections from patients with FCD revealed a reduction in excitatory synaptic inputs, which indicates fewer synaptic inputs onto these neurons and lower activity. In addition, astrocyte subtype 4 exhibited distinct metabolic characteristics and interaction patterns with neuronal subtypes, which suggests their significant role in epilepsy pathophysiology. Our findings indicate that several specific neuronal and astrocyte subtypes play critical roles in the genesis and/or progression of drug-resistant pediatric seizures and that targeting these subtypes may represent a new treatment option.

Background In this study, we aimed to assess the efficacy of surgical treatment in children with drug-refractory infantile epileptic spasms syndrome (IESS) and examine the factors influencing the post-surgical outcomes. Methods The clinical data of 30 children (18 males and 12 females) with epileptic spasms (ES) who underwent surgery at the Epilepsy Center of Shenzhen Children’s Hospital between June 2018 and June 2020 were retrospectively analyzed. Post-surgical outcomes were evaluated using the Engel Epilepsy Surgery Outcome Scale. Scalp electroencephalography and developmental quotient were assessed preoperatively and postoperatively. Univariate analysis and exact logistic regression analyses were used to identify the factors affecting the postoperative efficacy. Results Of the 30 patients who underwent surgical resection, 22 (73.3%) achieved Engel’s class I–II outcomes. Additionally, motor and cognitive functions improved in 14 patients (46.7%). The development of 12 (40%) patients remained at the preoperative development level. The median number of antiseizure medications taken preoperatively was 5.27 (range 2–10), which decreased to 1.90 (range 0–4) at the last follow-up. Seizure duration, etiology, positive positron emission tomography-magnetic resonance imaging (PET-MRI), surgery type, and lesion location were significantly correlated with the postoperative efficacy ( P  < 0.05). Positive PET/MRI findings and lesion location predicted independently the postoperative outcomes. Permanent impairments of motor or language function were rare, with only two cases reporting hydrocephalus and one reporting hemiplegia. Conclusions Surgery is an effective treatment option for children with IESS. Early referral and comprehensive preoperative evaluation are essential for identification of surgically treatable structural lesions. The primary surgically treatable cause is cortical malformation, followed by perinatal brain injury. Hemispheric disconnection is a preferred surgical approach. Positive PET/MRI findings and lesion location predicted the postoperative outcomes.

Hot deformation characteristics of Hastelloy X Ni-base superalloy were investigated at elevated temperatures. Hot compressive tests were carried out in the temperature and strain rate ranges from 900 to 1150 °C and 0.001 to 1 s–1, respectively. The constitutive equation relating flow stress, temperature, and strain rate was obtained based on the peak stresses. The flow behavior showed that the softening mechanisms were related to the dynamic recovery (DRV) and dynamic recrystallization (DRX). The flow stress of Hastelloy X was fitted well by the constitutive equation of the hyperbolic sine function. The constitutive analysis suggested that the hot deformation mechanism of the Hastelloy X was dislocation creep.

The flow behavior and associated microstructural changes of wrought 6069 Al alloy deformed in tension were analyzed in this work. Tensile tests were conducted on an extruded tube with a thickness of 1.6 mm in the temperature range of 300–500 oC, with initial strain rates from 0.001 to 0.1 s-1. The true stress–true strain curves exhibited a peak stress at a critical strain. The overall level of the flow curve increased when the strain rate was increased and/or the temperature was decreased. The flow curves exhibited a typical flow behavior with dynamic softening and showed that the softening degree after reaching the peak stress was dependent on the deformation conditions. This could be related to the softening mechanism. The main softening mechanism of the alloy was dynamic recovery (DRV) at low temperatures; dynamic recrystallization (DRX) occurred as deformed at high temperatures.

About 75% cases of epilepsy begin during childhood, and 10 - 30% of pediatric epilepsy patients are resistant to drug treatment. The predominant seizure type in children is focal cortical dysplasia (FCD) which is highly associated with drug-resistant epilepsy, but its underlying cause is poorly understood. We performed single-cell RNA sequencing and patch-clamp recording on fresh brain tissues obtained from pediatric FCD patients shortly after surgery to reveal critical factors contributing to FCD. We report that known epilepsy genes or significant transcriptomic alterations occur in only a few neuronal subgroups, suggesting that epilepsy-associated neurons cluster into only a few neuronal subtypes. These epilepsy-subtypes displayed significant epilepsy-related transcriptomic alterations, especially in the genes associated with excitation/inhibition balance and neuron functional signal pathways. Among eight epilepsy-subtypes, L2_4_CUX2_YWHAH and PVALB_RGS5 subtypes showed the most prominent alterations in FCD patient tissues. Supporting PV-neurons being important, recording from fast-spiking/parvalbumin-containing neurons in acute FCD patient brain slices revealed reduced excitatory synaptic inputs, implicating lower activity in these neurons and fewer synaptic inputs onto them. A higher percentage of mitochondria genes, and likely higher activity in the pathways associated with oxidative phosphorylation and ATP biosynthetic process, was observed in the epilepsy-subtypes, suggesting a high energy expenditure in them. Interestingly, the activity of the above two pathways in most epilepsy-subtypes was lower in the FCD patients, suggesting these subtypes may be more vulnerable to energy deficit in epilepsy. Altogether, transcriptomics is significantly altered in only a few neuronal subtypes in pediatric FCD patient brains. These selective epilepsy-subtypes may play prominent roles in the genesis of pediatric drug-resistant seizure and targeting them may provide new treatment options.

This study was designed to verify the stem cell properties of sheep amniotic epithelial cells and their capacity for neural differentiation. Immunofluorescence microscopy and reverse transcription-PCR revealed that the sheep amniotic epithelial cells were positive for the embryonic stem cell marker proteins SSEA-1, SSEA-3, SSEA-4, TRA-1-60 and TRA-1-81, and the totipotency-associated genes Oct-4, Sox-2 and Rex-1, but negative for Nanog. Amniotic epithelial cells expressed β-Ⅲ-tubulin, glial fibrillary acidic protein, nestin and microtubule-associated protein-2 at 28 days after induction with serum-free neurobasal-A medium containing B-27. Thus, sheep amniotic epithelial cells could differentiate into neurons expressing β-Ⅲ-tubulin and microtubule-associated protein-2, and glial-like cells expressing glial fibrillary acidic protein, under specific conditions.

Inverted planar perovskite solar cells offer opportunities for a simplified device structure compared with conventional mesoporous titanium oxide interlayers. However, their lower open-circuit voltages result in lower power conversion efficiencies. Using mixed-cation lead mixed-halide perovskite and a solution-processed secondary growth method, Luo et al. created a surface region in the perovskite film that inhibited nonradiative charge-carrier recombination. This kind of solar cell had comparable performance to that of conventional cells. Science , this issue p. 1442 High open-circuit voltages were achieved for planar perovskite solar cells by creating a graded junction. The highest power conversion efficiencies (PCEs) reported for perovskite solar cells (PSCs) with inverted planar structures are still inferior to those of PSCs with regular structures, mainly because of lower open-circuit voltages ( V oc ). Here we report a strategy to reduce nonradiative recombination for the inverted devices, based on a simple solution-processed secondary growth technique. This approach produces a wider bandgap top layer and a more n-type perovskite film, which mitigates nonradiative recombination, leading to an increase in V oc by up to 100 millivolts. We achieved a high V oc of 1.21 volts without sacrificing photocurrent, corresponding to a voltage deficit of 0.41 volts at a bandgap of 1.62 electron volts. This improvement led to a stabilized power output approaching 21% at the maximum power point.