查看更多>>摘要：Objective: Endoscopic port surgery is a promising alternative for the surgical treatment of intracerebral hypertensive basal ganglia hemorrhage (HBGH). The precise location of hematoma is a crucial step for surgery. The authors developed a simple, low-cost navigation method using an Android smartphone for the localization of HBGH. Methods: All patients' CT DICOM data were processed with an open-source software (3D Slicer). The volume of hematoma, angle, and length of trajectory were calculated automatically. A smartphone running the Android system and the Compass APP was used to help insert the inner introducer. An endoscopic port system was applied to create a working channel for neuro-endoscopic hematoma evacuation. Results: There were 27 patients enrolled in this study (mean age 56). All patients underwent successful surgical evacuation of HBGH with neuroendoscopic evacuation. The mean time taken for the surgical plan was 4 min. The total operation time from skin incision to final suture was 82.6 min. Compared with standard neuronavigation, mean error of trajectory was 5.1 mm. The mean preoperative hematoma volume was 44.8 ml. The optimal trajectory angle averaged 39.5and the length was 71 mm. Intraoperative blood loss was about 45 ml. Postoperative hematoma volume was 2.9 ml, and the average evacuation rate was 93.6%. One week after surgery, the mean GCS score was improved from 8.2 to 13.8 (p < 0.01). Conclusions: This simple, low-cost navigation method using 3D Slicer, an Android smartphone with the Compass APP, helps precisely insert the endoscopic working channel to the desired point, which is crucial for satisfactory evacuation of HBGH.
查看更多>>摘要：A systematic review and meta-analysis of the prognostic value of neurofilament light chain levels in multiple sclerosis treatment with natalizumab Relevant studies published before January 2022 were retrieved from the PubMed, Web of Science, and clinicaltrials.gov databases. Qualitative analysis and meta-analysis were included in 7 of the 46 papers. Differences in the Neurofilament light chain levels were used as the main efficacy measures, and the meta-analysis was performed using Review Manager version 5.3 software. Seven clinical trials were selected. Neurofilament light chain levels were lower in the 947 patients on natalizumab treatment than the 959 patients before therapy, with a moderate effect size of 0.73 (p < 0.00001). Mean Neurofilament light chain levels showed no significant difference between the remitting and relapsing phase of MS before and after natalizumab treatment. The EDSS scores of 41 MS patients in the relapsing phase after natalizumab treatment were signifi-cantly lower than those in 102 MS patients without therapy (MD =-0.45;95% CI =-0.85 to-0.05;P < 0.001). However, the EDSS scores in the remitting phase demonstrated no difference. The comparison of Neurofilament light chain across multiple groups demonstrates the potential of Nfl as a noninvasive biomarker of neuro-degeneration, evaluating the efficacy of natalizumab in MS patients. We also investigated the relationship be-tween different phases of relapsing-remitting MS with Neurofilament light chain levels. However, the value of Neurofilament light chain as a biomarker was hard to assess due to the limited number of studies. For clinical application, a comprehensive understanding of Neurofilament light chain concentrations in disease subtypes is required, and disease stages should be defined to develop standardized criteria.
查看更多>>摘要：Aim: This study was conducted to evaluate clinical outcomes after fibrinogen administration in hypofibrinogenemia following severe traumatic brain injury. Background: Post traumatic coagulopathy (PTC) is a common but devastating medical condition in patients with severe head injury. Hypofibrinogenemia is considered as an indicator for poor clinical outcomes in traumatic brain injury (TBI). Methods: In this randomized clinical trial (RCT), primarily 137 patients with severe traumatic brain injury (Glasgow coma scale score: GCS < 9) were enrolled. Thereafter, their plasma fibrinogen level was measured. The patients with primary hypofibrinogenemia (< 200 mg/dL) with no concurrent coagulopathy were randomly allocated into fibrinogen-receiving (n = 50) and control (n = 54) groups. P-value < 0.05 was considered as statistically significant. Results: Seventy-one patients were analyzed in the final step of the study. The mean value for age in fibrinogen and control groups was 25.64 +/- 10.71 and 28.91 +/- 12.25 years old, respectively. Male - female patients in both groups were equally distributed. In the fibrinogen receiving group, GCS scores were significantly higher after 24, 48, and 72 h compared to the control group (p = 0.000). Hematoma expansion was better controlled in the fibrinogen receiving group (p = 0.000). Notably, the number needed to treat (NNT) for fibrinogen infusion and hematoma expansion control was 2.3. Glasgow outcome scale-extended (GOSE) was significantly better in the fibrinogen group (p = 0.25). Multiple regression tests showed intracerebral hematoma (ICH) and severe brain edema had the most detrimental effect on GOSE outcomes. The need for cranial surgery, hospital stay duration, mechanical ventilator dependency, in hospital and 90-day post discharge mortality rates were similar in both study groups. Conclusion: In severe TBI, hypofibrinogenemia correction (> 200 mg/dL) could improve GOSE, GCS score progression within 3 days after primary head injury and hematoma expansion controllability.
查看更多>>摘要：Objective: This study aims to explore the relationship between baseline haemoglobin (Hb) content and poststroke cognitive impairment (PSCI) within 3 months following an acute ischaemic stroke or transient ischaemic attack (TIA).Methods: Data are from a national multicentre prospective study that recruited patients with acute ischaemic stroke/TIA within 7 days. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCA). PSCI was defined as a MoCA score <= 23 within 3 months after stroke onset. The relationship between Hb content and PSCI was assessed by a multiple regression model after adjusting for other potential confounders. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.Results: A total of 2240 patients were included in this study. The average age was 60.96 +/- 10.76 years old, and 784 (35.00%) patients experienced cognitive impairment within 3 months after acute ischaemic stroke/TIA. Patients with anaemia had a significantly lower MoCA score than those without anaemia at the 3-month followup (22.53 +/- 5.56 versus 23.68 +/- 4.77, P = 0.001). In a multiple regression analysis after adjusting for other confounders, patients with high Hb content were associated with a lower risk of PSCI than those with anaemia (OR 0.64, 95% CI 0.43-0.94, P = 0.02). Hb content was negatively related to the risk of PSCI within 3 months after stroke onset (OR 0.93, 95% CI 0.85-0.94 per 10 g/L increment, P = 0.04).Conclusion: Baseline Hb content was an independent protective predictor for PSCI in patients with acute ischaemic stroke/TIA.
uenal, SenaKaraarslan-Turk, F. TugraAkbostanci, M. CenkPeker, Elif...
4页
查看更多>>摘要：It has been suggested that the variations in the trajectory of the maxillary artery (MA) near the lateral pterygoid muscle (LPM) play a critical role in Botulinum neurotoxin (BoNT) injections in patients with jaw-opening/ deviation dystonia (JOD). In the case of a lateral course to the LPM, an extraoral injection entails risks of MA injury, pain, and hematoma. Previous reports suggest geographical differences in variations of the MA-LPM relationship. We aimed to determine these variations in Turkish individuals and highlight the need to establish a consensus on approach to LPM injections. In 284 individuals, contrast-enhanced magnetic resonance angiography (MRA) images were evaluated by two radiologists on both sides for the variations in the course of the MA in the infratemporal fossa. Images of 44 were excluded due to trauma, arteriovenous malformation, mass, surgery, and imaging artifacts. Of the included, 62.1% were female. In 480 evaluations of 240 individuals, the MA passed lateral to the LPM in 65.6% (n = 315). No sex difference was noted. In 51 individuals (21.3%), the MA course differed on the right and left sides (medial-lateral asymmetry). These results confirm that the lateral course of the MA is more frequent. In patients with JOD, the trajectory of the MA should be determined with imaging prior to extraoral BoNT injections. In the case of a lateral course, an intraoral approach seems to be safer to avoid a potential MA injury.
查看更多>>摘要：A potential relationship between poor clinical outcome and mean platelet volume (MPV), platelet distribution width (PDW) have been suggested by previous studies in acute ischemic stroke (AIS), but the conclusions continued to be controversial. Here, we performed meta-analysis of available studies to explore the effect of MPV, PDW on clinical outcomes in AIS. A systematic literature search was performed in PubMed, EMBASE, and Cochrane Library up to 21 Dec 2021. A total of 10 articles related to MPV and 4 articles related to PDW on the clinical outcome of AIS including 2,390 patients were enrolled in the meta-analysis. The overall result showed that MPV was decreased in favorable outcome group when compared with unfavorable outcome group [SMD (95%CI) = -0.52 (-0.80, -0.24)]. Subgroup analysis indicated that such trend was consistent in the retrospective study, prospective study, non-thrombolytic, EDTA anticoagulants, Sysmax hematology analyzers and detection time within 2 h. In the meta-analysis of PDW, the overall result and subgroup analyses of favorable outcome group did not observe the significant difference compared with unfavorable outcome group. In this metaanalysis, we found remarkable between-study heterogeneity, but Begg's test and Egger's test did not detect publication bias. In conclusion, this meta-analysis result suggested that elevated MPV may be a predictive marker of adverse clinical outcome of AIS, especially in non-thrombolytic patients, while PDW has insufficient value in predicting clinical outcome of AIS. Systematic review registration: This meta-analysis is registered on the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42022299316. https://www.crd.york.ac.uk/P ROSPERO/display_record.php?RecordID=299316).
查看更多>>摘要：Poststroke fatigue (PSF) is detrimental to rehabilitation and the pathogenesis is still indefinite. The neutrophil-tolymphocyte ratio (NLR) and prognostic nutritional index (PNI) are immune indicators reflecting the status of inflammation and nutrition and have been widely applied as prognostic biomarkers. We pointed to examine the connections between PSF and NLR, PNI in acute ischemic stroke patients. Between October 2020 and September 2021, 333 participants radiologically confirmed with first-ever ischemic stroke were enrolled from patients consecutively admitted to the Department of Neurology. Fatigue severity was evaluated by Fatigue Severity Scale (FSS) at 6 months after stroke. A total of 130 (39.0%) stroke survivors had PSF at 6 months after stroke. Patients in the PSF group had higher NLR and lower PNI on admission. The correlations between PSF and NLR (r = 0.750), and PNI (r =-0.685) were significant. In multivariate analyses, NLR (odds ratio [OR] = 11.132, 95% confidence internal [CI]:4.640-26.704, P < 0.001), PNI (OR = 0.420, 95%CI:0.292-0.603, P < 0.001), and self rating depression scale score (OR = 1.125, 95%CI:1.028-1.232, P < 0.001) stayed as independent predictors for PSF at 6 months after adjusting potential confounders. With the Receiver Operating Characteristic curve, the areas under the curve were 0.898 (95%CI:0.862-0.934, P < 0.001), and 0.862 (95%CI:0.819-0.904, P < 0.001), respectively; and the optimal cut-off values of NLR and PNI that best identified PSF were 4.05 (sensitivity:70.8%, specificity:96.1%), and 48.4 (sensitivity:71.5%, specificity:90.1%), respectively. In conclusion, NLR and PNI on admission were independently associated with PSF at 6 months in ischemic stroke persons. NLR and PNI can be used to early screen individuals at high risk for PSF.
查看更多>>摘要：Background: Ischemic stroke is a frequently encountered neurologic process with wide-spanning impact. A dreaded complication is "malignant" cerebral edema, necessitating decompression to reduce herniation risk. Following the publication of several landmark trials in 2015, endovascular thrombectomy (EVT) with novel clotremoval devices has emerged as an effective treatment for proximal large vessel disease. Herein, we examine recent national trends in EVT and decompressive craniectomy (DC) rates for acute stroke.Methods: National Inpatient Sample data were abstracted from 2006 to 2016. Primary outcomes were EVT and DC rates, compared using Cochrane-Armitage test of trend. Chi-square test was also used to compare data from 2015 to 2016. Secondary outcomes included inpatient mortality and home discharge rates.Results: EVT rates steadily increased from 2006 to 2016, with most change occurring from 2014 to 2016 (1.36% in 2014, 2.29% in 2016). DC rates similarly increased from 2006 to 2015, though a sharp decline was observed in 2016 (0.42% in 2015, 0.22% in 2016). Test of trend from 2006 to 2016 for both variables was found to be statistically significant (p = 0.001); DC rate change from 2015 to 2016 was also statistically significant (p < 0.01). Mortality rate and home discharge rate steadily improved over the study period.Conclusions: Recent innovation in stroke treatment has led to increased EVTs. While DC rate initially followed this same trend, a significant decline was noted in 2016, around the time that wider adoption of novel EVT technologies were instituted in clinical practice.
查看更多>>摘要：Objective: To investigate the association between lipoprotein-associated phospholipase A2 (Lp-PLA2) concentration and the incidence of acute ischemic stroke (AIS) in patients with atrial fibrillation (AF).Methods: A total of 257 patients admitted to the Kaifeng Central Hospital were enrolled in this study. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression analysis were used to determine the association between Lp-PLA2 and AIS in patients with AF.Results: In AF group, plasma Lp-PLA2 concentrations were significantly higher in patients with AIS than in those without it (277.4 vs 155.1, p < 0.001). And in the group of AIS patients, patients with AF also had a significantly higher level of Lp-PLA2 concentration than those without (277.4 vs 204.2, p < 0.001). The analysis of the ROC curve showed a significant diagnostic value of Lp-PLA2 for the incidence of AIS in patients with AF (AUC = 0.840, 95% CI: 0.737-0.871, p < 0.001), and the optimal cut-off point was 220.5 ng/ml, with a sensitivity and specificity of 82.14% and 75.5%, respectively. All AF patients were divided into two subgroups: the high LpPLA2 group (>= 220.5 ng/ml) and the low Lp-PLA2 group (<220.5 ng/ml). And multivariate logistic regression analysis showed that after adjustment of confounders, Lp-PLA2 (OR 12.48, 95%CI 5.73-27.16, p < 0.001) was independently associated with the incidence of AIS in patients with AF.Conclusions: Plasma Lp-PLA2 concentration was independently associated with the development of AIS in patients with AF. Lp-PLA2 is a potential biomarker for stratification of risk for AIS in patients with AF.
查看更多>>摘要：Evidence for effects of the dose of recombinant tissue plasminogen activator(rt-PA) in Asian populations is inconclusive. The standard dose may cause drug waste and increase economic burden in developing country. Therefore, we preliminarily describe the safety and efficacy of a new modified dose of rt-PA regimen(0.6 or 0.9 mg/kg, with a maximum dose of 50 mg) in real world settings. 265 consecutive patients with ischemic stroke were treated with intravenous(IV) rt-PA alone from all the 323 consecutive patients treated with reperfusion therapy between January 1, 2017 and March 31, 2020. Safety and Efficacy was assessed by early neurological improvement(ENI), early neurological deterioration(END), symptomatic intracranial hemorrhage(sICH) and 90-day outcome defined by modified Rankin scale(mRS). Subgroup analysis was conducted to draw comparisons between different dose groups ([0.5,0.6)mg/kg, [0.6,0.7)mg/kg, [0.7,0.8)mg/kg, [0.8,0.9]mg/kg). Among the 265 patients, 150(56.60%) had a favorable outcome at 3 months(3 M); Mortality occurred in 17(6.40%) in 3 M; sICH in 12(4.50%); ENI in 70(26.40%); END2 in 29(10.90%) and END4 in 18(6.80%). In subgroup analysis, there was a significant difference in sICH that more patients developed sICH in [0.8-0.9]mg/kg group(P = 0.044) in univariate analysis of different dose. After adjusting, there was no significant difference between 4 dosage groups. Significant differences were seen in gender, atrial fibrillation and baseline NIHSS in the multivariable model of favorable outcome at 3 M. Our study preliminarily shows a good safety and efficacy of our modified rt-PA regimen, indicating that this regimen should be worthy of further study especially in developing country to reduce the financial burden of patients and avoid drug waste.
NSTL
Elsevier