查看更多>>摘要：Background: Acute carbon monoxide poisoning (ACOP) commonly results in delayed neuropsychiatric sequelae (DNS). Currently, there are no reliable predictors. The aim of this article is to establish a practical model for predicting the development of delayed encephalopathy clinically. Methods: Retrospective analysis of clinical data were performed at a single institution for the past 6 years. 107 patients with ACOP were recruited, of who 67 developed DNS and 40 did not. Clinical characteristics of the patients were analyzed between the two groups. The risk factors associated with DNS development were screened to identify the potential markers for predicting DNS. A predictive model was then built, and the receiver operating characteristic (ROC) curve analysis was used to assess its predictive ability. Results: There were significant differences in 13 clinical features between the two groups. Four potential markers were identified. They were age, source of CO, Glasgow Coma Scale score and the initiation of HBOT. The potential predictive model showed an area under the curve (AUC) of 0.93 in the training set and 0.97 in the testing set. Conclusions: Our model could calculate the probability of DNS after acute CO poisoning. (c) 2021 Elsevier Ltd. All rights reserved.
Pernik, Mark N.Montgomery, Eric Y.Isa, SamyaSundarrajan, Chandrasekhar...
8页
查看更多>>摘要：Background: Non-functioning pituitary adenomas (NFPA) are often discovered incidentally. The natural history of NFPA is not well understood, obfuscating evidence-based management decisions. Meta-data of radiographically followed NFPA may help guide conservative versus operative treatment of these tumors. Methods: We searched PubMed, Medline, Embase, and Ovid for studies with NFPA managed nonopera-tively with radiographic follow-up. Studies on postoperative outcomes after NFPA resection and studies that did not delineate NFPA data from functional pituitary lesions were excluded. NFPA were divided into micro-and macroadenomas based on size at presentation. We performed a meta-analysis of aggregate data for length of follow-up, change in tumor size, rate of apoplexy, and need for resection during follow-up. Results: Our database search yielded 1787 articles, of which 19 were included for final analysis. The stud-ies included 1057 patients with NFPA followed radiographically. Macroadenomas were significantly more likely to undergo growth (34% vs. 12%; p < 0.01) or apoplexy (5% vs. < 1%; p = 0.01) compared to microadenomas. Resection was performed in 11% of all NFPA patients during follow-up regardless of size at presentation. Meta-regression showed that surgery during follow-up was associated with macroade-nomas and negatively associated with microadenomas that decreased in size. Conclusion: Low-quality evidence suggests that NFPA classified as macroadenomas have an increased rate of growth and apoplexy during follow-up compared to microadenomas. A significant minority of all NFPA patients ultimately underwent surgery. In select patients, nonoperative management may be the appropriate strategy for NFPA. Macroadenomas may require closer follow-up. (c) 2021 Elsevier Ltd. All rights reserved.
Hennessy, Maeve A.Coyne, Zachary L.O'Halloran, Philip J.Mullally, William...
9页
查看更多>>摘要：The role of surgical resection in recurrent Glioblastoma Multiforme (GBM) remains unclear. We aimed to investigate survival outcomes and associated prognostic factors in patients undergoing surgical reresection for recurrent IDH-wildtype GBM in a national neuro-oncology center. We evaluated all patients who underwent re-resection for recurrent GBM following adjuvant treatment between 2015 and 2018. 32 patients were eligible for inclusion. 19 (59%) were male, median age at re-resection was 53. Median time from initial surgery to re-resection was 13.5 months. Median overall survival (OS) was 28.6 months from initial surgery and 9.5 months from re-resection. MGMT methylation was significantly associated with improved OS from initial surgery, 40 months versus 19.1 months, (p = 0.004), and from reresection, 9.47 months versus 6.93 months, (p = 0.028). A late re-resection was associated with improved OS compared to an early re-resection, 44.1 months versus 15.7 months, (p = 0.002). There was a trend for improved outcomes in younger patients, median OS from initial surgery 44.1 months for 53 years compared to 21.7 months for patients 53, (p = 0.099). Higher Karnofsky Performance Status (KPS) at reresection was associated with improved median OS, 9.5 months versus 4.1 months for KPS >70 and <70 respectively, (p = 0.013). Furthermore, there was a trend for improved OS with greater extent of re-resection, however this did not reach statistical significance, possibly due to small sample size. Reresection for recurrent GBM was associated with improved OS in those with good performance status and could be considered in carefully selected cases.
查看更多>>摘要：To investigate the effectiveness of dynamic susceptibility contrast-perfusion weighted imaging (DSCPWI) in predicting the progression-free survival (PFS) and chemotherapeutic responsiveness of primary central nervous system lymphoma (PCNSL) before high-dose methotrexate-based chemotherapy. DSCPWI was used to analyze 35 patients who had pathology-confirmed PCNSL. Relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), relative mean transit time (rMTT) and relative time to peak (rTTP) were measured on parameter maps. The 5th, 50th and 95th percentile values of every parameter were recorded for enhanced tumors and compared with the parameters of the normally contralateral hemisphere. The ratio of each PWI parameter (rrCBV, rrCBF, rrMTT, rrTTP) was obtained. The influence of parameters on responsiveness and PFS was investigated by univariate Kaplan-Meier analysis and logistic regression and Cox regression for multivariate analysis with a stepwise method. Differences in PWI parameters between the higher and lower vascular endothelial growth factor (VEGF) groups were assessed by the Mann-Whitney U test. Eighteen patients achieved a complete response (CRi) after four initial cycles of chemotherapy. Patients with lower age (p = 0.011), higher VEGF (p < 0.001), higher Karnofsky Performance Status (KPS) (p < 0.001), higher rrCBV(95%) (p < 0.001), higher rrCBV(50%) (p = 0.016), higher rrCBF(95%) (p < 0.001), higher rrCBF(50%) (p = 0.002) showed better PFS; there was difference on age(p = 0.044), KPS (p < 0.001), VEGF (p < 0.001), rrCBV(95%) (p = 0.018), rrCBF(95%) (p = 0.018), rrCBF(50%) (p = 0.007) between CRi and nonCR(i). Multivariate analysis demonstrated that rrCBF(95%) (p = 0.037, 95% confidence interval: 1.065-7.206) was significantly associated with PFS. rCBV and rCBF may be used to assess the responsiveness and prognosis of PCNSL, and rCBF(95%) may be a better predictor. (C) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
查看更多>>摘要：High-grade gliomas (HGGs) are presently managed via surgical resection, external beam radiation therapy (EBRT), and chemotherapy. Although Gamma Knife radiosurgery (GKRS) is currently used to manage HGGs, it has not been considered standard care. This paper aims to compare the contribution of GKRS to clinical outcomes in patients in which gross total resection (GTR) cannot be achieved. We retrospectively reviewed the data of 99 patients with HGG (World Health Organization (WHO) grade III and IV) from two groups: group 1 consisted of 68 patients for which only EBRT was administered, and group 2 consisted of 31 patients for which EBRT and GKRS were administered. Patient demographic data, the extent of resection, IDH mutation, radiation dosage, progression-free survival (PFS), overall survival (OS), and follow-up time were recorded and compared across groups. The grade III/IV tumor ratio was 10/58 and 10/21 in groups 1 and 2, respectively. In group 2, PFS and OS were higher than in group 1 (P = 0.030 and 0.021). The mean follow-up time was 15.02 +/- 11.8 (3-52) and 18.9 +/- 98.6 (7-43) months in groups 1 and 2, respectively. In addition to the standard management of HGGs in patients without GTR, boost GKRS during the early postoperative period is beneficial for increasing PFS and OS. (c) 2021 Published by Elsevier Ltd.
查看更多>>摘要：Purpose: Marshall and Rotterdam are the most commonly used CT scoring systems to predict the outcome following traumatic brain injury (TBI). Although several studies have compared the performance of the two scoring systems in adult patients, none of these studies has evaluated the performance of the two scoring systems in pediatric patients. This study aimed to determine the predictive value of the Marshall and Rotterdam scoring systems in pediatric patients with TBI. Methods: This retrospective study included 105 children with admission GCS < 12, with a mean age of 6.2 (+/- 3.5) years. Their initial CT and status at hospital discharge (dead or alive) were reviewed, and both the Marshall and Rotterdam scores were calculated. We examined whether each score was related to the early death of pediatric patients. Results: The pediatric patients with higher Marshall and Rotterdam scores had a higher mortality rate. There was a good correlation between the Marshall and Rotterdam scoring systems (Spearman's rho = 0.618, significant at the 0.05 level). Both systems demonstrated a high degree of discrimination when predicting early mortality. The Marshall scoring system had reasonable discrimination (AUC 0.782), and the Rotterdam scoring system had good discrimination (AUC 0.729). Comparing the two CT scoring systems, the Marshall scoring system provided a better positive predictive value (90%) for early mortality than the Rotterdam scoring system (78%). Conclusions: Both the Marshall and Rotterdam scoring systems have good predictability for assessing mortality in pediatric patients with TBI. The performance of the Marshall scoring system was equal to or slightly better than that of the Rotterdam scoring system. (c) 2021 Elsevier Ltd. All rights reserved.
Wang, Michael T. M.Bhatti, M. TariqDanesh-Meyer, Helen, V
8页
查看更多>>摘要：Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure, manifested by papilledema and radiological findings, in the absence of an identifiable casual factor. The primary symptoms include headache, vision loss, and pulsatile tinnitus, and are recognized to have profound impacts on quality of life and visual function. IIH demonstrates a strong predilection towards obese women of reproductive age, and the population incidence is rising with the growing prevalence of obesity worldwide. The pathophysiology involves dysregulation of cerebrospinal fluid (CSF) dynamics and venous sinus pressure, and recent studies highlighting the pathogenic role of metabolic and hormonal factors have led to the identification of several pharmacological targets and development of novel ther-apeutic agents. The overarching treatment goals include symptomatic alleviation and prevention of per-manent vision loss. The Idiopathic Intracranial Hypertension Treatment Trial, the first of its kind randomized controlled trial on IIH, provides class I evidence for treatment with weight loss and acetazo-lamide. In medically refractive or fulminant cases, optic nerve sheath fenestration, CSF diversion, and venous sinus stenting, have been successfully implemented. However, there are few high-quality prospective studies investigating the treatment and natural history of IIH, highlighting the compelling need for further research to determine the optimal treatment regimen. (c) 2021 Elsevier Ltd. All rights reserved.
查看更多>>摘要：Objective: This study aims to observe the effects of direct suppression of the parabrachial nucleus (PBN) on chronic neuropathic pain (CNP) and CNP-related behaviors in mice. Methods: A CNP model was established using partial sciatic nerve ligation (PSNL) in mice. Two groups were established: the experimental (PSNL) group and the control (sham) group. An assessment of PBN-region c-Fos expression was conducted following von Frey hair stimulation in the PSNL group and the sham group, and the effects of pain induction were detected using behavioral experiments. The PBN activity of the mice with CNP was manipulated using the designer receptors exclusively activated by designer drugs method. Effective and empty virus groups were used to study the effects of PBN activity inhibition on the pain threshold and pain-related behavior in mice with CNP. Results: The mechanical pain threshold (MPT) of the mice in the PSNL group was significantly lower than in the sham group. After von Frey stimulation, the c-Fos-positive, PBN-region neurons in the PSNL group were increased compared with the sham group. The central distance in the open field test and the time spent in the central area were lower in the PSNL group than in the sham group. The mice in the PSNL group had a lower duration and fewer entries in the open arm of the elevated plus-maze than the mice in the sham group. There was no difference in immobility time between the PSNL group and the sham group. PBN activity inhibition in mice with CNP did not affect their MPT or anxiety-like behavior. Conclusion: CNP can induce anxiety-like behavior and increase PBN-induced pain in mice. However, direct inhibition of the PBN neuron activity alone cannot improve CNP or CNP-related behavior. (c) 2021 Elsevier Ltd. All rights reserved.
查看更多>>摘要：Objective: The aim of this retrospective cohort study was to study the impact of age on in-hospital complications and mortality following surgery for Ankylosing Spondylitis (AS) associated spine fractures. Methods: We extracted data from the Nationwide Inpatient Sample (NIS) database (1998-2018) using ICD-9/10 codes. Patients with a primary diagnosis of AS associated spine fractures who underwent fusion surgery were included. Complications and in-hospital mortality were analyzed. Results: A total cohort of 8526 patients was identified. Overall, the median age of the cohort was 69 years. AS associated fractures were equally distributed among cervical and thoracolumbar regions. Overall, complications were noted in 48% of patients and pulmonary complications were the most common (32%) followed by renal (13%) and infection (12%). Complications were seen in 57.3% of patients > 70 years of age compared to 38.4% of patients < 70 years of age (p < .0001). Also, 9.9 % of patients > 70 years of age had in-hospital mortality compared to 3.1 % of patients < 70 years of age (p < .0001). Based on surgical approaches, elderly patients (>70 years) who underwent anterior, posterior, and anterior + posterior approaches had 19.8%, 7.4% and 16.4% in-hospital mortality compared to 5.3%, 2.2% and 7.4% respectively for patients < 70 years. Conclusions: Elderly patients (>70 years of age) were 3.2 times more likely to have in-hospital mortality and higher complications compared to younger patients (57% vs. 38%). Cervical compared to thoracolumbar fractures and anterior compared to posterior surgical approaches were associated with higher complications and in-hospital mortality. (c) 2021 Elsevier Ltd. All rights reserved.
Kumar, A. AravinLim, Jia XuBakthavachalam, RameshKer, Justin R. X....
5页
查看更多>>摘要：External ventricular drainage (EVD) is carried out in many neurosurgical conditions for the diversion of cerebrospinal fluid. These EVD systems can, however, malfunction with potentially lethal consequences. Air bubbles within the EVD can result in air locking of the system with subsequent blockage of drainage, with blood clots and debris being the other causes. There are both non-invasive and invasive methods of rectifying such blockages, with invasive procedures having its associated risks. This is especially so for EVD revisions, with each surgery increasing the risk of ventriculitis. We describe a case of bilateral air locked EVD managed successfully with a novel non-invasive 'pressure differential efflux technique'. This method exploits the pressure gradient established by adjusting each EVD to a different height to evacuate the pneumoventricle. In addition, we present a sequential approach to the management of EVD malfunction, based on the current literature and our institutional protocol. (c) 2021 Elsevier Ltd. All rights reserved.
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