查看更多>>摘要：Background and objective: Compelling evidence shows that inflammation contributes to the development of aneurysmal subarachnoid hemorrhage (aSAH). Several studies have conducted in the recent past have revealed that the neutrophil-to-albumin ratio (NAR) is a new marker of inflammation. However, whether NAR can predict the prognosis of patients with aSAH has not been fully elucidated. Therefore, the aim of this study was to investigate the relationship between NAR and prognosis of aSAH. Methods: A total of 555 consecutive patients diagnosed with aSAH were retrospectively enrolled. The NAR was assessed for each patient upon admission. At the same time, the demographic and clinical parameters of patients were collected. The Glasgow Outcome Scale (GOS, a score of 1-3) at 3 months was used to evaluate disease outcomes. Results: Patients with unfavorable outcomes at 3 months were considerably older, had high levels of intraventricular and subarachnoidal hemorrhage, exhibited severe clinical conditions at admission, developed in-hospital complications, such as pneumonia and delayed cerebral ischemia. At admission, the NAR for GOS scores 4-5 was median [IQR] 0.231 [0.177-0.288] whereas that for GOS score 1-3 was 0.349 [0.264-4.449]; p < 0.001. The analysis revealed that the NAR was independently associated with unfavorable outcomes in patients with aSAH after adjusting for potential confounding factors (risk ratio [95% CI] 3.554 [2.601-4.857] per 0.1-point increment; p < 0.001). Moreover, a NAR of 0.274 was determined to be the best cutoff threshold for distinguishing between favorable and unfavorable outcomes in ROC analyses (AUC [95% CI] 0.782 [0.740-0.823]; p < 0.001; GOS 3-5: NAR >= 0.274 134/247 [54.3%] vs NAR < 0.274 47/308 [15.3%]; p < 0.001). Conclusion: This study demonstrates that NAR may be a novel prognostic marker in patients with aSAH. Elevated NAR is an independent factor predicting unfavorable outcome in patients with aSAH.
查看更多>>摘要：Objectives: Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders characterized by a deficit in social behaviors and nonverbal interactions such as reduced eye contact and facial expression. Changes in growth factors expression including Insulin-like growth factors (IGFs) have been shown in ASD. This project aimed to study the association of IGF-1 (rs12579108) promoter polymorphism and its serum concentration with ASD. Methods: DNA was extracted from blood samples of 200 ASD children and 198 healthy controls and genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and IGF-1 serum concentration was measured by ELISA. Results: The results showed that the prevalence of AA, CA, and CC genotypes were 2%, 61%, 37% in controls and 4%, 31%, and 65% in ASD patients, respectively (P = 0.0005). The prevalence of A and C alleles in the controls were 33% and 67% and in ASD patients were 19% and 81%, respectively (P = 0.001). We have also showed that serum IGF-1 concentration in ASD and control groups was 31.45 +/- 9.84 and 54.62 +/- 11.63 ng/ml, respectively (P = 0.001). Our results also showed that AA genotype is significantly related to decreased serum IGF-1 concentrations in ASD (CC, CA and AA serum levels were 50.22 +/- 12.68, 33.55 +/- 9.13 and 22.55 +/- 7.26 and in controls were 77.88 +/- 17.14, 54.77 +/- 15.31 and 31.33 +/- 9.91 ng/ml, respectively). Conclusion: It is concluded that there is a significant association between IGF-1 (rs12579108) promoter polymorphism and its serum concentration with ASD. We also suggest that AA genotype is linked to lower IGF-1 serum levels and may play as risk factor for ASD.
查看更多>>摘要：Postural impairment is one of the most disorders in patients with multiple sclerosis (MS), while fear of falling can exacerbate it in these patients. One of the leading causes of postural impairment and fear of falling in patients with MS is the cerebellum region's abnormalities, which may be modulated by cerebellar anodal transcranial direct current stimulation (a-tDCS). The present study aimed to investigate the effects of cerebellar a-tDCS concurrent with postural training (cerebellar a-CSC-PT) on postureand fear of falling in patients with MS. Thirtyseven patients with MS were assessed to randomly assign into cerebellar a-tDCSC-PT, sham tDCSC-PT, and postural training alone groups. All groups received 10-session postural training, while 20-minute cerebellar a-tDCS was added in the tDCS groups. Before, immediately and one month after the intervention, posture, balance and fear of falling were assessed using Biodex Balance System, Berg Balance Scale (BBS), and Fall Efficacy ScaleInternational (FES-I), respectively. Postural stability indices, BBS, and FES-I scores improved immediately and one month after the intervention in the cerebellar a-tDCSC-PT group (p < 0.001). Postural stability indices were immediately improved after intervention in the control groups (P < 0.05), while the changes were not maintained one month after intervention (P > 0.05). However, FES-I was not changed after the intervention in the control groups (P > 0.05). Cerebellar a-tDCS induces the effects of postural training on posture and balance and controls the fear of falling. This knowledge helps the physicians/therapists plan tDCS interventions to improve the balance, posture, and fear of falling in MS patients.
Jimenez, Adrian E.Snyder, M. HarrisonRabinovich, Emily P.Malkawi, Dima...
9页
查看更多>>摘要：Background: Meningiomas of the tuberculum sellae (TS) and planum sphenoidale (PS) are challenging to treat surgically. Transcranial approaches (TCAs) were the mainstay before endoscopic endonasal approaches (EEA) were developed, however the efficacy and safety of EEA approaches relative to TCA approaches remains unclear. Methods: The authors conducted a PRISMA-compliant systematic review of existing literature detailing the outcomes of both approaches. PubMed, Embase, Cochrane Library, and Clinicaltrials.gov were searched. Studies were included if they analyzed TS and/or PS meningiomas, included >= 5 patients, and reported at least one outcome of interest. Results: Overall, 44 retrospective studies met inclusion criteria, the majority being from single centers, between 2004 and 2020. In studies directly comparing postoperative outcomes among TCA and EEA approaches, EEA had significantly higher odds of visual improvement (OR = 3.24, p = 0.0053) and significantly higher odds of CSF leak (OR = 3.71, p = 0.0098) relative to TCA. Further, there were no significant differences between visual worsening (p = 0.17), complications (p = 0.51), and GTR rates (p = 0.30) for the two approaches. Meta-analysis demonstrated no significant association between nasoseptal flap (NSF) use and postoperative outcomes among EEA patients. There was also no significant association between study publication year and postoperative EEA outcomes. Conclusion: The present study demonstrates that EEA offers a viable alternative to TCA in the treatment of suprasellar meningiomas. In particular, EEA shows promise for superior visual outcomes, though postoperative CSF leaks are an important consideration among patients undergoing this approach.
查看更多>>摘要：A cross-sectional hospital records-based study was conducted to evaluate the prevalence, severity, outcomes, and identify demographic and clinical risk factors of coronavirus disease (COVID-19) in patients with MS. The study was conducted at multiple clinics in Oman, Kuwait, and the United Arab Emirates (UAE) from March 2020 to February 2021. The association of patient demographics, MS disease characteristics, and use of disease modifying therapies with outcomes of COVID-19 illness were evaluated using odds ratio. A total of 134 MS patients with COVID-19 (prevalence rate of 3.7%) having a median age of 35.5 years were analyzed in the study. A majority (126 [94.0%]) of patients had mild COVID-19 illness and 122 (91.0%) made a full recovery, while 1 (0.7%) patient died. The median EDSS score reported in the study was low (1.0). Univariate regression analysis showed high EDSS scores, progressive MS disease, and use of anti-CD20 therapy such as rituximab as risk factors for moderate to severe COVID-19 requiring hospitalization. Comorbidities were associated with a higher risk of non-recovery from COVID-19 in both univariate and multivariate analyses. Age, sex, smoking history, and duration of MS did not show a significant association with severity or adverse COVID-19 disease outcome. Identification of risk factors can aid in improving the treatment and monitoring of pwMS and COVID-19.
查看更多>>摘要：Minimally invasive surgery (MIS) techniques for posterior spine pedicle-screw fusion (PSF) may reduce the AIS surgery invasiveness, although they require a certain degree of patient selection based on the severity of the curve. The aim of this article is to systematically review the Literature to determine efficacy and safety of MISPSF in AIS correction, and to compare its outcomes with open-PSF. A systematic search of electronic databases from eligible articles was conducted. Only studies adopting MIS-PSF for AIS were included. Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed. P-value < 0.05 was considered significant. Thirteen studies for a total of 635 patients ungergoing MIS-PSF were included in this review. Pre-operative Cobb's angle ranged from 48.3. +/- 4.2. to 59.8. +/- 6.6., coronal correction from 58.1% to 79.1%, average operative time ranged from 252 to 526.8 min, average estimated blood loss from 138.8 +/- 50 to 1250 mL. Sixty-seven complications were recorded (9.9%), with 19 revisions (3.8%), resulting similar to those described in Literature using open-PSF. At meta-analysis, MIS-PSF (321 patients) compared to open-PSF (429 patients) showed lower coronal correction (although no statistically significant difference was found), estimated blood loss and length of hospital stay, but higher operative time. No differences in SRS-22, complications and revision rate were found. In conclusion, open-PSF shows a trend towards higher correction in the coronal plane and requires a shorter operative time when compared to MIS-PSF. It remains the gold standard for AIS correction, although MIS-PSF seems to be a viable and promising technique for selected patients.
查看更多>>摘要：Background: The benefits of adding upfront post-operative radiation, either whole-brain (WBRT) or cavity, after resection of brain metastases have been debated, particularly due to the long-term sequalae post radiation. We sought to compare the efficacy and safety between post-operative radiation versus resection alone. Methods: We searched various biomedical databases from 1983 to 2018, for eligible randomized controlled trials (RCT). Outcomes studied were local recurrence (LR), overall survival (OS) and serious (Grade 3 + ) adverse events. We used the random effects model to pool outcomes. Methodological quality of each study was assessed using the Cochrane Risk of Bias tool. We employed the GRADE approach to assess the certainty of evidence. Results: We included 5 RCTs comprising of 673 patients. The pooled odds ratio (OR) for LR is 0.26 (95% confidence interval (CI) 0.19-0.37, P < 0.001, GRADE certainty high), strongly supporting the use of post-operative radiation. Meta-regression analysis done comparing cavity and WBRT, did not show any difference in LR. The pooled hazard ratio (HR) for overall survival (OS) is 1.1 (95% CI 0.90-1.34, P = 0.37, GRADE certainty high). The treatment-related toxicities could not be pooled; the 2 studies which reported this did not find differences between the approaches. The risk of bias across the included studies was low. Conclusion: Our analysis confirms that upfront post-operative radiation significantly reduces the risk of LR. However, the lack of improvement in OS suggests that local control alone may not impact survival. Balancing local control, and neuro-cognitive effects of WBRT, cavity radiation seems to be a safe and effective option.
查看更多>>摘要：Central nervous system tumours are the leading oncology cause of paediatric mortality. The aim of this research was to identify stages within the diagnostic process of a primary paediatric brain tumour that could be improved resulting in better outcomes. Methods: The electronic medical records of Queensland Children's Hospital patients with central nervous system tumours between the 17/12/2014 till 11/12/2019 were retrospectively accessed. Time intervals of symptom onset to first medical review, location, time till medical imaging, subspecialty or neurosurgical review, timing of surgery, diagnosis and mortality status were recorded then analysed. Results: A total of 168 patients were included. Mean age to 7.5, 65% male, with pilocytic astrocytoma representing 31%. 71.4% of the population were from a major city as determined by Remoteness Area classification, ABS, with 19% inner regional and 9.5% being outer regional and remote. The average time from first medical review to diagnostic imaging was significantly different when comparing remoteness classification (p = 0.044). There was also a statistically significant difference in the duration of time from medical imaging to specialist review comparing major city and outer regional/remote (p = 0.016) and inner regional versus outer regional/ remote areas (p = 0.026). Conclusions: Delays in imaging in outer regional and remote Queensland are contributing to a delay in diagnosis and intervention in paediatric brain tumours. Service provision for neurosurgery in outer regional and remote Queensland is currently on par with inner regional and city areas. Suspicion of paediatric brain tumours is needed with clear referral pathways for general practitioners to access diagnostic imaging.
Hays, Leanne M. C.Udy, AndrewAdamides, Alexios A.Anstey, James R....
10页
查看更多>>摘要：Monitoring and optimisation of brain tissue oxygen tension (PbtO(2)) has been associated with improved neurological outcome and survival in observational studies of severe traumatic brain injury (TBI). We carried out a systematic review of randomized controlled trials to determine if PbtO(2)-guided management is associated with differential neurological outcomes, survival, and adverse events. Searches were carried out to 10 February 2022 in Medline (OvidSP), 11 February in EMBASE (OvidSP) and 8 February in Cochrane library. Randomized controlled trials comparing PbtO(2) and ICP-guided management to ICP-guided management alone were included. The primary outcome was survival with favourable neurological outcome at 6-months post injury. Data were extracted by two independent authors and GRADE certainty of evidence assessed. There was no difference in the proportion of patients with favourable neurological outcomes with PbtO(2)-guided management (relative risk [RR] 1.42, 95% CI 0.97 to 2.08; p = 0.07; I2 = 0%, very low certainty evidence) but PbtO(2)-guided management was associated with reduced mortality (RR 0.54, 95% CI 0.31 to 0.93; p = 0.03; I2 = 42%; very low certainty evidence) and ICP (mean difference (MD) -4.62, 95% CI -8.27 to -0.98; p = 0.01; I2 = 63%; very low certainty evidence). There was no significant difference in the risk of adverse respiratory or cardiovascular events. PbtO(2)- guided management in addition to ICP-based care was not significantly associated with increased favourable neurological outcomes, but was associated with increased survival and reduced ICP, with no difference in respiratory or cardiovascular adverse events. However, based on GRADE criteria, the certainty of evidence provided by this meta-analysis was consistently very low. MESH: Brain Ischemia; Intensive Care; Glasgow Outcome Scale; Randomized Controlled Trial; Craniocerebral Trauma.
查看更多>>摘要：Background: Two score families were introduced to help clinicians about the decision-making regarding intracranial aneurysms management. The first family estimates the growth/rupture risk (GRS), whereas the second provides straightforward recommendation (RS) for treatment decisions. However, both remain poorly validated and little is known about their agreement. In this paper, we performed a retrospective concordance analysis among the two scores families through their application to a multicenter cohort of SAH patients.Methods: Demographical, clinical and radiological data were extracted in conformance with the variables included in PHASES, UCAS, ELAPSS, Juvela's growth score (JGS), UIATS and Juvela's treatment score (JTS). Individual patients' score were calculated for both score families, and pooled data were then analyzed.Results: Overall, 146 patients were included. True positive rates were: 51.4% for PHASES; 71.9% for UCAS; between 60.3% and 90.4% for JTS; and between 27.4% and 68.5% for UIATS. In patients showing UIATS unclear recommendation and low JTS score (RS), UCAS outperformed PHASES (GRS) in identifying aneurysms at higher risk of rupture. Same results we found for patients with conservative UIATS recommendation and very low JTS score. Forty-to-sixty percent of aneurysms with unclear or conservative RS recommendation would have been identified as at high risk with GRS.Conclusions: Retrospectively applied, JTS appeared outperforming UIATS in correctly recommending treatment in a higher percentage of patients. UIATS and JTS appeared agreeing more with UCAS than PHASES predictions. Around 50% of patients with unclear or conservative UIATS/JTS recommendations were been classified as at higher growth risk by ELAPSS and JGS.
NSTL
Elsevier