Clinical Neurology and Neurosurgery最新文献

Accurate assessment of consciousness in patients with disorders of consciousness (DoC) remains a major clinical challenge, particularly when motor impairment masks evidence of preserved awareness. Recent advances in neuroadaptive artificial intelligence (NA-AI) may help transform brain-computer interfaces (BCIs) from experimental systems into more clinically scalable tools tailored to each patient, continuously adjusting their models in real time to changes in an individual's (neuro)physiological signals. Generative and self-adapting AI models can account for inter-individual variability and temporal instability in neural signals, enabling faster calibration, improved robustness and personalized decoding of conscious intent. AI world-model approaches further enable realistic and dynamic representations of a patient's neurophysiology, allowing BCIs to interpret neural activity in the context of evolving brain states rather than static classifications of consciousness levels. Emerging work in quantum-enhanced machine and deep learning suggests that some current computational bottlenecks in BCIs, including high-dimensional optimization and complex pattern discovery, may be further alleviated. We argue that the convergence of neuroadaptive AI and quantum-enabled computation could improve the sensitivity, speed and reliability of consciousness assessments. Given the exploratory stage of quantum-AI research, rigorous clinical validation and governance frameworks will be required to ensure safe deployment and improved patient outcomes. If validated, quantum-AI BCIs could reduce diagnostic uncertainty, improve prognostication and support ethically grounded decision-making for patients unable to communicate.

Objective: This study aimed to investigate the current status and associated influencing factors of antiplatelet therapy and CYP2C19 gene testing among patients with ischemic stroke and transient ischemic attack, and to identify potential entry points for precision pharmaceutical care to promote the more rational and individualized application of antiplatelet therapy.

Methods: A multidimensional research approach was used in this study. First, relevant guidelines were systematically searched and critically evaluated using evidence-based pharmaceutical methods to summarize the latest recommendations regarding antiplatelet therapy and CYP2C19 genetic testing in patients with ischemic stroke and transient ischemic attack. Subsequently, a retrospective analysis was conducted on real-world data from 147 patients to assess the actual implementation of antiplatelet therapy and genetic testing, as well as adherence to clinical guidelines. Finally, semi-structured interviews were conducted to identify the key factors influencing physicians' decisions to prescribe CYP2C19 genetic testing, based on which targeted interventions were formulated.

Results: Five guidelines were included, all of which recommended gene-guided antiplatelet therapy, with one providing a Grade A recommendation and four offering Grade B recommendations. Among the patients, 74.83% received guideline-concordant empirical dual antiplatelet therapy, whereas 11.56% underwent CYP2C19 genetic testing but did not adjust their medication regimen according to the test results. Physicians were more likely to order genetic testing for patients with abnormal liver function while underestimating other relevant clinical factors. Interviews with 14 physicians revealed that the key factors influencing the order of CYP2C19 genetic testing included capability (knowledge and skills), opportunity (environmental and resource), and motivation (emotional). Corresponding intervention recommendations included formulating localized clinical decisions, conducting medication consultations and training, enhancing medication education, and advocating expanded medical insurance policy coverage.

Conclusion: The adherence to guidelines regarding antiplatelet therapy and CYP2C19 genetic testing among patients with ischemic stroke and transient ischemic attack remains suboptimal, and the clinical utility of genetic testing is yet to be fully realized. Pharmacists should deliver comprehensive and precise pharmaceutical services from multiple perspectives to promote the rationalization and individualization of antiplatelet therapy.