Clinical Neurology and Neurosurgery最新文献_第7页

Transarterial embolization in non-cavernous and cavernous sinus dural arteriovenous fistulas: A systematic review and meta-analysis of proportions 经动脉栓塞治疗非海绵窦和海绵窦硬脑膜动静脉瘘：对比例的系统回顾和荟萃分析。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-07-31 DOI: 10.1016/j.clineuro.2024.108478

Background

Transarterial embolization (TAE) is pivotal in managing non-cavernous and cavernous sinus dural arteriovenous fistulas (CSDAVFs).

Methods

Systematic searches were conducted across ScienceDirect, Medline, and Cochrane databases for longitudinal studies on TAE outcomes in non-CSDAVFs and CSDAVFs. Post-procedural outcomes, including complete, incomplete, and failed AVFs obliteration, and end-study outcomes were analyzed.

Results

Our meta-analysis involved 27 studies with 643 patients and 736 fistulas. Symptoms in both groups included tinnitus (29.74 %), ocular/visual symptoms (29.12 %), hemorrhage (19.42 %), and headache (19.11 %). Feeding arteries mainly originated from the meningeal arteries (49.16 %). In non-CSDAVFs cases, fistula locations were within sinus complexes (69.23 %) and specific dural areas (28.31 %). Complete AVFs obliteration was 81 % (95 %CI: 70 % - 90 %), slightly higher in non-CSDAVFs (82 %, 95 % CI: 69 % – 92 %) than CSDAVFs (79 %, 95 %CI: 58 % - 95 %). Incomplete obliteration occurred in 14 % (95 %CI: 5 % - 39 %), with rates of 11 % (95 %CI: 2 % - 26 %) in non-CSDAVFs and 19 % (95 % CI: 5 % - 39 %) in CSDAVFs. Failed obliteration was rare (1 %, 95 %CI: 0 % - 3 %), with similar rates in both groups. At end-study follow-up, resolution of AVFs was achieved in 97 % of cases (95 %CI: 92 % - 100 %). However, complications occurred in 17 % of cases (95 %CI: 10 % - 25 %), with a higher incidence in CSDAVFs (22 %, 95 %CI: 9 % - 37 %) compared to non-CSDAVFs (13 %, 95 %CI: 6 % - 23 %).

Conclusions

TAE with embolic agents demonstrates favorable outcomes in non-CSDAVFs and CSDAVFs, with high rates of AVFs obliteration and resolution. Complications, particularly in CSDAVFs, warrant careful consideration in treatment decisions.

背景：经动脉栓塞（TAE）是治疗非海绵窦和海绵窦硬脑膜动静脉瘘（CSDAVFs）的关键：在ScienceDirect、Medline和Cochrane数据库中对非海绵窦动静脉瘘和海绵窦动静脉瘘TAE疗效的纵向研究进行了系统检索。分析了手术后的结果，包括完全、不完全和失败的动静脉瘘阻塞，以及最终研究结果：我们的荟萃分析涉及 27 项研究，643 名患者和 736 个瘘管。两组患者的症状包括耳鸣（29.74%）、眼部/视觉症状（29.12%）、出血（19.42%）和头痛（19.11%）。供血动脉主要来自脑膜动脉（49.16%）。在非 CDAVFs 病例中，瘘管位置位于静脉窦复合体内（69.23%）和特定硬膜区域内（28.31%）。动静脉瘘完全阻塞率为 81%（95%CI：70% - 90%），非 CSDAVFs（82%，95%CI：69% - 92%）略高于 CSDAVFs（79%，95%CI：58% - 95%）。不完全阻塞发生率为 14%（95%CI：5% - 39%），非 CSDAVF 为 11%（95%CI：2% - 26%），CSDAVF 为 19%（95%CI：5% - 39%）。阻塞失败的情况很少见（1%，95%CI：0% - 3%），两组的比率相似。在研究结束后的随访中，97% 的病例（95%CI：92% - 100%）的动静脉瘘得到了解决。然而，17%的病例出现了并发症（95%CI：10% - 25%），与非CSDAVFs（13%，95%CI：6% - 23%）相比，CSDAVFs的发生率更高（22%，95%CI：9% - 37%）：结论：使用栓塞剂的 TAE 对非 CSDAVF 和 CSDAVF 都有良好的疗效，动静脉瘘的阻塞率和消除率都很高。并发症，尤其是 CSDAVF 的并发症，需要在治疗决策中慎重考虑。

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引用次数: 0

Acute kidney injury is associated with soluble vascular cell adhesion molecule 1 levels and short-term mortality in patients with ischemic stroke 急性肾损伤与可溶性血管细胞黏附分子 1 水平和缺血性中风患者短期死亡率有关

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-07-26 DOI: 10.1016/j.clineuro.2024.108470

Background

The mechanisms that modulate the onset of acute kidney inlury (AKI) after ischemic stroke (IS) and valuable biomarkers to predict the occurrence and prognosis of AKI among patients with IS are missing.

Objective

To evaluate the frequency of AKI and the prognostic validity of clinical and laboratory biomarkers in predicting AKI and short-term mortality after the IS.

Methods

Ninety-five patients with IS were enrolled. Baseline IS severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and disability was determined after three-month follow-up using the modified Rankin Scale. Patients with IS were also categorized as survivors and non-survivors after the follow-up. Baseline data and laboratory biomarkers were obtained up to 24 h of the admission.

Results

Fifteen (15.7 %) patients with IS presented AKI. The proportion of patients with vitamin D deficiency and the mortality were higher among those with AKI than those without AKI (p=0.011 and p-0.009, respectively). Patients with AKI showed higher disability and higher increased soluble vascular cellular adhesion molecule-1 (sVCAM-1) than those without AKI (p=0.029 and p=0.023, respectively). Logistic regression analysis showed that only sVCAM-1 was associated with the occurrence of AKI after IS [odds ratio (OR): 2.715, 95 % confidence intereval (CI): 1.12–6.67, p=0.027]. When both AKI and NIHSS were evaluated as explanatory variables, this panel showed an OR of 5.782 (95 % CI: 1.09–30.43, p<0.001) and correctly classified 83.6 % of cases.

Conclusion

In conclusion, sVCAM-1 levels showed a potential useful for prediction of AKI after IS.

背景缺血性卒中（IS）后急性肾损伤（AKI）发病的调节机制以及预测IS患者AKI发生和预后的有价值的生物标志物尚不明确。方法95例IS患者入组。采用美国国立卫生研究院脑卒中量表（NIHSS）评估IS的基线严重程度，采用改良Rankin量表确定随访三个月后的残疾程度。随访结束后，IS 患者还被分为存活者和非存活者。结果15名（15.7%）IS患者出现了AKI。有 AKI 的患者维生素 D 缺乏的比例和死亡率均高于无 AKI 的患者（分别为 p=0.011 和 p-0.009）。与无 AKI 患者相比，AKI 患者的残疾率和可溶性血管细胞粘附分子-1（sVCAM-1）的增加率更高（分别为 p=0.029 和 p=0.023）。逻辑回归分析显示，只有 sVCAM-1 与 IS 后发生 AKI 相关[几率比（OR）：2.715，95% 置信区间（CI）：1.12-6.67，P=0.027]。当 AKI 和 NIHSS 均作为解释变量进行评估时，该面板显示 OR 为 5.782（95 % CI：1.09-30.43，p<0.001），正确分类了 83.6 % 的病例。

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引用次数: 0

Feasibility, efficacy, and safety of mechanical thrombectomy via sheathless transradial access as a first-line strategy: A case series 通过无鞘经桡动脉入路进行机械血栓切除术作为一线策略的可行性、有效性和安全性：病例系列

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-07-26 DOI: 10.1016/j.clineuro.2024.108471

Objective

Although mechanical thrombectomy (MT) is primarily performed via transfemoral access (TFA), transradial access (TRA) is a potential alternative in older patients or those with tortuous vessels. However, the small radial artery diameter restricts the use of large-bore balloon guides and aspiration catheters, a limitation that may be overcome using the sheathless technique. Thus, we aimed to explore the feasibility, efficacy, and safety of sheathless TRA-MT as a first-line treatment approach for acute ischemic stroke.

Methods

This single-center retrospective case series included patients who underwent TRA-MT as first-line treatment between September 2020 and June 2023. Per our MT protocol, TRA was not the first-line approach in cases of left anterior circulation lesions with a type 3 aortic arch. We evaluated treatment effectiveness based on the successful recanalization rate, puncture-to-recanalization time, and modified first-pass effect; access route effectiveness based on the puncture-to-first-pass time and switch-to-TFA rate; and procedure safety based on procedure-related and severe puncture site complications.

Results

Sheathless 8-F guide catheters were used in 68 % and large-bore aspiration catheters in 70 % of the procedures. Successful recanalization was achieved in 98 % of the patients, with a modified first-pass effect in 54 % of them. The median puncture-to-first-pass and puncture-to-recanalization times were 20.5 and 33 min, respectively. The rate of procedure-related complications was low (4 %), with no severe puncture site complications.

Conclusion

Sheathless TRA-MT enabled the use of large-bore guide and aspiration catheters, providing a swift approach to the target and satisfactory outcomes, and might be an effective first-line treatment for acute ischemic stroke.

目的虽然机械血栓切除术（MT）主要通过经股动脉入路（TFA）进行，但经桡动脉入路（TRA）对于年龄较大或血管迂曲的患者来说是一种潜在的替代方法。然而，桡动脉直径较小，限制了大口径球囊导引器和抽吸导管的使用，而无鞘技术可以克服这一限制。因此，我们旨在探索无鞘 TRA-MT 作为急性缺血性卒中一线治疗方法的可行性、有效性和安全性。方法这一单中心回顾性病例系列纳入了 2020 年 9 月至 2023 年 6 月间接受 TRA-MT 作为一线治疗的患者。根据我们的 MT 方案，TRA 并非 3 型主动脉弓左前循环病变的一线治疗方法。我们根据再通成功率、穿刺到再通时间和改良的首通效果评估了治疗效果；根据穿刺到首通时间和切换到TFA率评估了入路效果；根据手术相关并发症和严重穿刺部位并发症评估了手术安全性。结果68%的手术使用了无热8-F导引导管，70%的手术使用了大口径抽吸导管。98%的患者获得了成功的再通路，其中54%的患者获得了改良的首通效果。穿刺到首次通过和穿刺到再狭窄的中位时间分别为 20.5 分钟和 33 分钟。结论无热 TRA-MT 可使用大口径导引和抽吸导管，能迅速到达目标并获得满意的结果，可能是急性缺血性卒中的有效一线治疗方法。

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引用次数: 0

Surgical resection of glioblastoma in the very elderly: An analysis of survival outcomes using the surveillance, epidemiology, and end results database 老年胶质母细胞瘤的手术切除：利用监测、流行病学和最终结果数据库分析生存结果

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-07-26 DOI: 10.1016/j.clineuro.2024.108469

Objective

Patients with glioblastoma (GBM) often undergo surgery to prolong survival. However, the use of surgery, and more specifically achieving gross total resection (GTR), in patients >80 years old has yet to be fully assessed. Using the Surveillance, Epidemiology, and End Results (SEER) database, we aim to assess the efficacy of surgical resection, radiotherapy (RT) and chemotherapy (CT) on overall survival (OS) in very elderly GBM patients compared to elderly counterparts (age 65–79 years).

Methods

The SEER database was queried for all patients >65 years old with GBM (2000–2020). Patients not undergoing surgery or biopsy were excluded. Patients were stratified by age, and demographic relationships were assessed with chi-squared testing for categorical variables. Bivariable models were created using Kaplan-Meier survival estimates. All significant variables from bivariable analysis were included on multivariable Cox survival regression models to determine independent associations between clinical variables and OS.

Results

A total of 27,090 operative GBM patients were identified; 1868 patients (15.92 %) were very elderly and 10,092 patients (84.38 %) were elderly. Very elderly patients were less likely to undergo GTR (28 % vs 35 %, p<0.001), RT (59 % vs 78 %, p<0.001) and CT (40 % vs 66 %, p<0.001). In multivariable Cox regression analysis, very elderly patients who achieved GTR (HR=.696, p<0.001), received RT (HR=0.583, p<0.001) and underwent CT (HR=0.4197, p<0.001) had significantly improved OS compared to very elderly patients that did not undergo these treatment options.

Conclusion

Currently, very elderly GBM patients undergo lower rates of aggressive surgery, RT and CT. However, very elderly patients that undergo surgery, RT and CT may have a survival advantage. These treatments should be considered as potential options for this patient population.

目的胶质母细胞瘤（GBM）患者通常通过手术来延长生存期。然而，手术的使用，更具体地说是实现大体全切除术（GTR），在 80 岁的患者中还没有得到充分评估。利用监测、流行病学和最终结果（SEER）数据库，我们旨在评估手术切除、放疗（RT）和化疗（CT）与老年患者（65-79 岁）相比，对高龄 GBM 患者总生存期（OS）的疗效。未接受手术或活检的患者被排除在外。根据年龄对患者进行分层，并通过对分类变量进行卡方检验来评估人口统计学关系。使用 Kaplan-Meier 生存估计值建立二变量模型。双变量分析中的所有重要变量都被纳入多变量 Cox 生存回归模型，以确定临床变量与 OS 之间的独立关联。结果共确定了 27090 例 GBM 手术患者，其中 1868 例患者（15.92%）为高龄患者，10092 例患者（84.38%）为老年患者。高龄患者接受 GTR（28 % vs 35 %，p<0.001）、RT（59 % vs 78 %，p<0.001）和 CT（40 % vs 66 %，p<0.001）的可能性较低。在多变量 Cox 回归分析中，与未接受这些治疗方案的老年患者相比，接受 GTR（HR=.696，p<0.001）、RT（HR=0.583，p<0.001）和 CT（HR=0.4197，p<0.001）的老年患者的 OS 显著改善。然而，接受手术、RT 和 CT 治疗的高龄患者可能具有生存优势。这些治疗方法应被视为这类患者的潜在选择。

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引用次数: 0

Predictive value of early serum ACSL4 and ASITN/SIR grade for motor function recovery in patients with post-ischemic stroke lower limb neurological sequelae after modified constraint-induced movement therapy 早期血清 ACSL4 和 ASITN/SIR 分级对缺血性中风后下肢神经后遗症患者改良约束诱导运动疗法后运动功能恢复的预测价值

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-07-26 DOI: 10.1016/j.clineuro.2024.108464

Background

Ischemic stroke accounts for over 85 % of all stroke types. Acyl-CoA synthetase long chain family member 4 (ACSL4) is considered to promote myocardial and cerebral ischaemia/ reperfusion. However, up to now, no study focused on the role of ACSL4 in patients with post-stroke lower limb neurological sequelae.

Objective

The present study aimed to investigate the predictive value of ACSL4 and collateral circulation for lower limb neurological sequelae of ischemic stroke patients after modified constraint-induced movement therapy (mCIMT).

Methods

This is a prospective cohort study which included 99 ischemic stroke patients with lower limb neurological sequelae who were admitted to our hospital during January 2021 to December 2022. All patients received mCIMT after the admission. Collateral circulation was evaluated by digital subtraction angiography (DSA) and graded by the American Society of Interventional and Therapeutic Neuroradiology/ Society of Interventional Radiology (ASITN/SIR) grading system. Enzyme linked immunosorbent assay (ELISA) was used to detect serum ACSL4. Basic characteristics were collected and lower limb motor function was measured by Fugl-Meyer score (FMS), modified Ashworth score (MAS) and Brunnstrom stage, as well as timed up and go (TUG) test, ten-Meter walk test (10MWT), and six-minute walk test (6MWT) before and after treatment.

Results

Serum ACSL4 and percentage of patients with ASITN/SIR 0–1 decreased significantly after treatment compared with the values before treatment. Patients with higher baseline serum ACSL4 values at admission showed significantly lower FMS scores, higher TUG and 10MWT, as well as lower 6MWT. Patients with ASITN/SIR grade 0–1 at admission only showed significantly higher TUG and 10MWT, as well as lower 6MWT. Receiver operating characteristic (ROC) curves showed ACSL4 and ASITN/SIR grade could be used to predict the prognosis. Logistic regression found only national institutes of health stroke scores (NIHSS) was the independent risk factor for post-treatment motor impairment after mCIMT.

Conclusion

Higher levels of ACSL4 and ASITN/SIR 0–1 are associated with poor recovery of motor functions of patients with post-stroke sequelae after mCIMT.

背景缺血性中风占所有中风类型的 85% 以上。乙酰辅酶长链家族成员 4（ACSL4）被认为能促进心肌和脑缺血/再灌注。本研究旨在探讨 ACSL4 和侧支循环对缺血性脑卒中患者改良约束诱导运动疗法（mCIMT）后下肢神经系统后遗症的预测价值。方法这是一项前瞻性队列研究，纳入了我院在 2021 年 1 月至 2022 年 12 月期间收治的 99 例下肢神经系统后遗症缺血性脑卒中患者。所有患者均在入院后接受了 mCIMT 检查。侧支循环通过数字减影血管造影术（DSA）进行评估，并根据美国介入和治疗神经放射学会/介入放射学会（ASITN/SIR）分级系统进行分级。使用酶联免疫吸附试验（ELISA）检测血清 ACSL4。收集了患者的基本特征，并在治疗前后通过Fugl-Meyer评分（FMS）、改良Ashworth评分（MAS）和Brunnstrom分期以及定时起立行走（TUG）测试、十米步行测试（10MWT）和六分钟步行测试（6MWT）测量了患者的下肢运动功能。入院时血清 ACSL4 基线值较高的患者的 FMS 评分明显较低，TUG 和 10MWT 值较高，6MWT 值较低。仅入院时 ASITN/SIR 分级为 0-1 的患者 TUG 和 10MWT 值明显较高，6MWT 值较低。接收者操作特征曲线（ROC）显示，ACSL4 和 ASITN/SIR 分级可用于预测预后。Logistic 回归发现，只有美国国立卫生研究院卒中评分（NIHSS）是 mCIMT 治疗后运动功能障碍的独立危险因素。

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引用次数: 0

Cross-sectional survey study of the natural history of LAMA2-related dystrophy LAMA2 相关营养不良症自然史的横断面调查研究

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-07-25 DOI: 10.1016/j.clineuro.2024.108467

Background

LAMA2-related dystrophies (LAMA2-RD) are a rare group of neuromuscular disorders with a broad spectrum of phenotype severity, ranging from mild to severe. We performed a cross-sectional study of LAMA2-RD through motor function and pulmonary tests to establish the disease's natural history.

Methods

Forty-four individuals with LAMA2-RD were included and evaluated once through functional outcome measures including Motor Function Measure 32 (MFM32), Revised Upper Limb Module (RULM), goniometry, and Forced Vital Capacity (FVC). Fixed Effect Regression Model (ERM) and Kaplan-Meier curve were used for calculating the rate of the disease progression

Results

Patients were between 2 and 25 years old (mean 11.4), the most frequent phenotype presentation was non-ambulant (N=36, 81.8%) while eight patients (18,2 %) were ambulant. The non-ambulant group presented a more severe progression of the disease. Non-ambulant patients had a 1.85 % decrease in FVC/year against 1.32 %/year among ambulant patients. In the non-ambulant group, there was a 4.2 % drop/year in the MFM32-D2 domain (p<0.00001), a 2.6 % drop/year in the D3 domain (p<0.0001), and a 2.7 % drop/year in the MFM32 global assessment (p<0.0001). However, the non-ambulant group's evaluation of upper limb function through the RULM scale did not show a statistically significant reduction. In the non-ambulant group, elbow and knee retractions worsened 3.22 degrees/year (p=0.00087) and 1.92 degrees/year, respectively. While in those patients who acquired gait, elbow and knee retractions worsened 2.45 degrees/year (p=0.0003) and 1.73 degrees/year (p=0.01), respectively.

Conclusion

This study confirmed the progressive nature of LAMA2-RD, both in ambulant and non-ambulant patients. MFM32, FVC, and goniometry were identified as promising outcome measures for natural history studies and clinical trials in LAMA2-RD.

背景LAMA2相关肌营养不良症（LAMA2-RD）是一类罕见的神经肌肉疾病，其表型严重程度从轻微到严重不等。我们通过运动功能和肺功能测试对 LAMA2-RD 进行了横断面研究，以确定该病的自然史。方法纳入了 44 名 LAMA2-RD 患者，并通过运动功能测量 32 (MFM32)、修订的上肢模块 (RULM)、动态关节角度测量法和强制生命容量 (FVC) 等功能结果测量进行了一次评估。采用固定效应回归模型（ERM）和 Kaplan-Meier 曲线计算疾病的进展速度。结果患者年龄在 2-25 岁之间（平均 11.4 岁），最常见的表型是非行走型（36 人，81.8%），8 名患者（18.2%）为行走型。非行动不便组患者的病情发展更为严重。非卧床患者的 FVC 年均下降率为 1.85%，而卧床患者的 FVC 年均下降率为 1.32%。在非行动不便组中，MFM32-D2 领域每年下降 4.2 %（p<0.00001），D3 领域每年下降 2.6 %（p<0.0001），MFM32 整体评估每年下降 2.7 %（p<0.0001）。然而，通过 RULM 量表对非盲人组上肢功能的评估并未显示出统计学意义上的显著下降。在非步行者组中，肘关节和膝关节后伸分别恶化了 3.22 度/年（p=0.00087）和 1.92 度/年。结论本研究证实，LAMA2-RD 在步行和非步行患者中均具有进行性。MFM32、FVC和动态关节角度测量被认为是LAMA2-RD自然史研究和临床试验的有前途的结果测量指标。

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引用次数: 0

Repeat percutaneous rhizotomy for trigeminal neuralgia is not associated with an increased risk of postoperative complications 三叉神经痛重复经皮根切术与术后并发症风险增加无关

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-07-22 DOI: 10.1016/j.clineuro.2024.108466

Background and objectives

Patients undergoing percutaneous rhizotomy for trigeminal neuralgia (TN) may require several procedures to manage their pain. However, it is not fully understood whether repeat procedures influence postoperative complication rates.

Methods

We retrospectively reviewed patients undergoing rhizotomy at our institution from 2011 to 2022. Patients were included only if they had no history of prior interventions including microvascular decompression (MVD) or radiosurgery. We collected baseline patient information, pain characteristics, and postoperative complications for each patient. Patients were dichotomized into those undergoing primary rhizotomy versus those undergoing a repeat rhizotomy. Potential drivers of postoperative complications were included in a multivariate logistic regression model.

Results

Of the 1904 cases reviewed, 965 met our inclusion criteria. 392 patients underwent primary rhizotomy, and 573 patients underwent repeat rhizotomies. The repeat rhizotomy group was significantly older, p<0.001. Patients in the repeat rhizotomy group expressed higher frequencies of bilateral pain, p=0.01. Patients in the repeat rhizotomy group demonstrated a significantly higher rate of preoperative numbness and postoperative numbness, p<0.001. There were no significant differences in any of the considered complications between the single rhizotomy and repeat rhizotomy groups. On multivariate logistic regression, repeat rhizotomy did not predict an increased risk of any postoperative complications, p=0.14.

Conclusions

Patients undergoing repeat rhizotomy may be at risk of postoperative numbness but are not at increased risk for postoperative complications. These results are of use to patients who are poor surgical candidates, and thus may require multiple rhizotomies to effectively manage their pain over time.

因三叉神经痛（TN）而接受经皮根切术的患者可能需要多次手术来控制疼痛。然而，重复手术是否会影响术后并发症的发生率，目前尚不完全清楚。我们回顾性研究了 2011-2022 年期间在我院接受根切术的患者。只有既往未接受过微血管减压术（MVD）或放射外科手术等干预的患者才被纳入。我们收集了每位患者的基线信息、疼痛特征和术后并发症。我们将患者分为初次根管切开术患者和再次根管切开术患者。术后并发症的潜在驱动因素被纳入多变量逻辑回归模型。在所审查的 1904 例病例中，有 965 例符合我们的纳入标准。392名患者接受了初次根茎切除术，573名患者接受了重复根茎切除术。重复根状茎切除术组患者的年龄明显偏大，P<0.001。重复根状茎切除术组患者出现双侧疼痛的频率更高，P=0.01。重复根状茎切除术组患者术前麻木和术后麻木的比例明显更高，P<0.001。单一根状茎切除术组和重复根状茎切除术组的并发症无明显差异。在多变量逻辑回归中，重复根状茎切除术并不能预测术后并发症风险的增加，P=0.14。接受重复根状切开术的患者可能有术后麻木的风险，但术后并发症的风险并没有增加。这些结果对那些不适合手术的患者很有帮助，他们可能需要多次根状切开术才能长期有效地控制疼痛。

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引用次数: 0

Causal association between rheumatoid arthritis and risk of stroke: A Mendelian randomization study 类风湿性关节炎与中风风险之间的因果关系：孟德尔随机研究

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-07-21 DOI: 10.1016/j.clineuro.2024.108465

Background

Active rheumatoid arthritis (RA) may damage vascular endothelial cells, thereby increasing the likelihood of adverse cardiovascular events. However, it is not yet clearly established whether RA also increases the risk of adverse cerebrovascular events, particularly stroke.

Objective

This study was designed to evaluate the likelihood of a causal association between RA and stroke.

Method

A two-sample Mendelian randomization (MR) analysis was performed using the inverse variance-weighted (IVW) average, weighted median, and MR-Egger regression methods. The analysis utilized publicly available summary statistics datasets from Genome-wide association studies (GWAS) meta-analyses for RA in individuals of European descent (total n = 484,598; case = 5427, control = 479,171) as the exposure cohort, and from GWAS meta-analyses for "vascular/heart problems diagnosed by doctor: stroke" in individuals included in the UK Biobank (total n = 461,880; case = 7055, control = 454,825, MRC-IEU consortium) as the outcome cohort.

Results

Eight single-nucleotide polymorphisms with genome-wide significance were selected from the GWASs on RA as the instrumental variables. The results of the MR-Egger and weighted median analyses showed no causal association between RA and stroke (OR = 1.081, 95 % CI [0.943–1.240], P = 0.304) vs. OR = 1.079, 95 % CI [0.988–1.179], P = 0.091), respectively. However, the inverse variance-weighted (IVW) analysis results revealed a causal association between RA and stroke (OR = 1.115, 95 % CI [1.040–1.194], P = 0.002). Cochran's Q test and MR-Egger regression revealed no evidence of heterogeneity and horizontal pleiotropy.

Conclusion

The MR analysis results indicated that rheumatoid arthritis (RA) may be causally associated with an increased risk of stroke.

背景：活动性类风湿性关节炎（RA）可能会损伤血管内皮细胞，从而增加发生不良心血管事件的可能性。然而，RA是否也会增加脑血管不良事件，尤其是中风的风险，目前尚未明确：本研究旨在评估 RA 与中风之间因果关系的可能性：方法：采用逆方差加权平均法（IVW）、加权中位数法和 MR-Egger 回归法进行了双样本孟德尔随机化（MR）分析。该分析采用了公开可用的全基因组关联研究（GWAS）荟萃分析数据集（总人数 = 484,598 人；病例 = 5427 人，对照 = 479,171 人）作为暴露队列，并采用了全基因组关联研究荟萃分析数据集（总人数 = 484,598 人；病例 = 5427 人，对照 = 479,171 人）作为暴露队列，以及全基因组关联研究荟萃分析数据集（总人数 = 484,598 人，病例 = 5427 人，对照 = 479,171 人）作为暴露队列：中风 "的 GWAS meta 分析作为结果队列（总人数 = 461,880 人；病例 = 7055 例，对照 = 454,825 例，MRC-IEU 联合体）。研究结果从有关 RA 的全球基因组研究中选取了 8 个具有全基因组意义的单核苷酸多态性作为工具变量。MR-Egger分析和加权中位数分析结果显示，RA与中风之间没有因果关系（OR = 1.081，95 % CI [0.943-1.240]，P = 0.304）；OR = 1.079，95 % CI [0.988-1.179]，P = 0.091）。然而，逆方差加权（IVW）分析结果显示 RA 与中风之间存在因果关系（OR = 1.115，95 % CI [1.040-1.194]，P = 0.002）。Cochran的Q检验和MR-Egger回归没有发现异质性和水平多向性的证据：MR分析结果表明，类风湿性关节炎（RA）可能与中风风险增加有因果关系。

{"title":"Causal association between rheumatoid arthritis and risk of stroke: A Mendelian randomization study","authors":"","doi":"10.1016/j.clineuro.2024.108465","DOIUrl":"10.1016/j.clineuro.2024.108465","url":null,"abstract":"<div><h3>Background</h3><p>Active rheumatoid arthritis (RA) may damage vascular endothelial cells, thereby increasing the likelihood of adverse cardiovascular events. However, it is not yet clearly established whether RA also increases the risk of adverse cerebrovascular events, particularly stroke.</p></div><div><h3>Objective</h3><p>This study was designed to evaluate the likelihood of a causal association between RA and stroke.</p></div><div><h3>Method</h3><p>A two-sample Mendelian randomization (MR) analysis was performed using the inverse variance-weighted (IVW) average, weighted median, and MR-Egger regression methods. The analysis utilized publicly available summary statistics datasets from Genome-wide association studies (GWAS) meta-analyses for RA in individuals of European descent (total n = 484,598; case = 5427, control = 479,171) as the exposure cohort, and from GWAS meta-analyses for \"vascular/heart problems diagnosed by doctor: stroke\" in individuals included in the UK Biobank (total n = 461,880; case = 7055, control = 454,825, MRC-IEU consortium) as the outcome cohort.</p></div><div><h3>Results</h3><p>Eight single-nucleotide polymorphisms with genome-wide significance were selected from the GWASs on RA as the instrumental variables. The results of the MR-Egger and weighted median analyses showed no causal association between RA and stroke (OR = 1.081, 95 % CI [0.943–1.240], P = 0.304) vs. OR = 1.079, 95 % CI [0.988–1.179], P = 0.091), respectively. However, the inverse variance-weighted (IVW) analysis results revealed a causal association between RA and stroke (OR = 1.115, 95 % CI [1.040–1.194], P = 0.002). Cochran's Q test and MR-Egger regression revealed no evidence of heterogeneity and horizontal pleiotropy.</p></div><div><h3>Conclusion</h3><p>The MR analysis results indicated that rheumatoid arthritis (RA) may be causally associated with an increased risk of stroke.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141765689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Safety and efficacy of tirofiban combined with intravenous thrombolysis and endovascular treatment in acute large vessel occlusion stroke 替罗非班联合静脉溶栓和血管内治疗治疗急性大血管闭塞性卒中的安全性和有效性。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-07-20 DOI: 10.1016/j.clineuro.2024.108463

Objective

This study assesses the safety and efficacy of tirofiban for patients with large vessel occlusion stroke after intravenous thrombolysis.

Methods

This study data was from SUSTAIN, DEVT, and RESCUE BT trials. According to whether the use of tirofiban who underwent endovascular treatment and preceding intravenous thrombolysis was divided into the tirofiban group and the no-tirofiban group. The safety outcomes were symptomatic intracranial hemorrhage, any intracranial hemorrhage within 48 h, and 3-month mortality. The efficacy outcome was defined as a score of 0–2 on the modified Rankin Scale scores at 3 months.

Results

A total of 372 patients with intravenous thrombolysis were included in these SUSTAIN, DEVT, and RESCUE BT trials. Adjusted multivariate analysis showed that tirofiban with intravenous thrombolysis was not associated with symptomatic intracranial hemorrhage (aOR, 0.87; 95 % CI, 0.49–1.57; P=0.65), any intracranial hemorrhage within 48 h (aOR, 1.00; 95 % CI, 0.60–1.66; P=1.00), 3-month mortality (aOR, 1.10; 95 % CI, 0.56–2.19; P=0.78) and 3-month modified Rankin Scale scores 0–2 (aOR, 0.72; 95 % CI, 0.42–1.25; P=0.25) in patients with acute large vessel occlusion. In the subgroup analysis, we found that tirofiban was not recommended for females (aOR, 0.34; 95 % CI, 0.12–0.93), baseline Alberta Stroke Program Early CT Score≤9 (aOR, 0.37; 95 % CI, 0.18–0.76), and cardiogenic embolism (aOR, 0.36; 95 % CI, 0.14–0.97).

Conclusion

Tirofiban combined with intravenous thrombolysis in patients with acute large vessel occlusion may be safe. Further studies need to confirm the effectiveness of tirofiban after intravenous thrombolysis in different stroke etiology.

研究目的本研究评估了替罗非班对静脉溶栓后大血管闭塞性卒中患者的安全性和有效性：本研究数据来自 SUSTAIN、DEVT 和 RESCUE BT 试验。根据是否使用替罗非班将接受血管内治疗和静脉溶栓的患者分为替罗非班组和无替罗非班组。安全性结果为症状性颅内出血、48小时内任何颅内出血和3个月死亡率。疗效结果定义为3个月后改良Rankin量表评分为0-2分：SUSTAIN、DEVT和RESCUE BT试验共纳入了372名静脉溶栓患者。调整后的多变量分析显示，替罗非班联合静脉溶栓与无症状性颅内出血（aOR，0.87；95 % CI，0.49-1.57；P=0.65）、48 小时内任何颅内出血（aOR，1.00；95 % CI，0.60-1.66；P=1.00）、急性大血管闭塞患者 3 个月死亡率（aOR，1.10；95 % CI，0.56-2.19；P=0.78）和 3 个月改良 Rankin 量表评分 0-2 分（aOR，0.72；95 % CI，0.42-1.25；P=0.25）。在亚组分析中，我们发现女性（aOR，0.34；95 % CI，0.12-0.93）、基线阿尔伯塔卒中计划早期 CT 评分≤9（aOR，0.37；95 % CI，0.18-0.76）和心源性栓塞（aOR，0.36；95 % CI，0.14-0.97）不推荐使用替罗非班：结论：替罗非班联合静脉溶栓治疗急性大血管闭塞患者可能是安全的。结论：替罗非班联合静脉溶栓治疗急性大血管闭塞患者可能是安全的，需要进一步研究证实替罗非班联合静脉溶栓治疗不同卒中病因的有效性。

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引用次数: 0

Cytokines in cerebrospinal fluid as a prognostic predictor after treatment of nusinersen in SMA patients 脑脊液中的细胞因子是 SMA 患者接受纽西那生治疗后的预后预测指标。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-07-19 DOI: 10.1016/j.clineuro.2024.108462

Objectives

Recent studies have suggested that neuroinflammation may play a role in the progression of spinal muscular atrophy (SMA), and this may influence the efficacy of antisense oligonucleotide treatment. This study explored the biomarkers associated with SMA and the efficacy of nusinersen therapy. Methods: Fifteen patients with SMA were enrolled and their motor function (World Health Organization motor milestone, Hammersmith Functional Motor Scale Expanded (HFMSE), and Revised Upper Limb Module [RULM] scores, and 6-minute walking test) was evaluated before, during (63 days), and after (6 months) nusinersen treatment. The concentrations of monocyte chemoactive protein 1 (MCP1), tumour necrosis factor-alpha (TNF-α), and interleukin (IL)-10 in the cerebrospinal fluid were measured at the indicated time points, and their correlations with motor function were analysed. Results: A significant increase in MCP1 was observed after 6 month’s treatment compared with that before treatment, while TNF-α gradually decreased over the course of treatment. IL-10 levels were negatively correlated with HFMSE scores before treatment, and reductions in IL-10 levels were correlated with improvements in RULM scores. Conclusions: This study suggests that neuroinflammation may be associated with the severity of SMA and with the therapeutic effects of nusinersen, which could have clinical implications in the treatment of SMA.

研究目的最近的研究表明，神经炎症可能在脊髓性肌萎缩症（SMA）的进展过程中发挥作用，这可能会影响反义寡核苷酸治疗的疗效。本研究探讨了与SMA相关的生物标志物以及纽西奈森疗法的疗效：方法：研究人员招募了15名SMA患者，在纽西奈森治疗前、治疗期间（63天）和治疗后（6个月）评估了他们的运动功能（世界卫生组织运动里程碑、Hammersmith功能性运动量表扩展版（HFMSE）、修订版上肢模块[RULM]评分和6分钟步行测试）。在指定时间点测量了脑脊液中单核细胞化学活性蛋白1（MCP1）、肿瘤坏死因子-α（TNF-α）和白细胞介素（IL）-10的浓度，并分析了它们与运动功能的相关性：结果：与治疗前相比，治疗 6 个月后 MCP1 水平明显升高，而 TNF-α 则在治疗过程中逐渐下降。治疗前，IL-10水平与HFMSE评分呈负相关，而IL-10水平的降低与RULM评分的改善相关：本研究表明，神经炎症可能与 SMA 的严重程度以及纽西那生的治疗效果有关，这可能对 SMA 的治疗具有临床意义。

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引用次数: 0