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Obstructive Sleep Apnea in Pregnancy: A Comprehensive Review of Maternal and Fetal Implications 妊娠期阻塞性睡眠呼吸暂停:母体和胎儿影响的全面回顾
IF 3 Q3 Medicine Pub Date : 2024-05-07 DOI: 10.3390/neurolint16030039
A. Maniaci, L. La Via, B. Pecorino, Benito Chiofalo, G. Scibilia, Salvatore Lavalle, P. Scollo
Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition in pregnancy, associated with various maternal and fetal complications. This review synthesizes the current evidence on the epidemiology, pathophysiology, and neurological consequences of OSA in pregnancy, along with the potential management strategies. Articles were sourced from the PubMed, EMBASE, and Cochrane databases until 2023. Our comprehensive review highlights that the incidence of OSA increases during pregnancy due to physiological changes such as weight gain and hormonal fluctuations. OSA in pregnancy is linked with gestational hypertension, pre-eclampsia, gestational diabetes, and potential adverse fetal outcomes such as intrauterine growth restriction and preterm birth. Continuous positive airway pressure (CPAP) therapy remains the most effective management strategy for pregnant women with OSA. However, adherence to CPAP therapy is often suboptimal. This comprehensive review underscores the importance of the early recognition, timely diagnosis, and effective management of OSA in pregnancy to improve both maternal and fetal outcomes. Future research should focus on enhancing screening strategies and improving adherence to CPAP therapy in this population.
阻塞性睡眠呼吸暂停(OSA)是妊娠期的一种常见病,但诊断率低,与孕产妇和胎儿的各种并发症有关。本综述综合了有关妊娠期 OSA 的流行病学、病理生理学和神经学后果的现有证据,以及潜在的管理策略。文章来源于PubMed、EMBASE和Cochrane数据库,截止日期为2023年。我们的综合综述强调,由于体重增加和激素波动等生理变化,妊娠期 OSA 的发病率会增加。妊娠期 OSA 与妊娠高血压、先兆子痫、妊娠糖尿病以及胎儿潜在的不良结局(如宫内生长受限和早产)有关。持续气道正压(CPAP)疗法仍然是治疗孕妇 OSA 最有效的方法。然而,CPAP 治疗的依从性往往不尽如人意。本综述强调了早期识别、及时诊断和有效管理妊娠期 OSA 对改善母体和胎儿预后的重要性。未来的研究重点应放在加强筛查策略和提高该人群对 CPAP 治疗的依从性上。
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引用次数: 0
Correction: Szymanowicz et al. Headache and NOTCH3 Gene Variants in Patients with CADASIL. Neurol. Int. 2023, 15, 1238–1252 更正:Szymanowicz等:《CADASIL患者的头痛和NOTCH3基因变异》。Neurol.2023, 15, 1238-1252
IF 3 Q3 Medicine Pub Date : 2024-05-06 DOI: 10.3390/neurolint16030038
Oliwia Szymanowicz, Izabela Korczowska-Łącka, B. Słowikowski, Małgorzata Wiszniewska, Ada Piotrowska, Ulyana Goutor, Paweł P. Jagodziński, W. Kozubski, J. Dorszewska
Figure Description [...]
图表说明 [...]
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引用次数: 0
Oxidative Stress and Neurodegeneration: Insights and Therapeutic Strategies for Parkinson's Disease. 氧化应激与神经退行性变:帕金森病的见解和治疗策略》。
IF 3 Q3 Medicine Pub Date : 2024-04-29 DOI: 10.3390/neurolint16030037
Erjola Bej, Patrizia Cesare, Anna Rita Volpe, Michele d'Angelo, Vanessa Castelli

Parkinson's disease (PD) is a progressive neurodegenerative condition marked by the gradual deterioration of dopaminergic neurons in the substantia nigra. Oxidative stress has been identified as a key player in the development of PD in recent studies. In the first part, we discuss the sources of oxidative stress in PD, including mitochondrial dysfunction, dopamine metabolism, and neuroinflammation. This paper delves into the possibility of mitigating oxidative stress as a potential treatment approach for PD. In addition, we examine the hurdles and potential of antioxidant therapy, including the challenge of delivering antioxidants to the brain and the requirement for biomarkers to track oxidative stress in PD patients. However, even if antioxidant therapy holds promise, further investigation is needed to determine its efficacy and safety in PD treatment.

帕金森病(PD)是一种进行性神经退行性疾病,其特征是黑质中的多巴胺能神经元逐渐退化。近年来的研究发现,氧化应激是导致帕金森病发展的一个关键因素。在第一部分中,我们讨论了帕金森病氧化应激的来源,包括线粒体功能障碍、多巴胺代谢和神经炎症。本文深入探讨了减轻氧化应激作为一种潜在治疗方法的可能性。此外,我们还研究了抗氧化疗法的障碍和潜力,包括将抗氧化剂输送到大脑所面临的挑战,以及追踪帕金森病患者氧化应激的生物标记物的要求。然而,即使抗氧化疗法前景广阔,仍需进一步研究以确定其在帕金森病治疗中的有效性和安全性。
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引用次数: 0
Pain Catastrophizing: How Far Have We Come. 疼痛灾难化:我们已经走了多远
IF 3 Q3 Medicine Pub Date : 2024-04-26 DOI: 10.3390/neurolint16030036
Katarina Simic, Boris Savic, Nebojsa Nick Knezevic

The perception of pain is strongly influenced by various social, emotional, and cognitive factors. A psychological variable which has consistently been shown to exert its influence on pain is a cognitive process referred to as pain catastrophizing. Numerous studies have found it to be a strong predictor of pain intensity and disability across different clinical populations. It signifies a maladaptive response to pain marked by an exaggerated negative assessment, magnification of symptoms related to pain, and, in general, a tendency to experience marked pain-related worry, as well as experiencing feelings of helplessness when it comes to dealing with pain. Pain catastrophizing has been correlated to many adverse pain-related outcomes, including poor treatment response, unsatisfactory quality of life, and high disability related to both acute and chronic pain. Furthermore, there has been consistent evidence in support of a correlation between pain catastrophizing and mental health disorders, such as anxiety and depression. In this review, we aim to provide a comprehensive overview of the current state of knowledge regarding pain catastrophizing, with special emphasis on its clinical significance, and emerging treatment modalities which target it.

对疼痛的感知深受各种社会、情感和认知因素的影响。疼痛灾难化是一种认知过程,它一直被证明会对疼痛产生影响。大量研究发现,在不同的临床人群中,它是疼痛强度和残疾的一个强有力的预测因素。它标志着一种对疼痛的不适应反应,其特点是夸大负面评估、放大与疼痛相关的症状,总的来说,倾向于经历明显的与疼痛相关的担忧,以及在处理疼痛时的无助感。疼痛灾难化与许多与疼痛相关的不良后果有关,包括治疗反应差、生活质量不理想以及与急性和慢性疼痛相关的高度残疾。此外,有一致证据支持疼痛灾难化与焦虑和抑郁等心理健康疾病之间存在相关性。在这篇综述中,我们旨在全面概述当前有关疼痛灾难化的知识,特别强调其临床意义以及针对疼痛灾难化的新兴治疗模式。
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引用次数: 0
An Extensive Study Regarding the Microscopic Anatomy of the Early Fetal Human Optic Nerve. 关于人类胎儿早期视神经显微解剖的广泛研究
IF 3 Q3 Medicine Pub Date : 2024-04-24 DOI: 10.3390/neurolint16030035
Mihai Alin Publik, Florin Mihail Filipoiu, Adrian Vasile Dumitru, Andrei Precup, Ioan-Andrei Petrescu, Iulian Slavu, Raluca Florentina Tulin, Adrian Tulin, Andra Ioana Baloiu, Monica Mihaela Cirstoiu, Octavian Munteanu

The development of the optic nerve and its surrounding tissues during the early fetal period is a convoluted period because it spans both the organogenesis period and the fetal period. This study details the microscopic anatomy and histoembryology of the optic nerve in embryos during the early fetal period, including the second half of the first trimester of pregnancy. Serial sections through the orbit of variously aged embryos allowed us to analyze the nerve in both longitudinal and transverse aspects. A histological assessment and description of the structures surrounding and inside the nerve were performed, highlighting the cellular subtypes involved. By employing immunohistochemical techniques, we could characterize the presence and distribution of astrocytes within the optic nerve. Our findings suggest that by the 8th gestational week (WG) the structures are homologs to all the adult ones but with an early appearance so that maturation processes take place afterward. By this age, the axons forming the nerve are definitive adult axons. The glial cells do not yet exhibit adult phenotype, but their aspect becomes adult toward the 13th week. During its development the optic nerve increases in size then, at 14 weeks, it shrinks considerably, possibly through its neural maturation process. The morphological primordium of the blood-nerve barrier can be first noted at 10 WG and at 13 WG the morphological blood-nerve barrier is definitive. The meningeal primordium can be first noted as a layer of agglomerated fibroblasts, later toward 13 WG splitting in pachymeninx and leptomeninges and leaving space for intrinsic blood vessels.

胎儿早期视神经及其周围组织的发育是一个复杂的时期,因为它跨越了器官形成期和胎儿期。本研究详细介绍了胎儿早期(包括妊娠头三个月的后半期)胚胎视神经的显微解剖学和组织胚胎学。通过对不同年龄胚胎眼眶的连续切片,我们对神经进行了纵向和横向分析。我们对神经周围和内部的结构进行了组织学评估和描述,突出了所涉及的细胞亚型。通过免疫组化技术,我们可以确定视神经内星形胶质细胞的存在和分布特征。我们的研究结果表明,到第 8 个孕周(WG)时,视神经结构与所有成年视神经结构同源,但出现较早,因此成熟过程发生在此之后。在这个年龄段,形成神经的轴突是明确的成人轴突。神经胶质细胞还没有表现出成体表型,但在第 13 周时,其表型会变成成体。在发育过程中,视神经的体积不断增大,到 14 周时,视神经体积明显缩小,这可能是神经成熟过程的结果。血神经屏障的形态初基可在第 10 周时首次发现,而在第 13 周时,血神经屏障的形态已确定。脑膜原基最初表现为一层聚集的成纤维细胞,后来在 13 WG 时会在棘脑膜和钩脑膜上分裂,并为固有血管留出空间。
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引用次数: 0
The Impact of Acute Postoperative Pain in Developing Chronic Pain after Total Knee Arthroplasty. 全膝关节置换术后急性疼痛对形成慢性疼痛的影响
IF 3 Q3 Medicine Pub Date : 2024-04-18 DOI: 10.3390/neurolint16020034
N. Knezevic, Osman Syed, Christopher Kabir, Aisha Patel, Isabel Rao Shuai, Antony R. Tharian
While total knee arthroplasties (TKAs) are performed with the intent to reduce pain, chronic postsurgical pain (CPSP) is one of the most well-documented complications that can occur following surgery. This study aimed to assess whether perioperative factors, focusing on acute postsurgical pain and perioperative opioid consumption, were associated with the development of chronic postsurgical pain. Under general anesthesia, 108 patients underwent TKA and were treated postoperatively with a multimodal analgesia approach. Numeric Rating Scale (NRS) pain scores at rest and with movement were recorded on postoperative days 0-3, 7, 14, and 30. Patients were sent a survey to assess chronic pain at months 22-66, which was examined as a single-group post hoc analysis. Based on the responses, patients were either classified into the CPSP or non-CPSP patient group. Chronic postsurgical pain was defined as an NRS score ≥ 4 with movement and the presence of resting pain. The primary outcome was a change in NRS. There were no differences in NRS pain scores with movement in the first 30 days postoperatively between patients with CPSP and without CPSP. Each unit increase in resting pain on postoperative days 3 and 14 was associated with significantly greater odds of CPSP presence (OR = 1.52; OR = 1.61, respectively), with a trend towards greater odds of CPSP at days 7 and 30 (OR = 1.33; OR = 1.43, respectively). We found that very intense pain in the initial phase seems to be related to the development of CPSP after TKA.
虽然进行全膝关节置换术(TKAs)的目的是为了减轻疼痛,但慢性术后疼痛(CPSP)是术后可能出现的并发症中最有据可查的一种。本研究旨在评估围手术期因素(主要是急性手术后疼痛和围手术期阿片类药物的消耗)是否与慢性手术后疼痛的发生有关。在全身麻醉的情况下,108 名患者接受了 TKA 手术,术后接受了多模式镇痛治疗。术后第 0-3、7、14 和 30 天记录了休息时和运动时的疼痛评分。向患者发送了一份调查问卷,以评估患者在术后 22-66 个月的慢性疼痛情况,并进行了单组事后分析。根据患者的回答,将其分为 CPSP 或非 CPSP 患者组。手术后慢性疼痛的定义是:运动时 NRS 评分≥ 4 分,且存在静息痛。主要结果是 NRS 的变化。有 CPSP 和没有 CPSP 的患者在术后前 30 天活动时的 NRS 疼痛评分没有差异。术后第 3 天和第 14 天静息疼痛每增加一个单位,出现 CPSP 的几率就明显增加(OR = 1.52;OR = 1.61,分别为 1.52 和 1.61),第 7 天和第 30 天出现 CPSP 的几率也呈增加趋势(OR = 1.33;OR = 1.43,分别为 1.33 和 1.43)。我们发现,TKA术后初期的剧烈疼痛似乎与CPSP的发生有关。
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引用次数: 0
Thecaloscopy Reduces the Risk of Recurrent Perineural (Tarlov) Cysts after Microsurgical Resection. 膀胱镜检查可降低显微外科切除术后复发会阴(Tarlov)囊肿的风险。
IF 3 Q3 Medicine Pub Date : 2024-04-17 DOI: 10.3390/neurolint16020033
M. Luchtmann, A. Klammer, Mircea-Alin Iova, André Roth, Vijay Kumar Chanamolu, C. Mawrin, J. Warnke
Sacral Tarlov cysts (TCs), often asymptomatic, can cause significant pain and severe neurological dysfunction. Conventional treatments are generally associated with high recurrence and complication rates. Specifically, the substantial recurrence rates, which can reach as high as 50%, significantly impact long-term outcomes. Recent evidence increasingly supports the hypothesis that the formation of Tarlov cysts (TCs) may be associated with inflammatory processes within the nerve root sheath, further exacerbated by elevated cerebrospinal fluid (CSF) pressure. This retrospective study explores thecaloscopy, combined with surgical techniques, as a more effective alternative. We observed a total of 78 patients, 48 of whom underwent endoscopic fenestration of the arachnoid sheath in addition to microsurgical resection of the TC. We found that the fenestration of the arachnoid sheath at the level of lumbosacral spinal nerve root entry led to a significantly decreased risk of developing recurrent TCs (5/48 vs. 9/30). Only one of the patients suffered from a persistent new bladder dysfunction after microsurgical resection. This presented technique provides a promising treatment path for the future management of TCs, offering a safe and more effective treatment option compared to previous methods. Additionally, the advantages of the thecaloscopy provide pathophysiological implications regarding the development of perineural cysts.
骶骨塔洛夫囊肿(Tarlov cysts,TCs)通常无症状,但可引起明显疼痛和严重的神经功能障碍。传统治疗方法的复发率和并发症发生率通常很高。具体而言,复发率可高达 50%,这对长期治疗效果有很大影响。最近有越来越多的证据支持这样一种假设,即塔尔洛夫囊肿(TCs)的形成可能与神经根鞘内的炎症过程有关,而脑脊液(CSF)压力升高又进一步加剧了这种炎症过程。这项回顾性研究探讨了颅骨镜检查与手术技术相结合,作为一种更有效的替代方法。我们共观察了 78 名患者,其中 48 人在接受显微外科手术切除 TC 的同时,还接受了内窥镜蛛网膜鞘切开术。我们发现,在腰骶部脊神经根入口处进行蛛网膜鞘切开术后,复发性 TC 的发病风险明显降低(5/48 对 9/30)。只有一名患者在显微手术切除后出现了新的持续性膀胱功能障碍。与以往的方法相比,该技术提供了一种更安全、更有效的治疗方案,为今后治疗膀胱直肠癌提供了一条前景广阔的治疗途径。此外,膀胱镜检查的优势还为会厌囊肿的发展提供了病理生理学意义。
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引用次数: 0
Neurocognitive Impairment and Social Cognition in Parkinson's Disease Patients. 帕金森病患者的神经认知障碍和社交认知。
IF 3 Q3 Medicine Pub Date : 2024-04-16 DOI: 10.3390/neurolint16020032
T. Doskas, Konstantinos Vadikolias, Konstantinos T. Ntoskas, George D. Vavougios, D. Tsiptsios, Polyxeni Stamati, Ioannis Liampas, V. Siokas, L. Messinis, G. Nasios, E. Dardiotis
In addition to motor symptoms, neurocognitive impairment (NCI) affects patients with prodromal Parkinson's disease (PD). NCI in PD ranges from subjective cognitive complaints to dementia. The purpose of this review is to present the available evidence of NCI in PD and highlight the heterogeneity of NCI phenotypes as well as the range of factors that contribute to NCI onset and progression. A review of publications related to NCI in PD up to March 2023 was performed using PubMed/Medline. There is an interconnection between the neurocognitive and motor symptoms of the disease, suggesting a common underlying pathophysiology as well as an interconnection between NCI and non-motor symptoms, such as mood disorders, which may contribute to confounding NCI. Motor and non-motor symptom evaluation could be used prognostically for NCI onset and progression in combination with imaging, laboratory, and genetic data. Additionally, the implications of NCI on the social cognition of afflicted patients warrant its prompt management. The etiology of NCI onset and its progression in PD is multifactorial and its effects are equally grave as the motor effects. This review highlights the importance of the prompt identification of subjective cognitive complaints in PD patients and NCI management.
除运动症状外,神经认知障碍(NCI)也会影响帕金森病(PD)前驱期患者。帕金森病的神经认知障碍包括从主观认知抱怨到痴呆等各种症状。本综述的目的是介绍帕金森病NCI的现有证据,并强调NCI表型的异质性以及导致NCI发病和进展的一系列因素。我们使用PubMed/Medline对截至2023年3月与帕金森病NCI相关的出版物进行了综述。该病的神经认知症状和运动症状之间存在相互联系,这表明存在共同的潜在病理生理学,而NCI和情绪障碍等非运动症状之间也存在相互联系,这可能会对NCI造成混淆。运动和非运动症状评估可与影像学、实验室和遗传学数据相结合,用于预测 NCI 的发病和进展。此外,NCI 对患者社会认知的影响也需要及时处理。帕金森氏病 NCI 发病和进展的病因是多因素的,其影响与运动影响同样严重。本综述强调了及时发现帕金森病患者的主观认知症状并对 NCI 进行管理的重要性。
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引用次数: 0
[125I]IPC-Lecanemab: Synthesis and Evaluation of Aβ-Plaque-Binding Antibody and Comparison with Small-Molecule [18F]Flotaza and [125I]IBETA in Postmortem Human Alzheimer's Disease. [125I]IPC-Lecanemab:Aβ-Plaque 结合型抗体的合成与评估,以及与小分子 [18F]Flotaza 和 [125I]IBETA 在死后人类阿尔茨海默病中的比较。
IF 3 Q3 Medicine Pub Date : 2024-04-08 DOI: 10.3390/neurolint16020031
Christopher Liang, Cayz G. Paclibar, Noresa L. Gonzaga, Stephanie A. Sison, Harman S. Bath, Agnes P. Biju, Jogeshwar Mukherjee
Therapeutic antibodies for reducing Aβ plaque load in Alzheimer's disease (AD) is currently making rapid progress. The diagnostic imaging of Aβ plaque load in AD has been underway and is now used in clinical studies. Here, we report our preliminary findings on imaging a therapeutic antibody, Lecanemab, in a postmortem AD brain anterior cingulate. [125I]5-iodo-3-pyridinecarboxamido-Lecanemab ([125I]IPC-Lecanemab) was prepared by coupling N-succinimidyl-5-([125I]iodo)-3-pyridinecarboxylate with Lecanemab in modest yields. The distinct binding of [125I]IPC-Lecanemab to Aβ-rich regions in postmortem human AD brains was higher in grey matter (GM) containing Aβ plaques compared to white matter (WM) (GM/WM was 1.6). Anti-Aβ immunostaining was correlated with [125I]IPC-Lecanemab regional binding in the postmortem AD human brains. [125I]IPC-Lecanemab binding was consistent with the binding of Aβ small molecules, [18F]flotaza and [125I]IBETA, in the same subjects. [18F]Flotaza and [125I]IBETA, however, exhibited significantly higher GM/WM ratios (>20) compared to [125I]IPC-Lecanemab. Our results suggest that radiolabeled [125I]IPC-Lecanemab retains the ability to bind to Aβ in human AD and may therefore be useful as a PET imaging radiotracer when labeled as [124I]IPC-Lecanemab. The ability to directly visualize in vivo a promising therapeutic antibody for AD may be useful in treatment planning and dosing and could be complimentary to small-molecule diagnostic imaging to assess outcomes of therapeutic interventions.
减少阿尔茨海默病(AD)Aβ 斑块负荷的治疗性抗体目前进展迅速。对阿尔茨海默病 Aβ 斑块负荷的诊断成像一直在进行,目前已用于临床研究。在此,我们报告了我们对一种治疗性抗体--Lecanemab--在AD死后大脑前扣带回中成像的初步研究结果。[125I]5-碘-3-吡啶羧酰胺-莱卡单抗([125I]IPC-Lecanemab)是通过将 N-琥珀酰亚胺基-5-([125I]碘)-3-吡啶羧酸酯与莱卡单抗偶联制备的,产量不大。[125I]IPC-Lecanemab与死后人类AD大脑中富含Aβ的区域明显结合,与白质(WM)相比,含有Aβ斑块的灰质(GM)结合率更高(GM/WM为1.6)。抗Aβ免疫染色与AD死后人脑中[125I]IPC-Lecanemab区域结合相关。[125I]IPC-Lecanemab的结合与Aβ小分子[18F]氟他扎和[125I]IBETA在同一受试者中的结合一致。然而,与[125I]IPC-Lecanemab 相比,[18F]氟他扎和[125I]IBETA 的 GM/WM 比率(>20)明显更高。我们的研究结果表明,放射性标记的[125I]IPC-Lecanemab在人类AD中仍能与Aβ结合,因此标记为[124I]IPC-Lecanemab后可用作PET成像放射性示踪剂。在体内直接观察一种有希望治疗AD的抗体可能有助于制定治疗计划和剂量,并可与小分子诊断成像相结合,评估治疗干预的效果。
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引用次数: 0
Mortality Predictors for Adult Patients with Mild-to-Moderate Traumatic Brain Injury: A Literature Review. 轻度至中度创伤性脑损伤成人患者的死亡率预测因素:文献综述。
IF 3 Q3 Medicine Pub Date : 2024-04-05 DOI: 10.3390/neurolint16020030
Ansam Eghzawi, Alameen Alsabbah, Shatha Gharaibeh, Iktimal Alwan, Abeer Gharaibeh, Anita V. Goyal
Traumatic brain injuries (TBIs) represent a significant public health concern, with mild-to-moderate cases comprising a substantial portion of incidents. Understanding the predictors of mortality among adult patients with mild-to-moderate TBIs is crucial for optimizing clinical management and improving outcomes. This literature review examines the existing research to identify and analyze the mortality predictors in this patient population. Through a comprehensive review of peer-reviewed articles and clinical studies, key prognostic factors, such as age, Glasgow Coma Scale (GCS) score, the presence of intracranial hemorrhage, pupillary reactivity, and coexisting medical conditions, are explored. Additionally, this review investigates the role of advanced imaging modalities, biomarkers, and scoring systems in predicting mortality following a mild-to-moderate TBI. By synthesizing the findings from diverse studies, this review aims to provide clinicians and researchers with valuable insights into the factors influencing mortality outcomes in adult patients with a mild-to-moderate TBI, thus facilitating more informed decision making and targeted interventions in clinical practice.
创伤性脑损伤(TBI)是一个重大的公共卫生问题,其中轻度至中度病例占事故的很大一部分。了解轻度至中度创伤性脑损伤成年患者的死亡率预测因素对于优化临床管理和改善预后至关重要。本文献综述对现有研究进行了审查,以确定和分析这一患者群体的死亡率预测因素。通过对同行评审文章和临床研究的全面回顾,探讨了一些关键的预后因素,如年龄、格拉斯哥昏迷量表 (GCS) 评分、是否存在颅内出血、瞳孔反应性和并存的医疗状况。此外,本综述还探讨了先进的成像模式、生物标志物和评分系统在预测轻度至中度创伤性脑损伤后死亡率方面的作用。通过综合不同研究的结果,本综述旨在为临床医生和研究人员提供关于影响轻度至中度创伤性脑损伤成年患者死亡率的因素的宝贵见解,从而有助于在临床实践中做出更明智的决策和有针对性的干预措施。
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引用次数: 0
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Neurology International
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