首页 > 最新文献

Therapeutic Advances in Neurological Disorders最新文献

英文 中文
Possible clinical and radiological predictors of haemorrhagic transformation in acute stroke patients undergoing dual antiplatelet therapy: a clinical study. 接受双重抗血小板治疗的急性中风患者出血性转变的可能临床和放射学预测因素:一项临床研究。
IF 4.7 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-21 eCollection Date: 2024-01-01 DOI: 10.1177/17562864241289735
Maria Rosaria Bagnato, Ilaria Maestrini, Leonardo Bruno, Ilaria Ciullo, Federica D'Agostino, Giordano Lacidogna, Federico Marrama, Alfredo Paolo Mascolo, Alessandro Rocco, Marina Diomedi

Background: The predictors of intracranial haemorrhagic transformation (HT) in acute ischaemic stroke (AIS) patients undergoing dual antiplatelet therapy (DAPT) are not well known.

Objectives: The aim of this study is to identify the possible clinical and radiological predictors of HT in patients, irrespective of clinical indication for this treatment.

Design: This study is a monocentric cohort retrospective study.

Methods: We enrolled consecutive AIS patients, from our prospective register, admitted to Stroke Unit between June 2021 and June 2023 undergoing DAPT with Acetylsalicylic Acid and Clopidogrel within 72 h from symptoms onset. According to current guidelines, DAPT indication was for patients with a minor stroke, symptomatic intracranial artery stenosis and carotid angioplasty stenting. We collected clinical, demographical and radiological data. We used ABC/2 method to measure stroke volume in magnetic resonance imaging (MRI)/Diffusion-weighted imaging (DWI) sequences performed within 48 h. The primary outcome was the presence of HT at non-contrast brain computed tomography, performed 7 days after commencing DAPT.

Results: One hundred ninety-four patients were included. Twenty-eight (14.4%) presented HT. Higher NIH Stroke Scale (NIHSS) and MRI/DWI lesion volume related to increased risk of HT (p < 0.001). Reperfusion therapy and mechanical thrombectomy (MT), stent placement and a loading dose (LD) of dual antiplatelet or Clopidogrel were associated with a higher occurrence of HT (p < 0.05). Furthermore, we individuated an NIHSS cut-off value >4 (area under the curve (AUC) 0.80, sensitivity 0.82, specificity 0.65) and a volume cut-off value >8.2 ml (AUC 0.82, sensitivity 0.79, specificity 0.80) associated with an increased risk of HT (respectively, adjusted odds ratio (adj. OR) 6.5, confidence interval (CI) 1.3-32.7, p = 0.024 and adj. OR 11.0, CI 3.1-39.2, p < 0.001).

Conclusion: In clinical practice, MT treatment, antiplatelet LD administration, stent placement and clinical severity may relate to a higher risk of HT in patients with AIS and DAPT in the acute phase. In particular, we found that lesion volume cut-off could help to identify patients at greater risk of HT, regardless of the indication for DAPT.

背景:接受双重抗血小板治疗(DAPT)的急性缺血性卒中(AIS)患者颅内出血转化(HT)的预测因素尚不十分清楚:本研究旨在确定患者发生出血性转化的可能临床和放射学预测因素,无论该治疗的临床指征如何:本研究是一项单中心队列回顾性研究:我们从我们的前瞻性登记册中选取了 2021 年 6 月至 2023 年 6 月期间入住卒中单元的连续 AIS 患者,这些患者在症状出现后 72 小时内接受了乙酰水杨酸和氯吡格雷的 DAPT 治疗。根据现行指南,DAPT适用于轻微脑卒中、无症状颅内动脉狭窄和颈动脉血管成形术支架植入术患者。我们收集了临床、人口统计学和放射学数据。我们采用ABC/2法测量48小时内磁共振成像(MRI)/弥散加权成像(DWI)序列中的卒中体积,主要结果是在开始DAPT 7天后进行的非对比脑计算机断层扫描中出现HT:结果:共纳入了 194 名患者。结果:共纳入 194 名患者,其中 28 人(14.4%)出现高热。较高的美国国立卫生研究院卒中量表(NIHSS)和 MRI/DWI 病灶体积与 HT 风险增加有关(p p 4(曲线下面积(AUC)0.80,敏感性 0.82,特异性 0.65),体积临界值 >8.2 ml(AUC 0.82,灵敏度 0.79,特异性 0.80)与 HT 风险增加有关(分别为调整比值比(adj. OR)6.5,置信区间(CI)1.3-32.7,p = 0.024 和调整比值比(adj. OR)11.0,CI 3.1-39.2,p 结论:在临床实践中,MT 治疗、抗血小板 LD 给药、支架置入和临床严重程度可能与急性期使用 DAPT 的 AIS 患者发生 HT 的风险较高有关。特别是,我们发现,无论 DAPT 的适应症如何,病变体积截断有助于识别 HT 风险较高的患者。
{"title":"Possible clinical and radiological predictors of haemorrhagic transformation in acute stroke patients undergoing dual antiplatelet therapy: a clinical study.","authors":"Maria Rosaria Bagnato, Ilaria Maestrini, Leonardo Bruno, Ilaria Ciullo, Federica D'Agostino, Giordano Lacidogna, Federico Marrama, Alfredo Paolo Mascolo, Alessandro Rocco, Marina Diomedi","doi":"10.1177/17562864241289735","DOIUrl":"https://doi.org/10.1177/17562864241289735","url":null,"abstract":"<p><strong>Background: </strong>The predictors of intracranial haemorrhagic transformation (HT) in acute ischaemic stroke (AIS) patients undergoing dual antiplatelet therapy (DAPT) are not well known.</p><p><strong>Objectives: </strong>The aim of this study is to identify the possible clinical and radiological predictors of HT in patients, irrespective of clinical indication for this treatment.</p><p><strong>Design: </strong>This study is a monocentric cohort retrospective study.</p><p><strong>Methods: </strong>We enrolled consecutive AIS patients, from our prospective register, admitted to Stroke Unit between June 2021 and June 2023 undergoing DAPT with Acetylsalicylic Acid and Clopidogrel within 72 h from symptoms onset. According to current guidelines, DAPT indication was for patients with a minor stroke, symptomatic intracranial artery stenosis and carotid angioplasty stenting. We collected clinical, demographical and radiological data. We used ABC/2 method to measure stroke volume in magnetic resonance imaging (MRI)/Diffusion-weighted imaging (DWI) sequences performed within 48 h. The primary outcome was the presence of HT at non-contrast brain computed tomography, performed 7 days after commencing DAPT.</p><p><strong>Results: </strong>One hundred ninety-four patients were included. Twenty-eight (14.4%) presented HT. Higher NIH Stroke Scale (NIHSS) and MRI/DWI lesion volume related to increased risk of HT (<i>p</i> < 0.001). Reperfusion therapy and mechanical thrombectomy (MT), stent placement and a loading dose (LD) of dual antiplatelet or Clopidogrel were associated with a higher occurrence of HT (<i>p</i> < 0.05). Furthermore, we individuated an NIHSS cut-off value >4 (area under the curve (AUC) 0.80, sensitivity 0.82, specificity 0.65) and a volume cut-off value >8.2 ml (AUC 0.82, sensitivity 0.79, specificity 0.80) associated with an increased risk of HT (respectively, adjusted odds ratio (adj. OR) 6.5, confidence interval (CI) 1.3-32.7, <i>p</i> = 0.024 and adj. OR 11.0, CI 3.1-39.2, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>In clinical practice, MT treatment, antiplatelet LD administration, stent placement and clinical severity may relate to a higher risk of HT in patients with AIS and DAPT in the acute phase. In particular, we found that lesion volume cut-off could help to identify patients at greater risk of HT, regardless of the indication for DAPT.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241289735"},"PeriodicalIF":4.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Beyond lines of treatment: embracing early high-efficacy disease-modifying treatments for multiple sclerosis management. 超越治疗线:在多发性硬化症治疗中采用早期高效疾病修饰疗法。
IF 4.7 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-16 eCollection Date: 2024-01-01 DOI: 10.1177/17562864241284372
Celia Oreja-Guevara, Sergio Martínez-Yélamos, Sara Eichau, Miguel Ángel Llaneza, Jesús Martín-Martínez, Joaquín Peña-Martínez, Virginia Meca-Lallana, Ana María Alonso-Torres, Ester Moral-Torres, Jordi Río, Carmen Calles, Adrián Ares-Luque, Lluís Ramió-Torrentà, María Eugenia Marzo-Sola, José María Prieto, María Luisa Martínez-Ginés, Rafael Arroyo, María Ángeles Otano-Martínez, Luis Brieva-Ruiz, Montserrat Gómez-Gutiérrez, Alfredo Rodríguez-Antigüedad, Victoria Galán Sánchez-Seco, Lucienne Costa-Frossard, Miguel Ángel Hernández-Pérez, Lamberto Landete-Pascual, Montserrat González-Platas, José E Meca-Lallana

Recent advances in multiple sclerosis (MS) management have shifted perspectives on treatment strategies, advocating for the early initiation of high-efficacy disease-modifying therapies (heDMTs). This perspective review discusses the rationale, benefits, and challenges associated with early heDMT initiation, reflecting on the obsolescence of the traditional "first-line" and "second-line" treatment classifications. The article emerges from the last update of the consensus document of the Spanish Society of Neurology on the treatment of MS. During its development, there was a recognized need to further discuss the concept of treatment lines and the early use of heDMTs. Evidence from randomized controlled trials and real-world studies suggests that early heDMT initiation leads to improved clinical outcomes, including reduced relapse rates, slowed disease progression, and decreased radiological activity, especially in younger patients or those in early disease stages. Despite the historical belief that heDMTs involve more risks and adverse events compared to moderate-efficacy DMTs (meDMTs), some studies have reported comparable safety profiles between early heDMTs and meDMTs, though long-term safety data are still lacking. The review also addresses the need for a personalized approach based on patient characteristics, prognostic factors, and preferences, explores the importance of therapeutic inertia, and highlights the evolving landscape of international and national guidelines that increasingly advocate for early intensive treatment approaches. The article also addresses the challenges of ensuring access to these therapies and the importance of further research to establish long-term safety and effectiveness of DMTs in MS.

多发性硬化症(MS)治疗的最新进展改变了人们对治疗策略的看法,主张尽早启用高效的疾病修饰疗法(heDMTs)。这篇观点综述讨论了早期启动 heDMT 的理由、益处和挑战,并对传统的 "一线 "和 "二线 "治疗分类的过时进行了反思。这篇文章源于西班牙神经病学学会关于多发性硬化症治疗的共识文件的最后一次更新。在该文件的制定过程中,人们认识到有必要进一步讨论治疗线的概念和 heDMTs 的早期使用。来自随机对照试验和真实世界研究的证据表明,早期开始使用 heDMT 可改善临床疗效,包括降低复发率、减缓疾病进展和减少放射学活动,尤其是对年轻患者或处于疾病早期阶段的患者。尽管人们历来认为,与中等疗效的 DMTs(meDMTs)相比,heDMTs 涉及更多的风险和不良事件,但一些研究报告显示,早期 heDMTs 和 meDMTs 的安全性相当,但仍缺乏长期安全性数据。综述还讨论了根据患者特征、预后因素和偏好采取个性化治疗方法的必要性,探讨了治疗惰性的重要性,并强调了国际和国内指南不断变化的情况,这些指南越来越多地倡导早期强化治疗方法。文章还探讨了确保获得这些疗法所面临的挑战,以及进一步开展研究以确定 DMTs 在多发性硬化症中的长期安全性和有效性的重要性。
{"title":"Beyond lines of treatment: embracing early high-efficacy disease-modifying treatments for multiple sclerosis management.","authors":"Celia Oreja-Guevara, Sergio Martínez-Yélamos, Sara Eichau, Miguel Ángel Llaneza, Jesús Martín-Martínez, Joaquín Peña-Martínez, Virginia Meca-Lallana, Ana María Alonso-Torres, Ester Moral-Torres, Jordi Río, Carmen Calles, Adrián Ares-Luque, Lluís Ramió-Torrentà, María Eugenia Marzo-Sola, José María Prieto, María Luisa Martínez-Ginés, Rafael Arroyo, María Ángeles Otano-Martínez, Luis Brieva-Ruiz, Montserrat Gómez-Gutiérrez, Alfredo Rodríguez-Antigüedad, Victoria Galán Sánchez-Seco, Lucienne Costa-Frossard, Miguel Ángel Hernández-Pérez, Lamberto Landete-Pascual, Montserrat González-Platas, José E Meca-Lallana","doi":"10.1177/17562864241284372","DOIUrl":"10.1177/17562864241284372","url":null,"abstract":"<p><p>Recent advances in multiple sclerosis (MS) management have shifted perspectives on treatment strategies, advocating for the early initiation of high-efficacy disease-modifying therapies (heDMTs). This perspective review discusses the rationale, benefits, and challenges associated with early heDMT initiation, reflecting on the obsolescence of the traditional \"first-line\" and \"second-line\" treatment classifications. The article emerges from the last update of the consensus document of the Spanish Society of Neurology on the treatment of MS. During its development, there was a recognized need to further discuss the concept of treatment lines and the early use of heDMTs. Evidence from randomized controlled trials and real-world studies suggests that early heDMT initiation leads to improved clinical outcomes, including reduced relapse rates, slowed disease progression, and decreased radiological activity, especially in younger patients or those in early disease stages. Despite the historical belief that heDMTs involve more risks and adverse events compared to moderate-efficacy DMTs (meDMTs), some studies have reported comparable safety profiles between early heDMTs and meDMTs, though long-term safety data are still lacking. The review also addresses the need for a personalized approach based on patient characteristics, prognostic factors, and preferences, explores the importance of therapeutic inertia, and highlights the evolving landscape of international and national guidelines that increasingly advocate for early intensive treatment approaches. The article also addresses the challenges of ensuring access to these therapies and the importance of further research to establish long-term safety and effectiveness of DMTs in MS.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241284372"},"PeriodicalIF":4.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Nerve decompression for diabetic peripheral neuropathy with nerve entrapment: a narrative review. 神经减压术治疗伴有神经卡压的糖尿病周围神经病变:综述。
IF 4.7 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-14 eCollection Date: 2024-01-01 DOI: 10.1177/17562864241265287
Chenlong Liao, Wenchuan Zhang

Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes which primarily affects the sensory nervous system. Pain is the most common complaint that prompts patients to seek medical advice. With various presentations and intricate pathological mechanisms, diabetic peripheral neuropathic pain is currently the most crucial and challenging aspect of managing diabetic complications. As a heterogeneous disorder, there is no medication or treatment modality that is effective for all types of DPN and its associated neuropathic pain. Peripheral nerve decompression provides a new option for treating patients with diabetic peripheral neuropathic pain in the lower extremities. However, the clinical applicability of nerve decompression has been debated since it was first proposed. This review discusses the theoretical basis of nerve decompression, the clinical indications, and the progress of basic research based on the pathological mechanisms and nerve impairment patterns of diabetic peripheral neuropathic pain. The heterogeneity of DPN patients is summarized in terms of three aspects: complex pathophysiological mechanisms, multilevel nervous system involvement, and various nerve impairment properties. Identifying the presence of nerve entrapment among complex pathophysiological mechanisms is the key to successful outcomes. Tinel signs, focal pain, mechanical allodynia, and two-point discrimination were reported to be prognostic factors for good surgical outcomes, and their predictive ability might stem from their association with the early stage of entrapment neuropathy.

糖尿病周围神经病变(DPN)是糖尿病最常见的并发症之一,主要影响感觉神经系统。疼痛是促使患者就医的最常见主诉。糖尿病周围神经病理性疼痛的表现多种多样,病理机制错综复杂,是目前糖尿病并发症治疗中最关键、最具挑战性的问题。作为一种异质性疾病,没有一种药物或治疗方法对所有类型的 DPN 及其相关神经病理性疼痛都有效。周围神经减压术为治疗糖尿病下肢周围神经痛患者提供了一种新的选择。然而,自神经减压术首次提出以来,其临床适用性一直备受争议。本综述讨论了神经减压术的理论基础、临床适应症以及基于糖尿病周围神经痛的病理机制和神经损伤模式的基础研究进展。从复杂的病理生理机制、多层次神经系统受累和各种神经损伤特性三个方面总结了 DPN 患者的异质性。在复杂的病理生理机制中识别神经卡压的存在是成功治疗的关键。据报道,Tinel 征、局灶性疼痛、机械异感和两点辨别力是良好手术效果的预后因素,其预测能力可能源于它们与卡压神经病变早期阶段的关联。
{"title":"Nerve decompression for diabetic peripheral neuropathy with nerve entrapment: a narrative review.","authors":"Chenlong Liao, Wenchuan Zhang","doi":"10.1177/17562864241265287","DOIUrl":"https://doi.org/10.1177/17562864241265287","url":null,"abstract":"<p><p>Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes which primarily affects the sensory nervous system. Pain is the most common complaint that prompts patients to seek medical advice. With various presentations and intricate pathological mechanisms, diabetic peripheral neuropathic pain is currently the most crucial and challenging aspect of managing diabetic complications. As a heterogeneous disorder, there is no medication or treatment modality that is effective for all types of DPN and its associated neuropathic pain. Peripheral nerve decompression provides a new option for treating patients with diabetic peripheral neuropathic pain in the lower extremities. However, the clinical applicability of nerve decompression has been debated since it was first proposed. This review discusses the theoretical basis of nerve decompression, the clinical indications, and the progress of basic research based on the pathological mechanisms and nerve impairment patterns of diabetic peripheral neuropathic pain. The heterogeneity of DPN patients is summarized in terms of three aspects: complex pathophysiological mechanisms, multilevel nervous system involvement, and various nerve impairment properties. Identifying the presence of nerve entrapment among complex pathophysiological mechanisms is the key to successful outcomes. Tinel signs, focal pain, mechanical allodynia, and two-point discrimination were reported to be prognostic factors for good surgical outcomes, and their predictive ability might stem from their association with the early stage of entrapment neuropathy.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241265287"},"PeriodicalIF":4.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11475385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Personality traits in patients with multiple sclerosis: their association with nicotine dependence and polypharmacy. 多发性硬化症患者的人格特质:与尼古丁依赖和多药治疗的关系。
IF 4.7 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-14 eCollection Date: 2024-01-01 DOI: 10.1177/17562864241279118
Janina Meißner, Niklas Frahm, Michael Hecker, Silvan Elias Langhorst, Pegah Mashhadiakbar, Barbara Streckenbach, Katja Burian, Julia Baldt, Felicita Heidler, Jörg Richter, Uwe Klaus Zettl
<p><strong>Background: </strong>The modifiable risk factor exerting the most substantial influence on the development and disease course of multiple sclerosis (MS) is cigarette smoking. Furthermore, smoking is associated with a higher risk of suffering from one or more comorbidities and potentially contributes to polypharmacy. We aimed to use personality tests to explore health-promoting and harmful patient characteristics.</p><p><strong>Objective: </strong>To investigate two important factors influencing the course of MS - the degree of smoking dependence and the status of polypharmacy - in association with personality traits.</p><p><strong>Design: </strong>This is a bicentric, cross-sectional study.</p><p><strong>Methods: </strong>We collected sociodemographic, clinical and medical data from patients with MS (<i>n</i> = 375) at two German neurological clinics. The participants were asked to complete the NEO Five-Factor Inventory (NEO-FFI) and the Temperament and Character Inventory-Revised (TCI-R). Relationships between variables were examined using correlation analyses, and differences between groups were examined using linear models. Current smokers with MS were also asked to complete the Fagerström questionnaire to categorize them into patients with mild, moderate and severe smoking dependence.</p><p><strong>Results: </strong>In our sample, 67.5% were women, and the mean age was 48.1 years. The patients had a median Expanded Disability Status Scale of 3.0 at a median disease duration of 10 years. Patients with MS with severe smoking dependence had on average a significantly higher neuroticism score in the NEO-FFI compared to those with mild or moderate smoking dependence. Patients with MS and polypharmacy had significantly higher neuroticism scores than those without. In the extraversion scale of the NEO-FFI, patients with MS and polypharmacy had significantly lower scores on average. Significant differences were also found when analysing the TCI-R in patients with MS and heavy smoking dependence, with higher scores for harm avoidance (HA) and lower scores for reward dependence, self-directedness (S-D) and cooperativeness (CO) in various subscales. Polypharmacy in patients with MS was associated with higher scores for HA and self-transcendence. Furthermore, patients with polypharmacy showed lower values than patients without polypharmacy in individual subscales of the dimensions of persistence, S-D and CO.</p><p><strong>Conclusion: </strong>Using the NEO-FFI, we were able to show that neuroticism is a detrimental trait and extraversion a protective trait in patients with MS in relation to nicotine dependence and polypharmacy. In addition, the evaluation of the TCI-R showed that high HA as well as low S-D and CO scores were more common in patients with MS and nicotine dependence or polypharmacy. With this knowledge, the risk of polypharmacy and smoking can be understood in the context of personality characteristics and targeted treatment and
背景:对多发性硬化症(MS)的发病和病程影响最大的可改变风险因素是吸烟。此外,吸烟还与患有一种或多种并发症的较高风险有关,并可能导致多重用药。我们的目的是利用人格测试来探索促进健康和有害健康的患者特征:调查影响多发性硬化症病程的两个重要因素--吸烟依赖程度和多药治疗状况--与人格特征的关联:这是一项双中心横断面研究:我们收集了德国两家神经科诊所的多发性硬化症患者(375 人)的社会人口学、临床和医学数据。参与者被要求填写 NEO 五因素量表 (NEO-FFI) 和气质与性格量表-修订版 (TCI-R)。使用相关性分析检验变量之间的关系,使用线性模型检验组间差异。我们还要求目前患有多发性硬化症的吸烟者填写法格斯特伦(Fagerström)问卷,以便将他们分为轻度、中度和重度吸烟依赖患者:在我们的样本中,67.5%为女性,平均年龄为48.1岁。患者的中位残疾状况量表(Expanded Disability Status Scale)为 3.0,中位病程为 10 年。与轻度或中度吸烟依赖的多发性硬化症患者相比,重度吸烟依赖的多发性硬化症患者在NEO-FFI中的神经质平均得分明显更高。合并多种药物治疗的多发性硬化症患者的神经质得分明显高于未合并多种药物治疗的患者。在NEO-FFI的外向性量表中,多发性硬化症和多种药物依赖患者的平均得分明显较低。在分析多发性硬化症和重度吸烟依赖患者的 TCI-R 时也发现了明显的差异,在各分量表中,避免伤害(HA)的得分较高,而奖励依赖、自我导向(S-D)和合作性(CO)的得分较低。多发性硬化症患者的多种药物治疗与较高的 "避免伤害 "和 "自我超越 "得分有关。此外,在持久性、S-D 和 CO 维度的各个分量表中,多药患者的得分低于无多药患者:结论:我们使用 NEO-FFI 分析表明,神经质是多发性硬化症患者的有害特质,而外向性则是与尼古丁依赖和多种药物相关的保护性特质。此外,对 TCI-R 的评估显示,在尼古丁依赖或使用多种药物的多发性硬化症患者中,高 HA 分以及低 S-D 分和 CO 分更为常见。有了这些知识,就可以根据人格特征来了解多种药物和吸烟的风险,并提供有针对性的治疗和咨询。
{"title":"Personality traits in patients with multiple sclerosis: their association with nicotine dependence and polypharmacy.","authors":"Janina Meißner, Niklas Frahm, Michael Hecker, Silvan Elias Langhorst, Pegah Mashhadiakbar, Barbara Streckenbach, Katja Burian, Julia Baldt, Felicita Heidler, Jörg Richter, Uwe Klaus Zettl","doi":"10.1177/17562864241279118","DOIUrl":"https://doi.org/10.1177/17562864241279118","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The modifiable risk factor exerting the most substantial influence on the development and disease course of multiple sclerosis (MS) is cigarette smoking. Furthermore, smoking is associated with a higher risk of suffering from one or more comorbidities and potentially contributes to polypharmacy. We aimed to use personality tests to explore health-promoting and harmful patient characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate two important factors influencing the course of MS - the degree of smoking dependence and the status of polypharmacy - in association with personality traits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This is a bicentric, cross-sectional study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We collected sociodemographic, clinical and medical data from patients with MS (&lt;i&gt;n&lt;/i&gt; = 375) at two German neurological clinics. The participants were asked to complete the NEO Five-Factor Inventory (NEO-FFI) and the Temperament and Character Inventory-Revised (TCI-R). Relationships between variables were examined using correlation analyses, and differences between groups were examined using linear models. Current smokers with MS were also asked to complete the Fagerström questionnaire to categorize them into patients with mild, moderate and severe smoking dependence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In our sample, 67.5% were women, and the mean age was 48.1 years. The patients had a median Expanded Disability Status Scale of 3.0 at a median disease duration of 10 years. Patients with MS with severe smoking dependence had on average a significantly higher neuroticism score in the NEO-FFI compared to those with mild or moderate smoking dependence. Patients with MS and polypharmacy had significantly higher neuroticism scores than those without. In the extraversion scale of the NEO-FFI, patients with MS and polypharmacy had significantly lower scores on average. Significant differences were also found when analysing the TCI-R in patients with MS and heavy smoking dependence, with higher scores for harm avoidance (HA) and lower scores for reward dependence, self-directedness (S-D) and cooperativeness (CO) in various subscales. Polypharmacy in patients with MS was associated with higher scores for HA and self-transcendence. Furthermore, patients with polypharmacy showed lower values than patients without polypharmacy in individual subscales of the dimensions of persistence, S-D and CO.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Using the NEO-FFI, we were able to show that neuroticism is a detrimental trait and extraversion a protective trait in patients with MS in relation to nicotine dependence and polypharmacy. In addition, the evaluation of the TCI-R showed that high HA as well as low S-D and CO scores were more common in patients with MS and nicotine dependence or polypharmacy. With this knowledge, the risk of polypharmacy and smoking can be understood in the context of personality characteristics and targeted treatment and ","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241279118"},"PeriodicalIF":4.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11475248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Optimizing outcomes in drug-resistant mesial temporal lobe epilepsy patients undergoing stereoelectroencephalography-guided radiofrequency thermocoagulation. 优化接受立体脑电图引导射频热凝术的耐药颞叶中叶癫痫患者的疗效。
IF 4.7 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI: 10.1177/17562864241286867
Stéphane Jean, Rifeng Jiang, Yihai Dai, Weitao Chen, Weihong Liu, Donghuo Deng, Panashe Tevin Tagu, Xiaoqiang Wei, Shan Chen, Xinrong Fang, Shiwei Song

Background: Mesial temporal lobe epilepsy (MTLE) epileptiform discharges have been reported to arise from the hippocampus or the extrahippocampal medial temporal cortex, such as the amygdala, and then propagate to the temporal lobe cortex. The surgical ablation of which of these structures would result in a better postoperative outcome is debatable.

Objective: To assess the possible factors that might have influenced the postoperative outcome of a group of drug-resistant mesial MTLE patients who underwent stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC).

Design: Single-center, retrospective.

Methods: The present study utilized a pre- and postoperative gray matter voxel-by-voxel ablation mapping comparison approach, along with a white matter mapping of longitudinal changes in the native space technique, to evaluate the association between the post-SEEG implantation signal recordings (obtained from clinically relevant electrode contacts used during RFTC) and the post-RFTC ablation volume of the different selected regions of interest (ROIs).

Results: The study included 22 patients (12 men and 10 women, mean age 28.86 ± 14.04 years). Sixteen patients (72.72%) were seizure-free (SF), and six patients (27.27%) were non-SF. Five patients (22.72%) experienced mild side effects following RFTC. The post-RFTC follow-up period varied from 12 to 48 months, with an average of 24.17 ± 9.86 months. The SF group was associated with a higher number of implanted electrode contacts in the amygdala that were used during RFTC, a larger preoperative volume of the amygdala; a larger ablation volume of both the amygdala and rhinal cortex. The ablation volume of the white matter was statistically similar between both groups.

Conclusion: This study provides valuable insights into the significance of the amygdala and rhinal cortex as ROIs in the preoperative evaluation of patients with MTLE. Future implantation scheme plans should consider evaluating the preoperative volume of these ROIs. Additionally, increasing the number of electrode contacts implanted within these regions might be beneficial to capture more clinically relevant signals and enhance their ablation volume.

背景:据报道,颞叶中叶癫痫(MTLE)的癫痫样放电来自海马或海马外内侧颞叶皮层,如杏仁核,然后传播到颞叶皮层。手术消融这些结构中的哪一个会带来更好的术后效果尚存争议:评估可能影响一组接受立体脑电图(SEEG)引导下射频热凝术(RFTC)的耐药中位MTLE患者术后疗效的因素:单中心、回顾性研究:本研究采用术前和术后灰质逐体素消融映射对比方法,以及白质映射原生空间纵向变化技术,评估SEEG植入后信号记录(从RFTC期间使用的临床相关电极触点获得)与RFTC后不同选定感兴趣区(ROI)消融体积之间的关联:研究共纳入 22 名患者(12 名男性和 10 名女性,平均年龄为 28.86 ± 14.04 岁)。16名患者(72.72%)无癫痫发作(SF),6名患者(27.27%)无癫痫发作。五名患者(22.72%)在接受 RFTC 治疗后出现了轻微的副作用。RFTC 后的随访期从 12 个月到 48 个月不等,平均为 24.17 ± 9.86 个月。SF 组在 RFTC 期间使用的杏仁核植入电极触点数量较多,术前杏仁核体积较大;杏仁核和菱形皮层的消融体积较大。两组白质的消融体积在统计学上相似:这项研究为杏仁核和菱形皮质作为MTLE患者术前评估的ROIs提供了宝贵的见解。未来的植入计划应考虑评估这些区域的术前体积。此外,增加植入这些区域的电极触点数量可能有利于捕获更多临床相关信号并增加其消融量。
{"title":"Optimizing outcomes in drug-resistant mesial temporal lobe epilepsy patients undergoing stereoelectroencephalography-guided radiofrequency thermocoagulation.","authors":"Stéphane Jean, Rifeng Jiang, Yihai Dai, Weitao Chen, Weihong Liu, Donghuo Deng, Panashe Tevin Tagu, Xiaoqiang Wei, Shan Chen, Xinrong Fang, Shiwei Song","doi":"10.1177/17562864241286867","DOIUrl":"https://doi.org/10.1177/17562864241286867","url":null,"abstract":"<p><strong>Background: </strong>Mesial temporal lobe epilepsy (MTLE) epileptiform discharges have been reported to arise from the hippocampus or the extrahippocampal medial temporal cortex, such as the amygdala, and then propagate to the temporal lobe cortex. The surgical ablation of which of these structures would result in a better postoperative outcome is debatable.</p><p><strong>Objective: </strong>To assess the possible factors that might have influenced the postoperative outcome of a group of drug-resistant mesial MTLE patients who underwent stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC).</p><p><strong>Design: </strong>Single-center, retrospective.</p><p><strong>Methods: </strong>The present study utilized a pre- and postoperative gray matter voxel-by-voxel ablation mapping comparison approach, along with a white matter mapping of longitudinal changes in the native space technique, to evaluate the association between the post-SEEG implantation signal recordings (obtained from clinically relevant electrode contacts used during RFTC) and the post-RFTC ablation volume of the different selected regions of interest (ROIs).</p><p><strong>Results: </strong>The study included 22 patients (12 men and 10 women, mean age 28.86 ± 14.04 years). Sixteen patients (72.72%) were seizure-free (SF), and six patients (27.27%) were non-SF. Five patients (22.72%) experienced mild side effects following RFTC. The post-RFTC follow-up period varied from 12 to 48 months, with an average of 24.17 ± 9.86 months. The SF group was associated with a higher number of implanted electrode contacts in the amygdala that were used during RFTC, a larger preoperative volume of the amygdala; a larger ablation volume of both the amygdala and rhinal cortex. The ablation volume of the white matter was statistically similar between both groups.</p><p><strong>Conclusion: </strong>This study provides valuable insights into the significance of the amygdala and rhinal cortex as ROIs in the preoperative evaluation of patients with MTLE. Future implantation scheme plans should consider evaluating the preoperative volume of these ROIs. Additionally, increasing the number of electrode contacts implanted within these regions might be beneficial to capture more clinically relevant signals and enhance their ablation volume.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241286867"},"PeriodicalIF":4.7,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Thrombectomy for patients with a large infarct core: a study-level meta-analysis with trial sequential analysis. 针对大面积梗死核心患者的血栓切除术:研究层面的荟萃分析与试验序列分析。
IF 4.7 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-09 eCollection Date: 2024-01-01 DOI: 10.1177/17562864241285552
Hong-Jie Jhou, Li-Yu Yang, Po-Huang Chen, Cho-Hao Lee

Background: The effectiveness and safety of endovascular treatment compared with medical management alone regarding outcomes for patients with a large infarct core remain uncertain.

Objectives: To juxtapose the clinical outcomes of thrombectomy versus the best medical care in patients with a large infarct core.

Design: Systematic review and meta-analysis.

Data sources and methods: We conducted searches in PubMed, Cochrane, and Embase for articles published up until November 8, 2023. Randomized trials were selected for inclusion if they encompassed patients with large vessel occlusion and sizable strokes receiving thrombectomy. The primary outcome was functional outcomes at 3 months after pooling data using random-effects modeling. Safety outcomes included mortality at 3 months, symptomatic intracranial hemorrhage (SICH), and decompressive craniectomy. We performed a trial sequential analysis to balance type I and II errors.

Results: From 904 citations, we identified six randomized trials, involving a cohort of 1897 patients with a large ischemic region. Of these, 953 individuals underwent endovascular thrombectomy. At 3 months, thrombectomy was significantly correlated with better neurological prognosis, as evidenced by the increased odds of good functional outcomes (odds ratio (OR), 2.90; 95% confidence interval (CI), 2.08-4.05) and favorable functional outcomes (OR, 2.40; 95% CI, 1.86-3.09). Mortality rates did not demonstrably diminish as a consequence of the endovascular management (OR, 0.78; 95% CI, 0.58-1.06). However, the incidence of SICH was greater in the thrombectomy group compared to those with only medical treatment (5.5% vs 3.2%; OR, 1.77; 95% CI, 1.11-2.83). The application of trial sequential analysis yielded definitive evidence regarding favorable function outcomes and a shift in the distribution of modified Rankin scale scores at 3 months; however, others remained inconclusive.

Conclusion: The results from most of the included trials display consistency. Meta-analysis of these six randomized trials offers high-quality evidence that thrombectomy significantly mitigates disability in patients with a large infarction, while also increasing the risk of SICH.

Trial registration: PROSPERO, CRD42023480359.

背景:与单纯药物治疗相比,血管内治疗对大面积心梗患者的疗效和安全性仍不确定:与单纯药物治疗相比,血管内治疗对大面积心梗患者的疗效和安全性仍不确定:将血栓切除术的临床疗效与大面积心梗患者的最佳治疗方法进行对比:设计:系统回顾和荟萃分析:我们在PubMed、Cochrane和Embase中检索了截至2023年11月8日发表的文章。如果随机试验涉及接受血栓切除术的大血管闭塞和大面积脑卒中患者,则将这些试验纳入其中。使用随机效应模型汇总数据后,主要结果是3个月后的功能性结果。安全性结果包括 3 个月的死亡率、症状性颅内出血(SICH)和减压开颅手术。我们进行了试验序列分析,以平衡I型和II型误差:我们从904条引文中确定了六项随机试验,涉及1897名大面积缺血患者。其中,953 人接受了血管内血栓切除术。3个月后,血栓切除术与更好的神经预后显著相关,良好功能预后的几率增加(几率比(OR),2.90;95% 置信区间(CI),2.08-4.05)和有利的功能预后(OR,2.40;95% CI,1.86-3.09)证明了这一点。死亡率并未因血管内治疗而明显降低(OR,0.78;95% CI,0.58-1.06)。不过,血栓切除术组的 SICH 发生率高于仅接受药物治疗的一组(5.5% vs 3.2%;OR,1.77;95% CI,1.11-2.83)。应用试验顺序分析法得出了关于3个月后良好功能结果和改良Rankin量表评分分布变化的确凿证据,但其他试验仍无定论:结论:大多数纳入试验的结果具有一致性。对这六项随机试验进行的 Meta 分析提供了高质量的证据,证明血栓切除术能显著减轻大面积心梗患者的残疾程度,同时也增加了 SICH 的风险:试验注册:prospero,CRD42023480359。
{"title":"Thrombectomy for patients with a large infarct core: a study-level meta-analysis with trial sequential analysis.","authors":"Hong-Jie Jhou, Li-Yu Yang, Po-Huang Chen, Cho-Hao Lee","doi":"10.1177/17562864241285552","DOIUrl":"10.1177/17562864241285552","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness and safety of endovascular treatment compared with medical management alone regarding outcomes for patients with a large infarct core remain uncertain.</p><p><strong>Objectives: </strong>To juxtapose the clinical outcomes of thrombectomy versus the best medical care in patients with a large infarct core.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources and methods: </strong>We conducted searches in PubMed, Cochrane, and Embase for articles published up until November 8, 2023. Randomized trials were selected for inclusion if they encompassed patients with large vessel occlusion and sizable strokes receiving thrombectomy. The primary outcome was functional outcomes at 3 months after pooling data using random-effects modeling. Safety outcomes included mortality at 3 months, symptomatic intracranial hemorrhage (SICH), and decompressive craniectomy. We performed a trial sequential analysis to balance type I and II errors.</p><p><strong>Results: </strong>From 904 citations, we identified six randomized trials, involving a cohort of 1897 patients with a large ischemic region. Of these, 953 individuals underwent endovascular thrombectomy. At 3 months, thrombectomy was significantly correlated with better neurological prognosis, as evidenced by the increased odds of good functional outcomes (odds ratio (OR), 2.90; 95% confidence interval (CI), 2.08-4.05) and favorable functional outcomes (OR, 2.40; 95% CI, 1.86-3.09). Mortality rates did not demonstrably diminish as a consequence of the endovascular management (OR, 0.78; 95% CI, 0.58-1.06). However, the incidence of SICH was greater in the thrombectomy group compared to those with only medical treatment (5.5% vs 3.2%; OR, 1.77; 95% CI, 1.11-2.83). The application of trial sequential analysis yielded definitive evidence regarding favorable function outcomes and a shift in the distribution of modified Rankin scale scores at 3 months; however, others remained inconclusive.</p><p><strong>Conclusion: </strong>The results from most of the included trials display consistency. Meta-analysis of these six randomized trials offers high-quality evidence that thrombectomy significantly mitigates disability in patients with a large infarction, while also increasing the risk of SICH.</p><p><strong>Trial registration: </strong>PROSPERO, CRD42023480359.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241285552"},"PeriodicalIF":4.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical and ethical challenges in decision-making for patients with disorders of consciousness and locked-in syndrome from Chinese neurologists' perspectives. 从中国神经科医生的角度看意识障碍和锁定综合征患者决策中的临床和伦理挑战。
IF 4.7 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-09 eCollection Date: 2024-01-01 DOI: 10.1177/17562864241283328
Meiqi Li, Yifan Yan, Katja Kuehlmeyer, Wangshan Huang, Steven Laureys, Haibo Di

Background: The diagnosis of and life-sustaining treatment (LST) for patients with disorders of consciousness (DoC) and locked-in syndrome (LIS) have been the subject of intense debate.

Objective: We aim to investigate the application of diagnostic knowledge, opinions about the administration of LST, and ethical challenges related to DoC and LIS.

Design: A cross-sectional study.

Methods: A survey was conducted among Chinese neurologists. Questionnaires included three vignettes (unresponsive wakefulness syndrome (UWS); minimally conscious state (MCS), and LIS). They were randomly distributed among neurologists from August 2018 to December 2019.

Results: A sample of 360 questionnaires was included (response rate: 78%). Overall, 63% of the participants chose the correct diagnostic category. The neurologists who received the MCS case chose the category more accurately than the neurologists with the UWS (p < 0.001) and LIS case (p = 0.002). Most neurologists preferred never to limit LST for their patients (47%, 63%, and 67% in UWS, MCS, and LIS groups, p = 0.052). A large group of neurologists believed UWS patients could feel pain (73%), with no difference from MCS and LIS patients (p > 0.05). Deciding for patients in the absence of surrogates was rated extremely challenging.

Conclusion: A large proportion of Chinese neurologists in our study didn't apply the accurate diagnostic categories to the description of DoC and LIS patients. This calls for more education and training. Most Chinese neurologists were reluctant to limit LST for patients. This may indicate that there may be a need to emphasize the allocation of more resources toward long-term care in China.

背景:意识障碍(DoC)和锁定综合征(LIS)患者的诊断和维持生命治疗(LST)一直是激烈争论的主题:我们旨在调查诊断知识的应用、对 LST 施用的看法以及与 DoC 和 LIS 相关的伦理挑战:设计:横断面研究:方法:对中国的神经科医生进行调查。问卷包括三个小故事(无反应清醒综合征(UWS)、微意识状态(MCS)和 LIS)。问卷于2018年8月至2019年12月在神经科医生中随机发放:共纳入 360 份问卷样本(回复率:78%)。总体而言,63%的参与者选择了正确的诊断类别。收到 MCS 病例的神经科医生比收到 UWS 病例的神经科医生更准确地选择了类别(P = 0.002)。大多数神经科医生倾向于从不限制患者的 LST(UWS 组、MCS 组和 LIS 组的比例分别为 47%、63% 和 67%,P = 0.052)。大部分神经科医生认为 UWS 患者能感觉到疼痛(73%),与 MCS 和 LIS 患者无差异(p > 0.05)。在没有替代者的情况下为患者做决定被认为极具挑战性:结论:在我们的研究中,很大一部分中国神经科医生在描述DoC和LIS患者时没有应用准确的诊断类别。这需要更多的教育和培训。大多数中国神经科医生不愿意限制患者的 LST。这可能表明,在中国需要强调为长期护理分配更多资源。
{"title":"Clinical and ethical challenges in decision-making for patients with disorders of consciousness and locked-in syndrome from Chinese neurologists' perspectives.","authors":"Meiqi Li, Yifan Yan, Katja Kuehlmeyer, Wangshan Huang, Steven Laureys, Haibo Di","doi":"10.1177/17562864241283328","DOIUrl":"10.1177/17562864241283328","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of and life-sustaining treatment (LST) for patients with disorders of consciousness (DoC) and locked-in syndrome (LIS) have been the subject of intense debate.</p><p><strong>Objective: </strong>We aim to investigate the application of diagnostic knowledge, opinions about the administration of LST, and ethical challenges related to DoC and LIS.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Methods: </strong>A survey was conducted among Chinese neurologists. Questionnaires included three vignettes (unresponsive wakefulness syndrome (UWS); minimally conscious state (MCS), and LIS). They were randomly distributed among neurologists from August 2018 to December 2019.</p><p><strong>Results: </strong>A sample of 360 questionnaires was included (response rate: 78%). Overall, 63% of the participants chose the correct diagnostic category. The neurologists who received the MCS case chose the category more accurately than the neurologists with the UWS (<i>p</i> < 0.001) and LIS case (<i>p</i> = 0.002). Most neurologists preferred never to limit LST for their patients (47%, 63%, and 67% in UWS, MCS, and LIS groups, <i>p</i> = 0.052). A large group of neurologists believed UWS patients could feel pain (73%), with no difference from MCS and LIS patients (<i>p</i> > 0.05). Deciding for patients in the absence of surrogates was rated extremely challenging.</p><p><strong>Conclusion: </strong>A large proportion of Chinese neurologists in our study didn't apply the accurate diagnostic categories to the description of DoC and LIS patients. This calls for more education and training. Most Chinese neurologists were reluctant to limit LST for patients. This may indicate that there may be a need to emphasize the allocation of more resources toward long-term care in China.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241283328"},"PeriodicalIF":4.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cerebral air embolism following a hemodialysis session successfully treated with hyperbaric oxygen: a case report. 使用高压氧成功治疗血液透析后的脑空气栓塞:病例报告。
IF 4.7 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-09 eCollection Date: 2024-01-01 DOI: 10.1177/17562864241287457
Amine Bousbaa, Marianne Renou, Coralie Poulain, Pierre Laurent, Najeh El Esper, Gabriel Choukroun, Pauline Caillard

We describe here the first case of cerebral air embolism (CAE) due to a dysfunctional long-term central venous catheter for hemodialysis in a 39-year-old woman with a history of lung transplantation. Air emboli are rare but potentially fatal complications of hemodialysis, in particular, when they involve the brain. Early management with hyperbaric oxygen therapy (HBOT) is critical to prevent deterioration of the patient's condition. In this case, our patient presented her first symptoms, likely a seizure due to multiple cerebral air emboli, during her hemodialysis session. She was then monitored in the Nephrology Intensive Care Unit in accordance to the medical reference center (with HBOT). Twelve hours later, she experienced secondary deterioration, presenting with acute aphasia, left hemineglect syndrome, and hemiplegia. She was rapidly transferred to the medical reference center for HBOT. The patient fully recovered after receiving three sessions of HBOT. She also presented a seizure during each HBOT session, attributed to hyperoxia. She never experienced another seizure after the episode of CAE. This case highlights the importance of considering patients who have a lung transplant to be at increased risk for air emboli during hemodialysis and the need to rapidly recognize symptoms and start treatment, including HBOT, to optimize recovery.

我们在此描述了首例因血液透析用中心静脉导管长期失灵而导致脑空气栓塞(CAE)的病例,患者是一名 39 岁的女性,曾接受过肺移植手术。空气栓塞是血液透析中罕见但可能致命的并发症,尤其是当空气栓塞累及大脑时。早期使用高压氧疗法(HBOT)治疗对防止患者病情恶化至关重要。在本病例中,患者在血液透析过程中首次出现症状,很可能是由于多发性脑空气栓塞引起的癫痫发作。随后,她在肾内科重症监护室接受了医学参考中心的监测(使用 HBOT)。12 小时后,她的病情继发恶化,出现急性失语、左侧偏瘫综合征和偏瘫。她被迅速转到医疗参考中心接受 HBOT 治疗。在接受了三个疗程的 HBOT 治疗后,患者完全康复。在每次 HBOT 治疗期间,她都会出现癫痫发作,原因是高氧所致。CAE 发作后,她再也没有发作过。本病例强调了考虑肺移植患者在血液透析期间发生空气栓塞风险增加的重要性,以及迅速识别症状并开始治疗(包括 HBOT)以优化康复的必要性。
{"title":"Cerebral air embolism following a hemodialysis session successfully treated with hyperbaric oxygen: a case report.","authors":"Amine Bousbaa, Marianne Renou, Coralie Poulain, Pierre Laurent, Najeh El Esper, Gabriel Choukroun, Pauline Caillard","doi":"10.1177/17562864241287457","DOIUrl":"https://doi.org/10.1177/17562864241287457","url":null,"abstract":"<p><p>We describe here the first case of cerebral air embolism (CAE) due to a dysfunctional long-term central venous catheter for hemodialysis in a 39-year-old woman with a history of lung transplantation. Air emboli are rare but potentially fatal complications of hemodialysis, in particular, when they involve the brain. Early management with hyperbaric oxygen therapy (HBOT) is critical to prevent deterioration of the patient's condition. In this case, our patient presented her first symptoms, likely a seizure due to multiple cerebral air emboli, during her hemodialysis session. She was then monitored in the Nephrology Intensive Care Unit in accordance to the medical reference center (with HBOT). Twelve hours later, she experienced secondary deterioration, presenting with acute aphasia, left hemineglect syndrome, and hemiplegia. She was rapidly transferred to the medical reference center for HBOT. The patient fully recovered after receiving three sessions of HBOT. She also presented a seizure during each HBOT session, attributed to hyperoxia. She never experienced another seizure after the episode of CAE. This case highlights the importance of considering patients who have a lung transplant to be at increased risk for air emboli during hemodialysis and the need to rapidly recognize symptoms and start treatment, including HBOT, to optimize recovery.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241287457"},"PeriodicalIF":4.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long-term analysis of infections and associated risk factors in patients with multiple sclerosis treated with ocrelizumab: pooled analysis of 13 interventional clinical trials. 接受奥克立珠单抗治疗的多发性硬化症患者感染及相关风险因素的长期分析:13 项介入性临床试验的汇总分析。
IF 4.7 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-08 eCollection Date: 2024-01-01 DOI: 10.1177/17562864241277736
Tobias Derfuss, Robert Bermel, Chien-Ju Lin, Stephen L Hauser, Ludwig Kappos, Timothy Vollmer, Giancarlo Comi, Gavin Giovannoni, Hans-Peter Hartung, Martin S Weber, Jianmei Wang, Nikki Jessop, Cathy Chognot, Licinio Craveiro, Amit Bar-Or

Background: Patients with multiple sclerosis (PwMS) have an increased risk of infections.

Objectives: To characterize incidence, clinical characteristics, outcomes and risk factors of infections, and serious infections (SIs) in ocrelizumab (OCR)-treated PwMS.

Design: Post-hoc analysis of pooled data from 6155 patients in 13 clinical trials.

Methods: Descriptive analyses of clinical characteristics and outcomes were reported over ⩽14 years. A Poisson Generalized Estimating Equation model was constructed to examine risk factors in a subgroup of patients with longer exposure to OCR (n = 2092).

Results: Over a median (max) treatment period of 3.7 (13.9) years, 420/6155 patients (6.8%) experienced 583 SIs, excluding coronavirus disease 2019. Incidence rates in relapsing multiple sclerosis (RMS; 1.50 per 100 patient years [95% confidence interval (CI): 1.34-1.68]) and progressive multiple sclerosis (PMS; 3.70 [95% CI: 3.27-4.17]) remained stable over this period. Lower respiratory tract, urinary tract, abdominal and gastrointestinal, and skin infections were the most commonly reported SIs. Most SIs (~90%) resolved, and treatment with OCR was continued in >80% of cases. The presence of 1 or ⩾2 comorbidities (rate ratio = 1.66, 2.73, respectively), recent relapse activity (2.06), and Expanded Disability Status Scale (EDSS) score ⩾6.0 (2.02) were significant risk factors for SIs in patients with RMS treated over a median (max) period of 8.3 (11.2) years. In patients with primary PMS treated over a median (max) period of 7.1 (11.8) years, an EDSS score ⩾6.0 was associated with the greatest risk of SIs, a 4-fold increase (rate ratio, 4.31), followed by abnormal immunoglobulin (Ig)M levels (1.89), the presence of ⩾2 comorbidities (1.80), and having overweight/obesity (1.46). Time on OCR and abnormal IgG levels were not significantly associated with an increased SI risk.

Conclusion: Continuous long-term treatment with OCR is associated with a manageable infection risk profile. Optimal disease control and addressing modifiable risk factors may reduce the risk of infections.

背景:多发性硬化症(PwMS)患者的感染风险增加:多发性硬化症患者(PwMS)感染风险增加:描述接受奥克立珠单抗(OCR)治疗的多发性硬化症患者感染和严重感染(SIs)的发生率、临床特征、结果和风险因素:设计:对13项临床试验中6155名患者的汇总数据进行事后分析:报告了14年来的临床特征和结果的描述性分析。构建了泊松广义估计方程模型,以研究暴露于 OCR 时间较长的患者亚组(n = 2092)的风险因素:结果:在3.7(13.9)年的中位数(最长)治疗期内,420/6155名患者(6.8%)经历了583次SI,不包括2019年冠状病毒病。在此期间,复发性多发性硬化症(RMS;1.50/100 患者年 [95% 置信区间 (CI):1.34-1.68])和进行性多发性硬化症(PMS;3.70 [95% CI:3.27-4.17])的发病率保持稳定。下呼吸道、泌尿道、腹部和胃肠道以及皮肤感染是最常报告的 SI。大多数 SI(约 90%)都得到了缓解,超过 80% 的病例继续接受了 OCR 治疗。在接受中位(最长)8.3(11.2)年治疗的 RMS 患者中,存在 1 种或⩾2 种并发症(比率分别为 1.66 和 2.73)、近期复发活动(2.06)和残疾状况扩展量表(EDSS)评分⩾6.0(2.02)是 SIs 的重要风险因素。在治疗时间中位数(最长)为 7.1 (11.8) 年的原发性 PMS 患者中,EDSS 评分⩾6.0 与 SIs 风险最大相关,增加了 4 倍(比率为 4.31),其次是免疫球蛋白 (Ig)M 水平异常 (1.89)、存在⩾2 种合并症 (1.80) 和超重/肥胖 (1.46)。服用 OCR 的时间和 IgG 水平异常与 SI 风险的增加无明显关联:结论:OCR的长期持续治疗与可控的感染风险相关。最佳的疾病控制和解决可改变的风险因素可降低感染风险。
{"title":"Long-term analysis of infections and associated risk factors in patients with multiple sclerosis treated with ocrelizumab: pooled analysis of 13 interventional clinical trials.","authors":"Tobias Derfuss, Robert Bermel, Chien-Ju Lin, Stephen L Hauser, Ludwig Kappos, Timothy Vollmer, Giancarlo Comi, Gavin Giovannoni, Hans-Peter Hartung, Martin S Weber, Jianmei Wang, Nikki Jessop, Cathy Chognot, Licinio Craveiro, Amit Bar-Or","doi":"10.1177/17562864241277736","DOIUrl":"https://doi.org/10.1177/17562864241277736","url":null,"abstract":"<p><strong>Background: </strong>Patients with multiple sclerosis (PwMS) have an increased risk of infections.</p><p><strong>Objectives: </strong>To characterize incidence, clinical characteristics, outcomes and risk factors of infections, and serious infections (SIs) in ocrelizumab (OCR)-treated PwMS.</p><p><strong>Design: </strong><i>Post-hoc</i> analysis of pooled data from 6155 patients in 13 clinical trials.</p><p><strong>Methods: </strong>Descriptive analyses of clinical characteristics and outcomes were reported over ⩽14 years. A Poisson Generalized Estimating Equation model was constructed to examine risk factors in a subgroup of patients with longer exposure to OCR (<i>n</i> = 2092).</p><p><strong>Results: </strong>Over a median (max) treatment period of 3.7 (13.9) years, 420/6155 patients (6.8%) experienced 583 SIs, excluding coronavirus disease 2019. Incidence rates in relapsing multiple sclerosis (RMS; 1.50 per 100 patient years [95% confidence interval (CI): 1.34-1.68]) and progressive multiple sclerosis (PMS; 3.70 [95% CI: 3.27-4.17]) remained stable over this period. Lower respiratory tract, urinary tract, abdominal and gastrointestinal, and skin infections were the most commonly reported SIs. Most SIs (~90%) resolved, and treatment with OCR was continued in >80% of cases. The presence of 1 or ⩾2 comorbidities (rate ratio = 1.66, 2.73, respectively), recent relapse activity (2.06), and Expanded Disability Status Scale (EDSS) score ⩾6.0 (2.02) were significant risk factors for SIs in patients with RMS treated over a median (max) period of 8.3 (11.2) years. In patients with primary PMS treated over a median (max) period of 7.1 (11.8) years, an EDSS score ⩾6.0 was associated with the greatest risk of SIs, a 4-fold increase (rate ratio, 4.31), followed by abnormal immunoglobulin (Ig)M levels (1.89), the presence of ⩾2 comorbidities (1.80), and having overweight/obesity (1.46). Time on OCR and abnormal IgG levels were not significantly associated with an increased SI risk.</p><p><strong>Conclusion: </strong>Continuous long-term treatment with OCR is associated with a manageable infection risk profile. Optimal disease control and addressing modifiable risk factors may reduce the risk of infections.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241277736"},"PeriodicalIF":4.7,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11470513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patient-reported treatment satisfaction in essential tremor: levels of satisfaction and predictors of satisfaction. 患者报告的本质性震颤治疗满意度:满意度水平和满意度预测因素。
IF 4.7 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-07 eCollection Date: 2024-01-01 DOI: 10.1177/17562864241271994
Anjali Varghese, Diane S Berry, Ali Ghanem, Nora C Hernandez, Elan D Louis

Background: Although managing symptoms is paramount for both essential tremor (ET) patients and their healthcare providers, studies of treatment satisfaction are surprisingly lacking.

Objectives: We evaluated the satisfaction of patients who used a range of treatments and assessed the relation of a wide array of factors to satisfaction.

Methods: One hundred four ET participants (age = 74.5 ± 10.2 years) completed a battery of self-report items. These included demographic information, measures of tremor and clinical history, psychological state, current ET treatment, and a series of questions about satisfaction with treatment.

Results: Analyses of responses to the four current treatment satisfaction questions revealed that the proportion of participants who were satisfied ranged from 35.0% to 57.3% (i.e., approximately 1/3 to 1/2); conversely, the proportion who were dissatisfied ranged from 9.2% to 37.0%. The remainder were neutral. Higher satisfaction levels were observed in participants who were included in treatment selection and who had undergone deep brain stimulation surgery, p's < 0.05. Lower levels of satisfaction were found in participants with a negative psychological state, higher self-rated tremor severity, head/voice/jaw tremors, and more severe physical side effects; and who used botulinum toxin therapy, p's < 0.05.

Conclusion: Between 1/3 and 1/2 of patients were satisfied with their treatment, whereas up to 1/3 were dissatisfied. In this initial exploration of correlates of treatment satisfaction in ET patients, we identified a number of associations between satisfaction and clinical, psychological and treatment variables. Additional research is warranted to further explore the nature of these relations over time.

背景:虽然控制症状对本质性震颤(ET)患者及其医疗服务提供者都至关重要,但有关治疗满意度的研究却出人意料地缺乏:我们评估了患者对一系列治疗方法的满意度,并评估了一系列因素与满意度的关系:14 名 ET 参与者(年龄 = 74.5 ± 10.2 岁)完成了一系列自我报告项目。这些项目包括人口统计学信息、震颤测量和临床病史、心理状态、目前的 ET 治疗以及一系列有关治疗满意度的问题:对四个当前治疗满意度问题的回答进行分析后发现,满意的参与者比例从 35.0% 到 57.3%(即约 1/3 到 1/2 )不等;相反,不满意的比例从 9.2% 到 37.0% 不等。其余的人持中立态度。参与治疗选择和接受过深部脑刺激手术的参与者的满意度较高,P's P's 结论:1/3到1/2的患者对治疗感到满意,而不满意的患者高达1/3。在对 ET 患者治疗满意度相关因素的初步探索中,我们发现了满意度与临床、心理和治疗变量之间的一些关联。随着时间的推移,还需要进行更多的研究来进一步探讨这些关系的性质。
{"title":"Patient-reported treatment satisfaction in essential tremor: levels of satisfaction and predictors of satisfaction.","authors":"Anjali Varghese, Diane S Berry, Ali Ghanem, Nora C Hernandez, Elan D Louis","doi":"10.1177/17562864241271994","DOIUrl":"https://doi.org/10.1177/17562864241271994","url":null,"abstract":"<p><strong>Background: </strong>Although managing symptoms is paramount for both essential tremor (ET) patients and their healthcare providers, studies of treatment satisfaction are surprisingly lacking.</p><p><strong>Objectives: </strong>We evaluated the satisfaction of patients who used a range of treatments and assessed the relation of a wide array of factors to satisfaction.</p><p><strong>Methods: </strong>One hundred four ET participants (age = 74.5 ± 10.2 years) completed a battery of self-report items. These included demographic information, measures of tremor and clinical history, psychological state, current ET treatment, and a series of questions about satisfaction with treatment.</p><p><strong>Results: </strong>Analyses of responses to the four current treatment satisfaction questions revealed that the proportion of participants who were satisfied ranged from 35.0% to 57.3% (i.e., approximately 1/3 to 1/2); conversely, the proportion who were dissatisfied ranged from 9.2% to 37.0%. The remainder were neutral. Higher satisfaction levels were observed in participants who were included in treatment selection and who had undergone deep brain stimulation surgery, <i>p</i>'s < 0.05. Lower levels of satisfaction were found in participants with a negative psychological state, higher self-rated tremor severity, head/voice/jaw tremors, and more severe physical side effects; and who used botulinum toxin therapy, <i>p</i>'s < 0.05.</p><p><strong>Conclusion: </strong>Between 1/3 and 1/2 of patients were satisfied with their treatment, whereas up to 1/3 were dissatisfied. In this initial exploration of correlates of treatment satisfaction in ET patients, we identified a number of associations between satisfaction and clinical, psychological and treatment variables. Additional research is warranted to further explore the nature of these relations over time.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241271994"},"PeriodicalIF":4.7,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Therapeutic Advances in Neurological Disorders
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1