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Relationship between Contingent Negative Variation and afterimage duration in migraine patients 偏头痛患者的或然负变异与残像持续时间之间的关系
Pub Date : 2024-05-17 DOI: 10.3389/fneur.2024.1401212
Simeon Giesen, Florian Rimmele, Tim P. Jürgens, Jörg Scheidt, Johannes Drescher, Ann-Kristin Leonhardt, Sophia Schulze, Birgit Harbeck, Wolfgang Meyer, B. Müller, Peter Kropp, Armin Keller
Abnormalities in electrocortical parameters and persistence of afterimage after visual stimulation are known to occur in migraine patients. The results of studies on Contingent Negative Variation (CNV) and afterimage persistence in migraine patients suggest a link between these two phenomena and a connection to the pathomechanism of migraine.To date, no studies have investigated both afterimage duration and CNV parameters in the same subjects. The aim of this study was to investigate the relationship between the early component of CNV (iCNV) and the duration of the afterimage in migraine patients.Sixty seven migraine patients from the headache center of the University of Rostock Medical Center were examined for iCNV amplitude, iCNV habituation and afterimage duration. The subjects also completed questionnaires developed for this study and the MIDAS (Migraine Disability Assessment) questionnaire.Associations were found between iCNV amplitude and afterimage duration and between habituation capacity and afterimage duration. A deficit in habituation capacity correlated with a significantly prolonged afterimage duration. Increased iCNV amplitude and prolonged afterimage duration were also significantly correlated.Conclusions about the pathophysiology of migraine can be drawn from the results of this study. The results support the hypothesis of cortical hyperexcitability as a consequence of a low pre-activation level, which may be a possible contributory cause of migraine. Furthermore, they allow assessment of whether the afterimage examination, which is easier and quicker to perform than the CNV examination, can be used as a diagnostic tool or as a parameter to monitor the course of therapy in people with migraine.
众所周知,偏头痛患者会出现皮层电参数异常和视觉刺激后的残像持续现象。对偏头痛患者的或然负变异(CNV)和余像持续性的研究结果表明,这两种现象之间存在联系,并与偏头痛的病理机制有关。本研究旨在调查偏头痛患者中CNV早期成分(iCNV)与余像持续时间之间的关系。来自罗斯托克大学医学中心头痛中心的67名偏头痛患者接受了iCNV振幅、iCNV习惯化和余像持续时间的检查。研究发现,iCNV 振幅与残像持续时间之间存在关联,习惯化能力与残像持续时间之间也存在关联。习惯化能力不足与残像持续时间明显延长相关。从本研究结果中可以得出偏头痛病理生理学的结论。研究结果支持大脑皮层过度兴奋是低预激活水平的结果这一假设,这可能是偏头痛的诱因之一。此外,研究还评估了比CNV检查更简便快捷的余像检查是否可用作偏头痛患者的诊断工具或监测治疗过程的参数。
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引用次数: 0
Long term follow-up of heart rate variability in healthcare workers with mild COVID-19 对患有轻度 COVID-19 的医护人员的心率变异性进行长期随访
Pub Date : 2024-05-17 DOI: 10.3389/fneur.2024.1403551
Filippo Liviero, Maria Luisa Scapellato, Anna Volpin, Monica Battistella, Laura Fabris, Laura Brischigliaro, Franco Folino, Angelo Moretto, Paola Mason, Sofia Pavanello
Prior investigations into post-COVID dysautonomia often lacked control groups or compared affected individuals solely to healthy volunteers. In addition, no data on the follow-up of patients with SARS-CoV-2-related autonomic imbalance are available.In this study, we conducted a comprehensive clinical and functional follow-up on healthcare workers (HCWs) with former mild COVID-19 (group 1, n = 67), to delineate the trajectory of post-acute autonomic imbalance, we previously detected in a case–control study. Additionally, we assessed HCWs for which a test before SARS-CoV-2 infection was available (group 2, n = 29), who later contracted SARS-CoV-2, aiming to validate findings from our prior case–control investigation. We evaluated autonomic nervous system heart modulation by means of time and frequency domain heart rate variability analysis (HRV) in HCWs during health surveillance visits. Short-term electrocardiogram (ECG) recordings, were obtained at about 6, 13 months and both at 6 and 13 months from the negative SARS-CoV-2 naso-pharyngeal swab (NPS) for group 1 and at about 1-month from the negative NPS for group 2. HCWs who used drugs, had comorbidities that affected HRV, or were hospitalized with severe COVID-19 were excluded.Group 1 was split into three subgroups clinically and functionally followed at, about 6 months (subgroup-A, n = 17), 13 months (subgroup-B, n = 37) and both at 6 and 13 months (subgroup-C, n = 13) from the negative SARS-CoV-2 NPS. In subgroup-A, at 6-month follow-up compared with baseline, the spectral components in the frequency domain HRV parameters, showed an increase in normalized high frequency power (nHF) (t = 2.99, p = 0.009), a decrease in the normalized low frequency power (nLF) (t = 2.98, p = 0.009) and in the LF/HF ratio (t = 3.13, p = 0.006). In subgroup B, the comparison of the spectral components in the frequency domain HRV parameters, at 13-month follow-up compared with baseline, showed an increase in nHF (t = 2.54, p = 0.02); a decrease in nLF (t = 2.62, p = 0.01) and in the LF/HF ratio (t = 4.00, p = 0.0003). In subgroup-C, at both 6 and 13-month follow-ups, the spectral components in the frequency domain HRV parameters were higher than baseline in nHF (t = 2.64, p = 0.02 and (t = 2.13, p = 0.05, respectively); lower in nLF (t = 2.64, p = 0.02 and (t = 2.13, p = 0.05, respectively), and in LF/HF (t = 1.92, p = 0.08 and (t = 2.43, p = 0.03, respectively). A significant proportion of HCWs reported persistent COVID-19 symptoms at both the 6 and 13-month follow-ups, seemingly unrelated to cardiac autonomic balance. In group 2 HCWs, at 1-month follow-up compared with baseline, the spectral components in the frequency domain HRV parameters, showed a decrease in nHF (t = 2.19, p = 0.04); an increase in nLF (t = 2.15, p = 0.04) and in LF/HF (t = 3.49, p = 0.002).These results are consistent with epidemiological data suggesting a higher risk of acute cardiovascular complications during the first 30 days after COVID
之前对感染 COVID 后自主神经失调症的研究往往缺乏对照组,或仅将患者与健康志愿者进行比较。在本研究中,我们对曾患有轻度 COVID-19 (第 1 组,n = 67)的医护人员(HCWs)进行了全面的临床和功能随访,以勾勒出我们之前在病例对照研究中发现的急性自主神经失衡后的轨迹。此外,我们还评估了在感染 SARS-CoV-2 之前接受过检测的高危人群(第 2 组,n = 29),他们后来感染了 SARS-CoV-2,目的是验证我们之前的病例对照调查的结果。我们通过时域和频域心率变异性分析(HRV)评估了健康监测访问中高危人群的自律神经系统心脏调节情况。我们分别在第 1 组 SARS-CoV-2 鼻咽拭子(NPS)阴性后约 6 个月、13 个月以及第 2 组 SARS-CoV-2 鼻咽拭子阴性后约 1 个月采集了短期心电图(ECG)记录。第一组被分为三个亚组,分别在 SARS-CoV-2 NPS 阴性后约 6 个月(A 亚组,n = 17)、13 个月(B 亚组,n = 37)以及 6 个月和 13 个月(C 亚组,n = 13)进行临床和功能随访。在亚组 A 中,与基线相比,随访 6 个月时,频域心率变异参数中的频谱成分显示归一化高频功率(nHF)增加(t = 2.99,p = 0.009),归一化低频功率(nLF)减少(t = 2.98,p = 0.009),低频/高频比值减少(t = 3.13,p = 0.006)。在 B 亚组中,13 个月随访时与基线相比,频域心率变异参数的频谱成分比较显示 nHF 增加(t = 2.54,p = 0.02);nLF 减少(t = 2.62,p = 0.01),LF/HF 比值减少(t = 4.00,p = 0.0003)。在 C 亚组中,在 6 个月和 13 个月的随访中,nHF 的频域心率变异参数的频谱成分均高于基线(t = 2.64,p = 0.02 和(t = 2.13, p = 0.05, respectively);nLF(t = 2.64, p = 0.02 and (t = 2.13, p = 0.05, respectively)和 LF/HF(t = 1.92, p = 0.08 and (t = 2.43, p = 0.03, respectively)分别低于基线。相当一部分高危产妇在 6 个月和 13 个月的随访中都报告了持续的 COVID-19 症状,这似乎与心脏自主神经平衡无关。在第 2 组高危人群中,与基线相比,随访 1 个月时,频域心率变异参数的频谱成分显示 nHF 下降(t = 2.19,p = 0.04);nLF 上升(t = 2.15,p = 0.04),LF/HF 上升(t = 3.49,p = 0.002)。在轻度 COVID-19 恢复后的急性期,与 SARS-CoV-2 相关的自律神经失衡在首次 SARS-CoV-2 NPS 阴性后 6 个月得到缓解。然而,相当一部分高危工人报告了长期的 COVID-19 症状,而这些症状点似乎与心脏自律神经平衡无关。未来的研究肯定要进一步检验自律神经失衡是否在长期 COVID 综合征的发病机制中发挥作用。
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引用次数: 0
Editorial: Multiple sclerosis and related disorders: challenges and approaches to mechanisms, biomarkers, and therapeutic targets 社论:多发性硬化症及相关疾病:机制、生物标记物和治疗目标的挑战与方法
Pub Date : 2024-05-17 DOI: 10.3389/fneur.2024.1427299
Yang Zhou, Philippe Patrick Monnier, Jin-Zhou Feng, Shou-Gang Guo, Cong-Cong Wang
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引用次数: 0
Inflammation and endothelial function relevant genetic polymorphisms, carotid atherosclerosis, and vascular events in high-risk stroke population 中风高危人群中与炎症和内皮功能相关的基因多态性、颈动脉粥样硬化和血管事件
Pub Date : 2024-05-16 DOI: 10.3389/fneur.2024.1405183
Hong Chen, Ting Qing, Hua Luo, Ming Yu, Yanfen Wang, Wei Wei, Yong Xie, Xingyang Yi
To identify the associations of 19 single nucleotide polymorphisms (SNPs) in genes involved in inflammation and endothelial function and carotid atherosclerosis with subsequent ischemic stroke and other vascular events in the high-risk stroke population.This was a multicenter community-based sectional survey and prospective cohort study in Sichuan, southwestern China. Eight communities were randomly selected, and the residents in each community were surveyed using a structured face-to-face questionnaire. Carotid ultrasonography and DNA information were obtained from 2,377 out of 2,893 individuals belonging to a high-risk stroke population. Genotypes of the 19 SNPs in genes involved in inflammation and endothelial function were measured. All the 2,377 subjects were followed up for 4.7 years after the face-to-face survey. The primary outcome was ischemic stroke, and the secondary outcome was a composite of vascular events.Among the 2,377 subjects, 2,205 (92.8%) completed a 4.7-year follow-up, 947 (42.9%) had carotid atherosclerosis [372 (16.9%) carotid vulnerable plaque, 405 (18.4%) mean IMT > 0.9 mm, 285 (12.0%) carotid stenosis ≥15%]. Outcomes occurred in 158 (7.2%) subjects [92 (4.2%) ischemic stroke, 17 (0.8%) hemorrhagic stroke, 48 (2.2%) myocardial infarction, and 26 (1.2%) death] during follow-up. There was a significant gene–gene interaction among ITGA2 rs1991013, IL1A rs1609682, and HABP2 rs7923349 in the 19 SNPs. The multivariate logistic regression model revealed that carotid atherosclerosis and the high-risk interactive genotypes among the three SNPs were independent with a higher risk for ischemic stroke (OR = 2.67, 95% CI: 1.52–6.78, p = 0.004; and OR = 3.11, 95% CI: 2.12–9.27, p < 0.001, respectively) and composite vascular events (OR = 3.04, 95% CI: 1.46–6.35, p < 0.001; and OR = 3.23, 95% CI: 1.97–8.52, p < 0.001, respectively).The prevalence of carotid atherosclerosis was shown to be very high in the high-risk stroke population. Specific SNPs, interactions among them, and carotid atherosclerosis were independently associated with a higher risk of ischemic stroke and other vascular events.
本研究是在中国西南部四川省开展的一项基于社区的多中心横断面调查和前瞻性队列研究。本研究在四川西南部地区开展了一项多中心社区横断面调查和前瞻性队列研究,随机选取了八个社区,采用结构化面对面问卷调查的方式对每个社区的居民进行了调查。在 2,893 名脑卒中高危人群中,有 2,377 人接受了颈动脉超声检查并获得了 DNA 信息。测量了涉及炎症和内皮功能基因的 19 个 SNPs 的基因型。在面对面调查后,对所有 2377 名受试者进行了长达 4.7 年的随访。在 2377 名受试者中,2205 人(92.8%)完成了 4.7 年的随访,947 人(42.9%)患有颈动脉粥样硬化[372 人(16.9%)患有颈动脉易损斑块,405 人(18.4%)平均 IMT > 0.9 mm,285 人(12.0%)颈动脉狭窄≥15%]。随访期间,158 名(7.2%)受试者出现了预后[92 名(4.2%)缺血性卒中、17 名(0.8%)出血性卒中、48 名(2.2%)心肌梗死和 26 名(1.2%)死亡]。在 19 个 SNPs 中,ITGA2 rs1991013、IL1A rs1609682 和 HABP2 rs7923349 之间存在明显的基因-基因交互作用。多变量逻辑回归模型显示,颈动脉粥样硬化和三个 SNPs 中的高危交互基因型与缺血性脑卒中的较高风险是独立的(OR = 2.67,95% CI:1.52-6.78,P = 0.004;OR = 3.11,95% CI:2.12-9.27, p < 0.001, respectively)和复合血管事件(OR = 3.04, 95% CI: 1.46-6.35, p < 0.001; and OR = 3.23, 95% CI: 1.97-8.52, p < 0.001, respectively)。在高危中风人群中,颈动脉粥样硬化的患病率非常高。特定的 SNPs、它们之间的相互作用以及颈动脉粥样硬化与缺血性脑卒中和其他血管事件的高风险独立相关。
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引用次数: 0
Idarucizumab in dabigatran-treated patients with acute stroke: a review and clinical update 伊达珠单抗治疗达比加群治疗的急性脑卒中患者:综述与临床更新
Pub Date : 2024-05-16 DOI: 10.3389/fneur.2024.1389283
Senta Frol, Janja Pretnar Oblak, M. Šabovič, G. Ntaios, Pawel Kermer
Idarucizumab is an antibody fragment specific for the immediate reversal of dabigatran anticoagulation effects. The use of idarucizumab is approved for dabigatran-treated patients suffering from life-threatening or uncontrolled bleeding and those in need of urgent surgery or invasive procedures. Data from randomized controlled clinical trials and real-world experience provide reassuring evidence about the efficacy and safety of idarucizmab use in patients with acute stroke. In this narrative review, we summarize the available real-world evidence and discuss the relevance and importance of idarucizumab treatment in acute stroke patients in everyday clinical practice. In addition, we also discuss special issues like prothrombin complex concentrate application as an alternative to idarucizumab, its application before endovascular therapy, sensitivity of thrombi to lysis, and necessary laboratory examinations.
伊达珠单抗是一种特异性抗体片段,可立即逆转达比加群的抗凝作用。伊达珠单抗获准用于经达比加群治疗后出现危及生命或无法控制的出血的患者,以及需要紧急手术或侵入性程序的患者。随机对照临床试验的数据和实际经验为伊达珠单抗用于急性卒中患者的疗效和安全性提供了可靠的证据。在这篇叙述性综述中,我们总结了现有的真实世界证据,并讨论了伊达珠单抗治疗急性卒中患者在日常临床实践中的相关性和重要性。此外,我们还讨论了一些特殊问题,如凝血酶原复合物浓缩物作为 idarucizumab 的替代物、其在血管内治疗前的应用、血栓溶解的敏感性以及必要的实验室检查。
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引用次数: 0
Temporal bone marrow of the rat and its connections to the inner ear 大鼠颞骨骨髓及其与内耳的联系
Pub Date : 2024-05-16 DOI: 10.3389/fneur.2024.1386654
Paola Perin, Daniele Cossellu, Elisa Vivado, L. Batti, Ivana Gantar, Fabian F. Voigt, Roberto Pizzala
Calvarial bone marrow has been found to be central in the brain immune response, being connected to the dura through channels which allow leukocyte trafficking. Temporal bone marrow is thought to play important roles in relation to the inner ear, but is still largely uncharacterized, given this bone complex anatomy. We characterized the geometry and connectivity of rat temporal bone marrow using lightsheet imaging of cleared samples and microCT. Bone marrow was identified in cleared tissue by cellular content (and in particular by the presence of megakaryocytes); since air-filled cavities are absent in rodents, marrow clusters could be recognized in microCT scans by their geometry. In cleared petrosal bone, autofluorescence allowed delineation of the otic capsule layers. Within the endochondral layer, bone marrow was observed in association to the cochlear base and vestibule, and to the cochlear apex. Cochlear apex endochondral marrow (CAEM) was a separated cluster from the remaining endochondral marrow, which was therefore defined as “vestibular endochondral marrow” (VEM). A much larger marrow island (petrosal non-endochondral marrow, PNEM) extended outside the otic capsule surrounding semicircular canal arms. PNEM was mainly connected to the dura, through bone channels similar to those of calvarial bone, and only a few channels were directed toward the canal periosteum. On the contrary, endochondral bone marrow was well connected to the labyrinth through vascular loops (directed to the spiral ligament for CAEM and to the bony labyrinth periosteum for VEM), and to dural sinuses. In addition, CAEM was also connected to the tensor tympani fossa of the middle ear and VEM to the endolymphatic sac. Endochondral marrow was made up of small lobules connected to each other and to other structures by channels lined by elongated macrophages, whereas PNEM displayed larger lobules connected by channels with a sparse macrophage population. Our data suggest that the rat inner ear is surrounded by bone marrow at the junctions with middle ear and brain, most likely with “customs” role, restricting pathogen spread; a second marrow network with different structural features is found within the endochondral bone layer of the otic capsule and may play different functional roles.
研究发现,髑髅骨髓是大脑免疫反应的核心,它通过通道与硬脑膜相连,允许白细胞迁移。颞骨骨髓被认为在内耳方面发挥着重要作用,但鉴于这种骨骼复杂的解剖结构,颞骨骨髓在很大程度上仍未被描述。我们利用光片成像清除样本和显微 CT 鉴定了大鼠颞骨髓的几何形状和连通性。通过细胞含量(尤其是巨核细胞的存在)可识别清除组织中的骨髓;由于啮齿类动物体内不存在充气腔,因此在显微 CT 扫描中可通过其几何形状识别骨髓簇。在已清理的瓣膜骨中,通过自发荧光可对耳囊层进行划分。在软骨内层,可观察到与耳蜗基底和前庭以及耳蜗顶相关的骨髓。耳蜗顶软骨内层骨髓(CAEM)与其余软骨内层骨髓分离,因此被定义为 "前庭软骨内层骨髓"(VEM)。一个更大的骨髓岛(鞍旁非内软骨骨髓,PNEM)延伸到半规管臂周围的耳囊外。PNEM主要通过类似于犊骨的骨通道与硬脑膜相连,只有少数通道通向耳道骨膜。相反,软骨内骨髓通过血管环(CAEM 的血管环通向螺旋韧带,VEM 的血管环通向骨性迷宫骨膜)与迷宫和硬膜窦相连。此外,CAEM 还与中耳的鼓膜张力窝相连,VEM 则与内淋巴囊相连。内侧软骨髓由小叶组成,小叶之间以及小叶与其他结构之间通过内衬有细长巨噬细胞的通道相连,而外侧软骨髓则显示出较大的小叶,小叶之间通过通道相连,内衬有稀疏的巨噬细胞。我们的数据表明,大鼠内耳与中耳和大脑的交界处被骨髓包围,骨髓很可能具有 "海关 "作用,限制病原体的扩散;在耳囊软骨内骨层中发现了另一个具有不同结构特征的骨髓网络,可能发挥着不同的功能作用。
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引用次数: 0
Soluble biomarkers for Neuromyelitis Optica Spectrum Disorders: a mini review 神经脊髓炎谱系障碍的可溶性生物标记物:微型综述
Pub Date : 2024-05-16 DOI: 10.3389/fneur.2024.1415535
Rachel E. Rodin, Tanuja Chitnis
The Neuromyelitis Optica Spectrum Disorders (NMOSD) constitute a spectrum of rare autoimmune diseases of the central nervous system characterized by episodes of transverse myelitis, optic neuritis, and other demyelinating attacks. Previously thought to be a subtype of multiple sclerosis, NMOSD is now known to be a distinct disease with unique pathophysiology, clinical course, and treatment options. Although there have been significant recent advances in the diagnosis and treatment of NMOSD, the field still lacks clinically validated biomarkers that can be used to stratify disease severity, monitor disease activity, and inform treatment decisions. Here we review many emerging NMOSD biomarkers including markers of cellular damage, neutrophil-to-lymphocyte ratio, complement, and cytokines, with a focus on how each biomarker can potentially be used for initial diagnosis, relapse surveillance, disability prediction, and treatment monitoring.
神经脊髓炎谱系障碍(NMOSD)是一种罕见的中枢神经系统自身免疫性疾病,以横贯性脊髓炎、视神经炎和其他脱髓鞘发作为特征。NMOSD 以前被认为是多发性硬化症的一种亚型,但现在人们知道它是一种独特的疾病,具有独特的病理生理学、临床过程和治疗方案。尽管近来在 NMOSD 的诊断和治疗方面取得了重大进展,但该领域仍然缺乏经过临床验证的生物标志物,而这些生物标志物可用于对疾病严重程度进行分层、监测疾病活动性并为治疗决策提供依据。在此,我们回顾了许多新出现的 NMOSD 生物标志物,包括细胞损伤标志物、中性粒细胞与淋巴细胞比值、补体和细胞因子,重点介绍了每种生物标志物如何用于初步诊断、复发监测、残疾预测和治疗监测。
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引用次数: 0
A predictive model in patients with chronic hydrocephalus following aneurysmal subarachnoid hemorrhage: a retrospective cohort study 动脉瘤性蛛网膜下腔出血后慢性脑积水患者的预测模型:一项回顾性队列研究
Pub Date : 2024-05-16 DOI: 10.3389/fneur.2024.1366306
Dai Rao, Li Yang, Xu Enxi, Siyuan Lu, Qian Yu, Li Zheng, Zhou Zhou, Yerong Chen, Chen Bo, Shan Xiuhong, Sun Eryi
Our aim was to develop a nomogram that integrates clinical and radiological data obtained from computed tomography (CT) scans, enabling the prediction of chronic hydrocephalus in patients with aneurysmal subarachnoid hemorrhage (aSAH).A total of 318 patients diagnosed with subarachnoid hemorrhage (SAH) and admitted to the Department of Neurosurgery at the Affiliated People’s Hospital of Jiangsu University between January 2020 and December 2022 were enrolled in our study. We collected clinical characteristics from the hospital’s medical record system. To identify risk factors associated with chronic hydrocephalus, we conducted both univariate and LASSO regression models on these clinical characteristics and radiological features, accompanied with penalty parameter adjustments conducted through tenfold cross-validation. All features were then incorporated into multivariate logistic regression analyses. Based on these findings, we developed a clinical-radiological nomogram. To evaluate its discrimination performance, we conducted Receiver Operating Characteristic (ROC) curve analysis and calculated the Area Under the Curve (AUC). Additionally, we employed calibration curves, and utilized Brier scores as an indicator of concordance. Additionally, Decision Curve Analysis (DCA) was performed to determine the clinical utility of our models by estimating net benefits at various threshold probabilities for both training and testing groups.The study included 181 patients, with a determined chronic hydrocephalus prevalence of 17.7%. Univariate logistic regression analysis identified 11 potential risk factors, while LASSO regression identified 7 significant risk factors associated with chronic hydrocephalus. Multivariate logistic regression analysis revealed three independent predictors for chronic hydrocephalus following aSAH: Periventricular white matter changes, External lumbar drainage, and Modified Fisher Grade. A nomogram incorporating these factors accurately predicted the risk of chronic hydrocephalus in both the training and testing cohorts. The AUC values were calculated as 0.810 and 0.811 for each cohort respectively, indicating good discriminative ability of the nomogram model. Calibration curves along with Hosmer-Lemeshow tests demonstrated excellent agreement between predicted probabilities and observed outcomes in both cohorts. Furthermore, Brier scores (0.127 for the training and 0.09 for testing groups) further validated the predictive performance of our nomogram model. The DCA confirmed that this nomogram provides superior net benefit across various risk thresholds when predicting chronic hydrocephalus. The decision curve demonstrated that when an individual’s threshold probability ranged from 5 to 62%, this model is more effective in predicting the occurrence of chronic hydrocephalus after aSAH.A clinical-radiological nomogram was developed to combine clinical characteristics and radiological features from CT scans, aiming to enhance the a
江苏大学附属人民医院神经外科在2020年1月至2022年12月期间共收治了318例蛛网膜下腔出血(SAH)患者。我们从医院的病历系统中收集了患者的临床特征。为了确定与慢性脑积水相关的风险因素,我们对这些临床特征和放射学特征进行了单变量和LASSO回归模型,并通过十倍交叉验证对惩罚参数进行了调整。然后将所有特征纳入多变量逻辑回归分析。基于这些发现,我们开发了临床放射学提名图。为了评估其分辨性能,我们进行了接收者操作特征曲线(ROC)分析,并计算了曲线下面积(AUC)。此外,我们还采用了校准曲线,并将 Brier 评分作为一致性指标。此外,我们还进行了决策曲线分析 (DCA),通过估算训练组和测试组在不同阈值概率下的净收益,确定我们模型的临床实用性。单变量逻辑回归分析确定了 11 个潜在风险因素,而 LASSO 回归则确定了 7 个与慢性脑积水相关的重要风险因素。多变量逻辑回归分析发现了三个独立的预测因素:脑室周围白质改变、腰椎外引流和改良费舍尔分级。包含这些因素的提名图可以准确预测训练组和测试组的慢性脑积水风险。每个队列的 AUC 值分别为 0.810 和 0.811,表明提名图模型具有良好的判别能力。校准曲线和 Hosmer-Lemeshow 检验表明,在两个队列中,预测概率与观察结果之间的一致性极佳。此外,Brier 评分(训练组为 0.127,测试组为 0.09)进一步验证了我们的提名图模型的预测性能。DCA 证实,在预测慢性脑积水时,该提名图在各种风险阈值下都能提供卓越的净效益。决策曲线显示,当个体的阈值概率在 5% 到 62% 之间时,该模型在预测 aSAH 后慢性脑积水的发生方面更有效。这一创新的提名图显示出了巨大的潜力,它能准确预测aSAH患者的慢性脑积水情况,从而帮助临床医生制定个性化的最佳治疗方案。
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引用次数: 0
PCSK9 inhibitor in acute ischemic stroke patient receiving mechanical thrombectomy: early outcomes and safety 接受机械血栓切除术的急性缺血性脑卒中患者服用 PCSK9 抑制剂:早期疗效和安全性
Pub Date : 2024-05-16 DOI: 10.3389/fneur.2024.1375609
Jonguk Kim, Uichan Hong, Cindy W. Yoon, Jin Woo Bae, Joung-Ho Rha, H. Park
Lipid-lowering therapies are mainstays in reducing recurrence after acute ischemic stroke (AIS). Evolocumab, a Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor, is a promising lipid-lowering agent known to decrease LDL cholesterol and mitigate vascular events alongside statins. However, its effects on the early functional outcomes post-mechanical thrombectomy (MT) remain unclear. This study aimed to assess the short-term effects and incidence of bleeding events after the early, off-label use of PCSK9 inhibitors in AIS patients undergoing MT.We retrospectively analyzed patients who had MT at a Regional Stroke Center from December 2018 to April 2023. Our primary outcome was discharge functional outcomes. Secondary outcomes included early neurologic deterioration (END), symptomatic intracerebral hemorrhage (sICH), 3-month functional outcomes, 3-month recurrence rate, and lipid profiles.Of 261 patients (mean age 69.2 ± 11.7, men 42.9%), 42 were administered evolocumab peri-procedurally. While baseline characteristics were similar between the two groups, evolocumab group demonstrated improved discharge outcomes, with a lower mean NIHSS (8.8 ± 6.8 vs. 12.4 ± 9.8, p = 0.02) and a higher percentage of patients with discharge mRS ≤ 3 (52.4% vs. 35.6%, p = 0.041). The 3-month follow-up show a non-significant trend toward an improved outcome in the evolocumab group. Multivariable analysis indicated that evolocumab had a potential impact on favorable discharge outcomes (aOR 1.98[0.94–4.22] for mRS ≤ 3 and 0.47[0.27–0.84] for lower ordinal mRS). Notably, evolocuamb users exhibited fewer instances of END and sICH, although they do not reach statistical significance. Additionally, the evolocumab group demonstrated potential benefits in LDL cholesterol reduction over time.Early use of evolocumab in AIS patients undergoing MT appeared to be safe and associated with better early functional outcomes. The potential benefit of the PCSK9 inhibitor shown here warrants further prospective studies.
降脂疗法是减少急性缺血性中风(AIS)后复发的主要手段。Evolocumab 是一种 Proprotein convertase subtilisin-kexin type 9 (PCSK9) 抑制剂,是一种很有前景的降脂药,可降低低密度脂蛋白胆固醇,与他汀类药物一起缓解血管事件。然而,它对机械性血栓切除术(MT)后早期功能结果的影响仍不清楚。本研究旨在评估在接受MT的AIS患者中早期、标签外使用PCSK9抑制剂后的短期效果和出血事件发生率。我们回顾性分析了2018年12月至2023年4月在区域卒中中心接受MT的患者。我们的主要结果是出院功能预后。次要结局包括早期神经功能恶化(END)、症状性脑出血(sICH)、3个月功能结局、3个月复发率和血脂概况。在261名患者(平均年龄为69.2±11.7岁,男性占42.9%)中,42名患者在术前使用了evolocumab。虽然两组患者的基线特征相似,但 evolocumab 组的出院预后更好,平均 NIHSS 更低(8.8 ± 6.8 vs. 12.4 ± 9.8,p = 0.02),出院时 mRS ≤ 3 的患者比例更高(52.4% vs. 35.6%,p = 0.041)。3个月的随访结果显示,evolocumab组的预后改善趋势并不显著。多变量分析表明,evolocumab 对出院预后有潜在影响(mRS ≤ 3 的 aOR 为 1.98[0.94-4.22],mRS 较低序数的 aOR 为 0.47[0.27-0.84])。值得注意的是,使用 evolocuamb 的患者发生 END 和 sICH 的情况较少,但未达到统计学意义。此外,随着时间的推移,evolocumab组在降低低密度脂蛋白胆固醇方面显示出潜在的益处。在接受MT治疗的AIS患者中早期使用evolocumab似乎是安全的,并且与更好的早期功能预后相关。本文显示的 PCSK9 抑制剂的潜在益处值得进一步开展前瞻性研究。
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引用次数: 0
Efficacy and safety of Apixaban in the treatment of cerebral venous sinus thrombosis: a multi-center study 阿哌沙班治疗脑静脉窦血栓的有效性和安全性:一项多中心研究
Pub Date : 2024-05-16 DOI: 10.3389/fneur.2024.1404099
Naaem Simaan, Issa Metanis, Asaf Honig, Hen Hallevi, Andrei Filioglo, Rom Mendel, Rani Barnea, Jonathan Naftali, Eitan Auriel, Shorooq Aladdin, David Orion, Najib Dally, Ronen R. Leker, Jeremy Molad
Information regarding the safety and efficacy of specific direct oral anticoagulants (DOAC) in the treatment of cerebral sinus and venous thrombosis (CSVT) is scarce. Apixaban is one of the most frequently prescribed DOACs. Therefore, we aimed to compare the safety and efficacy of Apixaban with those of vitamin k antagonists (VKA) in patients with CSVT.Prospective CSVT databases from seven academic medical centers were retrospectively analyzed. Patients treated with Apixaban were compared to those treated with VKA. Data on demographics, clinical presentations, risk factors, radiological and outcome parameters were studied.Overall, 403 patients were included in the analysis. Of them, 48 (12%) were treated with Apixaban, and 355 (88%) were treated with VKA. Rates of coagulopathies were significantly higher in the VKA-treated patients but no other differences between the groups were found in baseline characteristics and underlying etiology. No significant differences were found between groups in efficacy or safety parameters including the rates of recanalization, favorable outcomes, one-year mortality, seizures, intracranial hemorrhage or CSVT recurrences.Our data suggests that Apixaban may be safe and effective for patients with CSVT. These results should be tested in prospective randomized clinical studies.
有关特定直接口服抗凝剂(DOAC)治疗脑窦和静脉血栓形成(CSVT)的安全性和有效性的信息很少。阿哌沙班是最常用的DOAC之一。因此,我们旨在比较阿哌沙班与维生素 k 拮抗剂(VKA)对 CSVT 患者的安全性和有效性。对七个学术医疗中心的前瞻性 CSVT 数据库进行了回顾性分析,并将接受阿哌沙班治疗的患者与接受 VKA 治疗的患者进行了比较。分析共纳入了 403 名患者,其中 48 人(12%)接受了阿哌沙班治疗。其中,48人(12%)接受了阿哌沙班治疗,355人(88%)接受了VKA治疗。接受 VKA 治疗的患者发生凝血病变的比例明显更高,但在基线特征和潜在病因方面,两组之间没有发现其他差异。我们的数据表明,阿哌沙班可能对 CSVT 患者安全有效。这些结果应在前瞻性随机临床研究中得到验证。
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Frontiers in Neurology
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