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P.044 Ambient air pollution and emergency department presentations for pediatric primary headache and seizure disorders in Calgary, Canada P.044 环境空气污染与加拿大卡尔加里小儿原发性头痛和癫痫发作的急诊就诊率
K. Sjonnesen, M. Szyszkowicz, J. Kuziek, T. Pringsheim, S. Orr
Background: Climate change, and fossil fuel combustion threaten the health of children globally through direct and indirect mechanisms,1 such as the exacerbation of ambient air pollution.1,2 Increased ambient air pollutant concentrations are associated with emergency department (ED) visits for episodic and paroxysmal neurologic conditions in adults in the Toronto region of Canada.4,5 We hypothesize that, in Calgary, Alberta, increased ambient air pollutants will be positively associated with the daily burden of pediatric ED presentations for migraine and seizures, and that a greater effect size may be present due to increased regional variability in ambient PM2.5 concentrations.3,4 Methods: Emergency records from the National Ambulatory Care Reporting System, comprising 17552 primary seizure and headache cases between 0-18 years of age and presenting to Calgary-region emergency departments between January 2012-December 2021, will be included. Quasi-Poisson regression modeling incorporating ambient air pollutants, seasonality and meteorological covariates will estimate relative risk and 95% confidence intervals of ED visit counts relative to increases in air pollutants. Results: Results currently pending and will be available for presentation. Conclusions: Significant results may inform further inquiry into the impact of air pollutants on children with neurological conditions and identify potential contributions of air quality to healthcare service demand in the Calgary region.
背景:气候变化和化石燃料燃烧通过直接和间接机制威胁着全球儿童的健康,1 例如环境空气污染的加剧。1,2 环境空气污染物浓度的增加与加拿大多伦多地区成人发作性和阵发性神经系统疾病的急诊就诊有关。我们假设,在阿尔伯塔省卡尔加里市,环境空气污染物的增加与每天因偏头痛和癫痫发作而到急诊室就诊的儿童人数呈正相关,而且由于环境 PM2.5 浓度的地区变异性增加,可能会产生更大的影响:2012年1月至2021年12月期间,卡尔加里地区急诊科共接诊17552例0-18岁的原发性癫痫发作和头痛病例,这些病例的急诊记录来自全国非卧床护理报告系统(National Ambulatory Care Reporting System)。结合环境空气污染物、季节性和气象协变量的准泊松回归模型将估算出相对于空气污染物增加的相对风险和 95% 的置信区间。结果:目前正在等待结果,并将在报告中公布。结论:重要结果可为进一步研究空气污染物对神经系统疾病儿童的影响提供信息,并确定空气质量对卡尔加里地区医疗保健服务需求的潜在影响。
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引用次数: 0
P.067 Pharmacological prophylaxis for chronic migraine: A systematic review and network meta-analysis of randomized controlled trials P.067 慢性偏头痛的药物预防:随机对照试验的系统回顾和网络荟萃分析
M. Khalili, A. Liaghatdar, F. Mahdian, T. Levit, S. Moradi, E. Hedayati, K. Torabiardakani, F. Ahmadi, S. Khademioore, A. Sofi-Mahmudi, T. Atkin-Jones, V. Patil, F. Mirzayeh Fashami, S. Mehmandoost, S Sharma, M. Fereshtehnejad, J. Busse, B. Sadeghirad
Background: We performed a network meta-analysis of randomized controlled trials to assess the comparative effectiveness of available pharmacological prophylaxis for migraines. Methods: We searched MEDLINE, EMBASE, Web of Science, Scopus, PsycINFO and Cochrane CENTRAL up to October 2023 for trials that: (1) enrolled adults diagnosed with chronic migraine, and (2) randomized them to any prophylactic medication vs. another medication or placebo. We performed a random-effects frequentist network meta-analysis for patient-important outcomes. Results: We included 193 randomized trials. Compared to placebo, CGRP monoclonal antibodies (mean difference [MD] -1.7, 95%CI: -1.1 to -2.2), injection of botulinum toxin (MD -1.8, 95%CI: -0.7 to -2.9), calcium channel blockers (MD -1.8, 95%CI: -0.5 to -3.0), beta-blockers (MD -1.4, 95%CI: -0.2 to -2.6), and anticonvulsants (MD -1.1, 95%CI: -0.4 to -1.8) were among the most effective treatments in reducing average number of headache days per months. Anticonvulsants (Risk Ratio [RR] 2.3, 95%CI: 1.8 to 3.0), calcium channel blockers (RR 1.8, 95% CI: 1.1 to 3.1), and tricyclic antidepressants (RR 2.3, 95% CI: 1.3 to 3.8) showed the highest risk of discontinuation due to adverse events. Conclusions: Our findings suggest that CGRP inhibitors, botulinum toxin, and beta-blockers may provide the greatest benefit, and tolerability, for reducing the frequency of migraine headaches.
背景:我们对随机对照试验进行了网络荟萃分析,以评估现有偏头痛药物预防疗法的比较效果。方法我们检索了 MEDLINE、EMBASE、Web of Science、Scopus、PsycINFO 和 Cochrane CENTRAL(截至 2023 年 10 月)中符合以下条件的试验:(1)招募了被诊断为慢性偏头痛的成年人,(2)将他们随机分配到任何预防性药物与另一种药物或安慰剂中。我们对患者重要结果进行了随机效应频数网络荟萃分析。分析结果我们纳入了 193 项随机试验。与安慰剂相比,CGRP单克隆抗体(平均差[MD]-1.7,95%CI:-1.1至-2.2)、注射肉毒杆菌毒素(MD-1.8,95%CI:-0.7至-2.9)、钙通道阻滞剂(MD-1.8,95%CI:-0.5至-3.0)、β-受体阻滞剂(MD-1.4,95%CI:-0.2至-2.6)和抗惊厥药(MD-1.1,95%CI:-0.4至-1.8)是减少每月平均头痛天数的最有效治疗方法。抗惊厥药(风险比 [RR] 2.3,95%CI:1.8 至 3.0)、钙通道阻滞剂(RR 1.8,95%CI:1.1 至 3.1)和三环类抗抑郁药(RR 2.3,95%CI:1.3 至 3.8)因不良反应而停药的风险最高。结论我们的研究结果表明,CGRP抑制剂、肉毒杆菌毒素和β-受体阻滞剂可为降低偏头痛频率提供最大的益处和耐受性。
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引用次数: 0
P.144 Comparative analysis of spinal cord-derived and induced pluripotent-derived neural stem & progenitor cells for SCI therapy P.144 脊髓衍生细胞和诱导多能神经干细胞及祖细胞用于 SCI 治疗的比较分析
RV Sandarage, A. Galuta, E. Tsai
Background: Induced pluripotent stem cells (iPSCs) have revolutionized spinal cord injury (SCI) treatment by generating neural stem/progenitor cells (NSPCs). However, understanding how iPSC-derived NSPCs compare to authentic spinal cord NSPCs remains unclear. This study thoroughly characterizes bona fide spinal cord NSPCs and their isogenic iPSC-derived counterparts, iPSC-SC and iPSC-Br. Methods: Human spinal cord and skin tissue were obtained with ethics approval to establish primary NSPC cultures. iPSCs were derived from these primary cells and differentiated into iPSC-SC and iPSC-Br NSPCs. Assessments encompassed differentiation, proliferation capabilities, immunostaining, and RNA sequencing for differential gene expression. Results: Functional and transcriptional differences were identified between bona fide NSPCs and iPSC-SC/iPSC-Br. Bona fide and iPSC-SC NSPCs exhibited spinal cord regionalization, while iPSC-Br displayed forebrain regionalization. iPSC-derived NSPCs shared features reminiscent of early developmental stages, including embryonic patterning genes and increased proliferation rates. Notably, differentiation profiles were most similar between bona fide and iPSC-Br, with substantial distinctions observed between bona fide and iPSC-SC. Conclusions: This study unveils unique regional, developmental, and functional characteristics distinguishing spinal cord NSPCs from iPSC-derived counterparts. Addressing these disparities holds promise for enhancing iPSC-derived NSPC therapies in spinal cord injuries, contributing to a deeper understanding of their potential applications in regenerative medicine.
背景:诱导多能干细胞(iPSC)通过产生神经干/祖细胞(NSPC),彻底改变了脊髓损伤(SCI)的治疗方法。然而,iPSC衍生的NSPC与真正的脊髓NSPC相比如何,目前仍不清楚。本研究对真正的脊髓NSPC及其同源iPSC衍生的对应细胞(iPSC-SC和iPSC-Br)进行了深入研究。 方法:经伦理批准获得人类脊髓和皮肤组织以建立原代NSPC培养物。评估包括分化、增殖能力、免疫染色和差异基因表达的 RNA 测序。结果真正的NSPC和iPSC-SC/iPSC-Br之间存在功能和转录差异。真正的NSPC和iPSC-SC表现出脊髓区域化,而iPSC-Br则表现出前脑区域化。值得注意的是,真正的iPSC-Br和iPSC-SC之间的分化特征最为相似,而真正的iPSC-Br和iPSC-SC之间则有很大区别。结论:这项研究揭示了脊髓NSPC与iPSC衍生的对应物在区域、发育和功能方面的独特特征。解决这些差异有望加强 iPSC 衍生的 NSPC 治疗脊髓损伤的效果,有助于深入了解它们在再生医学中的潜在应用。
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引用次数: 0
P.008 Spontaneous retropulsion in autopsy verified PSP P.008 经尸检证实的帕金森病患者的自发性后叩背
J. Das, A. Rajput, M. Kim, E. Noyes
Background: Postural instability is a common symptom of progressive supranuclear palsy (PSP). Retropulsion is one form of postural instability. Spontaneous retropulsion involves loss of balance without external provocation. Others have reported on retropulsion in the clinical setting while testing for postural instability but rates of spontaneous retropulsion in the community have not been described. This study examines the prevalence of spontaneous retropulsion in PSP. Methods: A retrospective chart review examined 60 patients from the Saskatchewan Movement Disorders Program with clinical and pathology-confirmed diagnosis of PSP. We identified patients who endorsed spontaneous retropulsion. The data was analysed with univariate logistic regression. Results: The study included 43 males and 17 females. Spontaneous retropulsion was reported in 18 (30%) patients. Among the variables, only sex showed a statistical significance (p = 0.0184) with females more likely to report spontaneous retropulsion (OR = 4.25). Other variables (PSP onset age, onset age of balance impairment, gait impairment, and disease duration) were not statistically significant. Conclusions: Our data suggest that spontaneous retropulsion is common in PSP, with females being at a significantly higher risk than males. This is useful information when counselling patients on risk-avoidance behaviour to prevent falls.
背景:姿势不稳是进行性核上性麻痹(PSP)的常见症状。后推是姿势不稳的一种形式。自发性后退是指在没有外部刺激的情况下失去平衡。其他人在临床环境中进行姿势不稳定性测试时也曾报告过反抽现象,但在社区中的自发性反抽发生率尚未得到描述。本研究探讨了自发性后仰在 PSP 中的发生率。方法:对萨斯喀彻温运动障碍项目的 60 名临床和病理确诊为 PSP 的患者进行了回顾性病历审查。我们确定了认可自发性后退的患者。数据采用单变量逻辑回归法进行分析。研究结果研究对象包括 43 名男性和 17 名女性。有 18 名患者(30%)报告了自发性后退。在所有变量中,只有性别具有统计学意义(p = 0.0184),女性更有可能报告自发性后退(OR = 4.25)。其他变量(PSP发病年龄、平衡障碍发病年龄、步态障碍和病程)均无统计学意义。结论我们的数据表明,自发性后仰在 PSP 中很常见,女性的风险明显高于男性。这对指导患者避免跌倒的风险行为很有帮助。
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引用次数: 0
P.088 Wounded glioma syndrome: neurologic worsening in patients with subtotal resection in high-grade gliomas P.088 受伤胶质瘤综合征:高级别胶质瘤次全切除术患者的神经功能恶化
C. Ma, M. Rizzuto, D. Chen, M. Fatehi Hassanabad, S. Makarenko
Background: For treatment of high-grade gliomas (HGGs), subtotal resection (STR) may be preferred to minimize injury to eloquent areas. We aimed to characterize neurologic deficits developed in STR patients within the first month post-operatively and to establish a potential threshold for a safe volume of residual tumor to avoid neurological worsening. Methods: This is a single institution retrospective chart review, with 146 charts reviewed and 78 patients deemed eligible. Preoperative deficits and postoperative neurological deficits presenting prior to 1 month after surgery were captured. Imaging features such as tumour volume, edema, and other pertinent imaging characteristics were collected from preoperative and postoperative imaging. Results: Most patients that developed a postoperative deficit presented with motor deficits (55.1%), while only 1.3% of patients developed new or worsening tremor after surgery. On average, in patients with a new deficit, 26.5% of tumor was resected, and all patients had more than 19% of residual tumor. Conclusions: Postoperative neurologic deficits may develop after a subtotal resection when an average of 73.5% of tumor remains. The proposed threshold for tumor resection is greater than 26.5% to minimize the potential of neurologic worsening 1 month postoperatively.
背景:在治疗高级别胶质瘤(HGGs)时,可能首选次全切除术(STR),以尽量减少对神经区域的损伤。我们的目的是描述 STR 患者术后一个月内出现的神经功能缺损,并确定安全残留肿瘤体积的潜在阈值,以避免神经功能恶化。方法:这是一项单机构回顾性病历审查,共审查了 146 份病历,78 名患者被认为符合条件。记录了术前缺陷和术后 1 个月前出现的神经功能缺损。从术前和术后成像中收集了肿瘤体积、水肿和其他相关成像特征。结果:大多数术后出现障碍的患者(55.1%)表现为运动障碍,而只有1.3%的患者在术后出现新的震颤或震颤加重。在出现新障碍的患者中,平均有26.5%的肿瘤被切除,所有患者的残留肿瘤均超过19%。得出结论:当肿瘤平均残留 73.5% 时,次全切除术后可能会出现神经功能缺损。建议肿瘤切除的阈值应大于 26.5%,以尽量减少术后 1 个月神经功能恶化的可能性。
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引用次数: 0
D.4 Safety and efficacy of delandistrogene moxeparvovec versus placebo in Duchenne muscular dystrophy (EMBARK): Pivotal Phase 3 primary results D.4 Delandistrogene moxeparvovec 对安慰剂治疗杜氏肌营养不良症的安全性和有效性(EMBARK):关键的第三阶段主要结果
JR Mendell, F. Muntoni, CM McDonald, EM Mercuri, E. Ciafaloni, H. Komaki, C. Leon-Astudillo, A Nascimento, C. Proud, U. Schara-Schmidt, A. Veerapandiyan, C. Zaidman, M. Guridi, A. Murphy, C. Reid, C. Wandel, E. Darton, S. Mason, RA Potter, T. Singh, W. Zhang, P. Fontoura, JS Elkins, L. Rodino-Klapac
Background: Duchenne muscular dystrophy (DMD) is caused by DMD gene mutations. Delandistrogene moxeparvovec is an investigational gene transfer therapy, developed to address the underlying cause of DMD. We report findings from Part 1 (52 weeks) of the two-part EMBARK trial (NCT05096221). Methods: Key inclusion criteria: Ambulatory patients aged ≥4-<8 years with a confirmed DMD mutation within exons 18–79 (inclusive); North Star Ambulatory Assessment (NSAA) score >16 and <29 at screening. Eligible patients were randomized 1:1 to intravenous delandistrogene moxeparvovec (1.33×1014 vg/kg) or placebo. The primary endpoint was change from baseline in NSAA total score to Week 52. Results: At Week 52 (n=125), the primary endpoint did not reach statistical significance, although there was a nominal difference in change from baseline in NSAA total score in the delandistrogene moxeparvovec (2.6, n=63) versus placebo groups (1.9, n=61). Key secondary endpoints (time to rise, micro-dystrophin expression, 10-meter walk/run) demonstrated treatment benefit in both age groups (4-5 and 6-7 years; p<0.05).There were no new safety signals, reinforcing the favorable and manageable safety profile observed to date. Conclusions: Based on the totality of functional assessments including the timed function tests, treatment with delandistrogene moxeparvovec indicates beneficial modification of disease trajectory.
背景:杜兴氏肌营养不良症(DMD)是由 DMD 基因突变引起的。Delandistrogene moxeparvovec是一种研究性基因转移疗法,旨在解决DMD的根本原因。我们报告了由两部分组成的 EMBARK 试验(NCT05096221)第一部分(52 周)的结果。研究方法主要纳入标准:筛查时年龄≥4-16 岁且小于 29 岁的非卧床患者。符合条件的患者按 1:1 随机分配到静脉注射 delandistrogene moxeparvovec(1.33×1014 vg/kg)或安慰剂。主要终点为非甾体抗炎药总评分从基线到第52周的变化。结果:第52周时(样本数=125),主要终点未达到统计学意义,但delandistrogene moxeparvovec组(2.6,样本数=63)与安慰剂组(1.9,样本数=61)的非甾体抗炎药物总分与基线相比的变化存在名义差异。关键次要终点(起立时间、微量肌营养不良蛋白表达、10米步行/跑步)在两个年龄组(4-5岁和6-7岁;P<0.05)均显示出治疗获益。结论根据包括定时功能测试在内的所有功能评估结果,使用delandistrogene moxeparvovec治疗对疾病轨迹的改变是有益的。
{"title":"D.4 Safety and efficacy of delandistrogene moxeparvovec versus placebo in Duchenne muscular dystrophy (EMBARK): Pivotal Phase 3 primary results","authors":"JR Mendell, F. Muntoni, CM McDonald, EM Mercuri, E. Ciafaloni, H. Komaki, C. Leon-Astudillo, A Nascimento, C. Proud, U. Schara-Schmidt, A. Veerapandiyan, C. Zaidman, M. Guridi, A. Murphy, C. Reid, C. Wandel, E. Darton, S. Mason, RA Potter, T. Singh, W. Zhang, P. Fontoura, JS Elkins, L. Rodino-Klapac","doi":"10.1017/cjn.2024.95","DOIUrl":"https://doi.org/10.1017/cjn.2024.95","url":null,"abstract":"Background: Duchenne muscular dystrophy (DMD) is caused by DMD gene mutations. Delandistrogene moxeparvovec is an investigational gene transfer therapy, developed to address the underlying cause of DMD. We report findings from Part 1 (52 weeks) of the two-part EMBARK trial (NCT05096221). Methods: Key inclusion criteria: Ambulatory patients aged ≥4-<8 years with a confirmed DMD mutation within exons 18–79 (inclusive); North Star Ambulatory Assessment (NSAA) score >16 and <29 at screening. Eligible patients were randomized 1:1 to intravenous delandistrogene moxeparvovec (1.33×1014 vg/kg) or placebo. The primary endpoint was change from baseline in NSAA total score to Week 52. Results: At Week 52 (n=125), the primary endpoint did not reach statistical significance, although there was a nominal difference in change from baseline in NSAA total score in the delandistrogene moxeparvovec (2.6, n=63) versus placebo groups (1.9, n=61). Key secondary endpoints (time to rise, micro-dystrophin expression, 10-meter walk/run) demonstrated treatment benefit in both age groups (4-5 and 6-7 years; p<0.05).There were no new safety signals, reinforcing the favorable and manageable safety profile observed to date. Conclusions: Based on the totality of functional assessments including the timed function tests, treatment with delandistrogene moxeparvovec indicates beneficial modification of disease trajectory.","PeriodicalId":9571,"journal":{"name":"Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques","volume":"88 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141101014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
E.1 Focal leptomeningeal vascular anomalies on brain MRI: a mimic of leptomeningeal metastatic disease E.1 脑核磁共振成像上的灶性脑膜血管异常:脑膜转移性疾病的模拟病例
M Malik, A Yang, J. Germann, SS Haile, H. Son, A. Vetkas, V Pai, A Boutet, DM Mandell
Background: The diagnosis of leptomeningeal metastatic disease has major prognostic implications. We report 13 patients with a radiologically distinct, focal, enhancing leptomeningeal lesion on brain MRI mimicking leptomeningeal metastatic disease. Methods: These patients were assessed at University Health Network between January 2001 and December 2023. Results: Median age was 68 years and 10 patients were women. All patients had brain MRI including contrast-enhanced T2-weighted FLAIR and T1-weighted spin echo sequences. MRI in all patients showed a focal enhancing lesion along the leptomeningeal surface of the brain. The MRI exams were reported as possible metastatic disease for the majority (9/13) of patients. Each lesion was curvilinear rather than sheet-like, and some consisted of multiple connected/branching curvilinear structures with the appearance of abnormal vessels. Some lesions had visible connection with a nearby cortical vein. The lesions were distinct from normal blood vessels. Follow-up contrast-enhanced brain MRI for 8/13 patients at a median of 3.9 years showed all lesions were unchanged over time. Conclusions: We describe a distinct kind of focal, enhancing leptomeningeal lesion on brain MRI that mimics metastatic disease. These lesions are likely a type of low-flow vascular anomaly. Their curvilinear/branching shape and intense enhancement particularly on T2-weighted FLAIR images distinguishes these lesions from tumor.
背景:脑膜转移性疾病的诊断对预后有重要影响。我们报告了 13 例患者,他们在脑部 MRI 上出现放射学上明显的、局灶性、增强性脑膜病变,模仿脑膜转移病。方法:这些患者于2001年1月至2023年12月期间在大学健康网络接受评估。结果中位年龄为 68 岁,10 名患者为女性。所有患者均接受了脑部磁共振成像检查,包括对比增强 T2 加权 FLAIR 和 T1 加权自旋回波序列。所有患者的核磁共振成像均显示沿大脑皮质表面有局灶性增强病变。大多数患者(9/13)的核磁共振检查报告为可能的转移性疾病。每个病灶都呈曲线状而不是片状,有些病灶由多个相连/分支的曲线结构组成,并伴有异常血管的外观。有些病变与附近的皮质静脉有明显的连接。病变与正常血管截然不同。8/13 名患者在中位 3.9 年的随访对比增强脑部 MRI 显示,所有病变均无变化。结论:我们描述了脑部核磁共振成像上一种独特的局灶性、增强性脑膜病变,这种病变与转移性疾病相似。这些病变很可能是一种低流量血管异常。其曲线/分支形状和强强化(尤其是在 T2 加权 FLAIR 图像上)将这些病变与肿瘤区分开来。
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引用次数: 0
P.013 Accuracy of clinical assessments with virtual care in outpatient neurological setting P.013 神经科门诊虚拟护理临床评估的准确性
J. Pellegrino, L Lee
Background: Virtual neurological assessments were increasingly used and an important viable option during the COVID-19 pandemic. However, the accuracy of such assessments is unknown. Methods: Clinical records were reviewed in a predominant multiple sclerosis outpatient clinic at an academic teaching hospital from March 23rd 2020 to March 23rd 2021 during the COVID-19 pandemic. Patients assessed during this period were analyzed with an initial virtual assessment compared to subsequent in person evaluations. Results: 1036 patients were included. 27.8% (n=288) of consultations were video and 72.2% (n=748) telephone. A total of 13.8% (n=143) of virtual consultations revealed clinical disparities, specifically 13.5% (n=39) video and 13.9% (n=104) telephone consultations. Of all the 1036 cases, 2.32% (n=24) patients stated they were stable but significant changes were seen on the exam, changing the clinical impression. 11.5% (n=119) stated they were deteriorating virtually but not confirmed when examined in person, with an alternative explanation found. Conclusions: Virtual assessments were accurate in over 85% of the outpatient neurological cases during the pandemic. However, it should be noted that the in person neurological exam led to a change in clinical opinion in 13.8% of assessments. 2.32% patients described clinical stability, but different clinical management plans resulted when significant exam findings were identified.
背景:在 COVID-19 大流行期间,虚拟神经评估的使用越来越多,成为一种重要的可行选择。然而,此类评估的准确性尚不清楚。方法在 COVID-19 大流行期间,我们查阅了一家学术教学医院多发性硬化症主要门诊从 2020 年 3 月 23 日至 2021 年 3 月 23 日的临床记录。对在此期间接受评估的患者进行了分析,并将最初的虚拟评估与随后的亲自评估进行了比较。结果共纳入 1036 名患者。27.8%(n=288)的咨询是通过视频进行的,72.2%(n=748)的咨询是通过电话进行的。共有 13.8%(n=143)的虚拟会诊显示出临床差异,特别是 13.5%(n=39)的视频会诊和 13.9%(n=104)的电话会诊。在所有 1036 个病例中,2.32%(n=24)的患者表示病情稳定,但在检查中发现明显变化,改变了临床印象。11.5%(n=119)的患者表示他们的病情在无形中恶化,但当面检查时并未得到证实,而是找到了其他解释。结论在大流行期间,超过 85% 的神经科门诊病例的虚拟评估是准确的。但应注意的是,在 13.8%的评估中,亲自进行的神经系统检查导致了临床意见的改变。2.32%的患者描述临床病情稳定,但在发现重要检查结果时,临床治疗方案却发生了变化。
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引用次数: 0
P.117 Antiplatelet and anticoagulation use and outcomes following chronic subdural hematoma drainage: systematic review and meta-analysis P.117 慢性硬膜下血肿引流术后抗血小板和抗凝血药物的使用与预后:系统回顾和荟萃分析
E. Liu, A. Zhou, N Tilbury, J Su, A. Persad, J. Radic
Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition which can be treated with surgical evacuation. A significant percentage of CSDH patients are on antiplatelet or anticoagulation therapy at baseline which may influence risk of recurrence and postoperative thromboembolic events Methods: A search was conducted in MEDLINE (1946 to April 6, 2023), Embase (1974 to April 6, 2023), and PubMed (up to April 6, 2023) on preoperative use of antiplatelet or anticoagulation therapy and outcomes following surgical evacuation of CSDH. Results: Our literature includes 14,410 patients ifrom 42 studies, with 3218 (22%) in the antiplatelet (AP) group, 1731(12%) in the anticoagulation (AC) group, and 9537 (66%) in the no antithrombotics (NA) group. The AP group had significantly higher recurrence compared to NA (OR = 1.21, 95% CI = 1.04 to 1.40, p = 0.01). The AC group also had significantly high recurrence compared to NA (OR = 1.39. 95% CI = 1.15 to 1.68, p = 0.0007). However, being on any antithrombotic therapy is also associated with significantly higher thromboembolic events (OR 5.41, 95% CI 3.16 to 9.26, p < 0.00001). Conclusions: Patients on antithrombotic therapy have both higher recurrence and higher thromboembolic risk compared to patients not on antithrombotic therapy.
背景:慢性硬膜下血肿(CSDH)是一种常见的神经外科疾病,可通过手术清除治疗。很大一部分 CSDH 患者在基线时正在接受抗血小板或抗凝治疗,这可能会影响复发和术后血栓栓塞事件的风险:在 MEDLINE(1946 年至 2023 年 4 月 6 日)、Embase(1974 年至 2023 年 4 月 6 日)和 PubMed(截至 2023 年 4 月 6 日)中对 CSDH 术前使用抗血小板或抗凝疗法以及手术排空后的结果进行了检索。结果:我们的文献包括来自 42 项研究的 14410 例患者,其中抗血小板(AP)组 3218 例(22%),抗凝(AC)组 1731 例(12%),无抗血栓(NA)组 9537 例(66%)。AP 组的复发率明显高于 NA 组(OR = 1.21,95% CI = 1.04 至 1.40,P = 0.01)。AC 组的复发率也明显高于 NA 组(OR = 1.39,95% CI = 1.15 至 1.68,P = 0.0007)。然而,接受任何抗血栓治疗也与血栓栓塞事件显著增加有关(OR 5.41,95% CI 3.16 至 9.26,p < 0.00001)。结论与未接受抗血栓治疗的患者相比,接受抗血栓治疗的患者复发率和血栓栓塞风险都更高。
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引用次数: 0
P.093 BMI as a predictor of recurrence in high-grade meningioma: A single center retrospective cohort study P.093 预测高级别脑膜瘤复发的体重指数:单中心回顾性队列研究
P. Toyota, A. Persad, E. Liu, J Saini, V. Zherebitskiy, R. Auer, L. Hnenny
Background: Elevated BMI has been proposed as a risk factor for the development of meningioma. The relationship between body mass index (BMI) and disease control in high-grade meningioma has not yet been examined. A retrospective cohort study was performed to assess the relationship between high-grade meningioma recurrence and BMI. Methods: This is a retrospective cohort study of patients with Grade 2 or Grade 3 meningioma at a single tertiary care center between 2008 and 2017. We collected clinical data including age, sex, BMI, location, Simpson grade, brain invasion, and radiation treatments. Disease control was monitored on followup MRI scans. We stratified patients by BMI greater than or less than 25. Results: A total of 45 patients were included. Recurrence was observed in 15 patients (33.3%). There were 32 (71.1%) patients with BMI > 25, and 13 (28.9%) patients with normal BMI. Patients with elevated BMI had higher risk of recurrence (p=0.04). Multivariate analysis identified BMI as an independent predictor of recurrence. Conclusions: Our results suggest that overweight patients with a Grade 2 or Grade 3 meningioma are at higher risk of recurrence than patients with normal BMI. The explanation for this association unknown. Further research is suggested to confirm and better characterize this association.
背景:体重指数升高被认为是脑膜瘤发病的一个风险因素。目前尚未研究体质指数(BMI)与高级别脑膜瘤疾病控制之间的关系。我们进行了一项回顾性队列研究,以评估高级别脑膜瘤复发与体重指数之间的关系。方法:这是一项回顾性队列研究,研究对象为 2008 年至 2017 年间在一家三级医疗中心就诊的 2 级或 3 级脑膜瘤患者。我们收集了包括年龄、性别、体重指数、位置、辛普森分级、脑侵犯和放射治疗在内的临床数据。通过随访核磁共振扫描监测疾病控制情况。我们根据 BMI 大于或小于 25 对患者进行了分层。结果:共纳入 45 例患者。15名患者(33.3%)出现复发。32名患者(71.1%)的体重指数大于25,13名患者(28.9%)的体重指数正常。体重指数升高的患者复发风险更高(P=0.04)。多变量分析确定 BMI 是复发的独立预测因素。结论:我们的研究结果表明,体重超重的 2 级或 3 级脑膜瘤患者的复发风险高于体重指数正常的患者。这种关联的原因尚不清楚。建议开展进一步研究,以证实并更好地描述这种关联。
{"title":"P.093 BMI as a predictor of recurrence in high-grade meningioma: A single center retrospective cohort study","authors":"P. Toyota, A. Persad, E. Liu, J Saini, V. Zherebitskiy, R. Auer, L. Hnenny","doi":"10.1017/cjn.2024.198","DOIUrl":"https://doi.org/10.1017/cjn.2024.198","url":null,"abstract":"Background: Elevated BMI has been proposed as a risk factor for the development of meningioma. The relationship between body mass index (BMI) and disease control in high-grade meningioma has not yet been examined. A retrospective cohort study was performed to assess the relationship between high-grade meningioma recurrence and BMI. Methods: This is a retrospective cohort study of patients with Grade 2 or Grade 3 meningioma at a single tertiary care center between 2008 and 2017. We collected clinical data including age, sex, BMI, location, Simpson grade, brain invasion, and radiation treatments. Disease control was monitored on followup MRI scans. We stratified patients by BMI greater than or less than 25. Results: A total of 45 patients were included. Recurrence was observed in 15 patients (33.3%). There were 32 (71.1%) patients with BMI > 25, and 13 (28.9%) patients with normal BMI. Patients with elevated BMI had higher risk of recurrence (p=0.04). Multivariate analysis identified BMI as an independent predictor of recurrence. Conclusions: Our results suggest that overweight patients with a Grade 2 or Grade 3 meningioma are at higher risk of recurrence than patients with normal BMI. The explanation for this association unknown. Further research is suggested to confirm and better characterize this association.","PeriodicalId":9571,"journal":{"name":"Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques","volume":"3 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141101277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques
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