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C.6 Sex differences in neurodevelopmental outcomes and brain development from early-life to 8-years in preterm males and females C.6 早产男性和女性从生命早期到 8 岁的神经发育结果和大脑发育的性别差异
R. Christensen, V. Chau, A. Synnes, T Guo, R. Grunau, S. Miller
Background: Sex is associated with differences in early outcomes with preterm males at greater risk for mortality and morbidity. The objective of this study was to examine preterm sex differences in neurodevelopmental outcomes and brain development from early-life to 8-years. Methods: A prospective cohort of preterm infants born 24-32 weeks gestation were followed to 8-years with standardized measures. MRI scans were performed after birth, term-equivalent age and 8-years. Associations between sex, risk factors, brain volumes, white matter fractional anisotropy (FA) and outcomes were assessed using generalized estimating equations. Results: Preterm males (N=83) and females (N=72) had similar risk factors, brain injury and pain exposure. Sex was a predictor of cognitive scores (P=0.02) and motor impairment (P=0.03), with males having lower cognitive scores and higher motor impairment over time. There was a sex effect for FA (P=0.04), with males having lower FA over time. There were significant sex-brain injury and sex-pain interactions for cognitive and motor outcomes. Conclusions: In this longitudinal study, preterm males had lower cognitive scores and greater motor impairment, which may relate to differences in white matter maturation. Effects of brain injury and pain on outcomes is moderated by sex, indicating a differential response to early-life adversity in preterm males and females.
背景:性别与早期结果的差异有关,早产男性的死亡率和发病率风险更高。本研究旨在探讨早产儿从生命早期到 8 岁期间在神经发育结果和大脑发育方面的性别差异。研究方法对妊娠 24-32 周的早产儿进行前瞻性队列研究,采用标准化测量方法随访 8 年。在婴儿出生后、足月和 8 岁时进行核磁共振成像扫描。使用广义估计方程评估了性别、风险因素、脑容量、白质分数各向异性(FA)和结果之间的关系。结果如下早产男性(83 人)和女性(72 人)的风险因素、脑损伤和疼痛暴露相似。性别是认知评分(P=0.02)和运动障碍(P=0.03)的预测因素,随着时间的推移,男性的认知评分较低,运动障碍较高。FA存在性别效应(P=0.04),随着时间的推移,男性的FA更低。在认知和运动结果方面,存在明显的性别-脑损伤和性别-疼痛交互作用。结论在这项纵向研究中,早产男性的认知评分较低,运动障碍较大,这可能与白质成熟的差异有关。脑损伤和疼痛对结果的影响受性别影响的调节,这表明早产男性和女性对早年逆境的反应不同。
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引用次数: 0
P.127 Quality of life (QoL) using EORTC QoL-C30 and BN20 among patients who underwent brain tumor resection in a tertiary hospital in Saudi Arabia P.127 沙特阿拉伯一家三级医院脑肿瘤切除术患者的生活质量(QoL)(采用 EORTC QoL-C30 和 BN20 测量
R. Moshref, L. Moshref, A. Sabbagh, K. Bajunaid, M. Alyousef, S. Baeesa, R. Daghistani, FA Alhalawani, MA Aljehani, NM Shibriq, WA Saber, AB Khojah, RM Alsayed
Background: Quality of life (QoL) is the awareness of individuals’ well-being in life in physical, personal, mental and social wellbeing and needs to be addressed in brain tumor patients. Methods: A retrospective study conducted in 2017 in a single academic center that included patients diagnosed with brain tumors in a 10 year period. The assessment of the QoL was done using the European Organization for Research and Treatment of Cancer (EORTC), a standardized model (QLQ-C30) that assess several domains (Global Health, Physical function, Role functioning, Emotional Functioning, Cognitive functioning, social functioning and symptoms domain) and Brain cancer model (BN20) to assess symptoms to evaluate all aspects of wellbeing. Results: The total number of patients included in this study is 76 patients with no gender predilection. The most common brain tumor was meningioma by 40% followed by glioma/ others. More than half of the brain tumor patients had a WHO grade I (65%), intermediate grading grade II (15%) and higher grading grade III/IV (20%). The scales and measurements of functioning in life were low in all types of brain tumors. Conclusions: Quality of life in brain tumor patients seemed poor regardless of the type. Further prospective studies are needed to assess QoL worldwide.
背景:生活质量(QoL)是对个人在身体、个人、精神和社会福祉等方面生活幸福感的认识,需要在脑肿瘤患者中得到关注。研究方法2017年,在一家学术中心开展了一项回顾性研究,研究对象包括10年内确诊的脑肿瘤患者。QoL评估采用欧洲癌症研究和治疗组织(EORTC)的标准化模型(QLQ-C30),该模型评估多个领域(全球健康、身体功能、角色功能、情感功能、认知功能、社会功能和症状领域),并采用脑癌模型(BN20)评估症状,以评估福祉的各个方面。研究结果本研究共纳入 76 名患者,无性别偏好。最常见的脑肿瘤是脑膜瘤,占 40%,其次是胶质瘤/其他。半数以上的脑肿瘤患者属于世卫组织 I 级(65%)、中级 II 级(15%)和高级 III/IV 级(20%)。在所有类型的脑肿瘤中,生活功能的量表和测量结果都很低。结论无论哪种类型的脑瘤,脑瘤患者的生活质量似乎都很差。需要进一步开展前瞻性研究,在全球范围内评估生活质量。
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引用次数: 0
P.128 Pituitary apoplexy: a retrospective single center cohort study P.128 垂体中风:一项回顾性单中心队列研究
E. Parker, S. Imran, A. Hebb, N. Kureshi, D. Clarke
Background: Pituitary apoplexy is a rare clinical syndrome resulting from infarction or hemorrhage of a pituitary tumor. Here, we present a large single center retrospective cohort study of patients with apoplexy. Methods: Patients with symptomatic apoplexy treated from January 2000 to October 2022 were isolated from the Halifax Neuropituitary Program’s database, containing prospectively entered data. Patients treated surgically typically presented with vision deterioration or decreased consciousness. Patient demographics, tumor size, endocrinologic values, and clinical outcomes were analyzed. Results: Eighty-three patients met our inclusion criteria. Seventy-two percent of tumours (n=60) were biochemically non-functioning adenomas. Sixty (72.3%) patients were treated surgically, while twenty-three (27.7%) were treated conservatively. At time of presentation, patients treated surgically had a tumor size in maximum dimension of 2.7±1.4 cm versus 1.6±0.5 cm for those treated conservatively (p=0.0003). There were no significant differences in endocrinological values at time of presentation between groups. Fifteen percent (n=9) of patients treated surgically underwent an additional surgery (mean 2.8±2.0 years from index), of which 67% (n=6) were secondary to tumor recurrence. Conclusions: This is one of the largest reported series of apoplexy with long-term follow up. A subset of surgically treated patients will require additional intervention, highlighting the importance of ongoing follow up in this population.
背景:垂体性脑瘫是一种罕见的临床综合征,由垂体瘤梗死或出血引起。在此,我们对垂体功能骤停患者进行了一项大型单中心回顾性队列研究。研究方法从哈利法克斯神经垂体项目数据库中分离出2000年1月至2022年10月期间接受治疗的无症状垂体功能骤停患者,该数据库包含前瞻性输入的数据。接受手术治疗的患者通常会出现视力衰退或意识减退。对患者的人口统计学特征、肿瘤大小、内分泌学值和临床结果进行了分析。结果83名患者符合我们的纳入标准。72%的肿瘤(n=60)为无生化功能腺瘤。60名患者(72.3%)接受了手术治疗,23名患者(27.7%)接受了保守治疗。就诊时,手术治疗患者的肿瘤最大尺寸为(2.7±1.4)厘米,而保守治疗患者的肿瘤最大尺寸为(1.6±0.5)厘米(P=0.0003)。两组患者发病时的内分泌值无明显差异。在接受手术治疗的患者中,15%(n=9)的患者再次接受了手术治疗(平均手术时间为(2.8±2.0)年),其中67%(n=6)的患者是继发于肿瘤复发。结论:这是长期随访的最大规模的脑瘫系列报道之一。一部分接受过手术治疗的患者需要进行额外干预,这凸显了对这部分患者进行持续随访的重要性。
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引用次数: 0
P.033 Electrophysiological signatures of sedation in pediatric patients P.033 儿科患者镇静的电生理特征
M. Grinberg, M Han, K Jones, S. Blain-Moraes
Background: Sedation in PICU masks physical exam findings, leading to diagnostic challenges. In adult models, electroencephalography can evaluate the brain’s response to sedation using feedforward connectivity and anteriorization of alpha hubs, proving useful for prognostication. Feasibility of model translation into pediatric population was assessed, with the hypothesis that the same markers of adaptive reconfiguration would correlate with a higher potential for recovering consciousness. Methods: Electroencephalograms from children undergoing sedation were analyzed for strength and direction of functional connectivity using the weighted and directed phase lag index. Target population was refined with an iterative inclusion criteria. We examined relationships between hub location reconfiguration, directed phase lag index, baseline Glasgow Coma Scale, and 3-month post-treatment Glasgow Outcome Scale-Extended. Results: Evaluation of 14 subjects showed promise in children aged 5-18 undergoing sedation with midazolam, dexmedetomidine, and propofol. Further analysis of five subjects revealed a correlation between adaptive reconfiguration during anesthesia and both higher baseline Glasgow Coma Scale and Glasgow Outcome Scale-Extended scores post-treatment. Conclusions: The findings indicate that the functional brain network connectivity model may have diagnostic and prognostic potential regarding children’s consciousness levels. While the initial data is promising, further analysis of six additional cases is pending and deemed essential to thoroughly evaluate the model’s efficacy.
背景:在重症监护病房使用镇静剂会掩盖体格检查结果,从而给诊断带来困难。在成人模型中,脑电图可以通过前馈连接和阿尔法中枢前移来评估大脑对镇静的反应,这对预后判断非常有用。我们评估了将模型转化为儿科模型的可行性,并假设同样的适应性重构标记将与更高的意识恢复潜力相关。研究方法使用加权和定向相位滞后指数分析了接受镇静治疗的儿童脑电图的功能连接强度和方向。根据迭代纳入标准对目标人群进行了细化。我们研究了中枢位置重构、定向相位滞后指数、基线格拉斯哥昏迷量表和治疗后 3 个月格拉斯哥结果量表扩展之间的关系。结果显示对 14 名受试者进行的评估显示,使用咪达唑仑、右美托咪定和丙泊酚进行镇静治疗的 5-18 岁儿童有望获得疗效。对 5 名受试者的进一步分析表明,麻醉期间的适应性重新配置与治疗后较高的格拉斯哥昏迷量表基线和格拉斯哥结果量表扩展评分之间存在相关性。结论:研究结果表明,大脑功能网络连接模型可能对儿童的意识水平具有诊断和预后潜力。虽然初步数据很有希望,但还需要对另外六个病例进行进一步分析,这对彻底评估该模型的疗效至关重要。
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引用次数: 0
P.049 Acetazolamide use for myoclonus: case report of 2 patients with progressive myoclonic epilepsy and literature review P.049 使用乙酰唑胺治疗肌阵挛:2 例进行性肌阵挛癫痫患者的病例报告和文献综述
P. Teixeira Marques, A. Atif, V. Lira, Q. Zulfiqar Ali, D. Andrade
Background: Cortical myoclonus originates at cerebral cortex, predominantly occurring on voluntary movements. Few case reports described usage of Acetazolamide (ACZ) for myoclonus. Methods: Chart review of 2 patients was performed. Literature review was conducted on myoclonus and ACZ using Pubmed. Results: 22-year-old female was diagnosed with Progressive Myoclonic Epilepsy (PME) secondary to a KCNC1 mutation. Her symptoms started at 10 years old with bilateral tonic clonic seizures (BTCS), later developing progressive ataxia and myoclonus, involving face and limbs, which worsened with stimulus and menses. Medications included Perampanel, Clonazepam and Levetiracetam, however myoclonus was still limiting. At the age of 19, ACZ 250 mg BID was started for 2 weeks around her menses. Follow up revealed significant improvement of myoclonus, resulting in better ambulation, balance and speech, sustained 2.5 years after. 67-year-old male presented BTCS at the age of 53 along with cortical myoclonus, dementia and ataxia, leading to diagnosis of PME with a mutation on IRF2BPL. Improvement of myoclonus occurred with ACZ 250 mg BID biweekly, although balance and cognition still deteriorated. Conclusions: Previous literature outlines 4 cases of action myoclonus that responded to ACZ. We believe that ACZ should be considered to treat myoclonus, especially in cases with cortical involvement and hormonal fluctuations.
背景:皮层性肌阵挛起源于大脑皮层,主要发生在自主运动时。很少有病例报告描述使用乙酰唑胺(ACZ)治疗肌阵挛。研究方法对 2 名患者进行病历回顾。使用 Pubmed 对肌阵挛和 ACZ 进行文献回顾。结果:22岁的女性被诊断为继发于KCNC1基因突变的进行性肌阵挛癫痫(PME)。她的症状始于10岁时的双侧强直阵挛发作(BTCS),后来发展为进行性共济失调和肌阵挛,面部和四肢均受累,并在受到刺激和月经来潮时加重。治疗药物包括培南帕奈、氯硝西泮和左乙拉西坦,但肌阵挛仍有局限性。19 岁时,她在月经前后开始服用 ACZ 250 毫克,每天两次,持续两周。随访显示,肌阵挛明显好转,从而改善了行走、平衡和言语能力,这种情况持续了 2.5 年。67 岁的男性在 53 岁时出现 BTCS,同时伴有皮层肌阵挛、痴呆和共济失调,最终被诊断为 IRF2BPL 基因突变的 PME。使用ACZ 250毫克,每两周一次,每次服用250毫克,肌阵挛有所改善,但平衡能力和认知能力仍在恶化。结论:以前的文献概述了 4 例对 ACZ 有反应的肌阵挛病例。我们认为应考虑使用 ACZ 治疗肌阵挛,尤其是在皮质受累和激素波动的病例中。
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引用次数: 0
P.053 Concomitant corticosteroid use in ravulizumab-treated adults with anti-AChR antibody-positive gMG: results from the CHAMPION MG open-label extension P.053 雷珠单抗治疗抗ACHR抗体阳性gMG成人患者同时使用皮质类固醇:CHAMPION MG开放标签扩展研究的结果
MW Nicolle, D Annane, A Meisel, T. Vu, R. Mantegazza, M Katsuno, V. Bril, R Aguzzi, G Frick, J. Howard
Background: Treatment of generalized myasthenia gravis (gMG) with reduced steroid dosages may minimize steroid-associated AEs. Corticosteroid dosage changes were not permitted during the 26-week, CHAMPION MG study of ravulizumab in adults with anti-acetylcholine receptor antibody-positive (AChRAb+) gMG. Participants who completed the study could receive ravulizumab in the open-label extension (OLE; NCT03920293); corticosteroid adjustments were permitted. Methods: Patients could receive intravenous ravulizumab (blind induction or bridging dose at Week 26 [OLE start] for those previously receiving placebo or ravulizumab, respectively, then 3000–3600 mg at Week 28 and every 8 weeks thereafter) for ≤4 years. Results: Among 161 patients (78 ravulizumab, 83 placebo) who entered the OLE and received ravulizumab for ≤164 weeks, 113 received oral or enteral corticosteroids during the OLE; the proportion treated with >10 mg/day corticosteroids decreased from 58% (n=66) at first OLE dose to 37% (n=42) (35 [31%] received ≤5 mg/day and 71 [63%] received ≤10 mg/day) at last reported dose. Fourteen patients (12%) discontinued corticosteroids. The mean (SD) corticosteroid dosage/patient decreased from 17.5 (11.9) mg/day at first OLE dose to 11.7 (10.9) mg/day at last assessment. Conclusions: Ravulizumab decreased corticosteroid use in patients with AChRAb+ gMG, suggesting a steroid-sparing role for ravulizumab.
背景:减少类固醇剂量治疗全身性肌无力(gMG)可最大限度地减少类固醇相关的不良反应。在对抗性乙酰胆碱受体抗体阳性(AChRAb+)成人重症肌无力患者进行的为期26周的CHAMPION MG研究中,不允许改变皮质类固醇的剂量。完成研究的参与者可在开放标签扩展研究(OLE;NCT03920293)中接受雷珠单抗治疗;允许调整皮质类固醇用量。研究方法患者可接受静脉注射雷珠单抗(之前接受过安慰剂或雷珠单抗治疗的患者可分别在第26周[OLE开始]接受盲诱导剂量或桥接剂量,然后在第28周接受3000-3600毫克的雷珠单抗,此后每8周一次),持续时间不超过4年。研究结果在161名进入OLE并接受雷珠单抗治疗≤164周的患者(78名雷珠单抗患者,83名安慰剂患者)中,有113名患者在OLE期间接受了口服或肠内皮质类固醇治疗;接受>10毫克/天皮质类固醇治疗的患者比例从OLE首次用药时的58%(66人)下降到最后一次用药时的37%(42人)(35人[31%]接受>5毫克/天皮质类固醇治疗,71人[63%]接受>10毫克/天皮质类固醇治疗)。14名患者(12%)停用了皮质类固醇。每位患者的皮质类固醇平均剂量(标度)从首次服用 OLE 时的 17.5(11.9)毫克/天降至最后一次评估时的 11.7(10.9)毫克/天。结论雷珠单抗减少了 AChRAb+ gMG 患者的皮质类固醇用量,表明雷珠单抗具有节省类固醇的作用。
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引用次数: 0
P.137 Neurosurgical consultations in Nova Scotia: a descriptive analysis P.137 新斯科舍省的神经外科会诊:描述性分析
E. Parker, MA MacLean, E Leck, J. Han, A Alwadei, R Greene, D. Clarke
Background: Receiving and managing neurosurgical consultations are central to providing quality patient care but are resource intensive processes. As part of an ongoing quality improvement initiative, we conducted a single-institution descriptive analysis of adult neurosurgical consultations. Methods: A retrospective review of prospectively collected consultation records and call schedules from a 12-month period from February 2019 to 2020 was performed. Consults were graded according to disposition (admission for surgery, non-operative admission, additional investigations recommended, opinion without further investigations, unnecessary consult). Results: There were 1916 consultations reviewed, with 52% of calls (n=991) originating outside of our hospital, and 72% (n=1387) coming from an emergency department. Cranial cases made up 64% (n=1230) of consults, while the remaining 36% (n=688) were spine cases. The mean patient age was 60.1±0.4 years. In multinomial logistic regression analysis, age, geographical distance of consulting site, and consult specific variables (neurosurgical subspecialty, inside vs. outside call, emergency department vs. inpatient ward or private office) were associated with consult disposition (p < 0.001). Conclusions: This study provides a descriptive analysis of neurosurgical consultations in Nova Scotia. Results from this study may be used to address inefficacies in the neurosurgical consultation process, including targeted education for consulting physicians.
背景:接受和管理神经外科会诊是为患者提供优质医疗服务的核心,但却是一个资源密集型过程。作为正在进行的质量改进计划的一部分,我们对单个机构的成人神经外科会诊进行了描述性分析。方法:我们对 2019 年 2 月至 2020 年 12 个月期间前瞻性收集的会诊记录和呼叫时间表进行了回顾性审查。根据处置情况(手术入院、非手术入院、建议额外检查、无进一步检查意见、不必要的会诊)对会诊进行分级。结果:共审查了 1916 次会诊,其中 52% 的电话(n=991)来自本医院以外,72% 的电话(n=1387)来自急诊科。颅脑病例占咨询病例的 64%(n=1230),其余 36%(n=688)为脊柱病例。患者平均年龄为(60.1±0.4)岁。在多项式逻辑回归分析中,年龄、会诊地点的地理距离和会诊的具体变量(神经外科亚专科、内部呼叫与外部呼叫、急诊科与住院病房或私人办公室)与会诊处置相关(P < 0.001)。结论:本研究对新斯科舍省的神经外科会诊进行了描述性分析。研究结果可用于解决神经外科会诊过程中的低效问题,包括对会诊医生进行有针对性的教育。
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引用次数: 0
P.065 Understanding treatment barriers and adherence among people living with amyotrophic lateral sclerosis P.065 了解肌萎缩侧索硬化症患者的治疗障碍和坚持治疗的情况
G. Matte, D. Blackburn, D. Bolano Del Vecchio
Background: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with only four approved treatments in North America - sodium phenylbutyrate (PB) and ursodoxicoltaurine (TURSO, also known as taurursodiol), riluzole, edaravone, and tofersen. Poor treatment adherence reduces clinical effectiveness which can adversely impact disease progression and mortality rates. Understanding barriers and adherence to treatment in clinical practice is essential to address these issues. Methods: A scoping review was conducted in PubMed, Medline, Embase, and Web of Science. Retained studies were, (1) published in English, (2) included adults with ALS, (3) explored treatment non-adherence and/or identified barriers associated with non-adherence in ALS in real world clinical practice, (4) focused on ≥1 of the four approved ALS medications, and (5) used a measurement of adherence. Observational studies, real-world data, and case reports were included. Quality assessment was performed. Results: The review illustrated several knowledge gaps, including limited data on the incidence of non-adherence to ALS treatment in clinical practice, a lack of understanding regarding barriers to treatment adherence in ALS, and an absence of studies outside of western societies. Conclusions: We demonstrate a dearth of real-world data on treatment adherence in ALS and highlight opportunities for advancing research into this important area.
背景:肌萎缩侧索硬化症(ALS)是一种致命的神经退行性疾病:肌萎缩性脊髓侧索硬化症(ALS)是一种致命的神经退行性疾病,在北美仅有四种获批的治疗方法--苯丁酸钠(PB)和乌索二醇(TURSO,又称牛磺二醇)、利鲁唑、依达拉奉和托福森。治疗依从性差会降低临床疗效,从而对疾病进展和死亡率产生不利影响。要解决这些问题,了解临床实践中的治疗障碍和治疗依从性至关重要。研究方法在 PubMed、Medline、Embase 和 Web of Science 上进行了范围界定审查。保留的研究必须:(1)以英文发表;(2)纳入了 ALS 成人患者;(3)探讨了 ALS 在实际临床实践中的治疗不依从性和/或确定了与不依从性相关的障碍;(4)关注四种获批 ALS 药物中的≥一种;(5)使用了依从性测量方法。研究纳入了观察性研究、真实世界数据和病例报告。进行了质量评估。结果:综述显示了一些知识空白,包括临床实践中不坚持 ALS 治疗的发生率数据有限、对 ALS 患者坚持治疗的障碍缺乏了解,以及缺乏西方社会以外的研究。结论:我们展示了 ALS 治疗依从性方面真实世界数据的匮乏,并强调了推进这一重要领域研究的机会。
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引用次数: 0
P.026 Success with incrementally faster times to endovascular therapy (SWIFT-EVT): a systematic review and meta-analysis P.026 成功加快血管内治疗时间(SWIFT-EVT):系统回顾和荟萃分析
B. Legere, A Mohamed, S. Elsherif, R. Saqqur, D. Schoenfeld, AM Slebonick, M. Mccartin, J. Price, K. Zachrison, JA Edlow, M. Saqqur, A. Shuaib, S Thomas
Background: Previous research demonstrates that for acute ischemic stroke (AIS) cases, rapid endovascular therapy (EVT) performance improves outcomes. This study provides updated metrics summarizing estimates for modified Rankin Scale (mRS) gains accrued by streamlining time to EVT. Methods: A systematic review and meta-analysis (MA) was conducted using electronic databases. Eligible studies reported time-benefit slope with times from AIS onset (or time last-seen-normal) to EVT commencement; the predictor was onset-to-groin (OTG) time. Primary and secondary outcomes were 90-day functional independence (mRS 0-2) and 90-day excellent function (mRS 0-1), respectively. Results: The five included studies showed increased chance of good outcome with each hour of pre-EVT time savings for mRS 0-2 for 0-270’ (OR 1.25, 95% CI 1.16-1.35, I2 40%) and 271-360’ time frame (1.22, 95% CI 1.12-1.33, I2 58%). For studies assessing mRS 0-1, pooled effect estimates were appropriate for the 0-270’ time frame (OR 1.34, 95% CI 1.19-1.51, I2 27%) and the 271-360’ time frame (OR 1.20, 95% CI 1.03-1.38, I2 60%). Conclusions: Each hour saved from AIS onset to EVT start is associated with a 22-25% increased odds of functional independence, a useful metric to inform patient-specific and systems planning decisions.
背景:先前的研究表明,对于急性缺血性卒中(AIS)病例,快速血管内治疗(EVT)可改善预后。本研究提供了最新的指标,总结了通过缩短 EVT 时间而获得的改良 Rankin 量表(mRS)收益的估计值。方法:利用电子数据库进行了系统回顾和荟萃分析 (MA)。符合条件的研究报告了从 AIS 发病(或最后一次见到正常人的时间)到 EVT 开始的时间效益斜率;预测指标是发病到龈沟(OTG)时间。主要和次要结果分别为 90 天功能独立(mRS 0-2)和 90 天功能良好(mRS 0-1)。结果:纳入的五项研究显示,在0-270'(OR 1.25,95% CI 1.16-1.35,I2 40%)和271-360'(1.22,95% CI 1.12-1.33,I2 58%)时间范围内,EVT前时间每节省一小时,mRS 0-2的良好预后几率就会增加。对于评估 mRS 0-1 的研究,0-270'时间段(OR 1.34,95% CI 1.19-1.51,I2 27%)和 271-360' 时间段(OR 1.20,95% CI 1.03-1.38,I2 60%)的汇总效应估计值合适。结论:从 AIS 开始到 EVT 开始,每节省一小时,功能独立的几率就会增加 22%-25%,这是一个有用的指标,可为特定患者和系统规划决策提供信息。
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引用次数: 0
P.132 Blood loss quantification and management strategies in cranial neurosurgery: a systematic review P.132 颅脑神经外科手术中的失血量化和管理策略:系统性综述
DD George, J. Chrisbacher, T. Mattingly, T. Schmidt, K. Walter
Background: Blood loss quantification and management are important facets of cranial surgery, having been linked with adverse outcomes if management is inadequate. While many studies report estimated blood loss (EBL) as an outcome measure, inconsistencies exist in EBL quantification and management strategies Methods: A systematic review of cranial surgery literature on blood loss measurement and management was conducted according to PRISMA guidelines utilizing a novel software platform, Nested Knowledge Results: Initial search yielded 1029 non-duplicated. 107 full-text studies were included. 70% of studies were retrospective. Most common treatment conditions were 41% craniosynostosis (44/107) and 36% tumor (39/107). Most common EBL measurement methods were comparison of pre-operative and post-operative hemoglobin/hematocrit in 46.7% (50/107), anesthesia record in 26.2% (28/107), and surgeon estimation in 9.3% (10/107). 53.3% of studies did not specify a quantification methodology. Blood loss management strategies also varied, with transfusion being the most common method in 64.5% (69/107) of studies Conclusions: EBL quantification and blood loss management remain important clinical and research metrics. Despite this, significant heterogeneity exists in blood loss quantification and management strategies, with most studies providing no data on EBL quantification. Standardization of EBL quantification/reporting should be undertaken to improve comparability and consistency across studies.
背景:失血量的量化和管理是颅脑手术的重要环节,如果管理不当,会导致不良后果。虽然许多研究将估计失血量(EBL)作为结果测量指标,但在 EBL 定量和管理策略方面存在不一致之处:根据 PRISMA 指南,利用新颖的软件平台 Nested Knowledge Results 对有关失血量测量和管理的颅脑手术文献进行了系统性回顾:初步搜索结果为 1029 项非重复。共纳入 107 篇全文研究。70%的研究为回顾性研究。最常见的治疗条件是41%的颅骨发育不良(44/107)和36%的肿瘤(39/107)。最常见的 EBL 测量方法是比较术前和术后血红蛋白/血细胞比容(46.7% (50/107))、麻醉记录(26.2% (28/107))和外科医生估计(9.3% (10/107))。53.3%的研究未说明量化方法。失血管理策略也各不相同,64.5%(69/107)的研究中输血是最常见的方法:EBL 定量和失血管理仍然是重要的临床和研究指标。尽管如此,失血定量和管理策略仍存在明显的异质性,大多数研究未提供 EBL 定量数据。应该对 EBL 定量/报告进行标准化,以提高各项研究的可比性和一致性。
{"title":"P.132 Blood loss quantification and management strategies in cranial neurosurgery: a systematic review","authors":"DD George, J. Chrisbacher, T. Mattingly, T. Schmidt, K. Walter","doi":"10.1017/cjn.2024.233","DOIUrl":"https://doi.org/10.1017/cjn.2024.233","url":null,"abstract":"Background: Blood loss quantification and management are important facets of cranial surgery, having been linked with adverse outcomes if management is inadequate. While many studies report estimated blood loss (EBL) as an outcome measure, inconsistencies exist in EBL quantification and management strategies Methods: A systematic review of cranial surgery literature on blood loss measurement and management was conducted according to PRISMA guidelines utilizing a novel software platform, Nested Knowledge Results: Initial search yielded 1029 non-duplicated. 107 full-text studies were included. 70% of studies were retrospective. Most common treatment conditions were 41% craniosynostosis (44/107) and 36% tumor (39/107). Most common EBL measurement methods were comparison of pre-operative and post-operative hemoglobin/hematocrit in 46.7% (50/107), anesthesia record in 26.2% (28/107), and surgeon estimation in 9.3% (10/107). 53.3% of studies did not specify a quantification methodology. Blood loss management strategies also varied, with transfusion being the most common method in 64.5% (69/107) of studies Conclusions: EBL quantification and blood loss management remain important clinical and research metrics. Despite this, significant heterogeneity exists in blood loss quantification and management strategies, with most studies providing no data on EBL quantification. Standardization of EBL quantification/reporting should be undertaken to improve comparability and consistency across studies.","PeriodicalId":9571,"journal":{"name":"Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques","volume":"5 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141098998","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}
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Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques
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