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Comparing morbidity and mortality in adult patients with acute traumatic cervical spinal cord injury in 2013–2017 and 2018–2022: a retrospective 10-year national trend analysis 比较2013-2017年和2018-2022年成年急性外伤性颈脊髓损伤患者的发病率和死亡率:回顾性10年全国趋势分析
IF 1.9 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-06-12 DOI: 10.1016/j.jocn.2025.111382
Aladine A. Elsamadicy , Paul Serrato , Selma Belkasim , Sina Sadeghzadeh , Shaila D. Ghanekar , Syed I. Khalid , Sheng-fu Larry Lo , Daniel M. Sciubba
{"title":"Comparing morbidity and mortality in adult patients with acute traumatic cervical spinal cord injury in 2013–2017 and 2018–2022: a retrospective 10-year national trend analysis","authors":"Aladine A. Elsamadicy , Paul Serrato , Selma Belkasim , Sina Sadeghzadeh , Shaila D. Ghanekar , Syed I. Khalid , Sheng-fu Larry Lo , Daniel M. Sciubba","doi":"10.1016/j.jocn.2025.111382","DOIUrl":"10.1016/j.jocn.2025.111382","url":null,"abstract":"<div><h3>Objectives</h3><div>While considerable attention has been dedicated to quality improvement in spine surgery, few studies have evaluated progress in spinal cord injury (SCI) outcomes. This study aimed to assess whether morbidity and mortality trends have improved for acute cervical SCI patients in the last decade.</div></div><div><h3>Methods</h3><div>The American College of Surgeons Trauma Quality Programs database was retrospectively queried and outcomes for adult patients with acute cervical SCI were compared between two 5-year groups: 2013–2017 and 2018–2022. Patient demographics, comorbidities, type of injury, treatment modality, and adverse events (AEs) were assessed. Multivariable logistic regression was used to identify independent predictors of AEs, non-routine discharge (NRD), and in-hospital mortality.</div></div><div><h3>Results</h3><div>Compared to patients in the 2013–2017 cohort (n = 41,666), patients in the 2018–2022 cohort (n = 54,755) were significantly older on average (<em>2013</em>–<em>2017: 54.0 ± 18.8 years, 2018</em>–<em>2022: 56.1 ± 18.5 years, p < 0.001</em>) and had a significantly higher baseline comorbidity burden. Mean Injury Severity Score (ISS) was slightly higher in the 2018–2022 cohort than in the 2013–2017 cohort (<em>2013</em>–<em>2017: 21.1 ± 15.3, 2018</em>–<em>2022: 21.3 ± 14.2, p < 0.001</em>). Falls (<em>2013</em>–<em>2017: 19.9 %, 2018</em>–<em>2022: 48.9 %, p < 0.001</em>) were the most common mechanism of injury in the 2018–2022 cohort while “Other” injury was most common in the 2013–2017 cohort (<em>2013</em>–<em>2017: 60.0 %, 2018</em>–<em>2022: 4.5 %, p < 0.001</em>). Patients in the 2018–2022 had a higher frequency of any surgical procedure (<em>2013</em>–<em>2017: 47.7, 2018</em>–<em>2022: 53.7, p < 0.001</em>). The 2018–2022 cohort had a lower frequency of NRD (<em>2013</em>–<em>2017: 75.3 %, 2018</em>–<em>2022: 74.2 %, p < 0.001</em>) and unplanned reoperation (<em>2013</em>–<em>2017: 0.9 %, 2018</em>–<em>2022: 0.5 %, p < 0.001</em>), as well as shorter mean LOS (<em>2013</em>–<em>2017: 12.2 ± 15.7 days, 2018</em>–<em>2022: 12.6 ± 16.2 days, p < 0.001)</em> compared to the 2013–2017 patient cohort. Conversely, the 2018–2022 cohort had a significantly greater rate of in-hospital mortality (<em>2013</em>–<em>2017: 11.3 %, 2018</em>–<em>2022: 12.6 %, p < 0.001</em>) and unplanned ICU admission (<em>2013</em>–<em>2017: 3.0 %, 2018</em>–<em>2022: 4.9 %, p < 0.001</em>)than the 2013–2017 cohort. On multivariable analysis, undergoing treatment for SCI from 2018 to 2022 was significantly associated with decreased odds of NRD (<em>aOR: 0.73, 95 % CI: 0.70</em>–<em>0.76</em>), but increased odds of in-hospital mortality (<em>aOR: 1.18, 95 % CI: 1.11</em>–<em>1.26</em>).</div></div><div><h3>Conclusion</h3><div>Our study suggests patients undergoing treatment from 2018 to 2022 were at decreased risk of NRD, but increased risk of in-hospital mortality compared to patients ","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"138 ","pages":"Article 111382"},"PeriodicalIF":1.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy and safety of stereotactic radiosurgery for large meningiomas: A comprehensive systematic review and meta-analysis 立体定向放射手术治疗大脑膜瘤的疗效和安全性:一项全面的系统回顾和荟萃分析
IF 1.9 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-06-11 DOI: 10.1016/j.jocn.2025.111384
Bardia Hajikarimloo , Salem M. Tos , Ibrahim Mohammadzadeh , Sara Hemmati , Alaleh Savedkoohi , Maryam Diyanati , Diba Akbarzadeh , Mohammadamin Sabbagh Alvani , Ehsan Bahrami Hezaveh , Rana Hashemi , Mohammad Amin Habibi
{"title":"Efficacy and safety of stereotactic radiosurgery for large meningiomas: A comprehensive systematic review and meta-analysis","authors":"Bardia Hajikarimloo ,&nbsp;Salem M. Tos ,&nbsp;Ibrahim Mohammadzadeh ,&nbsp;Sara Hemmati ,&nbsp;Alaleh Savedkoohi ,&nbsp;Maryam Diyanati ,&nbsp;Diba Akbarzadeh ,&nbsp;Mohammadamin Sabbagh Alvani ,&nbsp;Ehsan Bahrami Hezaveh ,&nbsp;Rana Hashemi ,&nbsp;Mohammad Amin Habibi","doi":"10.1016/j.jocn.2025.111384","DOIUrl":"10.1016/j.jocn.2025.111384","url":null,"abstract":"<div><h3>Background</h3><div>Managing large intracranial meningiomas (LIMs) is challenging. Because of the significant morbidity associated with resection, stereotactic radiosurgery (SRS) has increasingly been employed for LIMs. This systematic review and meta-analysis assessed the role of SRS in LIMs.</div></div><div><h3>Methods</h3><div>On March 21, 2025, we performed a literature search. Studies evaluating outcomes after upfront or adjuvant SRS in patients with LIMs, with volumes larger than 8 cm<sup>3</sup> or a maximum diameter exceeding 2.5 cm, were included.</div></div><div><h3>Results</h3><div>Eleven studies involving 793 patients were included. The mean tumor volume ranged from 14.1 to 37.3 cm<sup>3</sup>. The meta-analysis revealed a pooled local control (LC) rate of 91 % (95 % CI: 86 %–94 %). Additionally, the analysis demonstrated a pooled 5-year progression-free survival (PFS) rate of 92 % (95 % CI: 86 %–96 %) and a 10-year PFS rate of 81 % (95 % CI: 76 %–84 %). It exhibited a pooled overall survival (OS) rate of 88 % (95 % CI: 77 %–96 %), a 5-year OS rate of 94 % (95 % CI: 89 %–97 %), and a 10-year OS rate of 88 % (95 % CI: 58 %–100 %). Moreover, the meta-analysis revealed a pooled adverse radiation effect (ARE) and post-SRS resection rates of 19 % (95 % CI: 7 %–36 %) and 3 % (95 % CI: 0 %–8%), respectively. Hypofractionated SRS (99 % [95 % CI: 91 %–100 %]) was associated with a significantly higher pooled OS rate than volume-staged SRS (82 % [95 % CI: 69 %–92 %]) and single session SRS (85 % [95 % CI: 48 %–100 %]) (P = 0.01).</div></div><div><h3>Conclusion</h3><div>Upfront or adjuvant SRS is linked to promising radiological and clinical outcomes with manageable radiation-related complications. Further research is needed to compare upfront versus adjuvant SRS and evaluate the relative efficacy and safety of single-session, hypofractionated, and volume-staged SRS in individuals with LIMs.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"138 ","pages":"Article 111384"},"PeriodicalIF":1.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Collateral gains from vascular microsurgical intervention on the V1 segment dolicoarteriopathy of the vertebral artery: alleviating restless leg syndrome and urgency urinary incontinence symptoms in refractory vertebrobasilar insufficiency cases 血管显微外科介入治疗椎动脉V1节段多动脉病的获益:缓解难治性椎基底动脉功能不全患者的不宁腿综合征和急迫性尿失禁症状
IF 1.9 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-06-11 DOI: 10.1016/j.jocn.2025.111369
Efecan Cekic , Baylar Baylarov , Mehmet Besir Surme , Hakki Perk , Mehmet Erkan Ustun
{"title":"Collateral gains from vascular microsurgical intervention on the V1 segment dolicoarteriopathy of the vertebral artery: alleviating restless leg syndrome and urgency urinary incontinence symptoms in refractory vertebrobasilar insufficiency cases","authors":"Efecan Cekic ,&nbsp;Baylar Baylarov ,&nbsp;Mehmet Besir Surme ,&nbsp;Hakki Perk ,&nbsp;Mehmet Erkan Ustun","doi":"10.1016/j.jocn.2025.111369","DOIUrl":"10.1016/j.jocn.2025.111369","url":null,"abstract":"<div><h3>Background</h3><div>This study assesses the efficacy of vascular microneurosurgical interventions on the V1 segment dolicoarteriopathies (grade 2 and 3 kinks) of the vertebral artery (VA) in patients with refractory vertebrobasilar insufficiency (VBI), manifesting as secondary benefits for restless leg syndrome (RLS) and urgency urinary incontinence (UUI).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 78 patients for RLS and UUI symptoms who underwent vascular procedures primarily for refractory VBI due to V1 segment dolicoarteriopathy. Depending on the severity of arterial kinking, the surgical techniques varied from arteriolysis to perivascular sympathectomy and graft positioning. Patients underwent diagnostic evaluations, including brain magnetic resonance imaging (MRI), brain and cervical MRI angiography, and preoperative as well as postoperative (at 3-month follow-up) perfusion studies utilizing Computerized Tomography (CT) perfusion studies.</div></div><div><h3>Results</h3><div>Significant symptomatic improvement was noted post-surgery, with 85.7% of patients experiencing complete resolution of RLS and substantially reducing UUI symptoms. The microneurosurgical approach resulted in complete remission of VBI-related symptoms in 87.8% of patients, with the rest showing partial or marked improvement. Regarding cerebral perfusion, 17 out of 20 patients showed objective improvements in perfusion studies in paracentral lobule, which translates to an 85% enhancement rate. This significant increase in perfusion correlates with symptomatic relief.</div></div><div><h3>Conclusion</h3><div>Vascular interventions for V1 segment dolicoarteriopathy are associated with clinical improvements in RLS and UUI symptoms, in addition to refractory VBI symptoms. The correlation between improved perfusion metrics and symptom resolution suggests a vascular contribution to the pathophysiology, emphasizing vascular assessment in refractory VBI cases.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"138 ","pages":"Article 111369"},"PeriodicalIF":1.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Identifying patients at risk of increased health utilization following lumbar spine surgery 确定腰椎手术后有增加健康利用风险的患者
IF 1.9 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-06-11 DOI: 10.1016/j.jocn.2025.111349
Rushmin Khazanchi , Divy Kumar , Anitesh Bajaj , Robert J. Oris , Austin R. Chen , Daniel E. Herrera , Rohan M. Shah , Shravan Asthana , Samuel G. Reyes , Pranav Bajaj , Wellington K. Hsu , Alpesh A. Patel , Srikanth N. Divi
{"title":"Identifying patients at risk of increased health utilization following lumbar spine surgery","authors":"Rushmin Khazanchi ,&nbsp;Divy Kumar ,&nbsp;Anitesh Bajaj ,&nbsp;Robert J. Oris ,&nbsp;Austin R. Chen ,&nbsp;Daniel E. Herrera ,&nbsp;Rohan M. Shah ,&nbsp;Shravan Asthana ,&nbsp;Samuel G. Reyes ,&nbsp;Pranav Bajaj ,&nbsp;Wellington K. Hsu ,&nbsp;Alpesh A. Patel ,&nbsp;Srikanth N. Divi","doi":"10.1016/j.jocn.2025.111349","DOIUrl":"10.1016/j.jocn.2025.111349","url":null,"abstract":"<div><h3>Background</h3><div>Adequate preoperative identification of patients at risk of significant healthcare utilization after surgery could help guide preoperative decision-making as well as postoperative patient management. While several studies have proposed mechanisms and risk factors for healthcare utilization, no studies have developed a prognostic machine learning model to quantify and functionalize predictions.</div></div><div><h3>Methods</h3><div>A cohort of lumbar fusion and lumbar decompression surgeries was queried from a tertiary academic medical center from 2002 to 2022. Patient and operative characteristics were systematically extracted for each surgery. Several machine learning algorithms were employed and optimized to predict high healthcare utilizers using an aggregate 90-day index. SHAP feature importance values were computed for the top performing model.</div></div><div><h3>Results</h3><div>A total of 10,128 unique lumbar decompression surgeries and 2,890 unique lumbar fusion surgeries were included. The Random Forest model had the highest performance of tested models (AUROC of 0.766 for lumbar decompression, 0.727 for lumbar fusion). Both models outperformed the ASA benchmark model. The top three predictors of high health utilization in the decompression cohort included preoperative lumbar stenosis, preoperative benzodiazepine use, and preoperative neuromodulator use. The top three predictors for the fusion cohort included preoperative opioid use, preoperative neuromodulator use, and preoperative benzodiazepine use. Other Key variables spanned several domains including preoperative medication usage, patient demographics, and operative indications and characteristics.</div></div><div><h3>Discussion</h3><div>This study demonstrates the successful creation of a prognostic machine learning model for prediction of high healthcare utilization within 90 days of lumbar spine surgery. These models, after external validation, have the potential to be instrumental aspects of a spine surgeon’s workflow.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"138 ","pages":"Article 111349"},"PeriodicalIF":1.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outcomes of surgically managed brainstem cavernous Malformations: A systematic review and Meta-Analysis 手术治疗脑干海绵状血管瘤的结果:系统回顾和荟萃分析
IF 1.9 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-06-11 DOI: 10.1016/j.jocn.2025.111371
Brandon Edelbach , Ahmad K. AlMekkawi , Adnan Shaik , Rekha P. Swamy , Emily He , Karl R. Abiaad , Ryan A Hess , James P. Caruso , Carlos A. Bagley , Tarek Y. El Ahmadieh , Yifei Duan , Jonathen D. Breshears
{"title":"Outcomes of surgically managed brainstem cavernous Malformations: A systematic review and Meta-Analysis","authors":"Brandon Edelbach ,&nbsp;Ahmad K. AlMekkawi ,&nbsp;Adnan Shaik ,&nbsp;Rekha P. Swamy ,&nbsp;Emily He ,&nbsp;Karl R. Abiaad ,&nbsp;Ryan A Hess ,&nbsp;James P. Caruso ,&nbsp;Carlos A. Bagley ,&nbsp;Tarek Y. El Ahmadieh ,&nbsp;Yifei Duan ,&nbsp;Jonathen D. Breshears","doi":"10.1016/j.jocn.2025.111371","DOIUrl":"10.1016/j.jocn.2025.111371","url":null,"abstract":"<div><h3>Background</h3><div>Brainstem cavernous malformations (BSCMs) are rare vascular lesions that can cause significant neurological deficits due to their critical location. This systematic review and <em>meta</em>-analysis aims to synthesize the available evidence on the hemorrhage rates, risk factors, and clinical outcomes of BSCMs to guide clinical decision-making.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was performed in PubMed, Scopus, Medline for articles published from 1986 to June 2024. Studies reporting on the clinical outcomes of BSCMs were included. Data on patient demographics, hemorrhage rates, risk factors, and outcomes were extracted and analyzed using random-effects <em>meta</em>-analysis models.</div></div><div><h3>Results</h3><div>A total of 81 studies involving<!--> <!-->4046 patients with BSCMs were included. The annual hemorrhage rate was 4.67 % per patient-year, with a rehemorrhage rate of 34.44 % per year. At diagnosis, 31 % of patients presented with motor deficits, 51 % with cranial nerve palsies, and 2.05 % with respiratory dysfunction. Surgical intervention was performed in all cases, with 65.38 % of patients achieving a favorable outcome (modified Rankin Scale score ≤ 2). However, early postoperative morbidity and mortality rates remained significant at 11.53 %. A significant risk factor for increased rates of post-operative morbidity and mortality was male sex and rates of post-operative morbidity and mortality were found to significantly decrease from 1990 s till early 2020 s.</div></div><div><h3>Conclusion</h3><div>BSCMs carry a substantial risk of hemorrhage and neurological morbidity. While surgical intervention can provide favorable outcomes for selected patients, the risks and benefits must be carefully weighed on an individual basis as there is still considerable risk of post-operative hemorrhage. Further prospective studies are needed to refine risk stratification and management strategies for BSCMs.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"138 ","pages":"Article 111371"},"PeriodicalIF":1.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Olfactory groove schwannoma complicated by communicating hydrocephalus 嗅觉沟神经鞘瘤并发交通性脑积水
IF 1.9 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-06-10 DOI: 10.1016/j.jocn.2025.111372
Kengo Kishida , Hideki Oka, Manato Sakamoto, Shigeomi Yokoya
{"title":"Olfactory groove schwannoma complicated by communicating hydrocephalus","authors":"Kengo Kishida ,&nbsp;Hideki Oka,&nbsp;Manato Sakamoto,&nbsp;Shigeomi Yokoya","doi":"10.1016/j.jocn.2025.111372","DOIUrl":"10.1016/j.jocn.2025.111372","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"138 ","pages":"Article 111372"},"PeriodicalIF":1.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Aneurysmal subarachnoid hemorrhage in elderly patients: fluctuations in serum sodium levels were associated with poor neurological outcomes 老年患者动脉瘤性蛛网膜下腔出血:血清钠水平波动与神经预后不良相关
IF 1.9 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-06-09 DOI: 10.1016/j.jocn.2025.111370
Wataru Uchida, Tomoya Kamide, Kouichi Misaki, Daisuke Wajima Sho Takata, Mitsutoshi Nakada
{"title":"Aneurysmal subarachnoid hemorrhage in elderly patients: fluctuations in serum sodium levels were associated with poor neurological outcomes","authors":"Wataru Uchida,&nbsp;Tomoya Kamide,&nbsp;Kouichi Misaki,&nbsp;Daisuke Wajima Sho Takata,&nbsp;Mitsutoshi Nakada","doi":"10.1016/j.jocn.2025.111370","DOIUrl":"10.1016/j.jocn.2025.111370","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the clinical characteristics and treatment outcomes of aneurysmal subarachnoid hemorrhage (aSAH) in elderly (aged ≥75 years) and nonelderly patients (&lt;75 years).</div></div><div><h3>Methods</h3><div>This single-center retrospective study enrolled 59 patients with aSAH between November 2019 and November 2023. Patients were categorized into elderly and nonelderly groups based on a cutoff of 75 years, with further subdivisions of the elderly group based on the modified Rankin Scale (mRS) score at discharge into favorable (mRS score 0–3) and poor (mRS score 4–6) outcomes. Clinical data, including the World Federation of Neurosurgical Societies (WFNS) grade, aneurysm size, and various clinical and laboratory parameters, were analyzed.</div></div><div><h3>Results</h3><div>The elderly group exhibited higher mRS scores 4–6 and larger aneurysms. Univariate and multivariate analyses identified fluctuating serum sodium levels as a significant predictor of poor neurological outcomes (P = 0.048) in elderly patients. The receiver operating characteristic curve of serum sodium variability showed a cutoff value of 10 mEq/L for good neurological outcomes (sensitivity, 84.6 %; specificity, 66.7 %; area under the curve, 0.87).</div></div><div><h3>Conclusions</h3><div>Elderly patients with aSAH typically present with more severe symptoms, which contribute to poorer outcomes, and larger aneurysms. However, stabilizing serum sodium fluctuations during treatment could improve the prognosis, emphasizing the need for careful perioperative management.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"138 ","pages":"Article 111370"},"PeriodicalIF":1.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Remnant cholesterol and post-stroke cognitive function: A multicenter prospective study 残余胆固醇与脑卒中后认知功能:一项多中心前瞻性研究
IF 1.9 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-06-08 DOI: 10.1016/j.jocn.2025.111355
Hong Li , Zhengbao Zhu , Mengyao Shi , Hao Peng , Daoxia Guo , Tan Xu , Jing Chen , Yonghong Zhang , Jiang He , Chongke Zhong , Xiaoqing Bu
{"title":"Remnant cholesterol and post-stroke cognitive function: A multicenter prospective study","authors":"Hong Li ,&nbsp;Zhengbao Zhu ,&nbsp;Mengyao Shi ,&nbsp;Hao Peng ,&nbsp;Daoxia Guo ,&nbsp;Tan Xu ,&nbsp;Jing Chen ,&nbsp;Yonghong Zhang ,&nbsp;Jiang He ,&nbsp;Chongke Zhong ,&nbsp;Xiaoqing Bu","doi":"10.1016/j.jocn.2025.111355","DOIUrl":"10.1016/j.jocn.2025.111355","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the association between baseline remnant cholesterol (RC) levels and post-stroke cognitive impairment (PSCI) at three months following the event.</div></div><div><h3>Methods</h3><div>The data utilized in this research originated from a pre-arranged subsidiary investigation of the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). RC levels were determined using the formula: RC (mmol/L) = total cholesterol (TC) − low-density lipoprotein cholesterol (LDL-C) − high-density lipoprotein cholesterol (HDL-C), and cognitive function was assessed by the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at three months post-stroke. The relationship between RC tertiles and PSCI was examined using binary logistic regression analysis.</div></div><div><h3>Results</h3><div>In this prospective study, 523 participants were included. Patients with the highest tertile of RC levels exhibited a significantly decreased risk of developing PSCI in comparison to those in the lowest tertile [Odds Ratio (OR): 0.38; 95% Confidence Interval (CI): 0.23–0.63; <em>P</em> for trend &lt; 0.001]. This relationship remained even after adjusting for multiple variables (OR: 0.40; 95% CI: 0.21–0.75; <em>P</em> for trend &lt; 0.001). Among patients with body mass index (BMI) ≤ 24.9 kg/m<sup>2</sup>, those in the second and highest tertiles of RC levels showed reduced risks of PSCI (OR: 0.32; 95% CI: 0.13–0.80 and OR: 0.16; 95% CI: 0.06–0.44, respectively), compared to the lowest tertile; however, this relationship was not observed in patients with BMI &gt; 24.9 kg/m<sup>2</sup> (<em>P</em> for interaction = 0.036).</div></div><div><h3>Conclusions</h3><div>In ischemic stroke patients, elevated baseline RC levels were linked to a decreased risk of PSCI at 3 months, particularly among those who were not overweight.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"138 ","pages":"Article 111355"},"PeriodicalIF":1.9,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hemoglobin decline within 24 h post-mechanical thrombectomy as an indicator of poor clinical outcomes 机械取栓后24小时内血红蛋白下降作为临床预后不良的指标
IF 1.9 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-06-07 DOI: 10.1016/j.jocn.2025.111367
Masahiro Uchimura , Tomohiro Yamasaki , Mizuki Kambara , Tsutomu Yoshikane , Tomomi Kimiwada , Kentaro Hayashi
{"title":"Hemoglobin decline within 24 h post-mechanical thrombectomy as an indicator of poor clinical outcomes","authors":"Masahiro Uchimura ,&nbsp;Tomohiro Yamasaki ,&nbsp;Mizuki Kambara ,&nbsp;Tsutomu Yoshikane ,&nbsp;Tomomi Kimiwada ,&nbsp;Kentaro Hayashi","doi":"10.1016/j.jocn.2025.111367","DOIUrl":"10.1016/j.jocn.2025.111367","url":null,"abstract":"<div><h3>Background</h3><div>Mechanical thrombectomy (MT) for acute large vessel occlusion (LVO) significantly improves patient prognosis. However, despite successful recanalization achieved through MT, some patients still have unfavorable outcomes. Although anemia in the context of ischemic stroke is recognized as a detrimental prognostic factor, its impact on patients undergoing MT remains inconclusive. Post-MT anemia is frequently a target of intervention, but its prevention is of greater importance. We investigated the extent of hemoglobin (Hb) reduction after MT for acute LVO, its impact on prognosis, and potential preventive strategies.</div></div><div><h3>Methods</h3><div>The study included 102 patients who underwent MT between January 2016 and December 2022. Hb levels were monitored from admission until day 10 post-MT. We collected data on age, sex, weight, cause of ischemic stroke, location of vessel occlusion, and details regarding MT. The administration of recombinant tissue plasminogen activator, pre-stroke antithrombotic therapy, National Institutes of Health Stroke Scale (NIHSS) score, and presence of chronic kidney disease or chronic heart failure were also recorded. The modified Rankin Scale (mRS) score was assessed on admission and at 3 months follow-up. Factors associated with mRS scores of 3–6 at 3 months were identified.</div></div><div><h3>Results</h3><div>The highest Hb decrease was noted from admission to 24 h post-MT, with the median Hb level reaching its lowest point on day 4. Poor prognosis was associated with mRS score on admission (odds ratio [OR], 6.94; 95% confidence interval [CI], 1.28–37.60), NIHSS score (OR, 1.14; 95% CI, 1.04–1.25), modified thrombolysis in cerebral infarction 2c–3 recanalization (OR, 0.16; 95% CI, 0.03–0.73), and Hb decrease 24 h post-MT (OR, 2.17; 95% CI, 1.07–4.43). Hb decrease 24 h post-MT was significantly associated with more than two device passes (<em>p</em>-value, 0.037).</div></div><div><h3>Conclusions</h3><div>A decrease in Hb 24 h post-MT was associated with a negative prognosis, with a decrease in Hb being linked to more than two device passes. Efforts should be directed toward optimizing the first-pass effect in MT to enhance procedural efficacy and clinical outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"138 ","pages":"Article 111367"},"PeriodicalIF":1.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Complications of ventriculoperitoneal shunting: Is there further need of more evidence-based approach to care? 脑室-腹膜分流术的并发症:是否需要更多循证治疗方法?
IF 1.9 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-06-06 DOI: 10.1016/j.jocn.2025.111352
Chiazor U. Onyia , Omotayo A. Ojo
{"title":"Complications of ventriculoperitoneal shunting: Is there further need of more evidence-based approach to care?","authors":"Chiazor U. Onyia ,&nbsp;Omotayo A. Ojo","doi":"10.1016/j.jocn.2025.111352","DOIUrl":"10.1016/j.jocn.2025.111352","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Despite extensive research on VP (ventriculoperitoneal) shunt-related problems leading to development of evidence-based recommendations, several published papers reporting complications (especially rare ones) still suggest disparities in management approach. The authors sought to broadly quantify the level of evidence on approach to care documented in the literature and to characterize these differences in the light of evidence-based practice.</div></div><div><h3>Methods</h3><div>A systematic review of the English literature was performed in accordance with PRISMA guidelines to evaluate the levels of evidence across published clinical studies on management of various VP shunt complications reported in the literature. Selected articles on VP shunt complications were subgrouped according to their respective ICD- 10 code classifications and level of evidence documented.</div></div><div><h3>Results</h3><div>A total of 1,983 papers were reviewed, of which 171 met criteria of inclusion. Nine studies were classified as level III evidence, the remaining reached level IV evidence. Apart from BASICS multicenter randomized trial, there were no other level I or level II studies. Besides guidelines by the HRCN (i.e. Hydrocephalus Clinical Research Network) and the Infectious Diseases Society of America as well as 3 papers suggesting algorithms for treatment, there were no other standardized protocols on management of VP shunt complications identified.</div></div><div><h3>Conclusion</h3><div>With only few universally accepted guidelines, the superiority of one technique over the other in the management of most VP shunt complications still remains unclear in the context of the available evidence. This highlights the imperative for consensus statements possibly generated through multicentre cross-continental structured surveys to unify various treatment paradigms for uniformity of approach to care.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"138 ","pages":"Article 111352"},"PeriodicalIF":1.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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