Neurologia medico-chirurgica最新文献

{"title":"Questionnaire-based Survey on the Prevention of Surgical Site Infection after the Publication of Its Guidelines for Neurosurgery in Japan.","authors":"Hiroshi Kondo, Fusao Ikawa, Toshihiko Mayumi, Yoshio Takesue, Masahiro Uchimura, Nobuhiro Mikuni, Nobutaka Horie","doi":"10.2176/jns-nmc.2024-0152","DOIUrl":"10.2176/jns-nmc.2024-0152","url":null,"abstract":"<p><p>In recent years, the Japanese neurosurgical field has been added to the guidelines for the appropriate use of antimicrobial agents for the prevention of surgical site infection; however, the awareness of neurosurgeons and specific methods for surgical site infection prevention in the Japanese neurosurgical field remains unclear. Therefore, we report a repeat survey conducted after the addition of guidelines on the appropriate use of antimicrobial agents for the prevention of surgical site infection and compare it with our previous survey on surgical site infection prevention conducted in 2018. A questionnaire-based survey was conducted via the Internet among members of the Japanese Neurosurgical Society and the Japanese Society of Chemotherapy. The survey response rate was 34.1% (270/792). More than 90% of the respondents were facility directors or specialists, and their institutions were universities and private hospitals. Cefazolin sodium was used in 88% of cases, and the percentage of cases started immediately before surgery increased to 85% (65% in the previous survey). Intraoperative administration intervals were most frequent every 3 hours (62%). Preoperative hair washing was performed by 76% of patients, a rate lower than that reported in the previous survey. Approximately 89% used partial removal, 75% used povidone-iodine for surgical field disinfection, double gloves were used by 46%, and antibacterial sutures by only 36% of surgeons. Compared with the 2018 survey, improvements were observed in the use of antibiotics for which guidelines were developed; however, other aspects of surgical site infection prevention need to be clarified, and guidelines for surgical site infection in the field of neurosurgery are necessary.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"141-147"},"PeriodicalIF":2.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256365","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}

{"title":"Intraoperative Superficial Temporal Artery-middle Cerebral Artery Bypass Failure during Combined Bypass Surgery in Children with Moyamoya Disease.","authors":"Toshiaki Hayashi, Tomomi Kimiwada, Keita Tominaga, Hidenori Endo","doi":"10.2176/jns-nmc.2024-0242","DOIUrl":"10.2176/jns-nmc.2024-0242","url":null,"abstract":"<p><p>Pediatric patients with moyamoya disease frequently show rapid progression with a high risk of stroke. Indirect revascularization is widely accepted as a surgical treatment for pediatric moyamoya disease, but it does not augment cerebral blood flow immediately, which leaves patients at risk for stroke peri-operatively. This delay in flow augmentation may make adding direct bypass the better option. This study documents our cases of direct bypass failure that underwent indirect bypass supplemented with superficial temporal artery-middle cerebral artery bypass to evaluate the adverse effects of direct bypass failure. A retrospective review of all surgeries for pediatric moyamoya disease after introducing intraoperative indocyanine green videoangiography to confirm direct bypass patency identified 78 surgical hemispheres. Direct bypass failure was defined as failure to confirm blood flow from the superficial temporal artery to the middle cerebral artery on indocyanine green videoangiography. The occurrence of ischemic complications was evaluated by magnetic resonance imaging. During the period, postoperative ischemic complications were seen in 3 surgical hemispheres (3.8%) and one contralateral hemisphere (1.3%). One case in which hyperventilation was difficult to control postoperatively developed extensive cerebral infarction. Direct bypass failure was seen in 3 patients (3.8%), none of whom had additional cerebral infarction on magnetic resonance imaging. The results of this study indicate that failure of direct bypass surgery does not necessarily lead to cerebral infarction. Based on these results, surgeons can safely attempt to add a direct bypass to an indirect bypass, with special attention to perioperative patient management.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"133-140"},"PeriodicalIF":2.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047347","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}

{"title":"Relationship between Preoperative Adjacent Disc Height and the Occurrence of Adjacent Vertebral Body Fractures after Balloon Kyphoplasty for Osteoporotic Fractures at the Thoracolumbar Junction.","authors":"Motonori Ishii, Yusuke Nishimura, Yu Yamamoto, Yoshitaka Nagashima, Takafumi Tanei, Masahito Hara, Masakazu Takayasu, Ryuta Saito","doi":"10.2176/jns-nmc.2024-0200","DOIUrl":"10.2176/jns-nmc.2024-0200","url":null,"abstract":"<p><p>Adjacent vertebral fractures after balloon kyphoplasty are speculated to occur in association with increased mechanical pressure due to rigid cement-augmented vertebrae. This study aimed to clarify whether adjacent vertebral fractures are more likely to occur after balloon kyphoplasty for osteoporotic vertebral fractures when the intervening adjacent disc degeneration is advanced. We retrospectively reviewed the findings for 99 patients who underwent balloon kyphoplasty for the first-ever osteoporotic vertebral fracture at the thoracolumbar junction levels (T11-L2). Radiological parameters and clinical data were compared for the cranial and caudal vertebrae between the groups with and without adjacent vertebral fractures within 1 year postoperatively. Postoperative adjacent vertebral fractures occurred in 20 patients (12 cranial adjacent vertebral fractures and eight caudal adjacent vertebral fractures). The cranial mean disc height was 5.87 ± 1.48 mm in the cranial adjacent vertebral fracture group and 7.98 ± 1.73 mm in the non-cranial adjacent vertebral fracture group (p < 0.01), and the caudal mean disc height was 6.24 ± 1.83 mm in the caudal adjacent vertebral fracture group and 9.55 ± 2.03 mm in the non-caudal adjacent vertebral fracture group (p < 0.01). According to receiver operating characteristic analysis, the optimized cutoff values of cranial mean disc height for cranial adjacent vertebral fracture occurrence and caudal mean disc height for caudal adjacent vertebral fracture occurrence were 6.37 mm and 7.70 mm, respectively. Multiple logistic regression models showed increased odds ratios for low disc height and large cement volume for cranial adjacent vertebral fractures and low disc height and cement leakage for caudal adjacent vertebral fractures. In conclusion, patients with advanced preoperative degeneration of the adjacent disc showed a higher incidence of adjacent vertebral fracture after balloon kyphoplasty.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"113-119"},"PeriodicalIF":2.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382866","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}

{"title":"Systemic Immune-inflammation Index Is Associated with Symptomatic Cerebral Hyperperfusion after Revascularization Surgery in Moyamoya Disease.","authors":"Taiji Yamamoto, Haruto Uchino, Masaki Ito, Taku Sugiyama, Miki Fujimura","doi":"10.2176/jns-nmc.2024-0170","DOIUrl":"10.2176/jns-nmc.2024-0170","url":null,"abstract":"<p><p>Revascularization surgery for moyamoya disease poses risks of complications, requiring appropriate management. Although precise prediction is difficult, the systemic immune-inflammation index is a calculable marker that reflects systemic inflammatory conditions. We aimed to investigate the association between postoperative complications and the systemic immune-inflammation index. We included 91 hemispheres from 71 patients who underwent combined revascularization surgery for moyamoya disease. Symptomatic cerebral hyperperfusion, radiological ischemic and hemorrhagic complications, and temporal muscle swelling that caused brain shift were assessed. The systemic immune-inflammation index ratio was calculated from blood test results from the preoperative day and the day after surgery. The association between the systemic immune-inflammation index ratio and postoperative complications was assessed using univariate and multivariate analyses. A receiver operating characteristic analysis was performed to evaluate the diagnostic value of the systemic immune-inflammation index ratio for postoperative complications. The frequencies of postoperative symptomatic cerebral hyperperfusion, ischemic and hemorrhagic complications, and temporal muscle swelling were detected in 24 (26%), 15 (16%), 11 (12%), and 5 (5%) hemispheres, respectively. The systemic immune-inflammation index ratio was higher in the group with postoperative complications than in the group without (median 4.6 vs. 2.7). Multivariate analysis demonstrated the systemic immune-inflammation index ratio as an independent factor associated with symptomatic cerebral hyperperfusion (odds ratio 2.4, 95% confidence interval 1.5-4.0). The receiver operating characteristic analysis demonstrated that the optimal threshold of the systemic immune-inflammation index ratio was 4.3, with a specificity of 0.96 and sensitivity of 0.63. The systemic immune-inflammation index ratio is an indicator of postoperative complications, including symptomatic cerebral hyperperfusion in moyamoya disease, and can be used for effective postoperative management.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"120-125"},"PeriodicalIF":2.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047350","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}

{"title":"The Feasibility of Early Shunting for Hydrocephalus after Subarachnoid Hemorrhage.","authors":"Naoki Nishizawa, Tomohiko Ozaki, Tomoki Kidani, Nobuyuki Izutsu, Shin Nakajima, Yonehiro Kanemura, Toshiyuki Fujinaka","doi":"10.2176/jns-nmc.2023-0300","DOIUrl":"https://doi.org/10.2176/jns-nmc.2023-0300","url":null,"abstract":"<p><p>The feasibility of early shunting for hydrocephalus after the occurrence of subarachnoid hemorrhage has not yet been explored. We investigated factors associated with the development of hydrocephalus and the risk of shunt obstruction or infection in patients undergoing early shunt surgery. All cases of hydrocephalus after subarachnoid hemorrhage managed at our institution between January 2010 and December 2020 were included. Patients were classified based on the timing of shunt implantation after hemorrhage onset into either the early shunt group (≤28 days) or the late shunt group (>28 days). Of 138 subarachnoid hemorrhage patients managed during the recruitment period, 53 underwent shunt surgery, with 15 in the early shunt group and 38 in the late shunt group. The severity of subarachnoid hemorrhage, presence of Sylvian hematoma, and placement of an external ventricular and/or cisternal drain were significantly associated with the development of hydrocephalus. There was no significant difference between the early and late groups in terms of the rate of shunt obstruction or infection. In the early group, preoperative cerebrospinal fluid cell count was significantly higher in those who developed obstruction than those who did not (307.3 ± 238.2/3 μL vs. 73.8 ± 95.7/3 μL; p = 0.0364). This retrospective study showed no significant difference between early and late shunt implantation in the rate of shunt obstruction and infection. These findings suggests that planning shunt surgery in the early phase after subarachnoid hemorrhage might be feasible, depending on cerebrospinal fluid test results.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493113","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}

{"title":"The Role and Reliability of Unruptured Intracranial Aneurysm Treatment Score in Decision-making in Surgical Indications for Unruptured Intracranial Aneurysms Based on the Results at a Japanese Single Center.","authors":"Shigeo Yamashiro, Ken Uekawa, Masatomo Kaji, Toshihiro Amadatsu, Hiroaki Matsuzaki, An Murai, Akitake Mukasa, Toru Nishi","doi":"10.2176/jns-nmc.2024-0255","DOIUrl":"https://doi.org/10.2176/jns-nmc.2024-0255","url":null,"abstract":"<p><p>To clarify the role and reliability of unruptured intracranial aneurysm treatment score in the treatment indications of unruptured intracranial aneurysm for Japanese patients, we performed a retrospective comparative analysis of our actual decision-making and unruptured intracranial aneurysm treatment score judgment. The unruptured intracranial aneurysm treatment score was applied to each of 208 Japanese patients with diagnosis of unruptured intracranial aneurysm for a year. The patients included were classified into 4 groups by integrating actual decisions with the scoring of unruptured intracranial aneurysm treatment score. Of 94 patients treated, unruptured intracranial aneurysm treatment score recommended repair for 64 (68.1%, \"appropriately treated\") and observation for 5 (5.3%, \"possible over-treated\"). Among 114 patients under observation, unruptured intracranial aneurysm treatment score recommended repair for 19 (16.7%, \"possible under-treated\") and observation for 29 (25.4%, \"appropriately conservative\"). In the remaining 91 patients judged as \"not definitive\" by the unruptured intracranial aneurysm treatment score, 66 (72.5%) were determined as conservative follow-up. From the perspective of the unruptured intracranial aneurysm treatment score, its sensitivity and specificity were 85.3% and 88.6%, respectively. Our findings suggest that in Japanese patients with unruptured intracranial aneurysm, unruptured intracranial aneurysm treatment score is a reliable tool for guiding treatment decisions for unexpertized clinicians; however, the final judgment should be made by a trained neurosurgeon, especially in cases categorized as not definitive.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493114","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}

{"title":"Outcome after Endovascular Treatment of Patients with Acute Ischemic Stroke with Large Vessel Occlusion over 90 Years of Age.","authors":"Fuminori Shimizu, Kazutaka Uchida, Hiroto Kakita, Sou Sawamura, Akihiro Kanbara, Yuji Kitada, Yoshinori Akiyama, Takashi Yoshida, Satoru Fujiwara, Hirotoshi Imamura, Chiaki Sakai, Manabu Shirakawa, Shinichi Yoshimura, Nobuyuki Sakai","doi":"10.2176/jns-nmc.2024-0232","DOIUrl":"https://doi.org/10.2176/jns-nmc.2024-0232","url":null,"abstract":"<p><p>The effectiveness of endovascular therapy for patients aged 90 years and over (≥90 years) is still not well understood. We compared the patients aged ≥90 years with those aged 85-89 years, 80-84 years, and <80 years using data from the Japanese Registry of NeuroEndovascular Therapy that enrolled acute large vessel occlusion patients from January 2015 to December 2019. The primary outcome was the rate of return of the modified Rankin Scale to at least the premorbid modified Rankin Scale after 30 days. Secondary outcomes were the incidences of intracranial hemorrhage and mortality.Among 13,540 patients, patients aged ≥90 years, 85-89 years, 80-84 years, and <80 years were 1,104, 1,925, 2,477, and 8,034. The prevalence of female gender, the premorbid Rankin Scale, and the National Institutes of Health Stroke Scale score before endovascular therapy were highest in the patients aged ≥90 years (n [%], 819 [74.2]; median [interquartile range]; 2 [0-3], and 21 [15-26]). The primary outcome of the adjusted odds ratio (95% confidence intervals) for the patients aged 85-89 years, 80-84 years, and <80 years for ≥90 years was 0.89 (0.72-1.10), 0.95 (0.77-1.16) and 1.07 (0.89-1.28). However, the incidence of symptomatic intracranial hemorrhage was lower in patients aged ≥90 years compared with patients aged 85-89 years and <80 years (adjusted odds ratio [95% confidence intervals]; 1.86 [1.16-2.98] and 1.71 [1.11-2.64]). The return of the modified Rankin Scale to at least the premorbid modified Rankin Scale after 30 days in patients aged ≥90 years with large vessel occlusion was not significantly different in other groups but symptomatic intracranial hemorrhage was less observed than in younger patients.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493112","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}

{"title":"Quality-adjusted Life Years and Costs of Mechanical Thrombectomy for Very Elderly Patients with Acute Ischaemic Stroke.","authors":"Takeshi Inaba, Mio Sakuma, Fumihiro Sakakibara, Kazutaka Uchida, Takeshi Morimoto","doi":"10.2176/jns-nmc.2024-0157","DOIUrl":"10.2176/jns-nmc.2024-0157","url":null,"abstract":"<p><p>This study aimed to evaluate the cost-effectiveness of mechanical thrombectomy (MT) in patients aged 90 years and older with acute ischaemic stroke (AIS). We developed a cost-effectiveness model to compare MT with standard medical care (SMC) to SMC alone. The model, incorporating parameters for the effectiveness and costs of MT with SMC and SMC alone, was simulated until the cohort reached 100 years of age. The parameters were estimated from the prospective cohort study of the RESCUE-Japan Registry 2, claims databases, and published literature, with the perspective being Japan's public healthcare system. In the base-case model for an 8-year simulation period, the quality-adjusted life years (QALYs) for MT with SMC and SMC alone were 1.463 and 1.054 years, respectively. The expected costs were 14,553,772 Yen and 13,732,646 Yen, respectively. The incremental cost-effectiveness ratio (ICER) of MT with SMC compared to SMC alone was 2,009,744 Yen per QALY. A probabilistic sensitivity analysis showed a 66% probability that MT with SMC would be below the ICER threshold of 5,000,000 Yen per QALY. The cost-effectiveness analyses demonstrated that performing MT in addition to SMC for AIS in patients aged 90 years and older was acceptable from a cost-effectiveness perspective.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"52-60"},"PeriodicalIF":2.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Early-onset Efficacy of Anti-calcitonin Gene-related Peptide Monoclonal Antibodies for Patients with Migraine in Real-world Clinical Practice: Study Protocol for an Exploratory Clinical Trial.","authors":"Takafumi Tanei, Satoshi Maesawa, Yusuke Nishimura, Tomotaka Ishizaki, Yoshitaka Nagashima, Miki Hashida, Shun Yamamoto, Masahiko Ando, Yachiyo Kuwatsuka, Atsushi Hashizume, Toshihiko Wakabayashi, Ryuta Saito","doi":"10.2176/jns-nmc.2024-0201","DOIUrl":"10.2176/jns-nmc.2024-0201","url":null,"abstract":"<p><p>Three anti-calcitonin gene-related peptide monoclonal antibodies (CGRP-mAbs) are available in Japan: galcanezumab, fremanezumab, and erenumab. Early-onset efficacy has been demonstrated for each CGRP-mAb in comparison with placebo, but differences among the drugs are unclear. Only galcanezumab requires 2 doses at the initial injection. This study is a multicenter, open-label, randomized, two-group comparison trial, consisting of the random selection of a CGRP-mAb and 6 consecutive injections, and then discontinuation of the CGRP-mAb after 6 injections. The primary outcome is a comparison of early-onset efficacy between galcanezumab and both fremanezumab and erenumab after the initial injection. The secondary outcomes are comparisons between galcanezumab and both fremanezumab and erenumab, and between fremanezumab and erenumab as follows: weekly number of headache days, migraine days, and acute medication use are compared to baseline during one month after initial injection; time of subjectively perceiving onset of effect after initial injection; monthly changes in headache status from baseline to after third (3rd) injections; effective rates after initial and 3rd injections; improvement rates of depression scores between baseline and after 3rd injections; changes in number of absenteeism and presenteeism days in each month from baseline to after 3rd injections; proportion of ineffective cases after 3rd injections; recurrence rates and time to recurrence after CGRP-mAb discontinuation; effective rates of CGRP-mAb re-injections; detection of clinical factors associated with effectiveness after the initial and 3rd injections. The aim of this study is to investigate differences in early-onset efficacy among the CGRP-mAbs, and when and to what extent headache symptoms recur after discontinuation.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"71-80"},"PeriodicalIF":2.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of Machine-learning Model to Predict Anticoagulant Use and Type in Geriatric Traumatic Brain Injury Using Coagulation Parameters.","authors":"Gaku Fujiwara, Yohei Okada, Eiichi Suehiro, Hiroshi Yatsushige, Shin Hirota, Shu Hasegawa, Hiroshi Karibe, Akihiro Miyata, Kenya Kawakita, Kohei Haji, Hideo Aihara, Shoji Yokobori, Motoki Inaji, Takeshi Maeda, Takahiro Onuki, Kotaro Oshio, Nobukazu Komoribayashi, Michiyasu Suzuki, Naoto Shiomi","doi":"10.2176/jns-nmc.2024-0066","DOIUrl":"10.2176/jns-nmc.2024-0066","url":null,"abstract":"<p><p>This study aimed to investigate the patterns of anticoagulation therapy and coagulation parameters and to develop a prediction model to predict the type of anticoagulation therapy in geriatric patients with traumatic brain injury. A retrospective analysis was performed using the nationwide neurotrauma database of Japan. Elderly patients (≥65 years) with traumatic brain injury. Patients were divided into 3 groups based on their daily anticoagulant medication (none, direct oral anticoagulant [DOAC], and vitamin K antagonist [VKA]), and coagulation parameters were compared in each group. We then developed a machine-learning model to predict the anticoagulant using coagulation parameters and visualized the pattern using a heat map. A total of 495 patients were enrolled and divided into 3 groups: none (n = 439), DOACs (n = 37), and VKA (n = 19). Comparing none to DOAC and DOAC to VKA for prothrombin time-international normalized ratio (PT-INR), the mean difference and 95% confidence intervals (CIs) were 0.38 (95% CI: 0.59-0.17) and 1.56 (95% CI: 1.21-1.90), and for activated partial thromboplastin time (APTT), the mean difference between none to DOAC and DOAC to VKA was 3.46 (95% CI: 0.98-5.94) and 95% CI was 7.39 (95% CI: 3.29-11.48). A prediction model for the type of anticoagulant used by PT-INR and APTT was developed using machine-learning methods, and a heat map visually revealed their relationship with acceptable predictive ability. This study revealed the characteristic patterns of coagulation parameters in anticoagulants and a pilot model to predict anticoagulant use.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"61-70"},"PeriodicalIF":2.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}