central nervous system

中枢神经系统
  • 文章类型: Journal Article
    这些指南遵循了世界围产期医学协会的使命,与围产期医学基金会合作,它汇集了世界各地的团体和个人,旨在改善中枢神经系统异常的产前检测,并适当转诊怀疑胎儿异常的妊娠。此外,本文件为医疗从业人员提供了进一步的指导,目的是规范超声异常发现的描述.
    These guidelines follow the mission of the World Association of Perinatal Medicine, in collaboration with the Perinatal Medicine Foundation, which brings together groups and individuals worldwide, with the aim to improve prenatal detection of central nervous system anomalies and the appropriate referral of pregnancies with suspected fetal anomalies. In addition, this document provides further guidance for healthcare practitioners with the goal of standardizing the description of ultrasonographic abnormal findings.
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  • 文章类型: Practice Guideline
    暂无摘要。
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  • 文章类型: Journal Article
    目前使用人类分级系统对犬脑膜瘤进行分级。最近发布的指南已经调整了用于狗的人类分级系统。这项研究的目的是验证犬脑膜瘤的新指南。为了评估观察员之间的协议,5名兽医外科病理学家根据人类分级系统单独或根据新指南对158例犬脑膜瘤进行分级。组织学分级和每个分级标准(有丝分裂分级,入侵,自发性坏死,大核,小细胞,细胞过多,模式丢失和发育不良)使用Fleisskappa指数进行评估。通过比较2个分级系统获得的诊断与一致等级(考虑参考分类)来评估诊断准确性(灵敏度和特异性)。根据指南,4位经验丰富的兽医神经病理学家之间达成共识,获得了一致的组织学等级。与人类单独分级相比,犬特异性指南增加了观察者之间的一致性:组织学分级(κ=0.52);侵袭(κ=0.67);坏死(κ=0.62);小细胞(κ=0.36);模式丢失(κ=0.49)和间变(κ=0.55)。有丝分裂等级一致性仍然很大(κ=0.63)。该指南提高了识别1级脑膜瘤的敏感性(95.6%)和识别2级脑膜瘤的特异性(96.2%)。总之,新的犬脑膜瘤分级指南与在1级和2级脑膜瘤诊断中观察者间一致性的整体改善和更高的诊断准确性相关.
    Canine meningiomas are currently graded using the human grading system. Recently published guidelines have adapted the human grading system for use in dogs. The goal of this study was to validate the new guidelines for canine meningiomas. To evaluate the inter-observer agreement, 5 veterinary surgical pathologists graded 158 canine meningiomas following the human grading system alone or with the new guidelines. The inter-observer agreement for histologic grade and each of the grading criteria (mitotic grade, invasion, spontaneous necrosis, macronucleoli, small cells, hypercellularity, pattern loss and anaplasia) was evaluated using the Fleiss kappa index. The diagnostic accuracy (sensitivity and specificity) was assessed by comparing the diagnoses obtained with the 2 grading systems with a consensus grade (considered the reference classification). The consensus histologic grade was obtained by agreement between 4 experienced veterinary neuropathologists following the guidelines. Compared with the human grading alone, the canine-specific guidelines increased the inter-observer agreement for: histologic grade (κ = 0.52); invasion (κ = 0.67); necrosis (κ = 0.62); small cells (κ = 0.36); pattern loss (κ = 0.49) and anaplasia (κ = 0.55). Mitotic grade agreement remained substantial (κ = 0.63). The guidelines improved the sensitivity in identifying grade 1 (95.6%) and the specificity in identifying grade 2 (96.2%) meningiomas. In conclusion, the new grading guidelines for canine meningiomas are associated with an overall improvement in the inter-observer agreement and higher diagnostic accuracy in diagnosing grade 1 and grade 2 meningiomas.
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  • 文章类型: Journal Article
    作者介绍了使用2016年WHO世界卫生组织中枢神经系统肿瘤分类诊断的661名年轻成人胶质母细胞瘤的队列,利用全面的基因组分析(CGP)来探索他们的基因组景观,并评估他们与当前定义的疾病实体的关系。这项分析探索了具有致病功能证据的变异,常见拷贝数变异(CNVs),以及文献中没有描述的几个新颖的融合事件。肿瘤突变负荷(TMB)突变特征,解剖位置,和肿瘤复发进一步探讨。使用从CGP收集的数据,利用无监督的机器学习技术在先前指定的年轻成胶质细胞瘤中鉴定10个基因组类别.作者将这些分子类别与当前的世界卫生组织指南联系起来,并参考当前文献,以在可能的情况下提供治疗和预后描述。
    The authors present a cohort of 661 young adult glioblastomas diagnosed using 2016 WHO World Health Organization Classification of Tumors of the Central Nervous System, utilizing comprehensive genomic profiling (CGP) to explore their genomic landscape and assess their relationship to currently defined disease entities. This analysis explored variants with evidence of pathogenic function, common copy number variants (CNVs), and several novel fusion events not described in literature. Tumor mutational burden (TMB) mutational signatures, anatomic location, and tumor recurrence are further explored. Using data collected from CGP, unsupervised machine-learning techniques were leveraged to identify 10 genomic classes in previously assigned young adult glioblastomas. The authors relate these molecular classes to current World Health Organization guidelines and reference current literature to give therapeutic and prognostic descriptions where possible.
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  • 文章类型: Journal Article
    在儿科中枢神经系统(CNS)肿瘤中缺乏重新照射的临床方案。为了填补这个空白,瑞典儿科放射治疗工作组(SBRTG)编制了关于儿科中枢神经系统肿瘤(弥漫性内在脑桥神经胶质瘤,室管膜瘤,生殖细胞瘤和髓母细胞瘤)。自2019年以来,这些药物一直在瑞典的所有儿科放射治疗中心进行临床实践。自实施以来,对根据指南治疗的所有儿科患者的临床结局和毒性进行了年度回顾,以补充指南.本文介绍了瑞典关于小儿中枢神经系统肿瘤再照射的国家指南。
    There is a lack of clinical protocols for re-irradiation in paediatric central nervous system (CNS) tumours. To fill this void, the Swedish Workgroup of Paediatric Radiotherapy (SBRTG) compiled national guidelines on re-irradiation in paediatric CNS tumours (diffuse intrinsic pontine glioma, ependymoma, germinoma and medulloblastoma). These have been in clinical practice since 2019 in all paediatric radiotherapy centres in Sweden. Since the implementation, the guidelines have been complemented with a yearly review on clinical outcome and toxicities in all paediatric patients treated according to the guidelines. This article presents the Swedish national guidelines on re-irradiation in paediatric CNS tumours.
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  • 文章类型: English Abstract
    Viral encephalitis (meningitis) is a common infectious disease of the central nervous system (CNS), which is an inflammatory disease caused by viruses invading the brain parenchyma and meninges. It is a global disease and a serious threat to human health as an acute and severe medical condition. CNS infections can be caused by a variety of viruses, including herpes viruses, enteroviruses, and arboviruses, etc. Identification and diagnosis of the pathogens remains a major clinical challenge. In order to standardize the application of nucleic acid and antibody tests of patients with viral encephalitis (meningitis), experts in the field of virology, infectious diseases, clinical medicine and laboratory testing in China reached the consensus after repeated discussions. The current consensus mainly consists of the domestic and foreign pathogen types, the detection techniques, the detection strategies and schemes for Chinese viral encephalitis, thereby providing a reference for the clinical diagnosis and disease prevention and control of viral encephalitis (meningitis).
    病毒性脑(膜)炎是常见的中枢神经系统感染性疾病,是病毒侵袭脑实质与脑膜导致的炎症性疾病。病毒性脑(膜)炎呈世界性分布,临床以急症和重症常见,严重威胁人类健康。多种病毒可导致中枢神经系统感染,包括疱疹病毒、肠道病毒和虫媒病毒等,病原体鉴定仍是病毒性脑(膜)炎在临床上的主要难题。为规范、合理地应用病原体诊断技术开展脑脊液的病毒核酸检测与抗体检测,由国内病毒学、传染病学、临床医学及医学检验等领域的专家组成的专家组,经反复讨论达成本共识,主要从国内外病毒性脑(膜)炎病原种类、检测技术及检测策略等方面进行阐述,并提出针对我国病毒性脑(膜)炎病原体的检测策略和方案,以期为病毒性脑(膜)炎的临床诊断以及疾病预防控制提供参考。.
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  • 文章类型: Journal Article
    中枢神经系统(CNS)癌症的NCCN指南着重于以下成人CNS癌症的管理:神经胶质瘤(WHO1级,WHO2-3级少突胶质细胞瘤[1p19q删除,IDH-突变体],WHO2-4级IDH突变星形细胞瘤,WHO4级胶质母细胞瘤),颅内和脊髓室管膜瘤,髓母细胞瘤,有限和广泛的脑转移,软脑膜转移,非艾滋病相关原发性中枢神经系统淋巴瘤,转移性脊柱肿瘤,脑膜瘤,和原发性脊髓肿瘤。中枢神经系统癌症NCCN指南管理部分的算法和原则中包含的信息旨在帮助临床医生浏览中枢神经系统肿瘤患者的复杂管理。几个重要原则指导成人脑肿瘤的手术治疗和放射治疗和全身治疗。NCCNCNS癌症小组至少每年举行一次会议,审查其机构内审核员的意见,检查出版物和摘要中的相关新数据,并重新评估和更新他们的建议。这些NCCN指南见解总结了小组关于胶质瘤分子谱分析的最新建议。
    The NCCN Guidelines for Central Nervous System (CNS) Cancers focus on management of the following adult CNS cancers: glioma (WHO grade 1, WHO grade 2-3 oligodendroglioma [1p19q codeleted, IDH-mutant], WHO grade 2-4 IDH-mutant astrocytoma, WHO grade 4 glioblastoma), intracranial and spinal ependymomas, medulloblastoma, limited and extensive brain metastases, leptomeningeal metastases, non-AIDS-related primary CNS lymphomas, metastatic spine tumors, meningiomas, and primary spinal cord tumors. The information contained in the algorithms and principles of management sections in the NCCN Guidelines for CNS Cancers are designed to help clinicians navigate through the complex management of patients with CNS tumors. Several important principles guide surgical management and treatment with radiotherapy and systemic therapy for adults with brain tumors. The NCCN CNS Cancers Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize the panel\'s most recent recommendations regarding molecular profiling of gliomas.
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  • 文章类型: Journal Article
    原发性中枢神经系统淋巴瘤(PCNSL)是一种中枢神经系统限制性非霍奇金淋巴瘤,其组织病理学诊断主要是大B细胞淋巴瘤。提供具体的,为医疗专业人员提供基于证据的建议,并促进更加标准化,为PCNSL患者提供有效和安全的治疗,中华医学会中国神经外科学会和中国抗癌协会血液恶性肿瘤学会的专家小组共同制定了基于证据的共识。在全面检索文献并进行系统综述后,我们进行了两轮Delphi研究,就以下建议达成共识:应通过多模态断层扫描引导活检或微创手术,尽可能安全全面地获取PCNSL患者的组织病理学标本.皮质类固醇应该退出,或者不被管理,如果患者状态允许,在活检前怀疑PCNSL的患者。应进行MRI(增强和DWI)以诊断和评估在必要时间点使用全身PET-CT的PCNSL患者。简易精神状态检查可用于临床管理中的认知功能评估。新诊断的PCNSL患者应采用基于甲氨蝶呤的联合大剂量方案治疗,并可在诱导治疗时采用利妥昔单抗包涵方案治疗。自体干细胞移植可作为一种巩固疗法。难治性或复发性PCNSL患者可以用依鲁替尼治疗,有或没有大剂量化疗作为再诱导疗法。立体定向放射外科可用于复发性病变有限的PCNSL患者,这些患者对化学疗法难以治疗,并且以前曾接受过全脑放射疗法。疑似原发性玻璃体视网膜淋巴瘤(PVRL)的患者应通过玻璃体活检进行诊断。并发VRL的PVRL或PCNSL患者可采用全身和局部联合治疗。
    Primary central nervous system lymphoma (PCNSL) is a type of central nervous system restricted non-Hodgkin lymphoma, whose histopathological diagnosis is majorly large B cell lymphoma. To provide specific, evidence-based recommendations for medical professionals and to promote more standardized, effective and safe treatment for patients with PCNSL, a panel of experts from the Chinese Neurosurgical Society of the Chinese Medical Association and the Society of Hematological Malignancies of the Chinese Anti-Cancer Association jointly developed an evidence-based consensus. After comprehensively searching literature and conducting systematic reviews, two rounds of Delphi were conducted to reach consensus on the recommendations as follows: The histopathological specimens of PCNSL patients should be obtained as safely and comprehensively as possible by multimodal tomography-guided biopsy or minimally invasive surgery. Corticosteroids should be withdrawn from, or not be administered to, patients with suspected PCNSL before biopsy if the patient\'s status permits. MRI (enhanced and DWI) should be performed for diagnosing and evaluating PCNSL patients where whole-body PET-CT be used at necessary time points. Mini-mental status examination can be used to assess cognitive function in the clinical management. Newly diagnosed PCNSL patients should be treated with combined high-dose methotrexate-based regimen and can be treated with a rituximab-inclusive regimen at induction therapy. Autologous stem cell transplantation can be used as a consolidation therapy. Refractory or relapsed PCNSL patients can be treated with ibrutinib with or without high-dose chemotherapy as re-induction therapy. Stereotactic radiosurgery can be used for PCNSL patients with a limited recurrent lesion who were refractory to chemotherapy and have previously received whole-brain radiotherapy. Patients with suspected primary vitreoretinal lymphoma (PVRL) should be diagnosed by vitreous biopsy. PVRL or PCNSL patients with concurrent VRL can be treated with combined systemic and local therapy.
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  • 文章类型: Journal Article
    目的:德国放射肿瘤学学会神经肿瘤学工作组与德国癌症学会神经肿瘤学工作组成员合作,旨在制定诊断和治疗中枢神经系统(CNS)辐射诱导坏死(RN)的实用指南。
    方法:DEGRO工作组的小组成员邀请专家,参加了一系列会议,补充了他们的临床经验,进行了文献综述,并在临床常规中制定了包括贝伐单抗在内的RN药物治疗建议。
    结论:RN的诊断和治疗需要多学科的护理结构和明确的流程。诊断必须在神经放射学家的共同知识的跨学科水平上进行,放射肿瘤学家,神经外科医生,神经病理学家,还有神经肿瘤学家.建议采用多步骤方法作为审查尽可能多的特征以提高诊断置信度的机会。有关放射治疗(RT)技术的其他信息对于RN的诊断至关重要。未治疗和进行性RN的误诊可导致严重的神经功能缺损。在本实践指南中,我们提出了治疗相关变化的详细命名法和多步骤诊断方法.
    OBJECTIVE: The Working Group for Neuro-Oncology of the German Society for Radiation Oncology in cooperation with members of the Neuro-Oncology Working Group of the German Cancer Society aimed to define a practical guideline for the diagnosis and treatment of radiation-induced necrosis (RN) of the central nervous system (CNS).
    METHODS: Panel members of the DEGRO working group invited experts, participated in a series of conferences, supplemented their clinical experience, performed a literature review, and formulated recommendations for medical treatment of RN including bevacizumab in clinical routine.
    CONCLUSIONS: Diagnosis and treatment of RN requires multidisciplinary structures of care and defined processes. Diagnosis has to be made on an interdisciplinary level with the joint knowledge of a neuroradiologist, radiation oncologist, neurosurgeon, neuropathologist, and neuro-oncologist. A multistep approach as an opportunity to review as many characteristics as possible to improve diagnostic confidence is recommended. Additional information about radiotherapy (RT) techniques is crucial for the diagnosis of RN. Misdiagnosis of untreated and progressive RN can lead to severe neurological deficits. In this practice guideline, we propose a detailed nomenclature of treatment-related changes and a multistep approach for their diagnosis.
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  • 文章类型: Journal Article
    由于疾病的复杂性和可用的对照研究数量有限,原发性中枢神经系统(PCNSL)的管理是神经肿瘤学中最有争议的主题之一。2021年,鉴于最新进展和改变实践的随机试验的出版,欧洲神经肿瘤协会(EANO)成立了一个多学科工作组,以更新先前发表的针对有免疫能力的成人PCNSL患者的循证指南,并增加了关于免疫抑制患者的章节.该指南为PCNSL的治疗提供了共识考虑和建议,包括老年人眼内表现和具体管理。与以前的指南相比,主要的变化包括加强了ASCT在一线治疗中巩固的证据,前瞻性评估年轻和老年患者的化疗组合,澄清利妥昔单抗的作用,即使数据仍不确定,新代理人的角色,以及合并免疫抑制患者和原发性眼部淋巴瘤。该指南应帮助临床医生进行日常实践和决策,并作为该领域未来研究的基础。
    The management of primary central nervous system (PCNSL) is one of the most controversial topics in neuro-oncology because of the complexity of the disease and the limited number of controlled studies available. In 2021, given recent advances and the publication of practice-changing randomized trials, the European Association of Neuro-Oncology (EANO) created a multidisciplinary task force to update the previously published evidence-based guidelines for immunocompetent adult patients with PCNSL and added a section on immunosuppressed patients. The guideline provides consensus considerations and recommendations for the treatment of PCNSL, including intraocular manifestations and specific management of the elderly. The main changes from the previous guideline include strengthened evidence for the consolidation with ASCT in first-line treatment, prospectively assessed chemotherapy combinations for both young and elderly patients, clarification of the role of rituximab even though the data remain inconclusive, of the role of new agents, and the incorporation of immunosuppressed patients and primary ocular lymphoma. The guideline should aid the clinicians in everyday practice and decision making and serve as a basis for future research in the field.
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