• 文章类型: Journal Article
    2014年,爱尔兰议会白皮书呼吁在爱尔兰更多地解决与运动有关的脑震荡(SRC),要求采用运动集团(CISG)的脑震荡指南,并在SRC回归游戏(RTP)管理中提高一致性。十年后,目前尚不清楚这些请求是如何得到解决的。最近,英国政府将所有基层体育的准则集中到一份SRC文件中。这项研究旨在调查爱尔兰体育和国家理事机构(NGB)中所有公开可用的SRC指南,以确定是否需要集中指南。搜索了爱尔兰体育和爱尔兰体育联合会,以查找爱尔兰所有公认的NGB和体育活动。在网站上搜索与SRC有关的任何信息,并在MicrosoftExcel中提取和整理数据。总的来说,83项运动和/或NGB中有15项包括SRC指南,其中9个提供了RTP协议。实施了CISGs指南和工具的各种迭代。有记录的SRC风险的几项运动都没有指南。调查结果表明,整个爱尔兰体育运动的指导脱节和过时。此外,有记录的脑震荡风险的运动没有SRC指南。这项研究为在爱尔兰基层体育中采用集中指南提供了支持。
    In 2014, an Irish parliament white paper called for greater addressing of sport-related concussions (SRCs) in Ireland, requesting the adoption of the Concussion in Sport Group\'s (CISGs) guidelines and greater consistency in SRC return to play (RTP) management. Ten years later, it is unclear how these requests have been addressed. Recently, the United Kingdom\'s government centralised guidelines to one SRC document for all grassroots sports. This study aimed to investigate all publicly available SRC guidance in Irish sports and national governing bodies (NGBs) to determine if centralised guidelines are warranted. Sport Ireland and the Irish Federation of Sports were searched for all recognised NGBs and sports in Ireland. Websites were searched for any information pertaining to SRCs and data were extracted and collated in Microsoft Excel. In total, 15 of 83 sports and/or NGBs included SRC guidance, nine of which provided RTP protocols. Various iterations of the CISGs guidance and tools were implemented. Several sports with a documented SRC risk had no guidelines present. The findings indicate disjointed and outdated guidance across Irish sport. Additionally, there are sports with a documented concussion risk that have no SRC guidance available. This study provides support for centralised guidelines to be adopted in Irish grassroots sports.
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  • 文章类型: Journal Article
    这篇全面的综述深入研究了颅内动脉瘤神经介入治疗的发展领域。探索双重抗血小板治疗(DAPT)对血管内卷绕的关键辅助手段,支架辅助卷绕(SAC),分流支架,和流动中断(囊内)装置。尽管越来越多的证据支持DAPT成功减少血栓栓塞事件,对最佳方案缺乏共识,剂量,持续时间很明显。导致这种变异性的因素包括影响治疗反应的遗传多态性和关于与DAPT相关的出血性并发症的临床意义的持续辩论。这篇综述分析了各种干预措施的术前和术后抗血小板使用情况。当务之急是正在进行的研究,以定义最佳的DAPT持续时间,在颅内动脉瘤治疗中,确保血栓形成和出血之间的微妙平衡。
    This comprehensive review delves into the evolving field of neurointervention for intracranial aneurysms, exploring the critical adjunct of Dual Antiplatelet Therapy (DAPT) to endovascular coiling, stent-assisted coiling (SAC), flow-diversion stents, and flow-disruption (intrasaccular) devices. Despite growing evidence supporting the success of DAPT in reducing thromboembolic events, the lack of consensus on optimal regimens, doses, and duration is evident. Factors contributing to this variability include genetic polymorphisms affecting treatment response and ongoing debates regarding the clinical significance of hemorrhagic complications associated with DAPT. This review analyzes pre- and post-procedural antiplatelet usage across various interventions. The imperative lies in ongoing research to define optimal DAPT durations, ensuring a nuanced approach to the delicate balance between thrombosis and hemorrhage in intracranial aneurysm management.
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  • 文章类型: Journal Article
    目的:已经建立了脑损伤指南(BIG)来指导成人与TBI相关的管理。这里,将BIG标准应用于儿科TBI患者以评估可靠性,安全,和资源利用。
    方法:2012年1月至2023年7月在一级儿科创伤中心对所有18岁或以下的儿童TBI患者进行了回顾性研究。TBI的严重程度(BIG1/2/3)由两名独立的观察者通过对初始颅骨成像的回顾来评估。评估了观察者间的可靠性。基于BIG标准的重复头颅成像预测,入住ICU,和神经外科会诊与队列观察结果进行了比较.收集了结果数据,包括神经外科干预和死亡率。
    结果:纳入了三百五十九名患者,平均年龄为5.3岁。损伤严重程度包括44BIG1(12.2%),170大2(47.4%),和145大3人受伤(40.4%)。评估者间可靠性为96.4%。所有患者都获得了神经外科咨询,虽然只有40.4%的指导方针预测。在166名BIG1/2患者中获得重复成像,平均每个患者进行1.3次CT扫描和0.8次MRI/快速MRI。根据BIG标准,未推荐的104例(77.6%)患者使用了ICU。最终,37名患者,所有BIG3,需要神经外科干预;分类为BIG1/2的患者不需要神经外科干预。
    结论:BIG标准可以应用于儿童TBI,具有较高的观察者间可靠性,并且无需正规的神经外科培训。BIG的回顾性应用预测了较少的影像学研究,ICU入院,和神经外科咨询,而不忽视需要神经外科干预的患者。
    OBJECTIVE: Brain Injury Guidelines (BIG) have been established to guide management related to TBI in adults. Here, BIG criteria were applied to pediatric TBI patients to evaluate reliability, safety, and resource utilization.
    METHODS: A retrospective study was performed on all pediatric TBI patients aged 18 years or younger from January 2012 to July 2023 at a Level 1 Pediatric Trauma Center. The severity of TBI (BIG 1/2/3) was rated by review of initial cranial imaging by two independent observers. Inter-observer reliability was assessed. Predictions based on BIG criteria regarding repeat cranial imaging, ICU admission, and neurosurgical consultation were compared with observations from the cohort. Outcome data was collected, including neurosurgical intervention and mortality rate.
    RESULTS: Three hundred fifty-nine patients were included with mean age of 5.3 years. Injury severity included 44 BIG 1 (12.2%), 170 BIG 2 (47.4%), and 145 BIG 3 injuries (40.4%). Inter-rater reliability was 96.4%. Neurosurgical consultation was obtained in all patients, though only predicted by guidelines in 40.4%. Repeat imaging was obtained in 166 BIG 1/2 patients, with an average of 1.3 CT scans and 0.8 MRIs/rapid MRIs per patient. ICU was utilized in 104 (77.6%) patients not recommended per BIG criteria. Ultimately, 37 patients, all BIG 3, required neurosurgical intervention; no neurosurgical interventions were required in those classified as BIG 1/2.
    CONCLUSIONS: BIG criteria can be applied to pediatric TBI with high inter-observer reliability and without formal neurosurgical training. Retrospective application of BIG predicted fewer imaging studies, ICU admissions, and neurosurgical consults without overlooking patients requiring neurosurgical intervention.
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  • 文章类型: Journal Article
    我们对人脑功能的理解可以通过研究其他生物体中的类似脑结构得到极大的帮助。在整个脊椎动物物种中具有神经化学和解剖学同源性的一种大脑结构是蓝斑(LC),脑干中含有神经元的去甲肾上腺素(NE)的一小部分,贯穿整个中枢神经系统。LC几乎涉及大脑功能的各个方面,包括唤醒和学习,已使用单个单位记录在大鼠和非人灵长类动物中进行了广泛检查。最近的工作已经扩展到非模型物种中推定的LC单单位电生理记录,斑马雀.鉴于随着研究工作扩展到其他脊椎动物,正确识别类似结构的重要性,我们建议在评估脑干单单位尖峰或钙成像时,采用一致的解剖学和电生理学指南来识别跨物种的LC神经元.这种共识标准将允许对LC在脑功能和行为中的作用有信心的跨物种理解。
    Our understanding of human brain function can be greatly aided by studying analogous brain structures in other organisms. One brain structure with neurochemical and anatomical homology throughout vertebrate species is the locus coeruleus (LC), a small collection of norepinephrine (NE) containing neurons in the brainstem that project throughout the central nervous system. The LC is involved in nearly every aspect of brain function, including arousal and learning, which has been extensively examined in rats and non-human primates using single unit recordings. Recent work has expanded into putative LC single unit electrophysiological recordings in a non-model species, the zebra finch. Given the importance of correctly identifying analogous structures as research efforts expand to other vertebrates, we suggest adoption of consensus anatomical and electrophysiological guidelines for identifying LC neurons across species when evaluating brainstem single unit spiking or calcium imaging. Such consensus criteria will allow for confident cross-species understanding of the roles of the LC in brain function and behavior.
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  • 文章类型: Journal Article
    Subarachnoid hemorrhage caused by intracranial aneurysm (aneurysmal subarachnoid hemorrhage,aSAH) poses a significant threat to the health of the Chinese people. The prognosis of aSAH patients is poor, with a mortality of up to 50%, which is a public health problem in China. The clinical evaluation, surgical ctrategies, and perioperative management are important parts of clinical management for aSAH patients. This clinical management guideline consists of 112 recommendations on epidemiology, clinical imaging diagnosis, prognosis evaluation, treatment strategies and selection, anesthesia management, perioperative care, and management of special populations with aSAH, aiming to provide clinical guidance for clinical doctors and related professionals.
    动脉瘤性蛛网膜下腔出血(aSAH)严重危害我国人民健康。aSAH患者的预后差,其病死率可高达50%,是我国一个严峻的公共卫生问题。关于aSAH的临床评估、外科处理策略和围手术期管理是临床管理的重要组成部分。本临床管理指南围绕aSAH的流行病学、临床影像诊断、预后评价、治疗策略及选择、麻醉管理、围手术期护理和特殊人群aSAH管理建议等方面,共形成112条推荐意见,旨在为临床医师、其他相关专业人员提供实用的临床指导建议。.
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  • 文章类型: Journal Article
    Unruptured intracranial aneurysm (UIA) has an estimated prevalence of about 7% among adults aged 35-75 in China. With the aging population trend, the detection rate of UIA is increasing. Most UIA are incidentally discovered and typically asymptomatic. There has been ongoing debate regarding the choice between aggressive treatment and conservative management. Although UIA has a low annual risk of rupture, once rupture occurs, the mortality and disability rates are high. Based on evidence-based medicine, this clinical management guideline provides 44 recommendations on population screening, clinical imaging diagnosis, risk assessment of growth and rupture, treatment strategies and selection, postoperative follow-up, and management of special populations with UIA. Aiming to provide clinical guidance for clinical doenrs and relevant professionals.
    未破裂颅内动脉瘤(UIA)在我国35~75岁成人中的患病率约7%。随着人口老龄化趋势,UIA检出率增加。大多数UIA是偶然发现的,通常无症状,选择手术治疗还是保守治疗一直存在争议。尽管UIA的年破裂风险低,但一旦发生破裂,其致死率和致残率高。本临床管理指南基于循证证据,围绕UIA的人群筛查、临床影像诊断、生长破裂风险评估、治疗策略及选择、术后随访和特殊人群UIA管理建议等方面,共形成44条推荐意见,旨在为临床医师、其他相关专业人员提供实用的临床指导建议。.
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  • 文章类型: Journal Article
    Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening neurological emergency with high mortality, and even patients receiving optimal medical care may develop long-term disability, which seriously affects their quality of life and increases the heavy medical burden on society and families. To provide comprehensive clinical management advice, the Society of Neurosurgery of the Chinese Medical Association, the Society of the Chinese Stroke Association of the National Medical Center for Neurological Diseases, and the National Clinical Research Center for Neurological Diseases jointly formulate \"Chinese Guidelines for the Clinical Management of Patients With Ruptured Intracranial Aneurysms in 2024\". The evidence sources are divided into the Chinese population and other populations, using a modular format to provide recommendations, summaries of relevant opinions, and future research directions on epidemiology, clinical imaging diagnosis, prognosis evaluation, treatment strategies and choices, anesthesia management, perioperative care, and recommendations for the management of aSAH in special populations. It provides practical clinical guidance and recommendations for doctors and related professionals.
    动脉瘤性蛛网膜下腔出血(aSAH)是一种高致死率的神经外科急症,即使患者接受了最佳的医疗护理,仍有可能出现长期残疾,严重影响患者生活质量,给社会和家庭增加了沉重的医疗负担。为提供全面的临床管理意见,中华医学会神经外科学分会、中国卒中学会脑血管外科分会、国家神经系统疾病医学中心与国家神经系统疾病临床研究中心联合制订《中国破裂颅内动脉瘤临床管理指南(2024版)》,将证据来源分为中国人群和其他人群,并采用模块化形式,对aSAH的流行病学、临床影像诊断、预后评价、治疗策略及选择、麻醉管理、围手术期护理和特殊人群aSAH管理建议等问题提供推荐意见、相关意见概述及未来研究方向,为医师及相关专业人员提供了实用的临床指导建议。.
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  • 文章类型: Journal Article
    With the popularization of cerebrovascular imaging technology, the clinical detection rate of unruptured intracranial aneurysm (UIA) is increasing. UIA has a low risk of rupture, but once ruptured, it can seriously affect human health. The treatment of UIA is highly controversial and has attracted widespread clinical attention. The Society of Neurosurgery of the Chinese Medical Association, the Society of Cerebrovascular Surgery of the Chinese Stroke Association, the National Center for Neurological Diseases, and the National Center for Clinical Research on Neurological Diseases jointly formulate \"Chinese guideline for the clinical management of patients with unruptured intracranial aneurysm management (2024)\", which adopts a modular format, highlighting management recommendations and indicating current research deficiencies and future research directions. It provides comprehensive clinical management recommendations on UIA epidemiology, population screening, clinical imaging and diagnosis, rupture risk assessment, treatment decisions and choices, postoperative follow-up, and long-term management. The evidence sources are divided into the Chinese population and other populations, which helps guide clinical practice in China.
    随着脑血管影像技术的普及,未破裂颅内动脉瘤(UIA)临床检出率越来越高。UIA破裂风险低,但是一旦破裂,严重影响人类健康。UIA治疗存在较大争议,引起临床广泛关注。中华医学会神经外科学分会、中国卒中学会脑血管外科分会、国家神经系统疾病医学中心与国家神经系统疾病临床研究中心联合制订《中国未破裂颅内动脉瘤临床管理指南(2024版)》,该指南采用模块化形式,突出推荐意见,并指出当前研究不足及未来研究方向,从UIA流行病学、人群筛查、临床影像诊断、破裂风险评估、治疗决策及选择,术后随访及长期管理等方面提供了全面的临床管理意见。将证据来源分为中国人群和其他人群,有助于指导国内临床实践。.
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  • 文章类型: Journal Article
    世界卫生组织(WHO)建议儿童在出生后6个月内完全母乳喂养。这项建议对于脊髓损伤(SCI)的女性来说可能具有挑战性,由于SCI对运动和生理的影响,她们面临着独特的挑战和母乳喂养障碍。医疗保健专业人员(HCPs)量身定制的护理服务对于帮助女性克服这些潜在障碍非常重要。然而,HCP通常缺乏信心和SCI特定知识来满足SCI母亲的需求。一个国际临床医生小组,研究人员,顾问,和妇女生活经验的形成,以创建一个可访问的资源,可以解决这一差距。全面调查母乳喂养并发症,挑战,资源,并对SCI母亲的生活质量进行了评估,同时进行环境扫描,以评估现有的产后指南,并评估其作为SCI后母乳喂养建议的相关性和可用性。在这项工作的基础上,本文为HCPs提供了基于证据的建议,包括但不限于全科医生,产科医生,儿科医生,理疗师,哺乳顾问,护士,助产士,职业治疗师,以及与SCI的准母亲和现任母亲一起工作的物理治疗师。
    The World Health Organization (WHO) recommends that children be breastfed exclusively for the first 6 months of age. This recommendation may prove challenging for women with spinal cord injury (SCI) who face unique challenges and barriers to breastfeeding due to the impact of SCI on mobility and physiology. Tailored provision of care from health care professionals (HCPs) is important in helping women navigate these potential barriers. Yet, HCPs often lack the confidence and SCI-specific knowledge to meet the needs of mothers with SCI. An international panel of clinicians, researchers, consultants, and women with lived experience was formed to create an accessible resource that can address this gap. A comprehensive survey on breastfeeding complications, challenges, resources, and quality of life of mothers with SCI was conducted, along with an environmental scan to evaluate existing postpartum guidelines and assess their relevance and usability as recommendations for breastfeeding after SCI. Building on this work, this article provides evidence-based recommendations for HCPs, including but not limited to general practitioners, obstetricians, pediatricians, physiatrists, lactation consultants, nurses, midwives, occupational therapists, and physiotherapists who work with prospective and current mothers with SCI.
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  • 文章类型: Journal Article
    目标:在癫痫中,早期诊断,准确确定癫痫类型,正确选择抗癫痫药物,监控都是必不可少的。然而,尽管最近在癫痫的分类和管理方面取得了治疗进展和概念上的重新考虑,埃及以及其他几个资源有限的国家在日常实践中仍然存在严重差距。过早死亡,生活质量差,社会经济负担,认知问题,不良的治疗结果,合并症是重大挑战,需要在各级采取紧急行动。认识到这一点,一组埃及癫痫专家通过一系列连续会议进行了会议,以确定有关癫痫诊断和治疗的主要概念,最终目标是建立全国性的埃及共识。
    方法:共识是通过改进的Delphi方法形成的。对最新相关文献和国际准则进行了彻底审查,以评估其对埃及局势的适用性。之后,安排了几次远程和实时回合,以就所有列出的声明达成最终协议。
    结果:在第一轮审查的278份声明中,256达到≥80%的一致性。对第一轮未达成共识的22项声明进行了现场讨论和完善,然后进行最后的现场投票,然后对所有剩余的声明达成共识。
    结论:随着这些统一建议的实施,我们相信这将大大改善埃及癫痫患者的护理质量和治疗结果.
    结论:这项工作代表了一组医学专家的努力,根据先前发表的建议,在考虑资源有限国家的适用方案的同时,就与癫痫患者相关的最佳医疗实践达成一致。预计该文件的发布将最大程度地减少许多渎职问题,并为个人和政府层面的更好的医疗服务铺平道路。
    OBJECTIVE: In epilepsy, early diagnosis, accurate determination of epilepsy type, proper selection of antiseizure medication, and monitoring are all essential. However, despite recent therapeutic advances and conceptual reconsiderations in the classification and management of epilepsy, serious gaps are still encountered in day-to-day practice in Egypt as well as several other resource-limited countries. Premature mortality, poor quality of life, socio-economic burden, cognitive problems, poor treatment outcomes, and comorbidities are major challenges that require urgent actions to be implemented at all levels. In recognition of this, a group of Egyptian epilepsy experts met through a series of consecutive meetings to specify the main concepts concerning the diagnosis and management of epilepsy, with the ultimate goal of establishing a nationwide Egyptian consensus.
    METHODS: The consensus was developed through a modified Delphi methodology. A thorough review of the most recent relevant literature and international guidelines was performed to evaluate their applicability to the Egyptian situation. Afterward, several remote and live rounds were scheduled to reach a final agreement for all listed statements.
    RESULTS: Of 278 statements reviewed in the first round, 256 achieved ≥80% agreement. Live discussion and refinement of the 22 statements that did not reach consensus during the first round took place, followed by final live voting then consensus was achieved for all remaining statements.
    CONCLUSIONS: With the implementation of these unified recommendations, we believe this will bring about substantial improvements in both the quality of care and treatment outcomes for persons with epilepsy in Egypt.
    CONCLUSIONS: This work represents the efforts of a group of medical experts to reach an agreement on the best medical practice related to people with epilepsy based on previously published recommendations while taking into consideration applicable options in resource-limited countries. The publication of this document is expected to minimize many malpractice issues and pave the way for better healthcare services on both individual and governmental levels.
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