神经内分泌肿瘤24例临床分析

本文对我院2010-04-2012-05收治的24例消化系统神经内分泌肿瘤（NEN5）患者发病部位、病理特征和预后进行总结，现报告如下。     

重型颅脑损伤合并二次脑损伤的临床研究

目的 探讨二次脑损伤的发病规律、诊断及治疗。方法 对临床诊断的216例二次脑损伤(SBI)患者,分析其临床特点及治疗资料。结果 SBI多见于重型颅脑损伤患者,发病率可达52.7％,且多见于年轻人及复合伤者,伤后3 d为发病高峰。结论SBI可明显加重原发性脑损伤,极大地影响患者的预后。     

延髓不同区域梗死的预后分析

目的探讨延髓不同区域梗死的临床特点及预后相关因素。方法选取2019年4月至2019年11月哈尔滨医科大学附属第一医院神经内科就诊的急性延髓梗死患者63例作为研究对象,收集患者的临床相关信息,包括一般资料、临床症状体征、并发症、影像学特点,应用NIHSS评分评价疾病的严重程度,应用mRS评分评价预后。结果 (1)延髓梗死患者中,男性发病率高于女性。延髓梗死最常见的部位为外侧、头段、左侧。延髓外侧梗死多见于纵向分布中的延髓中段,内侧梗死多见于延髓头段。发病年龄中61～70岁为发病高峰年龄段。其中,男性在51～60岁发病率高于女性,女性在61～70岁发病率高于男性,且两者差异均有统计学意义。(2)单因素分析中,吞咽困难、咽反射异常在30 d预后良好组高于预后不良组,头晕或眩晕、恶心呕吐在90 d预后良好组高于预后不良组,四肢瘫在90 d预后不良组高于预后良好组,且组间差异均有统计学意义。外侧梗死在90 d预后良好组高于预后不良组,组间差异有统计学意义。呼吸困难在90 d预后不良组高于与预后良好组,组间差异有统计学意义。进展性卒中在30 d、90 d预后不良组均高于预后良好组,组间差异有统计学意义。(3)多因素logistic回归分析中吞咽困难与30 d预后不良负相关,外侧梗死、恶心呕吐与90 d预后不良负相关。中枢性面瘫为30 d预后不良独立危险因素。进展性卒中为30 d、90 d预后不良的独立危险因素。结论 (1)延髓梗死发病率男性高于女性,女性发病高峰年龄高于男性。(2)延髓头段梗死发病率高于中段、尾段梗死,外侧梗死发病率高于内侧梗死。延髓横向梗死中外侧梗死较其他区域梗死预后良好。(3)中枢性面瘫为延髓梗死30 d预后不良的独立危险因素。进展性卒中为延髓梗死预后不良的独立危险因素。     

消化系统癌症并发抑郁的发病情况及其影响因素分析

目的探讨消化系统癌症患者抑郁症发病情况并分析其影响因素。方法回顾性分析我院在2013年3月至2014年12月收治的240例消化系统癌症患者,采用SDS量表和HAMD量表评定患者的抑郁情况并进行相关因素调查。结果消化系统癌症患者的抑郁症总体发病率为45.83%,抑郁程度主要为轻度和中度。文化程度较低、临床分期趋于晚期的患者更容易出现抑郁症状。结论消化系统癌症患者并发抑郁症的发生率较高,抑郁程度与文化程度、TNM分期关系紧密,临床工作中应当加以足够重视。     

丘脑出血23例临床分析

目的通过对23例丘脑出血的病例分析,探讨其临床特点与预后。方法结合CT或MRI资料对23例丘脑出血患者 的临床特点及预后进行分析。结果基本治愈2例,显著进步6例,进步7例,无变化3例,恶化1例,死亡4例,死亡率17％。结论 丘脑出血多见于高龄及高血压病患者;眼球运动障碍尤其是其中的垂直凝视麻痹为其特征性眼征;其预后与出血量、部位有关。     

丘脑出血23例临床分析

目的通过对23例丘脑出血的病例分析，探讨其临床特点与预后。方法结合CT或MRI资料对23例丘脑出血患者的临床特点及预后进行分析。结果 基本治愈2例，显著进步6例，进步7例，无变化3例，恶化1例，死亡4例，死亡率17%。结论 丘脑出血多见于高龄及高血压病患者；眼球运动障碍尤其是其中的垂直凝视麻痹为其特征性眼征；其预后与出血量、部位有关。     

糖尿病并发眼肌麻痹27例临床研究

目的 :探讨糖尿病并发眼肌麻痹的临床特点、治疗反应及预后 ,并对其发病机制进行探讨。方法 :对 2 7例糖尿病并发眼肌麻痹的临床资料进行回顾性总结 ,对其临床特点、治疗措施及预后进行分析。结果 :该并发症大多并发于 2型糖尿病 ,以急性起病、复视就诊者居多 ,13例TCD检查均示有脑动脉硬化及供血不足 ,治疗以综合治疗措施为基础。结论 :眼肌麻痹是糖尿病少见并发症 ,发病与代谢紊乱及血管因素有关 ,与糖尿病病程无平行关系。综合治疗、严格控制血糖可收到良好效果     

外伤性脑梗死的CT诊断

目的总结外伤性脑梗死的CT特征,探讨其发生机制,揭示其对疾病预后的判定价值。方法回顾性分析40例外伤性脑梗死患者头颅CT表现及相关临床资料。结果轻微外伤引起的脑梗死多发于儿童,好发部位为基底节内囊区,预后较好;重症外伤引起的脑梗死好发于成人,发病部位多见于颅内血肿同侧,且大脑后动脉支配区域最为多见,预后较差。结论CT扫描对外伤性脑梗死的诊断及预后判定有重要价值。     

围术期脑卒中53例临床分析

目的 分析围术期脑卒中的临床特点,探讨其危险因素、病因发病机制、发病率及防治措施.方法 对21000例手术患者中53例脑卒中患者的临床资料进行回顾性分析.结果 经积极治疗后治愈3例,好转41例,恶化自动出院6例,死亡3例.其发病率为0.248%,缺血性卒中发病率明显高于出血性卒中.结论 围术期脑卒中以老年多见,多合并冠心病、高血压、糖尿病、心房纤颤等慢性疾病,病因及发病机制主要与低灌注、栓子栓塞以及血液学有关;起病急、病情重、预后差,尽早明确诊断,及时治疗,改善预后,防重于治.     

垂体泌乳素瘤影像生长方式分类和临床关系的研究

目的对泌乳素瘤的影像学生长方式进行分类,探索其与临床治疗及预后之间的关系。方法选择在我科治疗的168例泌乳素瘤患者(男性60例,女性108例)为研究对象,对其影像学生长方式进行分类,与临床治疗及预后进行对比研究。结果鞍内型(B型)生长多见于低年龄(82.8%,P0.05)及低泌乳素(76.7%,P0.05)患者,突破型(A型)及包绕型(C型)生长多见于高年龄(两者合计68.0%,P0.05)及高泌乳素(两者合计66.2%,P0.05)患者。结论泌乳素瘤的影像学生长方式会因患者性别、年龄及泌乳素水平变化而发生改变,寻找相互之间的关系对选择合理的治疗方法、探索发病原因及发病机制及改善预后具有一定的参考意义。     

European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for digestive neuroendocrine carcinoma

This ENETS guidance paper, developed by a multidisciplinary working group, provides up-to-date and practical advice on the diagnosis and management of digestive neuroendocrine carcinoma, based on recent developments and study results. These recommendations aim to pave the road for more standardized care for our patients resulting in improved outcomes. Prognosis is generally poor for digestive NEC, most are advanced at diagnosis and median survival in metastatic disease is 11–12 months. Surgery can be of benefit for localized disease after extensive preoperative imaging. Carboplatin in combination with etoposide is recommended as first-line treatment for metastatic disease. Irinotecan with fluoropyrimidines has the best evidence as second-line treatment. Immunotherapy plays a minor role in biomarker-unselected patients. Molecular profiling if available is encouraged to identify new targets. More prospective clinical trials are highly needed to fulfil the unmet needs in this field, especially on new predictive and prognostic biomarkers and to improve survival of patients with advanced disease.     

自发性小脑出血手术治疗长期预后的相关影响因素分析

目的探讨自发性小脑出血(spontaneous cerebellar hemorrhage,SCH)手术治疗患者长期预后的相关影响因素及其意义。方法对2015年—2018年连续收治的49例SCH手术患者的临床资料进行回顾性分析;分析各临床指标与长期预后的关系。患者平均随访时间28.4个月。预后用格拉斯哥预后量表(Glasgow outcome scale,GOS)评分评定,GOS评分1~3分为预后不良,4~5分为预后良好。结果本组患者的平均年龄为(56.9±17.65)岁,男性占71.4%;预后良好者36例(73.5%),预后不良者13例(26.5%),其中死亡患者9例(18.4%)。单因素分析示:术前GCS评分、入院时随机血糖水平、血肿最大直径、影像学脑干受压(基底池受压)与长期预后有显著关系(P<0.05-0.005)。Logistic回归分析示:入院时随机血糖水平高(OR=1.566,95%CI 1.076~2.279,P=0.019)和影像学脑干受压征(OR=13.533,95%CI 1.058~173.024,P=0.045)为影响长期预后的独立危险因素。结论入院时随机血糖水平高与影像学脑干受压征是影响SCH手术治疗长期预后的独立危险因素。SCH预后相关因素的分析有助于临床医生作出合理的治疗决策。     

Prognosis of 908 patients with intracerebral hemorrhage in Chengdu,Southwest of China

Background and purpose: Intracerebral hemorrhage (ICH) is the deadliest, most disable and least treatable form of acute cerebral accident. Prognostic risk factors of ICH are not yet fully identified. This study investigated the possible clinical factors leading to poor outcomes in patients with ICH, which can be used to guide clinical treatment and predict prognosis. Methods: We prospectively enrolled patients with ICH who were admitted within 7 d of stroke onset from January 2012 to April 2014. The prognostic factors of patients with ICH were analyzed in univariate analyses and logistic regression analyses. Results: A total of 908 consecutive patients with ICH (mean age, 57.87 ± 13.92 years) were finally included, of which 616 patients (67.8%) were male. 59.5%, 54.5% and 52.2% patients with ICH had poor outcomes (death/disability) at 3, 6 and 12 months, respectively. Stroke severity and stroke-related complications during hospitalization were independently associated with poor outcomes both at 3 and 12 months. In addition, hyperglycemia, hematocrit and blood urea nitrogen on admission were independently associated with poor outcomes at three months. Conclusion: This study found that severity of ICH and stroke-related complications were independent predictors of poor outcomes at three months and one year after ICH. Thereby, it highlights the importance of understanding the role of clinical features in ICH prognostic evaluation.     

Invited Review: Pathology of pituitary neuroendocrine tumours: present status,modern diagnostic approach,controversies and future perspectives from a neuropathological and clinical standpoint

Neuroendocrine tumours of the adenohypophysis have traditionally been designated as pituitary adenomas to underline their usually indolent growth and lack of metastatic potential. However, they may demonstrate a huge spectrum of growth patterns and endocrine disturbances, some of them significantly affecting health and quality of life. To predict tumour growth, risk of postoperative recurrence and response to medical therapy in patients with pituitary neuroendocrine tumours is challenging. A thorough histopathological and immunohistochemical diagnostic work-up is an obligatory part of a multidisciplinary effort to precisely define the tumour type and assess prognostic and predictive factors on an individual basis. In this review, we have summarized the current status in the pathology in pituitary neuroendocrine tumours based on the selection of references from the PubMed database. We have presented possible diagnostic approaches according to the current pituitary cell lineage-based classification. The importance of recognizing histological subtypes with potentially aggressive behaviour and identification of prognostic and predictive tissue biomarkers have been highlighted. Controversies related to particular subtypes of pituitary tumours and a still limited prognostic impact of the current classification indicate the need for further refinement. Multidisciplinary approach including clinical, pathological and molecular genetic characterization will be essential for improved personalized therapy and the search for novel therapeutic targets in patients with pituitary neuroendocrine tumours.     

Prognostic factors varying with age in patients with aneurysmal subarachnoid hemorrhage

With the advent of an aging society, more elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) have been treated. We investigated if prognostic factors differ with age in aSAH patients. In a prospectively maintained aSAH database at multiple institutions from 2013 to 2016, 238 patients who underwent clipping or coiling for a ruptured aneurysm within 48 h of onset were divided into elderly (≥75 years; 57 patients) and non-elderly groups, or categorized into 4-age groups (<54, 55–64, 65–74, and ≥75 years). Prognostic factors and clinical characteristics were retrospectively analyzed. The elderly group had a higher incidence of pre-morbidities, co-morbidities, poor admission World Federation of Neurological Surgeons (WFNS) grades, modified Fisher grade 4, and resultantly 90-day poor outcomes (modified Rankin scale [mRS] 3–6). Multivariate logistic regression analyses revealed that independent determinants for poor outcomes were hypertension and modified Fisher grade 4 in the elderly group, and admission WFNS grades IV–V, systemic complications, non-procedural cerebral infarction and shunt-dependent chronic hydrocephalus in the non-elderly group. The 4-age group analyses showed that higher age group was more frequently associated with the prognostic factors. As higher age itself causes poor outcomes and more association of prognostic factors, prognostic factors in elderly patients may be rather limited.     

Primary intraventricular hemorrhage in adults: etiological causes and prognostic factors in Chinese population

Primary intraventricular hemorrhage (PIVH) is a rare type of hemorrhagic stroke that is poorly understood. We aimed to explore the features of this disease in Chinese population via an institutional prospective study. Adult patients diagnosed with PIVH from January 2013 to January 2016 were enrolled in this study. Data, including clinical variables, radiological features, and yield of angiography, were collected to evaluate the clinical features, etiological causes, and prognostic factors of this disease. A total of 67 patients (73.6%) were diagnosed with PIVH which constituted 3.2% of contemporary patients with hemorrhagic stroke in our hospital. Thirty-four patients (52.3%) were diagnosed with vascular structural abnormality (VSA)-related PIVH, and the etiologies included Moyamoya disease (22.4%), arteriovenous malformations (17.9%), aneurysms (7.5%), bilateral internal carotid artery dissection (1.5%), and tumor (1.5%). Idiopathic PIVH was diagnosed in 31 patients (47.7%), including coagulopathy in 3 (4.5%). Patients with VSA-related PIVH were younger than idiopathic PIVH patients, with a mean age of 37.1 ± 14.6 years, and idiopathic PIVH patients were more commonly hypertensive. The overall mortality rate was 11.9%, and 21 patients (31.3%) had a poor outcome at the 6-month follow-up. Patients with younger age, lower Graeb score, and a known etiology of arteriovenous malformation might be associated with a favorable outcome. We recommended routine thin-slice computed tomography (CT) scan, computed tomographic angiography (CTA), and digital subtraction angiography (DSA) for patients with PIVH. The etiological causes and prognostic factors of PIVH in Chinese patients were associated with distinctive features.     

Simultaneous multiple hypertensive intracranial hemorrhages

We retrospectively reviewed the clinical and radiological findings, management, and factors correlated with outcomes in 20 patients with simultaneous multiple hypertensive intracranial hemorrhages (ICH). The mean admission Glasgow Coma Scale score was 7.8. The most common hematoma location was the putamen, while putamen-brainstem hematomas were the most common combination. The mean hematoma volume was 27.5 mL. Eight patients had favorable outcomes and 12 had poor outcomes. Statistical analysis identified that the GCS score on admission, hematoma distribution (unilateral supratentorial hematomas were the most favorable), and total hematoma volume were prognostic factors. This study provides important information on the clinicoradiological findings and prognosis in patients with simultaneous multiple hypertensive ICH.     

The link between childhood trauma and depression: insights from HPA axis studies in humans

Childhood trauma is a potent risk factor for developing depression in adulthood, particularly in response to additional stress. We here summarize results from a series of clinical studies suggesting that childhood trauma in humans is associated with sensitization of the neuroendocrine stress response, glucocorticoid resistance, increased central corticotropin-releasing factor (CRF) activity, immune activation, and reduced hippocampal volume, closely paralleling several of the neuroendocrine features of depression. Neuroendocrine changes secondary to early-life stress likely reflect risk to develop depression in response to stress, potentially due to failure of a connected neural circuitry implicated in emotional, neuroendocrine and autonomic control to compensate in response to challenge. However, not all of depression is related to childhood trauma and our results suggest the existence of biologically distinguishable subtypes of depression as a function of childhood trauma that are also responsive to differential treatment. Other risk factors, such as female gender and genetic dispositions, interfere with components of the stress response and further increase vulnerability for depression. Similar associations apply to a spectrum of other psychiatric and medical disorders that frequently coincide with depression and are aggravated by stress. Taken together, this line of evidence demonstrates that psychoneuroendocrine research may ultimately promote optimized clinical care and help prevent the adverse outcomes of childhood trauma.     

Prognostic interictal electroencephalographic biomarkers and models to assess antiseizure medication efficacy for clinical practice: A scoping review

Antiseizure medication (ASM) is the primary treatment for epilepsy. In clinical practice, methods to assess ASM efficacy (predict seizure freedom or seizure reduction), during any phase of the drug treatment lifecycle, are limited. This scoping review identifies and appraises prognostic electroencephalographic (EEG) biomarkers and prognostic models that use EEG features, which are associated with seizure outcomes following ASM initiation, dose adjustment, or withdrawal. We also aim to summarize the population and context in which these biomarkers and models were identified and described, to understand how they could be used in clinical practice. Between January 2021 and October 2022, four databases, references, and citations were systematically searched for ASM studies investigating changes to interictal EEG or prognostic models using EEG features and seizure outcomes. Study bias was appraised using modified Quality in Prognosis Studies criteria. Results were synthesized into a qualitative review. Of 875 studies identified, 93 were included. Biomarkers identified were classed as qualitative (visually identified by wave morphology) or quantitative. Qualitative biomarkers include identifying hypsarrhythmia, centrotemporal spikes, interictal epileptiform discharges (IED), classifying the EEG as normal/abnormal/epileptiform, and photoparoxysmal response. Quantitative biomarkers were statistics applied to IED, high-frequency activity, frequency band power, current source density estimates, pairwise statistical interdependence between EEG channels, and measures of complexity. Prognostic models using EEG features were Cox proportional hazards models and machine learning models. There is promise that some quantitative EEG biomarkers could be used to assess ASM efficacy, but further research is required. There is insufficient evidence to conclude any specific biomarker can be used for a particular population or context to prognosticate ASM efficacy. We identified a potential battery of prognostic EEG biomarkers, which could be combined with prognostic models to assess ASM efficacy. However, many confounders need to be addressed for translation into clinical practice.