The objective of this guideline is to outline the role of magnetic resonance imaging(MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury(SCI).Methods A systematic revi...The objective of this guideline is to outline the role of magnetic resonance imaging(MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury(SCI).Methods A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI.This review focused on longitudinal studies that controlled for baseline neurologic status.A multidisciplinary Guideline Development Group(GDG) used this information,their clinical expertise,and patient input to develop recommendations on the use of MRI for SCI patients.Based on GRADE(Grading of Recommendation,Assessment,Development and Evaluation),a strong recommendation is worded as " we recommend," whereas a weaker recommendation is indicated by "we suggest." Results Based on the limited available evidence and the clinical expertise of the GDG,our recommendations were:(1) "We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention,when feasible,to facilitate improved clinical decision-making"(quality of evidence,very low) and(2) "We suggest that MRI should be performed in adult patients in the acute period following SCI,before or after surgical intervention,to improve prediction of neurologic outcome "(quality of evidence,low).Conclusions These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.展开更多
Drug-induced hypersensitivity syndrome (DIHS) is a rare but severe disease with multiorgan failure. Recently, the association of the human herpesvirus (HHV) family, particularly of HHV-6, with DIHS has been reported. ...Drug-induced hypersensitivity syndrome (DIHS) is a rare but severe disease with multiorgan failure. Recently, the association of the human herpesvirus (HHV) family, particularly of HHV-6, with DIHS has been reported. We report a 43-year-old female diagnosed as having DIHS based on the clinical course and laboratory examinations. The HHV-6 reactivation was demonstrated by significantly increased levels of the specific antibody in her paired sera and by polymerase chain reaction of HHV-6 DNA. Notably, transient hypogammaglobulinaemia was detected in the early stage of the disease, which was associated with the disease activity. By contrast, the serum IgE level and eosinophils were increased 2 or 3 weeks later. In addition, serum levels of interferon γ, interleukin (IL)-4 and soluble IL-2 receptor, which were increased in the early phase of the disease, decreased gradually after the corticosteroid therapy.展开更多
颈椎前路减压植骨融合内固定(anterior cervical decompression and fusion,ACDF)手术是治疗退行性颈脊髓病的常见术式,疗效确切。但术后常并发吞咽困难,文献报道其发生率为2%~83%不等。本研究旨在分析ACDF术后吞咽困难发生的危险因素,...颈椎前路减压植骨融合内固定(anterior cervical decompression and fusion,ACDF)手术是治疗退行性颈脊髓病的常见术式,疗效确切。但术后常并发吞咽困难,文献报道其发生率为2%~83%不等。本研究旨在分析ACDF术后吞咽困难发生的危险因素,明确其对临床预后的影响。全球共26个机构(北美地区12个、亚太地区6个、欧洲地区5个、拉美地区3个)参与此项多中心前瞻性研究。纳入标准:①年龄≥18岁;②有退行性颈脊髓病症状,至少有一项临床体征;③影像学证实颈脊髓受压;④无颈椎手术史。排除标准:①无症状;②感染;③肿瘤;④类风湿性关节炎;⑤强直性脊柱炎;⑥合并腰椎管狭窄。入选的470例患者中男280例,女190例;年龄21~87岁(平均53.0岁);行单纯颈椎前路减压融合术447例、颈椎前后联合入路减压融合术23例。主要评价指标包括术前及术后6、12、24个月改良日本骨科学会(modified Japanese Orthopaedic Association,mJOA)评分、Nurick评分、颈椎功能障碍指数(neck disability index,NDI)、SF-36生活质量量表、术后30天内吞咽困难起始时间、严重程度、持续时间、结局等。展开更多
文摘The objective of this guideline is to outline the role of magnetic resonance imaging(MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury(SCI).Methods A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI.This review focused on longitudinal studies that controlled for baseline neurologic status.A multidisciplinary Guideline Development Group(GDG) used this information,their clinical expertise,and patient input to develop recommendations on the use of MRI for SCI patients.Based on GRADE(Grading of Recommendation,Assessment,Development and Evaluation),a strong recommendation is worded as " we recommend," whereas a weaker recommendation is indicated by "we suggest." Results Based on the limited available evidence and the clinical expertise of the GDG,our recommendations were:(1) "We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention,when feasible,to facilitate improved clinical decision-making"(quality of evidence,very low) and(2) "We suggest that MRI should be performed in adult patients in the acute period following SCI,before or after surgical intervention,to improve prediction of neurologic outcome "(quality of evidence,low).Conclusions These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.
文摘Drug-induced hypersensitivity syndrome (DIHS) is a rare but severe disease with multiorgan failure. Recently, the association of the human herpesvirus (HHV) family, particularly of HHV-6, with DIHS has been reported. We report a 43-year-old female diagnosed as having DIHS based on the clinical course and laboratory examinations. The HHV-6 reactivation was demonstrated by significantly increased levels of the specific antibody in her paired sera and by polymerase chain reaction of HHV-6 DNA. Notably, transient hypogammaglobulinaemia was detected in the early stage of the disease, which was associated with the disease activity. By contrast, the serum IgE level and eosinophils were increased 2 or 3 weeks later. In addition, serum levels of interferon γ, interleukin (IL)-4 and soluble IL-2 receptor, which were increased in the early phase of the disease, decreased gradually after the corticosteroid therapy.
文摘颈椎前路减压植骨融合内固定(anterior cervical decompression and fusion,ACDF)手术是治疗退行性颈脊髓病的常见术式,疗效确切。但术后常并发吞咽困难,文献报道其发生率为2%~83%不等。本研究旨在分析ACDF术后吞咽困难发生的危险因素,明确其对临床预后的影响。全球共26个机构(北美地区12个、亚太地区6个、欧洲地区5个、拉美地区3个)参与此项多中心前瞻性研究。纳入标准:①年龄≥18岁;②有退行性颈脊髓病症状,至少有一项临床体征;③影像学证实颈脊髓受压;④无颈椎手术史。排除标准:①无症状;②感染;③肿瘤;④类风湿性关节炎;⑤强直性脊柱炎;⑥合并腰椎管狭窄。入选的470例患者中男280例,女190例;年龄21~87岁(平均53.0岁);行单纯颈椎前路减压融合术447例、颈椎前后联合入路减压融合术23例。主要评价指标包括术前及术后6、12、24个月改良日本骨科学会(modified Japanese Orthopaedic Association,mJOA)评分、Nurick评分、颈椎功能障碍指数(neck disability index,NDI)、SF-36生活质量量表、术后30天内吞咽困难起始时间、严重程度、持续时间、结局等。
