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Objective:To summarize and evaluate the best evidence of perioperative nutrition management for patients with acoustic neuroma, and to provide evidence-based basis for clinical nurses.Methods:BMJ best clinical practice, UpToDate, Cochrane Library, Guidelines International Network, Scottish Intercollegiate Guidelines Network, the official website of Ontario Registered Nurses Association, JBI Australian evidence-based health care center, PubMed, Embase, CINAHL, Yimaitong, Chinese biomedical literature database, CNKI, Wanfang database and other domestic and foreign databases related to clinical practice guidelines, expert consensus, evidence summary, systematic evaluation, sysmtem analysis, clinical randomized scientific control were seached. The retrieval time was limited from June 1st, 2013 to June 1st, 2023. Evaluated the quality of the included literatures, and conduct evidence extraction, grade evaluation and summary analysis.Results:A total of 17 literatures were included, including 5 guidelines, 6 expert consensus, 2 best practices and evidence summary, 2 system evaluation and 2 randomized scientific control. A total 27 of best evidence was formed, covering five aspects: nutrition management team construction, screening and evaluation of nutrition and dysphagia, timing and implementation of nutrition support, specific measures of nutrition management, continuous nutrition management after discharge.Conclusions:This study summarized the best evidence of perioperative nutritional management of acoustic neuroma, and provides evidence-based basis for clinical nurses. However, its recommendations are not specialized, some of them are controversial, and come from many countries. In clinical practice, we should make a comprehensive analysis in combination with the actual clinical situation and other relevant factors, and make some choices, so as to promote the improvement of clinical nursing quality.
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Objective:To investigate the feasibility, safety and reasonable operation of nasointestinal canal indwelling guided by miniature system in severe neurosurgery patients, and compare its advantages and disadvantages with traditional blind insertion.Methods:A prospective randomized controlled trial design was used to select 128 critically ill patients in need of enteral nutrition support at the Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University from March 2022 to October 2023 by convenient sampling method. They were divided into blind insertion group and visualization group by random number table method, with 64 cases in each group. Nasointestinal canal indwelling was performed in the blind insertion group by traditional blind insertion method, and in the visualization group, nasointestinal canal indwelling was performed by indentations guided by the miniature visualization system. The success rate of initial catheterization, the time of catheterization, complications, changes of vital signs during catheterization and changes of nutritional indexes after catheterization were evaluated in 2 groups.Results:In the blind insertion group, there were 35 males and 29 females, aged (59.44 ± 13.84) years old. In the visualization group, there were 41 males and 23 females, aged (58.28 ± 12.08) years old. The success rate of the first catheter placement in the visual group was 96.8% (62/64), higher than that in the blind group 82.8% (53/64), and the difference was statistically significant ( χ2=6.94, P<0.05). The catheter placement time of the visualization group was (20.08 ± 2.69) min, which was shorter than that of the blind insertion group (38.19 ± 3.79) min, and the difference between the two groups was statistically significant ( t=29.99, P<0.05). There was no significant difference in the incidence of complications, changes of vital signs during catheterization and the changes of nutritional indexes after catheterization between two groups (all P>0.05). Conclusions:Compared with traditional blind nasointestinal canal indwelling, nasointestinal canal indwelling guided by the miniature visualization system can improve the success rate of the first catheterization and shorten the catheterization time. Although there is no difference in the complication rate, changes in vital signs during catheterization and changes in nutritional indexes after catheterization, it is believed that with the continuous development and upgrading of this technology, it will further reflect the advantages of this technology, which is worthy of further clinical trials and application.
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Objective:To explore the application effects of a neurosurgical mixed-reality distance teaching (NMDT) model in standardized residency training in neurosurgery.Methods:We built an NMDT system using mixed-reality technology and remote interaction technology, and designed the implementation procedure according to the teaching objectives. After the teaching activities were completed, a teaching satisfaction questionnaire survey was conducted among 20 neurosurgery resident trainees, in which they provided satisfaction scores for the same teaching content with different teaching models (i.e., the NMDT model and traditional teaching model). SPSS 22.0 software was used to perform the t test for data analysis. Results:There were significant differences between the NMDT model and the traditional teaching model in key indicators including the score for "completion of teaching objectives" (9.20±0.68 vs. 8.25±0.70, P<0.001) and the score for "satisfaction with learning gains" score (8.95±0.67 vs. 8.05±0.92, P=0.001). The NMDT model also outperformed the traditional teaching model in the other individual scores and the total score. Conclusions:The NMDT model can improve teaching quality, increase training efficiency, and enrich teaching content, which is worthy of promotion.
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Abstract Deep brain stimulation (DBS) is recognized as an established therapy for Parkinson's disease (PD) and other movement disorders in the light of the developments seen over the past three decades. Long-term efficacy is established for PD with documented improvement in the cardinal motor symptoms of PD and levodopa-induced complications, such as motor fluctuations and dyskinesias. Timing of patient selection is crucial to obtain optimal benefits from DBS therapy, before PD complications become irreversible. The objective of this first part review is to examine the fundamental concepts of DBS for PD in clinical practice, discussing the historical aspects, patient selection, potential effects of DBS on motor and non-motor symptoms, and the practical management of patients after surgery.
Resumo Nas últimas três décadas, a estimulação cerebral profunda (ECP) se tornou um tratamento bem estabelecido para doença de Parkinson (DP) e outros transtornos do movimento. A eficácia a longo prazo na DP foi bem documentada para a melhora dos sintomas motores cardinais da DP e das complicações induzidas pelo uso do levodopa, como as flutuações motoras e as discinesias. O momento da seleção do paciente é crucial para se obter os benefícios ideais da ECP, antes que as complicações da DP se tornem irreversíveis. O objetivo desta primeira parte da revisão é examinar os conceitos fundamentais da ECP na prática clínica, discutindo os aspectos históricos, a seleção de pacientes, os potenciais efeitos da ECP nos sintomas motores e não motores da doença e o manejo prático dos pacientes após a cirurgia.
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ABSTRACT BACKGROUND: Embolization is a promising treatment strategy for cerebral arteriovenous malformations (AVMs). However, consensus regarding the main complications or long-term outcomes of embolization in AVMs remains lacking. OBJECTIVE: To characterize the most prevalent complications and long-term outcomes in patients with AVM undergoing therapeutic embolization. DESIGN AND SETTING: This systematic review was conducted at the Federal University of Alagoas, Arapiraca, Brazil. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Data were obtained from MEDLINE, PubMed, LILACS, and SciELO databases, which included the epidemiological profile of the population, characteristics of the proposed therapy, complications (hemorrhagic events and neurological deficits), and long-term outcomes (modified Rankin scale pre- and post-treatment, AVM recanalization, complete obliteration, and deaths). RESULTS: Overall, the analysis included 34 articles (2,799 patients). Grade III Spetzler-Martin AVMs were observed in 34.2% of cases. Notably, 39.3% of patients underwent embolization combined with radiosurgery. The most frequently reported long-term complication was hemorrhage, which occurred in 8.7% of patients at a mean follow-up period of 58.6 months. Further, 6.3% of patients exhibited neurological deficits after an average of 34.7 months. Complete obliteration was achieved in 51.4% of the cases after a mean period of 36 months. Recanalization of AVMs was observed in 3.5% of patients. Long-term death occurred in 4.0% of patients. CONCLUSION: Embolization of AVMs is an increasingly safe strategy with low long-term complications and satisfactory outcomes, especially in patients who have undergone combination therapies. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/ Registration number CRD42020204867.
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Investigación histórica y biográfica de Manuel Juan María Balado, uno de los primeros médicos dedicados a la neurocirugía en forma exclusiva, quien sentó las bases de la especialidad en Argentina y Latinoamérica. Su trabajo, investigaciones y descubrimientos tuvieron impacto sobre las corrientes científicas mundiales de la época, otorgándole características particulares a la escuela Argentina. Entre sus múltiples aportes se destacan trabajos sobre la inervación del iris, la vía óptica, el cuerpo geniculado y la aracnoiditis optoquiasmática, siendo su principal aporte la sistematización de la iodoventriculografía que alcanzó relevancia mundial hasta la aparición de la tomografía computada. El presente trabajo recorre la biografía de un hombre que quedó opacado en la historia médica por la importancia de sus descubrimientos
Historical and biographical research of Manuel Juan María Balado, one of the first physician dedicated exclusively to neurosurgery, who laid the foundations of the specialty in Argentina and Latin America. His work, research and discoveries had an impact on the world scientific currents of the time, giving high profile to the Argentine school. Among his many contributions, works on the innervation of the iris, the optic pathway, the geniculate body and optochiasmatic arachnoiditis stand out, with his main contribution being the systematization of iodoventriculography that achieved global relevance until the appearance of computed tomography. This work covers the biography of a man who was overshadowed in medical history due to the importance of his discoveries
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Abstract The present review attempts to discuss how some of the central concepts from the Lurian corpus of theories are relevant to the modern neuropsychology of epilepsy and epilepsy surgery. Through the lenses of the main Lurian concepts (such as the qualitative syndrome analysis), we discuss the barriers to clinical reasoning imposed by quadrant-based views of the brain, or even atheoretical, statistically-based and data-driven approaches. We further advice towards a systemic view inspired by Luria's clinical work and theorizing, given their importance towards our clinical practice, by contrasting it to the modular views when appropriate. Luria provided theory-guided methods of assessment and rehabilitation of higher cortical functions. Although his work did not specifically address epilepsy, his theory and clinical approaches actually apply to the whole neuropathology spectrum and accounting for the whole panorama of neurocognition. This holistic and systemic approach to the brain is consistent with the network approach of the neuroimaging era. As to epilepsy, the logic of cognitive functions organized into complex functional systems, contrary to modular views of the brain, heralds current knowledge of epilepsy as a network disease, as well as the concept of the functional deficit zone.
Resumo A presente revisão tenta discutir como alguns dos conceitos centrais do corpus de teorias lurianas são relevantes para a moderna neuropsicologia da epilepsia e cirurgia da epilepsia. Através das lentes dos principais conceitos lurianos (como a análise qualitativa de síndromes), discutimos as barreiras ao raciocínio clínico impostas por visões do cérebro baseadas em quadrantes, ou mesmo abordagens ateóricas, baseadas em estatísticas e orientadas por dados. Aconselhamos ainda uma visão sistêmica inspirada na clínica e na teorização de Luria, dada sua importância para nossa prática clínica, contrastando-a com as visões modulares quando apropriado. Luria forneceu métodos teóricos de avaliação e reabilitação de funções corticais superiores. Embora seu trabalho não abordasse especificamente a epilepsia, sua teoria e abordagens clínicas na verdade se aplicam a todo o espectro da neuropatologia e respondem por todo o panorama da neurocognição. Essa abordagem holística e sistêmica do cérebro é consistente com a abordagem de rede da era da neuroimagem. Quanto à epilepsia, a lógica das funções cognitivas organizadas em sistemas funcionais complexos, ao contrário das visões modulares do cérebro, anuncia o conhecimento atual da epilepsia como uma doença em rede, bem como o conceito de zona de déficit funcional.
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Fundamento la craneosinostosis es una de las patologías neuroquirúrgicas más frecuentes en la edad pediátrica. Los conocimientos sobre su manejo son de vital importancia para intervenir con el tratamiento de manera oportuna. Objetivo caracterizar los pacientes operados de craneosinostosis no sindrómica. Métodos se realizó un estudio descriptivo y de corte transversal, en el período enero/2018- diciembre/2022, con la totalidad de pacientes intervenidos de craneosinostosis en el Hospital Pediátrico José Luis Miranda, de Villa Clara (N=28). Las variables analizadas fueron: sexo, color de la piel, clasificación de la malformación según sutura afectada, síntomas y signos asociados a la malformación, edad al realizar la intervención quirúrgica, técnica quirúrgica y complicaciones. Resultados se observó predominio del sexo masculino y de pacientes con color blanco de la piel. La forma de presentación más frecuente fue la escafocefalia, y se asoció a síntomas como el retardo en el desarrollo psicomotor y estrabismo. Las técnicas quirúrgicas realizadas fueron de remodelado total de la bóveda craneal, que en la mayoría de los niños se realizó antes de los 23 meses. La complicación más frecuente fue la infección de la herida quirúrgica. Conclusiones la craneosinostosis es una patología neuroquirúrgica frecuente en el sexo masculino. La forma de presentación más frecuente es la escafocefalia y se puede asociar a síntomas y signos neurológicos. Las técnicas quirúrgicas realizadas para remodelado de la bóveda craneal se deben realizar antes del primer año de vida, con vistas a disminuir el índice de complicaciones.
Background craniosynostosis is one of the most frequent neurosurgical pathologies in the pediatric age. Knowledge about its management is of vital importance to intervene with treatment in a timely manner. Objective to characterize the patients operated on for non-syndromic craniosynostosis. Methods a descriptive and cross-sectional study was carried out, from January/2018 to December/2022, with all the patients operated on for craniosynostosis at the José Luis Miranda Pediatric Hospital, in Villa Clara (N=28). The analyzed variables were: sex, skin color, classification of the malformation according to the affected suture, symptoms and signs associated with the malformation, age at surgery, surgical technique, and complications. Results a predominance of the male sex and patients with white skin color was observed. The most frequent form of presentation was scaphocephaly, and it was associated with symptoms such as delayed psychomotor development and strabismus. The surgical techniques performed were total remodeling of the cranial vault, which in most children was performed before 23 months old. The most frequent complication was infection of the surgical wound. Conclusions craniosynostosis is a frequent neurosurgical pathology in the male sex. The most frequent form of presentation is scaphocephaly and it can be associated with neurological symptoms and signs. Surgical techniques performed for remodeling of the cranial vault must be performed before the first year of life, in order to reduce the complications rate.
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Objective:To investigate the status quo and influencing factors of decision-making regret of surrogate decision makers (SDMs) in neurocritically ill patients.Methods:This study was a cross-sectional survey. A total of 110 critically ill patients admitted to Department of Neurosurgery, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from August 2021 to April 2022 were selected as the research objects by convenient sampling method. Different methods were adopted in the research including general information questionnaire, Chinese Version of Decision-Making Regret Assessment Scale, Disease-Related Knowledge Awareness Questionnaire, General Self-Efficacy Scale, Self-Rating Anxiety Scale, Self-Rating Depression Scale to conduct a questionnaire survey on SDMs in neurocritically ill patients. Multiple linear stepwise regression was used to analyze the influencing factors of decision-making regret in SDMs in neurocritically ill patients.Results:Among the 110 patients with severe neurological diseases, 50.0% (55/110) had no regret, 30.9% (34/110) had mild regret, and 19.1 (21/110) had moderate and severe regret. The results of univariate analysis showed that gender had a statistically significant effect on the score of SDMs decision regret in neurocritical patients ( t=6.57, P<0.05). The age, relationship with patients, education level, decision-making style, place of residence, and monthly income of the family had no effect on the score of regret in decision-making ( t=0.09-1.01, all P>0.05). The results of correlation analysis showed that the score of decision-making regret of SDMs in neurocritically ill patients was negatively correlated with the scores of disease-related knowledge and self-efficacy ( r=-0.342, -0.252, both P<0.05), and positively correlated with the scores of anxiety and depression ( r=0.403, 0.360, both P<0.05). The results of multiple linear regression showed that gender, disease-related knowledge, self-efficacy, anxiety and depression were important factors affecting the decision-making regret of SDMs in neurocritically ill patients ( t values were -3.37-4.31, all P<0.05). Conclusions:SDMs in neurocritically ill patients have a higher degree of decision-making regret, and gender, disease-related knowledge, self-efficacy, anxiety, depression are important influencing factors, suggesting that medical staff can alleviate the decision-making regret of SDMs through decision-making assistance interventions.
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There are still many existing problems in the training of medical undergraduates and microsurgery talents in China, such as lack of scientific research ability and scientific literacy of medical undergraduates, insufficient practical ability, short of scientific research opportunities for medical undergraduates, and inadequate talent reserve in microsurgery. In view of the above shortcomings, Wannan Medical College has established a training course on microneurosurgery technology for medical undergraduates, and made a preliminary exploration to solve the above problems. Through the training, undergraduates not only improve their practical ability, but also stimulate their interest in microsurgery, which will help them adapt to clinical and scientific research work at an early stage. Neurosurgical microscopic technology training with emphasis on extracurricular expansion as main content, plays an important role in the cultivation of undergraduate microscopic skills, the establishment of basic theories of neurosurgery, the improvement of scientific research accomplishment and the expansion of extracurricular vision.
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The standardized training system for physicians has been implemented for many years in China. Based on the current situation of neurosurgery specialist training and the sub-professional development, the study discusses the specific plan and direction of glioma sub-professional physicians training from the aspects of glioma sub-professional physicians training outline, training content, requirements of glioma sub-professional training base, training assessment methods and training management. It provided reference for the training of neurosurgical glioma professionals in China, so as to make glioma receive comprehensive and standardized treatment.
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Objective:To observe the application effect of mind mapping combined with interactive communication mode in clinical teaching of neurosurgery.Methods:A total of 40 students who practiced in the Department of Neurosurgery in the Affiliated Hospital of Guizhou Medical University from September 2019 to September 2020 were included in the control group, and traditional teaching was adopted; another 40 students who practiced from October 2020 to October 2021 were included in the observation group, and mind mapping combined with interactive communication mode was adopted for teaching. The two groups of students were taught for 2 weeks, and after the teaching, the teaching effect was compared between the two groups. SPSS 25.0 software was used to conduct t-test and Chi-square test. Results:After 2 weeks of teaching, the scores of theoretical knowledge (90.38±4.03) and practical operation skills (93.37±3.48) in the two groups were higher than those before teaching [(85.52±5.26) and (87.25±4.48)], with statistically significant differences ( t=4.63, 6.83, P<0.001). The case analysis score of the two groups was higher than that before teaching, and that of the observation group (86.03±6.07) was higher than that of the control group (79.13±5.57), with statistically significant differences ( t=5.30, P<0.001). The scores of interpersonal communication ability and cooperation ability of the two groups were higher than those before teaching. The scores of interpersonal communication ability (82.53±4.74), cooperation ability (169.73±7.55) of the observation group were higher than those of the control group [(77.93±4.45) and (158.42±8.01)], with statistically significant differences ( t=4.48, 6.49, P<0.001). Conclusion:Mind mapping combined with interactive communication mode can effectively improve the clinical basic knowledge and clinical practice ability of interns in the Department of Neurosurgery, and improve their communication and cooperation ability.
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Critical neurosurgery is one of the difficulties and key points in the standardized residency training of neurosurgery. Through the systematic and standardized training of the residents of the Intensive Care Unit of Neurosurgery Department in The First Affiliated Hospital of Chongqing Medical University, consisting of first aid skills training, multi-modal case analysis with complementary theory and practice, expansion of neuroimaging and electrophysiological knowledge, specialized knowledge training in surgical operation and perioperative management, and regular case discussion, their clinical thinking becomes more mature, the time to master the management methods of neurosurgical intensive care patients is significantly shortened, the initiative to participate in clinical practice is also significantly increased, and the perioperative management methods of neurosurgical patients are more deeply understood. These trainings have effectively improved the teaching effect of neurosurgery intensive care unit.
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Objective:To explore the application effect of progressive case teaching method based on core competency in standardized nursing training.Methods:A total of 63 nursing students rotated in department of neurosurgery from June 2020 to June 2022 were selected as the research objects and randomized into experimental group ( n=31) and control group ( n=32). The experimental group adopted the progressive case teaching method based on core competency, and the control group adopted the conventional teaching mode. The data was analyzed using SPSS 26.0 to conduct t-test or non-parametric test based on the data normality for comparing the theory results, objective structure clinical examination (OSCE) scores, core competency, self-directed learning ability scores, teaching satisfaction and nursing satisfaction of patients in two wards between the two groups. Results:The theoretical results ( t=4.74, P<0.001) and OSCE scores ( t=3.81, P<0.001) of the experimental group were better than those of the control group. The scores of core competency and autonomous learning ability ( t=4.32, P<0.001) of the experimental group were better than those of the control group. The teaching satisfaction score ( t=2.21, P=0.044) and patient satisfaction score ( t=2.92, P=0.011) of the observation group were better than those of the control group. Conclusion:The progressive case teaching method based on core competency can improve the post competency of nurses, and also improve the teaching satisfaction rate and patient satisfaction rate, which is worthy of being carried out in the subsequent teaching activities.
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Objective:To develop dynamic management strategies for intraoperative acquired pressure injuries (IAPI) in neurosurgery patients and evaluate their implementation effects, so as to provide constructive suggestions for the management of IAPI.Methods:This study was conducted by a non-synchronous before and after control study. From January 2021 to December 2022, 220 patients undergoing neurosurgery in the Second Affiliated Hospital of Guilin Medical College were conveniently selected as the study objects, and divided into the control group and the observation group with 110 patients in each group according to the time of operation. The control group was given routine nursing measures to prevent IAPI, and the observation group was given dynamic management program based on timing theory on bisis of routine nursing. The score of preoperative stress injury,incidence of IAPI and the self-efficacy scores of nurses in the management of stress injury in operating room were compared between the two groups.Results:Before intervention, the scores of preoperative stress injury in control group and observation group were (14.69 ± 2.93) points and (14.78 ± 2.89) points, respectively, with no statistical significance ( t=-0.23, P>0.05).After the intervention, the incidence of IAPI was 3.64%(4/110) in the control group and 0 in the observation group, and the difference was statistically significant ( χ2=4.07, P<0.05). The self-efficacy scores of nurses in the management of stress injury before and after intervention were (29.13 ± 4.87) and (36.41 ± 5.83), respectively, and the difference was statistically significant ( t=-6.21, P<0.05). Conclusions:The implementation of dynamic management strategy of IAPI can effectively reduce the incidence of IAPI in neurosurgery patients and improve the self-efficacy of nurses in operating room.
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Objective:To investigate the application of "micro ward" teaching based on the concept of dedicated education units (DEU) in the standardized training of neurosurgery residents.Methods:The 22 neurosurgery residents enrolled in 2021 for standardized training were assigned to the control group with traditional teaching method. The 24 neurosurgery residents enrolled in 2022 were assigned to the observation group with the "micro ward" teaching method based on the DEU concept. The theoretical knowledge and operational skill scores, clinical thinking ability, and teaching satisfaction were compared between the two groups of students before and after the training. SPSS 21.0 was used to perform chi-square test, Z test and t test. Results:The observation group had higher scores in terms of surgical skills [(190.63±4.35) vs. (86.79±4.82)] and case analysis [(190.54±5.06) vs. (86.13±5.35)] than the control group ( P<0.05). The scores were higher in the observation group than in the control group in terms of broadening thinking, overall thinking, curiosity, and cognitive maturity after training ( P<0.05). The observation group had a significantly higher proportion of students who were satisfied with standardized neurosurgery training teachers, teaching methods, and teaching results than the control group ( P<0.05). Conclusion:The application of "micro ward" teaching based on the concept of DEU in the standardized training of neurosurgery residents can effectively improve the clinical practice ability and professional quality of trainees, cultivate their specialized clinical thinking, enhance their independent learning ability, and improve the training quality. Therefore, this teaching method is worth promoting.
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Objective:To investigate the effects of case-based learning combined with clinical anatomy in neurosurgery internships.Methods:We included students in grades 2014 and 2015 (test group, n=58) and those in grade 2013 (control group, n=48) doing internships in The first Affiliated Hospital of Shantou University Medical College. The test group adopted case-based learning combined with clinical anatomy in the form of neurosurgery intern learning groups. The group learning consisting of four sessions was held twice a week for a total of four times. The traditional teaching method was used in the control group. All the students filled in the Self-Directed Learning Readiness Scale before and after neurosurgery internships. The test group filled in the Satisfaction Survey on case-based learning combined with clinical anatomy after neurosurgery internships. SPSS 20.0 was used to perform t test. Results:Before neurosurgery internships, there was no difference in self-directed learning ability between the test group and control group ( t=0.25, P=0.807). After the internships, the total score of self-directed learning ability was significantly improved in both the test group ( t=-6.49, P<0.001) and the control group ( t=-4.68, P<0.001). The test group showed improvements in six learning factors, while the control group had no significant changes in love of learning and learning motivation. Compared with the control group, the test group showed a significantly higher total score of self-directed learning ability ( t=2.17, P=0.032) and significantly higher scores of efficient learning ( t=3.81, P=0.001) and learning motivation ( t=4.20, P=0.001). The students in the test group were generally satisfied with the new method combining case-based learning and clinical anatomy. Conclusion:The new method combining case-based learning and clinical anatomy has positive effects on students' self-directed learning ability, especially on learning efficiency and motivation, with a high degree of satisfaction from the students.
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Objective:To explore the clinical application of portable head and neck magnetic resonance imaging (MRI) device in neurosurgery.Methods:A total of 213 patients with brain diseases who were scanned by portable head and neck MRI device in Center of Neurosurgery, Zhujiang Hospital, Southern Medical University from June to September 2022 were selected. The portable head and neck MRI images and 3.0T conventional MRI images of 10 randomly selected patients were compared; the differences in signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of different sequences were analyzed. Thirty-one patients accepted tracheal intubation/tracheotomy, or ventilator-assisted breathing were selected as special patient group, and another 30 patients were as general patient group; the differences in comprehensive diagnostic scores of portable head and neck MRI images were compared. Noise intensity differences in different sequences between 3.0T conventional MRI and portable head and neck MRI were statistically compared. Twenty hospitalized volunteers with normal hearing in our center from July to August 2022 were selected, conventional 3.0T MRI and portable head and neck MRI were performed successively, and the noise intensity of different sequences in them was evaluated by using a 5-point system.Results:Compared with those in 3.0T conventional MRI images, the SNR and CNR of T1WI, T2WI, and Liquid attenuated reverse recovery sequence (FLAIR) sequences in portable head and neck MRI images were significantly lower ( P<0.05). No significant difference was noted in the comprehensive diagnostic scores of portable head and neck MRI images between special patients and general patients ( P>0.05). Compared with that in the 3.0T conventional MRI, the noise intensity of different sequences in portable head and neck MRI was significantly reduced ( P<0.05). These volunteers had significantly reduced noise intensity scores of different sequences in portable head and neck MRI compared with that in conventional 3.0T MRI ( P<0.05). Conclusion:Portable head and neck MRI device is easy to use, enjoying high safety, imaging quality and suitability, which meets the clinical needs for neurosurgery patients.
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Objective:To investigate the clinical features of patients with epilepsy in Neurosurgery Outpatient and influencing factors for their seizure control.Methods:Six hundred and seventy-three epilepsy patients admitted to Neurosurgery Outpatient of 6 hospitals including Fifth Affiliated Hospital of Zhengzhou University from September 2017 to December 2022 were chosen. Clinical data (including general demographic data, education level, onset age, onset cycle and duration, course of onset, family annual income and seizure control) were collected using a questionnaire prepared by He'nan Epilepsy Systematic Diagnosis and Treatment Center to summarize the clinical features. Univariate and multivariate Logistic regressions were used to analyze the influencing factors for their seizure control.Results:(1) In these 673 epilepsy patients, 50 (7.4%), 78 (11.6%), 192 (28.5%), 100 (14.9%), 68 (10.1%), 72 (10.7%) and 113 (16.8%), respectively, were <1 year old (infant stage), 1-2 years old (children stage), 3-5 years old (preschool stage), 6-16 years old (juvenile stage), 17-39 years old (young stage), 40-64 years old (middle-aged stage) and ≥65 years old (elderly stage). In the past medical treatment history, 23.0% (155/673) patients did not receive intervention, 72.4% (487/673) received medication, and 4.6% (31/673) received surgical treatment; 55.9% (376/673) had good seizure control and 44.1% (297/673) had poor seizure control. (2) Secondary education ( OR=2.199, 95% CI: 1.037-15.221, P=0.033), primary education or below ( OR=3.544, 95% CI: 2.101-21.343, P=0.012), daily seizures ( OR=4.788, 95% CI: 1.369-33.103, P=0.011), each seizure lasted ≥3 min ( OR=4.179, 95% CI: 3.338-18.550, P=0.003), course of disease≥3 years ( OR=0.199, 95% CI: 0.077-0.602, P=0.001), course of disease for 1-3 years ( OR=0.379, 95% CI: 0.108-0.882, P=0.031), and currently taken antiepileptic drugs for 3 or more ( OR=6.237, 95% CI: 2.195-17.837, P=0.001) were independent risk factors for poor seizure control in epilepsy patients. Conclusion:In Neurosurgery Outpatient, children with diseases before childhood enjoy the largest proportion; drug therapy remains the main treatment; low education level, short seizure cycle, long duration of attack, long course of disease, and multiple drugs used in these patients imply poor anti-epileptic effecacy.
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Objective To explore the risk factors for intracranial infection in patients after neurosurgery,con-struct and validate a Nomogram prediction model.Methods Data of 978 patients who underwent neurosurgery in a hospital in Nanjing from January 1,2019 to December 31,2022 were retrospectively analyzed.Independent risk fac-tors were screened through logistic univariate and multivariate analyses.Modeling variables were screened through Lasso regression.A Nomogram model was constructed and internally validated by logistic regression.Effectiveness of the model was evaluated with receiver operating characteristic(ROC)curve,calibration curve and decision curve.Results Among 978 patients underwent neurosurgery,293 had postoperative intracranial infection,with an inci-dence of healthcare-associated infection of 29.96％.There was no significant difference in age,gender,proportion of coronary heart disease,cerebral infarction,diabetes and hypertension between the infected group and the non-in-fected group(all P＞0.05).Multivariate logistic analysis showed that postoperative intracranial hypertension,fe-ver,increased neutrophil percentage in blood routine examination,turbid cerebrospinal fluid,positive Pan's test,decreased glucose concentration,abnormal ratio of cerebrospinal fluid/serum glucose,positive microbial culture,absence of indwelling external ventricular drainage tubes,presence of indwelling lumbar cistern drainage tubes,use of immunosuppressive agents,and long duration of surgery were independent risk factors for postoperative intracra-nial infection in patients who underwent neurosurgery(all P＜0.05).Fifteen variables were screened out through Lasso regression.Fourteen variables were finally included for modeling after collinear screening,missing data impu-tation(random forest method)and checking pairwise interaction items.A Nomogram prediction model was con-structed,with the area under ROC curve,sensitivity,specificity,and accuracy of 0.885,0.578,0.896,and 0.704,respectively.Internal validation of the model was conducted.The modeling and validation groups presented similar effects.The calibration curve and decision curve also indicated that the model had good predictive efficacy.Conclusion The constructed Nomogram prediction model for postoperative intracranial infection after neurosurgery is scientific,and the prediction indicators are easy to obtain.The model presents with high stability,reliability,and application value,thus can provide reference for the assessment of postoperative intracranial infection after neuro-surgery.