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多个脑部病变是否总是意味着更差的结局?来自尼泊尔科什/普尔班达尔省一家三级护理中心的评估证据。

Do Multiple Brain Lesions Always Connote Worse Outcomes? Appraisal Evidence from a Tertiary Care Center in Koshi/Purbanchal Province of Nepal.

机构信息

Department of Psychiatry, National Academy of Medical Sciences, Bir Hospital Nursing Campus, Gaushala, Kathmandu, Nepal.

Department of Neurosurgery, College of Medical Sciences, Bharatpur, Chitwan, Nepal.

出版信息

Adv Exp Med Biol. 2022;1374:91-103. doi: 10.1007/5584_2021_642.

Abstract

Advances in medicine comprising diverse diagnostic and management modalities call for a bundle approach to improve patient care. This study aimed to present diagnostic patterns in patients with multiple intracranial lesions together with connoted survival implications. We retrospectively reviewed medical files of 85 patients with tumor and non-tumor intracranial lesions. Metastatic brain lesions were identified in 23.5% of patients. Neurological pathogenesis underlay 29.4%, infectious 21.2%, and vascular 14.1% of lesions, with the remaining portion comprising less frequent disorders. A favorable prognosis was predicted in 52/85 (61.2%) of the study population despite a variety of pathologies, which speaks for substantial improvements in outcomes of once hardly manageable or mortal brain disorders, comprising both common and rare conditions. The improvements are to the credit of advances in medical radio-imaging enhancing the diagnostic power which enables a precise stratification of brain pathologies. We emphasize the use of an algorithmic evaluation of patients presenting with multiple brain lesions for differential diagnosis and survival prognostication. There seems to be an ongoing transition from imperfect probabilistic prediction models to precision medicine, which determines advantages in disease management and outcome.

摘要

医学的进步包括多种诊断和治疗方式,需要采用综合方法来改善患者的治疗效果。本研究旨在介绍伴有不同预后意义的颅内多发病变的诊断模式。我们回顾性分析了 85 例颅内肿瘤和非肿瘤性病变患者的病历。转移性脑病变在患者中的占比为 23.5%。神经病变占 29.4%,感染性病变占 21.2%,血管性病变占 14.1%,其余部分为较少见的病变。尽管存在多种病变,但研究人群中仍有 52/85(61.2%)的患者预后良好,这表明曾难以治疗或致命的脑部疾病的治疗效果得到了实质性改善,包括常见和罕见疾病。这一进步归功于医学放射影像学的进步,提高了诊断能力,从而能够对脑部病变进行精确的分层。我们强调对表现为多发性脑病变的患者进行算法评估,以进行鉴别诊断和预后预测。目前似乎正在从不完善的概率预测模型向精准医学转变,这为疾病管理和结果带来了优势。

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