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急性脊髓损伤患者治疗的临床操作指南:关于MRI基线在临床治疗决策与结果预测中作用的几点建议（英文）

中华神经外科疾病研究杂志 2017年第6期16卷 529-529页

作者： Fehlings MG Martin AR Tetreault LA Aarabi B Anderson P arnold pm Brodke D Burns AS Chiba K Dettori JR Furlan JC Hawryluk G Holly LT Howley S Jeji T Kalsi-Ryan S Kotter M Kurpad S Kwon BK Marino RJ Massicotte E Merli G Middleton JW Nakashima H Nagoshi N Palmieri K Singh A Skelly AC Tsai EC Vaccaro A Wilson JR Yee A Harrop JS Toronto Western Hospital University Health Network University of Toronto University College Cork University of Maryland University of Wisconsin University of Kansas Medical Center The University of Kansas University of Utah Toronto Rehabilitation Institute University Health Network National Defense Medical College Spectrum Research Inc University of California at Los Angeles Christopher & Dana Reeve Foundation Ontario Neurotrauma Foundation University of Cambridge Medical College of Wisconsin University of British Columbia Thomas Jefferson University Hospital University of Sydney Nagoya University Keio University The University of Kansas Ottawa Hospital Research Institute Thomas Jefferson University Li Ka Shing Knowledge Institute St. Michael's Hospital Sunnybrook Health Sciences Centre

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 *** 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 *** 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.

关键词：神经外科疾病医学研究患者

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Risk for emerging bipolar disorder, variants, and symptoms in children with attention deficit hyperactivity disorder, now grown up

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World Journal of Psychiatry 2015年第4期5卷 412-424页

作者： Ahmed Z Elmaadawi Peter S Jensen L Eugene arnold Brooke SG Molina Lily Hechtman Howard B Abikoff Stephen P Hinshaw Jeffrey H Newcorn Laurence Lee Greenhill James M Swanson Cathryn A Galanter Department of Psychiatry Indiana University School of Medicine-South Bend Campus REACH Institute Department of Psychiatry Ohio State University Department of Psychiatry University of Pittsburgh Department of Psychiatry and Pediatrics McGill University Health Center Department of Child and Adolescent Psychiatry The Child Study Center at NYU Langone Medical Center Department of Psychology University of California Department of Psychiatry and Pediatrics Icahn School of Medicine at Mount Sinai Department of Clinical Child and Adolescent Psychiatry New York Psychiatric Institute Department of Pediatrics and Epidemiology Child Development Center University of California Department of Psychiatry State University of New York Downstate Medical Center and Kings County Hospital Center

AIM: To determine the prevalence of bipolar disorder(BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder(ADHD) through 14 years' follow-up, when participants were between 21-24 years ***: First, we examined rates of BD type Ⅰ?and Ⅱ diagnoses in youth participating in the NIMH-funded Multimodal Treatment Study of ADHD(MTA). We used the diagnostic interview schedule for children(DISC), administered to both parents(DISC-P) and youth(DISCY). We compared the MTA study subjects with ADHD(n = 579) to a local normative comparison group(LNCG, n = 289) at 4 different assessment points: 6, 8, 12, and 14 years of follow-ups. To evaluate the bipolar variants, we compared total symptom counts(TSC) of DSM manic and hypomanic symptoms that were generated by DISC in ADHD and LNCG subjects. Then we sub-divided the TSC into pathognomonic manic(pm) and non-specific manic(NSM) symptoms. We compared the pm and NSM in ADHD and LNCG at each assessment point and over time. We also evaluated the irritability as category A2 manic symptom in both groups and over time. Finally, we studied the irritability symptom in correlation with pm and NSM in ADHD and LNCG ***: DISC-generated BD diagnosis did not differ significantly in rates between ADHD(1.89%) and LNCG 1.38%). Interestingly, no participant met BD diagnosis more than once in the 4 assessment points in 14 years. However, on the symptom level, ADHD subjects reported significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P pm symptoms than LNCG, with pm means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and pm, ADHD status associated with greater NSM than pm. However, Over 14 years, the NSM symptoms declined and changed to pm over time(df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability(BD DSM criterion-A2) rates were significa

关键词： Multimodal treatment study of attention deficit hyperactivity disorder Irritability Attention deficit hyperactivity disorder Diagnostic interview schedule for children Bipolar disorder

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