Neurologic Alternative Payment Models—Bridging the Gap

神经系统替代支付模式-弥合差距

This Viewpoint discusses alternative payments models and the responsibilities of health care professionals.

此观点讨论了替代支付模式和医疗保健专业人员的职责。

REF: Kannarkat JT, Kannarkat GT, Jones LK Jr. Neurologic Alternative Payment Models-Bridging the Gap. JAMA Neurol. Published online January 8, 2024. doi:10.1001/jamaneurol.2023.5053 PMID: 38190142

Psychedelics in Addiction Treatment—Navigating a Sociopolitical Rift

成瘾治疗中的迷幻药-导航社会政治裂痕

This Viewpoint discusses the use of psychedelics in treatment for substance use disorders.

此观点讨论了迷幻药在治疗物质使用障碍中的使用。

REF: Mehtani NJ, Anderson BT, Mitchell JM. Psychedelics in Addiction Treatment-Navigating a Sociopolitical Rift. JAMA Neurol. Published online January 16, 2024. doi:10.1001/jamaneurol.2023.5173 PMID: 38227310

Revisiting the Emergency Department

重新访问急诊科

This essay describes the author’s first time in an emergency department since accompanying his mother for neurologic evaluation.

本文描述了作者自从陪同母亲进行神经系统评估以来第一次在急诊科。

REF: Thomson B. Revisiting the Emergency Department. JAMA Neurol. 2024;81(4):315-316. doi:10.1001/jamaneurol.2023.5623 PMID: 暂无

Sublingual Edaravone Dexborneol for the Treatment of Acute Ischemic StrokeThe TASTE-SL Randomized Clinical Trial

舌下含服依达拉奉右旋冰片治疗急性缺血性中风味觉-SL随机临床试验

This randomized clinical trial investigates if sublingual edaravone dexborneol improves functional outcome in patients with acute ischemic stroke. Among patients with AIS within 48 hours, sublingual edaravone dexborneol could improve the proportion of those achieving a favorable functional outcome at 90 days compared with placebo.

这项随机临床试验研究了舌下含服依达拉奉右旋冰片是否可以改善急性缺血性中风患者的功能预后。在48小时内的AIS患者中，与安慰剂相比，舌下含服依达拉奉右冰片可以提高90天内达到良好功能结局的患者的比例。

REF: Fu Y, Wang A, Tang R, et al. Sublingual Edaravone Dexborneol for the Treatment of Acute Ischemic Stroke: The TASTE-SL Randomized Clinical Trial [published correction appears in JAMA Neurol. 2024 Apr 1;81(4):425]. JAMA Neurol. Published online February 19, 2024. doi:10.1001/jamaneurol.2023.5716 PMID: 38372981 PMCID: PMC10877503

Endovascular Thrombectomy Treatment Effect in Direct vs Transferred Patients With Large Ischemic StrokesA Prespecified Analysis of the SELECT2 Trial

直接与转移的大面积缺血性卒中患者的血管内血栓切除术治疗效果SELECT2试验的预设分析

This prespecified analysis of the SELECT2 trial assesses endovascular thrombectomy treatment effects in transferred vs directly presenting patients and evaluates the association between transfer times and neuroimaging changes with endovascular thrombectomy clinical outcomes. Both directly presenting and transferred patients with large ischemic stroke in the SELECT2 trial benefited from EVT, including those with low ASPECTS at referring hospitals. However, the association of EVT with better functional outcomes was numerically better in patients presenting directly to EVT-capable centers. Prolonged transfer times and evolution of ischemic change were associated with worse EVT outcomes. These findings emphasize the need for rapid identification of patients suitable for transfer and expedited transport.

这项SELECT2试验的预设分析评估了转移与直接就诊患者的血管内血栓切除术治疗效果，并评估了转移时间和神经影像学变化与血管内血栓切除术临床结局之间的相关性.在SELECT2试验中，直接就诊和转诊的大面积缺血性卒中患者均受益于EVT，包括转诊医院低方面的患者。然而，在直接到有EVT能力的中心就诊的患者中，EVT与更好的功能结局的相关性在数值上更好。转移时间延长和缺血性改变的进展与EVT预后较差相关。这些发现强调需要快速识别适合转移和快速运输的患者。

REF: Sarraj A, Hill MD, Hussain MS, et al. Endovascular Thrombectomy Treatment Effect in Direct vs Transferred Patients With Large Ischemic Strokes: A Prespecified Analysis of the SELECT2 Trial. JAMA Neurol. Published online February 8, 2024. doi:10.1001/jamaneurol.2024.0206 PMID: 38363872 PMCID: PMC10853865

Batoclimab vs Placebo for Generalized Myasthenia GravisA Randomized Clinical Trial

Batoclimab与安慰剂治疗全身性重症肌无力的随机临床试验

This randomized clinical trial investigates the effectiveness and safety of the neonatal fragment crystallizable receptor monoclonal antibody, batoclimab, in adults with generalized myasthenia gravis. Batoclimab increased the rate of sustained MG-ADL improvement and was well tolerated in adult patients with generalized MG. Clinical effects and the extent of IgG reduction were similar to those previously reported for efgartigimod and rozanolixizumab. Future studies of large sample size are needed to further understand the safety profile of batoclimab.

这项随机临床试验研究了新生儿片段可结晶受体单克隆抗体batoclimab在成人重症肌无力中的有效性和安全性。Batoclimab增加了mg-adl的持续改善率，并且在患有全身性MG的成年患者中具有良好的耐受性。临床效果和IgG降低程度与先前报道的efgartigimod和rozanolixizumab相似。未来的大样本量研究需要进一步了解batoclimab的安全性。

REF: Yan C, Yue Y, Guan Y, et al. Batoclimab vs Placebo for Generalized Myasthenia Gravis: A Randomized Clinical Trial. JAMA Neurol. Published online March 4, 2024. doi:10.1001/jamaneurol.2024.0044 PMID: 38436998 PMCID: PMC10913013

Posttraumatic Epilepsy and Dementia Risk

创伤后癫痫和痴呆风险

This cohort study investigates associations of posttraumatic epilepsy with dementia risk. In this community-based cohort, there was an increased risk of dementia associated with PTE that was significantly higher than the risk associated with head injury or seizure/epilepsy alone. These findings provide evidence that PTE is associated with long-term outcomes and supports both the prevention of head injuries via public health measures and further research into the underlying mechanisms and the risk factors for the development of PTE, so that efforts can also be focused on the prevention of PTE after a head injury.

这项队列研究调查了创伤后癫痫与痴呆风险的关系。在这个以社区为基础的队列中，与PTE相关的痴呆风险增加，显著高于单独与头部损伤或癫痫发作/癫痫相关的风险。这些发现提供了证据，表明PTE与长期结果有关，并支持通过公共卫生措施预防头部受伤，并进一步研究PTE发展的潜在机制和危险因素，因此也可以集中精力在预防头部受伤后的PTE。

REF: Schneider ALC, Law CA, Gottesman RF, et al. Posttraumatic Epilepsy and Dementia Risk. JAMA Neurol. Published online February 26, 2024. doi:10.1001/jamaneurol.2024.0010 PMID: 38407883 PMCID: PMC10897826

LDL-C Levels and Bleeding Risk in Patients Taking DAPT After Minor Ischemic Stroke or TIA

轻度缺血性卒中或TIA后服用DAPT患者的ldl-c水平和出血风险

This cohort study investigates the association of low-density lipoprotein cholesterol (LDL-C) levels with bleeding risk in patients taking dual antiplatelet therapy (DAPT) after minor ischemic stroke or transient ischemic attack (TIA). The findings suggest that low LDL-C levels are associated with an increased bleeding risk within 3 months among patients with MIS or HRTIA receiving DAPT, especially those taking ticagrelor-aspirin. Weighing the risks and benefits is crucial when simultaneously considering the selection of LDL-C target strategies and DAPT regimens among these patients.

这项队列研究调查了轻度缺血性卒中或短暂性脑缺血发作 (TIA) 后接受双重抗血小板治疗 (DAPT) 的患者的低密度脂蛋白胆固醇 (ldl-c) 水平与出血风险的关系。研究结果表明，在接受DAPT的MIS或HRTIA患者中，低ldl-c水平与3个月内出血风险增加相关，尤其是服用替格瑞洛-阿司匹林的患者。当同时考虑在这些患者中选择ldl-c目标策略和DAPT方案时，权衡风险和收益至关重要。

REF: Cheng A, Xue J, Wang A, et al. LDL-C Levels and Bleeding Risk in Patients Taking DAPT After Minor Ischemic Stroke or TIA. JAMA Neurol. Published online March 4, 2024. doi:10.1001/jamaneurol.2024.0086 PMID: 38436990 PMCID: PMC10913006

Time to Anticoagulation Reversal and Outcomes After Intracerebral Hemorrhage

脑出血后抗凝逆转时间和预后

This cohort study evaluates whether door-to-treatment time is associated with outcome among patients with anticoagulation-associated intracerebral hemorrhage treated with reversal interventions. In US hospitals participating in Get With The Guidelines-Stroke, earlier anticoagulation reversal was associated with improved survival for patients with ICH. These findings support intensive efforts to accelerate evaluation and treatment for patients with this devastating form of stroke.

这项队列研究评估了接受逆转干预治疗的抗凝相关脑出血患者的治疗时间是否与预后相关。在参与卒中指南Get的美国医院中，早期抗凝逆转与改善ICH患者的生存率相关。这些发现支持为加速这种破坏性中风患者的评估和治疗而付出的巨大努力。

REF: Sheth KN, Solomon N, Alhanti B, et al. Time to Anticoagulation Reversal and Outcomes After Intracerebral Hemorrhage. JAMA Neurol. Published online February 9, 2024. doi:10.1001/jamaneurol.2024.0221 PMID: 38335064 PMCID: PMC11002694