关键词： American Academy of Neurology   brain death   coma depassé   irreversible coma   practice guidelines   World Brain Death Project  

摘要： Background: There remains a lack of awareness around the American Academy of Neurology (AAN) procedural criteria for brain death and the surrounding controversies, leading to significant practice variability. This survey study assessed for existing knowledge and attitude among healthcare professionals regarding procedural criteria and potential change after an educational intervention. Methods: Healthcare professionals with increased exposure to brain injury at Mayo Clinic hospitals in Arizona and Florida were invited to complete an online survey consisting of 2 iterations of a 14-item questionnaire, taken before and after a 30-minute video educational intervention. The questionnaire gathered participants' opinion of (1) their knowledge of the AAN procedural criteria, (2) whether these criteria determine complete, irreversible cessation of brain function, and (3) on what concept of death they base the equivalence of brain death to biological death. Results: Of the 928 people contacted, a total of 118 and 62 participants completed the pre-intervention and post-intervention questionnaire, respectively. The results show broad, unchanging support for the concept of brain death (86.8%) and that current criteria constitute best practice. While 64.9% agree further that the loss of consciousness and spontaneous breathing is sufficient for death, contradictorily, 37.6% believe the loss of additional integrated bodily functions such as fighting infection is necessary for death. A plurality trusts these criteria to demonstrate loss of brain function that is irreversible (67.6%) and complete (43.6%) at baseline, but there is significantly less agreement on both at post-intervention. Conclusion: Although there is consistent support that AAN procedural criteria are best for clinical practice, results show a tenuous belief that these criteria determine irreversible and complete loss of all brain function. Despite support for the concept of brain death first developed by the Presid

关键词： multimodal sensing   synaptic transistor   biomimetic memory/learning   environment-interactive   artificial intelligence  

摘要： As the initial stage in the formation of human intelligence, the sensory-memory system plays a critical role for human being to perceive, interact, and evolve with the environment. Electronic implementation of such biological sensory-memory system empowers the development of environment-interactive artificial intelligence (AI) that can learn and evolve with diversified external information, which could potentially broaden the application of the AI technology in the field of human-computer interaction. Here, we report a multimodal artificial sensory-memory system consisting of sensors for generating biomimetic visual, auditory, tactile inputs, and flexible carbon nanotube synaptic transistor that possesses synapse-like signal processing and memorizing behaviors. The transduction of physical signals into information-containing, presynaptic action potentials and the synaptic plasticity of the transistor in response to single and long-term action potential excitations have been systematically characterized. The bioreceptor-like sensing and synapse-like memorizing behaviors have also been demonstrated. On the basis of the memory and learning characteristics of the sensory-memory system, the well-known psychological model describing human memory, the "multistore memory" model, and the classical conditioning experiment that demonstrates the associative learning of brain, "Pavlov's dog's experiment", have both been implemented electronically using actual physical input signals as the sources of the stimuli. The biomimetic intelligence demonstrated in this neurological sensory-memory system shows its potential in promoting the advancement in multimodal, user-environment interactive AI.

关键词： ADEM   Children   COVID-19   MIS-C   Neurologic complications  

摘要： Background: Presently, it is known that, even if less frequently than in adults, children can develop a severe new coronavirus disease 2019 (COVID-19). Children with the SARS-CoV-2 infection can have neurological signs and symptoms of disease more frequently than previously thought, revealing the involvement of the central nervous system, the peripheral nervous system, or both. Aim of this manuscript is to highlight the neurologic complications associated with SARS-CoV-2 among pediatric patients with COVID-19, suggesting when to monitor carefully neurologic development. Main findings: Children with a severe chronic underlying disease, infants and toddlers and those who develop the so-called multisystem inflammatory syndrome (MIS-C) are those with the highest incidence of neurological complications. Fortunately, in most of the cases, neurological manifestations, mainly represented by headache and anosmia, are mild and transient and do not significantly complicate the COVID-19 course. However, in some cases, very severe clinical problems associated with relevant alterations of neuroimaging, electroencephalography, nerve conduction studies and electromyography findings can develop. Generally, almost all the children with COVID-19 and neurological manifestations till now described have made a complete recovery, although in some cases this has occurred after several weeks of treatment. Moreover, COVID-19 infection during pregnancy has been found associated with an increased risk of obstetric complications that can lead to neurological acute and long-term manifestations in neonates. Conclusions: Based on data showing the neurologic impact of COVID-19 in pediatric age, we suggest monitoring neurological development a few months after healing in pediatric patients who have presented MIS-C, seizures or other neurological manifestations and in children of pregnant women with COVID-19 in order to detect overt and subtle deficits.

关键词： Acute hepatic porphyria   Peripheral neuropathy   Neuropsychiatric features   Epilepsy   Cerebrovascular disorders   Givosiran  

摘要： Porphyrias are a set of rare inherited metabolic disorders, each of them representing a defect in one of the eight enzymes in the haem biosynthetic pathway resulting in the accumulation of organic compounds called porphyrins. Acute hepatic porphyrias (AHP) are those in which the enzyme deficiency occurs in the liver, of which acute intermittent porphyria is by far the most common subtype. Neurology of the AHP is still challenging in practice, and patients rarely receive the correct diagnosis early in the disease course. For AHP, which primarily affects the central and peripheral nervous system, the cause of symptoms seems to be the increased production of neurotoxic precursors, in particular delta-aminolaevulinic acid and porphobilinogen. Neurological complications usually result from severe episodes of acute attacks. The neurologic hallmark of porphyrias is an acute predominantly motor axonal neuropathy resembling a Guillain-Barre ' syndrome that generally occurs after the onset of other clinical features such as abdominal pain and central nervous system manifestations. Neuropsychiatric syndromes, seizures, encephalopathy, and cerebrovascular disorders are among the possible central nervous system presentations. Therapeutic approach to AHP is divided into management and prophylaxis of an acute attack, including long standing options such as intravenous hematin and new therapeutic agents such as givosiran.