关键词： Stroke   Surgery   Anesthesia   Hypotension  

摘要： Purpose The association between intraoperative hypotension and perioperative acute ischemic stroke is not well described. We hypothesized that intraoperative hypotension would be associated with perioperative acute ischemic stroke. Methods Four-year retrospective cohort study of elective non-cardiovascular, non-neurological surgical patients. Characteristics of patients who had perioperative acute ischemic stroke were compared against those of patients who did not have acute ischemic stroke. Multivariable logistic regression was used to determine whether hypotension was independently associated with increased odds of perioperative acute ischemic stroke. Results Thirty-four of 9816 patients (0.3%) who met study inclusion criteria had perioperative acute ischemic stroke. Stroke patients were older and had more comorbidities including hypertension, coronary artery disease, diabetes mellitus, active tobacco use, chronic obstructive pulmonary disease, cerebral vascular disease, atrial fibrillation, and peripheral vascular disease (all P < 0.05). MAP < 65 mmHg was not associated with increased odds of acute ischemic stroke when modeled as a continuous or categorical variable. MAP < 60 mmHg for more than 20 min was independently associated with increased odds of acute ischemic stroke, OR = 2.67 [95% CI = 1.21 to 5.88, P = 0.02]. Conclusion Our analysis suggests that when MAP is less than 60 mmHg for more than 20 min, there is increased odds of acute ischemic stroke. Further studies are needed to determine what MAP should be targeted during surgery to optimize cerebral perfusion and limit ischemic stroke risk.

关键词： Psychogenic nonepileptic seizures   Functional motor disorder   Clinical factors   Psychiatric factors   Autonomic nervous system  

摘要： Purpose Heart transplantation (HT) is the gold-standard treatment for end-stage heart failure. In spite of its innumerous benefits, it still involves complications. Among them, neurological complications significantly impact patient's morbidity and mortality. The aim of this study is to determine the prevalence, prognosis and predictors of neurological events after HT. Methods Between January 2007-December 2017, data from all patients who underwent orthotopic HT in this single center were collected and analyzed considering seizures, ischemic and hemorrhagic stroke as neurological complications. Univariate and multivariate analysis were performed to determine significant predictors; ROC curves were generated to establish blood pressure cutoffs that influence the presence of neurological events. Mortality between groups was evaluated through Kaplan Meier curves and Log Rank test. Results We assessed 132 patients from 15-76 years of age (mean 51.8), 73.5% men, mainly in INTERMACS profile 3 (78.8%). Etiologies included Chagas disease (26.7%), ischemic cardiomyopathy (26.7%), idiopathic dilated cardiomyopathy (24.4%) and other (22.2%). Neurological events before transplant occurred in 16.7%. The prevalence of neurological complications after HT was 17.4% (8.7% ischemic stroke, 60.9% hemorrhagic stroke, 30.4% seizures), and occurred mainly in the first 10 postoperative days (71.4%). In the multivariate analysis, the difference between systolic blood pressure (SBP) before HT and on the 3rd postoperative day was an independent predictor of neurological events (p-value 0.018; 95% CI of 1.007-1.080 OR 1.043). A cut off value of SBP gradient>31,9mmHg (64.3% sensitivity,63% specificity;AUROC 0.652) significantly increased the risk of neurological complications (p=0.006, 95%CI 1.576-14.692 OR 4.811). Presence of neurological events was related to a longer hospital stay (38.6 days for patients with events, 29.1 days for patients without, p=0.019). However, up to the first-ye

关键词： arrhythmias   brain   dog   hemangiosarcoma   ventricular septum  

摘要： Background Brain metastases are well known for disseminated hemangiosarcoma involving the right atrium/auricle. Case report An 8-year-old male Australian Shepherd Dog presented with a 3-day history of circling to the left. A neurological examination revealed obtunded mentation, right hemi-inattention, bilateral strabismus towards the left side and absent physiological nystagmus. In addition, the dog had muffled heart sounds on auscultation and exercise-induced weakness. Laboratory findings included hypercoagulability and marked elevation in the C-reactive protein concentration. Electrocardiography detected a sinus rhythm with right bundle-branch block and ventricular bigeminy. Echocardiography revealed an extensive interventricular septal mass. Due to the grave prognosis, the owners elected for euthanasia, and a complete necropsy was performed. The main pathological findings were an interventricular septal and left ventricular hemangiosarcoma, with metastases in the brain, lungs, spleen and adrenal glands. No evidence of tumour infiltration was found in the right atrium. Conclusion To the authors' knowledge, this is the first report of neurological signs due to confirmed brain metastases in a dog with interventricular septal hemangiosarcoma. Although the right atrium is the main location for cardiac hemangiosarcoma, the interventricular septum should be evaluated in all cases.

关键词： Adrenergic receptors   calcium channel   calcium channel blocker   neurovascular unit   vasopressor  

摘要： Adrenoceptor and calcium channel modulating medications are widely used in clinical practice for acute neurological and systemic conditions. It is generally assumed that the cerebrovascular effects of these drugs mirror that of their systemic effects - and this is reflected in how these medications are currently used in clinical practice. However, recent research suggests that there are distinct cerebrovascular-specific effects of these medications that are related to the unique characteristics of the cerebrovascular anatomy including the regional heterogeneity in density and distribution of adrenoceptor subtypes and calcium channels along the cerebrovasculature. In this review, we critically evaluate existing basic science and clinical research to discuss known and putative interactions between adrenoceptor and calcium channel modulating pharmacotherapies, the neurovascular unit, and cerebrovascular anatomy. In doing so, we provide a rationale for selecting vasoactive medications based on lesion location and lay a foundation for future investigations that will define neuroprotective paradigms of adrenoceptor and calcium channel modulating therapies to improve neurological outcomes in acute neurological and systemic disorders.

关键词： Myelopathy   motor neurons   spinal cord   panniculus reflex   cutaneous trunci  

摘要： Objectives The aim of this study was to perform the cutaneous trunci reflex (CTR) in neurologically normal cats using two different instruments and determine how body condition score (BCS), body circumference, age, sex and instrument type may affect this reflex. Methods Sixty-five cats without evidence of neurologic disease were prospectively enrolled. Cats were randomly assigned to have the reflex tested first using a pair of hemostatic forceps or the integrated Babinski tip of an MDF Babinski Buck Reflex Hammer. After 30 mins, the reflex was retested using the other instrument. Data collected included the reflex presence, reflex caudal border, reflex intensity (weak, moderate, strong) and reflex symmetry (unilateral or bilateral). The influence of BCS, body circumference, age and sex on these variables was statistically evaluated along with effect of the instrument used. Results The CTR was elicited bilaterally in 52 (80%) cats and unilaterally in 64 (98%) cats. In two cats, the CTR was only able to be elicited using the Buck Reflex Hammer, while in four cats, the CTR was only able to be elicited using hemostatic forceps. Body circumference, BCS, age and sex had no effect on the presence, caudal border, intensity or symmetry of the CTR, regardless of the instrument used. No difference in the bilateral presence of the CTR was noted based on the instrument used first (P = 0.53). When assessing the influence of the instrument on reflex presence, caudal border, intensity and symmetry, the hemostatic forceps elicited the reflex further caudally (P = 0.02) and usually bilaterally (P = 0.02). Conclusions and relevance The CTR could be elicited in the majority of cats with both instruments. However, hemostatic forceps elicited a reflex more caudally and bilaterally symmetrical than the Buck Reflex Hammer.

关键词： Functional Motor Disorders   Psychogenic non-epileptic seizures   Functional Neurological Disorder   Psychogenic Disorder  

摘要： IntroductionLiterature on childhood Functional Neurological Disorders (FNDs) is spare. Clinical presentations are vaguely characterized and often misdiagnosed in younger ages. Their main neurological features enrol: Psychogenic non-epileptic seizures (PNES), Functional movement disorders (FMDs), sensory alterations, cephalgia and feeding *** study was aimed to better characterize the childhood population of FND, because of they represent an emerging challenge for clinicians, giving its higher presentation in the younger age and the difficulties of an early and differential diagnosis as well as an effective management.MethodsOur study retrospectively examined the characteristics of 82 FNDs children and adolescents (8 to 16 y.o.; 13 males; 29 females) referred as neurological inpatients of an urban academic neuropsychiatric department, from 2014 to 2019. Three main clinical aspects were analysed: type and pattern of symptoms manifestations (DSM-5 criteria); Life Events; family functioning.ResultsFND accounted for 2% of 5-years consultations of neurological inpatients (M: F=1:2). The clinical presentation was characterized in 70% by pattern of co-expressed neurological symptoms: FMDs (9.5%); PNES (12%); dizziness/lipothymia (12%); paraesthesia/anaesthesia (16%). Generalized pain was associated in 38% of the reported patterns while cephalgia in 44%. Sleep disorders were reported in 40%. Previous psychiatric diagnoses were uncommon (2 out 82). Antecedent stressors were identified in 97% of patients for personal illness history and in the 93% for chronic illness in the family anamnesis. Family problems were in 25% of cases.ConclusionsOur data contributes to better characterize the childhood population of FND, describing clinical patterns of presentation, highlighting putative antecedent stressors and risk

关键词： Neurology   Science   Gross domestic product   Scientific production  

摘要： Objective Scientific productivity is relevant to support clinical activity, improve therapeutic strategies, and understand the pathophysiological mechanisms of neurological disorders. We performed an updated bibliometric research to assess the country-specific relationship between neurological scientific production and socio-economic variables of dedicated resources. Methods Neurological scientific productivity of 168 countries, from 1996 to 2019, was obtained using the SCImago online website. Data on gross domestic product (GDP), percentage of GDP spent in research and development, and number of researchers per million people were obtained using the World Bank Group website. Results The USA was the first country in terms of documents produced (260,030), followed by Germany (69,841), Japan (65,200), the UK (60,914), and Italy (50,017). Except for Japan, all the most productive countries had an increase in scientific productivity in the last 12 years. In 2019, the USA still ranked first in the number of neurological papers published, followed by Germany, the UK, Italy, and Japan. Among the most productive countries, Canada and Japan did not increase the percentage of GDP spent in research over time. Except for Canada and Japan, all the most productive countries increased the number of researchers in the last years. Conclusions Our analysis provided novel evidence of the adequacy of the scientific return on country-specific investment of local dedicated resources.

关键词： COVID19 pandemic   Lockdown   Health care   Child neurology   Telemedicine  

摘要： Background: The costs and benefits of full lockdown measures are debated. Neurologically impaired children are a vulnerable population with specific needs in terms of protection against infection and access to health services. Objectives: We investigated the effects of lockdown on the health of children with neurological disorders and on their access to care during lockdown. Methods: Data from 514 children (282 males e 232 females) were collected through physician administered interviews to investigate: the occurrence of viral-like physical symptoms, the correlation between the risk of developing such symptoms and several demographic and clinical variables, the occurrence of any worsening of the children's neurological conditions during lockdown, and their access to care services during this period. Results: 49.1% experienced at least one symptom during the study period, but no child developed severe complications. The prevalence of symptoms was significantly lower during lockdown than during the previous two months. The underlying neurological condition worsened in 11.5% of the patients. Children who regularly left the home during lockdown were greater risk of exhibiting symptoms. During lock down, 67.7% had a specialist appointment cancelled, 52.6% contacted their paediatrician, and 30.9% contacted their child neuropsychiatrist. Among patients who usually receive rehabilitation, 49.5% continued remotely. Conclusion: Lockdown protected children from infections. Telemedicine and telerehabilitation constituted a valid alternative for the care and treatment of these children, but they should not become a widespread and definitive model of care. COVID-19 and other emergency response plans must take into account the specific needs of children with disabilities. (c) 2020 Elsevier Inc. All rights reserved.

摘要： Background Distemper is a viral multisystem disease that affects dogs of all ages. So far, there are only palliative treatments and the consequence of the disease is decreasing the quality of life of the animals and in more severe cases is euthanasia. Mesenchymal stem cells (MSCs) are potential candidates for the treatment of distemper due mainly to their immunomodulatory and anti-inflammatory characteristics. Although the most explored source for the isolation of MSC in dogs is the adipose tissue, the collection results in invasive procedures, and the cells may be influenced by the age and physical conditions of the donor, so there is great interest in seeking alternative sources of MSC. Our objectives are to validate and define an optimized isolation protocol for canine umbilical cord MSCs for application in dogs diagnosed with neurological sequels of distemper. Methods The umbilical cords obtained in elective cesarean sections were processed according to the following protocols: Group 1 - 1 hour in collagenase 1 mg/ml, group 2 - 1 hour in trypsin 0.125% + 1 hour in collagenase 1 mg/ml, and group 3 - tissue explants. Following isolation, the cells were cultured in the same way, in DMEM culture medium, and a CO2 incubator at 37°C. After cultivation, the groups were subjected to evaluation of specific membrane markers by flow cytometry (CD90, CD44, CD29, CD45, CD34, CD14, and HLA-DR). Later in this project, we will carry out cell differentiation tests and the therapeutic evaluation will be carried out through the transplantation of umbilical cord MSCs in dogs diagnosed with neurological sequels of distemper. Results Using the same amount of starting material, groups 1 and 2 showed more adhered cells (at least ten times greater) than group 3, in addition to having greater expansion capacity along the passages. Groups 1 and 2 were similar in the number of cells obtained, with group 2 showing more homogeneous morphology from passage 2. In a preliminary study of me