关键词： Blood flow simulations   1D models   3D models   1D-3D coupled models   ECMO   Multiscale models  

摘要： Computational blood flow models in large arteries elucidate valuable relationships between cardiovascular diseases and hemodynamics, leading to improvements in treatment planning and clinical decision making. One such application with potential to benefit from simulation is venoarterial extracorporeal membrane oxygenation (VA-ECMO), a support system for patients with cardiopulmona r y failure. VA-ECMO patients develop high rates of neurological complications, partially due to abnormal blood flow throughout the vasculature from the VAECMO system. To better understand these hemodynamic changes, it is important to resolve complex local flow parameters derived from three-dimensional (3D) fluid dynamics while also capturing the impact of VAECMO support throughout the systemic arterial system. As high-resolution 3D simulations of the arterial network remain computationally expensive and intractable for large studies, a validated , multiscale model is needed to compute both global effects and high-fidelity local hemodynamics. In this work, we developed and demonstrated a framework to model hemodynamics in VA-ECMO patients using coupled 3D and onedimensional (1D) models (1D -> 3D). We demonstrated the ability of these multiscale models to simulate complex flow patterns in specific regions of interest while capturing bu l k flow throughout the systemic arterial system. We compared 1D, 3D, and 1D -> 3D coupled models and found that multiscale models were able to sufficiently captu r e both global and local hemodynamics in the cerebral arteries and aorta in VA-ECMO patients. This study is the first to develop and compare 1D, 3D, and 1D -> 3D coupled models on the larger arterial system scale in VA-ECMO patients, with potential use for other large scale applications.

关键词： Autoantibodies   cancer   immunophenotypical characterization   paraneoplastic neurological syndromes  

摘要： Paraneoplastic neurological syndromes (PNS) are a group of rare and severe immune-mediated disorders that affect the nervous system in patients with cancer. The best way to diagnose a paraneoplastic neurological disorder is to identify anti-onconeural protein antibodies that are specifically associated with various cancers. The aim of this multicentric study was to clinically and immunologically characterize patients with PNS and study their association with cancer. Patients suspected to have PNS were enrolled from various clinical centres and were characterized immunologically. This study population consisted of 112 patients. Onset of PNS was mainly subacute (76%). PNS patients had various neurological disorders and symptoms. PNS developed before the diagnosis of cancer in 28 definite PNS patients and in six suspected PNS patients. The most frequent autoantibodies detected in PNS patients were anti-Hu and anti-Yo. One definite PNS patient with cerebellar syndrome had anti-Tr antibody and seven patients had atypical antibodies. The literature associates these antibodies with various neurological disorders and cancers. Our observations confirm the important role of autoantibodies in PNS and their importance for the early diagnosis of cancer in PNS patients.

关键词： shoulder dystocia   neurological   risk factors   hospitalizations   offspring  

摘要： Objective The study aimed to evaluate risk factors and implications of shoulder dystocia (SD) on the neurological outcome of successfully delivered offspring. Study Design This is a cohort analysis including 207,571 deliveries. Risk factors for SD were evaluated using general estimation equation multivariable analyses. Offspring hospitalization incidence up to age 18years due to neurological conditions was compared between both groups. Kaplan-Meyer curve was used to assess the cumulative hospitalization incidence. Cox proportional hazards model was used to control for confounders. Results SD complicated 0.2% ( n =353) of deliveries included in the study ( n =207,571). Risk factors for SD were fetal macrosomia, maternal diabetes mellitus, male gender, and advanced maternal age ( p <0.05 for all). Higher perinatal mortality was observed among SD cases (2.8 vs. 0.4%, p <0.001). In most of the investigated neurological conditions no significant differences were found between the groups. Comparable rates of cumulative neurological-related hospitalization were observed (log rank p -value=0.342) as well as lack of association between SD and neurological hospitalization (adjusted HR=0.73;95% CI 0.36-1.47;p =0.381) when controlled for gestational age. Conclusion Risk factors for SD are macrosomia, diabetes mellitus, male gender, and advanced maternal age. SD is not associated with long-term neurological morbidity of the offspring.

关键词： altered mental status   cortical spreading depression   electroencephalography   headache and neurological deficits with cerebrospinal fluid lymphocytosis   human herpesvirus 7  

关键词： COVID-19   Neurology   Ethics   Ethical consideration  

摘要： Coronavirus disease 2019 (COVID-19) pandemic has struck many countries and caused a great number of infected cases and death. Healthcare system across all countries is dealing with the increasing medical, social, and legal issues caused by the COVID-19 pandemic, and the standards of care are being altered. Admittedly, neurology units have been influenced greatly since the first days, as aggressive policies adopted by many hospitals caused eventual shut down of numerous neurologic wards. Considering these drastic alterations, traditional ethical principles have to be integrated with state-of-the-art ethical considerations. This review will consider different ethical aspects of care in neurologic patients during COVID-19 and how this challenging situation has affected standards of care in these patients.

关键词： Adult medulloblastoma   Chemotherapy   Radiotherapy   Survival   Database  

摘要： Introduction Medulloblastoma (MB) is the most common primary malignant intracranial tumor in childhood, but it is very rare in adults, and for this reason, the optimal treatment has not yet been defined. We designed a multicentric study in order to define relevant outcome measures for future prospective studies. Materials and methods The project involved 10 Italian centers. The database shared among the centers contains epidemiological, diagnostic (radiological and histological/molecular), therapeutic, recurrence information, and survival data. Results A total of 152 patients (102 males and 50 females, median age 32) were included in the study. Twenty-three of 152 patients had a diagnosis of classic medulloblastoma, 52/152 had desmoplastic/extensive nodularity, 2/152 had large-cell anaplastic medulloblastoma, and the remaining had diagnoses not otherwise specified. Almost all patients underwent craniospinal irradiation after surgery;in 85.5% of patients, adjuvant chemotherapy, mainly platinum- and etoposide-based chemotherapy, was performed immediately after RT. Upon recurrence, most patients were retreated with various chemotherapy regimens, including intrathecal chemotherapy in patients with leptomeningeal dissemination. The overall survival (OS) rate at 5 years was 73.3% (95% CI, 65.0-80.0%). The median OS for the whole group of patients was 112 months. Conclusions The data collected were mainly consistent with the literature. A limitation of this study was the large number of patients lost to follow-up and the lack of molecular data for most patients diagnosed until 2010. An important challenge for the future will be MB biologic characterization in adults, with the identification of specific genetic patterns. It will be important to have more national and international collaborations to provide evidence-based management strategies that attempt to obtain a standard of care.

关键词： Ischemic stroke   Antiplatelet drug   Stroke management   Clinical outcome  

摘要： Background: Our previous trial acute dual study (ADS) reported that dual antiplatelet therapy (DAPT) using cilostazol and aspirin did not reduce the rate of short-term neurological worsening in non-cardioembolic stroke patients. Present posthoc analysis investigated whether the impact of combined cilostazol and aspirin differed among stroke subtypes and factors associated with neurological deterioration and/or stroke recurrence. Methods: Using the ADS registry, the rate of neurological deterioration, defined as clinical worsening and/or recurrent stroke, including transient ischemic attack was calculated. Stroke subtypes included large-artery atherosclerosis (LAA), small vessel occlusion (SVO), other determined etiology (Others), and undetermined etiology of stroke (Undetermined). Results: Data of 1022 patients were analyzed. Deterioration was seen in 104 (10%) patients, and the rates were not markedly different between patients treated with DAPT vs. aspirin in any stroke subtypes: LAA, 19% vs. 11%, (p = 0.192);SVO, 10% vs. 10% (p = 1.000);Others, 6% vs. 6% (p = 1.000);Undetermined, 11% vs. 8% (p = 0.590). Diabetes mellitus was the independent factor associated with deterioration (odds ratio 4.360, 95% confidence interval 1.139-16.691, p = 0.032) in the LAA group. Age (1.030 [1.004-1.0571, p = 0.026), systolic blood pressure (1.012 [1.003-1.0221, p = 0.010), and infarct size (2.550 [1.488-4.3711, p = 0.001) were associated with deterioration in SVO group, and intracranial stenosis/occlusion was associated with it in the Undetermined group (3.744 [1.138-12.3181, p = 0.030). Conclusions: Combined cilostazol and aspirin did not reduce the rate of short-term neurological deterioration in any clinical stroke subtype. The characteristics of patients whose condition deteriorates in the acute period may differ based on the stroke subtypes.

关键词： SARS-CoV-2   COVID-19   Blood-brain barrier   Neurological complications   Inflammatory response   Neurotropism  

摘要： The main discussion above of the novel pathogenic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has focusedon the immediate risks and impact on the respiratory system;however, the effects induced to the central nervous system are currently unknown. Some authors have suggested that SARS-CoV-2 infection can dramatically affect brain function and exacerbate neurodegenerative diseases in patients, but the mechanisms have not been entirely described. In this review, we gather information from past and actual studies on coronaviruses that informed neurological dysfunction and brain damage. Then, we analyzed and described the possible mechanisms causative of brain injury after SARS-CoV-2 infection. We proposed that potential routes of SARS-CoV-2 neuro-invasion are determinant factors in the process. We considered that the hematogenous route of infection can directly affect the brain microvascular endothelium cells that integrate the blood-brain barrier and be fundamental in initiation of brain damage. Additionally, activation of the inflammatory response against the infection represents a critical step on injury induction of the brain tissue. Consequently, the virus' ability to infect brain cells and induce the inflammatory response can promote or increase the risk to acquire central nervous system diseases. Here, we contribute to the understanding of the neurological conditions found in patients with SARS-CoV-2 infection and its association with the blood-brain barrier integrity.

关键词： Autonomic   Multiple system atrophy   POTS   American autonomic society   Viewpoint