摘要： Background: Cranial and cervical nerve (CCN) injury is recognized as a possible complication after carotid endarterectomy (CEA), which may result in minor local neurologic deficiencies and significant discomfort for the patient. The aim of this study is to investigate the effect of a mini-skin incision (<5 cm) on the CCN injury after CEA in comparison to standard longitudinal incision of 12-15 cm in a high volume center, and to evaluate health-related quality of life (HRQOL) outcomes in those patients who had undergone both types of the skin incision. Methods: From January 2013 to December 2019, 446 CEAs (47.3%) were performed through a standard neck incision of 12-15 cm (group A), while 496 (52.7%) were performed through a mini-skin incision (<5 cm) (group B). Sixty-two patients underwent standard neck incision on one side and mini-skin incision on the other side (subgroup B). The main outcome measures were stroke, death, CCN injuries, cervical hematoma rates, and reinterventions. The HRQOL was assessed at baseline and after 30 days using Medical Outcomes Study Short-Form 36 and 6 disease-specific modified Likert scales. Results: The stroke and death rate at 30 days was 1.12% in group A and 1% in group B (P = 1). The incidence of CCN deficits was significantly lower in group B (5.1%) in comparison to group A (13.4%) (P < 0.001). The cervical hematoma was more common after standard incision (4.9% vs. 1.2%, P = 0.02). HRQOL at 1 month showed that the outcomes after mini-skin incision were significantly better for less difficulty with eating/swallowing and neck pain (P < 0.01). Conclusions: CEA through a small incision (<5 cm) may reduce CCN complications without additional perioperative neurologic risks. As validated by patients with bilateral disease who experienced both surgical techniques, mini-skin incision is also associated with better HRQOL at 1 month, particularly with regard to eating/swallowing and neck pain.

关键词： COVID-19   Alzheimer's disease   Mild cognitive impairment   Behavioral effects   Anxiety   Depressive disorders  

摘要： Introduction Healthy elderly, mild cognitive impairment and Alzheimer's disease populations have been among the most affected in the early stages of the COVID-19 pandemic due to the direct effects of the virus, and numerous indirect effects now emerge and will have to be carefully assessed over time. Methods This article reviews the main articles that have been published so far about the direct and indirect effects of the COVID-19 pandemic on these particularly fragile populations. Results The pandemic associated to COVID-19 has shifted most of the health resources to the emergency area and has consequently left the three main medical areas dealing with the elderly population (oncology, time-dependent diseases and degenerative disease) temporarily "uncovered". In the phase following the emergency, it will be crucial to guarantee to each area the economic and organizational resources to quickly return to the level of support of the prepandemic state. Conclusions The emergency phase represented a significant occasion of discussion on the possibilities of telemedicine which will inevitably become increasingly important, but all the limits of its use in the elderly population have to be considered. In the post-lockdown recovery phase, alongside the classic medical evaluation, the psychological evaluation must become even more important for doctors caring about people with cognitive decline as well as with their caregivers.

关键词： Cervical trauma   Facet dislocation   Management   Spinal fracture   Unilateral  

摘要： BACKGROUND: The treatment of unilateral CFD in patients without neurologic deficits remains controversial, especially in the choice of the best surgical approach. Our objective is to determine the way spine surgeons from Latin America manage this condition. METHODS: A survey regarding management and surgical strategies was conducted by the AO Spine Latin American Trauma Study Group considering the treatment of unilateral CFD. RESULTS: All AO Spine Latin American Trauma Study Group members were sent a link to the survey, among whom 285 replied, with 197 respondents answering all the questions. Nonsurgical management was considered by 25% of the surgeons. The majority stated that magnetic resonance imaging is necessary (65%) to treat this type of patient. A posterior approach was preferred by 44%, an anterior approach by 29%, and a combined approach by 25%, while 2.2% did not answer. Traction was not used by the majority of respondents (62%). In the setting of an anterior disk herniation, the majority of surgeons preferred to employ an anterior (45%) or combined (44%) approach versus an isolated posterior approach (only 0.5%). Comparing early versus late cervical trauma, fewer surgeons adopted an isolated anterior approach with the latter (29% vs. 15%). CONCLUSIONS: Wide variations exist in the management of unilateral CFD by Latin American surgeons, with early injuries generally treated using either an anterior or posterior approach and treated early but after an MRI, while a combined approach is used more commonly with late injuries. Either an anterior or combined approach is used when disk herniation is present.

摘要： [...]for Horizon Europe to match the investment given to NIH in, for instance, Alzheimer's disease research (now close to $3 billion per year), it would have to dedicate up to 20% of its total budget. Worldwide, in 2019, stroke and ischaemic heart disease were the leading cause of death and disability in people aged 50 years and older. Horizon Europe has five “mission areas”: climate change; oceans, seas, coastal, and inland waters; smart cities; soil health and food; and cancer.

关键词： Antiviral drugs   Congenital cytomegalovirus infection   Fetal therapy   Immunoglobulin   Neonatal therapy  

摘要： Infants with symptomatic congenital cytomegalovirus infection (cCMV) suffer from long-term sequelae. This study aimed at evaluating the efficacy of combining immunoglobulin (Ig) fetal therapy (FT) and neonatal therapy (NT) with antiviral drugs to improve neurological outcomes of affected infants. Women whose fetuses had symptomatic cCMV received Ig injection into the fetal peritoneal cavity and/or maternal blood as FT, while affected newborns received oral valganciclovir or intravenous ganciclovir as NT. We compared the neurological outcomes at >= 18 months old between infants receiving FT with or without NT (FT group) and those receiving NT only (NT group). From 2009-2019, 15 women whose fetuses had symptomatic cCMV received FT, while 19 newborns received NT only. In FT group, two newborns died, and two were <18 months old. Neurological outcomes of the remaining 11 infants in FT group were as follows: normal 45.5 %, mild impairments 36.4 %, and severe impairments 18.2 %. In NT group, one newborn died, one's parents refused the follow-up, one was <18 months old, and two had only chorioretinitis as symptoms. Neurological outcomes of the remaining 14 infants in NT group were as follows: normal 21.4 %, mild impairments 14.3 %, and severe impairments 64.3 %. The proportion of infants with severe impairments in FT group was significantly lower than that in NT group (18.2 % vs 64.3 %, p < 0.05). This is the first trial demonstrating that the combination of Ig FT and NT with antiviral drugs may be more effective in improving neurological outcomes of newborns with symptomatic cCMV as compared to NT only.

摘要： This study focuses on the application, advantages, and disadvantages of E-learning in neurology education. The findings of the study demonstrate that E-learning can effectively improve learning efficiency and reduce learning costs. Neurologists can access the right study material on the Internet anytime, anywhere. Compared with traditional teaching methods, it is easier for text, graphics, animation, audio, video, and other multimedia formats of E-learning to attract learners' interest. This makes the complex subject of neurology, including its basic theories, more vivid, and easier to understand for young neurologists. Moreover, in clinical practice, gaps in knowledge and skills acquisition can be bridged by treating virtual patients and watching videos of examination techniques and pathological signs. Compared with traditional teaching methods, E-learning can better meet individual needs, and thus it has come to be one of the foremost choices for young neurologists to continue learning.

摘要： Background: Penetrating Carotid artery injuries are rarely encountered even in busy in urban Trauma Centers. Repair is preferred over ligation for Internal (IC) and Common Carotid (CC) arteries. To date, the use of temporary shunts correlated to neurological outcomes has not been reported. Objectives are to specifically address the question: In patients with penetrating IC or CC injury requiring repair, does use of temporary shunts decrease mortality and/or improve neurologic outcomes? We hypothesized that the use of temporary shunts during revascularization might produce improvements in both areas. Methods: A literature search was performed through Medline Complete-PubMed, Cochrane, Ovid, and Embase for the period of 1900-2019. PRISMA guidelines were utilized. Thirty-two articles met inclusion criteria, ranging from 1960-2018. These were analyzed to determine whether surgical repair was performed with or without the use of temporary shunts. External Carotid artery injuries were excluded. Pre-and postoperative neurological outcomes and overall outcomes were analyzed. Non-parametric data were analyzed with Fisher's Exact or Chi-square tests as applicable. Statistical significance was set to a p-value < 0.05. Results: There were a total of 973 patients with penetrating IC and CC injuries;136 (14%) patients underwent ligation and were excluded. Our study population consisted of 837 patients;126 (15.1%) with shunts (WS), 711 (84.9%) without shunts (WOS). Mortality stratified to patients repaired WS versus WOS was 5.6% versus 11.1% (p=0.058). Neurological improvement was noted to be similar for patients undergoing repair WS - 14.2% versus WOS - 13.7% (p=0.8). Worsening neurological status for patients shunted WS - 3.4%, versus WOS - 9.0% (p=0.038). Data were analyzed for outcome variables including neurological deficits with or without mortality. Patients shunted had an improved and/or unchanged neurological outcome compared to patients not shunted during repair - 91.3%