关键词： organ donation   brain death   organ donor   clinical practice guidelines   systematic review  

摘要： Objective The objectives of this study were to systematically identify and describe guidelines for the care of neurologically deceased donors and to evaluate their methodological quality, with the aim of informing and supporting the new Canadian guidelines for the management of organ donors. Methodology Following a systematic search, we included any document endorsed by an organ donation organization, a professional society, or a government, that aims to direct the medical management of adult, neurologically deceased, multi-organ donors. We extracted recommendations pertaining to six domains: the autonomic storm, hemodynamic instability, hormone supplementation, ventilation, blood product transfusions, and general intensive care unit (ICU) care. Methodological quality of the guidelines was assessed by the validated AGREE-II tool. Main findings This review includes 27 clinical practice guidelines representing 26 countries published between 1993 and 2019. Using the AGREE-II validated tool for the evaluation of guidelines' quality, documents generally scored well on their scope and clarity of presentation. Nevertheless, quality was limited in terms of the scientific rigor of guideline development. Recommendations varied substantially across the domains of managing the autonomic storm, subsequent management of hemodynamic instability, hormone therapy, mechanical ventilation, blood product transfusion, and general ICU care. We found consistent recommendations for low tidal volume ventilation subsequent to the publication of a landmark clinical trial. Conclusion Highly inconsistent recommendations for deceased donor care summarized in this review likely reflect the relatively slow emergence of high-quality clinical research in this field, as well as a late uptake of recent validated guideline methodology. Even in this context of few randomized-controlled trials, our group supported the need for new Canadian guidelines for the management of organ donors that follow rigorou

关键词： Antidepressant action   Antiepileptic properties   Biochemical tissue markers   Chronic effects   Terpenoid derivative  

摘要： The compound (+)-limonene epoxide has antioxidant, anxiolytic, and antihelminthic properties. However, investigations to determine its long-term exposure were not performed. We investigated the systemic toxicological profile after chronic exposure as well as the antidepressant and antiepileptic potentialities of (+)-limonene epoxide on mice. Initially, we evaluated acute toxicity onArtemia salinanauplii and cytotoxicity on mice erythrocytes and peripheral blood mononuclear cells (PBMC). Aftterwards, mice were chronically treated for 120 days by gavage with (+)-limonene epoxide (25, 50, and 75 mg/kg/day) and this exposure was assessed by pathophysiological measurements. For antidepressant and anticonvulsivant analysis, we performed the forced swimming and tail suspension protocols and pentylenetetrazol- and picrotoxin-induced seizures, respectively. (+)-Limonene epoxide showed a LC(50)value of 318.7 mu g/mL onA. salinashrimps, caused lysis of red blood cells at higher concentrations only but did not show cytotoxicity on PMBC, which suggests pharmacological safety if plasma concentrations do not exceed 100 mu g/mL. Macroscopic, hematological, clinical chemistry, and nutritional changes were not detected, though focal areas of hepatic necrosis, inflammatory infiltrate, and karyolysis have been detected at 75 mg/kg/day. The compound inhibited the developing of pentylenetetrazol- and picrotoxin-induced seizures,decreased deaths, and reduced immobility times, mainly at 75 mg/kg. So, it reversed reserpine effects, suggesting antidepressant effects should be linked to serotonergic and/or adrenergic transmission. It is feasible that (+)-limonene epoxide plays a benzodiazepine-like anticonvulsive action and may be also recommended as an antidote for poisonings caused by central depressants.

关键词： 神经病学  

ISBN: (纸本)9787547850718

摘要： 本书是由复旦大学附属华山医院、复旦大学附属中山医院、上海交通大学医学院附属仁济医院、上海交通大学医学院附属瑞金医院、上海交通大学附属第一人民医院的近百位专家共同编写的大型神经病学临床参考书。本书分为四篇。总论部分介绍神经系统疾病的诊断与检查技术、基础知识及近年的进展；症状篇以神经系统症状为切入点，介绍其诊断与鉴别诊断；中枢神经系统疾病，周围神经、神经肌肉疾病及其他则以解剖部位为主线，以疾病机制为分类依据，介绍神经系统疾病的病因、发病机制、临床表现、诊治方法等。本书利用内外科整合的视角，坚持纵向思维与横向思维相结合的编写方式，侧重对学科新技术、新理论的梳理及对国内外临床实践指南的介绍，使本书内容紧跟学科发展，从而为读者提供科学、实用、前沿、权威的临床指导。本书的读者对象为神经内科和神经外科专科医师、进修生及研究生，亦可供其他临床学科医师、基础学科研究人员使用。

关键词： Nervous system   Autoinflammatory diseases   NLRP3-associated autoinflammatory disease   Familial Mediterranean fever   Sensorineural hearing loss   Chronic aseptic meningitis  

摘要： Objective: Systemic autoinflammatory diseases (SAIDs) are a group of disorders characterized by a dysregulation of innate immune system leading to multi-systemic inflammation. We aim to assess the neurological manifestations of Chinese adult patients with SAIDs. Methods: Eighty adult patients (>= 16 years) were diagnosed as SAIDs from April 2015 to June 2019, at the center of adult autoinflammatory diseases, Department of Rheumatology, Peking Union Medical College Hospital. Clinical and genetic features of these patients were collected. All patients underwent neurologic, ophthalmologic and otolaryngologic evaluation. Results: Totally 31 out of 80 (38.8%) patients had neurological manifestations, including 14 familial Mediterranean fever (45.2%), 6 NLRP3-associated autoinflammatory disease (19.4%), 5 tumor necrosis factor receptor-associated periodic fever syndrome (16.1%), 5 NLRP12-associated autoinflammatory disease (16.1%), and 1 Yao syndrome (3.2%). Twenty patients (64.5%) were adult-onset. The median time of diagnosis delay was 11.7 years (0.5-50 years). The common neurological damage included headache (28 patients, 90.3%), sensorineural hearing loss (6, 19.4%), dizziness (4, 12.9%), cerebral infarction/hemorrhage (4, 12.9%), chronic aseptic meningitis (3, 9.7%), intracranial hypertension (3, 9.7%), papilledema (3, 9.7%), optic neuritis (2, 6.5%), and hydrocephalus (1, 3.2%). Severe neurological damage was observed in 8 patients (25.8%), including brain atrophy, hydrocephalus, complete hearing loss, chronic aseptic meningitis and optic neuritis. Conclusion: Neurological damage was diverse in SAIDs patients. Neurological symptoms should be fully realized by physicians, in not only pediatric but also adult patients with SAIDs. CSF analysis and brain images should be performed promptly. Early diagnosis and appropriate treatment are essential to avoid irreversible neurological complications. (C) 2020 Elsevier Inc. All rights reserved.

关键词： COVID-19   stroke   Seizures   Native Americans  

摘要： Objective: To study the central nervous system (CNS) complications in patients with COVID-19 infection especially among Native American population in the current pandemic of severe acute respiratory syndrome virus (COVID-19). Methods: Patients with confirmed COVID-19 infection at University of New Mexico hospital (UNMH) were screened for development of neurological complications during Feb 01 to April 29, 2020 via retrospective chart review. Results: Total of 90 hospitalized patients were screened. Out of seven patients, majority were Native Americans females, and developed neurological complications including subarachnoid hemorrhage (SAH), Intraparenchymal hemorrhage (IPH), Ischemic stroke (IS) and seizure. All 7 patients required Intensive care unit (ICU) level of care. Patients who developed CNS complications other than seizure were females in the younger age group (4 patients, 38-58 years) with poor outcome. Out of 7, three developed subarachnoid hemorrhage, two developed ischemic infarction, and four developed seizure. Two patients with hemorrhagic complication expired during the course of hospitalization. All three patients with seizure were discharged to home. Conclusion: Patients with serious CNS complications secondary to COVID-19 infection were observed to be Native Americans. Patients who developed hemorrhagic or ischemic events were observed to have poor outcomes as compared to patients who developed seizures.

摘要： Inadequate preparation for transition to adult-oriented systems of care leads to gaps in treatment and can result in poor health outcomes for youth with special healthcare needs. Coordination between primary care and specialists must occur at multiple levels of organizations to improve transition for youth with neurological disorders. This review focuses on the transition process from the pediatrician's perspective, highlights common obstacles, addresses the unique needs of youth with intellectual disabilities, reviews relevant guidelines, and discusses emerging transition strategies. Key recommendations include defining the roles of the different healthcare providers and using multidisciplinary collaboration to overcome limited resources. (C) 2020 Elsevier Inc. All rights reserved.

关键词： COVID-19   SARS-CoV2   Disease prevalence   Neurological manifestations   Neurological symptoms   Coronavirus   Common data element   Case report form  

摘要： Since its original report in January 2020, the coronavirus disease 2019 (COVID-19) due to Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection has rapidly become one of the deadliest global pandemics. Early reports indicate possible neurological manifestations associated with COVID-19, with symptoms ranging from mild to severe, highly variable prevalence rates, and uncertainty regarding causal or coincidental occurrence of symptoms. As neurological involvement of any systemic disease is frequently associated with adverse effects on morbidity and mortality, obtaining accurate and consistent global data on the extent to which COVID-19 may impact the nervous system is urgently needed. To address this need, investigators from the Neurocritical Care Society launched the Global Consortium Study of Neurological Dysfunction in COVID-19 (GCS-NeuroCOVID). The GCS-NeuroCOVID consortium rapidly implemented a Tier 1, pragmatic study to establish phenotypes and prevalence of neurological manifestations of COVID-19. A key component of this global collaboration is development and application of common data elements (CDEs) and definitions to facilitate rigorous and systematic data collection across resource settings. Integration of these elements is critical to reduce heterogeneity of data and allow for future high-quality meta-analyses. The GCS-NeuroCOVID consortium specifically designed these elements to be feasible for clinician investigators during a global pandemic when healthcare systems are likely overwhelmed and resources for research may be limited. Elements include pediatric components and translated versions to facilitate collaboration and data capture in Latin America, one of the epicenters of this global outbreak. In this manuscript, we share the specific data elements, definitions, and rationale for the adult and pediatric CDEs for Tier 1 of the GCS-NeuroCOVID consortium, as well as the translated versions adapted for use in Latin America. Global effo

关键词： Blood pressure   Cerebral hemorrhage   Spot sign   Intraventricular hemorrhage   Early neurological decline  

摘要： Purpose The spot sign is associated with intracerebral hemorrhage (ICH) expansion and neurological decline. However, the relationship of the spot sign to secondary intraventricular hemorrhage (IVH) has not been well established. The presence of the spot sign in secondary IVH may provide information regarding neurologic outcome in a population with known poor prognosis. Methods A subset analysis was performed of patients with IVH from the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-II) study, a randomized clinical trial examining the effect of intensive blood pressure reduction on hematoma expansion. The presence of the spot sign was determined on CTA and IVH expansion was measured in the first 24 hours. The primary outcome measure was early neurological decline (END), defined as >= 2-point decrease in Glasgow Coma Scale (GCS) score or >= 4-point increase in NIH Stroke Scale (NIHSS). Secondary outcomes including various radiological and clinical factors were also measured. Results Of 57 patients included in this analysis, the spot sign was present in 17 (29.8%). The spot sign was a predictor of END in univariate (PP=0.04 for NIHSS) and multivariate analyses using GCS scores (OR=7.2, CI 1.6 - 32.5, P=0.01). Median 90 day modified Rankin Scale (mRS) scores were significantly different between spot sign-positive and spot sign-negative groups (P=0.02). Conclusions The presence of the spot sign is associated with END in patients with secondary IVH. Identifying this radiologic feature could have important implications for triaging these patients to the appropriate level of care.

关键词： Daily mobility   Body-worn sensor   Wearable   Factor analysis   Gait disorder  

摘要： The aim of this study was to establish a comprehensive and yet parsimonious model of daily mobility activity in patients with neurological gait disorders. Patients (N = 240) with early-stage neurological (peripheral vestibular, cerebellar, hypokinetic, vascular or functional) gait disorders and healthy controls (N = 35) were clinically assessed with standardized scores related to functional mobility, balance confidence, quality of life, cognitive function, and fall history. Subsequently, daily mobility was recorded for 14 days by means of a body-worn inertial sensor (ActivPAL(R)). Fourteen mobility measures derived from ActivPAL recordings were submitted to principle component analysis (PCA). Group differences within each factor obtained from PCA were analyzed and hierarchical regression analysis was performed to identify predictive characteristics from clinical assessment for each factor. PCA yielded five significant orthogonal factors (i.e., mobility domains) accounting for 92.3% of the total variance from inertial-sensor-recordings: ambulatory volume (38.7%), ambulatory pattern (22.3%), postural transitions (13.3%), sedentary volume (10.8%), and sedentary pattern (7.2%). Patients' mobility performance only exhibited reduced scores in the ambulatory volume domain but near-to-normal scores in all remaining domains. Demographic characteristics, clinical scores, and fall history were differentially associated with each domain explaining 19.2-10.2% of their total variance. This study supports a low-dimensional five-domain model for daily mobility behavior in patients with neurological gait disorders that may facilitate monitoring the course of disease or therapeutic intervention effects in ecologically valid and clinically relevant contexts. Further studies are required to explore the determinants that may explain performance differences of patients within each of these domains and to examine the consequences of altered mobility behavior with respect to patients' risk

关键词： clinical study   COVID-19   neurology practice   telemedicine