关键词： cerebral blood flow   cerebral ischemia   neuroinflammation   neuronal cell death   serum and glucocorticoid-regulated kinase  

摘要： Cardiopulmonary arrest (CA) is the leading cause of death and disability in the United States. CA-induced brain injury is influenced by multifactorial processes, including reduced cerebral blood flow (hypoperfusion) and neuroinflammation, which can lead to neuronal cell death and functional deficits. We have identified serum and glucocorticoid-regulated kinase-1 (SGK1) as a new target in brain ischemia previously described in the heart, liver, and kidneys (i.e., diabetes and hypertension). Our data suggest brain SGK1 mRNA and protein expression (i.e., hippocampus), presented with hypoperfusion (low cerebral blood flow) and neuroinflammation, leading to further studies of the potential role of SGK1 in CA-induced brain injury. We used a 6-min asphyxia cardiac arrest (ACA) rat model to induce global cerebral ischemia. Modulation of SGK1 was implemented via GSK650394, a SGK1-specific inhibitor (1.2 mu g/kg icv). Accordingly, treatment with GSK650394 attenuated cortical hypoperfusion and neuroinflammation (via Iba1 expression) after ACA, whereas neuronal survival was enhanced in the CA1 region of the hippocampus. Learning/memory deficits were observed 3 days after ACA but ameliorated with GSK650394. In conclusion, SGK1 is a major contributor to ACA-induced brain injury and neurological deficits, while inhibition of SGK1 with GSK650394 provided neuroprotection against CA-induced hypoperfusion, neuroinflammation, neuronal cell death, and learning/memory deficits. Our studies could lead to a novel, therapeutic target for alleviating brain injury following cerebral ischemia. NEW & NOTEWORTHY Upregulation of SGK1 exacerbates brain injury during cerebral ischemia. Inhibition of SGK1 affords neuroprotection against cardiac arrest-induced hypoperfusion, neuroinflammation, neuronal cell death, and neurological deficits.

摘要： Additionally, the study by Kong and colleagues3 cited by Li and colleagues' Correspondence did not report co-infection, but rather early cases of COVID-19 in Wuhan, China, that were detected through the national influenza surveillance programme; existing influenza surveillance networks have been used for sentinel testing and to look for potential signs of community transmission worldwide, as supported by the WHO Global Influenza Surveillance and Response System. Furthermore, influenza-like illness is a syndromic definition and does not imply influenza to be the causative illness; its description aligns closely with the “acute respiratory infection” definition used to prompt testing for COVID-19 in earlier WHO and national guidelines.4 Our group has shown previously that, in patients with new neurological disease and evidence of more than one infection, there are additional challenges in thinking about causality, particularly when the results are from specimens collected outside the CNS.5,6 TS was an advisor for the GlaxoSmithKline ebola vaccine programme, chaired the Siemens diagnostics clinical advisory board and healthineers clinical advisory board, and also has a pending patent test for bacterial meningitis based on a blood test (GB 1606537.7; April 14, 2016). BS reports non-financial support from UK National Institute for Health Research through its Global Health Research Group on Brain Infections, outside the submitted work.

关键词： Neurological complications   SARS-CoV-2   Pandemic  

摘要： Background In December 2019, unexplained cases of pneumonia emerged in Wuhan, China, which were found to be secondary to the novel coronavirus SARS-CoV-2. On March 11, 2020, the WHO declared the Coronavirus Disease 2019 (COVID-2019) outbreak, a pandemic. Objective To clarify the neurological complications of SARS-CoV-2 infection including the potential mechanisms and therapeutic options. Methods We conducted a systematic literature search from December 01, 2019 to May 14, 2020 using multiple combinations of keywords from PubMed and Ovid Medline databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included articles with cases of COVID-19 where neurological involvement was evident. Results We were able to identify 82 cases of COVID-19 with neurological complications. The mean age was 62.3 years. 37.8% of the patients were women (n = 31). 48.8% of the patients (n = 40) had cerebrovascular insults, 28% (n = 23) had neuromuscular disorders, and 23% of the patients (n = 19) had encephalitis or encephalopathy. Conclusions Neurological manifestations of COVID-19 are not rare, especially large vessel stroke, Guillain-Barre syndrome, and meningoencephalitis. Moving forward, further studies are needed to clarify the prevalence of the neurological complications of SARS-CoV-2 infection, investigate their biological backgrounds, and test treatment options. Physicians should be cautious not to overlook other neurological diagnoses that can mimic COVID-19 during the pandemic.

关键词： cardiac surgery   cardiopulmonary bypass   delirium   hyperoxia   postoperative pulmonary complications  

关键词： Iatrogenesis   Elderly   Neurological manifestations   Adverse drug events  

摘要： Older people are often exposed to polypharmacy in a multimorbidity context. Inappropriate polypharmacy is often harmful, increasing the risk of inappropriate prescriptions and therefore adverse drug events (ADEs). Five to 20% of all hospital admissions are related to ADE in older people, among which 40 to 70% could be prevented. However, identifying ADEs and drug-related admissions in the elderly is challenging because ADEs often present as common geriatric problems such as falls, delirium, which might be due to the aging process, underlying diseases, and/or medications. In the pharmacovigilance database of the World Health Organization, drug-related neurological manifestations are the third reported cause of ADEs in the elderly, and neurological drugs are the third leading class of medications involved in ADEs. We must therefore be particularly vigilant, both in our prescriptions but also in our diagnoses to avoid prescribing inappropriate treatments and detect ADEs. Even though multiple pharmacologic changes occur in the elderly (absorption, distribution, drug metabolism and excretion), most of medications are still often prescribed at the same daily dosage as in young adults. When prescribing any drug for old patients, we should remember that daily intake should be adapted to these specificities, keeping in mind the old well-known aphorism "start low, go slow". In this review, we describe the main drug-related neurological manifestations (drug-induced movement disorders, falls, seizures, delirium, hypoglycemia, stroke, hyponatremia, peripheral neuropathy and myopathy, and serotonin syndrome) and the main drugs associated with neurological manifestations (dopamine receptor blocking agents, antithrombotics, anti-cholinergics, beta-lactams, antidepressants, benzodiazepines, mood stabilizers). (C) 2020 Elsevier Masson SAS. All rights reserved.

关键词： Continuous electroencephalography (CEEG)   EEG   Critical care   Nonconvulsive seizure   Intensive care  

摘要： Monitoring critically ill patients in NCCU requires multiple modalities including neurological examinations, measurement of metabolic parameters (partial pressure of brain oxygen or micro dialysis), and monitoring of physiological parameters (Intracranial pressure monitoring, transcranial Doppler, and continuous electroencephalography [CEEG]). CEEG is an efficient monitoring tool to characterize spells, assess degree of encephalopathy, complement neuroimaging for identifying cause of possible coma, assess level of sedation, detect ischemia or vasospasm, and to assist with prognostication [4]. A review of 208 patients admitted to a neurocritical care unit from the emergency department (ED) for acute transient neurological deficits, loss of consciousness, or unclear motor phenomena found variability with clinical suspicion [16]. NCSE was successfully terminated for five patients (63%), but only one experienced clinical improvement, which was transient; and all eight patients eventually died after a period of prolonged coma.” [...]it remains unclear if treating NCSE affects outcome in patients with SAH [46].

关键词： Autism Spectrum Disorder   Neurologic music therapy   Coordination   Elastic displays   Technological intervention  

摘要： Aim: To evaluate the efficacy of Neurologic Music Therapy (NMT) using a traditional and a technological intervention (elastic touch-display) in improving the coordination of children with Autism Spectrum Disorder (ASD), as a primary outcome, and the timing and strength control of their movements as secondary outcomes. Methods: Twenty-two children with ASD completed 8 NMT sessions, as a part of a 2-month intervention. Participants were randomly assigned to either use an elastic touch-display (experimental group) or tambourines (control group). We conducted pre- and post- assessment evaluations, including the Developmental Coordination Disorder Questionnaire (DCDQ) and motor assessments related to the control of strength and timing of movements. Outcomes and results: All participants improved their coordination, according to the DCDQ scores, and exhibited better control of their movements according to the strength and timing assessments after the intervention. Participants who used the elastic touch-display scored higher on the DCDQ. Conclusions and implications: NMT is an efficacious treatment to improve the coordination skills of children with ASD. Elastic touch-displays provide more benefits than the use of tambourines.

关键词： Fundoplication   Pediatric   GORD   GERD  

摘要： Background and objective: Aspiration pneumonia is a common and serious complication to gastroesophageal reflux disease (GERD) among neurologically impaired children. Medication of GERD does not effectively prevent aspiration pneumonia, and whether antireflux surgery with fundoplication is better in this respect is uncertain. The objective was to determine whether fundoplication prevents aspiration pneumonia among children with neurological impairment and GERD. Methods: This was a population-based cohort study from Denmark, Finland, Norway and Sweden, consisting of neurologically impaired children with GERD who underwent fundoplication. The risk of aspiration pneumonia before fundoplication (preoperative person-time) was compared with the risk after surgery (postoperative person-time). Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs). Except for confounding adjusted for by means of the "crossover like" design, the HRs were adjusted for age, sex, year of entry and respiratory diseases. Results: Among 578 patients (median age 3.5 years), the preoperative person-time was 956 years and the postoperative person-time was 3324 years. Fundoplication was associated with 56% decreased overall HR of aspiration pneumonia (HR 0.44, 95% CI 0.27-0.72), and the HRs decreased over time after surgery. The risk of other types of pneumonia than aspiration pneumonia was not clearly decreased after fundoplication (HR 0.79, 95% CI 0.59-1.08). The 30-day mortality rate was 0.7% and the complication rate was 3.6%. Conclusions: Antireflux surgery decreases, but does not eliminate, the risk of aspiration pneumonia among neurologically impaired children with GERD. Fundoplication may be a treatment option when aspiration pneumonia is a recurrent problem in these children. (c) 2020 Elsevier Inc. All rights reserved.