关键词： COVID-19   SARS-CoV-2   Neurotropic   ACE2  

摘要： Coronavirus disease 2019 (COVID-19), a disease caused by the novel betacoronavirus (SARS-CoV-2), has become a global pandemic threat. The potential involvement of COVID-19 in central nervous system (CNS) has attracted considerable attention due to neurological manifestations presented throughout the disease process. In addition, SARS-CoV-2 is structurally similar to SARS-CoV, and both bind to the angiotensin-converting enzyme 2 (ACE2) receptor to enter human cells. Thus, cells expressing ACE2, such as neurons and glial cells may act as targets and are thus vulnerable to SARS-CoV-2 infection. Here, we have reviewed the neurological characteristics of COVID-19 and summarized possible mechanisms of SARS-CoV-2 invasion of the CNS. COVID-19 patients have presented with a number of different neurological symptoms such as headache, dizziness, hyposmia, and hypogeusia during the course of illness. It has also been reported recently that some cases of COVID-19 have presented with concurrent acute cerebrovascular disease (acute ischemic stroke, cerebral venous sinus thrombosis, cerebral hemorrhage, subarachnoid hemorrhage), meningitis/encephalitis, acute necrotizing hemorrhagic encephalopathy, and acute Guillain-Barre syndrome. Furthermore, SARS-CoV-2 RNA detected in a cerebrospinal fluid specimen of a patient with COVID-19 have provided direct evidence to support the theory of neurotropic involvement of SARS-CoV-2. However, the underlying neurotropic mechanisms of SARS-CoV-2 are yet to be established. SARS-CoV-2 may affect CNS through two direct mechanisms (hematogenous dissemination or neuronal retrograde dissemination) or via indirect routes. The underlying mechanisms require further elucidation in the future.

摘要： Background The pediatric stroke outcome measure (PSOM) is a standardized, disease-specific outcome measure. We aimed to validate the overall classification of neurological deficit severity using PSOM. Methods We identified 367 neonates/children with arterial ischemic stroke (AIS) (Derivation Cohort). We analyzed the PSOM subscales (scored as 0 [no deficit], 0.5 [minimal/mild deficit;normal function], 1 [moderate deficit;slowing function], or 2 [severe deficit;missing function]) to derive severity levels using latent class analysis (LCA). We validated a severity classification scheme (PSOM-SCS) in: (a) children who had Pediatric Evaluation of Disability Inventory (PEDI;n = 63) and/or the Pediatric Quality-of-Life Inventory (PedsQL;n = 97) scored;and (b) an external cohort (AIS;n = 102) with concurrently scored modified Rankin Scale (mRS), King's Outcome Scale for Childhood Head-Injury (KOSCHI) and PSOM. Results Within the Derivation Cohort, LCA identified three severity levels: "normal/mild," "moderate," and "severe" (83.7%, 13.3%, and 3%, respectively). We developed severity classification based on PSOM subscale scores: "normal/mild"-normal function in all domains or slowing in one domain, "moderate"-slowing in >= 2 domains or missing function in one domain, and "severe"-missing function in >= 2 domains or slowing in >= 1 plus missing in one domain. PEDI and PedsQL both differed significantly across the severity groups. PSOM-SCS displayed high concordance with mRS (agreement coefficient [AC2] = 0.88) and KOSCHI (AC2 = 0.79). Conclusion The PSOM-SCS constitutes a valid tool for classifying overall neurological severity emphasizing function and encompassing the full range of severity in pediatric stroke. Impact Arithmetic summing of the PSOM subscales scores to assess severity classification is inadequate. The prior severity classification using PSOM overestimates poor outcomes. Three distinct severity profiles using PSOM subscales are identified. The PSOM-SCS is in m

关键词： Headache   CSF lymphocytosis   HaNDL   VGCC   calcium channel   migraine  

摘要： Background Headache and Neurological Deficits with cerebrospinal fluid (CSF) Lymphocytosis (HaNDL) is an increasingly recognised syndrome but the aetiology remains unclear. HaNDL has striking clinical features similar to Familial Hemiplegic Migraine (FHM), commonly related to gene mutations encoding the P/Q-type voltage-gated calcium channel (VGCC). Case report We report a case of HaNDL associated with high P/Q-type voltage-gated calcium channel antibodies. Extensive investigations excluded alternative diagnoses and CSF lymphocytosis resolved within 3 months. The case was complicated by raised intracranial pressure resulting in an enlarged blind spot, papilloedema and bilateral lateral rectus palsies. Conclusion This novel association of P/Q-type voltage-gated calcium channel antibodies with HaNDL has implications for the pathology of HaNDL and spectrum of voltage-gated calcium channel-antibody disorders. We compare the clinical features of FHM and HaNDL and the potential pathological role of these antibodies. This case also highlights that raised intracranial pressure is a common feature of HaNDL, rarely resulting in serious complications.

摘要： Effects of cuteness-perception on individual cognition, emotion, behavior have significant implications for moral education. On the one hand, cuteness perception will make individuals think that moral violations are more serious and lead to tougher moral judgments;on the other hand, cuteness perception can activate moral emotions such as compassion and empathy, and induce to expand the scope of moral concern. Cuteness perception can also promote people to engage in altruistic moral behaviors such as donating, helping, etc. Based on these findings, we suggest to provide the lively content of moral education with diverse educational forms and take advantage of the anthropomorphic effect of cuteness while reduce the negative effects of cuteness.

摘要： Background: This was a retrospective chart review of procedural pain assessments and interventions during arterial catheter insertion in an adult neurological intensive care unit where patients with impaired consciousness are common. Overall, pain assessment was well documented (100%) by Registered Nurses, but not specific to arterial line insertion. Nurse practitioners commonly placed arterial lines and used local analgesia in over 75% of the documented procedures. Aims: The purpose of this study was to examine healthcare providers' pain-related practices documented during arterial catheter insertion, one of the most painful procedures in a neurological intensive care unit. Secondary purposes were determining whether patient characteristics, procedure-related factors, or provider licensure were associated with pain assessment or procedural pain interventions. Design: A retrospective records review design was used. Methods: 120 electronic patient medical records were reviewed during a one-year period. Results: 100 charts met inclusion criteria. Nurses assessed all pain within 4 hours following the procedure in all charts but procedure-specific pain assessments were documented in 4% of charts. Pain-related interventions for arterial line insertion were local analgesic (76% of charts) and other procedure-specific interventions (10%). Significant associations occurred between procedure specific pain assessments and decreased number of insertion attempts (p = .006) and between pain interventions and number of insertion attempts (p = .003). No provider documented procedural pain assessment regarding arterial line insertion. Associations between patient characteristics and pain interventions were significant for patient ethnicity (F = 8.967, p = .007). Conclusions: Overall pain assessment was documented (100%) but not specific to arterial line insertion. Although arterial line insertion can be extremely painful, patients were rarely assessed for such pain by any clinician

关键词： autoantibody   Autoimmune encephalitis   autoimmune neurological disease   encephalitis   myasthenia gravis   neuromyelitis optica   stiff person syndrome  

摘要： Autoimmune neurological diseases are an expanding group of phenotypically characteristic, potentially treatable syndromes. A number of these conditions are mediated by autoantibodies. The last decade has identified distinctive clinical clues to help diagnose these diseases, and increased clinical experience regarding the effectiveness of immunotherapies. Awareness of these conditions among non-specialists – as well as neurologists and psychiatrists – is crucial as early immunotherapy improves outcomes. To discuss the most common antibody-associated neurological conditions, we focus on autoimmune myasthenic syndromes and neuromyotonia in the peripheral nervous system, and their rapidly expanding central nervous system counterparts, which include neuromyelitis optica and autoimmune encephalitis. We also discuss other related conditions, including stiff person syndrome and classical paraneoplastic neurological syndromes. We discuss strategies for identification, differential diagnosis, investigation and treatment. Although individually these conditions are uncommon, cumulatively they form a significant group of treatable diseases that frequently present to general medicine and are important for all physicians to recognize promptly. © 2020

关键词： Hedgehog pathway   Traumatic brain injury   Neurovascular unit   Blood-brain barrier   Oxygen-glucose deprivation   Inflammation  

摘要： The homeostasis of the neurovascular unit (NVU) is disrupted after traumatic brain injury (TBI), and therapeutic strategies targeting the NVU would likely improve neurological outcomes after TBI. Sonic Hedgehog (Shh), which is an endogenous activator of the Hedgehog pathway, promotes brain repair in various injuries. In this study, the controlled cortical impact (CCI) was used to establish a moderate TBI model in adult male Sprague-Dawley rats (250-300 g), and the NVU was reconstructed in vitro from the blood-brain barrier (BBB) and neurons to investigate the effects of exogenous Shh protein on TBI. The modified neurological severity scores (mNSS) and Morris water maze tests were used to evaluate the effect of Shh on neurological function after TBI. The effect of Shh on the NVU in vivo was evaluated by detecting the degrees of cerebral edema and neuronal apoptosis. The integrity and permeability of the BBB, the level of inflammatory factors, and the expression of apoptotic proteins were detected to explore the effect of exogenous Shh on the NVU in vitro. The results showed that exogenous Shh reduced cerebral edema and neuronal apoptosis and promoted neurological recovery after TBI in rats. In vitro experiments showed that Shh-induced activation of the Hedgehog pathway promoted stability of the NVU by reducing damage to the tight junction structure and inhibiting the release of inflammatory factors and neuron apoptosis. Based on these results, the Shh-induced activation of the Hedgehog pathway might be a new promising treatment for TBI.

关键词： COVID-19   Neurological manifestations   Headache   Test and smell disorders   Muscle pain  

摘要： Introduction Neurological manifestations can occur during coronavirus disease 19 (COVID-19). Several pathogenic mechanisms have been hypothesized, without conclusive results. In this study, we evaluated the most frequent neurological symptoms in a cohort of hospitalized COVID-19 patients, and also investigated the possible relationship between plasmatic inflammatory indices and olfactory disorders (ODs) and between muscle pain and creatine kinase (CK). Methods We consecutively enrolled hospitalized COVID-19 patients. A structured questionnaire concerning typical and neurological symptoms, focusing on headache, dizziness, ODs, taste disorders (TDs), and muscle pain, was administrated by telephone interviews. Results Common neurological symptoms were reported in the early phase of the disease, with a median onset ranging from 1 to 3 days. Headache showed tension-type features and was more frequently associated with a history of headache. Patients with ODs less frequently needed oxygen therapy. Inflammatory indices did not significantly differ between patients with and without ODs. Muscle pain did not show any association with CK level but was more frequently associated with arthralgia and headache. Conclusion In our cohort, ODs were an early symptom of COVID-19, more frequently reported by patients with milder forms of disease. Headache in association with arthralgia and muscle pain seems to reflect the common symptoms of the flu-like syndrome, and not COVID-19 infection-specific.

关键词： Machine learning   Soft-computing   Ensemble   Neurological disorders   Parkinson disease  

摘要： Parkinson disease is a neurodegenerative disorder of the central nerve system which affects body movements. The proposed technique selects best five machine learning models competitively, out of 25 state-of-the-art regression models to generate a robust ensemble. Data from 42 patients having early stage of Parkinson disease were collected which contains a total of 5875 voice recordings. Numerous state-of-the-art machine learning models have been explored to predict the motor Unified Parkinson's Disease Rating Score (UPDRS) for the collected voice measures. Evaluation parameters such as correlation, R-Square, RMSE, and accuracy have been calculated for comparative analysis. Results from the ensemble model consisting of best five models have been recalculated to analyze the prediction. K-fold validation has been incorporated to measure the robustness of ensembled model. The proposed ensemble yields UPDRS with higher accuracy of 99.6% making it well suitable to assist the diagnose for Parkinson disease.

关键词： Varicella zoster virus   Nervous system   Varicella   Herpes zoster   Encephalitis   POL III   Host genetics   Immunodeficiency  

摘要： Varicella zoster virus (VZV) is a pathogenic human herpes virus which causes varicella as a primary infection, following which it becomes latent in peripheral autonomic, sensory, and cranial nerve ganglionic neurons from where it may reactivate after decades to cause herpes zoster. VZV reactivation may also cause a wide spectrum of neurological syndromes, in particular, acute encephalitis and vasculopathy. While there is potentially a large number of coding viral mutations that might predispose certain individuals to VZV infections, in practice, a variety of host factors are the main determinants of VZV infection, both disseminated and specifically affecting the nervous system. Host factors include increasing age with diminished cell-mediated immunity to VZV, several primary immunodeficiency syndromes, secondary immunodeficiency syndromes, and drug-induced immunosuppression. In some cases, the molecular immunological basis underlying the increased risk of VZV infections has been defined, in particular, the role of POL III mutations, but in other cases, the mechanisms have yet to be determined. The role of immunization in immunosuppressed individuals as well as its possible efficacy in preventing both generalized and CNS-specific infections will require further investigation to clarify in such patients.