关键词： 临床医学  

ISBN: (纸本)9787030650191

摘要： 本书改编自第二版Current Diagnosis & Treatment：Neurology。为了便于推广应用，较大程度地缩减了原版教材的篇幅，删除了“中枢神经系统肿瘤”、“创伤”、“脑脊液动力学紊乱”、“酒精中毒”、“药物依赖”等超出国内神经病学教学大纲的章节。在疾病概论中适当补充了国内的流行病学资料，并根据国内医疗现状对神经系统疾病诊断和治疗部分进行了修订。考虑到教材的特殊性，本书内容以延续经典为主，同时将神经病学最新进展穿插其中，汇集了作者们宝贵的临床经验，语言纯正、图文并茂。

摘要： Brain oedema can create a ‘vicious cycle’ of increased intracranial pressure (ICP) and worsening oedema, which, if uninterrupted, can lead to brain herniation and death. Decompressive craniectomy (DC), a surgical procedure in which part of the skull is removed and the dura opened, is an effective strategy for controlling ICP [1].

关键词： Multiple sclerosis   Speech   Disease disability   Disease duration   Rehabilitation  

摘要： Purpose. In this study, we attempted to assess the phonation and articulation subsystem changes in patients with multiple sclerosis compared to healthy individuals using Dysphonia Severity Index and Formant Centralization Ratio with the aim of evaluating the correlation between these two indexes with neurological status. Materials and Methods. A sample of 47 patients with multiple sclerosis and 20 healthy speakers were evaluated. Patients' disease duration and disability were monitored by a neurologist. Dysphonia Severity Index and Formant Centralization Ratio scores were computed for each individual. Acoustic analysis was performed by Praat software;the statistical analysis was run using SPSS 21. To compare multiple sclerosis patients with the control group, Mann-Whitney U test was used for non-normal data and independent-samples t test for normal data. Also a logistic regression was used to compare the data. Correlation between acoustic characteristics and neurological status was verified using Spearman correlation coefficient and linear regression was performed to evaluate the simultaneous effects of neurological data. Results. Statistical analysis revealed that a significant difference existed between multiple sclerosis and healthy participants. Formant Centralization Ratio had a significant correlation with disease severity. Conclusion. Multiple sclerosis patients would be differentiated from healthy individuals by their phonation and articulatory features. Scores of these two indexes can be considered as appropriate criteria for onset of the speech problems in multiple sclerosis. Also, articulation subsystem changes might be useful signs for the progression of the disease.

关键词： Targeted surgical prevention   RRSO   RRESDO   Ovarian cancer   BRCA   Acceptability  

摘要： Primary surgical prevention in the form of risk-reducing salpingo-oophorectomy (RRSO) is the most effective option and the gold standard for ovarian cancer (OC) risk-reduction, particularly given the absence of an effective national OC screening programme. However, premenopausal RRSO leads to premature surgical menopause with detrimental long-term health sequelae particularly in women who do not/are unable to take hormone replacement therapy (HRT). HRT uptake in women undergoing premenopausal oophorectomy appears low and is dependent on informed counselling, the safety of HRT and efficacy in mitigating the health sequelae of premature menopause. Acceptance of a central role for the fallopian tube in OC etiopathogenesis, coupled with the detrimental consequences of premature menopause, has led to the attractive proposal of early-salpingectomy with delayed oophorectomy as an alternative OC surgical prevention strategy in premenopausal women who have completed childbearing but decline or wish to delay RRSO. The successful implementation of risk reducing surgery for OC prevention depends on the acceptability of surgery to both, recipients (e.g. BRCA1/BRCA2 carriers) and intervention deliverers (healthcare professionals/researchers). Acceptability is also informed by an understanding of health outcomes following risk reducing surgery and the safety of HRT. It is therefore vital to understand the effects of surgery on important health outcomes such as cardiovascular health, neurological function and bone health. We present a comprehensive review of acceptability, the selected health outcomes mentioned above and HRT safety following risk reducing surgery. (C) 2020 Published by Elsevier Ltd.

关键词： Conversion disorder   Stroke mimic   Functional neurological disorder  

摘要： Objective The prognosis of motor functional neurological disorder (FND) is considered poor;however, all data come from chronic cohorts collected by specialists. The aim of this study was to determine the clinical outcome of acute FND, captured as 'stroke-mimics'. Methods A meta-analysis of studies with outcome data on functional stroke mimics. Authors were contacted to provide more information on their FND mimics, including baseline, discharge and follow-up stroke scales. A random effects meta-analysis of proportion of 'good outcome' was the primary measure of interest, with additional descriptive and statistical analysis. 'Good outcome' employed the usual conventions of modified Rankin Score (mRS) or National Institutes of Health Stroke Scale (NIHSS) <= 1. Results Eight studies with 79 patients were identified and analysed, all of cohorts undergoing thrombolysis. The mean age at presentation was 49.7 years with a 62% female preponderance, and median NIHSS score of 4. The proportion of patients with mRS or NIHSS <= 1 changed significantly from admission to discharge or follow up [from 24 (30%) to 50 (63%), p < 0.001]. Meta-analysis of the synthesized data showed the pooled standardized mean change (SMC) was statistically significant (SMC = - 1.28, [95% CI = -2.25, - 0.30], p = 0.010) indicating good symptomatic outcome for acute FND patients presenting as stroke-mimics. Heterogeneity was large. Conclusion Patients presenting with acute motor FND have good outcome of their presenting symptoms by discharge and at follow-up, following thrombolysis for presumed stroke, in contrast to specialist cohorts. Demographic differences, in addition to the thrombolysis, are possible explanations for these more favourable results.

关键词： Phthalate   Quinolinic acid (QA)   Kynurenine Pathway (KP)   Neurologic disorder   Reproductive  

摘要： Background: Quinolinic acid (QA), a neuroactive metabolite produced during tryptophan degradation, is implicated in the pathogenesis of several neurological disorders. Phthalates are structurally similar to QA, and exposure to phthalates has demonstrated increased QA production and excretion in rodent studies. We recently showed that very high exposure to dibutyl phthalate was associated with higher concentrations of urinary QA in men. However, no human studies examined the associations between background (low) phthalate exposures and QA. Objectives: To examine the associations of urinary concentrations of phthalate metabolites with QA. Methods: Female participants (N = 126) who participated in a prospective cohort study at the Massachusetts General Hospital Fertility Center provided 758 urine samples (273 during pregnancy and 485 during nonpregnancy). Concentrations of 11 phthalate metabolites and QA in urine were measured. We used multivariable linear mixed effect models to estimate the percent change in urinary QA concentrations associated with a doubling (100%) of urinary phthalate metabolite concentration, and evaluated whether there was effect modification by pregnancy status. Results: Women's mean (standard deviation) age was 34.2 (4.0) years with a body mass index of 23.5 (3.7) kg/m(2). The women were primarily Caucasian (92%), had at least a college degree (98%), and none were current smokers. Pairwise Spearman correlations between concentrations for phthalate metabolites and QA measured in the same urine samples ranged from 0.36 for MEHP to 0.68 for dibutyl phthalate (DBP) metabolites. In multivariable-adjusted models, the percent change in urinary QA concentrations was significantly higher for each doubling of several urinary phthalate metabolite concentrations. For example, each doubling of DBP metabolites was associated with a 13.7% (95%CI: 10.6, 16.9)% higher QA. Associations between the low molecular weight phthalate metabolites and QA were stronger a

摘要： Background & Aim Background Neurologic disorders such as Parkinson’s disease, Alzheimer’s, disease, multiple sclerosis, stroke, and spinal cord injury are caused by a either neural cell loss or neurologic cell injury processes. Management of these disorders would therefore be expected to replace the lost cells, clear the pathological hallmarks or repair cell function. Stem cells offer the possibility of a renewable source of replacement cells and tissues as a form of innovative treatment in regenerative *** This study aims to evaluate the clinical profile and outcomes of cellular therapy given to all patients with neurologic disorders enrolled in the Institute of Personalized Molecular Medicine, center of regenerative medicine in a tertiary hospital in the Philippines. This study aims to provide information with regards to the paucity of local data in stem cell therapy in the ***, Results & Conclusion Methods This is a 10 year-retrospective descriptive study of the medical records of patients who completed 6 cycles of mesenchymal stem cells and neural stem cells infusion. Clinical profiles were evaluated and outcome in terms of functional status, subjective effects, and quality of life after the cellular *** Among the 48 cases enrolled, only 29 have completed and were included in the study. Majority of the patients have neurodegenerative disease like Parkinson’s disease, second is from acute spinal cord injury, and least with brain tumor. Other diseases enrolled are stroke, encephalopathy, dementia, multiple sclerosis and motor neuron disease. Most patients have an average age of 60-70 years old. Majority are male. Clinical outcomes show that functional status of pre and post treatment has no significant difference, however there are subjective reports of multiple improvements among the disease categories on post-treatment. No significant adverse effects *** Most common patients catered are those with neurodegenera

摘要： Objectives To compare pre-season to post-season changes on a battery of clinical neurological outcome measures between non-contact, contact, and collision sport athletes over multiple seasons of play. Methods 244 high school and collegiate athletes participating in multiple non-contact, contact, and collision sports completed standardized annual pre-season and post-season assessments over 1-4 years. Pre/post-season changes in 10 outcome measures assessing concussion symptoms, neurocognitive performance, and balance were compared between the groups using linear mixed models. Results Small, but statistically significant overall pre/post-season change differences were present between the groups for Axon computerized neurocognitive test processing speed, attention, and working memory speed scores (Axon-PS, Axon-Att, Axon-WMS), as well as Balance Error Scoring System (BESS) total score. Small seasonal declines not exceeding reliable-change thresholds were observed in the collision sport group relative to the contact and non-contact groups for Axon-PS and Axon-Att scores. The collision and contact sport groups demonstrated less pre-/post-season improvement than the non-contact sport group for Axon-WMA and BESS, with less BESS improvement also observed in the collision sport group relative to the contact sport group. Overall, longitudinal performance on all 10 outcome measures remained stable in all 3 groups over 4 years. Conclusion Our findings do not necessarily support the notion that participation in sports associated with exposure to repetitive head impacts has clinically meaningful cumulative effects over the course of a season, nor over four consecutive seasons in high school and collegiate athletes.

关键词： stroke   longitudinal study   EEG   biomarker   recovery of function   upper extremity  

摘要： Background. The time course of cortical activation and its relation with clinical measures may elucidate mechanisms underlying spontaneous neurobiological recovery after stroke. Objective. We aimed to investigate (1) the time course of cortical activation as revealed by EEG-based spectral characteristics during awake rest and (2) the development of these spectral characteristics in relation to global neurological and upper-limb motor recovery in the first 6 months poststroke. Methods. Resting-state EEG was measured serially in 41 patients after a first-ever ischemic stroke, within 3 and at 5, 12, and 26 weeks poststroke. We computed the brain symmetry index (BSI) and directional BSI (BSIdir) over different frequency bands (1-25 Hz, delta, theta) and delta/alpha ratio (DAR). The National Institutes of Health Stroke Scale (NIHSS) and Fugl-Meyer motor assessment of the upper extremity (FM-UE) were determined as clinical reflections of spontaneous neurobiological recovery. Longitudinal changes in spectral characteristics and within- and between-subject associations with NIHSS and FM-UE were analyzed with linear mixed models. Results. Spectral characteristics showed a gradual normalization over time, within and beyond 12 weeks poststroke. Significant within- and between-subject associations with NIHSS were found for DAR of the affected hemisphere (DAR(AH)) and BSIdir(delta). BSIdir(delta) also demonstrated significant within- and between-subject associations with FM-UE. Conclusions. Changes in spectral characteristics are not restricted to the time window of recovery of clinical neurological impairments. The present study suggests that decreasing DAR(AH) and BSIdir(delta) reflect improvement of global neurological impairments, whereas BSIdir(delta) was also specifically associated with upper-limb motor recovery early poststroke.

摘要： Using medical records, the neurologic impairment was considered due to the ISB if the deficit was in the C5 or C6 dermatome distribution (thumb, index finger, or radial forearm). To assess risk factors, Firth penalized logistic regression was conducted, due to the small number of patients with nerve injury. [...]ISB were performed primarily by anesthesiologists with additional training in regional anesthesia; therefore, they have more technical expertise.