关键词： Quality   Quality improvement   Specialty units   Specialty critical care unit   Standards   Collaboration   Neurocritical care   Neurocritical care unit   Intensive care   Intensive care unit   Critical care   Team-based care   Transfer  

摘要： The Neurocritical Care Society and the Society of Critical Care Medicine have worked together to create a perspective regarding the Standards of Neurologic Critical Care Units (Moheet et al. in Neurocrit Care 29:145-160, 2018). The most neurologically ill or injured patients warrant the highest standard of care available;this supports the need for defining and establishing specialized neurological critical care units. Rather than interpreting the Standards as being exclusionary, it is most appropriate to embrace them in the setting of team-based care. Since there are many more patients than there are highly specialized beds, collaborative care and appropriate transfer agreements are essential in promoting excellent patient outcomes. This viewpoint addresses areas of clarification and emphasizes the need for collegiality and partnership in delivering the best specialty critical care to our patients.

关键词： Sleep   Sleep deprivation   Intensive care unit   Brain injury   Critical illness  

摘要： Sleep is fundamental for everyday functioning, yet it is often negatively impacted in critically ill patients by the intensive care setting. With a focus on the neurological intensive care unit (NeuroICU), this narrative review summarizes methods of measuring sleep and addresses common causes of sleep disturbance in the hospital including environmental, pharmacological, and patient-related factors. The effects of sleep deprivation on the cardiovascular, pulmonary, immune, endocrine, and neuropsychological systems are discussed, with a focus on short-term deprivation in critically ill populations. Where evidence is lacking in the literature, long-term sleep deprivation studies and the effects of sleep deprivation in healthy individuals are also referenced. Lastly, strategies for the promotion of sleep in the NeuroICU are presented.

摘要： Purpose The relation between left ventricular assist device (LVAD) inflow cannula malposition and pump thrombus has been reported. This study aimed to investigate pump position, derived from chest X-rays of HM3 patients, in correlation to any neurological dysfunction (ND) and specifically to ischemic stroke (IS) and intracranial hemorrhage (ICH).Methods This retrospective analysis was performed on routinely acquired X-rays of 33 patients (Age: 62.4±9.3 yrs, male: 89.5%, BMI: 28.3±4.9kg/m²) implanted with a HM3 between 2014 and 2017. Device position was quantified in patients with and without any neurological dysfunction (noND) from frontal and lateral X-ray parameters characterizing the inflow cannula (IC), pump depth in relation to spine, diaphragm or horizontal *** The analysis of X-rays (38.6±24.3 days postoperative) revealed a significant smaller IC angle of HM3 patients with any ND vs. noND (2.52±11.59° vs. 13.92±9.74°, p=0.029). Additionally, the IC angle in the frontal view (IS: 0.23±11.34° vs. noIS: 13.92±9.45°, p=0.012) as well as the pump depth (IS: 19.7±16.8mm vs. noIS: 38.3±19.6mm, p=0.044) were significantly smaller for HM3 patients with IS. Using receiver operating characteristic (ROC) curve-derived cut-points, IC angle <10.06° provided 100% sensitivity and 72% specificity (C-statistic=0.867) for predicting IS. Stratified by IC angle, freedom from any IS at 12 months was 100% (>10.06°) and 50.4% (<10.06°) respectively (p=0.004). Further, no significant differences were found in any parameter between patients with and without *** In HM3 patients, inflow cannula malposition identified from X-rays serves as a risk factor for neurological dysfunction and especially ischemic stroke.

关键词： Transfusion   Recipient   Adverse transfusion reaction   Neurological   Unconsciousness   Convulsion  

摘要： Objectives. - Many transfused patients present severe, sometimes critical, clinical conditions. The occurrence of adverse transfusion reactions may cause the clinical condition to deteriorate. A study was conducted aimed at establishing whether the presence of neurological signs during an adverse transfusion reaction increases its severity. Methods. - From 1 January 2010 to 30 June 2019, adverse reactions with neurological signs were extracted from the French haemovigilance database system. Two signs observed at the time of the reaction were analysed: unconsciousness and convulsions. Stroke was excluded. The type of reaction, its severity, the blood product involved and its imputability were all studied. Results. - During the study period, 10,670 reactions were reported, including 20 (0.19%) imputed to the transfusion with unconsciousness and/or convulsions. Unconsciousness without convulsions was frequently observed (14 reports, 70.0%). Convulsions were reported in 5 cases (25.0%), with 1 case being associated with unconsciousness. Unconsciousness and/or convulsions were present in 9 allergic reactions (45.0%) and 4 transfusion-associated circulatory overloads (20.0%). Nine reactions were severe (45.0%), 7 were life-threatening (35.0%) and 1 case resulted in the recipient's death (5.0%). A red blood cell and a platelet concentrate transfusion were involved in 8 reactions (40.0%) each, although the imputability of the blood product was certain in only 2 of the reactions. Conclusion. - Unconsciousness and/or convulsions were rarely observed in adverse reactions reported in transfused patients. Nevertheless, the presence of these signs highlights the severity of the adverse reactions (17 reactions, 85.0%). (C) 2020 Societe francaise de transfusion sanguine (SFTS). Published by Elsevier Masson SAS. All rights reserved.

关键词： Research ethics   Neuroethics   iPS   Stem cell research   Bodily integrity   Personal identity  

摘要： We examine the ethics of using induced pluripotent stem cells (iPSCs) in cell transplantation treatment of neurologic diseases and the essential types of ethical benchmarks required in clinical trials in neurology using iPSCs, including embryonic pluripotent stem cells. We focus on two issues: (1) comparison and (2) criticism of the two types of neuro-hype (neuro-purism and neuro-essentialism). In order to ensure that the dialog on ethical benchmarks continues to develop in a manner that promotes trust with society and research subjects, concerns about the clinical use of pluripotent stem cells (particularly iPSCs) in neurology must be at the forefront of any ethics discussion.

关键词： Metastatic spinal cord compression (MSCC)   Spinal metastases   Laminectomy   Decompressive surgery   Ambulation   Frankel grade  

摘要： Metastatic spinal cord compression (MSCC) is a frequent phenomenon in advanced tumor diseases with often severe neurological impairments. Affected patients are often treated by decompressive laminectomy. To assess the impact of this procedure on Karnofsky Performance Index (KPI) and Frankel Grade (FG) at discharge, a single center retrospective cohort study of neurologically impaired MSCC-patients treated with decompressive laminectomy between 2004 and 2014 was performed. 101 patients (27 female/74 male;age 66.1 +/- 11.5 years) were identified. Prostate was the most common primary tumor site (40%) and progressive disease was present in 74%. At admission, 80% of patients were non-ambulatory (FG A-C). Imaging revealed prevalently thoracic MSCC (78%). Emergency surgery (< 24 h) was performed in 71% and rates of complications and revision surgery were 6% and 4%, respectively. At discharge, FG had improved in 61% of cases, and 51% of patients had regained ambulation. Univariate predictors for not regaining the ability to walk were bowl dysfunction (p = 0.0015), KPI < 50% (p = 0.048) and FG < C (p = 0.001) prior to surgery. In conclusion, decompressive laminectomy showed beneficial effects on the functional outcome at discharge. A good neurological status prior to surgery was key predictor for a good functional outcome.

关键词： Traumatic brain injury   Minocycline   Neurological impairment   Iron metabolism  

摘要： There is currently no effective treatment for neurological impairment caused by traumatic brain injury (TBI). It has been reported that excessive iron production in the brain may be a key factor in neurological impairment. In the present study, we investigated the effects of minocycline, a semi-synthetic tetracycline antibiotic, against TBI-induced neurological impairment and explored its underlying mechanism. Neurological impairment was assessed by foot-fault test, cylinder test, wire hang test, and Morris water maze. Nissl staining was performed to evaluate cell viability in the brain. The iron concentrations in cerebrospinal fluid (CSF), serum, and brain tissues were examined. The Fe2+- and Fe3+-chelating activity of minocycline was measured. Finally, the expression levels of important iron metabolism proteins ferritin, transferrin receptor 1 (TfR1), divalent metal transporter 1 (DMT1), ferroportin 1 (FPN1), and hepcidin in the hippocampus and cortex were measured by Western blot analysis. The results indicate that minocycline significantly attenuated the neurological impairment caused by TBI and increased neuronal viability. Minocycline showed a Fe2+- and Fe3+-chelating activity in vitro and reduced the iron concentration in CSF and brain tissues (cortex and hippocampus). Minocycline also inhibited the overexpression of ferritin and TfR1, but did not affect the expression of DMT1. Minocycline restored the expression of FPN1 by decreasing the expression of hepcidin. In conclusion, minocycline may attenuate neurological impairment caused by TBI and regulate iron metabolism.

关键词： Breast-feeding   Infant   Vitamin B-12 deficiency   Psychomotor retardation   Megaloblastic anemia   Addison-Biermer disease  

摘要： Background Vitamin B-12 (cobalamin, cbl) deficiency in children is rare and may occurs in exclusively breast fed infants of mothers on vegetarian or vegan diet with lack of appropriate supplementation. The clinical manifestation of vitamin B12 deficiency include neurological disorders, megaloblastic anemia and failure to thrive. Routine and commonly used laboratory tests such as cell blood count (CBC) or serum vitamin B-12 level are sufficient for appropriate diagnosis. Typical therapy is based on intramuscular cobalamin injections. Early diagnosis and early onset of treatment are crucial factors for long-term prognosis of patients as the duration of deficiency may be correlated with the development of long lasting changes in the nervous system. The purpose of this article is to present influence of maternal vitamin B-12 deficiency as a cause of infant psychomotor retardation. Case presentation We report the case of a 7 months old girl whose parents sought medical advice due to pathological somnolence and developmental regression of their daughter with onset approximately 2 months prior to the visit. Following several diagnostic tests it was determined that the infant's symptoms were due to vitamin B-12 deficiency which was secondary to the mother's latent Addison-Biermer disease. Apart from neurological symptoms the infant also showed megaloblastic anemia which is typical to cobalamin deficiencies. Intramuscular vitamin B-12 supplementation resulted in instant improvement of the patient's general condition and blood morphology. Unfortunately, psychological examination indicated long-term psychomotor retardation due to delayed diagnosis of B-12 deficiency. Conclusions Vitamin B-12 levels should be considered during differential diagnosis of neurological symptoms in exclusively breast-fed infants especially if they co-exist with megaloblastic anemia and psychomotor retardation.

关键词： Neurological impairment   Undernutrition   Nutritional status   Nutritional requirement   Gastroesophageal reflux   Constipation   Enteral nutrition   Gastrostomy   Jejunal feeding   Pediatrics  

摘要： The prevalence of children with neurological impairment (NI) presenting feeding difficulties and gastrointestinal symptoms is rising. The most recent guidelines recommend early nutritional assessment and intervention in order to prevent undernutrition and growth failure, along with the proper diagnosis and treatment of some frequent gastrointestinal symptoms, such as gastroesophageal reflux disease (GERD) and constipation, which can further worsen the feeding process and nutritional status. Nonetheless, the nutritional issues and growth deficits of children with NI are often considered to be of low priority or under recognised by healthcare providers. The present article proposes ten top tips that highlight the major points along the nutritional management pathway of NI children. The implementation of these tips in all healthcare settings could potentially improve patient outcomes and reduce morbidity and mortality.