关键词： electroencephalography   evoked potentials   functional magnetic resonance imaging   minimally conscious state   positron emission tomography   resting state fMRI   transcranial magnetic stimulation   traumatic brain injury   unresponsive wakefulness syndrome   vegetative state  

摘要： Background and purpose Patients with acquired brain injury and acute or prolonged disorders of consciousness (DoC) are challenging. Evidence to support diagnostic decisions on coma and other DoC is limited but accumulating. This guideline provides the state-of-the-art evidence regarding the diagnosis of DoC, summarizing data from bedside examination techniques, functional neuroimaging and electroencephalography (EEG). Methods Sixteen members of the European Academy of Neurology (EAN) Scientific Panel on Coma and Chronic Disorders of Consciousness, representing 10 European countries, reviewed the scientific evidence for the evaluation of coma and other DoC using standard bibliographic measures. Recommendations followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The guideline was endorsed by the EAN. Results Besides a comprehensive neurological examination, the following suggestions are made: probe for voluntary eye movements using a mirror;repeat clinical assessments in the subacute and chronic setting, using the Coma Recovery Scale - Revised;use the Full Outline of Unresponsiveness score instead of the Glasgow Coma Scale in the acute setting;obtain clinical standard EEG;search for sleep patterns on EEG, particularly rapid eye movement sleep and slow-wave sleep;and, whenever feasible, consider positron emission tomography, resting state functional magnetic resonance imaging (fMRI), active fMRI or EEG paradigms and quantitative analysis of high-density EEG to complement behavioral assessment in patients without command following at the bedside. Conclusions Standardized clinical evaluation, EEG-based techniques and functional neuroimaging should be integrated for multimodal evaluation of patients with DoC. The state of consciousness should be classified according to the highest level revealed by any of these three approaches.

关键词： Out-of-hospital cardiac arrest   Child   Prognosis   Electroencephalography   Computed tomography  

摘要： The prognosis of patients who are comatose after resuscitation remains uncertain. The accurate prediction of neurological outcome is important for management decisions and counseling. A neurological examination is an important factor for prognosti-cation, but widely used sedatives alter the neurological examination and delay the response recovery. Additional studies including electroencephalography, somatosen-sory-evoked potentials, brain imaging, and blood bio-markers are useful for evaluating the extent of brain injury. This review aimed to assess the usefulness of and provide practical prognostic strategy for pediatric post-resuscitation patients. The principles of prognostication are that the assessment should be delayed until at least 72 hours after cardiac arrest and the assessment should be multimodal. Furthermore, multiple factors including unmeasured confounders in individual patients should be considered when applying the prognostication strategy.

关键词： Cardiac arrest   Prognosis   Cerebral oxyhemoglobin   Wavelet phase coherence   Functional near-infrared spectroscopy   Hypoxic-ischemic brain injury  

摘要： Background The prognosis for cardiac arrest (CA) is associated with the degree of cerebral ischemia. We investigated the relationship between the wavelet coherence of cerebral oxyhemoglobin (HbO₂) among different channels and outcomes after CA. Moreover, we aimed to develop a prognostication method after *** Eighty-three post-resuscitation patients were included. The HbO₂ data were collected during the post-resuscitation period (median day, 1) using functional near-infrared spectroscopy. The coherence between sections of prefrontal HbO₂ oscillations in five frequency intervals (I, 0.6-2 Hz; II, 0.15-0.6 Hz; III, 0.05-0.15 Hz; IV, 0.02-0.05 Hz; and V, 0.0095-0.02 Hz) were analyzed. We evaluated the outcomes using cerebral performance category (CPC) scores (good outcome, CPC ≤ 2 and poor outcome, CPC ≥ 3) at 3 months after CA. Additionally, the predictive method was developed using the biomarker and coherence value after *** Among the included patients, 19 patients (22.9%) had a good outcome. Poor outcome group had significantly lower phase coherence in the myogenic frequency interval III compared to good outcome group (0.36 ± 0.14 vs. 0.54 ± 0.18, P < 0.001). The predictive method using neuron-specific enolase (NSE) and interval III value demonstrated good discrimination (area under the curve 0.919; 95% confidence interval, 0.850-0.989).Conclusions The predictive method using NSE and phase coherence of HbO₂ in the interval III from the vascular smooth muscle cells could be a useful tool for prognosticating after CA. This suggests that evaluating cerebral ischemia using phase coherence of HbO₂ might be a helpful outcome predictor following CA.

关键词： Laparoscopic surgery   Liver retraction methods   Needle grasper   Crural suture   Children  

摘要： Aim of the study Liver retraction during laparoscopic fundoplication is important for obtaining an optimal space. Several methods have been developed, but the risks and benefits are unclear. We compared three different approaches and evaluated their safety and utility. Methods Forty-three neurologically impaired patients who underwent laparoscopic fundoplication between 2005 and 2018 were classified into three groups: A, snake retractor method, n = 18;B, crural suture method, n = 13;C, needle grasper method, n = 12. Patients' characteristics and outcomes were reviewed. Main results The liver retraction time was significantly shorter in group C than in A or B (p < 0.05). The operative times were shorter in groups B and C than in A. There were no significant differences in the liver enzyme levels. The liver enzyme levels increased temporarily but improved within a week. The C-reactive protein levels were significantly lower in group B than in A or C (p < 0.05). Conclusions The most convenient method was the needle grasper method, as the other two approaches create conflict with the operator's forceps. The crural suture method damages the liver less, but requires higher surgical skill levels. It is important to select the appropriate method according to the operator's skill and the patient's size and deformity.

关键词： Serious game   Physical rehabilitation   Computer vision   Neurological diseases   Motivation  

摘要： Objective: Being aware that serious games can be an interesting and appealing tool, the objective of this paper is to present the Physioland, a serious game based on image processing techniques, developed to monitor the physical therapy practice of patients with reduced mobility as a consequence of neurological disease. Materials and Methods: Several tests were performed in a clinical environment. The system stores every second the data relative to alignment, compensation and speed of the patient while he/she performs each exercise. The sample consisted of eleven elements aged from 17 years to 83 years, with neurological diseases in a mild or moderate state, with sequelae such as hemiparesis, paraparesis, hemidystonia, cerebellar syndrome and hemihyposthesia. Each patient used the game in twice a week in sessions of physical therapy, with the duration of about thirty minutes, for twelve to fifteen sessions. In each session, the patient performed several challenges, for two and a half minutes or five minutes each, according to his/her physiotherapeutic plan. Results: All the patients suffered oscillations in their behavior, but with better or worse performances, higher or lower scores, they were able to successfully complete the different exercises provided by Physioland, which are part of their physiotherapeutic plans. Conclusion: Based on the results obtained it can be said that it was possible to adapt specific exercises of traditional physical therapy to situations of electronic game, reason why Physioland fulfills the objective of monitoring the practice of physical therapy of patients with reduced mobility as a consequence of neurological disease.

关键词： CasRx   Ptbp1   retinal ganglion cells   Parkinson’s disease  

摘要： Conversion of glial cells into functional neurons represents a potential therapeutic approach for replenishing neuronal loss associated with neurodegenerative diseases and brain injury. Previous attempts in this area using expression of transcription factors were hindered by the low conversion efficiency and failure of generating desired neuronal types in vivo. Here, we report that downregulation of a single RNA-binding protein, polypyrimidine tract-binding protein 1 (Ptbp1), using in vivo viral delivery of a recently developed RNA-targeting CRISPR system CasRx, resulted in the conversion of Mailer glia into retinal ganglion cells (RGCs) with a high efficiency, leading to the alleviation of disease symptoms associated with RGC loss, Furthermore, this approach also induced neurons with dopaminergic features in the striatum and alleviated motor defects in a Parkinson's disease mouse model. Thus, glia-to-neuron conversion by CasRx-mediated Ptbp1 knockdown represents a promising in vivo genetic approach for treating a variety of disorders due to neuronal loss.

关键词： Ischemic stroke   Early neurological deterioration   Clopidogrel   Genetic polymorphism   Platelet membrane receptor   Glycoprotein IIIa   Pharmacogenetics  

摘要： Background Early neurological deterioration (END) is common in acute ischemic stroke (IS). However, the underlying mechanisms for END are unclear. The aim of this study was to evaluate the associations of 16 variants in clopidogrel-relevant genes and interactions among these variants with END in acute IS patients receiving clopidogrel treatment. Methods We consecutively enrolled 375 acute IS patients between June 2014 and January 2015. Platelet aggregation was measured on admission and after the 7-10 days of clopidogrel treatment. The 16 variants in clopidogrel-relevant genes were examined using mass spectrometry. The primary outcome was END within the 10 days of admission. Gene-gene interactions were analyzed by generalized multifactor dimensionality reduction (GMDR) methods. Results Among the 375 patients, 95 (25.3%) patients developed END within the first 10 days of admission. Among the 16 variants, only CYP2C19*2 (rs4244285) AA/AG was associated with END using single-locus analytical approach. GMDR analysis revealed that there was a synergistic effect of gene-gene interactions among CYP2C19*2 rs4244285, P2Y12 rs16863323, and GPIIIa rs2317676 on the risk for END. The high-risk interactions among the three variants were associated with the higher platelet aggregation and independent predictor for END after adjusting for the covariates (hazard ratio: 2.82;95% confidence interval: 1.36-7.76;P = 0.003). Conclusions END is very common in patients with acute IS. The mechanisms leading to END are most likely multifactorial. Interactions among CYP2C19*2 rs4244285, P2Y12 rs16863323, and GPIIIa rs2317676 may confer a higher risk for END. It was very important to modify clopidogrel therapy for the patients carrying the high-risk interactive genotypes.

关键词： Tobacco smoke   Trauma   Brain injury   Oxidative stress   Blood-brain barrier   Tight junctions   Nrf2   Antioxidant  

摘要： Background Traumatic brain injury (TBI) is among the most prevalent causes of cerebrovascular and neurological damage worldwide. To this end, tobacco smoke (TS) has been shown to promote vascular inflammation, neurovascular impairments, and risk of cerebrovascular and neurological disorders through oxidative stress (OS) stimuli targeting the blood-brain barrier (BBB) endothelium among others. It has been recently suggested that premorbid conditions such as TS may exacerbate post-TBI brain damage and impact recovery. Methods Our study investigated the mechanisms underlying the exacerbation of TBI injury by TS using a weight drop model. For this purpose, male C57BL/6J mice, age range 6-8 weeks, were chronically exposed to premorbid TS for 3 weeks. Test animals were then subjected to TBI by guided vertical head weight drop using a 30 g metal weight free felling from an 80 cm distance before reaching the target. We analyzed the physical activity and body weight of the mice before TBI and 1 h, 24 h, and 72 h post-injury. Finally, mice were sacrificed to collect blood and brain samples for subsequent biochemical and molecular analysis. Western blotting was applied to assess the expression of Nrf2 (a critical antioxidant transcription factor) as well as tight junction proteins associated with BBB integrity including ZO-1, Occludin, and Claudin-5 from brain tissues homogenates. Levels of NF-kB (a pro-inflammatory transcript factor which antagonizes Nrf2 activity) and pro-inflammatory cytokines IL-6, IL-10, and TNF-alpha were assessed in blood samples. Results Our data revealed that premorbid TS promoted significantly increased inflammation and loss of BBB integrity in TBI when compared to TS-Free test mice. Additionally, mice chronically exposed to TS before TBI experienced a more significant weight loss, behavioral and motor activity deficiency, and slower post-TBI recovery when compared to TS-free TBI mice. Conclusion The effects of premorbid TS appear consequential to th

关键词： Chorioamnionitis   fetal brain   inflammation   neurodevelopmental outcome   prematurity  

摘要： Objective: Preterm premature rupture of membranes (PPROM) is a risk factor for chorioamnionitis (CA) and injury to the fetal brain. However, prolongation of gestation prevents morbidity and decreases complications of prematurity. The current investigation is to define risk factors for the adverse neurological outcome from the influence of PPROM of at least 7 days. Methods: A case-control study included three groups of preterm infants born at the University Hospitals Bonn and Essen, Germany. The first group consisted of infants with PPROM of at least 7 days and no chorioamnionitis (CA) (PPROM group), the second included preterm infants with CA (CA group), and the third group consisted of infants without PPROM and CA (control group). The outcome was assessed using Bayley Scales of Infant Development at a corrected age of 24 months. Each group consisted of 20 corresponding infants with an identical birth weight and gestational age at birth. Results: There was no significant difference between the mental development index (MDI) and psychomotor development index (PDI) scores (mean +/- SD): the MDI score was 101 +/- 14 in the PPROM group, 98 +/- 12 in the CA group and 96 +/- 17 in the control group;the PDI score 96 +/- 10, 89 +/- 16, and 90 +/- 17, respectively. Multiple regression analysis revealed no significant influence of PPROM and CA on neurological outcome. Conclusions: PPROM of at least 7 days has no influence on neurodevelopmental outcome at a corrected age of 24 months when birth is initiated in the case of beginning CA.