摘要： Literary scholars, cultural theorists, Americanists: steel yourselves to recognize, in these unmissable books by Ralph James Savarese and Melanie Yergeau, your lack of an important literacy. “Are you, dear reader,” ironizes autist professor Yergeau, channeling Jane Austen, “autistic or non-autistic? Can there ever really be any in-between?” Outside the autistic/nonautistic binary, autists (eschewing the objectivizing terminology of “autistic-as-modifier” [2]) work with “rhetorics of plasticity” to open onto “plastic futures” (133). Savarese, parent of autist poet and filmmaker DJ Savarese, shares with us his son’s pithy childhood indictment of the judgment of nonautists, a.k.a. free people, with regard to autists: “Free people treat my people, very smart people who type to communicate, as mindless.” As you read these monographs on the rich rhetorical and literary lives of autists, you may shudder to imagine yourself aligned with the skeptical Harvard experts who, as Stephen...

关键词： Cardiac arrest   Cardiopulmonary resuscitation   Biomarker   Serum tau   Outcome   Prognostication   Inflammation   Hypothermia  

摘要： Aim: We evaluated serum tau protein as biomarker for poor neurological outcome over an extended observation period in patients after successful cardiopulmonary resuscitation (CPR) treated with mild therapeutic hypothermia (MTH) or normothermia (NT). Methods: This is a retrospective analysis of a prospective observational study including 132 patients after successful CPR. Serum tau was determined in 24 h intervals for up to 168 h after CPR. Patients were treated with MTH targeting a temperature of 33 C for 24 h or NT according to current guidelines. Neurological outcome was assessed with the Cerebral Performance Categories Scale (CPC) at hospital discharge. Results: Forty-three percent of the patients were treated with MTH. Serial serum tau levels (pg/ml) showed a peak between 72-96 h after CPR (159 (IQR 27-625). Patients with poor neurological outcome (CPC 3-5) at hospital discharge (n = 68) had significantly higher serum tau levels compared to patients with good neurological outcome at 0-24 h (164 (48-946) vs. 69 (12-224);p = 0.009), at 24-48 h (414 (124-1049) vs. 74 (0-215);p 0.001), at 48-72 h (456 (94-1225) vs. 69 (0-215);p 0.001) and at 72-96 h (691 (197-1173) vs. 73 (0-170);p 0.001). At 72-96 h the AUC to predict poor neurological outcome was 0.848 (95% CI: 0.737-0.959). Serum tau levels were not significantly different between patients with MTH and NT in multivariate analysis after adjusting for clinical relevant covariates. Conclusion: Serum tau showed highest values and the best prognostic discrimination of poor neurological outcome at 72-96 h after CPR. Prolonged elevation may indicate ongoing axonal damage in patients with hypoxic encephalopathy.

关键词： canine   CSF   neurolocalization   neurology  

摘要： Background Cerebrospinal fluid (CSF) analysis aids in categorizing underlying disease processes in patients with neurologic disease. Convention suggests that CSF should be collected caudal to the lesion. However, little evidence exists to justify this assertion. Hypothesis/Objectives Evaluate the clinicopathologic differences between CSF collected from the cerebellomedullary (CM) and lumbar cisterns in dogs presented for evaluation of neurologic disease. Animals Fifty-one client-owned dogs undergoing magnetic resonance imaging (MRI) and CSF collection for investigation of neurologic disease. Methods Cerebrospinal fluid was prospectively collected from the CM and lumbar cisterns in all patients. The total protein (TP) concentration, red blood cell (RBC) count, and total nucleated cell count (TNCC) were analyzed within 30 minutes of collection. Results and cytology findings were interpreted by a single pathologist. Results Fifty-one paired samples were collected. The TNCC (P < .001), RBC (P < .001), and TP (P < .001) were different between collection sites. When grouped by neurolocalization, TP (intracranial, P < .001;cervical, P < .001;thoracolumbar, P < .001) and RBC (intracranial, P < .001;cervical, P <= .002;thoracolumbar, P = .006) counts were significantly different. The TNCC was significantly different in the cervical (P = .04) and thoracolumbar localizations (P = .004) but not for intracranial (P = .30) localizations. The pathologist's interpretation differed between sites in 66.7% of the cases (34/51). Conclusions In dogs with lesions that neurolocalized to the brain or cervical spinal cord, there may be clinical benefit in collecting fluid from both the CM and lumbar cisterns. In dogs with thoracolumbar myelopathy, CSF collected from the CM cistern may not be representative of the underlying disease process.

摘要： Not only neurologists but, more importantly, general practitioners (GPs) and internists must be proficient in the clinical neurological examination and Bayesian decision-making process for diagnosis and management. The Objective Structured Clinical Examinations (OSCEs) in neurology at UG, PG, and DM level are another potential area for research in India to improve the validity and reliability of performance-based-assessment, wherein, examinees, rotate through a wide variety of standardized patients (SPs) or partial task trainers (PTTs). “Cross sectional concurrent nested mixed methods” studies have utilized data collection by an electronic communication tracker along with qualitative survey questionnaires.

关键词： Migraine   Brain injury   Vestibular migraine   Neurological symptom   Vestibular symptom   Havana   US diplomats  

摘要： Between 2016 and 2017, several U.S. Diplomats in Havana, Cuba, experienced perplexing vestibular and neurological symptoms attributed to an unknown source. They presented with significant vestibular and headache symptoms similar to individuals who experience vestibular migraine (VM). As such, we hypothesize that VM may be a possible explanation for the Havana cohorts presenting symptoms. To evaluate this hypothesis, we compared symptoms reported by the affected individuals in Havana, Cuba, to symptoms reported by corresponding patients from a tertiary academic neurotology clinic with a chief complaint of vertigo or disequilibrium, who met the International Classification of Headache Disorders criteria for VM. The prevalence of the Havana subjects experiencing various symptomatic domains was compared with the VM cohort, leading to 26 unique domains and statistical comparisons between the cohorts. Of the 26 domains compared between the two cohorts, 18 were not significantly different. This included the two most important components of meeting criteria for VM, namely the co-existence of headache and vestibular symptoms. On regression analysis, the only feature which kept its significant difference between the two cohorts was acute intense head pressure (P = 0.007). The domains with similar occurrence ratios included dizziness, headache, light sensitivity, hearing reduction, and tinnitus. In other words, multiple headache and vestibular symptoms, consistent with VM criteria, were similar between the two cohorts. The considerable similarities across various domains between VM patients and Havana subjects could be due to migraine as a possible common etiology for both groups. We propose VM as a potential etiology for the symptomatology in the U.S. diplomats in Cuba.

关键词： IVIg   Immunoblot   Antibody   Cell-based assay   Specificity  

摘要： Background Therapy of autoimmune diseases of the central and peripheral nervous system with intravenous IgG immunoglobulin (IVIg) is well established. Since IVIg is produced from pooled human plasma, autoantibodies can be found in IVIg products and, accordingly, in patient sera after transfusion. The de novo evidence or disappearance of anti-neural autoantibodies after IVIg treatment has so far not been systematically examined. Methods We screened 50 neurological patients before and after IVIg treatment for classical onconeural and the most common neurological surface autoantibodies as well as for ganglioside autoantibodies and 23 different antinuclear autoantibodies using immunoblot or cell-based indirect immunofluorescence assays. Furthermore, we screened 31 neurological patients with previously known seropositivity for disappearance of the corresponding antibody after treatment. Results After IVIg treatment, 90% of all sera were de novo positive for antinuclear antibodies, especially for Ro-52. In contrast, 94% of all sera did not show any de novo-positive anti-neural antibodies. In the remaining three cases, titers were very low. Importantly, 12.9% of all tested sera of patients with known antibody positivity turned false negative after IVIg treatment and titers were falsely low in 37% of the remaining sera. Conclusions Here, we present for the first time results of a broad screening for clinically relevant autoantibodies before and after IVIg treatment in neurological patients. We identified a high specificity but reduced sensitivity for anti-neural antibody testing after IVIg transfusion. In contrast, antinuclear antibody testing is not reliable after IVIg treatment. These results are of high practical importance for diagnostic of neuroimmunological diseases.

摘要： Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. In the past 30 years, the absolute numbers of deaths and people with disabilities owing to neurological diseases have risen substantially, particularly in low-income and middle-income countries, and further increases are expected globally as a result of population growth and ageing. This rise in absolute numbers of people affected suggests that advances in prevention and management of major neurological disorders are not sufficiently effective to counter global demographic changes. Urgent measures to reduce this burden are therefore needed. Because resources for health care and research are already overstretched, priorities need to be set to guide policy makers, governments, and funding organisations to develop and implement action plans for prevention, health care, and research to tackle the growing challenge of neurological disorders.

关键词： Intracorporeal bone grafting   Minimally invasive surgery   Short-segment percutaneous fixation   Thoracolumbar burst fracture  

摘要： OBJECTIVE: We evaluated the clinical and radiographic outcomes of patients with thoracolumbar burst fractures and neurological deficits treated with minimally invasive decompression and intracorporeal bone grafting combined with percutaneous short-segment stabilization. METHODS: Patients with thoracolumbar burst fractures and neurological deficits underwent minimally invasive decompression and intracorporeal bone grafting combined with percutaneous short-segment stabilization. Instrumentation was removed approximately 1 year after vertebral fracture union. The clinical and radiographic outcomes were analyzed. RESULTS: The mean operative duration and intraoperative bleeding volume were 135 +/- 63 minutes and 120 +/- 200 ml, respectively. The average American Spinal Injury Association impairment scale scores had significantly improved at the final follow-up examination. The visual analog scale score had decreased from 7.8 +/- 1.1 preoperatively to <2.9 +/- 1.3 (P < 0.05) at 1 week postoperatively. The Oswestry disability index had decreased from 86.1 +/- 8.8 preoperatively to 15.9 +/- 6.4 (P < 0.05) at 1 year postoperatively. The canal stenosis index had improved from 43.4% +/- 12.0% to 93.8% +/- 4.8% (P < 0.05). The sagittal Cobb angle had been corrected from 17.8 degrees +/- 7.5 degrees to 4.0 degrees +/- 1.9 degrees (P < 0.05) and remained at 4.9 degrees +/- 2.0 degrees (P > 0.05) at 1 year postoperatively. The sagittal index had been corrected from 16.6 degrees +/- 6.1 degrees to 0.3 degrees +/- 4.6 degrees (P < 0.05) and remained at 1.5 degrees +/- 4.5 degrees (P > 0.05) at 1 year postoperatively. The anterior vertebral height had increased from 49.3% +/- 11.1% to 97.6% +/- 6.5% (P < 0.05) and remained at 95.7% +/- 6.0% (P> 0.05) at 1 year postoperatively. After implant removal, the total kyphosis correction losses were 1.5 degrees +/- 0.8 degrees for the Cobb angle, 2.0 degrees +/- 1.1 degrees for the sagittal index, and 3.4% +/- 2.1% for the anterior vertebral

关键词： Bystander   Cardiac arrest   Cardiopulmonary resuscitation   Emergency medical dispatcher   Resuscitation  

摘要： Background: We evaluated the association between survival and bystandercardiopulmonary resuscitation (CPR) with or without dispatcher instructions (DI) considering the time from emergency call receipt by the dispatch center to emergency medical services (EMS) personnel's contact with the patient (i.e. time to EMS arrival). Methods: This prospective study conducted in Osaka City, Japan, from 2009 to 2015 included patients with medical cause-related out-of-hospital cardiac arrest whowere >= 18 years old. The primary outcome was one-month favorable neurological survival. Using multiple logistic regression models, the adjusted odds ratios (AOR) of independent and DI-dependent CPR for the primary outcome were compared with no CPR. Adjustments were made for patients' age, sex, activities of daily living before the cardiac arrest, year of cardiac arrest, location, presence or absence of witnesses, etiology of cardiac arrest, and the time from EMS contact with the patient to patient's arrival at the hospital. The effective estimated "time to EMS arrival" was also calculated. Results: For analyses 10,925 individuals were eligible. Independent CPR had a significantly higher onemonth favorable neurological survival than no CPR whereas there was no significant difference between DI-dependent CPR and no CPR (AOR, 1.90 [1.47-2.46] and 1.16 [0.91-1.47], respectively). The estimated "time to EMS arrival" for a one-month favorable neurological survival after independent CPR was <= 13 min. Conclusions: Bystander CPR that did not need DI was associated with significantly higher one-month favorable neurological survival than no CPR, with an effective estimated "time to EMS arrival" of <= 13 min. (C) 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.y