关键词： Melatonin   Alzheimer's disease   Parkinson's disease   Multiple sclerosis   Epilepsy  

摘要： Background. - The aging process is not univocal, both body and brain age. Neurological disorders are a major cause of disability and death worldwide. According to the Global Burden of Disease Study 2015, neurological diseases are the second most common cause of death and 16.8% of total deaths are caused by neurological diseases worldwide. Neurological disease deaths have risen 36% worldwide in 25 years. Melatonin is a neuroregulator hormone that has free radical scavenger, strong antioxidant, anti-inflammatory, and immunosuppressive actions. These major properties of melatonin can play an important role in the pathophysiological mechanisms of neurological diseases. In addition, melatonin is necessary for circadian rhythm. Studies have shown that melatonin levels are low in people with neurological diseases. Both preventive and therapeutic effects of melatonin are known for many diseases, including neurological diseases (e.g., Alzheimer's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, Huntington's disease, epilepsy, headache, etc.). Based on all these reasons, clinical trials of melatonin were performed and successful results were declared. Conclusions. - In this review, biological and chemical knowledge of melatonin, its experimental effects, and the clinical impact on patients with neurological disorders were described. According to all of the beneficial results obtained from experimental and clinical trials, melatonin may have a prophylactic and therapeutic effect on neurological diseases. Strong collaboration between neurologists and health service policy makers is needed to encourage use of melatonin in the patients suffering from neurological diseases. Melatonin may be the solution we have been looking for. (C) 2019 Elsevier Masson SAS. All rights reserved.

摘要： Severe neurological impairment (SNI) is a term commonly used in the medical literature, though there is no agreed definition. This limits opportunities for research into healthcare needs, treatment opportunities, resource planning, and outcome. We reviewed the literature to establish consistency of use of the term and to place it in the context of other commonly employed terms used to describe children with severe, complex medical needs. Forty-two articles were included for full-text analysis, with 23 including a definition of SNI. Motor impairment, intellectual disability, communication difficulties, and increased care needs were included in the definition in 80%, 70%, 30%, and 13% of papers respectively. Dependence on others for decision-making, chronicity, and distinction between disorders of the central nervous system and peripheral nervous system were less frequently included. There is wide variation in the use of the term SNI. A consensus-based definition of this term would be useful to facilitate future research. What this paper adds There is inconsistency in use of the term severe neurological impairment (SNI), limiting research efforts. In defining SNI, considerations are mobility, intellectual disability, communication difficulties, and increased care needs. Distinction between acute and chronic, central and peripheral nervous system disorders, and dependence on others for decision-making were less significant.

关键词： competency   needs analysis   neurological assessment   nurse   survey  

摘要： Despite the importance of neurological assessment, there is a lack of research directed at nurses' competency in performing these assessments. We aimed to identify nurses' competency levels in performing neurological assessments and prioritize their related training needs using importance-performance analysis. This survey research was conducted and reported based on the enhancing the quality and transparency of health research (EQUATOR) guidelines. A total of 213 nurses participated in a descriptive, cross-sectional survey study. Exploratory factor analysis identified seven factors that together accounted for 7.34% of the variance: cerebral function, signs and symptoms, pathologic reflexes, motor strength, assessment of an unconscious patient, reporting and documentation, and neurological assessment scales. There were significant gaps between importance and performance for all seven factors. The importance-performance matrix identified the neurological assessment scales factor as a high priority for continuing education. Emergency department nurses reported lower neurological assessment competency when compared with ward and intensive care unit nurses. The analysis of training needs is beneficial for developing programs to enhance neurological assessment competency. Training in neurological assessment scales is a priority for nurses, and they prefer simulation- and practicum-based methods.

关键词： Chronic pain   Low back pain   Neuralgia   Nuropathy   Pain neurology   Rediculopathy  

摘要： Pain is often the initial complaint for which patients seek medical care, presenting both a diagnostic and therapeutic challenge to the primary care provider. The appreciation of pain is not merely the result of abnormal sensory stimulation causing an unpleasant sensation but rather a combination of the recognition of the somatic discomfort in association with an emotional response to that discomfort. The perception of pain and the extent of distress and disability can vary depending on previous experience, cultural background, situational factors, and comorbid psychiatric disease. Though acute pain is usually the result of tissue damage, this is not always the case, as evidenced by primary headache disorders. Chronic pain may be the result of an injury, irreversible underlying disease, or clinical conditions such as fibromyalgia for which the mechanism remains unclear. Treatment of the underlying cause will usually effect a resolution or improvement in the pain, but when the discomfort persists, a consultation with a neurologist or pain management specialist should be considered. (C) 2019 Elsevier Inc. All rights reserved.

关键词： Zebrafish   Deltamethrin   Sodium tanshinone IIA sulfonate   Melatonin   Cardiotoxicity  

摘要： The pyrethroid insecticide deltamethrin has been reported to have an effect on vertebrate development and cardiovascular disease. Sodium tanshinone HA sulfonate (STS) is considered to have cardioprotective effects and melatonin is known to regulate sleep-waking cycles. In this experiment, we used transgenic zebrafish Tg (kdrl:mCherry) and Tg (my17:GFP) to investigate whether STS and melatonin could reverse the cardiovascular toxicity and neurotoxicity induced by deltamethrin. Zebrafish embryos were exposed to 25 mu g/L deltamethrin at 10 hpf and treated with 100 mmolil. STS and 1 mu mol/L melatonin showed that deltamethrin treatment affected normal cardiovascular development. In situ hybridization and qRT-PCR results showed that deltamethrin could interfere with the normal expression of cardiovascular development-related genes vegfr2, shh, gata4, nkx2.5, causing functional defects in the cardiovascular system. In addition, deltamethrin could affect the sleep-waking behavior of larvae, increasing the activity of larvae, decreasing the rest behavior and the expression of hcrt, hcrtr, aanat2 were down-regulated. The addition of melatonin and STS can significantly alleviate cardiovascular toxicity and sleep-waking induced by deltamethrin, while restoring the expression of related genes to normal levels. Our study demonstrates the role of STS and melatonin in protecting cardiovascular and sleep-waking behavior caused by deltamethrin. (C) 2019 Elsevier Ltd. All rights reserved.

摘要： We read with interest the article by Cho et al ([1]), published in a recent issue of I Critical Care Medicine i on neurocritical care for patients receiving extracorporeal membrane oxygenation (ECMO). In this circumstance, the security of the diagnosis is essential, and it is important to measure arterial blood gases from both right upper limb and femoral vessels/post-membrane lung samples in order to ensure all systemic blood gas measurements are over the legal threshold ([4]). [Extracted from the article]

关键词： Bypass surgery   Atherosclerotic occlusion   Neurological deterioration   Watershed shift  

摘要： Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery is considered not the primary but the last treatment option for acute atherosclerotic occlusions refractory to medical treatment. We retrospectively evaluated patients who underwent STA-MCA bypass surgery for acute atherosclerotic occlusion intractable to other treatments. From June 2010 to May 2014, 10 patients underwent STA-MCA bypass surgery for acute atherosclerotic occlusion at our hospital. The sites of occlusion were the internal carotid artery (n = 5) and the proximal MCA (n = 5). All 10 patients showed good patency in the anastomosis after bypass surgery, and postoperative cerebral angiography showed a newly formed border zone between the existing collateral blood flow and bypass graft blood flow. Transient neurological deterioration (TND) developed in 4 patients after STA-MCA bypass surgery (40%). All 4 patients showed worsened hemiparesis or aphasia 2-3 days after bypass surgery and improvement in neurological deficits within 1 week after bypass surgery. Diffusion MRI in patients with TND showed new cerebral infarctions near the newly formed border zone. In our series of bypass surgeries for acute atherosclerotic occlusion, postoperative changes in hemodynamic status, also called watershed zone shift, may be one of the causes of new cerebral infarctions near the newly formed border zone. (C) 2020 Elsevier Ltd. All rights reserved.

关键词： Emergency medical services   Out-of-hospital cardiac arrest   Blood gases   Hydrogen-ion concentration  

摘要： BackgroundThe knowledge of new prognostic factors in out-of-hospital cardiac arrest (OHCA) that can be evaluated since the beginning of cardiopulmonary resuscitation (CPR) manoeuvres could be helpful in the decision-making process of prehospital care. We aim to identify metabolic variables at the start of advanced CPR at the scene that may be associated with two main outcomes of CPR (recovery of spontaneous circulation (ROSC) and neurological outcome).MethodsProspective observational study of all non-traumatic OHCA in patients older than 17years assisted by emergency medical services (EMS), with doctor and nurse on board, between January 2012 and December 2017. Venous blood gases were sampled upon initially obtaining venous access to determine the initial values of pH, pCO(2), HCO3-, base excess (BE), Na+, K+, Ca2+ and lactate. ROSC upon arrival at the hospital and neurological status 30days later (Cerebral Performance Categories (CPC) scale) were *** included 1552 patients with OHCA with blood test data in a 6-year period. ROSC was achieved in 906 cases (58.4%), and good neurological recovery at 30days (CPC I-II) occurred in 383 cases (24.68%). In multivariate analysis, we found a significant relationship between non-recovery of spontaneous circulation (no-ROSC) and low pH levels (adjusted odds ratio (OR) 0.03 (0.002-0.59), p=0.020), high pCO(2) levels (adjusted OR 1.03 [1.01-1.05], p=0.008) and high potassium levels (adjusted OR 2.28 [1.43-3.61], p=0.008). Poor neurological outcomes were associated with low pH levels (adjusted OR 0.06 [0.02-0.18], p<0.001), high pCO(2) (adjusted OR 1.05 [1.03-1.08], p<0.001), low HCO3- (adjusted OR 0.97 [0.94-0.999], p=0.044), low BE (adjusted OR 0.96 [0.93-0.98], p<0.001) and high potassium levels (adjusted OR 1.37 [1.16-1.60], p<0.001).ConclusionThere is a significant relationship between severe alterations of venous blood-gas variables and potassium at the start of CPR of non-traumatic OHCA and low-ROSC rate and

关键词： Glycyrrhizin   HMGB1   pharmacological inhibitor   neuroprotection   neurological disorders   inflammation  

摘要： Glycyrrhizin (glycyrrhizic acid), a bioactive triterpenoid saponin constituent of Glycyrrhiza glabra, is a traditional medicine possessing a plethora of pharmacological anti-inflammatory, antioxidant, antimicrobial, and antiaging properties. It is a known pharmacological inhibitor of high mobility group box 1 (HMGB1), a ubiquitous protein with proinflammatory cytokinelike activity. HMGB1 has been implicated in an array of inflammatory diseases when released extracellularly, mainly by activating intracellular signaling upon binding to the receptor for advanced glycation end products (RAGE) and toll-like receptor 4 (TLR4). HMGB1 neutralization strategies have demonstrated disease-modifying outcomes in several preclinical models of neurological disorders. Herein, we reveal the potential neuroprotective effects of glycyrrhizin against several neurological disorders. Emerging findings demonstrate the therapeutic potential of glycyrrhizin against several HMGB1-mediated pathological conditions including traumatic brain injury, neuroinflammation and associated conditions, epileptic seizures, Alzheimer's disease, Parkinson's disease, and multiple sclerosis. Glycyrrhizin's effects in neurological disorders are mainly attributed to the attenuation of neuronal damage by inhibiting HMGB1 expression and translocation as well as by downregulating the expression of inflammatory cytokines. A large number of preclinical findings supports the notion that glycyrrhizin might be a promising therapeutic alternative to overcome the shortcomings of the mainstream therapeutic strategies against neurological disorders, mainly by halting disease progression. However, future research is warranted for a deeper exploration of the precise underlying molecular mechanism as well as for clinical translation.

关键词： Immunohistochemistry techniques   Immunostaining   Cerebellum   Neurons   Thalamus   Cerebral cortex   Central nervous system   Cytoplasm  

摘要： Genetically modified swine disease models are becoming increasingly important for studying molecular, physiological and pathological characteristics of human disorders. Given the limited history of these model systems, there remains a great need for proven molecular reagents in swine tissue. Here, to provide a resource for neurological models of disease, we validated antibodies by immunohistochemistry for use in examining central nervous system (CNS) markers in a recently developed miniswine model of neurofibromatosis type 1 (NF1). NF1 is an autosomal dominant tumor predisposition disorder stemming from mutations in NF1, a gene that encodes the Ras-GTPase activating protein neurofibromin. Patients classically present with benign neurofibromas throughout their bodies and can also present with neurological associated symptoms such as chronic pain, cognitive impairment, and behavioral abnormalities. As validated antibodies for immunohistochemistry applications are particularly difficult to find for swine models of neurological disease, we present immunostaining validation of antibodies implicated in glial inflammation (CD68), oligodendrocyte development (NG2, O4 and Olig2), and neuron differentiation and neurotransmission (doublecortin, GAD67, and tyrosine hydroxylase) by examining cellular localization and brain region specificity. Additionally, we confirm the utility of anti-GFAP, anti-Iba1, and anti-MBP antibodies, previously validated in swine, by testing their immunoreactivity across multiple brain regions in mutant NF1 samples. These immunostaining protocols for CNS markers provide a useful resource to the scientific community, furthering the utility of genetically modified miniswine for translational and clinical applications.