摘要： This commentary is on the original article by Joachim et al. on pages 201-206 of this issue.

关键词： dietary phytochemicals   NLRP3 inflammasome   neuroinflammation   neurological disorders  

摘要： Neurological disorders occur in the central and peripheral nervous system and include Alzheimer's disease, stroke, and spinal cord injury. Activation of the innate immune system inevitably occurs in all forms of neurological disorders. The NOD-, LRR- and pyrin domain-containing 3 (NLRP3) inflammasome is a multimolecular complex that can sense danger signals associated with neurological disorders. Assembly of the NLRP3 inflammasome promotes caspase-1-mediated interleukin-1 beta and interleukin-18 maturation in microglia, where neuroinflammation contributes to neurological disease development and progression. Thus, this review attempts to elucidate the current knowledge regarding NLRP3 inflammasome activation and its crucial role in the pathogenesis of neurological disorders. Recent scientific findings with respect to neuroprotective effects of dietary phytochemicals against NLRP3 inflammasome-mediated neurological disorders summarized in this review suggest that modulation of the NLRP3 inflammasome assembly by plant-derived phytochemicals could be a potential strategy for prevention or treatment of neurological disorders.

摘要： Background In May, 2018, Children's Hospital Colorado noted an outbreak of enterovirus A71 (EV-A71) neurological disease. We aimed to characterise the clinical features of EV-A71 neurological disease during this outbreak. Methods In this retrospective observational cohort study, children (younger than 18 years) who presented to Children's Hospital Colorado (Aurora, CO, USA) between March 1 and November 30, 2018, with neurological disease (defined by non-mutually exclusive criteria, including meningitis, encephalitis, acute flaccid myelitis, and seizures) and enterovirus detected from any biological specimen were eligible for study inclusion. The clinical characteristics of children with neurological disease associated with EV-A71 were compared with those of children with neurological disease associated with other enteroviruses during the same period. To explore the differences in clinical presentation of acute flaccid myelitis, we also used a subgroup analysis to compare dinical findings in children with EV-A71-associated acute flaccid myelitis during the study period with these findings in those with enterovirus D68 (EV-D68)-associated acute flaccid myelitis at the same hospital between 2013 and 2018. Findings Between March 10 and Nov 10, 2018, 74 children presenting to Children's Hospital Colorado were found to have enterovirus neurological disease;EV-A71 was identified in 43 (58%) of these children. The median age of the children with EV-A71 neurological disease was 22.7 months (IQR 4.0-31.9), and most of these children were male (34 [7996] children). 40 (93%) children with EV-A71 neurological disease had findings suggestive of meningitis, 31 (72%) children showed evidence of encephalitis, and ten (23%) children met our case definition of acute flaccid myelitis. All children with EV-A71 disease had fever and 18 (42%) children had hand, foot, or mouth lesions at or before neurological onset. Children with EV-A71 disease were best differentiated from those with oth

关键词： Aplasia cutis   Incontinentia pigmenti   Klinefelter syndrome  

摘要： We report a rare case of a newborn male affected by incontinentia pigmenti, Klinefelter syndrome, and aplasia cutis congenita, who developed severe cutaneous, neurological, and ophthalmological manifestations. Genetic analysis showed the presence of the common mutation of NEMO (exon 4-10 deletion), Klinefelter syndrome karyotype (47 XXY), and random X inactivation. This is in accordance with the severity of involvement of the affected tissues (skin, central nervous system, and retina). Indeed, the patient developed typical skin lesions all over the body, except the head. Equally, multiple lesions diffusely involving both the cortical grey matter and subcortical white matter of the cerebellum and cerebral hemispheres were observed. Discussing current knowledge about the etiopathogenesis of skin and brain lesions in incontinentia pigmenti, our case seems to support the proapoptotic origin of central nervous system involvement. Possibly, incontinentia pigmenti patients suffer an impaired protection against apoptosis at the level of cerebral endothelial cells of small vessels, leading to vascular damage and subsequent ischemic brain lesions.

关键词： Functional network atlas estimation   Brain network fusion   Connectomic feature selection   Multi-kernel network manifold learning   Discriminative biomarker identification   Brain connectome   Autism spectrum disorder   Classification  

摘要： Image-based brain maps, generally coined as `intensity or image atlases', have led the field of brain mapping in health and disease for decades, while investigating a wide spectrum of neurological disorders. Estimating representative brain atlases constitute a fundamental step in several MRI-based neurological disorder mapping, diagnosis, and prognosis. However, these are strikingly lacking in the field of brain connectomics, where connectional brain atlases derived from functional MRI (fRMI) or diffusion MRI (dMRI) are almost absent. On the other hand, conventional connectomic-based classification methods traditionally resort to feature selection methods to decrease the high-dimensionality of connectomic data for learning how to diagnose new patients. However, these are generally limited by high computational cost and a large variability in performance across different datasets, which might hinder the identification of reproducible biomarkers. To address both limitations, we unprecedentedly propose a brain network atlas-guided feature selection (NAG-FS) method to disentangle the healthy from the disordered connectome. To this aim, given a population of brain connectomes, we propose to learn how estimate a centered and representative functional brain network atlas (i.e., a population center) to reliably map the functional connectome and its variability across training individuals, thereby capturing their shared traits (i.e., connectional fingerprint of a population). Essentially, we first learn the pairwise similarities between connectomes in the population to map them into different subspaces. Next, we non-linearly diffuse and fuse connectomes living in each subspace, respectively. By integrating the produced subspace-specific network atlases we ultimately estimate the population network atlas. Last, we compute the difference between healthy and disordered network atlases to identify the most discriminative features, which are then used to train a predictive learne

摘要： BACKGROUND Acute acquired comitant esotropia (AACE) is a relatively rare type of pediatric strabismus, often described as a possible presentation of intracranial pathology. The risk of having neurological disease in isolated AACE is not clear, because many previously published cases had other neurological or ophthalmological abnormalities. The purpose of this study was to analyze the incidence of neurological abnormalities in children presenting with AACE and otherwise normal neurological and ophthalmological evaluations. METHODS The medical records of consecutive patients >4 years of age with AACE examined by a single practitioner from 2014 to 2018 were reviewed retrospectively. The main outcome measure was the presence of neurological disease. Children with duction deficits, incomitant esodeviations, and hyperopia of >2.00 D were excluded. RESULTS A total of 20 children (11 males;mean age, 9.8 +/- 4.1 years) were included. Mean esodeviation was 29.5(Delta) +/- 14.8(Delta) (range, 10(Delta)-55(Delta)). All had an otherwise normal ophthalmological and neurological evaluations. Of the 20, 19 (95%) had normal brain neuroimaging. One child that did not have neuroimaging was followed over 2 years without developing any neurological sequelae. CONCLUSIONS In our study cohort, pediatric AACE not accompanied by other ophthalmic and neurological abnormalities was not a manifestation of intracranial pathology. In such cases, the decision to perform neuroimaging should take into account other factors, including caregivers' preferences and availability for close monitoring.

关键词： Stroke   early neurological improvement   outcome   definition   NIHSS  

摘要： Background and Purpose: Early neurologic improvement (ENI) in patients treated with alteplase has been shown to correlate with functional outcome. However, the definition of ENI remains controversial and has varied across studies. We hypothesized that ENI defined as a percentage change in the National Institute of Health Stroke Scale (NIHSS) score (percent change NIHSS score) at 24-hours would better correlate with favorable outcomes at 3 months than ENI defined as the change in NIHSS score (delta NIHSS score) at 24 hours. Methods: Retrospective analysis of prospectively collected single-center quality improvement data was performed of all acute ischemic stroke (AIS) patients treated with alteplase. We examined delta NIHSS score and percent change NIHSS score in unadjusted and adjusted logistic regression models as predictors of a favorable outcome at 3 months (defined as mRS 0-1). Results: Among 586 patients who met the inclusion criteria, 194 (33.1%) had a favorable outcome at 3 months. In fully adjusted models, both delta NIHSS score (OR per point decrease 1.27;95% confidence interval [CI] 1.19-1.36) and percent change NIHSS score (OR per 10 percent decrease 1.17;95% CI 1.12-1.22) were associated with favorable functional outcome at 3 months. Receiver operating characteristic (ROC) curve comparison showed that the area under the ROC curve for percent change NIHSS score (.755) was greater than delta NIHSS score (.613) or admission NIHSS (.694). Conclusions: Percentage change in NIHSS score may be a better surrogate marker of ENI and functional outcome in AIS patients after receiving acute thrombolytic therapy. More studies are needed to confirm our findings.

关键词： emergency medical dispatching   Emergency Medical Services   out-of-hospital cardiac arrest   recognition  

摘要： Introduction: To date, there are no published data on the association of patient-centered outcomes and accurate public-safety answering point (PSAP) dispatch in an American population. The goal of this study is to determine if PSAP dispatcher recognition of out-of-hospital cardiac arrest (OHCA) is associated with neurologically intact survival to hospital discharge. Methods: This retrospective cohort study is an analysis of prospectively collected Quality Assurance/Quality Improvement (QA/QI) data from the San Antonio Fire Department (SAFD;San Antonio, Texas USA) OHCA registry from January 2013 through December 2015. Exclusion criteria were: Emergency Medical Services (EMS)-witnessed arrest, traumatic arrest, age <18 years old, no dispatch type recorded, and missing outcome data. The primary exposure was dispatcher recognition of cardiac arrest. The primary outcome was neurologically intact survival (defined as Cerebral Performance Category [CPC] 1 or 2) to hospital discharge. The secondary outcomes were: bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and prehospital return of spontaneous return of circulation (ROSC). Results: Of 3,469 consecutive OHCA cases, 2,569 cases were included in this analysis. The PSAP dispatched 1,964/2,569 (76.4%) of confirmed OHCA cases correctly. The PSAP dispatched 605/2,569 (23.6%) of confirmed OHCA cases as another chief complaint. Neurologically intact survival to hospital discharge occurred in 99/1,964 (5.0%) of the recognized cardiac arrest group and 28/605 (4.6%) of the unrecognized cardiac arrest group (OR = 1.09;95% CI, 0.71-1.70). Bystander CPR occurred in 975/1,964 (49.6%) of the recognized cardiac arrest group versus 138/605 (22.8%) of the unrecognized cardiac arrest group (OR = 3.34;95% CI, 2.70-4.11). Conclusion: This study found no association between PSAP dispatcher identification of OHCA and neurologically intact survival to hospital discharge. Dispatcher identification of OHC

关键词： Epilepsy and religion   Prophet Mohammad   Prophet of Islam   Inspirational spells   Revelations   Epilepsy in Muslim history  

摘要： Introduction: The Prophet of Islam is one of the several famous religious figures who allegedly suffered from epilepsy. Early Greek chronicler Theophanes was one of the first to mention that the revelations of The Prophet were episodes of epilepsy, sparking a debate that has continued to date. This argument, for the most part, was confined to historic literary writings only until it was quoted by sonic eminent neurologists of recent times. They suggested probable diagnosis of temporal lobe epilepsy, adding credibility to the historical claims. Material and method: Review of works of some prominent historians, orientalists, literati from previous twelve centuries, and recent neurologists who believed The Prophet to be epileptic was clone. The resource material that influenced them to believe this was likewise examined. Other archived literature including Hadith, the primary resource material that provides detailed information about the day-to-day happenings in The Prophet's life with books on the life of The Prophet by orientalists and Muslim historians describing such features during revelations and other events, was scrutinized. Documentations of these events from all resources were compared and analyzed from a neurological perspective. Results: The author on analysis found literature indicating faulty translations of the original Arabic text into Latin as one of the reason for misleading conclusions. Verbatim translations of Arabic phrases used symbolically have taken away the exact construal giving it a wrong perspective. Similarly, The Prophet's peri-revelation episodes as they appear in Hadith when evaluated from a neurological perspective suggest that The Prophet did not have epilepsy. Conclusion: A judicious analysis of the features on which the historians and literati based their suspicion to label The Prophet epileptic, provides little supportive evidence when analyzed from a neurological perspective. Without judicious analysis of clinical data chances of m