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

关键词： Neurite orientation dispersion and density imaging   Cervical spondylotic myelopathy   Diffusion tensor imaging   Fractional anisotropy   Intracellular volume fraction   Neurological recovery  

摘要： BACKGROUND CONTEXT: Predicting postoperative prognosis with preoperative diagnostic imaging has clinical importance. Recent studies have indicated the utility of diffusion tensor imaging (DTI) to quantify the severity of cervical spondylotic myelopathy (CSM) and assess the prognosis of surgical outcomes. However, how to apply DTI to evaluate CSM in a clinical setting is not fully elucidated. Neurite orientation dispersion and density imaging (NODDI) is a model-based practical diffusion-weighted magnetic resonance imaging analysis for estimating specific microstructural features related directly to neuronal morphology. In a prior study, we indicated preoperative NODDI parameters are a promising tool with which to predict neuronal recovery after decompression surgery in patients with CSM with 2 years follow-up. However, the correlation between NODDI parameters and postoperative long-term outcomes and change of parameters over time postoperatively has remained largely unknown. STUDY DESIGN: Retrospective cohort study. PURPOSE: To determine the change of parameters of NODDI and conventional DTI over time, and the relationship between parameters and neurological recovery 2 years after surgery. PATIENT SAMPLE: We included 28 consecutive patients with nontraumatic cervical lesions from CSM who underwent laminoplasty and were followed up for > 2 years. Patients underwent magnetic resonance imaging before and approximately 2 weeks, 6 months, and 1 year after surgery. OUTCOME MEASURES: In addition to conventional DTI metrics, we evaluated intracellular volume fraction (ICVF) and orientation dispersion index, which are metrics derived from NODDI. The Japanese Orthopedic Association (JOA) scoring system was used before and 2 years after surgery to assess neurological outcome (JOA recovery rate). METHODS: NODDI and conventional DTI values were measured at the C2-C3 intervertebral level (control value) and the most compressed levels (C3-C7 intervertebral levels) were measured by

摘要： Neurological disorders are the largest contributor to the global burden of disease in terms of morbidity, as measured with disability-adjusted life years, and the second largest contributor to mortality.1 If neurological disorders are included that have so far not been accounted for in the Global Burden of Diseases, Injuries, and Risk Factors (GBD) study, such as cerebral malaria, then the proportion of people with neurological diseases becomes even larger, especially in low-income and middle-income countries (LMICs).2 The Policy View in The Lancet Neurology by Feigin and colleagues,3 which sets out priorities and recommendations to tackle the growing burden of neurological disorders using GBD data, is therefore a welcome and timely call for action. Environmental risk factors such as climate change and air pollution, which is especially pronounced in the megalopolises of LMICs, must also be understood and addressed to reduce disease burden; a relationship has been shown between air pollution and cardiovascular disease, including stroke.6 Creating and maintaining healthy environments is key to curbing the epidemic of communicable and non-communicable neurological disorders in LMICs and is part of the One Health approach, which deals with the interconnectedness of human, animal, and environmental health. A One Health approach also involves collaboration across multiple sectors, including communities (eg, patients, their families, care deliverers, faith organisations), the public sector (eg, governments, public health institutions, academia, education), the private sector, and non-governmental organisations.

关键词： adverse childhood experiences   childhood sexual abuse   conversion disorder   functional neurological disorder   predictive factors   treatment outcome  

摘要： Objective Explore trauma, stress, and other predictive factors for treatment outcome in conversion disorder/functional neurological disorder (CD/FND). Methods Prospective observational design. Clinical cohort study among consecutive outpatients with DSM-IV CD/FND in a specialized mental health institution for somatic symptom disorders and related disorders (SSRD), presented between 1 February 2010 and 31 December 2017. Patient files were assessed for early childhood trauma, childhood sexual abuse, current stress, and other predictive factors. Patient-related routine outcome monitoring (PROM) data were evaluated for treatment outcome at physical (Patient Health Questionnaire [PHQ15], Physical Symptoms Questionnaire [PSQ]) level as primary outcome, and depression (Patient Health Questionnaire [PHQ9]), anxiety (General Anxiety Disorder [GAD7]), general functioning (Short Form 36 Health Survey [SF36]), and pain (Brief Pain Inventory [BPI]) as secondary outcome. Results A total of 64 outpatients were included in the study. 70.3% of the sample reported childhood trauma and 64.1% a recent life event. Mean scores of patients proceeding to treatment improved. Sexual abuse in childhood (F(1, 28) = 30.068, beta = 0.608 p < .001) was significantly associated with worse physical (PHQ15, PSQ) treatment outcome. 42.2% reported comorbid depression, and this was significantly associated with worse concomitant depressive (PHQ9) (F[1, 39] = 11.526, beta = 0.478, p = .002) and anxiety (GAD7) (F[1,34] = 7.950, beta = 0.435, p = .008) outcome. Conclusion Childhood sexual abuse is significantly associated with poor treatment outcome in CD/FND. Randomized clinical trials evaluating treatment models addressing childhood sexual abuse in CD are needed.

关键词： HINT1   Psychiatric   Neurodevelopmental   ARAN-NM  

关键词： Epilepsy   Depression   Adolescent   Mental health screening  

摘要： Purpose: Depression is one of the most prevalent psychiatric comorbidities in epilepsy. This quality improvement project compared a standardized rating scale, the Neurological Disorders Depression Inventory-Epilepsy for Youth (NDDI-E-Y), with physician opinion to see if it improved sensitivity to depressive symptoms. Results: A convenience sample of thirty adolescents with epilepsy ages 12-17 (mean [M] = 15.02, standard deviation [SD] = 1.81;53% female) participated in the screening. Thirteen percent of the sample scored in the Elevated range on the NDDI-E-Y (exceeded cutoff). Seven percent of the sample were rated by the physician as definitely showing signs of depression. There were two false negatives when the NDDI-E-Y score exceeded the established cutoff, but physician rating was negative for depressive symptoms. Conclusion: This pilot project shows that the NDDI-E-Y is a convenient clinical tool with the potential to improve sensitivity in the detection of depressive symptoms in adolescents with epilepsy. (C) 2020 Elsevier Inc. All rights reserved.