关键词： NDDI-E   Georgian version   Epilepsy   Depression screening  

摘要： Introduction: This study aimed to validate a Georgian version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). The distribution of psychiatric disorders was assessed among patients with epilepsy. Methods: One hundred and thirty consecutive adult patients with epilepsy completed the NDDI-E and the Beck Depression Inventory (BDI). All patients were further assessed by a qualified psychiatrist. Results: In 31 (23.8%) patients, a diagnosis of major depression was revealed. The internal consistency of the NDDI-E was 0.695. Receiver operating characteristics (ROC) showed an area under the curve of 0.975. A cutoff score of >= 16 resulted in a sensitivity of 0.90 and a specificity of 0.939. The screening questionnaire showed a significantly positive correlation with BDI scores (Spearman's rho - 0.684), indicating good concurrent validity. Discussion: The Georgian version of the NDDI-E is a reliable tool for the detection of depressive disorders in individuals with epilepsy. (C) 2019 Elsevier Inc. All rights reserved.

摘要： The article presents a case study of a 54-year-old man was referred to the emergency department with 4-month history of altered vision and depressive symptoms. It mentions his diagnose of Heidenhain variant Creutzfeldt–Jakob disease (HvCJD) that is a rapidly progressive neurodegenerative entity and often challenges neurologists and psychiatrists in clinical practice.

关键词： Multi-hospital systems   Hospital bed management   Specialization   Queueing networks  

摘要： We study the impact of specialization on the operational efficiency of a multi-hospital system. The mixed outcomes of recently increasing hospital mergers and system re-configuration initiatives have raised the importance of studying such organizational changes from all the relevant perspectives. We consider two configuration scenarios for a multi-hospital system. The first scenario assumes that all the hospitals in the system are general, which implies they can provide care to all types of patients. In the alternative configuration, we specialize each hospital in certain level of care, which means they serve only specific types of patients. By considering an extensive number of possible settings for a multi-hospital system, we characterize the situations in which one scenario outperforms the other in terms of extending access of patients to care. Our results show that whenever the percent of patients with shorter length of stay in the system increases, specialization of healthcare services can maximize the accessibility of care. Also, if the patient load is balanced between all hospitals in the system, it seems more likely that all hospitals benefit from specialization. We conclude that the strategic decision of designing a multi-hospital system requires careful consideration of patient mix among arrivals, relative length of stay of patients, and distribution of patient load between hospitals.

关键词： Cognitive fatigability   Cognitive fatigue   Mental exhaustion   Mental fatigue   Multiple sclerosis   Nervous system diseases   Stroke   Systematic review   Time-on-task   Traumatic brain injury  

摘要： Introduction Although fatigue is a well-studied concept in neurological disease, cognitive fatigability (CF) is less understood. While most studies measure fatigue using subjective self-report, fewer have measured CF objectively. Given the negative impact of CF on quality-of-life, there is a need for targeted interventions. The objective of this review was to determine which procedural, behavioural and pharmacological treatments for objectively measured CF are available to people living with neurological conditions. Methods In accordance with the PRISMA guidelines, systematic searches for randomized control trials (RCTs), case-controlled studies and case reports/series were conducted across the Ovid Medline, PsycInfo, EMBASE and Cochrane Library databases. English-language articles published between 1980 and February 2019 were considered for eligibility. Included were those that objectively measured CF in individuals with neurological disease/disorder/dysfunction between the ages of 18 and 65 years. Studies were reviewed using a modified Cochrane Data Extraction Template. Risk of bias was assessed using the Cochrane Risk of Bias tool. The review process was facilitated using Covidence software (). Two authors reviewed articles independently, with a third resolving conflicts regarding article inclusion. Results The search identified 450 records. After duplicates were removed and remaining titles/abstracts were screened for eligibility, 28 full-text articles were assessed, and two studies were included in the qualitative synthesis. Studies were a priori divided into those with pharmacological, procedural or behavioural interventions. Two studies met eligibility criteria;both of these included participants with multiple sclerosis. One study utilized a procedural intervention (i.e. transcranial direct current stimulation), while the other utilized a pharmacological intervention (i.e. fampridine-SR). Studies were evaluated for risk of bias, and evidence from both eligibl

关键词： Stroke   acute stroke treatment   endovascular treatment   thrombectomy   medical decision making  

摘要： Background: We assessed the occurrence of neurological deficits that may impede the capacity to provide consent for trial participation in patients with an acute stroke, who are eligible for endovascular treatment (EVT). Methods: We used data from the Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective observational cohort study. We included 1526 patients with an anterior large vessel occlusion, undergoing EVT between March 2014 and June 2016. We based our assessment of decision-making capacity for trial participation on neurological symptoms influencing conditions concerning informed consent as stated in the declaration of Helsinki. We formulated a strict and a mild capacity assessment rule, using 2 different cut points in item scores on the National Institutes of Health Stroke Scale (NIHSS). Results: Applying the strict and mild rule, respectively 1469 (96%) and 1220 (80%) patients deemed not capable of decision-making for trial participation on admission, and 1077 (79%) and 825 (60%) patients at 24-48 hours after admission. Highest frequencies of predefined scores suggesting incapacity based on the strict rule were on the NIHSS items "Level of Consciousness Questions" (59%), "Best Gaze" (68%), and "Best Language" (58%). Patients who were considered incapable were older (median 71 versus 66 years, P = .043), had higher NIHSS scores (median 16 versus 8, P < .001), and had more often left hemisphere strokes (55% versus 28%, P < .001) than patients who were presumably capable. Conclusions: In the majority of patients with an anterior circulation stroke who are eligible for EVT, neurological deficits are present that may impede the capacity to provide informed consent for trial participation.

关键词： ATPase activity   immunofluorescence localization   neurological diseases   P4-ATPases   protein expression  

摘要： ATP8A2 is a P4-ATPase (adenosine triphosphate) that actively flips phosphatidylserine and phosphatidylethanolamine from the exoplasmic to the cytoplasmic leaflet of cell membranes to generate and maintain phospholipid asymmetry. Mutations in the ATP8A2 gene have been reported to cause severe autosomal recessive neurological diseases in humans characterized by intellectual disability, hypotonia, chorea, and hyperkinetic movement disorders with or without optic and cerebellar atrophy. To determine the effect of disease-associated missense mutations on ATP8A2, we expressed six variants with the accessory subunit CDC50A in HEK293T cells. The level of expression, cellular localization, and functional activity were analyzed by western blot analysis, immunofluorescence microscopy, and ATPase activity assays. Two variants (***376Met and ***429Met) expressed at normal ATP8A2 levels and preferentially localized to the Golgi-recycling endosomes, but were devoid of ATPase activity. Four variants (***429Asn, pAla544Pro, ***625Trp, and ***702Arg) expressed poorly, localized to the endoplasmic reticulum, and lacked ATPase activity. The expression of these variants was increased twofold by the addition of the proteasome inhibitor MG132. We conclude that the ***376Met and ***429Met variants fold in a native-like conformation, but lack key amino acid residues required for ATP-dependent lipid transport. In contrast, the ***429Asn, pAla544Pro, ***625Trp, and ***702Arg variants are highly misfolded and undergo rapid proteosomal degradation.

关键词： Biomarkers   Malnutrition   Risk factors  

摘要： Dehydration is common and frequently under-diagnosed in chronic malnourished children, leading to life-threatening conditions. In this pilot study we applied bioimpedance vector analysis (BIVA) to determine hydration status in 52 neurologically impaired (NI) paediatric patients (14.08 +/- 5.32). Clinical and biochemical data were used to define malnutrition and dehydration. Body composition analysis and hydration were also assessed by BIVA and we considered 143 normal-weight healthy subjects (15.0 +/- 1.7), as controls for hydration status assessment. BIVA revealed a pathological hydration status in NI children, showing higher resistance (p < 0.001) and reactance values (p = 0.001) compared to controls. No differences in reactance and resistance were detected between well-nourished and under-nourished subjects. Four patients out of 52 showed mild signs of dehydration;no severe dehydration was detected. Laboratory data, suggestive for dehydration, were similar in well-nourished and under-nourished NI subjects. In conclusion, in our sample of NI paediatrics, dehydration according to clinical signs and laboratory data was under-diagnosed. BIVA showed specific bioelectrical characteristics that could be compatible with impaired hydration status. Further studies are necessary to confirm that BIVA may an applicable tool for defining dehydration status and guiding rehydration in NI children.

关键词： Risk management   Indoor air   Microbiome   Diet   Chelation   Health policy  

摘要： The human environment and exposures arising therefrom are major contributors to neurological disorders ranging from stroke to neurodegenerative diseases. Reduction of exposure to environmental risk factors, with the goal of disease prevention or control, is addressed at the individual as well as the societal level and in recognition of differential subject vulnerability. We examine some practical solutions in high-income countries that may allow a better adaptation to environmental risks and reduce their adverse impact on the nervous system. We consider the citizen's role in reducing unhealthy exposures and explore new approaches to treatment. (C) 2019 Elsevier Masson SAS. All rights reserved.

关键词： Ischemic stroke   miR-494   HDAC3   neuron  

摘要： HDAC3 is an essential negative regulator of neuronal plasticity and memory formation. Although a chemical inhibitor has been invented, little is known about its endogenous modulators. We explored whether miR-494 affects HDAC3-mediated neuronal injury following acute ischemic stroke. A substantial increase in plasma miR-494 was detected in AIS patients and was positively associated with the mRS at one year after symptom onset. The miR-494 levels were transiently increased in the infarcted brain tissue of mice. In contrast, miR-494 levels were reduced in neurons but increased in the medium after OGD. Intracerebroventricular injection of miR-494 agomir reduced neuronal apoptosis and infarct volume at the acute stage of MCAO, promoted axonal plasticity and long-term outcomes at the recovery stage, suppressed neuronal ataxin-3 and HDAC3 expression and increased acetyl-H3K9 levels in the ipsilateral hemisphere. In vitro studies confirmed that miR-494 posttranslationally inhibited HDAC3 in neurons and prevented OGD-induced neuronal axonal injury. The HDAC3 inhibitor increased acetyl-H3K9 levels and reversed miR-494 antagomir-aggravated acute cerebral ischemic injury, as well as brain atrophy and long-term functional recovery. These results suggest that miR-494 may serve as a predictive biomarker of functional outcomes in AIS patients and a potential therapeutic target for the treatment of ischemic stroke.

关键词： addiction   controllable   enlightenment   gambling   reaching-grasping  

摘要： In this paper, I postulate that the processing of concepts which are deemed controllable is rooted in neurological machinery located in the posterior parietal cortex specialised for the processing of objects which are immediately actionable because they are within reach. This is demonstrated with reference to the near-miss effect in gambling behaviour, where it is argued that the configurative proximity of the near-miss outcome to the win outcome creates the impression that the win outcome is 'almost within reach' or controllable. The perceived realisability of the desired outcome increases subjective reward probability and the associated expected action value, which impacts decision-making and behaviour. When extended to substance addiction, this novel hypothesis adds fresh insight into understanding the motivational effects associated with cue exposure and opportunity for drug-taking. Moreover, by postulating that a perception of control can be generated to minimise unpleasant affective states, it can also reconcile contrasting models of decision-making and provide a neurological explanation for the efficacy of mindfulness-based techniques in treating addictions. With reference to the previously hypothesised link between the self and control, these ideas can provide an explanation for the increased subjective value of self-associated concepts in the 'endowment effect', as well as a neurological correlate for the concept of the 'narrative self'. This paper therefore provides an innovative and unifying perspective for the study and treatment of behavioural and substance addictions as well as contributing to our neurological understanding of philosophical approaches to the self.