关键词： Cardiac arrest   Automated external defibrillator   Cardiopulmonary resuscitation   Public policy  

摘要： Background: Randomized controlled trials or observational studies showed that the use of public-access automated external defibrillator (AED) was effective for patients with out-of-hospital cardiac arrest (OHCA). However, it is unclear whether public-access AED use is effective for all patients with OHCA irrespective of first documented rhythm. We aimed to evaluate the effect of public-access AED use for OHCA patients considering first documented rhythm (shockable or non-shockable) in public locations. Methods: From the Utstein-style registry in Osaka City, Japan, we obtained information on adult patients with OHCA of medical origin in public locations before emergency-medical-service personnel arrival between 2011 and 2015. Primary outcomewas 1-month survivalwith favorable neurological outcome. Multivariable logistic regression analysiswas performed to assess the association between the public-access AED pad application and favorable neurological outcome after OHCA by using one-to-one propensity score matching analysis. Results: Among 1743 eligible patients, a total of 336 (19.3%) patients received public-access AED pad application. The proportion of patients who survived 1-month with favorable neurological outcome was significantly higher in the pad application group than in the non-pad application group (29.8% vs. 9.7%;adjusted odds ratio [AOR], 2.85;95% confidence interval [CI], 1.73-4.68, AOR after propensity score matching, 2.46;95% CI, 1.29-4.68). In a subgroup analysis, the AORs of patients with shockable or non-shockable rhythms were 3.36 (95% CI, 1.786.35) and 2.38 (95% CI, 0.89-6.34), respectively. Conclusions: Public-access AED pad application was associated with better outcome among patients with OHCA of medical origin in public locations irrespective of first documented rhythm. (C) 2019 Elsevier B.V. All rights reserved.

关键词： Antiganglioside antibodies   Gangliosides   Guillain-Barre syndrome   Polyradiculoneuropathy   Nodo-paranodopathies  

摘要： Gangliosides are sialylated glycosphingolipids, highly abundant in our nervous system. Antibodies targeting gangliosides are usually developed as a consequence of molecular mimicry following infections. Antiganglioside antibodies are implicated in many neurological disorders such as acute and chronic polyradiculoneuropathies which includes different variants of Guillain-Barre syndrome, chronic inflammatory demyelinating polyradiculoneuropathy and multifocal motor neuropathy. Presence of such antibodies in paraneoplastic peripheral neuropathy, neurodegenerative disorders, multiple sclerosis, myasthenia gravis and amyotrophic lateral sclerosis have also been reported. Recent evidence supports a role of antiganglioside antibodies in the pathogenesis of acute vestibular syndrome. Binding of antibodies to gangliosides on axonal membranes, nodes of Ranvier, myelin sheath components, Schwann cells, neuromuscular junctions or other neural cell surfaces may elicit inflammatory damage through complement-dependent and independent mechanisms, resulting in nerve conduction blocks and subsequent axonal degeneration. Gangliosides are essential for proper cell signaling, transduction and influences neuroplasticity, all of which are affected by autoimmune mediated damage. Better insight into the pathophysiological role of antiganglioside antibodies in different neurological diseases may improve their utility as diagnostic and prognostic biomarkers.

摘要： Use of bionic overground exoskeletons to assist with neurological rehabilitation is becoming increasingly prevalent and has important implications for physiotherapists and their patients. Yet, there is a paucity of research about the impact of integrating this technology on physiotherapists' work. The purpose of this study was to explore how the training and implementation of using the Ekso robotic exoskeleton with patients affects physiotherapists' work. An exploratory qualitative study of three physiotherapists working at a neurological rehabilitation centre in Eastern Canada was conducted using one-on-one semistructured interviews in July 2017. Audio recordings were transcribed verbatim, and data was coded and analyzed using thematic analysis. Six themes emerged from the data: developing organizational capacity;ethical use of technology;benefits of the equipment;challenges of the equipment;cognitive workload;and the technological environment. The results suggest that the adoption and integration of bionic exoskeletons into rehabilitation practice is not as simple as training physiotherapists and giving them the device. More research is needed to understand the increased cognitive demands of working with patients using technologically advanced exoskeletons within a dynamic, technology-rich healthcare environment, while managing patient expectations and ethical use.

关键词： vasculitis   autoinflammatory diseases   hypertension   anti-TNF  

摘要： A 9.5-year-old boy was referred with a 2-year history of recurrent fever, myalgia, abdominal pain and various neurological manifestations associated with increased acute phase reactants and IgG level. During the recent episode, severe hypertension and right-sided hemiparesis developed and angiography demonstrated irregularities and stenosis in renal and mesenteric artery branches. Although these manifestations were consistent with polyarteritis nodosa (PAN), the consanguinity of his parents, a cousin with similar clinical features and early disease onset led to suspicion of deficiency of adenosine deaminase type 2 (DADA2) diseases. DADA2 was established by demonstration of decreased ADA2 enzyme activity and a homozygous G47R mutation in the CECR1 gene. The diagnosis of DADA2 is challenging because of the overlapping manifestations with PAN and other periodic fever syndromes. DADA2 should be considered in the differential diagnosis of PAN. Raised IgG levels (usually low in DADA2) should be sought in future cases.

关键词： parainfluenza virus 5   virus discovery   encephalitis   neurological disease   cattle   genome analysis   in situ hybridization   simian virus 5   bovine astrovirus   bovine herpesvirus  

摘要： The etiology of viral encephalitis in cattle often remains unresolved, posing a potential risk for animal and human health. In metagenomics studies of cattle with bovine non-suppurative encephalitis, parainfluenza virus 5 (PIV5) was identified in three brain samples. Interestingly, in two of these animals, bovine herpesvirus 6 and bovine astrovirus CH13 were additionally found. We investigated the role of PIV5 in bovine non-suppurative encephalitis and further characterized the three cases. With traditional sequencing methods, we completed the three PIV5 genomes, which were compared to one another. However, in comparison to already described PIV5 strains, unique features were revealed, like an 81 nucleotide longer open reading frame encoding the small hydrophobic (SH) protein. With in situ techniques, we demonstrated PIV5 antigen and RNA in one animal and found a broad cell tropism of PIV5 in the brain. Comparative quantitative analyses revealed a high viral load of PIV5 in the in situ positive animal and therefore, we propose that PIV5 was probably the cause of the disease. With this study, we clearly show that PIV5 is capable of naturally infecting different brain cell types in cattle in vivo and therefore it is a probable cause of encephalitis and neurological disease in cattle.

关键词： Blood-brain barrier   brain-targeted drug delivery systems   CNS   drug targeting   neurological disorders   lipid nanoparticles   drug metabolism  

摘要： The neurological disorders affect millions of people worldwide, and are bracketed as the foremost basis of disability-adjusted life years (DALYs). The treatment options are symptomatic and often the movement of drugs is restricted by a specialized network of endothelial cell layers (adjoined by tight cell-to-cell junction proteins;occludin, claudins, and junctional adhesion molecules), pericytes and astroglial foot processes. In recent years, advances in nanomedicine have led to therapies that target central nervous system (CNS) pathobiology via altering signaling mechanisms such as activation of PI3K/Akt pathway in ischemic stroke arrests apoptosis, interruption of alpha-synuclein aggregation prevents neuronal degeneration in Parkinson's. Often such interactions are limited by insufficient concentrations of drugs reaching neuronal tissues and/or insufficient residence time of drug/s with the receptor. Hence, lipid nanoformulations, SLNs (solid lipid nanoparticles) and NLCs (nanostructured lipid carriers) emerged to overcome these challenges by utilizing physiological transport mechanisms across blood-brain barrier, such as drug-loaded SLN/NLCs adsorb apolipoproteins from the systemic circulation and are taken up by endothelial cells via low-density lipoprotein (LDL)-receptor mediated endocytosis and subsequently unload drugs at target site (neuronal tissue), which imparts selectivity, target ability, and reduction in toxicity. This paper reviews the utilization of SLN/NLCs as carriers for targeted delivery of novel CNS drugs to improve the clinical course of neurological disorders, placing some additional discussion on the metabolism of lipid-based formulations.

摘要： Introduction Despite all improvements in diagnostic imaging and therapeutic modalities, Infective endocarditis (IE) remains a highly letal disease especially in children. Stroke is an uncommon complication of endocarditis in children but it is an major cause of acquired brain injury and is assiociated with a higher mortality rate. Purpose To determine the prevalence of neurological events in infective endocarditis among children in the Tunisian context. Methods This was a prospective study that enrolled all children admitted for IE in the cardiology department of Monastir hospital between 1983 and 2017. Included Patients had definite IE based on the modified Ducke criteria. Results Fourty children with IE were identified, including 19   boys and 21   girls aged one to eighteen years. Sixteen (40%) had congenital heart disease. Left-sided IE occurred in 33 patients (82.5%), and vegetations were identified in 33   individuals (82.5%). The most often encountered microorganisms in our population were Streptococcus viridans and Staphylococcus aureus, which were identified in five and four patients, respectively. Stroke occurred in 9   patients, including five with cerebral infarction and three with intracerebral hemorrhage. The incidence of stroke in children with left-sided IE was significantly higher than in those with right-sided IE (17.5% vs. 2.5%, P   <   0.001). The most common manifestation of stroke was hemiparesis (63%). The mortality in children with IE was 50%. The mortality rate in patients who had stroke was significantly higher than those who hadn’t (75% versus 35%, P   =   0.05). Conclusions Our study indicates that stroke is common among children with IE, especially in those with left-sided IE, and stroke may increase their risk of death.

关键词： 文献计量学   《中文核心期刊要目总览》   核心期刊   神经病学   精神病学   专家评审   中华神经医学杂志   原理和方法  

摘要： 《中华神经医学杂志》主编:我们谨此郑重通知:依据文献计量学的原理和方法,经研究人员对相关文献的检索、统计和分析,以及学科专家评审,贵刊《中华神经医学杂志》入编《中文核心期刊要目总览》2017年版(即第8版)之“神经病学与精神病学”类的核心期刊。