摘要： Most spinal cord injury (SCI) research programs focus only on the injured spinal cord with the goal of restoring locomotor function by overcoming mechanisms of cell death or axon regeneration failure. Given the importance of the spinal cord as a locomotor control center and the public perception that paralysis is the defining feature of SCI, this "spinal-centric" focus is logical. Unfortunately, such a focus likely will not yield new discoveries that reverse other devastating consequences of SCI including cardiovascular and metabolic disease, bladder/bowel dysfunction and infection. The current review considers how SCI changes the physiological interplay between the spinal cord, the gut and the immune system. A suspected culprit in causing many of the pathological manifestations of impaired spinal cord-gut-immune axis homeostasis is the gut microbiota. After SCI, the composition of the gut microbiota changes, creating a chronic state of gut "dysbiosis". To date, much of what we know about gut dysbiosis was learned from 16S-based taxonomic profiling studies that reveal changes in the composition and abundance of various bacteria. However, this approach has limitations and creates taxonomic "blindspots". Notably, only bacteria can be analyzed. Thus, in this review we also discuss how the application of emerging sequencing technologies can improve our understanding of how the broader ecosystem in the gut is affected by SCI. Specifically, metagenomics will provide researchers with a more comprehensive look at post-injury changes in the gut virome (and mycome). Metagenomics also allows changes in microbe population dynamics to be linked to specific microbial functions that can affect the development and progression of metabolic disease, immune dysfunction and affective disorders after SCI. As these new tools become more readily available and used across the research community, the development of an "ecogenomic" toolbox will facilitate an Eco-Systems Biology approach to s

摘要： [...]meningitis is one of the four largest contributors of disability due to neurological disorders which, in turn, are the leading cause of disability worldwide.1 In genome-wide association studies, the genomes of people with diseases are compared with those of healthy controls to identify small genetic changes, single-nucleotide polymorphisms, that contribute to disease susceptibility and phenotype. Eight (6%) of these 13 diagnoses had a likely clinical impact, with seven guiding treatment. [...]this technique could be a helpful upfront diagnostic screening tool for neurological infections.3 Just over 3 years ago, Zika virus infection during pregnancy was recognised as a major cause of microcephaly and other congenital anomalies in the developing fetus and newborn. Immune checkpoint-inhibiting antibodies such as pembrolizumab were found to bind to inhibitory molecules on immune cells, potentially reinvigorating antiviral immune activity.7 In a case series including eight patients with PML that had different underlying conditions, like HIV infection or lymphoma, pembrolizumab therapy led to clinical improvement or at least stabilisation of PML in five (63%) patients, accompanied by reduced CSF JC viral load and increased anti-JC virus activity.8 Although the results are encouraging, more data are needed to further define the efficacy and risk profile of this therapy in patients with PML with different underlying conditions.

关键词： ADAMTS13   VWF   Intravenous thrombolysis   Stroke   ADMA   SDMA  

摘要： Although intravenous thrombolysis (IVT) with recombinant tissue-plasminogen-activator represents a highly effective treatment in acute ischemic stroke patients, not every patient benefits. We hypothesized that pretreatment levels of mediators of hemostasis (VWF and ADAMTS13) and dimethylarginines (ADMA and SDMA) are associated with early neurological improvement and outcome after IVT in ischemic stroke. Moreover we aimed to investigate the link between ADAMTS13 and markers of inflammation (CRP, IL-6, MMP-9 and MCP-1). In 43 patients with acute ischemic stroke treated with IVT blood samples for determination of the different markers were strictly taken before treatment, as well as at 24 h, 3, 7 and 90 days after symptom onset. Early neurological improvement was assessed using the shift between National Institutes of Health Stroke Scale (NIHSS) at baseline and at 24 h. Outcome at 90 days was assessed using the modified Rankin Scale. The lowest quartile of ADAMTS13 activity was independently associated with less improvement in NIHSS (baseline-24 h) (OR 1.298, p = 0.050). No independent association of ADMA or SDMA levels at baseline with outcome could be shown. Furthermore, IL-6, MCP-1 and CRP levels at 90 days significantly differed between patients with low and high ADAMTS13 activity. Thus, ADAMTS13 might indicate or even influence efficacy of IVT.

摘要： Objectives To determine whether the neurological examination correctly distinguishes between central and peripheral vestibular lesions in dogs. Materials and Methods Retrospective study on dogs with vestibular disease presenting to two referral clinics in Germany. Results Ninety-three dogs were included;neurological examination suggested central vestibular disease in 62 and a peripheral lesion in 31. MRI diagnosis was central vestibular disease in 68 dogs and peripheral in 25. Of the 62 dogs with a lesion localisation diagnosed as central vestibular by neurological exam, 61 were correctly identified (98.4%). Twenty-four of the 31 dogs diagnosed with a peripheral lesion by neurological exam had a consistent lesion on MRI (77.4%). Clinical Significance The neurological examination is efficient at identifying lesions in the central vestibular system but less so for peripheral lesions. Therefore it is prudent to recommend imaging in dogs that show signs of peripheral vestibular syndrome but do not rapidly respond to treatment.

关键词： Arboviruses   Guillain-Barre syndrome   Human influenza   Peripheral nervous system diseases   Polyneuropathies   Public hospitals   Sentinel surveillance  

摘要： Objective To test the hypotheses that emerging viruses are associated with neurological hospitalizations and that statistical models can be used to predict neurological sequelae from viral infections. Methods An ecological study was carried out to observe time trends in the number of hospitalizations with inflammatory polyneuropathy and Guillain-Barre syndrome (GBS) in the state of Rio de Janeiro from 1997 to 2017. Increases in GBS from month to month were assessed using a Farrington test. In addition, a cross-sectional study was conducted analyzing 50 adults hospitalized for inflammatory polyneuropathies from 2015 to 2017. The extent to which Zika virus symptoms explained GBS hospitalizations was evaluated using a calibration test. Results There were significant increases (Farrington test, P<0.001) in the incidence of GBS following the introduction of influenza A/H1N1 in 2009, dengue virus type 4 in 2013, and Zika virus in 2015. Of 50 patients hospitalized, 14 (28.0%) were diagnosed with arboviruses, 9 (18.0%) with other viruses, and the remainder with other causes of such neuropathies. Statistical models based on cases of emerging viruses accurately predicted neurological sequelae, such as GBS. Conclusion The introduction of novel viruses increases the incidence of inflammatory neuropathies.

关键词： health anxiety   psychiatry   neurology   outpatient  

摘要： Objectives Prevalence of health anxiety is highly varied based on different settings and samples studied. This study aimed to assess the prevalence of health anxiety among outpatients attending neurology and psychiatry outpatient setting in tertiary care hospital and understand the clinical correlates. Participants and Methods This was a cross-sectional study conducted in the outpatient settings including participants fulfilling study criteria. The assessments included semi-structured proforma for demographic and clinical details, general hypochondriasis subscale of Illness Behavior Questionnaire, and Short Health Anxiety Inventory. Data were collected in Epi-info and data analysis was done using STATA12. Results The health anxiety was reported to be 25% and 19% among psychiatry and neurology outpatients, respectively. Higher education level positively correlated with health anxiety. Skilled workers tend to have higher health anxiety than semiskilled workers. Patients with diagnosis of somatoform disorder and multiple diagnosis scored higher on health anxiety in both the settings. Conclusion Health anxiety appears to be common in psychiatry and neurology settings and needs further evaluation to understand its impact on consultation and health resource usages.

关键词： Obesity   Multiple sclerosis   Stroke   Physical activity   Behavior change   Self-management   Ecological frameworks  

摘要： Objective: This randomized controlled pilot study examined the feasibility and efficacy of a SystemCHANGE (TM) (SC) weight management intervention in adults with either multiple sclerosis or stroke. Methods: Participants (n = 61) were randomized into two interventions: SC, which taught skills to modify personal environments, or active-control (AC), which taught health behavior guidelines. Sessions were held weekly for 12 weeks. Feasibility measures included recruitment and attrition rates. The primary outcome of body weight and secondary outcomes of emotional well-being and healthy behaviors were measured before and after the interventions. Results: Average recruitment rate was 3.6 participants per month. Attrition rate was 14.8%. On average, 9.1 sessions were completed for SC and 10.7 for AC. Differences in weight loss were non-significant between interventions (P = 0.182), but significantly declined across both interventions (P = 0.011). Physical activity (P = 0.002), depression (P < 0.001), anxiety (P = 0.023), and self-efficacy (P = 0.022) all significantly improved for SC compared to AC. Conclusions: SC was feasible to implement and efficacious in improving secondary outcomes of emotional well-being and healthy behaviors, but was not efficacious in improving the primary outcome of weight loss. More research is needed to optimize SC. Practice implications: SC might be an alternative approach to cognitive-behavioral therapy for promoting emotional well-being and healthy behaviors. (c) 2019 Elsevier B.V. All rights reserved.

关键词： Chronic disease   disability   headache  

摘要： BACKGROUND: Migraine is a chronic disorder that negatively affects a patient's quality of life (QOL). As little is known about the QOL of migraine sufferers in Saudi Arabia, our aim was to investigate the QOL and the level of migraine-associated disability of migraine *** AND METHODS: This cross-sectional study was conducted in neurology clinics at King Abdulaziz Medical City for National Guard and Prince Sultan Military Medical City in Riyadh, Saudi Arabia, from August to December 2018. The migraine-specific QOL questionnaire (MSQ), version 2.1, was used to measure restrictive, preventive, and emotional domains. The sum of the item responses ranged between 0 and 100, with higher scores indicating better QOL. A descriptive analysis of numerical variables was reported in terms of means and standard deviation, while categorical variables were described using frequencies and ***: A total of 300 migraine patients completed the questionnaire;67% were females. Age of participants ranged from 20 to 53 years, with mean age of 34.21 (SD=7.26). The mean score in the QOL restrictive domain was 51.8 +/- 19, whereas the mean scores for preventive and emotional domains were 54 +/- 18 and 46.3 +/- 23.4, respectively. Low QOL scores were associated with young ages, long disease duration, frequent migraine attacks, and presence of chronic ***: Chronic migraine has a negative impact on QOL, predominantly in young patients, patients with frequent attacks, those not using preventive medications, and those suffering from chronic diseases.

关键词： Deep learning   natural evolution strategies   artificial bee colony   L1-principal component analysis   neurological disorder   EEG signal classification  

摘要： BACKGROUND:A neurological disorder is one of the significant problems of the nervous system that affects the essential functions of the human brain and spinal cord. Monitoring brain activity through electroencephalography (EEG) has become an important tool in the diagnosis of brain disorders. The robust automatic classification of EEG signals is an important step towards detecting a brain disorder in its earlier stages before status deterioration. OBJECTIVE:Motivated by the computation capabilities of natural evolution strategies (NES), this paper introduces an effective automatic classification approach denoted as natural evolution optimization-based deep learning (NEODL). The proposed classifier is an ingredient in a signal processing chain that comprises other state-of-the-art techniques in a consistent framework for the purpose of automatic EEG classification. METHODS:The proposed framework consists of four steps. First, the L1-principal component analysis technique is used to enhance the raw EEG signal against any expected artifacts or noise. Second, the purified EEG signal is decomposed into a number of sub-bands by applying the wavelet transform technique where a number of spectral and statistical features are extracted. Third, the extracted features are examined using the artificial bee colony approach in order to optimally select the best features. Lastly, the selected features are treated using the proposed NEODL classifier, where the input signal is classified according to the problem at hand. RESULTS:The proposed approach is evaluated using two benchmark datasets and addresses two neurological disorder applications: epilepsy disease and motor imagery. Several experiments are conducted where the proposed classifier outperforms other deep learning techniques as well as other existing approaches. CONCLUSION:The proposed framework, including the proposed classifier (NEODL), has a promising performance in the classification of EEG signals, including epilepsy

关键词： 神经病学   在线教学   翻转课堂  

摘要： 如何开展在线神经病学医学本科教育,是临床医学教育者需要思考的问题。在线翻转课堂秉承"先学后教、以学定教"的教学目标,适应师生空间分离的特点,是以患者为基础、实践性强的神经病学线上理想教育模式。现就在线翻转课堂在神经病学本科教学的应用进行探讨。