关键词： Anterior cruciate ligament   Pain   Sensation   Neuroanatomy   Analgesia  

摘要： Anterior cruciate ligament (ACL) tears is a devastating injury and one of the most common knee injuries experienced by athletes in the United States. Although patients reach maximal subjective improvement by one-year following ACL reconstruction, many patients often experience moderate to severe post-operative pain. Opioids, intra-articular injections, and regional anesthesia have been previously implemented to mediate post-operative pain. However, chronic opioid usage has become an epidemic in the United States. Alternative analgesic modalities, such as nerve blocks, have been implemented in clinical practice to provide adequate pain relief and minimize opioid usage. Periarticular injections targeted towards local neurological structures performed concomitantly with nerve blocks provides superior pain relief and satisfaction than isolated nerve blocks. Therefore, it is imperative for physicians to understand local neurological anatomy around the knee joint in order to provide adequate analgesia while minimizing opioid consumption. This purpose of this investigation is to summarize (1) neurogenic origins of pain generators and mediators in sites affected by ACL reconstruction and autograft harvest sites and (2) analgesia utilized in ACL reconstruction. (C) 2019 Elsevier GmbH. All rights reserved.

关键词： Moraxella catarrhalis   Outbreak   Molecular epidemiology  

摘要： Background: Moraxella catarrhalis is a common agent causing upper and lower respiratory tract infections, particularly of ventilated patients. The bacteria are transmitted between humans by direct and indirect contacts. However, reports of nosocomial outbreaks by this pathogen are scarce. Aim: To analyse M. catarrhalis strains isolated during an outbreak in a medical rehabilitation centre to reveal their clonal relationship and to elucidate potential transmission routes. Methods: Extensive environmental and medical staff sampling was performed. Phenotypic and genotypic analyses of 15 isolates were executed, including repetitive element palindromic polymerase chain reaction (repPCR) and whole-genome sequencing. Furthermore, an intensified hygiene regimen was installed. Findings: The clonal nature of nine patient isolates and a simultaneous presence of separate entities including a strain isolated from a physician during staff screening was confirmed. Although neither asymptomatic carriers among the staff persons nor outbreak strain-contaminated fomites were identified for a specific intervention, the outbreak ceased due to maximum general and specific hygiene precautions. Retrospective analysis showed the increasing prevalence of M. catarrhalis strains over a period of two years before the incidence. Since then and after returning to the regular hygiene regimen, only one patient with a phenotypically diverse M. catarrhalis isolate has been documented. Conclusion: The first M. catarrhalis outbreak involving nine patients of a neurological and trauma rehabilitation centre was reported. Potential transmission pathways were discussed. Comprehensive outbreak analyses insinuated the extension of routine laboratory storage time for defined species. (C) 2019 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

关键词： functional annotation   immune response   miRNA   neurological functions   pathogenesis   Zika virus  

摘要： Background The concurrent Zika Virus (ZIKV) outbreaks in the United States and Northeast Brazil have evoked global surveillance. Zika infection has been correlated with severe clinical symptoms, such as microcephaly, Guillain-Barre syndrome, and other congenital brain abnormalities. Recent data suggest that ZIKV predominantly targets neural progenitor cells leading to neurological impairment. Despite the clinical evidence, detailed experimental mechanism of ZIKV neurotropic pathogenesis has not been fully understood yet. Here we hypothesized that ZIKV produces miRNAs, which target essential host genes involved in various cellular pathways facilitating their survival through immune evasion and progression of disease during brain development. Methods From genome sequence information using several bioinformatic tools, we predicted pri-miRNAs, pre-miRNAs, and finally the mature miRNAs produced by ZIKV. We also identified their target genes and performed functional enrichment analysis to identify the biological processes associated with these genes. Finally, we analyzed a publicly available RNA-seq data set to determine the altered expression level of the targeted genes. Results From ZIKV genome sequence, we identified and validated 47 putative novel miRNAs. Functional enrichment of the targeted genes demonstrates the involvement of various biological pathways regulating cellular signaling, neurological functions, cancer, and fetal development. The expression analysis of these genes showed that ZIKV-produced miRNAs downregulate the key genes involved in these pathways, which in turn may lead to impaired brain development. Conclusions Our finding proposes novel ZIKV miRNAs and their targets, which upon experimental validation could help developing new therapeutics to combat ZIKV infection and minimize ZIKV-mediated pathologies.

关键词： IgA vasculitis   Encephalopathy   MRI   Arterial spin labeling   Cytokine   Interleukin-6  

摘要： Immunoglobulin A vasculitis (IgAV) occasionally induces central nervous system (CNS) involvement, which is usually transient with no sequelae except for hemorrhagic stroke. It is thought to be useful to measure serum and cerebrospinal fluid (CSF) cytokine levels for better understanding the pathological condition in encephalopathy, but there have been no reports in acute encephalopathy with IgAV. We describe an 8-year-old boy with IgAV who had neurological sequelae after complication of acute encephalopathy, focusing on the cytokine profiles and unique biphasic findings of magnetic resonance imaging. He presented with status epilepticus and mildly intensified area in the occipital lobe on the fluid-attenuated inversion recovery view. Arterial spin labeling (ASL) revealed the reduction of cerebral blood flow in the left hemisphere. On day 5 of illness, these abnormal findings disappeared, but delayed hyperintensity lesions on diffusion-weighted images newly emerged. Furthermore, CSF interleukin (IL)-6 levels markedly increased without elevated levels of IL-10 during the acute phase of disease. He suffered from long-lasting hemiparesis and intellectual impairment. In conclusion, acute encephalopathy with IgAV could cause neurological sequelae by prolonged seizure, and elevated IL-6 in CSF and laterality of cerebral blood flow in ASL might be useful to predict the prognosis of CNS dysfunction of IgAV. (C) 2019 Elsevier Ltd. All rights reserved.

关键词： Sialorrhea   Drooling   Botulinum   Salivary   Aspiration   Pneumonia  

摘要： Objective: To describe the effects of salivary gland Botulinum Toxin-A (SG BoNT-A) on children with drooling due to neurological dysfunction. Methods: This was a 31/2-year prospective observational case series design of children referred for SG BoNT-A injections at a pediatric hospital (2010-2014). Outcomes were parent-reported severity, frequency, impact of drooling, and respiratory morbidity;and, from hospital records, number of respiratory hospital admissions. Results: Out of 17 children treated, complete data were available for 15 (including 8 boys) aged 3-14 years (Mean = 9.9 years;SD = 3.4), with a combined total of 71 injections. Most had cerebral palsy (n = 11), classified as Level V (n = 10) or IV (n = 1) on the Gross Motor Function Classification Scale (GMFCS). In almost all instances, parents reported reductions in severity, frequency, and impact of drooling, and parent-reported respiratory morbidity. Among those with posterior drooling (n = 12), most children (n = 10) did not have advanced respiratory disease. A trend towards reduced respiratory-related hospital admissions was observed during SG BoNT-A treatment periods. Conclusion: SG BoNT-A can improve severity, frequency, and impact of drooling. It can also reduce respiratory-related hospital admissions in children with posterior drooling without advanced respiratory disease. For children with advanced respiratory disease, it may reduce severity and impact of drooling.

关键词： Conferences   Gender disparity   Gender gap   Gender representation   Neurological surgery conferences   Neurosurgery   Women in neurosurgery  

摘要： BACKGROUND: Women constitute a minority (9.2%) of academic neurosurgeons. We previously found that women in academic medicine are disadvantaged in funding and career advancement opportunities. We hypothesized that women are also underrepresented at neurosurgical society conferences. METHODS: Programs from the 2014-2018 meetings of the Congress of Neurological Surgeons (CNS), American Association of Neurological Surgery (AANS), and North American Skull Base Society (NASBS) were analyzed. Demographic data, including name, gender, and geographic region of practice, were collected for speaker, moderator, or leadership positions. chi(2) statistical analysis was performed for difference in gender representation across all opportunity spots. RESULTS: In the period 2014-2018, there was no female presidents or honored guest at any academic meetings analyzed;53.8% of executive committees comprised all men. Women often constituted a minority (<15%) of speakers and moderators at CNS, AANS, and NASBS meetings: speakers (% female, range), 8.6 (5.5-11.7), 13.6 (10.1-19.7), and 10.5 (5.6-16.6);moderators (% female, range), 7.8 (0-14.3), 23.0 (81.3-91.3), and 13.0 (8.6-18.7). Conference panels frequently comprised all men (58% CNS, 20.7% AANS, 61% NASBS). chi(2) analysis found a disparity in male and female participation across all opportunity spots (P = 0.002). Additionally, female participants are often repeated, decreasing total number of unique women participating. There was no significant increase in female participation across the study period. CONCLUSIONS: In 2014-2018, underrepresentation of women in national neurosurgical conferences either matched or exceeded the baseline gender disparity seen in academic neurosurgery. We discussed potential causes of and strategies to address these findings.

关键词： Port-wine birthmark   Seizures   Migraine   Stroke-like episodes   Magnetic resonance imaging   Consensus statement  

摘要： Objective: We aimed to identify the current status and major unmet needs in the management of neurological complications in Sturge-Weber syndrome. Methods: An expert panel consisting of neurologists convened during the Sturge-Weber Foundation Clinical Care Network conference in September 2018. Literature regarding current treatment strategies for neurological complications was reviewed. Results: Although strong evidence-based standards are lacking, the implementation of consensus-based standards of care and outcome measures to be shared across all Sturge-Weber Foundation Clinical Care Network Centers are needed. Each patient with Sturge-Weber syndrome should have an individualized seizure action plan. There is a need to determine the appropriate abortive and preventive treatment of migraine headaches in Sturge-Weber syndrome. Likewise, a better understanding and better diagnostic modalities and treatments are needed for stroke-like episodes. As behavioral problems are common, the appropriate screening tools for mental illnesses and the timing for screening should be established. Brain magnetic resonance imaging (MRI) preferably done after age one year is the primary imaging modality of choice to establish the diagnosis, although advances in MRI techniques can improve presymptomatic diagnosis to identify patients eligible for preventive drug trials. Conclusion: We identified the unmet needs in the management of neurological complications in Sturge-Weber syndrome. We define a minimum standard brain MRI protocol to be used by Sturge-Weber syndrome centers. Future multicenter clinical trials on specific treatments of Sturge-Weber syndrome-associated neurological complications are needed. An improved national clinical database is critically needed to understand its natural course, and for retrospective and prospective measures of treatment efficacy. (C) 2019 Elsevier Inc. All rights reserved.

关键词： CD200   intracerebral hemorrhage   blood-brain barrier  

摘要： CD200 is widely distributed in the central nervous system and plays an essential role in the immune response in neurological diseases. However, little is currently known about the effects of CD200 signaling on the blood-brain barrier (BBB) function after intracerebral hemorrhage (ICH). In this study, the role of CD200 during ICH in an autologous blood induced mouse ICH model was investigated. Following ICH, critical protein expression, BBB permeability, and neurological function were measured with or without CD200Fc administration. Our results showed that both the expression of CD200 and CD200R1 decreased after ICH and administration of CD200Fc attenuated BBB leakage and improved neurological functions. In conclusion, our work demonstrated that CD200Fc might be a potential treatment option for ICH by protecting the BBB and improving functional outcomes.

关键词： Neurogenetics   Next-generation sequencing   Gene panel   Clinical exome   Whole-exome sequencing   Diagnostic yield  

摘要： The exponential knowledge on the genetic etiology and the trend towards genetically-specific therapies for previously untreatable disorders, requires neurologists to be familiar with the strengths and weaknesses of Next-Generation Sequencing (NGS). Our aim was to assess the diagnostic yield of NGS studies in clinical practice in our setting. We performed a retrospective, cross-sectional, 18 months long study, from a single Portuguese center, of consecutive neurological patients for whom a NGS study was requested. A diagnosis rate (DR) of 33.2% was achieved for a total of 190 patients (89 children). It was higher for muscle diseases (DR 61.1%). In 20%, an inconclusive molecular diagnosis was obtained. The rate of incidental findings (IF) was 5.3%. We found better DR for clinical exome (52.6%. p < 0.05) although only 14% of patients were characterized using this approach. The performance of gene panels for muscle diseases was better but not statistically significant (DR 56.3% vs. 31.7% overall, p > 0.05). The reduced number of patients in several phenotypic groups limits the interpretation of specific diagnostic yields. The better yield of gene panels for muscle diseases suggests that gene panels may be a more cost-effective first-line test in well-defined phenotypes. For heterogeneous phenotypes and overall, WES-based virtual panels or clinical exome should be favored. We present daily practice evidence that, with the constraints of our health system, for one third of the patients with neurological disorders of undetermined etiology a definitive diagnosis can be reached with NGS. (C) 2019 Elsevier Ltd. All rights reserved.

关键词： Walking   Gait speed   Diabetes   Disability   Cardiovascular  

摘要： Background: Neurologic gait abnormalities (NGA) increase risk for falls and dementia, but their pathophysiologic substrates or association with disability have been poorly investigated. We evaluated the association of NGA with clinical characteristics and functional status in older community-dwellers. Methods: Gait characteristics were measured in older community-dwellers without neurological or psychological diseases participating to the Health Aging Body Composition study. NGA were rated using standardized readings of video-recorded short walks, combined with standard neurological exam. We tested cross-sectional associations with demographics, vascular risk factors, comorbidities, cognitive function and disability. Results: Of 177 participants (median age [IQR] = 82 [4] years, 55% women, 58% Caucasian), 49 (27.7%) had NGA. The most prevalent sub-types were unsteady (10.7%), hemiparetic (4.5%) and parkinsonian (4%). In multivariable logistic regression models, diabetes was associated with higher risk (OR = 3.24, 95% CI = 1.38-7.59), whereas higher physical activity (OR = 0.89, 95% CI = 0.80-0.99) and gait speed (OR = 0.04, 95% CI = 0.005-0.27) with lower risk of NGA. Prevalence of NGA was associated with difficulty in at least 1 activity of daily living, adjusting for confounders (OR = 2.90, 95% CI = 1.11-7.58). After adjusting for gait speed, this association was attenuated to non-significance (OR = 2.13, 95% CI = 0.71-6.37). Conclusions: In our sample of community-dwelling older adults without neurological diseases, NGA, detected with a standardized neurological exam, part of usual physicians' training, were common. The relationships with diabetes and reduced physical activity might suggest vascular dysfunction as an underlying contributor to NGA. These results, if confirmed by longitudinal studies, which should also disentangle the relationship between NGA, gait speed and disability, might add information for preventing and managing mobility disability.