关键词： Neuron-specific enolase   Cardiac arrest   Cardiopulmonary resuscitation   Prognosis  

摘要： Aim: Neuron-specific enolase (NSE) increases in response to brain injury and is recommended for outcome prediction in cardiac arrest patients. Our aim was to investigate whether NSE measured at different days after a cardiac arrest and its kinetics would improve the prognostic ability of two cardiac arrest specific risk scores. Methods: Within this prospective observational study, we included consecutive adult patients after cardiac arrest. We calculated the Out-of-hospital cardiac arrest (OHCA) score and the Cardiac Arrest Hospital Prognosis (CAHP) score upon ICU admission and measured serum NSE upon admission and days 1, 2, 3, 5 and 7. We calculated logistic regression models to study associations of scores and NSE levels with neurological outcome defined by Cerebral Performance Category (CPC) scale and in-hospital death. Results: From 336 included patients, 180 (54 degrees 6) survived until hospital discharge, of which 150 (45 degrees 6) had a good neurological outcome. NSE at day 3 showed the highest prognostic accuracy (discrimination) for neurological outcome (area under the curve (AUC) 0.89) and in-hospital mortality (AUC 0.88). These results were robust in reclassification statistics and across different subgroups. NSE kinetics with admission levels serving as a baseline did not further improve prognostication. NSE on day 3 significantly improved discrimination of both clinical risk scores (CAHP from AUC 0.81 to 0.91;OHCA from AUC 0.79 to 0.89). Conclusion: NSE measured at day 3 significantly improves clinical risk scores for outcome prediction in cardiac arrest patients and may thus add to clinical decision making about escalation or withdrawal of therapy in this vulnerable patient population.

关键词： cerebrospinal fluid   GFAP   NF-L   protein markers   tau protein  

摘要： Background Elevated levels of the cerebrospinal fluid (CSF) neuronal injury markers (neurofilament light chain [NF-L] and total tau protein [t-tau]) and of the astroglial marker glial fibrillary acidic protein (GFAP) are found in etiologically different neurological disorders affecting the peripheral and the central nervous system. Aims To explore the role of CSF biomarkers in the clinical management of patients admitted for alarming neurological symptoms, but in whom neurological disorders could be excluded. Methods Study participants were patients seeking medical attention for neurological symptoms primarily considered to be caused by a neurological diagnosis and investigated according to clinical routine. Demographic, clinical, and CSF data were extracted retrospectively from medical records. Patients with a final neurological diagnosis were excluded. Results Out of 990 patients, 900 with a neurological diagnosis were excluded leaving 90 patients without a final neurological diagnosis. Sixty-eight (75.6%) were females. Median (range) age at lumbar puncture was 34.7 (16.9-65.1) years. Age-adjusted CSF-NF-L, CSF-t-tau, and CSF-GFAP concentrations were normal in 89 (98.9%), 86 (95.6%), and 87 (96.7%) patients, respectively. Conclusion In patients with significant neurological symptoms but in whom a neurological diagnosis could not be made, the CSF markers NF-L, t-tau, and GFAP did not indicate signs of neuronal or astroglial cell damage close to symptom onset. Consequently, increased levels of CSF markers are not expected in this patient group and, if present, should raise suspicion of underlying neurological disorders and motivate further investigations.

关键词： diffuse large B-cell lymphoma   DLBCL   CD19   cytokines   ABCL   aggressive B-cell lymphoma  

关键词： Motor axon regeneration   Collagen scaffold   Complete spinal cord transection   Locomotor recovery   Neuronal regeneration  

摘要： Many studies have shown that rodents exhibit a certain degree of spontaneous motor function recovery even if they suffer from spinal cord complete transection injury. However, the characteristics of spontaneous locomotor recovery and its associated neurobiological mechanisms are unclear. In this study, we observed that spontaneous locomotor function recovery of hind limbs could also be detected in a canine thoracic (T8) spinal cord complete transection model. In addition, the spontaneous locomotor recovery of canines could be further promoted by chronic implantation of Taxol- or human bone marrow mesenchymal stem cell-modified bio-scaffolds. Moreover, functional bio-scaffolds implantation promoted locomotor outcome could be significantly weakened (drop to the spontaneous recovery level) but not totally abolished by resection in the lesion site. The neurological mechanism for functional bio-scaffolds improved locomotor outcome was primarily dependent on the formation of neuronal bridging but not the long-distance regeneration of descending motor axons throughout the lesion gap. Besides that, we found that spontaneously achieved locomotor recovery of hind limbs was unable to be weaken by repetitive resection of the lesion area, indicating the mechanism for spontaneous locomotor recovery was independent on functional neurological bridging throughout the lesion gap.

关键词： Adverse effects   Cancer immunotherapy   Immunotherapy   Risk factors   Tumour biomarkers  

摘要： Paraneoplastic neurological syndromes (PNSs) comprise a group of disorders that can affect any part of the nervous system in patients with cancer and frequently result from autoimmune responses triggered by the ectopic expression of neuronal proteins in cancer cells. These disorders are rare, although the introduction of immune-checkpoint inhibitors (ICIs) into cancer treatment algorithms has renewed interest in PNSs. ICIs are associated with a considerably increased incidence of immunological toxicities compared with traditional anticancer therapies, including neurological immune-related adverse effects (nirAEs) that can manifest as PNSs. Theoretically, the use of ICIs might increase the risk of PNSs, in particular, in patients with the types of cancer that are most frequently associated with these disorders (such as small-cell lung cancer), emphasizing the importance of their prompt diagnosis and treatment to prevent irreversible neurological deficits. To facilitate the recognition of these disorders in the context of immune-checkpoint inhibition, we provide an overview of PNSs, including the main syndromes, types of neuronal autoantibodies and associated immunological mechanisms. We also review the scenarios in which nirAEs fulfil the criteria for PNSs and examine their frequency and clinical presentations. Finally, we provide recommendations for the prevention and management of PNSs that can occur during ICI therapy.

关键词： Catatonia   Extrapyramidal disorder   Parkinsonism   Major depression   Schizophrenia  

摘要： Catatonia is a well-described clinical syndrome characterized by features that range from mutism, negativism and stupor to agitation, mannerisms and stereotype. Causes of catatonia may range from organic brain disorders to psychiatric conditions. Despite a characteristic syndrome, catatonia is grossly under diagnosed. The reason for missed diagnosis of catatonia in neurology setting is not clear. Poor awareness is an unlikely cause because catatonia is taught among conditions with deregulated consciousness like vegetative state, locked-in state and akinetic mutism. We determined the proportion of catatonia patients correctly identified by neurology residents in neurology emergency. We also looked at the alternate diagnosis they received to identify catatonia mimics. Twelve patients (age 22-55 years, 7 females) of catatonia were discharged from a single unit of neurology department from 2007 to 2017. In the emergency department, neurology residents diagnosed none of the patients as catatonia. They offered diagnosis of extrapyramidal syndrome in 7, meningitis in 2, and conversion reaction, acute psychosis/encephalopathy and non-convulsive status epilepticus in one each. Their final diagnosis at discharge was catatonia due to general medical condition in 6 (progressive supranuclear palsy in 2, post-status epilepticus, uremic encephalopathy, glioblastoma multiforme and tuberculous meningitis in one each), catatonia due to major depression in 4, schizophrenia and idiopathic catatonia in one each. Extrapyramidal syndrome appeared as common mimic of catatonia. The literature reviewed also revealed the majority of organic catatonia secondary to causes that are usually associated with extrapyramidal features. Therefore, we suggest that neurologists should consider catatonia in patients presenting with extrapyramidal syndromes.

关键词： Out-of-hospital cardiac arrest   Outcome   Machine learning analysis  

摘要： Background: This study aimed to train, validate and compare predictive models that use machine learning analysis for good neurological recovery in OHCA patients. Methods: Adult OHCA patients who had a presumed cardiac etiology and a sustained return of spontaneous circulation between 2013 and 2016 were analyzed;80 degrees. of the individuals were analyzed for training and 20% were analyzed for validation. We developed using six machine learning algorithms: logistic regression (LR), extreme gradient boosting (XGB), support vector machine, random forest, elastic net (EN), and neural network. Variables that could be obtained within 24 hours of the emergency department visit were used. The area under the receiver operation curve (AU ROC) was calculated to assess the discrimination. Calibration was assessed by the Hosmer-Lemeshow test. Reclassification was assessed by using the continuous net reclassification index (NRI). Results: A total of 19,860 OHCA patients were included in the analysis. Of the 15,888 patients in the training group, 2228 (14.05) had a good neurological recovery;of the 3972 patients in the validation group, 577 (14.5%) had a good neurological recovery. The LR, XGB, and EN models showed the highest discrimination powers (AUROC (95% CI)) of 0.949 (0.941-0.957) for all), and all three models were well calibrated (Hosmer-Lemeshow test: p>0.05). The XGB model reclassified patients according to their true risk better than the LR model (NRI: 0.110), but the EN model reclassified patients worse than the LR model (NRI: -1.239). Conclusion: The best performing machine learning algorithm was the XGB and LR algorithm.

关键词： Functional Neurological Disorder   Conversion Disorder   Education   Neuropsychiatry  

摘要： Objectives of this study were to identify the knowledge and support needs for a wide range of health professions who come in contact with patients with Functional Neurological Disorders (FND) in Australia. Invitations to an anonymous online survey (36 items) were sent to health professionals (practicing in the fields of neurology, psychiatry, psychology, general practice, nursing and physiotherapy) who are involved in the care of patients suffering from FND. Potential participants were invited via professional and hospital databases, advertising in professional newsletters as well as direct emails. A total of 538 health professionals completed the questionnaire. Most participants did not feel well educated about FND with only 14% of General practitioners (GPs) reporting 'good' knowledge. Neurologists, GPs and nurses reported lower clinical interest and greater negative attitude towards FND than psychiatrists, psychologists and physiotherapists. Many health professionals do not feel confident discussing the possibility of a Functional Neurological Disorder with a patient. Seeing more patients per year was significantly correlated with greater knowledge (r = 0.54) and confidence diagnosing (r = 0.49) FND. It was also significantly related to confidence in discussing the diagnosis of FND with a patient (r = 0.44). These factors were not significantly related to years of practice. Although patients suffering from Functional Neurological Disorders are commonly seen by many health professionals in clinic practice, there is little training in this area and self-perceived knowledge in Australia is generally poor. There is, however, clear interest in this area and our findings suggest that improved teaching and education of health professionals about FND and its management could potentially have a significant impact towards better patient care. Crown Copyright (C) 2019 Published by Elsevier Ltd. All rights reserved.