关键词： Biomarkers   Prognostic markers  

摘要： Study design Retrospective cohort study of 82 patients with cervical traumatic spinal cord injury (TSCI). Objectives Determine the relevance of preoperative MRI to predict neurological recovery following cervical TSCI. Setting Level I trauma center specialized in TSCI. Methods The following three MRI parameters were assessed: presence of an intramedullary hemorrhage, intramedullary lesion length and maximal compression of the spinal cord compression (MSCC). Analyses were performed to assess the relationship between MRI parameters and three neurological outcomes: ASIA motor score (AMS), improvement by at least one ASIA impairment scale (AIS) grade (conversion of AIS grade), and reaching AIS grade D or E. Results Predicting AMS based on initial AIS grade and intramedullary hemorrhage resulted in a validation R-squared of 0.662, and of 0.636 when using only the initial AIS grade. Predicting conversion of AIS grade based on initial AIS grade, intramedullary hemorrhage and lesion length resulted in a validation c-index of 0.704, and of 0.727 when using only the initial AIS grade. Predicting the likelihood of a follow-up AIS grade D or E based on initial AIS grade and intramedullary hemorrhage in a validation c-index of 0.903, and of 0.873 when using only the initial AIS grade. Conclusions Intramedullary hemorrhage and lesion length assessed from preoperative MRI were predictors of the neurological recovery following cervical TSCI. However, the clinical benefit of these MRI parameters to predict the neurological recovery remains limited when the initial AIS grade is available, confirming that the initial neurological status remains the most important predictor of the neurological outcome.

关键词： Neurology residency   Recruitment   Racial bias   Standardized test   Education  

摘要： Purpose: We sought to correct a low interview rate for racial groups underrepresented in medicine (URM) by analyzing our interview selection process, identifying sources of unintended bias, and developing a new process that would provide a more racially diverse interview pool. Methods: We analyzed our review process to determine at which point we were eliminating URM candidates at a higher rate than those who are not from an underrepresented group. A point system was created incorporating clinical grades, extracurricular activities, research, letters of recommendation, board exam scores, and life experiences. We compared the rate at which interviews were offered to URM candidates and compared those rates to historical data. We then analyzed the new process by comparing groups who were offered interviews to those who were not. Results: In 2016, 56% of URM applicants were screened out by a mandatory minimum United States Medical Licensing Examination (USMLE) test score, whereas only 39% of all other groups were disqualified by test scores. This led to 20% of the URM applicants receiving interview offers. By comparison, 30.6% of other groups were offered interviews. After removing the required minimum test score for application review and modifying the screening process to a more holistic one the following application cycle, 24.5% of URMs were offered interviews in 2017 compared to 28.1% of 1% of others. Conclusions: A comprehensive review of applications that minimizes emphasis on USMLE step 1 scores substantially reduced the difference between the percentages of URMs and those of other racial backgrounds who were offered interviews for a Neurology residency.

关键词： Antiviral treatment   Developmental quotient   Microcephaly   Sequelae   Small for gestational age  

摘要： Objective: This study aimed to evaluate the neurodevelopmental outcomes of infants with symptomatic congenital cytomegalovirus (SCCMV) disease after antiviral treatment and investigate the symptoms at birth associated with a developmental quotient (DQ) < 70. Methods: In this prospective study conducted from 2009 to 2018, infants with SCCMV disease who received oral valganciclovir (VGCV;32 mg/kg/day) for 6 weeks (November 2009 to June 2015) or 6 months (July 2015 to March 2018) were evaluated for their neurodevelopmental outcomes at around 18 months of corrected age. Sequelae were categorized as follows: no impairment with a DQ >= 80 and no hearing dysfunction;mild sequelae including unilateral hearing dysfunction or a DQ of 70-79;and severe sequelae with a DQ < 70, bilateral hearing dysfunction requiring hearing aids, blindness or epilepsy requiring anti-epileptic drugs. DQ was assessed using the Kyoto Scale of Psychological Development. Symptoms at birth associated with a DQ < 70 were determined using univariate and receiver operating characteristic curve analyses. Results: Of the 24 treated infants, 21 reached > 18 months of corrected age. Six (29%) were no impairment, 4 (19%) had mild sequelae, and 11 (52%) developed severe sequelae. The symptoms at birth associated with a DQ < 70 were microcephaly and/or small for gestational age. Conclusion: In our cohort of infants with SCCMV disease after VGCV treatment, the incidence of severe sequelae at 18 months of corrected age was around 50%. When microcephaly and/or small for gestational age are seen at birth, a low DQ may appear even after oral VGCV treatment. (C) 2019 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

关键词： Spinal cord diseases  

关键词： Palliative care concerns   neurological patients   symptom burden   prospective observational design   validation   outcome measurement  

摘要： Background: There is growing interest to integrate palliative care and its structures into the care of neurological patients. However, in Germany there is no comprehensive assessment tool capturing the symptoms of patients with advanced neurological diseases. Aim: To validate a newly developed palliative care measurement tool based on an extension of the validated core documentation system Hospice and Palliative Care Evaluation considering additional neurological issues (HOPE+). Design: Prospective, observational study using HOPE+ and as external criteria, the Eastern Cooperative Oncology Group (ECOG) performance status and the 12 months "surprise" question (12-SQ) in a neurological population, and assessment for its construct validity and diagnostic accuracy. Setting/participants: All newly admitted patients to the Department of Neurorehabilitation, Dr. Becker Rhein-Sieg-Clinic aged 18-100 years (#DRKS00010947). Results: Data from 263 patients (63 +/- 14 years of age) were analyzed. HOPE+ revealed a moderately correlated six-factor structure (r = -0.543-0.525). Correlation analysis to evaluate discriminant validity using ECOG as external criterion was high (rs(261) = 0.724, p < 0.001) and confirmed for severely affected patients by adding the 12-SQ ("No"-group: 48.00 +/- 14.92 vs "Yes"-group: 18.67 +/- 7.57, p < 0.009). Operating characteristics show satisfactory diagnostic accuracy (area under the curve: 0.746 +/- 0.049, 95% confidence interval = 0.650-0.842). Conclusion: HOPE+ demonstrates promising psychometric properties. It helps to assess palliative care issues of patients in neurological settings and, in combination with the 12-SQ, conceivably conditions when to initiate the palliative care approach in a population underrepresented in palliative care structures so far.

关键词： neurodegeneration   neurological disorders   mouse models   transcriptomics  

摘要： Target nomination for drug development has been a major challenge in the path to finding a cure for several neurological disorders. Comprehensive transcriptome profiles have revealed brain gene expression changes associated with many neurological disorders, and the functional validation of these changes is a critical next step. Model organisms are a proven approach for the elucidation of disease mechanisms, including screening of gene candidates as therapeutic targets. Frequently, multiple models exist for a given disease, creating a challenge to select the optimal model for validation and functional follow-up. To help in nominating the best mouse models for studying neurological diseases, we developed a web portal to visualize mouse transcriptomic data related to neurological disorders. Users can examine gene expression changes across mouse model studies to help select the optimal mouse model for further investigation. The portal provides access to mouse studies related to Alzheimer's diseases (AD), Parkinson's disease (PD), Huntington's disease (HD), Amyotrophic Lateral Sclerosis (ALS), Spinocerebellar ataxia (SCA), and models related to aging.

关键词： Rod microglia   Ageing   Neurological disease   Traumatic brain injury (TBI)   Neuroinflammation  

摘要： The striking morphology of microglia is one of their most prominent characteristics, with many studies categorising microglial function based on morphology e.g. ramified, hyper-ramified, activated, or amoeboid. Communications regarding rod microglia in neurological disease are scant, and where reported, these cells are rarely the focus of discussion. These factors make it difficult to determine how widespread these cells are not only through the brain but also across diseases. Studies in experimental diffuse brain injury are the first reports of not only significant numbers of rod microglia, but distinct arrangements of these cells, reminiscent of carriages of a train. This review summarises the available reports of rod microglia in vivo and rod-like microglia in vitro and eludes to possible functions and signalling cascades that may evoke this distinct morphology. More investigations are required to fully elucidate the function that rod microglia play in neurological diseases.

关键词： Urethrostomy   perineal   vertebral canal   positioning   nerve injury   neurological status   FLUTD  

摘要： Objectives The aim of this study was to evaluate and quantify the changes in neurological status in cats after perineal urethrostomy performed in dorsal and ventral recumbency. Methods This was a prospective, randomised study. Twenty male castrated cats with feline lower urinary tract disease presented for perineal urethrostomy were enrolled in this study. Surgery was performed in either dorsal recumbency (group A) or ventral recumbency (group B). Motor response of patellar tendon, gastrocnemius muscle, pelvic limb withdrawal and perineal reflexes, as well as the presence of spinal pain in the lumbosacral region, motor function of the tail and faecal continence, were examined before surgery, and 24 h and 14 days after surgery. Results The animals had a mean weight of 5.07 +/- 1.08 kg, with a mean age of 6.12 +/- 1.85 years. Weight and age were not significantly different between groups A and B (both P = 0.897). All tested parameters of the neurological examination performed prior to surgery were considered normal in both groups (P = 1). The comparison between neurological examinations (perineal reflex and spinal pain) before and 24 h after surgery revealed a significantly decreased briskness of the perineal reflex and an increased occurrence of spinal pain 24 h after surgery (P = 0.043 and P = 0.031, respectively). However, the changes of aforementioned parameters were statistically insignificant (P = 0.249 and P = 0.141) between groups A and B. The other parameters (patellar tendon, pelvic limb withdrawal and gastrocnemius muscle reflexes, motor function of the tail and faecal continence) were statistically insignificant (P = 1) before surgery and 24 h after surgery, as well as between groups A and B 24 h after surgery. Results of all tested parameters were statistically insignificant (P = 1) before surgery and 14 days after surgery, as well as between groups A and B 14 days after surgery. Conclusions and relevance The briskness of the perineal reflex was significa

摘要： While specific guidelines exist for initiation, there are no evidence-based guidelines for termination of cardiopulmonary resuscitation (CPR). B DISCUSSION: b Factors to consider in the decision to continue or terminate resuscitation efforts include patient's wishes (if known), age, comorbidities, functional status, time to CPR, initial rhythm, duration of CPR, and underlying cause, among others. During prolonged CPR, point of care ultrasound may be of benefit provided it does not affect the quality of CPR. [Extracted from the article]

关键词： Medication-overuse headache   migraine   education   quality   guidelines   neurology training  

摘要： Background In Norway, as in most other countries, the training program for clinical neurology has no mandatory headache program. Knowledge in headache management must therefore be acquired during everyday clinical training. The objectives of this study were to investigate neurology residents' knowledge of headache. Methods A questionnaire survey was undertaken among neurology residents in Norway. Results All 17 neurological departments in Norway participated, and 143 residents responded (86%). Sixty percent were women, mean age was 32.5 years, and the respondents had an average of 28 months clinical training in neurology. Fifty-six percent knew the approximate prevalence of migraine and chronic headache. Thirty-seven percent asked their patients about disability, quality of life, and social functioning at every consultation. Further, 72% would prescribe prophylaxis for chronic tension-type headache and 97% for very frequent migraine. One third wrongly stated that use of the most common headache prophylactics could lead to medication-overuse headache. Headache diaries were used regularly by 63% for diagnostic purposes, and 73% requested an MRI for all long-lasting headaches referred to neurological outpatient clinics. Conclusion Although a major public health problem, headache knowledge is moderate at best, and its management clearly varies. There is an unmet need for a better and more structured headache training program in Norway.