关键词： Brain evolution   neocortex   paraflocculi   Reithroparamyinae   Paramyinae   Paleogene  

摘要： Little is known about the early evolution of the brain in rodents. We report on nine new virtual endocasts for one of the most primitive family of rodents, Ischyromyidae, based on five specimens of Pseudotomus and Notoparamys (Paramyinae) and four specimens of Reithroparamys and Rapamys (Reithroparamyinae), dating from the early Eocene to the late middle Eocene of North America (Colorado, Wyoming, Utah and Montana). The virtual endocasts were obtained from high-resolution X-ray micro-computed tomography data. Comparisons with previously described ischyromyid virtual endocasts allow us to make inferences about the ancestral condition of the brain in rodents. Since Reithroparamyinae are suggested to be more closely related to the squirrel-related clade than other Ischyromyidae, comparisons were also made with the oldest virtual endocast for a squirrel, which gave us the opportunity to look at finer neurological changes occurring in the early evolution of squirrels. These new data permit a preliminary assessment of the endocranial diversity in Ischyromyidae. The results do not show evidence for a clear increase in Encephalization Quotient through time for early rodents. Instead, variation among species could be due to ecological factors (e.g., locomotion). Significant expansion in the neocortex and increase in paraflocculi ratios may have occurred in the transition from Ischyromyidae to Sciuridae, as previously hypothesized. Large olfactory bulbs and exposed midbrain are inferred to have been features present in the common ancestor of rodents, while neocortical expansion is reconstructed as having occurred twice independently within Ischyromyidae.

关键词： Endoscopic endonasal surgery   juvenile angiofibroma   neurological morbidity   quality of life   dry eye syndrome  

摘要： Objectives/Hypothesis Although transnasal endoscopic resection (TER) of juvenile angiofibroma (JA) is unquestionably less invasive than traditional external approaches, several endonasal and neurovascular structures are sacrificed during the procedure. The aim of this study was to evaluate long-term neurological morbidity and related quality of life following TER of JA. Study Design Retrospective cohort study. Methods All patients who underwent TER for JA at the Unit of Otorhinolaryngology-Head and Neck Surgery of the University of Brescia from 1994 to 2016 were contacted to know their availability to undergo a battery of tests aimed to assess lacrimal secretion (Schirmer test), impairment of sensitive nerves (electrophysiological threshold test), and impact on quality of life of tearing reduction and sensitivity impairment with the Ocular Surface Disease Index (OSDI) and visual analogue scale (VAS) (0-10), respectively. Results Thirteen patients were included. Mean follow-up was 77 months (range, 19-156 months). The median Schirmer test value was 5.5 mm and 28.5 mm for the treated and untreated sides, respectively (P = .003). Analysis of sensitivity revealed significant impairment only in the hard palate. The mean OSDI score was 6.8 (normal). The mean values of the VAS scores for hard palate, buccal mucosa, gum, and premaxillary skin were 1.7, 1.7, 1.2, and 2.3, respectively. Conclusions TER for JA can result in objective reduction of lacrimal secretion and sensitivity impairment;nevertheless, their impact on quality of life is negligible. The predictable neurological morbidity of TER should be discussed during preoperative counseling. Level of Evidence 4 Laryngoscope, 129:2184-2188, 2019

关键词： Perioperative stroke   Morbidity   Mortality   NIS  

摘要： Perioperative stroke in non-vascular, non-neurological surgery is a potential cause of high levels of in hospital morbidity and mortality. Although, perioperative stroke following non-vascular and non neurological surgery is a relatively infrequent event;high surgical volume results in thousands of patients experiencing neurological deficits. We aim to determine if perioperative stroke is an independent risk factor for 30-day in-hospital morbidity and mortality following common non-vascular non-neurological surgery. This is a retrospective analysis of 4,264,963 surgical procedures identified in the Nationwide Inpatient Sample (NIS) from the years 2000 through 2011. The exposure of interest was stroke within 30 days of total knee arthroscopy, total hip arthroscopy, lung segmentation and resection, appendectomy, hemicolectomy, cholecystectomy, and lysis of peritoneal adhesions. Study outcomes were in-hospital mortality and in-hospital morbidity. Our study found an in-hospital morbidity, in-hospital mortality, and perioperative stroke rate of 5.5%, 0.8%, and 0.2%, respectively. Multivariable analysis revealed perioperative stroke to be a significant independent predictor (p < 0.001) of length of stay exceeding 14 days (OR = 4.55, 95% CI: 4.21-4.91), cardiovascular complications (OR = 1.96, 95% CI: 1.75-2.19), pulmonary complications (OR = 2.07, 95% CI: 1.89-2.27). The impact of perioperative stroke on in-hospital mortality was (OR = 8.53, 95% CI: 7.87-9.25), whereas cardiovascular complications impact on in-hospital mortality was (OR = 8.36, 95% CI = 7.67-9.10, p < 0.001). This study identified perioperative stroke as an independent predictor of 30-day in-hospital morbidity and mortality following non-vascular, non-neurological surgery. (C) 2019 Elsevier Ltd. All rights reserved.

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.