关键词： Onchocerca volvulus   Epilepsy   Neurological features  

摘要： Human onchocerciasis, caused by infection by the filarial nematode Onchocerca volvulus, is a major neglected public health problem that affects millions of people in the endemic regions of sub-Saharan Africa and Latin America. Onchocerciasis is known to be associated with skin and eye disease and more recently, neurological features have been recognized as a major manifestation. Especially the latter poses a severe burden on affected individuals and their families. Although definite studies are awaited, preliminary evidence suggests that neurological disease may include the nodding syndrome, Nakalanga syndrome and epilepsy but to date, the exact pathophysiological mechanisms remain unclear. Currently, the only way to prevent Onchocera volvulus associated disease is through interventions that target the elimination of onchocerciasis through community distribution of ivermectin and larviciding the breeding sites of the Similium or blackfly vector in rivers. In this review, we discuss the epidemiology, potential pathological mechanisms as well as prevention and treatment strategies of onchocerciasis, focusing on the neurological disease.

关键词： Karenia brevis (K. brevis)   brevetoxin   headache   exposure-response   illness cost  

摘要： Human respiratory and gastrointestinal illnesses can result from exposures to brevetoxins originating from coastal Florida red tide blooms, comprising the marine alga Karenia brevis (K. brevis). Only limited research on the extent of human health risks and illness costs due to K. brevis blooms has been undertaken to date. Because brevetoxins are known neurotoxins that are able to cross the blood-brain barrier, it is possible that exposure to brevetoxins may be associated with neurological illnesses. This study explored whether K. brevis blooms may be associated with increases in the numbers of emergency department visits for neurological illness. An exposure-response framework was applied to test the effects of K. brevis blooms on human health, using secondary data from diverse sources. After controlling for resident population, seasonal and annual effects, significant increases in emergency department visits were found specifically for headache (ICD-9 784.0) as a primary diagnosis during proximate coastal K. brevis blooms. In particular, an increased risk for older residents (>= 55 years) was identified in the coastal communities of six southwest Florida counties during K brevis bloom events. The incidence of headache associated with K. brevis blooms showed a small but increasing association with K. brevis cell densities. Rough estimates of the costs of this illness were developed for hypothetical bloom occurrences.

关键词： MRS   Wilson's disease   Neurological changes   Children  

摘要： Purpose: Although brain magnetic resonance spectroscopy (MRS) imaging findings in adult Wilson disease (WD) have been explained in extensive details, a paucity of information currently exists regarding brain MRS imaging findings in pediatric WD. The purpose of this study was to clarify the role of brain MRS in detecting early metabolite abnormalities in children with WD. Patient and methods: A case-controlled prospective study included 26 children with WD and 26 healthy controls. All children were subjected to examination on a 1.5 T MRI scanner. The spectra of N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr), as well as the metabolite ratios of NAA/Cho, NAA/Cr, and Cho/Cr, were measured and compared between two groups. Results: Eight patients revealed increased signal intensity in the basal ganglia at T1-weighted images. When compared with healthy controls, WD patients showed a significant decrease (p < 0.05) in NAA (63.8 +/- 9.6 vs 97.6 +/- 3.8), Cho (46.7 +/- 8.9 vs 87.3 +/- 4.7), Cr (44 +/- 10.1 vs 81.9 +/- 4.05), NAA/Cho (1.92 +/- 1.2 vs 3.34 +/- 0.55), NAA/Cr (1.29 +/- 0.7 vs 2.46 +/- 0.34), and Cho/Cr (0.78 +/- 0.4 vs 2 +/- 0.13). Patients complicated with liver cell failure showed a significant decrease in all previous parameters (p < 0.05) than patients without complications. Patients with mixed neurological and hepatic diseases showed a severe reduction in NAA, NAA/Cr, and NAA/Cho compared with patients with hepatic disease only. Conclusion: MRS in pediatric WD detects early neurological changes even with normal MRI.

关键词： Anticipated stigma   Healthcare utilization   COPD   Neurological disorders  

摘要： This descriptive correlational study explored the experience of anticipated stigma and its association with health-seeking behavior in individuals with COPD or a neurological disorder. Participants with COPD (n = 38) or neurological disorders (n = 39) were recruited from specialty practices. The Chronic Illness Anticipated Stigma Scale (CIASS) and Healthcare Access Measure (HAM) were used to measure stigma and healthcare utilization in this population. Socio-demographic and illness-related data were entered into a hierarchical regression analysis to identify variables that contribute to anticipated stigma from three sources. The mean scores of anticipated stigma by family and friends, coworkers, and healthcare workers were low to moderate at 7.96, 11.68 and 7.94 respectively. Mean score on the HAM was 12.94, indicating moderate delay, in healthcare utilization. The HAM was correlated with anticipated stigma by family and friends and healthcare provider subscales (r = .293, p = .010;r = .449 p = .000), indicating a relationship between higher levels of anticipated stigma in these areas and lower levels of healthcare utilization. Anticipated stigma by coworkers was correlated with neurological disorders (r = .257, p = .048). In a final model, 20%, 35.4% and 16.8% of the variance of anticipated stigma from 3 sources can be explained in the final model. Findings from this study describe low to moderate levels of anticipated stigma from three sources is experienced in individuals with COPD and neurological disorders and lends new understanding about the association of stigma to healthcare utilization behavior in this population. Strategies are needed to mitigate the effects of stigma on healthcare utilization.

关键词： Paraneoplastic neurological syndrome   Vascular endothelial growth factor (VEGF)   Tumor necrosis factor-alpha (TNF-alpha)   Interleukin 4 (IL-4)   S-100B   Neuron-specific enolase (NSE)  

摘要： The blood-brain barrier (BBB) disruption is a critical step in paraneoplastic neurological syndrome (PNS) development. Several cytokines have been implicated in BBB breakdown. However, the exact step-by-step mechanism in which PNS develops is unknown, and the relationship between a systemic neoplasm and BBB is multilevel. The aim of the present study was to examine serum markers of BBB breakdown (S100B protein, neuron-specific enolase, NSE) and concentrations of proinflammatory (TNF-alpha, VEGF) and anti-inflammatory/immunosuppressive cytokines (IL-4), and to establish their interrelationship in patients with PNS. We analyzed 84 patients seropositive for onconeural antibodies that originated from a cohort of 250 cases with suspected PNS. Onconeural antibodies were estimated with indirect immunofluorescence and confirmed with Western blotting. Serum S-100B was estimated using electrochemiluminescence immunoassay. NSE, VEGF, TNF-alpha and IL-4 were analyzed with ELISA. We found that S-100B protein and NSE serum concentrations were elevated in PNS patients without diagnosed malignancy, and S-100B additionally in patients with peripheral nervous system manifestation of PNS. Serum VEGF levels showed several abnormalities, including a decrease in anti-Hu positive patients and increase in PNS patients with typical manifestation and/or central nervous system involvement. Increase in TNF-alpha was observed in patients with undetermined antibodies. To conclude, the presence of paraneoplastic neurological syndrome in seropositive patients does not affect serum markers of BBB breakdown, with the exception of the group without clinically demonstrated malignancy and patients with peripheral manifestation of PNS. S-100B and NSE might increase during early phase of PNS. VEGF may be involved in typical PNS pathophysiology.

摘要： Background: Chronic back pain affects many aspects of everyday life and is a common reason for medical visits, leading to high direct and indirect health care costs. Innovative and cost-effective non-pharmacologic pain management methods should be promoted to ensure adequate treatment. Aims: The aim of this pilot study was to investigate the pain-relieving effect of Therapeutic Touch in adult neurologic patients with back pain. Design: A pretest-post-test randomized controlled trial. Settings: A university hospital in Austria. Participants/Subjects: Patients with back pain diagnosis (N = 29) on hospital admission. Methods: A pilot study was conducted for 3 months. The control group (n = 14) received the pharmacologic pain management recommended by the World Health Organization;patients in the intervention group (n = 15) received additionally four Therapeutic Touch treatments on 4 consecutive days. The Quebec Back Pain Disability Scale and the Numeric Pain Rating Scale were used as outcome measures to evaluate activity domains affected by back pain and pain intensity. Results: Pain improvement was found in the intervention group according to the mean score of the Quebec Back Pain Disability Scale (day 1: 72.53, standard deviation [SD] +/- 14.10;day 4: 39.47, SD +/- 8.77;p < .001). The Numerical Pain Rating Scale score averaged 4.33 points (SD +/- 2.09) on the first day and 2.47 points (SD +/- 1.12) on the fourth day. The long-term effect of Therapeutic Touch was significant and indicated a major effect (Pillai's trace = .641, F-(3.12) = 7.1, p = .005, eta(2)(p) = .641). Conclusions: Therapeutic Touch seems to be a noninvasive nursing intervention for back pain management to provide more professional patient care. (C) 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

关键词： DIAGNOSIS of abdominal pain   MORPHINE   DIPHENHYDRAMINE (Drug)   NEUROLOGIC manifestations of general diseases   DIAGNOSIS   SNAKEBITES   COMPUTED tomography   LIPS   PALPATION   VITAL signs   CHILDREN   THERAPEUTIC use  

摘要： The article presents a case study of 9-year-old male with abdominal pain and lip swelling after he awoke from a nap. It mentions his laboratory tests, including blood counts, electrolytes, and urinalysis, were normal; and also mentions Abdominal computed tomography scan showed free fluid in his pelvis and received morphine, diphenhydramine, and fluids prior to arrival.

关键词： Diarrhea   Tube feeding   Natural food   Neurological patients  

摘要： Background & aims: Diarrhea has negative consequences for patients, health care staff and health care costs when neurological patients are fed enterally over long periods. We examined the effect of tube feeding with natural foods in reducing the number of fluid stool evacuations and diarrhea in critically ill neurological patients. Methods: A multicenter, prospective, open-label and randomized controlled trial (RCT) was conducted at facilities in Germany specializing in early rehabilitation after neurological damage. Patients of the INTERVENTION group were fed by tube using a commercially available product based on real foods such as milk, meat, carrots, whereas CONTROL patients received a standard tube-feed made of powdered raw materials. All received enteral nutrition over a maximum of 30 days. The number of defecations and the consistency of each stool according to the Bristol Stool Chart (BSC) were monitored. In addition, daily calories, liquids and antibiotic-use were recorded. Results: 118 Patients who had suffered ischemic stroke, intracerebral hemorrhage, traumatic brain injury or hypoxic brain damage and requiring enteral nutrition were enrolled;59 were randomized to receive the intervention and 59 control feed. There were no significant differences in clinical screening data, age, sex, observation period or days under enteral nutrition between the groups. Patients in both groups received equivalent amount of calories and fluids. In both groups antibiotics were frequently prescribed (69.5% in the INTERVENTION group and 75.7% in the CONTROL group) for 10-11 days on average. In comparison to the CONTROL group, patients in the INTERVENTION group had a significant reduction of the number of watery stool evacuations (type 7 BSC) (minus 61%, IRR = 0.39, p < 0.001). Further statistical evaluations using the following corrections: major diarrhea-associated confounders (number and duration of antibiotics);shorter observation period of 15 days;excluding patients with

关键词： Autoimmune cytopenia   Evans syndrome   primary immunodeficiency   CTLA deficiency   neurological disorder   lymphoproliferation  

摘要： PurposeImmune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia (AIHA) are associated in the definition of Evans syndrome (ES). The occurrence of neurological involvement in this population is poorly described and suggests an underlying primary immunodeficiency (PID). We aimed to describe the clinical manifestations, evolution, and PID profiles of these ***'CEREVANCE is a French, nationwide prospective cohort that includes children with chronic ITP, AIHA, and ES. Patients with a neurological involvement were described. Centralized radiological and pathological reviews and genetic analyses were *** October 2016, eight patients (7/181 ES, 1/371 AIHA, and 0/615 ITP) were identified, all male, with a median age (range) at cytopenia onset of 11.5years (1.6-15.8). Neurological symptoms appeared with a median delay of 6years (2.5-18) after cytopenia and were polymorphic: seizures (n=4), cranial nerve palsy (n=2), Brown-Sequard syndrome (n=2), intracranial pressure (n=2), vertigo (n=1), and/or sensory neuropathy (n=1). Magnetic resonance imaging (MRI) showed inflammatory lesions, confirmed by pathology for five patients with macrophagic or lymphoplasmocytic infiltrates. All patients had other relevant immunopathological manifestations: pulmonary nodules (n=6), lymphoproliferation (n=4), abnormal immunophenotype (n=8), and hypogammaglobulinemia (n=7). Treatment consisted of steroids that improved symptomatology and MRI. Five patients relapsed and three had an asymptomatic radiological progression. A PID was identified in 3/8 patients: 22q11.2 microdeletion (n=1) and CTLA deficiency (n=2).ConclusionNeurological involvement is a rare and severe late event in the course of childhood ES, which can reveal an underlying PID. Imaging and pathology examination highlight a causative immune dysregulation that may guide targeted therapeutic strategies.

关键词： spinal cord injury   low frequency pulsed electromagnetic field   neurological function   oligodendrocyte   remyelination  

摘要： Low frequency pulsed electromagnetic field (LFPEMF) has been shown to provide anti-inflammatory and antioxidative effects. However, there are no reports on whether LFPEMF can treat spinal cord injury (SCI) and its therapeutic mechanism. Therefore, this study was conducted to investigate whether LFPEMF can promote the recovery of neurological function after SCI in rats and its therapeutic mechanism. Basso-Beattie-Bresnahan (BBB) score and transcranial magnetic motor-evoked potentials (tcMMEPs) were recorded to assess the recovery of neurological function. Hematoxylin and eosin (HE) staining and luxol fast blue (LFB) staining were performed to assess the severity of SCI. Immunofluorescence (IF) staining and western blotting (WB) were performed to assess the differentiation of oligodendrocyte precursor cells (OPCs) into oligodendrocytes (OLs). Toluidine blue (TB) staining was performed to assess remyelination. WB and enzyme-linked immunosorbent assays (ELISA) were performed to assess the expression of neurotrophins and inflammatory factors. Our results showed that following stimulation by LFPEMF, there were significant improvements in BBB scores, tcMMEP amplitudes, the extent of the damage, and reduced demyelination in rats after SCI. The mature OLs, the number of well-myelinated fibers, and the myelin sheath thickness significantly increased in rats stimulated by LFPEMF after SCI. The expression of neurotrophins significantly increased, and the expression of inflammatory factors significantly decreased in rats stimulated by LFPEMF after SCI. Therefore, we suggest that LFPEMF can promote the recovery of neurological function in rats after SCI by improving the differentiation of OPCs into OLs and promoting remyelination, as well as by inhibiting inflammation and promoting neurotrophic effects. (c) 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:449-456, 2019.