关键词： neurointensive care unit   neurocritical care team   neurointensivist   outcome   mortality  

摘要： Background: Admission to an intensive care unit (ICU) specialized for brain and spine injury patients is associated with improved outcome. We investigated the effects of the first dedicated, combined neurological and neurosurgical ICU (NeuroICU) in Korea on patient outcomes. Methods: The first dedicated NeuroICU in Korea was established in March 2013. We retrospectively analyzed the clinical data and compared the outcomes between patients admitted to the ICU before and after NeuroICU establishment. The predicted mortality of NeuroICU patients was calculated using their Acute Physiology and Chronic Health Evaluation II scores. Patients' functional outcomes were evaluated using their modified Rankin scale (mRS) scores at 6 months after ICU admission, which were obtained from medical records or telephone interviews. Results: We included 2487 patients, 1572 and 915 of whom were admitted prior to and after NeuroICU establishment, respectively. The demographic characteristics, Glasgow Coma Scale scores, and disease proportions did not differ significantly between the groups. The length of ICU stay and the number of days on ventilation were significantly lower in NeuroICU patients than they were in general ICU patients (P = .024, P = .001). Intensive care unit mortality was significantly lower in NeuroICU patients (7.3% vs 4.7%, P = .012). The predicted mortality was obtained from 473 NeuroICU patients. The mortality ratio (observed mortality/predicted mortality) was 0.34 (8.9%/26.1%), and 228 (48.1%) patients showed good functional recovery (mRS, 0-2). Conclusion: Our findings suggest that admission to a dedicated NeuroICU significantly improves the neurological outcomes of patients with brain and spine injuries, including their postoperative care, in Korea.

关键词： Antibody   Cerebrospinal fluid   Neurological syndrome   Indirect immunofluorescence   Central nervous system  

摘要： Background: To evaluate indirect immunofluorescence patterns of auto-antibodies and the targeting antigens to Immunoglobulin Gs (IgGs) in the cerebrospinal fluid (CSF) by a tissue-based assay(TBA). Methods: CSF samples were collected from 793 patients. Auto-antibody levels were measured via an immunofluorescence assay. Results: 110 (13.9%) CSF samples with a specific response were confirmed. Of these, 37 showed a neuronal pattern, 57 an astrocyte pattern, 7 a neuronal and astrocyte pattern, and 9 samples showed an oligodendrocyte pattern. In the neuronal antibody group, 16 patients had NMDAR-IgGs, 3 had LGi1-IgGs, 2 had AMPA2-IgGs, 2 had GAD65-IgGs, 1 patient had GABA-IgGs, and 1 patient had overlapping NMDAR-IgGs and AQP4-IgGs. Of the unidentified neuronal antibodies, two were cellular surface antibodies, three were cellular surface and cytoplasm antibodies, three were cytoplasm antibodies, and four were nuclear and cytoplasm antibodies. Among the 57 patients with the astrocyte pattern, 28 patients were positive for AQP4-IgGs, 21 were positive for GFAP-IgGs, 5 patients had overlapping AQP4 and GFAP-IgGs, and 3 patients had an unidentified antigen. Seven patients showed neuronal and astrocyte patterns simultaneously;four of them had unknown neuronal antibodies. In the patients with an oligodendrocyte pattern, one was positive for MOG-IgGs and four for MBP-IgGs. Conclusions: The TBA is helpful for diagnosing autoimmune neurological syndrome, especially in patients with unknown antibodies and antigens. Presence of unidentified antibodies against neuronal or glial cells could be an interesting finding, but should be investigated in future studies which incorporate parallel serum samples at an appropriate IgG dilution.

关键词： Pug   Bulldog   Hemivertebra   English language   Kyphosis   English  

摘要： OBJECTIVE To investigate whether hemivertebra subtype as determined via CT was associated with breed and Cobb angle (a measure of the degree of spinal curvature) in apparently neurologically normal French Bulldogs, English Bulldogs, and Pugs. ANIMALS Client-owned French Bulldogs (n = 58), English Bulldogs (30), and Pugs (12) with thoracic hemivertebrae that underwent CT for reasons unrelated to spinal disease. PROCEDURES CT scans of each dog were evaluated, and hemivertebrae were categorized by subtype (ventral aplasia, ventral hypoplasia, lateral aplasia, lateral hypoplasia, ventrolateral aplasia, ventrolateral hypoplasia, ventral and median aplasia, ventral and median hypoplasia, and symmetric hypoplasia). The Cobb angle was measured, and kyphosis was defined as a Cobb angle > 10 degrees. Results were compared among breeds. RESULTS 243 hemivertebrae were identified in the French Bulldog group, 100 in the English Bulldog group, and 19 in the Pug group. Breed was significantly associated with hemivertebra subtype. Pugs were more likely than French and English Bulldogs to have ventral hypoplasia and less likely to have ventral and median hypoplasia. English Bulldogs were more likely than French Bulldogs to have ventral and median hypoplasia. Compared with other hemivertebra subtypes, ventral hypoplasia was associated with a greater Cobb angle and a higher likelihood of kyphosis. Pugs were more likely than the other 2 breeds to have kyphosis. CONCLUSIONS AND CLINICAL RELEVANCE Pugs had a different spectrum of hemivertebra subtypes than French and English Bulldogs in this study. Additional research is necessary to evaluate the clinical relevance of this finding.

关键词： Cardiac arrest   Heart arrest   Partial pressure of arterial carbon dioxide   PaCO2  

摘要： Aims: Partial pressure of arterial carbon dioxide (PaCO2) is a regulator of cerebral blood flow after brain injury. We sought to test the association between PaCO2 after resuscitation from cardiac arrest and neurological outcome. Methods: A prospective protocol-directed cohort study across six hospitals. Inclusion criteria: age >= 18, non-traumatic cardiac arrest, mechanically ventilated after return of spontaneous circulation (ROSC), and receipt of targeted temperature management. Per protocol, PaCO2 was measured by arterial blood gas analyses at one and six hours after ROSC. We determined the mean PaCO2 over this initial six hours after ROSC. The primary outcome was good neurological function at hospital discharge, defined a priori as a modified Rankin Scale <= 3. Multivariable Poisson regression analysis was used to test the association between PaCO2 and neurological outcome. Results: Of the 280 patients included, the median (interquartile range) PaCO2 was 44 (37-52) mmHg and 30% had good neurological function. We found mean PaCO2 had a quadratic (inverted "U" shaped) association with good neurological outcome, with a mean PaCO2 of 68 mmHg having the highest predictive probability of good neurological outcome, and worse neurological outcome at higher and lower PaCO2. Presence of metabolic acidosis attenuated the association between PaCO2 and good neurological outcome, with a PaCO2 of 51 mmHg having the highest predictive probability of good neurological outcome among patients with metabolic acidosis. Conclusion: PaCO2 has a "U" shaped association with neurological outcome, with mild to moderate hypercapnia having the highest probability of good neurological outcome.

关键词： MRI   Outcome   Spontaneous spinal epidural hematoma   Surgical decompression  

摘要： OBJECTIVE: Spontaneous spinal epidural hematoma (SSEH) is a rare and morbid entity, with the prognosis affected by delayed diagnosis and surgical intervention. The correlation between the timing of the intervention and neurological recovery has not been clearly reported. We present a retrospective study of SSEH to determine the correlation between the timing of surgical intervention and changes in the spinal cord signal on magnetic resonance imaging (MRI) with the neurological outcome. METHODS: The records of 14 patients who had undergone surgical decompression of SSEHs during a 10-year duration were reviewed. The diagnosis was established from the MRI, intraoperative, and histopathological examination findings. RESULTS: We identified 14 patients from both centers, 6 of whom were male. Their mean age was 54.1 years. The onset was spontaneous, and 2 patients were receiving anticoagulant therapy. The most common presentation was paraplegia (n = 8), followed by paraparesis (n = 3) and quadriparesis (n = 2). Spinal cord signal changes were demonstrated on all T2-weighted MRI studies. The response to surgery was favorable for 13 of our patients at the 6-month follow-up examination. The spinal cord changes had persisted in 5 patients on the 6-month postoperative MRI scan. All 14 patients, except for 1, had a favorable neurological outcome at the last follow-up examination. CONCLUSIONS: Significant neurological recovery after surgical decompression of SSEHs can be achieved, despite the significant preoperative neurological deficits, spinal cord changes on MRI, and delayed timing of intervention.

关键词： Endothelin-1 (ET-1)   Cytokines   Central nervous system   Blood-brain barrier (BBB)   Chymase   Mast cells   Endothelin subtype B receptor (ETB)   Endothelin subtype A receptor (ETA)   Cerebral blood flow (CBF)  

摘要： Endothelins were discovered more than thirty years ago as potent vasoactive compounds. Beyond their well-documented cardiovascular properties, however, the contributions of the endothelin pathway have been demonstrated in several neuroinflammatory processes and the peptides have been reported as clinically relevant biomarkers in neurodegenerative diseases. Several studies report that endothelin-1 significantly contributes to the progression of neuroinflammatory processes, particularly during infections in the central nervous system (CNS), and is associated with a loss of endothelial integrity at the blood brain barrier level. Because of the paucity of clinical trials with endothelin-1 antagonists in several infectious and non-infectious neuroinflammatory diseases, it remains an open question whether the 21 amino add peptide is a mediator/modulator rather than a biomarker of the progression of neurodegeneration. This review focuses on the potential roles of endothelins in the pathology of neuroinflammatory processes, including infectious diseases of viral, bacterial or parasitic origin in which the synthesis of endothelins or its pharmacology have been investigated from the cell to the bedside in several cases, as well as in non-infectious inflammatory processes such as neurodegenerative disorders like Alzheimers Disease or central nervous system vasculitis. (C) 2018 Elsevier Inc. All rights reserved.

关键词： early neurological deterioration   meta-analysis   rate   stroke   thrombolytic therapy  

摘要： Objectives The rate of early neurological deterioration (END) occurring after thrombolytic therapy is controversial. To explore a more precise estimation of the rate, a meta-analysis was conducted in the present study. Methods The relevant studies were identified by searching PubMed, EMBASE, and Cochrane Collaboration Database up to June 2018. The definition of END was prespecified according to the most commonly used definition: >= 4-point increase in National Institutes of Health Stroke Scale between admission and 24 hr. The meta-analysis was performed by using the STATA 12. Results Eleven studies with a total of 3,539 subjects, including 373 patients with END and 3,166 patients without END, were collected. The pooled analysis showed that the rate of END occurring after thrombolytic therapy was about 11.0% (95% CI: 7.8%-14.3%). Subgroup analysis by continent showed that the rate of END occurring after thrombolytic therapy of patients in Asia (15.9%, 95% CI: 7.4%-24.5%) was higher than in Europe (7.6%, 95% CI: 4.9%-10.3%) and in North America (11.8%, 95% CI: 8.5%-15.0%). Subgroup analysis by onset to treatment time (OTT) displayed that the rate of END occurring after thrombolytic therapy was 5.4% (95% CI: 1.2%-9.5%), 15.6% (95% CI: 9.6%-21.5%), and 18.5% (95% CI: 11.2%-25.8%) for the patients whose OTT <= 120.0 min, from 120.1 to 179.9 min, from 180.0 to 270.0 min, respectively. Conclusion The rate of END occurring after thrombolytic therapy is about 11.0%. This finding may provide a scientific reference for researchers to evaluate the efficacy and safety of thrombolytic therapy.

关键词： HIV   Cerebrospinal fluid   Neurogranin  

摘要： Purpose of ReviewThe aim of this study was to examine the synaptic biomarker neurogranin in cerebrospinal fluid (CSF) in different stages of HIV infection and in relation to what is known about CSF neurogranin in other neurodegenerative *** FindingsCSF concentrations of neurogranin are increased in Alzheimer's disease, but not in other neurodegenerative disorder such as Parkinson's disease, frontotemporal dementia, and Lewy body dementia. Adults with HIV-associated dementia have been found to have decreased levels of neurogranin in the frontal cortex, which at least to some extent, may be mediated by the proinflammatory cytokines IL-1 and *** neurogranin concentrations were in the same range for all groups of HIV-infected individuals and uninfected controls. This either indicates that synaptic injury is not an important part of HIV neuropathogenesis or that CSF neurogranin is not sensitive to the type of synaptic impairment present in HIV-associated neurocognitive disorders.

关键词： Soft neurological signs   Family history   Sporadic   Schizophrenia   Neurological abnormalities   Motor integration   Parental   Paternal   Maternal   Bipolar   Unipolar depression  

摘要： Objective: Neurological soft signs (NSS) are a group of minor non-localizable neurological abnormalities found more often in patients with schizophrenia. The aim of the current study was investigate whether there is any difference in their manifestation in familial vs. sporadic schizophrenia. Material and methods: The study sample included 120 patients suffering from schizophrenia according to DSM-5 (71 males and 49 females;aged 32.79 +/- 11.11 years old) and 110 normal controls (57 males and 53 females;aged 33.38 +/- 10.14 years old). The assessment included the Neurological Evaluation Scale (NES) and the detailed investigation family history. The statistical analysis included exploratory Analysis of Covariance. Results: The results of the current study suggest that NSS are more frequent in familial cases of schizophrenia and are even more pronounced in cases with family history of psychosis in either first or second degree relatives. Discussion: Overall the results suggest the presence of a spectrum of increasing severity from healthy controls to sporadic cases, to cases with non-psychotic family history and eventually to cases with psychotic family history, rather than a categorical distribution.

关键词： NEURAL development   NEUROLOGICAL disorders   B cells   SPINAL cord injuries   LYMPHOCYTES   INFLAMMATION   IMMUNE system  

摘要： The immune system is a major contributor to brain homeostasis and pathogenesis of neurological diseases. However, the role of B lymphocytes (cells) in the brain is poorly understood. In this review, we describe the functions of the different subtypes of B cells in brain development and neurological diseases. B cells are classified into several subtypes according their function and gene expression. B-1a cells, which participate in innate immunity by producing natural antibodies, are abundant in the developing brain, and mediate oligodendrocyte development. In conditions such as autoimmune encephalomyelitis, spinal cord injury, and stroke, B-2 cells exacerbate the pathology by producing pathogenic autoantibodies. On the other hand, regulatory B cells suppress inflammation by secreting interleukin-10 and play beneficial roles in pathological conditions. Here, we summarize the distribution and function of B cells during brain development and neurological diseases. (C) 2018 Elsevier B.V. and Japan Neuroscience Society. All rights reserved.