关键词： Insular glioma   Resection   Neurological deficit   Motor deficit   Language deficit   Single surgeon  

摘要： The resection of insular gliomas remains a neurosurgical challenge due to the close proximity of functionally important cortical, white matter tracts, and vasculature structures. More recently, the feasibility of resection has gained traction, however, there is a lack of consolidated neurological deficit metrics. Thus, the aim of this study was to determine the incidences of neurological deficits following insular glioma resection to better guide selection algorithms and resource allocations. Searches of seven electronic databases from inception to August 2018 were conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted and pooled using meta-analysis of proportions. Meta-regression was used to identify potential sources of heterogeneity. Nineteen observational studies reported the neurological outcomes of 890 insular glioma patients. The pooled incidences of new temporary and permanent motor deficits were 11% (95% CI, 6-17%) and 4% (95% CI, 2-7%) respectively, and new temporary and permanent language deficits were 11% (95% CI, 6-17%) and 2% (95% CI, 0-4%) respectively. Single-surgeon series reported significantly lower incidences of both permanent motor (2% vs 7%;P < 0.001) and language (1% vs 3%;P = 0.03) deficits. The incidences of motor and language neurological deficits following insular glioma resection have been quantified, and will assist in determining the suitability and appropriateness of pursuing surgical resection for insular glioma. We note that permanent neurological deficits are lowest when reported by series describing outcomes of a single surgeon, indicating most optimal outcomes may be best achieved after intense training and/or greater experience.

关键词： Blood-brain barrier   Endothelial cell   Tight junction   Claudin-5  

摘要： Tight junction proteins of the blood-brain barrier are vital for maintaining integrity of endothelial cells lining brain blood vessels. The presence of these protein complexes in the space between endothelial cells creates a dynamic, highly regulated and restrictive microenvironment that is vital for neural homeostasis. By limiting paracellular diffusion of material between blood and brain, tight junction proteins provide a protective barrier preventing the passage of unwanted and potentially damaging material. Simultaneously, this protective barrier hinders the therapeutic effectiveness of central nervous system acting drugs with over 95% of small molecule therapeutics unable to bypass the blood-brain barrier. At the blood-brain barrier, claudin-5 is the most enriched tight junction protein and its dysfunction has been implicated in neurodegenerative disorders such as Alzheimer's disease, neuroinflammatory disorders such as multiple sclerosis as well as psychiatric disorders including depression and schizophrenia. By regulating levels of claudin-5, it is possible to abrogate disease symptoms in many of these disorders. This review will give an overview of the blood-brain barrier and the role of tight junction complexes in maintaining blood-brain barrier integrity before focusing on the role of claudin-5 and its regulation in homeostatic and pathological conditions. We will also summarise therapeutic strategies to restore integrity of cerebral vessels by targeting tight junction protein complexes.

关键词： Johns Hopkins adapted cognitive exam   Chinese,version   validity   reliability   NICU  

摘要： Objective: To evaluate the reliability and validity of the Chinese version of the Johns Hopkins Adapted Cognitive Exam (ACE) in neurological intensive care unit patients. Design: The English version of the ACE was translated and adapted into Chinese. The cognitive function of 40 critically ill NICU patients was assessed using the Chinese version of the ACE and the Mini-mental state examination (MMSE) battery. Scores on the ACE and MMSE were analyzed, and the scale's content validity, construct validity, concurrent validity, internal consistency, inter-rater reliability, and test-retest reliability metrics were determined. Result: The coefficients for the Pearson correlations between individual item scores and total score ranged from 0.617 to 0.938, and content validity was good. ACE scores were significantly correlated with MMSE scores(r = 0.822, p<0.05). Five factors were extracted during the principal component analysis, the cumulative contribution of which was 85.90%. Overall, the factor loading of each item was 0.5, and the scale had good construct validity. The Chinese version of the ACE demonstrated good internal consistency (Cronbach'alpha = 0.756), inter-rater reliability (ICC>0.95), and test-retest reliability (ICC = 0.652-0.979). Conclusions: The results of this study suggest that the Chinese version of the ACE was a reliable and valid screening tool for cognitive impairment in NICU patients. List of abbreviations: ACE: (Johns Hopkins Adapted Cognitive Exam);NICU : (neurological intensive care unit);MMSE: (Mini-Mental State Examination);SPSS: (the Statistical package for the Social Sciences);ICC: (Intra-class Correlation Coefficients);SCCM: (Society of Critical Care Medicine);PICS: (post-intensive care syndrome);ARDS:(acute respiratory distress syndrome);MoCA;(Montreal Cognitive Assessment);EFA: (exploratory factor analysis).

关键词： Prehospital emergency care (MeSH)   Emergency medical services (MeSH)   Critical care (MeSH)   Traumatic brain injury (MeSH)   Airway management (MeSH)   Endotracheal intubation (MeSH)   Patient outcome assessment (MeSH)   Glasgow outcome scale (MeSH)  

摘要： Background: Patients with isolated traumatic brain injury (TBI) are likely to benefit from effective prehospital care to prevent secondary brain injury. Only a few studies have focused on the impact of advanced interventions in TBI patients by prehospital physicians. The primary end-point of this study was to assess the possible effect of an on-scene anaesthetist on mortality of TBI patients. A secondary end-point was the neurological outcome of these patients. Methods: Patients with severe TBI (defined as a head injury resulting in a Glasgow Coma Score of <= 8) from 2005 to 2010 and 2012-2015 in two study locations were determined. Isolated TBI patients transported directly from the accident scene to the university hospital were included. A modified six-month Glasgow Outcome Score (GOS) was defined as death, unfavourable outcome (GOS 2-3) and favourable outcome (GOS 4-5) and used to assess the neurological outcomes. Binary logistic regression analysis was used to predict mortality and good neurological outcome. The following prognostic variables for TBI were available in the prehospital setting: age, on-scene GCS, hypoxia and hypotension. As per the hypothesis that treatment provided by an on-scene anaesthetist would be beneficial to TBI outcomes, physician was added as a potential predictive factor with regard to the prognosis. Results: The mortality data for 651 patients and neurological outcome data for 634 patients were available for primary and secondary analysis. In the primary analysis higher age (OR 1.06 CI 1.05-1.07), lower on-scene GCS (OR 0.85 CI 0.79-0.92) and the unavailability of an on-scene anaesthetist (OR 1.89 CI 1.20-2.94) were associated with higher mortality together with hypotension (OR 3.92 CI 1.08-14.23). In the secondary analysis lower age (OR 0.95 CI 0.94-0.96), a higher on-scene GCS (OR 1.21 CI 1.20-1.30) and the presence of an on-scene anaesthetist (OR 1.75 CI 1.09-2.80) were demonstrated to be associated with good patient outcomes while

关键词： Algorithms   Applied mathematics   Artificial intelligence   Bioassays and physiological analysis   Biology and life sciences   Brain damage   Brain electrophysiology   Brain mapping   Cardiac arrest   Cardiology   Clinical medicine   Clinical neurophysiology   Computer and information sciences   Critical care and emergency medicine   Diagnostic medicine   Electroencephalography   Electrophysiological techniques   Electrophysiology   Imaging techniques   Machine learning   Machine learning algorithms   Mathematical and statistical techniques   Mathematics   Medicine and health sciences   Multivariate analysis   Neuroimaging   Neurology   Neurophysiology   Neuroscience   Physical sciences   Physiology   Principal component analysis   Prognosis   Research and analysis methods   Research Article   Resuscitation   Simulation and modeling   Statistical methods   Statistics  

摘要： Early prediction of the potential for neurological recovery after resuscitation from cardiac arrest is difficult but important. Currently, no clinical finding or combination of findings are sufficient to accurately predict or preclude favorable recovery of comatose patients in the first 24 to 48 hours after resuscitation. Thus, life-sustaining therapy is often continued for several days in patients whose irrecoverable injury is not yet recognized. Conversely, early withdrawal of life-sustaining therapy increases mortality among patients who otherwise might have gone on to recover. In this work, we present Canonical Autocorrelation Analysis (CAA) and Canonical Autocorrelation Embeddings (CAE), novel methods suitable for identifying complex patterns in high-resolution multivariate data often collected in highly monitored clinical environments such as intensive care units. CAE embeds sets of datapoints onto a space that characterizes their latent correlation structures and allows direct comparison of these structures through the use of a distance metric. The methodology may be particularly suitable when the unit of analysis is not just an individual datapoint but a dataset, as for instance in patients for whom physiological measures are recorded over time, and where changes of correlation patterns in these datasets are informative for the task at hand. We present a proof of concept to illustrate the potential utility of CAE by applying it to characterize electroencephalographic recordings from 80 comatose survivors of cardiac arrest, aiming to identify patients who will survive to hospital discharge with favorable functional recovery. Our results show that with very low probability of making a Type 1 error, we are able to identify 32.5% of patients who are likely to have a good neurological outcome, some of whom have otherwise unfavorable clinical characteristics. Importantly, some of these had 5% predicted chance of favorable recovery based on initial illness severity

关键词： Cholesterol   Sphingolipids   Development   Neurological diseases   Nervous system  

摘要： Brain is a vital organ of the human body which performs very important functions such as analysis, processing, coordination, and execution of electrical signals. For this purpose, it depends on a complex network of nerves which are ensheathed in lipids tailored myelin;an abundant source of lipids in the body. The nervous system is enriched with important classes of lipids;sphingolipids and cholesterol which compose the major portion of the brain particularly in the form of myelin. Both cholesterol and sphingolipids are embedded in the microdomains of membrane rafts and are functional units of the neuronal cell membrane. These molecules serve as the signaling molecules;hold important roles in the neuronal differentiation, synaptogenesis, and many others. Thus, their adequate provision and active metabolism are of crucial importance in the maintenance of physiological functions of brain and body of an individual. In the present review, we have highlighted the physiological roles of cholesterol and sphingolipids in the development of the nervous system as well as the association of their altered metabolism to neurological and neurodegenerative diseases.

关键词： Neurological disorders   Children/adolescents   HIV   Prevalence   Correlates  

摘要： Background: The aim of this study was to determine the prevalence of neurological disorders and their associated correlates and relations with clinical and behavioural problems among children and adolescents with HIV/AIDS (CA-HIV). Methods: This study involved a sample of 1070 CA-HIV/caregiver dyads who were evaluated at their 6-month follow-up visit as part of their participation in the longitudinal study, 'Mental health among HIV infected CHildren and Adolescents in KAmpala and Masaka, Uganda (the CHAKA study)'. Participants completed an extensive battery of measures that included a standardized DSM-5-referenced rating scale, the parent version (5-18 years) of the Child and Adolescent Symptom Inventory-5 (CASI-5). Using logistic regression, we estimated the prevalence of neurological disorders and characterised their associations with negative clinical and behavioural factors. Results: The overall prevalence of at least one neurological disorders was 18.5% (n = 198;95% CI, 16.2 20.8). Enuresis / encopresis was the most common (10%), followed by motor/ vocal tics (5.3%);probable epilepsy was the least prevalent (4%). Correlates associated with neurological disorders were in two domains: socio-demographic factors (age, ethnicity and staying in rural areas) and HIV-related factors (baseline viral load suppression). Enuresis/encopresis was associated with psychiatric comorbidity. Neurological disorders were associated with earlier onset of sexual intercourse (adjusted OR 4.06, 95% CI 1.26-13.1, P = 0.02). Conclusions: Neurological disorders impact lives of many children and adolescents with HIV/AIDS. There is an urgent need to integrate the delivery of mental and neurological health services into routine clinical care for children and adolescents with HIV/AIDS in sub-Saharan Africa.

关键词： Adverse reactions   Drug administration   Drug interactions   Drug screening   Drug therapy   Drug-food interactions   Medical personnel   Medicine and health sciences   Neurological drug therapy   People and places   Pharmaceutics   Pharmacists   Pharmacology   Population groupings   Professions   Research Article   Routes of administration  

摘要： It is estimated that around five to 10.0% of hospital admissions occur due to clinical conditions resulting from pharmacotherapy. Clinical pharmacist's activity can enhance drug therapy's effectiveness and safety through pharmacotherapy interventions (PIs), thus minimizing drug-related problems (DRPs) and optimizing the allocation of financial resources associated with health care. This study aimed to estimate the DRPs prevalence, evaluate PI which were performed by clinical pharmacists in the Neurology Unit of a Brazilian tertiary teaching hospital and to identify factors associated with the occurrence of PI-related DRP. A single-arm trial included adults admitted in the referred Unit from 2012 July to 2015 June. Patients were evaluated during their hospitalization period and PIs were performed based on trigger DRPs that were detected in medication reconciliation (admission or discharge) or during inpatient follow-up. Student's t-test, Chi-square test, Pearson and Multiple logistic regression models to analise the association among age, number of drugs, hospitalization period, and number of diagnoses with occurrence of DRPs. Analyses level of significance was 5%. In total 409 inpatients were followed up [51.1% male, mean age of 49.1 (SD 16.5)]. Patients received, on average, 11.9 (SD 5.8) drugs, ranging from two to 38 drugs per patient, and 54.3% of the sample presented at least one DRP whose most frequent description was "untreated condition". From all 516 performed PIs that resulted from DRPs, 82.8% were accepted and the majority referred to "drug introduction" (27.5%). Multiple logistic regression showed that age, length of hospital stay, number of drugs used, diagnosis of epilepsy, multiple sclerosis and myasthenia gravis would be clinical variables associated with DRP (p < 0,05). Monitoring the use of drugs allowed the clinical pharmacist to detect DRPs and to suggest interventions that promote rational pharmacotherapy.

摘要： In the middle of the flanks of women lies the womb, a female viscous, closely resembling an animal;for it is moved of itself hither and thither in the flanks, also upwards in a direct line to below the cartilage of the thorax, and also obliquely to the right or to the left, either to the liver or the spleen;and it likewise is subject to prolapsus downwards, and, in a word, it is altogether erratic. It delights, also, in fragrant smells, and advances towards them;and it had an aversion to fetid smells and flees from them;and, on the whole the womb is like an animal within an animal.

关键词： Intracerebral hemorrhage   Secondary neurological deterioration   Time period   Hypodensities   Noncontrast computed tomography  

摘要： Background: Secondary neurological deterioration in patients with spontaneous intracerebral hemorrhage (sICH) develops within the first 24 or 48 h after ICH onset and appears to portend a poor prognosis. We aimed to verify whether hypodensities within an acute ICH detected by noncontrast computed tomography (NCCT) were able to predict secondary neurological deterioration and investigate which monitoring window was of the highest predictive value. Materials/methods: This study involved sICH patients from three clinical centers of Fudan University between October 1, 2016 and March 31, 2018. Logistic regression analysis was used to assess the association between hypodensities and secondary neurological deterioration. The receiver operating characteristic curve of the subjects was performed to evaluate the critical value of the detection time window of hypodensities that best predicted the secondary neurological injury. Then, we divided the detection time window of hypodensities into 0-1.5 h, 1.5-3 h, 3-4.5 h and 4.5-6 h, and calculated the sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and accuracy respectively. Results: A total of 240 ICH patients met the inclusion criteria, 97 (40.42%) of whom were observed secondary neurological deterioration. Hypodensities were positive in 113 patients (47.08%), and more common in patients with secondary neurological deterioration (76.25%). The multivariate logistic regression analysis demonstrated that infratentorial hemorrhage (P < .001), the baseline hematoma volume (P = .015), and the presence of hypodensities on admission CT scan (P < .001) were independent predictors of secondary neurological deterioration. The sensitivity, specificity, PPV, and NPV of hypodensities in predicting secondary neurological deterioration were 76.3%, 72.7%, 65.5%, and 81.9%, respectively. When the time to the baseline NCCT was 114.5 min, the hypodensities were of the highest predictive value. Besides, t