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.

关键词： cannabinoids   neurogenesis   neurology   psychiatric disorders  

摘要： Cannabinoid signalling modulates several aspects of brain function, including the generation and survival of neurons during embryonic and adult periods. The present review intended to summarise evidence supporting a role for the endocannabinoid system on the control of neurogenesis and neurogenesis-dependent functions. Studies reporting participation of cannabinoids on the regulation of any step of neurogenesis and the effects of cannabinoid compounds on animal models possessing neurogenesis-dependent features were selected from Medline. Qualitative evaluation of the selected studies indicated that activation of cannabinoid receptors may change neurogenesis in embryonic or adult nervous systems alongside rescue of phenotypes in animal models of different psychiatric and neurological disorders. The text offers an overview on the effects of cannabinoids on central nervous system development and the possible links with psychiatric and neurological disorders such as anxiety, depression, schizophrenia, brain ischaemia/stroke and Alzheimer's disease. An understanding of the mechanisms by which cannabinoid signalling influences developmental and adult neurogenesis will help foster the development of new therapeutic strategies for neurodevelopmental, psychiatric and neurological disorders.

关键词： conversion disorder   psychogenic nonepileptic seizures   functional movement disorders   functional paralysis  

摘要： Functional neurological disorders (FND) are complex and prevalent neuropsychiatric conditions. Importantly, some patients with FND develop acute onset symptoms requiring emergency department (ED) evaluations. Historically, FND was a rule-out diagnosis, making assessment and management in the ED difficult. While the rapid triage of potential neurological emergencies remains the initial task, advancements have altered the approach to FND. FND is now a rule-in diagnosis based on validated neurological examination signs and semiological features. In this perspective article, we review signs and semiological features that can help guide the initial assessment of FND in the acute setting. Thereafter, we outline potential approaches to introduce a suspected diagnosis of FND to patients in the ED, while emphasizing the need for a comprehensive neurological evaluation. Physical and occupational therapy may be useful adjunct assessments in some individuals. Notably, clinicians in the ED setting are important members of the interdisciplinary approach to FND.

关键词： drug-induced liver injury   fatty liver   hepatology  

摘要： Surgically accessing pathological lesions located within the central nervous system (CNS) frequently requires creating an incision in cosmetic regions of the head and neck. The biggest factors of surgical success typically tend to focus on the middle portion of the surgery, but a vast majority of surgical complications tend to happen towards the end of a case, during closure of the surgical site incisions. One of the most difficult complications for a surgeon to deal with is having to take a patient back to the operating room for wound breakdowns and, even worse, wound or CNS infections, which can negate all the positive outcomes from the surgery itself. In this paper, we discuss the underlying anatomy, pharmacological considerations, surgical techniques and nutritional needs necessary to help facilitate appropriate wound healing. A successful surgery begins with preoperative planning regarding the placement of the surgical incision, being cognizant of cosmetics, and the effects of possible adjuvant radiation therapy on healing incisions. We need to assess patient's medications and past medical history to make sure we can optimise conditions for proper wound reepithelialisation, such as minimizing the amount of steroids and certain antibiotics. Contrary to harmful medications, it is imperative to optimise nutritional intake with adequate supplementation and vitamin intake. The goals of this paper are to reinforce the mechanisms by which surgical wounds can fail, leading to postoperative complications, and to provide surgeons with the reminder and techniques that can help foster a more successful surgical outcome.