关键词： conversion disorder   functional neurological symptom disorder   veterans   dialectical behavior therapy   primary care  

摘要： This case report describes the application of a dialectical behavioral therapy-informed psychotherapy approach to treating conversion disorder (functional neurological symptom disorder) with motor dysfunction in a Veterans Administration Health System Primary Care-Mental Health Integration Clinic. "Jane," a 30-year-old veteran, was diagnosed with conversion disorder, major depressive disorder (MDD), and posttraumatic stress disorder (PTSD). She completed 25 sessions of treatment focused on improving emotion regulation and interpersonal skills over an 8-month period. At the end of treatment, Jane demonstrated improved motor ability and clinically significant improvements in her reported symptoms of MDD (per the Patient Health Questionnaire-9) and PTSD (per the PTSD Checklist-Civilian Version). This case report supports the conceptualization of conversion disorder as a function of emotion dysregulation and the application of a dialectical behavior therapy-informed treatment approach.

关键词： NEUROLOGICAL disorders   MACROPHAGES   HIV   AIDS patients   T cells  

摘要： Macrophage (mac)-tropic human immnunodeficiency virus type 1 (HIV-1) and simian immnunodeficiency virus (SIV) in brain are associated with neurological disease. Mac-tropic HIV-1 evolves enhanced CD4 interactions that enable macrophage infection via CD4, which is in low abundance. In contrast, mac-tropic SIV is associated with CD4-independent infection via direct CCR5 binding. Recently, mac-tropic simian-human immunodeficiency virus (SHIV) from macaque brain was also reported to infect cells via CCR5 without CD4. Since SHIV envelope proteins (Envs) are derived from HIV-1, we tested more than 100 HIV-1 clade B Envs for infection of CD4-negative, CCR5(+) Cf2Th/CCR5 cells. However, no infection was detected. Our data suggest that there are differences in the evolution of mac-tropism in SIV and SHIV compared to HIV-1 clade B due to enhanced interactions with CCR5 and CD4, respectively.

关键词： cell replacement therapy   depletion   microglia   neuroinflammation  

摘要： Microglia are prominent immune cells in the central nervous system (CNS) and are critical players in both neurological development and homeostasis, and in neurological diseases when dysfunctional. Our previous understanding of the phenotypes and functions of microglia has been greatly extended by a dearth of recent investigations. Distinct genetically defined subsets of microglia are now recognized to perform their own independent functions in specific conditions. The molecular profiling of single microglial cells indicates extensively heterogeneous reactions in different neurological disorders, resulting in multiple potentials for crosstalk with other kinds of CNS cells such as astrocytes and neurons. In settings of neurological diseases it could thus be prudent to establish effective cell-based therapies by targeting entire microglial networks. Notably, activated microglial depletion through genetic targeting or pharmacological therapies within a suitable time window can stimulate replenishment of the CNS niche with new microglia. Additionally, enforced repopulation through provision of replacement cells also represents a potential means of exchanging dysfunctional with functional microglia. In each setting the newly repopulated microglia might have the potential to resolve ongoing neuroinflammation. In this review, we aim to summarize the most recent knowledge of microglia and to highlight microglial depletion and subsequent repopulation as a promising cell replacement therapy. Although glial cell replacement therapy is still in its infancy and future translational studies are still required, the approach is scientifically sound and provides new optimism for managing the neurotoxicity and neuroinflammation induced by activated microglia.

关键词： Fetal open neural defects   mode of delivery   myelomeningocele  

摘要： Background Controversy exists regarding the optimal mode of delivery for fetuses with open neural tube defects. Objective To compare neurological outcomes among infants with open neural tube defects who underwent vaginal compared with caesarean delivery. Search strategy Electronic databases MEDLINE, EMBASE, Scopus, and *** were searched from inception to November 2017. Selection criteria Eligible studies included observational or randomised studies comparing vaginal and caesarean delivery in pregnancies with fetal open neural tube defects who did not undergo prenatal repair. Data collection and analysis Two reviewers independently reviewed abstracts and full-text articles. Outcomes were compared between vaginal and caesarean delivery and prelabour caesarean versus exposure to labour. The primary outcome was motor-anatomic level difference. Secondary outcomes included shunt requirement, sac disruption, meningitis, and ambulation at 2 years. Meta-analysis was performed and mean difference or odds ratios with 95% CI were calculated. Main results Of 201 abstracts identified in the primary search, nine studies (672 women) met the eligibility criteria. Comparing vaginal and caesarean delivery, there was no significant difference in motor-anatomic level difference (mean difference -0.10, 95% CI -0.58 to 0.38;I-2 = 57%). The vaginal delivery group was less likely to require a shunt or have sac disruption [odds ratio (OR) 0.37, 95% CI 0.14-0.95 and OR 0.46, 95% CI 0.23-0.90, respectively]. Comparisons by prelabour caesarean versus exposure to labour showed no significant difference in motor-anatomic level difference (OR 1.29, 95% CI 0.63-3.21) or ambulation at 2 years (OR 2.13, 95% CI 0.35-13.12). Conclusion Caesarean delivery was not associated with improved neurological outcomes among fetuses with open neural tube defects. Tweetable abstract Available evidence does not support routine caesarean delivery for fetuses with open neural tube defects.

关键词： Alpha-lipoic acid   Central nervous system   Neurological disorders   Psychiatric disorders  

摘要： Despite the existence of many preclinical studies, scientific evidence is lacking on the clinical use of alpha-lipoic acid (ALA) for central nervous system disorders. Therefore, we aimed at revising the literature concerning the use of ALA for the treatment of psychiatric and neurological conditions and to point out what is missing for the introduction of this antioxidant to this purpose. For this systematic review we performed a search using PubMed and SCOPUS databases with the following keywords: alpha-Lipoic Acid AND central nervous system OR psychiatric disorders OR neurological disorders OR mood disorders OR anxiety OR psychosis OR Alzheimer OR Parkinson OR stroke. The total number of references found after automatically and manually excluding duplicates was 1061. After primary and secondary screening 32 articles were selected. Regarding psychiatric disorders, the studies of ALA in schizophrenia are advanced being ALA administration related to the improvement of schizophrenia symptoms and side effects of antipsychotic medication. In neurological disorders, ALA as a supplement was effective in the prevention of Alzheimer disease progression. For stroke, the use of the supplement ALAnerv (R) (containing 300mg ALA) presented important results, since it was observed a reversal of clinical parameters and oxidative imbalance in these patients. For other neurological conditions, such as encephalopathy, multiple sclerosis, traumatic brain injury, mitochondrial disorders and migraine, the results are still preliminary. Overall, there is a need of well-designed clinical trials to enhance the clinical evidences of ALA effects for the treatment of neurological and psychiatric conditions.

摘要： Neurofibromatosis type II (NF2) is a disease that lacks effective therapies. NF2 is characterized by bilateral vestibular schwannomas (VSs) that cause progressive and debilitating hearing loss, leading to social isolation and increased rates of depression. A major limitation in NF2 basic and translational research is the lack of animal models that allow the full spectrum of research into the biology and molecular mechanisms of NF2 tumor progression, as well as the effects on neurological function. In this protocol, we describe how to inject schwannoma cells into the mouse brain cerebellopontine angle (CPA) region. We also describe how to apply state-of-the-art intravital imaging and hearing assessment techniques to study tumor growth and hearing loss. In addition, ataxia, angiogenesis, and tumor-stroma interaction assays can be applied, and the model can be used to test the efficacy of novel therapeutic approaches. By studying the disease from every angle, this model offers the potential to unravel the basic biological underpinnings of NF2 and to develop novel therapeutics to control this devastating disease. Our protocol can be adapted to study other diseases within the CPA, including meningiomas, lipomas, vascular malformations, hemangiomas, epidermoid cysts, cerebellar astrocytomas, and metastatic lesions. The entire surgical procedure takes similar to 45 min per mouse and allows for subsequent longitudinal imaging, as well as neurological and hearing assessment, for up to 2 months.

关键词： 神经病学   高等职业教育   教材  

ISBN: (纸本)9787568043243

摘要： 本书介绍了神经专科病史采集，神经系统检查及辅助检查，神经系统疾病的病因、发病机制、临床表现、诊断及治疗等方面，增加了神经系统疾病的康复治疗部分内容。编写时既考虑作为教材的科学性、系统性，又兼顾了先进性、实用性和普及性。

关键词： physical activity   portable recordings   spinal cord injury  

摘要： Various portable monitors have been used to quantify physical activity but most rely on detecting limb movement with a sensor rather than measuring muscle activity. Our first goal was to design and validate a portable system for recording surface electromyographic activity (EMG) from eight muscles over 24 h. The modular system includes: (1) preamplifiers that filter and amplify signals;(2) a preprocessor unit for further filtering and amplification, signal offset and power supply modification;(3) a data-logger for analog-to-digital conversion;a flash memory card for data storage and (4) a rechargeable battery. The equipment samples EMG at 1000 Hz, has a resolution of 2.6 mu V and records signals up to 10 mV. The built-in analog filters create a bandwidth appropriate for surface EMG. Our second aim was to test the system biologically by recording EMG from able-bodied and spinal cord injured participants. Modifications were made to electrodes for remote preamplifier placement, and to the battery connection after pilot testing. Thereafter, 31 consecutive 24-h EMG recordings were successful. Both the engineering and biological validation of this system establishes it as a valuable tool for measuring physical activity from different muscles in real-world environments whether individuals have an intact or damaged nervous system.

关键词： Prostate   Bladder Wall   Soreness   Psychosocial Factors   functional failure   Client Characteristics   Urinals   scoring system   Physiologic Calcification  

摘要： OBJECTIVE To evaluate ultrasonically determined bladder wall thickness (BWT) and prostatic calcification presence, in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and to correlate the findings with patient characteristics and the urinary, psychosocial dysfunction, organ specific, infection and neurological/systemic symptoms, and tenderness (UPOINT) classification system. MATERIAL AND METHODS Between January 2008 and December 2017, data of 1294 patients diagnosed with chronic prostatitis, in a single urology clinic, meeting a number of selective inclusion/exclusion criteria, were retrospectively analyzed. Patients, compliant to fill out all requested questionnaires, between the ages of 21-65 years were included to the study. Exclusion criteria were noncompliance of filling out required questionnaires, acute and/or chronic bacterial prostatitis, history of genitourinary cancer, history of recent prostate surgery, and diagnosis of neurological diseases affecting the bladder. RESULTS The median patient age and UPOINT subdomain was determined as 37 (IQR = 13, range 21-65) and 2 (IQR = 1, range 0-5), respectively. Median values for BWT, National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), and International Index of Erectile Function were 3 (IQR = 1, range 2-6, 7), 4 (IQR = 6, range 1-23), and 25 (IQR = 10, range 1-30), respectively. The presence of calcification demonstrated a significant association with total NIH-CPSI score and BWT, whereas its relation with age and total UPOINT score was insignificant. However in contrast to calcification status, BWT >= 3.3 showed a strong and statistically significant relation to all the described measurements. CONCLUSION Measurement of BWT can be used as an accessible and objective method for the diagnose of CP/CPPS according to UPOINT scoring system. (C) 2018 Elsevier Inc.

摘要： Background and Purpose We aimed to evaluate factors associated with neurological worsening among patients with lacunar or non-lacunar infarction admitted within 3 hours and between 3 and 24 hours after stroke onset. Methods All patients admitted to Haukeland university hospital between 2006 and 2016 with acute cerebral infarction on MRI and admission within 24 hours were included. Repeated National Institute of Health Stroke Scale (NIHSS) scoring was performed in all patients whenever possible. Neurological worsening during the hospital stay was defined as NIHSS score increase >= 3 compared to NIHSS score on admission. Results In patients with lacunar infarction admitted within 3 hours of onset, neurological worsening was associated with low NIHSS score on admission, low body temperature, and leukoaraiosis, whereas only internal carotid artery stenosis or occlusion was associated with neurological worsening in non-lacunar infraction. For patients admitted 3-24 hours after onset, neurological worsening was associated with low body temperature, high systolic blood pressure, and short time from onset to admission in patients with lacunar infarction, whereas high systolic blood pressure, high NIHSS score on admission, middle cerebral artery occlusion, and high blood glucose were associated with neurological worsening in patients with non-lacunar infarction (all P < 0.05). Conclusions Lacunar infarctions with minor neurological deficits within 3 hours of stroke onset are at high risk of neurological worsening especially if concomitant low body temperature and leukoaraiosis.