关键词： 72-h   Therapeutic hypothermia   Asphyxial   Paediatric   Out-of-hospital cardiac arrest  

摘要： Background: Recent studies suggest that a 48-h therapeutic hypothermia protocol does not improve outcomes in paediatric out-of-hospital cardiac arrest survivors. The aim of this study was to evaluate the effect of 72-h therapeutic hypothermia at 33 degrees C compared to normothermia at 35.5 degrees C-37.5 degrees C on outcomes and the incidence of adverse events in paediatric asphyxial out-of-hospital cardiac arrest survivors. Methods: We conducted this retrospective cohort study at a tertiary paediatric intensive care unit between January 2010 and June 2017. All children from 1 month to 18 years of age with asphyxial out-of-hospital cardiac arrest and a history of at least 3 min of chest compressions who survived for 12 h or more after the return of circulation were eligible. Results: Sixty-four patients met the eligibility criteria for the study. Forty-nine (76.6%) of the 64 children were male, and the mean age was 4.86+/-5.26 years. Twenty-four (37.5%) of the children had underlying disorders. The overall 1-month survival rate was 43.2%. Twenty-five (39.1%) of the children received therapeutic hypothermia at 33 degrees C for 72 h. The 1-month survival rate was significantly higher (p = 0.037) in the therapeutic hypothermia group (15/25, 60%) than in the normothermia group (12/39, 30.8%). The therapeutic hypothermia group had significantly better neurological outcomes (7/15, 46.7%) than the normothermia group (1/12, 8.3%) (p = 0.043). Conclusion: Paediatric asphyxial out-of-hospital cardiac arrest was associated with high mortality and morbidity. Seventy-two-hour therapeutic hypothermia was associated with a better 1-month survival rate and 6-month neurological outcomes than normothermia in our paediatric patients with asphyxial out-of-hospital cardiac arrest.

关键词： Exosome   microRNA   neurorestoration   neurovascular niche   stroke  

摘要： Ischemic stroke is caused by a regional interruption of cerebral blood flow to the brain. Rigorous pre-clinical and clinical research has made landmark progress in stroke treatment using thrombolytics and endovascular thrombectomy. Although numerous successful neuroprotective therapeutic agents for ischemic stroke have been reported in pre-clinical studies, most of them failed in clinical testing. Persistent pre-clinical research has demonstrated that the ischemic brain is not only passively dying but is also actively recovering. Within the neurovascular niche in the peri-infarct tissue, repair mechanisms thrive on the interactions between the neural and vascular compartments. In this review, we discuss exogenous therapy using mesenchymal stromal cell-derived exosomes to amplify endogenous brain repair mechanisms and to induce neurorestorative effects after stroke. Emerging evidence indicates that multiple communication axes between the various organs such as the brain, heart, kidney and gut, and whole body immune response mediated by the spleen can also affect stroke outcome. Therefore, in this review, we summarize this evidence and initiate a discussion on the potential to improve stroke outcome by amplifying multiple brain repair mechanisms after stroke, and by targeting peripheral organs and downstream events to enhance recovery in the injured brain and promote over all well being.

关键词： Extracorporeal cardiopulmonary resuscitation   Extracorporeal membrane oxygenation   Out-of-hospital cardiac arrest   Low-flow time  

摘要： Propose: The aim of this retrospective study was to investigate the prognostic factors in extracorporeal cardiopulmonary resuscitation (ECPR) patients and to assess their accuracy as predictors of a favorable neurological outcome. Materials and methods: Between October 2009 and December 2017, we retrospectively analyzed witnessed out-ofhospital cardiac arrest patients who were admitted to our hospital and resuscitated with ECPR. We compared the baseline characteristics, pre-hospital clinical course, arrest causes, and blood samples on admission for the favorable and unfavorable outcome groups. Results: Among the 135 patients included, 22 (16%) had a favorable neurological outcome. Low-flow time was shorter (median 38 vs. 48 min, p <0.001) in the favorable neurological outcome group: in multiple logistic analyses, low-flow time was significantly associated with a favorable neurological outcome (odds ratio, 0.88;95% confidence interval, 0.82-0.94). The area under the receiver-operating characteristic curve of low-flow time was 0.80 (95% confidence interval, 0.70-0.89), and the cut-off value of 58 min corresponded to a sensitivity of 0.25 and a specificity of 1.0. Conclusions: In ECPR patients, low-flow time was significantly associated with a favorable neurological outcome, and ECPR should be performed within 58 min of the low-flow time. (C) 2018 Elsevier Inc. All rights reserved.

关键词： Neurological   Emergency   Pregnancy   Puerperium   Imaging   Stroke  

摘要： The altered physiologic state of female patients during and just after pregnancy places them at an increased risk for several potentially life-threatening neurologic disorders. Swift diagnosis of such pathology and related complications is critical in order to reduce risk of morbidity and mortality to both the mother and the fetus. Neuroimaging plays an important role in the emergent diagnosis of pathology associated with pregnancy and puerperium, and it is critical for the radiologist to be cognizant of correlative imaging findings. Furthermore, given concerns regarding risks of neuroimaging to the fetus, it is important for the radiologist to act as an informed consultant regarding balancing fetal risks and the mother's health. The purpose of this review is to elucidate the underlying pathophysiology and neuroimaging findings associated with diagnoses that are unique to or highly associated with pregnancy and puerperium, as well as to understand the role that CT and MR play in diagnosis during and just after pregnancy, and their respective risks to the fetus.

关键词： Anterior temporal lobe   Semantic   Lexical   Naming   Anomia  

摘要： Prior research has implicated the left temporal pole (LTP) as a critical region for naming semantically unique items, including famous faces, landmarks, and musical melodies. Most studies have used a confrontation naming paradigm, where a participant is presented with a stimulus and asked to retrieve its name. We have proposed previously that the LTP functions as a two-way, bidirectional convergence region brokering between conceptual knowledge and proper names for unique entities. Under this hypothesis, damage to the LTP should result in a "two way" impairment: (1) defective proper name retrieval when presented with a unique stimulus (as shown in prior work);and (2) defective concept retrieval when presented with a proper name. Here, we directly tested the second prediction using a "recognition-from-name" paradigm. Participants were patients with LTP damage, brain-damaged comparisons with damage outside the LTP, and healthy comparisons. Participants were presented with names of famous persons (e.g., "Marilyn Monroe"), landmarks (e.g., "Leaning Tower of Pisa"), or melodies (e.g., "Rudolph the Red Nosed Reindeer") and were asked to provide conceptual knowledge about each. We found that individuals with damage to the LTP were significantly impaired at conceptual knowledge retrieval when given names of famous people and landmarks (but this finding did not hold for melodies). This outcome supports the theory that the LTP is a bidirectional convergence region for proper naming, but suggests that melody retrieval may rely on processes different from those supported by the LTP. (C) 2018 Elsevier Ltd. All rights reserved.

关键词： brain ischemia   curcumin   Alzheimer's disease   neurodegeneration   amyloid   tau protein   autophagy   mitophagy   apoptosis   genes  

摘要： In recent years, ongoing interest in ischemic brain injury research has provided data showing that ischemic episodes are involved in the development of Alzheimer's disease-like neuropathology. Brain ischemia is the second naturally occurring neuropathology, such as Alzheimer's disease, which causes the death of neurons in the CA1 region of the hippocampus. In addition, brain ischemia was considered the most effective predictor of the development of full-blown dementia of Alzheimer's disease phenotype with a debilitating effect on the patient. Recent knowledge on the activation of Alzheimer's disease-related genes and proteinse.g., amyloid protein precursor and tau proteinas well as brain ischemia and Alzheimer's disease neuropathology indicate that similar processes contribute to neuronal death and disintegration of brain tissue in both disorders. Although brain ischemia is one of the main causes of death in the world, there is no effective therapy to improve the structural and functional outcomes of this disorder. In this review, we consider the promising role of the protective action of curcumin after ischemic brain injury. Studies of the pharmacological properties of curcumin after brain ischemia have shown that curcumin has several therapeutic properties that include anti-excitotoxic, anti-oxidant, anti-apoptotic, anti-hyperhomocysteinemia and anti-inflammatory effects, mitochondrial protection, as well as increasing neuronal lifespan and promoting neurogenesis. In addition, curcumin also exerts anti-amyloidogenic effects and affects the brain's tau protein. These results suggest that curcumin may be able to serve as a potential preventive and therapeutic agent in neurodegenerative brain disorders.

关键词： CMOS circuit   embedded DSP   implantable system   low noise low power amplifier   Neural interface  

摘要： Developing new tools to better understand disorders of the nervous system, with a goal to more effectively treat them, is an active area of bioelectronic medicine research. Future tools must be flexible and configurable, given the evolving understanding of both neuromodulation mechanisms and how to configure a system for optimal clinical outcomes. We describe a system, the Summit RC+S "neural coprocessor," that attempts to bring the capability and flexibility of a microprocessor to a prosthesis embedded within the nervous system. This paper describes the updated system architecture for the Summit RC+S system, the five custom integrated circuits required for bi-directional neural interfacing, the supporting firmware/software ecosystem, and the verification and validation activities to prepare for human implantation. Emphasis is placed on design changes motivated by experience with the CE-marked Activa PC+S research tool;specifically, enhancement of sense-stim performance for improved bi-directional communication to the nervous system, implementation of rechargeable technology to extend device longevity, and application of MICS-band telemetry for algorithm development and data management. The technology was validated in a chronic treatment paradigm for canines with naturally occurring epilepsy, including free ambulation in the home environment, which represents a typical use case for future human protocols.

关键词： Stereotactic irradiation   Brain metastases   Survey in Japan  

摘要： BackgroundTo determine the current practice of stereotactic irradiation (STI) for brain metastases in Japan by a questionnaire *** questionnaire was distributed to 313 institutions performing STI with one of the following machines: Gamma Knife (GK), CyberKnife (CK), Novalis (Nov), or other linear accelerator (LINAC)-based systems (OLS). The participation was *** were 163 responding institutions. The total number of STI treatments between April 2013 and March 2014 was 10,684. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) were performed in 8624 (80.7%) and 2060 (19.3%) cases, respectively. Whole-brain radiation therapy (WBRT) was performed for a total of 3515 cases. For a case model of a 1.5-cm solitary brain metastasis in a non-eloquent area, the most common GTV-PTV margin was 2mm (22 of 114 institutions), and an institutional standard fraction was 1 (75 of 114 institutions). The doses for the model case also varied from 13.0 to 26.0Gy (Median 20Gy) when converted to SRS (/=10). A prescription point was at the PTV margin the most. The median dose constraints which were converted to SRS (/=3) to organs at risk were 12.2, 12.7, and 13.7Gy for optic nerves, cavernous sinus, and brainstem, *** for brain metastases in current practice varied significantly among institutions. These different strategies relied mostly on the type of treatment machine used. It is thus necessary to establish a common guideline to express dose prescriptions and plan qualities for different STI machines.

关键词： Carotid artery stenting   Occlusion intolerance   NIRS cerebral oximetry   Stump pressure  

摘要： Carotid artery stenting (CAS) with proximal protection can expose occlusion intolerance (OI) due to ipsilateral cerebral hemisphere hypoperfusion. Near-infrared spectroscopy (NIRS) cerebral oximetry can monitor regional cerebral oxygenation (rSO(2)) in the frontal lobes, and is used during CAS to predict cerebral blood flow insufficiency. The aim of this study was to evaluate rSO(2) as a predictor of OI during CAS. We retrospectively examined 146 patients who underwent CAS with proximal protection. An INVOS NIRS oximeter was used for rSO(2) measurement, which was compared with stump pressure (SP) measured by a guiding catheter during occlusion of the common carotid artery (CCA) and external carotid artery. For the lesion with OI, distal filter protection was combined with proximal protection if possible, and CCA was intermittently occluded during the procedure. Twenty-seven patients (18%) developed OI. The relative decrease in NIRS oximeter saturation (Delta rSO(2)) on the ipsilateral side was significantly lower in the OI group than in the tolerance group (14 5.1% vs. 3.4 +/- 3.5, p < 0.0OI). Using Delta rSO(2) of 8% as the cutoff value for predicting OI, sensitivity was 92% and specificity was 89%. SP was significantly lower in the OI group than in the tolerance group (22 +/- 13 mmHg vs. 40 +/- 22 mmHg, p < 0.0OI). Using SP <= 25 mmHg as the cutoff value for predicting Dl, sensitivity was 78% and specificity was 77%. Delta rSO(2) was more reliable than SP for predicting OI. Distal filter protection should be combined with proximal protection to prevent prolonged neurological symptoms due to OI. (C) 2018 Elsevier Ltd. All rights reserved.