关键词： Medical education   Educational measurement   Medical students   Physical examination   Neurology  

摘要： Introduction. - Since 2014-2015, practical teaching of clinical observation skills for 2nd year medical students at our faculty has been discipline-based;previously, each clinical lecturer had to cover all medical fields. We assessed the impact of this teaching reform on the neurological examination skills of medical students in a before-and-after study. Methods. - Pre-reform 3rd and post-reform 2nd and 3rd year medical students (n = 62, n = 71 and 52, respectively) had to perform 7 neurological examination items, for which performance criteria had been pre-defined. Subsequently, we assessed whether the mean grade in neurological examination skills during the test at the end of the 2nd year was different between students who had received neurological teaching from a neurologist (n = 29) or another specialist (n = 102). Results. - The median [interquartile range] number of items acquired by post-reform 3rd year students (4 [2-5]) was higher than that of pre-reform 3rd year students (2 [1-3];P<0.001), but lower than that of post-reform 2nd year students (5 [4-6];P = 0.01). The mean grade obtained during the practical test was not different in students trained by a neurologist or another specialist. Conclusion. - Acquisition of neurological examination skills improved after the teaching reform which consisted of: (1) a discipline-based practical teaching of clinical observation skills;(2) a training of clinical lecturers to teach a limited list of educational objectives;and (3) the introduction of a practical test at the end of the 2nd year of medical studies. However, there was a decline in clinical observation skills between 2nd and 3rd year medical students. (C) 2018 Societe Nationale Francaise de Medecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

关键词： Quantitative EEG   Cardiac arrest   Post anoxic Coma   Machine learning   Medical informatics  

摘要： Objective: Analysis of the electroencephalogram (EEG) background pattern helps predicting neurological outcome of comatose patients after cardiac arrest (CA). Visual analysis may not extract all discriminative information. We present predictive values of the revised Cerebral Recovery Index (rCRI), based on continuous extraction and combination of a large set of evolving quantitative EEG (qEEG) features and machine learning techniques. Methods: We included 551 subsequent patients from a prospective cohort study on continuous EEG after CA in two hospitals. Outcome at six months was classified as good (Cerebral Performance Category (CPC) 1-2) or poor (CPC 3-5). Forty-four qEEG features (from time, frequency and entropy domain) were selected by the least absolute shrinkage and selection operator (LASSO) method and used in a Random Forests classification system. We trained and evaluated the system with 10-fold cross validation. For poor outcome prediction, the sensitivity at 100% specificity (Se-100) and the area under the receiver operator curve (AUC) were used as performance of the prediction model. For good outcome, we used the sensitivity at 95% specificity (Se-95). Results: Two hundred fifty-six (47%) patients had a good outcome. The rCRI predicted poor outcome with AUC = 0.94 (95% CI: 0.83-0.91), Se-100 = 0.66 (0.65-0.78), and AUC = 0.88 (0.78-0.93), Se-100 = 0.60 (0.510.75) at 12 and 24 h after CA, respectively. The rCRI predicted good outcome with Se-95 = 0.72 (0.61-0.85) and 0.40 (0.30-0.51) at 12 and 24 h after CA, respectively. Conclusions: Results obtained in this study suggest that with machine learning algorithms and large set of qEEG features, it is possible to efficiently monitor patient outcome after CA. We also demonstrate the importance of selection of optimal performance metric to train a classifier model for outcome prediction. Significance: The rCRI is a sensitive, reliable predictor of neurological outcome of comatose patients after CA. (C) 2018 In

关键词： PARNELL'S mustached bat   AUDITORY processing disorder   AUDITORY cortex   MAGNETIC resonance imaging   BRAIN stem  

摘要： Substantial knowledge of auditory processing within mammalian nervous systems emerged from neurophysiological studies of the mustached bat (Pteronotus parnellii). This highly social and vocal species retrieves precise information about the velocity and range of its targets through echolocation. Such high acoustic processing demands were likely the evolutionary pressures driving the over-development at peripheral (cochlea), metencephalic (cochlear nucleus), mesencephalic (inferior colliculus), diencephalic (medial geniculate body of the thalamus), and telencephalic (auditory cortex) auditory processing levels in this species. Auditory researchers stand to benefit from a three dimensional brain atlas of this species, due to its considerable contribution to auditory neuroscience. Our MRI-based atlas was generated from 2 sets of image data of an ex-vivo male mustached bat's brain: a detailed 3D-T2-weighted-RARE scan [(59 x 63 x 85) mu m(3)] and track density images based on super resolution diffusion tensor images [(78) mu m(3)] reconstructed from a set of low resolution diffusion weighted images using Super-Resolution-Reconstruction (SRR). By surface-rendering these delineations and extrapolating from cortical landmarks and data from previous studies, we generated overlays that estimate the locations of classic functional subregions within mustached bat auditory cortex. This atlas is freely available from our website and can simplify future electrophysiological, microinjection, and neuroimaging studies in this and related species.

关键词： eye movement disorders   inborn errors of metabolism   movement disorders   adult-onset  

摘要： Inborn errors of metabolism in adults are still largely unexplored. Despite the fact that adult-onset phenotypes have been known for many years, little attention is given to these disorders in neurological practice. The adult-onset presentation differs from childhood-onset phenotypes, often leading to considerable diagnostic delay. The identification of these patients at the earliest stage of disease is important, given that early treatment may prevent or lessen further brain damage. Neurological and psychiatric symptoms occur more frequently in adult forms. Abnormalities of eye movements are also common and can be the presenting sign. Eye movement disorders can be classified as central or peripheral. Central forms are frequently observed in lysosomal storage disorders, whereas peripheral forms are a key feature of mitochondrial disease. Furthermore, oculogyric crisis is an important feature in disorders affecting dopamine syntheses or transport. Ocular motor disorders are often not reported by the patient, and abnormalities can be easily overlooked in a general examination. In adults with unexplained psychiatric and neurological symptoms, a special focus on examination of eye movements can serve as a relatively simple clinical tool to detect a metabolic disorder. Eye movements can be easily quantified and analyzed with video-oculography, making them a valuable biomarker for following the natural course of disease or the response to therapies. Here, we review, for the first time, eye movement disorders that can occur in inborn errors of metabolism, with a focus on late-onset forms. We provide a step-by-step overview that will help clinicians to examine and interpret eye movement disorders. (c) 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

关键词： Musculoskeletal disorders   neurological disorders   gait analysis   feature selection  

摘要： Musculoskeletal and neurological disorders are common devastating companions of ageing, leading to a reduction in quality of life and increased mortality. Gait analysis is a popular method for diagnosing these disorders. However, manually analyzing the motion data is a labor-intensive task, and the quality of the results depends on the experience of the doctors. In this paper, we propose an automatic framework for classifying musculoskeletal and neurological disorders among older people based on 3D motion data. We also propose two new features to capture the relationship between joints across frames, known as 3D Relative Joint Displacement (3DRJDP) and 6D Symmetric Relative Joint Displacement (6DSymRJDP), such that the relative movement between joints can be analyzed. To optimize the classification performance, we adapt feature selection methods to choose an optimal feature set from the raw feature input. Experimental results show that we achieve a classification accuracy of 84.29% using the proposed relative joint features, outperforming existing features that focus on the movement of individual joints. Considering the limited open motion database for gait analysis focusing on such disorders, we construct a comprehensive, openly accessible 3D full-body motion database from 45 subjects.

关键词： Patient outcome assessment   Perforator territory infarction   Small size   Statin   Surgical treatment   Unruptured intracranial aneurysm  

摘要： The risk associated with surgical treatment for small-to-moderate size unruptured intracranial aneurysms (SMUlAs, defined as <15 mm) has not been well characterized. Authors aimed to investigate risk factors for poor outcome in surgical treatment of SMUlAs. The data of prospectively collected 801 consecutive patients harboring 971 surgically treated SMUlAs was evaluated. Neurological worsening (NW) was defined as an increase in 1 or more modified Rankin Scale at 12-month. Clinical and radiological characteristics were compared. Neurological worsening was observed in 45 (4.6%). In multivariate analysis, only perforator territory infarction (PTI) on postoperative diffusion-weighted imaging (odds ratio (OR), 13;95% confidence interval (CI), 4.9-32, p < 0.0001), and aneurysm locations (paraclinoid (OR, 6.9;95% CI, 3.1-15, p < 0.0001), basilar artery (OR, 4.5;95% CI, 1.5-14, p = 0.008), vertebral artery (OR, 11;95% CI, 3.3-34, p < 0.0001)) were related to neurological worsening. Multivariate analysis showed that statin use (OR, 12;95% CI, 3.8-39, p < 0.0001) and aneurysm locations (internal carotid artery-posterior communicating artery (OR, 3.9;95% CI, 1.8-8.2, p < 0.0001) and basilar artery (OR, 6.3;95% CI, 2.3-17, p = 0.008)), and aneurysm size >10 mm (OR, 5.3;95% CI, 1.8-15, p = 0.003) were related to PTI. Although all SMUlAs should be carefully considered whether to be treated, those with statins, specific locations, and larger sizes should perhaps be more meticulously contemplated, and neurosurgeons should continue to avoid PTI. (C) 2018 Elsevier Ltd. All rights reserved.

关键词： drug development   BASELINE  

摘要： [...]the benefit/risk analysis of the tested interventions is constantly limited for this special population, and the lack of data may frequently result in inappropriate prescribing and hinder evidence‐based decision‐making. [...]subgroup analysis by baseline physical frailty parameters may allow (a) to better differentiate responders versus nonresponders, thus consenting to enhance the effect size of treatments, improve the drugs prescription, and contain costs; (b) to identify subgroups of patients more susceptible to treatment‐related adverse events, thus more properly defining the safety and tolerability profiles of the tested compounds; (c) to stratify individuals according to more accurate risk profile groups in order to more correctly allocate resources; and (d) to investigate the neurobiological and neuropathological changes occurring at different phases of the individual's aging process. [...]adopting baseline variables that are informative of the global health status of the participant may consent to increase the homogeneity of the study samples, thus limiting the often overlooked “horse‐racing effect” in clinical trials.

关键词： Music   Rehabilitation   Stroke   Alzheimer's disease   Parkinson's disease  

摘要： During the last decades, there have been major advances in mapping the brain regions that underlie our ability to perceive, experience, and produce music and how musical training can shape the structure and function of the brain. This progress has fueled and renewed clinical interest towards uncovering the neural basis for the impaired or preserved processing of music in different neurological disorders and how music-based interventions can be used in their rehabilitation and care. This article reviews our contribution to and the state-of-the-art of this field. We will provide a short overview outlining the key brain networks that participate in the processing of music and singing in the healthy brain and then present recent findings on the following key music-related research topics in neurological disorders: (i) the neural architecture underlying deficient processing of music (amusia), (ii) the preservation of singing in aphasia and music-evoked emotions and memories in Alzheimer's disease, (iii) the mnemonic impact of songs as a verbal learning tool, and (iv) the cognitive, emotional, and neural efficacy of music-based interventions and activities in the rehabilitation and care of major ageing-related neurological illnesses (stroke, Alzheimer's disease, and Parkinson's disease). (C) 2018 Elsevier Ltd. All rights reserved.

关键词： Ataxia-telangiectasia   ATM   Kinase-dead   DNA damage response   Double-strand breaks   Cerebellar atrophy  

摘要： The genome instability syndrome, ataxia-telangiectasia (A-T) is caused by null mutations in the ATM gene, that lead to complete loss or inactivation of the gene's product, the ATM protein kinase. ATM is the primary mobilizer of the cellular response to DNA double-strand breaks (DSBs) - a broad signaling network in which many components are ATM targets. The major clinical feature of A-T is cerebellar atrophy, characterized by relentless loss of Purkinje and granule cells. In Atm-knockout (Atm-KO) mice, complete loss of Atm leads to a very mild neurological phenotype, suggesting that Atm loss is not sufficient to markedly abrogate cerebellar structure and function in this organism. Expression of inactive ("kinase-dead") Atm (Atm(KD)) in mice leads to embryonic lethality, raising the question of whether conditional expression of Atm(KD) in the murine nervous system would lead to a more pronounced neurological phenotype than Atm loss. We generated two mouse strains in which Aten was conditionally expressed as the sole Atm species: one in the CNS and one specifically in Purkinje cells. Focusing our analysis on Purkinje cells, the dynamics of DSB readouts indicated that DSB repair was delayed longer in the presence of Atm(KD) compared to Atm loss. However, both strains exhibited normal life span and displayed no gross cerebellar histological abnormalities or significant neurological phenotype. We conclude that the presence of Atm(KD) is indeed more harmful to DSB repair than Atm loss, but the murine central nervous system can reasonably tolerate the extent of this DSB repair impairment. Greater pressure needs to be exerted on genome stability to obtain a mouse model that recapitulates the severe A-T neurological phenotype.