关键词： Coronary artery bypass grafting   No-touch aorta   Anaortic   Arterial revascularization  

摘要： OBJECTIVES: Our goal was to compare the observed and the expected rates of postoperative cerebrovascular accidents (CVA) in a large cohort of consecutive patients undergoing off-pump coronary artery bypass grafting (CABG) using the Pi-circuit as a no-touch technique. METHODS: From January 2001 to May 2016, 3081 patients were consecutively submitted to an off-pump CABG operation using the Pi-circuit. A CVA was defined as a neurological deficit, lasting less (transient ischaemic attack) or more (stroke) than 24 h, diagnosed by a neurologist and confirmed by a computed tomography or magnetic resonance imaging scan of the brain. The primary end point was to compare the observed and the expected rates of CVAs;the latter was obtained using the Society of Thoracic Surgeons' calculator. The secondary end point was to compare the observed and the expected mortality rates using the Society of Thoracic Surgeons' calculator and the prevalence of postoperative complications. Moreover, we identified some subgroups at higher risk. RESULTS: The postoperative rate of CVAs was 0.5% (14 cases): 2 (0.1%) were transient ischaemic attacks and 12 (0.4%) were strokes. The mean expected CVA rate (1.6%) was significantly higher than the observed rate (P < 0.001). None of patients who experienced postoperative CVAs died. The observed mortality was 1.3% (40 patients) vs the expected mortality (2.6%), which was significantly higher (P < 0.001). Multivariable analysis identified age > 70 years old, diabetes, extracardiac vasculopathy and chronic renal failure as risk factors for postoperative CVAs. However, in all the subgroups of risk, except for those with chronic renal failure, the use of the Pi-circuit was associated with a low rate of CVAs. CONCLUSIONS: The Pi-circuit should be included as a possible choice among no-touch techniques. The observed rate of CVAs of 75% is lower than the expected rate.

关键词： Neuroimmunology   Autoantibodies   Abnormal movement   Chorea   Dystonia   Orofacial dyskinesia   Paraneoplastic neurological   syndrome   Autoimmune encephalitis  

摘要： Movement disorders are extremely common and diverse in autoimmune encephalitis (AE) and paraneoplastic neurological syndromes (PNS). They can sometimes represent the main neurological disorder of a given patient, or just be part of a larger neurological syndrome. Early diagnosis of AE or PNS is essential, as the associated abnormal movements can be effectively treated with immunomodulators. Nevertheless, the diagnosis is often delayed because of the large number of differential diagnoses (infections, metabolic disorders, genetic and degenerative diseases) and because the semiology of abnormal movements arising during AE and PNS is often not well known. However, there are highly specific clinical features, depending on the associated autoantibodies, age and gender of the patient, and associated cancers. Such features are likely to rely on specific mechanisms, the knowledge of which could lead to new therapeutic proposals. Also, the growing body of work on AE and PNS provides a better understanding of the links between immunity and neuronal degeneration, and immunity and genetic specificities. Thus, the purpose of this article is to present the current knowledge and different subtypes of movement disorders associated with AE and PNS, as well as the mechanisms that can lead to neuronal dysfunction. (C) 2018 Elsevier Masson SAS. All rights reserved.

关键词： Gastroesophageal reflux   Neurologically impaired children   Fundoplication   Gastro-jejunal tube feeding   Total esophagogastric dissociation   Systematic review   Meta-analysis  

摘要： Neurologically impaired children (NIC) suffer severe gastroesophageal reflux (GER) with poor fundoplication outcome. Aims of the study were: (1) to determine the recurrence of GER after fundoplication in NIC;(2) to compare fundoplication versus gastro-jejunal tube feeding insertion (GJ) and fundoplication versus total esophagogastric dissociation (TEGD) in primarily treating GER in NIC. Using defined search strategy, two investigators identified all comparative studies reporting the mentioned procedures to primarily treat GER in NIC. The study was conducted under PRISMA guidelines. The meta-analysis was performed using RevMan 5.3. Data are mean +/- SD. Of 3840 titles/abstracts screened, 14 studies on fundoplication (2716 pts.) reported a recurrence/persistence of GER higher in NIC (14.2 +/- 8.3%) than in neurologically normal (9.4 +/- 5.2%;p=0.0001), with an increased incidence of re-do fundoplication (12.6 +/- 7.0% versus 9.1 +/- 4.5%;p<0.01). Three studies revealed a similar risk of undergoing subsequent fundoplication after GJ (4.9 +/- 2.1%) or initial fundoplication (12.0 +/- 0.6%;p=ns). Four studies showed a lower recurrence of GER following TEGD (1.4 +/- 1.1%) than fundoplication (24.8 +/- 1.4%;p=0.002). NIC are at risk of recurrence/persistence of GER after fundoplication or GJ. TEGD seems more effective to primarily treat GER in NIC. Prospective randomized controlled trials are necessary to establish which is the ideal treatment of GER in NIC.

关键词： Heart arrest   Patient outcome assessment   Hypothermia   Induced   Gray matter  

摘要： Aims: This study aimed to evaluate the prognostic accuracy of the gray matter to white matter ratio (GWR) in predicting neurological outcomes in post-cardiac arrest patients treated with target temperature management. Data sources: We systematically searched MEDLINE and EMBASE (Search date: 09/13/2017). Included studies were those evaluating neurological outcomes using the cerebral performance categories scale. We performed a subgroup analysis based on the location of the measurement. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the risk of bias. Results: In total, 1150 patients from 10 observational studies were included. GWR of the basal ganglia (BG) average showed the highest value (area under the curve [AUC] 0.96, SE 0.02, Q 0.90) compared with the putamen/posterior limb of internal capsule (AUC 0.93, SE 0.05, Q 0.87), overall average (AUC 0.91, SE 0.02, Q 0.85), and cerebrum (AUC 0.89, SE 0.05, Q 0.82) for prognostic accuracy. Furthermore, the highest pooled diagnostic odd ratio of GWR for predicting poor neurological outcomes was shown for the BG average (21.00, 95% CI 6.85-64.40) followed by the overall average (20.71, 95% CI 9.53-44.98), putamen/posterior limb of internal capsule (16.08, 95% CI 4.36-59.23), and cerebrum (13.96, 95% CI 4.26-45.76). Conclusions: GWR in the early cranial computed tomography scan had high prognostic value in predicting poor neurological outcomes in post-cardiac arrest patients. The BG GWR had the highest prognostic accuracy when compared to other locations of the brain.

关键词： Neurological soft signs   Bipolar disorder   Schizophrenia   Meta-analysis   Systematic review  

摘要： Neurological soft signs (NSS) are subtle deficits in motor coordination, sensory integration, and sequencing of complex motor acts. Increased NSS is a well-established feature of patients with schizophrenia but a relatively smaller number of studies have investigated NSS in bipolar disorder (BD). Some authors but not others suggested that NSS can distinguish schizophrenia from BD. We conducted a meta-analysis of 18 studies to quantitatively review NSS in BD in comparison to schizophrenia and healthy controls. The current meta-analysis compared NSS scores of 725 BD patients and 634 healthy controls, and 391 BD and 471 schizophrenia patients. Patients with BD had significantly higher NSS scores (d = 1.14, CI = 0.89-1.44) than healthy controls and increased scores in BD was evident in all aspects of NSS (d = 0.88-0.99). BD was associated with a less severe increase in NSS compared to schizophrenia, however, between-group difference was modest (d = 0.42, CI = 0.18-0.65). The results of this meta-analysis demonstrated that BD is characterized by a robust increase in NSS which is only moderately less severe than schizophrenia. Increased NSS is a common feature of both disorders. (c) 2018 Elsevier B.V. and ECNP. All rights reserved.

关键词： Caudal articular processes   Cr   Hemivertebrae   Myelopathy   Transitional vertebrae  

摘要： Congenital vertebral malformations (CVMs) are common in brachycephalic dogs such as the pug, and are often considered incidental findings. However, specific CVMs have been suggested to be associated with neurological deficits in pugs. The objective of this study was to investigate the clinical importance of CVMs in the pug by comparing computed tomography studies of the thoracolumbar spine from pugs without neurological deficits with those from pugs with a confirmed T3-L3 spinal cord lesion and neurological deficits consistent with a chronic T3-L3 myelopathy. A total of 57 pugs were recruited into the study from Sweden (n=33), United Kingdom (n=21) and Norway (n = 3);30 with neurological deficits and 27 without. Focal T3-L3 pathology was confirmed in all pugs with neurological deficits by magnetic resonance imaging (n = 29) and/or pathology (n = 15). Computed tomography studies of the thoracolumbar spine from pugs with and without neurological deficits were compared to investigate possible associations between presentation of neurological deficits consistent with chronic T3-L3 pathology and signalment variables, presence of CVMs and type of CVMs. Congenital vertebral malformations were as common in pugs with, as in pugs without, neurological deficits. Regardless of neurological status, the majority of pugs (96%) presented with one or more CVM. An association between presence, or type of CVM in the T1-L3 vertebral column, and neurological deficits consistent with T3-L3 pathology could not be confirmed. (C) 2018 Published by Elsevier Ltd.

关键词： Atlantoaxial instability   Craniovertebral instability   Trisomy 21   Down syndrome  

摘要： Purpose: Children with trisomy 21 are at a greater risk for craniocervical junction instability than the general population. These children frequently require administration of anesthesia due to surgical (including otolaryngological) interventions and are at risk for neurological injury. We reviewed the current literature describing iatrogenic neurological injury in children with trisomy 21 undergoing anesthesia in order to facilitate the development of safety recommendations. Methods: A systematic review of the literature was performed using Medline, Embase, Scopus, and Google Scholar, following the PRISMA statement. All cases of perioperative neurological injury in children with trisomy 21, aged 18 and under were identified. Clinical and radiographic data were extracted for each report. The data were synthesized to develop recommendations regarding perioperative management. Results: Of 348 articles screened, 16 cases of iatrogenic neurological injury (in children ages 0.7-18 years) were identified. Three injuries occurred during otolaryngological surgeries, nine during sedation for incubation for non-otolaryngological surgery, one during sedation for neuroimaging, one while restraining a child, and two were due to intraoperative head and neck positioning while anesthetized. Preoperative screening was reported in four cases. A diagnosis of atlantoaxial instability (AAI) or atlantooccipital instability (AOI) was made immediately following symptom presentation in three cases but was often delayed by a median (IQR) of 30(11.5-912.5) days. No cases resolved spontaneously, with 2 patients progressing to brain death and 12 requiring surgical stabilization. Of the latter, seven showed improvement, whereas one died 5 months later. No intraoperative precautions during the index procedure were reported in any of the 16 cases. Conclusion: latrogenic neurological injury in children with trisomy 21 are rare but severe and likely under reported. Although the role of preoperative

关键词： Cilia   Zebrafish   Homozygosity   Hydrocephalus   Genetically modified animals   Cerebrospinal fluid   Mouse models   Heterozygosity  

摘要： Cerebrospinal fluid flow is crucial for neurodevelopment and homeostasis of the ventricular system of the brain, with localized flow being established by the polarized beating of the ependymal cell (EC) cilia. Here, we report a homozygous one base-pair deletion, c.1193delT (***398Glnfs*2), in the Kinesin Family Member 6 (Kif6) gene in a child displaying neurodevelopmental defects and intellectual disability. To test the pathogenicity of this novel human Kif6 mutation we engineered an analogous C-terminal truncating mutation in mouse. These mutant mice display severe, postnatal-onset hydrocephalus. We generated a Kif6-LacZtransgenic mouse strain and report expression specifically and uniquely within the ependymal cells (ECs) of the brain, without labeling other multiciliated mouse tissues. Analysis of Kif6 mutant mice with scanning electron microscopy (SEM) and immunofluorescence (IF) revealed specific defects in the formation of EC cilia, without obvious effect of cilia of other multiciliated tissues. Dilation of the ventricular system and defects in the formation of EC cilia were also observed in adult kif6 mutant zebrafish. Finally, we report Kif6-GFP localization at the axoneme and basal bodies of multi-ciliated cells (MCCs) of the mucociliary Xenopus epidermis. Overall, this work describes the first clinically-defined Kif6 homozygous null mutation in human and defines Kif6 as a conserved mediator of neurological development with a specific role for EC ciliogenesis in vertebrates.

摘要： Background The glymphatic (glial-lymphatic) pathway is a fluid-clearance pathway identified in the rodent brain in 2012. This pathway subserves the flow of CSF into the brain along arterial perivascular spaces and subsequently into the brain interstitium, facilitated by aquaporin 4 (AQP4) water channels. The pathway then directs flow towards the venous perivascular and perineuronal spaces, ultimately clearing solutes from the neuropil into meningeal and cervical lymphatic drainage vessels. In rodents, the glymphatic pathway is predominantly active during sleep, when the clearance of harmful metabolites such as amyloid beta (A beta) increases two-fold relative to the waking state. Glymphatic dysfunction, probably related to perturbed AQP4 expression, has been shown in animal models of traumatic brain injury, Alzheimer's disease, and stroke. The recent characterisations of the glymphatic and meningeal lymphatic systems in rodents and in humans call for revaluation of the anatomical routes for CSF-interstitial fluid flow and the physiological role that these pathways play in CNS health. Recent developments Several features of the glymphatic and meningeal lymphatic systems have been shown to be present in humans. MRI scans with intrathecally administered contrast agent show that CSF flows along pathways that closely resemble the glymphatic system outlined in rodents. Furthermore, PET studies have revealed that A beta accumulates in the healthy brain after a single night of sleep deprivation, suggesting that the human glymphatic pathway might also be primarily active during sleep. Other PET studies have shown that CSF clearance of A beta and tau tracers is reduced in patients with Alzheimer's disease compared with healthy controls. The observed reduction in CSF clearance was associated with increasing grey-matter concentrations of A beta in the human brain, consistent with findings in mice showing that decreased glymphatic function leads to A beta accumulation. Altered A