关键词： Neurological injury   Axillary nerve   Suprascapular nerve   Posterior bone block  

摘要： Recurrent posterior glenohumeral instability poses a challenge for treatment. Bone block procedures have been advocated in cases where a bony defect is present. However, these techniques are not free of complications due to the proximity of neurovascular structures. The aim of this study is to measure the distance to the axillary and suprascapular nerves at the different steps of the procedure. Ten frozen human cadavers were used. The bone graft was prepared and placed on the posterior aspect of the glenoid, where it was fixed with two K-wires in different positions: parallel to the articular surface and with 20A degrees of medial angulation. The distance from the entry and exit points of the K-wires to the axillary and suprascapular nerves was measured. At the exit point, mean distance from the superior K-wire to the axillary nerve was 4.4 mm in the neutral position and 14.4 mm when medially angulated (p = 0.01) and 2.6 mm and 11.5 mm, respectively, for the inferior K-wire (p < 0.01). No differences were found at the entry point (p = 0.7 and p = 0.3). For the suprascapular nerve, mean distance to the entry point of the superior K-wire was significantly greater when it was inserted with 20A degrees of medial angulation than when placed in neutral position (p = 0.04). No differences were found for the inferior K-wire (p = 0.35). Posterior bone block surgery should be performed taking into consideration the possibility of axillary nerve injury anteriorly at the exit point of the K-wires. Wire and screw insertion parallel to the glenoid articular surface may reduce the risk, while increased wire or screw medial angulation with respect to the glenoid surface may heighten risk. Not applicable (cadaveric study).

关键词： multiple sclerosis   nervous system disorders  

摘要： [...]ICD-10-CM billing codes were not in effect prior to 2015. [...]acutely elevated blood pressure has been linked to the posterior reversible encephalopathy syndrome which refers to acute neurological symptoms in the setting of reversible subcortical vasogenic brain edema caused by abrupt blood pressure changes or direct effects of cytokines on the endothelium [4]. Emerging literature suggests that Takotsubo cardiomyopathy can indeed lead to acute neurological diseases such as acute ischemic stroke through the development of arrhythmias and wall motion abnormalities that favor thrombosis [5].

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： 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： 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： 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： 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： 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.