摘要： Click to view the accompanying paper in this volume.

关键词： Nosocomial infections   Critical care   Pneumonia   Ventilator-associated pneumonia   Urinary tract infections   Ventriculostomy-associated infections  

摘要： Background: Healthcare-associated infections (HAIs) occur frequently in neurological intensive care units (neuro-ICUs);however, data differentiating associations with various diagnostic categories and resulting burdens are limited. This prospective cohort study reported incidence rates, pathogen distribution, and patient-related outcomes of HAIs in a neuro-ICU population from April 2010 to March 2016. Methods: Laboratory results and specific clinical indicators were used to categorize infections as per National Healthcare Safety Network nosocomial infection surveillance definitions. Patient outcomes studied included length of stay and mortality. Results: There were 6,033 neuro-ICU admissions resulting in 20,800 neuro-ICU days over the 6-year study period. A total of 227 HAIs were identified for a rate of 10.9/1,000 ICU days. Device-associated infections accounted for 80.6% of HAIs, with incidence rates (per 1,000 device days) being 18.4 for ventilator-associated pneumonia;4.9 for catheter-associated urinary tract infections (CAUTIs);4.0 for ventriculostomy-associated infections;and 0.6 for central line- associated blood stream infections (CLABSIs). Of the various diagnostic categories, subdural hematoma and intracerebral/intraventricular hemorrhage were associated with the highest pooled HAIs, with incidence rates of 21.3 and 21.1 per 1,000 neuro-ICU days, respectively. Prolonged neuro-ICU length of stay was strongly associated with all HAIs. Conclusions: This large-scale surveillance study provides estimates of the risk of common HAIs in neurocritical care patients and their effect on hospitalization. Preventive strategies kept rates of infection very low, in particular CAUTI, CLABSI, and Clostridium difficile infections, and inhibited the emergence of resistant organisms. (c) 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

关键词： equine herpesvirus type 1   sequencing   diversity  

摘要： Equine herpesvirus 1 (EHV-1) causes respiratory disease, abortion, neonatal death and neurological disease in equines and is endemic in most countries. The viral factors that influence EHV-1 disease severity are poorly understood, and this has hampered vaccine development. However, the N752D substitution in the viral DNA polymerase catalytic subunit has been shown statistically to be associated with neurological disease. This has given rise to the term neuropathic strain, even though strains lacking the polymorphism have been recovered from cases of neurological disease. To broaden understanding of EHV-1 diversity in the field, 78 EHV-1 strains isolated over a period of 35years were sequenced. The great majority of isolates originated from the United Kingdom and included in the collection were low passage isolates from respiratory, abortigenic and neurological outbreaks. Phylogenetic analysis of regions spanning 80% of the genome showed that up to 13 viral clades have been circulating in the United Kingdom and that most of these are continuing to circulate. Abortion isolates grouped into nine clades, and neurological isolates grouped into five. Most neurological isolates had the N752D substitution, whereas most abortion isolates did not, although three of the neurological isolates from linked outbreaks had a different polymorphism. Finally, bioinformatic analysis suggested that recombination has occurred between EHV-1 clades, between EHV-1 and equine herpesvirus 4, and between EHV-1 and equine herpesvirus 8.

关键词： Alzheimer's disease   amyotrophic lateral sclerosis   antisense oligonucleotides   Duchenne muscular dystrophy   Huntington's disease   myotonic dystrophy   nusinersen   spinal muscular atrophy  

摘要： The introduction of genetics revolutionized the field of neurodegenerative and neuromuscular diseases and has provided considerable insight into the underlying pathomechanisms. Nevertheless, effective treatment options have been limited. This changed recently when antisense oligonucleotides (ASOs) could be translated from in vitro and experimental animal studies into clinical practice. In 2016, two ASOs were approved by the United States US Food and Drug Administration (FDA) and demonstrated remarkable efficacy in Duchenne muscular dystrophy (DMD) and spinal muscular atrophy (SMA). ASOs are synthetic single-stranded strings of nucleic acids. They selectively bind to specific premessenger ribonucleic acid (pre-mRNA)/mRNA sequences and alter protein synthesis by several mechanisms of action. Thus, apart from gene replacement, ASOs may therefore provide the most direct therapeutic strategy for influencing gene expression. In this review, we shall discuss basic mechanisms of ASO action, the role of chemical modifications needed to improve the pharmacodynamic and pharmacokinetic properties of ASOs, and we shall then focus on several ASOs developed for the treatment of neurodegenerative and neuromuscular disorders, including SMA, DMD, myotonic dystrophies, Huntington's disease, amyotrophic lateral sclerosis and Alzheimer's disease.

关键词： Hysteria   Babylon   Assyria   Egypt   Greece   Rome  

摘要： The word hysteria originated in the Corpus Hippocraticum (c420 BCE) as a natural explanation for a variety of diseases in women linked in the Greco-Roman mind to an animate or inanimate womb, but which in the last five centuries has evolved to describe an elusive disorder of brain +/- mind in men and women, currently referred to by neurologists as "functional neurological disorder". The Babylonians, Assyrians and Egyptians had no knowledge of brain or psychological function. Babylonian and Assyrian descriptions of disease and behaviour include only rare examples suggestive of modern hysteria. An earlier suggestion that the Greek concept of hysteria was transmitted from Egypt is not supported by recent evidence. The Greco-Roman civilisations had some knowledge of neuroanatomy, but little of nervous system function, conceived in terms of humors. The examples cited here suggestive of modern hysteria are relatively infrequent and fragmentary. The most plausible are attempts to separate the "sacred disease" from other causes of loss of consciousness. The great achievement of Greco-Roman medicine was in introducing natural causation, including causation linked to the womb, rather than gods or evil spirits. Nevertheless medicine, magic and religion have remained intertwined to varying degrees in all cultures up to the present time, despite the growth of modern scientific medicine. The study of hysteria in ancient civilisations adds interesting insight into the evolution of thinking about brain, psyche, mind and self. Babylonian and Egyptian medical and behavioural descriptions are based on observation. Greek and Roman accounts include some subjective aspects, probably linked to early attempts to understand identity, the psyche, intellectual and emotional functions. The great philosophical debate whether the latter resided in the head/brain (Plato) or the heart (Aristotle) has only been settled in the last few centuries, during which hysteria also became linked to brain +/-

关键词： brain injuries   heart arrest   hyperoxia   nervous system  

摘要： BACKGROUND: Studies examining the association between hyperoxia exposure after resuscitation from cardiac arrest and clinical outcomes have reported conflicting results. Our objective was to test the hypothesis that early postresuscitation hyperoxia is associated with poor neurological outcome. METHODS: This was a multicenter prospective cohort study. We included adult patients with cardiac arrest who were mechanically ventilated and received targeted temperature management after return of spontaneous circulation. We excluded patients with cardiac arrest caused by trauma or sepsis. Per protocol, partial pressure of arterial oxygen (Pao(2)) was measured at 1 and 6 hours after return of spontaneous circulation. Hyperoxia was defined as a Pao(2) >300 mm Hg during the initial 6 hours after return of spontaneous circulation. The primary outcome was poor neurological function at hospital discharge, defined as a modified Rankin Scale score >3. Multivariable generalized linear regression with a log link was used to test the association between Pao(2) and poor neurological outcome. To assess whether there was an association between other supranormal Pao(2) levels and poor neurological outcome, we used other Pao(2) cut points to define hyperoxia (ie, 100, 150, 200, 250, 350, 400 mm Hg). RESULTS: Of the 280 patients included, 105 (38%) had exposure to hyperoxia. Poor neurological function at hospital discharge occurred in 70% of patients in the entire cohort and in 77% versus 65% among patients with versus without exposure to hyperoxia respectively (absolute risk difference, 12%;95% confidence interval, 1-23). Hyperoxia was independently associated with poor neurological function (relative risk, 1.23;95% confidence interval, 1.11-1.35). On multivariable analysis, a 1-hour-longer duration of hyperoxia exposure was associated with a 3% increase in risk of poor neurological outcome (relative risk, 1.03;95% confidence interval, 1.02-1.05). We found that the association with poor n

关键词： Metabolomics   Optic neuropathies   GC-MS   Metabolomics   Method validation   Fingerprinting  

摘要： The optic nerve is made of highly specialized neurons and the energetic supply to their axons is crucial due to their great demand. The energy comes basically through the oxidative phosphorylation in the mitochondria, supported by glia I cells metabolism. Mitochondrial dysfunction is a shared feature encountered within the optic neuropathies, including Leber's Hereditary Optic Neuropathy, Leigh's Syndrome, or Kjer's syndrome. In an effort to investigate the metabolic alterations produced within the optic nerve in a mutant mouse model of Neurological Visual Disease (NVD), a rapid, robust, and efficient one-single phase extraction methodology has been developed and validated for the GC-MS platform. Once the method was successfully validated for lactic acid and pyruvic acid as markers of an adequate optic nerve function, the protocol was applied to unveil the metabolomic signature of the wild-type mouse optic nerve. Along the chromatographic profile of the optic nerve, 94 peaks were identified and, to our knowledge, for the first time. Afterwards, a targeted metabolomics analysis was performed to quantify lactic acid and pyruvic acid in the NDV mice group (n = 8) and its corresponding wild-type (n = 8). Finally, an untargeted metabolomic study was carried out and univariate and multivariate data analyses showed 34 compounds modified in the optic nerve of the mouse with NVD mutation. Then, the metabolic reaction network of the identified metabolites highlighted alterations in the catabolism of proteins, TCA cycle, and urea cycle, reflecting a mitochondrial energetic dysfunction. Taken together, this metabolomic study has proven to be suited for the study of optic neuropathies. (C) 2018 Elsevier B.V. All rights reserved.

关键词： 医学人文   神经病学   临床实践   教学方法   调查   研究  

摘要： 目的探究医学人文融入神经病学临床实践教学方法的必要性和意义。方法调查157名医学生和临床教师对临床实践教学的看法,采用临床实践教学方法调查问卷进行问卷调查。结果所有教师都表示医学人文融入神经病学临床实践教学很有必要,有利于临床实践教学的顺利、有效实施。54.7%的学生认为床边教学操作经常被患者拒绝或不配合;70%以上的医学生认为医学人文融入神经病学临床实践教学很有必要。结论医学人文融入神经病学临床实践有利于提高医患沟通能力和实践教学的开展。

关键词： 教学实践   临床医学系   病例   学习   高等医学院校   常见疾病   临床见习   神经病学  

摘要： 神经病学临床见习是高等医学院校临床医学系开设的课程,与临床关系密切。教学目标是掌握神经系统常见疾病的解剖和理论基础,建立分析思路,对疾病诊疗提出自己的看法和见解。

关键词： CBL   本科生   神经病学教学  

摘要： 目的观察CBL教学法在本科生神经病学教学中的应用效果。方法将首都医科大学临床医学专业本科生40人随机分为实验组和对照组,分别采用CBL和LBL教学法对他们进行神经病学教学,比较两组的教学效果和学习获益情况。结果实验组的学习效果测试成绩显著高于对照组(P<0.05)。实验组学生在学习兴趣、自学能力、临床思维、临床技能方面的获益程度显著高于对照组(P<0.05)。结论 CBL教学法在本科生神经病学教学中应用具有显著优势。