摘要： Neurologically impaired children (NIC) often experience swallowing difficulties and gastroesophageal reflux disease (GERD). Although these conditions could place children in a state of poor nutritional status and prevent them from thriving, there is insufficient research evaluating growth and nutritional status following fundoplication in these patients. This is a retrospective study of patients who were neurologically impaired and underwent Nissen fundoplication between April 2001 and March 2015. Seventy-six patients were enrolled, and the follow-up period was 12 months or longer. Growth was measured by the change in body weight and height. Nutritional status was measured by the change in body mass index, serum albumin and protein level. Median age at operation was 1.85 years old, and median body weight was 10 kg. The respective Z scores for weight and height showed significant improvements after 1 year since the operation compared to 1 year within the operation (-2.42 +/- 2.19 vs. -1.31 +/- 1.96, P < 0.001) (-1.6 +/- 2.16 vs. -1.05 +/- 1.69, P = 0.002). The respective Z scores for body mass index, albumin and protein also showed improvements after 1 year since the operation compared to 1 year within the operation (-2.07 +/- 2.99 vs. -0.89 +/- 2.1, P < 0.001) (3.55 +/- 0.48 vs. 3.86 +/- 0.45, P < 0.001) (6.22 +/- 0.76 vs. 6.65 +/- 0.51, P < 0.001). Hospital visitation scores associated with reflux were significantly lower after the operation (4.1 +/- 3.43 vs. 1.18 +/- 1.67, P < 0.001). In summary, after Nissen fundoplication in NIC with GER, growth and nutritional status improved significantly. Also, hospital visitation scores associated with reflux decreased after the operation.

关键词： Nervous System   Pharmaceutical Preparations   Ion Channels   AMPA receptor antagonist   Epicoccum   Neurotransmitter Receptors   Ligand-Gated Ion Channels   Neurologic Disorders   Prosencephalon   Cerebellum   AMPA Receptors   Drug Liberation  

摘要： The need for improved medications for psychiatric and neurological disorders is clear. Difficulties in finding such drugs demands that all strategic means be utilized for their invention. The discovery of forebrain specific AMPA receptor antagonists, which selectively block the specific combinations of principal and auxiliary subunits present in forebrain regions but spare targets in the cerebellum, was recently disclosed. This discovery raised the possibility that other auxiliary protein systems could be utilized to help identify new medicines. Discussion of the TARP-dependent AMPA receptor antagonists has been presented elsewhere. Here we review the diversity of protein complexes of neurotransmitter receptors in the nervous system to highlight the broad range of protein/protein drug targets. We briefly outline the structural basis of protein complexes as drug targets for G-protein coupled receptors, voltage-gated ion channels, and ligand-gated ion channels. This review highlights heterodimers, subunit-specific receptor constructions, multiple signaling pathways, and auxiliary proteins with an emphasis on the later. We conclude that the use of auxiliary proteins in chemical compound screening could enhance the detection of specific, targeted drug searches and lead to novel and improved medicines for psychiatric and neurological disorders.

关键词： Benztropine   Botulinum toxin   Glycopyrrolate   Scopolamine   Parkinson's disease   Cerebral palsy   Amyotrophic lateral sclerosis  

摘要： Sialorrhea is a common distress associated with certain neurological disorders. The aim of this study is to compare the pharmacological agents used for treating sialorrhea by network meta-analysis. Electronic databases were searched for randomized clinical trials comparing active drugs with either placebo or other active drugs. Total drooling scores was the primary outcome measure. Inverse variance heterogeneity model was used for both direct and mixed treatment comparison analysis. Twenty one studies were included in the systematic review and 15 in the meta-analysis. Compared to placebo, benztropine, botulinum toxins A and B are associated with a significant reduction in the frequency and severity of drooling both in the overall neurological disorders as well as for children with cerebral palsy. Only botulinum toxin A and B were associated with significant therapeutic effects in Parkinson's disease. Benztropine and botulinum toxins A and B were observed to be effective in reducing sialorrhea associated with neurological disorders. (C) 2018 Elsevier Ltd. All rights reserved.

关键词： Spinal cord injury   MMR spectroscopy   Metabolomic profiling   Biomarker   Stem cell  

摘要： Background: Acute Spinal Cord Injury (ASCI) is still having substantial morbidity and mortality despite of advanced therapeutics. Major obstacles are paucity of monitoring tools or biomarkers for severity determination, recovery and prognostication. A prospective case control pilot study with serum H-1 NMR spectroscopic metabolic profiling was carried out to evaluate metabolites perturbations and its relationship with recovery and to see role of stem cells in facilitating neurological recovery. Methodology: Twenty subjects with ASCI were classified on the basis of therapeutic modality into surgical fixation alone (Group-1, n = 10), stem cell adjuvant (Group-2, n = 10) and healthy controls (Group-0, n = 10). Serum samples were collected at admission (baseline) and after six months (follow-up). NMR data of serum sample were quantified and subjected to Wilcoxon and ANOVA tests. Further validation was performed using supervised OSC-PCA and OPLS-DA by incorporating substantial control samples. Result Twenty-eight metabolites were identified;well resolved resonances of fifteen metabolites were quantified wherein seven were statistically significant. Predominantly amino acids and ketone bodies played vital role in the differentiation of groups. Conclusions: Serum NMR spectroscopy reveals certain metabolites perturbations having clear correlation with pattern of recovery in treated ASCI subject. Stem cells treatment group had comparatively effective recovery.

关键词： Aortic dissection   Stroke   Predictors   Morbidity   Neurological recovery  

摘要： OBJECTIVES: Despite improvement in operative and cerebral perfusion techniques, cerebral malperfusion and neurological injury remain a dreaded complication of acute type A aortic dissection. We aimed to identify predictors for postoperative stroke and analyse the impact on morbidity, neurological recovery and mid-term survival. METHODS: Between 2000 and 2017, 303 (71.9% men, mean age 58.9 +/- 13.6 years) patients with acute type A aortic dissection underwent surgical repair. Clinical and imaging data were retrospectively evaluated. Patients were divided into 2 groups depending on the presence of postoperative stroke. RESULTS: Postoperative stroke was detected in 15.8% (n = 48) of the patients. Patients with postoperative stroke showed higher rates of preoperative cardiopulmonary resuscitation (stroke: 18.8% vs no stroke: 3.5%, P < 0.001) and malperfusion syndrome (stroke: 47.9% vs no stroke: 22.4%, P < 0.001). Multivariable analysis identified the presence of bovine aortic arch [odds ratio (OR) 2.33, 95% confidence interval (CI) 1.086-4.998;P = 0.030], preoperative cardiopulmonary resuscitation (OR 6.483, 95% CI 1.522-27.616;P = 0.011) and preoperative malperfusion (OR 2.536, 95% CI 1.238-5.194;P = 0.011) as independent predictors for postoperative stroke. Postoperative stroke had a strong impact on morbidity and was associated with higher rates of postoperative complications and a significantly longer hospital stay (stroke: 23 +/- 16 days vs no stroke: 17 +/- 18 days, P = 0.021). Postoperative stroke was not independently associated with in-hospital mortality (adjusted OR 1.382, 95% CI 0.518-3.687;P = 0.518). There was no difference in mid-term survival between patients with stroke and patients without stroke. CONCLUSIONS: This study identified independent preoperative predictors for postoperative stroke. Although postoperative stroke was associated with significant morbidity and postoperative complications, significant impairment in mid-term survival could not be

关键词： acute   Guillain-Barre syndrome   Restless legs syndrome   stroke  

摘要： ObjectivesWhile the Restless legs syndrome (RLS) is usually recognized as a chronic condition, it has often been diagnosed among patients with acute neurological illnesses, in which limb discomfort is reported. This study was conducted to determine how many among these, actually have acute-onset RLS, and also to evaluate characteristics of this subgroup of patients with Guillain-Barre syndrome (GBS) and stroke developing acute-onset RLS. MethodsConsecutive patients diagnosed with GBS and eligible stroke patients, admitted to our Neurology services over a 1-year period, were enrolled. They were evaluated for symptoms of RLS based on IRLSSG consensus criteria and the AIIMS RLS Questionnaire for Indian patients (ARQIP). ResultsForty adults with GBS and 58 with stroke were included. A total of 10 of the 40 (25%) patients with GBS developed definite acute RLS, which was mostly monophasic. Seven (70%) of these had demyelinating type of GBS, a significant association with acute RLS (P=.024). Six of the 58 stroke patients (10%) developed definite acute-onset, often persistent RLS. Subcortical location showed significant association with increased risk of developing acute RLS (P<.001). All patients diagnosed with acute-onset RLS had an immediate and good response to dopamine agonists. ConclusionThis is the first study showing that acute-onset RLS is common, affecting nearly 25% of patients with GBS and 10% patients with acute stroke. Recognizing and treating it can majorly contribute toward symptom relief and early improvement in the quality of life for this population.

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

关键词： Blood-brain barrier   Neuro-vascular interactions   Neurodegeneration   Neuroimmunology  

摘要： The blood coagulation protein fibrinogen is deposited in the brain in a wide range of neurological diseases and traumatic injuries with blood-brain barrier (BBB) disruption. Recent research has uncovered pleiotropic roles for fibrinogen in the activation of CNS inflammation, induction of scar formation in the brain, promotion of cognitive decline and inhibition of repair. Such diverse roles are possible in part because of the unique structure of fibrinogen, which contains multiple binding sites for cellular receptors and proteins expressed in the nervous system. The cellular and molecular mechanisms underlying the actions of fibrinogen are beginning to be elucidated, providing insight into its involvement in neurological diseases, such as multiple sclerosis, Alzheimer disease and traumatic CNS injury. Selective drug targeting to suppress the damaging functions of fibrinogen in the nervous system without affecting its beneficial effects in haemostasis opens a new fibrinogen therapeutics pipeline for neurological disease.

关键词： Depression   MCS gene   Nervous System Diseases   patient health questionnaire   Stroke   Neurologic Disorders   Anxiety   Hospital anxiety and depression scale  

摘要： Background: It is unclear whether anxiety and depression impact health-related quality of life (HRQoL) equally across neurological diseases. This study examines the association between anxiety or depression and HRQoL in select neurological disorders. Methods: HRQoL was measured using the Short Form Health Survey (SF-12) in neurological patients: epilepsy (n=279), migraine (n=268), multiple sclerosis (MS) (n=222), stroke (n=204), and Parkinson's disease (PD) (n=224). Depression and anxiety symptoms were assessed using the Patient Health Questionnaire (PHQ-9) and Hospital Anxiety and Depression Scale (HADS-A), respectively. Multiple linear regression was used to evaluate variables associated with the SF-12 mental health component (MCS) and physical health component scores (PCS). Pratt index was used to estimate the relative importance of anxiety and depression on HRQoL. Results: Anxiety and depression had the largest contribution to PCS in stroke and to MCS in epilepsy. Overall, anxiety and depression had a larger contribution to MCS as compared to PCS, except in stroke patients. Different patterns were seen across neurological diseases, with mental health variables strongly affecting MCS in all conditions, with also a sizable contribution to PCS in migraine, MS, and stroke. Conclusions: Anxiety and depression have varying impacts on HRQoL across neurological diseases. It is important for clinicians to be aware of how these patterns differ in each condition.