关键词： Aneurysm rupture   Critical care   Pulmonary complications   Subarachnoid hemorrhage  

摘要： OBJECTIVE: Because the clinical course of spontaneous aneurysmal subarachnoid hemorrhage (aSAH) can be compromised by pulmonary complications, we sought to review post-treatment outcomes in aSAH patients with and without pulmonary complications. METHODS: Patient demographic, clinical, and outcome data (March 2003-January 2007) were analyzed retrospectively. Patients underwent microsurgical or endovascular treatment for aSAH;pulmonary complications were reported. Outcomes were assessed using the Glasgow Outcome Scale (GOS) scores at the 1-year, 3-year, and 6-year follow-up visits. RESULTS: The cohort comprised 471 patients (mean age, 53.7 +/- 12.4 years;men, 332/471 [70%]). The mean Glasgow Coma Scale (GCS) score at presentation was 11.9 1 3.0. Of 471 patients, 47% (n = 223) presented with a Hunt and Hess score of Z3 and 76% (n = 357) with a Fisher grade of 3. Treatment was clipping for 69% (279/407) and coiling for 31% (128/407) of patients. Pulmonary complications occurred in 210 of 471 (45%) patients. Nearly one-half of patients were discharged to home (215/471, 46%), and more than one-half had a good outcome defined as a GOS score of 5 at their 1-year (226/403, 56%), 3-year (217/397, 55%), and 6-year (203/380, 53%) follow-up visits. Logistic regression showed age and GCS scores as outcome predictors at all time points, whereas pulmonary complications predicted poor outcome only at the 1-year follow-up visit. CONCLUSIONS: Pulmonary problems represent the most common nonneurologic medical complications after aSAH. Despite advances in critical care, pulmonary complications represented predictors of short-term poor outcome only at the 1-year follow-up visit, whereas the medical history of the patient became more relevant for prognosis in long-term follow-up.

关键词： Neurosteroids   Non-genomic pathways   Neuroplasticity   Neurological disorders  

摘要： Neurosteroids are neuroactive brain-born steroids. They can act through non-genomic and/or through genomic pathways. Genomic pathways are largely described for steroid hormones: the binding to nuclear receptors leads to transcription regulation. Pregnenolone, Dehydroepiandrosterone, their respective sulfate esters and Allopregnanolone have no corresponding nuclear receptor identified so far whereas some of their non-genomic targets have been identified. Neuroplasticity is the capacity that neuronal networks have to change their structure and function in response to biological and/or environmental signals;it is regulated by several mechanisms, including those that involve neurosteroids. In this review, after a description of their biosynthesis, the effects of Pregnenolone, Dehydroepiandrosterone, their respective sulfate esters and Allopregnanolone on their targets will be exposed. We then shall highlight that neurosteroids, by acting on these targets, can regulate neurogenesis, structural and functional plasticity. Finally, we will discuss the therapeutic potential of neurosteroids in the pathophysiology of neurological diseases in which alterations of neuroplasticity are associated with changes in neurosteroid levels. (C) 2018 Elsevier Inc. All rights reserved.

关键词： Exome   Next generation sequencing   Neuro-genetic   Phenotype   Variants  

摘要： Objective: To share the experience of next-generation sequencing (NGS) in delineating molecular basis of neurogenetic disorders in adults of Indian origin. Patients and methods: Adults (aged 18 years) evaluated in a single neurology unit at a tertiary-care teaching hospital between August 2014 and September 2016, underwent NGS for (i) sporadic occurrence of neurological disorder where an extensive search did not reveal an acquired cause or (ii) familial or sporadic, uncommon, seemingly genetic disorder where single monogenic cause could not be ascertained based on phenotype. Presence of pathogenic/likely-pathogenic variants, novel genetic variants, and novel phenotype associations were noted. Results: Clinical phenotypes included: neuromuscular (n = 14), extrapyramidal (n = 8), ataxia (n = 7), leukoencephalopathy (n = 6), spastic paraplegia (n = 5), stroke (n = 4), progressive myoclonic epilepsy (n = 1) and epilepsy with developmental delay (n = 1). Fifty-eight variants were identified in 43 genes in 34 patients, that included 15 (25.9%) reported variants. Genetic diagnosis could be established in 14 (30.43%) subjects. Six probands (13%) harboured previously unreported variants in a clinically relevant gene. Nine probands harboured unreported variants in two or more different genes associated with the clinical phenotype. In three probands we noted novel associations between the phenotype and genetic variation. In all patients, genetic diagnosis impacted treatment and prognostication. Conclusions: We present data of NGS in adults with suspected neuro-genetic disorders from India and this is the first report of its kind. It sets a platform for further basic science research to validate 'novel' variants and those of `uncertain significance' as pathogenic or otherwise with specific reference to Indian ethnicity.

摘要： The article presents a case study of a 78-year-old woman who was presented to the emergency department with loss of consciousness persistent diplopia, and a syncopal event. The patient was also observed with the sign of parkinsonism. The reason for the patient's condition was postural hypotension from idiopathic Parkinson disease. She was treated with levodopa/carbidopa and aspirin.

关键词： Radiographer reporting   Advanced practice   Magnetic resonance imaging   Neurological imaging   Observer performance  

摘要： Introduction: To analyse the objective structured examination (OSE) results of the first cohorts of radiographers (n = 13) who successfully completed an accredited postgraduate programme in clinical reporting of neurological magnetic resonance imaging (MRI) examinations of the head and cervical spine. Methods: Forty MRI examinations were used in the OSE which included a range of abnormal cases (prevalence of abnormal examinations approximated 50%) and included: haemorrhage, infarction, demyelination disease, abscess, mass lesions (metastatic deposits, meningioma, glioma, astrocytoma);and disc disease, cord compression, stenosis, ligament rupture, syringomyelia appearances on patients referred from a range of referral sources. Normal variants and incidental findings were also included. True/false positive and negative fractions were used to mark the responses which were also scored for agreement with the previously agreed expected answers based on agreement between three consultant radiologists' reports. Results: The mean sensitivity, specificity and agreement rates for all head and cervical spine investigations (n = 520) combined were 98.86%, 98.08% and 88.37%, respectively. The highest scoring cases were cases which included astrocytoma, disc protrusion with cord compression and glioma. The most common errors were related to syringomyelia, ligament rupture and vertebral fracture. Conclusions: These OSE results suggest that in an academic setting, and following an accredited postgraduate education programme, this group of radiographers has the ability to correctly identify normal MRI examinations of the head/cervical spine and are able to provide a report on the abnormal appearances to a high standard. Further work is required to confirm the clinical application of these findings. Crown Copyright (c) 2018 Published by Elsevier Ltd on behalf of The College of Radiographers. All rights reserved.

关键词： Quantitative susceptibility mapping   Wilson's disease   magnetic resonance imaging   copper accumulation  

摘要： Background: Wilson's disease (WD) is a copper metabolism disorder that causes hepatolenticular degeneration. It is important to diagnose WD before central nervous system involvement. Purpose: To demonstrate the early susceptibility changes associated with the copper accumulation in the brain of neurologically asymptomatic pediatric patients with WD using quantitative susceptibility mapping (QSM). Material and Methods: Twelve patients with neurologically asymptomatic WD (mean age = 13.7 +/- 3.3 years) and 14 age-matched controls were prospectively examined using a 1.5-T clinical scanner. Routine magnetic resonance (MR) sequences and a three-dimensional multi-echo spoiled gradient echo (GRE) sequence were used and QSM maps were reproduced. The quantitative susceptibility of corpus striatum, thalamus, substantia nigra, and pons were analyzed with the region of interest analysis on QSM maps. The susceptibility values of two groups were statistically compared using a two-sample t-test. Results: Conventional MR images of the patients and control group were similar. However increased magnetic susceptibility in the thalamus, pons and left posterior putamen were observed in the patients compared to the control group (p < 0.05). Conclusion: We observed statistically increased susceptibility values in the brains of neurologically asymptomatic patients with WD although the conventional MR images were normal. This might be compatible with early brain impairment, before neurological symptoms occur.

关键词： Cardiac arrest   Nonagenarian   Very elderly   ICU   Mortality  

摘要： Background: The number of cardiac arrests (CA) in the group of very elderly patients >= 90 years) is expected to increase markedly due to the world's rapidly ageing population. However, only little is known about long term outcome, CA- and intensive care unit (ICU) characteristics of patient's >= 90 years (nonagenarians) suffering from CA. Methods: This single-center retrospective study included all adult patients >= 90 years after CA and return of spontaneous circulation (ROSC) which were treated at our ICU between January 1st 2008 and September 15th 2016. Patients were followed at least 1-Year after ICU discharge for assessment of survival and neurological outcome. Aim of the study was to evaluate CA- and patients characteristics, as well as ICU- and neurological outcome after CA in patient's >= 90 years. Results: 657 patients >= 90 years were treated at our ICU during the study period, of these we could identify 48 patients with CA and successful resuscitation. 27 (56%) were female and the median age was 91.7 (90.7 - 92.6) years. 41 (85%) patient suffered from in-hospital CA. Cardiac events leading to CA were observed in 19 (40%) patients. Initial rhythm was shockable (VT/VF) in 12 (25%) patients and time to ROSC was median 4 (1.6 - 9.5) minutes. Patients after CA who survived the ICU stay had significantly lower SAPS II score (44 (36 - 55) vs. 58 (46.5 - 75.5), p < 0.05), lower maximum lactate (2.8 (1.9 - 4.3) mmol/l vs. 6.2 (4 - 9) mmol/l, p < 0.001) and higher pH (7.29 (7.26 - 7.38) vs. 7.23 (7.12 - 7.32), p < 0.05) on admission compared to patients with CA who did not survive the ICU stay. Overall, after CA, 39 (81%) patients needed mechanical ventilation, 44 (92%) received catecholamine support, 17 (35%) received red blood cell transfusion and 4 (8%) received renal replacement therapy. Mechanical ventilation and red blood cell transfusion was significantly more common in ICU non-survivors (both p < 0.05). 19 (46%) patients survived the ICU-stay, of these 86%

摘要： This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://***/about/our-business/policies/article-withdrawal).This article has been retracted at the request of the *** authors have plagiarized part of a paper that had already appeared in Journal of Neuro-Oncology 74 (2005) 99-103 https://***/10.1007/s11060-004-4204-7. One of the conditions of submission of a paper for publication is that authors declare explicitly that their work is original and has not appeared in a publication elsewhere. Re-use of any data should be appropriately cited. As such this article represents a severe abuse of the scientific publishing system. The scientific community takes a very strong view on this matter and apologies are offered to readers of the journal that this was not detected during the submission process.