关键词： CoQ10   MDA   SOD   Acute ischemic stroke   Neurological deficit  

摘要： Disruption of prooxidant-antioxidant balance may lead to oxidative stress which is known as a mechanism contributing to ischemic stroke. Coenzyme Q10 (CoQ10) is an endogenous antioxidant that could be effective in preventing oxidative stress. However, the contribution of serum levels of CoQ10 in clinical neurological outcomes following ischemic stroke has not been clearly established. This study aims at measuring serum concentration of CoQ10 along with major indicators of antioxidant and oxidant among patients within 24h after onset of the stroke symptoms, and investigating their relation with the clinical status of patients. Serum levels of CoQ10, superoxide dismutase (SOD), and malondialdehyde (MDA) were measured in 76 patients and 34 healthy individuals. Severity of the neurological deficit, functional disability, and cognitive status in ischemic subjects were respectively studied with the National Institutes of Health stroke scale (NIHSS), modified Rankin Scale (MRS), and Mini-Mental State Examination (MMSE). Stroke patients had significantly lower serum level of CoQ10 and SOD as compared to controls (27.34 +/- 35.40ng/ml, 18.58 +/- 0.76/ml, respectively;p<0.05), whereas the serum MDA level was significantly higher (38.02 +/- 2.61m, p<0.05). A significant negative correlation was detected between the serum CoQ10 level and scores of NIHSS and MRS. A similar association was discerned between the SOD level and the neurological deficit score. The serum MDA level was also found to be strongly correlated with all three neurological scales. These findings suggest that the serum level of CoQ10 like other antioxidant and oxidant markers can significantly change early after ischemic stroke and they are substantially associated with clinical neurological outcomes.

关键词： Asystole   Bradycardia   Cerebellopontine angle   Hypotension   Neurosurgery   Trigeminal nerve   Trigeminocardiac reflex  

摘要： BACKGROUND: The trigeminocardiac reflex (TCR) is characterized by bradycardia, decrease of mean arterial blood pressure, and sometimes, asystole during surgery. We critically reviewed TCR studies and devised a novel classification scheme for assessing the reflex. METHODS: A comprehensive systematic literature review was performed using PubMed, MEDLINE, Web of Science, EMBASE, and Scielo databases. Eligible studies were extracted based on stringent inclusion and exclusion criteria. Statistical analyses were used to assess cardiovascular variables. TCR was classified according to morphophysiologic aspects involved with reflex elicitation. RESULTS: A total of 575 patients were included in this study. TCR was found in 8.9% of patients. The reflex was more often triggered by interventions made within the anterior cranial fossa. The maxillary branch (type II in the new classification) was the most prevalent nerve branch found to trigger the TCR. Heart rate and mean arterial blood pressure were similarly altered (P = 0.06;F = 0.3912809), covaried with age (P = 0.012;F = 9.302), and inversely correlated to each other (r = -0.27). CONCLUSIONS: TCR is a critical cardiovascular phenomenon that must be quickly identified and efficiently classified and should trigger vigilance. Prompt therapeutic measures during neurosurgical procedures should be carefully addressed to avoid unwanted complications. Accurate categorization using the new classification scheme will help to improve understanding and guide the management of TCR in the perioperative period.

关键词： Brain-machine interfaces (BMI)   movement intention   rehabilitation   stroke   spinal cord injury (SCI)  

摘要： Motor rehabilitation based on the association of electroencephalographic (EEG) activity and proprioceptive feedback has been demonstrated as a feasible therapy for patients with paralysis. To promote long-lasting motor recovery, these interventions have to be carried out across several weeks or even months. The success of these therapies partly relies on the performance of the system decoding movement intentions, which normally has to be recalibrated to deal with the nonstationarities of the cortical activity. Minimizing the recalibration times is important to reduce the setup preparation and maximize the effective therapy time. To date, a systematic analysis of the effect of recalibration strategies in EEG-driven interfaces for motor rehabilitation has not yet been performed. Data from patients with stroke (4 patients, 8 sessions) and spinal cord injury (SCI) (4 patients, 5 sessions) undergoing two different paradigms (self-paced and cue-guided, respectively) are used to study the performance of the EEG-based classification of motor intentions. Four calibration schemes are compared, considering different combinations of training datasets from previous and/or the validated session. The results show significant differences in classifier performances in terms of the true and false positives (TPs) and (FPs). Combining training data from previous sessions with data from the validation session provides the best compromise between the amount of data needed for calibration and the classifier performance. With this scheme, the average true (false) positive rates obtained are 85.3% (17.3%) and 72.9% (30.3%) for the self-paced and the cue-guided protocols, respectively. These results suggest that the use of optimal recalibration schemes for EEG-based classifiers of motor intentions leads to enhanced performances of these technologies, while not requiring long calibration phases prior to starting the intervention.

关键词： Complications   neurocritical care   nonneurological complications   outcome   systemic complications   traumatic brain injury  

摘要： Introduction and Aims: Recognizing and treating nonneurological complications occurring in traumatic brain injury (TBI) patients during intensive care unit (ICU) stay are challenging. The aim is to estimate various nonneurological complications in TB! patients. The secondary aim is to see the effect of these complications on ICU stay, disability, and mortality. Materials and Methods: This was a prospective observational study at the neuro-ICU of a Level-I trauma center. A total of 154 TBI patients were enrolled. The period of the study was from admission to discharge from ICU or demise. Inclusion criteria were patients aged >16 years and patients with severe TBI (Glasgow coma score [GCS] <= 8). Nonneurological complications were frequent in TBI patients. Results: We observed respiratory complications to be the most common (61%). Other complications, in the decreasing order, included dyselectrolytemia (46.1%), cardiovascular (34.4%), coagulopathy (33.1%), sepsis (26%), abdominal complications (17.5%), and acute kidney injury (AKI, 3.9%). The presence of systemic complications except AKI was found to be significantly associated with increased ICU stay. Most of the patients of AKI died early in ICU. Respiratory dysfunction was found to be independently associated with 3.05 times higher risk of worsening clinical condition (disability) (P < 0.018). The presence of cardiovascular complications during ICU stay (4.2 times, P < 0.005), AKI (24.7 times, P < 0.02), coagulopathy (3.13 times, P < 0.047), and GCS <6 (4.2 times, P < 0.006) of TBI was independently associated with significantly increased risk of ICU mortality. Conclusion: TBI patients tend to have poor outcome due to concomitant nonneurological complications. These have significant bearing on ICU stay, disability, and mortality.

关键词： Neural cell adhesion molecule   Bioactive peptides   Mimetic peptides   Fibroblast growth factor receptor   Neurological disorders  

摘要： The neural cell adhesion molecule (NCAM) plays a pivotal role in the development and maintenance of the nervous system via homophilic (NCAM-NCAM) and heterophilic (NCAM-other molecules) interactions. Many synthetic peptides have been engineered to mimic these interactions and induce NCAM-downstream signaling pathways. Such NCAM mimetics have displayed neuritogenic and neuroprotective properties, as well as synaptic modulation in vitro and in vivo. Furthermore, they have been used successfully in preclinical studies to treat neurological disorders including stroke, traumatic brain injury and Alzheimer's disease. This review focuses on recent progress in the development of NCAM mimetic peptides, in particular, on establishing C3, plannexin, and FGL as therapeutic candidates for neurological disorders.

关键词： Ischemic stroke   Clopidogrel resistance   Early neurological deterioration   CYP2C19 polymorphism   Dual antiplatelet therapy  

摘要： Purpose To investigate the associations between CYP2C19 genotypes and early neurological deterioration (END), and to carry out a stratified analysis of the effectiveness of clopidogrel alone and dual antiplatelet therapy with clopidogrel and aspirin for prevention of END according to CYP2C19 genotypes in ischemic stroke (IS) patients. Methods This was a prospective, observational, two-center study. A total of 375 acute IS patients were enrolled. Platelet aggregation was measured before and after the 7-to 10-day treatment. Clopidogrel resistance (CR) was assessed by adenosine diphosphate-induced platelet aggregation. CYP2C19* 2 (rs4244285) and CYP2C19* 3 (rs4986893) genotypes were examined using mass spectrometry. The primary outcome was END during the 10 days after admission. Results Among the 375 patients, 144 patients received clopidogrel alone, 231 patients took clopidogrel plus aspirin, 153 patients (40.8%) had CR, 95 patients (25.3%) experienced END. Patients carrying CYP2C19* 2 AG/AA (CYP2C19* 2 reduced-function alleles) and CR were associated with a higher risk for END, and dual antiplatelet therapy was associated with a lower risk for END. Stratified analyses revealed that there was no significant difference in the incidence of END between patients not carryingCYP2C19* 2 reduced-function alleles who received clopidogrel plus aspirin and those who received clopidogrel alone. However, dual antiplatelet therapy was more effective at reducing END and inhibiting platelet aggregation than clopidogrel alone for carriers of at least one CYP2C19* 2 reduced-function allele. Conclusions The frequency of END was very high after acute IS in the Chinese population. Dual therapy with clopidogrel and aspirin may be adequate for patients carrying CYP2C19* 2 reduced-function alleles. Genetic testing may be useful to guide personalized and precise antiplatelet therapy. Clinical trial registration information The study described here is registered at http://***/(uniq

摘要： Neurological disability is often associated with feeding and gastrointestinal disorders leading to malnutrition and growth failure. Assessment of nutritional status represents the first step in the clinical evaluation of children with neurological disability. The European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recently issued a consensus statement on gastrointestinal and nutritional management in children with neurological disability. Here we critically review and address implications of this consensus for clinical practice, including assessment and monitoring of nutritional status, definition of nutritional requirements, diagnosis and treatment of gastro-oesophageal reflux disease, and indications for and modalities of nutritional support. There is a strong evidence base supporting the ESPGHAN guidelines;their application is expected to lead to better management of this group of children.

关键词： Prophylactic vaccination   journals   Cohort Studies   Type 1 Diabetes Mellitus   Internal Medicine   Narcolepsy  

摘要： The above letter to the editor written by “Lars Andersson” (stated to be affiliated with Department of Physiology and Pharmacology, Karolinska Institutet), published in print and online in the Journal of Internal Medicine in Wiley Online Library https://***) on the date given above, has been retracted by agreement between the journal’s Editor‐in‐Chief Ulf de Faire, the Association for Publication of the Journal of Internal Medicine and John Wiley & Sons Limited. The retraction has been agreed due to the author’s use of what appears to be a false name and affiliation. Reference Andersson L. Contradictory data on type 1 diabetes in a recently published article ‘Risks of neurological and immune‐related diseases, including narcolepsy, after vaccination with Pandemrix: a population‐ and registry based cohort study with over 2 years of follow‐up’ (J Intern Med 2013). J Intern Med 2014; 276: 414-7.

关键词： mode of delivery   neurological morbidity   autism   pervasive developmental disorder  

摘要： Objective The study's objective was to determine whether mode of delivery has an impact on the long-term risk for neurologic morbidity of the offspring. Materials and Methods This population-based cohort analysis included all term singleton deliveries between 1991 and 2014. The study population was divided into two study group: elective cesarean deliveries (CD) versus vaginal deliveries (VD). Urgent cesarean deliveries, pregnancy, and delivery complications including preeclampsia and gestational diabetes were excluded. The evaluation of cumulative neurological hospitalization rate over time was performed with a Kaplan-Meier survival analysis and Cox proportional hazards models were used to study the independent association between mode of delivery and neurological morbidity while controlling for potential confounders. Results During the study period 132,054 deliveries met the inclusion criteria, 11,746 CD (8.9%), and 120,308 (91.1%) VD. A total of 3,626 neurological hospitalizations were documented with 2.70% (3,244) in the VD group as compared with 3.25% (382) in the CD group. The survival curves showed higher cumulative hospitalization rates in the CD as compared with the VD group ( p 0.001). The Cox analysis demonstrated CD to be an independent risk factor for pediatric neurological hospitalizations ( p <0.001). Conclusion Term elective CD is an independent risk factor for neurological morbidity of the offspring.

关键词： Equistasi   Gait analysis   Parkinson's disease   Surface electromyography