关键词： Cardiac arrest   Neurological outcome   Functional outcome   Quality of life  

摘要： Background: Data on long-term functional outcome and quality of life (QoL) after out-of-hospital cardiac arrest (OHCA) are limited. We assessed long-term functional outcome and health-related QoL of OHCA survivors regardless of arrest aetiology. Methods: All adult unconscious OHCA patients treated in 21 Finnish ICUs between March 2010 and February 2011 were followed. Barthel Index (BI), activities of daily living (ADL), accommodation, help needed and received, working status, car driving and self-experienced cognitive deficits were assessed in 1-year survivors (N = 206, 40.9% of the original FINNRESUSCI cohort) with a structured telephone interview. Health-related QoL and more complex ADL-functions were evaluated by EQ-5D and instrumental ADL questionnaires. Results: Good outcome, defined as Cerebral Performance Categories 1 or 2, had been reached by 90.3% of survivors. The median BI score was 100, and 91.3% of survivors were independent in basic ADL-functions. The great majority of survivors were living at home, only 8.7% lived in a sheltered home or needed institutionalized care. Of home-living survivors 71.4% scored high in instrumental ADL assessment. The majority (72.6%) of survivors who were working previously had returned to work. Health-related QoL was similar as in age-and gender-adjusted Finnish population. Conclusions: Long-term functional outcome was good in over 90% of patients surviving OHCA, with health-related quality of life similar to that of an age and gender matched population.

关键词： continuing medical education   CME   neurology  

摘要： Continuing medical education (CME) is designed to keep physicians up-to-date on ever-changing practices and guidelines to provide patients with high quality care. CME is especially important in the field of neurology due to rapidly evolving knowledge and medical advances, and is a required element of maintenance of certification. CME itself has evolved from a passive, didactic approach to a learner-centered approach which utilizes new technologies, online learning, and simulations. CME improves knowledge, skills, and, to a lesser extent, patient outcomes, with multimodal, interactive interventions found to be most effective in teaching health care professionals. However, little data are available on CME in neurology. There is a significant gap in knowledge about CME interventions that work for neurologists. Rigorous education research, as well as making effective CME interventions more readily available to neurologists, is critical to optimize lifelong learning of physicians in the field of neurology.

关键词： Single   Risk Factors   Surgical Portosystemic Shunt   congenital portosystemic shunt   Incidence   Canis familiaris  

摘要： Objective: To determine the incidence, outcome, and risk factors for postattenuation neurological signs (PANS) and seizures after attenuation of single congenital porto-systemic shunts (CPSS) in dogs. Study design: Retrospective cohort study. Sample population: Dogs (N=253) with single CPSS. Methods: Medical records of dogs treated by surgical attenuation of a single CPSS between February 2000 and July 2015 were reviewed for signalment and preoperative and postoperative clinical outcomes, including the occurrence of PANS. Univariable and multivariable binary logistic regression was used to assess risk factors for PANS and for seizures. Results: Twenty-eight (11.1%) dogs developed PANS, including 12 (4.7%) dogs with seizures. Five (17.9%) dogs with PANS did not survive to discharge. Risk factors for PANS included the presence of hepatic encephalopathy (HE) immediately preoperatively (P5.038, odds ratio [OR] 2.704, CI 1.057-6.922) and increasing age (P<.001, OR 1.476, CI 1.223-1.780). Risk factors for seizures included the presence of HE immediately preoperatively (P=.048, OR 3.538, CI 1.013-12.363) and increasing age (P=.009, OR 1.364, CI 1.082-1.720). No association was found between the location of portosystemic shunts (extrahepatic and intrahepatic) and postoperative PANS (P=.532) or seizures (P=.620). Similarly, preemptive administration of levetiracetam did not influence the risk of PANS (P=.991) or seizures (P=.752). Conclusion: Preoperative HE and older age in dogs with a CPSS increased the odds of developing PANS and seizures in our population. Preemptive administration of levetiracetam did not protect dogs against the development of PANS or seizures.

关键词： Child development   Flavivirus infections   Malformations of cortical development   Neurological sequelae   Zika virus infection  

摘要： Limited information is available on health outcomes related to Zika virus infection acquired during childhood. Zika virus can cause severe central nervous system malformations in congenitally exposed fetuses and neonates. In vitro studies show the capacity of Zika virus to infect neural progenitor cells, induce central and peripheral neuronal cell deaths, and target different brain cells over the course of brain development. Studies of postnatally infected mice and nonhuman primates have detected degradation of neural cells and morphologic brain cell changes consistent with a broad neuroinflammatory response. In addition, case reports of central nervous system disease in adults and in adolescents secondary to Zika virus infection suggest that Zika virus may have a broader impact on neurological health beyond that observed in congenitally exposed newborns. Long-term neurological complications have been observed with other acquired flaviviral infections, with clinical symptoms manifesting for years after primary infection. The extent to which postnatal Zika virus infection in humans negatively affects the central and peripheral nervous systems and causes long-term neurological damage or cognitive effects is currently unknown. To better understand the potential for neurological sequelae associated with acquired Zika virus infection in children, we reviewed the biological, clinical, and epidemiologic literature and summarized the evidence for this link. First, we review biological mechanisms for neurological manifestations of Zika virus infection in experimental studies. Second, we review observational studies of congenital Zika virus infection and case studies and surveillance reports of neurological sequelae of Zika virus infection in adults and in children. Lastly, we discuss the challenges of conducting Zika virus-neurological sequela studies and future directions for pediatric Zika virus research.◆ (Copyright © 2018. Published by Elsevier Inc.)

关键词： cerebellar hypoplasia   deafness   neonatal diabetes   NEUROD1 mutation   retinitis pigmentosa  

摘要： The basic helix-loop-helix (bHLH) transcription factor, neuronal differentiation 1 (NEUROD1) (also known as BETA2) is involved in the development of neural elements and endocrine pancreas. Less than 10 reports of adult-onset non-insulin-dependent diabetes mellitus (NIDDM) due to heterozygous NEUROD1 mutations and 2 cases with permanent neonatal diabetes mellitus (PNDM) and neurological abnormalities due to homozygous NEUROD1 mutations have been published. A 13year-old female was referred to endocrine department due to hyperglycemia. She was on insulin therapy following a diagnosis of neonatal diabetes mellitus (NDM) at the age of 9-weeks but missed regular follow-up. Parents are second cousin. There was a significant family history of adult onset NIDDM including patient's father. Auxological measurements were within normal ranges. On laboratory examination blood glucose was 33.2 mmol/L with undetectable c-peptide and glycosylated hemoglobin level of 8.9% (73.8 mmol/mol). She had developed difficulty in walking at the age of 4 years which had worsened over time. On further evaluation, a diagnosis of visual impairment, mental retardation, ataxic gait, retinitis pigmentosa and sensory-neural deafness were considered. Cranial magnetic resonance imaging revealed cerebellar hypoplasia. Molecular genetic analysis using targeted next generation sequencing detected a novel homozygous missense mutation, ***150Asn(c.449T>A), in NEUROD1. Both parents and 2 unaffected siblings were heterozygous for the mutation. We report the third case of PNDM with neurological abnormalities caused by homozygous NEUROD1 mutation, the first caused by a missense mutation. Heterozygous carriers of the ***150Asn mutation were either unaffected or diagnosed with diabetes in adulthood. It is currently unclear whether the NEUROD1 heterozygous mutation has contributed to diabetes development in these individuals.

关键词： Chloroquine   Hydroxychloroquine   Nervous System Diseases   Primary Progressive Multiple Sclerosis  

摘要： The process of finding new therapeutic indications for currently used drugs, defined as 'repurposing', is receiving growing attention. Chloroquine and hydroxychloroquine, with an original indication to prevent or cure malaria, have been successfully used to treat several infectious (HIV, Q fever, Whipple's disease, fungal infections), rheumatological (systemic lupus erythematosus, antiphospholipid antibody syndrome, rheumatoid arthritis, Sjogren's syndrome), and other immunological diseases. Indeed, they have anti-inflammatory, immunomodulating, anti-infective, antithrombotic, and metabolic effects. Among the biological effects of chloroquine and hydroxychloroquine, it is important to highlight their antitumoral properties, likely due to their strong antiproliferative, antimutagenic, and inhibiting autophagy capacities. These effects make these drugs a possible option in the treatment of several tumors in association with radiotherapy and chemotherapy. Finally, the repurposing of chloroquine and hydroxychloroquine is currently being examined for neurological diseases such as neurosarcoidosis, chronic lymphocytic inflammation with pontine perivascular enhancement responsive to corticosteroids, and primary progressive multiple sclerosis. Several ongoing clinical trials have been testing these drugs in non-neoplastic and neoplastic diseases. Moreover, the well-demonstrated good tolerability of chloroquine and hydroxychloroquine make them safe even during pregnancy. Gastrointestinal and cutaneous manifestations are considered not to be serious, while retinal, neuromuscular, and cardiac toxicities are classified as serious adverse events.

关键词： Kinematics   Trajectories (Physics)   Degrees of freedom   Design   Wounds   Nervous system   Robotics   End effectors   Optimization   Errors  

摘要： The cost of therapy is one of the most significant barriers to recovery after neurological injury. Robotic gait trainers move the legs through repetitive, natural motions imitating gait. Recent meta-analyses conclude that such training improves walking function in neurologically impaired individuals. While robotic gait trainers promise to reduce the physical burden on therapists and allow greater patient throughput, they are prohibitively costly. Our novel approach is to design a new single degree-of-freedom (DoF) robotic trainer that maintains the key advantages of the expensive trainers but with a simplified design to reduce cost. Our primary design challenge is translating the motion of a single actuator to an array of natural gait trajectories. We address this with an eight-link Jansen mechanism that matches a generalized gait trajectory. We then optimize the mechanism to match different trajectories through link length adjustment based on nine different gait patterns obtained from gait database of 113 healthy individuals. To physically validate the range in gait patterns produced by the simulation, we tested kinematic accuracy on a motorized wooden proof-of-concept of the gait trainer. The simulation and experimental results suggested that an adjustment of two links can reasonably fit a wide range of gait patterns under typical within-subject variance. We conclude that this design could provide the basis for a low-cost, patient-based electromechanical gait trainer for neurorecovery.

关键词： lectures   flipped classroom   just-in-time teaching   neurology education  

摘要： The lecture has been a core pedagogical method since the early days of formal medical education. Although approaches to formal lectures have evolved over the years, there has been ongoing debate about the role that lectures should play in modern medical education. Arguably, traditional lectures do not align well with modern learning theory, and do not take full advantage of our current knowledge of how people learn. In many modern medical curricula, lectures have been replaced by self-study activities, including video-based lectures, computer-based learning modules, and other self-directed learning. We argue that scheduled together time is still important, particularly in neurology education, where there is a strong emphasis on clinical reasoning. We outline alternative teaching methods that effectively use this time, including the flipped classroom, just-in-time teaching, problem-based learning, and team-based learning. We discuss ways in which these approaches may be particularly conducive to components of neurology education.