Risk factors for neurological complications and their correlation with survival following pediatric liver transplantation

Despite the improved outcomes of LT, post‐operative NCs remain a significant cause of morbidity and mortality. The aim of the study was to identify the incidence of and risk factors for NCs in children who underwent LT. The medical records of pediatric patients who underwent LT at Asan Medical Center Children's Hospital between January 1994 and December 2010 were retrospectively analyzed. The onset and types of NC and pretransplant variables associated with NC were evaluated. We identified 190 children (85 boys [44.7%], 105 girls [55.3%]) of mean age 4.1 ± 4.7 yr, who underwent LT. Forty‐six NCs occurred in 41 (21.6%) patients after LT, the most common being seizures (n = 13, 28.3%) and encephalopathy (n = 10, 21.7%). Of the 46 NCs, 24 (52.2%) occurred within three months after LT. Multivariate analysis showed that primary liver disease, preoperative neurological problems, preoperatively higher serum creatinine concentration, and graft failure were significant risk factors for NCs. The survival rate was significantly lower for patients with NCs than for those without (p < 0.001). NCs after pediatric LTs were common and associated with a higher mortality rate in our study. Close monitoring and appropriate risk management may improve the long‐term outcomes of pediatric patients who undergo LT.     

脑卒中后抑郁多种相关因素分析

目的 对脑卒中第四周发生脑卒中后抑郁(post stroke depression,PSD)患者进行患病率及多种相关因素的研究,期望对于PSD患者早期诊断和干预治疗提供帮助.方法 采用病例-对照研究方案.选用符合标准的所有脑卒中住院患者,抑郁患者为病例组,其余患者为对照组,对各相关因素进行统计学分析.结果 共调查101例患者,最后能够配合完成所有调查任务的有88例.PSD总发病人数为33例,占37.5%,其中,轻度抑郁14例,占42.42%,中度抑郁16例,占48.48%,重度抑郁3例,占9.09%.结论 神经功能缺损程度为PSD的危险因素,日常生活能力、社会支持为PSD的保护因素.     

远程缺血预处理对大鼠局灶性脑缺血/再灌注损伤的保护作用

目的探讨远程缺血预处理(RIPC)对大鼠局灶性脑缺血/再灌注(I/R)损伤的影响。方法SD雄性大鼠70只,随机分组,每组10只。对照组仅行单纯缺血后再灌注;RIPC组按RIPC与脑缺血间隔时间不同分为30min及1、2、12、24和48h组,即反复3次夹闭双侧股动脉造成肢体缺血5min、再灌注5min后,分别间隔30min及1、2、12、24和48h后,行大脑中动脉栓塞(MCAO)120min、再灌注24h。对各组动物进行神经功能缺损评分,然后行氯化三苯四唑(TTC)染色,计算脑梗死容积。结果与对照组比较,RIPC1、2和24h组神经功能缺损评分显著下降,差异有显著性(P均<0.05);而RIPC30min、12h和48h组与对照组比较差异均无显著性(P均>0.05)。脑梗死容积百分比RIPC1h组〔(17.9±7.5)%,P=0.016〕、2h组〔(18.3±11.2)%,P=0.019〕和24h组〔(20.2±11.9)%,P=0.047〕均明显小于对照组〔(30.5±9.8)%〕;而RIPC30min、12h和48h组与对照组比较差异无显著性(P均>0.05)。结论RIPC对大鼠局灶性脑I/R损伤有保护作用,其保护时程为预处理后1～2h,24h后再次出现。     

Utility of the Community Integration Questionnaire in a sample of adults with neurological and neuropsychiatric disorders receiving prevocational training

Purpose: To investigate utility of the Community Integration Questionnaire (CIQ) in a mixed sample of adults with neurological and neuropsychiatric disorders. Method: Cross-sectional, interview-based study. Participants were community-dwelling adults with disabilities resulting from neurological and neuropsychiatric disorders (N?=?54), who participated in a pre-vocational readiness and social skills training program. Psychometric properties of the Community Integration Questionnaire (CIQ) were assessed and validated against Mayo-Portland Adaptability Inventory (MPAI) and The Problem Checklist from the New York University Head Injury Family Interview (PCL). Results: Based on the revised scoring procedures, psychometric properties of the CIQ Home Competency scale were excellent, followed by the Total score and Social Integration scale. Productive Activity scale had low content validity and a weak association with the total score. Convergent and discriminant validity of the CIQ were demonstrated by correlation patterns with MPAI scales in the expected direction. Significant relationship was found with PCL Physical/Dependency scale. Significant associations were found with sex, living status, and record of subsequent employment. Conclusions: The results provide support for the use of the CIQ as a measure of participation in individuals with neurological and neuropsychiatric diagnoses and resulting disabilities.

• Implications for Rehabilitation

• An important goal of rehabilitation and training programs for individuals with dysfunction of the central nervous system is to promote their participation in social, vocational, and domestic activities.

• The Community Integration Questionnaire (CIQ) is a brief and efficient instrument for measuring these participation domains.

• This study demonstrated good psychometric properties and high utility of the CIQ in a sample of 54 individuals participating in a prevocational training program.

     

年龄因素对脑梗死患者急性期神经功能和日常生活活动能力恢复的影响

摘要 目的：比较不同年龄组脑梗死患者急性期神经功能及日常生活活动能力恢复的差异。 方法：2012—2014年住院介入康复治疗的脑卒中急性期患者126例,根据年龄分为4组：A组（≤54岁）、B组（55—64岁）、C组（65—74岁）、D组（75岁及以上）,于康复治疗前和出院时,分别采用美国国立卫生院脑卒中量表（NIHSS）、Barthel指数（BI）对各年龄组患者的神经功能缺损水平、日常活动能力进行评定和分析。 结果：D组患者康复治疗前后BI差值显著低于B组（P＜0.05）,相关分析显示BI差值跟年龄呈线性负相关（P＜0.05,相关系数r=-0.212）;D组出院时NIHSS评分（NIHSS1）显著低于B、C组（P＜0.05）,BI日均改善率（|BI1-BI0|/介入时程）显著低于A、B组（P＜0.05）。 结论：年龄是影响脑梗死患者神经功能和日常生活能力恢复的重要因素,75岁以上高龄患者其功能恢复程度和速度均降低,而低于75岁者脑梗死急性期其神经功能和日常活动能力恢复无显著差异。     

A prospective open-label study of sirolimus for the treatment of anti-Hu associated paraneoplastic neurological syndromes

Background

Several lines of evidence suggest a T cell–mediated immune response in paraneoplastic neurological syndromes with anti-Hu antibodies (Hu-PNS). In order to investigate whether suppression of T cell–mediated immune responses in Hu-PNS patients improved their neurological outcome, we performed a prospective open-label, single-arm study on sirolimus.

Methods

Seventeen progressive Hu-PNS patients were treated with sirolimus with an intended treatment duration of 8 weeks. Primary outcome measures were (i) functional improvement, defined as a decrease of one or more points on the modified Rankin Scale (mRS), and (ii) improvement of neurological impairment, defined as an increase of one or more points on the Edinburgh Functional Impairment Tests (EFIT).

Results

One patient showed improvement on both clinical scales (mRS and EFIT). This patient presented with limbic encephalitis and improved dramatically from an mRS score of 3 to mRS 1. Another patient, with subacute sensory neuronopathy, remained stable at mRS 2 and improved one point on the EFIT scale. The other patients showed no improvement on the primary outcome measures. Median survival was 21 months.

Conclusion

We conclude that treatment of Hu-PNS patients with sirolimus may improve or stabilize their functional disabilities and neurological impairments. However, the effects of this T cell–targeted therapy were not better than reported in trials on other immunotherapies for Hu-PNS.Trial Registration https://www.clinicaltrialsregister.eu/ctr-search/trial/2008-000793-20/NL.     

Tuberculous meningitis in adults--experience from Turkey

Background: The annual incidence of tuberculous meningitis (TM) is unknown. TM is a disease that still often results in residual sequelae, and has a mortality rate ranging between 15 and 51%. Experience of countries such as Turkey where drug‐resistant tuberculosis and TM are prevalent is important. Methods: Clinical and laboratory findings of 42 patients with TM, followed between 1991 and 2002, were evaluated retrospectively. Results: Twenty‐eight female and 14 male patients were included in this study. The mean age of the patients was 33.9 ± 13.2 years (range, 16–60 years). Fourteen had a history of pulmonary tuberculosis; 12 reported close contact with a person with active pulmonary tuberculosis; three were diagnosed with active pulmonary tuberculosis; two, with HIV infection; two, with Pott's disease; and one, with systemic lupus erythematosus. On admission, 17 patients were diagnosed with stage I; 15, with stage II; and 10, with stage III disease. Hemiparesis (35.7%), cranial nerve palsy (30.9%), and altered consciousness (26.9%) were the most common neurological deficits. Prolonged duration of pre‐existing symptoms and female gender were found as significant risk factors in those who develop neurological sequelae (p < 0.01 and p < 0.05, respectively). Cranial computerised tomography revealed various pathological findings in all but five patients. Sulcus effacement was the most common radiological finding. Enlargement of ventricles, focal cerebral oedema/shunt, calcification of meninges, tubercle, and infarction were other common abnormal radiological findings. Conclusions: Prolonged duration of pre‐existing symptoms and female gender are predictors of neurological sequelae of TM. Early identification of such patients and prompt initiation of anti‐tuberculosis therapy may improve their outcome.     

Hypoesthesia in generalised anxiety disorder and major depression disorder

Abstract

Objective: The determination of soft signs can be a conducive practice to understand the differential etiology between depression and anxiety. This study aims at examining malleolar hypoesthesia role in distinguishing between patients with generalised anxiety disorder (GAD) and major depression disorder (MDD).

Methods: This study examines the presence of malleolar hypoesthesia in patients with GAD (n?=?47) compared to patients with MDD (n?=?48) and healthy individuals (controls; n?=?99). The Wartenberg wheel, a medical device for neurological use, was employed to determine the presence of hypoesthesia on both sides of the ankles.

Results: The data revealed: i) MDD patients showed higher hypoesthesia than GAD patients (p?=?.008), ii) participants with hypoesthesia had higher anxiety and depression scores than participants without hypoesthesia (all p?<?.001) and iii) logistic regression model indicated that hypoesthesia can be a predictor of MDD relative to GAD diagnosis (Odds Ratio: 17.43 (1.40–217.09; p?=?.026)).

Conclusions: Malleolar hypoesthesia was higher in MDD than GAD. The detection of hypoesthesia may help to investigate the differential etiology between MDD and GAD diagnosis.