The development of the neurocritical care specialty in China based on the analysis of neurocritical care unit volume and quality.

PURPOSE: Through three neurocritical care unit (NCCU) surveys in China, we tried to understand the development status of neurocritical care and clarify its future development. METHODS: Using a cross-sectional survey method and self-report questionnaires, the number and quality of NCCUs were investigated through three steps: administering the questionnaire, sorting the survey data, and analyzing the survey data. RESULTS: At the second and third surveys, the number of NCCUs (76/112/206) increased by 47% and 84%, respectively. The NCCUs were located in tertiary grade A hospitals or teaching hospitals (65/100/181) in most provinces (24/28/29). The numbers of full-time doctors (359/668/1337) and full-time nurses (904/1623/207) in the NCCUs increased, but the doctor-bed ratio and nurse-bed ratio were still insufficient (0.4:1 and 1.3:1). CONCLUSION: In the past 20 years, the growth rate of NCCUs in China has accelerated, while the allocation of medical staff has been insufficient. Although most NCCU hospital bed facilities and instruments and equipment tend to be adequate, there are obvious defects in some aspects of NCCUs.

Clinical characteristics of autoimmune encephalitis with co-existence of multiple anti-neuronal antibodies.

BACKGROUND: An increasing number of cases of autoimmune encephalitis (AE) with co-existing multiple anti-neuronal antibodies have been reported in recent years. However, the clinical significance of the concurrent presence of multiple anti-neuronal antibodies in patients with AE remains unclear. METHODS: We retrospectively enrolled AE patients with multiple anti-neuronal antibodies treated at our center between August 2019 and February 2022. We also reviewed cases reported in multiple literature databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed on selection process. And then the clinical and laboratory data of these cases were collected for review and summary. RESULTS: A total of 83 AE cases with multiple antibodies (9 cases from our center and 74 cases from the literatures reviewed) were identified. In our center, nine patients presented with encephalitis symptoms, clinically characterized as disturbed consciousness, seizures, cognitive impairment, and psychiatric disorders. Of the 83 cases, 73 cases had co-existence of 2 types of antibodies, 8 cases had 3 types, and 2 cases had 4 types. Thirty-nine cases (39/83, 46.9%) were confirmed or suspected of also having a tumor, of which the most common was lung cancer (28/83, 33.7%). Partial or complete recovery was achieved in 57 cases (57/83, 68.6%), while 26 cases (26/83, 31.3%) died during treatment or follow-up. CONCLUSIONS: AE with co-existing multiple anti-neuronal antibodies is a specific subgroup, that is increasingly recognized in clinical practice. The co-existence of multiple anti-neuronal antibodies has a major impact on clinical features, disease progression, and prognosis.

The development of neurocritical care in China from the perspective of evaluation and treatment of critical neurological diseases.

Objective: To understand the varieties, evaluation, treatment, and prognosis of severe neurological diseases using the third NCU survey in China. Design: A cross-sectional questionnaire study. The study was completed in three main steps: filling in the questionnaire, sorting out the survey data, and analyzing the survey data. Results: Of 206 NCUs, 165 (80%) provided relatively complete information. It was estimated that 96,201 patients with severe neurological diseases were diagnosed and treated throughout the year, with an average fatality rate of 4.1%. The most prevalent severe neurological disease was cerebrovascular disease (55.2%). The most prevalent comorbidity was hypertension (56.7%). The most prevalent complication was hypoproteinemia (24.2%). The most common nosocomial infection was hospital-acquired pneumonia (10.6%). The GCS, APACHE II, EEG, and TCD were the most commonly used (62.4-95.2%). The implementation rate of the five nursing evaluation techniques reached 55.8-90.9%. Routinely raising the head of the bed by 30°, endotracheal intubation and central venous catheterization were the mostprevalent treatment strategies (97.6, 94.5, and 90.3%, respectively). Traditional tracheotomy, invasive mechanical ventilation and nasogastric tube feeding (75.8, 95.8, and 95.8%, respectively) were more common than percutaneous tracheotomy, non-invasive mechanical ventilation and nasogastric tube insertion (57.6, 57.6, and 66.7%, respectively). Body surface hypothermia brain protection technology was more commonly used than intravascular hypothermia technology (67.3 > 6.1%). The rates of minimally invasive hematoma removal and ventricular puncture were only 40.0 and 45.5%, respectively. Conclusion: In addition to traditional recognized basic life assessment and support technology, it is necessary to the use of promote specialized technology for neurological diseases, according to the characteristics of critical neurological diseases.

Application of quantitative EEG in acute ischemic stroke patients who underwent thrombectomy: A comparison with CT perfusion.

OBJECTIVE: This study aimed to evaluate the predictive value of quantitative electroencephalography (QEEG) in the outcome of patients with acute ischemic stroke (AIS) who underwent mechanical thrombectomy (MT) and to assess the correlation between clinical outcome and QEEG and CT perfusion (CTP) data. METHODS: Twenty-nine MT patients were included in this prospective study. Continuous electroencephalography (EEG) monitoring was performed, in which delta power, the δ/α ratio (DAR), and the (θ + Î´)/(α + ß) ratio (DTABR) were calculated. The clinical scores at different points were recorded. Based on the modified Ranking scale, the patients were divided into good and poor outcome groups. Several CTP parameters were recorded before MT. The correlation between QEEG, CTP parameters, and clinical scores was analyzed using the Spearman correlation analysis. The predictive value of QEEG indices and CTP parameters for the 3-month outcome was compared using the receiver operating characteristic (ROC) curve. RESULTS: Delta power except for 7 days after MT, DAR, DATBR, and several CTP parameters were all significantly associated with the clinical scores. Although some CTP parameters were associated with the clinical scores, they were less powerful than QEEG in predicting a good or poor outcome at 3 months. Among the different explored EEG indicators, the predictive value of delta 24 h after MT was the highest. CONCLUSIONS: QEEG indices may have a certain predictive value for the outcome of AIS patients who underwent MT. SIGNIFICANCE: QEEG may become a new prognostic tool in AIS patients who underwent MT, facilitating the planning and management of related rehabilitation plans.

Nerve Growth Factor is a Potential Treated Target in Tg(SOD1*G93A)1Gur Mice.

Nerve growth factor (NGF) is a protective factor of neural cells; the possible relationship between the NGF and the pathogenesis of amyotrophic lateral sclerosis (ALS) hasn't been completely known. In this study, we observed and analyzed the expression and distribution of NGF, as well as the possible relationship between the NGF expression and distribution and the neural cell death in both SOD1 wild-type (WT) and Tg(SOD1*G93A)1Gur (TG) mice applying the fluorescence immunohistochemistry method. The results showed that the expression and distribution of NGF in the anterior horn (AH), the lateral horn (LH), and the surrounding central canal (CC) significantly increased at the supper early stage of ALS (Pre-onset stage) and the early stage (Onset stage), but the NGF expression and distribution in the AH, the LH, and the surrounding CC significantly reduced at the progression stage. The astrocyte, neuron, and oligodendrocyte produced the NGF and the neural precursor cells (NPCs) produced the NGF. The neural cell death gradually increased accompanying with the reduction of NGF expression and distribution. Our data suggested that the NGF was a protective factor of neural cells, because the neural cells in the AH, the LH, and the surrounding CC produced more NGF at the supper early and early stage of ALS; moreover, the NPCs produced the NGF. It implied that the NGF exerted the protective effect of neural cells, prevented from the neural cell death and aroused the potential of self-repair in the development of ALS.

Human viral encephalitis associated with suid herpesvirus 1.

BACKGROUND: Suid herpesvirus type 1 (SHV1) is a type of neurotropic virus able to infect various species. However, the clinical cases of human SHV1 encephalitis are still rarely reported, and the clinical characteristics, treatment, and prognosis of human SHV1 encephalitis are still unclear. METHODS: In this study, we reported 2 cases of human encephalitis associated with SHV1 infection and reviewed the other 18 cases from the literatures. A total of 20 cases with human SHV1 encephalitis were summarized and re-analyzed. RESULTS: Nineteen of 20 patients had a history of swine-related occupational exposure before illness onset. All patients initially presented with influenza-like symptoms and then developed seizures, disturbed consciousness, and endophthalmitis. All patients with clinical outcome of modified Rankin Scale of 5 or 6 suffered from rapid progressive respiratory failure. The results of cerebrospinal fluid (CSF) indicated aseptic or viral infection. MRI findings of SHV1 encephalitis were prone to distribute in temporal-frontal and insular cortex, which was similar to the pattern of herpes simplex virus encephalitis, while some cases with involvements of gray matter nuclei had a high rate of mortality. Metagenomic next-generation sequencing (mNGS) revealed that all patients had unique SHV1 sequences with variable reads in the CSF. CONCLUSIONS: The variant SHV1 can cause a new type of human viral encephalitis, characterized by acute, fulminating, and catastrophic central nervous system infection. Rapid progressive respiratory failure and extensive lesions of deep gray matter nuclei might be indicators to poor prognosis. No approved treatments for the encephalitis are available, but it is possible to diagnose encephalitis quickly by mNGS.

The cortical thickness correlates of clinical manifestations in the mid-stage sporadic Parkinson's disease.

The cortical thickness has gained an extensive attention as a pathological alteration of sporadic Parkinson's disease (sPD), the alteration of pathological cortical thickness may distinctly contribute to the consistent clinical manifestations. Therefore, we investigated the cortical thickness correlates of clinical manifestations in the mid-stage sPD from the Han population of Chinese mainland (HPCM). A sample of 67 mid-stage sPD patients and 35 matched controls from HPCM were performed a corticometry of magnetic resonance imaging (MRI) and the assessment of clinical manifestations including the demographic and disease-related characteristics, and underwent the final analysis of the cortical thickness correlates with the clinical manifestations. In our result, we demonstrated that no significant differences in the demographic characteristics were found among the two groups. The tests of clinical disease-related characteristics demonstrated that the significant differences in the Hoehn and Yahr scale, the UPDRS Part I-IV, the symptom-dominant side (right/left/double), the tremor subscoree off (e), the tremor subscoref on (f), Webster, MMSE, HDS-R, DF, DB, SVFT, SDS, HAMD17, HAMD 24, CDT, CDR, LEDD and PDSI were observed between the mid-stage sPD patients and the controls. The analysis about the cortical thickness correlates with the clinical manifestations revealed that a significant correlation between UPDRS-I and Frontal-Sup-Orb-R and Rectus-R; DB and Frontal-Sup-Orb-R and Frontal-Inf-Orb-R; SDS and Frontal-Sup-Orb-R, Frontal-Mid-Orb-R, Rectus-R and Cingulum-Ant-R respectively in the mid-stage sPD patients from HPCM. Our data showed that the cortical thinning in the right frontal Orb, rectus and cingulum were the pathological base of some clinical manifestations including the cognitive impairment, hallucinations, psychosis, the depressed mood, the anxious mood, apathy, the sleep problems, the nighttime or/and daytime sleepiness, the short term memory stores and the central execution, as well as the sexual desire disorder in the mid-stage sPD patients, suggesting that the dysfunctions of brain regions of some cortical thinning are closely correlated with some clinical manifestations of the mid-stage sPD.

The Alterations of Cortical Volume, Thickness, Surface, and Density in the Intermediate Sporadic Parkinson's Disease from the Han Population of Mainland China.

Many symptoms of sporadic Parkinson's disease (sPD) can't be completely explained by the lesion of simple typical extrapyramidal circuit between striatum and substantia nigra. Therefore, we investigated the alteration of cortical volume, thickness, surface, and density in the intermediate sPD from the Han population of Mainland China in order to find the new pathological brain regions associated with the complex clinical manifestations of sPD. The cortical volume, thickness, surface and density were examined using the voxel-based cortical morphometry and corticometry on magnetic resonance image (MRI) in 67 intermediate sPD and 35 controls, the multiple adjusted comparisons analysis of all MRI data were employed to assess the relationships between the cortical morphometric alteration in the specific brain regions and sPD. Results showed that a significantly shrunk volume, thinned thickness and enlarged or reduced surface of cortex in some specific brain regions were closely associated with sPD, but all cortical densities were not different. The majority of morphometric alteration of hemisphere cortex was symmetric, but that in the left hemisphere was more significant. The cortical morphometric alterations in the frontal, temporal, parietal, occipital and limbic lobe, cerebellum, caudate, and thalamus were closely related to the clinical neural dysfunction (Clinical manifestations) of sPD. Our data indicated that the deficits of extensive brain regions involved in the development of sPD, resulted in a series of correspondent complex clinical manifestations in the disease.