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woensdag 28 februari 2018

The Lancet: [Review] Advances in the diagnosis and treatment of fungal infections of the CNS

[Review] Advances in the diagnosis and treatment of fungal infections of the CNS
Fungal infections of the CNS are challenging to treat and their optimal management requires knowledge of their epidemiology, host characteristics, diagnostic criteria, and therapeutic options. Aspergillus and Cryptococcus species predominate among fungal infections of the CNS. Most of these fungi are ubiquitous, but some have restricted geographical distribution. Fungal infections of the CNS usually originate from primary sites outside the CNS (eg, fungal pneumonia) or occur after inoculation (eg, invasive procedures).
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[Comment] Two steps forward for myelin repair in multiple sclerosis
Multiple sclerosis is a convolution of inflammation, degeneration, and variable repair, the timing and extent of which determines whether the clinical course is slow with periods of recovery or a progressive worsening of symptoms. Accordingly, to improve outcomes for patients with multiple sclerosis—particularly progressive multiple sclerosis—multipronged, combination therapies are probably needed. Existing therapies that modulate the immune system, such as alemtuzumab, are increasingly effective.
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[Corrections] Corrections
Ballard C, Banister C, Khan Z, et al. Evaluation of the safety, tolerability, and efficacy of pimavanserin versus placebo in patients with Alzheimer's disease psychosis: a phase 2, randomised, placebo-controlled, double-blind study. Lancet Neurol 2018; 17: 213–22—In the online Appendix on page 5, a figure has been added showing the adjusted mean change from baseline to week 12 for NPI–NH psychosis score of 12 or more and the figure legend should read "Adjusted mean (SE) change from baseline in NPI-NH psychosis score for patients with baseline score ≥12." Additionally on page 6 in the Appendix, a figure has been added showing the adjusted mean change from baseline to week 12 for NPI–NH psychosis score of less than 12 and a figure legend has been added, which should read "Adjusted mean (SE) change from baseline in NPI-NH psychosis score for patients with baseline score <12." Finally, in the Article on page 218, the Appendix has been cited two additional times with respect to the new figures and should read "In participants with more severe psychotic symptoms (NPI–NH psychosis score ≥12), … (mean difference −4·43 [95% CI −7·81 to −1·04], Cohen's d=–0·73; p=0·011; appendix)"; and "In participants with mild psychotic symptoms (NPI–NH psychosis score <12), … (mean difference −0·42 [95% CI −2·52 to 1·68], Cohen's d=–0·077; p=0·694; appendix)." These corrections have been made to the online version as of Feb 26, 2018.
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[In Context] The hard problem of consciousness: understanding our reality
In the 17th century, the philosopher RenĂ© Descartes proposed that the very act of thinking about one's existence is evidence of the presence of a mind distinct from the body. This notion came to be known as Cartesian dualism, spawning the dictum "cognito ergo sum" (I think, therefore I am). According to Descartes, consciousness is irrefutable—even if everything else you think you know is an illusion—because consciousness is observed from within. The troubling aspect of consciousness is that it is very difficult to describe scientifically.
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[Articles] Use of brain diffusion tensor imaging for the prediction of long-term neurological outcomes in patients after cardiac arrest: a multicentre, international, prospective, observational, cohort study
In patients who are unconscious 7 days after cardiac arrest, the normalised WWM-FA value, measured by diffusion tensor imaging, could be used to accurately predict neurological outcome at 6 months. This evidence requires confirmation from future large-scale trials with a strict protocol of withdrawal or limitation-of-care decisions and time window for MRI.
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