RESUMEN
OBJECTIVE: To present an analysis of American Academy of Neurology (AAN) membership demographics and practice trends over the past decade. METHODS: Data from the 2009 AAN Census and 2010 Practice Profile Form (PPF) surveys were compared to results from 2004 and 2000 surveys. The Census was sent to all AAN members, and the PPF was sent to a random sample of US practicing neurologists. RESULTS: Since 2000, AAN membership increased by 31%, and the number of US neurologist-members increased by 14%. Mean age of US neurologists increased from 48.6 to 53.3 years, and 23.9% of neurologists are women. There was a 15% increase in the proportion of neurologists relative to the US population, from 3.41 neurologists per 100,000 population in 2000 to 3.92 neurologists in 2009. In 2009, 24.1% of US neurologists were in solo practice, 27.8% were in a neurology group, and 35.6% were in multispecialty/university settings, with little change in practice arrangements over time. The top 5 practice interest areas were unchanged since 2004 as were the number of hours devoted to patient care (42.3) or total work hours per week (57.1). Little change was observed in performed procedures, except increased use of botulinum toxin and nerve blocks and a decline in lumbar punctures. Neurologists rely more on physician assistants to see follow-up and new patients independently (p < 0.001). CONCLUSION: Despite advances in neurologic diagnosis and therapy, there has been little change in practice characteristics of US neurologists.
Asunto(s)
Academias e Institutos/organización & administración , Investigación Biomédica/organización & administración , Miembro de Comité , Neurología/estadística & datos numéricos , Médicos/estadística & datos numéricos , Adulto , Investigación Biomédica/tendencias , Censos , Atención a la Salud/estadística & datos numéricos , Femenino , Geografía/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Neurología/tendencias , Pautas de la Práctica en Medicina , Recursos HumanosRESUMEN
Our experience with West Nile virus infection revealed that 54% of 28 patients had a focal neurological deficit at presentation. A meningitis or encephalitis syndrome was absent in 47% of patients with focal deficits. Details of the variety of deficits, the time to development of deficits, and the associated radiological and laboratory findings are also discussed in the present report.
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Enfermedades del Sistema Nervioso/fisiopatología , Enfermedades del Sistema Nervioso/virología , Fiebre del Nilo Occidental/complicaciones , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The present study was undertaken to characterize further the structure and function of cutaneous nerves which we have previously shown to associate with skin immune cells (Hosoi et al., Nature 1993: 363:159). Ultrastructurally, axons were prominent within the superficial dermis and epidermis in neonatal murine skin, but they were inconspicuous in adult murine and primate skin. Immunohistochemical and immunoultrastuctural evaluation of normal adult human and simian skin for neural cell adhesion molecule (N-CAM), however, defined a plexus of axons surrounding superficial dermal mast cells and extending as delicate, vertical branches into the overlying epidermal layer. Antibodies to neuropeptides substance P, calcitonin gene-related peptide, and to nerve cell-specific clathrin (LCb subunit) also reacted with this neural plexus. Double labeling disclosed intimate associations of N-CAM-positive axons with dermal chymase-positive mast cells as well as with epidermal CD1a-positive Langerhans' cells by confocal scanning laser microscopy. Functionally, capsaicin applied to forearm skin revealed by 6 h discharge of mast cell chymase and induction of E-selectin in adjacent microvascular endothelium, events consistent with release of substance P from axons and subsequent stimulation of cytokine-mediated mast cell-endothelial interaction. Identical application of capsaicin to human skin xenografted to immunodeficient mice, and thus experimentally lacking in unmyelinated axons, failed to show similar findings. These results provide additional support to the concept that an elaborate network of cutaneous axons may play a functional role in regulation of skin inflammation and immunity.
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Axones/fisiología , Epidermis/inervación , Células de Langerhans/citología , Mastocitos/citología , Piel/inervación , Adulto , Animales , Axones/ultraestructura , Péptido Relacionado con Gen de Calcitonina/metabolismo , Capsaicina/administración & dosificación , Clatrina/metabolismo , Gránulos Citoplasmáticos/efectos de los fármacos , Células Epidérmicas , Epidermis/metabolismo , Humanos , Técnicas para Inmunoenzimas , Células de Langerhans/metabolismo , Macaca fascicularis , Masculino , Mastocitos/metabolismo , Ratones , Ratones Endogámicos , Microscopía Confocal , Moléculas de Adhesión de Célula Nerviosa/metabolismo , Piel/citología , Piel/metabolismo , Trasplante de Piel , Sustancia P/metabolismoRESUMEN
Psychological stress has been implicated as a risk factor for a number of medical conditions. The association has been particularly well-studied for coronary heart disease. In contrast, there are only a few studies regarding the role of psychological stress as a risk factor for stroke. Additional research is clearly necessary to better delineate the degree of risk and the physiological mechanisms through which psychological stress may play a role in the development of cerebrovascular disease.
Asunto(s)
Trastornos Cerebrovasculares/complicaciones , Estrés Psicológico/complicaciones , Humanos , Proyectos de Investigación/normas , Factores de Riesgo , Estrés Psicológico/fisiopatología , Personalidad Tipo A , GuerraRESUMEN
We report a rare case of primary Merkel cell tumor (MCT)-like neuroendocrine carcinoma (i.e., small cell carcinoma) associated with the submandibular gland in a 73-year-old man. Despite the lack of a known skin primary, the tumor exhibited cytomorphologic (predominant single cells with "intermediate filament buttons" in the background), ultrastructural (dense core granules and a globular aggregate of intermediate filaments) and immunohistochemical (paranuclear globular coexpression of cytokeratin and neurofilaments) features identical to that of MCT. The tumor contained an aneuploid peak with DNA index of 1.1 and an S phase of 20.5%. The tumor measured 5.8 cm and was situated between the skin and submandibular gland, with which it was closely associated but separated by connective tissue. The literature on MCT without a known skin primary is reviewed, and the cytomorphologic features that allow the distinction between MCT, lymphoma and oat cell carcinoma are discussed.