Mission Health System

About: Mission Health System is a healthcare organization based out in Asheville, North Carolina, United States. It is known for research contribution in the topics: Population & Health care. The organization has 1034 authors who have published 991 publications receiving 16509 citations. The organization is also known as: Mission Foundation & Mission Hospital.

The limbic system.

Abstract: Byline: V. RajMohan, E. Mohandas "The hypothalamus, the anterior thalamic nucleus, the cingulate gyrus, the hippocampus and their interconnections, constitute a harmonious mechanism which may elaborate the functions of central emotion as well as participate in the emotional expression." James Papez, 1937 The limbic system consists of the phylogenetically old limbic lobe and other subcortical structures and their connections. Although not empirically proven, the limbic system is a functional concept which may be employed to explain various brain functions.[sup] [1] History Paul Pierre Broca in 1878 spoke of ' le grand lobe limbique' or the great limbic lobe and applied the term "limbic" (from the Latin limbus for border) to the curved rim of the cortex which incudes the cingulate and the parahippocampal gyri. However, its putative role in emotion was elaborated by the American physician, James Papez in 1937 in the seminal paper titled 'A proposed mechanism of emotion'. This anatomical model is referred to as the Papez circuit.[sup] [2] Yakovlev in 1948 proposed Yakovlev's circuit in the control of emotion involving the orbitofrontal, insular and anterior temporal lobe cortex, the amygdala and the dorsomedial nucleus of thalamus.[sup] [3] In 1952, Paul D. MacLean coined the term "limbic system" to describe Broca's limbic lobe and related subcortical nuclei as the collective neural substrate for emotion.[sup] [1] MacLean was also instrumental in proposing and defining the Triune concept of the brain. MacLean's evolutionary "Triune brain theory" proposed that the human brain was in reality three brains in one: the R-complex (reptilian complex), the limbic system and the neocortex.[sup] [4] The concept of the limbic system has since been further expanded and developed by Nauta, Heimer and others. Components of the Limbic System There is no universal agreement on the total list of structures, which comprise the limbic system. The brain regions that constitute the limbic system are: *Limbic cortex i. Cingulate gyrus ii. Parahippocampal gyrus *Hippocampal formation i. The dentate gyrus ii. Hippocampus iii. Subicular Complex *Amygdala *Septal area *Hypothalamus These structures form a complex network for controlling emotion.[sup] [5] Limbic lobe The limbic lobe situated at the inferomedial aspect of the[sup] cerebral hemispheres, consists of two concentric gyri surrounding[sup] the corpus callosum. Broca proposed that the larger outer gyrus[sup] be named[sup] " limbic gyrus" and the smaller inner one "the intralimbic gyrus".[sup] The limbic gyrus (limbic lobe) consists of the[sup] isthmus of the cingulate gyrus, the parahippocampal gyrus (both of which are continuous via a bundle of white matter called "cingulum") and the subcallosal area.[sup] [6] The cingulate gyrus (Latin = Belt ridge) dorsal to the corpus callosum is heavily interconnected with the association areas of the cerebral cortex. The parahippocampal gyrus in the medial temporal lobe contains several distinct regions, the most important being the entorhinal cortex (ERC). The ERC funnels highly processed cortical information to the hippocampal formation and serves as its major output pathway.[sup] [5] The hippocampal formation Hippocampal formation in the temporal lobe has three distinct zones: *The dentate gyrus *The hippocampus proper *The subiculum Embryologically, the hippocampal formation is an extension of the medial edge of the temporal lobe. The entire hippocampal formation has a length of about 5 cm from its anterior end at the amygdala to its tapering posterior end near the splenium of the corpus callosum.[sup] [5] Dentate gyrus The dentate gyrus is composed of three layers: an outer acellular molecular layer, a granular middle layer and an inner polymorphic layer. …

Consensus Summary Statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care : A statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine

Abstract: Neurocritical care depends, in part, on careful patient monitoring but as yet there are little data on what processes are the most important to monitor, how these should be monitored, and whether monitoring these processes is cost-effective and impacts outcome. At the same time, bioinformatics is a rapidly emerging field in critical care but as yet there is little agreement or standardization on what information is important and how it should be displayed and analyzed. The Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine, and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to begin to address these needs. International experts from neurosurgery, neurocritical care, neurology, critical care, neuroanesthesiology, nursing, pharmacy, and informatics were recruited on the basis of their research, publication record, and expertise. They undertook a systematic literature review to develop recommendations about specific topics on physiologic processes important to the care of patients with disorders that require neurocritical care. This review does not make recommendations about treatment, imaging, and intraoperative monitoring. A multidisciplinary jury, selected for their expertise in clinical investigation and development of practice guidelines, guided this process. The GRADE system was used to develop recommendations based on literature review, discussion, integrating the literature with the participants' collective experience, and critical review by an impartial jury. Emphasis was placed on the principle that recommendations should be based on both data quality and on trade-offs and translation into clinical practice. Strong consideration was given to providing pragmatic guidance and recommendations for bedside neuromonitoring, even in the absence of high quality data.

Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care : a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine.

Abstract: Neurocritical care depends, in part, on careful patient monitoring but as yet there are little data on what processes are the most important to monitor, how these should be monitored, and whether monitoring these processes is cost-effective and impacts outcome. At the same time, bioinformatics is a rapidly emerging field in critical care but as yet there is little agreement or standardization on what information is important and how it should be displayed and analyzed. The Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine, and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to begin to address these needs. International experts from neurosurgery, neurocritical care, neurology, critical care, neuroanesthesiology, nursing, pharmacy, and informatics were recruited on the basis of their research, publication record, and expertise. They undertook a systematic literature review to develop recommendations about specific topics on physiologic processes important to the care of patients with disorders that require neurocritical care. This review does not make recommendations about treatment, imaging, and intraoperative monitoring. A multidisciplinary jury, selected for their expertise in clinical investigation and development of practice guidelines, guided this process. The GRADE system was used to develop recommendations based on literature review, discussion, integrating the literature with the participants’ collective experience, and critical review by an impartial jury. Emphasis was placed on the principle that recommendations should be based on both data quality and on trade-offs and translation into clinical practice. Strong consideration was given to providing pragmatic guidance and recommendations for bedside neuromonitoring, even in the absence of high quality data.