关键词： 神经内科   中国医师协会   军医大学   医学心理   医师培训   神经病学   郑健   脑血管病  

摘要： 一、陆军军医大学(重庆新桥医院)第二附属医院神经内科医学中心简介陆军军医大学第二附属医院神经内科始建于1953年,原名为第三军医大学第二附属医院神经内科,2018年医院随大学转递陆军,更名为陆军军医大学第二附属医院神经内科,对外又称重庆市新桥医院神经内科。2019年整合神经内科、医学心理科及疼痛康复科成立神经内科医学中心。经过张基漠教授、王东武教授、郑健教授、帅杰教授等几代人的努力,科室已成为集教学、医疗、科研、战备为一体的研究型特色科室。目前该学科为博士/硕士授予权学科和临床医学博士后流动站站点学科。本医学中心为国家神经内科专科医师培训基地、中国医师协会介入神经病学医师培训基地;是重庆市重点学科、重庆市神经病学临床研究中心、重庆市脑血管病防治创新团队、重庆市脑血管病研究创新群体以及重庆市卒中学会会长单位。

关键词： exercise   brain   BDNF   iron   microbiota   Alzheimer’   s disease   Parkinson’   s disease  

摘要： As life expectancy has increased, particularly in developed countries, due to medical advances and increased prosperity, age-related neurological diseases and mental health disorders have become more prevalent health issues, reducing the well-being and quality of life of sufferers and their families. In recent decades, due to reduced work-related levels of physical activity, and key research insights, prescribing adequate exercise has become an innovative strategy to prevent or delay the onset of these pathologies and has been demonstrated to have therapeutic benefits when used as a sole or combination treatment. Recent evidence suggests that the beneficial effects of exercise on the brain are related to several underlying mechanisms related to muscle-brain, liver-brain and gut-brain crosstalk. Therefore, this review aims to summarize the most relevant current knowledge of the impact of exercise on mood disorders and neurodegenerative diseases, and to highlight the established and potential underlying mechanisms involved in exercise-brain communication and their benefits for physiology and brain function.

关键词： Perforin   Granzyme   Cattle   Alphaherpesvirus   Neuropathology  

摘要： Perforin and granzymes are essential components of the cytotoxic granules present in cytotoxic T lymphocytes and natural killer cells. These proteins play a crucial role in a variety of conditions, including viral infections, tumor immune surveillance, and tissue rejection. Besides their beneficial effect in most of these situations, perforin and granzymes have also been associated with tissue damage and immune diseases. Moreover, it has been reported that perforin and granzymes released during viral infections could contribute to the pathogenesis of diseases. In this review, we summarize the information available on human perforin and granzymes and their relationship with neurological infections and immune disorders. Furthermore, we compare this information with that available for bovine and present data on perforin and granzymes expression in cattle infected with bovine alphaherpesvirus types1 and-5. To our knowledge, this is the first review analyzing the impact of perforin and granzymes on neurological infections caused by bovine herpesviruses.

关键词： Ethics   Medical education   History of medicine   Professional identity formation  

关键词： Stroke   Surgery   Anesthesia   Hypotension  

摘要： Purpose The association between intraoperative hypotension and perioperative acute ischemic stroke is not well described. We hypothesized that intraoperative hypotension would be associated with perioperative acute ischemic stroke. Methods Four-year retrospective cohort study of elective non-cardiovascular, non-neurological surgical patients. Characteristics of patients who had perioperative acute ischemic stroke were compared against those of patients who did not have acute ischemic stroke. Multivariable logistic regression was used to determine whether hypotension was independently associated with increased odds of perioperative acute ischemic stroke. Results Thirty-four of 9816 patients (0.3%) who met study inclusion criteria had perioperative acute ischemic stroke. Stroke patients were older and had more comorbidities including hypertension, coronary artery disease, diabetes mellitus, active tobacco use, chronic obstructive pulmonary disease, cerebral vascular disease, atrial fibrillation, and peripheral vascular disease (all P < 0.05). MAP < 65 mmHg was not associated with increased odds of acute ischemic stroke when modeled as a continuous or categorical variable. MAP < 60 mmHg for more than 20 min was independently associated with increased odds of acute ischemic stroke, OR = 2.67 [95% CI = 1.21 to 5.88, P = 0.02]. Conclusion Our analysis suggests that when MAP is less than 60 mmHg for more than 20 min, there is increased odds of acute ischemic stroke. Further studies are needed to determine what MAP should be targeted during surgery to optimize cerebral perfusion and limit ischemic stroke risk.

关键词： Psychogenic nonepileptic seizures   Functional motor disorder   Clinical factors   Psychiatric factors   Autonomic nervous system  

摘要： Purpose Heart transplantation (HT) is the gold-standard treatment for end-stage heart failure. In spite of its innumerous benefits, it still involves complications. Among them, neurological complications significantly impact patient's morbidity and mortality. The aim of this study is to determine the prevalence, prognosis and predictors of neurological events after HT. Methods Between January 2007-December 2017, data from all patients who underwent orthotopic HT in this single center were collected and analyzed considering seizures, ischemic and hemorrhagic stroke as neurological complications. Univariate and multivariate analysis were performed to determine significant predictors; ROC curves were generated to establish blood pressure cutoffs that influence the presence of neurological events. Mortality between groups was evaluated through Kaplan Meier curves and Log Rank test. Results We assessed 132 patients from 15-76 years of age (mean 51.8), 73.5% men, mainly in INTERMACS profile 3 (78.8%). Etiologies included Chagas disease (26.7%), ischemic cardiomyopathy (26.7%), idiopathic dilated cardiomyopathy (24.4%) and other (22.2%). Neurological events before transplant occurred in 16.7%. The prevalence of neurological complications after HT was 17.4% (8.7% ischemic stroke, 60.9% hemorrhagic stroke, 30.4% seizures), and occurred mainly in the first 10 postoperative days (71.4%). In the multivariate analysis, the difference between systolic blood pressure (SBP) before HT and on the 3rd postoperative day was an independent predictor of neurological events (p-value 0.018; 95% CI of 1.007-1.080 OR 1.043). A cut off value of SBP gradient>31,9mmHg (64.3% sensitivity,63% specificity;AUROC 0.652) significantly increased the risk of neurological complications (p=0.006, 95%CI 1.576-14.692 OR 4.811). Presence of neurological events was related to a longer hospital stay (38.6 days for patients with events, 29.1 days for patients without, p=0.019). However, up to the first-ye

关键词： arrhythmias   brain   dog   hemangiosarcoma   ventricular septum  

摘要： Background Brain metastases are well known for disseminated hemangiosarcoma involving the right atrium/auricle. Case report An 8-year-old male Australian Shepherd Dog presented with a 3-day history of circling to the left. A neurological examination revealed obtunded mentation, right hemi-inattention, bilateral strabismus towards the left side and absent physiological nystagmus. In addition, the dog had muffled heart sounds on auscultation and exercise-induced weakness. Laboratory findings included hypercoagulability and marked elevation in the C-reactive protein concentration. Electrocardiography detected a sinus rhythm with right bundle-branch block and ventricular bigeminy. Echocardiography revealed an extensive interventricular septal mass. Due to the grave prognosis, the owners elected for euthanasia, and a complete necropsy was performed. The main pathological findings were an interventricular septal and left ventricular hemangiosarcoma, with metastases in the brain, lungs, spleen and adrenal glands. No evidence of tumour infiltration was found in the right atrium. Conclusion To the authors' knowledge, this is the first report of neurological signs due to confirmed brain metastases in a dog with interventricular septal hemangiosarcoma. Although the right atrium is the main location for cardiac hemangiosarcoma, the interventricular septum should be evaluated in all cases.

关键词： Adrenergic receptors   calcium channel   calcium channel blocker   neurovascular unit   vasopressor  

摘要： Adrenoceptor and calcium channel modulating medications are widely used in clinical practice for acute neurological and systemic conditions. It is generally assumed that the cerebrovascular effects of these drugs mirror that of their systemic effects - and this is reflected in how these medications are currently used in clinical practice. However, recent research suggests that there are distinct cerebrovascular-specific effects of these medications that are related to the unique characteristics of the cerebrovascular anatomy including the regional heterogeneity in density and distribution of adrenoceptor subtypes and calcium channels along the cerebrovasculature. In this review, we critically evaluate existing basic science and clinical research to discuss known and putative interactions between adrenoceptor and calcium channel modulating pharmacotherapies, the neurovascular unit, and cerebrovascular anatomy. In doing so, we provide a rationale for selecting vasoactive medications based on lesion location and lay a foundation for future investigations that will define neuroprotective paradigms of adrenoceptor and calcium channel modulating therapies to improve neurological outcomes in acute neurological and systemic disorders.