关键词： 药源性疾病   药学服务   神经病学   潜在危险   临床药师   心得体会   药物疗效   医院合理用药  

摘要： 神经病学疾病复杂多样,治疗药物成百上千种,药物间相互作用多,药源性疾病发生率高,药物疗效和潜在危险成为药师如何提高医院合理用药的一大难题。本文通过临床药师在神经病学疾病中为患者提供药学服务实践,总结心得体会,为专科临床药师提供可参考的工作模式。

关键词： 办刊宗旨   中国医师协会   神经疾病   神经解剖学   普及与提高   神经病学   专业期刊   神经内外科  

摘要： 《中国现代神经疾病杂志》为国家卫生健康委员会主管、中国医师协会主办的神经病学类专业期刊。办刊宗旨为:理论与实践相结合、普及与提高相结合,充分反映我国神经内外科临床科研工作重大进展,促进国内外学术交流。所设栏目包括述评、专论、论著、临床病理报告、应用神经解剖学、神经影像学、循证神经病学、流行病学调查研究、基础研究、临床研究、综述、临床医学图像、病例报告、临床病理(例)讨论、新技术新方法等。

关键词： Bladder   bowel   goal-setting   MRCP   neurorehabilitation   rehabilitation   spasticity   upper motor neurone syndrome  

摘要： Neurorehabilitation is often thought of as a stand-alone process occurring in a defined unit. However, patients with neurological conditions make up a large proportion of general medical admissions and general practitioner consultations. They often present with an upper motor neurone syndrome that requires careful management of their weakness, disordered motor control, spasticity and bladder/bowel dysfunction. Spasticity management can be particularly challenging, but is rewarding if physical and pharmacological measures are used appropriately and in a timely manner. This review attempts to explain the process of rehabilitation and how it can improve the care of neurological patients in all settings. Through the basic principles of rehabilitation – assessment, goal-setting, intervention and evaluation – function can be optimized while preventing complications and minimizing distress to patients, families and carers. © 2020

摘要： 1 Introduction Patients with suspected acute ischemic stroke require rapid assessment in order to receive the earliest most appropriate reperfusion *** the landmark National Institute of Neurological Disorders and Stroke (NINDS) study in 1995, intravenous thrombolysis remains the main treatment approved by the U.S. [1].Stroke mimics (SM) comprise both non neurological condition (like hypertension, diabetes mellitus, metabolic dysfunction, cardiac syncope due to arrhythmia, malignancy and atrial fibrillation), and neurological disorder (as seizure (considered the leading cause of mimic), migraine (mostly aura with focal neurological symptoms like aphasia or hemi sensory loss), septic meningitis, heatstroke, spinal epidural mass, dementia, functional neurological disorder [4–9]) that can present is an ED setting with a neurological focal deficit miming a stroke.[...]data from literature have showed that stroke mimics treated with IVrt-PA have good clinical outcomes and low incidence of intracranial bleeding [14–17], suggesting that clinicians should not postpone thrombolysis because its potential benefit in definite ischemic stroke might be higher than the risk of complications in stroke mimics [18,19].Data from Gupta and Lang (2009 [45]) suggest that several historic data like abrupt onset (symptoms often maximal at that time), static course, spontaneous remissions/cures, paroxysmal symptoms (generally nonkinesigenic), psychiatric comorbidities, secondary gain (often not apparent), risk factors for conversion disorder (sexual and Movement incongruous with organic movement disorders physical abuse, trauma), psychological stressors, multiple somatizations/undiagnosed conditions, employed in allied health professions (infrequent); and movement characteristics as variability over time (frequency, amplitude, direction/distribution of movement), distractibility reduces or resolves, attention increases movement, selective disability, entrainment (especially with t

关键词： Functional neurological symptom disorder   Functional neurological disorders   Conversion disorder   Psychogenic   Dissociative disorders   Multidisciplinary team   Therapy   Outpatient  

摘要： Aim We report results from a 5-week MDT treatment programme, with individualised sessions, for a selected group of patients with FNSD, delivered in a neuropsychiatric outpatient setting. Primary aims were to (1) reduce symptoms, (2) improve functional performance and (3) improve health status. Methods Treatment involved individual sessions of neuropsychiatry, cognitive behavioural therapy, physiotherapy, occupational-therapy, education and family meetings. Outcome measures collected at the beginning and end of treatment and at 6 months, were patient and clinician reported. Aims were assessed by the following: symptom reduction (PHQ15, PHQ9, GAD7, SPIN, Rosenberg);health and social functioning (HONOS, WSAS);functional performance (COPM);health status (EQ-5D-5L) and patient-rated perception of improvement (CGI). Results Analyses of 78 patients completing the programme and attending a 6-month review revealed high-baseline levels of disability compared to EQ-5DL population norms and high rates of disability and psychopathology as indicated by the WSAS and mental health indices (PHQ9, GAD7, SPIN, Rosenberg's self-esteem). At baseline, 92.3% met the IAPT caseness threshold for depression and 71% met the IAPT caseness threshold for anxiety. A Friedman ANOVA over the three time points and Dunn-Bonferroni post hoc tests indicated statistically significant improvements from admission to discharge and admission to 6-month follow-up. Sustained improvements were seen in somatic symptoms (PHQ15), depression (PHQ9), anxiety (GAD7), health and social functioning (HONOS), functionality (COPM), health status (EQ-5D-5L) and patient-rated clinical global improvement (CGI). Conclusion An MDT can effectively deliver an outpatient programme for FNSD which can serve as an alternative to costlier inpatient programmes. Early identification and treatment of co-morbidities is advised.

关键词： Neurological soft signs (NSS)   HIV Associated neurocognitive disorder (HAND)   HIV   Cognition  

摘要： Neurological soft signs (NSS) are frequently found in severe mental disorders, such as Alzheimer's disease, schizophrenia or HIV associated neumcognitive disorder (HAND) which includes asymptomatic neumcognitive impairment (ANI), mild neumcognitive disorder (MND) and HIV-associated dementia. To characterize NSS in patients with HIV we examined them with respect to neuropsychological deficits typically found in the disorder. 67 HIV + patients without a history of head trauma, opportunistic infections, severe psychiatric disorders or acute confounding comorbidities of the Central nervous system (CNS) were recruited. NSS and neumpsychological deficits were examined on the Heidelberg scale and the Cambridge Neumpsychological Test Automated Battery (CANTAB), respectively. Semantic and phonemic verbal fluency were additionally established. According to NIMH and NINDS criteria, 18 patients were diagnosed with ANI and 21 with MND, 28 showed no cognitive deficits. NSS total scores were significantly correlated with several cognitive domains and NSS subscales. These correlations were confirmed when motor performance was entered as a covariate. According to our findings, NSS in HIV positive patients are significantly correlated with deficits in a broad range of neuropsychological domains. Similar findings were reported in schizophrenia, emphasizing the transdiagnostic character of NSS and supporting NSS examination in screening HIV patients for HAND.

关键词： cardiomyopathy   genotype-phenotype   polyneuropathy   transthyretin amyloidosis   V122I  

摘要： V122I is one of more than 130 mutations in transthyretin gene associated with hereditary TTR (ATTRv) amyloidosis. Main clinical expression is an infiltrative pseudohypertrophic cardiomyopathy with mild or no neurological symptoms. It is particularly common among African-Americans (prevalence: 3%-4%). We report 12 subjects from seven unrelated Caucasian families hailing from Sicily and carrying the V122I mutation. One patient was homozygous for V122I and in another family two subjects also carried the E89Q variant in compound heterozygosity. All the subjects underwent neurologic/neurophysiologic evaluation and cardiologic baseline tests;in five of them, cardiac magnetic resonance and/or (99 m) Tc-DPD scintigraphy were performed. Three of 12 subjects were asymptomatic carriers. Of the remaining nine subjects, in four of nine patients, the nerve conduction studies revealed a polyneuropathy;in one of them, this represents the only sign of disease after 5 years of follow-up. In eight of nine subjects, we found a hypertrophic restrictive cardiomyopathy and cardiac failure, associated with a carpal tunnel syndrome. Although in non-Afro-American individuals V122I prevalence is low, subjects carrying this mutation have been identified in the United Kingdom, Italy, and France. Our report describes a large cohort of V122I Caucasian patients from a non-endemic area, confirming the possible underestimation of this mutation in the non-African population. Moreover, it highlights the heterogeneity in the genotype-phenotype correlation of ATTRv mutations, suggesting that the presence of a polyneuropathy has to be identified as soon as possible, since available treatments are, in Europe, so far authorized only for ATTRv amyloid peripheral neuropathy.

关键词： Cerium dioxide   Nanoparticles   Inhalation   Alzheimer's disease   Amyloid-beta  

摘要： Increasing evidence from toxicological and epidemiological studies indicates that the brain is an important target for ambient (ultrafine) particles. Disturbance of redox-homeostasis and inflammation in the brain are proposed as possible mechanisms that can contribute to neurotoxic and neurodegenerative effects. Whether and how engineered nanoparticles (NPs) may cause neurotoxicity and promote neurodegenerative diseases such as Alzheimer's disease (AD) is largely unstudied. We have assessed the neurological effects of subacute inhalation exposures (4 mg/m(3) for 3 h/day, 5 days/week for 4 weeks) to cerium dioxide (CeO2) NPs doped with different amounts of zirconium (Zr, 0%, 27% and 78%), to address the influence of particle redox-activity in the 5xFAD transgenic mouse model of AD. Four weeks post-exposure, effects on behaviour were evaluated and brain tissues were analysed for amyloid-beta plaque formation and reactive microglia (Iba-1 staining). Behaviour was also evaluated in concurrently exposed nontransgenic C57BL/6J littermates, as well as in Western diet-fed apolipoprotein E-deficient (ApoE(-/-)) mice as a model of vascular disease. Markers of inflammation and oxidative stress were evaluated in brain cortex. The brains of the NP-exposed 5xFAD mice revealed no accelerated amyloid-beta plaque formation. No significant treatment-related behaviour impairments were observed in the healthy C57BL/6J mice. In the 5xFAD and ApoE(-/-) models, the NP inhalation exposures did not affect the alternation score in the X-maze indicating absence of spatial working memory deficits. However, following inhalation exposure to the 78% Zr-doped CeO2 NPs changes in forced motor performance (string suspension) and exploratory motor activity (X-maze) were observed in ApoE(-/-) and 5xFAD mice, respectively. Exposure to the 78% doped NPs also caused increased cortical expression of glial fibrillary acidic protein (GFAP) in the C57BL/6J mice. No significant treatment-related changes neuro

关键词： academic career   graduate medical education   neurosurgery   residency  

摘要： OBJECTIVE: Many studies have sought to determine predictors of academic career placement in surgical subspecialities. However, previous research has yet to establish whether the ranking of a surgeon's undergraduate institution or medical school is significantly associated with pursuit of an academic career. The purpose of this study was to investigate these novel factors' predictive impact on an academic career in the surgical subspeciality of neurosurgery. Factors investigated included undergraduate university rankings, medical school rankings, and residency program rankings. DESIGN: Data were retrospectively collected for 884 alumni of Accreditation Council for Graduate Medical Education neurological surgery residency programs. Bivariate analyses were conducted to determine covariates for a logistic regression model, and multivariate analysis was performed with 13 covariates to determine which factors were independently associated with academic career trajectory. RESULTS: In multivariate analysis, factors that were independently associated with an academic career in neurological surgery included having 1 year or more of protected research time during residency (odds ratio [OR] =1.96, p = 0.020), attending a "top" undergraduate university (OR =1.88, p = 0.00033), attending a "top" research medical school (OR = 1.53, p = 0.031) attending a residency program affiliated with a "top" research medical school (OR= 1.78, p = 0.012), possessing a Master of Science (OR = 3.46, p = 0.00097), or Doctor of Philosophy (OR = 2.05, p = 0.0019) degree, and completing a clinical fellowship (OR = 2.56, p = 1.90 x 10(-8)). CONCLUSIONS: Our study establishes 3 novel factors for predicting residents' choice of pursuing an academic career in neurological surgery, namely undergraduate university rank, medical school rank, and completing residency at a program affiliated with a "top" research medical school. Such findings reinforce the notion that educational and training environments are