关键词： 真实性评价   案例教学   神经病学   医学教学  

摘要： 为弥补临床医学教学中学生缺少实践锻炼机会,难以对学生临床技能进行实时有效评估的缺点,探讨将真实性评价下的案例教学法引入《神经病学》的课堂教学,将纯粹的阶段性评价改善为阶段性评价与形成性评价相结合,并运用临床教学案例的讨论,增强医学本科生运用课本理论知识解决临床实际诊断问题的能力。经调查,新的教学模式初步取得成功,并得到广大学生的好评。

关键词： COVID-19   Encephalitis   Guideline   Neuroscience   SARS-COV-2  

摘要： BACKGROUND: The coronavirus disease of 2019 (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has recently been designated a pandemic by the World Health Organization, affecting 2.7 million individuals globally as of April 25, 2020, with more than 187,000 deaths. An increasing body of evidence has supported central nervous system involvement. METHODS: We conducted a review of the reported data for studies concerning COVID-19 pathophysiology, neurological manifestations, and neuroscience provider recommendations and guidelines. RESULTS: Central nervous system manifestations range from vague nonfocal complaints to severe neurological impairment associated with encephalitis. It is unclear whether the neurological dysfunction results from direct viral injury or systemic disease. The virus could affect brainstem pathways that lead to indirect respiratory dysfunction, in addition to direct pulmonary injury. Necessary adaptations in patient management, triage, and diagnosis are evolving in light of the ongoing scientific and clinical findings. CONCLUSIONS: The present review has consolidated the current body of data regarding the neurological impact of coronaviruses, discussed the reported neurological manifestations of COVID-19, and highlighted the recommendations for patient management. Specific recommendations pertaining to clinical practice for neurologists and neurosurgeons have also been provided.

关键词： Brain injury   Peri-articular ossification   Orthopaedic   Rehabilitation   Surgery   X-ray  

关键词： anxiety   Fowler's syndrome   functional neurological symptom disorders   psychological disorders   somatization   urinary retention  

摘要： Aims Chronic urinary retention occurring in young women is poorly understood and a cause may not be found in a majority of cases. Different psychological comorbidities and functional neurological symptom disorders (FNDs) have been reported;however, these have been poorly explored. Methods At the International Consultation on Incontinence Research Society meeting in 2019, a panel of clinicians generated a proposal to explore the relationship between psychological comorbidities, FNDs, and urinary retention in women with chronic idiopathic urinary retention. Results Psychological comorbidities such as depression and anxiety, and FNDs such as leg weakness and loss of consciousness, have been reported in women with idiopathic urinary retention. Individuals react differently to physical and emotional stressors, and experimental models have demonstrated a relationship between the stress response and developing urinary retention. Trauma, particularly sexual trauma, may be a shared risk factor for developing psychological comorbidities and urinary retention. Children with voiding postponement often suffer from psychological comorbidities and behavioral disturbances;however, there is no evidence to suggest that this progresses to urinary retention in adulthood. "Psychogenic urinary retention" has been described in the urology and psychiatry literature in the past, and anecdotal cases of successful voiding following psychotherapy have been reported, though the true pathophysiology of this entity is uncertain. Conclusion Psychological and functional disorder comorbidities are reported in women with chronic urinary retention. The nature of the association between urinary retention and functional neurological disorder comorbidities needs to be further explored in terms of a disorder of bladder-brain interaction.

关键词： Head trauma   Pediatric   Cerebrovascular oxygenation   Blood-brain barrier   Cerebrovascular damage   Vasoreactivity   Neurological sequel  

摘要： Clinical evidence suggests that a mild traumatic brain injury occurring at a juvenile age (jmTBI) may be sufficient to elicit pathophysiological modifications. However, clinical reports are not adequately integrated with experimental studies examining brain changes occurring post-jmTBI. We monitored the cerebrovascular modifications and assessed the long-term behavioral and electrographic changes resulting from experimental jmTBI. In vivo photoacoustic imaging demonstrated a decrease of cerebrovascular oxygen saturation levels in the impacted area hours post-jmTBI. Three days post-jmTBI oxygenation returned to pre-jmTBI levels, stabilizing at 7 and 30 days after the injury. At the functional level, cortical arterioles displayed no NMDA vasodilation response, while vasoconstriction induced by thromboxane receptor agonist was enhanced at 1 day post-jmTBI. Arterioles showed abnormal NMDA vasodilation at 3 days post-jmTBI, returning to normality at 7 days post injury. Histology showed changes in vessel diameters from 1 to 30 days post-jmTBI. Neurological evaluation indicated signs of anxiety-like behavior up to 30 days post-jmTBI. EEG recordings performed at the cortical site of impact 30 days post-jmTBI did not indicate seizures activity, although it revealed a reduction of gamma waves as compared to age matched sham. Histology showed decrease of neuronal filament staining. In conclusion, experimental jmTBI triggers an early cerebrovascular hypo-oxygenation in vivo and faulty vascular reactivity. The exact topographical coherence and the direct casualty between early cerebrovascular changes and the observed long-term neurological modifications remain to be investigated. A potential translational value for cerebro-vascular oxygen monitoring in jmTBI is discussed.

关键词： Neonatal hypoxic ischaemic encephalopathy (HIE)   Therapeutic hypothermia   Minor neurological signs   Neurodevelopmental   Neuromotor  

摘要： Background: Neurodevelopmental follow-up in Neonatal Hypoxic Ischaemic Encephalopathy (HIE) typically focusses on major neuromotor (cerebral palsy, CP) and severe cognitive impairment. Outcomes in those without major neuromotor impairment are less well explored. Objectives: To examine behavioural, cognitive and neurological outcomes after neonatal HIE, in a clinical cohort of children without CP, at age 2 years. Methods: Clinical routine outcome data from children admitted to a tertiary centre with neonatal HIE for hypothermia treatment between 05/08/09-30/05/2016. Children were assessed for neuromotor status - particularly minor neurological signs (MNS), with Bayley Scales of Infant and Toddler Development III (Bayley III) or Ages and Stages Questionnaire-3 (ASQ), Child Behavior Checklist 1.5-5 (CBCL), Quantitative Checklist for Autism in Toddlers (Q-CHAT). Results: Of 107 children, 75.5% had normal neurology, 12.1% CP, 12.1% MNS. Children with CP were excluded from analyses. For those without CP, Bayley-III scores were in the average range for the majority;mild cognitive delay observed in 5%, 4.2% language, 1.3% motor development;severe delay in 1.3% for cognitive, 4.2% for language. More than in the normative population scored in clinical ranges for CBCL externalising, sleep, and other problems. No significant difference was seen for Q-CHAT. Children with MNS were significantly more likely to have impaired Bayley-III scores, parent-reported internalising, sleep, and other problems. Conclusions: In this clinical cohort, the majority of children had favourable outcome at 2 years. However, children with MNS were at risk for cognitive and behavioural difficulties and will benefit from enhanced clinical follow-up and support. Crown Copyright (C) 2020 Published by Elsevier Ltd on behalf of European Paediatric Neurology Society. All rights reserved.

关键词： FMRP   granules   mRNP granules   protein synthesis   RNA   stress granules  

摘要： RNA granule formation, which can be regulated by RNA-binding proteins (RBPs) such as fragile X mental retardation protein (FMRP), acts as a mechanism to control both the repression and subcellular localization of translation. Dysregulated assembly of RNA granules has been implicated in multiple neurological disorders, such as amyotrophic lateral sclerosis. Thus, it is crucial to understand the cellular pathways impinging upon granule assembly or disassembly. The goal of this review is to summarize recent advances in our understanding of the role of the RBP, FMRP, in translational repression underlying RNA granule dynamics, mRNA transport and localized. We summarize the known mechanisms of translational regulation by FMRP, the role of FMRP in RNA transport granules, fragile X granules and stress granules. Focusing on the emerging link between FMRP and stress granules, we propose a model for how hyperassembly and hypoassembly of RNA granules may contribute to neurological diseases.

关键词： Bee products   Neuroprotection   Neurodegeneration   Phenolic compounds  

摘要： Background: According to the World Health Organization, two billion people will attain the age of 60 years or more by 2050. Ageing is a major risk factor for a number of neurodegenerative disorders, which currently possess challenge to the global health status, carrying economic and social consequences. Therefore, attention has been dedicated towards the development of neuroprotective agents derived from natural sources. Honeybee products, such as honey, bee pollen, bee bread, propolis, royal jelly, beeswax, and bee venom have been used for therapeutic purposes since ancient times in Egypt, Greece, and China. Despite the emergence of modern medicine, bee products remain clinically relevant owing to their potential as anti-inflammatory, anti-oxidant, and neuroprotective agents. Scope and approach: This review demonstrates the potential of bee products against neurological disorders in the light of the current literature. Key findings and conclusions: Bee products and individual isolated components have enormous therapeutic potential for multiple neurological disorders. The different studies show overall neuroprotective and nerve-tonic characteristics of bee products, mainly due to their anti-oxidant, anti-inflammatory and anti-apoptotic features. However, some limitations such as allergic reactions and the cytotoxic effect of some bee products warrant a special care in its development as drug leads in future studies.

关键词： Hypoxic-ischemic encephalopathy   miR-124   Oxygen-glucose deprivation   Neuron damage   Neuron survival  

摘要： Neonatal hypoxic-ischemic encephalopathy (HIE) is a major cause of lifelong disabilities worldwide, without effective therapies and clear regulatory mechanisms. MicroRNAs (miRNAs) act as a significant regulator in neuroregeneration and neuronal apoptosis, thus holding great potential as therapeutic targets in HIE. In this study, we established the hypoxia-ischemia (HI) model in vivo and oxygen-glucose deprivation (OGD) model in vitro. Zea-longa score and magnetic resonance imaging were applied to verify HI-induced neuronal dysfunction and brain infarction. Subsequently, a miRNA microarray analysis was employed to profile miRNA transcriptomes. Down-regulated miR-124 was found 24 h after HIE, which corresponded to the change in PC12, SHSY5Y, and neurons after OGD. To determine the function of miR-124, mimics and lentivirus-mediated overexpression were used to regulate miR-124 in vivo and in vitro, respectively. Our results showed that miR-124 overexpression obviously promoted cell survival and suppressed neuronal apoptosis. Further, the memory and neurological function of rats was also obviously improved at 1 and 2 months after HI, indicated by the neurological severity score, Y-maze test, open field test, and rotating rod test. Our findings showed that overexpression of miR-124 can be a promising new strategy for HIE therapy in future clinical practice.

摘要： Objectives Provide educate to other healthcare providers caring for neurologically devastated patients transitioning to comfort care and the families of those patients on expectations of signs of distress after extubation to comfort care. Feel comfortable with providing adequate sedation to neurologically devastated patients transitioning to comfort care. Importance. Patients extubated to comfort in the neurological intensive care unit (Neuro-ICU) are unique because their principal underlying cause of death is primarily neurological; thus, their end of life symptoms may be related to neurological pathology, multisystem dysfunction, or both. However, little is known about symptom development and control in these patients. Objective(s). To determine if patients in the NeuroICU have persistent signs of distress after removal of life-sustaining therapies and, if signs of distress do develop, determine the time to distress control. Method(s). Retrospective medical record review of patients who died in a Neuro-ICU at a single tertiary center over a 12-month period. Inclusion criteria were mechanical ventilation with extubation to comfort care and deaths from neurologic pathology. Patients were excluded if under the age of 18, pregnant, had penetrating brain injury, declared brain dead, received cardiopulmonary resuscitation < 24 hours prior to cardiac death, or had incomplete medical record documentation. Results. Of the 38 patients included, 28 (73.7%) developed signs of distress. Of those 28 patients, 20 (71.4%) developed signs of distress that took >50% of their remaining time after extubation to attempt to achieve distress control. The average time in attempting to achieve distress control was 4.1 hours (S.D.: 4.7 hours). The average time to cardiac death was 4.7 hours (S.D.: 5.78 hours). Conclusion(s). Patients in the Neuro-ICU often have persistent signs of distress after removal of life-sustaining therapies. The time to distress control for more than half of these