关键词： 教学模式   教学效果   神经内科   见习   PBL   TBL  

摘要： 目的采取PBL+TBL教学模式相结合的教学方法探索在神经病学见习中的效果。方法选取锦州医科大学2016级60名本科生为教学对象,PBL+TBL教学法作为试验组,传统教学法作为对照组,每组30人,分别对两组学生进行理论考试和技能考试,并对成绩进行对比统计学分析,同时进行问卷调查。结果试验组的理论和技能成绩均优于对照组(P<0.05);试验组在对神经病学兴趣、授课形式、综合分析问题能力、主动学习能力、临床综合思维能力、临床技能操作能力、团队协作能力等方面满意度均优于对照组,差异有统计学意义(P<0.05)。结论神经内科见习采用PBL联合TBL教学方法能提高神经病学学习效率,提高学习兴趣,有利于学生们自主解决问题及团队协作精神的培养。

关键词： 精神病学   文献计量学   神经病学   中国脑血管病   核心期刊   专家评审   通知   原理和方法  

摘要： 《中国脑血管病杂志》主编:我们谨此郑重通知:依据文献计量学的原理和方法,经研究人员对相关文献的检索、统计和分析,以及学科专家评审,贵刊《中国脑血管病杂志》入编《中文核心期刊要目总览》2017年版(即第8版)之“神经病学与精神病学”类的核心期刊。

关键词： 微信平台   实况教学   神经病学   临床教学  

摘要： 目的研究基于微信平台结合实况教学在神经病学临床教学中的应用效果。方法选取2016级南华大学临床医学专业本科学生90名作为研究对象,随机分为试验组和对照组,每组各45名。试验组采用基于微信平台结合实况教学,对照组采用传统教学法。教学结束后,对90名学生进行一致考核,比较2组教学效果。结果试验组的考核成绩、教学满意度均高于对照组,差异均有统计学意义(P<0.05)。结论基于微信平台结合实况教学可提高神经病学的临床教学效果。

关键词： 神经精神疾病   康复医学   精神病学   神经遗传学   神经病学   科研方法   科研成果   核心期刊  

摘要： 《中国神经精神疾病杂志》为我国神经病学与精神病学核心期刊,国内外公开发行。本刊以广大神经内科、神经外科、精神科及相关学科(包括神经生物学、神经遗传学及康复医学等)医师为主要读者,报道神经精神学科领域领先的科研方法、科研成果和临床诊疗经验,以及对神经精神疾病临床有指导意义的基础理论研究。一直被《中文核心期刊要目总览》、《中国科技论文统计源期刊》、中国科学引文数据库(CSCD)等收录为核心期刊。

关键词： Molecular biology   Neuroscience  

摘要： The advent and wide-spread adoption of electric lighting over the past century has profoundly affected the circadian organization of physiology and behavior for many individuals in industrialized nations;electric lighting in homes, work environments, and public areas have extended daytime activities into the evening, thus, increasing night-time exposure to light. Although initially assumed to be innocuous, chronic exposure to light at night (LAN) is now associated with increased incidence of cancer, metabolic disorders, and affective problems in humans. However, little is known about potential acute effects of LAN. To determine whether acute exposure to low-level LAN alters brain function, adult male, and female mice were housed in either light days and dark nights (LD;14 h of 150 lux:10 h of 0 lux) or light days and low level light at night (LAN;14 h of 150 lux:10 h of 5 lux). Mice exposed to LAN on three consecutive nights increased depressive-like responses compared to mice housed in dark nights. In addition, female mice exposed to LAN increased central tendency in the open field. LAN was associated with reduced hippocampal vascular endothelial growth factor-A (VEGF-A) in both male and female mice, as well as increased VEGFR1 and interleukin-1 beta mRNA expression in females, and reduced brain derived neurotrophic factor mRNA in males. Further, LAN significantly altered circadian rhythms (activity and temperature) and circadian gene expression in female and male mice, respectively. Altogether, this study demonstrates that acute exposure to LAN alters brain physiology and can be detrimental to well-being in otherwise healthy individuals.

关键词： extracorporeal membrane oxygenation   Neurological Pupil index   outcome   prognostication   pupillometry  

摘要： BACKGROUND: Venoarterial extracorporeal membrane oxygenation therapy (VA-ECMO) after refractory cardiogenic shock or cardiac arrest has significant morbidity and mortality. Early outcome prediction is crucial in this setting, but data on neuroprognostication are limited. We examined the prognostic value of clinical neurologic examination, using an automated device for the quantitative measurement of pupillary light reactivity. METHODS: An observational cohort of sedated, mechanically ventilated VA-ECMO patients was analyzed during the early phase after ECMO insertion (first 72 h). Using the NPi-200 automated infrared pupillometer, pupillary light reactivity was assessed repeatedly (every 12 h) by calculating the Neurological Pupil index (NPi). Trends of NPi over time were correlated to 90-day mortality, and the prognostic performance of the NPi, alone and in combination with the 12-h PREDICT VA-ECMO score, was evaluated. RESULTS: One hundred consecutive patients were studied (51 with refractory cardiogenic shock and 49 with refractory cardiac arrest;12-h PREDICT VA-ECMO, 40%;observed 90-day survival, 43%). Nonsurvivors (n = 57) had significantly lower NPi than did survivors at all time points (all P < .01). Abnormal NPi (< 3, at any time from 24 to 72 h) was 100% specific for 90-day mortality, with 0% false positives. Adding the 12-h PREDICT VA-ECMO score to the NPi provided the best prognostic performance (specificity, 100% [95% CI, 92%-100%];sensitivity, 60% [95% CI, 46%-72%];area under the receiver operating characteristic curve, 0.82). CONCLUSIONS: Quantitative NPi alone had excellent ability to predict a poor outcome from day 1 after VA-ECMO insertion, with no false positives. Combining NPi and 12-h PREDICT-VA ECMO score increased the sensitivity of outcome prediction, while maintaining 100% specificity.

摘要： Background Antireflux surgery is commonly performed in children, yet evidence for its efficacy is limited. The aim of this review was to determine the effect of antireflux surgery with regard to objective measures of quality of life (QoL) and value of upper gastrointestinal investigations in neurologically normal (NN) and neurologically impaired (NI) children. Methods A systematic review was conducted of articles reporting children undergoing antireflux surgery in whom preoperative and postoperative objective testing was performed. Primarily, Embase, CINAHL, MEDLINE and PubMed were searched from inception to April 2019. Methodological Index for Non-randomized Studies (MINORS) criteria were used to assess article quality. Results Of 789 articles, 14 met the eligibility criteria, 12 prospective observational and 2 retrospective studies. The median MINORS score was 59 center dot 4 (i.q.r. 39 to 62 center dot 5) per cent. Seven studies reported assessment of validated QoL measures before and after antireflux surgery in 148 children. Follow-up ranged from 1 to 180 months. All studies confirmed significant improvements in QoL measures among NN and NI children at all follow-up points. Eleven studies reported on preoperative and postoperative investigations in between 416 and 440 children children. Follow-up ranged from 0 center dot 5 to 180 months. Nine studies confirmed improvements in gastro-oesophageal reflux using 24-h oesophageal pH monitoring with or without manometry, but conflicting results were identified for four studies reporting gastric emptying. No studies reported fluoroscopy or endoscopy adequately. Conclusion Based on the results of studies of low-to-moderate quality, antireflux surgery improved QoL and reduced oesophageal acid exposure in NN and NI children in the short and medium term. Although antireflux surgery is a common elective operation, the lack of rigorous preoperative and postoperative evaluation(s) in the majority of patient-reported studies is

关键词： Brain metastases   Stereotactic radiosurgery   Single-isocenter multiple-targets radiosurgery   Treatment accuracy   Neurotoxicity   Radiation-induced brain necrosis  

摘要： Purpose To assess the neurocognitive function and neurological toxicity of frameless linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) in patients with 10 or more brain metastases (BM). Patients and methods Forty consecutive adult patients who received SRS for ten or more 10 BM < 3 cm in maximum size were evaluated. All plans were generated using a single-isocenter multiple-target (SIMT) SRS technique with doses of 22 Gy for lesions < 2 cm and 16-18 Gy for those >= 2 cm in size. Survival analyses were estimated by Kaplan-Meier method from the date of SRS. Neurocognitive function using the Hopkins verbal learning test-revised (HVLT-R) and activity of daily living scale (ADLS) were collected prospectively at baseline and at 3,6 and 12-month follow-up. Toxicity was assessed by the National Cancer Institute Common Toxicity Criteria for Adverse Events (Version 5.0). Results With a median follow-up of 10.8 months, 1-year survival and local control rates were 65% and 86%, respectively. Grade 2 or 3 toxicity occurred in eleven patients, being associated with radiological changes suggestive of radiation necrosis in seven patients. Three months after SRS, the mean relative decline was 14.2% for HVLT-R delayed recall, 12.3% for HVLT-R recognition, and 9.8% for HVLT-R total recall. A significant deterioration of HVLT-R scores ranged from 5.5 to 18.7% of patients at different time points. ADLS scores declined over time, but changes were not significant. Conclusions SRS is an effective and safe approach for patients with 10 or more BM able to maintain the pretreatment neurocognitive function in the majority of patients.

关键词： methotrexate   myasthenia gravis   Alzheimer's disease   immunosuppressive drug   disease modifying anti-rheumatic drug   anticancer drug  

摘要： Methotrexate, a structural analogue of folic acid, is one of the most effective and extensively used drugs for treating many kinds of cancer or severe and resistant forms of autoimmune diseases. In this paper, we take an overview of the present state of knowledge with regards to complex mechanisms of methotrexate action and its applications as immunosuppressive drug or chemotherapeutic agent in oncological combination therapy. In addition, the issue of the potential benefits of methotrexate in the development of neurological disorders in Alzheimer's disease or myasthenia gravis will be discussed.

关键词： Diagnosis   Spinal cord diseases  

摘要： Study design Prospective, single-blinded study. Objective To design and evaluate the use of an interview based version of the anorectal portion of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam in the acute inpatient rehabilitation (AIR) setting. Setting AIR unit. Methods Participants admitted to AIR underwent standard ISNCSCI exams (S-ISNCSCI) as part of routine inpatient care within 3 days of being administered an interview version of the anorectal portion of the ISNCSCI (I-A-ISNCSCI). Agreement between the anorectal portion of the S-ISNCSCI (S-A-ISNCSCI) and the I-A-ISNCSCI was evaluated. Results Forty of forty-five enrolled participants completed the assessments. Agreement between the I-A-ISNCSCI and S-A-ISNCSCI was substantial for anorectal sensation to light touch (k = 0.71, 95% CI 0.52-0.90, N = 36), pin prick (k = 0.68, 95% CI 0.48-0.87, N = 38), deep anal pressure (k = 0.77, 95% CI 0.53-1.00, N = 37), and completeness of injury based on combined sacral sensory criteria (k = 0.72, 95% CI 0.47-0.97, N = 40);and fair for voluntary anal contraction (k = 0.29, 95% CI -0.01 to 0.59, N = 36). Responses of "I don't know" were excluded from agreement analyses. Conclusions This pilot study was a first step in developing interview based tools such as the I-A-ISNCSCI in an AIR setting providing convenient access to individuals with SCI and their direct feedback. The study design introduces potential recall bias and may not match true clinical situations such as remote follow-up of neurological changes for chronic patients. The use of interview based tools for assessing individuals with SCI remains worthy of further study.