关键词： Paraneoplastic syndrome   Immune checkpoint inhibitor   Anti-PD-1 inhibitor   Nivolumab, anti-Hu antibody   Neurologic immune related adverse events  

摘要： We present an illustrative case of a 62-year-old woman with small cell lung cancer who developed progressive worsening of pre-existing anti-Hu antibody associated sensory neuronopathy after treatment with programmed cell death-1 (PD-1) inhibitor, nivolumab. We review the literature and identify 6 reported cases to understand the clinical outcomes of patients with anti-Hu paraneoplastic neurologic syndrome (PNS) treated with anti-PD-1 treatment. The PNS clinical spectrum comprised of encephalitis, a combination of sensory neuronopathy and anti-NMDAR encephalitis, isolated sensory neuronopathy, and encephalomyelitis. Immune checkpoint inhibitor have the potential to worsen pre-existing anti-Hu PNS and may promote the development of anti-Hu PNS.

关键词： Neurotransmission   Brain Reward Cascade (BRC)   Opioid Use Disorder (OUD)   Endorphinergic mechanisms   Dopamine release and homeostasis   Genetic testing of addiction liability   Reward Deficiency Syndrome (RDS)   Endorphinergic deficiency syndrome   Opioid deficiency syndrome   Dopamine deficiency syndrome   Precision Addiction Management (PAM)  

摘要： The consensus of the current literature strongly supports the concept that brain neurotransmitters, and second messengers involved in the net release of dopamine in the mesolimbic region, especially the Nucleus Accumbens (NAc), is directly linked to motivation, anti-stress, incentive salience (wanting), and well-being. The role of dopamine in terms of alcohol withdrawal symptomology, cocaine craving behavior, dopamine -condensation products (TIQs), and more recently, the genetic aspects of drug-seeking and pro-dopamine regulation, provide compelling evidence of the relevant molecular neurological correlates of dopaminergic /endorphinergic mechanisms in reward circuitry due to genetic polymorphisms and epigenetic insults. In the face of an Americans opioid epidemic, the clinical consensus is to treat Opioid Use Disorder (OUD) with life-long opioid substitution therapy. However, the authors suggest a paradigm shift involving novel modalities like targeting the endorphinergic system linked to dopamine release at the NAc, in terms of the induction of required "dopamine homeostasis." Utilizing the known genetic - environmental interaction theorem P = G + E, the authors provide a clear rationale for the adoption of genetic risk testing coupled with endorphinergic/dopamine regulation to address dysfunction across the brain reward circuitry. The goal of altering resting-state, functional connectivity may require a gentle "neurotransmitter fix" vis enkephalinase inhibition to overcome or combat - self-induction of acute dopamine release via psychoactive substance misuse resulting in chronic dopamine down-regulation. As subsets of reward deficiency, we are poised to provide novel, genetically guided therapy for endorphinergic, opioidergic, and dopaminergic deficiencies and related syndromes, utilizing "Precision Addiction Management.

关键词： Nicotine   ROS   autophagy   melatonin  

摘要： Purpose: The aim of this study was to explore the mechanism of neurological changes underlying the toxicity of nicotine. Materials and methods: Rat pheochromocytoma 12 (PC12) cells and human neuroglia (HM) cells were used. The ROS levels of the cells were detected by the FACScan. Autophagy flux was monitored by a tandem monomeric RFP-GFP-tagged LC3 lentivirus. The autophagic proteins LC3, SQSTM1/p62 and Beclin1 were detected by western blot assay. In order to evaluate the effects of nicotine and melatonin on the morphological changes of neurons, primary cortical neurons were obtained and immunocytochemistry of TUBB3 tubulin were conducted. Results: Nicotine increased the levels of reactive oxygen species (ROS) in PC12 and HM cells in a concentration-dependent manner. Microscopy showed increased autophagic flux in nicotine-treated PC12 cells. Subsequent western blotting results showed that nicotine induced increase in the levels of LC3B-II and Beclin1, and decreased SQSTM1/p62 in a concentration-dependent manner. Finally, nicotine treatment reduced the length of TUBB3-positive axons and dendrites. Melatonin, a mitochondrially targeted antioxidant, reduced the ROS level, and blocked autophagy activation and the morphologic structural changes induced by nicotine. Conclusions: Our results suggested that the role of nicotine in neuronal toxicity maybe through the induction of ROS and the subsequent activation of autophagy. These effects could be restored by melatonin.

关键词： neurological disorders   Parkinson's disease   Alzheimer's disease   glioblastoma   epilepsy   multiple sclerosis   nose-to-brain   blood brain barrier   nanoformulations  

摘要： Although the global prevalence of neurological disorders such as Parkinson's disease, Alzheimer's disease, glioblastoma, epilepsy, and multiple sclerosis is steadily increasing, effective delivery of drug molecules in therapeutic quantities to the central nervous system (CNS) is still lacking. The blood brain barrier (BBB) is the major obstacle for the entry of drugs into the brain, as it comprises a tight layer of endothelial cells surrounded by astrocyte foot processes that limit drugs' entry. In recent times, intranasal drug delivery has emerged as a reliable method to bypass the BBB and treat neurological diseases. The intranasal route for drug delivery to the brain with both solution and particulate formulations has been demonstrated repeatedly in preclinical models, including in human trials. The key features determining the efficacy of drug delivery via the intranasal route include delivery to the olfactory area of the nares, a longer retention time at the nasal mucosal surface, enhanced penetration of the drugs through the nasal epithelia, and reduced drug metabolism in the nasal cavity. This review describes important neurological disorders, challenges in drug delivery to the disordered CNS, and new nasal delivery techniques designed to overcome these challenges and facilitate more efficient and targeted drug delivery. The potential for treatment possibilities with intranasal transfer of drugs will increase with the development of more effective formulations and delivery devices.

关键词： 神经病学   PBL   CBL   临床教学   可逆性胼胝体压部病变综合征   教学效果  

摘要： 以问题为基础的学习(PBL)与以案例为基础的学习(CBL)相结合的教学法在医学教学中应用越来越广泛,本文探讨了两种教学法在神经病学临床实习中的应用效果。对2018级实习生采用PBL与CBL相结合的教学法进行教学,对PBL结合CBL的教学实施及培训效果等多方面进行探讨。PBL结合CBL教学法增加了学生对神经病学的学习兴趣,提高了学生的临床实践技能,拓宽了学生的临床思维,增强了学生分析和解决问题的能力,获得了较好的教学效果。

关键词： 形成性评价   神经病学   临床实习教学  

摘要： 目的:探讨形成性评价在神经病学临床实习教学中的应用和教学效果。方法:以我校2014级100名临床医学本科实习生为教学对象,随机分为实验组(n=50)和对照组(n=50)。实验组运用形成性评价教学和评价方式、对照组采用终结性评价方法进行考核评价,将两组学生的考试成绩进行比较。结果:实验组学生出科成绩为(92.3±4.1)分,对照组为(87.4±6.5)分,实验组学生成绩优于对照组,差异有统计学意义(P<0.05);实验组学生对形成性评价体模式满意度较高。结论:形成性评价有助于激发学生学习的兴趣,提高自学能力、创新能力以及解决问题的能力,提高神经病学临床实习的教学质量。

关键词： 教学法   神经病学   临床见习  

摘要： 目的:提高学生的临床实践能力和综合素质。方法:采用以问题为中心教学法(PBL)、案例教学法(CBL)、以团队为基础教学法(TBL)来提升学生的学习兴趣和培养综合能力。结果:作为传统讲授式教学法(LBL)的补充,PBL、CBL、TBL对学生学习兴趣的提升和综合能力的培养方面各有利弊。结论:PBL、CBL、TBL 3种教学模式的应用,让学生以问题为导向、以案例为基础,在团队中“身临其境”地参与临床,充分调动学生的学习兴趣,提高学生的临床实践能力和综合素质。

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： 中医院校   神经病学   教学经验   山东中医药大学  

摘要： 神经病学内容抽象、庞杂、逻辑性强,中医院校开立的神经病学相关基础课程较少,学时相对较短,导致神经病学成为中医院校多数医学生的学习痛点。教师要在教学过程中不断优化教学设计,通过医学史、疾病史、典型案例等导课提高学生的学习兴趣;在多媒体、网络、教具等教学手段基础上把思维导图应用于板书设计;以讲授法、案例教学及PBL教学为主,其他教学方法为辅,使学生有效学习,学习有效;采用改良型Mini-CEX对学生进行临床能力考核,提升学生的岗位胜任力。