关键词： 神经病学   教学治量   临床培养   住院医师  

摘要： 在中国,随着人口的老龄化,包括卒中、癫痫、帕金森病和痴呆等神经病学疾病发病率逐年升高.神经病学系列课程,尤其是神经解剖学课程是医学生和住院医师普遍感到难以掌握而又比较重要的一组神经系统疾病.教学医院对神经系统疾病的临床教学担负着重要责任,在教学时既要针对医学院校不同层次的医学生进行授课;同时要注重循证医学研究和专业知识的更新.临床教学阶段主要是传授使用理论知识来解决实际问题的能力.因此,在神经病学疾病临床教学中,合理融合多种教学模式一方面可以使医学生更直观理解复杂的神经解剖,提高住院医师临床思维能力的培养,另一方面也可以引导学生主动思考、提高解决临床实际问题的能力,以提高神经病学临床教学质量.

关键词： adult   neurological disease   rural   stigma  

摘要： Stigma is a widely recognised public health issue. Many people with neurological disease and their families experience stigmatisation, adding to their burden of illness. Rural populations are typically small, lack anonymity, and often have a higher proportion of older adults with inadequate access to specialised services and resources. Although generally isolated, rural areas can offer benefits such as a sense of familiarity and interconnectedness. The purpose of this scoping review was to map the existing evidence on stigma associated with non-communicable neurological disease in rural adult populations and identify key findings and gaps in the literature. Our literature search of peer-reviewed English language articles published from 1 January 1992 to 22 June 2017 was conducted across five databases yielding 8,209 results. After duplicate removal, pairs of reviewers independently screened 6,436 studies according to inclusion criteria developed a priori;36 articles were identified for inclusion in this review. Study characteristics were described and illustrated by frequency distribution, findings were grouped thematically, and each of the five types of stigma were identified (social, self, health professional, associative, structural). Four factors influencing stigma (knowledge, familiarity, beliefs, and rurality) and four overarching stigma-related themes (concealment;exclusion;disempowerment, discrimination, and unequal opportunities;and issues related to healthcare systems and providers) emerged. In urban-rural comparison studies, rural residents were generally less knowledgeable about the neurological disease and more stigmatised. The impact of other factors (i.e., gender, age, and education) on stigma varied and are stated where associations were reported. Three main gaps were identified including: low attention to stigma related to neurological diseases other than epilepsy, limited cross-cultural comparisons of stigma related to neurological disease, and inc

关键词： Sturge-Weber syndrome   Seizures   Family history   Gender   Brain involvement   Port-wine birthmark   Glaucoma  

摘要： Background: Sturge-Weber syndrome (SWS) is caused by a somatic mutation in GNAQ leading to capillary venous malformations in the brain presenting with various neurological, ophthalmic, and cognitive symptoms of variable severity. This clinical variability makes accurate prognosis difficult. We hypothesized that the greater extent of physical factors (extent of skin, eye, and brain involvement), presence of possible genetic factors (gender and family history), and age of seizure onset may be associated with greater symptom severity and need for surgery in patients with SWS. Methods: The questionnaire was collected from 277 participants (age: two months to 66 years) with SWS brain involvement at seven US sites. Results: Bilateral brain involvement was associated with both learning disorder and intellectual disability, whereas port-wine birthmark extent was associated with epilepsy and an increased likelihood of glaucoma surgery. Subjects with family history of vascular birthmarks were also more likely to report symptomatic strokes, and family history of seizures was associated with earlier seizure onset. Learning disorder, intellectual disability, strokelike episodes, symptomatic stroke, hemiparesis, visual field deficit, and brain surgery were all significantly associated with earlier onset of seizures. Conclusion: The extent of brain and skin involvement in SWS, as well as the age of seizure onset, affect prognosis. Other genetic factors, particularly variants involved in vascular development and epilepsy, may also contribute to neurological prognosis, and further study is needed. (C) 2018 Published by Elsevier Inc.

关键词： astrocytes   interleukin-17A   interleukin-17 receptor subunits   middle cerebral artery occlusion   oxygen-glucose deprivation  

摘要： We previously reported that astrocytes are the main sources of interleukin (IL)-17A production that could aggravate neuronal injuries in ischemic stroke. However, the effects of IL-17A on ischemic astrocytes themselves and the underlying molecular mechanism are still unclear. In this study, we found that recombinant mouse (rm) IL-17A could significantly (P<0.05 or <0.001) alleviate 1-hour oxygen-glucose deprivation (OGD)/reoxygenation (R) 24-hour-induced ischemic injuries in cortical astrocytes with a dose-dependent manner (n=6 per group). The Western blot and cell cycle analysis results revealed that rmIL-17A significantly (P<0.05) inhibited procaspase-3 cleavage without affecting cell proliferation in 1-hour OGD/R 24-hour-treated cortical astrocytes (n=6 per group). Among the five IL-17 receptor subunits (IL-RA, -RB, -RC, -RD, and -RE), only IL-17RA (P<0.01) and -17RC (P<0.05) membrane translocation (not messenger RNA and protein) levels were downregulated in cortical astrocytes following 1-hour OGD/reperfusion 24hours, and rmIL-17A could significantly (P<0.05 or <0.001) inhibit this downregulation (n=6 per group). To further verify the impact of IL-17A on the neurological outcome of ischemic stroke, we found that the intracerebroventricular injection of IL-17A neutralizing monoclonal antibody remarkably (P<0.001) reduced the astrocyte activation and improve neurological function (P<0.05 or <0.01) of mice following 1-hour middle cerebral artery occlusion/reperfusion (R) 3 to 7 days (n=6 or 8 per group). These results suggested that IL-17A-mediated alleviation of cortical astrocyte ischemic injuries could affect the neurological outcome of mice with ischemic stroke, which might be mainly dependent on the cell apoptosis pathway through inhibiting the downregulation of IL-17RA and -17RC membrane translocations.

关键词： Families   Activity restriction   Schooling  

摘要： When a child is diagnosed with epilepsy, counseling regarding the same is done by the treating doctor. Most parents are frightened and have poor knowledge about epilepsy. Therapeutic advice including drug dosage, administration and side effects takes up the major part of physician's time, thereby neglecting important issues like home seizure management, follow up and *** lacunae in knowledge require systematic patient and family education. To address these issues, an expert group meeting of pediatric neurologists and epileptologists in India along with social workers/epilepsy educators, legal experts, parents, and teachers was held. The various aspects regarding parental counseling in children with epilepsy were discussed and a consensus document was formulated. Here authors present the group consensus statement on counseling parents and caregivers of children with epilepsy. This document is intended to help physicians and pediatricians counsel the families when a child is diagnosed with epilepsy.

关键词： Percutaneous   Minimally invasive   Pedicle screw   Thoracolumbar fracture   Internal fixation  

摘要： ObjectivesTo compare the efficacy and safety of novel percutaneous minimally invasive pedicle screw fixation and traditional open surgery for thoracolumbar fractures without neurological *** adult patients with single thoracolumbar fracture between June 2014 and June 2016 were recruited in this study, randomly divided into open fixation group (group A) or minimally invasive percutaneous fixation group (group B). Clinical and surgical evaluation including surgery time, blood losses, radiation times, hospital stay, and complication were performed. The two groups of patients with pre-operative and last follow-up anterior height ratio of fracture vertebral, Cobb angle of fracture vertebral, and VAS score of back pain were *** patients completed valid follow-ups, with an average time period of 15.4months (12-26months). Group B achieved much better results in time of operation, intra-operative blood loss, and length of stay than group A (P<0.05). Group A was significantly better than group B in the times of radiation (P<0.05). The VAS score was significantly lower in group B than in group A at three days after the operation (P<0.05). There were no significant differences between the two groups in the anterior height ratio of fracture vertebral, Cobb angle, and VAS score in the last follow-up (P>0.05). No injured nerve or other severe complications occurred in both groups;one of the patients from group A had back and loin pain lasting for about one month, which resolved after analgesia and functional training. There was no significant difference between the two groups in incidence of *** percutaneous pedicle screws with angle reset function can achieve the same effect as traditional open pedicle screw fixation in the treatment of thoracolumbar fractures without nerve injuries. Percutaneous minimally invasive pedicle screw fixation has the characteristics of shorter operative time, less bleeding, and less pain, but

关键词： Continuous ambulatory peritoneal dialysis   familial hyperphosphatemic tumor calcinosis   primary FGF23 deficiency   sevelamer   sudden vision loss  

摘要： Hyperphosphatemia in the absence of renal failure is an unusual occurrence, particularly in children, but is a common primary feature of familial hyperphosphatemic tumor calcinosis. We report a child with hyperphosphatemia who presented with multiple episodes of neurologic dysfunction involving lower motor neuron facial nerve palsy along with sequential visual loss. He also had an episode of stroke. There was an extensive metastatic calcification of soft tissue and vasculature. Hyperphosphatemia with normal serum alkaline phosphatase, calcium, parathyroid hormone, and renal function was noted. He was managed with hemodialysis and sevelamer (3 months) without much success in reducing serum phosphate level, requiring continuous ambulatory peritoneal dialysis (3 years). Intact fibroblast growth factor 23 (FGF23) was undetectable, with C-terminal FGF23 fragments significantly elevated (2575 RU/ml, normal < 180 RU/ml). Sequencing demonstrated homozygous c. 486C >A (p. N162K) mutation in FGF23 exon 3, confirming the diagnoses of primary FGF23 deficiency, the first case to be reported from India.

关键词： canine   neoplasia   spinal  

摘要： Vertebral lesions and associated neurological signs occur in dogs with multiple myeloma, however, veterinary literature describing MRI findings is currently lacking. The objective of this multicenter, retrospective, case series study was to describe neurological signs and MRI findings in a group of dogs that presented for spinal pain or other neurological deficits and had multiple myeloma. Electronic records of four veterinary referral hospitals were reviewed. Dogs were included if they had a pathologically confirmed diagnosis of multiple myeloma, had presented for spinal pain or other neurological signs, and had undergone MRI of the vertebral column. The MRI studies were evaluated and the anatomical location of lesion(s), signal intensity, presence of extra-dural material, degree of spinal cord compression, extent of vertebral lesions, and contrast enhancement were recorded. Twelve dogs met inclusion criteria. Most dogs (n = 8) had a chronic progressive history, with varying degrees of proprioceptive ataxia and paresis (n = 11), and spinal pain was a feature in all dogs. The MRI findings were variable but more consistent features included the presence of multiple expansile vertebral lesions without extension beyond the outer cortical limits of affected vertebrae, and associated extradural material causing spinal cord compression. The majority of lesions were hyper- to isointense on T2 (n = 12) and T1-weighted (n = 8) sequences, with variable but homogeneous contrast-enhancement (n = 12). These described MRI characteristics of multiple myeloma may be used to aid early identification and guide subsequent confirmatory diagnostic steps, to ultimately improve therapeutic approach and long-term outcome.

摘要： Paraneoplastic neurological syndromes (PNS) constitute a heterogeneous group of cancer-related disorders that can affect any level of the central and peripheral nervous system. There is compelling evidence that PNS are caused by an immune response directed against neural antigens that are abnormally expressed by the tumour. PNS are frequently associated with neural-specific autoantibodies whose characterization has direct implications for diagnostic workup, treatment and outcome, The last decade has seen a dramatic rise in the discovery of novel autoantibodies associated with PNS, which has led to more accurate diagnoses and earlier treatments, potentially resulting in better outcomes. The latest advancements in the field of autoimmune neurology have paved the way to a more comprehensive understanding of PNS;yet, many aspects of their immunopathogenesis remain to be elucidated and patient-tailored treatment strategies still need to be optimized.

摘要： The article highlights the idea of Franciscus Sylvius, of attending bedside rounds that emphasized clinical learning and consisted of presentations and teaching at the bedside of patients. It mentions that groups of physicians examining patients together at the bedside became symbolic of inpatient care; and also mentions the styles of rounding like bedside rounding, hallway rounding, and conference room rounding.