关键词： Enterovirus D68   Animal model   Respiratory disease   Neurological disease   Acute flaccid myelitis   Antiviral   Guanidine  

摘要： Enterovirus D68 (EV-D68) is unique among enteroviruses because of the ability to cause severe respiratory disease as well as neurological disease. We developed separate models of respiratory and neurological disease following EV-D68 infection in AG129 mice that respond to antiviral treatment with guanidine. In four-week-old mice infected intranasally, EV-D68 replicates to high titers in lung tissue increasing the proinflammatory cytokines MCP-1 and IL-6. The respiratory infection also produces an acute viremia. In 10-day-old mice infected intraperitoneally, EV-D68 causes a neurological disease with weight-loss, paralysis, and mortality. In our respiratory model, treatment with guanidine provides a two-log reduction in lung virus titers, reduces MCP-1 and IL-6, and prevents histological lesions in the lungs. Importantly, viremia is prevented by early treatment with guanidine. In our neurological model, guanidine treatment protects mice from weight-loss, paralysis, and mortality. These results demonstrate the utility of these models for evaluation of antiviral therapies for EV-D68 infection.

关键词： Child   decision making   disability   life-threatening events   physician  

摘要： Purpose: Children with severe neurological disabilities are at an increased risk of acute, life-threatening events. We assessed physicians' attitudes when making decisions in these situations. Methods: We surveyed physicians in pediatric intensive care, neurology, and rehabilitation units in Swiss hospitals. The questionnaire explored participants' attitudes toward life-threatening situations in two scenarios: a child with profound intellectual and multiple disabilities (PIMD) and an infant with spinal muscular atrophy (SMA) type I. Results: The participation rate was 55% (52/95). There was a consensus favoring non-invasive ventilation and comfort care as well as avoiding tracheostomy and invasive ventilation. For the child with PIMD, 61% of participants opposed cardiopulmonary resuscitation (CPR), 51% for the child with SMA. Physicians with over 20 years of experience were significantly more opposed to providing CPR than less experienced colleagues. Conclusions: Physicians held different views, influenced by personal factors. This highlights the importance of standardizing multidisciplinary processes toward approaching these complex situations.

关键词： 参与式教学法   中西医结合神经病学   临床教学  

摘要： 在医学专业学生基础知识弱化与临床实践能力欠缺的客观环境下,根据中西医结合神经病学的课程特点,提出"参与式"教学方法应用于该课程中,指导学生课前参与教学准备,课中参与教学过程,课后参与临床评价,临床参与实践诊疗,以激发学生对学习的热情,加深学生对知识的理解,增强学生的临床实践能力,促进创新型中医药人才的培养。

关键词： brain phospholipids   functional improvement   medical multi-nutrient   neuroplasticity   neuroprotection   traumatic brain injury  

摘要： Traumatic brain injury (TBI) leads to cellular loss, destabilization of membranes, disruption of synapses and altered brain connectivity, and increased risk of neurodegenerative disease. A significant and long-lasting decrease in phospholipids (PLs), essential membrane constituents, has recently been reported in plasma and brain tissue, in human and experimental TBI. We hypothesized that supporting PL synthesis post-injury could improve outcome post-TBI. We tested this hypothesis using a multi-nutrient combination designed to support the biosynthesis of PLs and available for clinical use. The multi-nutrient, Fortasyn((R)) Connect (FC), contains polyunsaturated omega-3 fatty acids, choline, uridine, vitamins, cofactors required for PL biosynthesis, and has been shown to have significant beneficial effects in early Alzheimer's disease. Male C57BL/6 mice received a controlled cortical impact injury and then were fed a control diet or a diet enriched with FC for 70 days. FC led to a significantly improved sensorimotor outcome and cognition, reduced lesion size and oligodendrocyte loss, and it restored myelin. It reversed the loss of the synaptic protein synaptophysin and decreased levels of the axon growth inhibitor, Nogo-A, thus creating a permissive environment. It decreased microglia activation and the rise in beta-amyloid precursor protein and restored the depressed neurogenesis. The effects of this medical multi-nutrient suggest that support of PL biosynthesis post-TBI, a new treatment paradigm, has significant therapeutic potential in this neurological condition for which there is no satisfactory treatment. The multi-nutrient tested has been used in dementia patients and is safe and well tolerated, which would enable rapid clinical exploration in TBI.

关键词： 神经病学   教学方法   教学探索   医学再教育  

摘要： 医学教育是一个终身过程。医学生毕业后再教育是根据医院需求有目的、有计划、有组织地培养医药卫生人才的教育活动。教学医院招收进修生实地培养是对下级医院医生系统培养、规范操作、理念更新的主要方式,教学医院在再教育环节中承担重要责任。神经病学是一门专业性强的学科,如何让进修生在短暂的进修期内学有所获,提高培育质量,结合长期的临床教学实践工作,浅谈几点体会。

关键词： Blood-brain barrier   Brain targeting   Neurological diseases   Carrier-mediated transport   Nanoparticles   Liposomes  

摘要： Brain specific drug delivery is one of the most interesting and challenging areas of research. The blood-brain barrier separates the brain from blood and acts as a barrier to protect the brain from microorganisms, neuro-toxins and chemical substances. But, the same mechanism poses an obstacle for the entry of many drugs into the brain. Worldwide, approximately 1.5 billion people are suffering from CNS disorders, such as Parkinson's disease, Alzheimer's disease, multiple sclerosis, amyotrophic lateral sclerosis, stroke, HIV-dementia and others. This number indicates the importance of delivering drugs effectively into the brain for treating various brain diseases. The recent advancements in drug targeting, a concept was introduced by Dr. Paul Ehrlich as 'magic bullet' give lot of hopes for delivering drugs specifically to the brain regions to treat brain diseases. This review discusses about the various targeting strategies to deliver drugs into the brain for treating neurological diseases.

关键词： homocysteine   dementias   stroke   inflammation   vascular endothelium  

摘要： Homocysteine (Hcy) is a sulfur-containing amino acid that is generated during methionine metabolism. Physiologic Hcy levels are determined primarily by dietary intake and vitamin status. Elevated plasma levels of Hcy can be caused by deficiency of either vitamin B12 or folate. Hyperhomocysteinemia (HHcy) can be responsible of different systemic and neurological disease. Actually, HHcy has been considered as a risk factor for systemic atherosclerosis and cardiovascular disease (CVD) and HHcy has been reported in many neurologic disorders including cognitive impairment and stroke, independent of long-recognized factors such as hyperlipidemia, hypertension, diabetes mellitus, and smoking. HHcy is typically defined as levels >15 micromol/L. Treatment of hyperhomocysteinemia with folic acid and B vitamins seems to be effective in the prevention of the development of atherosclerosis, CVD, and strokes. However, data from literature show controversial results regarding the significance of homocysteine as a risk factor for CVD and stroke and whether patients should be routinely screened for homocysteine. HHcy-induced oxidative stress, endothelial dysfunction, inflammation, smooth muscle cell proliferation, and endoplasmic reticulum (ER) stress have been considered to play an important role in the pathogenesis of several diseases including atherosclerosis and stroke. The aim of our research is to review the possible role of HHcy in neurodegenerative disease and stroke and to understand its pathogenesis.

关键词： neurotransmitters   sleep   sleep and waking impairments   sleep–waking cycle  

摘要： This review addresses contemporary experimental data on the functioning of the main neurotransmitter systems of the brain involved in arousal reactions and the maintenance of waking. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.

关键词： Syndromic surveillance   Bayesian model   Spatio-temporal model   Hidden markov model   Gibbs sampling   West Nile Virus  

摘要： A potentially sensitive way to detect disease outbreaks is syndromic surveillance, i.e. monitoring the number of syndromes reported in the population of interest, comparing it to the baseline rate, and drawing conclusions about outbreaks using statistical methods. A decision maker may use the results to take disease control actions or to initiate enhanced epidemiological investigations. In addition to the total count of syndromes there are often additional pieces of information to consider when assessing the probability of an outbreak. This includes clustering of syndromes in space and time as well as historical data on the occurrence of syndromes, seasonality of the disease, etc. In this paper, we show how Bayesian theory for syndromic surveillance applies to the occurrence of neurological syndromes in horses in France. Neurological syndromes in horses may be connected e.g. to West Nile Virus (WNV), a zoonotic disease of growing concern for public health in Europe. A Bayesian method for spatio-temporal cluster detection of syndromes and for determining the probability of an outbreak is presented. It is shown how surveillance can be performed simultaneously for a specific class of diseases (WNV or diseases similar to WNV in terms of the information available to the system) and a non-specific class of diseases (not similar to WNV in terms of the information available to the system). We also discuss some new extensions to the spatio-temporal models and the computational algorithms involved. It is shown step-by-step how data from historical WNV outbreaks and surveillance data for neurological syndromes can be used for model construction. The model is implemented using a Gibbs sampling procedure, and its sensitivity and specificity is evaluated. Finally, it is illustrated how predictive modelling of syndromes can be useful for decision making in animal health surveillance.

关键词： 神经病学   网络教学   传统教学  

摘要： 目的探讨神经病学教学中结合应用网络平台与传统教学结合的效果。方法选择2017年5月至2017年8月临床医学专业本科进行《神经病学》学习的一个大班120名学生作为观察组,利用网络教学与传统教学方法结合教学,另外选取另一大班118人作为对照组,仅利用传统教学法进行教学,比较2组教学质量。结果观察组学习结束后的考试中病例分析试题知识点错误数为(3.528±0.627)个,P <0.001。对照组病例分析试题知识点错误数为(6.421±0.749)个,P <0.001;观察组学习结束后考试中病例分析试题知识点正确率为85.5%、对照组正确率66.5%,P <0.01;学习结束后观察组112名学生对教学的满意度为93.33%,对照组83名学生对教学的满意度为70%,行χ2检验,P <0.001。结论在神经病学教学中结合应用网络教学与传统教学方法进行教学,能够提升教学质量,可在临床推广。