关键词： 主体互动   教学模式   神经病学   临床技能   学习能力   教学改革  

摘要： 神经病学这门学科除了理论性很强之外,实践性也非常强,传统的"灌输式"教学模式因为忽略了主体之间的交流互动,已不能满足神经病学临床技能的教学要求。对临床技能的牢固掌握,会促进本科生对这门学科理论知识更深刻的理解,激发他们对神经病学的学习兴趣。我们科室尝试将"主体互动"教学模式应用于神经病学临床技能教学中,充分发挥了师生之间、学生之间的互动作用,取得了较满意的教学效果,促进了培训教师教学素养的提升,提高了本科生的临床技能和学习能力。

关键词： 案例为中心的学习   神经病学   留学生   临床教学  

摘要： 目的:比较不同教学模式在留学生神经病学临床带教中的应用效果。方法:回顾2012-2015年期间75名医学院本科留学生的神经病学临床教学的数据,根据主要带教方式分成传统模式教学组,案例为中心的教学组和问题为导向的教学组,结合问卷反馈、考试成绩、后续发展等三方面指标,分析带教过程中的主要问题,评价不同带教模式在留学生教学效果上的差异。结果:教学过程中的问题主要包括语言障碍和文化差异所导致的学生与带教老师之间、学生与患者之间的沟通困难以及专业英语教材和教学模式上的不足所导致的理论掌握程度受限。案例为中心教学组的留学生对教学反馈的正面评价比例相对最高,理论考试成绩的平均分更高,但三组教学模式下的留学生攻读高一级学位的比例并无显著差异。结论:将案例为中心的教学方法应用于神经病学临床带教中有助于提高留学生的学习兴趣和临床教学效果。

关键词： intermittent rhythmic delta activity   intensive care   EEG   stroke   pathophysiology  

摘要： Introduction. Frontal intermittent rhythmic delta activity (FIRDA), a transient rhythmic slow wave pattern over the anterior EEG leads, has been reported in a wide variety of cerebral lesions and different metabolic disturbances. Few authors have analyzed the frequency and clinical significance of FIRDA in the critical care setting. We aimed to better understand these issues in our intensive care cohort and if possible, try to delineate its underlying mechanisms. Methods. Video-EEG reports of consecutive adult patients in the neurological intensive care unit (NICU) since 2009 were retrospectively reviewed to identify cases with FIRDA. Demographic, clinical, and laboratory data were obtained from EEG reports and patient charts. Age- and sex-matched patients with acute stroke, hospitalized in NICU and no FIRDA on video-EEG monitoring served as the control group. Results. Among 162 patients who underwent video-EEG monitoring, FIRDA was documented in 17%. Female prevalence was 50% and age ranged from 23 to 82 years. Twenty-three (82%) of patients with FIRDA had a diagnosis of stroke. Comparison of demographic characteristics, EEG findings, metabolic disturbances and prognoses revealed no differences between stroke cases with and without FIRDA, except for higher frequency of acute and chronic isolated posterior circulation infarcts in patients with FIRDA. Conclusion. FIRDA is more commonly encountered in the neurocritical care setting as compared with outpatient EEG clinics. Our findings in stroke patients indicate that involved vascular territories may be related to the generation of FIRDA.

关键词： IMPACT factor (Citation analysis)   NEUROSCIENCES   PERIODICAL articles   MEDICAL literature   PERIODICAL editors  

关键词： In-hospital cardiac arrest   Heart arrest   Cardiopulmonary resuscitation   Prognosis   Clinical decision-making   Medical futility  

摘要： Background: A do-not-attempt-resuscitation order is issued when it is against the wishes of the patient that cardiopulmonary resuscitation is performed, or when the chance of good quality survival is minimal. Therefore it is essential for physicians to make an objective prearrest prediction of the outcome after an in-hospital cardiac arrest (IHCA). Our aim was external validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score in a population based setting. Methods: The study was based on a retrospective cohort of adult IHCAs in Stockholm County 2013-2014 identified through the Swedish Cardiopulmonary Resuscitation Registry. This registry provided patient and event characteristics and neurological outcome at discharge. Neurologically intact survival is defined as Cerebral Performance Category score (CPC) 1 at discharge. Data for the GO-FAR variables was obtained from manual review of electronic patient records. Model performance was evaluated by measure of discrimination with the area under the receiver operating curve (AUROC) and calibration with assessment of the calibration plot. Results: The cohort included 717 patients with neurologically intact survival at discharge of 22%. In complete case analysis (523 cases) AUROC was 0.82 (95% CI 0.78-0.86) indicating good discrimination. The calibration plot showed that the GO-FAR score systematically underestimates the probability of neurologically intact survival. Conclusion: The GO-FAR score has satisfactory discrimination, but assessment of the calibration shows that neurologically intact survival is systematically underestimated. Therefore, only with caution should it without model update be taken into clinical practice in settings similar to ours.

关键词： double-negative T cells   neuroblastoma   opsoclonus-myoclonus syndrome   paraneoplastic syndrome   paediatric neuroinflammation  

摘要： Studies of cerebrospinal fluid (CSF) T cells in children are limited, dueespecially to the lack of control data. In adults, gamma/delta T cells (TCR-) residing in the intrathecal space are sometimes involved in neuroinflammation. To evaluate the possible role of T cells in paediatric neuroinflammation, we immunophenotyped cerebrospinal fluid (CSF) and blood lymphocytes using flow cytometry in a case-control study of 100 children with non-inflammatory neurological disorders (NIND), 312 with opsoclonus-myoclonus (OMS) and 23 with other inflammatory neurological disorders (OIND). In NIND, the negative correlation between CSF T cell frequency and patient age was striking: median frequency of 27% in infants and 33% in teens. Interindividual variations were largest in the youngest. There was no gender effect. In all OMS, after correcting for age, only a small effect of OMS severity remained. Measurement of markers for T cell activation [human leucocyte antigen D-related (HLA-DR)], maturation (CD45RA, CD45RO) or intracellular cytokine staining [interleukin (IL)-4, interferon (IFN)-] failed to discriminate OMS and NIND groups. Of seven OMS immunotherapies/combinations, none altered the frequency of total CSF T cells or subsets significantly. In OIND, the CSF T cell frequency was <10% for single samples of other paraneoplastic disorders [anti-neuronal nuclear antibody (ANNA)-1, PCA-1, teratoma-associated syndrome], cerebellar ataxia (post-infectious, ataxia-telangiectasia), acute disseminated encephalomyelitis, neuroborreliosis and encephalitis. This study provides new insights into CSF T cells in the paediatric population. Although their role in CSF remains elusive, the negative age correlation, resistance to immunotherapy and our age cut-off references for NIND are important findings for the design of future paediatric studies.

关键词： Ossification of the posterior longitudinal ligament   Thoracic spine   Posterior surgery   Clinical outcome  

摘要： Highlights • There is currently no preoperative factor for prediction of neurological outcome. • Postoperative change of kyphosis had no significant impact on the neurological outcome. • Recovery of JOA score during the first 3 months can predict the final neurological outcome.

关键词： Tubercular dacryoadenitis   Intracranial extension   Acute tuberculosis  

摘要： We report a case of young adult female with swelling in the superolateral aspect of left orbit for two weeks which was diagnosed as tubercular dacryoadenitis with intracranial extension without any neurological features. Tubercular dacryoadenitis is very rare but still makes an important differential diagnosis of lacrimal gland swellings especially in endemic areas like India. Few cases of tubercular dacryoadenitis have been reported in the past;but not a single case with intracranial extension in young adults with short history and without neurological symptoms. Although radiological investigations are routinely done in orbital lesions, it is advisable do so even in acute cases to look for intracranial extension before the appearance of neurological features. Tubercular dacryoadenitis though rare, should be kept as a differential diagnosis of acute or chronic lacrimal gland swellings in endemic areas.