关键词： 虚拟病例   标准化病人   神经病学   临床见习  

摘要： 目的评价虚拟病例与标准化病人相结合教学方式在神经病学见习教学中的应用效果。方法选择大连医科大学第一临床学院2014级临床医学专业127名本科学生为研究对象。将其随机分为实验组和对照组,实验组63名学生,采用虚拟病例与标准化病人相结合教学方式;对照组64名学生,采用传统教学方式。两组学生分别开展相应的神经病学见习教学。采用统一的客观结构化临床考试方式对两组学生进行考核,同时就临床见习效果对两组学生进行问卷调查。结果实验组学生考核成绩(85.52±3.78)分明显高于对照组学生(80.56±4.52)分,其差异具有统计学意义(t=一6.704,P=0.000)。实验组教学方式在提高学生学习兴趣、自学能力、临床思维、理论知识理解以及未来进入临床实习的自信心方面均优于对照组教学方式,其差异具有统计学意义(P

关键词： 缺血性卒中   复发   短暂性脑缺血发作   缺血性脑血管病   北京天坛医院   首都医科大学   神经系统疾病   神经病学  

摘要： 首都医科大学附属北京天坛医院神经病学中心、国家神经系统疾病临床医学研究中心王拥军教授、张长青博士等的一项研究发现．责任脑动脉狭窄程度不低于70％和卒中前3个月内反复短暂性脑缺血发作（TIA）,是缺血性脑血管病复发的危险因素。

关键词： 大脑   宾夕法尼亚大学   神经病学   神经科学   博士  

摘要： 大脑的一生经历了哪些神奇变化？近日，美国神经科学专家戴维·珀尔马特博士和宾夕法尼亚大学神经病学系主任弗朗西斯·金森博士总结了大脑一生经历的10道关。

关键词： AIS conversion   cervical   intramedullary high-signal intensity   magnetic resonance imaging   spinal cord injury  

摘要： Variable and unpredictable spontaneous recovery can occur after acute cervical traumatic spinal cord injury (tSCI). Despite the critical clinical and interventional trial planning implications of this tSCI feature, baseline measures to predict neurologic recovery accurately are not well defined. In this study, we used data derived from 99 consecutive patients (78 male, 21 female) with acute cervical tSCIs to assess the sensitivity and specificity of various clinical and radiological factors in predicting recovery at one year after injury. Categorical magnetic resonance imaging parameters included maximum canal compromise (MCC), maximum spinal cord compression (MSCC), longitudinal length of intramedullary lesion (IML), Brain and Spinal Injury Center (BASIC) score, and a novel derived Combined Axial and Sagittal Score (CASS). Logistic regression analysis of the area under the receiver operating characteristic curve (AUC) was applied to assess the differential predictive value of individual imaging markers. Admission American Spinal Injury Association Impairment Scale (AIS) grade, presence of a spinal fracture, and central cord syndrome were predictive of AIS conversion at one year. Both BASIC and IML were stronger predictors of AIS conversion compared with MCC and MSCC (p=0.0002 and p=0.04). The BASIC score demonstrated the highest overall predictive value for AIS conversion at one year (AUC 0.94). We conclude that admission intrinsic cord signal findings are robust predictive surrogate markers of neurologic recovery after cervical tSCI. Direct comparison of imaging parameters in this cohort of patients indicates that the BASIC score is the single best acute predictor of the likelihood of AIS conversion.

关键词： Sigma 1 receptor   S1RA   Stroke   Neuroprotective effects   MMP-9   Astrogliosis  

摘要： The glutamate N-methyl-D-aspartate receptor (NMDAR) plays an essential role in the excitotoxic neural damage that follows ischaemic stroke. Because the sigma-1 receptor (sigma 1R) can regulate NMDAR transmission, exogenous and putative endogenous regulators of sigma 1R have been investigated using animal models of ischaemic stroke. As both agonists and antagonists provide some neural protection, the selective involvement of sigma 1Rs in these effects has been questioned. The availability of S1RA (E-52862/MR309), a highly selective sigma 1R antagonist, prompted us to explore its therapeutic potential in an animal model of focal cerebral ischaemia. Mice were subjected to right middle cerebral artery occlusion (MCAO), and post-ischaemic infarct volume and neurological deficits were determined across a range of intervals after the stroke-inducing surgery. Intracerebroventricular or intravenous treatment with S1RA significantly reduced the cerebral infarct size and neurological deficits caused by permanent MCAO (pMCAO). Compared with the control/sham-operated mice, the neuroprotective effects of S1RA were observed when delivered up to 5 h prior to surgery and 3 h after ischaemic onset. Interestingly, neither mice with the genetic deletion of sigma 1R nor wild-type mice that were pre-treated with the sigma 1R agonist PRE084 showed beneficial effects after S1RA administration with regard to stroke infarction. S1RA-treated mice showed faster behavioural recovery from stroke;this finding complements the significant decreases in matrix metalloproteinase-9 (MMP-9) expression and reactive astrogliosis surrounding the infarcted cortex. Our data indicate that S1RA, via sigma 1R, holds promising potential for clinical application as a therapeutic agent for ischaemic stroke.

关键词： imaging   paraneoplastic   autoimmune   encephalitis   spinal cord  

摘要： Autoimmune disorders are becoming increasingly recognized within the broader field of neurology. The discovery of multiple, novel, neutrally targeted autoantibodies over the past decade and their translation into commercially available testing, in particular, has aided in the more rapid diagnosis of these disorders. When considering imaging in autoimmune neurologic disorders, it is important, when possible, to visualize the autoimmune process itself, as well as to make sure that the patient does not have an associated malignancy driving the overall process. Positron emission tomographic scans can aid in the detection of small tumors with limited spread, as well as in the visualization of autoimmune processes affecting the brain and/or spinal cord. In autoimmune disorders of the central nervous system, imaging abnormalities can appear within the limbic system, extralimbic areas, and spinal cord. Such imaging abnormalities can serve as objective markers to follow over time to assess patients' responses to treatment. It is important to recognize that overlapping syndromes (for instance, both demyelinating and autoimmune or both infectious and autoimmune) exist and that inflammatory disorders can leave behind sequelae that can be recognized on subsequent imaging. Work is currently underway to develop more specific imaging techniques for autoimmune neurologic disorders.

关键词： Suicide attempt   Self-poisoning   Neurological diseases   Neuropsychiatry  

摘要： Neurological diseases have a profound impact on quality of life. We investigated the risk of suicide attempt in ten neurological diseases. Case-control study. Cases were identified from the Danish Poison Information Centre database in the period 2006-2013. The prevalence of ten neurological diagnoses was compared with the prevalence in a randomly sampled age- and gender-matched control group. We identified 8974 cases of suicidal attempt and 89,740 controls. We found an association between suicide attempt in nine of ten neurological diseases and disease groups, including stroke [odds ratio (OR) 3.1, 95% confidence interval (CI) (2.8-3.6)], Huntington's disease [OR 8.8, 95% CI (3.2-24.1)], amyotrophic lateral sclerosis [OR 5.0, 95% CI (1.7-14.6)], Parkinson's disease [OR 2.9, 95% CI (1.8-4.6)], Alzheimer's disease and other degenerative diseases [OR 4.8, 95% CI (3.1-7.5)], multiple sclerosis [OR 1.5, 95% CI (1.1-2.1)], epilepsy [OR 4.5, 95% CI (4.1-5.0)], hereditary and idiopathic neuropathy [OR 2.2, 95% CI (1.1-4.3)] and myasthenia gravis [OR 4.3, 95% CI (2.0-9.4)]. Nine out of ten chronic neurological diseases were associated with an increased risk of suicide attempt. These data must be considered for clinicians treating this vulnerable group of patients.

关键词： Branch atheromatous disease   early neurological deterioration   mean platelet volume   glycoprotein IIb/IIIa   platelet activation  

摘要： Background: The most attentive clinical problem in patients with branch atheromatous disease (BAD) is early neurological deterioration (END). Although the platelet activation (PA) is involved in pathogenesis, the relationship between PA and END has remained unclear. We investigated clinical data including mean platelet volume (MPV, fL) as a marker for PA to identify clinically useful biomarkers for END. Methods: A total of 64 patients with BAD were investigated retrospectively, and divided into 2 groups based on whether neurologic symptoms deteriorated or not: BAD with and without END (END and non-END). The END was defined as patients with point increase of 1 or greater in the National Institutes of Health Stroke Scale (NIHSS);non-END was defined as those without such increase. Clinical features such as NIHSS, modified Rankin scale (mRS), laboratory data including MPV, lesion size (LS, mm) on admission, and treatments were compared between the 2 groups. Results: Of 64 patients, 17 cases had an END. The median values of NIHSS, mRS, MPV, and LS on admission were significantly greater in END than in non-END (P <.05, respectively). There was no correlation of MPV with NIHSS, mRS and LS, respectively. The median values of MPV were significantly higher in END than in non-END and control (P <.05, respectively). A receiver operating characteristic curve indicated a value of 10.1 as cutoff level for MPV to discriminate between END and non-END. Conclusions: High MPV values on admission may be an independent biomarker for END. Physicians should pay more careful attention to END in BAD showing MPV values higher than 10.1 on admission.

关键词： nose-to-brain delivery   neurological diseases   drug delivery systems   in situ-based gels   brain tumor   Alzheimer's disease  

摘要： In situ-based gel drug delivery systems that can bypass the blood-brain barrier, deliver the therapeutics to the desired site, reduce peripheral toxicity and control drug release kinetics have been developed. Some of the therapeutics used to treat neurological diseases suffer from poor bioavailability. Preclinical reports from several researchers have proven that the delivery of drugs to the brain via the nose-to-brain route using in situ gels holds great promise. However, safety issues on the toxicity of the nasal mucosa, transportation of the drugs to specific brain regions and determination of the required dose are factors that must be considered when designing these gels. This review will be focused on in situ-based gels that are used for the delivery of therapeutics via the nose-to-brain route, preclinical reports and challenges.

关键词： Kallikrein-Kinin system   Bradykinin   Kinin   Brain injury   Neurological disorders   Biomarkers  

摘要： Neurological disorders represent major health concerns in terms of comorbidity and mortality worldwide. Despite a tremendous increase in our understanding of the pathophysiological processes involved in disease progression and prevention, the accumulated knowledge so far resulted in relatively moderate translational benefits in terms of therapeutic interventions and enhanced clinical outcomes. Aiming at specific neural molecular pathways, different strategies have been geared to target the development and progression of such disorders. The kallikrein-kinin system (KKS) is among the most delineated candidate systems due to its ubiquitous roles mediating several of the pathophysiological features of these neurological disorders as well as being implicated in regulating various brain functions. Several experimental KKS models revealed that the inhibition or stimulation of the two receptors of the KKS system (B112 and B2R) can exhibit neuroprotective and/or adverse pathological outcomes. This updated review provides background details of the KKS components and their functions in different neurological disorders including temporal lobe epilepsy, traumatic brain injury, stroke, spinal cord injury, Alzheimer's disease, multiple sclerosis and glioma. Finally, this work will highlight the putative roles of the KKS components as potential neurotherapeutic targets and provide future perspectives on the possibility of translating these findings into potential clinical biomarkers in neurological disease.