关键词： 文献报告会   血管神经病学   研究生培养  

摘要： 目的探讨定期文献报告会在血管神经病学研究生临床教学中的效果。方法选取首都医科大学附属北京天坛医院神经病学中心血管神经病学科2病区的临床实习轮转研究生,开展定期文献报告会,最终评价教学效果。结果研究生的文献阅读量明显增加,查阅文献、归纳整理文献的能力、临床专业知识及制作幻灯、表达交流能力均有了很大提高,能够更好地发现和解决临床问题,临床教学效果良好。结论定期文献报告会对提高学生临床能力、科研能力及表达能力有重要意义,值得推广。

关键词： Soluble CD163   acute HIV infection   neurocognitive impairment   central nervous system   cerebrospinal fluid   plasma   combination antiretroviral therapy  

摘要： Background. Myeloid activation contributes to cognitive impairment in chronic human immunodeficiency virus (HIV) infection. We explored whether combination antiretroviral therapy (cART) initiation during acute HIV infection impacts CD163 shedding, a myeloid activation marker, and in turn, implications on the central nervous system (CNS). Methods. We measured soluble CD163 (sCD163) levels in plasma and cerebrospinal fluid (CSF) by enzyme-linked immunosorbent assay in Thais who initiated cART during acute HIV infection (Fiebig stages I-IV). Examination of CNS involvement included neuropsychological testing and analysis of brain metabolites by magnetic resonance spectroscopy. Chronic HIV-infected or uninfected Thais served as controls. Results. We examined 51 adults with acute HIV infection (Fiebig stages I-III;male sex, >90%;age, 31 years). sCD163 levels before and after cART in Fiebig stage I/II were comparable to those in uninfected controls (plasma levels, 97.9 and 93.6 ng/mL, respectively, vs 99.5 ng/mL;CSF levels, 6.7 and 6.4 ng/mL, respectively, vs 7.1 ng/mL). In Fiebig stage III, sCD163 levels were elevated before cART as compared to those in uninfected controls (plasma levels, 135 ng/mL;CSF levels, 10 ng/mL;P < .01 for both comparisons) before normalization after cART (plasma levels, 90.1 ng/mL;CSF levels, 6.5 ng/mL). Before cART, higher sCD163 levels during Fiebig stage III correlated with poor CNS measures (eg, decreased N-acetylaspartate levels), but paradoxically, during Fiebig stage I/II, this association was linked with favorable CNS outcomes (eg, higher neuropsychological test scores). After cART initiation, higher sCD163 levels during Fiebig stage III were associated with negative CNS indices (eg, worse neuropsychological test scores). Conclusion. Initiation of cART early during acute HIV infection (ie, during Fiebig stage I/II) may decrease inflammation, preventing shedding of CD163, which in turn might lower the risk of brain injury.

关键词： 翻转课堂   中西医   神经病学   临床教学   问题   应用效果  

摘要： 依据中西医结合神经病学的临床教学实际特点,引入翻转课堂教学模式,初步分析在中西医结合神经病学临床教学中翻转课堂的实施措施,改善以往教学模式的不足和缺点,尽可能将课前以及课堂时间最大化利用,将学生积极性和学习兴趣激发,最终展现以学生为中心的临床教学目的,不但可将学生掌握相关知识程度提升,也能够更好的提升学生团队合作、自主学习、分享交流能力。中西医结合神经病学实际上是结合现代神经病学和传统中医理论通过现代化技术对神经系统疾病发展以及发生研究的诊疗技术。文章主要阐述中西医结合神经病学临床教学中应用翻转课堂模式的作用。

关键词： Heavy metals  

摘要： In this work, for the first time, the human heavy metal proteome was predicted. According to the results, aluminum, cadmium, mercury and lead metalloproteomes might constitute up to 8.9%, 18.4%, 15% and 4% of the entire human proteome, respectively. The abundance of the predicted heavy metal-binding proteins in various organ-specific proteomes was retrieved from the Human Protein Atlas database showing higher expression profiles for Cd- and Hg-binding proteins in all studied organs (especially in the prostate, heart and pancreas) compared with the other heavy metals. Possible perturbations in cellular trafficking and homeostasis of essential metals by heavy metal proteomes were highlighted. Furthermore, this study showed that molecular linkages between heavy metal proteomes and major neurological disorders or various types of cancer were more significant for Cd followed by Hg, Al and Pb. Interestingly, integrated gene network analysis revealed that Cd and Hg proteomes share so far unknown gene circuits with these two types of disorder.

关键词： Anti-MOG antibody encephalitis   Rett syndrome   MECP2   Mutation   MRI  

摘要： Background: Rett syndrome (RTT) is a neurodevelopmental disorder primarily caused by mutations in the methyl-CpG-binding protein 2 (MECP2) gene, resulting in developmental regression after normal development during infancy. Transient presentation of many autistic features is also commonly seen in RTT. Anti-myelin oligodendrocyte glycoprotein (MOG)-antibody encephalitis is an acquired relapsing demyelinating syndrome characterized by a variety of neuroinflammatory symptoms. Here, we report a case of anti-MOG antibody encephalitis in a patient with genetically confirmed RTT, which mimicked many of the features of RTT. Case report: A three-year-old girl presented with subacute verbal and motor dysfunction, along with involuntary movements and marked irritability. Magnetic resonance imaging (MRI) revealed extensive white matter lesions, with anti-MOG antibodies detected in the serum and cerebrospinal fluid, resulting in an initial diagnosis of anti-MOG antibody encephalitis. However, additional testing of the MECP2 gene was performed in response to persistent involuntary hand movements in combination with progressive verbal and motor deterioration. Sequencing analysis revealed a known pathogenic mutation in MEPC2, indicating a concurrent diagnosis of RTT. Conclusion: Both RTT and anti-MOG antibody encephalitis are rare conditions. Similarities in disease presentation suggest that anti-MOG antibody encephalitis may mimic many of the symptoms of RTT. (C) 2018 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

关键词： Burst fracture   Incomplete neurological deficit   Lumbar   Schanz pedicle screw   Short-segment fixation  

摘要： PURPOSE: We have introduced a method of modified posterior short-segment pedicle screw fixation and evaluated its clinical effects in treating lumbar burst fractures with incomplete neurological deficits. METHODS: The data from 22 patients with lumbar burst fracture and incomplete neurological deficits who had undergone modified posterior short-segment instrumentation with Schanz screw fixation from January 2012 to February 2018 in our clinic were evaluated in the present retrospective study. All Schanz screws were implanted in an oblique downward direction into the vertebrae above and below the injured vertebra (insertion depth, 90%-100%). The implants were removed similar to 1 year after surgery. Neurological function, back pain, anterior and posterior body height ratio, kyphosis angle, percentage of canal compromise, fracture severity, and treatment-related complications were evaluated. RESULTS: Technical success was achieved in all 22 patients. No infection, instrument loosening or failure, or breakage was observed. Statistically significant improvements with regard to the anterior body height (P < 0.05) and posterior body height (P < 0.05) ratios, kyphosis angle, and percentage of canal compromise (P < 0.05) were observed at 1 week postoperatively or the final follow-up visit. No correction loss had occurred at the final follow-up examination. Postoperatively, all patients with neurological deficits had functional improvement equivalent to grade on the American Spinal Injury Association impairment scale and fracture union. Back pain was greatly improved postoperatively. CONCLUSIONS: Short-segment Schanz screw fixation implanted in an oblique downward direction seems to be a promising method for lumbar burst fractures with incomplete neurological deficits because it provided good clinical and radiographic outcomes.

摘要： To determine the relationship between alterations in the activity of the enzymes participating in antioxidative defense system and neurological soft signs (NSS) in schizophrenic patients with the first episode psychosis (S-FE, n = 19), patients in relapse (S-R, n = 46), and healthy controls (HC, n = 20). NSS intensity and enzymatic plasma activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPX) were compared between S-FE, S-R and HC subjects and a follow-up correlation analyses between the enzyme activities and NSS intensity was performed. NSS intensity was increased four times in schizophrenic patients compared with healthy controls. Activities of SOD and CAT were 40% decreased in S-FE and these reductions were ameliorated by antipsychotic treatment. GPX activity was 20% decreased in both patient groups compared with controls. A negative correlation between NSS intensity and GPX activity was specifically found in the S-FE patients. The data in this report argue that a reduction of GPX activity might be one of the causes for the emergence of NSS at the onset of schizophrenia, and provide the evidence that antipsychotic therapy can attenuate activity reductions of SOD and CAT, but not the activity reduction of GPX and the intensity of NSS.

关键词： LIPODYSTROPHY, PARTIAL, ACQUIRED, SUSCEPTIBILITY TO   neurological complication   Review, Systematic   aluminium   Complication  

关键词： nerve conduction study   Sensation   Arsenic   medical examination   Neurologic Examination  

摘要： Chronic arsenic intoxication is known to cause multisystem impairment and is still a major threat to public health in many countries. In Toroku, a small village in Japan, arsenic mines operated from 1920 to 1962, and residents suffered serious sequelae of arsenic intoxication. We have performed annual medical examinations of these residents since 1974, allowing us to characterize participants' long-term health following their last exposure to arsenic. The participants could not be described as having "chronic arsenic intoxication," because their blood arsenic levels were not measured. In this study, we defined them as having "probable arsenic intoxication." Symptoms frequently involved the sensory nervous system, skin, and upper respiratory system (89.1-97.8%). In an analysis of neurological findings, sensory neuropathy was common, and more than half of the participants complained of hearing impairment. Longitudinal assessment with neurological examinations and nerve conduction studies revealed that sensory dysfunction gradually worsened, even after exposure cessation. However, we could not conclude that arsenic caused the long-term decline of sensory function due to a lack of comparisons with age-matched healthy controls. This is the first study to characterize the longitudinal sequelae after probable arsenic exposure. Our study will be helpful to assess the prognosis of patients worldwide who still suffer from chronic arsenic intoxication.