关键词： Closed-loop   Mitochondrial function   Oxidative stress   Deep brain stimulation   ATP sensing  

摘要： Dynamic feedback based closed-loop medical devices offer a number of advantages for treatment of heterogeneous neurological conditions. Closed-loop devices integrate a level of neurobiological feedback, which allows for real-time adjustments to be made with the overarching aim of improving treatment efficacy and minimizing risks for adverse events. One target which has not been extensively explored as a potential feedback component in closed-loop therapies is mitochondrial function. Several neurodegenerative and psychiatric disorders including Parkinson's disease, Major Depressive disorder and Bipolar disorder have been linked to perturbations in the mitochondrial respiratory chain. This paper investigates the potential to monitor this mitochondrial function as a method of feedback for closed-loop neuromodulation treatments. A generic model of the closed-loop treatment is developed to describe the high-level functions of any system designed to control neural function based onmitochondrial response to stimulation, simplifying comparison and future meta-analysis. This model has four key functional components including: a sensor, signal manipulator, controller and effector. Each of these components are described and several potential technologies for each are investigated. While some of these candidate technologies are quite mature, there are still technological gaps remaining. The field of closed-loop medical devices is rapidly evolving, and whilst there is a lot of interest in this area, widespread adoption has not yet been achieved due to several remaining technological hurdles. However, the significant therapeutic benefits offered by this technology mean that this will be an active area for research for years to come.

关键词： Discharge planning   Post-acute care discharge score   Diagnostic accuracy   Post-acute care facilities   Screening tool   Social worker referral  

摘要： Background: Early identification of patients requiring transfer to post-acute care (PAC) facilities shortens hospital stays. With a focus on interprofessional assessment of biopsychosocial risk, this study's aim was to assess medical and neurological patients' post-acute care discharge (PACD) scores on days 1 and 3 after hospital admission regarding diagnostic accuracy and effectiveness as an early screening tool. The transfer to PAC facilities served as the outcome ("gold standard"). Methods: In this prospective cohort study, registered at ClinicalTrial. gov (NCT01768494) on January 2013, 1432 medical and 464 neurological patients (total n = 1896) were included consecutively between February and October 2013. PACD scores and other relevant data were extracted from electronic records of patient admissions, hospital stays, and interviews at day 30 post-hospital admission. To gauge the scores' accuracy, we plotted receiver operating characteristic (ROC) curves, calculated area under the curve (AUC), and determined sensitivity and specificity at various cut-off levels. Results: Medical patients' day 1 and day 3 PACD scores accurately predicted discharge to PAC facilities, with respective discriminating powers (AUC) of 0.77 and 0.82. With a PACD cut-off of >= 8 points, day 1 and 3 sensitivities were respectively 72.6% and 83.6%, with respective specificities of 66.5% and 70.0%. Neurological patients' scores showed lower accuracy both days: using the same cut-off, respective day 1 and day 3 AUCs were 0.68 and 0.78, sensitivities 41.4% and 68.7% and specificities 81.4% and 83.4%. Conclusion: PACD scores at days 1 and 3 accurately predicted transfer to PAC facilities, especially in medical patients on day 3. To confirm and refine these results, PACD scores' value to guide discharge planning interventions and subsequent impact on hospital stay warrants further investigation.

关键词： Work -- Psychological aspects   Maturation (Psychology)   Self-help techniques   Neurosciences   Physiological effects of dopamine   Personality change  

摘要： The article talks about the negative psychology of human brain towards work along with the ways for its elimination. It include information on the role of seeking system in the creation of the natural impulse to explore worlds, learn about environments, and extract meaning from circumstances along with its deactivation by organizations.

关键词： Neurological disorder   Brain tumor   Mouse model   CRISPR   Cas9  

摘要： Neurological disorders often occur because of failure of proper brain development and/or appropriate maintenance of neuronal circuits. In order to understand roles of causative factors (e.g. genes, cell types) in disease development, generation of solid animal models has been one of straight-forward approaches. Recent next generation sequencing studies on human patient-derived clinical samples have identified various types of recurrent mutations in individual neurological diseases. While these discoveries have prompted us to evaluate impact of mutated genes on these neurological diseases, a feasible but flexible genome editing tool had remained to be developed. An advance of genome editing technology using the clustered regularly interspaced short palindromic repeats (CRISPR) with the CRISPR-associated protein (Cas) offers us a tremendous potential to create a variety of mutations in the cell, leading to "next generation" disease models carrying disease-associated mutations. We will here review recent progress of CRISPR-based brain disease modeling studies and discuss future requirement to tackle current difficulties in usage of these technologies.

关键词： SCHIZOPHRENIA   NEUROLOGIC examination   PATHOLOGICAL psychology   ANTIPSYCHOTIC drugs   COGNITIVE ability  

摘要： Here, we investigated neurological soft signs (NSSs) in treatment resistant schizophrenia (TRS) vs treatment responder schizophrenia (SZ) patients. TRS is a severe condition, affecting approximately one-third of schizophrenia patients and representing a relevant clinical challenge. NSSs are neurological abnormalities reportedly described in schizophrenia patients and linked to dysregulated network connections. We explored the possibility that NSSs may be: i) more severe in TRS patients;ii) differentially associated to clinical/cognitive variables in TRS vs SZ;iii) predictive of having TRS. In addition, we evaluated whether diagnosis may mediate NSSs associations with the above-mentioned variables. Consecutive patients with schizophrenia diagnosis underwent stringent assessment for TRS diagnosis. Demographics and clinical variables were recorded. Psychopathology (by Positive and Negative Syndrome Scale, PANSS), cognitive performances, and NSSs (by Neurological Evaluation Scale, NES) were tested. TRS had higher scores than SZ patients in total NES score and in almost all NES subscales, even after correction for duration of illness and antipsychotic dose (ANCOVA, p < 0.05). NSSs significantly correlated with multiple clinical, psychopathological, and cognitive variables (above all: duration of disease and negative symptoms) in TRS but not in SZ patients. Two-way ANOVA showed NSS-x-diagnosis interaction in determining outcomes on multiple cognitive performances, but not in other clinical variables. However, simple main effect analysis detected a significant relationship between high severity NSSs and TRS diagnosis on multiple clinical and cognitive outcomes. Hierarchical regression analysis showed that diagnosis was among a discrete number of predictors yielding significant increases in variance explained on NES total, Sensory Integration and Other Signs subscales' scores. NSSs, together with antipsychotic dose and disease severity, were found to be significantly predic

关键词： 临床神经病学   专家   杂志   群策群力   审稿人  

摘要： 在过去的2017年度（2017年1月1日～2017年12月31日），临床神经病学杂志的各位编委和审稿人群策群力、保质保量地完成了审稿任务，在此向他们表示诚挚的谢意!以下是2017编辑年度审稿专家名单：

关键词： 翻转课堂   标准化病人   神经病学   教学改革  

摘要： 目的探索教学方法改革。方法应用翻转课堂结合标准化病人教学法对神经病学中脑血管疾病章节进行授课,并与传统教学组的笔试、标准化病人问诊及查体考核成绩进行对比研究。结果实验组同学的考核成绩优于传统教学组,其收集病史、体格检查的能力,以及科学、系统的临床思维能力更强。结论翻转课堂结合标准化病人教学法可以提高神经内科临床教学质量。

关键词： 帕金森病   诊断方法   咖啡因   人员招募   神经病学   平均年龄   受试者   血液  

摘要： 一项新的研究发现，血液中的咖啡因水平或许能提供一种更加简便的帕金森病诊断方法。以往有研究发现，咖啡因与患帕金森并风险较低之间存在相关，但是我们并不清楚这种相关的机制是什么。美国神经病学学会的研究人员招募了108名患有帕金森病的受试者，以及31名平均年龄与前者相仿，但不患有帕金森病的受试者。

关键词： 中医药院校   中西医结合神经病学   住院医师规范化培训  

摘要： 为贯彻上海市住院医师规范化培训政策,培养中医专业的新人才,中医药院校的中西医结合神经病学在临床带教中要不断优化带教方案,对教学形式、内容、考核等方面进行深入的探讨,教学中注重中西医并重,突出神经病学的专科性,利用多模式的教学手段,设置分层带教计划,兼顾循证医学思维的养成和经验的传承,满足不同类型规培医师的培训要求,努力为中西医结合神经内科的人才储备作出贡献。

关键词： biomarker   cerebrospinal fluid   cervical spinal cord injury   magnetic resonance imaging  

摘要： Biomarkers of acute human spinal cord injury (SCI) could provide a more objective measure of spinal cord damage and a better predictor of neurological outcome than current standardized neurological assessments. In SCI, there is growing interest in establishing biomarkers from cerebrospinal fluid (CSF) and from magnetic resonance imaging (MRI). Here, we compared the ability of CSF and MRI biomarkers to classify injury severity and predict neurological recovery in a cohort of acute cervical SCI patients. CSF samples and MRI scans from 36 acute cervical SCI patients were examined. From the CSF samples taken 24 h post-injury, the concentrations of inflammatory cytokines (interleukin [IL]-6, IL-8, monocyte chemotactic protein-1), and structural proteins (tau, glial fibrillary acidic protein, and S100 beta) were measured. From the pre-operative MRI scans, we measured intramedullary lesion length, hematoma length, hematoma extent, CSF effacement, cord expansion, and maximal spinal cord compression. Baseline and 6-month post-injury assessments of American Spine Injury Association Impairment Scale (AIS) grade and motor score were conducted. Both MRI measures and CSF biomarker levels were found to correlate with baseline injury grade, and in combination they provided a stronger model for classifying baseline AIS grade than CSF or MRI biomarkers alone. For predicting neurological recovery, the inflammatory CSF biomarkers best predicted AIS grade conversion, whereas structural biomarker levels best predicted motor score improvement. A logistic regression model utilizing CSF biomarkers alone had a 91.2% accuracy at predicting AIS conversion, and was not strengthened by adding MRI features or even knowledge of the baseline AIS grade. In a direct comparison of MRI and CSF biomarkers, the CSF biomarkers discriminate better between different injury severities, and are stronger predictors of neurological recovery in terms of AIS grade and motor score improvement. These findings demon