关键词： 沟通交流   神经病学   专业学位   研究生  

摘要： 目的探讨沟通交流培训对神经病学专业学位研究生情商的影响。方法选择新乡医学院就读的神经病学专业学位研究生60名,对其进行沟通交流能力培训,采用标准情商EQ测试量表对研究生培训前、后的沟通交流能力进行测定。结果 60名研究生中,情商得分81~100分9名;41~80分46名;40分以下5名。经过培训,男、女性研究生情商均有提高(P<0.05),20~30岁、无工作经历的研究生培训前、后的情商得分差异显著(P<0.05),各年级专业研究生情商评分均提高,且组间差异有统计学意义(P=0.026)。结论沟通交流培训对神经病学专业学位研究生的人际沟通有积极的意义,应重视学生人文关怀能力和沟通交流能力的培养。

关键词： autonomic neuropathy   diabetic encephalopathy   diabetic neuropathy   insulin pump   insulin therapy by continuous subcutaneous infusion   type 1 diabetes mellitus  

摘要： Objectives. To study neurological complications in patients with type 1 diabetes mellitus (DM 1) receiving different methods of insulin therapy. Materials and methods. A total of 34 patients aged 18–40 years with DM 1 for 14.25 ± 9.25 years and receiving insulin therapy were studied. At the time of the study, patients of group 1 had been receiving insulin therapy by continuous subcutaneous infusion therapy (insulin pump) for 4.5 ± 1.5 years;the duration of the preceding period of standard therapy by repeated s.c. injections (basal-bolus therapy) was 11.3 ± 5.4 years. Patients of group 2 had been on basal-bolus therapy for 12.7 ± 7.7 years. Clinical evaluation of neurological status, autonomic changes, and testing on the MMSE, MoCA, HADS, TSS, NSS, and NDS were performed in patients of both groups. Results and conclusions. Patients of group 1, as compared with those of group 2, had less severe neuropathic, cognitive, and autonomic disorders and had a more favorable emotional background, indicating that the first treatment was more effective. © 2017, Springer Science+Business Media, LLC, part of Springer Nature.

关键词： myelin basic protein   experimental autoimmune encephalomyelitis   lysine acetylation   post-translational modifications   liquid chromatography-tandem mass spectrometry   multiple sclerosis  

摘要： Citrullination of arginine residues is a post translational modification (PTM) found on myelin basic protein (MBP), which neutralizes MBPs positive charge, and is implicated in myelin damage and multiple sclerosis (MS). Here we identify lysine acetylation as another neutralizing PTM to MBP that may be involved in myelin damage. We quantify changes in lysine and arginine PTMs on MBP derived from mice induced with an experimental autoimmune encephalomyelitis (EAE) model of MS using liquid chromatography tandem mass spectrometry. The changes in PTMs are correlated to changes in neurological disability scoring (NDS), as a marker of myelin damage. We found that lysine acetylation increased by 2-fold on MBP during peak NDS post-EAE induction. We also found that mono- and dimethyl-lysine, as well as asymmetric dimethyl-arginine residues on MBP were elevated at peak EAE disability. These findings suggest that the acetylation and methylation of lysine on MBP are PTMs associated with the neurological disability produced by EAE. Since histone deacetylase (HDAC) inhibitors have been previously shown to improve neurological disability, we also show that treatment with trichostatin A (a HDAC inhibitor) improves the NDS of EAE mice but does not change MBP acetylation.

关键词： Nonketotic hyperglycinemia   Glycine   MAPK   Neuronal damage   Rat brain  

摘要： High glycine (GLY) levels have been suggested to induce neurotoxic effects in the central nervous system of patients with nonketotic hyperglycinemia (NKH). Since the mechanisms involved in the neuropathophysiology of NKH are not totally established, we evaluated the effect of a single intracerebroventricular administration of GLY on the content of proteins involved in neuronal damage and inflammatory response, as well as on the phosphorylation of the MAPK p38, ERK1/2, and JNK in rat striatum and cerebral cortex. We also examined glial fibrillary acidic protein (GFAP) staining, a marker of glial reactivity. The parameters were analyzed 30 min or 24 h after GLY administration. GLY decreased Tau phosphorylation in striatum and cerebral cortex 30 min and 24 h after its administration. On the other hand, synaptophysin levels were decreased in striatum at 30 min and in cerebral cortex at 24 h after GLY injection. GLY also decreased the phosphorylation of p38, ERK1/2, and JNK 30 min after its administration in both brain structures. Moreover, GLY-induced decrease of p38 phosphorylation in striatum was attenuated by N-methyl-d-aspartate receptor antagonist MK-801. In contrast, synuclein, NF-kappa B, i kappa B, inducible nitric oxide synthase and nitrotyrosine content, and GFAP immunostaining were not altered by GLY infusion. It may be presumed that the decreased phosphorylation of MAPK associated with alterations of markers of neuronal injury induced by GLY may contribute to the neurological dysfunction observed in NKH.

关键词： Immune checkpoint inhibitors   Neurological adverse events   Anti-PD-1   Anti-CTLA-4   Encephalitis   Meningitis   Polyneuropathy   Myositis  

摘要： Purpose of Review Immune checkpoint inhibitors represent a major step forward in the field of oncologic immunotherapy these last years and have significantly increased survival of cancer patients in an ever-growing number of indications. These agents block specific immune checkpoint molecules (programmed cell death protein 1 and its ligand as well as cytotoxic T-lymphocyte-associated antigen 4) that normally downregulate the immune response. These new agents show a specific range of adverse effects induced by abnormal immunologic activation. Recent Findings Many different neurologic adverse events have been described, including encephalitis, myelopathy, aseptic meningitis, meningoradiculitis, Guillain-Barre-like syndrome, peripheral neuropathy (including mononeuropathy, mononeuritis multiplex, and polyneuropathy) as well as myasthenic syndrome. Summary Immune checkpoint inhibitors have shown promising results in cancer but can possibly induce autoimmune disorders. Although rare, neurological adverse events require prompt recognition and treatment to avoid substantial morbidity.

关键词： NEUROLOGICAL disorders   ENCEPHALITIS   EPIDEMIOLOGY   CELL differentiation   MEDICAL screening   DNA sequencing  

摘要： More routine application of molecular methods, including next generation sequencing, to CSF and brain tissue might contribute to a decrease in the number of cases with unknown causes in the future. A randomised clinical trial5 of Vietnamese patients with tuberculous meningitis, whose treatment included dexamethasone, examined the effect of the single-nucleotide polymorphism rs17525495 in the promoter region of the leukotriene A4 hydrolase gene (LTA4H). The research group showed that, among 439 individuals, those with the TT genotype were more likely to survive than those with the CC genotype (hazard ratio 3·5, 95% CI 1·1–11·4).

关键词： Competency-based assessment   Assessment and evaluation in graduate medical education   Neurosurgery   ACGME competencies  

摘要： OBJECTIVES: The purpose of this study was to determine the effect of the Accreditation Council for Graduate Medical Education Milestones on the assessment of neurological surgery residents. The authors sought to determine the feasibility, acceptability, and utility of this new framework in making judgments of progressive competence, its implementation within programs, and the influence on curricula. Residents were also surveyed to elicit the effect of Milestones on their educational experience and professional development. DESIGN, SETTING, AND PARTICIPANTS: In 2015, program leadership and residents from 21 neurological surgery residency programs participated in an online survey and telephone interview in which they reflected on their experiences with the Milestones. Survey data were analyzed using descriptive statistics. Interview transcripts were analyzed using grounded theory. RESULTS: Response themes were categorized into 2 groups: outcomes of the Milestones implementation process, and facilitators and barriers. Because of Milestones implementation, participants reported changes to the quality of the assessment process, including the ability to identify struggling residents earlier and design individualized improvement plans. Some programs revised their curricula based on training gaps identified using the Milestones. Barriers to implementation included limitations to the adoption of a developmental progression model in the context of rotation block schedules and misalignment between progression targets and clinical experience. The shift from time-based to competency-based evaluation presented an ongoing adjustment for many programs. Organized preparation before clinical competency committee meetings and diverse clinical competency committee composition led to more productive meetings and perceived improvement in promotion decisions. CONCLUSIONS: The results of this study can be used by program leadership to help guide further implementation of the Milestones and

关键词： Clinical reasoning skills   cognitive heuristics   educational interventions   educational research   evidence-based education   Holmesian reasoning   mentorship   Miller's pyramid   neurological diagnosis   neurology education   neurophilia   neurophobia   pedagogical strategies   pedagogy   technology-enhanced learning  

摘要： Neurology has a reputation, particularly as a complex "head-to-toe" discipline for undergraduate medical students. Neurophobia syndrome, a global phenomenon, fundamentally stems from pedagogical deficiencies during the undergraduate curriculum, the lack of vertical integration between basic neurosciences and clinical bedside neurology, the lack of clinical reasoning exercises, cognitive heuristics, and clinical problem-solving, errors in diagnostic competence, and hyposkilia. This ultimately results in poor clinical competence and proficiency in clinical neurology and causes attrition in nurturing a passion for learning the neurology discipline. This article explores plausible factors that contribute to the genesis of neurophobia and multifaceted strategies to nurture interest in neurosciences and provide possible solutions to demystify neurology education, especially the need for evidence-based educational interventions. Remodeling neurology education through effective pedagogical strategies and remedial measures, and using the Miller's pyramid, would provide a framework for assessing clinical competence in clinical bedside neurology. Technology-enhanced education and digital classrooms would undoubtedly stamp out neurophobia in medical students of the 21st century. It will not frighten off another generation of nonneurologist physicians to empower them to hone expertise in order to tackle the increasing burden of neurological disorders in India. Furthermore, promoting neurophilia would facilitate the next generation of medical students in pursuing career options in neurology which would be quintessential not only in closing India's looming neurologist workforce gap but also in fostering interest in research imperatives in the next generation of medical students.

关键词： canine model   mesenchymal stromal cells   placenta   spinal cord injury  

摘要： Spinal cord injury (SCI) is a devastating disorder that affects humans and dogs. The prognosis of SCI depends on the severity of the injury and can include varying levels of motor and sensory deficits including devastating paraplegia and quadriplegia. Placental mesenchymal stromal cells (PMSCs) have been shown to improve wound healing and possess neuroprotective and immunomodulatory capabilities, but have not yet been clinically tested for the treatment of SCI. This study established a protocol to isolate fetal PMSCs from canine placentas and characterized their paracrine secretion profile and ability to stimulate neurons in vitro to assess their potential as a treatment option for neurological disorders in dogs. Canine PMSCs (cPMSCs) were plastic adherent and capable of trilineage differentiation. cPMSCs expressed typical MSC markers and did not express hematopoietic or endothelial cell markers. Genotyping of cPMSCs revealed fetal rather than maternal origin of the cells. cPMSCs were viable and mitotically expansive in a collagen hydrogel delivery vehicle, and they secreted the immunomodulatory and neurotrophic paracrine factors interleukin (IL)-6, IL-8, monocyte chemoattractant protein 1 (MCP-1), and vascular endothelial growth factor (VEGF). cPMSCs also stimulated the growth of complex neural networks when co-cultured with SH-SY5Y cells, a neuroblastoma cell line used to model neuron growth in vitro. cPMSCs are analogous to human PMSCs. They meet the criteria to be defined as MSCs and represent a potential regenerative therapy option for neurological disorders in dogs with their robust growth in collagen hydrogel, stimulation of neural network formation, and secretion of potent paracrine factors. (c) 2017 International Society for Advancement of Cytometry

关键词： conversion disorder   functional movement disorders   psychogenic nonepileptic seizures   anterior cingulate cortex   occipital cortex  

摘要： BackgroundLinks between dissociation and functional neurological disorder (FND)/conversion disorder are well-established, yet the pathophysiology of dissociation remains poorly understood. This MRI study investigated structural alterations associated with somatoform and psychological dissociation in FND. We hypothesized that multimodal, paralimbic cingulo-insular regions would relate to the severity of somatoform dissociation in patients with FND. MethodsFreeSurfer cortical thickness and subcortical volumetric analyses were performed in 26 patients with motor FND and 27 matched healthy controls. Patients with high dissociation as measured by the Somatoform Dissociation Questionnaire-20 (SDQ) or Dissociative Experiences Scale (DES) were compared to controls in stratified analyses. Within-group analyses were also performed with SDQ and DES scores in patients with FND. All cortical thickness analyses were whole-brain corrected at the cluster-wise level. ResultsPatients with FND and high somatoform dissociation (SDQ>35) showed reduced left caudal anterior cingulate cortex (ACC) cortical thickness compared to controls. In within-group analyses, SDQ scores inversely correlated with left caudal ACC cortical thickness in patients with FND. Depersonalization/derealization scores positively correlated with right lateral occipital cortical thickness. Both within-group findings remained statistically significant controlling for trait anxiety/depression, borderline personality disorder and post-traumatic stress disorder, adverse life events, and motor FND subtypes in post-hoc analyses. ConclusionUsing complementary between-group and within-group analyses, an inverse association between somatoform dissociation and left caudal ACC cortical thickness was observed in patients with FND. A positive relationship was also appreciated between depersonalization/derealization severity and cortical thickness in visual association areas. These findings advance our neuropathobiological unders