关键词： 住院医师规范化培训   转化医学   翻转课堂   微信   讲授教学法   神经病学   教育  

摘要： 目的探索转化医学联合微信翻转课堂教学模式在神经病学住院医师规范化培训中的应用效果。方法选取蚌埠医学院第二附属医院2019级和2020级住培生(内科专业+全科医学专业+神经病学专业)共42名学生为研究对象,随机分成两组(试验组及对照组各21名),试验组采用转化医学联合微信翻转课堂教学模式,利用微信群及微课进行课前预习、课后复习及互动交流;对照组采用传统讲授法教学。轮转结束后对两组住培生进行考核。结果试验组的理论成绩、技能成绩、病例综合分析成绩均超过对照组,差异均有统计学意义(P<0.05);试验组学员在思考能力、学习兴趣、解决问题、语言沟通、文献检索上对教学模式的认可人数均超过对照组,差异均有统计学意义(P<0.05)。结论转化医学联合微信翻转课堂模式能够提高住培生的自学能力及临床综合能力,激发发展自主学习和终生学习的能力,提高医学创新及科研水平,可在住培实践教学中应用推广。

关键词： anion transport   endosome   Kufs disease   organellar homeostasis   vesicular CLC  

摘要： ClC-6 is an intracellularly localised member of the CLC family of chloride transport proteins. It presumably functions in the endolysosomal compartment as a chloride-proton antiporter, despite a paucity of biophysical studies in direct support. Observations of lysosomal storage disease, as well as neurodegenerative disorders, emerge with its disruption by knockout or mutation, respectively. An incomplete understanding of wild-type ClC-6 function obscures clear mechanistic insight into disease aetiology. Here, high-resolution recording protocols that incorporate extreme voltage pulses permit detailed biophysical measurement and analysis of transient capacitive, as well as ionic transport currents. This approach reveals that wild-type ClC-6 activation and transport require depolarisation to voltages beyond 140 mV. Mutant Y553C associated with early-onset neurodegeneration exerts gain-of-function by shifting the half-maximal voltage for activation to less depolarised voltages. Moreover, we show that the E267A proton glutamate mutant conserves transport currents, albeit reduced. Lastly, the positive shift in activation voltage shown by V580M, a mutant identified in a patient with late-onset lysosomal storage disease, can explain loss-of-function leading to disease. Key points Ionic composition and pH within intracellular compartments, such as endolysosomes, rely on the activity of chloride/proton transporters including ClC-6. Distinct CLCN6 mutations were previously found in individuals with neurodegenerative disease, and also putatively associated with neuronal ceroid lipofuscinosis. Limited knowledge of wild-type ClC-6 transport function impedes understanding of mechanisms underlying these conditions. We resolved transient and transport currents that permit measurement of voltage- and pH-dependences, as well as kinetics, for wild-type and disease-associated mutant ClC-6s. These findings define wild-type ClC-6 function robustly, and reveal how alterations of the slow a

关键词： Functional neurological disorders   Conversion disorders   Neurological practice   Education   Survey  

摘要： Background Functional neurological disorders (FND) are disabling medical conditions commonly seen in neurological practice. Neurologists play an essential role in managing FND, from establishing a diagnosis to coordination of multidisciplinary team-based treatment for patients. With this study, we investigated the knowledge and the clinical experience of Italian neurologists in managing patients with FND. Methods Members of the Italian Society of Neurology were invited via e-mail to participate in this ad hoc online survey;492 questionnaires were returned completed. Results The term "Functional neurological disorders" in reference to FND was used more frequently than other psychological (e.g., psychogenic or conversion), or descriptive terms (e.g., non-organic or stress-related). When speaking with patients, the respondents stated that they preferred explaining symptoms based on abnormal functioning of the nervous system than discussing mental illness and that they would refer their patient to a psychologist rather than to a psychiatrist. Few considered that physiotherapy and psychiatric interventions are useful approaches to treating FND. Some believed that patients simulate their symptoms. Conclusions Overall, the responses suggest that knowledge about scientific advances in FND is somewhat sparse. A psychiatric-centered view of FND opens the way to an approach in which neurobiological and psychological aspects constitute essential factors of the condition. In this context, professional education could improve understanding of FND and optimize patient management.

关键词： 神经病学   诊疗  

ISBN: (纸本)9787313268006

摘要： 本书内容包括两部分，第一章介绍了神经病学诊断的历史源头、发展及现状；第二章至第十六章分别介绍了头痛的诊断思路、头晕的诊断思路、脑血管疾病的诊断思路、运动障碍的诊断思路、认知障碍的诊断思路、围脑膜感染的诊断思路、自身免疫性脑炎的诊断思路、癫痫的诊断思路、慢性炎性脱髓鞘性神经根周围神经病的诊断思路、肌病的诊断思路、神经系统遗传病的诊断思路、神经眼科疾病的诊断思路、神经口腔科疾病的诊断思路、功能性神经疾病的诊断思路、内科疾病相关脑病的诊断思路等。本书内容丰富，层次清晰，论述严谨，适合神经精神内科医师、普通内科医师、眼科、口腔科及相关医护人员使用。

关键词： carbon monoxide   delayed neurological sequelae   poisoning  

摘要： Objectives Acute carbon monoxide (CO) poisoning survivors may experience persistent neurological sequelae (PNS) and delayed neurological sequelae (DNS). This study evaluated the clinical features, laboratory results, acute brain lesions (ABLs) on diffusion-weighted imaging (DWI) at presentation, and long-term outcomes and explored differences between patients with PNS and DNS. Methods The study included 443 patients who had experienced CO poisoning, underwent DWI and completed 1-year follow-ups. The demographics, comorbidities, symptomatology, laboratory results, ABLs on DWI at presentation, and long-term outcomes were compared between patients with PNS and those with DNS. Results The 42 (9.5%) and 96 (21.7%) patients with PNS and DNS, respectively, showed no significant differences in demographics, duration of CO exposure, initial conscious level, symptomatology, and laboratory results. ABLs on DWI were observed in 33 patients (33/42) with PNS and 62 patients (62/96) with DNS. The most common region of ABLs was the globus pallidus (60.6% and 56.6% in PNS and DNS, respectively). The proportion of ABLs present and lesion distribution did not differ significantly between the two groups. At 1 year, a significantly higher proportion of patients in the PNS group showed a good outcome (defined as modified Rankin Scale [mRS] scores of 0-2, 81%) compared with the DNS group (81% vs. 56.3%, p = .047). Conclusion Demographics, clinical features, laboratory results, and acute brain lesions on MRI at presentation did not differ between the PNS and DNS groups. However, the long-term outcome of PNS was better than that of DNS.

关键词： Medical education   Clinical neurophysiology   Specialization in neurology   Training in neurophysiology  

摘要： Introduction Clinical neurophysiology deals with nervous system functions assessed with electrophysiological and ultrasound-based imaging techniques. Even though the need for highly specialized neurophysiologists has increased, residency training rarely takes today's requirements into account. This study aimed to snapshot the neurophysiological training provided by Italian specialization schools in neurology. Methods A single-page web-based survey comprising 13 multiple-choice categorical and interval scale questions was sent via e-mail to neurology specialization school directors. The survey addressed the programs' structural neurophysiology organization, time dedicated to each clinical neurophysiology subspecialty, and descriptors assessing the discipline's importance (e.g., residents who attempted residential courses, gained certifications, or awards gained). Results The most studied neurophysiological techniques were electroencephalography (EEG) and electromyography (EMG). Most specialization schools devoted less than 3 months each to multimodal evoked potentials (EPs), ultrasound sonography (US), and intra-operative monitoring. Of the 35 specialization schools surveyed, 77.1% reported that four students, or fewer, participated in the Italian Society of Clinical Neurophysiology Examination in Neurophysiology. Of the 35 specialization centers surveyed, 11.4% declared that the final evaluation required students to discuss a neurophysiological test. Discussion Our survey underlined the poorly standardized technical requirements in postgraduate neurology specialization schools, wide variability among training programs, and limited training on multi-modal evoked potentials, intraoperative monitoring, and sonography. These findings underline the need to reappraise and improve educational and training standards for clinical neurophysiology during postgraduate specialization schools in neurology with an international perspective.

关键词： COVID-19   SARS-CoV-2   Neurological diseases   Post-COVID  

摘要： Acute and post-acute neurological symptoms, signs and diagnoses have been documented in an increasing number of patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19). In this review, we aimed to summarize the current literature addressing neurological events following SARS-CoV-2 infection, discuss limitations in the existing literature and suggest future directions that would strengthen our understanding of the neurological sequelae of COVID-19. The presence of neurological manifestations (symptoms, signs or diagnoses) both at the onset or during SARS-CoV-2 infection is associated with a more severe disease, as demonstrated by a longer hospital stay, higher in-hospital death rate or the continued presence of sequelae at discharge. Although biological mechanisms have been postulated for these findings, evidence-based data are still lacking to clearly define the incidence, range of characteristics and outcomes of these manifestations, particularly in non-hospitalized patients. In addition, data from low- and middle-income countries are scarce, leading to uncertainties in the measure of neurological findings of COVID-19, with reference to geography, ethnicity, socio-cultural settings, and health care arrangements. As a consequence, at present a specific phenotype that would specify a post-COVID (or long-COVID) neurological syndrome has not yet been identified.

关键词： Spinal cord injury   X-ray   Inflammation   Glial scar   p38 MAPK   Akt   Nerve function  

摘要： Spinal cord injury (SCI) is a common clinical disease that can cause permanent disruption of nerve function. Inflammation and glial scar formation influence the recovery of injured spinal cord. X-ray irradiation can reduce inflammation, inhibit cell proliferation and increase cell apoptosis. However, the regulatory effects of X-ray irradiation on inflammation and glial scars and the underlying molecular mechanisms are still unclear. This study was aimed to investigate the therapeutic effect and molecular mechanism of X-ray irradiation on spinal cord injury. Behavioural experiments showed that X-ray irradiation can promote the recovery of nerve function after SCI. X-ray irradiation inhibited the inflammatory response by reducing the expression of inflammatory factors (TNF-alpha and IL-1 beta) at the lesion site, thereby reducing neuronal apoptosis. X-ray irradiation inhibited the formation of the glial scar (GFAP and vimentin) in the lesion. P38MAPK and Akt signalling pathways were involved in these processes. Furthermore, the 10 Gy dose had the most significant effects among the 2 Gy, 10 Gy and 20 Gy doses. In summary, X-ray irradiation may exert an active therapeutic effect on SCI by inhibiting inflammation and glial scar formation, which may be related to the inhibition of p38MAPK and Akt signalling pathways.