关键词： 临床药理基地   中山医院   专科培训   神经内科   国家教育委员会   临床决策支持系统   神经病学   脑疾病  

摘要： 复旦大学附属中山医院(简称中山医院)神经内科为国家临床重点专科,国家教育委员会批复的重点学科,国家级临床药理基地,神经病学博士学位授予点,国家卫生健康委员会(原国家卫生和计划生育委员会)首批批准、设立的神经内科住院医师规范化专科培训基地及复旦大学癫痫诊治中心之一,国家卫生健康委员会(原国家卫生和计划生育委员会)批复的脑卒中筛查与防治基地,上海市脑卒中救治中心。

关键词： 神经外科学   神经重症   急诊医学   重症医学   神经影像   神经介入   神经系统疾病   神经病学  

摘要： 推荐理由:神经重症医学作为新兴的神经病学和神经外科学亚专业,综合神经病学、神经外科学、重症医学、麻醉医学、急诊医学及神经影像、神经介入等多学科知识、技能,为神经系统疾病危重患者提供全面、系统和高质量的医学监护与救治。但是,这一学科在中国的发展面临许多挑战。缺乏主题创新、设计合理及实施规范的临床研究是亟待解决的"瓶颈"问题。针对这一问题,我国多学科专家共同探讨总结出了神经重症医学的6个优先发展方向,并发表于近期出版的《中华医学杂志》。

关键词： 博士研究生培养   硕士研究生   神经病学   博士研究生导师   诊疗中心   专科医师培训   神经内科   疑难杂症  

摘要： 一、首都医科大学附属北京朝阳医院神经内科简介首都医科大学附属北京朝阳医院神经内科成立于1984年,经过30多年的发展壮大,已发展成为集医疗、教学、科研、预防于一体的诊疗中心。其中脑血管病患者诊疗数量位居北京地区前列,并在神经危重症患者的救治和疑难杂症的诊治方面积累了丰富的经验。神经内科是首都医科大学的神经病学硕士研究生和博士研究生培养点,博士后流动站,北京地区第一批神经专科医师培训基地。目前,科室有博士研究生导师2人,硕士研究生导师7人。科室拥有病床127张(本部75张+西院52张),其中重症监护床位10张(本部6张+西院4张)。

关键词： Bone marrow   Fasudil   Mesenchymal stem cells   Ischemic stroke   Neurological function   Inflammation   Infarction  

摘要： Stroke remains a highly deadly and disabling disease with limited treatment tragedies due to the limitations of available treatments;novel therapies for stroke are needed. In this article, the synergistic results of dual bone marrow mesenchymal stem cells (BMSC) and fasudil treatment in rat models of ischemic stroke still require further identification. Sprague-Dawley rats were used to construct the middle cerebral artery, occlusion models. BMSCs were incubated with fasudil, and MTT was performed to evaluate cell proliferation. The rats were treated with fasudil + BMSC, BMSC, fasudil, and saline. Blood samples were collected for complete blood count analysis and measurement of serum TNF-alpha levels. The neurological functions were evaluated. After the rats were sacrificed, immunohistochemical staining and TTC staining was performed. Fasudil promoted the proliferation of BMSCs and induced their differentiation into neuron-like cells. BMSCs increased the proportion of neutrophils;nevertheless, fasudil counteracted the neutrophil increase. The TUJ-1/MAP2/VIII factor expression in the fasudil + BMSC group was significantly higher than that in the other groups. The number of GFAP-positive cells decreased in the fasudil + BMSC and BMSC alone groups. The infarct volume in the fasudil + BMSC and BMSC alone groups was significantly lower than in the fasudil alone and control groups. Both BMSCs and fasudil exert neurorestorative effects in rat models of cerebral ischemia. Fasudil neutralizes the pro-inflammatory effects of BMSCs, while BMSCs and fasudil together had synergistic effects promoting neurovascular remodeling and neurological function recovery in stroke. A combination of BMSCs and fasudil provides a promising method for the treatment of ischemic stroke.

关键词： cigarette smoke   neonatal exposure   nicotine   nicotine replacement therapy   postnatal exposure   tobacco  

摘要： Smoking during pregnancy is hazardous to both the mother and the foetus, according to a substantial amount of recorded data. Exposure to nicotine and other compounds in cigarette smoke increases the risk of sudden infant death syndrome (SIDS) by two to five times during pregnancy. Serotonergic abnormalities have been discovered in SIDS infants in the zone of the medulla oblongata, which is known to control cardio-respiratory function. SIDS establishes a connection between depression, learning difficulties and behavioural disorders. Prenatal nicotine intake during the second trimester affects the dopaminergic neurological system, making the foetal brain more susceptible to nicotine and developing ADHD symptoms not just in a foetus but in adolescents also. Prenatal nicotine exposure alters the neurological route of neurotransmitters, acetylcholine and dopamine. Nicotine enhances neuronal activity in adults but desensitizes these processes in babies and young children exposed prenatally. The impact of a neurotoxin like nicotine is determined by the amount and duration of exposure. Continued exposure throughout pregnancy will influence a wide range of activities in the neurodevelopment, whereas exposure confined to a single stage of pregnancy may only affect the processes that are forming at that stage. To decrease the effect of nicotine on neonates due to maternal smoking strategies like nicotine replacement therapy (NRT), folic acid treatment and other behavioural treatments have been studied. Hence, this review focuses on the impact of exposure to nicotine on neonates, which results in various neurological consequences and smoking cessation therapies.

关键词： Cerebral infarction   clinical deterioration   magnetic resonance imaging   perfusion imaging   stroke  

摘要： Minor stroke due to large vessel occlusion (LVO) is associated with poor outcomes. Hypoperfused tissue fate may be more accurately predicted by severity-weighted multiple perfusion strata than by a single perfusion threshold. We investigated whether poor perfusion profile evaluated by multiple Tmax strata is associated with early neurological deterioration (END) in patients with minor stroke with LVO. Ninety-four patients with a baseline National Institute of Health Stroke Scale score <= 5 and anterior circulation LVO admitted within 24 hours of onset were included. Tmax strata proportions (Tmax 2-4 s, 4-6 s, 6-8 s, 8-10 s, and >10 s) against the entire hypoperfusion volume (Tmax >2 s) were measured. The perfusion profile was defined as the shift of the distribution of the Tmax strata proportions towards worse hypoperfusion severity compared with that of the entire cohort using the Wilcoxon-Mann-Whitney generalised odds ratio (OR);its performance to predict END was tested. The area under the curve of perfusion profile was 0.785 (95% confidence interval [CI]: 0.691-0.878, p < 0.001). Poor perfusion profile (generalised OR >1.052) was independently associated with END (adjusted OR 13.42 [95% CI: 4.38-41.15], p < 0.001). Thus, perfusion profile with severity-weighted multiple Tmax strata may predict END in minor stroke and LVO.

摘要： The recent interest in brain health from policy makers is also a result of the relentless efforts to raise awareness by initiatives such as OneNeurology, which keeps advocating for neurological disorders to be considered a public health priority. A forthcoming report form the Council will present their “landscape analysis”, which is an “overview of the scale and scope of brain research activities” that have been funded by EU large initiatives over the past 15 years. The adoption should not only place the prevention of neurological disorders as a key part of the EU implementation roadmap for tackling non-communicable diseases but also change research priorities and the public health strategic plan of the EU, which does not mention neurological health at present.

关键词： Medicine/Public Health   general   Pediatrics   Pediatric Surgery  

摘要： Background Severe neonatal hyperbilirubinemia has been known to cause the clinical syndrome of kernicterus and a milder one the syndrome of bilirubin-induced neurologic dysfunction (BIND). BIND clinically manifests itself after the neonatal period as developmental delay, cognitive impairment, and related behavioral and psychiatric disorders. The complete picture of BIND is not clear. Methods The Gunn rat is a mutant strain of the Wistar rat with the BIND phenotype, and it demonstrates abnormal behavior. We investigated serotonergic dysfunction in Gunn rats by pharmacological analyses and ex vivo neurochemical analyses. Results Ketanserin, the 5-HT2AR antagonist, normalizes hyperlocomotion of Gunn rats. Both serotonin and its metabolites in the frontal cortex of Gunn rats were higher in concentrations than in control Wistar rats. The 5-HT2AR mRNA expression was downregulated without alteration of the protein abundance in the Gunn rat frontal cortex. The TPH2 protein level in the Gunn rat raphe region was significantly higher than that in the Wistar rat. Conclusions It would be of value to be able to postulate that a therapeutic strategy for BIND disorders would be the restoration of brain regions affected by the serotonergic dysfunction to normal operation to prevent before or to normalize after onset of BIND manifestations. Impact We demonstrated serotonergic dysregulation underlying hyperlocomotion in Gunn rats. This finding suggests that a therapeutic strategy for bilirubin-induced neurologic dysfunction (BIND) would be the restoration of brain regions affected by the serotonergic dysfunction to normal operation to prevent before or to normalize after the onset of the BIND manifestations. Ketanserin normalizes hyperlocomotion of Gunn rats. To our knowledge, this is the first study to demonstrate a hyperlocomotion link to serotonergic dysregulation in Gunn rats.

摘要： This commentary is on the original article by Diskin et al. on pages 200–208 of this issue.