神经元核内包涵体病(neuronal intranuclear inclusion disease,NIID)是一种缓慢进展的神经元退行性疾病,主要特征为中枢神经系统、外周神经系统以及内脏组织中广泛分布嗜酸性透明核内包涵体[1].

Objective:To investigate the efficacy and cognitive function of 3 new antiepileptic drugs Oxcarbazepine (OXC), Lamotrigine (LTG) and Levetiracetam (LEV) in children with self-limited epilepsy with centrotemporal spikes (SeLECTS).Methods:This was a prospective study.A total of 98 children with SeLECTS who were treated in the Second Affiliated Hospital of Xinxiang Medical University from January 2014 to June 2020 were divided into OXC group, LTG group and LEV group according to the applied therapeutic drugs.Video electroencephalograph (EEG), Wechsler Intelligence Scale for Children (WISC) and event-related potentials (ERPs) of the children were collected before treatment and 48 weeks of treatment.Clinical efficacy and impact on cognitive function among the 3 groups were compared.Results:(1)Efficacy: There was no significant difference in the effective rate of seizure reduction after treatment among the 3 groups( χ2=0.808, P=0.668). There was no significant difference in EEG remission rate among the 3 groups( χ2=0.763, P=0.683). (2)Cognitive function: ①Intragroup comparison of WISC findings showed that the full scale score (FIQ) and verbal intelligence quotient (VIQ) were significantly enhanced, and the scores of comprehension, vocabulary, arithmetic, decoding and spelling subtests were more significantly enhanced in OXC group after treatment (all P<0.05). In the LTG group, FIQ, VIQ and operational intelligence quotient (PIQ) were significantly enhanced after treatment (all P<0.05), and the subtest scores of comprehension, vocabulary, arithmetic, mapping and layout were significantly enhanced (all P<0.05). In LEV group, FIQ, VIQ and PIQ were significantly enhanced after treatment (all P<0.05), especially the increase in the VIQ, and the scores of vocabulary, understanding, similarity, arithmetic, decoding and puzzle subtests were significantly enhanced (all P<0.05). Pairwise comparison of WISC findings showed that there were no significant differences in the FIQ, VIQ, PIQ and subtest scores before treatment among the 3 groups (all P>0.05). After treatment, the arithmetic and decoding scores of OXC group were significantly higher than those of LTG group (all P<0.05), which were comparable between OXC group and LEV group (all P>0.05). The PIQ and the scores of mapping and layout in LTG group were significantly higher than those of the other 2 groups (all P<0.05). The LEV group had higher scores in vocabulary, comprehension and spelling than those of the other 2 groups (all P<0.05), which had higher decoding scores than those of the LTG group (all P<0.05). No significant differences were found in decoding scores between LEV and OXC group (all P>0.05). Higher VIQ and FIQ were detected in LEV group than those of the other 2 groups (all P<0.05). ②Intragroup comparison of ERPs showed that the latency of LEV group after treatment was significantly shorter than that before treatment ( P<0.05), and there was no significant difference between the other 2 groups before and after treatment (all P>0.05). Pairwise comparison of ERPs showed that before treatment, there were no significant differences in P300 amplitude and latency among the 3 groups (all P>0.05). After treatment, the latency of LEV group was significantly shorter than that of the other 2 groups ( P<0.05), and there was no significant difference in the amplitude between the 3 groups before and after treatment ( P>0.05). Conclusions:(1)In the treatment of SeLECTS in children, OXC, LTG and LEV have reliable and equivalent effects.(2)OXC, LTG and LEV have protective effects on cognitive function in children with SeLECTS.After treatment, LEV provides the strongest protective effect on FIQ, and the protective effect on VIQ is equivalent to OXC, but better than LTG.LTG is superior in protecting spatial perception and PIQ.

ObjectiveTo investigate the P300 evoked by Stroop Color Word Task in children with emotional neglect, and to explore their implication for inhibition control.MethodsA cluster sampling was conducted for the first grade students of a middle school in Sanmenxia City, Henan Province. The students from 3 classes were assessed by standard Raven reasoning test and Child Neglect Scale (CNS), and a total of 147 eligible students were screened out. Children were divided into the emotional neglect group (n=40) and the control group (n=40) according to the 27% before and after the score of CNS emotional neglect factor. Both groups completed the Stroop Color word task, and EEG data were collected to compare the response time, accuracy, amplitude and latency of P300 between the two groups.ResultsThe CNS total score and the scores of safety neglect, communication neglect, physical neglect and emotional neglect factors in the emotional neglect group were significantly higher than those in control group (t=15.003, 4.301, 11.495, 4.803, 23.957, P<0.01). The average reaction time in the incongruent task of emotional neglect group was significantly longer than that in the control group [(879.02±101.52) ms vs. (756.93±113.91) ms, t=5.061, P<0.01]. Under incongruent task, the average amplitude of P300 in emotional neglect group was lower than that of the control group [(3.97±1.12) μV vs. (8.71±1.24) μV, t=-17.976, P<0.01]. The average latency of P300 of emotional neglect group was longer than that of the control group [(361.81±39.69) ms vs. (301.35±33.67) ms, t=7.346, P<0.01].ConclusionUnder incongruent task, children with emotional neglect had longer response time, longer latency and lower amplitude of P300， which suggested that children with affective neglect may have inhibition and control disorder.

目的 探讨血清脂联素水平对诊断急性脑梗死后认知功能障碍的价值.方法 采用整群抽样法,于2018年10月至2020年4月选取新乡医学院第二附属医院神经内科收治的141例急性脑梗死患者作为研究对象,分为脑梗死后认知功能障碍组(n=73)及脑梗死后无认知功能障碍组(n=68).于入院次日晨起时取患者外周静脉血,测定血清脂联素水平.采用美国国立卫生研究院卒中量表(NIHSS)、蒙特利尔认知评估量表(MoCA)分析患者的神经功能缺损及认知功能障碍.采用Pearson相关分析法分析急性脑梗死患者MoCA评分与血清脂联素水平的相关性.绘制受试者工作特征(ROC)曲线分析血清脂联素水平诊断脑梗死后认知功能障碍的价值.结果 两组患者的基线资料、NIHSS评分比较,差异无统计学意义(P>0.05).脑梗死后认知功能障碍组患者的MoCA评分、血清脂联素水平低于脑梗死后无认知功能障碍组,差异有统计学意义(P<0.01).Pearson相关性分析显示,急性脑梗死患者的MoCA评分与血清脂联素水平呈正相关(r=0.411,P<0.05).将脑梗死后认知功能障碍组患者按照脑梗死面积分为腔隙脑梗死组(n=51)、小面积脑梗死组(n=11)、大面积脑梗死组(n=11),3组患者的血清脂联素水平比较差异无统计学意义(P>0.05),但随着脑梗死面积扩大,血清脂联素水平呈现下降趋势.血清脂联素水平预测脑梗死后认知功能障碍的ROC曲线下面积为0.694(95％CI=0.607～0.781,P<0.05),敏感度和特异度分别为48.5％、84.9％.结论 急性脑梗死认知功能障碍患者的脂联素水平较低,血清脂联素水平可以对脑梗死后认知功能障碍提供一定的诊断价值.

目的 系统评价醒脑静注射液联合阿替普酶治疗缺血性脑卒中的疗效和安全性.方法 计算机检索中国知网、万方、VIP、CBM、PubMed、The Cochrane Library、Embase,系统收集有关醒脑静注射液联合阿替普酶治疗缺血性脑卒中的随机对照研究,纳入9项研究涉及1005例患者,并采用RevMan 5.3软件对纳入的相关研究进行Meta分析.结果 与对照组相比,观察组的有效率增加;NIHSS评分、NDS评分、缺血面积、TNF?α、PS、hs?CRP、IL?1、IL?6、IL?8水平降低;MoCA评分、ADL评分以及基底动脉、大脑中动脉左侧、大脑中动脉右侧、大脑前动脉左侧、大脑前动脉右侧、大脑后动脉左侧、大脑后动脉右侧、椎动脉左侧和椎动脉右侧血流速度升高;且两组不良反应发生率无显著差异.结论 当前证据显示,醒脑静注射液联合阿替普酶对缺血性脑卒中患者有较好的疗效和安全性,但受纳入研究的质量和数量限制,所得结论仍需高质量的多中心、双盲临床随机对照试验予以验证.

目的 检测老年癫痫患者急性发作后血浆外泌体中长链非编码RNA(LncRNA)MIR155HG表达水平,并探讨其对老年患者预后的意义.方法 159例老年癫痫患者,根据随访期间是否发生预后不良将患者分为预后不良组和预后良好组.采用实时荧光定量-聚合酶链反应(qRT-PCR)检测患者血浆外泌体中LncRNA MIR155HG表达水平;分析预后不良组老年癫痫患者血浆外泌体LncRNA MIR155HG与血浆细胞因子水平相关性;分析血浆外泌体LncRNA MIR155HG水平对老年癫痫患者预后不良的预测价值;分析影响老年癫痫患者预后不良的因素.结果 预后不良组血浆外泌体LncRNA MIR155HG及血浆白细胞介素(IL)-2、IL-6、IL-8、IL-1β、肿瘤坏死因子(TNF)-α水平显著高于预后良好组(P<0.05);预后不良组老年癫痫患者血浆外泌体LncRNA MIR155HG与血浆IL-2、IL-6、IL-8、IL-1β、TNF-α 水平呈正相关(P<0.05);血浆外泌体LncRNA MIR155HG水平预测老年癫痫患者预后不良的曲线下面积(AUC)为0.852,截断值为1.171,特异性为79.5％,敏感度为85.5％;LncRNA MIR155HG、TNF-α是影响老年癫痫患者预后不良的独立危险因素.结论 老年癫痫患者血浆外泌体Ln-cRNA MIR155HG水平的变化与病情发展及预后密切相关.

精神分裂症是一组病因不明的重性精神障碍,患者常因营养欠佳导致各种感染性疾病.然而,因颅内感染而直接出现脑疝症状的,国内鲜有报道.现将1例精神分裂症合并以脑疝为首发症状的脑脓肿报告如下. 1 资料与方法 患者,女,36 岁,主诉"突发呕吐、意识模糊11 h",2021年1月3日被新乡医学院第二附属医院收住.

目的 系统评价阿戈美拉汀治疗脑卒中后抑郁的疗效和安全性.方法 计算机检索PubMed、The Cochrane Librar-y、VIP、万方和中国知网数据库,搜集有关阿戈美拉汀联合常规方法治疗脑卒中后抑郁患者的临床研究,检索时限为建库至2021年1月.提取治疗前后各项研究中的汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、美国国立卫生研究院卒中量表(Na-tional Institutes of Health Stroke Scale,NIHSS)、Barthel指数、睡眠障碍量表(SDRS)等评分,以及生物因子(BDNF、NGF、NE、5-HT)水平,采用Revman5.3软件进行文献质量评价及Meta分析.结果 共纳入9篇文献,合计324例患者.Meta分析结果显示,脑卒中后抑郁患者采用阿戈美拉汀联合常规方法治疗,其HAMD评分较治疗前明显降低(MD=-13.79,95％CI:-18.18～-9.41,P<0.001),且有效率为83％(95％CI:0.52～1.15,P<0.001);NIHSS评分明显降低(MD=-6.35,95％CI:-7.50～-5.20,P<0.001),BI指数明显升高(MD=17.73,95％CI:5.52～29.94,P<0.001),SDRS评分明显降低(MD=-19.71,95％CI:-23.86～-15.57,P<0.001);BDNF水平明显升高(MD=2.95,95％CI:0.90～4.99,P<0.001).结论 当前证据显示,阿戈美拉汀联合常规治疗可有效改善脑卒中后抑郁患者的抑郁症状、神经功能、日常生活能力和失眠症状,且一定程度提升BDNF水平,但受纳入研究数量和质量的限制,所得结果仍需进一步研究证实.

目的 通过分析OTD(临床观察—理论学习—病例讨论)结合标准化病人(SP)教学法在心内科教学中的效果,探讨在临床医学教学中的高效教学方法.方法 选取我校五年制临床医学本科学生为研究对象,根据自然班级随机分为对照组(传统教学组)和教改组(OTD结合SP教学法组),对照组采用传统的课堂理论授课及常规的临床见习,教改组采用OTD结合SP教学法,带教结束后通过理论考核、临床技能考核和问卷调查的方式进行教学效果评价,观察两组学生之间的教学效果差异.结果 入组时两组学生的成绩差异无统计学意义(P>0.05);带教结束时,教改组学生的理论成绩、临床技能成绩和满意度调查均高于对照组差异有统计学意义(P<0.001).在调查问卷中,教改组学生对掌握的理论知识、自主学习能力、临床思维能力、沟通能力、临床综合能力、达到实习目标、对带教老师的满意度高于对照组,差异均有统计学意义(P<0.001).结论 OTD结合SP教学法可提高临床医学教学的效果,加深临床医学生的理论知识的储备,提高学生的临床思维、自主学习和医患沟通能力.

曲克芦丁(troxrutin)又称为维生素P4,具有抑制红细胞及血小板聚集?防止血栓形成?改善微循环?增加血氧含量?改善侧支血管生成的作用,能够对抗5-羟色胺和缓激肽引起的血管损伤,减轻毛细血管通透性及细胞?血管水肿[1],不良反应较少,因此在临床中被广泛地应用.

ObjectiveTo explore the effect of flipped classroom mode in the clinical probation teaching for undergraduate mental health students， so as to expand the new mode of clinical teaching in psychiatry department.MethodsA total of 85 undergraduate psychiatric students from Xinxiang Medical University in 2016 were selected. All participants were divided into experimental group （n=43） and control group （n=42） according to the random number table method. The flipped classroom clinical teaching mode was adopted to experimental group， and the traditional practice mode for control group. The probation lasted for 12 weeks. Theoretical knowledge of symptomology， psychiatric clinical skills （OSCE）， doctor-patient communication ability（SEGUE） and clinical thinking ability were assessed at the end of probation.ResultsAfter the probation， students in experimental group obtained higher scores in theoretical knowledge， clinical skills， doctor-patient communication ability and clinical thinking ability compared with control group. The differences were statistically significant ［（33.08±1.72） vs. （32.06±2.33）， （51.61±2.12） vs. （48.32±2.86）， （18.14±1.98） vs. （14.62±2.15）， （91.26±14.13） vs. （82.40±10.89）， t=2.307， 6.034， 3.230， 7.846， P<0.05 or 0.01］.ConclusionApplying the flipped classroom mode into the clinical probation teaching for mental health undergraduate students may help to improve students' theoretical knowledge level and clinical operation ability， faciliate doctor-patient communication， and have a positive impact on their clinical thinking ability.

目的:基于荟萃分析(Meta分析)方法,系统评价阿戈美拉汀对抑郁症伴睡眠障碍患者的睡眠改善效果及其安全性,为临床治疗提供循证参考.方法:检索PubMed、the Cochrane Library、EMBase、中国知网、万方数据库和维普数据库,纳入从建库至2020年4月公开发表的关于阿戈美拉汀治疗抑郁症伴睡眠障碍患者的中英文文献[研究组患者单独使用阿戈美拉汀口服治疗,对照组患者单独使用5-羟色胺再摄取抑制类抗抑郁药(米氮平、帕罗西汀或艾司西酞普兰等)治疗或阿戈美拉汀联合其他药物治疗],提取汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分和匹茨堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)相关数据,采用RevMan 5.3软件进行文献质量评价和Meta分析.结果:共纳入8项研究,合计332例患者.Meta分析结果显示,抑郁症伴睡眠障碍患者单独使用阿戈美拉汀治疗后,其HAMD评分(SMD=-5.31,95％CI=-6.28～-4.33,P<0.00001)、PSQI总分(SMD=-3.66,95％CI=-4.16～-3.17,P<0.00001)均较治疗前明显降低,差异均有统计学意义.结论:阿戈美拉汀对抑郁症伴睡眠障碍患者的抑郁症状和失眠症状均有较好的改善作用,但受纳入研究的质量和样本量限制,该结论需大样本、多中心、长时间的随访结果进行验证.

目的:探讨人格特质及应对方式对医学生心理健康的影响.方法:采用分层整群抽样法对潍坊医学院486名医学生进行艾森克人格问卷简式量表(EPQ-RSC)、简易应对方式问卷(SCSQ)及一般健康问卷(GHQ-20)调查研究,采用通径分析研究影响医学生心理健康的主要因素及其作用方式.结果:研究显示,外向型和神经质人格是医学生自我肯定的影响因素;精神质和神经质人格是忧虑的影响因素;精神质、神经质和外向型人格是焦虑的主要影响因素.积极应对方式对自我肯定和忧虑有影响;消极应对方式仅对自我肯定有影响.4种人格特质中,神经质和精神质人格对心理健康的影响较大..结论:不同人格特质对医学生心理健康有直接影响,也可通过应对方式对个体心理健康产生间接影响.应对方式对医学生心理健康有直接影响作用.

随着医学模式转变、教育教学改革、医学人才培养需要,建设研究生《临床思维与医患沟通》优质课程尤为重要.临床思维与医患沟通贯穿于整个临床诊疗活动中,本优质课程通过设立教学目标、改革教学方法等系统讲授相关理论知识,并注重临床实践性,有助于提高研究生的临床诊疗水平和医患沟通技能,从而提高研究生培养质量.

目的:探讨迷你临床演练评估(Mini-Clinical Evaluation Exercise,Mini-CEX)在临床医学专业学生临床能力培训考核中的有效性.方法:选取临床医学本科生80名,分为实验组和对照组,分别采用Mini-CEX及传统教学法教学,比较两种教学方法的教学效果.结果:实验组医学生的理论及临床技能成绩明显高于对照组;教师及学生对Mini-CEX教学法满意度较高.结论:Mini-CEX可作为医学生临床能力评价体系的有效组成部分,在临床教学中应用.

目的:分析翻转查房带教法在临床医学专业实习教学中的效果,探讨在临床实习中的高效教学方法.方法:选取在我院实习的临床本科学生为研究对象,根据入科时的综合成绩排名分组,单号排名31人为对照组,采用传统的日常查房带教法,双号排名30人为实验组,采用翻转查房带教法.带教结束后通过理论及临床技能考核和问卷进行效果评价.结果:入组时两组学生的成绩差异无统计学意义(P＞0.05);带教结束时,实验组学生成绩和满意度调查均高于对照组(P＜0.05).结论:翻转查房带教法可明显提高带教效果,可提高学生的理论知识及临床综合能力,适合在教学医院中推广应用.

目的 探讨托吡酯与卡马西平单药治疗癫痫部分性发作的疗效和安全性.方法 计算机检索PubMed、Cochrane、Embase、中国知网、万方数据库和中国生物医学文献数据库中,建库—2019年01月31日关于托吡酯与卡马西平单药治疗癫痫部分性发作患者的临床对照试验文章.对其进行文献筛选,数据提取,文献质量及风险偏倚评估,并交叉核对,使用Meta分析专用软件Revman 5.3进行数据分析.结果 初检文献459篇,最终纳入文献12篇,共2348例患者,其中托吡酯组1075例,卡马西平组1273例.其中高质量文献3篇,低质量文献9篇.Meta分析结果显示:托吡酯组完全控制540例,占52.38％(540/1031);卡马西平组完全控制546例,占45.73％(546/1194),两组差异有统计学意义[OR=1.53,95％CI(1.05,2.24),P<0.05].托吡酯组有效204例,占37.02％(204/551);卡马西平组有效326例,占47.52％(326/686),两组差异无统计学意义[OR=0.91,95％CI(0.70,1.19),P>0.05].托吡酯组出现不良反应372例,占39.45％(372/943);卡马西平组出现不良反应466例,占44.72％(466/1042),两组差异有统计学意义[OR=0.75,95％CI(0.56,1.00),P<0.05].结论 托吡酯单药治疗癫痫部分性发作的疗效及安全性优于卡马西平.

目的 探讨环状RNA小脑变性相关蛋白1反义转录物(CDR1as)与微小RNA-7(miR-7)在癫痫患者血浆中的表达及与脑电图异常的关系.方法 选取2016年12月—2019年12月在新乡医学院第二附属医院门诊及住院的癫痫患者87例为观察组,并根据脑电图结果分为正常组(6例)、轻度异常组(18例)、中度异常组(37例)及重度异常组(26例);选取同期健康体检者90例为对照组.实时荧光定量PCR(qPCR)法检测血浆CDR1as、miR-7水平,酶联免疫吸附测定(ELISA)法检测血浆白细胞介素(IL)-2、肿瘤坏死因子(TNF)-α和IL-1β水平;Pearson法分析癫痫患者血浆CDR1as、miR-7水平与IL-2、TNF-α和IL-1β水平的相关性.结果 对照组、正常组、轻度异常组、中度异常组、重度异常组血浆CDR1as、IL-2、TNF-α和IL-1β水平总体呈升高变化,miR-7水平总体呈降低变化,差异均有统计学意义(P<0.05).癫痫患者血浆CDR1as水平与IL-2、TNF-α和IL-1β水平呈正相关(P<0.05),miR-7水平与IL-2、TNF-α和IL-1β水平呈负相关(P<0.05).结论 CDR1as、miR-7在癫痫患者血浆中分别呈高表达、低表达,与炎症因子水平、脑电图异常程度密切相关,可能通过影响炎症反应引起脑部异常放电.

目的 观察地塞米松对心肌梗死大鼠巨噬细胞极化、炎症反应及心功能的影响.方法 将44只雄性SD大鼠分为3组:假手术组、对照组、实验组,其中假手术组采用随机等间隔抽样法抽取8只,其余36只大鼠建立AMI模型,24 h后将建模成功存活的19只大鼠随机分为对照组10只和实验组9只,实验组大鼠在建模后24 h肌肉注射1次地塞米松磷酸钠注射液(1 mg/kg),对照组肌肉注射1次生理盐水(0.2 mL/kg).术后4周,对所有存活的大鼠行超声心动图检测心功能;HE染色法检测梗死区心肌组织形态学改变;RT?PCR检测心肌梗死区周围组织M1型巨噬细胞标志物IL?6、TNF?α和M2型巨噬细胞标志物IL?10、TGF?β1的mRNA表达水平.结果 (1)AMI模型大鼠24 h存活率低于假手术组(P<0.05);实验组与对照组大鼠4周生存率比较差异无统计学意义(P>0.05).(2)对照组和实验组大鼠LVESD、LVEDD大于假手术组(P<0.05),LVEF及FS低于假手术组(P<0.05);实验组LVESD及LVEDD小于对照组(P<0.05),LVEF及FS高于对照组(P<0.05).(3)HE染色示假手术组心肌组织细胞排列均匀,无明显病理改变,实验组的心肌细胞结构优于对照组.(4)RT?PCR示:对照组及实验组大鼠梗死区周围组织TNF?α、IL?6、IL?10和TGF?β1的mRNA相对表达量显著高于假手术组(均P<0.05);与对照组比较,实验组大鼠M1型巨噬细胞标志物TNF?α和IL?6的mRNA相对表达量显著降低(均P<0.05),M2型巨噬细胞标志物IL?10和TGF?β1的mRNA相对表达量显著升高(均P<0.05).结论 地塞米松可减轻大鼠急性心肌梗死区的心肌组织损伤及改善心功能;其机制可能与地塞米松通过调节M1型巨噬细胞向M2型极化,抑制心肌组织炎症反应及梗死后心室重构有关.

皮肌炎(dermatomyositis,DM)是一组主要累及皮肤和肌肉的自身免疫性疾病,以亚急性及慢性起病为主,在儿童及成人中均可发生,女性发生率明显高于男性[1].皮肤表现是皮肌炎常见的临床症状,主要表现为眶周水肿性红斑、Gottron征、对称性紫红斑、皮肤异色症、颈部V型红斑等症状,也有部分患者以肢体无力前来就诊.皮肌炎及多发性肌炎患者合并肿瘤风险较健康人明显增高,常见的合并肿瘤为乳腺癌、卵巢癌、鼻咽癌、肺癌等[2-3].对于皮肌炎患者合并直肠癌的病例,国内类似文献报道相对较少,现对1例皮肌炎合并直肠癌病例临床特点进行分析,报道如下.