目的:探讨微格教学法在腰椎穿刺术技能培训中的应用效果.方法:随机选取神经内科实习医学生63名,分为对照组(n=31)和实验组(n=32),分别按照模拟教学法和微格教学法进行培训;培训后的63名学生采用统一的腰椎穿刺术考核评分表(百分制)进行考核,比较教学效果.结果:微格教学组的考核成绩及腰椎穿刺术成功率明显高于模拟教学组.结论:微格教学法能明显提高临床医学生的腰椎穿刺术操作能力,具有较高的教学应用价值.

现阶段我国临床医学专业学位硕士研究生的培养目标是培养具有较强的临床实践能力和一定的科学研究能力、可适应未来医学科学发展需要的高层次、高素质医学人才.因此,大力增强和提高研究生的科研意识和科研能力是目前临床医学专业学位硕士研究生培养的必然要求.中南大学湘雅三医院通过多年的探索和研究,逐渐形成了具有湘雅特色的临床医学专业学位硕士研究生培养模式.

神经系统体格检查中高级脑功能的检查内容多且复杂,教学难度大,如何让学生系统的掌握检查内容,做到体查全面流畅、手法正确是神经病学教学中面临的重要问题.现基于多种量表和临床经验,制定高级脑功能检查的简明流程,结合多元化的教学方法,为神经病学的教学模式改革提供了新的思路.

Objective:To analyze the clinical characteristic and prognosis of anti-Hu antibody associated paraneoplastic neurological syndrome.Methods:Two cases of anti-hu associated paraneoplastic neurological syndrome were reported and the relevant literature was reviewed.Results:One of the patients showed severe central hypoventilation,accompanied by peripheral neuropathy.But systemic PET-CT did not detect tumors.Another patient showed nonspecific presentation,but the tumor was found in the head and neck,which were mainly distributed in the sinus and parotid gland.Nasal sinus mass was confirmed as small cell carcinoma by pathological biopsy.The symptoms of the patient were relieved after resection of the sinus lumps.We have reviewed data of 477 cases of anti-Hu associated paraneoplastic neurological syndrome from the MEDLINE.Most of patients presented with subacute sensory neuropathy.Most of cerebral MRI manifestation did not show abnormalities.Small cell lung cancer was the most common combined type of tumors.In all the cases,2.5％ of the patients presented with central hypoventilation.Conclusion:Paraneoplastic neurological syndrome constitutes a reason for central hypoventilation without underlying causes.Anti-hu and other paraneoplastic syndrome-related antibodies detection is helpful to detect the tumors,and may provide a more favorable time for the treatment of cancers.

To solve the problem of neurology trainee students for less chance to contact emergency cases and operation chance constraints, we established a new teaching model which is composed of computer simulation case plus SimMan patient simulators. As effective supplement of clinical practice, this new model of teaching is more vivid and comprehensive to demonstrate the development of the disease, and is conducive to further improve the capacity of students to deal with clinical problems.

目的 大面积脑梗患者死亡的主要原因是脑疝形成,本实验的目的是建立一个有效的预测模型,对脑疝的发生进行早期预测.方法 采用回顾性调查的方法,搜集74名大面积脑梗患者(19名患者发生脑疝)的临床、生化、影像学指标44项.利用单因素判别分析建立单因素模型,利用逻辑回归(logistic recession,LR)、随机森林(random forest,RF)、人工神经网络多层感知机(multiplayer perception,MLP)建立多因素预测模型,对大面积脑梗患者的预后进行预测.用受试者工作特征曲线下面积(area under receiver operation characteristic,AUROC)评判预测模型好坏.结果 在单因素模型中,以梗死最大截面面积为预测因子的模型预测效果最好,其AUROC为0.87,选择40cm2为截断点时敏感度为0.93、特异度为0.64.在多因素模型中,LR模型其敏感度为0.89、特异度为0.84 、AUROC为0.89;MLP模型其敏感度为0.93、特异度为0.79、A UROC为0.88;RF模型其敏感度为0.95、特异度为0.74、AUROC为0.92.结论 RF模型效果优于其他模型,可用作医学辅助诊断系统来预测脑疝在大面积脑梗患者的发生.

<正>1一般资料男性患者,60岁,因突发意识障碍12 h于2 0 1 2年4月7日入院。患者于清晨起床后突发意识不清,摔倒在地,呼之不应,呕吐两次,非喷射性,呕吐物为胃内容物。无发热、气喘、呼吸困难,无肢体抽搐、乏力麻木,无大小便失禁,立即送至

Studies have shown that glycolysis increases during seizures, and that the glycolytic metabolite lactic acid can be used as an energy source. However, how lactic acid provides energy for seizures and how it can participate in the termination of seizures remains unclear. We reviewed possible mechanisms of glycolysis involved in seizure onset. Results showed that lactic acid was involved in seizure onset and provided energy at early stages. As seizures progress, lactic acid reduces the pH of tissue and induces metabolic acidosis, which terminates the seizure. The specific mechanism of lactic acid-induced acidosis involves several aspects, which include lactic acid-induced inhibition of the glycolytic enzyme 6-diphosphate kinase-1, inhibition of the N-methyl-D-aspartate receptor, activation of the acid-sensitive 1A ion channel, strengthening of the receptive mechanism of the inhibitory neurotransmitter γ-minobutyric acid, and changes in the intra- and extracellular environment.

Metabolic modulation of neuronal excitability is becoming increasingly important as an antiepileptic therapy. It was reported that the glycolytic inhibitor 2-deoxy-D-glucose (2-DG) and the activation of the ATP-sensitive potassium ion channel (K(ATP) channel) had an antiepileptic effect in models of epilepsy. To explore whether 2-DG exerts an antiepileptic effect through upregulation of the K(ATP) channel subunits Kir6.1 and Kir6.2, the expression of these subunits in hippocampus of five groups of mice with pilocarpine-induced status epilepticus (SE) was evaluated. A seizure group with pilocarpine-kindling convulsions (EP) was compared to similar groups treated with high, medium, and low 2-DG concentrations (100-500 mg/kg) and a normal control group (Con). Kir6.1 and Kir6.2 mRNAs and proteins were analyzed at 4 h, 1 days (acute period), 7 days (latent period), 30, and 60 days (chronic period) following SE. In the seizure group (compared to the Con group), hippocampal expression of Kir6.1 and Kir6.2 increased dramatically at 1, 7, and 30 days, and was further increased after treatment with medium and high dose 2-DG (all P < 0.05). Our results suggest that 2-DG may exert an antiepileptic effect through up-regulation of mRNAs and protein levels of Kir6.1 and Kir6.2, which may therefore be used as molecular targets in the treatment of epilepsy with 2-DG.

Metabolic regulation of neuronal excitability was increasingly recognized as an important factor in seizure control.Reducing the excitability of nerve cells is the way which ketogenic.diet,2-deoxy-D-glucose and fructose-1,6-bisphosphate provides the antiepileptic effects.Although the specific antiepileptic mechanism is not fully understood,good clinical effects of glycolysis inhibitor were obtained.In this article,the progress on the antiepileptic mechanism of glycolysis inhibitor was reviewed.

痫性发作时大量神经元异常同步放电而导致脑内生物能量大量消耗,在此应激状态下,无氧酵解供能系统启动以缓解有氧代谢(三羧酸循环)供能系统的能量供应短缺。研究表明,糖酵解过程作为生物体内重要的旁路供能途径,参与了痫性发作过程,为痫性发作提供能量,而其代谢产物乳酸可能参与痫性发作的终止。现就糖酵解过程参与痫性发作的可能作用机制,从下述两个方面进行综述(1)糖酵解过程在痫性发作能量代谢中的作用;(2)糖酵解过程代谢产物可能影响痫性发作的终止。

目的探讨心理护理对急性上消化道出血病人治疗效果的影响。方法选择急性上消化道出血病人73例,随机分为治疗组41例,予以西医常规治疗、内科常规护理及心理护理;对照组32例,予以西医常规治疗及内科常规护理。统计分析2组治愈、好转及无效病人例数,对照分析2组病人平均住院天数。结果经心理护理后,治疗组治疗有效率较对照组有显著提高,且治疗组病人平均住院天数显著少于对照组病人。结论上消化道出血病人实施心理护理干预可明显改善病人的心理健康状况,使疾病得到良好的控制,病人可早日康复出院。

目的探讨电话回访对提高采取门诊药物治疗的精神分裂症患者服药依从性的影响。方法将145例门诊首发精神分裂症患者分为回访组75例及对照组70例。对照组予常规护理。对回访组患者在常规护理基础上,分别于治疗后的第2周、第12周、第20周进行了3次电话回访。在第1次就诊时、治疗第8周、第16周、第6个月复诊时用简明精神病量表(BPRS)评价患者病情的严重程度,同时进行服药依从性的评定。结果首次就诊时2组患者BPRS量表评分与服药依从性比较,无统计学差异(p>0.05),经门诊治疗8周、16周及6个月后发现回访组BPRS评分显著低于对照组,服药依从性明显提高(p<0.05)。结论对采取门诊服药治疗的首发精神分裂症患者进行电话回访能提高其服药依从性。

Objective: To examine the aberrant neurophysiological response during the parametric N-back task in schizophrenia,and investigate the dynamic dysfunction in the WM system of schizophrenia.Methods: 20 schizophrenic patients and 20 matched healthy controls performed a parametric n-back task with increasing working memory(WM) load(0-Back,1-Back and 2-Back),while the EEG was recorded during they performed the task.Results: Schizophrenia performed significant poorly than normal subjects in 1-back and 2-back task(P0.01).For controls,P3 peak amplitude decreased progressively as WM load increased(0-back 1-back 2-back),while schizophrenic subjects showed no significant difference between the amplitude of P3 elicited in 1 and 2-back task(0-back1-back=2-back).Moreover,the patient group showed larger P3 amplitude than that of controls in central region in 0,1,2-back task,and parietal region in 2-back task.The difference wave N450 appeared at the frontal and parietal areas by subtraction of ERP in the lower load task from the higher load task.Schizophrenia demonstrated an enhanced 1-0 difference wave N450 in parietal region compared with controls,but a reduced 2-1 difference wave N450 in the same region(P0.05).Conclusion: Schizophrenia showed significant WM impairment.The short-term storage deficit in schizophrenia might be associated with the physiological inefficiency of parietal lobe and the reduced WM capacity.

[目的]明确遗传性视力障碍的鉴别诊断及高度近视的临床特征.[方法]对一个家系五代共35名成员中15例视力障碍者进行眼科全面检查.[结果]15位患者均因高度近视视力下降,可以矫正15例;5例有红绿色觉缺失,5例眼底检查显示以弥漫性视网膜脉络膜萎缩,色素沉着,动静脉变细,颞侧弧形斑,豹纹状眼底为特征的近视改变;11例视野异常;11例患者视网膜电图(F-ERG)检查出现视杆细胞的暗适应异常和视锥细胞的反应受损;8例视觉诱发电位(F-VEP)检查潜伏期均延长,视觉传导功能障碍.[结论]该家系高度近视为常染色体不完全显性遗传.近视程度随年龄、屈光度增加而加重.眼底、视野、视觉电生理检查有其相应的特征,可为鉴别诊断提供客观依据.

临床资料 患者男性,农民,49岁,因头痛1年,加重伴左侧肢体乏力,抽搐4 d于2006年12月20日入院.患者3年前开始排酱油样小便,血常规检查示白细胞、红细胞、血小板数减少(具体不详),酸溶血(Hams)试验(+),抗人球蛋白(Coomb's)试验(-),诊断为阵发性睡眠性血红蛋白尿(paroxysmal nocturnal hemoglobinuria,PNH),给予司坦唑醇、泼尼松、再造升血片、氨肽素治疗后,小便颜色转为黄色。

Objective Linkage analysis were performed in 2 pure Chinese paroxysmal kinesigenic dyskinesia families to localize the locus of them. Method Microsatellites markers corresponding to pericentrometric region of chromosome 16 were used in parametric and nonparametrie linkage analysis for 27 members in the 2 pedigrees, haplotypes were constructed subsequently. Result The maximum LOD score and NPL score in the 2 families were all negative, P values were significantly larger than 0.05.No haplotype segregated with PKD phenotype was found. It showed no evidence of association with known PKD loci in both pedigrees, providing evidence for a novel PKD locus. Conclusion PKD is heterogeneous, a novel PKD locus may be in pure Chinese pedigrees.

Objective:To investigate changes in the cognitive architecture of N-back performance in deficit and nondeficit schizophrenia under parametric increasing WM load.Methods:20 deficit schizophrenic patients,20 nondeficit patients and matched healthy comparison subjects were studied in a parametric N-back task(n=0,1,2,3).Results:The deficit schizophrenia were significantly different from the nondeficit patients and healthy subjects in the response accuracy of 1-back and 2-back test,while the nondeficit schizophrenia were different from healthy subjects only in the 2-back test.Furthermore,deficit patients showed significant lengthening in reaction time longer than nondeficit patients.Conclusion:Although N-back tasks validly access executive dysfunction as a neurocognitive trait in schizophrenia,there may be different underlying neural mechanism which caused more serious impairment in the N-back performance in deficit schizophrenia.It is necessary to make further study of neuro-anatomy and functional image.

目的 探讨述情障碍对生活质量的影响及其心理中介作用模型.方法 377名大二、大三学生完成多伦多20个条目述情障碍量表(TAS-20)、世界卫生组织生活质量量表(WHOQOL-100)、自评抑郁量表(SDS)、状态特质焦虑问卷(STAI)、应对方式和社会支持量表问卷调查.运用比较研究分析述情障碍对生活质量的影响;运用Pearson相关分析以及结构方程建模分析方法,确定心理中介作用最佳模型.结果 (1)述情障碍高、中、低分三组之间生活质量各维度及总体生活质量差异具有显著性(躯体功能χ2=35.15,P=0.00;心理功能F=51.44,P=0.00;独立性F=28.75,P=0.00;社会交往F=36.82,P=0.00;生活环境F=26.69,P=0.00;生活信念χ2=38.89,P=0.00;总体生活质量χ2=33.87,P=0.00);(2)各变量之间相关分析具有显著性(P＜0.01);(3)最佳模型为完全心理中介作用模型,能够解释生活质量变异的87.4%,拟合指数均在理想范围内(χ2/df=1.72,GFI=0.927,IFI=0.967,CFI=0.967,RMSEA=0.048),路径系数均具有显著性(述情障碍到负性情绪的路径系数β=0.30,P=0.00;述情障碍到应对方式的路径系数β=0.49,P=0.00;负性情绪到生活质量的路径系数β=-0.94,P=0.00).结论 (1)述情障碍对大学生生活质量具有广泛而显著损害作用;(2)述情障碍对生活质量的作用是一种完全中介效应,通过负性情绪、应对方式、社会支持等中介变量实现;其中负性情绪是关键性中介变量。

识记内容从短时记忆或工作记忆转移到长时记忆需要一定时间,依赖于特定的神经生理机制与过程,这一过程即记忆的巩固(consolidation of memory).