International consensus classification of hippocampal sclerosis in temporal lobe epilepsy: A Task Force report from the ILAE Commission on Diagnostic Methods

Hippocampal sclerosis (HS) is the most frequent histopathology encountered in patients with drug‐resistant temporal lobe epilepsy (TLE). Over the past decades, various attempts have been made to classify specific patterns of hippocampal neuronal cell loss and correlate subtypes with postsurgical outcome. However, no international consensus about definitions and terminology has been achieved. A task force reviewed previous classification schemes and proposes a system based on semiquantitative hippocampal cell loss patterns that can be applied in any histopathology laboratory. Interobserver and intraobserver agreement studies reached consensus to classify three types in anatomically well‐preserved hippocampal specimens: HS International League Against Epilepsy (ILAE) type 1 refers always to severe neuronal cell loss and gliosis predominantly in CA1 and CA4 regions, compared to CA1 predominant neuronal cell loss and gliosis (HS ILAE type 2), or CA4 predominant neuronal cell loss and gliosis (HS ILAE type 3). Surgical hippocampus specimens obtained from patients with TLE may also show normal content of neurons with reactive gliosis only (no‐HS). HS ILAE type 1 is more often associated with a history of initial precipitating injuries before age 5 years, with early seizure onset, and favorable postsurgical seizure control. CA1 predominant HS ILAE type 2 and CA4 predominant HS ILAE type 3 have been studied less systematically so far, but some reports point to less favorable outcome, and to differences regarding epilepsy history, including age of seizure onset. The proposed international consensus classification will aid in the characterization of specific clinicopathologic syndromes, and explore variability in imaging and electrophysiology findings, and in postsurgical seizure control.     

神经内科超说明书用药循证医学甄鉴

为了解某院神经内科超说明书用药情况和用药合理性,选取该院神经内科病区2016年6月~2016年12月共2988条长期医嘱,进行超说明书用药循证依据分析。结果发现神经内科超说明书用药均有循证医学证据支持,但证据质量存在差异。建议在实际应用中应充分评估超说明用药的有效性和安全性,尽量规避风险。     

Neurologie et psychiatrie. Des relations historiques complexes

In France, in the 19th century, French neurologists emerged as specialists among general medicine practitioners with no direct relationship to alienists. La Pitié-Salpêtrière was the Mecca of neurology and the Sainte-Anne Hospital Center that of psychiatry. The chair occupied by Charcot was above all neurologically unambiguous, unrelated to alienists. In the 20th century, the creation of a Certificate of Higher Studies (CES) in neuropsychiatry was decreed in 1949. In 1968, in accordance with the work of Henri Ey, it was proposed that neuropsychiatry be divided into two distinct CESs: neurology and psychiatry. This governmental decision was taken in a very particular context, that of the social upheaval and demonstrations of May 1968, which culminated in numerous demands and various reforms. The evolution of these two fields in France took a different path from that of Germany and the countries under its influence. In America, which is a mixture of cultures, there has been a development that could be considered to be a hybrid progression that was alternately in step with the French and at times more linked to Germany. We evoke the particular case of Jean Lhermitte. In recent years, many psychiatrists and neurologists, of all generations, have expressed the desire for a new reconciliation of these two specialties.     

中医院神经内科医院感染病例抗菌药物使用情况分析

目的：探讨抗菌药物使用对中医院神经内科医院感染发生的影响。方法对150例发生医院感染的神经内科住院患者感染前抗菌药物使用情况进行回顾性调查和统计学分析。结果150例医院感染病例中,发生医院感染前曾使用抗菌药物者占全部研究对象的80.7%,其中曾应用4种以上抗菌药物的为51例,占全部对象的34.0%,分别与未使用及使用1、2、3种抗菌药物者相比,差异有统计学意义（P〈0.05）。结论长期大量以及不合理应用抗菌药物是引发中医院神经内科医院感染的重要危险因素,应当在治疗中予以高度重视。     

针对性护理干预在神经内科气管切开患者中的应用

目的：探讨针对性护理干预在神经内科气管切开患者中的护理效果。方法：回顾性总结分析本院在2010年7月-2013年7月期间收治的90例患者的临床病例资料,按照随机数字表法分为两组,分别采用常规护理和针对性护理干预,比较两组患者的临床护理效果。结果：观察组患者术后感染率及HAMA评分均优于对照组,两组比较差异均有统计学意义（P〈0．05）。结论：对神经内科患者进行针对性护理干预能够有效改善患者术后各项临床症状,有助于临床治疗效果的巩固,具有临床推广应用价值。     

164例骨科住院患者神经内科术前评估会诊病例分析

目的通过分析综合性医院骨科住院患者神经内科术前评估会诊的临床资料,探讨神经内科术前评估会诊骨科患者的意义。方法统计2011年5月1日至2012年4月30日神经内科术前评估会诊的骨科住院患者的临床资料。对申请会诊的骨科住院患者的一般情况、疾病诊断以及术前评估会诊内容、预后等进行统计分析。结果术前评估会诊患者共164例,男78例,女86例,年龄24～89（60．2±12.3）岁。脊柱骨科（37.8％,62／164）、创伤骨科（31．1％,51／164）及矫形骨科（23．2％,38／164）申请会诊数量最多。术前评估会诊种类：脑梗死101例（61．6％,101／164）最常见,其次为脑出血后遗症15例（9．1％,15／164）及帕金森病14例（8．5％,14／164）等。神经内科术前评估会诊意见包括：（1）指导患者围手术期用药,包括脑血管病、帕金森病、癫痫及其他神经系统疾病。（2）评估骨科术后脑梗死的风险,评价脑血管狭窄程度及侧支循环。（3）会诊需要检查的内容以经颅多普勒[52．4％（86／164）]、颈部血管超声[44．5％（73,164）]及头颅CT[37．8％（62／164）]最常见。（4）共取消手术8例。经术前会诊的患者仅有3例（2例老年痴呆患者,1例帕金森病患者）术后出现神经系统并发症。结论神经内科术前评估会诊骨科患者有利于降低其脑卒中风险,改善患者临床预后,避免出现神经系统并发症。     

神经重症康复病房气管切开术后拔管困难患者的临床特点分析

目的 探讨神经重症康复病房气管切开术后拔管困难患者的临床特点。 方法 回顾性分析2015年1月至2019年5月由淄博市中心医院康复科神经重症康复病房收治的气管切开术后患者122例,根据患者是否成功拔管分为2组,拔管成功组（73例）和拔管困难组（49例）。采用全面无反应性量表（FOUR）和昏迷恢复量表（CRS-R）评定患者的意识状态,采用口腔摄入功能量表（FOIS）评定患者的进食能力,采用纤维内窥喉镜观察气道解剖结构,采用Marianjoy分泌物五分评分量表、Rosenbek渗漏-误吸量表（PAS）行分泌物潴留及吞咽误吸评分。先采用单因素分析,再进行多因素Logistic回归分析,筛选危险因素。 结果 单因素分析显示,年龄、意识状态、吞咽功能、分泌物潴留、误吸和声门开放水平可能是影响神经重症气管切开术后患者拔管的因素(P<0.05)。Logistic回归分析显示,咽喉部分泌物潴留多［OR=9.380,95%CI(3.010,29.231),P<0.05］和声门开放水平差［OR=0.186,95%CI(0.083,0.417),P<0.05］是神经重症气管切开术后患者拔管的危险因素。 结论 咽喉部分泌物潴留多和声门开放水平差是神经重症气管切开术后患者拔管困难的独立危险因素。纤维内窥喉镜在诊治过程中起着十分重要的作用。     

专科护理质量敏感指标管理模式在神经内科住院患者中的应用

目的:探讨专科护理质量敏感指标管理模式在神经内科住院患者中的应用效果。方法:选取2018年10月1日~2019年10月31日神经内科收治的患者80例,将2018年10月1日~2019年3月31日收治的40例患者作为对照组,采取传统护理质量管理模式;将2019年4月1日~10月31日收治的40例患者作为观察组,采取专科护理质量敏感指标管理模式。比较两组改进项目质量评价情况、护理风险事件发生情况及护理满意度。结果:观察组分级护理落实率、护理技术规范率、风险应对合格率和康复训练落实率均高于对照组(P<0.05,P<0.01);观察组护理风险事件发生率低于对照组(P<0.01);观察组护理态度、专业能力、综合服务质量评分及护理满意度总评分均高于对照组(P<0.01)。结论:在神经内科住院患者中应用专科护理质量敏感指标,能有效改善护理服务质量,降低护理风险事件发生率,提高护理满意度。     

临床护理人员分层级管理对神经科护理服务质量的影响

目的探讨临床护理人员分层级管理对神经科护理服务质量的影响.方法将我院52名神经科护理人员实施常规管理设为实施前组,2017年3月-2018年2月在常规管理基础上实施分层级管理设为实施后组.比较实施分层级管理前后护理人员的护理质量优良率、护理理论知识及操作技能考核成绩、患者护理满意度.结果实施分层级管理后本组护理人员护理理论知识、操作技能考核成绩均显著高于实施前(P<0.01);护理质量优良率(93.8%)、患者护理满意度(95.0%)显著高于实施前(80.8%、86.5%)(P<0.01).结论对神经科护理人员实施分层级管理,能显著提高护理人员的护理理论水平,增强护理操作技能,改善护理质量,提高患者的护理满意度.