Digital phenotyping in Parkinson's disease: Empowering neurologists for measurement-based care

There remains a significant mismatch between the complexity and variability of symptoms and disabilities in Parkinson's disease (PD), and the capabilities of existing validated assessment tools to objectively measure and monitor them. However, with the advances of circuit and sensor technologies, it is now possible to apply the concept of digital phenotyping to PD, providing a moment-by-moment quantification of individual patient phenotypes using personal digital devices, such as smartphones. Such technology holds considerable potential if a patient-centered multidisciplinary team is able to select digital outcomes that are not only clinically relevant, but also provide measurement-based care results that support individual patient clinical decision making. However, it is likely to be a long road, requiring large collaborative efforts to undertake a number of essential steps before full integration and synchronization of these outcomes into patient management platforms that can deliver individualized data to patients, caregivers, and treating neurologists. In the meantime, both neurologists and patients can empower themselves with digital technologies, working as a team to define the ways that new technologies can be most powerfully employed in PD management. Once digital phenotyping becomes feasible and widely adopted in PD communities, it is likely to expand our understanding of individual PD patients' lives and priorities, leading to targeted treatments and better outcomes for PD patients and their families.     

美国新药技术成熟度评价研究

目的研究提出适合我国新药研发和药品安全管理的技术成熟度评价机制。方法借鉴美国新药研发技术成熟度等级(biomedical technology readiness level,BTRL)评价标准与方法,结合我国新药研发、监管和产业化特点,提出我国成熟度评价等级和指标,并在重大新药创制科技重大专项研发管理中开展探索分析。结果与结论探索建立我国化学药和生物制品技术成熟度评价等级标准,将为我国新药研发科研项目和保障药品安全提供管理与评估工具,为其他行业领域提供参考借鉴。     

虚拟现实技术在急诊医学教育中的探索与实践

目的探讨虚拟现实技术在急诊医学教育中应用的可行性和教学效果。方法对徐州某高校急救与救援医学专业48名本科生,在教学过程中随机分为对照组(24人)和虚拟现实教学组(24人),对比分析两组急诊医学专业课(创伤医学、急救医学和灾害医学)的成绩,评价虚拟现实技术在急诊医学教育中的效果。结果对照组创伤医学、急救医学、灾害医学三门专业课成绩分别为:(73.6±8.3)分、(76.2±9.5)分、(73.8±8.1)分;而虚拟现实教学组三门专业课成绩分别为:(85.3±5.2)分、(87.4±6.2)分、(92.6±5.5)分,均高于对照组,差异有统计学意义。结论与传统教学方法相比,虚拟现实技术在急诊医学教育中具有一定的优越性,是适应当前急诊医学教育人才培养的一种好的教育教学方法。     

“MMIF+PBL”教学法在神经外科专科教学中的应用

专科研究生的培养是医学教育中不可或缺的部分,传统的教学模式学生主动性较差,知识传授无法跟上知识更新的速度。PBL教学法(problem based learning)以学生为主体、问题为导向、小组讨论为主要形式,老师为引导者,学生主动进行知识探索,培养自身"归纳"与"查新"能力。多模态影像融合技术将影像信息进行数字化综合处理,并进行可视化,广泛用于临床实践中。两者相结合打破传统教材章节框架的束缚,以具体患者诊疗过程为线索,将枯燥的课本知识变为生动的小组讨论,将抽象的解剖学知识进行三维可视化,并以规范化的形式进行课程实施,理论联系实际,提高了教学效率,并消除时间与场地的限制,使教学效率最大化。本文比较了传统教育模式与新的教育模式,在培养研究生的"归纳"与"查新"能力方面,新的教学模式效率更高,更适合现代神经外科研究生教育。     

基于弥散张量成像技术的双相障碍患者脑白质纤维束异常分析

目的探讨抑郁期双相障碍患者脑白质纤维束的变化。方法选取42例未用药双相障碍抑郁期患者(患者组)和年龄、性别及右利手与之相匹配的59名对照者(对照组)进行DTI检查,根据约翰霍普金斯大学人类白质纤维束图谱,将大脑白质组织分割为20条公认存在的粗大纤维束,应用PANDA软件计算每个被试者每条白质纤维束的4项平均弥散属性,采用非参数置换检验比较2组在20条白质纤维束上弥散指标的差异,将差异有统计学意义的脑白质纤维束弥散指标与临床指标进行Pearson相关分析。结果患者组左侧钩束各向异性分数(fractional anisotropy,FA)值低于对照组(0.40±0.01与0.41±0.01,P=0.001);胼胝体辐射线额部FA值低于对照组(0.36±0.02与0.38±0.02,P<0.001);左侧钩束径向弥散率(radial diffusivity,RD)值高于对照组(6.57×10^-4±2.41×10^-5与6.40×10^-4±2.42×10^-5,P=0.0017)。Pearson相关分析显示,2组弥散指标差异有统计学意义的白质纤维束与临床指标之间均无相关性。结论抑郁期双相障碍患者钩束及胼胝体辐射线额部存在脑白质完整性破坏。     

The ventrolateral periaqueductal grey updates fear via positive prediction error

Aversive, positive prediction error (+PE) provides a mechanism to update and increase future fear to uncertain threat predictors. The ventrolateral periaqueductal grey (vlPAG) has been offered as a neural locus for +PE computation. Yet, a causal demonstration of vlPAG +PE activity to update fear remains elusive. We devised a fear discrimination procedure in which a danger cue predicts shock deterministically and an uncertainty cue predicts shock probabilistically, requiring prediction errors to achieve an appropriate fear response. Recording vlPAG single‐unit activity during fear discrimination in Long‐Evans rats, we reveal activity related to shock is consistent with +PE and updates subsequent fear to uncertainty at the trial level. We further demonstrate that vlPAG inhibition during shock selectively decreases future fear to uncertainty, but not danger, and temporal emergence of this effect is consistent with single‐unit activity. These findings provide causal evidence that vlPAG +PE is necessary for fear updating.