Development of white matter microstructure and executive functions during childhood and adolescence: a review of diffusion MRI studies

Diffusion magnetic resonance imaging (dMRI) provides indirect measures of white matter microstructure that can be used to make inferences about structural connectivity within the brain. Over the last decade, a growing literature of cross-sectional and longitudinal studies have documented relationships between dMRI indices and cognitive development. In this review, we provide a brief overview of dMRI methods and how they can be used to study white matter and connectivity and review the extant literature examining the links between dMRI indices and executive functions during development. We explore the links between white matter microstructure and specific executive functions: inhibition, working memory and cognitive shifting, as well as performance on complex executive function tasks. Concordance in findings across studies are highlighted, and potential explanations for discrepancies between results, together with challenges with using dMRI in child and adolescent populations, are discussed. Finally, we explore future directions that are necessary to better understand the links between child and adolescent development of structural connectivity of the brain and executive functions.     

多学科协作模式康复护理对脑卒中吞咽功能障碍患者吞咽功能及吸入性肺炎发生的影响

目的探讨多学科协作模式康复护理对脑卒中吞咽功能障碍患者吞咽功能及吸入性肺炎发生的影响。方法选择2018年3月-2020年3月我科收治的脑卒中吞咽功能障碍患者86例,按照随机数字表法分为对照组和观察组,每组43例。对照组采取常规专科护理。观察组采取多学科协作模式康复护理,持续干预12周。比较两组护理前后心理状态、神经功能、吞咽功能及吸入性肺炎发生率。结果两组护理前焦虑自评量表(SAS)、抑郁自评量表(SDS)、美国国立卫生研究院卒中量表(NIHSS)评分比较,差异无统计学意义(P>0.05);观察组护理后SAS、SDS、NIHSS评分低于对照组(P<0.05);观察组吞咽功能恢复优良率为90.70%,高于对照组的74.42%,吸入性肺炎发生率为4.65%,低于对照组的20.93%(P<0.05)。结论多学科协作模式康复护理能够改善脑卒中吞咽功能障碍患者心理状态,促进神经及吞咽功能恢复,预防吸入性肺炎的发生。     

非小细胞肺癌脑转移放射治疗进展

肺癌是目前世界上发病率第二、死亡率第一的恶性肿瘤。非小细胞肺癌（NSCLC）是其主要病理类型,且易发生脑转移。目前,NSCLC脑转移的主要治疗方式包括手术、放疗、化疗、分子靶向治疗和免疫治疗等。放疗是脑转移局部治疗的常用方法,随着技术和药物的不断发展更新,放疗与其他治疗手段如何联合是目前临床研究热点。本文将对NSCLC脑转移放射治疗进展进行综述,从而为临床工作中治疗方案的选择提供参考。     

标准引领下医学人才培养过程规范建构与实践

近年来,我国职业教育办学规模已实现跨越式发展。进一步加强内涵建设,提升育人质量将成为职业教育可持续发展的基本路径。标准建设是检验学校人才培养质量的重要依据。文章通过构建标准建设基本路径,基于健康产业发展需求,分析医学人才过程中的重要环节,完善专业人才培养方案,优化课程体系,制定包括课程、课堂教学、实践教学、临床教学等各环节在内的一系列教学相关标准,梳理教学管理制度,成立专门的质量管理组织,通过质量管理部门、校系二级督导、学生、教师等多途径收集质量信息,依据标准开展教学诊断与分析,加强信息反馈及改进监督,形成了标准建设-组织保证-诊断分析-反馈改进的保证体系,可持续提升育人质量。     

Electroacupuncture improves learning and memory functions in a rat cerebral ischemia/reperfusion injury model through PI3K/Akt signaling pathway activation

Electroacupuncture has been widely used to treat cognitive impairment after cerebral ischemia, but the underlying mechanism has not yet been fully elucidated. Studies have shown that autophagy plays an important role in the formation and development of cognitive impairment, and the phosphoinositide 3-kinase(PI3 K)/Akt signaling pathway plays an important role in autophagy regulation. To investigate the role played by the PI3 K/Akt signaling pathway in the electroacupuncture treatment of cerebral ischemia/reperfusion rat models, we first established a rat model of cerebral ischemia/reperfusion through the occlusion of the middle cerebral artery using the suture method. Starting at 2 hours after modeling, electroacupuncture was delivered at the Shenting(GV24) and Baihui(GV20) acupoints, with a dilatational wave(1–20 Hz frequency, 2 mA intensity, 6 V peak voltage), for 30 minutes/day over 8 consecutive days. Our results showed that electroacupuncture reduced the infarct volume in a rat model of cerebral ischemia/reperfusion injury, increased the mRNA expression levels of the PI3 K/Akt signaling pathwayrelated factors Beclin-1, mammalian target of rapamycin(mTOR), and PI3 K, increased the protein expression levels of phosphorylated Akt, Beclin-1, PI3 K, and mTOR in the ischemic cerebral cortex, and simultaneously reduced p53 mRNA and protein expression levels. In the Morris water maze test, the latency to find the hidden platform was significantly shortened among rats subjected to electroacupuncture stimulation compared with rats without electroacupuncture stimulation. In the spatial probe test, the number of times that a rat crossed the target quadrant was increased in rats subjected to electroacupuncture stimulation compared with rats without electroacupuncture stimulation. Electroacupuncture stimulation applied to the Shenting(GV24) and Baihui(GV20) acupoints activated the PI3 K/Akt signaling pathway and improved rat learning and memory impairment. This study was approved by the Animal Ethics Committee of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, China(approval No. 8150150901) on March 10, 2016.     

基于泛素-蛋白酶体途径探讨远志散“益气化痰开窍”治疗阿尔茨海默病的科学内涵＊

阿尔茨海默病（Alzheimer′s disease，AD）是一种常见的神经系统退行性疾病，磷酸化Tau蛋白异常聚集所形成的神经纤维缠结（Neurofibrillary tangles，NFTs）是AD的典型病理特征，直接参与AD的发生发展。因此，AD的治疗可从调节磷酸化Tau蛋白异常聚集入手。中医学认为“痰浊”是导致AD发生的重要病理因素之一，“正气亏虚，痰浊蒙窍”是AD的核心病机。“痰浊”与磷酸化Tau蛋白异常聚集密切相关，磷酸化Tau蛋白异常聚集可归属“痰浊”的范畴。化痰开窍与减少磷酸化Tau蛋白聚集在AD的治疗中有不谋而合之处。泛素-蛋白酶体系统（Ubiquitin-proteasome system，UPS）是细胞内蛋白降解的主要途径，参与AD进程中磷酸化Tau蛋白的降解。UPS功能受损是磷酸化Tau蛋白异常聚集和AD发生的重要原因。本文试图从中医“痰”的视角认识磷酸化Tau蛋白异常聚集，探讨中医“痰浊”与现代医学磷酸化Tau蛋白异常聚集的相关性，并从UPS视角提出益气化痰开窍法治疗AD的作用机制假说，推测UPS可能是远志散益气化痰开窍干预AD的主要途径，精确调控UPS可能是未来研究防治AD的新视角，为科学阐释通过调控UPS蛋白降解途径治疗AD的作用机制提供新思路。     

Modelling human pathology of traumatic brain injury in animal models

Traumatic brain injury (TBI) is caused by a head impact with a force exceeding regular exposure from normal body movement which the brain normally can accommodate. People affected include, but are not restricted to, sport athletes in American football, ice hockey, boxing as well as military personnel. Both single and repetitive exposures may affect the brain acutely and can lead to chronic neurodegenerative changes including chronic traumatic encephalopathy associated with the development of dementia. The changes in the brain following TBI include neuroinflammation, white matter lesions, and axonal damage as well as hyperphosphorylation and aggregation of tau protein. Even though the human brain gross anatomy is different from rodents implicating different energy transfer upon impact, especially rotational forces, animal models of TBI are important tools to investigate the changes that occur upon TBI at molecular and cellular levels. Importantly, such models may help to increase the knowledge of how the pathologies develop, including the spreading of tau pathologies, and how to diagnose the severity of the TBI in the clinic. In addition, animal models are helpful in the development of novel biomarkers and can also be used to test potential disease‐modifying compounds in a preclinical setting.