目标教学运用在神经内科临床护理带教中的效果及方法

目的探究目标教学运用在神经内科临床护理带教中的效果及方法。方法选取2018年6月-2019年6月期间到该院神经内科实习的48名女护生作为研究对象,采取随机双盲方法,将其均分为两组,各24例,对照组护生行常规护理带教模式,观察组护生行目标教学护理带教,对比两组护生出科综合成绩和带教满意度。结果观察组出科综合成绩显著高于对照组(t=3.732、6.862、6.715,P<0.05),且带教满意度优于对照组(χ~2=5.400,P<0.05)。结论在神经内科临床护理带教工作中运用目标教学法可调动护生学习积极性,提升护士对护理知识的掌握程度,提高带教满意度。     

Rehabilitation: the Cinderella of neurological research? A bibliometric study

Rehabilitation is under-represented in the neurological literature on disabling diseases. A Medline search was conducted to retrieve the articles published between January 1991 and June 1994 under the main headings of Stroke, Parkinson's disease, Multiple sclerosis, Brain injury, Ataxia and Dementia. These were then combined with the sub-heading Rehabilitation. The former search yielded 27724 articles, the latter 1272 (4.6%). In 1992, the Journal of Citation Reports (JCR) assigned to Journals publishing rehabilitation papers an average Impact Factor (IF) of 0.7–2.8 (median 1.8): that is, 31–90% (depending on the various main headings, median 68%) of the average IF given to Journals publishing non-rehabilitation papers. In the present study, the weight of the literature was defined as the product of the number of articles multiplied by the IF of the corresponding Journal (IF=0 for non-JCR Journals). Across the various neurologic conditions, the weight of the Rehab literature was 0.1–7% (median 2%) of the weight of the non-Rehab literature. The results suggest that neurology is still reluctant to face the disability challenge.

---

Sommario La riabilitazione è scarsamente rappresentata nella letteratura neurologica sulle patologie che causano disabilità. Gli Autori hanno interrogato la banca-dati Medline nella ricerca degli articoli pubblicati fra il Gennaio 1991 ed il Giugno 1994 sotto le parole-chiave Stroke, Parkinson's disease, Multiple Sclerosis, Brain injury, Ataxia e Dementia. È stato poi eseguito un incrocio con la parola-chiave secondaria Riabilitazione.La prima ricerca ha prodotto 27724 articoli mentre la seconda ne ha prodotti 1272 (4.6%). Nel 1992 il Journal of Citation Reports (JCR) ha attribuito alle Riviste che hanno pubblicato articoli con tema riabilitativo un Impact Factor (IF) medio di 0.7–2.8 (mediana 1.8), pari al 31–90% (a seconda della parola-chiave principale: mediana delle percentuali 68%) dell'IF medio attribuito alle Riviste che hanno pubblicato soltanto articoli su temi non riabilitativi. In questo studio è stato definito come peso della letteratura il prodotto del numero di articoli per l'IF delle rispettive Riviste (IF=0 per le Riviste non censite dal JCR). A seconda delle diverse patologie neurologiche, il peso della letteratura riabilitativa variava fra 0.1 e 7% (mediana 2%) del peso della letteratura non riabilitativa.I risultati suggeriscono che la Neurologia sia ancora riluttante ad affrontare la sfida che le pone la disabilità.

     

神经内科临床实习生临床思维能力培养实践

目的 探讨提高神经内科临床医学实习生临床思维能力的方法。方法 选择2017年至2018年临床医学实习生为研究对象,2018年为试验组（98人）,2017年为对照组（95人）。试验组实施临床思维能力培养,对照组采用传统常规的方法培养。实习结束前,采用自制的《临床医学实习生临床思维能力调查问卷》进行调查,评价教学效果。使用SPSS 14.0进行t检验和卡方检验。结果 试验组与对照组均存在临床思维的片面性、表像性、定势性、被动性、懒惰性、简化性、混乱性等问题,试验组存在的临床思维方面问题较对照组明显下降（P<0.001）,其中试验组的临床思维的片面性、表像性、定势性、被动性、懒惰性方面与对照组比较差异有统计学意义（P<0.05）。除语言沟通与表达能力外,试验组的其他临床思维能力自评得分与对照组比较差异都有统计学意义（P<0.05）。试验组的出科考核成绩与对照组比较差异也有统计学意义（P<0.05）。结论 临床医学生在神经内科实习阶段实施临床思维训练,有利于培养学生的临床思维能力,提高人才培养质量。     

Increased yield of full GBA sequencing in Ashkenazi Jews with Parkinson's disease

Background

Variants in GBA are the most common genetic risk factor for Parkinson's disease (PD), and are especially prevalent in the Ashkenazi Jewish (AJ) population. However, most studies on GBA in AJ genotype only seven selected Gaucher-associated pathogenic variants rather than sequencing the whole gene, which may leave carriers of PD-associated GBA variants undiscovered.

Conversion of nonfusing mumps virus infections to fusing infections by selective proteolysis of the HN glycoprotein

Mumps virus strains differ in their ability to induce cell fusion following an infection: strains with activeneuraminidase (NANase) fail to cause cell fusion, while strains with less active NANases cause cell fusion. When chymotrypsin is added to infected cells, cell fusion is amplified in a concentration-dependent manner for all mumps virus strains. Virions produced in such infections do not express HN glycoprotein-associated activities. Chymotrypsin treatment of purified mumps virus in vitro results in sequential cleavage into two glycopolypeptides, HNc1 (32K) and HNc2′ (41K), with concomitant loss of hemagglutinating and NANase activities, and infectivity. Further incubation with chymotrypsin causes complete degradation of HNc1 and digestion of HNc2′ to HNc2 (13K–19K). Both HNc2′ and HNc2 contain the [³H]palmitic acid label found in the HN polypeptide, which suggests that these fragments are associated with the viral membrane. Analyses of infected cells and released virions indicate that chymotrypsin acts similarly on HN exposed at the cell surface. Exogenous NAnase does not abolish the protease-augmented cell fusion though it does reduce cell fusion of untreated fusing strain infections. These results confirm that mumps virus HN glycoprotein is critically linked to cell fusion cytopathology and show that cyrptic cell fusion activity in nonfusing strain infections can be unmasked by the proteolytic removal of the HN glycoprotein.     

Functional inhibition and release: unilateral tachistoscopic performance and stereoelectroencephalographic activity in a case with left limbic status epilepticus

During prolonged nonconvulsive unilateral left limbic status epilepticus, a natural model of functional hemispheric inhibition, we performed two tachistoscopic experiments, a lexical decision task associated with a RVF (left hemisphere) superiority and a facial matching task associated with a LVF (right hemisphere) superiority. We found that epileptic activity in the left hemisphere, especially rhythmic high-frequency "tonic" discharges, inhibited performance on the lexical task but not on the facial matching task. This suggests that only cognitive activity in the discharging hemisphere is inhibited. Strikingly, the best performance of the right hemisphere was obtained while the left hemisphere was most inhibited, suggesting a functional balance of inhibition and release.     

不同带教模式在神经内科护理教学中的应用效果评价

目的研究不同带教模式在神经内科护理教学中的应用效果。方法选取2018年6月—2019年7月期间在该院实习的62名护士为研究对象,随机均分为两组,对照组采用传统教学,观察组采用PBL教学,观察两组的教学效果。结果实施后观察组护理实习生的理论知识分数(93.72±1.13)分与对照组护理实习生的理论知识分数(85.92±2.75)分相比较高,差异有统计学意义(t=14.607,P<0.001),观察组护理实习生的实践操作分数(95.25±2.43)分与对照组护理实习生的实践操作分数(84.36±4.64)分相比较高,差异有统计学意义(t=11.576,P<0.001),护生对教学的评价教学评价差评率0.00%与对照组19.35%相比较低,差异有统计学意义(χ2=4.613,P=0.032)。结论不同带教模式应用在神经内科护理教学中效果不同,PBL教学与传统教学相比较好,能够有效地提高护理实习生的理论和实践能力,受到了护理实习生的一致认可,值得在临床中应用。     

Giant axonal neuropathy. Report of a case with normal hair.

A further case of giant axonal neuropathy is described. The diagnosis was made by sural nerve biopsy in a boy presenting signs of a progressive spinocerebellar syndrome with polyneuropathy. Ultrastructurally a severe abnormality of this peripheral nerve, with loss of thick myelinated nerve fibers and the presence of giant axonal swellings was evident. The axonal swellings appeared to be caused by an accumulation of filaments which were also present in Schwann cells, as well as in endothelial and perineurial cells, justifying the term of "generalized microfibrillar hyperplasia". It is most remarkable that the patient's hair was not unusual, in contrast to the previously reported cases who had "kinky hair".     

The sunflower syndrome. A new look at "self-induced" photosensitive epilepsy

The stereotyped, episodic abnormal behaviour manifested by a child and her mother on exposure to a particular sort of sunlight is described in detail. The child is the first fully documented patient with this so-called "self-induced" form of photosensitive epilepsy in whom for several years no electroencephalographic sensitivity to flickering light could be demonstrated. The probability that the cingulate circuit may be the anatomical substrate involved in the pathogenesis of these patients' unusual response to sunlight is discussed. Both patients also exhibited remarkably persistent habit rhythmias--the one common to both being that of circling.     

小儿癫痫和智力低下的研究

我院小儿神经学组近年来对癫痫及智力低下进行了综合研究。在整体动物及神经细胞水平研究了神经肽(CCK,Som)与神经递质(GABA)之间的关系;初步探讨了铁诱发癫痫的化学机制;研究了抗癫痫药对发育中脑的影响;用双盲交叉法观察了新药“抗病灵”的疗效;利用24小时脑电图从临床电生理角度进一步探讨了癫痫的发病机制,解决了癫痫难以观察的问题。还在全国范围内进行了智力低下的流行病学调查,并分析其原因。