心脑血管病社区人群队列研究进展

心脑血管疾病研究中,队列研究（cohort study）具有相对明确的因果顺序、证据强度高的
特点,是了解其疾病史和探索病因的重要方法。针对心脑血管疾病,国际和国内进行了大量的以社区
为基础的队列研究,每个研究的规模、地点、调查方法和终点事件不尽相同,并在心脑血管病的流行
病学方面取得了巨大的成果。本文就国际和国内影响较大的心脑血管社区队列研究进展做一综述。     

外国留学生神经内科学的教学体会

目的 探讨留学生教学中存在的问题。
方法 收集2011-2012年带教的来自东南亚及阿拉伯地区的50名留学生的神经内科见习课讲解及见习
带教情况的数据，对发现的问题进行总结。
结果 教学过程中发现的问题有语言障碍和文化差异，教材问题及神经内科学的特殊性。
结论 根据留学生教学中存在的问题，针对性地提出改善教学质量、提高教学效果的方法。     

卒中及短暂性脑缺血发作二级预防指南 （第二部分）

最新版指南提供了如何对缺血性卒中或短暂性脑缺血发作后存活患者预防未来卒中事件
的基于医学证据的全面、及时的建议。指南的受众是所有参与这些患者二级预防的临床医师。基于
证据的建议包括控制危险因素,干预血管阻塞,心源性卒中患者的抗凝治疗和非心源性卒中患者的
抗血小板治疗。建议还包括各种特殊病因如主动脉弓粥样硬化、主动脉夹层、卵圆孔未闭、高同型半
胱氨酸血症、高凝状态、抗心磷脂抗体综合征、镰状细胞病、脑静脉窦血栓形成及妊娠等的卒中二
级预防。指南有专门章节阐述颅内出血后的抗血小板和抗凝治疗,以及指南的执行情况。     

卒中及短暂性脑缺血发作二级预防指南 （第三部分）

最新版指南提供了如何对缺血性卒中或短暂性脑缺血发作后存活患者预防未来卒中事件
的基于医学证据的全面、及时的建议。指南的受众是所有参与这些患者二级预防的临床医师。基于
证据的建议包括控制危险因素,干预血管阻塞,心源性卒中患者的抗凝治疗和非心源性卒中患者的
抗血小板治疗。建议还包括各种特殊病因如主动脉弓粥样硬化、主动脉夹层、卵圆孔未闭、高同型半
胱氨酸血症、高凝状态、抗心磷脂抗体综合征、镰状细胞病、脑静脉窦血栓形成及妊娠等的卒中二
级预防。指南有专门章节阐述颅内出血后的抗血小板和抗凝治疗,以及指南的执行情况。     

卒中及短暂性脑缺血发作二级预防指南（第四部分）

最新版指南提供了如何对缺血性卒中或短暂性脑缺血发作后存活患者预防未来卒中事件
的基于医学证据的全面、及时的建议。指南的受众是所有参与这些患者二级预防的临床医师。基于
证据的建议包括控制危险因素，干预血管阻塞，心源性卒中患者的抗凝治疗和非心源性卒中患者的
抗血小板治疗。建议还包括各种特殊病因如主动脉弓粥样硬化、主动脉夹层、卵圆孔未闭、高同型半
胱氨酸血症、高凝状态、抗心磷脂抗体综合征、镰状细胞病、脑静脉窦血栓形成及妊娠等的卒中二
级预防。指南有专门章节阐述颅内出血后的抗血小板和抗凝治疗，以及指南的执行情况。     

脑微出血和认知障碍的研究进展

脑微出血作为脑小血管病的一种影像学标志,与认知功能障碍的关系日渐受到关注。目前
临床研究发现微出血广泛存在于正常人群以及脑血管疾病或神经变性疾病引起认知障碍的患者,进
一步研究认为微出血可能是引起认知障碍的独立危险因素,主要影响执行功能,其数量与认知障碍
呈正相关。本文对其展开综述,并简要阐述了微出血可能引起认知障碍的发病机制,可能为临床治疗
或延缓高危人群的认知衰退提供帮助。     

脑侧支循环影像学评价研究进展

本综述阐述了脑侧支循环的特点、侧支循环影像学评价方法及其优点和局限性。主要包
括经颅多普勒超声、磁共振血管成像、计算机断层扫描血管成像、计算机断层扫描灌注成像、数字减
影血管造影、多时相计算机断层扫描血管成像。帮助临床医师在疾病早期选择合适的影像学方法评
价侧支循环状态,指导临床决策和预后。     

内皮祖细胞在缺血性卒中后血管再生 中的作用

缺血性卒中后的血管重建通过内皮祖细胞（endothelial progenitor cell,EPC）的增殖、迁移、
分化形成新生血管过程,无需依赖原有的血管系统,是目前血管再生治疗的新策略。EPC可促进脑
缺血组织的血管再生和修复,促进卒中患者神经功能的恢复,也可独立预测心脑血管疾病患病风险。
现就近年来EPC及其在缺血性卒中后血管再生中作用的研究进展作一综述     

分期支架治疗颈内动脉次全闭塞伴对侧颈内动脉狭窄的疗效与安全性观察

目的 观察分期支架治疗颈内动脉次全闭塞伴对侧颈内动脉狭窄患者的疗效及安全性。
方法 回顾性分析2017年1-12月在西安交通大学第一附属医院神经内科连续住院的颈内动脉次全
闭塞伴对侧颈内动脉狭窄患者的临床资料。采用分期治疗的方法，一期使用小球囊扩张次全闭塞侧
颈内动脉，间隔2周后进行二期支架置入。观察手术技术成功率，手术成功指一期小球囊扩张后狭窄
率减小，局部无夹层，且二期支架置入位置良好，残余狭窄率≤30%，前向血流mTICI 3级；围手术期
并发症（包括高灌注综合征、脑梗死、TIA等）及死亡情况；随访1个月、3个月、6个月及3年的mRS评分，
以及心脑血管事件和全因死亡。
结果 共纳入7例颈内动脉次全闭塞患者，平均年龄63.0±3.4岁，男性6例；其中6例为左侧，6例合
并对侧颈内动脉狭窄≥50%。手术技术成功率100%（7/7），所有患者均未发生围手术期并发症及死
亡。1个月随访时1例患者mRS评分为1分，其他6例均为0分，其余时间点所有患者均为0分，3年随访时1
例患者于术后1年发生冠心病。
结论 分期支架治疗在颈内动脉次全闭塞伴对侧颈动脉狭窄患者中相对安全，并对颈内动脉狭窄
的改善明显。     

复杂后循环颅内段动脉粥样硬化性病变的诊疗进展

中国是颅内动脉粥样硬化疾病的高发地区，多种危险因素与之有关。前后循环颅内动脉
狭窄/闭塞在危险因素分布上存在一定的差异性，同时后循环动脉的解剖结构具有自身独特的特点且
具有较多的解剖变异性。本综述回顾了基于颅内动脉粥样硬化的Mori分型、LMA分型，并对复杂后循
环颅内段动脉粥样硬化性病变进行了临床定义。由于复杂后循环颅内段动脉粥样硬化性病变药物治
疗效果往往不佳，卒中复发率高，同时血管内治疗又较困难，因此，本文从解剖结构、危险因素、卒中
病理生理特点、侧支循环、影像学评估及临床治疗进展多个方面对复杂后循环病变进行了综述。     

Mental health matters in elementary school: first-grade screening predicts fourth grade achievement test scores

The objective of the study was to evaluate whether mental health problems identified through screens administered in first grade are related to poorer academic achievement test scores in the fourth grade. The government of Chile uses brief teacher- and parent-completed measures [Teacher Observation of Classroom Adaptation-Revised (TOCA-RR) and Pediatric Symptom Checklist (PSC-Cl)] to screen for mental health problems in about one-fifth of the country's elementary schools. In fourth grade, students take the national achievement tests (SIMCE) of language, mathematics and science. This study examined whether mental health problems identified through either or both screens predicted achievement test scores after controlling for student and family risk factors. A total of 17,252 students had complete first grade teacher forms and these were matched with fourth grade SIMCE data for 11,185 students, 7,903 of whom also had complete parent form data from the first grade. Students at risk on either the TOCA-RR or the PSC-Cl or both performed significantly worse on all SIMCE subtests. Even after controlling for covariates and adjusting for missing data, students with mental health problems on one screen in first grade had fourth grade achievement scores that were 14-18 points (~1/3 SD) lower than students screened as not at risk. Students at risk on both screens had scores that were on average 33 points lower than students at risk on either screen. Mental health problems in first grade were one of the strongest predictors of lower achievement test scores 3 years later, supporting the premise that for children mental health matters in the real world.     

留学生见习带教在提高青年医生教学技能中的作用

目的通过评价和比较青年医师带教留学生和传统学生的教学技能的不同,探索留学生见习带教对青年医师教学技能的影响。方法以首都医科大学附属北京天坛医院神经内科负责见习带教工作的20名青年医生为研究对象,随机分入带教留学生的实验组和传统带教组。每组各10名青年医生,每人带教3次。由教学干事完成对于青年医生带教能力的评估试卷。组间比较包括:文献阅读质量、教学讲义质量、讲授技能、讨论技能、演示技能、课堂组织技能、课堂管理技能。比较两组带教青年医师的教学能力。组间比较应用独立样本t检验。P0.05为差异有显著性。结果留学生带教组与传统带教组的青年医师相比,拓展了知识的广度,增加了文献阅读的数量和深度,提高了英语书写、听力和阅读的能力,总体教学能力高于传统带教组。结论留学生见习带教可以提高青年医师的教学能力,进而提高医学留学生教育的质量。     

中国某高校留学生跨文化适应压力及其心理因素

目的：调查留学生跨文化适应压力的检出率及其相关因素。同时了解留学生的生理、心理因素与社会适应及中国文化之间的相互作用。方法采用抑郁焦虑压力量表、修订版社会文化适应量表和留学生版跨文化适应量表调查某高校共100名来自9个不同国家的留学生。结果调查结果显示32%的留学生存在跨文化适应压力问题,排前两位的适应问题分别是思念家乡和饮食问题。同时,留学生也存在压力、抑郁和焦虑等心理问题,不同年级留学生的压力问题发生率分别为：大一9.6%、大二37.5%、大三10.6%、大四25%、大五25%。抑郁症状发生率分别为：大一28.6%、大二12.5%、大三5%、大四40%和大五31.2%。焦虑症状发生率分别为：大一52.3%、大二37.5%、大三12.1%、大四30%和大五28.1%。社会文化适应第一位障碍是语言问题,其次是留学生在中国文化下保留自己的风俗习惯和个人兴趣的问题。结论留学生的适应问题突出,高校有必要加强引导和制定相关政策,以便留学生更好的适应中国文化。     

The Urban Teaching Cohort: pre-service training to support mental health in urban schools

Abstract

Supporting students’ mental health needs is critical in high-poverty urban school districts where many students are at risk for mental health problems. Although teacher–student relationships are at the core of student mental health promotion in the classroom, many teacher preparation programmes do not adequately prepare pre-service teachers entering into urban teaching for the realities of urban teaching. Miami University’s Urban Teaching Cohort (UTC) is an innovative, community-based approach to preparing pre-service teachers for work in the field of urban teacher preparation. In this paper, we review research on the challenges impacting the mental health of urban youth, describe how these challenges connect to the work of urban teachers and discuss how urban teacher preparation can help teachers better support students’ mental health. We discuss the elements of the UTC programme and how this preparation approach can help teachers build relationships with urban students and their families, as well as understand their communities from an asset perspective, to create a positive classroom community that supports the mental health of all students. Preliminary qualitative data indicate student and community support for the programme and support the impact of the programme on relationships and teaching practices.     

The use of instructive feedback for teaching language skills to children with autism

Instructive feedback (IF) is a teaching strategy in which extra information is presented to a student during teaching trials for other target skills. Research has shown that when IF is utilized with students with disabilities, they acquire additional skills without additional instructional time (fewer trials and sessions), resulting in more efficient instruction. Only one published study has focused specifically on the effectiveness of IF for children with autism, and demonstrated that the inclusion of IF resulted in more efficient teaching during 1:1 instruction for four preschoolers with autism/developmental delay. The current pair of studies seeks to replicate and extend the findings of Reichow and Wolery. In Study 1, we examined the effectiveness of IF with older students with autism with greater levels of impairment. Out of four students, only one showed more efficient acquisition with IF than without IF during 1:1 instruction. In Study 2, the student who demonstrated positive effects with IF in Study 1 participated in dyad instruction with IF. The effectiveness of IF for that student did not extend to the dyad context for this student.     

Sight Word Instruction for Students with Autism: An Evaluation of the Evidence Base

This paper reviews the evidence on sight word instruction as a method of teaching students with autism and significant cognitive and verbal limitations to read printed words. Nine single-subject studies were rated using Reichow et al.'s (J Autism Dev Disord 38:1311-1319, 2008) evaluative method for identifying evidence-based practice, and studies with at least adequate methodology were analyzed to identify common intervention features. Results yielded evidence in support of a massed trials approach featuring student response to a succession of items, differential positive reinforcement, systematic prompting, and use of visual supports. Across studies, students learned to identify printed words, even those with limited oral language and no prior reading instruction. However, no studies addressed the effects of sight word instruction on broad literacy outcomes.     

内蒙古高校不同专业、年级学生神经衰弱患病情况

目的 了解内蒙古高校不同专业、不同年级学生神经衰弱患病情况。方法 采用随机整群抽样法,以中国精神疾病分类方案与诊断标准第二版(CCMD-Ⅱ)中神经衰弱标准作最终诊断,并进行卡方检验。结果 该病总患病率为12.64％。蒙汉翻译专业患病率最高达19.74％,药学专业最低为2.63％,两者比较有显著性差异(P<0.05);按专业性质类型分,蒙语类专业患病率最高为18.18％,农学类专业最低为6.25％。一年级患病率最高,至五年级逐年级递减。结论 蒙语专业及低年级学生应作为重点防治对象。     

血管性痴呆教学的初探:以问题为基础的教学法的应用

目的探讨以问题为基础教学法(problem base-learning,PBL)在血管性痴呆教学中的应用效果。方法以首都医科大学7年制临床医学专业28名学生作为教学对象,在血管性痴呆的教学中,随机分为PBL教学组或传统教学组,教学后以问卷调查方式对2组的教学效果进行比较分析。结果 PBL教学法与传统教学法相比,学生在自主学习能力、提出问题能力、解决问题能力、临床实践能力和团队合作能力各方面均显著提高。结论在血管性痴呆的临床教学中,PBL教学法可提高学生的学习兴趣和积极性,并培养学生科学的临床思维,从而提升教学质量,具有良好的前景,值得推广和普及。     

以问题为基础的学习方法在留学生脑血管疾病教学中的探讨

目的  探讨以问题为基础的学习方法（probelm-based learning,PBL）应用在留学生脑血管疾病教学中的效果。 方法  将120例医学留学生根据教学方式不同分为两组,传统教学组（60例）和PBL教学组（60例）,对比两组的教学效果。 结果  PBL教学组的理论成绩（60.59±8.89 vs 54.11±9.97,P=0.024）、口语成绩（57.29±9.88 vs 51.99±10.30,P=0.029）及格率（88.3% vs 65.0%,P=0.009）明显高于传统教学组。 结论  PBL教学法有助于留学生脑血管疾病的理论教学和口语教学。     

The neurology resident as teacher: evaluating and improving our role

There is a need to improve the quality of teaching done by neurology residents because neurology residents are intimately involved in medical student education. This article reviews the available literature on techniques to improve the teaching ability of resident physicians. Eight randomized prospective studies were identified from health and education databases. The outcomes measured were student ratings of residents or objective ratings of interactions between residents and students. The skills curriculum provided a more robust response, and the objective standardized teaching examination (OSTE) provided a standardized outcome. There continues to be a need for studies specifically addressing the teaching by neurology residents and fellows.