多元化教学模式在缺血性脑血管病介入进修医师培训中的应用探索

目的 探讨多元化教学模式在提高缺血性脑血管病介入诊疗进修医师培训质量和效率方面的应用。方法 选择2018年1月—2022年12月在南京大学医学院附属鼓楼医院神经内科接受脑血管介入培训的进修医师为研究对象,应用多元化教学模式,即将多种教学方法融合交叉的培训模式进行教学。采用问卷调查的形式对进修医师满意度及其在培训前后介入诊疗理论知识和实践操作能力进行评估。结果 共纳入55名进修医师,年龄32～50岁,其中男性51名（92.73%）。89.09%的进修医师对多元化教学模式非常满意;分别有83.64%和85.45%的进修医师认为多元化教学模式激发了学习兴趣和自主学习能力。经过多元化教学模式培训后,能够独立完成颅外支架置入治疗的进修医师显著增加(41.82%vs. 12.73%,P=0.002)。结论 多元化教学模式是提高缺血性脑血管病介入进修医师培训质量和效率的有效手段。     

颅内静脉窦血栓形成的治疗进展

颅内静脉窦血栓形成(cerebral venous and sinus thrombo-sis,CVST)是缺血性脑血管病的一种少见类型,占全部脑卒中不足1%[1]。其病因复杂,起病形式多样,常被误诊漏诊。病情可在数小时或数天内迅速变化.近年来随着临床医生对该病的重视,神经影像技术以及神经介入放射学技术的飞[2]     

椎动脉优势现象对后循环缺血的影响及可能机制

正后循环缺血(PCI)是指各种原因导致的椎-基底动脉系统的缺血性改变,包括TIA和脑梗死两类,约占缺血性脑卒中的20%[1]。虽然PCI的发病因素与发病机制与前循环缺血性病变相似,但是目前PCI的相关病因及机制仍不明确[2]。近年来随着神经影像学与神经介入技术在脑血管病诊断和治疗中的广泛应用,对颅内外血管本身的发育异常,特别是单侧椎动脉优势(VAD)现象对PCI的影响日渐引起学者的关注[3]。本     

会商制度在血管神经病学进修医师教学中的应用

目的 探讨会商制度在血管神经病学进修医师教学中的作用。 方法 选取2015年4月-2016年3月首都医科大学附属北京天坛医院脑血管病中心的进修医师,在进 行传统进修教学的同时,组织进修医师参加病例会商,通过出入科考核和进修医师的满意度调查评 价会商制度在血管神经病学进修医师教学中的作用。 结果 共有42名进修医师完成了结合会商制度的教学计划。入科考核成绩平均分为（72.1±8.9）分,出 科考核成绩平均分为（86.5±9.2）分,有显著差异（P =0.02）,进修医师对进修教学的满意度为95.2%。 结论 会商制度可以提高进修医师管理血管神经病科患者的综合能力,对提升进修医师教学质量有 重要影响。     

缺血性脑血管病的血管内治疗

缺血性脑血管病为病残和病死率较高的中枢神经系统疾病,不仅给患者身体和精神带来痛苦,同时也给其家庭及社会造成极大的经济负担[1]。随着我国社会人口老龄化的趋势,缺血性脑血管病导致的各类问题亦日趋严重[2]。如何对缺血性脑血管病患者进行合理而规范的治疗,一直是相关领域医     

血管介入模拟器在临床医学实习生脑血管病教学中的应用

目的 探讨血管介入模拟器在临床医学实习生脑血管病教学中的应用效果。方法 选取2020年7月—2021年12月在解放军总医院第八医学中心神经内科实习的61名临床医学本科生为研究对象,其中33名试验组学员采用血管介入模拟器+传统教学模式进行培训,28名对照组学员采用传统教学模式进行培训。实习结束时通过出科理论知识、实践操作考核成绩以及问卷调查评价两种脑血管病带教模式的效果。结果 试验组学员出科时理论知识[（88.61±4.05）分vs.(83.43±4.21)分,P<0.001]、实践操作[（89.73±3.32）分vs.(85.54±3.17)分,P<0.001]考核成绩均高于对照组。问卷调查结果显示：试验组学员对神经内科产生兴趣的程度、对脑血管病认识的程度、自学能力、文献阅读水平均优于对照组,差异有统计学意义（均P<0.05）。结论 血管介入模拟器应用于脑血管病临床实习带教中提高了实习生对神经内科的兴趣,培养了实习生的学习主动性,提高了脑血管病临床实习的教学效果。     

缺血性脑血管病介入治疗的培训模式研究——“卫生部脑卒中筛查与防治工程培训项目——颈动脉支架置入技术培训班”经验介绍

目的探讨缺血性脑血管病介入治疗医师培训的方法和模式。方法对首都医科大学附属北京天坛医院急诊介入科颈动脉支架置入术培训班学员进行理论学习和操作训练,培训后进行考核对培训效果进行检验。结果参与2013年1~2月第一批培训的学员共30名,年龄30~45岁,平均(35.0±6.8)岁。全部学员均完成了培训并进行了考核,理论考试全部通过,理论成绩平均(82.1±4.2)分;操作考核也全部通过,总分平均(80.3±6.3)分。结论个体化教学和统一教学结合进行理论和操作技术培训颈动脉支架置入手术学员收效较好。     

神经介入治疗过程中并发症的防治

神经介入治疗学是随着近代神经影像学技术以及介入材料工程学的进展而建立和发展起来的新兴学科。由于脑血管病是神经内外科最常见的疾病之一，故神经介入治疗的应用范围非常广泛。目前，除北京、天津、上海、广州、武汉等大城市已相继建立了神经介入治疗中心外，其他中、小城市也在纷纷开展神经介入治疗工作。在国内从事神经介入治疗的医师中，多数为神经外科医师，     

急性缺血性卒中血管内治疗技术培训模式研究——急性缺血性卒中血管内治疗培训班经验介绍

目的 探讨培训介入医师急性缺血性卒中血管内治疗技术的方法和模式.方法 对中国卒中学会国际卒中介入培训学院,首都医科大学附属北京天坛医院主办的"急性缺血性卒中血管内治疗培训班"学员进行血管内治疗技术理论和实践培训,并通过实践工作后1年进行毕业答辩,对学员的培训成果进行检验.结果 完成培训并在实际工作中开展急性缺血性卒中血...     

抗血小板治疗在血管内治疗缺血性脑血管病中的应用

血管内治疗能显著降低缺血性脑血管病的致残、病死及卒中复发率。随着神经介入技术 和材料以及患者筛选策略的进步，缺血性卒中患者应用血管内治疗也日益增加。抗血小板治疗作为 缺血性卒中预防和治疗的重要手段，是血管内治疗中的重要一环，阿司匹林、氯吡格雷等是基石性 抗血小板药物，但具体的用药方案尚不统一。本文回顾和总结了国内外指南针对缺血性脑血管病行 血管内治疗患者的抗血小板策略建议，以及重要血管内治疗研究中采用的抗血小板治疗方案，以期 为神经介入医师行血管内治疗时抗血小板药物的应用提供参考。     

视频脑电图在小儿癫痫诊断中的应用

目的评价视频脑电图(video-EEG)在小儿癫诊断中的应用价值。方法对126例具有发作性症状的患儿进行连续8h的包括清醒、睡眠、诱发试验及必要的认知测验的视频脑电图监测。结果经发作期视频脑电图证实,39例初诊为癫性发作的患儿中14例(35%)为非癫性发作;15例其他症状发作中13例(86%)为非癫性发作。64例样放电患儿中51例(80%)确定发作类型,22例(34%)确定癫类型。视频脑电图可发现短暂轻微的癫发作及样放电引起的一过性认知损伤。结论视频脑电图在排除非癫性发作、确定癫性发作的类型、评价脑电-临床关系方面可提供准确可靠的证据,进一步提高癫的临床诊断水平。     

Role of glutathione in repair of free radical damage in hippocampus in vitro.

Depletion of glutathione (GSH), an intrinsic antioxidant, increases vulnerability to free radical damage in a number of cell systems. This study investigates the role of GSH in limiting electrophysiological damage and/or recovery from free radical exposure in slices of guinea pig hippocampus. Synaptic potentials (PSPs) and population spikes (PSs) were recorded from field CA1. Free radicals were generated from 0.006% peroxide through the Fenton reaction. Analysis of the input-output curves showed that peroxide treatment decreased PSPs and impaired ability of the PSPs to generate PSs as previously reported. Recovery was nearly total within a half hour. Treatment with 5 mM buthionine sulfoximine (BSO) for 2 h depleted hippocampal GSH to 79.2% of control values. The extent of free radical damage was not increased. Recovery, however, was only partial. GSH was further depleted by oxidation with diamide or covalent bonding with dimethyl fumarate (DMF) immediately before and during the peroxide treatment. Neither diamide nor DMF treatment in BSO-incubated tissue enhanced peroxide-induced electrophysiological deficits. Following these treatments, however, tissue showed little recovery from free radical damage. We conclude that glutathione is essential for repair processes in hippocampal neurons exposed to oxidative damage.     

Neuroprotective properties of memantine in different in vitro and in vivo models of excitotoxicity

The pathogenesis of stroke, trauma and chronic degenerative diseases, such as Alzheimer's disease (AD), has been linked to excitotoxic processes due to inappropriate stimulation of the N-methyl-D-aspartate receptor (NMDA-R). Attempts to use potent competitive NMDA-R antagonists as neuroprotectants have shown serious side-effects in patients. As an alternative approach, we were interested in the anti-excitotoxic properties of memantine, a well-tolerated low affinity uncompetitive NMDA-R antagonist presently used as an anti-dementia agent. We explored in a series of models of increasing complexity, whether this voltage-dependent channel blocker had neuroprotective properties at clinically relevant concentrations. As expected, memantine protected neurons in organotypic hippocampal slices or dissociated cultures from direct NMDA-induced excitotoxicity. However, low concentrations of memantine were also effective in neuronal (cortical neurons and cerebellar granule cells) stress models dependent on endogenous glutamate stimulation and mitochondrial stress, i.e. exposure to hypoxia, the mitochondrial toxin 1-methyl-4-phenylpyridinium (MPP+) or a nitric oxide (NO) donor. Furthermore, memantine reduced lethality and brain damage in vivo in a model of neonatal hypoxia-ischemia (HI). Finally, we investigated functional rescue (neuronal capacity to migrate along radial glia) by memantine in cerebellar microexplant cultures exposed to the indirect excitotoxin 3-nitropropionic acid (3-NP). Potent NMDA-R antagonists, such as (+)MK-801, are known to block neuronal migration in microexplant cultures. Interestingly, memantine significantly restored the number of neurons able to migrate out of the stressed microexplants. These findings suggest that inhibition of the NMDA-R by memantine is sufficient to block excitotoxicity, while still allowing some degree of signalling.     

Storage of lipofuscin in neurons in mucopolysaccharidosis

Summary A histochemical and ultrastructural study was made on the brain of a 23-year-old man with Sanfilippo's syndrome. In accordance with previous reports the cortical nerve cells contained a PAS-positive lipid storage substance. This showed intense autofluorescence in UV-light and was positive with various stains for lipofuscin. The storage material appeared ultrastructurally as inclusion bodies composed of short lamellated membranes, granular material, and vacuoles. In addition, concentrically and transversely lamellated membranous cytoplasmic bodies were observed in the nerve cells. It is concluded that the PAS-positive lipid storage material in the neurons was composed partly of lipofuscin in addition to other lipids presumably glycosphingolipids.Supported by a grant from the Expressen Prenatal Research Foundation