Neurological complications of hematopoietic cell transplantation in children and adults

Hematopoietic cell transplantation（HCT） is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen（HLA）-matched donor（allogeneic） or from the patient（autologous）. Before HCT, the patient is prepared with high dose chemotherapy and/or radiotherapy to destroy residual malignant cells and to reduce immunologic resistance. After HCT, chemotherapy is used to prevent graft rejection and graft versus host disease（Gv HD）. Neurological complications are related to the type of HCT, underlying disease, toxicity of the conditioning regimens, immunosuppression caused by conditioning regimens, vascular complications generated by thrombocytopenia and/or coagulopathy, Gv HD and inappropriate immune response. In this review, neurological complications are presented according to time of onset after HCT：（1） early complications（in the first month）-related to harvesting of stem cells, during conditioning（drug toxicity, posterior reversible encephalopathy syndrome）, related to pancytopenia,（2） intermediate phase complications（second to sixth month）-central nervous system infections caused by prolonged neutropenia and progressive multifocal leukoencephalopathy due to JC virus,（3） late phase complications（after sixth month）-neurological complications of Gv HD, second neoplasms and relapses of the original disease.

Erratum to “Is Alzheimer’s Disease an Adaptability Disorder? What Role Does Happiness Have in Treatment, Management and Prevention” [World Journal of Neuroscience 5 (2015) 180-188]

A case presentation indicating the importance of “happiness” in childhood causing memory block until the patent presented with probable mixed vascular and neurodegenerative memory loss at 60 years of age is presented to highlight the role of emotional factors in causing the disease. The question of whether Alzheimer’s disease is an adaptability disorder is raised, given the patient blocked out her memory of her childhood experience. The importance of “happiness” as a treatment goal raises issues of advocacy and Guardianship as well as capacity, which is addressed by actual case reference and court action in defence of the patient’s rights to have their wishes respected and observed. Functional mental capacity assessment, using the Functional Mental State Measure (FMSM) gives a greater indication of neuronal reserve than standard cognitive testing, as it helps to unravel the dilemma associated with pure cognitive assessment in Alzheimer’s Disease as well as vascular dementia patients and patients who, despite retained and intact functional capacity and ability to express their wishes, i.e. “best interest”, are “wrongly” placed under Guardianship. A General Systems approach, which recognises functional interaction as optimal and withdrawal or inadequate and/or inappropriate response as not, provides further understanding of the relationship between emotional factors, memory and neurodegenerative (Alzheimer’s) disease.

系统辨证脉学对《黄帝内经》脉诊命题的继承创新

系统辨证脉学遵循《黄帝内经》脉诊“可诊有过之脉”原则建立脉象信息系统,对传统脉诊定义模糊及歧义之处进行明晰,完善了脉诊信息采集的维度,形成了5个维度、25对脉象要素信息描述系统。遵循《黄帝内经》“凡诊者,必知终始”,建立脉象分析系统,依据脉象要素与机体状态的映射关系,耦合形成脉象系统。脉象系统包括体质、病因、病机、西医疾病等,各个脉象系统通过脉象要素之间的联系能够反映疾病过程中的重要节点、责任因素及内在动力学,即中医临床脉诊的“心智模型”。在脉象系统的指导下,能够灵活、准确地制定临床治疗原则,形成内在逻辑严密的临床综合治疗服务包,实现多层次、多维度指导下的综合治疗。

心血管疾病与心理疾病流行病学及相关机制研究新进展

根据WHO公布的最新统计数据显示,心血管疾病是全球的头号死因——每年死于心血管疾病的人数多于任何其他疾病,因此心血管疾病研究是世界公共卫生需要攻克的重要难题。与此同时,根据2022年WHO发布的数据统计,中国心理疾病患病率高达17%,近20年,中国人抑郁症发病率增长了120倍,且研究发现心血管疾病和心理疾病之间有着显著的相关性并存在一定的内在机制。本文旨在阐述心血管疾病和心理疾病之间的相关关系及其内在机制最新研究进展,从而发现焦虑症和抑郁症是心血管疾病的重要驱动因素,其可以通过自主神经系统和下丘脑-垂体-肾上腺轴对心脏造成损伤,而缺血性心肌病和心肌梗死可以通过介导脑部缺血性损伤和炎症反应来诱发不良情绪以及认知障碍。本文能够为心血管疾病高风险患者提供更多预防思路,也为心理疾病患者的诊断治疗提供新的研究方向,并为双心学科的交融提供参考。

艾司氯胺酮临床应用的研究进展

氯胺酮一直作为非巴比妥类静脉麻醉药广泛应用于临床麻醉和镇静,其右旋异构体艾司氯胺酮于2019年在我国上市,镇静、镇痛效果优于氯胺酮且不良反应更少。本文将针对艾司氯胺酮在精神神经系统疾病、临床麻醉及急危重症等领域的临床应用及常见不良反应作一系统综述,以期对临床使用提供参考。

Glymphatic system:a gateway for neuroinflammation

The glymphatic system is a relatively recently identified fluid exchange and transpo rt system in the brain.Accumulating evidence indicates thatglymphatic function is impaired not only in central nervous system disorders but also in systemic diseases.Systemic diseases can trigger the inflammatory responses in the central nervous system,occasionally leading to sustained inflammation and functional disturbance of the central nervous system.This review summarizes the current knowledge on the association between glymphatic dysfunction and central nervous system inflammation.In addition,we discuss the hypothesis that disease conditions initially associated with peripheral inflammation ove rwhelm the performance of the glymphatic system,thereby triggering central nervous system dysfun ction,chronic neuroinflammation,and neurodegeneration.Future research investigating the role of the glymphatic system in neuroinflammation may offer innovative therapeutic approaches for central nervous system disorders.

Polymeric nanocarriers for nose-to-brain drug delivery in neurodegenerative diseases and neurodevelopmental disorders

Neurodegenerative diseases are progressive conditions that affect the neurons of the central nervous system(CNS)and result in their damage and death.Neurodevelopmental disorders include intellectual disability,autism spectrum disorder,and attention-deficit/hyperactivity disorder and stem from the disruption of essential neurodevelopmental processes.The treatment of neurodegenerative and neurodevelopmental conditions,together affecting~120 million people worldwide,is challenged by the blood—brain barrier(BBB)and the blood—cerebrospinal fluid barrier that prevent the crossing of drugs from the systemic circulation into the CNS.The nose-to-brain pathway that bypasses the BBB and increases the brain bioavailability of intranasally administered drugs is promising to improve the treatment of CNS conditions.This pathway is more efficient for nanoparticles than for solutions,hence,the research on intranasal nano-drug delivery systems has grown exponentially over the last decade.Polymeric nanoparticles have become key players in the field owing to the high design and synthetic flexibility.This review describes the challenges faced for the treatment of neurodegenerative and neurodevelopmental conditions,the molecular and cellular features of the nasal mucosa and the contribution of intranasal nano-drug delivery to overcome them.Then,a comprehensive overview of polymeric nanocarriers investigated to increase drug bioavailability in the brain is introduced.

Effects of Ginkgo biloba extract EGb761 on neural differentiation of stem cells offer new hope for neurological disease treatment

Stem cell transplantation has brought new hope for the treatment of neurological diseases.The key to stem cell therapy lies in inducing the specific differentiation of stem cells into nerve cells.Because the differentiation of stem cells in vitro and in vivo is affected by multiple factors,the final differentiation outcome is strongly associated with the microenvironment in which the stem cells are located.Accordingly,the optimal microenvironment for inducing stem cell differentiation is a hot topic.EGb761 is extracted from the leaves of the Ginkgo biloba tree.It is used worldwide and is becoming one of the focuses of stem cell research.Studies have shown that EGb761 can antagonize oxygen free radicals,stabilize cell membranes,promote neurogenesis and synaptogenesis,increase the level of brain-derived neurotrophic factors,and replicate the environment required during the differentiation of stem cells into nerve cells.This offers the possibility of using EGb761 to induce the differentiation of stem cells,facilitating stem cell transplantation.To provide a comprehensive reference for the future application of EGb761 in stem cell therapy,we reviewed studies investigating the influence of EGb761 on stem cells.These started with the composition and neuropharmacology of EGb761,and eventually led to the finding that EGb761 and some of its important components play important roles in the differentiation of stem cells and the protection of a beneficial microenvironment for stem cell transplantation.

Is Alzheimer’s Disease an Adaptability Disorder? What Role Does Happiness Have in Treatment, Management and Prevention

A case presentation indicating the importance of “happiness” in childhood causing memory block until the patent presented with probable mixed vascular and neurodegenerative memory loss at 60 years of age is presented to highlight the role of emotional factors in causing the disease. The question of whether Alzheimer’s disease is an adaptability disorder is raised, given the patient blocked out her memory of her childhood experience. The importance of “happiness” as a treatment goal raises issues of advocacy and Guardianship as well as capacity, which is addressed by actual case reference and court action in defence of the patient’s rights to have their wishes respected and observed. Functional mental capacity assessment, using the Functional Mental State Measure (FMSM) gives a greater indication of neuronal reserve than standard cognitive testing, as it helps to unravel the dilemma associated with pure cognitive assessment in Alzheimer’s Disease as well as vascular dementia patients and patients who, despite retained and intact functional capacity and ability to express their wishes, i.e. “best interest”, are “wrongly” placed under Guardianship. Maladaptive responses, to control the change in external environment that are sensed or perceived, and which lead to disorder or to susceptibility to disease, exemplify a General Systems Theory approach, in which appropriate and adequate responses to environmental change, in behavioural terms, by a person, whether independently, or as the recipient or giver, or both, leads to functional interaction and happiness.

基于“治未病”理念的大学生心理问题三级防护体系构建与实践研究

“治未病”是中国传统医学的重要思想,强调“未病先防、既病防变、病好防复”三个方面。心理危机预防干预在守护学生成长成才、维护校园安全稳定等方面发挥着重要作用。本文借鉴“治未病”理念,构建大学生心理问题的三级防护体系,并以成都医学院为例开展实践探索,为促进高校大学生心理健康教育工作提供经验与参考。

肠道菌群与相关性疾病的研究进展

肠道是人体重要的消化器官和排毒器官 ,其回旋盘转的结构被形象地称为人体的“ 第二大脑”。肠道中寄生着数以亿计的细菌 ,这些细菌与机体互利共生 ,通过发酵食物为宿主及自身提供能量和营养物质 ,参与机体的代谢 ,构成“宿 主—肠道菌群共代谢”的代谢模式。此外,肠道菌群还能协助机体抵御病原体的侵入,促进人体健康、抵御疾病越来越多的研究表明,当机体受到外源或内源性刺激时,肠道内的微生物群落会发生改变 ,而肠道菌群的紊乱与炎症性肠病、代谢性疾病、免疫系统疾病、精神系统疾病以及肿瘤等疾病的发生发展息息相关。本文综述了肠道菌群影响各类疾病发病机制的研究进展,旨在为疾病的临床治疗提供新的参考和思路。

身心治疗对消化系统疾病患者临床效果的影响

目的:探讨身心治疗对消化系统疾病患者临床效果的影响。方法:选取2019年8月—2020年9月巨野县中医医院门诊收治的132例消化系统疾病患者作为研究对象,按照随机摸球法分为观察组与对照组,各66例。对照组给予常规西药治疗,观察组在对照组基础上给予身心治疗,比较两组临床疗效及治疗前后的症状评分、生活质量、心理韧性及应对方式。结果:观察组治疗总有效率明显高于对照组,差异有统计学意义(P<0.05)。治疗后,两组症状(腹痛、反胃、反酸、烧灼感)评分低于治疗前,且观察组各项症状评分明显低于对照组,差异有统计学意义(P<0.05)。治疗后,两组简明健康调查问卷(SF-36)评分明显高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。治疗后,两组心理弹性量表(CD-RISC)评分明显高于治疗前,且观察组力量性、乐观性、坚韧性评分明显高于对照组,差异有统计学意义(P<0.05)。治疗后,两组积极应对评分高于治疗前,消极应对评分低于治疗前,且观察组积极应对评分高于对照组,消极应对评分低于对照组,差异有统计学意义(P<0.05)。结论:消化系统疾病患者给予身心治疗效果较好,能够缓解患者临床症状,提高其生活质量、心理韧性,可促使患者选择积极的应对方式。

Remote multi‐wave radioneuroengineering:An innovative technology for non‐contact radio restoration of damaged nervous tissue of the human brain and spinal cord

Objectives: Significant advances in neurosciences will result from research focused on the non‐contact treatment of the nervous tissue(NT).The objective of the article is to describe a novel non‐contact method of restoration of damaged NT of the human brain and spinal cord that was termed multi‐wave neuro‐bioengineering. Methods: The method includes a purposeful complex program of different therapeutic ionizing and non‐ionizing electromagnetic radiation effects on the damaged NT,which is approved for clinical practice. Exposure of the human brain to a stepwise algorithmized combination of different ionizing and non‐ionizing radiations and simultaneous application of various types of electromagnetic radiation at the specific site of restoration considerably reduce the adverse effects of all types of radiation on NT.Results: The technology for non‐contact restoration of the injured tissue of brain or spinal cord was appiled in 30 cases of neurological disorders using the stereotaxic system, structural resonance therapy, radiotherapy and focused ultrasound. The applied methods are approved for humans and theor programmed combination opens new perspective for the treatment of brain and spinal cord disorders. Conclusions: The approach provides quick restoration of the disordered function of damaged brain tissue and establishes a new paradigm of radio non‐contact neurorestoration of the brain and spinal cord.

益生菌的临床研究进展

目的为益生菌的临床应用提供参考。方法系统检索益生菌临床应用的理论基础、研究进展和临床使用现状。结果与结论益生菌在儿科疾病、呼吸系统疾病、消化系统疾病、心血管疾病、精神疾病、肿瘤中的应用均有较好的有效性与安全性。高质量、大型的临床研究有待进一步开展,以规范和推广益生菌在临床的使用。

奥马哈系统在社区慢性疾病患者心理干预中的应用效果

目的评估奥马哈系统在社区慢性疾病患者心理干预中的应用效果。方法选取社区卫生服务中心于2012年3月-2013年4月记录在案的110例慢性疾病患者为研究对象,根据其纳入档案顺序随机分成常规干预组（A组,n=53）和奥马哈系统干预组（B组,n=57）。比较两组干预前后的SDS指数、SAS评分,干预后的生活质量评分。结果两组干预后的SDS指数、SAS评分均较干预前明显降低,且B组干预后的SDS指数、SAS评分明显低于A组（P〈0.05）;干预后,B组的生理功能、一般健康状况、精力、社会功能及情感职能的生活质量评分均明显高于A组（P〈0.05）。结论奥马哈系统干预方案用于社区慢性疾病患者可有效缓解其不良情绪,改善其不良心理状态,值得推广应用。

住院精神障碍患者共病神经系统疾病的状况调查

目的 探讨精神病院住院患者精神障碍与神经系统疾病共病的特征.方法 研究对象为2012年5-11月天津市安定医院602例住院精神疾病患者,按患者入院顺序并于入院5d后依次进行调查.精神障碍及神经系统疾病的诊断参照国际疾病分类第10版（ICD-10）诊断标准.结果 602例精神疾病住院患者中共病神经系统疾病72例,共病率为12.0％；共病的神经疾病主要是脑梗死、癫（痫）和帕金森病,共病率分别为7.5％（45例）、4.2％（25例）、0.3％（2例）,以脑梗死共病率最高.精神分裂症、双相障碍、抑郁障碍、器质性精神障碍、使用酒精所致的精神和行为障碍患者平均年龄分别为（55±10）、（50±7）、（52±7）、（58±10）和（47±4）岁,差异无统计学意义（F=0.298,P=0.878）；性别比（男/女）分别为21/10、5/2、1/3、24/4、2/0,其间差异有统计学意义（x2=34.566,P=0.000）；神经系统疾病共病率分别为7.1％（31/439）、11.9％ （7/59）、11.4％（4/35）、90.3％（28/31）和9.1％（2/22）,差异有统计学意义（x2=169.7,P=0.000）,以器质性精神障碍的神经系统疾病共病率最高.结论 精神障碍患者神经系统疾病共病率较高,常伴发的神经系统疾病为脑梗死、癫（痫）和帕金森病,以脑梗死最为常见；精神障碍共病神经系统疾病具有一定的年龄和性别特征,共病率以器质性精神障碍者最高.

新医改后农村基层卫生机构三种主要慢性病管理研究

高血压、糖尿病和精神疾病在农村地区患病率较高且经济负担较重,三种慢性病的预防和控制尤为重要。文章通过描述山东省莒南县、梁山县和平阴县乡镇卫生院和村卫生室三种慢性病管理功能的开展情况、管理工作量、管理形式、药物配备和卫生人员专业知识能力五方面内容来探讨新医改前后农村基层卫生机构三种慢性病系统管理的现状和变化,以期为新医改的实施提供现实依据。

关爱农村“留守儿童”

“留守儿童”是我国社会转型时期的一个特殊群体,他们的父母外出经商、务工,把他们留在原住地交给其祖辈或其它亲属照料,这部分儿童由于长期得不到父母面对面的教育、关爱,存在严重的监护缺失、教育滞后、心理病态发展等问题。笔者认为应以学校寄宿制为主导,家庭、政府和社会多方面力量协调作用,营造关爱留守儿童的社会氛围,构筑起面向留守儿童的一套完备的社会化服务体系。

安适合剂4号对小鼠中枢神经系统影响

安适合剂４号由夜交藤、柏子仁、酸枣仁、麦冬、朱砂等组成。临床上与氯丙嗪合用于抗精神病，能产生协同作用，且使后者用量及副作用减少。药理实验表明，安适合剂４号能使小鼠自主活动次数减少；对硝酸士的宁所致小鼠惊厥有抗惊厥作用；对戊巴比妥所致小鼠睡眠，能使翻正反射消失时间缩短，睡眠时间延长，且与剂量成正比例。

基于和法论治理论辨治脑科复杂性疾病

脑科复杂性疾病多为危重病、慢性病、疑难病等,临床上需要长期的多重用药。针对复杂性疾病的特点,根据脑病病种的具体病机,和法论治,诸法并施,方药相宜,个体化用药,是比较好的临床应对策略。通过肝胆管癌骨髓转移并脑转移、多发性腔隙性脑梗死并血管性帕金森综合征、线粒体脑肌病并病毒性脑膜炎继发性癫痫、脑动脉瘤性蛛网膜下腔出血并交通性脑积水、遗传性代谢病、舌根鳞癌切除术后迷走神经性呕吐6个医案,阐述了脑科复杂性疾病的和法论治用药特点:脑与奇恒互藏同治,脑与多脏燮理同治,多虚多实与多种亚治法复方以治,气血水火升降出入失调与承制调衡同治,神机轴、经隧、髓系等神经通路疏导平调同治,虚不受补与变通以治。