Student Evaluations of the Courses in Medical Psychology at the Medical Department of the RWTH Aachen: A Three-Year Report

Introduction: With the introduction of a new curriculum “Modellstudiengang Medizin” in Aachen, the education in medical psychology was also restructured. This paper presents data from the students’ evaluations of the Basic Course in Medical Psychology and the new teaching format “Systemblock Psyche” over a three-year time span. Method: All students were asked to evaluate the courses anonymously online. Effect sizes [1] were calculated to compare acceptance of the different course types and also changes across time. Results: Both the Basic Course in Medical Psychology and the Systemblock Psyche were rated as “good” to “satisfactory” and were in their overall acceptance comparable to other courses and system blocks. Continuous improvement in acceptance was found for the Basic Course (d = 0.30 - 0.57). The Systemblock Psyche received varying evaluations but achieved higher scores on comprehensibility (d = 0.20) and communication among teachers (d = 0.34) than other system blocks. On the other hand, students rated the education in medical psychology as less relevant than other courses (d = 0.28 and 0.77, respectively). Conclusion: Overall, the acceptance rating was satisfactory and comparable to other evaluation studies conducted in earlier curricula. However, ratings of the relevance of the courses in medical psychology were disappointing and indicate the difficulty of teaching a biopsychosocial model to medical students.

Reversibility of visual field defects through induction of brain plasticity: vision restoration, recovery and rehabilitation using alternating current stimulation

For decades visual field defects were considered irreversible because it was thought that in the visual system the regeneration potential of the neuronal tissues is low.Nevertheless,there is always some potential for partial recovery of the visual field defect that can be achieved through induction of neuroplasticity.Neuroplasticity refers to the ability of the brain to change its own functional architecture by modulating synaptic efficacy.It is maintained throughout life and just as neurological rehabilitation can improve motor coordination,visual field defects in glaucoma,diabetic retinopathy or optic neuropathy can be improved by inducing neuroplasticity.In ophthalmology many new treatment paradigms have been tested that can induce neuroplastic changes,including non-invasive alternating current stimulation.Treatment with alternating current stimulation(e.g.,30 minutes,daily for 10 days using transorbital electrodes and^10 Hz)activates the entire retina and parts of the brain.Electroencephalography and functional magnetic resonance imaging studies revealed local activation of the visual cortex,global reorganization of functional brain networks,and enhanced blood flow,which together activate neurons and their networks.The future of low vision is optimistic because vision loss is indeed,partially reversible.

Non-invasive electrical brain stimulation:from acute to late-stage treatment of central nervous system damage

Non-invasive brain current stimulation（NIBS） is a promising and versatile tool for inducing neuroplasticity,protection and functional rehabilitation of damaged neuronal systems.It is technically simple,requires no surgery,and has significant beneficial effects.However,there are various technical approaches for NIBS which influence neuronal networks in significantly different ways.Transcranial direct current stimulation（t DCS）,alternating current stimulation（ACS） and repetitive transcranial magnetic stimulation（r TMS） all have been applied to modulate brain activity in animal experiments under normal and pathological conditions.Also clinical trials have shown that t DCS,r TMS and ACS induce significant behavioural effects and can – depending on the parameters chosen – enhance or decrease brain excitability and influence performance and learning as well as rehabilitation and protective mechanisms.The diverse phaenomena and partially opposing effects of NIBS are not yet fully understood and mechanisms of action need to be explored further in order to select appropriate parameters for a given task,such as current type and strength,timing,distribution of current densities and electrode position.In this review,we will discuss the various parameters which need to be considered when designing a NIBS protocol and will put them into context with the envisaged applications in experimental neurobiology and medicine such as vision restoration,motor rehabilitation and cognitive enhancement.

The psychological experience of Chinese nurses in support of COVID-19 frontline:A qualitative study

Objective: The objective of the study is to explore the real psychological experience of the frontline support nurses in fight against COVID-19,so as to provide a reference basis for targeted intervention and ensure the mental health of the frontline support nurses.Methods: The objective sampling method was used to conduct semi‑structured interviews with 9 frontline support nurses fighting COVID‑19,and the interview contents were analyzed using Colaizzi’s 7‑step method.Results: The psychological experience of frontline support nurses in fight against COVID-19 can be summarized into four themes: Thecoexistence of negative psychological experience and positive psychological experience (tension, anxiety, fear, and depression);psychologicalpressure;many factors that affect the negative psychological experience (the stimulation of the external environment, the care of family members,the guidance of network public opinion);and solid support system (good family support and rich social support).Conclusion: Although frontline support nurses have negative emotions and bear great psychological pressure, they all have a high sense ofprofessional responsibility. Therefore, managers should pay attention to their psychological experience and provide targeted assistance to them.

认知风格影响归类过程中的神经活动—来自fMRI研究的证据

行为学研究表明归类过程中的反应具有认知风格上的不同,但未有研究明确探讨归类过程的神经活动是否也受认知风格的影响。本研究通过双重认知风格分型任务筛选出分析型和整体型被试,以探讨归类过程中二者之间是否表现出神经活动的差异。实验任务要求被试从两个待选物中选出与目标物属于同一类别的一个。同时,采用f MRI技术扫描并记录他们完成任务时的BOLD信号。结果发现,与基线任务相比,整体型和分析型个体均激活了额-枕网络的一些脑区,包括额下回、楔前叶、枕中回等,表明不同认知风格个体在任务中可能共享与工作记忆等相关的脑区。另外,与分析型个体相比,整体型个体在右额下回、右旁海马回呈现更广泛的特异性激活,提示,认知风格可以影响归类过程中的脑活动,而整体型个体大脑右半球更强烈的活动表明这一类型认知风格个体在归类时更依赖于远距离的语义联结。

认知风格分型的神经基础：静息态fMRI研究

认知风格是个体习惯性的加工偏好。行为研究和任务态的功能成像研究已为认知风格分型理论提供了丰富的依据,但关于个体安静无任务状态下的脑活动是否也能表现出认知风格上的差异仍知之甚少。本研究使用静息态功能磁共振(f MRI)技术,以在校大学生为研究对象,以较为严格的标准使用认知风格分型任务分离出整体型和分析型认知风格被试,通过分析两组被试局部脑活动的一致性和整体脑活动的功能连接性,考察了静息条件下认知风格分型的神经基础。结果发现,不同认知风格群体的脑局部和整体活动均可能存在差异。个体越偏向分析型认知风格,左侧小脑的激活越强;左侧小脑与双侧大脑的功能区有更强、更广泛的连接。结果提示,安静无任务下个体的脑活动也可能表现出认知风格上的差异。

Gene therapy with caspase-3 small interfering RNA-nanoparticles is neuroprotective after optic nerve damage

Apoptosis,a key mechanism of programmed cell death,is triggered by caspase-3 protein and lowering its levels with gene therapy may rescue cell death after central nervous system damage.We developed a novel,non-viral gene therapy to block caspase-3 gene expression using small interfering RNA(siRNA)delivered by polybutylcyanoacrylate nanoparticles(CaspNPs).In vitro CaspNPs significantly blocked caspase-3 protein expression in C6 cells,and when injected intraocularly in vivo,CaspNPs lowered retinal capsase-3 immunofluorescence by 57.9%in rats with optic nerve crush.Longitudinal,repeated retinal ganglion cell counts using confocal neuroimaging showed that post-traumatic cell loss after intraocular CaspNPs injection was only 36.1%versus 63.4%in lesioned controls.Because non-viral gene therapy with siRNA-nanoparticles can selectively silence caspace-3 gene expression and block apoptosis in post-mitotic neurons,siRNA delivery with nanoparticles may be promising for neuroprotection or restoration of central visual system damage and other neurological disorders.The animal study procedures were approved by the German National Act on the use of experimental animals(Ethic Committee Referat Verbraucherschutz,Veterinärangelegenheiten;Landesverwaltungsamt Sachsen-Anhalt,Halle,Germany,#IMP/G/01-1150/12 and#IMP/G/01-1469/17).

Nanoparticles as a tool to deliver drugs to the retina and brain:an update

Over the past few years,different neurontargeted nanoparticles(NPs)were designed to deliver drugs to enhance neuron protection and recovery,and much progress was made in our understanding of the uptake mechanism and the related physicochemical properties.Physicochemical properties attracting much attentions in NP's design and modification include particle size,surface hydrophobicity。

信号引导注意力的视功能康复疗法治疗视野缺损

Background: In patients with postgenicular lesions of the visual system, areas of residual vision (ARVs) are the main predictor of recovery induced by vision restoration therapy (VRT). In these partially defective regions, the elevated pe rceptual thresholds can be acutely reduced by attentional cueing. Objective: To examine whether directing attention to ARVs using a visuospatial cue also increa ses longterm neural plasticity and thus enhances permanent training outcome. M ethods: In a prospective, randomized clinical trial, treatment outcome was compa red in patients with postgenicular visual system lesions who received either sta ndard VRT (control group [CG]; n=10) or VRT with attentional cueing (experim en tal group [EG]; n=9). Visual field size was determined before and after a 6-m on th treatment period using Tübingen Automated Perimetry and computerbased high resolution perimetry (HRP) and in regular intervals throughout this period b y HRP and detection performance in VRT. Results: In the area of the cue, restora tion of vision was significantly greater than during VRT without cueing: cued pa tients showed a much more pronounced shift of the visual field border toward the blind area than that observed in the CG or in uncued regions of the EG. Focusin g attention at ARVs during treatment changed topographic and temporal patterns o f recovery as compared with uncued regions of the visual field. Conclusions: Use of a visuospatial cue to focus attention at areas of residual vision amplifies longterm neuronal plasticity. The authors propose that topdown signals preac tivate partially damaged areas of V1, thus linking visual and attentional neuron al networks, with the effect of permanently increasing conscious visual percepti on.

Effects of unpredictable chronic stress on behavior and brainderived neurotrophic factor expression in CA3 subfield and dentate gyrus of the hippocampus in different aged rats

Background Brain-derived neurotrophic factor （BDNF） is a stress-responsive intercellular messenger modifying hypothalamic-pituitary-adrenal （HPA） axis activity. The interaction between stress and age in BDNF expression is currently not fully understood. This study was conducted to observe unpredictable stress effect on behavior and BDNF expression in CA3 subfield （CA3） and dentate gyrus of hippocampus in different aged rats. Methods Forty-eight Wistar rats of two different ages （2 months and 15 months） were randomly assigned to six groups： two control groups and four stress groups. The rats in the stress group received three weeks of unpredictable mild stress. The depression state and the stress level of the animals were determined by sucrose preference test and observation of exploratory behavior in an open field （OF） test. The expressions of BDNF in CA3 and dentate gyrus of the hippocampus were measured using immunohistochemistry. Results Age and stress had different effects on the behavior of different aged animals （age： F=6.173, P〈0.05, stress： F=6.056, P 〈0.05）. Stress was the main factor affecting sucrose preference （F=123.608, P 〈0.05）. Decreased sucrose preference and suppressed behavior emerged directly following stress, lasting to at least the eighth day after stress in young animals （P 〈0.05）. The older stress rats showed a lower sucrose preference than young stress rats （P 〈0.05）. Older control rats behaved differently from the younger control animals in the OF test, spending more time in the central square （P 〈0.05）, exhibiting fewer vertical movements （P 〈0.05） and less grooming （P 〈0.05）. Following exposure to stress, older-aged rats showed no obvious changes in vertical movement and grooming. This indicates that aged rats were in an unexcited state before the stress period, and responded less to stressful stimuli than younger rats. There was significantly lower BDNF expression in the CA3 and dentate gyrus regions of the hippocampus following stress in both age groups （P〈0.05）, a reduction that was still present at the eighth day after stress （P〈0.05）. Stress and age were the main factors affecting the expression of BDNF （F=9.408, P 〈0.05; F=106.303, P 〈0.05）. The aged stress group showed lower BDNF expression compared to the young stressed group at every testing time point. Conclusion Stress has age-dependent effects on behavioral responses and hippocampal BDNF expression in rats.

Physiological and psychological improvements of Chinese women with breast cancer in perioperative period after brief structured psychotherapy

everal studies have demonstrated that 30%-40% of cancer patients suffer from psychiatric problems such as depression, anxiety and adjustment disorders. The more positively the breast cancer patients rated their appraisal and tangible dimensions of social support, the lower value their mean cortisol level. Malignant melanoma patients who received 6-week structured intervention showed a lessening of emotional discomfort, augmentation of immune function and a decreased recurrence rate and mortality.

Indirect targeting of MYC sensitizes pancreatic cancer cells to mechanistic target of rapamycin (mTOR) inhibition

Dear Editor,Pancreatic ductal adenocarcinoma(PDAC)remains a significant health problem with an increase in the incidence and a five-year survival rate of only 10%[1].The Phosphoinositide 3-kinase-protein kinase-B-mechanistic target of rapamycin(PI3K-AKT-mTOR)pathway is a driver pathway in PDAC and an important therapeutic target[2].We[3]and others[4–6]have demonstrated that the mTOR kinase is a therapeutic target in PDAC,and rationally designed mTOR inhibitor(mTORi)-based combination therapies are emerging[2].

颅内压与眼内压的相关性及对视神经的影响：北京颅眼压力研究(iCOP)

通过逐渐梯度降低颅内压,明确颅内压逐渐降低过程中颅内压与与眼内压之间的关系及对视神经的影响,揭示颅内压降低导致压力相关性视神经损害的可能机理.采用8条实验用比格犬,分别于左侧侧脑室、左眼前房、左侧视神经蛛网膜下腔和腰大池内植入测压探头,同时监测颅内压、眼内压、视神经蛛网膜下腔压力和腰大池压力的变化.于右侧侧脑室内植入脑室外引流管,逐渐引流脑脊液实现梯度降低颅内压.对比分析基线和逐渐梯度下降过程中颅内压、眼内压、视神经蛛网膜下腔压力和腰大池压力之间的变化和关系,进而明确颅内压与眼内压之间的关系曲线.基线时,颅内压、眼内压、视神经蛛网膜下腔压力和腰大池压力各不相等且颅内压大于腰大池压力,而腰大池压力大于视神经蛛网膜下腔压力.跨筛板压力梯度在眼内压减视神经蛛网膜下腔压力时最大,次之为眼内压减腰大池压力,最小的是眼内压减颅内压.随着颅内压逐渐梯度下降,在一定范围内眼内压随着颅内压的降低而下降,此时跨筛板压力梯度保持相对稳定(即颅眼压力依赖区);但是,当颅内压降低超过某一阈值(即分界点)后,眼内压与颅内压相互分离(即颅眼压力非依赖区),此时跨筛板压力梯度因颅内压的降低而增大.因此,颅内压与眼内压在颅眼压力依赖区内相互协调,有助于保持跨筛板压力梯度的稳定.当颅内压降低超过某一阈值后,颅内压与眼内压之间的这种平衡被打破(即颅眼压力非依赖区)会导致跨筛板压力梯度升高.同时,颅内压降低会导致视神经压力梯度和跨视神经压力梯度升高,阻碍了脑脊液从颅内压蛛网膜下腔流入到视神经蛛网膜下腔,从而引起不同程度视神经损害的发生.

多病种言语性幻听症状影像遗传学特征及治疗靶点模式识别的研究概况

言语性幻听(AVHs)特指在确无外界现实声音刺激的条件下,患者体验到有针对自己的"真实"声音存在,多数"声音"给患者带来精神痛苦,是高致残致死性精神症状之一;并且AVHs可出现于多种精神障碍患者中,极易导致疾病的误诊误治。因此,探寻AVHs的病理特征和精准治疗靶点已经成为当前亟需解决的问题。采用基于高通量测序的基因组学技术和基于脑影像的脑连接组学技术,探索分裂症、双相障碍、单纯抑郁、边缘型人格障碍和具有AVHs症状的健康者等6类患者AVHs症状的影像遗传学特征;并采用模式识别技术,基于上述特征,建立不同病种AVHs早期定性诊断和疗效预测体系将有助于言语性幻听的机制研究。笔者从内源性遗传特征-内表型特征(脑环路/脑网络)-表型特征(临床表现)3个角度揭示不同病种AVHs共性及特异性影像遗传学特征,以确定不同AVHs的精准治疗靶点,对建立早期诊疗预测模型、提高早期治愈率具有重要的科学意义。

Pressure balance and imbalance in the optic nerve chamber： The Beijing Intracranial and Intraocular Pressure (iCOP) Study

To determine the interdependence of intracranial pressure(ICP) and intraocular pressure(IOP) and how it affects optic nerve pressures, eight normal dogs were examined using pressure-sensing probes implanted into the left ventricle, lumbar cistern, optic nerve subarachnoid space in the left eye, and anterior chamber in the left eye. This allowed ICP, lumbar cistern pressure(LCP), optic nerve subarachnoid space pressure(ONSP) and IOP to be simultaneously recorded. After establishing baseline pressure levels, pressure changes that resulted from lowering ICP(via shunting cerebrospinal fluid(CSF) from the ventricle) were recorded. At baseline, all examined pressures were different(ICP>LCP>ONSP), but correlated(P<0.001). As ICP was lowered during CSF shunting, IOP also dropped in a parallel time course so that the trans-lamina cribrosa gradient(TLPG) remained stable(ICP-IOP dependent zone). However, once ICP fell below a critical breakpoint, ICP and IOP became uncoupled and TLPG changed as ICP declined(ICP-IOP independent zone). The optic nerve pressure gradient(ONPG) and trans-optic nerve pressure gradient(TOPG) increased linearly as ICP decreased through both the ICP-IOP dependent and independent zones. We conclude that ICP and IOP are coupled in a specific pressure range, but when ICP drops below a critical point, IOP and ICP become uncoupled and TLPG increases. When ICP drops, a rise in the ONPG and TOPG creates more pressure and reduces CSF flow around the optic nerve. This change may play a role in the development and progression of various ophthalmic and neurological diseases, including glaucoma.

Movie therapy for children with amblyopia:restoring binocular vision with brain plasticity

Amblyopia is a common neurodevelopmental disorder that occurs when the two eyes do not send well matched visual signals to the brain early in life.The mismatch of the information coming from both eyes can have different causes:it may be due to differences in image clarity or contrast(called"anisometropia")because the two eyes require different corrective lens powers.