Case based learning(CBL)is one of the teaching modes in clinic education and it is important to explore its teaching methods and qualities.This article discussed on how to use debate in CBL in neurology teaching for seven-year-program students including its organization,topic choosing,rules and specific process in order to provide references for teaching reform.

Objective To validate the technique and establish the reference jitter values in voluntarily activated extensor digitorum communis using a concentric needle electrode (CNE) in healthy Chinese adults.Methods From January to August 2013,forty-two Chinese subjects from healthy examination center of our hospital were prospectively studied,including 20 males and 22 females.Routine electromyogram was tested and jitter was recorded with CNE in all subjects.The jitter values of action potentials pairs of muscle fibers were expressed as the mean consecutive difference (MCD) after 20 analyzed potential pairs.Results The mean MCD of 42 subjects was (23.0 ± 3.1) μs ranging from 17 to 32 μs.The mean jitter value of all 840 potential pairs was (22.8 ± 7.5) μs ranging from 8 to 54 μs.Upper 95％ confidence limits for mean MCD and individual MCD were 29.2 μs and 37.8 μs,respectively.The mean value of MCD of 20 males and 22 females were (23.2 ± 2.8) μs and (22.8 ± 3.4) μs,respectively.There was no statistic difference between genders in MCD (t =0.44,P =0.66).There was no correlation between age and MCD (r =0.11,P =0.48).The mean value of mean interpotential interval was (802 ± 139) μs ranging from 541 to 1 160 μs.Conclusion The present study confirms the suitability of jitter analysis with CNE,which can serve as an objective and valuable method for testing the function of neuromuscular conjunctions.

Objective To investigate the relationship between the level of serum cystatin C (CysC) and cognitive function in patients with acute cerebral lacunar infarction caused by small vessel disease . Methods One hundred twen-ty-three patients with acute cerebral lacunar infarction were divided into 3 groups according to serum cystatin C level. Patients were further divided into normal group (n=64), vascular mild cognitive impairment (VaMCI) group(n=36),and vascular dementia( VaD) group (n=23). The CysC, estimated glomerular filtration rate (eGFR), serum creatinine (Scr), TC, TG, HDL, LDL, fast glucose, HbA1C, NIHSS, MMSE, ADAS-cog score were compared between the 3 groups. Multivari-able logistic regression analysis was used to examine the association of serum CysC with cognitive function. Results Sub-jects with higher CysC levels tended to have lower MMSE score(21.98 ± 6.08 vs. 25.02 ± 4.69 vs. 25.10 ± 3.95 )and higher ADAS-cog score(17.73±14.23 vs. 12.51±10.39 vs. 10.67±7.53). The higher CysC was, the higher SCr and lower eGFR were. Subjects with severer cognition impairment tended to have higher CysC(0.93 ± 0.21 vs. 1.10 ± 0.45 vs. 1.34 ± 0.58). Multivariable logistic regression showed the regression coefficient was 7.06(P<0.05). Conclusion Elevated Serum CysC is one of the risk factors of cognitive dysfunction and associated with the severity in patients with small vessel disease-re-lated acute lacunar cerebral infarction.

Non-alcoholic fatty liver disease (NAFLD) is an important type in chronic liver diseases. Its incidence is growing. It is regarded as the liver manifestation of metabolic syndrome, which is closely correlated with the onset of cardiocerehrovascular diseases. The prevention of stroke in patients with NAFLD is very important. Statius are the most important type of medications. They decrease cholesterol synthesis, upregulate low-density lipoprotein (LDL) receptor in the liver and lower the levels of low-density lipoprotein cholesterol (LDL-C) in circulation through inhibiting hydroxy-methyl-glutaryl coenzyme A (HMG-CoA) reductase, and thus effectively reduce the risks of stroke. Besides, the pleiotropy of statins and their effects on cholesterol-related cell signaling pathway may relieve or prevent the progression of NAFLD. There is greater controversy about whether statins can be used in patients with chronic liver diseases because they have some adverse reactions on liver, The evidence available has demonstrated that statins can he used safely in patients with NAFLD, and usually liver enzymes have no need to be monitored. Too much attention on the liver toxicity of statins may result in inappropriate drug withdrawal, and brings about the increased risk of cardiovascular events. So further evaluation is needed for the efficacy and safety of statins in patients with NAFLD.

Autophagy is a metabolic pathway that widely presents in eukaryotic cells through the lysosomal mechanism to degrade its components. Autophagy regulates cell death not only by activating classic autophagosomal-lysosomal pathway, but also by influencing the occurrence and development of apoptosis and necrosis. Currently, the effect of autophagy in neuronal injury after acute cerebral ischemia/hypoxia and its specific mechanisms remain unclear. Studies have demonstrated that the autophagy after ischemia/hypoxia has a neuroprotective effect, such as maintaining neuronal homeostasis and reducing neuronal death; but other studies have also suggested that autophagy may aggravate neuronal injury after ischemia/hypoxia by activating multiple pathways, and even induce neuronal death.

Many investigations have demonstrated that microRNA (miRNA) is not only involved in the modulation of nerve cell growth and physiological activity, but also responsible for dysfunctions in synaptogenesis or synaptic plasticity, neurodegenerative diseases, tumorgenesis in the nervous system, as well as in cerebrovascular disorders. With the intensive researches in miRNA, it is possible gradually to explain the related pathogenic mechanisms of some major diseases in the nervous system.

Understanding the basic mechanism of reading is the foundation for studying the pathogenesis of alexia and its rehabilitation care. Functional magnetic resonance imaging is one of imaging methods that can display the neurological activities in brain in vivo. It has been used in the studies of linguistics in recent years, particularly in the mechanisms of reading and processing. The article reviews the lateralization of Chinese single word processing and whether or not the specific brain region for cognitive processing of Chinese characters exists.

NADPH oxidases are a family of multi-subunit enzyme eomplexes.It catalyzes the production of reactive oxygen species (ROS).A large number of studies have shown that oxidative stress plays a very important role in cerebral ischemia-reperfusion injury,and the find of the expression changes about NADPH oxidase after cerebral ischemia may provide a new idea for the prevention and treatment of ischemic stroke.NADPH oxidase may become a new therapeutic target.

Objective To investigate the short-term prognosis of acute severe stroke patients treated with early partly of enteral nutrition followed by parenteral nutrition,only early enteral nutrition or only conventional family feeding.Methods According to stratified random method,97 severe acute stroke patients were divided into three groups,including early partly enteral nutrition and parenteral nutrition therapy group (study group,33 cases),only early enteral nutrition group (32 cases),and only conventional family feeding group (32 cases).The nutritional status,mortality,and incidence of infection were observed in the three groups at 21 days; NIH Stroke Scale (NIHSS) and Barthel Index at 21 days were compared among the three groups,and Modificied Rankin Scale (mRS) were compared at 90 days.Results At 21 days,the nutritional parameters including triceps skinfold thickness,mid-arm muscular circumference,hemoglobin,serum albumin,serum prealbumin and triglycerides in the study group were better than that in the other two groups.The incidence of malnutrition(10.0％ (3/30),37.5％ (9/24),12/19) and infection (18.2％ (6/33),40.6％ (13/32),56.3％ (18/32)) among the three groups were significantly different (x2 =15.2417,P =0.0005 ; x2 =10.1030,P =0.0064).The mortality (9.1％ (3/33),25.0％ (8/32),40.6％(13/32); x2 =8.6777,P =0.0131) and the NIHSS score (11.51 ±2.68,13.22 ±2.71,14.48 ± 2.55 ;F =7.86,P =0.0008) in the intervention group were lower than that in the other two groups.However,the Barthel Index had no significant difference among the three groups.At 90 days,the mRS grade 0 to l and the mRS grade 2 to 3 had no significant difference among the three groups; However,the mRS grade 4 to 5 among the three groups were statistical difference.Conclusion The early partly enteral nutrition combined with the stage of parenteral nutrition therapy can improve the short-term prognosis of severe acute stroke,though it cannot improve the Barthel Index on the 21th day.

Objective To compare the intensity of cognitive impairment and the level of pathological lesion in hippocampus induced by ischemia or chronic stress for a more valuable guidance in the treatment of post-stroke cognitive impairment(PSCI).Methods Forty male adult SD rats were divided medially into 4 groups:control,stress,ischemia and ischemia plus stress.Animals in 3 treatment groups were subjected respectively to an operation of modified selective middle cerebral artery occlusion or a procedure of continuous 3-week chronic unpredictable mild stress or a combined program of the two treatments.Morris water maze was employed to assess hippocampus-dependent learning and memory function and the brain-derived neurotrophic factor(BDNF)expression was detected by immunohistochemical staining in CA3 area and the mRNA amplification through semi-quantitative reverse transcription polymerase chain reaction(RT-PCR).Results Both chronic stressors and ischemia could significantly decrease the learning and memory function in rats like the escape latency in the performance of the Morris water maze test compared with the controL The stress group was related preferentially to a more severe deterioration in the learning function but not statistically in the memory loss as compared to ischemia group.The cognitive function decreased more markedly in rats when suffered the chronic unpredictable mild stresses plus ischemia,In comparison to control,ischemia significantly increased BDNF+ cells in hippocampal CA3 area (27.0 ±2.5 vs 20.1 ±2.1),while stress markedly reduced the expression of BDNF(15.2 ± 1.8 vs 20.1 ±2.1).Their combined effects still statistically led to a reduction in BDNF expression(8.2 ± 1.5,F =52.87,P ＜0.05).The same tendency was found in BDNF mRNA expression.Conclusions Stress may preferentially and powerfully influence hippocampus-dependent cognitive function compared with ischemia and the combination of focal ischemia and stress leads to the most impairments in cognition and hippocampal BDNF expression.Data suggest that more attention should be given to the strategies to increase the resistance to psychosocial stressors and decrease the depressed symptoms for a full PSCI recovery.