Electrophysiological and hemodynamic evidence for late maturation of hand power grip and force control under visual feedback

Several human imaging studies have described the neural network involved in power grip under visual control and the subset of cortical areas within this network that are sensitive to force modulation. As there is behavioral evidence for late maturation in even simple hand motor tasks involving visual feedback, we aimed at identifying the neural correlates of these developmental changes. Subjects from three developmental age groups (9-11, 15-17, and adults) performed the same power grip task in both a functional magnetic resonance imaging and an event-related potential (ERP) session. Trials started with a visual target indicating whether to squeeze at 20%, 40%, or 75% of their maximum and online visual feedback on the actual amount of force was provided. Longer reaction times and more shallow slopes of the force curve characterized the behavior of the younger age groups, especially the children. Both neurophysiological methods detected both general as well as force modulation-specific maturational changes. General development was characterized by decreasing ERP amplitudes and increasing deactivation of an extended network, closely resembling the so-called "default" network. The most pronounced developmental changes specific for force control were observed in an ERP component and brain regions involved in feedback processing. In contrast to adult subjects, we found evidence for a stronger dependency on visual feedback information in the younger age groups. Our results also suggest that the ability to deactivate task-irrelevant networks might be a late developmental achievement.     

Abnormal default-mode network activation in cirrhotic patients: a functional magnetic resonance imaging study

Background: Recently, increasing numbers of studies have demonstrated that, in humans, a default-mode functional network exists in the resting state. Abnormal default-mode network in various diseases has been reported; however, no report concerning hepatic cirrhosis has been published to date.

Purpose: To prospectively explore whether the resting-state network in patients with hepatic cirrhosis is abnormal or not, using functional magnetic resonance imaging (fMRI).

Material and Methods: 14 patients with hepatic cirrhosis (12 male, two female; 45±9 years) and 14 age- and gender-matched healthy volunteers (12 male, two female; 42±10 years) participated in a blocked-design fMRI study. A modified Stroop task with Chinese characters was used as the target stimulus. Statistical Parametric Mapping 99 software was employed to process the functional data. Individual maps and group data were generated for patients with hepatic cirrhosis and for healthy controls, respectively. Intergroup analysis between patients and healthy controls was also generated using the two-sample t-test model. Cluster analyses were done based on the group data, and an identical P value ≤0.01 with continuously connected voxels of no less than 10 was defined as significant deactivation. After fMRI scanning was complete, behavioral Stroop interference tests were performed on all subjects; reaction time and error number were recorded.

Results: Functionally, deactivation of the posterior cingulate cortex (PCC) and precuneus was absent when subjects performed the incongruous word-reading task; deactivation of the PCC, precuneus, and ventral medial prefrontal cortex was increased when they performed the incongruous color-naming task.

Conclusion: The functional as well as behavioral data suggest that cirrhotic patients may have an abnormal deactivation mode. The absence of deactivation in the PCC and precuneus may be a sensitive rather than specific marker in patients with hepatic cirrhosis.     

Emergency Medical Service (EMS) systems in developed and developing countries

OBJECTIVES: To compare patient- and injury-related characteristics of trauma victims and pre-hospital trauma care systems among different developed and developing countries. METHOD: We collated de-identified patient-level data from national or local trauma registries in Australia, Austria, Canada, Greece, Germany, Iran, Mexico, New Zealand, the Netherlands, the United Kingdom and the United States. Patient and injury-related characteristics of trauma victims with injury severity score (ISS) >15 and the pre-hospital trauma care provided to these patients were compared among different countries. RESULTS: A total of 30,339 subjects from one or several regions in 11 countries were included in this analysis. Austria (51%), Germany (41%) and Australia (30%) reported the highest proportion of air ambulance use. Monterrey, Mexico (median 10.1min) and Montreal, Canada (median 16.1min) reported the shortest and Germany (median: 30min) and Austria (median: 26min) reported the longest scene time. Use of intravenous fluid therapy among advanced EMS systems without physicians as pre-hospital care providers, varied from 30% (in the Netherlands) to 55% (in the US). The corresponding percentages in advanced EMS systems with physicians actively involved in pre-hospital trauma care, excluding Montreal in Canada, ranged from 63% (in London, in the UK) to 75% in Germany and Austria. Austria and Germany also reported the highest percentage of pre-hospital intubation (61% and 56%, respectively). CONCLUSION: This study provides an early look at international variability in patient mix, process of care, and performance of different pre-hospital trauma care systems worldwide. International efforts should be devoted to developing a minimum standard data set for trauma patients.     

影像本科生实习教学模式的探索

从影像本科生实习管理、PACS系统的应用学习、多媒体教学应用、横向和纵向诊断思维培养四个方面对影像本科生实习教学模式进行了有益的实践探索,以期培养合格的影像医学人才。     

卫生事业管理专业人才培养中的系统开放性思维解读与启示

随着我国医疗卫生体制改革的不断推进,社会对卫生管理人才的综合能力要求不断提高。我国高校的卫生事业管理专业是一门边缘交叉性学科,在人才培养模式方面尚不成熟,尤其缺乏人才培养的开放性。文章叙述了以系统开放性原理为基础,从内外环境建设方面探索并构建卫生事业管理专业人才培养新模式的必要性和可行性。     

利用现代教育技术尝试国际化教学模式

高等教育国际化带来先进的教育理念和教育思想.我们尝试了国际化教学模式,配合现代教育技术,运用在生物化学与分子生物学的教学上.在研究生的教学实践中取得了比本科生更好的教学效果.因此我们得出结论,为了在教学内容、教学方法上更适应国际发展,应该注意教学模式的多样化和个性化.     

剖宫产术后再次妊娠分娩的相关因素分析

目的：探讨剖宫产术后再次妊娠的适宜分娩方式。方法：回顾分析我院178例剖宫产术后再次妊娠妇女的分娩方式,并随机选取同期非瘢痕子宫阴道分娩和再次剖宫产孕妇资料进行对比分析。结果：剖宫产再次妊娠阴道试产的成功率为71.3%,其产后表现与正常孕妇相似,产后出血量、住院时间、并发症明显低于再次剖宫产者。结论：剖宫产史作为再次妊娠剖宫产的指征是不合理的,符合试产条件的在严密监护下可试产,以减少再次术后的各种危险和并发症。     

医疗系七年制学生医学英语的连续性教学初探

七年制医学教育是一种长学制本硕连读的医学教育新模式,全面扎实的外语能力是七年制学生培养中的重要环节,但目前我国医学院校医疗系七年制医学生的医学英语教学中普遍存在着英语教学严重不足、课程设置不合理、缺乏统一的标准和教材、忽略能力的逐步培养以及缺乏良好的学习和应用医学英语的环境的问题,为改变这一现状,使医疗系七年制的医学生能够更好的适应当今社会发展对于医学英语的需求,需要构筑医学英语的连续性教学模式,在医学院校医学英语教学的课程设置、教材选择、授课教师等多个环节制定连续性的培养计划,并采用多样性的教学模式,促使学生语言能力的更大幅度提高。     

农村卫生服务网络中连续性服务存在的问题与对策

本文分析了农村三级卫生服务网络之间的协调性与连续性的意义及其存在的卫生服务提供缺乏系统性、机构间缺乏有效的衔接与合作的机制、缺乏保障卫生服务连续性的政策支持等问题,从重构和完善卫生服务提供系统、强化机构间衔接与合作机制、发挥新型农村合作医疗制度对促进连续性卫生服务的导向作用及完善和保障卫生服务连续性政策的可持续发展等方面提出建议。     

医院社区联动自我管理教育模式对糖尿病患者治疗效果的影响研究

目的评价医院社区联动自我管理教育模式对常规治疗效果不佳的2型糖尿病患者的代谢控制、自我管理水平和生活质量的影响。方法将134例常规治疗后糖化血红蛋白水平超过6.5%的2型糖尿病患者随机分为医院社区联动自我管理教育组(自我管理组,74例)和常规糖尿病健康教育管理组(对照组,60例)两组。自我管理组首先在综合医院糖尿病中心接受连续五天的全日制糖尿病自我管理教育,随后建立社区健康管理档案定期接受电话和门诊随访。对照组仅接受常规糖尿病健康教育和社区常规跟踪随访。评价干预前和实施健康教育管理1年后的血糖、血压、血脂、糖尿病知识、自我管理水平和生活质量的变化。结果干预后,两组患者的空腹血糖、餐后血糖和糖化血红蛋白水平均较干预前显著下降,差异有统计学意义(P<0.05);同时,自我管理组患者的空腹血糖、餐后血糖和糖化血红蛋白水平显著低于对照组,差异均有统计学意义(P<0.05)。干预后,自我管理组糖尿病知识、自我管理效能和技能得分均显著高于对照组,差异有统计学意义(P<0.05)。干预后,自我管理组患者的满意维度得分和生活质量总分显著提高,并且满意维度评分优于对照组,差异均有统计学意义(P<0.05)。结论医院社区联动自我...