A modality-specific somatosensory evoked potential test protocol for clinical evaluation: A feasibility study

ObjectiveWe aimed to establish an objective neurophysiological test protocol that can be used to assess the somatosensory nervous system.MethodsIn order to assess most fiber subtypes of the somatosensory nervous system, repetitive stimuli of seven different modalities (touch, vibration, pinprick, cold, contact heat, laser, and warmth) were synchronized with the electroencephalogram (EEG) and applied on the cheek and dorsum of the hand and dorsum of the foot in 21 healthy subjects and three polyneuropathy (PNP) patients. Latencies and amplitudes of the modalities were assessed and compared. Patients received quantitative sensory testing (QST) as reference.ResultsWe found reproducible evoked potentials recordings for touch, vibration, pinprick, contact-heat, and laser stimuli. The recording of warm-evoked potentials was challenging in young healthy subjects and not applicable in patients. Latencies were shortest within Aβ-fiber-mediated signals and longest within C-fibers. The test protocol detected function loss within the Aβ-fiber and Aδ-fiber-range in PNP patients. This function loss corresponded with QST findings.ConclusionIn this pilot study, we developed a neurophysiological test protocol that can specifically assess most of the somatosensory modalities. Despite technical challenges, initial patient data appear promising regarding a possible future clinical application.SignificanceEstablished and custom-made stimulators were combined to assess different fiber subtypes of the somatosensory nervous system using modality-specific evoked potentials.     

基于Brown高级护理实践的癌痛专科护士岗位构建

通过文献回顾总结当前国内疼痛专科护士发展及癌痛管理中的不足,在此基础上以Brown高级护理实践理论框架为理论指导,侧重于资格要求、癌痛评估以及出院后的随访对癌痛专科护士岗位构建进行设计,旨在更好地促进癌痛专科护理的开展,提升癌痛护理水平。     

标准引领下医学人才培养过程规范建构与实践

近年来,我国职业教育办学规模已实现跨越式发展。进一步加强内涵建设,提升育人质量将成为职业教育可持续发展的基本路径。标准建设是检验学校人才培养质量的重要依据。文章通过构建标准建设基本路径,基于健康产业发展需求,分析医学人才过程中的重要环节,完善专业人才培养方案,优化课程体系,制定包括课程、课堂教学、实践教学、临床教学等各环节在内的一系列教学相关标准,梳理教学管理制度,成立专门的质量管理组织,通过质量管理部门、校系二级督导、学生、教师等多途径收集质量信息,依据标准开展教学诊断与分析,加强信息反馈及改进监督,形成了标准建设-组织保证-诊断分析-反馈改进的保证体系,可持续提升育人质量。     

中医皮肤病住院医师规范化培训存在的问题与改革

目的研究云南中医药大学皮肤病科住院医师规范化培训存在的问题,找到改革的关键。方法结合实际教学及规培现状进行分析:规培学员不够重视;规培内容多,规培时间短;规培学员水平参差不齐,轮转方案不够个性化等问题。近年来,皮肤科根据自身特点注重住院医师规范化培训工作的开展。通过对规培学员临床诊疗能力、学习能力、中医思维、师生沟通情况及规培满意度进行打分。结果对156位出科规培医师进行满意度调查及考核,大部分住院医师对所在科室科培训工作满意度较高,中医临床能力得到增强。在本科规培人员2月以上组80分以上的人数高于2月以下组(P<0.05)。结论通过加强考勤管理、制定适合的规培方案、改革教学内容及开展内容丰富的教学活动、加强业务学习,突出中医特色,不断促使学员进行学习皮肤病相关知识,皮肤科规培工作取得了一定成效。     

CACNA1C基因表达水平对弥漫性大B细胞淋巴瘤利妥昔单抗耐药的预测价值

目的:探讨钙离子通道A1C（calcium voltage-gated channel subunit alpha1 C，CACNA1C）基因表达水平对弥漫性大B细胞淋巴瘤（diffuse large B cell lymphoma，DLBCL）患者利妥昔单抗耐药的预测价值。方法:选取我院在2015年3月至2017年5月收治的DLBCL患者93例，均采用利妥昔单抗+CHOP方案化疗，随访2年，根据淋巴瘤化疗疗效评定标准，分为利妥昔单抗耐药组和敏感组；免疫组化法检测所有患者肿瘤组织的钙调蛋白CACNA1C基因、B淋巴细胞瘤-2（B-cell lymphoma-2，BCL-2）基因、PRDM1基因表达情况；绘制受试者工作曲线（receiver operating characteristic curve，ROC），分析CACNA1C基因、BCL-2基因、PRDM1基因水平在预测DLBCL利妥昔单抗耐药中的效能。结果:93例患者中共出现利妥昔单抗耐药病例26例，耐药率为27.96%；在一般资料方面耐药与敏感病例比较差异无统计学意义（P>0.05）；耐药组患者CACNA1C着色细胞比例（40.12±15.44)% vs (69.62±17.65）%低于敏感组，BCL-2着色细胞比例（66.31±15.92)% vs (47.43±14.66）%高于敏感组，PRDM1着色细胞比例（73.42±21.64)% vs (56.73±18.59）%高于敏感组，差异具有统计学意义（P<0.05）；ROC曲线显示，CACNA1C基因（AUC=0.848，95%CI=0.765~0.932）曲线下面积大于BCL-2基因（AUC=0.777，95%CI=0.673~0.881）和PRDM1基因（AUC=0.615，95%CI=0.486~0.744）；CACNA1C与BCL-2基因表达联合预测的曲线下面积（AUC=0.915，95%CI=0.854~0.976）显著高于三种基因表达水平单独预测，其中CACNA1C基因的最佳截点值为58.61%，BCL-2的最佳截点值为48.33%，此时联合预测在预测利妥昔单抗耐药的敏感性和特异性分别为80.77%和89.55%。结论:CACNA1C基因表达水平在预测DLBCL患者利妥昔单抗耐药方面具有较好的价值，其中CACNA1C与BCL-2联合预测利妥昔单抗耐药价值更高。     

论新时代高校图书馆的“四大要素”建设

在新时代图书馆的背景下,针对高校图书馆"四大要素",即人才的知识化、资源的科学化、设备的智能化与服务的人性化展开论述。人才队伍建设是图书馆发展的第一要素,也是图书馆发展的关键;资源建设是图书馆开展信息服务的基础;现代化设备的建设是图书馆提高服务质量的保障;人性化服务体系的建设是图书馆发展的方向。通过对"四大要素"的不断建设,从而推动高校图书馆转型发展。     

Cerebrovascular and neurological perspectives on adrenoceptor and calcium channel modulating pharmacotherapies

Adrenoceptor and calcium channel modulating medications are widely used in clinical practice for acute neurological and systemic conditions. It is generally assumed that the cerebrovascular effects of these drugs mirror that of their systemic effects – and this is reflected in how these medications are currently used in clinical practice. However, recent research suggests that there are distinct cerebrovascular-specific effects of these medications that are related to the unique characteristics of the cerebrovascular anatomy including the regional heterogeneity in density and distribution of adrenoceptor subtypes and calcium channels along the cerebrovasculature. In this review, we critically evaluate existing basic science and clinical research to discuss known and putative interactions between adrenoceptor and calcium channel modulating pharmacotherapies, the neurovascular unit, and cerebrovascular anatomy. In doing so, we provide a rationale for selecting vasoactive medications based on lesion location and lay a foundation for future investigations that will define neuroprotective paradigms of adrenoceptor and calcium channel modulating therapies to improve neurological outcomes in acute neurological and systemic disorders.