Subsystem macroarchitecture of the intrinsic midbrain neural network and its tectal and tegmental subnetworks

The midbrain is the smallest of three primary vertebrate brain divisions. Here we use network science tools to reveal the global organizing principles of intramidbrain axonal circuitry before adding extrinsic connections with the remaining nervous system. Curating the experimental neuroanatomical literature yielded 17,248 connection reports for 8,742 possible connections between the 94 gray matter regions forming the right and left midbrain. Evidence for the existence of 1,676 connections suggests a 19.2% connection density for this network, similar to that for the intraforebrain network [L. W. Swanson et al., Proc. Natl. Acad. Sci. U.S.A. 117, 31470–31481 (2020)]. Multiresolution consensus cluster analysis parceled this network into a hierarchy with 6 top-level and 30 bottom-level subsystems. A structure–function model of the hierarchy identifies midbrain subsystems that play specific functional roles in sensory–motor mechanisms, motivation and reward, regulating complex reproductive and agonistic behaviors, and behavioral state control. The intramidbrain network also contains four bilateral region pairs designated putative hubs. One pair contains the superior colliculi of the tectum, well known for participation in visual sensory–motor mechanisms, and the other three pairs form spatially compact right and left units (the ventral tegmental area, retrorubral area, and midbrain reticular nucleus) in the tegmentum that are implicated in motivation and reward mechanisms. Based on the core hypothesis that subsystems form functionally cohesive units, the results provide a theoretical framework for hypothesis-driven experimental analysis of neural circuit mechanisms underlying behavioral responses mediated in part by the midbrain.

According to the classical view, early in vertebrate development the neural plate invaginates to form the neural tube, which immediately displays three sequential swellings that were called the primary forebrain, midbrain (MB), and hindbrain vesicles by von Baer in 1837 (1) and that are followed by the presumptive spinal cord caudally. Together, these four differentiations or morphogenetic units of the neural tube go on to generate the entire adult central nervous system (2, 3). As a major part of a systematic research program to analyze the organizing principles of mammalian nervous system macroconnectivity, we recently completed a study of forebrain intrinsic circuitry (4), and here we present a similar study of MB intrinsic circuitry.Based on developmental and adult topographic features, the MB can be divided into two great parts: tectum (TC) dorsally and tegmentum (TG) ventrally (5, 6). In mammals, the TC in turn has two parts, the superior and inferior colliculi, which are important nodes in circuitry related to visual and auditory functions, respectively (3). The TG, in contrast, is much more differentiated structurally and functionally, with a variety of gray matter regions that have been intensively analyzed over the last 75 y. Among the most prominent are three cranial nerve nuclei (oculomotor nucleus, trochlear nucleus, and midbrain nucleus of the trigeminal nerve), as well as the pretectal region, red nucleus, substantia nigra and ventral tegmental area, midbrain raphe nuclei, periaqueductal gray, and midbrain reticular nucleus (3).This topographic approach to biological structure–function organization is like dividing the body in human anatomy into head, neck, trunk, and upper and lower limbs with hands and feet. Topographic anatomy is particularly useful for describing and mapping structure–function spatial relationships of body parts and for surgical procedures. For example, the hand is an obvious body part with especially important and intricate functions in humans. Systems anatomy, however, is an equally valid and complementary way of describing global principles of body organization. In human biology, the body is conveniently and systematically divided into about a dozen interrelated systems (skeletal, digestive, respiratory, nervous, and so on), and components of each typically play a role in topographic parts such as the hand. The systems approach is particularly useful for organizing vast amounts of data into simplified, readily understandable conceptual frameworks or models of how the body works as a whole.The nervous system can also be treated from the complementary topographic and systems perspectives (7), and it is the only bodily system remaining without a relatively simple global systems model, largely because its cellular network architecture is much more complex than the other systems. However, general network analysis tools, which can be applied to any complex system, from the internet to social interactions in a human population, offer one promising approach (8, 9). Basic requirements include a systematic parts list for the network, an understanding of how each part works, and an account of how the parts are connected to form a functional system (10). Our long-term strategy for the rat nervous system follows the time-honored approach to solving any difficult problem, that is, to proceed from coarser-grained to finer-grained analyses, analogous to the strategy used to sequence the human genome (11). Thus, using a nested approach, we have started at the coarse-grained macro level of analysis (axonal macroconnections from one gray matter region to another gray matter region), as a prelude and framework for analyses at the finer-grained meso level (connections between neuron types making up each gray matter region), micro level (connections between individual neurons making up each neuron type), and nano level (the set of synapses formed by each neuron) (12).     

复发性阿弗他溃疡心理因素生物标志物研究进展

复发性阿弗他溃疡（recurrent aphthous ulcer，RAU）是一种口腔黏膜常见的炎症性溃疡类疾病。据调查，人群中RAU的发病率高，且溃疡发作时灼痛明显，尤其是重型复发性阿弗他溃疡（major recurrent aphthous ulcer，MaRAU）发作时疼痛剧烈，严重影响着人们的日常工作和生活。RAU的病因和发病机制尚不清楚，心理因素对RAU的影响不容忽视。迄今为止，国内外关于心理因素对RAU的研究多倾向于主观量表的评估，对其客观生物标志物的研究较少。本文就近年来国内外RAU心理因素生物标志物的研究进展作一综述。     

ICU患者家属创伤后成长体验的质性研究

目的 深入了解神经外科ICU患者家属创伤后成长的真实体验。方法 采用质性研究中描述性现象学研究法,于2019年4月—8月对12名上海市某三级甲等综合医院神经外科ICU患者家属进行深入访谈,借助Nvivo 11软件管理访谈资料,采用Colaizzi 7步分析法进行归纳分析并提炼主题。 结果 共提炼出4个主题：人生哲学的改变,包括对生命的欣赏、关注自身健康、确立生活的优先次序、不确定的未来;个人力量增强,包括挖掘优势潜能、责任感增强、自我依靠感增强;与他人关系改善,包括“为己利他”行为、人际交往中获益;有效应对,包括设定希望、向下比较、学会自我调适。 结论 神经外科ICU患者家属在对抗逆境的过程中能体验到创伤后成长,呈现积极的自我变化现象,临床医护人员应关注患者家属的积极体验,将创伤后成长与临床心理护理整合,促成临床干预向以激发潜能、培养积极力量、促进成长为主题的范式转变。     

Efficacy of a dyadic intervention to improve communication between patients with cancer and their caregivers: A randomized pilot trial

ObjectiveCancer-related communication is critical for patients’ and caregivers’ adaptation to illness. This randomized pilot study was conducted to test the feasibility, acceptability, and efficacy of a specific dyadic intervention to improve communication.MethodsA four weekly-session intervention was developed to reinforce cancer-related patient-caregiver communication. Patients receiving treatment for any diagnosed cancer, and their caregivers, were recruited from two oncology clinics in Belgium. Sixty-four patient-caregiver dyads were assigned randomly to intervention and waitlist groups. Cancer-related dyadic communication, dyadic coping and emotional distress were assessed at baseline and post-intervention.ResultsThe intervention attrition rate was 6 %. Linear mixed models were performed on 60 dyads. Significant two-way group × time interaction indicated improvement in participants’ cancer-related dyadic communication frequency (β = ?1.30; SE = 0.31; p = .004), self-efficacy (β = ?10.03; SE = 3.90; p = .011) and dyadic coping (β = ?5.93; SE = 2.73; p = .046) after the intervention.ConclusionThese results indicate that the brief dyadic communication intervention is feasible and acceptable, and show preliminary evidence of efficacy.Practice implicationsEncouraging patients and caregivers to discuss personal cancer-related concerns may improve their ability to cope with the illness together.     

基于共享决策的医护-家属联动干预对胃癌患者的影响

目的:探讨基于共享决策的医护-家属联动干预对胃癌患者的影响。方法:选择2017年1月1日~2020年1月31日在胃肠外科治疗的胃癌患者106例,采用随机信封法分为观察组58例和对照组48例;对照组实施常规营养支持与护理,观察组在对照组基础上实施基于共享决策的医护-家属联动干预模式;比较两组干预前后治疗依从性,心理状态[采用焦虑自评量表(SAS)和抑郁自评量表(SDS)],恢复时间,各项营养指标变化[包括人血白蛋白(ALB)、前白蛋白(PRE)、转铁蛋白(TRF)]及并发症发生情况。结果:干预后,两组治疗依从性均高于干预前(P<0.05),且观察组高于对照组(P<0.05);干预后,两组SAS、SDS评分均低于干预前(P<0.05),且观察组低于对照组(P<0.05);观察组肛门排气时间、胃肠道功能恢复时间、下床活动时间及住院时间均短于对照组(P<0.01,P<0.05);出院后,两组ALB、PRE、TRF水平均高于干预前(P<0.05),且观察组高于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论:将基于共享决策的医护-家属联动干预模式应用于胃癌患者的护理中,能提高患者治疗依从性,缓解焦虑、抑郁情绪,改善营养指标水平,降低并发症发生率,对促进患者恢复具有重要意义。     

脊髓损伤患者及其配偶二元应对体验的质性研究

目的 探讨脊髓损伤患者及其配偶二元应对体验,为开展针对性的干预对策提供参考依据。 方法 采用目的抽样法,选取2020年4月—2021年3月入住安徽省某三级甲等综合医院脊柱外科的脊髓损伤患者12例及其配偶12名进行半结构化访谈,采用Colaizzi 7步分析法进行资料归纳并提炼主题。 结果 基于二元应对系统交互模型归纳出积极应对（共同面对、一致的疾病信念、转变沟通态度）、消极应对（适应困难、过度的保护行为、回避或冲突）、困难与挑战（亲密感丧失、寻求外部支持、构建新常态）共3个主题和9个亚主题。结论 脊髓损伤患者及其配偶积极应对与消极应对并存。医护人员需重视对患者及其配偶积极二元应对的引导,重点开展以夫妻为中心的应对干预,使其能更好地面对疾病,改善临床结局。     

子宫腺肌症对患者的心理影响及心理护理效果观察

目的 分析子宫腺肌症可能对患者造成的心理影响,探讨子宫腺肌症患者的心理护理方法,观察护理效果。方法 将62例子宫腺肌症患者随机分配为常规护理干预组和心理护理干预组,每组31例。对常规护理干预组患者,实施常规护理干预措施。对心理护理干预组患者,在常规护理干预措施的基础上,进一步对其实施针对性的心理护理干预措施。结果 心理护理干预组患者的焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分,以及睡眠质量自评量表(SRSS)各维度评分,都明显低于常规护理干预组,差异具有统计学意义。心理护理干预组患者的生活质量综合评定量表(GQOLI-74)各维度评分,要显著的高于常规护理干预组,差异同样具有统计学意义。结论 应重视并切实做好对子宫腺肌症患者的心理护理工作,这能够有效缓解患者的焦虑、抑郁情绪,提高患者的心理健康水平,改善患者的水平及生活质量。     

CT机的性能及运行状态监测

介绍了CT机的性能及运行状态在临床诊断中的重要性，分析了CT机各部件的监测与维护特点。应用CT核心组件持续监测总结法，解决了CT机的性能及运行状态监测非系统化的问题，为医院掌握CT机的实时性能状况提供了有力的依据，保障了设备准确稳定地运行。     

醋酸曲普瑞林联合心理干预治疗特发性中枢性性早熟患儿的疗效观察

摘 要 目的：探讨醋酸曲普瑞林联合心理干预治疗特发性中枢性性早熟患儿的疗效。方法: 40例中枢性性早熟患儿随机分为观察组和对照组,每组20例。对照组给予肌注醋酸曲普瑞林,每28 d 1次;观察组在对照组治疗基础上,增加每28 d 1次的心理干预。观察比较两组患儿治疗1年前后的情绪稳定性、抑郁心理、治疗依从性,以及身高、体质量、生长速度、骨龄（BA）、预测成年身高（PAH）等各项生长指标变化。结果:治疗1年后,观察组患儿的情绪稳定性评分及抑郁心理HAMD评分均显著低于对照组(P＜0.05),用药依从性明显高于对照组(P＜0.05)。观察组患儿的生长速度、PAH均显著高于对照组(P<0.05)。结论:醋酸曲普瑞林联合心理干预治疗特发性中枢性性早熟患儿,可以缓解患儿的抑郁心理、稳定情绪、提高用药依从性,且有效地提高生长速度,显著改善患儿的PAH。