晚钠电流的魅影--从交感性 T 波到Takotsubo 综合征

交感性 T 波是一类与交感应激有关的心脏电生理异常，而 Takotsubo 综合征包含了心电生理异常和心脏机械功能异常两方面。二者有共同的发病机制，包括交感兴奋、晚钠电流（late sodium current，ⅠNaL ）及钙调蛋白介导的心肌细胞电生理异常等。它们可能是同一种疾病不同的临床表现形式。     

医院感染管理现况调查及对策研究

目的：总结目前医院感染管理存在的问题及探讨相应的对策。方法：调查分析我院2014年10月25日所有住院患者。结果：共收集132例患者，其中医院感染5例，感染率最高科室是综合内科；感染部位主要是下呼吸道；抗菌药物使用率是40．00％，其中综合内科使用率最高。结论：应加强重点科室的监测及干预，加强抗菌药物合理应用的培训和监督；从而降低我院院感的发生率。     

Stimulating the ventrolateral prefrontal cortex (VLPFC) modulates frustration-induced aggression: A tDCS experiment

BackgroundThe prefrontal cortex is crucial for top-down regulation of aggression, but the neural underpinnings of aggression are still poorly understood. Past research showed the transcranial direct current stimulation (tDCS) over the ventrolateral prefrontal cortex (VLPFC) modulates aggression following exposure to risk factors for aggression (e.g., social exclusion, violent media). Although frustration is a key risk factor for aggression, no study to date has examined the modulatory role of tDCS on frustration-induced aggression.ObjectivesBy exploring the VLPFC involvement in frustration-aggression link, we tested the hypothesis that the anodal tDCS over right and left VLPFC modulates frustration-induced aggression. We also explored whether tDCS interacts with gender to influence frustration-induced aggression.Methods90 healthy participants (45 men) were randomly assigned to receive anodal or sham tDCS over the right or left VLPFC before being frustrated by an accomplice. To increase reliability, several tasks were used to measure aggression.ResultsWe found that anodal tDCS over the left VLPFC, compared to sham stimulation, increased aggression. Unexpectedly, no main effect was found following tDCS of right VLPFC. However, we also found a significant interaction between gender and tDCS, showing that males were more aggressive than females following sham stimulation, but females became as aggressive as males following active tDCS.ConclusionOverall, these results shed light on the neural basis of frustration-induced aggression, providing further evidence for the involvement of VLPFC in modulating aggressive responses, and on gender differences in aggression. Future research should further investigate the role of stimulating the VLPFC on frustration-induced aggression.     

The benefits of simultaneous tDCS and working memory training on transfer outcomes: A systematic review and meta-analysis

BackgroundTranscranial direct current stimulation (tDCS) has shown potential as an effective aid to facilitate learning. A popular application of this technology has been in combination with working memory training (WMT) in order to enhance transfer effects to other cognitive measures after training.ObjectiveThis meta-analytic review aims to synthesize the existing literature on tDCS-enhanced WMT to quantify the extent to which tDCS can improve performance on transfer tasks after training. Furthermore, we were interested to evaluate the moderating effects of assessment time point (immediate post-test vs. follow-up) and transfer distance, i.e., the degree of similarity between transfer and training tasks.MethodsUsing robust variance estimation, we performed a systematic meta-analysis of all studies to date that compared WMT with tDCS to WMT with sham in healthy adults. All procedures conformed to PRISMA guidelines.ResultsAcross 265 transfer measures in 18 studies, we found a small positive net effect of tDCS on improving overall performance on transfer measures after WMT. These effects were sustained at follow-up, which ranged from 1 week to one year after training, with a median of 1 month. Additionally, although there were no significant differences as a function of transfer distance, effects were most pronounced for non-trained working memory tasks.ConclusionsThis review provides evidence that tDCS can be effective in promoting learning over and above WMT alone, and can durably improve performance on trained and untrained measures for weeks to months after the initial training and stimulation period. In particular, boosting performance on dissimilar working memory tasks may present the most promising target for tDCS-augmented WMT.     

Assessment of extravascular lung water by measuring the number of pulmonary ultrasound B-lines before and after CBP in patients with MODS

To determine whether the change in the number of pulmonary ultrasound B-line can accurately assess the extravascular lung water (EVLW) before and after continuous bedside blood purification (CBP) in patients with multiple organ dysfunction syndrome (MODS).Seventy-six patients with MODS who underwent CBP were examined within 24 hours before and after CBP using pulmonary ultrasound to detect the number of ultrasound B-line or using pulse indicator continuous cardiac output method to examine extravascular lung water, blood oxygenation index, and B-type natriuretic peptide (BNP) content. The correlation of the change in the number of B lines before and after CBP treatment with the negative balance of 24 hours liquid, the change of oxygenation index, and BNP content were analyzed.In the 76 patients, CBP treatment significantly decreased EVLW, the number of B-line, and BNP (P < .05 for all), while it significantly increased the oxygenation index (P < .05). Correlation analysis showed that the decrease in B-line number after CBP treatment was positively correlated with the 24 hours negative lung fluid balance, decrease of EVLW, oxygenation index improvement, and decreased BNP content. The change in the numbers of pulmonary ultrasound B-line can accurately assess the change of EVLW before and after CBP treatment and reflect the efficiency of ventilation in the lungs and the risk of heart failure.Thus, it can replace pulse indicator continuous cardiac output as an indicator for evaluating EVLW in patients with MODS treated with CBP.     

Pinging the brain with transcranial magnetic stimulation reveals cortical reactivity in time and space

BackgroundSingle-pulse transcranial magnetic stimulation (TMS) elicits an evoked electroencephalography (EEG) potential (TMS-evoked potential, TEP), which is interpreted as direct evidence of cortical reactivity to TMS. Thus, combining TMS with EEG can be used to investigate the mechanism underlying brain network engagement in TMS treatment paradigms. However, controversy remains regarding whether TEP is a genuine marker of TMS-induced cortical reactivity or if it is confounded by responses to peripheral somatosensory and auditory inputs. Resolving this controversy is of great significance for the field and will validate TMS as a tool to probe networks of interest in cognitive and clinical neuroscience.ObjectiveHere, we delineated the cortical origin of TEP by spatially and temporally localizing successive TEP components, and modulating them with transcranial direct current stimulation (tDCS) to investigate cortical reactivity elicited by single-pulse TMS and its causal relationship with cortical excitability.MethodsWe recruited 18 healthy participants in a double-blind, cross-over, sham-controlled design. We collected motor-evoked potentials (MEPs) and TEPs elicited by suprathreshold single-pulse TMS targeting the left primary motor cortex (M1). To causally test cortical and corticospinal excitability, we applied tDCS to the left M1.ResultsWe found that the earliest TEP component (P25) was localized to the left M1. The following TEP components (N45 and P60) were largely localized to the primary somatosensory cortex, which may reflect afferent input by hand-muscle twitches. The later TEP components (N100, P180, and N280) were largely localized to the auditory cortex. As hypothesized, tDCS selectively modulated cortical and corticospinal excitability by modulating the pre-stimulus mu-rhythm oscillatory power.ConclusionTogether, our findings provide causal evidence that the early TEP components reflect cortical reactivity to TMS.     

基于“血不利则为水”理论探讨乳腺癌术后上肢淋巴水肿辨治

“血不利则为水”乃《金匮要略》提出的著名论断,由此形成的“血水同治法”极大丰富了水肿病治疗。本文结合乳腺癌术后上肢淋巴水肿的临床特点,通过探讨“血不利则为水”的内涵及其病变过程中因“血不利”而致上肢肿胀的机理,认为活血利水法是防治乳腺癌术后上肢淋巴水肿的关键大法,具体应用中当结合益气行气、滋阴清热、疏肝健脾、化痰通络等法。