英美国家全科医生运行模式及对我国的启示

目的通过系统检索与分析英、美两国的全科医生运行模式,提出我国现行全科医生运行模式中出现的问题,总结国外经验与教训,为问题的解决建言献策。方法检索国内外文献,可获取与全科医生运行模式相关的政策法规与研究报告。结果目前,我国家庭医生签约服务推进中存在全科医疗服务供给严重不足、全科医生教育滞后、薪酬激励不力、医保支付衔接不畅、社会关注不够等问题。结论要借鉴英美国家较成熟的全科医疗模式经验,建立合理的薪酬支付方式、完善当前的全科医学教育培养体系,通过加强宣传和保障力度,提高家庭医生的职业认同及社会认可。     

右侧低频rTMS对老年抑郁症患者抑郁症状及认知功能的影响

目的探讨右侧低频重复经颅磁刺激(rTMS)对老年抑郁症患者抑郁症状及认知功能的影响。方法采用随机数字表法将86例老年抑郁症患者分为低频组(43例)和对照组(43例)。2组在抗抑郁药物治疗的基础上, 低频组给予1.0 Hz的rTMS治疗, 刺激部位为右侧背外侧前额叶皮质区, 每日治疗1次, 每次20 min, 每周5次, 治疗4周, 共20次;对照组给予相同时间和频次的伪刺激治疗。分别于治疗前及治疗第1、2、3、4、6、8周末, 采用汉密尔顿抑郁量表(HAMD-24)评估2组患者的抑郁情况, 采用威斯康星卡片分类测验(WCST)、连线测试A(TMT-A)评估患者治疗前及治疗4、8周末的认知功能, 治疗期间记录患者的不良反应。结果治疗前, 2组患者的HAMD评分及WCST评分组间差异均无统计学意义(P>0.05)。治疗第1、2、3、4、6、8周时, 2组患者的HAMD评分均较组内治疗前明显下降(P<0.05);治疗3、4、6、8周后, 各时间点低频组的HAMD评分均低于对照组, 且组间差异均有统计学意义(P<0.05)。治疗4、8周后, 2组患者WCST评分中的完成分类数...     

Minocycline Attenuates Microglial Response and Reduces Neuronal Death after Cardiac Arrest and Cardiopulmonary Resuscitation in Mice

The possible role of minocycline in microglial activation and neuronal death after cardiac arrest(CA) and cardiopulmonary resuscitation(CPR) in mice was investigated in this study. The mice were given potassium chloride to stop the heart beating for 8 min to achieve CA, and they were subsequently resuscitated with epinephrine and chest compressions. Forty adult C57BL/6 male mice were divided into 4 groups(n=10 each): sham-operated group, CA/CPR group, CA/CPR+minocycline group, and CA/CPR+vehicle group. Animals in the latter two groups were intraperitoneally injected with minocycline(50 mg/kg) or vehicle(normal saline) 30 min after recovery of spontaneous circulation(ROSC). Twenty-four h after CA/CPR, the brains were removed for histological evaluation of the hippocampus. Microglial activation was evaluated by detecting the expression of ionized calcium-binding adapter molecule-1(Iba1) by immunohistochemistry. Neuronal death was analyzed by hematoxylin and eosin(H&E) staining and the levels of tumor necrosis factor-alpha(TNF-α) in the hippocampus were measured by enzyme-linked immunosorbent assay(ELISA). The results showed that the neuronal death was aggravated, most microglia were activated and TNF-α levels were enhanced in the hippocampus CA1 region of mice subjected to CA/CPR as compared with those in the sham-operated group(P<0.05). Administration with minocycline 30 min after ROSC could significantly decrease the microglial response, TNF-α levels and neuronal death(P<0.05). It was concluded that early administration with minocycline has a strong therapeutic potential for CA/CPR-induced brain injury.     

重复经颅磁刺激治疗幻肢痛的临床疗效研究

目的:采用fMRI中心理生理交互作用(PPI)分析与已知"疼痛矩阵"存在有效连接的大脑表层皮质部位并作为刺激区,为重复经颅磁刺激(rTMS)治疗幻肢痛提供一种新的确立靶点的方法。方法:24例上肢截肢患者随机分为试验组和对照组各12例。试验组行任务态fMRI扫描,以前扣带回为感兴趣区进行PPI分析,与之存在有效连接的区域中选表层皮质的脑区作为靶点进行r TMS,对照组常规选取M1区。治疗前后进行疼痛评估。结果:PPI结果显示前扣带回与左侧中央后回、双侧岛叶呈正共变性,与左侧后扣带回、左侧背外侧前额叶(DLPFC)呈负共变性。其中与DLPFC共变性最显著,试验组以此作为治疗靶点。两组治疗后疼痛评分均显著低于治疗前(P0.05);治疗前两组评分无显著差异,治疗后试验组疼痛评分均显著低于对照组(P0.05)。结论:对与前扣带回(ACC)有显著共变性的DLPFC进行rTMS治疗可显著缓解截肢后的幻肢痛,提示基于患者个体的可塑性特征,针对性地对有关脑区进行靶向治疗可能达到更为显著的治疗效果。