Zum Vorschlag des Erlasses einer Richtlinie über die Ausübung der Patientenrechte in der grenzüberschreitenden Gesundheitsversorgung – Was ist neu?

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瑞芬太尼在产科麻醉镇痛中的应用

瑞芬太尼是一种新型的超短效阿片药物,它的出现使得麻醉可控性和预见性得到了优化。最近有更多的研究将它用于产科的麻醉与镇痛,为产科麻醉用药带来了新的选择。本文将就瑞芬太尼近年来在产科麻醉与镇痛方面的临床研究进展进行探讨。     

Visual scenes trigger immediate syntactic reanalysis: evidence from ERPs during situated spoken comprehension

A central topic in sentence comprehension research is the kinds of information and mechanisms involved in resolving temporary ambiguity regarding the syntactic structure of a sentence. Gaze patterns in scenes during spoken sentence comprehension have provided strong evidence that visual scenes trigger rapid syntactic reanalysis. However, they have also been interpreted as reflecting nonlinguistic, visual processes. Furthermore, little is known as to whether similar processes of syntactic revision are triggered by linguistic versus scene cues. To better understand how scenes influence comprehension and its time course, we recorded event-related potentials (ERPs) during the comprehension of spoken sentences that relate to depicted events. Prior electrophysiological research has observed a P600 when structural disambiguation toward a noncanonical structure occurred during reading and in the absence of scenes. We observed an ERP component with a similar latency, polarity, and distribution when depicted events disambiguated toward a noncanonical structure. The distributional similarities further suggest that scenes are on a par with linguistic contexts in triggering syntactic revision. Our findings confirm the interpretation of previous eye movement studies and highlight the benefits of combining ERP and eye-tracking measures to ascertain the neuronal processes enabled by, and the locus of attention in, visual contexts.     

Do women with epilepsy have increased frequency of menstrual disturbances?

PROBLEM: Menstrual disorders, reduced fertility and sexual problems seem to be more frequent in women with epilepsy than in the general population. Most investigations concerning menstrual disturbances in epilepsy patients, however, are small and based on selected materials. We therefore wanted to investigate the frequency of menstrual disturbances in a large, unselected population of epilepsy patients. METHODS: A retrospective, questionnaire study of a cohort of female outpatients, aged 18-45 was conducted. Each patient chose a close female friend who served as control, to optimise matching regarding age and lifestyle. RESULTS: Answers were received from 265 patients and 142 controls. Menstrual disturbances were more frequent in patients with epilepsy (48.0%) than in controls (30.7%) (P=0.004). Menstrual disturbances were more frequent in patients on polytherapy versus monotherapy (P=0.049) and more frequent in patients with high seizure frequency (>5seizures/year) compared to patients with a lower seizure frequency or those seizure free (P=0.006). The frequency of menstrual disturbances was higher in patients on valproate compared to carbamazepine monotherapy (P=0.045). CONCLUSION: This investigation confirms that women with epilepsy have an increased frequency of menstrual disturbances compared to women without epilepsy. In women with high seizure frequency and in those on polytherapy, the frequency of menstrual disturbances are further increased. The highest frequency of menstrual disturbances occurred in women using valproate.     

Bone mineral density as a marker of cumulative endogenous estrogen exposure: Relationship to background genetic risk of psychotic disorder

BackgroundAlterations in bone mineral density (BMD) in patients with psychotic disorder may reflect the effect of treatment (disease effect observed in patients but not their siblings) or, as an intermediate marker of cumulative endogenous estrogen exposure, alterations in the neuroprotective effect of estrogen in the brain (vulnerability effect observed in patients and siblings).MethodsDual X-ray absorptiometry (DEXA) scans were acquired in 62 patients with a psychotic disorder, 67 non-psychotic siblings of patients with a psychotic disorder, and 48 controls. BMD (g/cm²), Z-scores and T-scores were measured in the lumbar spine and proximal femur. Associations between group and BMD were investigated with multilevel random regression analyses. Group × sex interactions and effects of antipsychotic medication (AP) on BMD were examined.ResultsGroup was not associated with BMD outcome measures, although patients had consistently lower BMD measures compared to both siblings and controls. There were no significant group × sex interactions, but stratified analyses showed that BMD measures in female patients were significantly lower in comparison to female controls and siblings (e.g. total femoral BMD, P vs. C: B = ? 0.100, p = 0.010; P vs. S: B = ? 0.104, p = 0.008). After excluding female patients who used prolactin-raising AP, the effect was attenuated (e.g. total femoral BMD, P vs. C: B = ? 0.073, p = 0.072; P vs. S: B = ? 0.085, p = 0.051). In men, there were no significant BMD differences between patients and controls.ConclusionFamilial risk of psychotic disorder was not associated with BMD. Instead, decreased BMD in the femur may reflect treatment effects or non-familial risk associated with low cumulative endogenous estrogen levels in women.     

甘草甜素药代动力学

甘草是中医处方中使用频率最高的中草药之一,主要有效成分是甘草甜素(glycyrrhizin,GL),具有抗炎,抗肝细胞毒性,抗干扰素诱导,抗病毒和抗溃疡等作用[1,2].并被广泛应用于临床治疗慢性肝炎,过敏性疾患,炎症和胃溃疡.近年已报道GL可增强免疫功能,并改善病毒感染患者的临床状况,调节短期和长期反复焦虑患者的精神状态[3].