人参皂甙Rb_1和Rg_1对小鼠中枢神经递质受体和脑内蛋白质合成的影响

应用放射配基结合法测定了人参皂甙Rb_1和Rg_1对α_1,α_2,β肾上腺素能受体、M胆碱能受体、5-羟色胺、多巴胺及GABA等七种受体的作用。结果均不能证明它们对这七种受体有亲和力。但给动物ip药物连续5天,Rb_1和Rg_1均能使中枢M胆碱受体密度显著增高。Rb_1及Rg_1还能显著增加脑内蛋白质的含量。上述实验结果对解释人参的中枢作用提供了重要证据。     

Assessing the impact of a gynaecomastia assessment and treatment infographic in primary care in Greater Manchester

IntroductionMen with gynaecomastia are routinely referred to breast clinics, yet most do not require breast surgical intervention. The aim of this study was to assess the impact of a novel point-of-care gynaecomastia decision infographic in primary care on the assessment, management and referral practices to tertiary breast surgical services.MethodsA study was carried out of male patient referrals from primary care in Greater Manchester to a tertiary breast centre between January and March in 2018–2020. Referral patterns were compared before and after the infographic went live in general practices in Greater Manchester in January 2020. Data were collected for gynaecomastia referrals, including aetiology, investigation and management.ResultsIn total, 394 men were referred to a tertiary breast centre from 163 general practices, of which 271 (68.8%) had a diagnosis of gynaecomastia. Use of the decision infographic by primary healthcare providers was associated with a decrease in male breast referrals with gynaecomastia (79.6% to 62.0%). Fewer gynaecomastia patients were referred with a benign physiological or drug-related cause after implementation of the infographic (52.2% vs 41.8%). Only 10 (3.7%) patients with gynaecomastia underwent breast surgery during the study period.ConclusionImplementation of a gynaecomastia infographic in primary care in Manchester was associated with a reduction in gynaecomastia referrals to secondary care. We hypothesise that implementation of the infographic into primary care nationally may potentially translate to hundreds of patients receiving more specialty-appropriate referrals, improving overall management of gynaecomastia. Further study is warranted to test this hypothesis.     

模拟教学法可改善成人糖尿病患者的血糖控制

初级保健医师(primary care physicians,PCPs)对继续医学教育的需求很大.为了评估以病例为基础的模拟教学法是否可以提高初级保健医师对糖尿病的诊疗水平,美国明尼苏达州健康合作者研究基金会和医疗集团进行了相关的研究. 研究选择了美国明尼苏达州健康合作者研究基金会和医疗集团旗下的11个诊所的41名初级保健医师,随机分为参与模拟教学组和不参与模拟教学组.在模拟教学组中,给每位初级保健医师派发了1 2个2型糖尿病的模拟病例,这些病例都是针对研究人员在电子病历中观察到的初级保健医师诊疗水平的不足之处所专门设计的,每个模拟病例都需要初级保健医师在15分钟内完成诊疗过程.