上海市虹口区居民家庭医生签约行为的影响因素分析

背景家庭医生制度在新一轮基层卫生服务改革中被赋予了新的内涵,成为实现全民健康的抓手。而同时,了解民众对于家庭医生的接受程度及其签约行为的主要影响因素十分重要。目的分析上海市虹口区居民家庭医生签约行为的影响因素,为推进基层卫生改革提供理论基础与实证依据。方法 2015年12月—2016年1月采用多阶段整群抽样法对上海市虹口区常住居民进行问卷调查。记录居民家庭医生签约情况,并采用自行设计的《上海市虹口区家庭医生制度评估调查》调查问卷进行问卷调查,问卷内容主要包括基本人口学信息、自身健康状况(是否患慢性病)、首诊就医习惯(首诊医疗机构)、家庭医生签约综合满意度、家庭医生签约服务认知情况(是否清楚家庭医生签约后优惠服务内容)。并采用多元Logistic回归分析分析居民家庭医生签约行为的影响因素。结果共发放问卷900份,回收有效问卷614份,有效回收率68.22%。其中家庭医生签约401例(65.31%),未签约213例(34.69%)。家庭医生签约居民年龄、上海本地户籍率、慢性病患病率、家庭医生签约综合满意度、家庭医生签约服务认知清楚率高于未签约居民,退休率低于未签约居民(P<0.05)。家庭医生签约与未签约居民受教育水平、月收入、首诊就医习惯比较,差异有统计学意义(P<0.05)。多元Logistic回归分析结果显示,受教育水平、首诊就医习惯、家庭医生签约综合满意度、家庭医生签约服务认知情况是居民家庭医生签约行为的影响因素(P<0.05)。结论受教育水平、首诊就医习惯、家庭医生签约综合满意度、家庭医生签约服务认知情况分别是居民家庭医生签约行为的影响因素。     

Felbamate produces antidepressant‐like actions in the chronic unpredictable mild stress and chronic social defeat stress models of depression

Felbamate is an anticonvulsant used in the treatment of epilepsy. In this study, we investigated the antidepressant‐like actions of felbamate in mice. The effects of felbamate were first assessed using the forced swimming test (FST) and tail suspension test (TST), and then investigated in the chronic unpredictable mild stress (CUMS) and chronic social defeat stress (CSDS) models of depression. The changes in the hippocampal brain‐derived neurotrophic factor (BDNF) signaling cascade after chronic stress and felbamate treatment were also examined. It was found that felbamate exhibited antidepressant‐like activities in the FST and TST without affecting the locomotor activity of mice. Felbamate was also effective in both the CUMS and CSDS models of depression. Moreover, felbamate administration fully restored the decreased hippocampal BDNF signaling pathway in both the CUMS‐stressed and CSDS‐stressed mice. Collectively, felbamate has antidepressant‐like actions in mice involving the hippocampal BDNF system.     

鲜天南星水提取物对小鼠子宫纤维瘤的抑制作用和对小鼠雌激素的影响

【摘要】目的 探讨鲜天南星水提取物对小鼠子宫纤维瘤的抑制作用及对小鼠雌激素水平的影响。方法 选取SD健康雌性小鼠30只,随机分为正常组、模型组、实验组3组,每组各10只,对模型组、实验组进行子宫纤维瘤模型建立,正常组不作处理。实验组小鼠予以鲜天南星水提取物进行干预,正常组、模型组小鼠注射等体积生理盐水。对小鼠子宫重及子宫系数进行统计计算,酶联免疫吸附试验法检测雌二醇（Estradiol,E2）、孕酮（Progesterone,P）、卵泡刺激素（Follicle stimulating hormone,FSH）、黄体生成激素（Luteinizing Hormone,LH）水平。结果 干预后,模型组及实验组小鼠子宫重及子宫系数均高于正常组,实验组小鼠子宫重及子宫系数均低于模型组（P＜0.05）;干预后,模型组及实验组小鼠血清E2、P、FSH、LH水平均高于正常组,但实验组小鼠血清E2、P、FSH、LH水平均低于模型组（P＜0.05）。结论 鲜天南星水提取物可对小鼠子宫纤维瘤起到一定的抑制作用,并能对E2、P、FSH、LH等激素水平进行调控,为子宫纤维瘤的临床治疗提供一定的理论依据,值得临床借鉴。     

基于FPGA的神经突触的硬件实现及放电性能比较

目前专门对化学突触硬件实现的研究较少,采用FPGA芯片技术硬件实现化学突触,对神经元网络的硬件实现具有重要价值。运用DSP Builder软件,对以Hodgkin-Huxley神经元为突触前神经元和突触后神经元的化学突触数学模型进行建模。在DSP Builder模型的基础上,将化学突触的DSP Builder模型进行合理的拆分,然后分别将各个模块在FPGA所对应的软件环境下进行编译运行,最后下载到FPGA核心芯片中,硬件实现5种基于不同机理的化学突触模型。采用相关系数法,对仿真结果和硬件结果在同一个周期内的突触前神经元动作电位、突触后神经元动作电位以及突触电流的幅值进行对比,验证硬件实现的准确性。5种硬件实现的化学突触均可以较好地传递动作电位,但是各个模型消耗资源不同,模型3所消耗的内部乘法器资源(69%),约为模型5资源(31%)的2倍,表明突触模型数学复杂度越高,其消耗的乘法器资源越多。相关系数法的对比结果显示,模型3相关度最高,为0.791 3,模型4相关度最低,为0.693 5。虽然模型3数学复杂度高、硬件资源消耗多,但是其表现的生物性最好。硬件实现的5种突触模型均能较好地呈现化学突触的单向传递性,其中模型5硬件资源消耗少、相关度高,建议以其作为化学突触硬件实现的首选。     

Ambient mass spectrometry for rapid diagnosis of psychoactive drugs overdose in an unstable patient

A 25-year-old man suffered from consciousness change was sent to our emergency department by friends who reported that they were not sure what had happened to him. Physical examination revealed bilateral pupils dilatation, lethargy, slurred speech, and ataxia. Computer-aided tomographic scan of the brain revealed no definite evidence of intracranial lesions. Routine laboratory tests revealed total physiological turmoil. Despite immediate commencement of aggressive treatment, the patient's condition deteriorated long before the traditional drug screen provided an answer for the identities of the multiple drugs overdose. It ended up with the need for cardiopulmonary resuscitation, but in vain. At the end of the tragic event, under the suggestion of a colleague, a portion of the patient's urine specimen was sent to our university esoteric laboratory for rapid analysis by means of a newly-developed thermal desorption-electrospray ionization-mass spectrometry. Ketamine, 3,4-methylenedioxymethamphetamine, and 3,4-methylenedioxyamphetamine were identified in the urine sample within 30 s. Conventional toxicological testing techniques like gas chromatography–mass spectrometry or liquid chromatography-mass spectrometry are currently used for identifying abused drugs. One concern is their time-consuming sample pretreatment which leads to relatively low efficiency in terms of turnaround time for revealing the identity of the consumed drugs particularly when the patients are severely overdosed. We learned a lesson from this case that a more efficient toxicological identification technique is essential to expedite the process of emergency care when the patients are so heavily overdosed that they are under critical life-threatening conditions.