定期随访对脑梗死恢复期患者神经功能及社会活动功能的影响

目的:探讨医务人员院外定期随访对脑梗死恢复期患者神经功能恢复及社会活动功能的影响作用。方法:选取我科急性缺血性卒中经治疗后好转出院患者共151例,分为观察组74例和对照组77例。出院后医务人员根据自制随访流程对观察组进行2周1次的随访,对照组未进行随访,3个月、1年后分别对2组进行改良Rankin评分(mRS)及社会活动功能量表(FAQ)评估。结果:出院3个月后,2组mRS评分、FAQ评分及社会活动功能评定未见统计学差异,观察组残疾率明显低于对照组(P0.05)。1年后,2组的mRS评分、致残率、FAQ评分及社会活动障碍率均低于3个月时(P0.05,0.01),且观察组mRS评分、致残率、FAQ评分及社会活动功能障碍率均明显低于对照组(均P0.05)。结论:医务人员院外定期随访可促进脑梗死恢复期患者神经功能及社会活动功能恢复,功能的恢复较为缓慢。     

Effect of glycosylation on protein folding: a close look at thermodynamic stabilization

Glycosylation is one of the most common posttranslational modifications to occur in protein biosynthesis, yet its effect on the thermodynamics and kinetics of proteins is poorly understood. A minimalist model based on the native protein topology, in which each amino acid and sugar ring was represented by a single bead, was used to study the effect of glycosylation on protein folding. We studied in silico the folding of 63 engineered SH3 domain variants that had been glycosylated with different numbers of conjugated polysaccharide chains at different sites on the protein's surface. Thermal stabilization of the protein by the polysaccharide chains was observed in proportion to the number of attached chains. Consistent with recent experimental data, the degree of thermal stabilization depended on the position of the glycosylation sites, but only very weakly on the size of the glycans. A thermodynamic analysis showed that the origin of the enhanced protein stabilization by glycosylation is destabilization of the unfolded state rather than stabilization of the folded state. The higher free energy of the unfolded state is enthalpic in origin because the bulky polysaccharide chains force the unfolded ensemble to adopt more extended conformations by prohibiting formation of a residual structure. The thermodynamic stabilization induced by glycosylation is coupled with kinetic stabilization. The effects introduced by the glycans on the biophysical properties of proteins are likely to be relevant to other protein polymeric conjugate systems that regularly occur in the cell as posttranslational modifications or for biotechnological purposes.     

老年心肌梗死患者恢复期的护理

目的 探讨老年心肌梗死患者恢复期的护理干预效果.方法 对本院2008年1月～2011年6月收治的60例老年心肌梗死患者实施临床护理干预,采用症状自评量表(SCL-90)、西雅图心绞痛调查表(SAQ)和对健康知识的掌握程度对于预前后情况进行对比.结果 干预后,患者的SCL- 90总分和各指标得分均低于干预前,差异具有显著意义(P＜0.05);患者的躯体活动受限程度、治疗满意程度和疾病认识程度得分高于干预前,差异具有显著意义(P＜0.05).患者的健康知识掌握情况明显改善,与干预前相比差异具有显著意义(P＜0.05).结论 对老年心肌梗死患者恢复期实施及时有效的护理干预,可增强患者治疗的信心;指导患者养成科学合理的生活方式,可减少并发症的发生和最大限度地改善患者的生活质量.     

地黄饮子加减治疗老年脑梗死恢复期临床研究

目的:临床研究地黄饮子加减治疗老年脑梗死恢复期的效果。方法:将142例确诊的年龄大于或等于60岁的脑梗死患者随机分为两组,治疗组72例,对照组70例,两组均在西医常规治疗的基础上,治疗组72例采用地黄饮子加减治疗;对照组70例用中风回春丸治疗,两组疗程均为4周。结果:治疗组在各方面疗效优于对照组,两组比较差异有统计学意义(P<0.05)。结论:地黄饮子加减治疗老年脑梗死恢复期患者在改善症状及总生活能力状态有明显优势,与改善肾虚体质有关。     

Efficacy and Safety of Continuous Local Infusion of Ropivacaine after Retroperitoneoscopic Live Donor Nephrectomy

Morphine‐based analgesia is effective but can compromise donor safety. We investigated whether continuous infusion of local anesthetics (CILA) can provide sufficient pain control and reduce morbidity related to opiate analgesics after hand‐assisted retroperitoneoscopic (HARS) live donor nephrectomy. Forty consecutive live kidney donors underwent HARS and were treated with the ON‐Q system providing CILA with 0.5% ropivacaine through two SilvaGard^® catheters placed in the retroperitoneal cavity and the rectus sheath, respectively. The case control group consisted of 40 donors matched with regard to sex, age, BMI and surgical technique. All donors were maintained on standardized multimodal analgesia combining nurse‐controlled oxycodone treatment and acetaminophen. CILA donors had lower median cumulative consumption of morphine equivalents (CCME) (7 mg [0–56] vs. 42 mg [15–127]; p < 0.0000001), lower incidence of nausea (18 [45%] vs. 35 [87.5%] donors; p < 0.001), shorter time in postoperative care unit (160 vs. 242.5 min; p < 0.001) and shorter hospital stay (4 [4–7] vs. 6 [4–11] days; p < 0.001). In 32.5% of CILA donors the CCME was 0 mg (0% in matched control group, p < 0.001). CILA with 0.5% ropivacaine provides effective postoperative pain relief, reduces the need for opioid treatment and promotes postoperative recovery.     

自信心心理训练对精神分裂症患者自尊影响的研究

目的：探讨自信心心理训练对精神分裂症患者自尊的影响。方法：将70例18～55岁精神分裂症康复期患者随机分为研究组（自信心训练联合药物治疗）和对照组（单纯药物治疗）,研究组在给予抗精神病药物治疗的基础上,每周进行两次自信心训练,持续5周,共10次;对照组给予单纯药物治疗。干预前后两组分别进行自尊量表（Self-Esteem Scale,SES）评定,了解患者自尊水平改善状况。结果：入组时两组SES评定无差异（t=-0.69,P=0.81）,干预前后SES评分研究组比较差异有统计学意义（t=-9.00,P=0.00）,对照组比较差异无统计学意义（t=0.45,P=0.67）。两组干预前、后SES比较差异有统计学意义（t=2.70,P=0.02）。结论：自信心心理训练可以提升精神分裂症康复期患者的自尊水平。     

Locating an extracellular K+-dependent interaction site that modulates betaine-binding of the Na+-coupled betaine symporter BetP

BetP, a trimeric Na(+)-coupled betaine symporter, senses hyperosmotic stress via its cytoplasmic C-terminal domain and regulates transport activity in dependence of the cytoplasmic K(+)-concentration. This transport regulation of BetP depends on a sophisticated interaction network. Using single-molecule force spectroscopy we structurally localize and quantify these interactions changing on K(+)-dependent transport activation and substrate-binding. K(+) significantly strengthened all interactions, modulated lifetimes of functionally important structural regions, and increased the mechanical rigidity of the symporter. Substrate-binding could modulate, but not establish most of these K(+)-dependent interactions. A pronounced effect triggered by K(+) was observed at the periplasmic helical loop EH2. Tryptophan quenching experiments revealed that elevated K(+)-concentrations akin to those BetP encounters during hyperosmotic stress trigger the formation of a periplasmic second betaine-binding (S2) site, which was found to be at a similar position reported previously for the BetP homologue CaiT. In BetP, the presence of the S2 site strengthened the interaction between EH2, transmembrane α-helix 12 and the K(+)-sensing C-terminal domain resulting in a K(+)-dependent cooperative betaine-binding.     

Age‐related changes in the ease of dynamical transitions in human brain activity

Executive functions, a set of cognitive processes that enable flexible behavioral control, are known to decay with aging. Because such complex mental functions are considered to rely on the dynamic coordination of functionally different neural systems, the age‐related decline in executive functions should be underpinned by alteration of large‐scale neural dynamics. However, the effects of age on brain dynamics have not been firmly formulated. Here, we investigate such age‐related changes in brain dynamics by applying “energy landscape analysis” to publicly available functional magnetic resonance imaging data from healthy younger and older human adults. We quantified the ease of dynamical transitions between different major patterns of brain activity, and estimated it for the default mode network (DMN) and the cingulo‐opercular network (CON) separately. We found that the two age groups shared qualitatively the same trajectories of brain dynamics in both the DMN and CON. However, in both of networks, the ease of transitions was significantly smaller in the older than the younger group. Moreover, the ease of transitions was associated with the performance in executive function tasks in a doubly dissociated manner: for the younger adults, the ability of executive functions was mainly correlated with the ease of transitions in the CON, whereas that for the older adults was specifically associated with the ease of transitions in the DMN. These results provide direct biological evidence for age‐related changes in macroscopic brain dynamics and suggest that such neural dynamics play key roles when individuals carry out cognitively demanding tasks.     

新型冠状病毒肺炎病人康复早期心理应激状态调查及影响因素分析

目的 探讨新型冠状病毒肺炎（COVID-19）病人康复早期心理应激状态及其影响因素。方法 以2020年3月1日至2020年3月14日由专科医院治愈出院并转入我院隔离观察病房的COVID-19康复者126例为研究对象,通过网络问卷调查采集心理学信息,问卷包含创伤后应激障碍自评量表（PTSD-SS）、抑郁自评量表和焦虑自评量表。采用多元线性回归分析检验影响因素。结果 126例PTSD-SS评分平均（45.5±18.9）分,39例（31.0%）存在应激障碍;创伤性再体验评分平均（15.4±6.8）分,52例（41.3%）有反复重现体验症状;回避症状评分平均（11.9±5.7）分,35例（27.8%）存在回避症状;警觉性增高评分平均（11.3±5.0）分,51例（40.5%）警觉性增高。28例（22.2%）有焦虑情绪,48例（38.1%）有抑郁情绪。多因素线性回归分析发现,退休、心理支持与PTSD-SS评分及其三个症状评分呈显著负相关（P<0.05）,女性、焦虑情绪与PTSD-SS评分及其三个症状评分呈显著正相关（P<0.05）,抑郁情绪与警觉性增高评分呈显著正相关（P<0.05）。结论 近1/3的COVID-19病人康复早期存在应激障碍,女性、未退休、缺乏心理支持、存在焦虑抑郁情绪这四大类人群应激障碍症状尤为严重,建议所有康复病人定期接受心理评估