Clinical outcome following Transcatheter Aortic Valve Implantation in patients with impaired left ventricular systolic function

Objectives: To determine the prevalence of impaired left ventricular (LV) systolic function and its impact on the in‐hospital and long‐term outcome in patients who underwent Transcatheter Aortic Valve Implantation (TAVI). Background: Although impaired LV function may be considered a contra‐indication for aortic valve replacement, the hemodynamic characteristics of transcatheter valves may offer procedural and long‐term clinical benefit in such patients. Methods: 230 consecutive patients underwent TAVI with the Medtronic‐CoreValve System. Impaired LV function was defined by a Left Ventricular Ejection Fraction (LVEF) ≤ 35% (European Multicenter Study on Operative Risk Stratification and Long‐term Outcome in patients with Low‐Flow/Low‐Gradient Aortic Stenosis). Study endpoints were selected and defined according to the Valve Academic Research Consortium recommendations. Results: Compared with patients with a LVEF > 35% (n = 197), those with LVEF ≤ 35% (n = 33) were more often male (78.8 % vs. 46.7%, P < 0.001), more symptomatic (NYHA class III or IV, 97.0% vs. 77.2%, P = 0.008) and had a higher prevalence of prior coronary artery disease (63.6% vs. 43.1%, P = 0.029). The Logistic EuroSCORE was 14.8% and 22.8, respectively (P = 0.012). No difference was observed between the two groups in in‐hospital or 30‐day mortality (3.0% vs. 9.6%, P = 0.21), the Combined Safety Endpoint at 30 days (24.2% and 24.4%, P = 0.99) and survival free from readmission at one year (69.2% and 69.7%, P = 0.85). After adjustment, LVEF ≤ 35% was not associated with an increased risk of 30‐day mortality, in‐hospital complications and survival free from readmission at follow‐up. Conclusion: The immediate and long‐term outcome after TAVI did not differ between patients with an impaired and preserved LVEF. LVEF ≤ 35% did not predict adverse immediate and long‐term outcome. These findings suggest that TAVI should not be withheld in selected patients with impaired LV function. © 2011 Wiley Periodicals, Inc.     

《医宗金鉴》对张氏正骨流派学术思想的影响

《医宗金鉴》是清代由政府组织编写的综合性医学丛书,其立论精辟,尤重实用,对后世影响甚大。湖南岳阳张氏正骨始于清末,在张氏正骨发展过程中,不断吸收并结合了《医宗金鉴》等医学著作和民间特色技术,在继承的基础上体现了创新,强调“筋骨并重,内外调和”、“去瘀生新,气血相和”,逐渐形成了以“和”为核心的张氏正骨学术思想。本文着重探讨《医宗金鉴》对湖南岳阳张氏正骨相关学术思想和实际应用的影响。认为张氏正骨流派在正骨手法、内外方药、针推技术等方面继承了《医宗金鉴》主要的学术理念,并不断发展创新骨伤技术方法、药物应用等。     

基于数据挖掘技术探讨郭勇教授治疗肝癌的用药规律

[目的] 探讨郭勇教授治疗肝癌的处方用药规律,传承名中医治疗肝癌的指导思想并推广应用。[方法] 收集郭师治疗肝癌的处方,基于信息管理系统软件建立数据库,统计药物使用频次,并对药物的药性、药味、归经等进行描述性分析。[结果] 药性频率最高的是寒(34.46%),其次是温(29.94%)、平(27.12%),累计频率达91.52%;药味频率最高的是甘(37.09%),其次是苦(23.64%)、辛(17.45%),累计频率达78.18%;药物归经频率最高的是肝(19.61%)、其次是脾(15.50%)、肺(15.25%)、胃(14.29%),累计频率达64.65%。采用关联法则、复杂网络分析、聚类分析等数据挖掘方法,确定处方中各种药物的使用频次和药物之间的关联规则,前6位中药依次为:白芍、郁金、预知子、猫爪草、猫人参、太子参。从核心处方总结出,郭师治疗肝癌多用猫人参、猫爪草、郁金、预知子、白芍等药物。[结论] 郭师治疗肝癌,重视辨病与辨证相结合,应用灵活,配伍严谨。数据挖掘应用对于挖掘名老中医临床经验具有重要的价值。     

袁秀丽学术思想浅析

袁秀丽主任医师系第六批全国老中医药专家学术经验继承工作指导老师,澄江学派四川名家陈治平先生亲传弟子。袁师注重学习经典,认为治病之要,首在治神;同时强调学习现代医学知识,临证灵活运用中西医手段,擅用针刺及中药治疗疾病。     

Distinct electrophysiological signatures of task-unrelated and dynamic thoughts

Humans spend much of their lives engaging with their internal train of thoughts. Traditionally, research focused on whether or not these thoughts are related to ongoing tasks, and has identified reliable and distinct behavioral and neural correlates of task-unrelated and task-related thought. A recent theoretical framework highlighted a different aspect of thinking—how it dynamically moves between topics. However, the neural correlates of such thought dynamics are unknown. The current study aimed to determine the electrophysiological signatures of these dynamics by recording electroencephalogram (EEG) while participants performed an attention task and periodically answered thought-sampling questions about whether their thoughts were 1) task-unrelated, 2) freely moving, 3) deliberately constrained, and 4) automatically constrained. We examined three EEG measures across different time windows as a function of each thought type: stimulus-evoked P3 event-related potentials and non–stimulus-evoked alpha power and variability. Parietal P3 was larger for task-related relative to task-unrelated thoughts, whereas frontal P3 was increased for deliberately constrained compared with unconstrained thoughts. Frontal electrodes showed enhanced alpha power for freely moving thoughts relative to non-freely moving thoughts. Alpha-power variability was increased for task-unrelated, freely moving, and unconstrained thoughts. Our findings indicate distinct electrophysiological patterns associated with task-unrelated and dynamic thoughts, suggesting these neural measures capture the heterogeneity of our ongoing thoughts.

Cognitive neuroscience has reached a consensus that the brain is not idle at rest (1). This rings intuitively true: When left alone, our minds rarely stay still. Moreover, recent evidence suggests that rest is not a homogeneous state (2), nor is the brain truly “at rest” as it fluctuates across time and contexts (3–6). This too is intuitive: What is striking is not just that we move from thought to thought unprompted but also the diverse ways that trains of thought unfold over time. Sometimes, our thoughts freely wander between topics. You might remember this morning’s run, then imagine gardening, then think about the dinner you’ll cook tonight. Other times, we deliberately constrain our thoughts and work diligently toward a goal. In a quiet moment, you might methodically contemplate the results of your latest experiment. Still other times, our thoughts get stuck on an affectively salient topic, from which it is difficult to break free. You might worry, over and over, about your niece who is going through major surgery next week.Research has traditionally examined the internal train of thought in the context of mind wandering. This field has expanded at such a rapid pace that some have dubbed this the “era of the wandering mind” (7). To date, the vast majority of mind-wandering research has focused on the static content of individual thoughts. In particular, mind-wandering studies have primarily focused on task-unrelated thought (8)—that is, thoughts that are unrelated to an ongoing, typically externally oriented, task (8–10). In the laboratory, subjects’ thoughts are often unrelated to the experimental task (9). Task-unrelated thought is also frequent in everyday life (11), as when a student becomes distracted during a lecture or while driving.Recent theories are less task-centric and instead focus on the dynamics of mind wandering—that is, how internal trains of thoughts unfold over time (12–17). In particular, the “dynamic framework” of spontaneous thought distinguishes three subtypes within the train of thoughts: 1) deliberately constrained, 2) automatically constrained, and 3) freely moving thoughts (12, 14). Constraints on the train of thoughts serve to focus internal attention on a topic for extended periods of time. For example, deliberately constrained thoughts occur when a person actively directs her thoughts to goal-relevant information (e.g., when you contemplate your latest experiment). This type of constraint is implemented through cognitive control. Automatically constrained thoughts focus on affectively or personally salient information that is difficult to disengage from (e.g., when you worry about your niece who will have surgery). This type of constraint is automatic in nature and thought to operate largely outside of cognitive control. In contrast, freely moving thoughts occur when both of these constraints are weak, allowing the mind to wander with no overarching purpose and direction (e.g., when your thoughts drift from a movie, to gardening, to dinner). Notably, the dynamic framework purports that these three subtypes of thoughts are independent of task relatedness. In other words, task-related and task-unrelated thoughts can both be deliberately constrained, automatically constrained, or freely moving. See SI Appendix for further details about the relationship between dynamic categories.Empirical research on the dynamics of thought is in its infancy. Behavioral research has focused on contrasting task-unrelated thoughts with the other three subtypes of thoughts, with a particular emphasis on freely moving thoughts. These findings suggest that self-reported freely moving and task-unrelated thoughts have distinct behavioral markers. For example, studies of mind wandering in everyday life found that self-reports of freely moving and task-unrelated thought fluctuate at different rates throughout the day (11). Consistent with predictions of the dynamic framework, these studies reported that task-unrelated and freely moving thoughts are only modestly correlated (r < 0.3) and they occurred independent of each other (8, 11). Specifically, although task-related thoughts are often deliberately constrained and task-unrelated thoughts sometimes move freely, the dynamic framework predicts that this is not always the case. In fact, task-related thoughts can move freely (e.g., when a graphic designer freely associate ideas for her new website design) or be automatically constrained (e.g., when someone obsesses over a problem at work). Task-unrelated thoughts can be deliberately or automatically constrained (e.g., when you construct a grocery list or worry about your niece’s surgery during a lecture). The only two empirical studies to date have focused explicitly on freely moving thought (8, 11). Although this provides some initial evidence that task-unrelated thought is different from dynamic thoughts, no studies have assessed the neural correlates of dynamic thought types. The identification of different electrophysiological signatures of these thought types would thus provide important validation that these categories reflect distinct entities.In the current study, we examined the electrophysiological signatures of the four types of thought by recording an electroencephalogram (EEG) while participants performed an attention task. Participants occasionally answered thought-sampling questions about the nature of their thoughts throughout the task. Thought sampling is the standard method in mind-wandering research: Participants are randomly interrupted as they perform a laboratory task and answer questions about their immediately preceding thoughts (9, 10). In line with previous studies, we ask the standard question about whether participants’ thoughts were task-unrelated (see ref. 8 for a review). In addition, we asked whether subjects’ trains of thought were freely moving, deliberately constrained, and automatically constrained.We used electroencephalography because this method has the temporal resolution necessary to capture the transient changes in neural activity corresponding to our trains of thoughts, including stimulus-evoked, task-dependent activity and stimulus-independent, intrinsic activity. We first examined event-related potentials (ERPs), which index the electrophysiological response evoked by task-relevant stimuli. Previous research suggests that task-unrelated thought attenuates the magnitude of ERP components associated with sensory (18–20) and cognitive (21–24) processing of task-relevant stimuli. ERPs therefore provide an electrophysiological signature of when a participant has disengaged from task-relevant stimuli. We predicted that task-unrelated thoughts would be associated with a reduced P3 ERP component.To index stimulus-independent, intrinsic neural activity, we examined spectral power in the alpha band (8 to 14 Hz) during a time window after the offset of ERPs, which is unlikely to be impacted by stimulus-evoked responses. This segregation of the poststimulus time window allowed us to disentangle stimulus-evoked, task-dependent responses captured by ERP components in the earlier window and stimulus-independent activity likely associated with the subject’s ongoing thoughts as captured by alpha power in the later time window (as illustrated in Fig. 1). Alpha-power increases recorded over posterior sites have been associated with internal attention (23, 25) as well as spontaneous brain activity recorded at rest that is not elicited by external stimuli (26, 27). In contrast, frontal alpha has been linked to creative, divergent thinking (28, 29). Accordingly, we hypothesized that task-unrelated thoughts would be associated with enhanced posterior alpha power, whereas freely moving thoughts would be associated with increased frontal alpha power. Given that our dynamic thought-sampling questions address variability within the train of thought over time, we examined the neural correlates of these thought dynamics by capturing momentary changes in alpha power (i.e., alpha-power variability) over the same ERP-free time window. We predicted that freely moving thought would be associated with increased alpha-power variability, whereas constrained thought would show reduced alpha-power variability.Open in a separate windowFig. 1.EEG measures across the poststimulus time window. We examined three EEG measures. Stimulus-evoked activity as captured by P3 ERP components was examined during the 0- to 0.6-s poststimulus time window. Alpha power and variability index intrinsic neural activity not impacted by an external stimulus examined after the offset of P3s during the 0.6- to 1.8-s poststimulus time window.     

基于学术论文产出的国家公派研究生培养质量分析

本文基于本校开展公派研究生项目的工作实践,将公派研究生和同级同导师未留学研究生进行对照,采用文献计量学方法,对研究生论文产出、分布特点和影响力进行统计,对比分析论文发表数量、被引频次、影响因子、合作状况、高水平期刊论文比例等客观数据,以期从一个侧面反映国家公派研究生项目对提高研究生培养质量所发挥的作用,为开展公派研究生项目的其他院校提供参考。     

环境与健康保护：从理论到行动的转化之路——“第六届环境与职业医学国际学术研讨会”纪要

＂第六届环境与职业医学国际学术研讨会暨《环境与职业医学》杂志创办30周年研讨会＂于2014年10月16—18日在上海市召开,会议的主题是＂环境与健康保护：从理论到行动＂。此次会议由上海市疾病预防控制中心、上海市预防医学研究院、上海市预防医学会、《环境与职业医学》杂志主办,复旦大学公共卫生学院、江苏省预防医学会、浙江省预防医学会协办。共有44位中外专家进行了报告,200余位参会者就＂环境相关疾病的预防与控制＂＂职业人群的健康保护＂＂环境与职业医学中的组学研究＂＂环境政策与公共卫生＂等内容展开讨论。本次会议收到中英文论文投稿近200篇,同时设置了壁报展示并评选出3份优秀壁报。在＂《环境与职业医学》编者、审者、作者交流会＂上,编委会成员和审稿专家共同回顾了杂志创办30年来的发展历程,为杂志的发展提出了缩短出版周期、提供增值服务、进入重要数据库等意见。本次会议的成功举办可望进一步加深加强上海与国际国内在相应领域的联系与合作,更好地促进环境与职业医学领域理论与实际的结合、基础与临床的整合、微观与宏观的融合,为环境健康研究注入新的活力。     

天津市东丽医院引进学科带头人的实践与探索

本文介绍了天津市东丽医院引进学科带头人所取得的成效,并通过分析在学科带头人引进工作中存在的问题,结合医院实际,提出改进二级医院学科带头人引进工作的建议,促进医院的持续、快速、有序发展。     

The neural basis of unwanted thoughts during resting state

Human beings are constantly engaged in thought. Sometimes thoughts occur repetitively and can become distressing. Up to now the neural bases of these intrusive or unwanted thoughts is largely unexplored. To study the neural correlates of unwanted thoughts, we acquired resting-state fMRI data of 41 female healthy subjects and assessed the self-reported amount of unwanted thoughts during measurement. We analyzed local connectivity by means of regional homogeneity (ReHo) and functional connectivity of a seed region. More unwanted thoughts (state) were associated with lower ReHo in right dorsolateral prefrontal cortex (DLPFC) and higher ReHo in left striatum (putamen). Additional seed-based analysis revealed higher functional connectivity of the left striatum with left inferior frontal gyrus (IFG) in participants reporting more unwanted thoughts. The state-dependent higher connectivty in left striatum was positively correlated with rumination assessed with a dedicated questionnaire focussing on trait aspects. Unwanted thoughts are associated with activity in the fronto-striatal brain circuitry. The reduction of local connectivity in DLPFC could reflect deficiencies in thought suppression processes, whereas the hightened activity in left striatum could imply an imbalance of gating mechanisms housed in basal ganglia. Its functional connectivity to left IFG is discussed as the result of thought-related speech processes.