男男性行为人群不同性伴寻找场所HIV和梅毒感染及相关行为特征

目的了解不同性伴寻找场所男男性行为人群(MSM)艾滋病病毒(HIV)/梅毒感染状况,以及相关的行为特征。方法采用应答推动方法(RDS),在MSM活动场所定时、定点对MSM人群进行招募和询问式匿名调查,采集血样进行血清学检测。结果共调查400人,寻找性伴场所属酒吧型的占21.5%,浴室型占2.5%,公园型占11.3%,网络型占60.0%,其他型占4.5%。不同年龄、文化、职业、婚姻状态、性取向者,性伴寻找场所的差异有统计学意义(P<0.05)。52.3%酒吧型MSM年龄≤22岁,44.4%公园型年龄≥36岁;公园型MSM学历在初中及以下者占43.2%;网络型MSM学历在大专及以上者为44.5%;网络型未婚为90.4%,浴室型在婚及其他婚姻状况为60.0%。近6月性伴数≥6人、无保护性男男性行为均以其他型最高,分别为15.8%、76.5%;酒吧等其他型53.2%有主动肛交,90.8%有无保护性口交;浴室型50.0%有异性性行为,10.3%酒吧等其他型有卖性商业性行为,14.6%酒吧/浴室型有买性商业性伴,43.2%公园型性伴年龄相差≥11岁。不同场所型MSM HIV知识知晓率,是否知道性伴相关健康问题、不知道性伴相关健康状况的差异有统计学意义(P<0.05)。不同场所型MSM的HIV/梅毒累计感染率差异有统计学意义(P<0.05),浴室/其他型MSM的HIV感染率为20.7%,浴室/公园型MSM的梅毒累计感染率为36.4%。结论 MSM人群寻找性伴场所与艾滋病高危行为及HIV/梅毒感染相关,应根据不同场所MSM的人口学及性行为特征,有针对性地开展健康教育和行为干预。     

The timing of the conscious intention to move

The foundation of modern neuroscience and psychology about intention for action was laid by B. Libet et al. [(1983) Brain 106 , 623–642]. They reported the time of awareness of wanting to move to be about 0.2 s before voluntary movement onset. However, despite repeated confirmation of the result, their method has been criticised for its dependence on self‐reported timing and subjective memory, and the interpretation has been widely debated without general consensus. Here, we show that the mean time of the conscious intention to move was 1.42 s before movement, estimated based on the subject’s real‐time decision of whether or not there was a thought to move when a tone occurred. This event is after the onset of the bereitschaftspotential, an electroencephalographic activity preceding voluntary movement, but about 1 s earlier than the timing of intention reported previously based on the subject’s recall. Our result solves some problems of the conventional method, thus giving a clearer answer to the controversies. The difference between the conventional result and our result suggests that the perception of intention rises through multiple levels of awareness, starting just after the brain initiates movement.     

漂浮疗法对大学生免疫功能的影响

目的:采用淋巴细胞转化率为指标研究漂浮疗法对个体免疫功能的影响。方法:以淋巴细胞转化率作为免疫功能变化指标。被试为43名大学生(男22名,女21名),年龄18～24岁。被试随机分为4组,其中前3组均采用漂浮疗法,但具体过程略有不同。第1组:漂浮,播放漂浮治疗专用音乐;第2组:漂浮,通过内部通讯系统进行放松指导;第3组:漂浮,无任何听觉刺激;第4组为对照组。每人完成4次治疗。结果:各组被试治疗前的淋巴细胞转化率没有显著性差异(F=0.733P=0.539)。采用漂浮治疗的各组中,只有第3组淋巴细胞转化率在治疗前后有显著性差异犤(91.7±4.2)%vs(84.8±7.2)%犦,而对照组治疗前后该项检查的结果也有显著性差异犤(93.0±2.8)%vs(89.3±4.2)%犦。第3组被试治疗前后淋巴细胞转化率变化显著大于第2组被试(t=2.168,P=0.043)。男女被试的淋巴细胞转化率在治疗前分别为87.68%和86.95%,两者没有显著性差异(t=0.314,P=0.755)。男女被试的淋巴细胞转化率在治疗前后的变化没有显著性差异(t=0.503P=0.620)。结论:漂浮疗法的确可以提高被试的细胞免疫功能,但是漂浮治疗中使用额外的听觉刺激可能会影响到改善免疫力的作用。性别对于淋巴细胞转化率变化没有显著影响。该研究的结果在应用于临床前,尚需要进一步研究。     

彩色多普勒超声与核素对甲状腺结节的诊断价值比较

目的比较彩色多普勒超声与核素检查对甲状腺结节的诊断价值。 方法对34例明确诊断的甲状腺结节的彩色多普勒超声与核素的检查结果进行回顾性分析。 结果2种影像学方法都可以显示甲状腺的形态、位置、大小,但彩色多普勒超声对甲状腺位置、大小、内部结构、回声、血流状况更为清晰有效。超声检查出的结节如果小于1cm,核素对其发现则显得困难。但核素可以反应甲状腺摄锝功能,可以反应甲状腺结节的寒热温良的特性。结节的囊实性和核素的寒热温良特性没有明显关联。 结论彩色多普勒超声和核素是从不同的侧面对甲状腺结节进行观察和说明。2种影像学方法都无创,有效,结合使用可提高诊断敏感性和准确性。     

Metabolic MR imaging of regional triglyceride and creatine content in the human heart

An optimized echo‐planar spectroscopic imaging sequence is proposed to facilitate spatial mapping of triglyceride and total creatine content in the human heart. The sequence integrates local‐look field of view reduction, cardiac and respiratory gating, and dedicated reconstruction steps to account for gradient channel delays, field inhomogeneity, and phase incoherence due to residual motion. The technique is demonstrated in 12 volunteers in comparison to single voxel point‐resolved spectroscopy in the septal wall at 1.5 T. Triglyceride‐to‐water and total creatine‐to‐water ratios derived from echo‐planar spectroscopic imaging (0.48 ± 0.18% and 0.06 ± 0.03%) and point‐resolved spectroscopy (0.52 ± 0.17% and 0.07 ± 0.02%) were found to agree well. In the septal region, intraclass correlation coefficients ranging from 0.67 to 0.72 were estimated. A relatively weak agreement (intraclass correlation coefficients: 0.34 and 0.52) was found for sectors in the lateral wall due to field gradients induced by the posterior vein and limited sensitivity of the receive coil array in this area. On the basis of the findings, it is concluded that fast spectroscopic imaging of both cardiac triglyceride and total creatine content is feasible. Shimming and sensitivity challenges in the lateral region remain, however, to be addressed. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.     

“神转不回，回则不转”理论治疗痫证临证探微

[目的] 探求“ 神转不回,回则不转”理论的内涵及其临床治疗痫证的运用。[方法] 通过查阅《黄帝内经》及后世医药典籍等,分析“神转不回,回则不转”理论,依此阐释痫证病机及立法选方,分析典型案例以论述其理论。[结果] 痫证是由神气逆乱、三焦不通而诱发,五脏不平、内生积滞致痫证不愈,神回不转,神机失用,痫证避无可避,方以柴胡加龙骨牡蛎汤为基础,整理三焦枢转五脏神气,荡平五脏积滞并解其标。所举验案为气机阻滞、痰火扰神之证,治以清肝泻火、豁痰醒神之法,方用柴胡加龙骨牡蛎汤合涤痰汤加减,辄收佳效。[结论“] 神转不回,回则不转”说明人之神机、气血阴阳不能逆乱,应当在各脏间一以贯之流转,每脏间如环无端运转;痫证的治疗应以“通”字为法,方以柴胡加龙骨牡蛎汤加减,旨在通调使道,平治五脏,标本兼顾,恢复神机,并以言语宽慰,则可痫定神安。     

轻浅慢针法及其临床运用举隅

根据疾病特点和临床诊疗经验创立轻浅慢针法。介绍该针法的操作方法、功效和适用证，并例举该针法治疗智力低下、小儿抽动症和结节性红斑验案三则。     

Alteration to will as an experience of technology and nursing

This paper presents one finding to arise from a recent qualitative research study that examined ways of understanding technology in surgical nursing, and examines its implications for nursing and health care practice. Although the research reported identified eight qualitatively different ways of understanding technology, this paper examines the specific experience that technology can alter will (volition). The experience described is a new area of knowledge and is in need of further examination and research. Nonetheless, it is significant to understanding technology, contemporary nursing practice and the provision of health care services. The paper concludes with some suggested approaches for curtailing the experience and a discussion related to challenges that arise from the finding that technology can alter the free will of nurses.     

5岁以下儿童支气管哮喘发生及持续发展的危险因素分析

我国调查显示约有90．33％支气管哮喘（简称哮喘）儿童首次喘息发生在5岁及以前,虽然临床上有如此高的患病率,但5岁以下反复喘息儿童因难以获得肺通气功能等客观的哮喘评估指标,临床诊断需基于患儿的病史、临床表现及其对平喘药物的治疗反应来确定。故目前有关5岁及以下年幼儿哮喘的诊断手段十分有限。本文通过对患儿的出生史、喂养营养史、家居环境因素、遗传因素、过敏原及病原微生物分析,了解5岁及以下哮喘患儿的既往危险因素及导致其持续发展的危险因素,对5岁及以下儿童哮喘的早期识别诊断、早期治疗提供理论依据。