分级诊疗背景下多病共存患者就医机构选择行为及其影响因素研究

背景 近年来,国内针对多病共存患者在分级诊疗背景下就医机构选择行为的研究较少,研究多病共存患者的就医机构选择行为有重要的现实意义。目的 以分级诊疗为视角,分析多病共存患者就医机构选择行为及其影响因素,为进一步落实分级诊疗制度和合理配置医疗资源提供研究参考。方法 采用随机抽样法,选取2019-06-01至2020-01-01在上海市杨浦区中心医院医疗联合体（上海市杨浦区中心医院和上海市杨浦区定海、延吉、长白社区卫生服务中心）就诊的多病共存患者为研究对象。采用自设问卷对其进行调查,收集多病共存患者的一般资料,了解其对分级诊疗政策的认知情况及实际遵守情况、在不同疾病控制状况下至社区卫生服务中心首诊的意愿,以及其选择就诊医疗机构时考虑的因素等。采用二分类Logistic回归分析多病共存患者此次因病就医是否选择至社区卫生服务中心首诊的影响因素。结果 共发放1 100份问卷,回收有效问卷1 072份,有效问卷回收率为97.45%。1 072例多病共存患者中,老年（≥60岁）多病共存患者占85.07%(912/1 072)。624例（58.21%）患者表示知晓分级诊疗制度;940例（87.69%）患...     

Effects of chemical mediators of anaphylaxis on ciliary function

We assessed the effects of selected chemical mediators of anaphylaxis on CBF in vitro. Ciliated epithelial cells were obtained from the trachea of conscious sheep with a cytology brush and suspended in a perfusion chamber containing KH. Ciliary activity was viewed microscopically and recorded on videotape for subsequent slow-motion analysis of CBF. Prostaglandin E1 (10(-8) M to 10(-6) M), prostaglandin E2 (10(-10) M to 10(-6) M), and leukotriene-C4 (10(-8) M) increased CBF between 7% and 33%. Histamine caused ciliostimulation only at the relatively high concentrations above 10(-5) M (7% increase in CBF), whereas prostaglandin F2 alpha (10(-10) M and 10(-6) M) was without effect. In no preparation was ciliary discoordination observed. These findings indicate that several chemical mediators of anaphylaxis stimulate CBF and that the previously described impairment of mucociliary transport in stable allergic asthma or antigen-induced bronchoconstriction is probably not caused by a primary alteration of ciliary function.     

Origins of the projections of the superior colliculus to the dorsal lateral geniculate nucleus and the pulvinar in the rabbit

The origins of the projections of the superior colliculus to the dorsal lateral geniculate nucleus and to the pulvinar in Dutch-belted rabbits were investigated using horseradish peroxidase (HRP) methods. Following injections of HRP in the dorsal lateral geniculate nucleus, retrogradely labeled neurons were found in the upper two-thirds of the stratum griseum superficiale of the ipsilateral superior colliculus. Most of the labeled somata were spindle-shaped, and their major axes tended to be perpendicular to the surface of the superior colliculus. In contrast, following injections of the pulvinar, labeled neurons were found in the lower third of the ipsilateral stratum griseum superficiale. In these cases, the labeled somata were larger than those labeled following dorsal lateral geniculate injections and were multipolar in shape.     

Gross anatomy: An outdated subject or an essential part of a modern medical curriculum? Results of a questionnaire circulated to final-year medical students

Final-year undergraduate medical students were given a questionnaire on the gross anatomy curriculum they had experienced in their first year at medical school 5 years earlier. They were asked to evaluate the relevance of the dissection course, lectures and seminars in gross anatomy for clinical courses, clerkships, and everyday practical work on the ward. About two-thirds of the students found the time spent on 10 different regions in anatomy to be adequate, and a considerable number of students would have liked even more details. The vast majority expressed a wish to repeat topographical anatomy during their clinical teaching. Furthermore, ～75% of the students showed interest in short, specialized dissection courses during the clinical curriculum. Medical students just before graduation ranked gross anatomy with the dissection course and integrated clinical topics as a keystone for their clinical courses. The results of such surveys should be taken into consideration when discussing modification to teaching gross anatomy or arguing about a balanced dissection course. © 1993 Wiley-Liss, Inc.     

Adrenaline turnover rates in the medial preoptic area and mediobasal hypothalamus in relation to the release of luteinizing hormone in female rats

The turnover rates of adrenaline in the medial preoptic area and mediobasal hypothalamus, areas which, respectively, include the cell bodies and terminals of luteinizing hormone-releasing hormone neurons, have been measured in female rats on pro-oestrus, the day of the preovulatory surge of luteinizing hormone, and on dioestrus, the preceding day. A rise in the rate of turnover was found in the medial preoptic area coinciding with the surge of luteinizing hormone in the late afternoon of pro-oestrus; the rate of turnover at this time was higher than at the same time on dioestrus. No changes in turnover rate were found in the mediobasal hypothalamus within either of these days.The results indicate that the adrenaline-containing projections to the preoptic area may be actively involved in the production of the spontaneous preovulatory surge of luteinizing hormone in rats.     

Nocturnal penile tumescence as a biologic marker in assessing erectile dysfunction

Recent findings challenge the belief that most cases of impotence are psychogenic. Research indicates that nocturnal penile tumescence (NPT) can be viewed as a biologic marker for physiologic erectile capacity. Thus, the test can help to distinguish between physicogenic and psychogenic impotence. To determine proximal causes of erectile failure, other evaluations are easily performed during NPT monitoring.