医改前后门诊病人就医心理调查

目的：探讨医改后门诊病人就医心理的变化及影响因素.方法：医改前后分别采用自制《病人心理调查问卷》对某医院的1 206例门诊病人进行问卷调查.结果：医改前后的病人在年龄、性别、费用来源、对医务人员服务的满意程度方面差异无统计学意义（x^2值1.213～4.984,P＞0.05）;在就诊时间、诊次、对疾病的态度、未及时就诊的原因、就医前的担心、对医生的希望、择医的依据、对医院设施评价等方面的差异均有统计学意义（x^2值7.248～217.239,P＜0.05）.结论：医改后病人自我保护意识增加但就医并不及时;影响门诊病人就医的因素有医务人员的工作态度、服务水平及就医费用.     

深圳市龙岗区流动人口疟疾流行病学分析

目的：分析深圳市龙岗区流动人口疟疾流行状况,为制定疟疾预防控制措施提供依据.方法：用回顾性流行病学研究方法对深圳市龙岗区1993～2003年外来流动人口疟疾流行情况进行分析.结果：10年间流动人口疟疾发病3 027例,占全区病例数的58.82%.疟疾发病有明显的季节性和地方聚集性.患者年龄主要为15～60岁,职业以种养、打石、烧砖、建筑为主.暴发流行主要与存在传疟媒介,外来民工居住场所蚊虫孳生地多,民工缺乏自我保护意识等因素有关.结论：流动人口是引发深圳市龙岗区疟疾流行的主要原因.     

抗抑郁治疗对卒中后抑郁及神经功能康复的影响

目的探讨氟西汀抗抑郁治疗对卒中后抑郁(PSD)患者的抑郁症状和神经功能康复的影响及其安全性。方法将91例PSD患者随机分为治疗组46例和对照组45例,两组同时应用脑血管病治疗药物,治疗组加用氟西汀治疗。采用汉密尔顿抑郁量表(HAMD)、日常生活自理能力量表(Barthel指数记分)和神经功能缺损程度评定疗效和功能改善状况。结果治疗后治疗组HAMD量表减分率与对照组比较,差异有高度显著性(P<0.01),神经功能缺损程度积分值降低与Barthel评分提高,治疗组优于对照组(P<0.05和P<0.01)。治疗组抑郁症状改善的显效率和神经功能缺损改善的总有效率均显著高于对照组(P<0.001和P<0.05)。氟西汀的主要副反应为失眠、焦虑和恶心。结论氟西汀抗抑郁治疗能明显改善PSD患者的抑郁症状和神经功能,且副反应轻。     

脑外伤病人的临床伦理问题探讨

脑外伤病人占外科病人很大一部分比例,其治疗过程艰难而复杂,而且在治疗过程中涉及很多伦理学问题,值得探讨和研究.本文作者通过多年来诊治脑外伤病人的经验,从伦理学的角度对脑外伤治疗过程中的一些问题进行了探讨,以期更有利于保障患者和医务工作者的合法权益、减少医疗纠纷,摆正医生与患者位置关系,使脑外伤患者得到更好的治疗.     

利多卡因-月桂醇二元共熔系统的体外经皮渗透利多卡因-月桂醇二元共熔系统的体外经皮渗透

目的研究利多卡因-月桂醇二元共熔系统对利多卡因经皮渗透的影响。方法制备不同比例的利多卡因-月桂醇二元共熔混合物和含二元共熔混合物的透皮贴剂。测定了利多卡因和利多卡因-月桂醇二元共熔混合物在pH 7.9的磷酸盐缓冲液的溶解度。以Franz类型的单室扩散池测定利多卡因及利多卡因-月桂醇二元共熔混合物贴剂的体外透皮性能。结果利多卡因-月桂醇二元共熔混合物的熔点明显比利多卡因低。含利多卡因-月桂醇二元共熔混合物贴剂中利多卡因的稳态透皮速率是纯利多卡因贴剂的6倍。结论利多卡因-月桂醇二元低共熔混合物中的利多卡因具有较高的热力学活性，从而显著提高了利多卡因的体外透皮速率。     

Monomeric and dimeric states exhibited by the kinesin‐related motor protein KIF1A

Abstract: KIF1A, a kinesin‐related motor protein that transports pre‐synaptic vesicles in neurons, was originally presumed to translocate along microtubules (MT) as a monomer. Protein structure predictions from its amino acid sequence failed to identify the long coiled‐coil domains typical of kinesins, which led researchers to believe it does not oligomerize into the canonical kinesin dimer. However, mounting evidence using recombinant chimeric protein indicates that KIF1A, like conventional kinesin, requires dimerization for fast, unidirectional processive movement along MTs. Because these studies are somewhat indirect, we wished to test the oligomerization state of native KIF1A, and to compare that to full‐length recombinant protein. We have performed hydrodynamic analyses to determine the molecular weights of the respective complexes. Our results indicate that most native KIF1A is soluble and indeed monomeric, but recombinant KIF1A is a dimer. MT‐binding studies also showed that native KIF1A did not bind to MTs in either the presence of AMP‐PNP, apyrase, or adenosine triphosphate (ATP), but recombinant KIF1A bound to MTs most stably in the presence of ATP, indicating very different motor functional states. To further characterize KIF1A's dimerization potential, we prepared peptides corresponding to the neck domains of MmKIF1A and CeUnc104, and by circular dichroism spectroscopy compared these peptides for their ability to form coiled‐coils. Interestingly, both MmKIF1A and CeUnc104 neck peptides formed homodimeric coiled‐coils, with the MmKIF1A neck coiled‐coil exhibiting the greater stability. Collectively, from our data and from previous studies, we predict that native KIF1A can exist as both an inactive monomer and an active homodimer formed in part through its neck coiled‐coil domain.     

低频重复经颅磁刺激对尿毒症失眠患者的临床研究

【摘要】目的 研究重复经颅磁刺激（rTMS）对尿毒症失眠患者的疗效及静息态功能磁共振成像（rs fMRI）下大脑自发神经活动低频振幅（ALFF）的变化。方法 选取2015年3月~2016年6月在南充市中心医院血液净化中心进行维持性血液透析的尿毒症失眠患者31例,分为rTMS治疗组（n=21）与空白对照组（n=10）。rTMS治疗组接受rTMS治疗,在治疗前后采用匹兹堡睡眠质量指数量表（PSQI）、阿森斯失眠量表（AIS）进行评分及rs fMRI图像采集。空白对照组不接受rTMS治疗,不采集rs fMRI图像,其余与rTMS治疗组相同。对比分析rTMS治疗组治疗前后睡眠量表评分及低频振幅（ALFF）的差异。结果 rTMS组治疗15d后,与治疗前及空白对照组入组15d后相比,尿毒症失眠患者睡眠情况明显改善。rTMS组治疗前后ALFF值比较,差异有统计学意义（P＜005）,其中双侧眶额叶、双侧杏仁核、左侧海马、左侧前扣带回的ALFF值增高,双侧脑岛的ALFF值降低。结论 低频可rTMS通过影响大脑相关脑区神经活动强弱来治疗尿毒症患者的失眠,改善睡眠结构。     

Intra and intersubject variability in auditory steady-state response amplitude with high modulation rates to 1000 Hz amplitude modulated and tone pip stimuli

Abstract

Objective: This study set out to provide further information on how high modulation/stimulus rates affect the auditory steady-state response (ASSR) amplitude for a 1000-Hz tone, and how this effect varies between individuals. Both sinusoidal amplitude modulated tones and tone pip stimuli were investigated. Design: Modulation/stimulus rates were 70, 80, and 90 Hz and the peak to peak stimulus levels were matched for the two different types of stimuli, at 90.5 dBSPLppe. Study sample: The study was carried out on fourteen normally-hearing adults (9 males and 5 females) Results: Overall the ASSR amplitude to the two types of stimuli was similar. In general there was an increasing response amplitude between rates of 70 and 90 Hz; The relationship between the amplitude of the response and the modulation /stimulus rate varied considerably between subjects. Conclusions: Optimum stimulus rates based on group data may not give the best rate in a significant proportion of subjects. Currently tone pip ABR is the primary method used in assessing hearing in babies. Finding a way of avoiding suboptimal stimulus rates for ‘80-Hz’ ASSR in babies will improve the likelihood of ASSR being seen as an alternative.     

Frequency‐specific disruptions of neuronal oscillations reveal aberrant auditory processing in schizophrenia

Individuals with schizophrenia exhibit abnormalities in evoked brain responses in oddball paradigms. These could result from (a) insufficient salience‐related cortical signaling (P300), (b) insufficient suppression of irrelevant aspects of the auditory environment, or (c) excessive neural noise. We tested whether disruption of ongoing auditory steady‐state responses at predetermined frequencies informed which of these issues contribute to auditory stimulus relevance processing abnormalities in schizophrenia. Magnetoencephalography data were collected for 15 schizophrenia and 15 healthy subjects during an auditory oddball paradigm (25% targets; 1‐s interstimulus interval). Auditory stimuli (pure tones: 1 kHz standards, 2 kHz targets) were administered during four continuous background (auditory steady‐state) stimulation conditions: (1) no stimulation, (2) 24 Hz, (3) 40 Hz, and (4) 88 Hz. The modulation of the auditory steady‐state response (aSSR) and the evoked responses to the transient stimuli were quantified and compared across groups. In comparison to healthy participants, the schizophrenia group showed greater disruption of the ongoing aSSR by targets regardless of steady‐state frequency, and reduced amplitude of both M100 and M300 event‐related field components. During the no‐stimulation condition, schizophrenia patients showed accentuation of left hemisphere 40 Hz response to both standard and target stimuli, indicating an effort to enhance local stimulus processing. Together, these findings suggest abnormalities in auditory stimulus relevance processing in schizophrenia patients stem from insufficient amplification of salient stimuli.