延安歌唱通过文字媒介向口头媒介的转换,激活诗歌发展本身内蕴的"歌唱性",打破了"诗乐分途"的理论束缚,推进了新诗大众化的实践进程;它遵循了工农大众在劳动中"一呼一吸"的生理机制及其所产生的身体节奏,紧紧贴近大众的物质生产、日常生活与情感逻辑,使得"诗歌"终于成为大众不可或缺的"精神食粮";由于转换为口头媒介,延安歌唱反而巧妙地解决了唱词中书面语与口语的纠结、普通话与方言的缠绕,生产出一种源自民间、能够交还民间并被大众真正接纳的抒情话语方式.

目的 探讨品管圈对达芬奇管腔器械返洗率的影响.方法 成立品管圈小组,调查科室达芬奇管腔器械返洗率现状,分析影响因素,制订对策并实施.采用目测+光源放大镜检测法和ATP生物荧光检测法对品管圈管理实施前后达芬奇管腔器械清洗效果进行检测,计算返洗率,同时记录清洗时间.结果 品管圈管理实施后,目测+光源放大镜检测达芬奇管腔器械返洗率由19.6％降至8.2％,ATP生物荧光检测返洗率由24.7％降至9.8％,清洗时间由(5.55±0.73) min降至(3.57-0.36) min,差异均具有统计学意义.结论 品管圈可降低达芬奇管腔器械的返洗率,可提高清洗质量和效率.

我国领导权威以民主集中制为基石,以党政法规制度建设为框架,显现出法理型权威特征.在从严治党与依法治国的建设过程中,领导权威起着关键性的桥梁作用,新时代必须推进领导权威法治化.但目前领导权威面临着领导环境、国家治理现代化、风险社会等挑战,部分领导干部存在"越权"与"失度"等行为,原因在于传统观念尚未完全转型、权责一致尚未完全实现.为促进领导权威法治化,应当把握好三对平衡关系,健全管理体制机制,加强领导干部队伍建设.

行政公益诉讼涉及行政机关、检察机关和法院三个机关,以及行政权和司法权两种权力的运用.行政机关、检察机关和法院分别实施行政权、司法监督权和司法裁判权,共同保护公共利益.行政公益诉讼必须坚持司法谦抑性,凸显检察权行使限度和司法审查的强度.司法谦抑性要求检察机关尊重行政机关初次判断、重视行政公益诉讼诉前程序、尊重行政裁量权、理解风险社会下行政规制的局限性、考虑行政不能作为以及贯彻行政监督优先于检察监督.

近年来,中央和地方持续出台利好政策推进智慧养老发展.在地方实践中,浙江省、安徽省与上海市在加快智慧养老的平台建设、构建标准体系、建立监管机制、引导社会资本参与等方面积累了先进经验.然而,智能技术介入养老服务,给政府治理责任机制、市场规制机制以及老年人信息权益保障制度带来了法律上的挑战.研究表明,完善顶层设计、健全财政及监督机制可强化政府治理责任,更新传统市场规制法、构建统一的行业标准与管理规范可完善市场规制机制,完善《中华人民共和国老年人权益保障法》、调适知情同意原则的应用模式可为老年人信息权益提供法律保障.

在美丽乡村建设的过程中,河南进行了多元的探索,为未来乡村振兴提供了借鉴.实践一:以许昌鄢陵县为代表.只有生态空间良好,生产空间集约高效,才能给农民营造更宜居的生活空间,新农村建设才会更有活力.生产、生活、生态的"三生一体"再加上美丽的乡村景观,鄢陵乡村发展作了最好的阐释.实践二:修武美学经济带动乡村振兴.修武作为一个内陆小县,它冲破了产业升级只能靠科技的固化思维,全面激活生态环境和历史文化资源,在中原开辟出一条美学经济驱动产业升级的新路径.实践三:以信阳郝堂村为代表.恢复集体经济,壮大集体经济的实力,给乡村建设提供物质基础.提出"把乡村建设得更像乡村"的乡村建设经验.实践四:以兰考张庄村为代表.张庄村一手培育支撑产业,一手增加农民就业,产业发展和吸纳农民就业相互支撑,为张庄的乡村振兴插上腾飞的翅膀.实践五:以开封西姜寨村为代表.西姜寨村作为2020年中国农民丰收节的主会场,体现了科技兴农的强大力量.实践六:乡村文化振兴.文化振兴能改善农民精神风貌,提高乡村生活文明程度.乡土文化既传统又时尚,既是文化又可变成产业.乡土文化传承好和发展好,不仅能够弘扬传统文化,而且能够推动乡村振兴.

人口老龄化时代,传统养老模式已捉襟见肘,基于人工智能和大数据的智慧养老模式成为积极应对老龄化的新举措.但智慧养老作为一种新型的养老方式也面临着行业标准及产品技术应用缺少法律规定、老年人相关权益保护不到位、侵权责任承担规则不明确、监管制度不完善、司法救助机制不健全的法律困境.为此,应当明确行业标准及产品技术的应用、加强老年人相关权益法律保障、明确侵权责任的承担规则、完善监管制度、健全司法救助机制来提升养老服务的品质和效率,更好地保护老年人的权益.

随着黄河流域生态保护和高质量发展上升为重大国家战略,跨区域生态环境协同治理的作用日益凸显.鲁豫两省签订的生态补偿"对赌协议"属于"政府间行政协议",其实质是"公法契约",具有"软法"治理价值.政府间行政协议作为黄河流域协同治理的主要机制具有必要性和可行性.黄河流域生态保护面临"决策难"、"执行难"的困境,其克服路径为通过政府间行政协议进行协同治理.政府间行政协议体现了绿色发展原则,以"软法"促进治理法治化、提升执法协同创新,推进生态文明建设和法治政府建设.政府间行政协议的完善路径为:由《黄河保护法》明确规定、完善协议签订和管理组织体系、多元利益主体参与缔结程序、凸显核心内容、建立信息共享和动态评估机制、建立纠纷解决机制,以促进黄河流域生态保护和高质量发展.

Objective:To investigate the effects of hippocampal injection of tyrosine kinase receptor binding protein B3(Ephrin-B3) agonist on spontaneous seizures and the expression of hippocampal secretory glycoprotein (Reelin) and phosphorylated adaptor protein (p-Dab1) in epileptic model rats.Methods:Seventy-eight rats were randomly divided into control group and model group according to body mass matching with 39 rats in each group.The rats in control group were fed normaly, and the rats in model group were established epilepsy model by intraperitoneal injection of lithium chloride pilocarpine. The hippocampal tissues were taken in the acute phase (7 days), quiescent phase (14 days) and chronic phase (60 days) after the successful induction of status epilepticus. The levels of Reelin protein and p-Dab1 protein in the hippocampal tissues of epileptic model rats and normal rats were detected by immunohistochemistry and Western blot.And thirteen rats were randomly selected at each time point. Another 48 rats were randomly divided into normal Fc-control group, normal EphB3-Fc group, epilepsy Fc-control group and epilepsy EphB3-Fc group, with 12 rats in each group. Rats in the first two groups were fed normally, and those in the latter two groups were established epileptic model. Seven days after modeling, all rats were injected into bilateral hippocampus with EphB3-Fc (Ephrin-B3 agonist) and FC control (control agent of Ephrin-B3 agonist) according to the grouping, once a day for 7 days. After administration, the changes of behavior and EEG were observed within two weeks. At the same time, the expression of Reelin protein and p-Dab1 protein were detected by immunohistochemistry and Western blot. SPSS 21.0 was used for statistical analysis, One-way ANOVA was used for multi group comparison, and Tukey's test was used for pairwise comparison.Results:The results of immunohistochemistry and Western blot showed that compared with the control group, the levels of Reelin and p-Dab1 protein in hippocampus of model group decreased significantly at 7, 14 and 60 days after epilepsy (all P<0.01). The results of immunohistochemistry showed that compared with epilepsy Fc-control group, the levels of p-Dab1 ((0.41±0.04), (0.58±0.06), P<0.05) in epilepsy EphB3-Fc group increased significantly.Western blot result showed that the level of p-Dab1 in epilepsy EphB3-Fc group increased compared with that of epilepsy Fc-control group (1.34±0.04), (2.26±0.10), P<0.01). Compared with epilepsy Fc-control group, epilepsy EphB3-Fc group showed less average seizure duration ((39.00±1.79)s, (26.50±1.87)s; t=23.21, P<0.01), less frequencies ((2.00±0.89), (0.50±0.55); t=2.32, P<0.01) and less latent period ((6.33±1.37)day, (12.50±1.87)day; t=2.52, P<0.01) in spontaneous recurrent seizures. Compared with epilepsy Fc-control group, epilepsy EphB3-Fc group showed lower average amplitude ((37.30±1.21)μV, (29.00±1.41)μV; t=25.14, P<0.01), less average seizure duration ((5.35±0.19)s, (2.35±0.19)s; t=3.13, P<0.01). Conclusion:Ephrin-B3 alleviated spontaneous recurrent seizures by upregulating Reelin and p-Dab1 in temporal lobe epilepsy rat.

目的 分析抗接触蛋白相关蛋白-2(CASPR2)抗体相关脑炎癫痫发作的临床特征.方法 对2018年9月至2020年11月郑州大学第五附属医院及郑州大学第一附属医院神经内科收治的7例抗CASPR2抗体相关脑炎癫痫发作患者的临床表现、辅助检查、治疗及预后进行回顾分析.结果 7例患者年龄10～72岁,中位年龄62岁,其中5例男性,2例女性.癫痫发作类型中复杂部分性发作(CPS)5例(71.43％),全面性强直-阵挛发作(GTCS)4例(57.14％),未见其特征性发作表现,4例(57.14％)出现边缘系统症状,5例(71.43％)合并自主神经功能障碍.血清学未见特异性改变,脑脊液检查可出现蛋白、淋巴细胞水平升高,血清抗体检测敏感度高于脑脊液.2例(28.57％)出现头颅磁共振成像(MRI)异常,3例(42.86％)脑电图可见异常.所有患者均接受癫痫药物、免疫治疗,6例好转.随访1例复发,2例死亡.结论 以癫痫发作为主要症状的脑炎患者需考虑抗CASPR2抗体相关脑炎的可能,及时进行抗体检测明确诊断,早期给予抗癫痫、免疫治疗,一般预后较好.

目的 探讨快速康复护理在脊柱转移瘤患者中的应用及其对患者快速康复和护理满意度的影响.方法 入组2018年3月至2020年10月郑州大学第一附属医院收治的经病理学确诊的脊柱转移瘤患者60例,采用随机数字表法分为2组,每组30例,即应用快速康复护理的观察组和常规康复护理的对照组.治疗过程中及术后随访时,采用疼痛视觉评分、自制调查量表进行术后患者状态及护理满意度评价.结果 观察组功能恢复总有效率93.33％,高于对照组的73.33％,差异统计学意义(χ2=4.320,P=0.038).观察组患者住院时间为(10.42±0.78)d,短于对照组的(12.55±1.09)分,差异有统计学意义(t=4.875,P=0.029).观察组患者术后6个月VAS评分为(2.06±0.37)分,低于对照组的(4.59±0.72)分,差异有统计学意义(t=7.824,P=0.016).观察组并发症总发生率为3.33％,低于对照组的26.67％,差异有统计学意义(χ2=6.405,P=0.011).观察组患者护理满意度为96.67％,高于对照组的73.33％,差异有统计学意义(χ2=6.405,P=0.011).结论 快速康复护理可有效帮助脊柱转移瘤患者实现早期活动与快速康复,提高患者护理满意度,改善患者预后.

Objective:To explore the clinical and electrophysiological characteristics of flail arm syndrome (FAS).Methods:Clinical and electrophysiological data were collected on 13 FAS patients and 31 persons with upper limb onset amyotropic lateral sclerosis (UL-ALS), including the amplitude of compound muscle action potential (CMAP) related to median nerve, ulnar nerve, and axillary nerve motor conduction. A split-hand index (SI) was calculated by dividing the CMAP amplitude of abductor pollicis brevis by that of the abductor digiti minimi. Clinical features, the CMAP amplitudes and SIs were compared between the FAS and UL-ALS patients.Results:Compared with UL-ALS patients, the age at onset among the FAS patients was older (averaging 60.9 years). The development to the second stage was longer (24±6 months). The upper limb reflexes of 15% of the FAS patients had disappeared and those of 77% were weakened, while the lower limb reflexes of 54% of the FAS patients were active and 38% were weakened, significantly different from the UL-ALS patients. However, there were no significant differences in the CMAP amplitudes of the median and ulnar nerves, nor in SI between the FAS and UL-ALS patients. The SIs of the FAS patients with upper motor neuron signs were significantly lower than those of FAS patients without such signs. Among the FAS patients, the average CMAP amplitude of the ulnar nerve was the highest, followed by those of the median and axillary nerves. Among the UL-ALS patients, however, the average CMAP amplitude of the ulnar nerve was not significantly different from that of the axillary nerve.Conclusions:FAS patients with upper motor neuron signs are more likely to have slip hand. The CMAP amplitude of their axillary nerve tends to be lower than that of their median and ulnar nerves. FAS seems to be a special type of ALS.

检察机关提起行政公益诉讼维护未成年人合法权益,既可避免发生未成年人领域受损害的"公地悲剧",亦是践行国家亲权理念下人权保障的要求.检察机关提起未成年人保护公益诉讼,存在的权责规定模糊、案件来源单一、忽略未成年人群体特殊性等问题.其完善路径为:细化法律规定;聚焦重点领域,积极探索案件来源;案件类型化;多元主体共治,积极、稳妥推进未成年人领域行政公益诉讼制度发展.只有这样,才能开启未成年人综合司法保护时代.

目的 探讨缺血型烟雾病(MMD)患者不同临床症状的特点和影响因素.方法 回顾性收集2018年6月至2019年8月于郑州大学第五附属医院就诊的MMD患者的一般临床资料.根据患者的临床症状分为头晕组、短暂性脑缺血发作(TIA)组和脑梗死组.根据患者的数字减影血管造影(DSA)结果行Suzuki分期和侧支循环分类,把侧支循环分为硬脑膜血管吻合系统、软脑膜血管吻合系统、室管膜下血管吻合系统和丘脑、纹状体内血管吻合系统.根据患者MRI中缺血灶的部位分为皮质区、分水岭区、和深穿支区.对患者一般临床资料和侧支循环进行分析.结果 TIA组和脑梗死组收缩压水平高于头晕组(P<0.05),头晕组较TIA组和脑梗死组Suzuki分期更晚(P<0.05);脑梗死组皮质区缺血灶发生率高于头晕组和TIA组(P<0.05),TIA组分水岭区缺血灶发生率高于头晕组(P<0.05),TIA组深穿支区域缺血灶发生率高于头晕组和脑梗死组(P<0.05).脑梗死组软脑膜血管吻合系统发生率高于头晕组和TIA组(P<0.05),头晕组硬脑膜血管吻合系统发生率高于TIA组和脑梗死组(P<0.05),3组间室管膜下血管吻合系统和丘脑纹状体血管吻合发生率差异无统计学意义(P>0.05).结论 缺血型MMD患者不同临床症状的发生与多种因素有关,侧支循环与缺血型MMD患者的临床症状有相关性.软脑膜血管吻合系统与脑梗死的发生有关,硬脑膜血管吻合系统与头晕的发生有关;MMD患者脑缺血患者梗死部位多位于皮质区,TIA缺血灶多发生在分水岭区和深穿支动脉分布区;收缩压水平升高可能与脑梗死和TIA发生有关.

目的 探讨线粒体脑肌病伴高乳酸血症和卒中样发作综合征的分子生物学特征.方法 收集2011-01—2020-01郑州大学第五附属医院和郑州大学第一附属医院经肌肉病理和基因测序同时确诊的42例MELAS综合征的临床表现、影像学、肌肉病理和基因测序等资料,对其血液和新鲜尿液的基因测序结果进行回顾性分析.结果 42例患者均发现mtNDA突变,30例患者发生3243 A>G突变,血液检出25例发生3243 A>G突变,突变率为22.15％～100％(36.26±13.38)％;尿液检出30例发生3243 A>G突变,细胞突变率为38.46％～100％(59.49±22.67)％;发现3271 T>C突变、13513 G>A突变分别3例,1642 G>A、3093 C>G、3256 C>T、3302 A>G、3697 G>A和15242 G>A突变分别1例,其中3093 C>G、3697 G>A和15242 G>A突变国外已经报道,而国内尚未见报道.与血液的线粒体DNA突变率相比,尿液的突变率显著增高,差异有统计学意义(P<0.05).结论 3243 A>G是MELAS综合征最常见的突变位点.3093 C>G、3697 G>A和15242 G>A突变丰富了国内MELAS综合征线粒体基因突变的特点.尿液的mtDNA突变率高于血液,可作为MELAS综合征患者及亲属基因测序的首选标本.

Objective:To explore the short-term outcomes of a 3D printed trabecular block cage to assist posterior internal fixation for the treatment of patients with basilar invagination and atlantoaxial dislocation.Methods:Between June 2017 and February 2019, 12 patients with basilar invagination and atlantoaxial dislocation underwent atlantoaxial distraction and posterior internal fixation at Department of Orthopedics, The First Affiliated Hospital to Zhengzhou University. They were 5 males and 7 females, aged from 34 to 62 years (average, 45.6 years). 3D printed cages were inserted intraoperatively between the joints of the atlantoaxial lateral mass. The atlanto-dental interval interval (ADI), cervico-medullary angle (CMA) and distance from tip of the odontoid process to Chamberlain's line (DOCL) and the Japanese Orthopedic Association (JOA) scale were compared between preoperation and 12 months postoperation to observe the fusion of the joints of the atlantoaxial lateral mass.Results:Operation went on uneventfully in all the 12 patients. Operation time averaged 116.5 min (from 85 to 190 min), fluoroscopy frequency 9.4 times (from 6 to 21 times), and intraoperative bleeding 82.3 mL (from 50 to 210 mL). No such postoperative complications occurred as cerebrospinal leak, cerebral infarction, or breakage, displacement or loosening of implants. All patients were followed up for 18 to 42 months (mean, 26.3 months). Their preoperative JOA, ADI, CMA and DOCL [8.33±0.98, (8.66±1.64) mm, 119.63°±4.15° and (9.66±2.15) mm] were significantly improved to 14.17±1.03, (2.63±0.59) mm, 153.76°±7.88° and (2.07±0.69) mm ( P<0.05) at 12 months postoperation. Bony fusion was achieved in all the operative segments. Conclusion:In the treatment of patients with basilar invagination and atlantoaxial dislocation, a 3D-printed trabecular block cage can be used to assist posterior internal fixation to achieve satisfactory reduction and maintain the height of joint space, leading to satisfactory short-term outcomes.

目的 探讨并总结3D打印技术在脊柱肿瘤患者护理中的应用与方法.方法 选择2018年1月至2020年12月于郑州大学第一附属医院骨科应用3D打印植入物进行治疗的脊柱肿瘤患者26例,其中应用3D打印植入物治疗患者13例纳入观察组,应用常规植入物(钛笼)治疗患者13例纳入对照组.在脊柱肿瘤常规护理基础上,对观察组加强3 D打印模型的指导与并发症的观察、护理,比较2组患者视觉模拟评分法(VAS)评分、护理满意度及并发症情况.结果 观察组患者住院时间(10.68±0.95)d,明显短于对照组的(12.47±1.12)d(t=4.965,P=0.028).观察组患者术后6个月时VAS评分(2.76±1.17)分,明显低于对照组的(4.37±0.59)分(t=7.624,P=0.017).观察组患者护理满意度评分(9.57±0.41)分,明显高于对照组的(7.96±0.55)分(t=5.346,P=0.023).2组术后6个月均未见复发.观察组并发症发生率15.38％,低于对照组的30.76％,但差异无统计学意义(χ2=0.503,P=0.478).结论 通过对脊柱肿瘤患者加强3D打印模型的术前宣教与并发症的观察与护理,可有效帮助患者改善术后疼痛及预后,提高患者的满意度.

Objective:To evaluate the outcome of surgery for sympathetic cervical spondylosis with abnormal imaging.Methods:The patients with sympathetic cervical spondylosis with the abnormal imaging who received anterior cervical discectomy and fusion (ACDF) treatment from 2015-2018 were reviewed. The symptoms wee scored with somatization self-rating scale (SSS) and 20 points evaluation system before and after operation and at the last follow-up.Results:The SSS scores before, after the operation and at the last follow-up were (45.50±10.39), (27.67±3.62) and 21.50(11) respectively. The scores at postoperative week one and last follow-up were 17.83 (95% CI: 4.660-31.007, P<0.05) and 18.00 (95% CI: -0.701-36.701, P>0.05) respectively, which were lower than preoperative scores. There was no significant difference in SSS scores between the last follow-up and postoperative week one (95% CI: -17.840-18.174, P>0.05). The scores by the 20 points evaluation system were (8.50±1.87) before the operation, 1(2) at first week after operation, and 0.5(4) at the last follow-up. As compared with preoperative scores, the scores at postoperative week 1 and last follow-up decreased by 6.67 (95% CI: 3.980-9.353, P<0.05) and 6.17 (95% CI: 0.660-11.673, P<0.05) respectively. There was no significant difference between the last follow-up and one week after operation (95% CI: -4.879-5.879, P>0.05). At the last follow-up, one patient showed part of the recurrence symptoms, and the rest 25 patients recovered without relapse. Conclusion:ACDF can achieve good therapeutic effect for sympathetic cervical spondylosis with abnormal imaging.

目的 探讨亨廷顿病(HD)患者临床特点、诊疗方法以及疾病进展情况,分析HD家系遗传特点.方法 在知情、自愿的原则下,收集2017年8月郑州大学第五附属医院神经内三科收治的1个HD家系患者的临床资料,绘制遗传家谱图,并进行随访.结果 该家系6例已发病患者中,有5例患者以不同程度的肢体不自主舞动、行走不稳、运动迟缓、焦虑抑郁起病,部分伴有高级智能缺损,1例青少年HD患者儿童期以痫性发作起病.该家系发病年龄8～58岁,病程5～24 a,其中5例患者已死亡,先证者疾病进展较快.先证者的CAG拷贝数为53次,其2个儿子CAG拷贝数分别为53和58次.结论 HD早期诊断困难,特征性临床症状及家族史尤为重要,基因诊断对于阴性家族史患者是有效的确诊方法.该家系下一代患者发病年龄较前代更小,存活时间较前代更短.对HD患者需定期随访,症状前期的患者需早识别,并在生育期提供遗传咨询.

目的 探讨热量限制饮食方法对急性脑梗死患者神经功能及血清细胞因子转化生长因子-β1(TGF-β1)和脑源性神经营养因子(BDNF)表达的的影响.方法 选取2019-01—2020-04郑州大学第五附属医院神经内科住院的60例急性脑梗死患者,随机分为热量限制干预组与对照组,干预组在对照组治疗的基础上加用减少每日30％热量摄入的饮食干预法,3个月后对比2组治疗前后神经功能缺损(NIHSS评分)及血清神经损伤指标水平.结果 治疗后2组NIHSS评分均低于治疗前,且干预组低于对照组(P<0.05).治疗后所有患者血清TGF-β1水平均明显高于治疗前(P<0.05),且干预组血清TGF-β1水平(59.69±5.27)μg/L高于对照组(48.62±5.25)μg/L(P<0.05).治疗后所有患者血清BDNF水平均明显高于治疗前(P<0.05),且干预组血清BDNF水平(49.05±4.01)ng/mL高于对照组(34.08±3.53)ng/mL,差异有统计学意义(P<0.05).结论 一定程度的热量限制可能提升抑炎因子水平及刺激神经营养因子在急性脑梗死患者机体的释放并改善神经功能.