精神的解脱:《麦克白》中“睡眠”意象分析

莎士比亚在其四大悲剧之一《麦克白》中描述了多个人物角色的睡眠,同时,他也把死亡比喻为睡眠。因此,《麦克白》中的"睡眠"意象具有双层含义:一般意义的"睡眠"以及"死亡"。实际上,在该剧中,很多主要人物只能在睡眠中或死亡后得到精神上或心理上的解脱。因此,对该剧中邓肯、麦克白以及麦克白夫人的睡眠进行意象分析可以诠释该剧的悲剧性意义。

“睡眠-心理-行为”护理模式在老年女性冠心病失眠患者中的应用效果

目的探究“睡眠-心理-行为”护理模式在老年女性冠心病失眠患者中的应用效果。方法选取2020年10月至2022年10月兰陵县人民医院收治的86例老年女性冠心病失眠患者,根据随机数字表法分为对照组(43例)和实验组(43例)。对照组给予常规护理,实验组给予“睡眠-心理-行为”护理,比较两组护理前后的睡眠质量、负面情绪。结果实验组护理后的睡眠质量评分低于对照组(P<0.05)。实验组护理后的焦虑、抑郁评分低于对照组(P<0.05)。结论“睡眠-心理-行为”护理模式在老年女性冠心病失眠患者中的应用效果较好,能够有效改善睡眠质量,调节负面情绪,临床值得推广应用。

应关注银行卡在农村地区中的“睡眠卡”不断增多问题

银行卡是商业银行向社会公开发行．具有消费信用、转账结算、存取现金等全部或部分功能．作为结算支付工具的各类卡的统称。银行卡集支付结算和信贷两大基本功能于一体，不仅为持卡人带来结算和信用透支等各种便利条件．而且还可以减少大量的现金流通和使用．因此，银行卡在我国被大力推广和使用。

Objective and subjective measures for sleep disorders

Subjective and objective measures of sleep structure or quality could help to characterize the chronic sleep disturbances, with relation to patients＇ risk factor profiles and co-morbidities. Studies have shown that discrepancies can occur between subjective data regarding sleep disturbances and the impact of insomnia and objective assays, and surrogate markers of sleep and sleep disturbances. Both objective and subjective measures should be incorporated into clinic studies. It seems likely that sleep quality is represented by a combination of more than one subjective sleep parameter. Objective and subjective assessments of sleep quality may relate to different parameters. Future studies incorporated both subjective and objective measures could help to address the sleep disorders.

Changes of serum adrenocorticotropic hormone and cortisol levels during sleep seizures

Objective Measuring the serum concentrations of adrenocorticotropic hormone （ACTH） and cortisol in epileptic seizures during sleep to investigate their link to the EEG changes. Methods Pre-surgical evaluation was performed by videoEEG monitoring using 24 channel recording. Thirty six epilepsy patients could be attributed to two groups： 28 patients had spontaneous seizures, and the other 8 patients whose seizures were induced by bemegride. Another 11 persons with confirmed psychogenic non-epileptic seizures （PNES） served as control group. Blood samples were obtained at five points： wake （08：00 a.m.）, sleep （00：00 a.m.）, and shortly before, during and after an epileptic seizure. The serum ACTH and cortisol were measured and analyzed by chemiluminescent immunoassay. Results The levels of ACTH and cortisol in serum underwent significant changes： declining below the average sleep-level shortly before seizures, increasing during seizures, and far above the average wake-level after seizures （P 〈 0.001）. Such changes did not occur in the control group （P 〉 0.05）. The ACTH and cortisol levels had no significant difference between spontaneous group and bemegride-induced group （P 〉 0.05）. Conclusion The serum concentrations of ACTH and cortisol during sleep seizures are linked with pre-ictal and ictal EEG changes in epilepsy patients.

教育者权威性与道德教育对象的态度改变

社会心理学研究证实,传达者权威性在目标靶态度改变中具有"权威效应"和"睡眠者效应"。社会转型时期道德教育者的权威趋于失落,主要表现在:传统权威的颠覆、法定权威的衰微、知识权威的消解、感召权威的缺失。"睡眠者效应"并没有否定"权威效应"的积极功能,因此要促进教育对象正确道德态度的形成、或是错误道德态度的改变,道德教育者必须重构其感召权威和知识权威,其路径在于:提升道德人格,使教育对象产生敬佩感;融注积极情感,使教育对象产生亲切感;注重专业发展,使教育对象产生信赖感。

论罗伯特·弗罗斯特《雪夜林边小伫》中的象征主义

文章研究了美国著名诗人罗伯特·弗罗斯特《雪夜林边小伫》一诗中的象征意义。在对本诗简略介绍和讨论象征主义概念的基础上,作者从诗歌中反映的矛盾角度,对本诗中象征主义的应用作出分析。

芳香疗法对广泛性焦虑障碍患者“睡眠-觉醒”障碍的疗效观察

目的:探讨芳香疗法对广泛性焦虑障碍患者睡眠-觉醒障碍患者的影响。方法:选取2022年6月至2023年7月福建省泉州市晋江市第三医院护理部收治的广泛性焦虑障碍伴“睡眠-觉醒”障碍患者108例作为研究对象,按照随机数字表法分为对照组和观察组,每组54例。对照组给予常规护理干预,观察组给予常规治疗加芳香疗法。采用焦虑自评量表(SAS)评估2组患者的心理状态,采用匹兹堡睡眠质量指数(PSQI)比较2组患者睡眠质量的差异,采用精神分裂症患者生命质量量表(SQOL)评估2组患者的生命质量改善效果。结果:干预后,观察组PSQI评分、SAS评分显著低于对照组,观察组SQOL评分显著高于对照组,差异均有统计学意义(均P<0.05)。结论:芳香疗法可有效改善广泛性焦虑障碍患者焦虑情绪,提高睡眠质量和生命质量。

Investigation on Risk Factors of Cerebrocardiac Vascular Thrombotic Diseases in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

Objective: To observe the risk factors of thrombosis in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods: From February 2001 to April 2003, 24 patients with moderate and severe OSAHS (OSAHS group) and 19 healthy adults (control group) were recruited. Their blood samples were drawn at 6∶00 and 16∶00 respectively for testing hemocrit, platelet aggregation (PAG), whole blood viscosity (WBV), prothrombin time (PT), activated partial thromboplastin time (APTT), plasma fibrinogen (Fng) and endothelin (ET).Results: There was a significantly higher hemocrit, WBV, Fng and ET as well as a significant shortening of PT and APTT at 6∶00 than that at 16∶00 in OSAHS group. However, there was no significant difference in all testing items between 6∶00 and 16∶00 in control group. The hemocrit, WBV, PAG, plasma Fng and ET were significantly higher, and PT and APTT were obviously shorter at 6∶00 in OSAHS group than those at 6∶00 in control group. A higher hemocrit, PAG, plasma Fng and ET, a longer PT and APTT were observed at 16∶00 in OSAHS group, compared with those at 16∶00 in control group.Conclusion: In OSAHS patients there were striking risk factors of thrombosis, which is more remarkable in the early morning than in the afternoon.

ADJUSTING EFFECTS OF APPLICATION OF GARLIC PASTE AT SHNQU (神阙 CV8) ON THE CIRCADIAN RHYTHM OF BODY TEMPERATURE INDUCED BY SLEEP DEPRIVATION

Objective To observe the effect of application of garlic paste at Shenque （神阙 CV8） on the circadian rhythm in sleep deprivation young students. Metheds Twenty healthy volunteer young male students from Southern Medical University were randomly divided into three groups： normal group （A）, sleep deprivation group （B） and treatment group （C）. Volunteers in group B and C received 48 h sleep deprivation （SD）, and in the mean time volunteers in group C were treated by garlic paste at Shenque （神阙 CV8）, while those in group A had no any treatment. The body temperature of all the volunteers was detected at 6：00 am, 12：00 am, 6：00 pm and 0：00 am, respectively, after the treatment. Results The mean body temperature values in group A and C both were highest at 6： 00 pm and lowest at 6： 00 am which had a significant difference in each group （P〈0.01）; in group B, the mean body temperature was highest at 0：00 am and lowestat 6：00 am, no significant difference was found between them （P〉0.05）. Results of cosine analysis showed that in subjects of group B the circadian rhythm of body temperature still kept going well after SD, but the peak amplitude and amplitude of vibration were higher than those of group A, and the acrophase of group B was obviously lower than that of group C and A. The 3 indexes of group C were similar to those of group A, denoting that garlic paste application of Shenque （神阙 CV8） could prevent disorders of circadian rhythm of the body temperature. Conclusion The garlic paste application at Shenque （神阙 CV8） can adjust circadian rhythm and accelerate the recovery processes of circadian rhythm in SD young students.

Evaluation of latent links between irritable bowel syndrome and sleep quality

AIM:To examine the links between quality of sleep and the severity of intestinal symptoms in irritable bow-el syndrome(IBS).METHODS:One hundred and forty-two outpatients(110female,32 male)who met the Rome Ⅲ criteria for IBS with no psychiatric comorbidity were consecutively en-rolled in this study.Data on age,body mass index(BMI),and a set of life-habit variables were recorded,and IBS symptoms and sleep quality were evaluated using the questionnaires IBS Symptom Severity Score(IBS-SSS)and Pittsburgh Sleep Quality Index(PSQI).The associa-tion between severity of IBS and sleep disturbances was evaluated by comparing the global IBS-SSS and PSQI score(Pearson's correlation and Fisher's exact test)and then analyzing the individual items of the IBS-SSS and PSQI questionnaires by a unitary bowel-sleep model based on item response theory(IRT).RESULTS:IBS-SSS ranged from mild to severe(120-470).The global PSQI score ranged from 1 to 17(median 5),and 60 patients were found to be poor sleepers(PSQI>5).The correlation between the global IBS-SSS and PSQI score indicated a weak association(r=0.2 and 95% CI:-0.03 to 0.35,P<0.05),which becomes stronger using our unitary model.Indeed,the IBS and sleep disturbances severities,estimated as latent variables,resulted significantly high intra-subject cor-relation(posterior mean of r=0.45 and 95% CI:0.17 to 0.70,P<0.05).Moreover,the correlations between patient features(age,sex,BMI,daily coffee and alcohol intake)and IBS and sleep disturbances were also ana-lyzed through our unitary model.Age was a signif icant regressor,with patients≤50 years old showing more severe bowel disturbances(posterior mean=-0.38,P<0.05)and less severe sleep disturbances(posterior mean=0.49,P<0.05)than older patients.Higher daily coffee intake was correlated with a lower sever-ity of bowel disturbances(posterior mean=-0.31,P<0.05).Sex(female)and daily alcohol intake(modest)were correlated with less severe sleep disturbances.CONCLUSION:The unitary bowel-sleep model based on IRT revealed a strong positive correlation between the severity of IBS symptoms and sleep disturbances.

Should nonalcoholic fatty liver disease be regarded as a hepatic illness only?

The highly increasing prevalence of obesity and type 2 diabetes mellitus in the general population makes nonalcoholic fatty liver disease the most common diagnosis in every-day practices. Lifestyle changes （mainly exercise withdrawal and weight gain） have probably heightened the prevalence of nonalcoholic fatty liver disease. Mortality in patients with Nonalcoholic Fatty Liver Disease is significantly higher when compared with that of the same age-gender general population. Hepatologists claim to bear a new burden, being Nonalcoholic Fatty Liver Disease strongly linked to systemic diseases.

COGNITIVE AND EMOTIONAL IMPAIRMENT IN OBSTRUCTIVE SLEEP APNEA SYNDROME

Objective To evaluate the emotional and cognitive status in patients with obstructive sleep apnea syndrome (OSAS), using neuropsychological tests and evoked-related potential (P3). Methods Sixteen patients diagnosed of OSAS were tested by Hamilton rating scale for anxiety (HRSA) and Hamilton rating scale for depression (HRSD). Other three groups, OSAS patient group (n=21), snoring group (n=21), and control group (n=21), were administered polysomnography (PSG), auditory evoked event-related potential (P3), and clinic memory test. The results were analyzed using general linear model (GLM) analysis and Post Hoc test. Results Twelve OSAS patients’ scores of HRSA and HRSD were beyond the normal range, 26.42 ±4.48 and 22.08 ±3.97 respectively. The auditory P3 latency in OSAS group was 363.1 ±22.9 ms (Fz), 368.57 ±28.03 ms (Cz), in snoring group 336.57 ±31.08 ms (Fz), 339.81 ±31.76 ms (Cz), in control group 340.8 ±28.7 ms (Fz), 338.29 ±29.21 ms (Cz). There were significant differences between OSAS group and snoring group, as well as control group (P< 0.05). No significant difference was seen between snoring group and control group. No significant difference was noted in P3 amplitude among three groups. Memory quotient (MQ) reduced in snoring group compared with control group. Conclusions Emotional disturbances are common clinical features in OSAS patients. Abnormal auditory P3 latency indicates the cognitive dysfunction in OSAS patients. Nocturnal hypoxaemia may play an important role on it. Snorers should be monitored because of the tendency to develop cognitive impairment.

Auditory evoked potentials recorded in monkeys with hallucinatory-like behaviors induced by bromocriptine

Objective Bromocriptine and other dopamine D2 receptor agonists can affect a range of behaviors in nonhuman primates, particularly those behaviors associated with motor and mental function, such as suppressant behaviors and hallucinatory-like behaviors in monkeys. Besides bromocriptine, the dysfunction of the rapid eye movement sleep （REM） mechanism may also contribute to hallucinations. Dissociation of wakefulness, REM, and non-REM （NREM） can cause a series of psychotic symptoms. Methods In present study, we simultaneously recorded auditory evoked potentials （AEP） from five cerebral regions in monkeys during normal and psychotomimetic states to investigate and compare state-dependent changes in AEE Results Phase reversal of peak-to-baseline amplitude of 250 ms component （PBA250） in dorsolateral prefrontal cortex was common characteristic of hallucinatory-like and REM, and that hallucinatory-like and REM shared the equivalent modulatory orderliness of the PBA250 in dorsolateral prefrontal cortex. This result suggests that hallucinatory-like and REM share an equivalent electrophysiological modulatory in dorsolateral prefrontal cortex. Conclusion Our results reveal that emergence of the N250 in dorsolateral prefrontal cortex is an exclusive marker that may help to discern whether hallucinatory-like behaviors is exhibited, which suggests that dorsolateral prefrontal cortex may be the most pivotal region for exhibition of hallucinatory-like behaviors.

Sleep disorders and chronic kidney disease

Sleep disorders have a profound and well-documented impact on overall health and quality of life in the general population. In patients with chronic disease, sleep disorders are more prevalent, with an additional morbidity and mortality burden. The complex and dynamic relationship between sleep disorders and chronic kidney disease(CKD) remain relatively little investigated. This article presents an overview of sleep disorders in patients with CKD, with emphasis on relevant pathophysiologic underpinnings and clinical presentations. Evidence-based interventions will be discussed, in the context of individual sleep disorders, namely sleep apnea, insomnia, restless leg syndrome and excessive daytime sleepiness. Limitations of the current knowledge as well as future research directions will be highlighted, with a final discussion of different conceptual frameworks of the relationship between sleep disorders and CKD.