Effects of anesthetic propofol on release of amino acids from the spinal cord during visceral pain

As one of general anesthetics, propofol, has been used for surgical procedures of visceral organs. However, the mechanisms underlying the action of propofol on visceral nociception remain controversial. The aim of this study is to test whether the antinociception of systemic administration of propofol against visceral stimuli is related to the changes in release of excitatory and inhibitory amino acids in the spinal cord. The spinal microdialysis catheters were implanted subarachnoidally via the atlanto-occipital membrane in healthy SD rats. The rats received an intraperitoneal injection of acetic acid for visceral pain induction 10 min after intraperitoneal pretreatment with vehicle or propofol (100 mg/kg). The acetic acid-induced writhing assay was used to determine the degree of antinociception. Cerebrospinal fluid dialysate was collected by microdialysis from the spinal subarachnoid space before pretreatment and after visceral pain induction. Visceral pain-induced release of amino acids into the dialysate, including glutamate, aspartate, and γ-amino butyric acid was evaluated by measuring the changes in the concentrations of these amino acids. Acetic acid increased release of aspartate and glutamate, and decreased release of γ-amino butyric acid in the cerebrospinal fluid as measured by microdialysis. Pretreatment with propofol significantly decreased writhing responses induced by visceral pain, suppressed the visceral pain-induced aspartate and glutamate release, and reversed the decreased release of γ-amino butyric acid in the cerebrospinal fluid. These data provide evidence for a potential mechanism for the antinociceptive effects of propofol on visceral nociception.     

Special safety considerations in preparation of technetium Tc-99m DTPA for cerebrospinal fluid–related imaging procedures

ObjectiveTo review special safety considerations in the preparation of technetium 99m (Tc-99m) diethylenetriaminepentaacetic acid (DTPA; generic name, pentetate) for cerebrospinal fluid (CSF)–related imaging procedures.Data sourcesReview of practices and results at one institution supplemented with findings and recommendations from the literature. Literature searches were conducted via Medline/PubMed using the following terms: Tc-99m DTPA/pentetate, CSF, cisternography, intrathecal, and adverse reactions. The author's own files were also searched for articles (e.g., in newsletters) not indexed by Medline/PubMed.Study selectionArticles considered appropriate for review included all human research studies, reviews, case reports, abstracts, and letters published in English on Tc-99m DTPA use in CSF-related imaging procedures, especially with regard to safety or adverse reactions.Data extractionAll information related to safety precautions and adverse reactions associated with Tc-99m DTPA injected intrathecally or otherwise used for CSF-related imaging procedures were considered.Data synthesis18 years’ experience in one institution was reviewed with the added perspective of literature findings and recommendations.ConclusionWith proper attention to safety considerations, Tc-99m DTPA can be safely used in CSF-related imaging procedures.     

无锡市城乡居民2001~2005年伤害死亡状况

目的分析无锡市城乡居民伤害的死亡状况和潜在寿命损失,为采取干预措施提供基础依据。方法用描述性流行病学方法对2001~2005年伤害的死亡监测资料进行分析。结果5a伤害平均死亡率为63.43/10万,在死因顺位中排第4位;按潜在寿命损失年(PYLL)排位,伤害从第4位跃居为第2位,总PYLL为38140,PYLL‰为12.36人年。居民伤害死亡的前4位死因是交通运输事故(包括机动车辆交通事故和机动车以外运输事故),跌落、自杀、淹溺;1~14岁组儿童主要以淹溺为主,占该组死亡总数的52.75%;15~54岁组死因顺位均以交通运输事故、自杀为主,分别占该组死亡总数的59.07%、51.33%;5.5岁~以跌落、交通运输事故为主,分别占31.21%、25.96%。结论伤害是无锡市居民的主要死亡原因之一,是危害青壮年人群健康和生命的最主要危险因素,对劳动力的损失影响最明显。政府必须尽快把伤害纳入疾病预防控制规划,采取有效的措施进行干预。     

无锡市吸毒人群美沙酮维持治疗的效果

目的对江苏省无锡市美沙酮维持治疗（MMT）门诊运行1年多以来的情况进行评估。为制订相应的干预措施提供科学依据。方法按照国家工作组规定的入组标准，收治自愿参加MMT的患者，对受治者进行基线调查和评估。结果在965例中，能坚持维持治疗者904例（93．68％），脱失61例（6．32％）；经过MMT后，静脉注射毒品现象得到有效的控制，社会功能有所恢复，与家人关系得到改善，有工作者比例上升，治疗者对MMT门诊的总满意率达98．08％。结论MMT在减少高危行为、降低吸毒危害、减少违法犯罪、恢复家庭和社会功能方面成效显著。     

无锡市某校中学生乙型肝炎病毒携带率调查及干预措施

目的调查中学生乙肝表面抗原（HBsAg）携带情况，探讨在中学生重点人群中进行免疫等综合干预措施的必要性。方法选择一所有代表性的职业学校，对在校学生验血查HBsAg和抗-HBs（乙肝表面抗体）。结果学生HBsAg阳性携带率平均为1．70％，抗-HBs阳性率32．78％；HBsAg（-）学生接种乙型肝炎疫苗的接种率为71．60％，对全程接种疫苗的62名学生检测抗-HBs其阳转率为91．9％。结论对学生人群进行乙肝免疫等于预措施极为重要，在中小学应实施乙肝疫苗的强化接种。     

残存钉螺观察及控制措施

目的了解变电所墙外残存钉螺复燃情况，探索长期有效的控制措施。方法采用机械抽样法调查螺点钉螺，确定活螺密度和有螺面积，灭螺方法分别为五氯酚钠药物浸杀、氯硝柳胺药物浸杀以及氯硝柳胺药物喷洒和沟渠硬化工程灭螺。结果第1次复燃距1974年为26年，第2次复燃距2000年为1年，第3次复燃距2001年为6年，今后是否复燃有待于进一步观察。结论不同的灭螺措施对钉螺的控制效果有所不同，大规模的筑圩药浸灭螺可快速有效压缩钉螺面积；但对特殊环境下的残存钉螺还需因地制宜，采用不同常规的方法。     

微量注射泵的工作原理及其应用

目的:通过对微量注射泵的原理及应用进行分析,深刻了解微量注射泵的工作原理,使其在应用中发挥更好的作用.方法:介绍微量注射泵的结构和原理以及在应用中注射速度设置的相关问题,分析日常使用中常出现的故障,提出日常维护方案.结果:通过给出微量注射泵速度设置的公式、介绍5个最常见故障实例,提出排除故障方法及日常维护方法.结论:微量注射泵作为一种重要的医疗设备已经在各级医院广泛应用,只有掌握好其性能、维护方法才能使其在医院治疗中发挥更好、更规范的作用.     

小剂量纳洛酮对吗啡经小儿骶管镇痛效果及不良反应的影响

目的观察小剂量纳洛酮对吗啡经小儿骶管镇痛效果及其不良反应的影响。方法60例3～6岁手术小儿随机均分为纳洛酮组(A组)和吗啡组(B组)。两组在骶管阻滞时给予1%利多卡因-吗啡混合液,A组术后24 h静脉持续泵注纳洛酮0.25μg·kg-1·h-1。分别于术毕1、4、8、16、24 h比较两组的镇痛效果,记录恶心呕吐、皮肤瘙痒和尿潴留等不良反应。结果两组镇痛效果差异无统计学意义;但A组恶心呕吐不良反应明显少于B组(P<0.05)。结论术后小剂量纳洛酮静脉持续泵注能减少小儿骶管吗啡镇痛时恶心呕吐的不良反应而不影响其镇痛效果。     

实行三级目标责任制的实践与体会

无锡市人民医院2006年6月起实行"院、大科、专科三级目标责任制",突出专科管理.坚持"按职责、按制度、按操作流程"的工作原则,着力提升医疗质量.以强化素质培训为抓手,加强基础管理.以建树服务品牌为载体,推进精神文明建设.     

The influence of CYP2A6 polymorphisms and cadmium on nicotine metabolism in Thai population

We investigated the influence of genetic, cadmium exposure and smoking status, on cytochrome P450-mediated nicotine metabolism (CYP2A6) in 182 Thai subjects after receiving 2 mg of nicotine gum chewing for 30 min. The urinary excretion of cotinine was normally distributed over a 2 h period (logarithmically transformed). Individuals with urinary cotinine levels in the ranges of 0.01–0.21, and 0.52–94.99 μg/2 h were categorized as poor metabolizes (PMs: 6.5%), and extensive metabolizers (EMs: 93.5%), respectively. The majority of EMs (45%) carried homozygous wild-type genotypes (CYP2A6*1A/*1A, CYP2A6*1A/*1B and CYP2A6*1B/*1B), whereas only 1% of PMs carried these genotypes. Markedly higher frequencies of EMs were also observed in all heterozygous defective genotypes including the null genotype (*4C/*4C; 1 subject).A weak but significant positive correlation was observed between total amounts of urinary cadmium excretion and total cotinine excretion over 2 h. Our study shows generally good agreement between CYP2A6 genotypes and phenotypes. Smokers accumulated about 3–4-fold higher mean total amounts of 2-h urinary cadmium excretion (127.5 ± 218.2 ng/2 h) than that of non-smokers (40.5 ± 78.4 ng/2 h). Among the smokers (n = 16), homologous wild-type genotype *1/*1 was significantly the predominant genotype (6/16) compared with other defective allele including *4C/*4C. In addition, 2 h urinary excretion of cotinine in smokers of all genotypes was significantly higher than non-smokers. The proportion of smokers who smoked more than 5 cigarettes/day was significantly higher in EMs in all CYP2A6 genotypes (n = 14) than in PMs (n = 0).