新疆高氟低碘环境与亚临床型克汀病

本文对和田不同类型的碘缺乏病区,采用瑞文联合型中国农村智力常模表,分别随机抽样检查了7～14岁学生130名,并同步检查了听力、四项精神运动及甲状腺功能。高氟低碘病区儿童平均IQ71.09±6.84,平均听阈24.08±13.18dB,骨龄发育落后检出率28.5％,24小时甲状腺吸I~(131)”率59.87±14.63％,TSH 21.09±9.43μU/ml,亚克汀病患病率15.71％;低碘病区平均IQ 77.32±11.54,平均听阈19.91±7.23 dB,骨龄发育落后检出率13.5％,甲状腺吸I~(131)率50.26±19.25％,TSH 11.05±11.49μU/ml,亚克汀病患病率9.36％。补碘对照区平均IQ 95.76±17.52,平均听阈16.08±3.21 dB,骨龄发育落后检出率3.88％,甲状腺吸I~(131)率23.61±11.71％,TSH6.26±2.88μU/mL,亚克汀病患病率为3.20％。上述各项参数和病区之间,均有显著差异。说明在缺碘病区同时并存高氟摄入时,氟可加剧由缺碘而引起的中枢神经损害和体躯发育障碍。在104例精神轻度发育迟泄的儿童中,亚克汀病的检出率69.23％。     

Consumption of a mid-morning snack improves memory but not attention in school children

Muthayya, S., T. Thomas, K. Srinivasan, K. Rao, A. V. Kurpad, J.-W. Van Klinken, G. Owen and E.A. de Bruin: Consumption of a mid-morning snack improves memory but not attention in school children. Physiol Behav 00(0) 000-000, 2006.--This study aimed to determine whether consumption of a mid-morning snack with appropriate energy compensation through a smaller breakfast or lunch, resulted in improved cognitive performance of 7-9 year old children with a low and high socioeconomic status (LSES and HSES, n=35 and 34 respectively). The children were each randomly assigned to three iso-caloric dietary interventions: control (standard breakfast, no snack and standard lunch), intervention A (small breakfast, snack, and standard lunch) and intervention B (standard breakfast, snack, and small lunch), using a cross-over design. The children were tested on three different days, each one week apart. Computerised tests of cognitive performance, consisting of memory, sustained attention and psychomotor speed, were performed during four sessions, i.e., prior to breakfast, after breakfast, after a mid-morning snack and after lunch. Having a mid-morning snack resulted in a smaller decline in immediate and delayed memory in LSES but not in HSES children. Having a snack did not influence sustained attention and psychomotor speed in either LSES or HSES children. This study shows that a more evenly distributed energy intake throughout the morning by consuming a mid-morning snack improves memory performance in school-age LSES children even when the total amount of energy consumed during the morning is not altered.     

Reaction time in patients with HIV/AIDS and correlation with CD4 count: a case-control study

There are conflicting reports on the presence of neurocognitive dysfunction during the initial, medically asymptomatic stage of HIV infection. This study aimed to assess the psychomotor speed and attention ability of antiretroviral treatment-na?ve Nigerian Africans with HIV/AIDS and the impact of CD4 levels on their cognitive performance. Two hundred and eighty-eight randomly selected age-, sex- and level of education-matched subjects participated, comprising 96 HIV-positive asymptomatic and 96 HIV-positive symptomatic patients and 96 HIV-negative controls. The simple reaction and binary choice reaction time tasks were used for cognitive assessment. The binary choice reaction time indicated that the HIV-positive patients had impaired attention ability and significant psychomotor slowing compared with the controls (P<0.05), but psychomotor slowing was obvious among the symptomatic HIV-positive patients only using the simple reaction time tasks. Significant psychomotor retardation was observed in HIV-positive patients with CD4 levels of 200-499 cells/mm(3) (P=0.02) and <200 cells/mm(3) (P<0.001), and impaired ability for sustained attention was present irrespective of the CD4 level (P<0.001). We conclude that psychomotor retardation and impaired attention are significantly worse in HIV-positive subjects compared with controls and are adversely affected by decreasing CD4 levels. The sensitivity of the neuropsychological tool used can affect the degree of impairment measured.     

Opioid medication and driving ability

In many European countries the use of opioids for long‐term treatment of nonmalignant pain has dramatically increased during the last decade in order to improve the patient's quality of life, to allow an active social life and the return to work. In modern society, driving is regarded as an essential activity of daily living. Since opioids are centrally acting drugs that may interfere with the ability of safely driving a motor vehicle, the question arises of whether or not and on which conditions patients under continuous opioid medication may be considered fit to drive. In this article the evidence from recent studies of opioid effects on driving ability of patients is reviewed. Based on these data, the prerequisites and restrictions for driving under chronic opioid medication are outlined and practical guidelines are proposed.     

精神运动康复理念在老年护理中的应用

随着我国平均期望寿命的延长以及生活品质的提升,我国近几年来推行的“医养结合”型养老政策逐渐步入正轨,如何提升老年人及周围人群的生活质量越来越受到世界各地政府的重视。因此精神运动康复理念在老年护理中的应用将备受关注。目前在我国还处于起步发展阶段,相关联的指标体系尚在完善阶段,值得探讨研究。如何将精神运动康复理念与老年康复护理相结合,并有效的协助康复理疗师使老年患者更快康复,值得我们深思。     

秦巴山区6～14岁儿童精神运动功能检查方法与诊断标准研究

目的通过对儿童精神运动功能检查方法与诊断标准的研究，为亚克汀病诊断提供依据。方法以秦巴山区6～14岁儿童精神运动功能检查结果，对选用的检查项目进行筛选，并建立区域年龄常模以及异常值划界标准。结果①从初选的9个检查项目中筛选出了6个对亚克汀病儿童具有良好区分度的项目；②得到精神运动功能成套检查量表的常模标准分为300．00±34．61，异常值划界标准为检查标准总分值〈231；③检查量表1个月后的再测信度为0．87；④量表的实证效度与构想效度检验结果良好。结论精神运动功能检查量表有较好的信度和效度，可以为亚克汀病的诊断提供参考依据。     

The role of simulation in developing surgical skills

Surgical training has followed the master-apprentice model for centuries but is currently undergoing a paradigm shift. The traditional model is inefficient with no guarantee of case mix, quality, or quantity. There is a growing focus on competency-based medical education in response to restrictions on doctors’ working hours and the traditional mantra of “see one, do one, teach one” is being increasingly questioned. The medical profession is subject to more scrutiny than ever before and is facing mounting financial, clinical, and political pressures. Simulation may be a means of addressing these challenges. It provides a way for trainees to practice technical tasks in a protected environment without putting patients at risk and helps to shorten the learning curve. The evidence for simulation-based training in orthopedic surgery using synthetic models, cadavers, and virtual reality simulators is constantly developing, though further work is needed to ensure the transfer of skills to the operating theatre.     

Sensory and Sensorimotor Features in Violinists and Violists With Neck Pain

Objective

To investigate sensory and sensorimotor function in violin and viola players with and without neck pain.

Design

Prospective, cross-sectional study.

Setting

University laboratory.

Participants

Convenience sample of violin players with playing-related neck pain (n=22), violinists without neck pain (n=21), and healthy nonmusician comparison subjects (n=21).

Interventions

Not applicable.

Main Outcome Measures

Measures include thermal pain thresholds (cold and heat) and pressure pain thresholds (PPTs) over the cervical spine and over a remote region (tibialis anterior muscle). Motor performance tests including reaction times, speed of movement, accuracy, coordination, and tapping speed assessed with a special upper-limb test battery.

Results

Musicians with neck pain had significantly lower heat and elevated cold pain thresholds as well as lower PPTs over C5-6 (P<.01) and over the tibialis anterior (P<.05). Motor performance tests revealed no differences between the symptomatic and asymptomatic musicians and nonmusician comparison groups (P>.05).

Conclusions

Violin players with neck pain demonstrated signs of sensory impairment, suggesting that playing-related neck pain may be associated with augmented central pain processing consistent with findings in other neck pain groups. No differences were evident in the motor performance tests. Fine motor skills of violin players may be better assessed in the context of playing their musical instruments before definitive conclusions can be drawn about the presence or not of sensorimotor impairments in this group of musicians with playing-related neck pain.     

5,6-dihydroxytryptamine, a serotonergic neutotoxin, is formed endogenously in the rat brain

Methamphetamine (MA) in high doses produces long-term toxic effects on the serotonergic system in the rat brain, including depletions of 5-hydroxytryptamine (5-HT) and 5-hydroxyindoleacetic acid and reductions in 5-HT reuptake and tryptophan hydroxylase activity. In this study, the formation of 5, 6-dihydroxytryptamine (5, 6-DHT), a serotonergic neurotoxin, was observed in the rat hippocampus after a single 100 mg/kg injection of MA. The 5, 6-DHT was detected by reverse-phase high-performance liquid chromatography with electrochemical detection in tissue samples taken 0.5-4 h after MA administration; the highest levels of 5, 6-DHT (0.032 ng/mg wet tissue) were detected at 1 h. Following administration of MA, 5-HT was also depleted in the neocortex, but 5, 6-DHT was not detected as frequently in this brain region as in the hippocampus. Comparisons were made between the long-term hippocampal 5-HT depletions seen either after an injection of MA or after intraventricular 5, 6-DHT infusions and the levels of 5, 6-DHT measured in the hippocampus shortly after each treatment. The amount of 5, 6-DHT produced after MA administration appears to be adequate to cause the observed long-term 5-HT depletions. We suggest that 5, 6-DHT formed from 5-HT may mediate the neurotoxic effects of MA on serotonergic nerve terminals.     

Effects of calcium channel inhibitors on ethanol effects and pharmacokinetics in healthy volunteers

Previous studies have shown that calcium channel antagonists alter the effects of alcohol in animals and humans. We selected a phenylalkylamine, verapamil, and a dihydropyridine, nimodipine, to determine whether these drugs would affect the subjective or psychomotor effects of ethanol in humans. Subjects ingested verapamil (80 mg, PO), nimodipine (30 and 60 mg, PO), or placebo 60 min before drinking an alcohol (0.7 g/kg) or placebo beverage. Subjects' mood, psychomotor performance, physiological status, and blood alcohol levels were assessed up to 3 h after beverage ingestion. Alcohol increased “drunk” ratings and impaired psychomotor performance (p < 0.05). Blood alcohol levels were decreased by nimodipine pretreatment, but not by verapamil pretreatment. Subjective and psychomotor effects of alcohol were not altered as a function of nimodipine or verapamil pretreatment. Nimodipine, verapamil, and alcohol, either alone or in combination, had no effect on blood pressure or heart rate.