合并静止性震颤的原发性震颤患者临床特点分析

目的了解北京地区社区中老年人原发性震颤(essential tremor,ET)的临床特征及其与预后的关系。方法2000年在北京城区、近郊平原、远郊山区调查了2835名55岁以上中老年人,采用筛查和临床诊断两步法确诊患者。发现ET患者135例,对其中合并静止性震颤的患者进行分析,并于2004年对其进行随访。结果其中合并上肢静止性震颤患者17例,占12.6%,合并静止性震颤组震颤总分、头部震颤的比例、肢体震颤总分均明显高于对照组。两组年龄、性别组成、病史无显著性差异,姿势性震颤和动作性震颤的程度差异不明显。4年后随访到13例(13/17),其中3例死亡,实际调查的10例中有9例仍诊断为ET,另1例诊断为临床很可能ET。结论有相当部分社区ET患者可以合并静止性震颤,合并静止性震颤的患者提示病情较重。     

Can skin temperature manipulation, with minimal core temperature change, influence plasma volume in resting humans?

We investigated body-fluid distribution in resting humans, during short-term, whole-body skin temperature modification, in which core temperature changes (ΔT_c) were minimal. Seven males participated in hot (36.2°C (s.d. 0.7), 44% relative humidity (rh; s.d. 3)), temperate (22.0°C (s.d. 1.0), 52% rh (s.d. 6)), and cool trials (14.4°C (s.d. 1.6), 74% rh (s.d. 9)), while seated at rest. Total body water (TBW), extracellular fluid (ECF), erythrocyte (RCV) and plasma volumes (PV) were measured using a simultaneous radionuclide dilution technique. In the cold, PV contracted by 205 ml (±60) by the end of exposure (p = 0.04), while in the heat, PV expanded 108 ml (±123; p = 0.02). Both RCV and TBW remained stable, regardless of the environment. Despite fluid movement across the vascular wall, ECF, interstitial and intracellular volumes were relatively unaffected by skin temperature. It was concluded that, at rest, and with minimal ΔT_c, the intravascular fluid volume was dependent on prevailing environmental conditions, and its impact on local skin temperature and venomotor tone. Accepted: 12 July 1999     

Effects of repeated fatiguing rhythmical hand work

Summary In a model work place (hand-grip dynamometer), eleven subjects performed rhythmical hand-grip contractions to exhaustion (frequency 30/min). In each working cycle the contraction and rest phases were distinguished. The work to exhaustion was repeated four times (four working periods with 15-min rest intervals). The tests were performed at 40, 60, 80, 100% MVC. Analysis of Variance showed no difference in the group means (mean values of each working period and load level) for the duration of the contraction or rest phases, the integrated bioelectrical muscle activity (iEMG) of flexors, extensors, brachioradialis (iEMG referred to working cycle and contraction phase) or iEMG of the thenar muscles (referred to the working cycle), or in the duration of the R-R interval in the ECG during comparable periods of the experiments. The endurance times decreased from working period 1–4, and a similar decrease occurred in the force-time product. It may be concluded from these results that 15 min rest is insufficient for adequate recovery from hand-exhaustion exercise.     

遗传性发作性无力附1例临床及神经电生理分析

本文报告1例临床不典型的遗传性发作性无力，又称高钾性周期麻痹，通过作高钾试验、低钾试验及冷水试验等特殊检查，以及应用运动神经传导波幅的变化鉴别发作期与间歇期而确诊，神经电生理应用于本病为国内首次报告。本文对发病机理从神经电生理角度进行了探讨。     

Regional differences in rest decay and recoveries of contraction and the calcium transient in rabbit ventricular muscle

The rates of rest decay (for rest periods of between 0.5 min and 10 min) and recovery from the rested state (following 10 min of rest) of cell shortening and the amplitude of the intracellular calcium transient were compared in epicardial and endocardial ventricular myocytes isolated from rabbit hearts. The object of these experiments was to determine whether reported transmural differences in action potential duration, myosin type expression and metabolic enzyme content are able to influence the control of contraction. Cells isolated from these two regions of the ventricular wall displayed almost identical twitch shortening and calcium transient characteristics during steady-state electrical stimulation at 0.5 Hz. Despite this, rest decay of cell shortening was faster and recovery from the rested state slower in endocardial cells than in epicardial cells. Neither of these differences could be explained in terms of changes of calcium transient amplitude or time course. We tried to mimic the effect of prolonged rest by application of caffeine to empty the sarcoplasmic reticulum of calcium. The regional differences in recovery of contraction from the rested state were not reproduced in the recovery of contraction after caffeine application, suggesting that the effect is produced by something other than refilling of the sarcoplasmic reticulum. It is suggested that changes in factors that affect myofilament calcium sensitivity produce the regional differences in rest decay and post-rest recovery of contraction.     

组织多普勒成像评价静息冠心病患者心脏局部功能

目的 在静息状态下应用组织多普勒成像(TDI)的多种测量指标评价冠心病患者的心脏局部功能,并探讨心脏局部功能测定在冠心病诊断中的价值.方法 对47例主诉胸痛的住院患者进行TDI检查,测定左室16个节段的收缩峰速度(Sm)、舒张早期峰速度(Em)、舒张晚期峰速度(Am)、等容收缩时间(IVCT)和等容舒张时间(IVRT).所有患者同时行冠状动脉造影检查,有至少1支直径狭窄≥50％的冠状动脉则诊断冠心病.规定直径狭窄≥50％且＜90％的冠状动脉支配节段为轻度病变节段,直径狭窄≥90％的冠状动脉支配节段为重度病变节段,其余节段为非病变节段.结果 非冠心病(13例)、1支病变(11例)、2支病变(11例)以及3支病变(12例)患者性别构成、年龄、心率、冠心病易患因素、左室射血分数及跨二尖瓣舒张早期血流速度与舒张晚期血流速度比值(E/A)比较差异均无统计学意义(P＞0.05).与非病变节段(390个)比较,轻度病变节段(162个)和重度病变节段(144个)的Sm、Em、Err/Am明显下降(P＜0.01),IVRT明显延长(P＜0.01),轻度病变节段IVCT与非病变节段比较差异无统计学意义(P＞0.05),但重度病变节段IVCT显著延长(P＜0.05).如果以至少存在3个节段的Sm＜ 2.50 cm/s且IVRT＞ 87 ms作为诊断冠心病的标准,则该标准诊断冠心病的敏感度为79.4％ (27/34),特异度为84.6％(11/13),阳性预测值为93.1％(27/29),阴性预测值为61.1％(11/18),准确度为80.9％(38/47).结论 静息状态下,冠心病患者病变部位的心脏局部功能变化体现在收缩和舒张运动速度的下降和等容运动时间的延长,综合分析心脏节段运动速度和运动时间有助于冠心病的诊断.     

Ventilatory adjustments during sustained resistive unloading in exercising humans

Summary Effect of He-O₂-breathing (79.1%:20.9%) compared to air-breathing on inspiratory ventilation ( _I) and its different components [tidal volume (V _T), the duration of the phases of each respiratory cycle (t _I,_{t TOT})] as well as on inspiratory mouth occlusion pressure (P _0.1) were studied in six normal men at rest and during 72 constant-load exercises (90 W) over a much longer period than in previous studies. Results showed that, irrespective of the order of administration of the two gases (7 min air 7 min He-O₂ or vice versa): at rest,P _0.1 decreased during He-O₂ inhalation but no changes in _I and breathing pattern were detectable; during exercise, sustained He-induced hyperventilation was observed without any change in the absolute value ofP _0.1; increase inP _0.1 between the resting period and exercise (P _0.1) was significantly higher during He-O₂-breathing than during air breathing; this He-induced hyperventilation was associated with a sustained increase inV _T/t _I, but with constantt _I/t _TOT. Helium-breathing during exercise cannot be a simple situation of resistance unloading, as has been suggested. We conclude that He-O₂-breathing, after the initial compensation period, induces reflex changes in ventilatory control with an increase in inspiratory neural drive. Moreover, it appears that exerciseP _0.1 is not a legitimate index of inspiratory neural drive whenever restP _0.1 changes according to the nature of the inhaled gas mixture.     

Thermal stress and physiological strain in the glass bangle industry

Summary A preliminary survey of the few units of the small-scale glass bangle industry in Firozabad, Agra District, Uttar Pradesh, indicated that the workers were exposed to severe degrees of heat stress during various operations in the manufacturing processes. A more detailed study in eight glass bangle units was therefore undertaken to make quantitative estimates of heat stress on exposed workers in the summer season. The thermal data collected confirmed that the heat stress on the workers was severe but measurement of certain physiological indicators revealed relatively low levels of strain amongst the exposed workers. The findings could be attributable to high degrees of acclimatization, but further observations in the field supplemented by studies on simulated exposures of volunteers in a climatic chamber seem to be warranted.     

Dental case management: increasing access to oral health care for families and children with low incomes

BACKGROUND: Medicaid beneficiaries have lower rates of dental visits and higher rates of dental disease compared with the rest of the population. Beneficiaries ascribe their low use of services to difficulties finding dentists who treat patients with Medicaid. Dentists cite low reimbursement rates, excessive paperwork, and patients' not keeping appointments and poor oral health literacy as reasons for not accepting patients with Medicaid. The authors pilot-tested the effectiveness of a dental case management program (DCMP) in increasing dentists' participation in Medicaid and Medicaid beneficiaries' use of services. METHODS: A dental case manager recruits dentists to participate in the Medicaid program, arranges training in billing procedures, resolves billing and payment problems, educates clients about the use of dental services and keeping appointments, links clients to dental offices, identifies potential barriers to care and helps clients obtain transportation to appointments. The authors evaluated the levels of participation of dentists in the DCMP in Medicaid and Medicaid beneficiaries' use of services. RESULTS: Dentists accepting new Medicaid patients increased from two to 28, with 145 dental visits a month provided to Medicaid beneficiaries. The percentage of Medicaid beneficiaries receiving dental services increased from 9 to 41 percent after the DCMP was implemented. CONCLUSIONS: The authors found that the DCMP was effective in increasing Medicaid beneficiaries' use of services, increasing dentists' participation in Medicaid, minimizing administrative burdens related to Medicaid participation, and increasing oral health literacy and treatment compliance among clients with low incomes.     

Evaluation of autonomic nervous system in sleep apnea patients using pupillometry under occlusal stress: a pilot study

Aims: Recently, it has been proposed that obstructive sleep apnea syndrome (OSAS) is characterized by an imbalance in autonomic nervous tone. Pupil size has been considered a valid test for studying the autonomic nervous system (ANS). Pupillometry is a simple and non-invasive tool to assess the size and dynamics of the pupil. The purpose of this study was to evaluate, by pupillometry, the hypothesis that subjects with OSAS present ANS dysregulation.

Methods: The study group included 10 males aged between 40 and 50 years with polysomnographic diagnoses of mild OSAS. The control group included 10 males with similar ages with an apnea–hypopnea index (AHI) of less than 5, after polysomnography. Pupillometry was performed by digital infrared pupillometer (25 frame/s). Recordings were processed to measure the area of the pupil frame by frame. The subjects underwent four subsequent recordings: infrared light at rest mandible position (RP); infrared light at forced habitual occlusion (FHO); yellow-green light at RP; and yellow-green light at FHO. According to literature, linear and non-linear information was extracted from the recordings.

Results: As expected, the two groups did not differ statistically in age and body mass index (BMI), while there was a significant difference in the AHI. In the within-group comparison of pupil size, there were significant differences between RP and FHO under infrared conditions in the control group. There was a significant difference in the determinism percentage (Det%) in the RP infrared condition between the control and OSAS groups.

Conclusions: The results of the current study confirm ANS dysregulation in OSAS patients and provide a new possible strategy for studying this pathology by using pupillometry through linear and non-linear mathematical models.