肺结核病延误诊断原因分析及对策

[目的]分析石家庄市区肺结核病人的归口管理情况及肺结核病人延误诊断的原因。[方法]对2004年石家庄市区确诊230例肺结核病人发病、就诊和治疗过程情况进行了统计。[结果]230例病人中有72例误诊为上呼吸道感染、43例误诊为肺炎、15例误诊为肺癌、30例误诊为陈旧性肺结核、70例诊为活动型肺结核。就诊延迟98例、确诊延迟82例、发现延迟50例。[结论]肺结核病的控制不仅要有一支专业的防痨队伍,还要有政府支持、各部门的联合与协作,发现可疑肺结核病人要及时进行转诊、实行归口管理,只有这样才能使我国的肺结核病人发病率下降。     

Intrinsic oscillations in spike trains indicate non-renewal statistics due to convergence of inputs in dorsal cochlear nucleus neurons

The occurrence of intrinsic oscillations (IOs) in a unit’s discharge is reflected by a prominent peak in the power spectrum (i.e., Fourier transform of the autocorrelation function) of spike trains obtained from single-unit discharge, at a frequency independent of stimulus spectral characteristics. IOs have been reported by researchers in the dorsal cochlear nucleus (DCN) of both the cat and the Mongolian gerbil. It has been hypothesized that IOs are related to inter-spike interval (ISI) regularity (e.g., [Hear. Res. 58 (1992) 153]). This hypothesis is tested in this paper. Responses to multiple presentations of 50–300 ms duration tone bursts, at and near the unit’s best frequency (BF) at 20–60 dB re threshold were recorded from DCN units of barbiturate-anesthetized (30 units), as well as decerebrate (53 units) Mongolian gerbils. IOs in the recordings were then compared with the IOs in simulations of spiking-neuron models. The models were selected because: (1) their ISI regularity characteristics follow those of experimental data and (2) their IO properties are completely determined by their ISI regularity. Such comparison reveals that Ghoshal’s hypothesis fails for a fraction of the units. These results suggest a re-evaluation of the purported relationship between IOs, ISI regularity, and SAM response. Alternate hypotheses are proposed here using computational models that are based on convergence of multiple neural inputs onto the unit under study. These models produce non-renewal statistics that resemble those of the experimental data, as is evident from IO-based analysis.     

Quantitative comparisons of corticothalamic topography within the ventrobasal complex and the posterior nucleus of the rodent thalamus

To compare the topographic precision of corticothalamic projections to the ventrobasal (VB) complex and the medial part of the posterior (POm) complex, different anterograde tracers were placed in neighboring parts of the primary (SI) and secondary (SII) somatosensory cortical areas. The location of labeled corticothalamic terminals and their beaded varicosities were plotted, and the digital reconstructions were analyzed quantitatively to determine the extent of overlapping projections from the cortical injection sites. Among animals that received all tracer injections in SI cortex, tracer overlap in the thalamus varied according to the proximity of the cortical injection sites. Regardless of which combination of somatic representations were injected in SI, within each animal the amount of tracer overlap in POm was similar to that observed in VB, and a matched-sample statistical analysis failed to reveal significant differences in the proportion of the labeled regions that contained overlapping projections from the injected cortical sites. Among those animals in which the tracers were injected into the whisker representations of SI and SII, the amount of tracer overlap in the thalamus was not affected by the proximity of the cortical injection sites. Instead, tracer overlap appeared to be related to the degree of somatotopic correspondence. Furthermore, within each of these animals, the amount of tracer overlap in POm was similar to that found in the VB complex. These results indicate that POm has a well-defined topographic organization that is comparable to the degree of topography observed in the VB complex.     

四川省结核病归口管理实施情况分析

目的：分析四川省结核病归口管理工作现状,评价实施结核病归口管理的效果。方法：检查全省结核病归口管理实施情况,比较结核病归口管理实施前后后省肺结核病人登记管理。结果：实施结核病归口管理后,全省肺结核病人登记管理质量明显提高。结论：采取有效措施,进一步规范结核病归口管理。     

行政干预对结核病归口管理的影响

目的　评价行政干预对结核病归口管理的作用及效果。方法 随机选取17所综合医院作为调查点,采取行政干预与法律监督相结合的措施落实结核病归口管理,对采取措施前后综合医院的归口管理情况进行调查对比。结果 通过干预措施,综合医院肺结核病人的转诊率和疫情报告率分别由干预前的24.3%和27.0%提高到干预后的75.3%和87.2%。结论 加强行政干预,严格依法监督,可有效促进结核病归口管理的落实。     

Cutaneomotor integration in human hand motor areas: somatotopic effect and interaction of afferents

The aim of this study was to elucidate sensorimotor integration in human hand motor areas, its time course, somatotopy and the interaction of sensory fields arising from two different fingers. We studied the influence of different intensities of electrical digital stimulation of two different fingers on motor-evoked potentials elicited in hand muscles by transcranial magnetic stimulation (TMS). Single conditioning electrical stimuli were applied to the right second (D2) and fifth fingers (D5) individually and also to both fingers (D2+D5) simultaneously in six normal volunteers. Magnetic tests, adjusted to produce a response in the abductor digiti minimi muscle of the right hand, were delivered using a circular and a focal coil. The digital stimuli were delivered to the finger at the sensory threshold (ST), at 3 and 5 times the ST, and over the pain threshold at interstimulus intervals (ISIs) ranging from 10 to 100 ms. In order to define the anatomical level of the sensorimotor interactions, the effect of the digital stimulation on TMS was compared to the effect on transcranial electrical stimulation. When the peripheral stimulation was delivered at the ST a small inhibitory effect was found only when stimulating both fingers. At 3 times the ST we detected a topographic distribution of motor-evoked potential inhibition, which partially disappeared at higher intensity (5 times the ST); two types of convergence effects took place at different ISIs. When conditioning stimuli were painful, somatotopy and convergence were lost. Sensorimotor integration shows somatotopy and interaction of afferents at different sites. The intensity of the conditioning stimulus plays an important role in topography and sensory convergence. The importance of these mechanisms in physiology and physiopathology is discussed.     

zdhhc17对斑马鱼集中延伸运动的调节及其机制 

目的 通过抑制zdhhc17基因的表达,探讨其在斑马鱼胚胎发育过程中的作用及机制。方法 通过显微注射zdhhc17吗啉反义寡聚核苷酸(MO)抑制zdhhc17翻译,观察斑马鱼胚胎发育过程中相关表型的变化。利用斑马鱼整封原位杂交技术,检测集中延伸运动相关标记基因（dlx3b、ntl、myod1、 tbx6等）的表达变化。利用RT-PCR技术,检测集中延伸运动相关调控因子mRNA表达水平的变化。 结果 敲除zdhhc17基因后,斑马鱼胚胎集中延伸运动出现严重缺陷,主要表现为尾部弯曲变短（82/118）,且集中延伸运动相关标记基因表达异常,钙黏附蛋白家族cdh1、padh18a mRNA水平降低。结论 zdhhc17通过调节钙黏附蛋白家族cdh1、padh18a基因的表达,进而影响细胞黏附运动,最终参与调控斑马鱼胚胎集中延伸运动。     

集合不足型外隐斜合并调节不足三种治疗方法的比较

目的 比较集合调节训练、三棱镜配戴矫正和近视屈光过矫在集合不足型外隐斜合并调节不足患者中的疗效.方法 横断面研究,将10～35岁的60名确诊为集合不足型外隐斜合并调节不足患者随机分为3组,每组20例,A组行三棱镜配戴矫正,B组行近视屈光过矫-0.50 D戴镜矫正,C组行集合调节视功能训练,于3个月后复查隐斜度和视功能采用配对t检验和单因采方差分析 结果 复查各项视功能参数3组患者之间差异有统计学总义 A组患者隐斜度增加(t=1 2.65,P＜0.01),近距正相对融合范围减小(t=12.65,P＜0.01),症状先短暂缓解后加重;B组患者隐斜度增加(t=4.63,P＜0.01),近距正E相对融合范围减小(t＝6.71,P＜0.01),调节幅度减小(t=14.3,P＜0.01),症状明显加重;C组患者隐斜度显著减小(t=-11.61,P＜0.01),近距正相对融合范围显著增大(t=-22.40,P＜0.01),调节幅度显著增大(t=-31.06,P＜0.01),症状明显改善 结论 集合不足型外隐斜合并调节不足患者采用集合调节视功能训练能明显改善症状,减少近距隐斜度,增加近距正相对融合范围和调节幅度,是一种有效可行的治疗方法.