Dopamine effects on the intestinal circulation.

The effects of intra-arterial infusion of dopamine on superior mesenteric artery blood flow, intestinal flow, intestinal oxygen consumption, and capillary density were studied in anesthetized dogs before and after blockade of dopamine receptors with haloperidol and after beta-adrenergic receptor blockade with propranolol. Mesenteric blood flow to a distal segment of the small intestine was measured with an electromagnetic blood flow-meter and intestinal oxygen consumption was calculated from the measured arteriovenous oxygen difference across the intestine and total blood flow. Intestinal capillary density was estimated from the clearance of 86Rb. In normal animals prior to dopaminergic or beta-adrenergic blockade, dopamine caused a dose-related decrease in mesenteric blood flow, intestinal oxygen consumption, and 86Rb clearance. Only the lowest dose of the drug, 1 mug/Kg.-min., did not significantly change the intestinal capillary density. In dogs pretreated with the dopamine receptor, antogonist, haloperidol, dopamine (20 mug/Kg.-min.) caused a significant increase in blood flow and oxygen consumption and did not significantly alter the number of perfused intestinal capillaries. These increases in haloperidol-blocked animals administered dopamine were reversed by propranolol. Our results indicate that dopamine caused smooth muscle contraction in mesenteric arterioles and precapillary sphincters, thereby producing intestinal ischemia and hypoxia. These findings with haloperidol and propranolol indicate that dopamine stimulates at least two different receptors in the canine mesenteric vascular bed: a constrictor receptor blocked by haloperidol and a dilator receptor blocked by propranolol.     

老年急性心肌梗塞合并多器官功能衰竭临床分析

目的:探讨老年急性心肌梗塞(AMI)合并老年多器官功能衰竭(MOFE)的临床特点、治疗及转归。方法:回顾分析解放军总医院2004年1月至2006年12月所有238例老年AMI患者中的20例老年AMI合并MOFE患者的资料,分析这些患者的临床特点、治疗及转归。结果:老年广泛前壁AMI患者死亡率为80%;合并心源性休克的MOFE患者死亡率为60%;在老年AMI合并MOFE患者中以肺感染为诱因的占85%;老年AMI患者如合并脑血管基础性疾病,则死亡率为83.3%;在衰竭器官中,以心、肺、肾最为多见,分别占100%、80%、60%;早期介入治疗较溶栓治疗对患者的存活意义更大。结论:老年人AMI合并MOFE时心肌梗塞部位、是否合并心源性休克、脑血管基础疾病对患者预后影响非常大,心脏衰竭可能是老年AMI合并MOFE的始动因素,积极预防肺感染的发生、对合适病人早期实施介入治疗可能会逆转某些老年AMI患者发生MOFE的过程,或者提高救治成功率。     

与老年人跌倒有关的环境危险因素分析

目的 了解老年人的跌倒情况以及有关的环境致跌危险因素。方法 调查415人,运用访谈、观察和查阅病历的方法收集资料。结果 发生在户外和家中的跌倒各占50%,多数跌倒与环境因素有关。环境危险因素主要是地在潮湿或台阶倾斜等易滑倒的因素,通道中有杂物、地面不平、梯级过高等易绊倒的因素。户外跌倒中67.5%有环境因素存在,而在家中的跌倒中为46.2%。能独自活动者58.7%的跌倒发生在户外,不能独自活动者81.3%的跌倒发生在家中。结论 环境危险因素是致老年人跌倒的重要因素,主要有易致滑倒和易致绊倒的因素,应对老年人的健康教育和家庭护理中引起重视。户外的环境危险因素对能独自活动者威胁更大,户外活动的安全是他们主要应重视的问题。居家环境危险因素对能独自活动者和不能独自活动者均构成威胁。对不能独自活动者来说,居家安全是预防跌倒的关键。     

Comprehensive care for haemophilia around the world

Summary.  Comprehensive haemophilia care has been defined as the continuing supervision of all medical and psychosocial factors affecting the person with haemophilia family. Services offered by haemophilia treatment centres (HTCs) adopting the comprehensive care model include establishing prophylaxis and other treatment protocols, development of psychosocial, education and research programme, maintenance of a patient registry, genetic and reference diagnostic services and orchestration and management of a wide variety of multidisciplinary interventions. Most centres practising this model of care are based in developed countries and can meet costs for plentiful treatment products through government or insurance-company funding. Not all the programmes are dependent on the level of product supply, however, and many have been supported in countries with emerging economies as part of national healthcare systems, particularly in relation to blood management. In this paper we present perspectives from different areas of the world on how to adopt, adapt and achieve economically appropriate models of comprehensive care.     

Brain deviations in adult obese-hyperglycemic mice (ob/ob)

In the brain of adult obese-hyperglycemic mice (ob/ob) deviations, such as reduced brain weight, diminished myelination, and reduced amount of DNA were found. These findings cannot be explained by hypothyroidism in adults since above mentioned deviations could only have been caused by a reduced thyroidal activity in the first weeks of postnatal life. Therefore, our data are in support of the earlier hypothesis of congenital hypothyroidism.     

Perioperative myocardial infarction related to coronary bypass surgery.

Frank lead electrocardiograms were recorded from 149 normal and abnormal adult males using four different electrode placements. All chest electrodes were placed at: (1) the fourth intercostal space level, (2) the fifth intercostal space level, (3) the fourth intercostal space level with V₄ substituted for C, and (4) the fifth intercostal space level with V₄ substituted for C.Differences in mean values of many commonly used amplitudes and orientations were not statistically significant among the four recording methods, but amplitude differences for individual subjects were often large and difficult to predict. When V₄ is substituted for C, as commonly done in some laboratories, R_x decreased and R_z increased by more than 10 per cent in about 40 per cent of the cases. In about 70 per cent of the cases, R_x and R_z changed significantly when electrode level was shifted from the fifth to the fourth intercostal space. For these 70 per cent, it does not appear possible to accurately predict increase or decrease of R_x, R_z, or QRS_m.Analysis programs which depend on individual amplitude measurements are likely to be significantly affected by electrode placement. It is suggested that criteria for analysis programs developed using a specified version of the Frank system should ideally be applied only to electrocardiograms recorded in the same manner.     

老年类风湿关节炎患者抗角蛋白抗体检测意义

目的：了解抗角蛋白抗体（AKA）对老年类风湿关节炎（EORA）的诊断意义。方法：以Wistar大鼠中1／3食管组织冰冻切片为底物，采用间接免疫荧光光检测51例EORA及139例对照组的血清AKA，记录同期临床及实验室指标。结果：AKA对EORA诊断敏感性为31．4％，特异性为98．6％，早期EORA患者AKA阳性率28．6％，AKA阳性组IgM、血沉（ESR）较阴性组高；医生及患者对病情活动性评分、Sharp评分有增高趋势。16例AKA阳性EORA中，类风湿因子（RF）、抗核周因子（APF）、抗Sa抗体阳性数分别为11、15例和4例，AKA和APF相关。结论：AKA有助于EORA诊断及早期诊断，是病情活动性及严重性指标。     

Changes in house design reduce exposure to malaria mosquitoes

House design may affect an individual's exposure to malaria parasites, and hence to disease. We conducted a randomized-controlled study using experimental huts in rural Gambia, to determine whether installing a ceiling or closing the eaves could protect people from malaria mosquitoes. Five treatments were tested against a control hut: plywood ceiling; synthetic-netting ceiling; insecticide-treated synthetic-netting ceiling (deltamethrin 12.5 mg/m2); plastic insect-screen ceiling; or the eaves closed with mud. The acceptability of such interventions was investigated by discussions with local communities. House entry by Anopheles gambiae, the principal African malaria vector, was reduced by the presence of a ceiling: plywood (59% reduction), synthetic-netting (79%), insecticide-treated synthetic-netting (78%), plastic insect-screen (80%, P < 0.001 in all cases) and closed eaves (37%, ns). Similar reductions were also seen with Mansonia spp., vectors of lymphatic filariasis and numerous arboviruses. Netting and insect-screen ceilings probably work as decoy traps attracting mosquitoes into the roof space, but not the room. Ceilings are likely to be well accepted and may be of greatest benefit in areas of low to moderate transmission and when used in combination with other malaria control strategies.