基于“同气相求”理论的激痛点疗法治疗顽固性偏头痛15例

笔者基于"同气相求"理论,遵循经络辨证,以"求同气、通经络"为治则,针刺患侧或双侧手足少阳经远端激痛点及井穴,同时按揉近端激痛点,治疗顽固性偏头痛15例,现报道如下。1临床资料15例患者均为2018年1月至2018年6月包头医学院第二附属医院针灸科门诊就诊的顽固性偏头痛患者,其中男6例,女9例;单侧头痛9例,双侧6例;年龄15~65岁,平均46岁;病程0.5~15年,平均2年。均表现为单侧或双侧颞部反复发作的搏动性疼痛,伴失眠、健忘,痛甚者恶心,行头颅CT或MRI检查未见异常。     

Multiparametric Analysis of Heart Rate Variability Used for Risk Stratification Among Survivors of Acute Myocardial Infarction

A multiparametric heart rate variability analysis was performed to prove if combined heart rate variability (HRV) measures of different domains improve the result of risk stratification in patients after myocardial infarction. In this study, standard time domain, frequency domain and non-linear dynamics measures of HRV assessment were applied to 572 survivors of acute myocardial infarction. Three parameter sets each consisting of 4 parameters were applied and compared with the standard measurement of global heart rate variability HRVi. Discriminant analysis technique and t-test were performed to separate the high risk groups from the survivors. The predictive value of this approach was evaluated with receiver operator (ROC) and positive predictive accuracy (PPA) curves. Results - The discriminant analysis shows a separation of patients suffered by all cause mortality in 80% (best single parameter 74%) and sudden arrhythmic death in 86% (73%). All parameters of set I show a high significant difference (p<0.001) between survivors and non-survivors based on two-tailed t-test. The specificity level of the multivariate parameter sets is at the 70% sensitivity level (ROC) about 85–90%, whereas HRVi shows maximum levels of 70%. The PPA in the all cause mortality group is at the 70% sensitivity level twice as high as the univarihate HRV measure and increases to more than fourfold as high within the VT/VF group. In conclusion, in this population, the multiparametric approach with the combination of four parameters from all domains especially from NLD seems to be a better predictor of high arrhythmia risk than the standard measurement of global heart rate variability.     

Oncogene-mediated propagation of tracheal epithelial cells from two cystic fibrosis fetuses with different mutations. Characterization of CFT-1 and CFT-2 cells in culture

Abstract. Primary tracheal epithelial cells obtained from two fetuses with cystic fibrosis (CF) were successfully transfected with a plasmid vector recombined with the large T oncogene of SV40. The resulting tracheal cells were propagated in culture for up to 25 passages and retained the mutations of the CF genes carried by the two fetuses, one heterozygous for the S549N and N1303K substitutions (CFT-I cells), and the other homozygous for the most common deletion ΔF508 (CFT-2 cells). The transfected cells: (a) expressed the SV40 large T oncogene, as determined by immunofluorescence and Northern blot analysis; (b) retained typical epithelial morphology, as assessed by the presence of microvilli, desmosomes, gap junctions, and cytokeratin expression; (c) were fully responsive to the cAMP-stimulating agents isproterenol, forskolin and vasoactive intestinal peptide for cAMP production and PKA activation; (d) do not produce any tumour in the athymic nude mice; (e) were diploid and tetraploid with a normal chromosomal complement at early passages, and (f) exhibited the abnormal regulation of chloride conductance characteristic of CF.
These results indicate that CFT-1 and CFT-2 cells constitute a suitable model for: (a) comparison of the maturation and function of the CFTR protein mutated in the two nucleotide-binding domains; (2) analysis of the biochemical defect in CF epithelial airway cells, (c) development of new therapeutic agents, and correction of the CF defect by gene replacement therapy in vitro .     

Clinical Interest of a Sensor Driven Algorithm Limiting Ventricular Pacing Rate During Supraventricular Tachycardia in Dual Chamber Pacing

A sensor driven algorithm limiting ventricular pacing rate during supraventricular tachycardia (SVT) is included in a dual chamber rate modulated pacemaker sensitive to acceleration forces (Relay, 294-03, Intermedics Inc.). According to the intensity of concomitant exercise, the ventricular pacing rate is limited either to the programmed maximum pacing rate (MPR) or to an interim lower limit, called "conditional ventricular tracking limit" (CVTL). The MPR prevails over the CVTL when the sensor calculated pacing rate exceeds the minimal rate by more than 20 beats/mm. The purpose of the study is to determine the clinical safety and efficacy of this algorithm in patients with intermittent SVT. Method: a Relay was implanted in four patients with a bradycardia/tachycardia syndrome and in four patients with complete atrioventricular block (CAVB). All had episodes of paroxysmal atrial tachycardia. The units were programmed in DDDR: rate responsive parameters were adjusted by simulating the rate response during three levels of exercise to let the MPR override the CVTL only during strenuous exercise. Holter monitors and exercise testings were performed at 3-month follow-up. Results: in seven patients, Holter recordings showed Supraventricular arrhythmias at rest with a ventricular pacing rate limited to the CVTL. Appropriate rate increases during exercise testings were also demonstrated. Three devices had to be reprogrammed in DDIR tone patient suffering from nearly permanent atrial flutter and two patients not tolerating the CVTL pacing rate at rest). Conclusion: the CVTL algorithm is effective in protecting against high ventricular pacing rates during Supraventricular arrhythmias. It allows the selection of the DDDR mode even with a high MPR in patients with intermittent SVT.     

Effect of Short Atrioventricular Delay on Cardiac Output

RONASZEKI, A., ET AL.: Effect of Short Atrioventricular Delay on Cardiac Output. Short atrioventricular (AV) delay modifies late diastolic filling dynamics. The effect of this change on cardiac output [CO) was studied in closed chest, AV blocked canine preparations (N: 10), during AV sequential pacing (80 bpm). CO (thermodilution technique) and transmitral flow velocity (TMFV, pulsed-wave Doppler) were measured and compared (paired t-test) on the basis of TMFV pattern, when atrial contraction (A wave) started just after early diastolic transmitral flow deceleration [PR:219 ± 25 ms, mean ± SD) and when A wave occurred at the end of late diastole and shortened due to the next ventricular contraction (PR: 56 ± 11 ms). The short AV delay resulted in 12.0 ± 5.9% decrease of CO, reflecting the interrupted late diastolic atrial transport. Properly timed atrial contraction is necessary for optimal AV sequential pacing.     

Contraception and abortion coverage: what do primary care physicians think?

BackgroundInsurance coverage for family planning services has been a highly controversial element of the US health care reform debate. Whether primary care providers (PCPs) support public and private health insurance coverage for family planning services is unknown.Study DesignPCPs in three states were surveyed regarding their opinions on health plan coverage and tax dollar use for contraception and abortion services.ResultsAlmost all PCPs supported health plan coverage for contraception (96%) and use of tax dollars to cover contraception for low-income women (94%). A smaller majority supported health plan coverage for abortions (61%) and use of tax dollars to cover abortions for low-income women (63%). In adjusted models, support of health plan coverage for abortions was associated with female gender and internal medicine specialty, and support of using tax dollars for abortions for low-income women was associated with older age and internal medicine specialty.ConclusionThe majority of PCPs support health insurance coverage of contraception and abortion, as well as tax dollar subsidization of contraception and abortion services for low-income women.     

Preclinical to Clinical Translation of CNS Transporter Occupancy of TD-9855, a Novel Norepinephrine and Serotonin Reuptake Inhibitor

Background:

Monoamine reuptake inhibitors exhibit unique clinical profiles that reflect distinct engagement of the central nervous system (CNS) transporters.

Methods:

We used a translational strategy, including rodent pharmacokinetic/pharmacodynamic modeling and positron emission tomography (PET) imaging in humans, to establish the transporter profile of TD-9855, a novel norepinephrine and serotonin reuptake inhibitor.

Results:

TD-9855 was a potent inhibitor of norepinephrine (NE) and serotonin 5-HT uptake in vitro with an inhibitory selectivity of 4- to 10-fold for NE at human and rat transporters. TD-9855 engaged norepinephrine transporters (NET) and serotonin transporters (SERT) in rat spinal cord, with a plasma EC₅₀ of 11.7ng/mL and 50.8ng/mL, respectively, consistent with modest selectivity for NET in vivo.Accounting for species differences in protein binding, the projected human NET and SERT plasma EC₅₀ values were 5.5ng/mL and 23.9ng/mL, respectively. A single-dose, open-label PET study (4–20mg TD-9855, oral) was conducted in eight healthy males using the radiotracers [¹¹C]-3-amino-4- [2-[(di(methyl)amino)methyl]phenyl]sulfanylbenzonitrile for SERT and [¹¹C]-(S,S)-methylreboxetine for NET. The long pharmacokinetic half-life (30–40h) of TD-9855 allowed for sequential assessment of SERT and NET occupancy in the same subject. The plasma EC₅₀ for NET was estimated to be 1.21ng/mL, and at doses of greater than 4mg the projected steady-state NET occupancy is high (>75%). After a single oral dose of 20mg, SERT occupancy was 25 (±8)% at a plasma level of 6.35ng/mL.

Conclusions:

These data establish the CNS penetration and transporter profile of TD-9855 and inform the selection of potential doses for future clinical evaluation.     

在线继续医学教育对医生知识、态度和行为的效果

有越来越多的医生选择学习在线课程来进行继续医学教育,但却很少有严格的评估方法来确定在线继续医学教育活动的效果.鉴于此,美国阿拉巴马大学医学院继续医学教育部的研究人员进行了相关研究.应用时间序列设计的方法,来比较完成了继续医学教育网站提供的任意30分钟在线继续医学教育课程的医生在教育活动前后其知识、态度和自我报告的在临床实践中诊疗行为的变化.