两种药品使用政策对门诊基本药物使用的影响

目的 分析引进日均费用（DDC）较低的药品及对原药品采取限量措施政策实施前后院、科室两级门诊基本药物使用的变化以及影响。方法 收集2017年5月~2018年8月政策实施前后基本药物在门诊的使用情况资料,比较相同通用名的降压药类基本药物之和与全部降压药的DDDs、各引进的相同通用名的降压药类基本药物的DDDs、各相同通用名的基本药物的平均DDC、各相同通用名的基本药物在门诊使用量最大的两个科室的平均DDC、各相同通用名的基本药物在使用量最大的两个科室间的平均DDC,并进行分析。结果 所引进的药品的DDC低于原药品（P＜0.05）;引进的相同通用名的降压药类基本药物之和高于全部降压药在政策实施前后门诊使用的DDDs;引进相同通用名的降压药类基本药物使用的DDDs变化比较,政策实施后高于政策实施前（P＜0.05）;政策实施后各相同通用名的基本药物在门诊使用的平均DDC较政策实施前降低,政策实施后引进的相同通用名的基本药物在门诊使用量最大的两个科室的平均DDC较实施政策前下降（P＜0.05）;仅氨氯地平、缬沙坦在政策实施前后各时间段各科室间使用量不同（P＜0.05）。结论 通过引进DDC较低的基本药物,再加以行政性用药管理,可以增加基本药物在相同药理作用药品中的使用频度、提高各基本药物的使用频度、降低基本药物的平均日费用,但是同时各科室之间药品使用变化是不一致的,需要加强交流,促进基本药物的使用。     

Reflection of the systemic mechanisms of instrumental behavior in the activity of brain neurons

Changes in the impulse activity of neurons of the sensorimotor, parietal associative, and visual areas of the cerebral cortex were studied during the performance of conditioned instrumental alimentary behavior by an animal. Comparative analysis of impulse activity of the neurons investigated showed that 71.4% of the cells of the parietal associative area of the cerebral cortex were activated when the conditional stimulus was turned on; 75.8% of neurons of the visual cortex were activated when the animal pressed the pedal; 82.5% of the cells of the somatosensory and 75.8% of the visual area of the cerebral cortex increased activity upon appearance of milk in the food dispenser. During lapping of the milk, 75.8% of cells of the visual cortex showed reduction of activity. Reorganization of the impulse activity of individual neurons of the cerebral cortex reflected the unfolding of pretriggering integration formed as the result of preliminary training of the animal. The character of the impulse activity of the neurons investigated at the stage of realization of the program of the action and obtaining of reinforcement was determined primarily by the streams of afferent excitations arising during the perception of parameters of the stage-related and final results of the behavior. Translated from Zhurnal Vysshei Nervnoi Deyatel'nosti imeni I. P. Pavlova, Vol. 43, No. 2, pp. 333–340, March–April, 1993.     

Angioarchitectural form, functional distributive pattern and classification of the filiform papillae on the crossbred Japanese cat tongue anterodorsal surface in scanning electron microscopic specimens.

The purpose of this study was to undertake a three-dimensional comparative observation of the angioarchitectural form, functional distributive pattern and classification of the filiform papillae (FiP) as they appear on the entire dorsal surface of the front of the Japanese cat tongue using microvascular cast specimens (MVCS). By means of the corrosive resin casting technique, the MVSC of the FiP of the cat tongue were prepared and examined in detail under the scanning electron microscope (SEM). On the frontal half of the anterodorsal surface of the anterior tongue, types I-V of the FiP are arranged in the form of a A with the point in the direction of the apex and in an oblique line running from the antero-central to both postero-peripheral regions. In the rear half of the anterodorsal surface of the anterior part of the tongue, types I-V of the FiP are arranged in the form of a V with the point in the direction of the root and in an oblique line running from both antero-peripheral regions to the postero-median region or towards the pharynx on the anterior centro-dorsal surface of the tongue. The FiP, arranged in an oblique line running fron the central to the apical part of both the periphery and the pharyngeal region of the cat tongue, can be classified into five types (Types I-V) according to the shape and size of the main process (MP), numbers of the accessory processes (AP) and regional position of the lozenge arrangement. FiP Types I-III consisted of an MP which contained a large spoon-shaped and concave network process, and the AP contained a bundle of spin-like processes arranged radially at the anterior basal margin of the MP. FiP Types IV and V consisted only of MP. It was conjectured that the lozenge arrangement of the A and V form FiPs, classified into five types (Types I-V) from the frontal portion of the anterodorsal surface toward the pharynx on the front of the tongue, play a functionally assistant role in the mastication of food and sucking of liquid, including milk.     

Structure and nature of macrophages participating in the Wallerian degeneration of nerve fibers

The posttraumatic processes of Wallerian degeneration of nerves have been illuminated in detail. The dynamics of the breakdown of axons and the myelin sheaths of nerve fibers has been established, as have been the periods of the changes in the composition of myelin, and the reactive changes in the Schwann cells and the connective tissue structures in the makeup of the nerve as well as the formation of "foam" cells have been described. The controversial questions which have been raised in these studies regarding the role of the cellular elements (the Schwann cells, the endoneurial fibroblasts, the cells of the epi- and perineurium) during Wallerian degeneration remain unresolved until the present time. In particular, the question as to which cells participate in the cleanup of the products of the breakdown of the myelin sheaths, and as to the character of the inflammatory infiltration in Wallerian degeneration and the degree of the participation of the various cellular elements in the destructive and reparative processes, has not been elucidated. Some investigators believe that the Schwann cells accomplish the cleanup of the products of the breakdown of the myelin sheaths. There are also data suggesting that the macrophages are of considerable significance in the cleanup of the products of the breakdown of nerve fibers of both the PNS and the CNS following their injury. It has been demonstrated by means of monoclonal antibodies to macrophages, radioautography, and immunocytochemical methods that these macrophages have a hematogenous origin.(ABSTRACT TRUNCATED AT 250 WORDS)     

Investigation of a pain syndrome of spinal origin (on the concept of the generator mechanism of the pain syndrome)

A pain syndrome was induced in rats by means of a microinjection of purified tetanus toxin into the posterior horns of gray matter of the lumbosacral segments of the spinal cord. The toxin was used as a means of disturbing inhibitory mechanisms. Investigation showed that a pain syndrome can be reproduced if afferent stimulation from the periphery is blocked (by division of the nerves of the hind limbs or division of the dorsal lumbosacral roots on the side of injection of the toxin). Under these conditions the latent period of onset of the syndrome was lengthened and the degree of its development weakened a little in the initial stages by comparison with animals with intact afferentation. In many animals with blocked afferentation from the hind limb general manifestations (restlessness, aggressiveness, crying, etc.) were accompanied by a localized response in the form of increased licking, biting, or even chewing the tissues of the deafferented limb at the site of projection of the pain (the phantom syndrome). In some animals only the general reaction was observed without localization of the pain (protopathic pain). In all cases the attacks of pain arose paroxysmally. In animals with intact limb innervation the zones of licking were trigger zones of facilitated induction of an attack of pain. Injection of glycine into the affected posterior horns of the spinal cord abolished the pain syndrome during the time of action of the glycine. It is concluded that the pain syndrome is based on the formation of a generator of pathologically intensified excitation, as a result of disturbance of inhibitory processes, in the system of neurons connected with pain sensation. These mechanisms are evidently those principally concerned in the pathogenesis of all pain syndromes.     

Stability of the behavioral specialization of neurons

The constancy of the association of the activity of the neurons of the limbic cortex and food-procuring behavior has been analyzed in neurons specially selected on the basis of the criterion of length of recording in experiments in rabbits. Comparison of the activity in the first and second halves of the period was carried on the basis of the average frequency for the time of each half of the recording, the average frequency in each of 10 distinctive acts of cyclical behavior, as well as on the basis of the probability of the presence of activation in these acts. It was demonstrated that behavioral specialization, defined as the presence of 100% activiation of the cell in specific acts, did not change in the course of the recording, and was a stable information-containing characteristic of the association of the activity of the neuron with the animal's behavior.Translated from Zhurnal Vysshei Nervnoi Deyatel'nosti imeni I. P. Pavlova, Vol. 40, No. 2, pp. 291–300, March–April, 1990.     

胎儿直肠黏膜下层微血管构筑的研究

目的研究胎儿直肠黏膜下层器官内微血管的分布特点。为临床直肠相关疾病病机的分析及术式改进提供血供方面的基础资料。方法胎儿尸体20例,墨汁灌注,组织切片及组织揭层透明蒲片,光镜下观察直肠黏膜下层微血管的构筑情况,测量黏膜下层毛细血管分部密度。结果上半直肠黏膜下层微动脉多呈环状分布,下半直肠黏膜下层微血管多呈纵行的丛状分布。在上半直肠前壁及直肠颈后壁中线部位存在毛细血管"相对低密度区"。结论直肠黏膜下层的微血管网、丛在整个直肠血供中起核心作用,在上半直肠前壁及直肠颈后壁中线部位存在毛细血管"相对低密度区"。     

The features of the participation of the cholinergic mechanisms of the accumbens and caudate nuclei in the regulation of an instrumental defense reflex in dogs

The influence of microinjections of carbacholine (0.1, 0.05, and 1.0 μg) into the dorsal striatum (head of the caudate nucleus) and the ventral striatum (nucleus accumbens) on the motor components of the instrumental response and the criteria of execution of an instrumental task was studied in chronic experiments in eight dogs, based on a model of an instrumental defense reflex associated with the maintenance of a specific posture. The varied participation of the cholinoreactive structures of the caudate and accumbens nuclei in the regulation of the instrumental defense reflex was demonstrated in the dogs. Data were obtained indicating that the cholinoreactive system of the contralateral head of the caudate nucleus is structurally included in the regulation of the motor components of the instrumental response, of the main component of the reorganization of posture (the “disburdening” of the working extremity), and in the regulation of the tonic component of the voluntary movement and of its form. At the same time, the injection of carbacholine into the nucleus accumbens exerted, rather, a nonspecific activating influence on the motor systems. An improvement in attention to significant stimuli and the prolongation of the observed effects were also features of the activation of the cholinoreactive system of this nucleus. These changes took place in the case of both ipsi- and contralateral influences; this makes it possible to consider the inclusion mainly of sensory mechanisms in the realization of these influences. Translated from Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 79, No. 7, pp. 29–40, July, 1993.     

A systemic approach to the surgical treatment of degenerative-dystrophic diseases of the hip joint]

Based on the experience gained with the surgical treatment of over 900 patients with different forms of degenerative dystrophic diseases of the hip joint the current principles of the choice of different types of surgical interventions were defined. As far as the patients with aseptic necrosis of the head of the femur are concerned, the main problem in this case lies in the early diagnosis of osteonecrosis. The surgical treatment is specified by the leading factor of the pathogenesis at every stage of the development of the process (vascular disorders, changes in the biomechanism of the joint). The planning of operations in patients with dysplastic coxarthrosis rests on the consideration of 8 basic factors that influence the disease by means of factorial analysis and determination of the prognostic estimations of the treatment efficacy.     

Muscle fiber conduction velocity during isometric contraction and the recovery period

Changes of muscle fiber conduction velocity (MFCV) detected by surface array electrodes during an isometric contraction and the recovery period were evaluated. The location on skin measured for action potentials of muscle fiber in m. biceps brachii was a distance of 5 mm and 30 mm from the end-plate to the distal tendon. The MFCV was evaluated by averaging raw EMG waves. The MFCVs at both locations declined gradually during the loads of sustained isometric contractions of 30, 50, and 70% of the maximum voluntary contraction (MVC). The degree of the decrease of the MFCV was extremely intense during a sustained contraction of 70% MVC. The values of the MFCV at the location of 5 mm from the end-plate in the period close to the exhaustion state showed a significant decrease compared with the values in the initial period during the contractions for the above three kinds of loads, while the decrease of the MFCV at the location of 30 mm from the end-plate was not found to be so significant during the contractions. In the recovery period, the contraction of 5% MVC was maintained, and the resultant MFCVs restored gradually to the value of the initial period. At the location of 5 mm from the end-plate, the MFCVs at 15 minutes after the end of the load were significantly higher than those just after the end of the load. At the location of 30 mm from the end-plate, the increases of the MFCVs during the recovery period did not show significant changes. Changes of the MFCV during the isometric contraction and the recovery period depend greatly on the location of the electrodes measured for the action potentials of the muscle fibers.     

Contribution of motor unit activity enhanced by acute fatigue to physiological tremor of finger.

The contribution of motor unit activity to a physiological tremor (hereafter called as tremor) in a middle finger is studied by both a power spectrum and a correlation analysis in which the correlation coefficient and the coherence spectrum are obtained when five kinds of loads, 0, 50, 100, 150, and 200 g, are added to the middle finger for two minutes in a loading experiment on twelve male subjects. A weight of 200 g is applied to the subjects for ten minutes in a fatigue experiment. Throughout both experiments, the middle finger remains stretched from the load of the weight. The tremor is measured by an accelerometer (MT-3T, Nihon Kohden, Japan) attached to the middle finger, and the surface electromyogram (EMG) is measured by bipolar electrodes placed on m. extensor digitorum communis. A power spectrum analysis is carried out on the tremor and EMG, and a correlation analysis is performed on the relationship between the tremor and the demodulated EMG. It is found in the loading experiment that when the weight on the finger increases, the amplitude of the tremor oscillation increases since the activity of the motor units of the muscle is enhanced by the phenomenon of recruitment. Two frequency components of the tremor spectra at 10 Hz and 25 Hz under a no load condition reflect the components of the activity of the motor units of the muscle because the tremor shows a significant correlation in the frequency zone of 10 Hz and 25 Hz with the demodulated EMG. The lower frequency component of the tremor spectrum at 10 Hz results in synchronized activity of the motor units, while the higher frequency at 25 Hz occurs from the stretch reflex loop via the motoneurons of the spinal cord. The shift of the higher frequency component to the lower frequency domain due to the load of the weight originates from the prolongation of the response time of the finger mechanical system because the lag time at the peak of the correlation coefficient increases with the load of the weight. It is found in the fatigue experiment that the amplitude of the tremor oscillation increases with the progress of fatigue. The increase is caused by the recruitment of the motor unit activity of the muscle holding the finger as well as by the synchronization of the firings of the motoneurons. The progress of the synchronization is verified by the fact that the mean power frequency (MPF) of the EMG spectrum decreases and the correlation between the tremor and the demodulated EMG increases with the progress of fatigue. The mechanisms of the increase of the amplitude of the tremor oscillation under the load of the weight to the finger and under the state of fatigue of the finger are elucidated by the analysis of the tremor and EMG.     

Study of the degree of pneumatization of the viscerocranium in man and pongidae]

The volumes of the paranasal sinuses of 41 adult skulls of humans, gorillas, chimpanzees and orangutans, were examined with use of a Computertomograph type SOMATOM DR. The percentage distribution of the volumes of the different paranasal sinuses showed that the maxillary sinus always had the greatest volume. The maxillary sinus of the humans showed the smallest volume percentage in comparison with the pongids. The typical differences between humans and pongids were observed in the ethmoidal cells and the sphenoidal sinus. The ethmoidal cells of the gorilla and the orangutan have to be defined as rudimentary. Those of the humans come to more than 20% of the total volume of the paranasal sinuses of all hominoids. Differing from the humans, the sphenoidal sinus of the pongids pneumatizes almost the whole sphenoid bone. This volume percentage of the pongids is twice as high as that of the humans. In addition, an index was calculated from the volume of the facial skeleton volume and the total volume of the paranasal sinuses and defined as the degree of pneumatization. We found that the gorilla has the highest degree of pneumatization followed by the chimpanzee, the orangutan, and the humans. The lowest degree of pneumatization of the humans may be related to the reduction of the jaws.     

鞍侧腔的胚胎发育及其临床意义

目的：研究鞍侧腔形态结构及其内容物的胚胎发育。方法：对45例不同胚(胎)龄时期的鞍旁结构行组织学连续切片，观察鞍侧腔壁结构及其内容物的形态学变化过程。结果：鞍侧腔的发育可分为3个时期：(1)胚龄6～10周时，形成此区的最初边界；(2)胎龄11～16周时，显示鞍侧腔的构建过程，其腔壁约在胚胎14～16周形成。此期鞍侧腔外侧壁外层由脑膜层组成，内层由基质纤维包绕Ⅲ、Ⅳ、Ⅵ和V1神经复合体组成；而其内侧壁主要由垂体囊和基质纤维构成；(3)胎龄17周至出生后鞍侧腔诸壁及其内容物充分发育。结论：(1)鞍侧腔位于蝶鞍外侧区骨膜-硬膜间隙内，由脑神经、颈内动脉、丛状静脉管(海绵窦)及胶原纤维组成。(2)这些静脉管仅有内皮、纤维细胞和结缔组织构成。     

Anatomo-microscopic study of the walls of the superior cerebral veins

The authors studied the structure and disposition of the tissue components of the tunicae of the superior cerebral veins at the levels of the subdural space and of the superior sagittal sinus. It was observed that, at the level of the transition vein-sinus, the tunica adventitia is formed by numerous and voluminous fascicles of collagenic fibers and thin elastic fibers, which describe system spirals more opened distant to the superior sagittal sinus. The tunica intima of these vascular segments exhibits an endothelium resting on a network of elastic fibers, which may play the role of an internal elastic lamina. From the lateral, superior and inferior walls of the sinus, there originates a connective system whose fascicles of collagenic and elastic fibers incorporated to the vascular walls after describing a stretch in spiral around the vascular lumen. The authors admit that this dispositive connective collagenic-elastic, more the presence of the septums fibrous of the venous walls, give to the superior cerebral veins one property of the lengthening and of the shortening of the walls, in order to regulate the blood debit to the sinus. Also, ist was noted that, at the level of the subdural space, vascular walls exhibits a fibrous structure similar to that of the sinus, and are fixed to the interne face of the cranial dura-mater, to the lateral wall of the sinus and to the falx cerebri. These adherences contribute to preserve the integrity of the walls and even of the resistance during the elevation of the venous pression, preventing to the collapsus of these veins.     

The effect of amino acids on unconditioned interoceptive reflexes

Summary The aim of this work was the study of the effect of amino acids on the unconditioned interoceptive reflexes. The work was conducted on fasting cats and on those which were fed in condition of urethane anesthesia. Neutralized solutions of glutamic acid, cysteine and alanine were injected intravenously in the 1 : 10^–3 concentration. The author studied the changes of the reflex reactions in response to the stimulation of duodenal mechanoreceptors, the chembreceptors of the perfused section of the small intestine, the baroreceptors of carotid sinus and in response to the electric stimulation of the central end of the femoral nerve. After the intravenous administration of amino acids to fasting animals a change of the blood pressure pressor reactions into depressor was noted, while in animals which were fed the depressor reactions changed into pressor. The pressor reflex to stimulation of the femoral nerve was depressed both in fasting cats and in those which were fed. In stimulation of the baroreceptors of carotid sinus in these conditions the reflexes did not follow any definite laws.Reactions in response to the stimulation of the chemoreceptors of the perfused portion of intestine did not change. Thus, the intravenous administration of amino acids has a definite effect on the character of the reflexes, mainly by changing the condition of the peripheral part of the reflex arc.Evidently, the change in the metabolic processes occurring in the receptive zones and the impulsation which is transmitted from the zone to the central nervous system are decisive in the mechanism of interoceptive reflexes.Presented by Active Member of the AMN SSSR V. N. Chernigovskii     

乳腺电阻抗成像非均匀介质电场的初步分析

目的：在验证旋转电极法对乳腺电阻抗断层成像的方法的可行性之后，进一步对非均匀电场分布进行分析．为此后的成像算法修正提供依据，以便能获得更接近实际的阻抗分布图像。方法：基于EIT实验平台，利用NaCI溶液模拟均匀介质，铁棒模拟引入到均匀介质中电导率不同的非均匀介质，研究铁棒在NaCI溶液中不同位置对其电场分布的影响。结果：得到铁棒在NaCl溶液中的轴对称位置上对中间测量电极下的电流值影响及铁棒在NaCl溶液中不同的位置对中间测量电极的电流值影响。结论：在研究电导率不同的铁棒对均匀介质NaCl溶液电场影响的实验中，该实验结果为下一步对成像算法的修正及提高重建的图像的分辨率提供了指导。     

2 rules for the life cycles of cestodes in the ecosystem

Rule I: The more advanced in its primary evolution the life cycle of a cestode is, the greater is the participation of the animal component of the ecosystem in it. The direct influence of the non-living component of the ecosystem on the course of the cycle is one and the same with both the primarily evolved 2-host and 3-host life cycles within the separate orders. Rule II: In the secondarily evolved life cycles of cestodes, when compared with their initial life cycles, the following things are observed: a) either a decrease of both the participation of the animal component of the ecosystem in the life cycle and the direct influence of the non-living component of the ecosystem on the course of the cycle; b) or a decrease only of the participation of the animal component of the ecosystem in the life cycle, without any change in the direct influence of the non-living component of the ecosystem on the course of the cycle; c) or, quite rarely, a decrease only of the direct influence of the non-living component of the ecosystem on the course of the life cycle, without any change in the participation of the animal component of the ecosystem in the life cycle.