EXPERIMENTAL SYPHILIS IN THE RABBIT : IV. CUTANEOUS SYPHILIS. PART 2. CLINICAL ASPECTS OF CUTANEOUS SYPHILIS.

From the study of a large number of rabbits with generalized cutaneous syphilis following local inoculation with Treponema pallidum, lesions were found most often about the hind feet and legs, the head, the front feet and legs, and the tail. There was further evidence of a selective distribution of cutaneous lesions in the fact that, on a given part of the body, the lesions were usually confined to a few restricted areas. About the head, they occurred almost exclusively on the sides and bridge of the nose, the lids, the brows, the lips, and the base and free portions of the ears. On the front feet and legs, the seat of predilection was the extensor and lateral surfaces of the fore arm, the carpus, and the feet, while on the posterior extremities they were situated upon the dorsum and lateral surfaces of the feet and ankles from the level of the tendo achillis to the base of the fifth toe. The positions of greatest frequency were the region of the tarsus and external malleolus, the base of the fifth metatarsal, the lateral and posterior surfaces of the heel and tendo achillis, and the base of the fifth toe. In many instances, the positions of predilection were exposed positions or areas of skin covering bony or tendinous prominences. It was also found that the character of the lesions differed somewhat in the various locations. The lesions of the head were mostly small circumscribed papules or processes of diffuse infiltration; on the fore arms and feet, affections of this type were about equally divided with larger granulomatous masses of a chancre-like character, while on the hind feet and legs, granulomatous lesions were far more numerous than those of any other type and frequently reached a very large size. The cutaneous eruption usually consisted of only a few lesions confined to some one part of the body, but occasionally they were more numerous and more widely distributed. In this connection, it was noted that when multiple lesions appeared in a given area at about the same time, the growth of most of them was abortive, and, as a rule, only one or two developed to any considerable size. Especial emphasis was placed upon this phenomenon of inhibition as a factor of fundamental importance in the experimental infection. From clinical observation, it was found that, as a rule, the first cutaneous eruption occurred at from 2 to 4 months after inoculation but might occur either earlier or later, depending upon the circumstances in the individual case. The earliest eruptions appeared 3 weeks after inoculation and the latest 2 years and 8 months, but, as a rule, the time between inoculation and the appearance of the first eruption did not exceed 4 to 6 months. Successive crops of cutaneous lesions appeared in a number of animals usually within the first 6 months after inoculation. In a few instances, however, there were repeated eruptions extending over a period of 2 years or more, the longest recorded period being 3 years and 7 months. The duration of individual lesions was found to be extremely variable, ranging from a few days in the case of a macular erythema to more than 2 years in the case of a few granulomatous lesions. The average duration of the lesions appeared to vary somewhat with the nature of the lesion but on the whole was not more than 2 to 4 months. No limits could be fixed, however, for the duration of an active skin infection as a whole. Again, it was found that the cutaneous infection tended to pursue a periodic or relapsing course. This was seen in the mode of growth and resolution of individual lesions, the occurrence of successive periods of eruption, and the recurrence of completely healed lesions, all of which was interpreted as evidence of the essential relapsing nature of syphilitic infections.     

The antileishmanial agent licochalcone A interferes with the function of parasite mitochondria.

Our previous studies have shown that licochalcone A, an oxygenated chalcone, has antileishmanial (M. Chen, S.B. Christensen, J. Blom, E. Lemmich, L. Nadelmann, K. Fich, T.G. Theander, and A. Kharazmi, Antimicrob, Agents Chemother. 37:2550-2556, 1993; M. Chen, S.B. Christensen, T.G. Theander, and A. Khrazmi, Antimicrob. Agents Chemother. 38:1339-1344, 1994) and antimalarial (M. Chen, T.G. Theander, S.B. Christensen, L. Hviid, L. Zhai, and A. Kaharazmi, Antimicrob. Agents Chemother. 38:1470-1475, 1994) activities. We have observed that licochalcone A alters the ultrastructure of the mitochondria of Leishmania promastigotes (Chen et al., Antimicrob. Agents Chemother. 37:2550-2556, 1993). The present study was designed to examine this observation further and investigate the mechanism of action of antileishmanial activity of licochalcone A. Electron microscopic studies showed that licochalcone A altered the ultrastructure of Leishmania major promastigote and amastigote mitochondria in a concentration-dependent manner without damaging the organelles of macrophages or the phagocytic function of these cells. Studies on the function of the parasite mitochondria showed that licochalcone A inhibited the respiration of the parasite by the parasites. Moreover, licochalcone A inhibited the activity of the parasite mitochondrial dehydrogenase. The inhibition of the activity of the parasite mitochondrial enzyme correlated well with the changes in the ultrastructure of the mitochondria shown by electron microscopy. These findings demonstrate that licochalcone A alters the ultrastructure and function of the mitochondria of Leishmania parasites.     

Spinal cord injury: preventing secondary injury.

Spinal cord injury is devastating to the victim, as well as being costly in terms of medical expenses, lost wages, and lost independence. The initial damage to the spinal cord results from several mechanisms of injury--flexion, extension, compression, penetration, rotation, and the disease process. When the spinal cord is injured and there is necrosis of the nervous tissue, no regeneration of that tissue occurs. Unlike in the peripheral nervous system, where regeneration is possible, the spinal cord is part of the central nervous system, as is the brain. The spinal cord extends from the base of the skull to the L1 vertebrae: the cervical levels innervate the diaphragm and muscles of the arms; the thoracic levels innervate the muscles of the chest and abdomen; and the lumbar and sacral levels innervate the muscles of the legs. In addition, the sacral levels are responsible for bowel, bladder, and sexual function. The higher the level of injury, the more severe the loss of function because, not only is the level of injury affected, but also the levels below. Injury occurs by initial trauma to the surrounding ligaments, bones, and muscles, which then affect the spinal cord. There may be total loss of function with damage completely across the cord or partial loss of function with damage affecting only part of the cord. No current treatment can reverse this initial injury, which causes irreversible damage within minutes of injury. Secondary damage occurs as the injury spreads over several hours. Treatment can help prevent this secondary damage.     

Hand behaviors of women during childbirth

An exploratory study was conducted to determine what could be inferred from the hand behaviors of women during childbirth. The specific study questions were: What are the hand actions? What are the objects of the hand actions? What are the purposes of the hand actions? The influence of the uterine state, i.e., contraction or relaxation, on the hand behaviors was also explored. A preliminary study was conducted from which three components of hand behaviors were identified: the hand action, the object of the action, and the purpose of the action. Nine discrete hand actions were defined according to the inter-relationship of the posture, characteristic motion, and the mode of contact of the hand upon the object: grasping, pressing, rubbing, non-moving, gesticulating, holding, playing, palpating, and striking. The objects of the hand actions were grouped into three distinct groups including: the self, inanimate items, and other persons. Eleven purposes of the hand action were inductively defined from the preliminary study: attacking, augmenting, bracing, caretaking, comforting, containing, inactivating, informing, orienting, regulating, and requesting. A data collection instrument, in grid form, to accommodate the rapid recording of the nine types of hand action, the three objects of the actions, and the eleven purposes of the actions, was constructed. The study was conducted in the labor and delivery unit of an urban university-related teaching and research hospital. The specific setting for the study included two sites: the single bed labor room, the primary site; and the delivery room, the secondary site. Thirty women, 10 primigravida and 20 multigravida, ranging from 17 to 34 years of age were the subjects of the study. Of the 30 subjects, 23 experienced a normal onset of labor and 7 had labor induced. The duration of labor ranged from 1 1/2 to 16 1/2 hours with the mean duration 8 3/4 hours. Direct observation was the method for data collection. Observations were conducted once every half hour throughout the subjects' labor experience. During each observation session, the hand behaviors were recorded during one uterine contraction and during 60 seconds of uterine relaxation. The data were tabulated by frequency and by percentage in relation to the hand action, the object of the hand action, the purpose of the hand action, and the uterine state. Findings related to the hand actions demonstrated a predominance of grasping (28%; 765/2,724) and pressing (25%; 670/2,724) actions. Rubbing actions (16%; 421/2,724) and non-moving actions (11%; 313/2,724) were the next most frequently observed actions.(ABSTRACT TRUNCATED AT 400 WORDS)     

精神分裂症患者治疗前后阴、阳性症状与血气分析的相关研究

目的 探讨精神分裂症患者治疗前后阴、阳症状与血气分析结果的变化及其相关性.方法 选择2010 年3 月至2011 年1 月在广州市精神病医院住院的精神分裂症患者41 例,治疗前、后评定"阳性和阴性综合征量表"(PANSS),并抽取股动脉血进行血气分析检测.采用配对t 检验比较治疗前后各量表评分和血气分析结果的差异,并对PANSS 量表得分的影响因素进行相关和多元线性回归分析.结果 经过治疗后,除各量表评分显著降低外(治疗前的P 分、N 分、G 分、PANSS 总分为22.512 ±4.728、21.000 ±7.533、37.902 ±6.640、81.415 ±13.025;治疗后的P 分、N 分、G 分、PANSS总分为8.439 ±2.608、12.610 ±5.468、21.561 ±4.405、42.610 ±9.884;P ＜0.001),PCO2 、HCO-3 、BE、BB、K+、标准pH 值是升高的(治疗前的PCO2 、HCO-3 、BE、BB、K+、pHst 为40.622 ±5.678、24.910 ±2.841、0.283 ±2.078、48.263 ±2.080、3.659 ±0.269、7.409 ±0.031;治疗后的PCO2 、HCO-3 、BE、BB、K+、pHst 为43.995 ±3.702、26.456 ±1.982、1.100 ±1.996、49.244 ±1.637、3.968 ±0.301、7.425 ±0.023;P ＜0.01),pH 值是降低的(治疗前pH 为7.407 ±0.028,治疗后pH 为7.397 ±0.018;P ＜0.05),均具有统计学意义.治疗前P 分的影响因素为标准离子钙(β＝0.414;P ＜0.01),治疗前G 分的影响因素为氧分压和标准离子钙(β1 ＝0.384,β2 ＝0.376,P 均＜0.05),治疗前PANSS 总分的影响因素为氧气总浓度和标准离子钙(β1 ＝6.624,β2 ＝0.369,P 均＜0.05);治疗后N 分的影响因素为治疗前的标准离子钙和治疗后K+浓度(β1 ＝-0.433,β2 ＝-0.437,P 均＜0.01);P 分减分值的影响因素为治疗前的标准离子钙(β＝0.388,P ＜0.05),N 分减分值的影响因素为治疗后的离子钙和有效氧饱和度(β1 ＝0.412,β2 ＝-0.331,P 均＜0.05),G 分减分值的影响因素为治疗前的标准离子钙和治疗后Na+浓度(β1 ＝0.337,β2 ＝0.357,P 均＜0.05),PANSS 总分减分值的影响因素为治疗前的标准离子钙(β＝0.374,P ＜0.05).结论 精神分裂症治疗后代谢效应偏碱,呼吸效应偏酸,总体pH 值降低;标准离子钙浓度与精神分裂症的症状及治疗预后均紧密相关.     

同种异体原位心脏移植术后患者的心理特征分析及护理对策

目的：分析行同种异体原位心脏移植术治疗的患者术后心理特征及护理对策,评价实施针对性护理措施的效果。方法选择初次在本院进行同种异体原位心脏移植术的34例患者为研究组,另选择在本院门诊检查的84例健康人群为对照组,采用 SAS 量表、SDS 量表、SCL-90量表和社会支持量表评估患者的心理状态,研究组与对照组比较分析患者的心理特征,研究组护理干预前后比较评价针对性护理的效果。结果研究组患者 SAS 总标准分、SDS 标准分和 SCL-90总均分显著高于对照组,社会支持量表评分显著低于对照组,组间比较差异有统计学意义(t=14.796、4.531、9.522和-10.914,P<0.01);研究组护理干预后 SAS 总标准分、SDS 标准分和 SCL-90总均分显著降低,社会支持总体评分显著提高,护理干预前后比较差异有统计学意义(t =14.352、15.727、12.945、5.143,P<0.01)。结论同种异体原位心脏移植术治疗的终末期心脏病患者术后普遍存在躯体化、抑郁、焦虑、敌对、恐怖等不良心理状态,采取对症护理干预措施可显著改善患者的心理状态。     

纯钛种植体表面改性对骨结合的影响

背景：研究表明,对种植体表面进行化学、物理、生物化学等改性,可以显著提高种植体表面的生物学活性和骨结合强度。目的：综述并比较不同纯钛表面改性方法对骨结合的影响。方法：以“纯钛、种植体、种植、种植体表面、表面改性、生物活性、生物相容性、骨结合、研究进展”为中文关键词,以“pure titanium,implants,plant,the surface of the implant,surface modification,biological activity,biocompatibility,osseointegration,research progress”为英文关键词,用计算机检索CNKI数据库、万方数据库和PubMed数据库。结果与结论：钛具有稳定的化学性能、良好的生物相容性及较高的抗断裂强度,因而在种植修复中被广泛应用,但钛种植体是一种生物惰性材料,直接植入人体后的生物相容性和生物学活性较差,影响其与骨的结合。为提高种植体骨结合强度,目前最为有效的方法是对纯钛表面进行改性。大多数研究表明,经过改性后的种植体具有一定的骨诱导作用,可促使骨细胞在其表面黏附、增殖、分化及矿化。钛种植体经过物理、化学、生物化学等改性处理后,其表面形貌、化学成分、表面粗糙度及亲水性能等发生改变,从而提高了种植体的生物相容性和生物活性,促进了骨结合的发生。     

THE CHEMISTRY OF THE LIVER IN ACUTE YELLOW ATROPHY

From the liver of a young man who died of typical, " idiopathic" acute yellow atrophy of the liver, after an illness of six weeks, there were isolated and identified the following amino acids: Histidin, lysin, tyrosin, leucin, glycocoll, alanin, prolin, glutaminic acid, aspartic acid. These were found free in extracts of the liver, and presumably represent products of the autolysis of liver cells, although the amount of soluble non-protein nitrogen present in the extracts was so large as to suggest that there must be some other source for these substances. Small quantities of free proteoses and peptones, and of xanthin and hypoxanthin, were also found in the extracts. In the insoluble proteins of the liver the proportion of diamino acids was decreased slightly as compared with normal livers. The proportion of protein phosphorus was increased, probably because of active regenerative proliferation, while the sulphur was normal in amount. Iron was increased because of the large quantity of blood in the liver and the hematogenous pigmentation of the liver cells. Gelatigenous material was increased both absolutely and relatively, because of the loss of parenchyma and the proliferation of the stroma. The proportion of water to solids was much increased, there having been a loss of over two-thirds of the entire parenchymatous elements of the liver. The amount of fat, lecithin and cholesterin was not far from that normal for the liver.     

UROBILIN PHYSIOLOGY AND PATHOLOGY : V. THE RELATION BETWEEN UROBILIN AND CONDITIONS INVOLVING INCREASED RED CELL DESTRUCTION.

Further evidence is presented, in addition to that of our previous papers, that the intestinal tract is, under ordinary circumstances, the sole place of origin of urobilin. So long as the biliary tract remains sterile the presence of the pigment in bile and urine is entirely dependent upon the passage of bile to the intestine. Animals rendered urobilin-free by the collection of all the bile from the intubated, uninfected common duct, remain urobilin-free during and after extensive blood destruction caused by intravenous injections of distilled water, as also after reinjections of the animal''s own blood, hemolyzed in vitro. No urobilin appears in the bile, urine, or feces of animals so intubated when blood destruction has been caused by sodium oleate, or by an agent, toluylenediamine, which damages the liver as well as the blood. On the other hand, when bile flow into the intestine is uninterrupted, urobilinuria occurs during blood destruction caused in any of the ways mentioned and it parallels, both in severity and duration, the destructive process. Merely increasing the amount of bilirubin within the intestines of healthy dogs by feeding urobilin-free bile, will lead to marked urobilinuria. The extravasation of blood into the tissues, resulting from the trauma of an operation for intubation of a bile duct, does not lead to urobilinuria in animals losing all of the bile after this operation, but may do so when only a small fraction of the bile is drained, while the remainder reaches the intestine as usual. The production of artificial hematomas, without operation, is not followed by urobilinuria, under the circumstances last mentioned, but merely by an increase in the bilirubin of the bile. The effect on the liver of the anesthetic employed during the intubation may be responsible for the difference in the two cases. During the course of certain intercurrent infections affecting some of the intubated animals, notably distemper, there was a drop in the hemoglobin percentage of the circulating blood, accompanied by an increased output of bile pigment or further by urobilinuria, when the conditions were such that bile still reached the intestine. The findings pointed to increased blood destruction as a factor in the urobilinuria. The evidence presented, taken with that of our previous papers, suffices to demonstrate, that urobilinuria, occurring during blood destruction, is primarily the result of an increased excretion of bilirubin from which, in turn, an unusually large quantity of urobilin is formed within the intestine. The liver fails to remove from the portal blood all of the latter pigment which is resorbed and consequently some of it reaches the kidneys and urine. Our work has been carried out on animals with uninfected biliary tracts and livers, save for one case which has special mention. The influence of infection of the biliary tract on the place of formation of urobilin and the development of urobilinuria will be discussed in a succeeding communication.     

Comparison of the postantibiotic and postantibiotic sub-MIC effects of levofloxacin and ciprofloxacin on Staphylococcus aureus and Streptococcus pneumoniae.

The postantibiotic subminimum inhibitory concentration effect (PA SME) may simulate in vivo drug exposure more accurately than the postantibiotic effect (PAE) since subinhibitory concentrations of drug persist between antibiotic dosings. In this study, we compared the PAEs and PA SMEs of levofloxacin and ciprofloxacin for clinical isolates of fluoroquinolone-susceptible Staphylococcus aureus and Streptococcus pneumoniae. At two times the MIC, PAEs of levofloxacin were an average of 0.6 h longer than the PAEs obtained for ciprofloxacin for methicillin-susceptible and methicillin-resistant S. aureus strains. The PAEs of levofloxacin and ciprofloxacin ranged from 1.8 to 3.1 and 1.1 to 2.4 h, respectively. Continued exposure of the methicillin-resistant strain to 1/16, 1/8, and 1/4 the MIC resulted in PA SMEs of 6.5, 15.3, and >22.3 h, respectively, for levofloxacin and 3.8, 8.0, and 12.3 h, respectively, for ciprofloxacin. For isolates of S. pneumoniae, at two times the MIC of both fluoroquinolones, the average PAEs of levofloxacin and ciprofloxacin were equivalent: 1.3 h for the penicillin-susceptible isolate and 0.6 h for the penicillin-resistant isolate. Continued exposure of the penicillin-susceptible S. pneumoniae strain to 1/16, 1/8, and 1/4 the MIC resulted in average PA SMEs of 1.0, 1.4, and 2.8 h, respectively, for levofloxacin and 1.8, 2.0, and 2.5 h, respectively, for ciprofloxacin. Continued exposure of penicillin-resistant S. pneumoniae to 1/16, 1/8, and 1/4 the MIC of the same fluoroquinolones resulted in average PA SMEs of 0.6, 1.1, and 2.9 h, respectively, for levofloxacin and 0.6, 1.1, and 1.5 h, respectively, for ciprofloxacin. The PA SMEs observed demonstrate the superior activity of levofloxacin against methicillin-susceptible or methicillin-resistant S. aureus. Although PAEs were similar for the penicillin-susceptible and penicillin-resistant S. pneumoniae strains, the PA SME of levofloxacin at one-fourth the MIC was longer for penicillin-resistant S. pneumoniae.     

Evaluation of intervention research in weight reduction in post menopausal women

To describe the evidence that has accrued for interventions targeting weight loss in postmenopausal women, and to assess the strengths and limitations of weight loss interventions in postmenopausal women using the framework of evaluation theory, including definition of the problem and the use of theoretical framework and mediators. Electronic databases were used, including CINAHL, EBSCO Host, Google scholar, Medline, and the Science Citation Index, Expanded, in the Web of Science from 1995 to December 2009. Keyword searches included the terms obesity, obese, overweight, menopause, and weight management interventions. Searches were combined to find reports addressing 1 or more keywords. Experimental design studies that examined physical activity or dietary intervention effects on weight loss or body composition changes in postmenopausal women were selected for review. Reports of 15 intervention studies met inclusion criteria from the list of 120 generated through the database searches. Each article was evaluated for 1) effects produced as a result of the intervention, 2) the characteristics of the problem of postmenopausal obesity, 3) specification of theoretical constructs and critical inputs that guide the design of an intervention, and 4) link of the theoretical predictors and the outcome measures selected. Four types of interventions were tested in the 15 research reports. Only 5 of the 15 used theories or models to guide the interventions. All of the interventions resulted in some positive weight management outcome, such as lowered body mass index, fat mass, waist circumference, systolic blood pressure, glucose, and cholesterol. Overall, the reviewed research showed efficacy of varying intensities of exercise when combined with hypocaloric diet or meal replacement therapy in producing low body weight, low fat, improved insulin sensitivity, glycemic control, and cardio-respiratory fitness. The external validity of the 15 studies was limited in reporting of a clear delineation of the problem, theoretical frameworks, and application of the findings.     

ICU患儿医院感染的目标性研究

目的:研究ICU患儿医院感染病例,分析其可能的危险因素,以便有针对性的采取防控措施。方法:以2009年9月～2010年6月入住ICU的101例医院感染患儿为研究对象,分别对性别、体重≤2500g、基础疾病≥3个、激素的使用等18个自变量进行比较。结果:住ICU天数>7d、抗菌药使用种类>2种、抗菌药使用时间>7d、机械通气(侵袭性诊疗)、激素的使用、基础疾病≥3个、新生儿肺炎、新生儿呼吸窘迫综合征、性别、早产儿、低体重儿这11个因素是医院感染的可能危险因素。结论:合理使用抗菌药、尽量缩短入住ICU的时间、减少侵袭性操作将有利于预防和控制ICU医院感染。     

EXPERIMENTAL ACUTE NEPHRITIS: THE VASCULAR REACTIONS AND THE ELIMINATION OF NITROGEN

By combining physiological and anatomical methods in the study of experimental nephritis it is possible to distinguish types of nephritis in which either tubular or vascular changes predominate, and are essentially characteristic of the lesion produced, but it is not possible to say that a given poison produces exclusively tubular or exclusively vascular lesions. The so-called epithelial poisons (potassium chromate, uranium nitrate and corrosive sublimate) present anatomical evidence of extensive tubular injury, and in the early stages show, on physiological study, no evidence of vascular injury other than exaggerated contraction and dilatation of the vessels and increased diuresis. On the other hand, the vascular poisons, arsenic and cantharidin, which produce but little injury to the tubules, tend to cause anuria and are characterized by minimal contraction and dilatation of the vessels and little or no flow of urine. From the physiological point of view these two types may be, for practical purposes, considered as examples of tubular and vascular nephritis. They are not, however, pure types; for the increased diuresis of the early tubular type is in itself evidence of vessel irritability and similar to the increased irritability caused by small doses of vascular poisons, and on the other hand, this essentially vascular lesion is accompanied by slight morphological changes in the tubular epithelium. Furthermore, the tubular lesions of chromium and uranium and corrosive sublimate pass into a stage closely resembling the vascular type, if not identical with it. Two forms of late tubular nephritis may be recognized. One of these, the anuric form, is accompanied by severe gastro-intestinal disturbance and evidence of approaching anuria; physiological tests show diminished power of dilatation of the vessels and corresponding inhibition of diuresis. The second form, the polyuric, is characterized by a condition of polyuria up to the moment of anesthesia; physiological tests show that the power of dilatation is retained, but little or no diuresis occurs. Whether the vascular incompetency of the anuric form of late tubular lesions is a natural consequence of the vessel irritability seen in the early stages or is the result of the elimination of secondary poisons through the glomeruli cannot be absolutely determined. The peculiar impermeability of the glomerulus following anesthetization in the polyuric form, which is essentially a stage of recovery, we hope to explain by investigations now in progress. Studies of the elimination of nitrogen show that in tubular nephritis, as represented by uranium nephritis, the output of nitrogen is considerably diminished. This apparently occurs also in chromate nephritis but is not clearly demonstrated. In both forms the onset of gastro-intestinal disturbances appears to bear a definite relation to the retention of nitrogen. On the other hand, as the nitrogen of the feces is not appreciably altered, these disturbances cannot be explained by the elimination through the intestine of toxic bodies of nitrogenous nature. The nitrogen elimination in the urine in vascular nephritis as represented by arsenic nephritis is not only not diminished but is greatly increased as the result of the increased metabolism caused by arsenic. If at the height of this increased elimination, uranium nitrate is administered, the nitrogen output is markedly diminished. These observations demonstrate that not only are the tubular lesions in arsenic nephritis of little moment, but also that serious injury of the epithelium, as that due to uranium, may cause a temporary nitrogen retention. A consideration of all the facts here presented allows us to conclude that although it is not possible to demonstrate that an experimental nephritis may be purely tubular or purely vascular, which is in accord with our clinical and pathological studies of human material, it is possible, if we combine the results of anatomical, physiological and chemical study, to recognize lesions which are predominantly tubular or vascular, or which change rather sharply from one to the other type, and are, therefore, of great value in the study of the problems of nephritis.     

STUDIES ON UROBILIN PHYSIOLOGY AND PATHOLOGY : IV. UROBILIN AND THE DAMAGED LIVER.

A variety of evidence is presented, all of which supports the view that in the uninfected animal the intestinal tract is the only place of origin of urobilin, not merely under normal circumstances, but when there is biliary obstruction. Animals rendered urobilin-free by collection of all of the bile from the intubated common duct remain urobilin-free even after severe hepatic injury. In our experiments urobilinuria was never found after liver damage except when bile pigment was present in the intestine. Thus, for example, it appeared during the first days after Ugation of the common duct, but disappeared as the stools became acholic. When this had happened a small amount of urobilin-free bile, given by mouth, precipitated a prompt urobilinuria. After obstruction of the duct from one-third of the liver, mild urobilinuria was found, but no bilirubinuria. In animals intubated for the collection of a part of the bile only, while the rest flowed to the duodenum through the ordinary channels, liver injury caused urobilinuria, unless indeed it was so severe as to lead to bile suppression, when almost at once the urobilinuria ceased, though the organism became jaundiced. The evidence here presented, when taken with that of our previous papers, clearly proves that urobilinuria is an expression of the inability of the liver cells to remove from circulation the urobilin brought by the portal stream, with result that the pigment passes on to kidney and urine. Urobilinuria occurs with a far less degree of liver injury than does bilirubinuria. Our work has, for the most part, been carried out with animals having uninfected livers and bile passages. But the influence of cholangitis with infection has been briefly discussed in the light of some preliminary observations. The influence of infection on the place of formation of urobilin and on the occurrence of urobilinuria will form the subject of another communication.     

Discovery of the causative organism of Weil's disease: historical view

On January 20, 1915, Inada and Ido announced the discovery of the causative agent of Weil's disease. Subsequently, on February 13, 1915, they published the first paper on the discovery of the causative organism (a new species of Spirochaeta) of Weil's disease. Besides discovering the causative organsim of the disease, Inada and colleagues clarified the pure culture in medium, and determined the source and route of the infection, its pathology and morbid anatomy; the distribution of the organism in various organs and tissues; the excretion of the spirochete, and its division, filterability, and morphological characteristics; and the clinical picture, laboratory findings, diagnosis, prophylaxis, and treatment of the disease. These studies were conducted by Inada, Ido, Kaneko, Hoki, and Ito, in the years 1914 to 1915. In the early investigation of leptospirosis, Inada and colleagues played a prominent part. We would like to remember these remarkably complete and definitive original achievements on leptospirosis made by Inada and colleagues. Received: August 21, 2000 / Accepted: December 12, 2000     

临床护理人力资源配置研究

目的 通过对部分军队医院护理人力资源现况的调研，依据卫生资源配置的有关理论，通过专家调查、护理人力资源利用效率情况分析及护理项目的分级研究，提出医院护理人力资源微观配置结构比例标准。方法 采用整群抽样的方法调查部分军队医院护理人员利用情况，进行了描述性分析研究。结果 不同等级的医院、不同的科室工作量和工作效率并不完全相同，忙闲不均，各级护理人员在多数操作项目中没有层次差别，因而人力资源的能级浪费与不适宜服务并存。结论 对护理项目进行分级研究，从而配置护理人员内部结构，将护理人员按照完成的护理项目合理组合，形成最佳的能力结构和职称结构，真正实现以病人为中心的整体护理。     

Facial anatomy of the fetus

Real-time ultrasonography was used in this study to demonstrate details of the anatomy of the face and neck of the fetus. Details such as the ocular globe, vitreous body, lens, anterior chamber, rectus muscles, optic nerve and disc, and the ophthalmic artery are visible at the level of the eye. The helix, scaphoid fossa, triangular fossa, concha, antihelix, antitragus, intertragic incisure, and lobule can be seen at the level of the ear. The tip of the nose, the alae nasi, and the columna are also seen. The epiglottis is visible in the vestibulum of the larynx. The fetal face is an important structure that can provide invaluable information in the search for congenital malformations, and possibly also in fetal behavior.     

Visual clues to emotional states: Rodin's "Burghers of Calais"

In the well-known, recorded Gsell-Rodin conversations of 1911, Gsell summarized Rodin's theory of the expressiveness of the human image: "Generally the face alone is considered to be the mirror of the soul: the mobility of the features of the face seems to us the unique exteriorization of the spiritual life. In reality, there is not one muscle of the body that does not express variations within. Each speaks of joy or sadness, enthusiasm or despair, calm or rage. Out-stretched arms, an unrestrained torso can smile with as much sweetness as eyes or lips. But in order to be able to interpret all aspects of the flesh, one must be trained patiently in the spelling and reading of the pages of this beautiful book" (Art: Conversations With Paul Gsell. Translated by deCaso J, Sanders PB. Berkeley, CA, University of California Press, 1984, p 10). The question thus arises, how can we as students of the human condition undertake this necessary training? How might we develop the aesthetic senses to appreciate the legibility of the human face and form more fully? For assistance in this undertaking we naturally turn to the artist. For the artist "sees" the world through eyes trained to acutely appreciate color, light and shadow, surface and volume, and inner truth. In particular, the education and training of Rodin, and the development of his artistic technique and insight, offer the health care professional rich intellectual material for this study. A closer look at the conception and evolution of Rodin's masterpiece, "The Burghers of Calais," amply illustrates this vision.     

正确掌握老年病人的合理用药

老年人随着年龄的不断增长，各器官功能的逐渐减退，对药物的吸收、分布、代谢、排泄及其作用与青年人相比都有很大差异，又由于体弱多病，用药种类较多，药物的不良反应也随之增加。老年病人用药必须严格遵照药物的体内过程及药物代谢动力学理论，结合患者的生理、病理条件，合理使用药物，以取得最佳的疗效。正确掌握合理有效的用药，要结合老年人年高、体弱、多病的特点，选择最佳剂量、时间，合理的配伍和用药方法。既要考虑药物有效性、合理性和安全性，又要权衡药物疗效、配伍禁忌。临床医师必需要以对病人健康极端负责的精神，精通业务，通晓药理及有关知识，慎重、准确地使用药物，尽量避免药物不良反应的产生。确保老年病人的用药安全和疗效。     

Lower urinary tract symptoms in women and quality of life

Lower urinary tract symptoms (LUTSs) are the most common symptoms in women at all age groups worldwide, and their prevalence is increasing with age. LUTSs have a multifactorial status. The risk factors are age, race, pregnancy, birth, menopause, hysterectomy, obesity, chronic cough, depression, profession and family history. LUTSs have negative effects on women's quality of life, especially on the medical, physical, social, psychological, economical and sexual aspects. Studies report a relationship between the sexual dysfunction and urogynaecological diseases. Although the pathophysiology of high prevalence of sexual dysfunction in women with LUTS is not well known, it is estimated that the LUTS and sexual dysfunction occur due to the effects of low oestrogen levels on vagina, urethra, trigone epithelium and the atrophy of pelvic floor muscles. Especially women, who experience urinary incontinence (UI) and subgroup problems, report more common sexual dysfunctions (hypoactive sexual desire disorder, very urgent need for urination during the sexual intercourse and leakage, lack of sexual arousal, orgasm problems, sexual pain disorders). Despite the high prevalence of LUTS and its negative effects on the quality of life, the help-seeking behaviours of women for overcoming LUTS differ according to the level of disturbance. Nurses should cooperate with other health care personnel in LUTS prevention, diagnosis, treatment/follow-up, in the diagnosis of sexual dysfunction due to LUTS and its management. This article discusses the prevalence of LUTS, the risk factors of LUTS, the quality of life of women with LUTS, the negative effects of LUTS on sexual life and its nursing care.