Telehealth in the Pacific: Current Status and Analysis Report (1999–2000)

From the summer of 1999 to the spring of 2000, we undertook an on-site investigation of the management and operational status of telehealth in the Pacific. The writers also gathered additional materials upon returning to Japan to provide as detailed a report as possible on the current status and analysis of telemedicine in the Pacific. Following the collapse of the Soviet Union, various regions around the world has sought a gentler alternative to deterrence by arms. The writers of this paper believe one such means is telemedicine. We believe telemedicine services may help offset the emotional stress and sense of inequality experienced by islanders and civilians living around military bases, which the financial benefits of the so-called base-economy alone has never been able to remedy. There are numerous medical support activities currently operating in the Pacific region, and telecommunications is the most effective tool for connecting and unifying such a vast region. We believe that projects for this region must have a clear focus and objective and be able to demonstrate concrete results in order to win subsidies or aid.     

The beneficial effects of qigong (气功) on the ventricular function and microcirculation of deficiency in heart-energy hypertensive patients

Ultrasonic cardiograms were performed on 120 aged subjects. Experiments showed the left ventricular function in the hypertensive aged group (80 cases) was lower than that in the aged normal blood pressure group (40 cases), while the left ventricular function in the deficiency of Heart-energy hypertensive patients (46 cases) was lower than in the non-deficiency of Heart-energy hypertensive patients (34 cases). After practising Qigong for 1 year, cardiac output was increased. The total peripheral resistance decreased and the ejection fraction mitral valve diastolic closing velocity and the mean velocity of circumferential fiber shortening tended to be increased. The results indicate Qigong has a regulatory effect on haemodynamic alteration, as well as on improvement of the left ventricular function. Nailfold microcirculation detection of 120 aged subjects was made. The results showed that hypertension had an accelerating effect on the disturbance of microcirculation. The incidence of disturbance of microcirculation was 73.91% in the deficiency of Heart-energy hypertensive patients, after 1 year of Qigong practice, the incidence of disturbance of microcirculation was 39.13% (P<0.01). The results suggest Qigong has an effect on Heart-energy and regulation of the blood channel.     

Transforming the Lab: Technological and Societal Concerns in the Pursuit of De- and Regeneration in the German Morphological Neurosciences, 1910–1930

This paper focuses on the make-up of different cultures in experimental neurology, neuroanatomy, and clinical psychiatry. These cultures served as important research bases for early regenerative concepts and projects in the area of neurology and psychiatry at the beginning of the 20th century. Nevertheless, the developments in brain research and clinical neurology cannot be regarded to be isolated from broader societal developments, as the discourses on social de- and regeneration, neurasthenia, nerve-weakness and experiences of the brain-injured after WWI show. Societal and cultural developments directly influenced researchers’ conceptualisation, scientific ideas, and even their experimental and clinical orientation. They directly reflect which scientific problems the neuroscientists felt inclined to address and what areas they began to leave aside. Using the concept of socio-technical experiments, it is demonstrated that research methodologies in neuronal de- and regeneration studies were not simply a product of recent advances in the scientific differentiation of somatic neurology or brain-psychiatry. Moreover, they resulted in important interdisciplinary attempts which emerged from great collaborative work including neuroscientists from various areas of investigation in both basic and clinical contexts.     

Perspectivity in Psychiatric Research: The Psychopathology of Schizophrenia in Postwar Germany (1955–1961)

The reorganization of psychiatric knowledge at the turn of the twentieth century derived from Emil Kraepelin’s clinical classification of psychoses. Surprisingly, within just few years, Kraepelin’s simple dichotomy between dementia praecox (schizophrenias) and manic-depressive psychosis (bipolar disorders) succeeded in giving psychiatry a new framework that is still used until the present day. Unexpectedly, Kraepelin’s simple clinical scheme based on the dichotomy replaced the significantly more differentiated nosography that dominated psychiatric research in the last three decades of the nineteenth century (Janzarik in Themen und Tendenzen der deutschsprachigen Psychiatrie. Springer, Berlin, 1974). Moreover, although all the components of the future development were already available shortly after 1868, the real course, which led to Kraepelin’s dichotomy, was unpredictable then. This paper explores the ways in which the unpredictability of psychiatric knowledge and the postulate of a rationality underlying psychopathological phenomena interacted in the debates regarding the classification of psychoses. It examines the “natural antagonism” between the practical aspirations of an increasingly specialized medical nosology and unitary conceptions, which, in a psychopathological countermovement, emphasized that no somatic criteria can be specified for the majority of psychic abnormalities and that all nosological distinctions are not binding (Janzarik 1974, 20). In this context, this paper investigates the revival of unitary theories of psychosis in postwar German psychiatry and seeks to understand why the forms of thinking that dominated nineteenth-century psychiatry have proved to be very lasting. Furthermore, this paper emphasizes the perspectivity underlying psychiatric research on psychoses and explores the ways in which writing the history of the schizophrenia concept involves inevitably writing the history of the entire psychiatry.     

Examining Inequality in the Public Health Workforce Distribution in the Centers for Disease Control and Prevention(CDCs) System in China, 2008–2017

Objective Allocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention. Using the Centers for Disease Control and Prevention(CDCs) system of China as an example, we evaluated inequality in the public health workforce distribution across different regions in China between 2008 and 2017, with the aim of providing information for policymakers to support resource allocation and address growing health inequities.Methods We used three standard public health workforce inequality indices-Gini coefficient, Theil L,and Theil T-and spatial autocorrelation analysis to explore spatial clusters of the workforce in different provinces, visualized with geographical tools.Results The aggregate workforce-to-population ratio decreased from 1.47 to 1.42 per 10,000 population from 2008 to 2017, and was consistently lower than the National Health Commission's(NHC)recommended critical shortage threshold of 1.75. The workforce distribution inequality indices varied by regional socioeconomic and health system development. Geographic clustering of CDCs workforce distribution was evident, with H–H and L–L clusters in western China and the Guangdong-Fujian region,respectively.Conclusions Our study addressed key issues for government and policymakers in allocation of public health human resources. There is an urgent need for careful identification of analytic questions that will help carry out public health functions in the new era, alongside policy implications for an equitable distribution of the public health workforce focusing on the western region and low–low cluster areas.     

Walking on water: The biomechanics of Michael A. MacConaill (1902–1987)

Biomechanics is a subject that draws on knowledge from many disciplines. One of its great practitioners in the last century was the Irish anatomist M.A. MacConaill. In this paper, we review some of MacConaill's fundamental contributions to biomechanics, namely: the hydrodynamic theory of synovial joint lubrication, the kinematics of joint motion and conjunct rotations; and the theory of spurt and shunt muscles. The aim is to revisit these topics in the light of current research, and to draw some conclusions about the import of his research in the context of recent developments in the field. The paper concludes with a discussion of science in Ireland, the development of the field of biomechanics since MacConaill's time, and some other matters.     

Experimental Podophyllotoxin (Bajiaolian) Poisoning:——Ⅱ. Effects on the Liver, Intestine, Kidney, Pancreas and Testis

Young male rats were orally intubated with podophyllotoxin: Group I, control animals, orally fed with vehicle only; Group Ⅱ, fed with an initial dose of 5 mg.kg~(-1) b.w., followed by a daily dose of 1.67 mg.kg~(-1) b.w. for 7d. Group Ⅲ, fed with an initial dose of 15 mg.kg~(-1) b.w., followed by a daily dose of 5 mg.kg~(-1) b.w. for 7d. All animals were sacrificed 72 h after the last dosing. Histopathological examination revealed dose-related fatty change of the liver, atrophy and degenerative changes of the intestinal epithelial linings and testicular seminiferous tubules. Depletion of the pancreatic acinar cell granules was also apparent in the Group Ⅲ animals. No pathology, however, was observed in the kidneys. The present study demonstrated for the first time degenerative changes in the liver, intestine, testis, and pancreas of animals ingested podophyllotoxin. These pathological changes correlate well with the clinical signs/symptoms of abnormal liver function, abdominal pain and diarrhea, and     

The effects of Valsalva maneuver on venipuncture pain in children: comparison to EMLA® (lidocaine–prilocaine cream)

Background

Venipuncture is one of the most painful events for children in hospitals. Valsalva maneuver (VM) decreases the incidence and severity of pain on venipuncture pain in adults. This study was designed to evaluate VM as compared with Eutectic Mixture of Local Anesthetic (EMLA^®) cream for venipuncture pain in children.

Method

In this study, we evaluated the effect of VM on venipuncture pain in children. 60 patients scheduled for elective surgery were randomly divided into three groups. In Group V, children were punctured during VM. In Group E, EMLA^® 5 % cream and in Group C (control group) vaseline was applied on the non-dominant hand 60 min before the venipuncture. Patients made a pain assessment using visual analog score (VAS). Mean arterial pressure (MAP), heart rate (HR), and SpO₂ measurements were obtained during the venous cannulation.

Results

Respectively, the VAS was 2.15 ± 1.95 for Group V and 1.00 ± 0.79 for Group E and 2.55 ± 2.74 for Group C. A significant reduction in the severity of pain was observed in Group E. The difference being statistically significant (p < 0.05), the VAS of Group V was higher than Group E but lower than Group C (p > 0.05).

Conclusions

On the basis of data from this study, the VM is a simple and a practical method to reduce venipuncture pain in children but not as effectively as EMLA^®.     

Brice Clarke (1895–1975) and the control of tuberculosis in Northern Ireland

Among the problems facing Northern Ireland after its foundation in 1920, one of the most daunting was the prevalence of tuberculosis, a chronic communicable disease with highest mortality among young women and men in the prime of life. Over a quarter of a century, legislative changes tardily responded, and in spite of, or because of its magnitude, Brice Clarke (1895–1975) devoted himself to the challenge. After decorated service in the Great War of 1914–19 he returned to finish his medical studies in Queen''s University Belfast and held hospital appointments until he became Chief Tuberculosis Officer for Belfast and soon afterwards Director of Tuberculosis Services in Northern Ireland.For twenty years he was an enthusiastic proponent of collapse therapy, and even before the new chemotherapy hastened the natural decline in the tuberculosis epidemic he trumpeted the value of properly equipped chest clinics and generously funded welfare schemes. His garden at Hillsborough could not contain him in retirement; he set off on a slow boat to Japan in 1962, and returned to pen biographical sketches of famous consumptives until his death in 1975 at the age of 80.

In acute cases consider the disease, in chronic cases consider the patient.Hippocrates.

     

The Role of Ca~(2+) and Cyclic AMP in the Modulation of BenzodiazepineReceptor on Aldosterone Secretion

PK11195, a ligand of peripheral-type benzodiazepine receptor can stimulate thealdosterone secretion of isolated adrenal glomerulosa cell: this effect could be abolished by nifedipinewhich mainly blocks the calcium channel in plasma membrane, but could not be abolished bydantrolene, a selective blocker of mitochondria calcium channel. Even under the condition of themaximum stimulative effects on aldosterone secretion, PK11195 could not change the cyclic AMP(cAMP) content in isolated glomerulosa cells. These results indicated that in the modulatory mecha-nism of benzodiazepine receptor on aldosterone secretion, the intracellular messenger might be theCa~(2+) from extracellular Ca~(2+) pool, but not the Ca~(2+) from mitochondria Ca~(2+) pool or cAMP.     

Study on the efficacy and safety of Xueyou Mixture (血友合剂) in treating hemophilia

Objective:To observe the effect of Xueyou Mixture(血友合剂,XYM) on blood coagulation factors and its safety in treating hemophilia.Methods:To the randomly selected 65 inpatients of hemophilia,XYM was administered accompanied with intravenous dripping of liver cell growth factor 60-100 mg once a day to protect the liver,with no blood products like concentrated Ⅷ and FⅨ factors or blood plasma given.The treatment lasted for 3 weeks.The short-term eff icacy and adverse reactions were observed.The long-term efficacy in patients was observed in a follow-up study of 6-12 months after they were discharged from the hospital but continuously took XYM orally.Results:The short-term markedly effective rate in the patients was 95.38%(62/65).After they were treated for 3 weeks,the level of FⅧ factor activity increased in 56 patients of type A from(3.32±2.21) % to(4.18±2.23) %,and in 9 of type B from(4.92±1.81) % to(5.64±1.96) %.Compared with that before treatment,the difference was signif icant in both of them(P<0.01).No obvious adverse reaction was found in the treatment period.The follow-up study showed that in 22 patients of type A,the FⅧ factor activity ratio increased from(3.25±2.11) % to(6.31±2.16) %,(8.36±1.05) %,and(16.38±2.71) % in the 2nd,3rd and 6th month after discharge respectively,all showing significant difference to that before treatment(P<0.01);and in 4 patients of type B,it increased from(4.15±2.26) % to 7.8% and 11.6%(mean value) in the 2nd and 6th month respectively.Conclusion:XYM could raise the activity of factors Ⅷ and Ⅸ in patients with hemophilia,and the degree of the rise is related with the duration of the therapy,with no obvious adverse reaction,which strikes out a new path and new train of thinking for the treatment of the disease by non-blood preparation.     

The Influence of LHRH, EB and PGF2α on the Development of Ovarian Follicles in Guinea Pigs

Effects of luwinizing hormone releasing hormone ( LHRH), estradiot benzoate (EB), prostaglandin (PGF2α) and the age of animals on the development of ovarian follicles in immature and mature guinea pigs were studied. Administration of 5ng LHRH / hr, 10 times a day, starting from 20-30 days Of age induced the flrst vaginal opening within 4 days, and 5 of the 10 animals had first ovulation. Tire results also show that appropriate doses of EB facilitated the development of ovary. The granulosa cells of guinea pigs at different ages were cocuttured with the pituitart, glands of mature ones in vitro. Results indicate that the responsiveness of granulosa cells of 20-day-guinea prgs to gonadotropins was similar to that of the matured ones. Effects of gonadotrophin on ovulation in hysterectomized and PGF2α or saline-treated animals were tested. Results demonstrate that when PGF2α was given simultaneously with hCG or FSH, 80% of the guinea pigs ovulawd and had fresh, healthy looking corpus tuteum. It is concluded that increased LHRH release from hypothatamus may be the key factor for tire onset of puberty in guinea prgs. EB and PGF2α can influence the development of the ovary.     

Comparative Study on the Effects of Two Contraceptive Injections (Mesigyna, Cyclofem) on Blood Coagulation and Fibrinolysis

Mesigyna and Cyclofem are two monthly injections,which consistof two differ-entprogestationalhormones ( NET-EN,DMPA) with differentestrogens respective-ly.World Health Organization( WHO) has carried out researches on these two in-jectable contraceptives for more than2 0 years.Through pharmacodynamics,phar-macokinetics and large scale of clinical researches[1～ 3 ] ,it has been proved thatthesetwo monthly injectable contraceptives had notonly reliable effects butalso compara-tively low si…     

Robert Whyttt (1714–1766): from dropsy in the brain to tuberculous meningitis

Robert Whytt was born and educated in Edinburgh and served the City in the Royal Infirmary. A prolific author, his major work is usually said to be his Essay on the Vital and other Involuntary Movements of Animals (1751), based on his belief that a ‘sentient principle’ was not limited to the nervous system but was distributed throughout the body, a view that brought him into conflict with Albrecht von Haller, who held that the sentient and motor powers of the body were those of a machine. Whatever about the speculative nature of the sentient principle, Whytt was a clinician blessed with unusual clarity, and he is remembered today for his Observations on the Dropsy in the Brain (1768). Therein he described the clinical signs and symptoms of what later came to be recognised as tuberculous meningitis, the acute disease which appears early in the haemic spread of the infection in a child, and which was fatal until the discovery of chemotherapy and antimicrobials. John Cheyne, in describing two terminal cases, recognised the connexion between hydrocephalus and scrophula, and Dorothy Price provided a precise guide to the clinical picture in 1942. When streptomycin became available Christopher McSweeney used it to alter the bleak picture in Dublin, and was helped by the prevention resulting from neonatal BCG immunisation. Later antimicrobials have facilitated the avoidance of emergent bacillary resistance.