Prevention of stroke in urban China: a community-based intervention trial

BACKGROUND AND PURPOSE: Stroke has been the second leading cause of death in large cities in China since the 1980s. Meanwhile, the prevalences of hypertension and smoking have steadily increased over the last 2 decades. Therefore, a community-based intervention trial was initiated in 7 Chinese cities in 1987. The overall goal of the study was to evaluate the effectiveness of an intervention aimed at reducing multiple risk factors for stroke. The primary study objective was to reduce the incidence of stroke by 25% over 3.5 years of intervention. METHODS: In May 1987 in each of 7 the cities, 2 geographically separated communities with a registered population of about 10 000 each were selected as either intervention or control communities. In each community, a cohort containing about 2700 subjects (>/=35 years old) free of stroke was sampled, and a survey was administered to obtain baseline data and screen the eligible subjects for intervention. In each city, a program of treatment for hypertension, heart disease, and diabetes was instituted in the intervention cohort (n approximately 2700) and health education was provided to the full intervention community (n approximately 10 000). A follow-up survey was conducted in 1990. Comparisons of intervention and control cohorts in each city were pooled to yield a single summary. RESULTS: A total of 18 786 subjects were recruited to the intervention cohort and 18 876 to the control cohort from 7 cities. After 3.5 years, 174 new stroke cases had occurred in the intervention cohort and 253 in the control cohort. The 3.5-year cumulative incidence of total stroke was significantly lower in the intervention cohort than the control cohort (0.93% versus 1.34%; RR=0.69; 95% CI, 0.57 to 0.84). The incidence rates of nonfatal and fatal stroke, as well as ischemic and hemorrhagic stroke, were significantly lower in the intervention cohort than the control cohort. The prevalence of hypertension increased by 4.3% in the intervention cohort and by 7.8% in the control cohort. The average systolic and diastolic blood pressures increased more in the control cohort than in the intervention cohort. Among hypertensive individuals in the intervention cohort, awareness of hypertension increased by 6.7% and the percentage of hypertensives who regularly took antihypertensive medication increased 13.2%. All of these indices became worse in the control cohort. The prevalence of heart diseases and diabetes increased significantly in the both cohorts (P<0.01). The prevalence of consumption of alcohol increased slightly, and that of smoking remained constant in both cohorts. CONCLUSIONS: A community-based intervention for stroke reduction is feasible and effective in the cities of China. The reduction, due to the intervention, in the incidence of stroke in the intervention cohort was statistically significant after 3.5 years of intervention. The sharp reduction in the incidence of stroke may be due to the interventions having blunted the expected increase in hypertension that accompanies aging as well as to better and earlier treatment of hypertension, particularly borderline hypertension. Applied health education to all the residents of the community may have prevented some normotensive individuals from developing hypertension and improved overall health awareness and knowledge.     

Influence of fetal to neonatal transition on nitric oxide synthase expression in the nucleus tractus solitarius in sheep

Transition from fetal to newborn life is accompanied by a marked rise in circulating norepinephrine (NE) concentrations though arterial blood pressure does not substantively change. Nitric oxide (NO) plays an important role in the central regulation of sympathetic tone in the nucleus tractus solitarius (NTS) and neuronal NO synthase (nNOS) expression is functionally regulated in the brain. The purpose of these studies was to determine the influence of transition at birth on nNOS expression in the brainstem nuclei, particularly in the NTS, associated with changes in arterial pressure and plasma NE concentration. Experiments were performed using time-dated gestational ewes with twin fetuses. Arterial blood pressure was recorded and arterial blood NE concentrations were measured in the term fetus (gestational 147-148 days) and newborn lambs (4 h of postnatal age). The fetal and newborn animals were then perfused with 4% paraformaldehyde. Sections of the medulla were examined by using both immunolabeling with a polyclonal antibody directed against nNOS and nicotinamide adenine dinucleotide phosphate diaphorase (NADPHd) histochemistry, a marker for expression of nNOS. Micrographs were quantified using a microscope with reticule grid to measure the number of positive cells containing color staining in the brainstem nuclei. Plasma NE concentration in the newborn was more than two-fold greater compared to fetal values but mean arterial blood pressure was similar between fetus and newborn. The nNOS positive cells and NADPHd positive cells were significantly increased in the medial NTS (mNTS) of the newborn compared to fetus. nNOS immunoreactivity and NADPHd reactivity tended to increase in the rostral ventral medulla (RVM) in newborn, but were not altered in other brainstem nuclei during the transition from fetal to newborn life. The results suggest that nNOS expression in the mNTS is predominately enhanced at 4 h of neonatal age vs. the term fetus. We conclude that elevated circulating NE is associated with up-regulation of nNOS in the mNTS which may serve a protective role in central regulation of neonatal arterial blood pressure.     

The tyrosine kinase inhibitor genistein directly inhibits GABAA receptors

The protein tyrosine kinase (PTK) inhibitor genistein has been widely used to examine potential effects of tyrosine phosphorylation on neurotransmitter function. We report here that genistein inhibits GABAA receptors through a direct effect. Extracellular application of genistein and GABA reversibly inhibited GABA-activated currents recorded from HEK293 cells expressing rat alpha1beta2gamma2S or alpha1beta2 receptors, even when genistein was preequilibrated in the intracellular solution. Daidzein, an analog of genistein that does not block PTK, also inhibited GABA-activated current. Coapplication of lavendustin A, a specific inhibitor of PTK, had no effect on the GABA response. Our results demonstrate that genistein has a direct inhibitory effect on GABAA receptors that is not mediated via inhibition of tyrosine kinase.     

Recovery of visual field function in the optic neuritis treatment trial

PURPOSE: To assess the pattern of recovery of the visual field of patients with optic neuritis and to determine whether all affected portions of the visual field recover similarly or certain portions of the visual field have greater recovery. METHODS: We reviewed the Humphrey Visual Field (Allergan-Humphrey Inc, San Leandro, California) data from the initial and 6-month examination for the involved and fellow eyes of patients enrolled in the Optic Neuritis Treatment Trial (ONTT). The average threshold for each patient was calculated for the entire tested field and for locations within concentric rings having a radius 3, 9, 15, 21, and 27 degrees from fixation. The absolute amount of improvement and percentage improvement in average threshold between entry and the 6-month follow-up examination were determined for each patient. These measurements were compared within the concentric rings to assess patterns of recovery. RESULTS: Patients with localized defects recovered 86%+/-20% of their initial defect in average threshold, whereas those having diffuse defects recovered an average of 85%+/-23%. The area about fixation had the greatest relative recovery of threshold (87%+/-21% at 3 degrees); the relative recovery decreased with increasing eccentricity from fixation (P<.01). CONCLUSIONS: Patients with optic neuritis have a marked return of visual field function that does not appear to differ between patients with diffuse or localized field defects. The reduced redundancy of axons in the periphery of the field compared with near fixation may be responsible for the greater relative recovery of threshold near fixation.     

人眼眩光失能测定及其临床意义

目的:观察国产仪器测定眩光失能的性能与规律,并讨论其临床意义。方法:采用MGT—1多功能视觉眩光测试仪(海军医学研究所研制),按规定方法操作。测定正常人30名56眼(矫正视力全部≥1.0,晶体透明,无其他明显眼病),晶体混浊患者15人27眼。测定目标亮度及眩光亮度设置为中—中及弱—中两档分别模拟白天及夜间眩光失能。结果:中—中状态下,眩光失能值正常人均值为9.22%(全距0～31),低于晶体混浊者(24.05%,全距9～67),两者差异显著。正常眼在弱—中状态眩光失能值较中—中状态明显(均值20.12%,全距0～56)。不同频率条件对正常及晶体混浊眼眩光失能的影响不同,低频及中频较高频区的影响明显。结论:作为视功能评论指标,眩光失能检查是一种实用方法。在眼科临床及人体工效学上具有重要的意义。     

Studies on the sorption of elemental mercury vapor by soils

Mercury vapor sorption by soil increased curvilinearly with the increase of soil moisture content until a maximum was reached. A further increase of moisture content caused a decline in mercury sorption. The percent moisture contents which gave maximal increase of²⁰³Hg vapor sorption in these soils coincide quite closely with their water-holding capacity values at 1/3 bar.Soil microorganisms may play a part in moist soil for the increase of elemental mercury vapor sorption and subsequent transformation to mercuric form.Mercury vapor diffused into both dry and moist soil columns and the diffusion profile can be described by an exponential function of the form, y=ae^–bx, where a is the adsorption characteristics of the soil, b is the diffusivity coefficient and x is the depth of soil. The diffusivity coefficient for mercury vapor varied with the soil type and its moisture content.Supported in part by grant R-803948 from the U.S. Environmental Protection Agency. Technical Paper No. 5489, Oregon Agricultural Experiment Station.     

反复流产患者的中医护理对策

目的 :探讨结合现代护理观为指导的具有中医特色的整体护理模式。方法 :运用中医基础理论知识 ,针对引起反复流产患者的病因 ,将患者主要分为内分泌异常型、免疫异常型、生殖道异常型、感染型、全身性疾病影响型、染色体异常型施以护理。结果 :依据不同证型 ,有的放矢的实施护理 ,使患者明确了引起反复流产的根本原因、治疗措施、注意事项、预防保健方法 ,消除了紧张、恐惧、焦虑等心理障碍 ,树立了再次妊娠的信心 ,提高了妊娠成功率     

神阙穴敷贴对原发性骨质疏松症骨钙素的影响

目的　观察神阙穴贴补血益精透皮贴对原发性骨质疏松症骨钙素 (BGP)的影响。方法　选择原发性骨质疏松症患者130名 ,分神阙穴贴药组 (补血益精穴位透皮贴剂 )、西药组 (羟乙磷酸钠片 )、中药组 (补血益精药丸 )、空白对照组。结果和结论　穴位敷贴组能显著提高骨钙素 (7.69± 1.65 )。穴位敷贴组与中药组 (7.82± 0 .99)和西药对照组 (7.13± 0 .89)对原发性骨质疏松症的骨钙素调整作用基本一致 (P>0 .0 5 )。     

多巴胺对大鼠移植肾热缺血再灌注损伤的预处理

目的　观察在大鼠的热缺血再灌注损伤的动物模型中多巴胺的前处理是否可以降低肾脏的免疫活性。方法　♂Lewis大鼠缺血前给予不同浓度多巴胺 (2、5、10 μg·kg-1·min-1)持续灌注 4 8h ,对照组用生理盐水。灌注后夹住左肾动脉 1h ,取右肾检测血氧化酶 (HO 1) ,5d后取左肾用于免疫组化分析。结果　多巴胺的前处理可以降低肾脏单核吞噬细胞的浸润和MHC Ⅱ的表达 ,提高肾脏HO 1的含量。结论　多巴胺的前处理可以降低缺血再灌注损伤肾脏的免疫活性。     

降纤酶对血栓形成和光化学诱导大鼠脑缺血的影响

目的:探讨降纤酶对血栓形成和光化学诱导大鼠脑缺血的影响。方法:①对血栓形成的影响:10只大鼠分为生理氯化钠溶液对照组及降纤酶治疗组(每组各5只),采用微循环方法观察降纤酶治疗后肠系膜血栓溶解情况,分别在光照后1,2,5,10min记录对照组及治疗组血栓体积及占管腔体积比。②对光化学诱导大鼠脑缺血的影响:72只大鼠以光化学法制成左顶叶皮层缺血模型,治疗组于缺血后1,3,6,9,12,24h由尾静脉注射降纤酶8U·kg~(-1)),对照组按相同时间点用等量生理氯化钠溶液尾静脉注射。进行神经功能评分,缺血48h后处死,标本用HE及TTC染色,观察梗死灶病理改变及测定梗死灶体积。结果:①对血栓形成的影响:降纤酶治疗组血栓体积明显减小,占管腔体积百分比减少,与对照组相比有显著性差异(P<0.05)。②对光化学诱导大鼠脑缺血影响:缺血1,3,6h治疗组神经功能评分改善,脑梗死体积明显减小,与对照组相比有极显著性差异(P<0.01),相应时间点病理改变轻于对照组。缺血9h给药组神经功能评分有改善,脑梗死体积亦较对照组小,统计学有显著差异(P<0.05)。12和24h治疗组与对照组相比无显著差异(P>0.05)。结论:降纤酶能有效溶解肠系膜血栓并减小光化学诱导大鼠脑梗死体积。