Prevalence and characteristics of driving difficulties in Operation Iraqi Freedom/Operation Enduring Freedom combat returnees

We studied the prevalence and characteristics of self-reported driving difficulties and examined their association with traumatic brain injury (TBI) and/or posttraumatic stress disorder (PTSD) in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans who were seen at a Department of Veterans Affairs outpatient polytrauma clinic. In this study, we used a brief driving questionnaire and chart reviews to assess the prevalence and characteristics of driving difficulties in the following four groups of patients: TBI only, PTSD only, TBI + PTSD, and Neither (neither TBI nor PTSD). Compared with before deployment, 93% of OIF/OEF veterans seen in the polytrauma clinic reported more difficulties with driving in at least one domain, with the most common areas of difficulty being (1) problems with anger or impatience (82%), (2) general driving difficulties (65%), and (3) experiences with near misses (57%). Patients with PTSD (with or without TBI) reported the most significant driving impairments, whereas respondents with a history of only TBI endorsed driving difficulties similar to veterans without either diagnosis. Qualitative analysis of veterans' comments also revealed similar patterns. Self-reported driving problems were common among OIF/OEF returnees. Respondents who had a diagnosis of PTSD (with or without TBI) reported the most severe driving difficulties since returning from deployment. The association between PTSD and driving problems warrants further investigation.     

Assessment and treatment of common persistent sequelae following blast induced mild traumatic brain injury

The ongoing wars in Iraq and Afghanistan and terrorist activity worldwide have been associated with an increased incidence of blast injuries. While blast injuries share similarities with blunt or penetrating traumatic injuries, there are unique mechanistic elements of blast injury that create increased vulnerability to damage of specific organs. This review highlights the mechanism of blast-related injury, describes the common sequelae of blast exposure that may impact rehabilitation care, and summarizes the intervention strategies for these blast-related sequelae.     

Use of plasmid analysis to determine the source of bacterial invasion of the urinary tract

Gram negative colonisation and infection of the urinary tract is a well recognised complication of the neuropathic bladder caused by spinal cord injury (SCI). K. pneumoniae accounts for one third of all urinary tract infections in hospitalised SCI patients. Plasmid analysis has been shown to reliably fingerprint bacterial strains, particularly K. pneumoniae, so that growth from two separate locations in or on the body can be accurately analysed as to migration from a reservoir to a target location. Eighty seven hospitalised SCI patients on intermittent catheterisation for a total of 586 patient-weeks were studied. Twice weekly catheterised urine specimens and once weekly rectal swab cultures were taken from each patient. Thirty seven patients experienced at least one clinically significant (colony count greater than 10,000/mL) urinary tract colonisation caused by K. pneumoniae, representing 66 total colonisations. Further analysis of 31 of these 37 patients revealed: K. pneumoniae in all of their stool cultures (p less than 0.05) and the identical strain of K. pneumoniae in the urine as well as the stool in 72% of the 66 colonisations (p less than 0.05). Analysis of 14 patients without K. pneumoniae urinary colonisations showed absence of faecal K. pneumoniae in 3, and predominant growth in only 4. In 22 of the 37 patients, multiple K. pneumoniae urinary colonisations were noted, representing 27 pairs of colonisation. Fifteen of the pairs were found to be relapsing (caused by two identical bacterial strains), and 12 were recurrent (caused by two different bacterial strains). Thirteen of the 15 relapsing pairs also had identical urine and stool K. pneumonia strains (p less than 0.05). All colonisations were treated with appropriate antibiotics based on culture and sensitivity reports. Fourteen of the 15 relapsing colonisation pairs have identical antibiograms (p less than 0.05), while all 12 of the recurrent colonisation pairs had different antibiograms (p less than 0.05). The differences noted on sensitivity patterns (antibiograms) correlated with differences among strains of K. pneumoniae based upon plasmid analysis. Treatment of bacteriuria did not affect the nature of repeated colonisations regardless of the antibiotic chosen, the route of administration or the duration of treatment.     

人体抑制素α亚基片段的合成及活性研究

用固相多肽合成法的Fmoc**化学合成了4个人抑制素α亚基片段,经三氟醋酸裂解、高效液相纯化,产物总收率20%～63%。考察人工合成的四种抑制素α亚基肽片段对大鼠离体培养黄体细胞孕酮分泌的影响,结果表明4种抑制素α亚基肽片段均显著抑制大鼠黄体细胞的基础孕酮分泌。     

Between Two Worlds: A Multi-Institutional Qualitative Analysis of Students’ Reflections on Joining the Medical Profession

BACKGROUND  Recent changes in healthcare system and training mandates have altered the clinical learning environment. We incorporated reflective writing into Internal Medicine clerkships (IMcs) in multiple institutions so students could consider the impact of clerkship experiences on their personal and professional development. We analyzed student reflections to inform curricula and support learning. METHODS  We qualitatively analyzed the reflections of students at 3 US medical schools during IMcs (N = 292) to identify themes, tone, and reflective quality using an iterative approach. Chi-square tests assessed differences between these factors and across institutions. FINDINGS  Students openly described powerful experiences. Major themes focused on 4 categories: personal issues (PI), professional development (PD), relational issues (RI), and medical care (MC). Each major theme was represented at each institution, although with significant variability between institutions in many of the subcategories including student role (PI), development-as-a-physician (PD), professionalism (PD) (p < 0.001). Students used positive tones to describe student role, development-as-a-physician and physician–patient relationship (PD) (p < 0.01–0.001), and negative tones for quality and safety (MC) (p < 0.05). Only 4% of writings coded as professionalism had a positive tone. Students employed a “reporting” voice in writing about clinical problem-solving, healthcare systems, and quality/safety (MC). DISCUSSION  Reflection is considered important to professional development. Our analysis suggests that students at 3 institutions reflect on similar experiences. Theme variability across institutions implies curricula should be tailored to local culture. Reflective quality analysis suggests students are better equipped to reflect on certain experiences over others, which may impact learning. Student reflections can function as a mirror for our organizations, offer institutional feedback for support and improvement, and inform curricula for learners and faculty. Preliminary findings were presented at the plenary session of the National Meeting of the Clerkship Directors in Internal Medicine, October 2007, Pittsburgh, PA.     

促性腺激素释放多肽(GRP)对体外培养小鼠垂体分泌LH的影响

合成的促性腺激素释放多肽(GRP)及其类似物GRp～NH₂,[Glu^7.9.14Lys^6.10]GRP(6～14),[phe¹⁴]GRP(5～14)和[phe¹⁴]GRP浓度在0.05mmol·L^-1时,具有刺激体外培养的小鼠垂体分泌LH的作用。其活性依此相当对照垂体的115.4,114.2,140,160和179%。小鼠于妊振第7～9天或第1～5天,每只sc[phe¹⁴]GRP1mg·d^-1,或于妊娠第2～4天每只sc[phe¹⁴]GRP(5～14)1mg·d^-1,有40～60%的妊娠动物出现死胎。     

3—溴甲基头孢烯亚砜的合成

头孢菌素是疗效高、毒性小、较好的一类广谱半合成抗生素。由于头孢菌素 C 发酵单位低、成本高,因此以青霉素扩环制备3—甲基头孢菌素己广泛用于生产。但在3—位引入活性基团以制备3—取代头孢菌素,目前还在探索阶段。国外这方面己有一些报导。根据国内头孢菌素生产的现状,结合现有条件,我们采用青霉素 G 为开始原料,经酯化、氧化、先扩     

Efficacy of multidisciplinary treatment program on long-term outcomes of individuals with Parkinson's disease

We examined the impact of multidisciplinary clinical management of the Parkinson's Disease Research, Education, and Clinical Center program on Parkinson's disease progression. Initial and follow-up scores on the Part III Motor Examination subscale of the Unified Parkinson's Disease Rating Scale (UPDRS) were examined. Overall, 37 (75.5%) of the 49 patients demonstrated stable or improved UPDRS motor scores at 1- to 3-year follow-up; in the 1-year group (n = 28), 22 patients (78.6%) improved, while 6 (21.4%) worsened. In the 2-year group (n = 15), 10 (66.7%) improved, while 5 (33.3%) worsened. In the 3-year group (n = 6), 5 (83.3%) improved, while 1 (16.7%) worsened. Multidisciplinary interventions included neurology (95.9% of patients), physiatry (93.9%), nursing (87.8%), psychology (42.9%), medication changes (59.2% increases, 18.4% decreases), rehabilitation therapies (physical, occupational, speech-language, 67.3%), functional diagnostic testing (18.4%), support group (16.3%), home exercise instruction (85.7%), and disease and wellness education (81.6%). Improved and worsened patients did not significantly differ on the individual program components. Clinical implications and study limitations are discussed.