Changes in serum concentrations of 3,3',5'-triiodothyronine and 3,5,3'-triiodothyronine during prolonged moderate exercise.

The effect of moderate bicycle exercise (3.5 h) on peripheral thyroid hormone metabolism was studied under two conditions (with and without glucose infusion) in four normal males. Serum T3, rT3, total protein, plasma glucose, and FFA were determined. Exercise induced an increase in rT3 from 29 to 40 ng/dl (P less than 0.01), a decrease in T3 from 154 to 147 ng/dl (P less than 0.01), and an increase in T4 from 7.1 to 7.5 micrograms/dl (P less than 0.05). When glucose was infused during exercise, the changes in rT3 were blunted (P less than 0.01) and the changes in T3 and T4 were diminished. During exercise, rT3 correlated with FFA (r = 0.95) and plasma glucose (r = -0.87). When glucose was infused during exercise, these correlations decreased (r = 0.81 and -0.56, respectively). Since moderate, prolonged exercise induces a state of early or acute starvation it is concluded that the changes in peripheral thyroid hormone metabolism reported here are similar to those found in starvation. The temporal changes of rT3, FFA, and plasma glucose during exercise suggest a relationship between thyroid hormone metabolism and the uptake and utilization of FFA and glucose or the mixture of these body fuels.     

新缩瞳剂包公藤甲素人工合成研究

包公藤甲素是从包公藤(Erycibe obtusifolia Benth.)茎中提得的一个新莨菪烷生物碱,具有强烈的缩瞳作用,临床用于治疗青光眼。本文报道用合成的6β-乙酰氧基托品酮为原料,经卤代、水解、还原和N-去甲基化等反应合成包甲素(8)。经光谱测定证实8与天然包甲素的结构完全一致。合成品系外消旋体,其作用机理与天然品相同,而强度则减半。     

Osteosarcoma: use of MR imaging and MR spectroscopy in clinical decision making

Magnetic resonance (MR) imaging was performed on 14 patients with histologically proved osteosarcoma (mean age, 14.4 years). There was excellent correlation of intramedullary tumor extent as determined with MR imaging and pathologic examination (r = 99%). This was facilitated by the presence of a chemical shift artifact at the tumor-marrow interface on the T1-weighted images. The correlation between CT and pathologic findings was not as good (r = 84%). In a single patient, however, a 10-cm length of sclerotic bone was incorrectly interpreted as being tumor. If this case is excluded, the correlation between CT and pathologic findings improves significantly (r = 96%). T2-weighted images were optimal in demonstrating soft-tissue bulk and breach of the epiphysis or cortex. Vascular involvement was also readily defined. The T2 value of the tumor soft-tissue component decreased in patients who were deemed to have responded well to therapy. Two patients with very high T2 values after chemotherapy developed wide-spread metastatic disease and died. Phosphorus-31 MR spectroscopy of five patients with osteosarcoma showed elevated levels of phosphomonoesters (PMEs), inorganic phosphate (Pi), and phosphodiesters (PDEs). PME and PDE peak areas decreased in three patients after chemotherapy, while Pi peak areas increased.     

Primary Ewing sarcoma: follow-up with Ga-67 scintigraphy

While avid accumulation of gallium-67 citrate and technetium-99m methylene diphosphonate (MDP) occurs initially in most cases of primary Ewing sarcoma, uptake after therapy is less well defined. Thirty patients with Ewing sarcoma who underwent Ga-67 and bone scintigraphy at diagnosis, at completion of therapy, and at relapse from 1978 to 1988 were evaluated. All 30 patients showed less primary site Ga-67 activity following therapy. Twenty-three of 28 patients who underwent corresponding bone scintigraphy showed less uptake, but residual activity was usually more intense than with Ga-67. Avid reaccumulation of Ga-67 occurred in four of five patients with primary site relapse, while patients who underwent bone scintigraphy showed less change. It was concluded that a greater decrease in Ga-67 than in Tc-99m MDP uptake often occurs in patients successfully treated for primary Ewing sarcoma. Information obtained at Ga-67 scintigraphy is most likely to be helpful if results of bone scintigraphy remain abnormal or if occult relapse is suspected.     

Nurses'' opinions of the introduction of computer-assisted learning for use in patient education

Computers have only recently begun to find a place in the everyday work of health care staff. The use of computer-assisted learning (CAL) in patient education is in its infancy. However, the medium appears to offer several advantages to patients. The successful integration of the medium into clinical practice requires the acceptance and support of staff members. Little research exists to date which examines staff responses to the introduction of CAL into their workplace. This small study (n = 14) aims to explore the reactions of staff to the introduction of an experimental CAL package for use in the education of renal patients on continuous ambulatory peritoneal dialysis (CAPD). The opinions of staff members to CAL are probed and their views ascertained regarding the usefulness of CAL to both staff and patients. Results suggest that, despite their initial reservations about CAL, staff were generally positive about the medium.     

Surface of the brain: three-dimensional MR images created with volume rendering

Image processing and volume rendering have been applied to magnetic resonance (MR) images to produce three-dimensional views of the surface of the brain. Four healthy volunteers and 17 patients with a variety of disorders underwent MR imaging of the head, and these images were processed and subjected to volume rendering. The resulting three-dimensional views depict abnormalities of the brain surface, as well as important landmarks of normal brain surface anatomy such as precentral, postcentral, superior temporal, and inferior frontal gyri, which are difficult to identify on cross-sectional images.     

The internal consistency and intra-rater reliability of an assessment practice grid for community nurses

The development of instruments to measure clinical competence in nursing shows little evidence of a systematic approach and studies of reliability and validity are absent. The present study was carried out using data on practice assessment collected in the course of a post-registration nursing programme. The data were analysed for internal consistency and intra-rater reliability. The instrument used to assess practice in the present study is highly internally consistent and there is evidence to support intra-rater reliability. However, further development and testing of the instrument is required.     

Survey of carer satisfaction with the quality of care delivered to in-patients suffering from dementia

Quality assurance in British National Health Service provision stresses the importance of taking account of the consumer's viewpoint Elderly patients with dementia are not always able to contribute usefully to satisfaction surveys Therefore, their carers' views were sought in order to assess the quality of services offered to this client group Forty-one carers of patients discharged from the eight wards for the elderly mentally ill in Leicestershire, England, were randomly selected Individual focused interviews were conducted in carers' own homes Both quantitative and qualitative data were obtained by use of a questionnaire designed to tap the patients'/carers' experiences from preadmission, through hospital stay to post-discharge Interviewees were asked to describe their favourable/unfavourable impressions of, and reactions to, all aspects of hospital care These interviews were tape-recorded Analysis of the data included quantitative measurements of scale ratings Grounded theory was used to analyse qualitative data A wealth of information was uncovered using this research technique Much that was positive about the service was elicited However, carers highlighted areas where they felt the quality of care could be improved within all the foci discussed Twenty-two recommendations for quality improvements in service provision were made in the report as a result of this survey