垂体催乳素瘤的诊断和治疗指南

首次测定确立高催乳血症必需避免过度的静脉穿刺压力,理想的情况是醒后或饭后致少1h来测试.     

Joint-level kinetic redundancy is exploited to control limb-level forces during human hopping

Compensatory mechanisms can take advantage of neuromechanical redundancy to meet global task goals in spite of local injuries or perturbations. We hypothesized that joint-level kinetic redundancy is also exploited during intact, unperturbed human locomotion to accomplish limb-level force goals. The limb-level force goals of hopping in place at a constant frequency are minimizing cycle-to-cycle variance of vertical ground reaction force and varying horizontal (fore-aft) ground reaction force to make backward and forward corrections in position from cycle to cycle. Uncontrolled Manifold analysis of joint torque variance showed that hoppers exploited redundancy to minimize vertical force variance at landing, mid-stance, and takeoff, and to vary horizontal force at landing and takeoff. Timing fluctuations, however, increased vertical force variance. We conclude that joint torque variance is not random noise, but has functional relevance and is purposefully structured to meet specific locomotor goals. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Family physician views about primary care reform in Ontario: a postal questionnaire

Background  

Primary care reform initiatives in Ontario are proceeding with little information about the views of practicing family physicians.     

茶碱对有呼吸窘迫综合征的极早产儿患血管运动性肾病的预防作用研究：一项随机双盲安慰剂对照试验

背景:血管运动性肾病是早产儿常见的肾功能障碍性疾患。目的:确定茶碱是否可以预防有呼吸窘迫综合征的极早产儿罹患血管运动性肾病。方法:随机双盲安慰剂对照试验,50例胎龄≤32周须辅助通气的早产儿。婴儿接受3d茶碱(1m g/kg)或安慰剂静脉注射。每天测定其24h尿量。在第2、第5及第11天,收集血样及12h尿并进行电解质、肌酐、尿素分析。结果:茶碱组患儿的第1天排尿量的组别x(s)为2.4(0.9)m l/(kg·h),显著高于安慰剂组[1.6(1.0)m l/(kg·h);P=0.023]。茶碱组少尿或无尿的发生率(5%)显著低于安慰剂组(33%)。在第一次给予茶碱/安慰剂后24h,茶碱…     

Parvovirus: the expanding spectrum of disease

Treatment of parvovirus infections among immunocompromised hosts using immunoglobulin has provided the clinician with a useful therapeutic tool but has also highlighted the problems concerning chronic disease states. The discovery of the human parvovirus B19 in 1975 and subsequent studies of its effects in humans have identified this virus as the causative agent of a broad spectrum of diseases. Recent improvements regarding the development of sensitive PCR techniques and methods for cultivation have provided new insight into its pathogenic role, its virology and immunology, and the varied clinical manifestations. The current state of knowledge concerning parvovirus enabled us to divide the long list of diseases caused by this virus into three main categories: (1) diseases found among normal hosts (asymptomatic disease, erythema infectiosum, arthropathy, hydrops fetalis), (2) hematologic diseases (aplastic crisis, chronic anemia, idiopathic thrombocytopenic purpura, transient erythroblastopenia of childhood, Diamond-Blackfan anemia) and, finally, (3) a heterogeneous group of diseases, in which the etiologic role of parvovirus is less clear and sometimes putative (neurologic disease, rheumatologic disease, vasculitic and myocarditic syndromes). In particular, arthropathy, hydrops fetalis and the hematologic disorders may be of pediatric concern. Consequently, it is of paramount importance that in all of these cases the clinician includes parvovirus as a differential diagnosis.     

Atherosclerosis in APOE*3-Leiden transgenic mice: from proliferative to atheromatous stage

BACKGROUND: This study documents (1) the progression of atherosclerosis along the entire arterial tree in APOE*3-Leiden mice after 1, 4, 6, 9, and 12 months of a high-fat/high-cholesterol (HFC) diet and (2) the amount and phenotype of DNA-synthesizing and apoptotic cells in different lesion types after 6 months of HFC diet. METHODS AND RESULTS: Diet duration was correlated with a craniocaudal progression of lesion development and with an increase in severity of the lesion. Typically, the lesions contained smooth muscle cells, macrophages, and T lymphocytes and were covered by an intact endothelium. Whereas DNA synthesis (BrdU uptake) was usually elevated in type II lesions (8.6+/-0.8% versus 1.0+/-0.2% in the nondiseased arterial wall; P<0.05), apoptosis was found primarily in advanced lesions (type IV, 1.3+/-0.1% and type V, 1.2+/-0.2% versus 0.04+/-0.04% in the nondiseased arterial wall [P<0.05]). Cell phenotyping revealed that the majority of DNA synthesis and apoptosis was confined to the macrophage-derived foam cell (68.6+/-3. 0% and 82.2+/-4.6%, respectively). CONCLUSIONS: This study shows that in APOE*3-Leiden mice, duration of an HFC diet is associated with (1) a craniocaudal progression of lesion development and (2) an increased complexity of atherosclerotic lesions. Furthermore, DNA synthesis is predominant in early lesions, whereas apoptosis is present mainly in more advanced lesions. Both parameters of cell turnover are confined primarily to the macrophage-derived foam cell.     

Upper Limit Ventricular Stimulation in Respiratory Rate Responsive Pacing due to Electrocautery

Transient programmed upper limit stimulation (150 bpm) was observed during repetitively utilized electrocautery in the beginning of an open-heart surgical procedure in a patient with a minute ventilation rate responsive ventricular pacemaker. This tachycardia caused severe hemodynamic deterioration, and was also initiated by internal heart massage and manual ventilation. Considering the recommendations of the manufacturer, this series of serious events could have been prevented, when reprogramming to the inhibited mode had been executed in anticipation of the operation.