畹町经济开发区2004-2013年鼠疫监测结果分析

目的了解畹町经济开发区鼠疫疫源地的活动现状,为预防控制鼠疫提供科学数据。方法采用常规鼠疫监测方法,监测鼠疫宿主、媒介数量的变化趋势,并进行统计分析。结果 2004-2013年鼠疫宿主黄胸鼠种群率86.38%,室内密度2.68%,室外密度2.94%;染蚤率23.51%,印鼠客蚤指数0.37;检验鼠、蚤标本3 984份,检测动物血清758份,结果均为阴性。结论畹町鼠疫宿主密度超过预警指标,要做好鼠疫防控措施,严防鼠疫出现周期性复燃。     

Differential time course of the vasodilator action of various calcium antagonists

Summary— It is rather the rate of the vasodilator effect than its magnitude which determines the triggering of reflex tachycardia associated with dihydropyridine calcium antagonists (DHP-CA). We therefore compared the rate of the vasodilator effects of a series of CA (both DHP and non-DHP) in rat isolated mesenteric artery preparations (size 256 ± 3 μm, length 2 mm) from male Wistar rats (weighing 300–350 g) in an isolated wire myograph according to Mulvany and Halpern [12]. The mean force of the KCl-induced contraction amounted to 2.3 ± 0.1 mN/mm. Potency (given as IC₅₀-values), differential time course of action and recovery of the contractile response of the vessels after wash-out were established. These three parameters adhere to the following sequences; (1. potency) S,S-barnidipine > (S)-lercanidipine > barnidipine HCl > amlodipine > nifedipine, lacidipine > (R)-lercanidipine > verapamil, mibefradil; (2. differential time course) lacidipine, amlodipine > (S)- and (R)-lercanidipine. S,S-barnidipine, barnidipine HCl > mibefradil, verapamil, nifedipine; (3. recovery) nifedipine > verapamil, S,S-barnidipine, amlodipine > barnidipine, lacidipine > mibefradil, (R)-lercanidipine > (S)-lercanidipine. In conclusion, S,S-barnidipine proved to be the most potent vasodilator agent; interestingly, barnidipine was 20 times less potent when applied as a racemic mixture. A slow onset of action in DHP is a very important mechanism in preventing reflex tachycardia. For non-DHP (verapamil, mibefradil) reflex tachycardia probably is prevented by a direct effect on the conductive tissue in the myocardium.     

HOW DO GENERAL PRACTITIONERS MANAGE PATIENTS AT RISK FROM STROKE?

SUMMARY This study assessed by means of a postal questionnaire how general practitioners (GPs) manage patients at risk from stroke. Of the 640 GPs sent a questionnaire, 294 (46%) replied. In patients with a recent transient ischaemic attack or minor ischaemic stroke, 24% of responding GPs would not arrange any investigations. Sixty-one per cent refer under half of their patients for further investigation, although 99% of GPs would commence aspirin. Seventy-seven per cent of GPs were aware of the benefits of carotid surgery. For patients in atrial fibrillation, most GPs (77%) thought that warfarin reduced stroke rates, but only 20% would consider commencing warfarin, although 26% would commence aspirin. In hypertensive patients, the GPs' threshold for treatment ranged from 135 to 200mmHg systolic (median 160mmHg), and from 90 to 110mmHg diastolic (median 100mmHg). Most GPs (84%) would treat isolated systolic hypertension with a median threshold of 180mmHg (range 140-240mmHg). The results of this study suggest that some patients at risk from stroke may not receive optimal investigation and treatment in the community.     

Deep brain stimulation and the ethics of protection and caring for the patient with Parkinson's dementia

Deep brain stimulation (DBS) is an effective neurosurgical treatment for patients with advanced Parkinson's disease (PD) suffering from motor complications that are refractory to further medication management. DBS requires an invasive procedure of implanting brain electrodes while awake, followed by implantation of neurostimulators under general anesthesia. The neurostimulator requires battery monitoring and replacement approximately every 3 to 5 years. These two elements of the technology provide numerous decision points about continuing therapies that can involve ethical choices. Although motor function can be improved with subthalamic nucleus (STN) DBS, the long‐term risks of living with implanted hardware should be carefully evaluated for patients with diminishing cognitive capacity. We describe two cases where ethical dilemmas occurred postoperatively as a result of cognitive decline and describe salient ethical dimensions that illustrate the need for a proactive postoperative plan for supervision as a prerequisite for surgery to include neuropsychological testing to predict the likelihood of net benefit to the patient and family beyond just motor improvement. © 2008 Movement Disorder Society     

Radio-anatomic position for the lateral radiographic view of the human patello-femoral joint

Summary Recent clinical and epidemiological studies have emphasised the importance of the patello-femoral joint (P-FJ) in osteoarthritis. X-ray examination of this joint for joint space width (JSW) assessment using the standard medio-lateral view is difficult. In 26 femora, the mean angle of inclination between the medial and lateral condyles measured at their inferior and anterior surfaces, relative to a line passing between the medial and lateral femoral epicondyles, was used to define the optimum alignment of the x-ray tube. The results showed that for medio-lateral radiography of the P-FJ, the central ray of the x-ray beam should be directed cranially, in a upward projection by 5° and then anteriorly by 4°, resulting in superimposition of the inferior and anterior condylar surfaces respectively. The value of these angles was confirmed by radiographs of the 26 femora and 10 post mortem joints. The margins for joint space width measurement were identified by embedding lead balls, within the cartilage of the cadaveric knees, and were defined as the median vertical ridge of the patella and the middle of the patella groove on the femur.

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Une position radio-anatomique pour la radiographie de profil de l'articulation fémoro-patellaire humaine

Résumé De récentes études cliniques et épidémiologiques ont souligné l'importance de l'articulation fémoropatellaire (AFP) dans l'arthrose du genou. L'examen radiographique de cette articulation, notamment pour l'appréciation de l'épaisseur de l'interligne articulaire en incidence médiolatérale de routine, est difficile. Sur 26 fémurs, l'angle moyen d'inclinaison des surfaces inférieure et antérieure des condyles latéral et médial par rapport à une ligne unissant les deux épicondyles a été utilisé pour définir l'alignement optimal du tube radiogène. Les résultats ont montré que pour une radiographie médio-latérale de l'AFP, le faisceau central de rayons X devait être dirigé crânialement de 5°, et antérieurement de 4°, permettant ainsi d'obtenir la superposition des deux condyles. La validité de ces angles a été confirmée par les radiographies de 26 fémurs et de 10 articulations cadavériques. Les repères pour la mesure de l'épaisseur de l'interligne articulaire, identifiés par l'insertion de billes de plomb dans le cartilage des articulations cadavériques, ont été définis comme étant la crête verticale médiane de la patella et le milieu de la gorge patellaire du fémur.

     

The natural history of cardiac rhabdomyoma with and without tuberous sclerosis

The aim of the present study is to contribute to the knowledge of the natural history of cardiac rhabdomyoma in children with and without tuberous sclerosis. In a retrospective study, 33 children with cardiac rhabdomyoma were collected from three pediatric cardiology centres. In 30/33 patients tuberous sclerosis was associated. High prevalence of cardiac rhabdomyoma was found in infancy, with 21/23 detected before the age of 1 year, and 11/33 before 1 month of age. Cardiac manifestations were present in 19 patients: cardiac rhythm disturbances were detected in 13; in 6/33 a Wolff-Parkinson-White syndrome was documented, of which 4 presented paroxysmal arrhythmias. Obstructive or regurgitative phenomena were present in 5; and in 2 patients surgical removal proved necessary. With the exception of one tumoural mass in the right atrium, all 77 tumours were located somewhere in the ventricles, including at atrioventricular valve level. Because of spontaneous regression of most of the tumoural masses, treatment should at first be symptomatic, while surgical removal is required only in life-threatening conditions, as documented in 2 of our 33 patients.