血脂调节剂的研究——Ⅰ.HMG-CoA还原酶抑制剂M-8614A及MH-2688B产生菌的筛选

利用酶联免疫吸附测定法,酶标β-羟基β-甲基-戊二酸单酰铺酶A(HMG-CoA)还原酶抑制剂Compactin抗体,定向筛选血脂调节剂。从青霉M-8614菌株发酵液中分离到M-8614A。该物质理化性质及波谱解释表明与Mevastatin为同一物质。 M-8614菌株用亚硝酸盐等诱变剂处理,从诱变株MH-2688发酵液中分离到MH-2688B。该物质理化性质及波谱解释表明与Lovastatin为同一物质。     

Hypoplasia of the cerebellar vermis in neurogenetic syndromes

There are conflicting reports on the relationship between cerebellar vermal lobule hypoplasia and autism. Using quantitative magnetic resonance image analysis, we measured the cerebellar vermis in 125 normal individuals with a broad age range and 102 patients with a variety of neurogenetic abnormalities. We conclude that hypoplasia of cerebellar vermal lobules VI and VII is a nonspecific finding that even occurs in several conditions without autistic behavior. This suggests that it is not a specific neuroanatomical marker for autism, nor is cerebellar dys- genesis likely to be solely responsible for clinical autistic behaviors.     

Patient-Physician Pairing: Does Racial and Ethnic Congruity Influence Selection of a Regular Physician?

Many public and private sector efforts are devoted toward increasing the training of physicians from under-represented minority groups, yet little has been documented regarding the association between physicians' racial backgrounds and the patient populations they serve. To address this question, we use 1987 National Medical Expenditure Survey to examine the impact of race/ethnicity on the matching between physician and patients. Our results show that minority patients are significantly more likely to report having a minority physician as their regular doctor. We estimate that minority patients are five times as likely as non-minorities to report that their regular physician is a member of a racial/ethnic minority. This effect is especially pronounced among Hispanics who identify a Hispanic physician as their regular provider 19 times more often than non-minorities. After controlling for other socio-economic factors, both these figures remain significant, but drop by approximately one-half. These results support the notion that minority patients tend to see minority physicians at a disproportional rate independent of other socio-economic factors.     

Effects of recombinant humanen dothelial-derived interleukin-8 on hemorhagic shock in rats

目的：研究重组人内皮细胞衍生的白细胞介素－８（ＩＬ８）对失血性休克的作用．方法：大鼠股动脉放血至ＭＡＢＰ５３２ｋＰａ，维持９０ｍｉｎ，复制晚期失血性休克模型．输血后，静脉注射ＩＬ８２５０μｇ·ｋｇ－１．放免法测定血浆ＥＴ１和６ＫＰＧＦ１α含量．结果：给予ＩＬ８后，ＭＡＢＰ显著提高，休克状态改善，２ｈ存活率相应提高；休克晚期血浆ＥＴ１水平比正常明显升高（２１±４ｖｓ８２±１８ｎｇ·Ｌ－１，Ｐ＜００１），血浆６ＫＰＧＦ１α含量明显降低（１０７±１２ｖｓ１５７±１１ｎｇ·Ｌ－１，Ｐ＜００１）．ＩＬ８显著降低血浆ＥＴ１水平（１０±４ｎｇ·Ｌ－１，Ｐ＜００１），提高血浆６ＫＰＧＦ１α含量（３６８±１６ｎｇ·Ｌ－１，Ｐ＜００１）．结论：ＩＬ８具有较好的抗休克作用．     

Preventive care for patients following myocardial infarction. The Wessex Research Network (WReN)

OBJECTIVE: We aimed to assess general practice care for patients following a myocardial infarction (MI). METHOD: A structured review was carried out of general practice records of patients identified from hospital administration data. A total of 266 survivors following MI were identified from the discharge data of 13 hospitals in Southern England and registered with 71 GPs belonging to the Wessex Research Network. Median time since hospital discharge was 2.1 years. The main outcome measures were the provision of appropriate preventive care, including cardiac rehabilitation, drug therapy, and lifestyle advice for modifiable risk factors. RESULTS: Basic care was provided to nearly all patients; 253 (95.1%, 95% Cl 91.8-97.4) had blood pressure documented after their MI, 216 of 234 patients eligible for aspirin (92.3%; 88.1-95.4) had been recommended treatment, and the provision of advice on smoking cessation was documented for 27 of 33 continuing smokers (81.8%; 64.5-93.0). However, only 73 of 236 patients eligible to attend a structured rehabilitation programme (30.9%; 25.0-36.8) were documented as having received rehabilitation. Of 89 patients with heart failure following MI, 33 (37.1%; 27.1-48.0) had no record of having been offered treatment with an ACE inhibitor. Total cholesterol measurement was documented for only 144 patients (54.1%; 48.1-60.1). We estimate that there is still the potential to prevent between 4 and 9 deaths in this group of 266 surviving patients in the next 2 years by further improving the quality of follow-up care. CONCLUSIONS: Preventive care in patients with proven ischaemic heart disease in general practice remains haphazard, even among doctors enthusiastic to participate in research and to audit their quality of care. As general practitioners we should ensure that we are providing high quality preventive care to patients with clinical disease before we focus on the even more demanding task of primary prevention.      

Interaction of human immunodeficiency virus type 1 envelope protein with liposomes containing galactosylceramide

Summary The glycosphingolipid galactosylceramide (GalCer) has been identified as an alternate receptor for the human immunodeficiency virus type 1 (HIV-1). Here we review a liposome flotation assay used to study the interaction of the HIV-1 envelope glycoprotein (env) with artificial membrane vesicles containing GalCer. The properties of binding, the nature of the env binding site for GalCer, and the implications of this interaction for HIV-1 infection are discussed.     

The Middle Cranial Fossa Approach in Managing Lesions of the Temporomandibular Joint

The temporomandibular joint (TMS) lies at the skull base. Its bony roof forins part of the floor of the middle cranial fossa. It is bounded by the infratemporal fossa, external auditory canal, middle ear, and eustachian tube. When wide resection of tumors arising within the TMJ is necessary, skull base approaches permit complete resection with oncologically sound margins. Precise pathologic diagnosis can be difficult and extra care should be taken to ensure diagnostic accuracy. Outcomes are improved if attention and effort is directed to rehabilitation of the TMJ. Five such cases are presented and the literature is reviewed.     

Albuterol Delivery by Metered-Dose Inhaler With a Pediatric Mechanical Ventilatory Circuit Model

Study Objective . To determine albuterol delivery by metered-dose inhaler (MDI) in an in vitro pediatric mechanical ventilatory circuit model. The influence of a spacing device, endotracheal tube (ETT) diameter and length, and air humidity was also investigated. Design . An albuterol MDI canister was connected to an AeroVent spacer or Airlife MDI adapter and ETT 4.0, 5.0, or 6.0 mm at commercially available and equal lengths. The ETT tip was attached to an in-line filter holder with a 1-μm type A/E glass fiber filter. Ventilator settings were fractional concentration of inspired oxygen 50%, tidal volume 250 ml, inspiratory:expiratory (I:E) ratio 1:3, rate 25 breaths/minute, temperature 35°C, and a decelerating flow pattern. Ten albuterol canisters were activated two times each (total 2000 μg) into dry (4.0-, 5.0-, and 6.0-mm ETT) and humidified air (4.0- and 6.0-mm ETT) and repeated in triplicate. Percentage MDI output was determined by weighing the filter before and after drug administration (balance sensitivity 10 μg). Significant differences (p≤0.05) among the groups with and without a spacer and in dry and humidified air were determined by ANOVA with Scheffe's multiple comparison test. Multiple regression was used to determine significant associations between ETT diameter and length and delivery. Main Results . With the AeroVent spacer in humidified air, delivery with the 4.0- and 6.0-mm ETT was approximately 2.3% and 5%, respectively. The spacer and dry air significantly improved delivery. Conclusions . In humidified air, the dose of albuterol by MDI with an AeroVent spacer should be doubled for children intubated with 6.0-mm ETT, and four puffs administered for every one puff desired for 4.0-mm ETT. The results of this investigation should prove useful in initial clinical trials of albuterol MDI in ventilator-dependent infants and children.     

An analytical framework of physician productivity and variation in utilization.

The utilization of medical services by patients is an important determinant of doctor productivity, but this factor does not appear to have been given much attention in previous studies. In order to answer the question of why is there a wide variation in doctor output at low level medical facilities in China, an analytical framework of doctor productivity and utilization is developed. The simulation model is used to produce data that can be analyzed by such a framework. Great uncertainty about patient flows is one reason for the average lower and varying doctor productivity in lower level health facilities. Until uncertainty can be reduced, more flexibility is needed at the lower level to cope with changing utilization patterns and patient characteristics. The management by doctors of non-patient care activities (preventive programmes, medical research, teaching, and administration) is crucial to any approach to using doctor resources more effectively and efficiently.