Isoflurane Anesthesia Attenuates Endothelium-dependent Pulmonary Vasorelaxation by Inhibiting the Synergistic Interaction between Nitric Oxide and Prostacyclin

Background: Endothelium-derived nitric oxide causes vasodilation in part by increasing the dilator activity of other endothelium-derived mediators, including prostacyclin and a K sup +ATP channel-dependent hyperpolarizing factor. Although previous studies have proposed that isoflurane (ISO) depresses endothelium-dependent vasorelaxation by inhibiting endothelium-derived nitric oxide activity, the effects of ISO on the interactions among endothelium-derived dilators have not been characterized. The aim of this study was to determine the mechanisms underlying the inhibitory effect of ISO on endothelium-dependent relaxation in canine pulmonary arteries. Specifically, the goal was to assess the effects of ISO on the individual actions and on the synergistic interactions of these endothelium-derived mediators.

Methods: Canine pulmonary arterial rings were suspended for isometric tension recording. The effects of 1 minimum alveolar concentration ISO (0.4 mM) on vasorelaxation responses to bradykinin, A23187, acetylcholine, cromakalim, and SIN-1 were assessed in phenylephrine-precontracted rings with and without pretreatment with a nitric oxide synthase inhibitor (N sup omega -nitro-L-arginine methyl ester; L-NAME), a cyclooxygenase inhibitor (indomethacin), or a K sup +ATP, channel inhibitor (glybenclamide).

Results: Isofluane attenuated pulmonary vasorelaxation induced by bradykinin, A23187, and cromakalim but had no effect on relaxation induced by acetylcholine or SIN-1. Neither the nitric oxide-mediated nor the prostacyclin-mediated components of relaxation induced by bradykinin and A23187 were altered by ISO. However, ISO abolished the K sup +ATP -mediated component of relaxation and the K sup +ATP -dependent synergistic interaction between nitric oxide and prostacyclin.     

The ends of outcomes assessment

Outcomes assessment holds great promise to improve the quality and efficiency of health care. By subjecting practices to rigorous and systematic analysis, we should be in a position to make judgments about what does and does not work in clinical practice. However, the outcomes of outcomes assessment themselves should be approached with the same critical eye. Among the many sorts of criteria by which to evaluate outcomes assessment are several key parameters: foremost among them are cognitive outcomes, ethical outcomes, and economic outcomes. Only when these outcomes are thoroughly explored and taken into account will the fullest potential of outcomes assessment be realized.     

格林—巴利综合征患者血清和脑脊液中的抗硫脂抗体

探讨抗硫脂抗体与格林－巴利综合征（ＧＢＳ）的关系。方法采用固相酶联免疫吸附法对急性期ＧＢＳ患者血清和脑脊液（ＣＳＦ）中抗硫脂ＩｇＧ和ＩｇＭ抗体进行检测。结果ＧＢＳ患者血清和ＣＳＦ中抗硫脂ＩｇＧ及ＩｇＭ抗体的阳性率均明显高于正常对照组；血清中抗硫脂ＩｇＭ抗体滴度与标本收集时患者发病天数呈负相关（Ｐ＜０．０５），而血清中抗硫脂ＩｇＧ抗体滴度与临床分级（Ｐ＜０．０１）、ＣＳＦ中抗硫脂ＩｇＧ抗体滴度（Ｐ＜０．０１）呈正相关；血清中抗硫脂ＩｇＧ或ＩｇＭ阳性的ＧＢＳ患者，体检时有不同程度的感觉障碍患者为５６％，而血清中抗硫脂抗体阴性患者仅为１６％，两者之间差异有显著意义（Ｐ＜０．０５）。结论抗硫脂抗体可能在ＧＢＳ的病理过程中起重要作用     

肝癌的介入放射治疗

作者对８６５例行介入放射治疗的肝癌（７７３例原发性，９２例转移性）进行放射形态学的观察。将病例分为三组：巨块型４５７例，结节型１２４例和弥散型２８４例。介入疗法包括：一次或重复化疗药物栓塞或肝动脉灌注，临床症状明显改善。术后平均存活期１４．８个月。同时也观察了因栓塞及各类不同栓塞剂而引起的明显并发症。同时讨论了患者存活期以及重复栓塞和肝转移性肿瘤的某些特性，并着重讨论过去认为单用化疗药物肝动脉灌注治疗效果不好的转移性肝癌与同时使用栓塞治疗的不同效果。     

Relationships between demographic variables and family dynamics of childbearing families

Hakulinen T, Paunonen M, Laippala P. International Journal of Nursing Practice 1997; 3: 247–254
Relationships between demographic variables and family dynamics of childbearing families
In this study relationships between demographic variables and family dynamics of childbearing families in Finland were studied. The sample was 160 urban families expecting their first or second child in the third trimester of pregnancy. One-hundred and eighteen families participated in the study. The Family Dynamics Questionnaire (FDQ) and the Family Dynamics Measure (FDM) were used in this study. Most expectant parents reported their family was well-functioning. Mothers of higher socioeconomic status found more flexibility in their families than mothers of lower socioeconomic status. Fathers in families expecting their first baby reported more mutuality, role reciprocity and more stability than second-time fathers. The findings contribute cues for public health nurses and midwives regarding parity, socioeconomic status and family dynamics to provide more specific family guidance during the transition to parenthood. Realistic information on the changes in family dynamics after childbirth should be given to pregnant parents.     

Recombinant allergen fragments as candidate preparations for allergen immunotherapy

Background: Lately, renewed interest has arisen in the new forms of allergen immunotherapy because they may offer alternatives for drug treatment. Objective: The purpose of this study was to develop a well-characterized preparation of the main respiratory cow dander allergen, Bos d 2, with attenuated allergenic activity. Methods: The immunologic characteristics of Bos d 2 preparations were studied by indirect IgE ELISA, ELISA inhibition, Western blotting, histamine release, skin prick tests, and the proliferation tests of allergen-specific T-cell clones. Results: The complete recombinant Bos d 2 was observed to bind effectively, IgE of cow-allergic patients in indirect ELISA. In other experiments, the IgE-binding capacity of recombinant Bos d 2 proved to be lower compared with native Bos d 2. When the two overlapping recombinant fragments of Bos d 2 (corresponding amino acids 1-131 and 81-172, respectively) covering the whole molecule were compared with the complete recombinant Bos d 2 with several methods, only a low level of residual reactivity was observed. For example, recombinant fragments could not bind antibody at all in ELISA inhibition tests retaining, however, some reactivity in skin prick tests. In contrast, the fragments were able to stimulate vigorously Bos d 2-specific T-cell clones. Conclusion: The approach we have taken may offer a simple and reproducible way to produce hypoallergenic preparations for immunotherapy, circumventing simultaneously some of the problems of other experimental methods such as individual T-cell epitope recognition in peptide-based immunotherapy. (J Allergy Clin Immunol 1997;100:721-7.)     

An adjusted version of Kohlberg's moral theory: discussion of its validity for research in nursing ethics

Critics of Kohlberg's moral theory today focus on the content of his theory and more specifically on its justice-orientated moral concept. This has led to the well-known 'justice-care debate'. The purpose of this article is to critically examine the validity of Kohlberg's moral theory for research in nursing ethics from a caring perspective (referring to the content) as well as from a cognitive-structural perspective (referring to the basic assumptions of the model). The analysis points to the usefulness and value of the cognitive-structural model to empirically study nurses' ethical behaviour; the content of Kohlberg's model, however, needs to be adapted by adding a caring perspective as well as some personal and situational variables. An adjusted version of Kohlberg's model is proposed and discussed.     

Effects of dauricine,quinidine,and sotalol on action potential duration of papillary muscles in vitro

目的：观察蝙蝠葛碱对豚鼠乳头状肌的动作电位是否具有使用依赖性特征，并与奎尼丁、索他洛尔作平行比较．方法：利用细胞内微电极技术记录豚鼠乳头状肌跨膜动作电位．结果：蝙蝠葛碱２０μｍｏｌ·Ｌ－１能明显延长乳头状肌跨膜动作电位时程，在刺激周长为２００，３００，４００，６００，８００，１０００，２０００ｍｓ时，其延长动作电位时程的百分率分别为２２±８，１１±６，９±５，７±５，６±３，４３±２８，４５±２８，蝙蝠葛碱延长动作电位时程作用于刺激周期较短时作用明显，呈使用依赖性特征．而奎尼丁１μｍｏｌ·Ｌ－１和索他洛尔１０μｍｏｌ·Ｌ－１延长动作电位时程作用随刺激周期延长而增强，呈现逆向使用依赖性特征．结论：蝙蝠葛碱使用依赖性延长豚鼠乳头状肌动作电位时程．