Acute dilation to α2-adrenoceptor antagonists uncovers dual constriction and dilation mediated by arterial α2-adrenoceptors

Background and purpose:

In mouse tail arteries, selective α₂-adrenoceptor antagonism with rauwolscine caused powerful dilation during constriction to the α₁-adrenoceptor agonist phenylephrine. This study therefore assessed phenylephrine''s selectivity at vascular α-adrenoceptors and the mechanism(s) underlying dilation to rauwolscine.

Experimental approach:

Mouse isolated tail arteries were assessed using a pressure myograph.

Key results:

The α₂-adrenoceptor agonist UK14,304 caused low-maximum constriction that was inhibited by rauwolscine (3 × 10⁻⁸ M) but not by the selective α₁-adrenoceptor antagonist prazosin (10⁻⁷ M). Concentration–effect curves to phenylephrine, cirazoline or noradrenaline were unaffected by rauwolscine but were inhibited by prazosin, which was more effective at high compared with low levels of constriction. In the presence of prazosin, rauwolscine inhibited the curves and was more effective at low compared with high levels of constriction. Although rauwolscine alone did not affect concentration–effect curves to phenylephrine, noradrenaline or cirazoline, it caused marked transient dilation when administered during constriction to these agonists. Dilation was mimicked by another α₂-adrenoceptor antagonist (RX821002, 3 × 10⁻⁸ M), was dependent on agonist selectivity, and did not occur during adrenoceptor-independent constriction (U46619). During constriction to UK14,304 plus U46619, rauwolscine or rapid removal of UK14,304 caused transient dilation that virtually abolished the combined constriction. Endothelial denudation reduced these dilator responses.

Conclusions and implications:

Inhibition of α₂-adrenoceptors caused transient dilation that was substantially greater than the contribution of α₂-adrenoceptors to the constriction. This reflects a slowly reversing α₂-adrenoceptor-mediated endothelium-dependent dilation and provides a rapid, sensitive test of α₂-adrenoceptor activity. This approach also clearly emphasizes the poor selectivity of phenylephrine at vascular α-adrenoceptors.     

玉溪市某医院临床实习生心理健康调查及干预

目的：对玉溪市某医院临床实习生心理健康状况进行干预,探讨改善临床实习生心理健康和提高临床教学质量的方法．方法使用临床症状自评量表（SCL-90）对2009年1月至2013年1月在医院实习的临床实习生进行问卷调查．对实习生的干预包括：举办心理讲座,针对心理问题严重的个体进行心理咨询．同时对带教老师也进行培训,做到师生双向干预,从而探讨提高临床实习生心理健康的方法．结果临床实习生干预前调查216人,阳性人数34人（15.74%）,除恐惧因子外,其他各因子得分与全国常模比较,差异有统计学意义（＜0.05）;干预后调查149人,阳性人数20人（13.42%）,强迫症状因子、抑郁因子、焦虑因子、敌对因子、精神病性因子、总均分与干预前相比下降（＜0.05）,趋于常模水平．结论临床实习生心理问题突出,各带教医院应加强对临床实习生心理健康状况的关注,对实习生进行必要的心理干预,改善他们的心理健康状况,才能有效提高临床教学质量．     

健康是促进人的全面发展的必然要求——论中国特色的卫生发展战略

回顾和总结我国建国以来卫生政策的发展历程,分析卫生政策对卫生体系的影响,提出了对新时期卫生发展战略的新思考。     

多元化术前访视模式对瓣膜置换患者心理应激的影响

  目的  探讨多元化术前访视模式对心脏瓣膜置换患者心理应激的影响。  方法  选取2019年5月至2020年4月云南省心血管外科研究所/昆明市延安医院心脏大血管外科收治的单纯瓣膜置换患者100例，对照组50例，进行传统常规术前访视，干预组50例，实施多元化术前访视，比较2组患者在手术前1 d访视前、麻醉诱导前访视后血浆促肾上腺皮质激素（ACTH）和皮质醇（Cor）浓度，同时监测心率（HR）、平均动脉压（MAP））及进行焦虑（SAS）和抑郁（SDS）自评量表评估。  结果  访视前后2组患者HR、MAP和SDS无明显变化，P > 0.05，干预组的ACTH、Cor和SAS值访视后明显低于访视前（P < 0.05），且2组患者访视后3项值的结果比较，干预组低于对照组（P < 0.05）。  结论  多元化的术前访视模式能够提高患者对疾病术前相关知识的认知度能，缓解患者的不良情绪，有效减轻心理应激反应，使患者积极配合手术治疗和护理，提高患者满意度，提高护理质量。     

毛细管气相色谱法测定蔬菜中有机氯和拟除虫菊酯类农药残留

目的:应用毛细管柱气相色谱法测定蔬菜中三氯杀螨醇和4种拟除虫菊酯类农药残留量。方法:样品经乙腈提取和氯化钠盐析分层,再经硅镁柱净化,氮气流吹干后正己烷溶解定容,采用DB-1701毛细管柱分离,ECD检测,外标法定量。结果:平均加标回收率为80%～110.1%,相对标准偏差为1.3%～4.6%,检出限为0.12μg/kg～2.6μg/kg。结论:该方法准确、灵敏、可靠,适用于批量蔬菜样品的分析。     

Academy of Medicine-Ministry of Health Clinical Practice Guidelines: Attention Deficit Hyperactivity Disorder

The Academy of Medicine (AMS) and the Ministry of Health (MOH) have developed the clinical practice guidelines on Attention Deficit Hyperactivity Disorder (ADHD) to provide doctors and patients in Singapore with evidence-based treatment for ADHD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on ADHD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

1.1 Background information

Attention deficit hyperactivity disorder (ADHD) is a neuro-developmental disorder, characterised by the presence of early-onset persistent, pervasive and impairing hyperactive-impulsive and/or inattentive symptoms. The worldwide pooled prevalence was about 5.29%. While there has been no epidemiological study on the prevalence of this condition among children in Singapore, a local study reported the prevalence of externalising problems to be 4.9% among Singaporean primary school children. While ADHD symptoms decline with age, a meta-analysis reported that a significant proportion might have residual symptoms in adulthood. ADHD has been reported to be associated with negative outcomes, including poor academic achievement, reduced self-esteem and higher smoking rate. This condition is often picked up when the child is young, and children with ADHD are often treated by child psychiatrists and paediatricians.

1.2 Objectives and scope of guideline

These guidelines are not meant to be viewed as a protocol, but rather, to provide a framework to:

• Approach the assessment process, with the goals of arriving at a diagnosis and planning treatment.
• Inform the practitioner about the level of evidence for medication available in Singapore, to aid the decision about medication use.
• Inform about the evidence for non-pharmacological treatment approaches to help professionals plan treatment and discuss these with parents.

1.3 Target group

The target group of these guidelines are professionals who come into contact with children and adolescents below the age of 18 who have attention deficit hyperactivity disorder (ADHD). The information is intended to help professionals plan the treatment for such children and adolescents. Professionals should exercise caution when extrapolating the evidence beyond this stated age group.

1.4 Guideline development

These guidelines were produced by a multi-disciplinary workgroup appointed by the Academy of Medicine, Singapore. The workgroup comprised psychiatrists, paediatricians, educational psychologists, a medical social worker, a pharmacist, an advanced practice nurse and a parent representative.

1.5 Review of guidelines

Evidence-based clinical practice guidelines are only as current as the evidence that supports them. Users must keep in mind that new evidence could supersede recommendations in these guidelines. The workgroup advises that these guidelines be scheduled for review five years after publication, or earlier if new evidence appears that requires substantive changes to the recommendations.     

国外个人健康信息安全与隐私保护法制建设及启示

随着信息技术的快速发展,个人健康信息安全与隐私保护所面临的严峻挑战已成为卫生信息化建设中亟待解决的重要议题。欧美等部分发达国家均十分关注个人健康信息的安全与隐私保护,相继制定了一系列相关的法律法规以规范个人健康信息的存储、传输和利用。通过介绍国外个人健康信息安全与隐私保护法制建设情况,为我国个人健康信息安全与隐私保护法律的制定提供借鉴作用。     

回医理筋手法对兔颈肌慢性损伤干预的血清标志物研究

目的 通过对兔血清软组织损伤标志物的研究探索回医理筋手法对兔颈部骨骼肌慢性损伤的治疗作用及其机制.方法 选用日本大耳白兔39只,随机分为空白对照组、模型组、早期治疗组、晚期治疗组.除空白对照组外其余各组均采取颈椎前屈固定法造模.早期治疗组于造模1个月末进行回医理筋手法治疗,晚期治疗组于造模2个月末进行回医理筋手法治疗.治疗结束后分别对肌酸磷酸激酶(CK)、总超氧化物歧化酶(T-SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)等损伤标志物进行检测.结果 造模1个月末,与空白对照组比较,模型组的血清CK、T-SOD、GSH-PX、MDA等指标均增高(P＜0.01);造模2个月末时,模型组CK、MDA的血清含量高于空白对照组(P＜0.01),T-SOD、GSH-PX含量低于空白对照组(P＜0.01);与模型组相比,早期治疗组CK的血清水平显著降低(P＜0.01),其他指标差异无统计学意义(P＞0.05);兔颈椎前屈位固定造模3个月末时,模型组CK、MDA血清水平高于对照组(P＜0.05),T-SOD低于对照组(P＜0.05);早期治疗组MDA高于对照组(P＜0.05),而CK、T-SOD和GSH-Px含量和对照组差异均无统计学意义(P＞0.05);晚期治疗组的CK、MDA高于对照组(P＜0.05或P＜0.01);与模型组比较,早期治疗组CK、MDA下降,T-SOD升高(P均＜0.05);晚期治疗组血清CK、MDA含量高于早期组(P＜0.05).结论 回医理筋手法对兔颈肌损伤血清标志物有一定的降调作用,早期治疗的降调效果优于晚期治疗.