Analysis of hearing loss due to cis-diamminedichloroplatinum-II

Summary In order to establish an experimental model for the study of immunological reactions to exogenic immunogens in the upper and lower respiratory system NMRI mice were subjected to inhalation of the mitogenic and inflammatory response inducing lectin concanavalin A (Con A) and bovine serum albumin (BSA). Immunological reactions were induced in the upper respiratory tract and in the lungs. Serologically, the course of the antibody titre was measured by radio-immunoassay over several weeks. Germinal centre reactions in the nose and paranasal sinus equivalents were the morphological correlate. The lungs showed an increase in the number of macrophages and a thickening of the alveolocapillary membrane, but no germinal centre reactions were observed. These morphological and serological results may indicate a priming of the immune response in the upper respiratory tract leading to a subsequent production of antibodies in the lung.     

Measurement of condylar motion: a plea for the use of the condylar kinematic centre

In this study, a plea is given for the use of the kinematic centre in studies of the kinematics of the human temporomandibular condyle. The concept of the kinematic centre is based upon the assumption that the movements of the condyle-disc complex within the temporomandibular joint can reasonably well be described by those of a ball-shaped condyle-disc complex. The kinematic centre is then the centre of the sphere. Its movement traces have the advantage that they are smooth and have a good reproducibility between consecutive movements. Moreover, the open and close traces are just a few tenths of a millimetre apart and show no crossings. This makes the kinematic centre a suitable choice in order to avoid false-positive diagnoses in the study of internal derangements by means of condylar movement recordings. However, the kinematic centre has the disadvantage that the mandibular movements have to be recorded by rather complicated six degrees of freedom recording equipment and that the exploration algorithm for its location may sometimes have difficulties in finding the right location.     

形态学实验教学改革——建设形态学实验中心

形态学实验教学中心的建设,使形态学实验方法和实验手段进入了一个更高层次。但怎样才能最大程度地做到资源共享,充分发挥实验技术人员的作用,是值得探索和思考的问题。     

医学文化中心的南迁

以《中国医学百科全书．医学史》及《中国医籍考》为统计对象，分别代表历代著名医家及医籍的地理性分布，结果发现：中国医学文化中心自上古以来，经历了一个由北向南的大迁移，其分界线是元代。元以前，中医文化中心一直在北方，核心地带为陕西，河南，河北，四川，元以后，医学文化中心转移至南方，具体地说是苏浙皖地区，对医学文化中心转移的现象进行了若干探讨。     

Spatial distribution of various types of bulbar respiratory neurons in the rabbit

Summary In anesthetized rabbits, the burst activity of 277 single respiratory neurons was recorded extracellularly. The neurons were classified according to their spike incidence distribution within the respiratory cycle and to their response to lung distension or collapse ( or type). About one third of the neurons found in all animals were located at the level of the caudal end of the promontorium gliosum, widely scattered over the bulbar cross-section. More rostrally the units were located within a dorsal area neighbouring the tractus solitarius, more caudally within a ventral field surrounding the nucleus ambiguus. Most of the inspiratory neurons (the most frequently encountered type) were found within an antero-medial region of the medulla, extending down to about two thirds of its depth. Most of the inspiratory-expiratory units were found within an intermediate zone extending from antero-dorsal to postero-ventral. Most of the expiratory cells were found postero-ventrally. Most of the expiratory-inspiratory neurons (the rarest type) were again found within an antero-medial region at an intermediate depth. The neurons were located in the rostral and the units in the caudal part of the medulla. The average proportion of respiratory neurons to non-respiratory units was estimated as about 1:36 and the total number of bulbar respiratory neurons as 500 on each side.     

Cancer in the elderly: pancreatic cancer

Pancreatic cancer remains a devastating and difficult disease to diagnose and successfully treat. Its incidence increases with age, with 60% of patients being over the age of 65 at presentation. Due to the insidious nature and asymptomatic onset of pancreatic cancer approximately 85% of patients present with disseminated or locally advanced disease resulting in a very poor prognosis. In the past the elderly patient, who may be felt to be too frail for operative procedures or further therapy, may have missed out on optimal treatment. In this article we review the investigation and treatment of pancreatic cancer and examine current evidence with regard to pancreatic cancer in the elderly. The evidence suggests that surgical resection can be performed safely in patients who are fit for surgery in specialist centres but may require more intensive post-operative rehabilitation.     

Cognitive function in Coffin-Lowry syndrome

Coffin-Lowry syndrome (CLS) is an X-linked disorder associated with mental retardation, distinctive facies and hands, hypotonia, and skeletal abnormalities. The syndrome results from mutations in the RSK2 gene located in Xp22.2. Although the syndrome has been elucidated clinically, few, if any, studies have focused on the cognitive deficits of the affected males or carrier females. The subjects of the present study were selected from two African-American families who have the same missense mutation (C340T) in RSK2. The subjects included six affected males, seven carrier females, three normal males and three non-carrier (normal) females. Normal family members served as contrast/comparison cohorts to control for socio-economic, sociocultural and genetic variables which would impinge on intellectual abilities. Analysis of cognitive function, as measured by the Stanford-Binet Intelligence Scale, 4th edn, demonstrated a distinct hierarchy of abilities from normal to carrier to affected patients. The mean composite IQs of the cohorts were 90.8, 65.0 and 43.2 for normal, carrier and affected individuals, respectively. These findings lend support to the clinical concept of negative intellectual effects in carriers of certain X-linked mental retardation conditions. X-inactivation studies showed that carrier females had mild to significant skewing. Normal females in the family did not demonstrate skewing. The correlation coefficient between IQ and X-inactivation status among carriers was not significant.     

Calman-Hine reassessed: a survey of cancer network development in England, 1999-2000

Rationale, aims and objectives The paper assesses preliminary national data on the development of cancer care networks in England. Methods In January 2000, a national postal survey was sent to lead clinicians at 36 cancer centres and associate centres. Respondents were asked to provide basic numerical data on the design of the network (i.e. its configuration), detailing how many units it encompassed, and whether the centre was a multiple or a single entity. Results The survey highlighted national variations in the size and configuration of networks. The survey also highlighted tentative signs of shifts in clinical practice. The results showed that consultants at cancer centres and units were engaging in two forms of collaboration across centre–unit boundaries. Type 1 involved routine multidisciplinary team (MDT) outreach from centres to units, incorporating joint planning between clinicians at cancer centres and cancer units. Type 2 collaboration involved joint planning but also promoted joint centre and unit training and continuing professional development (CPD) programmes. Conclusions In our estimation, both forms of collaboration represented early evidence of qualitative changes in medical working practices. Organizational changes within cancer services have moved swiftly since initial soundings were taken in 2000 and we update our initial commentary in the light of recent empirical data. The findings may be of wider significance to managers and health practitioners who are working towards the implementation of delivery network elsewhere in the UK National Health Service.     

Spiritual support for terminally ill patients: nursing staff assessments

This study is part of a larger questionnaire survey concerned with the views of nursing staff on physical, emotional and spiritual support for terminally ill patients and decision making on the transition to the terminal phase of treatment. This article discusses the results concerning the spiritual support offered to terminally ill patients. The results describe the readiness and willingness of nursing staff to provide spiritual support, the expression of spiritual needs by patients, the provision of spiritual support, and problems occurring in providing this support. A total of 328 nurses working on the in-patient wards of 32 community health centres took part. Data were collected with a questionnaire including both multiple choice items and open-ended questions. The data were processed with SPSS software and the responses to the open-ended questions were interpreted using content analysis. The results revealed shortcomings in nurses' readiness and willingness to provide spiritual support and clearly highlighted the need for further training. Half of the nurses said they only rarely offered spiritual support to their patients. The nurses drew attention to problems within themselves, their patients and with the availability of the chaplain's services. The results also pointed to factors related to the health centre and nursing staff.     

Collaboration, facilities and communities in day care services for older people

Collaborative working in care for older people is often seen as a desirable goal. However, there can be problems with this approach. This paper reports on a single blind randomized controlled trial which was carried out to compare outcomes of rehabilitation in two settings: a day hospital and social services day centres augmented by visiting therapists. The subjects were 105 older patients. Principal outcome measures were the Barthel Index, Philadelphia Geriatric Centre Morale Scale and the Caregiver Strain Index. Two aspects of the trial are examined here. Firstly, we investigated whether trial patients were more disabled than regular day centre attendees. Levels of health and well being amongst trial patients were compared with those of a random sample of 20 regular attendees from both of the participating day centres and an additional voluntary sector day centre. Secondly, key staff from the different settings were interviewed to assess how well the day centre model had worked in practice. Trial patients were significantly more disabled than regular day centre attendees according to the Barthel Index (P < 0.001), but this difference was no longer significant after three months of treatment. The day centre model had several problems, principally discharge policy, acceptability, facilities and attitudes of staff and regular attendees. Positive aspects of the day centre model, as well as successful rehabilitation, included shared skills, knowledge and resources. This paper suggests that collaborative working in day centres requires multipurpose facilities. If health staff maintain a permanent presence, benefits can include improved joint working, easier access to health care and the use of rehabilitative therapy as a preventative strategy. Day care settings can be analyzed as representing different types of communities. Allowing older users a greater degree of choice in facilities may increase the acceptability of care.