Selective impairment of paired associate learning after administration of a centrally-acting adrenergic agonist (clonidine)

Eight normal volunteers had IV infusions of 200 g clonidine (a centrally-acting adrenergic agonist which reduces noradrenaline release), and saline in a double-blind cross-over design. Clonidine reduced subjective estimates of arousal but did not affect performance on the Digit Symbol Substitution Test. Clonidine impaired pairedassociate learning, but it did not affect performance on a number of measures of short and long term memory. The findings suggest either 1) that there is a specific (adrenergic) mechanism involved in the acquisition of novel associations, but not in other types of learning, or 2) that paired associate learning is more vulnerable than other learning tasks to disruption of adrenergic transmission.     

Serum digoxin concentrations in a representative digoxin — Consuming adult population

Summary As part of health examination of a representative sample of an adult population (n=8000) serum digoxin concentration was measured in 661 patients on continuous digoxin therapy. The prescribed mean daily dose of digoxin was significantly higher in men (223 µg) than in women (201 µg); the dose significantly decreased with increasing age. The mean serum digoxin concentration was the same in men and women and it differed insignificantly between age groups, although older persons tended to have a higher concentration. The age — adjusted mean steady state digoxin concentration was 1.02 ng/ml in men and 0.98 ng/ml in women; in about 60% the concentration was within the therapeutic range (0.80–2.00 ng/ml). The concentrations were clearly related to daily dose of digoxin. At equal dose levels old persons tended to have higher concentrations than younger persons. The interindividual variation in serum digoxin concentrations was very wide. However, when digoxin measurements in the same subjects were repeated about three months later, a good correlation between the two measurements was found. The interval between the last dose of digoxin and the collection of blood (up to 41 h) had relatively little effect on individual serum digoxin concentrations. Patients on concomitant thiazide or loop diuretic therapy had the same mean serum digoxin concentration as those not-receiving a diuretic. The mean concentration was significantly higher in patients taking a thiazide or loop diuretic combined with triamterene. The difference may have been due to an interaction between triamterene and digoxin.     

Effects of different speeds of induction with sevoflurane on the EEG in Man

The effects of two kinds of induction speed of sevoflurane anesthesia on the EEG pattern were compared in the same individual using medical student volunteers: a first exposure of 4% was given, followed after full recovery, by incremental doses of 1, 2 and 4% successively, each being administered for 10min. The arterial blood level of the anesthetic was measured using gaschromatograph. The changes of EEG pattern during fast induction with 4% were not represented by the abbreviation of those observed during the slow induction with the incremental doses. The administration of 4% induced a sudden appearance of high voltage, rhythmic slow waves of 2–3Hz at 1–3min when the arterial blood anesthetic level increased maximally, which was then followed by a pattern of faster activities of 10–14Hz mixed with 5–8Hz slow waves. In contrast, the administration of incremental doses induced an increase in frequency and amplitude of EEG activities in the light plane, followed by their decreases in deeper planes. The final EEG patterns were identical for both these methods of induction. These findings confirmed our previous hypothesis that not only the arterial blood level of anesthetics but the rate of its increase are important factors determining the EEG pattern of anesthesia.(Avramov MN et al.: Effects of different speeds of induction with sevoflurane on the EEG in man. J Anesth 1: 1–7, 1987)     

Contrasting effects of vasopressin,desglycinamide-vasopressin and amphetamine on a delayed matching to position task in rats

The effects of peripherally injected arginine vasopressin (AVP: 0–25 g/kg), its desglycinamide analogue (DGAVP: 0–25 g/kg), which is practically devoid of pressor activity, and d-amphetamine (AMP: 0–1.25 mg/kg) were studied using a delayed (0–32 s) matching to position task (Dunnett 1985). A limited hold for responding (20 s) was in operation. This task enables an accurate assessment of forgetting in rats. AVP reliably improved per cent correct performance, and this effect was substantiated by accuracy indices derived from signal detection theory (TSD). DGAVP, however, was inactive, suggesting that the parent peptide's pressor properties were responsible for its beneficial effects. AMP disrupted performance in a dose-related manner, and was the only substance to alter a TSD bias index (responsivity index, RI), indicating a degree of response repetition at the highest dose. These results are consistent with some earlier reports, and suggest that AVP may enhance memory by peripheral action, while AMP disrupts performance. Closer inspection of the data, however, suggested that the peptide reduced general responsiveness. A new index to measure bias (Sahgal 1987) suggested that AVP-treated subjects restricted their sample and choice responses to one side of the operant chamber, thereby achieving a spuriously high detection rate with few errors of commission (incorrect responses). It is concluded that AVP does not, after all, improve performance: on the contrary it has detrimental effects, and produces errors of omission (failure to respond).     

Long-term periodontal status of labially erupted canines following orthodontic treatment

Periodontal status was studied at the mesiobuccal, midbuccal and distobuccal aspects of contralateral pairs of canines in 22 postorthodontic patients aged 30 to 51 years with a mean time of 26.4 years (SD, 5.6) out of active treatment. The pretreatment models showed one canine erupting severely to the labial ("ectopic") with a contralateral canine in good arch alignment (control). None of the patients experienced relapse of the "ectopic" canine in a labial direction, and none had missing teeth, malalignment, overhanging restorations or open tooth contacts adjacent to the canines evaluated. Periodontal parameters were examined using a Michigan #0 probe with Williams markings. A nonstandardized light force was used and the measurements were rounded to the nearest millimeter. The results demonstrated statistically significant differences between the canines in probing attachment and bone levels (mean, 0.75; SD, 0.92; P less than 0.01) and width of attached gingiva (mean, 0.50; SD, 1.07; p less than 0.05) at the midbuccal aspects. The reason for these differences could only be speculated upon.     

基于双重差分法视角评估按病种分值付费对心血管病种患者的影响

目的 分析按病种分值付费政策对心血管病种患者实施效果并提供相关建议。方法 以广东省某大型三甲综合医院DIP政策实施前后收治的64 970份心血管病种患者为研究样本,通过描述性统计和双重差分法,分析两种不同医保支付方式(广州医保、其他医保)对相关医疗指标的影响。结果 按病种分值付费政策实施后,广州医保患者人均住院费用从49 060.62元下降到46 984.24元(t=-6.924,P＜0.001),自负金额减少2 104.67元(t=-10.654,P＜0.001),住院天数下降0.40天(t=-8.824,P＜0.001),三个指标的差异均具有统计学意义,而其他医保支付方式患者的这三个指标在两个时期的差异无统计学意义。在费用结构中有明显变化幅度的分别是综合医疗服务费(t=53.403,P＜0.001)、诊断费(t=50.198,P＜0.001)、治疗费(t=22.804,P＜0.001)、西药费(t=-12.488,P＜0.001)、血浆和血浆制品费(t=-7.93,P＜0.001)、耗材费(t=-17.901,P＜0.001)以及其他费用(t=-115.076,P＜0.001),差异均具有统计学意义,变化幅度最大的是耗材费,同比减少5.53%。以“风险级别”为分层标准对人均住院费用和住院天数进行双重差分法分层分析,政策效果仅发生在人均住院天数中“中低风险级别”和“没有出现死亡病例”两组病例。结论 按病种分值付费改革有利于增强医院自主管理意识,减轻参保人员个人负担水平,优化费用结构,但仍需加强控制重点费用类别,并未能充分体现医疗服务价值和达到促进分级诊疗目的,需提高支付标准的科学性和精准性。     

1990—2019年中国高血清低密度脂蛋白胆固醇疾病负担趋势分析与预测

目的 描述和分析1990—2019年中国高血清低密度脂蛋白胆固醇（high LDL cholesterol,高LDL - C）疾病负担状况及变化趋势,并预测未来5年的疾病负担,为中国高LDL - C科学防控提供依据。方法 提取2019年全球疾病负担（GBD 2019）中因高LDL - C造成的死亡数、死亡率及DALYs等疾病负担指标,相关指标均采用GBD 2019全球标准人口进行年龄标准化,采用平均年度变化百分比（AAPC）分析率的变化趋势,并应用R 4.1.0对1990—2016年中国因高LDL - C造成的死亡率和DALYs率建立ARIMA模型和NNAR模型,用2017—2019年的数据来评价两模型的拟合效果,最后用拟合效果最好的模型预测2020—2024年中国高LDL - C死亡率和DALYs率。结果 1990—2019年中国高LDL - C造成的死亡率（AAPC = 3.1%,P＜0.05）和DALYs率（AAPC = 2.2%,P＜0.05）整体呈波动上升趋势;标化死亡率和DALYs率增长14.21%和0.56%,男女性别比范围分别为1.33～1.67和1.36～1.76,男性高于女性;年龄别疾病负担≥70岁人群远高于15～49岁和50～69岁群体;ARIMA（0,2,0）和NNAR（1,1）模型预测与实际趋势基本一致,前者预测值与实际值相对误差、均方根误差（RMSE）、平均绝对误差（MAE）以及平均绝对百分误差（MAPE）均较小,预测精度更好。 结论 中国高LDL - C造成的疾病负担呈逐渐上升趋势,在2020—2024年将继续上升。男性、高龄人群疾病负担更加沉重,应采取针对性措施进行干预。     

康妇炎胶囊联合米非司酮对输卵管异位妊娠患者疗效分析

目的 探讨康妇炎胶囊联合米非司酮治疗输卵管异位妊娠的临床效果和安全性。方法 选取2017年5月—2019年5月就诊于我院的84例输卵管异位妊娠患者,按随机数字表法分为两组,各42例。对照组予以米非司酮治疗,观察组加用康妇炎胶囊治疗。比较两组临床疗效、包块大小和血β-人绒毛膜促性腺激素(β-HCG)、性激素水平、不良反应情况。结果 观察组临床总有效率为92.86%,高于对照组的73.81%,差异有统计学意义(χ2=5.486,P=0.019);两组治疗后包块大小均较治疗前小,观察组治疗后包块大小为(0.84±0.12)cm,较对照组的(1.16±0.18)cm小(t=9.586,P＜0.001);两组β-HCG均较治疗前低,β-HCG为(312.04±63.65)U/L,较对照组的(435.14±68.41)U/L低,差异有统计学意义(t=8.538,P＜0.001);两组治疗后卵泡刺激素(FSH)、雌二醇(E2)和促黄体生成素(LH)水平低于治疗前,观察组治疗后FSH(12.03±2.11vs14.58±2.23,t=5.383,P＜0.001)、E2(143.69±15.62vs158.95±16.37,t=4.371,P＜0.001)、LH为(9.34±1.53vs13.05±2.18,t=9.028,P＜0.001)均低于对照组;两组不良反应相比,差异无统计学意义(χ2=0.138,P=0.457)。结论 康妇炎胶囊联合米非司酮可增强输卵管异位妊娠治疗效果,改善性激素水平,加快包块消失,促进β-HCG复常,安全可靠。     

长链非编码RNA AGAP2-AS1在胶质瘤增殖过程中作用机制的研究

目的探究长链非编码RNA AGAP2-AS1在胶质瘤增殖过程中的作用机制。方法选取2018年12月-2019年11月期间的30例胶质瘤患者为观察组,同时期的30例脑外伤患者为对照组。比较两组的组织AGAP2-AS1 mRNA表达量、Ras及ERK1/2蛋白表达情况,并比较观察组中不同分级胶质瘤的AGAP2-AS1 mRNA表达量、Ras及ERK1/2蛋白表达情况,比较转染siRNA AGAP2-AS1与siRNANC的U87及U251细胞克隆数。结果观察组的RNA AGAP2-AS1 mRNA表达量、Ras及ERK1/2蛋白表达显著高于对照组,不同分级胶质瘤的RNA AGAP2-AS1 mRNA表达量、Ras及ERK1/2蛋白表达比较,差异有统计学意义(P<0.05),转染siRNA AGAP2-AS1的U87及U251细胞克隆数显著低于siRNA-NC,差异有统计学意义(P<0.05)。结论长链非编码RNA AGAP2-AS1可通过调控ERK/MAPK信号通路影响胶质瘤的增殖,下调AGAP2-AS1可显著影响胶质瘤细胞的克隆形成能力。     

Zinc Nutritional Status in a Series of Children with Chronic Diseases: A Cross-Sectional Study

Background: Zinc is an essential trace element for the normal growth and development of human beings. The main objective was to evaluate the nutritional status of zinc and its association with nutritional indicators in a series of children with chronic diseases. Methods: The prevalence of patients with dietary zinc deficiency or deficit zinc intake (<80% DRI: dietary reference intake) was analyzed through prospective 72 h dietary surveys, and serum zinc deficiency or hypozincemia (≤70 µg/dL in children under 10 years of age in both sexes and in females older than 10 years and <74 μg/dL in males older than 10 years) was measured through atomic absorption spectrophotometry. The participants were classified according to their nutritional status by body mass index (BMI). Results: Mean serum zinc level in obese (87 µg/dL), undernourished (85 µg/dL), and eutrophic children (88 µg/dL) were normal, but in the undernutrition (60% DRI) and eutrophic (67% DRI) groups the mean dietary zinc intake was low compared to that in the obesity group (81% DRI). There were different associations between nutritional parameters, dietary zinc intake, and serum zinc. All patients with hypozincemia had dietary zinc deficiency. Conclusions: In the whole series, 69% of participants showed a zinc intake lower than recommended and might be at high risk of zinc deficiency.