大鼠三叉神经本体觉中枢传导通路的电生理学证明

近年来形态学上发现了三叉神经领域本体感觉中枢通路,在此基础上,本文用电生理学方法,通过电刺激咬肌神经和压下颌,观察了由四级神经元组成的此通路的二级（三叉神经脊束核吻侧亚核背内侧部及邻接的网状结构）、三级（沿三叉神经感觉主核内缘存在的“带状区”）中继核团以及作为最后驿站的丘脑腹后内侧核等处的单位放电反应;另外又分别刺激或损毁二、三级中继核团,观察了丘脑腹后内侧核的单位放电变化,结果证明电刺激咬肌神经和压下颌,在上述核团都出现对本体觉冲动反应的单位放电,包括兴奋性反应单位、抑制性反应单位和无关单位三种类型,以兴奋性单位为主,占神经元单位放电总数的５２．９％～６７．７％．分别刺激二和三级神经元的所在核团,在丘脑腹后内侧核处发生相应的单位放电效应;损毁二和三级核团,本体觉传入冲动被阻断。本研究结果从电生理学上确证了形态学上发现的三叉神经本体感觉中枢通路的客观存在,从定性研究方面支持了定位研究的结果,并填补了以往生理学上只证明初级传入核团与丘脑腹后内侧核之间存在着一条多突触联系的本体觉传递通路但未能判断其具体行径和中继部位的空白,本研究并对方法论以及一些有关问题进行了讨论．     

Influence of Δ9 and cannabidiol on photically evoked after-discharge potentials

Two cannabinoids, ⁹ and cannabidiol, and several reference drugs were compared relative to their effects in a recently developed anticonvulsant test system, the after-discharge potentials of the visually evoked response; the potentials were recorded electrophysiologically from electrodes permanently mounted over the visual cortices of conscious rats. In anticonvulsant doses, trimethadione and ethosuximide produced an extensive depression of after-discharge activity, whereas diphenylhydantoin and cannabidiol exerted no such effect. In contrast, anticonvulsant doses of ⁹ and subconvulsant doses of pentylenetetrazol markedly increased after-discharge activity, which may represent a manifestation of their central nervous system excitatory properties. The data from the present study support our previously published observations from several other anticonvulsant tests that indicate the anticonvulsant characteristics of cannabidiol resemble those of diphenylhydantoin rather than those of trimethadione and that the central excitatory properties of ⁹ distinguish it from cannabidiol. The results consistently suggest that the cannabinoids will be effective against grand mal but not absence seizures.     

EFFECT OF ELECTROACUPUNCTURE OF SCALP-POINTS ON ABNORMAL DISCHARGES OF NEURONSAROUND THE CEREBRAL HEMORRHAGE FOCUS IN THE RAT

Thereexistdifferentdegreesofpathophysi ologicchangesinthetissuesaroundhemorrhagefocusafteracutecerebralhemorrhage[1 ] .Cere bralhemorrhageoftenleadstodysfunctionoftheneuronsinthebrain ,manifestingabnormalelec tricalactivity .Followingacutecerebralhemor rhage,duetotheoppressionofthehematomaandthetoxiceffectofthebloodcontentsaswellaschangesofthemicro environmentaroundthehemorrhagefocus,theelectricalactivityofthecerebralneuronsissuppressedatdifferentde grees.Electroacupuncture (EA)therapyworkell…     

Clinical Application of Breast Fiberoptic Ductoscopy in 354 Cases with Abnormal Nipple Discharge

OBJECTIVE To use the breast duct endoscope for studying thepathological characteristics of breast-duct disease with nipple discharge,and offer methods that can improve diagnostic accuracy.METHODS A total of 354 patients with nipple discharge were examinedusing the fiberoptic duct endoscope (FVS-3000M). Ducts and theirbranches were investigated to define and locate the extent of intraductallesions. Core biopsies were taken of suspicious lesions and the findingswere analyzed retrospectively.RESULTS In cases of bloody and serosanguineous nipple discharge,72.3% were papilloma and papillomatosis, 5.2% duct cancer and 22.5%mammary duct ectasia and galactophoritis. In patients with watery nippledischarge, 56.0% were papilloma and papillomatosis, 8.0% were breastcancer and 5 patients without abnormal findings were regarded asnormal.CONCLUSION Fiberoptic duct endoscopy can accurately locate the siteand pathology of nipple discharge allowing the improvement in diagnosisof early breast cancer.     

乳头溢液的诊治

目的 探讨乳头溢液的诊断和治疗方法。方法 回顾分析116例乳头溢液病例资料。结果 全部病例中，乳腺癌17例，乳腺导管内乳头瘤70例，导管内乳头状瘤病13例，共100例，占85.4％。结论 乳腺导管镜检查是乳头溢液病因诊断的首选方法，对乳头溢液特别是血性溢液应及早明确病因，以便进行合理的手术治疗。     

Effects of a multidisciplinary, post-discharge continuance of care intervention on quality of life, discharge satisfaction, and hospital length of stay: a randomized controlled trial.

OBJECTIVE: To determine the impact of a hospital-coordinated discharge care plan, involving a multidisciplinary team of primary health care providers, on hospital length of stay, quality of life, and both patient and general practitioner inclusion in, and satisfaction with, discharge procedures. DESIGN: This investigation comprised a prospective, randomized, controlled, clinical trial. SETTING: This multicentre and cross-jurisdictional study focused on areas of tertiary and primary health care as well as community allied health in Western Australia. PARTICIPANTS: Patients (n = 189) with chronic cardiorespiratory diagnoses were recruited from respiratory, cardiovascular, and general medical wards at two tertiary hospitals. INTERVENTION: Subjects were randomly assigned to one of two groups. Intervention group patients received a discharge care plan in accordance with that outlined in the Australian Enhanced Primary Care Package, completed before discharge and sent to the patient's general practitioner and other community service providers for review. Control patients were discharged under existing hospital processes. Outcome measures. Patients and general practitioners were surveyed pre-discharge and 7 days post-discharge for quality of life and opinion of discharge procedures. Hospital length of stay was also determined. RESULTS: Significant improvements in discharge planning involvement, health service access, confidence with discharge procedures, and opinion of discharge based on previous experience were seen for patients who received the discharge care plan. Further, improved perceptions of mental quality of life were observed within the first week post-discharge for intervention patients. Length of stay showed no difference between groups. Extent and speed of hospital-general practitioner communication were significantly improved via the intervention. CONCLUSIONS: Our results indicate that a multidisciplinary discharge care plan, initiated before separation, improves quality of life, involvement, and satisfaction with discharge care, and hospital-general practitioner integration. As such, it possesses benefits over current Western Australian hospital discharge procedures for the care of chronically ill populations.     

乳头溢液514例分析

目的 :探讨乳头溢液的病因和诊断方法 ,有效降低乳腺疾病的发生。方法 :采用乳头溢液涂片检查对 5 14例乳头溢液病例进行回顾性分析。结果 :乳腺导管内乳头状瘤 31.13% ,乳腺囊性小叶增生 2 2 .5 7% ,乳腺癌 14 .78% ,导管扩张症 13.0 4 % ,乳腺炎 12 .4 5 % ,其他 6 .0 3%。结论 :乳头溢液脱落细胞学检查是乳头溢液病因及诊断的首选检查 ,近红外线扫描检查有助于诊断。半数以上≥ 5 0岁乳头溢血患者是乳腺癌患者。早诊、早治溢液性乳腺疾病是防止乳腺癌的重要措施。     

单纯乳头溢液的诊治体会(附64例报告)

目的总结单纯性乳头溢液的诊断和治疗经验。方法对64例单纯性乳头溢液的诊断治疗进行回顾性分析。结果乳腺彩超及选择性乳管造影术对本病均有较高的诊断价值，阳性率分别为66．67％和71．88％。病变乳管内置管美蓝注射有助于病灶的探查和切除。结论乳腺彩超及选择性乳管造影对乳头溢液的诊断有很重要意义，通过美蓝指示行病变区乳腺区段切除安全有效。     

Opportunities for Improving Post-Hospital Home Medication Management Among Older Adults

SUMMARY

Effective post-hospital home medication management among older adults is a convoluted, error-prone process. Older adults, whose complex medication regimens are often changed at hospital discharge, are susceptible to medication-related problems (e.g., Adverse Drug Events or ADEs) as they resume responsibility for managing their medications at home. Human error theory frames the discussion of multi-faceted, interacting factors including care system functions, like discharge medication teaching that contribute to post-hospital ADEs. The taxonomy and causes of post-hospital ADEs and related risk factors are reviewed, as we describe in high-risk older adults a population that may benefit from targeted interventions. Potential solutions and future research possibilities highlight the importance of interdisciplinary teams, involvement of clinical pharmacists, use of transitional care models, and improved use of informational technologies.     

Pilot of the Patient Concerns Inventory – Ward Discharge in Patients following major reconstructive surgery for head and neck cancer

Planning discharge from hospital following microvascular free-tissue surgery can be complex and challenging. Planning involves the patient, carers, and multiple health professionals. Poor communication and expectations can delay discharge or give a suboptimal discharge process. It was hypothesised that prompt-list modelled along the principals of the Patient Concerns Inventory (PCI) could be help in discharge planning. The aim of this study was to define the items and format of a PCI-Ward Discharge (PCI-WD) and undertake a small pilot. Items appropriate for the PCI-WD were formulated through discussion with patients, carers, ward staff, Head and Neck Clinical Nurse Specialists, and clinicians. The pilot took place over three months from December 2019 through to February 2020. Audit approval was given by the hospital Audit Department. The PCI-WD comprises 43 items. Items from existing PCIs for use at diagnosis and follow-up consultations were reduced in number and 38 new or modified items added; six treatment related, five social care and social well-being, four psychological, emotional, and spiritual well-being, seven physical and functional well-being, and 16 discharge related. The pilot involved 14 free-tissue transfer patients, seven male, seven female, with an age range of 57 to 87 and a mean age of 72. Eight PCI-WD were returned. PCI-WD items identified most frequently were ‘surgery site other than head/neck’, ‘when do I come back to hospital’, ‘dental check-up/oral health care’ and ‘diet/eating’. Early findings suggest that PCI-WD could be a useful tool in aiding the discharge process. Further evaluation is required.