An experience of renal replacement therapy in a combined neonatal and paediatric intensive care unit of Hong Kong

Intensive care services are expensive. The experience of developing a combined paediatric and neonatal intensive care unit (ICU) in a regional hospital is reported with reference to the provision of renal support for the critically ill patients. The combined unit is staffed by a team of paediatric intensivists, each of whom has special interest in a subspecialty, including cardiology, respiratory medicine, nephrology and neonatology. In the past 7 years, renal replacement therapy (peritoneal dialysis and haemofiltration) was provided to 40 patients, with comparable mortality and complication rates to other reports. This arrangement has been feasible and might be more efficient than running separate paediatric and neonatal ICUs or combining the paediatric ICU with the adult ICU.     

羰基二咪唑酰化剂用于头孢菌素的合成

头孢菌素合成常采用混合酸酐法、DCC法、活化酯法等肽类合成方法。羰基二咪唑(简称CDI,I)法也属肽类合成方法。最近有文献报道,将此法用于头孢菌素C_3·位乙酰氧基的改造以及氨苄青霉素α-氨基的修饰。但用于头孢菌素C_7位缩合未见报道。本文采用     

The Effect of 50 Hz External Electrical Interference on Implanted Cardiac Pacemakers

The effects of injected 50 Hz alternating current on the function of cardiac pacemakers has been observed in 18 patients with implanted unipolar VVI units. Current, in the range 0-600 microA was applied via electrodes attached to the patients' upper body and feet and fed from a specially designed current injection unit at the bedside. Most implanted pacemakers reverted to interference mode in the current range 29-250 microA. At current levels just below the reversion current all units developed irregular and inappropriate pacing. This current level was pacemaker dependent and varied in the range 27-246 microA. The total reversion current depended on the location of the injecting electrodes and on the patients' posture. The sensitivity of the units to injected interference was increased by deep inspiration. Temporary pacing catheters fitted to an additional ten patients were used to monitor the interference voltage which would be sensed by an implanted unit. This voltage was similarly dependent on patient posture and on deep respiration. Current injection has proved to be a safe, controllable and reproducible method of testing the sensitivity of implanted pacemakers to 50 Hz external interference.     

加速创建爱婴医院进程 积极推广母乳喂养

为加速创建爱婴医院进程,昆明市妇幼保健院率先在全省开展了创建爱婴医院工作。他们大胆改革产科制度,实行母婴同室,建立健全了各项规章制度,实行母乳喂养系列化服务。     

Unilateral lesion of the nigrostriatal pathway decreases the firing rate and alters the firing pattern of globus pallidus neurons in the rat

Activities of spontaneously firing neurons in the globus pallidus of intact rats and rats that survived unilateral lesions of the nigrostriatal pathway for 3 days, 1 week, or 6-11 weeks were compared. No significant differences in neuronal firing rate, firing pattern, and number of cells per pass were observed between chloral hydrate-anesthetized control and lesioned animals. However, in locally anesthetized animals, pallidal cells fired significantly faster than in chloral hydrate-anesthetized animals, and the lesion caused a decrease in the firing rates of pallidal cells 1 week and 6-9 weeks postlesion. In addition, significant differences in the firing pattern of pallidal cells, as determined by the ratio of the mean to median interspike intervals, were seen between locally anesthetized controls and animals surviving 3 days, 1 week, and 6-9 weeks postlesion. This altered firing pattern tended to return to normal with time. The number of cells per pass was not significantly altered by the lesion. Data from this study suggest that, in locally anesthetized animals, the removal of the tonic dopaminergic input to the basal ganglia causes pallidal cells to decrease their firing rates in a time-dependent fashion and causes reversable firing pattern changes. This suggests that tonically active dopamine neurons, probably acting through the striatopallidal pathway, regulate the firing rate and mechanisms controlling the temporal ordering of spontaneous discharges of globus pallidus neurons.     

The relationship between receptor-effector unit heterogeneity and the shape of the concentration-effect profile: Pharmacodynamic implications

The apparent concentration-effect relationship is the ensemble of many effector units (such as individual cells or channels) that do not always exhibit a uniform stimulus-effect relationship. This concept is substantiated by many observations of heterogeneity in receptor-effector populations including hormone secreting cells, response to hormonal stimuli, activity pattern of second messengers, stimulus-evoked synaptic currents, and single ion channels. The relationship between drug concentration and magnitude of pharmacologic response is commonly described by the sigmoidalE _max model which was derived from the Hill equation. The sigmoidicity factor (N) in this model is assumed to be a pure mathematical parameter without physiological connotations. This work demonstrates that the numerical value ofN (measured empirically) is the product of two factors: (i) the degree of heterogeneity of the effector subunits, i.e., the elemental component that upon drug stimulus contributes its pharmacological effect independently and does not interact with other subunits (it could range from a single receptor up to a whole tissue), and (ii) value ofN ^*—the shape factor of the subunits' concentration-effect relationship. A special case of this approach occurs whenN ^*>5, which is an on-off case. HereN is determined by the distribution (density equation) of the subunit values. In case of heterogeneity of the microparameters of the effector subunits the apparentN will always have a lower value thanN ^*. According to this theory it can be concluded that without knowledge of the distribution of the microparameters no mechanistic interpretation can be deduced from the apparentN value. If in the futureN ^* can be determined by theoretical or experimental methods, the distribution function relatingN ^* toN can be calculated. The relevance of this theory is increased in view of the progress being made in advanced research techniques which may enable us to determine the concentration-effect relationship at the level of the individual effector unit.     

晚发性抑郁患者情绪调节机制的ERPs研究

目的采用事件相关电位探讨晚发性抑郁患者情绪调节障碍的神经生理机制。方法被试者包括16例晚发性抑郁患者（发病年龄≥60岁）与16名健康老年人。采用Go／Nogo实验范式，要求被试者对刺激序列中双个三角形进行按键反应（Go），单个三角形不反应（Nogo）。记录32导脑电。结果健康老年人中，Nogo刺激产生了明显的额中央区分布的N2Nogo和P3Nogo；与对照组相比，病例组的N2Nogo。波幅明显增高，而P3Nogo波幅显著降低，两者潜伏期无显著差异。结论晚发抑郁患者存在情绪调节障碍，其电生理学指标为N2Nogo明显增高和P3Nogo的显著降低，为晚发性抑郁的诊断和治疗提供了一定的客观评价指标。     

甘南州合作地区藏汉学生个性特征及其影响因素的初步探讨

对生长在合作地区的955名藏、汉族学生进行了个性特征及其影响因素的调查探讨。结果表明:本民族间男、女生E分比较,男生低于女生,显示女生性格较男生性格外向倾向性大。稳定性方面女生N分高于男生,即女生情绪一般不及男生稳定。此外与该地区藏汉族学生个性特征关系较为密切的因素是:兄弟姐妹数、父母亲文化程度、职业以及学前教育和智商。     

特殊药品管理方法探讨

笔者结合单位的做法和体会,对医疗单位等在特殊药品使用管理中存在的问题,提出特殊药品的管理应法制化、职责化、程序化、档案化及提高业务素质、奖优罚劣的管理方法。     

新生大鼠反复惊厥对NMDA受体表达的长期影响

目的：研究反复惊厥对大鼠脑内N-甲基-D-天门冬氨酸(NMDA)受体表达，以及成年期认知功能和惊厥阈的长期影响。方法：生后6d(用P6表示，下同)的Wistar大鼠随机分成两组，每组6只，惊厥组每日吸入三氟乙醚诱导惊厥发作1次，每次持续30min，连续6d；对照组同样操作但不吸入三氟乙醚。两组大鼠于P60-P65行Morris水迷宫实验，检测大鼠的学习记忆功能。于P75时给予大鼠腹腔注射戊四唑(PTZ)测定大鼠的惊厥阈。随即断头处死大鼠，分离大脑皮质和海马，匀浆提取细胞膜蛋白，应用免疫印记法测定NMDA受体亚基l(NRl)和NR2A-2D表达的变化。结果：从P6l至P65，两组大鼠寻找平台时间均逐渐缩短，惊厥组大鼠在P65的平均寻找平台时间较对照组显著延长。惊厥组大鼠注射PTZ后发生惊厥的潜伏期与对照组比较差异无显著性。在大脑皮层，惊厥组大鼠较对照组NRl和NR2B表达水平明显下调，在海马这两种亚基表达水平无明显改变，在大脑皮层和海马区，惊厥组较对照组NR2A表达水平明显下调，NR2C表达水平明显上调。两组在皮层和海马均无NR2D表达。结论；新生大鼠反复惊厥可导致远期认知障碍，同时伴有NMDA受体的数量和结构上的长期改变，NMDA受体表达的这种改变可能在发育期惊厥导致的脑长期认知功能损害中起重要作用。