无锡市冷却塔水军团菌污染状况及菌型分析

目的了解无锡市不同场所冷却塔水中军团菌污染状况和血清型别。方法按照无锡市地理分布抽取32家公共场所和8家工厂作为监测点,共抽取冷却塔水529份,按照卫生部《集中空调通风系统卫生规范》附录A"空调系统军团菌的检验分析方法"进行检测。结果 529份冷却塔水军团菌的检出率达14.18%(75/529),阳性率以商场和医院为高,分别为27.45%(14/51)和24.00%(18/75)。公共场所以7、8月份的阳性率为高,分别为18.75%(9/48)和25.25%(25/99);工厂工艺性冷却塔水军团菌在全年各月份均有检出。军团菌血清型以LP1为主,占78.67%(59/75)。结论无锡市不同场所冷却塔水中存在军团菌污染,对人群健康构成潜在威胁,需引起重视。     

Urogynaecology training in the UK: past, present and future

Introduction  With the implementation of Modernising Medical Careers, there has been considerable discussion and debate regarding the role of the urogynaecologist in secondary and tertiary care and how trainees with subspecialty training and those with a special interest fit into the current and future provision of urogynaecology services within the framework of obstetrics and gynaecology as a whole. Discussion  Because of these changes, training in urogynaecology has and will continue to see major changes. This will also have an impact on workforce planning and service provision within the NHS. An attempt to highlight these issues has been made in this article.     

Controlled freezing studies on boar sperm cryopreservation

Boar spermatozoa from different males were frozen at a number of cooling rates using a controlled-rate freezing machine designed to minimise thermal variables involved in the cooling process, to see whether inter-boar sperm cryosurvival may be improved by changing cooling rate. Four cooling rates in the range 3 °C min⁻¹ to 24 °C min⁻¹ from +5 °C to −5 °C and five cooling rates in the range 5 °C min⁻¹ to 80 °C min⁻¹ from −5 °C to −80 °C were tested. Motile spermatozoa were assessed by CASA, plasma membrane integrity by fluorescent probes (SYBR14/propidium iodide) and flow cytometry, and acrosome membrane integrity by lectins (PSA-rhodamine) and fluorescent microscopy. Cooling rate affected sperm cryosurvival from different boars in different ways; that is, spermatozoa from some individuals were less susceptible than those from others. For some individuals, sperm cryosurvival was poor regardless of cooling rate, but for others it was better with faster rates. This confirms cooling rate effects on sperm cryosurvival depend on inter-individual boar differences more than on the cooling process itself.     

腹主动脉阻断术临床原理及其上中下段安全时限探讨——兼述缺血再灌注损伤机制与对策及“二叉树耐受法则”

目的深入探讨腹主动脉阻断术的临床原理及其高中低位阻断安全时限等问题,以期在临床上安全地使用该技术。方法1980年-1982年我们首次进行了腹主动脉阻断安全时限及其阻断与撤钳后病理生理变化的前瞻性实验研究。结果表明:犬腹主动脉阻断25min为安全时限;在阻断安全时限内,犬体内血液动力学、血气酸碱、血液生化和主要的脏器超微结构(脑肺肝肾胰肠脊髓)仅发生轻度可逆性改变;如超出安全时限,上述指标则会发生难以代偿的严重改变。基于广义生命时空场论学说,通过对腹主动脉阻断术解剖学基础,腹主动脉阻断后与撤钳后综合征群(呼吸宭迫综合征、急性高血压性脑水肿、多脏器微栓塞病细胞综合征、撤钳后中枢性呼吸衰竭)及腹主动脉阻断所致的缺血再灌注损伤病理生理与细胞分子生物学机制等讨论,并根据近期实验与临床研究结果和结合文献复习对相关问题做了探讨,对临床上预防和治疗腹主动脉阻断术所致的缺血再灌注损伤提出了一整套对策。此外还叙述了预防腹主动脉阻断术并发症的远端主动脉灌注、脑脊液引流以及硬膜外冷却、控制性再灌注与缺血预/后处理等几种新技术。结果如果超出腹主动脉阻断术安全时限,则在术中与术后将发生缺血再灌注损伤、全身炎症反应综合征和多脏器衰竭。临床上,人类一次性持续腹主动脉阻断术安全时限如下:高位(T12水平,腹腔干A上)、中位(L2水平,肾A上)与低位(L4水平,髂总A上)均不能轻易超越25-30min。如术中须延时宁可采用间断阻断法。结论如果"二叉树耐受法则"(即体内任何一处大血管阻断均不能超出其固有安全时限,否则受术者非死必伤)被严格遵守,则腹主动脉阻断术中与术后病人的安全将得到保证。     

Atrial fibrillation ablation with esophageal cooling with a cooled water-irrigated intraesophageal balloon: a pilot study

Introduction: A left atrioesophageal fistula is an uncommon but devastating complication that may occur during atrial fibrillation (AF) ablation, and may be due to thermal injury occurring during the radiofrequency (RF) ablation. We examined the feasibility of an esophageal cooling (ECO) method using a cooled water-irrigated intraesophageal balloon (IB).
Methods and Results: Eight patients with drug-refractory AF underwent RF catheter ablation to encircle the ipsilateral pulmonary veins. During the RF ablation at the posterior left atrium, the esophageal lumen was cooled using a 9-Fr. IB catheter with a balloon length of 40 mm and diameter of 10 mm, in which cooled water, with a water temperature of 4.5 ± 3.1 °C, was irrigated while the luminal esophageal temperature (LET) was measured with an intraesophageal probe placed at a site close to the tip of the ablation catheter. In the control, the LET increased from 36.4 ± 0.8 °C to 40.5 ± 1.7 °C within 26.1 ± 8.2 seconds during 3.9 ± 1.2 RF energy applications, whereas with the ECO the LET decreased to 30.2 ± 2.9 °C at baseline (P<0.01 vs control), and increased only to 33.5 ± 2.9 °C (P<0.01 vs control) at most, within 30 seconds during 3.9 ± 1.2 RF energy applications. All pulmonary veins were successfully isolated in all patients without any complications. During a follow-up period of 3.1 ± 1.2 months, no esophageal injuries were observed and all but one patient have been free from any symptoms.
Conclusions: Use of an IB successfully lowers LET. This might have the potential of preventing esophageal injury, although further study is required.     

Neurotransmitter receptor heteromers and their integrative role in 'local modules': the striatal spine module

‘Local module’ is a fundamental functional unit of the central nervous system that can be defined as the minimal portion of one or more neurons and/or one or more glial cells that operates as an independent integrative unit. This review focuses on the importance of neurotransmitter receptor heteromers for the operation of local modules. To illustrate this, we use the striatal spine module (SSM), comprised of the dendritic spine of the medium spiny neuron (MSN), its glutamatergic and dopaminergic terminals and astroglial processes. The SSM is found in the striatum, and although aspects such as neurotransmitters and receptors will be specific to the SSM, some general principles should apply to any local module in the brain. The analysis of some of the receptor heteromers in the SSM shows that receptor heteromerization is associated with particular elaborated functions in this local module. Adenosine A_2A receptor–dopamine D₂ receptor–glutamate metabotropic mGlu₅ receptor heteromers are located adjacent to the glutamatergic synapse of the dendritic spine of the enkephalin MSN, and their cross-talk within the receptor heteromers helps to modulate postsynaptic plastic changes at the glutamatergic synapse. A₁ receptor–A_2A receptor heteromers are found in the glutamatergic terminals and the molecular cross-talk between the two receptors in the heteromer helps to modulate glutamate release. Finally, dopamine D₂ receptor–non-α₇ nicotinic acetylcholine receptor heteromers, which are located in dopaminergic terminals, introduce the new concept of autoreceptor heteromer.     

Mustard oil enhances spinal neuronal responses to noxious heat but not cooling

The TRPA1 agonist mustard oil (allyl isothiocyanate = AITC) induces heat hyperalgesia and mechanical allodynia in human skin and sensitizes rat spinal wide dynamic range (WDR) neuronal responses to noxious skin heating. We presently used electrophysiological methods to investigate if AITC affects the responsiveness of individual spinal WDR neurons to intense skin cooling. Recordings were made from cold-sensitive WDR neurons in lamina I and deeper dorsal horn; 21/23 also responded to noxious skin heating. Topical application of AITC excited 8/18 units and significantly enhanced their responses to noxious heat while not significantly affecting responses to the cold stimulus. Vehicle (mineral oil) had no effect on thermal responses. The data confirm a role for the TRPA1 agonist AITC in enhancing heat nociception without significantly affecting cold sensitivity.     

Neck design对牙根形种植体边缘骨吸收的影响

目的：评价种植体功能性负载后对种植体表面在边缘骨水平的宏观和微观结构的影响。方法：采用非嵌入式种植一期手术,不行引导骨再生术。种植术后按时间段（3,6,12个月）进行影像学观察。结果：Ankylos种植系统（1.32±0.24mm）3个时段出现轻微的骨吸收,有统计学意义（P〈0.05）。Straumann种植系统（0.76±0.19mm）与Osstem种植系统组（0.21±0.12mm）3个月时段骨吸收量显著减少,但3～6个月与6～12月时段骨吸收量无显著性差异（P〉0.05）。3个种植系统组在上、下颌植入部位的边缘骨吸收量无统计学意义（P〉0.05）。结论：不同颈部设计的牙根形种植体边缘骨吸收量具有显著性差异,宏观表面结构种植体系统比精密颈部与微观表面结构的种植系统边缘骨吸收更稳定。