A Study on Extension－Flexion Dynamic Lumbar Spine Radiographsin Patients with Lumbar Intervertebral Disc Herniation

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Recommendations for educational reform in the United States

This article suggests that the United States educational system needs significant changes. The goal of the article is to present a basic educational philosophy that would facilitate this reform. Specifically, education should be viewed as not only a means to an end that teaches basic skills for employment, but also as a process that enhances social development and self-actualization. Recommendations are offered to achieve this important goal.     

Independent learning among general practice trainees: an initial survey

Self-directed learning is a natural way for adults to learn. Vocational training for general practice is a preparation for unsupervised clinical work that will be supported, in the main, by continuing medical education. This study uses the Self-Directed Learning Readiness Scale to investigate factors influencing readiness for such learning among a sample of general practice trainees. Three principal factors emerged from analysis: enjoyment and enthusiasm for learning; a positive self-concept as a learner and a factor suggesting the possibility of a 'reproducing' orientation to learning. These factors may reflect approaches to learning in general rather than these adopted for professional learning, but offer helpful pointers for the development of both vocational training and of continuing medical education.     

Long term changes in the vascular wall after laser recanalization of an artery

All-Union Surgical Research Center, Academy of Medical Sciences of the USSR, Moscow. (Presented by Academician of the Academy of Medical Sciences of the USSR N. N. Malinovskii.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 112, No. 12, pp. 653–657, December, 1991.     

Development of quality of care indicators for Parkinson's disease.

Parkinson's disease (PD) is a major cause of disability. To date, there have been no large-scale efforts to measure the quality of PD care because of a lack of quality indicators for conducting an explicit review of PD care processes. We present a set of quality indicators for PD care. Based on a structured review of the medical literature, 79 potential indicators were drafted. Through a two-round modified Delphi process, an expert panel of seven movement disorders specialists rated each indicator on criteria of validity, feasibility, impact on outcomes, room for improvement, and overall utility. Seventy-one quality indicators met validity and feasibility thresholds. Applying thresholds for impact on outcomes, room for improvement, and overall utility, a subset of 29 indicators was identified, spanning dopaminergic therapy, assessment of functional status, assessment and treatment of depression, coordination of care, and medication use. Multivariable analysis showed that overall utility ratings were driven by validity and impact on outcomes (P < 0.01). An expert panel can reach consensus on a set of highly rated quality indicators for PD care, which can be used to assess quality of PD care and guide the design of quality improvement projects.     

Respiratory tract infections due to different rhinovirus serotypes and the influence of maternal antibodies on the clinical expression of the disease in infants.

Rhinoviruses were isolated from nasopharyngeal secretions of 49 children hospitalized because of severe respiratory tract infection. The isolates were typed using 90 type-specific antisera. No obvious relation between certain serotypes and the severity of illness was found. Serum samples were drawn from all children simultaneously with the nasopharyngeal secretions and screened for the presence of type-specific neutralizing antibodies. Children aged 1 week to 6 months had higher neutralizing antibody titers and revealed a lower degree of morbidity than older children. The decline of neutralizing serum antibodies with increasing age was correlated with a higher incidence of severe disease in those aged 7-12 months. Nevertheless, also in this age group children with mild clinical courses of disease were observed despite a low concentration or an absence of neutralizing serum antibodies. This indicates that not only neutralizing serum antibodies, but other factors also influence the clinical expression of RHV-induced disease.     

Cerebellar nuclear afferents--where do they originate? A re-evaluation of the projections from some lower brain stem nuclei

Summary Cerebellar nuclear afferents from some caudal brain stem nuclei in the cat were studied by means of retrograde transport after implantation of the wheat germ agglutinin-horseradish peroxidase complex in crystalline form in the cerebellar nuclei. The findings give evidence that projections to the cerebellar nuclei from certain nuclei of the reticular formation proper (e.g., from the gigantocellular reticular nucleus) are very modest, while there appears to be no or extremely few cerebellar nuclear afferents from the paramedian reticular, spinal trigeminal, gracile, cuneate and external cuneate nuclei. Previous tracer studies have given evidence that also the pontine and red nuclei send very few, if any, fibres to the cerebellar nuclei. All these brain stem regions are known to project to the cerebellar cortex. This relative lack of mossy fibre collaterals to the cerebellar nuclei is discussed with references to previous literature on the distribution of cerebellar nuclear afferents, and the problem of how the cerebellar nuclei are facilitated is considered.Abbreviations Br.c. superior cerebellar peduncle (brachium conjunctivum) - Br.p. middle cerebellar peduncle (brachium pontis) - C.r. interior cerebellar peduncle (restiform body) - HRP horseradish peroxidase - L left - N.c. cuneate nucleus - N.c.e. external cuneate nucleus - N.c.t. nucleus of corpus trapezoideum - NIA anterior interposed nucleus - NIP posterior interposed nucleus - NL lateral (dentate) nucleus - N.l.l. nuclei of lateral lemniscus - NM medial (fastigial) nucleus - N.m.X. dorsal motor vagal nucleus - N.mes. mesencephalic trigeminal nucleus - N.r.l. lateral reticular nucleus (nucleus of the lateral funiculus) - N.r.p. paramedian reticular nucleus - N.r.t. reticular tegmental pontine nucleus - N V, VI, VII, XII root fibres of cranial nerves - Ol.s. superior olive - P.h. nucleus praepositus hypoglossi - Py pyramid - R right - R.gc. gigantocellular reticular nucleus - R.l. lateral reticular nucleus of Meessen and Olszewski - R.p.c. caudal pontine reticular nucleus - R.pc. parvicellular reticular nucleus - R.v. ventral reticular nucleus - Tr.sp.V. spinal tract of the trigeminal nerve - T.s. solitary tract surrounded by nucleus of solitary tract - V.m. medial vestibular nucleus - WGA wheat germ agglutinin - WGA-HRP wheat germ agglutinin-horseradish peroxidase conjugate - V, VI, VII, X, XII motor nuclei of cranial nerves     

不同起搏模式对病人生存质量影响的调查研究

[目的]探讨不同起搏模式对病人生存质量（QOL）的影响。[方法]以健康调查问卷（SF一36量表）对112例不同起搏模式病人进行问卷调查，比较3种起搏模式下病人的QOL水平。[结果]除机体疼痛、角色情绪2个维度外其余6个维度（生理功能、角色限制、活力、社会功能、精神健康、总体健康）3种起搏模式间比较差异有统计学意义（P〈0．05）。[结论]应用AAI型、DDD型起搏器的病人生存质量优于VVI型起搏。     

Rhabdomyoma of the heart with intrapericardial expansion

A rare case of a rhabdomyoma originating from the surface of the right atrium in a 20-year-old female is reported. The tumor showed electrical activity and caused both outflow obstruction and tamponade symptoms. It was successfully removed by a right-sided thoracotomy. The clinical course, diagnostic investigations, and the therapeutical approach of this rare lesion are discussed.     

Synthesis of cyclic tryptathionine peptides

The helicity of the tryptathionine moiety of the phallotoxins has been recognized by comparison with cyclic tryptathionine tripeptides. In order to investigate the influence of the configuration of the component amino acids on the conformation of the cyclic peptides, six analogue thioether tripeptides containing L- and D-alanine and L- and D-cysteine, respectively, have been synthesized. The CD spectra of the peptides are very similar to each other, showing mirror images of the CD of phalloidin and, therefore, negative helicity. The spectra of the D-cysteine containing compounds differ from the L-cysteine containing compounds by their weakly positive ellipticity values around 270 nm. The cyclization reaction of Boc-Hpi-D-Ala-D-Cys(STrt)OCH₃, along with the cyclic tripeptide, afforded a cyclic hexapeptide by dimerization. The CD spectrum of the dimer is very similar to that of phalloidin, thus pointing to a positive helicity of its two tryptathionine moieties. The dimeric thioether peptide forms a rather strong complex with Cu²⁺ ions.