Interactions among the cannabinoids in the antagonism of the abdominal constriction response in the mouse

The ability of ⁹-tetrahydrocannabinol (THC), cannabinol (CBN), cannabidiol (CBD), 11-OH THC and 8,11-diOH THC to antagonise the abdominal constriction response in the mouse induced by formic acid, phenylquinone, 5-hydroxytryptamine, prostaglandin E₁ (PGE₁) and bradykinin was tested. THC was an effective antagonist against all nociceptive agents with an ED₅₀ in all cases between 1.0 and 2.6 mg/kg. CBN, while also effective against all nociceptive agents, was less potent than THC, with an ED₅₀ range between 46.2 and 112.5 mg/kg. CBD in doses as high as 200 mg/kg was without effect. Using PGE₁ as the nociceptive agent, 11-OH THC was equipotent to THC while 8,11-diOH THC was inactive. Naloxone, while able to antagonise the antinociceptive effect of morphine against formic acid-induced writhing, did not reverse the antinociceptive effects of THC. There were no pharmacological interactions between THC, CBD and CBN.     

女性医务人员健康状况的研究

目的探讨女性医务人员健康状况的特点。方法对2877例医院工作人员健康查体资料进行统计学分析。结果①女性医务人员中,41.0%的人员患有不同类型的疾病,略高于男性患病率（36.8%）,二者差异有统计学意义（P=0.029）;②女性医务人员高脂血症为31.9%（212/665）,低于男性（65.9%,274/416）;③脂肪肝患病率女性（32.6%,181/556）,亦低于男性（45.9%,151/329）;④女性相关疾病中,乳腺疾病和子宫肌瘤的患病率分别为4.8%和3.4%;而宫颈糜烂为20.2%;⑤女性医务人员高血糖为11.0%（77/702）,高血压为4.6%（56/1229）。结论女性医务人员中妇科与乳腺疾病是健康体检的重点,代谢性疾病也应加以关注。     

人文关怀在手术室护理中的应用

目的探讨在手术室护理中人文关怀的作用。方法将2012年5月至2012年11月200例手术患者随机分为两组,对照组100例,采取术前、术中常规护理,观察组100例,在对照组的基础上给予患者人文关怀,对比两组护理满意度及疗效。结果对照组各项指标满意度低于实验组(P<0.05),与对照组比较,实验组的住院时间明显缩短,痛苦小,并发症发生率低,P<0.05,差异均有统计学意义。结论 "以人为本"的人文关怀理念应用于手术室中,可充分提高护理质量及患者的满意度。     

Role of the liver in the disposition of intravenous nitroglycerin in the rat

Previous studies have indicated that the liver is the main site of nitroglycerin (NTG) elimination when the drug is systematically infused. To examine this hypothesis, we measured the apparent systemic clearance (Cls) of nitroglycerin in anesthesized rats receiving a constant intravenous infusion at a dose of 100 micrograms per kg per min. Animals were divided into shunt and sham groups; the former had undergone a portal vein ligation 10 days prior to the study, while the latter was subjected to a sham operation. On the study day, half of the animals of each group also received probenecid at 200 mg/kg, i.v., a drug previously reported to inhibit organic nitrate ester reductase (ONER) activity in rat liver. Arterial NTG samples were obtained at 41, 43 and 45 min of infusion in all four experimental groups; Cls was 439 +/- 32 ml per kg per min (mean +/- S.E.) in sham, 460 +/- 44 in sham and probenecid, 477 +/- 39 in shunt, and 461 +/- 34 in shunt and probenecid animals. During NTG infusion, hepatic blood flow (measured with a constant infusion of indocyanine green) was decreased markedly in shunted rats as was liver/body weight, indicating hepatic atrophy. The specific activity of hepatic ONER was similar in all four groups. In spite of marked differences in hepatic blood flow and hepatic mass, the Cls was similar in all four groups. The liver does not appear to be a major site for the elimination of systemic nitroglycerin as hitherto assumed.     

Recent advances in the pharmacotherapy for hyperbilirubinaemia in the neonate

Jaundice is a common cause for diagnostic works-up and therapeutic intervention in neonates. This is motivated by the risk for severe neurological sequelae (kernicterus). The mainstays of treatment for the past decades have been exchange transfusion and phototherapy. Exchange transfusion is now becoming rare due to immune prophylaxis in Rhesus-negative women, and treatment of sensitised infants with intravenous immunoglobulin. Several different pharmacological approaches have been studied as far as the treatment of neonatal jaundice. Of these, the focus of attention in recent years has been on the haem oxygenase inhibitors (metal meso- and protoporphyrins). These are effective inhibitors of bilirubin production and have been shown to significantly reduce peak serum bilirubin levels in several clinical trials, both when used prophylactically and therapeutically. However, questions remain regarding long-term safety, as well as the advisability of whole-scale inhibition of bilirubin production. Nevertheless, in selected infants with a high risk of severe jaundice, the use of haem oxygenase inhibitors may be acceptable. Pharmacotherapy in jaundiced infants is fraught with risks, as many drugs may increase the entry of bilirubin into the brain and presumably, the risk for neurotoxicity. Both the displacement of bilirubin from its albumin binding and interference with the function of phosphoglycoprotein in the blood–brain barrier are documented mechanisms in this respect.     

上海市社区卫生服务中心医务人员伦理学知识调查及建议

目的:调查上海社区卫生服务中心医务人员的伦理学知识认知情况.方法:采取分层抽样方式,于2016年6—8月对上海市245家社区卫生服务中心的7552名医务人员进行问卷调查.结果:医务人员对伦理学知识非常了解、基本了解、了解很少和完全不了解的人数分别为536人(7.1%)、5411人(71.7%)、1536人(20.3%)和69人(0.9%).不同岗位、职称、学历的医务人员之间存在着明显的伦理学知识认知差距.结论:上海社区卫生服务中心医务人员的伦理学知识了解程度仍有待提高,需加强伦理学知识的学习和应用.     

Piracetam in the treatment of cognitive impairment in the elderly

Reisberg, B., S.H. Ferris, M.K. Schneck, J. Corwin, P. Mir, E. Friedman, K.A. Sherman, M. McCarthy, and R.T. Bartus : Piracetam in the treatment of cognitive impairment in the elderly. Drug Dev. Res. 2: 475–480, 1982. Piracetam (Nootropil, 2-oxopyrrolidone acetamide) has been extensively investigated for the treatment of cognitive impairment. Initial studies on normal subjects and patients with mild or moderate cognitive decline have been somewhat encoruaging. Accordingly, we conducted a further evaluation of the effects of piracetam in the treatment of elderly outpatients 60 to 85 years of age with mild to moderate memory impairment consistent with a diagnosis of Primary Degenerative Dementia (PDD). In our first study, we examined the effects of piracetam in 20 patients. All patients received 7.2 g of piracetam and placebo for 4 weeks in accordance with a double-blind, randomized treatment order, crossover design with 1-week washout periods prior to each crossover period. Hence, the total study period for each patient was 10 weeks (1-4-1-4). An analysis of 43 psychometric measures revealed significant improvement (P < 0.05) in only three measures, all favoring the treatment condition. Recent findings support a rationale for examining the effects of piracetam in conjunction with cholinergic precursors in patients with cognitive decline. In our second study we conducted a 1-week open trial of 1.6 g of piracetam t.i.d. in conjunction with 3 g of choline cholride t.i.d. in 15 patients. Four patients were rated as clinically improved. These “responders” were all subjects with moderate cognitive impairment. The responders showed much higher RBC choline levels than the nonresponders, both at baseline and during treatment. We conclude that the present evidence indicates that the effects of piracetam treatment alone in elderly outpatients with mild to moderate congnitive decline are subtle and not of proven clinical significance. However, studies of longer duration and of piracetam in combination with other agents may eventually show genuine clinical utility.     

pH-Related Changes in the Absorption of Dipyridamole in the Elderly

The bioavailability of dipyridamole, a poorly soluble weak base, was evaluated in 11 healthy, older subjects (65 years), 6 with a low fasting gastric pH (control) and 5 with a fasting gastric pH > 5 (achlorhydric), in a randomized, crossover design. Subjects received 50 mg dipyridamole as a single oral dose both with and without pretreatment with 40 mg famotidine (control subjects) or 1360 mg glutamic acid HC1 (achlorhydric subjects). Gastric pH was monitored by Heidelberg radiotelemetric capsule. Gastric emptying of ^99mTc-radiolabeled orange juice was measured. Gastric pH appeared to be a primary determinant in dipyridamole absorption in the elderly. Elevated gastric pH resulted in compromised dipyridamole absorption compared to low-gastric pH conditions in all cases. The administration of glutamic acid hydrochloride to achlorhydric subjects prior to the dose of dipyridamole corrected for the decreased C _max and AUC(0–36) exhibited in achlorhydric subjects without pretreatment. T_max and k _a were slower in achlorhydrics, although pretreatment with glutamic acid HC1 tended to normalize these parameters. Based on these results, it would be beneficial for achlorhydrics to take glutamic acid hydrochloride prior to taking dipyridamole and other medications which need a low gastric pH for complete absorption. The administration of 40 mg famotidine was successful in elevating the gastric pH to >5 in all subjects and maintained it at >5 for at least 3 hr in all subjects tested. The lack of differences in C _max and AUC(0–36) with significant differences in T _max and k _a indicated that control subjects after treatment with famotidine may serve as an adequate model for achlorhydrics with respect to the extent of absorption, but not with respect to the rate of absorption. Gastric emptying of a nutrient liquid was significantly slower in achlorhydric subjects than in control subjects. Finally, fasting serum gastrin appeared to be a relatively reliable and easy method for screening for achlorhydria in the elderly.     

Adenosine mechanisms in the regulation of breathing in the rat

The central respiratory effects of various adenosine (A) analogues were studied in halothane-anesthetized rats. Intracerebroventricular (i.c.v.) and intraperitoneal (i.p.) injections of the A analogues (2-Cla, L-PIA, CHA and NECA) reduced minute ventilation (VE) due to decreases in respiratory frequency (f) as well as tidal volume (VT). Dose-dependent effects were seen after i.c.v. L-PIA in both normal and vagotomized rats. Analysis of the A-induced changes using the occluded breath technique revealed an increase in expiratory time (TE) as well as a decrease in inspiratory drive. NECA, a relatively specific A2 agonist seemed to be somewhat more potent in eliciting respiratory depression than a relatively specific A1 agonist like L-PIA. Pretreatment with the methylxanthine theophylline completely antagonized the respiratory depression induced by L-PIA. It is concluded that central A receptors are involved in the central regulation of breathing and that A interacts with the respiratory control system mainly by decreasing inspiratory neural drive and prolonging expiratory time.     

Nifedipine in the treatment of hypertension in the elderly

The effect of nifedipine monotherapy, retard tablets, 20 mg bid, was evaluated in 23 hypertensive patients, mean age, 79 +/- 2 years. Twenty-one patients completed an eight-week study. Blood pressure (BP) decreased to 160/90 mm Hg in 15 patients; in four additional patients diastolic BP dropped by 15% to 28%. In a subset of five patients with isolated systolic hypertension, a significant reduction in systolic BP was noted. Side effects were relatively mild and only two patients discontinued the study. The results suggest that nifedipine monotherapy offers an alternative, logic, therapeutic approach to hypertension in the elderly.     

Studies on the receptors involved in the action of the various agents in the phenylbenzoquinone analgesic assay in mice

1. Tolerance to the activity of several narcotic analgesics (morphine, levorphanol, and methadone) and several narcotic-antagonist analgesics (pentazocine, cyclazocine, and nalorphine) was studied in the mouse phenylbenzoquinone stretching test. Virtually complete tolerance was induced by chronic treatment with each of the narcotic agents, while no apparent tolerance was induced by the narcotic antagonists.2. In morphine-tolerant mice there was a high degree of cross-tolerance to the effects of not only the other narcotic drugs but also to those of the narcotic antagonists, acetylsalicylic acid, and physostigmine.3. The effects of morphine and pentazocine were antagonized by naloxone but not by atropine, while the effects of physostigmine were antagonized by atropine but not by naloxone. Neither atropine nor naloxone antagonized the effect of acetylsalicylic acid.4. The results of the tolerance study suggest that there is a fundamental difference in the consequences of receptor interaction for the narcotic and the narcotic-antagonist analgesics. Morphine-tolerant mice exhibit cross-tolerance non-specifically. The selectivity of naloxone and atropine differentiates the narcotic and narcotic-analgesics from the other two agents used in this analgesic test.     

生活方式干预在代谢综合征中应用观察

目的探讨生活方式干预在代谢综合征中应用疗效。方法随机分为干预组106例采取基础治疗联合生活方式干预,对照组110例采取基础治疗,干预组和对照组病例体重、收缩压、舒张压、血糖、三酰甘油、总胆固醇进行观察并进行比较。结果干预组与对照组比较P〈0.01有差异有统计学意义。干预前与干预组比较P〈0.01差异有统计学意义。干预前与对照组比较P〈0.05差异有统计学意义。结论代谢综合征治疗过程中生活方式干预非常重要,能够有效的加强患者的体能运动和饮食控制,降低体重,降低胰岛素抵抗,降低血糖,调节脂代谢紊乱防止心脑血管病变。     

Diurnal rhythm in the central dopamine turnover in the rat

Summary Under controlled conditions of environmental light and darkness of 12:12 h the turnover of dopamine and noradrenaline in brain of male Wistar rats was studied at different times of the day. The turnover was calculated from the decline of the amine concentrations either after inhibition of the tyrosine-hydroxylase with H 44/68 (200 mg/kg, i.p.) or after inhibition of the dopamine--hydroxylase with FLA 63 (40 mg/kg s.c.). Whereas the noradrenaline turnover showed only slight but not significant variations within 24 h, the turnover of the central dopamine exhibited significant variations with increased turnover rates in the second half of the light and first half of the dark period. Thus, diurnal variations have to be taken into account when studying the effects of drugs on the turnover of biogenic amines in the central nervous system.Parts of this work were presented at the 16th Spring-Meeting of the German Pharmacological Society, Mainz 1975 (Lemmer and Berger, 1975a) and at the Int. Congr. on Rhythmic Function in Biological Systems, Vienna 1975 (Lemmer and Berger, 1975b)     

Serotonin in the control of the sleep-like states in frogs

It has been established that brain serotonin (5-HT) is involved in the control of behavioral phenomena in amphibians. The transition of frogs from active wakefulness to sleep-like states was accompanied by alteration of brain 5-HT metabolism, i.e., in sleep-like state with plastic muscle tone 5-hydroxyindoleacetic acid (5-HIAA) level was reduced and in sleep-like state with rigid muscle tone both brain 5-HIAA and 5-HT were decreased. An experimental decrease of brain 5-HT level by inhibition of its biosynthesis by p-chlorophenylalanine (200 mg/kg) induced the sleep-like state of catatonic type, i.e., the state which was characterized by lowered brain 5-HT.     

Dose-related differences in the distribution of cocaine in the maternal-fetoplacental compartments in rats

Our goals were to examine whether a high dose of cocaine to causing CNS toxic manifestations in the pregnant rats influences the delivery of cocaine to the fetus, and whether the non-placental compartments have a significant role in the distribution of cocaine to the fetal tissues. Either a low or high dose of cocaine was infused intravenously to near-term pregnant rats. Arterial blood pressure and heart rate were monitored. Cardiac output and uterine and placental blood flows were measured by using radiolabeled microspheres. Plasma and tissue samples were obtained from the mother, placenta, and fetus and analyzed for cocaine and its metabolites via capillary gas chromatography/mass spectrometry. A high dose of cocaine induced convulsions that were accompanied by increased arterial blood pressure and decreased uteroplacental blood flow. However, the distribution pattern of cocaine and metabolites in the mother and fetus were similar between the high and low dose groups. Considerable amounts of cocaine and its metabolites were in the placenta. Previously ignored non-placental tissues, such as the amnion and myometrium appear to be a significant source for cocaine accumulation in the fetus.     

2008年上半年我院住院患者抗菌药物应用情况调查分析

目的：了解我院2008年上半年抗菌药使用情况,为促进临床合理使用抗菌药提供依据。方法：定期抽查我院2008年上半年出院病历600份,对抗菌药使用的基本情况、合理使用情况及围手术期预防用药情况进行统计分析。结果及结论：我院抗菌药使用率为82.3%,联合使用占抗菌药使用的39.9%,不合理使用占抗菌药使用的20.4%（不包括围手术期的术前给药时间和术后停药时间）,Ⅰ类切口手术预防性抗菌药使用率为100%。     

Neurotensin causes a greater increase in the metabolism of dopamine in the accumbens than in the striatum in vivo

Differential pulse voltammetry with carbon fibre electrodes was used to study the effect of central administration of neurotensin on the extracellular level of 3,4-dihydroxyphenylacetic acid (DOPAC) in the nucleus accumbens and the striatum in anaesthetised rats. Intracerebroventricular injection of neurotensin (10 micrograms) increased the peak height for DOPAC 20 min after administration in the nucleus accumbens but only after 40 min in the striatum. The maximum increase was similar in both regions, with 30% and 27% above the pre-injection basal level, respectively. Neurotensin (1 micrograms) however increased the extracellular level of DOPAC in the nucleus accumbens alone. Neurotensin (0.1, 1.0 and 3.0 micrograms/0.5 microliter), injected into the ventral tegmental area, induced a potent and long-lasting elevation of the peak height for DOPAC in the nucleus accumbens, while the same doses in the substantia nigra produced effects on the metabolism of dopamine in the striatum of smaller amplitude and shorter duration. The maximum effect of each dose was about 2.5 times greater in the mesolimbic, compared to the nigrostriatal system. Amphetamine (2 mg/kg, s.c.) decreased the extracellular level of DOPAC with a similar magnitude, both in the nucleus accumbens (52%) and the striatum (47%). Intracerebroventricular administration of neurotensin (1 micrograms), 5 min after amphetamine, did not alter the effect of amphetamine on the extracellular level of DOPAC either in the nucleus accumbens or the striatum. However, neurotensin (10 micrograms) partially reversed the effect of amphetamine in the nucleus accumbens and had a similar but smaller and delayed effect in the striatum. The results from the present study, together with previous neurobehavioural studies, suggest that neurotensin has a relatively selective action on the mesolimbic dopaminergic system in the rat.     

英国全科医疗绩效考核的经验及启示

总结英国全科医疗绩效考核内容和特性,对照上海社区全科医疗绩效考核现状,从建立评价指标体系、统一考评信息化平台、调整绩效考核结果兑现模式三方面提出优化社区卫生全科服务绩效考核的建议。