Deciding about mechanical ventilation in end-stage chronic obstructive pulmonary disease: how respirologists perceive their role

OBJECTIVE: To determine when respirologists approach patients with end-stage chronic obstructive pulmonary disease (COPD) to decide about the use of mechanical ventilation, what information they provide to patients and how they provide it. DESIGN: Self-administered national survey. PARTICIPANTS: All Canadian specialists in respiratory medicine; of 401 eligible respirologists, 279 (69.6%) returned a completed questionnaire. OUTCOME MEASURES: Timing and content of doctor-patient discussions regarding mechanical ventilation; physicians'' perception of their level of involvement in the decision-making process; and patient and physician characteristics that may influence decisions. RESULTS: Discussions were reported to occur most often at advanced stages of COPD: when the patient''s dyspnea was severe (reported by 235 [84.2%] of the respondents) or when the patient''s forced expiratory volume in the first second was 30% or less than predicted value (reported by 210 [75.3%]). A total of 120 respondents (43.0%) stated that they discuss mechanical ventilation with 40% or less of their COPD patients before an exacerbation necessitates ventilatory support. Most (154 [55.2%]) described the decision-making process as a collaboration between patient and physician; 83 (29.7%) reported that the patient decides after he or she has considered the physician''s opinion. Over half (148 [53.0%]) of the respondents indicated that they occasionally, often or always modify the information provided to patients in order to influence their decision about mechanical ventilation. CONCLUSIONS: Discussions with COPD patients concerning end-of-life decisions about mechanical ventilation are reported to occur in advanced stages of the disease or not at all, with patients'' input where possible. Information presented to patients is often modified in order to influence the decision. Future studies should explore ways to involve patients further in the decision-making process and to improve the process for both patients and physicians.     

MEMBRANE SYNTHESIS IN BACILLUS SUBTILIS : III. The Morphological Localization of the Sites of Membrane Synthesis

The results of several lines of investigation indicate that membrane growth in Bacillus subtilis does not occur at one or a small number of discrete zones. No indications of large regions of membrane conservation were observed. Kinetic labeling experiments of mesosomal and plasma membrane lipids indicate that the mesosomal lipids are not precursors of the plasma membrane lipids. Density shift experiments, in which the changes in buoyant density of membranes were studied after growth in deuterated media, showed no indication of large zones of conservation during membrane growth. Radioautography of thin sections of cells pulse labeled with tritiated glycerol showed no indication of specific zones of lipid synthesis. The consequences of these results for models of cell growth and division are discussed.     

东北小鲵中枢神经系统形态学与组织学初步研究

本文应用脊椎动物神经标本制作法和HE染色法,对东北小鲵中枢神经系统的外部形态和组织学结构进行了初步研究,描述了东北小鲵神经系统形态和组织学结构的特点,并与无尾两栖类和爬行类相对比,探讨了有尾两栖类的进化地位。结果表明:与无尾两栖类(如蛙)相比,东北小鲵中枢神经系统中,大脑半球较小,结构较为原始,小脑结构简单,是两栖类中较为原始的类群。此外,东北小鲵开始具有了臂神经丛和骶神经丛,但没有爬行类的发达,可作为两栖类向爬行类进化的证据之一。     

植物丝氨酸/精氨酸丰富(SR)蛋白的结构和功能及其在植物发育中的作用

丝氨酸／精氨酸丰富（SR）蛋白家族是真核生物中的一类剪接因子,在前体mRNA的组成性和选择性剪接中起作用。本文就近十几年来SR蛋白结构和功能及其在植物发育中的作用的研究进展作以介绍。     

珍稀鹤类巢址的空间聚类识别方法

依据2003年到2005年松嫩平原西部地区珍稀鹤类巢址调查数据,利用三种不同类型的指数进行分析研究:(1)拓扑指数,Voronoi图面积;(2)统计指数,Morishita指数;(3)空间指数,分维数.结果表明珍稀鹤类巢址空间格局具有明显的空间聚类分布,这三个指数使我们对珍稀鹤类巢址的聚类现象有了定量的认识,加深对自然保护区资源保护的重要性.     

Global transcriptional response of pig brain and lung to natural infection by Pseudorabies virus

Background  

Pseudorabies virus (PRV) is an alphaherpesviruses whose native host is pig. PRV infection mainly causes signs of central nervous system disorder in young pigs, and respiratory system diseases in the adult.     

5-HT_(1A)受体参与学习记忆的分子机制研究进展

5-HT(五羟色胺)能神经元是起源最早的神经元之一,在传统的神经元形成前,成长中的轴突就可释放5-HT,并且通过5-HT的各种亚型受体来实现不同的功能。近年来,随着5-HT、5-HTRs(五羟色胺受体)的基因克隆及5-HT受体选择性激动剂和拮抗剂的研究发展,5-HT系统在学习记忆中的作用越发明确,许多研究结果表明:5-HT系统在记忆的巩固、短时程记忆(STM)及长时程记忆(LTM)中起重要作用,5-HT1A受体更是在非脊椎动物及哺乳动物的脑中都高度表达,并通过相似的信号转导途径参与学习与记忆的形成和巩固。本文将介绍5-HT1A受体、5-HT1A受体激动剂、5-HT1A受体拮抗剂及其与学习记忆的联系,重点综述5-HT1A受体参与学习记忆的信号转导途径研究进展,讨论5-HT1A受体参与学习记忆的可能性分子神经生物学机制。