Epidemiology of traumatic cervical spinal cord injury in Tianjin, China.

STUDY DESIGN: A retrospective epidemiological study. OBJECTIVE: To describe the recent epidemiological characteristics of traumatic cervical spinal cord injury (TCSCI) in adults in Tianjin. SETTING: Tianjin Medical University General Hospital. METHODS: This study included all TCSCI patients aged ≥ 15 years who were admitted to a general hospital from December 2008 to November 2011. Epidemiological characteristics including gender, age, marital status, occupation, etiology, level of injury, severity and America Spinal Injury Association (ASIA) impairment scale were recorded. RESULTS: A total of 143 patients with TCSCI were included in the study. Mean age was 54.6 ± 14.6 years (men 53.5 ± 14.9 years, women 54.2 ± 12.1 years), with a range of 18-87 years, and the male/female ratio was 5:1. The leading cause was falls (49.7%), followed by motor vehicle accidents (36.4%). The most common injury site was C5, accounting for 42%. In all, 74 (51.7%) patients had complications; the most common complication was hyponatremia (30.1%), followed by urinary infection (23.1%), respiratory infection (18.2%), bedsore (9.8%) and deep venous thrombosis (4.9%). As for the severity, ASIA grade D was encountered most frequently. Six patients died, five of whom died from respiratory failure. CONCLUSION: The epidemiology of TCSCI has its own characteristics. Falls were the leading causes, and TCSCI occurred most frequently in the middle-aged and elders. Therefore, establishing public policies aimed at preventing injuries should focus on falls and more attention should be paid to the aged regarding their vulnerability to low fall. Additionally, complications should be prevented in TCSCI patients.

Anomalous potential response and (Na+ + K+)-ATPase in in vitro frog gastric mucosa.

In general, increasing K+ on the nutrient side decreases the transmucosal PD (nutrient becomes more negative) but after bathing the mucosa in zero K+ media for about 30 min, or longer, elevation of K+ on the nutrient side increases the PD, an anomalous effect. In Cl- media, increasing nutrient K+ from zero to 4 mM produces an increase in PD (an anomalous response) of 3.1 and 5.3 mV in 2 and 5 min, respectively. Ouabain (10(-3) M) to the nutrient side abolished the anomalous response as did removal of Na+ (choline for Na+) from bathing media. In SO4(2-) media (SO4(2-) for Cl-), a significant anomalous PD response was observed when K+ on the nutrient side was increased from zero to 1, 2 or 3 mM but not to higher K+ concentrations. In this case, ouabain also abolished the anomalous response. It is postulated, on the basis of the effects of ouabain and the use of choline media, that an electrogenic (Na+ + K+)-ATPase pump is present on the nutrient-facing membrane in which more Na+ than K+ are transported per cycle.

Effects of ouabain on frog gastric mucosa in vitro.

The effect of the addition of ouabain to the nutrient solution was determined on resistance, potential difference (p.d.) and H+ secretion rate. In NaCl media, 10(-3) M ouabain decreased significantly the p.d. from 25.6 mV to 16.1 mV in 30 min and to 11.0 mV in 60 min. No significant changes occurred in resistance and H+ secretion rate. In Na2SO4 (Cl(-)-free) media, ouabain produced a biphasic effect on p.d. The p.d. changed from -28.0 mV (nutrient-negative) to a nadir of -37.4 mV in 7 min and then increased to -16.4 mV in 60 min. At the nadir there was no significant change in resistance or H+ secretion rate but at 60 min, unlike Cl- media, resistance increased by 36% and H+ secretion rate decreased by 43%. To decide whether the ouabain-caused decrease in H+ rate in Na2SO4 media was due to an effect on the H+ pump or on resistance of the return pathways, the voltage was clamped at 0 and 40 mV. Clamping the voltage showed that in the case of a marked decrease in the H+ secretion rate, the H+ transport mechanism itself was inhibited (and not the parallel pathway). The decrease in p.d. due to ouabain in Cl- and SO42- media indicates that the (Na+ + K+)-ATPase mechanism may be electrogenic.

Emergency management and infection control in a radiology department during an outbreak of severe acute respiratory syndrome.

The World Health Organization classified Taiwan as a serious epidemic-stricken area when the extent of severe acute respiratory syndrome (SARS) in Taiwan became clear. As of 11 July 2003, 671 probable SARS cases had been identified in Taiwan and 7 healthcare workers had died from the disease. Radiographers were easily infected by SARS because they had close contact with suspected or probable cases while conducting chest X-ray examinations. Three radiographers had been infected by the end of May 2003. Because of the impact of SARS on the Radiology Department, the department established a SARS emergency infection control team and re-designed the department's infection-control and emergency-management procedures based on the concept of risk-grade protection. This effort included installing a radiographic room at the fever-screening station, re-allocating human resources in the Radiology Department, training the department staff in infection control, and drafting new operational procedures for radiographers conducting X-ray examinations on SARS patients. The goal of this program was to reduce the infection rate and distribute materials efficiently in the department. This article introduces the emergency-management procedure of the Radiology Department during the SARS outbreak and the infection-protection experience of the department staff.

Electrically silent Na+ and Cl- fluxes across the rabbit ciliary epithelium.

Unidirectional Na+, Cl-, and mannitol fluxes were measured across the isolated and short-circuited rabbit iris-ciliary body as functions of the Cl- concentration in the bathing solution (0, 26 and 80 mM). At constant Na+ concentration, Na+ fluxes increased on the average from 8.0 to 11.9 mu eq/hr as the Cl- concentration was raised and vice versa. Cl- fluxes also increased more than expected from simple diffusion; from 2.0 (26 mM) to 8.1 mu eq/hr (80 mM). Mannitol permeability (9.0 X 10(-7) cm/sec) was independent of the Cl- concentration and similar to that measured in "tight" epithelia. In Cl(-)-free solutions, there was good agreement between the measured electrical resistance and that calculated with the partial conductance equation. In Cl(-)-rich solutions, the calculated resistance was smaller than the measured resistance, suggesting electrically silent fluxes of Na+ and Cl-. These silent fluxes were of similar magnitude and possibly coupled with each other. This mechanism may provide an additional pathway for electrolyte movement across the ciliary epithelium.

Active transport of ascorbate across the isolated rabbit ciliary epithelium.

The transepithelial transport of ascorbate across the isolated rabbit ciliary epithelium (CE) was investigated. Unidirectional 14C-ascorbate fluxes were measured in the presence of equal concentrations of ascorbate on both sides of the tissue within the range of 0.025 to 1 mM. The blood to aqueous (Bl----Aq) flux increased from 6 to 95 nmoles/hr and showed nonlinearity and saturation. The aqueous to blood (Aq----Bl) flux increased, for the same range, from 0.5 to 23 nmoles/hr in a linear fashion. The permeability calculated from the Aq----Bl flux was similar to the CE permeability for mannitol suggesting that the Aq----Bl flux is mainly paracellular. The flux ratio Bl----Aq/Aq----Bl was between 4 to 12. Anoxia, ouabain and low Na+ in the media inhibited the Bl----Aq flux indicating that the transport system requires energy and a Na+ gradient. 3-O-methyl-D-glucose, D-isoascorbic acid and phlorizin also inhibited the Bl----Aq flux, suggesting that ascorbate and glucose may share a common carrier mechanism. Although the isolated CE preparation was clearly capable of flux separation and active transport, the rate of ascorbate transport measured in vitro is insufficient to maintain the aqueous ascorbate concentration observed in vivo.

Electrical parameters of the isolated monkey ciliary epithelium and effects of pharmacological agents.

The electrical properties of the isolated monkey ciliary epithelium (CE) were determined in an Ussing-type chamber. In a Hepes, HCO3- buffered solution, transepithelial potential difference (PD), short-circuit current (SCC) and electrical resistance (Rt) were -2.5 mV (aqueous-side negative), 8.5 microA and 246 omega, respectively. Epinephrine (0.01 mM) increased the SCC and PD across the isolated monkey CE when added to the aqueous-side bathing solution but was without effect when added to the blood-side bathing solution. Forskolin (0.01 mM) increased the SCC and PD when added to the bathing solution on either side. A disulfonic stilbene, DIDS (0.1 mM), reduced the SCC and PD when added to the aqueous-side bathing solution but was without effect when added to the blood-side bathing solution. Ouabain (0.1 mM) added to the aqueous-side produced a transient stimulation followed by a gradual inhibition of the SCC and PD. On the blood-side, ouabain directly inhibited the SCC and PD towards zero. Although the general electrical properties were similar to those of the isolated rabbit iris-ciliary epithelium, there were differences in the effects of these pharmacological agents on the electrical properties.

Possible mechanisms of salt-induced hypertension in Dahl salt-sensitive rats.

Genetic factors, diet, and salt sensitivity have all been implicated in hypertension. To further understand the mechanisms involved in salt-induced hypertension, cardiovascular, hemodynamics, and biochemical parameters in Dahl salt-sensitive rats were evaluated in animals on high- and low-sodium diets. During a 4-week treatment period, blood pressure was significantly elevated in the high (8.0%) salt group compared to the low (0.3%) salt group (p< or =0.05 for weeks 2 and 4, respectively). No significant changes were observed in heart rate. The increase in blood pressure was associated with significant increases in lower abdominal aortic and renal vascular resistance, along with a reduction in blood flow. A fourfold increase in arginine vasopressin was observed in animals on the high-salt diet. In contrast, there was no effect on plasma sodium, potassium, or aldosterone levels during the treatment period. As measured in isolated aortic rings, the high-salt diet also caused a significant elevation in stimulated norepinephrine release and a reduction in cyclic GMP levels. These data suggest that salt-induced elevation in blood pressure is due to activation of both the sympathetic and arginine vasopressin systems via mechanisms involving decreased cyclic GMP generation in vascular smooth muscle.

Concentrations of radionuclides of size fractionated fly-ash emissions from a thermal power plant using Taiwan coal.

Coal, fly ash and bottom ash samples were taken from a 300-MWe coal-fired power plant with a daily coal consumption of 2400 tons. A high volume sampler coupled with several mesh testing sieves was used to separate fly ash samples into different size fractions. Determination of the concentrations of 40K, 238U, 226Ra, 210Pb, 210Po, 228Th and 228Ra was carried out either by gamma or alpha spectrometry. For elements volatilized during combustion, their radionuclide concentrations decrease with increasing particle size. The enrichment factors for all radionuclides mentioned above were studied. Their values range from 31.0 for 210Po to 2.2 for 228Ra. Of all radionuclides studied, 210Po and 210Pb are the most volatile elements; therefore, an increase in the natural radiation level should first be indicated by an increase in these two nuclides.

Natural radiation background in metropolitan Taipei.

A high-pressure ionization chamber was used to measure the natural background radiation in metropolitan Taipei, Taiwan, R.O.C. during a period in 1987-1988. The average exposure rate was 27.55 x 10(-10) C kg-1 h-1 including cosmic radiation, but the radon contribution was excluded. Scintillation survey meter, gamma-ray spectroscopy for soil samples, in-situ measurement with a NaI(Tl) detector coupled to a portable multichannel analyzer, instrumental neutron activation analysis of rock samples, and even thermoluminescent dosimeters were used as complementary measuring devices. Areas of higher radiation background were detected. They are the radium-bearing Peitou stones, an unusual occurrence of uraniferous zone at Sanhsia, and uranium precipitation in the glassy olivine basalt in a tea field at Tachi. All these areas are located in suburban sites of Taipei. Three types of building in Taipei City were selected for radon detection. No significantly elevated level of radon was detected, since Taipei is located in a semitropical area where ventilation of buildings is not a problem.

Radon concentration in two largest cities in semitropical Taiwan.

Grab sampling either using the active charcoal method in combination with an ionization chamber or using a working level monitor was performed for the measurement of radon concentration in Taiwan's two largest cities Taipei and Kaohsiung. Long-term monitoring of radon concentration in dwellings and business buildings was also carried out with cellulose nitrate films as the alpha detectors. The average indoor radon concentration in these two cities is 17 +/- 6 Bq m-3. The outdoor radon concentration is about one-half of that on average. As assessed according to the model of UNSCEAR 1988, the induced effective dose equivalent is 0.67 mSv y-1. Radon concentration in coal mines showed an average of 88.5 +/- 9.5 Bq m-3.

Effects of adrenergic agonists and cyclic AMP on the short-circuit current across the isolated rabbit iris-ciliary body.

Epinephrine, isoproterenol and norepinephrine (10(-6) M - 10(-4) M) reduced the short-circuit current (SCC) across the isolated rabbit iris-ciliary body when added to the blood side (pigmented layer) bathing solution but were without effect when added to the aqueous side (non-pigmented layer) bathing solution. The effect was observed in both HCO-3-rich and HCO-3-free solutions, although it was smaller in the latter. Propranolol and phentolamine (10(-5) M) partially blocked the action of the adrenergic agonists, 8Br-cAMP (1 mM), on the other hand, stimulated the SCC when added to either bathing solution. The apparent contradiction between these results is explained on the basis of separate cyclic AMP compartmentalization in the two epithelial cell layers and the lack of adrenoceptors in the non-pigmented layer.

Effects of adrenergic drugs on intracellular electrical potential difference of rabbit ciliary epithelial cells.

The effects of adrenergic drugs on intracellular electrical potential difference (PDI) of rabbit ciliary epithelial cells were investigated. Epinephrine as well as norepinephrine hyperpolarized the PDI at lower concentrations (10(-6) M) and depolarized the PDI at higher concentrations (greater than 10(-5) M). Isoproterenol produced a depolarization of PDI and phenylephrine caused a hyperpolarization only. After pretreatment with propranolol, the change of PDI by isoproterenol was minimal. Selective agonists and antagonists were used to further characterize adrenergic effects on the PDI. Both beta 1 and beta 2 agonists caused a depolarization of PDI while both beta 1 and beta 2 antagonists produced a hyperpolarization. Alpha 1 antagonist depolarized the PDI and alpha 2 antagonist hyperpolarized the PDI. Such electrophysiological effects of the adrenergic drugs confirm the presence of alpha and beta adrenoceptors in the rabbit ciliary epithelial cells.

Bicarbonate and DIDS effects on intracellular potential difference in rabbit ciliary epithelium.

A change of [HCO3-] in the solution bathing isolated rabbit ciliary epithelium from 30 mM to 0, or vice versa, resulted in a change of intracellular electrical potential difference (PDI) of 7 mV. Intermediate [HCO3-] (5, 10 and 15 mM) solutions were also tested. No perceivable change of PDI occurred when [HCO3-] changed from 30 to 15 mM. PDI depolarized gradually when [HCO3-] decreased from 30 or 15 mM to 0 mM, but PDI hyperpolarized at a faster rate when [HCO3-] increased from 0 to 15 or 30 mM. The amount of change of PDI from 15 to 5 mM, or vice versa, and from 10 to 0 mM or vice versa, was 4 mV. The stilbene, DIDS (10(-4) M), hyperpolarized the PDI in HCO3(-)-rich solutions. The response of DIDS was reduced in HCO3(-)-free medium and inhibited in Cl(-)-free solution. The results suggest the existence of an electrogenic bicarbonate transport or Na+/HCO3- cotransport system.

Direct stimulation by succinate of Na+:K+ pump in rabbit ciliary epithelium.

The effects of succinate on the intracellular potential difference, PDI, were measured in isolated rabbit ciliary processes. Concentration-dependent increases in the hyperpolarization of PDI occurred between 1 and 15 mM succinate in NaCl Ringers. With 5 mM succinate, there was a 6 mV hyperpolarization. Even though the hyperpolarization of PDI was comparable with 10 and 15 mM succinate, it was more sustained at the latter two concentrations. Succinate also elicited comparable hyperpolarizations of PDI in either Cl(-)-free or HCO3(-)-free Ringers. Similarly, following incubation with either 0.1 mM DIDS or 3 mM BaCl2 the effect of succinate on PDI was unchanged. Five mM succinate had no effect if it was added after 5 mM malonate. Malonate (5 mM) rapidly reversed a 5 mM succinate-induced hyperpolarization of PDI which also suggests a metabolically mediated effect on PDI. An isosmotic substitution of Na+ with NMDG Ringers depolarized PDI, whereas PDI depolarized biphasically during exposure to 0.1 mM ouabain. The addition of 5 mM succinate had no effect on either the time course or the magnitude of the depolarization of PDI during blocking of the Na+:K+ pump with either Na(+)-free Ringers or ouabain. Taken together, these results show that succinate selectively stimulates the Na+:K+ pump, but has no effect on any Cl-, HCO3- or a Ba2(+)-sensitive K+ conductance.

Effects of forskolin, prostaglandin F2 alpha, and Ba2+ on the short-circuit current of the isolated rabbit iris-ciliary body.

To gain information on the role of cyclic AMP (cAMP), ion transport and cell membrane permeability on aqueous humor formation, agents with well-known effects on transport properties in other epithelia were tested on the isolated rabbit iris-ciliary body. Forskolin stimulated the short-circuit current (SCC) by 37.5% when added to the aqueous-side solution. Forskolin was ineffective when added to the blood-side solution or when HCO3- was absent from the bathing solutions. The effect of forskolin confirms the presence of adenylate cyclase in the ciliary epithelium and the involvement of cAMP in ion transport. In HCO3- -rich media, 5 X 10(-5) M prostaglandin F2 alpha (PGF2 alpha), produced a prompt 25% increase in the SCC when added to the aqueous-side, and a small stimulatory SCC response when added to the blood-side. No change in SCC occurred when PGF2 alpha was added to either side of a HCO3- -free bathing solution. It is implied that cAMP acts on a HCO3- dependent transport system. These results are consistent with the previously observed stimulation of the SCC by 8Br-cAMP. BaCl2, 2.5 mM, on the aqueous-side increased the SCC by 240.5%, but reduced the SCC by 26% when added to the blood-side solution. The Ba2+ effects indicate the presence of high conductance K+ channels in the basolateral membranes of both the pigmented and non-pigmented cell layers.

Ascorbate-stimulated active Na+ transport in rabbit ciliary epithelium.

In a physiological medium (134 mM Na+ concentration), unidirectional blood-to-aqueous and aqueous-to-blood Na+ fluxes across the isolated rabbit ciliary epithelium are large, rendering the detection of a net transport difficult. At 134 mM an active component for Na+ may be obscured by diffusional fluxes and a bidirectional Na(+)-Cl- cotransport. Considering that the active transport saturates at about 30 mM, experiments were performed at this reduced Na+ concentration to minimize the influence of diffusional pathways. A net blood-to-aqueous Na+ flux that ranged from 0.25 to 0.81 mu eq/hr was obtained. Addition of ascorbic acid to the aqueous side under this condition increased the blood-to-aqueous flux with little effect on the flux in the opposite direction. Ouabain inhibited both the Na+ and ascorbate-stimulated Na+ transport. The increase in blood-to-aqueous Na+ flux by ascorbate was also observed in tissues bathed with [Na+] closer to physiological levels (100 mM). These results indicate that the rabbit ciliary epithelium transports Na+ into the posterior chamber. Since aqueous ascorbate stimulates Na+ transport, it may be implicated in both Na+ movement and aqueous humor secretion. However, the rate of Na+ transport can only account for a small fraction of total aqueous humor production.

Rilmenidine-induced ocular hypotension: role of imidazoline1 and alpha 2 receptors.

PURPOSE: To examine ocular actions by rilmenidine, an imidazoline1 and alpha 2 adrenoceptor agonist. METHODS: Intraocular pressure was measured in normal and sympathetically denervated rabbits by pneumatonometry. Electrically stimulated 3H-norepinephrine release from sympathetic nerves was determined in isolated, perfused rabbit iris-ciliary bodies. cAMP levels were evaluated in rabbit iris-ciliary bodies by radioimmunoassay. Ca2+ concentrations were measured in rabbit transformed nonpigmented ciliary epithelial cells by fluorescence ratio microscopy. RESULTS: Topical, unilateral administration of rilmenidine produced hypotensive responses in normal rabbits which were antagonized by either bilaterally administered efaroxan, an imidazoline receptor antagonist or rauwolscine, an alpha 2 receptor antagonist. Sympathectomy also eliminated the ocular hypotensive response. Rilmenidine (0.001, 0.01, 0.1, 1 microM) caused 5 +/- 1%, 18 +/- 5%, 35 +/- 10%, and 48 +/- 9% inhibition, respectively, of 3H-norepinephrine overflow whereas 10 microM efaroxan or rauwolscine caused enhancement of norepinephrine release by 102 +/- 23% or 86 +/- 25%, respectively. Furthermore, pretreatment with efaroxan or rauwolscine partially antagonized the inhibition of norepinephrine release induced by rilmenidine. In other experiments, rilmenidine (1 microM) inhibited isoproterenol-stimulated cAMP accumulation in rabbit iris-ciliary bodies by 43 +/- 9% which was antagonized by 10 microM efaroxan or rauwolscine. Rilmenidine induced large increases in [Ca2+]i in rabbit nonpigmented ciliary epithelial cells which were effectively antagonized by efaroxan or rauwolscine. CONCLUSIONS: These in vivo and in vitro data suggest that the ocular hypotensive activity induced by rilmenidine is due, in part, to suppression of sympathetic neuroeffector function in the rabbit ciliary body and that alpha 2 adrenergic receptors and/or imidazoline1 receptors are involved.

Elevation of intracellular Ca2+ concentration in rabbit nonpigmented ciliary epithelial cells by allicin.

A previous study has shown that allicin produces changes in aqueous humor dynamics, and this study was conducted to examine possible cellular mechanisms. In rabbit nonpigmented ciliary epithelial cells, basal levels of [Ca2+]i were determined to be 164 +/- 34 nM. Allicin, a sulfhydryl-reactive agent, induced Ca2+ transients at 0.01 mM and at 0.2 mM, the Ca2+ transient peaked at 732 +/- 35 nM. Allicin-induced Ca2+ transients were prevented by pretreatment with dithiothreitol which did not affect the basal Ca2+ levels. Allicin had only a slight, insignificant, effect on L-type Ca2+ currents, and allicin-induced Ca2+ transients were also present under extracellular Ca(2+)-free conditions. These data suggest that intracellular Ca2+ stores are the most probable source of allicin's effect. Pretreatment of cells with ryanodine, an inhibitor of Ca(2+)-induced-Ca(2+)-release, inhibited allicin-induced Ca2+ transients, but the basal Ca2+ levels were unaffected by ryanodine. Thus, allicin-induced Ca2+ transients are most likely mediated through ryanodine-sensitive intracellular Ca2+ stores.

Intraocular pressure lowering by S-allylmercaptocysteine in rabbits.

The purpose of this study was to examine the actions of a garlic-derived compound, S-allylmercaptocysteine (SAMC) on intraocular pressure (IOP) and to determine the possible involvement of sulfhydryl reactivity, sympathetic neuronal activity and atrial natriuretic peptide (ANP) in the IOP response. Topical, unilateral application of SAMC (20, 100, 200 microg) elicited dose-dependent decreases in IOP. The magnitude of the IOP-lowering effect induced by SAMC was between four to six mmHg. The ocular hypotensive responses were unilateral, peaked at one to three hours and lasted from two to four hours. The IOP-lowering effect by SAMC (100 microg) was enhanced modestly by topical, bilateral pretreatment with a reducing agent, tris(2-carboxyethyl) phosphine (100 microg) which itself produced no change in IOP. No alteration of pupil diameter was observed following topical application of either SAMC or tris(2-carboxyethyl) phosphine. Thus, alteration of sulfhydryl reactivity does not seem to be a major mechanism of action for SAMC. SAMC caused no change of basal and electrically stimulated norepinephrine release in rabbit iris-ciliary bodies, ruling out a prejunctional effect on sympathetic nerve activity. However, SAMC increased the ANP levels in aqueous humor by five-fold. It is concluded that the ocular hypotensive response induced by SAMC in rabbits could involve the elevation of ANP levels in aqueous humor.