The effect of psychosocial factors on outcomes of cochlear implantation

Conclusion: Psychosocial factors should be considered during cochlear implantation (CI). There were differences in psychosocial characteristics according to the etiology of deafness. The outcomes may be affected by psychosocial variables such as the severity of mental distress and social problems as well as duration of deafness. Objective: To evaluate the psychosocial characteristics of deaf people undergoing CI and to determine which psychosocial factors affect performance after CI. Methods: A total of 289 subjects who underwent CI were enrolled. The participants were classified into prelingually deaf (pre-LD) and postlingually deaf groups (post-LD), including progressive and sudden deafness subgroups. The Minnesota Multiphasic Personality Inventory (MMPI) was administered before CI to measure psychosocial and emotional problems. To measure CI outcomes, speech perception ability was assessed by the open-set Korean version of the Central Institute of Deafness (K-CID) test and categories of auditory performance (CAP) scores before and after CI. Results: Approximately 45% of subjects experienced psychological problems before undergoing CI. Subjects in the Pre-LD group had more psychosocial distress and were more likely to be oversensitive in interpersonal situations, while those in the post-LD group were more depressed. Deafness duration and psychosocial factors significantly predicted hearing ability after CI. Deafness duration directly and indirectly affected the outcome of CI. That is, duration of deafness caused psychosocial problems, which may have resulted in negative effects on outcomes of CI.     

Factors influencing waiting times for diagnosis of Autism Spectrum Disorder in children and adults

AimsTo identify the main factors predicting delays in diagnosis for Autism Spectrum Disorder (ASD) at three stages in the diagnostic process: wait for first appointment; assessment duration, and total wait for diagnosis.MethodData were gathered from 150 case notes (80 child and 70 adult cases) from 16 diagnosing services across Scotland.ResultsHaving more information pre-assessment was associated with a reduced duration of the diagnostic process for children. This relationship was partially mediated by a reduction in the number of contacts required for diagnosis. In adults, having more factors associated with ASD (increased risk) reduced the wait time from referral to first appointment, but increased the overall duration of the diagnostic process. The latter relationship was partially mediated by an increase in the number of contacts required for diagnosis.ConclusionWithin children's services, increasing the amount of relevant information available pre-assessment is likely to reduce total duration of the assessment process by reducing number of contacts required. Having a high risk of ASD as an adult appears to result in being seen more quickly following referral, but also to increase the number of contacts needed and assessment duration. As a result, it increases and total duration overall.     

Efficacy of sunitinib in patients with metastatic or unresectable renal cell carcinoma and renal insufficiency

AimThe aim of this retrospective, registry-based study was to analyse treatment outcomes in patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib and renal insufficiency (RI).MethodsThe cohort included 790 patients treated with sunitinib between 2006 and 2013. At the start of sunitinib therapy 22, 234, and 534 patients had severe (glomerular filtration rate [GFR] <30 ml/min/1.73 m²), moderate (GFR 30–60 ml/min/1.73 m²) or mild RI/normal renal function (GFR >60 ml/min/1.73 m²), respectively.ResultsFor the three groups defined above, median progression-free survival (PFS) (95% confidence interval [CI]) was 5.3 months (0.1–18.5), 8.1 months (6.2–9.9) and 11.3 months (9.4–13.2) (p = 0.244), and median overall survival (OS) was 26.3 months (1.2–51.4), 21.2 months (13.2–29.1) and 26.3 months (22.6–29.9) (p = 0.443), respectively. The disease control rates were 45.5%, 56.4% and 59.2%, respectively (p = 0.374). No unexpected toxicity was reported in the patients with RI, but the treatment was more frequently discontinued because of adverse events and the duration of therapy was significantly shorter in these patients (p = 0.007).ConclusionsDuration of first-line targeted treatment for mRCC was significantly shorter for patients with RI, and may have translated into a trend to shorter PFS. These results highlight the need for optimal management of side-effects in patients with mRCC and RI.     

Effects of neferine on Kv4.3 channels expressed in HEK293 cells and ex vivo electrophysiology of rabbit hearts

Aim:

Neferine is an isoquinoline alkaloid isolated from seed embryos of Nelumbo nucifera (Gaertn), which has a variety of biological activities. In this study we examined the effects of neferine on Kv4.3 channels, a major contributor to the transient outward current (I_to) in rabbit heart, and on ex vivo electrophysiology of rabbit hearts.

Methods:

Whole-cell Kv4.3 currents were recorded in HEK293 cells expressing human cardiac Kv4.3 channels using patch-clamp technique. Arterially perfused wedges of rabbit left ventricles (LV) were prepared, and transmembrane action potentials were simultaneously recorded from epicardial (Epi) and endocardial (Endo) sites with floating microelectrodes together with transmural electrocardiography (ECG).

Results:

Neferine (0.1–100 μmol/L) dose-dependently and reversibly inhibited Kv4.3 currents (the IC₅₀ value was 8.437 μmol/L, and the maximal inhibition at 100 μmol/L was 44.12%). Neferine (10 μmol/L) caused a positive shift of the steady-state activation curve of Kv4.3 currents, and a negative shift of the steady-state inactivation curve. Furthermore, neferine (10 μmol/L) accelerated the inactivation but not the activation of Kv4.3 currents, and markedly slowed the recovery of Kv4.3 currents from inactivation. Neferine-induced blocking of Kv4.3 currents was frequency-dependent. In arterially perfused wedges of rabbit LV, neferine (1, 3, and 10 μmol/L) dose-dependently prolonged the QT intervals and action potential durations (APD) at both Epi and Endo sites, and caused dramatic increase of APD₁₀ at Epi sites.

Conclusion:

Neferine inhibits Kv4.3 channels likely by blocking the open state and inactivating state channels, which contributes to neferine-induced dramatic increase of APD₁₀ at Epi sites of rabbit heart.     

1237例夫精宫腔内人工授精周期临床妊娠结局探讨

目的:探讨患者年龄,不孕年限,输卵管通畅度和注入宫腔内前向运动精子总数(NMSI)对夫精宫腔内人工授精(AIH)临床妊娠率的影响,旨在更好地指导临床工作.方法:选取835对夫妻1 237个AIH周期,按年龄分为:≤35岁、36～39岁、≥40岁组;按不孕年限分为:＜2年、2～4年及＞4年;按输卵管通畅度分为:双侧输卵管通畅、单侧输卵管通畅和双侧输卵管不全通畅组;按处理后NMSI分为＜2、2～5、5～10及＞10×106组.结果:临床妊娠175例,周期妊娠率为14.1％,夫精宫腔内人工授精临床妊娠的成功率随着患者年龄及不孕年限的增加而降低,差异具有统计学意义(P＜0.05);注入宫腔内前向运动精子总数(NMSI)小于5×106时临床妊娠率低,差异具有统计学意义(P＜0.05);双侧及单侧榆卵管通畅组妊娠率高于双侧输卵管不全通畅组.结论:年龄≥40岁,不孕年限＞4年,处理后注入宫腔内前向运动精子总数(NMSI)小于5×106或双侧输卵管不全通畅的患者,不适合继续尝试IUI治疗.     

预注顺阿曲库铵与增大其剂量在全麻诱导中的效果比较

目的：通过观察在全麻诱导插管中,预注顺阿曲库铵和增大其剂量两种给药方式对其起效时间、临床有效时间及肌松效果的影响,并进行对比,指导此药的临床应用。方法选择18~55岁,ASAⅠ~Ⅱ级择期行妇科手术的女性患者90例,随机分为3组,每组30例,分别为3ED95组、预注组（预注顺阿曲库铵0.015 mg/kg,4 min后给予0.135 mg/kg）和4ED95组。麻醉诱导使用芬太尼、咪达唑仑、丙泊酚,麻醉维持应用靶控微量泵输注丙泊酚、瑞芬太尼,TOF模式监测肌松情况。记录血压、心率及全身皮肤情况,记录肌松药起效时间、临床有效时间及气管插管条件评级。结果各组麻醉诱导期间血流动力学的变化比较均无统计学意义,各组肌松药起效时间分别是（184±56）s、（141±31）s、（135±45）s,预注组、4ED95组分别与3ED95组之间的比较均有统计学意义（P＜0.05）,但4ED95与预注组相比较无统计学意义（P＞0.05）;各组临床有效时间分别是（41±8）min、（44±6）min、（53±8）min,4ED95组分别与3ED95组、预注组相比较均有统计学意义（P＜0.05）,预注组与3ED95组比较无统计学意义（P＞0.05）。结论预注顺阿曲库铵与增大其剂量均能加快药物的起效时间,但前者比后者维持的临床有效时间更短,更有利于患者的苏醒及快速拔管。     

Maternal pre‐pregnancy body mass index is not associated with infant and young child feeding in low‐income Mexican children 1–24 months old

Pre‐pregnancy overweight and obesity is associated with shorter breastfeeding (BF) duration. Whether pre‐pregnancy overweight and obesity is associated with other aspects of infant and young child feeding (IYCF) has not been investigated. We used data from 370 children born January 1999–September 2001 in a semi‐urban community in Morelos, Mexico, where information on how they were fed was available at 1, 3, 6, 9, 12, 18 and 24 months of age. We modified the World Health Organization's dietary diversity indicator to assess the quality of the complementary foods. An index that included BF, quality of complementary foods and other behaviours was constructed to measure IYCF. We used survival analysis to examine the association of pre‐pregnancy body mass index (pBMI) category and BF duration and mixed models for quality of complementary food and IYCF index. Mean maternal pBMI was 24.4 ± 4.1; 31% were overweight, and 9% were obese. pBMI was not associated with BF duration. Quality of complementary food improved over time (6 months, 1.3 ± 1.3; 24 months, 3.8 ± 1.04). Compared with normal‐weight women, overweight and obese women were more likely to feed from more food groups (0.24 ± 0.11 point, P = 0.03), but this did not improve diet diversity from 6 to 24 months. IYCF index decreased throughout follow‐up (1 month, 7.8 ± 2.4; 24 months, 5.5 ± 1.8), and pBMI was not associated with IYCF (?0.11 ± 0.13 point, P = 0.4). We conclude that heavier women were not engaging in IYCF behaviours that were distinct from those of normal‐weight women from 1 to 24 months post‐partum.     

Oxytocin discontinuation after the active phase of labor is established

Despite the widespread usage of oxytocin, there is still no consensus on its mode of administration. The scope of the present meta-analysis was to assess the effect of oxytocin discontinuation after the active phase of labor is established on maternal fetal and neonatal outcomes. We searched Medline, Scopus, Popline, ClinicalTrials.gov and Google Scholar databases. Eight studies were finally retrieved, which involved 1232 parturient. We observed significantly decreased rates of cesarean sections among parturient that discontinued oxytocin (OR 0.51, 95% CI 0.35, 0.74) as well as decreased rates of uterine hyperstimulation (OR 0.33, 95% CI 0.19, 0.58). Similarly, cases of non-reassuring fetal heart rates were fewer among women that did not receive oxytocin after the establishment of the active phase of labor (OR 0.63, 95% CI 0.41, 0.97). Keeping in mind the aforementioned maternal and neonatal adverse effects that seem to result from infusion of oxytocin until delivery, future practice should aim towards its discontinuation after the establishment of the active phase of labor, as it does not seem to influence the total duration of labor. Future studies should aim towards specific populations of parturient in order to clarify whether different approaches are needed.