Intrapartum fetal surveillance: a physiological approach

Continuous utero-placental circulation, and patent umbilical blood vessels ensure an uninterrupted transfer of oxygen and nutrients to the fetus as well as clearance of metabolic waste products. The onset of labour characterized by progressive and strong uterine contractions poses a threat to fetal oxygenation as a result of collapsing the spiral arterioles traversing the myometrium to supply the placental bed, and repetitive compression of the blood vessels within the umbilical cord. Human fetuses are equipped with compensatory mechanisms to cope with transient interruptions of blood supply during labour. The ability to compensate may be blunted in cases of poor fetal reserves, increased metabolic demand (macrosomia or maternal fever), and due to non-hypoxic pathways (e.g. chorioamniontis or fetal hypovolumia-hypotension syndrome). Intrapartum fetal surveillance involves prompt recognition of the features that signal the onset of fetal decompensation on the cardiotocograph (CTG) to ensure a timely intervention to avoid hypoxic-ischaemic encephalopathy (HIE) or perinatal deaths. This article summarises a ‘physiological approach’ to the interpretation of the CTG which, in places, conflicts with other current UK guidance.     

呼吸机自动测量气道阻断压与标准测量方法的一致性

目的 验证呼吸机自动测量的气道阻断压(airway occlusion pressure,P0.1)与标准测量方法的一致性,以及不同触发形式对自动测量结果的影响。方法 选择采用非阻断自动测量P0.1的呼吸机,分别进行模拟肺和临床试验。调节全自动自主呼吸模拟肺,模拟具有不同呼吸努力和呼吸力学特征的48种状态,应用待检测呼吸机,以压力支持通气模式为模拟肺进行通气。临床研究部分纳入15例接受压力支持通气的成年患者。两部分研究均随机交叉应用压力和流量触发,采集呼吸机自动监测的P0.1后,采用标准呼气末气道阻断法进行P0.1测量,作为标准参考值。采用Bland-Altman检验分析P0.1呼吸机监测值与标准参考值的一致性,计算残差(呼吸机监测值-标准参考值)和95%一致性区间,比较不同触发形式对残差的影响。结果 在模拟肺验证中,P0.1呼吸机监测值与标准参考值之间的残差(95%一致性区间)在压力和流量触发下分别为0.04(－0.63~0.70)和－0.54(－1.44~0.36)cmH₂O(1 cmH₂O=0.098 kPa),两者相比差异具有统计学意义(P<0.001)。临床观察获得了相似的结果,压力和流量触发时的残差(95%一致性区间)分别为－0.11(－0.73~0.52)和－0.54(－1.50~0.59)cmH₂O,差异无统计学意义(P>0.05),表明呼吸机监测值与标准参考值间存在一致性。结论 压力触发时,呼吸机非阻断法自动测量的P0.1与标准方法具有良好的一致性。而流量触发明显低估P0.1,建议自动监测时切换到压力触发。     

Analysis of Progression Patterns and Failure Sites of Patients With Metastatic Lung Adenocarcinoma With EGFR Mutations Receiving First-line Treatment of Tyrosine Kinase Inhibitors

BackgroundReliable prediction of progression patterns and failure sites for patients with stage IV lung adenocarcinoma is valuable for physicians to deliver personalized tyrosine kinase inhibitor (TKI) treatment.Patients and MethodsWe retrospectively enrolled 266 patients who had stage IV lung adenocarcinoma and received first-line TKI treatment from 2013 to 2017 in Shanghai Chest Hospital. The clinical characteristics at initial diagnosis, progression patterns, and failure sites were analyzed with the attempt to identify some predictive factors for progression patterns and failure sites.ResultsAmong all patients, 62.4% developed systemic progression, and 37.6% developed oligoprogression. Both cohorts had a median progression-free survival (PFS) of 9 months. The percentage of patients who developed original and distant failure was 39.1% and 60.9%, respectively. Patients with oligometastasis at initial diagnosis were more prone to develop oligoprogression (odds ratio [OR], 4.370; 95% confidence interval [CI], 1.881-10.151; P = .001), whereas pulmonary metastasis was negatively correlated with oligoprogression (OR, 0.567; 95% CI, 0.330-0.974; P = .04). Both oligometastasis diagnosis (OR, 2.959; 95% CI, 1.347-6.500; P = .007) and the maximum diameter of the primary lung lesion (threshold 3.25 cm: OR, 3.646; 95% CI, 2.041-6.515; P = .0001) were strong predictive factors for original failures. Osseous metastasis at initial diagnosis might be an indication for distant failure (OR, 0.536; 95% CI, 0.316-0.909; P = .021).ConclusionOver one-half of patients with stage IV lung adenocarcinoma receiving first-line TKI treatment developed systemic progression and distant failure. Metastasis patterns at initial diagnosis was the most important predictive factor for progression patterns and failure sites. The maximum diameter of the primary lung lesion and evidence of osseous metastasis were also found to be significant indicative factors for failure sites.     

保留自主呼吸对于重度急性呼吸窘迫综合征患者的影响：弊大于利

急性呼吸窘迫综合征（ARDS）是临床上常见的以顽固性低氧为表现的呼吸功能不全或衰竭的综合征，肺不均一性是其主要病理生理特点。传统观点认为，保留ARDS患者自主呼吸有助于改善全身氧合。但是近年来发现，对于重度ARDS患者，保留患者自主呼吸会加重肺损伤，过强的自主呼吸会导致重度ARDS患者跨肺压升高、肺内气体摆动、肺水肿加重以及人机不同步，引起患者肺内炎症加重，氧合功能恶化，最终影响患者预后，增加病死率。本文就自主呼吸对重度ARDS患者呼吸功能的影响机制展开综述。     

Transforming brain signals related to value evaluation and self‐control into behavioral choices

The processes involved in value evaluation and self‐control are critical when making behavioral choices. However, the evidence linking these two types of processes to behavioral choices in intertemporal decision‐making remains elusive. As the ventromedial prefrontal cortex (vmPFC), striatum, and dorsolateral prefrontal cortex (dlPFC) have been associated with these two processes, we focused on these three regions. We employed functional magnetic resonance imaging during a delayed discounting task (DDT) using a relatively large sample size, three independent samples. We evaluated how much information about a specific choice could be decoded from local patterns in each brain area using multivoxel pattern analysis (MVPA). To investigate the relationship between the dlPFC and vmPFC/striatum regions, we performed a psychophysiological interaction (PPI) analysis. In Experiment I, we found that the vmPFC and dlPFC, but not the striatum, could determine choices in healthy participants. Furthermore, we found that the dlPFC showed significant functional connectivity with the vmPFC, but not the striatum, when making decisions. These results could be replicated in Experiment II with an independent sample of healthy participants. In Experiment III, the choice‐decoding accuracy in the vmPFC and dlPFC was lower in patients with addiction (smokers and participants with Internet gaming disorder) than in healthy participants, and decoding accuracy in the dlPFC was related to impulsivity in addicts. Taken together, our findings may provide neural evidence supporting the hypothesis that value evaluation and self‐control processes both guide the intertemporal choices, and might provide potential neural targets for the diagnosis and treatment of impulsivity‐related brain disorders.     

Changes to foot pressure pattern in post-stroke individuals who have started to walk independently during the convalescent phase

BackgroundAbnormal foot contact patterns following stroke affect functional gait; however, objective analysis targeting independent walking is lacking.Research questionHow do walking abilities and foot pressure patterns differ between post-stroke individuals who achieved independent walking and healthy controls? Secondarily, how do the abilities and patterns in post-stroke individuals change before and after achieving independent walking? Can these changes become criteria for permitting independent walking?MethodsTwenty-eight individuals with hemiplegia and 32 controls were enrolled. Motor dysfunction score (MDScore), walking speed (WSpeed), and foot pressure patterns were measured when they were first able to walk without orthosis or physical assistance (1st assessment) and when they achieved independent walking around discharge (2nd assessment). Foot pressure patterns were measured using insole-type foot pressure-measuring system. Ratios of partial foot pressure to body weight (%PFP), ratios of anteroposterior length of center of pressure (COP; %Long), and backward moving distance of COP to the foot length (%Backward) were calculated. Parameters during the 2nd assessment were compared with those of controls and those during the 1st assessment. During the 2nd assessment, relationships among the parameters, MDScore, and WSpeed were analyzed.ResultsDuring the 2nd assessment, no difference was observed in both %Long and %Backward between the non-paretic limbs and the controls. While the %Backward was higher, the %PFP of toes and %Long were lower in the paretic limb than in the controls. Although the %Backward was lower, both %PFP of toes and %Long of the paretic limb were higher in the 2nd assessment than in the 1st assessment. During the 2nd assessment, both %Long and % Backward values of the paretic limb moderately correlated with MDScore and WSpeed.SignificanceAfter improvement of foot pressure in toes, both an increase in anteroposterior length and a decrease in backward moving of COP path were objective signs permitting independent walking.     

Prevalence and evolution of snoring and the associated factors in two-year-old children

ObjectivesTo evaluate the prevalence and persistence of snoring during the first two years of life in two Finnish birth cohorts and to assess the associated factors.Study designThe study population comprised 947 children from the CHILD-SLEEP (CS) and 1393 children from the FinnBrain (FB) birth cohorts. Questionnaires were provided to both parents when the child was 24 months of age. The questionnaire consisted of parts concerning the child's sleep and environmental factors.ResultsThe combined prevalence of habitual snoring in the two birth cohorts at the age of 24 months was 2.3% (95% CI 1.5–3.1), which is markedly lower than reported previously.Children suffering from recurrent infections (CS odds ratio (OR) 3.9, 95% CI 1.2–12.5) or asthma (FB OR 4.3, 1.4–13.5) snored habitually more often. Both the mother's (CS OR 3.2, 1.2–9.0) and father's (CS OR 3.4, 1.4–8.0) snoring every night added to the risk of the child snoring. In the multivariate models, parental snoring (CS adjusted odds ratio (OR_a) 2.8, 1.1–6.8), the mother's lower level of education (CS OR_a 2.9, 1.2–7.5, FB OR_a 2.1, 1.0–4.5), and the mother's lower monthly income (FB OR_a 2.9, 1.3–6.3) associated with the child's habitual snoring.ConclusionsThe prevalence of habitual snoring in two Finnish birth cohorts is lower than reported previously. The independent risk factors for habitual snoring at the age of two years were the parents' snoring and the mother's low income and low education.     

Episodic memory: Neuronal codes for what,where, and when

Episodic memory is defined as the ability to recall events in a spatiotemporal context. Formation of such memories is critically dependent on the hippocampal formation and its inputs from the entorhinal cortex. To be able to support the formation of episodic memories, entorhinal cortex and hippocampal formation should contain a neuronal code that follows several requirements. First, the code should include information about position of the agent (“where”), sequence of events (“when”), and the content of the experience itself (“what”). Second, the code should arise instantly thereby being able to support memory formation of one‐shot experiences. For successful encoding and to avoid interference between memories during recall, variations in location, time, or in content of experience should result in unique ensemble activity. Finally, the code should capture several different resolutions of experience so that the necessary details relevant for future memory‐based predictions will be stored. We review how neuronal codes in entorhinal cortex and hippocampus follow these requirements and argue that during formation of episodic memories entorhinal cortex provides hippocampus with instant information about ongoing experience. Such information originates from (a) spatially modulated neurons in medial entorhinal cortex, including grid cells, which provide a stable and universal positional metric of the environment; (b) a continuously varying signal in lateral entorhinal cortex providing a code for the temporal progression of events; and (c) entorhinal neurons coding the content of experiences exemplified by object‐coding and odor‐selective neurons. During formation of episodic memories, information from these systems are thought to be encoded as unique sequential ensemble activity in hippocampus, thereby encoding associations between the content of an event and its spatial and temporal contexts. Upon exposure to parts of the encoded stimuli, activity in these ensembles can be reinstated, leading to reactivation of the encoded activity pattern and memory recollection.     

MIND not Mediterranean diet related to 12-year incidence of cognitive impairment in an Australian longitudinal cohort study

Introduction

Associations between the Mediterranean-DASH diet Intervention for Neurological Delay (MIND) diet and incidence of cognitive impairment have not been evaluated outside the United States.

中药材产业扶贫的空间格局及其主要影响因素探讨

通过对"全国中药资源普查及种质共享数据专题服务——中药材产业扶贫"数据资料及"康美中药网——中药全产业链服务平台"各贫困地区中药材资源信息的整理分析,构建中国贫困地区的中药材种植面积、产值等数据库,利用ArcGIS软件绘制贫困地区中药材种植情况空间分布图,从中发掘和总结当前我国中药材产业扶贫的空间格局特征和发展规律。在此基础上,通过参考"中国减贫数据库"及"国务院扶贫开发领导小组办公室"的相关报告,综合分析影响中药材产业扶贫成效的主要因素,并提出相应的建议,以期对贫困地区开展中药材产业扶贫工作提供参考。