Validation of the Functional Status II questionnaire in the assessment of extremely-low-birthweight infants

Aim  The increased survival of infants born at extremely low birthweight (ELBW) has been associated with significant morbidity, including higher rates of neurodevelopmental disability. However, formalized testing to evaluate these problems is both time-consuming and costly. The revised Functional Status questionnaire (FS-II) was designed to assess caregivers' perceptions of the functional status of children with chronic diseases.
Method  We evaluated the reliability and validity of the FS-II for ELBW infants at 18 to 22 months corrected age using data from the US Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN). Exploratory factor analyses were conducted using data from the network's first follow-up study of 1080 children born in 1993 to 1994 (508 males, 572 females [53%]), and results were confirmed using data from the next network follow-up of 4022 children born in 1995 to 2000 (1864 males, 2158 females [54%]).
Results  Results suggest that a two-factor solution comprising measures of general health and independence is most appropriate for ELBW infants. These factors differed from those found among chronically ill children, and new, more appropriate scales are presented for screening ELBW survivors. Both scales demonstrated good internal consistency: Cronbach's α=0.87 for general health and α=0.75 for independence. Construct validity of the scales was assessed by comparing mean scores on the scales according to scores on the Bayley Scales of Infant Development, second edition (BSID-II), and medical conditions.
Interpretation  As hypothesized, infants with greater functional impairments according to their BSID-II scores or medical conditions had lower scores on the general health and independence scales, supporting the validity of the scales.     

Midazolam as a sole sedative for computed tomography imaging in pediatric patients

Objective: To evaluate the efficacy and adverse effects of i.v. midazolam as a sole agent for sedation in children for computed tomography (CT) imaging. Materials and Methods: Prospective clinical trial in which 516 children under ASA classification II–IV (273 boys and 243 girls) in the age group of 6 months to 6 years for elective CT scan were enrolled over a 17‐month period. Patients were administered i.v. midazolam 0.2 mg·kg^?1 and further boluses of 0.1 mg·kg^?1 (total 0.5 mg·kg^?1) if required. Measurements included induction time, efficacy, side effects, complications, and degree of sedation. Sedation was graded on the basis of Ramsay sedation score (RSS) as over sedated (RSS 5–6), adequately sedated (AS, RSS 3–4), under sedated (RSS 1–2), or failed if the procedure could not be completed or another agent had to be administered. Results: Of the 516 procedures, 483 brains, 16 chests, and 17 abdomens were scanned with a mean duration of 4.75 ± 1.75 min with a mean dose of 0.212 mg·kg^?1 of i.v. midazolam. Four hundred and sixty‐five (90.12%) patients were AS in 5.9 ± 0.7 min while 40 (7.75%) patients required additional boluses. Of these 40 patients, 24 (4.65%) required a single bolus, 12 (2.32%) required two boluses, whereas the remaining four (0.78%) required three boluses. In 11 (2.13%; P < 0.0001) patients, the scan could not be completed satisfactorily. Side effects were seen in 46 (9.11%) patients in the form of desaturation, hiccups (seven patients, 1.38%), and agitation (four patients, 0.79%). Desaturation (SpO₂ 90–95%) was seen in 35 (6.93%) patients, which was corrected by topical application of oxygen. None of the patients exhibited any complications such as pulmonary aspiration or need to maintain airway. The patients were kept under observation for 1 h after the procedure. Conclusion: The level of sedation achieved in children with midazolam 0.2 mg·kg^?1 is adequate for imaging with minimal side effects, no airway complications, and fast recovery. It can be recommended as the sole agent for sedation in pediatric patients for CT imaging.     

论西部大开发背景下的新疆高等医学教育

新疆作为向西开放的前沿,其特殊的历史地位、现实作用和区域特色都将在西部大开发战略中发挥举足轻重的影响。探讨新疆高等医学教育改革与发展的总体思路,更好地发挥教育资源的作用,大量培养西部建设需要的、适应性强的复合型和实用型医学人才是我们面临的又必须解决的一个重大课题。     

Relationship between thigh muscle mass and augmented pressure from wave reflections in healthy adults

Skeletal muscle may be viewed as an endocrine organ that releases numerous factors with the potential to influence vascular tone. Previous cross-sectional studies have shown an inverse relationship between muscle mass and arterial stiffness. We examined the relationship between muscle mass, arterial pressure in the aorta and brachial artery, and pressure from wave reflections [characterized as heart rate corrected augmentation pressure (AP)] and augmentation index (AIx). Twenty-seven (13 male, 14 female) subjects who were non-smokers and had no known cardiovascular or metabolic diseases visited the laboratory for two sessions of testing. Upon arriving for the first session, mid-thigh muscle (mCSA) and fat (fCSA) cross-sectional area were assessed using peripheral Quantitative Computed Tomography. Following this, concentric one-repetition maximum (1-RM) testing was completed to assess knee extensor strength. The second visit consisted of taking brachial and aortic blood pressure measurements. A significant positive relationship was found between mCSA and brachial systolic blood pressure (r = 0.47, p = 0.02), but not between mCSA and aortic systolic blood pressure (r = 0.35, p = 0.09). There was an inverse association between mCSA and AP75 (?0.49, p = 0.01) and AIx75 (?0.49, p = 0.01). In conclusion, muscle mass is associated with brachial systolic blood pressure and inversely associated with pressure from wave reflections. Our findings suggest a link between global musculo-skeletal integrity and cardiovascular hemodynamics in young healthy adults.     

The functional-organic dichotomy: postinfectious irritable bowel syndrome and inflammatory bowel disease-irritable bowel syndrome

Gastroenterologists often encounter situations when the clinical and pathophysiological features that typically distinguish functional from organic disorders overlap. This "blurring of boundaries" can occur with post-infectious irritable bowel syndrome (PI-IBS), a subset of IBS and a newly described entity IBD-IBS. The key associating features include pain and usually diarrheal symptoms that are disproportionate to the observed pathology, microscopic inflammation, and often a co-association with psychological distress. A previous initiating gastrointestinal infection is required for PI-IBS and assumed for IBD-IBS. Using this perspective we discuss the clinical and pathophysiological features of PI-IBS and IBD-IBS and the growing evidence for the overlapping features of these two disorders in terms of alteration of gut flora, immune dysregulation, and role of stress. A unifying model of PI-IBS and IBD-IBS is proposed that may have important clinical and research implications. It obligates us to reframe our understanding of illness and disease from the dualistic biomedical model into a more integrated biopsychosocial (BPS) perspective.     

维拉帕米在治疗室上性心动过速中致心绞痛1例报道

目的对1例室上性心动过速患者在用维拉帕米治疗中导致心绞痛发作分析。方法对1例室上性心动过速患者在用维拉帕米治疗前后的症状、体征、及心电图变化情况进行观察。结果室上性心动过速患者在用维拉帕米治疗中导致心绞痛。结论维拉帕米治疗室上性心动过速时可导致心绞痛发作。