两种不同方法经鼻盲探气管插管的临床观察

目的探讨两种不同方法经鼻盲探气管插管成功率。方法将25例需经鼻盲探气管内插管麻醉的手术患者随机分成观察组(13例)和对照组(12例)。采用镇静镇痛健忘法经鼻腔插入气管内导管,观察组当导管出鼻后孔达咽部时套囊充气10~15ml,对照组不充气。结果观察组13例盲探插管均成功,占100%;对照组12例,盲探成功5例,占42%;其中试验组一次插管成功11例,占85%,对照组为3例,占25%。两组对比有显著性(P<0.01)。结论咽部套囊充气法,可提高经鼻盲探插管的成功率。     

Synthesis, and antiprotozoal and antibacterial activities of S-substituted 4,6-dibromo- and 4,6-dichloro-2-mercaptobenzimidazoles.

The synthesis and some germicidal activities in vitro of two congener series of S-substituted 4,6-dihalogeno-2-mercapto-1H-benzimidazoles are reported. There was no substantial difference between antibacterial activities of corresponding 4,6-dichloro- and 4,6-dibromo-derivatives. The present results confirm lower susceptibility to substituted benzimidazoles of Gram-negative compared to Gram-positive bacteria. Minimum inhibitory concentrations (MICs) of a majority of the novel derivatives ranged between 25 and 100microg/ml for Gram-positive bacteria. The most active compounds (MICs for Gram-positive bacteria: 0.78-50microg/ml) were 4,6-dichloro-2-(4-nitrobenzylthio)-1H-benzimidazole and 4,6-dibromo-2-(4-nitrobenzylthio)-1H-benzimidazole that were 4-32 times more potent than nitrofurantoin against all Gram-positive bacteria utilized but Escherichia faecalis, against which they were, respectively, 2 and 4 times less potent than nitrofurantoin. Among Gram-negative bacteria used, Stenotrophomonas maltophilia and Bordetella bronchiseptica were most sensitive (as evidenced by a number of MICs 400microg/ml). All the new compounds were at least several times more active against Giardia intestinalis (IC(50): 0.006-0.053microg/ml), and a half of them were at least several times more active against Trichomonas vaginalis (IC(50): 0.0015-0.182microg/ml) than metronidazole (IC(50): 0.210 and 0.037microg/ml, respectively), the drug of choice in the treatment of G. intestinalis and T. vaginalis infections.     

Skin and the Non‐Human Human: Transformation and Reversal in Titian's The Flaying of Marsyas

The article puts forward an aesthetic and psychoanalytic analysis of Titian's painting, The Flaying of Marsyas, arguing that the painting is a reflection on the human subject as a being constituted by skin and by a core of non‐humanity. The analysis is partly an answer to Melanie Hart's (2007) article ‘Visualizing the mind: Looking at Titian's Flaying of Marsyas', addressing features of the painting not commented on by Hart, and supplementing Hart's (Kleinian) theoretical frame by involving Didier Anzieu's ‘skin ego’, Slavoj Zizek's concept of the ‘non‐human’, Giorgio Agamben's term of the ‘Muselmann’, and Anton Ehrenzweig's psychoanalytic theory of artistic creation. Whereas Hart is focusing on form and colour, I also turn my attention towards the texture of the painting.     

Assessing and combining repeated prognosis of physicians and temporal models in the intensive care

ObjectiveRecently, we devised a method to develop prognostic models incorporating patterns of sequential organ failure to predict the eventual hospital mortality at each day of intensive care unit (ICU) stay. In this study, we investigate using a real world setting how these models perform compared to physicians, who are exposed to additional information than the models.MethodsWe developed prognostic models for days 2–7 of ICU stay by data-driven discovery of patterns of sequential qualitative organ failure (SOFA) scores and embedding the patterns as binary variables in three types of logistic regression models. Type A models include the severity of illness score at admission (SAPS-II) and the SOFA patterns. Type B models add to these covariates the mean, max and delta (increments) of SOFA scores. Type C models include, in addition, the mean, max and delta in expert opinion (i.e. the physicians’ prediction of mortality).ResultsPhysicians had a statistically significantly better discriminative ability compared to the models without subjective information (AUC range over days: 0.78–0.79 vs. 0.71–0.74) and comparable accuracy (Brier score range: 0.15–0.18 vs. 0.16–0.18). However when we combined both sources of predictions, in Type C models, we arrived at a significantly superior discrimination as well as accuracy than the objective and subjective models alone (AUC range: 0.80–0.83; Brier score range: 0.13–0.16).ConclusionThe models and the physicians draw on complementary information that can be best harnessed by combining both prediction sources. Extensive external validation and impact studies are imperative to further investigate the ability of the combined model.     

Influence of visual feedback sampling on obstacle crossing behavior in people with Parkinson's disease

The purpose of the current study was to investigate the role of visual information on gait control in people with Parkinson's disease as they crossed over obstacles. Twelve healthy individuals, and 12 patients with mild to moderate Parkinson's disease, walked at their preferred speeds along a walkway and stepped over obstacles of varying heights (ankle height or half-knee height), under three visual sampling conditions: dynamic (normal lighting), static (static visual samples, similar to stroboscopic lighting), and voluntary visual sampling. Subjects wore liquid crystal glasses for visual manipulation. In the static visual sampling condition only, the patients with Parkinson's disease made contact with the obstacle more often than did the control subjects. In the successful trials, the patients increased their crossing step width in the static visual sampling condition as compared to the dynamic and voluntary visual sampling conditions; the control group maintained the same step width for all visual sampling conditions. The patients showed lower horizontal mean velocity values during obstacle crossing than did the controls. The patients with Parkinson's disease were more dependent on optic flow information for successful task and postural stability than were the control subjects. Bradykinesia influenced obstacle crossing in the patients with Parkinson's disease.     

Factors affecting prophylactic immunization compliance in elderly veterans: A study of pneumococcal immunization in the aged

Immunization among the high risk groups, including the elderly, remains unacceptably low for pneumococcal and influenza vaccines. This study determined the factors which influence pneumococcal vaccine compliance in the aged. A questionnaire developed for this study was mailed to all 300 veterans in west central Florida who were 85 years or older and were eligible for ambulant medical care at the James A. Haley Veterans Hospital, Tampa, Florida. They were asked regarding circumstances which influenced their decision for or against accepting pneumococcal vaccine. Ninety-two persons responded in self-addressed stamped envelopes and data were analyzed six months following mailing date. The single most important factor for not accepting vaccination was lack of information and unawareness that the immunization was necessary (81%). Fear of “shots” and side effects was the next most important reason for not taking the vaccine (15%). Lack of transportation to the doctor’s office prevented 12% of the subjects. Some subjects also did not have an interest in prophylactic immunization (8%). These data suggest that the lack of awareness, knowledge and information about pneumococcal immunization plays major roles in its poor acceptance among the elderly. Health education measures should improve vaccine compliance in this population who suffer from higher death rates and complications from pneumonia.