Effects of intensive induction chemotherapy for extensive-disease small cell bronchogenic carcinoma in protected environment-prophylactic antibiotic units

Fifty-five patients with extensive-disease small cell bronchogenic carcinoma received three courses of intensive, inpatient, remission induction chemotherapy in (25 patients) or out (30 patients) of protected environment-prophylactic antibiotic (PEPA) units. Chemotherapy consisted of ECHO induction (E = epipodophyllotoxin VP-16-213; C = cyclophosphamide; H = hydroxydaunorubicin; O = Oncovin) and PRIME maintenance (PR = procarbazine; I = ifosfamide; ME = methotrexate). All evaluable patients (22 in the protected environment group and 26 in the control group) had a complete (50 percent in the protected environment group and 54 percent in the control group) or partial (50 percent in the protected environment group and 46 percent in the control group) remission. Median response and survival durations for both treatment groups were similar. The median survival duration of patients with a complete remission favored the protected environment group (16.5 versus 12.67 months; p = 0.20). Two patients (one from each group) are alive and disease-free for more than four years. Myelosuppression was intense and more pronounced in the protected environment group (p ≤ 0.01). Infectious complications were less common in patients receiving intravenous prophylactic antibiotics and in those treated with intravenous antibiotics in PEPA units (p ≤ 0.04). There were no treatment-related deaths, although treatment might have contributed to the death of three patients in the protected environment group and four in the control group. The administration of intensive ECHO induction chemotherapy to patients with extensive small cell bronchogenic carcinoma produced a high complete remission rate, although there was no significant long-term survival advantage over a program of less intensity. The administration of intravenous prophylactic antibiotics and the use of PEPA units significantly reduced the infectious morbidity of chemotherapy.     

Triad-conditioning Transcranial Magnetic Stimulation in Parkinson's Disease

BackgroundTranscranial magnetic stimulation (TMS) has been used to reveal excitability changes of the primary motor cortex (M1) in Parkinson's disease (PD). Abnormal rhythmic neural activities are considered to play pathophysiological roles in the motor symptoms of PD. The cortical responses to external rhythmic stimulation have not been studied in PD. We recently reported a new method of triad-conditioning TMS to detect the excitability changes after rhythmic conditioning stimuli, which induce facilitation by 40-Hz stimulation in healthy volunteers.ObjectiveWe applied a triad-conditioning TMS to PD patients to reveal the motor cortical response characteristics to rhythmic TMS.MethodsThe subjects included 13 PD patients and 14 healthy volunteers. Three conditioning stimuli over M1 at an intensity of 110% active motor threshold preceded the test TMS at various inter-stimulus intervals corresponding to 10–200 Hz.ResultsThe triad-conditioning TMS at 40 Hz induced no MEP enhancement in PD patients in either the On or Off state, in contrast to the facilitation observed in the normal subjects. Triad-conditioning TMS at 20–33 Hz in the beta frequency elicited significant MEP suppression in PD patients. The amount of suppression at 20 Hz positively correlated with the UPDRS III score.ConclusionWe observed abnormal M1 responses to rhythmic TMS in PD. The suppression induced by beta frequency stimulation and no facilitation by 40-Hz stimulation may be related to abnormal beta and gamma band activities within the cortical-basal ganglia network in PD patients. The motor cortical response to rhythmic TMS may be an additional method to detect physiological changes in humans.     

一氧化氮吸入联合高频震荡通气治疗新生儿严重呼吸衰竭的疗效分析

目的 探讨一氧化氮吸入(iNO)联合高频震荡通气(HFOV)治疗新生儿严重呼吸衰竭疗效。 方法 选取2013年3月至2016年3月60例HFOV中高参数设置下氧合差的患儿[吸入氧浓度(FIO₂)＞60%,经皮血氧饱和度(TcSO₂)＜80%],采用随机数字表法分为观察组及对照组,观察组予iNO联合HFOV治疗,对照组予单纯HFOV治疗,治疗中监测血气分析、血氧饱和度、血压、心率,监测血常规、出凝血时间、高铁血红蛋白等指标。比较两组的机械通气时间、救治成功率以及并发症发生率。 结果 iNO联合HFOV,能显著改善患儿氧合指数,使呼吸机参数逐渐下调至安全范围,且合理调整参数后患儿无明显不适,缩短患儿机械通气时间,提高呼吸衰竭患儿的抢救成功率。机械通气时间对照组为(107.00±39.60)h,观察组为(89.34±22.75)h,两组比较,差异有统计学意义(P＜0.05);死亡率对照组32.14%,观察组9.37%,两组比较,差异有统计学意义(P＜0.05)。观察组在未用iNO之前PH值、氧分压(PaO₂)、二氧化碳分压(PaCO₂)、动脉氧分压与吸入氧浓度比(PaO₂/FiO₂)、氧合指数(OI)值均差异无统计学意义(P＞0.05)。iNO后2 h、24 h比较差异有统计学意义(P＜0.05)。     

Feasibility and usability of measuring receipt of sealants in 2 states

BackgroundThe authors examined the reliability and validity of the Dental Quality Alliance childhood sealant measure under actual use conditions in Texas and Florida. The 2 states provide care for almost 20% of children in Medicaid nationally.MethodsThe authors used dental claims data to examine the reliability of the caries risk assessment component of the measure. They examined validity using a 3-year look-back period to identify children who were inaccurately included in the measure denominator as sealant eligible when they were not owing to already sealed, missing, or restored teeth.ResultsThe children identified at elevated risk varied between the states, with 85% at elevated risk in Texas and 39% in Florida in 2017. Different methods can be used to calculate risk, raising questions about reliability. In Texas, 31% of children included in the denominator were not eligible to receive sealants owing to already sealed, missing, or restored teeth. The magnitude of the underestimation increased with age, so by the time children were 9 years old, 40% were not measure eligible yet included in the denominator. Similar results were observed for Florida.ConclusionsThe authors propose eliminating the caries risk assessment requirement and incorporating a 3-year look-back period to identify already sealed, missing, or restored molars.Practical ImplicationsThe reliability and validity of the sealant measure needs to be enhanced. Measure misspecification in which children are not correctly identified as needing sealants can contribute to inaccurate development of quality improvement goals, performance improvement projects, or pay-for-quality programs.     

Spectrotemporal dynamics of the EEG during working memory encoding and maintenance predicts individual behavioral capacity

We investigated the effect of memory load on encoding and maintenance of information in working memory. Electroencephalography (EEG) signals were recorded while participants performed a modified Sternberg visual memory task. Independent component analysis (ICA) was used to factorise the EEG signals into distinct temporal activations to perform spectrotemporal analysis and localisation of source activities. We found ‘encoding’ and ‘maintenance’ operations were correlated with negative and positive changes in α‐band power, respectively. Transient activities were observed during encoding of information in the bilateral cuneus, precuneus, inferior parietal gyrus and fusiform gyrus, and a sustained activity in the inferior frontal gyrus. Strong correlations were also observed between changes in α‐power and behavioral performance during both encoding and maintenance. Furthermore, it was also found that individuals with higher working memory capacity experienced stronger neural oscillatory responses during the encoding of visual objects into working memory. Our results suggest an interplay between two distinct neural pathways and different spatiotemporal operations during the encoding and maintenance of information which predict individual differences in working memory capacity observed at the behavioral level.     

鞍山市铁东区公共场所卫生基层问题及解决建议

笔者作为基层卫生监督工作人员经过十多年的公共场所卫生监督工作,通过对鞍山市铁东区公共场所卫生监督情况进行分析。发现当前存在许多公共场所卫生监督执法困难和难题,主要表现为卫生监督队伍薄弱,新兴公共场所剧增,公共场所执法依据不确定性（无法可依）等问题。笔者提出相应的解决建议,应转变卫生监督观念,提高监督管理质量。     

云南省曲靖市护理人力资源配置现状调查

目的：通过调查,分析曲靖市各级医疗机构护理人力资源配置情况,为卫生行政管理部门为医疗机构合理配置护理人力,保障护理工作质量及医疗安全提供依据。方法通过调查问卷,对全市有法人代表的23个市、县（区）、乡镇、企业、民营医院、社区卫生服务中心等医疗机构的护理管理部门及4382名护士进行调查,应用SPSS17.0统计软件进行统计分析。结果虽然床护比基本达标,临床护理岗位人员人力资源缺乏依然存在,人力资源不足依然是困扰护理管理的首要因素,护理队伍结构不合理,护理人员身份多元化,编制内护士比例逐渐降低,对护理职业的认同感及薪酬的满意度不容乐观。结论多途径、多渠道增加护理人员,尤其是编制内护士。有计划的重点培养一批护理骨干,在护理队伍中起好承上启下的引领、带动作用。尽快建立编制外护士管理标准,稳定护理队伍。改善护理人员待遇,尤其是技术职称的评定和聘任,不能与医疗机构其它卫生专业技术岗位形成巨大差距。