Identifying the Optimal Radiation Dose in Locally Advanced Non–Small-cell Lung Cancer Treated With Definitive Radiotherapy Without Concurrent Chemotherapy

Introduction

The optimal radiation dose for locally advanced non–small-cell lung cancer (NSCLC) is not known for patients who receive sequential chemoradiation (CRT) or definitive radiotherapy (RT) only. Our objective was to determine whether a benefit exists for radiation dose escalation for these patients.

序贯性脏器功能衰竭评分和CURB-65评分及肺炎严重指数评分对重症肺炎患者28天死亡的预测效能比较研究

背景重症肺炎是呼吸系统常见的急危重症,病死率高、社会负担重。早期准确评估重症肺炎患者的病情和预后,有助于临床决策。序贯性脏器功能衰竭（SOFA）评分、CURB-65评分以及肺炎严重指数（PSI）评分可以从不同方面反映肺炎严重程度,然而对于预测重症肺炎预后的最佳风险评分还没有达成共识。目的 探讨SOFA评分、CURB-65评分及PSI评分对重症肺炎患者短期预后的预测效能。方法 本研究为多中心、前瞻性观察性研究,选取2017年12月至2022年3月在河南中医药大学第一附属医院等11家医院重症监护室（ICU）和呼吸与危重症医学科住院的重症肺炎患者作为研究对象。根据患者确诊重症肺炎后28 d内是否死亡将其分为存活组和死亡组,于住院当天对患者进行SOFA评分、CURB-65评分和PSI评分。比较两组患者临床特征和3种风险评分。绘制3种风险评分预测重症肺炎患者28 d死亡的受试者工作特征（ROC）曲线,并采用Hosmer-Lemeshow检验和校准度图等评价风险评分的预测效能。使用X-tile v3.6确定最优风险评分的最佳临界值对患者进行分层,并绘制重症肺炎患者Kaplan-Meier生存曲线,...     

Alternative laparoscopic technique for cholecystectomy during pregnancy

Laparoscopic cholecystectomy had been considered contraindicated during pregnancy. A few brief clinical reports have appeared in the literature, but no trials attesting to the safety to the fetus (and mother) have been published. Laparoscopic cholecystectomy during pregnancy has advantages for the mother in that it speeds her recovery, giving her less pain, and decreasing the chance of incisional hernias from large incisions. Using an open, Hasson technique combined with low-pressure pneumoperitoneum via an abdominal wall lift, safety to the fetus is enhanced. Herein is described a laparoscopic cholecystectomy in a 14-week-pregnant woman under continuous epidural anesthesia and wearing sequential-compression-device hose; no untoward events occurred.     

Alcohol and “bursts” of aggressive behavior: ethological analysis of individual differences in rats

A quantitative ethological analysis of rodent aggression was performed in order to characterize the aggression-heightening effects of alcohol in certain individuals. In dyadic confrontations, a resident rat pursues, threatens and attacks an intruder, who reacts with defensive, flight and submissive behaviors. The behavioral data from five series of experiments conducted from 1984 through 1989 were subjected to a lag sequential analysis that identified highly predictable sequences of aggressive behavior, and to interval analysis that delineated a burst pattern of aggressive behavior. These analyses revealed a distinct behavioral sequence of pursuit sideways threat attack bite aggressive posture that occurs in bursts with an inter-event interval of less than 6.6 s. In the total population, alcohol heightened attack behavior at low acute doses (0.1, 0.3, 1.0 g/kg) in 47% of the animals (n=44), suppressed reliably attack behavior in another 25% (0.1–3.0 g/kg;n=23) and had unreliable effects in the remaining 28% (n=24). The peak enhancement of aggressive behavior was seen over more than a log cycle of alcohol doses (0.1, 0.3 or 1.0 g/kg) in different individuals. In an additional group of rats (n=20), individuals were identified according to whether or not acute low alcohol doses enhanced or suppressed the frequency of attack bites. In the subgroup of five rats who doubled their attack frequency upon acute alcohol challenge, this aggression-heightening effect was confirmed on repeated occasions. The aggression-heightening effects of alcohol were seen during the high-rate interactions in the initial phase of the confrontation and particularly during the lower level of fighting later on. Regardless of alcohol dose and subgroup, the highly predictable sequence of pursuit sideways threat attack bite aggressive posture remained intact as long as the individual was able to fight. The present analysis identifies those individuals in whom low alcohol doses increase the frequency of attack behavior, the number of aggressive elements in bursts and particularly the time in burst. Alcohol produces these changes without altering the latency to initiate aggressive behavior, the rate of aggressive behavior within a burst or the number of bursts in an encounter. Alcohol may lengthen aggressive bursts by preventing termination of longer aggressive sequences rather than by altering the initiation of this behavior.We dedicate this paper to our friend Dr. Milos Krsiak, Professor of Pharmacology, Charles University, Prague, Czechoslovakia     

序贯性与非序贯性早期肠内营养对食管癌术后患者临床疗效的比较研究

目的 观察食管癌术后序贯性早期肠内营养与非序贯性早期肠内营养的临床疗效,明确食管癌患者是否从序贯性营养支持疗法中获益。方法 将92例拟行食管癌根治术的患者分为序贯性早期肠内营养组（46例）和非序贯性早期肠内营养组（46例）,比较两组临床结局指标（胃肠道功能恢复情况、肠内营养耐受情况、术后并发症、术后住院时间）和营养指标（白蛋白、前白蛋白等）。结果 与非序贯性早期肠内营养组相比,序贯性早期肠内营养组首次肛门排气时间缩短,首次自然排便和肠内营养耐受性良好例数增加,差异均有统计学意义（P<0.05）。两组患者的术后营养指标、人体成分、术后并发症、术后住院时间比较,差异均无统计学意义（P>0.05）。结论 对于食管癌术后患者,序贯性早期肠内营养支持方案有利于胃肠道功能的恢复和肠内营养耐受性的提高,值得临床进一步推广。     

头孢呋辛钠序贯治疗儿童肺炎疗效分析

目的 评价抗生素序贯疗法治疗小儿支气管肺炎的疗效及成本.方法将120例病例随机分为序贯疗法组60例,静脉注射组60例,根据疗效标准及治疗成本进行分析.结果 序贯疗法组总有效率93.33%,静脉注射组总有效率86.67%,按疗效与成本综合分析,以序贯疗法优于静脉注射组.结论 头孢呋辛钠序贯疗法治疗小儿支气管肺炎有重要的临床应用价值.     

两种颅脑放疗方式对合并1~3个脑转移瘤的非小细胞肺癌患者的疗效对比

目的 比较全脑放疗+同步推量适形放疗(SIB-CRT)与全脑放疗后序贯推量适形放疗(SCRT)治疗非小细胞肺癌(NSCLC)合并脑转移瘤的治疗效果.方法 65例NSCLC合并1~3个脑转移瘤患者,分为同步组32例、序贯组33例,分别采用全脑放疗(38.7 Gy/18 f)+SIB-CRT(脑转移瘤52.2 Gy/18 f)、全脑放疗(30 Gy/10 f)后SCRT(脑转移瘤21 Gy/7 f).比较两组的住院时间、近期疗效、中位生存时间以及6个月、1年、2年生存率.结果 放疗后1个月,同步组的客观缓解率及疾病控制率分别为78.1%、100.0%,分别高于序贯组的45.5%、81.8%(P<0.05).同步组的中位生存期为17.0个月,长于序贯组的11.0个月(P<0.05).同步组6个月、1年、2年生存率分别为93.8%、67.8%、32.1%,分别高于序贯组的75.8%、48.5%、9.7%(P<0.05).颅脑放疗方式与患者的生存时间相关(P<0.05),序贯组患者的死亡风险是同步组患者的2.55倍.结论 对于合并1~3个脑转移瘤的NSCLC患者,全脑放疗+SIB-CRT的疗效优于全脑放疗后SCRT.     

Scalp potentials to pitch change in rapid tone sequences. A correlate of sequential stream segregation

The object of the study was to look for a neurophysiological substrate of sequential auditory stream segregation. When a sequence of tones alternates rapidly between pitches separated by more than a few semitones, there is a tendency for it to be perceived as two independent "streams". We examined the scalp potentials evoked when the pitch interval abruptly changes, to see whether there are response parameters which might be correlated with sudden stream segregation and/or integration. For 3 s a continuous synthesized tone of "clarinet" timbre oscillated between pitches of F4 and F#4 (one semitone higher) at 16 notes/s, perceived as an integrated stream. The upper note was then raised to E5 (11 semitones above F4, perceived as segregated streams) for a further 3 s and the cycle was repeated 40 times. In a second condition also starting with oscillation between F4 and F#4, the upper note was lowered to E4 (one semitone below F4, still perceived as a single stream). Further conditions examined the changes between oscillations of 1 and 11 semitones down from E5, 1 and 23 semitones up from F4, and 10 and 11 semitones up from F4. Virtually no potentials were detectable during the periods of unchanging oscillation, but an N1/P2 complex was evoked on each change in the pitch interval. The N1 was termed "MN1" on account of its arguable relatedness to the mismatch negativity, recorded in a separate experiment using discontinuous tones at a much slower rate. The mean peak latency of the MN1 varied between 96 and 123 ms, the shortest latencies being recorded, not to the largest changes of pitch interval but to the widest pitch intervals between the new tone and the immediately preceding one. Therefore, although a causal relationship with streaming cannot necessarily be inferred, the MN1 latency appears to mark the degree of pitch contrast between consecutive tones, in correlation with the streaming effect. Electronic Publication     

Classical Skin Conductance Response Conditioning: Effects of Random Intermittent Reinforcement

To assess some implications of incremental-decremental learning theories for classical conditioning, skin conductance response conditioning in humans was examined as a function of reinforcement schedule. First anticipatory responses (FARs: latency from 1.0 to 3.5 sec after signal onset) were not affected by reinforcement ratio, but, during the first half of training, the probability of second anticipatory responses (SARs: latency from 3.6 to 7.0 sec after signal onset) increased with increases in reinforcement ratio. FAR and SAR probabilities decreased across sequences of successively reinforced trials and increased across sequences of successively nonreinforced trials. These results are incompatible with the theoretical expectation that response likelihood should increase following reinforced trials and decrease following nonreinforced trials. Alternative accounts of the results are discussed.     

Stimulus presentation rate dissociates sequential effects in event-related potentials and reaction times

The present study explored the impact of the stimulus presentation rate on sequential effects in event-related potentials (ERPs) and reaction times (RTs). Random series of equiprobable tones were presented at interstimulus intervals (ISIs) of 1.3, 2.1, and 2.9s. Fast and accurate choice responses to the tones were required. Although sequential effects in RTs were stable across all ISIs, the common first-order repetition effect in P300 amplitude was only observed at the 1.3-s ISI and not at the slower presentation rates. This dissociation between the first-order effects in RTs and ERPs speaks against an explanation of both effects by a common expectancy mechanism. In addition, sequential effects were observed as early as about 100 ms after stimulus onset in the lateralized readiness potential. Together with similar sequential effects in P300 latency, this finding supports a continuous flow model of information processing.