Changes in rapidly extracted auditory evoked potentials during tracheal intubation

BACKGROUND: One of the problems encountered in assessment of the hypnotic level during anesthesia is the extraction of a consistent and reliable measure online and close to real time. Hemodynamic parameters such as heart rate and blood pressure are not, at least with the traditional single parameter versus time presentation, adequate for ensuring an optimal level of anesthesia, especially when using neuromuscular blocking agents (NMBA). In the literature, it has been demonstrated that auditory evoked potentials (AEP) are able to provide two aspects relevant to determining level of anesthesia: firstly, they have identifiable anatomical significance and, secondly, their characteristics reflect the way the brain perceives a stimulus. METHODS: The aim of this study was to evaluate the AEP index based on a system identification model, the autoregressive model with exogenous input (ARX-model), and to compare it to the classical method, the moving time average (MTA). The ARX enables the extraction within 15-25 sweeps, depending on the signal-to-noise ratio (SNR), whereas MTA typically needs 250-500 sweeps. The hypothesis of the present study was that since the ARX-model extracts the AEP faster than the MTA-model, the former should be able to detect changes during the brief, intense stimulus of endotracheal intubation. Twelve female patients scheduled for gynecological surgery were included in the study. Anesthesia was initiated with thiopentone and maintained with isoflurane and alfentanil. The AEP was mapped into an index (AEP-index) normalized to 100 when the individual was awake and decreasing to an average of 25 during thiopentone induced anaesthesia. The results were compared to those obtained by MTA-extracted AEP. RESULTS: During tracheal intubation 9 patients showed an increase in the ARX-extracted AEP-index larger than 15, and 6 of these patients showed an increase larger than 25 (mean increase=33, SD=18). The MTA-extracted AEP-index showed only one patient with an increase larger than 15. The ARX-extracted AEP changed significantly faster than the MTA-extracted AEP. CONCLUSION: The ARX-extracted AEP-index increases during tracheal intubation. There is a significant difference between the ARX-extracted AEP and the traditional MTA-extracted AEP, in terms of response time. In order to trace short-lasting changes in the hypnotic level by AEP, the AEP should be extracted by a method with a fast response such as the ARX-model.     

Total versus tube-related additional work of breathing in ventilator-dependent patients

BACKGROUND: In tracheally intubated or tracheostomized spontaneously breathing patients, tube resistance can highly increase the patient's work of breathing. In this study we focused upon the relationship between total (WOBtot) and tube-related additional inspiratory work of breathing (WOBadd) and compared different ventilatory modalities for proper tube compensation. METHODS: In ten tracheostomized spontaneously breathing patients we measured WOBtot and WOBadd in the continuous positive airway pressure (CPAP) mode, under inspiratory pressure support of 5, 10, and 15 cmH2O in the pressure support ventilation (PSV) mode, and under flow-adjusted pressure support in the automatic tube compensation (ATC) mode. WOBadd and WOBtot were calculated on the basis of measured tracheal pressure and esophageal pressure, respectively. Inspiratory peak tracheal pressure above PEEP was taken as an estimate of pressure support beyond mere tube compensation (i.e., overcompensation). RESULTS: The percentage of the tube-related WOBadd on WOBtot in the CPAP mode was 52%. It decreased with increasing pressure support in the PSV mode from 32% (PSV 5 cmH2O) to 17% (PSV 15 cmH2O). WOBadd was only 15% of WOBtot in the ATC mode. In contrast to the other ventilatory modes, reduction of WOBadd in the ATC mode was achieved with the smallest amount of overcompensation, i.e. with minimal pressure assist beyond mere tube compensation. CONCLUSION: In tracheally intubated or tracheostomized spontaneously breathing patients, adequate compensation of tube resistance (i.e. with minimal overcompensation and minimal undercompensation) is best done by the ATC mode.     

青春期的性生理特征及其卫生教育

了解青春期的生理变化特征及其卫生,对青少年身心的健康成长和良好心理素质的培养具有重要意义.文章通过对青春期性心理特征的分析,重点阐述了如何对青少年加强性心理与心理卫生的教育.     

急性肛周脓肿手术方法的改进

目的:探讨、研究急性肛周脓肿一期根治新术式.方法:回顾分析 1996～ 2004年 123例急性肛周脓肿一期根治术式 改进后病人的临床资料.结果:所有病人均一次性治愈,无术后复发肛瘘及遗留肛门失禁.结论:采用该术式治疗急 性肛周脓肿,具有治愈率高、病人痛苦小、手术恢复快、费用低、并发症少等优点.     

职业技术学校的职业道德教育的现状与对策

职业教育的大力发展,需要良好的职业道德教育.由于中等职业技术学校职业道德教育呈下滑趋势,因此必须采取 一些行之有效的方法,使职业道德教育落到实处,从而提高整个中华民族的道德水准.     

应用彩色血流像素定量技术分析子宫肌瘤介入治疗后的血流灌注变化

目的提出一种新的基于计算机彩色目标分割技术的声像图彩色血流像素定量技术。方法应用笔者开发的计算机彩色血流像素定量软件 ,分析经阴道超声引导下穿刺注射无水酒精治疗子宫肌瘤前后的血流灌注状态变化 ,对照组应用半定量计数法分析血管条数增减评介血流灌注变化。结果应用计算机彩色血流像素定量软件统计肿块血流像素/肿块像素的比值 ,介入前肿块血流像素/肿块像素比值是(15.65±9.61) % ,介入治疗后第4～6个月减少为(5.91±3.35) % ,半定量血管计数结果分别为(4.8±2.34)条和(1.23±0.59)条 ,后者结果的准确性低于应用计算机彩色血流像素定量技术自动检测的结果。结论通过临床应用分析 ,使用计算机彩色血流像素定量技术 ,对兴趣区血流灌注状态进行定量分析的方法 ,比传统半定量方法的定量概念、精确度和可操作性都有了进一步的改进和提高。     

补骨方治疗膝骨性关节炎的疗效观察

目的　探讨应用补骨方治疗膝骨关节炎的疗效。方法　临床应用补骨方和芬必得治疗老年性膝骨性关节炎 6 0例 4周 ,并比较随访疗效。结果　治疗后两组患者症状平均分值、日常活动功能障碍平均分值和总评分平均分值较治疗后显著升高 ,膝关节临床症状明显减轻 ,关节功能显著改善 ,比较具有显著性差别 (P <0 0 1)。经统计学处理 ,两组膝关节日常生活活动评分治疗前后。两组临床资料没有显著差异 (P >0 0 5 ) ,具可比性。结论　补骨方能明显改善膝骨关节炎患者的临床症状和关节功能。     

A UK multi‐centre pilot study of speech and swallowing outcomes following head and neck cancer

Speech and swallowing are important components of health‐related quality of life following head and neck cancer treatment. The aim of this study was to demonstrate the value of prospective multi‐centre evaluation by Speech and Language Therapists and to compare health‐related quality of life with speech and swallowing impairments. The University of Washington Head and Neck questionnaire version 4 (UW‐QOL) and Therapy Outcome Measures (TOM) were rated before and 6 months after cancer treatment in 95 patients from 12 centres. There was deterioration in TOM scores at 6 months. Pretreatment UW‐QOL swallowing was ranked equal first, with speech fourth. At 6 months speech was first and swallowing second. There were positive correlations between UW‐QOL swallowing and TOM dysphagia and between UW‐QOL speech and TOM laryngectomy, voice, phonology and dysarthria disorders. Both outcome measures are suitable for routine practice. Adaptation of TOM scales for use with head and neck cancer patients may improve sensitivity, validity and therapist compliance.     

Assessing the Quality of Life of Adults with Chronic Respiratory Diseases in Routine Primary Care: Construction and First Validation of the 10-Item Respiratory Illness Questionnaire-Monitoring 10 (RIQ-MON10)

BACKGROUND: As doctors' judgements about the burden of a disease often differ from patients' own assessments a manageable method to incorporate the latter into routine care might support patient-centered decision-making. For this purpose we shortened the 55-Item Quality of Life for Respiratory Illness Questionnaire (QoL-RIQ). METHODS: Secondary analyses of the data of 3 controlled studies (n = 328, 502 and 555). PROCEDURES: inter-item correlations, scale distributions, Cronbach's alpha and factor analysis. Dyspnoea, forced expiratory volume in 1 s (FEV1), COOP/WONCA charts, the Medical Research Council-ECCS symptoms questionnaire and the MOS-SF 36 served as criteria to test validity and responsiveness. RESULTS: Item-reduction resulted in a 10-item short form (alpha's 0.87-0.90), consisting of 2 5-item factors: (1) physical and emotional complaints and (2) physical and social limitations. The correlations of the short form with dyspnoea (r from 0.57 to 0.60), the generic health status instruments (r from 0.39 to 0.59) and lung function (r from 0.10 to 0.15) fulfilled the criteria. FURTHER RESULTS: a clinical relevant score difference (> 0.5) between upper and lower quartiles of the convergent instruments, an intraclass correlation between repeated scores in a stable group of 0.82 and a standardised response mean of 0.86 in an improved group of patients. CONCLUSIONS: The short form (RIQ-MON10) maintained the psychometric properties of the original instrument and is promising for assessing quality of life (QoL) during routine primary care visits.     

How well do parents know their children? implications for proxy reporting of child health-related quality of life

OBJECTIVES: This study examined parental knowledge of their children's oral-health-related quality of life (OHRQoL) (Objective 1), and the effects of different analytical techniques to manage 'Don't know' (DK) responses on the validity and reliability of the questionnaire (Objective 2) and the level of agreement between parental and child reports (Objective 3). METHODS: The parental (PPQ) and child (CPQ11-14) components of the Child Oral Health Quality of Life Questionnaire were used. Objectives 1 and 2 were addressed in the study that involved 221 parents and Objective 3 in the study that involved 63 pairs of parents and children. Four methods for treating DK responses in the PPQ were tested: listwise deletion, item mean imputation, imputation of the value zero and adjustment of scores to account for items with DK responses. RESULTS: Respectively, 26 and 11% of the parents gave > or = 3 and 6 > or = DK responses to 33 items comprising the PPQ. DK responses were associated with child's age and clinical condition, and parental gender. The methods of managing DK responses did not have differing effects on the measurement properties of the PPQ and the level of agreement between parents and children. CONCLUSION: Some parents have limited knowledge concerning their children's OHRQoL. However, given that parental and child reports are measuring different realities, information provided by parents is useful even if it is incomplete.