A comparison of seriously ill patients with or without AIDS requiring prolonged mechanical ventilation

Purpose

The aim of this study was to compare differences in underlying diagnoses, weaning outcomes, discharge disposition, and survival in prolonged mechanical ventilator (PMV)–dependent patients with and without AIDS.

Methods

Ninety consecutive AIDS patients requiring PMV were retrospectively matched with 90 clinically similar non-AIDS patients to form matched cohorts to determine differences in their outcomes.

Results

AIDS patients had more acute diagnoses requiring PMV, whereas non-AIDS patients had more chronic diagnoses (P < .001). Weaning outcomes were alike with 31 (35%) AIDS and 37 (41%) non-AIDS patients successfully weaned. More AIDS patients went home, and fewer, to nursing facilities (P = .04). In each cohort, successfully weaned patients had significantly longer survival than their unweaned counterparts (all P < .001). Successful weaning reduced the risk of death in AIDS and non-AIDS patients (hazard ratios, 0.29 and 0.20; 95% confidence intervals, 0.17-0.50 and 0.11-0.36, respectively; all P < .001).

Conclusions

AIDS had little effect on weaning success or survival. Successful weaning increased survival regardless of a diagnosis of AIDS. The AIDS patients had more home discharges and fewer to nursing facilities, which likely resulted from the AIDS patients having more acute illnesses leading to PMV than the non-AIDS patients.     

乳头溢液95例临床分析

目的探讨乳头溢液的不同性质及其与乳癌的关系和治疗方法。方法对95例单侧单孔乳头溢液病人进行乳房B超、导管造影、细胞病理学检查,并结合手术病理学检查进行分析。结果鲜红色血性溢液8例,其中乳癌2例,导管内乳头状瘤5例,导管扩张症1例;暗红色或咖啡色血性溢液33例,其中乳癌6例,导管内乳头状瘤21例,导管扩张症4例,乳腺增生症2例;淡黄色浆液性溢液29例,其中乳癌1例,导管内乳头状瘤5例,导管扩张症15例,乳腺炎4例,乳腺增生症4例;清亮透明性溢液25例,其中导管内乳头状瘤5例,导管扩张症13例,乳腺炎2例,乳腺增生症5例。结论乳头血性及淡黄色浆液性溢液均应引起高度重视,发现后应及时手术以防癌变;导管微切术是目前有效的治疗方法。     

Ideal Suggestions for Discharge Training and Telephone Counseling of Patients With Coronary Artery Bypass Graft Surgery: A Randomized Controlled and Experimental Study

BackgroundIn this context, discharge training and telephone counseling given to patients who underwent coronary artery bypass graft surgery increase the ability of patients to cope with and adapt to their self-care.MethodsThis study was a randomized controlled, experimental design. Both experimental and control groups consisted of 35 individuals with G*power analysis (n = 70). Patients in the experimental group were given discharge training and telephone counseling for two months. At the end of the process, data collection forms were administered to both groups for the last time. Necessary ethical approvals were taken and consent was taken from the patients.ResultsAfter the discharge training and telephone counseling given to the experimental group, the mean Exercise of Self-Care Agency Scale (ESCA) score of the patients increased by 13.94; the mean Coping and Adaptation Processing Scale (CAPS) increased by 13.6. The mean ESCA score of the control group increased by 7.86; the mean CAPS score increased by 9.14. The effect size that occurred for both groups was statistically significant (P < 0.05).ConclusionPositive results were achieved in the experimental group which received given discharge training and telephone counseling.Trial RegistrationClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT05104996","term_id":"NCT05104996"}}NCT05104996     

The influence of information structuring and health literacy on recall and satisfaction in a simulated discharge communication

Objective

We investigated the effects of information structuring and its potential interaction with pre-existing medical knowledge on recall in a simulated discharge communication.

Preoperatively predicting non-home discharge after surgery for gynecologic malignancy

Objective

Returning home after surgery is a desirable patient-centered outcome associated with decreased costs compared to non-home discharge. Our objective was to develop a preoperative risk-scoring model predicting non-home discharge after surgery for gynecologic malignancy.

刺激乳头在硬膜外麻醉分娩镇痛产妇中的应用

我科2007年3月-2009年3月对硬膜外麻醉分娩镇痛的初产妇实施刺激乳头方法,有利于加强宫缩,缩短产程,减少产后阴道出血量,提高新生儿早吸吮成功率。比静滴催产素加强宫缩更加经济、安全,减少产妇的痛苦,取得了较好的临床效果,现报告如下。     

Florid papillomatosis of the male nipple

The authors present a case of an adenoma of the nipple in a 61-year-old man who reported a 6-month history of nodularity and itching at his left nipple. Examination revealed a firm, well-defined, vascularized tumor measuring .8 cm that altered the normal anatomy of the nipple. A total excision of the nipple and areola was performed. The histological diagnosis was adenoma of the nipple. No recurrent tumor has been observed during 4 years of postoperative follow-up. An adequate excision of the lesion is curative without any risk of recurrence or development of malignancy.     

Spatial dynamics of receptive fields in cat primary visual cortex related to the temporal structure of thalamocortical feedforward activity

We investigated how changes in the temporal firing rate of thalamocortical activity affect the spatiotemporal structure of receptive field (RF) subunits in cat primary visual cortex. Spike activity of 67 neurons (48 simple, 19 complex cells) was extracellulary recorded from area 17/18 of anesthetized and paralyzed cats. A total of 107 subfields (on/off) were mapped by applying a reverse correlation technique to the activity elicited by bright and dark rectangles flashed for 300 ms in a 20x10 grid. We found that the width of the (suprathreshold) discharge fields shrank on average by 22% during this 300-ms-long stimulus presentation time. Fifty-eight subfields (54%) shrank by more than 20% of peak width and only ten (less than 10%) showed a slight increase over time. The main size reduction took place 40-60 ms after response onset, which corresponded to the transition from transient peak firing to tonic visual activity in thalamocortical relay cells (TC). The experimentally obtained RFs were then fitted with the aid of a neural field model of the primary visual pathway. Assuming a Gaussian-shaped spatial sensitivity profile across the RF subfield width, the model allowed us to estimate the subthreshold RF (depolarization field, D-field) from the minimal discharge field (MDF). The model allowed us to test to what degree the temporal dynamics of thalamocortical activity contributes to the spatiotemporal changes of cortical RFs. To this end, we performed the fitting procedure either with a pure feedforward model or with a field model that also included intracortical feedback. Spatial and temporal parameters obtained from fits of the experimental RFs matched closely to those achieved by simulating a pure feedforward system with the field model but were not compatible with additional intracortical feedback. Thus, our results show that dot stimulation, which optimally excites thalamocortical cells, leads to a shrinkage with respect to the size of the RF subfield at the first transient response of visual cortical RFs which seems mainly due to a change in the thalamic firing pattern. In these experiments little or no influence from intracortical sources was observed, which, however, may play a role when using more complex visual stimuli.     

肿块型慢性胰腺炎的诊治

目的　总结肿块型慢性胰腺炎 (mass typechronicpancreatitis ,MTCP )的诊治经验 ,以提高对该病的认识。方法　回顾性分析近 8年来手术治疗的 2 5例MTCP患者的临床资料。 2 5例中行CT检查 2 3例 ,B超检查 2 1例 ,逆行胰胆管造影检查 (ERCP) 6例 ,超声内镜检查 (EUS) 5例 ,阳性发现率分别为 95 .7% ,85 .7% ,83 .3 % ,10 0 %。 2 5例均接受手术治疗 ,其中行胰十二指肠切除或保留幽门的胰十二指肠切除术 17例 ,保留十二指肠的胰头次全切除术 (Beger手术 ) 1例 ,胰头部分挖除、胰管空肠吻合术 (Freys手术 ) 3例。胰体尾部切除术 4例。 结果　上腹痛是MTCP的主要临床症状。肿块位于胰头部者 2 1例 (84.0 % ) ,胰体尾部者 4例 (16.0 % )。术前诊断为MTCP 16例 ,胰腺癌 9例。术后病理诊断为MTCP 2 2例 ,慢性胰腺炎合并胰腺癌 3例 ,术前误诊率 2 4.0 %。术后发生胰漏 1例 ,吻合口出血 2例 ,并发症发生率为 12 .0 %。术后近期 92 .0 %的患者腹痛缓解。 2 3例获 1～ 5年随访 ,平均随访 3 .4年 ,82 .6%的患者疗效满意。结论　MTCP应及早手术 ,多可获得满意疗效 ,并对减缓疾病进程有利。     

Unilateral Dichotomy of Nipple (Intraareolar Polythelia) and Areola: Report of a Case and Surgical Correction

An unusual case of intraareolar polythelia with two nipples is presented. The dichotomy affected not only the nipple, but also the areola. No other breast malformation existed. Surgical correction was performed by transposition flaps sutured to one another in the center of the areola. The anatomic and functional results were satisfactory.