院前急救心肺复苏条件差异对心脏骤停病人的疗效影响

目的:研究提高心脏骤停病人院前救治的综合水平以及影响心脏骤停院前救治效果的因素。方法:采用对目标人群中心脏骤停病人进行院前心肺复苏术,用院前心肺复苏术临床效果研究调查346份病例资料。结果:按照院前心肺复苏的条件进行分组对比分析,发现在呼救反应时间长短、有无旁观者参与、有无电击除颤方面的差异具有统计学意义(P0.05),而气道开放后使用球囊面罩和气管插管差异无统计学意义。结论:心脏骤停病人在呼救反应时间小于10分钟、现场有旁观者参与复苏、早期启用电除颤者心肺复苏成功率最高。     

A prospective,phase II,open-label study (JO22903) of first-line erlotinib in Japanese patients with epidermal growth factor receptor (EGFR) mutation-positive advanced non-small-cell lung cancer (NSCLC)

Introduction

The epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitor erlotinib is associated with survival benefits in patients with EGFR mutation-positive non-small-cell lung cancer (NSCLC). This phase II, single-arm study examined the efficacy and safety of first-line erlotinib in Japanese patients with EGFR mutation-positive NSCLC.

Methods

Eligible patients received erlotinib 150 mg/day until disease progression or unacceptable toxicity. The primary endpoints were progression-free survival (PFS) and safety.

Results

A high degree of concordance was observed between different mutation testing methodologies, suggesting feasibility of early, rapid detection of EGFR mutations. Median PFS was 11.8 months (95% confidence interval [CI]: 9.7–15.3) at data cut-off (1 June 2012) (n = 102). Exon 19 deletions seemed to be associated with longer PFS compared with L858R mutations; T790M mutations were tentatively linked with shorter PFS. The safety profile was as expected: rash (any grade; 83%) and diarrhea (any grade; 81%) were most common. Six interstitial lung disease (ILD)-like cases were reported, and 5 were confirmed as ILD-like events by the extramural committee. Two patients died of treatment-related pneumonitis (JAPIC Clinical Trials Information number: Japic CTI-101085).

Conclusion

Erlotinib should be considered for first-line treatment in this subset of Japanese patients, with close monitoring for ILD-like events.     

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of advanced epithelial ovarian carcinoma: Upfront therapy,at first recurrence,or later?

Aim

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) has been proposed as treatment for advanced epithelial ovarian carcinoma (EOC). No consensus exists on when to administer CRS + HIPEC during the natural history of the disease, namely, as upfront therapy, at first recurrence, or at second or subsequent recurrence.

Patients and methods

We analyzed a series of patients with advanced EOC collected prospectively in an institution with a peritoneal malignant disease treatment program. Patients were treated with CRS + HIPEC upfront, at first recurrence, and at second or subsequent recurrence.

Results

We treated 42 patients: 15 upfront, 19 at first recurrence, and 8 at second or subsequent recurrence. Cytoreduction was complete (CC0) in 75% of cases; residual disease was <2.5 mm (CC1) in 25%. Severe morbidity (CTCAE v.3.0, grade 3–4) was 26%, and hospital mortality was 7%. After a median follow-up of 24 months, median overall survival was 77.8 months for patients treated upfront, 62.8 months for patients treated at first recurrence, and 35.7 months for patients treated at second or subsequent recurrence. Disease-free survival was 21.1 months, 18 months, and 5.7 months, respectively. Overall survival in the upfront and first recurrence groups was similar, and statistically significant differences with the second recurrence group were identified (p < 0.03).

Conclusions

Treatment of advanced EOC using CRS + HIPEC is promising in terms of overall survival and disease-free survival when administered as upfront and at first recurrence therapy. These results warrant further evaluation in a randomized trial.     

无缝管理模式在术晨首台手术患者候诊期应用的伦理分析

目的:通过对无缝管理模式在术晨首台患者候诊期应用的效果评价,探讨相关的伦理问题。方法:选取400例首台手术患者,随机分为改良组200例,对照组200例,经实施采无缝管理模式,并采用焦虑量表评分(SAS),对两组手术患者的焦虑程度及护理服务满意度进行分析比较。结果:通过对改良组与对照组的研究对比显示:改良组与对照组相比差异有统计学意义(P0.05)。结论:无缝管理模式在术晨首台手术患者候诊期的应用,给护患提供了良好的交流平台,更好地满足患者的心理、伦理需求,做到"护患不分离",确保将"以病人为中心"的人文关怀落实到实处。     

Condylar position following mandibular advancement: Its relationship to relapse

Forty-one patients who elected to receive a bilateral sagittal osteotomy to advance the mandible were examined clinically and radiographically to assess condylar position preoperatively and at three specific times post-operatively. Parameters designed to measure changes in condylar and distal fragment position were located on tracings and digitized for statistical analysis. Changes in distal fragment position included advancement and clockwise rotation during the surgical interval and significant posterior relapse with continued clockwide rotation during the period of maxillomandibular fixation. A small amount of counterclockwise rotation associated with interocclusal splint removal was seen following fixation release. No significant condylar movement was seen during the surgical interval. During the period of maxillomandibular fixation, both condyles exhibited a significant superior movement, and the left condyle also moved posteriorly. No changes in condylar position were noted following release of fixation. The clinical significance of these condylar movements is not clear. Despite minimal changes, 18 patients, six of whom had had no preoperative symptoms and one of whom had exhibited reciprocal clicking, complained of temporomandibular joint pain or noise postoperatively. This suggests that maintenance of condylar position during surgery may not prevent temporomandibular joint dysfunction. In addition, the observed 37% relapse in surgical advancement in the absence of significant condylar distraction implies the interaction of other factors in the relapse process.     

Predicting small for gestational age in the first trimester of pregnancy using maternal ophthalmic artery Doppler indices

Objective: To assess the capacity of maternal ophthalmic Doppler indices for predicting small for gestational age (SGA) newborns in the first trimester of pregnancy.

Methods: We performed a prospective observational cohort study involving 499 singleton pregnancies during the first trimester scan (11–14 weeks). The following maternal ophthalmic Doppler indices were assessed: pulsatility index (PI), first diastolic peak velocity (PD1) and peak ratio (PR)?=?PD1/peak systolic velocity. We considered SGA all newborns with weight below 10th percentile. We used chi-square test (χ²) to compare the groups. We used area under receiver operating characteristics (ROC) curves with 95% confidence intervals (CI) and detection rate of 5% of false positive of each maternal ophthalmic Doppler index and the mean uterine artery PI for prediction SGA.

Results: 27 (5.4%) patients delivered SGA newborns, 12 (2.4%) patients developed preeclampsia (PE) and delivered SGA newborns, and 460 had uneventful pregnancies (controls). We observed significant difference of PI and PR between SGA (SGA and SGA+PE) and control groups, p?=?0.043 and p?=?0.014, respectively. To 5% of false positive, the detection rate of SGA (SGA and SGA+PE groups) using PI, PD1 and PR were 14.8, 3.7, 14.8, 16.7, 16.7 and 16.7%, respectively. Mean uterine PI was significantly higher in the SGA+PE group (p?=?0.003).

Conclusion: The isolated use of maternal ophthalmic Doppler indices or in combination with uterine artery Doppler, in the first trimester of pregnancy, was not efficient to predict SGA newborns.     

Conversion of traditional osseointegrated bone-anchored hearing aids to the Baha® attract in four pediatric patients

Bone-anchored hearing aids are external devices attached to the skull via a titanium implant, and can be used for multiple types of hearing loss. Traditionally, osseointegrated implants have been coupled to the external processor with a percutaneous abutment, but more recently, a fully implanted, transcutaneous magnet-based system has become available. Skin reactions from the percutaneous portion are a common complication that can prevent use of the device during critical windows of language development and learning in children. We describe our experience replacing the Baha^® abutment system with the Baha^® Attract in four pediatric patients. Specific operative considerations for incision placement, and magnet and implant coverage are discussed. All patients maintained osseointegration, had excellent long-term wound healing without post-operative infection, and were able to wear their devices more consistently.     

Impact of school sealant programs on oral health among youth and identification of potential barriers to implementation

BackgroundSchool sealant programs (SSPs) increase sealant prevalence among children lacking access to oral health care. SSPs, however, are substantially underused. From 2013 through 2018, the Centers for Disease Control and Prevention funded 18 states for SSP activities in high-need schools (≥ 50% free and reduced-price meal program participation). From 2019 through 2020, the authors assessed SSPs' impact in reducing caries and how states expanded SSPs. The authors also discuss potential barriers to expansion.MethodsFor Aim 1, the authors used a published methodology and SSP baseline screening and 1-year retention data to estimate averted caries over 9 years attributable to SSPs. For Aim 2, the authors used state responses to an online survey, phone interviews, and annual administrative reports.ResultsUsing data for 62,750 children attending 18.6% of high-need schools in 16 states, the authors estimated that 7.5% of sound, unsealed molars would develop caries annually without sealants and placing 4 sealants would prevent caries in 1 molar. Fourteen states reported SSP expansion in high-need schools. The 2 most frequently reported barriers to SSP expansion were levels of funding and policies requiring dentists to be present at assessment or sealant placement.ConclusionsThe authors found that SSPs typically served children at elevated caries risk and reduced caries. In addition, the authors identified funding levels and policies governing supervision of dental hygienists as possible barriers to SSP expansion.Practical ImplicationsIncreasing SSP prevalence could reduce caries. Further research on potential barriers to SSP implementation identified in this study could provide critical information for long-term SSP sustainability.     

Maternal Plasma P-selectin at 11 to 13 Weeks of Gestation in Hypertensive Disorders of Pregnancy

Objective. To determine if development of preeclampsia is preceded by altered maternal plasma P-selectin and if the levels are related with uterine artery pulsatility index. Methods. Plasma P-selectin and uterine artery pulsatility index were measured at 11–13 weeks in 121 cases that subsequently developed preeclampsia, 87 cases that developed gestational hypertension and 208 unaffected controls. Results. In the preeclampsia group the median multiple of the median in controls (MoM) P-selectin and uterine artery PI were significantly increased (1.2 MoM and 1.3 MoM). There was no significant association between P-selectin and uterine artery pulsatility index in either the preeclampsia or control group. Conclusion. In pregnancies that develop preeclampsia there is evidence of platelet activation from the first trimester. However, there is no direct link between the degree of impaired placentation and platelet activation.