Activity of the hypothalamic-pituitary-adrenal axis in mice selected for left- or right-handedness

Asymmetry in brain modulation of the immune system has been previously described. In mice, paw preference has been shown to be associated with immune reactivity but the mechanisms involved in such an association are not yet known. The autonomic nervous system and the neuroendocrine system are considered as major candidates for neural influences on the immune system. In the present study, the activity of the hypothalamic-pituitary-adrenal (HPA) axis of adult female mice selected for paw preference (left-handers vs. right-handers) was assessed by measuring both adrenocorticotropic hormone (ACTH) and corticosterone plasma levels, as well as the in vitro responses of hypothalamus and adrenocortical cells to various hormone releasing stimuli. The results reported here showed no difference in the activity of the HPA axis between left- and right-handed mice, suggesting that this neuroendocrine axis is not implicated in the association between functional brain asymmetry and immune reactivity. However, our results do not exclude the possibility that the HPA axis could play a role in such an association under other circumstances, such as during development or stressful situations.     

经食管心房调搏对阵发性室上性心动过速的诊断价值

目的 探讨经食管心房调搏对阵发性室上性心动过速的分型及定位诊断价值。方法 回顾性分析食管心房调搏对193例阵发性室上性心动过速分型及定位诊断结果，并与心内电生理检查诊断结果比较。结果 经食管心房调搏对慢-快型AVNRT及顺向性AVRT的诊断敏感性、特异性、准确性均较高，对少见型AVNRT的诊断敏感性低(25％)。结论 阵发性室上性心动过速发作时食管与体表心电图P^-波起始与极性是诊断阵发性室上性心动过速的关键。经食管心房调搏对心动过速旁道定位误诊原因主要是心动过速时体表心电图P^-波往往与T波融合，导致V1、I导联P^-波极性及V1导联P^-波起始部形态改变。     

Estimating lead‐time bias in lung cancer diagnosis of patients with previous cancers

Surprisingly, survival from a diagnosis of lung cancer has been found to be longer for those who experienced a previous cancer than for those with no previous cancer. A possible explanation is lead‐time bias, which, by advancing the time of diagnosis, apparently extends survival among those with a previous cancer even when they enjoy no real clinical advantage. We propose a discrete parametric model to jointly describe survival in a no‐previous‐cancer group (where, by definition, lead‐time bias cannot exist) and in a previous‐cancer group (where lead‐time bias is possible). We model the lead time with a negative binomial distribution and the post–lead‐time survival with a linear spline on the logit hazard scale, which allows for survival to differ between groups even in the absence of bias; we denote our model Logit‐Spline/Negative Binomial. We fit Logit‐Spline/Negative Binomial to a propensity‐score matched subset of the Surveillance, Epidemiology, and End Results–Medicare linked data set, conducting sensitivity analyses to assess the effects of key assumptions. With lung cancer–specific death as the end point, the estimated mean lead time is roughly 11 months for stage I&II patients; with overall survival, it is roughly 3.4 months in stage I&II. For patients with higher‐stage lung cancers, the mean lead time is 1 month or less for both outcomes. Accounting for lead‐time bias reduces the survival advantage of the previous‐cancer group when one exists, but it does not nullify it in all cases.     

Assisted living nursing practice: medication management: Part 1. Assessing the resident for self-medication ability

Self-administration of medication suggests that individuals are functionally and cognitively competent to manage their health care. Older adults take a significant number of medications (borderline polypharmacy) as well as an unaccounted for number of over-the-counter, as necessary, and herbal remedies. Assisted living residences, moving from a social to a more medical model, are responsible for the safety and well-being of their residents. In addition, the prospect of aging-in-place in the residence is increasingly associated with appropriate medical and medication management. Assisted living services in most states include assistance with medication, but the nature of the assistance varies widely, at times approaching what even a nonclinical observer would regard as medication administration. Although state assisted living regulations can be quite specific regarding medication storage, there are scant guidelines about the components of a thorough assessment as to whether a resident can safely self-administer his or her medications. This article discusses assessment criteria of self-medication ability, drawn from a variety of instruments. In keeping with assisted living nursing standards of practice, the assisted living nurse has a critical responsibility in assessment of this self-care ability.