Omission of radiotherapy in elderly women with early stage metaplastic breast cancer

PurposeMultiple studies have evaluated the omission of radiation therapy (RT) in elderly women with invasive carcinoma; no studies to date have assessed this question for metaplastic breast cancer (MBC). This study is the only known study describing national practice patterns and addressing the impact of RT versus observation on survival in elderly women with T1-2N0 MBC.MethodsThe National Cancer Data Base was queried (2004–2013) for women aged ≥70 years with T1-T2N0 MBC that underwent lumpectomy. Multivariable logistic regression ascertained factors associated with RT administration. Kaplan-Meier analysis evaluated overall survival (OS) between patients treated with or without postoperative RT. Cox proportional hazards modeling determined variables associated with OS. Propensity matching was performed in order to address indication bias.ResultsOf 547 total patients, 176 (32%) underwent observation, and 371 (68%) received postoperative RT. Temporal trends revealed that withholding RT steadily declined over the studied time period. RT delivery was less likely in patients not undergoing hormonal therapy or those ≥80 years old. In both the overall population and following propensity matching, delivery of RT was associated with higher OS (p < 0.001 for both). On Cox multivariate analysis, poorer OS was independently associated with advancing age, higher T stage, high-grade disease, and omitting postoperative RT (p < 0.05 for all).ConclusionsAlthough level I evidence exists to omit RT in select elderly women, this is the only study evaluating this notion for MBC. These results do not support the routine withholding of RT in T1-2N0 MBC owing to the independent association with worse survival.     

Erreurs médicamenteuses en anesthésie : enquête prospective au niveau des CHU Marocains

Introduction

Medication errors are a major public health problem because of their morbidity and financial costs. In anesthesia, few articles publications, mostly retrospective, have assessed its incidence and outcomes. By our prospective study, we intend to identify and describe the drug errors in anesthesia in four university hospitals in Morocco.

Material and methods

After approval of our ethics committee, a prospective study was conducted in nine hospitals affiliated to four university hospitals (Rabat, Casablanca, Fes and Marrakech) from October 2009 to June 2010. Data collection was carried out by an anesthesiologist at each hospital who was designated by the investigator. Informations were based on practitioner's statements. Medication errors were divided into distinct categories: substitution errors, omission errors, errors of the way of administration, dosage and dilution errors. The consequences were classified into four levels according to their severity.

Results

During the study period, 9199 anesthetic procedures were reported (mean response of 36%). General anesthesia was performed in 75% of patients. Sixteen cases of drug errors were reported (an incidence of 1/575 with 1/405 in a pediatric setting). The drugs involved were dominated by hypnotics (six cases/16) and morphine (four cases/16). Medication errors were mainly due to labeling mistakes (seven cases/16) and to attention deficit due to fatigue and stress (seven other cases) leading to substitution error in most of cases (10 cases/16. Errors were mainly made by the less experienced practitioners (14 cases/16). They occurred during the induction phase (seven cases/16) as well as during the interview process (nine cases/16), and also during emergent surgeries (seven errors/16) as well as during elective ones (nine errors/16). No errors caused death. Pulmonary edema (recognized as a grade III severity incident) was secondary to inappropriate administration of adrenaline.

Conclusion

Our study helped us to set recommendations, which are approved by the Moroccan pharmacovigilance center, and in accordance with the international committees to prevent the occurrence of medication errors in our daily anesthetic practice.     

Olfactory bulb removal and response suppression in rats

Following either olfactory bulb damage or control surgery, Sprague-Dawley rats were trained on a VI 30-sec reinforcement schedule until their response rate stabilized and then placed on one of three schedules to assess response suppression ability: omission training, extinction, or DRL. Animals with OB damage responded at higher rates than controls during VI training and performed less efficiently on all measures of response suppression ability. The results were compared with performance by animals with septal damage from a previous study.     

Omission of breakfast and risk of gastric cancer in Mexico

AIM: To investigate factors associated with gastric cancer (GC) in the Mexican population using a validated questionnaire. METHODS: We designed and validated in Spanish a Questionnaire to Find Factors Associated with Diseases of the Digestive Tract using GC as a model. A crosssectional study using 49 subjects, with confirmed histopathological GC diagnosis, and 162 individuals without GC participated. Odds ratio and 95% CIs were estimated in univariate and multivariate analysis adjusted for possible confounding factors. In order to match agegroups, a multivariate sub-analysis was performed in subjects ≥ 39 years of age and in females and males separately. RESULTS: In the univariate analysis, we found an association between GC and education to primary level or below, low socioeconomic status, the use of dental prostheses, omission of breakfast, consumption of very hot food and drink, addition of salt to prepared foods, consumption of salt-preserved foods and the pattern of alcohol consumption. We found protection against GC associated with the use of mouthwash, food refrigeration and regular consumption of fruit and vegetables. In the multivariate sub-analysis with subjects of ≥ 39 years, the omission of breakfast was identified as a risk factor for GC. CONCLUSION: Our study suggests an association between the omission of breakfast and the failure to refrigerate food with GC in the Mexican population.     

血细胞自动分析仪误报异常信息及漏诊恶性血液病原因分析

目的探讨血细胞自动分析仪误报异常信息及漏诊恶性血液病的原因。方法病人静脉血经EDTA—K2抗凝后用Sysmex SF-3000血细胞自动分析仪检测,同时制备血涂片瑞氏染色检查外周血白细胞分类。结果500例异常信息中真实信息286例,假信息214例;107例初复诊恶性血液病用血液分析仪检查漏诊率18．7％（20／107）。结论Sysmex SF-3000血细胞自动分析仪可作为大量血液常规检杏中的过筛工具,对仪器检测出现异常信息以及特殊低（高）值计数而仪器检测无异常信启提示的标本,必须进一步进行血涂片显微镜检查复核。     

传染病漏报原因分析与对策

目的加强传染病疫情管理工作，提高疫情报告的及时性与准确性，减少漏报发生。方法对安阳市第三人民医院2005年1月—2007年12月门诊和病房传染病疫情报告进行的监控检查情况和漏报产生的原因进行分析。结果3年漏报率分别为1．68％、0．65％和0．79％。对疫情报告重要性认识不足，对防病知识学习不够，疫情报告管理欠规范是疫情迟报、漏报的原因。结论全员培训，强化管理，加强督查和指导，是有效降低漏报率的关链。     

Evidence for the role of serotonin in the inhibition of specific motor responses

Two behavioural paradigms were used to test the effects of serotonin depletion on a specific form of response inhibition. Treatment with both p-chlorophenylalanine (p-CPA) at 200 mg/kg and lesions of the medial raphe nucleus impaired the acquisition of a step-off passive-avoidance response. The experimental design allowed the elimination of alternative interpretations in terms of increased sensitivity to shock and increased responsiveness to stimuli. p-CPA also impaired response inhibition during an omission-training schedule. The results of the three studies support a general role of serotonin in withholding specific instrumental (reinforced) motor actions. The results contrast with those of studies supporting a role of noradrenaline in response inhibition. A tentative conclusion supports Konorski's (1967) suggestion for differentiation of various types of response inhibition that are mediated by different neurochemical systems.     

郑州市2004-2010年20例孕产妇死亡漏报原因分析

目的分析2004-2010年郑州市孕产妇死亡漏报发生的环节及影响因素,为保证今后孕产妇死亡监测信息的准确性、科学性提供指导性帮助。方法采用随机抽样和重点线索追踪相结合的方法,对郑州市孕产妇死亡监测进行质量控制;对孕产妇死亡漏报资料进行回顾性分析。结果 2004-2010年郑州市孕产妇死亡共漏报20例,漏报率为10.75%,其中城市漏报率为7.69%,农村漏报率为11.56%,漏报率呈逐年下降趋势。计划外孕产妇、有过转诊、妊娠合并症及医院内发生在妇产科以外科室死亡的孕产妇易发生漏报。结论加强卫生行政部门的领导与协调作用,加大监测经费投入,加强对监测人员的业务培训,完善监测技术规范,改进质量控制方法,建立健全奖罚制度,是减少孕产妇死亡漏报的关键。     

外科手术部位感染率低的原因分析及对策探讨

目的分析外科手术部位感染率过低的原因,掌握手术部位感染诊断标准,减少医院感染漏报,及时发现医院感染流行趋势,采取控制措施,防止医院感染暴发。方法选择开展较多、手术部位一旦发生感染对患者安全威胁性较大的手术:包括胆囊切除或(和)胆管手术,结肠、直肠切除术,阑尾切除术,疝手术,乳房切除术,剖宫产,子宫切除术及附件切除术,全髋关节置换术,食道贲门手术,腰椎间盘摘除术,监测时间为2011年1月1日-6月30日及2012年1月1日-6月30日,共监测1 180例手术,对手术部位感染率进行对比分析。结果 2011年半年监测手术部位感染率1.99%,调整感染率4.74%;比国内报道低6～9倍;通过分析原因,对医院感染诊断标准再培训、加强病原微生物送检等,2012年半年监测手术部位感染率4.68%,调整感染率32.12%;与2011年比较差异有统计学意义(χ2=141.841,P=0.000)。结论手术部位感染率偏低的原因是医生漏报所致;采取整改措施后,提高了手术部位感染的识别能力,减少了漏报,对及时发现医院感染暴发具有重要意义。