• 【紫杉醇在晚期胃癌血液透析患者中的药代动力学: 一例报告。】 复制标题 收藏 收藏
    DOI:10.3748/wjg.v12.i32.5237 复制DOI
    作者列表:Kawate S,Takeyoshi I,Morishita Y
    BACKGROUND & AIMS: :We report for the first time the possibility of weekly paclitaxel chemotherapy for a patient with advanced, nonresectable gastric cancer undergoing hemodialysis. A 50-year-old man with chronic renal failure due to bilateral polycystic kidneys, who had undergone hemodialysis three times a week for 5 years, presented with hematemesis in December 2004. Based on the diagnosis of gastric cancer with lymph node metastases, surgery was performed. On the 15th postoperative day, the patient was treated with chemotherapy using paclitaxel. Paclitaxel was administered at a dose of 60 mg/m2 as a 1 h iv infusion in 250 mL of saline. Hemodialysis was started 1 h after the completion of the paclitaxel infusion and was performed for 3 h. Paclitaxel was administered weekly on d 1, 8, and 15 on a 28-d cycle. The maximum plasma concentration of paclitaxel was 1390 microg/L. The area under the curve of paclitaxel was 4398.6 microg x h/L. Grade 2 leukopenia was encountered during the first cycle. The plasma concentrations of paclitaxel from 6 to over 24 h after the infusion were 0.01 to 0.1 micromol/L in our patient, and these concentrations have been shown to be effective on inhibiting the growth of gastric cancer cells without producing adverse side effects in the patient. The plasma concentration of paclitaxel was not influenced by hemodialysis. We conclude that the pharmacokinetics of paclitaxel is not altered in a patient with renal failure, and that weekly paclitaxel is a suitable treatment regimen for hemodialysis patients with advanced gastric cancer.
    背景与目标: : 我们首次报告了接受血液透析的晚期,不可切除的胃癌患者每周进行紫杉醇化疗的可能性。一名50岁的男子因双侧多囊肾而患有慢性肾功能衰竭,他每周接受3次血液透析,持续5年,2004年12月出现呕血。根据胃癌伴淋巴结转移的诊断,进行了手术治疗。术后第15天,患者接受紫杉醇化疗。紫杉醇以60 mg/m2的剂量在250 mL生理盐水中静脉输注1 h。紫杉醇输注完成后1小时开始血液透析,并进行3小时。紫杉醇每周在第1、8和15天的28天周期给药。紫杉醇的最年夜血浆浓度为1390 μ g/L。紫杉醇曲线下面积为4398.6 μ g × h/L。在第一个周期中遇到2级白细胞减少症。在我们的患者中,输注后6至24小时内紫杉醇的血浆浓度0.01至0.1 micromol/L,并且这些浓度已被证明对抑制胃癌细胞的生长有效,而不会在患者中产生不良副作用。紫杉醇的血浆浓度不受血液透析的影响。我们得出的结论是,在肾功能衰竭患者中,紫杉醇的药代动力学没有改变,并且每周紫杉醇是晚期胃癌血液透析患者的合适治疗方案。
  • 【一项通用实践研究,旨在比较喷雾剂 (“otomize”) 与标准滴剂制剂 (“sofradex”) 治疗外耳道炎患者的疗效和耐受性。】 复制标题 收藏 收藏
    DOI:10.1185/03007999009111486 复制DOI
    作者列表:Smith RB,Moodie J
    BACKGROUND & AIMS: :In an open, multi-centre study in general practice, a comparison was made of the efficacy, tolerability and acceptability of a neomycin/dexamethasone preparation administered by metered-dose spray ('Otomize') and a framycetin/gramicidin/dexamethasone preparation ('Sofradex') administered as drops in 60 patients with otitis externa. Patients were allocated at random to receive one or other preparations 3-times daily for 10 days and were followed-up again 14 days after cessation of therapy. Clinical assessments were carried out under observer blind conditions on entry (Day 0) and on Days 10 and 24 of the severity of erythema, swelling and debris in the affected ear(s). A global assessment of clinical outcome was made by the doctor on Day 10. There were no significant differences in the two groups at the start of treatment. Significant improvement occurred in both groups from Day 0 to Day 10 and from Day 10 to Day 24 in all symptoms, with the proportion symptom-free in the 'Otomize' group significantly greater than in the 'Sofradex' group at 24 days, and approaching significance at 10 days. Significantly more patients in the 'Otomize' group were rated as having a good clinical outcome by the physician, and fewer patients experienced discomfort on application. Few side-effects were reported by either treatment group, none necessitating discontinuation of therapy.
    背景与目标: : 在一项常规的开放,多中心研究中,比较了通过定量喷雾 ('Otomize') 和framycetin/gramicidin/地塞米松制剂的疗效,耐受性和可接受性。地塞米松制剂 ('Sofradex') 以滴剂形式在60例外耳道炎患者中使用。患者被随机分配接受一种或其他制剂,每天3次,持续10天,并在停止治疗后14天再次随访。在进入 (第0天) 以及受影响的耳朵中红斑,肿胀和碎屑的严重程度的第10天和第24天,在观察者盲条件下进行临床评估。医生在第10天对临床结果进行了全面评估。治疗开始时两组无显著差异。在所有症状中,两组从第0天到第10天以及从第10天到第24天均出现显着改善,“otomize” 组无症状的比例在24天显着高于 “sofradex” 组,并在10天接近显着性。医生将 “otomize” 组中的更多患者评为具有良好的临床结果,并且更少的患者在应用中出现不适。任何治疗组都很少报告副作用,没有必要停止治疗。
  • 【Beckwith-Wiedemann综合征和半增生的肿瘤监测: 对证据的严格审查和当地实践的建议指南。】 复制标题 收藏 收藏
    DOI:10.1111/j.1440-1754.2006.00908.x 复制DOI
    作者列表:Tan TY,Amor DJ
    BACKGROUND & AIMS: :There is strong evidence for an association between overgrowth disorders such as Beckwith-Wiedemann syndrome and the development of neoplasia. An increased cancer risk has also been observed in individuals with isolated hemihyperplasia. We critically review the evidence for tumour surveillance in Beckwith-Wiedemann syndrome and isolated hemihyperplasia and suggest local practice guidelines.
    背景与目标: : 有强有力的证据表明,Beckwith-Wiedemann综合征等过度生长性疾病与肿瘤的发展之间存在关联。在孤立的半增生个体中也观察到癌症风险增加。我们严格审查了Beckwith-Wiedemann综合征和孤立性半增生中肿瘤监测的证据,并提出了当地实践指南。
  • 【宫颈细胞学筛查-城市周围地区的知识,态度和实践。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Bailie R,Pick W,Cooper D
    BACKGROUND & AIMS: AIM:To determine the knowledge, attitudes and practice of women living in peri-urban settlements with regard to screening for cervical cancer. METHOD:A community-based questionnaire survey of 165 women living in a defined area of Khayelitsha, a peri-urban settlement on the outskirts of Cape Town. RESULTS:Two hundred households were visited, with a response rate of 84%. Median age of respondents was 27.5 years. The majority of interviewees were married (53.3%), unemployed (61.5%), had an educational status of standard 4 or less (58.1%) and had been living in Cape Town for 4 years or more (64.3%). The median parity was 2 (range 0-11). Most interviewees were currently using contraception (52.4%). One-third (35.4%; 95% CI 28.1-42.7%) of interviewees had heard of the Pap smear. Of these women, most had obtained their information from the midwife obstetric unit (MOU), and this was the most commonly reported facility where Pap tests were known to be done. The majority of interviewees did not regard the test (or the prospect thereof) as embarrassing (88.4%), painful (89.1%) or harmful (90.9%), and indicated that they would have the test done (89.1%). The most important reason for choice of where the test should be done was proximity to place of residence (83.9%). More than one-third of interviewees reported having had a Pap test (37.2%; 95% CI 28.8-44.8%). The most common reason for not having had a test was that the interviewee had never heard of it (81.3%). Most had undergone the test at a MOU (65.6%), where it had been part of an antenatal work-up (80.3%). Fewer than half of the interviewees who had undergone a test knew the result of their test. CONCLUSION:The antenatal, obstetric and family planning services in the area have been effective, to a limited extent, in providing information and conducting screening. However, these services are missing many opportunities to fulfill this function, and knowledge and practice of cervical cytology screening in this community are poor. With the implementation of a rational policy for screening in this area there is the potential to achieve good coverage.
    背景与目标:
  • 【经腋窝入路无气内镜甲状腺切除术30例。】 复制标题 收藏 收藏
    DOI:10.1097/00129689-200608000-00006 复制DOI
    作者列表:Yoon JH,Park CH,Chung WY
    BACKGROUND & AIMS: :Surgery for thyroid disease requires skin incisions that can result in postsurgical problems such as prominent scars, adhesions, hypesthesia, and paresthesia in the neck. To overcome these problems we performed gasless endoscopic thyroidectomy via an axillary approach. Between May 2004 and April 2005, 30 patients underwent gasless endoscopic thyroidectomy via an axillary approach. The mean operating time was 126.8+/-32.4 minutes, and the mean length of hospital stay was 4.3+/-1.1 days. No cases required conversion to open surgery and none involved significant intraoperative complications. Three patients (10.0%) complained of slight hypesthesia or paresthesia in the anterior chest wall, and only 2 patients (6.7%) complained of discomfort while swallowing 4 months after surgery. All patients were satisfied with the cosmetic results. Gasless endoscopic thyroidectomy via an axillary approach is feasible and safe and provides excellent cosmetic results with a minimal degree of postoperative complaints.
    背景与目标: 甲状腺疾病的手术需要皮肤切口,这可能会导致术后问题,如突出的疤痕、粘连、感觉减退和颈部感觉异常。为了克服这些问题,我们通过腋窝入路进行了无气内窥镜甲状腺切除术。在2004年5月和2005年4月之间,有30例患者通过腋窝入路接受了无气内窥镜甲状腺切除术。平均手术时间为126.8 +/-32.4分钟,平均住院时间为4.3 +/-1.1天。没有病例需要转换为开放手术,也没有涉及明显的术中并发症。3例患者 (10.0%) 主诉前胸壁轻微感觉减退或感觉异常,仅2例患者 (6.7%) 主诉术后4个月吞咽时不适。所有患者对美容结果均满意。通过腋窝入路进行的无气内窥镜甲状腺切除术是可行且安全的,并且可提供出色的美容效果,并且术后主诉程度最小。
  • 【晚期结直肠癌患者的黑色素瘤裂解物脉冲树突状细胞疫苗接种: 来自I期研究的报告。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Burgdorf SK,Fischer A,Claesson MH,Kirkin AF,Dzhandzhugazyan KN,Rosenberg J
    BACKGROUND & AIMS: :Immune therapy have shown new and exciting perspectives for cancer treatment. Aim of our study was to evaluate toxicity and possible adverse effects from vaccination of patients with advanced colorectal cancer with autologous dendritic cells (DC) pulsed with lysate from a newly developed melanoma cell line, DDM-1.13. Six patients were enrolled in the phase I trial. Autologous DCs were generated in vitro from peripheral blood monocytes in the presence of granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4). DCs were pulsed with melanoma cell lysate from a cloned and selected melanoma cell line enriched in expression of MAGE-A antigens and deficient in expression of melanoma differentiation antigens: tyrosinase, MART-1 and gp100. Vaccinations were administered intradermally on the proximal thigh with a total of five given vaccines at 2 weeks intervals. Each vaccine contained 3-5 x 10(6) DCs. Five of the six patients received all five vaccines. The treatment was well tolerated in all patients without any observed vaccine-correlated adverse effects. Treatment with this DC-based cancer vaccine proved safe and non-toxic.
    背景与目标: : 免疫疗法为癌症治疗展示了新的令人兴奋的观点。我们研究的目的是评估用新开发的黑色素瘤细胞系DDM-1.13的裂解液对自体树突状细胞 (DC) 进行疫苗接种的毒性和可能的不良反应。6名患者参加了I期试验。在存在粒细胞-巨噬细胞集落刺激因子 (gm-csf) 和interleukin-4 (IL-4) 的情况下,从外周血单核细胞体外产生自体dc。用来自克隆和选择的黑色素瘤细胞系的黑色素瘤细胞裂解液对dc进行脉冲,该细胞系富含MAGE-a抗原的表达,并且缺乏黑色素瘤分化抗原的表达: 酪氨酸酶,MART-1和gp100。在大腿近端皮内接种疫苗,每隔2周共接种5种疫苗。每种疫苗含有3-5x10(6) dc。六名患者中有五名接受了全部五种疫苗。所有患者的治疗耐受性良好,没有观察到任何与疫苗相关的不良反应。使用这种基于DC的癌症疫苗进行治疗被证明是安全且无毒的。
  • 【乳腺癌流行的局部治疗方案对对照临床试验以外生存的影响: 印度北部一家专业乳腺部门的经验。】 复制标题 收藏 收藏
    DOI:10.1007/s00268-006-0037-1 复制DOI
    作者列表:Tewari M,Pradhan S,Kumar M,Shukla HS
    BACKGROUND & AIMS: BACKGROUND:This study aimed at analyzing different treatments of breast cancer (BC) prevalent in the region, their effect on patients' survival, and discusses the most suitable method within available resources. METHODS:The study was set up at a tertiary care hospital in north India. We retrospectively reviewed data of 473 female BC patients who attended the departments of Surgical Oncology and Radiotherapy from January 1997 to December 1999. Patients with cTNM stage IV and inoperable stage III were included; those who defaulted or were lost to follow-up were excluded. Out of 473 patients, 372 were selected. The selected patients were divided into groups on the basis of place and type of local treatment they received: (1) local excision only, (2) standard breast conservation therapy (BCT), (3) total mastectomy (TM) + axillary lymph node dissection + radiotherapy (RT), and (4) modified radical mastectomy (MRM) + RT. Data regarding recurrence and survival were analyzed in December 2005. Minimum follow-up was 6 years. RESULTS:Overall recurrence rates were significantly higher in patients operated elsewhere (P <0.0001). Of 194 operated at our Breast Unit, 25 (14.6%) of 171 MRM patients and none of 23 BCT had recurrence. Of 178 patients operated elsewhere, 44 (100%), 6 (42.9%), 41 (41%), and 8 (40%) developed recurrence in groups 1, 2, 3, and 4 respectively. Overall survival was significantly better in patients with MRM at our unit versus TM outside (93.6% vs. 80%). CONCLUSIONS:Several types of treatment from improper local excision alone, BCT, TM, to a carefully done MRM are prevalent here. Properly done, MRM yields significant local control with survival benefit and appears to remain the gold standard in management of our BC patients.
    背景与目标:
  • 【代表性全科样本中晚年失眠的危险因素。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Morgan K,Clarke D
    BACKGROUND & AIMS: BACKGROUND:Insomnia is widely reported and widely treated in general practice, yet relatively little research has focused on the natural history of the condition in primary care settings. As a result, there is at present little information to enable clinicians to assess insomnia risk, or anticipate outcomes in older general practice populations.

    AIM:To estimate, using 8-year longitudinal data, the risk of insomnia onset associated with selected health and lifestyle factors.

    METHOD:Survivors from a nationally representative sample (n = 1042) of elderly people originally interviewed in 1985 were reassessed in 1989 (n = 690) and 1993 (n = 410). At the first follow up in 1989, 84 new cases of insomnia were identified (a weighted incidence rate per person per year at a risk of 3.1%; 95% CI = 2.7-3.5). In logistic regression analyses controlling for age and sex, the risk of insomnia onset was then assessed in relation to the selected factors.

    RESULTS:Three factors assessed in 1985 were significantly and independently related to incident insomnia: psychometric ratings consistent with depressed mood odds ratio (OR) = 4.41; 95% CI = 3.32-5.43); health index scores indicating lower physical health status (OR = 1.19; 95% CI = 1.06-1.31 per unit change in scale score); and moderate and low levels of physical activity (OR = 1.91 and 2.14; 95% CI = 1.91-3.62 and 2.14-3.64 respectively). However, although depressed mood represented a major risk factor, the most likely source of risk was physical rather than mental ill-health.

    CONCLUSIONS:Psychiatric, somatic and lifestyle factors significantly and independently increase the risk of insomnia in older general practice patients. In predicting incident sleep disturbance, these factors exceed in importance the age and sex of patients.

    背景与目标: 背景 : 失眠在一般实践中已被广泛报道和广泛治疗,但针对初级保健机构中该病的自然史的研究相对较少。因此,目前几乎没有信息可以使临床医生评估失眠风险,或预测老年全科医生的结果。
    目标 : 使用8年的纵向数据进行估计,失眠发作的风险与选定的健康和生活方式因素有关。
    方法 : 1989年 (n = 690) 和1993 (n = 410) 重新评估了来自1985年最初接受采访的具有全国代表性的老年人样本 (n = 1042) 的幸存者。在第一次随访1989年,发现了84例新的失眠病例 (每人每年加权发病率,风险为3.1%; 95% CI = 2.7-3.5)。在控制年龄和性别的逻辑回归分析中,然后根据所选因素评估失眠发作的风险。
    结果 : 1985年评估的三个因素与失眠事件显着且独立相关: 符合抑郁情绪优势比 (OR) = 4.41; 95% CI = 3.32-5.43); 健康指数得分表明较低的身体健康状况 (OR = 1.19; 95% CI = 1.06-1.31每单位变化的量表得分); 和中等和低水平的体育活动 (OR = 1.91和2.14; 95% CI分别 = 1.91-3.62和2.14-3.64)。但是,尽管情绪低落是主要的危险因素,但最可能的危险来源是身体健康而不是精神健康不良。
    结论 : 精神病学,躯体和生活方式因素显着且独立地增加了老年全科患者的失眠风险。在预测事件睡眠障碍时,这些因素的重要性超过了患者的年龄和性别。
  • 【晚期癌症患者对肿瘤基因组分析中次级种系发现的兴趣和态度。】 复制标题 收藏 收藏
    DOI:10.1200/JOP.2016.020057 复制DOI
    作者列表:Hamilton JG,Shuk E,Genoff MC,Rodríguez VM,Hay JL,Offit K,Robson ME
    BACKGROUND & AIMS: PURPOSE:Tumor genomic profiling (TGP) can reveal secondary findings about inherited disease risks in a patient with cancer. Little is known about how patients with advanced cancer, currently the primary users of TGP, perceive the benefits and harms of secondary germline findings. METHODS:We conducted semistructured interviews with 40 patients with advanced breast, bladder, colorectal, or lung cancer who had TGP. Qualitative interview data were evaluated by using a thematic content analysis approach. RESULTS:Most participants expressed interest in the prospect of learning their secondary germline findings (57%), although a minority was equivocal (29%) or disinterested (14%). Reasons for these preferences varied but were influenced by participants' perceptions of diverse benefits and harms of this information, which they regarded as relevant to themselves; their families; and other patients with cancer, medical science, and society. These attitudes were uniquely shaped by participants' personal disease experiences and health status. CONCLUSION:Many patients with advanced cancer are interested in learning secondary germline findings and hold optimistic and perhaps unrealistic beliefs about the potential health benefits. Patients also have important concerns about clinical and emotional implications of this information. These perceptions are necessary to address to ensure that patients make informed decisions about learning secondary germline findings.
    背景与目标:
  • 【腹腔镜胃癌全胃切除术: 我们92例的经验。】 复制标题 收藏 收藏
    DOI:10.3109/13645706.2012.743919 复制DOI
    作者列表:Corcione F,Pirozzi F,Cuccurullo D,Angelini P,Cimmino V,Settembre A
    BACKGROUND & AIMS: INTRODUCTION:Laparoscopic total gastrectomy (LTG) is seldom used for gastric cancer because the complex vascularization and lymphatic drainage makes lymphadenectomy and esophagojejunal anastomosis difficult and requires special skills. Our aim was to demonstrate the feasibility and accuracy of LTG in gastric cancer with D2 lymphadenectomy. MATERIAL AND METHODS:Eighty-eight LTG and four laparoscopic remnant gastrectomies (LRGs) were performed over >12 years. The median patient age was 64 years, and the male/female ratio was 1.49/1. Eighty-seven patients had a D2 and only five patients had a D1 lymphadenectomy. We propose the retrospective analysis of intra- and perioperative mortality and morbidity. RESULTS:In only four of 96 cases approached by laparoscopy, a conversion to laparotomy was needed. There were two (2.17%) perioperative deaths in 92 procedures and few complications. Histological data show 79 advanced gastric cancers (AGC), 11 early gastric cancers (EGC), and two gastric diffused lymphomas. The five-year Kaplan-Meier overall survival in patients with EGC and AGC was 100% and 58%, respectively. CONCLUSIONS:The results demonstrate the feasibility of an oncologically correct minimally invasive total gastrectomy. We would like to promote comparisons among different institutions to achieve better standardization of indications and techniques for a laparoscopic approach to gastric cancer.
    背景与目标:
  • 【贝伐单抗和厄洛替尼靶向治疗适合复发性胶质母细胞瘤患者的分子特征.初步经验。】 复制标题 收藏 收藏
    DOI:10.1007/s00701-012-1536-5 复制DOI
    作者列表:D'Alessandris QG,Montano N,Cenci T,Martini M,Lauretti L,Bianchi F,Larocca LM,Maira G,Fernandez E,Pallini R
    BACKGROUND & AIMS: BACKGROUND:Advances in comprehension of molecular biology of glioblastoma (GBM) have led to the development of targeted therapies. The aim of the present study was to evaluate the efficacy and safety of a targeted therapeutic approach in which administration of bevacizumab and erlotinib was tailored on the molecular profile of recurrent GBM. METHODS:We prospectively enrolled ten adult patients suffering from recurrent GBM who had undergone surgical resection and standard chemo-radiotherapy. Tumor tissue was assessed for the expression of EGFRvIII and MGMT promoter methylation by RT-PCR, and for PTEN and VEGF expression by immunohistochemistry. Normal PTEN status was required for inclusion. Patients with VEGF overexpressing tumors (10/10) were treated with bevacizumab (10 mg/kg iv every 2 weeks in 6-week cycles); patients whose tumor expressed EGFRvIII (4/10) added erlotinib (150 mg/day orally; 300 mg/day if on enzyme-inducing antiepileptic drugs). Therapy was continued until disease progression or unacceptable toxicity. Primary endpoints of the study were response rate (RR), 6-month progression-free survival (PFS-6), and safety profile. RESULTS:The RR and PFS-6 were 100 % (4/4) and 50 % (3/6) in patients treated with bevacizumab+erlotinib (n = 4) and bevacizumab (n = 6), respectively. In the whole cohort (n = 10), RR and PFS-6 were both 70 % (7/10); median PFS and overall survival (OS) were 8.0 (3.0-31.0) and 9.5 (5.0-31.0) months, respectively. No grade 3/4 adverse events were observed; three patients treated with bevacizumab+erlotinib displayed grade 1/2 rash not requiring dose reduction; one patient treated with bevacizumab developed intratumoral hemorrhage requiring treatment discontinuation. CONCLUSION:To our knowledge, this is the first study on recurrent GBM in which administration of bevacizumab and erlotinib was tailored on the molecular profile of the patient's tumor. Although we treated a limited number of patients, we obtained significantly higher RR and PFS-6 than those reported in a previous trial lacking molecular tumor analysis.
    背景与目标:
  • 【通过实践整合行动和大小感知。】 复制标题 收藏 收藏
    DOI:10.1177/0301006617715378 复制DOI
    作者列表:Coutte A,Camus T,Heurley L,Brouillet D
    BACKGROUND & AIMS: :Size perception is known to influence our usual interactions with environment. Numerous studies highlighted that during the visual presentation of an object, the properties of manual actions vary as a function of this object's size. In order to better understand the dynamic variations of relationships between size perception and action, we used an experimental paradigm consisting in two phases. During a previous implicit learning phase, a manual response (right or left) was specifically associated with the appearance of a large or small stimulus. During further test phase, participants were required to prepare a response while discriminating the color of a stimulus (GO/No GO task). We observed that the response execution was faster when the size of the stimulus was congruent with the size that had been associated to this response (during implicit learning phase). These results suggest that when a response usually co-occurs with visual stimuli characterized by a specific size pattern, the response and the size pattern become integrated. Any subsequent preparation and execution of this action are therefore influenced by the reactivation of this visual pattern. This result brings out new insights on how sensorimotor interactions may modulate the ability to anticipate perceptive size variations in the environment.
    背景与目标: : 众所周知,大小感知会影响我们通常与环境的互动。大量研究强调,在对象的视觉呈现过程中,手动动作的属性随对象大小的变化而变化。为了更好地理解大小感知和动作之间关系的动态变化,我们使用了一个由两个阶段组成的实验范例。在先前的内隐学习阶段,手动响应 (右或左) 与大或小刺激的出现特别相关。在进一步的测试阶段,要求参与者在区分刺激颜色的同时准备响应 (GO/No GO任务)。我们观察到,当刺激的大小与与该响应相关的大小一致时 (在隐式学习阶段),响应执行更快。这些结果表明,当响应通常与以特定大小模式为特征的视觉刺激同时发生时,响应和大小模式将成为一体。因此,此操作的任何后续准备和执行都受到此视觉模式重新激活的影响。该结果为感觉运动相互作用如何调节预测环境中感知大小变化的能力带来了新的见解。
  • 【患者咨询课程对一年级药学专业学生的沟通理解,结果期望和自我效能感的影响。】 复制标题 收藏 收藏
    DOI:10.5688/ajpe768152 复制DOI
    作者列表:Rogers ER,King SR
    BACKGROUND & AIMS: OBJECTIVES:To evaluate first-year doctor of pharmacy (PharmD) students' communication apprehension, outcome expectations, and self-efficacy for communication over the duration of a 15-week patient-counseling course. DESIGN:First-year PharmD students (n=94) were asked to complete a 47-item, self-administered questionnaire on 3 occasions over the duration of the Nonprescription Drugs/Patient-Counseling course during the fall 2009 and 2010 semesters. ASSESSMENT:Eighty-seven of 94 students completed the survey instrument across data collection periods. There were significant reductions in total communication apprehension scores and in the communication apprehension subscores for meetings and public speaking, and significant increases in self-efficacy over time. No differences were found for outcome expectations of communication scores or the subscores for interpersonal conversations and group discussion. CONCLUSIONS:Communication apprehension may be decreased and self-efficacy for communication increased in first-year PharmD students through a 15-week Nonprescription Drugs/Patient-Counseling course using small-group practice sessions, case studies, and role-play exercises in conjunction with classroom lectures.
    背景与目标:
  • 【接受乳腺癌手术的女性先进成像应用趋势。】 复制标题 收藏 收藏
    DOI:10.1002/cncr.27838 复制DOI
    作者列表:Breslin TM,Banerjee M,Gust C,Birkmeyer NJ
    BACKGROUND & AIMS: BACKGROUND:Evidence-based guidelines recommend limited perioperative diagnostic imaging for new breast cancer diagnoses. For patients aged >65 years, conventional imaging use (mammography, plain radiographs, and ultrasound) has remained stable, whereas advanced imaging (computed tomography [CT], nuclear medicine scans [positron emission tomography/bone scans], and magnetic resonance imaging [MRI]) use has increased. In this study, the authors evaluated traditional and advanced imaging use among younger patients (aged ≤ 65 years) undergoing breast cancer surgery. METHODS:The MarketScan Commercial Claims and Encounters Research Database from 2005 through 2008 was analyzed to evaluate the use of conventional and advanced diagnostic imaging associated with surgery for ductal carcinoma in situ (DCIS) or stage I through III invasive breast cancer. RESULTS:The study cohort included 52,202 women (13% with DCIS and 87% with stage I-III breast cancer). The proportion of patients undergoing conventional imaging remained stable, whereas the average number of conventional imaging tests per patient increased from 4.21 tests in 2005 to 4.79 tests per patient in 2008 (P < .0001). For advanced imaging, the proportion of women who underwent imaging increased from 48.8% in 2005 to 68.8% in 2008 (P < .0001), as did the number of tests per patient (from 1.53 tests in 2005 to 1.98 tests in 2008; P < .0001). MRI examinations accounted for nearly all of the increase in advanced imaging. Patients who underwent MRI examinations received significantly more traditional imaging tests compared with to those who did not, indicating that these tests are additive and are not replacing traditional imaging. CONCLUSIONS:The current results demonstrate that the use of perioperative breast MRI has increased among women aged <65 years. Further study is indicated to determine whether the benefits of this procedure justify increased use.
    背景与目标:
  • 【胆固醇目标的实现和更高成本的他汀类药物的处方: 一般实践中的横断面研究。】 复制标题 收藏 收藏
    DOI:10.3399/bjgp12X659286 复制DOI
    作者列表:Fleetcroft R,Schofield P,Duerden M,Ashworth M
    BACKGROUND & AIMS: BACKGROUND:There is conflicting evidence as to whether achievement of cholesterol targets at the population level is dependent on the choice and cost of statin. AIM:To investigate the practice-level relationship between cholesterol quality indicators in patients with heart disease, stroke, and diabetes and prescribing of low-cost statins. DESIGN AND SETTING:Correlations and linear regression modelling of retrospective cross-sectional practice-level data with potential explanatory variables in 7909 (96.4%) general practices in England in 2008-2009. METHOD:Quality indicator data were obtained from the Information Centre and prescribing data from the NHS Business Authority. A 'cholesterol quality indicator' score was constructed by dividing the numbers of patients achieving the target for cholesterol control of ≤5 mmol/l in stroke, diabetes, and heart disease by the numbers on each register. A 'low-cost statin' ratio score was constructed by dividing the numbers of defined daily doses of simvastatin and pravastatin by the total numbers of defined daily doses of statins. RESULTS:Simvastatin accounted for 83.3% (standard deviation [SD] = 15.7%) of low-cost statins prescribed and atorvastatin accounted for 85.7% (SD = 14.8%) of high-cost statins prescribed. The mean cholesterol score was 73.7% (SD = 6.0%). Practices using a higher proportion of the low-cost statins were less successful in achieving cholesterol targets. An increase of 10% in the prescribing of low-cost statins was associated with a decrease of 0.46% in the cholesterol quality indicator score (95% confidence interval = -0.54% to -0.38%, P<0.001). CONCLUSION:Greater use of low-cost statins was associated with a small reduction in cholesterol control.
    背景与目标:

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