Advances in Shock Management and Fluid Resuscitation in Children

Shock in children is associated with signifcant mortality and morbidity, particularly in resource-limited settings. The principles of management include early recognition, fuid resuscitation, appropriate inotropes, antibiotic therapy in sepsis, supportive therapy for organ dysfunction, and regular hemodynamic monitoring. During the past decade, each step has undergone several changes and evolved as evidence that has been translated into recommendations and practice. There is a paradigm shift from protocolized-based care to personalized management, from liberal strategies to restrictive strategies in terms of fuids, blood transfusion, ventilation, and antibiotics, and from clinical monitoring to multimodal monitoring using bedside technologies. However, uncertainties are still prevailing in terms of the volume of fuids, use of steroids, and use of extracorporeal and newer therapies while managing shock. These changes have been summarized along with evidence in this article with the aim of adopting an evidence-based approach while managing children with shock.

Surviving the Illness: A Phenomenological Study of Women Diagnosed With Cancer

@#Introduction: This study aims to understand female cancer sufferers’ coping mechanism after they resume work but continue to receive cancer treatment. Methods: A phenomenological approach was used for exploring how these women cope with cancer and their work and family responsibilities. Hence, the living experiences of cancer surviving women were gathered to provide an in-depth understanding of the issue. A total of 10 participants suffering from different types of cancer were selected for the interviews. Data were collected through interview sessions aided by social media. Daily activities were monitored from diagnosis until the subjects returned to work (12 months of monitoring). Results: Seven themes emerged: (1) lowering expectation, (2) ask help from others, (3) take charge and responsibilities, (4) engage in problem-solving, (5) letting go, (6) contribute back to society, (7) spiritual strengthening. The study provides an insight into these women’s coping abilities when maintaining their resilience on the journey to being proclaimed as survivors. Conclusion: The findings create awareness about how employed women manage to have work-life balance despite continuous cancer treatment. Family practitioners can use the study results as a guideline for helping women cope with the different tasks at home and office.

Effects of ginsenoside Rg1 on survivin protein expression and apoptosis in rats with spinal cord ischemia-reperfusion injury / 西安交通大学学报(医学版)

Objective: To observe the effects of ginsenoside Rg1 pretreatment on the expression of survivin protein and apoptosis after spinal cord ischemia-reperfusion injury (SCII) in rats so as to explore the possible mechanism of ginsenoside Rg1 on motor function recovery after SCII in rats. Methods: We selected 120 adult healthy SD rats to construct the model of SCII and randomly divided them into four groups: sham operation group, ischemia group, ischemia-reperfusion group, and drug group. Basso Beattie and Bresnahan score (BBB score) was used to evaluate the motor function of the hind limbs of the rats. The expressions of survivin protein and apoptosis-inducing factor (AIF) was observed by immunohistochemistry. The expression and activity of survivin protein and Caspase-9 in each group were observed and analyzed by Western blot and RT-PCR. Results: The intervention of ginsenoside Rg1 could increase the score of the motor function of the rat hind limbs. It could decrease the number of AIF positive cells, but increase the number of survivin protein positive cells. Ginsenoside Rg1 could decrease the expressions of survivin and Caspase-9, and decrease the apoptosis of nerve cells in SCII. Conclusion: Ginsenoside Rg1 could inhibit the expression of Caspase-9 by promoting the expression of survivin protein and decrease the apoptosis of rat SCII induced by the level of cytoplasmic AIF.

How to view multiple disagreements of IDSA about the Surviving Sepsis Campaign's recommendations / 医学研究生学报

Infectious Diseases Society of America (IDSA) published a POSITION STATEMENT to declare not endorse the Surviving Sepsis Campaign guidelines (2016) which is issused shortly after. The article summarizes some of IDSA's specific concerns about distinguishing sepsis from non-infectious syndromes, time to initiation of empiric antibiotic therapy, blood cultures and iv access catheters, combination and multidrug therapy, procalcitonin, pharmacokinetics/pharmacodynamics, prolonged prophylaxis, and duration of therapy. IDSA pays more attention to reduce the unnecessary overexposure of antibiotics and its perspectives are valuable to optimize antibiotic therapy.

Assessment of compliance to 2016 surviving Sepsis campaign bundles among adult patients admitted at ManilaMed–Medical Center Manila diagnosed with Sepsis

Introduction@#Sepsis is an emerging problem that needs to be recognized early and addressed promptly with hydration and appropriate antibiotics. This study aims to assess the adherence to surviving sepsis campaign (SSC) bundle within three hours and six hours, length of hospital stay and mortality among adult patients admitted at ManilaMed–Medical Center Manila diagnosed with sepsis.@*Methods@#A retrospective cohort study was performed in all adult patients admitted at ManilaMed–Medical Center Manila diagnosed with sepsis and septic shock from January to September 2017. Parameters for SSC bundle for three and six hours were used to assess compliance. Outcomes such as length of hospital stay and mortality were determined.@*Results@#This study included a total of 85 subjects and majority are females (56%). Mean age of study subject was 67.5±17.67 years. Adherence to SSC bundle in three and six hours were observed particularly in blood cultures (45%), administering broad-spectrum antibiotics (69%), fluid resuscitation at 30 mL/kg for hypotensive patients (22%) and administering vasopressors (78%) to maintain systemic perfusion. However, adherence to other parameters of the bundle was not observed, namely: measurement and re-measurement of lactate levels and measurement of CVP and SCVO2. In terms of outcome, the average length of hospital stay is 11 days and mortality was 42%.@*Discussion@#Sepsis is a fatal disease if not promptly recognized and addressed. The SSC bundle was formulated to guide clinicians and other healthcare providers in managing sepsis or septic shock patients. Some of the parameters are absent or are not routinely done in some institution, maximizing the resources that are present is ideal. @*Conclusion@#The compliance rate is deemed submaximal since eyeing for a 90-100% compliance rate is recommendable in a tertiary hospital. Emphasis on early identification, obtaining blood cultures and timely initiation of antimicrobials should be done.

Factors Associated with Complicated Grief in Students Who Survived the Sewol Ferry Disaster in South Korea

OBJECTIVE: The Sewol ferry disaster caused shock and grief in South Korea. The aim of this study was to identify the factors associated with symptoms of complicated grief (CG) among the surviving students 20 months after that disaster. METHODS: This study was conducted using a cross-sectional design and a sample of 57 students who survived the Sewol ferry disaster. Data were collected using the following instruments: Inventory of Complicated Grief (ICG), the Lifetime Incidence of Traumatic Events-Child, the Child Report of Post-Traumatic Symptoms (CROPS), KIDSCREEN-27, Family Adaptability and Cohesion Evaluation Scales-III, the Peri-traumatic Dissociation–Post-traumatic Negative Beliefs–Post-traumatic Social Support scale, and the Strengths and Difficulties Questionnaire. A generalized linear model using a log link and Poisson distribution was performed to identify factors associated with symptoms of CG. RESULTS: The mean score on the ICG was 15.57 (standard deviation: 12.72). Being born in 1999, a higher score on the CROPS and a lower score in autonomy and relationship with parents on the KIDSCREEN-27 were related to higher levels of CG. CONCLUSION: Twenty months after the Sewol ferry disaster, 24.5% of surviving students were suffering from CG. This study uncovered a vulnerable population of bereaved children at high risk for CG.

Factors Associated with Post-traumatic Stress Symptoms in Students Who Survived 20 Months after the Sewol Ferry Disaster in Korea

BACKGROUND: The Sewol ferry disaster caused national shock and grief in Korea. The present study examined the prevalence and associated factors of post-traumatic stress disorder (PTSD) symptoms among the surviving students 20 months after that disaster. METHODS: This study was conducted using a cross-sectional design and a sample of 57 students (29 boys and 28 girls) who survived the Sewol ferry disaster. Data were collected using a questionnaire, including instruments that assessed psychological status. A generalized linear model using a log link and Poisson distribution was performed to identify factors associated with PTSD symptoms. RESULTS: The results showed that 26.3% of participants were classified in the clinical group by the Child Report of Post-traumatic Symptoms score. Based on a generalized linear model, Poisson distribution, and log link analyses, PTSD symptoms were positively correlated with the number of exposed traumatic events, peers and social support, peri-traumatic dissociation and post-traumatic negative beliefs, and emotional difficulties. On the other hand, PTSD symptoms were negatively correlated with psychological well-being, family cohesion, post-traumatic social support, receiving care at a psychiatry clinic, and female gender. CONCLUSION: This study uncovered risk and protective factors of PTSD in disaster-exposed adolescents. The implications of these findings are considered in relation to determining assessment and interventional strategies aimed at helping survivors following similar traumatic experiences.

Critical analysis of maternal deaths from sepsis in a tertiary care center and lessons learned

Background: Maternal mortality in India is reported to be 300 to 500 per 100,000 births in the Bulletin of World Health Organisation. It is far away from Millennium development goal 5 where it is required to reduce MMR to 109 per 100, 000 live births. Sepsis in pregnancy continues to be the third leading cause of preventable maternal deaths in India, still accounts for up to 10 to 50% of maternal deaths in our country. Aim: It was to critically analyze all the mothers who died due to sepsis in order to identify factors associated with deaths. Materials and methods: This prospective study was carried out in the labor room, Department of Obstetrics and Gynecology, King George hospital, Andhra Medical College for a period of twelve months from November 2016 to October 2017. All the mothers who died due to sepsis were included in the study and they were all analyzed modelled on the United Kingdom Confidential Enquiries into maternal deaths. Results: During the study period there were 44 total maternal deaths out of 5863 births giving maternal mortality ratio of 641 per 100,000 maternities. Out of 44 maternal deaths, 14 were due to sepsis making it the leading cause of maternal mortality in our institute. Out of fourteen deaths due to Chuppana Ragasudha, Atluri Phani Madhavi, Pulidindi Sanjana Sharon, Hyma, Sirisha, Syamala, Sravanthi, Sagarika. Critical analysis of maternal deaths from sepsis in a tertiary care center and lessons learned. IAIM, 2017; 4(12): 5-9. Page 6 sepsis nine were due to direct causes and the remaining five were due to indirect causes such as pneumonia, sickle cell disease with malaria, and pancytopenia. The ages of the women who died ranged from 19 to 38 years with a median age of 26 years. All had normal body mass index. Five women who died were tribals, six from rural areas and the remaining three from slums of urban areas. Eight women were primigravid. Eight women died from sepsis in the antenatal period, two deaths were in the first trimester after criminal abortion, three due to pneumonia, one had intrauterine dead fetus infected and the other was due to pancytopenia. Four deaths were due to genital tract sepsis after cesarean section and two were due to genital tract sepsis after normal delivery. These six had risk factors such as anemia, prolonged rupture of membranes etc. Conclusion: In few cases, the outcome was inevitable, but for majority it might have been different had the infection been diagnosed and treated more promptly. There are lessons learned from the deaths of these women to improve the survival of mothers and to achieve millennium development goal 5.

Association of lovastatin overcoming gefitinib resistance with integrin β1 and survivin / 第二军医大学学报

Objective To investigate the association of lovastatin overcoming gefitinib resistance with the levels of integrin β1 and Survivin in human non-small cell lung cancer (NSCLC) cell line PC9 in vitro, and to explore the possible mechanism. Methods The NSCLC cell line PC9 with acq uired gefitini-resistance were divided into 4 groups; control group (RPM1 1640), gefitinib group (1 /μmol/L gefitinib), lovastatin group (5 μmol/L lovastatin), and gefitinib combined with lovastatin group (1 μmol/L gefitinib+5 /μmol L lovastatin). After treatment with different drugs in each group, the inhibition of cell proliferation was detected by cell counting kit-8 (CCK-8) test, the levels of integrin ft 1 and Survivin mRNA were detected by PCR, and the expressions of integrin (31 and Survivin protein were detected by Western blotting analysis. Results Compared with the control group, lovastatin group and gefitinib group, lovastatin combined with gefitinib treatment had significantly inhibited proliferation of PC9 cells with acquired gefitinib-resistance (P<0. 01), and the expressions of integrin)31. Survivin protein and mRNA in PC9 cells were significantly decreased in the three groups (P<0. 05, P<0. 01). Conclusion Mechanisms of lovastatin combined with gefitinib in overcoming gefitinib resistance may be through blocking integrin β1-p-Akt-Survivin signaling pathway, indicating that the combination treatment might be an effective strategy for gefitinib resistance.

Undergone and expecttation from Sepsis 1 to Sepsis 3 of Sepsis / 医学研究生学报

The knowledge about sepsis has undergone a transition from that of Sepsis 1.0 to that of Sepsis 3.0, which reflects a deeper insight into this syndrome -multiple organ dysfunctions resulting from SIRS-CARS, immunity, metabolism, microcirculation, and other comprehensive factors .Although sepsis 3.0 does not represent a perfect understanding of the disease , it is an improvement on the cognition of the body's response to the stimulation of infection .

Undergone and expecttation from Sepsis 1 to Sepsis 3 of Sepsis / 医学研究生学报

The knowledge about sepsis has undergone a transition from that of Sepsis 1.0 to that of Sepsis 3.0, which reflects a deeper insight into this syndrome -multiple organ dysfunctions resulting from SIRS-CARS, immunity, metabolism, microcirculation, and other comprehensive factors .Although sepsis 3.0 does not represent a perfect understanding of the disease , it is an improvement on the cognition of the body's response to the stimulation of infection .

Role of surviving caregiver on bereaved children's mental development: A review / 中国心理卫生杂志

In this paper,we analyzed the role of the surviving caregiver on bereaved children's mental development.In bereaved family,living with mother,appropriate expression of grief,good psychological health level and positive parent-child interaction could promote the healthy development of bereaved children.Otherwise,bereaved children would suffer the secondary damage which stemmed from surviving caregiver's inappropriate reaction.Therefore,further research could explore the effect of bereavement type and the personality of surviving caregiver on the relation between surviving caregiver and bereaved children's mental development.

Surviving Sepsis Guidelines 2016:continuous changes in sepsis managements / 中国小儿急救医学

The Surviving Sepsis Guidelines were first published in 2004,with revisions in 2008 and 2012.In January 2017,the fourth revision of the Surviving Sepsis Guidelines was presented at the 46th annual SCCM meeting and published online in Critical Care Medicine.The updated guideline was generated by 55 international experts and providing 93 recommendations on early management of sepsis and septic shock.There are numerous major advances in the revision of the guidelines.Among the various topics covered,initial resuscitation and antibiotic therapy are the domains in which the most important changes and advances were made.

Diagnostic value of serum and bile survivin levels in obstructive jaundice / 中国现代普通外科进展

Objective:To detect the bile and serum survivin levels in patients with obstructive and to determine whether bile and/or serum survivin be helpful in distinguishing malignant obstructive jaundice (cholangiocarcinoma) from benign obstructive jaundice.Methods:Bile and serum survivin levels were determined using enzyme-linked immunosorbent assay.Receiver operating characteristic (ROC) curve was used to evaluate the feasibility of bile and/or serum in differentiating malignant obstructive jaundice from benign obstructive jaundice.Results:Mean bile survivin concentrations were significantly higher in cholangiocarcinoma compared to choledocholithiasis,benign biliary stricture,compressive stenosis and normal controls(P＜ 0.05,respectively).However,only mean serum survivin concentrations were significantly higher in cholangiocarcinoma than normal controls(P=0.009).For bile survivin,the area under the curve (AUC) was 0.780(P ＜ 0.001),and the optimal cut-off value determined was 772.28 pg/mL,providing a sensitivity of 67.27 ％ and a specificity of 80.85 ％.But the AUC was only 0.600 for serum survivin (P=0.084).Conclusions:These findings reveal that bile survivin is significantly increased in patients with cholangiocarcinoma,and bile survivin may be a useful indicator in differentiating distinguishing cholangiocarcinoma from benign obstructive jaundice.

"17 años después": Tumores sólidos infantiles es hoy un reto interminable

Introducción: El objetivo del estudio fue conocer el número de casos de cada tumor hubo en un periodo de quince años (1999-2014) y el porcentaje de pacientes supervivientes a julio del 2016 y que continúan asistiendo a consultas de seguimiento. Materiales y métodos: Se revisaron los datos registrados en cuanto al diagnóstico de tumores sólidos en niños en Panamá de cuatro bases de datos diferentes ocurridos desde 1999 hasta el 2014. Se calculó el porcentaje de pacientes que hasta julio del 2016 están vivos y asistiendo a consultas de seguimiento.Resultados: 672 pacientes fueron diagnosticados con tumores sólidos, con edades al momento del diagnóstico entre un mes y 15 años. De ellos 52% viven y están el seguimiento sin patología oncológica. De los casos registrados el 41% son tumores cerebrales y el 58.9% corresponden a tumores sólidos no cerebrales, susceptibles a manejo quirúrgico como tumor de Wilms, neuroblastoma, rabdomiosarcoma, osteosarcoma, tumores hepáticos y tumores germinales. Un 8.9% de todos los casos corresponden a retinoblastoma. Conclusiones: Se reflexiona acerca mejoras futuras entre las cuales: la sospecha temprana y referencia efectiva, la priorización de cupos para citas cuando hay sospecha de un cáncer y la conciencia social sobre el cáncer infantil son claves para el éxito.

Introduction: The aim of the study was to determine the incidence of each tumor was in a period of fifteen years (1999-2014 ) and the percentage of patients surviving July 2016 and continue to attend follow-up visits. Material and methods: Reviewed four different data base for the registry of new cases of pediatric tumors in fifteen year in Panama (1999-2014). Was calculed the percentage of patients who still alive until July 2016 and attending follow-up visits was calculated Results: 672 pediatrics patients were diagnosed in the range of age al diagnosis between 1-month old and 15 years. We found that 52% are actually alive and in follow-up to the moment that this paper is finished. The 41% of cases are tumors of the central nervous system, 58.9% of the cases are visceral solid tumors prone to surgical management such as Wilms tumor, Neuroblastoma, Germ-Cell tumors, rabdomiosarcoma, hepatic tumors and 8.9% are retinoblastomas. Conclusion: A reflection of future measures made us propose: early detection and prompt reference efforts, the attention of premonitory case for the suspicion of pediatric tumor and the advocacy of the social conscience for the problem of childhood cancer.

Late presentation of ALCAPA syndrome in an elderly Asian lady

Coronary artery anomalies are often discovered incidentally during cardiac catheterization or computed tomography coronary angiography and may involve the affected coronary artery origin and its course. Coronary artery anomalies are associated with congenital heart disease. The affected coronary arteries may have an unusual high take off origin, origin from contralateral or non-coronary sinus, origin from the pulmonary artery, single coronary system or coronary artery fistula.

Relative Impact of the 2012 SSC Guideline Recommendations under the Scope of Numbers Needed to Treat (NNTs).

The surviving sepsis campaign (SSC) guidelines aimed to reduce mortality in severe sepsis and septic shock. The present study was performed to find out which and how many recommendations of the 2012 SSC update were based on significant effects from clinical studies in adult patients with severe sepsis and septic shock, leading to numbers needed to treat (NNTs). Every reference of the SSC 2012 guideline regarding clinical trials in adult patients was screened for absolute risk reduction regarding mortality to calculate NNTs. 17 relevant clinical trials out of 338 were identified. The NNTs ranged between 3.55 to 23.24. Significant reductions of mortality were detected, and items recommended in the SSC guidelines regarding early goal directed therapy (EGDT)/standard operating procedures (SOP)/sepsis bundles, early therapy with antibiotics, combined antibiotic therapy, and use of norepinephrine. Therapy with norepinephrine and the 6h bundles revealed the lowest NNTs. Significant reductions in mortality with restricted or no recommendations regarded therapy with hydrocortisone, therapy with highdose antithrombin III, and enteral feeding with eicosapentaenoic acid, gamma-linolenic acid and antioxidants. In conclusion, only a few recommendations of the 2012 SSC guidelines are based on significant beneficial effects coming from clinical trials in patients with severe sepsis and septic shock. When transferring study results and NNTs, physicians should take into account the own setting and own subgroup of patients. If feasible, costs of additional treatment success may be quantified underlying NNTs.

Clinical studies of surviving sepsis bundles according to PiCCO on septic shock patients / 中华危重病急救医学

Objective To explore the effect of early goal-directed therapy (EGDT) according to pulse indicated continuous cardiac output (PiCCO) on septic shock patients.Methods Eighty-two septic shock patients in Subei People's Hospital of Jiangsu Province from January 2009 to December 2012 were enrolled and randomly divided into two groups using a random number table,standard surviving sepsis bundle group (n=40) and modified surviving sepsis bundles group (n =42).The patients received the standard EGDT bundles in standard surviving sepsis bundle group.PiCCO catheter was placed in modified surviving sepsis bundles group.Fluid resuscitation was guided by intrathoracic blood volume index (ITBVI) with the aim of 850-1 000 mL/m2.Dobutamine was used to improve the heart function according to left ventricular contractile index (dPmax) and stroke volume index (SVI).The mean arterial blood pressure (MAP) was maintained 65 mmHg (1 mmHg=0.133 kPa) or above with norepinephrine.Extra-vascular lung water was monitored for the titration of liquid and diuretics.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA) score,the number of patients needed vasopressor,serum procalcitonin (PCT),lactic acid and lactate extraction ratio,the amount of fluid resuscitation,duration of mechanical ventilation,duration of intensive care unit (ICU) stay,hospital mortality were recorded in both groups.Results After treatment,the APACHE Ⅱ score,SOFA score and the number of patients needed vasopressor were gradually reduced in both groups,and those in modified surviving sepsis bundle group were significantly lower than those of standard sepsis bundle group at 72 hours (APACHE Ⅱ score:13.1 ± 6.5 vs.20.9 ± 7.5,SOFA score:8.8 ± 4.3 vs.14.6 ± 4.9,the number of patients needed vasopressor:8 vs.17,all P＜0.05).Arterial blood lactate clearance rate was gradually increased after treatment in both groups.Lactate clearance rate in modified surviving sepsis bundle group was significantly higher than that of standard surviving sepsis bundle group [6 hours:(18.2 ± 8.3)％ vs.(10.8 ± 7.5)％,t=-6.036,P=0.001 ; 12 hours:(22.6 ± 7.3)％ vs.(12.4 ± 8.1)％,t=-4.536,P=0.001 ; 24 hours:(27.8 ± 5.6)％ vs.(16.4 ± 9.5)％,t=-5.882,P=0.000].The amount of fluid resuscitation within 6 hours in modified surviving sepsis bundle group increased significantly compared with standard surviving sepsis bundle group (mL:3 608 ± 715 vs.2 809 ± 795,t=-3.865,P=0.033).The amount of fluid resuscitation within 24,48 and 72 hours in modified surviving sepsis bundle group was significantly less than that of standard modified surviving sepsis bundle group with the nadir at 72 hours (mL:918 ± 351 vs.1 805 ± 420,t=5.907,P=0.037).Duration of mechanical ventilation (hours:98.4 ± 20.3 vs.143.3 ± 29.6,t=9.766,P=0.001) and ICU stay (days:7.1 ± 3.1 vs.9.5 ± 2.5,t=2.993,P=0.004) were significantly reduced in modified surviving sepsis bundle group compared with standard surviving sepsis bundle group.The hospital mortality in modified surviving sepsis bundle group was slightly lower than that in standard surviving sepsis bundle group [16.7％(7/42)比 17.5％(7/40),x2=0.010,P=0.920].Conclusions Modified surviving sepsis bundle treatment according PiCCO can reduce the severity of disease in patients with septic shock,can make more accurately guide fluid resuscitation,and can reduce lung water and duration of mechanical ventilation and ICU stay.It has great clinical significance.

Perfil sociodemográfico e econômico dos sobreviventes ao câncer segundo o grau de resiliência / Economic and socio-demographic profile of cancer survivors according to degree of resilience / Perfil sociodemográfico y económico de los sobrevivientes de cancer según el grado de resiliencia

O objetivo deste trabalho foi descrever o perfil sociodemográfico e econômico dos sobreviventes ao câncer segundo o grau de resiliência, atendidos no Serviço de Oncologia do Hospital Escola da Universidade Federal de Pelotas, Rio Grande do Sul. Trata-se de um estudo descritivo, de corte transversal, desenvolvido com 264 sobreviventes ao câncer em avaliação médica no período de março a junho de 2010. A coleta de dados ocorreu mediante entrevistas, aplicação da versão brasileira da Escala de Resiliência de Wagnild e Young e consulta nos prontuários. Os resultados indicam o predomínio do sexo feminino (67, 8%), idosos (47, 4%), casados (52, 6%), da raça branca (83, 3%), renda principal o benefício/aposentadoria (75, 4%). O alto grau de resiliência foi maior entre os homens (47, 1%), os idosos (44, 8%), os solteiros (47, 9%), os não brancos (52, 3%) e os que possuem emprego (55, 6%). Constatou-se que a caracterização desta população é relevante, pois poderá contribuir para a identificação dos fatores promotores da elevada resiliência.

The aim of this paper was to describe the economic and socio-demographic profile of cancer survivors, seen by the Oncology College Hospital Service of the Federal University of Pelotas, Rio Grande do Sul, according to their degree of resilience. It is a descriptive cross-sectional study, carried out with 264 cancer survivors under medical evaluation from March to June 2010. Data collection occurred through interviews, application of the Brazilian version of Wagnild and Young's Resilience Scale and consultation of the patients' hospital notes. The results indicate the prevalence of females (67.8%), older adults (47.4%), married persons (52.6%), whites (83.3%) and those whose main income is benefits or pension (75.4%). The high degree of resilience was greater among men (47.1%), older adults (44.8%), single people (47.9%), non-whites (52.3%) and those employed (55.6%). It was ascertained that the characterization of this population is relevant, because it will contribute to identifying factors which promote high resilience.

El objetivo del trabajo fue describir el perfil sociodemográfico y económico de los sobrevivientes de cáncer según el grado de resiliencia, atendidos en el Servicio de Oncología del Hospital Escuela de la Universidad Federal de Pelotas, Rio Grande do Sul. Se trata de un estudio descriptivo, de corte transversal, hecho con 264 sobrevivientes de cáncer en evaluación médica durante el período de marzo a junio de 2010. La colecta de informaciones ocurrió mediante entrevistas, aplicación de la versión brasileña de la Escala de Resiliencia de Wagnild y Young y consulta a los prontuarios. Los resultados indicaron el predominio del sexo femenino (67, 8%), ansíanos (47, 4%), casados (52, 6%), de la raza blanca (83, 3%) y renta principal beneficio/jubilación (75, 4%). El alto grado de resiliencia fue mayor entre los hombres (47, 1%), los ansíanos (44, 8%), los solteros (47, 9%), los no blancos (52, 3%) y los que poseen empleo (55, 6%). Se constató que la caracterización de esta población es relevante, pues podrá contribuir para la identificación de los factores promotores de la elevada resiliencia.

Establishing long-term surviving model of ventilator induced lung injury in piglets by large tidal volume ventilation / 中华急诊医学杂志

Objective To establish a long-term surviving model of ventilator induced lung injury ( VILI) in piglets with large tidal volume ventilation. Methods A total of 21 piglets were randomly( random number) divided into trial experiment group (group A,n =9), injury group ( group B,n =6) and control group ( group C, n = 6). Each piglet was intubated orotracheally and intravascular cannulae were inserted both into carotid artery and external jugular vein. The tidal volume in 60 - 80 ml/kg was given to rats of group A and 50 ml/kg to rats of group B, and free breath to rats of group C. Vital signs, pneumatic mechanics, blood-gas analysis and hemodynamics were monitored every hour ( group A and group B from just after the model established 0 h, group C from 0 ～6 h). The t test or ANOVA test was used for statistical analysis. Left lung tissue was sent to biopsy after experiment. Results About 6 hours after mechanical ventilation with large tidal volume, PaO2/FiO2 lower significantly both in A and B group in comparison with control group (P ＜0.05 ) and histological changes hit the ALl criteria. Piglets ventilated with 50 ml/kg of tidal volume could survive for long-term. Conclusions The model of VILI in piglets made with 50 ml/kg of tidal volume ventilation was established successfully and survived for long-term.