BACKGROUND & AIMS: OBJECTIVES:To determine whether previously reported high mortality rates associated with bilateral femoral fractures have decreased over time. DESIGN:Retrospective review. SETTING:Urban academic trauma center. PATIENTS: STUDY GROUP:54 adults with bilateral femoral fractures treated at our center from 2000 to 2006. The 108 fractures were initially treated with external fixation (11%), reamed antegrade nailing (23%), and reamed retrograde nailing (67%). Unilateral control group: 461 patients with unilateral femoral fractures treated at our center from 2002 to 2005. INTERVENTION:Univariate analysis compared our results with those of a published historical control group from the same center approximately 15 years ago (study period, 1984-1990). MAIN OUTCOME MEASUREMENTS:Mortality rates. RESULTS:We noted marked differences between the current mortality rate associated with bilateral femoral fractures and that of the historical control group. The mortality rate decreased over time at our center for both bilateral (26%-7%, P = 0.002) and unilateral (12%-2%, P = 0.0001) fractures. Mortality rates were still significantly higher (P = 0.037) for bilateral (7%) than for unilateral (2%) fractures. CONCLUSIONS:Mortality rates and Injury Severity Scores were reduced for bilateral and unilateral femoral fractures compared with data reported 15 years ago from the same center. The improved outcome might be related in part to changes in resuscitation, triage, intensive care, and orthopaedic management of the patients. However, considering that the Injury Severity Score also significantly decreased, the improvement might have occurred because of changes in injury patterns, perhaps secondary to improved safety features in motor vehicles. LEVEL OF EVIDENCE:Prognostic level III. See instructions for authors for a complete description of levels of evidence.

背景与目标： 目的：确定先前报道的与双侧股骨骨折相关的高死亡率是否随时间降低。
设计：回顾性审查。
单位：城市学术创伤中心。
耐心：
研究小组：从2000年至2006年，我们中心对54例成年人的双侧股骨骨折进行了治疗。最初对108例骨折进行了外固定（11％），顺行扩钉（23％）和逆行扩钉（67％）。单侧对照组：2002年至2005年在我中心接受治疗的461例单侧股骨骨折患者。
干预：单变量分析将我们的结果与大约15年前（研究期，1984-1990年）同一中心的已发表历史对照组的结果进行了比较。
主要观察指标：死亡率。
结果：我们注意到当前与双侧股骨骨折相关的死亡率与历史对照组之间存在显着差异。在我们中心，双侧（26％-7％，P = 0.002）和单侧（12％-2％，P = 0.0001）骨折的死亡率均随时间降低。双侧（7％）的死亡率仍显着高于单侧（2％）的骨折（P = 0.037）。
结论：与15年前同一中心报道的数据相比，双侧和单侧股骨骨折的死亡率和严重程度评分降低。改善的结局可能部分与患者的复苏，分诊，重症监护和整形外科治疗有关。但是，考虑到伤害严重性评分也显着降低，可能是由于伤害模式的改变而导致的改善，这可能是机动车安全性得到改善之后的结果。
证据级别：预后等级III。有关证据水平的完整说明，请参见作者说明。

BACKGROUND & AIMS: :Huangshui (HS), the by-product of Chinese Baijiu, has attracted considerable attention due to its nutrient and microbial composition; however, none of the studies has explored the polysaccharides in HS yet. Here, from HS, we isolated a novel polysaccharide, HSP-3, with an average molecular weight of 26.40 kDa. The structure was elucidated based on monosaccharide composition and methylation analysis, NMR, FT-IR, and AFM analysis. It is mainly composed of mannose (46.6%), galactose (17.3%), arabinose (11.2%), glucose (10.5%), xylose (8.2%), fucose (5.2%), and rhamnose (1.0%). The backbone of HSP-3 was made up of → 2)-β-d-Manp-(1 → 2,6)-β-d-Manp-(1 → 6)-β-d-Galp-(1 → 3,6)-β-d-Galp-(1 → 4)-α-l-Rhap-(1 → 3,4)-α-l-Rhap-(1 → . Moreover, stimulation of the production of ROS, NO, TNF-α and IL-6, upregulation of the mRNA and protein expression levels of TNF-α and IL-6 in THP-1 cells, and enhanced the pinocytic and phagocytic capacities of THP-1 cells exhibited significant immunomodulatory properties of HSP-3. Altogether, this study suggests that HSP-3 could be used as an active component in functional foods.

背景与目标： ：白酒的副产品hui水（HS）由于其营养成分和微生物成分而备受关注。然而，尚无研究探讨HS中的多糖。在这里，我们从HS分离出一种新型多糖HSP-3，其平均分子量为26.40 kDa。根据单糖组成和甲基化分析，NMR，FT-IR和AFM分析阐明了结构。它主要由甘露糖（46.6％），半乳糖（17.3％），阿拉伯糖（11.2％），葡萄糖（10.5％），木糖（8.2％），岩藻糖（5.2％）和鼠李糖（1.0％）组成。 HSP-3的骨架由→2）-β-d-Manp-（1→2,6）-β-d-Manp-（1→6）-β-d-Galp-（1→3组成，6）-β-d-Galp-（1→4）-α-l-Rhap-（1→3,4）-α-l-Rhap-（1→ ，TNF-α和IL-6，THP-1细胞中TNF-α和IL-6的mRNA和蛋白表达水平上调以及增强THP-1细胞的吞噬和吞噬能力表现出HSP-S的显着免疫调节特性。 3.总的来说，这项研究表明，HSP-3可以用作功能性食品中的活性成分。

BACKGROUND & AIMS: :Soil salinity is a major abiotic stress that limits plant growth and productivity. High concentrations of sodium chloride can cause osmotic and ionic effects. This stress minimises a plant's ability to uptake water and minerals, and increases Na+ accumulation in the cytosol, thereby disturbing metabolic processes. Prolonged plant exposure to salt stress can lead to oxidative stress and increased production of reactive oxygen species (ROS). Higher plants developed some strategies to cope with salt stress. Among these, mechanisms involving nitric oxide (NO) and polyamines (PAs) are particularly important. NO is a key signalling molecule that mediates a variety of physiological functions and defence responses against abiotic stresses in plants. Under salinity conditions, NO donors increase growth parameters, reduce Na+ toxicity, maintain ionic homeostasis, stimulate osmolyte accumulation and prevent damages caused by ROS. NO enhances salt tolerance of plants via post-translational protein modifications through S-nitrosylation of thiol groups, nitration of tyrosine residues and modulation of multiple gene expression. Several reviews have reported on the role of polyamines in modulating salt stress plant response and the capacity to enhance PA synthesis upon salt stress exposure, and it is known that NO and PAs interact under salinity. In this review, we focus on the role of NO in plant response to salt stress, paying particular attention to the interaction between NO and PAs.

背景与目标： ：土壤盐分是一种主要的非生物胁迫，限制了植物的生长和生产力。高浓度的氯化钠会引起渗透和离子作用。这种胁迫使植物吸收水分和矿物质的能力降至最低，并增加了Na在细胞质中的积累，从而干扰了代谢过程。植物长时间暴露于盐胁迫下会导致氧化胁迫并增加活性氧（ROS）的产生。高等植物制定了一些应对盐胁迫的策略。其中，涉及一氧化氮（NO）和多胺（PAs）的机制尤为重要。 NO是关键信号分子，可介导植物的多种生理功能和对非生物胁迫的防御反应。在盐度条件下，NO供体会增加生长参数，降低Na毒性，保持离子稳态，刺激渗透液积累并防止ROS引起的破坏。 NO通过硫醇基团的S-亚硝基化，酪氨酸残基的硝化和多种基因表达的调节，通过翻译后蛋白质修饰增强植物的耐盐性。一些评论已经报道了多胺在调节盐胁迫植物反应中的作用以及在盐胁迫下增强PA合成的能力，并且已知NO和PA在盐度下相互作用。在这篇综述中，我们着重于NO在植物对盐胁迫的响应中的作用，特别注意NO和PA之间的相互作用。

BACKGROUND & AIMS: :Tuberculosis (TB) is an intricate infectious disease that causes a large number of deaths in the population. Interleukin (IL)-6 and IL-13 play functional roles in host resistance to Mycobacterium tuberculosis infection. Our aim in this study was to explore the association of IL-6 and IL-13 polymorphisms with TB susceptibility in the Western Chinese Han population. The case and control groups comprised 900 TB patients and 1534 healthy controls, respectively, and four single-nucleotide polymorphisms (SNPs) were genotyped in IL-6 and five SNPs in IL-13 through the improved multiplex ligation detection reaction method. We found no genetic variants in the IL-6 or IL-13 genes that were related to TB susceptibility in the analysis of alleles, genotypes, genetic models, and TB clinical subtypes, except for a trend toward low pulmonary tuberculosis and extrapulmonary tuberculosis susceptibility for the SNPs rs1295686 and rs20541. Our study did not find a link between IL-6 and IL-13 polymorphisms and TB susceptibility in the Western Chinese Han population. Therefore, our present data revealed the challenge of applying IL-6 and IL-13 SNPs as genetic markers for TB and that increased sample sizes and additional races are needed for further studies.

背景与目标： 结核病（TB）是一种复杂的传染病，会导致人口大量死亡。白介素（IL）-6和IL-13在宿主对结核分枝杆菌感染的抗性中发挥功能性作用。我们在这项研究中的目的是探讨中国西部汉族人群中IL-6和IL-13多态性与结核病易感性的关系。病例组和对照组分别包括900 TB患者和1534名健康对照组，并通过改进的多重连接检测反应方法对IL-6中的四个单核苷酸多态性（SNP）和IL-13中的五个SNP进行了基因分型。在等位基因，基因型，遗传模型和结核病临床亚型分析中，我们没有发现与结核易感性相关的IL-6或IL-13基因的遗传变异，除了低肺结核和肺外结核易感性的趋势外。 SNP rs1295686和rs20541。我们的研究未发现中国西部汉族人群IL-6和IL-13多态性与结核病易感性之间存在联系。因此，我们目前的数据揭示了将IL-6和IL-13 SNPs用作结核病的遗传标志物所面临的挑战，并且需要进一步增加样本量和其他种族。

BACKGROUND & AIMS: OBJECTIVE:To test the performance of CK5/6 for the differentiation between mesothelioma, adenocarcinoma and benign mesothelia/proliferations in effusion cytology. STUDY DESIGN:CKS/6 immunocytochemistry was applied to ethanol-fixed cytospin preparations from 74 benign and malignant effusions. RESULTS:Reactivity was seen in 7 of 8 mesotheliomas and in 9 of 11 benign mesothelial proliferations but also in 11 of l7 pulmonary adenocarcinomas and in 12 of 31 adenocarcinomas of nonpulmonary origin. Reactivity was also found in 3 of 5 non-small cell lung carcinomas and 1 of 1 squamous carcinoma. CONCLUSION:CK5/6 reactivity was found in a considerable proportion of metastatic adenocarcinomas of pulmonary and nonpulmonary origin. The high reactivity rate in pulmonary adenocarcinomas disagrees with the results obtained with histologic sections from solid tumor tissue, and CK5/6 seems to be of very limited value as an additional marker in effusion cytology.

背景与目标： 目的：探讨CK5 / 6在间质细胞学中对间皮瘤，腺癌和良性间皮细胞/增生的分化能力。
研究设计：CKS / 6免疫细胞化学被应用于来自74例良性和恶性积液的乙醇固定的细胞离心制备物中。
结果：在8个间皮瘤中有7个和11个良性间皮增生中有9个反应性，但在17个肺腺癌中有11个和31个非肺源性腺癌中均可见到反应性。在5个非小细胞肺癌中有3个和1个鳞状癌中有1个也发现了反应性。
结论：在相当一部分肺和非肺源性转移性腺癌中发现了CK5 / 6反应性。肺腺癌的高反应率与从实体瘤组织的组织学切片获得的结果不同，并且CK5 / 6作为积液细胞学中的其他标志物似乎价值非常有限。

BACKGROUND & AIMS: :Although microorganisms account for the largest fraction of Earth's biodiversity, we know little about how their reproductive barriers evolve. Sexual microorganisms such as Saccharomyces yeasts rapidly develop strong intrinsic post-zygotic isolation, but the role of extrinsic isolation in the early speciation process remains to be investigated. We measured the growth of F1 hybrids between two incipient species of Saccharomyces paradoxus to assess the presence of extrinsic post-zygotic isolation across 32 environments. More than 80% of hybrids showed either partial dominance of the best parent or over-dominance for growth, revealing no fitness defects in F1 hybrids. Extrinsic reproductive isolation therefore likely plays little role in limiting gene flow between incipient yeast species and is not a requirement for speciation.

背景与目标： ：尽管微生物是地球生物多样性的最大组成部分，但我们对其生殖屏障如何进化知之甚少。性微生物（例如酵母）迅速发展出强大的内在合子后分离，但是外源分离在早期物种形成过程中的作用仍有待研究。我们测量了两个Saccharomyces paradoxus初始物种之间的F1杂种的生长，以评估在32个环境中外部合子后分离的存在。超过80％的杂种显示出最佳亲本的部分优势或对生长的过度主导，表明F1杂种中没有适合性缺陷。因此，外源性生殖分离可能在限制初始酵母物种之间的基因流动方面几乎没有作用，并且不是物种形成的必要条件。

BACKGROUND & AIMS: :Preimplantation genetic testing for aneuploidy (PGT-A) does not create normal embryos, but selecting a viable embryo for a fresh transfer has the potential to deliver an extra effect for live birth from a stimulated cycle by evading the attrition associated with embryo cryopreservation. Improved genetic tests are now available for selecting viable embryos; however, current embryo cryopreservation techniques also have a superior survival rate, which means it is now possible to transfer most morphologically suitable embryos from a stimulated cycle one at a time. The cumulative live birth rate from a stimulated cycle is now unlikely to be superior compared with morphological assessment alone, with any benefit likely to be associated with a reduction in the risk of miscarriage and the time to pregnancy. This communication offers a perspective on the likely benefit and disbenefit of PGT-A based on the outcome of modern-day clinical studies. Caution should be advised regarding offering PGT-A to every woman. Quantifying the likely miscarriage benefit and live birth disbenefit for an appropriate patient group may help to better inform couples who might be considering adding aneuploidy screening to their treatment cycle.

背景与目标： ：非整倍性的胚胎植入前遗传学测试（PGT-A）不能产生正常的胚胎，但是选择一个有生命的胚胎进行新的移植有可能通过避免与胚胎冷冻保存相关的损耗而在刺激周期中为活胎带来额外的效果。现在可以使用改良的基因测试来选择有生命的胚胎。然而，目前的胚胎冷冻保存技术也具有较高的存活率，这意味着现在有可能一次从一个刺激的周期中转移出形态上最合适的胚胎。与单独的形态学评估相比，现在受刺激周期的累计活产率现在不可能更高，任何益处都可能与减少流产风险和怀孕时间有关。该交流基于现代临床研究的结果，对PGT-A可能带来的好处和不利之处提供了一个观点。在为每位女性提供PGT-A时应谨慎。对合适的患者群体量化可能的流产益处和活产不利影响，可能有助于更好地告知可能正在考虑在其治疗周期中增加非整倍性筛查的夫妇。

BACKGROUND & AIMS: BACKGROUND:Non-valvular atrial fibrillation (AF) carries an increased risk of stroke mediated by embolism of stasis-precipitated thrombi originating in the left atrial appendage. Both oral anticoagulants and antiplatelet agents have proven effective for stroke prevention in most patients at high risk for vascular events, but primary stroke prevention in patients with non-valvular AF potentially merits separate consideration because of the suspected cardio-embolic mechanism of most strokes in AF patients. OBJECTIVES:To characterize the relative effect of long-term oral anticoagulant treatment compared with antiplatelet therapy on major vascular events in patients with non-valvular AF and no history of stroke or transient ischemic attack (TIA). SEARCH STRATEGY:We searched the Cochrane Stroke Group Trials Register (June 2006). We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE (1966 to June 2006) and EMBASE (1980 to June 2006). We contacted the Atrial Fibrillation Collaboration and experts working in the field to identify unpublished and ongoing trials. SELECTION CRITERIA:All unconfounded, randomized trials in which long-term (more than four weeks) adjusted-dose oral anticoagulant treatment was compared with antiplatelet therapy in patients with chronic non-valvular AF. DATA COLLECTION AND ANALYSIS:Two review authors independently selected trials for inclusion, assessed quality and extracted data. The Peto method was used for combining odds ratios after assessing for heterogeneity. MAIN RESULTS:Eight randomized trials, including 9598 patients, tested adjusted-dose warfarin versus aspirin (in dosages ranging from 75 to 325 mg/day) in AF patients without prior stroke or TIA. The mean overall follow up was 1.9 years/participant. Oral anticoagulants were associated with lower risk of all stroke (odds ratio (OR) 0.68, 95% confidence interval (CI) 0.54 to 0.85), ischemic stroke (OR 0.53, 95% CI 0.41 to 0.68) and systemic emboli (OR 0.48, 95% CI 0.25 to 0.90). All disabling or fatal strokes (OR 0.71, 95% CI 0.59 to 1.04) and myocardial infarction (OR 0.69, 95% CI 0.47 to 1.01) were substantially but not significantly reduced by oral anticoagulants. Vascular death (OR 0.93, 95% CI 0.75 to 1.15) and all cause mortality (OR 0.99, 95% CI 0.83 to 1.18), were similar with these treatments. Intracranial hemorrhages (OR 1.98, 95% CI 1.20 to 3.28) were increased by oral anticoagulant therapy. AUTHORS' CONCLUSIONS:Adjusted-dose warfarin and related oral anticoagulants reduce stroke, disabling stroke and other major vascular events for those with non-valvular AF by about one third when compared with antiplatelet therapy.

背景与目标： 背景：非瓣膜性心房颤动（AF）会增加由左心耳产生的淤积沉淀的血栓栓塞介导的中风风险。事实证明，口服抗凝药和抗血小板药均可在大多数血管事件高风险患者中有效预防卒中，但由于怀疑大多数AF卒中的心脏栓塞机制，对非瓣膜性AF患者的初次卒中预防可能值得单独考虑耐心。
目的：研究长期口服抗凝治疗与抗血小板治疗相比对非瓣膜性房颤，无卒中或短暂性脑缺血发作（TIA）史的患者主要血管事件的相对作用。
搜索策略：我们搜索了Cochrane中风组试验登记册（2006年6月）。我们还搜索了Cochrane对照试验中央注册簿（CENTRAL）（2006年第2期Cochrane图书馆），MEDLINE（1966年至2006年6月）和EMBASE（1980年6月至2006年6月）。我们联系了心房颤动协作组织和该领域的专家，以确定尚未发表和正在进行的试验。
选择标准：所有无混淆的随机试验，将长期（四周以上）调整剂量的口服抗凝治疗与抗血小板治疗相比较，用于慢性非瓣膜性房颤患者。
数据收集与分析：两位评价作者独立选择了纳入，评估质量和提取数据的试验。评估异质性后，使用Peto方法合并比值比。
主要结果：八项随机试验（包括9598名患者）在无中风或TIA的AF患者中测试了调整剂量的华法林与阿司匹林（剂量范围为75至325 mg / day）。平均总体随访时间为1.9年/参与者。口服抗凝剂与降低所有中风的风险（几率（OR）0.68，95％置信区间（CI）0.54至0.85），缺血性中风（OR 0.53，95％CI 0.41至0.68）和全身性栓塞（OR 0.48， 95％CI 0.25至0.90）。口服抗凝剂可以使所有致残或致命性中风（OR 0.71，95％CI 0.59至1.04）和心肌梗塞（OR 0.69，95％CI 0.47至1.01）得到显着但没有显着降低。这些治疗与血管性死亡（OR 0.93，95％CI 0.75至1.15）和所有原因死亡率（OR 0.99，95％CI 0.83至1.18）相似。口服抗凝治疗可增加颅内出血（OR 1.98，95％CI 1.20至3.28）。
作者的结论：与抗血小板治疗相比，调整剂量的华法令和相关的口服抗凝药可使非瓣膜性房颤患者的中风，中风和其他主要血管事件减少约三分之一。

BACKGROUND & AIMS: :Clearance of intracellular infections caused by Salmonella Typhimurium (STm) requires IFN-γ and the Th1-associated transcription factor T-bet. Nevertheless, whereas IFN-γ-/- mice succumb rapidly to STm infections, T-bet-/- mice do not. In this study, we assess the anatomy of immune responses and the relationship with bacterial localization in the spleens and livers of STm-infected IFN-γ-/- and T-bet-/- mice. In IFN-γ-/- mice, there is deficient granuloma formation and inducible NO synthase (iNOS) induction, increased dissemination of bacteria throughout the organs, and rapid death. The provision of a source of IFN-γ reverses this, coincident with subsequent granuloma formation and substantially extends survival when compared with mice deficient in all sources of IFN-γ. T-bet-/- mice induce significant levels of IFN-γ- after challenge. Moreover, T-bet-/- mice have augmented IL-17 and neutrophil numbers, and neutralizing IL-17 reduces the neutrophilia but does not affect numbers of bacteria detected. Surprisingly, T-bet-/- mice exhibit surprisingly wild-type-like immune cell organization postinfection, including extensive iNOS+ granuloma formation. In wild-type mice, most bacteria are within iNOS+ granulomas, but in T-bet-/- mice, most bacteria are outside these sites. Therefore, Th1 cells act to restrict bacteria within IFN-γ-dependent iNOS+ granulomas and prevent dissemination.

背景与目标： ：清除由鼠伤寒沙门氏菌（STm）引起的细胞内感染需要IFN-γ和Th1相关转录因子T-bet。但是，尽管IFN-γ-/-小鼠迅速死于STm感染，但T-bet-/-小鼠却没有。在这项研究中，我们评估了免疫应答的解剖结构以及与细菌感染STm感染的IFN-γ-/-和T-bet-/-小鼠的脾脏和肝脏的关系。在IFN-γ-/-小鼠中，肉芽肿形成不足和可诱导的NO合酶（iNOS）诱导，细菌在整个器官中的传播增加，并迅速死亡。与缺乏所有IFN-γ来源的小鼠相比，提供IFN-γ的来源可以逆转这种情况，与随后的肉芽肿形成同时发生，并且可以大大延长生存期。攻击后，T-bet-/-小鼠诱导显着水平的IFN-γ-。此外，T-bet-/-小鼠的IL-17和嗜中性粒细胞数目增加，而中和IL-17会减少嗜中性粒细胞，但不会影响所检测细菌的数目。出人意料的是，T-bet-/-小鼠在感染后表现出令人惊讶的野生型样免疫细胞组织，包括广泛的iNOS肉芽肿形成。在野生型小鼠中，大多数细菌都位于iNOS肉芽肿内，但在T-bet-/-小鼠中，大多数细菌都位于这些部位之外。因此，Th1细胞的作用是将细菌限制在IFN-γ依赖性iNOS肉芽肿中，并阻止其传播。

BACKGROUND & AIMS: OBJECTIVE:Dietary phytate (IP6) enjoys a reputation as an inhibitor of calcium renal stone formation, although there are very few human studies to support this notion. In South Africa, urolithiasis occurs in the white (W) but is rare in the black (B) population. We undertook this unique human model to further investigate the IP6 theory. METHODS:Healthy W and B males completed baseline food-frequency recall questionnaires. Dietary intake of IP6 was restricted for 18 days. An IP6 dietary supplement was ingested on days 15-18. Twenty-four-hour urinary phytate and other urinary components were determined. Relative supersaturations of calcium salts were calculated. The urinary metastable limit (MSL) of calcium oxalate (CaOx) and its crystallisation kinetics were determined experimentally. RESULTS:Habitual dietary intake of IP6 and its urinary excretion were significantly higher in B than in W (1650 ± 202 vs. 640 ± 134 mg/d, P = .0002 and 1.13 ± 0.12 vs. 0.75 ± 0.13 μM, P <.05, respectively). In B, urinary phytate decreased significantly after 15 days of IP6 restriction, but in W, its excretion remained constant. After supplementation, urinary IP6 increased significantly in both groups reaching levels commensurate with the baseline value in B. No significant differences occurred in B in any of the routine urinary risk factors throughout the trial. However, in W, urinary citrate excretion increased on day 18 relative to day 0. There were no significant intragroup or intergroup changes in relative supersaturation, metastable limit, or crystallization kinetics. CONCLUSIONS:Despite notable differences in the renal handling of ingested IP6, there were no changes in any of the well-established urinary risk factors for calcium renal stone formation in either of our uniquely different test groups. We conclude that, in the absence of hard evidence, claims that IP6 is a stone inhibitor remain unproven.

背景与目标： 目的：膳食植酸（IP6）作为抑制肾结石形成的钙素而享有盛誉，尽管很少有人类研究支持这种观点。在南非，尿石症发生在白人（W）人群中，但在黑人（B）人群中很少见。我们采用了这种独特的人类模型来进一步研究IP6理论。
方法：健康的W和B男性完成了基线食物频率召回问卷。 IP6的饮食限制为18天。在第15-18天摄入IP6膳食补充剂。测定了二十四小时的尿肌醇六磷酸和其他尿液成分。计算了钙盐的相对过饱和度。草酸钙（CaOx）的尿亚稳态极限（MSL）及其结晶动力学是通过实验确定的。
结果：B组的日常饮食中IP6及其尿排泄量显着高于W组（1650±202 vs. 640±134 mg / d，P = .0002和1.13±0.12 vs. 0.75±0.13μM，P <。分别为05）。在B中，IP6限制15天后，尿肌醇六磷酸显着减少，但在W中，其排泄量保持恒定。补充后，两组的尿中IP6均显着升高，达到与B的基线值相当的水平。在整个试验中，B中的任何常规尿液危险因素均无显着差异。但是，在W中，相对于第0天，第18天尿液中柠檬酸盐的排泄量增加。相对过饱和度，亚稳态极限或结晶动力学方面，组内或组间没有显着变化。
结论：尽管摄入的IP6在肾脏处理方面存在显着差异，但在我们两个不同的测试组中，任何公认的尿钙钙结石形成的危险因素均无变化。我们得出的结论是，在没有确凿证据的情况下，声称IP6是结石抑制剂的说法仍未得到证实。

BACKGROUND & AIMS: :Background Women with ischemia and no obstructive coronary artery disease are increasingly recognized and found to be at risk for major adverse cardiovascular events. Methods and Results In 214 women with suspected ischemia and no obstructive coronary artery disease who completed baseline and 1-year follow-up vasodilatory stress cardiac magnetic resonance imaging, we investigated temporal trends in angina (Seattle Angina Questionnaire [SAQ]), myocardial perfusion reserve index, blood pressure, and left ventricular (LV) remodeling and function from baseline to 1-year follow-up and explored associations between these different parameters. We observed concordant positive trends in 4/5 SAQ domains, SAQ-7, myocardial perfusion reserve index, blood pressure, LV mass, and LV mass-to-volume ratio. There was no association between SAQ-7 improvement and myocardial perfusion reserve index improvement over 1-year follow-up (P=0.1). Higher indexed LV end-diastolic volume and time to peak filling rate at baseline were associated with increased odds of clinically relevant SAQ-7 improvement (odds ratio [OR], 1.05; 95% CI, 1.0-1.1; and OR, 2.40; 95% CI, 1.1-5.0, respectively). Hypertension was associated with decreased odds of SAQ-7 improvement (OR, 0.41; 95% CI, 0.19-0.91). Conclusions In women with ischemia and no obstructive coronary artery disease clinically treated with cardiac medications over 1 year, we observed concurrent temporal trends toward improvement in SAQ, myocardial perfusion reserve index, blood pressure, LV mass, and LV mass-to volume ratio. We showed that abnormalities in LV morphology and diastolic function at baseline were predictive of clinically significant improvement in angina at follow-up, whereas history of hypertension was associated with lower odds. Future studies are needed to assess the mechanisms and treatments responsible for the improvements we observed. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT02582021.

背景与目标： ：背景缺血且没有梗阻性冠状动脉疾病的女性越来越多地被发现，并被发现有发生严重不良心血管事件的风险。方法和结果在214名完成了基线和1年随访的血管舒张压心脏磁共振成像的可疑缺血且无梗阻性冠状动脉疾病的女性中，我们调查了心绞痛（西雅图心绞痛问卷[SAQ]），心肌灌注储备的时间趋势从基线到1年的随访期间的血压指数，血压和左心室（LV）重塑和功能，并探讨了这些不同参数之间的关联。我们在4/5 SAQ域，SAQ-7，心肌灌注储备指数，血压，左心室质量和左心室质量体积比中观察到一致的积极趋势。在一年的随访中，SAQ-7的改善与心肌灌注储备指数的改善之间没有关联（P = 0.1）。较高的索引左室舒张末期容积和达到基线的峰值充血时间与临床相关SAQ-7改善的几率增加相关（赔率[OR]为1.05； 95％CI为1.0-1.1； OR为2.40； 95） ％CI，分别为1.1-5.0）。高血压与SAQ-7改善的几率降低相关（OR，0.41； 95％CI，0.19-0.91）。结论在临床使用心脏药物治疗超过1年的缺血且无梗阻性冠状动脉疾病的女性中，我们观察到了同时改善SAQ，心肌灌注储备指数，血压，LV质量和LV质量体积比的时间趋势。我们显示，基线时LV形态和舒张功能异常可预测随访时心绞痛的临床显着改善，而高血压病史则与更低的几率相关。需要进一步的研究来评估导致我们观察到的改善的机制和治疗方法。注册网址：https://www.clinicaltrials.gov;唯一标识符：NCT02582021

BACKGROUND & AIMS: :Decompression stress and exposure to hyperoxia may cause a reduction in transfer factor of the lung for carbon monoxide and in maximal aerobic capacity after deep saturation dives. In this study lung function and exercise capacity were assessed before and after a helium-oxygen saturation dive to a pressure of 2.5 MPa where the decompression rate was reduced compared with previous deep dives, and the hyperoxic exposure was reduced by administering oxygen intermittently at pressures of 50 and 30 kPa during decompression. Eight experienced divers of median age 41 years (range 29-48) participated in the dive. The incidence of venous gas microemboli was low compared with previous deep dives. Except for one subject having treatment for decompression sickness, no changes in lung function or angiotensin converting enzyme, a marker of pulmonary endothelial cell damage, were demonstrated. The modified diving procedures with respect to decompression rate and hyperoxic exposure may have contributed to the lack of changes in lung function in this dive compared with previous deep saturation dives.

背景与目标： ：减压应力和高氧暴露可能会导致深度饱和潜水后肺中一氧化碳的转移因子和最大有氧运动能力降低。在这项研究中，在氦氧饱和度潜水至2.5 MPa的压力之前和之后评估了肺功能和运动能力，与以前的深潜相比，减压率降低了，而在200℃的压力下间歇地给氧减少了高氧暴露减压期间为50和30 kPa。八名经验丰富的潜水员，中位数年龄为41岁（29-48岁），参加了此次潜水。与以前的深潜相比，静脉气体微栓塞的发生率低。除一名接受减压病治疗的受试者外，未证明肺功能或血管紧张素转化酶（肺内皮细胞损伤的标志物）发生变化。与以前的深度饱和潜水相比，在减压和高氧暴露方面经过改进的潜水程序可能导致该肺功能缺乏变化。

BACKGROUND & AIMS: :Patients with familial hypercholesterolemia (FH) are especially at risk for premature cardiovascular disease (CVD). Recent studies revealed C-reactive protein (CRP) as a strong predictor of future first or recurrent CVD events, suggesting that CRP plays an important role in the development of atherosclerosis. The aim of this study was to evaluate the effect of one year of simvastatin treatment on serum levels of CRP and to assess the influence of risk factors for CVD on CRP concentrations in patients with FH. We measured baseline CRP levels in 337 patients with FH. A second blood sample, collected after one year of treatment with simvastatin (20--40 mg once daily) was measured in a subgroup of 129 patients. Patients with CVD present at baseline had significantly higher serum levels of CRP (2.26 mg/l versus 1.55 mg/l, P<0.001). CRP levels were associated with smoking, body mass index, age, levels of triglycerides (TG), and the use of NSAIDs or anticoagulation drugs. Simvastatin therapy significantly improved lipid profiles in the intervention group. There was a small, but non-significant decrease of CRP levels upon treatment. CRP decreased from 1.51 mg/l median (interquartile range (IQR) 0.76--3.41) at baseline to 1.24 mg/l median (IQR 0.72--2.92) after treatment, (P=0.328). In conclusion, CRP levels were associated with the presence of CVD in FH patients. Simvastatin therapy had no significant effect on CRP levels in these patients.

背景与目标： ：家族性高胆固醇血症（FH）的患者特别容易患早发性心血管疾病（CVD）。最近的研究表明，C反应蛋白（CRP）是将来发生首次或复发CVD事件的有力预测指标，表明CRP在动脉粥样硬化的发展中起着重要作用。这项研究的目的是评估辛伐他汀治疗一年对CRP血清水平的影响，并评估CVD危险因素对FH患者CRP浓度的影响。我们测量了337例FH患者的基线CRP水平。在129名患者的亚组中，使用辛伐他汀治疗一年（20--40 mg，每天一次）后收集的第二份血液样品进行了测量。基线时出现CVD的患者血清CRP水平明显升高（2.26 mg / l对1.55 mg / l，P <0.001）。 CRP水平与吸烟，体重指数，年龄，甘油三酸酯（TG）水平以及NSAID或抗凝药物的使用有关。辛伐他汀疗法可显着改善干预组的血脂水平。治疗后，CRP水平有少量但无明显下降。治疗后CRP从基线时的中位数1.51 mg / l（四分位间距（IQR）0.76--3.41）降至治疗后的1.24 mg / l中位数（IQR 0.72--2.92）（P = 0.328）。总之，在FH患者中CRP水平与CVD的存在有关。辛伐他汀疗法对这些患者的CRP水平无明显影响。

BACKGROUND & AIMS: BACKGROUND:Early identification and treatment of serious infections improves clinical outcomes. Previous studies have found that septic patients without fever are more likely to die than those with fever, due to delay in antibiotic administration. AIM:To determine whether antibiotic treatment and mortality differed in afebrile adult patients presenting to the Emergency Department with bacteraemia, compared with those with a history of fever. METHODS:Retrospective six-month audit of all adult patients with positive blood cultures taken in the Emergency Department (ED) of a single tertiary hospital. Outcomes included receipt of antibiotics within 4 and 24 h of ED arrival, in-hospital mortality and 30-day mortality. RESULTS:227 patients with clinically significant bacteraemia were identified, of which 38 (16.7%) were afebrile in ED. There was no statistically significant difference in the proportion of afebrile or febrile patients receiving antibiotics within 4-h (44.7% vs 55.6%, p = 0.222) or 24-h (89.5% vs 95.2%, p = 0.163) of arrival at ED. Inpatient mortality was not statistically different in the afebrile and febrile groups 15.8% vs 6.9%, p = 0.070), but 30-day mortality was higher among afebrile patients (27.6% vs 10.1%, p = 0.010). CONCLUSIONS:There was no significant difference in receipt of antibiotics within 4 h or 24 h ED arrival between the febrile and afebrile groups. However, afebrile patients experienced higher 30-day mortality. While most bacteraemic patients received antibiotics within 24 h, only half received antibiotics within 4 h, representing a key area for improvement. This article is protected by copyright. All rights reserved.

背景与目标： 背景：早期识别和治疗严重感染可改善临床结局。先前的研究发现，由于延迟服用抗生素，没有发烧的败血症患者比有发烧的败血症患者更有可能死亡。
目的：确定在急诊就诊有细菌血症的成年发热成年患者与发烧史患者相比，抗生素治疗和死亡率是否存在差异。
方法：对在一家三级医院急诊室进行的所有成年血液培养阳性的成年患者进行为期六个月的回顾性审核。结果包括ED到达后4和24小时内收到抗生素，住院死亡率和30天死亡率。
结果：鉴定出227例具有临床意义的菌血症的患者，其中38例（16.7％）在ED中发热。在到达ED的4小时内（44.7％vs 55.6％，p = 0.222）或24-h（89.5％vs 95.2％，p = 0.163）内接受抗生素治疗的发热或发热患者的比例没有统计学上的显着差异。高热组和高热组的住院死亡率无统计学差异，分别为15.8％和6.9％，p = 0.070，但高热患者的30天死亡率更高（27.6％和10.1％，p = 0.010）。
结论：高热组和低热组之间在ED到达4小时或24小时内接受抗生素的情况无显着差异。但是，发热患者的30天死亡率更高。虽然大多数细菌患者在24小时内接受了抗生素治疗，但只有一半的患者在4小时内接受了抗生素治疗，这是需要改善的关键领域。本文受版权保护。版权所有。

BACKGROUND & AIMS: :Anticoagulation and proper INR (International Normalized Ratio) monitoring is essential for patients having mechanical heart valves; it is vital in these patients in order to prevent lethal complications such as valve thrombosis and systemic embolism. In pregnancy, it becomes even more important as pregnancy itself is a hypercoagulable state. This report describes a female patient having undergone mitral valve replacement with a Starr Edward metallic prosthesis. She came back to the operating surgeon after 10 years of valve replacement with a history of three uneventful healthy deliveries and no follow-up and INR monitoring during this period.

背景与目标： ：抗凝和适当的INR（国际标准化比率）监测对于患有机械性心脏瓣膜的患者至关重要；对于这些患者而言，至关重要的是防止致命的并发症，如瓣膜血栓形成和全身性栓塞。在怀孕期间，由于怀孕本身处于高凝状态，这一点变得更加重要。该报告描述了一位女性患者，该患者接受了Starr Edward金属假体置换二尖瓣。在更换了10年的瓣膜后，她又回到了外科手术医生那里，经历了3次健康的分娩，并且在此期间没有随访和INR监测。