BACKGROUND & AIMS: BACKGROUND:Surveys of the population are commonly used to obtain information on health status. Increasingly, researchers are linking self-reported health status information to primary care consultation data. However, it is not known how participating in a health-related survey affects consultation behaviour. The objective of this study was to assess whether completion of a health-related questionnaire changes primary care consultation behaviour. METHODS:Participants were 3402 adults aged 50 and over from the general population in North Staffordshire, UK, who completed a health-related postal survey received in April 2003. The survey was predominantly about occurrence and severity of knee pain in the last year. Primary care attendance for the three months following response was compared to three control periods: i) the three months prior to the survey, ii) the same time period in the previous year and iii) the same time period in the following year. Comparisons were made on consultations for any problem, consultations for musculoskeletal disorders and consultations for knee problems. RESULTS:The percentage of subjects consulting for any condition was marginally higher for the three months directly after receipt of the questionnaire but the difference was only statistically significant in comparison to the three months before the survey (64% v. 62%, p = 0.05). There was little difference in consultation prevalence for musculoskeletal problems immediately after the survey compared to the three control periods. There was an increase of 37% in knee disorder consultations for the three months after the survey compared to the three months directly before the survey (p = 0.02). However, consultation prevalence for knee problems was identical for the three months after the survey to the same time periods in the years prior to and following the survey (both p = 0.94). CONCLUSION:The results from this study suggests that questionnaires related to physical health do not affect the standard consulting behaviour of patients, even for the symptom under investigation. This should reassure researchers who wish to link self-reported health status and medical care utilisation and clinicians whose patients are involved in such research.

背景与目标：

BACKGROUND & AIMS: :Surgically correctable forms of primary aldosteronism are generally held to be less common than forms requiring medical therapy. However, with the availability of improved diagnostic techniques and the adoption of a systematic and thorough diagnostic work-up they can be identified more commonly than expected. Adrenal vein sampling (AVS) for measurement of cortisol and aldosterone has emerged as the 'gold standard' diagnostic test for identifying unilateral causes of primary aldosteronism that are amenable to surgical cure. Adrenalectomy can provide long-term normalisation of blood pressure and correction of primary aldosteronism in about 55% of patients with an aldosterone-producing adenoma and can markedly ameliorate blood pressure control in the rest. This chapter summarises the diagnostic work-up suggested for identifying these forms and examines the other diseases mimicking mineralocorticoid excess that enter into the differential diagnosis of surgically curable primary aldosteronism.

背景与目标： : 手术可纠正的原发性醛固酮增多症的形式通常被认为比需要药物治疗的形式不常见。但是，随着改进的诊断技术的可用性以及系统而彻底的诊断工作的采用，可以比预期的更普遍地识别它们。用于测量皮质醇和醛固酮的肾上腺静脉采样 (AVS) 已成为 “金标准” 诊断测试，用于确定可手术治愈的原发性醛固酮增多症的单侧原因。肾上腺切除术可提供约55% 的产生醛固酮的腺瘤患者的血压长期正常化和原发性醛固酮增多症的纠正，并可显着改善其余患者的血压控制。本章总结了建议用于识别这些形式的诊断工作，并检查了其他模仿盐皮质激素过量的疾病，这些疾病进入了手术可治愈的原发性醛固酮增多症的鉴别诊断疾病。

BACKGROUND & AIMS: :In the present pilot study, the feasibility of a site-of-care cervicovaginal self-sampling methodology for HPV-based screening was tested in 346 women residing in underserved rural areas of Northern Greece. These women provided self-collected cervicovaginal sample along with a study questionnaire. Following molecular testing, using the cobas® HPV Test, Roche®, HPV positive women, were referred to colposcopy and upon abnormal findings, to biopsy and treatment. Participation rate was 100%. Regular pap-test examination was reported for 17.1%. Among hrHPV testing, 11.9% were positive and colposcopy/biopsy revealed 2 CIN3 cases. Non-compliance was the most prevalent reason for no previous attendance. Most women reported non-difficulty and non-discomfort in self-sampling (77.6% and 82.4%, respectively). They would choose self-sampling over clinician-sampling (86.2%), and should self-sampling being available, they would test themselves more regularly (92.3%). In conclusion, self-sampling is feasible and well-accepted for HPV-based screening, and could increase population coverage in underserved areas, helping towards successful prevention.

背景与目标： : 在本试点研究中，对居住在希腊北部服务不足的农村地区的346名妇女进行了基于HPV筛查的护理现场宫颈阴道自采样方法的可行性进行了测试。这些妇女提供了自我收集的宫颈阴道样本以及研究问卷。在分子测试之后，使用cobas®罗氏HPV检测®HPV阳性女性被转诊至阴道镜检查和异常发现后，进行活检和治疗。参与率为100%。报告定期进行17.1% 巴氏试验检查。在hrHPV检测中，11.9% 例为阳性，阴道镜/活检显示2例CIN3。不遵守是以前没有出席的最普遍原因。大多数妇女报告说，自我取样没有困难，也没有不适 (分别为77.6% 和82.4%)。他们将选择自采样而不是临床医生采样 (86.2%)，并且如果自采样可用，他们将更定期地测试自己 (92.3%)。总之，自我采样对于基于HPV的筛查是可行的且被广泛接受，并且可以增加服务不足地区的人口覆盖率，从而有助于成功预防。

BACKGROUND & AIMS: :Genetic factors are important for developing primary and subsequent malignancies in children. This study investigated the role of genetic factors involved in DNA-repair. Designed as a feasibility study, it addressed the possibility of obtaining samples for genetic analyses from former patients through the German Childhood Cancer Registry. Testing feasibility was as important as the biological question itself. We analyzed the expression of DNA-repair genes in untreated primary fibroblasts of 20 individuals with a second neoplasm compared to 20 matched single neoplasm cases using customized cDNA microarrays (1344 gene sequences, about 800 genes). Matching was by first neoplasm, age, and year of first diagnosis. Forty-six percent of the 52 contacted second neoplasm cases and 18% of the 132 single neoplasm patients participated in the study. The DNA-repair gene results show small differences in the basal gene expression of FTH1 and CDKN1A. To our knowledge, this is the first study using gene expression arrays in untreated primary fibroblasts regarding second neoplasms after a childhood neoplasm. We were able to recruit childhood cancer patients for genetic analyses long after diagnosis. The biological importance of the differences in the DNA-repair gene expression has to be elucidated yet.

背景与目标： : 遗传因素对于发展儿童原发性和继发恶性肿瘤很重要。这项研究调查了参与DNA修复的遗传因素的作用。作为一项可行性研究，它解决了通过德国儿童癌症登记处从以前的患者那里获得用于基因分析的样本的可能性。测试可行性与生物学问题本身一样重要。我们使用定制的cDNA微阵列 (1344个基因序列，约800个基因) 分析了20个具有第二个肿瘤的个体的未处理的原代成纤维细胞中DNA修复基因的表达，与20个匹配的单个肿瘤病例相比。根据首次肿瘤，年龄和首次诊断的年份进行匹配。52例接触第二肿瘤病例中的6% 例和132例单一肿瘤患者中的18% 例参加了研究。DNA修复基因结果显示FTH1和CDKN1A的基础基因表达差异很小。据我们所知，这是第一项使用基因表达阵列在未经治疗的原发性成纤维细胞中进行的关于儿童肿瘤后第二次肿瘤的研究。我们能够在诊断后很长时间招募儿童癌症患者进行基因分析。必须阐明DNA修复基因表达差异的生物学重要性。

BACKGROUND & AIMS: BACKGROUND:The complement system is an important mediator of inflammation, which plays a pivotal role in atherosclerosis and acute myocardial infarction (AMI). Animal studies suggest that activation of the complement cascade resulting in the formation of soluble membrane attack complex (sMAC), contributes to both atherosclerosis and plaque rupture and may be the direct cause of tissue damage related to ischemia/reperfusion injury. However clinical data of sMAC during an AMI is sparse. Accordingly the aim was to investigate the prognostic role of sMAC in patients with ST-segment elevation myocardial infarction (STEMI). METHODS:We included 725 STEMI-patients admitted to a single, high-volume invasive heart centre, treated with primary percutaneous coronary intervention (PCI), from September 2006 to December 2008. Blood samples were drawn immediately before PCI. Plasma sMAC was measured using an in-house immunoassay. Endpoints were all-cause mortality (n = 62) and the combined endpoint (n = 122) of major cardiovascular events (MACE) defined as cardiovascular mortality and admission due recurrent AMI or heart failure. Follow-up time was 12 months. RESULTS:During 12 months of follow-up 62 patients died from all causes and 122 patients reached the combined end-point of MACE. Patients with high sMAC (>75th percentile) had increased risk of both all-cause mortality and MACE. Even after adjustment for confounding risk factors by Cox-regression analyses, high levels of sMAC remained an independent predictor of all-cause mortality (hazard ratio 1.81 [95% CI 1.06-3.06; P = .029]) and MACE (hazard ratio 1.70 [95% CI 1.16-2.48; P = .006]). CONCLUSIONS:High plasma sMAC independently predicts all-cause mortality and MACE in STEMI-patients treated with PCI.

背景与目标：

BACKGROUND & AIMS: :Leiomyosarcoma of the innominate vein is a rare but usually lethal disease. We report the case of a 50-year-old woman, undergoing a curative resection of the tumor. She is alive and free of disease at 88-month follow-up. Surgical excision remains the current optimal treatment able to provide a chance of cure. KEY WORDS: Late survival, Venous leiomyosarcoma.

背景与目标： : 无名静脉平滑肌肉瘤是一种罕见但通常致命的疾病。我们报告了一名50岁的女性，正在接受肿瘤的根治性切除。在88个月的随访中，她还活着并且没有疾病。手术切除仍然是目前能够提供治愈机会的最佳治疗方法。关键词: 晚期生存，静脉平滑肌肉瘤。

BACKGROUND & AIMS: OBJECTIVES:We evaluated the functional and oncological outcomes of transoral laser microsurgery (TLM) in patients with previously untreated supraglottic carcinoma compared with the outcomes in salvage cases after radiation-based treatment. METHODS:We conducted a retrospective case-control study at a single academic tertiary care institution. The functional outcomes were stratified by prior irradiation and were assessed at baseline, less than 1 week after operation, and at last follow-up. RESULTS:Five patients underwent TLM for previously untreated disease, and 5 previously irradiated patients underwent salvage TLM for local failure. No patient required tracheostomy. There was no local recurrence after TLM as primary therapy, and none of those patients required radiotherapy. One salvage patient developed local recurrence. The duration of feeding tube dependence (p = 0.049) and the rates of chronic aspiration (more than 1 month after operation; p = 0.048) were significantly higher in the salvage TLM cases than in the previously untreated cases. The median scores on the PSS-HN Understandability of Speech were 75 ("usually understandable") in the salvage group and 100 ("always understandable") in the previously untreated group. CONCLUSIONS:Both local control and function were better in the previously untreated patients than in the salvage patients. Our findings provide support for the use of TLM as a primary treatment modality for selected supraglottic carcinomas, but also suggest a potential for functional recovery in both previously untreated and salvage cases.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Early and late dumping are complications of gastric bypass surgery. Early dumping occurs within an hour after eating, when the emptying of food into the small intestine triggers rapid fluid shifts into the intestinal lumen and the release of gastrointestinal hormones, resulting in gastrointestinal and vasomotor symptoms. Late dumping occurs between 1 and 3 hours after carbohydrate ingestion and is caused by an exaggerated insulin release, resulting in hypoglycemia. Almost no data are currently available on the prevalence of early and late dumping or their impact on health-related quality of life (QoL). OBJECTIVES:To study the prevalence of early and late dumping in a large population of patients having undergone a primary Roux-en-Y gastric bypass (RYGB) and its effect on QoL. SETTING:Cross-sectional study at a single bariatric department in the Medical Center Leeuwarden, The Netherlands between 2008 and 2011. METHODS:In 2013, this descriptive cohort study approached by email or post all patients who underwent a primary RYGB in the setting between 2008 and 2011 in one hospital. These patients were asked to fill in standardized questionnaires measuring their QoL (RAND-36), anxiety and depression (HADS), fatigue (MFI-20) and any disease specific indicators of early and late dumping syndrome. RESULTS:The questionnaire was completed and returned by 351 of 613 patients (57.1%) and 121 nonobese volunteers. Participants were mostly female (80%), aged 42 (40-54 years), with an excess weight loss of 76.8% [IQR 61-95] after RYGB surgery 2.3 [ IQR 1.6-3.4] years earlier. Self-reported complaints of moderate to severe intensity suggestive of early and late dumping were present in 18.8% and 11.7% of patients, respectively. Patients with early and late dumping demonstrated significantly lower scores on the RAND-36 and HADS compared with patients without dumping. No differences were seen in the MFI-20 scores between patients with or without early and late dumping. CONCLUSION:In this descriptive cohort, self-reported complaints suggestive of early and late dumping of moderate-to-severe intensity were, respectively, 18.8% and 11.7% in a cohort after primary gastric bypass surgery. These complaints were associated with markedly reduced health-related QoL.

背景与目标：

BACKGROUND & AIMS: :Transforming small independent practices to patient-centered medical homes is widely believed to be a critical step in reforming the US health care system. Our team has conducted research on improving primary care practices for more than fifteen years. We have found four characteristics of small primary care practices that seriously inhibit their ability to make the transformation to this new care model. We found that small practices were extremely physician-centric, lacked meaningful communication among physicians, were dominated by authoritarian leadership behavior, and were underserved by midlevel clinicians who had been cast into unimaginative roles. Our analysis suggests that in addition to payment reform, a shift in the mind-set of primary care physicians is needed. Unless primary care physicians can adopt new mental models and think in new ways about themselves and their practices, it will be very difficult for them and their practices to create innovative care teams, become learning organizations, and act as good citizens within the health care neighborhood.

背景与目标： : 将小型独立实践转变为以患者为中心的医疗之家被广泛认为是改革美国医疗体系的关键一步。我们的团队在改善初级保健实践方面进行了超过15年的研究。我们发现了小型初级保健实践的四个特征，这些特征严重抑制了他们向这种新护理模式转变的能力。我们发现，小型实践以医师为中心，缺乏医师之间的有意义的沟通，以专制领导行为为主导，并且被那些被赋予缺乏想象力的角色的中层临床医生服务不足。我们的分析表明，除了支付改革之外，还需要改变初级保健医生的思维方式。除非初级保健医生能够采用新的心理模式，并以新的方式思考自己和他们的做法，否则他们和他们的做法将很难创建创新的护理团队，成为学习型组织，并在医疗保健社区内充当好公民。

BACKGROUND & AIMS: :Bruton tyrosine kinase (BTK) links the B-cell antigen receptor (BCR) and Toll-like receptors with NF-κB. The role of BTK in primary central nervous system (CNS) lymphoma (PCNSL) is unknown. We performed a phase I clinical trial with ibrutinib, the first-in-class BTK inhibitor, for patients with relapsed or refractory CNS lymphoma. Clinical responses to ibrutinib occurred in 10 of 13 (77%) patients with PCNSL, including five complete responses. The only PCNSL with complete ibrutinib resistance harbored a mutation within the coiled-coil domain of CARD11, a known ibrutinib resistance mechanism. Incomplete tumor responses were associated with mutations in the B-cell antigen receptor-associated protein CD79B. CD79B-mutant PCNSLs showed enrichment of mammalian target of rapamycin (mTOR)-related gene sets and increased staining with PI3K/mTOR activation markers. Inhibition of the PI3K isoforms p110α/p110δ or mTOR synergized with ibrutinib to induce cell death in CD79B-mutant PCNSL cells.Significance: Ibrutinib has substantial activity in patients with relapsed or refractory B-cell lymphoma of the CNS. Response rates in PCNSL were considerably higher than reported for diffuse large B-cell lymphoma outside the CNS, suggesting a divergent molecular pathogenesis. Combined inhibition of BTK and PI3K/mTOR may augment the ibrutinib response in CD79B-mutant human PCNSLs. Cancer Discov; 7(9); 1018-29. ©2017 AACR.See related commentary by Lakshmanan and Byrd, p. 940This article is highlighted in the In This Issue feature, p. 920.

背景与目标： : 布鲁顿酪氨酸激酶 (BTK) 将b细胞抗原受体 (BCR) 和Toll样受体与NF-κ B联系起来。BTK在原发性中枢神经系统 (CNS) 淋巴瘤 (PCNSL) 中的作用尚不清楚。我们使用ibrutinib (一流的BTK抑制剂) 对复发或难治性CNS淋巴瘤患者进行了I期临床试验。13例 (77% 例) PCNSL患者中有10例出现ibrutinib的临床反应，包括5例完全反应。唯一具有完全伊布替尼抗性的PCNSL在CARD11的卷曲螺旋结构域中具有突变，这是已知的伊布替尼抗性机制。不完全的肿瘤反应与b细胞抗原受体相关蛋白CD79B的突变有关。CD79B-mutant PCNSLs显示出哺乳动物雷帕霉素靶 (mTOR) 相关基因集的富集，并且PI3K/mTOR激活标记物的染色增加。抑制PI3K亚型p110α/p110δ 或mTOR与伊布替尼协同诱导CD79B-mutant PCNSL细胞死亡。意义: 伊布替尼在中枢神经系统复发或难治性b细胞淋巴瘤患者中具有重要活性。PCNSL的反应率大大高于CNS外弥漫性大b细胞淋巴瘤的报道，表明分子发病机制不同。BTK和PI3K/mTOR的联合抑制可能会增强CD79B-mutant人pcnsl中的伊布替尼反应。癌症椎间盘; 7(9); 1018-29。©2017 AACR。请参阅Lakshmanan和Byrd的相关评论，p。940本文在本刊功能第920页中突出显示。

BACKGROUND & AIMS: :Between February 26, 1981, and July 30, 1987, 36 patients underwent orthotopic liver transplantation for primary sclerosing cholangitis associated with ulcerative colitis. Three of the 36 recipients died within 3 mo because of graft nonfunction or surgical complications. The other 33 (92%) lived for at least 1 yr. Two of the 33 died after 12 and 14 mo, respectively, of recurrent cholangiocarcinoma that was not diagnosed before transplantation. Four other patients died of recurrent liver failure (three cases) or immunoblastic sarcoma (one case) after 14, 21, 36 and 44 mo. Twenty-seven (75%) of the patients are still alive 23 to 81 mo after transplantation. Two patients have been diagnosed as having colorectal cancer 11 and 21 mo respectively, after transplantation, for an overall incidence of 5.6% (2 of 36) and a corrected incidence of 6.5% (2 of 31) if the three early deaths and two later deaths caused by cholangiocarcinomas are excluded. It is not known whether colorectal malignancies were present but undetected at the time of transplantation or whether they developed afterward. It is clear that patients who undergo liver transplantation for primary sclerosing cholangitis associated with ulcerative colitis should have careful follow-up of the colon, including colonoscopy and multiple biopsies of the colorectal mucosa. Whether proctocolectomy should be considered prophylactically after liver transplantation is an unresolved issue.

背景与目标： : 在1981年2月26日和1987年7月30日之间，有36例患者因溃疡性结肠炎相关的原发性硬化性胆管炎接受了原位肝移植。36名接受者中有3名因移植物无功能或手术并发症而在3个月内死亡。其他33人 (92%) 至少活了1年。33例中的2例分别在移植前未诊断出的复发性胆管癌分别在12和14个月后死亡。另外4例患者在14、21、36和44个月后死于复发性肝衰竭 (3例) 或免疫母细胞肉瘤 (1例)。移植后23至81个月，有27 (75%) 例患者仍然存活。两名患者在移植后分别被诊断为结直肠癌11和21个月，如果排除了由胆管癌引起的三例早期死亡和两例晚期死亡，则总发生率为5.6% 例 (36例中的2例) 和6.5% 例的校正发生率 (31例中的2例)。尚不清楚是否存在结直肠恶性肿瘤，但在移植时未发现，或者其后是否发展。很明显，接受肝移植治疗与溃疡性结肠炎相关的原发性硬化性胆管炎的患者应仔细随访结肠，包括结肠镜检查和结肠粘膜的多次活检。肝移植后是否应预防性考虑直肠结肠切除术是一个尚未解决的问题。

BACKGROUND & AIMS: :Serous carcinomas most commonly arise within the uterine corpus or ovary/fallopian tube, but there are 2 prior case reports of primary vaginal serous carcinoma. We report 2 examples of high-grade serous carcinoma arising within the urethra or a urethral diverticulum (1 case each). Both neoplasms exhibited the classic morphologic features of high-grade serous carcinoma, and a combination of clinical, radiologic, and pathologic examination excluded other possible sites of primary neoplasm.

背景与目标： : 浆液性癌最常见于子宫体或卵巢/输卵管，但有2例原发性阴道浆液性癌。我们报告了2例尿道或尿道憩室内发生的高级别浆液性癌 (各1例)。两种肿瘤均表现出高级别浆液性癌的经典形态特征，并且临床，放射学和病理学检查的组合排除了原发肿瘤的其他可能部位。

BACKGROUND & AIMS: :Increasing healthcare expenditure is a matter of concern in many countries, particularly in relation to the underlying drivers of such escalation that include ageing, medical innovation, and changes in the burden of disease, such as the growing prevalence of chronic diseases. Most healthcare systems in developed countries have been designed to 'cure' acute episodes, rather than to 'manage' chronic conditions, and therefore they are not suitably or efficiently organized to respond to the changing needs and preferences of users. New models of chronic care provision have been developed to respond to the changing burden of disease and there is already considerable practical experience in several different countries showing their advantages but also the difficulties associated with their implementation. In this paper, we focus on the Spanish experience in terms of policy changes and pilot studies focused on testing the feasibility of moving towards chronic care models. In particular, we discuss a framework that identifies and analyses ten key prerequisites to achieving high performing chronic care-based healthcare systems and apply it to the current Spanish National Health System (NHS). We find that the design of the Spanish NHS already meets some of these pre-requisites. However, other features are still in their early stages of development or are being applied only in limited geographical and clinical contexts. We outline the policies that are being implemented and the pathway that the Spanish NHS is taking to address the crucial challenge of the transition towards an optimal health system focused on chronic care. Given the current evidence and trends, we expect that the pathway for developing a chronicity strategy being followed by the Spanish NHS will significantly transform its current healthcare delivery model in the next few years.

背景与目标： : 在许多国家，医疗保健支出的增加是一个令人关注的问题，特别是在这种升级的潜在驱动因素方面，包括老龄化、医疗创新和疾病负担的变化，例如慢性病的日益流行。发达国家的大多数医疗保健系统旨在 “治愈” 急性发作，而不是 “管理” 慢性病，因此它们没有适当或有效地组织起来以应对用户不断变化的需求和偏好。已经开发了新的长期护理模式，以应对不断变化的疾病负担，几个不同国家已经有相当多的实践经验，显示了它们的优势，但也显示了与实施相关的困难。在本文中，我们着重于西班牙在政策变化方面的经验，并着重于测试转向慢性病模式的可行性的试点研究。特别是，我们讨论了一个框架，该框架确定并分析了实现高性能的基于慢性护理的医疗保健系统的十个关键先决条件，并将其应用于当前的西班牙国家卫生系统 (NHS)。我们发现西班牙NHS的设计已经满足了其中一些先决条件。但是，其他功能仍处于开发的早期阶段，或者仅在有限的地理和临床环境中应用。我们概述了正在实施的政策以及西班牙NHS为应对向以长期护理为重点的最佳卫生系统过渡的关键挑战而采取的途径。鉴于目前的证据和趋势，我们预计西班牙NHS遵循的制定慢性病策略的途径将在未来几年内显着改变其当前的医疗保健模式。

BACKGROUND & AIMS: :This article sets out the findings from research on the impact of a, UK based, chefs in schools teaching programme on food, health, nutrition and cookery. Professional chefs link with local schools, where they deliver up to three sessions to one class over a year. The research measured the impact of a standardised intervention package and changes in food preparation and consumption as well as measuring cooking confidence. The target group was 9-11year olds in four schools. The main data collection method was a questionnaire delivered 2weeks before the intervention and 2weeks afterwards. There was a group of four matched control schools. Those taking part in the intervention were enthused and engaged by the sessions and the impact measures indicated an intention to change. There were gains in skills and confidence to prepare and ask for the ingredients to be purchased for use in the home. Following the session with the chef, the average reported cooking confidence score increased from 3.09 to 3.35 (by 0.26 points) in the intervention group - a statistically significant improvement. In the control group this change was not statistically significant. Children's average reported vegetable consumption increased after the session with the chef, with the consumption score increasing from 2.24 to 2.46 points (0.22 points) again, a statistically significant increase with no significant changes in the control group. The research highlights the need to incorporate evaluation into school cooking initiatives as the findings can provide valuable information necessary to fine-tune interventions and to ensure consistency of the healthy eating messages.

背景与目标： : 本文阐述了基于英国a的学校厨师对食品，健康，营养和烹饪教学计划的影响研究结果。专业厨师与当地学校建立联系，在那里他们一年为一堂课提供多达三节课。该研究测量了标准化干预包的影响以及食物制备和消费的变化，并测量了烹饪信心。目标群体是四所学校的9-11岁儿童。主要数据收集方法为干预前2周及干预后2周发放问卷。有一组由四所匹配的控制学校组成。参加干预的人受到会议的热情和参与，影响措施表明有改变的意图。准备和要求购买用于家庭的食材的技能和信心得到了提高。与厨师会谈后，干预组的平均烹饪信心得分从3.09增加到3.35 (0.26分)，这是统计学上的显着改善。在对照组中，这种变化没有统计学意义。与厨师见面后，儿童平均报告的蔬菜消费量增加，消费得分从2.24分增加到2.46分 (0.22分)，在统计学上显着增加，而对照组没有显着变化。该研究强调了将评估纳入学校烹饪计划的必要性，因为研究结果可以提供必要的宝贵信息，以微调干预措施并确保健康饮食信息的一致性。

BACKGROUND & AIMS: PURPOSE:The issue of unidentified volume expansion is well recognized as a cause for resistance to antihypertensive therapy. The aim of study is to identify contribution of negative fluid balance to hypertension control and impact on endothelial and cardiac functions among primary hypertensive patients who do not have kidney failure. MATERIALS AND METHODS:This is a prospective interventional study with one-year follow-up. Preceded by volume status measurements were performed by a body composition monitor (BCM), the patients were put on ambulatory blood pressure monitoring for 24 hours. Then, echocardiographic assessments and flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) measurements were completed. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. RESULTS:At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower CIMT, left ventricle mass index, left ventricular end-diastolic diameter, mean systolic and diastolic BP, non-dipper patient ratio, and higher FMD. In negatively hydrated group, target organ damage significantly reduced during trial. CONCLUSIONS:The significance of negative hydration status with respect to blood pressure control, endothelial and cardiac functions within primary hypertensive patients who do not suffer from kidney failure has been demonstrated.

背景与目标：