BACKGROUND & AIMS: Calcitriol has been widely used in the management of osteoporosis, but its efficiency is a matter of controversy. It is not known whether combinations of calcitriol and antiresorptive agents such as etidronate and calcitonin are superior to calcitriol alone in the treatment of postmenopausal osteoporosis. To make this determination, 30 Turkish women with postmenopausal osteoporosis between 45 and 68 years of age were randomized to receive either intermittent cyclical etidronate (400 mg/day, for 14 days) followed by 60 days of cyclical calcitriol therapy 0.25 microg twice daily (group 1; n = 10), or calcitriol 0.25 microg twice daily (group 2; n = 10), or calcitriol 0.25 microg/day in combination with 100 IU intranasal salmon calcitonin taken every other day (group 3; n = 10) through a 1-year period. Bone mineral density (BMD) of lumbar spine (L2 to L4) was determined for each patient by dual-photon absorptiometry (153Gd) at baseline, after 6 months, and at the end of the study. There was no significant difference among groups with respect to mean spinal BMD at baseline, after 6, and after 12 months. No significant spinal BMD changes occurred in any group from baseline, after 6 months, and after 12 months. Four patients in groups 1 and 2 and five patients in group 3 developed hypercalcemia at least once during therapy. Hypercalciuria occurred at least once in 9, 10, and 7 patients in groups 1, 2, and 3, respectively. One patient in group 2 developed a renal stone at the end of the study. Mean urine hydroxyproline levels did not change significantly in any group with respect to baseline. The data suggest that one-year treatment with calcitriol, given either alone or in combination with antiresorptive agents, does not improve spinal BMD in Turkish women with postmenopausal osteoporosis, and is associated with a high rate of adverse events.

背景与目标： 骨化三醇已被广泛用于骨质疏松症的治疗，但其有效性尚有争议。在绝经后骨质疏松症的治疗中，骨化三醇和抗再吸收剂（如依替膦酸和降钙素）的组合是否优于骨化三醇，尚不明确。为了确定这一点，将30例年龄在45至68岁之间的绝经后骨质疏松症的土耳其妇女随机接受间歇性周期性依替膦酸治疗（400 mg /天，持续14天），然后接受60天周期性钙三醇治疗，每天两次，每次0.25 microg（组） 1； n = 10），或每天两次两次钙钙三醇0.25微克（组2； n = 10），或每隔一天服用100 IU鼻内鲑降钙素与钙三醇0.25微克/天组合（组3； n = 10）， 1年期限。在基线，6个月后和研究结束时，通过双光子吸收法（153Gd）为每位患者确定腰椎（L2至L4）的骨密度（BMD）。各组之间在基线，6个月后和12个月后的平均脊柱骨密度没有显着差异。从基线，6个月和12个月后的任何组中，没有明显的脊柱BMD变化发生。在治疗期间，第1组和第2组的4名患者和第3组的5名患者至少发生一次高钙血症。高钙尿症分别在第1、2和3组的9、10和7名患者中至少发生一次。在研究结束时，第2组的一名患者出现了肾结石。相对于基线，平均尿羟脯氨酸水平在任何组中均无显着变化。数据表明，单独或与抗吸收药联合使用骨化三醇治疗一年并不能改善绝经后骨质疏松症的土耳其妇女的脊柱BMD，并且不良反应发生率较高。

BACKGROUND & AIMS: Evidence relating dietary sodium and blood pressure comes from a variety of sourcesanimal experiments, observational epidemiologic studies, migration studies, and randomized controlled trials. In this review, we examine new findings in each of these areas published during 1995 and 1996. Results from both observational epidemiologic studies and randomized controlled trials demonstrated a dose-response association between dietary sodium and blood pressure in humans. The relationship of dietary sodium to blood pressure was modified by age, race, body weight, and initial level of blood pressure. On average, a 100-mmol decrease in urinary sodium was associated with a reduction of approximately 3 mm Hg in systolic and a 2 mm Hg in diastolic blood pressure. In a general population, this blood pressure reduction would substantially reduce the societal burden of cardiovascular and renal diseases.

背景与目标： 与饮食中钠和血压有关的证据来自多种来源，包括动物实验，观察性流行病学研究，迁移研究和随机对照试验。在这篇综述中，我们研究了1995年和1996年在上述每个领域中发表的新发现。观察流行病学研究和随机对照试验的结果均表明，人类饮食中钠与血压之间存在剂量反应关系。饮食钠与血压的关系因年龄，种族，体重和初始血压水平而改变。平均而言，尿钠减少100 mmol可使收缩压降低约3 mm Hg，舒张压降低2 mm Hg。在一般人群中，这种血压降低将大大减轻心血管疾病和肾脏疾病的社会负担。

BACKGROUND & AIMS: OBJECTIVE:The mechanism behind the epidemiologically evident inverse relation between Helicobacter pylori seropositivity and risk of oesophageal adenocarcinoma (OAC) remains obscure. Severe corpus gastritis is unlikely to be in the causal pathway. With the hypothesis of a uniformly low risk, the associations of OAC with duodenal ulcer and gastric ulcer were explored, both linked to H pylori infection but with different patterns of bacterial colonisation and intragastric acidity. Possible associations of oesophageal squamous cell carcinoma (OSCC) with these ulcer types were also addressed. DESIGN AND PATIENTS:Retrospective cohorts of 61,548 and 81,379 unoperated patients with duodenal ulcer and gastric ulcer, respectively, recorded in the Swedish Inpatient Register since 1965, were followed from the first hospitalisation until the date of any cancer, death, emigration, definitive surgery, or 31 December 2003. Standardised incidence ratios (SIRs), with 95% CIs, expressed relative risk of oesophageal cancer, compared with the Swedish population matched for age, sex and calendar period. RESULTS:Contrary to expectation, patients with duodenal ulcer had a significant 70% excess risk of OAC (SIR 1.7, 95% CI 1.1 to 2.5). Gastric ulcer was unrelated to OAC (SIR 1.1, 95% CI 0.6 to 1.7). Although duodenal ulcer was non-significantly associated with a small excess of OSCC (SIR 1.3, 95% CI 0.96 to 1.8), gastric ulcer was linked to 80% increased risk (SIR 1.8, 95% CI 1.4 to 2.3). CONCLUSION:The inverse association between H pylori and OAC does not pertain to all infections. The pattern of gastric colonisation and/or impact on acidity may be important. With the reservation for the possibility of confounding, this study also provides some support for the importance of intragastric environment in the aetiology of OSCC.

背景与目标： 目的：幽门螺杆菌血清阳性与食管腺癌（OAC）风险之间的流行病学证据呈负相关。严重的胃炎胃炎不太可能在因果关系中。假设风险均一，探讨了OAC与十二指肠溃疡和胃溃疡的相关性，二者均与幽门螺杆菌感染有关，但细菌定植和胃内酸度不同。食管鳞状细胞癌（OSCC）与这些溃疡类型的可能关联也得到了解决。
设计和患者：自1965年以来在瑞典住院患者登记表中记录的分别有61,548和81,379例未手术的十二指肠溃疡和胃溃疡患者的回顾性队列，从首次住院治疗直至癌症，死亡，移民，定型手术，或2003年12月31日。与年龄，性别和日历时期相匹配的瑞典人群相比，具有95％CI的标准发生率（SIR）表示食道癌的相对风险。
结果：与预期相反，十二指肠溃疡患者发生OAC的风险显着增加70％（SIR 1.7，95％CI 1.1至2.5）。胃溃疡与OAC无关（SIR 1.1，95％CI 0.6至1.7）。尽管十二指肠溃疡与少量过量的OSCC无显着相关性（SIR 1.3，95％CI 0.96至1.8），但胃溃疡与80％的风险增加相关（SIR 1.8，95％CI 1.4至2.3）。
结论：幽门螺杆菌与OAC之间的负相关并不适用于所有感染。胃定植的模式和/或对酸度的影响可能很重要。由于保留了混淆的可能性，本研究还为胃内环境在OSCC病因中的重要性提供了一些支持。

BACKGROUND & AIMS: :The aim of this study was to examine the different patterns of cerebellar and/or brainstem atrophy in spinocerebellar ataxia (SCA) type 3 and 6. Eighteen patients (SCA3 n=9, SCA6 n=9) and 15 healthy volunteers were studied. Voxel-based morphometry (VBM) was applied to segmented grey matter (GM) and white matter (WM) of high-resolution T1-weighted brain volumes of each group. We found reduction of grey matter in the pons as well as in the vermis in SCA3 as compared to control subjects. In SCA6 significant grey matter loss was found in hemispheric lobules bilaterally as well as in the vermis. White matter analysis revealed significant changes in SCA3, especially in the pons, in the white matter surrounding the dentate nucleus (DN) and in the cerebellar peduncles, whereas no significant white matter reduction was found in SCA6 patients. Our results demonstrate different patterns of grey and white matter affection detected by magnetic resonance imaging (MRI) in SCA3 and SCA6 patients, confirming the pathological concept of cortical cerebellar atrophy in SCA6. In contrast, SCA3 represents a form of ponto-cerebellar atrophy with predominant affection of pontine nuclei and fibre tracts.

背景与目标： ：本研究的目的是检查3型和6型脊髓小脑共济失调（SCA）的小脑和/或脑干萎缩的不同模式。研究了18例患者（SCA3 n = 9，SCA6 n = 9）和15名健康志愿者。将基于体素的形态计量学（VBM）应用于每组高分辨率T1加权脑体积的分段灰质（GM）和白质（WM）。我们发现，与对照组相比，SCA3的脑桥和ver中的灰质减少了。在SCA6中，在双侧的半球小叶以及在mis骨中都发现了明显的灰质损失。白质分析显示，SCA3的显着变化，尤其是在脑桥，齿状核（DN）周围的白质和小脑梗的脑桥中，特别是在脑桥中，而在SCA6患者中未发现显着的白质减少。我们的研究结果表明，在SCA3和SCA6患者中，通过磁共振成像（MRI）检测到灰白色和白色物质的影响方式不同，这证实了SCA6皮质小脑萎缩的病理学概念。相反，SCA3代表了一种桥脑小脑萎缩的形式，主要影响桥脑核和纤维束。

BACKGROUND & AIMS: OBJECTIVE:To evaluate the maternal and neonatal outcomes of pregnancies complicated with isolated oligohydramnios at term, managed by induction of labor. METHODS:We conducted a retrospective case-control study. 138 women with uncomplicated oligohydramnios at term [amniotic fluid index (AFI) < or =5 cm] and a low Bishop score (< or =6) underwent induction of labor with prostaglandin E2. These women were compared to 67 women who underwent induction of labor at 42 weeks' gestation and 276 women at low-risk pregnancy and spontaneous onset of labor, matched for parity and race. RESULTS:Cesarean section (CS) rate was similar in the study and the post-date group (17.4 and 17.9%, respectively), but significantly higher than the spontaneous labor group (5.8%, OR 3.42, 95% CI 1.75-6.68). No differences were found with other outcomes. CONCLUSION:Pregnancies with isolated oligohydramnios at term apparently are not at higher risk of perinatal complications, but induction of labor is associated with increased rate of CS.

背景与目标： 目的：评估足月妊娠并通过引产管理的妊娠合并轻度羊水过少的孕妇和新生儿的结局。
方法：我们进行了一项回顾性病例对照研究。 138名足月[羊水指数（AFI）<或= 5 cm]且Bishop评分低（<或= 6）的单纯性羊水过少的妇女接受前列腺素E2引产。将这些妇女与67名在42周妊娠时引产的妇女和276名在低危妊娠和自发性发作的妇女进行比较，以实现同等和种族匹配。
结果：剖宫产（CS）率在研究中和后期组相似（分别为17.4和17.9％），但显着高于自然分娩组（5.8％，OR 3.42，95％CI 1.75-6.68）。 。与其他结果无差异。
结论：足月妊娠少羊水过少的孕妇显然没有围产期并发症的高风险，但是引产与CS发生率增加有关。

BACKGROUND & AIMS: OBJECTIVE:This study reviewed whether participants who were given a continence education package, which included a Continence Educational Brochure (CEB), and who indicated that they were bothered by incontinence symptoms changed health-seeking behaviors about their incontinence problem because of being given the brochure. METHOD:This study used a descriptive and exploratory design. Participants were given the CEB and asked to read the information. They were also asked to complete a continence questionnaire and mail this back to the research team. Participants who indicated that they were bothered by a continence problem and consented to being interviewed were telephoned 2 to 3 months later. They were asked questions to determine their actions and progress in relation to managing their continence problem and whether the CEB had influenced their behavior. SETTING AND SUBJECT:A total of 631 participants (352 females, 55.8%; 279 males, 44.2%) from 4 rural and regional settings in Victoria, Australia, participated. Of this sample, 111 participants (78 females, 70.3%; 33 males, 29.7%) who reported that they were bothered by a continence problem were interviewed 3 months after being given the CEB. RESULTS:Two thirds of the total sample of participants (n=111) sought help for their continence problem. Approximately 70.3% (n=78) continued to have a continence problem. Of this group, 84.6% were still bothered by the continence problem and 65.4% had taken action to treat their incontinence. Forty-nine participants (44.1%) indicated that they had discussed the issue of bladder or bowel problems with someone directly because of this study or the information contained in the brochure. More than 94% of participants who remembered the CEB indicated that they believed the brochure would be helpful if given to other people. CONCLUSIONS:These findings suggest that the CEB prompted individuals to discuss their continence problem and in fewer cases to seek professional help. Given these findings, distribution of a continence education package is advocated as a continence health promotion strategy.

背景与目标： 目的：本研究回顾了参加者的节制教育包，其中包括节制教育手册（CEB），并指出他们因节制失禁症状而受到困扰，从而改变了他们对失禁问题的健康寻求行为，因为他们获得了手册。
方法：本研究采用描述性和探索性设计。参加者获得了CEB的邀请，并要求阅读信息。还要求他们填写节制问卷并将其邮寄回研究团队。 2至3个月后打电话给表示自己受到节制问题困扰并同意接受采访的参与者。他们被问到问题，以确定他们在处理自控问题方面的行动和进展，以及CEB是否影响了他们的行为。
地点和主题：来自澳大利亚维多利亚州4个农村和地区性地区的631名参与者（352名女性，占55.8％； 279名男性，占44.2％）参加了该项目。在该样本中，有111名参与者表示接受节制问题后感到困扰，他们被告知接受CEB后接受了采访（78名女性，占70.3％； 33名男性，占29.7％）。
结果：参与者（n = 111）的总样本的三分之二寻求帮助，以解决他们的节制问题。大约70.3％（n = 78）仍然存在尿失禁问题。在这一组中，仍有84.6％的人患有尿失禁问题，还有65.4％的人已经采取了行动来治疗他们的尿失禁。 49名参与者（44.1％）表示，由于该研究或小册子中包含的信息，他们直接与某人讨论了膀胱或肠道问题。记得CEB的参与者中，超过94％的参与者表示，他们认为该手册对其他人有帮助。
结论：这些发现表明，CEB促使个人讨论他们的节制问题，并在较少的情况下寻求专业帮助。鉴于这些发现，提倡分发节制教育一揽子计划作为节制健康促进策略。

BACKGROUND & AIMS: To determine the efficacy of endoscopic variceal ligation (EVL) in prophylaxis on the rate of first esophageal variceal bleeding, we conducted a prospective, randomized trial in 126 cirrhotic patients with no history of previous upper gastrointestinal bleeding and with esophageal varices endoscopically judged to be at high risk of hemorrhage. The end-points of the study were bleeding and death. Life-table curves showed that prophylactic EVL significantly diminished the rate of variceal hemorrhage (12/62 [19%] vs. 38/64 [60%]; P = .0001) and overall mortality (17/62 [28%] vs. 37/64 [58%]; P = .0011). The 2-year cumulative bleeding rate was 19% (12/ 62) in the EVL group and 60% (38/64) in the control group. The 2-year cumulative mortality rate was 28% (17/62) in the EVL group and 58% (37/64) in the control group. Comparison of Kaplan-Meier estimates of the time to death of both groups showed significantly lower mortality in the ligation group (P = .001). Patients undergoing EVL had few treatment failures and died mainly of hepatic failure. The lower risk in the EVL group was attributed to a rapid reduction of variceal size. Prophylactic EVL was more efficient in preventing first bleeding in patients with good condition (Child A) than in those with decompensated disease (Child B and C). We conclude that prophylactic EVL can decrease the incidence of first variceal bleeding and death over a period of 2 years in cirrhotic patients with high-risk esophageal varices.

背景与目标： 为了确定内镜下静脉曲张结扎术（EVL）预防第一次食道静脉曲张破裂出血的疗效，我们对126例无既往有上消化道出血史且经内镜检查认为是食管静脉曲张的肝硬化患者进行了一项前瞻性随机试验。高出血风险。研究的终点是出血和死亡。生命表曲线表明，预防性EVL显着降低了曲张静脉出血的发生率（12/62 [19％] vs. 38/64 [60％]； P = .0001）和总死亡率（17/62 [28％] vs 37/64 [58％]； P = 0.0011）。 EVL组的2年累积出血率为19％（12/62），对照组为60％（38/64）。 EVL组的2年累积死亡率为28％（17/62），对照组为58％（37/64）。 Kaplan-Meier对两组死亡时间的估计值的比较表明，结扎组的死亡率显着降低（P = .001）。接受EVL的患者几乎没有治疗失败，主要死于肝功能衰竭。 EVL组中较低的风险归因于曲张静脉大小的迅速减小。预防性EVL预防状况良好的患者（儿童A）比失代偿性疾病的患者（儿童B和C）更有效地防止首次出血。我们得出结论，在高危食管静脉曲张的肝硬化患者中，预防性EVL可以在2年内降低首次静脉曲张破裂出血和死亡的发生率。

BACKGROUND & AIMS: :Medial preoptic area (MPOA) and ventral bed nucleus of the stria terminalis (VBST) neurons are involved in maternal behavior, but the neural sites to which the maternally relevant neurons project have not been determined. Since MPOA and VBST neurons express Fos during maternal behavior, we used a double-labeling immunocytochemical procedure to detect both Fos and a retrograde tracer, wheat germ agglutinin (WGA), in order to determine where these Fos neurons project. On Day 4 postpartum, fully maternal females were separated from their litters. On Day 5, WGA was iontophoretically injected into one of the following regions known to receive MPOA and/or VBST input: Lateral septum, medial hypothalamus at the level of the ventromedial nucleus, lateral habenula, ventral tegmental area, retrorubral field, or periaqueductal gray. On Day 7, females received a 2-h test with either pups or candy, after which they were perfused and their brains were processed for the detection of Fos and WGA. As expected, females tested with pups had more Fos-containing neurons in the MPOA and VBST than did females tested with candy. After WGA injections into several brain sites, the number of double-labeled cells observed in the MPOA and VBST was greater for the maternal females when compared to the non-maternal females. Therefore, these results pinpointed neural circuits that were activated during maternal behavior. For the maternal females, Fos-containing neurons in the MPOA projected most strongly to the medial hypothalamus at the level of the ventromedial nucleus and to the lateral septum, while Fos-containing neurons in the VBST projected most strongly to the retrorubral field, ventral tegmental area, and medial hypothalamus. Although relatively few MPOA and VBST neurons which expressed Fos during maternal behavior projected to the periaqueductal gray, these Fos-expressing neurons made up a relatively large proportion of the MPOA and VBST projection to the periaqueductal gray. This study suggests that MPOA and VBST efferents project to a variety of regions to promote full maternal responsiveness.

背景与目标： ：孕产妇的行为涉及视神经内侧视前区（MPOA）和纹状体终末腹侧核（VBST）的母亲行为，但尚未确定与母亲相关的神经元投射到的神经部位。由于MPOA和VBST神经元在孕产妇行为期间表达Fos，因此我们使用双重标记免疫细胞化学方法检测Fos和逆行示踪剂小麦胚芽凝集素（WGA），以确定这些Fos神经元的位置。在产后第4天，将完全产妇的母猪从其产仔中分离出来。在第5天，将WGA离子电渗注入已知可接收MPOA和/或VBST输入的以下区域之一：外侧中隔，腹侧内侧丘脑，腹侧核，腹侧被膜区，腹侧被盖区，后睑缘视野或导水管周围灰色。在第7天，雌性接受幼犬或糖果进行2小时的测试，然后对它们进行灌注，并对其大脑进行处理以检测Fos和WGA。不出所料，用幼犬测试的雌性在MPOA和VBST中的含Fos的神经元要多于用糖果进行测验的雌性。 WGA注射到多个大脑部位后，与非母体雌性相比，母体雌性在MPOA和VBST中观察到的双标记细胞数量更多。因此，这些结果指出了在孕产妇行为中被激活的神经回路。对于孕产妇，MPOA中含有Fos的神经元在腹膜内侧核和外侧中隔的投射力最强，而VBST中含有Fos的神经元在后睑内侧，腹侧被膜的投射力最强。区域和内侧下丘脑。尽管在产妇行为中表达Fos的MPOA和VBST神经元相对较少，但会投射到导水管周围的灰色，但这些表达Fos的神经元在MPOA和VBST投射至导水管周围的灰色中所占的比例相对较大。这项研究表明，MPOA和VBST传出可投射到多个区域，以促进全面的孕产妇反应。

BACKGROUND & AIMS: :Japanese people in both Japan and in Hawaii have a lower incidence of hip fractures than white people in Hawaii or on the mainland of the United States. Hip fractures usually occur after a fall, and differing incidence rates of falls might contribute to the observed differences in hip fracture rates. To investigate this possibility we undertook a prospective study of falls among elderly Japanese men and women living in Hawaii using intensive surveillance methods similar to those used in studies of predominantly white populations. For our Japanese participants, the incidence rates of total falls were 139 per 1000 person years for men and 276 per 1000 person years for women. Age adjusted rate ratios of falls for predominantly white populations compared with our Japanese participants ranged from 1.8 to 2.3 for women and from 2.6 to 4.7 for men. The risk of injuries when they did fall, however, was not lower for our Japanese participants than reported for white participants. For our Japanese population, past falls, female gender, and daytime hours were associated with an increased incidence of falls.

背景与目标： ：在日本和夏威夷，日本人的髋部骨折发生率比夏威夷或美国大陆的白人低。髋部骨折通常在跌倒后发生，跌倒的发生率不同可能会导致观察到的髋部骨折发生率的差异。为了调查这种可能性，我们进行了一项前瞻性研究，研究了居住在夏威夷的日本老年男性和女性跌倒的情况，采用了与主要针对白人人口的研究相似的强化监视方法。对于我们的日本参与者，男性总跌倒发生率是每千人年139例，女性每千人年276例。与日本人相比，以白人为主的年龄调整后的跌倒比率，女性为1.8到2.3，男性为2​​.6到4.7。但是，对于日本参与者来说，跌倒时受伤的风险并不比白人参与者低。对于我们的日本人口来说，以往的跌倒，女性性别和白天营业时间与跌倒发生率增加相关。

BACKGROUND & AIMS: :With currently available combination chemotherapy regimens, the outcome of the patients newly diagnosed with aggressive non-Hodgkin's lymphoma (NHL) identified as 'high' and 'high-intermediate' risk groups according to the international prognostic index (IPI) is still unsatisfactory and a more innovative therapy is urgently required to improve the survival of the patients. The purpose of this study was to compare the efficacy of rituximab given in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) and ESHAP (etoposide, methylprednisolone, high-dose Ara-C, cisplatin) vs CHOP-ESHAP and upfront high-dose therapy (HDT) and autologous stem cell transplantation (ASCT) vs standard CHOP in patients aged < or = 65 years old newly diagnosed with 'high' and 'high-intermediate' risk aggressive lymphoma enrolled onto two consecutive treatment trials at the institute. Between May 1995 - July 2002, 84 patients, aged 15 - 65 years old, with newly diagnosed aggressive NHL and an age-adjusted IPI of 2 or 3 were enrolled. The median age of the patients was 38 years (range 15 - 65). The baseline demographic features, in particular the major prognostic variables, were similar between the treatment groups. Patients treated with rituximab-CHOP-ESHAP received eight cycles of rituximab (375 mg m(-2) on day 1 of cycles 1 - 6 and days 21 and 28 of cycle 7) plus CHOP (day 3 of cycles 1, 3 and 5) and ESHAP (day 3 of cycles 2, 4 and 6 and day 1 of cycle 7) at 21-day intervals. Patients enrolled onto the CHOP-ESHAP-HDT arm (n = 23) were treated with three courses of CHOP and then switched to two or four cycles of ESHAP followed by HDT. Patients treated with CHOP alone (n = 25) were treated with the standard eight cycles of CHOP. The rate of complete remission was significantly improved with rituximab-CHOP-ESHAP compared with either CHOP-ESHAP-HDT or CHOP alone (67% compared with 44% and 36%, respectively; p = 0.043). With a median follow-up time of 53 months, the 5-year overall survival (OS) was improved by the addition of rituximab-61% with rituximab-CHOP-ESHAP, compared with 43% for CHOP-ESHAP-HDT and 24% for CHOP alone (p = 0.088). Significant increases in failure-free survival (FFS) and disease-free survival (DFS) (61% and 96%), compared with CHOP-ESHAP-HDT (34% and 90%) and CHOP (16% and 44%; p = 0.002 and p < 0.001, respectively) were observed. Compared to CHOP, rituximab-CHOP-ESHAP yielded significantly superior OS (p = 0.014), FFS (p < 0.001) and DFS (p < 0.001). The survivals, however, were not significantly different from patients treated with CHOP-ESHAP-HDT. It is concluded that rituximab-ESHAP-CHOP is superior over standard CHOP and fares comparably to upfront HDT/ASCT in previously untreated patients with aggressive lymphoma. A prospective randomized controlled trial is warranted to confirm these results.

背景与目标： ：根据目前的联合化疗方案，根据国际预后指标（IPI），新诊断为侵袭性非霍奇金淋巴瘤（NHL）的患者的预后仍然不理想，并且迫切需要一种更具创新性的疗法来提高患者的生存率。这项研究的目的是比较利妥昔单抗与CHOP（环磷酰胺，阿霉素，长春新碱，泼尼松）和ESHAP（依托泊苷，甲基强的松龙，大剂量Ara-C，顺铂）联合使用的利妥昔单抗与CHOP-ESHAP和前期高剂量联合治疗的疗效在该研究所进行的两项连续治疗试验中，对新诊断为“高”和“高中度”风险性侵袭性淋巴瘤的年龄≤65岁的患者进行剂量治疗（HDT）和自体干细胞移植（ASCT）与标准CHOP对照。在1995年5月至2002年7月之间，纳入了84例年龄在15至65岁之间，新诊断为侵袭性NHL且年龄校正后的IPI为2或3的患者。患者的中位年龄为38岁（范围15-65）。治疗组之间的基线人口统计学特征，尤其是主要的预后变量相似。接受利妥昔单抗-CHOP-ESHAP治疗的患者接受了八个周期的利妥昔单抗（第1-6周期的第1天以及第7周期的第21和28天）（375 mg m（-2））加CHOP（第1、3和5周期的第3天） ）和ESHAP（周期2、4和6的第3天和周期7的第1天），间隔为21天。入组CHOP-ESHAP-HDT组（n = 23）的患者接受了三个疗程的CHOP治疗，然后切换到ESSHAP的两个或四个周期，然后进行HDT。单独接受CHOP治疗的患者（n = 25）接受了标准的八个CHOP周期治疗。与单独使用CHOP-ESHAP-HDT或CHOP相比，利妥昔单抗-CHOP-ESHAP的完全缓解率显着提高（分别为67％，44％和36％； p = 0.043）。中位随访时间为53个月，利妥昔单抗-CHOP-ESHAP加利妥昔单抗-61％改善了5年总生存（OS），相比之下，CHOP-ESHAP-HDT和43％改善了5年总生存率仅适用于CHOP（p = 0.088）。与CHOP-ESHAP-HDT（34％和90％）和CHOP（16％和44％）相比，无失败生存率（FFS）和无病生存率（DFS）显着增加（61％和96％）；分别观察到= 0.002和p​​ <0.001）。与CHOP相比，利妥昔单抗-CHOP-ESHAP产生显着优越的OS（p = 0.014），FFS（p <0.001）和DFS（p <0.001）。但是，其存活率与用CHOP-ESHAP-HDT治疗的患者无明显差异。结论是，对于以前未经治疗的侵袭性淋巴瘤患者，利妥昔单抗-ESHAP-CHOP优于标准CHOP，且其费用可与前期HDT / ASCT相提并论。必须进行前瞻性随机对照试验来证实这些结果。

BACKGROUND & AIMS: :An inverse relationship between age and human papillomavirus (HPV) prevalence has been reported in many developed countries, but information on this relationship is scarce in many other parts of the world. We carried out a cross-sectional study of sexually active women from the general population of 15 areas in 4 continents. Similar standardised protocols for women's enrolment, cervical specimen collection and PCR-based assays for HPV testing were used. HPV prevalence in different age groups was compared by study area. 18,498 women aged 15-74 years were included. Age-standardised HPV prevalence varied more than 10-fold between populations, as did the shape of age-specific curves. HPV prevalence peaked below age 25 or 35, and declined with age in Italy, the Netherlands, Spain, Argentina, Korea and in Lampang, Thailand and Ho Chi Minh, Vietnam. This was not the case in Songkla, Thailand nor Hanoi, Vietnam, where HPV prevalence was low in all age groups. In Chile, Colombia and Mexico, a second peak of HPV prevalence was detected among older women. In the poorest study areas in Asia (Shanxi, China and Dindigul, India), and in Nigeria, HPV prevalence was high across all age groups. The substantial differences observed in age-specific curves of HPV prevalence between populations may have a variety of explanations. These differences, however, underline that great caution should be used in inferring the natural history of HPV from age-specific prevalences.

背景与目标： ：许多发达国家已经报告了年龄与人乳头瘤病毒（HPV）患病率之间的反比关系，但世界上其他许多地方都缺乏有关这种关系的信息。我们对来自四大洲15个地区的总人口中的性活跃妇女进行了横断面研究。使用了类似的标准化协议进行女性入组，子宫颈标本采集和基于PCR的HPV检测方法。通过研究区域比较了不同年龄组的HPV患病率。其中包括18,498名15-74岁的女性。年龄标准化的HPV患病率在不同人群之间变化超过10倍，特定年龄曲线的形状也是如此。 HPV感染率在25岁或35岁以下达到峰值，在意大利，荷兰，西班牙，阿根廷，韩国以及泰国南邦和越南胡志明市随着年龄的增长而下降。在泰国的宋卡和越南的河内，情况并非如此，那里的所有年龄段的人乳头瘤病毒感染率都很低。在智利，哥伦比亚和墨西哥，在老年妇女中发现了HPV感染率的第二高峰。在亚洲最贫困的研究地区（中国山西和印度的丁迪古尔）以及尼日利亚，所有年龄段的人乳头瘤病毒感染率都很高。在人群之间HPV流行的年龄特定曲线中观察到的实质差异可能有多种解释。但是，这些差异强调，应根据年龄特定的患病率推断HPV的自然病史时应格外谨慎。