BACKGROUND & AIMS: :Carbon monoxide (CO) poisoning may result in focal and diffuse neuropathological changes, including basal ganglia lesions. The effect of CO poisoning on basal ganglia volumes over time is unclear. We assessed basal ganglia volumes longitudinally following CO poisoning. We prospectively enrolled 73 CO poisoned patients who underwent brain MR imaging on day 1 (baseline), 2 weeks, and 6 months post-CO poisoning. Basal ganglia volumes were obtained. One patient had bilateral globus pallidus lesions at two weeks and 6 months. Of the CO-poisoned patients 28% had volume reduction in at least one basal ganglia structure by 6 months, of which 21% had putamen, 15% had caudate, 15% had globus pallidus, and 16% had total basal ganglia volume reduction. Putamen volumes were significantly smaller from baseline to six months (p = 0.02). Verbal memory and mental processing speed correlated with smaller putamen and globus pallidus volumes. Carbon monoxide poisoning results in basal ganglia volume reduction 6 months post CO poisoning. Slow mental processing speed and impaired memory correlated with smaller putamen and globus pallidus volumes. Clinicians need to be aware of basal ganglia neuropathologic changes in the absence of observable lesions following CO poisoning.

背景与目标： ：一氧化碳（CO）中毒可能会导致局灶性和弥漫性神经病理学改变，包括基底神经节病变。随着时间的推移，CO中毒对基底神经节体积的影响尚不清楚。我们在CO中毒后纵向评估了基底神经节的体积。我们前瞻性地招募了73名在CO中毒后第1天（基线），第2周和6个月接受脑MR成像检查的CO中毒患者。获得基底神经节体积。一名患者在两周零六个月出现双侧苍白球苍白球病变。在CO中毒的患者中，到6个月时，至少一个基底神经节结构中有28％的体积减小，其中21％的壳状蛋白，15％的呈尾状，15％的苍白球和16％的整个基底神经节的体积减小。从基线到六个月，壳核的体积显着减小（p = 0.02）。言语记忆和心理处理速度与较小的壳核和苍白球体积有关。一氧化碳中毒导致CO中毒后6个月，基底神经节体积减少。心理处理速度慢和记忆力减退与较小的壳核和苍白球体积有关。在CO中毒后没有可观察到的病变的情况下，临床医生需要注意基底神经节神经病理学改变。

BACKGROUND & AIMS: :We review a 15-year experience with childhood idiopathic thrombocytopenic purpura (ITP) at a tertiary-care pediatric hospital in Croatia. Data confirm that ITP is typically a self-limited bleeding disorder that usually presents with mild symptoms in children between 1 and 10 years of age and affects both sexes equally. At presentation, more than half of the children had platelet counts of <10x10(9)/L. The absence of preceding viral infection and insidious onset of symptoms were significantly associated with development of chronic ITP. In our experience, observation without specific therapy seems to be the optimal approach to a child with ITP.

背景与目标： ：我们回顾了克罗地亚一家三级儿科医院15年儿童特发性血小板减少性紫癜（ITP）的经验。数据证实，ITP通常是一种自限性出血性疾病，通常在1至10岁的儿童中表现出轻度症状，并平等地影响两性。在介绍时，超过一半的儿童血小板计数<10x10（9）/ L。先前病毒感染的缺乏和症状的隐匿发作与慢性ITP的发生显着相关。根据我们的经验，不进行特殊治疗的观察似乎是ITP儿童的最佳治疗方法。

BACKGROUND & AIMS: :Only 2 comprehensive surgical series, published in 1977 and 1983, have evaluated clinicopathologic features of the ascending aorta. Retrospective review of medical records and microscopic slides was performed on 513 consecutive patients with surgical resection of ascending aortic tissue (1985 to 1999). Patients were 2 to 89 years old (mean 59 y), and 303 (59%) were men. Aneurysm or dissection was the indication for surgery in 479. Aortic valves were also excised in 360. Systemic hypertension was present in 279, inherited connective tissue disease (ICTD) in 67, arteritis in 33, and acquired connective tissue disease in 16. Microscopy showed cystic medial degeneration (CMD) in 209, aortic dissection (AD) in 109 (with CMD in 56), normal media in 90, aortitis in 57 (with CMD in 14), and other findings in 48. The most significant, independent risk factor of CMD and AD was ICTD (confidence interval=7.61 and 2.26, respectively). Systemic hypertension was more common in patients with AD than without (P=0.0202). Normal media was the most common histologic finding associated with bicuspid aortic valve (P<0.0001). Among 57 patients with aortitis (giant cell in 39), ages ranged from 16 to 85 years (mean 64 y), and 42 (74%) were women; only 8 had Takayasu arteritis, and 11 had temporal or systemic arteritis. In surgically resected ascending aorta, the 3 most common histologic findings were CMD, AD, and normal media. ICTD, systemic hypertension, and bicuspid aortic valve were common comorbid findings. Giant cell aortitis occured predominantly in women, usually without systemic disease.

背景与目标： ：仅在1977年和1983年出版的2个综合外科手术系列中，评估了升主动脉的临床病理特征。回顾性审查了513例行升主动脉组织手术切除的患者（1985年至1999年）的病历和显微幻灯片。患者为2至89岁（平均59岁），其中303例（59％）为男性。 479例手术是动脉瘤或夹层手术的指征。360例也切除了主动脉瓣。279例出现全身性高血压，67例患有遗传性结缔组织病（ICTD），33例患有动脉炎，16例获得性结缔组织病。囊性内侧变性（CMD）209例，主动脉夹层（AD）109例（CMD 56例），正常介质90例，主动脉炎57例（CMD 14例），其他发现48例。 CMD和AD的因素是ICTD（置信区间分别为7.61和2.26）。 AD患者的全身性高血压比非AD患者更常见（P = 0.0202）。正常介质是与二尖瓣主动脉瓣相关的最常见的组织学发现（P <0.0001）。在57例主动脉炎患者中（39个巨大细胞），年龄在16至85岁之间（平均64岁），其中42例（74％）为女性。只有8例患有高津动脉炎，11例患有颞部或全身性动脉炎。在手术切除的升主动脉中，最常见的3种组织学发现是CMD，AD和正常介质。 ICTD，系统性高血压和双尖瓣主动脉瓣是常见的合并症。巨细胞主动脉炎主要发生于女性，通常无全身性疾病。

BACKGROUND & AIMS: :In an open, multi-centre study in general practice, a comparison was made of the efficacy, tolerability and acceptability of a neomycin/dexamethasone preparation administered by metered-dose spray ('Otomize') and a framycetin/gramicidin/dexamethasone preparation ('Sofradex') administered as drops in 60 patients with otitis externa. Patients were allocated at random to receive one or other preparations 3-times daily for 10 days and were followed-up again 14 days after cessation of therapy. Clinical assessments were carried out under observer blind conditions on entry (Day 0) and on Days 10 and 24 of the severity of erythema, swelling and debris in the affected ear(s). A global assessment of clinical outcome was made by the doctor on Day 10. There were no significant differences in the two groups at the start of treatment. Significant improvement occurred in both groups from Day 0 to Day 10 and from Day 10 to Day 24 in all symptoms, with the proportion symptom-free in the 'Otomize' group significantly greater than in the 'Sofradex' group at 24 days, and approaching significance at 10 days. Significantly more patients in the 'Otomize' group were rated as having a good clinical outcome by the physician, and fewer patients experienced discomfort on application. Few side-effects were reported by either treatment group, none necessitating discontinuation of therapy.

背景与目标： ：在一项开放，多中心的常规研究中，比较了通过定量喷雾（“ Otomize”）和新霉素/短杆菌肽/短杆菌肽/地塞米松制剂给药的新霉素/地塞米松制剂的疗效，耐受性和可接受性（ “ Sofradex”）在60例外耳炎患者中以滴剂形式给药。随机分配患者每天3次接受一种或其他制剂，共10天，并在停止治疗后14天再次随访。在进入者（第0天）以及第10和第24天观察者失明的情况下，对患病耳朵的红斑，肿胀和碎屑的严重程度进行了临床评估。在第10天，医生对临床结果进行了全面评估。治疗开始时，两组之间没有显着差异。从第0天到第10天，从第10天到第24天，两组的所有症状均有明显改善，在第24天，“ Otomize”组中无症状的比例显着大于“ Sofradex”组，并且接近在10天的意义。医师认为“ Otomize”组中的更多患者具有良好的临床效果，并且更少的患者在使用时感到不适。任一治疗组均报告很少有副作用，没有副作用需要终止治疗。

BACKGROUND & AIMS: :This study aimed to clarify the effectiveness of post-operative oral care, including tooth brushing, denture cleaning and tongue cleaning, after digestive tract surgery. Subjects included 30 elderly patients aged 60-98 years (74.9 +/- 7.8 years) who underwent digestive tract surgery. Subjects were randomly divided into an intervention group and a control group. In the intervention group, the following oral care was provided daily over a 5-min period in the morning starting at baseline (day of surgery) and continued for 5 days: gargling with povidone iodine, tooth brushing, denture cleaning using a special brush and tongue cleaning using a tongue brush. In the control group, the subjects only gargled with povidone iodine. We compared the following variables between the two groups at baseline and 5 days later: the sensation of dry mouth, intra-oral gas concentration, pulmonary sounds, body temperature and bacterial flora. The number of patients with abnormal pulmonary sounds (dry or moist rales) increased from 1 to 2 in the intervention group and from 0 to 4 in the control group (P < 0.05). The average number of bacterial species per subject for the control group was 3.64 +/- 1.34 pre-operatively and 3.50 +/- 1.74 post-operatively, whereas that for the intervention group was 3.08 +/- 0.95 pre-operatively and 2.62 +/- 0.65 post-operatively. In the intervention group, there was a significant decrease in the number of bacterial species (P < 0.05). These findings indicate that post-operative oral care in elderly patients undergoing digestive tract surgery lowers the number of bacterial species found in the oral cavity. This effect, in turn, might improve respiratory function.

背景与目标： ：这项研究旨在阐明消化道手术后口腔清洁的有效性，包括刷牙，义齿清洁和舌头清洁。受试者包括接受消化道手术的30位年龄在60-98岁（74.9 /-7.8岁）的老年患者。将受试者随机分为干预组和对照组。在干预组中，每天从基线（手术日）开始，在每天的5分钟内，每天进行以下口腔护理，并持续5天：用聚维酮碘漱口，刷牙，使用专用刷子清洁义齿和使用舌刷清洁舌头。在对照组中，受试者仅含聚维酮碘。我们在基线和5天后比较了两组之间的以下变量：口干的感觉，口内气体浓度，肺音，体温和细菌菌群。在干预组中，肺音异常（干音或湿音）的患者数量从1增加到2，对照组从0增加到4（P <0.05）。对照组术前平均细菌种类为3.64 /-1.34，术后为3.50 /-1.74，而干预组术前为3.08 /-0.95，术后为2.62 /-0.65。操作上。在干预组中，细菌种类的数量显着减少（P <0.05）。这些发现表明，接受消化道手术的老年患者的术后口腔护理降低了在口腔中发现的细菌种类的数量。反过来，这种效果可能会改善呼吸功能。

BACKGROUND & AIMS: The dose, efficacy, and side effects of continuous intravenous infusion (CIVI) of morphine were compared with continuous subcutaneous infusion (CSCI) of morphine in patients with chronic cancer pain. Eligible patients were referred to the Palliative Care Program and were receiving a stable dose of CIVI of morphine. The design was a within-patient, one-way crossover; in which each patient provided data before and after a switch from CIVI to CSCI of morphine. "Rescue" doses were 50% of the hourly dose given every 2 hours as needed. Morphine was infused intravenously (i.v.) and subcutaneously (s.c.) via a McGaw/AccuPro Volumetric Infusion Pump. After baseline data, including side effects and pain assessment, were obtained, patients were evaluated twice daily for toxicity and analgesic efficacy. Those who had a stable CIVI dose for 48 consecutive hr were crossed over to the CSCI at the same dose as the intravenous (i.v.) phase. A stable dose was defined as no dose change, four or less rescue doses in the previous 24 hr, and a pain rating of none or mild. CIVI was considered equal to CSCI if these criteria were maintained for 96 consecutive hr. Fifty-seven patients were entered, and 40 were evaluable (15 women and 25 men). The median age was 67 (range 30-83 years). All 40 participants, after maintaining a stable dose throughout the i.v. phase, crossed to the s.c. phase and remained on s.c. for at least 48 hr. Thirty-two patients maintained a stable dose throughout the i.v. and s.c. phases. The mean stable i.v. dose (day 2) was 5.05 mg/hr, and the mean stable s.c. dose (day 4) was 5.7 mg/hr (P = 0.01). The mean number of rescue doses on day 2 was 0.83 per 24 hr versus 0.80 per 24 hours on day 4 (P = 0.6). The mean categorical pain score on day 2 was 0.83, and on day 4, 0.85 (P = 0.7). The mean visual analogue scale (VAS) on day 2 was 22.9 mm versus 17.6 mm on day 4 (P = 0.1). The mean incidence of side effects on day 2 was 1.7, and on day 4, 2.0 (P = 0.2). No patient was withdrawn or had a dose reduction due to unacceptable toxicity. There were two reports of local toxicity (mild erythema) at the SC needle insertion point, which required a site change. All of our 40 patients had adequate pain control with CIVI and CSCI morphine. Of the eight participants who were not maintained on the same i.v. and s.c. dose, all had adequate pain control and a similar side-effect profile on a higher s.c. morphine dose. These data suggest that the i.v. and s.c. routes are equianalgesic for most patients when administered as a continuous infusion. Pain control and side-effect profiles are quite similar and acceptable. s.c. morphine is an excellent alternative to i.v. morphine in both inpatients and outpatients requiring parenteral morphine for pain.

背景与目标： 比较了慢性癌症疼痛患者中吗啡连续静脉输注（CIVI）与吗啡连续皮下输注（CSCI）的剂量，疗效和副作用。符合条件的患者被转到姑息治疗计划，并接受稳定剂量的吗啡CIVI。该设计是患者内部的单向交叉。其中每个患者提供了从吗啡从CIVI切换到CSCI之前和之后的数据。 “救援”剂量是根据需要每2小时给予的每小时剂量的50％。吗啡通过McGaw / AccuPro容量输注泵静脉内（i.v.）和皮下（s.c.）输注。获得包括副作用和疼痛评估在内的基线数据后，每天对患者进行两次毒性和止痛效果评估。连续48个小时具有稳定CIVI剂量的患者以与静脉内（i.v.）阶段相同的剂量转入CSCI。稳定剂量定义为无剂量变化，在过去24小时内有四个或更少的急救剂量，疼痛等级为无或轻度。如果连续96个小时保持这些标准，则认为CIVI等于CSCI。入组患者57例，其中40例可评估（女性15例，男性25例）。中位年龄为67岁（范围为30-83岁）。在整个静脉内维持稳定剂量后，所有40位参与者阶段，跨到南卡罗来纳州相并保持在s.c.至少持续48小时。在整个静脉内，有32名患者维持了稳定的剂量。和s.c.阶段。平均稳定i.v.剂量（第2天）为5.05 mg / hr，平均稳定s.c.剂量（第4天）为5.7 mg / hr（P = 0.01）。第2天的平均急救剂量为每24小时0.83，而第4天为每24小时0.80（P = 0.6）。第2天的平均类别疼痛评分为0.83，第4天的平均疼痛评分为0.85（P = 0.7）。第2天的平均视觉模拟量表（VAS）为22.9毫米，而第4天为17.6毫米（P = 0.1）。第2天的副作用的平均发生率为1.7，而第4天的平均发生率为2.0（P = 0.2）。没有患者因不可接受的毒性而退出或剂量减少。有两份关于SC针插入点的局部毒性（轻度红斑）的报道，需要进行部位改变。我们所有的40名患者均通过CIVI和CSCI吗啡可以很好地控制疼痛。在没有保持相同i.v.的八位参与者中和s.c.剂量较高时，所有患者均具有足够的疼痛控制和较高的皮下副作用。吗啡剂量。这些数据表明和s.c.当以连续输注方式给药时，对于大多数患者而言，这两种途径均具有镇痛作用。疼痛控制和副作用状况非常相似且可以接受。南卡罗来纳州吗啡是静脉注射的绝佳替代品。需要胃肠外吗啡治疗的住院患者和门诊患者中的吗啡疼痛。

BACKGROUND & AIMS: :Extensive literatures have shown significant trend of progressive electrical changes according to the proliferative characteristics of breast epithelial cells. Physiologists also further postulated that malignant transformation resulted from sustained depolarization and a failure of the cell to repolarize after cell division, making the area where cancer develops relatively depolarized when compared to their non-dividing or resting counterparts. In this paper, we present a new approach, the Biofield Diagnostic System (BDS), which might have the potential to augment the process of diagnosing breast cancer. This technique was based on the efficacy of analysing skin surface electrical potentials for the differential diagnosis of breast abnormalities. We developed a female breast model, which was close to the actual, by considering the breast as a hemisphere in supine condition with various layers of unequal thickness. Isotropic homogeneous conductivity was assigned to each of these compartments and the volume conductor problem was solved using finite element method to determine the potential distribution developed due to a dipole source. Furthermore, four important parameters were identified and analysis of variance (ANOVA, Yates' method) was performed using design (n = number of parameters, 4). The effect and importance of these parameters were analysed. The Taguchi method was further used to optimise the parameters in order to ensure that the signal from the tumour is maximum as compared to the noise from other factors. The Taguchi method used proved that probes' source strength, tumour size and location of tumours have great effect on the surface potential field. For best results on the breast surface, while having the biggest possible tumour size, low amplitudes of current should be applied nearest to the breast surface.

背景与目标： ：大量文献显示，根据乳腺上皮细胞的增殖特性，进行性电变化的显着趋势。生理学家还进一步假设，恶性转化是由于持续的去极化和细胞分裂后细胞无法重新极化所致，因此与非分裂或静止状态的癌症相比，癌症发展的区域相对去极化了。在本文中，我们提出了一种新的方法，即Biofield Diagnostic System（BDS），它可能具有增强乳腺癌诊断过程的潜力。该技术基于分析皮肤表面电势以鉴别诊断乳房异常的功效。我们通过将乳房视作处于仰卧状态的半球，且各层厚度不相等，从而开发出了接近实际的女性乳房模型。各向同性的各向同性电导率分配给这些隔室，并使用有限元方法解决了体积导体问题，以确定由于偶极子源而产生的电势分布。此外，确定了四个重要参数，并使用设计进行了方差分析（ANOVA，Yates方法）（n =参数数量4）。分析了这些参数的作用和重要性。 Taguchi方法进一步用于优化参数，以确保与其他因素产生的噪声相比，来自肿瘤的信号最大。使用的Taguchi方法证明了探针的源强度，肿瘤大小和肿瘤位置对表面电势场有很大的影响。为了在乳腺表面获得最佳效果，同时应尽可能增大肿瘤的大小，应在最靠近乳腺表面的地方施加较小的电流。

BACKGROUND & AIMS: We report on an association study between a tetranucleotide repeat polymorphism in the GABR beta1 gene and manic-depressive illness in a Spanish population. This gene may be an important candidate for bipolar affective disorders since severe GABergic alterations have been described in patients. Although our results do not reveal a clear evidence for association between manic-depressive illness and GABR beta1, we have found significant differences between patients and controls in the female subpopulation.

背景与目标： 我们报告了GABR beta1基因中的四核苷酸重复多态性与西班牙人群的躁狂抑郁症之间的关联研究。该基因可能是双相情感障碍的重要候选者，因为已在患者中描述了严重的GABergic改变。尽管我们的结果并未显示出躁狂抑郁症与GABR beta1之间存在关联的明确证据，但我们发现女性亚人群中的患者与对照组之间存在显着差异。

BACKGROUND & AIMS: PURPOSE:To assess the technical feasibility, thrombogenicity, and biocompatibility of a new biodegradable poly-L-lactic acid (PLLA) anastomotic stent. METHODS:A polytetrafluoroethylene bifurcated graft was implanted in 17 pigs through a midline abdominal incision. After transverse graft incision, 17 316L stainless steel stents and 17 PLLA stents were randomly implanted at both iliac anastomotic sites and deployed with a 6-mm balloon under direct vision without angiography. Intended follow-up was 1 week in 6 pigs receiving oral acetylsalicylic acid (ASA) and in 7 pigs receiving ASA/clopidogrel; 4 pigs receiving ASA/clopidogrel were followed for 6 weeks. At the end of the study, the segments containing the stents were surgically explanted and processed for histology to measure the mean luminal diameter, intimal thickness, and the vascular injury and inflammation scores. RESULTS:Initial technical success of stent placement was achieved in all animals without rupture of the suture. Two pigs died (unrelated to the stent) at 3 days after operation (1 in groups A and B). At 1 week, all PLLA stents showed thrombotic occlusion with the use of ASA alone. In contrast, all PLLA stents remained patent with concurrent administration of ASA/clopidogrel. All metal stents were patent regardless of the antiplatelet regimen. The mean luminal diameter of patent PLLA stents (4.13+/-0.17 mm) was comparable to metal stents (4.27+/-0.35 mm, p=0.78) at 1 week, but significantly diminished at 6 weeks (3.21+/-0.44 versus 4.19+/-0.18 mm, p=0.005). Histological analysis showed no signs of excessive recoil. PLLA stents induced a higher inflammation score (1.79+/-0.56) and more intimal hyperplasia (0.34+/-0.11 mm) compared to metal stents [1.27+/-0.44 mm (p<0.001) and 0.18+/-0.04 mm (p=0.006), respectively] at 6 weeks. Vascular injury was comparable between PLLA and metal stents. CONCLUSION:Biodegradable PLLA stents showed higher thrombogenicity and reduced patency compared to metal stents during early follow-up. Although ASA and clopidogrel prevented thrombotic occlusion, the increased inflammatory response and neointima formation remain major concerns of PLLA stents. A solution to this problem might be the incorporation of anti-inflammatory drugs into the PLLA stent.

背景与目标： 目的：评估新型可生物降解的聚-L-乳酸（PLLA）吻合支架的技术可行性，血栓形成性和生物相容性。
方法：通过腹部中线切口将聚四氟乙烯分叉移植物植入17头猪。横向移植后，将17个316L不锈钢支架和17个PLLA支架随机植入两个both吻合部位，并在不进行血管造影的情况下在直视下用6毫米球囊展开。预期的随访结果是：6头接受口服乙酰水杨酸（ASA）的猪和7头接受ASA /氯吡格雷的猪。对4只接受ASA /氯吡格雷的猪进行了6周的随访。在研究结束时，将包含支架的节段进行外科手术切除并进行组织学处理，以测量平均腔直径，内膜厚度以及血管损伤和炎症评分。
结果：在所有动物中均未发生缝线破裂的情况下，支架植入取得了初步的技术成功。术后3天有2头猪死亡（与支架无关）（A和B组为1只）。在第1周，仅使用ASA时，所有PLLA支架均显示血栓闭塞。相反，所有PLLA支架在同时使用ASA /氯吡格雷的情况下仍保持专利。无论抗血小板方案如何，所有金属支架均已获得专利。专利PLLA支架的平均腔直径（4.13 /-0.17 mm）在1周时可与金属支架（4.27 /-0.35 mm，p = 0.78）相媲美，但在6周时显着减小（3.21 // 0.44对4.19 /-） 0.18毫米，p = 0.005）。组织学分析显示没有过度后坐的迹象。与金属支架[1.27 /-0.44 mm（p <0.001）和0.18 /-0.04 mm（p = 0.006）相比，PLLA支架引起更高的炎症评分（1.79 /-0.56）和更多的内膜增生（0.34 /-0.11 mm）。分别]在6周。 PLLA和金属支架之间的血管损伤相当。
结论：在早期随访中，与金属支架相比，可生物降解的PLLA支架显示出更高的血栓形成性和通畅性降低。尽管ASA和氯吡格雷预防了血栓闭塞，但炎症反应和新内膜形成的增加仍然是PLLA支架的主要关注点。解决此问题的方法可能是将抗炎药掺入PLLA支架中。

BACKGROUND & AIMS: STUDY OBJECTIVE:To examine the prevalence, symptomatology, risk factors, and other infections associated with urogenital chlamydial infection in pregnant teenagers. DESIGN:Retrospective case-control study by medical record review. SETTING:Prenatal care clinic for adolescents at University of Tennessee Medical Center, Knoxville, Tennessee. PARTICIPANTS:Pregnant adolescents younger than 19 years of age who were diagnosed with chlamydial infection on the first prenatal visit from 1988 to 1994 were studied. Pregnant adolescents of similar age and socioeconomic background who came in the same day for the first prenatal visit, but were not infected, made up the control group. INTERVENTION:Routine prenatal questionnaires regarding personal and medical histories, and routine prenatal screening, including pelvic examination with Papanicolaou (PAP) smear and laboratory investigations for common genital infections and sexual transmitted disease (STDs), were obtained. MAIN OUTCOME MEASURES:Analyzed the prevalence of chlamydial infection and compared the infected group to the control group with regard to race, behavioral factors, symptoms, prenatal screening results, other concurrent genital infections, and histories of STDs. RESULTS:Of a total population of 596 pregnant teenagers, 67 (11.24%) were infected with Chlamydia trachomatis. In multivariate analysis, black race (odds ratio [OR] = 4.01; 95% confidence interval [CI] = 1.74-9.23; p = 0.001) and greater gestational age at first prenatal visit (OR = 1.11; 95% CI = 1.04-1.18; p = 0.001) were independently associated with chlamydial infection. Age, marital status, number of pregnancies, smoking, alcohol abuse, drug abuse, age at first intercourse, and multiple sex partners were not associated with the infection. Likewise, the symptom of vaginal discharge (a complaint of > 70% in each group), other genital co-infections (found > 50% in each group, mainly candidiasis and bacterial vaginosis), abnormal PAP smears (found > 60% in each group) and histories of STDs or previous chlamydial infection were not significantly different between case and control groups. Human papillomavirus infection, trichomonal infection, and dysplasia or atypia were found more often in patients infected with chlamydia, but were not statistically significant. CONCLUSION:Pregnant adolescents in east Tennessee were at risk for chlamydial infection as well as for other genital infections and abnormal PAP smears. Routine prenatal chlamydial screening is warranted because of a lack of specific symptoms.

背景与目标： 目的：研究孕妇青少年泌尿生殖道衣原体感染的患病率，症状，危险因素和其他感染情况。
设计：回顾性病例对照研究，病历审查。
地点：田纳西州诺克斯维尔市田纳西大学医学中心的青少年产前保健诊所。
研究对象：1988年至1994年第一次产前检查时被诊断患有衣原体感染的19岁以下的青少年。年龄相同，社会经济背景相似的怀孕青少年在同一天进行第一次产前检查，但未感染，组成了对照组。
干预措施：获得有关个人和医学史的常规产前问卷，以及常规的产前筛查，包括用帕潘尼古拉（PAP）涂片进行盆腔检查以及常见生殖器感染和性传播疾病（STD）的实验室检查。
主要观察指标：分析衣原体感染的发生率，并就种族，行为因素，症状，产前筛查结果，其他并发生殖器感染和性病史进行比较，比较感染组和对照组。
结果：在596名怀孕的青少年总数中，有67名（11.24％）感染了沙眼衣原体。在多变量分析中，黑人种族（赔率[OR] = 4.01； 95％置信区间[CI] = 1.74-9.23； p = 0.001）和第一次产前检查时的胎龄较高（OR = 1.11； 95％CI = 1.04- 1.18； p = 0.001）与衣原体感染独立相关。年龄，婚姻状况，怀孕次数，吸烟，酗酒，药物滥用，初次性交年龄和多性伴侣均与感染无关。同样，白带的症状（每组投诉> 70％），其他生殖器合并感染（每组发现> 50％，主要是念珠菌病和细菌性阴道病），PAP涂片异常（每发现> 60％）病例组和对照组之间的性病史或以前的衣原体感染史无显着差异。感染衣原体的患者更常发现人乳头瘤病毒感染，滴虫感染和异型增生或异型性，但无统计学意义。
结论：田纳西州东部的怀孕青少年有衣原体感染以及其他生殖器感染和PAP涂片异常的危险。由于缺乏特定症状，需要常规的产前衣原体筛查。

BACKGROUND & AIMS: :It has often been suggested that mood and personality predispose to peptic ulcer, but little prospective evidence exists. We used longitudinal data from the Alameda County Study to seek associations of psychological characteristics with later ulcer development, taking into account the possible confounding or mediating, taking into account the possible confounding or mediating roles of nonpsychological factors. Among 4,595 Alameda County Study subjects ulcer-free in 1965, we studied five baseline psychological measures (depression, hostility, ego resiliency, social alienation or anomy, and personal uncertainty) with respect to reported ulcer in 1973-1974. All five measures had significant age-adjusted associations with incident ulcer [odds ratio (O.R.) 1.8-2.6]. After adjustment for smoking, drinking, skipping breakfast, lack of sleep, painful medical conditions, and liver disease, three measures remained significant: depression, anomy, and hostility. The age-adjusted O.R. of 2.8 [95% confidence interval (C.I.) 1.6, 4.8] for an upper versus a lower tertile index of independently predictive psychological factors fell to 2.1 with adjustment for health-related behaviors and medical conditions, and reached 1.7 (C.I. 1.0, 3.1) after addition of education to the model. We conclude that depression, maladjustment, and hostility are prospectively associated with peptic ulcer. These associations are partially accounted for by confounding or mediation by standard risk factors, and are to some extent related to socioeconomic status.

背景与目标： ：经常有人提出情绪和性格易患消化性溃疡，但几乎没有前瞻性证据。我们使用来自阿拉米达县研究的纵向数据，寻求心理特征与以后溃疡发展的关联，同时考虑到可能造成混淆或介导的因素，并考虑到非心理因素可能造成的混淆或中介的作用。 1965年，在4,595名阿拉米达县研究无溃疡的受试者中，我们研究了针对1973-1974年报告的溃疡的五项基线心理测量（抑郁，敌对，自我恢复力，社会疏远或失聪以及人身不明朗）。所有这五项措施的年龄校正后均与溃疡发生率显着相关[比值比（OR）1.8-2.6]。在调整了吸烟，饮酒，不吃早餐，缺乏睡眠，痛苦的医疗状况和肝病之后，仍然有三项重要指标：抑郁，失常和敌意。调整年龄的O.R.独立于预测性心理因素的三分位数指数的2.8 [95％置信区间（CI）1.6，4.8]的百分比随健康相关行为和医疗条件的调整降至2.1，并达到1.7（CI 1.0，3.1）在模型中添加了教育之后。我们得出结论，抑郁，适应不良和敌意性与消化性溃疡有关。这些关联部分是由标准风险因素造成的混淆或调解造成的，在某种程度上与社会经济地位有关。

BACKGROUND & AIMS: BACKGROUND:Angiotensin-converting enzyme (ACE) inhibitors prevent the expansion and rupture of aortic aneurysms in animals. We investigated the association between ACE inhibitors and rupture in patients with abdominal aortic aneurysms. METHODS:We did a population-based case-control study of linked administrative databases in Ontario, Canada. The sample included consecutive patients older than 65 (n=15,326) admitted to hospital with a primary diagnosis of ruptured or intact abdominal aortic aneurysm between April 1, 1992, and April 1, 2002. FINDINGS:Patients who received ACE inhibitors before admission were significantly less likely to present with ruptured aneurysm (odds ratio [OR] 0.82, 95% CI 0.74-0.90) than those who did not receive ACE inhibitors. Adjustment for demographic characteristics, risk factors for rupture, comorbidities, contraindications to ACE inhibitors, measures of health-care use, and aneurysm screening yielded similar results (0.83, 0.73-0.95). Consistent findings were noted in subgroups at high risk of rupture, including patients older than 75 years and those with a history of hypertension. Conversely, such protective associations were not observed for beta blockers (1.02, 0.89-1.17), calcium channel blockers (1.01, 0.89-1.14), alpha blockers (1.15, 0.86-1.54), angiotensin receptor blockers (1.24, 0.71-2.18), or thiazide diuretics (0.91, 0.78-1.07). INTERPRETATION:ACE inhibitors are associated with a reduced risk of ruptured abdominal aortic aneurysm, unlike other antihypertensive agents. Randomised trials of ACE inhibitors for prevention of aortic rupture might be warranted.

背景与目标： 背景：血管紧张素转换酶（ACE）抑制剂可防止动物主动脉瘤的扩张和破裂。我们调查了腹主动脉瘤患者中ACE抑制剂与破裂之间的关系。
方法：我们在加拿大安大略省的相关行政数据库中进行了基于人群的病例对照研究。该样本包括1992年4月1日至2002年4月1日之间入院的65岁以上的连续患者（n = 15,326），其主要诊断为腹主动脉瘤破裂或完整。
结果：与未接受ACE抑制剂的患者相比，入院前接受ACE抑制剂的患者出现动脉瘤破裂的可能性显着降低（优势比[OR] 0.82，95％CI 0.74-0.90）。对人口统计学特征，破裂危险因素，合并症，ACEI禁忌症，保健措施和动脉瘤筛查的调整也得出了相似的结果（0.83，0.73-0.95）。在高破裂风险的亚组中发现了一致的发现，包括年龄超过75岁的患者和有高血压病史的患者。相反，对于β受体阻滞剂（1.02，0.89-1.17），钙通道阻滞剂（1.01，0.89-1.14），α受体阻滞剂（1.15，0.86-1.54），血管紧张素受体阻滞剂（1.24，0.71-2.18）未观察到这种保护性关联。 ，或噻嗪类利尿剂（0.91、0.78-1.07）。
解释：与其他降压药不同，ACE抑制剂与降低腹主动脉瘤破裂的风险有关。 ACE抑制剂预防主动脉破裂的随机试验可能是必要的。

BACKGROUND & AIMS: BACKGROUND AND PURPOSE:Scleroderma is an immune-mediated disease characterized by excess deposition of collagen leading to microvascular occlusion. Morbidity and mortality are often secondary to pulmonary hypertension from injury to pulmonary microvasculature and interstitial lung disease. This study correlated P-wave findings on the 12-lead electrocardiogram (ECG) with mean pulmonary artery pressure (mPAP) measured by right heart catheterization in patients with scleroderma. METHODS:A retrospective review of 12-lead ECGs in 23 patients referred to a rheumatology clinic with the diagnosis of scleroderma was performed. Right heart catheterization was performed within 1 month of the resting ECG. RESULTS:Linear regression related P-wave amplitude in lead II with mPAP (r = 0.52, P = .011) This model was 73% sensitive and 67% specific for the presence or absence of elevated mPAP. CONCLUSIONS:P-wave amplitude analysis on the ECG may be helpful in the assessment of pulmonary hypertension in patients with scleroderma.

背景与目标： 背景与目的：硬皮病是一种免疫介导的疾病，其特征是胶原蛋白的过度沉积导致微血管闭塞。发病率和死亡率通常是继发于肺动脉高压的疾病，从损伤到肺微脉管系统和间质性肺疾病。这项研究将硬皮病患者的12导联心电图（ECG）上的P波发现与右心导管检查测得的平均肺动脉压（mPAP）相关联。
方法：回顾性分析23例转诊至风湿病诊所并诊断为硬皮病的患者的12导联心电图。静息ECG后1个月内进行右心导管检查。
结果：与mPAP的铅II线性回归相关的P波振幅（r = 0.52，P = .011）该模型对存在或不存在mPAP升高的敏感性为73％，特异性为67％。
结论：心电图的P波幅值分析可能有助于评估硬皮病患者的肺动脉高压。

BACKGROUND & AIMS: :Cyclic and congenital neutropenia are caused by mutations in the human neutrophil elastase (HNE) gene (ELA2), leading to an immunodeficiency characterized by decreased or oscillating levels of neutrophils in the blood. The HNE mutations presumably cause loss of enzyme activity, consequently leading to compromised immune system function. To understand the structural basis for the disease, we implemented methods from bioinformatics to analyze all the known HNE missense mutations at both the sequence and structural level. Our results demonstrate that the 32 different mutations have diverse effects on HNE structure and function, affecting structural disorder and aggregation tendencies, stability maintaining contacts, and electrostatic properties. A large proportion of the mutations are located at conserved amino acids, which are usually essential in determining protein structure and function. The majority of the disease-causing HNE missense mutations lead to major structural changes and loss of stability in the protein. A few mutations also affect functional residues, leading into decreased catalytic activity or altered ligand binding. Our analysis reveals the putative effects of all known missense mutations in HNE, thus allowing the structural basis of cyclic and congenital neutropenia to be elucidated. We have employed and analyzed a set of some 30 different methods for predicting the effects of amino acid substitutions. We present results and experience from the analysis of the applicability of these methods in the analysis of numerous genes, proteins, and diseases to reveal protein structure-function relationships and disease genotype-phenotype correlations.

背景与目标： ：循环性和先天性嗜中性白血球减少症是由人类嗜中性粒细胞弹性蛋白酶（HNE）基因（ELA2）突变引起的，导致免疫缺陷，其特征是血液中嗜中性粒细胞水平降低或振荡。 HNE突变可能导致酶活性下降，因此导致免疫系统功能受损。为了了解该疾病的结构基础，我们采用了生物信息学的方法来分析序列和结构水平上所有已知的HNE错义突变。我们的结果表明，这32种不同的突变对HNE的结构和功能有多种影响，影响结构异常和聚集趋势，保持接触的稳定性以及静电性质。大部分突变位于保守氨基酸上，这通常是决定蛋白质结构和功能所必需的。大多数引起疾病的HNE错义突变会导致主要的结构变化和蛋白质稳定性的损失。一些突变也影响功能残基，导致催化活性降低或配体结合改变。我们的分析揭示了HNE中所有已知的错义突变的推定作用，因此可以阐明周期性和先天性中性粒细胞减少的结构基础。我们已经采用并分析了一组约30种不同的方法来预测氨基酸取代的影响。我们目前的结果和经验，从这些方法在众多基因，蛋白质和疾病的分析中的适用性分析来揭示蛋白质结构-功能关系和疾病基因型-表型的相关性。

BACKGROUND & AIMS: :Immune therapy have shown new and exciting perspectives for cancer treatment. Aim of our study was to evaluate toxicity and possible adverse effects from vaccination of patients with advanced colorectal cancer with autologous dendritic cells (DC) pulsed with lysate from a newly developed melanoma cell line, DDM-1.13. Six patients were enrolled in the phase I trial. Autologous DCs were generated in vitro from peripheral blood monocytes in the presence of granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4). DCs were pulsed with melanoma cell lysate from a cloned and selected melanoma cell line enriched in expression of MAGE-A antigens and deficient in expression of melanoma differentiation antigens: tyrosinase, MART-1 and gp100. Vaccinations were administered intradermally on the proximal thigh with a total of five given vaccines at 2 weeks intervals. Each vaccine contained 3-5 x 10(6) DCs. Five of the six patients received all five vaccines. The treatment was well tolerated in all patients without any observed vaccine-correlated adverse effects. Treatment with this DC-based cancer vaccine proved safe and non-toxic.

背景与目标： ：免疫疗法已显示出令人兴奋的癌症治疗新观点。我们研究的目的是评估用新开发的黑素瘤细胞系DDM-1.13裂解物脉冲的自体树突状细胞（DC）对晚期结直肠癌患者进行疫苗接种的毒性和可能的​​不良反应。一期试验招募了六名患者。在粒细胞-巨噬细胞集落刺激因子（GM-CSF）和白介素-4（IL-4）的存在下，由外周血单核细胞体外产生自体DC。用来自克隆和选择的黑色素瘤细胞系的黑色素瘤细胞裂解液对DC进行脉冲处理，该黑色素瘤细胞系富含MAGE-A抗原的表达，而黑色素瘤分化抗原（酪氨酸酶，MART-1和gp100）的表达不足。在大腿近端皮内注射疫苗，每两周间隔注射五种给定的疫苗。每种疫苗均包含3-5 x 10（6）个DC。六名患者中有五名接受了全部五种疫苗的治疗。所有患者对治疗的耐受性良好，没有观察到疫苗相关的不良反应。用这种基于DC的癌症疫苗治疗证明是安全且无毒的。