BACKGROUND & AIMS: PROBLEM:Thrombophilia has been associated with poor obstetrical outcomes. To determine the association of specific inherited thrombophilias and recurrent pregnancy loss, 10 thrombophilic genes were investigated. METHOD OF STUDY:A total of 550 women with a history of recurrent pregnancy loss had buccal swabs taken for DNA analyses of the following gene mutations: factor V G1691A, factor V H1299R (R2), factor V Y1702C, factor II prothrombin G20210A, factor XIII V34L, beta-fibrinogen -455G>A, PAI-1 4G/5G, HPA1 a/b(L33P), methylenetetrahydrofolate reductase (MTHFR) C677T, MTHFR A1298C. The frequencies of these mutations were compared with controls published in the literature. RESULTS:When examined individually, PAI-1 4G/5G (P = 0.009), factor XIII V34L (P < 0.0001), and homozygous MTHFR C667T (P < 0.0001) correlated significantly with recurrent pregnancy loss compared with controls. The frequency of the factor V Y1702C mutation was extremely low in patients and controls; thus, this gene was removed from further calculations. The remaining six mutated genes, when analyzed cumulatively, also corresponded with recurrent pregnancy loss (P < 0.0001). CONCLUSION:A panel of thrombogenic gene mutations consisting of factor V G1691A, factor V H1299R (R2), factor II prothrombin G20210A, factor XIII V34L, beta-fibrinogen -455G>A, PAI-1 4G/5G, HPA1 a/b(L33P), MTHFR C677T, and MTHFR A1298C can identify individuals at risk for recurrent pregnancy loss.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Many apparently disparate risk factors have been implicated as causes of eating disorders. This study was designed to test the hypothesis that 2 broad classes of risk factors exist for bulimia nervosa: those that increase the risk for development of a psychiatric disorder in general and those that increase the risk of dieting. It was predicted that the latter are especially common among persons with bulimia nervosa.

METHODS:A case-control design was used involving 2 integrated comparisons. First, 102 subjects with bulimia nervosa were compared with 204 healthy control subjects without an eating disorder. Second, the same 102 subjects with bulimia nervosa were compared with 102 subjects with other psychiatric disorders. To reduce sampling bias, the subjects were recruited directly from the community. A broad range of putative risk factors was assessed.

RESULTS:The subjects with bulimia nervosa and the healthy control subjects differed in their rates of exposure to most of the putative risk factors. Far fewer differences were evident between the subjects with bulimia nervosa and the control subjects with other psychiatric disorders, although exposure to factors that were likely to increase the risk of dieting and to negative self-evaluation and certain parental problems (including alcohol use disorder) were substantially more common among those with bulimia nervosa.

CONCLUSIONS:The findings support the hypothesis that bulimia nervosa is the result of exposure to general risk factors for psychiatric disorder and risk factors for dieting. An unexpected finding was the particularly high rates of premorbid negative self-evaluation and certain parental problems among those with bulimia nervosa.

背景与目标： 背景 : 许多明显不同的危险因素被认为是饮食失调的原因。这项研究旨在检验以下假设: 神经性贪食症存在两大类危险因素: 通常增加精神疾病发展风险的因素和增加节食风险的因素。据预测，后者在神经性贪食症患者中尤其常见。
方法 : 使用了涉及2个综合比较的病例对照设计。首先，将102名患有神经性贪食症的受试者与204名没有进食障碍的健康对照受试者进行比较。其次，将患有暴食症的相同102受试者与患有其他精神疾病的102受试者进行比较。为了减少抽样偏差，直接从社区招募了受试者。评估了广泛的推定危险因素。
结果 : 患有神经性贪食症的受试者和健康对照受试者在暴露于大多数推定危险因素的比率上有所不同。神经性贪食症的受试者与其他精神疾病的对照受试者之间的差异要少得多，尽管暴露于可能增加节食风险的因素以及负面的自我评估和某些父母问题 (包括酒精使用障碍) 在神经性贪食症患者中更为普遍。
结论 : 研究结果支持以下假设: 神经性贪食症是暴露于精神疾病的一般危险因素和节食的危险因素的结果。一个意想不到的发现是，在神经性贪食症患者中，病前负面自我评估和某些父母问题的发生率特别高。

BACKGROUND & AIMS: :Varicocele is considered a predominantly unilateral left-sided disease. However, since male fertility is preserved with only one healthy testis, infertility perforce represents bilateral testicular dysfunction. It was hypothesized that: (i) right varicocele cannot be diagnosed by palpation and therefore has not been treated in the past by the traditional treatment, and (ii) right varicocele causes impaired oxygen supply in the right testicular microcirculation, leading to germ cell degeneration. This study performed venographies of both right and left internal spermatic veins during the treatment of 840 infertile men with varicocele and analysed the results using tools of fluid mechanics. Histopathology of the right testis revealed stagnation of blood flow and degenerative changes attributed to lack of adequate oxygenation in all testicular cell types. Right varicocele was found in the vast majority of the patients. We found that due to the destruction of one-way valves, pathologic hydrostatic pressure is produced in the testicular venous microcirculatory system about five times higher than normal, exceeding arteriolar pressure. The pressure gradient between the arterioles and venules in the testicular tissue is therefore reversed, leading to persistent hypoxia. Right varicocele, although undetected, is prevalent in infertile men with varicocele, hence only bilateral occlusion of the internal spermatic veins, including the associated bypasses, eliminating the pathologic hydrostatic pressure will lead to resumption of arterial blood flow in the testicular microcirculation.

背景与目标： : 精索静脉曲张被认为是一种主要的单侧左侧疾病。但是，由于只有一个健康的睾丸可以保留男性的生育能力，因此不育表现为双侧睾丸功能障碍。假设 :( i) 无法通过触诊来诊断右精索静脉曲张，因此过去没有通过传统疗法进行治疗，并且 (ii) 右精索静脉曲张会导致右睾丸微循环中的氧气供应受损，导致生殖细胞变性。这项研究在治疗840名患有精索静脉曲张的不育男性期间对左右精索内静脉进行了静脉造影，并使用流体力学工具分析了结果。右睾丸的组织病理学显示，由于所有睾丸细胞类型缺乏足够的氧合，导致血流停滞和退行性变化。在绝大多数患者中发现了右精索静脉曲张。我们发现，由于单向阀的破坏，睾丸静脉微循环系统中产生的病理性静水压力约为正常水平的五倍，超过了小动脉压力。因此，睾丸组织中小动脉和小静脉之间的压力梯度相反，导致持续的缺氧。右精索静脉曲张虽然未被发现，但在患有精索静脉曲张的不育男性中很普遍，因此只有双侧精索内静脉 (包括相关的旁路) 闭塞，消除病理性静水压将导致睾丸微循环中动脉血流的恢复。

BACKGROUND & AIMS: PURPOSE:Peptide growth factors are known accelerators of corneal wound healing, probably mediated through increased proliferation of the cells; however, information about their effect on keratocyte motility is lacking. The influence of peptide growth factors on keratocyte migratory activity was investigated, using the following growth factors: platelet derived growth factor (PDGF-BB), epidermal growth factor (EGF), acidic fibroblast growth factor (aFGF), basic fibroblast growth factor (bFGF), insulin-like growth factor-I (IGF-I) and transforming growth factor-beta-1 (TGF-beta 1).

METHODS:Keratocytes were seeded on gels of type 1 collagen, growth factor added, and the cells left to migrate for 72 hours. Subsequently, the number of keratocytes at the different levels in the collagen gel was evaluated by optically sectioning the gel at 20 microns, intervals, with an inverted phase contrast microscope.

RESULTS:PDGF, EGF and bFGF at 10 ng/ml, all increased the number of keratocytes at the different levels of the gel as compared to a non-stimulated control (p < 0.05 or p < 0.01, students t-test). TGF-beta proved to be a strong inhibitor of keratocyte migration, decreasing the number of keratocytes observed at every level in the gel (p < 0.05 and p < 0.01, students t-test), whereas no effect of IGF-I and aFGF was found. During the 72 hours of migration, no contraction of the collagen gels was observed. Autoradiography of histological sections of the gels showed that during the 72-hour period only TGF-beta and 10% fetal bovine serum induced an increase in keratocyte proliferation.

CONCLUSION:PDGF, EGF and bFGF increase keratocyte migration, independent of proliferation in a collagen gel invasion assay and might promote corneal wound healing, not only by increasing cell proliferation, but also through increased motility.

背景与目标： 目的 : 肽生长因子是已知的角膜伤口愈合的促进剂，可能是通过细胞增殖增加介导的; 但是，缺乏有关它们对角质细胞运动的影响的信息。用以下生长因子: 血小板衍生生长因子 (pdgf-bb)，表皮生长因子 (EGF)，酸性成纤维细胞生长因子 (aFGF)，碱性成纤维细胞生长因子 (bFGF)，胰岛素样生长因子-I (igf-i) 和转化生长因子-β1 (tgf-β1)。
方法 : 将角质细胞接种在1型胶原蛋白的凝胶上，添加生长因子，细胞迁移72小时。随后，通过用倒置相差显微镜以20微米的间隔光学切片来评估胶原蛋白凝胶中不同水平的角质形成细胞的数量。
结果 :PDGF，EGF和bFGF为10 ng/ml，与未刺激的对照相比，在凝胶的不同水平下，所有这些都增加了角质细胞的数量 (p <0.05或p <0.01，学生t检验)。TGF-β 被证明是角质细胞迁移的强抑制剂，减少了在凝胶中每个水平观察到的角质细胞的数量 (p <0.05和p <0.01，学生t检验)，而没有发现igf-i和aFGF的作用。在迁移的72小时内，未观察到胶原蛋白凝胶的收缩。凝胶组织学切片的放射自显影显示，在72小时内，只有TGF-β 和10% 胎牛血清诱导角质细胞增殖增加。
结论 :PDGF，EGF和bFGF增加角质细胞迁移，在胶原蛋白凝胶侵袭试验中独立于增殖，并且可能不仅通过增加细胞增殖，而且通过增加运动性来促进角膜伤口愈合。

BACKGROUND & AIMS: Ligation of surface IgM on B cells responding to lipopolysaccharide (LPS) suppresses terminal differentiation and high-rate Ig secretion with no effect on proliferation. As shown here, different B cell populations show characteristic mean values of ligand concentration required for 50% inhibition, with Gaussian distributions of sensitivity to IgM receptor ligation that reflect cellular heterogeneity of 'al-or-none' inhibitions in single cells. Differential sensitivity of B cell populations to IgM ligation seems to be locally determined by the cellular environment and unrelated to the 'maturity' of the responding cells. Thus, while long-lived peritoneal B cells are 3- to 5-fold more resistant than splenic B cells, there is no difference in sensitivity between short- and long-lived B cells in the spleen. Furthermore, while B cells in bone marrow and spleen differ in sensitivity by two orders of magnitude, B cells differentiated in vitro from bone marrow pre-B cells are as resistant as splenic B cells. Moreover, bone marrow cell culture supernatants restore a high level of sensitivity in such cell populations. Differential sensitivity to IgM receptor ligation is reproduced by multivalent nominal antigen, in cell populations that show identical dose-response inhibition curves to direct activation of protein kinase C by phorbol esters. We conclude that the level of sensitivity to IgM ligation is independent of the life span or maturity of the B cell, but differentially regulated in vivo by putative tissue factors.

背景与目标： 对脂多糖 (LPS) 响应的b细胞上的表面IgM连接抑制了终末分化和高速度Ig分泌，而对增殖没有影响。如这里所示，不同的b细胞群体显示出50% 抑制所需的配体浓度的特征平均值，其对IgM受体连接的敏感性的高斯分布反映了单细胞中 “al-or-none” 抑制的细胞异质性。B细胞群体对IgM连接的不同敏感性似乎是由细胞环境局部决定的，与响应细胞的 “成熟度” 无关。因此，尽管长寿命的腹膜b细胞的抵抗力比脾b细胞高3至5倍，但脾脏中短寿命b细胞和长寿命b细胞之间的敏感性没有差异。此外，尽管骨髓和脾脏中的b细胞的敏感性相差两个数量级，但从骨髓前b细胞体外分化的b细胞与脾b细胞一样具有抵抗力。此外，骨髓细胞培养上清液在此类细胞群体中恢复了高水平的敏感性。在显示出与佛波酯直接激活蛋白激酶C相同的剂量反应抑制曲线的细胞群体中，多价名义抗原再现了对IgM受体连接的不同敏感性。我们得出的结论是，对IgM连接的敏感性水平与b细胞的寿命或成熟度无关，但在体内受假定的组织因素的差异调节。

BACKGROUND & AIMS: Tn10, like several other transposons, exhibits a marked preference for integration into particular target sequences. Such sequences are referred to as integration hotspots and have been used to define a consensus target site in Tn10 transposition. We demonstrate that a Tn10 hotspot called HisG1, which was identified originally in vivo, also functions as an integration hotspot in vitro in a reaction where the HisG1 sequence is present on a short DNA oligomer. We use this in vitro system to define factors which are important for the capture of the HisG1 target site. We demonstrate that although divalent metal ions are not essential for HisG1 target capture, they greatly facilitate capture of a mutated HisG1 site. Analysis of catalytic transposase mutants further demonstrates that the DDE motif plays a critical role in 'divalent metal ion-dependent' target capture. Analysis of two other classes of transposase mutants, Exc+ Int- (which carry out transposon excision but not integration) and ATS (altered target specificity), demonstrates that while a particular ATS transposase binds HisG1 mutants better than wild-type transposase, Exc+ Int- mutants are defective in HisG1 capture, further defining the properties of these classes of mutants. Possible mechanisms for the above observations are considered.

背景与目标： Tn10与其他几个转座子一样，表现出对整合到特定靶序列的明显偏好。此类序列被称为整合热点，并已用于定义Tn10转座中的共有靶位点。我们证明了最初在体内鉴定的称为HisG1的Tn10热点在HisG1序列存在于短DNA寡聚物上的反应中也起着体外整合热点的作用。我们使用此体外系统来定义对于捕获HisG1靶位点很重要的因素。我们证明，尽管二价金属离子对于HisG1靶捕获不是必需的，但它们极大地促进了突变HisG1位点的捕获。催化转座酶突变体的分析进一步表明，DDE基序在 “二价金属离子依赖性” 靶捕获中起关键作用。对另外两类转座酶突变体Exc Int- (进行转座子切除但不整合) 和ATS (改变靶特异性) 的分析表明，尽管特定的ATS转座酶比野生型转座酶更好地结合HisG1突变体，但Exc Int-突变体在HisG1捕获中存在缺陷，进一步定义这些类别的突变体的属性。考虑了上述观察的可能机制。

BACKGROUND & AIMS: :The final elimination step of self-reactive T cells occurs in the medulla of the thymus where a complex framework provided by stromal cells supports an optimal milieu for their selection. Here we present evidence that tight junctions (TJs) widely join medullary stromal cells of the human thymus. Occludin (OCLN) and claudin-1 (CLDN-1) of TJ-associated molecules were dominantly expressed in medullary thymic epithelial cells (mTECs), and CLDN-4 and CLDN-7 were also localized in some mTECs near Hassall's corpuscles. Interestingly, p53-like transcription factors were found to upregulate OCLN and CLDN-1 in human TEC lines, as recently suggested in the regulation of mTEC function. Furthermore, dendritic cells (DCs) of the medulla, with a major role for selection of thymocytes, expressed CLDN-1 and OCLN as well, implying that the interposition of DCs within the mTEC scaffold is also helped by TJs. Analysis of freeze-fracture replicas of the thymus revealed TJ strand structures in the vicinity of gap junction plaques through which small molecules might move, as implied by dye-transfer analysis of a medullary cell line. Thus, it is thought that p53-like molecules regulate TJ-associated interactions of medullary stromal cells and that this mechanism might be associated with an intercellular communication network, probably for preserving the medullary niches.

背景与目标： : 自反应性T细胞的最终消除步骤发生在胸腺的髓质中，其中基质细胞提供的复杂框架支持其选择的最佳环境。在这里，我们提供了证据，表明紧密连接 (TJs) 广泛地连接了人胸腺的髓质基质细胞。TJ相关分子的Occludin (OCLN) 和claudin-1 (CLDN-1) 在髓样胸腺上皮细胞 (mtec) 中主要表达，CLDN-4和CLDN-7也位于Hassall小体附近的一些mtec中。有趣的是，正如最近在mTEC功能的调节中所建议的那样，发现p53-like转录因子上调人TEC系中的OCLN和CLDN-1。此外，对胸腺细胞的选择具有主要作用的髓质树突状细胞 (dc) 也表达CLDN-1和OCLN，这意味着DCs在mTEC支架内的插入也受到TJs的帮助。胸腺的冷冻断裂复制品分析显示，TJ链结构位于缝隙连接斑块附近，小分子可能会穿过缝隙连接斑块移动，如髓质细胞系的染料转移分析所暗示的那样。因此，人们认为p53-like分子调节延髓基质细胞的TJ相关相互作用，并且该机制可能与细胞间通信网络有关，可能用于保护延髓壁。

BACKGROUND & AIMS: The fluorescence intensity decay of the single tryptophan residue, Trp-187, of free annexin V is described by the sum of three lifetime components (5.4, 1.3, and 0.4 ns), which may be correlated to three ground-state classes of Trp conformers. The two major classes (44 and 48%) are embedded in the protein matrix. When annexin V binds to calcium and liposomes made of dioleoylphosphatidylcholine and dioleoylphosphatidylserine, similar results are obtained whatever the (10-200) lipid ratio. The Trp fluorescence decay is fitted with only two components (6.9-7.2 and 2.0-2.2 ns). Decay-associated spectra reveal that the longest lifetime of bound annexin V can be related to Trp residues (60%) located in a partially polar environment, which could correspond to the protein-membrane interface. The shortest lifetime is attributed to Trp residues (40%) which reside in a hydrophobic surroundingthese Trp residues would penetrate into the phospholipid membrane and contribute to the stabilization of the 2D-array of annexin V molecules.

背景与目标： Trp-187，游离膜联蛋白V的单个色氨酸残基的荧光强度衰减由三个寿命分量 (5.4、1.3和0.4 ns) 的总和描述，这可能与Trp构象的三个基态类别相关。两个主要类别 (44和48%) 嵌入蛋白质基质中。当膜联蛋白V与钙和由二油酰基磷脂酰胆碱和二油酰基磷脂酰丝氨酸制成的脂质体结合时，无论 (10-200) 脂质比率如何，都获得相似的结果。Trp荧光衰减仅适合两种组分 (6.9-7.2和2.0-2.2 ns)。衰变相关光谱表明，结合膜联蛋白V的最长寿命可能与位于部分极性环境中的Trp残基 (60%) 有关，这可能对应于蛋白质-膜界面。最短的寿命归因于存在于疏水性周围的Trp残基 (40%)，这些Trp残基会渗透到磷脂膜中，并有助于膜联蛋白V分子的2d阵列的稳定。

BACKGROUND & AIMS: :At mammalian body temperature, the plague bacillus Yersinia pestis synthesizes lipopolysaccharide (LPS)-lipid A with poor Toll-like receptor 4 (TLR4)-stimulating activity. To address the effect of weak TLR4 stimulation on virulence, we modified Y. pestis to produce a potent TLR4-stimulating LPS. Modified Y. pestis was completely avirulent after subcutaneous infection even at high challenge doses. Resistance to disease required TLR4, the adaptor protein MyD88 and coreceptor MD-2 and was considerably enhanced by CD14 and the adaptor Mal. Both innate and adaptive responses were required for sterilizing immunity against the modified strain, and convalescent mice were protected from both subcutaneous and respiratory challenge with wild-type Y. pestis. Despite the presence of other established immune evasion mechanisms, the modified Y. pestis was unable to cause systemic disease, demonstrating that the ability to evade the LPS-induced inflammatory response is critical for Y. pestis virulence. Evading TLR4 activation by lipid A alteration may contribute to the virulence of various Gram-negative bacteria.

背景与目标： : 在哺乳动物体温下，鼠疫杆菌合成具有低Toll样受体4 (TLR4) 刺激活性的脂多糖 (LPS)-脂质A。为了解决弱TLR4刺激对毒力的影响，我们对鼠疫耶尔森氏菌进行了修饰，以产生有效的TLR4-stimulating LPS。即使在高攻击剂量下，改良的鼠疫耶尔森氏菌在皮下感染后也完全无毒。对疾病的抵抗力需要TLR4，衔接子蛋白MyD88和共受体MD-2，并且CD14和衔接子Mal显着增强。对于针对改良菌株的免疫灭菌，需要先天和适应性反应，并且可以保护恢复期小鼠免受野生型鼠疫耶尔森氏菌的皮下和呼吸攻击。尽管存在其他已建立的免疫逃避机制，但改良的鼠疫耶尔森氏菌无法引起全身性疾病，这表明逃避LPS诱导的炎症反应的能力对于鼠疫耶尔森氏菌的毒力至关重要。通过脂质A改变逃避TLR4激活可能有助于各种革兰氏阴性细菌的毒力。

BACKGROUND & AIMS: :The Management Academy for Public Health is a team-based training program jointly offered by the School of Public Health and the Kenan-Flagler Business School at the University of North Carolina at Chapel Hill. This 9-month program teaches public health managers how to better manage people, information, and finances. Participants learn how to work in teams with community partners, and how to think and behave as social entrepreneurs. To practice and blend their new skills, teams develop a business plan that addresses a local public health issue. This article describes the program and explains the findings of the process evaluation, which has examined how best to structure and deploy a team-based method to create more effective, more entrepreneurial public health managers. Findings indicate that recruitment and retention are strong, program elements are relevant to learners' needs, and learners are satisfied with and value the program. Several specific benefits of the program model are identified, as well as several elements that support business plan success and skills' application on the job. On the basis of these findings, four success factors critical for developing similar programs are identified.

背景与目标： : 公共卫生管理学院是由公共卫生学院和北卡罗来纳大学教堂山分校的Kenan-Flagler商学院联合提供的基于团队的培训计划。这个为期9个月的计划教公共卫生经理如何更好地管理人员，信息和财务。参与者将学习如何与社区合作伙伴一起团队合作，以及如何作为社会企业家进行思考和行为。为了实践和融合他们的新技能，团队制定了解决当地公共卫生问题的商业计划。本文介绍了该计划并解释了过程评估的结果，该评估研究了如何最好地构建和部署基于团队的方法，以创建更有效，更具企业家精神的公共卫生经理。研究结果表明，招聘和保留能力很强，课程要素与学习者的需求相关，并且学习者对课程感到满意并重视。确定了计划模型的几个特定好处，以及支持业务计划成功和技能在工作中的应用的几个要素。根据这些发现，确定了开发类似计划的四个成功因素。

BACKGROUND & AIMS: BACKGROUND:Insomnia is widely reported and widely treated in general practice, yet relatively little research has focused on the natural history of the condition in primary care settings. As a result, there is at present little information to enable clinicians to assess insomnia risk, or anticipate outcomes in older general practice populations.

AIM:To estimate, using 8-year longitudinal data, the risk of insomnia onset associated with selected health and lifestyle factors.

METHOD:Survivors from a nationally representative sample (n = 1042) of elderly people originally interviewed in 1985 were reassessed in 1989 (n = 690) and 1993 (n = 410). At the first follow up in 1989, 84 new cases of insomnia were identified (a weighted incidence rate per person per year at a risk of 3.1%; 95% CI = 2.7-3.5). In logistic regression analyses controlling for age and sex, the risk of insomnia onset was then assessed in relation to the selected factors.

RESULTS:Three factors assessed in 1985 were significantly and independently related to incident insomnia: psychometric ratings consistent with depressed mood odds ratio (OR) = 4.41; 95% CI = 3.32-5.43); health index scores indicating lower physical health status (OR = 1.19; 95% CI = 1.06-1.31 per unit change in scale score); and moderate and low levels of physical activity (OR = 1.91 and 2.14; 95% CI = 1.91-3.62 and 2.14-3.64 respectively). However, although depressed mood represented a major risk factor, the most likely source of risk was physical rather than mental ill-health.

CONCLUSIONS:Psychiatric, somatic and lifestyle factors significantly and independently increase the risk of insomnia in older general practice patients. In predicting incident sleep disturbance, these factors exceed in importance the age and sex of patients.

背景与目标： 背景 : 失眠在一般实践中被广泛报道和广泛治疗，但针对初级保健机构中该病的自然史的研究相对较少。因此，目前几乎没有信息可以使临床医生评估失眠风险，或预测老年全科医生的结果。
目标 : 使用8年的纵向数据进行估计，失眠发作的风险与选定的健康和生活方式因素有关。
方法 : 1989年 (n = 690) 和1993 (n = 410) 重新评估了来自1985年最初接受采访的具有全国代表性的老年人样本 (n = 1042) 的幸存者。在第一次随访1989年，发现了84例新的失眠病例 (每人每年加权发病率，风险为3.1%; 95% CI = 2.7-3.5)。在控制年龄和性别的逻辑回归分析中，然后根据所选因素评估失眠发作的风险。
结果 : 1985年评估的三个因素与失眠事件显着且独立相关: 符合抑郁情绪优势比 (OR) = 4.41; 95% CI = 3.32-5.43); 健康指数得分表明较低的身体健康状况 (OR = 1.19; 95% CI = 1.06-1.31每单位变化的量表得分); 和中等和低水平的体育活动 (OR = 1.91和2.14; 95% CI分别 = 1.91-3.62和2.14-3.64)。但是，尽管情绪低落是主要的危险因素，但最可能的危险来源是身体健康而不是精神健康不良。
结论 : 精神病学，躯体和生活方式因素显着且独立地增加了老年全科患者的失眠风险。在预测事件睡眠障碍时，这些因素的重要性超过了患者的年龄和性别。

BACKGROUND & AIMS: Tumour cells at the invasive front of carcinomas have been found to differ substantially from the rest of tumour cells in a variety of human cancers. The present multivariate survival analysis of 94 oral squamous cell carcinomas (OSCCs) revealed that both the argyrophilic nucleolar organizer regions-associated protein (AgNOR) content of invading tumour cells and a multiparametric histopathological tumour front grade were significantly and independently associated with tumour-related death, irrespective of conventional Broders' grade and clinical stage of the tumours. High tumour front scores and AgNOR content at the invasive OSCC front thus seem to reflect increased malignant potential. Proliferative activity, assessed by standardized AgNOR analysis, most probably represents one of the biological features underlying the usefulness of evaluating the invasive tumour front.

背景与目标： 在各种人类癌症中，已发现位于癌侵袭性前沿的肿瘤细胞与其他肿瘤细胞有很大不同。目前对94例口腔鳞状细胞癌 (oscc) 的多变量生存分析显示，侵袭性肿瘤细胞的嗜银核仁组织区相关蛋白 (AgNOR) 含量和多参数组织病理学肿瘤前等级均与肿瘤相关死亡显着且独立相关，与肿瘤的常规broders等级和临床分期无关。因此，侵袭性OSCC前沿的高肿瘤前沿得分和AgNOR含量似乎反映了恶性潜能的增加。通过标准化的AgNOR分析评估的增殖活性，很可能代表了评估侵袭性肿瘤前沿有用性的生物学特征之一。

BACKGROUND & AIMS: :Thirty-three consecutive liver-transplant recipients were prospectively studied over a 37-mo period for evidence of cytomegalovirus infection. Sixteen (48%) episodes of cytomegalovirus infection were identified; 9 were primary infections and 7 were recurrent infections. Beginning with patient 8, gamma-globulin prophylaxis was routinely administered to most patients. Twelve potential risk factors for cytomegalovirus infection were evaluated and included pretransplant cytomegalovirus serological status of donor and recipient; recipient's age, sex, race, and liver disease; number and type of blood products transfused; type and intensity of immunosuppression; and occurrence of rejection. The Cox proportional hazards model identified positive donor cytomegalovirus serology as the single most important risk factor for subsequent development of cytomegalovirus infection, regardless of recipient cytomegalovirus serological status. In addition, use of gamma-globulin prophylaxis seemed to be protective against the occurrence of disseminated cytomegalovirus disease.

背景与目标： : 在37个月的时间内，对33位连续的肝移植受者进行了前瞻性研究，以寻找巨细胞病毒感染的证据。确定了16 (48%) 例巨细胞病毒感染; 9例为原发感染，7例为复发性感染。从患者8开始，大多数患者常规使用丙种球蛋白预防。评估了巨细胞病毒感染的十二个潜在危险因素，包括供体和受者的移植前巨细胞病毒血清学状态; 受者的年龄，性别，种族和肝脏疾病; 输血的血液制品的数量和类型; 免疫抑制的类型和强度; 和排斥的发生。Cox比例风险模型确定阳性供体巨细胞病毒血清学是随后发生巨细胞病毒感染的唯一最重要的危险因素，而与受体巨细胞病毒的血清学状况无关。此外，使用丙种球蛋白预防似乎可以预防弥漫性巨细胞病毒疾病的发生。

BACKGROUND & AIMS: :Nonhealing diabetic foot ulcers (DFUs) are a common and costly complication of diabetes. Microbial burden, or "bioburden," is believed to underlie delayed healing, although little is known of those clinical factors that may influence microbial load, diversity, and/or pathogenicity. We profiled the microbiomes of neuropathic nonischemic DFUs without clinical evidence of infection in 52 individuals using high-throughput sequencing of the bacterial 16S ribosomal RNA gene. Comparatively, wound cultures, the standard diagnostic in the clinic, vastly underrepresent microbial load, microbial diversity, and the presence of potential pathogens. DFU microbiomes were heterogeneous, even in our tightly restricted study population, but partitioned into three clusters distinguished primarily by dominant bacteria and diversity. Ulcer depth was associated with ulcer cluster, positively correlated with abundance of anaerobic bacteria, and negatively correlated with abundance of Staphylococcus. Ulcer duration was positively correlated with bacterial diversity, species richness, and relative abundance of Proteobacteria, but was negatively correlated with relative abundance of Staphylococcus. Finally, poor glycemic control was associated with ulcer cluster, with poorest median glycemic control concentrating to Staphylococcus-rich and Streptococcus-rich ulcer clusters. Analyses of microbial community membership and structure may provide the most useful metrics in prospective studies to delineate problematic bioburden from benign colonization that can then be used to drive clinical treatment.

背景与目标： : 无法愈合的糖尿病足溃疡 (DFUs) 是糖尿病的常见且昂贵的并发症。微生物负担或 “生物负荷” 被认为是延迟愈合的基础，尽管对可能影响微生物负荷，多样性和/或致病性的那些临床因素知之甚少。我们使用细菌16s核糖体RNA基因的高通量测序，对52例个体的神经性非缺血性DFUs的微生物群进行了分析，而没有感染的临床证据。相比之下，伤口培养物 (临床上的标准诊断) 大大低估了微生物负荷，微生物多样性和潜在病原体的存在。即使在我们严格限制的研究人群中，DFU微生物群也是异质的，但分为三个簇，主要由优势细菌和多样性区分。溃疡深度与溃疡簇有关，与厌氧菌的丰度呈正相关，与葡萄球菌的丰度呈负相关。溃疡持续时间与细菌多样性，物种丰富度和变形菌的相对丰度呈正相关，但与葡萄球菌的相对丰度呈负相关。最后，血糖控制不佳与溃疡群有关，中位血糖控制最差的集中于富含葡萄球菌和富链球菌的溃疡群。微生物群落成员和结构的分析可能会在前瞻性研究中提供最有用的指标，以从良性定植中描绘出有问题的生物负荷，然后将其用于推动临床治疗。

BACKGROUND & AIMS: :Active surveillance and diagnosis of the influenza pandemic (H1N1) 2009 (pH1N1) have played a critical role in the effective control and prevention of the pandemic in China. Although several commercially available real-time PCR kits for pH1N1 virus have been used in diagnostic laboratories in Beijing, little has been known about the performance of these kits for detecting pH1N1 virus. In this study, the performance of two commercial real-time PCR kits in Beijing was evaluated. Analysis of clinical samples showed that the positive detection rate for the AgPath-ID™ kit (38.2%) was significantly higher than that for the Da An H1N1 kit (30.0%) (McNemar's chi-square test, P=0.000). The limit of detection (LOD) of the AgPath-ID™ kit was 10(2), 10(2), and 10(3) copies/reaction for the Influenza A (set 1), H1N1 Influenza A (set 2) and H1N1 Influenza A Sub H1 (set 3) genes, respectively, whereas the LOD of the Da An kit was 10(3) copies/reaction for both H1 and N1 genes. Although the AgPath-ID™ kit exhibited a significantly higher detection rate for pH1N1 than the Da An kit, cross-reactivity to A/PR8/34 was found for the AgPath-ID™ kit for H1N1 Influenza A (set 2).

背景与目标： : 对流感大流行 (H1N1) 2009 (pH1N1) 的积极监测和诊断在有效控制和预防中国大流行方面发挥了关键作用。尽管北京的诊断实验室已经使用了几种市售的pH1N1病毒实时PCR试剂盒，但对这些试剂盒检测pH1N1病毒的性能知之甚少。在这项研究中，评估了北京两种商用实时PCR试剂盒的性能。临床样本分析表明，AgPath-ID的阳性检出率™试剂盒 (38.2%) 显着高于Da H1N1试剂盒 (30.0%) (McNemar卡方检验，P = 0.000)。AgPath-ID的检测极限 (LOD)™试剂盒分别为甲型流感 (第1组) 、甲型H1N1流感 (第2组) 和甲型H1N1流感亚H1 (第3组) 基因的10(2) 、10(2) 和10(3) 拷贝/反应，而Da An试剂盒的LOD对于H1和N1基因均为10(3) 个拷贝/反应。虽然AgPath-ID™试剂盒对pH1N1的检出率明显高于Da一试剂盒，发现AgPath-ID对a/PR8/34的交叉反应性™甲型H1N1流感试剂盒 (第2套)。