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)。

BACKGROUND & AIMS: :Hemorrhage is the most preventable cause of posttraumatic death. Many cases are potentially anatomically salvageable, yet remain lethal without logistics or trained personnel to deliver diagnosis or resuscitative surgery in austere environments. Revolutions in technology for remote mentoring of ultrasound and surgery may enhance capabilities to utilize the skill sets of non-physicians. Thus, our research collaborative explored remote mentoring to empower non-physicians to address junctional and torso hemorrhage control in austere environments. Major studies involved using remote-telementored ultrasound (RTMUS) to identify torso and junctional exsanguination, remotely mentoring resuscitative surgery for torso hemorrhage control, understanding and mitigating physiological stress during such tasks, and the technical practicalities of conducting damage control surgery (DCS) in austere environments. Iterative projects involved randomized guiding of firefighters to identify torso (RCT) and junctional (pilot) hemorrhage using RTMUS, randomized remote mentoring of MedTechs conducting resuscitative surgery for torso exsanguination in an anatomically realistic surgical trainer ("Cut Suit") including physiological monitoring, and trained surgeons conducting a comparative randomized study for torso hemorrhage control in normal (1g) versus weightlessness (0g). This work demonstrated that firefighters could be remotely mentored to perform just-in-time torso RTMUS on a simulator. Both firefighters and mentors were confident in their abilities, the ultrasounds being 97% accurate. An ultrasound-naive firefighter in Memphis could also be remotely mentored from Hawaii to identify and subsequently tamponade an arterial junctional hemorrhage using RTMUS in a live tissue model. Thereafter, both mentored and unmentored MedTechs and trained surgeons completed resuscitative surgery for hemorrhage control on the Cut-Suit, demonstrating practicality for all involved. While remote mentoring did not decrease blood loss among MedTechs, it increased procedural confidence and decreased physiologic stress. Therefore, remote mentoring may increase the feasibility of non-physicians conducting a psychologically daunting task. Finally, DCS in weightlessness was feasible without fundamental differences from 1g. Overall, the collective evidence suggests that remote mentoring supports diagnosis, noninvasive therapy, and ultimately resuscitative surgery to potentially rescue those exsanguinating in austere environments and should be more rigorously studied.

背景与目标： : 出血是创伤后死亡最可预防的原因。许多病例在解剖学上可能是可挽救的，但如果没有后勤人员或训练有素的人员在严峻的环境中进行诊断或复苏手术，则仍然致命。超声波和外科手术远程指导技术的革命可能会增强利用非医生技能的能力。因此，我们的研究合作探索了远程指导，以使非医生能够在严峻的环境中解决交界处和躯干出血控制问题。主要研究包括使用远程远程超声 (RTMUS) 识别躯干和交界性放血，远程指导复苏手术以控制躯干出血，理解和减轻此类任务期间的生理压力，以及在严峻环境中进行损伤控制手术 (DCS) 的技术实用性。迭代项目包括随机指导消防员使用RTMUS识别躯干 (RCT) 和交界 (pilot) 出血，随机远程指导MedTechs在解剖学上逼真的外科训练器 (“切割服”) 中进行躯干放血的复苏手术，包括生理监测，和训练有素的外科医生进行了一项比较随机研究，以正常 (1g) 与失重 (0g) 的躯干出血控制。这项工作表明，可以远程指导消防员在模拟器上执行及时的躯干RTMUS。消防员和导师都对自己的能力充满信心，超声波97% 准确。孟菲斯的一名未经超声检查的消防员也可以从夏威夷进行远程指导，以识别并随后在活组织模型中使用RTMUS填塞动脉交界性出血。此后，经过指导和未经指导的MedTechs和训练有素的外科医生都完成了复苏手术，以控制剪裁服上的出血，这证明了所有参与者的实用性。虽然远程指导并没有减少MedTechs的失血，但它增加了程序信心并减少了生理压力。因此，远程指导可能会增加非医生执行心理艰巨任务的可行性。最后，失重的dc是可行的，与1g没有根本差异。总体而言，集体证据表明，远程指导支持诊断，无创治疗以及最终的复苏手术，以潜在地挽救那些在严峻环境中放血的人，因此应进行更严格的研究。

BACKGROUND & AIMS: :Suicide and violence are significant problems in a subset of Iraq/Afghanistan-era veterans. This study investigates how posttraumatic stress disorder (PTSD) and resilience in veterans are associated with suicidal ideation and violent impulses while controlling for known covariates of both adverse outcomes. Structured clinical interviews were conducted of N = 2,543 Iraq/Afghanistan-era U.S. veterans. Compared with veterans denying suicidal ideation or violent impulses (n = 1,927), veterans endorsing both (n = 171) were more likely to meet diagnostic criteria for PTSD, report childhood abuse, combat exposure, physical pain symptoms, and drug misuse, and less likely to endorse self-direction/life purpose. Veterans reporting concurrent suicidal ideation and violent impulses had higher odds of misusing drugs and reporting pain symptoms relative to veterans reporting suicidal ideation only (n = 186) and had lower odds of endorsing self-direction/life purpose compared with veterans reporting violent impulses only (n = 259). The findings underscore the importance of examining drug abuse, physical pain symptoms, and self-direction/life purpose, as well as PTSD and history of trauma, in the context of clinical assessment and empirical research aimed at optimizing risk management of suicide and violence in military veterans. (PsycINFO Database Record

背景与目标： : 自杀和暴力是伊拉克/阿富汗时代退伍军人的一个重要问题。这项研究调查了退伍军人的创伤后应激障碍 (PTSD) 和韧性如何与自杀意念和暴力冲动相关，同时控制了两种不良结果的已知协变量。对N = 2,543伊拉克/阿富汗时代的美国退伍军人进行了结构化的临床访谈。与否认自杀意念或暴力冲动的退伍军人 (n = 1,927) 相比，支持这两者的退伍军人 (n = 171) 更有可能满足PTSD的诊断标准，报告儿童期虐待，战斗暴露，身体疼痛症状和药物滥用，并且不太可能认可自我指导/生活目标。与仅报告自杀意念的退伍军人相比，报告同时自杀意念和暴力冲动的退伍军人滥用药物和报告疼痛症状的几率更高 (n = 186)，并且与仅报告暴力冲动的退伍军人相比，认可自我指导/生活目标的几率更低 (n = 259)。研究结果强调了在旨在优化自杀和暴力风险管理的临床评估和实证研究的背景下，检查药物滥用，身体疼痛症状，自我指导/生活目的以及PTSD和创伤史的重要性。退伍军人。(PsycINFO数据库记录

BACKGROUND & AIMS: :Previous studies have shown that drugs which block the reuptake of catecholamine neurotransmitters improve impulse control in diseases such as attention deficit hyperactivity disorder (ADHD). Serotonin-specific reuptake inhibitors (SSRI) lack efficacy in ADHD and have been linked to increased suicide risk. The present study investigated drugs with affinity for one or more of the monoamine reuptake transporters using the 5-choice serial reaction time task, a model of attention and impulsivity in rodents. We also tested the effects of the alpha(2)-adreoceptor antagonist, idazoxan and novel antidepressant, agomelatine, which both increase cortical noradrenaline concentrations through non-reuptake mechanisms. Improvements in impulse control were observed with venlafaxine, a serotonin and noradrenaline re-uptake inhibitor (SNRI) but not bupropion (dopamine and noradrenaline re-uptake inhibitor). Sibutramine (SNRI) reduced premature responses by ~50% at the highest dose tested but this was not significant. All three of the SSRIs tested reduced premature responding in a dose-dependent manner, although also slowed response and collection latencies. Neither idazoxan nor agomelatine significantly reduced premature responding, suggesting a lack of efficacy at the doses tested. None of the drugs tested improved attention in this task but sibutramine (SNRI), fluoxetine (SSRI) and paroxetine (SSRI) all increased omissions at the highest dose tested. These data suggest that the SNRIs and SSRIs reduce premature responding but tend to be less specific than noradrenaline specific reuptake inhibitors in this model. SSRIs did not induce any specific impairment in impulse control in this model.

背景与目标： : 先前的研究表明，阻断儿茶酚胺神经递质再摄取的药物可改善注意力缺陷多动障碍 (ADHD) 等疾病的冲动控制。血清素特异性再摄取抑制剂 (SSRI) 在ADHD中缺乏疗效，并与自杀风险增加有关。本研究使用5选择系列反应时间任务 (啮齿动物的注意力和冲动性模型) 研究了对一种或多种单胺再摄取转运蛋白具有亲和力的药物。我们还测试了 α (2)-受体拮抗剂咪唑嗪和新型抗抑郁药阿戈米拉汀的作用，它们均通过非再摄取机制增加皮质去甲肾上腺素浓度。使用文拉法辛 (一种5-羟色胺和去甲肾上腺素再摄取抑制剂 (SNRI)) 但未使用安非他酮 (多巴胺和去甲肾上腺素再摄取抑制剂) 观察到冲动控制的改善。在测试的最高剂量下，西布曲明 (SNRI) 将过早反应降低约50%，但这并不显著。测试的所有三个ssri均以剂量依赖性方式减少了过早反应，尽管也减慢了反应和收集延迟。依达唑烷和阿戈米拉汀均未显着降低过早反应，表明在测试剂量下缺乏疗效。测试的药物均未提高此任务中的注意力，但西布曲明 (SNRI)，氟西汀 (SSRI) 和帕罗西汀 (SSRI) 在测试的最高剂量下均增加了遗漏。这些数据表明，在该模型中，snri和SSRIs减少了过早反应，但特异性不如去甲肾上腺素特异性再摄取抑制剂。在该模型中，SSRIs不会在冲动控制中引起任何特定的损害。

BACKGROUND & AIMS: AIMS:To assess the relationship between ambulance attendances, emergency department (ED) presentations and hospital admissions for acute alcohol intoxication and the timing of public holidays, sporting and social events. DESIGN:Time-series analysis was used to explore trends in intoxication in the context of major events. SETTING:Population of Melbourne, Victoria, Australia between 2000 and 2009. PARTICIPANTS:All patients attended by ambulance, presenting to hospital EDs, or admitted to hospital who were classified as acutely alcohol intoxicated. MEASUREMENT:Analysis of daily numbers of presentations for acute alcohol intoxication associated with major events were undertaken, including lead and lag effects. Analyses controlled for day of week and month of year to address temporal and seasonal variations. FINDINGS:Alcohol intoxication presentations were significantly elevated the day before all public holidays, with intoxication cases on the day of public holidays only higher on New Year's Day (ambulance 6.57, 95% confidence intervals (CI): 3.4-9.74; ED 3.34, 95% CI: 1.28-5.4) and ANZAC Day (ambulance 3.71, 95% CI: 0.68-6.75). The Australian Football League (AFL) Grand Final (ED 2.37, 95% CI: 0.55-4.19), Commonwealth Games (ED 2.45, 95% CI: 0.6-4.3) and Melbourne Cup Day (ambulance 6.14, 95% CI: 2.42-9.85) represented the sporting events with significant elevations in acute intoxication requiring medical attention. The last working day before Christmas was the only social event where a significant increase in acute intoxication occurred (ambulance 8.98, 95% CI: 6.8-11.15). CONCLUSIONS:Acute alcohol intoxication cases requiring ambulance, emergency department and hospital in-patient treatment increase substantially on the day preceding public holidays and other major social events.

背景与目标：

BACKGROUND & AIMS: :Stable isotope analysis of feces can provide a non-invasive method for tracking the dietary habits of nearly any mammalian species. While fecal samples are often collected for macroscopic and genetic study, stable isotope analysis can also be applied to expand the knowledge of species-specific dietary ecology. It is somewhat unclear how digestion changes the isotope ratios of animals' diets, so more controlled diet studies are needed. To date, most diet-to-feces controlled stable isotope experiments have been performed on herbivores, so in this study I analyzed the carbon and nitrogen stable isotope ratios in the diet and feces of the meerkat (Suricata suricatta), a small omnivorous mammal. The carbon trophic discrimination factor between diet and feces (Δ13Cfeces) is calculated to be 0.1 ± 1.5‰, which is not significantly different from zero, and in turn, not different than the dietary input. On the other hand, the nitrogen trophic discrimination factor (Δ15Nfeces) is 1.5 ± 1.1‰, which is significantly different from zero, meaning it is different than the average dietary input. Based on data generated in this experiment and a review of the published literature, carbon isotopes of feces characterize diet, while nitrogen isotope ratios of feces are consistently higher than dietary inputs, meaning a discrimination factor needs to be taken into account. The carbon and nitrogen stable isotope values of feces are an excellent snapshot of diet that can be used in concert with other analytical methods to better understand ecology, diets, and habitat use of mammals.

背景与目标： : 粪便的稳定同位素分析可以为追踪几乎任何哺乳动物物种的饮食习惯提供一种非侵入性方法。虽然通常收集粪便样本进行宏观和遗传研究，但稳定的同位素分析也可以用于扩展特定物种饮食生态学的知识。目前尚不清楚消化如何改变动物饮食的同位素比率，因此需要进行更多的饮食控制研究。迄今为止，大多数饮食控制的粪便稳定同位素实验都是在食草动物上进行的，因此在这项研究中，我分析了猫鼬 (Suricata suricatta) 的饮食和粪便中的碳和氮稳定同位素比。饮食和粪便之间的碳营养歧视因子 (Δ13Cfeces) 计算为0.1 ± 1.5 ‰，与零没有显着差异，并且反过来与饮食输入没有差异。另一方面，氮营养歧视因子 (Δ15Nfeces) 为1.5 ± 1.1 ‰，与零显着不同，这意味着它不同于平均饮食投入。根据该实验中产生的数据以及对已发表文献的回顾，粪便的碳同位素表征饮食，而粪便的氮同位素比率始终高于饮食投入，这意味着需要考虑歧视因素。粪便的碳和氮稳定同位素值是饮食的绝佳快照，可以与其他分析方法一起使用，以更好地了解哺乳动物的生态，饮食和栖息地使用。

BACKGROUND & AIMS: :Wound infections are an infrequent but serious complication of total knee arthroplasty. Between January 1984 and November 1987, 20 of 243 (8.2%) patients at two affiliated hospitals developed surgical wound infections following 259 total knee arthroplasty procedures performed in clean-air operating rooms. Eighteen (90%) of the patients had deep infections; nine required removal of the prosthesis. A single surgeon (surgeon X) was associated with 18 of the procedures that had subsequent infection (risk ratio (RR) = 9.4, 95% confidence interval (CI) 2.2-39), and an investigation was carried out in an effort to explain the difference in infection rates between surgeon X and other surgeons. In a cohort study, stratified analyses identified a preoperative American Society of Anesthesiologists (ASA) physical status class greater than or equal to 3, surgeon X, and early postoperative use of a continuous passive motion device as risk factors associated with surgical wound infection following total knee arthroplasty procedures. Logistic regression analyses identified being a patient operated on by surgeon X with an ASA class greater than or equal to 3 as the only significant independent risk factor for total knee arthroplasty-associated surgical wound infections (RR = 9.3, 95% CI 2.8-31). The effect due to surgeon X could not be explained by receipt or timeliness of administration of antimicrobial prophylaxis, type of prosthesis inserted, duration of operation, postoperative use of continuous passive motion, or underlying etiology of joint disease. The authors conclude that surgical technique and patient's severity of illness were the primary determinants of surgical wound infection after total knee arthroplasty. This study demonstrates the complexity of epidemiologic investigation of surgical wound infections and the importance of considering patient severity of illness when interpreting surgeon-specific infection rates.

背景与目标： : 伤口感染是全膝关节置换术的罕见但严重的并发症。在1984年1月和1987年11月之间，两家附属医院的243名患者中有20名 (8.2% 名) 在清洁空气手术室中进行了259次全膝关节置换术后发生了手术伤口感染。18 (90%) 名患者患有深部感染; 9名需要移除假体。单个外科医生 (外科医生X) 与18例随后感染的手术相关 (风险比 (RR) = 9.4，95% 置信区间 (CI) 2.2-39)，并进行了一项调查，以解释外科医生X与其他外科医生之间感染率的差异。在一项队列研究中，分层分析确定术前美国麻醉医师协会 (ASA) 的身体状况等级大于或等于3，外科医生X，以及术后早期使用连续被动运动装置是与全膝关节置换术后手术伤口感染相关的危险因素。Logistic回归分析确定是由ASA等级大于或等于3的外科医生X手术的患者，是全膝关节置换相关手术伤口感染的唯一重要独立危险因素 (RR = 9.3，95% CI 2.8-31)。不能通过接受或及时施用抗菌药物，插入的假体类型，手术持续时间，术后使用连续被动运动或关节疾病的潜在病因来解释外科医生X的作用。作者得出结论，手术技术和患者的疾病严重程度是全膝关节置换术后手术伤口感染的主要决定因素。这项研究证明了外科伤口感染的流行病学调查的复杂性，以及在解释外科医生特定的感染率时考虑患者疾病严重程度的重要性。