BACKGROUND & AIMS: :Two-hundred and ninety-three patients without a previous vaginal delivery were randomized to intracervical/extra-amniotic application of 0.5 mg prostaglandin E2 (PGE2) or to gel only. Of the patients who received PGE2, 18.7% were admitted before the next morning due to spontaneous abortion, bleeding or pains. No other side-effect was observed. A statistically significant dilatation of the cervical canal was found in the prostaglandin group. Thirty percent of the treated patients did not need further dilatation of the cervix 25.4% were non-responders to PGE2 and 7.7% were hyper-responders. The number of uterine perforations, pelvic inflammatory disease (PID) or retained pregnancy products were not influenced by the pretreatment with PGE2.

背景与目标： : 两百九十三名先前没有阴道分娩的患者被随机分配到宫颈内/羊膜外应用0.5 mg前列腺素E2 (PGE2) 或仅凝胶。在接受PGE2的患者中，有18.7% 人因自然流产，出血或疼痛而在第二天早晨之前入院。未观察到其他副作用。在前列腺素组中发现了具有统计学意义的宫颈管扩张。30% 的接受治疗的患者不需要进一步扩张子宫颈，25.4% 是对PGE2无反应的患者，7.7% 是高反应的患者。Pge2预处理不会影响子宫穿孔，盆腔炎 (PID) 或保留的妊娠产物的数量。

BACKGROUND & AIMS: :Ongoing blood loss and iron-deficiency anemia are common problems in patients on hemodialysis; therefore, nephrology clinicians are particularly concerned with their patients who are scheduled for surgery Surgery can cause significant blood and iron losses, thereby worsening their preexisting anemia. However, patients on hemodialysis can be effectively treated preoperatively by adjusting their continued doses of intravenous (i.v.) iron and recombinant human erythropoietin (EPO) therapy, based on expected blood and iron losses. This valuable strategy can help improve surgical and anemia outcomes as well as decrease EPO requirements and the need for transfusions. This article examines the use of IV iron and EPO therapy as preventive therapy for anemia in patients on hemodialysis prior to invasive surgical procedures, illustrated with an experience from a dialysis unit and patient case studies.

背景与目标： : 持续失血和缺铁性贫血是血液透析患者的常见问题; 因此，肾脏病临床医生特别关注计划进行手术的患者，这些患者可能会导致大量的血液和铁损失，从而加剧其先前存在的贫血。但是，可以根据预期的血液和铁损失，通过调整静脉内 (i.v.) 铁和重组人促红细胞生成素 (EPO) 治疗的持续剂量，在术前有效治疗血液透析患者。这种有价值的策略可以帮助改善手术和贫血的结果，并减少EPO的需求和输血的需求。本文研究了在侵入性外科手术之前使用IV铁和EPO疗法作为血液透析患者贫血的预防疗法，并结合透析单位和患者案例研究的经验进行了说明。

BACKGROUND & AIMS: The purpose of this study was to determine if quantitative measurements of regional asynergy add independent prognostic information to global ejection fraction in patients with chronic coronary artery disease. Four hundred eighty-six patients with a history of Q-wave myocardial infarction who underwent gated-equilibrium radionuclide angiography at least 3 months after infarction were monitored for a median duration of 4.7 years. During follow-up there were 95 deaths. Four of five regional asynergy indexes analyzed were associated with overall mortality. The strength of the association between overall mortality and the index that proved to be optimal (univariate chi2 = 26.4, p < 0.001) was stronger than for global ejection fraction (univariate chi2 = 21.5, p < 0.001). For patients with global ejection fraction <40%, 4-year survival was 87% for those with a low asynergy index versus 65% for those with a high asynergy index (p = 0.016). In conclusion, indexes of regional asynergy add independent prognostic information to global left ventricular ejection fraction.

背景与目标： 这项研究的目的是确定区域不同步的定量测量是否为慢性冠心病患者的整体射血分数增加了独立的预后信息。对486例有Q波心肌梗死病史的患者进行了监测，这些患者在梗死后至少3个月接受了门控平衡放射性核素血管造影，中位持续时间为4.7年。在随访期间，有95人死亡。分析的五个区域异步指数中有四个与总体死亡率相关。总死亡率与被证明是最佳的指数 (单变量chi2 = 26.4，p <0.001) 之间的关联强度强于整体射血分数 (单变量chi2 = 21.5，p <0.001)。对于整体射血分数 <40% 的患者，非同步指数低的患者87% 4年生存率，而非同步指数高的患者65% (p = 0.016)。总之，区域非同步指数为整体左心室射血分数增加了独立的预后信息。

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BACKGROUND & AIMS: PROBLEM:It is unclear if the immunologic alterations induced by pregnancy could persist. METHOD OF STUDY:Antenatal rubella sero-negativity was correlated with gravidity, abortions and parity in 112 083 gravidae managed during 1997-2015, with further analysis stratified for factors known to influence rubella serology. RESULTS:The 10.2% sero-negative gravidae had different characteristics, and the incidence showed significant difference and positive trend (P<.001 for both) with gravidity, abortions and parity. The pattern remained consistent when analysis was stratified for advanced age, high body mass index and medical history, but was negated by hepatitis B virus infection except for abortions, and by high body mass index for parity. For gravidity 2-4, no difference in rubella sero-negativity was found between gravidae with all previous pregnancies ended in abortion vs delivery. CONCLUSION:Prior pregnancies diminished rubella immunity in a dose-dependent manner, which may be a reflection of the cumulative effect of pregnancy-associated maternal immunologic alteration.

背景与目标：

BACKGROUND & AIMS: :We report the case of a 60-year-old man who first presented with transient difficulty of word recall. Subsequent MRI revealed an invasive brain tumor in the left frontal lobe. The patient underwent open biopsy, and diffuse astrocytoma(WHO grade II)was diagnosed. However, the malignant potential of this tumor was not particularly low because of a few enhancement on preoperative evaluation, and radiation therapy was initially performed. Four months after ending irradiation, temozolomide treatment was introduced for tumor regrowth. After another 2 months, combined chemotherapy with bevacizumab was also started due to tumor enlargement, which was evaluated as malignant transformation to glioblastoma. Two focal lesions with signal hyperintensity on DWI appeared in the frontal and temporal lobes at different locations 3 months after starting bevacizumab. The left temporal lesion subsequently changed to a ring-enhanced tumor, and glioblastoma(WHO grade IV)was finally diagnosed at decompressive surgery. Another frontal lesion, however, continued to maintain a favorable course without any changes in signal despite appearing as similar signal-hyperintense lesions. The temporal hyperintense lesion may undergo malignant transformation into glioblastoma with typical radiological appearance. Recent studies on image changes following bevacizumab treatment have attracted widespread attention, and the clinical significance of such hyperintense lesions has gained attention. This present case was thought to be valuable because of the contradistinctive aspects at the same time, in which the hyperintense lesions of the frontal and temporal lobes seemed to represent antitumor activity or drug refractory effects based on bevacizumab treatment.

背景与目标： : 我们报告了一名60岁男子的案例，该男子首次出现短暂的单词回忆困难。随后的MRI显示左额叶有浸润性脑肿瘤。患者接受了开放性活检，并诊断为弥漫性星形细胞瘤 (WHO II级)。然而，由于术前评估的增强作用，该肿瘤的恶性潜能并不是特别低，并且最初进行了放射治疗。放疗结束四个月后，替莫唑胺治疗肿瘤再生。另外2个月后，由于肿瘤扩大，贝伐单抗联合化疗也开始，这被评估为恶性转化为胶质母细胞瘤。开始使用贝伐单抗3个月后，在不同位置的额叶和颞叶出现了两个DWI信号高信号的局灶性病变。左颞部病变随后变为环状增强肿瘤，最终在减压手术中诊断为胶质母细胞瘤 (WHO IV级)。然而，尽管出现类似的信号高信号病变，但另一额叶病变继续保持良好的病程，而信号没有任何变化。颞高强度病变可能会发生恶性转化为具有典型放射学外观的胶质母细胞瘤。近年来关于贝伐单抗治疗后图像变化的研究引起了广泛关注，此类高强度病变的临床意义也引起了人们的关注。由于同时存在不同的方面，因此本病例被认为是有价值的，其中额叶和颞叶的高强度病变似乎代表了基于贝伐单抗治疗的抗肿瘤活性或药物难治性作用。

BACKGROUND & AIMS: OBJECTIVES:To assess the extent to which prior hormone therapy modifies the breast cancer risk found with estrogen plus progestin (E+P) in the Women's Health Initiative (WHI) randomized trial. METHODS:Subgroup analyses of prior hormone use on invasive breast cancer incidence in 16,608 postmenopausal women in the WHI randomized trial of E+P over an average 5.6 years of follow-up. RESULTS:Small but statistically significant differences were found between prior HT users and non-users for most breast cancer risk factors but Gail risk scores were similar. Duration of E+P use within the trial (mean 4.4 years, S.D. 2.0) did not vary by prior use. Among 4311 prior users, the adjusted hazard ratio (HR) for E+P versus placebo was 1.96 (95% confidence interval [CI]: 1.17-3.27), significantly different (p=0.03) from that among 12,297 never users (HR 1.02; 95% CI: 0.77-1.36). The interaction between study arm and follow-up time was significant overall (p=0.01) and among never users (p=0.02) but not among prior users (p=0.10). The cumulative incidence over time for the E+P and placebo groups appeared to cross after about 3 years in prior users, and after about 5 years in women with no prior use. No interaction was found with duration (p=0.08) or recency of prior use (p=0.17). Prior hormone use significantly increased the E+P hazard ratio for larger, more advanced tumors. CONCLUSION:A safe interval for combined hormone use could not be reliably defined with these data. However, the significant increase in breast cancer risk in the trial overall after only 5.6 years of follow-up, initially concentrated in women with prior hormone exposure, but with increasing risk over time in women without prior exposure, suggests that durations only slightly longer than those in the WHI trial are associated with increased risk of breast cancer. Longer-term exposure and follow-up data are needed.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:Successful hemodialysis requires reliable vascular access that can deliver adequate blood flow. An arteriovenous fistula is preferred for access because of its longevity and low frequency of complications, but up to 60% of arteriovenous fistulas created surgically are never suitable for hemodialysis because of nonmaturation (insufficient vascular dilatation). Decreased arterial elasticity may impair dilatation, thereby affecting fistula maturation. This study evaluated the feasibility of brachial artery elasticity measurement in patients with chronic kidney disease obtained during routine pre-operative mapping ultrasound (US) imaging before hemodialysis access placement and compared the measurements to those obtained in healthy volunteers. METHODS:Brachial artery functional US studies were collected from 75 patients undergoing routine preoperative mapping for hemodialysis access and 50 healthy volunteers. Vascular strain was calculated from the change in intima-media thickness between end systole and end diastole, and vascular stress was estimated from the pulse pressure. Assuming a linear elastic medium, the elastic modulus was estimated as the ratio of vascular stress to strain. RESULTS:Elastic modulus measurements were significantly higher in patients than in volunteers (130 versus 100 kPa; P = .01). With combined volunteer and patient data, there was a significant correlation between elasticity and systolic blood pressure (R2 = 0.23; P < .001). Elasticity was correlated with age in volunteers but not in patients (R2 = 0.14; P = .017; R2 < .001; P = .829, respectively). CONCLUSIONS:This analysis of clinical arterial vessel biomechanics shows that a noninvasive US measurement can detect elastic modulus differences between patients with chronic kidney disease and healthy individuals. Future studies will correlate the elastic modulus with histologic characteristics and eventual arteriovenous fistula maturation, which may provide supplemental information on arterial biomechanical properties as a useful addition to current predictors of fistula success.

背景与目标：

BACKGROUND & AIMS: :Comparative analysis is the preferred method of inferring RNA secondary structure, but its use requires considerable expertise and manual effort. As the importance of secondary structure for accurate sequence alignment and phylogenetic analysis becomes increasingly realised, the need for secondary structure models for diverse taxonomic groups becomes more pressing. The number of available structures bears little relation to the relative diversity or importance of the different taxonomic groups. Insects, for example, comprise the largest group of animals and yet are very poorly represented in secondary structure databases. This paper explores the utility of maximum weighted matching (MWM) to help automate the process of comparative analysis by inferring secondary structure for insect mitochondrial small subunit (12S) rRNA sequences. By combining information on correlated changes in substitutions and helix dot plots, MWM can rapidly generate plausible models of secondary structure. These models can be further refined using standard comparative techniques. This paper presents a secondary structure model for insect 12S rRNA based on an alignment of 225 insect sequences and an alignment for 16 exemplar insect sequences. This alignment is used as a template for a web server that automatically generates secondary structures for insect sequences.

背景与目标： : 比较分析是推断RNA二级结构的首选方法，但其使用需要相当的专业知识和人工努力。随着二级结构对于准确的序列比对和系统发育分析的重要性日益认识，对用于不同分类组的二级结构模型的需求变得越来越迫切。可用结构的数量与不同分类组的相对多样性或重要性几乎没有关系。例如，昆虫是最大的动物群体，但在二级结构数据库中的代表性很差。本文探讨了最大加权匹配 (MWM) 通过推断昆虫线粒体小亚基 (12S) rRNA序列的二级结构来帮助自动化比较分析过程的效用。通过结合有关取代和螺旋点图的相关变化的信息，MWM可以快速生成二级结构的合理模型。这些模型可以使用标准的比较技术进一步完善。本文基于225昆虫序列的比对和16个示例性昆虫序列的比对，提出了昆虫12S rRNA的二级结构模型。此对齐方式用作web服务器的模板，该模板会自动生成昆虫序列的二级结构。

BACKGROUND & AIMS: :High-grade serous ovarian carcinoma (HGSOC) is the most prevalent and malignant ovarian tumor.To identify co-expression modules and hub genes correlated with platinum-based chemotherapy resistant and sensitive HGSOC, we performed weighted gene co-expression network analysis (WGCNA) on microarray data of HGSOC with 12 resistant samples and 16 sensitive samples of GSE51373 dataset.A total of 5122 genes were included in WGCNA, and 16 modules were identified. Module-trait analysis identified that the module salmon (cor = 0.50), magenta (cor = 0.49), and black (cor = 0.45) were discovered associated with chemotherapy resistant, and the significance for these platinum-resistant modules were validated in the GSE63885 dataset. Given that the black module was validated to be the most related one, hub genes of this module, alcohol dehydrogenase 1B, cadherin 11, and vestigial like family member 3were revealed to be expressional related with platinum resistance, and could serve as prognostic markers for ovarian cancer.Our analysis might provide insight for molecular mechanisms of platinum-based chemotherapy resistance and treatment response in ovarian cancer.

背景与目标： 高级别浆液性卵巢癌 (HGSOC) 是最常见和最恶性的卵巢肿瘤。为了确定与铂类化疗耐药和敏感的HGSOC相关的共表达模块和hub基因，我们对HGSOC的微阵列数据进行了加权基因共表达网络分析 (WGCNA)，其中GSE51373数据集的12个耐药样品和16个敏感样品。WGCNA共包含5122个基因，并鉴定了16个模块。模块-性状分析发现模块鲑鱼 (cor  =   0.50) 、品红色 (cor  =   0.49) 和黑色 (cor  =   0.45) 与化疗耐药相关，并在GSE63885数据集验证了这些耐铂模块的意义。鉴于黑色模块被证实是最相关的一个，该模块的中枢基因，乙醇脱氢酶1B，钙粘蛋白11和残留样家族成员3被发现与铂类抗性表达相关，并可作为卵巢癌的预后指标，我们的分析可能为卵巢癌铂类化疗耐药的分子机制和治疗反应提供深入的研究。

BACKGROUND & AIMS: :This paper proposes a new sequential weighted least squares (SWLS) method for positron emission tomography (PET) reconstruction. The SWLS algorithm is noniterative and can be considered as equivalent to the penalized WLS (PWLS) method under certain initial conditions. However, a full implementation of SWLS is computationally intensive. To overcome this problem, we propose a simplified SWLS as a reasonable alternative to the SWLS. The performance of this SWLS method is evaluated in experiments using both simulated and clinical data. The results show that the method can be advantageously compared with the original SWLS both in computation time and reconstruction quality.

背景与目标： : 本文提出了一种新的顺序加权最小二乘 (SWLS) 方法，用于正电子发射断层扫描 (PET) 重建。SWLS算法是非迭代的，在某些初始条件下可以视为等效于惩罚WLS (PWLS) 方法。但是，SWLS的完整实现需要大量计算。为了克服这个问题，我们提出了一种简化的SWLS作为SWLS的合理替代方案。使用模拟和临床数据在实验中评估了该SWLS方法的性能。结果表明，该方法在计算时间和重建质量上都可以与原始SWLS进行比较。

BACKGROUND & AIMS: BACKGROUND:It is uncertain whether antipsychotic long-acting injection (LAI) medication in schizophrenia is associated with better clinical outcomes than oral preparations. AIMS:To examine the impact of prior treatment delivery route on treatment outcomes and whether any differences are moderated by adherence. METHOD:Analysis of data from two pragmatic 1-year clinical trials in which patients with schizophrenia were randomised to either an oral first-generation antipsychotic (FGA), or a non-clozapine second-generation antipsychotic (SGA, CUtLASS 1 study), or a non-clozapine SGA or clozapine (CUtLASS 2 study). RESULTS:Across both trials, 43% (n = 155) of participants were prescribed an FGA-LAI before randomisation. At 1-year follow-up they showed less improvement in quality of life, symptoms and global functioning than those randomised from oral medication. This difference was confined to patients rated as less than consistently adherent pre-randomisation. The relatively poor improvement in the patients prescribed an LAI pre-randomisation was ameliorated if they had been randomised to clozapine rather than another SGA. There was no advantage to being randomly assigned from an LAI at baseline to a non-clozapine oral SGA rather than an oral FGA. CONCLUSIONS:A switch at randomisation from an LAI to an oral antipsychotic was associated with poorer clinical and functional outcomes at 1-year follow-up compared with switching from one oral antipsychotic to another. This effect appears to be moderated by adherence, and may not extend to switching to clozapine. This has implications for clinical trial design: the drug from which a participant is randomised may have a greater effect than the drug to which they are randomised.

背景与目标：

BACKGROUND & AIMS: BACKGROUND AND PURPOSE:The roles of DTI and dynamic susceptibility contrast-enhanced-PWI in predicting the angiographic vascularity of meningiomas have not been studied. We aimed to investigate if these 2 techniques could reflect the angiographic vascularity of meningiomas. MATERIALS AND METHODS:Thirty-two consecutive patients with meningiomas who had preoperative dynamic susceptibility contrast-enhanced-PWI, DTI, and conventional angiography were retrospectively included. The correlations between angiographic vascularity of meningiomas, classified with a 4-point grading scale, and the clinical or imaging variables-age and sex of patient, as well as size, CBV, fractional anisotropy, and ADC of meningiomas-were analyzed. The meningiomas were dichotomized into high-vascularity and low-vascularity groups. The differences in clinical and imaging variables between the 2 groups were compared. Receiver operating characteristic curve analysis was used to determine the diagnostic performance of these variables. RESULTS:In meningiomas, angiographic vascularity correlated positively with CBV but negatively with fractional anisotropy. High-vascularity meningiomas demonstrated significantly higher CBV but lower fractional anisotropy as compared with low-vascularity meningiomas. In differentiating between the 2 groups, the area under the curve values were 0.991 for CBV and 0.934 for fractional anisotropy on receiver operating characteristic curve analysis. CONCLUSIONS:CBV and fractional anisotropy correlate well with angiographic vascularity of meningiomas. They may differentiate between low-vascularity and high-vascularity meningiomas.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:To evaluate the performance of diffusion-weighted imaging (DWI) against the reference standard of gadolinium-enhanced T1-weighted imaging (Gd-T1-WI) in children. METHODS:Thirty-nine consecutive patients (mean age 5.7 years) with suspected acute pyelonephritis underwent magnetic resonance imaging (MRI) including DWI and (the reference standard) Gd-T1-WI. Each study was read in double-blinded fashion by two radiologists. Each kidney was graded as normal or abnormal. Sensitivity and specificity of DWI were computed. Agreement between sequences and interobserver reproducibility were calculated (Cohen κ statistic and the McNemar tests). RESULTS:Thirty-two kidneys (41 %) had hypo-enhancing areas on Gd-T1-W images. The sensitivity and specificity of DWI were 100 % (32/32) and 93.5 % (43/46). DWI demonstrated excellent agreement (κ = 0.92,) with Gd-T1-W, with no significant difference (P = 0.25) in detection of abnormal lesions. Interobserver reproducibility was excellent with DWI (κ = 0.79). CONCLUSION:DWI enabled similar detection of abnormal areas to Gd-T1-WI and may provide an injection-free means of evaluation of acute pyelonephritis. KEY POINTS:• Diffusion weighted magnetic resonance imaging (DWI) can confirm acute pyelonepritis. • DWI provided comparable results to gadolinium enhanced T1-W MRI in acute pyelonepritis. • Contrast medium injection could be avoided for diagnosing acute pyelonephritis by MRI. • MRI with T2-WI and DWI provide a fast and comprehensive diagnostic tool.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:In the United States, chronic obstructive pulmonary disease (COPD) diagnosis is often a lengthy process, and consequently results in delays in treatment in early stages. Disease progression and complication may result in increased levels of healthcare service use. To understand the economic burden of COPD prior to diagnosis in the U.S., trends in utilization and costs during the period before initial COPD diagnosis were compared with matched controls. METHODS:A retrospective case-control study was conducted using medical and pharmacy claims data from a large managed care health plan representing a base population of over 30 million covered lives in the U.S. COPD patients with at least 12 months of continuous enrollment and aged 40 years or older were identified (n=28,968) and matched to up to three random controls (n=81,322) by age, gender, region of plans and index date. Multivariate regression models were used to estimate average incremental service use and cost between COPD patients and controls. Moreover, trends in utilization and costs for the COPD patients were examined over 36 months before diagnosis. RESULTS:COPD patients used 1.5-1.6 times more inpatient/emergency department (IP/ED) services and office visits compared to control patients. The average incremental annual costs for IP/ED services, office visits, and medical and pharmacy services were estimated at $550, $238, $1438 and $401, respectively, after adjusting for age, gender, region and comorbid conditions. The 36-month trend analysis showed that COPD patients' healthcare utilization and costs increased gradually over time, often with a marked increase in the month before COPD diagnosis. CONCLUSIONS:COPD patients in the U.S. consumed substantial healthcare services and costs prior to diagnosis. More timely diagnosis and subsequent treatment may avoid costly healthcare utilization and unnecessary mortality and morbidity post-diagnosis.

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