BACKGROUND & AIMS: The exact mechanism for the decrease in intestinal calcium absorption with age is not yet understood. A decrease with age in serum 1,25-dihydroxyvitamin D (1,25(OH)2D) or a decrease in the intestinal vitamin D receptor (VDR) protein concentration are possible causes. The objective of this study was to examine the effect of age on these factors. Fifty-nine young women age 25-35 years were compared with 41 elderly women age 65-83 years who underwent measurements of VDR, calcium absorption using a 20 mg and 100 mg calcium carrier, and calciotropic hormones. Calcium absorption by both tests was lower in the elderly women compared with the young women (p < 0.05). Serum 1,25(OH)2D and duodenal VDR protein concentration were not significantly different between the two age groups. Serum 1,25(OH)2D correlated with the 20 mg calcium absorption test in both young (r = 0.35, p < 0.007) and elderly women (r = 0.58, p < 0.0001) and with the 100 mg calcium absorption in the elderly (r = 0.32; p < 0.05). VDR did not correlate with calcium absorption in young women or elderly women, nor did VDR correlate with serum 1,25(OH)2D and serum 25-hydroxyvitamin D. In summary, the decrease in calcium absorption cannot be explained by a decrease in intestinal VDR. The correlation between serum 1,25(OH)2D and both calcium absorption tests only accounts for 12-30% of the variance in the age-related change in the calcium absorption tests. Other factors, not yet understood, are responsible for the decline in calcium absorption with age.

背景与目标： 随着年龄的增长，肠道钙吸收减少的确切机制尚不清楚。血清1,25-二羟基维生素D（1,25（OH）2D）随年龄的减少或肠道维生素D受体（VDR）蛋白质浓度的减少是可能的原因。这项研究的目的是研究年龄对这些因素的影响。比较了59名年龄在25-35岁之间的年轻女性与41位年龄在65-83岁之间的女性，这些女性进行了VDR测量，使用20 mg和100 mg钙载体的钙吸收量以及亲钙性激素。与年轻女性相比，老年女性的两种测试中的钙吸收均较低（p <0.05）。在两个年龄组之间，血清1,25（OH）2D和十二指肠VDR蛋白浓度无显着差异。血清1,25（OH）2D与年轻（r = 0.35，p <0.007）和老年妇女（r = 0.58，p <0.0001）的20 mg钙吸收测试以及老年人的100 mg钙吸收相关（r ＝ 0.32； p ＜0.05）。 VDR与年轻妇女或老年妇女的钙吸收无关，也不与血清1,25（OH）2D和血清25-羟维生素D相关。 VDR。血清1,25（OH）2D与两种钙吸收试验之间的相关性仅占钙吸收试验中与年龄相关的变化方差的12％至30％。钙吸收随着年龄的增长而下降的其他原因尚不明确。

BACKGROUND & AIMS: BACKGROUND:The human somatosensory system comprises dissociable paths for discriminative and affective touch, reflected in separate peripheral afferent populations and distinct cortical targets. Differences in behavioral and neural responses to affective touch may have an important developmental role in early social experiences, which are relevant for autism spectrum disorder (ASD). METHODS:Using probabilistic tractography, we compared the structural integrity of white matter pathways for discriminative and affective touch in young children with ASD and their typically developing (TD) peers. We examined two tracts: (1) a tract linking the thalamus with the primary somatosensory cortex, which carries discriminative tactile information, and (2) a tract linking the posterior insula-the cortical projection target of unmyelinated tactile afferents mediating affective touch-with the anterior insula, which integrates sensory and visceral inputs to interpret emotional salience of sensory stimuli. We investigated associations between tract integrity and performance on a standardized observational assessment measuring tactile discrimination and affective responses to touch. RESULTS:Both the thalamocortical and intrainsular tracts showed reduced integrity (higher mean diffusivity) in the ASD group compared to those in the TD group. Consistent with the previous findings, the ASD group exhibited impaired tactile discriminative ability, more tactile defensiveness, and more sensory seeking (e.g., enthusiastic play or repetitive engagement with a specific tactile stimulus). There was a significant relation between intrainsular tract integrity and tactile seeking. The direction of this relation differed between groups: higher intrainsular mean diffusivity (MD) (reflecting decreased tract integrity) was associated with increased tactile seeking in the TD group but with decreased tactile seeking in the ASD group. In the TD group, decreased tactile defensiveness was also associated with higher intrainsular MD, but there was no relation in the ASD group. Discriminative touch was not significantly associated with integrity of either tract in either group. CONCLUSIONS:These results support previous findings suggesting a central role for the insula in affective response to touch. While both discriminative and affective touch and both somatosensory tracts are affected in ASD, the restriction of brain-behavior associations to the intrainsular tract and tactile seeking suggests more complex and perhaps higher-order influence on differences in tactile defensiveness and discrimination.

背景与目标： 背景：人体体感系统包括区分性和情感性接触的可分离路径，分别反映在不同的周围传入群体和不同的皮层目标中。行为和神经对情感接触的反应差异可能在早期的社会经历中具有重要的发展作用，这与自闭症谱系障碍（ASD）有关。
方法：我们使用概率束摄影术，比较了ASD幼儿和典型的发展中（TD）同伴的辨别性和情感性触觉的白质通路的结构完整性。我们检查了两个通道：（1）将丘脑与初级体感皮层相连的通道，该通道带有可分辨的触觉信息；（2）将后岛绝缘体（未髓鞘的触觉传入的皮层投射目标与介导情感接触的皮层投射目标）相连接的通道。前岛绝缘，整合了感觉和内脏的输入，以解释感觉刺激的显着性。在标准的观察评估中，我们研究了管道完整性与性能之间的关联，该评估评估了触觉辨别力和对触摸的情感反应。
结果：与TD组相比，ASD组的丘脑皮质和脑内束道均显示完整性降低（平均扩散率更高）。与之前的发现一致，ASD组表现出触觉辨别能力受损，触觉防御能力增强和寻求更多感官感受（例如，对特定触觉刺激的热情玩耍或反复参与）。道内完整性与触觉寻求之间存在显着的关系。各组之间的这种关系的方向是不同的：TD组的较高的趾内平均扩散度（MD）（反映了管道完整性的降低）与触觉的增加相关，而ASD组的触觉的下降相关。在TD组中，触觉防御力下降也与较高的总动脉内MD有关，但在ASD组中则没有关系。辨别性触觉与两组中任何一条道的完整性均无显着相关性。
结论：这些结果支持以前的发现，表明绝缘体在对触摸的情感反应中起着核心作用。尽管区分性和情感性接触以及体感束都受到ASD的影响，但脑行为关联对束缚束和触觉的限制表明对触觉防御和辨别力差异的影响可能更为复杂，甚至可能更高。

BACKGROUND & AIMS: OBJECTIVES:To describe the prevalence of oral diseases and their impact on oral-health-related quality of life in people with severe mental illness undertaking community-based psychiatric care. METHODS:A survey was conducted at eight outpatient psychiatric care clinics in Tower Hamlets, London, UK. One hundred and twelve consecutive patients with mental illness were invited to participate in this study. They were clinically examined and asked to complete the oral health impact profile (OHIP) questionnaire. RESULTS:The response rate was 79% (n = 89); 57 (64%) males and 58 persons over 45 years of age (65%) participated in this survey. Overall OHIP score was 25.4 (95% CI 23.3, 27.4), 70 (78%) were smokers and 45 (51%) had been to the dentist in the last two years. Forty-seven (53%) respondents had caries in at least one tooth, 60 (67%) had 21 teeth and more, and 14 (16%) used dentures. Advanced periodontal treatment was indicated in 42 (55%) of patients and 52.8% (n = 47) patients reported current pain. CONCLUSION:Overall, this survey found that oral health has a great impact on patients with severe mental illness being treated in the community setting and their oral health is poorer than the national adult general population. Future research should consider the causes that relate to the poorer oral health in this population and potential health promotion mechanisms in this population to encourage an upstream approach to health.

背景与目标： 目的：描述接受社区精神病治疗的重度精神疾病患者的口腔疾病患病率及其对口腔健康相关生活质量的影响。
方法：在英国伦敦塔哈姆雷特市的八家门诊精神病诊所进行了一项调查。连续邀请112名精神疾病患者参加这项研究。对他们进行了临床检查，并要求他们填写口腔健康影响概况（OHIP）问卷。
结果：回应率为79％（n = 89）；男性（57％）（64％）和58岁以上的58人（65％）参加了这项调查。 OHIP总体得分为25.4（95％CI 23.3、27.4），吸烟者为70（78％），最近两年去牙医的患者为45（51％）。 47名（53％）的被调查者的至少一颗牙齿上有龋齿； 60（67％）的人有21颗及以上的牙齿，以及14颗（16％）的假牙。 42名（55％）患者表示进行了牙周治疗，目前有疼痛的患者占52.8％（n = 47）。
结论：总体而言，该调查发现，口腔健康对在社区环境中接受治疗的严重精神疾病患者有很大影响，并且其口腔健康比全国成年人口还差。未来的研究应考虑与该人群口腔健康较差的原因以及该人群中潜在的健康促进机制，以鼓励采用上游健康方法。

BACKGROUND & AIMS: Importance:Opioid use disorder (OUD) frequently begins in adolescence and young adulthood. Intervening early with pharmacotherapy is recommended by major professional organizations. No prior national studies have examined the extent to which adolescents and young adults (collectively termed youth) with OUD receive pharmacotherapy. Objective:To identify time trends and disparities in receipt of buprenorphine and naltrexone among youth with OUD in the United States. Design, Setting, and Participants:A retrospective cohort study was conducted using deidentified data from a national commercial insurance database. Enrollment and complete health insurance claims of 9.7 million youth, aged 13 to 25 years were analyzed, identifying individuals who received a diagnosis of OUD between January 1, 2001, and June 30, 2014, with final follow-up date December 31, 2014. Analysis was conducted from April 25 to December 31, 2016. Time trends were identified and multivariable logistic regression was used to determine sociodemographic factors associated with medication receipt. Exposures:Sex, age, race/ethnicity, neighborhood education and poverty levels, geographic region, census region, and year of diagnosis. Main Outcomes and Measures:Dispensing of a medication (buprenorphine or naltrexone) within 6 months of first receiving an OUD diagnosis. Results:Among 20 822 youth diagnosed with OUD (0.2% of the 9.7 million sample), 13 698 (65.8%) were male and 17 119 (82.2%) were non-Hispanic white. Mean (SD) age was 21.0 (2.5) years at the first observed diagnosis. The diagnosis rate of OUD increased nearly 6-fold from 2001 to 2014 (from 0.26 per 100 000 person-years to 1.51 per 100 000 person-years). Overall, 5580 (26.8%) youth were dispensed a medication within 6 months of diagnosis, with 4976 (89.2%) of medication-treated youth receiving buprenorphine and 604 (10.8%) receiving naltrexone. Medication receipt increased more than 10-fold, from 3.0% in 2002 (when buprenorphine was introduced) to 31.8% in 2009, but declined in subsequent years (27.5% in 2014). In multivariable analyses, younger individuals were less likely to receive medications, with adjusted probability for age 13 to 15 years, 1.4% (95% CI, 0.4%-2.3%); 16 to 17 years, 9.7% (95% CI, 8.4%-11.1%); 18 to 20 years, 22.0% (95% CI, 21.0%-23.0%); and 21 to 25 years, 30.5% (95% CI, 30.0%-31.5%) (P < .001 for difference). Females (7124 [20.3%]) were less likely than males (13 698 [24.4%]) to receive medications (P < .001), as were non-Hispanic black (105 [14.8%]) and Hispanic (1165 [20.0%]) youth compared with non-Hispanic white (17 119 [23.1%]) youth (P < .001). Conclusions and Relevance:In this first national study of buprenorphine and naltrexone receipt among youth, dispensing increased over time. Nonetheless, only 1 in 4 commercially insured youth with OUD received pharmacotherapy, and disparities based on sex, age, and race/ethnicity were observed.

背景与目标： 重要性：阿片类药物使用障碍（OUD）经常在青春期和成年期开始。主要专业组织建议尽早进行药物治疗。以前的国家研究都没有研究OUD的青少年和年轻人（统称为青年）接受药物治疗的程度。
目的：确定美国OUD青年中丁丙诺啡和纳曲酮的接受时间趋势和差异。
设计，地点和参与者：使用来自国家商业保险数据库的身份不明数据进行回顾性队列研究。分析了970万年龄在13至25岁之间的970万青年的入学和完全健康保险理赔，确定了在2001年1月1日至2014年6月30日期间被诊断为OUD的个人，最终随访日期为2014年12月31日。分析于2016年4月25日至12月31日进行。确定了时间趋势，并使用多变量logistic回归确定与用药相关的社会人口统计学因素。
暴露：性别，年龄，种族/民族，邻里教育和贫困程度，地理区域，人口普查区域和诊断年份。
主要结果和措施：在首次接受OUD诊断后的6个月内分发药物（丁丙诺啡或纳曲酮）。
结果：在20822名被诊断为OUD的青年中（占970万样本的0.2％），男性中有13698名（65.8％），非西班牙裔白人中有17119名（82.2％）。在首次观察到的诊断中，平均（SD）年龄为21.0（2.5）岁。从2001年到2014年，OUD的诊断率增长了近6倍（从每100000人年0.26增至每100000人年1.51）。总体而言，在诊断后的6个月内分配了5580（26.8％）名年轻人用药，其中接受丁丙诺啡的4976（89.2％）名接受药物治疗的青年人和接受纳曲酮的604名（10.8％）。药物治疗的收入增加了十倍以上，从2002年的3.0％（引入丁丙诺啡时）到2009年的31.8％，但随后几年却下降了（2014年为27.5％）。在多变量分析中，年龄较小的个体接受药物治疗的可能性较小，年龄调整为13至15岁的概率为1.4％（95％CI，0.4％-2.3％）； 16至17年，9.7％（95％CI，8.4％-11.1％）； 18至20年，22.0％（95％CI，21.0％-23.0％）；和21至25年，分别为30.5％（95％CI，30.0％-31.5％）（差异P <<。001）。与非西班牙裔黑人（105名[14.8％]）和西班牙裔（1165名[20.0]）相比，女性（7124名[20.3％]）与男性（13698名[24.4％]）接受药物治疗的可能性较小（P <.001）。 ％]的年轻人与非西班牙裔白人（17119 [23.1％]）的年轻人相比（P <）。001）。
结论和相关性：在这项关于丁丙诺啡和纳曲酮的年轻人接受的首次国家研究中，随着时间的流逝，配药量增加。尽管如此，只有四分之一的有OUD的商业保险青年接受了药物治疗，并且观察到了基于性别，年龄和种族/民族的差异。

BACKGROUND & AIMS: OBJECTIVE:To measure chlamydia testing and positivity rates among 16-39 year olds attending Aboriginal Community Controlled Health Services (ACCHSs). METHODS:Retrospective non-identifiable computerised records containing consultation and chlamydia testing data were collected for patients (16-39 years) attending eight ACCHSs during 2008-09 in urban, regional and remote settings for the Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) system. Annual chlamydia testing and positivity rates were estimated. RESULTS:Over two years, 13,809 patients aged 16-39 years (57.8% female, 82.3% Aboriginal or Torres Strait Islander) attended. The annual overall chlamydia testing rate was 13.0% (2008) and 16.0% (2009). Testing rates were higher among females (p<0.001) and among patients aged 16-29 than 30-39 years (males: p=0.01; females: p<0.001). Chlamydia positivity was 8.5% overall; similar in females (8.7%) and males (7.8%) (p=0.46); highest among 16-19 years (females: 17.4%; males: 13.0%), declining to 1.5% among females 35-39 years (p<0.001) and 4.8% among males 30-34 years (p<0.001). CONCLUSIONS:Chlamydia testing at these ACCHSs approached recommended levels among some patient groups, however, it should increase. High positivity among younger people highlights they should be targeted. IMPLICATIONS:Young people should be targeted for sexual health interventions. ACCHSs are well placed to provide enhanced sexual health services if appropriately resourced.

背景与目标： 目的：测量参加原住民社区控制健康服务（ACCHS）的16-39岁人群的衣原体检测和阳性率。
方法：收集了2008-09年间在城市，区域和偏远地区参加澳大利亚AC衣原体增强前哨监视协作组织（ACCESS）的八个ACCHS的患者（16-39岁）的回顾性，不可识别的计算机记录，其中包含咨询和衣原体检测数据系统。估计每年的衣原体检测和阳性率。
结果：两年多来，共有13809名年龄在16-39岁之间的患者（女性占57.8％，原住民或托雷斯海峡岛民占82.3％）参加了研究。每年的衣原体总检出率分别为13.0％（2008年）和16.0％（2009年）。女性和16-29岁的患者的测试率高于30-39岁的患者（p <0.001）（男性：p = 0.01；女性：p <0.001）。衣原体阳性率为8.5％。女性（8.7％）和男性（7.8％）相似（p = 0.46）；在16-19岁之间最高（女性：17.4％；男性：13.0％），在35-39岁的女性中下降到1.5％（p <0.001），在30-34岁的男性中下降到4.8％（p <0.001）。
结论：这些ACCHS的衣原体检测在某些患者组中已达到推荐水平，但应增加。年轻人中的高度积极性凸显了他们应该成为目标。
后果：应该针对年轻人进行性健康干预。如果资源适当，ACCHS可以提供​​更好的性健康服务。

BACKGROUND & AIMS: :The effect of ascorbic acid on iron retention from a diet with predicted low iron bioavailability (containing minimal meat and ascorbic acid) was investigated in iron-depleted premenopausal women. Eleven women were depleted of storage iron (indicated by serum ferritin) through a combination of diet (5.0 mg Fe/2000 kcal for 67-88 d) and phlebotomy. They then consumed a diet containing 13.7 mg Fe/2000 kcal, supplemented with placebo or ascorbic acid three times daily (1500 mg total) with meals for 5.5 wk. Ascorbic acid improved apparent iron absorption (balance method) [38 +/- 2% (means +/- SEM) vs 27 +/- 2%]. Ascorbic acid also improved hemoglobin, erythrocyte protoporphyrins, and serum iron but not hematocrit, serum ferritin, iron-binding capacity, or transferrin saturation. In iron-depleted women consuming a diet with predicted poor iron availability, ascorbic acid supplementation enhanced body iron retention for 5.5 wk.

背景与目标： ：在缺铁的绝经前妇女中研究了抗坏血酸对铁的生物滞留量具有预期低铁含量（含少量肉和抗坏血酸）的饮食中铁保留的影响。通过饮食（5.0 mg Fe / 2000 kcal，67-88 d）和静脉放血相结合，耗尽了11名妇女的铁储备（以血清铁蛋白表示）。然后，他们进食了含有13.7 mg Fe / 2000 kcal的饮食，每天补充3次（共1500 mg）安慰剂或抗坏血酸，并进餐5.5周。抗坏血酸提高了表观铁的吸收（平衡法）[38 /-2％（平均值/-SEM）对27 /-2％]。抗坏血酸还可以改善血红蛋白，红血球原卟啉和血清铁，但不能改善血细胞比容，血清铁蛋白，铁结合能力或转铁蛋白饱和度。在饮食中铁含量低的女性中，铁的可利用性预计较差，补充抗坏血酸可增加体内铁保持5.5周的能力。

BACKGROUND & AIMS: :The possible combined effects of caffeine and exercise on blood pressure (BP) regulation were examined in 34 healthy, normotensive (BP less than 135/85 mm Hg) young men (mean age 27 +/- 3 years) in a placebo-controlled, double-blind crossover design. Each subject performed submaximal and symptom-limited maximal supine bicycle exercise 1 hour apart after ingestion of placebo or caffeine (3.3 mg/kg). Heart rate, BP, cardiac output and peripheral vascular resistance were compared for placebo and caffeine days. Postdrug baseline showed that caffeine increased systolic and diastolic BP and peripheral vascular resistance (p less than 0.001 for each) and decreased heart rate (p less than 0.01) but did not change stroke volume or cardiac output. BP and vascular resistance effects of caffeine remained during submaximal exercise resulting in an additive increase in BP while negative chronotropic effects of caffeine disappeared. At maximal exercise substantially more subjects (15 on caffeine vs 7 on placebo, p less than 0.02) had systolic BP greater than or equal to 230 mm Hg and/or greater than or equal to 100 mm Hg for diastolic BP. Plasma norepinephrine levels were not significantly different across days, but epinephrine was higher at maximal exercise and cortisol was increased post-drug and throughout maximal exercise on caffeine days. Data indicate that caffeine increases BP additively during submaximal exercise and may cause excessive BP responses at maximal exercise for some individuals. The pressor effects of caffeine appear to be due to increasing vascular resistance rather than cardiac output.

背景与目标： ：在安慰剂对照的34名健康，血压正常（血压低于135/85 mm Hg的年轻人）（平均年龄27 /-3岁）中，研究了咖啡因和运动对血压（BP）调节的可能联合作用，双盲交叉设计。服用安慰剂或咖啡因（3.3 mg / kg）后，每位受试者间隔1小时进行次最大和症状受限的最大仰卧自行车运动。比较安慰剂和咖啡因天的心率，血压，心输出量和外周血管阻力。药物后基线显示，咖啡因可增加收缩压和舒张压以及周围血管阻力（每个P值均小于0.001）和降低心率（P值均小于0.01），但并未改变中风量或心输出量。在极少运动的情况下，咖啡因对血压和血管阻力的影响仍然存在，从而导致血压的累加增加，而咖啡因的负变时效作用消失了。在最大程度的运动中，更多的受试者（咖啡因为15，安慰剂为7，p小于0.02）的收缩压大于或等于230 mm Hg和/或舒张压大于或等于100 mm Hg。血浆去甲肾上腺素水平在各天之间无显着差异，但在最大运动量时，肾上腺素较高，而在咖啡因日后和整个最大运动量中，皮质醇增加。数据表明，咖啡因在次最大运动量时会增加BP，并且可能对某些个体在最大运动量时导致过度的BP反应。咖啡因的升压作用似乎是由于血管阻力增加而非心输出量增加所致。

BACKGROUND & AIMS: :The effects of temporal variation in the quality of short-lived annual plants on oviposition preference and larval performance of insect herbivores has thus far received little attention. This study examines the effects of plant age on female oviposition preference and offspring performance in the large cabbage white butterfly Pieris brassicae. Adult female butterflies lay variable clusters of eggs on the underside of short-lived annual species in the family Brassicaceae, including the short-lived annuals Brassica nigra and Sinapis arvensis, which are important food plants for P. brassicae in The Netherlands. Here, we compared oviposition preference and larval performance of P. brassicae on three age classes (young, mature, and pre-senescing) of B. nigra and S. arvensis plants. Oviposition preference of P. brassicae declined with plant age in both plant species. Whereas larvae performed similarly on all three age classes in B. nigra, preference and performance were weakly correlated in S. arvensis. Analysis of primary (sugars and amino acids) and secondary (glucosinolates) chemistry in the plant shoots revealed that differences in their quality and quantity were more pronounced with respect to tissue type (leaves vs. flowers) than among different developmental stages of both plant species. Butterflies of P. brassicae may prefer younger and smaller plants for oviposition anticipating that future plant growth and size is optimally synchronized with the final larval instar, which contributes >80% of larval growth before pupation.

背景与目标： ：短寿命一年生植物质量的时间变化对昆虫食草动物的产卵偏好和幼虫性能的影响迄今很少受到关注。这项研究调查了大白菜白蝴蝶皮菜芸of科植物年龄对雌性产卵偏好和后代性能的影响。成年雌性蝴蝶在芸苔科短寿命的一年生物种的底下产下可变的卵簇，包括短寿命的一年生的芸苔和西纳皮斯arvensis，它们是荷兰芸苔假单胞菌的重要食用植物。在这里，我们比较了B. nigra和S. arvensis植物在三个年龄等级（年轻，成熟和衰老前）上的P. brasicae的产卵偏好和幼虫性能。在这两种植物中，芸苔假单胞菌的产卵偏好都随着植物年龄的增长而下降。尽管黑斑病菌在所有三个年龄段的幼虫表现相似，但在欧文氏菌中，偏好和性能之间的相关性很弱。对植物嫩芽中主要（糖和氨基酸）和次要（芥子油苷）化学的分析表明，与两种植物物种的不同发育阶段相比，组织类型（叶与花）的质量和数量差异更为明显。 。芸苔假单胞菌的蝴蝶可能更喜欢较小和较小的植物进行产卵，因为预期将来的植物生长和大小与最终幼虫期最佳同步，这在化in之前贡献了80％以上的幼虫生长。

BACKGROUND & AIMS: BACKGROUND:The process and preparation of moving from child to adult services (transition) is a challenging period of time for young people and represents significant changes in care and support systems. The proliferation of mobile phone applications for health purposes suggests that it is an area for further investigation. OBJECTIVE:The review explores the potential to use mobile phone technology to help support young liver transplant recipients moving to adult services. It represents the first review conducted in this specialism and considers a new model of support for young liver patients. METHODS:A systematic rapid review of the published peer-reviewed literature. RESULTS:Two searches were conducted: Search 1: the use of technology to support transition to adult services (6 studies) and Search 2: how best to support liver transplant recipients during transition (6 studies). DISCUSSION:Research shows that to achieve positive transition young people need information about their condition and transition. The process needs to be guided by transition readiness, rather than the young persons' age. Although parents and support networks should be in place and are valued, transition should build upon self-management and independence. Results suggest that there appears to be scope to use mobile phone technology to support transition. This is the first time a review has explored the types of issues or concerns facing liver transplant patients and how these can be addressed through mobile phone technology.

背景与目标： 背景：从儿童服务到成人服务（过渡）的过程和准备工作对年轻人来说是一个充满挑战的时期，代表了护理和支持系统的重大变化。出于健康目的，手机应用的激增表明这是一个需要进一步研究的领域。
目的：该评论探讨了使用手机技术来帮助支持年轻的肝移植受助者转为成人服务的潜力。它代表了该专业的首次审查，并考虑了一种为年轻肝病患者提供支持的新模式。
方法：对已发表的同行评审文献进行系统的快速综述。
结果：进行了两次搜索：搜索1：使用技术支持向成人服务的过渡（6个研究）；搜索2：如何在过渡期间最好地支持肝移植接受者（6个研究）。
讨论：研究表明，要实现积极的过渡，年轻人需要有关其状况和过渡的信息。该过程需要以过渡的准备程度为指导，而不是以年轻人的年龄为指导。尽管父母和支持网络应到位并受到重视，但过渡应建立在自我管理和独立性的基础上。结果表明，似乎有可能使用手机技术来支持过渡。这是第一次审查肝移植患者面临的问题或疑虑的类型以及如何通过移动电话技术解决这些问题。

BACKGROUND & AIMS: :Achieving 'universal access' to antiretroviral HIV treatment (ART) in lower income and transitional settings is a global target. Yet, access to ART is shaped by local social condition and is by no means universal. Qualitative studies are ideally suited to describing how access to ART is socially situated. We explored systemic barriers to accessing ART among people who inject drugs (PWID) in a Russian city (Ekaterinburg) with a large burden of HIV treatment demand. We undertook 42 in-depth qualitative interviews with people living with HIV with current or recent experience of injecting drug use. Accounts were analysed thematically, and supplemented here with an illustrative case study. Three core themes were identified: 'labyrinthine bureaucracy' governing access to ART; a 'system Catch 22' created by an expectation that access to ART was conditional upon treated drug use in a setting of limited drug treatment opportunity; and 'system verticalization', where a lack of integration across HIV, tuberculosis (TB) and drug treatment compromised access to ART. Taken together, we find that systemic factors play a key role in shaping access to ART with the potential adverse effects of reproducing treatment initiation delay and disengagement from treatment. We argue that meso-level systemic factors affecting access to ART for PWID interact with wider macro-level structural forces, including those related to drug treatment policy and the social marginalization of PWID. We note the urgent need for systemic and structural changes to improve access to ART for PWID in this setting, including to simplify bureaucratic procedures, foster integrated HIV, TB and drug treatment services, and advocate for drug treatment policy reform.

背景与目标： ：在较低的收入和过渡环境中实现对抗逆转录病毒HIV治疗（ART）的“普遍获得”是全球目标。然而，获得抗逆转录病毒药物的途径取决于当地的社会状况，绝不是普遍的。定性研究非常适合描述获得抗逆转录病毒疗法在社会上的位置。我们探索了在俄罗斯城市（叶卡捷琳堡）注射艾滋病毒（HIV）需求量很大的注射毒品者（PWID）中获取ART的系统性障碍。我们对具有当前或最近注射吸毒经验的艾滋病毒感染者进行了42次深入的定性访谈。对帐目进行了主题分析，并在此处补充了说明性的案例研究。确定了三个核心主题：控制获取抗逆转录病毒药物的“迷宫式官僚主义”；期望在有限的药物治疗机会的情况下获得抗病毒药物的条件是要获得抗逆转录病毒药物而创建的“系统捕​​获22”；以及“系统垂直化”，即艾滋病毒，结核病和药物治疗之间缺乏整合，影响了抗逆转录病毒疗法的获取。综上所述，我们发现系统性因素在影响获得ART的过程中起着关键作用，并具有再生治疗起始延迟和脱离治疗的潜在不利影响。我们认为影响PWID获得抗逆转录病毒疗法的中观系统性因素与更广泛的宏观结构性相互作用，包括那些与药物治疗政策和PWID的社会边缘化有关的因素。我们注意到迫切需要进行系统和结构上的改革，以改善在这种情况下PWID获得抗逆转录病毒疗法的机会，包括简化官僚程序，促进艾滋病毒，结核病和药物治疗的综合服务以及倡导药物治疗政策改革。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: BACKGROUND:Testosterone replacement in hypogonadal males improves body composition, sexual function, and health-related quality of life. Male cancer survivors are at risk of androgen deficiency; however, when and in whom testosterone should be replaced remain unanswered questions. OBJECTIVE:The aim of our study was to define the prevalence of androgen deficiency in this patient group through assessment of testosterone levels and related measures. DESIGN:This was a cross-sectional, observational study of cases and controls. We recruited 176 cancer survivors and 213 controls, aged 25-45 yr. RESULTS:Of cancer survivors, 97% had received chemotherapy and 40% radiotherapy. Cancer survivors had lower total testosterone (tT) levels than controls (mean difference 2.67 nmol/liter; 95% confidence interval 1.58-3.76; P = 0.003), and 24 of 176 (13.6%; 95% confidence interval 9.3-19.5) had a tT less than 10 nmol/liter, which was less than 2.5% centile for controls. Cancer survivors had a greater fat mass, higher fasting insulin and glucose levels, increased fatigue, and reduced sexual function and health-related quality of life. In both cohorts, the tT correlated negatively with insulin levels and negatively with body fat mass; however, the difference in tT between them was independent of fat mass. We measured tT and SHBG and calculated bioavailable testosterone. The changes in calculated bioavailable testosterone were similar to tT. CONCLUSIONS:A significant proportion of young male cancer survivors had a frankly low tT associated with an increased fat mass and insulin level compared with controls. These factors would be predicted to improve in response to testosterone replacement therapy and provide a powerful argument for an interventional study of testosterone therapy in young male cancer survivors.

背景与目标： 背景：性腺功能减退男性中的睾丸激素替代可改善身体组成，性功能以及与健康相关的生活质量。男性癌症幸存者有雄激素缺乏症的风险；然而，何时何地应更换睾丸激素仍未解决。
目的：我们的研究目的是通过评估睾丸激素水平和相关措施来确定该患者组中雄激素缺乏症的患病率。
设计：这是对病例和对照的横断面观察性研究。我们招募了176位年龄在25-45岁之间的癌症幸存者和213位对照。
结果：在癌症幸存者中，有97％接受了化疗，而40％接受了放疗。癌症幸存者的总睾丸激素（tT）水平低于对照组（平均差异2.67 nmol /升; 95％置信区间1.58-3.76; P = 0.003），176人中有24人（13.6％; 95％置信区间9.3-19.5） tT小于10 nmol /升，对于对照而言，小于2.5％百分位。癌症幸存者的脂肪量更大，空腹胰岛素和葡萄糖水平更高，疲劳加剧，性功能下降以及与健康相关的生活质量下降。在这两个队列中，tT与胰岛素水平呈负相关，与体脂质量呈负相关。但是，它们之间的tT差异与脂肪量无关。我们测量了tT和SHBG，并计算了生物利用睾丸激素。计算的生物利用睾丸激素的变化与tT相似。
结论：与对照组相比，相当大比例的年轻男性男性癌症幸存者的tT明显较低，与脂肪量和胰岛素水平增加有关。这些因素预计将对睾丸激素替代疗法的反应有所改善，并为年轻男性癌症幸存者进行睾丸激素疗法的干预研究提供有力论据。

BACKGROUND & AIMS: OBJECTIVE:This survey study explores the relationship between area-specific perceived self-competence, perceived social support, gender, and substance use in young adolescents. METHOD:Questionnaires were administered to 140 male and 131 female adolescents attending middle school to assess self-perception of competencies, social support, and substance use. Correlations were performed between the predictor variables and the substance use measures. Hierarchical multiple regressions were also used to identify potential interactions between gender, perceived competencies, and perceived social support in the prediction of specific substances. RESULTS:Higher perceived scholastic competence was associated with less substance use in both genders. In boys, more perceived support from teachers, and to a lesser degree parents, was associated with less substance use, particularly in those with low scholastic competence. In girls, social support was unrelated to substance use except for support from classmates, which was associated with more cigarette and marijuana use. However, in girls with low scholastic competence, more support from peers was consistently associated with more substance use. CONCLUSIONS:The gender differences in risk factors for early substance use identified in this study deserve further investigation, in view of their potential relevance for adolescent substance abuse prevention and early intervention.

背景与目标： 目的：这项调查研究探讨了特定地区的感知自我能力，感知社会支持，性别和青少年吸毒之间的关系。
方法：对140名上中学的男性和131名女性青少年进行问卷调查，以评估他们对能力，社会支持和药物使用的自我感觉。在预测变量和物质使用度量之间进行了相关。分层多元回归还用于确定特定物质的预测中性别，感知能力和感知社会支持之间的潜在相互作用。
结果：较高的认知能力与较少使用毒品有关。在男孩中，老师和较低程度的父母给予更多支持的感觉与减少毒品的使用有关，特别是在那些学力不强的人中。在女孩中，除了同学的支持外，社会支持与毒品的使用无关，后者与吸烟和大麻的使用有关。然而，在学力低下的女孩中，同龄人更多的支持始终与更多的吸毒相关。
结论：鉴于本研究对青少年药物滥用的预防和早期干预具有潜在的相关性，本研究中确定的早期药物使用危险因素中的性别差异值得进一步调查。

BACKGROUND & AIMS: OBJECTIVE:The objective of our study was to evaluate whether 0.3-second cine CT can be used to detect air trapping in the lungs of young children. SUBJECTS AND METHODS:In 30 children (mean age, 25 months), 0.3-second cine CT was performed at six levels during 3 seconds of quiet breathing. The study population was divided into an air trapping group (n = 24) and a no-air trapping group (n = 6). Lung density was measured at an abnormal area (with or without air trapping) and an adjacent normal area on inspiratory and expiratory phase images. Lung density differences between inspiration and expiration were calculated and compared in abnormal areas (with or without air trapping) and in normal areas. Their percentages were calculated and compared between the two groups. In addition, lung density differences between abnormal and adjacent normal areas were calculated and compared between the two groups. RESULTS:Lung density differences between inspiration and expiration were smaller in areas with air trapping (mean +/- SD, -19 +/- 34 H) than in abnormal areas without air trapping (138 +/- 36 H) (p < 0.001) or in normal areas (111 +/- 49 H) (p < 0.001). Their percentages were smaller in the group with air trapping (-27% +/- 54%) than in the group with no air trapping (120% +/- 87%) (p < 0.001). In the group with air trapping, lung density differences were larger at the expiratory phase (260 +/- 77 H) than at the inspiratory phase (129 +/- 69 H) (p < 0.001), but did not change through the respiratory cycle in the group with no air trapping (p > 0.05). CONCLUSION:Air trapping can be accurately detected in the lungs of free-breathing young children using 0.3-second cine CT.

背景与目标： 目的：本研究的目的是评估0.3秒的电影CT是否可用于检测年幼儿童肺部的空气滞留情况。
研究对象和方法：在30名儿童（平均年龄25个月）中，在安静呼吸的3秒内以六个级别进行了0.3秒的电影CT检查。研究人群分为空气诱捕组（n = 24）和无空气诱捕组（n = 6）。在吸气和呼气相位图像上的异常区域（有或没有空气滞留）和相邻的正常区域测量肺密度。计算了吸气和呼气之间的肺密度差异，并在异常区域（有或没有空气滞留）和正常区域中进行了比较。计算他们的百分比，并在两组之间进行比较。此外，计算并比较了正常和邻近正常区域之间的肺密度差异。
结果：有空气滞留的区域（平均/-SD，-19 /-34 H）的吸气和呼气之间的肺密度差异要小于没有空气滞留的异常区域（138 /-36 H）（p <0.001）或在有空气滞留的区域。正常区域（111 /-49 H）（p <0.001）。空气滞留组的百分比（-27％/-54％）比没有空气滞留组的百分比（120％/-87％）小（p <0.001）。在有空气滞留的组中，呼气阶段（260 /-77 H）的肺密度差异大于吸气阶段（129 /-69 H）的肺密度差异（p <0.001），但在整个呼吸周期中没有变化。没有空气滞留的组（p> 0.05）。
结论：使用0.3秒的电影CT可以准确地检测自由呼吸的幼儿的肺部空气捕获。

BACKGROUND & AIMS: STUDY DESIGN:A descriptive cadaveric study incorporating a novel nerve root marking technique. OBJECTIVES:To describe the displacement and strain of the lumbosacral nerve roots in the lateral recess during straight leg raise (SLR) without disrupting the foraminal ligaments. SUMMARY OF BACKGROUND DATA:Previous studies document 2 to 8 mm of lumbosacral nerve root displacement during SLR. Prior dissection methods incorporated laminectomy and facetectomy. METHODS:Lower limbs and associated nerve roots of 5 unembalmed cadavers (n = 10) were studied. Metal markers were inserted intraneurally within the lateral recess of L4, L5, and S1 with a modified spinal needle. Fluoroscopic images were digitized to evaluate displacement and strain during SLR. RESULTS:The lumbosacral nerve roots in the lateral recess moved less and experienced less strain during SLR than described in previously published reports. Statistically significant distal displacement occurred at hip positions greater than 60 degrees of flexion at all nerve root levels (P < 0.01). CONCLUSIONS:The lumbosacral nerve roots (L4, L5, S1) moved less and underwent less strain during SLR testing than previously reported and may require hip motion greater than 60 degrees to produce substantive displacement in the lateral recess. Additional research is needed to examine the effects of prepositioning during SLR.

背景与目标： 研究设计：描述性尸体研究，结合了新的神经根标记技术。
目的：描述直腿抬高（SLR）过程中腰recess部腰s神经根的位移和张力，而不会破坏孔韧带。
背景资料摘要：先前的研究记录了SLR期间腰s神经根移位2至8 mm。先前的解剖方法包括椎板切除术和小平面切除术。
方法：研究了5只无肢尸体（n = 10）的下肢和相关的神经根。用改良的脊柱针将金属标记物插入L4，L5和S1的侧凹内。将荧光镜图像数字化以评估SLR期间的位移和应变。
结果：与先前发表的报告相比，SLR期间腰recess外侧的腰s神经根移动较少，并且承受的张力较小。在所有神经根水平上，髋部大于60度屈曲的位置发生统计学上显着的远侧移位（P <0.01）。
结论：与以前报道的相比，腰LR神经根（L4，L5，S1）移动少，承受的拉力也较小，可能需要髋部运动大于60度才能在侧隐窝产生实质性移位。需要进行其他研究以检查SLR期间预置位的影响。