BACKGROUND & AIMS: INTRODUCTION:the potential health impacts due to the decommissioned Nuclear power plants (NPP) located in Borgo Sabotino and Garigliano in Central Italy (active from the early 1960s to the late 1980s) have raised several concerns. Brain, thyroid, breast and lung cancer and leukaemia have been associated with exposure to ionizing radiations, but the health effects of nuclear plants on the resident populations are controversial. OBJECTIVE:to evaluate whether living close to NPPs is associated with an increased risk of cancer incidence and mortality. METHODS:we defined a cohort of residents within 7 km from the NPPs during the period 1996-2002. Individual follow-up for vital status at 01.01.2007 was conducted using municipality data. Gender specific Standardized Incidence and Mortality Ratios, adjusted for age, were calculated (SIR and SMR) using the regional population as reference. Each participant's address was assigned to a distance from the NPP on the basis of a GIS. A relative risk (RR, CI95%), adjusted for age and socioeconomic status, was calculated in 3 bands of increasing radius from the plants: 0-2, 2-4, and 4-7 km (reference group), using a Poisson regression model. RESULTS:the cohort was of 39,775 people, 32%of whom lived near (0-4 km) the NPP. No differences in mortality was found when comparing the cohort with the regional population; among women living within 7 km from the NPP, we found thyroid cancer incidence higher than expected (SIR 1.53 CI95% 1.18-1.95). However, when the analysis was conducted on the basis of the distance from the NPP, we found a statistically significant increase in male mortality only for causes unrelated to radiation exposure (all causes, stomach cancer, and cardiovascular diseases). No mortality excess was observed among women living close to the NPPs. No statistically significant distance-related gradient was observed for cancer incidence both in men and women. CONCLUSIONS:living close to the NPP was not associated with mortality for causes related to radiation exposure. However, the results suggest to continue the epidemiological surveillance of the population.

背景与目标： 简介：位于意大利中部的Borgo Sabotino和Garigliano（从1960年代初到1980年代后期活跃）的退役核电站（NPP）对健康的潜在影响引起了人们的关注。脑，甲状腺，乳腺癌，肺癌和白血病与暴露于电离辐射有关，但核植物对常住人口的健康影响尚存争议。
目的：评估生活在核电厂附近是否与增加的癌症发病率和死亡率风险有关。
方法：我们定义了1996-2002年期间距离核电厂7公里以内的居民群。使用市政数据对2007年1月1日的生命状况进行了个人随访。使用区域人口作为参考，计算了按年龄调整的按性别划分的标准发病率和死亡率（SIR和SMR）。根据GIS，将每个参与者的地址分配给距NPP一段距离。根据年龄和社会经济状况调整了相对风险（RR，CI95％），使用泊松在来自植物的半径逐渐增加的3个波段中计算得出：0-2、2-4和4-7 km（参考组）回归模型。
结果：该队列有39,775人，其中32％生活在NPP附近（0-4 km）。将队列与区域人口进行比较时，没有发现死亡率差异。在距NPP 7公里以内的女性中，我们发现甲状腺癌的发病率高于预期（SIR 1.53 CI95％1.18-1.95）。但是，当根据与NPP的距离进行分析时，我们发现统计学上仅在与辐射暴露无关的原因（所有原因，胃癌和心血管疾病）上男性死亡率有显着增加。在生活在国家淘汰计划附近的妇女中，没有发现死亡率过高的现象。在男性和女性中，均未观察到癌症发病率具有统计学意义的距离相关梯度。
结论：接近NPP与因辐射暴露引起的死亡率无关。但是，结果表明要继续对该人群进行流行病学监测。

BACKGROUND & AIMS: PURPOSE:To identify risk factors for corneal graft rejection and rejection irreversibility. DESIGN:Retrospective cohort study. METHODS:setting: Institutional. patients: A total of 1438 consecutive eyes of 1438 patients who underwent corneal transplantation for optical indication at the Centre Hospitalier National d'Ophtalmologie des XV-XX, Paris, France, between December 1992 and December 2010 were studied. Surgical technique was penetrating keratoplasty (PK) in 1209 cases, anterior lamellar keratoplasty (ALK) in 165 cases, and Descemet stripping with endothelial keratoplasty in 64 cases. main outcome measures: Cumulative incidence of rejection episodes and rejection irreversibility rate. RESULTS:A total of 299 cases of rejection episodes were identified, of which 145 (48.5%) were irreversible after treatment. In multivariate analysis, the cumulative incidence of rejection episodes was influenced by recipient age (P = .00002), recipient rejection risk (P = .0003), lens status (P = .00003), and surgical group (P = .035). A higher incidence of rejection episodes was observed in young patients (<20 years) and patients aged from 41 to 50, high-risk recipients, aphakic eyes and eyes with anterior chamber intraocular lens, and eyes with PK (compared with eyes with ALK). Rejection episodes were more likely to be irreversible for high-risk recipients (P = .02), for eyes with preoperative hypertony (P = .009), and for eyes with poor visual acuity at presentation (P = .002). CONCLUSIONS:Recipient rejection risk and surgical group are the main risk factors for rejection as they both influence the incidence of rejection and the reversibility rate. Recipient age and lens status are predictive factors for the occurrence of rejection. Preoperative hypertony is a predictive factor for rejection irreversibility.

背景与目标： 目的：确定角膜移植排斥反应和排斥反应不可逆的危险因素。
设计：回顾性队列研究。
方法：设置：制度。患者：研究了1992年12月至2010年12月在法国巴黎国家眼科中心XV-XX中心进行角膜移植以进行光学指示的1438例患者的1438张连续眼睛。手术技术为穿透性角膜移植术（PK）1209例，前板层角膜移植术（ALK）165例，地塞米特剥离加内皮角膜移植术64例。主要结局指标：排斥反应发作的累积发生率和排斥反应不可逆率。
结果：共鉴定出299例排斥反应病例，其中145例（48.5％）在治疗后是不可逆的。在多变量分析中，排斥发作的累积发生率受受体年龄（P = .00002），受体排斥风险（P = .0003），晶状体状态（P = .00003）和手术组（P = .035）的影响。 。在年轻患者（<20岁）和41岁至50岁的患者，高风险接受者，无晶状体眼和前房人工晶状体眼以及PK眼（与ALK眼）相比，观察到排斥反应的发生率更高。 。高风险接受者（P = .02），术前高渗眼（P = .009）和呈现时视力差的眼睛（P = .002）的排斥反应更可能是不可逆的。
结论：接受排斥反应的风险和手术组是排斥反应的主要危险因素，因为它们都影响排斥反应的发生率和可逆性。接受者年龄和晶状体状态是排斥反应发生的预测因素。术前高渗是排斥反应不可逆的预测因素。

BACKGROUND & AIMS: INTRODUCTION:The aim of this study was to assess population-based changes in incidence, treatment, and in short- and long-term survival of patients with acute respiratory distress syndrome (ARDS) over 23 years. MATERIALS AND METHODS:Analysis of all patients in Iceland who fulfilled the consensus criteria for ARDS in 1988-2010. Demographic variables, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and ventilation parameters were collected from hospital charts. RESULTS:The age-standardised incidence of ARDS during the study period was 7.2 cases per 100,000 person-years and was increased by 0.2 cases per year (P < 0.001). The most common causes of ARDS were pneumonia (29%) and sepsis (29%). The use of pressure-controlled ventilation became almost dominant from 1993. The peak inspiratory pressure (PIP) has significantly decreased (-0.5 cmH(2) O/year), but the peak end-expiratory pressure (PEEP) has increased (0.1 cmH(2) O/year) during the study period. The hospital mortality decreased by 1% per year (P = 0.03) during the study period, from 50% in 1988-1992 to 33% in 2006-2010. A multivariable logistic regression model revealed that higher age and APACHE II score increased the odds of hospital mortality, while a higher calendar year of diagnosis reduced the odds of mortality. This was unchanged when dominant respiratory treatment, PIP and PEEP were added to the model. The 10-year survival of ARDS survivors was 68% compared with 90% survival of a reference population (P < 0.001). CONCLUSION:The incidence of ARDS has almost doubled, but hospital mortality has decreased during the 23 years of observation. The 10-year survival of ARDS survivors is poor compared with the reference population.

背景与目标： 简介：本研究的目的是评估23年来急性呼吸窘迫综合征（ARDS）患者的发病率，治疗以及短期和长期生存的基于人群的变化。
材料与方法：分析冰岛所有在1988-2010年间符合ARDS共识标准的患者。人口统计学变量，急性生理和慢性健康评估II（APACHE II）得分和通气参数均从医院病历表中收集。
结果：研究期间ARDS的年龄标准化发病率为每100,000人年7.2例，并且每年增加0.2例（P <0.001）。 ARDS的最常见原因是肺炎（29％）和败血症（29％）。从1993年开始，几乎一直使用压力控制通气。最高吸气压力（PIP）明显降低了（-0.5 cmH（2）O /年），但是最高呼气末压力（PEEP）却增加了（0.1 cmH （2）O /年）。在研究期间，医院死亡率每年下降1％（P = 0.03），从1988-1992年的50％下降到2006-2010年的33％。多变量logistic回归模型显示，较高的年龄和APACHE II评分增加了医院死亡率的可能性，而较高的诊断日历年降低了死亡率的可能性。当将主要呼吸治疗，PIP和PEEP添加到模型中时，情况没有改变。 ARDS幸存者的10年生存率为68％，而参考人群的90％生存（P <0.001）。
结论：在23年的观察中，ARDS的发病率几乎翻了一番，但医院死亡率却下降了。与参考人群相比，ARDS幸存者的10年生存率很低。

BACKGROUND & AIMS: PURPOSE:To study the incidence of retinopathy of prematurity (ROP) in a neonatal intensive care unit and obtain information on risk factors associated with ROP. METHODS:Four hundred twenty-three infants were screened for ROP between July 2006 and July 2010. Demographic information, clinical data, and risk factors were reviewed. RESULTS:The incidence was 40.4% (171 infants) for ROP, 9.2% (39 infants) for severe ROP, and 5.67% (24 infants) for laser treatment. Mean gestational age and birth weight were significantly lower among infants with ROP versus those without ROP (26 ± 0.13 vs 28.55 ± 0.12 weeks, P < .0001 and 840.5 ±17.49 vs 1,190.24 ± 20.20 g, P < .0001, respectively). Birth weight (P < .001), gestational age (P < .001), mechanical ventilation therapy (P = .039), and necrotizing enterocolitis (P = .019) were independent risk factors for ROP. CONCLUSION:Gestational age and birth weight were the most significant risk factors for developing ROP. The study population had an elevated percentage of infants with birth weight less than 1,000 g (extremely low birth weight), yet there was no corresponding increase in severe ROP incidence and treatment when compared to other studies.

背景与目标： 目的：研究新生儿重症监护病房早产儿视网膜病变（ROP）的发生率，并获得有关ROP相关危险因素的信息。
方法：2006年7月至2010年7月，对423例婴儿进行了ROP筛查。回顾了人口统计学信息，临床数据和危险因素。
结果：ROP的发生率为40.4％（171例婴儿），重度ROP的发生率为9.2％（39例婴儿），激光治疗的发生率为5.67％（24例婴儿）。患有ROP的婴儿的平均胎龄和出生体重显着低于没有ROP的婴儿（26±0.13 vs 28.55±0.12周，P <.0001和840.5±17.49 vs 1,190.24±20.20 g，P <.0001）。出生体重（P <.001），胎龄（P <.001），机械通气治疗（P = .039）和坏死性小肠结肠炎（P = .019）是ROP的独立危险因素。
结论：妊娠年龄和出生体重是发生ROP的最重要危险因素。该研究人群的出生体重低于1,000 g（极低的出生体重）的婴儿百分比升高，但是与其他研究相比，严重的ROP发生率和治疗没有相应增加。

BACKGROUND & AIMS: INTRODUCTION:The most severe complication of parenteral nutrition (PTN) is catheter-related infection (CRI). OBJECTIVES:To study the incidence rate and factors associated to CRI. MATERIAL AND METHODS:271 patients followed at the Nutrition Unit for 6 months. The composition of the PTN was calculated according to the metabolic demands. 20.3% received a lipid solution enriched with omega-3 fatty acids (SMOF Fresenius Kabi®) and 79.7% with olive oil (Clinoleic Baxter®). RESULTS:The rate of CRI was 25 per 1,000 days of PTN (55 patients: 61.7±17.8 years, 60.3% males, 29.3±10.6 days of hospital stay and 10.4% mortality). Coagulase-negative Staphylococcus was the most frequently isolated microorganism. There were no differences by age, gender, mortality, or composition of the PTN between patients with or without infection. The patients treated with omega-3 received more calories with the PTN, at the expense of higher intake of glucose and lipids. However, the rate of infection was similar, although there was a not significant trend towards a lower infection rate when using the omega-3 composition (14.5% vs. 23.1%, respectively, p = 0.112). The duration of the nutritional support was higher in patients with CRI (13.0 ± 9.7 vs. 9.3 ± 8.1, p = 0.038). Total mortality (16.9%) was independent of the presence or absence of CRI (10.4% vs. 18.7%, p = 0.090) or of the use of omega-3 lipids or olive oil in the PTN (10.9% vs. 18.5%, p = 0.125). CONCLUSION:Patients submitted to PTN have a high rate of CRI. The presence of infection is related to the duration of the PTN, being independent of the age, gender, and composition of the solution. The use of omega-3 lipid solutions may be beneficial although further studies are needed to confirm this.

背景与目标： 简介：肠胃外营养（PTN）的最严重并发症是导管相关感染（CRI）。
目的：研究CRI的发生率及相关因素。
材料与方法：271例患者在营养科接受了6个月的随访。根据代谢需要计算PTN的组成。 20.3％的人接受了富含omega-3脂肪酸（SMOF FreseniusKabi®）的脂质溶液，而79.7％的接受了橄榄油（ClinoleicBaxter®）的脂质溶液。
结果：PTN的CRI率为25/1000天（55例患者：61.7±17.8岁，男性为60.3％，住院时间为29.3±10.6天，死亡率为10.4％）。凝固酶阴性葡萄球菌是最常分离的微生物。在有或没有感染的患者之间，PTN的年龄，性别，死亡率或组成没有差异。用omega-3治疗的患者接受PTN吸收的卡路里更多，但要以增加葡萄糖和脂质的摄入为代价。但是，感染率相似，尽管使用omega-3组合物时感染率降低的趋势并不明显（分别为14.5％和23.1％，p = 0.112）。 CRI患者的营养支持持续时间更长（13.0±9.7与9.3±8.1，p = 0.038）。总死亡率（16.9％）与是否存在CRI（10.4％对18.7％，p = 0.090）或PTN中是否使用omega-3脂质或橄榄油无关（10.9％对18.5％， p = 0.125）。
结论：PTN患者的CRI率很高。感染的存在与PTN的持续时间有关，而与溶液的年龄，性别和组成无关。尽管需要进一步的研究来证实这一点，但使用omega-3脂质溶液可能是有益的。

BACKGROUND & AIMS: :Obesity affects multiple points along the breast cancer control continuum from prevention to screening and treatment, often in opposing directions. Obesity is also more prevalent in Blacks than Whites at most ages so it might contribute to observed racial disparities in mortality. We use two established simulation models from the Cancer Intervention and Surveillance Modeling Network (CISNET) to evaluate the impact of obesity on race-specific breast cancer outcomes. The models use common national data to inform parameters for the multiple US birth cohorts of Black and White women, including age- and race-specific incidence, competing mortality, mammography characteristics, and treatment effectiveness. Parameters are modified by obesity (BMI of ≥ 30 kg/m(2)) in conjunction with its age-, race-, cohort- and time-period-specific prevalence. We measure age-standardized breast cancer incidence and mortality and cases and deaths attributable to obesity. Obesity is more prevalent among Blacks than Whites until age 74; after age 74 it is more prevalent in Whites. The models estimate that the fraction of the US breast cancer cases attributable to obesity is 3.9-4.5 % (range across models) for Whites and 2.5-3.6 % for Blacks. Given the protective effects of obesity on risk among women <50 years, elimination of obesity in this age group could increase cases for both the races, but decrease cases for women ≥ 50 years. Overall, obesity accounts for 4.4-9.2 % and 3.1-8.4 % of the total number of breast cancer deaths in Whites and Blacks, respectively, across models. However, variations in obesity prevalence have no net effect on race disparities in breast cancer mortality because of the opposing effects of age on risk and patterns of age- and race-specific prevalence. Despite its modest impact on breast cancer control and race disparities, obesity remains one of the few known modifiable risks for cancer and other diseases, underlining its relevance as a public health target.

背景与目标： 从肥胖症的预防到筛查和治疗，肥胖症通常会在相反的方向上影响着乳腺癌控制连续性的多个方面。在大多数年龄段，肥胖症在黑人中也比白人更为普遍，因此它可能导致观察到的种族差异。我们使用来自癌症干预和监视模型网络（CISNET）的两个已建立的仿真模型来评估肥胖对特定种族乳腺癌结果的影响。该模型使用共同的国家数据为美国多个黑人和白人妇女的出生队列提供参数，包括特定年龄和种族的发病率，竞争性死亡率，乳房X线照片特征和治疗效果。肥胖（BMI≥30 kg / m（2））及其特定于年龄，种族，队列和时间段的患病率会改变参数。我们测量年龄标准化的乳腺癌的发病率和死亡率，以及肥胖引起的病例和死亡。直到74岁，肥胖症在黑人中比白人更为普遍。 74岁以后，它在白人中更为普遍。这些模型估计，美国肥胖引起的乳腺癌病例中，白人的比例为3.9-4.5％（黑人），黑人的比例为2.5-3.6％（跨模型）。考虑到肥胖对<50岁女性的风险具有保护作用，在这个年龄段消除肥胖可能会增加两个种族的发病率，但会减少50岁以上女性的发病率。总体而言，跨模型的肥胖症分别占白人和黑人乳腺癌死亡总数的4.4-9.2％和3.1-8.4％。但是，由于年龄对风险和年龄和种族特定患病率的模式产生了相反的影响，因此肥胖患病率的变化对乳腺癌死亡率的种族差异没有净影响。尽管肥胖症对乳腺癌的控制和种族差异影响不大，但肥胖症仍然是为数不多的已知可改变的癌症和其他疾病风险之一，突显了肥胖症作为公共卫生目标的重要性。

BACKGROUND & AIMS: OBJECTIVE:Our purpose was to determine whether the incidence of postoperative endometritis and wound infection is associated with the method of placental removal at the time of cesarean section.

STUDY DESIGN:Parturients undergoing cesarean delivery were prospectively randomized to have the placenta removed manually or spontaneously. Patients were excluded from participation if they had received intrapartum prophylactic antibiotics or had been determined to have chorioamnionitis. After delivery of the infant women in the manual group had the placenta extracted by the primary surgeon, whereas women in the spontaneous group had the placenta delivered by gentle traction on the umbilical cord. All study subjects received perioperative prophylactic antibiotics. The primary outcome variable was a postcesarean infection, defined as postecsarean endometritis or wound cellulitis requiring drainage and antibiotic therapy.

RESULTS:A total of 333 women were enrolled in the investigation, with 165 assigned to the manual removal group and 168 allocated to have spontaneous removal. There were no statistically significant differences in mean gestational age, frequency or duration of ruptured membranes, frequency or duration of labor, or mean number of vaginal examinations between the two study groups. Postoperative infections occurred in 25 of 168 (15%) women in the spontaneous delivery group compared with 44 of 165 (27%) women in which the placenta was manually extracted (relative risk 0.6, 95% confidence interval 0.4 to 0.9, p = 0.01). Subset analysis of patients delivered with ruptured membranes similarly demonstrated a statistically significant reduction in the incidence of postoperative infections with spontaneous placental removal compared with manual extraction (20% vs. 38%, relative risk 0.5, 95% confidence interval 0.3 to 0.9, p = 0.02). There was a similar trend toward a reduction in postdelivery infections associated with spontaneous placental removal in women with intact membranes; however, this difference did not attain statistical significance.

CONCLUSIONS:Spontaneous delivery of the placenta after cesarean delivery is associated with a decrease in the incidence of postcesarean infections.

背景与目标： 目的：我们的目的是确定剖宫产时子宫内膜炎和伤口感染的发生率是否与胎盘切除方法有关。

研究设计< / strong>：接受剖腹产的产妇前瞻性随机分组，以手动或自发去除胎盘。如果患者接受了产前预防性抗生素或已确定患有绒膜羊膜炎，则将其排除在研究对象之外。婴儿分娩后，手工组的妇女由主治医师取出胎盘，而自发组的妇女则通过在脐带上轻轻牵引而分娩了胎盘。所有研究对象均接受围手术期预防性抗生素治疗。主要结果变量是剖宫产后感染，定义为需要引流和抗生素治疗的剖宫产后子宫内膜炎或伤口蜂窝织炎。

结果：该研究共纳入333名妇女，其中165名分配给手动删除组，并分配168个自发删除。在两个研究组之间，平均胎龄，胎膜破裂的频率或持续时间，分娩的频率或持续时间，或阴道检查的平均次数在统计学上没有显着差异。自发分娩组中168名女性中有25名（15％）发生了术后感染，而人工抽取胎盘的165名女性中有44名（27％）发生了术后感染（相对危险度0.6，95％置信区间0.4至0.9，p = 0.01 ）。与手工提取相比，对膜破裂患者的亚组分析显示，自发性胎盘切除术后术后感染的发生率有统计学意义的降低（20％比38％，相对危险度0.5，95％置信区间0.3到0.9，p = 0.02）。具有完好的胎膜的妇女，自发去除胎盘相关的分娩后感染也有类似的趋势。但是，这种差异没有统计学意义。

结论：剖宫产后胎盘的自然分娩与剖宫产后感染的发生率降低有关。

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