BACKGROUND & AIMS: :A number of competing risks and benefits influence the rates of neonatal morbidity and mortality in elective cesarean delivery versus expectant management. To compare these rates, we developed complex decision trees to model the expected outcomes among hypothetical cohorts of 1,000,000 uncomplicated pregnancies undergoing elective cesarean delivery versus 1,000,000 comparable pregnancies undergoing routine pregnancy management. A separate tree was created for each complication, including neonatal death, respiratory morbidity, intracranial hemorrhage, and brachial plexus injury. We found that neonatal mortality was increased among elective cesarean deliveries, but perinatal mortality was higher with routine expectant management due to fetal deaths. Respiratory morbidity was substantially more common among infants delivered by elective cesarean delivery, whereas intracranial hemorrhage and brachial plexus injury were less common. We conclude that the fetal/neonatal impact of elective cesarean is mixed, but any improvement in perinatal health is likely to be small.

背景与目标： ：许多竞争性风险和收益影响选择性剖宫产与预期管理方式下新生儿发病率和死亡率的比率。为了比较这些比率，我们开发了复杂的决策树，以对假设的队列中预期的结果进行建模，该队列在进行了选择性剖宫产的1,000,000例简单并发症妊娠与进行常规妊娠管理的1,000,000例可比较妊娠之间比较。为每种并发症创建一棵单独的树，包括新生儿死亡，呼吸系统疾病，颅内出血和臂丛神经损伤。我们发现，选择性剖宫产分娩的新生儿死亡率增加，但由于胎儿死亡，常规的常规处理导致围产期死亡率更高。择期剖宫产分娩的婴儿中呼吸系统疾病的发病率更为普遍，而颅内出血和臂丛神经损伤的情况则较不常见。我们得出结论，选择性剖宫产对胎儿/新生儿的影响是混合的，但是围产期健康的任何改善都可能很小。

BACKGROUND & AIMS: :Immunocompromise after a major injury is presumed to be a predisposing factor for sepsis. Mice subjected to sublethal cecal ligation and puncture (CLP) and challenged 5 days later with Pseudomonas aeruginosa had more bacterial growth in lung tissue, lower serum interferon gamma (IFN-gamma) and interleukin (IL) 12,and higher serum IL-10 when compared with sham CLP mice challenged with Pseudomonas. To test the functional significance of these alterations in cytokine production in the immune response to bacteria, we administered IFN-gamma and anti-IL-10 to post-CLP mice before the Pseudomonas challenge. Administration of IFN-gamma and anti-IL-10 did not improve bacterial clearance or mortality in post-CLP mice. In further studies, we administered IFN-gamma to IL-10 knockout mice before a challenge with P. aeruginosa. Our results showed no significant differences in bacterial clearance or mortality in IL-10 knockout mice with or without IFN-gamma treatment compared with wild-type controls. Finally, because most mortality occurred within 2 to 3 days of the Pseudomonas challenge in the aforementioned studies and was likely associated with a marked proinflammatory response, we investigated the effect of IFN-gamma and anti-IL-10 on clearance of Pseudomonas in C3H/HeJ mice, which do not mount an exaggerated proinflammatory response to endotoxin or Gram-negative bacteria. Neither clearance of the Pseudomonas bacteria nor mortality was improved in C3H/HeJ mice receiving anti-IL-10 and IFN-gamma. These results suggest that the suppressed IFN-gamma and IL-12 responses, in combination with an exaggerated IL-10 response to P. aeruginosa challenge after injury, do not correlate with bacterial clearance or survival.

背景与目标： ：大伤后的免疫功能低下被认为是败血症的诱因。进行半致死盲肠结扎和穿刺（CLP）并在5天后用铜绿假单胞菌攻击的小鼠的肺组织中细菌生长更多，血清干扰素-γ（IFN-γ）和白介素（IL）12更低，而血清IL-10更高。与假单胞菌攻击的假CLP小鼠相比。为了测试这些变化对细菌免疫反应中细胞因子产生的功能意义，我们在假单胞菌攻击之前向CLP后小鼠施用了IFN-γ和抗IL-10。在CLP后小鼠中，IFN-γ和抗IL-10的使用不能改善细菌清除率或死亡率。在进一步的研究中，我们在铜绿假单胞菌攻击之前向IL-10敲除小鼠施用了IFN-γ。我们的结果表明，与野生型对照相比，接受或未接受IFN-γ治疗的IL-10基因敲除小鼠的细菌清除率或死亡率无显着差异。最后，由于在上述研究中大多数死亡发生在假单胞菌攻击后的2到3天内，并且可能与明显的促炎反应有关，因此我们研究了IFN-γ和抗IL-10对C3H / 3中假单胞菌清除的影响HeJ小鼠，对内毒素或革兰氏阴性细菌没有过度的促炎反应。接受抗IL-10和IFN-γ的C3H / HeJ小鼠的假单胞菌细菌清除率和死亡率均未提高。这些结果表明，损伤后抑制的IFN-γ和IL-12反应，加上对损伤后铜绿假单胞菌攻击的过度IL-10反应，与细菌清除率或存活率无关。

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: OBJECTIVE:To examine the analytic role of arsenic exposure on cancer mortality among the low-dose (well water arsenic level <150 μg/L) villages in the Blackfoot-disease (BFD) endemic area of southwest Taiwan and with respect to the southwest regional data. METHOD:Poisson analyses of the bladder and lung cancer deaths with respect to arsenic exposure (μg/kg/day) for the low-dose (<150 μg/L) villages with exposure defined by the village median, mean, or maximum and with or without regional data. RESULTS:Use of the village median well water arsenic level as the exposure metric introduced misclassification bias by including villages with levels >500 μg/L, but use of the village mean or the maximum did not. Poisson analyses using mean or maximum arsenic levels showed significant negative cancer slope factors for models of bladder cancers and of bladder and lung cancers combined. Inclusion of the southwest Taiwan regional data did not change the findings when the model contained an explanatory variable for non-arsenic differences. A positive slope could only be generated by including the comparison population as a separate data point with the assumption of zero arsenic exposure from drinking water and eliminating the variable for non-arsenic risk factors. CONCLUSION:The cancer rates are higher among the low-dose (<150 μg/L) villages in the BFD area than in the southwest Taiwan region. However, among the low-dose villages in the BFD area, cancer risks suggest a negative association with well water arsenic levels. Positive differences from regional data seem attributable to non-arsenic ecological factors.

背景与目标： 目的：探讨台湾西南部黑脚病（BFD）流行地区低剂量（井水砷水平<150μg/ L）村庄中砷暴露对癌症死亡率的分析作用数据。
方法：对低剂量（<150μg/ L）村庄的砷暴露量（μg/ kg /天）进行膀胱和肺癌死亡的泊松分析，暴露量由该村庄的中位数，均值或最大值定义或没有区域数据。
结果：使用村庄中井水砷中位数作为暴露指标，通过将水平> 500μg/ L的村庄包括在内，引入了分类错误，但是没有使用村庄平均值或最大值。使用平均砷含量或最大砷含量的泊松分析显示，对于膀胱癌以及膀胱癌和肺癌的模型，显着的负癌斜率因子。当模型包含非砷差异的解释变量时，包含台湾西南地区的数据并没有改变结果。只有将比较人群作为一个单独的数据点，并假设饮用水中砷的暴露量为零，并消除非砷危险因素的变量，才能产生正斜率。
结论：BFD地区低剂量（<150μg/ L）村庄的癌症发生率高于台湾西南地区。但是，在BFD地区的低剂量村庄中，癌症风险提示与井水砷水平呈负相关。与区域数据的正差异似乎归因于非砷生态因素。

BACKGROUND & AIMS: BACKGROUND:The complement system is an important mediator of inflammation, which plays a pivotal role in atherosclerosis and acute myocardial infarction (AMI). Animal studies suggest that activation of the complement cascade resulting in the formation of soluble membrane attack complex (sMAC), contributes to both atherosclerosis and plaque rupture and may be the direct cause of tissue damage related to ischemia/reperfusion injury. However clinical data of sMAC during an AMI is sparse. Accordingly the aim was to investigate the prognostic role of sMAC in patients with ST-segment elevation myocardial infarction (STEMI). METHODS:We included 725 STEMI-patients admitted to a single, high-volume invasive heart centre, treated with primary percutaneous coronary intervention (PCI), from September 2006 to December 2008. Blood samples were drawn immediately before PCI. Plasma sMAC was measured using an in-house immunoassay. Endpoints were all-cause mortality (n = 62) and the combined endpoint (n = 122) of major cardiovascular events (MACE) defined as cardiovascular mortality and admission due recurrent AMI or heart failure. Follow-up time was 12 months. RESULTS:During 12 months of follow-up 62 patients died from all causes and 122 patients reached the combined end-point of MACE. Patients with high sMAC (>75th percentile) had increased risk of both all-cause mortality and MACE. Even after adjustment for confounding risk factors by Cox-regression analyses, high levels of sMAC remained an independent predictor of all-cause mortality (hazard ratio 1.81 [95% CI 1.06-3.06; P = .029]) and MACE (hazard ratio 1.70 [95% CI 1.16-2.48; P = .006]). CONCLUSIONS:High plasma sMAC independently predicts all-cause mortality and MACE in STEMI-patients treated with PCI.

背景与目标： 背景：补体系统是炎症的重要介质，在动脉粥样硬化和急性心肌梗死（AMI）中起关键作用。动物研究表明，补体级联反应的激活导致可溶性膜攻击复合物（sMAC）的形成，有助于动脉粥样硬化和斑块破裂，并且可能是与缺血/再灌注损伤相关的组织损伤的直接原因。但是，在AMI期间sMAC的临床数据很少。因此，目的是研究sMAC在ST段抬高型心肌梗死（STEMI）患者中的预后作用。
方法：我们纳入了从2006年9月至2008年12月接受初次经皮冠状动脉介入治疗（PCI）的725名STEMI患者，这些患者接受了单个大容量浸润性心脏中心治疗。使用内部免疫测定法测量血浆sMAC。终点为全因死亡率（n = 62），主要心血管事件（MACE）的综合终点（n = 122）被定义为心血管疾病的死亡率和复发性AMI或心力衰竭的入院率。随访时间为12个月。
结果：在随访的12个月中，有62例患者因各种原因死亡，有122例患者达到了MACE的综合终点。 sMAC高的患者（> 75％）增加了全因死亡率和MACE的风险。即使在通过Cox回归分析调整了混杂的危险因素之后，高水平的sMAC仍然是全因死亡率（危险比1.81 [95％CI 1.06-3.06; P = .029]）和MACE（危险比1.70）的独立预测因子。 [95％CI 1.16-2.48； P = .006]。
结论：血浆sMAC高可独立预测接受PCI治疗的STEMI患者的全因死亡率和MACE。

BACKGROUND & AIMS: BACKGROUND:Choline is essential for fetal brain development, and it is not known whether a typical American diet contains enough choline to ensure optimal brain development. OBJECTIVE:The study was undertaken to determine whether supplementing pregnant women with phosphatidylcholine (the main dietary source of choline) improves the cognitive abilities of their offspring. DESIGN:In a double-blind, randomized controlled trial, 140 pregnant women were randomly assigned to receive supplemental phosphatidylcholine (750 mg) or a placebo (corn oil) from 18 wk gestation through 90 d postpartum. Their infants (n = 99) were tested for short-term visuospatial memory, long-term episodic memory, language development, and global development at 10 and 12 mo of age. RESULTS:The women studied ate diets that delivered ∼360 mg choline/d in foods (∼80% of the recommended intake for pregnant women, 65% of the recommended intake for lactating women). The phosphatidylcholine supplements were well tolerated. Groups did not differ significantly in global development, language development, short-term visuospatial memory, or long-term episodic memory. CONCLUSIONS:Phosphatidylcholine supplementation of pregnant women eating diets containing moderate amounts of choline did not enhance their infants' brain function. It is possible that a longer follow-up period would reveal late-emerging effects. Moreover, future studies should determine whether supplementing mothers eating diets much lower in choline content, such as those consumed in several low-income countries, would enhance infant brain development.

背景与目标： 背景：胆碱对胎儿脑部发育至关重要，尚不清楚典型的美国饮食中是否含有足够的胆碱以确保最佳的脑部发育。
目的：本研究旨在确定孕妇补充磷脂酰胆碱（胆碱的主要饮食来源）是否能改善其后代的认知能力。
设计：在一项双盲，随机对照试验中，从怀孕18周到产后90天，随机分配了140名孕妇接受补充磷脂酰胆碱（750毫克）或安慰剂（玉米油）。他们的婴儿（n = 99）在10和12个月大时接受了短期视觉空间记忆，长期情境记忆，语言发展和整体发展的测试。
结果：这些妇女所研究的饮食中，食物中的胆碱/日摄入量约为360毫克/天（孕妇的推荐摄入量约为80％，哺乳期妇女的推荐摄入量约为65％）。磷脂酰胆碱补充剂的耐受性良好。在全球发展，语言发展，短期视觉空间记忆或长期情境记忆方面，各组没有显着差异。
结论：孕妇食用含适量胆碱饮食的磷脂酰胆碱不能增强婴儿的脑功能。较长的随访期可能会显示出较晚出现的影响。此外，未来的研究应确定补充食用胆碱含量低得多的饮食的母亲（如在几个低收入国家食用的饮食）是否会增强婴儿的大脑发育。

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: :Fetal growth, birth weight specific mortality rates and effect of sick leave or hospitalization on the fetal growth were investigated in a material of 476 twin pregnancies managed at University Central Hospital of Turku in years 1970-81. Birth weights of twin babies at any gestational age were slightly but not significantly higher than in earlier materials. When compared to growth curve of singleton fetuses, the growth rate of both twins is equal to singletons up to 30th week of pregnancy, being thereafter slower than in singleton pregnancies. Although duration of sick leave and hospitalization increased considerably during the study period, no change in the duration of pregnancy nor in the weight of twin babies occurred. Instead perinatal mortality decreased from 101/per thousand to 36.2/per thousand. Birth weight specific mortality rates did not differ from those in singleton fetuses.

背景与目标： ：在1970-81年间，在图尔库大学中心医院进行的476次双胎妊娠研究中，研究了胎儿的生长，特定体重的死亡率以及病假或住院对胎儿生长的影响。在任何胎龄的双胞胎婴儿的出生体重均比早期胎龄婴儿的出生体重稍高但不明显。与单胎胎儿的生长曲线相比，直到怀孕第30周，双胎的生长速度等于单胎，此后比单胎妊娠要慢。尽管在研究期间病假和住院时间显着增加，但怀孕时间或双胞胎婴儿的体重均未发生变化。相反，围产期死亡率从101 /千降低到36.2 /千。出生体重比死亡率与单胎胎儿无异。

BACKGROUND & AIMS: AIMS:We sought to evaluate bleeding complications and periprocedural outcomes of the radial approach (RA) as compared to the femoral approach (FA) during percutaneous coronary intervention (PCI) in "real-world" patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS:The study group consisted of 22,812 consecutive patients with STEMI treated with PCI and stent implantation between January 2014 and June 2015 in 151 tertiary invasive cardiology centres in Poland (the ORPKI Polish National Registry). Patients treated using the RA and FA were compared using a propensity score analysis to avoid possible selection bias. The analysis was carried out in an "as-treated" manner. The FA was used in 9,334 (40.9%) and the RA in 13,478 (59.1%) patients. After propensity score matching, a higher total amount of contrast (191.8±8.0 vs. 174.8±68.8 ml; p=0.001) and lower radiation doses (1,279.5±1,346.3 vs. 1,182.6±887 mGy; p=0.02) were reported in FA. More access-site-related bleeding complications after both angiography (0.17% vs. 0.02%; p=0.004) and PCI (0.23% vs. 0.09%; p=0.049) were reported in the FA group. Periprocedural death (1.94% vs. 0.93%; p=0.001) was more common after PCI performed with the FA. CONCLUSIONS:The radial approach was associated with a lower incidence of periprocedural death in STEMI patients as well as a significant reduction of bleeding complications at the access site.

背景与目标： 目的：我们试图评估“现实” ST段抬高型心肌梗死（STEMI）患者在经皮冠状动脉介入治疗（PCI）期间与股动脉入路（FA）相比，bleeding动脉入路（RA）的出血并发症和围手术期结局）。
方法与结果：该研究小组于2014年1月至2015年6月在波兰的151个三级侵入性心脏病学中心（ORPKI波兰国家注册中心）对22,812例连续的STEMI患者进行了PCI和支架植入治疗。使用倾向评分分析比较使用RA和FA治疗的患者，以避免可能的选择偏倚。该分析以“处理后”的方式进行。 FA用于9,334（40.9％），RA用于13,478（59.1％）患者。倾向得分匹配后，FA中的造影剂总量较高（191.8±8.0 vs. 174.8±68.8 ml； p = 0.001）和较低的放射剂量（1,279.5±1,346.3 vs.1,182.6±887 mGy； p = 0.02）。在FA组中，血管造影后（0.17％vs. 0.02％; p = 0.004）和PCI（0.23％vs. 0.09％; p = 0.049）出现更多的与出入部位相关的出血并发症。在FA进行PCI后，围手术期死亡（1.94％vs. 0.93％; p = 0.001）更为常见。
结论：radial动脉入路与STEMI患者围手术期死亡的发生率较低，以及进入部位出血并发症的发生率显着降低有关。

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岁女性的发病率。总体而言，在各模型中，肥胖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: BACKGROUND:Outcome in stroke trials is often based on a 3-month modified Rankin scale (mRS). How 3-month mRS relates to longer-term outcomes will depend on late recovery, delayed stroke-related deaths, recurrent strokes, and nonstroke deaths. We evaluated 3-month mRS and death/disability at 1 and 5 years in a population-based cohort study. METHODS AND RESULTS:In 3-month survivors of ischemic stroke (Oxford Vascular Study; 2002-2014), we related 3-month mRS to disability (defined as mRS >2) at 1 and 5 years and/or death rates (age/sex adjusted). Accrual of disability and index-stroke-related and nonstroke deaths in each poststroke year was categorized according to 3-month mRS. Among 1606 patients with acute ischemic stroke, 181 died within 3 months, but 126 index-stroke-related deaths and 320 other deaths occurred during the subsequent 4866 patient-years of follow-up up to 5 years. Although 69/126 (54.8%) post-3-month index-stroke-related deaths occurred after 1 year, mRS>2 at 1 year strongly predicted these deaths (adjusted hazard ratio=21.94, 95%CI 7.88-61.09, P<0.0001). Consequently, a 3-month mRS >2 was a strong independent predictor of death at both 1 year (adjusted hazard ratio=6.67, 95%CI 4.16-10.69, P<0.0001) and 5 years (adjusted hazard ratio=2.93, 95%CI 2.38-3.60, P<0.0001). Although mRS improved by ≥1 point from 3 months to 1 year in 317/1266 (25.0%) patients with 3-month mRS ≥1, improvement in mRS after 1 year was limited (improvement by ≥1 point: 91/858 [10.6%]; improvement to mRS ≤2: 13/353 [3.7%]). CONCLUSIONS:Our results reaffirm use of the 3-month mRS outcome in stroke trials. Although later recovery does occur, extending follow-up to 1 year would capture most long-term stroke-related disability. However, administrative mortality follow-up beyond 1 year has the potential to demonstrate translation of early disability gains into additional reductions in long-term mortality without much erosion by non-stroke-related deaths.

背景与目标： 背景：中风试验的结果通常基于3个月的改良兰金量表（mRS）。 3个月的mRS与长期结果的关系将取决于晚期康复，中风相关的延迟死亡，中风复发和非中风死亡。在一项基于人群的队列研究中，我们评估了3个月的mRS和1年和5年时的死亡/残疾。
方法和结果：在3个月的缺血性中风幸存者中（牛津血管研究; 2002-2014），我们将3个月的mRS与1岁和5岁时的残疾（定义为mRS> 2）和/或死亡率（年龄/性别调整）。根据每个月的3个月mRS对残疾的累积以及与卒中相关的卒中和非卒中死亡进行分类。在1606例急性缺血性中风患者中，有3个月内有181例死亡，但在随后的4866个患者年的随访中（长达5年）发生了126例与中风相关的死亡，还有320例其他死亡。尽管1年后发生69/126（54.8％）的3个月后与指数卒中相关的死亡，但1年时的mRS> 2强烈预测了这些死亡（调整后的危险比= 21.94，95％CI 7.88-61.09，P < 0.0001）。因此，在1年（调整后的危险比= 6.67，95％CI 4.16-10.69，P <0.0001）和5年（调整后的危险比= 2.93，95％）下，三个月的mRS> 2是死亡的强有力的独立预测因子。 CI 2.38-3.60，P <0.0001）。尽管317/1266（35.0％）3个月mRS≥1的患者在3个月至1年间mRS改善了≥1点，但1年后mRS的改善是有限的（≥1点的改善：91/858 [10.6 ％]； mRS≤2的改善：13/353 [3.7％]）。
结论：我们的研究结果重申了在卒中试验中使用3个月的mRS结果。尽管确实会出现稍后的康复，但将随访延长至1年将捕获大多数与中风相关的长期残疾。但是，对1年以上的行政死亡率进行随访，有可能证明将早期残疾的增加转化为长期死亡率的进一步降低，而不会因非中风相关的死亡而受到很大的侵蚀。

BACKGROUND & AIMS: BACKGROUND:Research has shown a strong link between alcohol use and a variety of problems, including violence. Parker and colleagues have presented a selective disinhibition theory for the link between alcohol use and homicide (and other violence) that posits a causal relationship that is also influenced by other situational and contextual factors. This model is particularly well suited for aggregate-level investigations. In this study, we examine the impact of alcohol factors, including consumption measures and Alcoholics Anonymous (AA) membership rates, on homicide mortality rates in Ontario, and test predictions derived from the selective disinhibition model. METHODS:Time series analyses with ARIMA modeling were applied to total, male, and female homicide rates in Ontario between 1968 and 1991. The analyses performed included total alcohol consumption, spirits consumption, beer consumption, and wine consumption. Missing AA membership data were interpolated with cubic splines. RESULTS:For the total population and males, homicide rates were significantly and positively related to total alcohol consumption and to the consumption of beer and spirits. They were also negatively related to AA membership rates in the analyses involving spirits and wine and positively related to unemployment rates in the analyses involving beer, wine, and total alcohol. Among females, none of the measures were significant predictors of homicide mortality rates. CONCLUSIONS:These data provide important support for the selective disinhibition model and confirm important relationships between per capita consumption measures and homicide mortality rates, especially among males, seen in other studies. Additionally, the results for AA membership rates are consistent with the hypothesis that AA membership and treatment for misuse of alcohol can exert beneficial effects observable at the population level.

背景与目标： 背景：研究表明，饮酒与包括暴力在内的各种问题之间有着密切的联系。帕克及其同事针对酒精滥用与凶杀（和其他暴力）之间的关系提出了选择性抑制理论，该理论提出了因果关系，该因果关系还受到其他情况和背景因素的影响。该模型特别适合于汇总级别的调查。在这项研究中，我们研究了酒精因素（包括消费量度和匿名的酒精滥用（AA）成员率）对安大略省凶杀死亡率的影响，并检验了基于选择性去抑制模型的测试预测。
方法：采用ARIMA模型进行时间序列分析，对1968年至1991年安大略省的总凶杀率，男性和女性凶杀率进行了分析。分析包括总酒精消费，烈酒消费，啤酒消费和葡萄酒消费。缺少的AA成员资格数据使用三次样条进行插值。
结果：对于总人口和男性，凶杀率与总酒精消费以及啤酒和烈酒的消费呈显着正相关。在涉及烈酒和葡萄酒的分析中，它们与AA成员资格率也呈负相关，而在涉及啤酒，葡萄酒和总酒精度的分析中，它们与失业率成正相关。在女性中，没有一项措施是凶杀死亡率的重要预测指标。
结论：这些数据为选择性去抑制模型提供了重要支持，并证实了人均消费量与凶杀死亡率之间的重要关系，特别是在男性中，这在其他研究中可见。此外，AA成员资格率的结果与以下假设一致：AA成员资格和滥用酒精的治疗可以产生在人群水平上可观察到的有益效果。

BACKGROUND & AIMS: :This paper reevaluates the recently reported excess mortality following transurethral resection of the prostate (TURP) for benign hypertrophy as compared with traditional open resection (OPEN). We studied survival through linkage of hospital discharge data with mortality data for the entire male population of Denmark (1977-85). For a maximum of 10.5 years 38,067 prostatectomy patients were followed. Adjusting for age and health status before surgery, TURP patients were subject to significantly higher levels of mortality than OPEN patients (RR = 1.19, 95% confidence interval (1.15-1.24). The extent to which this difference is attributable to the surgical intervention itself remains an open question. The two groups of patients are quite different with regard to age and preoperative health status, and available data may not be sufficient to control such differences through statistical analysis. On the other hand, the difference in mortality persisted over calendar time, even during periods when the pattern of utilization for the two procedures changed significantly (constant RR = 1.19, adjusting for age and comorbidity). The most important causes of death among Danish TURP patients differ from the causes suggested on the basis of previously reported Canadian data. The current evidence is thus ambiguous with regard to hypothetical biologic mechanisms behind the excess mortality over TURP patients. Further investigations are needed to evaluate the safety and effectiveness of prostate surgery.

背景与目标： ：本文对与传统的开放性切除术（OPEN）相比，最近报道的经尿道前列腺良性肥大经尿道前列腺切除术（TURP）后的额外死亡率进行了重新评估。我们通过将出院数据与丹麦整个男性人口（1977-85年）的死亡率数据相联系来研究生存率。在长达10.5年的时间里，对38,067例前列腺切除术患者进行了随访。调整手术前的年龄和健康状况后，TURP患者的死亡率要比OPEN患者高得多（RR = 1.19，95％置信区间（1.15-1.24）。两组患者在年龄和术前健康状况方面都存在很大差异，现有数据可能不足以通过统计分析来控制这种差异；另一方面，死亡率的差异在整个日历时间内仍然存在，即使在这两种方法的使用方式发生显着变化的时期（恒定RR = 1.19，已根据年龄和合并症进行了调整），丹麦TURP患者中最重要的死亡原因也不同于先前报道的加拿大所建议的原因。因此，目前的证据对于超过T的超额死亡率背后的假设生物学机制尚不明确。 URP患者。需要进一步的研究以评估前列腺手术的安全性和有效性。

BACKGROUND & AIMS: Milk (Similac), sucrose (12% wt/vol), or water were delivered to crying normal newborns once per minute for 5 minutes, in a volume of 0.1 mL/delivery. Milk and sucrose markedly reduced infant crying, and this calm persisted during the 3 minutes after substance delivery. Infants who received water were only marginally quieted, and this calm did not persist. Despite quieting agitated infants, milk did not cause them to bring their hands to their mouths during the period of milk treatment, whereas infants who received sucrose did bring their hands to their mouths. These data demonstrate that milk effectively quiets human newborns, that its quieting effects endure, and that the mechanisms that quiet and that underlie hand-in-mouth engagement are separable and independent.

背景与目标： 每分钟一次将牛奶（Similac），蔗糖（12％wt / vol）或水分5次输给哭泣的正常新生儿，持续5分钟，每次输注0.1 mL。牛奶和蔗糖显着减少了婴儿的哭泣，这种平静在药物输送后的3分钟内持续存在。刚喝水的婴儿只有一点点安静下来，这种平静并没有持续下去。尽管使躁动不安的婴儿安静下来，但是在进行乳汁治疗期间，牛奶并未使他们把手伸到嘴里，而接受蔗糖的婴儿却使把手伸到了嘴里。这些数据表明，牛奶有效地使人的新生儿安静，其安静效果得以持久，并且安静和作为亲手参与的基础的机制是可分离且独立的。

BACKGROUND & AIMS: STUDY OBJECTIVE:The aim was to examine whether a high intake of aluminium containing antacids is a risk for Alzheimer's disease. DESIGN:The mortality from dementia (1970-87), coded from death certificates as underlying or contributory cause of death, was compared with national rates in a cohort of patients who had surgery for gastroduodenal ulcer disease between 1911 and 1978. SETTING:Patient data were obtained from patient records from major hospitals in western Norway. PARTICIPANTS:4179 patients were identified who met the study criteria, which included having had a documented stomach operation, having a reliably identifiable personal number, and being alive on Jan 1, 1970. MEASUREMENTS AND MAIN RESULTS:The standardised mortality ratio for dementia was 1.10 (95% CI 0.85-1.40, n = 64) for all patients, while for patients operated on in the period 1967-78 it was 1.25 (95% CI 0.66-2.13, n = 13). CONCLUSIONS:As the majority of patients operated on after 1963 have probably been heavy consumers of aluminium containing antacids, the study provides meager evidence that a high intake of aluminium is an important risk factor for Alzheimer's disease, the major cause of dementia. However, the possibility of a raised mortality from Alzheimer's disease cannot be ruled out due to probable misclassification both in diagnosis and exposure. In addition, the observation period may have been too short to detect an effect since the latent period for Alzheimer's disease may be very long.

背景与目标： 研究目的：目的是检查高摄入量的含铝抗酸药是否会引起阿尔茨海默氏病。
设计：将1911年至1978年间接受手术治疗胃十二指肠溃疡疾病的患者队列中的痴呆死亡率（1970-87）与全国死亡率进行比较，该死亡率以死亡证明书中的基础或造成的死亡原因进行编码。
地点：患者数据来自挪威西部主要医院的患者记录。
参加者：确认符合研究标准的4179例患者，其中包括有记录的胃部手术，具有可靠可识别的个人号码以及1970年1月1日还活着。
测量和主要结果：所有患者的痴呆症标准死亡率为1.10（95％CI 0.85-1.40，n = 64），而在1967-78年间接受手术的患者为1.25（95％CI 0.66-2.13） ，n = 13）。
结论：由于1963年以后接受手术的大多数患者可能都是含铝制抗酸剂的大量消费者，因此该研究提供的证据很少，大量摄入铝是导致痴呆症主要原因的阿尔茨海默氏病的重要危险因素。然而，由于在诊断和暴露方面可能分类错误，因此不能排除阿尔茨海默氏病死亡率升高的可能性。另外，由于阿尔茨海默氏病的潜伏期可能很长，因此观察期可能太短而无法检测到效果。