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。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :Coronary artery fistula with giant coronary artery ectasia is a rare abnormal CHD. Multidetector CT is useful for the diagnosis. Early diagnosis and surgery are recommended.

背景与目标： ：冠状动脉瘘伴巨大冠状动脉扩张是一种罕见的冠心病异常。 Multidetector CT对诊断很有用。建议及早诊断和手术。

BACKGROUND & AIMS: :Mortality is a well-recognized complication of Gram-negative bloodstream infection (BSI). The aim of this study was to develop a model to predict mortality in patients with Gram-negative BSI by using the Pitt bacteraemia score (PBS) and other clinical and laboratory variables. A cohort of 683 unique adult patients who were followed for at least 28 days after admission to Mayo Clinic Hospitals with Gram-negative BSI from 1 January 2001 to 31 October 2006 and who received clinically predefined appropriate empirical antimicrobial therapy was retrospectively identified. Multivariable logistic regression was used to identify independent risk factors for 28-day all-cause mortality. Regression coefficients from a multivariable model were used to develop a risk score to predict mortality following Gram-negative BSI. Malignancy (OR 3.48, 95% CI 1.94-6.22), liver cirrhosis (OR 5.42, 95% CI 2.52-11.65), source of BSI other than urinary tract or central venous catheter infection (OR 5.54, 95% CI 2.42-12.69), and PBS (OR 1.98, 95% CI 0.92-4.25 for PBS of 2-3 and OR 6.42, 95% CI 3.11-13.24 for PBS ≥4) were identified as independent risk factors for 28-day mortality in patients with Gram-negative BSI. A risk-score model was created by adding points for each independent risk factor, and had a c-statistic of 0.84. Patients with risk scores of 0, 4, 8, 12 and 16 had estimated 28-day mortality rates of approximately 0%, 3%, 14%, 45%, and 81%, respectively. The Gram-negative BSI risk score described herein estimated mortality risk with high discrimination in patients with Gram-negative BSI who received clinically adequate empirical antimicrobial therapy.

背景与目标： ：死亡率是公认的革兰氏阴性血流感染（BSI）并发症。这项研究的目的是通过使用皮特菌血症评分（PBS）和其他临床和实验室变量，开发一种预测革兰氏阴性BSI患者死亡率的模型。回顾性分析了2001年1月1日至2006年10月31日在梅奥诊所医院接受革兰阴性BSI随访的至少28天的683名独特的成年患者，他们接受了临床上预先定义的适当的经验性抗菌治疗。多变量logistic回归用于确定28天全因死亡率的独立危险因素。来自多变量模型的回归系数用于建立风险评分，以预测革兰氏阴性BSI后的死亡率。恶性肿瘤（OR 3.48，95％CI 1.94-6.22），肝硬化（OR 5.42，95％CI 2.52-11.65），除尿路或中央静脉导管感染以外的BSI来源（OR 5.54，95％CI 2.42-12.69） ，并且将PBS（对于2-3的PBS，OR 1.98，95％CI 0.92-4.25，对于PBS≥4的OR 6.42，95％CI 3.11-13.24）被确定为Gram-28患者28天死亡率的独立危险因素。负BSI。通过为每个独立的风险因素加分来创建风险评分模型，并具有0.84的c统计量。风险评分为0、4、8、12和16的患者估计28天死亡率分别约为0％，3％，14％，45％和81％。本文所述的革兰氏阴性BSI风险评分估计了接受临床上足够的经验性抗微生物治疗的革兰氏阴性BSI患者的死亡率，并具有较高的判别力。

BACKGROUND & AIMS: BACKGROUND:The dialysis practice guideline in Japan sets a limit on the allowed interdialytic weight gain (IDWG) <6%. However, the effects of relative gain of fluid volume to body weight may differ in presence of morbid conditions. Here, we examined whether or not the associations between IDWG and mortality differ by serum albumin (sAlb), a nutritional and illness marker. DESIGN:The study type used was prospective cohort study. SUBJECTS:Patients who participated in the Japan Dialysis Outcomes and Practice Pattern Study (phase 1-4 [1999-2011]) and received thrice-weekly hemodialysis. METHODS:IDWG was the exposure of interest and was collected every 4 months, divided into 7 categories as follows: <2%, 2% to 3%, 3% to 4% (reference), 4% to 5%, 5% to 6%, 6% to 7%, and >7%. sAlb was treated as both an effect modifier and confounder and dichotomized into ≥3.8 g/dL and <3.8 g/dL segments, according to the protein-energy wasting criteria proposed by the International Society of Renal Nutrition and Metabolism. MAIN OUTCOME MEASURE:The outcome in this study was all-cause mortality. RESULTS:A total of 8,661 patients were analyzed. Time-varying Cox regression analyses revealed that, when sAlb was ≥3.8 g/dL, an IDWG >7% was associated with greater risk of mortality (adjusted hazard ratio [AHR] 2.74; 95% confidence interval [CI], 1.49-5.05). When sAlb was <3.8 g/dL, however, IDWGs <2% (AHR 1.89; 95% CI, 1.50-2.39) and 4% to 5% (AHR 0.75; 95% CI, 0.58-0.96) were associated with mortality (P for interaction = .001). Cubic spline analyses showed that the mortality increased when IDWG exceeded 6% for patients with sAlb ≥3.8 g/dL; in contrast, for patients with sAlb <3.8 g/dL, the mortality increased when IDWG was <3% and decreased when IDWG was between 4% and 6%. LIMITATION:The main limitation was possible residual confounding. CONCLUSIONS:The direction and magnitude of the associations between IDWG and mortality were modified by sAlb. Dialysis experts should take these results into account when revising the clinical practice guidelines.

背景与目标： 背景：日本的透析实践指南对允许的透析间增重（IDWG）<6％设置了限制。但是，在存在病态的情况下，体液量相对于体重的相对增加的影响可能会有所不同。在这里，我们检查了IDWG和死亡率之间的关联是否因营养和疾病标志物血清白蛋白（sAlb）而异。
设计：使用的研究类型为前瞻性队列研究。
参加日本透析结果和实践模式研究（1-4期[1999-2011]）并每周接受三次血液透析的患者。
方法：IDWG是感兴趣的暴露量，每4个月收集一次，分为7类，分别为：<2％，2％至3％，3％至4％（参考），4％至5％，5％至6％，6％至7％和> 7％。根据国际肾脏营养与代谢学会提出的蛋白质能量浪费标准，将sAlb视为效应修饰剂和混杂因素，并分为≥3.8g / dL和<3.8 g / dL区段。
主要观察指标：本研究结果为全因死亡率。
结果：共分析了8661例患者。随时间变化的Cox回归分析显示，当sAlb≥3.8 g / dL时，IDWG> 7％与更大的死亡风险相关（调整后的危险比[AHR] 2.74; 95％置信区间[CI]，1.49-5.05 ）。但是，当sAlb <3.8 g / dL时，IDWGs <2％（AHR 1.89; 95％CI，1.50-2.39）和4％至5％（AHR 0.75; 95％CI，0.58-0.96）与死亡率相关（互动的P = .001）。三次样条分析表明，当sAlb≥3.8g / dL的患者IDWG超过6％时，死亡率增加；相反，对于sAlb <3.8 g / dL的患者，当IDWG <3％时死亡率增加，而当IDWG在4％至6％之间时死亡率降低。
局限性：主要局限性是可能的残余混杂。
结论：sAlb改变了IDWG与死亡率之间的关联的方向和大小。修订临床实践指南时，透析专家应考虑这些结果。

BACKGROUND & AIMS: AIMS:To reduce sudden cardiac death, implantable cardioverter-defibrillators (ICDs) are indicated in patients with ischaemic and non-ischaemic dilated cardiomyopathy and a left ventricular ejection fraction (LVEF) ≤35%. Current guidelines do not recommend device therapy in patients with a life expectancy <1 year since benefit in these patients is low. In this study, we evaluated the incidence and predictors of early mortality (<1 year after implantation) in a consecutive primary prevention population. METHODS AND RESULTS:Analysis was performed on a prediction and validation cohort. The primary endpoint was all-cause mortality at 1 year. The prediction cohort comprised 861 prophylactic ICD recipients with ischaemic cardiomyopathy or dilated cardiomyopathy from the Academic Medical Center (Amsterdam) and Thorax Center Twente (Enschede). Detailed clinical data were collected. After multivariate analysis, a risk score was developed based on age ≥75 years, LVEF ≤ 20%, history of atrial fibrillation, and estimated glomerular filtration rate (eGFR) ≤30 mL/min/1.73 m(2). Using these predictors, a low (≤1 factor), intermediate (2 factors), and high (≥3 factors) risk group could be identified with 1-year mortality of, respectively, 3.4, 10.9, and 38.9% (P< 0.01). Afterwards, the risk score was validated in 706 primary prevention patients from the Erasmus Medical Center (Rotterdam). One-year mortality was, respectively, 2.5, 13.2, and 46.3% (all P< 0.01). CONCLUSION:A simple risk score based on age, LVEF, eGFR, and atrial fibrillation can identify patients at low, intermediate, and high risk for early mortality after ICD implantation. This may be helpful in the risk assessment of ICD candidates.

背景与目标： 目的：为了减少心脏猝死，在缺血性和非缺血性扩张型心肌病且左心室射血分数（LVEF）≤35％的患者中，建议使用植入式心脏复律除颤器（ICD）。目前的指南不建议对预期寿命<1年的患者进行器械治疗，因为这些患者的获益很低。在这项研究中，我们评估了连续的一级预防人群的发生率和早期死亡率（植入后<1年）的预测指标。
方法和结果：对预测和验证队列进行了分析。主要终点是1年时的全因死亡率。该预测队列包括来自学术医学中心（阿姆斯特丹）和特温特胸腔中心（恩斯赫德）的861名患有缺血性心肌病或扩张型心肌病的预防性ICD接受者。收集详细的临床数据。经过多变量分析后，根据年龄≥75岁，LVEF≤20％，房颤病史和估计的肾小球滤过率（eGFR）≤30mL / min / 1.73 m（2）得出风险评分。使用这些预测因子，可以确定低（≤1因子），中（2因子）和高（≥3因子）风险组，其一年死亡率分别为3.4％，10.9％和38.9％（P <0.01）。 ）。之后，在伊拉斯姆斯医学中心（鹿特丹）的706名一级预防患者中验证了风险评分。一年死亡率分别为2.5％，13.2％和46.3％（所有P <0.01）。
结论：基于年龄，LVEF，eGFR和心房颤动的简单风险评分可以确定ICD植入后早期死亡的低，中和高风险患者。这可能有助于ICD候选人的风险评估。

BACKGROUND & AIMS: AIMS:To identify the causative agent of the mortality in the fish, Mugil cephalus, in Muttukadu lagoon. METHODS AND RESULTS:An enteric bacterium from the kidneys of moribund fish M. cephalus, was isolated and identified as Enterobacter cloacae (MK). Mugil cephalus was experimentally infected by this isolate and was re-isolated from the kidneys of the moribund fish. Enterobacter cloacae isolates from the lagoon water (MW1, MW2 and reference strain ATCC 13047) and the reference strain were not able to induce similar pathogenesis. The putative factor imparting pathogenicity to the MK isolate was identified as a cationic molecule, which migrated towards the cathode on agarose gel electrophoresis. CONCLUSIONS:The Ent. cloacae (MK) isolate harbouring a cationic factor was the causative agent for the mortality of M. cephalus, found in Muttukadu lagoon. SIGNIFICANCE AND IMPACT OF THE STUDY:This study reveals that human enteric bacteria MK which is considered as nonpathogenic to fish, may become pathogenic to fish when it harbours this cationic factor. This cationic factor is found to be pathogenic to the fish M. cephalus leading to mortality. It was also found to be pathogenic to mice. Therefore, the shuttling of Ent. cloacae, harbouring cationic factor, between human and fish may be of human health importance.

背景与目标： 目的：确定在穆图卡杜泻湖中的鱼类（Mugil cephalus）的死亡率的病因。
方法与结果：分离出垂死鱼类头颅分枝杆菌的肾脏中的一种肠道细菌，并将其鉴定为泄殖腔肠杆菌（MK）。 Mugil cephalus实验性地被这种分离物感染，并从垂死鱼类的肾脏中重新分离出来。从泻湖水中分离出的阴沟肠杆菌（MW1，MW2和参考菌株ATCC 13047）和参考菌株无法诱导相似的发病机理。赋予MK分离物致病性的推定因子被鉴定为阳离子分子，在琼脂糖凝胶电泳中向阴极迁移。
结论：耳鼻喉科。带有阳离子因子的泄殖腔（MK）分离物是Muttukadu泻湖中发现的M.cephalus死亡的病原体。
该研究的意义和影响：该研究表明，人类肠道细菌MK被认为对鱼类无致病性，但当它携带这种阳离子因子时，可能对鱼类具有致病性。发现这种阳离子因子对鱼头颅分枝杆菌有致病性，导致死亡。还发现它对小鼠是致病的。因此，Ent的穿梭。人与鱼之间具有阳离子因子的泄殖腔可能对人类健康很重要。

BACKGROUND & AIMS: :The purpose of this study was to examine whether selective iNOS inhibition can restore the hemodynamic changes and reduce the nitrotyrosine levels in the cerebral cortex of rats with streptozotocin-induced diabetes during endotoxin-induced shock. The study was designed to include three sets of experiments: (1) measurement of changes in systemic hemodynamics, (2) measurement of biochemical variables, including iNOS activity and nitrotyrosine formation in the brain, and (3) assessment of mortality rate. Rats were randomly divided into four groups: group 1, control; group 2, LPS: Escherichia coli endotoxin, 10.0 mg/kg (i.v.) bolus; group 3 (i.v.) LPS and L-N6-(1-iminoethyl)-lysine (L-NIL), 4mg/kg (i.p.); and group 4, LPS and NG-nitro-L-arginine methyl ester (L-NAME), 5 mg/kg (i.p.). In nondiabetic rats, administration of L-NIL prevented the hemodynamic and biochemical changes, and increases in plasma nitrite and cerebral nitrotyrosine levels induced by LPS. Administration of L-NAME partially prevented these LPS-induced changes. On the other hand, in diabetic rats, administration of L-NIL only partially prevented the hemodynamic and biochemical changes, and increases in plasma nitrite and cerebral nitrotyrosine levels associated with LPS. Administration of L-NAME, however, had no effects on these LPS-induced changes in diabetic rats. There was a significant difference in nitrotyrosine levels between nondiabetic and diabetic rats in groups 2, 3, and 4 at 2 and 3 h after the treatment (at 3 h; nondiabetic--control, 4.6 +/- 0.4; LPS (i.v.), 8.9 +/- 1.0, LPS (i.v.) + L-NIL, 4.7 +/- 0.5; LPS (i.v.) + L-NAME, 7.1 +/- 0.9; diabetic--control, 5.5 +/- 0.4; LPS (i.v.), 13.6 +/- 1.2; LPS (i.v.) + L-NIL, 9.0 +/- 0.9; LPS (i.v.) + L-NAME, 13.0 +/- 1.0; densitometric units). Insulin therapy resulted in a decrease in iNOS activity (at 3 h: 1.0 +/- 0.5 fmol mg min), nitrotyrosine formation (at 3 h; 5.0 +/- 0.5, densitometric units), and mortality rates (30% at 6 h, 50% at 12 h) in the LPS (i.v.) + L-NIL group of diabetic rats. Selective iNOS inhibition in diabetic rats could not improve hemodynamic instability, chemical changes, iNOS activity, and nitrotyrosine formation during septic shock compared with the improvements observed in nondiabetic rats. Tight glucose control along with administration of L-NIL can result in more effective restoration of the biochemical changes of septicemia in diabetic rats. Thus, hyperglycemia may be one of the mechanisms related to the aggravation of endotoxin-induced shock.

背景与目标： ：本研究的目的是研究选择性内源性iNOS抑制能否在内毒素诱导的休克期间恢复链脲佐菌素诱发的糖尿病大鼠的血流动力学变化并降低其大脑皮质的硝基酪氨酸水平。该研究被设计为包括三组实验：（1）测量全身血流动力学的变化，（2）测量生化变量，包括iNOS活性和脑中硝基酪氨酸的形成，以及（3）死亡率评估。将大鼠随机分为四组：第1组，对照组；和第2组。第2组，LPS：大肠埃希菌内毒素，每次推注10.0 mg / kg（i.v.）；第3组（静脉）LPS和L-N6-（1-亚氨基乙基）-赖氨酸（L-NIL），4mg / kg（腹膜）;第4组，LPS和NG-硝基-L-精氨酸甲酯（L-NAME），5 mg / kg（腹膜内）。在非糖尿病大鼠中，L-NIL的给药阻止了血流动力学和生化变化，并增加了LPS诱导的血浆亚硝酸盐和脑硝基酪氨酸水平。 L-NAME的管理部分阻止了这些LPS引起的变化。另一方面，在糖尿病大鼠中，L-NIL的施用仅部分阻止了血流动力学和生化变化，并增加了与LPS相关的血浆亚硝酸盐和脑硝基酪氨酸水平。但是，在糖尿病大鼠中，L-NAME的给药对这些LPS诱导的变化没有影响。第2、3和4组的非糖尿病和糖尿病大鼠在治疗后2和3 h的硝酸酪氨酸水平存在显着差异（3 h;非糖尿病对照组4.6 /-0.4; LPS（iv）8.9） /-1.0，LPS（iv）L-NIL，4.7 /-0.5； LPS（iv）L-NAME，7.1 /-0.9；糖尿病对照，5.5 /-0.4； LPS（iv），13.6 /-1.2； LPS（iv）L-NIL，9.0 /-0.9； LPS（iv）L-NAME，13.0 /-1.0；光密度单位）。胰岛素治疗导致iNOS活性（3 h：1.0 /-0.5 fmol mg min），硝基酪氨酸形成（3 h; 5.0 /-0.5，光密度单位）和死亡率（6h，50时30％）降低LPS（iv）L-NIL组的糖尿病大鼠在12 h时的％）。与非糖尿病大鼠相比，对糖尿病大鼠的选择性iNOS抑制不能改善败血性休克期间的血流动力学不稳定，化学变化，iNOS活性和硝基酪氨酸形成。严格的葡萄糖控制以及L-NIL的使用可以使糖尿病大鼠败血病的生化变化更有效地恢复。因此，高血糖症可能是与内毒素诱发的休克加重有关的机制之一。