BACKGROUND & AIMS: OBJECTIVE:To investigate clinically relevant intra-individual and mean changes in health-related quality of life (HRQoL) with the Short Form-36 Health Survey (SF-36) need to acknowledge that SF-36 is trademarked ie: SF-36(R) following cardiac intervention for Australian and Danish patients. DESIGN:Prospective observational study in tertiary cardiac centres in Townsville, Queensland, Australia and Copenhagen, Denmark. Two hundred coronary artery bypass graft surgery (CABG) patients of two Townsville hospitals, and 47 CABG or percutaneous coronary intervention (PCI) patients of a Copenhagen hospital. The main outcome measures are eight SF-36 health subscales at baseline and six months post-intervention. RESULTS:Australian and Danish patients experienced similar HRQoL pre-intervention. By six months post-intervention, patients experienced a significant mean improvement in all subscales of the SF-36 survey (p < or = 0.05), although up to 27% of patients had a clinically significant decline in HRQoL from baseline. CONCLUSIONS:These results demonstrate that it is necessary to investigate intra-individual changes in HRQoL as well as group mean changes as they produce different conclusions. In addition, establishing clinically significant intra-individual change standards may assist researchers and clinicians in determining whether an individual may benefit from therapy or intervention.

背景与目标： 目的：要通过36型健康调查（SF-36）调查与健康相关的生活质量（HRQoL）的临床相关个体内和平均变化，需要承认SF-36是商标，即：SF-36（ R）对澳大利亚和丹麦患者进行心脏干预后。
设计：在澳大利亚昆士兰州汤斯维尔和丹麦哥本哈根的三级心脏中心进行前瞻性观察研究。两家汤斯维尔医院的200例冠状动脉搭桥术（CABG）患者，以及哥本哈根医院的47例CABG或经皮冠状动脉介入治疗（PCI）患者。主要结果指标是基线时和干预后六个月的八个SF-36健康子量表。
结果：澳大利亚和丹麦患者经历了类似的HRQoL干预前。干预后六个月，患者在SF-36调查的所有子量表中均经历了显着的平均改善（p <或= 0.05），尽管高达27％的患者的HRQoL与基线相比有临床上的显着下降。
结论：这些结果表明，有必要研究HRQoL的个体内部变化以及群体均值变化，因为它们会产生不同的结论。此外，建立具有临床意义的个体内部变更标准可能有助于研究人员和临床医生确定个人是否可以从治疗或干预中受益。

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: :This article sets out the findings from research on the impact of a, UK based, chefs in schools teaching programme on food, health, nutrition and cookery. Professional chefs link with local schools, where they deliver up to three sessions to one class over a year. The research measured the impact of a standardised intervention package and changes in food preparation and consumption as well as measuring cooking confidence. The target group was 9-11year olds in four schools. The main data collection method was a questionnaire delivered 2weeks before the intervention and 2weeks afterwards. There was a group of four matched control schools. Those taking part in the intervention were enthused and engaged by the sessions and the impact measures indicated an intention to change. There were gains in skills and confidence to prepare and ask for the ingredients to be purchased for use in the home. Following the session with the chef, the average reported cooking confidence score increased from 3.09 to 3.35 (by 0.26 points) in the intervention group - a statistically significant improvement. In the control group this change was not statistically significant. Children's average reported vegetable consumption increased after the session with the chef, with the consumption score increasing from 2.24 to 2.46 points (0.22 points) again, a statistically significant increase with no significant changes in the control group. The research highlights the need to incorporate evaluation into school cooking initiatives as the findings can provide valuable information necessary to fine-tune interventions and to ensure consistency of the healthy eating messages.

背景与目标： ：本文列出了英国某位厨师在学校教学计划中对食品，健康，营养和烹饪产生的影响方面的研究结果。专业厨师与当地学校建立了联系，在当地学校，一年中最多可为一个班级提供三节课程。该研究测量了标准化干预措施的影响以及食品制备和食用变化以及对烹饪信心的评估。目标人群是四所学校的9-11岁儿童。主要数据收集方法是在干预前2周和干预后2周发送问卷。有四所匹配的对照学校。参加会议的人热情而参与，影响措施表明有改变的意向。准备和要求购买在家中使用的食材时，技巧和信心得到了提高。与厨师会面后，干预组的平均报告烹饪信心评分从3.09提高到3.35（增加0.26分），具有统计学意义。在对照组中，这种变化没有统计学意义。与厨师交谈后，儿童的平均蔬菜摄入量据报道有所增加，消费量分数从2.24分再次提高至2.46分（0.22分），具有统计学意义，而对照组没有显着变化。这项研究强调了将评估纳入学校烹饪计划的必要性，因为研究结果可以提供必要的有价值的信息，以微调干预措施并确保健康饮食信息的一致性。

BACKGROUND & AIMS: :Non-compliance with oral self-care recommendations, despite education and motivation, is a major problem in preventive dentistry. Forming concrete if-then action plans has been successful in changing self-care behavior in other areas of preventive medicine. This is the first trial to test the effects of a brief planning intervention on interdental hygiene behavior. Two hundred thirty-nine participants received a packet of floss, information, and a flossing guide. They were randomly assigned to a control or an intervention group. The intervention took 1.16 minutes and consisted of forming a concrete plan of where, when, and how to floss. Baseline measures and two-week and two-month follow-ups included self-report, residual floss, and theory of planned behavior variables. The intervention significantly affected flossing in that group at two-week and two-month follow-ups, as compared with the control group. This study provides evidence for the effects of a concise intervention on oral self-care behavior.

背景与目标： ：尽管有教育和动机，但仍未遵守口腔自我保健的建议，是预防牙科的主要问题。制定具体的“如果-则-则”行动计划已成功地改变了其他预防医学领域的自我保健行为。这是第一个测试简短的计划干预对牙齿间卫生行为影响的试验。 239名参与者收到了一包牙线，信息和牙线指南。他们被随机分配到对照组或干预组。干预过程花了1.16分钟，包括制定何时何地，何时以及如何使用牙线的具体计划。基线测量以及两周和两个月的随访包括自我报告，残留牙线和计划的行为变量理论。与对照组相比，干预在两周和两个月的随访中显着影响了该组的牙线剔除。这项研究为简洁干预对口腔自我护理行为的影响提供了证据。

BACKGROUND & AIMS: BACKGROUND:The fourth Millennium Development Goal (MDG) calls for a two-thirds' reduction between 1990 and 2015 in deaths of children younger than five years; achieving this will require widespread use of effective interventions, especially in poor countries. We present the first report of the Child Survival Countdown, a worldwide effort to monitor coverage of key child-survival interventions in 60 countries with the world's highest numbers or rates of child mortality. METHODS:In 2005, we developed a profile for each of the 60 countries to summarise information on coverage with essential child survival interventions. The profiles also present information on demographics, nutritional status, major causes of death in children under 5 years of age, and the status of selected health policies. Progress toward the fourth MDG is summarised by comparing the average annual rate of reduction in under-5 mortality in each country with that needed to achieve the goal. The profiles also include a comparison of the proportions of children in the poorest and richest quintiles of the population who received six or more essential prevention interventions. Each country's progress (as measured by defined indicators of intervention coverage) was put into one of three groups created on the basis of international targets: "on track"; "watch and act"; and "high alert". For indicators without targets, arbitrary thresholds for high, middle, and low performance across the 60 countries were used as a basis for categorisation. FINDINGS:Only seven countries are on track to met MDG-4, 39 countries are making some progress, although they need to accelerate the speed, and 14 countries are cause for serious concern. Coverage of the key child survival interventions remains critically low, although some countries have made substantial improvements in increasing the proportion of mothers and children with access to life saving interventions by as much as ten percentage points in 2 years. Children from the poorest families were less likely than those from wealthier families to have received at least six essential prevention interventions. INTERPRETATION:Our results show that tremendous efforts are urgently needed to achieve the MDG for child survival. Profiles for each country show where efforts need to be intensified, and highlight the extent to which prevention interventions are being delivered equitably and reaching poor families. This first report also shows country-specific improvements in coverage and highlights missed opportunities. The "Countdown to 2015" will report on progress every 2 years as a strategy for increasing accountability worldwide for progress in child survival.

背景与目标： 背景：第四项千年发展目标（MDG）要求在1990年至2015年之间将五岁以下儿童的死亡人数减少三分之二；要实现这一目标，就需要广泛使用有效的干预措施，尤其是在贫穷国家。我们将提交儿童生存倒计时的第一份报告，这是一项全球性的工作，目的是监测儿童死亡率或死亡率最高的60个国家/地区中主要儿童生存干预措施的覆盖率。
方法：2005年，我们为60个国家/地区中的每个国家/地区建立了概况，以总结有关基本儿童生存干预措施覆盖面的信息。简介还提供有关人口统计学，营养状况，5岁以下儿童主要死亡原因以及某些卫生政策状况的信息。通过将每个国家5岁以下儿童死亡率的年均降低速度与实现该目标所需的速度进行比较，总结了实现第四项千年发展目标的进展。概况还包括比较接受六种或更多种基本预防干预措施的最贫穷和最富有的五分之一人口中儿童的比例。将每个国家的进展情况（按确定的干预覆盖率指标衡量）归入根据国际目标建立的三个小组之一： “观看并表演”；和“高度戒备”。对于没有指标的指标，将60个国家/地区的绩效中高，中，低水平的任意阈值用作分类的基础。
结果：只有七个国家有望实现MDG-4，尽管有39个国家需要加快速度，但仍取得了一些进展，还有14个国家引起了严重关注。关键的儿童生存干预措施的覆盖率仍然非常低，尽管一些国家在将获得救生干预措施的母亲和儿童的比例在两年内提高了十个百分点方面取得了实质性的改善。最贫穷家庭的孩子比富有家庭的孩子接受至少六项基本预防干预的可能性较小。
解释：我们的结果表明，为实现儿童生存的千年发展目标，迫切需要付出巨大的努力。每个国家的概况显示了需要加强努力的地方，并强调了公平地实施预防干预措施并惠及贫困家庭的程度。该第一份报告还显示了特定国家/地区在覆盖率方面的改进，并重点介绍了错过的机会。 “到2015年倒计时”将每两年报告进展情况，以此作为在全球范围内增加对儿童生存进展的责任感的战略。

BACKGROUND & AIMS: :We developed a novel multifaceted psychosocial intervention program which involves screening for psychological distress and comprehensive support including individually tailored psychotherapy and pharmacotherapy provided by mental health professionals. The purpose of the present study was to investigate the feasibility of the intervention program and its preliminary usefulness for reducing clinical psychological distress experienced by patients with recurrent breast cancer. The subjects who participated in the 3 months intervention program completed psychiatric diagnostic interview and several self-reported measures regarding psychological distress, traumatic stress, and quality of life. The assessments were conducted before the intervention (T1), after the intervention (T2), and 3 months after the intervention (T3). A total of 50 patients participated in the study. The rates of participation in and adherence to the intervention program were 85 and 86%, respectively. While the proportion of psychiatric disorders at T2 (11.6%) was not significantly different from that at T1 (22.0%) (p = 0.15), the proportion of that at T3 (7.7%) had significantly decreased compared with that at T1 (p = 0.005). The novel intervention program is feasible, is a promising strategy for reducing clinically manifested psychological distress and further controlled studies are warranted.

背景与目标： ：我们开发了一种新颖的多层面心理社会干预计划，涉及筛查心理困扰和综合支持，包括由心理健康专业人员提供的量身定制的心理治疗和药物治疗。本研究的目的是调查干预计划的可行性及其对减少复发性乳腺癌患者所经历的临床心理困扰的初步有用性。参加了为期3个月的干预计划的受试者完成了精神病学诊断性访谈，并就心理困扰，创伤压力和生活质量进行了几项自我报告的措施。评估是在干预之前（T1），干预之后（T2）和干预之后3个月（T3）进行的。共有50名患者参加了该研究。干预计划的参与率和遵守率分别为85％和86％。尽管T2的精神疾病比例（11.6％）与T1（22.0％）的比例无显着差异（p = 0.15），但T3的精神疾病的比例（7.7％）较T1（p = 0.005）。新的干预计划是可行的，是减少临床表现出的心理困扰的有前途的策略，因此有必要进行进一步的对照研究。

BACKGROUND & AIMS: BACKGROUND:Web-based alcohol interventions are a promising way to reduce alcohol consumption because of their anonymity and the possibility of reaching a high numbers of individuals including heavy drinkers. However, Web-based interventions are often characterized by high rates of attrition. To date, very few studies have investigated whether individuals with higher alcohol consumption show higher attrition rates in Web-based alcohol interventions as compared with individuals with lower alcohol consumption. OBJECTIVES:The aim of this study was to examine the attrition rate and predictors of attrition in a Web-based intervention study on alcohol consumption. METHODS:The analysis of the predictors of attrition rate was performed on data collected in a Web-based randomized control trial. Data collection took place at the University of Konstanz, Germany. A total of 898 people, which consisted of 46.8% males (420/898) and 53.2% females (478/898) with a mean age of 23.57 years (SD 5.19), initially volunteered to participate in a Web-based intervention study to reduce alcohol consumption. Out of the sample, 86.9% (781/898) were students. Participants were classified as non-completers (439/898, 48.9%) if they did not complete the Web-based intervention. Potential predictors of attrition were self-reported: alcohol consumption in the last seven days, per week, from Monday to Thursday, on weekends, excessive drinking behavior measured with the Alcohol Use Disorder Identification Test (AUDIT), and drinking motives measured by the Drinking Motive Questionnaire (DMQ-R SF). RESULTS:Significant differences between completers and non-completers emerged regarding alcohol consumption in the last seven days (B=-.02, P=.05, 95% CI [0.97-1.00]), on weekends (B=-.05, P=.003, 95% CI [0.92-0.98]), the AUDIT (B=-.06, P=.007, 95% CI [0.90-0.98], and the status as a student (B=.72, P=.001, 95% CI [1.35-3.11]). Most importantly, non-completers had a significantly higher alcohol consumption compared with completers. CONCLUSIONS:Hazardous alcohol consumption appears to be a key factor of the dropout rate in a Web-based alcohol intervention study. Thus, it is important to develop strategies to keep participants who are at high risk in Web-based interventions.

背景与目标： 背景：基于网络的酒精干预是减少酒精消费的一种有前途的方法，因为它们的匿名性和与包括重度饮酒者在内的大量个人接触的可能性。但是，基于Web的干预措施通常具有高流失率的特点。迄今为止，很少有研究调查酒精摄入量较高的人是否比酒精摄入量较低的人在基于网络的酒精干预中显示出更高的减员率。
目的：本研究的目的是在基于网络的酒精摄入量干预研究中检查流失率和流失预测因子。
方法：对基于网络的随机对照试验中收集的数据进行了流失率预测指标的分析。数据收集在德国康斯坦茨大学进行。共有898人（平均年龄为23.57岁（SD 5.19），其中男性为46.8％，男性为420/898，女性为53.2％，男性为478/898），最初自愿参加了一项基于网络的干预研究，以期减少饮酒。在样本中，有86.9％（781/898）是学生。如果参与者未完成基于Web的干预，则归为未完成（439/898，48.9％）。自我预测潜在的损耗的因素：每周最近7天（周一至周四，周末）饮酒，通过酒精使用障碍识别测试（AUDIT）衡量的过度饮酒行为以及通过饮酒量度的饮酒动机动机问卷（DMQ-R SF）。
结果：在最近7天（B =-。02，P = .05、95％CI [0.97-1.00]），周末（B =-。05， P = .003、95％CI [0.92-0.98]），审核（B =-。06，P = .007、95％CI [0.90-0.98]）和学生身份（B = .72， P = .001，95％CI [1.35-3.11]），最重要的是，未完成者的酒精消耗量明显高于完成者。
结论：在基于网络的酒精干预研究中，有害的酒精消费似乎是辍学率的关键因素。因此，制定策略以使参加基于Web的干预措施的高风险参与者保持重要。

BACKGROUND & AIMS: BACKGROUND:The routine implementation of sternal precautions to prevent sternal complications that restrict the use of the upper limbs is currently worldwide practice following a median sternotomy. However, evidence is limited and drawn primarily from cadaver studies and orthopaedic research. Sternal precautions may delay recovery, prolong hospital discharge and be overly restrictive. Recent research has shown that upper limb exercise reduces post-operative sternal pain and results in minimal micromotion between the sternal edges as measured by ultrasound. The aims of this study are to evaluate the effects of modified sternal precautions on physical function, pain, recovery and health-related quality of life after cardiac surgery. METHODS/DESIGN:This study is a phase II, double-blind, randomised controlled trial with concealed allocation, blinding of patients and assessors, and intention-to-treat analysis. Patients (n = 72) will be recruited following cardiac surgery via a median sternotomy. Sample size calculations were based on the minimal important difference (two points) for the primary outcome: Short Physical Performance Battery. Thirty-six participants are required per group to counter dropout (20%). All participants will be randomised to receive either standard or modified sternal precautions. The intervention group will receive guidelines encouraging the safe use of the upper limbs. Secondary outcomes are upper limb function, pain, kinesiophobia and health-related quality of life. Descriptive statistics will be used to summarise data. The primary hypothesis will be examined by repeated-measures analysis of variance to evaluate the changes from baseline to 4 weeks post-operatively in the intervention arm compared with the usual-care arm. In all tests to be conducted, a p value <0.05 (two-tailed) will be considered statistically significant, and confidence intervals will be reported. DISCUSSION:The Sternal Management Accelerated Recovery Trial (S.M.A.R.T.) is a two-centre randomised controlled trial powered and designed to investigate whether the effects of modifying sternal precautions to include the safe use of the upper limbs and trunk impact patients' physical function and recovery following cardiac surgery via median sternotomy. TRIAL REGISTRATION:Australian and New Zealand Clinical Trials Registry identifier: ACTRN12615000968572 . Registered on 16 September 2015 (prospectively registered).

背景与目标： 背景技术：正中胸骨切开术是目前世界范围内普遍采用的预防胸骨并发症限制上肢使用的胸骨预防措施的常规措施。但是，证据是有限的，主要来自尸体研究和骨科研究。胸骨预防措施可能会延迟康复，延长出院时间，并且限制过多。最近的研究表明，上肢锻炼可减轻手术后的胸骨疼痛，并通过超声测量使胸骨边缘之间的微动最小。这项研究的目的是评估改良的胸骨预防措施对心脏手术后身体机能，疼痛，恢复以及与健康相关的生活质量的影响。
方法/设计：该研究是一项II期，双盲，随机对照试验，具有隐蔽分配，患者和评估者盲目性和意向性治疗分析。心脏手术后，将通过正中胸骨切开术招募患者（n = 72）。样本量的计算是基于以下主要方面的最小重要差异（两点）：身体机能短。每个小组需要三十六名参与者来应对辍学（20％）。所有参与者将被随机分配接受标准或改良的胸骨预防措施。干预小组将收到指导原则，以鼓励安全使用上肢。次要结果是上肢功能，疼痛，运动恐惧症和与健康相关的生活质量。描述性统计将用于汇总数据。主要假设将通过重复测量方差分析进行检验，以评估与常规护理组相比，干预组从基线到术后4周的变化。在将要进行的所有测试中，p值<0.05（两尾）将被认为具有统计学显着性，并将报告置信区间。
讨论：胸骨管理加速恢复试验（SMART）是一项两中心的随机对照试验，旨在研究修改胸骨预防措施（包括安全使用上肢和躯干）的影响是否影响患者的身体功能和术后康复通过正中胸骨切开术进行心脏手术。
试验注册：澳大利亚和新西兰临床试验注册标识符：ACTRN12615000968572。已于2015年9月16日注册（可能已注册）。

BACKGROUND & AIMS: BACKGROUND:Unstable angina and non-ST elevation myocardial infarction (NSTEMI) are common acute coronary events. Homocysteine is a novel risk factor for coronary heart diseases. Together with the conventional risk factors, they may affect the outcome of non-ST coronary events. OBJECTIVE:This study aims to determine the effect of clinical risk factors that are responsible for the occurrence of mortality, and the composite outcome of mortality, nonfatal myocardial infarction and serious rehospitalization within 6 months after the onset of non-ST acute coronary syndromes. METHODS:A total of 124 Filipino patients were interviewed and tested for blood homocysteine levels and lipid profiles. Outcomes were assessed after 6 months. RESULTS:Homocysteinemia (>16 micromol/l) is associated with increased mortality and composite outcomes (mortality, nonfatal reinfarction, and serious rehospitalization), even if adjusted for conventional risk factors. No association was detected for the conventional risk factors. Earlier acute coronary syndrome was found to be positively associated with mortality and the composite outcomes. Early stroke is associated with increased composite outcomes, whereas greater mortality and adverse outcomes were observed in NSTEMI compared with intermediate-risk unstable angina. CONCLUSION:Increased homocysteine level is associated with mortality and serious nonfatal outcomes in patients with unstable angina and NSTEMI.

背景与目标： 背景：不稳定型心绞痛和非ST段抬高型心肌梗塞（NSTEMI）是常见的急性冠状动脉事件。同型半胱氨酸是冠心病的一种新的危险因素。与常规危险因素一起，它们可能会影响非ST冠状动脉事件的结果。
目的：本研究旨在确定导致非ST急性冠状动脉综合征发病后6个月内死亡发生的临床危险因素以及死亡率，非致命性心肌梗塞和严重再次住院的综合结果的影响。
方法：总共对124名菲律宾患者进行了访谈并测试了其血液中同型半胱氨酸水平和血脂水平。 6个月后评估结果。
结果：高半胱氨酸血症（> 16 micromol / l）与死亡率增加和综合结局（死亡率，非致命性再梗塞和严重的住院治疗）相关，即使已针对常规危险因素进行了调整。常规危险因素未发现相关性。早期发现急性冠状动脉综合征与死亡率和综合结局呈正相关。早期卒中与综合预后增加相关，而与中等风险的不稳定型心绞痛相比，NSTEMI观察到更高的死亡率和不良预后。
结论：不稳定型心绞痛和NSTEMI患者高半胱氨酸水平升高与死亡率和严重的非致命性预后有关。

BACKGROUND & AIMS: OBJECTIVE:To study the influence of clinical and angiographic factors on global and regional left ventricular (LV) function after rescue percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). METHODS:We performed repeat cardiac catheterization in 102 patients who underwent rescue PCI at our centre. Eighty-two patients had suitable baseline and follow-up ventriculograms, which were analyzed offline by an automated edge detection technique. RESULTS:The mean (standard deviation [SD]) follow-up period was 22 (15) months. PCI was completed in all patients between 3 to 24 hours following the onset of pain. Improved global and regional LV systolic function was observed in 55 (67%) patients, and deterioration in 27 (33%). On univariate analysis, baseline ejection fraction (p = 0.005) and coronary stenting (p = 0.05) were associated with improved LV systolic function. Preprocedure TIMI flow, postprocedure TMP grade, time-to-reperfusion, and use of glycoprotein (GP) IIb/IIIa inhibitors did not influence LV systolic function. On multivariate analysis, ejection fraction at the time of rescue PCI (odds ratio [95% confidence interval]: 0.427 [0.234, 0.780]; p = 0.006) and stenting 3.944 (1.182, 13.156; p = 0.026) were predictors of improved LV systolic function. CONCLUSION:Successful rescue PCI was associated with improved LV function at follow up in the majority of patients. Stenting, but not GP IIb/IIIa inhibitor therapy, predicted improved LV function in the area supplied by the infarct-related artery. These improvements in regional wall motion were independent of the time taken to establish reperfusion, provided the intervention was carried out between 3 to 24 hours from the onset of pain.

背景与目标： 目的：探讨急性心肌梗死（AMI）急诊经皮冠状动脉介入治疗（PCI）后临床和血管造影因素对整体和区域左心室（LV）功能的影响。
方法：我们对102名在我们中心接受了急诊PCI的患者进行了重复心脏导管插入术。八十二例患者有合适的基线和心室图，并通过自动边缘检测技术对其进行了离线分析。
结果：平均随访时间（标准差[SD]）为22（15）个月。疼痛发作后3至24小时内，所有患者均完成PCI。 55例（67％）患者的整体和区域左室收缩功能得到改善，而27例（33％）患者恶化。单因素分析显示，基线射血分数（p = 0.005）和冠状动脉支架置入术（p = 0.05）与左室收缩功能改善有关。术前TIMI流量，术后TMP分级，再灌注时间以及糖蛋白（GP）IIb / IIIa抑制剂的使用均不影响LV收缩功能。在多变量分析中，抢救PCI时的射血分数（几率[95％置信区间]：0.427 [0.234，0.780]； p = 0.006）和支架置入3.944（1.182，13.156; p = 0.026）是LV改善的预测指标收缩功能。
结论：大多数患者随访中成功的抢救性PCI与左室功能改善有关。支架术（但不是GP IIb / IIIa抑制剂疗法）预示着梗死相关动脉所供应区域的LV功能会改善。这些区域壁运动的改善与建立再灌注所需的时间无关，只要在疼痛发作后的3至24小时内进行干预即可。

BACKGROUND & AIMS: BACKGROUND:Among the most serious sequelae to an initial episode of Major Depressive Disorder (MDD) during adolescence is the significant increase in the probability of recurrence. This study reports on an integrated CBT/IPT program, provided in a group format, that was developed to decrease the rate of MDD recurrence in emerging adults. METHODS:Participants were 89 young adults who were not depressed at study entry but had experienced MDD during adolescence. Participants were assigned to a CBT/IPT prevention program or to an assessment only control condition and were followed through the first 2 years of college. RESULTS:Risk for MDD recurrence was reduced more than 50% for the prevention program participants compared to assessment only controls. The intervention also conferred beneficial effects on academic performance for those students who completed the majority of the group sessions. LIMITATIONS:The study included a self-selected sample of emerging adults who were aware of their history of depression. Due to the small sample size, it will be important to evaluate similar interventions in adequately-powered trials to determine if this is a replicable finding. CONCLUSIONS:With 51% of the assessment only participants experiencing a MDD recurrence during the first 2 years of college, these findings support the need for programs designed to prevent MDD recurrence in young adults. The current program, based on IPT and CBT principles, appears to reduce the rate of MDD recurrence among previously depressed emerging adults.

背景与目标： 背景：在青春期主要抑郁症（MDD）初期发作的最严重后遗症中，复发几率显着增加。这项研究报告了以小组形式提供的综合CBT / IPT计划，该计划旨在降低新兴成年人的MDD复发率。
方法：参与者为89位年轻成年人，他们在入学时并未感到沮丧，但在青春期曾经历过MDD。参与者被分配到CBT / IPT预防计划或仅评估控制状况，并被跟踪到大学学习的前两年。
结果：与仅评估对照组相比，预防计划参与者的MDD复发风险降低了50％以上。干预还为完成大部分小组课程的学生们的学业成绩带来了有益的影响。
局限性：该研究包括自我选择的新兴成年人的样本，这些成年人意识到他们的抑郁症史。由于样本量较小，因此在足够有力的试验中评估类似干预措施，以确定这是否是可重复的发现，这一点很重要。
结论：只有51％的评估参与者在大学的头两年内经历了MDD复发，这些发现支持需要制定旨在预防年轻人MDD复发的计划。基于IPT和CBT原则的当前计划似乎降低了先前抑郁的新兴成年人中MDD复发率。

BACKGROUND & AIMS: :Forty patients who had been treated for three years in an ad-hoc, assertive treatment team for patients who had suffered a first psychotic episode were compared to forty patients who had been followed up after a first psychotic episode in a community mental health team. All patients had suffered a first or early psychotic episode. The main differences between the two teams was that the ad-hoc team was assertive in its approach, offered more structured psycho-education, relapse prevention and psycho-social interventions, and had a policy of using atypical anti-psychotics at the lowest effective dose. There were many differences in outcome measures at the end of three years between the two groups. The EI patients are more likely to be taking medication at the end of three years. They are more compliant with medication. They are more likely to be prescribed atypical medication. The EI patients are more likely to have returned to work or education. The EI patients are more likely to remain living with their families. They are less likely to suffer depression to the extent of requiring anti-depressants. They appear to commit less suicide attempts. The patients in the EI service also appear to be less likely to suffer relapse and re-hospitalisation, and are less likely to have involuntary admission to hospital. They have systematic relapse prevention plans based on early warning signs. They and their families receive more psycho-education. These indications suggest that the EI patients are at the end of three years better able to manage their illness/vulnerability on their own than the CMHT patients. More patients in the EI group stopped using illicit drugs than in the CMHT group. All the above changes were statistically significant except for the number of patients who stopped using illicit drugs. In this case it is believed that the sample size was too small to demonstrate significance. These results suggest that an ad-hoc early intervention team is more effective than standard community mental health team in treating psychotic illness.

背景与目标： ：在社区精神卫生小组中，将40例在第一次精神病发作后接受过专心，果断的治疗团队治疗的患者与40例在第一次精神病发作后进行了随访的患者进行了比较。所有患者均经历了第一次或早期精神病发作。这两个团队之间的主要区别在于，特设团队在方法上比较果断，提供了更有条理的心理教育，预防复发和心理社会干预措施，并制定了以最低有效剂量使用非典型抗精神病药的政策。两组在三年结束时的结局指标之间存在许多差异。 EI患者在三年结束时更有可能服用药物。他们对药物的依从性更高。他们更有可能被开具非典型药物。 EI患者更有可能重返工作岗位或接受教育。 EI患者更有可能继续与家人同住。他们不太可能因需要抗抑郁药而患上抑郁症。他们似乎没有自杀的企图。 EI服务中的患者似乎也不太可能遭受复发和再次住院，并且也不太可能自愿住院。他们根据预警信号制定了系统的预防复发计划。他们和他们的家人接受了更多的心理教育。这些迹象表明，与CMHT患者相比，EI患者在三年结束时能够更好地自行控制疾病/脆弱性。与CMHT组相比，EI组中停止使用违禁药物的患者更多。除停止使用违禁药物的患者人数外，以上所有变化均具有统计学意义。在这种情况下，可以认为样本量太小而无法显示出显着性。这些结果表明，特设的早期干预小组在治疗精神病方面比标准的社区精神卫生小组更有效。

BACKGROUND & AIMS: OBJECTIVES:To assess the influence of race on long-term outcomes following percutaneous coronary intervention (PCI) with paclitaxel-eluting stents (PES). BACKGROUND:Data on the influence of race on long-term outcomes following PCI with drug-eluting stents are limited because of severe underrepresentation of minority populations in randomized trials. METHODS:We compared 5-year outcomes of 2,301 whites, 127 blacks, and 169 Asians treated with PES in the TAXUS IV, V, and ATLAS trials. Outcomes were adjusted using a propensity score logistic regression model with 1:4 matching. RESULTS:Blacks were more likely than whites to be female, have a history of hypertension, diabetes mellitus, congestive heart failure, and stroke, but were less likely to have prior coronary artery disease. Compared with whites, Asians were younger, more likely to be male, have stable angina, and left anterior descending disease, and less likely to have silent ischemia, previous coronary artery bypass surgery, prior coronary artery disease, diabetes mellitus, peripheral vascular disease, and to receive glycoprotein IIb/IIIa inhibitors. Despite higher antiplatelet compliance, the adjusted 5-year rates of myocardial infarction (15.4% vs. 5.4%, P < 0.001) and stent thrombosis (5.6% vs. 1.1%, P = 0.002) were higher in blacks than whites. Despite lower antiplatelet compliance, Asians had no differences in myocardial infarction and stent thrombosis compared with whites. Mortality and revascularization rates were similar between the three groups. CONCLUSIONS:The long-term risk of major thrombotic events after PCI with PES was higher in blacks, but not Asians, compared with whites. The mechanisms underlying these racial differences warrant further investigation.

背景与目标： 目的：评估种族对紫杉醇洗脱支架（PES）经皮冠状动脉介入治疗（PCI）后长期结局的影响。
背景：由于随机试验中少数群体的严重代表性不足，有关种族对药物洗脱支架PCI后长期预后影响的数据有限。
方法：在TAXUS IV，V和ATLAS试验中，我们比较了接受PES治疗的2,301名白人，127名黑人和169名亚洲人的5年结局。结果使用倾向评分逻辑回归模型与1：4匹配进行调整。
结果：黑人比白人更有可能是女性，有高血压，糖尿病，充血性心力衰竭和中风的病史，但以前患有冠状动脉疾病的可能性较小。与白人相比，亚洲人更年轻，男性更容易，有稳定的心绞痛和左前降支疾病，无声缺血，先前进行冠状动脉搭桥手术，先前有冠状动脉疾病，糖尿病，周围血管疾病，并接受糖蛋白IIb / IIIa抑制剂。尽管抗血小板依从性更高，但黑人的白人校正后5年心肌梗塞发生率（15.4％vs. 5.4％，P <0.001）和支架内血栓形成（5.6％vs. 1.1％，P = 0.002）高于白人。尽管抗血小板依从性较低，但与白人相比，亚洲人在心肌梗塞和支架血栓形成方面无差异。两组的死亡率和血运重建率相似。
结论：与白人相比，黑人（而非亚洲人）的PCI与PES术后PCI发生重大血栓事件的长期风险更高。这些种族差异的潜在机制值得进一步调查。

BACKGROUND & AIMS: BACKGROUND:To investigate the incidence of surgical intervention in very low birth weight (VLBW) infants and the impact of surgery on neurodevelopmental outcomes at corrected ages (CAs) of 18-24 months, using data from the Korean Neonatal Network (KNN). METHODS:Data from 7,885 VLBW infants who were born and registered with the KNN between 2013 to 2016 were analyzed in this study. The incidences of various surgical interventions and related morbidities were analyzed. Long-term neurodevelopmental outcomes at CAs of 18-24 months were compared between infants (born during 2013 to 2015, n = 3,777) with and without surgery. RESULTS:A total of 1,509 out of 7,885 (19.1%) infants received surgical interventions during neonatal intensive care unit (NICU) hospitalization. Surgical ligation of patent ductus arteriosus (n = 840) was most frequently performed, followed by laser therapy for retinopathy of prematurity and laparotomy due to intestinal perforation. Infants who underwent surgery had higher mortality rates and greater neurodevelopmental impairment than infants who did not undergo surgery (P value < 0.01, both). On multivariate analysis, single or multiple surgeries increased the risk of neurodevelopmental impairment compared to no surgery with adjusted odds ratios (ORs) of 1.6 with 95% confidence interval (CI) of 1.1-2.6 and 2.3 with 95% CI of 1.1-4.9. CONCLUSION:Approximately one fifth of VLBW infants underwent one or more surgical interventions during NICU hospitalization. The impact of surgical intervention on long-term neurodevelopmental outcomes was sustained over a follow-up of CA 18-24 months. Infants with multiple surgeries had an increased risk of neurodevelopmental impairment compared to infants with single surgeries or no surgeries after adjustment for possible confounders.

背景与目标： 背景：使用韩国新生儿网络（KNN）的数据，调查极低出生体重（VLBW）婴儿的外科手术发生率以及18个月至24个月校正年龄（CA）手术对神经发育结局的影响。
方法：本研究分析了2013年至2016年间在KNN出生和登记的7885名VLBW婴儿的数据。分析了各种外科手术的发生率和相关的发病率。比较了有手术和无手术的婴儿（2013年至2015年出生，n = 3,777）在18-24个月CA时的长期神经发育结局。
结果：在新生儿重症监护病房（NICU）住院期间，共有7,885例婴儿中的1,509例接受了手术干预。外科手术治疗动脉导管未闭（n = 840），然后进行激光治疗以治疗由于视网膜穿孔而导致的早产儿视网膜病变和剖腹手术。与未接受手术的婴儿相比，接受手术的婴儿死亡率更高，神经发育障碍更大（P值均<0.01）。在多变量分析中，与未进行手术的患者相比，单次或多次手术增加了神经发育障碍的风险，调整后的优势比（OR）为1.6，95％置信区间（CI）为1.1-2.6，2.3为95％CI为1.1-4.9。
结论：在新生儿重症监护病房住院期间，大约五分之一的VLBW婴儿接受了一项或多项外科手术。在CA 18-24个月的随访中，外科手术对长期神经发育结局的影响得以持续。与仅进行一次手术或未进行可能的混杂因素调整后不进行任何手术的婴儿相比，进行多次手术的婴儿神经发育受损的风险增加。

BACKGROUND & AIMS: :One of the worst HIV/AIDS epidemics in the world is occurring in South Africa, where heterosexual exposure is the main mode of HIV transmission. Young people 15-24 years of age, particularly women, account for a large share of new infections. Accordingly, there is an urgent need for behavior-change interventions to reduce the incidence of HIV among adolescents in South Africa. However, there are few such interventions with proven efficacy for South African adolescents, especially young adolescents. A recent cluster-randomized controlled trial of the 'Let Us Protect Our Future!' HIV/STD risk-reduction intervention for Grade 6 South African adolescents (mean age = 12.4 years) found significant decreases in self-reported sexual risk behaviors compared with a control intervention. This article describes the intervention, the use of the social cognitive theory and the reasoned action approach to develop the intervention, how formative research informed its development and the acceptability of the intervention. Challenges in designing and implementing HIV/STD risk-reduction interventions for young adolescents in sub-Saharan Africa are discussed.

背景与目标： ：南非是世界上最严重的HIV / AIDS流行病之一，异性接触是HIV传播的主要方式。 15-24岁的年轻人，尤其是女性，在新感染中占很大比例。因此，迫切需要改变行为的干预措施，以减少南非青少年中艾滋病毒的发生率。但是，很少有这类干预措施对南非青少年特别是年轻青少年具有有效的疗效。最近一项“让我们保护我们的未来！”的集群随机对照试验。与对照干预相比，南非6级（平均年龄= 12.4岁）青少年的HIV / STD降低风险干预措施发现自我报告的性风险行为显着降低。本文介绍了干预措施，社会认知理论的使用以及采取合理的行动方法来开发干预措施，形成性研究如何告知其发展以及干预措施的可接受性。讨论了为撒哈拉以南非洲地区的青少年设计和实施降低艾滋病毒/性病风险的干预措施所面临的挑战。